" I have entered so fully into the mechanical details of the treatment to recall them distinctly to mind, as they are absolutely essential in these cases, and will serve as a guide in all other applications, and once under stood I need not enter again and again upon the same points.
" We must always warn the patient of what is coming; we must first apply the dispersing electrode to the abdomen, thoroughly moistened with warm water; we must have the intra-pelvic electrode aseptic, and intro duce this with the greatest possible gentleness; we must thoroughly insulate all but the active portion of the instrument, avoiding metallic contact with vagina, vulva or speculum, and never establish the current until all intra-pelvic disturbance has ceased, always increasing the current very gradually, avoiding all pain at the site of the active pole, hearing in mind this most important and invariable law in gynecological electro therapeutics that the intrauterine or intra-pelric pole must never curare pain; in fact, should not be fell; upon the site of the abdominal diapers ing pole the burning can be lessened by increasing the size of the electrode. All shock must be avoided; the connections made before the current is established, and not severed until after it is broken.' Beyond this minute description of this method, which we borrow from Engelmaiin, because he has practically worked it out under the guidance of Apostoli's experience, we are unfortunately in a position to make no positive statement. That the method, when attention is paid to minute detail, is not dangerous or very painful may be accepted as true, and in this respect it has the advantage over double puncture through the ab dominal wall. What is wanted, however, is comparative evidence from
a large number of observers that the method is effective, and this evi dence is not as yet at our disposal. It is not claimed for the method that it will cause the disappearance of the tumors, but only that by means of it the growth of the tumor may be arrested, diminution in size acquired, and the symptoms palliated. If such is the fairly uniform result then obviously this method of electrolysis should be ever tested before subject ing a patient to that most dangerous of all abdominal operations, where the tumor is large, hysterectomy, as also before resorting to removal of the tubes and ovaries for the purpose of inducing early menopause and thus indirectly affecting the tumor. The method has the advantage over the injection of ergot in that, to judge from the reported cases, the effects are more speedy as regards palliation of the symptoms. The time is pre mature, however, for any further expression of opinion, and will remain so until gynecologists are educated up to the use of such high intensities as Apostoli and Engelmann claim are a sine qua non. So far as we are aware no deaths have been reported after the use of this method, while a number are directly traceable to that which is advocated by Cutter, Freeman and others, a method which it should be stated has never in spired much confidence in the profession and in regard to which many of the leading gynecologists have pronounced themselves as opponents.