George Julius Engelmann

“ Success was impossible with the indiscriminate application of electricity in the various branches of medicine; in gynecology we deal with resistances of 200 and 300 ohms, as low as 40, but never above 600 or 800, whilst we use currents up to 250 milliamperes, most commonly between 20 and 80 milliamperes; the neurologist, on the contrary, rarely goes as high as 20 milliamperes, and usually uses from 2 to 5 milliamperes, and the resistance of the tissues between his electrodes is from 5000 to 10,000 ohms and over. ”

“ The wire rheostat to measure resistance, the interruptor, the metronome to break the current, the rheotome to change the current, the water rheostat to interpose resistance, or increase or decrease the current without even the slight jar occasioned by the insertion of single elements, are not necessary for ordinary work; but these, like the coulombmeter to measure the quantity of electricity, the voltmeter to measure the electromotive force of the elements, and the amperemeter to measure their ampere capacity, are all demanded for progressive scientific investigation. ”

“ The galvanic current, thanks to its commercial value, can now be measured and dosed with the utmost precision, and all its practically important characteristics can be more accurately recorded than those of any other medicinal agent. For all practical purposes—I am speaking only of the application of galvanism by the polar method, in gynecological practice—we need only know the intensity of the current in milliampères, the time of application, and the site, nature, and size of the electrodes. ”

“ As electricity for illuminating purposes differs from electricity as a motor, so does the electrotherapy of the neurologist differ from that of the gynecologist, and I look upon the clear understanding of this distinction as absolutely essential to the development of electrotherapy; the want of it has been one of the most effective bars in the way of progress. ”

“ An essential to successful gynecological electrotherapy is a smooth current, the most complete avoidance of shock, which is, on the contrary, a valuable feature in the practice of the neurologist; we carefully avoid the effect of opening, closing, and reversing of the current, which is a highly important diagnostic and therapeutic resource in neurology. ”

“ The electrode must be soaked in hot water, the superabundance of which is expressed before it is placed. The water is to be as hot as it is comfortably borne by the patient; cold water must be avoided, as it lessens the conducting power of the electrode, offers greater resistance than hot water because it does not saturate the epidermis so rapidly, and because it is not only uncomfortable, but might even endanger a patient suffering from a chronic inflammatory trouble, for which we so often make these applications. ”

“ The electric current, both galvanic and faradic, is a most subtile agent, which may be made to serve many purposes, and which possesses numerous, greatly varying, and even antagonistic properties, which can be developed at will by the accessory apparatus and the method of application. ”

“ The use of electricity is rapidly gaining in favor among gynecologists, and this is due to the galvanometer, mainly, hardly less to the introduction of the polar method—i.e., the direct application to the tissues, and to the use of strong, effective currents—making it possible to apply the current without those long sittings of twenty and thirty minutes, which made it an impossibility for the busy practitioner heretofore. ”

“ The determination of the milliampère intensity of a faradic battery is more than useless, it is deceptive, as the ampère intensity carries no conception of the true force of this kind of electricity, which is produced by induction, and by frequent making and breaking of the current. ”

“ Whilst commerce and industry have developed the most wonderful properties in this agent, and have utilized it to a marvelous degree, the medical profession has almost ignored it, though known for an entire century, since the time when Galvani, at sunset, on a September evening, one hundred years ago, while endeavoring to suspend the legs of a skinned frog, by a copper hook through the spinal column, to the iron railing of his garden terrace, observed the twitching of the muscles when the copper hook touched the iron railing. ”

“ Hardaway, so that among a limited number of specialists this one property of galvanism was thoroughly appreciated; but to the profession at large the electric current still remained the same mysterious agent, regarded with indifference, with distrust, or with awe, until Apostoli, in 1883, gave us the key to the successful application of electricity for the destruction of fibroid tumors by urging, 1. Localization, the limitation of effect to one active pole, which must be placed within the tissues; and, 2. The use of currents stronger than any hitherto applied in medical practice. ”

“ The resistance of the tissues in ohms is not practically necessary, as in gynecological practice we know that the resistance varies between 60 and 800, usually between 200 and 300 ohms, and this is more closely indicated by the location of the poles, as the physician who applies electricity judiciously and scientifically should know about what the resistance of certain parts generally is. ”

“ Measure and Dosage of Galvanism. The milliampèremeter. Upon the use of this instrument, absolutely essential to successful practice, the present advance in gynecological electrotherapy is based. The instrument may be either horizontal (tangent) or perpendicular, and for gynecological purposes should indicate from 1 to 250 milliampères. Whilst the neurologist may need one with more exact reading from 1 to 10, enabling him even to distinguish one-half or one-quarter of a milliampère, the gynecologist must have wider scope, and, as a rule exactness to a single milliampère is not essential ”

“ These electrodes must be so arranged that firm connection, best by a screw, can be made with the rheophore; and one of the intrauterine electrodes must be of non-corrodable metal, best of platinum, for use in connection with the positive pole; as oxygen and acids are set free at this pole, an electrode of corrodable metal is soon affected and is not only rendered useless, but is imbedded in the tissues and hard to withdraw.
It will be found convenient to have a stylet and sound in one and the same instrument, of platinum, one end straight and pointed, the other curved and blunt, which. ”