Stated Meeting, December 3, 1897, the President, F. C. Wilson, M. D., in the chair.
[1]. Stenographically reported for this journal by C. C. Mapes, Louisville, Ky.
Uterine Fibroma. Dr. L. S. McMurtry: I present this specimen of uterine fibroma on account of two very interesting features of this class of tumors which it illustrates. The first relates to the morphology of these growths. The tumor is a very large one, and occupied the entire pelvis and the abdomen to the superior limits of the umbilical and lumbar regions. It is a multi-nodular tumor, and its disposition in relation to the fundus of the uterus is unlike any specimen that I have ever encountered. It will be observed that the neoplasm springs from the lower segments of the uterus, and the fundus is not involved in the growth at all.
The second feature of interest, and this is especially interesting from a surgical point of view, is the relation of the bladder to the tumor. It is very common for the bladder to be carried upward with the growth, thus rendering it very liable to injury in operation. This feature is exceptionally conspicuous in this tumor on account of the nodular condition where the bladder was attached, forming a sulcus. In releasing the bladder, after splitting the capsule, the uneven surface of the tumor caused me to inflict an injury upon the coats of that viscus. After dissecting off the bladder I found that I had made an opening in it at this point. It was immediately closed with a double row of catgut sutures. The operation was done six days ago, and the convalescence of the patient has been most satisfactory indeed. The bladder injury has not complicated the patient’s convalescence at all, its function being carried on just the same as if it had not been involved. The convalescence has been afebrile from the beginning, and recovery is assured.
The method I observed in treating the pedicle was to amputate the cervix very low down, leaving a very small rim of the cervix, and suturing the peritoneum over it all the way across the pelvis, making the pedicle extraperitoneal. The conformation of the growth and its relation to the cervix uteri made this method of dealing with the pedicle especially applicable in this particular instance. The patient is thirty-four years of age, and the operation was urgent on account of persistent hemorrhage and marked pressure symptoms.
Discussion. Dr. J. A. Larrabee: I would like to ask the reporter for what length of time this tumor had been developing?
Dr. L. S. McMurtry: The woman was thirty-four years of age, and according to the history obtained the tumor was first noticed three years ago. The patient has made a beautiful convalescence. I present the specimen on account of its morphology, and because of the difficulties that might be encountered in performing an operation in such cases by the bladder being impacted in the sulcus.
Tubercular Testis. Dr. W. O. Roberts: This patient is twenty-four years of age; his father and mother are living; father sixty-four, mother fifty-four; his grandfather on his father’s side died at the age of sixty-four of what was supposed to be consumption; his father’s twin brother died at the age of twenty, after an illness of eight months, of consumption; his mother’s family history is good.
This young man had gonorrhea seven years ago, with orchitis of both sides as a complication, the left testicle swelling first, then the right; the swelling lasted in each for about two weeks. Had gonorrhea again in November, 1896, and says again in December of the same year. At this time he noticed that his left testicle was getting hard in places and was swollen, but there was never any pain. The inflammatory process has never been very acute. However, he noticed after taking a horseback or bicycle ride the testicle would be somewhat tender. Had another attack of gonorrhea during the month of September of the present year, which he says lasted only two weeks, and during this attack the testicle was also affected.
He now has a swelling of the left testicle, and a hardness about it and in the epididymis, which I would like for the members to examine, expressing an opinion as to the nature of the trouble.