The essential steps in the method used in the cases reported in this paper consist first in obtaining satisfactory sample of urine. The patient is instructed not to take fluids after 6:00 P.M. the night before to insure is then used for the rest. The rabbit which has been previously isolated for at least two days is opened under morphine anesthesia and the ovaries examined. If negative, fifteen to twenty-five cubic centimeters are injected, depending on the specific gravity of the urine.
A urine of specific gravity of less than 1.015 is considered unsatisfactory, although we have obtained several definite positive results with urines of specific gravity of meters are injected intravenously and the rabbits kept isolated for the next forty-eight hours, following which another laparotomy is performed and the ovaries again inspected. The presence of large corpora haemorrhagica and lutein body formation indicates a positive test. In the negative tests the ovaries remain small, gay, and may have a few small translucent cysts.
The test in our hands has been far more valuable as a means of differential diagnosis than in ascertaining, early, whether of not the patient was pregnancy, We have has to cases of teratoma of the testicle and no chorio epitheliomata of hydatid moles, and negative test has served in three instances to set us at ease, where we would otherwise have been in doubt.
As outline of twenty-one cases of the ninety reported will serve to show how the test has been of service in our hospital.
(1) Mrs. T., aged thirty. Amenorrhea, question of fibroid or pregnancy. Test positive. Abortion two months.
(2) Mrs. S., aged forty-three. Amenorrhoea, question of menopause or fibroid. Test positive three times. Delivered.
(3) Mrs. W., aged twenty-four .Amenorrhoea, with pain. Test negative. Operated,cystic ovary.
(4) Mrs. B., aged twenty-seven. Amenorrhea. Test positive. D and C showed placental tissue. Test negative in two days.
(5) Mrs. S., aged thirty-five. Enlarging uterus, with regular menstruations for five months. Test positive. Delivered.
(6) Miss C., aged seventeen. Rapidly enlarging uterus to full term size. Irregular bleeding. Test negative. Operated and pathologic diagnosis: proliferating fibromyoma with early malignant change.
(7) Miss M., aged twenty-five. Amenorrhoea, suspect ectopic. Test negative. Operated and pathologic diagnosis: tubo-ovarian abscess.
(8) Mr. M., aged twenty. Suspected pituitary tumor. Test negative. Autopsy showed cerebellar tumor.
(9) Mrs. V., aged twenty-eight. Suspected ectopic pregnancy. Test positive. Left hospital with indefinite diagnosis, questionable false positive.
(10) Miss B., aged twenty-seven. Aborted at home, bleeding two days after curettage. Test negative. Haemorrhage stopped two days later.
(11) Mrs. M., aged forty. Irregular menses, suspect fibroid or pregnancy. Test negative. No enlargement after five months.
(12) Mrs. W., aged thirty-five. Very obese and abdomen enlarging, endocrine dysfunction. Test positive. Near term.
(13) Mrs. Z., aged thirty-seven. Amenorrhea, tubes tied off in previous cesarean operation. Test positive three times. Therapeutic abortion revealed pregnancy. Since delivered full term.
(14) Mrs. W., aged thirty-give. Irregular bleeding two months, pain right tube. Test negative. Found to have atresia of cervix after coagulation.
(15) Mrs. P., aged forty-eighty. Suspect menopause. Test positive. Delivered.
(16) Mr.J., aged nineteen. Tumor of testicle. Test negative. Proven to be inflammatory.
(17) Miss R., aged twenty-four. Amenorrhea nine days past time for period. Intact hymen. Test positive. Delivered.
(18) Miss B., aged seventeen. Coitus fourteenth intermenstrual day, amenorrhea three weeks. Test negative twice. Menstruated three and one- half weeks late.
(19) Mrs. A.,aged forty-five. Amenorrhea and hot flushes. Test positive. Delivered.
(20) Mrs. J.M, aged forty-four. Amenorrhea and hot flashes twenty- two years after last pregnancy. Test positive. Criminal abortion, menstruate regularly since.
(21) Mrs. N., aged twenty-give. Bleeding after delivery for two months. Test negative. Treatment of endocervicitis Stopped bleeding.
In the ninety cases which we are reporting we had two possible errors, one false negative, which was checked in two weeks and found to be strongly positive and one questionable false positive which we have Portland above in Case 9. The table of results is as follows:
Cases.
41 Negative .
1 False negative Female.
45 Positive.
1 False positive.
2 Negative.
We have tried to give a short history of the evolution of the Friedman test, as well as outline the technique of both the Aschheim-Zondek and Friedman tests. We have abstracted in a very superficial ways few of the available articles to show the results and opinions of others who have had longer experience and many more cases than we in order to add weight to our opinions.
We have outlined the Young technic, which we believe is the best method of doing the Friedman test yet to appear in literature, and we have given a summary of a few of the more interesting cases in order to show the importance of the use of this tests in confirming normal pregnancy and deferentially diagnosing the more or less acute abdominal conditions, such as ectopic gestation, hydatid mole and chorio-Epithelioma.
Finally, we have tried to show the importance of the test on ascertaining the completeness of removal of the products of gestation and have made mention of its usefulness in tumors of the pituitary and testicle.
