That indefatigable worker in the electrical treatment of the diseases of women, Apostoli, has quite recently called attention to a new method of applying electricity to cases of hyperplasia and of chronic endonietritis, giving in detail the rat ionale of the method as deduced from an experience extending over four years. From his monograph' we take the following condensed account of the method and the reasoning on which its applica tion depends.
Apostoli's new method aims at utilizing to the greatest possible degree the chemical and the trophic action of electricity, in order to destroy the diseased endometrium and to exert a derivatory effect on the uterus. The routine methods generally resorted to for the cure of chronic en dometritis and of hyperplasia one and all aim at altering vicious nutrition, at causing absorption of the hyperplastic tissue, at eliminating the patho logical processes in the endometrium. These methods, it is the experience of all, are slow in action, often ineffective, and where efficient this is only after the lapse of considerable time. For these reasons Apostoli has rejected them, and after prolonged experience advocates the substitution of electricity as being, where proper precautions are taken, uniformly safer, and, where the current is properly utilized, as being followed by excellent results.
For the purpose of application of this new method, Apostoli uses special electrodes which we will briefly describe. The external electrode, he claims, must possess such qualities as will enable very intense currents to be used without causing discomfort or doing injury to the woman, and these qualities are obtainable by means which diminish to the greatest possible degree the resistance of the skin. In galvanization of the female genital organs it is ever to be borne in mind that they are not specially sensitive to the action of the current, no matter how intense, and that the problem simply is to neutralize the action of the current at the ex ternal electrode, which, as we have elsewhere stated, is accomplished by increasing the surface over which the current is disseminated externally. Soft, moist, adhesive, potter's clay is the material which, in Apostoli's hands, has answered best for the external electrode, and by means of it he has been able to triple and quadruple the maximum current which it was formerly deemed safe to employ. This clay must be plastic and soft in order to allow of accurate adaptation to the skin; it must retain its humidity, and the layer must be uniform in thickness and not too thick, else it offers additional resistance to the passage of the current. Apostoli prepares this electrode as follows: In a wooden or metal mould, about centimetres high, he places a layer of wet tarletan, and then fills the mould with the worked clay exactly to the top. This clay-mass should
be large enough to cover the entire abdomen, and before being applied the skin should be carefully examined for abrasions, and if one is found it should be covered with collodion, else the skin will be cauterized at this point. Connection is made with the battery by means of a metal plate fused to the rheophore, and this plate is pressed gently into the clay.
Apostoli's internal electrode, which he calls the excitateyr infra ukrin, is in shape and size like the average uterine sound. The handle is about four inches long, and is constructed of celluloid, which is not only a poor conductor of electricity but also aseptic in that it does not absorb. This handle slips over the electrode proper so that the surface not in use is thoroughly insulated. This sound electrode is constructed of platinum, an agent which is not corroded when the positive pole is used. Before inserting the electrode into the uterus it should always be carefully disinfected, and it is introduced like the ordinary uterine sound.
In utilizing the chemical galvano-caustic action it is essential to re member the different effects of the positive and of the negative poles. In cases of hyperplasia or of endometritis, where hemorrhage and leucorrhea are marked symptoms, the internal electrode is to be connected with the positive pole, and in the reverse instances with the negative. To express the matter in Apostoli's words: "Although both poles favor retrogression and denutrition in case of uterine hypertrophies, associated with en dometritis and congestive parenchymatous metritis, together with this general action there are indications peculiar to each pole: The positive pole, the acid pole, relieves congestion, is hemostatic in the highest degree, is useful particularly in the hemorrhagic, congestive, or ulcerative forms; it prevents the tendency to excessive vascularization, and by the same process it becomes the indirect remedy against persistent leucorrhea; the negative or basic pole, is diluent, scarcely at all hemostatic, and tends to excite the sluggish or perverted circulation which is present in the old, atrophic, or indurated forms of chronic metritis, and it affects this by powerfully congesting the endometrium. It is the pole to be selected in cases of chronic indurated metritis, whether complicated by amenor rhea or by dysmenorrhea, and it is also applicable with similar success to the treatment of other inflammatory processes in which hemorrhage does not predominate." Such being the special electrodes which Apostoli utilizes, and such being the reasons for the choice of one or another pole as the internal one, it remains to describe the method of application of the current, the intensity to be selected, the duration of the stance and the frequency of repetition.