LReprinted from the New York Journal of Gynecology and Obstetrics for 
December, 1893], 
SUBINVOLUTION OF UTERUS, AND ITS TREATMENT 
BY ELECTRICITY.1 
Bv Dr. Chas. G. Cannady,Vaoanoke, Va., 
Physician in charge of Roanoke Sanitarium. 
Member of American Medical Association, American Electro-Therapeutic Association, British 
liynatcological Association, London ; Pan-American Medical Congress, etc., etc. 
Sir James Simpson’s “Subinvolution;” Scanzoni’s “Chronic 
Parenchymatous Metritis;” Klobes’ “ Habitual Hyperaemia, with 
Profuse Proliferation of Connective Tissue;” Edis’ “Metritis;” 
Hodges’“ Irritable Uterus;” Lisfrancs’ “Engorgement;” Kiwisch’s 
“ Infarctus,” and Nceggerath’s “ Diffuse Interstitial Metritis,” or any 
other name/that may describe the enlarged and engorged condition of 
the uterus only recalls to the practitioner, up to a few years since, the 
stubborn and unyielding condition he has trt treat. To Sir James 
Simpson we are more indebted than to any other for accurately 
defining and calling attention to its frequency and treatment. One of 
the first to describe its macroscopical and microscopical appearance 
was Snow Beck in 1851. 
Its ietiology is interesting in the extreme. Everything that could 
have been credited with producing a pathological condition of the 
pelvic organs has been claimed an exciting cause, but it seems that 
a large number of those cases coming under observation have followed 
abortions, lacerations, twin pregnancies, and similarly enlarged 
pregnant uteri (viz: large children, hydramnios, etc), and in those 
delicately constituted as to uterine development. This will cover a 
wide field ; and to this might be added another very frequent cause, 
viz.: the practice of using ergot at some time during labor, which 
stimulates the contraction of the unstriped muscular fibre, producing 
a quasi-tetanoid spasm of the uterus, which subsequently fails to 
contract sufficiently to induce involution. As to Histology: The bulk 
of the investigators concede that the uterus consists of unstriped 
muscular fibres in the highest state of development, varying in length 
from one-one-hundred-and-tenth to one-fortieth of an inch, as it is 
found in the unimpregnated or gravid state, also yellow elastic, 
■Read before the American Electro-Therapeutic Association at Apollo Hall, 
Chicago, September 14, 1893, at its annual meeting, Messrs. Lopthorn Smith, 
Hays and Massey, in discussion endorsed the paper. ' ~ . " 2 
Chas. G. Cannady, M. D. 
fibrellar and homogeneous connective tissue, round spindle-shaped and 
irregular cells (Thomas’ elementary fusiform fibre cells) serous 
membranes, mucous membrane, nerves, blood vessels and lymphatics. 
During gestation, the muscle cells enlarge to ten times their size in 
the unimpregnated uterus. All the remaining anatomical structures of 
the uterus during gestation are enlarged. After parturition, the uterus 
should rapidly decrease, until in four to six weeks it has attained its 
normal size. This change is the result of the fatty degeneration of the 
muscular fibre, with the subsequent absorption of this fatty material, 
and its removal from the uterus. This is brought about by the impaired 
nutrition, the result of the chronic contraction of the unstriped 
muscular fibre, which contraction should be immediate and permanent 
after delivery, otherwise, the nutrition of the cells are not impaired, 
foundation for excessive amount of connective tissue is laid, and 
normal involution cannot obtain. As all writers recently have 
occasion to regret, pathology is very scanty on a disease which has had 
a recognized position in gynaecology for the last forty five years, it is 
evident to all observers that there is an excessive amount of tissue 
present in the uterus, and that there is also quite a defective condition 
of both the vascular and lymphatic systems. No clear and concise 
limits can be definitely fixed between the pathology of some forms of 
chronic metritis and subinvolution. Mary Putnam Jacobi, who, under 
a very careful study of the subject, found the muscular fibres enlarged, 
with nuclei disappearing, and smaller fibres with indistinct central 
nuclei; others still smaller in which the nuclei were distinct, while in 
another variety no nuclei were discovered, but granular and oil 
globules were found, and that the wasting of the cell began in the 
protoplasm and ended in the nucleus. She found among these fibres 
nucleated connective tissue cells and amorphous tissue. The blood 
vessels and lymphatic were very much enlarged and intimately 
connected with the muscular tissue, which she considers a strong 
diagnostic point from chronic metritis, as herself and De Sinety have 
shown in the latter a perivascular condition is present. Its diagnosis 
is generally easy, when we remember that an abortion or pregnancy must 
be present as a starting point. Hanson finds that involution extends 
over a period of twelve weeks, but that in two-thirds of the cases the 
uterus has returned to normal in from to ten weeks. Weakness 
of the back, excessive lochial discharge, or the appearance of men- 
orrhagia may be the most important symptoms found during the 
puerperium. Evidently in the first stage, we have hyperemia and Subinvolution of Uterus, and fts Treatment by Electricity. 
3 
congestion. A large flabby uterus, with thickness of walls increased 
and the sound reveals an enlarged uterine cavity; the mucous 
membrane bleeds freely. Whether this be chronic metritis or subin 
volution uteri following abortion or confinement, matters little in the 
treatment. 
As to treatment: that, other than electricity, will only lightly be 
touched upon. As prophylactic clearing well the uterus of clots, the 
use of weak antiseptic vaginal injections, refraining from use of ergot, 
or any of its kindred drugs at any time in labor, or, if used during 
labor, to be continued for several days after labor at suitable times to 
induce and maintain contraction of unstriped muscular fibre, and to 
induce physiological mal-nutrition, so necessary for the fatty degener- 
ative process common in normal involution. Tonics, baths and drugs, 
hastening abortion, with nutritious diet will accomplish much in build- 
ing up the system. Vaginal injections of hot water i io or 115°, using 
three or four gallons once daily, with pledgets of cotton every third 
night, inserted up the vagina, saturated with anhydrons glycerine and 
boro-glyceride, with the application of iodized phenol on a cotton 
wrapped probe, or, better still, by a few drops injected into the cavity 
of the uterus with an intra-uterine syringe, provided the os is patulous, 
will all hasten the cure. If the os is very much congested, a Buttle 
scarificator plunged into the cervix and the congestion relieved in this 
way will do much good toward aiding a cure. But the greatest amount 
of good can be accomplished in the least time by the proper application 
of electricity. The detection of subinvolution is generally not accom- 
plished as early as the tenth day, from the fact that any symptoms 
referable to this is not generally attributed to this cause, but if it is 
detected at so early a stage, that is, at ten days, and the intra-uterine 
dimensions is found to be ten centimetres, and much tenderness does 
not exist, we should use the Medium Engleman Coil, having a length 
of 200 metres and a diameter of seven millimetres, with the bipolar 
vaginal electrode, after the manner suggested by Apostoli, using as 
powerful current as the patient is able to stand to accomplish the 
object. This to be continued for five minutes, then to be discontinued 
for ten minutes, with the electrode in same position, when the current 
should be re-applied for a period corresponding for same time, when 
tne electrode should be removed. If a more powerful effect is desired, 
the intra-uterine bipolar method should be tried, having the proximal 
pole of the intra-uterine electrode stop at the os and the distal as far 
toward the fundus as it will reach, pressing it alternately to posterior, 4 
Chas. G. Cannady, M. D. 
anterior and lateral portions of uterus. This is to be used with 
Engelman’s coarse coil, having a diameter of one-fourth millimetres 
and a length of sixty-six metres, with a strong current. But in failing 
to effect involution in this manner, as will often be the case, owing to 
such a sensitive condition of parts, or to the infiltration of tissue being 
so abundant and so organized as to preclude any certain results from 
the treatment, we must adopt another. The writer is mainly influenced 
by Hansen’s observations as to diagnosis of subinvolution, and if there 
is found at the second week a uterus varying from eight to thirteen 
centimetres, at third week from seven and five-tenths to ten and five- 
tenths, and at the fourth week from seven to nine centimetres, and 
fifth week from six to nine centimetres, it is concluded subinvolution 
is to be dealt with; and, provided symptoms are present as above 
described, the case is treated on a different plan, by aiming, first, to 
reduce the engorged and congested condition; secondly, to absorb 
hyperplastic elements, and, thirdly, to restore tone to muscular and 
vascular structures. This consists of, first, positive galvanic intra- 
uterine application of at least thirty milliamperes from eight to ten 
minutes, and if much tenderness exists and pain is induced, to be 
followed by the vaginal bipolar application of the faradic current from 
a coil having a diameter of .225 millimetres, and having a length of 
600 metres, after the method as described by Engleman. By this 
means the uterus is relieved of engorgement, the unstriped muscular 
tissue composing the uterine walls are strengthened, and the walls of 
the blood vessels are restored to their normal contractile powers. The 
capillaries are relieved of their hyperaemic condition, and the process 
of involution is in every way aided. Bipolar intra-uterine faradization 
must be carried out to be effective in this instance by the bipolar 
intra-uterine sound. 
If the subinvolution has passed the stage of active congestion invo- 
lution may he hastened by using the negative pole of the galvanic current 
—intra-uterine—especially if the uterus presents a hardened condition. 
In several instances in which ergot was freely used during labor, the 
author has used The daily application of the faradic current to uterus 
for seven or eight days, as used by Trippier and Apostoli, of Paris, and 
in each instance with the happiest results, and is of the opinion that 
this should be used in all cases where ergot has been freely used during 
labor; strict antisepsis being carried out in each instance. 
By this method described, the conclusion is reached that subinvolu- 
tion uteri can be cured in one-half of the time consumed by any other 
means than electrical.