ELECTRICITY IN MEDICINE, 
INCLUDING A S?KCI A L ACCOUNT OF 
"The Gaivano-Cautery in Nasal Surgery. 
-B Y- 
HARRISON ALLEN, M.D. 
[REPRINTED PROM THE JOURNAL OP THE FRANKLIN INSTITUTE, APRIL, l&k.f 
“Merrihew Print” (J. Spencer Smith), 501 Chestnut St. [Reprinted from the Journal of the Franklin Institute, April, 1885.] 
ELECTRICITY IN MEDICINE. 
By Harrison Ai.len, M. D. 
[Abstracts from a lecture on the subject of “ Electricity in Medicine,” deli vered at the 
International Electrical Exhibition, Tuesday evening, September 30,1884.] 
[The lecture, as originally delivered before the International Electri- 
cal Exhibition, included a general resume of the applications of elec- 
tricity to the study of the phenomena of life, and especially to the 
practice of medicine. Of necessity a subject so comprehensive when 
arranged in a manner suitable for a popular occasion admitted of no 
expression of individual views, and indeed was so treated as to give to 
the auditor a general idea of the importance of electricity as an aid to 
physiology and to therapeutics, rather than to elaborate a single theme 
of interest to the investigator. After reverting to the phenomena of 
electrical animals, the lecturer passed to the observations of Franklin 
on the constant current upon the living body. An account of the 
researches of Galvani and Volta followed, and a succinct description 
was presented of the uses of these varieties of electricity in medicine 
as contrasted with that of faradism. The applications of the incan- 
descent wire as a cautery as well as a means of illumination of the 
throar-passages ensued. Examples were given of the methods of 
Duchenne in studying the functions of muscles by determining isolated 
contractions of separate muscles by the induced current as well as the 
method referred to Reichenbach as a means of ascertaining the effects of 
a powerful current of electricity) which was caused to be passed 
through a powerful stationary magnet) upon the sense of sight. The 
method last-named was held by the lecturer to have special interest at 
this time, since the organizations of societies devoted to psychical 
research would probably lead to the repetition of the Baron von 
Reichenbach’s experiments in this country. 
In selecting from this extensive range of subjects one theme which 
would bear elaboration, the author has concluded that an exposition of 
that form of electricity in the application of which he is personally the 
most interested, would afford the best opportunity of presenting obser- 
vations which might claim to be original, namely, in the use of the 
galvano-cautery as an agent in the treatment of diseases of the nasal 
chambers.—H. A.] 2 
Ladies and Gentlemen : I desire to bring to your attention this 
evening a subject in which I have for a number of years felt a warm 
interest; indeal, to such an extent is this the case, that this lecture in 
great part will be a statement of my own experience. It will make 
no pretence to be any other than a record of my own conclusions on a 
subject of great practical importance. 
THE GALVANO-CAUTERY IN NASAL, SURGERY. 
In 1873 I began a series of observations on the use of the galvano- 
eautery in the treatment of nasal disease. At that time the only 
battery available for the purpose was that of Burn’s, an instrument 
which, notwithstanding the fact that its activity is dependent upon the 
immersion of the plates in a stationary bath, and the additional defect 
that currents of air are to be constantly transmitted through the fluid 
to secure efficacy, combines many advantages, among which may be 
mentioned its portability, the ease with which it can be cleansed, and, I 
may add, its durability, for the instrument at that time purchased has 
been in almost daily use for ten years. The greater number of these 
observations now recorded, therefore, were made with the Burn battery, 
although I have supplemented it in my practice with a larger, more 
efficient, yet bulkier instrument. At the beginning of my studies I 
was much discouraged to find that the conductors, the electrode, and 
the circuit maker, were all large, heavy, and imperfectly adapted 
for use upon chambers, so small and imperfectly illuminated, as are 
those of the nose. The cords were heavy and cable-like, and the 
electrodes adapted for the coarser purposes of surgery. In these 
respects they were admirably adapted (let it be understood) to all 
operations in general surgery, and especially to those involving vascular 
structures, such as the tongue. I desire to return my acknowledg- 
ments to Mr. Otto Flemming, of Philadelphia, to whom the prob- 
lem was presented in 1874, to furnish for the purpose I designed, a 
more delicate electrode and a lighter and more available form of con- 
ducting cords. Without detaining you with the details of Mr. Flem- 
ming’s efforts, aided bv my own suggestions, I succeeded abont the time 
above-mentioned in having prepared for my use a form of electrode 
which has remained to this day the basis upon which all similar instru- 
ments have been made which have been used by me (Fig. 1.) The 
electrode is simply a pair of delicate copper wires, measuring a little over 
one millimeter in diameter, separated throughout their entire lengths by 
asbestos, except at those portions which are continuous with a terminal 3 
platinum loop. The copper wires and asbestos are firmly wrapped with 
insulating silk, and the entire instrument when completed will present 
an average length of fifteen centimetres, a width of from two to three 
millimetres, and the platinum loop varying in length from three to 
fifteen millimetres. The weight of each one of these electrodes never 
exceeds 148 grains. Such an electrode is flexible, is readily cleansed, 
is light in weight, and is durable. The platinum loop at the end of 
the instrument can be modified in shape in ways already understood 
by electricians, and nothing novel is presented under that head. The 
extent, however, to which the platinum loop may be made to extend 
beyond the copper wires is a matter of much importance, if it is 
desired to make a linear eschar. It follows that the length of the 
platinum loop will determine the length of the eschar itself. When, 
however, a mere point of contact with the living membrane is desired, 
there is no objection to wrapping the electrode almost its entire length, 
thus leaving a mere tip of the platinum exposed. When it is desired 
to apply the cautery to the naso-pharynx, it is prudent to wrap every 
part of the instrument except its free end, in order that the posterior 
edge of the soft palate be not involved in the burn. 
Fig. L—'Two electrodes of peculiar shape in use by the Author. 
The width of the cable with which I began my observations 
equalled about ten millimetres; but for the last year, I have succeeded 
in having very satisfactory results from a cord exactly one-half this 
width and of corresponding light weight. I desire next to call your 
attention to the battery which I have now in use, a battery designed by 
Dr. Carl Seiler and Mr. Otto Flemming, and known under their names. 
The novelty of the battery consists in the fact that the plates themselves 
are stationary, and the fluid is brought in contact with them by an 
upward motion which is determined by the pressure of the operator 4 
upon a treadle. The advantage of this method of bringing the plates 
in contact with the fluid is a decided one. The moment the foot of 
the operator is removed from the treadle, the current ceases, and there 
is no danger as is so often acknowledged to exist in the use of the Burn 
battery, of neglecting the plates and allowing them to remain in immer- 
sion a longer time than is needed. 
Fig. 2.—The double Seiler-Flemming battery employed by the Author. The two sets 
of plates are seen united by a flat band of metal. The case inclosing the two separate 
batteries opens in front, displaying the cells. The plates (which are seen pendant over 
the cells) and the treadle are shown. Above the figure of the battery lies a figure of 
the Flemming electrode-handle and the electrode in position. 
We have in this apparatus an exceedingly powerful agent, especially 
when the battery is made of double strength, as I have of late been using 
it (Fig. 2); that is to sav when two batteries (each one representing the 
chemical strength of that instrument known as the “ Seiler-Flemming 
Battery,” worked by a single treadle are united. A current from this 
powerful instrument is passed into a single short loop of platinum wire, 
and develops a heating effect of the highest destructive power. Yet 
the degree of heat is so rapidly evolved as to produce the desired effect 
upon the membrane with the least amount of pain. It may be held 5 
as an axiom in the application of the galvano-cautery, that the pain of 
an application is in direct ratio to a low degree of incandescence; 
or, expressed differently, the ease with which the applications can be 
borne is in direct ratio to the scintillating appearance of the loop and of 
the white color which attends incandescence. The single disadvantage 
associated with the employment of the white scintillating incandescence is 
the danger, or rather the liability, of fusing the platinum wire; but 
this can be readily averted by bringing the wire in contact with -the 
tissues which it is destined to destroy, immersing the plates in the 
fluid, and then making a current. The contact should be of momentary 
duration, and be limited simply by the time which the will-power can 
press upon the button at the side of the current-maker. The moment 
the finger presses tho button inward there is a quick flash of light 
from the electrode; the instant it is removed, the wire again becomes 
of the ordinary appearance of platinum; so that while the process ot 
destruction is going on, the finger of the operator is opening and 
closing the circuit very much after the manner in which a telegraph 
operator works the Morse indicator. With one exception, which 
followed upon the incautious pressure of the button, thus making a 
circuit before the battery fluid was raised up against the plates, I have 
never fused a platinum loop. In the instance named the short interval 
of time which intervened between the appreciation of intense heat, 
which I had thus inadvertently maintained in the loop, and the time 
required for me to break the circuit was sufficient to fuse the wire. 
It goes without saying that with a battery so powerful, great 
prudence is required in manipulating the electrode ; but when properly 
used and with the precautions which naturally belong to the use of 
all surgical agencies whatsoever upon the living economy, I can 
say that the galvano-cautery in the treatment of nasal disease is abso- 
lutely safe. The single point which may be urged—that is to say, one 
which at least came to me with a sense of surprise—was the effect upon 
the tissues at the side of the platinum wire not in contact with it, but 
simply in its neighborhood. The tissues were thrown into a state of 
high vascular excitement by the presence of the heated loop near them ; 
and one can very readily understand that the amount of radiant heat 
thrown off to the membranes in their immediate proximity from the 
heated wires would produce a roasting effect if long maintained in one 
position; but fortunately, almost all effects desired by the use of the 
cautery are obtained quickly ; and two or three flashes of heat from the electrode, while it destroys the tissues which are in contact with 
the loop, do not have, in a chamber so moist sis is that of the nose, any 
deleterious effect upon the adjacent surfaces. One of the most annoy- 
ing effects in the use of the heated wire, is noticed in the removal of 
tumors from the roof of the naso-pharynx; for in this region the con- 
tact of the heated wire at the base of the growth is at the same time in 
close proximity to the structures at the orifice of the Eustachian tube, 
and the destruction of the tumor may go on coincidently with the 
roasting of the membranes at this orifice ; but even in this instance the 
heated wire need be maintained for a short time only, as the loop is 
narrowed, it passes more and more toward the median line of the 
naso-pharynx and is to a corresponding degree, removed from the 
neighborhood of the tube. 
The ease which the surgeon possesses of making eschars with this 
instrument, exposes him to the peculiar danger of attempting to do too 
much at a single sitting, and to hasten a treatment, otherwise tedious, 
by too often repeated or too deeply made applications. If the surgeon 
is desirous of reducing tumorefaction or swelling, I believe it is a rule, 
which should never be departed from, that the employment of extreme 
caution, producing slight effects with the wire at intervals of at least 
one day or two days apart, endeavoring to use the white heat in such 
a way as not to draw much blood, in other words to destroy the super- 
ficial or epithelial surface rather than the deep connective tissue or 
matrix, produces the best result in the long run. If, however, it is 
necessary to remove enlarged masses, the cautery-snare had best be 
employed in place of the electrode, (see p. 318). The slightest contact 
of the wire against the epithelium will at once carbonize the surface, 
while at the same time it will coagulate the albumen in the membrane 
beneath it. In this way, an effect is secured which is in every way 
comparable to that produced by caustics of the chemical group, such as 
nitric acid, etc.; whereas, if the destruction is deeply effected and hemor- 
rhage ensue a lesion is established and the patient is subjected to the 
uncertainty attending a wound. 
The wound may be the site of deposition of irritating substances in 
the air, of the diptheritic deposit, and at best is the location of tenacious 
clot-like exudations, which from the very fact that they form upon 
surfaces exposed constantly to the incoming and outgoing air soon 
become in part dessicated, and serve as sources of irritation to the 
surfaces already acknowledged to be in a morbid state. Whereas, if 7 
the surgeon is content to produce localized death by making firm 
coagula of albumen, these will be thrown off slowly (say from three to 
five days) and will leave beneath them a healthy surface, which, as a 
rule, does not a second time form an eschar. A small surface being 
covered at a single sitting, permits the operator to make applications 
to adjacent areas, without waiting for an eschar to come off from a given 
surface. I have often at a single sitting produced slight eschars in 
both right and left nasal chambers, the roof of the pharynx, and the 
tonsil. As a rule, however, it is desirable to make au application to 
one spot only at a single sitting. 
In the order of the locations to which applications are to be made, 
may be mentioned first, the under surface of the middle turbinated 
bone, which can readily be reached by a small straight cautery, the 
head being thrown well back on the shoulders; second, the under 
surface of the inferior turbinated bone, which can be reached by a large 
straight electrode, the head being held in an easy position, and the 
floor of the nose being horizontal to the axis of the body; third, the 
roof of the naso-pharynx, which can be readily reached, either by 
thrusting an instrument directly through the nose into the pharynx, or 
by bending one at a convenient angle, and permitting a small amount 
of platinum wire to be exposed ; fourth, the tissue at the outer side of 
the middle turbinated bone, corresponding to the region at which the 
maxillary sinus communicates with the nose; fifth, the region at the 
sides of the pharynx, and the orifice of the larynx. One of the most 
interesting of such methods of application is that of reaching the roof 
of the naso-pharynx through the nose. If a perfectly straight instru- 
ment, placed into the nose, and be thrust back along the floor until it 
reaches an obstruction, being allowed to remain in this position, and the 
rhinal mirror being employed to inspect the naso-pharynx, the end of the 
electrode will be found resting against the roof of the pharynx ; so that 
the roof of the naso-pharynx can be burned with absolute freedom and 
impunity, within the limits above named, by simply taking the 
electrode and forcing it through the nose as far as it will go and burn- 
ing the tissue against which it rests. In this way, diseased tissues at 
the roof of the pharynx can be successfully treated when it will be im- 
practicable to inspect them by the use of the rhinal mirror, or indeed, 
in any other way than the one here indicated. 
By the employment of cocoaine, the vessels can be notably con- 
stricted. In this way the soft cushiony masses of tissue can be held 8 
well out of the way (a very great advantage), at the same time, the 
cocoaine will exert its useful effect in obtunding sensibility. That the 
effect is to any extent that of a local anaesthetic, I have great reasons 
to doubt, but it is an exceedingly useful agent, and enables satisfactory 
treatments (often prolonged and tedious), to be borne by young children 
and nervous adults with the greatest possible satisfaction. It is curious 
that the cocoaine is ineffectual in some instances. 1 have now under 
my care a child six years of age, upon whom it has utterly failed. It 
produced no constriction of the vessels, and no diminution of sensibility. 
In other instances, I have remarked that the effect is exceedingly 
transient, lasting only for five, at the utmost ten minutes, and is 
practically of no use in controlling exaltations of sensibility. Dr. F. II. 
Bosworth, was the first to record the striking effects of cocoaine in con 
stricting the blood vessels of the mucous membranes of the nose. It 
must, however, occur to any one who employs it, so decided are its 
effects in the majority of instances; but it is not a little curious that 
the first two patients upon whom I tried its effects were the two whose 
cases I have alluded to. The use of the cocoaine must not be for- 
gotten in connection with the employment of high grades of heat in 
the electrode. I have never ventured to use it on a surface which was 
very vascular, without first freely using the cocoaine ; for it is in every 
way probable that the scintillating white heat might cause free bleed- 
ing, no matter how little used, upon large uncontracted venous sinuses. 
Since the weight of the handle of the electrode is considerable, it 
may under some circumstances be advisable to insert the electrodes 
(possibly one in either nasal chamber) and to touch lightly the free 
ends of the portions projecting beyond the nostrils with the handle of 
the electrode, at the time that the current is passed into, the instrument 
by means of the interrupter. Of course, the moment the contact is 
made with the two poles of the electrode, there will be a flash of heat 
at the platinum loop which is lodged against the tissue desired to be 
cauterized. The advantage which is secured by applications made in this 
manner is conspicuous. In those patients who are unusually sensitive 
to pain or those who for any reason cannot properly control the motions 
of the head, such untoward disturbance cannot change the positions of 
the electrodes; for the backward and lateral motions of the head will 
simply break the contact between the electrode and the conductimg 
wires. With the instrument in which the electrode and wires are firmly 
united (see Fig. 2), the motion of the head will often rudely disturb 9 
the position, cause cauterizations to be made in undesirable parts, and 
prove in every way to be annoying and unsurgical. In some instances, 
I have employed an electrode which retains a long, slender, flexible 
platinum loop, which can take any form desired by moderately exerted 
pressure, and which when thrust through the nose so as to touch the 
vault of the pharynx will conform to the curvature of that wall, and 
thus enable the operator to reach a point much further back than he 
possibly could by a straight, rigid instrument. 
Fig. 3.—The galvano-cautery snare described in the text.—1. The cable of the battery; 
2, the canula (which is not shown In full length); 3, the platinum wire; 4, the vulcanite 
carriage, with screws holding the ends of the platinum wire, with metallic contact with 
the hinge connections, by which the current is transmitted from the cables to the wire; 
5, slotted barrel of aluminium; 6, a movable nut on the screw ; 7, a small portion of the 
screw disengaged from the slotted barrel; 8, milled stationary screw-head. 
A great advantage of the use of the galvano-cautery is its application 
to the principle of the snare. It is well known that a loop of wire 
which is steadily narrowed has great power in severing the attachment 
of tumors and other outgrowths. When of a large size they may be 
sufficiently powerful to pass through bony structures, as well as the 
softer parts of the body. The principle of the snare has been employed 
both in the throat, the ear, and the nose; but when my attention was 
first directed to this subject the forms available were too large 
and heavy for the delicacy of manipulation demanded in removing 
small tumors lodged in the narrower recesses of the nose. Moreover, 
no snare that I could then find would permit the galvanic current to 
pass through the 'loop at the time it was being narrowed. I was led, 
therefore, to inquire into the practicability of an instrument which 
would be at once light, of small size, and yet sufficiently power- 
ful to remove that class of hypertrophied tissues and polypoid growths 
which are of such frequent occurrence in the nasal chambers. The 
instrument shown in Fig. 3 combines these qualifications, and satisfac- 
torily performs the service for which it was designed. The only feature 
of an essential character which may be said to be novel is the fact that 
the platinum wire (3, Fig. 3) forming the snare is covered with a 10 
uniform coat of copper, except alone the portion forming the loop, 
which is bare. As a consequence of this arrangement the current of 
electricity from the battery is conducted through a double canula (1, 
Fig. 3) by means of the copper. 
The slotted barrel (5, Fig. 3) of the instrument, including the milled 
screw-head (8, Fig. 3) is of aluminium. The carriage (4, Fig. 3) is of 
vulcanite. The cables (1, Fig. 3) are attached to the carriage by a 
swinging pivot, the invention of Mr. Starr, of the S. S. White Manu- 
facturing Company. The weight of the instrument is less than half 
ounce. The canula measures four inches in length; the aluminium 
shaft four inches. The length of the instrument is therefore exactly 
eight inches when the screw and carriage are carried well within the 
shank but when withdrawn to its utmost the length of the entire 
instrument is nine and a half inches. The advantages of the elec- 
trical snare over others in use are; the facility with which the small 
loop can be carried against a small growth not exceeding the size of a 
grain of wheat or corn ; the ability to grasp readily the pedicle, and by 
a few turns of the movable nut to cut its way into the tumor, when by 
an application of the current, all points of resistance can be easily over- 
come. The most vascular structures may be freely entered and divided. 
If a growth be hard, resilient, or of a size so large as not to enable the 
loop to be readily engaged upon its base, the wire is simply held against 
the side of the growth, when the current will gradually burn its way 
into the mass to any extent which may be determined by the operator. 
When it is in this way received within the growth, the loop may, as 
before, be narrowed and a portion of it removed. It will be seen that 
failure to remove at least a portion of the growth attacked is an event 
exceedingly unlikely to occur. I have been particularly struck with 
the facility with which hypertrophies of the inferior turbinated bone 
can in this way be treated, and if cocaine be freely applied before the 
operation, it constitutes, in my judgment, the most speedy and the least 
painful of any means by which such conditions can be reduced. The 
current passing through the battery to the instrument can be inter- 
rupted by any of the numerous devises with which the practical elec- 
trician is familiar, or the treadle of the battery can be depressed and 
locked, and the interruption of the current be determined by the 
pressure of the finger on the key in the handle. This is under all 
circumstances desirable, since the weight of the cells is sufficient to 
demand considerable force to be exerted by the foot, always enough to 
destroy the delicacy of the manipulation of the instrument.