★★★★★
By H. R. COSTON, M.D.,
Fayetteville, Tenn.
Source - Therapeutic Gazette, a Monthly Journal of General, Special, and Physiological Therapeutics, by H. A. HARE, M.D. and EDWARD MARTIN, M.D. 1900
On July 12 last I was called several miles into Alabama to see Mrs. L., in consultation with Dr. A. A. Hatcher, of Huntsville, Ala. The history of the case is as follows:
Mrs. L. is fifty-two years old, the mother of two children, the youngest of whom is twenty- eight - an epileptic; the first – born died in infancy of " bowel complaint." The patient passed the climacteric at forty-seven-five years ago without trouble. Father died of pneumonia, mother of " heart disease; " one maternal aunt died of cancer of the breast. Mrs. L. has always been delicate, but fairly healthy; never strong, but never confined to her bed and but seldom to her room. About January 1,1899, she began to notice, at intervals, slight discharges of blood or " bloody water. " She consulted her family physician, who told her that the discharge was possibly only a slight return of the menses and not to bother about it. He failed to make a vaginal examination, and hence lost the golden opportunity to save the patient. When I was called July 12, six months after first symptoms – I found the discharge was continuous, some days very severe, while other days it would be only a stain.
Upon digital examination I came upon a roughened and infiltrated area about one inch within the vulvovaginal orifice, and this surface extended around the entire canal up to and involving the cervix and os uteri. This surface was very fragile and bled profusely because of the examination. The left broad ligament was greatly thickened and the inguinal glands enlarged and sensitive. She complained bitterly of the pain incident to the examination. I introduced a bivalve speculum, but owing to the extremely fragile nature of the growth I was unable to open the instrument sufficiently to bring the os uteri into view. The portion of the vaginal walls visible was red, bleeding, and very fragile, breaking down under the finger.
The appetite was fairly good and the bowels and kidneys acting about as usual, but she was markedly cachectic. The disease had extended to such a degree that operative measures were out of the question. I gave her, at this first visit, a wash of potassium permanganate, and a tonic of sulphate of strychnine and iron.
Two weeks later the patient was removed to Fayetteville, and after explaining to the husband that cure was beyond hope, I began the local use of a three-per-cent solution of methyl blue in equal parts of alcohol and water. I made an application of this solution every second day, swabbing it over the entire diseased area as best I could. The hemorrhage began to decrease in quantity from the first application, and soon the infiltrated area commenced to grow softer and the tissues became less fragile and permitted an ocular view of the os uteri. In the mean-time I was giving her tonics and alteratives.
When she left for home two months later the hemorrhage had almost entirely ceased. The ulcerated surface had healed-cicatrized-except in the left fornix; in that place there was a small area that refused to heal, and I believe this ulcerated spot was continuous with the infiltration of the broad ligament.
At this writing-four months from beginning treatment-the patient is in very fair condition; sometimes she will go an entire week without a stain, when there will be a slight hemorrhage. The thickening in the broad ligament is, of course, increasing. She is, however, a few pounds heavier now than when treatment was first begun.
I do not bring methyl blue forward as a curative agent for cancer, but as a local application in inoperable cases this one case would indicate that it is very excellent. Certain it is that the hemorrhage was greatly reduced- almost stopped- and the superficial ulceration healed to a great extent.
The patient will soon die, however, from systemic infection.
The local use of methyl blue is not original with me, and I have lost the reference to the article from which I obtained my information, and hence I am unable to give the name of the originator. I read of it in the THERAPEUTIC GAZETTE
