ON THE TREATMENT OF FIBROIDS OF THE UTERUS

BY MEANS OF DRY EARTH.

WITH OUTLINE TRACINGS OF THREE CASES SO TREATED IN THEIR VARIOUS STAGES OF PROGRESS.

BY ADDINELL HEWSON, SR., A.M., M.D.,

PHILADELPHIA, PA.

GENTLEMEN:

I must first acknowledge the compliment paid to me, and which I highly prize, namely, that of having been asked to make this address before you to-day. As many of you are aware, I have been for more than twelve years most zealously engaged in studying the "Uses of Earth in Surgery." All of the work involved in such study has been done under the bans of ridicule, of malice, and, if worse, of assertions of unsoundness of mind, and that, too, by men in the profession who knew such to be untrue. Thank God! I have not only outlived such villany, but can even boast of having been well rewarded in my successes of the treatment in the single subject on which I shall have the honor to address you to-day.

Some eight years ago I was, one morning, in the south of France, and whilst eating my breakfast was commenting on the public spirit of the famous resort in which we then were, on its having a daily paper with a list of the most recent arrivals at its hotels. I had scarcely uttered my remark, when the waiter presented me with a telegram, the direction of which, for me, was correct in every detail. I exclaimed, "why even this is better than what I get at home! They have spelt all my name right!" I immediately opened the message, and to my utter surprise it was from one of the most famous anatomists of America. It was, to come cut his thigh off-he was then over ten miles away from me. I hastened without delay, as I would to any stranger in a strange land who I knew was such a sufferer, as he must be from the wording of his summons. I, howVOL. XXXI.-40

ever, had nothing to take with me but my pocket-case and a pound of prepared clayey earth. Such, indeed, had often been my only resources when caught away from home on this side. of the Atlantic, travelling, as then, for rest and recreation.

I was not long in reaching the doctor, and in determining his condition, and what was to be done for him. He had an open, suppurating knee-joint of the right side, which had evidently been fully laid open on each side of the patella by the hands of a skilful surgeon. Such an operation, he told me, had been done by one of the best of American surgeons, and the same high authority had told him, some time previous to his leaving home for Europe, that if he should have another attack of suppuration in the joint like that for which he had made these free incisions, he should send to the nearest surgeon and have the limb removed above the knee. I examined it carefully, took into consideration all the details of the case, and then said, candidly, "My dear doctor! I am, like yourself, a stranger in a strange land, and have come promptly and honestly to you to see what I could do for you in my desolate state as to instruments. But," said I, further, " even if I had the necessary instruments I would not yet sacrifice that limb." "What!" he exclaimed, "would you still do?" I said I would make still another attempt to save it, and that by covering it with clean earth. "Ah!" said he, "that is just the thing I had in my mind when I telegraphed for you this morning after reading of your arrival in —. I wanted to try the dry earth treatment." "Hurrah!" said I, "not only for Mother Earth, but for the public spirit of people in the place which sustains a lively enough paper to keep all advised of the most recent arrivals in it. If it had not been for that paper I would have been away in twenty-four hours' time, my whereabouts afterwards discovered too late for me to do you any service." I went to work at once, and soon had the joint enveloped with the earth, and he was expressing himself, constantly, delighted with the relief it gave him before I got everything properly adjusted about him. The application of the earth was made in my usual manner, namely, that of filling the cavities and suppurating surfaces with clean, finely powdered clayey earth, and retaining this in place by strips of bandage two and a half inches wide, which were spread with a thick paste made of the earth and water. The layer of bandaging was made in the ordinary way of strapping the knee, and,

and

when dried, held everything intact. When I saw my patient the next morning, he reported that he had the best night's rest he had had for many a night, and that, too, without any of the anodynes he had been in the habit of using, and which I tabooed at my interview the day previous. He was delighted with the relief he had gotten. Each subsequent day he improved, and at the end of two weeks he was out of doors on one of his old crutches, free of pain or suffering of any kind, and confident of his radical cure being at hand.

He then (at the end of two weeks) stated that there was a lady in the town-an old patient of his-on whom he had made an explorative operation for ovariotomy some years previous. He had then made a section in the left side over nine inches long where he found a multilocular fibroid involving the uterus, ligaments, and deep pelvic tissues to such an extent as to render its removal absolutely impossible. There was nothing for him to do but to return the mass and close up the wound. Prior to doing this, however, he put the immense mass in scales and determined its weight, as accurately as he could under such circumstances, to be over thirty pounds. He then returned it into the abdomen and closed up the wound. The patient recovered from this operation, and then expressed her determination never to let the doctor be beyond her reach.

constantly near him, And now, from what

When he was sent to Europe she was always in the same town where he was. she had seen from my treatment with him, she was sure I could cure her, and nothing would satisfy her until I had seen and examined her, and given her a positive opinion as regards this point. I was candid with her, and said one's prognoses in all such cases must always be guarded, but that if I could not make a cure of her I could give her some positive relief. Of this I was sure. For, from the effect observed immediately after the application of the earth dressing, I had learnt long since to make this as a positive promise, not always before or after the first application, but certainly within the time of the first five of them. If there was relief then, we might always look for that being positive and permanent.

She readily let me apply the dressing. It was a layer of the paste of clay over the abdomen, made to lay close by smearing it with a wooden spatula, and then retaining this layer in place by a series of bandage-strips well smeared on their inner side

with the paste of clay, and arranged on a broad board so as to overlap each other slightly, just as the scultitus is applied. This dressing of the clay I had originally made a full half inch thick, but soon had learned that a quarter of an inch was sufficient. My purpose of mixing it into a thick paste was to adopt the easiest way of applying it with security for its remaining in situ when it became dry. To increase this security I had in the earliest of my uses of the clay, or earth-dressings, resorted to the expedient of laying a piece of tarlatan gauze of loose texture on this layer of earth before applying the retaining bandage. This practice I have frequently continued, and have never found a better expedient for the purpose. The four years' experience and experimentation, which I had then gone through with, had taught me, also, that the efficiency of earth as a discutient agent was essentially due to the earth being dry, and in that state kept in complete contact with the cutaneous covering of the growth. To make it stick I have mixed it into a paste with water; the rapidity of this drying has been dependent, not only on the locality and the thinness of the application, but also on the intensity of the action almost immediately set up in the dressing. For here, as in every other previous case in which I had applied the earth, heat was quickly generated, so as to make such an increase of temperature readily perceptible in contrast with that of the mixture of clay and water in the bowl.

The details of the preparation, mode of applying, and direct effects of the earth-dressing, which were the same in this as in many other cases familiar to me at this time, must, however, be postponed until I have completed the details of this and some other cases which I think proper to introduce to you as illustrative of the earth's action on fibroids of the uterus.

Dr. -'s patient the next day, the day after my first application of the earth-dressing, was relieved in every respect. She was not only relieved of pain, but diminished in size in every direction. My plan was to measure her by a tape measure around the chest at the xyphoid; three inches above the umbilicus; at the same; three inches below the same; and across from one anterior superior spinous process to the other. This was done with a strong, unyielding measure, drawn as tightly as possible. Such a method of measuring I have now abandoned for a more accurate one. Its use was, however, definite and accurate enough to show the changes occurring daily in her

case. My present plan of making measurements I will explain hereafter.

The patient's condition steadily improved from day to day, so that at the end of three weeks from my first application of the dressing she was reduced nearly one-half in size. She was full of life and spirits, declaring that she was going to desert her old doctor, and hang on to her dirty one. "Oh!" said I, "that won't do. I am no poacher, even in a foreign land. You are Dr.'s patient, and it is only with his consent that you will adopt any such plan." "I will make that all right," said she," the doctor and I are old friends." "Very well," was my reply.

The next day the doctor came to me, and said, "Do let Mrs. join your party. You will be the means of curing her." “Very good,” was my reply; "I will be most happy to do all I can towards such a result. But it was not to be done in her way without your approbation." "Take her, by all means," said he, "you have already been detained by the two of us over a month, and you must be getting impatient to be moving on with your family." I said, "Yes, it is high time I was moving. I have been here five weeks, but would not, except for the attraction of your cases, have staid here twenty-four hours. I am well satisfied with the relief I have given you both, and would not now be thinking of leaving you, except that I think you can take care of each other." "Oh, no," said he, "you are entitled to the credit in both our cases. Take her with you, and I will be most ready and the first to credit you with our cases."

My party started in a few days, the lady in the same train, and she was always for twelve weeks from the time I began her treatment constantly under my observation. We went through Switzerland, Austria, Prussia, Holland, and the north of France, reaching Paris the Monday of a week made famous by the assembling of a great medical congress there.

Reading over the list of arrivals to my patient, I came to the name of our mutual friend, the doctor; but I quickly said, "this is Dr. and wife, and it cannot be our doctor, for he was a widower when I left him." "Oh!" said she, "that is all right; you made such a good cure of him before leaving

that he has got married again."

And so it was. I went immediately to see him, found him well, with the joint all closed, and free of osteal and periosteal