Eggel, Schrenk, Lohlein, and E. Martin reported four unsatisfactory cases to the Berlin Obstetrical Society.° On the other hand Winckel,' although he failed of observing any com plete cure after this treatment, still confirmed Hildebrandt's statements relative to the arrest of hemorrhage and the reduction in the size of the tumors. A considerable number of uterine myomata have been treated at my clinic, in careful pursuance of the method in question, and chiefly by my former assistant, Prof. Zweifel. We were unable to observe any considerable decrease in the size of the tumors, although the hemorrhages were, in many instances, checked, for a varying period, after the treat ment.
The diminution in the size of the tumors was transient and often characteristic, as long as the contractions referable to the ergotin con tinued. True diminution cannot, however, be said to have occurred. A similarly deceptive appearance of diminution may be produced by con gestion occurring at the menstrual epoch.
In a case, observed by myself, the dimensions, taken with all possible precautions, were as follows: Circumference, at the umbilicus, 87 etm.; at a point midway between the navel and the symphvsis, 86 ctm ; distance: between the ensiform cartilage and the umbilicus, 17 ctm.; distance from the syinphysis to the xiphoid cartilage, 38 ctm. These dimensions increased, during the eight days preceding the menses, to 90, 89, 18 and 40 ctm., in spite of injections of ergotin and without complicating tympanites. After violent hemorrhage, which continued 5 days, they were again reduced to 85, 85, 15 and 33 ctm., respectively. Later they returned to their former size, and remained, thereafter, un affected by the hypodermic administration of ergot.
Emmet and Barker' also reported, to the N.Y. Obstetrical Society, that they had had no success with this method of treatment. On the other hand Byford (loc. cit.) finds the results, in 61 cases, to have been as follows: Completely cured, 18; reduction of the size of the tumor and arrest of hemorrhage, 26; arrest of bleeding, only, 5; no results, 12.
Quite recently Leopold' has published the following observations on the use of long•continued hypodermatic injections of ergotin. His cases were twelve in number. In three of them no changti occurred in the fibroids. In five the hemorrhages were considerably lessened, and in four cases the tumors also became somewhat reduced in size. Similar experiences were
recorded by Schorler (1. c.) at SchrOder's clinic. In not a single instance was a cure obtained. Out of 61 cases occurring in private practice, 37 were improved, and 24 not improved. Of twenty dispensary patients, seven were improved and 13 not improved.
On the other hand Jakubasch ' states that in 22 cases he "almost in variably observed an amelioration of symptoms." Fritsch,' Brnbeeker.' and Dean' have described cases of expulsion of sub-mucous fibroids through the vagina, terminating favorably, after treatment of this kind. P. Muller has published four cases in which he observed considerable reduction in the size of the tumors, following the injection of ergotin.
All observers agree that, even when the treatment is most carefully conducted, i.e., by means of deep injections into the upper abdominal regions, very violent local pains, indurations, inflammation and abscesses of the skin may be the results. Transitory symptoms of ergot poisoning have, moreover, been occasionally Considerable unanimity of opinion prevails regarding the necessity of making more than 50 hypo dermic injections before any definitive conclusion can be drawn concern ing their efficacy in any individual case. This fact makes it the more necessary to take the irritating local effects of the treatment into account.
Lent' observed notable improvement in one case, after the hypo dermic use of ergotin. A peritonitis, of problematical source, caused the patient's death, and no statement is made concerning the possible connec tion between the peritoneal inflammation and the treatment.
Allen' observed reduction in the size of the tumor and diminution of hemorrhage after the hypodermic use of ergotin. The injections were made, in his case, on the left side of the abdomen. After the 30th injec tion an extensive thrombosis occurred in the veins of the left leg and per sisted for three months. When metrorrhagia recurred, after several months, injections of ergot were resumed, this time on the right side of the abdo men, and were soon followed by serious venous thrombosis in the right leg.
Lusk' treated a case of large myoma for one month by almost daily injections of one grain of ergotin. The tumor diminished in size, but became gangrenous. The patient died of peritonitis.