THE ETIOLOGY OF FIBROIDS OF THE UTERUS.
This dictum must be adhered to in spite of the ingenious rea sonings of Virchow (Geschwulste III. p. 150), and in spite of the careful and interesting studies on this topic by Winckel,' which support the views of the former author. Virchow called attention to the " irritative char acter" manifested in the growth of myomata, and suggested that in these cases either an unusually aggravated degree of local irritation, or a condi tion of local antemia was the efficient agent. As acceptable as these phrases may be in a general way, as little are they supported by direct observation. And when in this very instance Virchow and Winckel refer to the periodical congestions of the uterus, to the processes occurring in tile puerperal state, to a previously existing chlorosis and so forth, they do not in the least help to explain how these every-day occurrences can give rise to the development of myomata in individual cases. More over, if importance be attached to the condition of the functions of the uterus, on the one hand to their exercise (miscarriages, births), on the other to their abeyance (sterility,) we find that the examination of statis• tics throws no light upon this topic. But, although such statistics are, as we shall see, quite unreliable, considering the imperfections inherent to this method, yet we should not, in our devotion to a pet theory, exclude them as altogether worthless. As far as concerns diseased conditions in the vicinity of the uterus or within that viscus, these are just as likely to be effects as active causes in the formation of tumors. The portio vaginalis affords a good illustration of the etiological insignificance of local irrita tion. Although this region is most exposed to injurious influences, it is very rarely the seat of myomata. These tumors, moreover, are scarcely ever observed in prolapsed uteri.
Patients' statements are not of the slightest value in determining questions of etiology. Of what avail is it to us to be told that three out of one hundred and fifteen patients affected with uterine fibroids noticed the first symptoms of the disease immediately after marriage. (Witickel.) Moreover, although Winkel quotes statements according to which vio lent vomiting, a fall downstairs, intense mental excitement, etc., are positively put forth as the starting-points of the disease, he himself points out the fallacies contained in such statements. Granted even the correct
ness of these observations, as far as concerns the patients themselves, this does not bring us any nearer the solution of the question. At any rate, as far as I am concerned, I must confess that to me the formation and development of fibroids is just as incomprehensible now as formerly. I can understand how colds, improper behavior at the menstrual epoch, etc., may give rise to metritis, catarrh, and other affections, but I cannot con ceive in what manner even "long continued and very fatiguing singing at the time of the monthly flow " may " under favorable conditions" lead to the formation of a myoma. Engelmann,' indeed, found that catching cold during menstruation was the etiological factor in one (sic) out of three hundred and sixty-two cases of uterine fibroma ! ! It has already been stated that Cohnheim' attributes all neoplasms to the development of embryonal deposits, to germinal matter which has not been used in physiological, normal growth. Thus Cohnheim states that the phenomena of pregnancy afford proof of the truth of his hy pothesis as far as regards the uterus, that is, as showing that this organ contains germinal matter which, under physiological stimulation, is capable of manifesting periodical growth. It is surely conceivable that this ger minal matter may occasionally undergo irregular, atypical development without physiological stimulation, and this is particularly liable to occur when physiological stimulation is exercised seldom or not at all. This coincides closely with the fact that uterine myomata always develop after puberty, and are especially liable to be met with in old maids. We will shortly have to investigate how far the latter assertion is actually correct or the opposite. However this may be, it suffices to have directed atten tion to the importance of the above hypothesis of Cohnheim, which is sat isfactory in so far at least as it serves to again direct the researches con cerning the causes of tumor formation into anatomical channels. Whether these researches result in the demolition or in the further support of the hypothesis, they will at any rate furnish us with wider views as to the etiology of tumors than the hitherto current, wholly unsatisfactory ones.