The treatment consists in extirpation either by the ligature, excision, or enucleation. The ligature, even as in case of uterine myoma, best guards against hemorrhage, although it has not always so answered. Iti the case which McClintock treated with Johnston there occurred profuse hemorrhage on the fifth day following on necrosis and ulceration. On the eleventh day the ligature was removed, and thereafter the tumor was gradually taken off piecemeal, and only after three weeks did the growth entirely disappear. Although this case eventuated happily, it clearly proves the danger of the method. It belongs to the year 1845. Ecrase ment and the galvano-cautery, although they have the advantage of rap idly removing the tumor, carry with them no immunity against hemor rhage, and this is well illustrated by the two operations of Neugebauer on one and the same patient. The heated wire does not slip, like the cold, under the circumference of the round tumor, but cuts the more certainly at the locality where it is placed the more carefully the cautery is worked. A portion of the tumor may remain, which will slowly grow and necessitate a second operation. It seems to me that the ligature should be of special value in case of great vascularization of these tumors, although I have not tested it in case of fibromata of the vagina. Espe cially do I think this is true, since, by guarding against hemorrhage, we also guard against slow necrosis of a large tumor. Where the fibroma
has not a very broad base it may well be ligated. in two portions; or else in case of pediculated fibromata, a wire ligature might be thrown around the pedicle and left there, the greater portion of the tumor being excised. Simple excision of pediculatal tumors by means of the scissors has often been performed, and there has not always' been much hemorrhage. Twice it had to be checked by iron tampons, and also in the slender pediculated myomatous polyp of Scanzoni. Simple excision is not so favorable as in case of uterine myomata, since these growths in the vagina do not lie in an organ which will contract after their removal, and thus aid in limiting the risk of hemorrhage. In case of vaginal myomata with fibrous pedi cles, the ligature is to be recommended. In case of round, broad-based fibromyomata, which are fairly movable, enucleation, after cutting the mucous membrane next to the tumor, even as Dupuytren did, is, with out question, the best method, especially since sutures may be more readily inserted. In case of small, long tumors, longitudinal incision into the capsule is preferable. If possible sutures should also be inserted here, since thereby there is greater chance of union by first intention. Where the cavity left after enucleation is large, much may be accomplished by means of compression with iodoform gauze and the wearing of a T-bandage.