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78 R a d i u m
uterus was found enlarged and hard with a cervix lacerated and eroded.
The clinical diagnosis was a very early carcinoma of cervix or a chronic
metritis with cervical erosions and lacerations. A circular amputation
of the cervix was performed with the Byrne cautery knife, leaving 2^
inches of uterine canal. Two thousand four hundred milligram hours
of radium were given within the uterus. The pathological report stated
ihat the cervix was not malignant. Convalescence was stormy because
of secondarv haemorrhage from the cervix. The patient left the hospital
in 3 weeks with the cervix healed and in good condition.
Two years laler this patient complained of abdominal pain once a
month. There was never any flow and no fever. She looked well. Six
months later the pain each month had increased and a presumptive diagnosis
of haemalomctra was made, and a laparotomy was performed. The
pelvic organs were very adherent, and there was a double haematosalpinx
of considerable size, and the uterus was distended with old menstrual
blood. A supravaginal hysterectomy with a double salpingo-oophorectomy
was done. The stump of the cervix was split for drainage and the
patient made a slow but satisfactory recovery.
Here is a case in which 2400 milligram hours of radium within the
uterus failed to stop ihe menstrual periods for more than iy2 years. The
menstrual function then slowly returned, but. as there was a stenosis of
ihe cervical canal, due lo the cautery amputation, there was no drainage
and the blood backed up into the uterus and tubes.
The fibroid cases treated with radium were 21 in number. For the
most part they were small fibroid tumors in the wall of the uterus, or
'inall myomata. In only 3 cases have tumors larger than a fetal head
been treated, and we have been careful to exclude submucous or pedunculated
tumors, and Ihose causing pelvic pain. With one exception.
the patients' ages have been between 40 and 50 years. These patients
were all subjected to a careful bimanual examination under anaesthesia
and an intra-uterine invesligation with a curette before the radium was
introduced into the uterus. The usual radium dose was 1200 milligram
hours. One patient received 1500 milligram hours and two received
2400 milligram hours at one session. The results have been excellent.
Patient, aged 26. with a fibroid tumor extending 3 inches above the
-ymphysis, was flowing heavily, and refused surgical measures. Radium
was used after its effect had been fully explained to her. The result
of one 1200 milligram hour dose was all that could be desired. The
flow ceased, and the tumor slowly became reduced in size.
I know of only two cases where ihe bleeding did not stop with the
single 1200 milligram hour dose. In both of these cases the periods
have been reduced to normal in frequency and amount, the uterus remaining
about stationary in :.ize.
In one case surgery was combined with radium treatment. A
myoma fillingthe pelvis was treated with a 1500 milligram hour dose.
the tubes being sutured in place, and an cxtensive^operation for lacerated
perineum and rectoccle was carried out with excellent result from both
radium and surgery.
Two patients, with large fibroids, heavy flow, and very low haemoglobin
have had a 2400 milligram hour radium treatment, each as a
preliminary to a later supravaginal hysterectomy. In each case the flow
ceased, the haemoglobin increased, and the patient became a good operative
risk with eventual recovery after hvstcreciomv.