With this issue we commence the third year of our regular contribution to this electro-therapeutic department. When experimental philosophy first gave practical electrical currents to the uses of the world they passed from the hands of physicists and philosophers into the medical profession, which, in turn, for the most part, passed on the gift to a shrewd and sagacious set of men called quacks, who knew a good thing when they saw it. They got great glory and money out of what scientific medicine spurned. But at all times for a century past there have been isolated men in the profession applying their genius to the creation of a reputable electro-therapy.

After Duchenne labored the task was easier. When Apostoli appeared the beginning of the end was in sight. To-day the therapeutics of medical electricity is firmly established, and not more empirically than the therapeutics of the majority of drugs. If pathology was an exact science electro-therapy would be much more exact than it has yet become, but another ten years of progress may do much in this respect.

At one time neurology almost monopolized expert skill in the uses of medical currents. Later the gynecologist took hold of the crude, cheap haphazard apparatus which supplied this agent to medicine and under the guidance of a brilliant and

methodical leader developed the manufacturer into a skilled workman, producing the high grade apparatus we now possess; and with these improved means and the surgeon's aid extended the application of electricity into half the domain of practice.

Finally, the general practitioner is recognizing the utility of acquiring sufficient knowledge of technique to keep in his own hands a great number of cases which otherwise would slip away from him- cases especially which yearly fatten the pockets of the venders of "patent medicines."

Four of our recent issues have been devoted to an important phase of electro-therapeutics, involving both refinement of apparatus and advanced knowledge of electrical methods to bring to pass the excellent results described. These uses of faradic sedation in acute local inflammatory processes have served to illustrate in a very interesting manner the broadening influence of improved appliances and the general application of the teachings of electro-physics. It is something of a jump from the old magneto-electric contrivance to the high tension induction coil currents of to-day, and from the neurologists nerve and muscle effects to the treatment of parotitis, appendicitis, carbuncle and acute inflammations of the pelvic viscera, reported in our late numbers. It is fitting that our space should be devoted

in this beginning of a new year of medical progress to the branch of work in which that progress has been most representatively promoted so far as relates to therapeutical achievements of electricity, viz.: electro-gynecology.

The pelvic affections which most concern the average physician for tunately are the very ones in which electricity has proved most reliable and beneficial.

Omitting surgical exigencies it may be fairly stated that the following conditions are more successfully treated by electro-medical methods than by any of the customary routine or topical forms of treatment which do not include electricity. In fact this agent is nearly indispensable to securing the best results in disorders of menstruation, hemorrhage, neuralgias, subinvolution, undeveloped uterus, stenosis, sterility, displacements, prolapsus, metritis, endometritis, peri-uterine inflammations, exudations and adhesions, leucorrhea, muscular debility of uterine supports; and to these may be added uterine fibroids. Intelligent discrimination in cases of the latter will tend to obviate disappointment and prevent blame from falling upon electricity for failure to extend its influence into the realm of miracle.

In

their local applications medical electric currents are defeated by certain conditions-suppuration for example --and by malignant degenerations as well as by cystic tumors, etc. Electricity can accomplish enough good, however, in the female pelvis to render it unnecessary to try to make it cure everything. Classifying uterine fibroids into sub-mucous, sub-peritoneal and interstitial, it will dispel confusion in the reader's mind to state that in the interstitial class alone is Apostoli's method indicated and successful. In these cases it cures all the bad symptoms-hemorrhage and pain-arrests the growth, holds it in check and often reduces the size of the tumor, but not always.

Its great work lies in nullifying the evils of pressure and the growth of the neoplasm, and doing it safely.

Surgery removes the tumor, but interstitial fibroids are least amenable

to removal, and the symptoms and neurotic disturbances which sometimes remain after operation are very disappointing. When it is a question of choice between surgery and electricity, it is the consensus of opinion to try electricity first; for it in no ways interferes with any ultimate procedure. I shall refer in a moment to cases from my own records, but the following, reported by Dr. T. G. Garry to the Obstetrical and Gynecological Society at Leeds, England, are so interesting as to deserve reprint:

Mrs. J., age 26, married five years; sterile; backache and pelvic pain; aggravated by walking or standing; reflex symptoms; profuse leucorrhea of a greenish color and offensive odor, dyspareunia, uterus enlarged, prolapsed and very tender to touch, great tenderness in region of broad ligaments; left ovary enlarged and painful.

Diagnosis: Metritis, endometritis, salpingitis and ovaritis.

With a history of much treatment and little benefit Dr. Garry pursued ordinary methods for four months without result, when a choice be tween laparotomy and electricity became an ultimatum. The patient preferred electricity. The galvanic current was employed May 17, 1890, applied 50 milliamperes positive, intra-uterine current for four minutes. There was a great deal of reddish discharge afterwards, which continued during the following day. May 23 gave 80 mil., four minutes, which was too strong a dose and which was reduced to 45 mil. on the next application, five days later. Treatment was continued with intervals of rest until the middle of February, a total of 35 intra-uterine applications; 22 positive and 13 negative.

Results: Leucorrhea had ceased. Uterus freely movable without the slightest pain. Peri-uterine tenderness had disappeared, and left ovary could not be felt by an ordinary examination. Two years later she was delivered of a healthy child, and at date of report was pregnant again.

The superiority of conservative electrical treatment (when it is successful in such cases) is in no way

more plainly pointed out than by considering the possibilities of motherhood after the thorough going laparotomist had got through with Mrs. J. An artificial menopause in early life is not desirable.

Miss P., age 25. Constant backache; pain and dragging in pelvis, especially in left side, aggravated by slightest exertion; dysmenorrhea, leucorrhea and menorrhagia. Uterus enlarged, anteflexed and congested; fullness and tenderness in the region of the left broad ligament.

Diagnosis: Uterine and ovarian congestion; probably salpingitis (left) anteflexion, stenosis, hypertrophy of uterus. Previous dilatation had afforded no relief; dysmenorrhea had been getting worse for a year, despite local treatment, and removal of the ovaries was proposed.

Again the patient preferred electricity. Treatment with the constant current was begun on July 2, 1890. Vaginal, 30 mil. positive, five minutes, to relieve the pelvic congestion. Repeated every second day till July 10, when it became possible to pass intra-uterine electrode. The uterine cavity was then found to be over four inches in depth. July 17, menses, lasting five days; pain slight.

July 27 resumed, with 55 mil. positive, application five minutes. August 5 and 8 gave 20 mil. August 15, 50 mil.; five minutes.

Menstruated August 26, flow much less and comparatively painless.

Treatment was continued until October 25. Result: Dysmenorrhea, menorrhagia and pelvic pain permanently relieved; patient continuing well after the lapse of three years.

Mrs. W., aged 25. Sterile; constant backache and pelvic pain; painful evacuations, menorrhagia and leucorrhea.

Diagnosis: Endometritis, retroversion, congestion of left ovary.

Treatment: June 24, 1890, 40 milliamperes, intra-uterine, positive, five minutes. June 30, 50 mil., and July 5, 60 mil. were given, with lessening of discharge. July 9, complained of pain and bearing down feeling. Left Ovary enlarged and tender. Admin

istered 60 mil. positive, five minutes, which was followed by a sanguineous

discharge lasting for twenty-four hours.

July 12, reported felt much better; gave 70 mil., seven minutes. Treatment continued till 29th, when she had gone nearly a fortnight beyond her period. Gave 50 mil. negative, five minutes, and next period was practically normal. Treatment was kept up till October 7, when she was entirely free from discharge and pain, and the uterus was normally situated.

Miss J., age 21. Amenorrhea; had never menstruated. The treatment employed was constant current percutaneously. After 12 applications menses appeared and thereafter continued regularly. In cases of primary amenorrhea it may be stated in passing that the presence or absence of any subjective sensations is a guide to estimating the probable value of electric stimulation. If entirely absent, from sexual non-development the current cannot regulate a function which does not exist-but in irregularities, suppression from neurotic causes, anemia, cold, etc., electricity in one form or another has, since the long list of cases of Golding Bird, before 1840, down to the present time, been the one agent upon the use of which the results could be predicted with well-nigh mathematical certainty. The careful physician will, of course, exclude pregnancy and will in anemic states attend to the general condition, but when properly indicated and rightly applied electricity is potent, both to control bleeding states of the uterus and to restore the diverted menstrual function.

Mrs. R., widow, age 32, three children and one miscarriage. Mensturation absent for over a year, but has each month a sanguineous discharge through the nostrils; the face being also swollen and tender to touch, with a great deal of watery discharge from the eyes.

November 4 administered 40 mil. negative galvanism, intra-uterine, five minutes. Gradually increased this as tolerance permitted, till at the ninth seance 70 milliamperes was reached. Menstruation reappeared and continued regularly.

Mrs. M., age 27. Sterile; before marriage menstruation was regular and painless. Since then has suffered severely from dysmenorrhea. During the first day and before flow is established has several faiting spells. Leucorrhea, resembling white of egg. Diagnosis: Anteflexion, with enlarged fundus; stenosis; endocervicitis; pin-hole os; uterine cavity 31-4 inches. Treatment was begun August 28, with 20 mil. positive gal. to cervical canal, four minutes. September 4 and 8, 20 and 25 milliamperes, positive, five minutes. September 12, 40 mil. neg. intra-uterine, five minutes. September 17, flow appeared.

Had a good deal of pain; fainted once. Continued treatment till October 16, when next period occurred. It was quite painless, without fainting symptom. In the two months she had eleven treatments and uterus is still anteverted, but otherwise she has been permanently relieved.

The dilatation of pin-hole os and of stenosis of the uterine cervix by the electrolytic method is one of the most satisfactory things in local treatment. Simple, quickly performed, absolutely painless and without risk, it is infinitely preferable to instrumental divulsion, both in the operation and result.

Mrs. C., married; two children; has pelvic pain, menorrhagia; flow usually lasting ten days; latterly she has been unwell every fourteen days; profuse leucorrhea; uterus retroverted, enlarged and low in the pelvis; fundus tender to touch; cavity 41-4 inches.

Diagnosis: Retroversion and hypertrophy of uterus with chronic metritis.

October 16 gave 45 mil. positive gal., five minutes. October 20 and 23, 55 mil.

October 24, flow commenced today and continued profusely for ten days, the current strength having been too small to control it. November 13, 17, 24 and 27 positive 60, positive 70, positive 75 and positive 70 milliamperes respectively, were given for five minutes. December 5 flow appeared, lasting five days only, although very pro

fuse.

Four treatments of 78 mil. each were given in December, and at irregular intervals during January, February and March. Periods continued regular, but profuse.

Recognizing that dosage hitherto had been insufficient to accomplish the result, 120 mil. was given for six minutes on April 1. April 9 flow be gan, lasting five days, and normal in every respect.

April 19, 120 mil.; April 26, 170 mil., and April 28, 190 mil., were given with final treatment of 100 mil. on May 5. May 9 menstruation was normal; the patient remained well, and at this time is pregnant and expects to be confined in about six weeks.

Mrs. A., age 43. Has suffered for several years from menorrhagia; flow lasting usually eight days. Is usually kept in bed for the first three days; profuse leucorrhea; constant pain in left ovarian region; worse after her period; os patulous and cervix extremely congested. The treatment of this soft, bleeding uterus was begun November 19 with 30 milliamperes of positive galvanism for five minutes.

November 22 and 25 dose was increased to 40 and 50, which was still too little, for next period was more profuse than usual.Three applications of 60 mil. were given in December with small improvement, and treatment was suspended until March, when four applications were given, raising the dose from 80 to 115 mil. This proved adequate, the next period was normal, and the gain has been permanent.

Miss H., age 26. Has suffered for several years from dysmenorrhea. On examination nothing abnormal was detected beyond a hyperesthetic condition of the endometrium and spasmodic contraction at internal os. Six intra-uterine positive applications of the constant current completely relieved this case.

Mrs. B., age 38; one child; menorhagia; flow usually lasting three weeks and accompanied by great pain; uterine cavity measures eight inches.

Diagnosis: Fibroid tumor of uterus reaching above umbilicus.

Treatment began December 11 with positive galvanic application of 35 mil. four minutes. December 15 gave 70 mil. Had sanguinary discharge lasting a day. December 18 period very profuse and painful. January 8 and 14, gave 60 and 68 mil. On January 20 her period was much less profuse. Treatment was continued during February, March, April and May, and renewed again in October and November, the largest dose being 170 milliamperes, and applications 24.

Result: Since March 16 periods have been normal in every respect, averaging four days in duration and free from pain. There is a decided diminution in size of growth, which was growing rapidly before electrical treatment was commenced.

Mrs. W., age 39; two children, four miscarriages; duration of illness two years; menorrhagia; flow lasting usually three weeks, and accompanied by great pain, at times of a spasmodic nature; reflex symptoms; uterus over four inches deep.

Diagnosis: Interstitial fibroid of the uterus. Treatment began February 18. Thirteen applications were made by May 2, when her period was normal for the first time in two years. Continued treatment during May and June.

Result: She has been permanently relieved and enjoys good health.

Mrs. L., age 24; married six years; sterile; uterus acutely anteflexed; a large intra-mural fibroid projecting through the anterior wall. The posterior cul-de-sac is occupied by a hard painful swelling about the size of a hen's egg, and probably inflammatory exudate; cavity of uterus, 41-2 inches; menorrhagia and dysmenorrhea; flow lasting 12 days, with severe pain most of the period. Distinguished gynecologists (non-electrical) had suggested operation, after failure of medical procedures. The patient shrunk from the prospect and welcomed the hope of benefit from electricity.

When first seen she was completely blanched by the hemorrhages of thirteen months. She was unable to walk without assistance, and it was with great reluctance that the case was undertaken.

May 18.-Tentative treatment was begun with 30 mil. intra-uterine, the electrode being passed with difficulty. She was unable to get home. Following two more treatments she had a profuse and painful period. Resuming with 70 mil., her period on June 29 lasted but four days. No clots and but little pain. During July 80 mil. was given per seance. July 27 period lasted but two days, painless. August 7, uterus in good position, but slightly anteverted, and only 3 and one-half inches in depth. 100 mil. dose was reached by August 21, when there was a marked improvement in every way. The enlarged fundus was diminished, the lump in the culde-sac was no larger than a marble. With occasional further treatment she improved for two years, when she became pregnant, and after a normal labor, died during the puerperum, from some cause not known to the writer.

Pain and hemorrhage are the two great symptoms which bring these uterine patients to the physician. Happily, in controlling them, even when applied empirically, before a complete diagnosis can be made, the polar effects of the current employed are each-positive and negativemost harmoniously related to the pathological indications for treatment. In fact, in expert hands, safety is assured, and the chemical action of the pole which controls the dominating symptom is, in most cases, found also to be the pole adapted to the treatment of the cause.

I will cite but one more case which, however, is remarkable in several ways: January, 17, 1894, Mrs.

age 26, married six years; no children; menstruated at 13. Regular until two months ago; then noticed a continuous show of blood, increasing during the last fortnight into decided hemorrhage, with severe backache. She presented the appearance of grave disease and advanced age; was in a state of complete mental and physical prostration, crying and frightened, and as hyperesthetic as if she was in the agonies of acute strychnine poisoning. She had just been bluntly told by a doctor on whom she called that "she had a