E. Martin describes gangrenous disintegration of sub-mucous tumors leading to fatal pya3mia.
Horwitz' mentions cases of sub-serous tumors leading to the same re sult. In his cases it is, however, doubtful whether there were actual gangrene of the tumors or necrotic disintegration of the same, presently to be described. It is also possible that the sub-serous tumors had undergone th changes above-mentioned, as a result of septicaemia. Po laillon ' describes similar cases. Gangrene of sub-mucous fibromata, oc curring in the post-partum state, by no means always leads to pyemia or to other severe diseases. Extrusion of the tumor and a complete cure is perhaps more frequently the result of gangrene. Thus Kfichenmeister (Michauk, hoc. cit.) s tw a myoma weighing M5 gm. expelled, on the forty-fourth day after confinement, after long-continued suppuration and high fever. Ramsey' witnessed the expulsion of a tumor weighing kilogr., on the sixteenth day after labor.
A sub. mucous myoma of the posterior uterine wall was gradually ex pelled by a gangrenous process. In this case, gangrene was produced by injections of liq. ferri sesquichlorat. made immediately after labor, by Sedgwick,' on account of secondary hemorrhage. Maunoury (quoted by Siisserott, p. 14) and Ashwell (ibid. p. 20) witnessed the expulsion of such tumors by gangrene, during the post-partunt state.
Such tumors are sometimes expelled during the puerperal state, by simple uterine contractions without gangrene or degeneration of the neoplasms, and a complete cure is thus effected in the safest possible way. Falin, Tarnier: Oldham (Demarquay et St. Vol, loc. cit.), Priestley ° and Valtorta ' observed cases of this nature. Gangrenous disintegration of the tumors, attended by septic symptoms, must be carefully distin guished from the peculiar necrosis occurring in large interstitial and sub serous fibromata, which is almost exclusively observed in the puerperal state.
The necrosis under discussion is characterized by softening of the tumor, beginning in the centre. This process is, however, not depend ent upon the ingress of air or of any substance capable of producing putrefaction. The softening seems to begin with an abundant serous
effusion into the tissues of the tumor, occurring in the early periods of the post-partum state, and perhaps produced by vascular disturbances. At all events the tumor becomes larger and softer soon after parturition, or furnishes distinct evidences of fluctuation.
The change in size is often only apparent, because the diminution in the size of the uterus, in which the tumor does not participate, causes the latter to appear larger than before. In other cases this source of error may be easily eliminated, and the enlargement with concomitant soften ing clearly demonstrated.
The tumor is usually sensitive to pressure, under these circumstances, owing to its tense condition. This fact has often been referred to as sumed inflammatory processes in the fibroid. Investigation of the tumors has, almost always, shown a disintegration of their tissues, attended by the formation of a soft, pulpy mass, which is of a light yellow color, if blood be absent. The pulpy mass is darker in color and not unlike coffee grounds in appearance, if blood be present, and consists of disintegrated muscular and connective-tissue elements, the destruction of which seems to have been principally inaugurated by fatty degeneration.
Since firm connective-tissue bands, particularly those accompanying the vessels, often remain intact, the entire cavity of the tumor presents a trabecular structure, the interstices of which are filled with the pulp of the degenerated neoplasm. The fibroid thus frequently assumes the ap pearance of a compound cystic tumor. The most casual investigation shows, however, that the individual alveolme or interspaces possess no wall peculiar to themselves, but consist merely of tissues undergoing degene ration. No considerable collections of pus have been discovered in the degenerated fibromata, although the morbid process affecting them has often been interpreted as a suppurative inflammation.