THE ELECTROLYTIC TREATMENT — OF— URETHRAL STRICTURES, WITH A FEW SELECT CASES, With the CO MJPJLI311ENTS of BY ROBERT NEWMAN. M. D., OF NEW YORK CITY. REPRINT FROM New England Medical Monthly, JUNE, 1883. ADDITIONAL ANSWERS TO COR- RESPONDENTS ABOUT THE ELECTROLYTIC TREATM ENT OF URETHRAL STRICTURES, WITH A FEW SELECT CASES. BY ROBERT NEWMAN, M. D., NEW YORK. Permanent Member American Medical Association, Hon- orary Member Ulster County Medical Society, Mem- ber Pathological Society, N. Y., etc. SINCE the publication of my articles in the New York Medical Bccord, August 12th and 19th, 1882, “Ten Years Experi- ence in the Treatment of Stricture of the Urethra by Electrolysis,” a large corres- pondence has been received from physic- ians, either making further queries about the method, or reporting success in adopt- ing it. I have answered many practical and theoretical questions by letter, but found the correspondence accumulating; many needing too long explanations, so that it was impossible to do justice to the subject in all cases. This article is in- tended to supply this want, and my corres- pondents will find in it their queries an- swered, and all supplementary information given, either in the new cases related, or in the brief tabulated rules about the operation. Since my last report was written, August, 18S2, almost daily new cases have been presented and treated, with the same uni- form success as related in the former pa- per. Scarcely any simple cases came, and most of them were the worst and most aggravated strictures, which can come un- der observation, and many patients were accompanied by their family physicians, who acknowledged that they could not pass such strictures with any instrument, no matter how small. In all cases the strictures were passed by the electrode bougie. This means that the absorbent power of the electrolysis enabled that size of the instrument to pass, which could not have been done without the aid of the electrolysis. To illustrate this power and the method, some selected cases will be related here. Case I.—Six strictures of 25 years standing, impassable by instruments, cured by Electrolysis. October, 1882, Dr. D., set. 57 years, a regular physician, practicing in Long Isl- and, suffered with strictures of the urethra for over 25 years, and has been treated off and on, in the usual manner, with only temporarv relief. He noticed the stricture first in 1S57, which gradually became worse. Since 1877 he has been under the care of one of our most eminent surgeons, lately deceased, who during these yeais never could pass an instrument through all the strictures into the bladder. 1S82, October 17th.—Patient came un- der my treatment, complaining of having scarcely a stream of water at all, not be- ing able to use a force sufficient to propel the water. The stream is very small, almost diminished to a dribble. Penis is cold and flabby. Meatus is large, admit- ting a sound, No. 26, French. A small whalebone bougie a boule detects the whole urethra in an indurated state, scarcely free from strictures anywhere. The whole canal is a mass of strictures with little intermissions, and the small bulb is arrested everywhere. The bougie passed with difficulty three distinct stric- tures, and was firmly grasped and arrested at the fourth, at 5 inches from the meatus. No instrument would pass this fourth stric- ture. I. Electrolysis.-—The patient was kept standing, resting himself with one hand on the back of a chair, the other hand holding the electrode from the positive pole of the battery, and pressing the wet sponge cover against the thigh. A stiff 2 electrode bougie, insulated, except the metal end, egg shaped, No. 11, French, is introduced into the urethra, the other end of the bougie is connected with the wire, which in turn is connected with and used as the negative pole of the battery, and completes the circuit. As soon as the bougie is arrested by the first stricture, the current of the electricity is slowly increased cell by cell, till the susceptibility of the patient tells that the current is strong enough, without causing pain. During this seance ten cells were used for twenty minutes. There was slow progress but the electricity worked its way through all the strictures, and at last entered the blad- der. The current was kept up while the bougie was being withdrawn, and was held loosely in each stricture till it could bo moved easily, and it was distinctly felt that the contraction was absorbed. The bougie was neither pushed nor pulled, only guided by two fingers of the hand. The work was thereby done entirely by the galvanism, without causing any pain nor a particle of hemorrhage. The pa- tient was much pleased with the result, and passed water immediately in a good full stream. From this operation the seat of the strictures was ascertained to be as follows: 1st Stricture at If inches from the meatus. 2nd “ “ “ “ “ 3rd “ “ 4* “ “ “ 4th “ “ 5 “ “ “ “ 5th “ “ 6} “ “ “ Gth “ “ 7 November 8th.— Since the last opera- tion, about three weeks ago, patient has attended to his practice, and has felt bet- ter, than for many years. II. Electrolysis was used in the same manner as before, with an electrode bou- gie, No. 14, French, which passed through all the strictures in ten minutes, while a current of ten cells was working. November IS th. III. Electrolysis with a conical sound No. 17, as the negative pole, which after passing, was replaced by a No. 17, French, egg-shaped bulb. In withdrawing, the latter worked up and absorbed each stricture in turn, so that the instrument could be moved about freely without any restriction; ten cells were used for thirteen minutes. To use two electrodes in succession during one seance is against the rules, but was indicated in this case as an exception. December 22nil, 18S2. IV. Electroly- sis.—Bougie No. 20, French, with ten cells for ten minutes. Strictures were tight, but offer less resistance, and bougie soon passed through all of them. There is much improvement. 1883, January 5th. V. Electrolysis.— Bougie No. 21 passed easily; nine cells for twelve minutes. January 19tli. VI. Electrolysis.—Bou- gie No. 23 for twelve minutes, with a cur- rent of eight cells, passed, but had to work each stricture separately. February 13th. VII. Electrolysis.— Bougie, No. 2G, French, with seven cells for eleven minutes, passed more easily than ever before. In four minutes had worked through all strictures, and passed into the bladder. Not the slightest pain was occasioned. The patient is in excel- lent health, has regained a natural stream of water with good force, and says he feels better now than he ever did during the last 25 years. Is well in every respect. Case II.—Four strictures 15 years old, with, incontinence of urine. October llth, 18S2.—Mr. B., from Jer- sey, was brought to my office by Dr. Field. The patient has suffered for fif- teen years without being cured by the usual methods. He is now run down, very weak, has lost flesh, is never free from pain, is constantly straining, and can neither pass water, nor retain it. The urine dribbles away constantly from over- flow, and thereby excoriates the tender skin, notwithstanding that the patient wears an urinal. The patient passes sleep- less nights and is in constant agony. At present no instrument will pass. On ex- amination, I found that no instrument 3 would pass the strictures. The exploring bougie a boule encountered a mass of hard strictures, which were passed only by man- ipulation and with difficulty, and was soon arrested. Then a small filiform guide en- tered everywhere into lacunae, which bled on ever so careful an examination, and at five inches from the meatus no instrument would pass any further. The family physi- cian present, said he knew that no instru- ment would pass any further than five inches. If he had been able to pass it, he would not have brought the patient to me. Electrolysis was then tried. The patient was placed on the operating table in a half recumbent position. The posi- tive sponge electrode was held on the abdomen ; the negative pole in the form of a No. 14 French bougie was inserted into the urethra. The electric current was gradually increased to eleven cells and during seven minutes the bougie made steady progress, advancing slowly, and working its way into the bladder, to the great relief of everybody present. There were four distinct strictures at 3J, 5, 6J and 8 inches respectively from the meatus. October 21tli.—Filiform bougie was tried in vain, it hung in lacunae everywhere, and fearing to cause too much irritation, it was abandoned. A whalebone bougie No. S passed easily into the bladder. II. Electrolysis was used with a bougie, No. 14, French, which, with a power of seven cells, worked slowly through all the strictures. The third stricture was very tight. Present, Drs. Field, Payne and Brush. The electrolytic applications were con- tinued at intervals of ten days. In four seances up to November 2Sth, the patient has so much improved that he has gained fifteen pounds of flesh, which gives him normal weight; the water passes freely ; the bladder is entirely under control, and the urinal discarded. He is well, attends to his business and enjoys life. Case III.—Four strictures of 20 years standing cured by four seances of Electro- lysis. November 14th, 1882.—Telor T., set. G2 years, residing in New York city, came to me with complete occlusion of the urethra, and consequent retention of urine, lias suffered for twenty years with strictures, a consequence of urethritis. No treatment has cured him. The strictures became worse, so that recently he is in constant pain, having had retention and inconti- nence at the same time, the water con- stantly dribbling away and incapacitating him for any work. The smallest instru- ment would not pass the stricture, but an electrode bougie, No. 14, French, worked its way slowly, with the power of twelve cells for seventeen minutes, through all the strictures and into the bladder. Present, Drs. Meier and Bassett. December 20tli.—After three electrolytic applications, the patient savs that his stream is large, and he is better in every way than for the last twenty years. Soon after a bougie, No. 23, French, passed easily. Case IV.—Stricture of ten years—Eup- ture (partialJ of urethra. 1883, February 20th.—Dr. Munson, of Bridgeport, had the kindness to bring this interesting case to my office, with the fol- lowing history : Mr. A., set. 36 years, suf- fers from a stricture of over ten years standing, a consequence of urethritis, which otf and on closes up. He is an inventor and made himself an instrument for the dilatation of the stricture, consist- ing of a steel rod, surrounded by a spiral spring, which by turning was inserted into the stricture like a corkscrew. He felt the stricture closing up entirely, and used his instrument as he had done before. In giving another twist, he ruptured the ure- thra, which caused severe pain and hemor- rhage. Micturition could only be per- formed imperfectly, merely bv an overflow of the bladder, causing a dribbling away. The patient was brought to mv officq by his family physician, Dr. Munson. From 4 tlie history of the case it was evident, that the treatment most indicated for relief would be perineal section, but as the pa- tient needed immediate relief, I tried the introduction of instruments into the ure- thra. Whalebone bougies a boule, and guides of different sizes would not enter further than five inches, the seat of the stricture and rupture. Each guide entered and stuck in some of the pouches, but none entered or passed the stricture. Therefore the filiforms were abandoned for fear of creating more irritation and hemorrhage, and direct Electrolysis tried. An electrode bougie, No. 12, French, as negative pole, was carefully introduced and manipulated in the urethra, while the positive sponge electrode, held above the pubes, closed the circuit of a galvanic bat- tery of which seven cells were used. The bulb of the electrode glided by manipula- tion over the partial rupture of the urethra and engaged itself in the stricture, where it advanced slowly, absorbing and finally passing. The patient was nervous, but held still, felt each movement as the bou- gie advanced, without any pain, nor was a drop or a show of blood drawn. Immedi- ately after this operation the patient passed a steady good stream of water such as ho had not seen for years. Tho Electrolysis was used for ten min- utes. Ilectal suppositories of belladonna were ordered. March 6th.—Since tho operation the patient has felt comfortable, and the stream of water has increased in size. Electrolysis with a bougie, No. 14, French, was worked for twenty minutes with eleven cells, and passed the stricture slowly, absorbing considerably the indu- rated masses. On April 10th, Dr. Mun- son reported the patient much improved and doing well. Aggravated cases like the foregoing and others with different complications 1 see often, almost daily, so that I could tabu- late hundreds of them. The operation never causes pain, nor detention from ordi- nary business, which often surprises the patient. A physician residing in Connec- ticut, who had been treated at my office, wrote me on his return home: “ I was much surprised to find that there was less irritation after the use of electricity, than after the introduction of the simple sound. The annoyance caused by the electricity was simply zero.” Since my article was written last sum- mer, I have received many reports from eminent practitioners, that they have either adopted my method, or have practiced it in- dependently with equal success. Among others, Dr. D. A. Farrand, of Detroit, Mich., writes Oct. 6th, 1SS2, that after reading my article, he has operated with Electrolysis on about eighteen strictures with very grati- fying results. Great pleasure was given me in a letter from Dr. Hutchinson, of Providence, dated September 28th, 1882, in which he says, he has operated in twenty-one cases, in the last six months, with unvarying success. By the unique good results the'method of electrolysis in the treatment of strictures is fully tried and established ; every day brings new converts, and new friends. I will conclude this article with some rules, as a safe guide for practitioners, who wish to adopt the treatment of electrolysis in stricture of the urethra, which will also serve as answers to numerous questions received from correspondents. 1. The battery needed, is any good, steady galvanic battery ; the 20 cell Dres- cher battery is a good and cheap instru- ment, sufficient to begin with. II. E. Stammers, 1430 Broadway, New York city, has made me an excellent battery, which has many advantages. 2. The fluid for the battery ought not be used too strong. 3. liheostate and galvanometer, attached to the batteries, are convenient niceties, but for our purpose, and the battery used, not necessary. 4. For the positive pole a carbon elec- trode is used, covered with sponge, mois- 5 tened with warm water, and held firmly against the cutaneous surface of the pa- tient’s hand, thigh or abdomen. 5. For the absorption of the stricture the negative pole is always used. G. Electrode bougies are firm sounds in- sulated, with a hard baked mass of rubber; the point is a metal bulb, egg-shaped, which is the acting part in contact with the stricture. These electrode bougies are made by Geo. Tieman & Co., as also bv II. E. Stammers, and other instrument makers. 7. The curve of the bougie is- short; large curves are mistakes. 8. The plates must be immersed in the battery fluid before the electrodes are placed on the patient, and raised again after the electrodes have been removed. 9. All operations must begin and end while the battery is at zero, increasing and decreasing the power of the current slowly, and gradually ; avoiding any shock to the patient, or any interruption of the current. 10. Before operating, the susceptibility of the patient to the electric current should be ascertained. 11. The problem is to absorb the stric- ture, not to cauterize. 12. At first it is best to operate only by the first method of absorption, “ weak cur- rents, at long intervals 13. The exact number of cells to be used can not be given, it must be regula- ted according to the work to be done. As a general rule six to twelve cells may be used. 14. The seances should be at intervals, not too frequent in succession. 15. The best position for the patient to assume during the operation, is that which is most comfortable for him and the opera- tor. I prefer the erect posture, but the recumbent, or others may be used. 1G. Anaesthetics I like to avoid; I want the patient conscious, so that he can tell how he feels. 17. Force should never be used; the bougie must be guided in the most gentle way ; the electricity alone must be allowed to do the work. 18. During one seance, two electrodes in succession should never be used. 19. All strictures are amenable to the treatment by electrolysis. 20. Pain should never be inflicted by the use of electrolysis; therefore it should not be applied, when the urethra is in an acute, or even subacute inflammatory con- dition. 68 West 35th Street, New York, Mat, 1883. FEINTED BY Gould & Stiles—Book and Job Printers, Bridgeport, Conn. THIS PAPE R WAS PUBLISHED IX THE Hew Kit.((laud Medical Monthly;, A MONTHLY JOURNAL DEVOTED TO THE SCIENCE AND PRACTICE OF MEDICINE AND SURGERY. IT IS SUPPORTED BY T1IE MOST ABLE CONTRIBUTORS AND WRITERS IN THIS COUNTRY AND ABROAD. EVERY ISSUE CONTAINS FIFTY PAGES OF READING MATTER WHICH IS DIVIDED INTO THE FOLLOWING HEADINGS: ORIGINAL COMMUNICATIONS, EDITORIALS, BOOK NOTICES, REVIEWS AND CUR- RENT MEDICAL LITERATURE, RE- PORTS OF SOCIETIES, OBIT- UARY NOTICES, AB- STRACTS, NOTES AND COMMENTS. PROBABLY NO MEDICAL JOURNAL 1IAS EVER BEEN PUBLISHED IN THIS COUNTRY THAT HAS IN SO SHORT TIME ACHIEVED SO GREAT A POPULARITY. All communications of whatever nature, should be addressed to the undersigned, WILLIAM 0. 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