Reports of Societies

1901 Boston Medical and Surgical Journal  
fibroid growing from the posterior surface of the uterus. The probe passed into the uterine cavity forward 3^inches, where with a little manipulation it passed over a rounded mass which bled easily, and which was evidently another fibroid, of submucous variety, in the uterine cavity. March 12. After a thorough curetting of the uterine cavity myomectomy was performed through a central abdominal incision in the median line, and a subperitoneal fibroid was first removed, which proved to be made up
more » ... of several individual fibroids, making quite a multiple mass. Incision was then made through the anterior uterine wall from the os internum to the fundus, and the submucous fibroid enucleated. A strip of iodoform gauze was then carried from the interior of the uterus through the cervical canal and out into the vagina, its upper portion being left in the uterine cavity. This was to insure free drainage from any portions of the disintegrating capsule through the natural passages. The incision having been closed with chromicized catgut, several smaller fibroids, eight in number, interstitial in character, which could be easily felt in various portions of the uterine wall, were cut down upon and shelled out. The abdominal incision was closed in layers. She was sitting up on the fourteenth day and was discharged March 31, with an internal measurement of the uterus of 2| inches. In reviewing the above case I would suggest the following : (1) The importance of performing myomectomies in preference to hysterectomies, in most of the cases of fibroids during the child-bearing period. (2) Even though the patient and her friends may prefer a total hysterectomy for various reasons, principally among which are the facts of the extreme suffering of the patient or the great loss of blood, which make them desirous of absolutely putting an end to the menstrual process, it is generally better surgery to remove the cause of the suffering, and leave the uterus and ovaries in a state which may be of great future usefulness and certainly able to perform their normal functions. (3) The greater length of time necessary to perform several myomectomies in any given case is usually more than overbalanced by the complete insurance of the integrity of the organs involved. -•-De. Owen Copp : There are certain general considerations in relation to the drink habit upon which I would like to say a few words. I do not know that anything need be said in regard to the importance of this subject, but I was interested the other day to look over the results of the investigation by the Bureau of Statistics of Labor in relation to the influence of the liquor traffic upon pauperism, insanity and crime. It was the method of the investigator to interview all persons who had been committed or passed before the courts during a twelve months' period. Some 3,000 cases of pauperism were investigated. It was found that about 40% of them had been brought into that condition by the direct use of alcoholics and some 5% by their use by parents or guardian. In round numbers 45% of the paupers were such because of alcoholics. Some 26,000 convictions were investigated. More than 17,000 were for drunkenness; 2% or 3% more for drunkenness and other offences. Of the 8,000 or more convictions for crimes other than drunkenness more than 50% of the persons were under the influence of liquor at the time the intent to commit the crime was formed. In about 84% of all convictions the use of alcoholics led to the condition which caused the commission of the crime. Coming to the investigation of the cases of insanity, it was found that about 25% of the commitments of the insane were directly due to their use by the patient. I find in looking over the admissions to the institutions for the last year that the assigned cause of insanity was intemperance in more than 15% of the cases, and that more than 10% of them were affected with alcoholic insanity. Now, if we take into consideration that of these three classes there are at the present time more than 20,000 who are fully supported by the State or by the cities and towns, and that at least 50% of them owe their downfall to this particular cause, and then include the expense of police, courts and partial support of many others, you see there is a very large financial burden being borne on this account. If we add the remote consequences according to the laws of heredity, resulting in degeneracy of mind and body, certainly we are impressed with the very great importance of the subject, and we also feel that the public has a right, for its own protection and for the benefit of the individual, to interfere. Now, as to the measures of relief there is great difficulty. In the first place in the treatment of the habit in very many cases, and perhaps the majority, we have no co-operation from the patient. Immediately there comes up the question of how far the liberty of the individual can be interfered with. In English legislation of more than 50 years ago the lunacy laws allowed the inebriate to become an inmate of insane hospitals and asylums. He became such voluntarily. Very 1 See page
doi:10.1056/nejm190108221450806 fatcat:3k6nag24vnfjtlvznnh6ccwhmq