CLINICAL NOTES 
UPON THE USE OF 
3*fie -Cautery. 
[iV 
WILLIAM A. BYRD, M. D., ETC., 
■ QU/A’CV, ILLINOIS. 0 
Reprinted from The Practitioner, January, iSSo. 
BALTIMORE: 
THE PRACTITIONER PUBLISHING CO. 
1880. CLINICAL NOTES UPON THE USE OF THE GALVANO- 
CAUTERY. 
WILLIAM A. BYRD, M. D., ETC., QUINCY, ILLINOIS. 
The galvano-cautery, as a safe and reliable means of performing 
many operations, has not been appreciated by the profession generally 
to the extent that its merits demand. That a more frequent use may 
be made of it is the hope that actuates me to record a few of the cases 
illustrating its use in my hands. 
Follicular Pharyngitis a?id Nasal Catarrh.—Early in June, 1878, 
Prof. W. L. P. C , aged 35, consulted me in regard to follicular 
pharyngitis and nasal catarrh that he had been troubled with for years. 
He had been under the treatment of some excellent physicians, but 
never obtained any but temporary relief. The nasal mucous mem- 
brane was red and swollen so as to seriously interfere with breathing. 
The pharynx was granular, with dilated and tortuous vessels in the 
mucous membrane. The voice husky, and impaired further by the 
partial closure of the nostrils. 
June 29th, 1878, with the assistance of Drs. M. Rooney, W. C. 
Pipino, and J. A. Wagner, with the patient under chloroform, I ap- 
plied the wire of the galvano-cautery battery to the posterior pharynx, 
making three parallel applications an inch and a half long, an inch 
apart, burning just the width of the wire and barely through the 
mucous membrane. I also cauterized the mucous membrane over the 
middle turbinated bone in each nostril pretty thoroughly. A gargle 
of a weak solution of chlorate of potassa with carbolic acid was 
ordered. The nostrils to be syringed out with warm salt water as the 
occasion required. The next morning there was considerable swelling 
and pain, which rapidly subsided. In a week he was well, and has 
remained so. 2 
Galvano-Cautery. W. A. Byrd. 
The contraction of the cicatricial tissue deprived the mucous mem- 
brane of the nostrils of its erectile property and obliterated the en- 
larged varicose vessels of the pharynx. 
Since then I have operated in the same manner upon a good many 
patients with uniformly good results in all but two, so far as I know. 
One of the two left the city before I could determine whether she was 
well or not; the other got well of the pharyngitis and catarrhal trouble 
in one nostril. The other nostril was obstructed by a deflection of the 
septum narium, that I expect to remedy by an operation suggested 
by Dr. A. J. Steele, of St. Louis, and published in the St. Louis 
Courier of Medicine, for May, 1879 (p. 485, et seg.\ an operation by 
the performance of which I very effectually relieved Dr. Jacob A. 
Wagner—mentioned above—of the same trouble. 
Fistula in Ano a?id Hemorrhoides.—In the treatment of these affec- 
tions the galvano-cautery excels anything that I have made use of 
after dilatation of the rectum. For my opinions expressed at greater 
length upon this subject, I beg leave to refer the reader to an article 
of mine, entitled “Dilatation of the Rectum in the Treatment of 
Hemorrhoides, Fissured Anus, and as a Prophylactic Measure in 
Fistulae,” published in the May 24th, 1879, number of the Hospital 
Gazette, and the August 29th, 1879, number of the Medical Press and 
Circular. Its superiority over the ligature is its causing less pain 
and the short time required to perform the operation in its entirety. 
In operating for fistulae by this means there is freedom from pain and 
hemorrhage, and an eschar is left to hold the wound open and secure 
union from the bottom, obviating the liability to bridging over of tissue 
and the re-establishing of the trouble, as is the case if the patient 
is operated upon with the knife and the after-treatment entrusted to 
careless or incompetent hands. 
George L , a middle-aged bartender, presented himself with a 
fistula in ano of fifteen years’ standing. With the assistance of Dr. 
Wm. C. Pipino, a platinum wire was passed through the fistula, and 
the current passed, when the heated wire was drawn slowly through 
the tissues, causing but little pain and no hemorrhage. No anaesthetic 
was used. A cherry stone, and a bit of wood nearly an inch long and 
half an inch wide, were found in the fistulous track. The wound was 
dressed with an oiled rag pressed down to the bottom of the wound, 
and renewed night and morning. No anodynes were required in the 
after-treatment. In ten days he was well. Ga/vano-Cautery. IV. A. Ryrd. 
3 
August ist, 1879, was called to see Miss Mary S , aged 22, who 
was suffering from dysmenorrhea and hemorrhoides. The dysmenor- 
rhea was the result of a sharp ante-flexion of the uterus. There was 
habitual constipation, which likely produced the piles in the first 
instance, which condition being established contributed to keep up the 
constipation. Defecation being painful caused the patient to retain 
the contents of the bowels as long as possible; the mass, becoming 
harder and larger, distended the rectum and pressed the uterus out of 
position, interfering with the pelvic circulation, which again deranged 
the nutrition of the uterus and aggravated the hemorrhoides. 
I first dilated the uterus with laminaria tents, and August 6th, with 
the assistance of Dr. M. Rooney, the patient having been put under 
the influence of ether, I dilated the rectum fully and removed the 
hemorrhoides with Smith’s clamp and the caustic wire. The pain after 
the operation was so slight as to require but one dose of one-fourth 
of a grain of morph, sulph. for its relief. In a week she was well, and 
has remained so. 
Epithelioma and Rode?it Cancer.—August 22d, 1878, Mrs. George 
C , aged 40, called with her husband to consult me in regard to a 
wart-like excrescence, about the size of a walnut, that had made its 
appearance as a small nodule, some two years before, upon the outer 
side of the left breast. Without an anaesthetic, and with the assistance 
of her husband, I passed the wire around the tumor about half an 
inch external to its base, which I was enabled to do by making trac- 
tion upon the outer portion of the tumor, thereby raising the base 
and surrounding skin up into a cone shape. Passing the current, 
and keeping up the traction, the outer side was cut through first, 
leaving the traction applied to the central attachments. By this pro- 
cedure a cone-shaped excavation was left at the site of the tumor. 
The wound was dressed with carbolized vaseline and oakum. She 
stated that the pain was insignificant. Recovery was speedy and 
complete. 
March 13th, 1879, I was called to Edina, Missouri, by Dr. Lewis F. 
Nelson, to see Andrew B , aged 48, who was suffering from epi- 
thelioma of the left lower lip. At the corner of the mouth a place 
was eaten away as large as the end of the index finger, through which 
the saliva dribbled. The edges of the ulcer were creviced, red, angry 
looking and discharging ichor. 
A platinum wire was passed through the cheek with a Darby’s 
perineum needle, opposite the corner of the mouth, and half an inch 4 
Galvano- Cautery. W. A. Byrd. 
external to the nearest discoverable diseased tissue; the current 
was passed and the wire was gradually drawn upon, keeping carefully 
half an inch within the sound tissue until it cut out a little to the right 
of the centre of the lower lip. The loop was then placed at the 
point of commencement and carried around half an inch within the 
sound tissue, coming out a little to the left of the middle of the upper 
lip. The piece taken out was about the size of my thumb. An iron 
wire suture was then passed, about half an inch from the edge of the 
opening, through the whole thickness of the lip, and a leaden shield 
and perforated shot clamp put upon either end so as to draw the edges 
of the wound together. When the eschar was thrown off by suppu- 
ration, the granulations of either side were held in contact by this 
stay-suture and united, leaving, as Dr. Nelson writes me, a healthy 
lip, with very little deformity, and capable of retaining the saliva. 
September 13th, 1879, Mrs. Paul K , aged 56, consulted me in 
regard to a rodent cancer of the left ala, of ten years’ standing. The 
ulcer was about the size of a silver quarter dollar, only the outlines 
were irregular and the edges overhanging. Plate III., figure 2, fas- 
ciculus I., Hutchmson's Clinical Surgery, is an excellent representation 
of the condition, with the exception that Hutchinson figures the ulcer 
upon the right nostril. It began first as a spot of enlarged blood 
vessels, over which the skin thinned and gave way, permitting an 
ichorous discharge that would sometimes become dry enough to 
make gray, brittle, light-colored scab. Various caustic applications 
were applied by the physicians she consulted, but did no good, the 
sore continually but very gradually enlarging and giving considerable 
annoyance from the discharge and the itching, and also from the in- 
quiries of anxious friends about her red sore nose. I applied the 
heated wire to the whole surface of the ulcer and for some distance 
around it, destroying all the tissue I thought to be diseased. The 
wound was dressed with carbolized vaseline. She did not complain 
of pain during the operation. In ten days she was well. 
February 8th, 1879, I saw, with Dr. J. A. Wagner, Mrs. Julia B , 
aged 60, who was suffering with epithelioma, involving the whole gum 
of the right upper jaw. Owing to mitral insufficiency we did not give 
an anaesthetic, and the patient would permit only a partial removal of 
the diseased tissue. I he operation gave no relief. This was the 
only patient that I have operated on that complained of much pain 
from the cautery. Galvano-Cautery. W. A. Byrd. 
5 
Aneurism by Anastomosis.—October 6th, 1878, Dr. P. A. Marks 
brought to me Prof. C , aged 36, who was suffering with a 
“mother’s mark” in the right hypochondriac region In infancy it 
was very small; of late it had grown rapidly until it was the size of a 
hickory nut when seen by me. It had been irritated by the rubbing 
of the waistband of his trowsers, and was considerably inflamed. 
The platinum loop was thrown around its base, and the current 
passed. Very gradual traction was made upon the wire, so as to cut 
very slowly and cauterize well as it divided the tissues. The operation 
was almost painless and perfectly bloodless. Recovery was rapid. 
Tracheotomy.—For my experience with the galvano-cautery in the 
performance of this operation, I beg leave to refer the reader to an 
article upon that subject in the November, 1879, number of the St. 
Louis Clinical Record, or will send any one a reprint of it who 
may desire it. 
Extirpation of the Rectum.—Mrs. Philip B , aged 61, was sent 
to me by Dr. S. W. Durant, of Adams, Illinois, to have an operation 
performed to give her relief from pain, loss of blood and tenesmus dur- 
ing defecation. I sent her to St. Mary’s Hospital. An examination 
revealed, an inch and a half up the rectum, an indurated, nodulated 
mass, of half an inch or more in thickness, occupying the bowel and 
infiltrated in its coats for two inches. The opening through this 
mass would barely admit the passage, with some force, of the index 
finger, and was ulcerated throughout. From the ulcerated surfaces 
came a good deal of pus and blood when hardened feces were forced 
through the small opening. Dr. Durant was of the opinion that the 
stricture was of a malignant nature. 
I determined to remove the strictured portion of the bowel with 
the curette and the caustic wire, through dilating the sphincters, there- 
by saving those muscles for future use. 
February 25th, 1879, with the assistance of Drs. J. F. Durant, M. 
Rooney, M. Renick and J. A. Wagner, with the patient under ether, 
I introduced my hand, as a divulsor, into the rectum and through the 
stricture. The rectum was then held open with wire loop specula, 
while I scraped the softest portions of the growth with a Sims’ sharp 
uterine curette. The hard nodules were lifted with forceps and held 
terse while the heated wire was thrown around and cut through below 
their bases. All points where blood issued were well cauterized. 
There was great hemorrhage while using the curette. 6 
Galvano-Cautery. IV. A. Byrd. 
Warm injections of a solution of chlorate of potassa were ordered 
every four hours as an antiseptic. Anodynes were given as necessary, 
though she required but little, and tonics. 
Large-sized rectal bougies were passed daily after the first week, to 
prevent the cicatrix from contracting so as to reproduce a stricture. 
March 25th, there being no ulceration nor discharge of pus or 
blood or tenesmus, she was discharged. The cicatricial tissue that 
occupied the place of the tumor was not more than half an inch wide, 
was smooth, elastic, and had an opening through it of an inch and a 
half diameter. 
The tissues of the constricting mass were carefully examined under 
the microscope, but no evidence of malignancy was discovered. 
May 23d, she returned, complaining of difficulty in passing feces if 
hardened, but free from hemorrhage or suppuration. The cicatricial 
tissue had contracted, leaving the calibre of the bowel not more than 
three quarters of an inch in diameter. I his, with the assistance of 
Dr. S. W. Durant, I dilated, under ether, with my hand, and ordered 
it to be kept open by the daily use of Wales’ soft rubber dilators. 
August 1st, she returned, with constipation and trouble higher 
up the bowel, beyond my reach. With laxatives and tonics she 
improved, and is doing fairly well now ; yet I believe, that although 
we were unable to determine carcinoma, that disease is the trouble, 
and that she will yet die of it. 
Oozing Tumor of the Labia.—Mary E. C , aged 30, consulted 
me in regard to lobulated, raspberry-like excrescences upon both labia, 
extending down nearly to the anus. These growths rose above the 
surrounding skin, from one-half to three-quarters of an inch, and 
constantly exuded a stinking watery ichor that almost drove the 
woman wild with pain. I prescribed washes of solutions of carbolic 
acid of different strength, carbolic acid and glycerine, solutions of 
chloral, dry oxide of zinc, subnitrate of bismuth, and everything 
else that I thought would possibly give her relief. Nothing did any 
good. 
September 28th, 1878, with the assistance of Dr. William Zimmer- 
man, I removed the growths with the galvano-caustic loop, and 
cauterized the parts from whence they were removed deeply. The 
wound was dressed with carbolized vaseline. Recovery was rapid 
and complete. 
Amputation of the Cervix Uteri— Mrs. Jerome M , aged 35, 
came to me for relief from dysmenorrhea and dyspareunia. In Galvayio- Cautery. IV. A. Byrd. 
7 
making an examination, the upper portion of the vagina was found 
occupied by a tumor smooth to the touch, somewhat larger than a hen’s 
egg, and reaching to within an inch of the vulva. This could hardly 
be a polypus, as there had been no metrorrhagia, neither could it be an 
inverted uterus, as the lady was nulliparous, and besides I could detect 
the body of the uterus in its proper place by conjoined palpation. 
Introducing a speculum I was still more at a loss, for I discovered a 
smooth, light pink, oval mass of about the diameter of the bottom of a 
quinine bottle between the blades of the speculum, but nowhere could 
I see an os. It being a gloomy day and late in the afternoon, I told 
her I had not fully decided what was the matter, but to call again 
earlier in the day. 
At her next visit I detected a spot of mucus upon the centre of the 
tumor, and wiping it away discovered an opening not larger than the 
end of a knitting needle. Exploring this with a small probe I found 
it to be the os. The uterus was in its normal position but was four 
inches and a half deep. Here, then, was a case of hypertrophy of the 
cervix causing mechanical dysmenorrhea by encroaching upon the 
cervix, and dyspareunia by encroaching upon the vaginal space. 
Amputation of the cervix offered the only hope to her for recovery, 
and Sept. 30th, 1878, assisted by Drs. M. F. Bassett, M. Rooney and 
J. A. Wagner, the patient under ether and in Sims’ position, the vagina 
held open with a Sims speculum and the cervix steadied with a vul- 
sellum, I threw the wire around the cervix one inch from its extremity. 
One end of the wire was screwed tightly in the conducting rod on one 
side of the handle and passed through a hole I had drilled in the con- 
ductor on the other side so as to allow it to draw through easily, at the 
same time not permit the circuit to be broken. Then, by passing the 
current and drawing upon the loose end of the wire with a pair of 
small pliers, so as to have it cut slowly through the tissues, the cervix 
was severed without the loss of a single drop of blood. The opera- 
tion occupied about ten minutes’ time. Warm vaginal injections of a 
weak solution of carbolic acid were ordered three times a day. Her 
recovery was rapid. The dysmenorrhea and dyspareunia were com- 
pletely relieved. 
A great many writers, chiefest among whom is Dr. T. A. Emmet, 
claim that amputation of the cervix, especially with the galvano-cau- 
tery, is followed by contraction of the resultant cicatricial tissue and 
closure of the os in most instances. Their statements I do not doubt, 8 
Galvano-Caiitery. W. A. Byrd. 
but in this case the contraction was toward the centre of the wound 
surrounding the cervix, which pulled the os open. This I positively 
know, for not having seen the lady for several months until November 
27th, 1879, more than a year after the operation, she was in my office, 
and I mentioned Dr. Emmet’s statement concerning the results of 
such operations and desired an examination, to which she willingly 
consented. The cervix extends between one-half and three-quarters 
of an inch within the vagina, is not enlarged, the os is easily detected 
with the finger, is wider laterally than antero-posteriorly, readily admits 
Simpson’s sound, which passes two inches and a half in the proper 
direction for the uterine canal; in fact, except that a faint line of cica- 
tricial tissue can be detected by sight, but not by the touch, surround- 
ing the os, no one could suspect the uterus to have ever been in any 
but the most healthy condition. There is no flexion or version nor 
menstrual difficulty. 
The battery I use is one of Byrne’s perfected, made by the Western 
Electric Manufacturing Company, 220 Kinzie street, Chicago. It is 
the smallest efficient battery that is made, and can be easily transported 
with all necessary accessories in a small wooden valise. 
It is an excellent battery for electrolysis also, as I have by that 
method dissipated growths, but will leave the discussion of that subject 
for some future paper. 
The pipes for blowing the gas off the plates during action are 
entirely too brittle, but can easily be mended with bits of soft rubber 
tubing. The handles could be improved by having slide break-circuits 
applied. The ecraseur is a miserable thing that I do not believe any 
one would try to work with twice. Every one using the battery ought 
to have sufficient ingenuity to improvise electrodes. Perhaps I will 
refer to them at a future time. 
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