The Curability of Urethral 
Stricture by Electricity. 
An Investigation. 
BY 
E. L. KEYES, M. D. 
REPBINTBD PROM 
STfje Neto Yotfe JHcUical 
for October 6, 1888. Reprinted from the New York Medical Journal 
for October d, 1888. 
THE CURABILITY OF URETHRAL STRICTURE 
BY ELECTRICITY. 
AN INVESTIGATION.* 
E. L. KEYES, M.D. 
A wide-spread belief exists in the community, lay as 
well as medical, that material progress has been made of 
late years in the use of electricity as applied to the cure of 
urethral stricture. This belief includes the three presump- 
tions: (1) That any one, by following rules, may use the 
method successfully; (2) that electricity does no harm to 
the urethra; (3) that stricture cured by electricity is dis- 
sipated by absorption, and the urethra remains permanently 
open. 
In the autumn of 1887 a gentleman with stricture came 
to me from South America for treatment by electricity. 
His surgeons at home had failed to cure him by dilatation; 
he declined cutting there, and came to New York, where, 
he had learned at home, strictures are permanently cured 
by electricity. Not having commenced my experiments at 
that date, and not wishing to trifle with a private patient, 
I declined to accept his case, and he sought other advice. 
Shortly afterward a physician of New York in excellent 
standing wrote that he had a relative whom he wished to 
* Read before the American Association of Genito-urinary Surgeons 
at its second annual meeting. 2 
THE CURABILITY OF 
place in my hands for urethral treatment by means of elec- 
trolysis. I also declined to receive this case. Subsequently 
another gentleman, under my care for a neurotic condition 
of the urethra, left me with my consent, and was treated by 
his family physician electrolytically for an alleged stricture, 
which the physician promised to cure, assuring him that it 
was the cause of all his trouble. Not getting well under 
this physician’s care, he consulted Dr. Robert Newman as 
an authority upon urethral electrolysis, who assured him he 
had no stricture, but still proposed to remove his urethral 
symptoms by electricity. The patient returned to me un- 
relieved, declining further trial of electricity. 
In these and many other ways it has come to my knowl- 
edge that confidence in the value of electricity for the treat- 
ment of stricture has of late been rapidly growing through- 
out the land; therefore I determined to investigate the 
matter, and I turned to Dr. Robert Newman, of New York 
city, who is the apostle of this creed, and who alleges that 
he has radically cured two hundred cases (or thereabouts) 
of stricture by its use, and asked him for instruction and 
his co-operation in my investigation of the subject, which 
I assured him was honest, stating that, if my results jus- 
tified his assertions, I would advocate the method, and 
advise its use generally for the benefit of strictured man- 
kind. 
Dr. Newman kindly accepted the proposition, sent me 
his pamphlets, assured me that following his rules would 
convince me of their truth, and accepted from me a dispen- 
sary patient to treat that I might personally verify the re- 
sult attained by himself. I therefore procured from various 
dispensaries seven pronounced typical cases of urethral 
stricture; three of these I treated personally, with all the 
ability I possessed, commencing in January, 1888, follow- 
ing Dr. Newman’s rules as closely as I was able. URETHRAL STRICTURE BY ELECTRICITY. 
3 
Three patients I turned over to my assistant, Dr. E. 
Fuller, who treated them independently, fortified with ex- 
tra knowledge gained by personal observation of Dr. New- 
man’s operative method as practiced by himself (one case 
of urethral spasm was also treated by Dr. Fuller). The 
seventh case was sent to Dr. Newmau, who received the 
patient kindly, and treated him about once a week from Feb- 
ruary 6th until June 27th—nearly five months. My assist- 
ant, Dr. Fuller (once Dr. Garrison), always accompanied this 
patient on his visits to Dr. Newman, and immediately upon 
leaving him wrote down in a case-book what had happened 
during the interview. 
One other case previously treated came to me, and out 
of this material I propose to construct my report. 
Having entered the investigation without bias and in 
the hope of learning something, I make my report without 
fear of being misjudged, and from no motive except that 
of attempting to throw light upon a subject which is usu- 
ally shrouded in much mystery. 
To prepare properly for my work, I purchased the insu- 
lated urethral conductors of Newman, employed an admira- 
bly constant battery of A. Gaiffe (Paris), one having a mil- 
liamperemeter in the circuit, so that the amount of cur- 
rent used was constantly recorded under the eye of the 
operator. Dr. Fuller used the same battery upon his pa- 
tients. In order to assure myself that the milliampere- 
meter in the circuit of the Gaiffe battery was accurate, I 
procured a Barrett milliamperemeter, so as to test the for- 
eign gauge with one of the best of native make ; they were 
both joined on the same circuit, and accorded absolutely fox- 
all the lower measures of quantity, and for any combination 
of sets of cells in the battery. There was a moderate variation 
in the marking of the instruments between the points of 25 
and 50 milliamperes; but, as all my experiments were con- 4 
THE CURABILITY OF 
ducted at 5 milliamperes and below, I must conclude that 
the battery was a proper one and its action satisfactory, 
more especially as the cells were small, ten being required 
to give five milliamperes, so that gradations of smaller 
quantities of electricity became easy. 
Before detailing my cases I wish to remark that Dr. 
Newman is largely responsible in this country for the mod- 
ern electrolytic fervor as relating to urethral matters, since 
his statements of results have been the most pretentious. I 
will therefore call attention to some of Dr. Newman’s rules 
and assertions, that it may be seen how nearly my results 
correspond to his statements. 
Other literature upon the subject I shall mainly disre- 
gard, to escape needless repetition. The whole subject, 
from a literary standpoint, has very recently been discussed 
in an admirable manner by Dr. F. Tilden Brown, of New 
York.* To those interested in this branch of the subject 
I commend a perusal of Dr. Brown’s paper. He has di- 
gested the literary material and found it wanting in that con- 
cordance of fundamental sentiment (as to operative method, 
appropriate cases, and result) which might be expected from 
the advocates of a new system, if that system had a solid 
basis upon which to repose. 
Indeed, I feel I can do no better, to sum up his conclu- 
sions, than to quote from his paper where he says: “ I feel 
an apology is due for presenting before this section of the 
Academy a paper upon a theme with the status of which it 
has long been so well satisfied. If, before testing it in 
practice, I had reviewed the literature of the subject as care- 
*“An Essay read before the Surgical Section of the New York 
Academy of Medicine upon the Limitations of Electrolysis as a Thera- 
peutic Agent in Organic and Spasmodic Stricture of the Urethra, with 
Cases,” “ Journal of Cutaneous and Genito-urinary Diseases,” July, 
1888. URETHRAL STRICTURE BY ELECTRICITY. 
5 
fully as since, I should have seen that no further evidence 
was needed to assure the incredulous of its narrow scope, 
and equally well have recognized the futility of hoping 
to convince its advocates of any self-deception in the 
matter.” 
Dr. Brown gives his own personal results and condemns 
the method in so far as the alleged effect of permanently 
removing organic stricture is concerned, while he allows to 
electricity a certain effectiveness in removing spasm, an 
effect which Newman, in a letter to me, denies that it pos- 
sesses in any degree. 
In December, 1871,1 published the result of my attempt 
to cure ten patients of urethral stricture by electrolysis ap- 
plied according to the only method then existing—that of 
Mallez and Tripier. The merits of this method had been 
set forth most glowingly and with the same insistence and 
assurance of success that we now find made use of by Dr. 
Newman and those who employ his method. 
My ten cases turned out badly. Most of the patients 
bolted the hospital, being unwilling to endure the treatment, 
which was very painful; none were long under observation ; 
several remained in hospital,* but absolutely refused to 
continue the electricity, preferring “ cutting ” or other 
methods. 
The most pungent criticism I can make upon this my 
first effort to cure urethral stricture by the use of electricity 
is to relate the following incident: 
On a certain day, less than a year after terminating my 
experiments at the Charity Hospital, I accidentally encoun- 
tered a man, evidently in great distress, near Bellevue Hos- 
pital, toward which institution his course was directed. He 
was leaning against a post in the street, making serious ef- 
* “ Practical Electro-therapeutics . . . Electrolytic Treatment of 
Stricture,” etc., “ N. Y. Medical Journal,” December, 1871, p. 569. 6 
THE CURABILITY OF 
forts in the vain endeavor to pass his urine. I was moved 
by natural sympathy, and, approaching him, pleasantly asked 
him what his trouble was, and whether I could be of assist- 
ance to him. He looked up and replied: “Don’t you know 
me, Dr. Keyes?” “No,” I said; “who are you?” “I am 
one of the men,” he replied, “ whom you cured of stricture 
at Charity Hospital, and I can not pass my water.” 
The Mallez and Tripier method of using strong currents 
and cauterizing the stricture with the negative pole, so that 
a circular slough comes away, is no longer used and is justly 
condemned. I indeed have been criticised for employing 
it; and Dr. Newman has plainly stated that I misjudged 
the value of electricity in the urethra, because I employed 
electro-cautery and not electrolysis—a strong current in- 
stead of a weak one. I have accepted the criticism, being 
only justified by the assertions of Mallez and Tripier, which 
I was testing. 
My present personal investigation covers the modern 
method—namely, that advocated by Dr. Newman, who 
alleges such phenomenal success by it in the permanent cure 
of organic stricture. 
As to just where electro-cautery ceases and electrolysis 
begins in the urethra of man when the electrical current is 
used, I can not say. Strom,* of Christiania, found by ex- 
periment that stricture (after three or four weeks) could be 
produced in the urethra of the rabbit by the use of from 
two to eight elements, and sittings of from five to ten min- 
utes. The amount of current in milliamperes is, unfortu- 
nately, not given. 
Dr. Robert Newman may be cited as to four of his pub- 
lished articles—two being sets of one hundred successful 
cases each, one a defense of the merits of the method, and 
one rules for its safe and efficient performance. 
* “ Internat. Ctrlbl.1887. URETHRAL STRICTURE BY ELECTRICITY. 
7 
In August, 1885,* the first table of one hundred cases 
of permanent cure appeared. It is maintained that all be- 
came and remained permanently well, the cure being proved 
by examination in attestation of the fact at varying periods— 
the shortest, three and a half years after the alleged cure, 
the longest, eleven years—without intervening treatment 
and without relapse. 
The duration of the malady before treatment is stated 
to have varied from one to twenty-five years. The stricture 
was single or multiple, situated at points varying from close 
to the meatus up to nine inches. The average number of 
sittings required to effect a cure was about five or six, and 
two or three months about the average time. 
In no instance was the urethra brought up to a size 
larger than 28 (F.); most of the patients were discharged 
cured taking about 22 (F.). 
Newman’sf second tabulated one hundred cases of radi- 
cal cures were published in September, 1887. The term 
“ cured ” is omitted in this list; many patients are reported 
as not heard from in verification of their having retained the 
dilatation reached during treatment; others were still under 
treatment; some are reported “well” at intervals varying 
up to five years. The strictures had existed before treat- 
ment from one month to thirty years. The average num- 
ber of sittings was five or six, the time required for treat- 
ment about two to three months. 
Traumatic strictures and the result of recontraction after 
previous internal urethrotomy appear among the cases 
treated, and the patients are reported as being well for the 
time specified without relapse. I quote a few of the state- 
ments made: 
* “ New England Medical Monthly.” 
f “ Journal of the American Medical Association.” 8 
THE CURABILITY OF 
“ Electrolysis is applicable to all strictures in any part 
of the urethra.” 
“ Electrolysis will pass and enlarge any stricture when 
other instruments or the skill of surgeons fail, which I have 
often demonstrated.” 
“ It relieves at once—no relapse takes place.” 
In his defense of the method, Newman * alleges as 
causes of failure— 
1. Incompetence of the operator. 
2. Mismanagement. 
3. A mistaken diagnosis. 
He cites cases, accuses those who have used a strong 
instead of a weak current, advocates a special electrode, 
great gentleness, weak currents, long intervals between the 
sittings, etc., and concludes by stating that “ electrolysis 
can not fail, but operators may and do.” 
Finally, in his article giving the method in detail,f and 
referring to a long list of contributions from others upon 
the general subject, he gives twenty rules for the manage- 
ment of cases, which I need not repeat here, including 
specifications as to the battery, the galvanometer, the em- 
ployment only of the negative pole, the use of his egg- 
shaped bulb electrode, and how to turn the current on and 
off. In another paper (“Jour, of the Am. Med. Assoc.,” 
Sept. 24, p. 390) he says, speaking of his last one hundred 
cases: “ Each seance lasted from two to ten minutes. I do 
not like to prolong it more, except for good reasons.” 
He advocates the avoidance of pain, advises that the pa- 
tient be in the erect position, condemns the use of two elec- 
trodes in succession at one sitting, denounces the use of 
force or the employment of the treatment when the urethra 
* “Is Electrolysis a Failure?” “Med. Record,” Sept. 25, 1886. 
f “ The Armamentarium for the Treatment of Urethral Stricture by 
Electrolysis,” “Med. Register,” Philadelphia, 1887. URETHRAL STRICTURE BY ELECTRICITY. 
9 
is even subacutely inflamed, objects to anaesthetics, and 
states again: “ All strictures are amenable to the treatment 
by electrolysis.” He adds that the patients may keep 
about, that the method relieves at once and is devoid of 
pain, danger, or inconvenience, and not followed by haemor- 
rhage, fever, or other unpleasant consequences, and that no 
relapse takes place. 
I wish to state here that all my relations with Dr. New- 
man have been most amicable; he has been particularly 
courteous in supplying me with his pamphlets, and instruct- 
ing my assistant, Dr. Fuller, in furthering my study of the 
subject; and that I, on my part, entered into the investiga- 
tion in the hope of demonstrating that the method did pos- 
sess value, and to decide how much. 
In the following cases I have observed the rules laid 
down as nearly as possible, always using the negative pole 
of Newman’s electrode, lubricated with glycerin, and em- 
ploying mild currents; deviating from the rules somewhat 
occasionally, but not so much, it will be observed upon 
close reading, as Dr. Newman himself deviated in the case 
he kindly consented to treat for me in the presence of my 
assistant, Dr. Fuller. 
It is necessary in a question of this kind to be rather 
full in the history of the cases; therefore I give them more 
at length than might otherwise seem necessary. The case of 
J. D. (VIII), treated by Dr. Newman for me, is condensed 
from the note-book, the notes being written up by Dr. 
Fuller immediately after each sitting. 
Other physicians have tested the treatment in a few 
cases and furnished me with their unpublished conclusions. 
I can not, however, reproduce them here, nor any of them, 
unless I brought in all; my excuse is that this investiga- 
tion is a personal and not a statistical one, and I must of 
necessity confine my conclusions to the results of cases 10 
THE CURABILITY OF 
which have passed under my own eye and those subject to 
my personal direction. 
Case I—January 27, 1888.—A. M., aged seventy-four, a 
man in the possession, apparently, of full and vigorous health in 
spite of his years, passes acid urine, somewhat turbid with pus, 
every two hours in a small stream, with straining. Thirty-five 
years ago Dr. Yan Buren treated him for a deep urethral strict- 
ure by the use of steel sounds. Since that time no instrument 
has been used. At five inches I find a tight stricture admitting 
only a filiform whalebone. At two inches and a half slight 
contraction, admitting 22 F. bulb. 
30th.—Electrode 16 (F.) ; five milliampdres; three minutes; 
no effects. 
February 3d.—Electrode 16 (F.); five milliamptires; four 
minutes; no effects. 
7th and l^th.—No. 16 (F.) ; four and five milliamperes; four 
minutes; no effect. 
Much local disturbance followed this last effort, although 
the deep stricture was not passed and no blood appeared at the 
moment of operating; pain, however, followed, with fever, 
blood, excess of pus, and much increased local vesical irrita- 
bility, contining the patient to bed for a week. 
March 2d.—I therefore determined that more electricity 
and greater length of time were not desirable, but that the 
stricture must be dilated in any case, and introduced into the 
bladder easily over a whalebone guide a metallic 9 (F.) steel 
tunneled sound. As a result, there was little or no local dis- 
turbance, pus diminished, the stream became larger, the inter- 
vals longer. 
9th.—Over a whalebone guide I attempted to pass a No. 12 
(F.) electrode, using no force, five milliamperes for five min- 
utes, and failed to pass the stricture; considerable pain was 
complained of at once. The patient wrote to me twice after- 
ward during a month that great local disturbance followed, con- 
fining him to bed with local inflammation and much increase of 
pain, pus, and irritability. Then he wrote, making an appoint- 
ment to come up, but failed to appear. Six months later (Sep- URETHRAL STRICTURE BY ELECTRICITY. 
11 
tember 13th) I examined him and found his condition, and his 
stricture practically what they had been at our first interview. 
Filiform enters with difficulty; No. 9 tunneled engages, but will 
not pass. 
Surely in this case the electricity was not suitable, and, 
without the employment of force, produced more local dis- 
turbance than the use of ordinary dilatation with force had 
done at a previous sitting. 
Case II—January 30th.—L. F., aged thirty-one. Ten years 
ago, one year after gonorrhoea, Dr. E. A. Banks, at Bellevue 
Dispensary, passed a No. 18 (F.) steel sound, and told him he 
had stricture. Gleet continued, but no further instrument was 
introduced until two or three years ago, when, having a reten- 
tion of urine, he applied at the Bellevue Dispensary, and Dr. S. 
Alexander passed sounds, commencing with a small instrument 
and rapidly working up to 27 (F.). He remained well for a 
year, except for a continuous gleet, when retention again came 
on after drinking. He applied to Dr. Creary, at Bellevue, who 
relieved him with a catheter. Five weeks ago, again having 
retention after drinking, and applying at Bellevue, he was re- 
lieved by the passage of sounds Nos. 15, 17, 18, and 20 (F.), 
and since that time has had no retention, but a little vesical 
irritability. 
The meatus takes 30 (F.) at two inches and a half; a moder- 
ate annular stricture admits 23 (F.) at the bulbo-membranous 
junction; 19 (F.) goes easily through a soft area; a drop of 
blood follows withdrawal of the instrument. I use 30 (F.) 
bulb, five milliamperes, four minutes, and fail to pass the strict- 
ure at two inches and a half. 
February Oth. —Bulb 27 (F.), four milliamperes, four min- 
utes, and fail to pass stricture at two inches and a half ; 22 (F.) 
bulb, four milliamperes, four minutes, passes easily. 
13th.—No. 25 (F.) bulb, used carefully as a test, will not 
pass. I use 22 (F.) bulb, therefore, with three milliamperes, 
for five minutes. It passes, but with more difficulty than a 
week ago; this is upon the two-and-a-balf-inch stricture. 12 
THE CURABILITY OF 
20th.—Slight irritation followed, but the gleet is decidedly 
better; 22 bulb to-day will not pass. I use, therefore, 16 (F.) 
bulb, three milliamperes, six minutes, and pass the two-and-a- 
half-inch stricture without pain, bringing no blood. This 16 
bulb passes the deep stricture also easily without electricity. 
27th.—No. 18 bulb passes anterior stricture. I use 16 bulb 
again, five milliamperes, ten minutes, and enter the bladder 
again easily, this time with the current on. 
March 5th.—No. 20 bulb, five milliamperes, five minutes, 
passes two-and-a-half-inch stricture with a little effort; 17 bulb, 
five milliamperes, half a minute, passes deep stricture. 
19th.—No. 22 bulb, five milliamperes, five minutes, passes 
anterior stricture; 20 bulb, five milliamperes, four minutes, 
passes deep stricture. 
April 2d.—No. 25 bulb, five milliamperes, ten minutes, will 
not pass anterior stricture; 22 bulb, five milliamperes, passes 
and also enters bladder. 
23d.—I test stricture to-day at two inches and a half; 23 
bulb will not go ; 19 goes without electricity, then 21, and then 
with some effort 23. I then use 25 bulb, five milliamperes, 
twenty-five minutes, holding it firmly against the anterior 
stricture. It will not pass, so that in this case, after more than 
two months’ persistent treatment, the stricture is absolutely at 
the same size as when I commenced, 23 (F.). The deep urethral 
congested area, being soft and yielding to dilatation, has ad- 
vanced three sizes French. 
September 13th.—Re-examined ; 18 bulb will not pass two- 
and-a-half-inch stricture; 15 goes, and then with force I pass 
the 18 bulb; 18 blunt steel sound then enters, but will not pass 
deep stricture. 
Case III—February l^th.—F. S., aged thirty-three, com- 
plains of frequent urination in a small stream, due to stricture 
following a gonorrhoea acquired eight years ago; not previously 
treated; 14 (F.) bulb detects double linear stricture at two 
and three inches; 12 soft bougie easily enters bladder. I use 
16 (F.) bulb, five milliamperes, four minutes; it will not pass. 
8th.—No. 16 (F.) bulb, four milliamphres, one minute, will 
not pass anterior strictures; 10 (F.)bulb, four milliamperes, held URETHRAL STRICTURE BY ELECTRICITY. 
13 
in the strictured area four minutes, brings trace of blood. I do 
not attempt to pass the deep urethra. 
15th.—Patient reports the stream smaller, and that he is 
worse; this is doubtless because I did not pass the deep urethra 
at the last visit. I therefore now pass 12 (F.) soft bougie into 
the bladder, and use 12 (F.) bulb, three milliamperes, ten min- 
utes, in the anterior strictures; no blood. 
23d.—Mistaking the number, I try with some force to pass 
21 (F.) soft (instead of 12) ; it will not go, but dilates the strict- 
ure, so that 16 (F.) bulb enters anterior strictures and allows 
me to use four milliamperes for six minutes, with a trace of 
blood. 
28th.—Retention of urine for twenty-four hours after last 
sitting; 16 bulb goes with more difficulty than last time, but 
with it I use five milliamperes for ten minutes. 
March 7th.—No. 17 bulb goes with a little difficulty, bring- 
ing some blood, under the use of five milliamperes for eight 
minutes. 
16th.—No. 20 (F.) bulb, five milliamperes, ten minutes, will 
not pass. 
22d.—To-day, in despair of help from electricity, I use an 
ordinary conical steel sound, 21 (F.); it goes, bringing a faint 
trace of blood; I follow it with 20 bulb, using five milliamperes 
for five minutes. 
In this case, therefore, retention of urine was produced 
by the treatment, which was finally abandoned, and ordinary 
dilatation substituted for it. 
Case IV*—February 16th.—J. H., thirty-five, complains of 
difficulty in urination, and having had retention three times 
during the past eighteen months, gonorrhoea seven and two 
years ago; treatment by sounds at New York and Chambers 
Street Hospitals; stricture at bulbo-membranous junction. 
Filiform whalebone enters bladder, and over it a 19 (F.) tun- 
neled steel sound; the stricture is of the soft variety, a con- 
gested surface with underlying spasm. 
* Cases IV, V, VI, and VII treated lor me by Dr. E. Fuller. 14 
THE CURABILITY OF 
21}th.—Relief followed the sound, and no disturbance. To- 
day, 12 (F.) tunneled electrode, five milliamperes, two minutes, 
passes the stricture; electricity continued in all six minutes. 
March 2d.—A chill and fever followed the electrical treat- 
ment, causing the patient to lie up for three days ; 17 (F.) tun- 
neled electrode, five milliamperes, passes stricture in three min- 
utes. The current was kept in the stricture for nine minutes 
longer. 
9th.—Twenty-four hours after last sitting chill, fever, and 
vesical tenesmus laid the patient up for two days. Stream is 
now better than formerly; 20 (F.) tunneled bulb, four milliam- 
peres, fifteen minutes, enters bladder; current continued two 
minutes longer. 
April 6th.—No trouble after last sitting. Blunt 16 (F.) 
sound enters bladder without electricity; 20 (F.) bulb will not 
go; 22 (F.) bulb, five milliamperes, enters bladder in eight 
minutes. 
13th.—Only trace of blood follows. Retention occurred dur- 
ing the week, but now stream is again satisfactory; 22 (F.) 
bulb, five milliamperes, ten minutes, will not pass. 
20th.—Great complaint of pain and trouble in urinating dur- 
ing the entire week; worse than before the use of the elec- 
tricity, which he strenuously objects to. Electricity abandoned ; 
gradual dilatation with conical steel sounds by old method up 
to 26 (F.). 
27th.—No trouble followed last sitting; steel sounds used 
easily up to 32 (F.). 
In this case urethral fever, laying the patient up in bed, 
was produced by the electricity, retention of urine and great 
pain and distress; so that the treatment was abandoned, 
and ordinary dilatation substituted. 
Case V—March 27th.—M. 0., aged thirty-two, complains of 
stricture following gonorrhoea, and has retention at the time of 
application. No instruments have been ever used, except a 
sound in exploration just before his visit; at two inches and a 
half, triple linear stricture, admitting 19 (F.) blunt steel sound, 
which enters the bladder. URETHRAL STRICTURE BY ELECTRICITY. 
15 
80th.—The patient for a time since the exploration has 
had to use a 16 (F.) catheter in order to urinate. Soothing 
means were employed in the usual way, and a few deep urethral 
injections, until the catheter was discontinued and urination 
comfortably performed, the patient being apparently well. 
April 6th.—No. 17 (F.) bulb, three and four milliam peres, 
eight minutes, passes into bladder; tingling pain complained of. 
13th.—Retention followed electricity, and two days later 
perineal swelling and great local tenderness, making it difficult 
to walk. Brawny perineal induration remains. No electricity 
to-day. 
20th.—Better, but lump in the perinseum persists, although 
subsiding. 
In this case the electricity nearly produced perineal ab- 
scess, and was abandoned. 
Case YI—April 2d.—W. W., forty, complains of difficult 
urination in small quantities, following numerous attacks of 
gonorrhoea; never had retention, and no instrument has ever 
been passed. Meatus takes 20 (F.), which just detects a tight- 
ness at two inches and a half; 13 (F.) is arrested at the bulbo- 
membranous junction. Filiform whalebone enters bladder 
easily; over it a No. 11 (F.), tunneled electrode, 4 milliatnp&res, 
enters the bladder easily, without resistance, in one minute; 
trace of blood ; no pain. 
9th.—Meatus forcibly dilated to 22 (F.); 22 (F.) electrode, 
four milliamperes, one minute and a half, enters bladder easily; 
trace of blood; electricity continued in all two minutes. 
17th.—Stream smaller again, and some vesical irritability 
complained of. No electricity to-day. 
23d.—Meatus dilated to 26 (F.); 26 (F.) electrode, five milli- 
ampeires, ten minutes. It was resisted for eight minutes, and 
then passed. 
May 6th.—Some discharge from the urethra since the last 
application; 22 (F.), is the largest bulb that will pass the two- 
and-a-half-inch stricture. 
No attempt was made to test the size of the deeper strict- 
ure, and no electricity used. The patient now ceased to attend, 16 
THE CURABILITY OF 
and could not be found for a time, but he continued taking an 
alkaline medicine, which comforted him. 
28th.—A blunt steel sound, 22 (F.), enters the bladder; the 
stream is larger than formerly, and there is less difficulty in 
urinating, hut othei'wise all symptoms remain as they were 
when patient applied for treatment—namely, precipitous urina- 
tion of a fluid full of deep urethral shreds, pain at the head of 
the penis, and imperfect erection. In other words, the element 
spasm is better for the dilatation, and the addition of electricity 
to the dilatation did no harm. 
Manifestly there never was any deep urethral fibrous 
stricture in this case, or a jump from an 11 electrode 
(passed in one minute with four milliamperes) to a 22 
electrode, which would pass in one minute and a half with 
four milliamperes one week later, would have been impossi- 
ble. I say “ impossible ” advisedly, referring to my expe- 
rience in other cases with the method. 
Clearly this is the kind of case that deceives the unwary 
and those who wish to be convinced. The type of case is 
not very unusual. A man has several attacks of gonorrhoea; 
then he begins to urinate in a smaller stream. He has no 
gleet, but his urine is full of angular, thickish clumps of 
pus from the deep urethra; he often has pain in the penis 
and imperfect erection, and his urination is liable to trouble 
him by the precipitant urgency of the call. 
Examined with the bulb, the orifice, as usual, is a little 
small, and at two inches and a half is the habitual point of 
physiological narrowing. The steel sound hesitates at the 
bulbo-membranous junction ; perhaps it will not enter at 
all, even in competent hands. 
Such a case is often called one of deep urethral muscular 
spasm, due to anterior stricture of large caliber. It gets 
well by cutting the anterior strictures if—and, in my opin- 
ion, only if—the deep urethra is also dilated. 
It gets well under ordinary dilatation. It remains per- URETHRAL STRICTURE BY ELECTRICITY. 
17 
manently well in either case if, and only if, by the dilata- 
tion, by subsequent deep urethral injections, by deep ure- 
thral irrigation, or by soothing internal medicine, the catar- 
rhal surface yielding the shreds of pus is much bettered or 
cured. 
It often gets well without electricity, without cutting 
anteriorly, without dilatation of the deep urethra, under the 
use of deep urethral instillations of the nitrate of silver 
carefully applied. But dilatation always improves the 
facility of urination in these cases, while failing to dissipate 
the shreds of pus and the other symptoms, and electricity 
added to the dilatation manifestly does no harm, possibly 
good. I can not now decide this point. 
Certain it is that the amount of dilatation effected by 
the instrument carrying the electricity afforded the patient 
in this instance a larger stream, and allowed him to urinate 
with less effort; but to assert that it cured any fibrous 
stricture of the deep urethra is begging the diagnosis. 
September ll+th.—Re-examined to-day, this patient’s condi- 
tion is satisfactory. No. 20 bulb passes with moderate effort, 
the stream remains good, the symptoms of deep urethral in- 
flammation have disappeared, the spasm has not recurred. 
Whether the electricity helped the dilatation and the alkaline 
medicine in accomplishing this cure I can not say. If so, it is 
useful in spasm. 
Case VII—April 10th.—M. T., aged thirty-two, has had 
numerous attacks of gonorrhoea, and has noticed gradual dimi- 
nution of the size of the urinary stream for the past three years, 
with sometimes delay for more than an hour in starting the 
urine. He has passed a No. 8 (F.) soft bougie upon himself from 
time to time during the past year. At five inches and three 
quarters there is a stricture admitting No. 8 (F.); over filiform, 
12 (F.) electrode, tunneled, five milliampdres, enters the bladder 
in eleven minutes; the current was passed six minutes longer, 
a total of seventeen minutes. 18 
THE CURABILITY OF 
13th.—-No after-effect of a disagreeable sort from the elec- 
tricity, but the same difficulty and slowness of urination con- 
tinues. 
20th.—Reports that he can not now use his own instru- 
ment; he has had an attack of retention, partly relieved spon- 
taneously; he is frightened, and objects to further use of elec- 
tricity. Not even a filiform instrument can be made to enter 
to-day. The patient desires to enter a hospital. No further 
treatment used, as he is allowed to go to hospital. 
The case treated by Dr. Newman: 
Case YIII—February If, 1888.—J. D., aged forty-four, had 
gonorrhoea sixteen years ago; fifteen years ago, for retention 
of urine, meatotomy was performed in Bellevue Hospital, with 
dilatation.* No sounds were used subsequently, and in six or 
eight months recontraction manifested itself through frequent 
and difficult urination, and he was dilated up to 80 (F.). He 
then omitted the dilatation, and gradual recontraction oc- 
curred, but it did not seriously incommode him until two years 
ago, when for retention he was again dilated at the Demilt Dis- 
pensary up to 80 (F.). Ceasing the use of instruments again, 
recontraction asserted itself, and yesterday he again had reten- 
tion, and applied at a dispensary. No. 21 (F.) conical steel 
sound was introduced, and the patient sent to be treated by 
electrolysis. At four inches and a half from the meatus there 
is a double linear (fibrous) stricture, which can be detected by 
No. 15 bulb, although 21 (F.) steel sound passed yesterday. 
Dr. Newman kindly consented to cure this patient, although 
he objected that it was not a perfectly suitable case, since it had 
once been, as he then supposed, cut internally; however, he 
attempted its cure with confidence. 
6th.—Dr. Newman used 11 bulb, three railliamperes, ten 
minutes upon a guide, passing it several times back and forth 
through the stricture. He orders an injection of sulphate of 
zinc in water (gr. iij— § iv) to be used four times daily, and says 
* This patient stated at first that he had been cut, and it was sup- 
posed by Dr. Newman and myself that his stricture had been cut inter- 
nally. When questioned finally, he affirmed that the cutting was mea- 
totomy. URETHRAL STRICTURE BY ELECTRICITY. 
19 
the case is not typical, since there is a little pus, and a trace 
of blood follows the instrument; yet he purposes to continue. 
15th.—No. 14 (F.) bulb, tunneled, four milliamp&res. Some 
force is required to get the instrument through ; then the cur- 
rent is used, the instrument being passed back and forth through 
the stricture for ten minutes. 
22d.—No. 17 (F.) bulb, five milliamperes, passes after twelve 
minutes’ pressure. More blood than usual. 
March 7th.— Silver tunneled conical catheter, 18 (F.), is 
passed without appreciable obstruction ; this instrument is con- 
nected with the battery, and five milliamperes employed. 
IMh.—No. 21 (F.) bulb, five milliamperes, twenty minutes, 
will not pass; patient asserts that his stream is smaller. 
21st.—Patient still states that his stream is no better. No. 
21 (F.) bulb, five milliamperes, seventeen minutes, fails to pass, 
the patient perspiring profusely; then the same silver tunneled 
catheter which had been used March 7th was threaded upon a 
guide connected with the battery, and, after about ten minutes’ 
trial, the attempt to get into the bladder was abandoned, the 
instrument being grasped very tightly by the stricture. It was 
withdrawn after almost fifteen minutes, the patient feeling faint. 
Quinine ordered, and belladonna suppository. Dr. Newman 
maintains that the reason the instrument will not enter is 
“ spasm.” 
28th.—Patient states that after the last visit he was very 
sore for five days, and passed considerable blood. 
Dr. Newman admitted that the force used at the last visit 
had been a mistake, and that he had lost ground thereby. He 
denied that the spasm was due to the treatment, but stated that 
it was due, like many other queer things, to the “blizzard”— 
the storm which had prevailed on March 12th—stating that 
he had another case acting in the same way from the same 
cause. No. 20 (F.) bulb, five milliamperes, fifteen minutes, 
fails to pass, and Dr. Newman admits that now the stricture is 
tighter than before. He advises two weeks’ rest, and will begin 
again. 
April 11th.—Conical metallic tunneled 18 (F.) sound passed 
on a guide. The milliamperemeter was not used, hut the cur- 
rent was turned on until the patient‘said the instrument felt 20 
THE CURABILITY OF 
pretty warm. Considerable force was employed, and in about 
two minutes the sound entered the bladder; it wTas allowed to 
remain about four minutes and then withdrawn, followed by a 
fair amount of blood. 
17th.—Dr. Keyes tested the patient as to bis condition to- 
day. He found that only 12 (F.) would pass easily; the strict- 
ure bleeds; the meatus takes 29 (F.). 
18th.—Dr. Newman tries 21 (F.) bulb, but, failing to pass, 
gives it up, using no electricity. 
25th.—Dr. Newman injects a solution of cocaine into the 
deep urethra before introducing the electrode, 21 (F.), bulb; no 
milliampcsremeter is attached, but the current is increased until 
the patient complains of heat. The bulb will not pass, there- 
fore 18 (F.) conical steel sound, tunneled, is used with the cur- 
rent; some blood escapes. 
May 2d.—Patient states that there has been no improvement 
since commencing electricity. 
Dr. Newman tries 21 (F.) bulb, but fails after ten minutes; 
he then takes a conical instrument on a guide and dilates up to 
21 (F.), applying the current through this instrument; he now 
again introduces 21 (F.) bulb, which enters the bladder. Alto- 
gether electricity was applied three times in succession at this 
sitting; considerable blood followed. 
16th.—Dr. Newman uses 23 electrode without guide, five mil- 
liamperes, ten minutes. The instrument will not pass, and pa- 
tient declares that his stream is as small as ever. 
23d.—No. 25 electrode, five milliamperes, ten minutes, will 
not enter the bladder. 
25th.—Much blood followed the last operation, and is still 
flowing to-day. Dr. Keyes tests the stricture and finds it at 
four inches and a half (full) refusing to admit 14 bulb. 
30th.—No. 18 metallic conical sound introduced by Dr. 
Newman upon a guide with five milliamperes, and deep ure- 
thra dilated ; then 18 electrode, which now passes the stricture 
under five milliamperes, ten minutes. Considerable blood ap- 
pears. 
June 6th.—No. 23 electrode, with electricity, without guide, 
by Dr. Newman (Dr. Garrison being present), fails to pass the 
stricture, a failure ascribed by Dr. Newman to spasm. URETHRAL STRICTURE BY ELECTRICITY. 
21 
18th.—No. 25 electrode, five milliamperes, fails to pass. This 
time Dr. Newman ascribes the arrest to the triangular ligament. 
Much blood. 
17th.—No. 27 electrode, five milliamperes, six to eight min- 
utes, will not pass. Dr. Newman states that the obstruction is 
spasm, that the stricture is cured, and that the spasm will prob- 
ably soon get well if let alone. He prescribes belladonna and 
opium suppository. 
20th.—Dr. Newman introduces filiform bougie, and over it 
17 electrode, five milliamperes; much force used; considerable 
blood and pain. The instrument finally goes through. 
2J^th.—Considerable blood now after each sitting. Patient 
getting restless and discouraged. Dr. Newman to-day tries 22 
tunneled electrode on guide, five milliamperes, ten minutes, but, 
failing to pass, withdraws the electrode and substitutes over the 
guide a 17 tunneled electrode. This he passes through with 
considerable effort. Much blood. 
27th.—No. 25 electrode, five milliamperes, ten minutes, fails 
to pass. 
To-day Dr. Keyes explores. No. 17 bulb encounters stricture 
at four inches and a half. It passes through, finds no spasm be- 
yond, and enters the bladder. On withdrawal, it is firmly de- 
tained behind the stricture at a distance measured, after its re- 
moval, of four inches and three quarters. The double linear strict- 
ure therefore, after nearly five months’ treatment by electrolysis, 
will take a bulb two sizes (French) larger than at the commence- 
ment; its double linear character has disappeared; it is tougher, 
more fibrous, thicker than ever. Dr. Newman writes Dr. Keyes 
that the stricture at four inches and a half is cured, but that an- 
other stricture at five inches and a quarter is not yet well. This 
latter is the same stricture, in all certainty, the differences in 
alleged depth from the meatus being due to the fact that trac- 
tion is made upon the penis in one instance and not in the 
other. 
September 10th.—To-day, ten weeks and a half after cessa- 
tion of all treatment, Dr. Keyes examines the patient, who com- 
plains that his stream is getting very small, that he urinates fre- 
quently and with effort, and sometimes dribbles involuntarily. 
No. 17 bulb stops at four inches and a half. No instrument will 22 
THE CURABILITY OF 
go until size 8 is reached. This passes, is followed by 12. Then 
a 12 bulb goes through by exercising force, and catches distinctly 
upon withdrawal. Blood follows. No large instrument will 
pass. The result, therefore, is a loss of at least three sizes by 
fibrous recontraction in less than eleven weeks. 
. Dr. Newman called upon Dr. Keyes early in September in 
response to an invitation to attend the congress and discuss this 
paper, and stated that he would not acknowledge the result in 
this case, whether good or bad, as conclusive evidence for or 
against the method. 
The natural comment upon Dr. Newman’s case (VIII) 
is that relief did not occur at once or at all, that cure was 
not effected, that blood was brought, pain caused, the elec- 
tricity not always measured, and that more than one elec- 
trode was used at a single sitting. His treatment lasted 
nearly five months—a time, according to his published 
statements, ample for effecting a cure. 
As for my own several test cases, I may summarize them 
by saying that in no instance did any more benefit appear 
from the electricity than could have been obtained by ordi- 
nary dilatation; that most positive failure of cure must be 
reported for all; that pain, local inflammation, putting the 
patient to bed, and threatened perineal abscess must be 
noted as among the complications of treatment; that relapse 
as to recontraction of the stricture was found in all the cases 
tested, after a moderate interval, being most marked, how- 
ever, in the case of the patient treated by Dr. Newman for 
me. For his sake I regret this fact, since he was most 
kindly in his efforts to help my study, and I regret that his 
patient at least did not have a better fate. 
I must add one more case observed by myself before I 
commenced this investigation. 
Case IX.—E. S. E., aged thirty-eight. The patient I now 
present for your inspection is a lamentable instance of the 
harm that may be done by the use of electricity in the ure- 
thra in careless hands, the current in this case having been URETHRAL STRICTURE BY ELECTRICITY. 
23 
undoubtedly used at a strength capable of producing caustic 
effect. 
This patient visited me in August, 1887, stating that, being 
strictured in the anterior urethra at about two inches and a 
half, a physician passed 25 (French) sound upon him. Afterward, 
in Brooklyn, being assured by a homoeopath that he could cure 
him radically, he went to the latter, who, by treatment, so 
burned the urethra at the strictured (?) point as to inflame the 
canal, causing it to swell sufficiently to produce retention of 
urine, and left him permanently worse, with the hard lump 
which you will now feel as large as a small marble, nearly as 
hard as bone, and surrounding the urethra at about the middle 
of the pendulous portion. 
The patient then went to Dr. Newman, who treated him 
with mild currents about twelve times, assuring him he could 
help him,* yet producing no favorable effect, either upon the 
lump or upon the symptoms. 
The patient concluded, therefore, that he had had electricity 
enough, having suffered from retention a number of times dur- 
ing his treatment, and getting under Dr. Newman’s rather 
worse than better. He therefore applied to me, that other 
means of relief might be instituted. 
When I saw him, in August, 1887, he had painful and most 
pronounced chordee during erection. The lump, still present in 
his urethra, was insensitive to pressure; the strictured area ad- 
mitted with difficulty No. 11 (F.). 
I cut this man more extensively than any patient I have 
ever performed internal urethrotomy upon—namely, on August 
22, 1887, to 40 (F.) on the roof of the urethra. The penis is not 
very large, measuring only three inches and a third; but I en- 
deavored to cut through the limit of the morbid tissue. In this 
I failed, and the subsequent use of instruments did not prevent 
recontraction. The sounds passed with pain and brought blood, 
and the stream of urine was not materially increased in size. 
* Dr. Newman informs me that he declined to continue in the treat- 
ment of this patient, knowing his not to be a suitable case, and says 
that he sent him to me. 24 
THE CURABILITY OF URETHRAL STRICTURE. 
Therefore, on October 2,1887, nearly a year ago, I cut him again 
internally on the floor of the urethra, and, being determined to 
be through, I cut him to 44 (F.), cutting through the sheath of 
the urethra—indeed, cutting everything except the skin. Con- 
siderable subcutaneous haemorrhage, and at one time a moderate 
urinary infiltration, followed; but my object was accomplished, 
the cicatricial ring was fairly divided, the inflammatory symp- 
toms were easily subdued, and the patient has since grown fat 
and enjoys the best of health, passing a full stream at proper 
intervals. The hard lump remains, hut is slightly smaller. The 
patient passes for himself easily, once a week, a No. 34 French 
bougie. The chordee persists, there is no gleet, and the bladder 
is not irritable. 
To what extent, or whether ever, the cicatricial lump caused 
by the electricity will be absorbed, I can not say. 
In conclusion, I may state that electrolysis with a very 
mild current—I prefer to put it at less than two milliam- 
pbres and a half—does no harm ; in fact, does nothing that 
I can appreciate, and does not interfere with the benefit to 
be derived from ordinary dilatation. I believe that a strong 
current is full of danger, both immediately from irritating 
effect and ultimately from cicatricial effect; and that em- 
ployment of the negative pole does not prevent this. 
My study of the subject and the experience it has 
brought me, digested with all the impartiality I possess, lead 
me to state that the allegation that electricity, however em- 
ployed, is able to remove organic urethral stricture radically, 
lacks the requirement of demonstration. The confidence of 
its advocates that it will radically cure organic fibrous 
stricture is, in my opinion, due either to the combined 
credulity of the patient and imagination of the surgeon, or 
to some special but fortuitous act of Providence, upon the 
co-operation of which, in the case of his own patients, the 
general practitioner can not with any confidence rely. 
1 Park Avenue, New York, September, 1888. Case. 
1 
Zi 
1 Age. 
Number, size, 
and quality of 
strictures. 
Symptoms. 
Former 
treatment. 
No. of sittings. 
Sizes of elec- 
trodes. 
Amount of cur- 
rent and time 
of employment. 
Results during 
treatment. 
Duration of elec- 
trical treatment. 
Duration of en- 
tire observation. 
Final result 
when last 
tested. 
No. days between 
last application 
of electricity 
and final testing 
of urethra. 
Result. 
Days 
Days 
Days. 
I. 
A. M. 
74 
2-J inches, lin- 
Frequent urina- 
Dilatation 
5 
16 & 
4 & 5 milliam- 
Great irritation; 
37 
228 
Recontraction. 
188 
Failure. 
ear, 22 F, 
tion; small 
35 years 
12F. 
peres;3 and 
failure to pass 
films, 5 ins. 
stream; puru- 
ago. 
5 minutes. 
stricture. 
filiform. 
lent urine. 
II. 
L. F. 
31 
inches, 23 
Repeated 
Relief by 
9 
30 & 
4 & 5 milliam- 
Moderate gleet; 
82 
225 
Recontraction, 
143 
U 
F., films, 5 
retention. 
sounds. 
19F. 
peres;4 and 
comfort in urina- 
5 sizes. 
inches, 19 
25 minutes. 
tion as after for- 
soft. 
m’r use of sounds 
III. 
F. S. 
33 
2 and 3 
Frequent urina- 
-N othing. 
8 
10 & 
4 & 5 milliam- 
Retention from 
46 
46 
Treatment 
Not 
“ 
ins., double 
tion; small 
20 F. 
peres; 4 and 
dilatation once. 
abandoned; 
found 
linear films. 
stream. 
10 minutes. 
dilatation 
later. 
14. 
substituted. 
IV. 
J. II. 
35 
5 inches, 19 
Frequent urina- 
Sounds. 
5 
12 & 
4 & 5 milliam- 
Retention once, 
48 
56 
U 
a 
u 
F., linear, 
tion and re- 
22 F. 
peres; 3 and 
pain often. 
soft. 
tention. 
17 minutes. 
V. 
M. C. 
32 
2-J inches, 19 
Retention. 
Nothing. 
1 
17 F. 
3 & 4 milliam- 
Threatened 
1 
24 
U 
a 
u 
F., triple lin- 
phres; 8 min- 
perineal 
ear. 
utes. 
abscess. 
VI. 
W. W* 
40 
inches 
Frequent urina- 
Nothing. 
3 
11 & 
4 & 5 milliam- 
Vesical irrita- 
21 
200 
Increase of 
144 
Soft, non-fi- 
films, 20 F., 5 
tion; small 
26 F. 
peres; 1 and 
bility and ure- 
9 sizes F. 
brous strict- 
inches, soft, 
stream. 
10 minutes. 
thral discharge. 
ure, with 
13 F. 
spasm,over- 
come; cure 
permanent. 
VII. 
M. T. 
32 
5f inches, 8 
Fartial reten- 
Soft bou- 
1 
12 F. 
5 milliam- 
Retention. 
1 
11 
Treatment 
Not 
Failure. 
F., linear 
tion; small 
gie, No. 
pbres; 17 
abandoned 
found 
films. 
hesitating 
8 F. 
minutes. 
to enter 
later. 
stream. 
hospital. 
VIII 
J. D. 
44 
inches, 
Repeated 
Meatoto- 
20 
11 & 
3 milliam- 
Pain; blood; 
142 
219 
Worse bv 3 
75 
U 
films double 
retention. 
my, sub- 
21 F. 
pbres to an 
local distress; 
sizes than be- 
linear, 21 F. 
sequent 
unmeasured 
stream smaller 
fore tr’tment, 
courses of 
quantity; 10 
under treat- 
or by 9 sizes 
dilatation 
& 20 minutes. 
ment. 
if sound is ac- 
cept’d as gauge 
* Case of spasm. 
Cases IY, Y, YI, and VII treated by my assistant, Dr. Fuller. 
Case VIII treated for me by Dr. Robert Newman. REASONS WHY 
Physicians Should 
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