152 DISEASES OF THE UTERUS. 



into the uterine cavity, and the enlargement of the organ is not so 

 general and uniform. Very large interstitial fibromata, which rise 

 into the abdomen, may be mistaken for other abdominal growths ; 

 not for ovarian cysts, however which, though hard in places, also 

 as a rule present elastic, fluctuating portions to the touch but rath- 

 er for solid ovarian tumors and for subserous fibromata. But in 

 these two cases the womb itself does not form part of the tumor, 

 but is merely displaced by it ; and we must strive to ascertain if the 

 two bodies can be made to move independently of one another. If 

 so movable, the growth is probably ovarian ; if attached, it is most 

 likely a subserous fibroid ; but no absolute certainty of this can be 

 attained, because an ovarian growth may be bound fast to the womb, 

 and a subserous fibroid with a long pedicle may float freely. When 

 the uterine sound passes deeply into a tumor, or when its tip can 

 be felt through the walls of the growth, we may infer that the mass 

 is not merely attached to the uterus, but is the uterus itself. An 

 expert with the sound can also determine that the enlargement of 

 the organ is not uniform, but chiefly affects one or other wall. This 

 decidedly points toward the presence of an interstitial fibroid. 



Fibromyomata of the cervix, which are more rare, are easy of 

 diagnosis. They present either rounded, hard, circumscribed lumps, 

 which distend one of the lips of the os, or else appear as fibrous 

 polypi protruding from the cervix. 



PROGNOSIS. The prognosis of uterine fibromyomata has its good 

 and its bad points of view. The fact is well attested that such 

 tumors have now and then shrunk away and disappeared, but such 

 good fortune must never be counted on ; the more so, because these 

 rare cures seem never to be due to treatment, but rather to favor- 

 able accidental conditions parturition, the climacteric, or the like. 



The affection is generally to be regarded as incurable ; yet the 

 prognosis is so far favorable that life is seldom immediately imper- 

 illed by it. Sometimes, indeed, the envelope of the tumor suppu- 

 rates, causing peritonitis or pyaemia ; and the general nutrition has 

 been known to suffer seriously through the pressure of an enormous 

 fibrous tumor upon adjacent abdominal organs. The tumor some- 

 times ceases to grow so early as never to cause any symptoms ; 

 while others by their development render life a burden, until the 

 attainment of the climacteric brings about an arrest of development, 

 or until a sort of imperfect retrogression takes place by calcification 

 of the tumor. Spontaneous expulsion of the growth through the 

 uterine canal has been observed in a series of cases. A few times it 

 has been known to be expelled into the abdomen or into the blad- 

 der, and even to be discharged through the abdominal walls. Such 



