" On account of the hemorrhagic tendencies of the negative pole, this treatment is only applicable in cases unaccompanied by hemorrhage—a frequent symptom of uterine fibroids; if scanty menstruation, dysmenor rhea, or profuse discharge be present, negative electro-puneture, though not contra-indicated, should be preceded by negative electro-cauterization of high intensity; the uterine sound attached to the negative pole within the cavity, the large plate of the positive dispersing electrode upon the abdomen; we thus achieve an absorbent electrolytic action upon the tumor, though in a less degree, and overcome the co-existing symptoms, favoring an increase of the catamenial flow, overcoming the endometritis, relieving the dysmenorrhea, if any exist. An intensity of from 50 to 100 milliamperes should be used, or even 150 to 200 milliamperes, if decided action on the fibroid is desired.
" In fibroids accompanied by menorrhagia or metrorrhagia this must be first overcome by positive electro•cauterization of the uterine cavity; a platinum sound as the positive pole in the uterus, a large negative dis persing electrode upon the abdomen. It must not be forgotten that when a metal electrode is used in connection with the positive pole in the tissues it must be of platinum or of gold, lest it be corroded and im bedded in the organ. If high intensities be used this is an absolute ne cessity; lot this be remembered as applicable to the treatment of all possible affections. If the ordinary silver or copper probe be used in the uterine cavity as the positive pole, and a current of only 10 or 20 milliamperes is passed. the instrument will be found fixed; and when we attempt to with draw it after a few minutes, some force is requisite for its removal; if we then examine it We find the surface corroded, roughened, and darkened. This is due to the action of acids which accumulate at the positive pole. Should, by some oversight, a corrodible metal be used in this way, the current is gradually reduced and reversed, and, after a negative current of greater strength has been passed for a time, we can then withdraw the sound with ease. In case of hemorrhagic fibroids the positive electro cauterization of the uterine cavity with the platinum sound, with a current of from 100 to 150 milliamperes, should precede electrolysis prop er or negative electro-puncture, until all unusual flow has been over come. In this treatment of fibroids, where the highest intensities are used, we must apply the electric current with the utmost circumspection, taking into consideration all the accompanying conditions, those most to be guarded against being hemorrhage and inflammation.
" Method of application.—I will briefly recall what I have already said as to the method of application, since attention to the minutest details is necessary to success and to the comfort and safety of the patient. The consent of the patient must of course be obtained, as in case of any opera tive interference, and she should be given an idea of the treatment, that she may not be nervous and restless, but remain perfectly quiet during the action of the remedy. She may be promised that she will receive no shock, which embodies the idea of electricity to the laity, and is what ladies dread most; she can be assured that she will suffer no unbearable pain; that she will experience no discomfort whatsoever within, but that there will be a burning, not excessive, outside upon the abdomen. The
corset is removed, the skirts loosened so that respiration may be free, and the abdominal plate, warm and well moistened in simple hot water, is snugly adapted. The patient takes her place upon a gynecological operat ing table or chair, in the dorsal decubitus, the thighs flexed precisely as for ordinary treatment. The electrodes needed are a gold or platinum sound of ordinary dimensions, and a needle or stylet of the same material (though the steel instrument may be used) well fixed in a firm handle; for puncture through the vagina, this instrument should be of a length equal to that of other gynecological instruments, sound or applicator; for both sound and stylet we must have a separate insulator of heavy rubber, better still of glass, which may be kept more thoroughly aseptic. The abdominal or dispersing electrode is a thin plate of lead or tin alloy, as large as it can be used upon the abdomen, averaging six by nine inches, covered with a thin layer of sculptors' clay, held in place by gauze, or with punk or absorbent cotton and a soft thin buckskin cover, which is equally good.
" The shape which admits of the use of the largest possible plate is the oval, or, better still, the modified form of my plate, oval with convexi ties to avoid the thighs. This electrode is thoroughly soaked in water as warm as is comfortably borne, and snugly adapted to the abdomen, that it may rest in place a few minutes before treatment is begun, the current then passing more readily, with less pain; the friction, as I may say, caused by the efforts of the electric current to pass the resistance offered by the dry epidermis being possibly a source of pain, certainly lessening the effect of the current by loss of intensity in overcoming the greater re sistance. If this precaution is not observed, the operator will find an intense burning during the first few minutes, which lessens, however, as the tissues become soaked; the desired intensity having been attained, notwithstanding that no more cells are inserted into the circuit, the gal vanometer will indicate an increase in high intensities of as much as 10 milliamperes, and yet the pain lessens decidedly if the positive be the dis persing pole. I have seen it rise from 50 to 100 milliamperes, without augmenting the number of cells, when the abdominal plate had not been placed until the last moment, so that the dry epidermis offered a resist ance at first difficult to overcome. In other words, when the epidermis becomes soaked, less resistance is offered, more electricity passes, and if the positive be the dispersing pole the pain is lessened by the anesthetic effect of the pole, diminished at times to a minimum, though the inten sity of the current be increased. Before placing this plate we must examine the abdomen to see if it shows any abrasions or excrescences; if so they may be covered with a small piece of oiled silk or plaster, as such a spot would be the centre of intense pain if not guarded. An abrasion, a small blister where the epidermis is removed, centres upon itself much of the electric force, which always seeks the best conductor; or if an ex crescence, the increased pressure would cause a concentration of the cur rent at this point. The plate having been placed, it is covered by a warm dry towel, or a piece of oiled silk, to guard all garments in contact with it from moisture, which may lead to serious colds, to injury as well as mere discomfort.