THE TREATMENT OF UTERINE FIBROIDS.
Symptomatic treatment is only necessary before the removal of the tumors, and in cases unsuitable for operative interference.
Since time immemorial, two leading methods have been resorted to, for the cure of fibromata. One of these consists in the administra tion of medicines operating both generally and locally—the other in com plete or partial removal of the tumors by instrumental interference. It is unanimously conceded that we possess no certain means, no trustworthy methods, of producing reabsorption of a fibroma by constitutional treat ment.
Cases are, however, reported in which the use of Kreuznach, or some similar mineral water, is said to have cured such tumors. A similar result is reported to have followed the administration of calcium chloride (M'Clintock), bromide of potassium, iodide of potas sium, phosphorus, arsenic (Gueniot), and mercury. The general opin ion is that, if resorption of a fibroid have ever occurred during the use of these remedies,, it must be regarded as an accident. The majority of such cases may probably be referred to errors in diagnosis, involving the confusion of these tumors with limmatoceles or inflammatory deposits. We shall, later on, recur to the value of some of the above-mentioned remedies, in the palliative treatment of fibroids.
We cannot, as yet, pass so definitive a judgment upon the results of hypodermic injections of ergotin, as first employed by Hildebrandt.' It is not to be denied that, in pure myomata, especially if, as rarely happens, the tumor is not separated from the uterine parenchyma by a capsule, ergot may so influent the muscular fibres in and around the fibroma as to cause its atrophy and disappearance from defective nutrition. Spiegelberg' has particularly emphasized this fact, which is not, how ever, supported by any considerable statistical data Five cures have been observed by Hildebrandt in 25 cases of this nature, but so far as I know no others appear either in German or French literature. On the other hand Byford ' cites, from American literature, 18 cures effected by White, Goodrich, Howard, Jackson and others. The accuracy of this statement is, however, rendered somewhat doubtful by the fact that Byford quotes a case of Chrobak,' as cured, while Chrobak himself only claims that the symptoms were cured, while the tumor, a large part of which had been removed, could still be felt. It must, however, be admitted that a num
ber of complete cures have been effected by the hypodermic use of ergo tin. The possibility of errors in diagnosis, in some of the reported cases, must always be borne in mind. Even Hildebrandt' admits in his fifth case, the possibility that an inflammatory deposit may have been mistaken, for a fibroid.
This method of treatment is an exceedingly uncertain one, since, ac cording to universal experience, a cure can be counted on with but very little confidence. If it were possible to make the diagnosis of fibromata, with reference to their histology and their connection with the uterus, more exact, it might be easier to designate those cases in which hypodermic injections of ergot would be efficacious. It may be appropriate at this point to consider the value of this method of treatment in general. E. Jager' found that, out of 27 fibro-myomata of the uterus, treated by Hildebrandt, with hypodermic injections of ergotin, the tumor disap peared in 5, or 20 per cent. In 16 cases, or 64 per cent., amelioration of the symptoms occurred, i.e., hemorrhages were less frequent and the size of the tumors diminished. In 4 cases, i.e., in 16 per cent., no result was attained. In 20 other cases, reported by Bengelsdorf, Chrobak, Henning Scanzoni, Keating and Burrows, Jiiger found improvement nine times, i.e., in 42 per cent., no benefit eleven times, i.e., in 55 per cent., and no cures at all. He farther reports eleven cases, from E. Martin's clinic. In two of these improvement occurred, and in ten no result followed treatment. In five cases A. Martin (Jager, 1. c.) saw no result from hypodermic injections of ergotin. Fehling," hAvever, saw notable diminution in a tumor thus treated, and good results were attributed to the method by the members of the Leipzig Obstetrical Society, on the occasion of Fehling's report.