Castration of the Female by Irradiation

THE use of radiation in the treatment of benign pelvic lesions has been criticized in the past because it was thought that the subsequent menopausal symptoms were more severe than after surgical castration. Recent literature (1, 2, 3, 4) has corrected this impression in some quarters, but the feeling still seems to be fairly widespread. The dose of roentgen rays required to produce castration varies considerably in the reports of different authors (2, 3, 5, 6, 7, 8, 9, 10). It is seldom that the reasons for establishing any particular dosage figure are stated. It is also evident from the literature that it is not frequent practice to vary the roentgen dose in definite relation to the thickness of the patient. With these facts in mind, a study of our patients was begun with the following objectives: (1) Determination of the efficiency of castration by radiation methods; (2) Establishment of the required ovarian dose for permanent castration; (3) Development of a treatment technic to deliver a known and constant dose of radiation to the ovaries of any patient; (4) Determination, if possible, of the ovarian dose for temporary castration; (5) Comparison of the menopausal symptoms following castration by irradiation with those following surgical castration. The material studied consisted of the records of 334 patients treated for benign pelvic lesions with x-ray or radium. These patients received their treatment during the period July 1, 1925, to July 1, 1937. The follow-up information gives the status of the patients six or more months after treatment. The chief complaint in 260 patients was abnormal uterine bleeding. This included bleeding at the menopause with no palpable pathologic changes in the pelvis, diffuse uterine fibrosis, small fibromyomas and, in a few instances, excessive bleeding in young adults which had not responded to other methods of treatment. All of these patients were curetted on one or more occasions and the material examined microscopically. A smaller group, 52 in number, had chronic pelvic inflammatory disease of pyogenic or tuberculous origin. Endometriosis was present in nine other patients. In the rest, castration was attempted because of such debilitating extrapelvic lesions as carcinoma of the breast, advanced pulmonary tuberculosis, etc. Most of the patients were 40 years of age or older, only 45 of the 334 being in the younger group. During the twelve-year period covered by this study, the technic of irradiation has varied considerably in this clinic.