By some the electric needle is used in one of two ways-either the entire lesion is removed by it, or numerous punctures are made into it, so that the body of the growth is destroyed. While this method will undoubtedly cure a number of cases of the early basal-celled neoplasms, it has never appealed to the author, because it affords no chance for histological examination of the growth, and because one cannot be certain that he has gone beyond the margins of the growth. It would seem to be applicable only in extremely old and decrepit persons who cannot stand a more severe operation. An ordinary sixteen-cell silver chloride battery can be used, connecting the negative pole to the needle. If the operator is willing to take time, there is no necessity of causing any pain to the patient, for just as good results can be obtained from the prolonged action of a mild current as from the rapid action of a strong one.
Of late years the so-called fulguration has come into some prominence, thanks largely to the work of de Keating-Hart. Both the method of application and the results vary to some extent with the skill of the operator. Bainbridge* has recently written a concise review of the subject, and the following is derived largely from his paper.
The method known as altofrequent cytolosis, altofrequent scintillation, effleuvation, etc., was first employed by Riviere, of Paris, and was described by him in 1900. He advocated removing the tumor by surgical means and then applying high frequency sparks. A monopolar or bipolar current, with a short spark, of high frequency, high tension, and low amperage, is employed. Or a special apparatus using a monopolar current with a long spark may be used.
Oscillatory desiccation (Clark) consists in the production and sustaining of heat to cause the dehydration of the tissues treated. This is accomplished by a specialized, oscillatory high frequency current, delivered from a fine metal point and then through the air to the tissue.
Thermopenetration was first described by de Arsonval in 1896. It depends on the power of the high frequency current to cause a decided rise in temperature in tissues interposed between two electrodes. De Keating-Hart has used this method to render the tissues more radiosensitive, and by Nagelschmidt and Doyen for the destruction of neoplasms.
*Bainbridge: Internat. Clinics, 23d ser., iii, 268.
Diathermy or transthermy was experimented with in 1907 by Nagelschmidt, of Berlin, von Brendt, Preeps, and Zeyneck, of Vienna, and de Kraft, of New York. The apparatus employed elevates the temperature of the deep tissues to any required extent, the tumor being destroyed by coagulation. The greater the amperage employed the greater the heating. The voltage employed is relatively low.
The term bipolar voltaization is applied by Doyen to the method in which the electrode of the apparatus is held away from the part under treatment, and the sparks allowed to play upon the area.
Fulguration (de Keating-Hart) is founded upon the premise that the monopolar long spark of high frequency and high tension acts not only upon the neoplasm, but upon the soil on which the neoplasm has developed.- De Keating-Hart claims that the use of the high frequency short spark at a low tension acts as a tissue stimulant, but that a spark of the minimum length of 8 cm. applied for a sufficiently long space of time transforms a healthy area into a torpid wound, which heals largely by the contraction of the surrounding healthy tissue. It is considered that the same process that prevents the reformation of healthy epidermis after fulguration also retards or suppresses the growth of cancer cells.
As this method is the most important of the electrical ones before the medical profession today, it may be well to describe the apparatus used. The generating apparatus consists of a large coil and a rapid interrupter, which converts the street current of low voltage and high amperage into an interrupted current of high voltage and low amperage. The high frequency apparatus consists of an Oudin resonator, with spark gap and condensers of great capacity. The sterilizing and cooling apparatus comprises an air pump, driven by an electric motor, which forces air through an electric sterilizer, and the air is finally delivered at the electrode cool and sterile. The electrode consists of a metal mandril within a rubber tube.
The first step in the operation is purely surgical, consisting of the removal of the diseased tissue as completely as possible, then the spark is used for a long time, using sparks of high frequency and # high tension, and applying them to the entire wound. The electrode should be kept in steady motion, and no carbonization of tissue should result. "Ten minutes of fulguration should be used on an area of ten square centimeters".
Bainbridge wisely concludes his article by stating that, although at the present time the results seem good, still it is too early to draw any too optimistic conclusions, a statement with which all fair-minded men must agree.