THE PROPER CONSTRUCTION, CARE, AND USES OF THE GALVANO-CAUTERY APPARATUS. BY HENRY G. PIFFARD, M.D., SURGEON TO CHARITY HOSPITAL, PROFESSORJ OF DERMATOLOGY IN THE UNIVERSITY OF THE CITY OF NEW YORK, ETC. [REPRINTED FROM THE NEW YORK MEDICAL JOURNAL, APRIL, 1876.]] NEW YORK: D. APPLETON & COMPANY, 549 & 551 BROADWAY. 1876. THE POPULAR SCIENCE MONTHLY. CONDUCTED BY E- L. YOLTMANS. This periodical was started (in 1872) to promote the diffusion of valuable scientific knowledge, in a readable and attractive form, among all classes of the community, and has thus far met a want supplied by no other magazine in the United States. Seven volumes have now appeared, which are filled with instructive and interesting articles and ap- stracts of articles, original, selected, translated, and illustrated, from the pens of the leading scientific men of different countries. 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APPLETON & COMPANY, 54 9 & 55 1 BROADWAY. 1876. THE PROPER CONSTRUCTION, CARE, AND USES OF THE GALVANO-CAUTERY AP- PARATUS.1 The great value of the galvano-cautery as a surgical ap- pliance is admitted by all who are familiar with its use. Its employment, however, has been, until within a few years, quite restricted, owing to the inconveniences attending the management of the apparatus in vogue. The earlier instru- ments were large, importable,2 troublesome to arrange for use, and when in action were accompanied with the evolution of disagreeable and noxious fumes. How these difficulties were to be overcome was a problem which long waited a solution. The efforts ,of Stohrer, Trouve, and others, in Europe, met with a certain measure of success, inasmuch as their instru- ments were easy to arrange, and were unaccompanied with acid fumes. The size of the batteries, however, precluded their frequent use. This narrowed down the question to the possibility of obtaining an instrument capable of meeting the ordinary demands of the surgeon, and which, at the same time, should be strictly portable. Dr. John Byrne, an American physician, was the first to devise an apparatus fulfilling these requirements, by the con- struction of the instrument which bears his name. During the past year Dr. B. F. Dawson has designed another cautery, smaller in size than Byrne's, which also performs in an ad- 1 Read before the New York Medical Journal Association, March 10, 1876. 2 By a portable battery I here mean one that can be easily carried in the hand, and does not require the aid of a vehicle for its transportation from the office of the surgeon to the residence of a patient. 4 mirable manner. These two batteries being of different sizes and construction, a comparison of the specific efficiency of each is attended with some difficulty, and the question as to ■which of the two is constructed upon the better principles can hardly at present be answered without more elaborate com- parative tests than have as yet been made, Too much credit cannot be accorded to the gentlemen for the results which their experiments have produced. Have these batteries, how- ever, reached the limits of efficiency ? In other words, is it possible to construct an apparatus which shall be still more powerful without exceeding them in size, and w'hich shall not be much more expensive ? This question, I believe, can be answered in the affirmative, and that, too, without the involve- ment of any new principles, but simply by the more thorough utilization of old. The very unsatisfactory performance of a large Trouve battery, which I had obtained during the past year from Paris, led me to desire something more compact and reliable. An examination of the Dawson battery sat- isfied me in both these respects, but it was not clear that this particular construction possessed the greatest attainable power in proportion to size. It did not appear that every element of power had been utilized to the fullest extent. Be- fore adverting to the peculiarities of its construction, I trust I may be pardoned if I ask attention to the qualities which it is desirable that a cautery battery should possess, and also to some of the elementary principles of galvanism. A battery constructed for the purposes under consideration should be in the highest degree powerful, reliable, durable, convenient, and compact, so far as these several features are mutually compat- ible. It would be easy to construct an instrument in which either of these qualities is very highly developed, but it would be at the expense of the others, and would result in an appa- ratus which might be practically useless. The problem is, to combine them in a way that will enable us to obtain the greatest efficiency for the purposes designed. A galvano-cau- tery apparatus consists of several parts, to wit, the battery, the connections, the pole-cords, the handle or holder for the platinum instruments, and the instruments themselves. These different parts I will refer to seriatim. 5 The Battery.-Every galvanic battery adapted to cauter- izing purposes consists of four essential parts, namely, a posi- tive and a negative electrode, an exciting fluid or fluids, and a vessel or vessels for confining them. The simplest manner of arranging them is shown in Fig. 1. The positive electrode in almost universal use is zinc, while the negative commonly employed is either carbon or platinum (preferably the latter, except upon the score of ex- pense). In an arrangement like the above a current of posi- tive electricity commences at the inner surface of the zinc, traverses the liquid in the direction of the -|- arrow, traverses the plate P, and thence through the wire to the zinc again, continuing its course in the same manner so long as the con- nections remain unbroken, and it meets with no other obstacle. Fig. 1. Galvanic Battery: Z, Zinc Plate; P, Platinum Plate; c, Exciting Fluid which forms an Inside Connection ; d, Wire forming an Outside Connection. A negative current generated at the inner surface of the plati- num plate pursues an opposite direction, as indicated by the - arrow. The positive current alone concerns us at present. The strength of this current is expressed by the formula C = E - in which C represents the utilizable energy of the current, JLv, 6 and which is equal to E the electromotor power or initial energy of current, divided by R, which is the resistance or ob- stacle to its free circulation. Our object in the construction of an efficient battery is, to give C the largest possible value, and at the same time to re- strict the size of the apparatus. This may of course be effected by increasing E, or by diminishing R, or by both. The plates being zinc and platinum, E will be increased by enlarging their surface, or by employing an exciting fluid of great ac- tivity. Before attempting to reduce R, we must first consider its nature, wfliich is easily understood if we remember- 1. That every body, solid or fluids which is capable of act- ing as a conductor of electricity, offers at the same time a cer- tain amount of resistance to its passage. Different bodies vary in this respect, silver being the body which offers the least re- sistance, and water being one which offers a very great deal. 2. The resistance increases (other things being equal) in proportion to the length of the conductor • that is, a wire two feet in length offers twice as much resistance as one half that length. 3. The resistance increases with the diminution of the area of a cross-section of the conductor. In every battery circuit resistance is of course encountered both within the battery, which is termed the internal resist- ance and is represented by 7?,1 and outside of it in the wire connecting the plates. This latter is called the external re- sistance, and is represented by r, which changes our first for- mula into E P 1 - A + r For the present we will disregard r, and suppose that the plates, having been dipped into a vessel containing a suitable exciting fluid, are connected by the wire d (Fig. 1). At the instant the circuit is completed an energetic current is set in motion, and we find a liberation of oxygen at the positive, and of hydrogen at the negative electrodes. In a few moments, 1 The internal resistance R is mainly due to the resistance offered by the exciting fluid, and will vary with its composition and the breadth of the stratum whicli intervenes between the plates. * ►> ,. 7 however, the current diminishes in force, and continues to diminish until it is almost inappreciable. This is due in part to a sudden increase in the resistance developed within the bat- tery, and which soon becomes so great as to present a serious obstacle to the passage of the current. It is the result of several causes. The oxygen at the positive plate combines with the zinc, and this in turn with the acid present, and the fluid nearest the plate soon becomes saturated with a salt of zinc. Now, if the specific resistance of a 10 per cent, solution of sulphuric acid be represented by 1, the resistance of such a solution saturated with sulphate of zinc is about 17 (Callaud). The too rapid oxidation of the zinc must, therefore, be pre- vented. This may be effected by coating the surface of the plate with mercury, or what is called amalgamating the zinc. This keeps the oxidizing action within due bounds. The hy- drogen which appears at the negative plate is of course unable to combine with the platinum, but adheres to its surface in the form of little bubbles. As gases are even poorer conductors than fluids, these bubbles introduce an additional element of resistance to the passage of the current. A third cause of the stoppage of action arises from the fact that the layer of saturated fluid lying next the zinc loses its electrc-genetic power. The battery thus brought to a standstill may yet, however, be revived, and, as the causes are understood, a remedy is easily found. It consists in simply removing the saturated fluid from the immediate neighborhood of the zinc, and the hydrogen bubbles from the platinum, and in bringing fresh fluid in contact with them, and restoring to R the value it possessed at the commencement of the operation. This is effected by mechanical agitation. For this purpose a great number of contrivances, which need not at present be men- tioned, have been devised. A battery thus restored to ac- tivity will continue to give a current until the entire electro- genetic power of the ffuid has been exhausted, or until the zinc has been completely consumed by oxidation. As it takes a great deal of fluid to destroy a very little zinc, the former will, in a new battery, be expended first and must be renewed when it is desired to prolong the action. Let us now consider the external resistance. Whatever 8 may be the length or thickness of the connecting wire, or the material of which it is composed, a certain amount of resist- ance will be encountered, and certain changes in the condi- tion of the wire will occur. The one which particularly con- cerns us is the evolution of heat, and this increases in direct ratio with the resistance encountered. It is this conversion of electricity into heat which places at our disposal a valuable surgical appliance. It is frequently desirable to employ two batteries instead of the single one just alluded tOj arranged in such a manner that the zinc electrode of one is connected with the platinum of the other, and the circuit completed by joining the free poles of the two batteries together, as in Fig. 2. This would give us C = p as before; but, if the wire d is the same as used in the first instance, we will have 2 E upon analyzing R the formula C - 2 7? _|_ ?> instead of E . . .... C - 75 as in the single battery, which is a manifest gam 11 + r J in the value of C. Fro. 2. The energy of the utilizable current C is the result of two elements or qualities which always coexist, but which vary in their relations to each other according to circumstances. 9 These two qualities are known respectively as quantity or volume, and intensity or tension.1 By volume we mean the amount of electricity generated in the battery, and by tension its capacity for overcoming re- sistance. The volume is increased by enlarging the surfaces of the plates, the tension by increasing the number of cells, ar- ranged as in Fig. 2. The volume contributes mainly to the heating of the wire, while the tension enables the resistance to be overcome and the circuit to be established ; and experience has shown that a current of large volume but low tension will heat a short, coarse wire; but, if a greater length of the same wire is to be heated, the tension must be increased by the ad- dition of cells. On the other hand, a current of small volume but great tension will fail to heat a coarse wire, but may heat a considerable length of fine wire. With these principles and facts understood, the construc- tion of an efficient cautery apparatus is simply a question of detail; but it is just this matter of detail upon which success or failure will depend. The first point to be considered is the choice of the mate- rials for the electrodes. Pure rolled zinc is the most conven- ient and best substance at our command to use as the posi- tive plate. To make it a useful electrode, however, it is neces- sary that it should be amalgamated. This may be effected in several ways. The usual procedure is to dip the zinc plate in dilute sulphuric acid and then in mercury, in which it is left for a fraction of a minute. After it is taken out the excess of mercury is allowed to drain off, or may be rubbed off with the finger or a piece of cloth. A much better way, however, is to employ Moncel's amalgamating solution, which is prepared as follows: Mercury 100 grammes, Aqua regia (1 part nitric and 3 parts hydrochloric) 500 grammes. Dissolve the mercury with heat, and when cold add hydrochloric acid 500 grammes. The plate is dipped for a moment in the solution, removed and thoroughly rubbed underrunning water. The advantages 1 The word " intensity " is used by some writers in a different meaning, and is made synonymous with C. 10 of this method of amalgamating far outbalance the trouble of making the solution, as a plate thus prepared will remain in good working order very much longer than if amalgamated in the ordinary manner. For the negative electrode the choice lies between carbon and platinum. In Byrne's battery the former is used, in Daw- son's the latter. I think the platinum is to be preferred, for, although more costly than carbon, it is more durable and takes up less space in the battery. A zinc-platinum battery, with ordinary care, should be in as good condition (except as to waste of zinc), after being used a hundred times, as when new. A zinc-carbon battery will certainly not be, even with extraor- dinary care. , The distance which separates the plates is a matter of great importance, since the nearer the electrodes approach each other the less (cwteris paribus) will be the internal resist- ance, and by lessening II we increase C. They should not, however, be brought too close, as there must be some room to permit of agitation of the fluid. In the Dawson battery circulation of the fluid is accomplished by means of a solid agitator, which lies and is moved up and down between the electrodes.1 This, of course, makes it necessary that they should be a certain distance apart. Their actual distance is. about thirteen millimetres (£")• In Byrne's battery, agitated by air, the plates are much closer, which is a manifest ad- vantage over the other arrangement, provided the air agi- tation is as efficient as the patented one. To determine this point, I arranged two cells, w'ith the electrodes the same dis- tance apart in both, and in every respect alike, except that to one I adapted a Dawson agitator and to the other an air- injcctor, arranged for me by Mr. Boissier.2 After careful ex- periment, Mr. Boissier and myself were unable to perceive any material difference in the effects produced by the differ- ent kinds of agitation. This, of course, induced me to place my electrodes closer together than Dawson's, in order to re- 1 For particulars of the construction of this agitator, see U. S. patent No. 167,510, issued September 7, 1875, and the March number of the New Yobk Medical Joubnal. 2 Foreman of the Galvano-Faradic Manufacturing Company's shop. 11 duce R, an arrangement which constitutes one of the strong points of the Byrne battery. The distance between the plates which I finally adopted is nine millimetres Dawson's plates are a little wider than mine, but the ratio of total plati- num surface is about six in the former to ten in the latter. The agitator consists of a small tube at the end of the cell, the lower portion perforated with holes. A cross-tube passes to the tube of the second cell; a nozzle in the cross-tube re- ceives the soft rubber tubing attached to a bulb syringe. By compressing the bulb, air is driven through the tubes into the fluid, and effects a very thorough agitation. The connections throughout were made of pure copper, and the poles likewise. In order to protect these latter from the effects of the atmosphere, or a stray drop of acid from the battery, they were heavily plated with gold.1 The other ex- posed connections were similarly plated, but simply for orna- ment and uniformity. The cups employed were of vulcanite, and were obtained from Messrs. G. Tiemann & Co., and are the same as used in the Dawson battery manufactured by them. The next point to be considered is the battery fluid. The plain solution of sulphuric acid and water, first used in con- nection with zinc-platinum and zinc carbon (Grenet) batteries, is not sufficiently active for cautery purposes. Poggendorff added to the acid solution some bichromate of potash, which materially augments its power. Various modifications of Poggendorff's fluid have been employed, but the formula usu- ally followed is something like the following: Dissolve one and a half pound of bichromate of potash in one hundred and six fluid ounces of hot water, then add slowly twenty-six fluid ounces of sulphuric acid. The solution is ready for use when cold. A much more energetic, and every way better, fluid may be prepared by first making a saturated solution of bichro- mate of potash in boiling water. Filter when cold,2 and to 1 Nickel-plating, which it is now the fashion to employ about batteries, is a very poor substitute for gold, which, though costing a trifle more, will be found cheaper in the end. 2 The bichromate, which crystallizes out on cooling, will of course an swer for use again. . 12 every quart of the solution add eight fluid ounces of sulphuric acid, to which add when cold two fluid ounces of a saturated solution of nitrate of ammonium in nitric acid. This fluid may be used pure, but, even if diluted with an equal volume of water, it excites a very powerful current, and does not give rise to any nitrous fumes. The whole efficiency of a galvano-cautery apparatus does not depend upon the battery alone. For, however good this latter may be, if the pole-cords and handle are improperly constructed, their imperfections may more than counterbalance the effects which the battery is capable of producing. The fact that makers of these auxiliaries do not, as a rule, construct them in the most efficient manner, leads me to give a moment to their consideration. The pole-cords should combine in the highest degree flexi- bility and conductivity, so far as these properties are com- patible with each other. The more flexible the cords the more readily delicate manipulations can be performed. The cords which accompany the ordinary small-celled galvanic battery, used for electrolytic purposes, possess sufficient flexibility, but owing to their small diameter they are comparatively poor conductors, and will not answer the present purposes. The cords must be constructed specially for the object in view, good conductivity being of the first importance, as the value of r must be as small as possible throughout the external part of the circuit, except in that portion of it which is occupied by the platinum instrument, for the less resistance encountered, and the less heat evolved in other portions of the circuit, the greater will be the value of C at the parts where we specially need it. We must, therefore, consider the length and thick- ness of the cords, and the material of which they are composed. As a rule, the cords are made unnecessarily long. I have seen them six, seven, and even eight feet, in length. These were, perhaps, necessary in days of the old importable bat- teries, but, with the present small-sized instruments, which can be placed in the immediate neighborhood of any part of the patient's body, such lengths of cord are not required, are in- convenient, and, by adding just so much more resistance, pre- vent our obtaining the best effects. A length not exceeding 13 four and a half feet will answer every purpose. The cords should be about the thickness of a Faber's lead-pencil, and if properly made will have sufficient flexibility. The material of which they are composed should be one offering the least possible resistance. Silver, pure copper, and com- mercial copper, are the only substances which need be men- tioned. A few cords are made of the first, more of the second, while the majority are made from the third. In choosing be- tween them we must be governed by the degrees of specific resistance which they possess. The specific resistance of silver being taken as 100, that of pure copper is 100.1 (Latimer Clarke), while that of ordinary commercial copper is 250. As there is so little difference between silver and pure copper, the copper, being the cheaper of the two, is to be preferred, and is the material which should always be employed; but, strange to say, Shepard & Dudley is the only city firm which, so far as I am aware, even pretends to use it. The cord is not composed of a single wire, but of a bundle of small ones. The number of these is important. One firm here uses 50 wires to the cord, another 100, and a third 150. The cords which I ob- tained from Trouve contain 500. Upon theoretical grounds, which need not be here stated, the latter number is the best, and a few weeks ago I endeavored to persuade a manufacturer to increase the number of his wires. Argument failed to per- suade him; and it was only when I demonstrated with the battery the very marked difference in favor of my own, that he was convinced, and consented to abandon his 50-wire cord for a better one. I mention this as an example of the diffi- culty which is usually encountered in persuading manufac- turers to improve the quality of their instruments. They look at the matter from a purely commercial point of view, and sacrifice goodness to cheapness, believing that the ma- jority of purchasers will not be in a position to criticise their wares. The Handle.-The conducting parts of the handle should be of pure copper heavily gilt. One of the conducting wires should not be continuous, but should be broken in such a way that pressure upon a conveniently located button is necessary for the closing of the circuit. This is a matter of the utmost 14 importance, and yet I have never seen it in an American- made handle, except in the one shown me by Dr. Sass which he had made for his own use. Some of the American handles possess no device whatever for opening or closing the circuit. Others possess a slide, usually in an inconvenient position. In the handle which I myself employ (Trouve's), there is a combination of spring and slide which enables the circuit to be opened and closed instantly, or to be closed permanently if desired. The object of this contrivance is to keep the heat within due bounds. The only other methods of accomplishing this are, altering the decree of immersion of the plates, modi- fying the activity of agitation, or using a rheostat. These means must necessarily be under the control of the assistant, who of course receives his instructions from the operator. But before the instruction given can be carried out, a wire may burn in two, or a white heat do harm, when a red one would have done good. Hence instant control of the heat should be in the hands of the operator. This is specially needful when desiring to use a small cauterizing instrument at a red heat, or at the close of a loop operation, for, as the size of the loop diminishes, it gets hotter and hotter, and either cuts too fast, or breaks most annoyingly, just before the end of the operation. The platinum instruments themselves deserve a word. Some manufacturers arrange sets of cautery knives in which the platinum, twisted or hammered into different forms, is sol- dered into insulated conductors,1 which in turn may be adjust- ed to and removed from the handles. This places the surgeon at the mercy of the manufacturer, and compels him to have a set of rather expensive knives, and if one of them breaks at an operation he cannot readily supply a substitute. A much better way is to have a single connecting piece, into which all the knives fit. If the surgeon is then provided with a few lengths of platinum wire of different calibres, and a small pair of pliers, he can himself construct at a moment's notice an in- strument specially adapted to the particular case in which he 11 have seen one set of knives which were soldered into brass conduct- ors, which, having a very high specific resistance, is almost the worst me- tallic substance that could be employed for the purpose. 15 desires to use it. He will in addition require a loop-carrier. Most of those made are elaborate, intricate, and expensive. The one which I myself employ is a slight modification of the one furnished by Trouve, and would cost perhaps five dollars. A less convenient arrangement can generally be bought in the shops for about five times this sum. 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