Winckel ' removed the anterior lip in a case of epitheliomatons papil loma. Three years later a similar growth appeared on the posterior lip.
Schroder' amputated the cervix in thirteen cases, using the knife fol lowed by the application of the actual cautery.
One of these cases succumbed to trismus. Of the twelve patients who recovered, five remained well for two years, i.e., 42 per cent., and four had a return of the growth within that period of time, i.e., 32 per cent.
Many similar operations have been done by others, but the reported cases are few in number.
In view of what has been previously said on this topic it is not surpris ing that such a relatively small number of recoveries is noted after ampu tation of the cervix for cancer. We have seen that, by the time the first symptoms have been noticed the affection is almost invariably so far advanced as to make it seem impossible to operate through sound tissues; either the vault of the vagina is diseased, or the infiltration has already invaded the cellular tissue of the pelvis, or, finally, cancerous ulceration in the cervical canal has already progressed beyond the internal os, the surface of cervix as seen in the vagina still remaining intact. Finally there is not a small number of cases in which nothing of the preceding description is present, and in which the diseased parts seem to be sur rounded on all sides by healthy tissue, and yet either microscopical exam ination or the further course of the disease after operation very won reveals that the apparently healthy tissue was already permeated with cancer elements. Let me repeat once more that our chances of securing more favorable and more reliable results in the treatment of cancer of the uterus than have hitherto been obtained, depend entirely upon whether we shall succeed in detecting with certainty the disease in its incipiency, or, at any rate, at a much earlier stage than has been the case up to the present time.
It is nevertheless the duty of the physician in every case of cancer of the lower segment of the uterus, in which there seems to be a possibility of amputating beyond the limits of the disease, to do so without delay.
The operation is usually not a dangerous one and the hemorrhage can be readily controlled ; in short the disadvantages involved are insignificant in comparison with the uncertain chances of a cure, by any other methods, of an affection of such gravity as cancer of the uterus. Besides, in those cases in which perfect recovery has not followed the extirpation, the growth having recurred, the course of the disease is certainly changed for the better by the operation, as I shall show later on.
The operation is done as follows: Under antiseptic precautions the uterus is to be grasped, and dragged downwards, when the diseased por tions are removed with the knife or scissors.
When the disease extends up to the internal os, it is advisable to per form a funnel-shaped excision, as particularly recommended by Hegar.' The hemorrhage is often very profuse, and is the more grave according to the degree of anaemia previously existing. It is, therefore, advisable to complete the operation as quickly as possible, and then to employ at once the actual cautery, or other styptics, such as chromic acid, chloride of zinc, bromine, etc. The hemorrhage can be securely arrested by drawing together and uniting the cut edges of the mucous membrane over the stump, but the procedure not only takes up a good deal of time, during which of course more blood is lost, but above all exposes the patient to greater chances of recurrence. If any cancerous foci have been left behind in the apparently healthy tissues they will not only continue to extend, but may also inoculate the healthy mucous membrane with which they are brought in contact. But if the hemorrhage have been arrested by the energetic application of caustics, long-continued suppuration sets in, in the course of which any remnant of the neoplasm may possibly be destroyed. Moreover, small recurrent growths can be much more easily detected on the ulcerating surface, and then admit of easy removal.