OVARIOTOMY AND MYOMECTOMY EARLY IN PREGNANCY, WITH FULL-TERM DELIVERY

H. GRAD
1909 Journal of the American Medical Association  
depend its success or failure. If one gives elateri urn he is sure to be uniformly dissatisfied with the results, but if be will follow the lines suggested definite results will be attained. With regard to occasional starvation, this, too, is a method which can be used, and is an essential feature of the method advised in the use of elaterium. The patient is practically starved; but he can live a long time without the ordinary foods. However, one may drive the nutritive portions of the blood
more » ... ons of the blood out into the intracellular and lymph spaces; but stimu¬ lating the cellular secretory action in order to induce a return flow of the waste-laden and toxic lymph back into the general vascular circulation is not such a simple procedure. The serum obtained through the intestines by the use of elaterium is in the nature of a vicarious elimination, which is brought about by secretory action and not solely as the result of pressure. The fluid may be readily obtained clear by filter¬ ing, and is free of albumin; there may be a mere trace of it perhaps, but when such is the case it is accidental and due to the open spaces left by broken-down epithelium. The tissue lymph is albuminous and contains salts in a different proportion than is found in the serum drained off through the intestines. The relation of sterility and fibroids of the uterus has been widely discussed and two opinions defended by the opponents. One teaches the theory that the ster¬ ility is due to the growth in the uterus, while the other insists that the tumor is the cause of the sterility. As the cause of tumor formation in the uterus is not known, the opinions expressed are but a speculation. One opinion is entitled to as much consideration as the other. Fibroid tumors of the uterus are found in women under different modes of life; the married, the unmar¬ ried, the sterile as well as the fruitful are subject to this disease. These tumors are found in women who have suffered infection of the genital tract, and also in those who have never had an infection. They are found in the virtuous as well as in the morally lax, in the vir¬ gin as well as in the sexually promiscuous. In some cases the tumor appears early in life, in others later. The growths occur in women living in luxury as well as in their sisters of hard toil. They occur in women of all races, although the colored race is said to be more liable to these tumors. It is not known to what extent the physiologic con¬ gestion occurring periodically in the genital organs dur¬ ing menstruation is responsible for these tumor forma¬ tions, or if a responsibility can be put on this function at all. In this connection there is a case on record by Sutton1 which is of interest. In this case a tumor supposed to be a fibroid was present for ten years in the uterus of a childless woman, twice married, who had never men¬ struated or shown any evidence of physiologic ovulation. Emmet,2 who has studied the subject of disturbed menstruation in fibroids and their relation to sterility, expresses himself as follows : Between the ages of thirty and forty years the unmarried woman is fully twice as subject to fibrous tumors as the sterile or the fruitful. I have already pointed out that this is one of the tributes which an unmarried woman pays for her celibacy. It seems as if it were the purpose of Nature that the uterus should undergo the changes dependent on pregnancy and lactation about once in three years throughout the childbearing period, and that if the uterus is not physiologically occupied in child-bearing a fibroid will the more rapidly de¬ velop into a fibrous tumor as the woman advances in life. This will also be the case with the married woman who has taken means to prevent conception, as well as with her who has been sterile from some cause beyond her control, but to a less degree in the latter case. Finally, the woman who may have been fruitful in early life may have a tumor develop, but is less liable thereto from having once borne a child. On the other hand, Haultain3 holds that "sexual ex¬ citement in marriage favors the growths of fibroids; that fibroids tend to prevent child-bearing, and, further, that pregnancy in many cases, by promoting their growth, prevent conception in the future." A fibroid tumor may lie dormant for a long time in the uterus of a sterile woman; she may then conceive, and with the conception the tumor grows and becomes an active factor in causing an abortion of premature labor later in the pregnancy. A case of this kind came under observation last year. Case 1.-History.-Mrs. G., aged 35, had been married fif¬ teen years. She had one child two years after marriage but had not conceived since. She had a small fibroid in the uterus, the existence of which she had known for many years. The tumor never produced any symptoms. Six months previous to my examination she stopped menstruating but did not think that she was pregnant. The amenorrhea extended over four months; then she began to flow moderately. At first she thought it was a menstrual period ; the flow continuing over six-weeks convinced her that something was wrong. She con¬ sulted her physician, who called a consultation. Under a light chloroform narcosis a large tumor complicating a pregnancy was made out. She was transferred to the hospital for ob¬ servation, where a few days later she delivered herself of a five months' fetus. The placenta not coming away satisfac¬ torily, she was narcotized, the placenta removed and the uter¬ ine cavity thoroughly explored. With the hand in the uterus a fibroid was palpable, which projected into the cavity of the uterus, undoubtdly causing the premature labor. It was hoped that with the subinvolution of the uterus the tumor would re¬ turn to its previously quiescent state. Instead of that the pa¬ tient kept on flowing. Operation.-Seven weeks later, on account of severe metrorrhagia and anemia, the patient was operated on and a panhysterectomy performed. On opening the specimen it was found that the uterus had involuted perfectly but that the tumor extended clear through the uterine wsl\\ and projected into the cavity of the organ, causing the persistent metrorrhagia. Here we have a dormant tumor awakening into activ¬ ity by the conception, and by its rapid growth causing a premature labor and also bringing about symptoms that called for hysterectomy. While there is a distinct relation between sterility and fibroids of the uterus, the underlying cause of this rela¬ tion is not known. There are cases of pregnancy on rec¬ ord in uteri that apparently were hopelessly destroyed by myomatous tumors. Under what conditions does preg¬ nancy occur in organs so overwhelmingly damaged by fibroids?
doi:10.1001/jama.1909.92550220001001d fatcat:tt5xtchr75bx3ef7ld5jxjyuia