ELECTRICITY IN ECTOPIC GESTATION.
The earliest record of resort to electricity for the purpose of destroy ing the foetus developing outside of the uterus is in the year 1853 when Bachetti and Burci used electro-puncturo with the faradic current and successfully arrested gestation in the left Fallopian tube. ' About thirteen years later Braxton-Hicks tested faradization in a case of abdominal pregnancy, of three and a half months' duration, then resorted to punc ture of the cyst per vaginam, and the patient died a few days later from internal hemorrhage. In 1869, Allen, of Philadelphia, resorted to fara dization in a case of abdominal pregnancy at the fourth month with suc cess, and since this date the method may be said to have gradually gained ground, until to-day it has become the accepted procedure in instances of early ectopic gestation. It should be stated, however, that resort to elec tricity in this connection has remained almost entirely limited to this country. European obstetricians, with the exception of a few English, have held aloof from the method, preferring that by puncture of the cyst or the injection of narcotics, or latterly the very radical means of lapar otomy for the removal of the sac (Veit, Tait, Martin, and others). In this country, however, instances have multiplied so rapidly that in the neighborhood of fifty are now on record where electricity has been used with success in ectopic gestation, and at one time or another our most dis tinguished obstetricians have expressed their belief that it is the safest of all methods of treatment applicable to the anomaly in its early stages. The method indeed would need no defence, and at this date no lengthy exposition, were it not that latterly, owing to the strong operative ten dency of the times, there appears to be a desire to substitute laparotomy for it, a substitution for which, it seems to us, in face of the recorded successes from electricity and the greater risk of laparotomy, there is no justification. Thomas, of New York, who has bad such an exceptionally large experience in cases of extra-uterine pregnancy, states:' " The growing triumphs of abdominal surgery are apt to lead to the conviction that laparotomy should as a rule be the procedure of election in these cases. From this view I unqualifiedly dissent. In the electric current we appear to have an infanticide agent of reliable character, and, as in the woman, as Leopold has proved to be the case in the rabbit, the re tained foetus seems to be readily dealt with by the absorbent process of nature, this should be in the early months of pregnancy (I should say up to the fifth month) preferred to the more radical and dangerous proced ure of laparotomy." In another paper the same gentleman says:' " It (electricity) has these great advantages; if an error of diagnosis has been made, this remedy will do no harm; if the diagnosis be correct, experience proves it to be sufficient in its effect; it is almost painless, and causes none of the nervous disturbances created by a cutting operation, and it requires no surgical skill in its use." The objections which have been urged against resort to electricity are two in number. In the first place there is liability to rupture of the cyst, and, in the second place, we kill the fwtus and then leave it within the maternal abdomen where it may at any time suppurate and give rise to septictemia. Both of these objections are purely theoretical, seeing that in the large number of cases in which electricity has been resorted to rupture of the sac has never occurred, nor, so far as we can find any reference, has the dead fwtus become a source of danger to the mother. The only case which would seem to speak against electricity is the one recently reported' by Janvrin, of New York, and for this reason we record the essentials here. It concerns a case of tubal pregnancy at about the seventh week, where a delay in the application of electricity was ne cessitated by the fact that the doctor had engagements out of town; on his return the patient was told about her condition, and that it would be nec essary to resort to electricity for the destruction of the foetus. To quote
from the report, " While explaining to her what should be done, she was seized with intense pain in the right hypogastrium, severe vomiting, cold clammy perspiration, extreme pallor and rapid pulse, in fact the usual symptoms of collapse from shock. hypodermics of morphine and brandy were given at once, and hot applications to the extremities, and after a couple of hours reaction began. I attributed the symptoms to nervous shock, partly the result of the first onset of colicky pains, and partly the result of mental excitement. I could hardly believe there had been any rupture of the sac, although the pallor and faintness seemed to indicate a loss of blood. During the night reaction came on gradually, and by morning there was considerable tenderness over the site of the sac, a rise in temperature to 101°, pulse 116, and still rather feeble, and slight tym panites. There was evidently some inflammation of the tube and broad ligament; but as the patient was gradually recovering from the shock, and the bleeding, if any had occurred, had ceased, the demand for lap arotomy, which I had thought the previous evening would be called for within twenty-four hours, had passed for the time being." The localized pelvic inflammatory trouble yielded in a few days, and after consultation it was decided to resort to galvanism to destroy the foetus. " On the 15th at 4 P. u., the first application was made, Dr. Rockwell applying the positive polo to the abdominal wall, over the site of the tube, and direct ing the amount of current, while I applied the negative pole per vaqinam, to the lower part of the growth. Dr. Rockwell writes me as follows in reference to the current: " On account of the localized peritonitis that was supposed to exist, a rheostat was made use of in all the applications, so that the current might be increased to the maximum strength used without interruption, and consequently without shock, and in the same way gradually decreased. The highest strength of current used was about twenty volts," and each of the applications consumed ten minutes. I will add here that this was the twelfth case of extra-uterine pregnancy in which Dr. Rockwell had made use of galvanism to destroy the foetus, and in all of the other eleven cases the result had been perfectly success ful both as regards the mother and the child. The application was re peated on the 16th and 17th. The foetus was probably killed by the first application, but the two following were made use of simply to make its death perfectly certain. The patient was in good condition and spirits, and during the night of the 17th slept perfectly well, and awoke on the morning of the 18th feeling much refreshed. She had been kept in bed and perfectly quiet since the 9th (the day upon which she had experi enced the severe shock), and was guarded very carefully in all respects, so as to avoid all exertion on her part... If there had been any hemorrhage on the 9th it was thought that sufficient time had elapsed between that date and the 15th to allow the surface to heal before galvanism was re sorted to. The tenderness and other symptoms of peritonitis had passed away, and all the symptoms seemed favorable for a speedy recovery. Suddenly, at 9 A.m. of the 18th, she complained of feeling very weak, became cold and very pale, and the pulse extremely weak. The nurse immediately sent a messenger for me, but an hour elapsed before I was found and reached the patient. In the meantime a neighboring physi cian had been called, and he had made use of all the usual means for rallying the patient, but within an hour succeeding the appearance of the symptoms of hemorrhage death had taken place." At the autopsy the sac was found intact, with two large arteries crossing its anterior surface, and a number of smaller branches radiating from them. One of these branches had ruptured at the time of the first appearance of shock, and from this the secondary hemorrhage had occurred to which the patient had succumbed.