150 DISEASES OF THE UTERUS. 



sulated exudation, or with adhesions ; and these latter may by and 

 by hinder the tumor from lifting itself as it grows out of the pelvis, 

 so that the pressure upon the other pelvic organs may give rise to 

 the symptoms of incarceration. All these pressure-symptoms usu- 

 ally grow worse during the menstrual period. 



The submucous fibromyomata also soon create serious distress. 

 In this form the distended and hypertrophied womb itself forms the 

 tumor, and when large it naturally produces the same pressure-symp- 

 toms as those caused by subserous tumors. But the growth, being 

 enclosed in muscular masses, excites the latter to strong contraction. 

 The tumor, projecting into the womb, stretches and irritates its mu- 

 cous lining, thus inducing leucorrhoea and haemorrhages of great 

 frequence and severity. These metrorrhagias occur even when the 

 tumor itself is very poor in blood-vessels, and proceed entirely from 

 *the mechanically overladen vessels of the mucous membrane. At 

 first the bleedings seem to attend the menstrual periods, which are 

 then excessive and followed by a watery mucous discharge. By 

 and by the haemorrhages recur irregularly, and with ever-increasing 

 frequence and severity, so that the patient's life may be jeoparded 

 by sheer loss of blood. Great suffering during menstruation also 

 arises in this form of fibroma. There is pain, which is sometimes 

 continuous, and sometimes an intermittent uterine colic, like labor- 

 pain, due to the obstruction by the tumor to the menstrual flow. 

 If the catamenial function ceases permanently and this is apt to 

 take place quite late in life in these cases this distress is materially 

 abated or ceases entirely. Interstitial tumors occupy a middle posi- 

 tion both as regards seat and symptoms. Being well surrounded by 

 uterine tissue, and being under more favorable conditions for growth 

 than the subserous and submucous tumors generally are, their de- 

 velopment is often quite rapid, and they sometimes attain colossal 

 dimensions. 



The existence of a fibromyoma cannot be made out without man- 

 ual examination, and even then it is sometimes very difficult. The 

 subserous tumor is felt as a hard ball-like or nodular lump, which, 

 if it spring from the f undus, can be felt more easily through the ab- 

 dominal wall, and if from the lower part of the womb, is best found 

 through the fornix vaginae. The examination should aim to prove 

 that the tumor really proceeds from the womb, and does not merely 

 lie next to it. Sometimes an ovarian cyst or an old parametritic or 

 perimetritic exudation adheres so closely to the uterus that nothing 

 will shed light upon the case but a due weighing of other facts, 

 such as the consistence of the mass, which, if a fibroma, should be 

 hard, and never is soft unless it be in a state of cystic degeneration, 



