UTERINE FIBROIDS 
AND 
OTHER PELYIC TUMORS: 
THEIR 
THERSPEDTIC TREHTMENT 
AND 
GOZCsTIDTJGT TO THE nyEEEZCsTOH’jATJSH!. 
By HENRY FRASER CAMPBELL, M. D., 
AUGUSTA, GA. 
Reprinted prom the February (/88y) Number of the N. O. Med. and Surg. Journal. 
L. Graham & Son, Printers, 99 & 101 Gkavier St. 
ISS7. 
NEW ORLEANS: UTERINE FIBROIDS 
AND 
OTHER PELVIC TUMORS; 
their 
THERAPEUTIC TREATMENT 
AND 
CONDUCT TO THE MENOPAUSE. 
HENRY FRASER CAMPBELL, M. D 
AUGUSTA, GA. 
In the present advanced day of oophorectomy, hyste- 
rectomy and other brilliant and bloody operations, one is 
intuitively prompted to explain, if not to apologize, in pre- 
senting himself as the reporter and advocate of medicinal 
expedients in the management of these often perplexing 
abnormities. Nevertheless, the experience of the past 
should not be wholly lost sight of, even though largely sub- 
stituted by more direct, but not universally accepted and, 
albeit, often perilous methods. 
Many circumstances and conditions render it expedient 
that the individual experiences of those who have come 
frequently in contact with any considerable number and 
variety of such cases, at a period anterior to the sugges- 
. tion of the surgical procedures now urged as the only al- 
ternative between active effort and entire abandonment of 
the woman to her fate, shall find a place in our current 
teaching on the subject. A large number of the cases of 
uterine fibromata and analogous growths, though appar- 
I 2 
ently more or less rapidly approaching, from bloodless- 
ness, or other circumstances connected with the growth, a 
fatal degree of exanimation, are not in a condition that 
would justify abdominal section for either hysterectomy 
or oophorectomy with or without salpingotomy. Other 
subjects, when candidly informed of the discouraging sta- 
tistics of the one, and of the mutilation and barrenness 
of the others, absolutely refuse to submit to these opera- 
tions, or withhold their consent until the period of even 
the forlorn hope they offer has passed ; and yet another 
class with tumors of varying size, location and histology, 
are of an age to regard the hope offered by the approach 
of the menopause as a promise of ultimate relief in the 
decadence of vascular and trophic so universally 
recognized as an attendant on post-menstrual life. 
These latter cases, as may be seen in the following quo- 
tation from Keith, have good ground and encouragement 
for resisting both hysterectomy and oophorectomy as well 
as salpingotomy, any of which operations indeed, in m 3' 
own opinion, are seldom justifiable at that age, though this 
as it seems to me, appears to be the only period of life at 
which the two latter procedures have been able to claim 
any marked success in arresting the menstrual nisus and 
flow. 
“ To the woman with a fibroid uterus,” says Dr. Keith,* 
“who has passed the best of her years in weariness and 
pain, middle age brings relief, an 1 old age may be spent in 
peace. Hence the difficulty in knowing how far we are justi- 
fied in advising interference, for a disease that troubles for 
a time, though it rarely kills. It is often said that the 
operation for the removal of uterine fibroids is in much the 
same position now, that ovariotomy was five and twenty 
years ago. It is not so. It never will be so. The history 
of these two diseases is entirely different. As a rule, ova- 
rian disease is a merciless one ; it goes on and kills. As a 
rule, the active existence of an uterine fibroid is limited ; 
* Contributions to the Surgical Treatment of Tumors of the Abdomen. By Thomas 
Keith, M. D., LL. D., Edin., 1885. 3 
it rarely interferes directly with life. When menstruation 
ceases, the troubles of the patient soon begin to pass away, 
while the tumor itself, after a time becomes smaller, and in 
a few years little or no trace of it may be found. The 
patient gets along, lives more or less comfortably, gener- 
ally not even aware of its existence, and dies of something 
else. 
They have 
not much to gain by chancing a dangerous operation, and 
they may lose much, having much to lose. 
“ Till of late years, uterine tumors were let lie undisturbed 
unless when they were mistaken for ovarian cysts ; but the 
restless surgery of to-day will let nothing alone ;it has no 
patience for the menopause, and would attack all and sun- 
dry in some way or other, till one almost begins to think 
that individual responsibility has become old fashioned 
and gone out of date. So far as operations for the cure 
of this disease have yet gone, the mortality is out of all 
proportion to the benefits received by the few. 
“ Dr. Bigelow, of Washington, has lately collected all the 
cases placed on record up to March, 1884. At best, this 
must be an imperfect list, and can only show the least bad 
side of the operation. Of 359 operations there were only 
227 recoveries and 132 deaths, or a greater mortality than 
one out of every three operated on. 
The sum of misery in the 359 operations to the subjects of 
them, and to their friends, is something simply incalculable. 
So far as hysterectomy has thus gone, it has done more 
harm than good, and it would have been better that it had 
never been.” 
Though I have thus quoted from Dr. Keith, as one of 
the highest, and perhaps the latest authority on uterine 
tumors, such principles as are in accordance with my own 
views, and the objects of the present paper, it would be in- 
justice to him to leave the impression that hysterectomy is 
banished from his surgery. On the contrary, though he 
so strongly condemns the operation in cases offering the 
possible chance of relief, by the limitation of the men- 
strul life of the subject, his record in cases forlorn of this 4 
hope—and these are his only admitted ones—has been 
marked by successes, the most brilliant and sometimes, 
wonderful to contemplate. 
Unquestionably then, the menopause must be regarded as 
the great crisis in the life, activity and growth of the great 
majority of pelvic tumors, but especially of the uterine 
fibromata, and of the softer non-malignant growths of this 
organ. Whatever methods of management have been 
found to sustain the life of the patient, and in any 
measure to lessen the exhausting hemorrhage, or to retard 
the growth of the abnormity, until the advent of this period 
of reprieve, are certainly worthy of our careful considera- 
tion. 
All the several classes of cases just mentioned ;viz, those 
which cannot, those which will not, and those which ought 
not to be operated on by abdominal section are known— 
many of them—besides the burthen of the growth, to be sub- 
jected also to the most profuse, alarming and exhausting 
hemorrhages. Their pale and oedematous faces, their 
dropsical limbs, their oppressed and gasping respiration, 
and the tumultuous action of the feeble heart, tell us, at a 
glance, of a stage of exsanguination almost incompatible 
with continued existence. In profound interest, not unmixed 
with alarm, we debate in our minds the momentous ques- 
tion: “Can she hold out to reach the longed-for goal of 
her relief?” 
Wide observation in regard to many subjects even in the 
extreme condition here represented, endorses the answer 
given by Keith : “ Even in the worst of them, the chances 
are, that they will live on—not in comfort, certainly, some 
perhaps in misery—but still they will live, and not die.” 
It is in behalf of such cases and others of a less threaten- 
ing aspect and milder type, that I advocate the record of 
our experience and the results of such treatment as they 
admit of. 
With a cordial recognition of the fact that such cases 
are not generally left without attempts to repress the hem- 
orrhage, and to stay the exhaustion incident to the advance 5 
of the disease, I desire to give a brief statement of the 
methods I have pursued in regard to them from-an early 
period of my professional life. 
For this treatment, I lay claim to no special originality, 
except perhaps for the systematic combination of the me- 
dicinal agents; but I would urge its adoption as suitable to 
a large number of those cases of uterine fibromata and 
other pelvic tumors in which operative procedures have 
been decided against, and in those that are in expectancy 
of the menopause. Few women with uterine non-malig- 
nant and pelvic growths have applied to me in the past thirty 
years, and more especially where bleeding and atonic con- 
ditions were involved, who have not been placed with 
marked benefit upon the treatment herein reported. In 
the large majority of these cases the blood-losses were 
greatly diminished and a better condition of health and 
strength secured; in many the rapidity of the growth was 
obviously retarded, while in a few the diminution and 
final removal of the tumors seemed to be the happy result 
of the continued medication. 
In condensed statement, I may say that the iodide of 
potassium in 'combination with tartrate of iron and 
potassa, and ergot in combination with quinine—these 
agents being persistently continued, constitute the basis of 
the medicinal treatment referred to. 
I will not here discuss the physiological action or the ther- 
apeutic efficiency of agents so widely familiar to the pro- 
fession, and so generally resorted to, in many conditions 
of disease. 
I will tersely make a statement of the method and mode 
of their administration adopted. 
For many years the following was the formula for the 
iron and iodide of potassium 
If. Ferri et potassas tart". 
Potassii iodidi aa- • 3vj. 
Syr. zingiberis. 
Aqua aa Siv. 
day, in y2 glass of water before meals. 
M. S. Shake the vial, take i or 2 teaspoonfuls 3 times a 6 
The above was found to be a muddy and unacceptable 
combination from precipitation, though the therapeutic 
effect of the medicines seemed not to be impaired. 
At the present time, the following is the preparation 
used : 
ty. Ferri et potassas tart svj. 
Syrupi Sviij. 
M. 
Potass, iodidi svj. 
Elixir, simplicis (vel aquae) sviij. 
M. S. Take one or two teaspoonfuls from each vial 
three times a day in half a glass of water, before or after 
meals. 
In addition to the above, I seldom omit, whether 
the cases are marked by excessive hemorrhage or not, to 
place the patient upon the following combination : 
Quinias sulph ~...sij. 
Ext.ergotas solid siss. 
Mix and divide in forty pills, cover with capsules. 
S. T<ike one pill twice daily. 
In the submucous variety of uterine fibroids—intra-uterine 
polypi—metrorrhagia is frequent and profuse, or it may be 
constant and in a milder flow, but the subjects are always 
anaemic, somewhat dropsical, with heart and lung pertur- 
bation under the least fatigue. 
The indication in such cases, is not so much to check 
the growth, or to diminish the size of the tumor, as it is to 
check the hemorrhage, rehabilitate the blood and promote 
the expulsion of the fibroid from the uterus, that it may be 
removed by operation. 
In this class of cases I therefore eliminate the iodide of 
potassium from the treatment, and place the patient on the 
following: 
Ferri et potassas tart. .. .: siij 
Extract, ergotas solid. .sij 
Quinise sulphat sij 
M. and divide in 40 pills. Take one pill morning 
and noon before eating. 7 
Under the above treatment the tumor is expelled into the 
vagina in from two to six weeks, the metrorrhagia greatly 
diminished or arrested, the complexion and strength im- 
proved, while the patient is put in better condition for the 
operation, whether by ligature, ecrasseur or excision. In 
these cases of course the expulsive efforts of the uterus are 
principally promoted by the ergot, but to the quinine, 
besides its action as a general tonic, I attribute a material 
influence in giving steadiness and persistence to the uterine 
muscularity. Its effect also on the middle or muscular 
tunic—of unstriped fibre—of the arteries, is as I have else- 
where stated* similar to that of ergot on the uterine 
muscle, constructed of the same kind of fibre. By this 
same physiological action, and its attribute of lessening the 
morbid supply of blood to the growth, I believe it to be 
valuable in checking the increase of the subperitoneal 
fibromata, as well as that of other tumors and infarctions 
within the pelvic cavity unconnected with the uterus. 
As to the action of iodide of potassium as an element 
of this treatment, in view of the wide-spread and, accord- 
ing to many, still widening influence of syphilis, trans- 
mitted or acquired, over histological economy, this agent 
may be supposed, on this account, to exercise a beneficial 
influence in the reduction of these neoplasms in some 
cases. 
In the present connection it must not be regarded as far 
fetched or out of place, to refer to some of the circum- 
stances by which many of the women laboring under pelvic 
tumors and infarctions are conditioned, especially those in 
the South and Southwest and in other malarial regions ; along 
with their local disease and the exhausting drain attending 
it, they are the subjects of an abiding tox<emia, imposing 
upon them a constant liability to intercurrent paroxysms 
of fever of the most depressing character. These not only 
interrupt treatment, but increase the turgidity of the morbid 
growth, increase the blood-losses and superadd complica- 
tions every way undesirable. Apart then from any special 
* See Transactions American Gynecological Society, Vol.V, 1880. The Prophylactic 
and Therapeutic Value of Quinine in Obstetric and Gynecic Practice. 8 
influence over the growth, the widely recognized prophy- 
lactic and antidotal influence of quinine will render it ac- 
ceptable as an element of treatment in such tumors to a 
large number of observant practitioners.* 
The considerations heretofore presented have had in 
contemplation women in the middle and later stages of 
menstrual life, who have been discovered to be the subject 
of uterine and other pelvic growths and suffering from the 
disturbing and exhausting results attendant upon their 
presence and advancement. This is the period at which 
most of these tumors come under the purview of the gy- 
naecologist and general practitioner. It is the period of 
greatest activity of the growth, of the most frequent and 
abundant hemorrhage, and of the greatest exhaustion and 
danger to the woman. From this time to the completion 
of the menopause, all expedients are exhausted to check 
the hemorrhage, to sustain the vitality of the patient, and to 
prop her in her staggering journey towards the goal of her 
relief. This is the period, too—treatment having been 
neglected or failed to stay her downward progress—when 
abdominal section with the view to oophorectomy, extirpa- 
tion or hysterectomy, can, not unwarrantably, be debated ; 
but as I think, always only as a last and desperate resort. 
It is in view, as I have said, of cases in this stage of 
menstrual life, that I have endeavored to formulate and 
from the records of a somewhat extended ex- 
perience a persistent course of medication and management, 
that may serve to sustain and guide the woman through the 
bight and narrows of the most perilous strait in the progress 
of her disease. 
I will here distinctly state that the treatment is not insti- 
tuted with the expectation of removing the enormous 
growths and uterine fibroids that distend the abdomen, but 
for rendering them less burdensome ; not with the expect- 
ation of entirely arresting or preventing the hemorrhage, 
* I here take pleasure in referring to a valuable paper on “ The Sulphate of Quinine” 
published in the Virginia Medical Monthly and afterwards in a separate volume by Prof. 
O. F. Hanson, M. D., of Richmond, Va. This paper defines the uses and extends the 
applications of quinine, and is well worth the perusal of every practitioner of medicine in 
the South. 9 
but rendering it less profuse and exhausting ; not with the 
expectation of restoring health, but for rendering disease, 
dire and dreadful, more endurable. 
It may be asked if the treatment herein presented has 
been found always more or less beneficial in uterine fibroids 
and other pelvic growths? 
In reply, I may say I do not remember ever to have 
known a simple or multiple fibroma of the uterus to directly 
cause the death of the subject, but in the low condition of 
exsanguination and exanimation caused by the hemorrhage 
and irritation of fibroids, I have seldom failed to realize 
marked improvement in the general condition of the pa- 
tient, and in many cases I have observed what appeared 
to be a notable retardation in the increase of the growth. 
In several pelvic and abdominal tumors of both men 
and women, unconnected apparently with the uterine ap- 
paratus, I can report decided benefit to the general health 
and marked reduction and even disappearance of the tu- 
mor, in the prolonged use of iodide of potassium in com- 
bination with tartrate of iron and potassa. Of course, 
there are some cases of pelvic tumors or infarctions in 
which, while this or something similar may be the only 
rational medication practicable, yet, no reasonable expect- 
ation of relief can be entertained. The following is a nota- 
bly disastrous case of this kind : 
Mrs. H. S. G., the mother of many children, all grown, 
had long passed the menopause ; aged 56; when a hard 
resisting tumor, the size of an orange, was found pressing 
into the cavity of the pelvis. It was situated below the 
sacral promontory and appeared firmly attached to the 
anterior face of the sacrum. Its pressure soon interfered 
with the passage of fasces, which for a while was accom- 
plished by mechanical means. The progressive growth 
and tight impaction soon caused perforation of both the 
rectum and bladder resulting in free escape of fasces and 
and urine into the vagina. Numbness and paralysis came 
on from pressure on the sacral nerves. The circulation 
became interrupted by pressure on the large arterial trunks 10 
at the pelvis, and the patient died in less than one year 
from the discovery of the tumor, with irritative fever and 
exhaustion from gangrene of both her lower extremities. 
Extirpation of the tumor, either by the vagina or by ab- 
dominal section, did not appear to be a very practicable or 
hopeful measure, and the attempt was persistently rejected 
by the patient. 
The above case is recorded here more as an illustration 
of the .phenomenal disasters which attend the detention and 
locking of a growing tumor within the bony pelvis, than 
for the purpose of exhibiting the success or failure of any 
treatment, either medicinal or operative. An}r sub-perito- 
neal uterine fibroid that happened in a certain stage of 
growth to be detained in the bony pelvis, might become in 
a like manner impacted with an equally fatal result. 
The ascent of these uterine fibroids out of the bone-girt pel- 
vis into the more roomy cavity of the abdomen, must be 
recognized as an important episode in the history of their 
growth for the safety of the patient. On more than one 
occasion I have been able to relieve patients from distress- 
ing iPa*n by a simple dislodgement of the tumor, when par- 
tially jammed in the pelvis. 
As I have heretofore said, my remarks have related to 
cases of fibroma and other pelvic tumors in the middle and 
later stages of the menstrual life of the woman, when the 
reduction of the growth was less the object of treatment 
than that of carrying them on sately to the period when 
their gradual decline and subsidence might be hoped for 
by the advent of the menopause. Vailing from this class, 
I find among my records the notes of two cases of women 
at an earlier period, in which treatment seemed to be fol- 
lowed by the removal of all traces of the pelvic infarction, 
together with the perturbations of menstruation which had 
marked their presence. 
Miss S. A., of Washinghton; Ga., aged 22 years, in the 
spring of 1869 was referred to my care by the late Prof. 
Jos. A. Eve, of Augusta. This young woman had been the 
subject of impaired health for over two years. Her symp- 11 
Toms, as reported, were disturbed and irregular menstrua- 
tion, the flow being sometimes deficient, and at others 
amounting to profuse hemorrhage, with general emacia- 
tion and enlargement of the abdomen, which last feature 
had recently greatly increased. 
the patient was found to be anaemic and extremely ema- 
ciated. The abdominal enlargement resembled that of a 
woman eight months advanced in pregnancy. This was 
principally due to ascitic accumulation in the peritoneal 
cavity. By firm pressure nodulated masses could be felt 
in the hypogastric and iliac regions. Vaginal exploration 
found the uterus fixed in the pelvis, and bimanual pressure 
indicated the connection of this organ, apparently, with 
the pelvic tumor. There was more or less vesical tenes- 
mus, with scanty and turbid urine. The bowels, though 
torpid and constipated, presented no indication of me- 
On examination with Dr. Eve and Dr. H. H. Steiner, 
chanical obstruction. 
After some previous treatment with laxatives and diu- 
retics, the patient was placed within ten days upon the fol- 
lowing prescription: 
lodide of potassium 
Ferri et potassas tart, grs. 320 
Water , 
Qinger syrup aa § iv. 
M. S. Take one dessertspoonful, three times a day, 
befoVe meals, in one half glass of water. 
A highly nutritious diet was maintained. 
The case occurred at a period anterior to the free use of 
hot water by the vagina as recommended by Emmet, and 
of hot water by the rectum as recommended by Chadwick, 
(see hot rectal douche, Amer. Gynaecological Transactions 
Vol. 5), and no local measures beyond a daily vaginal 
injection of tepid water for the leucorrhoea, were recom- 
mended. 
The patient remained under observation for two months, 
during which time the ascitic accumulation had disappeared, 
the pelvic tumors had become less prominent, and the 12 
uterus easily movable in the pelvic cavity. There was no 
return of menstruation during her stay in Augusta. The 
complexion, strength and general health of the patient 
having been greatly restored she returned to Washington 
to continue treatment at home. Letters from the patient 
informed me of the re-establishment and regularity of men- 
struation and of the complete recovery of her health. 
The treatment with occasional interruptions was continued 
for eight months. 
By palpation over a year after, no trace of the tumors 
could be discovered.* No vaginal exploration was made. 
This lady called to see me several years after, as she 
kindly and truly said “ to show me that she was well, as 
she knew I would be gratified at the success of my treat- 
ment.” 
Mrs. G. 1., of Louisville, Ga., aged 24 years, came to 
Augusta, July 3d, 1885. She was weak, antemic and greatly 
emaciated from loss of blood. She had spent most of her 
time for several months upon her bed. In a recent “ turn ” 
the hemorrhage had been so profuse and exhausting that 
her husband became alarmed and her medical attendant 
referred her to me for examination and treatment. 
The abdominal wall was flat and somewhat retracted. 
There was no indication of enlargement in either of the 
iliac regions, but in the hypogastrium there was a decided 
elevation above the pubic brim of the pelvis, as if by a dis- 
tended bladder, or by the uterus in the fourth month of 
pregnancy. The tumor was firm and resisting to external 
pressure and apparently devoid of acute sensibility. Va- 
ginal exploration revealed the same hard and rotund bod}r 
pressing against the posterior face of the pubic wall and 
pushing the vault of the vagina downward, so as to oblite- 
rate the cavity. She had been for some time past troubled 
with vesical tenesmus and some dysuria. Where the blad- 
der, with any degree of distension, could be accommo- 
dated in this thorough occupation of the pelvic cavity, it 
seemed difficult to say. 
On making the most careful and extended efforts to ex- 13 
plore the cervix it was found to be entirely out of reach, 
from the extreme anteversion of the enlarged uterine globe. 
The organ was firmly fixed—impacted—in this anterior 
obliquity. 
A few days later, my friend, Dr. John S. Coleman, was 
requested to assist me in a more thorough examination by 
the vagina and, if possible, in an exploration of the uterine 
cavity. In no position, whether dorsal, semi-prone or 
genu-pectoral, could our combined efforts secure any 
change in the position of the massive uterus, or bring the 
cervix within the reach of the finger. The patient being 
greatly enfeebled from her recent loss of blood we were 
unwilling to fatigue her further, or to attempt probing un- 
less guided by the touch. 
I placed the patient, the day after arrival upon the fol- 
lowing : 
Potassii iodidi sxij. 
Elixir simp • • ■ ■ Op 
Mix and write : Dose one or two teaspoonfuls in com- 
bination. 
Ferri et polassae tart sxjj. 
Syrupi zingiberis Oj. 
Mix and write : Take one or two teaspoonfuls from each 
bottle, before each meal, in y2 glass of water. 
In addition to the foregoing; • 
Ext. ergotas solid siss. 
Quinire sulph , sjj- 
Mix and divide in 40 pills, cover with capsules ; write : 
Take one morning and at noon. 
A tepid vaginal douche was directed to be made night 
and morning. The patient was also requested to assume 
the genu-pectoral position each night and apply the reposi- 
tor tube, to allow air to enter the vagina. 
Though under this treatment the patient rapidly im- 
proved in color, in flesh and in strength ; though she was 
able to leave her bed, and, once or twice, had gone 
upon the street, daily repeated examinations in knee- 14 
breast posture failed for a longtime to discover any diminu- 
tion in the size of the mass, or the slighest change of its 
position, under either digital pressure or reversal of gravity. 
On the 29th of July, over twenty days from the begining 
of treatment, I perceived that decided movement in the 
uterine globe attended the entrance of air—and the patient 
told me that for the last few days, air would puff out of 
the vulva after lying down from the knee-breast posture. 
This entrance of air indicated movement, and a less tightly 
impacted condition. 
July 30th Mrs. J. returned home, with directions to 
continue treatment. 
Sept. 20th, 1885, Mrs. J. returned to Augusta for further 
examination and advice. Various letters had reported her 
as constantly improving in general health and activity since 
July 30th. Palpation could discover no tumor in the pel- 
vic region. On vaginal exploration the uterus was found 
low in the cavit}r of the pelvis, but only slightly anteverted. 
The most surprising diminution in the size of the organ 
was observable, and its perfect mobility in every direction 
was apparent. On placing* her in genu-pectoral posture, 
air quickly entered and distended the vagina on opening 
the vulva, and the uterus retired by reversed gravity above 
the normal plane. An elastic ring pessary 3]/2 inches in di- 
ameter was applied to sustain the organ in proper elevation. 
She had had two returns of menstruation without tendency 
to hemorrhage. The uterus, though greatly reduced, was 
evidently at this time still considerably above its normal 
size and weight. 
Recommended continuance' of treatment. Oct. 21st, 
1886; at this date Mrs J. paid her last visit. She called 
for examination as to her condition, and to have the pes- 
sary, which she said added to her comfort, renewed. One 
could scarcely lecognize in this cheerful, ruddy and majes- 
tic woman, the dispirited, pale and almost bed-ridden 
patient of over a year ago. She had continued treatment, 
somewhat interruptedly, to the present time. 
Though I did not measure the cavity with the sound, I may state that the uterus is reduced to the normal dimen- 
sions, and is normal in contour and position, except a 
slight tendency to prolapsus, due probably to its prolonged 
abnormal condition and relaxed ligaments. Menstruation 
had been regular and normal for over a year, and in every 
particular her health seemed fully restored. 
She was advised to continue her medicines for a while 
in reduced doses, after which she might probably safely 
abandon medication. 
I have seldom witnessed relief from a grave and threat- 
ening condition, which appeared to be so directly attribut- 
able to the influence of the treatment adopted. 
In conclusion, were I to endeavor to formulate ;principles 
from the foregoing considerations, and from my own ob- 
servation and experience, the following may perhaps be 
legitimately stated : 
First, that a large proportion of uterine fibro- 
mata and other pelvic tumors outside the ovarian 
cysts, are not properly the subjects for surgical treatment, 
either by hysterectomy, oophorectomy, salpingotomy or 
excision. 
Secondly, though these growths, especially the uterine 
fibroids, seldom per se destroy the life of the subject, 
and are limited in the duration of their injurious influence, 
they yet impose upon the woman a prolonged period of 
depression, exhaustion and ill health, during which period 
she is liable to succumb to intercurrent invasions of disease 
before the establishment of the menopause, or the time of 
expected relief. 
Thirdly, that a systematic and persistent therapeutic 
course, rationally adjusted to the nature and condition of 
the disease, is highly desirable. 
Fourthly, from the known physiological effects of ergot 
in combination with the salts of quinine, and of iron, with 
iodide of potassium, and in view of the results above pre- 
sented, we may regard such a combination as rationally 
applicable during the prolonged period of hemorrhage and 
exhaustion, so frequently marking the progress of these 
pelvic growths. 16 
Fifthly, that while such medication cannot be expected 
ordinarily to remove large fibroids, or materially arrest 
their advance, it exercises marked influence in diminishing 
the blood-losses, and in improving the nutrition and general 
health of the subject of such tumors ; and in some rare in- 
stances, apparently in younger subjects, it results in the 
entire disappearance of the growth and its deplorable con- 
comitants. 
And lastly, that in view of the danger of impaction, 
much pain being often produced from this cause, with 
increase of bleeding, a womb with growing fibroids 
should be frequently lifted out of the cavity of the true 
bon}r pelvis, by nightly self-replacement in the knee-breast 
posture.