84 Clinton

Jos. B. Ward...... Bedford ave. cor. Broadw'y,

do

do

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Melville Bryant.... 106 Adelphi.

W. C. Jardee...... Monroe st. near Franklin.

ARTICLE LVII.

Uterine Fibrous Polypi. By HENRY MINTON, M. D.

Miss D, aged about twenty-five years, medium size, auburn hair, blue eyes, amiable but very decided disposition, came under treatment about six years ago.

For some months previous to my seeing her, she had suffered repeatedly from uterine hemorrhage, attended with severe pelvic and hypogastric pains. Her case had always been looked upon and treated as one of severe menorrhagia.

Her catamenial periodicity was perfectly regular, never deviating a day from the usual twenty-eight, but the hemorrhagic engorgement was productive of the greatest suffering. Owing to the increasing severity of those attacks, I was consulted in regard to her case. I do not think that I have ever seen a more violent attack of uterine hemorrhage than this case presented on my first

visit. The hemorrhage and pains were frightful. It did not seem possible that she could survive many such attacks. The patient was very thin, pale and feeble-in fact, she was almost completely exsanguinated. The anæmia was not only manifested by the pallor of her skin, and the flabbiness of her muscles, but by the irregular breathing and palpitation of her heart.

Though I was informed that this attack was no more severe than many others from which she had suffered, and that in the course of three or four days this would pass over, and she would again be about the house, I, indeed, was quite apprehensive that the day had gone by when remedial means would be of much avail to the suffering creature before me.

The only ray of hope I could observe was in her indomitable will. Seeing me, I presume, looking rather despondent, she drew me near her, and whispered, for she could not speak loud, that she had lived through a good many such attacks, and could stand a good many more-that she was not going to die yet.

After making several prescriptions, and attending her through two of these attacks, I came to the conclusion that this was something more than menorrhagia dependent upon habit or an adynamic condition of the womb; the weight, tension, and severe expulsive pain which so tormented the patient, forbade the supposition that this was the discase. The immoderate flowing excluded the possibility of its being dysmenorrhoea. Were there a polypoid growth in the womb, the irritation would be constant and we would, therefore, expect the hemorrhage to be at least irregular in its periods, if not continuous. The whole difficulty was evidently dependent upon some organic uterine lesion, the nature of which could only be definitely ascertained by a vaginal examination.

I stated this conclusion plainly to the patient, and proposed an examination. Like a sensible girl, as she is, she at once readily consented. On passing the right index finger into the vagina, I discovered a large tumor, rather obscure in its nature, but which, nevertheless, I believed to be a polypus. I refrained from giving an opinion, until I had made a more thorough examination, which I promised to do on the following day. The next morning I found her suffering from severe pain, occasioned no doubt, by the excitement and irritation of the previous examination.

I have never had, before nor since, a patient that was so willing, [Senate, No. 77.]

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even anxious to afford me every opportunity of investigation that promised the least hope of revealing the true nature and location of her disease.

As a general thing, I am inclined to think that physicians are not thorough enough in their vaginal examinations-they too frequently feel a delicacy in making free use of all, or of employing every means of research in their exploration, and of repeating these explorations sufficiently often. The chief difficulty in treating uterine or sexual maladies is to overcome that fastidious delicacy which so often prevents the patient from revealing to her physician the whole extent and nature of her suffering. This reserve on the part of the patient is perfectly natural, proper, and highly to be commended; but it is the duty of the physician, when the gravity or obscurity of the case demands it, to explain to the patient the necessity of an examination that alone can reveal the true nature and indications of her disease. If she be intelligent, and places implicit confidence in her physician, she will at once accede to the request; if she refuses, it is clearly the duty of the attendant to decline assuming the responsibility of treating her altogether.

To resume, a thorough examination of the case amply confirmed my first supposition of a polypoid growth, about the size of a child's head, protruding from the os tincae, as an acorn does from its cup, the attachment being well up in the fundus uteri. I informed the patient as to what I had found, explained to her the nature and tendency of such growths, that it was the occasion of all her pains and flooding; that it could be removed, and she would soon regain her health and strength.

She was highly pleased with the prospect thus presented, and was willing to submit to any operation that held out the least hope of affording her relief. Previous to having anything done, however, she wished to consult her sister's family physician, who was an old and intimate friend of the family, and who had attended her long before the existence of a tumor had been suspected. To this I readily consented, as I knew him to be a man of sound judg ment, of long experience, and well versed in uterine diseases. Besides, I was desirous of having my diagnosis confirmed by good authority; so, in case the operation did not prove entirely successful, I would be somewhat exonerated for attempting what I had no doubt he would inform the patient and her friends was a formidable undertaking. But, alas! when he came to examine her,

he pronounced the tumor carcenomatous. The patient certainly had a face indicative of malignant disease.

I made several attempts to have his diagnosis reversed, by consulting several others eminent in the profession, but without success. They all advised me not to attempt its removal, as the patient was already much reduced in strength, and would in all probability sink under the operation; that I would derive no eredit from it, but on the contrary, would stand a good chance of aggravating a case which, if unmolested, might produce no more serious results than it had already done for months or even years to come.

It was of no avail for me to point out to them that every monthly attack was fast telling upon her general health; that what she gained in the interval was more than lost at each menstrual period; and that the disease, if not arrested, would, in a few months at best, end her existence. They pointed to her cachetic appearance, her emaciation, her waxen complexion, and the generally depraved condition of all her functions. They advised me to do all I could to strengthen and build up. her system, to give her tonics and stimulants that would hold out hopes of assisting her in reproducing blood faster than she could lose it by her monthly attacks, to allay her pains by sedatives and soothing injections, but under no circumstances to attempt the removal of the heterologous mass.

Of course in the face of such authority I refused to operate, although frequently solicited to do so by the patient.

After this I prescribed for her at irregular periods, for something over six months, affording her some relief, perhaps, by modifying the uterine irritation and consequent nervous excitement, but doing little if anything to permanently benefit her condition. As far as I could observe, she remained in about the same condition as when I first saw her. During all this time, I made frequent examinations. I brought to my aid all the different specula and instruments that are ever made use of in such explorations. I was never able to reach its pedicle by passing my finger around the tumor, neither was I able to detect its attachment with a sound; still at every examination I felt re-assured that my first diagnosis was correct.

About this time, my patient, who was constantly consulting spiritualists, clairvoyants, and doctors and doctresses of every school and persuasion, heard of a female physician, in New York,

who had performed some wonderful cures of diseases similar to hers. I offered no objection to her consulting whom she pleased -on the contrary, I rather encouraged her in receiving a visit from the lady physician in New York. She sent for her. The doctress examined the tumor and was extremely anxious to attempt its removal, providing I would assist in the undertaking. For several reasons, this I declined doing; though at the same time, I advised the patient to place herself in the lady's charge. I did this because I honestly believed the tumor could be successfully removed, and I also believed the doctress competent to the undertaking.

Not to be baulked by my refusal, they perseveringly sought for other assistance, and finally secured the services of an eminent accoucheur of New York. After several failures they at length succeeded in getting a ligature around the tumor, and effected its strangulation. If I remember rightly, the ligature was some eight or ten days in cutting its way through the mass. As soon strangulation became complete, a most foul and offensive discharge came on, and continued long after the putrid mass had separated and come away,.

From the subsequent history of the case, I have every reason to believe that the ligature, instead of being applied to the neck or pedicle of the tumor, was tied at or very near its middle, only embracing that portion which protruded from the os tincae. If this supposition be correct, it is not, therefore, to be wondered at that the tumor should again prove troublesome, that it should soon acquire new dimensions when the base or root, from which sprang all the vessels, nerves, and other apparatus concerned in its nutrition and development were left intact.

However, after this imperfect removal, or rather curtailment of the tumor, the patient soon began to gain strength and flesh; she soon lost her cancerous, cachectic appearance, and in an incredibly short time, she was enjoying good health-having gained about thirty pounds in less than three months.

This condition of improvement continued for something over eighteen months, when she again began to complain of excessive menstruation, and for which I was again called upon to prescribe. I soon ascertained that the tumor was fast acquiring its old dimen sions. As I had always felt somewhat mortified that another should have reaped the benefit-and a real benefit it was, too, both pecuniarily and in professional eclat-that I should have