File:The practice of surgery (1910) (14592423588).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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. 176.—Myomata. The symptoms of pressure, traction, pain, and discomfort are next inimportance to hemorrhage. The causes and nature of these symptomsare obvious when one considers the position of the uterus and its rela- TUMORS OF THE UTERUS 295 tions to other orp;ans. In most cases the uterus itself becomes somewhatenlarged, although an actual increase in the uterine body is not invari-able. With its associated tumors it may press downward or upward,backward or forward. It may drag or press upon the rectum, the blad-der, the urethra, the vagina, and may interfere with the functions of theintestines and other abdominal organs, for it may become inflamedand set up adhesions. As a result of all these derangements there maybe obstinate constipation, frequent micturition, leukorrhea,—dysmen-orrhea is common,—pain in the region of the coccyx or sacrum, colickystomachache, dyspepsia, headache, nausea, blurring of vision, and manyother indefinite abdominal and general nervous symptoms.
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Fig. 177.—Adhesions to uterine myoma. The diagnosis of uterine myoma is not so easy as would appear.Especially, these tumors must be distinguished from tumors of the ovaryand from intraligamentous cysts. Often it is extremely difficult todistinguish a tense cyst from a soft myoma. The common symptomof hemorrhage is not pathognomonic of myoma; associated growths andextensive adhesions may render obscure the diagnosis to the examininghands. The surgeon should make a bimanual examination and map outthe lower portion of the mass with fingers in the rectum as well as in thevagina. He should also endeavor to distinguish a uniform myomatousenlargement of the uterus from a pregnancy—often an extremely diffi- 29G FEMALE OllOAXS OF OEXEKATION cult matter. In this connoction he should ascertain accurately thetime, character, and amount of hemorrhage, the condition of thebreasts, and the presence or absence of a fetal heart. Pregnancy maybe present in a myomatous uterus. The uterine probe is

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