The loss of blood may be so excessive as to become the grave feature of the case.
Treatment.—It is to be remembered that the tumour is a simple cite, in no way to be re garded with apprehension such as a cancerous tumour would excite. It may be a constant worry and cause of suffering from pain, &c., but it need not prove fatal. The loss of blood occasioned by its presence is the serious part of it, since this may threaten life, either directly or by exhaustion, or by laying the patient open to other disease from the general bad health arising from it. The object of treatment is to relieve the symptonta ;IS much as possible till the child-bearing period is past, when a gradual ces sation of the patient's trouble is likely to ensue.
The tendency to lose blood may be restrained by avoiding everything that would increase the blood supply to the womb. As much rest as possible during the monthly illness is, therefore, desirable, and, if the patient be married, re straint as much as possible from the exercise of sexual functions. Pregnancy might be a serious complication, though occasionally a fibroid tu mour has almost or entirely disappeared after pregnancy and a successful confinement. Un married women should remain so if they are aware of the existence of such a tumour. Just before the monthly illness, opening medicine in the form of mineral water or effervescent citrate of magnesia is beneficial, and nourishing but unstimulating diet, with avoidance of spiritu ous liquors, should be the rule.
If the bleeding be excessive the effort to limit it should be made by taking the liquid extract of ergot, from one-half to a whole tea-spoonful in water thrice or four times daily ; and if ex cessive loss of blood during the period has been the rule, this should be taken for a day or two before the illness begins, and for a few days after it has ceased. To relieve pain a pill of one-third of a grain of extract of Indian hemp may be occasionally taken, or 30 grains of bromide of potassium dissolved in water. Iron tonics taken during the intervals are valuable for restoring or maintaining the general health. Pain is often also relieved by the use of some support to the uterus in the form of a pessary if such can be adjusted for the purpose.
If the loss of blood be so excessive or per sistent as to threaten serious consequences, a surgeon would probably propose an operation for the removal of the ovaries. The ovaries being removed, the monthly illness ceases, and thins nature's method of relieving the patient is anticipated.
Cancer of the disease may occur in the body of the womb or be limited to the neck (p. 619). The former case is compara tively rate. Cancer differs from fibroid and other simple tumours iu that it destroys the substance of the organ in which it is situated, spreading through it and from it to other parts, and tending also to pass to other organs. If it be removed it is liable to recur. For these
reasons a cancerous tumour is called malignant as opposed to simple. The womb is the com monest seat of cancer in the female, and its occurrence there is very frequent. It rarely occurs below the age of twenty years or above that of sixty, and is most frequent between forty and fifty. It has an inevitable tendency to death, and from one to two years is the average period of life after its appearance.
Its cause it is impossible to state. That it has a tendency to occur in families seems unde niable, and some distinguished authorities be lieve it occurs chiefly in women who have borne children, and in whom the neck of the womb has been torn. Such local irritation, however, may be only the exciting cause of the appear ance of a tumour to which the woman was already disposed.
There are several varieties of it. It is com mon as an affection of the liniug surface of the neck of the womb, gradually eating into and destroying the deeper parts, occasioning ulcera tion and thickening extending inwards.
Its symptoms are mainly pain, loss of blood, and discharge. The pain may not arise till the disease is far advanced, and is of a stabbing or burning kind, shooting up to the loins and down the thighs. It is generally worse at night It is the loss of blood that often arouses suspicion. It may occur from apparently trifling causes, and though it may be slight to begin with, it becomes at length a perpetual drain upon the body. As a consequence the person comes to have a characteristic appearance, the skin be coming of a peculiar sallow or dirty yellowish colour. The discharge is watery, tinged usually with blood, extremely irritating to the skin of the external parts, and of a very offensive smell. The disease may ulcerate its way into the bladder or bowel, so that water constantly dribbles away, or motions are passed from the genital passage.
The whole Aystem becomes affected and de ranged, and if death does not occur directly from loss of blood, exhaustion is frequently the consequence.
Treatment.—If the disease be detected early, enough, its removal by the knife may effect a cure, or at the least will for a season stop suffering and prolong life. Many methods of cure by medicines have been praised at dif ferent times, but all have been in the end found comparatively useless.
The foul discharge may be relieved by the injection with the enema syringe of water con taining 10 grains of thymol to the ounce, or of a 4-per-cent solution of carbolic acid.
To relieve pain opium in some form is the remedy. But it should be used under medical advice.
Everything possible should be done to main tain the patient's general health by plain nourishing food, the use of iron, quinine, and similar tonics, and the regulation of the bowels by such gentle medicines as a mineral water. Stimulants should be avoided as far as pos sible.