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hase hopeful curative means for the removal of morbid growths of the uterus. And I think the published observations of the enthusiastic laborers who have entered upon record their results in treating these turnors with ergot give us much reason to hope that fibrous tumors of the uterus can be cured by the use of medicine alone. One great difficulty that besets the introduction of any new method of treating disease, and which is now operating adversely to the introduction of this new process of cure, is that we expect too much. The great success of Hildebrandt has exceeded that obtained by most of his followers, and these latter, becoming disheartened by their early failures, are likely, many of them, to reject the whole as a plausible mistake. A more temperate expectation would enable us to secure reasonable results. It is quite probable that only partial benefit will accrue in the majority of instances..
As is well known, many multinuclear tumors become dense as cartilage, while some of them, through processes of degeneration still more complex, are transformed into masses of earthy matter. These of course can no more be absorbed than the chalky deposits of gout. Neither have they vitality enough in them to permit of any disorganizing influence from pressure; and there is so little blood circulating through them that their nutrition cannot be affected by the action of ergot or belladonna on their arterial tubes. Then, again, in tumors with multinuclear centres of origin, the fibrous structure of the uterus is sometimes so completely replaced by the multitude of morbid growths that its power of contraction is almost destroyed. While, on the other hand, tumors with but a single nucleus are generally associated with a very vascular condition of the uterus, and the muscular fibres are hypertrophied much as they are in pregnancy. These are the most rapidly growing and most mischievous tuinors; they are also the most easily affected by ergot.
Between these extremes we may expect a great variety of results in treatment. The degeneration in the more vascular forms of the tumor under the influence of ergot is probably similar to the pro. cess of involution of the uterus after parturition. As the circulation is diminished in quantity and retarded in motion, the vitality of the tumor is lowered until fatty metamorphosis is fully effected. The substance of the tumor and the hypertrophied fibres of the uterus are thus at the same time converted into material most easily absorbed.
Those who have observed many cases of ergotism in the uterus containing these tumors must have noticed another more summary influence occasionally exerted upon them; viz., their expulsion through the mouth of the uterus into the vagina with inversion more or less complete. Not alone are the polypoids thus driven down from the uterine cavity and their immediate detachment effected, or strangulation and gangrene brought about, but the tumors situated within the walls of the uterus are also expelled.
If the tumor is situated much nearer to the mucous than to the serous surface of the uterus, this is very likely to take place under protracted uterine contraction. Two remarkable cases of this kind have fallen under my observation within the last few years.
One occurred in April, 1870, and was enucleated, before the class of the Chicago Medical College and in the presence of several of my colleagues. The uterus was inverted and was replaced without any difficulty after the tumor was removed. In this case the form of ergot used was the fluid extract, and it was administered internally in half drachm doses. It was taken continuously for almost three weeks, and caused a great amount of suffering from the pain of contraction. The pulse was accelerated and the uterine globe very tender to the touch for several days before the expulsion of the tumor.
The other case occurred a few months since. The expulsion was produced under the influence of ergot administered hypodermically and by the mouth. The medicine was administered in both of these ways for about a month by my son, Dr. H. T. Byford. While in the agony of expulsion, the patient, who resided some distance from us in another part of the city, sent for a physician in her neighborhood. That gentleman discovered the tumor partially expelled, encouraged the process by traction, and amputated the protruding mass with the galvano-caustic wire. The uterus I understand is at the time of this writing still inverted.
I have been able to collect from journals and reports made to me by letters received from members of the profession an abstract of one hundred cases exhibiting the most favorable results from the treatment of fibrous tumors of the uterus.
It is well known that Prof. Hildebrandt, in a communication to the twenty-fifth No. of the Berliner Wöchenschrift as early as 1871, called the attention of the profession to the utility of ergotine in the treatment of fibrous tumors of the uterus. While administering it by hypodermic injections to moderate the hemorrhages so often a troublesome symptom in connection with these growtbs, he was struck with the decided diminution in the size of the tumor. A continuation of the remedy thus administered, resulted in the entire disappearance of one of them in fifteen weeks. In eight cases, all but two underwent great improvement. The great pain caused by the injection rendered the treatment intolerable to one of these two patients. In the other the treatment was discontinued on arcount of ergotic intoxication. In four others, the tumors were greatly diminished, and promised speedy cures, but for various reasons the treatinent was not continued. One tumor of huge size, reaching above the umbilicus, totally disappeared; while another extending to the ribs, and largely distending the abdomen, was greatly reduced. The debilitating hemorrhages and leucorrhoeal discharges were promptly relieved in six of them.
In the American Journal of Obstetrics for January, 1875, Dr. Hildebrandt gives a synopsis of nineteen more cases treated by him. Two of these were cured; and in six others the tumors were greatly diminished in size, and the hemorrhages relieved. In eleven of these cases all the disagreeable symptoms were relieved, but the size of the tumor was not perceptibly affected. The two last cases reported in this series of nineteen were not benefited.
Soon after Prof. Hildebrandt made his first report of cases, Dr. Bengelsdorf read a paper upon the subject at a meeting of the Greifswald Medical Society. He alluded to four cases in which he had used the hypodermic injections of ergot. Two of these were in patients after the menopause; neither of them seemed to be influenced by the treatment. In the other two the patients were menstruating and the subjects of severe inetrorrhagia. This symptom in both cases was very much mitigated, but the tumors were not materially, if at all, diminished in size. Treatment was interrupted in one of them after the administration of sixteen injections. Dr. Bengelsdorf was favorably impressed by the treatment.
Dr. Chrobak, of Vienna, reports, in the seventh volume, second number, of the Archives für Gynæcologie, nine cases.
In the first, the tumor the size of a small apple was partially expelled from the cavity of the body into the cervical canal; the mouth of the uterus was dilated by sponge, and the protruding segment removed with the scissors. In case second, after forty-three injections, the tumor, which was situated in the posterior wall of the uterus, was not reduced in size, but the hemorrhage was cured. The tumor in case third consisted of several nodules in the anterior wall of the uterus; after twenty-four injections, there was no diminution in size, but the hernorrhage was cured. In case fourth the tumor was situated in the posterior wall and reached up to the umbilicus; after three injections the treatment was discontinued on account of the pain and inflammation caused by them. In the fifth case the amount of hemorrbage was reduced, but the treatment was discontinued for the same reasons as in case fourth. The tumor in case sixth was large, the uterus rising above the umbilicus; after twelve injections without results, the patient could not be induced to receive further treatment. The seventh patient was fifty-seven years old, , and the tumor showed a multitudinous development; the second injection, which was administered eight days after the first, caused severe symptoms of collapse, and the treatment was discontinued. The tumor in the eighth case was in the anterior wall of the uterus and reached above the umbilicus, and the monthly flow continued from eight to ten days; seven injections were used, with diminution of the tumor and improvement in the hemorrhages; the treatment in this case he expected to continue at some future time. In the ninth case the uterus was anteverted, and the cavity measured four and three-fourths inches in length; after twelve injections the hemorrhages ceased and the tumor diminished in size; the uterine cavity measuring only three and one-third inches in length.
Dr. Lombe Attbill records three cases in the Irish Hospital Gazette for September 1st, 1874. The first case was benefited in the diminution of the flow and the improvement of health. The second case was under treatment but a very short time; only five injections were administered, when the patient refused to permit another because of the severe inflammation following them. The third case was benefited, but abandoned from the same cause.
Dr. J.P. Wbite, of Buffalo, N.Y., writes me that he believes it is in this direction—the use of ergot-we must look for relief in the intramural and non-pediculated varieties of uterine fibroids. He says, that in the last year and a half, he has resorted to ergot in these varieties with marked benefit. In a few instances they have been completely absorbed, and in a larger number, the growth of them was arrested, the tumors were diminished in size, and the hemorrhages were suspended. He says that the number of his cases is fourteen, and that not more than one-third can be called
cured, while in almost the same proportion, the growth has been stayed or diminished, and the bleeding arrested.
Dr. E. W. Jenks, of Detroit, Michigan, in a recent letter, says he has used ergot during the past two years in the treatment of fibroid tumors of the uterus with the most gratifying results. Seventyfive per cent. of all cases thus treated were benefited, as manifested by arrest of growth and control of hemorrhage. About ten per cent. of the patients he considered cured.
Dr. C. G. Goodrich, of Minneapolis, Minnesota, sends me a very brief account of the most remarkable case I have yet heard of: The treatment was commenced in 1870, and continued two years. In describing it, he says the uterus filled the whole space between the ilia, and measured in the transverse diameter twelve inches, and in the vertical nineteen inches, extended up under the ensiform cartilage and close up to the margin of the cartilages of the ribs. The treatment was followed by cramps in the uterus, which, he says, produced a wild enthusiasm in the mind of his patient, and inspired her with strong hopes of recovery. Without consulting him, she doubled the dose of medicine, which was administered internally, and as a consequence she was attacked with very strong uterine contractions and symptoms of metritis. This caused him to abandon treatment for about one month, and had it not been for the urgent determination of the patient, he would not have resumed it. She insisted that as this was the first medicine which had ever affected the enlarged organ, she believed it would cure her, and promised to obey his directions if he would proceed. She so promptly and rapidly improved that he doubted if it were not a coincidence with, rather than a consequence of, his treatment. Prompted by this doubt, he abandoned the use of the ergot and belladonna, and continued alterative treatment. The patient soon assured bim that she no longer felt the griping pains caused by the remedy, and that the tumor was softer and larger than when she took the ergot prescription. The ergot and belladonna were again resumed, and in four months she was able to make a trip to Boston alone. While absent, she continued to take the medicine. From this time she continued rapidly convalescing, and is now in the enjoyment of fine bealth.
Dr. H. C. Howard, of Champaign, Ill., sends me an account of two cases treated by him. The first case was in an unmarried woman. The tumor was one originating from a single nucleus, intramural, and as large as a pint measure. He administered