Fibroid Tumours of the Uterus: a Study of the degenerations and complications in 2,274 consecutive cases, including 337 cases of the writer's; also a study of 4,880 consecutive cases in their relation to Carcinoma and Sarcoma of the Uterus.*
BJOG: an International Journal of Obstetrics and Gynaecology
Surgeon-in-Chief to the Kensington Hospital foT Wo.men and Gyncecologist to the Stetson Hospital, Philadelphia. As early as 1894, as a result of the observation of the clinical history of women suffering from fibroid tumours, I became convinced of the fallacy of the classical teaching concerning the natural history of these tumours. At the time, I had operated upon but thirty women suffering from fibroid tumours. At the close of a paper read in 1894 (Noble, Cha,rles P. Uterine Fibroids. Med.
... e Fibroids. Med. and S u~g . Reporter, June 2, 1894), I said : "The comparatively small number of operations which I have done f o r fibroid tumours is evidence of the fact that for a long time I was profoundly influenced in my practice by the classical teaching concerning this disease. It was not until my own observations convinced me of the fallacies of that teaching that I felt justified in resorting to the removal of fibroid tumours except in the worst class of cases. I am coming more and more to believe, however, that it is the part of wisdom to remove fibroid tumours which are producing symptoms as soon as they are discovered ; in other words, that the principle of early operation which is now generally accepted with reference to ovarian tumours is equally applicable in the treatment of fibroid tumours." During the past twelve years every phase of the subject of fibroid tumours of the uterus has engaged my attention and diligent study, and I desire to present to you the results of my own experience with the subject and my study of its literature. In 1897 sixty-six hysteromyomectomies had been performed (Noble, Charles P. The Development and the Present Status of Hysterectomy for Fibromata. Trans. Amer. Gynec. Sac., 1897). The degenerations and complications present in these 66 women were tabulated and analysed, and the conclusion wns drawn that Read before. the American Medical Association, June 1906, and, by arrangement, published simultaneously in this JOURNAL and in the Journal of the Americnn Afedicul Association. Noble: Uterine Fibroicls 437 20 of the women, or about 30 per cent., would have died as a result of degeneration in the tumour itself or of the complicating diseases of the uterus, the tubes, or the ovaries. I n 1901 the number of patients operated upon for fibromyoma of the uterus had increased to 218. These cases were tabulated, analysed, and studied in a paper read before the British Gynaecological Society (Noble, Charles P. The Complications and Degenerations of Fibroid Tumours of the Uterus as Bearing upon the Treatment of these Growths. Brit. Gyluec. Ioum., Nov., 1901). The complications and degenerations were divided into three classes : (1) Those which lead to the death of the patient; (2) thoee threatening the life of the patient; and (3) those predisposing to more or less permanent invalidism of the patient. Of the 218 women operated upon, it was estimated that 66, or 30 per cent., would have died from the complications and degenerations present; that the life of 25 was threatened, and that in 30 others the patients were suffering from more or less permanent invalidism. In this connection the idea was developed that the proper method of studying the real nature of fibroid tumours was to study a consecutive series of cases, carefully noting the natural history of the tumours, the degenerations present in the tumour itself , and the complications present in the uterus, in the adnexa, and in other organs. It was held that in this way only a true estimate of the dangers of fibroid tumours could be reached. Reference was made to the only paper previously published in any way bearing upon the subject, in which the complications of fibroid tumours in the tumour and uterus itself met with in 205 cases were tsbulated by August Martin (Martin, A. Pathology and Therapeutics of the Diseases of Women. Boston, 1900, pp. 268-272). Such questions were discussed as sarcomatous degeneration, necrosis of the tumour, the relation of the menopause to fibroid tumours, the disappearance of fibroid tumours after the menopause and after labour, the ages of the patients operated upon, sterility, phlebitis, embolism, anemia, carcinoma aa a complication, and death from fibroid tumours in the natural course of the disease. The conclusion was drawn that upwards of one-third of women suffering from fibroid tumours would die without operation, as contrasted with a mortality of less than 10 per cent. from operation. The plan advocated in that paper, to study definite consecutive series of cases, bore fruit, and aince that time a number of valuable papers have appeared, each paper consisting of a study of a consecutive series of fibroid turnours treated by operation; so that, at the Journal oj Obstetrics and Gynaecology present time I am able to present for your consideration a study of the degenerations and complications in 2. 274 cases of fibromyoma of the uterus .