In summing up the whole question of treatment, it will be seen by what I have already said that not much faith can be put in drugs. The most useful are Ergotin (1 gr. in pill), Ergot (is to 3o mins. of Liq. Ext.), Ext. Viburni Prunifolii (3o mins. to I dr.), Styptol (r gr.), Hydrastis Canadensis (13 to 3o mins.) or Hydrastin (1 gr. in pill). Locally, swabbing with a caustic such as iodised phenol, pure carbolic acid or pure formalin, the glycerin and ichthyol tampon and the hot douche are of service in inflammatory cases. Of general measures, rest is most important, and a smart saline purge is useful. Iron should be looked on as a remedy to combat the resultant anwmia, not as a measure for checking the hwmor rhage.
When the loss is going on and is profuse enough to be alarming in spite of rest in bed, it may be necessary to check it for the time, and this may be done by packing with iodoform gauze. The most effectual method is to pack the uterus, which must be done with careful antiseptic precautions. This can, however, rarely he done without dilating the cervix, and if the cervix be dilated it is wiser to curette before packing. When the cervix is not sufficiently dilated, the haemorrhage can usually be stopped for the time by packing the vagina firmly with gauze or cotton swabs as described under Abortion. In the majority of cases the curette is the simplest, safest, and quickest method of stopping the hemor rhage. After it has been used, the uterus should be packed with iodo form gauze, which is allowed to remain in place for 24 hours. The treat ment of tumours causing hwmorrhage usually requires the assistance of a specialist.
Radiotherapy in Menorrhagia.—A very large amount of work has been done within the past few years in connection with the treatment of various forms of menorrhagia by means of X rays or of radium emanation.
The therapeutic effect seems to be due to the " hard " or gamma rays in which radium emanation is specially rich, while the X-ray tube by the use of suitable metal filters may be utilised as a source of them. The
primary effect of the rays is probably in most cases the production of ovarian atrophy with consequent menopause, but in the case of tumours such as myoma or cancer a destructive effect is also produced on the tumour cells, sufficient in most cases to lead to the diminution in size or even to the total disappearance of the tumour macroscopically. The details of the treatment should in all cases be left to an expert radio logist, and it is advisable that the advice of a gynecologist should also be taken lest an error in diagnosis be made and valuable time be wasted. Generally speaking, the cases most suitable for radiotherapy are those in which fibroids or inoperable cancer are the cause of the bleeding. Cases of so-called " luemorrhagic endometritis " which fail to benefit by ordinary methods of treatment should also be given a course of radiotherapy before the last resort of hysterectomy is decided upon. The cases unsuitable for this form of treatment are those occurring in young women, on account of the likelihood of bringing on a premature menopause with consequent sterility; those in which inflammatory disease exists, especially if asso ciated with suppuration in the tubes or ovaries; cases of degenerated, gangrenous or submucous fibroids or cases of early and operable cancer. The best results are attained in patients who are already approaching the menopause. The principal ill effect that has been observed is an increase of the hxmorrhage immediately after the commencement of treatment.
Where the haemorrhage has been severe enough to cause collapse, saline transfusion or injection, with other measures necessary to combat the collapse, will be required. (See under Haemorrhage and Shock.)— R. J. J.