On a New Method of Treatment of Chronic-Metritis, and Especially Endo-Metritis, by the Intra-Uterine Chemical Galvano-Caustic

APOSTOLI
1887 Boston Medical and Surgical Journal  
tube in its centre was pnt in communication with the piston-recorder by means of a rubber-tube. If there is no leakage of air beneath the shield, which, with proper care, may be obviated, it is easy to obtain a record upon smoked paper of the circulatory changes in the orbit. The most striking feature of these records is the peculiar shape of the pulse-curve. The curve is anacrotic, the secondary undulations appearing in the ascending portion and vertex. In order to greatly magnify these
more » ... I employed the ether piston instead of the ordinary form, and recorded its excursions by photography according to the method Fig. 2. described by me in the Journal of Physiology.6 Figure 2 is a somewhat reduced reproduction of the outline of one of the records obtained. The very marked similarity of the form of the pulse-curves in this record to that of the brain-tracing in Figure 1 , is very apparent. This tracing is entirely different from one taken from the carotid in the neck or from any peripheral bloodvessel. It shows very clearly how intimately the circulation of the orbit is related to that of the cranial cavity. The peculiar form of the pulse-curve may also contribute in a measure toward the advancement of our knowledge of vascular physiology in general. The purpose of this preliminary account of these researches is to call attention to the exceeding delicacy of the methods employed, and to record the interesting fact that the pulse-curve of the orbit is very similar to that of the brain. The subject should be of interest to ophthalmologists as well as physiologists. The researches to be made with the apparatus and methods employed in these experiments will naturally tend in two directions : first, to gain, so far as possible, information of the cerebral circulation ; secondly, to ascertain to what extent the condition of the circulation of the eye is indicated in the general record of the orbital tracing. -A correspondent of the Lancet (March 5th) describes a case of fracture of the thigh occurring during parturition. The patient was a quintipara ; the labor natural, vertex presentation, O. L. A. The birth of the head was followed very quickly by that of shoulders and body; and, as the latter came through the vulva, the attendant heard a snap, which proved to have been caused by a fracture of the patient's left thigh. The only thing noted as unusual about the case was the marked and quick rotation of the face to the right thigh after the birth of the head. Intra-cterine therapeutics is asserting its claims more and more, and is justly supplanting the old exterior treatment of the cervix. The new process, which I have followed for the past four years, in the electrical treatment of fibroids, I have pursued for the same length of time, and with equal success, in curing chronic-metritis ; and this same process is even better adapted to the treatment of the form generally called endo-metritis. For a lesion which, before invading the uterine parenchyma attacks first the mucous membrane, fixes itself there more or less to seize afterwards the surrounding parts, I apply a treatment wholly intra-uterine, and which will cauterize all the membrane affected. For the modern process of scraping, of liquid injections, or purely chemical intra-uterine cautery, I substitute a galvano-chemical treatment, less harsh, more concentrated, which can be localized, and which every woman can bear, if properly applied. The immediate chemical action which consists in a progressional destruction of the mucous membrane is soon followed by a process of shrinking and disintegration which promotes the absorption of the exudation and of the hyperplasia of new formations. To be successful in this operation it is necessary to have the following electrical instruments, the function and necessary qualities of which, ought to be well understood. First. A medical galvanometer divided, for intensity into milliamperes which I was the first to have graded to 200. It gives the only exact measurement of the electric force used, which before was known only in a vague and empirical way, by the enumeration of the number of cells (a cell once used never affording the same strength as a new one). Second. A permanent battery of sufficient size to last for some time, and to preserve practically the same strength, after several successive operations, which will furnish with a small number of cells, thirty on an average, a high intensity of 100 to 200 milliamperes ; the best battery is that of Leclanché ; a good portable battery of small volume is yet to be invented, but for the present, that with bi-sulphate of mercury with facultative immersion will suffice for the requirements of the operator. Third. An intra-uterine electrode of sufficient length to extend to all parts of the uterine cavity and which is not affected by acids, as platinum. It must also be provided with an isolating muff to protect the vagina, the best being a celluloid tube. Fourth. A neutral or insensible electrode, which applied on the abdomen, allows a very intense current to pass without pain, without heat, and without fear of burns ; the best is the one of clay, which I introduced in 1882. Fifth. Cords supple enough not to obstruct, and resisting enough not to be easily broken and cause interruptions painfully felt by the patient. The physician possessing a good instrument must conform strictly to the details of the operation hereafter described. First. Make a tepid and antiseptic vaginal injec-1
doi:10.1056/nejm188704211161602 fatcat:ulay3je4yfcxjaw2owfn235zdi