UTERINE FIBROIDS IN THEIR RELATIONS TO NANCY, PARTURITION AND CHILDBED.
The manifold pathological changes in the uterine mucous mem brane, dependent upon the development of these neoplasms, in addition to the catarrh and the profuse hemorrhages resulting from them, are obstacles in the way of conception. Numerous changes in the relations of the uterus to the adjoining organs, especially to the Fallopian tubes and the ovaries, and alterations in the form of its cavity, offer notable mechanical impediments to conception. This is specially true of sub mucous tumors, although the statement is equally applicable to certain sub-serous fibroids. We accordingly regard sterility as a frequent sequel of fibromata, although there has always existed great diversity of opinion in regard to this point. Since the time of Bayle, pathologists—as, for instance, Meckel, Cruveilhier, Virchow and recently, Cohnhoim—have steadfastly maintained that fibroids occur predominantly in nullipara3 or in women who have not had sexual intercourse. From this premise they have deduced the conclusion that complete inactivity of the genital iv paratus is either an exciting or at least a predisposing cause of the neo plasmata.
Almost all gynecologists, with the exception perhaps of Scanzoni and Spiegelberg, have entertained the opposite view, and Winkel and Rarig have quite recently demonstrated, by incontrovertible arguments, that sterility in these cases is the result of the tumor's presence.
It is the more interesting and important to discuss this question, because Colinheine adduces the presupposed fact that sterility leads to the development of myomata in support of his hypothesis concerning the formation of tumors in general.
A definitive settlement of the question seems unfortunately impossible at present, because statistics, upon which the decision must depend, furnish as yet too few and too uncertain data. Another prime reason is that anatomists have tabulated no numerical statistics to be compared with those of gynecologists. Since, therefore, the latter have only the opportunity of observing those cases of fibroma which produce trouble some symptoms during life, it is quite possible that the view of the pathologists would be generally adopted if the total number of uterine myomata, discovered after death, were known.
The scanty material at our disposal must be considered from two points of view. In the first place, it must be determined whether myomata are more frequent in nulliparw, and in those who have not had sexual inter course, than in women who have had intercourse, and have given birth to children. Then it must be ascertained whether women suffering from fibroids are or are not fruitful.
The first question can only be answered with approximate accuraly by the pathologists. Gynecologists can only state to which of these classes the majority of cases of fibroids presenting themselves for treatment belong.
Now the records all go to show, without exception, that these tumors occur with much greater frequency in married than in single women. Among 959 myomata, collected by ourselves, 072 occurred in married and only 287 in unmarried persons. The investigations of Routh have proven that these tumors also attack married women with decidedly greater rela tive frequency in England.
Winckel likewise reached the same result, having found the disposition to the development of fibroids twice as marked in the married as in the unmarried, that is in those persons who had seldom or never gratified their sexual desires.
Beigel (loc. cit., p. 425) found 86 married women among 146 who had fibroids. Michels found only 33 unmarried women among 160 patients with fibromata. Schroder (Schorler, 1. c.) found 614 married women among 792 oases, i.e., 77.5 per cent. A long series of observations lead ing to the same results might easily be adduced.
A similar unanimity of opinion prevails concerning the relation between fibromata and sterility. West found that only 7 among 43 married women with fibroids were childless. The remaining 36 had, however, only given birth to 61 children altogether, and 20 of the women had borne only 1 child each.