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R a d i u m 77
Our technique is to tie a strong silk thread into the eye of each
platinum capsule. The capsules arc then placed in a 20 per cent carbolic
and alcohol solution for 20 minutes. The rubber tubing is boiled: a
sterile nurse then inserts ihe radium capsules into the rubber tube, ties
off both ends of the tube vvith silk, leaving a long thread attached to one
end. By this measn, we have a silk thread attached to the rubber tube
and to each radium capsule. The screened radium is now ready for
use. Later, the three silk threads are attached to the patient's thigh
by adhesive plaster.
CHRONIC METRITIS
You will see that over half of our patients were suffering from
chronic metritis or small fibroids.
The metritis cases were all at about the menopause age and gave
no history nor physical findings of previous inflammatory trouble. The
principal symptom was uterine bleeding. They were all subjected to a
careful examination under anaesthesia, and uterine curetting. The curettings
were later examined by the pathologist. If the diagnosis of chronic
metritis was sustained by clinical findingsat ihe time of operation, these
patients received 1200 milligram hours of radium at one dose in two
50 milligram tubes in tandem, screened with 1 millimeter of platinum
and 2 millimeters of rubber. Radium was carried well up to the fundus
of the uterus, and kept there by a narrow strip of gauze packed into
the cervical canal and the vagina was packed full of dry gauze. Patients
have not had any difficulty in voiding, and we have not used a
self retaining catheter, as is the custom in some institutions. Gauze and
radium were removed 12 hours later, without difficulty or pain to the
patients. Our rule is bed for 6 days.
The results have been very satisfactory. Uterine bleeding stopped
in 5 or 6 weeks, and the uterus gradually became smaller in all but three
cases. Two cases had a second radium treatment. 6 months to a year
later, of 1200 milligram hours, which cured them, and the third case
came to subsequent operation vvith a very interesting pelvic condition.
A fourth case came to operation t year later for appendicitis, and as
the uterus was large and soft, even though there had been no vaginal
bleeding, the surgeon performed a supravaginal hysterectomy.
Of these 66 cases of chronic metritis. 11 had the combined treatment
of radium and surgery at the same sitting. Ihe operative procedures
were trachelorrhaphy, amputation, or repair of the anterior or
posterior vaginal walls. In many of these cases, the radium was placed
in the uterine canal and ihe rubber tube, used as a screen, stitched to
the anterior and posterior lips of the cervix with a chromic gut stitch.
This suture was tied with a half bow knot, leaving a long end which was
carried out of the vagina and attached to the patient's thigh. When
radium is thus fastened within the cervix and uterus, the vagina is not
packed with gauze. We have had no bad results from not using the gauze
packing and the repair operations have healed nicely.
FIBROIDS
In this group of 11 cases there is only one which had a Byrne cautery
amputation of the cervix, and I will report it in more detail.
Mrs. S. W.. age 33, Russian, was admitted to the hospital with a
history of spotting between periods for 2 months. On examination, the