Here then we have an instance of cure of what was largely a chronic pelvic cellnlitis by the persistent use of galvanism, the negative pole being used internally, and the positive externally.
Muncie ' reports the following cases, which wo select from his mono graph as instances of what may be expected from local in addition to routine measures, in cases where laparotomy seems to be the only measure offering hope of alleviation or of cure.
The first case proves conclusively what may be achieved in the way of palliation: " Mrs. C. O. S., twenty-seven years; married twice, the second time four years ago; no children, but two miscarriages two years before, both during the same year. After first miscarriage warconfined to her bed with fever, and pelvic and abdominal pain for several weeks; this occurred again after the second miscarriage, when she was more seriously ill. Since then she has been confined to her bed during each menstrual period by profuse hemorrhage and severe pelvic pain, has become thin and pale, and is scarcely ever free from distress in the hypogastric region, chiefly on the right side. She had heard a great deal of the present operative tendency, and was in dread of having some disease which would require the removal of her ovaries and womb, more or less, according to the popular idea of these organs. She was extremely anxious for a child, and was willing to do anything but deprive herself of that hope.
I found the uterus immovably ante-latero-verted, and adherent there; in the right broad ligament a well-marked very tender swelling, which was evidently the inflamed and swollen ovary and tube; in the left broad ligament a much smaller and less tender mass. The diagnosis was perfectly plain, and the prognosis equally so. It was a case for removal of the uterine appendages, if the patient was to be relieved from her .suffering, which certainly prevented her from enjoying life, and was gradually making her a chronic invalid. I told her so. She asked in reply whether nothing could be done to give her relief, so that she could at least be free from intermenstrual pain and suffer a little less at the periods, and whether it might not be possible for her to conceive at some future time. She said she had come to me because she had heard that I would give her a chance of being relieved before insisting on a capital operation; and she wanted to take that chance if it existed. I told her that I could give her no hope as to a cure (except by operation), little of relief, and still less of conception, but that I was willing to try what pal liative treatment would do if she would give me at least three months. To this she assented, and I began a regular course of galvanism every other day, iodoform and glycerin tampons after each sitting, two blisters a month over each ovarian region, hot vaginal douches. Tonics (chiefly iron, which she greatly needed), malt; and at the periods at first one or two suppositories of extract of opium, according to the pain, and hot applications to the abdomen. These latter remedies were used only dur ing trto periods. The patient began to improve within a month; the in termenstrual pain diminished; she said she could feel the relief each gal vanic sitting gave her. It certainly was not the iodoform which did it, although that may have helped a little. Her appetite improved, she gained flesh, and could walk quite long distances without feeling tired or experiencing pain. There was apparently little change in the local condi tion, except that the swelling was less tender and softer, perhaps a trifle smaller. The uterus remained immovable. But the general health of the patient improved so much, partly in consequence of the freedom from pain, that after five months of treatment she returned to her home in the western part of the State, with directions to continue the galvanism if she felt the need of it. This, her husband informed me by letter last September, was not the case, since his wife continued "amazingly well" and was growing stout; they were just going on a trip abroad, and would call to see me on their return.
We select the following cases from this same monograph as instances of the beneficial effect of galvanism in cases of chronic pelvic cellulitis and in pelvic peritonitis: "Mrs. A. M., twenty-six years, married five years, childless, came to me from Athens, Ga., because a year previously I had cured her sister of an anal fissure, which, I was informed, had baffled her family physician. Mrs. M. had a history of pelvic inflammation four years before, since which time she had been an invalid, scarcely ever free from diffuse pelvic pains, ovaralgia, sacralgia, bearing down. She also had an anal fissure. She had consulted an eminent gynecologist of this city, who had advised otiphorectomy. I found the uterus retroverted, immovably adherent, vaginal roof solid, cervix low in vagina, vagina short, loft ovary prolapsed, adherent, very tender, right ovary not dis tinctly palpable. I first cured her fissure by dilatation, thinking that possibly some of her pelvic pain might be reflex from the fissure. But while defecation became painless, the peculiar ovarian and supra-pubic pain and the bearing down persisted. So I began to use iodine to the vaginal vault, and iodoform and glycerin tampons. But the patient either did not bear the iodine well, or the pressure of the tampons distressed her. In fact I found that she could never wear more than one small glycerin tampon with comfort. I tried local galvanism, the large sponge first over the abdomen and then over the sacrum, the negative ball in the vagina; ten to sixteen cells, half an hour every ether day. A plain glycerin tampon at the end of each sitting. After fifteen sittings the patient had improved so much that she could walk a mile or more, and scarcely ever had any pelvic pain; she wanted to return home, but before discharging her, I yielded to her solicitation to enlarge the external os, which one of her former physicians had told her was contracted, and was the cause of her sterility and dysmenorrhea. I did not agree with this view, but as the patient harped on this point, I though no harm could come by making a shallow crucial incision into the lips of the os, and trim ming off the flaps, of course avoiding traction on the uterus, which was still immovable and retroverted. There was scarcely any pain now on pressure in the vaginal vault, and there seemed no danger of relighting the peri tonitis of four years before. I enlarged the external os, carefully avoid ing traction or dilatation (I had never dared to introduce the probe), and as a result set up a furious pelvic peritonitis which kept the patient in bed for six weeks, and put her precisely where she was before she came to me. As soon as she was able to come to my office, I recommenced the
galvanism, and after about a month's treatment she was as well as ever, and was discharged last March, wearing a small, soft rubber Albert Smith pessary, which she thought gave her some support in walking. I gave her directions about the continuance of the galvanism, and have not heard from her since. Hence I idler that she is doing well, as she was of the kind of patients who would be sure to let me know if my treat ment had not proved effectual." The second case is stated as follows: " Mrs. S. It, twenty-seven years of age, nullipara, married five years, who, since a miscarriage four years before, which was followed by a very severe attack of pelvic peritonitis, had suffered from frequent attacks of pelvic pain, which was localized chiefly in the left ovarian region, and had had several exacerbations of peritonitis. She had grown rapidly stout, her menstruation was irregular and scanty (sometimes skipping four to five months), and she remained childless. I found the uterus immovably fixed, the vaginal vault rigid and tense, the left ovarian region exquisitely tender. Careful passage of a probe produced dangerous reaction, so that I never dared repeat it. Hence I have never been able to benefit her sterility. But frequent local galvanization gave such relief, each sitting being immediately followed by absence of pain, that for several months she insisted on a daily sitting. In course of time she improved so much that only once in a while now does she call on me, when her left side feels badly, and I am glad to say that I can immediately relieve her." Instances similar in their results to the above might be inserted here, but these are sufficient to prove that in the galvanic current we possess a most valuable adjuvant means of treatment in cases of chronic cellulitis and peritonitis complicated or not with salpingitis or oophoritis. It is also evident that in view of the possibility of thus alleviating the general and the local condition of these patients, laparotomy for the removal of the uterine appendages should not be resorted to before electricity has been faithfully tested, excepting, of course, in those instances where the bimanual reveals marked distension of the tube, a distension which the rational history of recurrent attacks of pelvic peritonitis teaches us is dire to the presence of pus (pyosalpingitis). True enough we cannot speak of cure as the result of using electricity, but the accumulating testimony of individual observers points to the fact that neither can we predict cure in these chronic inflammatory affections after laparotomy. To quote the words of but a single operator:' " We are concerned now with the one symptom—pain, as a result of disease of the pelvic organs, exclusive of malignant disease. For the relief of pain supposed to be due, we will say, to ovarian or tubal disease, abdominal section is performed. The organs at fault are successfully removed, and the patient makes a good recovery. It may be a case in which both ovaries and tubes are removed, and as the disturbing element of menstruation is eliminated, the patient is encouraged to expect a cure. Three months elapse, and still the patient suffers, not from the old dysmonorrhea, but from a pain more or less constant. She is encouraged to wait patiently; but in some cases, which have probably occurred to all of us, time brings no relief, and pains of some kind persist, varying perhaps in degree at different times, but never entirely absent. There are a few cases in which the suffering after operation is even greater than it was before." It remains to speak of a further method of treatment of these masses of exudation which has been proposed and is particularly favored by Apostoli: We refer to electro-puncture, and faradization combined with intra-uterine cauterization. Hitherto we have considered purely sub acute or chronic inflammations around the uterus, but now we must also deal with acute, for Apostoli is much bolder than certainly the great majority of those who have resorted to electricity in the treatment of these affections, for he does not draw the line at acute processes. In the pres ence of the acute stage of an inflammatory affection around the uterus, lie holds the view that the ordinary palliative means, rest in bed, opium, etc., resorted to, are worse than useless seeing that they effect nothing in the way of cure. In a paper read before the British Medical Association in 1877, he states his practice and the rules which govern him, and this may be summarized as follows: His chief aims are to relieve the pain from which the woman is suffering, and as far as possible to nip the inflamma tory affection in the bud. In the acute stage he resorts to faradization under the following rules: He uses the current induced through a coil of long, thin wire, which is a current of tension or an anesthetic current, as opposed to that from a coil of thick, short wire—the quantity current. He thus avoids inflicting any pain on his patient whatsoever. The first applications are vaginal with a bipolar electrode, and their aim is purely sedative, each sitting lasting from five to twenty-five minutes, according to the interval which elapses before the patient declares the pain lessened. In these applications the greatest gentleness and avoidance of all shock are requisite. The sittings may be repeated twice daily, and before and after each the vagina should be douched copiously with a solution of the bi-chloride of mercury. Such are the rules for the acute stage. When pain and tenderness have been markedly lessened, or the process has become sub-acute, Apostoli proceeds to intra-uterine electrization—that is to say, he counsels us to break without fear of untoward result that gynecological axiom which tells us never to touch the interior of the uterus in the presence of any specially active inflammatory process around the organ. He claims nothing but good results, however, and proceeds as follows: At the outset lie resorts to utero-abdominal faradization, that is to say, one pole is in the uterus and the other on the abdomen, using currents of tension and gradually increasing them up to the point of individual tolerance. These uterine faradizations are repeated until there is evidence of decided amelioration in the local condition, when the galvanic current is substituted for the faradic. The galvanization is also intra-uterine, the chemical and stimulant properties of the constant current being utilized, with the end in view of causing absorption of the inflammatory exudation and of checking any tendency to suppuration.