In the beginning, short seances, from throe to five minutes, and currents up to forty milliamperes are recommended. The stances may be repeated twice a week, and after each the patient should be confined to bed for a while. At first the positive pole is the internal on account of its greater sedative property, but eventually the negative pole is substituted for its derivative effects. Throughout this treatment Apostoli emphasizes the strict necessity of careful antisepsis and great caution in manipulation. When the condition has become chronic galvano-puncture is to be joined to galvano-cauterization. In this stage Apostoli claims that the cauteri zation of the endometrium should be as energetic as possible, and the in flammatory remnants must be subjected to the direct action of the current, which is only possible by means of puncture, utilizing the negative as the active pole. The following are the general rules as laid down by hiin as applicable to puncture: The procedure being a painful one, it is advisable to administer an anesthetic, although, where the patient is of a phleg matic temperament and able to bear pain, it is preferable to dispense with anesthesia, since thus we have the sensations of the patient as a guide in regard to the intensity of the current which we may utilize. This inten sity will vary from fifty to two hundred and fifty milliamperes, and the ganef) may be prolonged to ten minutes. The number of stances neces sary will vary with the case. Apostoli tolls us that one puncture will sometimes suffice in case of slight parametritis, while in others ten to twelve may be requisite. While, in general, rest in bed after the punc ture is preferable, 'still Apostoli has thus treated a number of cases with out compelling them to desist from their usual avocations. Before resorting to puncture it is essential by careful examination to choose a site where there is no pulsation, and by preference the most projecting por tion of the exudation. The depth of the puncture should be about one centimetre, hardly more, for fear of injuring the peritoneum; perfect antisepsis should accompany it; at the termination of the seance the vagina should be tamponed with iodoform gauze. As the result of the puncture an escbar is induced which separates about the eighth day, and a sinus is left whence derivation is procured. This sinus will remain open, according to its depth and extent, for from fifteen to eighty days, and as long as it remains the tamponing with iodoform gauze must be continued.
Such in outline is the method which Apostoli has practised and from which he claims excellent results. Puncture in case of exudations has been tested by Engelmann, who reports a number of instances treated with marked success. Baker, of Boston, reports ' a single case in which he has tested it, and he states that the result was so satisfactory as to encourage him to give it a trial in other instances.
In weighing the evidence at our disposal, and for the present limit ing our remarks purely to chronic cases, the assertion appears warrant able that in electricity we possess a most valuable adjuvant method of treatment of the stubborn affections under consideration, and that in justice to his patients and to his specialty, the gynecologist is in duty bound to test it faithfully and intelligently before resorting to laparotomy, which operation should be made the strict Bernier ressort except where the physical examination gives unmistakable evidence of the presence of a tumor from the discharge of the contents of which into the peritoneal cavity a peritonitis may be predicated. To make one of these suffering
women comfortable, if not to entirely cure her, by means of electricity, redounds more to the credit of the gynecologist than if he sterilizes her and still does not cure her. There is certainly ground for hopefulness that in the treatment of these chronic inflammatory affections of the uterine adnexa electricity will find one of its chief fields of usefulness.
Before dismissing this subject we would refer to an affection of the surroundings of the uterus to which but little attention has' been paid and which has been but infrequently described, and this is pelvic lymphangitis and angeoleucitis. The affection has been described by Courty ' at con siderable length, and Muncie has written a paper on the subject. On physical examination the lymphatic glands are detected as enlarged, tender, movable to a greater or less degree according to the amount of complicating cellulitis, and in marked cases the lymphatic vessels may be also felt. For the relief of this lymphangitis there are no means at our disposal more effective than galvanism. In two of the instances recorded by Mund( this agent alone gave permanent relief. The following case taken from his monograph on electricity in gynecology illustrates the affection and the result obtainable from this agent: " Mrs. G., twenty four years, multipara, was sent me by Dr. Chas. Denison, of Denver, Col.
She complained chiefly of severe and constant sacralgia, dating from an attack of pelvic peritonitis four years before. I found the uterus re troverted, firmly adherent and immovable; the left ovary prolapsed and adherent; behind the uterus a number (five or six) of small, very sensitive nodules, which could be very clearly mapped out through the rectum, and were evidently situated in the retro-( ervical cellular tissue. These were evidently inflamed lymphatic glands. No pain was experienced on examination except when these nodules were touched, or the attempt was made to lift up the uterus. I found the patient exquisitely sensitive to all manipulations, for on passing the sound and gently testing with it the possibility of elevating the fundus uteri, she was seized with so severe pelvic pain that I was obliged to give her a hypodermic of morphine. Naturally I refrained from further active measures, and confined my efforts entirely to mild counter-irritant applications (iodine, iodoform, and glycerin) to the posterior vaginal vault, and to relieving the sacralgia by the galvanic current. I passed an olive-shaped electrode into the rectum, connected it with the positive pole, and placed the negative sponge on the abdomen. At times I placed the sponge on the sacrum for the purpose of including the sacral nerves in the current. Rapid im• provement followed; the pain soon left entirely, and I could distinguish a decided diminution in size and tenderness of the retro-uterine nodules. The lady came every day at first, and later every other day, from Brooklyn, where she was staying with friends, and returned without the least discomfort, although it was winter. After about twenty sittings she expressed herself so much relieved that she felt she could safely return home. I have not heard from her since, but believe she or Dr. Denison would have informed me if her pain had returned."