Results of operation: In 103 personal cases in which microscopical examination was very carefully carried out the results were as follow: Well without relapse on January 1, 1900: 1. Squamous-celled carcinoma of the cervix: 61 cases, 13, in all, living, or 21 per cent. 2. Adenocar einoma of the cervix: 12 cases, 2, in all, living, or 16 per cent. 3. Adenoearcinoma of the body: 30 cases, 19, in all, living, or 63 per cent. The periods elapsed varied from six years to eleven months.
The old plan of skinning or shelling out the bare uterus is, of all methods, the most liable to be followed by a recur rence, and must be abandoned. It is of supreme importance to catheterize the ureters to mark them out and so use them as guide.
Operation of quadrisection of the uterus personally used in 11 cases for the more complete removal of the disease. Thorough curettage with a serrated spoon curette; division of the vagina on all sides an inch below the diseased area; separation of the vagina from the bladder up to the vesico-uterinc peri toneal fold, which is widely opened; a wide opening of the posterior cal-de-sac. The uterus, now hinged by its broad ligaments, is brought out through the anterior opening, as in Martin's opera tion on the adnexa. This is easily done by pushing back the cervix and climbing up the anterior face of the uterus, step by step, until the fundus is reached, with stout-toothed forceps. The peritoneum posteriorly is well protected by an abundant loose gauze pack. The next step is the sagittal bisection of the uterus from the fundus through the cer vix and the attached vagina with scalpel and scissors. As the uterus is cut in halves in this way each median surface is grasped and held down by strong toothed forceps. One-half, the most af fected, is now allowed to retract into the vagina, while half the body of the uterus of the other side is removed by bisecting it horizontally at the cervical junction, cutting from the median cut surface out into the broad ligament and exposing in this way the uterine artery, which is clamped. The remainder of the operation is on the lines usually laid down, but the author considers that if the ureter is in volved it should also be excised and the cut end turned into the bladder. The 11 cases thus treated have recovered. H. A. Kelly (Jour. Amer. Med. Assoc., May 19, 1900).
Vaginal hysterectomy is the safest procedure; in the case of a movable uterus and a circumscribed cancer the mortality is almost nil. The main pur pose is to anticipate the infiltration of neighboring tissues, which is always see ondary to the growth and which, if the operation is a timely one, can always be achieved. 11. G. Richelot (Wiener med.
111:itter, Sept. 20, 1000).
Palliative Treatment.—When a radical operation is inadmissible, the diseased area may be thoroughly curetted and cau terized with the strong solution of chlo ride of iron or a 50-per-cent. solution of zinc chloride, applied on a pledget of cotton placed against the wound and held in place for twelve hours by a gauze tampon.
Haemorrhage and odor from the ulcer ated parts can, for a time, be controlled by strong astringent and antiseptic injec tions. A 1 to 500 solution of chloride of zinc acts both ways, as does perman ganate of potassium. The strength is limited by the toleration of the vagina and vulva.
Calcium carbide is valuable for its an msthetizing influence, for its remedial effect upon the offensive discharge, and especially for its efficacy in controlling hmmorrhage. It may be blown over the surface of the cancer, or pieces of it may be placed in the crater-like portions and covered with a tampon. The healthy portion of the vagina should be protected from its effects by covering it with a tampon saturated with glycerin. W. Grusdew (11llinchener med. Wocb., June 12, 1900).
Anodynes should be given freely for pain, commencing with the milder ones and ending with opiates. They do less harm than does the suffering. The gen eral treatment should be a supporting one.
Corpus Uteri.—Three varieties of car cinoma of the endometrium have been described: adenocarcinoma, malignant adenoma, and squamous-cell carcinoma.
The adenocarcinoma is similar to adenocarcinoma of the cervix, and af fects the mucous membrane quite ex tensively before deeply infiltrating the uterine walls.
Malignant adenoma commences as an enlargement and folding of the gland tubules, while still lined with a single layer of epithelium. The folds of con tiguous glands unite and form anasto mosing tubules filled with epithelial cells, which begin to proliferate atyp ically, and gradually distend and break through the tubules, to form the ordi nary nest-structure of cancer.
Squamous-cell carcinoma may occur as a primary growth in those cases in which the epithelium of the endome trium has become squamous in character, or it occurs secondary to squamous epi thelioma of the cervix.
The uterine wall is slowly invaded, and the glands of the broad ligament and along the internal iliac vessels become infected. When the changes have passed through the uterine walls, peritoneal ad hesions and infiltrations of the broad ligament connective tissue are formed.