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THE TREATMENT OF UTERINE FIBROIDS BY X RAYS.
1543 and a common form of the exclusive meat diet are each capable of producing good results in gout, that both, if carefully regulated to the digestive capacity of the individual, tend to eliminate the chief causative factor-viz., auto-toxsemia. I am in complete accord with Dr. Young in thinking that ’intestinal derangement is the primary factor in gout. This view is one to which I have sought to draw special attention for many years past. At the same time I cannot agree with him in regarding it as in any way an explanation. When it is analysed it explains nothing. What we have to consider is the varying liability to certain types of intestinal derangement.which we see as clinicians, and to ascertain so far as possible on what these depend. My explanation may or may not be the right one ; it is at any rate based on new facts obtained from experimental investigation. Briefly stated, my position is as follows. We have in gout a disorder of protein metabolism ; the thyroid glacd has long been known to be specially concerned in the metabolism of protein foods ; my observations have shown that the structure and function of this gland are modified by diet, and specially that meat is primarily a stimulant and later a depressant of its activity ; my clinical experience of gouty disorders is in harmony with that of those who find that in some cases a lacto-vegetarian diet and in other cases a diet rich in proteins is of special value in treatment ; and I believe that the favourable effects of the dietetic treatment in both instances are due to a large extent to the influence of the diet on the thyroid gland. In the case of the lacto-vegetarian diet the strain on the gland is diminished by a marked reduction in the amount of proteins in the food; in the case of the rich protein diet the normal digestion and metabolism of the proteins are promoted by the fact that the farinaceous and other foods .are restricted, and under these circumstances the stimulating effects of the diet on the thyroid gland assert themselves with advantage to the patient. I am, Sir, yours faithfully, CHALMERS WATSON. 1909. Nov. 14th, Edinburgh,
approximating to a purin-free diet, diet such
as
THE TREATMENT OF UTERINE FIBROIDS BY X RAYS. To the Editor of THE LANCET. think the following case should prove of interest, SIR,-I showing, as it does, that fibroid of the uterus may be successfully treated by being subjected to the influence of X rays. A woman, aged 37 years, married, one child, came to me with the following history. Two years previously she had been - curetted for the relief of menorrhagia due to a fibroid, but the relief obtained was only of a temporary nature. A year ago she again went into hospital with a view to operation. She was told, however, that the only cure would involve a removal of the uterus, and, failing that, the next best thing would be to curette again, the latter course being eventually carried out. I saw her for the first time about four months after she had been curetted and the monthly haemorrhages were again becoming excessive. I tried the usual routine treatment of ergot, hot douches, and rest, but with only moderate success, until finally her con-dition grew so grave that it became necessary to recommend operation. Before doing so, however, I determined to try the effect of treatment by exposure to X rays, and Dr. W. Ironside Bruce very kindly consented to carry it out. The fibroid at this time was of the size of a pigeon’s egg and was situated in the anterior wall of the cervical canal. In view of the position of the tumour irradiation was carried out with the patient in the knee-elbow position, the rays being directed from below upwards in the axis of the pelvic brim ; a filter composed of several layers of felt was placed between the skin and the tube, thereby all risk of X ray dermatitis was obviated. Each irradiation lasted ten minutes, and three sittings were given in the week. The total time of irradiation amounted to 70 minutes in all, and the current used was from an 8-inch coil taking a primary current of 100 v. 5 amps. The tube was one with a water-cooled anode having an equivalent spark gap of from 4 to 6 inches. In short, the amount of current passed through the tube was just as much as could be passed through it for ten minutes without rendering it too soft to be
of any use. After the first sitting the patient complained of aching pain in the back, which lasted until after the fourth exposure. The menstrual period, which occurred about this time, was accompanied by severe loss, but she found that the discomfort which she usually experienced two days before the onset was very much improved. At the conclusion of the sittings Dr. Ironside Bruce and myself again examined her. He could find no trace of growth and thought the cervix was normal. I thought I could still detect an ill-defined thickening in the anterior cervical wall on the site where the fibroid had been. The day after the examination her period occurred at its proper time, and she noticed, firstly, that it began without any warning of pains or discomfort; secondly, that it lasted only three days, and that there were no clots or sudden gushes so noticeable on previous occasions ; and thirdly, that on its cessation she felt perfectly well and fit to carry on her household duties instead of feeling a wreck for a day or so as she had always done before. Only 12 towels were used instead of the usual 27 or 30. Previously to irradiation the patient had been much troubled by a leucorrhoeal discharge; she tells me now that this is scarcely noticeable.-I am, Sir, yours faithfully,
URQUHART BARTHOLOMEW, M.R.C.S. M. R. C. S.Eng., En’., L. R. C. P. Lond., L.M.S.S.A. L.R.C.P. L. M. S. S. A. Lond. Green-street, W.C., Oct. 30th, 1909.
THE NATIONAL ASSOCIATION FOR THE FEEBLE-MINDED. To the Editor of THE LANCET. SIR,-Thank you very much for the notice you have inserted in THE LANCET re the annual report and conference, but you have omitted to make any mention of the Princess Christian’s Farm Colony which we have just opened near Tonbridge, a beautiful property of 171 acres. We hope that on this colony houses will be erected for men and women, boys and girls, and also a school for children ; although only half the farm is occupied by us at present, we can already house 30 boys, and are making immediate arrangements for the alteration of the present buildings so that they will accommodate another 20 ; it is hoped also that a home for girls will very shortly be taken in hand. I am, Sir, yours faithfully, A. H. P. KIRBY, Secretary. Denison House, 296, Vauxhall Bridge-road, S.W., Nov. 8th, 1909.
THE NATURE OF OSTEITIS DEFORMANS (PAGET) AND ITS RELATION TO MALIGNANT NEOPLASIA. To the Editor of THE LANCET. SIR,-In endeavouring to determine the natural relations of a novel morbid condition for which a definite place has not yet been found in our nosological cadres a great deal depends on the standpoint from which the pathologist surveys the scene. Having for many years taken special interest in"osteitis deformans"(Paget), chiefly with the object of determining its inter-relations with malignant neoplasia, it will perhaps interest your readers to know the conclusion at which I have arrived, after having studied the malady from this somewhat unusual standpoint. It will be remembered that three of Sir J. Paget’s five cases were complicated by malignant neoplasia, and so many other examples of this concomitancy have sinoe been reported that the impression has arisen that this form of bone disease is often complicated by malignant tumour formation. This being so, I was much surprised on going over the records of over a thousand consecutive cases of primary malignant tumours to find that not a single one of them was complicated with "osteitis deformans." In endeavouring to unravel this puzzle I was led to pay particular attention to the precise seats and nature of the tumour lesions in cases of this concomitancy, and it then became manifest that these affected chiefly the skeletal bones, and that they were generally described, as being of ’’sarcomatous"" nature, many of them having a
myeloid
structure.
From these and other
converging indications
of like
impoit
approximating to a purin-free diet, diet such
as
THE TREATMENT OF UTERINE FIBROIDS BY X RAYS. To the Editor of THE LANCET. think the following case should prove of interest, SIR,-I showing, as it does, that fibroid of the uterus may be successfully treated by being subjected to the influence of X rays. A woman, aged 37 years, married, one child, came to me with the following history. Two years previously she had been - curetted for the relief of menorrhagia due to a fibroid, but the relief obtained was only of a temporary nature. A year ago she again went into hospital with a view to operation. She was told, however, that the only cure would involve a removal of the uterus, and, failing that, the next best thing would be to curette again, the latter course being eventually carried out. I saw her for the first time about four months after she had been curetted and the monthly haemorrhages were again becoming excessive. I tried the usual routine treatment of ergot, hot douches, and rest, but with only moderate success, until finally her con-dition grew so grave that it became necessary to recommend operation. Before doing so, however, I determined to try the effect of treatment by exposure to X rays, and Dr. W. Ironside Bruce very kindly consented to carry it out. The fibroid at this time was of the size of a pigeon’s egg and was situated in the anterior wall of the cervical canal. In view of the position of the tumour irradiation was carried out with the patient in the knee-elbow position, the rays being directed from below upwards in the axis of the pelvic brim ; a filter composed of several layers of felt was placed between the skin and the tube, thereby all risk of X ray dermatitis was obviated. Each irradiation lasted ten minutes, and three sittings were given in the week. The total time of irradiation amounted to 70 minutes in all, and the current used was from an 8-inch coil taking a primary current of 100 v. 5 amps. The tube was one with a water-cooled anode having an equivalent spark gap of from 4 to 6 inches. In short, the amount of current passed through the tube was just as much as could be passed through it for ten minutes without rendering it too soft to be
of any use. After the first sitting the patient complained of aching pain in the back, which lasted until after the fourth exposure. The menstrual period, which occurred about this time, was accompanied by severe loss, but she found that the discomfort which she usually experienced two days before the onset was very much improved. At the conclusion of the sittings Dr. Ironside Bruce and myself again examined her. He could find no trace of growth and thought the cervix was normal. I thought I could still detect an ill-defined thickening in the anterior cervical wall on the site where the fibroid had been. The day after the examination her period occurred at its proper time, and she noticed, firstly, that it began without any warning of pains or discomfort; secondly, that it lasted only three days, and that there were no clots or sudden gushes so noticeable on previous occasions ; and thirdly, that on its cessation she felt perfectly well and fit to carry on her household duties instead of feeling a wreck for a day or so as she had always done before. Only 12 towels were used instead of the usual 27 or 30. Previously to irradiation the patient had been much troubled by a leucorrhoeal discharge; she tells me now that this is scarcely noticeable.-I am, Sir, yours faithfully,
URQUHART BARTHOLOMEW, M.R.C.S. M. R. C. S.Eng., En’., L. R. C. P. Lond., L.M.S.S.A. L.R.C.P. L. M. S. S. A. Lond. Green-street, W.C., Oct. 30th, 1909.
THE NATIONAL ASSOCIATION FOR THE FEEBLE-MINDED. To the Editor of THE LANCET. SIR,-Thank you very much for the notice you have inserted in THE LANCET re the annual report and conference, but you have omitted to make any mention of the Princess Christian’s Farm Colony which we have just opened near Tonbridge, a beautiful property of 171 acres. We hope that on this colony houses will be erected for men and women, boys and girls, and also a school for children ; although only half the farm is occupied by us at present, we can already house 30 boys, and are making immediate arrangements for the alteration of the present buildings so that they will accommodate another 20 ; it is hoped also that a home for girls will very shortly be taken in hand. I am, Sir, yours faithfully, A. H. P. KIRBY, Secretary. Denison House, 296, Vauxhall Bridge-road, S.W., Nov. 8th, 1909.
THE NATURE OF OSTEITIS DEFORMANS (PAGET) AND ITS RELATION TO MALIGNANT NEOPLASIA. To the Editor of THE LANCET. SIR,-In endeavouring to determine the natural relations of a novel morbid condition for which a definite place has not yet been found in our nosological cadres a great deal depends on the standpoint from which the pathologist surveys the scene. Having for many years taken special interest in"osteitis deformans"(Paget), chiefly with the object of determining its inter-relations with malignant neoplasia, it will perhaps interest your readers to know the conclusion at which I have arrived, after having studied the malady from this somewhat unusual standpoint. It will be remembered that three of Sir J. Paget’s five cases were complicated by malignant neoplasia, and so many other examples of this concomitancy have sinoe been reported that the impression has arisen that this form of bone disease is often complicated by malignant tumour formation. This being so, I was much surprised on going over the records of over a thousand consecutive cases of primary malignant tumours to find that not a single one of them was complicated with "osteitis deformans." In endeavouring to unravel this puzzle I was led to pay particular attention to the precise seats and nature of the tumour lesions in cases of this concomitancy, and it then became manifest that these affected chiefly the skeletal bones, and that they were generally described, as being of ’’sarcomatous"" nature, many of them having a
myeloid
structure.
From these and other
converging indications
of like
impoit