Diagnostic Use of Intra-uterine Iodized Oil Injection Combined with the X-rays, as Compared to Peruterine CO2Insufflation

INCREASING experience with peruterine tubal insufflation and with intra-uterine lipiodol injection (hysterosal-pingography) during the last few years has enabled us to study the comparative value of these diagnostic methods and to determine their relative advantages and limitations. The injection of fluids opaque to the X-ray into the uterus for the purpose of ascertaining tubal patency in sterility dates back to March, 1914, when Cary published his use of collargol in conjunction with the X-rays in the American Journal of Obstetrics (1). My work was done about the same time in Vienna and the first publication appeared in the Zentralblatt für Gynäkologie, May, 1914 (2). This dealt with the diagnosis of intra-uterine tumors by the aid of collargol injection and the X-rays. It was a preliminary report and concerned itself with the experimental data of one phase of the work. My main object was to find a non-operative method of determining tubal patency. My second, more complete, paper, dealing with the clinical application of this new method, appeared in Surgery, Gynecology and Obstetrics, April, 1915 (3). Cary's single report and my own reports were not followed up by further publications, a circumstance which, added to the definite interruption of such work entailed by the World War, may explain their escaping attention for some time. There is no doubt but that the same idea must have occurred to others, who believed they were presenting an original method. Thus, Douay, in his recent report presented at the Fifth Congress of the Association of French Gynecologists and Obstetricians at Lyons, September, 1927 (4), says that the very first attempt to inject an isotonic non-irritant fluid into the uterus with the object of determining tubal patency was made by Le Lorier. His results were to have been presented before the Congress of Lille in 1913, and were never published. Le Lorier believed that “if 20 cm.3 of this fluid were injected and none returned from the cervix, it was proof that the tubes were patent.” This is of interest in connection with Cary's later recommendation (5) to inject 1 cm.3 (10 : 15 minims) of saline for the same purpose. The inadequacy of this amount, to which I have called attention, has since been realized. Douay gives Dimier credit for being the first to inject into the uterus a fluid opaque to the X-rays. Dimier's attempts were made in 1913 upon patients at the Hospital Broca, under the direction of Pozzi. He used a 10 per cent solution of collargol and injected 7 to 8 c.c. As one patient died of peritonitis, Pozzi made him abandon his research. Owing to the war the paper was not published until 1916, when it appeared with Dartigues as his collaborator (6).