679  J

not  encapsulated.       I


cable.  Pure  myoma4a  are  rare,  grow  rapidly,  and  are  not
Fibroids  arise  during  tlie  period  of  sexual  activity,  and  never  before  puberty
or  after  the  menopause,  in  fact,  subsequent  to  the  climacteric  they  usually
remain  stationary  or  atrophy.  They  are  most  frequent  in  the  colored  race
and  in  the  married,  sexual  excitement  and  pregnancy  both  increasing  the  rate  of
growth.  Twenty  jjer  cent,  of  all  women  who  have  reached  the  age  of  thirty-
five  are  said  to  have  fibroids.  These  tumors  are  almost  always  multiple  and
vary  greatly  in  size.  The  body  of  the  uterus,  particularly  the  posterior  wall,
is  the  favorite  situation.  According  to  their  relations  with  the  uterine  wall,  they
may  be  interslitiah  submucous,  or  stibperitmiml ;  the  second  and  third  varieties
may  be  sessile  or  pedunculated.  A  pedunculated  submucous  growth  is  called  a
fibrous  polyp.  The  uterus  is  enlarged,  and  the  mucous  membrane  hypertro-
phied  and  sometimes  ulcerated.  According  to  the  situation  of  the  growth,  the
uterus  may  ascend,  descend,  or  be  pushed  towards  one  of  the  walls  of  the
pelvis,  while  4  submucous  growth  may  cause  inversion.  In  40  fKr  cent.
of  the  cases  (Fleck)  there  is  brown  atrophy  of  the  lieart,  a  fact  accounting  for
some  of  the  suj)den  deaths  after  operation.  In  54  per  cent.  (Tait)  there  are
inflammatory  changes  in  the  tubes  or  ovaries.  The  changes  which  may
occur  in  the  tumor  itself  are  edema,  necrobiosis,  suppuration,  gangrene,  cal-
cification, atrophy  (especially  after  castration  or  the  menopause),  and  fatty,
amyloid,  myxomatous,  cvstic,  or  sarcomatous  degeneration  (i-a  percent.).
The  growth  may  be  associated  also  with  chondroma  or  osteoma,  or  carcinoma
of  the  endometrium.
