The first method is that by electro-puncture, which Rockwell is appar ently inclined to accept as preferable to the older routine methods, since he calls it " the most speedy and effective method of treating areolar hyperplasia."' Electro-puncture is highly endorsed by Engelmann, and the method may be described in his words.' " In chronic metritis and hyperplasia we utilize the absorbent and electrolytic properties of the negative galvanic current and the chemical action of the negative pole; also the contracting and stimulating effect of the faradic currents of quality and low tension. These cases are frequently accompanied by a scanty menstrual flow and dysmenorrhea, hence the hemorrhagic tendencies of the negative pole are of service, as well as its electrolytic and cauterizing properties; the most effective treatment, if thero is no contra-indication, is negative electro puncture: passing a platinum needle into the indurated tissue parallel to the uterine canal, connecting this with the negative pole of the battery, placing the positive dispersing pole upon the abdomen, using a current of from 50 to 150 milliamperes. The larger stylet may also be inserted, or four or five needles at a time surrounding the os, all connected with one and the same negative pole. If amenorrhea, painful menstruation, or narrowing of the canal, especially in case of endometritis, accompany the hyperplasia, it is, first of all, important to remedy these conditions, and cauterization takes the place of puncture; that is, the uterine sound connected with the negative pole is used in the cavity, while the positive pole is in connection with the dispersing plate upon the abdomen.
" If weaker currents, from 40 to 60 milliamperes are used, electro puncture of the uterus may be repeated every third day; the application of currents of from 120 to 150 milliamperes should be from four days to one week apart, as they are accompanied by a slight destruction of tissue, which at first leaves an open canal, but at the end of that time nothing but a slight depression in the cervical tissue at the point of puncture remains Positive electro-puncture, the positive platinum polo in the uterine tissue, is to be tried only in case a greater destruction of tissue is desirable, an open canal remaining, through which detritus is discharged. The positive pole is more liable to produce a slough; hence, unless peculiar conditions exist which demand this procedure, the negative pole is far preferable on account of its electrolytic action, absorp tion is promoted in uterine and peri-uterine tissues, and the usually scant menstruation is increased." As for the details of electro-puncture of the uterus, the same writer thus states them: " I would recommend that all the precautions advocated in the puncture of fibroids be here observed; but since we cannot fix the uterus as we can a fibroid by pressure of the hand upon the abdomen, I prefer to insert the needle or stylet through the speculum. The uterus
is fixed by the bullet forceps, or vulcellum, if the former be not at hand, directly above the point of puncture, and the needle is then forced into the tissue; but since this is so firm that the ordinary platinum needle is liable to give, a somewhat heavier instrument is preferable; although I would hardly recommend the large stylet, as used in the fibroid and in cell ul i tic effusions According to the density of the tissue and the size of the uterus, the stylet for puncture may vary from the size of an ordinary needle to that of a number 1 English catheter, which I call the small stylet, or a number 4, which I call the large stylet, and use in fibroids and parametric effusions. If an ordinary heavy needle be used it should be inserted at least to the depth of one inch, better still deeper. All accompanying symptoms should be carefully weighed before puncture is resorted to. An admirable device, but one rather difficult of execution, is to insert four or five needles at the same time into the cervical tissue in a circle about the os, all connected to the same reophore. After four or five applications, massage of the uterus, the contraction and stimuls Lion by the proper faradic current, will rapidly further the attaining of the desired end." This method of treatment by electro-puncture has been also highly endorsed by Wniere,' of Paris. He has thus treated fully one hundred cases, using, however, the positive pole for puncture. It cannot be questioned that puncture by the negative pole is preferable, seeing that the softening and absorbent effect of this pole is the most marked.
The method of treating areolar hyperplasia by puncture is, to judge from the recorded cases, safe and effective. It would seem, however, peculiarly adapted to those instances where the uterus is markedly in durated, that is to say, in old chronic cases where the greatest possible revulsive effect is desirable. In more recent cases, where the uterus is large, heavy, and menorrhagia and profuse leucorrhea are predominant symptoms, we question if abdomino-vaginal galvanization, or galvano faradization, will not suffice. In these instances, although experience in the future may prove the assertion erroneous, we should prefer to precede electrical treatment by thorough curetting and cauterization of the en dometrium, for the chief source of the hemorrhages and the discharges is the presence of vegetations, fungosities of the endometriurn, and it seems rational to remove these radically at the outset, and then to proceed to abate congestion, to cause absorption, and to improve healthy nutri tion, by electrization. The time has not come as yet, for dog matic assertion; possibly the method of treating hyperplasia which we proceed to describe will prove, as is claimed for it, so ample in results as to forestall all other methods.