Matthews Duncan' observed a fibroma as large as a child's head, which disappeared so suddenly that he himself imagined that it had been enucleated spontaneously and had been expelled unnoticed. Playfair's' first case was probably one of pelvic exudation (compare my review in Canstatt's Jahresbericht, 1869); in the second case the tumor underwent suppuration. Burnton' speaks of the disappearance of a " fibrous en largement of the whole uterus" (probably chronic metritis) and men tions particularly that it was " not a distinct or separate fibrous tumor," and again that " it was not a distinct tumor growing into or from the uterus." In short this case is not one of absorption of a fibroma. G. Braun' describes in detail the suppuration of the tumor. Madge' ob served a diminution in size, that is to say, a partial disappearance of a fibromyoma after childbed. The description of Rigby's case, cited by Ashwell, is also so imperfect as to be unserviceable. In addition to the above nine cases I shall have to exclude one of Goodell, and one of Vel pearl, as I have not been able to obtain the original communications. That of Velpeau, moreover, seems to be the same one described by Cazeaux.
The following are positive examples of complete absorption of uterine fibromata: M'Clintock," one case; Ashwell (1. c.) three cases—one disappeared in consequence of childbed; Kidd,' two cases—one after menopause, one during childbed; Simpson," one case.
Gu6niot" reports the absorption of a large fibroid with febrile symptoms. lie also mentions an instance of complete absorption observed by Depaul, also one of marked diminution in size after premature delivery, and a case of Haller's. He also states that Herpin noticed the complete disappear ante of a fibroma after Caesarian section (?) In Cazeaux's ' two cases pregnancy and childbed respectively were the exciting causes of absorp tion. Courty ' and Plan' each record a case of this description, but so imperfectly that the observations are not convincing. Hildebrandt' ob served absorption not connected with childbed, Routh ° two cases during the menopause, while Boinet a reports three cases of this description. Sedgwick ' claims to have observed this occurrence thrice during child bed. The influence of childbed in this direction was clearly demonstra ble in Scanzoui's,' Gussmann's ° and Schroder's cases, and I am posi tive that I have seen one similar case myself, while in several other instances the rapid disappearance of previously felt tumors threw a doubt on the correctness of my diagnosis, and served but to prove to me how very easy it is to commit errors of diagnosis in similar cases in spite of conjoined manipulation and rectal palpation.
The cases of Holst and Spiegelberg" have been very carefully observed, while Meadow's" should probably not be considered here, as the disap pearance of the tumor (by absorption?) occurred only after artificial dila tation of the os uteri and partial enucleation from the capsule. During the progress of a confinement Lorain " noticed a uterine fibroma as large as a child's head. On the death of the patient twenty-two days later the tumor was no larger than a nut. If we include this case among those of complete absorption, my list will embrace thirty authentic cases, of which thirteen have occurred in conjunction with childbed, while most of the others developed during the menopause. I may as well .state, in this connection, that in none of the cases is there reasonable ground for assuming that treatment exercised the least curative influence.
We shall be more likely to gain an insight into the nature of the cir cumstances which lead to absorption, if we assume that this phenomenon took place chiefly in those cases of pure myomata which were imbedded in the tissues of the uterus, without the intervention of a capsule, as was emphasized by Spiegelberg (1. c.) The cases of Freund and A. Martin show that fatty metamorphosis alone is not sufficient to cause absorp tion, nor is pulpy softening more efficacious in this respect (compare Hecker, 1. c.). If, however, these changes occur in soft myomata, which are directly imbedded in uterine tissue, their absorption is the more comprehensible, as is also the influence in this direction of parturition and childbed, during which processes the contractions of the uterus and the involution of this organ induce similar changes in the entire mass of the muscular substance of the uterus.
We can also understand that the soft tumors will participate more readily in the general atrophy of the uterus which takes place at the menopause, than will dense, encapsulated fibromata. Of course I do not intend thereby to deny the possibility of the disappearance of encapsulated fibro mata, but I believe that the latter diminish in size rather as the result of induration and atrophy, and that distinct residua often remain, which anatomical investigation at least will succeed in detecting. It is just this condition of induration of the tumor, this diminution in size at the meno pause, which is so very frequently combined with calcification, as has previously been stated. The cases of Hildebrandt,' Lente ' and a large number of others are of this description.