Certain celebrated medicinal waters and sea baths are now much em ployed. Their efficacy, in certain cases, cannot be well denied, although their value is, on the whole, slight, and their effects uncertain. I have observed that, in general, anaemic persons do not derive benefit from mineral-water baths. Such patients rather experience relief from sea baths, or from the influence of life near the sea, upon their general health. It is difficult to distinguish between the local and general effects of these baths. They sometimes seriously aggravate the hemorrhages. Although a diminution of the menstrual flow often results from their use, I have quite as frequently seen an increase of it following their em ployment. This is probably referable to increased affiux of blood to the abdominal cavity. This is also the reason of the prejudicial effect of hip baths, in these cases.
The springs at Kreuznach, Iteichenhall, Krankenheil, and Kissingen, in Germany, and at Saline and Salies de Warn, in France, enjoy an especial although undeserved reputation in the treatment of uterine fibroids.
The springs of Kissingen, Marienbad, Carlsbad and Vichy, and of Bourbonne, in France, are efficacious for fleshy persons inclined to con stipation. These waters probably reduce the size of the uterus, and possibly of the tumor, by diminishing the tension in the abdominal arteries. I have often observed a temporary amelioration of some of the symp toms, particularly of the hemorrhages, after the use of these waters.
Few general directions can be given regarding the constitutional treat ment of fibroids, although it is doubtless of great importance. It relates chiefly to regulating the mode of life, and must be carefully adapted to the requirements of each individual case. Some form of iron is indicated by the anaemia of most patients suffering from fibromata. Even in those cases, however, in which it is tolerated by the stomach, producing no digestive disturbances, I have never been able to observe any appreciable benefit resulting from its use.
In those cases not adapted to operative interference, we are reduced to the necessity of symptomatic treatment. The symptom which is seldom or never absent; in cases of sub-mucous and interstitial tumors, and which, at all events, most imperils the patient's life, is hemorrhage. The means for checking dangerous hemorrhages are numerous and well-known. Among drugs for internal use, we shall consider at this time only ergot or ergotin; the utility of extr. hydrastis canadensis, so warmly recom
mended by Schatz' and others, is not yet sufficiently well established. Aside from these remedies cold applications to the abdomen, and cold va ginal douches prove valuable. I have never obtained permanent results from hot injections. The hemorrhage was indeed at once arrested by them, as a rule, but soon recurred.' Astringent vaginal injections of diluted liq. ferri chloridi, tannin, etc., likewise produce only temporary results. The only speedy and certain method of arresting the bleeding, consists in the careful introduction of a perfect tampon, preferably composed of cotton wool dipped in styptic solutions.
I find by reference to modern literature, that transfusion has been twice performed, after threatening uterine hemorrhage. One patient died during the operation,' the other recovered.' Only human blood should be used for the transfusion. I should not have attended to this point were it not for the fact that the transfusion of blood from an .inferior ani mal is favorably mentioned in a now gynecological text-book which is in many respects meritorious. It is a striking proof of the unscientific principles often governing modern medical practice that so venturesome and purely empirical a procedure as the transfusion of animal's blood should attract such general attention, at a time when the experiments of Panum and others have proven the deleterious results of the exchange of blood between different animal species.
The prevention of the recurrence of hemorrhage and the moderation of menstruation is more important than the temporary arrest of bleeding, which is usually easily accomplished. The means adapted for this end are local and general ones.
The latter variety embraces really only the subcutaneous administra• Lion of ergotin, according to Hildebrandt's method. The hemostatic effect of this drug, in a considerable number of cases, is beyond question, and although this effect be by no means certain or permanent, it still has the advantage of harmlessness over other methods of treatment.
The most radical measure for the prevention of hemorrhage is the ex tirpation of both ovaries, even when sound. By this means the menstrual congestion of the pelvic organs, which is the chief cause of the profuse bleeding, is obviated. But this subject has already been fully considered.