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years old, has made an almost entire recovery. She has taken the remedy for about a year and three months. There is still some enlargement of the thyroid gland, however. The eye-disturbance has almost entirely disappeared. She is unable to take more than

two or three grains of the thyroid extract daily, for any length of time, and sometimes has to stop it altogether for a time. She has not quite regained her color, being still quite anemic, but as far as the other symptoms go, seems to have recovered entirely. Dr. Lucy Hall-Brown: I am very much interested in what Dr. Read has said in regard to the giving of thyroid extract in exophthalmic goiter, as I have never ventured to do that on account of the fear that it might affect the heart unfavorably.

When in Europe last year I looked up the subject of the use of thyroid extract in goiter. I was told at the St. Thomas Hospital in London, that at the Royal Free they had been making a specialty of removing goiters. There the surgeon in charge told me that, although they had in the past removed many hundreds of goiters, at present they had almost entirely abandoned the knife in favor of thyroid extract. He spoke enthusiastically of the results which they were obtaining. The dose he always spoke of

in fractions of a sheep's thyroid and not in grains. Half a sheep's thyroid daily was usually given. Dr. Keen of Philadelphia was a passenger on the steamer by which I returned home and I compared notes with him. He had been visiting hospitals in Germany, notably in Heidelberg and Freiburg, and his son-in-law, Dr. Freeman, also a fellow passenger, had been for several months in Berlin. They had both informed themselves pretty thoroughly upon the use of thyroid gland in goiter, and the results were quite in accord with what was claimed for it at the Royal Free in London. All agreed, however, that in no case had good results been obtained by its use in exophthalmic goiter, on account of the effect it had upon the heart's action.

I have, since my return home, used it in several cases of simple goiter with good results, and possibly, since I have heard of Dr. Read's testimony, I may try it in cases of exophthalmic goiter.

Dr. Arthur Mathewson: I have been very much interested also, especially in reference to the treatment of exophthalmic goiter. Those cases seem to go in flocks. While I have seen a great many first and last, I have not seen any since I have known of this treatment.

Dr. Shaw So far my experience, with the treatment of exophthalmic goiter by the use of thyroid, has shown that some cases

improve and a great many do not. There is a good deal of division among physicians as to the methods of treatment; there is no 'uniformity among them. There are physicians to-day that operate for those cases, and I think myself that it is justifiable, because in some cases you cannot get any result, no matter what you give the patient. The operations occasionally fail, but in a large proportion of cases they certainly turn out very well, especially when only parts of the gland have been removed. I do not think there is any uniformity of opinion in regard to the subject, from what I know of the views of men who work in that field and what I see in the literature.

TREATMENT OF DYSMENORRHEA WITH THE GALVANIC CURRENT.

BY ONSLOW ALLEN GORDON, M.D.,
Associate Surgeon to St. Mary's Hospital.

Read before the Brooklyn Gynecological Society, May 1, 1896.

There seems to be a wide difference of opinion as to the pathological conditions prevailing in dysmenorrhea. That there are several etiological factors all agree, whether a larger number of cases belong under the head of neuralgic, obstructive, congestive, or a hyperesthetic condition of the endometrium has not been satisfactorily determined. It is reasonable to believe that any one of the above pathological conditions would cause painful menstruation. I am inclined to think that a large majority of cases are due to endometritis. That a very large number of women suffer intensely at the menstrual period every physician knows. It is not the purpose of the writer to enter into the question of pathology or the different methods of treatment of this distressing complaint, but simply to give expression to views from a limited experience with the galvanic current in the treatment of the same, and invite discussion on the subject by fellows of this society whose experiences are wide and whose opinions are valued. My experience with galvanism dates back about three years, and while I have not as many cases to record as some others, I have used it long enough to convince me that for cases not due to a faulty condition of the nervous system or an impoverished state of the blood, it is the best mode of treatment, and that it will give relief in more cases than any other agent.

Seventy-five per cent. of my cases have been relieved from the first, and twenty-five per cent. have required no treatment after eight or ten weeks. One or two of the greatest sufferers that have come under my care have been quite free from pain at the menstrual period for nearly three years; others return for treatment before the expected period once a month, while some are seen only once in five or six months, and report much relief.

It has been my custom to apply treatment once a week for a month, and then a few days before menstruation for a few times, after which the frequency is in accordance with the indications. I believe, however, that better results can be obtained by treatment twice a week for the first few weeks. My method of application does not differ from many others. I have a Law battery of sixty cells, and use an electrode which very closely resembles an ordinary uterine sound. Some prefer a clay electrode for the abdomen, but I have so far used one which I had made to order from copper, about four by six inches, and cover it with absorbent cotton for each patient. The uterine electrode is connected with the negative cord and inserted into the cervical canal, as far as it will go without pressure, and the current turned on until fifteen or twenty milliampères are reached. As a rule the electrode will glide past the internal os; before fifteen milliampères have been turned on, I have never found it necessary to use force or hold the cervix with a tenaculum. Care should be taken that the point of the sound does not rest against the fundus. I have found five or six minutes long enough for each application. Antiseptic precautions are observed throughout.

I will relate the history of two cases which I believe have been under observation long enough to justify me in forming an opinion as to the merits of the treatment.

Case 1.-Miss C., aged twenty. Menstruation began at twelve years. Was not very painful for the first few years, when it gradually became worse, until the pain was very severe for the first three days. The flow was about normal as to quantity. She tried all sorts of medicine, and finally settled down to paregoric, which she was using in large quantities when she came under my care. I applied the galvanic current once a week for four or five weeks, then before the expected period for a few times (not more than ten treatments altogether). Her first menstruation after treatment was begun was painless, and she has not found it necessary to take a sedative of any kind or remain in bed for the first day, as was her custom formerly. A period

I saw

of two years has now elapsed since the first treatment. her the other day, and she says she has very little trouble now, and is able to carry on the work of a stenographer with no interruption at the time of menstruation.

Case 2. Mrs. S., aged twenty-three years. Menses began at fourteen. Painless and regular for the first three years. Dysmenorrhea began at seventeen and became more pronounced at each succeeding period. Pain would last about one day. For three or four hours it was excruciating. This woman was a patient of mine for three years before I treated her with electricity, and I was often called to attend her in these paroxysms of pain, and I have never seen suffering more intense. The only relief came from the hypodermic injection of morphine. She had the first treatment with galvanism in May last, in which month. she had three applications; two in June, and one in July. Menstruation after the first treatment was without pain, and there was entire freedom from pain for eight months, when there was a partial return, but one treatment before menstruation in September, November, December, and January has afforded relief up to the present time, which completes a year from the beginning of treatment (ten applications in all).

In a recent paper by Dr. Massey he reports thirty-two cases treated by electricity, and twenty-seven cured. The following are extracts from his paper: "That menstrual pain is rarely, if ever, associated with obstruction is more definitely determined to-day than ever." "In nearly nine-tenths of the cases occurring in single women an endometritis is the exciting cause." "At no time has it been necessary to use force to insert the electrode." "The purpose of the electrical treatment is, therefore, not dilation, as has been incorrectly assumed by some physicians, but the cure of the congestion, inflammation, or malnutrition on which the condition depends."

It seems to me that the following advantages may be claimed for this mode of treatment:

1. Patients will submit to electrical treatment when an operation would be declined.

2. It can be carried out in the physician's office without an ansthetic, as it is attended by very little, if any, pain.

3. Any physician with the necessary appliance and a moderate knowledge of gynecological work can apply the treatment

without assistance.

4. Statistics show that the immediate and remote results are better than from any operative procedure.

DISCUSSION.

Dr. McNaughton: Mr. President, I have used galvanism for several years for such cases as the doctor has related, and on the whole it has been very satisfactory.

Several years ago I made many examinations of women who had dysmenorrhea. These were made during the menstrual period, and the changes in the uterus during menstruation I do not think are appreciated by physicians who have not made such investigations. In those having flexions the uterus becomes soft, and the canal becomes practically straight. As soon as that occurs the pains are diminished.

I think the passing of an electrode is like passing a sound, of course, plus the therapeutic effects of the electricity. I believe it is an excellent treatment. There are objections to placing on your table once a month, or twice a week, a young girl, and most of them are neurotic, and I have had some very unpleasant experiences in using electricity in these cases; so much so that I have declined to use it in some instances. It excites attention to that part, and there is, of course, the objection to making the examination, plus the excitation of the electricity. I think it is better and safer to administer an anesthetic and dilate the canal. Although, even after doing that, I have used electricity with benefit. I believe that endometritis is mostly due to flexion, and those patients, unless the deformity is corrected, are in danger of developing fibroids. My later experiences have only proven what I stated in a paper read some months ago.

Dr. W. H. Skene: I have used galvanism a little, but have been less fortunate than Dr. McNaughton. In cases of flexion I have had very little result from it, but neurotic cases and cases of malnutrition have been greatly benefited and relieved. In flexions I have had no relief at all, except by dilating, and using electricity after that.

Dr. L. G. Langstaff: I have not had a wide experience in using electricity for dysmenorrhea. I have used it in a few cases, with a good result in one or two. I think it is an agent which should be used as any other therapeutic agent-in selected cases. I think in selected cases you can use it with good effect. The objection to using it in a virgin is a decided objection, and it has been my habit to get a patient of that kind to try medical reme

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