Apostoli and Engelmann pursue a different method in the electrolytic treatment of fibroids. The practice of the former and the results ob. tained have been described by Carlet.' Currents of very high intensity are used, the external electrode consisting of the layer of potter's clay to which we have already referred. In his choice of the internal electrode he is guided by the fact as to whether meno- or metrorrhagia is an ac companying symptom or not, the positive pole being internal, on account of its anti-hemorrhagic property, where hemorrhage is a symptom, but otherwise the negative. The internal pole chosen is introduced into the cavity of the uterus where possible; if not an opening is made into the tumor per vaginam by means of the negative pole and its caustic, deriva tive action is utilized. The seances are frequent in number, of short duration, and some time elapses before any special effect on the tumor is noted, but the method is said to be free from danger if the operator is careful in its application and proceeds slowly. At the time of the writing of Carlet's monograph the method had been on trial for two years. Ab solute cure had never been attained, but cessation of or diminution in growth had frequently been noted. The method had then been tested in one hundred and eighteen cases, and since this number bas been largely increased.
This method of Apostoli's has been accepted by Engelman and he has utilized it with certain modifications. Since this method suggests itself as safer than that advocated by Cutter and Kimball, we cannot do better than insert here Engelmann's description of and remarks on the method as they appear in his recent monograph:' " Electrolysis proper is the typical treatment for the reduction of neoplasms, especially of uterine fibroids, in which we utilize both the polar and interpolar effect; the polar action of the metal cathode within the tissues of the growth, the most useful chemical effect of galvanism, and the catalectrotonic ac tion, that of the current emanating in concentrated form from this nega tive pole, as it passes through the tissue and is dispersed upon the opposite surface in the large neutral electrode.
" We may also puncture from both sides, using a penetrating needle in connection with both the positive and negative poles. This is admissi ble in external growths readily attacked from all sides. In the case of uterine fibroids, intramural or sub-serous, I consider negative electro puncture per vaginam, through the tissue of the cervix if possible, by far preferable to puncture by both negative and positive electrodes through the vaginal and abdominal portion; I object to any puncture through the abdomen, unless the tumor be agglutinated to the parietes, on account of the most unnecessary danger and suffering which invariably accompanies this proceeding. The puncture of such a tumor through the cervical tissue, or even through the vagina, avoids the peritoneum and causes but very little pain. The current can be dispersed by a sufficiently large
electrode upon the abdomen, so as to make the treatment very bearable and possible in the office, even if the highest intensities are used. If we puncture through the abdomen an anesthetic is necessary; the peritoneum and abdominal cavity are penetrated, and the danger of inflammation is at hand, as fluid is liable to exude into the cavity. This very serious risk accompanies the abdominal puncture in addition to minor dangers— such as the possibility of opening a large vessel—which we have equally in the vaginal puncture, but which seems to exist rather in theory than in practice, as I have seen no such results. The abdominal puncture assumes the dignity of an operation, necessitates anesthesia, and offers no corresponding advantages over the vaginal method. Among the comparatively small number of operations of this kind performed, cases of peritonitis, perimetritis, and death have occurred. If bipolar electrol ysis is desirable, this may be effected altogether through the vagina; but, as a rule, negative electro-puncture is advisable in preference to bipolar electrolysis—the insertion of both positive and negative needles into the tumor per the pain and danger is diminished by one half, one puncture being made instead of two.
" In electrolysis an intensity of from 50 to 250 milliamperes may be used for from three to eight minutes. All possible precautions must be taken in the first sitting in order to discover any idiosyncrasy of the patient, and a current of 50 milliamperes will suffice, attained by slow increase. The patient should lie down quietly for several hours after the application. If an intensity as high as 100 milliamperes is used at the first sitting, it is preferable that she remain in bed for the first twenty four hours, and that a cold compress or an ice-bag be placed upon the abdomen, to overcome any tendency to inflammatory reaction which may occur; hence the attention to details which is necessary, and the precau tions desirable in a first puncture, until the sufferance of the individual patient is tested. I have used as high as 250 milliamperes in my office, allowing the patient to return home in the street cars after an hour's rest; but such intensities must be attained only by gradual increase, and where we see any indication of inflammatory action the patient should remain in bed for a day or two, using the cold compress or the ice bag. The application is repeated according to the demands of the case and the severity of the treatment once or twice a week. Hemorrhage occasionally follows, sometimes soon after the treatment, sometimes not until six or eight hours have elapsed. This may be either from the uterine cavity, the fluidifying effect of the negative pole, or from a large vessel in the line of puncture, which has been temporarily closed by cauterization dur ing the action of the agent.