A brief recapitulation of the pathological changes which exist in these cases of chronic inflammatory affections of the uterine adnexa will assist us in estimating the probable worth of electricity as a palliative agent. We say palliative, for the reason that in many instances even laparotomy does not do more than this, and therefore we are not justified in speak ing of cure.
Dr. R. H. Fitz, the Professor of Pathology at the Harvard Medical school, has furnished us with the following description of the post-mortem findings in the cases under consideration: Chronic pelvic cellulitis is indicated by thickening, induration, and deformity (shrinkage) of the pelvic wall, or floor, or broad ligaments.
Chronic pelvic peritonitis is indicated by a superficial thickening, in duration, perhaps also shrinkage, of the pelvic peritoneum, with adhe sions, cheesy and cretaceous material, or fluid (bloody or serous).
In chronic pelvic peritonitis the tubes may show little or no change, or they may be shortened, thickened and dense, adherent, dilated or not, with or without contents. The ovaries may show no change, or may be indurated, deformed, buried in adhesions, with or without cysts.
In chronic salpingitis the tubes are elongated, dilated, varicose, the free end adherent or closed. The walls are thickened, the lining thick ened, gray, translucent, the surface smooth or granular. The contents are a watery, yellow, puriform material with flocculi and cheesy masses. This condition may become a hydrosalpinx.
In chronic oophoritis there is thickening, shrivelling, induration of the ovaries, with or without cheesy or calcareous masses. Adhesions are usually associated; the tubes need not be simultaneously affected, but may be.
These views, which emanate from a most careful observer, teach us a number of things. In the first place in any given case we are not in a position to state that the tubes or ovaries are altered; these organs may be imbedded in adhesions and yet be in themselves in a normal condition. Such being the case, and the laparotomist has himself often proved this by showing us specimens which he has removed and yet they were normal, the aim of treatment should be to cause the absorption of these masses of ,:xudation and the loosening of the adhesions, and it should not be directed towards the removal of organs which may be impaired in func tion but still not diseased. In the second place, we learn from the above considerations, that the woman's life is not imperilled by the conditions in her pelvis, although her life is often made practically unendurable. It follows, hence, that the treatment should be one which, while palliat ing her symptoms, will not subject her to any more risk than she is at the time under. Obviously laparotomy does subject her to risk, and we therefore must seek some method which does not.
Of the routine methods applicable to the treatment of these chronic inflammatory affections of the uterine adnexa, the persistent tamponade, the hot douche, etc., are scarcely effective, or at best but temporarily so, except where the condition is chiefly a chronic cellulitis. Some absorp tion of the masses of exudation may thus be induced, but where the changes are chiefly around the tubes and the ovaries, where the condition is mainly a chronic pelvic peritonitis, these methods, it is within the ex perience of all gynecologists, are not of much benefit, aside from the fact that but few patients are willing to submit to the very protracted treat ment necessitated, seeing that we are not able to promise marked and lasting amelioration. A priori we should expect speedier and more
marked results from electricity, and this is amply proved by a study of the few recorded cares in which this agent has been resorted to. By means of this agent we can unquestionably cause absorption of the in flammatory remnants, and in many instances this is all that is necessary to restore the woman to a state of relative well-being. The importance of this subject warrants us in appending a few illustrative cases taken from various sources, and thereby we also exemplify the manner after which the electricity is applied.
In Beard and Rockwell' is recorded the following case: In October, 1884, Mrs. S., aged thirty-four, came to me complaining of poor appetite, excessive constipation, dysmenorrhea, menorrhagia, sciatica, and partial paraplegia. She suffered in addition from a constant pain in the basilar region and a burgling and pressure throughout the abdomen. She called attention also to a constant pain in the lower portion of the spine, while sharp neuralgic attacks iu the uterine region contributed to make her life quite wretched. Upon examination I found the neck of the uterus crowded somewhat backwards and to the left side, while the left half of the os uteri was completely obliterated. The enlarged portion was larger than the surrounding tissue, but not acutely sensitive to moderate pressure. Pressure along the base of the swelling and posterior to the os caused greater pain. These objective symptoms, together with a pre vious history of acute cellular inflammation, rendered it evident that there was extensive exudation in the connective tissue. I therefore determined to subject her to persistent localized galvanization. For nearly a month the patient came every day, with the exception of Sundays, and sub sequently she visited me about every other day for three months. The applications were made directly to the diseased part, and when menstrua tion appeared, some three weeks after the inauguration of the local treat ment, the flow was not only markedly less in quantity, but attended by a very considerable decrease in pain. In a few weeks the distress along the sciatic nerve entirely disappeared, and the progress towards a fair degree of health was uninterrupted, until she was discharged as cured, after having received fifty-six local applications of the galvanic current. Under the absorptive influence of the current, the inflammatory exuda tion gradually disappeared, until in the end the finger could be swept entirely around the neck at its juncture with the body of the uterus. The readiness with which the sciatica disappeared indicates that it was caused by the pressure of the parametric exudation upon the pelvic floor.