In view of the imperfections attaching to medical statistics in general, all statements concerning, the frequency of myomata possess very little value, if any. The inconsistencies in the individual reports are of so gross a nature that they only serve to lessen in a greater degree their mutual value. The experience of any single observer, no matter how ex tensive it may be, is probably of scarcely any consequence. According to the statements of Bayle, which are perhaps the best known, and are of late so frequently quoted, among one hundred women above thirty-five years of age at least twenty possess such tumors. Again Monat found among the patients of the Salpetriere, one-fifth affected with uterine fibroids. In contradistinction to these, Richard found only seven exam ples of fibroma in eight hundred autopsies, and Pollock found only thirty-nine tumors of this character among eight hundred cases of uterine disease (compare West, Lc.) Klob, on the other hand, claims that forty per cent of all females above fifty years of age are affected with these growths.
Little reliance can be placed upon statements as to the frequency of the individual varieties or the site of these tumors. Among a total of ninety-eight cases, Hewitt encountered only fourteen of sub-mucous (pedi culated) fibroids. Of ninety-two cases reported by various observers in Mecklenburg (Winckel, I. c.), thirty-nine were pediculated. Of two hundred and thirty cases collected by Marion Sims' and Winckel, (1. c.), twenty-six were of the sub-mucous, seventy-four of the sub-serous, and one hundred and thirty of the intra-parietal variety. Of these one hun dred and four were located on the anterior, and seventy-seven on the posterior wall of the uterus.
Schorler (1. c.) observed 27 cervical tumors and 307 affecting the body of the uterus out of a total of 334 cases of fibromyoma. Of the 307 tumors of the uterine body, 106 were interstitial, 128 sub-serous, 24 sub-mucous, and 49 were classed as polypoid. The interstitial growths were found three and a half times more frequently in the anterior than in the posterior wall, whereas the sub-serous neoplasms occurred three times more frequently in the opposite situation.
Jacubasch (Charite-Annalen, 1881) saw sixty cases, and of this number the body and fundus were the seat of the tumor fifty-eight times, the cervix was only twice occupied by the growth. Twenty-two cases be longed to the sub-mucous variety of fibroid.
As regards the age of the patients, it may be stated that no indubitable case exists in which the disease has either been detected or has grown considerably before puberty, or after the occurrence of the climacteric period. It is rather difficult to determine whether, within these limits,
certain ages are especially disposed to diseased action in this direction. It is useless to collect medical observations for the settlement of this question unless pathological research shall at the same time furnish us with approximate figures as to the frequency with which such neoplasms are met with in all autopsies held on females. More than this, the ratio of the ages of all the females in each of the districts from which the statistics emanate, would previously have to be determined.
I have collated from the compilations of West, Beige], Hewitt, Dupuy tren, Moore Madden,' Engelmann,' and from my own notes, the following nine hundred and fifty-three cases, which are calculated to be of some service in this connection, and may be classified according to age as follows: Of five hundred and twenty-eight cases collected by Winkel (which are not comprised in the foregoing table, because West's, Hewitt's and Beigel's cases have been included in both tables) there were: These statistics demonstrate that most of the patients affected with fibroids were between twenty and fifty years of age at the time when they first sought medical relief. Nothing is to be gained by classifying the above cases according to the age at which the first symptoms were noted.
The latest table prepared by Schroder• presents results which differ somewhat from previous averages. 798 cases are tabulated as follows: A more interesting question is what influence do the sexual functions exert upon the development of fibromata. The opinion has beenand still is widely entertained in Germany, that unmarried individuals of ad vanced years are particularly disposed in this respect, but the experience of physicians shows that the contrary is undoubtedly true, and leads lather to the assumption that the exercise of the sexual functions favors the de velopment of such tumors.
The perusal of the reports of Schroder (1. c.), Hewitt, Marion Sims, Moore Madden, Engelmann, and of my own notes, discloses the fact that of nine hundred and fifty-nine patients affected with fibroids, six hun dred and seventy-two were married, and two hundred and eighty-seven unmarried. It is not to be supposed, of course, that all the individuals included in the latter category were virgins. Of those that were married, four hundred and sixty-four had borne children, the remainder were sterile. It will be shown later, that, according to the experience of phy sicians at least, this sterility is a result rather than the cause of the tumor formations.