GALVANISM 
OF 
UTERINE FIBROIDS. 
BY 
EPHRAIM CUTTER, M.D., 
OF NEW YORK. 
[Reprinted from the "Transactions of the Ninth International Medical Congress," Vol. II.) 
PRESS OF WM, F. FELL & CO,, 1220-24 SANSOM ST., PHILA., PA. Dr. Ephraim Cutter, New York City, read a paper on- 
GALVANISM OF UTERINE FIBROIDS. 
GALVANISME DES FIBROIDES UTERINES. 
DER GALVANISCHE STROM BEI UTERUSFIBROIDEN. 
Introduction.-Placed as a pioneer, I am in a position to review the history of this 
operation and draw conclusions therefrom. The time seems to have come for this to 
be done. 
While a deeply interested participator, I propose calmly and dispassionately to 
treat the subject on the basis of facts, giving opinions only where it cannot be helped, 
preferring that the reputation of the operation be based upon the character of the facts 
Vol. 11-44 rather than on opinions. All will meet with due respect and credit, as the great end of 
the matter is the relief of sufferers, the honor of gynaecology and persons being secondary. 
EXPECTATIONS. 
When, on August 21st, 1871,* the first American operation was performed, the 
expectation was only to arrest the development of the uterine fibroid. And this expectation 
was held in spite of the positive assertions of the medical gentlemen who may be said to 
have been at the head of their specialty in electricity. They affirmed that no good 
whatever could come from the proposed operation. On being asked if they had tried it, 
they said "no." I said then that I would try it, regarding the opprobia medicorum as 
a fair field for any to explore who had a sincere desire to remove said opprobia. 
HOW THE FIRST OPERATION CAME TO BE PERFORMED. 
Alxrat 1870, I provided myself with the best galvano-cautery apparatus (Stiihrer's 
pattern) I could find, for use in the treatment of diseases of the throat. In 1871 the 
Middlesex (Mass.) East District Medical Society met at the house of the late Dr. John 
Clough, of Woburn. At this meeting I showed this battery and its action on water, 
beef steak and mineral salts. The next day Dr. W. Symington Brown, of Stoneham, 
Mass., came to me and said that Mr. Robert Pierce, of Melrose, Mass., had a wife 
who was suffering with a uterine fibroid; that he had been in the U. S. Army under 
General Kilpatrick, whom he had lately seen at a public lecture the General gave 
in Malden, Mass. (I think); that the General inquired after his family, and being 
informed, told him about the cure of his own (the General's) tumor in his neck, at 
one sitting, by Dr. R. P. Lincoln, of New York) see New York Medical Record, Decem- 
ber 15th, 1870, Vol. V, No. 20); he suggested that Mrs. Pierce should receive like 
treatment, saying that the cured tumor was angiomatous. 
"Now," said Dr. Brown, "you have the means to do it, will you try?" I said 
that I was willing to try, if, having seen the patient, I could feel justified, and added 
that I did not think uterine fibroids were as amenable to the galvanic current as 
vascular growths. 
The patient was carefully examined, with the result that a day was set for the opera- 
tion, which was done August 21st, 1871, in the presence of Dr. Brown and others. No 
anaesthesia. An electrode, made of a small needle, and about four inches in length, 
was introduced into the uterus per vaginam, where the tumor was round, hard, and 
plainly felt. This account is different from that of Dr. W. S. Brown, which was 
reprinted in the American Journal of Obstetrics, New York, February, 1887, page 120, 
who speaks of three needles being used. I am sure there was only one. Over the 
pubis was a sponge electrode. Fifteen minutes' current. The needle could not be 
introduced over one inch, and that with great difficulty. 
After this operation I proposed to Dr. Gilman Kimball that we join in this matter. 
He is a man much older than myself, an accomplished, bold and brilliant surgeon, and 
the greatest living American ovariotomist, being noted for his original procedures in 
this specialty. 
He was present August 29th, 1871, with some eight or more physicians, when we 
operated on Mrs. Pierce the second time, using a needle of platinum, which twisted 
and turned in his hand and gave great dissatisfaction to all. Dr. Kimball was disgusted, 
and said he would have nothing to do with the operation unless better electrodes were 
produced, that would penetrate surely a fibroid as hard as a bullock's testicle. At once 
I invented a needle, of steel, shaped like a corkscrew, with the convolutions gold plated. 
*See Medical and Surgical Reporter, Phila., February 8th, 1878. W. S. Brown, Reporter. This did not work, and I then brought out the so-called " Cutter needles," which were 
made so as to cut and at the same time relieve the tension of the tissues, which bind 
when penetrated by a needle of a cylindrical shape, and strong enough to avoid the 
risk of breaking off and being left behind in the fibroid. Whatever has been or may 
be said of these needles, they were satisfactory as to penetration, and never failed save 
when they encountered a calcareously degenerated fibroid. 
Moreover, without these Cutter needles, the present history of galvanism of uterine 
fibroids would not have existed. 
In order to make sure work it was determined to use two or more needles, plunged 
deeply into the tissues of the fibroid, through the abdominal walls, with a battery large 
enough to create a positive and tangible amount of galvanic current. It was decided 
that if the operation was a failure, there should be no doubt about the failure, and thus 
secure valuable negative results, which are as important as positive ones, sometimes. 
To repeat: the main expectation in galvanism of uterine fibroids was the arrest of develop- 
ment. 
Remember, most of the cases operated on were of fibroids, large, hard, many-lobed, 
extra-uterine and intra-uterine, packing the pelvis, filling the abdomen, occurring in 
cases of bad general health and complications, such as abscess, ovarian tumors, opium 
eaters, etc. The worst cases receiver! the applications as well as the most promising. 
REALIZATIONS AFTER SIXTEEN YEARS' LAPSE OF TIME. 
Truly can it be said " the unexpected happened;" for besides tAe expected arrest of 
development, in a large part of the cases there have been realized- 
1. In some entire cures. 
2. In some great diminution of the growths. 
3. Relief from pain and hemorrhages in the large majority of cases. 
4. Attention to the operation by members of the medical profession of eminent 
character. 
5. Counting in all the numbers reported of cases that I can get hold of, there must 
have been over four hundred cases of applications of galvanism to uterine fibroids, while 
the unreported cases probably increase this number by scores. 
6. Another realization has been the variations from galvanism to faradism, in the 
mode of application, in the batteries, in the duration of applications, the number of 
applications, the kind of electrodes used, and the discovery of instruments to measure 
the current by milliamperes. 
7. The operation has been widely published and has become pretty well known. 
8. The time seems to have come when uterine fibroids are no longer " opprobia med- 
icorum." These results promise better things for the future, when our knowledge 
shall be more perfect and complete. 
ANSWERS TO CRITICS. 
These have been so many and unfavorable, that it would take a volume to record 
them. I will mention a few, as matters of history, in a syllabic way, so far as they 
relate to the writer's procedure :- • 
1. Criticisms before the operation. 
(а) " It is of no use to do this operation." 
(б) " Your battery will not answer." 
Reply. See the eighth realization. 
2. Criticisms after the operation. 
(a) No current; results produced by puncture alone. 
Reply. " Then treat the cases by puncture," I said, but none did have the courage to operate on uterine fibroids by simple puncture, as was done by galvano-puncture. 
Hence facts were answered by opinions not based on facts; this is not a demonstration. 
"No current." The late Dr. G. M. Beard, of New York, and Dr. David Prince, of 
Illinois, both proved there was a cun-ent by galvanometer. Earlier, Dr. A. C. Garratt, 
of Boston, and son, spent one thousand dollars in getting up a voltameter which proved 
there was a current. 
Galvanism does many other things besides deflecting the needles of a voltameter. 
These historical matters now are of no account save to show how critics, without 
having seen a case operated on, environed the pioneers with not very encouraging sur- 
roundings. They illustrate, also, the aptness of the subject of Dr. Sims' first boy 
composition-"Never to give an opinion as to anything you have not tried." 
(Z») Dr. Engelmann, at the 1886 meeting of the American Gynaecological Society, 
said, " ... By puncture through the vagina, possibly through the tissue of 
the uterus itself, you avoid most decidedly the dangers of peritonitis, which must 
accompany the abdominal puncture." Page 370, lines 18-21, Transactions of the 
American Gynaecological Society, 1886. 
Reply. This gentleman's dictum represents the conventional thought as to all punc- 
tured wounds of the abdomen. This thought is changing, due to the advance of modern 
surgery. If the dictum was put less positively and less universally, the position would 
be more tenable; for when it is shown that such abdominal punctures have been made 
and followed not by peritonitis, the dictum falls before a fact to the contrary; such has 
been the history of the operation. Had the dictum of this critic been qualified, there 
would have been another way to answer it. Critics must be met on their own and 
not on other grounds. 
(c) Abscess. 
Reply. These have been so rare as to disqualify any statement that represents 
their constant occurrence in this operation ; in truth, as before stated, cases complicated 
with abscess have been operated on. 
(d) Deaths. 
Reply. Four cases out of fifty has been the rate, and some of these occurred when 
the patient disobeyed orders. A death rate of thirty-three per cent, is no bar to an 
operation in some other departments of surgery. If this operation is debarred on a 
mortality of four out of fifty (though, as noted, two were due to carelessness, one was 
a morphia eater, and the fourth would have the operation at any risk), then capital 
operations should be unperformed. 
(e) No measurement. No operation without a measurement. 
Reply. The results show successful operations without a measurement by amperes, 
volts, etc. If the end of this operation was not the relief of the patient, but measure- 
ment, the criticism would hold. 
When the first operation was done, the state of things was much different from that 
of to-day, when amperemeters and voltameters are common, owing to the extended 
popular use of electricity, and there is more ground for the criticism than then. But 
to insist that galvanism cannot be applied to a uterine fibroid without a milliampere- 
meter is to go back on facts. It is not claimed that the milliamperemeter does the 
work, it merely measures-measuring a work does not do it. 
I am not arguing against the use of measurement ; I early took to Professor Moses 
G. Farmer, of Boston, then the best practical electrical authority, my battery, to be 
measured. He said that he had no instrument large enough to do it. Next, about 
1877, Dr. A. C. Garratt and son (who is a mechanical electrical expert), unknown to 
me, set to work to measure my battery, and at an expense, as before noted, of one 
thousand dollars, produced a galvanometer which registered 1.70 volts. This instru- 
ment was intercalated in a current that ran through an abdominal fibroid, both needles 
inserted, and the registering needle struck the terminal pin at 1.70 volts. Showing that as much if not more than 1.70 volts traversed the tumor. Dr. Garratt published, 
in the Southern Clinic, Richmond, Va., January, 1879, a paper entitled "Electricity 
Employed in a New Method in Gynaecology," and read before the Gynaecological 
Society of Boston, June 13th, 1878, to which the attention of those interested is referred. 
Later, Dr. G. M. Beard, of New York, and Dr- David Prince, of Illinois, came out with 
reports of measurement. 
WHAT ARE THE MEASUREMENTS OF ELECTRICITY? 
Electrical units adopted by the British Association. The fundamental units adopted 
are based upon the centimetre (length), the gramme (mass) and the second (time); or, 
as it is sometimes called, the C. G. S. system. For practical units the following are 
adopted:- 
The Ohm, as the unit of resistance, is that of a column of mercury having one 
square millimetre of section, and of a length to be hereafter determined by a com- 
mission specially appointed for that purpose. The length is supposed, however, to be 
between 104 and 105 centimetres. (Said to have been settled since.) 
The Volt as the unit of electro-motive force. This corresponds to nearly that of 
one Daniel cell-the standard Daniel cell has an electro-motive force of 1.079. 
The Ampere as the unit of current; which is the current produced by one volt 
through the resistance of one Ohm. 
The Coulomb as the unit of the quantity of electricity; which is defined by the con- 
dition that an ampere yields one coulomb per second. 
The Farad as the unit of capacity; which is such that one volt in a farad shall give 
one coulomb. 
The volt acting through an Ohm gives a current of one ampere; that is to say, one 
coulomb per second; and the farad is the capacity of a condenser which holds one 
coulomb, when the difference of potential of its two plates is one volt. 
The Watt as the unit of power, being the power possessed by a current of one ampere 
in one second, through a conductor whose ends differ in potential by one volt. 
The Joule, as the unit of work or heat, being generated by a Watt in a second. The 
Joule bears much the same relation to the Watt that the ampere bears to the coulomb, 
the Watt being the power to do a Joule of work." 
Here are seven units of measurement to choose from. Apostoli and others insist on 
the ampere, or rather the milli-ampere, which are measures of quantity, the thing I was 
after at the outset. 
But what am I to do when I have two batteries, one of nearly thirteen square feet of 
surface, and the other of one-eighth the amount of this surface, and both measuring the 
same amperes and volts ? And yet trials of experience tell that the work in relieving 
patients is much better with the large battery, so that I prefer to be annoyed with the 
discomforts of the great weight of it and its cell. 
There are other things that galvanism does besides overcoming resistance, in deposit- 
ing metals and decomposing salts and tissues. 
For example, to mention no more: " Fodere showed that galvanism influenced the 
rapidity of imbibition. He injected a solution of the sulphate of iron into the peri- 
toneum and a solution of potassic prussiate into the pleura of a living animal. Ordinarily, 
five or six minutes elapsed ere the result was manifested, but when a slight galvanic current 
was passed through the diaphragm, the combination was instantaneous. 
" The same results obtained when the reagents were thrown into the bladder and 
abdomen, or into the pleura and lung. " See Alabama Medical and Surgical Journal, 
May, 1887. Endosmosis: E. Cutter, 1856. 
It seems to me that this quotation sheds light on the subject. Galvanism does 
more than these things. For example, I passed one electrode through the right groin 
into a hard, obovoid fibro-myoid, and another electrode into the uterus, per vaginam, of a morphia eater, and passed the current of the smaller battery named for ten minutes, 
and in the course of a year the whole tumor disappeared. There was something done 
more than is registered by the units of resistance named above. If such results were 
constant, they would be units of therapeutic measurement. 
Those who carefully read over our reports, will see a relation simply of the facts as 
they happened. We do not dictate to others what they shall do, but are glad if they 
have done, or will do, better than we have in this new field of work. 
We honor and give due credit to all workers, but if any one, in time to come, gal- 
vanizes a uterine fibroid, we will not bar him out if he does not use a milliampere- 
meter, for the simple reason that such cases have been cured without a measuring 
instrument. Those who claim the operation as their own invention, ignoring the work 
of Dr. Kimball and myself, are welcome to do so, if they choose to occupy a false 
position. 
CRITICISMS OF DR. APOSTOLI'S ARTICLE, " TREATMENT OF FIBROID TUMORS OF THE 
UTERUS BY ELECTRICITY, WITH STATISTICS." " NEW YORK MEDICAL 
RECORD," August 13th, 1887. 
Read to the British Medical Association, Dublin, August 2d, 1887. 
Page 177, column 1, line 32. " I may, first of all, point out what my predecessors 
have done in the electrical cure of fibroids. Apparently they have used a current of 
electricity, but all attempts made were defective in ways that I may here recapitulate. 
"The current of electricity was employed (1) in a vague and variable manner. 
Sometimes there was faradization; sometimes there were continuous currents; some- 
times interrupted galvanic currents, but always without a definite object." 
Reply.-Now this statement is untrue, so far as relates to my procedure, which 
always excluded the faradic current and interrupted galvanic current, mainly on the 
diction of the late lamented Dr. Louis Elsberg, of New York, " That when electricity 
did good twenty times, galvanism benefited nineteen times, and the faradism one time. " 
But our author, loco cit., page 179, column 2, line 60, speaks of publishing a separate 
memoir on the faradism of uterine fibroids, which I am very glad to know and am 
anxious to see, but which dulls the edge of the criticism he makes when he states that 
his predecessors, by using sometimes galvanism and sometimes faradism, went in 
" defective " ways ; he has done the same thing himself. So, if they were defective in 
their ways, he himself is so, by his own showing, and thus makes void his criticism. 
" But always without a definite object." 
Reply.-As has been stated above, there always was a definite object, i. e., "The 
arrest of the growth of the fibroid." 
The largest, most hopeless, and rapidly increasing fibroids were attacked with one 
of the largest batteries ever used on a human being. The applications were made by 
profound punctures, through the abdominal walls, of the peritoneum, to repeat, 
purposely, so as to be sure that the current traversed the tumors, and them alone defi- 
nitely. This is not saying it in the best way, but it is my way, and the purpose is and 
was as definite as if one planted his fist into a bulty to stop the development of any 
more bluster. 
Again we quote, as above: " The current was set in motion in ignorance of its 
intensity, and with imperfect knowledge of the best means of employing it. ' ' 
Reply.-If, by intensity, he means the registration in amperes or milliamperes, I state 
that there were none in 1871. Volt meters existed which measured electro-motive 
force. Does the gentleman mean that we ought to have used an instrument in 1871, 
when the proceeding was inaugurated, that was not in public existence till 1879, if I 
am correctly informed ? If so, he requires more than any man could do ; hence the 
fallacy of the criticism. " And with imperfect knowledge of the best means of employment." 
This is a lame criticism. 
When the first operation was performed, I confess the knowledge of the best means 
of electrical employment was imperfect; nor is my knowledge perfect now. 
The gentleman's remarks, page 179, column 1, show that he regards his knowledge as 
imperfect, and yet he had the benefit of the experience of his predecessors, which I had 
not. There was absolutely nothing to guide me, for the simple reason that I had not seen 
nor heard of a case of uterine fibroids operated on by electricity. Worse than this, I was 
told by medical electrical experts that "it could not be done." May it be said 
here, that this utterance spurred me on to undertake the operation, and helped me to 
adopt the means that were used, as I thought that the operation should be performed, 
and, that if it failed it should not be from the lack of thoroughness. I tried to have 
the results so marked as to be of value negatively, if it failed. 
Dr. Apostoli's criticism is fallacious, as there could not but be imperfect knowledge 
of the best means of employing it, for the simple reason that no means whatever had 
been used, to my knowledge, when we performed the first operation. 
Daniel Webster once said of a man who erred, " I would not give a cent for a man 
who never made a mistake." To err is human, not to err is divine. 
Line 45. '1 The proceeding was purely empirical, discrediting a certain agent 
capable of doing much good or none at all, according to the skill and intelligence with 
which it was directed. ' ' 
Reply.-Purely empirical. Is this as bad as it seems ? If so, we have lots of terrible 
fellows among us who have been trying things empirically all their professional lives; 
for example, one has tried " kerosolene " by inhalation for the first time. Without a 
tracheotomy tube, he tried laryngotomy for the removal of a voluminous growth from 
the larynx of a woman in 1866. She speaks and sings now. McDowell tried 
ovariotomy; Norwood, veratrum viride. The medical profession are all the time trying 
things empirically, and God bless them for it. When there is so much medical evil to 
be remedied in the world, may they keep on trying. Indeed, Apostoli himself tried his 
own procedure empirically for the first time. 
The remaining part of the sentence is not clear. It may be the fault of the transla- 
tor, i. e. " discrediting a certain agent." The word "agent" doesnot mean dosage, 
as the next paragraph is devoted to it. Does it ? 
There is on my part no intention of discrediting anything or anybody who has had 
anything to do with the operation to help it along. I honor Apostoli and all who have 
done this operation. There is a distinction between a man and his sayings. We all 
are workers together to lift off the opprobia medicorum too numerous to-day. Still, in 
the paper under notice, one is struck by noting that Dr. Apostoli gives no credit to any 
operator but himself. On the contrary, other operators are charged with defects and 
want of skill. Having done this, neither he nor his friends can complain if he is con- 
fronted with the claims of others. 
"Secondly: Without dosage; that is to say, without any instrument in the form of a 
galvanometer." This does not mean the writer, as it states that I never used a galvano- 
meter; whereas, I have used one. I have witnesses to prove it. In my opinion, based 
on the results, while dosage is recommended, it is not absolutely essential to success. 
Measuring a work is not doing it. A man does not build a wall by measuring it. Now, 
while there are cases of this operation where absolute cures have been realized by gal- 
vanism, and where no milliamperemeter nor voltameter have been used, they show that 
good results have been had without them. Indeed, the cases in which I have used the 
meters aforesaid were not cured, so there was not the advantage gained that one would 
judge from the indispensability dictum as to dosage. If the end of the operation is 
measurement, then measurement is absolutely necessary; while, if the end of the opera- tion is cure, the advantage seems to be with those whom Dr. Apostoli decries, for I have 
yet to learn (I hope I am mistaken) that Apostoli has ever cured a uterine fibroid by 
electricity. 
In my reports,* I have dictated to none, and I will not be dictated to by any one 
who has not had as good results as I have had. 
Line 52. "Thirdly: In a dose insignificant." 
Reply.-I have used five hundred milliamperes. 
' ' Generally so small as to be useless. ' ' 
If Apostoli could meet with some of the cured cases and make this statement to 
them, I fear his experience would repeat that of one physician who made a somewhat 
similar statement, in the presence of a cured case of mine, at a gynaecological meeting. 
She was so indignant she could hardly restrain herself. The next day she visited him 
at his office, and he retracted. 
Line 54. "Fourthly: A method always extra-uterine, in no way directly acting 
upon the uterine cavity, and but slightly upon the neighboring parts of the vagina. ' ' 
Reply.-The word ' ' always ' ' is fatal to this dictum. It embraces too much ; it 
implies that Apostoli has seen all of our cases; but he never saw one. Indeed, if the 
statement was true, it does not prove that electricity should be always applied intra- 
uterine, for I have had cases where no uterus could be found, the growth being very 
large, hard as rock, packing the pelvis full and pushing the womb out of reach. 
What right has any one not present to say my electrodes did or did not penetrate intra- 
utero ? And, as for acting on the vagina, there is not much significance in the criticism, 
for I can see no reason why the vagina should be acted on only as it is in the way of 
the electrodes. 
But in many cases the punctures have been made purposely intra-uterine, and did 
act on the uterine cavity, because it came in the way of the electrodes, and the applica- 
tion was followed by intra-uterine discharge. It is our rule to act on the fibroid alone 
whether in intra- or extra-uterine, and such action I have found to cure and to justify 
my action. This was also the reason of the invention of my needles, which have never 
failed, save in a case of a calcareously degenerated fibroid. The rule is to penetrate the 
fibroids with needles in the easiest and shortest way possible, profoundly puncturing 
and conveying the whole current to the deepest part of the tumors. 
Line 57. "Fifthly: By a method often dangerous, from galvano-puncture being 
made above the pubes and through the abdominal integument." 
Reply.-First, this is a partial statement. The first case, in 1871, was almost 
exactly like Apostoli's method, per vaginam and abdomen. Sometimes both needles 
have been used through the vagina, sometimes one the same way and sometimes one 
by the rectum. As to danger, see statements before made as to deaths. 
Much obliged for the word "often," as it is not such a universal term as 
"always," which has been used in conversation about this operation, and shows a 
want of consideration. 
Line 60. "I originated a new and rational way of using electricity for this purpose. 
I have supplanted the old way (what way? mine or that of others?) by a method 
which is precise, by the introduction of the galvanometer of intensity. ' ' 
Reply.-Galvanometers are voltameters and amperemeters. Did the gentleman 
invent these? If any one before him intercalated a galvanometer during the operation 
on a uterine fibroid, it makes void his statement. I did this in 1878 or 1879. 
* E. Cutter, m.d. : " Contributions to Gynaecology. First fasciculus. The galvanic treatment 
of uterine fibroids: full text of first fifty oases." Octavo; eighty pages ; two cuts. Paper, 75 
cents ; cloth, $1.00. W. A. Kellogg, publisher; 9, West 29th St., New York. "Energetic by an absolutely novel service of high intensities of current, which I 
have progressively used from fifty to two hundred and fifty milliamperes." 
Reply.-I have used, as before stated, all along, five hundred milliamperes, accord- 
ing to my best judgment. 
"Tolerable, in spite of the enormity of these doses, because of a clay electrode." 
Reply.-Thanks to Apostoli. I think Martin's modification a better thing to use 
than clay, but this is opinion only. 
" Better localized by a direct application of the active pole by way of the vagina to 
the uterus, either in its cavity or in the substance of the fibroid. ' ' 
Reply.-Is this better localization than was used in 1871, of having the electrode 
buried profoundly deep in the very substance of the fibroid? If so, then language 
fails to express the meaning of things. And if, in 1883, it was original to better localize 
the galvano-puncture by putting one electrode through the neck of the womb, or 
through its substance (his method does not tell what to do when you cannot find the 
uterus), and the other clay electrode over the pubes (how is it when the fibroid makes 
the patient bigger than a woman at full term ?) where is the originality of 1871, when the 
uterus was punctured through the vagina and a sponge electrode used over the abdomen ? 
Column 2, line 24. ' ' Thoroughly under control by the exclusive choice of the 
unipolar method." 
Reply.-This is not a good term to use. Unless one has two poles, there can be no 
current, any more than a boat can be moved forward with one oar. 
But I will carry this no further. I am grateful to Dr. Apostoli for what he has 
done that has advanced the interests and knowledge of this subject. I distinguish 
between him and his sayings. When the latter are not sustained by history, history 
must have the preference. 
Dr. Apostoli has dictated to his predecessors and discredited them, even his own 
countrymen. , Would it not have been better to have given them credit for what they 
did, and not try to build upon their supposed ruins ? 
Fact is eternal. Opinion not based on fact is not wisdom. 
CONCLUSIONS. 
1. When an untried operation is proposed, it is not wise for those whose opinions 
are sought as experts to say it cannot be done. This present Congress and the attention 
paid to this subject must be uninspiring to those who interdicted me in 1871. 
2. It is wise to give all due credit for what they do. An old book says: " They 
measuring themselves by themselves are not wise." 
3. In performing this operation use common sense, and not follow any one's method 
unless indicated by the particular case in question. 
4. After this, any physician who says that uterine fibroids are hopelessly incurable 
is not sustained by the facts and evidence. 
5. I recommend warmly the use of the Salisbury plans of diet to be used in connec- 
tion with galvanism. I have known large fibroids to be cured in a few months by diet. 
I have known the same result by electricity; henceforth, I use one or both, as I am able. 
DISCUSSION. 
Dr. Kellogg, of Battle Creek, thought that Dr.Smith's paper was an eminently 
practical one. He felt satisfied that electricity would before long occupy a very 
important position in uterine therapeutics. He was already using it very extensively, 
but intended to use it much more. 
Dr. Bozeman, of New York, quite agreed with Dr. Smith that it was more 
rational to strengthen and develop a weak organ than to support it with mechanical 
appliances or to cut it away. He thought with Dr. Smith, that a perfect knowledge of the anatomy and physiology of the pelvic organs was a first requisite for successful 
gynaecology. 
Dr. A. Lapthorn Smith, of Montreal, replying for Dr. Apostoli, observed that the 
latter did not have Dr. Cutter in view when he related that until lately electricity 
had been used in an uncertain and, sometimes, hazardous manner. Prior to the 
Electrical Congress of Paris, when the definite measurement of electricity was fixed, 
there was no means of employing certain, definite doses; but, now that we have the 
means of measuring electricity accurately with the amperemeter, there was no 
longer any excuse for employing it haphazard, and every one can employ it rationally, 
the same as they would strychnine or atropine. Apostoli, he said, preferred to 
puncture the fibroid through the vagina rather than through the abdominal wall, 
for three reasons:- 
1. Because these growths were most often situated in the posterior segment of the 
uterus, and were more accessible from the posterior vaginal cul-de-sac. 
2. Because it was much less dangerous to puncture through the vagina, as the 
peritoneum could be avoided; and if an abscess resulted, it could with safety be 
drained into the vagina, which was kept antiseptic. 
3. The negative monopolar galvano-puncture was much more efficacious than the 
bipolar puncture, the whole force of the current being concentrated at the negative 
electrode in the substance of the fibroid, large pieces of which frequently came away. 
If the fibroid were situated in the anterior half of the uterus, Apostoli was con- 
tent to apply the negative intra-uterine current, which required no anaesthetics, but 
was somewhat longer. If the tumor caused metrorrhagia, he used, on the contrary, the 
positive pole, which possessed the property of arresting it. He had thus been able 
to cure many fibroids without puncture. He was much struck, at Apostoli's clinic, 
with the thorough manner in which antisepsis was carried out. Every visitor had 
to scrub his finger nails with bichloride solutions and soap and water, and even the most 
trivial examination of a patient was never made without a thorough irrigation of the 
vagina with 1-5000 sublimate solution. This probably explained Apostoli's wonder- 
ful immunity from accidents of any kind. 
Dr. F. W. Martin, of Chicago, said that the milliamperemetcr merely indicated 
the strength of the current which was passing, not its density nor the resistance it 
was overcoming; it was, therefore, not so essential a factor in the appliances for 
treatment as Apostoli maintained. He criticised Apostoli's method of treating 
hemorrhage, on account of the enormous strength of current it required. He was 
able to accomplish the same end with the use of far less force, by applying sounds 
successively to different sections of the uterine mucous membrane, each sound being 
insulated except for a very limited extent, the exposed part being situated at a dif- 
ferent distance from the extremity in each sound. He believed that a single cell 
battery like Cutter's was inefficient for the purposes for which it was constructed, and 
that it could by no means give rise to a currrent which would traverse a space of two 
inches through solid tissues, as asserted. 
Dr. James R. King, of Clifton Springs, N. Y.-I beg leave to occupy a small 
portion of the valuable time of this Section of the Congress, to call attention to some 
special points in the papers read on the subject of Uterine Fibroma, and to make 
some additional observations on the same. 
I was much interested in Dr. Nelson's instructive paper on the "Treatment of 
Uterine Myoma by Ergot. ' ' His experience and contributions are of special value 
to the profession. In 1877 I began a series of observations on the use of ergot in fibroma of the 
uterus. In the succeeding five years I kept a careful record of sixty-nine cases treated 
by ergot, with favorable results. I will not weary you with statistics at this time. In 
the latter part of this period of my experience I began using faradism and galvan- 
ism in the treatment of fibroma, and obtained better results than I had with the 
ergot. In 1882 I abandoned the use of the faradic current and employed only the 
galvanic current in the treatment of uterine fibroma. About this time I became 
greatly interested, encouraged and instructed by the ability, genius and success of our 
distinguished friend, Prof. Apostoli. I was greatly pleased with the good results I 
obtained from using galvanism after his method. In 1884 I became deeply interested 
in his successful reports and encouraging assurances presented at the International 
Medical Congress held at Copenhagen. 
In 1885 I went to Paris to see his work in the hospital, and was still more pleased 
with his method of treatment. 
I pause here to say that just before discontinuing the use of the faradic current 
in the treatment of uterine fibroma, I began using ergot in combination, first, with 
the faradic and later with the galvanic current. While I am sure that not too much 
can be said in praise of Prof. Apostoli and his work-which I regard as the greatest 
advance that has been made in the last decade in the department of gynaecology- 
yet we must ever remember that these cases are found in the practice of every physi- 
cian, while at the same time few have the courage to use a galvanic current of the 
great strength which Prof. Apostoli employs, and which seems so simple and success- 
ful in his hands. Ovariotomy in the hands of a skillful and practical surgeon is a 
very easy operation, but in the hands of one less skillful and experienced the same 
operation would be a failure. This same principle is true to a great extent in the 
treatment of fibroma by the strong galvanic current. In the skillful hands of Prof. 
Apostoli it is followed by no troublesome complications, but this is frequently not 
the case when used by less delicate operators. In my own experience I have several 
times had unfavorable complications. It is possible, however, for all operators in the 
field of gynaecology to use a milder galvanic current in combination with the internal 
use of ergot and obtain the most favorable results. I have used, as I said, ergot in 
sixty-nine cases of fibroma of the uterus, with considerable success. 
I have since treated a series of fifty-one cases with galvanism without ergot, with 
much better success. In the last two years I have had thirty-two cases of fibroma, 
in which I have employed galvanism, following closely in the line marked out by 
Prof. Apostoli. I have at the same time combined with it the use of ergot, and the 
results have been much more satisfactory, in the rapid diminution of the tumor and 
in lessening the hemorrhage. The muscular contractions induced by the continued 
use of ergot seem to decidedly hasten the chemical action and absorption resulting 
from the use of the galvanic current. In my experience the combined use of galvanism 
and ergot seems to be far more rapid and effectual in accomplishing the work for 
which they are employed-the diminution or dispersion of the tumor and the pre- 
vention of hemorrhage-than when either are employed alone. My plan is to use 
a strong galvanic current every second, third or fourth day, according to indications, 
also Squibb's fluid extract of ergot three times a day until marked pains occur, 
resembling the pain of dysmenorrhoea. Then I gradually decrease the dose until 
the pain ceases. 
Many interesting cases of recent date in which this plan of treatment has been 
employed might be given, but I will only refer to one. 
Case.-A single woman ; age, 39. The tumor was about five inches in diameter. The uterine canal five inches long. She suffered from menorrhagia and metrorrhagia, 
and was much weakened and exceedingly nervous, and was having convulsions of a 
nervous type every two or three weeks. She has been under my care two months. I 
have used the combined galvanic and ergot treatment; the tumor is reduced to one-third 
the original size. The menses are regular and normal, the convulsions have ceased, 
the nervousness has almost entirely disappeared, and she seems to be quite well. 
I wish to refer briefly to the important paper read by Dr. Smith, of Toronto, on 
the treatment of displacement, etc., by the faradic current. This subject is one of 
great practical value to the specialist, but still more so to the general practitioner ; 
first, because the manipulation is easy, secondly, because the most gratifying results 
are attainable. 
Few physicians can shorten the round ligaments, for displacements, by operative 
procedure, as does Prof. Alexander, of Liverpool, but all can shorten them by the use 
of the faradic current. I have found it of great service, not only in prolapsus, but 
also in flexion. When we have a weak spine with lateral curvature we apply electri- 
city to the weakened muscles and stimulate contraction, and thus develop muscular 
tissue. When a subinvoluted or hypertrophied uterus is bent in any direction, the 
muscles become weak, and atrophy necessarily follows. The faradic current corrects 
this condition more rapidly than any other therapeutic agent, and sooner enables the 
replaced, straightened and involuted uterus to retain its normal position. At the same 
time we have the tonic effect upon the muscles of the vagina and uterine ligaments. 
Dr. Gilman Kimball, of Lowell, Mass.-I do not wish to detract in the least 
from the reputation attained by Dr. Cutter in his application of electrolysis in the 
treatment of uterine fibroids, but it is proper, and only just to myself, to make a brief 
statement in regard to the circumstances which led, so far as I understand the matter, 
to the adoption of this special mode of treatment in this form of disease. 
A patient had come from a distant part of Massachusetts to consult me in refer- 
ence to a tumor in the abdomen, of several years' standing, which her physician had 
declared to be ovarian, and which could be cured only by removal by a surgical opera- 
tion. Upon examination I saw at once that the tumor in question was not ovarian, 
but a clear case of uterine fibroid. Upon telling the patient that an operation for its 
removal was too dangerous to be attempted, and therefore altogether unjustifiable, 
she was not only greatly disappointed, but exceedingly distressed at the thought that 
her case was such as to admit of no remedy. I endeavored to console her by stating 
that such cases were, as a rule, not at all of a dangerous character, and that persons 
similarly afflicted seldom died on account of their presence. Seeing that she was not 
to be comforted by any assurance of this kind, I then told her that I had been think- 
ing for some time of experimenting upon this form of tumor by the application of 
electricity or galvanism, and if she felt willing to be the first to submit to this form 
of treatment and come to the Hospital in Lowell, then under my charge, we could 
soon ascertain whether or not this plan of dealing with the case was likely to be of 
any benefit. She readily agreed to accept my suggestion, and in a few days later she 
presented herself at the hospital, and the day following was operated on, Dr. Cutter 
being present and assisting. This, so far as I know, is the first case on record of 
uterine fibroid treated by electrolysis. It deserves to be stated that the patient, at the 
time she came to consult me, was suffering greatly from a dropsical condition-ascites, 
hydrothorax and anasarca, and to such a degree that she had been unable to lie down 
for the past six weeks, and was, therefore, obliged to pass her nights by sitting up- 
right in a chair. The morning following the first operation I found my patient in 
excellent condition-had slept comfortably all night-and the dropsy almost entirely gone. She explained this change by saying that she had passed during the night, 
seemingly, gallons of urine. So much for the immediate effect of electrolysis in 
this case ; I made four or five operations in the course of two weeks, but my leaving 
for Europe at the beginning of the third week relieved me from further connection with 
the case, the patient at the same time returning to her home. I heard nothing further 
from the case till my return to Lowell, when I learned that she had died but a short 
time before, but the circumstances connected with her death I never ascertained. 
My second case occurred in the course of a few days after the first. The patient 
had been bed-ridden for many months, on account of a fibroid involving the uterus, as 
large as a man's head. I made one operation in this case, and subsequently two 
more weie performed by Dr. Cutter. The effect of these three operations was to 
bring about a complete disappearance of the tumor in the course of twelve months. 
I might give other cases equally marked, illustrating the effect of electrolysis in 
bringing about a similar result, but to present them in detail would require too much 
time. It would be doing injustice to Dr. Cutter if I were to omit stating that I am 
under great obligations to him for many important and useful suggestions bearing 
upon this subject, and particularly for his having supplied me with the various appli- 
ances which I have employed in most of my operations, and to him, probably more 
than to any one else in this country, is now due the present increasing belief in the 
great value of electrolysis in the treatment of uterine fibroids. 
Dr. Apostoli spoke in defence of his system. He wished to give Dr. Cutter all 
credit for his investigations, but now that we have the means of measuring electricity, 
a measurement made definite by the Electrical Congress of Paris, there is no excuse 
for using it haphazard, and every one should use it cautiously. 
Dr. Garratt, Boston.-I wish to say that my relation to Dr. Cutter's opera- 
tions was only to decide whether he actually passed any current through the tumor 
by means of the apparatus and method he employed. This was decided by me to 
have been done, as proved by experiment on the living rabbit, and also by a German 
galvanometer, but I could not measure it, as I knew of no reliable instrument at 
that time, nor could I tell how much electrolysis passed. Not to be mistaken, I 
attended one of his operations in connection with several physicians, taking along 
my galvanometer, which I attached to one of the conductors, so that the current 
could be shown while operating ; that is, to show whether any current passed. All 
the gentlemen present watched the estatic needle as the contact of battery was 
broken and made again, and all were satisfied that a current did pass. The source 
of difference of opinion in regard to a current passing from one large and powerful 
cell, is owing to the large electrodes, both being in the tissues near the hip, often, 
which offer much less resistance than is generally known. As to the laws of elec- 
tricity as now laid down, they are no more to be questioned than the laws of chem- 
istry or astronomy, by any scientific men. 
Dr. Ephraim Cutter, in closing the discussion, said, as to the question of pri- 
ority with Dr. Kimball, I wish to have no question with one whom I venerate, but 
will simply refer to Dr. W. Symington Brown's article, published February 8th, 1873, in 
the Philadelphia Medical and Surgical Reporter, and republished in the February 
number of the American Journal of Obstetrics, of 1887: "Still, it was con- 
cluded to make trial of electricity, which was done twice, under Dr. Cutter's 
supervision. The first trial was made August 21st; a second attempt was made eight 
days later; Dr. Gilman Kimball, of Lowell, was present at the second trial and 
inserted the needles." Dr. A. C. Garratt has answered Dr. Martin's wager of one thousand dollars, that my 
current would not go through two inches of tissue, by his experiments with a living 
rabbit; but I should like to have my son, Dr. John A. Cutter, testify as to an opera- 
tion in New York. 
Dr. John A. Cutter said, "I saw a small Brazilian woman with an immense 
abdominal fibroid, giving her the appearance of a woman at full term, anaesthetized ; 
I saw the Cutter battery put in running order, measured and found to have twenty- 
six and a half amperes of direct current. I saw two of the Cutter electrodes 
pushed deeply through the abdominal walls; I saw the battery connected with these 
electrodes, and the current allowed to pass for five and a half minutes; I saw 
an amperemeter intercalated, and it registered that one-half an ampere, or five 
hundred milliamperes of current were traversing the fibroid. The current was 
allowed to go through the tumor for three minutes longer; the battery was discon- 
tinued, and on measuring it showed to have twenty-six amperes of direct current, 
showing a loss of less than one-fiftieth of its strength during the operation. ' ' 
Dr. E. Cutter then asked the Chairman if he would have Dr. Apostoli come 
forward and state whether he had had any entire cures or not. Dr. Apostoli said 
that his cases were cured symptomatically; the tumor did not go away, but the 
patients felt so well that there was no inconvenience. Dr. Cutter then continued, 
that this was the second time in sixteen years he had ever replied to any criticisms, 
and he had only done so at this time because he thought that the Congress ought to 
know of the facts. He wanted all to join in this work; wished all that were in 
earnest God speed; his method or any others were of no importance, but we must 
"cure the women ! cure the women I "