THE RATIONAL TREATMENT 
OF 
UTERINE DISPLACEMENTS, 
BASED UPON A CONSIDERATION OF THE PATHO- 
LOGICAL CONDITIONS PRESENT. -s''' 
BY X / 
AUGUSTIN H. GOELET, M.D., 
New 
[Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XXIV., No. 2, 1891.] 
NEW YORK: 
WILLIAM WOOD & COMPANY, PUBLISHERS, 
56 & 58 Lafayette Place. 
1891. THE RATIONAL TREATMENT 
OF 
UTERINE DISPLACEMENTS, 
BASED UPON A CONSIDERATION OF THE PATHO- 
LOGICAL CONDITIONS PRESENT.1 
A study of the pathological changes which bring about 
these conditions, and of those which result as a consequence of 
the unnatural position of the organ, is particularly necessary 
for a proper appreciation of the treatment required to effect 
a cure. I will consider them, then, in connection w'ith each 
individual condition which they produce, together with such 
other changes as take place in the uterine structure itself, and 
endeavor to show the applicability of the method herein sug- 
gested. 
I of course have in view those malpositions which have 
existed for a time, and not those of recent origin (the result of 
some accident). Unfortunately, we are seldom consulted be- 
fore important changes take place rendering the displacement 
permanent. Hence little is necessary to be said about the 
treatment of these recent cases. When they do come under 
' Read before the New York Obstetrical Society, November 4th, 1890. 4 
GOELET : RATIONAL TREATMENT 
observation, however, immediate replacement is indicated, and, 
when it can be borne, a properly fitted pessary should be used 
to maintain the normal position until the impaired natural sup- 
ports can be toned up. While this may sometimes be effected 
by rest and general tonics, it is wiser and more certain treat- 
ment to bring to our aid certain agents at our command which 
will assist us in accomplishing this result, instead of depending 
too much upon nature and the pessary. The tonic effect of 
electricity is so well understood that it seems superfluous to 
dwell upon the method of its application in such cases. Both 
currents (faradic and galvanic) may be employed and have 
their separate indications. The faradic will be more effective 
used by the bipolar method in the vagina for strengthening the 
uterine supports, while the galvanic, especially the positive 
pole, may be used to exert a tonic and curative effect upon the 
uterus and its lining membrane, which is so often found in an 
inflamed state. 
I come now to the consideration of displacements produced 
by inflammatory changes acting as a maintaining cause, and 
where pathological changes are to be found in the walls of 
the organ itself. 
ANTEVERSION. 
In anteversion there is usually a chronic metritis and endo- 
metritis ; the uterus is infiltrated, thickened, and rigid ; the 
normal curve of the organ is obliterated, causing the external 
os to point to the hollow sacrum, and the fundus by its in- 
creased weight rests heavily on the bladder. In addition we 
may, according to Schultze, expect to find a posterior perime- 
tritis or parametritis in a chronic form. There may be pos- 
terior fixation and shortening of the recto-uterine ligaments as 
the result of this inflammatory process, and this must be taken 
into consideration in the treatment of the case. This condi- 
tion may exist and still there may be moderate mobility of 
the organ, unless there is anterior fixation also, which is in- 
frequent. 
It is evident from the condition present that the first steps 
in the treatment must be directed towards relieving the mor- 
bid process producing it, instead of vainly endeavoring to 
remedy the malposition before this is removed. I know of OF UTERINE DISPLACEMENTS. 
5 
no agent equal to galvanism for accomplishing this end, if it 
is judiciously employed. The chronic metritis and endome- 
tritis can certainly be relieved by it, and probably also the de- 
posit removed, and the adhesions may, in many instances, be 
relaxed and loosened under its influence conjoined with gen- 
tle massage. If there is much tenderness to pressure and the 
parts are irritable, treatment should commence with applica- 
tions of positive galvanism to the vagina of 50 to 80 milliam- 
peres used for five minutes every second day, with the external 
electrode placed alternately on the abdomen and lower spine. 
When the irritation has subsided it is time to begin with ap- 
plications to the uterine canal. The platinum electrode, 
moderately curved, and fixed in a rigid handle, should be in- 
troduced along the index finger as a guide. To facilitate its 
introduction the fundus may be gently lifted by pressing up 
through the anterior vaginal wall after the electrode has 
entered the cervical canal. The electrode should be arranged 
so as to come in contact with the whole uterine canal from 
external os to fundus ; but the fundus must not be touched 
roughly with the point of the electrode, nor rest too firmly on 
its point during the application. The electrode to be used 
must be made of platinum or the prepared steel, and no larger 
than the ordinary uterine sound, so as to allow the escape of 
gas around it. The positive is the pole always to be used in 
the beginning, unless the cervical canal is small and insuffi- 
cient for drainage of the secretions from the uterine cavity, in 
which case the negative may be cautiously employed first. Be- 
ginning at 30 milliamperes, the dose with the positive pole 
may be increased at each sitting as tolerance is established, 
until a strength of 50, 80, or 100 milliamperes is reached, and 
the external electrode may be applied alternately to the ab- 
domen or lower spine as the condition indicates. (The larger 
doses are by no means always necessary.) When the chronic 
inflammatory condition has been subdued the negative pole 
may be substituted, but the dose need rarely exceed 50 to 60 
milliamperes, used inside of the uterus with the bare elec- 
trode, and it should start at 20 milliamperes. If they are 
borne well, the applications may be made every second day 
and continue for five minutes. Massage or manipulation of 
the uterus with the electrode in position and while the current 6 
GOELET : RATIONAL TREATMENT 
is in action may be permissible after|the negative pole be- 
comes well tolerated. 
The use of glycerin tampons after the applications, made 
of four thicknesses of plain gauze flattened out, with a string 
loosely attached, will prove an excellent auxiliary in the treat- 
ment of these conditions. The gauze is preferred to the cot- 
ton or wool tampon, because it may be spread out in the 
vagina and will remain so, while the other becomes a firm 
lump or ball when it is soaked, and often irritates by exert- 
ing undue pressure where it is not wanted. Even when it 
becomes advisable to lift up the fundus with a properly ad- 
justed tampon, and the effect of the glycerin is still desired, 
it is preferable to use a gauze tampon next to the anterior 
vaginal wall and a vaselined cotton or wool tampon under it. 
The vagina being flattened antero-posteriorly in its closed 
state, the cotton-glycerin tampon will act as a plug, and the 
escape of discharges from the uterus will often be retarded by 
it. The proper use of vaselined tampons in the latter part of 
the treatment will be very much more satisfactory than a 
pessary. 
Where there is relaxation of the vagina and uterine sup- 
ports, something may be expected from bipolar faradization to 
the vagina. It will also prove useful (if the current from the 
long wire is used) in subduing a very sensitive condition 
which may exist primarily, prohibiting the use of the galvanic 
current, or which may occur in the course of the treatment. 
In outlining this course of treatment for anteversion, it is 
not, of course, intended that it should apply strictly to all the 
different conditions in the same manner, for some cases will 
present themselves where the treatment may be commenced 
at once with the negative pole and the progress will be more 
rapid. Such cases are those where the exudation, if present, 
is in a quiescent state and not sensitive. But usually the in- 
flammatory complications, or a menorrhagia which is so often 
attendant upon anteversion, demand the use of the positive 
pole until they have been overcome, before the negative can 
be employed. 
The negative pole used in the uterus is prompt in its action, 
because it takes effect directly upon the endometrium and 
uterine tissue; and if the external electrode is placed so as to OF UTERINE DISPLACEMENTS. 
7 
include any deposit between the two poles, it comes as well 
under the influence of the interpolar action as when the elec- 
trode is placed against it in the vagina. When an effective 
•dose cannot be tolerated in the uterus, however, it becomes 
necessary to resort to the vaginal applications. 
A version may sometimes be completely cured by using the 
positive pole only, but these are cases where the uterus is not 
unduly rigid and where there is no parametric exudation, or, if 
so, it is recent. 
ANTEFLEXION. 
In anteflexion there is rigidity at the point of flexion, a 
shrinking of the tissues of the anterior uterine wall, and an in- 
crease in volume of the posterior wall. This is the result of 
an endometritis and metritis occurring after the flexion takes 
place, making it permanent. Some authors believe that there 
is often posterior fixation of the cervix from a posterior para- 
metritis and shortening of the utero-sacral ligaments. In 
women who have not borne children, the parametritis may be 
subacute or chronic without having been preceded by an 
acute attack, and it is well to bear this in mind. It is not 
necessary always to trace such a condition to a badly managed 
labor, or abortion or gonorrhea, for it may result from ob- 
stinate constipation, or from pent-up catarrhal secretions in 
the uterine cavity because of the obstruction to drainage af- 
forded by the flexion. Anteflexion may be congenital or ac- 
quired. When congenital-or, as Schultze terms it, puerile- 
there is generally found an imperfectly developed uterus with 
either amenorrhea or a very scanty menstrual flow. Unless 
an active endometritis is present there is a decided obstruction 
to the passage of the sound at the point of flexion. When ac- 
quired, it is primarily due to a want of tone in the muscular 
structure of the uterus itself, or, as Graily Hewitt claims, a 
softness of the uterus." 
These statements are subject to some modification, for all 
flexed, undeveloped uteri are not necessarily congenital. 
Their development may be interfered with by a poorly nour- 
ished condition of the system at the time of puberty, or some 
accident occurring before puberty, displacing the organ then, 
may so interfere with its proper circulation and nutrition as 
fo stop its development. This is frequently the case with 8 
GOELET : RATIONAL TREATMENT 
retroflexions. I once saw a girl 19 years old with a retro- 
flexed uterus the size of a girl's of about 8 years, and there 
was only an effort at menstruation. She had been thrown 
from a carriage at about that age, and was supposed to have 
injured her back. The uterus was probably displaced at that 
time, and, remaining so, its development was arrested. 
Though the claim of Graily Hewitt, that there must have 
been a softening of the uterus before a flexion can occur, may 
be questioned, it is certainly true that the rigid uterus must 
be softened before the flexion can be permanently overcome. 
Hence the appropriateness of the treatment by galvanism. 
Attention to the different actions of the two poles will show 
which is indicated in commencing treatment. The negative, 
which produces a softening and relaxing effect, is the pole to 
be chosen. The indications for treatment are, first, to produce 
relaxation of the rigid uterine structure, as well as dilatation 
of the canal, to allow drainage from the cavity and promote 
absorption of any parametric deposit which may be present, 
and then to cure the metritis and endometritis and tone up 
the relaxed supports. 
There are two ways of accomplishing the first indication, 
viz., either by moderate dilatation with the steel dilator and 
the intra-uterine stem followed by galvanism, or by galvanism 
alone. In certain cases, as where the flexion is congenital or 
where it is very acute and there is stenosis, the cure can be 
more speedily and effectually accomplished by beginning with 
forcible dilatation, if there is nothing to contra-indicate it. 
The usual method of forcible dilatation or divulsion, however, 
is not to be thought of, as it is harsh and unnecessary. A 
moderate dilatation, carefully done under an anesthetic, and a 
straight hard-rubber stem, perforated through its centre so as 
to facilitate drainage, introduced immediately after and worn 
for a week while the patient is confined to bed, will accom- 
plish all that is desired, and is free from the objections to be 
urged against the other method. 
The operation is carried out in this way, viz.: The patient, 
when thoroughly anesthetized, is placed in the Sims position 
and the vagina is rendered aseptic. Seizing the cervix with 
the angular tenaculum (which does not tear out) on its ex- 
ternal surface, it is steadied and straightened out while the OF UTERINE DISPLACEMENTS. 
9 
dilator is introduced. The dilatation should be accomplished 
with as little force as possible, and should only be carried to 
that degree which will allow the introduction of the smallest- 
sized stem, No. 10. This is to be held in place by a loose iodo- 
form or creolin gauze tampon. The stems are of three sizes, 
10,12, and 14 (English scale), and should be used successively 
as relaxation without further dilatation allows their introduc- 
tion. The tampon and stem must be removed every day, 
cleansed, and replaced. After these stems have been worn 
for a week, the patient meanwhile being kept prone in bed, 
complete dilatation of the canal will be effected, while drain- 
age from the cavity is perfect. Besides, the straight stem has 
acted as a splint, and the uterus has been made straight and 
the rigidity of its walls has been overcome. With care and 
the proper use of galvanism a cure may be speedily ef- 
fected. 
A few applications of negative galvanism to the canal at in- 
tervals of two days, in doses of not over 10 to 20 milliam- 
peres two or three minutes, may be used at first, after the 
stem has been finally removed, if a tendency to rigidity or too 
much recontraction occurs; but this is seldom the case. It is 
usually appropriate to begin, after a few days, with positive 
galvanic applications to the endometrium every second or 
third day in doses of not over 30 to 50 milliamperes for three 
or five minutes. These latter applications tend not only to 
relieve the catarrhal condition of the endometrium, but also 
to tone up and stimulate the uterine muscular tissue, thereby 
aiding in effecting a permanent cure. It is appropriate also 
to follow every positive galvanic application by a five-minutes 
bipolar faradization of the vagina with the current of tension, 
which still further aids in restoring tone to the uterus and its 
supports and stimulates an increased and more normal men- 
struation.1 
'In treating patients of very sensitive nervous organization I use the 
faradic current through the rheostat, and find that they stand the applica- 
tions much better, and that the current can be used stronger as the increase 
is more gradual. The secondary coil is advanced only half over the primary 
at first, and the rheostat is turned gradually half-way on. Then, leaving it 
at that point, the secondary coil is pushed all the way up, and the rheostat is 
again turned slowly until all the resistance is cut off and the patient receives 
the full strength of the current. This is important, as, to be effective,, the 10 
GOELET : RATIONAL TREATMENT 
Where galvanism without forcible dilatation is elected to be 
used, the treatment will be commenced with negative appli- 
cations to the uterine canal, unless extreme sensitiveness is 
present, when a few positive vaginal applications, 50 to 60 
milliamperes, should precede the internal or intra-uterine 
treatment. These negative galvanic applications should be 
commenced with an electrode no larger than the uterine 
sound, fixed so as not to touch the fundus when introduced 
to its fullest .extent-in fact, it is only necessary to enter 
about two inches, or just beyond the point of flexion.1 The 
electrode may be passed preferably along the finger as a guide, 
or a speculum may be used if care is taken not to allow the 
metal portion of the electrode to come in contact with it. 
The current must be turned on as soon as the electrode en- 
ters the external os (10 or 15 milliamperes will be suffi- 
cient), and no force is to be used in its introduction, but 
rather let it slip in by its own weight. As soon as it has 
passed the angle it should be slowly withdrawn immediately 
at the first sitting. The external or inactive electrode is 
placed on the abdomen. At the second or third sitting, if 
the application is well tolerated, it may remain in for two or 
three minutes and the strength of the current may be in- 
creased to 20 milliamperes. As soon as the canal will allow it, 
the size of the electrode is to be increased one size at each 
sitting until the desired degree of dilatation has been accom- 
plished ; and the dose may be increased to 30 milliamperes, 
and the duration of the application may be lengthened to five 
minutes, if desired. In no instance will it be necessary to ex- 
ceed 50 milliamperes, unless the tissues are unusually dense ; 
and, when possible, it is best not to use even this strength, as 
faradic current must be given as strong as possible ; and it should be con- 
tinued, where a sedative effect is desired, until it ceases to be felt by the 
patient. 
1 The electrode which I use is an insulated shaft larger than any of the 
metallic tips which screw into it, thus making a shoulder 2 or 2£ inches 
from its extremity. The tips are made of Copper, nickel-plated, so they 
may be curved as desired, and are of different sizes, 9, 11, 13, 15, and 17 of 
the French scale. No. 9 corresponds in size with the ordinary uterine 
sound. The last two sizes are used exceptionally where an unusual de- 
gree of dilatation is required or when the uterus and canal are unusually 
large. OF UTERINE DISPLACEMENTS. 
11 
it is generally unnecessary and undesirable to cauterize the 
canal. In very old and obstinate cases of chronic metritis it 
may become necessary to exceed these doses in the later stages 
of the treatment, but generally it will not be required. 
As soon as complete relaxation has been brought about by 
this treatment, the positive pole must be substituted for the 
negative for its tonic effect and for the cure of the endometritis. 
The platinum sound or the prepared steel must be used, and at 
first the strength of the current should not exceed 30 milliam- 
peres, used for five minutes every second day, but may subse- 
quently be increased to 50 or 60 milliamperes. Bipolar fara- 
dization of the vagina may be employed advantageously, as 
described above. 
If more stimulation of the uterus is required, the faradic 
current may be applied to the cavity by means of the bipolar 
intra-uterine electrode. Used in this way it has a more direct 
effect upon the structure of the organ than when used in the 
vagina. But it is best not to do this until the galvanic appli- 
cations have been dispensed with, or, at any rate, not at the 
same sitting. 
RETROVERSION. 
It will be necessary to separate the treatment of retrover- 
sion and retroflexion, although they are considered together 
by most authors, because they often exist separately and re- 
quire a different line of treatment. Fixed retrod isplace- 
ments will likewise be considered separately, because their 
treatment presents certain difficulties which necessitate care- 
ful manipulation. 
A retroverted uterus presents the same heavy, rigid condi- 
tion as was shown to exist in anteversion, and there is like- 
wise a metritis and endometritis, with sometimes a chronic 
posterior perimetritis or parametritis, or an -exudation, as evi- 
dence of its previous existence. According to Schultze, there 
is relaxation of the utero-sacral ligaments, resulting from this 
posterior parametritis, in those cases which are permanent. 
The uterus can often be replaced when there is some exuda- 
tion present, unless adhesions have formed, though pain may 
be provoked by the attempt. 
The indications for treatment are the same as in antever- 
sion. If the cervical canal is not free enough to allow proper 12 
GOELET : RATIONAL TREATMENT 
drainage, the negative pole in the uterus must be used at firstr 
and this form of galvanism should be continued (unless a sen- 
sitive condition calls for the positive pole) until the rigidity 
of the organ has been overcome. The lateral posture of the 
patient, with the external electrode over the sacrum, is pre- 
ferred, and the uterus, when reducible, should be thrown into 
proper position by the internal electrode and held there during 
the application. The applications may be repeated every second 
day, and the strength of the current may be from 30 to 60 mil- 
liamperes, used for five minutes. After each galvanic applica- 
tion a five-or ten-minutes bipolar faradization of the vagina is 
advisable (current of tension), and the uterus is braced in po- 
sition by vaselined tampons. (If there is a tendency to menor- 
rhagia, the faradic applications would tend to increase it, and 
they should be postponed until this has been overcome.) If the 
organ is found soft, yielding, and sensitive, with a dilated ca- 
nal, as sometimes happens, the positive pole may be used to 
the cavity of the uterus from the start. 
As soon as the rigidity of the organ has been overcome, the 
positive pole is indicated for its tonic effect and for the cure 
of the endometritis. A suitable pessary should be fitted, and 
the applications are made every second or third day for five 
minutes each time. The strength of the current may vary 
from 40 to 100 milliamperes. The faradic vaginal applica- 
tions are continued throughout the treatment, at first the fine 
wire being used, and then the short, coarse wire coil. 
RETROFLEXION. 
Very much the same pathological condition is found exter- 
nal to the uterus with retroflexion as was shown to exist with 
retroversion, and the changes in the organ itself are similar to 
those found in anteflexion. There may be a posterior para- 
metritis, with exudation and more or less relaxation of the 
utero-sacral ligaments, though this is more often the condition 
where version and flexion are combined. There is loss of 
tone of the uterine walls, the posterior being shrunken and 
rigid while the anterior is unduly stretched. The body of 
the uterus is enlarged and heavy, and there is endometritis, 
with possibly a metritis also. 
The peri-uterine changes are not always constant or pro- OF UTERINE DISPLACEMENTS. 
13 
nounced, especially in the so-called congenital variety of com- 
paratively recent date, for cases are frequently seen where the 
changes in the uterine structure are the only abnormal con- 
ditions present. 
The indications for treatment are : (1) To secure drainage 
for the catarrhal secretions; (2) to soften and relax the rigid 
posterior wall and render the organ mobile, so that it may be 
retained in a normal position ; (3) to remove any existing para- 
metritis or deposit, and (4) to bring about resolution of the 
diseased mucosa; then (5) to tone up the relaxed uterus and 
its supports. 
The same condition of retroflexion calls for dilatation and 
the stem as was described when speaking of anteflexion. 
The electrical treatment of this condition is the same as 
that of anteflexion, except that the external electrode must 
be placed over the sacrum, because the interpolar action is 
desired upon the posterior wall. (The lateral posture of the 
patient will be found more convenient.) The negative pole 
is used at the commencement, and the electrode should be 
the size of the uterine sound and insulated to within two 
inches of its extremity. This is gently introduced to the fun- 
dus, while a current of 10 to 15 milliamperes is turned on, and 
is withdrawn almost immediately at the first application if there 
is any sensitiveness at the point of flexion. If pain is provoked 
and continues after the removal of the electrode, it may be 
quieted by a faradic vaginal application with the bipolar elec- 
trode (current of tension). 
It may be best not to increase the size of the electrode for 
the first two or three applications, but at the second sitting 
the uterus may be thrown forward into normal position by 
gently rotating the electrode as soon as it has entered its full 
length, unless the reposition causes too much pain, when it 
may be delayed. It is well always to replace the organ as 
soon as possible, however, and continue the application with 
the uterus in position for two or three minutes. There is no 
advantage to be gained in attempting to brace up the uterus 
with tampons until it has become softened and capable of free 
flexion forward as well as backward, though there is no ob- 
jection to a flat glycerin-gauze tampon when it is indicated. 
A.fter two, or perhaps three, sittings, the size of the electrode. 14 
GOELET : RATIONAL TREATMENT 
may be increased, the uterus being replaced every time while 
the current is turned on, and the strength may be increased to 
20 or 30 milliamperes and used for two or three minutes only. 
In some cases, especially in the virgin uterus, the size need not 
be increased beyond the third size (No. 13 French), the others 
being used when an extreme degree of dilatation is required. 
And in the virgin uterus it will hardly be necessary to increase 
the current beyond 30 milliamperes used for five minutes. 
But in old chronic cases in the multiparous uterus it may be- 
come necessary to increase the strength of the current to 50 
or 60 milliamperes. 
When the uterus has become thoroughly softened and ca- 
pable of retaining the normal position without support when 
the patient is in the lateral posture, the positive pole is to 
be substituted for the negative, and a five- to ten-minutes bi- 
polar faradization of the vagina should be made immediately 
after. Also, the organ should receive sufficient support (at 
first from tampons and later a suitable pessary) to maintain 
the corrected position when the patient is on her feet. 
This treatment by the positive pole, which should be at first 
every second day, and later every third or fourth day, should 
be continued until the uterus and its supports have been so 
toned up as to retain their normal position without artificial 
support. The strength of the current to be used will not need 
to be more than 30 to 40 milliamperes, used for five minutes, 
or 50 to 60 milliamperes for three or four minutes. 
It may be added that there is much to be gained by lessen- 
ing the pressure on the uterus from above by avoiding the use 
of corsets and exertions which increase it, and by avoiding 
constipation. The pessary should be worn for some time 
after active treatment has been suspended. 
If a case is met which does not become toned up sufficiently 
under this plan of faradization, this current maybe applied to 
the inside of the uterus by means of the intra-uterine bipolar 
electrode. This latter method of application acts more direct- 
ly upon the muscular structure of the uterus and is more ef- 
fective. The electrode must be introduced well up to the 
fundus, so that both metallic surfaces are within the cavity, as 
the application is very painful if one pole should happen to 
be in the cervix. Within the cavity, the current, when very OF UTERINE DISPLACEMENTS. 
15 
gradually increased, is quite as well borne as in the va- 
gina. 
This method of treatment has to recommend it the rational 
application of the different actions of the current in removing 
the cause and overcoming the effect of the malposition, and a 
fair degree of success may be reasonably expected if it is con- 
sistently carried out. Dilatation with the steel dilator pro- 
duces a rapid softening of the uterine structure. The tun- 
nelled stem allows free drainage from the cavity and produces 
further relaxation. Negative galvanism does the same thing 
in a more gradual manner. The uterine structure is softened, 
the canal is dilated, and the secretions, which are in the begin- 
ning thick and gelatinous, become liquefied and thin under its 
influence and drain away readily. Positive galvanism acts 
by toning up the muscular structure of the uterus; and by 
its direct caustic effect upon the endometrium a cure of the 
catarrhal conditions is brought about. 
The effect produced by the faradic current upon impaired 
muscle tissue is too well known to require explanation here. 
But the equallizing effect upon the circulation of the pelvis of 
the secondary current from the long, fine wire, when used by 
the bipolar method, is not so generally understood, nor is its 
sedative effect half appreciated, or it would come into more 
general use. 
FIXED RETRODISPLACEMENT. 
When the uterus is fixed in this position by inflammatory 
adhesions or exudation, it can sometimes be restored by appro- 
priate galvanic treatment, and if not always so as to retain the 
normal position without support, at least so that a pessary may 
be worn with comfort. Very careful manipulation is some- 
times necessary to avoid lighting up a fresh attack of inflam- 
mation. In old chronic cases where there is little or no sensi- 
tiveness to touch, active treatment may be commenced at once, 
but otherwise the treatment must begin with positive galvan- 
ism of from 40 to 60 milliamperes for five minutes, with the 
clay-covered carbon-ball electrode against the cervix or in the 
posterior cul-de-sac, and the externa] electrode over the sa- 
crum. If this does not promptly relieve, bipolar faradization 
of the vagina every day for ten or fifteen minutes from the 
fine-wire coil should be used in addition. Cases which are 16 
GOELET : RATIONAL TREATMENT 
not relieved by this treatment, and where pain is a promi- 
nent symptom, must be given the combined currents (galvano- 
faradic), with positive pole and covered-ball electrode in 
the vagina and negative over the abdomen or sacrum. The 
switch-board of De Watteville will be found very convenient, 
but, in its absence, one pole of the galvanic battery is connect- 
ed with the opposite pole of the faradic, and the other two 
poles used as if only one battery was in use. The galvanic is 
increased by means of the rheostat or the switch, according to 
the arrangement of the battery, and the faradic by advancing 
the secondary coil over the primary. 
The active treatment consists of negative galvanism to the 
uterine canal with the bare metallic electrode the whole 
length of the canal, with the patient in the lateral posture and 
the external electrode over the sacrum. The strength of cur- 
rent to be employed is from 30 to 60 milliamperes, used for 
five minutes every second day. At first no attempt should be 
made to lift up the uterus, and the electrode must have a suit- 
able curve so as to enter freely without provoking irritation. 
A fiat glycerin-gauze tampon may be introduced after each 
application, but no packing should be used until the tissues 
have become softened and relaxed. 
After three, or at most six, applications of this kind, 
stretching and loosening of the attachments maybe attempted 
with the electrode in position, and while the current is in 
action, by depressing the handle of the electrode toward the 
perineum. Following the applications now, vaselined tam- 
pons, packed well up behind the cervix and then filling the 
vagina, will prove a valuable aid. Each time a little more is 
accomplished. The size of the electrode is increased and the 
curve is lessened. After a while it will be possible to rotate 
the electrode in the uterus and hold it in position during the 
application. A systematic continuance of this method of 
treatment will in the majority of cases, after a variable length 
of time, cause an absorption of the deposit and allow the ad- 
hesions to be stretched and loosened, and the organ can be 
made to resume somewhat its normal position. It may be 
maintained by tampons until a suitable pessary can be borne, 
when it will be necessary to use, in addition to galvanism, the 
faradic current, first from the long wire, and later from the OF UTEKINE DISPLACEMENTS. 
17 
short, coarse-wire coil; and it may be applied either by the 
bipolar method to the vagina, or with one pole in the vagina 
and the other over the sacrum or abdomen, as appears best 
suited to the case in hand. 
Should there be a tendency to metrorrhagia or menorrhagia, 
the treatment must be commenced with positive galvanism to 
the uterine canal until this is overcome. Commencing with a 
current of 50 milliamperes, it may be progressively increased 
to 100 or 150 milliamperes, when necessary to accomplish the 
desired result. Then the negative pole may be used, as before 
described, with little fear of reproducing it. A bloody dis- 
charge from the uterus is sometimes kept up by the inter- 
ference with the circulation caused by a deposit or an irrita- 
tion of the endometrium by pent-up discharges in the cavity. 
This would only be aggravated by the positive pole, for the 
indication is to free the canal for drainage and soften and re- 
move the deposit. In this instance the negative is the pole to 
be used, but the dose may be so modified as not to produce 
undue irritation. 
It must be understood that if a distinct exudation tumor is 
present it should be attacked through the vagina by applica- 
tions of negative galvanism with the ball electrode covered 
with cotton or clay, or by galvano-puncture into the mass. 
If sensitive and painful, the positive pole should be used first. 
When the ball electrode is used, full doses will be required, 
ranging from 60 to 150 milliamperes, used for five minutes 
only. I prefer the galvano-puncture for these exudations, be- 
cause it acts more promptly; but it is contra-indicated when 
there is any inflammatory condition present. If the tumor is 
sensitive to touch and much pain is complained of, the positive 
puncture with 30 to 50 milliamperes for three or five minutes 
will afford marked relief, and rapid diminution in the size of 
the mass will sometimes be obtained. Negative puncture will 
be more effective in old chronic exudates which are painless 
and insensitive. The needle should be no larger than a small- 
sized exploring needle, and the penetration need not exceed 
one centimetre. The insulating sheath is passed along the 
finger as a guide, and is held firmly against the tumor as felt 
in the vagina, while the needle is passed through the sheath 
and into it. The puncture should not be repeated for a week 18 
GOELET : TREATMENT OF UTERINE DISPLACEMENTS. 
or ten days. Thorough antiseptic precautions must be ob- 
served by using an antiseptic vaginal douche both before and 
after the operation, and placing in the vagina a loose tampon 
of creolin or iodoform gauze, which is to be renewed every 
twenty-four hours.