It is apparent what difficulty there is in making definite statement in regard to the strength of current which it is essential to use in the elec trolytic treatment of fibroid tumors. The data for drawing our conclu sions are entirely too vague, seeing that operators, with few exceptions, do not state the current' strength used in milliamperes. Sufficient the statement for the present that resultelave been obtained both from feeble currents and long sittings, and from high currents and short sittings. This subject is one in which as yet each individual must experimentally work out his own deductions. We shall describe, somewhat in detail, the method advocated by Cutter, and next that favored by Apostoli and Engelmann, in the application of electricity to fibroid tumors. First, however, we must speak of the needles by means of which the growths are punctured. Beard and Rockwell' thus describe these necessary ad juncts: " For producing electrolysis in tissues beneath the skin fine needles of gold or gilded steel are used. The advantage of the gold is that it resists oxidation better than any other metal. Gold or gilded needles can, however, be used only with the negative pole, since with the positive they would be acted on. The conductors may be composed of two, four, six, eight or more needles. The needles may be insulated with hard rubber or collodion, or shellac, for about one-third of their length, so that when introduced into a tumor the skin may not be acted on and inflammation excited." Cutter' thus describes the electrodes he is in the habit of using: " An ordinary surgeon's director was taken, its point and edges were sharpened, an ebony handle was fitted to the flattened end, and two inches of the larger end were japanned for insulation. The dimensions are as follows: Length of instrument over all, eight and one-half inches; of blade, font and seven-eighths inches; width of blade at widest part, three-eighths of an inch. The angle made by the two wings of the blade may be repre sented in section by the letter V. The point of the angle is made dull. The effect of this arrangement is to draw the tissues over the sharp edges, represented by the free ends of the letter V, and thus cause a ready sec tion of the tissues penetrated. It is evident also, that the union of the two blades at this angle offers a great resistance to bending in any direction." The patient having been anesthetized Cutter inserts these electrodes deep into the tumor. The point of insertion depends on the location of the tumor. " If unilobar and in the cavity of the abdomen, one electrode is passed through the skin in on one side of the tumor, and the other in on the other side of the tumor. Or if the lobe or tumor is small, one electrode may be passed under the other at a distance of half an inch. If the tumor occupies the cavity of the pelvis and has several lobes in the abdomen, one electrode may be pushed in from the rectum or from the vagina, and the other electrode may be passed in through the abdominal walls. If the fibroid is confined to the pelvis, both electrodes are to be introduced through the rectum or vagina. Care should be taken to avoid any strongly pulsating vessel." In Cutter's reported series of cases the applications varied from three to fifteen minutes in duration, and the best results were obtained after the shorter interval. " The length of time was adjudged from the systemic symptoms. If the pulse became accelerated, the respiration hurried, the face pinched, the coun tenance hippocratic, and the skin sweaty and cold, it was thought time to stop. Etherization masks these symptoms somewhat, and should be allowed for, that is not to push the time too far. The first operation should be short, and, if well borne, the time may be increased in future operations."' The applications were repeated once a week, or every fort night, in certain instarres every day. The after-treatment consisted in confining the patient to bed for a few days.
Of the fifty cases recorded by Cutter the following is the resume of the results: in seven cases there was no arrest of the growth; in four cases, there was a fatal result; in twenty-five cases the growth was ar rested; in three cases, the symptoms were relieved; in eleven cases, there • was cure.
In the transactions of the American Gynecological Society for 1886, Baker, of Boston, reports the conclusions he has reacLod in regard to the value of electrolysis in the treatment of fibroid tumors. The method he has followed is essentially that of Cutter and of Kimball, although in a number of details he is at variance with them. He has tested electrol ysis in fourteen instances with the result of causing entire disappearance of the tumor once, and in twelve diminution from one-third to one-half. In the remaining instance, although the symptoms were greatly modified, there was no appreciable effect on the size of the tumor. In common with many others Baker does not approve of the form of battery which Cutter favors. He states that " the resistance of the body or of the tumor to the galvanic current being great, all authorities agree that the size of the cells should be moderate, or small and numerous, in order that the intensity of the current may be increased, and thus the resistance over come; whereas in the battery described (by Cutter) the surface of the plates is so great that the quantity of galvanism generated is large, which is valuable when thermic action is desired, but the intensity of the current is so low that the power of such a battery in conveying a galvanic current through a tumor would be small." He hence uses a Fleming and Talbot
battery of thirty cells, and steel electrodes japanned to within one inch of the tip, this being gold-plated. His experience leads him to formulate the following rules: 1. It is best to select a time for resort to electrolysis other than during, or for a week before, the menstrual period. 2. An anesthetic should always be administered. 3. Electrolytic needles should be used for both positive and negative poles. 4. The needles must be absolutely clean. 5. They should be buried deep in the tumor so that the current may be entirely limited to the growth. 6. The needles should be inserted at the most prominent point of the tumor, either through the abdominal walls, the vagina, the interior of the uterus, and the two needles should not be too nearly approximated. 7. The two electrodes being in the growth, one externally and the other internally, it matters not whether the positive needle or the negative is internal. 8. The needles having been inserted, the circuit should be completed, and, be ginning with four to six cells, we should within two or three minutes gradually increase the number to from eighteen to thirty cells of an or dinary battery, the number required varying much with the cleanliness of the battery and the freshness of the fluid. 9. The length of time oc cupied in the application should be from ten to twenty minutes, to be determined by the character of the pulse; and when this is found to be much more slow than normal and weak, the current should be either entirely discontinued, or the number of cells in use diminished. 10. There should be no interruption of the current during the application, and this should be gradually diminished and the circuit opened before withdrawing the electrodes. 11. The application should never be made in one's office, for the patient should always at once be put to bed and remain there for one week.
Baker has never found it necessary to make frequent applications. As a rule he waits a number of months after the first before repeating it. Only in one instance of the fourteen was he obliged to make three appli cations. Muncie's experience is in the same direction. In a case of large sub-peritoneal fibroid in which he tested electrolysis, puncturing through the vagina with the negative pole, and using a large abdominal electrode for the positive pole, although after two applications the patient refused further treatment, when he saw her about one year afterwards the tumor had disappeared. Freeman, of Brooklyn, is another advocate of electrol ysis, particularly in case of interstitial and sub-peritoneal tibioids. lie has treated eight cases,' and his conclusions' are as follows: All, or nearly all, non-malignant growths of the uterus may be cured by electrol ysis without endangering We, if taken at an early stage. I have not attempted to cure in this way those immense fibroids, measuring more than twelve inches in diameter. The kind and form of needle and the manner of introduction are of the greatest importance. That for the negative pole should be of steel, properly tempered, and strong enough not to break, insulated to within one-half or one inch from the point, the whole perfectly smooth and round, and brought to a fine point with out any cutting edge. This needle may be passed through any of the tissues without harm, as it separates but does not divide them. It is to be passed through the abdominal wall into the tumor from the most con venient point, always avoiding the intestines and bladder, or, in case of post-uterine fibroids it may be passed through the vaginal wall into the tumor, making sure, in every case, that the un-insulated portion of the needle is entirely buried in the morbid growth. Hydrogen gas collects at this pole and keeps the needle always bright. The positive pole should never be attached to the needle that is passed through the peritoneum into the tumor. It should be attached either to a platinum probe of large size, insulated and inserted well into the cavity of the uterus, or to a slightly curved and insulated platinum needle which is passed through the os uteri and thrust into the base of the tumor. A spring clamp should be used to connect the needles with the conducting wires so as to prevent frequent accidental openings and closing of the circuit. Sixteen to thirty ordinary zinc-carbon cells is as strong a current as I would advise, and from fifteen to forty minutes the limit of time. An anesthe tic should always be used, though the patient may be kept very lightly under its influence after the needles are introduced and connection is made with the battery, as the pain is not severe except at the opening and closing of the circuit. It is better to give plenty of time between the operations than to be in too great a hurry. Once, or at most twice, be tween the menstrual periods is often enough, and iu some cases too of ten.' In Martin's paper,' three cases are recorded where satisfactory results were obtained without puncture. He used a current of high tension and of small quantity, the negative electrode being placed in the rectum, vagina, or uterus, and the external, the positive electrode, on the abdo men in such a way as to cause the current to pass through the largest diameter of the growth.