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esercise, with very much the same symptoms; always made slow recovery.
Seven years ago, Dr. M., although she had few symptoms pointing to uterine disease, made a vaginal examination, and found a hard mass in the pelvis to the right side, and told her she had a tumor as large as a fist, which she could feel after her attention was called to the matter; various forms of treatment were made use of, both internal medication, and external applications, yet no improvement; the tumor grew, and attacks of pain, sickness, etc. became more frequent.
I was first called on December 30, 1872; found her suffering from severe pain in right side, very tender on pressure, sickness of stomach, with entire loss of appetite, and by times, nausea and vomiting, headache, and some slight febrile excitement. I got a history of her troubles, treated symptoms, kept her quiet, and found rest one of the most important means of giving relief; it took some three or four weeks for her to regain her strength sufficient to get out of bed; I then made a vaginal examination, found a tumor the size of a child's head, very solid, nodulated, tender, pressing down in Douglas' pouch, and occupying a greater portion of the pelvic cavity, the cervix healthy, rather high up, no enlargement or ulceration.
I saw her frequently during the spring inonths; was comfortable througb June, July, and August; then she had three months of ill health, with pain in side, and same symptoms as reported above, yet not so severe. My experience in uterine fibroids and their treatment being limited to one case of fibroid polypus, I concluded it would be better to avail myself of the knowledge and experience of our President, Dr. Atlee; after a careful and thorough examination, he diagnosed the case to be one of intramural fibroid; advised me to let it alone and treat symptoms, said I might try the use of muriate of ammonia, yet thought it would be of little service; as he thought, so my patient arrived at the same conclusion, after taking the first half bottle of the mixture. I continued to treat symptoms for one year; the tumor grew rapidly. She suffered more pain, with tenderness, and any exercise caused an increase of suffering for a time.
In the fall of 1874, she went to a neighbor's on a visit, took sick, and was confined to bed for seven reeks, with very much the same symptoms as in previous attacks, though more aggravated.
I now spoke to Dr. Atlee in regard to the injection of ergotine as recommended by Prof. Hildebrandt. I had the consent of my patient, yet I wanted encouragement from some one else; I got none from the doctor, who thought it would be of no service, and I would likely have trouble with abscesses. I then searched the journals for
cases of the kind, and in consultation with Dr F. M. Musser, we concluded to try the ergotine, as it was about the only chance our patient had for relief, or comfort for any time, although we thought our case an unfavorable one for a cure, believing, as Dr. Atlee said, the tumor to be in the wall of the uterus, and therefore not much affected by uterine contractions, but we might be able to cut off the supply of blood by the action of the ergot on the coats of the vessels, and in that way prevent its growth.
I then procured one ounce of Squibb's Solid Aqueous Extract of Ergot, made my solution as he directed, one minim representing one grain. I injected ten minims with ten of distilled water in the region of the umbilicus; this was followed by some pain and smarting, but not the intense burning pain reported by some physicians. Made sixteen injections, when I stopped eight days. She menstruated freely as usual, and natural in every respect. Then made sixteen more, when she menstruated in twenty-seven days from the commencement of the former period.
In the next intermenstrual period I made eleven injections, when she complained of very severe pain in the side, and I substituted onethird grain of morphia for the ergot; waited three days, and continued the ergot. After having made ninety-nine injections, slie, or I, became somewhat tired of the treatment, and, the weather being very warm, we took a rest. Called again in September; said she lad enjoyed better health during the summer than for some years ; could do more work, yet any active exercise was followed by pain. Tumor was smaller; thought the treatment had been of service, and was anxious to continue it if I thought it would be of any advantage. In the four following months I made seventy-eight injections. Could see no change in size of tumor; so I stopped, thinking I had given the remedy a fair trial.
In the following month she was not so well; thought she felt the want of the injections; had some pain in the side and headache, yet was not confined to bed.
Being anxious to bring my report up to date, I called April 25, 1876, found her at work, and pretty comfortable; troubled some with neuralgic headache; stronger than she had been for a long time; no hard spell for eighteen months. Tumor occupies the right inferior portion of abdominal cavity, solid, round, and smooth. On vaginal examination find it nodulated, pressing on the bladder, filling the pelvis, and pressing cervix to left almost out of reach. Cervix one inch in length, normal, no inflammation or ulceration, os small and soft; menses regular; very little leucorrhea, and she said “almost afraid to say how well I am."
I was very much pleased with the use of the ergot by hypodermic injection, not that we derived so much benefit from it in this case, yet it may be that it was the means of checking the growth. The tumor had more than doubled itself in size during the year before the injections were used, and has grown very little since. She is much more comfortable, stronger, suffers less pain, and no spell since. I know very well that nature sometimes does all for these cases that was done in this without any treatment, and that one case is no test of a remedy. In using Squibb's extract I have no fear of abscess, as I have made several hundred injections without any trouble. In this case a spot three inches square would cover the surface in which it was used. It always made her very drowsy in about fifteen minutes, with pain as if caused by uterine contraction, and an increase of leucorrhaal discharge. It never had any effect on the menstrual flow, which was always said to be natural; after using it for several days she complained that it affected her eyesight.
The first and most important step in every case is to make a correct diagnosis, for in these cases very much depends on the exact position in regard to its treatment and curability.
In this case I have been led, through watching its progress, symp. toms, and effect of treatment, to differ from our worthy president in regard to its position, or rather the class to which it belongs. I think if it were intramural we would have had more hemorrhage, which is always a prominent symptom, and not so much pain; the cervix would have been involved; here it is of normal length and not influenced; it is true we cannot pass a sound, but I believe the weight of the tumor has dragged the fundus to the right side, produced flexion to some extent, which prevents its passage. I think it is extra-uterine or subperitoneal from the fact that it has not dilated the os, caused so much pain and no hemorrhage. Dr. Alfred Meadows says, in a paper read before the Harveian Society, “the more peritoneal or subserous the tumor is, the more is pain the predominating symptom." There is always enlargement of the uterus in intramural tumors pushing forward the mucous membrane, blood attracted to the part and freely poured out with a great quantity of mucous discharge. Here we were never able to introduce the sound over one and a half inches, which I believe not due to the tumor being in the way, but to flexion.
The tumor I believe belongs to the incurable class removable only by gastrotomy, and no one would be hardy enough to attempt it. Dr. Matthews Duncan believes liquor calcis chloride of the Dublin Pharmacopæia possesses the power of entirely removing some
tumors, yet many others have failed, while some report improvement mostly in tumors in which hemorrhage was a prominent symptom.
Dr. Theophilus Parvin, of Indianapolis, says, in the American Practitioner, “ with the exception of ergot, more especially when used hypodermically, and even this frequently fails in accomplishing good, the medical therapeutics of these tumors must be regarded as sadly dark and uncertain."
Dr. Greenhalgh recommends the use of the actual cautery in the enucleation of intramural tumors, more especially those involving the cervix.
Dr. Alfred Meadows dilates or incises the cervix, breaks down or cuts the capsule, turns out the tumor from its bed or trusts to ergot to finish the work.
Several years ago I was asked to see a lady forty-eight years of age, mother of eight children, stout, looking the picture of good health, yet complaining very much of pain, remarking "they are like I had in confinement, and fully as as any pains I ever had at such times," menses coming on every two weeks, so very free she could scarcely be about, was compelled to give up her business of nursing. I made a vaginal examination, and found a small tumor in the cervix partly protruding from the os, took a double canula and removed it; being about the size of a pigeon's egg, was much surprised to find so small a tumor produce so much suffering and hemorrhage; a few applications of nitrate of silver completed a cure. She suffered for two years, was told by her physician it was change of life; when he insulted her, and drove her to me for advice by telling her a man might relieve her of some of her trouble, as she was a widow. It is always best to listen to the complaint of our patients, make a thorough examination, and not be satisfied with any thing else. L AMPETER, May 2, 1876.
J. H. MUSSER.
SCORBUTUS.-Having had under treatment a case of scorbutus, I now intend presenting to this society a brief history of it, as well as an outline of the treatment pursued, hoping it may not prove entirely uninteresting.
I have felt a peculiar interest in the case myself, not so much, however, in consequence of any peculiarity of its symptoms, or irregularity in its course, but rather because of the extreme rarity of its occurrence in private practice, and more particularly in an agricultural community like this, where the cheapest and most usual articles of diet are fresh vegetables, the very best antiscor
batics we possess. It is because of this infrequency that I present this case, and that I hope to obtain your attention upon this occasion.
The subject of the case which I am about to relate is the wife of an industrious laboring man. I have been professionally connected with bis family for a period of more than three years, during which time I found her to be, habitually, of a gloomy, or rather melancholy disposition, with a bilious-phlegmatic temperament. She is quite small, both short and slender, weighing, perhaps, about ninety pounds, and never since I have known her, I think, did she exceed a hundred. Her complexion is extremely dark. She said she had not been well a day for years, and has been continually expecting some terrible calamity to befall her in the shape of some fatal disease. In fact, she is a confirmed hypochondriac. She had been afflicted somewhat with dyspepsia, but very slightly so, during the last year or eighteen months previous to this attack; and for some time had been harboring the very erroneous impression that vegetables did not agree with her, and she therefore almost entirely abandoned the use of them. I was aware of her prejudice in this particular, and on several occasions endeavored to dissuade her from its practice, but, it seems, without success; for, when it became evident she was suffering from scurvy, I questioned her on the subject of eating vegetables, when she acknowledged she bad eaten scarcely any for months past, declaring it would kill her to eat them; and it was not until I insisted that she must make use of a more liberal amount of that kind of food, or she would certainly die for the want of it, as this was the whole cause of her sickness, that she at last, very reluctantly, however, consented to try a little, all the while declaring she knew the consequence would certainly be of the most disastrous character.
It was in the latter part of March that she sent for me to call and see her, when she informed me she was suffering from rheumatism, having severe pains in the extremities, and particularly in the lower limbs, across the chest, and in other parts of the body. She represented those pains as of the most excruciating character; but being familiar with her disposition as an inveterate complainer, I did not take so much heed of her representations, or make as thorough an examination as I might, or perhaps should, or would have done, under other circumstances; and as she had previously been afflicted with repeated attacks of subacute and chronic rheumatism, I concluded, rather hastily, that this was merely a repetition of the same disease. The fever was very slight, there being scarcely any excitement of the circulation, but she was suffering,