ELEC TROLYS1S 
IN 
THORACIC ANEURISM. 
BY 
HENRY I. BOWNJTCH, M. D. 
HEAD AT A MEETING OE THE SUFFOLK DISTRICT MEDICAL SOCIETY, 
MARCH 27, 1875. 
[Reprinted from The: Boston Medical and Surgical Journal, January 20, 1876.] THORACIC ANEURISM TREATED BY ELECTROLYSIS, 
WITH REMARKS THEREUPON. 
BY HENRY I. BOWDITCH, M. 1). 
T. A. S., forty years old, was by occupation a chief engineer in the 
United States navy. His father died of inflamed bowels, his mother of 
carcinoma uteri. In 1851 he entered the United States navy. In 
general he had been tolerably well, though never very strong; he had 
never had any long illness, and did not remember ever having severely 
strained himself. Previously to calling on me he had for three or four 
years had a little palpitation. In 1869, while at Norfolk, Va., he felt 
“ run down ” and generally unwell. A widower, he married a young 
wife in January, 1872. A cough appeared in the following spring and 
lasted about ten days, and then suddenly disappeared. He raised, dur- 
ing these days, only a little froth, without blood at any time ; but he 
could sleep only on his right side, because lying on the left side caused 
cough. During the following summer he considered himself as well as 
usual. He was able to walk as freely as ever until pulmonary symptoms 
reappeared three weeks before he called on me. At that time, one 
morning, when dressing, in the act of straightening his body in order 
to comb his hair, he was suddenly seized with a violent paroxysm of 
coughing, which could be relieved by gently bending forward his body ; 
but it was renewed when he placed himself in an erect posture. This 
condition of things continued ten days, during which he was quite ex- 
hausted by the cough; it caused restless nights, and compelled him to 
lie upon the right side. His appetite, however, continued. He had no 
hectics. In about ten days the cough was much lessened ; but mean- 
while, as he expressed himself, “ he had lost some flesh ” and “ all his 
strength,” and “ his wind was wholly gone.” His wife had heard a 
kind of “ clicking ” in the throat, apparently above the collar-bone. He 
had given up all duty for ten days. 
At his first visit to my study he was found to be a well-formed man 
with evident dyspnoea, not of the severest kind. He had a hard, dry 
cough. His pulse was 84 and not peculiar. He reported that usually 
he felt the best in the afternoon. 
Physical Exploration. — The superficial veins of neck and chest were 
distended. A distinct rounded prominence was seen between the right 2 
Thoracic Aneurism Treated by Electrolysis. 
clavicle and the fourth rib. The intercostal spaces, however, were visi- 
ble. The swelling was most prominent at the second rib, and at that 
part there was a distinct impulse with each motion of the heart. Semi- 
bronchial respiration was noted there, without rale. The whole of the 
prominence was flat on percussion, most so at the centre, and generally 
a little less sound in the right breast than in the left. Nothing peculiar 
about the heart. Save in the spot above named the lungs seemed well, 
front and back. Perhaps the right back had a little less sound on per- 
cussion than the left. Laryngoscopic and sphygmographic examina- 
tions revealed nothing definitely diagnostic. It appeared to me to be 
evidently a case of aortic aneurism, projecting from the arch towards 
the front and pushing forward the ribs. The limited locality in which 
the impulse was felt, namely, a space about two inches long in the 
second intercostal space, and the fact that only a very small portion of 
the lung seemed pressed upon, made the case not inappropriate for 
the trial of electrolysis. The patient had tried various remedies under 
other physicians, but had obtained no relief. 
November 12th. His nights had been troubled by dyspnoea, but he 
had been more easy when lying in a semi-recumbent position. Pulse 
72, smaller, a little irregular, equal in both wrists. Mind clear and calm 
in anticipation of the operation, which he had consented to, as he felt 
that it afforded the only possible chance of relief or cure. It was upon 
that ground alone that I advised the operation. 
Drs. J. Collins Warren and J. J. Putnam consented to aid me. Dr. 
Warren introduced three steel needles. I chose the softest and most 
central part of the tumor as the spot for their introduction. The 
needles were covered with varnish save at the very points. All were 
within half an inch from one another, and nearly parallel. They passed 
readily in about an inch and a half, and the extremities farthest from 
the chest undulated very visibly and undoubtedly under the influence 
of the aortic current. To these needles, which represented the posi- 
tive pole, Dr. Putnam attached twelve and, after some minutes, fifteen 
cells of the Storer battery, increasing the current gradually from zero. 
The introduction of the needles caused no pain. At the negative pole 
was a large pad ; it was placed on the left breast on a part correspond- 
ing to that in which the needles were placed in the right. A slight 
pricking sensation was caused under this pad, but no real pain or other 
discomfort was felt during the whole time the operation was con- 
tinued, except that towards the last the patient had pain low in the left 
back of the chest. Three minutes after this pain began (fourteen and 
one half minutes from the commencement of the current), the pulse 
rose to 92. The needles were still swaying strongly backward and for- 
ward as at the beginning of the operation. Soon the patient became 
pale, and looked faint; the pulse failed and the hands were cold ; evi- Thoracic Aneurism Treated by Electrolysis. 
dently serious results were threatening. The needles were immedi- 
ately withdrawn. Only a drop of sero-sanguinolent fluid escaped at 
each minute aperture. The pulse was lost a few moments at the 
wrist. The patient was laid flat in bed and was soon relieved from 
these untoward symptoms. The needles were all discolored and one 
was corroded. The patient soon recovered wholly his quiet of body and 
calmness of mind. He was ordered to remain perfectly at rest; to take 
beef-tea and milk, with a little brandy, for diet. Some strips of adhesive 
plaster were applied over the tumor. 
In a few hours one could not have recognized that the operation had 
been performed, except that in regard to every symptom the patient had 
greater comfort than he had had for several days before the operation. 
November 13th. I found that the relief had continued. The pulse, 
by report, had been about 84. The patient had had no uncomfortable 
symptom, only a slight local soreness where the needles were intro- 
duced. 
November 14th. Much the same as the day before, although he had 
required paregoric during the night because of his restlessness. He 
had perceived nothing materially different in his sensations since the 
operation. His aspect was that of comfort rather than of distress, and 
his respiration seemed easy. Pulse 86. The tumor was examined 
through the adhesive plaster; it had a hard, solid feel, very different 
from the soft pulsation observed before the operation. 
November 15th. Patient more restless and having some dyspncea ; 
opiates needed twice. At the time of the visit he was lying on his 
right side. Motion caused pain in front and sometimes in the back of 
the chest. Pulse 72, quiet. 
November 17th. He was sitting up, looking easy. The previous 
night he had been almost able to lie on his back. Slight sonorous 
rale was heard in both lungs. He was desirous of having a second 
operation. I found the tumor more prominent, apparently from ex- 
ternal inflammation. It was more solid, and the impulse was less dis- 
tinct. 
The patient being placed, as at the previous operation, in a semi- 
recumbent posture, three needles were introduced as before ; there was 
much less motion of them. Dr. Warren assisted me, Drs. Putnam and 
Oberly being present also. Twenty cells were at first used, a galva- 
nometer having been previously introduced into the current; the needle 
showed a deviation of thirty-three degrees. After three minutes twenty- 
two cells were used. At the fourth minute six more cells were added, 
causing a deviation of forty-five degrees. The pulse became a little 
weakened at the fifth minute. At eight and one half minutes the pa- 
tient had some pain in the right arm to the elbow. At twelve and one 
quarter minutes the deviation was forty-six degrees, and the patient felt Thoracic Aneurism Treated by Electrolysis. 
faint. The number of cells was reduced to sixteen, and the deviation 
fell to thirty-nine degrees. At fourteen minutes the pulse became 
weak, 80, and the needles wei'e removed ; the first of these had entered 
one inch and one eighth ; the second, one inch and nine sixteenths ; 
the third, one inch and a half. The introduction of them had been 
more difficult than at the previous operation, owing to the solidity of the 
tumor. 
During this operation, as at the first, no untoward symptoms appeared 
until after fourteen minutes, when the pulse and strength fell off. In 
both instances the removal of the electrical current relieved the patient, 
and the pulse regained its force. 
Six p. m. He was entirely comfortable ; the pains in the back and arm 
had gone ; the countenance was bright; he was cheerful and hopeful. 
Pulse 80, regular, sufficiently full. There was little or no cough. 
November 18th. The report was that the patient had had a comfort- 
able night; three drachms of paregoric had been taken. There was a 
slight redness of the nose, but no pain or dyspnoea or fever. The di- 
gestion was normal. Pulse 92, strong. Urine free. The patient was 
directed to omit the opiate if possible. 
November 19th. A very restless night (but without pain or dyspnoea), 
till the opiate was taken Avitli relief. There Avas pain in the shoulders 
towards evening. Pulse 84. The tumor had a very different feel from 
that which it had before the first operation ; it Avas decidedly firmer, giving 
the impression of a solid mass; there was no distinct fluctuation, but 
the sAvelling projected more. Although there was no external redness 
or tenderness, it seemed plain that all the parts around the points of 
puncture were swollen and hardened. 
Chloral hydrate gr. xv. 
Potassii bromidi gr. v. 
To be taken at bedtime and repeated pro re natd. 
November 20th. Delirium in the night, after the chloral, although 
the day Avas comfortable and the mind was clear. The appetite was 
fair. A slight Avheeze and hoarseness were noticed in the breathing. 
Pulse 84, smaller ; veins slightly distended. Tumor evidently larger, 
wdth a deep-seated pulsation. Omit bromide at night, if possible. 
November 23d. Owing to the apparent evil influence of the bromide, 
it had been omitted for two nights. The patient had sat up a good deal 
for relief. He Avas able to lie more nearly upon his back. When on 
the left side he had pain in the tumor. 
November 26th. He had been comparatively comfortable. The tumor 
Avas smaller and still solid, with only the slightest impulse. But there 
was bronchial respiration over the whole extent of the tumor. 
November 30th. The patient reported that he had lain on the left 
side, and felt easy. Thoracic Aneurism Treated by Electrolysis. 
December 3cl. Had lain indifferently on either side, and had walked in 
his chamber. There were no pains in the back and arms. 
December 6th. Rather more wheezing, which, with the slight cough, 
can be relieved by throwing the head, backward. Less appetite. A 
slight suppuration at one of the points where a needle had entered ; 
otherwise no apparent inflammation or other external result from the 
operation. 
December 11th. Pain in both sides. Pulse 80, less in the right ra- 
dial than in the left. 
December 14th. Some dyspnoea, requiring the patient to sit up at 
times. Pulse 60 to 70, and quite small in both radials. Digestion still 
fair. 
December 20th. Nights more restless, and the patient was growing 
weaker. He complained of more pulsation and heat in the tumor. 
Cough increased. No fever. Digestion still good. For two or three 
days the left hand had felt cold. The tumor was larger, and extended 
to the fourth rib ; it was quite solid, but towards the axilla there was 
an evident deep pulsation, and tenderness existed there. There was a 
little bronchial respiration at the front and in the back. Pure vesicular 
murmurs generally, in both lungs. 
December 28th. Some dysphagia during the past week ; otherwise no 
material change. 
January 3d. Severe pain in the chest; more cough: sputa frothy-white. 
The nights are tolerable ; extract of valerian is taken as a sedative. 
The tumor is still larger, but quite as solid ; in fact, the whole of the 
right breast is pressed out, and vesicular respiration is absent throughout 
that front and lessened in the right back. Through the left lung, front 
and back, the respiration is loud, puerile. On the day before (January 
2d), owing to pain, two leeches had been applied, which had caused free 
bleeding. 
January 6th. The tumor is larger, more painful. The patient had 
morphine injections with comfort. His countenance is much worse. 
Feet swollen. Bronchial respiration behind at the root of the right 
lung. 
January 16th. A letter from the attending surgeon says, “ Mr. S. 
still exists, but no better than when you last saw him. About a week 
ago he was suddenly seized with dyspnoea resembling asthma, during 
which his hands and ears became livid; from this he recovered only to 
have a more severe attack within twelve hours. When 1 saw him he 
was gasping for breath, with livid lips, ears, and face, and almost imper- 
ceptible pulse. The tumor has grown much larger within a few days.” 
The right lung was almost wholly useless, and the left was much im- 
paired. Both legs, the right arm, and the right side of the thorax were 
greatly oedematous. Scarcely any pulse in the right wrist; that in the Thoracic Aneurism Treated by Electrolysis. 
left was very small and feeble. The impulse of the heart shook the 
chest and head. He could not lie down ; an attempt to do so a few 
days previously caused such dyspnoea that he was thought to be dying. 
He sat up, resting his head on a chair in front of him. Little pain. No 
appetite. The hypodermic use of morphine kept him easy. The 
mind was terribly disturbed ; violent outbreaks of passion occurred ; 
he was delirious at times. 
January 21st. He died quietly. 
Autopsy by Dr. Fitz, January 22d. Body well formed, though small; 
marked rigor mortis; evident emaciation. Head not opened. 
Right chest much less distended than during life. A slight rounded 
prominence, two inches in diameter, near the cartilages of first, second, 
and third ribs of the right side. The skin over the upper anterior half 
of the right breast was firmly united to the ribs, mainly through thick- 
ening and condensation of the sub-cuticular areolar tissue. The pec- 
toral muscles were less in size than normal. The intercostals were pale 
and translucent, containing numerous gray and opaque lines apparently 
of fibrous tissue. At one part, between the first and second ribs, the 
intercostal muscle was absent over a space of the size of the finger- 
nail ; a pale, friable coagulum filled the space. 
The pericardium and heart showed no sign of disease. 
The left lung at its apex was adherent; and in the upper lobe, es- 
pecially towards its upper part, were numerous small, gray nodules, 
slightly opaque, grouped together in a more or less foliate manner. 
Elsewhere were occasional minute cheesy spots surrounded by dense 
pigmental fibrous tissue. The pleura near these spots was puckered 
and contracted. Similar appearances were observed in the upper part 
of the right lung. This lung was so firmly adherent anteriorly that to 
separate it the scalpel was needed. Posteriorly, the pleura costalis could 
be torn up with the finger. The lower lobe was separated from the 
diaphragm by about a pint and a half of clear yellow serum. This lobe 
was a more or less rounded mass ; the pleura over it was thickened, 
contracted, and opaque. The pleura was generally thickened every- 
where, but there were no adhesions. From the ascending aorta an 
aneurism of the size of an infant’s head projected and pushed out later- 
ally and upward above the superior vena cava and its branches. Its 
walls were thick except in the intercostal space formerly alluded to. 
The branches from the arch were unaffected. The inner surface for 
half an inch above the valves was comparatively unaltered, though the 
arch had undergone considerable dilatation. The interior of the sac 
proper was lined by a dense, partly decolorized, laminated thrombus, 
spread over the surface with tolerable uniformity. There was no one 
point where the clot seemed to show any definite relation to the prob- 
able entrance of the needles used in puncturing. The thoracic and Thoracic Aneurism Treated by Electrolysis. 
abdominal aorta showed occasional patches of chronic endarteritis. In 
the right subclavian vein was an old thrombus almost completely ob- 
structing the vessel. This vein had been cut off more than an inch 
and a half from its terminus ; hence its cervical extent could not be 
ascertained. The left subclavian and azygos veins were unobstructed. 
The oesophagus showed no signs of pressure. The mucous mem- 
brane of the trachea, in the immediate vicinity of the bifurcation, pre- 
sented marked alterations ; extensive ulcerations of it had occurred, 
exposing the cartilages over half of the circumference of the trachea. 
The mucous membrane adjacent to this was red and opaque, and both 
that and the ulcer were covered with a muco-purulent secretion. The 
spleen was normal. In the kidneys were alterations due to chronic 
passive congestion. The liver was normal in size ; the hepatic veins 
were gorged with blood. There was an approach to the nutmeg con- 
dition of the acini. The stomach and intestines were not examined. 
Remarks. — I believe this is the first case in this country of aneurism 
of the arch of the aorta in which electrolysis has been tried. But 
Dr. Keyes reports a case1 in which it was applied to an aneurism of 
the abdominal aorta. Four applications were made, March 30, April 
6, May 4, June 22,1871. Death occurred July 18th. Pain and nausea 
were relieved and the patient felt generally better, but was exhausted. 
As will be seen by the preceding history, although the tumor became 
harder after both operations, and lost a good deal of its impulse, and 
although in some respects the patient was relieved, as, for example, of 
his inability to lie save on one side, there was no real improvement, 
and death occurred sixty days after the first operation. This is not a 
verv flattering result. 
Let me now touch a little upon European and American experience, 
and finally try if possible to decide under what circumstances we ought 
to operate. 
Ciniselli, a distinguished physician in Italy, first proposed and per- 
formed the operation upon aortic aneurism'. In 1870, he reported nine 
cases between 1846 and 1866, fourteen between 1868 and 1870 ; 
twenty-three in all.2 Four of these only had been operated on by 
Ciniselli; nineteen were treated by others. The earlier cases were 
more fatal than the later ones. Only four out of the tw,enty-three 
seemed cured at the end of four, eight, eight and a half, and nine 
months. The number of operations in each case was as follows : in 
one case, twelve operations ; in two cases, six ; in seven cases, one ; in 
eleven cases, two. 
The numbers of needles used in the operations were in four cases, 
1 New York Medical Journal, December, 1871; quoted in Beard and Rockwell’s Medical 
and Surgical Electricity, New York, 1875, page 754. 
2 Annali Universali di Medicina, ccxiv. 292, November, 1870; Schmidt’s Jahrbiicher, 
cl. 31, 1871. Thoracic Aneurism Treated hy Electrolysis. 
two; in seven cases, three; in seven cases, four; in one case, five; 
in three cases, six ; and in one case, seven. 
The number of minutes during which electricity was applied was as 
follows: — 
In three cases it continued five minutes ; in four cases, thirty min- 
utes ; in two cases, ten minutes ; in two cases, twenty minutes ; in two 
cases, fifteen minutes ; in one case, eighteen minutes ; and in two cases, 
thirty-five minutes. 
Ciniselli uses the following arguments for operating: — 
(1.) Electro-puncture is the most rational method of treating aneu- 
risms of the aorta, internal as well as those externally visible. 
(2.) Electricity causes coagulation of the blood while being applied, 
and this effect increases after the operation is concluded, till the clot 
fills the sac and makes it a solid tumor. 
Among the favorable circumstances are : (1.) An aneurism inside 
of the walls of the chest. (2.) A sac projecting from the walls of the 
aorta with a narrow mouth. (3.) No complication with other inflam- 
mations or disturbances of the circulation than those caused by the tumor 
itself. (4.) A good constitution of the patient. 
The above would be favorable even if the tumor were distinctly pro- 
truding through the walls of the chest. 
Unfavorable circumstances are : (1.) Atheromatous disease of the 
artery. (2.) Local inflammations. (3.) Large mouth to the sac, or 
an enlarged artery communicating with the sac. (4.) If the aneurism 
project much from the surface of the chest and the opening from the 
artery be large enough to allow the blood freely to circulate, it may 
circulate in and around the coagulum, and if the covering of the aneu- 
rism be soft or sloughy, fatal external haemorrhage may occur. 
In all such unfavorable circumstances we must speak freely with the 
patient about the risks of the operation. 
The electrical apparatus must have sufficient force and tension. 
This method of treatment has apparently not been much used by 
others on the Continent of Europe.1 In Great Britain, however, it 
has been employed, and cases are published. Among them are the 
following;: — 
Dr. John Duncan, of Edinburgh, in a long article read before the 
Medico-Chirurgical Society, March 7, 1866, on galvano-puncture in 
aneurisms,2 cites a case which he claims as the first of its kind in Great 
Britain. A man forty-five years old consulted Dr. Duncan in 1864. 
Various remedies were ineffectually tried. The tumor covered half of 
the sternum and of each clavicle, and measured thirteen inches. Vari- 
1 Petrequin, of Lyons (Althaus, Value of Galvanism, London, 1846), first used galvan- 
ism for aneurisms. 
2 Edinburgh Medical and Surgical Journal, April, 1866, page 920. Thoracic Aneurism Treated by Electrolysis. 
ous nodules threatened to burst, superficial ulceration occurred and 
bloody fluid was exuding, and finally, copious haemorrhage took place 
just before the operation was done. December 8d, needles were kept 
in two hours and a half. Gas was disengaged during the operation. 
December 4th, two more needles were introduced and retained twenty- 
five minutes, when gas again escaped. The patient died December 11th. 
In Dr. Duncan’s history of the operation, he says that Liston operated 
in 1832 on subclavian aneurism. He gives Ciniselli’s tables of fifty 
cases, of which twenty-three were cured, twenty were not cured, and 
seven died ; four only were on the thoracic aorta, and these four were 
not cured. He states that intense pain is sometimes caused, and he ad- 
vises needles of the smallest size. 
In the Edinburgh Medical and Surgical Journal for August, 1867, 
Dr. Thomas R. Frazer treats of the subject, and gives a case in which 
sloughing ensued after the operation. The tumor augmented, and a 
second operation was performed. Clots were formed, but death was 
not delayed. Dr. Fi’azer would use galvanism to prevent an external 
opening, not hoping to cure an internal aortic aneurism. Experiments 
on the effects of galvanism are subsequently given. 
In the Edinburgh Medical and Surgical Journal for 1870 1 is a notice 
of three cases published by De Cristophoris of Milan. In all three in- 
stances the disease ended in death, although in the first it seemed miti- 
gated for a time and delayed. In the second, death ensued from external 
haemorrhage, two days after the operation. In the third, great relief fol- 
lowed temporarily, but death with internal haemorrhage in eleven days. 
Dr. Charles Bastian 2 gives a very interesting lecture on the whole 
subject, founded on a case in which he used electrolysis. He speaks of 
its innocuousness in the cases referred to. He operated October 8th, 
13th, and 18th, and the patient died October 29th. A sacculated 
aneurism of the most favorable kind for an operation was found. A 
clot unattached, but which Dr. Bastian considered the result of the 
operations, was found in it. Dr. Bastian used the needles as we did, 
that is, with the positive pole of the battery applied to them ; and he 
considers that the best method. 
In The Lancet for June 20, 1874, Dr. McCall An'derson, of Glasgow, 
reports the termination of a case first published in 1878,3 in which gal- 
vanism was used four times with the result of lessening the tumor to 
one fourth of its previous size. It had become solid, and the pulsation 
was much lessened. The patient felt well, though there was still a 
pulsation in the chest, and Professor Anderson did not claim the case 
as one of perfect cure, but at the same time he says, “No one can deny 
1 Page 537. 
2 The Lancet, November 22, 1873, page 594, and November 29, page 623. 
3 The Lancet, February 22, 1873, page 261. Thoracic Aneurism Treated by Electrolysis. 
the vast benefit which the patient has derived from galvano-puncture.” 
She went out to heavy work contrary to advice, and continued four 
months so occupied. The symptoms were all aggravated, and the patient 
died January 7, 1874, about thirteen months after the operation. 
Anderson advises to use the positive pole as we did; he recommends 
a large-celled battery, but a weak current. 
The following is a tabular statement of these facts up to November 
7, 1872 ; it comprises all that I have been able readily to find. 
THORACIC ANEURISM — ELECTROLYSIS. 
Date. 
Name. 
Number 
of 
Cases. 
Result (unknown in 13 cases). 
Cure. 
Death. 
Relief. 
1846-70. 
Ciniselli.1 
23 
6 
do. (in Althaus).2 
2 
1 
1, after four mos., 
Great relief in 
suddenly. 
the interval. 
1866. 
Duncan.3 
1 
1, on eighth day. 
1867. 
Duncan and Fra- 
zer.4 
1 
1, not delayed. 
1873. 
Bastian.5 
1 
1, on twenty-first 
day. 
1873. 
Althaus.2 
3 
1. 
2. 
do. (arteria in- 
nominata). 
1 
1, in a few days. 
1874. 
Anderson.6 
1 
1, in thirteen mos. 
Prolonged relief. 
f 1, late. 
Mitigated and re- 
1870. 
De Cristophoris.7 
3 
J 
lieved. 
j 1, in two days. 
Great relief. 
[ 1, in eleven days. 
Great relief. 
1872. 
H. I. B. 
1 
1. 
Relief to certain 
symptoms. 
37 
7 
11 
6 
A little less than one third die soon. A little more than one third 
are either cured or relieved. Less than one fifth are cured, and even 
these have relapses. 
What ought to be our position now in regard to this operation ? I 
should hold the following principles to be correct: — 
(1.) In any case in which treatment such as Valsalva’s, as modified 
by Tuffnell, or still further as suggested by myself,8 and in which there 
can be no doubt fro'm the physical exploration of the chest that aneu- 
rism of the arch of the aorta exists; if, moreover, we find that the lungs 
1 Sugli Aneurismi dell’ Aorta toracica. Milano, 1870; New York Medical Journal, De- 
cember, 1871. 
2 Medical Electricity. 
3 Edinburgh Medical and Surgical Journal, April, 1866, page 920. 
4 Edinburgh Medical and Surgical Journal, August, 1867, page 101. 
5 The Lancet, November, 1873, page 594. 
6 The Lancet, June 20, 1874. 
7 Edinburgh Medical and Surgical Journal, June, 1870, page 537. 
8 Proceedings of the Boston Society for Medical Observation, February, 1866, and subse- 
quently published in the Boston Medical and Surgical Journal. Thoracic Aneurism Treated by Electrolysis. 
11 
are not very much involved, if we have made up our minds that the 
case tends certainly to death, perhaps attended with severe suffering, — 
in such a case there can be no doubt that we should be justified in ad- 
vising electro-puncture, for relief at least, and with the hope of a cure 
if the aneurism be small. 
(2.) As to how it should be done, whether by applying to the needles 
the positive pole or the negative, or both, or one and the other alter- 
nately, I think no decision can be made further than this : the positive 
pole causes a firmer clot, and disengages less gas than the negative. It 
was used in our case. A great diversity of opinion exists as to these 
questions, which cannot be settled till we get further facts. 
(3.) A mild current should be used at first, and continued for some 
time. I have questioned whether in our case we did not too rapidly in- 
crease the number of cells, and whether it were not on that account 
that our patient had the peculiar symptoms. 
(4.) Absolute rest before and after the operation, if possible in a 
perfectly horizontal posture, should be maintained for months, according 
to the principles laid down by Tuffnell, although I would allow a little 
more food than he does. 
(5.) In regard to drugs, I should be governed by circumstances; 
gentle laxatives are admissible ; perhaps digitalis, if the pulse be too 
rapid. Iodide of potassium might be tried; also cold or compression ; 
if need be, leeches might be applied.