[PDF] Magnetic flimmers: light in the electromagnetic darkness

86789_3Magnetic_flimmers_light_in_the_magnetic_darkness.pdf BRAIN

A JOURNALOFNEUROLOG Y

OCCASIONAL PAPER

Magnetic flimmers:'light inthe

electromagnetic darkness'

Johannes W.Martens,

1

Peter J.Koehler

2 and JoostVijselaar 1

1 Departmentof Humanities,Utrecht University,Utrecht, TheNetherlands

2 Departmentof Neurology,Atrium MedicalCentre, Heerlen,The Netherlands

Correspondence to:Johannes W.Martens,

Valkstraat 33,

3514 THUtrecht,

The Netherlands

E-mail: martensarticles@xs4all.nlTranscranial magneticstimulation hasbecome animportant fieldfor bothresearch inneuroscience andfor therapysince Barker

in 1985showed thatit waspossible tostimulate thehuman motorcortex withan electromagnet.Today forinstance,

transcranial magneticstimulation canbe usedto measurenerve conductionvelocities andto createvirtual lesionsin the

brain. Thelatter optioncreates thepossibility toinactivate partsof thebrain temporarilywithout permanentdamage. In

2008, theAmerican Foodand DrugsAdministration approvedrepetitive transcranialmagnetic stimulationas atherapy for

major depressionunder strictconditions. Repetitivetranscranial magneticstimulation hasnot yetbeen clearedfor treatment

of otherdiseases, includingschizophrenia, anxietydisorders, obesityand Parkinson'sdisease, butresults seempromising.

Transcranial magneticstimulation, however,was notinvented atthe endof the20th century.The discoveryof electromagnet-

ism, theenthusiasm forelectricity andelectrotherapy, andthe interestin Beard'sconcept ofneurasthenia alreadyresulted inthe

first electromagnetictreatments inthe late19th andearly 20thcentury. Inthis article,we providea historyof electromagnetic

stimulation circa1900. Fromthe data,we concludethat Mesmer'slate 18thcentury ideasof 'animalmagnetism' andthe 19th

century absenceof physiologicalproof hada negativeinfluence onthe acceptanceof thistherapy duringthe firstdecades ofthe

20th century.Electromagnetism disappearedfrom neurologicaltextbooks inthe early20th centuryto recurat theend ofthat

century.Keywords:history ofmedicine; historyof electromagneticstimulation; phosphene;d"Arsonval; transcranialmagnetic stimulation

Introduction

‘Right hemisphere[electromagnetic] stimulationdecreases lying, left hemispherestimulation increaseslying. Spontaneouschoice to liemore orless canbe influencedby brainstimulation". (Karton andBachmann, 2011) Transcranial magneticstimulation hasbeen ahot topicsince the

1980s bothwith respectto research(e.g. thepathophysiology ofmigraine; Mullenerset al., 2001)as wellas treatment,for depres-

sion amongothers (Barkeret al., 1985;Lisanby et al., 2002; Walsh andPascual-Leone, 2003;Bolotova et al., 2006;Wu et al., 2008).Magnetic stimulation,however, isnot anew phe- nomenon. Atthe endof the19th centuryand atthe beginningof the 20thcentury, Frenchas wellas Germanscientists andphys- icians exposedtheir patientsto theinfluence ofelectromagnets. This typeof researchwas partof aphysical approachto nature

and totherapeutic possibilitiesbased onAugust Comte"sdoi:10.1093/brain/aws185Brain 2013:136; 971-979|971

Received December13, 2011.Revised May6, 2012.Accepted May30, 2012.Advance Accesspublication October5, 2012

?The Author(2012). Publishedby OxfordUniversity Presson behalfof theGuarantors ofBrain. All rightsreserved.

For Permissions,p leaseemail:journals.permissions@oup.comby guest on August 16, 2015Downloaded from (1798-1857) positivisticphilosophy, appliedto medicineby Claude Bernard(1813-78), EmilDu Bois-Reymond(1818-96),

Hermann vonHelmholtz (1821-94)and RudolfVirchow

(1821-1902) (Paul,1985; LeGouis,1997) amongothers. Atthe time, patientshad thechoice tovisit severalinstitutes tobe trea- ted withlight therapy,hydrotherapy, massage,gymnastics and electrotherapy. Physiciansworking atsuch instituteshad know- ledge ofgeneral medicalas wellas neurologicaldiseases. Thedis- covery ofelectromagnetism, enthusiasmfor electricityand electrotherapy (Killen,2006) andthe interestin Germanyin Beard"s conceptof neurastheniawould leadto thefirst electro- magnetic therapiesat theend ofthe 19thand thebeginning of the 20thcentury (Sicherman,1977; Berriosand Porter,1995). In this article,we reviewthe evolutionof (electro)magneticstimula- tion andtry toanswer thequestion whyinterest inthis therapy waned afterthe firstdecade ofthe 20thcentury.

Electrical stimulation:

pre-19th century To geta graspof theevolution ofmagnetic stimulation,it isim- portant tounderstand itsrelation withelectricity andelectrical stimulation. Duringthe 16thand 17thcentury, thesephenomena were interestingstudy topics.William Gilbert(1544-1603), the English physicianat thecourt ofQueen ElizabethI, Niccolo ` Cabeo (1586-1650)and RobertBoyle (1627-91)investigated the phenomenonof electricity.In 1743,professor ofphilosophy and medicineJohann GottlobbKru ¨ger (1715-59)wasoneofthe first tosuggest thatelectrification couldinfluence deeperstruc- tures withinthe humanbody, whichcould healand sustain health. Thediscovery ofthe Leydenjar (1745)became anenor- mous stimulantfor medicalapplication ofstatic electricity.The Swiss professorof experimentalphilosophy andmathematics Jean Jallabert(1712-68) wasthe firstto curea paralyticpatient with staticelectricity. Inthe secondhalf ofthe 18thcentury, the idea tookhold thatthere wasa relationshipbetween electricity and thenervous system.The discoveryof thenature ofthe effect of electricfish playeda rolewith thisrespect (Koehleret al.,

2009). Thisand severalother eventsat theend ofthe 18thcen-

tury resultedin medicalelectricity becomingmore orless accepted as officialmedical treatment. Beyond staticelectricity atthe endof the18th century,Luigi Galvani (1737-98)proposed theexistence ofwhat hethought of as autonomous‘animal electricity".In 1781,he observedmuscle contractions whenan assistanttouched thefemoral nerveof a dead frogwith ascalpel. In1786, heagain sawmuscle contrac- tions whenhe connecteda frogon abrass hookwith aniron fence. AlessandroVolta (1745-1826)was notconvinced thatin- trinsic animalelectricity existed;all ofGalvani"s resultscould be explained bybimetallic electricity.A fierceinternational debate about theorigin ofanimal electricityensued. Thediscussion ended whenin 1797Alexander vonHumboldt (1769-1859), after extensiveresearch, provedthat bothanimal andbimetallic electricity existed.Du Bois-Reymondcame upwith conclusiveevi-

dence some50 yearslater. Galvanism—asthe newlydiscovered bimetallic electricitywas called—gavean extraboost tothe thera-

peutic useof electricity.Although criticismwas voiced(Finger,

2006b), thesetreatments werelargely consideredsuccessful

and atthe endof the18th century,medical electricitywas more or lessaccepted asofficial medicalconduct (Rowbottomand Susskind, 1984,pp. 7-54;Vijselaar, 1999,pp. 51-5;Finger,

2004, pp.101-17; McComas,2011, pp.21-40).

Magnetic stimulation:

pre-19th century Medical practitionersexposed theirpatients tomineral magnetism since ancientGreek medicine.They usedmineral magnetswith a weak magneticfield. Around1600, Gilbertwas thefirst personto extensively describemagnetic phenomena(Gilbert, 1600).John Michell (1724-93)took animportant technologicalstep around

1750, whenhe wasable tocreate morepowerful magnetsartifi-

cially (Michell,1750). At thetime, naturalistsassumed electricityand magnetismwere related. Electricityas wellas mineralmagnets couldattract and repel otherobjects. Atthe sametime, theidea tookhold that electricity andnerve functionwere related(Aepinus, 1759), although therelationship betweenmagnets andthe nervous system wasnot obvious(Piccolino, 1998;Finger, 2006a; Koehler et al., 2009).Electrical stimulationwas painful,it causedtingling and mademuscles contract,whereas magnetsdid not.As elec- trical stimulationbecame verypopular, itwas asmall stepfor therapists totreat patientswith (artificial)mineral magnets. Mineral magnetismand mineralmagnetic treatmentwere taken seriously. In1774, theBavarian ScientificAcademy helda contest about thepossible electricand magneticeffects onthe nervous system. InFrance, physiciansCharles-Louis-Franc ¸ois Andry(1741-

1829) andMichel-Augustin Thouret(1748-1810), associatedwith

the ParisSocie ´te´Royale deMe ´dicine, concludedthat mineralmag- nets indeedinfluenced thehuman nervesystem. Theywere able to increasefever, migraineand itching. In theUSA, ElishaPerkins (1741-99)treated patientswith two artificial mineralmagnets, socalled ‘tractors".During oneof the sessions, heobserved amuscle contraction,which convinced Perkins ofthe efficacyof hismineral magnets.This treatment, applied totreat headaches,rheumatic symptoms,paralysis and other symptoms,became popularin theUSA andEngland (Perkins, 1798;Rowbottom andSusskind, 1984,pp. 55-70;

Vijselaar, 1999,p. 64).

During thelast quarterof the18th century,physician Franz Anton Mesmer"s(1734-1815) ideasplayed aparadoxical rolein propagating medicalmagnetism. Hestimulated theuse ofmineral magnets initially,but subsequentlydeveloped anew theory,not- ably ‘animalmagnetism". Atherapist, accordingto Mesmer, should beable tomagnetize apatient withouttools, thusalso without amineral magnet.According toMesmer"s ideas,a healthy person containeda balancedquantity ofmagnetic fluid.A dis- eased personwas supposedto havea lackof thismagnetic fluid, whereasa therapisthad itin excess.By ‘magnetizing"his

972|Brain 2013:136; 971-979J. W.Martens et al.

by guest on August 16, 2015Downloaded from patient, thetherapist wassupposed tobe ableto transfersome of his excessmagnetic fluidto thepatient (Vijselaar,1999, p.60-70). At first,Mesmer"s ‘animalmagnetism" andPerkin"s tractorswere received withenthusiasm inGermany, Franceand England. However, eventuallythe scientificcommunity wouldconsider medical magnetismas quackery.In 1784,a FrenchRoyal Commission, setup byLouis XVIand includingAntoine Lavoisier (1743-94), Joseph-IgnaceGuillotin (1738-1814)and Benjamin Franklin (1706-90),examined Mesmer"sclaims. Althoughpatients were sometimescured by‘animal magnetism",the commission found noevidence forthe existenceof Mesmer"smagnetic fluid. The therapeuticeffect wasbased onsuggestion andfraud. In

1799, physicianJohn Haygarth(1740-1828) andsurgeon

Richard Smithshowed thatPerkins" therapeuticeffect wasbased on suggestionand fraud(Vijselaar, 1999,p. 236).The ideasof quackery, suggestionand fraudwould continueto hauntboth animal andmineral magneticstimulation forat leasta century.

Discovery ofelectromagnetism

An importantstep indetermining therelation betweenthe human body andmagnetism wasthe discoveryof electromagnetismand the electromagnet.In 1820,the Danishscientist HansChristian Ørsted (1777-1851)uncovered therelationship betweenelectri- city andmagnetism. Duringone ofhis lectures,he observed movements ina magneticneedle inthe vicinityof anelectric cur- rent. Basedon thisobservation, Ørstedconcluded thatelectricity evoked magneticeffects. Using Ørsted"sresult, theFrench professorof mathematics Andre ´-Marie Ampe`re (1775-1836)built acomplex electromag- netic apparatus.Among others,he constructeda big‘solenoid" (derived fromthe Greekwords ‘solen"meaning ‘pipe"and ‘eidos" meaning‘shape") (Harper,2011). Thissolenoid consisted of aspiral-shaped electricalwire. Heconcluded thatthis solenoid worked asa magnetif anelectrical currentflowed throughthe wire. The mostimportant contributioncame fromMichael Faraday (1791-1867), whopublished theprinciple ofreciprocity. A magnet couldinduce electricityin anelectrical wireand vice versa, anelectrical wirecould movea magnet.The principle became thebasis forelectromotors andelectromagnets. Faraday demonstrated theseresults in1831 andpublished themin 1832 (Faraday, 1832). In 1854,Faraday concludedthat electromagnetsinfluenced not only metalconductors butalso moistconductors. Thisincreased the possible spanof influenceof electromagnetsto thehuman body (Faraday, 1854).In 1861,James ClerkMaxwell (1831-79)pub- lished hisfundamental equationsby whichhe mathematically proved mutualinduction. Fromthe equationsit becameclear that mutual inductionis drivenby thechange ofthe magneticfield in time andnot bythe strengthof themagnetic field(Maxwell, 1890).

Physiological research

Ørsted"s andFaraday"s discoveriesstimulated newinterest inelec- trotherapy andit becamea disciplineon itsown. Withthe discov-

ery ofthe electromagnet,which producedstronger magneticforces andtime-varying fields,researchers hopedto strip(elec-

tro)magnetic stimulationfrom itsMesmeric stigma.First, electro- magnets couldproduce strongermagnetic fieldsthan mineral magnets. Second,researchers coulduse time-varyingmagnetic fields forstimulation. Theeasiest wayto generatesuch amagnetic field isto interruptand startthe currentat certaintime intervals. Because electricityand magnetismwere relatedand because moist conductorswere influencedby electromagnets,researchers in magneticstimulation beganlooking forthe (possibilityof) mag- netic inductionof musclecontractions andother physiological proof. Therefore,they exposeddead andliving tissueto different magnetic fields.The resultsvaried significantly.Some researchers such asHeidenreich (nk) inGermany(Hermann, 1888)and M"Kendrick (nk) inEngland (M"Kendrick,1879) foundevidence that (electro)magneticfields causedmuscle contractionsin dead tissue. Others[Du Bois-Reymond,Brunner (nk)] questionedthese results (Hermann,1888). Also,agreement onthe influenceon living tissuewas notreached. ProfessorKeil (ofJena) exposed Faraday toa strongmagnetic fieldbut Faradaydid notnotice anything. Keil"sobservations didnot agreewith observations documented bythe Romanphysician CarloMaggiorani (1800-85) whodescribed theoccurrence ofdizziness insubjects after exposureto amineral magnet.These symptomsmatched the symptoms ofpersons withlesions inthe cerebellum(Magini and Maggiorani, 1886).Around 1880,a physicianfrom Dublinre- ported thathuman subjectsexperienced headaches,disturbance of consciousnessand dizzinessafter beingexposed tostrong elec- tromagnetic fields.But atthe endof thecentury, LordLindsay, later Earlof Crawford(1847-1913) andC. F.Warley (nk) reported that theirsubjects didnot experienceany symptomsat allin an electromagnet witha time-varyingmagnetic field.Nevertheless, Lord Kelvin(1824-1907) wasconvinced thatmagnetic fields[in the future]would havea noticeableeffect onhuman beings (Colombo, 1906).As aresult ofthe complexityand becauseof lack ofadded value,therapists almostonly usedmineral magnets for magnetictherapy duringthe secondhalf ofthe 19thcentury.

Mineral magnetictherapy

Despite lackof proofand Mesmer"sshadow, therapistscontinued to usemineral magnettherapy. Theyapplied themineral magnet therapy inthree forms.First, amagnet couldbe usedas an inductor forhypnoses. TheScottish surgeonJames Braid(1795-

1860) askedhis patientsto fixateon amineral magnet.As a

result, hebelieved, thenervous systembecame exhaustedand the patientbecame hypnotized.Vienna"s famouselectrotherapist and neurologistMoritz Benedikt(1835-1920) alsoused amineral magnet asan inductorfor hypnosis.However, inductionof hyp- nosis wasnot limitedto amagnet. Otherobjects suchas acandle also inducedhypnosis. Second,in hysterics,a mineralmagnet could beused totransfer symptomsfrom onepart ofthe body to another[Marie-Ernest Gelle

´(1834-1923), AlfredBinet (1857-

1911), CharlesFe

´re´(1852-1907)]. In1886, theFrench physician Joseph Babinski(1857-1932) wasable totransfer hemianaesthic symptoms fromone hystericalpatient toanother (Babinski,1886). Joseph BernardLuys (1828-97)continued thiswork afterBabinski recalled hisresults. Third,therapists, forinstance Benedikt,used a

Magnetic flimmersBrain 2013:136; 971-979|973

by guest on August 16, 2015Downloaded from magnet asdirect therapy(without hypnosis)for gastralgia(pain in the stomach),rachialgia (painin theback) andhysterical pains (Benedikt, 1892,1894).

Magnetic stimulation:late

19th centuryand early20th

century

Phosphenes: Frenchlight inthe

electromagnetic darkness As mentionedearlier, noexclusive proofexisted that(electro)mag- netic fieldsproduced aphysiological effect.Jacques-Arse `ne d"Arsonval (1851-1940),professor ofphysiology atthe prestigious

Paris Colle

`ge deFrance, successorto Charles-Edouard

Brown-Se

´quard (1817-94),and todaymainly knownfor his

work indiathermy, continuedscientific researchand tookthe first stepsto provea realeffect. Heinvestigated theconsequences of tissueexposure totime-varying electricand (electro)magnetic fields. Between1881 and1892, hediscovered thatlow frequency (electro)magnetic fieldsincreased tissueoxygen absorptionand carbon dioxideexcretion dueto increasedmetabolism andthat high-frequency electriccurrents wereable toanaesthetize the skin andlower bloodpressure asa resultof vasculardilatation. In 1893,he exposedanimals andhumans tohigh-frequency mag- netic fieldsof atleast 10000 Hz.For thispurpose,heconstructed small andlarge solenoidsin whicha subjectcould standupright. Around thecage theelectrical wireran ina spiralform (Fig.1). To prove thepresence ofthe (electro)magneticfield, d"Arsonvalfirst placed amercury thermometerand ananimal ina smallsolenoid.

Within seconds,the thermometerrose to150

? . Next,d"Arsonval placed bulbs,without anyconnection toan externalenergy source

in alarge solenoid.They burnedwhen thetime-varying (electro)magnetic fieldwas turnedon. Nevertheless,subjects did

not experienceany directphysiological effects,but accordingto d"Arsonval, this(electro)magnetic fieldhad apositive effecton metabolism asdid thetime-varying electricfield. Theexcreted carbon dioxideincreased from17 to37 l/h,blood pressure decreased andtemperature increased.d"Arsonval alsoexposed yeast andbacteria tothe time-varying(electro)magnetic fields. Long exposurecaused thedeath ofyeast andbacteria, whereas moderate exposuredecreased thetoxicity. Owingto theseresults, patients withsupposed metabolicdisorders, suchas diabetes, rheumatoid arthritis(considered assuch atthe time)and obesity would benefitfrom ‘d"Arsonvalization".But thesymptoms ofskin diseases werealso believedto improve.Remarkably, d"Arsonval never usedthe word‘magnetic field"or ‘magnets"in hisarticles, but alwaysreferred tohigh-frequency currents(d"Arsonval,

1893a,b; Rowbottomand Susskind,1984, pp.120-40).

Although stillno directphysiological effectwas observedafter exposure totime-varying electromagneticfields, physiciansGeorg Apostoli (1847-1900)and AugustinJoseph AnthelmeBerlioz (1853-1922) usedd"Arsonval"s solenoidto treat75 patientswith various disorders.To avoidMesmer"s stigma,they setup their experiment toprevent theinterference of‘suggestion". Theques- tion ofsuggestion beingthe maineffect ofelectrotherapy wasa hot topicat thetime, defendedby PaulMo

¨bius (1853-1907)and

for whicha specialdebate washeld, knownas the‘Frankfurt Council" (Koehlerand Boes,2010; Steinberg,2011). Intotal, Apostoli andBerlioz treatedtheir 75patients 2446times. Patients withrheumatoid arthritisand goutbenefited most, whereas patientswith certainforms ofhysteria andneuralgia did not showany improvement.Overall, theyconcluded that d"Arsonvalization couldbest beapplied topatients withmetabolic disorders (Apostoliand Berlioz,1895). A breakthroughcame in1896, whend"Arsonval, duringa lec- ture atthe Societe´de Biologiein Paris,announced thatsubjects observed phosphenes,and somealmost fainted,while being exposed toa time-varyingmagnetic field.Phosphenes hadbeen

Figure 1Illustration ofd"Arsonval"s sole´noı¨des(d"Arsonval, 1893b), withthanks tothe BiodiversityHeritage Library,and Harvard

University, MCZ,Ernst MayerLibrary.

974|Brain 2013:136; 971-979J. W.Martens et al.

by guest on August 16, 2015Downloaded from observed formany years(Purkyne, 1823;Marg, 1991;Wade,

2005). Aphosphene isdefined asawareness oflight dueto exci-

tation ofthe retinanot causedby light.A phosphenecaused by electricity iscalled anelectrophosphene andthat bymagnetism is called amagnetophosphene. Becaused"Arsonval hadno apparatus to objectifythe phosphene,he hadto relyon hissubject"s feed- back. Nevertheless,he wasconvinced thatthis phenomenonwas caused bya physiologicaleffect, especiallywhen combinedwith other effectsof time-varyingmagnetic fields,such asmuscle con- tractions. Thephysiological relationbetween phosphenesand time-varying magneticfields, however,would notbe elucidated until 1947(d"Arsonval, 1896;Barlow et al., 1947). d"Arsonval"s resultswere notreceived withenormous enthusi- asm. Severalphysicians investigatedd"Arsonval"s claims.The French physiciansFranc ¸oisMoutier(1881-1961),Challamel( nk) and Gidon( nk) confirmedthe decreasein bloodpressure. Roman physician Gay( nk) concludedthat d"Arsonvalizationnot only decreased bloodpressure (Fig.2), butalso decreasedsubjective suffering. Owingto thiscombination, d"Arsonvalizationwas pre- ferred aboveother therapiesfor neurasthenicpatients, apopular concept atthe time,with highblood pressure(Gay, 1904).Unlike the previouslymentioned physicians,Boedeker, Delhermand

Laquirrie

`re notedan increasein bloodpressure. TheGerman elec- trotherapist AlbertEulenburg (1840-1917)also confirmedan in- crease inblood pressureinstead ofa decrease.But JeanAlban

Bergonie

´(1857-1925), Andre´Broca (1857-1925)and G.Ferrie ´ (nk) didnot noteany effectat all(Zimmer andTurchini, 1910). Not everyonewas convinced,including theGerman physician Toby Cohn(1866-1929), whoconcluded thatthe effectswere the resultof suggestionand imagination,as only22 of76 patients benefitted subjectivelyfrom thetreatment withoutimprovement of anobjective (physiological)parameter (Cohn,1900; Loewyand Cohn, 1900;Gay, 1904).Although physiciansand physiologists did notagree onthe resultsof d"Arsonvalization,the treatment was describedin varioushandbooks inparticular inthe German- speaking countries,which suggeststhat itwas appliedin daily practice (Cohn,1910, 1912;Guilleminot, 1922;Mann, 1937). d"Arsonval hadalready distancedhimself fromthe discussion about thetherapeutic consequencesof histreatment. Hefocused on thephysiological phenomena(Eulenburg, 1900).

A clashbetween manufacturers

Although theFrench discussionfocused ontherapeutic conse- quences, thediscussion inGermany focusedon thephysiological effects andthe theoreticalexplanation. Threepossible theories were usuallycited: (i)magnets causea psychologicaleffect with- out theoccurrence ofan objectivephysiological phenomenon; (ii) magnetscause anelectrical effect,due tomutual induction, as describedby Faraday;and (iii)magnets attractor repelmag- netic particles.These particleswere supposedto movebecause of magnetic forcesand fields.If theseforces changedtheir direction periodically, theparticles alsochanged directionperiodically. This was supposedto causea vibrationthat, inturn, heatedthe tissue due tofriction. Forthe lasttwo explanationsto betrue, exposure to atime-varying magneticfield wouldbe necessary(Hermann,

1888; Beer,1902). Much electromagneticresearch wasdone inGermany, inpar-

ticular, Berlin.Ludimar Hermann(1838-1914), apupil ofEmil Du Bois-Reymond, wasa physiologistworking atthe Prussian Physiological Institutein Berlin.Early inhis career,he investigated the influenceof mineralmagnets ontissues. Oneof thereasons to repeat hisresearch wasthe riseof anew methodin medicaltreat- ment—a mineralmagnet-induced hypnosis.According to Hermann, whohad alsobeen criticalabout cerebrallocalization based on(pathological) anatomyuntil itwas provenphysiologic- ally (byFritsch andHitzig in1870; seeHagner, 2012),such treat- ments shouldnot beused untilit wasproven thatmagnets, both mineral andelectromagnets, hada physiologicaleffect. Otherwise, its effectwas nothingbut suggestion.After extensiveresearch, Hermann concludedin 1888,that mineraland electromagnets did notcause anyphysiological effectin aliving body.

‘Selbst unterden gu¨ nstigstenUmsta

¨nden istmit denuns zu

Gebote stehendenMitteln nichtdie geringstephysiologische Wirkung derMagneten aufthierische (undanscheinend auch pflanzische) Gebildeund Organismennachweisbar". [trans; Martens: Evenunder themost favourablecircumstances, with the currentmeans, notthe slightestphysiological effectof mag- nets onanimal (andprobably alsoon plant)objects andorgan- isms isdemonstrable.] (Hermann,1888) Hermann"s conclusionswould greatlyinfluence electromagnetic research becauseover andover againresearchers hadto refute the findingsof thisimportant physiologist(Hermann, 1888). Not onlyscientists andphysicians wereinterested inelectromag- nets and(electro)magnetic stimulation.In 1883,the Swisselec- trical engineerEugen KonradMu ¨ller (1853-1948)noticedakind of flickerin hiseyes duringrepairs ofan apparatuswith a time-varying electromagneticfield. Theflicker disappearedif he distanced himselffrom themachine orif hechanged themachine to anon-time-varying magneticfield. Between1883 and1887, Mu¨llerstartedresearch on(electro)magnetic stimulation.He was able toreproduce hisearlier findings.Later onhe wouldstate that the phenomenonwas mostclear ina bright-litroom anddid not Figure 2Decrease inblood pressureafter treatmentwith d"Arsonval"s autoconduction(Gay, 1904).

Magnetic flimmersBrain 2013:136; 971-979|975

by guest on August 16, 2015Downloaded from appear ina darkenedroom. Theflicker alsodisappeared ifhe closed hiseyes. For hisresearch (1887-96)he designeda newapparatus called the ‘radiator".He believedexposure tothis ‘radiator"increased his mental capacity.He alsoconcluded thathis apparatushad other effects: ithad asoporific effect;it hada positiveeffect oncough- ing; andit influencedthe nervesystem (taste,hearing, speechand seeing). Thisconvinced Mu¨ llerthathis‘radiator"hada physio- logical effectand mighthave amedical application.It wasnot until 1897that heinstalled hisdevice inthe Krankenanstaltin Aarau, Switzerland.The resultswere promising,but notpublished until 1901,when hesent applicationsfor patentsto theSwiss, Danish andEnglish patentoffices. Accordingto Mu¨ ller,his ‘radi- ator" differedsubstantially fromd"Arsonval"s solenoid(Fig. 3). Although d"Arsonval"ssolenoid operatedwith lowcurrents and high frequencies( 410000Hz),Mu¨ ller"sradiatorfunctionedwith high currentsand lowfrequencies (?60Hz).The effectof the solenoid wasbased onmutual induction,whereas theradiator had apure magneticeffect accordingto Mu¨ ller.As aresult, the physiological effectsalso differed.d"Arsonval"s solenoidhad a stimulant effect,whereas Mu¨ ller"sradiatorhadadepressive effect onthe nervoussystem. Therefore,he believedthat diseases with anabnormally irritablenervous systemcould beindications for treatment(Mu ¨ller,1901, 1902a,b). In 1898or18 99, Mu¨llerstar tedhisowninst itute‘Salus"in Zu¨rich andPa lmyroRodari(187 3-1912)was oneofthephysiciansto workfo rMu¨ll er,publishingthefir stresultsin1901(Fi gs4and

5).In 70% ofpatien tswi thanomaliesofthe sensory nervous

system,suchas neuralgi a,mi graine,sciaticaand irritativeformsof neurastheniawithsleepl essness, symptomsimproved(Rodari,

1901a,b, 1902).Nevert heless,neurologistBerchtho ldtBeer(nk)

hadre servationswithrespectto theresu ltsasLudimarHe rman n hadsh ownthat(ele ctro)mag netshadnophysiologicaleffects. However,hegave uphi sreserv atio nsafter seeingphosphenes whileexpo singhimselftoMu ¨ller"sradia tor.Thephenomenon was convincingalthough hecouldnotexpl ain itsoccurren ce.The treat- mentof pati entsbyBeerwasal sosu ccessful ,as90% of43pati ents benefitted.Heevenpa tent edather apeuticdeviceba sed on(elec- tro)magneticfields(Be er,1902;Be erandPollacsek, 1903,1904).

Otherphysi ciansincludingFrit zFrankenha

¨user(1 868-nk)atthe

medicalUniver sita ¨tspoliklinikinBerlin, Carl Lilienfeld(nk)inBerlin, Ka ´rolySc haffer(1864-1939 )andArthurvonSarbo(1 867-1943 )at theel ectromagneticinstituteinBudape stalsotreatedpatien tswi th Mu¨ller"sradiator .Theyobtainedmoreor lesssimi larresults(65-

90%im provement)asRodariandBe er, buttheywere unableto

presentaclea rph ysiological explanation(Frankenha

¨user,1902;

Lilienfeld,1902,1904 ;VonSarbo

´, 1903).Despit eallthepositi ve

therapeuticresults,Mu ¨ller"s‘radiato r"wasneverincorpor atedinto regularmedici neasanarticleby Roda ri(1 903)indicated.He sum- marizedthere sultsup to1903andhopedth atit woul dlessen the scepticalapproach (Rodari,1903). Mu¨ller"sradiatorwas notthe onlytherapeutic magnetic apparatus. On12 March1902, theGerman patentoffice received a requestfor apatent fromTru ¨b andCo., whichwasawardedon

30 June1903. Theapparatus consistedof amineral magnetor an

electromagnet placedon arotating axis(Fig. 6;Tru ¨b, 1903a,b).

Usually, Tru¨b"sapparatuswasequipped witha mineralmagnet. Mu¨ller,whoprobably wantedto protecthis ownpatents,

started awritten discussionwith physicistprofessor Salomon Kalischer (1845-1924),who translatedFaraday"s Experimental researches inelectricity into German.The discussionfocused on the differencebetween arotating time-varyingmineral magnetic field anda time-varyingelectromagnetic field,which resultedin the followingthree argumentsposed byMu ¨ller. First,during ex- posure toa rotatingmineral magneticfield asubject wasalways exposed tothe northand southpole ofthe mineralmagnet. Second, asubject ina time-varyingelectromagnetic fieldwas intermittently exposedto thenorth andsouth pole.Third, the electromagnetic fieldstrength intermittedas opposedto the static fieldstrength ofTru ¨b"s apparatus.Owingtothesediffer- ences, thephysiological effectsof bothapparatus differed.The discussion endedwithout awinner becauseMu ¨ller didnot react to Kalischer"srequest einen derWu ¨rde derWissenschaft Figure 3Schematic drawingof Mu¨ller"sradiator (Mu¨ller,

1902b).

976|Brain 2013:136; 971-979J. W.Martens et al.

by guest on August 16, 2015Downloaded from geziemenden sachlichenTon einzuhalten[translation: Martens: considering aprofessional toneappropriate tothe dignityof sci- ence] (Kalischer,1903 a,b;Mu¨ller,1903). Several physicianstreated theirpatients withTru ¨b"s rotating mineral magnet.According tothe Stuttgartphysician Eduard Gottschalk, (electro)magnetictherapy ingeneral wasa welcome addition tothe therapeuticarsenal forpatients withrheumatic diseases andneurasthenia. Gottschalk(1903) preferredTru ¨b"s rotating mineralmagnet toMu ¨ller"s radiator,asthefirstwas easier tooperate. Accordingto physiciansAdolf Loewy(1862-

1937) andNeumann, Mu¨ ller"sandTru¨b"sdevices producedthe

same electromagneticfields andwere thereforetherapeutically interchangeable. Theyreported observingphosphenes afterexpos- ure toTru ¨b"smineralmagnetandexperienced that75% oftheir patients improvedafter treatment(Loewy, 1903).A criticalnote came fromToby Cohn,who hadalso criticizedd"Arsonval"s solen- oid. Althoughhe andhis colleaguesreported seeingphosphenes, he opinedthat bothmineral magneticand (electro)magneticther- apy wasnothing butSuggestiontherapie(Cohn, 1904). Overall, themedical professiondid notenthusiastically welcome Mu¨ller"sradiatoror Tru¨ b"smineral magnet.Atthe79th

Naturforscher undA

¨rztekongress inDresden (1907),K. Martin(nk), chiefphysician ofthe Lorettobergsanatorium (Freiburg

i.B.), opinedthat onlya fewphysicians werestill interestedin therapeutic electromagnetism(Martin, 1909).In his1912 guide Elektrodiagnostik undElektrotherapie , Cohnreported that(elec- tro)magnetic therapywas hardlyapplied anymore.He usedthe argument thathad beenheard previously,notably thatmany physicians didnot treattheir patientswith (electro)magneticther- apy becauseit wasnot clearhow (electro)magnetictherapy worked, notaccepting suggestionas aproper treatment(Cohn,

1912). Remarkably,at thetime, referencesto (electro)magnetic

therapy arelacking inmany ofthe Englishand Americanhand- books. Inthe well-knownHandbuch derNeurologie of the1930s, the authorsummarizes [ina subchapterentitled ‘Dieelektromag- netische Behandlung(auch Permea-Elektrotherapiegenannt)"] that the methodwas popularin thefirst decadeof the20th century, when itwas advisedas asedative treatmentnot onlyin allkind of painful conditions,including neuralgias,lancinating painin tabes dorsalis, jointand musclerheumatism, butalso forsleeplessness, vasomotor disturbances,angina pectoris,and soforth. Hecontin- ued tomention thatthe methodhad notfound generalapplica- tion, butin afew specialinstitutes, particularlyin Switzerland, which maybe understoodfrom Mu¨ ller"sinfluence. Theauthor referred toK. E.Mu ¨ller, Kalischer,Eulenburg,LilienfeldandT. Cohn, concludingthe chapterby mentioningthat themedical lit- erature ofthe past20 years(1917-37) hadnot shownscientific publications orclinical reportsworth mentioning(Mann, 1937). Figure 4Patients treatedby Rodariin Aarau(Rodari, 1901b). The columnswith theresults mention‘cured", ‘improved",‘not cured" and‘improvement only"during theapplication. Figure 5Patients treatedby Rodariin Zu¨rich(Rodari, 1901b). The columnswith theresults mention‘cured", ‘improved"and

‘not cured".

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Conclusion

In the18th century,the BavarianScientific Academyconcluded that mineralmagnets influencedthe nervoussystem, butsoon after, animalmagnetism asproposed byMesmer wascondemned as quackeryby theFrench commission.With thediscovery of electromagnets inthe 19thcentury andthe popularityof electro- therapy, theinterest in(electro)magnetism increasedagain, but needed todissociate fromthe Mesmericstigma. Mineralmagnets were usedagain aroundthe middleof thecentury inparticular for hypnosis, transferof hystericalsymptoms andpain. Inthe mean- time, convincingevidence ofphysiological effectsfrom electro- magnets waslacking untild"Arsonval, duringthe lastdecade of the 19thcentury, demonstrateddirect (phosphenes)as wellas indirect (metabolic)effects. Research inand applicationof (electro)magneticstimulation has a longhistory, butpeaked inthe firstdecade ofthe 20thcentury. According tovarious handbooks,the methodseems tohave been used forseveral painfulconditions, inparticular inGerman-speak- ing countries,but subsequentlyonly ona smallscale in Switzerland. Enthusiasmwaned inthe seconddecade becauseof

the lackof clearproof andbecause, similarto electrotherapy,the effects wereconsidered tobe basedon suggestion.In themargins of medicine,a minorityof physicianscontinued applyingelectro-

magnetic therapy,but electromagneticphysiological research continued (Geddes,1991). In1947, Barlowcame upwith the physiological explanationof magnetophoshenes(Barlow et al.,

1947). In1965, Bickfordand Fremmingused apulsed magnetic

field insteadof sinusoidalalternating currentsand observedmuscle twitching infrogs, rabbitsand humans(Bickford andFremming,

1965). Also,in 1985,Anthony Barkersuccessfully stimulated

the humancortex withan electromagnet,resulting inan enor- mous increaseof interestin transcranialmagnetic stimulationat the endof the20th centuryand intothe 21stcentury (Barker et al., 1985).

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