The internal electrodes are either vaginal, cervical, uterine, rectal, vesical, since it is obviously possible and desirable to utilize all the cavi ties adjacent or in connection with the pelvic organs for the localization of the electric current. These electrodes should be covered with chamois or absorbent cotton, except where caustic effects are desired.
The vaginal electrode shown in Fig. 10 is of use for making applica tions to the walls of this canal, or else we may use a sound (Fig. 11), on'the end of which metal balls of various sizes are screwed, this latter form being especially applicable to instances where we wish to localize the current at a special point of the vaginal vault. This same sound with the smaller ball attached may also be used as a vesical or a rectal electrode, and on account of its small size it is peculiarly adapted to virgins. The metal staff may be effectively insulated by slipping a piece of gum elastic catheter or of rubber tubing over it. A convenient rectal electrode has an olive tip (Fig. 12). For the cervix a cup-shaped electrode answers well, and in the cervical canal, where it is patulous, the small ball elec also be used.
For intrauterine electrization there are a number of electrodes at our disposal. They are differently insulated according as it is desired to act on the entire endometrium or only on the fundus. In the first instance the insulation is to within 21 inches of the tip, and in the second np to about of an inch. In certain instances, as will be noted in its proper place, it is desirable to confine the current entirely to the uterus, and then a special electrode is needed. It is in this connection that Apostoli has devised a double or bipolar electrode, which in his hands has proved serviceable. It contains the two poles, the one carefully insulated from the other. The stem of the electrode is composed of two metallic cylinders, and each appears separately at the extremity of the sound. In Fig. 15 four models are shown, the larger being intended for cases where the uterus is large and its cavity widely dilated. The special ad vantages he claims for this electrode are: " Suppression of the cutaneous pole; concentration within the uterus of the entire electrical action; diminution of pain owing to the absence of any application of the current. to the skin; its greater efficacy, since the highest degree of uterine con tractility is obtainable with ease and the least pain from the use of stronger currents, of greater intensity, and consequently more active." ' The electrodes are connected with the battery by means of conduct ing cords of different colors in order that the rator may recognize at a glance the negative from the positive pole. As we have already stated, the poles of a galvanic battery are essentially different in their effects, and their individual properties must ever be utilized according to strict in dication. The diagnosis once made the operator should select the pole which he desires to utilize, and the intensity of the current should be drawn from it, the current from the other pole being spread over a large surface and thus neutralized. We are speaking now, of course, of direct
clectrization, where one electrode is internal and the other external. The electrodes should always be placed in position before the circuit is closed, and they should never be removed until the circuit has been opened. The closing and opening, further, should ever be gradual, the aim being always to avoid unnecessary shock to the patient.
Important questions which we must now consider are in regard to the proper intensity of the current and the duration of the application, ques tions which are in a rather unsettled state, and which further experience is necessary to finally settle. Until quite recently weak currents and long seances were the rule, and have yielded quite satisfactory results. Muncie says,' " a mild, steady, absolutely painless current from a galvanic battery will answer every therapeutical purpose, and is iu every way preferable to a powerful or interrupted constant current, which causes painful shock and gives positive pain The faradic current, on the other hand, is effectual exactly in proportion to its strength In order to obtain permanent relief, in fact in order to obtain any appreci able relief from galvanism, it must be given often, steadily, and for a long time The sittings should vary from fifteen to thirty minutes each." This quotation fairly well expresses the practice of the majority of gynecologists who have busied themselves at all with elec tricity. Latterly, however, a number of observers have published results obtained from the use of stronger currents in far less time, and a study of these results forces the conclusion that in gynecology we have been travel- / ling rather more slowly than is at all requisite, for no one will gainsay the assertion that if a given result is obtainable in less time from the use of strong currents these should be resorted to by preference, provided it can be shown that they are painless and do not injure the patient. The electro-therapeutics of the female genital organs are, however, as we have indicated, in a very unsettled state, owing largely to the fact that instru ments for precise measurements of intensities are only beginning to be used by gynecologists, and therefore data derivable from experience in the past, when measurements were rarely made and electricity was used empirically rather than scientifically, cannot be utilized for drawing deductions of value. The latest writer on the subject of the use of elec tricity in gynecology says, " there can be no question but that too weak currents have hitherto been used in the treatment of many of the diseases of the female sexual apparatus. Various conditions which I formerly failed to relieve have of late years responded fur more readily to treat ment simply because of the greater intensity of current that I have, with increased boldness, attempted.''-' He admits, however, that there is scope for difference of opinion in regard to the number of milliamperes neces sary to accomplish a given object, and for routine purposes he is for the present satisfied not to exceed fifty milliamperes.