Beigel' mentions a similar case. In all of these instances it is presume ble that labor pains had occurred either at or before the usual time, but being unable to overcome the resistance offered by the hard and infil trated cervix, had subsided.
Cohnstein relates that seven patients died from spontaneous or artifi cially induced abortion, five after, and two before delivery was accom plished, and in premature labor one died before and ten after delivery.
As regards the influence of pregnancy upon the course of the cancer ous affection, several instances have been reported where the disease made no progress at all during pregnancy, remaining in stain quo. (Spiegel berg.') Cohnstein, indeed, found in cases in which carcinoma of the uterus had existed for rather a long time before conception occurred, that the latter seemed to react comparatively favorably upon the local affec tion; thus, in thirteen cases of this kind, the disease was plainly acceler ated in three, made no noteworthy progress in six, and came to a corn plete halt in four instances. I will, however, venture to remind those who are inclined to draw the same deduction from these small figures, that it is controverted by a large number of observations showing that the symptoms of the disease first manifested themselves after conception, and that from that time on they speedily grew worse, under a rapid ex tension of the degeneration.
Typical instances of this hav3 been recorded by Depaul,' Pfann kuch,' Galabin,' Benicke and numerous other writers, and from my own limited experience also I am forced to maintain that, not only do the symptoms of cancerous disease quite often first develop during preg nancy, but they quickly become intensified, corresponding to an astonish ingly rapid growth of the neoplasm.
It was formerly thought that the artificial induction of abortion or premature labor was the proper treatment in these cases, and Lee was perhaps the strongest advocate of this plan, but of late the practice has been almost universally abandoned. The reasons therefore will be most appropriately discussed when we reach the consideration of the phenomena of labor in carcinoma of the uterus.
Starting out with the assumption that in cases of pregnancy complicated with cancer of the cervix, the chief task of the physician consists be yond a doubt in preserving the existence of the fcetus, one is tempted to denounce local treatment in these cases. Now while it is certainly true that energetic local treatment, such as amputation of the vaginal portions the removal of the diseased masses, or the application of strong caustic, may bring on abortion or premature labor, yet experience has gradually taught us that these accidents do not necessarily follow those procedures, but that, on the contrary, the latter may favorably modify the course of the disease and lighten the burthen of the patient's existence, and may even influence the conduct of delivery, contributing thereby directly to the preservation of the life of the child.
There can be no question that abortion has occurred after amputa tion of a diseased portio vaginalis. Instances of this have been reported by Cohustein, Benicke ' and many others. I have myself seen several.
On the other hand a large number of cases of this kind, some of older date, but most of them of recent occurrence, have been reported, in which the operation or a similar procedure did not interrupt pregnancy, delivery occurring at the normal time, and terminating more or less favorably. Instances of this have been communicated by Schatz, ' Schroder and Benicke.' Rutledge states that in eight operations of this description, gravidity was interrupted but three times. Galabin ' amputated a diseased cervix in the first month of pregnancy with the galvano.eaustic wire, abortion not occurring, and delivery being accomplished at full term. Godson Savory' removed an epithelioma of the external os with the in the seventh month of pregnancy, and a living child was born at the end of the tenth month. Although a recurrence took place, the patient shortly afterwards conceived again, and miscarried in the seventh month, the child being born alive, but dying immediately afterwards, and the mother dying thirteen days later.