The disappearance or 'absorption' of fibroids before the menopause / by Alban Doran.

  • Doran, Alban H. G. (Alban Henry Griffiths), 1849-1927.
Date:
1904
Catalogue details

Licence: In copyright

Credit: The disappearance or 'absorption' of fibroids before the menopause / by Alban Doran. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    up destructive changes of the kind just considered. But there is reason to believe that a fibroid almost purely made up of muscle- cells, a myoma in fact, is liable to share in the involution of the uterus after delivery. The author has found that it may undergo evolution13 during gestation, hence he must feel inclined to support the idea that the opposite process may naturally follow. Thirteen cases were tabulated by the present writer in his monograph and now, eleven years since the tables were prepared, the cases will still bear scrutiny. It is, however, not easy to feel certain that no destructive inflammation occurred in any particular case. We must also remember that a fibroid growth may be expelled during the puerperium and thrown away by a careless nurse or relative who may fail to inform the doctor of the fact. Boissard 14 reported a labour where the placenta was normally delivered. As the labour occurred in a lying-in hospital, the placenta was preserved for a midwives’ class, as a matter of routine. The demonstrator discovered a fibroid polypus as big as a hen’s egg, with its fundus firmly adherent to the chorion and its pedicle torn through. It is conceivable that a sub- mucous fibroid might be discharged in this manner or even expelled during the puerperium, without the doctor knowing anything about it, and without any teachers or routine system of examination being associated with the case. Had he recognised the existence of the fibroid before delivery, he would be easily misled if he examined the patient after convalescence. Again, recent research has shown that necrotic changes may take place even in a subserous fibroid in pregnancy or the puerperium. Stouffs 15 removed a necrotic subserous myoma three months after delivery. The growth had not, it would seem, diminished in size, but shrinkage is ultimately probable. Bearing these limitations in mind we may briefly consider the 13 cases, where the observers were more or less men of authority. Full details and references will be found in the writer’s original report. Kleinwachter, a great doubter as to the disappearance of fibroids as an event otherwise than very rare, watched a large series with much care. He examined a woman aged 32 in the fifth month of pregnancy. A hard, crescentic, pedunculated tumour, described as of the size of half a fist, stood out in relief from the right side of the gravid uterus. A month later it was found to have increased in bulk. The patient was safely delivered, and within two years the tumour had disappeared. The uterus was a little above the normal size. This case seems fairly reliable, but the report of earlier and frequently repeated examinations would have been more convincing, and precise information concerning absence of discharge is wanting. A