IV. Swelling and Elongation of the Anterior Lip of the Cervix.
In this condition, which is most common in primiparEe, the anterior lip is firmly wedged between the symphysis and the head, and if labor is not speedily terminated, especially if the pelvis is somewhat contracted, the lip forms a tumefaction below the head, that sometimes offers a se rious obstacle to the expulsion of the faqus. The more the head tends to descend, the more the swelling increases, and the greater the obstacle. In some eases the lip can be pushed upwards, and retained during the pains until the head slips past it, but it is usually necessary to apply the forceps. As a result of pressure thrombi may be formed in the lip, or the latter may tear and give rise to more or less serious hemorrhage.
Cazeaux has also mentioned, as causes of dystocia, abscess of the cervix, fungoid tumors, vegetations, and simple hypertrophy.
V. Cancer of the Cervix.
Theoretically, cancer of the uterus does not prevent fecundation, except as it depresses the general health of the woman; no obstacle is offered to the passage of the spermatozoa. Gueniot believes that pregnancy can only take place during the initial stage of cancer, since in the ulcerative stage not only are conjugal relations necessarily prevented, but numerous obstacles are presented to the union of the semen and the ovum. On the contrary, out of 127 cases observed by Cohnstein, in 21 the cancer had existed from several months to a year before pregnancy occurred; he even goes further and affirms that it favors the development of preg nancy in women between certain ages. We do not accept this view. In 21 cases Cohnstein was able to demonstrate that cancer existed for several months before pregnancy occurred, and in several instances it was not prevented by the presence of ulceration. Non-fungating epithelioma is the usual form, occurring 117 times in his 127 cases, the cauliflower appear ance being noted only 10 times.
The Mutual Influence of Pregnancy and Cancer.—The course of the pregnancy seems to depend essentially on the location, rather than on the extent, of the degeneration. It is less likely to be Interrupted if the dis ease is limited to the lips of the cervix, while as the cancer extends to the os internum, the chances of abortion increase. Lewes noted 40 per cent. of abortions in 120 cases, while Cohnstein saw 68 deliveries at term among 100 patients. Sometimes the pregnancy is prolonged past the
usual time, or the foetus dies and is retained in the uterus. In 5 per cent. of the cases observed by Cohnstein the pregnancy pursued its usual course with very slight disturbances, but in all the rest there were various trou bles, emaciation, slow fever, and oedema often appearing during the latter months, as well as neuralgic pains and psychical disturbances.
The Influence of Pregnancy on Cancer. —Cohnstein says if cancer begins during pregnancy, it always develops more or less rapidly; if, on the con trary, it existed for some time before pregnancy. the influence of this con dition seems to be relatively favorable. Gusserow, however, mentions a number of cases, proving that the neoplasm develops with extreme rapidity. The favorable influence of pregnancy, according to Cohnstein, is shown by the marked diminution of the hemorrhages, at least during the early months, the lessening of pain, and the improvement in the general con dition. If breaking down of the tissues takes place at this time, the change is rather fatty degeneration than necrosis. Contrary to its course in the non-pregnant woman, the cancer very rarely extends to the body of the uterus, the bladder, or the vagina.
only difficulty, according to Gusserow, is at the outset of the disease; still many errors have been made. The hemorrhage may be mistaken for that due to placenta prcevia.
When the cancer is confined to one lip of the cervix, spontaneous de livery is the rule, the prognosis being more favorable for both mother and child when the posterior lip alone is affected. When both lips are dis eased, or nearly the whole of the portio vaginalis, spontaneous delivery is more rare; the cervix may tear in several places, and rupture of the uterus may result from extension of the lacerations. Hemorrhage, sup puration and death from peritonitis, or septicaemia, are common results. The delivery is more apt to be spontaneous when it is premature. When the cancer has extended to the body of the uterus and to the surrounding tissues, spontaneous delivery is impossible. If the contractions are violent the uterus may rupture, if they are feeble the foetus may be retained, and the patient may succumb to hemorrhage or septicaemia.