Routh's statistics' form quite a valuable contribution for determining this question. His cases, however, as well as those of Winckol, which will be given shortly, may not be simply added to the foregoing 959 cases, or we should commit numerous errors in counting the same case two or three times over.
Routh found that, of three hundred and one patients affected with myomata, two hundred and forty-one, or eighty per cent., were married. This fact, according to the author, must carry the more weight, when it is remembered that in England the number of unmarried females is twice as large as the number of married. (This observation possesses, however, but little value, since children are included in the above cases.) Some additional statistics of Routh's are more interesting in this con nection. He states that the average age of married women in England is 40.6 years. Now between the ages of thirty-five and forty years, he found that fibromata were present in twenty-two married, but only in five un married females—or, in other words, that at this time of life such tumors occurred 4.4 times as often in the married as in the unmarried. The importance of this ratio is, however, lessened by the fact that at this age the percentage of the married to the unmarried is as 3.7 to 1.
Wiuckel's deductions are based upon a total of five hundred and fifty-five patients. Of these, one hundred and forty, or 24.2 per cent were single and childless, four hundred and fifteen, or 75.8 per cent. were married, and of
the latter number one hundred and thirty-four, or 24.3 per cent.,were ster ile. According to Winckel, there are in Saxony two thousand seven hun dred and ninety-seven married females of middle age, to two thousand two hundred and three single women, that is as 9 to 7.3, while the prevalence of myomata among the unmarried is to that among the married as 3 to 9—in other words, tumors of this nature occur almost twice as often among the married as they do among the unmarried.
It cannot be shown that childbirth exerts any influence upon the de velopment of myomata. We shall, however, discuss this topic more fully in another chapter.
All the other agents that have been here and there advanced as etiologi cal factors in the development of fibromata, are the outcome of purely subjeotive reasoning on the part of their propounders, and may with propriety be passed over in silence. One point is, however, deserving of mention, namely that, according to the statements of Gaillard Thomas and St. Vel and Demarquay, these tumors are probably more prevalent among certain other races (particularly the negro) than among the Euro pean.
Hereditary disposition has, up to the present time, not been shown to play any r6le; still I have recently twice found fibroids in two sisters. This may be only a coincidence, yet it is an occurrence to which it may be worth while to direct attention.