ELECTRICITY 
IN 
GYNECOLOGY. 
BY 
A. D. ROCKWELL, M.D., A. H. GOELET, M.D., 
e. l. h. McGinnis, m.d., a. h. buckmaster, m.d., 
A. LAPTHORN SMITH, M.D., 
FRANKLIN H. MARTIN, M.D., G. BETTON MASSEY, M.D. 
AND 
ALEXANDER J. C. SKENE, M.D. 
FROM 
THE MEDICAL NEWS, 
January 25, 1890. SUBSCRIPTION PRICE REDUCED TO $4 PER ANNUM. 
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GENERAL OBSER VAT IONS ON THE USE OF 
ELECTRICITY IN GYNECOLOGY} 
Bv A. D. ROCKWELlM.M., M.D., 
PROFESSOR OF ELECTRO-THERAPEUTICS AT THE NEW YORK POST- 
GRADUATE MEDICAL SCHOOL AND HOSPITAL. 
Until a recent period the advances in the thera- 
peutic uses of electricity were more especially along 
the line of those distinctively nervous affections that 
were neither specific nor structural in their nature. 
Cases of this latter type have always yielded but 
meagre results under electrical treatment, and I do 
not know that any competent authority seriously 
claims for electricity in most cases of structural dis- 
ease of the central or peripheral nervous system, 
more than temporary and palliative effects. And 
yet those who, arguing on the side of their prejudices, 
or out of the fulness of their ignorance of the sub- 
ject, ascribe to electricity a very low place in thera- 
peutics, do so mainly on the basis of its failure to 
cure a class of conditions incurable by any method 
of treatment. 
The statement that as a therapeutic agent <;the 
1 Read before the New York Academy of Medicine, Section in 
Obstetrics and Gynecology, November 27, 1889. 2 
ELECTRICITY IN GYNECOLOGY. 
effects of electricity are limited,” must indeed seem 
a rash observation to those who have had repeated 
evidence of the wide range of its influence in . the 
relief of nervous symptoms, and especially so to 
those who have witnessed the really remarkable re- 
lief so often afforded by intra-uterine applications 
of the galvanic current. When a man possessed of 
the experience of Keith, of Edinburgh, can say that 
many are prejudiced against electricity because they 
consider it quackery and know nothing about it; 
that his confidence in its power to relieve disturb- 
ing symptoms of uterine fibroids and to cure many 
chronic inflammatory conditions of the pelvis, con- 
tinues to increase, and that he has no fear for the 
future of electricity, we have testimony that must 
greatly outweigh assertions and opinions that are 
purely negative. 
In a recent and animated discussion of the sub- 
ject at the Societe de Chirurgie of Paris, equally 
favorable opinions were advocated by the majority 
of those engaged in the debate, and the strength of 
these opinions was accentuated by the fact that the 
majority of those who hold them are signally dis- 
tinguished as laparotomists. 
I do not propose here so much to give the results 
of my own experience in gynecological electro- 
therapeutics as to allude, and very briefly, to some 
points in the rationale of its effects. 
I call attention first to the faradic current. Its 
effects are mainly mechanical, and according to the 
construction of the helix and the length and thickness A D. ROCKWELL. 
3 
of the wire do we measure its action on the mus- 
cular tissues of the uterus. Applied directly to the 
uterus of animals in physiological experiments, the 
organ visibly contracts, although not to such an 
extent as the intestines, which, on application of 
the electrodes, can be seen to draw up gradually 
very much after the manner of a woman’s work- 
bag. Its action on the smooth muscular fibres of the 
human uterus, when applied therapeutically is analo- 
gous to that of ergot, although manifestly more 
prompt and energetic, especially under the influence 
of the positive pole, which possesses a much greater 
power over the involuntary muscles than the nega- 
tive. It is a current of alternation, of constant 
closing and breaking, hence it produces a sort of 
interstitial massage, heightening the activity of the 
circufation, accelerating absorptive processes, and 
influencing favorably the nutrition of parts. 
Faradization, by its power over muscular contrac- 
tions, sensibly increases temperature. According to 
the chemistry of the development of heat during 
muscular contractions, muscular work is the result 
of the decomposition of nitrogenous substances, and 
the muscles grow at the same time that they work 
and develop heat. That the value of the faradic 
current is more limited than the galvanic in the 
treatment of uterine disease must be immediately 
manifest to all who appreciate the difference between 
them, but in some conditions which come within 
the range of its physical and physiological activities, 
the faradic current may exceed in efficiency the 4 
ELECTRICITY IN GYNECOLOGY. 
galvanic. By its direct excitation of the smooth 
muscular fibres of the uterus we are enabled to com- 
bat that stasis of the circulation which is the begin- 
ning of uterine inflammation. 
By this method we obtain a veritable interstitial 
massage that is potent in overcoming the primary 
inertia of the organ, and in preventing an arrest of 
retrograde metamorphosis, through which comes 
sub-involution with its inevitable and persistent 
sequelae. In its purely local influence, then, faradi- 
zation would seem to be preventive rather than 
curative, as it relates to uterine disease; or rather 
it is preventive so far as concerns the latter condi- 
tion of uterine engorgement, and curative only in 
its initial stage. When the processes that go to 
make up the graver and more chronic diseases of 
the uterine parenchyma and its lining membrane 
have continued a long time, as is usually the case 
when medical interference is sought, the simple 
mechanical effects of the faradic current would be 
altogether misdirected. 
Here we resort to the electrolytic influence of the 
galvanic current, or rather to what may be more 
fitly termed its galvano-chemical cauterizing effects 
through wfliich are destroyed the granulations and 
fungoid growths of the diseased mucous membrane. 
By the interpolar influence of the current we correct 
a languid nutrition and hasten the absorption of 
exudations. 
Just as the positive pole of the faradic current has 
an action of its own, superior in effect to the nega- 5 
tive in causing uterine contractions, so the positive 
pole of the galvanic current has an action peculiar 
to itself. Here oxygen is generated and acids ac- 
cumulate, which render this pole directly haemo- 
static. It is, therefore, indicated in all hemorrhagic 
conditions, as well as where there exists an excess of 
the natural secretions. Owing, also, to the greater 
retractibility of cicatrices following positive galvano- 
cauterization, the results are more lasting in the 
treatment of fungoid growths, or vegetations, than 
could possibly be the case with the negative pole. 
At the negative pole, on the contrary, the alkalies 
precipitate, imparting caustic properties and causing 
effects fluidifying rather than haemostatic. The ab- 
sorptive process is undoubtedly more active under 
this pole than under the positive, and is especially 
indicated in indurated chronic metritis and for the 
resolution of fibroids. 
That the galvanic current often completely dissi- 
pates fibroid tumors of the uterus few will, I believe, 
affirm. In the treatment of scores of fibroids on 
the external surface of the body, I have never yet 
seen a single instance where one of them completely 
disappeared. As a rule, the reduction is compara- 
tively slight, unless suppuration is excited, which 
may be easily done. External fibroids are simply 
unsightly, and for this reason we desire to be rid 
of them, and as it is not possible to obtain more 
than a reduction in size, the knife is to be preferred, 
and electrolysis has fallen into disuse. We treat 
uterine fibroids, on the contrary, not because they 
A. D. ROCKWELL. 6 
are unsightly, but because associated with them are 
a train of symptoms sometimes of the most dis- 
tressing character. These symptoms can, it is be- 
lieved, be relieved to a greater or less extent by 
electrolysis, and sometimes so completely relieved 
as to lead to the belief, so far as the patient is con- 
cerned, that the tumor has entirely disappeared. In 
the great majority of cases, however, it is simply a 
symptomatic cure. The tumor is still there, but re- 
duced in size, and so far as pressure upon surround- 
ing parts is concerned, or any hemorrhagic tendency, 
is entirely harmless. I am a firm believer in the 
great utility of the galvanic current in the thicken- 
ings and infiltrations resulting from inflammation of 
the pelvic cellular tissue. For the absorption of old 
exudations in other parts of the body, this treatment 
has long been used with excellent results, and in 
pelvic exudations the results are even better. I 
have seen the treatment, persistently carried out, 
result not only in the absorption of large pelvic de- 
posits, but in the cure of the most obstinate and 
severe sciatica, and in the restoration of power to 
partially paralyzed limbs. In such cases, both 
sciatica and paralysis are caused, undoubtedly, by 
pressure upon the pelvic floor, and can be relieved 
only through the dissipation of the morbid products. 
There are two methods of action through which 
we obtain results from electrolysis. The first and 
most apparent is the absolute destruction of tissue 
which takes place at the time of treatment. Some 
suppuration may follow, and thus, by an actual loss 
ELECTRICITY IN GYNECOLOGY. A. D. ROCKWELL. 
7 
of substance apparent to the sight, the tumor de- 
creases in size. If, however, these were the only 
active forces in the electrolytic process, the method 
would lose much of its effectiveness. 
If this be not so, how can we account for the 
many well-attested cases where morbid growths have 
entirely disappeared under simple external applica- 
tions? Herein is the difference between the electro- 
lysis of organic and inorganic substances. In the 
electrolysis of inorganic substances the effects cease 
as soon as the current ceases, the substances remain- 
ing in the condition that the current left them. 
The electrolysis of organic substances, on the con- 
trary, starts a process that continues long after the 
current ceases to flow. Beside this subsequent effect, 
the current penetrates the tissue and induces various 
important changes beyond and beneath the eschar, 
and these combined agencies do far more, in many 
cases, to diminish the size of morbid growths and 
prevent further development than an actual destruc- 
tion of a limited area. 
A word in regard to the use of electricity for the 
relief of pain. No one can deny the excellent 
results that frequently follow the application of the 
galvanic and, indeed, of either current in uterine 
and ovarian pain, and as a somewhat extraordinary 
llustration of this I beg, in conclusion, to relate 
briefly a single case : 
The patient was a married woman, aged thirty, 
and was referred to me, March 15, 1886, by Dr. J. 
O. Farrington, of this city, under whose care she 8 
ELECTRICITY IN GYNECOLOGY. 
had been for some time. She sought relief for pains 
in the ovarian region that were not only excessive, 
but most persistent, in spite of all efforts for her 
relief—including extirpation of both ovaries. 
She had suffered more or less at each menstrual 
period for six or seven years, but for two years pre- 
vious to the operation to which she had submitted, 
the pain had been so agonizing as to render her life 
absolutely unendurable. Whde the menstruation 
was scanty, it was nevertheless always on time, and 
continued during a period of nearly two weeks in a 
halting, irregular manner and with few intermissions. 
Everything attempted for her relief having failed, it 
was proposed to remove both ovaries, a proposition 
to which the patient eagerly consented, and, on the 
3d of July, 1884, the operation was successfully 
performed by Dr. T. G. Thomas. 
. To the concern of all interested, however, the 
periodical appearance of blood still continued to 
some extent, associated with pains less acute, but 
still of a severe type. 
The flow gradually disappeared, but the pains in- 
creased, coming on at regular intervals until, at the 
end of nine months, they were quite as distressing as 
at any previous time, and so continued until I saw 
her, through the kindness of Dr. Farrington, about 
a year subsequently. Under internal applications 
of the galvanic current, varying from twenty-five to 
fifty milliamperes in strength, the paroxysms began 
to yield rapidly, resulting in a few months in a com- 
plete and what has been demonstrated a permanent 
recovery, for in the three years that have elapsed 
since the treatment was discontinued there has been 
no return of pain. A. D. ROCKWELL. 
9 
A very important practical question must immedi- 
ately suggest itself to every one who reads the account 
of this case, as it did to the patient herself. If the 
treatment by the galvanic current had been attempted 
first instead of last, would it have been necessary to 
perform the formidable operation that she underwent? 
While I cannot presume to answer this question, 
it is self-evident that an agent like the galvanic cur- 
rent, possessing such a marked influence over so 
many forms of pain of obscure origin, should pre- 
cede rather than follow severe operative procedures 
for their relief. THE TREATMENT OF CERTAIN PELVIC TUMORS 
BY GALVA NO-PUNCTURE, DRAINAGE BY 
THE VAGINA, AND I NT R A - UT E RIN E 
GALVANIZATION. 
By AUGUSTIN H. GOELET, M.D., 
OF NEW YORK. 
I desire to be understood, in the beginning, as 
referring only to such tumors as are easily accessible 
by the vagina for galvano-puncture, and to those 
which are so intimately associated or connected with 
the uterus as to be influenced by the chemical gal- 
vano-caustic applications to the endometrium, and 
trust that I may be pardoned for including under 
this caption pyosalpinx and hydrosalpinx. 
The subject of aspiration and drainage by the 
vagina is not new, but it is a method which has been 
almost abandoned of late in favor of laparotomy 
and drainage through the abdomen. I believe, how- 
ever, than I can present it in a more favorable light 
than has heretofore surrounded it. With our present 
perfected knowledge of antisepsis, there cannot pos- 
sibly be the same objection to this outlet which for- 
merly existed ; besides, the addition to our resources 
of the antiseptic power of the galvanic current ren- 
ders puncture and aspiration by the vagina harmless, 12 
ELECTRICITY IN GYNECOLOGY. 
when the condition is appropriate and the degree ot 
penetration is limited. Apostoli says : 
“ I have found that the galvanic current sent through 
culture media of pathogenic microbes is germicidal, 
which confirms what I said long ago, that this current 
was antiseptic, and would attenuate or sterilize certain 
conditions of germ growth.” 
This, then, is one explanation of the success fol- 
lowing vaginal punctures and aspiration by this 
method. I refer more particularly to the method 
of aspiration and drainage of fluctuating tumors by 
the vagina, as described in the New York Medical 
Journal of June 8, 1889. And I think that the gen- 
eral good results which I have obtained justify me 
in preferring and strongly advocating this method 
of treatment, in certain appropriate conditions, in 
lieu of other methods now in vogue. 
Dr. H. R. Bigelow, in The Medical News, May 
18, 1889, writing from Paris, says : 
“In the French Academy of Medicine they are dis- 
cussing methods of drainage by uterus and vagina, 
without the necessity of operating, so that the minds of 
the surgeons themselves are turned in conservative di- 
rections. I am sure that the time is in the near future 
when electricity shall solve the riddle.” 
As there may be some who have not read the 
article to which I refer, I will briefly desdribe 
the method and the trocar and canula which I 
use. It is a very fine silver canula, the size being 
No. 4 of the French scale, with a steel trocar, and AUGUSTIN H. GOELET. 
13 
covered with a slide of insulating material, which 
may be fixed by a screw to the shaft of the canula, 
so as to limit the degree of penetration. It is only 
capable of penetrating two centimetres, and it is 
seldom necessary to exceed one centimetre. The 
trocar is arranged for connecting with the battery, 
and the canula is made so as to be easily attached to 
an aspirator. 
The method of application is simple; after de- 
ciding upon the degree of penetration necessary, the 
slide is fixed, and the trocar point is drawn within 
the canula. The vagina and vulva are douched 
thoroughly with a solution of bichloride, the index 
finger is introduced and, taking care to avoid any 
pulsating vessel, the most dependent point is se- 
lected. Then the canula, with the point of the 
trocar concealed, is passed along the finger until it 
impinges against the point selected, the trocar is 
pushed down into place, and the canula is made to 
penetrate to the limit fixed by the slide. The trocar 
being then withdrawn, if no fluid escapes, the slide 
is readjusted lower down, and the canula, without 
the trocar, is introduced a little farther. When the 
fluid has been evacuated, the trocar is partially re- 
introduced and connected with the battery, the 
circuit being completed by a large clay electrode on 
the abdomen or back. In hydrosalpinx, the neg- 
ative pole is used through the canula, with not more 
than 50 M. for five minutes ; but in pyosalpinx, the 
cavity must be washed out with an antiseptic solu- 
tion, as an extra precaution, and I prefer the posi- 14 
ELECTRICITY IN GYNECOLOGY. 
The cut shows a platinum canula and trocar (No. 4, French catheter scale) made for me by 
Mr. Reynders, for the galvano-tapping of pyosalpinx through the vagina. The shaft is covered with 
an adjustable sheath (A) of hard rubber for insulation. This may be fixed at any point by the 
screw B and the degree of penetration limited. At C, there is a three-way stopcock, and at D, a 
connection for an irrigator, as well as a socket for connecting with the battery. When the trocar F 
is withdrawn, an aspirator may be attached to the rubber tubing E, and, after the pus has been 
drawn off by a quarter turn of the stopcock C the cavity may be flushed with an antiseptic solution, 
passing in at D through the canula. By turning the stopcock straight again, the fluid is allowed to 
escape through the tubing E into the aspirator bottle. Care must be observed not to over-distend 
the Fallopian tube, the walls of which have been much weakened in some cases. That I may not 
be misunderstood, I repeat that I limit the degree of penetration usually to one centimetre, and 
deem the procedure appropriate only when the tube is close to the vaginal wall, full and tense, 
demanding immediate interference. 
l 
\ AUGUSTIN H. GOELET. 
15 
tive pole because it is less irritating, and is believed 
to be more antiseptic, using 50 M. for five minutes. 
When the positive pole is applied, a canula made of 
platinum should be used, as the silver would be 
acted upon and unnecessary irritation provoked. 
The cauterization of the track of the puncture by 
the current shuts it off from the surrounding tissues 
and renders the absorption of septic material through 
that channel impossible, and by using a safe in- 
tensity, not exceeding 30 to 50 M. for five minutes, 
nothing unpleasant is to be apprehended. (The 
higher intensities necessary for fibroids are not to be 
thought of in these conditions.) The opening re- 
mains pervious a short time for drainage, and closes 
readily when it ceases, and if a dressing of iodoform 
gauze is frequently renewed in the vagina, there is 
nothing to be apprehended from that source. Resolu- 
tion in the diseased tube is promoted by the influence 
of the current and is subsequently still farther fa- 
vored by mild positive galvanism of the endo- 
metrium, which will likewise be appropriate for the 
coexisting endometritis. I limit this treatment by 
aspiration to such tubes as are close to the vaginal 
wall, and where fluctuation may be distinctly felt. 
These tubes are usually fixed by a mass of exuda- 
tion. ’ 
In these conditions, Apostoli adopts a somewhat 
different course. He punctures with his ordinary 
puncture needle, and allows the pus either then or 
subsequently to drain into the vagina through the 
puncture. But it appears to me that the method 16 
ELECTRICITY IN GYNECOLOGY. 
here suggested is better, because it at once gets rid 
of the accumulation which is a constant menace to 
the patient as long as it remains, and the cavity 
is rendered aseptic and put in the best possible 
condition for resolution. Dr. Bigelow says he 
has seen Apostoli puncture a pyosalpinx, enlarge 
the opening, and insert a drainage-tube with good 
result. 
This treatment of hydrosalpinx was suggested to 
me by the radical cure of three cases of hydrocele 
by the same method. They had repeatedly refilled 
after ordinary tapping, but never refilled after using 
negative galvanism through the canula. 
Small cysts close to the vaginal wall have been 
successfully treated in the same way. I have found 
one application usually sufficient in these small 
cysts, when the fluid is drawn off" first and a current 
of xoo M. to 150 M., negative, is used through the 
canula. 
The fibro-cyst is sometimes more obstinate in 
yielding to this treatment, especially those lined 
with a secreting membrane. Some I have found to 
yield to one tapping and negative galvanism of 
100 M. through the canula; but in other cases it has 
been necessary to make the application directly to the 
cavity. This is done by enlarging the opening with 
gradually increasing sizes of conical electrodes con- 
nected with the negative pole, until it will admit a 
bulb-electrode into the cavity. This bulb is fixed 
upon a small insulated shaft which is flexible, and 
through it a current of 150 to 200 milliamperes is AUGUSTIN H. GOELET. 
17 
concentrated within the sac. If drainage is not 
perfect through the opening, a rubber drainage-tube 
is inserted and fastened in position. A frequently 
renewed dressing of iodoform gauze is kept in the 
vagina. 
I will cite one case here which will illustrate the 
success following this method of treatment: 
The patient is married, and forty-one years old ; 
one child at term, and one miscarriage. She has 
suffered for eight years at her menstrual periods with 
severe pain in the left side of the pelvis, radiating 
down the thigh, which often compels her to re- 
main in bed for days at a time. Two years ago she 
was induced to visit the clinic of the Post-graduate 
School, where she saw Dr. Bache Emmet, who diag- 
nosed a fibroid tumor the size of a quart bowl. She 
was placed under the care of Dr. A. P. Dudley, who 
offered to remove the ovaries. This she declined. 
She continued to suffer, growing worse all the time, 
the attacks of pain being more severe and their 
duration longer, so that never a month passed that 
she did not find it necessary to keep her bed for ten 
days to two weeks at a time, and, at the same 
time, keep under the influence of opiates. This was 
her condition in February last when she consulted 
me. I found the tumor to the left of the uterus, to 
which it was attached near the cervico-vaginal 
junction, and close to the vaginal wall. I also diag- 
nosed a fibroid, and commenced treatment by gal- 
vanism. The intra-uterine applications were not 
well borne, so on February 26th, I made the first 
negative galvano-puncture through the vagina, using 
250 M. for five minutes. This puncture was imme- 18 
ELECTRICITY IN GYNECOLOGY. 
diately followed by a discharge of an ounce and 
a half of yellow fluid, which caused me to suspect 
the cystic character of the tumor; but as it did not 
continue, and the tumor was very firm, I concluded 
that it was only a small cyst on the surface, which 
had been emptied. 
March 5, the second negative galvano-puncture of 
250 M. for five minutes was made. No discharge 
followed. Her menstruation appeared two days later, 
and there was much less pain than before. 
March 12. Menstruation having ceased, the third 
galvano-puncture was made. This time the positive 
pole was used with 300 M. for five minutes. 
April 10. The fourth galvano-puncture, negative, 
200 M. for five minutes. 
18th. The fifth galvano-puncture, negative, 200 M. 
for five minutes. 
25th. The sixth galvano-puncture, negative, 
200 M. for seven minutes. 
A week after this puncture a copious watery dis- 
charge suddenly came from the vagina, and con- 
tinued to flow away in gushes. Investigation showed 
that it had come from the last puncture-track. The 
opening was enlarged, and the sound could be 
passed up four inches into a cavity. All the fluid 
was drawn off, but the discharge continued for two 
weeks—as much as a pint a day. 
May 18. A bulb electrode was introduced, and 
150 M. negative galvanism applied to the cavity for 
eight minutes Three days later all discharge 
ceased. She has had no pain since, and her men- 
struation has been normal. At the present time— 
six months since the last application—she is in per- 
fect health. What remains of the tumor is about 
the size of a hen’s egg. It gives her no incon- AUGUSTIN H. GOELET. 
19 
venience whatever. She has been seen recently 
by Dr. Dudley, who can vouch for her present con- 
dition. 
The dermoid cyst may be treated in the same way 
as the fibroid cyst, when it contains only sebaceous 
matter, for the negative pole will soften it, and allow 
it to drain away. My experience is limited to one 
case in the pelvis, though I have succeeded in cur- 
ing several on the surface of the body by this 
method. In this instance the tumor had been 
diagnosed as a small fibroma. At the first puncture 
a cavity was discovered, but there was no drainage 
from it. On enlarging the opening as before de- 
scribed, and exploring the sac, the nature of its 
contents was ascertained. Fifty milliamperes neg- 
ative galvanism were applied to the interior of the 
sac, a drainage-tube inserted, and a dressing of 
iodoform gauze placed in the vagina. This applica- 
tion was repeated every second day. Eight neg- 
ative galvano-caustic applications were sufficient to 
empty the cyst completely. It soon ceased to dis- 
charge and healed up. Now, four months after, 
there is scarely a trace of it to be felt. 
I fully realize that such treatment could have no 
effect upon the bone, hair, and teeth often found 
in these cysts, but these might be removed through 
the opening if the tumor was situated close to the 
vaginal wall. In the case just mentioned the cyst 
contained only sebaceous matter. 
The condition known as chronic pelvic cellulitis, 
which is usually manifested by a mass of exudation 20 
ELECTRICITY IN GYNECOLOGY. 
in one or both broad ligaments, including the tube 
and ovary, and associated with salpingitis and en- 
dometritis, yields very satisfactorily to galvanism of 
the endometrium. But it is very important to begin 
the treatment with a small dose—say 20 to 30 M.— 
for three to five minutes every second or third day, 
using the positive pole. And it is sometimes even 
better to begin with vaginal applications. The dose 
may be increased to 50 M. as tolerance is established. 
Later in the course of treatment it may become 
necessary to substitute the negative pole or vaginal 
puncture to hasten absorption. This condition 
dooms the patient to a life of misery, constantly 
threatened with peritonitis. Laparotomy does 
not always cure; but, by galvanism, she can be 
promptly relieved of pain, the deposit is softened 
and absorbed, the inflammatory complications are 
removed, and she is eventually restored to health 
with her ovaries and tubes intact and with a chance 
of conception. A case of this kind has recently 
come under my observation, and though it is only 
one of many others, some points in connection with 
it may be of interest here. 
The patient had a miscarriage two years ago, and an 
attack of acute pelvic cellulitis in January last, from 
which she recovered partially, so as to be able to go 
about, but always suffered great pain in the right 
side of the pelvis on standing, walking, or riding. 
Frequently the attacks of pain were so sharp as to 
send her to bed for several days, especially at the 
menstrual period. In the beginning of October she AUGUSTIN H. GOELET. 
21 
visited a clinic in this city, and was told that she 
had a tumor which was liable to burst and cause her 
death, and that it must be removed without delay. 
Careful examination, under chloroform, shortly 
after, when she consulted me, failed to reveal any- 
thing except a firm mass of exudation surrounding 
the right tube and ovary, and a retroflexed uterus 
partially fixed. The mass was extremely sensitive 
to touch, and the patient could scarcely walk a 
block. Treatment was begun with 30 M. positive 
galvanism, intra-uterine, three times a week, and the 
dose gradually increased to 60 M. She ceased to 
complain of pain after the sixth application. At 
this date she has had ten applications, and her im- 
provement is marked. She can walk or ride any 
distance without pain or inconvenience, and is able 
to do her own work. The mass is less than half its 
original size, and not sensitive to ordinary pressure. 
All of these cases, however, especially those of 
long standing, do not yield so readily to the intra- 
uterine applications alone, and it is then necessary 
to resort to vaginal galvano-puncture as advised by 
Apostoli. He uses a very fine needle, adjusted so 
as to penetrate only a half centimetre, using fifty 
milliamperes, positive, for five minutes. I have seen 
marked benefit follow such punctures, both in my 
own cases and those which I saw treated at his 
clinic. The patients themselves remark the in- 
creased benefit following this form of treatment. It 
may be more painful at the time, but the result, they 
say, outweighs the pain of the application. 
The intra-uterine chemical galvano-caustic appli- 22 
ELECTRICITY IN GYNECOLOGY. 
cations exert a decided influence upon fibroid 
tumors attached to the uterus, but which are not 
accessible for vaginal puncture, especially if they 
can be treated by including the growth between the 
two poles for the interpolar action. Dr. J. H. 
Gunning, of this city, tells me that he has had re- 
markably good results from the interpolar action of 
the current alone. 
It would seem unnecessary to add further testi- 
mony in favor of the treatment of uterine fibroids 
by electricity, since such authorities as Spencer 
Wells and Thomas Keith have abandoned hyster- 
ectomy and openly avow themselves in favor of 
Apostoli’s method. But there are some who refuse 
to be convinced, and some who, having tried it 
improperly and failed, are unwilling to admit that 
any good can come of it. 
As to fibroids,1 it does not always dissipate the 
tumor entirely, but the size is very materially les- 
sened ; its growth is arrested, and the symptoms 
are relieved. The pain is promptly lessened, hem- 
orrhage is absolutely controlled, and, as the tumor 
becomes reduced in size, the pressure symptoms are 
likewise removed. 
It sometimes requires a great deal of patience on 
the part of the physician, as well as the patient, and 
strong confidence in the agent, to make both hold 
out to a successful end. Thomas Keith truly says: 
1 Dr. Goelet stated that as others would discuss the subject of 
electricity in fibroids at the same meeting, it would be unnecessary 
for him to enter into it in detail. AUGUSTIN H. GOELET. 
23 
“Apostoli’s method, though slow, requiring much pa- 
tience, tenderness of manipulation, and thought, is still 
sure in its results.” 
He also adds of electricity : 
“My confidence in its power to relieve disturbing 
symptoms of uterine fibroids and to cure many chronic 
inflammatory conditions in the pelvis continues to in- 
crease, and I have no fears for the future of electricity. 
. . . Hysterectomy, remember, which is performed every 
day for a complaint that rarely of itself shortens life, kills 
every fourth or fifth woman who is subjected to it. This 
mortality must cease; it is not a question of surgery, it 
is a question of humanity. Every time that any disease 
can be cured without resorting to a bloody and dan- 
gerous operation, such as hysterectomy, progress is 
made in our art, and there is a gain to humanity, while 
surgery is the better of being purged of a deadly opera- 
tion. Even the fact that in my cases of hysterectomy 
the removal of the uterus .and ovaries was sooner or 
later followed by insanity in ten per cent, of the whole 
number, is enough for me to condemn any operation 
that removes these organs.” 
And this is the mature opinion of a most success- 
ful surgeon ; one who was the first to lower the mor- 
tality of abdominal surgery. 
The method of application should be more clearly 
explained and clinically taught in this country, for 
there are many to-day who have but a superficial 
knowledge of electricity, and some who are attempt- 
ing to use this agent without even knowing the dif- 
ference in the action of the galvanic and faradic 
currents, as well as many who do not realize the dif- 
ference in the action of the two poles. This is a 24 
ELECTRICITY IN GYNECOLOGY. 
deplorable fact, but, nevertheless, true, as the fol- 
lowing incident will attest: 
A lady consulted me recently about a tumor 
which proved to be a fibroid growing from the 
right side of the uterus. She volunteered the 
information that she had no confidence in elec- 
tricity, because her physician had been treating her 
for the past six months with that agent, and it had 
not only done her no good, but she was worse. He 
had told her that he did not himself think it was 
suitable for her case after he had given it a thorough 
trial. On inquiry, I learned that he did not pos- 
sess a galvanic battery, but had treated her with a 
small faradic battery, even puncturing with that 
current. That man is prepared to denounce elec- 
tricity as worthless. This patient has now been 
under my care since the middle of September, has 
had twelve positive galvano-caustic applications to 
the uterine canal, and one positive galvano-punc- 
ture. Previous to consulting me, she suffered con- 
stant pain, menstruated twice a month, and for 
seven or eight days profusely. She has had no 
pain since the sixth application. Her last period, 
which was twenty-nine days after that of the pre- 
vious month, lasted only three days. She is now 
progressing nicely, can walk or ride without pain 
or fatigue, and the tumor is smaller and very much 
softer. 
After giving Apostoli’s method, as I understood 
it, a thorough trial, I thought enough of it to visit 
him during the past summer and learn more about 
it. It is a mistake to suppose that any one can 
apply this method without special preparation or AUGUSTIN H. GOELET. 
25 
instruction. And I am now satisfied that Apostoli 
is but poorly understood by many who think they 
can grasp his ideas by reading his writings. It is 
necessary to see its practical application in order to 
comprehend it fully, and there is too much in the 
method to be learned in one or two visits to his 
clinic, even by those who understand electricity. A 
correct diagnosis is the first requisite, then experi- 
ence alone will enable one to decide the course to 
be pursued, else the negative pole will be used when 
the positive is indicated, and vice versa. It is very 
necessary to understand the technique of the appli- 
cation and to have confidence to administer it 
properly, taking care that self-confidence does not 
overstep the bounds of prudence. Always respect 
the actual suffering of a patient, but do not be de- 
ceived by her nervous apprehensions. By knowing 
the condition, experience will tell you nearly how 
much of galvanism she can bear. Apostoli has 
pointed out that in fibroids there is a comparative 
insensibility of the endometrium to the current, and 
he also lays stress upon the fact of the increased sen- 
sitiveness of the endometrium in inflammatory condi- 
tions of the appendages. The fact being, that in all 
these last-named conditions there always coexists an 
endometritis. But in uncomplicated endometritis 
the current is usually well borne. In treating diseases 
of the appendages, he says, begin always with the 
positive pole and a small dose and increase as toler- 
ance is established. In fibroids, it is often possible 
to begin with ioo milliamperes, and I have seen 26 
ELECTRICITY IN GYNECOLOGY. 
200 used in the uterus without causing the patient 
manifest inconvenience. I have likewise seen gal- 
vano-puncture of 200 milliamperes borne without 
much suffering when the pole used was positive. 
These and many other important points can only be 
appreciated by watching his work at his clinic. 
I followed him closely while there, and came 
away more than ever convinced of the general 
utility of electricity in gynecology. One cannot 
but be impressed with the method of his work, his 
honesty of purpose, and conscientious painstaking 
toward his patients, as well as the courtesy extended 
the physicians visiting his clinic. He exhibits 
with the most perfect freedom the histories of his 
cases, the records of his treatment, and the results. 
Every case treated there may be examined and 
questioned by any one present, and, if you do not 
request it, you are invited to examine the patient 
and express your opinion. The notes of progress 
and the treatment are announced to all present, 
and recorded by his assistant, and one is at liberty 
to verify any statement that is made. Since I have 
seen for myself, I have been astonished at the state- 
ments made by others, which are so contrary to my 
own experience. 
In conclusion, I desire to say that I do not think 
any one should condemn Dr. Apostoli or his method 
until they have visited his clinic and witnessed his 
work and his results. 
243 West Fifty-fourth St., New York. THE GALVANIC TREATMENT OF UTERINE 
FIBROMATA. 
w 
by e. l. h. mcginnis, m.d., 
ELECTRO-THERAPEUTIST TO THE WOMAN’S HOSPITAL IN THE STATE OF 
NEW YORK ; FELLOW OF THE NEW YORK* OBSTETRICAL SOCIETY, 
iOF THE PATHOLOGICAL SOCIETY OF NEW YORK, ETC. 
I am well aware that the above subject is one 
which has many times been written about, spoken 
about, and read about, and that there are few who 
have not already some idea of its utility; but there 
may be some who have formed opinions hurriedly 
or after insufficient trials, and as I welcome any ad- 
ditions to the literature on the subject, so have I 
ventured to hope that I could say something of 
interest to others. 
It is needless for me to go into the history of this 
treatment of the uterine fibroid growth in detail, 
but as far back as 1871 Dr. Cutter had found the 
advantage of the continuous galvanic current, and 
since then many observers have been at work on it, 
and have from time to time published their memoirs 
on the subject. 
There have been many different ways of applying 
the current to the tumor, all with the view of re- 
ducing its size and relieving the symptoms of this 28 
ELECTRICITY IN GYNECOLOGY. 
most unfortunate affliction ; but I propose here to 
speak more especially upon a course of treatment 
which statistics and time have shown to be better in 
every respect than the others, viz., that first brought 
into prominence by its originator, Dr. Georges 
Apostoli, in an article read before the British Med- 
ical Association, in 1887. 
He had then used it for five years, with most 
satisfactory results, and since that time he has 
steadily continued to study it in all its details, and 
reduce what had hitherto been a vague sort of em- 
piricism to an exact science. This step in itself was 
all-important, for many had tried galvanism, with a 
large number of failures and only occasional suc- 
cesses, and of the latter no one seemed to know ex- 
actly why good had been done. 
By the introduction of improved electrodes and 
a good milliamperemeter, however, we are now able 
to accomplish results entirely satisfactory to the vast 
majority of patients treated by it, and most gratify- 
ing to the attending gynecologist, and it is my firm 
belief that ere long its use will be universally recog- 
nized as the proper course to pursue before resorting 
to an operation the dangers of which we all know 
only too well. 
Even to-day we come into contact with empiricism 
regarding the use of electricity, as it is practised by 
charlatans or those ignorant of its proper handling. 
I have been told by patients, of the faradic, inter- 
rupted galvanic, and static currents having been 
used on them for the cure of their fibroids, and one E. L. H. MC GINNIS. 
29 
told me not long ago that a female practitioner, sup- 
posed to be largely endowed with “ natural elec- 
tricity ” (whatever that may mean), had treated her 
tumor with electricity by rubbing nearly all the 
outer layer of epithelium from her abdomen, and 
with the temporary relief which massage sometimes 
brings. Is it to be wondered at, then, that there are 
sceptics regarding its use? 
Since my appointment as Electro-therapeutist to 
the Woman’s Hospital several years ago, I have had 
abundant opportunity to test the values of the dif- 
ferent methods of application, and have found the 
results of those cases treated by Apostoli’s methods 
to be far better than the others. Puncture through 
the abdominal wall seemed to produce fair results in 
some cases, but I do not consider it as efficacious as 
Dr. Apostoli’s method. Although the modus oper- 
andi of it is comparatively well known, a hurried 
description may elucidate much that follows. 
He introduces one electrode, shaped like an ordi- 
nary uterine sound, into the canal, and the other, a 
moist pad of potter’s clay, is placed upon the ab- 
domen over a prominent nodule, if there be one, or 
at the upper limit of the growth, if it be rotund. 
These are then connected with the battery by the 
flexible conducting cords, one of which must reach 
the battery by way of the milliamperemeter, as the 
amount of current used is to be accurately measured. 
The current is then turned on, its strength in- 
creased very slowly and without shock, till the 
proper number of milliamperes is reached, and is 30 
ELECTRICITY IN GYNECOLOGY. 
kept there from five to twenty-five minutes, depend- 
ing upon the susceptibility of the patient, etc., and 
is then reduced in the same way, great care being 
taken to avoid any sudden break in the current, 
which would cause a shock to the patient. This 
method will answer for most cases in which the mass 
is situated in, or attached to, the fundus or anterior 
wall ; should the situation or attachment be the pos- 
terior wall, galvano-puncture is resorted to, with a 
trocar-pointed electrode. Its application is as fol- 
lows : A careful vaginal examination is made, and 
the posterior cul-de-sac thoroughly explored, any 
pulsating point being located, and avoided there- 
after. When a spot free from pulsation is found, 
the end of a small celluloid tube is placed against it 
and the trocar-electrode, with the handle firmly 
screwed to the end toward the operator, is passed 
through the celluloid sheath and the puncture made 
to a depth not exceeding one to two centimetres. 
This celluloid tube answers a double purpose : that 
of insulating the needle from the vagina and of 
preventing the point from entering too far or beyond 
the distance intended and previously arranged for. 
Should much haemorrhage occur when the needle is 
withdrawn, an accident I have never known to 
happen, a bivalve speculum can be introduced and 
forceps applied, or the positive pole be made to act 
as a haemostatic. 
This treatment is often administered without an 
anaesthetic, and the strength of the current should 
be no more than the patient can tolerate. It should E. L. H. MCGINNIS. 
31 
also be remembered that the current itself, in two or 
three moments, has a distinct local anaesthetic effect, 
thereby lessening the pain and allowing an increase 
of quantity. A current of 30 milliamperes has been 
found to produce benefit, and up to a certain point, 
stronger ones in proportion. I find that from 75 to 
150 milliamperes can be quite comfortably borne, 
and certainly produces most marked improvement. 
While trying to get exact measurements of the 
tumor in every case, it is often extremely difficult to 
do so, owing to the presence of gas in the intestine 
behind the mass, to the thickness of the abdom- 
inal walls, etc. One thing that I have noticed is 
misleading, viz., that in some cases which have been 
treated by this method, as the tumor diminishes in 
size an increased amount of adipose tissue is found 
in the abdominal wall. This point should not be 
overlooked when external measurements are taken 
for comparison with former ones. 
The proper use of the poles is of the greatest im- 
portance. To make a definite rule as to which 
should be used internally is impossible, as the nature 
of the symptoms will be our guide. In the class of 
non-bleeding fibroids, the negative pole is indicated 
for two reasons: first, because it seems to curtail the 
supplementary circulation by means of the rapid 
atrophy it causes, especially where puncture is made, 
and, second, because Dr. Apostoli has found that in 
bringing about a reduction of the mass, it is quicker. 
For the treatment of bleeding fibroids, the hsemo- 
static action of the positive pole has been too well 32 
ELECTRICITY IN GYNECOLOGY. 
proven to require extended notice. Not one single 
case of this kind which I have treated by the Apos- 
toli method has failed to give the greatest satisfaction 
to both patient and myself. Cases have come to 
me nearly exsanguinated, and I have managed by 
this means not only to stop the hemorrhage, but, to 
my delight, prevent its return. Surely, had the 
treatment no other merits, this one in itself would 
entitle it to a fair trial before operative procedure is 
resorted to. 
It is not my intention to claim any more than can 
be proved by many who are using it to-day, nor that 
a few applications of it will cure any and every 
fibroid with which it is possible for one to meet. 
That it is slow in its effects I know, and we must 
not be disappointed if marked diminution in the 
size of the mass is not noticed at once. The great 
majority of cases show little change under a month 
of treatment, which should be applied three times 
weekly. But I have found one (very rarely, two) 
thorough applications quite sufficient to control the 
most obstinate hemorrhage, provided a sufficiently 
strong current is used, and, what is most important, 
that every part of the endometrium be brought in 
contact with the electrode. This is sometimes very 
difficult, as the canal may be tortuous, and the stiff 
electrode then fails to touch some spot where there 
is bleeding. This may be provided for by the use 
of a flexible electrode, which is insulated to its 
platinum tip, which latter should be three-fourths 
of an inch long and shaped like a probe, but of E. L. H. MC GINNIS. 
33 
larger calibre. Having passed it to the entire depth 
of the uterus, it is held there, with one finger against 
the os, long enough to cauterize the parts in contact 
with the tip (the time to depend upon the strength 
of the current used), then gradually withdrawn, a 
very little at a time, till the entire endometrium has 
been cauterized. Should there be fungoid growths 
present, causing some if not all of the haemorrhage, 
they will be destroyed at the same time, thus answer- 
ing the purpose of curetting, and without leaving a 
fresh bleeding surface within the uterus. 
All these measures should be carried out in a 
rigidly antiseptic manner, washing out the vagina 
with a bichloride or carbolic solution, before and after 
each application, and immersing the intra-uterine 
electrode in a saturated solution of iodoform in 
ether, just before introducing it. The ether in- 
stantly evaporates, leaving a thin deposit of iodo- 
form on the electrode. Should germs even then be 
present, the current will be more than sufficient to 
destroy all life in them. 
No new method of treatment is brought before the 
profession without its detractors. This I consider 
most fortunate, as it leads to discussions and narra- 
tions of cases which cannot fail to instruct us, and 
many interesting features are thus developed, which 
are of the utmost value. 
One of the objections raised to the employment 
of the Apostoli method is the danger of a current 
strong enough to produce beneficial results. Im- 
properly used, I grant that damage may be done; 34 
ELECTRICITY IN GYNECOLOGY. 
but does a badly managed case of hysterectomy al- 
ways get well ? I would ask those who have made 
this objection to compare the results of the laparot- 
omists with those who have treated an equal num- 
ber of cases by this method ; the latter will be found 
much less dangerous to the lives of the patients, to 
say nothing of the long convalescence, pain, possi- 
ble mania, inability to continue in daily avocations, 
and haemorrhage during or after the operation. 
The experience of such well-known gynecologists 
and authorities as the Keiths, father and son, Sir 
Spencer Wells, Woodham Webb, Playfair, and 
others in Great Britain alone, must certainly silence 
many objections regarding its inutility, while in this 
country, men of undoubted ability have met with 
results far beyond their expectations. Often the 
patients themselves can judge of their improvement 
quite as well as the attending gynecologist, for who 
knows better than they that the pain and sense of 
pressure, the dreaded haemorrhage, the headache 
and backache so constant, as well as other reflex 
symptoms, are not what they once were? Who can 
tell better of the apparent loosening of the waist- 
bands attached to their clothing ? 
I have now under my care a case sent me by Dr. 
T. Gaillard Thomas, through whose courtesy I am 
enabled to report it: 
The patient was first seen by me in February of this 
year, and her history revealed the fact that she 
had noticed the enlargement in her abdomen four 
years ago; she had all the usual symptoms, includ- E. L. H. MC GINNIS. 
35 
ing several most severe haemorrhages, each of which 
had left her nearly bloodless. She was emaciated 
to an alarming extent, her pulse was weak, and she 
felt perfectly certain that the next haemorrhage 
would be her last, and that she could not recover 
from the effects of a hysterectomy. Her tumor was 
situated in the fundus, and extended to the ensi- 
form cartilage ; her waist measured forty-four inches 
in circumference, and examination revealed that her 
uterus was five and one-half inches deep. For- 
tunately the canal was straight, so I had little diffi- 
culty in introducing the electrode, and thoroughly 
cauterizing the endometrium. I began treatment 
at once, and continued it with two intermissions of 
two weeks each, when she was obliged to leave 
town, and also during her menstrual periods, till 
my departure for Europe, the last of June, and did 
not see her again till on my return, October ist. 
She has had no renewal of haemorrhage; her tumor 
is now down to the umbilicus; is not tender, and 
gives her no pain ; the canal is three and one-fourth 
inches long, and she can walk to my office, nine 
blocks from her home, three times weekly for her 
treatment, and can undergo the fatigue of a day’s 
shopping with only a moderate amount of discom- 
fort. 
I could occupy the reader’s attention with the 
narration of other cases were it advisable; but 1 
feel that I cannot close this paper, already too 
long, without reference to an article written by Dr. 
Thomas Keith, of London, and published in the 
British Medical Journal of June 8, 1889. In it he 
says: 36 
ELECTRICITY IN GYNECOLOGY. 
“ What I now plead for is, that for a time all bloody 
operations for the treatment of uterine fibroids should 
cease, and that Dr. Apostoli’s treatment, as practised by 
him [the italics are mine], should have a fair trial. 
Those who have hitherto most resisted the introduction 
of electricity are the surgeons who are best competent to 
carry it out. They are accustomed to manipulate in the 
pelvis, and they will not make mistakes of diagnosis, or 
'make them as seldom as it is possible to do. Hyster- 
ectomy, remember, which is performed every day for a 
complaint that rarely of itself shortens life, kills every 
fourth or fifth woman who is subjected to it. This mor- 
tality must cease; it is not a question of surgery, it is a 
question of humanity. Every time that any disease 
can be cured without resorting to a bloody and dan- 
gerous operation, such as hysterectomy, progress is made 
in our art, and there is a gain to humanity, while sur- 
gery is the better for being purged of a deadly opera- 
tion.” . . . 
“ It may seem strange to some, that after the results 1 
got in hysterectomy—results which almost make it justi- 
fiable—I should now begin to throw stones at the opera- 
tion, instead of trying still further to improve upon it; 
and but for Dr. Apostoli, I should now be doing so. I 
would give something to have back again those sixty- 
four women that I did hysterectomy for, that I might 
have a trial of Dr. Apostoli’s method upon them ; and I 
would give something never to have had the tear and 
wear of flesh and spirit that these operations cost me, 
for in scarcely one of them was the operation simple. 
“ I have, in the meantime, said my say, and it must 
not be forgotten that the opinion here expressed as to 
the value of Dr. Apostoli’s treatment is not that of an 
unsuccessful surgeon, but is the deliberate opinion of 
one who was the first to lower to a minimum the mor- 
tality that so long followed abdominal surgery, and 
who, by the best results yet obtained in hysterectomy— 
results that Dr. Playfair is pleased to call almost phe- 
nomenal—still retains that position.” E. L. H. MC GINNIS. 
37 
What can I add after such an opinion as the fore- 
going? I can simply say that my experience with 
Dr. Apostoli’s methods, while large, is more than 
satisfactory, and in quoting Dr. Keith’s praise and 
thorough indorsement of it I have expressed my 
own views. 
While abroad on business last summer, I was 
enabled to visit Dr. Apostoli’s clinic and to satisfy 
myself on many points regarding his histories and 
statistics, and I earnestly advise all who can possibly 
make an opportunity, to see him at his work in the 
Rue du Jour, to do so. 
You will be welcomed by a most charming and 
courteous gentleman, who will give you every pos- 
sible opportunity not only to see him operate, but 
to examine his cases and their histories, talk with 
them, ask them any questions regarding their con- 
dition and treatment that you may see fit, and, in 
fact, satisfy yourself on every possible point of the 
truth of his assertions and the merits of his methods. 
You will also meet colleagues from Germany, Russia, 
Scandinavia, and the South of Europe, as well as 
many English surgeons of renown, a few South 
Americans, and, I am proud to say, a goodly num- 
ber of our own countrymen; and nearly all have the 
same opinion as to the merits of Dr. Apostoli’s 
treatment, and seek his clinic for further instruction. 
In conclusion, let me urge upon the reader to 
give this method a proper and thorough trial before 
rushing his afflicted patient to the operating-room, 
there to undergo the dangers of the knife. 
35 West Thirty-eighth St. NOTES ON THE TREATMENT OF FIBRO- 
MYOMATA BY ELECTRICITY. 
By A. H. BUCKMASTERj^M.D., 
ASSISTANT SURGEON TO ST. PETER’S HOSPITAL, BROOKLYN, N. Y. 
This method of treatment has been before the 
profession for several years, and, while the consensus 
of opinion is decidedly in its favor, there are many 
who are disposed to deny its efficacy. The treat- 
ment requires patience, it is slow, and in cases where 
the tumor is treated solely on account of its size it 
is often impossible to gauge accurately slight varia- 
tions. Constipation, flatulence, increase in adipose 
tissue, congestion or oedema, all are apt to mislead 
and perplex the observer. There are several means 
by which the sceptical may become convinced that 
the treatment is valuable. 
First. By statements of individual observers, 
many of whom have not only claimed relief from 
symptoms and decrease in size, but also total disap- 
pearance of myomatous masses. The evidence of 
this class is most abundant. 
Second. The testimony of individuals supported 
by the observations of disinterested witnesses. This 
can best be obtained in the hospitals, and acorn- 40 
ELECTRICITY IN GYNECOLOGY. 
petent man should be invited to test the cases, who 
should be a thoroughly practical gynecologist as well 
as an electrician, and competent to recognize the 
coptra-indications for treatment. 
Third. The presentation of a reasonable explana- 
tion of the means by which the resulis are obtained. 
The explanation of the writer is founded on experi- 
ments on the non-striated muscular tissue of the 
dog’s heart and on fibroid tissue outside of the body. 
The experiments were as follows : 
The heart of an anaesthetized dog was exposed 
and a current of forty milliamperes made to traverse 
a portion of the ventricle. A piece of the ventricle' 
in the direct line of the current was excised and 
another some little distance from the direct influence 
of the current. When examined under the micro- 
scope the piece from the direct line of the current 
showed that the strife had become markedly granu- 
lar, while the piece outside of the direct line of cur- 
rent preserved the muscle cells unaltered. This 
granular appearance of the striae would indicate. 
degeneration of the muscle bundles. It is observed 
in fatty degeneration, and in such cases the contrac- 
tility is much impaired. This is the first evidence of 
absolute molecular disintegration of living cells by 
the interpolar action of the galvanic current, where 
such process is confined to the cells. 
The condition of rigor mortis is readily induced 
in a muscle through which circulation is maintained. 
The action of heat at n8° F., distilled water, acids 
even of the weaker kind, such as carbonic acid, bring A. H. BUCKMASTER. 
41 
it about. If death rigor occurred in any considerable 
part of the muscle tubes of the tumor there would 
result a marked diminution of its irritability, for it is 
a well-known fact that muscle under this condition 
ceases to respond to stimuli. To determine if this 
was so after treatment the following experiment was 
resorted to: 
It is assumed that the contractions of the uterus 
are followed by contractions of the vagina which 
are in direct proportion to them. Kehrer1 found 
in his experiments with rabbits, that exposure to air 
would give rise to a contraction which advanced 
through the whole genital canal,.while by chemical, 
mechanical, electric, and thermal irritation contrac- 
tions could be started at almost any point and were 
transmitted in one or the other direction, so that an 
increase in the vaginal pressure would indicate a 
contracted condition of the uterus. This method 
of indicating contractions of the uterus has been 
utilized by Milne Murray,2 of Edinburgh, in his 
experiments on the effects of hot water on the uterus. 
The following method was adopted by the writer : 
A rubber bag by which the vaginal pressure is to be 
determined is filled with water and communicates 
by a rubber tube with the proximal arm of a 
U-shaped glass tube which contains mercury. The 
other arm of the glass tube is opened at the end. 
1 Chadwick : Peristalsis of the Genital Tract. Trans, of Amer. 
Gyn, Soc., vol. x. 
3 Edinburgh Med. Journal, Aug. and Sept. 1886. 42 
ELECTRICITY IN GYNECOLOGY. 
When any pressure is made on the bag the column 
is pushed back, and this raises the discus of the 
mercury in the distal arm. The variation can be 
read by means of a graduated scale. The chief 
sources of error in using this means of measurement 
arise from having air mixed with the water, or hav- 
ing the tube of such thin rubber that it readily 
becomes distended by pressure. 
There are two methods of measuring the effects 
of stimuli on muscular contraction ; one is by ob- 
serving the comparative strength of the contraction, 
and the other is by ascertaining the smallest amount 
of current that will give a contraction; the latter 
method was in this instance adopted. The induced 
current with a sliding induction coil was used. The 
cell used was a constant one. The patient in posi- 
tion, the electrode was placed in the uterine canal. 
The bag filled with water was then introduced, and 
after waiting five or six minutes for the vagina to 
become accustomed to it, the faradic current was very 
gently turned on (the other arrangements being ex- 
actly similar to those used in the ordinary treatment) 
until contractions were induced in the uterus. The 
amount of this current was carefully calculated. The 
constant current was now gradually substituted by 
means of a rheostat until sixty milliamperes were 
registered. In about a minute the column of mer- 
cury showed an increased vaginal pressure of one- 
sixteenth of a pound. 
The current was turned off very gradually, and 
the patient allowed to remain perfectly quiet for A. H. BUCKMASTER. 
43 
twenty minutes; at the end of this time the slightest 
induced current that would give a contraction was 
considerably less than before the treatment.1 
The above experiments only point out a line of 
investigation. The writer has not had the time to 
repeat and test them as should be done; he merely 
indicates from the standpoint of the clinician what 
the laboratory worker may establish or disprove. 
So much for the interpolar action. In regard to 
the action at the poles it must not be forgotten that 
slight traumatism of the cavity of the uterus has an 
important effect upon the nutrition of the fibroid, 
and that there are many cases where fibroids have 
spontaneously disappeared. Gusserow states that 
various operative procedures, sponge-tents, incision 
of the mouth of the uterus, and intra-uterine injec- 
tions frequently cause sloughing of fibro-myomata 
by interference with nutrition from traumatism of 
the uterine mucous membrane. 
It is not my intention to narrate the histories of 
my cases, which present nothing brilliant in the way 
of cure. In no case has there been lack of improve- 
ment, in no case have I seen disappearance of the 
fibroid. 
In regard to the technique of the operation there 
has been but little improvement of late. The litera- 
ture of the subject is, and has been, overburdened 
with descriptions of visits to Apostoli and of his 
methods. A thorough knowledge of French is 
1 Unfortunately the writer has been unable to repeat this experi- 
ment, but hopes that others may do so. 44 
ELECTRICITY IN GYNECOLOGY. 
necessary to form any adequate personal opinion of 
Dr. Apostoli’s work, or to comprehend the state- 
ments of patients, and this requisite must present an 
insurmountable difficulty to many of these witnesses. 
To Dr. Austin Goelet, of this city, is due a cheap 
and efficient electrode with which many electricians 
are familiar. One fact has, I believe, escaped atten- 
tion in stating the dangers incident to these cases, 
and that is, chronic renal disease. Not only should 
the urine in all cases be examined for albumin, but 
the amount and specific gravity should be carefully 
considered. The writer has seen this complication 
assume most serious importance, and it should never 
be overlooked. In closing these brief remarks I 
desire to say that I believe that dissatisfaction in the 
treatment is usually due to failure in understanding 
and carrying out the principles enunciated by 
Apostoli. 
207 Clinton Street, Brooklyn. BI-POLAR FARADIZATION IN GYNECOLOGY. 
By A. LAPTHORN SMITH, B.A., M.D., M.R C.S. Emu., 
F.O.S. Lond., 
SURGEON TO THE WOMEN’S HOSPITAL AND LECTURER ON GYNECOLOGY 
IN THE MEDICAL FACULTY OF BISHOP'S UNIVERSITY, MONTREAL. 
Electricity is such a new subject and its different 
departments are.so numerous that it is no easy matter 
for all of us to keep pace with its progress. 
As is generally known, it was Faraday who dis- 
covered that an induced current of electricity is set 
up in a conducting wire which is placed near to, 
but not touching, another wire through which a 
current is passing. It is also well known that the 
appreciable effects of the passage of a current of 
electricity, either direct or induced, are greatly in- 
creased by the interruption of the current. Thus a 
continuous current of a hundred milliamperes can 
easily be borne, while if the same current be inter- 
rupted it will promptly knock one down. By 
making the primary wire into the form of a coil 
and placing a piece of soft iron within the coil the 
iron becomes magnetic whenever the current passes, 
and this body of magnetized metal in turn intensi- 
fies the current in the primary coil. The primary 
coil should be made of moderately coarse wire so 46 
ELECTRICITY IN GYNECOLOGY. 
as not to offer too great a resistance for the battery 
to overcome, as the battery, which should consist of 
two closed cells in a separate portable case, must 
have sufficient electro-motive force to push through 
the coil. The secondary or induced coil deserves 
special attention because it will depend entirely 
upon the shortness and coarseness, or the length 
and fineness of the wire, whether you will obtain 
those almost magical effects which some have 
claimed for it. There are many who cannot be- 
lieve that these differences are of any real conse- 
quence, and yet there is no fact in medicine of which 
I am more certain than that the results from these 
two wires are totally different. The coils which 1 
have been using for the past three years are wound 
as follows: the short wire coil, which is about 
twenty-five yards long, and No. 14 or 16 in diam- 
eter, is insulated with silk and varnished between 
the layers. The fine wire is about No. 40, which 
is the finest made, and is about a mile long. The 
short, thick wire gives out nearly the whole quan- 
tity of current that is induced in it, and is, there- 
fore, called the current of quantity, while the long, 
fine wire offers a tremendous friction or resistance 
to the passage of the current, and is, therefore, 
called the current of tension. I think this is a 
better name for it than current of quality, which 
it has sometimes been called. The current of 
quantity from the coarse coil, as has long been 
known, is an excellent tonic for muscular fibre, and 
I have used it to advantage in nearly every case in A. LAPTHORN SMITH. 
47 
which the symptoms could be traced to defective 
muscular contraction. It should be placed high in 
the list of tonic remedies, although I do not think 
that it possesses any miraculous virtues which are 
not possessed to a greater or less extent by gymnas- 
tics, regular exercise, strychnine, quinine, ergot, 
hydrastine, and cold and hot water. This much 
can be said for it, however, that it is a tonic espe- 
cially suitable for relaxation of those muscles which, 
owing to adverse circumstances, cannot be toned up 
by any or all of the above mentioned means, and, 
besides, it can be made directly on the muscles or 
group of muscles which are most at fault. By 
means of Apostoli’s bi-polar electrode it is espe- 
cially applicable to the muscular organs in the 
pelvis. For instance, in post-partum haemorrhage 
we can surely obtain instant and permanent con- 
traction of the uterus, no matter how exhausted it 
may be, by introducing the bi-polar electrode and 
turning on the coarse wire current. 
For those obstetricians who are frequently meet- 
ing with this accident, a small battery which can be 
set in action in an instant, might well find a place 
in the modern obstetric bag. I must confess, how- 
ever, that I have never put it to this use, for, 
although I have been looking for a case on which 
to try it, since I have been giving nature a little 
more chance I find that relaxation of the uterus is 
more and more rare. I have had, however, many 
cases of subinvolution due to the defective con- 
traction of the uterus, accompanied by the usual 48 
ELECTRICITY IN GYNECOLOGY. 
symptoms, and they have invariably been promptly 
relieved, and in a very reasonable time cured, by 
seances with the bi-polar intra-uterine electrode with 
the current of quantity as strong as the woman 
could bear it, and lasting ten or fifteen minutes. 
But it must be remembered that no such gratifying 
results will be obtained if the enlargement is due to 
fibrous tissue instead of muscle. Areolar hyperpla- 
sia, like fibroid, must be treated by the continuous 
current. Another class of cases with which I have 
had very gratifying results are those of deformity 
and displacement of the uterus, due to relaxation 
of its walls or of the muscles which hold it in the 
centre of the pelvis. The presence of strong adhe- 
sions, however, binding it down in a wrong shape 
or position, would diminish the probability, or even 
preclude the possibility of restoring it to its proper 
form or position. The cases in which I have been 
occasionally disappointed, were those in which the 
muscles of the uterine supports had undergone 
degeneration so long ago that there seemed to be 
little or no muscle left to work upon. In such cases 
I have abandoned this treatment for some more 
speedy one. 
This treatment is not at all applicable to cases of 
bleeding due to fungous endometritis, or to the 
presence of retained placental tufts. In those cases 
it is our manifest duty to remove them with the 
curette or, in the case of fungosities, to destroy them 
with the continuous current. The coarse wire fara- 
dism, however, is comparatively well known, so I A. LAPTHORN SMITH. 
49 
need say no more about it. The advantages of the 
bi-polar method are : 
First. It is less painful than the old method be- 
cause it does not require the current to pass through 
the skin, which is much more sensitive than the 
vagina. 
Second. It is easier to apply because it dispenses 
with the need of an assistant. 
Third. It allows a much stronger current to be 
tolerated. 
Fourth. It is consequently more effective because 
the higher the intensity of the dose the more marked 
the effects. 
These bi-polar electrodes are made with one pole 
at the extremity and the other separated from it by 
an interval of an inch or so of insulating material, 
so that the current has to go through the tissues to 
get from one pole to the other. In doing so, it 
seems to set up circles of induction in the neigh- 
boring’structures, as proved by the following obser- 
vation : when the current is started with a moderate 
strength from the fine wire coil the patient, if asked 
what she feels, will say that there is a numbness of 
about the size of a walnut. As you slide the sec- 
ondary wire over the primary more and more, she 
will say that the area of numbness has increased 
to the size of an orange, and finally when the whole 
strength is on, the numbness will have invaded the 
whole pelvis, including the area of pain. This can 
only be accounted for, I think, by the fact that in- 
duced currents are set up in the successive layers of 50 
ELECTRICITY IN GYNECOLOGY. 
tissue, which in a way take the place of contiguous 
wires on the telegraph poles. These bi-polar appli- 
cators are made of several sizes; two or three for 
the uterus, varying from the diameter of the uterine 
probe to that of the ordinary sound; and as in cer- 
tain cases, such as pregnancy, it may not be desira- 
ble to introduce anything into the uterus, there are 
several sizes made for the vagina. But one uterine 
and one vaginal electrode are practically all that are 
required. As a rule, the preference should be given 
to the intra-uterine applications because they are 
much more effective than the vaginal ones. 
We now turn to a short description of the quali- 
ties, indications, and methods of application of the 
comparatively new, and in its effects almost magi- 
cal, current from the fine wire. I have already said 
that it causes very little muscular contraction, but 
that it has the power of affecting the nervous system. 
The element of pain plays an important part in the 
diseases of women and very often exists where no 
organic lesion can be found. More especially is 
this the case with ovarian pain, a great many cases 
of which I have completely cured with less than a 
dozen applications of the fine wire faradism. How 
it does this I am unable to say. Apostoli thinks 
that it sets up vibrations in the nerves, travelling in 
an opposite direction to the ordinary or painful 
impulses. Perhaps the current of tension filling the 
nerve-fibres dams back the painful impulses, or 
perhaps the vibrations are so rapid that the con- A. LAPTHORN SMITH. 
51 
ducting power of the nerves is temporarily lost; but 
I think that Apostoli’s explanation is the best. 
There are three kinds of cases in which I have 
found the fine wire bi-polar faradization remarkably 
beneficial. They are : 
First. Ovarian pain where no organic disease 
could be found. I do not pretend for a moment 
that it would be of any use in even small ovarian 
cysts—the sooner they are removed by operation the 
better. When I see these on our society table I feel 
no regret that they have been removed ; but when 
surgeons remove healthy ovaries on account of pain 
only, I feel sorry that they were not aware how 
easily that pain could have been relieved by fine 
wire faradism. The first sitting should last ten, 
twenty or even thirty minutes, if it is that long 
before the patient can say that her pain has gone; 
it is then well to tell her that she may expect the 
pain to return after a few hours, but that each day 
it will stay away longer and longer, until after a 
variable number of sittings, rarely more than ten, 
the pain will remain away altogether. 
Second. In cases of abdominal pain due to hys- 
teria it acts promptly, not only in rendering the 
abdomen insensitive to pressure' but also in calming 
the general nervous crisis within a few minutes. 
This was one of the observations which struck me 
most at Apostoli’s clinic, that women who could 
scarcely bear to be touched with a feather on the 
abdomen, could, after five or ten minutes of fine 
wire faradism in the uterus or even in the vagina, 52 
ELECTRICITY IN GYNECOLOGY. 
endure any amount of kntading and punching 
without the slightest discomfort. In fact, parts 
which before were hyperaesthetic had now become 
anaesthetic. This has caused the charge against 
Apostoli of curing such cases by means of hypno- 
tism, but I feel sure that this is not the case, be- 
cause he does not possess that strange power, and 
besides many of the patients were totally ignorant 
of the nature of the treatment and its effects. This 
tolerance of hysterical patients for the full strength 
of the current of tension has often made me think 
that my apparatus was not working, until I attempted 
to test it on my own hand, when I found it unen- 
durable with one-fourth of the intensity which the 
patient could easily bear. On trying the same 
strength on well women you will also find that they 
cannot stand a quarter of the dose that an hysterical 
woman can. 
As I have already said, the current must be in- 
creased gradually in all cases, but very gradually 
when the pain is of an inflammatory nature. In 
bringing an application to an end, it is necessary to 
turn the current off before withdrawing the electrode, 
for the simple reason that the passage of the current 
over the much more sensitive vulva would cause the 
patient to shriek, although she could bear the same 
amount of current in the uterus or vagina without 
feeling it, 
Third. There are many women about the age of 
thirty who, though fleshy and apparently well sup- 
plied with blood, do not menstruate at all, or but A. LAPTHORN SMITH. 
53 
slightly. These women feel uncomfortable; their 
embonpoint makes them weak and they have many 
nervous symptoms which place them in the category 
of hypochondriacs. Anything that will bring on a 
full return of the menstrual flow gives them immense 
relief. I know of nothing that will attain this ob- 
ject more surely than three applications a week of 
the current of tension to the inside of the uterus, 
between the periods. Not only will the flow be re- 
established, but the uterus, which before measured 
less than normal, will soon develop to its full size. 
I am aware that there are other means of doing the 
same thing, but none of them is so satisfactory as 
this. 
Fourth. In vaginismus I have found it remarkably 
effective. The condition is due to hypersesthesia of 
the nerve terminals about the entrance of the vagina, 
and is really a form of hysteria. In most cases the 
other symptoms of hysteria, as abdominal tender- 
ness, etc., are present. In such a case the treat- 
ment may begin with one or two vaginal applica- 
tions, after which it will be easy to introduce the 
finger and to use the intra-uterine electrode. In 
some cases the hypersesthesia may be concentrated 
upon or limited to a small area as large as a ten- 
cent piece. The removal of the over-sensitive 
nerves has been recommended by Hilton for this 
often very intractable condition. Apostoli has d e- 
vised an electrode for such cases in which the tw o 
poles terminate in two hemispheres of carbon placed 
side by side and separated by a thin layer of gutta 54 
ELECTRICITY IN GYNECOLOGY. 
percha. When this is placed on the hyperaesthetic 
spot the fine wire current is forced to pass through 
the tissues in order to get from one pole to the 
other. With this instrument the current can be 
localized on two or three over-sensitive papillae. 
In the worst case of vaginismus I have had in twelve 
years the patient was cured by three applications 
and became pregnant at the next ovulation. 
Besides these four indications Apostoli has advo- 
cated a fifth, with which I have had no experience, 
viz.: in pelvic pain due to inflammatory condi- 
tions of the uterus or its appendages. I have feared 
so to use it because of its well-known stimulating 
effects, although it is true that iodine acts in the 
same way in similar conditions. Those who wish 
to try it will do well to remember Apostoli’s warn- 
ing not to push the strength of the application be- 
yond the point which can be easily borne, while, on 
the other hand, in pelvic pain of non-inflammatory 
or hysterical nature it is sometimes an advantage to 
push the current rapidly until its full strength is 
turned on. 
There are also some troublesome conditions of the 
bladder in which I have used bi-polar faradism with 
advantage, but which I have not the space to de- 
scribe. 
Before closing, I wish to disclaim any intention of 
considering bi-polar faradism as the only remedy in 
gynecology. Many of the conditions which we are 
called upon to treat are the natural outcome of wil- 
ful or ignorant disobedience of the laws of health, A.LAPTHORN SMITH. 
55 
and bi-polar faradism will not allow women to break 
them with impunity. Neither should we forget that 
the genital organs are not the only organs woman 
has, so that while we are calming her pain with 
electricity we should at the same time be removing 
the unhealthy conditions of the body generally, on 
which often the local disorder depends. All that I 
do claim for it is that it is a valuable addition to our 
therapeutic resources, especially in those diseases of 
women in which other methods of treatment often 
fail. REMARKS ON ELECTRICITY IN GYNECOLOGY 
AND A NEW PORTABLE GALVANIC BATTERY. 
By FRANKLIN H. MARTIN, M'.fC 
OF CHICAGO. 
Apostoli’s method, which was promulgated less 
than three years ago, first astonished, then excited 
the admiration of the entire medical world. Aston- 
ishment was expressed at a method which recom- 
mended such extraordinary means, and which 
claimed such brilliant results. Admiration was 
excited by the brilliancy of the author’s conception 
and the thoroughly scientific grounds upon which 
it was based. 
The instruments of precision introduced and 
made necessary by Apostoli’s method have enabled 
us not only to prove or verify the value of his work 
and to substantiate his startling assertions, but to go 
on applying the sound principles he has evolved to 
the relief of many pathological conditions peculiar 
to the female pelvis. 
One of the most important points to settle after 
the introduction of the high dosage system of treat- 
ment was the question of generation of current. 
We were aware that the ordinary batteries in use 58 
ELECTRICITY IN GYNECOLOGY. 
would give a maximum current strength through the 
body, from hand to hand, of but from eight to ten 
milliamperes. Certainly, then (forgetting in prac- 
tice what we only know in theory), we could not 
expect to get 300 milliamperes with the same 
instruments. We soon found, however, from prac- 
tical experience, that we were mistaken and that 
the battery which gave a current of but eight or ten 
milliamperes through the enormous resistance of the 
body from hand to hand, would give a marvellously 
strong one through the comparatively small resist- 
ance offered by the abdominal walls and pelvic 
tissue, with properly constructed electrodes. We 
now know that the resistance offered by these parts 
with the clay, or some form of substitute for the clay 
electrode, is less than 200 ohms instead of 2000, 
as was originally supposed. 
Any battery may be used which will give a maxi- 
mum electro-motive force of fifty volts, with but 
small internal resistance, which is without vibration, 
undulation, or interruption, which can be perfectly 
controlled by the operator, and which can be gradu- 
ally increased from zero to its maximum strength, 
and the reverse, without interruption. This includes 
the ordinary open circuit battery cells employed for 
office purposes, ranging in number from thirty-six 
to fifty—according to their electro-motive force. 
The Leclanche, the Law, and the Diamond Car- 
bon are usually preferred. For all work, except 
when puncture is required with small exposure of 
needle surface (thereby increasing the resistance) or FRANKLIN H MARTIN. 
59 
when extraordinary strength of current is required, 
the ordinary twenty-four to thirty cell zinc and car- 
bon chromate of potash batteries, such as are manu- 
factured by the Galvano-Faradic Battery Co., the 
Flemming, or the McIntosh Battery Co., are suffi- 
cient. My battery is the outcome of a series of ex- 
periments made with the end in view of bringing 
forth a small portable battery which would possess 
none of the objectionable features of the ordinary 
form and which would do the same amount of work 
as that required of the office stationary battery. 
The cell is a form of the chloride of silver cell, 
of sufficient power to give an electro-motive force 
of one volt, and an amperage of T ampere. So 
that a battery of fifty cells will do the same 
amount of work as thirty-six to forty Leclanche 
cells. A battery of thirty-five of these cells 
has done all of my outside work for a period of 
eight months, without change or renewal, and 
possesses greater working power to-day, because of 
decrease of its own internal resistance, than when 
I began. From experiments made with the battery 
it is estimated that it will run with ordinary use 
without recharging or without perceptible deteriora- 
tion in strength from one and a half to two years. 
As the battery is free from action when not working, 
it will remain in active condition a length of time 
in direct proportion to the amount of work required 
of it. There are two sizes of this battery manufac- 
tured by the McIntosh Battery Co., of Chicago, one 
of thirty-five cells and one of fifty cells. The fifty 60 
ELECTRICITY IN GYNECOLOGY. 
cell battery will generate a current of 300 milliam- 
peres with the Apostoli electrodes or any of the 
approved modifications. 
Next to the treatment of fibroid tumors of the 
uterus by galvanism, I have found the greatest satis- 
faction in treating inflammatory exudation in the 
pelvis. This includes all cases, from the simple 
thickening of one or both broad ligaments to com- 
plete fixation of all the organs of the pelvis, with a 
thick unyielding exudate matting everything to- 
gether. All acute inflammation, except secondary 
points arising from the irritation of already hardened 
exudate, should have disappeared in these cases 
before treatment is instituted. 
I speak advisedly, after a long experience with a 
large number of such cases, when I say that I do not 
believe that there is a case of the kind described 
which, if submitted to a persistent course of appli- 
cations of strong doses of galvanism in the proper 
manner, cannot be cured. The exudate will grad- 
ually but perceptibly disappear, the pain from pres- 
sure upon nerve fibres and nerve points will rapidly 
diminish, sympathetic disturbances will be relieved, 
displacements caused by contracting bands will 
gradually give way, and the general mobility of the 
pelvic organs will return, while coincidently the 
general health is restored from the effect of the elec- 
tricity on the general system. 
The best results are obtained in these cases from 
comparatively strong doses of from 75 to 125 milli- 
amperes. The object must be, in applying the FRANKLIN H. MARTIN. 
61 
electrodes, to include between them, as far as pos- 
sible, the area of greatest disease. This, occasionally, 
will admit the use of an intra-uterine electrode as 
the internal point of departure. When an intra- 
uterine electrode is employed, one of as large surface 
as practicable should be selected, to avoid undue con- 
centration and cauterization, which would give rise 
to subsequent cicatricial contraction. In the ma- 
jority of these cases, however, an intra-uterine elec- 
trode is not admissible because of the position of 
the exudate. In such cases it is necessary to employ 
a vaginal electrode so constructed that a thorough 
diffusion of the current is obtained, in order not to 
cauterize the mucous membrane of the vagina. For 
that purpose I employ an electrode composed of 
a slightly curved, insulated staff terminating in an 
exposed metal ball which is thickly covered with 
absorbent cotton moistened with water. By this 
simple instrument I can select any particular portion 
of the vagina required, with a soft yielding contact 
surface and thorough diffusion. The cotton is ap- 
plied to the instrument by folding a thick piece over 
the metal bulb, and fastening it around the staff at 
its point of attachment with the metal by means of 
a small rubber band. 
This instrument can be inserted with or without a 
speculum—more easily without, with the patient upon 
her back and the hips drawn near the edge of the 
bed or table. If a speculum is used, it should, of 
course, be withdrawn before the treatment is com- 
menced. When the internal electrode is in place, 62 
ELECTRICITY IN GYNECOLOGY. 
it should be attached to the negative pole of the 
battery. Having previously adjusted the external 
abdominal electrode and attached it to the positive 
pole, the current should be gradually turned on, em- 
ploying every precaution to prevent the slightest 
break or shock, until a strength of from 75 to 125 
milliamperes has been reached, the maximum strength 
tolerated varying between these figures with the 
varying sensibility of patients. The sitting should 
last from five to eight minutes, when the current 
should be gradually reduced to zero and the instru- 
ment removed. The treatment should be given 
every second day. The staff of the electrode is 
easily unloaded of its cotton by means of the 
dressing forceps, thus making it possible to observe 
perfect cleanliness. Cleansing the staff thoroughly, 
and the use of a fresh covering and fastening each 
time, of course, being imperative. 
This treatment persistently carried out will ac- 
complish exactly what I claim for it. It will not 
only absorb the slight exudations which merely pro- 
duce thickening of the vaginal vault, but it will 
cause the rapid disappearance of large, well-defined 
masses situated in the broad ligaments or in Douglas’s 
cul-de-sac. It will cause ovaries, large and tender 
from the irritation of inflammatory products, to 
assume their normal condition by removing the 
cause of the trouble. It will cause the disappear- 
ance of strong bands of adhesion, no matter where 
situated. 
It has long been known that mild currents, per- FRANKLIN H. MARTIN. 
63 
sisted in for a long time, would slowly cause disap- 
pearance of superficial exudates, but it hardly held 
its own with the old treatment of iodine applications 
and the glycerin plug, owing to the time and cum- 
bersome apparatus required. But a cumbersome 
apparatus alone is no longer a sufficient excuse to 
justify us in ignoring the rapid and complete results 
obtained with strong doses, and the other advantages 
offered by Apostoli’s instruments of precision. 
I am aware that many assertions of a fact do not 
carry the weight of a recitation of a series of well- 
authenticated cases possessing evidences of con- 
scientious reporting and of independent verifica- 
tion. I can only say in self-defence, that I have a 
series of just such cases in preparation for publica- 
tion, in which the diagnosis and, afterward, the 
results were verified in almost every instance by 
eminent gynecologists. 
My experience in the treatment of fibroid growths 
of the uterus by electricity amounts, in round num- 
bers, to two hundred cases. In that number of cases, 
not more than five failed to continue the treatment 
until results could be estimated. Of those who con- 
tinued treatment and made a fair test of its value, 
up to the present time but three have failed to obtain 
relief. One of these was a large, soft, spongy, 
rapidly growing subperitoneal growth, with a sus- 
picion of malignancy, in a patient who was so sensi- 
tive to the treatment as to be unable to receive a 
satisfactory dose. The second was a marked hgem- 
orrhagic case of a submucous variety, composed 64 
ELECTRICITY IN GYNECOLOGY. 
of many centres of development, which repeatedly 
dischaiged itself in small masses from the uterine 
canal, until finally the patient became discouraged 
and ceased treatment. The third case which I 
have been unable to influence favorably is one of a 
large, regular subperitoneal variety, which I have 
persistently labored with by means of the vaginal 
galvano-puncture with remarkably strong doses. I 
am unable to account for the stubbornness exhibited 
in this latter case, and shall recommend surgical in- 
terference. 
I am fortunate, considering the great number and 
variety of cases treated, to be able to record no 
deaths; my results, on" the whole, have been ex- 
ceedingly gratifying. About eighty-four per cent, 
are symptomatically cured, with an additional per 
cent, of actual cures. About fifteen cases are still 
under treatment. 
My methods, except in unimportant minor details, 
are in direct imitation of my friend and master, 
Apostoli. 
There were two varieties of cases that gave me a 
great deal of perplexity in my earlier work, because 
I could not find their counterpart in Apostoli’s pub- 
lications. The first was a large interstitial variety 
of fibroid with a marked haemorrhagic tendency, in 
which the patient would not tolerate a strong dose. 
In these cases the uterine canal is of great depth, 
and the haemorrhagic surface of necessity very ex- 
tensive. In order to check haemorrhage in such a 
case, a strong dose is imperative, unless some means FRANKLIN H. MARTIN. 
65 
of concentration is employed. Of course, if the 
ordinary platinum sound electrode is employed, of 
sufficient diameter and length to cover the whole 
internal surface of the uterine canal, a current of 
enormous strength must be employed to get sufficient 
concentration at any given point to cause coagula- 
tion and change of tissue, so as to check haemorrhage 
In other words, a certain intensity is required, and 
the intensity is in direct proportion to the strength 
of the current and in inverse proportion to the area 
of the electrode. As it was impracticable to employ 
a dose of more than from ioo to 200 milliamperes in 
many cases, on account of peculiar sensitiveness, I 
devised a means of internal concentration, or of 
limiting the area of the electrode. 
A series of experiments, which I have already 
mentioned in an article read three years ago at the 
International Congress, proved that a current of 
twenty-five milliamperes was necessary on an aver- 
age for each square centimetre of internal surface, 
exclusive of the positive platinum electrode, in 
order to accomplish coagulation sufficient to check 
haemorrhage. Upon that basis I constructed elec- 
trodes with a surface of four square centimetres, by 
means of which definite results were assured, and 
with which it was unnecessary to employ more than 
100 milliamperes current, different portions of the 
canal being treated in turn, at successive applica- 
tions, until in time all have been covered. These 
electrodes are easily cleansed by means of a nail- 
brush and are constructed so that they will not be 66 
ELECTRICITY IN GYNECOLOGY. 
injured by strong antiseptics. Their flexibility 
alone is a great recommendation. 
The other class of cases fortunately comprises but 
a small per cent, of all. They are distinguished 
by great sensitiveness and profuse haemorrhage at 
the menstrual period. They tolerate but a small 
current and are even severely prostrated by the 
small dose they are able to bear. These cases, of 
course, cannot be expected to improve unless 
they are enabled to take a decided dose, and the 
nervous prostration is so severe when such a dose 
is forced upon them that it renders the treatment 
intolerable. A marked hysterical element is often 
present in these cases. The subsequent prostration 
is produced no doubt by strong reflex disturbances. 
I have found that they are readily improved if 
means are adopted by which powerful doses can be 
administered at not too frequent intervals, and at 
the patient’s room where she need not be disturbed 
for six hours following treatment. I, therefore, get 
the dimensions of the uterine canal, and an electrode 
is constructed to fit it. I estimate its surface area 
in square centimetres, and estimate the strength of 
the current at twenty-five milliamperes per centi- 
metre that will be required at each sitting. I then 
order the patient to repair to her bed one hour be- 
fore treatment, and to take a full dose of morphine 
and atropine. If I find, upon turning on the current, 
the patient will not tolerate the dose required, I ask 
an assistant to saturate a handkerchief with chloro- 
form and give the patient just sufficient to enable FRANKLIN H. MARTIN. 
67 
me to attain my object. When that has been 
reached, the chloroform can be withdrawn, the pa- 
tient usually being able to stand the electricity after 
it has once reached its maximum strength. The 
current is then allowed to operate for ten minutes 
at the full strength required, when it is gradually 
withdrawn, and the patient instructed to remain 
quiet for at least six hours. 
If it is not deemed prudent to give the opiate, 
chloroform alone, of course, can be employed; but 
I employ the opiate because, as a rule, the patient 
requires nothing more. 
By this method I have repeatedly given doses 
varying in strength from 200 to 400 milliamperes, 
and prostration seldom follows. The dose is re- 
peated in from six to ten days. THE TREATMENT OF CHRONIC METRITIS WITH 
GALVANO-CHEMICAL CAUTERIZAT10N. 
By G. BETTON MASSEY, M.D., 
OF PHILADELPHIA. 
In regard to this new electrical treatment of the 
diseases of women, I am of the opinion that a for- 
ward movement of vast importance has been 
initiated. So positive and striking is this progress 
that a degeneration into a fad is to be feared; but 
the fear of this should not blind us to important 
facts. During the last few years electrical science 
has itself been revolutionized, and it would be 
strange indeed if our better knowledge of it did not 
lead to the better application of this force to the 
medical arts. 
Most authors have referred but little to one class 
of conditions in which I regard the galvanic cur- 
rent as possessed of an unique value. I allude to 
chronic inflammation of the uterus or of the endo- 
metrium. Theoretically, nothing could be better. 
In a convenient, clean, and controllable form we 
have an agent that will act as an alterative to the 
diseased membrane, and at the same time reduce 
interstitial hypertrophy by promoting both absorp- 70 
ELECTRICITY IN GYNECOLOGY. 
tion and contraction. What other remedy promises 
as much ? 
In practice I have found that facts coincide very 
closely with this theory. I will give several brief 
illustrations: 
A young married woman had been ill two and a 
half years, dating from a miscarriage. The symp- 
toms were those of a chronic metritis with copious 
leucorrhoea from a capacious cavity three inches in 
depth. Fifty milliamperes negative were applied 
intra-uterine for three minutes. Three days later 
she was better than for many months. After a 
second application the cavity decreased to the 
normal depth, and after a third she was completely 
cured. 
Another case was that of a lady, aged thirty-one, 
who had been suffering from leucorrhoea and pain 
since a miscarriage, two years before. Examina- 
tion showed a slightly lacerated os and a hypertro- 
phied uterus pouring forth an abundant purulent 
discharge from a three-inch cavity. Two intra- 
uterine negative and one positive cauterization 
were given with a current of fifty milliamperes, re- 
sulting in a prompt and complete cure. 
Another case presented symptoms of both chronic 
metritis and parametritis. This woman was seen at 
the Howard Hospital Clinic in September last, with 
the ordinary symptoms of chronic metritis dating 
back three years to a miscarriage. The uterus was 
enlarged and indurated with a three and a half inch 
cavity and a peculiar, hypertrophy of the anterior G. BETTON MASSEY. 
71 
lip. There were also decided fixation and tender- 
ness on the right. She was given four intra-uterine 
cauterizations varying in strength from fifteen to 
forty milliamperes. The result was a reduction of 
the cavity to two and a half inches plus, and the 
complete disappearance of a host of annoying symp- 
toms. 
In simple endometritis or uterine catarrh, galvanic 
currents locally applied are practically infallible. 
I have never seen a case resist them. The current 
strength need not exceed ten to thirty-five milliam- 
peres, using the bare intra-uterine electrode and an 
external indifferent pole of proper size. The choice 
of pole is governed by the presence or absence of 
menorrhagia, the positive pole being always used 
with this complication. When the endometritis is 
associated with slight cervical lacerations, it will 
usually be found unnecessary to perform the opera- 
tion for repair, as all symptoms disappear under this 
treatment, leaving the patient practically well, even 
though a slight irregularity in the cervix remains. REMARKS UPON THE USE OF ELECTRICITY IN 
THE TREATMENT OF FIBROID TUMORS OF 
THE UTERUS. / 
By ALEXANDER J. C. SKENE, M.D., 
OF BROOKLYN, NEW YORK. 
In estimating the value of electricity in the treat- 
ment of fibromata I have, of necessity, been guided 
by the opinions of others more than by my own 
observations. Owing to the extremely conflicting 
testimony of those who have expressed themselves, 
it has been very difficult to get at anything definite. 
One class of men has condemned this treatment 
without mercy. Another class has obtained the 
most perfect results—all that could be desired, in 
fact—and still another class has had an interme- 
diate experience. They have been able to relieve 
their patients of most or all of their symptoms, and 
have diminished the size of the tumors or retarded 
their growth. 
I have accepted the testimony of this latter class 
of witnesses because it apparently contained the 
most truth, and also because it agreed with what 
little experience I have had in my own practice. 
More than that, I have observed that those who 74 
ELECTRICITY IN GYNECOLOGY. 
avoid the extremes of praise and condemnation are 
gaining in numbers. 
Time will not permit a full review of the argu- 
ments employed by those who are opposed to this 
treatment of fibromata, but it may be said that the 
strongest opponents are those who know least about 
electro-physics and the therapeutic use of electricity. 
They h.'ve not thoroughly tried it in practice, but 
have theorized about it and insisted that from the 
nature of electricity it could not affect neoplasms, 
forgetting that, in this, electricity is like many other 
therapeutic agents which produce most valuable 
effects, while we do not know how such effects are 
produced. 
It has also been claimed that this agent is danger- 
ous, but that has been fully met by the fact that all 
the benefit can be obtained without taking the risks 
that were at one time supposed to be unavoidable. 
Scoffing and ridicule have been indulged in by a 
few, but they are signs of weakness in those who in- 
dulge in such methods of wrestling with questions in 
science, and may be passed without notice. 
Perhaps the most important question in the whole 
discussion is the relative merits of this and other 
methods of treatment. The claims of hysterectomy 
and the removal of the ovaries for fibromata have 
been urged with great vigor by those who are 
strongly addicted to surgery. There is, however, 
no evidence that this kind of surgery is safer or 
surer in its results than electricity. 
By a curious misuse of facts, it has been made to ALEXANDER J. C. SKENE. 
75 
appear that surgical treatment has advantages which 
it does not possess. Many cases are reported cured 
when they are simply relieved from the immediate 
effects of the fibroma and when, in fact, they are in 
worse health than before the operation. 
I have tried to get records to show that more 
cases have died from removal of the uterus and 
ovaries for the cure of fibromata than have died from 
fibromata without treatment of any kind. If such 
are the facts—and I believe that the records of New 
York and Brooklyn would show them to be—surely 
surgery does not compare favorably with electro- 
therapeutics. 
Add to this the cases that suffer ill-health after 
losing the ovaries and uterus, and the records of sur- 
gical treatment are not very largely in the interest 
of patients, though they may be in the interest of 
surgeons. 
Certainly, the claims of electro-therapeutics are 
too well sustained to be put aside by any adverse 
arguments which have been advanced. In fact, the 
record of the treatment of uterine fibromata by 
electricity is remarkably good considering the short 
time that it has been properly used, and this leads to 
the hope that when it is better understood and more 
wisely employed it will gain more confidence. 
Up to the present time it has, in its immature state, 
been competing with surgery, which has had the 
advantages of being perfected by long experience. 
Great progress has been made within a short time. 
In a recent discussion in the Academy of Medicine 76 
ELECTRICITY IN GYNECOLOGY. 
of Paris it was shown that strong currents are not 
necessary; neither is it necessary to puncture the 
tumor in order to get good results. This enables 
us to avoid all dangers, hence is a great improve- 
ment in the art. 
The science of electro-therapeutics has also been 
advanced greatly by the discovery of the action of 
the electric current upon tissue, as demonstrated by 
Dr. Buckmaster and confirmed by Dr. Van Cott, a 
demonstration which ought to silence all who have 
argued that such effects were impossible. DISCUSSION 
ON THE USE OF ELECTRICITY IN GYNECOLOGY. 
In the discussion which followed the reading of these 
papers: 
Dr. P. F. Munde, of New York, said that for a 
number of years he had been much interested in this 
subject of electrical treatment, and believed he had had 
ample opportunity to become acquainted with its practi- 
cal working. He could speak most decidedly in favor 
of electricity as a therapeutical agent in gynecology, and 
had published his views on this subject in an elaborate 
article several years ago. He had seen more benefit 
derived from galvanism than faradism in gynecological 
practice. He had also found that mild currents used 
for a long time are, as a rule, more efficacious than 
strong currents employed for a short time. He used a 
Leclanche forty-cell battery. For ordinary purposes he 
used a small meter registering only twenty milliamperes. 
He had another which registered 500 milliamperes. This 
he had used a few days ago in treating a fibroid, and 
had found it faulty and untrustworthy. 
With galvanism, placing the positive electrode next to 
the sensitive part in the pelvis, or on the abdominal 
wall, he had obtained excellent results in relieving the 
pain of chronic pelvic peritonitis. In old cases of in- 
flammation with adhesions, with more or less pain in 
the ovaries and tubes, he had found that the tri-weekly 
administration of electricity, with the positive current 78 
ELECTRICITY IN GYNECOLOGY. 
internally, was a decided benefit after a few months of 
treatment. On the other hand, a number of patients, 
after several months of such treatment, had received no 
appreciable benefit whatever, and laparotomy had to be 
performed. This showed that electrical treatment was 
not suited to these particular cases. However, he 
deemed it proper in all circumstances to give patients 
every opportunity for possible benefit from electricity 
before subjecting them to a radical operation which, by 
whoever performed, could never be without an element 
of danger. 
In obscure pelvic pain, due to an inflammatory deposit 
unrecognizable by digital examination, extending down 
the sciatic or crural nerves, he had seen instant relief 
follow the use of electricity after other treatment had 
failed. While he relied on electricity, and had found it 
of great benefit, especially in relieving pain, he thought 
it might be carried too far. He considered the length 
of time necessary to achieve satisfactory results was a 
great drawback to the use of electricity. If it was clear, 
however, that some good was being done, the time was, 
of course, not lost. 
As to the milliamperemeter, though he had two, he 
was by no means satisfied that it was at all necessary, 
and was inclined to look upon it as a sort of plaything. 
When using galvanism for the relief of pain, the sensa- 
tions of the patient, he thought, were a sufficient guide 
as to the strength of current to be employed; but when 
using the current in anaesthetized patients or for galvano- 
puncture, it was necessary to know exactly the strength. 
The faradic current he had found very useful in 
amenorrhcea, intra-uterine faradization being employed 
three times a week for this purpose. He had used 
electricity but once in extra-uterine pregnancy, the in- 
terrupted galvanic current being the one employed. He DISCUSSION. 
79 
had cured the patient, after nearly killing her by the 
shock. In pyosalpinx and pelvic abscess, laparotomy 
and drainage were certainly to be preferred to galvano- 
puncture. As to uterine fibroids, he had very decided 
views. He considered that the value of operative treat- 
ment in this class of cases was over-estimated. Out of 
123 cases coming under his observation, about 50 per 
cent, had required no treatment whatever. 62 had re- 
quired treatment, but only 8 of this number, in his 
opinion, had required Apostoli’s method, and 4 others 
called for galvano-puncture. Apostoli’s plan of treat 
ment covered only the intra-uterine use of galvanism, 
with the clay electrode on the abdomen, the galvano- 
puncture being not strictly his method. 
He had used the Apostoli treatment eight times in 
three years, and he could honestly say that while he 
believed it efficient for the removal of pain and the 
checking of haemorrhage, and admitted that the patients 
felt better for its use, not a single tumor which had come 
under his notice had been much reduced in size. By 
galvano-puncture he meant puncture through the va- 
gina, and this, in his opinion, was the ideal treatment 
for the cure of uterine fibro-myoma. The four cases in 
which he had employed it had been absolutely cured— 
that is, the tumors disappeared entirely, not a vestige 
being left. In one of the cases a single puncture gave 
rise to sloughing, and this sloughing itself destroyed the 
growth; in the others the cure was directly due to the 
effects of the electrical treatment. He was, therefore, a 
decided believer in galvano-puncture. At the same 
time, he believed it had its risks, and he thought it should 
never be employed at a physician’s office. 
Dr. Franklin H. Martin, of Chicago, exhibited a 
portable battery, and made some remarks upon the use 80 
ELECTRICITY IN GYNECOLOGY. 
of electricity in the treatment of certain pelvic diseases 
of the female (page 57). 
Dr. G. Betton Massey, of Philadelphia, then said 
that Dr. Goelet’s canula might itself answer as an elec- 
trode, which would have the special advantage of allow- 
ing the gas to escape through it. In speaking of the 
treatment of pelvic cellulitis, he said that in one case he 
had been using simple vaginal applications of the 
strength of seventy-five milliamperes with very good 
results. In the use of electricity in gynecological prac- 
tice he thought too much attention was paid to antiseptic 
washes. These were not necessary, he thought, if per- 
fectly clean and aseptic electrodes were employed. Dr. 
Massey agreed with Dr. Lapthorn Smith in his explana- 
tion of the action of bi-polar faradization, but said he 
could not agree with him as to the use of the coarse 
wire as contrasted with that of the fine. 
He could not agree with Dr. Munde in his opinion ot 
the milliamperemeter. He considered it of importance if 
more than five or six cells were employed. As to the sen- 
sations of the patient furnishing a guide for the strength of 
the current, he had seen as active a sensation caused by 
fifteen milliamperes with the negative pole in the uterus, 
as resulted from 350 milliamperes in other cases. In 
regard to the use of electricity in pyosalpinx, he had 
met with one instance in which the treatment for endo- 
metritis excited a flow of pus. He had reported the case 
to the Obstetrical Society of Philadelphia, and the pa- 
tient had since then been quite well. The passing ot 
the electrode in the direction of the left cornua of the 
uterus seemed to have been efficient in causing the 
result named. 
Dr. Buckmaster read some remarks, prepared by 
Dr. A. J. C. Skene, of Brooklyn, who was prevented 
from being present (page 39). DISCUSS ION. 
81 
Dr. H. J. Boldt, of New York, after speaking of the 
theory of the bi-polar action of the current on the tissues, 
ent on to say that those gentlemen who absolutely denied 
any value to electricity were those who had never given it 
an honest trial. They had no right to operate on any 
patient until electricity had been given a thorough test. 
That it would not, however, in every instance even alle- 
viate the symptoms he thought was perfectly true. As to 
pyosalpinx, he thought that these cases were cured when 
the tubes were cut out, and not otherwise. When the 
tubes were distended and the uterine extremities were 
closed, or when the tubes were agglutinated, what could 
be expected from electricity ? All that could be done 
then was to remove the tubes by laparotomy. But as 
long as the calibre of the tubes remained patent, it was 
well to try everything. Many mistakes, he said, were 
made in diagnosis, and he thought it was not advisable 
to be too enthusiastic. 
Dr. Goelet in closing the discussion, said he 
had cured at least thirteen cases by galvano-puncture, 
which otherwise could not have been relieved except by 
laparotomy—that is to say, the patients would otherwise 
have been mutilated; and he thought it was only right 
to try to cure these patients before mutilating them. By 
emptying the tubes and the use of the current subse- 
quently, the tubes might be rendered patent. He thought 
that the pus could be first emptied, and then the removal 
of the cause of the accumulation of the pus effected. 
The resolution of the proximal end of the tube could be 
produced by galvanism of the endometrium, and he was 
very glad to hear that in this particular his experience 
had been confirmed by Dr. Massey in the case related. 
He did not think that we ought to say that the removal 
of the tubes was a cure of pyosalpinx. It was a mutila- 
tion, and not a cure, and in many cases, indeed, the 82 
ELECTRICITY IN GYNECOLOGY. 
patient’s condition was more embarrassing after the 
operation than before. 
He thought that many of the failures with electricity 
which Dr. Munde said he had met with were to be at- 
tributed to the fact of his having used his currents too 
weak. Then, again, he thought that Dr. Munde had 
made a mistake in regarding the milliamperemeter as a 
plaything. Many women would bear intense pain and 
say nothing about it, and electricity might be thus ad- 
ministered in dangerous doses. It was also impossible 
to estimate the particular resistance of the tissues in 
every case; and, for these reasons, the meter was always 
an important auxiliary. 
The Ch ai rman asked Dr. Goelet whether his experience 
of intra-uterine galvanism had demonstrated to him the 
fact that an occluded tube had become patulous again, 
and was performing its function in a normal manner. 
He said that, of course, the fact of fecundation occurring 
did not imply that both tubes were functionating. 
In reply, Dr. Goelet said that he could only assume 
that complete recovery had ensued from the fact that all 
symptoms were completely removed, that menstruation 
became normal, and that there had been no reaccumu- 
lation in the affected tube. WAITE & BARTLETT MFC. CO. 
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