+ All Categories
Home > Documents > Abortus Incomplete

Abortus Incomplete

Date post: 21-Oct-2015
Category:
Upload: ngurah-arya-pradnyantara
View: 24 times
Download: 0 times
Share this document with a friend
Description:
jurnal about abortus
Popular Tags:
7
576 THE CANADIAN MEDIcAL AsSocIATIoN JOURNAL [Nov. 1931~~~~~~~ A CONSERVATIVE TREATMENT OF INCOMPLETE ABORTION By MURRAY BLAIR, M.D., C.M., Department of Gynccotogy and Obstetrics, Vancouver General Hospital, Vancouver CURRENT medical literature abounds in the rare and unusual in medicine, at the expense of the commonplace every-day prob- lems with which the general practitioner must grapple. Among the commonplace problems are there two commoner conditions to be met than gonorrhoea and abortion? And yet how often do we meet them in our medical reading? The object of this paper is to bring up again the subject of abortion, chiefly from the stand- point of treatment. The treatment here de- scribed is that used in our cases admitted to the Vancouver General Ho'spital during the past six months (January 1 to June 30, 1931). A good many years ago the profession be- came impressed with the conservative treat- ment of abortion as compared with the earlier and more radical methods of treatment. Much has been written about that protective zone of lymphocytes which lies in the basal structures of the endometrium and which if broken down by any form of trauma allows free access of the potentially infective areas to the maternal circulation. It is felt that if such a mental picture is kept before us probably the uterus will receive more of that respect which is rightfully its due. A study of the records of cases in the gynEecological service of the Vancouver General Hospital from January 1 to June 30, 1931, shows that 41 cases of abortion were admitted. These were classified as follows: complete, 10; incomplete, 28; threatened, 3. By complete abortion we mean those cases who were admitted as inevitable abortions, and who after admission succeeded in com- pletely emptying their own uteri or for some reason had therapeutic abortions performed. All 10 cases ran an afebrile and uneventful convalescence.' By incomplete abortion we mean those cases who were admitted with a history of amenorrheea, followed by bleeding, intermittent pain, and the passage of clots or masses of some sort before admission. By threatened abortion we mean those cases who came in showing the classical signs of impend- ing abortion, but whose crises were averted and who were discharged as normal cases of pregnancy. The treatment of complete and threatened abortion is carried out in this clinic on the same conservative lines as that of incomplete abortion. The detail of treatment is, however, not within the scope of this paper. GENERAL TREATMENT Incomplete abortion should be treated as an open wound and given the same care and con- sideration. Each patient with abortion admitted under the staff of the Vancouver General Hos- pital is put to bed, and an ice bag applied to the lower abdomien for the purpose of improv- ing and keeping up uterine tone. If there be bleeding, we may or may not elevate the foot of the bed, but it is doubtful if posture in bed has any influence on uterine bleeding. If the bleeding is marked, pituitrin 0.5 to 1 c.c. may be given. In our series it is surprising how very seldom it was found necessary to resort to an oxytocic. As soon as possible every patient with incom- plete abortion is placed on an examining table, a vaginal speculum inserted and, with a good light the vagina and cervix inspected. This procedure is carried out under strictly aseptic conditions. It is the only procedure in our whole routine which might be considered as bordering on the radical, rather than the con- servative, in treatment. One or two experiences however, have shown us that fragments of the products of gestation may lie, completely separated from the maternal wall, in the cervix, or even in the vagina. These fragments, being foreign bodies, can be readily removed with sponge forceps, but if left in situ, may or may not be expelled. If not, they must be absorbed and the process of absorption may lead to sepsis. We believe that a goodly number of [Nov. 1931' 576 THE CANADIAN MEDicAL AssoCIATION JOURNAL
Transcript
Page 1: Abortus Incomplete

576THE CANADIAN MEDIcAL AsSocIATIoN JOURNAL [Nov.

1931~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

A CONSERVATIVE TREATMENT OF INCOMPLETE ABORTION

By MURRAY BLAIR, M.D., C.M.,

Department of Gynccotogy and Obstetrics, Vancouver General Hospital,Vancouver

CURRENT medical literature abounds in therare and unusual in medicine, at the

expense of the commonplace every-day prob-lems with which the general practitioner mustgrapple. Among the commonplace problemsare there two commoner conditions to be metthan gonorrhoea and abortion? And yet howoften do we meet them in our medical reading?The object of this paper is to bring up againthe subject of abortion, chiefly from the stand-point of treatment. The treatment here de-scribed is that used in our cases admitted tothe Vancouver General Ho'spital during thepast six months (January 1 to June 30, 1931).A good many years ago the profession be-

came impressed with the conservative treat-ment of abortion as compared with the earlierand more radical methods of treatment. Muchhas been written about that protective zone oflymphocytes which lies in the basal structuresof the endometrium and which if broken downby any form of trauma allows free access ofthe potentially infective areas to the maternalcirculation. It is felt that if such a mentalpicture is kept before us probably the uteruswill receive more of that respect which isrightfully its due.A study of the records of cases in the

gynEecological service of the Vancouver GeneralHospital from January 1 to June 30, 1931,shows that 41 cases of abortion were admitted.These were classified as follows: complete, 10;incomplete, 28; threatened, 3.By complete abortion we mean those cases

who were admitted as inevitable abortions,and who after admission succeeded in com-pletely emptying their own uteri or for somereason had therapeutic abortions performed.All 10 cases ran an afebrile and uneventfulconvalescence.' By incomplete abortion wemean those cases who were admitted with ahistory of amenorrheea, followed by bleeding,intermittent pain, and the passage of clots ormasses of some sort before admission. By

threatened abortion we mean those cases whocame in showing the classical signs of impend-ing abortion, but whose crises were avertedand who were discharged as normal cases ofpregnancy.The treatment of complete and threatened

abortion is carried out in this clinic on thesame conservative lines as that of incompleteabortion. The detail of treatment is, however,not within the scope of this paper.

GENERAL TREATMENT

Incomplete abortion should be treated as anopen wound and given the same care and con-sideration. Each patient with abortion admittedunder the staff of the Vancouver General Hos-pital is put to bed, and an ice bag applied tothe lower abdomien for the purpose of improv-ing and keeping up uterine tone. If there bebleeding, we may or may not elevate the footof the bed, but it is doubtful if posture in bedhas any influence on uterine bleeding. If thebleeding is marked, pituitrin 0.5 to 1 c.c. maybe given. In our series it is surprising howvery seldom it was found necessary to resort toan oxytocic.As soon as possible every patient with incom-

plete abortion is placed on an examining table,a vaginal speculum inserted and, with a goodlight the vagina and cervix inspected. Thisprocedure is carried out under strictly asepticconditions. It is the only procedure in ourwhole routine which might be considered asbordering on the radical, rather than the con-servative, in treatment. One or two experienceshowever, have shown us that fragments of theproducts of gestation may lie, completelyseparated from the maternal wall, in the cervix,or even in the vagina. These fragments, beingforeign bodies, can be readily removed withsponge forceps, but if left in situ, may or maynot be expelled. If not, they must be absorbedand the process of absorption may lead tosepsis. We believe that a goodly number of

[Nov. 1931'576 THE CANADIAN MEDicAL AssoCIATION JOURNAL

Page 2: Abortus Incomplete

Nov 191 LI:ICMP EAOTO 7

cases have been saved from the category of"septic abortion" by this simple procedure.No bimanual examination is made, nor anymanipulation of the uterus that might in anyway even remotely suggest trauma.Having satisfied ourselves that those pro-

ducts of gestation remaining to make theabortion incomplete are inside the uterus, thefollowing routine treatment is instituted. Acomplete history is taken, a catheterized speci-men of urine sent to laboratory, a Wassermanntest is made, a complete blood count and theblood pressure is taken. The nursing treatmentconsists of absolute bed-rest, an ice-bag to thelower abdomen, plenty of fluids, a well roundedsupportive diet, a heavy Russian oil, ounces 1/2½three times a day, to be cut down if necessary,but if not enough to be followed up with asoap-suds enema every 48 hours. Should thetemperature and pulse remain within reason-able bounds, the patient is left strictly aloneand permitted to empty her own uterus in herown way. This, we believe, the overwhelming,majority are quite capable of doing. At leastso it has been found in our series.

HAEMORRHAGE

The old adage, "An empty uterus neverbleeds", might imply that a uterus onlypartially emptied bleeds freely. The initialfear of abortion is the fear of heemorrhage, andit is because of this that so many activemeasures are taken by many men. The routineuse of pituitrin, ergot, vaginal or even uterinepacking, intrauterine douches, curettage, etc.,are all introduced to offset the risk of im-mediate heemorrhage or subsequent infection.Our experience is that hawmorrhage from incom-plete abortion is by no means common.Threatened abortion of course demands ourstrictest watching because of the tendency to-wards sudden and vicious hemorrhage, butthreatened abortion is not considered in thispaper.

OXYTOCICSOxytocics are not given as a routine. The

reason is that they were not found necessaryto prevent bleeding and we have found themunsatisfactory as a method of completelyemptying the already partially emptied uterus.

TRAUMAUterine or vaginal packing was not resorted

to in our service. As a routine we consider itbad practice. Too little, we feel, has beenwritten about trauma in the presence of incom-plete abortion. The whole idea in our conserva-tive treatment is to keep infection fromspreading to the cellular tissues beyond theuterine wall. And how does post-partum in-fection spread? By means of lymphatics andby surface continuity, as does gonorrhoea inthe endometrium? No. The intrauterine in-fection accompanying abortion to a great,extent extends directly through the walls ofthe uterus to the cellular tissues beyond. Nodoubt the added risk accompanying curettagecomes far more from trauma than from the riskof carrying in infection. Trauma to uterinemusculature under such conditions breaks downthe protective leucocytic barrier around theinfected placental site and takes from themuscle something of its power to inhibit themigration of infective bacteria or their toxins.It is felt that the trauma to the uterine wallfrom packing, even vaginal packing, is veryreal and so to be avoided. Emergency hmemor-rhage is, of course, another matter, so obviousas to need no comment. Emergency, likenecessity, knows no law.The practice of many men to use the ex-

amining finger as a curette and to sweep out allparticles of the gestation still attached to theuterus is doubtless satisfactory from the stand-point of immediate results. It is, however,added trauma, no matter how gently the pro-cedure be carried out, and therefore, in ouropinion, better left undone. In view of this itis hardly necessary to comment on our attitudeconcerning curettage in the treatment of thiscondition. The exigencies of staff practicemay, however, be such as to make is impracticalto keep intractable cases in hospital indefinite-ly. Such a reason for performing a curettageis theoretically weak, but, practically, may atleast elicit sympathy. We curetted one caseof incomplete abortion in this group of casesfor the above reason.

INFECTED ABORTIONOne of the barometers of the financial condi-

tions in a community is, I think, the number ofabortions admitted to that community's hos.

BLAm: INcompimm ABoRTioN 577Nov. 1931]

Page 3: Abortus Incomplete

578

1931~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

pital. Especially is this so with regard to thenumber of criminal abortions. We have takenas a definition of criminal abortion only thosecases induced by the local application of anoutside agency, whether done by an abortionistor by the patient. Our experience seems toshow that self-induced abortions brought on bydrugs, exhaustion, and other agents cause littleor no more trouble than the innocent accidentalabortion. Either, of course, may cause a truepost-abortal sepsis. The number of abortionsadmittedly criminally induced, whether self-induced or by an abortionist, constitutes an

extraordinary percentage of the whole. Ourdefinition of criminal induction does not in-clude that vast field of inductions caused bydrugs, such as castor oil, quinine, and manyproprietary preparations containing ergot or

its derivatives. We have listed as criminallyinduced only those cases in which actual inter-ference had taken place via the vaginal route.Of these there were 16. Only 2 were admitted-ly brought on by the services of an abortionist.The great majority of criminally induced were

apparently self-inductions.. One reason, we

believe, is because this city is, on the whole,fairly free from such practitioners, and theother and best reason is that those people whoattend the free clinics of a general hospitalcannot afford the attention of such experts.The extremes that these women may go to torid themselves of their pregnancies apparentlyknow no bounds. Such criminal inductions are,

of course, potentially infective cases. Of course,

many criminal inductions may run a perfectlynormal convalescence, while many purely acci-dental abortions may become infected. Natural-ly this does not detract from the teaching thatall criminally induced abortions must betreated with suspicion until free from danger.We prefer the term "infected abortion" to

the more commonly used "septic abortion".We prefer it because sepsis implies usuallygeneralized septic&-mia, whereas by no means allinfections in abortion become generalized. Ourdefinition of infected abortion is an arbitraryone from a morbidity standpoint, and entirelyof our own making. We have classed all abor-tions as infected which had a temperature of101° or over on two successive days, includingthe day of admission. Under this definitioninfections were classified as follows:

TABLE I

No. Clean Infected Per cent

Complete abortion .... 10 10 0 0Incomplete abortion.... 28 14 14 50Threatened abortion.... 3 3 0 0

Of the 10 cases of complete abortion, 3 weretherapeutic, done at the instigation of themedical side for various reasons. There wasno morbidity. We are unable to get a definitehistory of criminal interference in any one ofthe remaining 7 cases. Three admitted usingdrugs, hot baths, etc., but we had every reasonto suspect 3 out of the 7 of having employedmechanical interference. However all ran aperfectly normal convalescence. It is prob-ably quite uncommon for an empty uterus tobecome infected. In other words, it is not theuterus that becomes infected primarily; it isthe content, as a general rule.Of the 28 cases of incomplete abortion, 14

were classified as infected. It mtist be pointedout that although 17 cases admitted criminalinterference, not all those cases can be includedamong the subsequent infections. Some ofthem ran perfectly normal charts and so areamong the 14 clean cases. By the same token,some of the innocent or accidental abortionsbecame febrile and appear among the 14 in-fected cases. The cause of the great differencebetween the percentages of infection in thecomplete and incomplete groups is, as pointedout, that in the latter there is a uterine contentto infect. If this last is a reasonable assump-tion, why not empty every uterus at once bycurettage and so offset any risk of infection?In reply the following statements seem reason-able: (1) We know that any remnant of thegestation products remaining may be infectedbefore we could so act, and that, if so, naturehas already established its protective zone.(2) We know that no radical procedure can beinstituted without some degree of trauma whichwe believe detracts from the organ's defences.(3) We know that no form of radical removalof the remaining products of gestation is cer-tain to be thorough and complete. (4) Weknow that any intrauterine procedure at sucha time may carry bacteria into a uterus hereto-fore uninfected.Our treatment of infected incomplete abor-

tion, as of the uninfected case, is strictly

THE CANADIAN MEDICAL AssociATioN JouRNAL578 [Nov. 1931

Page 4: Abortus Incomplete

No.13]BAR NoPEEAOTO7

supportive throughout. The initial procedureof observation of the cervix and vagina, withremoval of any loose pieces of the gestationproduct is carried out, and the usual treatmentfor any acute suppurative condition is insti-tuted. No attempt at antisepsis in any form isused. The patient herself is asked to combatthe infection through her own body fluids. Theduty of her attendants is to aid her in this taskin every way.

Rest in bed, posture, quiet, sleep, daily bowelmovements without purges, forced fluids, anal-gesics, heat to the abdomen, intravenousinjections of saline, blood transfusions, andscarlet fever antitoxin are the essentials. Theabove treatment is routine except for the lastthree procedures mentioned. Intravenous in-jections are given freely, as ordered, withthorough belief in their worth, always keepingin mind that a heart already taxed to capacitymay well become overtaxed by a sudden in-crease in circulatory content. We believesmall intravenous salines given often are wiserthan the larger amounts of 1,000 to 1,500 c.c.

Transfusions.-Blood counts are taken oftenin febrile cases, or in those losing any quantityper vaginam, usually every 48 hours. When,the blood condition drops any appreciable dis-tance we resort to blood transfusions. Againwe recommend small transfusions repeated,rather than a large addition to the blood con-tent. There is an added and most importantreason here, too, in that added fresh healthyblood means added antibodies and so addedammunition to the fighting forces of the host.Repeated addition of shock-troops at intervalsseems to get better results than a combinedattack at one time. A transfusion of not morethan 500 c.c. at one time seems the most satis-factory procedure. Of the 14 infected casestreated, 7 required blood transfusions one ormore times. Of course, a number of afebrilecases of incomplete abortions in our series alsowere treated with blood transfusions.

Scarlet fever antitoxin.-We reserved the useof scarlet fever antitoxin for those cases of in-fected abortion whom we considered seriouslyill. Due to the fact that so much criminal inter-ference took place there were some particularlyvirulent infections. Marked toxicity, as shownby high temperature, rapid pulse, great fluid

depletions, blood destruction, extensive cellularinfiltration about the seat of infection, peri-tonitis, etc., was to be seen in many of theseinfected patients. The reaction of these peopleto scarlet fever antitoxin was satisfactory inevery case, but the results are in some cases soremarkable that one might well *hesitate toreport them in so small a group. We realizefully that reporting the treatment of a smallnumber of abortions might well give resultsthat would lead to erroneous conclusions. Inour miniature series we had remarkable results.It is true that perhaps such results will notoccur again, but we feel that the results shouldbe published to show that in scarlet fever anti-toxin we have at least an additional weapon,perhaps a very valuable one, in the fightagainst infected uteri. It is known, however,that a great number, probably 50 per cent, ofintrauterine infections are due to a hamolyticstreptococcus. The strain of streptococcuswhich causes scarlet fever is now known to bea hamolytic strain, and its antitoxin has, attimes at least, a surprising effect on the toxin-produced by the streptococcus hmmolyticusgravidarum.We have used the serum both intranuscularly

and intravenously, on separate patients, and onthe same patient. In our very limited experi-ence we could see no advantage either way, sonow use the serum intramuscularly altogether.We have given minute doses at the beginningto immunize against anaphylaxis, but of latehave given the full dose at once and have foundlittle to worry about from that standpoint.

Urticarial rashes are almost always the rulefollowing this medication. Many patients havea violent skin reaction and are miserable untiltreated. We have controlled the rash very ef-fectively with adrenalin. One case of acutearthralgia followed the use of the serum. Thepatient refused to move herself and was movedonly with intense pain. At no time was thereany localized swelling or redness, nor was thereany febrile reaction. The patient recovered in24 hours without specific treatment;. We realizethat other clinics with far more experience areusing much larger doses, even three times, forthe original dose than we do. We can only saythat we have not felt the need for this, and ourresults, in this very limited number of cases,speak for themselves.

BLAIR: INcompLEiEABORTION 579Nov. 19311

Page 5: Abortus Incomplete

580 THE CANADIAN MEDICAL AssoCIATIoN~~~~~~~~~~~~~~~~~~~~~~~~JORA No.13

A number of temperature charts of the in-

fected cases treated with the scarlet fever anti-

toxin are here presented. The histories are not

appended, As it is felt that they would add little

beside space to the discussion. You are referred

TABLE II

1 0.43768 1 20 16 1 1

2 0.47368 1 20 6 1

3 0.42577 1 12 1 1

I 0.42139 1 1 1 1 25 1 1

5 C.41833 1 1 31 1

6 0.43062 1 1 17 1

7 0.43469 1 1 40 19 1

80.-46643 1 40 6 1

9 0.44108 1 1 10

10 0.45920 1 8 1

11 0.46765 1 40 8 1

12 0.46612 1 1 60 20 1

13 0.46854 1 1 20 22 1

14 1 20 9 1

Totals... 10 4 7 8 1 1 209 14 3

(Aver. 15)

1

7.-A .1~~~~

V~~~~~~~~~~~~~~~~~~~ 7

CHFART l.-Case No. 46765. The black dots representscarlet fever antitoxin injections.

..

r'~~~~~~~~~~~~~~~~~~~~~~7

CHART 2 -Case No. 46643. Acutely ill. The black

dots represent scarlet fever antitoxin injections

CHART3.-CaseN No. 47368.Ar remarkabler elult,aapparently from one scarlet fever antitoxin injection.*

MM,ay 21

IA "R 'rJ..

C4 3

CTTA T 4.-Case No. 43768. Very gravely M, witha remarkable, result following the third injection scarletfever antito '

.

-:7, - - ---, . . .. - -- - i-`-_:, .- '. "j. . ., .-t- i ..;i. 1 .14 7- .- .. .- -

P4,-,

-1

.:- I

I

580 THE CANADIAN MgDicAL, AssociATioN JOURNAL [Nov. 1931

ij

Page 6: Abortus Incomplete

Nov. 1931] BLAIR: INCOMPLETE ABORTION 581

"~~~~~'r 'C I'z~~~~~~~~~~~~~~~........

s 4 a t'

71

4-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~{7-4fl~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~.....

I I~~~~t-I0NI~"7

CHART 5.-Ca,se. No. 43469.

-y~~~~~~~~~~sta -s '~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~ 4 '7 't f~~~~~~~~~~~......

$ I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

CHART 6.-Case No. 46612. An intractable easefever antitoxin injeetion.

by the hospital number on the chart to the hos-pital number in Table II for a graphic analysisof the cause of illness and treatment.

Case No. 43,768, one of our scarlet fever anti-toxin cases, was subsequently readmitted to hos-pital because of a "lump in her abdomen." Thelump turned out to be a marked cellular infiltra-tion which subsequently had to be drained, andthe patient made a slow and tedious recovery.Two other cases were readmitted. No. 42,577came back complaining of vague pains. Physi-cal examination was negative and she was dis-charged in three days without complaints. No.42,139 is the only patient in our'series whom wepacked vaginally ana whom we subsequentlycuretted. On her second admission. she corn-

in extremis, with the result :following the third scarlet

plained of bleeding only. Posture, medication,transfusion, all gave little or no result. Theuterus was somewhat retroverted, somewhat en-larged, and the position could not be corrected.We packed the vagina, to stop- a pretty freeand depleting flow and in the hope of bringingaway intrauterine content. Failing this she wascuretted, the only case in which we found itnecessary to give radical treatment.

It will be noted that no reference to bloodcultures has been made. It is generally felt, weknow, that no study of this sort can be reallyscientific without blood cultures in all toxiccases. Blood cultures have been taken on a fewof these cases,-all negative. A number of factor-shave led us to stop the practice of routine cul-

BLAIR: INcompLETE ABORTION, 581Nov. 1931]

Page 7: Abortus Incomplete

tures. (1) Blood culture findings were unneces-sary in determining our plan of treatment. (2)Our hospital laboratory is a tremendously over-worked institution. (3) Recent studies byexpert bacteriologists show that positive bloodfindings are decidedly a matter of chance, sogreat is the dilution in the average case. Westrongly favour the taking of blood cultures inthose clinics where such procedure may becarried out with imipunity, but we respectfullysubmit that the lack of same should not belittlethe facts of this study as here presented.

SUMMARYOur series is, of course, too small to permit

of any conclusions. We wish to summarize thediscussion briefly, as follows:

1. In incomplete abortion, whether uninfectedor infected, a conservative treatment is followedthroughout.

2. The initial inspection of the cervix is, webelieve, a valuable procedure.

3. Hwmorrhage is not a feature to be feared,as a general rule.

4. Neither vaginal nor uterine packing, noroxytocics were used. It is advised that neitherbe resorted to except in emergency.

5. Emphasis is placed upon supportive treat-ment, especially repeated intravenous injectionsand small blood transfusions.

6. Scarlet fever antitoxin has apparently aplace in the fight against intrauterine infections.

THE X-RAY TREATMENT OF UTERINE HAEMORRHAGEAND UTERINE FIBROIDS*

BY L. J. CARTER, B.A., M.D., F.A.C.P., F.A.C.R.,The Bigelow Clinic,

Brandon -

XAmONG the outstanding memories of ten

years spent in general practice are theworries associated with the treatment of ag-gravated and persistent uterine haemorrhage,especially those occurring about the menopause.Ergotin and stypticin, curettages, rest in bed,cervical and vaginal packing often proved ofno avail. In many cases the major operationof hysterectomy was necessary. These severecases still frequently occur in the practice ofevery family physician, but an easier and safermethod of treatment is now possible of applica-tion. And it is the hope of the writer that,through the publication of this and other com-munications in our Journal, every family physi-cian in Canada may become familiarized withthe benefits which the radiotherapist can conferthrough the treatment by x-ray of these severeconditions.At the convention of the Canadian Radiologi-

cal Society, in 1923, and again at the conven-

* This paper is No. 10 in the series on Physio-therapy. For the preceding articles see the Journal,1931, 24: 263, 409, 539, 679, 831; and 1931, 25: 65,164, and 444.

tion of the Radiological Society of NorthAmerica in 1929, the writer presented the resultsof a series of treatments by x-ray of uterinehwemorrhage and associated conditions. Statisticswere furnished covering a period of fourteenyears, showing that the x-ray treatment ofuterine heemorrhage is good for 100 per centcure, providing that uterine malignancy has beenruled out. One hundred consecutive cases ofuterine heamorrhage and uterine fibroid wereanalyzed. The subsequent history of 85 of thesecases is known. With the exception of 3, whichproved to be malignant, there was no case offailure to arrest the hwemorrhage. This uni-formity of good results is confirmed by the ex-perience of every x-ray worker who has compiledand reported his results. It is not the purposeof this paper to make any detailed reference tothese statistics. The files of the leading x-rayjournals are teeming with the facts.In the series of 100 cases reported by the

writer the hwemorrhage was of all degrees ofseverity, but mostly of the aggravated type.There were severe haemorrhages, sudden in onsetand profuse in amount, many of the patients

-582 THECANADiANMEDicALAssocIA.TION- JOURNAL [NOV. 1931


Recommended