Caesarean section offers better prospects, and it is our only resource whenever the pelvic cellular tissue is affected, and the degeneration has extended beyond the internal os. If performed at the proper time, it ensures the preservation of the child, and does not even, as experience proves, always entail the death of the mother, although the latter, of course, succumbs eventually to the disease. For these reasons Caesarean section should be resorted to in those cases also in which delivery is possible in other ways, but which at the same time, however, offer only slight pros pects of saving the life of the child.
The following comprises all the cases of Caesarean section for carcinoma of the uterus, that I have been able to collect. Bartholinus ' performed the operation for rupture of the uterus, the foetus being dead at the time, and the mother expiring on the following day.
Oldham' saved both mother and child. In Greenhalgh's' case the patient died eighteen months later: nothing is stated as to the fate of the child. Galabin ' performed the operation upon a woman who was in labor in the eighth month of pregnancy, and who was already in a des perate condition. The festal heart sounds were no longer audible,—in fact the child was dead, and the mother died shortly after the operation.
Zweifel 5 was more fortunate: the mother died five days after the opera tion, hut the child was saved. saved a child by doing Caesarean section, the mother dying on the third day. The cases of Bischoff and Spencer Wells have already been mentioned. Herman records twelve cases of this operation, with death of the mother in eight. Two of the children were extracted dead. Newman's' case does not belong in this category, as the patient was not affected with cancer of the uterus, as already pointed out.
If the tumor appears susceptible of removal before or during labor, as much of it should be extirpated as is feasible, in order to allow of the child being delivered alive if possible. Cohnstein reports six cases of this kind, four of the children being extracted in a living condition, but two of them dying shortly afterwards; in the two remaining cases, one child was decomposed, while nothing is mentioned regarding the other. Of the mothers, four lived through childbed, and two died during that (period.
The question will always arise, after successful delivery, whether a radical operation should be done in the interest of the mother, either at once, or after tie lying-in period has terminated.