A brief review of the preceding cases will beget the conviction that Hil debrandt's method of sub-cutaneous ergotin injections constitutes a very valuable accession to our therapeutic armamentarium against uterine fibroids. This method seems well adapted for permanent or, at least, for long-continued arrest of hemorrhage, however uncertain its results may be with reference to the complete re-absorption or to a reduction in the size of the fibroids. In spite of the disagreeable results which may possibly result from this method, it is nevertheless the least dangerous and the most certain, particularly in cases of pure myomata of the sub-mucous variety.
Hildebrandt very properly emphasizes the fact that this method should not be employed if the tonicity of the uterine walls be impaired by either atrophy or areolar hyperplasia. If inflammatory products, resulting from parametritis or from perimetritis, be present, the method in ques tion is not to be recommended. Hildebrandt advised the use of a solution of the aqueous extract of ergot, 3 grammes, in glycerin and water, each 7.5 grammes. An amount of the solution equal to the quantity contained in a Pravaz's syringe is used for each injection. Later, the same author used solutions of the aqueous extract of ergot, 3 grammes in distilled water, 15 grammes, and the preparation of Wernich. Martin employed a solution of extract of ergot, 2 grammes, and of carbolic acid, one drop, in 10 grammes of distilled water. The aqueous extract of ergot deserves our preference, according to my experience. Wernich's preparation, for sale at the Augusta pharmacy, in Berlin, seemed to me to have no advantages, either with regard to certainty of its results or to freedom from pain, after its injection. It also spoiled very rapidly.
Dragendorff's sclerotinic acid was very badly tolerated by one of my cases, perhaps because it was not neutralized. The preparation of Zweifel deserves careful trial.
For the sake of completeness I shall now mention other methods em ployed for the radical cure of uterine myomata. None of them can claim recognition as genuine methods of treatment. Freund' saw spon taneous degeneration and extrusion of the tumors in two cases, after the internal use of the Jastrzember saline waters. Simpson' calls attention to the possibility of producing calcification of the fibroid by irritating it. Breslau' attempted this method and jeopardized the patient's life by in ducing pelvic peritonitis. A. Meadows' violently opposes this treatment.
Kimball ° tried electrolysis, introducing needles through the abdominal wall into the tumor, and employing a Bunsen battery. He claims to have completely cured a very large fibroma by this means. Routh' reports a similar result.
Freeman' uses electrolysis by introducing one needle into the tumor through the cervix, and the other through the abdominal walls. He re ports a case of large myoma, which almost disappeared after eight appli cations of this kind.
A. Martin,* of Paris, employed this method as follows: The positive electrode is applied to the cervix and the negative is placed over the ab domen. Eighty to one hundred seances are necessary, and fifteen to twenty-five cells are used in the battery. Out of twelve cases thus treated, four were cured, four improved, and four not benefited.
Zweifel° used electricity in two cases, in one of which a beneficial result was obtained. Cutter' used " electro puncture " in fifty cases of large fibroids. The electrodes were plunged through the abdominal parietes into the tumor. Each s6ance occupied from three to fifteen minutes, and the whole number from one to nineteen. Intervals of one or two weeks were allowed to elapse between the sittings. In seven cases no result was obtained, four times death ensued, thirty-two tumors ceased to grow, three were improved, and four " cured." Repeated efforts have been made to artificially produce gangrene of the tumors, which, when it occurs spontaneously, usually leads to favorable results. This method has been generally abandoned, on account of the great dangers incident to it, chief among which is absorption of septic material from the gangrenous tumor, which is still intimately connected with the uterus. Spontaneous gangrene is not attended by this danger, since it usually results from a separation of the tumor from the uterus. This point will be considered, at length, in our remarks concerning the enucleation of fibromata. Retzius ' first purposely induced spontaneous gangrene by repeated applications of the actual cautery. A cure ensued after protracted suppuration. West' produced gangrene of a myoma by partial enucleation and multiple incisions. The course of the case was at first favorable, but the patient finally succumbed to peritonitis.