FIBROCYSTIC TUMOR 
OF THE 
UTERUS; 
UNUSUAL TREATMENT; 
CURE 
BY 
E. J. BEALL, M.D., 
FORT WORTH, TEXAS. 
FROM THE 
Medical and Siircical Reporter, 
January 5, 1S89. From the Medical and Surgical Reporter, 
January 5, 1889. 
FIBRO-CYSTIC TUMOR OF THE 
UTERUS; UNUSUAL TREAT- 
MENT; CURE.1 
BY E. J. BEALL, M.D., 
FORT WORTH, TEXAS. 
At the April, 1887, meeting of the Texas 
State Medical Association, i presented a 
paper upon uterine fibro-myomata compli- 
cating delivery. In that paper I strongly 
urged enucleation in lieu of other measures, 
and gave the history of a case in which I 
enucleated a fibroid weighing three pounds, 
that completely blocked the pelvis, having 
incarcerated behind it a male child weigh- 
ing fully ten pounds. The case was success- 
ful in every particular—mother and child 
both well at the present time. 
Twelve weeks ago I was called in consul- 
tation with one of the most intelligent 
physicians of this section to see Mrs S., 
aged 37 years; married one year; had 
never conceived. Her mother, a sister, 
and a maternal aunt died of “malignant 
1 Read at the meeting of the Southern Surgical 
and Gynecological Association, Birmingham, Ala., 
Dec. 7, 1888. 2 
disease ” within the abdominal cavity. 
Upon her cousin I had performed lapa- 
rotomy for intra-peritoneal abscess that 
followed childbirth. She had suffered from 
metrorrhagia for several years. Some time 
prior to marriage her abdomen had begun 
to enlarge, and at the time of my visit the 
fundus uteri reached a point somewhat above 
the umbilicus. She was anaemic from 
profuse and protracted hemorrhage, and 
had more or less abdominal pain. 
A few days before I visited the case, an 
electrical trocar had been introduced into 
a fibro-cystic tumor that extended into and 
very much distended the vagina. As a 
result an ulcerative gangrenous process had 
arisen, attended with slight flow and odor. 
To the above procedure, though strict anti- 
sepsis had been observed, I attributed the 
elevated temperature and increased frequency 
of pulse I found present at my visit. Yet, 
some days prior to the elevation of temper- 
ature there had existed fever, which readily 
responded to quinine, and the patient lived 
in a malarious locality. The abdomen pre- 
sented a symmetrical contour ; the enlarged 
and elevated uterus inclined only slightly 
toward the right side. 
An examination disclosed a hard, slightly 
elastic tumor, filling a very much dilated 
and elongated vagina, extending to and 
slightly bulging the labia and just within a 
firmly closed and rigid ostium. The finger 
could be swept around the mass ; the edges 3 
of the cervix uteri could be made out, but 
it was widely dilated and occupied by the 
growth. 
As the tumor gradually developed, the 
uterus was both dilated and elevated, and 
the vagina dilated and lengthened. A sound 
could be introduced into the uterus on one 
side to a considerable depth ; but the sound 
movement was quite limited, and indicated 
a very lengthened and narrow cavity unoc- 
cupied by the attachments of the growth. 
This led me to infer that I had a tumor to 
deal with, the attachments of which, to the 
internal surface of the uterus, were quite 
extensive. Palpation and percussion also 
indicated a large, firm, very slightly elastic 
tumor, doubtless fibro - cystic, filling the 
vagina and elevating and enlarging the 
uterus to the dimensions already indicated. 
These facts of the case well in mind, what 
course should be pursued which would prove 
safest for a patient whose life is in the 
balance, to be turned for weal or woe by 
the act needed to be carried out by the 
physician for relief? 
It may be well to review some of the 
measures hitherto suggested for the treat- 
ment of uterine fibroids that the hearer may 
be prepared for comparison when I present 
the plan adopted, and which terminated so 
happily in this case. 
Palliative treatment, while applicable to 
minor and less severe cases, promised little 
in the one under consideration. Correcting 4 
displacement of the uterus was not indicated. 
Arresting hemorrhage by haemostatics, tam- 
pon, rest, etc., could only put off the inevi- 
table day for action of a decisive character. 
The medical treatment by alterative agents, 
whose office, it is thought, is to induce fatty 
degeneration; the use of ergot, which in 
some cases has produced good results, when 
tumors were decidedly interstitial or per- 
haps subserous, more particularly the former, 
when muscular contractility (the result of 
ergotism) would induce compression by 
muscular fibre—this method was not, to my 
mind applicable; at least it would be fraught 
with danger, by reason of the delay needed 
before radical results could be expected. 
From reading and experience I could not 
expect that electrolysis, so strongly urged 
by Apostoli, could effect changes in the 
growth with sufficient rapidity and thorough- 
ness, nor sufficiently exempt from danger, 
to commend it to this case, which I thor- 
oughly believed, required prompt, imme- 
diate measures. 
To the art of surgery and its ready appli- 
cation I now turned for a remedy. 
xst. Was abdominal section advisable? 
I believe there are those who would have 
resorted to the measure. That road has 
many a warning post, to one of limited 
experience, at every crook and fork ; like a 
boatman slowly and gently descending some 
placid winding stream ; suddenly and unex- 
pectedly he encounters unforeseen rocks or 5 
falls, while just before, everything was 
merrily well. The abdomen opened, an 
enlarged uterus and fibro-cystic contents 
turned over the pubes ; the broad ligaments 
ligated off; a large dilated and filled cervix 
to be cobble-stitched around, secured and 
tied, disengaging a mass from its circular 
grasp; that cervix as large as the calf of one’s 
leg—all this is pretty to read about in books 
and journals; it is exciting, and does well 
when one has the aegis of a metropolitan 
hospital, with its reports fingered only by 
the actor, and has leisure for study of results 
at a dead-house, the janitor his vigil; but 
not upon the living woman, at a farm-house ; 
the laity his audience; the husband, the 
mother, the sister hard by the operating- 
table, urging the surgeon to seek a safer, less 
formidable plan of treatment, if his con- 
science will allow and his judgment devise 
such. 
2d. As the tumor could be drawn down- 
ward, should I attempt to cut it away with 
scissors? This is sometimes practicable, 
and has been done often. 
3d. After traction with volsellum, should 
I endeavor to encircle the mass with the 
ecraseur and sever it as near as practicable 
to its fibrous attachments? 
4th. Should I endeavor to remove the 
tumor with Dr. Thomas’s serrated spoon, as 
has been done rapidly, safely, and surely, 
so often, by that brilliant man and his 
followers? 6 
5th. Should I enucleate, as Dhad done in 
former cases—a notable of which I 
have heretofore brought before the pro- 
fession ? 
The high opinion I entertain of this last 
measure induced me to preface this paper 
with a reference to a case in which I put 
that plan into successful execution. It is, 
in many instances, easily done, and attended 
with little danger. I urge the method when 
practicable, which it is in very many inter- 
stitial, submucous, and mixed tumors. My 
first effort in this case was to institute the 
enucleation process. At several places I 
essayed the plan, but signally failed: the 
capsule could not be peeled from the 
growth. 
To have incised the capsule and endeav- 
ored to force a gradual extrusion of the intra- 
capsular fibrcr-cystic growth by ergot, would 
have involved much time, besides-subjecting 
the patient to further'systemic infection. 
To the first proposition : Disinclination, 
by reason of inexperience, and fear of 
shock, etc., prevented its adoption. 
To the second and third : I could not 
consent for various reasons: pertinently, 
portions of the mass would have been left,, 
presenting a surface through which poisons 
could readily reach the uterine sinuses and- 
lymphatics, and thus originate a process of 
systemic infection fraught with great danger. 
To the fourth: The objections urged 
against the second and third are of equal 7 
import here. Additionally, in the hands of 
one whose experience with the Thomas ser- 
rated spoon is limited, uterine tissue might 
be injured—even the peritoneal cavity might 
be invaded. 
Having referred to the more prominent 
measures relied upon for the removal of 
growths connected with the uterus, it must 
not be inferred that cases do not occur to 
which these'various plans are applicable. 
But to tumors with a broad and extensive 
intra-uterineattachment, the sawing process, 
the ecrasement, or the incision must be fol- 
lowed by a digging-out of tumor remains: 
a harsh usage of the uterus, accompanied 
by the danger that belongs to shock, hem- 
orrhage, etc. Even after much digging, 
tumor elements will be left which may 
develop again at a future time, entailing 
perhaps, if nothing more, a hemorrhagic 
condition of a new endometrium, great risk 
of infection, etc. • t 
I do not claim that the manner in which 
I treated the case, the technique of which I 
am about to relate, is without precedent. 
But the plan has no advocates; and if such 
cases are known to others of the profession 
they may have had similar management 
accidentally, not intentionally. This, how- 
ever, is not so in my own case. What I did 
was not an accident growing out of an effort 
to do otherwise; but was the outcome of 
premeditation. 
If I am to be criticized for the method 8 
pursued it must not be ascribed to rashness, 
but to sober thought and conscientious con- 
clusions. At all events, the patient lives; 
the interested ones are of a good family and 
happy; and I have the knowledge that they 
have applauded and appreciated the services 
rendered in this most interesting case. 
The patient was placed in the dorsal 
position, the hips elevated, and chloroform 
administered. Sawyer’s forceps were intro- 
duced as high as the cervix and caused to 
embrace the tumor; gentle traction with 
slight to and fro movement was exercised. 
Very soon the labia and perineum were 
being bulged outward by the tumor upon 
which traction was being made. The left 
hand was held upon the enlarged abdomen, 
and the uterus could be felt descending 
pari passu with the advance of the tumor 
within the grasp of the forceps. At this 
stage of the operation I intended doing an 
epi$i®otomy to avoid an irregular laceration 
of the perineum, which was becoming pro- 
nouncedly distended. I did not do so, 
however, but elevated the handle of the for- 
ceps and endeavored to keep apace with the 
perineal tension. By external palpation 
and intra-vaginal examination I watched 
the lowering of the uterus and condition of 
parts as delivery progressed. Just here, 
notwithstanding the traction was cautiously 
and gently done, I discovered that the 
thinned perineum was giving away. I had 
now withdrawn at least a pound of the 9 
seven-pound growth beyond the external 
genitalia, and at once instituted search for 
cysts, upon finding which I opened and 
relieved of viscid colloidal material, thus 
reducing the mass I was endeavoring to 
remove. I then enlarged the perineum; 
made further traction, and further reduction 
by disposing of other small cysts. Pursuing 
this plan I was soon enabled to introduce 
my hand (having removed the forceps) by the 
side of the tumor, grasp it and make more 
intelligent traction. A few minutes later I 
could insinuate my hand into the uterus, 
grasp the tumor more firmly, and determine 
that the attachments were very general. 
Instead of removing large portions of the 
tumor and allowing fragments to remain, 1 
determined gently to invert the uterus, which 
I did, and bring in view the attachments of 
the growth, in order more thoroughly to 
separate it from the uterine wall, and better 
stanch the bleeding with haemostatic for- 
ceps and hot sublimate water. The tumor 
now being entirely removed by aseptic 
fingers and scissors; a hypodermic of ergot 
having been given; the bleeding all stopped, 
I returned the uterus to its normal position 
with great ease. The perineum was neatly 
stitched with number three gut ligature, 
and patient put to bed, knees tied together. 
Doing what I did, I could observe strict 
antisepsis. I left nothing within the uterus, 
nor returned anything for septic mischief. 
Little or no shock supervened, and but little 10 
hemorrhage. The patient was soon com- 
fortable. No fever or other untoward cir- 
cumstance retarded a rapid restoration to 
health. 
The perineum was primarily united; men- 
struation is occurring normally; health is 
re-established ; and a happy husband has a 
happy housewife, in every way qualified for 
her duties, domestic and marital.