A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
In the case of a fibroid tumor situated in the central stratum of
fibres the antagonism is equal at all points, and it is evident that
there is no tendency to rupture of the capsule, and much less crushing
influence exerted upon it than if it were situated slightly nearer the
mucous membrane. This variety of the tumor, therefore, yields to ergot
only as it may be starved out by diminution of its blood-supply and as
the effect of pressure, which we all know are the two conditions most
favorable to absorption.
Now I think we have arrived at a point in this investigation where we
can draw inferences as to the forms of tumors likely to be effected by
ergot in different ways, as well as those that will not be effected by
it. We do not expect ergot to cause painful and efficient contractions
in the healthy unimpregnated uterus; its fibres are not capable of such
contraction, and it is not until the fibres have become greatly
developed that they are susceptible to the impressions of ergot. In
cases of early abortion its action is very unreliable, but after the
fourth month of pregnancy it acts quite efficiently.
In tumors of the uterus the development of the fibrous structure is
sometimes so slight that it is incapable of contraction; there may be
so many nuclei of degeneration that there are not enough sound fibres
left for efficient contraction. Then, where there are many small tumors
developed in the uterine walls, the circulation is cut off to such a
degree that they degenerate into a cartilaginoid substance, and
sometimes they are infiltrated with calcareous material. In none of
these cases will ergot cause any appreciable results. When, however,
there are {265} but one, two, or three nuclei of morbid growths, as
they increase in size the fibres undergo the development necessary to
enable them to contract with great efficiency and render them
susceptible to the influence of ergot.
Another condition which influences the hypertrophic growth of the
fibres is the situation of the tumor. Subperitoneal tumors do not cause
as great growth in the fibres of their neighborhood as the intramural
or submucous varieties. A single intramural tumor causes great
development of the whole uterine tissues, but the development of the
wall in which it is situated decidedly predominates. The submucous
neoplasm so soon gains the uterine cavity that the development is
nearly the same in the whole organ. When, therefore, we administer
ergot for the cure of fibrous tumors of the uterus, the beneficial
action of the drug will depend upon the degree of development of the
fibres of the uterus and the position of the tumor with reference to
the serous or mucous surface. The nearer the mucous surface, the better
the effects. If the tumor is very near the lining membrane, we may hope
for its expulsion en masse or by disintegration.
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