The patient, a negress, had her first child in 1835 ; her second in 1838, and two months afterward the tumor pro- truded from the vagina. In 1845 a miscarriage at the fifth month. In 1846 a child was born at the full term, though the tumor was external during the entire term of pregnan- cy and parturition. In 1848 a miscarriage at five months ; and the next year two in the third month.
In 1860 she came under Dr. M.'s care, with severe and increasing dysmenorrhoea ; the tumor being about three- fourths as large as at the time of operation. After trying various expedients, a linen bag was found to be the most serviceable, and this she ever afterward wore ; any attempt to return the tumor within the vagina causing great dis- tress. During about a third part of each year she was obliged to give up work, keep her bed, and use opiates, etc. Dr. M. intended to remove the protruding mass when menstruation should cease, but it was found impossible to delay the operation, and it was therefore done on the 29th of May, 1861. The protrusion then was from 4 to 5 in. in. ; a catheter passing in 8J in. Around the os were five large ulcers. The ecraseur and the knife were both used, and the mass was removed about 2f in. from its extremity. The hemorrhage was not great ; and after the operation the cut surface, within the vagina, resembled a hollow cone. The patient did quite well, and was soon up and about. Three months after the operation, however, she had a very severe attack, owing to a closure of the uterine canal, and a retention of the catamenia. An opening was made ; and twice afterward it was necessary to repeat the operation. At the date of Dr. M.'s report of the case (Oct. 26th, 1862) the length of the uterine cavity was 4 in., and the patient was quite comfortable. Menstruation regular ; and ceased about the year 1867, at the age of 60 years.
The large size of the os uteri shows how impregnation must have been effected. Med. Jour. Vol. LXVII. p. 349. 1862. Dr. Henry A. Martin.
2735. Cast of the above protruding mass, taken just before the operation. (See last case.) 1862.
Dr. H. A. Martin.
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