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.
[Illustration: PLATE V.
Apostoli’s method of employing intense galvanic currents without
discomfort or injury to the patient.
The internal electrode, which he calls the _excitateur intrauterin_ is
held in the hand of the operator. The _dispersing_ electrode covers the
abdomen.]
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.