The symptoms of pressure are very marked in the case of intra-ligamentous tumors. The capacity of the bladder may be so diminished that there may be continuous incontinence of urine; or the bladder and the urethra may be so distorted, from traction and pressure, that urine is voided with great difficulty, and it is sometimes impossible to introduce the catheter. I have seen a woman with a fibroid the size of the adult head who could urinate only when upon her hands and knees. Pressure upon the pelvic nerves may, as has already been mentioned, produce great pain, and in some cases paralysis. Women are sometimes affected with sudden complete paralysis of one or both legs from the pressure of a fibroid. I have performed hysterectomy upon a woman who had on several occasions fallen helpless in the street from paralysis of the left leg caused by the pressure of a small intra-ligamentous fibroid tumor. All the pressure-symptoms are exaggerated at the menstrual period, on account of the swelling of the tumor that occurs at this time. Pressure upon the rectum is often very marked, and may cause constipation and hemorrhoids. Pressure upon the ureters causes dilatation, hydronephrosis, and uremia. This is a not infrequent cause of death, both in the untreated case and after operation for the relief of fibroids. The effect of fibroid tumors of large size upon the heart and blood-vessels has been remarked by several writers. Fatty degeneration and brown atrophy have been found associated with uterine fibroids in a number of instances. This is undoubtedly the explanation of some cases of death after operation. Martin has called attention to the disposition to thrombosis and embolism which seems to be especially marked in the telangiectatic form of tumor. This also explains some of the cases of sudden death that occur after operation. Operators have observed cases of sudden death, probably from embolism, occurring sometimes several weeks after hysterectomy for fibroid tumor. The =diagnosis= of uterine fibroids is made from a study of the symptoms already described and from the physical examination. If the tumor is large enough to be palpated through the abdominal wall, the hard consistency and the irregular bossed outline of the multinodular form of fibroid may be detected. By bimanual examination we determine the general enlargement, and perhaps the irregular outline, of the uterus. Sometimes, when the fibroid is small and interstitial, a slight elevation, or perhaps merely a local induration, may be felt. By grasping the cervix with a tenaculum and drawing it down while the palpating finger is in the rectum the whole of the posterior face of the uterus may be explored and small fibroid nodules discovered.