ELECTRICITY AS A REMEDY.

In a brief reference to the medical virtues of electricity in the treatment of diseases of women, only an outline of its physics can be given, so as to give the reader an approximate idea of its origin and phenomena.

The use that is being made of electricity in the arts has convinced everybody that it is a most powerful agent, which manifests itself in so many different phenomena that it is as mysterious to-day as it was centuries before Christ, when the Greeks first observed it in amber when rubbed with silk, and from which the term has been derived.

Electricity is developed in bodies from a variety of causes, among which are friction, pressure, chemical action, heat, and magnetism. We are acquainted with it only through the peculiarity of its action, and it behaves as a subtile, imponderable fluid of a compound nature, possessing opposite polarity when excited, giving rise to positive and negative electricities, but when at rest these forces seem to neutralize each other, and as such pervade all matter.

Chemical action is usually the most convenient for obtaining electricity for medicinal purposes, and the arrangement through which this is accomplished is called a cell or battery.

A battery in its simplest construction is made of a plate of zinc and a plate of copper partially immersed in dilute sulphuric acid. A disturbance of the neutral electricity now ensues, and by means of a delicate instrument, it may be observed that the zinc plate possesses a feeble charge of negative and the copper a feeble charge of positive electricity; at the same time there is a slight escape of hydrogen from the surface of the zinc. If now the plates are connected by means of a metallic wire, the chemical action increases and the hydrogen gas is now discharged from the surface of the copper. The wire is now traversed by an electric or voltaic current, which imparts to the connecting wire, thermal, magnetic and other properties.

The electricity does not, however, correspond to that which was peculiar to the metallic plates before they were connected by the wire, but the opposite electrical conditions discharge themselves from the wire: the direction of the current in the fluid, being from the positive or copper plate to the zinc or negative plate, and vice versa, so that the wire of the zinc plate is now positive, while that of the copper is negative.

Poles and electrodes. The wires or terminals are called the poles of the battery; instead of the term poles, the word electrode is now generally used. From what was said of the origin and direction of the current in the fluid, it is important to remember that the positive electrode or wire is connected to the negative plate, while the negative electrode is connected with the positive plate.

According to the extent of surface of both zinc and copper plates, exposed to the chemical action of the diluted sulphuric acid, or to the number of cells that are employed, by connecting the copper plate of one cell to the zinc plate of the next, the force and quantity of the electric current is correspondingly increased.

Batteries which consist of one solution and two metals rapidly lose their intensity, partly from the decrease in the chemical action owing to the neutralization of the sulphuric acid by its combination with the zinc, and partly from secondary currents, depositing a layer of hydrogen and metallic zinc on the copper plate, which destroys the dissimilarity of the metals, so that the electrical action ceases or the plates become polarized.

For this reason these single fluid batteries have almost entirely gone out of use, and batteries with two liquids have taken their place.

Electrolysis means to dissolve or decompose, by means of electricity, an organic or inorganic substance into its original elements. If, for instance, a current of electricity of four or five Bunsen’s cells is conducted to two inverted glass tubes, filled with water slightly acidulated to increase its conductivity, gas bubbles rise from the surface of each pole, and upon examination it is found that hydrogen is liberated at the negative pole and oxygen at the positive pole; and as the volume of hydrogen liberated is about twice that of oxygen, the experiment gives at once the qualitative and quantitative analysis of water.

Professor Bartholow, in his treatise on Medical Electricity says: “As animal tissues are composed of substances amenable to electrolytic decomposition, it is obvious that they must yield up their component elements in accordance with the laws of electrolysis. Albumen is coagulated, salts are separated into acids and bases, and water is resolved into oxygen and hydrogen. When the salts contained in the animal tissues—soda, potassa, lime—and water, are decomposed, the acids and oxygen appear at the positive pole, and the alkalies and hydrogen at the negative. It follows that if the positive electrode be composed of metal, it will be corroded by the action of chlorine and the acids, and the negative will remain unacted on and smooth. The tissues in the vicinity of each electrode are necessarily affected by the elements brought to them in accordance with chemical laws. About the positive the mineral acids and chlorine form combinations, and hence do not attack the tissues with the same energy as those about the negative pole. If, however, the positive electrode is composed of zinc, for example, the chlorine attacking it will form chloride of zinc, a very corrosive material. This principle has been utilized to produce caustic effects at the positive pole. Although the negative electrode remains smooth, much more than at the positive are seen these destructive effects from the action of the free alkali liberated in its neighborhood. When an ordinary electrode of carbon covered with soft sponge is made to conduct a strong galvanic current, the skin speedily becomes reddened, and may be made to ulcerate if the contact is sufficiently prolonged. If the carbon is applied directly, an intense burning is produced and the tissues are destroyed, leaving a slough, which is slowly detached and the ulcer remaining is difficult to heal. The caustic action is due chiefly to the soda, potash, and lime. Some effect must also be allowed to the disassociation of the tissues, to their transference from point to point and at the negative pole to the mechanical action of the liberated hydrogen.”

Interpolar regions. The reader must have been impressed with the peculiarity of each pole in possessing affinity or attraction for certain elements that constitute the animal tissue. Oxygen and acids accumulate around the positive pole, while alkalies are attracted to the negative pole; thus it must be an absolute fact that an actual transfer of particles in both directions to each pole must traverse the tissue lying between the two poles; this accounts in a great measure for the difference of the local effect on the tissues around the poles, one being in the nature of an acid the other of a caustic alkali. This naturally gave rise to an inquiry as to the effect that the galvanic current has on the structure between the two poles.

Dr. G. Betton Massey, author of “Electricity in the Diseases of Women,” asks and answers this question in the following manner: “What can be therapeutically accomplished when the seat of the disease is necessarily situated beyond the direct reach of the electrode? An answer drawn from both neurological and gynecological experience is that much can be accomplished; and this is doubtless due, in the first place, to the influence upon nutrition of the chemical changes that occur throughout the circuit, in the onward progress of the particles that appear free finally at the poles to the influence upon nutrition of the circulatory changes that result from vasomotor stimulation, and to the contractions produced in unstriated muscular tissue by heavy currents even at a distance. These results of quiet current transmission are governed in magnitude at a given spot by the density of the current at the situation and by the duration of the application. To accomplish much in the more distant parts of this region considerable strength must be employed, hence a delicate judgment is demanded in the selection of the size of the active pole to avoid cauterization on the one hand, and too great a diffusion on the other.”

To within a comparatively recent period, the methods of applying the electric current for the removal of abnormal growths have been somewhat crude if not dangerous. It appears that formerly altogether too much stress or weight was laid on the chemical or electrolytic effects that the electrodes wrought in the tissues, and very little or no credit was given to the passive current of galvanism as it traversed the tissues from pole to pole. Dr. Ephraim Cutter, of New York, advocated the so-called electro-puncture, and in the galvanic treatment of fibroid tumors of the uterus, these punctures were made through the abdominal walls. The electrodes for this purpose were stiletto shaped, with blades five inches long and three-eighths of an inch at their widest part; these were inserted into the tumor from opposite points. Wounds that were thus inflicted, necessarily involved more or less danger, and, although Dr. Cutter reported a great number of cures, the percentage of mishaps was too great to make electrical treatment popular among the profession.

It was not until Apostoli, a French physician, greatly modified the methods of employing electricity in the treatment of fibroid tumors, and sheared it in a great measure, not only of its dangers, but also of pain, that the medical profession took the question of electrical treatment in real earnest. The practice of Apostoli and his results were published in a monograph by Carlet, entitled, Du traitement electrique des tumeurs fibreuses de l’uterus, Paris, 1884. Apostoli evidently started out with a view to modify the most objectionable features of the electrical treatment. This consisted in reducing the number and size of the punctures and to lessen the painful sensation of the electric current to its minimum, so that the main points of difference are the shape and size of electrodes, and the site that is chosen for the puncture. In the first place he uses only one piercing or needle electrode, which is much smaller than that of Cutter, this may be attached to either the positive or negative cord of the battery, according to the accompanying symptoms. When hemorrhage is a symptom, the positive pole is used internally or carries the needle on account of its anti-hemorrhagic property, otherwise the negative pole carries the piercing electrode. This electrode is always used internally to puncture through the vagina or through the cervical tissue into the tumor; this is not nearly so painful as piercing the abdominal walls, nor does it wound the peritoneum.

The other electrode is called the dispersing electrode, because its purpose is to so disperse or scatter the current of this pole that it is hardly felt by the patient, much less produces any electrolytic or chemical effect on the skin. This electrode is made from a sheet of lead or copper nine by ten inches and covered with a layer of wet absorbent cotton; it is applied over the abdomen. This method is much safer than that formerly advocated by Dr. Cutter, and the results are much better. Dr. Engelman, who has accepted this method, says: “In electrolysis an intensity of 50 to 250 milliampÈres 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 milliampÈres 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 milliampÈres 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 precautions desirable in a first puncture, until the sufferance of the individual patient is tested. The application is repeated, according to the demands of the case and the severity of the treatment, once or twice a week.”

The milliampere meter is a galvanometer to measure the quantity of electricity that is applied, and as a chemical battery will of necessity change, a meter is the only means of judging the intensity of the current; so that without one there is danger of applying the current too strong, or an injustice may be done to the patient, and reproach cast on the treatment by not using it strong enough.

At the annual meeting of the American Medical Association, at Chicago, in 1887, Dr. Martin read a paper, in which he reported three cases that were treated with the most satisfactory results without puncture. The positive or external electrode was applied over the abdomen after the manner of Apostoli, and the negative electrode was placed in the rectum, vagina or uterus, in such a way as to cause the current to traverse the largest diameter of the tumor; this method is to my mind the ideal of an electrical treatment, it is galvanism without corrosion or electrolysis.

The number of eminent authorities that I have quoted, can hardly fail to convince the reader that electrical therapeutics in the treatment of fibroid tumors are not only efficacious, but in the infancy of experimental growth, so that every day will add new proofs and improved methods to the history of this most interesting subject. But this treatment is not limited in its usefulness to the removal of abnormal growths, for it has proven itself equally as effectual in the treatment of chronic inflammatory conditions of the pelvic organs. I have myself attained great success in curing certain forms of these diseases since the publication of “A New Treatment of Chronic Metritis,” by the same indefatigable author, Georges Apostoli, of Paris.

The value of electricity is now so firmly established that a physician who, ignorant of its virtues, and laboring under this self-imposed ignorance, brushes aside any reference to or desire for electrical treatment with a supercilious air, claiming “that there is nothing in it,” advertises himself as incompetent or insincere.

It must be apparent to anyone who has followed this brief outline from the beginning, that this subject requires a special and individual devotion, so as to become familiar, not only with the elementary principles of the physics of electricity, but with the technique of applying the treatment in each individual case. This, few persons have the honesty or ambition to acquire, and if they own a battery, it is more for show than for use. I am convinced that there are great possibilities in store for the curative value of the galvanic current, but it also requires a high order of intelligence to employ it, in order that those hopes may be realized.

“The positive pole is anodyne, sedative, anti-congestive, and anti-hemorrhagic. It combats and prevents the tendency to excessive vascularization, and consequently relieves congestion and inflammation and the pain depending upon these conditions. Its local or polar action, when used within the uterus, is hemostatic or styptic, and caustic, with high intensities of current.

“The negative pole is stimulating and has a marked electrolytic action. It tends to produce congestion, and a derivative effect which favors absorption of tumors, inflammatory deposits and adhesions. But great care must be observed in using it in some conditions, lest a new inflammation be rekindled.”

I have the record of a case where the womb was retroflexed and tied down by old inflammatory adhesions for nine years; the retroflexion dated back to a miscarriage. This woman had been an invalid since that time; her appetite was poor, and her digestion poorer, she was excessively constipated, suffered from pain during menstruation, but at other times there was a constant pain in the small of her back, which ran down the right thigh, the bladder was irritable, and there were neuralgic pains shooting from the ovaries down the groins. All these symptoms became more or less aggravated every few weeks or months. The womb was so firmly fixed or glued down on the lower portion of the spine, that it could not be moved an iota. This woman had tried all the remedies that I could suggest, except galvanism. This I concluded to try, by placing a large dispersing electrode on the small of her back, and the other electrode, properly prepared, so that it did not burn or cauterize, was introduced into the vagina, against the posterior aspect of the uterus. A current strength of from 90 to 120 milliampÈres was applied every other day for ten minutes; in six weeks the organ was quite movable, and in five months all adhesions had melted away, and the womb occupied its normal position, and the patient was in every way restored to health.

The diseases that are curable by galvanism are the different forms of subacute or chronic inflammation of the ovaries, and the consequent enlargement of these organs, small cysts or fibro-cysts of the ovaries are also amenable to the galvanic puncture.

Catarrhal inflammation of the Fallopian tubes, or when either or both ends are agglutinated with inflammatory exudation, so as to pen up their contents, which may be mucous, water, pus or blood, these fluids should be first aspirated or drawn off, and then, by means of appropriate galvanism, the normal conditions of the tubes may be restored.

Chronic catarrhs of the womb are especially suited for galvanic treatment, and when the inflammation invades the muscular structure of the uterus, giving rise to what was described as chronic metritis, there is no remedy that will yield the same positive and satisfactory result as electricity. Plate V gives a practical illustration of the employment of electricity for chronic inflammation of the uterus; the internal or negative pole is introduced into the uterine cavity and held there by the operator, the external or dispersing pole spreads over and rests on the abdomen.

Subinvolution of the uterus. I have already referred to this affection as an arrested involution of the womb after confinement at the end of the natural term, and after abortion. The womb in this condition remains permanently and preternaturally enlarged, and its entire tissue becomes the seat of a subacute or chronic inflammatory process. The vagina is also more or less relaxed, so that the heavy uterus sinks down into the pelvis, imparting to the patient a dragging or bearing-down sensation, which makes walking or any other exertion exceedingly difficult. In subinvolution an extra uterine electrode is not required, but only a vaginal electrode, so employed that a current of high intensity is passed through the uterus; this varies from 50 to 150 milliampÈres. The duration of each galvanization is from eight to ten minutes, and should be repeated every third or sixth day. I succeed as a rule in six to eight weeks in restoring the organ to its normal size, which I ascertain through comparative measurement at the beginning and end of the treatment.

If the subinvolution is complicated with retroflexion, then intra-uterine galvanization after the organ is replaced is the most effective treatment. Old pelvic adhesions and exudations as a result of pelvic cellulitis or peritonitis are amenable to galvanization after hot douches, sitz baths, and other discussives have failed to excite absorption.

Hemorrhoids and prolapse of the rectum; the former is a frequent concomitant of constipation, and the latter may be the result of an imperfect involution after confinement. I have employed galvanism for either with the most brilliant results.

It would be interesting for the reader were I to continue to cite different diseases in which electricity has been successfully employed, but that would require a systematic arrangement of the subject, which would be incompatible with the original purpose of this book. I simply desire to awaken an interest in a comparatively new remedial agent, in its present field of employment. There may be a great many ways to get relief, but that course which offers the least risk to life and the least suffering to the living is the one that should recommend itself to the sufferer. What patients need is not brilliant surgical exploits to make the reputation of an ambitious operator, but the conscientious aid of the conservative physician who is content to labor in the less pretentious capacity of an assistant to nature’s curative energy.