« SebelumnyaLanjutkan »
very anæmic. The discharge ceased and the tumor disappeared in five months from the time she first came under my care. The remedy was at first used hypodermically; but, on account of the pain and inflammation at the punctures, I was obliged to cease this mode of administering it, and gave it internally. Teaspoonful doses of Squibb's fluid extract were given twice a day for the last three months of the time the patient was under treatment.
In three other cases, in which the medicine was given internally, the tumors were very much reduced in size, but did not disappear. The hemorrhages and leucorrhoea were cured, and the patients restored to health.
In another, the hemorrhages and leucorrhea were rendered much less profuse, but the tumor was not reduced in size. In a colored senile patient, over sixty years of age, with a large
a multiple tumor, no effect was produced by the ergot.
In four of my cases I was obliged to suspend the treatment several times for a few days, to give the patients a respite from the almost constant pain.
Five of these complained of great beat and tenderness of the uterus after they had been under treatment about four weeks.
In all, the pulse was accelerated and remained small and weak.
As one of my cases presented some features of more than ordinary interest, I will give it more in detail : The patient had been married twelve years, was thirty-seven years old, and sterile. She had been aware of the existence of the tumor for three years, but could not give a very clear history of its progressive enlargement, The uterus extended three inches above the pubes, and was a little to the right of the median line, very hard and irregu. lar in shape; but I could not discover that there were subperito. neal nodules. Per vaginam the tumor could be felt to occupy the right side and anterior wall of the uterus, and fill up two-thirds of the pelvic cavity. The cavity of the uterus measured four and a quarter inches. A polypus, pyriform in shape, quite firm in consistence, about the size of a pigeon's egg, depended from the mouth of the uterus, and appeared to be attached to the upper part of the posterior wall of the cervix. The diagnosis was intramural fibrous tumor of the uterus, with two nuclei of development, and a fibrous polypus. The patient was somewhat anæmic from the long continuance of profuse leucorrhea and metrorrhagia. Without removing the polypus, I commenced treatment by giving the patient three grains of the solid extract of ergot three times a
day. The next menstrual flow was not so profuse, and the leucorrhoea diminished almost from the beginning. At the end of four months, the menstruation was normal, the leucorrhoea had ceased, the tumor was reduced to half its former dimensions, and the patient's health restored. A continuation of the treatment two months longer causing no further reduction of the tumor, it was suspended. During the treatment, I watched with much interest the effects produced upon the polypus; examining it once in every ten or twelve days. It showed decided decrease in size at the end of the first ten days, and progressively decreased until, at the expiration of four months, it was not more than one-third the size it presented when first examined. It was twisted off at this time with great ease, and its removal was followed by almost no loss of blood.
The only apology I have to offer for the brevity with which the cases in this paper are mentioned is my aim to give no more than was necessary to obtain a satisfactory exhibition of the results of treatment by the use of ergot.
1 4 1 1 1 1 2 1 4 1 2 9 1 3 1
1 2 1 3
3 1 3 1
SUMMARY OF CASES.
The total number of cases here cited is one hundred and one. Twenty-two of them are reported cured. In thirty-nine more the tumors were diminished in size, and the hemorrhage and other disagreeable symptoms removed. Nineteen of the remainder were benefited by the relief of the hemorrhages and leucorrhoeal discharges, while the size and other conditions of the tumors were unchanged. Out of the whole number only twenty-one cases entirely resisted the treatment. This shows results decidedly favorable in eighty of the one hundred and one cases.
We may still further appreciate the favorable effects of the treatment by the consideration that in twenty-one cases it was suspended, which is as great a number as resisted treatment.
It is also a noticeable fact that some of the cases in which the treatment was suspended were very much benefited by it.
I have no doubt that many more cases of fibrous tumors of the uterus treated by ergot might have been collected, had time permitted, as I have heard of cases the history of which I could not obtain.
In collating my cases, I have in no way selected or arranged them to influence inferences as to results, but I have faithfully recorded all I have received from correspondents, or found in journals, which were given sufficiently in detail to enable me to arrive at a correct idea of the treatment and its effect.
MODES OF USING ERGOT. Not much uniformity has been observed by the writers above quoted in the manner of using ergot.
Drs. Hildebrandt, Bengelsdorf, Chrobak, Atthill, and Jackson recommend, and use it hypodermically.
Drs. White, Jenks, and Howard administer it hypodermically, internally by the stomach, and in the form of suppositories in the vagina and rectum.
Some of the arguments in favor of the hypodermic injections are: 1st. It acts more rapidly and with more certainty. 2d. It does not produce the gastric disturbance sometimes caused by ergot when taken internally. 3d. It can be administered in this way when it is entirely impracticable to give it internally on account of the great exhaustion or gastric irritability of a patient.
The main objections to the hypodermic method seem to be:
1st, the pain inflicted by the needle; and, 2d, the inflammation and suppuration which ensue.
Dr. Hildebrandt has met with but one case where the pain of the puncture was an objection to its hypodermic use. With regard to abscesses he says: “I am sure I do not exaggerate when I say that up to the present time I bave myself made one thousand hypodermic injections of ergotine for various purposes, or have seen them made and observed their results in the clinical wards in charge of my assistants." And he then adds: “I have never seen an abscess follow the injections made by me personally, and only in three clinical cases did this occur. The chief reason why no abscesses formed among the large number of other injections is that I always injected the fluid very deep into the subcutaneous cellular tissue--perhaps even into the abdominal muscles.”
Dr. Atthill met with this difficulty in all three of his cases, although he also injects the fluid deep into the tissues.
Dr. Chrobak was obliged to desist from treatment on this account in four out of his nine cases.
Dr. Cowan was interrupted in his case by the formation of abscesses.
Thus it will be seen that much difficulty is experienced by many in carrying out the treatment.
Dr. Hildebrandt's reason does not seem to be the only one why practitioners are so troubled with this objection, since Dr. Atthill and others have also injected deeply. As far as I can judge, very few have been able, even by the most careful efforts, to achieve the same happy results in this respect as Dr. Hildebrandt.
Dr. Hildebrandt, and also Dr. Atthill, select the lower part of the abdomen as the part in which to make the injections.
Dr. Keating, of Philadelphia, injects just posterior to the great trocbanter.
Dr. Jackson selects the deltoid region, and thinks it makes but little difference where the insertion is made.
Dr. White, of Buffalo, injects over the abdomen, into the cervix uteri, and into the substance of the tumor if it is accessible, and has met with no bad results.
Dr. Wey used over two hundred injections in the abdominal region above the pubes in one case, and abscesses occurred in the seat of the puncture as often as once in eight operations.
Dr. Dean commenced using ergot in the form of Squibb's fluid extract by injecting it into the cavity of the uterus through a flexible catheter, but now he employs the solution of Squibb's solid extract dissolved in water-one grain to five minims. Of this he injects from ten to fifteen drops into the substance of the cervix about four times a month or once a week. He thinks the effects are more prompt and energetic than when administered hypodermically. His instrument consists of a barrel the same size as the common hypodermic syringe and a tube six inches long. He has known inflammation and suppuration to follow but once in his whole experience.
DIFFERENT PREPARATIONS. Believing the preparation of the medicine employed had much to do in causing the irritation thus observed, efforts have been made to find some form that would not produce the painful results thus described.
Hildebrandt is now in the habit of using Dr. Wernich's formula for the watery extract of ergot, and Dr. Mundé thinks it is very similar to the preparation made by Dr. Squibb. Dr. Hildebrandt added pure glycerine in the proportion of about one part to four of the solution, and the amount of the injection was forty minims. This contained a little over two grains of the extract; probably representing ten to twelve grains of the crude ergot.
Most American practitioners now use Dr. Squibb's preparation above referred to, some of them by dissolving it in pure water, while others add to the water a small amount of pure glycerine. Dr. Squibb recommends a solution of this extract as follows: Dissolve two hundred grains of the extract in two hundred and fifty minims of water by stirring; filter the solution through paper, and make up to three hundred minims by washing the residue on the filter with a little water. Each minim of this solution represents six grains of ergot in powder. Of this solution from ten to twenty minims are injected once daily or once in two days. This is the only preparation I have used in hypodermic injections, and I believe it the best we can at present procure.
Dr. Wey properly lays great stress on the necessity of having the solution fresh, believing that in a very short time it deteriorates, and becomes more irritating to the tissues. He says, "ergot thus . administered generally produces prompt effects. In most instances, in half an hour the patient experiences painful contractions of the uterus. The hand applied over the organ at once recognizes the increased hardness in the mass. These contractions increase in.