A CASE 
OF 
EXTRAUTERINE PREGNANCY; 
EMBRYO DESTROYED BY A TWENTY-MILLIAMPERE 
CURRENT WITHOUT INTERRUPTIONS; 
Together with Remarks on the Best Manner of Using 
Electricity for this Purpose. 
BY 
A. H. BUCKMASTER, M.D., 
OF BROOKLYN. 
FROM 
THE MEDICAL NEWS, 
July 21, 1888. [Reprinted from The Medical News, July 21, 1888.] 
A CASE OF EXTRAUTERINE PREGNANCY; 
EMBRYO DESTROYED BY A 20 MIL- 
LIAMPERE CURRENT WITHOUT 
INTERRUPTIONS; 
Together with Remarks on the Best Manner of Using 
Electricity for this Purpose.1 
By A. H. BUCKMASTER, M.D., 
OF BROOKLYN. 
On the 16th of February, 1888, Dr. A. J. C. 
Skene requested me to see Mrs. C., for the purpose 
of destroying an embryo that was developing outside 
of the uterus. 
The patient was an Englishwoman, twenty-nine 
years of age, and gave me the following history: 
She had been married four years; had one miscar- 
riage two years ago, and has a child three years of 
age. Her menstrual periods recur regularly, and 
have always been plentiful. She was troubled with 
dysmenorrhoea previous to her marriage, but since 
then has been free from pain. 
Last October the patient changed her residence, 
and menstruated the latter part of that month. She 
did not menstruate the following month (November), 
1 Read before the New York Academy of Medicine, Section on 
Obstetrics and Gynecology, May 24, 1888. 2 
BUCKMASTER, 
and thought she was pregnant. She had never 
passed over a period except when enceinte, and was 
much troubled with nausea and bladder irritation, 
symptoms she had experienced previously only when 
bearing child. 
On the 26th of December (the day on which the 
Christmas feast was held), while assisting in the 
preparation of the dinner, she had what she described 
as a " very queer turn." She said: "I never felt 
better in my life than I had that morning." A 
short time before dinner she became nauseated and 
went to the bath-room to vomit. She suddenly felt 
a violent pain in the " pit of the stomach," heard a 
ringing noise in the ears and fainted. She lay on 
the floor groaning and did not have strength enough 
to call loudly for assistance. She was found in this 
condition by her husband and removed to her bed. 
It is said that her face was very pale, and she fainted 
at each attempt to sit up. She was very thirsty, 
and "thought the doctor cruel" in that he did not 
permit her to drink all the water she desired. 
Dr. Francis W. Bowron, the family physician, was 
sent for, and from him I obtained the following 
history: 
" On December 26th I was summoned in great 
haste to Mrs. C., who was reported to be dying. I 
found her in a condition of collapse, pulseless at 
the wrist, the lips bloodless and the face pale and 
ghastly in expression. The heart was irregular and 
intermittent, and there was great pain in the abdo- 
men. She was treated as a case of internal hemor- 
rhage and in the evening rallied. The next day the 
symptoms of pain and shock recurred, and on the 
28th there was again an attack, but of much less EXTRAUTERINE PREGNANCY. 
3 
severity than before. On the 12th of January there 
was a recurrence of these fainting spells, also on the 
13th and 14th of January. Dr. Skene saw the pa- 
tient, who had been rapidly increasing in size, on 
the 14th of February, and made the diagnosis of 
extrauterine pregnancy. He recommended that Dr. 
Buckmaster be called in to use the electric current 
for the destruction of the foetus. The increase in 
size of the patient's abdomen was arrested after the 
first treatment by Dr. Buckmaster. The patient is 
now her natural size and in fair health." 
The following notes were obtained from Dr. 
Skene: 
" I saw Mrs. C., in consultation with Dr. Bowron, 
on the 14th of February. I found the lower part of 
the abdomen enlarged. The right iliac region was 
the most prominent, and there was slight tenderness 
on touch. Dulness on percussion from the right 
ilium across the lower part of the abdomen and up- 
ward to somewhat more than half the distance to 
the umbilicus. On the left side the dulness did not 
extend upward more than two inches. An ill- 
defined mass, elastic to the touch, was distinctly 
traceable on the right side. Vaginal examination 
showed that the uterus was crowded forward toward 
the pubes, and that it was somewhat enlarged and 
softened. The sac of Douglas was occupied by an 
elastic mass, in which fluctuation could be detected, 
and which felt not unlike a small ovarian cyst, and 
seemed to be part of the tumor felt in the right iliac 
region, from which the uterus appeared free. 
" The diagnosis was between an ovarian cyst fixed 
on the right side and an extrauterine pregnancy. 
Taking the physical signs with the clinical symptoms 4 
BUCKMASTER, 
a diagnosis of the latter condition was made. The 
general impression left on the mind of the examiner 
was that, without doubt, it was a case of extra- 
uterine pregnancy." 
I saw the case with Dr. Bowron on the 16th of 
February, and found the conditions as just described 
by Dr. Skene. The patient stated that she had pro- 
gressively increased in size during the past three 
weeks. 
After carefully considering the different methods 
for destroying the foetus, none of which seemed alto- 
gether satisfactory, I determined to use the galvanic 
current without interruptions, for reasons that will 
be stated later. 
The current1 was gradually increased by means of 
a rheostat until a strength of 20 milliamperes was 
reached-no attempt to go further than this was 
made, as the patient felt some pain. After main- 
taining the current for ten minutes it was gradually 
decreased. The patient experienced no shock. For 
the abdominal electrode was used a large plaque of 
clay with sixty-four square inches of contact; the 
vaginal electrode was of steel covered with wet ab- 
sorbent cotton. I w'as careful to press down on the 
abdominal electrode as much as the patient could 
bear, and also to raise the electrode in the vagina so 
that the current could be in as intimate relation to 
the foetus as possible. I regard this as important, 
because the fluid about the foetus offers so much re- 
sistance to the passage of the current. At the end 
of the seance the patient declared herself much re- 
1 A fifty cell chloride of silver battery, made by Mr. Barret, 
was used. EXTRAUTERINE PREGNANCY. 
5 
lieved from the pelvic pain that had greatly annoyed 
her. I attributed this relief to the sedative influence 
of the positive pole. I had used the positive pole 
in the vagina anticipating this result. 
Six days after the first treatment the patient was 
again seen and her physical condition found to be 
much improved. The appetite had returned and the 
abdominal circumference had markedly decreased. 
Both the patient and her friends were delighted with 
the result. The physical examination was very 
satisfactory. The cyst seemed to have lost much of 
its fluid contents. I felt quite sure that the child 
was dead, but as the thorough examination started 
up the old pelvic pain, I made another electrical 
application. The third, and, subsequently, three 
more applications were made for the relief of this 
pain, at intervals of about six days. None proved 
so efficacious as the first. 
At the third treatment the measurement around 
the abdomen had increased about an inch, and six 
days later was half an inch more, but after this, 
the circumference measurement steadily decreased. 
Toward the end of February and also at the end of 
March, the patient menstruated. 
The patient was seen three months after the first 
treatment and was in very good health. A hard 
mass can still be felt by making a vaginal examina- 
tion, and there is a slight tenderness about it. 
The questions which would naturally suggest them- 
selves with this and other cases of this kind are: 
ist. Was the diagnosis of extrauterine pregnancy 
warrantable ? 
We had the subjective symptoms of pregnancy 
already enumerated : nausea and irritable bladder, 6 
BUCKMASTER, 
and these symptoms were of special significance be- 
cause they had existed with the previous pregnancy 
and at no other time. Coupled with the cessation 
of the menstruation, the diagnosis of pregnancy 
would be highly probable. The uterus, although 
somewhat enlarged, did not correspond in size or 
condition of the cervix with the pregnant uterus of 
this period. It was pushed forward, and the fundus 
could be felt above the pubes. In the sac of Douglas 
was a large fluctuating mass rapidly increasing in size. 
About the time the second period was due the patient 
suffered from cramp-like pains followed by signs of 
internal hemorrhage. 
From the foregoing facts the case is about as clear 
as possible, except that there is no definite statement 
as to the casting off of the decidua, but we know it 
is often impossible to utilize this sign. 
2d. Was the child living when the electricity was 
first applied ? 
The rapid increase in size observed by the doctor 
and the patient during the latter part of January and 
during February, after the symptoms of a peritonitis 
had subsided, indicated, by exclusion, a living ovum. 
Conversely we supposed the death of the ovum from 
the fact that the tumor decreased in size immedi- 
ately after the treatment. It not only decreased in 
size but changed in character, losing its elastic feeling 
on account of the absorption of the fluid contents. 
It has been claimed recently that the placenta con- 
tinues to grow after the death of the foetus, but as 
we have seen no corroborative evidence, it is not 
worth consideration at present. EXTRAUTERINE PREGNANCY. 
7 
3d. Is the uninterrupted current the best means 
for destroying the foetus ? 
I shall say but little as to the advisability of the 
use of electricity. So many eminent Americans 
have advocated its employment, that it has justly 
become known as the American plan of treatment. 
Although an Italian, Bachetto, first used the current 
for the destruction of the foetus, he used it in con- 
nection with puncture, a procedure which indicates 
that he had no conception of the advantages of this 
potent agent. So, as Dr. Garrigues very justly re- 
marks, the honor of priority may be justly claimed 
by America. Dr. T. G. Thomas, whose experience 
has been very large, says, in his characteristically 
forcible manner, "It has these great advantages: if 
an error of diagnosis has been made, this remedy 
will do no harm; if the diagnosis be correct, expe- 
rience proves it to be sufficient in its effect; . . . 
and it requires no surgical skill in its use."1 Many 
cases will undoubtedly appear as the literature of the 
subject expands, in which, after cutting into the 
abdomen, it will be found impossible to complete 
the operation.2 
Three methods are in use for the destruction of 
the ovum by electricity.3 In the first method we 
may mention the use of the primary or secondary 
current of the ordinary faradic machine. This 
1 Trans. Amer. Gyn. Soc., vol. lx. 
2 See autopsy by T. G. Thomas, Trans. Amer, Gyn. Soc., vol. 
viii. p. 167. 
3 The use of the static form of electricity is not considered be- 
cause of the difficulties in the way of its application. 8 
BUCKMASTER, 
method is the one that has been most commonly 
used. For the second method we use a galvanic 
current of from ten to sixty milliamperes with in- 
terruptions ; and in the third class we consider the 
use of the galvanic current of effective intensity 
without interruptions, and increased or diminished 
gradually.1 
The first method depends for its effectiveness on 
the shocks produced by the rapid breaking of the 
current by the magnet. The current strength is in- 
significant, and is usually obtained from two cells. 
Landis2 applied the poles of a Flemming faradic bat- 
tery against the shoulder and opposite rump of a 
newborn rabbit, and then used the full force of the 
battery for five minutes, and yet the rabbit recov- 
ered. A newborn rabbit is killed by very slight 
violence, and it would appear from this and other 
experiments, which he made on minnowsand beetles, 
that embryonic life is not so easily destroyed by 
this agent as one might imagine. 
This idea will be confirmed in reading the very 
interesting history of a case of extrauterine preg- 
nancy by Dr. Ely Van De Walker.3 He used a 
powerful induction coil. He says : 
" The irritation from one induction coil was such that 
it could not be tolerated elsewhere about the body for a 
1 At the meeting of the Section before which this paper was read 
the writer stated that he believed his case was the first one in which 
the current had been applied in the manner above mentioned. 
He finds, however, that in Dr. Janvrin's case, which antedates 
his, it was so applied at Dr. Rockwell's suggestion. 
2 Landis: Amer. Joum. of the Med. Sciences, October, 1885. 
3 Trans. Amer. Gynecolog. Assoc., vol. xii. p. 296. EXTRAUTERINE PREGNANCY. 
9 
momentShe had ten seances of half 
an hour duration each, on the same number of consecu- 
tive daysOn the pelvic mass there 
was no evidence that I had made any impression what- 
ever. Its size remained the same, and its resistance to 
the touch, or what I would prefer to term tension, was 
unchanged." He determined to prolong the treatment 
to an hour. "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." 
The danger of producing rupture of an already 
weakened tube has been pointed out, but some of 
the recent writers are disposed to belittle this risk 
because we have no deaths directly traceable to it as 
a cause. We have had as yet too few cases reported 
to draw any such deduction, and the dangers of a 
possible rupture offer td my mind a valid objection 
against the use of the faradic current. 
By the second method, in which a comparatively 
strong galvanic current is used, the advantages of 
the first method are rendered greater, and the dan- 
ger of rupture is also increased. This is so true that 
I doubt if the second method is justifiable with our 
present knowledge of the subject. t)r. A. J. McCosh, 
speaking of a case treated by this method some time 
ago, says: "The contraction of the legs and abdo- 
men was very energetic when the current was inter- 
rupted." 1 
On February 15, 1887, at a meeting of the Ob- 
stetrical Society of New York, Dr. Paul F. Mund£ 
remarked that he had reported a case two years be- 
1 Trans. Amer. Gynecolog. Assoc., vol. ix. p. 173. 10 
BUCKMASTER, 
fore in which one pole was introduced into the 
rectum, and twenty four cells were used with inter- 
rupted shocks; the foetus was killed, but the patient 
received such a severe shock that she was collapsed, 
and was restored only after receiving repeated hypo- 
dermatics of brandy, ether, etc.1 
We use the third method precisely as we use the 
galvanic current for the destruction of a fibroid 
tumor. That a current of twenty milliamperes strength 
has a profound effect upon the cellular structure is 
shown by experiments that I made upon the heart of 
a living dog,2 in which it was observed that the striae 
of the heart's muscle became granular and indistinct. 
I speak of this to indicate with what a potent agent 
we are dealing, and also it gives us a reason to under- 
stand how the current is effective. 
In the case reported by the writer, twenty milliam- 
peres of current apparently caused the death of the 
embryo ; but if this amount of current should prove 
for any reason inefficient, or if instant results are 
desired, it may be increased upto 100 or 150 milliam- 
peres if necessary, when there could be no doubt of 
the result being attained. Sixty to eighty milliam- 
peres are often borne without discomfort by the 
patient without an anaesthetic. The fluid about the 
embryo offers so much resistance that the electrodes 
should be brought as near the child as possible, and 
to accomplish this the abdominal electrode should 
1 Amer. Journ. of Obstet., April, 1887. 
2 Prize Essay read before the Alumni Association of the Long 
Island Hospital Medical College, 1888. EXTRAUTERINE PREGNANCY. 
11 
be pressed down and the vaginal electrode raised 
under the mass. 
The writer has not considered the question of the 
use of electricity in connection with puncture of the 
sac, because he believes, from the experience of 
reported cases, that this procedure is more dangerous 
than laparotomy. 
To recapitulate in regard to the three methods of 
using electricity for the destruction of the foetus : 
1. The faradic current is not certain in its action 
and not without danger. It must be used a number 
of times and for prolonged seances. 
2. The interrupted galvanic current is more effec- 
tive than the faradic and by far the most dangerous 
of the three. It should never be used, because the 
other methods will accomplish all that is claimed for 
it, and it is in itself exceedingly dangerous. 
3. The uninterrupted galvanic current will accom- 
plish at once the death of the foetus; it will relieve 
the intense pelvic pain by the sedative influence of 
the positive pole placed in the vagina; it is without 
danger. 
In the application of this method, all that is neces- 
sary is any electric battery containing enough cells, 
connecting cords, a rheostat and a vaginal and an 
abdominal electrode. 
The battery used by the writer was the fifty cell 
chloride of silver battery made by Mr. John A. 
Barrett. It weighs but eleven pounds and is 11x7x6 
inches, so that it can be easily transported. Mr. 
Barrett has also invented a dry rheostat which can 
be carried in the pocket and which will prove very 12 
BUCKMASTER. 
satisfactory if the current strength desired is not 
greater than seventy-five milliamperes. 
The abdominal electrode consists of two parts, a 
plate of copper and under it a pad of ordinary cotton 
batting, two inches thick when dry. The latter 
should be applied so wet that the water drips from 
it. The copper plate may be procured from a 
plumber at the cost of a few cents, and cut with tin- 
ners' shears to the shape desired. A hole should be 
punched through it, and then by means of a piece 
of copper wire it can be fastened to the connecting 
cord. For the vaginal electrode almost any of those 
in the market, covered with a layer of wet cotton, 
will answer the purpose, and if they are large enough 
there need be no fear of cauterizing the vagina. 
The following rules for the application of the 
electricity may be followed with advantage: 
ist. Use the positive pole for the vaginal elec- 
trode. 
2d. The electrodes being in place and the con- 
nections secure, permit the current to increase in 
strength gradually, by means of the rheostat, until 
the patient complains of pain. 
3d. Press up the vaginal electrode and downward 
on the abdominal electrode, as much as the patient 
can bear. 
4th. If the immediate destruction of the foetus is 
imperative and the patient cannot bear more than 
twenty milliamperes, use an anaesthetic and pass a 
100 milliampere current. 
5th. Decrease the current gradually at the expira- 
tion of fifteen minutes. the Medical news. 
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