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I
    A  CASE  OF  SUB-MUCOUS  UTERINE  FIB&OID

                TREATED  BY ELECTROLYSIS.1, /

                    BY GEORGE HOLMES BIXBY, M. D.,
                Surgeon to St. Elizabeth's, Hospital for Women.

  November 15, 1876, I was consulted by Mrs. S., aged forty-five, a
native of Maine, but a resident of California, for an obscure abdominal
tumor.  Her mother died of cancer of the breast, and a sister after an
operation for the removal of a fibrous  tumor of the uterus which  had
undergone-partial spontaneous enucleation.   The patient was a decided
blonde,  above the average stature, with fair nutrition.   Menstruation
was established at seventeen, and continued normal.  She was married
at twenty-two, gave birth twice, the first time a year after marriage,
the last three years later, twenty-one years ago.   There were no mis-
carriages.   Menstruation continued regularly for the next twelve years.
Six years previous to  consulting  me,  a day or  two prior to a usual
period, her attention was accidentally directed to a growth in the right
ovarian region.  The tumor  slowly but  steadily increased in  size, but
for four years the general health, as well as the menstrual function, was
unaffected by its presence.  During  the last two years a  decided influ-
ence on the  catamenia  has been apparent.  At each period there was a
marked increase in the quantity of the flow and  a lengthening of the
duration of  the function.  Lasting when  she was in health from three
to five days, it was now prolonged to  ten, twelve, and at times fifteen
days, and attended by severe expulsive pains and  coagula.  The past
year all the above-mentioned irregularities  and  complications  have
steadily increased, together with severe gastric irritation  and a condi-
tion of general depression amounting well-nigh to coma.
   By palpation I found the abdomen covered b}*- a dense layer of adi-
pose tissue;  at the right of the median line, arising from within the
pelvis  and extending above the umbilicus, a smooth spherical tumor the
size of the foetal head,  apparently without adhesions.   Vaginal explora-
tion and bimanual palpation showed a well-defined growth arising from
the right and upper part of the  uterus, extending downward toward

          1  Head before the Obstetrical Society of Boston, May 11, 1878. 
              Uterine Fibroid  Treated by Electrolysis.

the cervical portion of the organ.  The sound passed nine inches.   By
rotating the tumor presenting  above the  pubes with the sound  in  the
uterine cavity, the intimate  relation of the tumor with  the  uterus  was
clearly established.
   Diagnosis :  sub-mucous uterine fibroid.
   Before entertaining any operative procedure, in  view of the  menor-
rhagia, I suggested a trial of ergot hypodermically  administered.  The
lateness  of the season necessitated an early return to California.   I  was
therefore obliged to postpone  the  treatment for the time.   The jour-
ney, undertaken  the  next week, was  attended with great  discomfort,
which aggravated all the symptoms at the next menstrual term.  Early
in January, 1877, she wrote me a'most doleful letter; her sufferings at
each menstrual period  the entire winter had  been  so intense that life
had become a burden.   She had determined, therefore, as soon  as  the
season would permit, to proceed East prepared for any operation which
would offer the slightest hope of relief.  A month later I saw her, three
days after her arrival in Boston.  The journey from her home  to  San
Francisco,  some sixty miles by stage, and the  remainder of the route,
requiring in  all ten days of  the  most tedious travel, exhausted  her
greatly.  While passing under the snow sheds, though well protected,
she experienced a  severe chill.  I suggested giving the patient ample
time to recuperate fully from the long and wearisome  trip before com-
mencing the proposed treatment.  On  the sixth day after  her  arrival
marked symptoms of phlebitis appeared in the left leg.  The inflamma-
tion continued with varying intensity, confining the patient to the  bed
for eleven weeks.
   All the symptoms having then subsided, I deemed it safe to begin the
ergot treatment.  Accordingly, I injected into the cellular tissue in the
vicinity of  the abdominal portion of the tumor fifteen minims of a so-
lution of Squibb's  aqueous extract of ergot, each  minim containing a
grain of  the drug.1   No result followed the first application.  The next
night fifteen grains of the same form of ergot were employed by rectal
suppository, and repeated on the following evening.  Four  hours after
the last application the most violent  uterine  contractions  ensued,  and
continued at intervals of ten or fifteen  minutes for  twenty-four hours.
The patient became so exhausted from the wear and  tear of the pains
and the loss of sleep that I  was forced to counteract the effects of the
ergot by large doses of opium by the rectum.
   At the patient's  fervent solicitation this method of  treatment  was
abandoned, for a time at least.
   September 7th, the case was carefully examined  under ether by Drs.
Kimball, Wheeler, Chadwick, and myself. The greater facility afforded
by the ansesthesia convinced us that any surgical interference was  not
        1 As prepared for me by my druggist, Mr. Edward Kelly, of Boston.
.")
2 
I
               Uterine Fibroid Treated by Electrolysis.             3

to be thought of, Drs. Kimball and Wheeler earnestly recommending
the trial of electrolysis.
   September 25th, four days after the cessation of the following men-
struation, without any previous preparation, the patient being profoundly
etherized, in  the presence and  with the  assistance of Drs.  Wheeler,
Webber, and  Cutter the electrolysis was performed as follows :  I intro-
duced one electrode into the segment of the tumor presenting in Doug-
las's cul-de-sac (the needle entering three  inches), the other pole being
applied to the surface of the abdomen immediately above the tumor.  Dr.
Webber allowed the current from fifteen and later from  eighteen cells
of a constant battery to pass through  the substance of the  tumor for ten
minutes. The pulse,  which was seventy and full before  the ether, fell
to sixty at the end of  five  minutes, and to  fifty at the close of the ap-
plication.  Complete  recovery from  ansesthesia  took place five hours
later, the pulse continuing slow and feeble.
   September  26th, a.m.   A  quiet  night;  urine voided voluntarily;
pulse 55; the abdomen somewhat tympanitic and sensitive on pressure.
Brandy and water wras ordered to be  taken half hourly.
   September  26th, p.  m.   Pulse 60 ; nourishment taken and retained.
   September  27th.  Reaction  fully established; pulse 70; slight ten-
derness over the abdomen  ; nourishment taken freely.
   From this  time on there was little of interest to note from  day to
day, convalescence proceeding without interruption, the patient resum-
ing her ordinary duties on the  eighth day.   Menstruation recurred Oc-
tober 25th, thirty days after the  operation, with an interval of  thirty-
six days; was painless, free from coagula, and of five  days'  duration.
The second menstruation  appeared February 14, 1878, continued five
days, was painless, and without coagula.   The  interval was  one hun-
dred and eleven days.   The third menstruation began March 17th, with
twenty-six days interval.   The  day previous  to the event the  patient
spent several hours in  active exercise  over an intensely hot fire.  The
flow continued ten days, but without complication.  A marked improve-
ment, general and local, dated  unquestionably from  a week  subsequent
to the operation, and  has continued without interruption.
   April 16th.   The patient considers herself in perfect health, walking
and driving  without  discomfort, having  added fifteen pounds  to her
weight.  A careful examination of the tumor showed its  upper  margin
to be two inches below the umbilicus; by actual measurement in all di-
mensions markedly diminished; the sound passed seven inches  instead
of nine before the electrolysis.
   April 26th.   Twenty days after the cessation  of the catamenia she
ventured to start for home.  A note  received subsequently to her arri-
val informs me that after quite a jar from shackling of the cars at Detroit
the catamenia appeared, the interval being thirty days.   She  was con- 
4              Uterine Fibroid Treated by Electrolysis.
siderably alarmed, and anticipated trouble.   On the contrary, however,
the function, though somewhat profuse, continued without the slightest
discomfort during the rest of the -journey.   In her note  she adds :  "I
have not felt a pain since I left Boston, and with the exception of slight
colds I have never been in better health." 
 
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