ART. I.-Surgical Diseases of Women-Uterine Polypi. By J. F. MINER, M. D. Uterine Polypi are of various forms, and differ greatly in location and structure, and are attended by a great variety of general and local symptoms; their physical and pathological characters are very well understood, while the causes of their growth are obscure and undetermined. A brief description will be premised, the chief object being to indicate the surgical treatment required for removal of these morbid growths. It is common to arrange these growths under one of three or four different heads, and authors generally give [descriptions of glandular, cellular. fibrous, mucous, and some other varieties of polypi. It is, however, probable that nearly all growing from mucous membranes consist of fibrocellular tissue, infiltrated by serous or synovia-like fluid, the abundance or scarcity of the fluid, contained in the meshes, making the principal difference between the tougher, fibrous or fassia-like, and the softer, mucous or gelatinous varieties. Some of these growths are composed almost wholly of serous or synovia-like fluid, while others contain little, if any. Neither the very soft or very dense contain blood-vessels in abundance, while those not so gelationous or fibrous often contain blood-vessels in some degree, and from this circumstance have been called vascular. This form of out-growth is rare in the uterus, and is usually of small growth. Most uterine polypi are feebly supplied with blood-vessels, and many times not any can be positively traced. In size they vary from a line in diameter to that of several inches, and the shape is also varied, though the smooth rounded variety attached by a pedicle of greater or less proportional diameter, is the more common form of the larger growths. Polypi may be attached to the fundus, walls, inner surface of cervix, or lips of the os-uteri, and upon this will depend the ease and safety with which they may be removed. The point of attachment is sometimes uncertain, a long pedicle may reach much higher than it can be traced. Polypi which grow from the lips or cervical canal do not neccessarily have any pedicle at all, but rest upon the surface by a broad base. Small polypoid growths from the size of a millet seed to that of a pea, often rest upon the lips of the os-uteri, or in the cervical canal, and give rise to troublesome and dangerous hemorrhage, and other distressing symptoms. These growths, if soft and gelatinous are easily removed, while if dense and fibrous, greater, difficulties will be presented. General Symptoms.-The symptoms which attend this disease are such as to rarely mislead, though it must be confessed that sometimes the diagnosis cannot be positive. At first there is often a profuse secretion of mucous, which becomes gradually more abundant, and soon is observed to be more or less mixed with blood; sometimes large quantities of blood will be discharged without any mucous; hæmorrhage is an important symptom, and rarely absent. The smaller growths which sometimes appear in great numbers upon the uterine neck and extend within the cervical canal, often give rise to profuse hemorrhage. There are almost always present constitutional smyptoms of uterine disturbance; the nervous system suffering most severly. When the tumor has become large, or the uterus has enlarged from the disturbance produced by the presence of an intra uterine growth, there is always bearing down pains; these pains sometimes appear almost like labor, coming on in paroxysms, and having the same expulsive effort. When the tumor has attained considerable size the uterus does often take on the same effort as in labor, and the tumor is thus often expelled or pushed as low as possible from the length of the pedicle and place of attachment; it is thus made apparent at the os-uteri when previously its presence could not have been demonstrated. The tumor and uterus, from consequent enlargement, may fill the pelvis and interfere with the functions of the bladder and rectum; this is rare, and the smaller varieties are much more often met in practice. These growths sometimes attain considerable size before their presence is mistrusted; this is seen in the fibrous or dense varieties, when there is neither hæmorrhagic or mucous discharge, and before the uterus has commenced any contraction for expulsion of its contents. When the above mentioned symptoms are present, it is indispensably proper to institute a careful examination with the finger, speculum, uterine sound, &c., to discover, if possible, their causes. Hæmorrhage should always attract immediate attention, though it will often be neglected, the patient looking upon it as some derangement of menstruation and not as a symptom of disease. Diagnosis cannot always be made positive; polypus may exist within the cavity of the uterus and still we are unable to detect it. Sometimes the os will admit the finger for a distance sufficient to distinguish some foreign growth; or possibly, by the aid of the sound, we may be able to discover that a polypus grows from the interior of the uterus. The os uteri may sometimes be dilated so as to admit of more perfect examination; patient, repeated examinations will in most cases lead to quite satisfactory conclusions. Polypus has been mistaken for, and is to be distinguished from, pregnancy, inversion of uterus, prolapsus uteri, cauliflower excressence, scirrhus, vaginal cystocele and vaginal hernia. It is believed that careful examination will distinguish it from these conditions, though when it is situated high up within the uterus and cannot be reached it may be impossible in its early stages to determine its presence, or the exact nature of the disease. The more common form of uterine out-growth-the mucous polypi of most authors upon the diseases of women-is some times overlooked by the inexperienced, and to this variety of the disease is directed especial attention. It has so frequently been brought to our notice after having existed for weeks or months and escaped detection, that a simple description and the means of treatment hardly appear sufficient to enlist the attention of many who attempt to find the cause of hæmorrhage which has even become alarming, or profuse leucorrhoea, which is continual and often largely mixed with blood. Examination is made by poor light or in a faulty manner, so that the small vesicles often escape notice and the hæmorrhage is ascribed to other and erroneous causes. Small, pearly elevations, of various sizes, from that of a pin-head to a pea, with very slender pedicle, or without any, and resting upon the surface of the uterine neck or within the cervical canal, is a quite frequent condition. These growths may be few or many in number, may be hard and resisting, or soft and gelatinous. They are covered by mucous membrane, and sup ART. I.-Surgical Diseases of Women-Uterine Polypi. By J. F. MINER, M. D. 1 Uterine Polypi are of various forms, and differ greatly in location and structure, and are attended by a great variety of general and local symptoms; their physical and pathological characters are very well understood, while the causes of their growth are obscure and undetermined. A brief description will be premised, the chief object being to indicate the surgical treatment required for removal of these morbid growths. It is common to arrange these growths under one of three or four different heads, and authors generally give [descriptions of glandular, cellular. fibrous, mucous, and some other varieties of polypi. It is, however, probable that nearly all growing from mucous membranes consist of fibrocellular tissue, infiltrated by serous or synovia-like fluid, the abundance or scarcity of the fluid, contained in the meshes, making the principal difference between the tougher, fibrous or fassia-like, and the softer, mucous or gelatinous varieties. Some of these growths are composed almost wholly of serous or synovia-like fluid, while others contain little, if any. Neither the very soft or very dense contain blood-vessels in abundance, while those not so gelationous or fibrous often contain blood-vessels in some degree, and from this circumstance have been called vascular. This form of out-growth is rare in the uterus, and is usually of small growth. Most uterine polypi are feebly supplied with blood-vessels, and many times not any can be positively traced. In size they vary from a line in diameter to that of several |
