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NLM001034384 
 
 
 
 
CLINICAL RESEARCHES
IN
ELECTRO-SURGERY.
      A. D.  ROCKWELL,  A.M., M.D.,
fellow of the n. y. academy of medicine ; membeb of the n. y.
   county medical society ; electbo-thebapeutist to the
            n. y. state woman's hospital,

                   /and

       GEO.  M.  BEARD, A.M., M.D.,
FELLOW OF THE N. Y. ACADEMY OF MEDICINE ; MEMBEB OF THE N. Y.
     COUNTY MEDICAL SOCIETY ; ELECTKO-THEBAPEUTIST TO
               DEMDLT DISPENSARY.
        NEW YORK:
WILLIAM WOOD & COMPANY,
     27 GREAT JONES STREET.
             1873.
A 
   VAJBE
   R6*S4c

Filwi y)0. 2830. yx?. 6 
PREFACE.
  Electro-Surgery is a  department of  science that
  has  been so little studied that any contribution to
  it, however  fragmentary and  imperfect, becomes of
  value.
   The pathway that  leads to truth on  this subject
  is at best  tortuous and obscure;  but every advance
  of the pioneers, every removal of obstructions,  makes
  the journey shorter, clearer and easier for those who
  are setting  out upon it.   An  early publication  of
 experience  and  experiments, provided it be candid
 and  thorough, will secure the aid of many collabora-
 tors who may perhaps be induced to carefully study
 the subject.
   Through a variety of laborers there will be brought
 out a variety of results which will reciprocally supple-
 ment and correct each other.  Therapeutics in all its
 branches, and certainly electro-therapeutics is a sub-
 ject so wide and so complex that only by comparing
 the studies of many observers can we arrive at the
 full truth.
  Although  a long time must  elapse before some of
the questions that may be raised in connection with 
4
 the  following clinical cases  can be fully answered,
 yet  strong  and important points are in the way of
 settlement.   The objection  that is  often and  very
 properly  brought  against  the early publication of
 clinical  experience, that it is apt  to teach  either
 absolute  error or  but half-truths,  need  not apply,
 provided  the  reports are fairly and impartially made,
 without any attempt to conceal or  distort or in  any
 way warp the evidence to sustain a theory, and no
 inferences are drawn  beyond the requirements of the
 demonstrated  facts.  We have not  attempted to ex-
 haust our experiments, but to  fairly represent them
 in all their aspects.  Cases of  absolute  or approxi-
 mate success  have been placed  side  by  side with
 cases of absolute  or approximate failure.  Cases where
 every opportunity was afforded for treatment,  and
 cases that failed  for lack of  opportunity, have been
 accorded equal prominence.  Cases in which the ordi-
 nary and accepted methods of treatment would have
 been sufficient have been mingled  with  those cases
 which  under  the  ordinary  and  accepted  methods
 would have been  utterly hopeless.
  Many inquiries  of great importance have been  left
 wholly or  partially unanswered;  to other problems
 a merely provisional solution has been given; while
 in some  departments  we have  been  able  to  draw
 generalizations that  have been  at  once  legitimate
and satisfactory.
  Those who  on  the one hand believe that electro- 
5
 therapeutics is the one great problem of the future,
 and those who  on the other hand suspect  that it is
 all a  delusion, will  be  equally disappointed.   The
 cases are taken from  both public  and private prac-
 tice, and many of them were treated in  the presence
 and with the assistance of able and recognized surgi-
 cal authorities.
  The method of  central  galvanization and electroli-
 zation by working  up the base, which we have recently
 devised  and employed,  will in the future be more
widely tested, and on the principles here indicated.
The striking  and  suggestive results obtained  in cer-
tain diseases of  the skin,  and especially under  central
galvanization, will probably excite  surprise.   Some
of the results, we  are  happy to state, have now been
confirmed by a number of observers.
                           A. D. R. and G. M. B. 
 
CLINICAL  RESEARCHES   IN  ELECTRO-
                  SURGERY.
                   CHAPTER I.

             Erectile or vascular tumors.
   Erectile or vascular tumors include both cutaneous
 and subcutaneous naevi.  The terms—cutaneous  and
 subcutaneous—however,  simply indicate a difference
 in seat but not  in kind.  The two forms are often asso-
 ciated,  and  the  wide-spread dilatation of cutaneous
 vessels attended with little swelling, that are commonly
 called mother spots, are evidently similar  in character
 to the subcutaneous variety to which Bell gave  the
 name of aneurism by anastomosis.
  In the treatment of the various forms of subcuta-
neous erectile tumors, both arterial and venous, it is
evident that electrolysis must bear an important part if
it does not altogether supersede the knife.   Its advan-
tages over other methods are various and decided.  1st.
There is not the slightest  hemorrhage; no more blood
need be lost then after any fracture.  2d.  No scar is
left. By proper insulation and care in the introduction of 
8
the needles and management  of the current, chemical
effects will be confined to the blood alone.  3d. During
the operation the pain is slight, and subsequently the pa-
tient experiences no inconvenience.  4th. The operation
is easily performed, and produces no such  disagreeable
reflections to either patients or friends as  the knife or
actual cautery.  The  number  of needles  to be  intro-
duced into the tumor depends very much on its size.
When the enlargement is slight, not exceeding in size
a small filbert, one needle is sufficient, while  a  naevus
an inch or more in breadth  and depth will require three
or four.
Subcutaneous erectile tumor of the right cheek ; complete
        recovery follows electrolytic treatment.

  Case I.—In April, 1871, Dr. D. F. Reynolds consult-
ed us in regard to the case  of a little child  aged eight
months, who was afflicted by an erectile tumor in the
right cheek.  It appeared shortly after birth, and had
gradually enlarged until  the date mentioned, when it
measured one and a-half inches in width and from one
half to three-quarters  of an inch in depth.   Upon firm
pressure the enlargement would almost  entirely disap-
pear.  The patient having been placed under the influ-
ence of chloroform, we operated at Bellevue Hospital in
the presence  of Dr. Frank Hamilton  and his class, by
introducing into the  four quarters of the  tumor four 
9
 small gilded steel needles insulated to within one-quarter
 of an inch of the points.
   During the passage of a current of very moderate
 tension the enlargement  gradually grew  harder and
 more prominent as the blood coagulated, and at the
 expiration of eight minutes, when the needles  were
 withdrawn,  the part was quite firm.  The child suffered
 no inconvenience during  or after  the  operation, and
 when seen the next  morning was  as well and playful
 as usual.   The  process of  absorption soon became
 manifest, and in  two months three-quarters of the clot
 had disappeared.
   From this time there was a most marked decrease in
 the rapidity of absorption, since but two months  more
 were required before the clot had entirely disappeared.*


 A large arterial  tumor in a weak, ill-nourished child;
    the result of electrolytic treatment unsatisfactorg.
   Case II.—Annie----, a child aged one year, was di-
rected to us by Dr. H. P. Farnham.  On her back over
the upper dorsal vertebrae we found a large fluctuating
arterial  tumor, nearly two inches in diameter at its
base.
  The child was markedly anasmic, and her general  con-
dition was much below par.
  * This case was briefly mentioned in the New York Medical Journal
before complete absorption had rendered the operation a success.
       1* 
10
   It was thought best, however, to operate, and in the
presence of Drs. Farnham, Pinkney, Grant, and others,
the needles were used in the same  manner as in the
previous case.  Coagulation was readily produced, but
owing to some unpleasant symptoms in the respiration
of the child the needles were withdrawn  (as the pro-
gress of the  case  subsequently attested) a  little pre-
maturely.
  Absorption set  in very  slowly indeed, and  after a
few weeks its effects were barely perceptible.  After a
couple of months it was evident that the circulation in
one portion was beginning to be re-established, but the
mother refused to allow anything more to be done for
the little, patient.   It should be stated that on the night
following the operation, the child was allowed to  lie
upon its back with the hard enlargement of coagulated
blood entirely unprotected.   Subsequently a soft circu-
lar ring was  prepared and placed around the  tumor,
but the irritation  already caused by the pressure was
followed by slight ulceration and discharge.
  This, however, healed in the course  of two weeks,
but it undoubtedly contributed towards  the  general
unsatisfactory result.  The slowness with which the
absorbing process was carried  on  is to be  attributed
undoubtedly  to impaired nutrition, and the  re-establish-
ment of the  circulation mainly to the  unfortunate ne-
cessity of cutting short the operation. 
11
Arterial erectile tumor from birth in a  child fifteen
  months old ; complete recovery under electrolyzation.
  Case  III.—In a  little  child  fifteen  months old,
upon whose face near the angle of the lower jaw a
small erectile tumor had existed from birth, electrolysis
was completely successful.   The patient was placed
under the influence  of chloroform, and two platinum
needles, insulated to  within one-third of an inch of the
points, and connected with the positive pole, were  in-
troduced into the two lower quarters of the tumor;
while two steel needles, connected with the negative pole
and insulated in a similar manner, were thrust into the
two upper quarters.  The current from twelve medium-
sized cells of a zinc-carbon battery was allowed to pass
for ten minutes, at the end of which time the coagula-
tion was complete.   Absorption of the clot rapidly be-
came manifest, and in four months it had entirely dis-
appeared, leaving no scar.
   In subsequent operations we have not hesitated  to
use steel or gilded needles for  the positive pole, since
the oxidation  which these metals undergo in all proba-
bility tends to accelerate coagulation.

Subcutaneous erectile tumor treated by electrolysis ; sub-
                  sequent sloughing.
   Case IV.—At the  request  of Dr.  Geo. K. Smith,
we operated, Nov. 22,  1871, on a case  of subcutaneous 
12
erectile tumor just over the inner angle of the eye in a
child sixteen months of age.  The tumor, which was
about the size of a hazel-nut, could easily be compressed.
The child was thoroughly etherized with the assistance
of Dr. F. H. Colton, and three insulated needles were
inserted into the tumor—two connected with the posi-
tive, and one with the negative pole.
  The current was from sixteen weak cells; the seance
twenty minutes.  The color of the tumor changed dur-
ing the operation and became hard through  the coagu-
lation.  Subsequently the tumor sloughed  at  certain
points, and the result was not satisfactory, since a de-
formity was left that may be permanent.  The mistake
we  made was in using too strong a current and unduly
prolonging  the operation. In our desire to avoid re-
peating the operation as had  been found necessary in
other cases, we went to the other extreme.
  The delicate skin of the child was so affected by the
action of the current that sloughing ensued  in spite of
the  insulation of the needles.
  This mistake is one that can be easily avoided.


        Ncevus in a child cured by electrolysis.

  Case V.—April  1,  1872,  we were requested by
Dr.  E. Bunker, of Brooklyn, to operate on a small
naevus on the neck  of a child eight  weeks old.  The
tumor was situated just below the chin, and was one-
third of an inch in diameter. 
13
   A current from eight zinc-carbon cells was applied
 into the tumor by means of a  small needle (uninsulat-
 ed) connected  with  the negative pole, while a sponge
 electrode attached to the positive was applied to  the
 surface of the  body.
   Immediately the diseased spot began to decompose
 and to change in color, and  ultimately  disappeared.
 The sitting was continued but four minutes.  No anaes-
 thetic was employed.
   Dr. Bunker informs us (June 15) that there are signs
 of reappearance of the growth.

                 Bronchocele {goitre).
   In the treatment of goitre etherization is not neces-
 sary, provided a needle is used that can be introduced
 with ease.  The ordinary glover's needle (small size)
 of the fancy stores, we find enters the skin easier than
 any other shape that we have tried.  It is not neces-
 sary to insulate the needles for goitre; but hard rubber
 can be melted on and  allowed to cool, in cases where in-
 sulation is required.   To  introduce the round needles
 into the skin of the neck is a matter of great difficulty.

 Simple or adenoid goitre in a child aged fourteen ; steady
      decrease in size  under electrolytic treatment.
   Case VI.—L. W., a girl aged  14 years,  first observ-
ed four years since a slight enlargement of the thyroid
gland.   It rapidly increased   in  size,  until Dec.  5, 
14
1871;  when she presented herself for examination it
was 1^ inches  in depth and 2 inches in width, reaching
to the anterior border of either sterno-cleido mastoi-
deus muscle.   The mass was quite movable and did
not in any way cause  inconvenience, excepting when
she attempted to  sing.  Iodine,  both internally and
externally, had been used without appreciable benefit.
For the first two months localized external galvaniza-
tion repeated  twice a week was alone tried,  resulting
in no diminution in the size of the swelling,  but  in a
very decided alleviation of  the distressing sensation of
strangling, which invariably occurred whenever she at-
tempted to sing.
  Subsequently the needles were introduced,  and to
this date the tumor has steadily decreased in size, until
it  is now, June 1, one-quarter its  original size, and
the indications are that it will entirely disappear.'  The
needle (a  small glover's needle),  has been introduced
some twenty times, but as  the pain  produced is very
slight no chloroform has at any time been used.


Fibrous goitre of four years' standing in a woman aged
   twenty-nine; considerable diminution in size under
   external galvanization and electrolyzation.

   Case VII.—K. M., an unmarried  woman,  aged 29,
observed some four years ago a slight swelling over the
right  side of  the  pomum Adami.  The growth was
rapid and  soon involved both lobes of the thyroid gland. 
15
 By accurate measurement  the distance from the pos-
 terior border of one sterno-cleido-mastoid muscle to the
 posterior border of its fellow was found to be seven
 and one-half inches.
   Five  applications  of localized  galvanization  during
 the three weeks following reduced the above measure-
 ment one-half an inch.  From the date of the  last ex-
 ternal application (March 18, 1872), a needle was intro-
 duced and the current allowed to act about fifteen min-
 utes.  Six  similar applications during  the following
 four weeks  reduced the distance  from the  two given
 points to six inches.  The patient after this came  but
 two or three times until June 23, when ether was ad-
 ministered, and three needles and eighteen zinc-carbon
 cells were used.   The  operation was continued fifteen
 minutes, when  two needles were withdrawn and  the
 cells increased to twenty-three, and the current allowed
 to pass  eight minutes longer.  The patient recovered
 rapidly from the effects of ether,  but, unfortunately,
 never returned to report progress.

 Large cystic tumor in the right axilla successfully  treated
                    by electrolysis.
  Case VIII.—Mary M., aged 33. noticed three years
ago a swelling in the right axilla, which gradually in-
creased until Feb. 29,1871, the date of her presentation
for  treatment, when it was about one-half the  size of
her clenched fist.  The swelling was hard and movable.
Alternate localized  galvanization  and faradization (ex- 
16
ternal applications) were essayed for one month, greatly
relieving the pain and slightly reducing the enlarge-
ment. April 2d.—The needles were attempted—one
being used at each seance.  The operation was repeated
eight times until June 26, when the tumor was no larger
than  a small chestnut.  She returned no more to the
Dispensary,  for the reason,  doubtless, that  absorption
had completed its work.  Another result of treatment is
worthy of notice.  The patient had borne four children,
and while nursing the first had suffered from a fissured
nipple on the side where the tumor was seated, and in
consequence was, during the whole  period of nursing,
unable to give nourishment to the child from the affect-
ed side.  With subsequent  children  the quantity  of
milk secreted by this breast was hardly one-half of that
given by the other.
  At the time of our first operations she was nursing a
child  twelve months old, and  thus  gave us an oppor-
tunity to demonstrate the value of electrization in in-
creasing the lacteal secretion.  The quantity of  milk
secreted rapidly increased until it quite equalled the
amount produced  by  the healthy side.

Cystic tumor of forehead of forty years'1 standing ; im-
      mediate and permanent cure by electrolysis.
  Case IX.—Mrs. H., aged 60, we first saw in consul-
tation with Dr. A. W.  Catlin, of Brooklyn, Nov. 9,1871.
  For forty years she had been afflicted with a tumor
on the forehead,  which,  in  appearance and size, and 
17
 in its feel and compressibility at the time we saw  it,
 exactly resembled a ripe Isabella grape.  This appear-
 ance had not, however, been constant; its size varied,
 and at one time after stooping it had considerably en-
 larged, and a vein connected with it and leading to-
 wards the upper part of the nose became swollen and
 prominent.
   Whether the enlargement was erectile or cystic was
 a matter of doubt.  Dr. A. B.  Crosby, who saw the
 case with us, regarded it as cystic.  The patient had re-
 fused to submit to any operation for the radical cure of
 the tumor—partly on account of fear of hemorrhage—
 and consequently, had worn the unpleasant deformity
 the  greater portion of her fife.  Nov.  11,  1871,  with
 the assistance of Drs. Catlin, Crosby, Cooper, and Wyck-
 off, local anaesthesia was used, and two small insulated
 needles were inserted into the  tumor near the base,
 one  pole connected with the positive and  the  other
 with the  negative pole of ten cells of a portable Gal-
 vano-Faradic Co.  zinc-carbon battery.   Immediately
 the  color of  the  tumor began to lighten, through the
 change of its fluid contents into oxygen and hydrogen
 gases, and in five minutes the whole  surface was al-
 most colorless,  and  the  tumor  was much distended.
 The  needles were now withdrawn;  there was no he-
 morrhage, but the gases began to escape at the places
 where the needles  were inserted.   Dr. Crosby  now
used a little  pressure, and  the  tumor  flattened with
more escape  of gas.   Under repeated pressure still 
18
 more gas escaped;  and in ten minutes from the be-
 ginning of the operation the tumor was perfectly flat-
 tened.  Gradually the residuum of the tumor disap-
 peared, and in a few weeks scarcely a trace of the long-
 standing deformity existed.

 Epithelioma involving one-half the lower lip; recovery
             under electrolytic treatment.
   Case X.—Mrs. J. C, aged 65.  In September, 1871,
 a little hard lump, the size of a pea, appeared on the left
 side of the under lip.  By Jan. 19, 1872, it had extend-
 ed from the angle of the mouth along the  lip to the
 median line.  The surface presented a warty appear-
 ance, was exceedingly hard, and bled readily.  Local-
 ized galvanization (external)  dissipated  almost com-
 pletely the excessive pain in  the  diseased  part.   On
 Jan. 26, five uninsulated needles were introduced into
 the lip, around and beneath the tumor, so as to entirely
 separate the healthy from the unhealthy tissue, and  a
 current of considerable tension from eighteen cells was
 allowed to pass for twenty-five minutes.   Equal parts
 of chloroform and ether were administered.
   Inflammation and suppuration followed, and in two
 days the entire tumor had sloughed away.
   By Feb. 2  the  inflammation had subsided, and the
 surface was covered with healthy granulations.  Im-
 provement continued  until Feb. 23,  when  the  sur-
face had entirely healed, and the patient was discharged
as cured, with a well-formed lip. 
19
 Large  uterine fibroid;  dissipation of pain and some
   decrease in the size of the tumor under  internal fara-
   dization and electrolysis.
   Case XL—Isabella McV. came to the Dispensary for
 examination and treatment, March 7th, 1871.
   Some eighteen months previously she first noticed a
 slight enlargement occupying the right iliac region. It
 gradually increased  in size,  and on examination we
 found a tumor extending from  the fundus  to  the os
 uteri.   The  menses and secretions were  normal, but
 the associated pains  in the hip and down the right limb
 were  of the  severest character.   The  woman was
 sleepless, without appetite, and suffered from continual
 vomiting.  The faradic current was first used by ap-
 plying a large flat electrode connected with the posi-
 tive pole, directly over the upper portion of the tumor,
 while the negative  electrode, so constructed  as to be
 readily introduced, was  held firmly against  the  right
 side of the cervix uteri.   The above treatment in con-
 nection with an occasional general  application was re-
 peated twice a week for nearly four months, resulting
 in great improvement to her general condition and effec-
 tually allayed the acute pain from which she had suffered.
  No effect was produced on the size  of the  growth,
except  that further  increase seemed  to  be checked.
In the latter part of June electrolysis was resorted to.
A long needle insulated  to within one inch of the
point was thrust into the tumor  as it could be felt at 
20
the right side  of the  cervex uteri.  -The current from
twenty-five cells was  allowed  to pass  for fifteen min-
utes, and the operation was repeated twice a week.
  After a  few applications  a  thick dark-colored dis-
charge appeared, and when this flow was most abund-
ant the patient's health was correspondingly better.
  After two months of this treatment the patient was
lost sight of, but the tumor had decreased decidedly in
size and become much softer, while  her  general health
remained good and her limbs free from  pain to the last
visit.

Indolent ulcer  of the arm ; recovery under local  galvan-
                      ization.
  Case XII.—Mary  H,  aged forty,  while  moving,
May 1, 1871,  fell  and  injured  the arm immediately
above the external condyle.  The pain was excessive
and continued to distress her for  several weeks, when
a small ulcer made its appearance and enlarged until it
was two inches in diameter.
  The  patient applied for treatment,  July 18.   The
ulcer was  covered with a dark-colored scab  three-
fourths of an inch, partly lifted from its resting-place by
exuberant and unhealthy granulations.
  The scab was removed, and a wet cloth in connection
with the  positive pole  was  applied to the  diseased
part while  the negative was placed on  an indifferent
but approximate part.  The galvanic current was used.
She suffered no more pain after the second seance, and 
21
as the applications were repeated  the  ulcer  rapidly
healed, until August 30, when the part was covered
by sound healthy skin.

Syphilitic ulcer; recovery follows three  operations by
                     electrolysis.
   Case XIII.—Catherine McK., aged forty, suffered
three years since from a number of syphilitic tubercles
and ulcers about her hips, thighs, and vulva. They per-
sisted a long time and gave her much annoyance, but
finally healed, with the exception of one on the inside of
the thigh. It was elevated nearly one-half an inch above
the surrounding surface, was  excessively painful, and
discharged an offensive secretion.  A needle connected
with  the positive pole was passed through the base of
the elevation,  and  a  current of  moderate  tension
allowed to pass for a few moments.   This application
dissipated all pain, and after the third seance, given
several weeks after  the first, soon healed, and the pa-
tient  was discharged from .the Dispensary. 
s
22
Recurrent fibroid tumor  of years'  standing.—Repeated
   electrolyzations without  etherization and attended with
   trifling pain.—Arrest of Growth.—Gradual decrease
   in the size of the tumor.
   Case XIV.—Mrs. P., a lady of middle age, was direc-
ted to us by Dr. F. Winston,  in Feburary, 1871.
   On  examination, we found under the right ear  a
large tumor, soft and movable, and equal in size to the
closed fist.  The enlargement  was  of the recurring
fibroid character, entirely painless, but most unsightly
in appearance.   The patient first observed the growth
some ten years since, when its size was barely appreci-
able.   It gradually enlarged until  it attained the size
of an ordinary hen's egg,  and was removed by the late
Dr. Cheeseman.
   A few months subsequently it made its appearance
a second time, and steadily enlarged, until at the expi-
ration of three years its size was somewhat greater
than when the first operation was performed.
   It was again removed by Dr. Willard Parker, but in
course of time returned.  The patient was now unwill-
ing to have the  operation by the  knife repeated, and
for seven years the tumor slowly increased to the  size
above  stated.
  To avoid any possibility of  exciting an action in the 
23
 tumor that might render it truly malignant in character,
 we at first made use only of external galvanization.
   After a  dozen applications no change could be per-
 ceived in its outward conformation ; but that the treat-
 ment had not been without some effect was manifested
 from the fact, that the head could now be turned in any
 direction without causing the  disagreeable  and some-
 times painful sensations that  had formerly followed
 pressure of the  deep portion of the growth on  the un-
 derlying tissues.
   We now decided to try the ordinary method of elec-
 trolysis, and accordingly introduced, an  inch into the
 tumor, a needle insulated to within half  an  inch of its
 point.  The application, alternating with external gal-
 vanization, was repeated some  twelve times during the
 course of two months, and  resulted in a very decided
 alteration in the shape, as well as a  marked  diminu-
 tion in the size of the growth.  After each operation
 a large quantity of free hydrogen  gas escaped  through
 the opening made by the needle,  followed  by a slight
 flow of blood.
  At this time two needles were used—the second one
 of platinum, and connected with the positive pole.  It
 should be stated that previously only twelve zinc car-
bon cells had been used, and the current allowed to pass
but ten minutes.   We now increased the cells to twenty,
and permitted the needles to remain some fifteen min-
utes ;  but when  they were withdrawn, neither gas nor
blood escaped, and yet it was absolutely certain  that 
24
the current had been passing every  moment, and with
power greater than in previous operations.
  In a few hours the tumor and tissues surrounding it
became greatly swollen, accompanied by very consider-
able pain.
  The pain and swelling were  relieved by a  poppy
poultice,  but a slight discharge continued through the
months of July and August, during  which time treat-
ment was intermitted.  In September, when the patient
returned to the city, the  discharge,  which had  ceased
two weeks previously, had evidently resulted in a still
further reduction of the tumor.
  The  treatment was resumed, and continued at inter-
vals during the past winter and spring.  The effect has
been a slow but constant decrease in size, until  now it
is about one-third its original size.
  At one time during an interval in the  treatment the
patient observed, in a portion  of the tumor to which
the needles had not been  applied, a  projection  which
rapidly enlarged until it was one-third of  an  inch  in
diameter,  and extended downward into the  healthy
tissue for more than an inch.  A single needle was in-
troduced into this unwelcome addition, and a mild cur-
rent allowed to pass for ten minutes.  The process  of
absorption was excited, and  in two  weeks  this protu-
berence completely disappeared.  It is interesting  to
note in this  description, that while the growth was
slowly  but steadily enlarging before the use of needles,
it has not, since the treatment by electrolysis was be- 
25
 gun,  shown the  slightest  disposition to increase  in
 those parts actually influenced by the current—although
 at one time several months  elapsed between the oper-
 ations.
    While the above case cannot be  cited as a brilliant
 result of electrolytic treatment, it is of exceeding inter-
 est, and has afforded many useful hints that have been
 of value  in other cases.   The pain of  introducing
 the needles was trivial; and  the electrolytic  action,
 even  when it was very intense,  produced little  or
 no sensation;  consequently it was  at no time  neces-
 sary to use chloroform, and   the  treatment was  as
 readily borne  as if the  applications were merely ex-
 ternal.  The impression very generally prevailing, that
 electrolyzation of  morbid  growths must  be  excru-
 ciatingly painful, is not confirmed by the test of expe-
 rience.  The above and  other  cases of like  character
 illustrate  that  fibroid tumors may be thus treated with
 but little  pain;  goitre, and some erectile tumors as well,
 are not acutely susceptible to the pain of electrolysis.
   Cases of scirrhus seem  to  be  more sensitive to the
 chemical action of the current;  and it is frequently ne-
 cessary to etherize the patient, although in other cases
local anaesthesia is sufficient.  In several instances  the
 introduction of the needles and the  action of  the cur-
 rent were borne with but little more fortitude than  it
 is necessary to exercise in some external applications.
  If, in the case related, it is found  necessary to  re-
move the  tumor at once by the process of undermining,
       o 
26
profound anaesthesia will have to be produced; since
without it, the consequent disintegration of the under-
lying sound tissue would cause intense pain.

   Cystic tumor of the submaxillary region: three opera-
tions ; rapid healing with slight disfigurement.   Success-
ful result.
   Case XV.—Miss------, a young lady in her teens,
was sent to us March 25th, 1872, by Dr. Wm. W. Reese.
The patient was of a  fragile constitution,  and had be-
come debilitated by confinement in  the stifling air of a
manufactory where she was employed.  For  one  year
she had been troubled with a tumor on the submaxill-
ary region of the left side, that was at first supposed to
be simply an  enlarged gland.  It  did  not,  however,
yield to the usual treatment that various physicians and
surgeons had given her, and at the  time we  saw it,  it
was about  the size of  an English walnut,  and was ap-
parently encysted. Lancinating pains  of a  tolerably
severe character were sometimes felt in and near the
growth.
   Careful examination made it pretty clear that the en-
largement was cystic; that soft substance was inside of
it, although the walls were  quite hard.   March 27th,
with the assistance of  Dr. Reeves and Hyde,  we  elec-
trolyzed a portion of the growth, and found that it was
really cystic and contained a  dark  cheesy substance.
The patient was fully etherized during the operation,
which lasted forty minutes.  Large and long needles
were employed, and 16 zinc-carbon cells. 
27
   The operation was followed for two days by  irrita-
tive fever, but by no other unpleasant result.   There
was considerable sloughing, but the bulk of the growth
remained as a large unsightly mass.  April 14th, we
again  operated by working up the base of the  tumor,
undermining it and separating it from  the surrounding
healthy tissue.  Dr. A. B. Crosby assisted at the oper-
ation,  and enucleated a portion of the mass before the
needles were inserted.   The irritative fever was slight-
er than after the previous operation.   An ulcer 1£ inch
in length and a half an inch in depth remained—the
surface presenting, as usual after electrolytic operations,
a charred appearance which at first alarmed the patient.
The subsequent healing was, in the judgment of  all the
surgeons, surprisingly rapid and satisfactory.   Dr. Cros-
by, in proper time,  brought the edges together and thus
expedited the reparative process, so that at the end of
a month only a trifling scar remained.  At one of these
operations the parenchymatous hemorrhage was  excel-
lently controlled by the  action of the  current, and  no
other styptic was required.  The patient had now posi-
tively improved in her general health, and was free from
any sign of the disease.  It was  hoped by all parties
that she would hear no more from the  tumor.  It had
been suspected at the close of the operation that a small
portion of the growth remained, but it was not deemed
advisable to protract the operation.
  Very soon, pains of quite a severe character began to
be felt  just beneath the skin in the region of the sub- 
28
lingual gland: then  followed  swelling,  and in a few
weeks a tumor  as large as a horse-chestnut, of the
same appearance and feel as the previous growth.   We
decided to  operate  again,  this  time with  absolute
thoroughness; the same surgeons being  present, and
also Dr. Mann.   Dr.  Crosby made an incision and enu-
cleated the growth, the operation being  completed by
electrolyzation with large needles as before.
  The work was thoroughly done; the base was  thor-
oughly electrolyzed.   During  the operation, a branch
of the facial artery was severed by the needle;  this
was tied by Dr.  Crosby.   The wound was treated  as
before and with the same result—rapid and satisfactory
healing, that has been permanent.  The  scar disfigures
but slightly, while the patient has improved in her gen-
eral health, and at the date  of writing  weighs  much
more than at the time of the operation.

   Large and painful  epithelioma of the upper lip of seve-
ral months' standing.—Removal by electrolysis and satis-
 actory healing.
   Case XVI.—Miss------, aged 20, was brought to us
by Dr. Corey, Oct. 23, 1871, to be treated for an epi-
thelioma of the upper lip that had distressed her for
several  months.   At this time  the  growth extended
from the median line to the left corner of the lip, being
about one inch in diameter  and one-half an inch in
 ength.   The  pain of  the growth was  at times very
great, especially when exposed to the cold; the disfig- 
29
urement was annoying, and there was an evident ten-
dency to quite rapid increase.  At the base, on the in-
ner surface of the lip and especially at the corner, hard
nodules were easily detected by the  finger.  With the
assistance of Dr. Corey, and in the presence of a num-
ber of physicians, we electrolyzed the upper portion of
the growth with five  small needles,  three connected
with the negative and two with the positive pole.  Full
anaesthesia was used, and the operation lasted twenty
minutes.  The needles were inserted  directly into the
body of the  tumor and not  around the base.  The
method  of working up  the base, we had not at that
time begun to employ.  The soft parts of the  tumor in
the vicinity of the negative pole decomposed with ra-
pidity.  A yellowish foam was developed, which, forc-
ing its way underneath the scab that covered the tumor,
oradually lifted it up  and completely  detached it from
the body of the growth.
   The  parts  presented  the usual charred appearance
after the operation, but there was little  or  no pain,
either in  the  tumor  or in the  vicinity.  There was,
however, considerable irritative fever, and the face was
somewhat swollen.  In the course of a week, the por-
tion of the diseased  part that had been electrolyzed
begun  to contract, and near the median line healthy
tissue appeared.   The lower part, that was little affect-
ed by  the needles, remained  as before.  Nov. 9, we
again operated  with four negative and one positive
needle with the same number of cells (16 zinc-carbon) 
30
and for  about the  same  time.  Dr.  Corey  admin-
istered the anaesthetic, and Drs. Armor, Caldwell, and
others were present.  This operation was more thor-
oughly performed than the previous  one, but the nee-
dles were not  inserted into the nodules  or  the  inner
surface,  but only into  the  superficial parts  of the
growth.   No  bad result followed; and by Nov. 27th
the tumor had contracted to one-third of its  original
size  and  was  healing rapidly.  The healing  process
continued until scarcely  any trace of the disease re-
mained.   The healing was almost perfect;  there was
an entirely natural skin in the region where  the tumor
had formerly existed, and the only cicatrix  was at the
corner of the  mouth.  Twitches of pain have been felt
in the vicinity of the scar, especially  on exposure to
cold,  giving  rise to the suspicion  that possibly that
portion of the growth was not  thoroughly treated.
   It is now one year since the  patient was treated, and
the recovery may be regarded as most satisfactory.   In
reference to this case it may be remarked:—
   1st. If the  diseased  mass  had  been  thoroughly
separated from the surrounding healthy tissues by  in-
serting large needles, one operation  would  have been
sufficient, and the cure would  probably have been  ab-
 solute.   This was the first case of the kind that we had
 treated, and we had  not then employed the method of
 working up the base and had not devised the long,
 sharp, double-edged needle which we now employ in the
 electrolyzation of large growths. 
31
   2d. There was  scarcely any hemorrhage or other
unpleasant  symptoms  during  or  after the operation,
excepting  the irritative  fever  of  which we  have
spoken.
   3d. The scar was probably less than if the knife had
been employed.

   Scirrhus of the left breast in a woman aged 45.— Com-
plete and instant relief from excruciating pain, and in the
course of four days, disappearance of one-half the growth
from one electrolytic operation.
   Case XVII.  Mrs.----, aged about 45, an inmate o
Bellevue Hospital, was affected with cancer of the left
breast.
   The main portion of the scirrhus was the size of an
ordinary orange, and extending in to the axilla were  a
number of cancerous nodules of considerable size.
   The surrounding and intervening tissue was as hard
and unyielding as the tumor itself.  The  process of
suppuration was beginning to manifest itself, and for
several  weeks the patient had  suffered  night  and day
the most excruciating pain through the diseased parts.
The first  operation  was performed  in one of the
wards of the hospital,  in  the presence of Prof.  Frank
Hamilton  (who  had requested us to operate by the
electrolytic method) and his private class.   The patient
having been etherized,  we introduced deeply  into the
upper portion of  the breast three gilded needles, and
with a fourth transfixed the largest of the axillary nod- 
32
ules.  The positive pole  (a large moist sponge) was
applied  to the under  portion of the gland.   No  very
decided change was manifest in the appearance of the
mass during the  operation other than some puffing up
of the skin, due to the disengaged hydrogen;  but very
soon after it began to  decrease in size, and in one week
not only had all the hardness of the surrounding tissue
and all the axillary enlargements  entirely disappeared,
but the mammary tumor had decreased in size at  least
one-half.  The most grateful relief the patient experi-
enced, however, was the complete  and seemingly per-
manent dissipation of pain.  In  ten days we  again
operated,  and by the same method, in the amphitheatre
and before Dr. Hamilton and the regular class of the
College.   On the following day the patient felt so com-
fortable that she left the  hospital, and in a week's  time
presented herself for  examination, when it was found
that there had been a still further decrease in  the  size
of the tumor.   She still remained  entirely free  from
pain,  and  was delighted with the results of treatment.
Most unfortunately, we  now lost sight of the  patient.
She never returned, and thus  an opportunity of wit-
nessing the final results in this case of scirrhus, in which
the immediate effects of electrolysis was so remarkable ,
was forever lost.
  The probabilities are  that the patient was satisfied
with the result of treatment, and did not feel it neces-
sary to continue it. 
33
  Scirrhus of two years'  standing involving the whole
right  breast.—Pain relieved by external  treatment,  but
electrolyzation with a strong current does not  appreciably
affect the growth.

  Case XVIII.—Mrs. D----, a  lady of middle age,
observed, during the winter of 1869, a very slight en-
largement on the right breast.
  Its  growth was  exceedingly slow until June of the
following year, when it rapidly increased in size, and in
two months it had involved the whole breast.
  She first consulted,  in  this city, Dr. Wm. H. Van
Buren, who pronounced it a case of scirrhus and  re-
ferred her to us  for electrolytic treatment.
  We found the tumor  to be remarkably hard, involv-
ing two of the axillary glands.
  The patient had for months suffered very great pain,
while the arm of the affected side was so  lame that it
was impossible to  lift it more than a little way from
the side.  External applications relieved the pain very
decidedly,  and  improved  the condition of  the arm so
that she was able to use it quite readily.
  On Dec. 4th, 1871, in the presence of Drs. Nott  and
Metcalfe, we etherized the patient and operated by in-
troducing into  the  upper portion of the  tumor  four
three-cornered needles, insulated to within one inch o
the points.  The current was from 36 zinc-carbon cells,
and in tension sufficient  to deflect the needle  of our
galvanometer some fifty degrees.   The needles remained
       9* 
34
 n position  twenty minutes; and although the current
was constantly  passing, the effect  on the substance
of the growth where the needles pierced was barely
appreciable, while the skin, covered by the large sponge
of the positive pole, was well-nigh blistered.
  The needles utterly failed, and we were forced to
content ourselves with  the  relief afforded  by external
applications, not  attempting the undermining or de-
structive process.

  Scirrhus  of the  breast, in a  married lady, of four
months' standing ; very severe pain;  very great relief of
pain  by  external galvanization and   electrolyzation by
working up the base.—Death from exhaustion.
  Case XIX.—Margaret D----, aged 35, was referred
to us, October 10,1871, by Drs. Skene and Corey, of the
Female Department of  Long Island  College Hospital.
She was affected with a tumor of the left  breast, that
was manifestly scirrhus.  The entire  mamma was hard,
quite firm, and presented, in spots, a  reddish and angry
appearance.  It  was four months since the attention
of the  patient had been called to  the growth, and
probably much longer than  that since its first  appear-
ance.   For  several  weeks the  pain  had been  terrible
and almost constant, and it was this fact more than any
apprehension of  the nature of the malady  that had
brought her to the hospital.
  The  face of  the patient was  considerably cachectic,
and her condition in general was one of debility. 
35
  We at once began treatment by localized faradization
(external).  The  applications  were  made with  wet
sponges, and the seances continued about ten minutes.
After the second application the pain diminished, and
after further treatments ceased almost entirely.
  This relief continued for six weeks or more, vary-
ing slightly at intervals.  External galvanization, local-
ized in  the same manner, was next  resorted to, with
apparently even greater effect than the faradization.
  The tumor, however, did not perceptibly diminish in
size, and therefore we  begun to try electrolysis, at first
with an insulated  needle, connected with the negative
pole, the positive  being applied  by  a sponge  on the
surface  of the  tumor.   The  comparatively slight  pain
caused by the operation was borne without an anaes-
thetic.  We may here remark, that  the  pain of intro-
ducing a  needle is sometimes greater than that of the
subsequent action  of the current on the deeper tissues,
and for that reason we have sometimes used local anaes-
thesia by ether spray,  and,  what is  more convenient
still, carbolic acid.  A mixture, first suggested to us by
our assistant, Dr. J. H. Sterling, composed of carbolic
acid one part and sulphuric ether two parts, applied  to
the skin, will cause a circumscribed anaesthesia lasting
for perhaps about ten minutes.  By this extremely simple
method anaesthesia may be restricted by a space one-
eighth of an inch in diameter.  As the skin offers the
chief resistance to the introduction of the needle, and
is more abundantly supplied with nerves than the deeper 
36
tissues, it is easy to understand that by this local  and
superficial anaesthesia the pain, and what is  oftentimes
worse, the dread of the  introduction of needle, can be
reduced to  a minimum.  The only effect of the electro-
lyzation several times repeated was to cause a sloughing
near the  spot where the  needle  was  inserted.   The
patient remained mostly free  from pain, but the body
of the growth refused to diminish.
  Just before the  needle was used, the patient  was
brought before the Kings Co. Medical Society,  and
there examined by  a large number of physicians  and
surgeons; the opinion was  unanimous that the  case
was  one of scirrhus.
  By request of Dr.  Geo. K. Smith,  of St. Peter's
Hospital, where the  patient was  staying, we now re-
solved to  try more thorough treatment, and on  No-
vember  14, 1871, the patient was fully anaesthetized by
Dr. Corey, and  three negative and three positive nee-
dles  were  inserted around the base of the upper  part
of the growth,  in  such a way  as to surround  that
portion of the tumor and  separate it from the healthy
tissue.
  This was the  first time that we employed this method
which we subsequenly  denominated—working up the
base.
  Drs. Armor,  Skene, Bunker, and other  physicians
and  surgeons were present.  The operation  lasted  half
an hour.   It was followed by some irritative fever and
by a sloughing of the parts; the patient rallied, how- 
37
 ever, to such an extent that she was able to leave the
 Hospital of St. Peter's, where she had been confined
 and to walk to her home.
   November 27, hemorrhage appeared from some ar-
 tery, and the patient lost a number of ounces of blood.
 She suffered, however, but little pain, and continued
 her housework.   Subsequently, we  operated  by the;
 same  method in the Hospital of  St. Peter's.  Drs.
 Spier, Ormiston, Hutton, and others were present, and
 assisted in the etherization.  The usual sloughing fol-
 lowed,  until the entire  body of the growth was re-
 moved; completely  detached from  the  surrounding
 part.   The  base  of the  part first operated on  had
 healed  up almost entirely.
   The patient went to her home in the city.  She  suf-
 fered little  or no  pain,  but was manifestly growing
 feeble,  and, April 22, she died of exhaustion.  Up to
 the day of her death she suffered very little pain.
   The  interesting  features in the above  case—which
 may be regarded as one of the worst manifestations of
 scirrhus of the breast—are, that it was so quickly re-
 lieved of pain by electricity, however administered, and
 that this relief was so permanent; that the size of the
 tumor did not diminish under the treatment; that the
 working up of the  base was followed  by  a very satis-
factory  healing; that this method was, however, adopt-
 ed  too  late  to prevent the  constitutional  infection
and finally, that the patient, even in her debility, bore
without the  trace of  a shock severe  and protracted
operations. 
38
  In their relations to electro-therapeutics there would
appear to be two general varieties of tumors  of the
breast; one variety  in  which  all or nearly  all  the
mamma is involved and is very hard, firm and unyield-
ing, the skin being tense, glossy, and indicating inflam-
mation and induration.   The  case above  described
would come under that head.   The variety is more
obstinate and unyielding; the pain may be relieved, as
in the case above cited, but the tumors do  not grow
smaller under the action of the current; they  can be
diminished in size or removed only by actual destruc-
tion of the  tissue.
  In the other variety the tumor involves but a limited
portion  of the breast;   the skin is  not  tense, but is
soft and yielding, and of  the natural  color; the growth
is felt as a nodule beneath the skin, and the pain is
not usually so severe as  in  the  other variety, and the
growth is much slower.   This variety is the one that is
most  disposed to  yield  to electrical  treatment.    Not
only is the pain relieved, but the  tumors grow softer
and smaller, and in some instances permanently disap-
pear.   In other cases their advance is arrested by the
treatment,  so that they remain stationary for months
or years.
  Whether  what  we call,  for  convenience sake, and
for clinical reasons, only two  varieties, are really but
different stages of  one variety; whether the latter may
sometimes come under the head of abscess, or of the
atrophying cancer described by Billroth, these ques-
tions we resign to the pathologists of the future. 
39
   Epithelial cancer in a lady aged 30, involving the rec-
 tum,  vagina,  and external parts.    Eleven electrolytic
 operations remove the growths, alleviate pain, and modify
 very greatly the rapidity with which the disease subse-
 quently reappears.
   Case XX.—The wife of a physician, aged about 30,
 had  for eight years of her married  life suffered from
 what was supposed to be scirrhus of the rectum,  which
 had been removed by ligatures at  different times  and
 by different surgeons.
   About three years before we saw  her, an epithelial
 cancer appeared at the entrance of  the vagina; this
 gradually increased in size and protruded, until by Oct.
 1871, it appeared to be about one-half as large as a cauli-
 flower, and much resembled one in  appearance.  The
 discharge was  very  profuse  and very offensive;  the
 pain  terrible and almost constant.   The growth was
 evidently increasing, and only with difficulty could the
 patient walk about the  house.
   A more distressing case of disease of any kind we
 had never seen.  After each  removal of the mass by
 the ligature, it would spring up almost before the sight
 and become larger than before.  There was about it a
 rankness,  a  fierceness, a  malignity,  quite unusual.
 Like rampant weeds in rich soil, the  more  it was  cut
 off, the faster it grew.   Escharotics of all kinds, as well
 as condurango,  had been tried, the latter remedy seem-
ing to do injury.
  The galvano-cautery had been suggested  by Dr. E. 
40
R. Peaslee, whom the patient consulted, and Dr. Byrne
had intended to give it a trial, but  deferred the opera-
tion in order to experiment with condurango.   Wre be-
gan treatment with external galvanization in order to
relieve the pain.   The first treatment acomplished noth-
ing; the third treatment, we connected an  insulated
rectal electrode with one  pole, while the positive, by
means of a wet cloth, was gently passed over the very
sensitive surface of the tumor.  The patient  was re-
lieved of pain for a whole night.   Satisfied with the
result, we now resolved to use the needles.
   With the assistance of Dr. Rotton  and the husband
of the patient we operated eleven times, with intervals
of two or three weeks between the seances.  Full etheri-
zation has been obtained in each operation.
   We used  two,  three, or four  needles, according to
circumstances, and both poles were  inserted into the
base of the growth.
   The first operation, Oct. 20,  which lasted  twenty-
five minutes, removed one-third  of the growth; and by
the end of the third operation, all the growth  external
to the orifice of the vagina was removed.
   Far up  in  the  vagina, the diseased portion could
readily be detected, spreading out  in all directions like
a watermelon vine.
   Nov. 15th, there were some evidences of a reappear-
ance of the external growth in those parts that were not
thoroughly electrized.  Nov. 22d, operated  again by
electrolysis for half an hour. 
41
  Dec. 5th, operated again by electrolysis in connection
with Dr. Byrne, who by the aid of his speculum applied
the galvano-cautery to the portions of the growth in
the vagina.   Jan. 17th, again operated by the same
method for 30 minutes.   The external ulcer caused by
the removal of the tumor had hitherto been about four
inches long, three inches wide, and one inch in depth,
extending from the middle of the labia beyond the anus
on the right side.
  This  ulcer  now  began to heal  at the edges  and
to contract.  Jan. 6th,  began the use  of  nitrate of
silver, applied  to the ulcer.   Jan. 8th, the discharge
which had come from  the vagina was much  dimin-
ished and the ulcer had contracted to half the original
size.  Jan. 21st,  operated by electrolysis in the vagina
chiefly.
  March 24th, repeated the operations with long nee-
dles, in the  vagina, on some ragged portions  of  the
growth.  We were  now able to ascertain by digital
examination that  there was a pretty  direct connection
between the growth in the rectum and the one in  the
vagina;  they seemed indeed to be  extensions from  a
common centre.
  The septum at the base of the tumor  in the vagina
was so thin that we much feared a recto-vaginal fistula,
and great care was necessary in operating, to preserve
this delicate and partially disorganized tissue that sepa-
rated the two canals.   April 21, again operated by
electrolysis. 
42
  Subsequently the actual cautery was once used, in
the hope that perhaps it might cause a more thorough
drying up of the profusely discharging surface  in the
vagina; but the results of its use were  unsatisfactory.
The febrile condition that followed was alarming, and
the local pain  was terrific for several days after the
operation.   During the summer, local applications  of
various  kinds  have been experimented with;  among
others, a mixture of iodine, iodide of potassium, and
glycerine, which was employed at the suggestion of Dr.
Byrne, and with good effect.
  During the year the patient  had taken cod-liver oil,
and  except by  intervals has  had a  good  appetite.
Twice a severe  and protracted attack of sciatica has
been brought on, apparently by exposure to cold.
  At one time the patient was confined to her bed, and
was somewhat hysterical.   During  the summer the
external part of the growth gradually reappeared, but
there was no difficulty in urination or defecation; and
hence we conclude that the portion in the rectum has
not greatly enlarged, and at the last examination the
condition  of  the vagina  was not seriously  altered.
We have all along feared  that  the disease would ex-
tend to  the uterus,  but examinations  made  at dif-
ferent times gave no evidence of involvement of that
organ.
  The operations were performed with a zinc-carbon
battery  of 18 cells, freshly charged.
  The constringing power of the current was observed 
43
at both  poles, but  most  decidedly  at  the positive.
After each operation the surface presented a dark  and
somewhat charred appearance, as though it had been
slightly burned.  No large artery was severed during the
operations, hence it was not necessary to use either the
ligature or persulphate of iron.  During the past winter
(1873) Dr. Byrne has twice operated on the external
portion of the growth with the galvano-cautery.   The
result has been a most satisfactory healing of the exter-
nal ulcer that has been much more permanent than the
healings  that followed electrolysis.
   We have given the above case in considerable detail,
because of its great interest to surgeons,  and especially
because  it illustrates most vividly  at once the value
and the limitations of electrolysis in malignant tumors.
It illustrates:—
   1. The power of electrolysis to control hemorrhage.
The growth was so vascular that it bled quite profusely
on the slightest  touch, and yet, under the various  and
protracted electrolytic treatments to which it was  sub-
jected, the amount of blood lost was but  a trifle.
   2. The fact that the electrolytic treatment does not
cause shock,  to the extent  that similar destruction of
tissue by other methods would be hkely to do.   Twice,
when chloroform was employed as  an anaesthetic, the
pulse  acted badly and  compelled  us to suspend the
operation sooner than we desired; but under etheriza-
tion the needles  were used for half an hour  and longer
without causing any shock.  The stimulus of the  cur- 
44
rent, with the occasional interruptions that are requir-
ed, seemed, by reflex influence on the central nervous
system, to act as an antidote to shock, as it has ap-
peared to do in other cases.
  3.  Better  healing,  and later  reappearance of  the
growth than after the operation  by ligature  and caus-
tics.   When removed by ligature this growth  sprang
up with  great rapidity—in the course of a few days;
even before the eyes, as it were, it seemed to enlarge,
and  to develop  an offensive discharge; and the base
never began to heal, even on the  edges.  After thor-
ough electrization of the base, this growth not only did
not show signs of recurrence for several weeks, but an
external ulcer of large size entirely healed.   With the
internal ulcer  on the feebly organized mucous tissues o
the vagina we were not so successful.
  4. The severe irritative fever that sometimes  follows
electrolysis.   After all the operations, the patient was
confined to her bed for several days, and was more or less
distressed by inflammation and swelling,  not only on the
edges of the ulcer, but at some distance  down the nates
and through the labia.   The swelling of  the labia was so
great that difficulty and pain were experienced in pass-
ing water.   It should be noted, however, that after the
operations with the  galvanic cautery  and  the actual
cautery, the irritative fever and surrounding inflamma-
tion were much  more decided and  distressing, and  for
that reason we returned to electrolysis.
   5. The utter inability of even  the most thorough and 
45
 repeated electrolyzations of the base, to permanently
 eradicate the  growth  in those parts  where it was
 connected with the mucous  membrane.  Although the
 base was  thoroughly worked  up  by  inserting  the
 needles  into  the  healthy  tissue  surrounding it so
 as to completely cut off  all communication between
 the natural and morbid parts, yet the disease  extended
 from the vagina—to all  appearances travelled bodily,
 according to Morgan's theory of cancer—until quite
 distant parts  were  attacked and  became saturated
 with cancerous degeneration.  The  external portion of
 the growth connected with the perinaeum and  nates
 was apparently eradicated as thoroughly and as success-
 fully as the cases of epithelioma of the lip, previous-
 ly reported, and the subsequent reappearance of the
 growth was due to the extension of the disease from
 the vagina.
   6. The comparative value of electrolysis and galvano-
 cautery.  The healing after electrolysis was incompara-
 bly more satisfactory than after the ligation ; but in
 the course of months the growth returned,  apparently
 by extension from the vagina.  Since the last operations
 by galvano-cautery there has been as yet no recurrence.
 The irritative fever that followed the electrolytic opera-
 tions was not  observed to  any  very  marked degree
 after the use of the galvano-cautery.
   Take the  case all in all, its long standing and  wide
extent,  its  excessively rapid growth and still  more
rapid reappearance  after  operation  by  ligature, the 
46
 requent repetition of long electrolyzations and  the
temporary benefit  resulting  therefrom, and the oppor-
tunity it afforded for comparing the advantages of elec-
trolysis  and galvano-cautery,  it may probably be re-
garded as without  a precedent in electro-surgery. 
47
                    CHAPTER II.

            CERTAIN DISEASES OP THE SKIN.

   The theoretical  arguments in favor of using  elec-
 tricity in diseases of the skin, and the methods to be
 employed, with the general results, we have elsewhere
 considered.*   Our present purpose is to illustrate by
 cases  what we have previously stated in an  abstract
 form.  We present the cases just as they appear in our
 note-book—the successful, the unsuccessful,  and the
 doubtful.
   We may,  perhaps, so  far repeat  what we  have
 previously  written on  the subject,  as to  state that
 in the electrical  treatment of diseases of the  skin
 both currents  are  required in the various forms of
 electrization, with  wet sponges and   cloths, with  dry
 metals and the metallic brush.   The best results are
 obtained by the galvanic current, and for reasons that
 will be clear, without  argument, to  those who  are
 familiar with  the  differential action of the two  cur-
 rents.
  During the past two years we have treated a number of
 cases of eczema, prurigo, and acne by central galvani-
zation  alone,  without  making any application to the
 diseased surface whatever;  and under this method  of
  * American Journal of Syphilography and Dermatology, January,
1872;  also Medical and Surgical Electricity,  pp. 600, 601. 
48
 treatment, the results have in  some  instances  been
 more satisfactory than  under any other  method  of
 using electricity in these affections.
   In central galvanization the negative pole is  applied
 to the epigastrium (the patient holding it by an  insu-
 lated electrode), while the positive is applied at the top of
 the head, over the region of the pneumogastric and the
 cervical sympathetic,  in  the neck,  and down the entire
 length of the spine, in such a way as to bring the brain,
 the pneumogastric, the spinal cord, and all the prominent
 ganglia andplexuses of the sympathetic—indeed the whole
 central  nervous system—under  the influence of the cur-
 rent*
   Not only after medication has failed, but after or-
 dinary localized electrization has accomplished but lit-
 tle, central galvanization is  sometimes  rapidly  and
 quite permanently efficacious.  We should judge from
 our observations up to the present time that under this
 treatment the more peripheral patches of cutaneous
 disease yielded  earlier than those on the trunk  and
near the centre}  for example, eczematous spots on the
hands and feet would sooner show signs of improve-
ment than spots of the same disease on the upper arm,
leg, and back.  The dependence  of certain diseases of
the skin—as eczema, acne, prurigo—on  the nervous
system is by the remarkable results of this method of
treatment demonstrated in a most interesting and  sug-
gestive manner.
 * This method is described in full detail  in the New York Medical
Journal, October, 1872. 
49
  We first used central galvanization in hysteria, hypo-
chondriasis, insanity, and other allied nervous affec-
tions, and the excellent results accomplished by it sug-
gested its use in cutaneous affections.
                      Eczema.
  It is an interesting comment on the value of theory
in medicine that in eczema, which has not been suppos-
ed to be a nervous disease, the effects of central galva-
nization, according to our present  experience, are as
decided  as  in prurigo, and the results here recorded
are more satisfactory than in almost  any  other form of
cutaneous disorder.
  At first we used  localized galvanization in eczema,
with sponges, cloths, and the metallic brush, and  ob-
tained thereby great relief of the itching, and in time
cure; but during the past year we  have used central
galvanization for this disease, making no application
whatever to the  diseased surface, and have obtained
far more rapid and we believe more  permanent results.
The following case illustrates  the  power  of central
galvanization in a most striking manner :—

Severe and obstinate chronic eczema of leg, eight years'1
  standing; intolerable  itching ; failure of various
  remedies ; rapid relief and  permanent  cure under
  central galvanization.
  Case I.—Mrs.  S. M----, an Irish  servant-girl, aged
51, was admitted to the Long Island College Hospital,
February 14, 1872,  with chronic eczema  of the  left
       3 
50
 leg about the ankle, and extending one-third of the
 distance to the knee.  The itching and pain were in-
 tolerable, and there was  much soreness.  The patient
 was in other respects strong and well, but had suffered
 from this affection by intervals for eight years.  Four
 years before she had been under treatment at the City
 Hospital, and  had been discharged apparently cured,
 but relapsed.
   The case was treated by iodoform, arsenic, bicarbo-
 nate of soda,  rhubarb, carbolate  of zinc, glycerine,
 cod-liver oil, iodide of potassium,  delcamara, acetate
 of lead, wine of  colchicum, and acetate  of potash.
 These remedies were variously used, in various modi-
 fications,  externally and internally.   From some  of
 these agents the  patient derived temporary relief of
 the itching and soreness'; but the average and ultimate
 effect was, that on April 1st the following record of the
 case was made in the hospital book:   ''Very painful,
 red and augry, rapidly extending, and now covering
 nearly the whole leg below the knee, and most of the
 dorsal aspect of the foot."
   Arsenic, and tincture of  cinchon.  comp. were  now
 ordered, but April 15th,  the record was : " Very much
 the same." At this time, Dr. Davis suggested localized
faradization. This suggestion was acted on with grati-
 fying  result; the  intense distress  was  at  once in  a
 measure relieved.
   April 16th, the  patient was more comfortable  than
 for a long time previous. 
51
   April 23d, very much improved and comparatively
 comfortable.
   At  this time Prof. A.  B.  Crosby,  the surgeon in
 charge of the ward, requested  us to see the patient,
 stating that she had been very  obstinate under the
 various remedies that he had  tried.  The  patient was
 suffering greatly from the severe itching and burning,
 and the soreness was so great that only with difficulty
 could she hobble about the ward.  The appearance of
 the diseased part was red and angry, and some por-
 tions were more or less covered by scales.
   We decided to try on the patient the effect of central
 galvanization, making no  application  whatever  to the
 diseased part.  We were induced to make this trial on
 the strength of  successes in other and milder cases of
 cutaneous diseases.  Our chief hope was, perhaps, to
 relieve the itching and pain; a permanent cure we had
 no reason to anticipate.   As the patient was a good and
 willing  subject on  which to  demonstrate electrical
 applications, she was taken before the class  of the
 Long Island College Hospital, and treated by central
 galvanization, the statement being made, that we did
 not hope thereby to cure, but  simply to illustrate the
 method of using electricity.
  The details of the applications were entrusted entirely
to Dr. Edwin E.  Smith, house-surgeon, who carried out
the treatment with great faithfulness, and to whom we
are indebted for the full history  of the case as here
presented. 
52
   The relief  of the itching and pain was very rapid,
 although on the  25th Dr. Smith made the following
 record:  "A  little more irritable."   This  result was
 probably due to over-treatment, too strong currents, or
 too prolonged applications.
   April 30th.—Patient " much better."
   May 10th.—"Still  steadily improving."   The  ap-
 pearance of  the leg was now much changed for the
 better.  The  most obstinate portion was the region
 about  the  ankle.  The applications were made four
 and  five  times a week with a 12-cell  zinc-carbon bat-
 tery  of Kidder for about ten minutes at a seance.
   May 25th.—A lotion of acetate  of  lead wash was
 ordered by Dr. Crosby, to contract the enlarged capil-
laries.
   June 5th.—" Patient is walking about out-doors with
comparative ease, and is nearly well."
   We again presented the case before the class of  the
 College,  demonstrated on her our method of central
galvanization, and pointed out the  extraordinary and
unlooked-for improvement.  The skin of  the whole
leg, except around the ankle, was well, and the patient
for a long time had  been entirely free from itching
 and pain.
   June 15th.—The patient was " discharged cured."
   Jan. 13th,  1873.—Dr.  Smith informs us that  there
has been  "no recurrence of the difficulty."
   The  above  case, taking all the facts  into considera-
tion—its  long standing, its inveteracy  under manifold 
53
  treatment, and  the  immediate and rapid relief and
  cure under central galvanization, is certainly most ex-
  traordinary, and it will not subtract from the instruc-
  tiveness and brilliancy of the result, if in future years
  a fresh attack of the disease should occur.   Although
  the case was not, so far as we know, studied by any re-
  cognized  specialist in dermatology,  yet  among the
  very many surgeons and physicians who watched its
  progress before and during the  electrical treatment,
  there was, we believe, no  difference of opinion in
  regard  to the diagnosis, and there was no  question
  that the cure was wrought entirely by central galvani-
  zation, acting upon the central nervous system, and thus
  improving the peripheral nutrition.

  Eczema of head and face and lower limbs in a child;
   rapid improvement, with disappearance of the erup-
   tion under central galvanization.
   Case H—John B----, aged 3 months, was admitted
 to the Electro-Therapeutical Department of Demilt Dis-
 pensary, March 8, 1872.  The child was affected with
 eczema of the scalp and face, which was most marked
 between the eyes, and  extended down the  back, and
 on the legs from the knees to the feet.
  The eruption was very moist, and the diseased part
 was  covered with thick yellow scabs.   The child was
very restless at night; was very constipated, and could
scarcely open its eyes.   The case had been treated by
various poultices and ointments.   At  that  time  we 
54
were experimenting with central galvanization in dis-
eases of the skin, and we  resolved to test the method
in this case.  After the third  application the  bowels
became more free, the child slept well, and the eruption
had dried up, and the scabs peeled off.  At the end of
two weeks the fourth and last application was given ;
the disease had then nearly disappeared from the back
and legs.   Since  that  time we have seen nothing of
the patient.
  It is proper to remark of the last case that, because
of the situation  of  the disease, it  was impossible to
use central  galvanization without directly  acting  on
some  portion of the diseased surface.  It is possible,
therefore, that the benefit was due in part to the local
action of the current,  and yet we were not able to
trace  any more rapid  improvement in  those portions
thus slightly acted on than in the portions not touched
by the electrodes.
  The effect of merely localized applications is illus-
trated by the following case:—

Chronic eczema of the legs and feet, one year's standing ;
  relief of pain and itching under localized faradization
  and galvanization.
  Case IH.—Michael P----, aged 64, had suffered for
twelve months from chronic  eczema of the legs and
feet, accompanied with terrible  itching and  burning
sensations.  The  affected parts were but little sensi-
tive to the electric current, either galvanic or faradic. 
55
Localized galvanization and faradization  were em-
ployed, and some of the time the electric brush with
a strong current was not only well borne, but was most
grateful to the  patient.  The applications were made
from five to twenty minutes.  In all  cases there was
relief of the  distressing pain.   Symptoms of relief be-
gan  to appear soon after the beginning of the seance,
and  at the close was sometimes absolute.  This relief
lasted at first from two to twelve  hours.
  The patient  continued treatment for three weeks—
in all six applications were made.   The intervals of
relief were sensibly lengthened, and the patient aban-
doned treatment.  With the  relief in the itching and
pain there was  corresponding relief in the appearance
of the diseased parts.

Eczema of arm and hands; relief of  pain and itching
  under localized galvanization.
  Case IV.—Mary C----, aged46, had been afflicted for
some time with eczema of the forearm and hands.  In
the palm and back of the hand there was considerable
disease,  and the pain  was  very intense.   She com-
plained of severe itching  and scalding. The general
condition of the  patient was very good.   The hands
were  considerably  swollen,  and patches of various
sizes appeared on the fingers.
  Localized galvanization was used, with good results.
There was relief of the pain  ; corresponding with the
relief of the pain there was  improvement  in the ap-
pearance of the disease. 
56
  The patient abandoned treatment before an exhaust-
ive trial had been made.
  The advantage of central  galvanization over merely
localized applications was shown in the following:—

Chronic eczema of twenty years'1 standing ; localized gal-
  vanization and improvement;  subsequent relapse, and
  more rapid and satisfactory improvement under cen-
  tral galvanization.
  Case V.—John P----, aged 52, had for twenty years
suffered  from chronic eczema, that attacked by turns
different parts of the body.  For four years he had, by
intervals, been  attending the Skin Department of the
Demilt Dispensary,  under the treatment of Dr. Wood-
ruff, who had  given  him various remedies, relying
chiefly on arsenic.   Under the  arsenic  treatment the
improvement was quite decided, but beyond a certain
point he  could not be carried.
  When brought into the Electro-Therapeutical De-
partment of the Dispensary, there was a small patch of
eczema on the back of the left hand, and a little of the
disease on  the right foot.  The history of the disease
had been, that it spread  over the  hand from this one
centre.
  Treatment by localized galvanization was used for
a month, with positive evidences of benefit.
  The disease subsequently recurred,  and the patient
again desired treatment.   At that time  we were using
central galvanization, and we resolved to test it in his 
57
case, making no electrical or other applications to the
diseased surface.   Under  this method of electrization
the relief was apparently more satisfactory than under
merely localized applications.  It is  more than prob-
able that the patient will again suffer relapse ; but, up
to the date of writing, we have heard no more of  him.

Chronic eczema  of the right foot, of ten years'1 standing ;
  rapid and complete relief from localized galvanization.
  Case VI.—Thomas D----, aged 28, came into the
Electro-Therapeutical Department of  the  Dispensary,
Sept. 19,1871.  For ten years chronic eczema of the right
foot and ankle had afflicted him, and for two weeks
the distress had been so great that he had been obliged
to give up his occupation,  which was that of waiter.
The  relief  from  pain, on galvanization with  wet
sponges, was immediate, and continued for some time
after the seance was concluded.  Some of  the time,
dry  metallic electrodes were  used, and  always  with
rapid relief to the distressing sensation of heat, by which
the disease  was marked.   The electric  brush was  used
at times, and even with a strong current was grateful
to the patient.  The patient  apparently recovered in
the course of  a month's treatment, and we then  lost
sight of him.
  In the above, as in some other cases of  painful  dis-
eases of the skin,  strong  currents were not only well
borne on  the diseased  surface, but were  exceedingly
grateful.
       3* 
58
                       Acne.
  Our  first experiments in the electrical treatment of
acne were failures.  These failures were due partly to
the neglect of the patients to persevere, and partly to
our not using central treatment.  Under the combined
influence of central and peripheral treatment, or under
central  alone, or peripheral alone, something may be
accomplished in this  affection,  although great perse-
verance is necessary, and it is not impossible that cases
which are relieved, or apparently cured, may relapse.
  Our observations in this department are as follows:—
Acne rosacea of long standing ;  immediate improvement
            under localized galvanization.
  Case VII.—A medical gentleman, aged about 60, in
April, 1872, requested us to treat him for acne rosacea
that  had  for some time caused him annoyance.  The
blood-vessels were considerably enlarged on both sides
of the nose,  the color was  a decided red, and there
was the usual thickening.  The health of the patient
was in other respects pretty good, excepting attacks of
indigestion with acidity.
  We began treatment with localized galvanization—
with wet cloths and  sponge,  sometimes using pure
metal with a sharp edge.  When the metal was used,
the dilated  capillaries were  electrolyzed under the
negative pole, and gases escaped with a  sound that
could be  easily heard.  There  was a tendency to re-
appearance of the dilated vessels, but after a few weeks1 
59
  treatment they were entirely destroyed, leaving no scar
  or trace, and  the color of the nose on both sides had
  disappeared.  There appeared to be also a diminution
  of the hypertrophied tissues.
   There has been, since that time,  some return of the
  affection, but  he is very much better than formerly.
  The habits of  the  patient were never intemperate, but
  he had always been accustomed to use more or less
  alcoholic liquors.
   A French physician has reported excellent results in
 the treatment of acne rosacea by electricity.
   The following is one of the earliest cases of disease
 of the skin that ever came under our observation :—
   Case VEIL—Mrs. ---- was referred to  us  in 1867,
 for treatment  for acne of very long  standing.  The
 limbs aud face were affected by the disease.   An im-
 mense variety  of treatment had been  employed, and
 the patient had consulted very many American and Eu-
 ropean authorities—among others, Hebra, of Vienna—
 and she was nothing better.
   At that time we had not used central galvanization,
 and had had no experience in the treatment of  diseases
 of the  skin by any method of electrization.
  As a matter of experiment,  we used general faradiza-
tion, but the patient did  not continue the treatment
long enough to determine just how much benefit  was
obtained thereby.
  It is by no means impossible that general faradiza-
tion, by improving the digestion and relieving the con- 
GO
 stipation, might be of great service in acne, either alone
 or in connection with central galvanization.
   In the above  case all the symptoms were aggravated
 at the monthly period ; it is not unlikely that general
 faradization or localized faradization of  the  patient,
 internal or external, might have been of service in re-
 lieving the dysmenorrhcea as well as the digestive dis-
 turbance, and this  might have relieved the acne.

 Acne of several years' standing treated by central gal-
           vanization and dry faradization.
   Case IX—In May, 1872, a  young man  of  26 was
 brought to us by Dr. Carpenter, complaining  of acne
 of the back especially, that for several years had been
 his companion.  The back was well covered with the
 eruption.  The digestion was not right, and the bowels
 were constipated.
   Central galvanization was at once used three times a
 week,  which a part of the time was varied  by dry
 faradization with the hand and  metallic electrodes—
 a method  Dr. Piffard had suggested to us as efficacious
 in acne,   There was very soon improvement: the large
spots began to dry up, but the patient went away after
 eight applications.
  During the presentsummer(1873)we have been treat-
ing a  case of acne indurata of the  face—a  patient
of  Dr.  Thayer—with   the   negative  pole  of the
galvanic current connected with metallic disks and
points, and electrodes armed with many sharp points, 
61
 alternating with central galvanization.  This case has
 improved slowly but  decidedly,  and is still  under
 treatment.
   Our  assistant, Dr. J.  H. Sterling, informs us that
 one year ago a  case of hereditary acne indurata  of
 the face and back under his care was treated by eigh-
 teen applications of  central galvanization without any
 other treatment, and the disease disappeared.  The con-
 stipation and headache, which had been very distress-
 ing, were also relieved.  Up to date (July 1873) the
 patient was well.
                      Prurigo.
   In prurigo it would be  consistent to expect benefit
 from electrical treatment.   Experience shows that this
 expectation is well  grounded.  All methods of using
 electricity seem to do good in prurigo.  Relief  of the
 itching is obtained by dry faradization and galvaniza-
 tion with wet sponges and cloths, but the most perma-
 nent results seem to come  from central galvanization.
 General prurigo, six years' standing; intense itching ;
   approximate cure after fifteen seances of central gal-
   vanization.
   Case XI.—W. R----, 9  years of age, came into the
Electro-Therapeutical  Department  of  Demilt  Dis-
pensary, April  11, 1872.    At  the age of three the
patient had scarlet fever; this was followed by general
prurigo that had  never been relieved.   The disease
covered  the back/ abdomen,  and  legs.  The itching
was most severe.  Sleep at  night had for years been in- 
62
 terrupted by this distress, and  marks  of scratching
 were everywhere seen.  The disease was at its worst on
 the back.
   Acting on the theory that the disease was of a ner-
 vous character,  Dr. Woodruff referred the case to the
 Electro-Therapeutical Department, when treatment by
 central galvanization was begun and continued for two
 months.  Towards the close  of the treatment, June 1,
 little remains of the eruption were seen  excepting  on
 the back, and there was very little itching.
   June 15.—The patient abandoned treatment; the re-
 covery appeared to be satisfactory. We have no further
 intelligence of the case.
   Dr. Sterling gives us the following case, the diag-
 nosis of which was not fully clear to him :—

 Lichen cegrius of long standing ;  some improvement un-
   der localized galvanization, and galvanization of the
   cervical sympathetic; much greater improvement un-
   der central galvanization.
   Case X.—Mr. G----, at the age of twelve, was at-
 tacked with an eruption  all over the body,  after sea-
 bathing.  Treatment cured the eruption, but a burning,
 smarting sensation was left in the fore-eye, that always
 was increased on any excitement.  Drinking  a cup  of
tea or coffee, or entering a heated room, would bring on
burning and smarting in the face, with very  decided
puffiness.   Arsenic and  various  other remedies  had
 been used faithfully.
   May 1, 1871.—Treatment by galvanization of the 
63
 sympathetic and localized galvanization was begun,
 and the result was  satisfactory; but relapse occurred,
 and some months subsequently he was treated by cen-
 tral galvanization alone, with very great improvement.
 He  still suffers  from slight relapses that are always
 benefited by electrical treatment.
               Psoriasis and pityriasis.
   These diseases have not, in our hands,  yielded to
 electrical treatment with great  rapidity.   They im-
 prove slowly,  however,  up to  a certain point,  and
 in some cases an  apparent cure, or something approxi-
 mate to a cure, may be  obtained by a long course of
 treatment.   Our  first experiments in the treatment of
 psoriasis by electricity were made with Dr. H. G.  Pif-
 ford at the Dispensary for Diseases of the Skin.
 General  pityriasis of four  years'1 standing;  slow but
  decided improvement  under  galvanization,  localized
  and central; relapse.
  Case XII.—Miss O----, aged 19, had for four years
been  a victim  of pityriasis,  that  attacked first the
scalp, causing profuse " dandruff," and  extending to
the trunk.  Treatment of various kinds,  external ap-
 plications and  internal  medication had  been used by
good surgeons,  and with great perseverance, for many
months.  The benefit had been slight and  transitory.
A short interval of disappearance of the patches of the
disease would be folio wed by a rapid reappearance, and
at no period had she been even approximately free
from the disease. 
64
  The patient was brought to us November, 1871, by
Dr. Freeman, who, at that time, had the patient under
observation.  The scalp was  then  pretty well covered
with  the  disease, and  behind the ears were large
patches.  Dandruff was  very abundant.   The health
of the patient was excellent.  Patches  of the disease
were also on the back, sides, breast, and abdomen.
  Treatment  by  localized   galvanization was com-
menced and continued for  three months by intervals.
The improvement was quite slow, but  after about
a month, some of the spots  on the  breast had entirely
disappeared.   The patches on the back  and sides were
most  obstinate, and although they changed  in their
character,  had not  entirely disappeared  when  the
patient left the city.
  The first evidence that the treatment was taking
hold  was  observed on the  head; for  several weeks
before the  close  of treatment,  the amount of " dan-
druff " had been reduced to a minimum.  The patches
of disease behind the ears yielded with  great slowness.
The patient relapsed  the next season, and was as bad
as ever.

Pityriasis  capitis  of many years'1  standing treated by
   galvanization without immediate effect, but subsequent
   improvement.
   Case XIII.—A physician had for many years been
annoyed by " dandruff,"  that was constant  and very
profuse. By  our request he took a  course  of gal-
vanization.  The hair was  thoroughly  moistened, and 
65
the applications  were  made over the head, as well
as over the neck and spine;  combining localized with
central galvanization.
  During the course of treatment, which lasted for sev-
eral weeks, there  was no apparent improvement; but
since the abandonment of the experiment the disease
has diminished.   It is not  improbable that here,  as
in  other diseases, the after effects  may be observed
even when the effects during treatment are negative.

Psoriasis of the arms and legs of thirty years'1 standing ;
    some improvement under localized faradization.
  Case XIV.—Mary P----, aged 63, had suffered
for thirty years from psoriasis that attacked the arms
and legs.   She was sent into the Electro-Therapeutical
Department of Demilt  Dispensary,  April 14th, 1871.
Treatment was commenced that day by localized gal-
vanization, by means of adjustable*  electrodes, cov-
ered with flannel.  Both poles were employed.
  This treatment was combined with central galvani-
zation.  The patient discontinued treatment  before
a fair trial had  been given; but some  improvement
was observed, even during the short time that she was
under observation.
                       Herpes.
  More than a century ago herpes zoster was treated by
  * Adjustable electrodes is a term that we have applied to flat metallic
electrodes of different sizes and shapes;  these are provided with
flannel or chamois covers. These covers are provided with elastic
borders, and may be put on and off at pleasure, and may be washed
like towels. 
66
Franklinic electricity, and, it is claimed, with success.
A spot of herpes circinatus disappeared  under  gal-
vanization, and up to date has not returned.
   In a case of herpes zoster associated with  neuralgia,
that we treated during the past year, the neuralgia was
rapidly and  permanently cured  by faradization; the
herpitic eruption  had nearly disappeared before elec-
tric treatment was begun.
   In another very ugly and obstinate case  of herpes
zoster of four weeks' standing there was a decided im-
provement in the  condition as soon  as  the galvanic
current was applied.   The most remarkable results of
the electrical treatment  of herpes have been obtained
in the variety known  as herpes  frontalis   sen  oph-
thalmicus.  This  disease, besides being very painful,
sometimes excites inflammation of the cornea, and de-
stroys  the eye.   In two cases that were treated at the
Brooklyn Eye and Ear Hospital by localized galvani-
zation, the relief of pain was immediate, and the cure
was rapid and permanent.  Both of these cases we saw,
and one we treated.  In both cases the eye was saved.

Elephantiasis of  the legs, over two years'1 standing, at-
   tended  with  ulceration and great  pain; relief of
  pain; removal  of the  elephantine skin  and very re-
   markable reduction in the size of one leg under local-
   ized galvanization.
   Case XV.—Mr. P---, an  Englishman of  middle
life, a man strong and vigorous beyond the  average, a
distiller of oils by occupation, returning from his daily 
67
 duties  on the  evening of February 22d, 1870, ob-
 served, on removing his socks, a small blister on the
 inner side of the left ankle.  The next day he  called
 on his  physician, Dr. Rotton, under whose care he re-
 mained for one year and more.
   The disease spread over the left foot and ankle, and
 in about two months the right foot was similarly at-
 tacked.   The blisters as they ruptured left inflamed
 and  angry surfaces in their  track.  The  disease in-
 volved the surface of the feet, and both legs up  to the
 knees.  The  treatment carried out  by Dr. R.  was
 mainly of a tonic and alterative character, with local
 applications of glycerine, carbolic acid, and lead wash.
 At one time Dr. Johnson saw the case, confirmed the
 diagnosis of elephantiasis,  and rendered a diagnosis
 positively unfavorable.
   We first saw the case by request of Dr. R. in May,
 1872.  At that time  the  right  leg below the knee
 measured twenty-five  inches in circumference, and it
 was covered all over with elephantine skin, excepting
 an ulcerating surface below  the ankle.  This ulcer was
 treated with charcoal poultice  and discharged freely.
 The  left leg was not greatly enlarged, but was red,
 angry, and inflamed, and kept up  an incessant dis-
 charge from the surface.
  The patient  suffered  horrible agonies, so  that at
night the neighbors  were  disturbed by his howling.
He was unable to move from the sofa on which he sat,
and where he  worked at his newly-learned trade of
cleaning gloves. 
68
  By our request Dr. E. Mann, one of our assistants,
undertook the experimental treatment of the  case by
electricity.   We had never known  of elephantiasis
being treated electrically, and  gave an unfavorable
prognosis, and were indeed inclined not to attempt it;
only by the earnest request of the patient and his phy-
sician we decided to try and see whether we might give
him some relief.   Localized faradization at first tried
by Dr. Mann accomplished nothing, and, so great was
the anaesthesia, was not felt by the patient.
  Localized  galvanization by means of wet sponges
and both poles with zinc-carbon battery of 16 cells was
appreciably felt,  and very  soon began to  relieve the
pain.
  The applications, from  10 to  30 minutes in length,
were made at first by Dr. Mann, and subsequently by
the daughter of the patient under our supervision.
  After two months' treatment the elephantine skin on
the left leg was removed,  the pain had ceased, and the
leg was reduced in circumference from twenty-Jive to
seventeen inches.    The  ulcerated  portion  below the
ankle was also nearly well.
  The electrical treatment was then  discontinued for
several months.  During the latter part of this time
there were evidences of relapse  and reappearance of
ulcers and  pain.   The case has been seen by a large
number of the profession.

  The features in  the cases here recorded most worthy
of note are the following:- 
69
  1. The rapid relief of the itching and pain of eczema,
prurigo, and herpes by local applications.
  2.  The relieving and curative effects of central gal-
vanization not only in prurigo, but also and especially
in eczema, which has not generally been supposed to
be so closely dependent on the nervous system.
  3.  The  fact that herpes, prurigo, and eczema yield
in some instances very rapidly, while psoriasis and
pityriasis are quite slow and obstinate.
  4.  The tendency of some  cases to relapse even after
they have  been greatly benefited, while in other cases
—notably in eczema and herpes—the cure is more or
less permanent.

 Comparative advantages  of electrolysis  and galvano
                      cautery.
  A question of  great interest in  electro-surgery is
the  comparative value of  electrolysis and galvano
cautery.  They are both used to accomplish some of
the same indications.
  We have thus compared the two methods—
  (1.) By using them simultaneously on the same case.
  (2.) By using them in succession on the same case.
  (3). By treating cases more or less similar, exclusive-
ly by one or the other.
  The conclusions at which we have arrived are these—
  1st. The relief of pain  of malignant  tumors is best
accomplished by electrolysis, or by external galvaniza-
tion.
  Cauterization  with  the galvano  cautery  burners
* 
70
modifies the  pain to  a certain extent,  and  in  some
grave cases  may have  a more  permanent relieving
influence than electrolysis, or external electrization;
but for the great majority of cases of ulcers or tumors,
where relief of pain is the leading indication—electro-
lysis or external galvanization, or both combined, will
best accomplish the purpose.
   2d.  Schirrus of the  breast, where there is no ulcera-
tion ; external fibroids and goitres, are best treated by
external electrization and electrolysis.
   3d. For the treatment of polypi—some other tumors,
with a base of moderate size and accessible, as of the
ear, nose, larynx and  uterus—the  galvano-cautery is
preferable to electrolysis.
   4th. In cases where large blood-vessels are involved
and there is consequently great liability to hemorrhage,
the galvano-cautery is  preferable to electrolysis.  Mod-
erate  hemorrhage can  be easily controlled by electro-
lysis,  especially by the positive pole.
   5th. Erectile tumors, superficial and  subcutaneous,
epithelial  and encephaloid cancers  in  all accessible
locations, may be treated with more or less success by
either electrolysis or galvano-cautery, or by both com-
bined.  We are inclined to the belief that the results
of a combination of the two  methods would be more
permanent in many cases than when only one is em-
ployed.  To  establish  this opinion by clinical experi-
ence will require time and careful observation.
  The accompanying  cuts represent the needles—in-
sulated and  non-insulated—and needle-holders that 
71
we have been accustomed to employ in the operations
recorded in this series of papers.   The large spear-
shaped needles, with sharp edges, we devised for the
method of working up the base.
 
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