148 DISEASES OF THE UTERUS. 



Fibromyomata often exist in a conglomerated form. The tumor 

 is then irregular and knobby in contour, instead of rounded. This 

 shape is sometimes attributable to the blending of several indepen- 

 dent tumors ; but more commonly the self -same morbid process 

 which causes the original growths in their simpler form again re- 

 peats itself in the substance of the new growth. Each vessel, with 

 its appertaining connective tissue and muscular fibres, proliferates, 

 and begets, as it were, a second generation of nodules within the 

 older ones. Although the fibromyoma springs from the uterine paren- 

 chyma, yet at a later stage it no longer remains closely connected 

 with it, but lies within the uterine substance, though quite isolated 

 from it by a layer of loose areolar tissue, so that it can very easily 

 be enucleated. Sometimes, however, old fibroids of large size main- 

 tain their connection with the womb by a pedicle, or even by a 

 broad fibromuscular band. Such an attachment usually contains 

 large blood-vessels. The womb is usually hypertrophied, but in 

 advanced age it is atrophied. Now and then it is elongated and 

 thinned, and it is often out of place. 



Fibromyomata rarely spring from the cervix, but rather from 

 the f undus or body. Their classification according to their more su- 

 perficial or deeper seat in the uterine wall is of great practical im- 

 portance. Thus we distinguish (1) the su bserous, (2) the submucous, 

 and (3) the interstitial fibroids, although many tumors present in- 

 termediate forms. In the subserous fibroma, the tumor, which 

 usually has originated in the outer layers of the womb, tends to- 

 ward the abdominal cavity, into which it projects in strong relief. 

 Its base, at first wide, may by degrees grow narrower, and ultimately 

 even present a mere stalk of the peritonaeum. Total detachment, 

 indeed, has been observed ; but in such cases the growth has soon 

 formed new adhesions, either in the vicinity of its point of origin 

 or in Douglas's cul-de-sac. Subserous fibroids are often multiple, 

 and usually are small ; but if their vascular connection with the 

 uterine parenchyma, by which they are nourished, should happen 

 to be kept up, they may attain a great size, and rise into the abdo- 

 men. By these large subserous tumors the womb is misplaced, 

 distorted, and stretched ; but it is almost never hypertrophied. 

 When springing from the side of the womb, they may penetrate 

 between the two folds of the broad ligament, forcing them asunder 

 so as eventually to lie quite outside of the peritonaeum. The sub- 

 mucous fibroid, on the contrary, tends to grow inward, toward the 

 cavity of the womb, into which it juts like a globe, distending it, 

 and displacing it to the side opposite to that whence it springs. Its 

 surface is covered either by mucous membrane alone, or by a thin 



