332^ • MATERNAL DYSTOKIA. 



sessile, and is covered by the mucous membrane ; but as it grows it 

 becomes pediculated. 



The fibroids of the uterus, as well as those of the vagina, are some- 

 times covered by the mucous membrane, and at other times grow beyond 

 it. They are sessile or pediculated, and of v^ariable volume and consis- 

 tency ; their surface is either smooth or irregular, as if composed of 

 a number of smaller tumors. 



Franck mentions that the pathological museum of the Munich Veteri- 

 nary School contains the uterus of a Cow, one of the cornua of which is 

 occupied by a myomatous tumor, springing from the muscular layer of 

 the part, and as large as a man's head. 



Sometimes the pediculated fibroids of the uterus, in consequence of the 

 elongation of their pedicle, extend beyond the os into the vagina, and 

 even in some instances pass through the latter and the vulva, and remain 

 suspended between the thighs. A case of this kind has been observed 

 by Granaveri and studied by Ercolani.* 



As we have observed, the presence of fibroids has a variable influence 

 on the process of parturition, according to their situation. Of course, 

 the larger, and particularly the submucous interstitial fibroids, only very 

 exceptionally allow successful fecundation to take place ; though in some 

 instances, when this occurs, absorption follows. During labor they may 

 predispose to rupture of the uterus, from the alteration they have pro- 

 duced in the texture of the organ. 



Submucous or superitoneal fibroids, when situated towards the fundus 

 of the uterus, or when only of a moderate size, very frequently offer 

 no particular obstacle to birth, and interfere but little with labor. It is 

 only when they are very large, and situated towards the cervix or vaginal 

 canal, that they may become a serious impediment to delivery. Those 

 with short pedicles, and which are designated "polypi," maybe projected 

 backwards before the advancing fcetus, and be mistaken for some part of 

 the latter by the unobservant obstetrist. 



Sometimes the tumors soften towards the termination of gestation, so 

 that during parturition they may be sufficiently compressed and flattened 

 for the foetus to pass over them. If they have an elongated pedicle 

 attached to some parts which is easily displaced, they may be pushed 

 beyond the vulva by the fcetus, or the pedicle may be ruptured by the 

 latter, and the parturient passage thus left unobstructed. 



The recognition of these tumors is not very difficult when they are 

 within reach of the hand. To prevent their being mistaken, during 

 manual exploration, for some part of an ordinary or deformed fcetus, 

 their nature and mode of attachment must be attended to. With this 

 object, the hand should be carefully passed between them and the 

 uterus and vagina in every direction, so as to find their pedicle, and thus 

 be assured that they do not belong to a foetus. 



With regard to the treatment, we must refer to the general indications 

 already given. We may only add that, when the tumors are not very 

 large, it is better not to interfere until Nature has done what it can 

 in overcoming the obstacle ; for in these Instances, as in so many others, 

 it sometimes effects surprising results. If they are pediculated and can 

 be reached, they may be incised, ligatured, or removed by the ecraseur ; 

 should the base not be attainable, or very extensive, they may be par- 

 tially extirpated. 



* Oreste and Falconio. Stiidii sulle Neoplasie a Massa distinta degli Animali Domestici, p. 58. 



