ELECTROLYSIS; 
ITS VALUE IN DIAGNOSIS AS WELL AS IN TREATMENT OF 
INTRA-ABDOMINAL AND INTRA-PELVIC TUMORS 
BY THE AID OF A NEW INSTRUMENT. 
BY 
EUGENE 0. GEHRUNG, MD, 
St. Louis, Mo. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXI., August, 1888.] 
NEW YORK: 
WILLIAM WOOD & CO., PUBLISHERS, 
56 & 58 Lafayette Place. 
1888. ELECTROLYSIS; 
ITS VALUE IN DIAGNOSIS AS WELL AS IN TREATMENT OF 
INTRA-ABDOMINAL AND INTRA-PELVIC TUMORS 
BY THE AID OF A NEW INSTRUMENT. 
BY 
EUGENE C. GEHRUNG, MD., 
St. Louis, Mo. 
[Reprinted from the American Journal of Obstetrics and Diseases 
of]Women and Children, Vol. XXL, August, 1888.] 
NEW YORK : 
WILLIAM WOOD & CO., PUBLISHERS, 
56 & 58 Lafayette Place. 
1888. ELECTROLYSIS; 
ITS VALUE IN DIAGNOSIS AS WELL AS IN TREATMENT OF 
INTRA-ABDOMINAL AND INTRA-PELYIC TUMORS 
BY THE AID OF A NEW INSTRUMENT.1 
Electrolysis in gynecology, though yet comparatively new, 
has already been described by master hands, and successes have 
been obtained upon which the profession may look with pride. 
It is not my intention to recapitulate what has been written, but 
merely to report a few facts which I have observed in my own 
practice. If I have misinterpreted the phenomena which pre- 
sented themselves in my cases, it is because I have been deceived, 
and I shall gladly accept a more correct interpretation. 
In my practice of electrolysis for the removal of fibroid tu- 
mors, I have observed two widely different processes toward their 
resolution. 
The first is that which is generally recognized. It may be 
shortly described as gradual atrophy, caused by a disarrange- 
ment and subsequent absorption of the constituent elements of 
the neoplasm, by means of electrolysis or electro-puncture, 
whereby the tumor may completely disappear, be reduced in 
size, or its further development prevented. 
The second mode of termination has heretofore not received 
the proper attention. It is closely allied to the former in its 
origin, but widely different in its ultimate conduct. It answers 
1 Read before the St. Louis Obstet. and Gyn. Soc., May 17th, 1888. 4 
Gehrvng : Electrolysis: Its Value in Diagnosis. 
to the following definition : " Cystic degeneration of fibroids 
caused by electrolytic punctured 
Around the tip of an electro-negative pole introduced into 
a uterine fibroid an accumulation of fluids and gases takes place, 
the product of electrolysis. Some of these mixed particles es- 
cape along the electrode, while some remain imprisoned on its 
withdrawal. These retained particles are usually absorbed, and 
may possibly represent an active principle in the process of 
atrophy of the fibroid. If, on the contrary, they are not ab- 
sorbed, the nucleus for the formation of a cyst is planted. 
This cyst of electro-chemical detritus grows by gradual increase 
of its contents and consequent thinning of its walls. Thus a 
fibroid may be transformed into a cysto-fibroid, and finally into 
an abscess, with the symptoms of septicemia, chills, elevated 
temperature, rapid pulse, nausea, headache, etc., etc. When 
these symptoms have occurred after the use of electrolysis 
it was said " the patient did not take kindly to electricity," 
the tumor instead of diminishing began to grow, " typhoid 
symptoms " resulted, and the patient died, or laparotomy was 
performed and the patient recovered. 
In support of the foregoing remarks I shall quote the head- 
ings of two only of the cases reported by Dr. Ephraim Cutter.1 
" Case II.-Large myo-fibroid ; softening and fluidity* fol- 
lowed first operation, tumor larger; case obstinate; abdominal 
section successful ; recovery. 
" Case X.-Abdominal tumor; at first very hard; after two 
applications assumed a cystic form; regarded as improved; 
third operation followed by typhoid symptoms neglect of or- 
dinary care; death." 
To quote more such cases from the same or other authors 
would unnecessarily prolong this paper without proving more. 
In two of my cases of the second variety (i. e.y cystic degener- 
ation) the symptoms tallied closely with those of the cases just 
quoted. 
The first case, consisting of a large bilobed myo-fibroma, pro- 
gressed quite satisfactorily, and the lady, who was a complete 
invalid, considered herself perfectly well after a few punctures. 
On examination of the tumors after a longer rest, I noticed a 
slight increase in size of these, and thought I could detect flue- 
1 Am. Journ. Obst., etc., February. 1887, pp. 121 and 127. 
2 Italics mine. Gehrung : Electrolysis: Its Value in Diagnosis. 
5 
tuation. Both of these facts I communicated to the patient's 
regular physician, and made to him propositions for the further 
treatment of the case. 
The doctor informed me, however, that it was too late to do' 
anything more for the patient, as she was to return to New York 
in a few days to join her husband. Dr. E. promised to recom- 
mend the patient into good hands. All Dr. E. and myself have 
learned of the case since is: "She was operated, and died from 
hemorrhage." Probably laparotomy. 
My second case was one of exudation-tumor, formed around 
a subserous fibroid, diagnosed by several physicians as long as 
fifteen years ago. About ten years ago, attempts were made to 
cure this fibroid by ergot and dilatation of the uterine cervix, in 
the vain hope of transforming it into a submucous fibroid, to be 
delivered wa/wrurZes; with the sole effect of settingup 
pelvic cellulitis or pelvic peritonitis, or both, wherefrom the 
patient came near losing her life. When she was brought to me 
by her family physician, I found the whole pelvis, with all its 
contents, massed into a solid cake, of irregular outline, reaching 
up to the umbilicus; callous in some places, in others of a fibrous 
hardness and completely immovable. This tumor had impinged 
to such an extent on the calibre of the rectum and bladder that 
the action of both was seriously interfered with, and great fear 
was entertained that these functions might, at any time, be 
completely interrupted. The case appeared hopeless, and had 
been considered so. long before the patient was brought to me. 
I applied the galvanic current, the negative pole in the vagina, 
for a long time, in the hope of lessening the size and causing- 
some mobility of the tumor, but without success. The case 
becoming more and more hopeless, I concluded to use electro- 
puncture. for which I selected principally what I considered to 
be the fibroid. Four or five punctures, with electrolysis, seemed 
to cause little or no improvement. Shortly after the last the 
patient began to have chills, fever, and "typhoid symptoms." 
The tumor was found to be enlarging, and showing signs of 
fluctuation. Assisted by Drs. Funkhouser and Eversole, I punc- 
tured the very thick wall of the cyst through the vagina with an 
aspirator-needle and drained a large quantity of a serous fluid 
and about an ounce of pus. While the cyst was draining, I 
enlarged the opening by means of a narrow bistoury. Through 
this opening I introduced one of my uterine aspirating tubes 
(double canula). and by means of it established a constant drain- 
age with carbolized water for several days and nights. The 
temperature and pulse were both reduced almost immediately. 
The tube slipped out of the cyst apparently too soon, and the 
cyst either refilled, or one of the other punctures went through 
the same process accompanied by all the symptoms of the former. 
The tapping was repeated, and this time the contents were a 
mixture of serum and pus, somewhat fetid. 
The patient was so much inconvenienced by the presence of 6 
Gehrung : Electrolysis: Its Value in Diagnosis. 
the drainage tube that I was prevailed upon to remove it, as I 
found to my regret, too soon again. The improvement that 
followed was soon replaced again by the same train of symptoms, 
and again an enlargement was detected with very obscure 
fluctuation. I should, however, not forget to state that each 
successive enlargement occupied a different position from the 
preceding ones. Meanwhile I had planned and constructed for 
me by the Leslie Surgical Instrument Co. of this city an in- 
strument which will be described below, by the aid of which 
the operation and after-treatment were much simplified. Since 
the tapping of this last cyst, the temperature range varied from 
97.7° to 99.8°. The patient ate, slept, and felt well. She gained 
considerably in weight, and is at this date, twenty days after the 
last puncture, perfectly well. She was able to sit up and walk 
about, with the drainage tube in situ, through which daily wash- 
ing and medication of the remnants of the cyst have been prac- 
tised; using two per cent carbolized water. Iodoform oil and 
pure tincture of iodine were used by aspiration and irrigation until 
the flow from the cyst was completely arrested; then only was the 
tube removed. Occasionally electrolysis was repeated in the hope 
of still further modifying the cyst-walls, or rather the walls of 
the new abscess, and thereby hastening the obliteration. Though 
almost complete anorexia and nausea existed before the evacua- 
tion, etc., the most nutritious and digestible diet was immediate- 
ly allowed and profitably retained.1 
The experience gained in these and other cases of my prac- 
tice of electrolysis forces me to the following conclusions: 1st. 
That " electrodes for puncturing intra-al)dominal or intro- 
pelvic tumors and cysts should l>e tuhular, and not solid, as 
heretofore advised by electro-therapeutists. Large-sized aspi- 
rator needles or trocar and canula will do well. If by the 
use of cylindrical electrodes a loss by irradiation of electricity, 
in comparison to fiat or crescentic electrodes, should really 
occur, this can easily be remedied by a slight increase in the 
quantity applied. The electrode being a tube, all fluids formed 
' While this article is going through the press, I have received the fol- 
lowing correspondence from the patient, whose case is here described. 
She left this city about a week after the removal of the canula. 
Baltimore, Md., July 1st, 1888. 
Dr. Gehrung. 
Dear Sir :-I arrived here June Sth. I had a very pleasant trip, but I 
was very much exhausted for several days after my arrival. I was very 
much afraid the first few weeks that there was another abscess forming,, 
as I had a great deal of pain and soreness. I feel greatly improved for 
the last ten or twelve days, I have a good appetite and am gaining strength 
and flesh. Since I am here I have fully gained 15 to 20 lbs. 
Yours, etc., Mrs. M. F. Gehrung : Electrolysis: Its Value in Diagnosis. 
7 
or found in a tumor or a cyst may be allowed to escape through 
it after the practice of electrolysis. By this precaution the 
cystic degeneration of fibromas may possibly be avoided, un- 
less otherwise desired. Or, if a cysto-fibroma be knowingly 
or accidentally punctured, the cyst can be drained and medi- 
cated, and the cure much hastened. This has been the result 
in my cases of this description. 
2d. The puncture should always be made at the most de- 
pendent point, if practicable, for the sake of drainage, and 
preferably through the vagina wdienever circumstances per- 
mit, selecting even here the most depending and most accessible 
part, and taking good care not to injure important organs or 
large blood-vessels. 
3d. Almost all non-malignant pelvic tumors, whether solid or 
cystic (abscesses included), can be treated with advantage, if not 
cured, by electrolysis, electrolytic puncture, or the latter com- 
bined with drainage and proper medication, without recourse 
to major operations. 
Dermoid cysts, on account of their solid contents, make an 
exception to this rule. Whether extra-uterine pregnancy, in 
its earlier stage, colloid or multi-locular cysts make an exception 
also, and for the same reason, or whether, by means of electro- 
lysis and the judicious use of the trocar, they will be classed 
among the tumors curable by electrolysis and drainage, will 
have to be decided in the future. If the puncture through the 
vagina is found impracticable, it will have to be performed at 
the most accessible and safest point through the rectum, uterus, 
or abdominal walls, never forgetting the point in view-drain- 
age. 
All cysts, fibro-cysts included, should be completely evacuated 
after the use of electrolysis. 
Much of wdiat has been said here concerning pelvic and ab- 
dominal tumors will certainly find application to tumors, cystic 
and solid, in other parts of the body. 
The following is a description of the instrument, which I 
have devised for this purpose and exclusively used in treatment 
of my cases of fibromata, solid and cystic, cystic tumors, and 
abscesses, by electrolysis, drainage, and medication: 
The instrument consists of a trocar and canula. 
The trocar, including the handle of two and three-fourths 
inches, measures seven and one-half inches. The steel of the 8 
Gehrung : Electrolysis: Its Value in Diagnosis. 
trocar reaches through the handle and terminates below in an 
expansion or bell to receive the tip of a rheophore. Its stem is 
four and three-fourths inches long, and rests, with the excep- 
tion of the point, in the canula. Just behind the point, the 
stem is thinner than elsewhere, so that the canula, by means of 
spring power, produced by a split in its distal extremity, will 
be prevented from causing any unevenness that might impede 
the introduction. The canula measures inches in length, 
and being arranged on the principle of a double canula, it has, 
inserted at an acute angle, an arm or canula one and one-half 
inch in length, almost parallel to the straight tube (see engraving), 
while the distal end of the tube is provided with a number of 
perforations or holes, like those in other drainage tubes, or like 
those in my aspirating uterine applicator.1 Lastly, there is an 
inner tube, which can easily be inserted and withdrawn, as it is 
fastened merely by a conical friction joint. Near the further end 
A. M. LESLIE S. I. CO 
ST. LOUIS. 
this tube carries a nut or septum which, when inserted into the 
outer canula, divides the perforated region into two nearly 
equal parts. A probe point may be attached to the inner 
canula so as to close the front openings of both canulae, there- 
fore the inner one of these has a few holes in the side, beyond 
the septum. 
All that is necessary beyond what is here described consists 
in two or three pieces of india-rubber tubing, provided at the 
ends with perforated metallic tips for the easy attachment to 
the canula and an aspirator of some kind-one piece of tub- 
ing to connect a vessel or bottle with the outer or influx canula 
containing the fluids to be used; a short one to connect the 
aspirator to the inner or outlet canula, and a third piece to 
lead to a vessel to receive the waste. The aspirator as described 
in the Am. Jour, of Obst., etc, or as since modified by me for 
this purpose, renders excellent service. The calibre of the 
canula may vary from No. 6 American scale for catheters (No. 
!Am. Jour. Obst., etc., July and December, 1886. Gehrung : Electrolysis : Its Value in Diagnosis. 
9 
9 French) to any size to suit the taste of the operator or the 
conditions of the case. The No. 6 is tlie size I used in my 
operations, but it is rather small, especially with thick fluids. 
The trocar and canula being plunged to the requisite depth 
into the tumor or cyst, the rheophore of the negative pole 
should be attached to the handle of the trocar and electrolysis 
applied in the requisite amount and the desired space of time. 
This done.the trocar is withdrawn and the fluid, if any be pres- 
ent, allowed or made to flow away through the canula, which 
is left in position. 
The cyst being drained, the next step is to introduce the in- 
ner canula into the space previously occupied by the trocar. 
After attaching the rubber tubes and aspirator as described (loc. 
cit.), the cyst can be washed by antiseptics and alterants, as car- 
bolic to tItj-), and mercurial bichloride solutions (To1o 
■oVo-), iodoform oil (20 gr. to oz.), tincture of iodine even 
to full strength, etc. By means of this apparatus these medi- 
caments can be applied by aspiration or irrigation as the operator 
may desire. 
When the cyst is cleansed and treated to satisfaction, the inner 
canula can be withdrawn, while the outer remains as a perma- 
nent drainage tube ; one of the two arms of the canula should 
now be closed by a cork of wood or metal, and the other should 
be closed by a perforated metallic tip to which is attached a 
very soft rubber bag.1 for the purpose of collecting for inspec- 
tion and examination all fluids that pass through the canula 
from one visit to another. In this way, the cyst or wound is 
hermetically sealed, without arresting the constantly secreted 
fluids within. 
The washing, etc., should be repeated about once a day. 
After the removal of the aspirating apparatus, nothing can be 
seen except the little rubber bag, as the whole drainage tube is 
safely ensconced within the vagina, just reaching to within the 
labia majora, enabling the patient not only to lie down with 
comfort, but to sit up, walk about, and to micturate and defecate 
with ease. 
If there is no fluid present, of course the trocar and canula 
may, after the use of electrolysis, be removed simultaneously, 
unless it be desired to leave the canula for future applications of 
this agent, without the necessity of a repeated puncture. For 
1 Children's rubber balloons, etc., will meet the indication. 10 
Gehrung : Electrolysis : Its Value in Diagnosis. 
the reapplication of electrolysis, either the trocar may be re-in- 
troduced through the canula and the rheophore attached, or the 
latter may be attached to the canula itself. A silver canula 
seems to be sufficient for all purposes, as, after a sojourn of 
twenty days in an abscess cavity with the occasional use of elec- 
trolysis and pure tincture of iodine, the canula came out as clean 
and sound as when introduced ; of course, a little tarnished. 
Twenty-four hours after the removal of the canula, viz., drain- 
age tube, neither by sight nor touch could the place be found 
where the tube had rested. 
1 should also mention that before the commencement of the 
operation the canula should be insulated with a thick layer 
of collodion or shellac, etc., taking care to leave uncovered all 
that part of it which is intended to penetrate the tissues, for 
reasons to be stated below. 
We come now to the diagnostic value of electrolysis, espe- 
cially as applied by means of the instrument which I have just 
described. 
From the literature on electro-therapeutics, as well as from 
my own practice, I consider myself authorized to state that one 
of the effects of electro-puncture, especially by the cathode or 
negative pole is, that the tissues perforated by the non-insulated 
part of the electrode become matted together and form a more 
or less continuous fistulous tract, whereby the escape of fluids 
into the interstices or intervals between the different tissues so 
perforated is prevented. It also appears to modify the tissues 
along the tract of the electrodes so that inflammatory processes 
will rarely, if ever, be witnessed. Even punctures through the 
peritoneum seem to be of little importance, for which we have 
the attest of many trustworthy authorities. 
If these premises are correct, we may conclude that: 
1st. Electro-puncture, especially if combined with drainage, 
etc., is a curative agent for many tumors, as fibroids, cysto- 
fibroids, cysts of a great variety, and abscesses ; and that, 
2d. Electrolysis renders exploratory punctures comparatively 
harmless, and far superior to ordinary acupuncture with aspi- 
rator needles or the needles of the hyprodermic syringe, which 
latter means have formerly been recommended to clear up a 
douctful diagnosis. 
Bas?d upon these facts, we are authorized, when the absolute 
differentiation between two possibilities has failed, when put to Gehrung : Electrolysis : Its Value in Diagnosis. 
11 
the test of the usual legitimate means of diagnosis, and espe- 
cially if both otherwise admit of electrolytic treatment fortheir 
cure, we are not only authorized, but may safely use the drain- 
age-electrode to clear up the mystery. The question being de- 
cided, either electrolysis alone or combined with drainage may 
be used, as the case demands. In many cases, an otherwise 
doubtful diagnosis may thus be decided, while in fact the cura- 
tive treatment for either is started. This appears to me to be 
a far safer way to differentiate than by opening the abdomen 
when in doubt. 
Had Dr. Semeleder, in his operations on ovarian cysts by 
electrolysis, made his punctures at the most dependent portion 
and drained the cysts, he would very probably have lessened 
the duration of the treatment considerably, diminished the 
number of punctures necessary, and lessened the mortality in 
his cases. Dr. Semeleder would probably have found more 
followers. 
While writing this paper, I came across The London Medical 
Record, containing an abstract of one of Dr. Apostoli's papers, 
in which Dr. A. advises and practises electro cautery puncture 
for hydro salpinx. Dr. A. makes a large fistulous tract by 
means of a large trocar. This corroborates my view as expressed 
above, that most intra-pelvic and intra-abdoininal cysts can be 
so reached and drained, and, I feel certain, with much greater 
facility and safety by my trocar and canula in combination with 
electrolysis. 
Apostoli and Engelmann both state that electrolysis does not 
work favorably on abscesses. This statement is correct only 
as long as the matter is permitted to stay in the cavity. As pus 
should never be retained in the body, and as it cannot well be 
absorbed without causing septic derangements, the electrolysis 
may be applied before emptying the abscess for the purpose 
of modifying its lining membrane. Then we should remove 
its contents and wash and medicate the cavity, use drainage, and 
if found advisable again and again electrolyze the cavity to 
stimulate it still more to obliteration. 
Dr. H. R. Bigelow1 reports a few cases operated by Dr. 
Martin, of Berlin. Dr. Martin found in perimetric exudates 
an abscess forming, and to avoid a possibility of puncturing a 
1 Am. Jour. Obst., etc., May, 1888. 12 
Gehrung : Electrolysis: Its Value in Diagnosis. 
loop of intestines that might be adherent in the mass, opened 
the abdominal cavity, forced down the abscess, and punctured 
it through the vagina, leaving the drainage tube without fur- 
ther medication or washing of the cavity until the complete 
obliteration of the abscess. The propriety of opening the ab- 
domen appears to me somewhat doubtful, as in such a case the 
bowel, if involved in the exudate, may not be found and con- 
sequently not be avoided with much greater certainty than if 
the abscess had been pushed down toward the vagina without 
laparotomy, and the drainage tube inserted. If with proper 
care the trocar is implanted in the middle line and made to 
pass up closely behind the womb while the abscess is pressed 
down in contact with the vagina, the chances of puncturing a 
loop of bowel, even if implicated in the exudate, are very small, 
while on the other hand laparotomy with its incidents, acci- 
dents, and sequelae, if practised in a larger number of cases, will 
show a greater mortality and worse consequences than even a 
possible puncture of the bowel. Until the contrary is proven, 
I shall continue to hope and expect that ane lectrolytic puncture 
through a loop of the bowel fixed in such an exudate will, after 
the abscess cavity is completely obliterated and the tube re- 
moved, heal up kindly, especially if the trocar and canula are of 
moderate calibre. 
If bad should come to worse, an entero-vaginal fistula would 
be the result-a condition much less bad and much more cura- 
ble in such cases than most of the sequelae of laparotomy. 
The scope of this paper being merely to communicate and 
urge this mode of treatment in the place of laparotomy, for cer- 
tain tumors, and not to report details and cases, I will not enter 
upon otherwise useful particulars. I shall mention, however, 
that in my operations from twenty-five to seventy-five mil- 
liamperes from five to twenty minutes have been used with 
satisfactory results, in quite a variety of tumors. Whether 
there is any gain in those extreme doses of electricity used by 
certain operators, except to know how large a dose human 
beings can tolerate, or whether these large quantities do not 
themselves prevent the sought-for result, 1 am not able to 
answer. This question will be solved by accumulating ex- 
perience.