Engelman!' is the most pronounced advocate in this country of high currents in the routine treatment of the diseases of women, and we instance his views by the following extracts from his recent paper:' " It seems but natural that a current of sufficient intensity to accom plish the desired result in the shortest possible time, without injury to the patient, should be used.
" Hitherto currents altogether too weak to be effective have been used, and to this we must, among other reasons, ascribe the incompleteness of results; it is evident that when a feeble remedy is indiscriminately used, and widely dispersed at that, but little can be expected. Tripier, it may be recalled, speaks of a current of from 8 to 15 milliamperes as one of average strength, and calls all over 20 excessive, and Ranney says that ' no patients will endure a current of over 20 milliamperes through a high resistance, and that very few will bear over 12 milliamperes.' What he calls a high resistance he does not state, and vague assertions such as this merely aggravate the existing confusion.
" How weak the currents used, even by scientific operators, are, is evident from the fact that many galvanometers are not made to register over 20 milliamperes, few as high as 40 milliamperes, and the highest those of Gaiffe, register not over 50 milliamperes.
"To Apostoli is due the credit of boldly passing boundaries which seemed already fixed by practice; in his work hitherto recorded he has used as high as 100 milliamperes, and last fall, during my attendance upon his clinic, he had begun to overstep this then most extreme limit, using up to 120 milliamperes, and had ordered an instrument which should .ndicate 150 milliamperes. I did the same, but during my winter's work, I found that even this intensity, hitherto unknown in medical electro-therapeutics, seemed insufficient, and that I could accomplish results more readily and more effectively by currents even stronger. As far as I could judge by the limited range of my galvanometer, and by the aid of the rheostat, I had used up to 200 milliamperes! I have since obtained an instrument indicating 250 milliamperes, and a recent letter from Apostoli informs me that his experience has been precisely similar, which confirms my belief that a wide range of possibilities is open to electro-therapeutics.
" Such intensities are possible and called for in gynecological electro therapeutics, where we are generally dealing with circumscribed parts, provided the localized polar method be adopted, by which we obtain low resistance and limitation of the current. I must again emphasize that in
all I have said I have had reference to electricity in gynecological practice, and only to galvanic and faradic electricity, not to static electricity, or to large quantity galvanism as used for the cautery.
" I do not claim that such high intensity of current is always judicious or necessary. I sometimes use only 1 or 2 milliamperes, often from 20 to 40, more generally from 40 to 80, and merely wish to establish the fact that if desirable, if necessary to accomplish the effect intended, currents of greater strength can be used without injury to the patient, without causing undue pain, and without the use of anesthetics." These views of Engelmann, re-enforced as they are by the report of numerous cases in which they were practically tested, deserve serious consideration. For the present it may be stated that much stronger currents may be used than have hitherto been deemed safe, and thereby not only is the time requisite for their administration much lessened, but the use of electricity is rendered less irksome both to the gynecologist and his patient. Furthermore, in view of the unquestionable fact that much benefit has in the past been derived from the application of weak currents, the future holds out the hope of permanent relief, in case of certain in flammatory affections of the uterine appendages, from resort to strong currents, something which from other routine measures we have never been justified in predicating. It is sufficiently apparent that definite rules for the choice of low or high intensities cannot be exactly formu lated. This is a point which each observer must determine for himself in individual cases. It should ever be borne in mind, however, that elec tricity must be considered, in its routine applications, simply as an adjuvant to other methods of treatment, and that while some of the agents at present in use may probably be largely dispensed with, there are others which are simply rendered more efficient by the scientific application of electricity. These points it will be our endeavor to ex emplify in the discussion of the individual affections in the treatment of which electricity has proved of value.