The Oliver-Sharpey Lectures ON THE ACTIVITY OF THE CAPILLARY BLOOD VESSELS, AND ITS RELATION TO CERTAIN FORMS OF TOXAEMIA: Delivered before the Royal College of Physicians of London
Authors: H. H. Dale
Journal: BMJ (1923)

x were referred to me by their own doctors on account of the fibroids, the carcinoma of the cervix having been overlooked in each case; had radiation been the recog'nized treatment for fibrolds, the probability is that these growths would have remained undiscovered until a much later period, as the radiologist has no more special training in gynaecological diagnosis than the general practitioner. DegeneraNion.A degenerating fibroid may cause serious symptoms, either from the effect of the degeneration itself as in red degeneration, or because the degenerated tissue has become infected with organisms, or merely from the absorption of the pro- ducts of degeneration.This last is, I think, much more important than is usually recognized, and accounts for the profounaI anaemia, often out of all proportion to the amount of blood lost, and the general ill health from which these patients suffer.Unfortunately not all the specimens in this series were examined in the laboratory, but of those which were, twenty- Dne were reported as having undergone degenerationi-ystic, red, calcareous, etc.; these degenerations occur much more frequently in fibroid uteri after the menopause when the blood supply is much diminished.How often degeneration occurs in a fibroid after an arti- ficial menopause produced by radiation I cannot say, myJ personal experience of this method of treatment being very small, but I see no reason to suppose its inicidence to be less than in fibroids after a natural menopause, and I have seen one case which required operation six years after an artificial menopause produced by x rays.This complication is often overlooked in the papers advocating radiation, as the cases are too recent, and it would be useful to have some of these series reviewed ten or twenty years later.It is impossible to say what would have lhappened to all these cases if they had been treated by radiation; I do inot suggest all would have ended fatally, thouglh probably sonme would; and certainly some would have required operation at a later date for urgent symptoms, when the patient's coni- dition would make operation a imiuch more serious matter.This danger is riecognized by many r-adiologists, and the more experienced of them advise all cases of fibroid to be examined by a gynaecologist so as to eliminate degenierationis of the tumour; but the great difficulty is to be sure witholut operation that a tumour is not undergoing degeneration, and the instances must be few in which a competenit gynaecologist will take the full responsibility of saying there is no degeneration.Inflamed Appendlages.This is a complication which precludes treatmenit by radiation, accordinig to the authorities on this method of treatment.Of course, acute inflammation will usually give rise to acute symptoms which are easily recognized, but ther e are cases which only come under treatment after the acute symptoms have subsided.In this series there was only one case which could not be included in one or other of the categories, but there -were several others with inflanmed appendages complicated with degenieratinig fibroids or with adhesions to rectum or intestines.Adhesions.Adhesions firmly binding rectum, bladder, or intestines to the tumour contraindicate the use of radiation, and yet how often do we unexpectedly find these adhesions during an operation!The following case one of the last in this series -is an instance:An unmarried woman, aged 49, one year past the menopause, with no previous history of inflammation, was brought to me because of recurring haemorrhage.Examination revealed the presence of a