[Entered at the Post-ʊmes, at wilmington, N. C., as Second Class Mail-Matter.] Prof Koch's Remedy for Tuberculosis-London Lancet... Impressions of the Results of Dr. Koch's Treatment of Tuberculosis, by Frederick S. Prof. Koch's Remedy for Tuberculosis; Some General Pathological Conditions-Brit- More Concerning Koch's Methods of Inoculation-N. Y. Medical Record.. Koch's Method of Treating Tuberculosis-Boston Medical and Surgical Journal. Has Gyenecology come to this? (Paragraph) A Surgical Hand Book, For the Use of Practitioners and Students, by Francis M. Epilepsy; Its Pathology and Treatment, by Hobart Amory Hare, M. D. Ointments and Oleates Especially in Diseases of the Skin, by John N. Shoemaker M.D. 38 The Medical Bulletin Visiting List, or Physicians' Call Record.. A Practical Treatise on Impotence and Sterility and Allied Disorders of the Male Sexual Organs. By . W. Gross, A.M., M.D., LL.D... The Free Acid of the Gastric Juice During Digestion. (Paragraph).. The American Public Health Association, In Charleston.-Heroic Old Charleston.- The Prevention of Consumption.-Prof. Venable on Chemical Disinfection............ Hinsdale's New Test Paper for Acids. (Paragraph) ......... Dr. S. W. Battle Returned from Berlin; Insanity; Franklin as a Doctor. Trials of Koch's Liquid Abroad, and Opinions of the Medical Press The Insane of the State-A Conjoint Meeting of Superintendents of Asylums, N. C. 62 64 COD LIVER OIL A combination of the best Norwegian Cod Liver Oil with MALTINE, in which, by the vacuum process, rancidity is prevented and disagreeable odor and taste of the oil removed. Base a Powerful Reconstructive Contains No Inert Emulsifier Does not disturb Digestion nor offend the Palate Is an active Starch Digester and Tissue Builder. Produces rapid Improvement in Appetite. Is used where "Emulsions" cannot be tolerated. A complete list of the Maltine Preparations and their formule will be sent on application. THE MALTINE MANUFACTURING CO.. (Please mention this Journal.) New York, NY NORTH CAROLINA MEDICAL JOURNAL. THOMAS F. WOOD, M. D.. CEO. GILLETT THOMAS, M. D..} }Editors. Number 1. Wilmington, January, 1891. Vol. 27. ORIGINAL COMMUNICATIONS. THE TREATMENT OF FIBROID TUMORS OF THE UTERUS. By GEORGE H. RонÉ, M.D., Professor of Obstetrics and Hygiéne in the College of Physicians and Surgeons, Baltimore; Gynecologist to St. Joseph's Hospital. (Read before the Medical and Chirurgical Faculty of Maryland, November 12th, 1890.) The object of this paper is to advocate a rational discrimination in the treatment of fibroid tumors of the uterus. Uterine fibroids differ greatly in size, situation, structure and character of the symptoms to which they give rise. The treatment demanded by these differences likewise varies. In structure, fibroid tumors are homologous with the tissue of the organ in which they are found. They are composed of muscular and fibrous tissue in varying proportions, usually encapsulated by a connective-tissue capsule, in which large vessels ramify. In some cases the growth is made up principally of muscular tissue, in others almost exclusively of white fibrous tissue. In the majority of case, however, the growths are composed of varying proportions of these two tissues, sometimes the muscular, at another the fibrous predominating. Most fibroid tumors, especially if of moderate size, are firm and solid, but the larger growths frequently have cysts or cavities filled with a lymphoid fluid. These fibro-cystic tumors often cause no little difficulty in diagnosis, being sometimes mistaken for ovarian cysts, at others confounded with pregnancy. It must not be forgotten that pregnancy and fibroid tumors may co-exist, although happily this combination is not very frequent. Fibroid growths may occupy any portion of the uterus. Their site of predilection appears to be the fundus and posterior wall of the corpus uteri. Schroder found 92 per cent. in the body of the uterus and only 8 per cent. in the cervix. With reference to their situation in the uterine walls, fibroids are usually classified into sub-mucous, sub-serous and interstitial. The sub-mucous projects into the uterine cavity, the sub-serous toward the cavity of the abdomen, and the interstitial occupy a more or less intermediate position between the inner and outer walls of the uterus. As a matter of fact, most large fibroid tumors begin as interstitial or intramural growths, and become sub-mucous. or sub-serous in consequence of the contractions they excite in the muscular walls, which forces them either inward or outward. Fibroid tumors may undergo fatty degeneration and be absorbed, they may slough and be cast off through the genital canal, they may undergo calcareous change and become encysted, and be thus carried through life, or may slough out in the form of concretions which have received the name of uterine stones. Finally, they may undergo sarcomatous degeneration and become malignant. All of these terminations are, however, exceptional. Generally the tumor continues growing until, or after, the menopause, and gives rise to symptoms more or less troublesome and in some cases sufficiently serious to demand active measures of relief. The most pronounced symptoms of fibroid tumors of the uterus are pain, hemorrhage and interference with the functions of other organs by pressure. They may also produce great discomfort by their weight. Occasionally the sub-mucous variety undergo sloughing, when they may cause the death of the patient by septicemia. The pain produced by uterine fibroids is sometimes so severe as to be alone a sufficient reason for medical or surgical interference. It usually manifests itself at the menstrual periods as dysmenorrhea, but may be constantly present as severe backache, bearing down simulating labor pains, especially in the sub-mucous variety, or neuralgia of the sciatic nerves. Sometimes there is persistent pain in the uterus itself, or more probably in its peritoneal covering, which is subjected to irritation or inflammation. Comparatively small fibroids situated low down in the uterine walls or in the cervix may cause severe irritation of the bladder by pressure. There is often vesical tenesmus with frequent micturition, causing the most intense suffering. The pressure upon the rectum may also give rise to constipation and great pain on going to stool. Hemorrhoids and oedema of the lower extremities are not infrequent complications due to interference with the venous circulation. During the menstrual periods these pressure symptoms are generally increased in severity. Intrapelvic or intra-abdominal pressure may also cause ascites and in some cases localized peritonitic processes. Hemorrhage is in most cases the symptom that urgently demands remedy. It is most frequent and gravest in the sub-mucous tumors, but may be an accompaniment of any variety. It may be alarming in cases where the tumors are so small as to be detected with difficulty on bimanual palpation. The bleeding usually occurs at the menstrual periods which are prolonged and more profuse than normal. The menstrual interval may be normal in duration, but in many cases is shortened, so that the bleeding recurs in two or three weeks. The blood is frequently discharged in large clots. Indeed, the discharge of clots at the menstrual period is an absolute indication of something abnormal, and should always invite attention to the condition of the uterus. In a very large proportion of cases it will be found to be an outward sign of fibroid growths. A definite relation exists between uterine fibroids and sterility. Whether the sterility is a cause or a consequence of the morbid growths is not positively determined. Statistical compilations show that about 75 per cent. of the women having fibroid tumors have never borne children. This may be regarded as fortunate, for in |