Extra-uterine Pregnancy and 
its Treatment by Elec- 
tricity. 
BY 
ELY VAN DE WAEKEE, M.D., 
SYRACUSE, NEW YORK. 
REPRINT FROM VOLUME XII 
ejgnecolofltcal ^Transactions. 
1887. EXTRA-UTERINE PREGNANCY AND ITS 
TREATMENT BY ELECTRICITY. 
ELY VAN DE WABKEB, M. D., 
Syracuse. 
The group of pelvic symptoms which lead us to recog- 
nize the presence of extra-uterine pregnancy, the proper time 
for interference with the viability of the ovum, the intensity 
and duration of the electrical current when employed to 
destroy it, the recognition of its death, and the after-be- 
havior of the pelvic mass by which we are able to confirm 
the previous diagnosis, are all matters of accumulated experi- 
ence, and not in any sense that of argument or opinion. 
That the subject has not completed the elementary stage of 
its literature, the following extract from a recent paper in 
the leading American special journal will prove. It is the 
report of a case of abdominal enlargement in which a diag- 
nosis of abdominal pregnancy of the fourth to fifth month 
was made. Ten applications of the galvanic current, of from 
six to eighteen cells, lasting ten minutes, were made; " so 
that, in three weeks from the first use of the galvanic cur- 
rent," and here is the remarkable part of the statement, 
" there was nothing left of the enlargement of the abdomen 
but a small lump on the right side, which proved to be the 
fundus uteri," and notwithstanding "that the abdomen was 
enlarged as high as the umbilicus." Here we are asked to 
accept as a fact that the entire mass of a five-months' fetus, 
with its fluid and solid annexes, were completely absorbed in 
three weeks, half of which time was occupied by the period 
of treatment, all of which, if true, were the contents of a sac 2 
EXTRA- UTERINE PREGNANCY. 
destitute of the machinery of absorption. It is the record of 
such facts as these which led me to remark that the ele- 
mentary literature of the subject was not completed, and in- 
duces me to narrate the following case: 
Mrs. X., aged twenty-seven years, has had delicate health 
since an attack of scarlet-fever at eighteen years of age. 
Mainly these errors were pelvic in their origin, consisting of 
menstrual neurosis, which existed rather as crises in the per- 
sistent ovarialgia and sacralgia. During this period she led 
quite an active life,'but was sure each month to pass several 
days in bed. She married at twenty-four years of age, without 
producing any material effect upon either the pelvic symptoms 
or general health. She aborted of a three-months' fetus in 1885. 
In June, 1886, she came into my hands. She was leading quite 
an active life, giving much time and strength to society en- 
gagements. She was pale and anemic, with uncertain appe- 
tite. Examination showed a minor degree of retroversion, 
which appeared the only objective error I could detect. Sub- 
jectively the entire pelvic space was hypersensitive, more so 
upon the left side than the right, as is frequently the case. 
There was no restriction to uterine movement, and yet, on giv- 
ing the vaginal portion a right-and-left to-and-fro movement, a 
reflex, narrowly-defined pain was elicited in the right side as 
high as the umbilicus-the seat of frequent pain on driving or 
walking. The pelvic space was free from induration or tumors. 
Menstruation was regular, lasting about five days, and rather 
scant. 
She last menstruated regularly on July 25th. On the after- 
noon of August 28th she was attacked with severe pain, begin- 
ning in the pelvis, and rapidly extending over the abdomen. 
There were some signs of collapse, which quickly disappeared 
on the free use of morphia hypodermically. On the following 
morning what was taken for menstruation made its appearance, 
having gone six days over the usual period. There was con- 
siderable abdominal tenderness, dysuria, and painful defeca- 
tion. Matters continued in this state until September 7th, 
when another outbreak of pain took place, which required sev- 
eral hypodermic injections of morphia to relieve. Following ELY VAN DE WARNER. 
3 
this outbreak was such a degree of hypogastric and intra-pelvic 
tenderness that an examination was extremely unsatisfactory. 
Paroxysms of pain occurred on the 10th and 14th of Septem- 
ber, and meanwhile metrorrhagia in moderate amount was con- 
stantly present. On the 17th a decidua was passed with but 
little pain. It was a complete uterine cast, about three inches 
long, an inch and a quarter wide, and its w'alls a quarter of an 
inch thick. This was followed two days later by an explosion 
of severe pain. Her physician attended her usually during 
these paroxysms, but, as he had more than usual interest in the 
case, I was sent for to make a thorough examination. A small 
tumor was readily detected lying to the right and slightly pos- 
terior' to the uterus. Combined palpation showed that it was 
situated either in the right tube or broad ligament. It was, to 
estimate the size, two inches long by an inch and a half in di- 
ameter, sharply defined, the walls tense, and 'conveying to the 
touch the sensation of fluid contents. The uterus was dis- 
placed to the left anteriorly, and moderately fixed. There was 
considerable tenderness in and about the tumor. The out- 
breaks of pain, the metrorrhagia, the casting of the decidua, 
and the tumor aroused at once the suspicion of ectopic preg- 
nancy. . The breasts gave negative symptoms, nor could any 
corroborative evidence be gained in any other direction. 
On September 19th, 23d, 25th, 26th, and 29th, there were 
paroxysms of pain, but of lessened intensity. There was a lull 
in the more active symptoms until October 4th, when there 
was a renewal of the pain, with an increase in the flowing. 
The next day Dr. Mann, of Buffalo, saw her with a view of 
confirming my diagnosis of the case, as I hesitated to expose 
the patient to the pain and danger of powerful faradisation 
without an expert opinion other than my own. When Dr. 
Mann had examined the decidual cast, he remarked that he 
would not hesitate to pronounce it a case of extra-uterine preg- 
nancy on its appearance alone, as it was so characteristic of the 
accident. After a careful examination of the patient, he con- 
firmed my diagnosis. 
The next day, the 6th, we began the electrical treatment. 
The tumor by this time had doubled in size. The uterus meas- 
ured three and a quartex* inches, and was displaced to the left 4 
EXTRA-UTERINE PREGNANCY. 
and forward, so that there was some bladder irritation and 
strangury, while the mass pressing backward into the rectum 
caused defecation to be difficult and painful. It did not require 
deep palpation to define the mass as occupying the entire ex- 
tent of the right tube. 
We had a powerful induction coil, with two zinc carbon 
cells, employing the full force of the secondary current. The 
tolerance of the pelvic region to the pain of the faradic current 
is remarkable. The irritation of the current from our induc- 
tion coil was such that it could not be tolerated elsewhere about 
the body for a moment, but our patient could bear it fairly well, 
provided the external electrode was firmly held with uniform 
pressure. She had ten seances of half an hour's duration each 
on the same number of consecutive days. During this period 
the pain continued in paroxysms, not uniform in intensity, but 
varying from day to day. The metrorrhagia continued ; the 
pelvic hyper-sensitiveness was unchanged, and rendered the 
application of the electrode additionally difficult and painful. 
On the pelvic mass there was no evidence that I had made any 
impression whatever. Its size remained the same, and its re- 
sistance to the touch, or what I would prefer to term tension, 
was unchanged. 
As neither her physician nor I was satisfied that the cur- 
rent had killed the fetus, we resolved to follow Dr. Mann's 
advice, and prolonged the treatment to one hour. Begin- 
ning on October 20th, we did so for three successive days, 
using the full strength of the induction coil. On the third 
day we found evidence that the electricity was accomplishing 
its work. After the first one-hour treatment the paroxysms of 
pain ceased ; there was pain, to be sure, but it had lost its ex- 
plosive character, and was the result of the mechanical effect 
of the mass. The most important evidence was a lessened ten- 
sion in the cyst-wall. We are told to look for a shrinkage in 
size as the first symptom of the death of the fetus, but it is an 
exceedingly difficult matter to determine slight differences in 
size of a small intra-pelvic mass, which from the nature of 
things must be palpated with great care and gentleness. It 
was weeks after that before we could say positively that it was 
any smaller, but from the time mentioned I could say without ELY VAN DE WARNER. 
5 
doubt that it -was softer. I believe this to be a sign more 
easy of early detection than shrinkage ; and, as shrinkage is 
evidently the result of diminished tension, it follows that the 
latter will be first evident to the touch. At least, it was so in 
this case. 
Another matter that appears important is, how far we 
are to regard the persistence of paroxysmal pain after begin- 
ning the electrical treatment as evidence of the viability of 
the ovum. I have read reports of cases in which the pain 
ceased partly or completely after one or two treatments. We 
were working in expectation of such a result, but it failed. 
I do not believe there was anything to criticise in our appli- 
cation of the current. The inner electrode was a small cone 
pressed directly against the vaginal expansion of the cyst; and 
the outer, a flat disk an inch in diameter, covered with cham- 
ois wet in water and applied to the part of the cyst most evi- 
dent by external palpation. Pain of an intense and explosive 
character might persist after the death of the fetus; but, if 
the theoretical explanation of pain of this character is true, 
namely, that it is due to steady expansion of the cyst-wall by 
a growing fetus, it ought not. Inasmuch as the cyst has 
been repeatedly known to rupture during an attack of pain, 
it would follow that it was caused by either expansion in its 
contents or contraction in its wall, or rupture in greater or 
less extent. Under the former, when the viability and growth 
of the fetus ceases, pain ought to stop, and under the latter 
explanation it might readily continue. There are sufficient 
muscular filaments in the expanded tube to explain intermit- 
ting and painful contraction after the arrest of fetal growth. 
So doubtful were we of the results that I kept sponges, liga- 
tures, and instruments ready packed to make laparotomy at 
any moment. My case does not make plain which of the two 
explanations was the true one, but the fact was evident that 
the paroxysms ceased when tension of the cyst diminished, a 
result obtainable under either conditions of the cyst-wall or 
contents. 
Was it necessary to continue the use of the current to the 6 
EXTRA-UTERINE PREGNANCY. 
extent that we did is an important and practical question ? 
Might we safely regard two or three transmissions of the 
powerful current we were using as sufficient ? I was in doubt 
then ; I believe that I know more about it now. 
I was called in consultation since the above in a case of 
chronic albuminuria in a young married woman, believed to be 
about three months pregnant. In her last confinement she had 
such a narrow escape of her life from the same cause that I did 
not hesitate to give the opinion that the production of abortion 
was justifiable. While in London during her second pregnancy 
the late Dr. Meadows gave the same opinion. I used the fara- 
dic current to cause the death of the fetus. An olivary- 
pointed metallic electrode was inserted in the os externum, and 
a small sponge electrode held over the uterine fundus exter- 
nally. . The current was from an induction-coil of a Waite & 
Bartlett cabinet battery run by four Leclanche cells. The full 
force of the coil was gradually turned on for half an hour every 
third day, and it required six seances before the subjective 
symptoms of pregnancy ceased, followed a week after by an 
easy and very safe abortion. 
Contrast with this a still later experience: 
A young woman twenty-nine years old had suffered from a 
large, non-fluctuating, intra-pelvic tumor for several years, de- 
veloped posterior to the uterus. It was difficult to curve the 
finger over the mass, and reach the cervix. She very impru- 
dently married, and about the first experience she met with after 
that event was pregnancy. Iler physician brought her to me, 
and we both agreed that to permit the pregnancy to go on 
gave her no hope for delivery at full term except by lapa- 
rotomy. This time I used the galvanic current, being dissatis- 
fied with my experience of the faradic. A strength of 50 mil- 
liamperes was used. An olivary electrode covered with cotton 
was pressed against the os externum, which was reached with 
difficulty, and the external positive electrode was a flat sponge. 
The current was passed for fifteen minutes, and repeated on 
the third day, when the nausea ceased and the mammary signs 
abated, followed four days later by abortion. ELY VAN DE WALKER. 
7 
The current was given slow interruptions by a rheatome, 
so as to pass it through the uterus in a series of shocks. It 
was far more painful than the faradic, as the burning sensa- 
tion of the external electrode was severe. The electric cur- 
rent destroys fetal life by inducing permanent molecular 
changes, and its power to reduce vital as well as non-vital 
compounds to their ultimate constituents, and thus rendering 
the process of life impossible. We do not expect to attain 
this result by the faradic form of the current, which has no 
electro-chemical force, but by the galvanic, which we know in 
its various degrees of intensity will induce such molecular and 
chemical changes as to destroy any form of life. The faradic 
current acts by a series of shocks that, continued long enough 
and repeated often enough, will cause fetal death. Hence I 
have come to the conclusion that I did not continue the use 
of electricity unnecessarily long, and that in all cases in which 
electricity is used to attain this end, it ought to be continued 
until this is indicated by some objective or subjective evi- 
dence. I say this in the absence of any evidence whatsoever 
of the character or quantity or intensity of current necessary 
to destroy the fetus in ectopic pregnancy. 
A word or two concerning the subsequent behavior of the 
cyst. It was seven months before one might say, by exter- 
nal and internal palpation, that no further trace of it could 
be detected. Having regard to the nature of the sac and its 
contents, this appears to conform to the normal. It would 
take about the same length of time for an inflammatory exu- 
date to disappear by absorption, and neither the sac nor its con- 
tents in electopic pregnancy is exposed to the same function 
in equal degree, to say nothing of its more difficult absorp- 
tion owing to the higher organization of its elements. Mild 
galvanization to the extent of ten milliamperes appear to con- 
siderably expedite the absorption. To say, then, that a five- 
months' fetus and its cyst could disappear to a mere trace in 
three weeks must be an instance of a fact observed obliquely. 
One other fact in the after history of this case is to me diffi- 
cult to account for, but may be important as an item of ac- 8 
EXTRA-UTERINE PREGNANCY. 
cumulated experience. The metrorrhagia that attended the 
active phase of the case has continued in a very passive form 
nearly constantly. It is just sufficient usually to cause a small 
stain upon a napkin, although until about four months ago it 
occasionally would cause her to change three or four times a 
day. The discharge is dark, containing minute granular mat- 
ter, and is never offensive. Menstruation is regular and the 
discharge totally different in character. Blunt curetting and 
intra-uterine applications of Churchill's tincture produced no 
effect. Multiple tampon with antiseptic wool has done more 
good than any other treatment.