in three sittings, at an interval of two to three days each time, about ten needles into the most extended veins, placed a conductor, connected with the negative pole, into the hand of the patient, at the same time connecting all the needles with the positive pole. The operation caused but little pain. After a few minutes the needles were removed, when, in place of the dilated veins, full, resistant cords were felt, a sure sign of complete coagulation. After a month, the greater portion of the veins was obliterated and the volume of the limb considerably reduced; only then those veins, heretofore of normal size, began to dilate a little, which circumstance can exercise no influence on our opinion of this modus operandi. Thus galvano-puncture appears to offer a sure method for the successful treatment of aneurisms and varices, and also appears to avoid the danger of phlebitis following the methods formerly employed.

The following is, according to Steinlin,' the chemical process ensuing in this method: The salts in the serum of the blood maintaining the albumen, fibrin, and casein in solution favor the coagulation of these substances on account of their decomposition through the electric current. The acids formed in consequence of this decomposition go to the positive pole, and these form, with the metal of the pole-needles-metallic salts, which precipitate the albumen, etc., thus causing a firm coagulation at the positive pole. Consequently the metal of which the needles consist has a considerable influence on the rapidity with which coagulation of the blood takes place. If the needle attached to the positive pole is made of platina, coagulation occurs slowly; if the platina needle is furnished with an iron point, this process ensues more rapidly, and more rapidly still if a zinc needle, or, on account of its brittleness, a steel needle, covered with zine, is introduced. For this reason Steinlin recommends for his operation the use of the last-mentioned kind of needle, which is to be connected

1 Galvanopunctur bei Varicositäten und Aneurysmen. Zeitschr. der k. k. Gesellschaft der Aerzte zu Wien, 1853, Heft iv.

with the positive pole of the pile, while the negative pole is, by means of a platina plate, or a sponge moistened with a solution of salt, placed near by on the skin, the conducting power of which is improved by a dilute acid or a solution of salt.

I was fortunate enough to cure permanently, through galvano-puncture, the case of aneurism described below, but must also remark that the final favorable result is perhaps not to be ascribed to galvano-puncture exclusively, inasmuch as digital compression was also employed.

CASE 110.-Mr. R., a druggist of Herrnhut, aged fiftytwo years, noticed for the first time, about twelve years ago, that the left knee was always warmer than the right, and that, at the same time, there existed also a small swelling in the middle of the knee-pan. About ten years later he struck the left knee very violently against a hard, angular substance, causing great pain and swelling of the joint. Through rest and the use of lead-water applications, the symptoms of irritation disappeared within eight days, the swelling being also diminished, but since that time pulsation was plainly perceived on either side of the patella, to which symptom the patient did not, however, pay much attention, causing him, nevertheless, to cover the knee with a compressing india-rubber bandage. In spite of this, the swelling gradually increased until, in the last years, pulsation could also be plainly felt in several dilated arteries in the vicinity of the patella—a group of symptoms causing the patient to go to Berlin for the purpose of consulting Dr. Wilms. He recommended the employment of galvanopuncture for the obliteration of the aneurism, which here undoubtedly existed, and sent the patient to my office, June 29, 1855. I found the following symptoms: The tumor was covered by skin of normal color, and easily moved; it covered the knee-pan to three-quarters of its extent, and thence extended partially to both sides, especially to the inner side, and partially upward, into the muscular tissue of the quadriceps femoris. Pulsation could not only be felt on

different points of the patella, but was also visible to the eye; the temperature was also considerably increased.

The operation was made for the first time on the 30th of June, 1865, by introducing as deeply as possible three needles, connected with the positive pole of Remak's zinc-carbon battery, into the most prominently-pulsating places of the tumor, while the negative conductor, covered with flannel and linen, measuring one and a half inches in diameter, rested on the thigh above. After the needles were kept in this position for half an hour, the current having the strength of twenty elements, they could only with a certain degree of force be extracted from the firm coagulum. No bleeding followed, nor was there any pain felt during the operation, a slight burning at the zinc pole excepted.' Upon Dr. Pirogoff's request, who was present at the operation, this, as well as the next three operations, was followed by a digital compression of the femoral artery at the beginning of the lower third of the thigh, made for twenty-four hours alternately by three attendants. The galvano-puncture was repeated on the 6th, 15th, 21st, and 29th of July, with the difference that the number of needles introduced on July 6th was three; on the 15th and 21st, ten; on the 29th, five; they always remaining in the vessel for half an hour. It was found that coagulation was less firm if ten needles acted simultaneously; at least,

1 According to Fromhold (1. c., page 110), the galvanic current must be of sufficient strength to form, in one minute, a coagulum of the size of a bean, at the positive pole, if tested with albumen taken from a fresh egg and placed in a saucer, and, besides, to cause a deviation of 25° of the magnetic needle. He also advises to connect each time but one needle with the positive conductor, allowing the galvanic current always to act for two minutes, and continuing the same method with each successive needle. I prefer the method employed by me of allowing the current to act continually at the same time on a larger number of needles (which, however, ought not to exceed five or six in number), for the reason that I have never, under these circumstances, observed the slightest bleeding follow the removal of the needles (the same happened also in another case of aneurism on the volar surface of the hand, the final result of which I regret to be unable to report), while Fromhold mentions the bleeding as not a rare result of his method.

after the operations made on the 15th and 21st, the withdrawal of one or the other needle was followed by a slight bleeding, which did not occur in the first, second, and fifth operations, after the introduction of a less number of needles. The long intervals between the single applications were necessary, on account of the patient feeling very much affected after each compression, and the thigh being very tender, in a considerable extent, to every touch. The pulsation in the tumor, however, became less each time, the coagulation in the bloodvessels rendering, at the same time, the tumor so firm and hard that the introduction of five needles was made only with some difficulty, on July 29th. When the patient left Berlin, August 8th, a very weak pulsation could be felt only at the upper part of the tumor, the volume of which was also considerably reduced. Concerning the further course, I was informed that, in the next days after the patient's departure, an abscess formed in the fibro-cellular tissue, on the lower inner border of the patella, in consequence of the suppuration of some needle-wounds, from which a few teaspoons of bloody pus were discharged, and which then healed within a week. Otherwise the patient, in a letter dated March 27, 1868, expressed his great satisfaction about the permanently happy result of the treatment, adding, finally, the following: "There exists but a moderate swelling, of about two inches in diameter, with a very weak pulsation. I always wear an elastic bandage around the knee, and I have but a few times perceived a sensation of heat, after exerting the knee considerably, while travelling in the mountains, but felt no pain or other inconvenience."

B. Electrolytical Treatment of Strictures, Exudations, Tumors, Ulcers, etc.

Crussel was the first to use electrolysis for the removal of strictures, exudations, ulcers, etc. He was followed 1 Die Electrolytische Heilmethode. Neue Med.-chir. Zeitung, 1847, No. 7. Med. Zeitung Russlands, 1847 und 1848.

by Willebrand, Spencer Wells, Ciniselli, etc. Lately this method has been revived by Scouteten and Tripier'-by the latter especially in the treatment of the obliterated lachrymal sac, the constricted Eustachian tube, and of stricture of the urethra, but most of all by Althaus, of London,' who, at the same time, tried to generalize this method, and to extend it to the treatment of serous exudations, strictures, wounds, and ulcers, and to tumors, especially those having soft contents. According to Althaus, two factors enter into the effect of the negative pole on animal tissues: 1. The mechanical effect of the liberated hydrogen, which can be seen, under the microscope, to rise in numberless vesicles, to penetrate the minutest parts of the tissues, and to separate their fibres. 2. The chemical effect of the free alkalies (potash, soda, and lime), generating with the hydrogen at the negative pole, and corroding the parts chemically. For the operations themselves Althaus used a battery, consisting of fifteen elements of Daniell, for the introduction into the tissues, a needle of gold or gilt steel attached to the negative pole, or various modifications of the needle in the shape of a fork, with two, four, six, eight teeth, or a dull blade, etc., while the circuit was made by applying to the skin a sponge, connected with the positive pole.

In the following we shall report the noticeable results of the electrolytical method for the treatment of the abovementioned diseases, discussing briefly, at the same time, the other methods of electricity employed for their removal :

1. In strictures of the urethra, Willebrand, following Crussel's example, introduced, as far as the stricture, a metallic sound, furnished with an india-rubber covering, from which only a conical silver point protruded, connecting it with the negative pole of a battery, while the conductor at

1 Arch. gén., 1866, page 18.

See Vorläufige Mittheilung über meine electrolytische Behandlung der Geschwülste und anderen chirurgischer Krankheiten. Deutsche Klinik, 1867, Nos. 34-36.