Among 106 married patients Rorig found only 31 childless, although 40 of the women had each given birth to but one child. The total number of children borne by 75 of the women was 190. Among Beigel's 86 married patients 21 were sterile, and among 21 patients treated by McClintock, 10 were childless.
Scanzoni found 35 childless women among 69 married women affected with fibroids. Michel had only 26 cases of sterility among 127 patients. Winckel's statistics on this point are the most elaborate.
Among the 415 cases of married women with fibroids collected by him, only 134, or 24.3 per cent., were sterile and 281 or 51.5 per cent. had borne one or more children. His statistics regarding the number of children borne by 108 women, affected with uterine fibroids, are most im portant. Winckel himself observed 46 of these cases and borrowed 62 from the statistics of Stisserott (Inaug. Dissert., Rostock, 1870.) 37 of Winckel's 46 patients had borne 114 children.
Siisserott's 62 patients bore 162 children. The average number of children for each woman was thus 2.7, while the average in Saxony was 4.5 children to each mother.
A second table prepared by Winckel, embracing these 108 cases, is still more instructive: Again 376 women had 1295 children, an average of 3.45. If the en tire number of children is proportioned to the number of married women having fibroids, each woman would have 2.1 children. But the average number, according to the above, would be 4.5.
Although the number of cases in these tables is not large, the conclu sions deducible from them are surprising. Although the number of patients with myomata, who have had one child, is quite large, the num ber of pluriparte and of multiparty is far below the usual average. This fact can only be explained by the supposition that the myoma prevented later conceptions.
From the above tables, together with my own recorded cases, I was able to collect 564 cases of fibroids in married women. 153 of these were sterile. Mention should be made at this time, of Marion Sims's ' statis tics, which are based on original observations. Among 255 women who had borne one child and then become sterile, he found fibromata present in 38 cases, i.e., 1 to 6.7. Among 250 married women who were child less, he found 57 cases of fibroid, or 1 to 4.3, and finally among 100 vir
gins who complained of pain in the hypogastrium, 24 fibromata, or 1 to about 4.15.
We accordingly reach the conclusion that uterine myomata are much more frequent in those persons who regularly gratify their sexual desires, than in those in whom a similar gratification can not be assumed.
The fruitfulness of women suffering from myomata is much dimin ished, but one is justified, in the above statistics, in regarding this as the result of the tumor's development. This view of the gynecologists con cerning the relation of myomata to conception, based, it is true, upon in complete statistical data, does not accord with the experience and theories of pathologists. The point in dispute can only be decided by farther observations, particularly by those relating to pathological anatomy.
The fact that pregnancy occurs with the greatest relative frequency in cases of sub-serous myomata, which produce the fewest pathological changes in the uterine cavity and the uterine mucous membrane, and that it occurs least frequently with sub-mucous fibroids,' the view that fibroids are rather the cause than the result of sterility.
The above statement that pregnancy occurs most frequently in cases of sub-serous fibromyomata can hardly be established by figures, unless all the histories be passed in review. It may be said that the tumor present in every carefully described case of uterine fibroma, in which pregnancy occurred, was of the sub-serous variety. The cases of interstitial and particularly of sub-mucous tumors is insignificant, as will be seen from what follows.
The fact that one often has opportunities of observing fibromata, in pregnancy and parturition, which do not affect these conditions, because they are sub-serous, accords with the above statement. Such cases are, of course, not published, and therefore the claim can not be substantiated by any considerable number of recorded cases.
It may be remarked, however, that Schroder's figures do not confirm this view. His table is as follows: From this table it would appear that sub-serous tumors, more than any other variety, predispose to sterility, which is not in conformity with what has already been said.