The Treatment of Fibroid Tumors of the Uterus after the Method of Dr. Apostoli

JOHN HOMANS
1891 Boston Medical and Surgical Journal  
Eveky one who lias felt obliged to remove uterine tumors by laparotomy has often hesitated at the performance of the operation, and has hoped that 6omo method would be found other than the formidable one which necessitates opening the abdomen and [Hitting ¡i wire around the uterus. Every surgeon dreads, at least I do, to make the long incision, sometimes more than twelve inches, to squeeze up the uterus in this coarse and cruel way. Besides this the resulting cicatrix is not unfrequeiitly the
more » ... unfrequeiitly the seat of an annoying ventral hernia. When, therefore, Dr. Apostoli published and explained his treatment of fibroid tumors of the uterus by electrolysis, and gave the details of several hundreds of cases treated in this way, I hoped that a more gentle and perhaps as effectual a way of relieving those affected with these growths had been discovered. For my own part I never have seen, and I do not see now, why the dispersing and dissolving powers of electricity should take effect on the fibroid growth aud not on the skin or muscle or tendon or fat or other structure through which the current passes. When we apply one electrode within the uterus and the other on the abdomen, why should the destructive powers of the current be exerted and take effect (as we wish) on the morbid growth, and not on the normal tissues ? The fibroid tumor is nothing but an aggregation of normal uterine tissue in an abnormal and excessive amount, and why should this aggregation of fibre be attacked aud nothing else ? I was slow to adopt Dr. Apostoli's treatment, and I knew nothing about the therapeutical effects of electricity. When, however, a friend, who is perhaps the most successful hysterectomist in the world, wrote me that he had tried electrolysis, and could endorse every word that Apostoli had written, it seemed to be my duty to subject my patients to this almost harmless method instead of compelling them to undergo a dangerous surgical operation. As I knew nothing about electricity or its application, I asked my friend Dr. Philip C. Knapp to provide me with a battery and with all the apparatus called for in Dr. Apostoli's treatise written by Dr. Lucien Carlet. I began the treatment of such fibroid cases as came to me iir*my private practice in December, 1887, and continued to treat them till July, 1888, and resumed treatment again in October. I wish to say that I have followed strictly Dr. Apostoli's directions to the best of my ability. As all of my readers may not be familiar with these directions, I will state my manner of proceeding. The patient, having her abdomen bare and lying upon a convenient table, is given an antiseptic vaginal douche; then a flat, somewhat pliable and perforated metal plate, about nine inches by five, is enveloped iu warm, moist potter's clay and wrapped up in muslin (like a poultice) ; this is then laid upon the abdomen in the pubic and umbilical regions over the tumor ; after this the sound, of platinum (for silver might bo melted by the current) or of gas-carbon, is introduced into the uteriue canal. When this has been inserted as far as possible, a protective tube of hard rubber is shoved up against the os uteri, so that the vaginal wall shall nowhere come in contact with the bare platinum (for it might be severoly burned). The wires of the battery are now connected with these two electrodes, that is, with the plate on the abdomen and the sound in the uterus, and the patient's hands are pressed down upon the clay. If the case is one in which there is great haemorrhage the uterine pole is made the positive one, as the positive pole is said to exert a chemical cauterization and to stop or diminish liajruorrliage. If there is no luemorrhage, the uterine pole is made tho negative one, because the negative one is said to have a dissolving or distintegrating or dispersing effect. A rheostat, or electricity measurer, is then connected so as to allow the current to pass, and the amount of electricity passing is measured by a galvanometer and is regulated by the rheostat. It is recorded in milliampères, that is, in degrees marked on the dial of the galvanometer, each degree being an amount of electricity called a milliampère. (In recording these cases I shall use our usual mark for degrees as signifying milliampères : thus, 42°will mean 42 milliampères.) I hope I have not been too tedious in this description, aud yet have made things clear. In these treatments I confined myself wholly to giving the antiseptic douches, to introducing and holding in position the uterine electrode, and Dr. Kuapp turned on and regulated the amount of electricity as I directed. Later on, my nephew, Dr. John Homans, 2nd, took Dr. Knapp's place. If this treatment by electrolysis is tolerably sure and safe we ought to practise it ; if it is not so, it is a great waste of time and very tedious and useless. Again, the battery is cumbersome aud expensive if trustworthy. I determined to settle the matter for myself if I could, because I thought it would be criminal to do hysterectomy if 1 could cure patients by Apostoli's method. I put one hundred and fifty Le Claudio cells in the cellar of my hospital, as the simplest and best battery. Beforo giving very brief reports of the cases treated, let me say that one frequent but not invaluable good effect of this treatment is the diminution or cure of pain and tenderness aud an increased ability to walk and stoop. A very marked anaesthetic and tonic effect is often also produced. One of the women, who was unable to go up stairs without resting every second step, was able after a few treatments to run up two flights, and others who were unable to bear any pressure on the abdomen could wear their clothes and move with ease aud comfort ; but these improvements were by uo means always permanent. In one instance also, chronic menorrliagia was cured, So much for the good effects of this treatment. On the other hand, pain and discomfort is sometimes produced, and haanorrhage which has not before existed has become troublesome. One case terminated fatally four weeks after the last application of electricity ; and, in the absence of an autopsy, 1 think the death must be attributed to septicemia caused by the treatment.
doi:10.1056/nejm189103121241101 fatcat:chrn7cbkbjhx5p67jlmc4ldw7e