24 December, 2005

100 years ago: Session 1905-06; Meeting VI - Uterine myoma

The Society met in the rooms of the Medical Club, 22 Carlton Place on Thursday 14th December 1905 at 9pm.

Dr T. K. Monro (Vice-President) in the chair: in all 18 Gentlemen were present.

The minutes of last meeting were read and approved.

New Member
The name of Dr Robert Taylor, Beechwood, Dalkeith Avenue Dumbreck, was proposed for membership by Dr James Hamilton & seconded by Dr J. P. Duncan.

Dr J. K. Kelly's paper
Dr J. K. Kelly then read a most interesting paper on "Uterine Myoma" & this was followed by a lantern demonstration of various pathological specimens in connection with the subject. A precis of Dr Kelly's Paper follows this minute.

A discussion followed in which Drs T. K. Monro, Stark, James Weir, Miller, Hamilton & Wauchope took part, asking for further information on several points and Dr Hamilton stated that he could not see why oophorectomy for the treatment of myomata should be condemned. Dr Kelly replied that he was of the opinion that it was better to remove the disease than to remove the ovaries alone then wait for a somewhat doubtful cure.

Dr Kelly was accorded a very hearty vote of thanks for his paper.
This was all the business.

Precis of Dr J. K. Kelly's paper
Dr Kelly referred first to the question of the division of tumours into Benign & Malignant & went on to state that some "benign" tumours can destroy life just as surely as Malignant ones, and Uterine myomata were one of this serious nature in many cases. The ordinary Symptomatology of the disease was then given, & it was insisted strongly that Uterine Myomata sometimes produced no symptoms except that of haemorrhage: & that even when a large tumour was present the patient had not noticed it. Pain in the case of this disease is a very variable symptom. The case of a woman 5 months pregnant was then cited in which a myoma as large as a small cocoa-nut was removed from the Uterine wall: cessaton of pain followed & the gestation & delivery were normal.

The dangers associated with Uterine Myomata were stated as follows:
1. Haemorrhage, producing syncope, anaemia & its consequences
2. Certain Cardiac conditions are induced in bad cases.
3. Renal disease from 1. Retention of urine followed by cystitis & 2. obstruction to Ureters.
4. Adhesions especially when Salpingitis is also present.
5. In Pregnancy 1. may necessitate Craniotomy or Caesarian Section 2. May induce rupture of Uterus 3. May induce post partum haemorrhage 4. May contribute to sepsis.

If Operation be called for from the interference from pressure effects on abdominal, thoracic, or pelvic structures Dr Kelly is of opinion that hysterectomy is as a rule safer than the induction of labour. With regard to the coincidence of pregnancy & myomata the remarkable crushing & moulding of tumour or foetus that is sometimes met with was referred to, & in such cases delivery sometimes takes place naturally in spite of the obstruction.

The comparative safety of Caesarian Section & Hysterectomy nowadays, has, however, altered the position of the Gynaecologist with regard to the treatment of such cases; and indeed now-a-days there are few myomata that cannot be treated with success if treatment be demanded. Dr Kelly then stated three typical cases of women with Uterine Myomata at various stages of development & stated the case for & against operation in each case, & then proceeded to state the principles that guided him in his own practice, viz: He advocates removal of the Myomata if
1. It causes Haemorrhage 2. if it be large even if symptoms are slight 3. if it be degenerated in any way or if disease of the adnexa are present, 4. If it is injuring the health of the patient in any way even if the menopause is not far off.

A proviso is made that the earlier the tumour can be removed the safer is the operation & the better is the condition of the patient afterwards.

The operative measures that may be adopted were dealt with.
1. Myomectomy is the ideal operation especially if it may be done per vaginam.
2. Hysterectomy is necessary when myomectomy is not practical.
3. Oophorectomy is to be reserved for cases where the number & size of the adhesions present contraindicate either of the first two methods.
If operation is refused palliative measures must be adopted eg haemorrhage & pressure symptoms must be treated.
Ralph Stockman

Archive: Royal College of Physicians and Surgeons of Glasgow
Reference: GB 250 RCPSG 73/1/11 Minute Book No. 6