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Medical Congress, International.
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THE CANADA LANGEN
LANGEON MEDIC

A MONTHLY JOURNAL OF

O

lysis, and an extremely vague notion as to the idea surgical applications which might comport with order of phenomena.

Ciniseli is the only one who won the honor and MEDICAL AND SURGICAL SAE, 26th4887lause of having brought electrolysis to a

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perfectly definite method, through having comprehended its mechanism and capabilities, regulating

BRARY the processes of its construction, and leaving no

STRICTURE OF THE URETHRA TREATED BY CHEMICAL GALVANO-CAUSTIC, OR ELECTROLYSIS.

BY DR. CARLOS BETTENCOURT, OF PERNAMBUCO.

hesitation as to the nature and extent of the services which it may afford. The surgical value of the method was not completely attained by Ciniselli.. It was Tripier who had the merit of appreciating the advantage of negative chemical galvanism in the treatment of urethral strictures, basing his conclusions on considerations and facts of another order, and impressing them on his followers during his service in the hospital for children, in Paris,

(Translated from the Portuguese of Uniao Medica.) where certain scrofulous manifestations had been

BY JOSEPH WORKMAN, M.D., TORONTO.

Electrolysis has been employed in the cure of strictures of the urethra, aneurisms, and various tumors. In 1807, Davy tried to destroy a fillet of muscular fibres with a pile of 150 elements, noting in its rapid decomposition alkalies at the negative pole and acids at the positive. Here were established the primary lineaments of the method, which Nelaton called electrolysis, and Iripier chemical galvano-caustic. After the celebrated experiment of Davy, some time having elapsed, Pravaz, Ciniselli (of Cremona), Broca, Nelaton, Velpeau, and numerous other celebrated surgeons, employed the method to destroy tumors and urethral strictures. Before, however, thinking of the application of galvanism, numerous empirical experiments relating to surgery were made; but the operatorial conditions being ill determined, and the interpretation of the results unsatisfactory, these investigations were abandoned. Between 1841 and 1848, Crussell, of St. Petersburg, wrote several memoirs on the electrolytic treatment of certain engorgements and tumors These works, in their plurality, are inedited, and are to be found in the archives of the Academy of Science in Paris. After some years of study of the method of cauterization, based on the analytic properties of the electric currents, Crussell renounced the thermo-galvanic method, and engaged in the study of thermo-galvanic cauterization. It is certain that this author had a confused view of the grand resources of electro

treated by the application of caustics, the result of which was judged of by the cicatrices produced. Soft and smooth cicatrices were attributed to alkaline applications, and hard and rough ones to acids, or the actual cautery. I set about studying experimentally," says Tripier, "the influence exerted on the cicatrix by the chemical origin of the wound;" he concluded from his experiments that chemical caustics give two principal sorts of cicatrices; the alkaline give soft cicatrices, which are but little, or not at all, retractile; the acid ones give hard and considerably retractile cicatrices; the negative pole of the pile gives cicatrices identical with those from alkalies; the positive pole gives cicatrices comparable to those from acids, and from the hot iron. Ciniselli precisely described the experimental conditions of a phenomenon, whose mechanism was first understood by him, from a series of facts observed with all the rigor of logic, and he thus became the creator of the method; Tripier, by assimilating the practical consequences of the facts empirically observed, and conjoining these consequences with preconceptions exclusively original, described the therapeutic indications of the method, with all scientific rigor.

The result of the investigations of Campos Bautista and Palomeque, in an inaugural thesis of 1870, fully confirm the proposition formulated by Mallez and Tripier, in relating their own experiments. Thus, then, negative electrolysis will be employed to destroy strictures of the urethra, and will furnish a soft, smooth and dilatable cicatrix;

the positive chemical galvanism will be used in the cure of aneurismal tumors and will give an albuminous coagulum. The attempts of Crussell and Wertheimber having failed to realise the idea of causing galvanism to act on urethral strictures, proved unprofitable. Their apparatus was imperfect, for the purpose of dissolving the peri-urethral engorgements, to which they ascribe the producing cause of the urethral contractions.

The electrode The electrode of Mallez is a staff, terminating in an olive, or a cylinder, and it is covered, excepting at its point, over its whole extent, by a gum-elastic sound. This instrument is introduced by a conductor; its management is difficult. The author had the idea of furnishing it with a conducting sound, but for several reasons he gave it up. Dr. Jardin, his Dr. Jardin, his clinical assistant, had an instrument constructed under his own instructions, similar to the urethro tome of Maisonneuve-less the cutting blade which was substituted by a rhomb of platinum, and had the catheter protected by a sheath of gum elastic. This instrument is perfect; it acts well, and there is no fear of injuring the wall of the urethra. The author presented it to the Paris Academy of Medicine. In the course of the month of January, 1885, I tried some experiments, in which I employed the two instruments. I took a large piece of the muscles of the loin of an ox, containing a dense aponeurosis, which divided the piece into two portions. A tent-canula was introduced perpendicularly, making a traject which merely gave passage to a canulated catheter of Jardin. I passed the lamina along the sulcus far enough to come into contact with the muscular texture. The positive pole of the pile of Gaiffe was placed on the muscle at a distance of 10 centimeters; the negative pole was placed in communication with the electrode. The circuit was made with the positive electrode. The distance through which the lamina had to pass was 8 centimeters, in reaching the aponeurosis at the centre. At the end of six minutes it appeared at the opposite orifice, having traversed the space without resistance. Now we know that aponeurosis is a hard, fibrous composite of bundles of laminous and elastic fibres, which interlace and form a compressed web, sufficiently resistent, and comparable to the fibrous texture of the urethral stricture. The same experiment was made with the instrument of Mallez, which gave the same result, but not so promptly

as the lamina of platinum. Another fillet of muscular fibres and aponeurotic tissue was encased by the metallic wire of our polypotome electrode, which is a modification of the constrictor of Maisonneuve, establishing the electric current; the primitive (positive) pole was put into communication with the instrument, contrary to the first experiment, and the negative pole with the muscle, thus making the circuit. the circuit. The experiment lasted 40 minutes; the wire became lost in the muscular texture and the tendinous parts, but desiring to hasten the re sult, I broke it. In proportion as the wire decomposed the textures, a fume of sour and piquant taste was formed, coincidently with the liberation of the gases; this fume was quite saponaceous at the negative pole. the negative pole. From the dissection of the parts traversed by the electrode the disorganization of the textures was exhibited, and we were satisfied that positive chemical galvanism, by the process employed by us, is an incontestible fact, which can be realised by any physician. We employed this process in the extirpation of an extra-uterine polypus, before we had seen the book of Tripier— Electrologia Medica-which we received a good while afterwards.

Dr. Fort, when acting as a clinicist in Rio de Janiero, relative to failure in an operation by electrolysis, published in the Gazette des Hopitaux, of Paris, No. 54, an observation which we here introduce, together with the reply of Dr. Jardin, because they are both very instructive. Dr. Fort says, "since I practised chemical surgery in Brazil, I have operated a considerable number of times on strictures of the urethra. I employ linear electrolysis, on a large scale, according to the process of Dr. Jardin. In the present instance I would ask Dr. Jardin whether his instrument might not be modified, with the view of avoiding all possible failures? The lamina of platinum, not cutting, which destroys a point of the stricture, appears to me too small, and I think it might, without inconvenience, be enlarged in its depth to the extent of 3 millimetres. I deem this necessary, considering the thickness of the canal of the urethra and its rela tions with the corpora cavernosa in the upper part.” The following are Dr. Fort's reasons given in de monstration of the utility of a modification of the lamina:

1st. In certain individuals the stricture presents some thickness of pathological texture, connected

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