Wired for Health

Physicians and surgeons have long used innumerable electrical gadgets in diagnosis and treatment, but they have usually kept the current outside the patient's body. Now they are developing new and daring ways to use electricity inside the body--and, in some cases, to make the electrical gadget a permanent implant with rechargeable batteries.

For Brain Hemorrhages. A weak electrical current, suggests Irish-born Dr. Sean F. Mullan of the University of Chicago, may be the answer to an age-old problem: how to stop bleeding in a brain artery. These hemorrhages, usually at a spot where a cerebral artery has ballooned out and leaked or burst, are notoriously hard to shut off promptly. The most obvious plug for a burst artery is a blood clot, but with a clot the problem is how to make it and how to keep it from traveling and causing still more brain damage. Dr. Mullan and fellow workers noted that not only does electricity promote clotting, but also, unaccountably, so does a piece of copper, cadmium or beryllium, even without an electric current to help the process.

The Chicago doctors have stopped bleeding from aneurysms (ballooned-out arteries) in the brain's arterial roundabout, the Circle of Willis, by drilling a hole in the patient's skull under a local anesthetic and inserting a stainless steel needle (see diagram). This has a hairlike electrode tip only 1/250 in. in diameter, which is positioned precisely by a double-grid system of X rays (see photos). The tip is the positive electrode for a minute current. The negative electrode is attached outside the skull. Within half an hour the iron in the electrode is "plated off" (in effect, dissolved), and much of it goes into the electrically induced blood clot that seals the artery.

With electrodes of steel, the electro-coagulation method offers the advantage of forming a clot quickly. This constitutes a sort of neurosurgical first aid for the aneurysm patient, enough to tide him over the first and most dangerous days after a hemorrhage. But clots formed in this way are apt not to be permanent, whereas if a piece of copper is implanted in the aneurysm and left there for a week, without an electric current, it forms a more permanent clot. So Dr. Mullan's team is now combining the two methods: forming a quick clot by electricity, and then leaving in place a copper needle inserted through the same hole in the skull. The two forms of electro-clotting technique have worked well in 16 out of 19 patients.

For High Blood Pressure. In the vast majority of cases, the cause of high blood pressure is unknown. The one thing certain is that the pressure can be influenced by the carotid nerves and the carotid nerve sinuses on each side of the neck. Two research teams have begun work almost simultaneously on electrical control of these "barorecep-tors" with "baropacers" to be implanted like heart pacemakers. At the A.M.A. convention in San Francisco, Dr. Aydin Bilgutay of the University of Minnesota showed a baropacer which picks up pulses of current from two electrodes implanted in the heart and uses those pulses to control electrical signals sent to an electrode wrapped around the carotid sinus. The device had worked well in dogs and he was ready to try it in man.

Then Dr. Seymour Schwartz of the University of Rochester reported that he had already implanted similar devices in two human patients. The major difference is that the Rochester pressure pacer uses no electrodes in the heart, but relies on its own battery pack, which can be recharged from outside the skin. A man with blood pressure running 220/120, despite drug treatment, had a pacer implanted on the right side of his neck two months ago, and is now reading 150/100 or lower. A woman patient who got the implant a month ago is doing equally well.

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