Reprinted from the North American Practitioner. 
THE MICROBIC ORIGIN OF FIBROID AND OTHER 
BENIGN TUMORS. 
By Henry T. Byford, M.D. 
Professor of Gynecology and Clinical Gynecology, College of Physicians and Surgeons, 
Chicago; Professor of Clinical Gynecology, Womans' Medical School, 
North-Western University ; Professor of Gynecology, Chicago 
Post-Graduate Medical School. • 
It is I think impossible at present to draw any definite conclusions' 
from the investigations of pathologists as to the cause of tumors. 
There is no doubt of the microbic origin of carcinoma and sarcoma, 
but pathology has not yet demonstrated it. In order to appreciate 
the relationship of benign tumors to micro-organisms let us call to 
mind some of the characteristics of those tumors and allied affections 
that are caused by microbes. 
Fibrosis of the uterus, more commonly called hyperplasia, sub- 
involution or chronic metritis, is a pathological condition bordering 
upon myofibroma and sarcoma as far as the ultimate histological 
changes are concerned. It occurs in connection with endometritis 
either of severe form or long duration, and hence must be either- 
directly or indirectly due to the action of micro-organisms. 
Sarcoma of the uterine walls, which I assume to be dependent upon 
microbes, cannot always be distinguished by the pathologist from 
fibro-myoma unless he has the clinical history to aid him. Sarcoma 
clinically as well as histologically may approach in character a benign 
tumor; it may grow very slowly, may be to a certain extent encap- 
sulated, may attain large size without metastasis and although large, 
often fails to return after operation. Fibroids may grow rapidly, may 
develop in numerous secondary nodules about the original one, and 
may exist in different parts of the genital track in the same women. 
I have met with them on both the vaginal and uterine walls of the 
same woman as well as both in the ovary and uterus. I have seen the 2 
surface of the uterus as thickly studded with them as the peritoneum 
is apt to be with tubercular nodules. I saw a soft fibro-myoma or 
myoma of the fundus as large as a six months' pregnant uterus that 
had no capsule, and which was as intimately connected with the re- 
mainder of the uterus as any sarcoma on the one hand or hyperplasia 
on the other, and more so than many sarcomas. 
When fibroids are infectious or recurring, it is supposed that they 
have become fibro-sarcoma. But if they are of microbic origin, it is 
probable that in some cases the infection may be unusually strong and 
invade the surrounding tissue so extensively as to produce new 
growths after the original tumors have been removed. 
While the ordinary encapsuled fibroid is a distinct form of tumor, 
the dividing line between its manifestations and those of certain other 
proliferations of microbic origin cannot be drawn. It is difficult to 
say that microbes begin their influence here and leave it off there. 
If microbes are the cause of similar proliferations of tissue more 
malignant than they, and of others less virulent than they, is it reason- 
able to suppose that microbes have nothing to do with them? 
The relation of infection to papilloma and papillomatous degenera- 
tion is instructive. As occurring on the skin about the genitals and in the 
vagina, there is no doubt but infection causes some of these formations. 
Some are due to syphilis, some to venereal infection without develop- 
ing either syphilis, gonorrhea or chancroid, as I have observed in 
married women whose husbands were loose in their habits, as well as 
in a young boy who had never had a venereal disease, and had just 
begun to cohabit with prostitutes of uncleanly surroundings. In 
many similar growths upon the hands it is impossible to demonstrate 
anything of the kind. Papillomatous or villous growths in ovarian 
tumors sometimes seem benign and sometimes malignant. There is 
no doubt but that the cells are transplanted on the peritoneum in 
many cases, and develop independently of the mother growth, while 
in others the removal of the original growth is followed by a disap- 
pearance of the disease. Here we have a diseased action which oc- 
curring in connection with syphilis is undoubtedly infectious and in 
•other conditions is with extreme probability mildly infectious, while 
in some cases it approaches malignancy in its power of invading 
tissues. It forms benign tumors with infectious qualities, the villous 
growth undoubtedly being due to a low form of micro-organism. 
The atypical growth of epithelial cells in proliferating ovarian 
cystomas, with unlimited production of secondary cysts from the 
inner epithelial surface makes it necessary to assume the presence of 
some living organism to account for the unending irritation. The fact 
that the papillomatous changes in some of these tumors are the result 
of the irritation of a germ, and that a large per cent of ovarian tumors 3 
are carcinomatous, would make it seem like straining a point to con- 
sider this equally persistent growth of epithelial cells as due to any- 
thing but germ irritation. That the germ or parasite has not the 
power of penetrating the cyst wall like that of carcinoma or of 
papilloma is not proof of its non-existence but merely of a difference 
in character. 
The growths produced by tuberculosis and syphilis, some forms of 
elephantiasis and infectious goitre are instances of the action of germs 
that produce new formations that are not malignant. 
Adenomas of the mucous membranes are microbic in origin since 
they are the product of inflammation. 
Many infectious diseases are more or less limited to certain periods 
of life, when the system is unable to resist their action or is most ex- 
posed to their influence. Thus the children's diseases are almost con- 
fined to early life, tuberculosis seems to develop better in young 
people, typhoid fever and malaria among adults, etc. Malignant 
tumors develop more at certain periods, carcinoma in middle and old 
age, sarcoma in young and middle age. Many benign tumors have 
similar limitations, fibroids of the uterus developing during menstrual 
life, chondromas and warty growths in young subjects, horny cuta- 
neous growths in middle age, etc. 
Tumors, although not strictly speaking degenerations, are degen- 
erative in their nature, and degenerative changes in living organisms, 
when not the result of perverted function, are usually brought about 
by microbic action. Tuberculous, syphilitic, malignant, malarial dis- 
eases are examples. When tissues lose their vitality they are at- 
tacked by microbes. It is by their action that dead tissues are broken 
up. The microbe as a producer of morbid conditions in the system 
is as by recent discoveries becoming a more and more prominent 
factor. 
To go back to fibroids, there are many facts that inferentially point 
to a microbic origin. Thus in women fibroids occur much more 
frequently in the uterus, in which the tissues are more exposed to in- 
fection than elsewhere. Not only do microbes readily gain access to the 
uterus but its varying states of activity and vigor, and, the frequency 
of inflammation make it an easy prey to them. They seldom occur 
in the heart. Were the Cohnhein theory the true one, I would expect 
fibroids to occur frequently in the heart which is subjected to strain 
and disturbance almost daily through excessive physical exertion, 
reflex excitation, valvular disease, Bright's disease, etc. 
The connection of endometritis, particularly of the hypertrophic 
variety, with fibroids is a matter of frequent comment. It is considered 
by Virchow, Olshausen, Winckel, Gottschalk and others as the cause. 
Hypertrophic endometritis means in most cases an abundance of in- 4 
fection, and constitutes a favorable condition for the invasion of 
germs. 
The beneficial action of curetting and electricity are more easily 
accounted for by supposing that they act by relieving the inflamma- 
tion and removing the germs. Ergot diminishes excessive vascularity 
in and about the tumor, and thus produces a condition less favorable 
to germ action, and the same may be said of oophorectomy and the 
ligating of the arteries supplying the uterus. 
I should also consider that cystic and even fatty degeneration were 
better accounted for by the action of microbes upon tissues of lowered 
vitality than by any other. 
Sudden unaccountable increase or diminution of growth is most 
satisfactorily explained by microbic action. A familiar example of 
sudden increase as well as gradual but complete cessation of activity 
in infected tissues is afforded by the action of old septic inflammatory 
diseases of the uterine appendages, during and between attacks. 
The tendency of uterine fibroids to stop growing at the menopause 
may be explained by the fact that the growths are old by that time, 
and the micrdbes have lost much of their vitality whether through the 
accumulation of their own excreta or otherwise and require increased 
rather than diminished vascularity for the maintenance of their 
vitality the same as do the pus germs. I have seen more tumors stop 
growing before the menopause than at that time. 
A relationship between fibroids of the uterus and gonorrhea has 
been asserted by some observers. Prochnowick has seen decided im- 
provement by alterative treatment in four cases occurring in connec- 
tion with syphilis. The alterative treatment of fibroid that was 
formerly popular can only be of benefit by destroying the germs 
which cause the fibroid. 
If it be true that fibroids are caused by microbes, then curettage of 
the uterus, intrauterine injections of germicides, such as the tincture 
of iodine, and perhaps the internal administrations of alteratives as in 
the treatment of syphilis should be of value in the treatment of small 
tumors. It is hardly to be expected that large tumors will be cured 
in this way more than the final lesions of syphilis can always be cured 
by the use of mercury and iodine.