NOVEMBER 6TH, 1872.

JOHN BRAXTON HICKS, M.D., F.R.S., President, in the Chair.

Present-50 Fellows and 8 Visitors.

Books were presented by Dr. Lombe Atthill, Dr. Graily Hewitt, Dr. F. Hogg, R.H.A., Dr. Lloyd Roberts, Mr. Spencer Wells, Dr. Emil Noeggerath, Dr. F. Verardini, the Clinical Society, the Royal College of Surgeons, &c.

The following gentlemen were elected Fellows of the Society Arthur H. W. Ayling, L.S.A.; Albert F. Field, M.R.C.S.; Henry Harris, M.D., Redruth; George Mendenhall, M.D., Cincinnatti; and Joseph Szczygielski, Warsaw.

TUMOUR OF THE UTERUS COMPLICATING
PREGNANCY.

By J. LUCAS WORSHIP, Esq.

C. C—, æt. 35, married two years and a half. Generally enjoyed good health. Has lost eight brothers and sisters in early life. Has five sisters living, all at present in good health, and having, many of them, large families. Can trace no history in her family, on either paternal or maternal side, of any tumour or cancer.

VOL. XIV.

20

Six months after her marriage had very severe pain in the left iliac fossa; there was no enlargement, and, although at times the pain was very acute, she continued in service, acting as charwoman, and sought no medical advice. Last catamenial period five months ago, August 1st. Three months ago observed slight enlargement of the abdomen, but did not think she was pregnant, and the pain became much worse. She now saw a medical man who, I believe, considered her to be suffering from ovarian disease. I saw her on August 1st, the abdomen was then the size of a woman in the seventh month of pregnancy. I examined her per vaginam and failed to discover anything abnormal; the os uteri was very high up and back towards the sacrum, the cervix was not elongated, and I did not think she was pregnant. The mammæ showed no signs of enlargement nor any increase of areola round the nipple. She could only lie on her left side, and her only complaint was of the acute pain in the left groin, difficulty in breathing, and constant vomiting. Pressing the tumour laterally it gave one the impression of a solid mass, quite inelastic and very painful to the touch. I thought there was little doubt, from the rapidity of its growth and the intense pain, that it was a malignant tumour of the left ovary.

Beyond giving her morphia and medicine to try and allay the sickness, I adopted no treatment, feeling sure that beyond alleviating pain no good could either be done by medicine or surgery.

She gradually became worse and worse, retaining nothing many minutes on her stomach, and often the character of the matter ejected was stercoraceous and exceedingly offensive. She was much emaciated and died on October 4th.

On October 6th, in the presence of my friends Messrs. Thompson and Pearless, I made a post-mortem examination. On opening the abdomen we found a large tumour, reaching from the pubis to the diaphragm, of a yellowish colour and of the shape of an hourglass, the upper division being very much larger than the lower. We took out the uterus as the specimen here shows, and found the os uteri filled with the usual plug of pregnancy, and on slitting up the organ

found an unruptured bag of liquor amnii of a deep clarety colour, and the fœtus in it. The skin of the fœtus appeared shrivelled, as if it had been dead some little time. On the posterior surface of the uterus are some solid tumours. We then made an incision into the tumour, which was very tough and full of cysts containing a greenish, viscid fluid. The ovaria appeared healthy and in their natural positions, but very small.

The PRESIDENT referred to a case of labour complicated with a large fibroma, attended by Mr. D. Taylor, in which the labour was perfectly normal.

Dr. PHILLIPS said that large fibroid masses at the fundus uteri generally interfered materially with efficient uterine action. The specimen exhibited was interesting as another illustration of the difficulty of diagnosing between fibrocystic disease of the uterus and multilocular ovarian tumour. He asked whether fibrocystic tumours of the uterus had ever been noticed to suppurate and discharge at regular intervals. There was now at Guy's, under his care, a case of uterine tumour extending high above the umbilicus but at intervals, generally of about four or six months there was a profuse discharge of blood and then of pus, and the tumour diminished to about half its size. The subsequent increase was gradual, and a similar increase and decrease had been noticed on several occasions, as the patient has been under observation for some years.

Dr. PROTHEROE SMITH said, to aid Dr. Phillips's inquiry as to the probable escape per vaginam of the fluid contents of fibrocystic growths of the uterus, he would mention by way of illustration three cases, the first was a patient of Dr. Blackburn of St. Bartholomew's Hospital who had a single abdominal tumour which became diminished in size and tension on the escape of considerable quantities of watery discharge per vaginam at irregular intervals. Having left town without any alteration in her case he lost sight of her. Another patient afflicted with the same symptoms of hydrometra of the uterus measured four inches by ten round, has experienced a like increase and diminution of a tumour continuous with the uterus which at one time reaches to the umbilicus and at another is felt only two inches above the pubes, and the condition has existed more or less for seventeen years. The third case, with much less uterine enlargement, gave a similar history, but though admitted into the Hospital for Women for three months there was during this time no discharge of water. In these and other cases, however, he had not the opportunity of ascertaining the fact by autopsy.

Dr. WYNN WILLIAMS exhibited a pessary for the treatment of flexions of the uterus, more especially ante- and latero-flexions. He was led to adopt the mode of treatment recommended through hearing the late Dr. Beaty, of Dublin, at the meeting of the British Association at Plymouth, recommend after the introduction of a stem into the uterus the placing of a round boxwood pessary for it to rest upon in the vagina, which prevented the extrusion of the stem, and on which it moved in a circular groove. This mode of procedure Dr. Wynn Williams found very inconvenient. The introduction of the boxwood pessary into the vagina of a virgin was no easy matter, and when there you could not ascertain the exact position of the stem and consequently of the uterus. To obviate this Dr. Wynn Williams got Messrs. Krohne and Sesemann to fit a diaphragm of india rubber, so as to fill up the centre of an ordinary Hodge's pessary, or, if preferred, Dr. Greenhalgh's modified Hodge. The one exhibited is Dr. Greenhalgh's, and in the unmarried it is certainly the one to be selected on account of its being much more readily introduced. Having adopted the usual measures and introduced a stem according to the fancy of the operator (the one used by Dr. Wynn Williams being a simple light vulcanite one), the pessary exhibited is introduced and placed in front of the stem. The position of the uterus can be readily ascertained by feeling the button of the septum through the india-rubber septum, and if too high can be easily coaxed downwards by the finger, and vice versa. The septum makes a very safe elastic bed for the button of the stem to rest upon, and when fixed in position the depression made by the button prevents any movement beyond that allowed by the elasticity of the thin septum of india rubber. The retention of the discharge is obviated by perforations in the diaphragm.

Mr. SCOTT thought the instrument an ingenious one, but had himself used with success a simple Hodge's pessary for the purpose of keeping the os in the required axis after the introduction of an intra-uterine stem in cases of ante- or retroflexion.