John Marshall's first description of surgical electrocautery

In their introduction to the first description of surgical electrocautery, Ramachandran and Aronson ¹ refer to the work of Bovie and Cushing, but incorrectly describe this as electrocautery. Electrocautery is the application of an electrically-heated element to the skin – a variation on the use of thermally-heated implements for cautery – a process which dates back to Hippocrates.

Bovie and Cushing, however, were responsible for the popularization of ‘electrosurgery’ or ‘surgical diathermy’ – in which heat is generated within tissue by the passage of high frequency electrical current (the high frequency is necessary to avoid muscle stimulation). This was an altogether much greater achievement and should not be confused with electrocautery.

The potentially fatal consequences of exposure to low frequency (50–60Hz) alternating current were highlighted by Thomas Edison (1847–1931) who held a patent for direct current distribution and led a propaganda campaign against using alternating current. He became involved in the development of the electric chair as a means of execution and publicly electrocuted animals to demonstrate the dangers of alternating current. However, alternating current had the overwhelming advantage that it could be transformed and efficiently distributed over long distances, and it soon supplanted Edison's patented direct current system for national power distribution.