" The stylet or sound, whichever is to be used, is steeped in a strong antiseptic solution, as is also the glass or rubber insulator; the vagina also should be cleansed. For electro-cauterization, the sound, covered up to two inches of the point by the insulator, is introduced into the uterine cavity with the utmost care; if possible it is preferable to intro duce the sound by the sense of touch. If the stylet is used for electro puncture, the point of entry having been carefully decided upon, the instrument is introduced, the point guarded by the index finger of the left hand, the handle grasped firmly by the right, counter pressure being made upon the abdominal protuberance. The puncture is then made for a depth of from one to three inches, according to the size of the tumor, the insulating cover is moved close against the vaginal and cervical mem brane, and care must be taken that the entire surface of the instrument not in action is guarded. The activity of the battery is now tested, the rheophores are attached to the electrodes and the screws firmly bound; the galvanometer needle must point directly to zero. The abdominal plate, evenly adapted everywhere, is held down with gentle pressure by the hands of the patient, while the operator either fixes the sound or stylet with an absolutely steady band, or rests it upon some suitable sup port, as the slightest motion, any jarring of cords or battery, in portable batteries, must be avoided. The patient must breathe evenly and steadily, and allow her hands to follow the respiratory heavings of the abdomen; we must see that the thighs nowhere touch the edge of the electrode, and if perchance the probe is to be passed through a speculum the slightest contact of its metal surfaco with the pole must be avoided. When any pain or discomfort that may have been caused by the introduc tion of the instrument has ceased, the current is established and gently increased, in the first sitting, in the course of a minute up to 50 or 100 milliamperes; later, when the sensibilities of the patient have been tested, 150 to 200, and even 250 milliamperes may be attained in the same time. For very sensitive patients I use the water rheostat, by means of which we can attain the desired intensity, increase and diminish the current without'even the slight shock caused by the addition of element after ele ment; a resistance of 500 or 1000 ohms are inserted, the number of cells probably needed thus brought into action, and the intensity gradually at tained by decreasing the resistance in the rheostat; for the breaking of the current the resistance is increased until it surpasses the intensity of the elements in the circuit.
" The first sitting should not be continued beyond five minutes, the current remaining at its height three minutes, then being slowly reduced. Currents of 200 milliamperes I have continued for eight minutes in later stages of the treatment. During the passage of the current the operator must constantly observe both the galvanometer and his patient. The needle should remain perfectly steady; during the first minute it will show an increase of a few milliamperes, but there must be no oscillation which indicates jarring or shock. The face of the patient and the gal vanometer must be constantly observed, and the operator must be on the lookout for any evidence of irregularity: a momentary contact of sound and speculum would produce a terrific shock. If the bare sound should
touch the vaginal membrane it would burrow its way and leave a grayish bed; if 'the thighs touch the edge of the abdominal plate, which must always be covered by the overlapping conductor, an intense burning is experienced; if not so covered, a shock; and these shocks are trying if not dangerous with such intensities. The most intense shock is caused by a carelessness, of which no one who ventures upon this treatment should be guilty, the sudden breaking of any one of the connections in the circuit, the dropping of the rheophore from the binding post at the battery or from the electrode, or the moving of one of the switches of the battery. In a portable battery, especial care must be taken lest dis turbance be caused, the slightest jar of the battery causing undulations of the current and shock. At the point at which the stylet is inserted, a grayish-yellow foam will accumulate, its mass depending upon the in tensity and duration of the current.
"After the full intensity has been attained and continued as long as seems necessary, the current is slowly reduced from cell to cell, with the utmost evenness and gentleness, and the circuit opened when at O. If the patient be very sensitive we may diminish the current by slowly in creasing the resistance by the water-rheostat. When the current has been broken the rheophores are detached and the active inter-pelvic pole is first removed, with the utmost caution; the abdominal plate is then taken off, the speculum inserted, and the vagina cleansed.
" I am in the habit of dusting iodoform over the cervix, and inserting a tampon of salycilated or borated cotton; in case of puncture I use the styptic iron cotton directly upon the point of attack, and pack it firmly to counteract the possibility of hemorrhage as far as possible. The patient should then lie down or go to bed, if at her home, and if not, as soon as she reaches it; but in all events she must rest in the office long enough to thoroughly dry her garments,which are more or less moistened by contact with the electrodes, notwithstanding all care; in cold weather this precaution must be invariably observed, as serious injury may follow neglect. A twenty-four hours' rest is generally all that is needed, but in individuals more susceptible it is well that they use the ice-bag upon the abdomen and remain in bed several days. The inflammatory swelling which sometimes follows is thus best counteracted and most rapidly reduced; but even when it does occur, I have never seen it accompanied by constitutional disturbance or elevation of temperature.
" The puncture should if possible be made through the cervix into the mass of the tumor; if the first is above the os, the next should be below, followed by one to the right and then to the left; if this is not feasible, we seek the point of greatest projection, towards the vagina, avoiding the peritoneum. In some cases a gush of blood, very profuse while it lasts, but not of long duration, may take place within the ten hours following the application, and the patient must be forewarned that not be alarmed. The firrhly packed iron cotton tampon is the best preventive, but the hot-water injection should also be recommended, as the patient will be much better satisfied to have some means at hand to counteract this apparently threatening symptom.