An Historical Review of Electroconvulsive Therapy

Abstract

T he initia l clinical tria l of electroco nvu lsive th erapy (ECT) was performed by Ugo Cerletti and Lucino Bin i at th e U niversity of Rome in 1938. T he following paper will exam ine both the developments wh ich led to the first trial of ECT, and th e use of ECT over th e subseque nt fifty years. Hopefull y, by inv est igating the historical aspect s of the development and progression of ECT , a bette r understa nding of this treatment modali ty ca n be attained. T he therapeutic use of electricity was not unique to ECT. T here is evidence th at Ancient Romans used th e cu r rent generated by electric eels for the treatment of headach es, gout, and to assist in obstetr ica l procedures. The recent his tory o f th e th erapeutic use of electricity dates to 1744 when th e journal entitle d " Electr icity and Medicine" was firs t publish ed. It was claimed here that elec tric stimu li co u ld be curative for " neurologic and mental cases of paralysis and ep ilepsy (1)." J.B. LeRoy in th e 175 5 ed ition of " Electr icity and Medicine" detailed a case of hyste rical blindness whic h was cured with three applicat ions of e lectric shock (1). In 1752 , Benjami n Franklin recorded th e use of an "elec tro static mach ine to cu re a woman of hys terical fits (2). " By th e mid 19th century the use of electrothera py had so progressed that G.B.C. Duchenne (often refer red to as th e Fath er of Electrotherapy) would say, "No sin ce re neurologist could p ract ice wit hout the use of electrotherapy (1)." Bu t , despite th e documented use of electrotherapy through th e 19th century, there is little ev idence that th is was of any influence in th e development of ECT. The historical emphasis in the medicina l use of electricit y was on the electric st im ulus in and of itsel f, whereas the e lectricity in ECT was used solely for its co nv u lsan t proper t ies. A more important co ntribution to the development of ECT was th e work of Jul ius Wagner-Jauregg . It was a co mmon observation in th e lat e nineteenth ce ntury tha t a wide variety of d isorders often improved clinically following febrile ep isodes. Wagner-Jau regg, in 1917 , attempted to a lleviate the symptoms of dementia paralyti ca (neuro-syphilis) by ind uc ing fever with th e intram uscular injection of blood from patients with ma laria. Of th e fir st nine patient s he investigated, three had a complete recovery, three had a temporary symptom-