SYMPTOMS. — Watery and bloody dis charges, gradually becoming offensive and mixed with small particles of broken down tissue, are the first symptoms. Pain becomes prominent in the advanced stages. If discharges and disintegrating masses of tissue are retained, it is colicky in character, but in time those of chronic peritonitis assume prominence. Pains shooting into the iliac regions and down the limbs also become troublesome after extensive infiltration has taken place.
—The offensive and irreg ular bloody discharges beginning at or after the menopause, the character of the pains and the progressive nature of the symptoms arouse suspicion. Mi croscopical examination of the tissue brought out by a curette should always be made.
— The prognosis is better than that of carcinoma of the cervix; the surrounding tissues are not as rap idly infected. An early operation often effects a cure.
-The only indication is hysterectomy. Abdominal hysterectomy would seem to have the preference, since affected glands of the broad liga ment and at the pelvic brim can be seen and enucleated. If the surrounding glands are affected the disease may be expected to return even though the vis ible ones be removed; hence the only benefit of abdominal over vaginal hys terectomy is that the return may be somewhat slower. Therefore the for mer is only to be chosen when the con ditions are such that the risk would be but little greater: i.e., when the vaginal method presents some unusual difficul ties.
Vaginal hysterectomy is performed the same as for carcinoma of the cervix, ex cept that the incisions can be made close to the cervix, and that the Fallopian tubes and as much of the upper portions of the broad ligaments as possible should be taken.
Curettage is only palliative, and should be done with a sharp curette without pressure against the friable uterine walls. Carbolic acid, the solution of perchloride of iron, or a 50-per-cent. solution of zinc chloride should then be applied freely to the uterine cavity.
Case of a woman, 52 years of age, who had a uterine cancer involving the va gina, in whom operation was out of the question. A 3-per-cent. solution of methyl-blue in equal parts of alcohol and water was applied over the entire dis eased area. This was followed by a de crease in the luemorrhage, the tissues became less fragile, and the infiltrated area softer. At the end of two months the had almost ceased and the ulcerated surface had healed, except ing at the fornix. Four months after be ginning treatment, the patient's condi tion was fair and she had improved in weight. (See METHYL-BLUE, volume iv.) IL R. Coston (Then. Gaz., Apr. 15, 19001.
After-results in 40 eases of vaginal hysterectomy: 1. In a certain propor tion of cases patients suffering from cancer of the uterus may be relieved by operation for periods of many years; in some eases for so long a time—seven years and upward—that there seems some probability that the relief may be permanent. 2. The proportion of cases
in which this result can be expected must remain very small so long as pa tients generally only seek advice at a late stage of the disease. 3. Conse quently the great desideratum is early diagnosis. Improvement in this direc tion depends to some extent on a better appreciation on the part of women themselves of the early symptoms of the disease, and especially of the sig nificance of bleeding after the meno pause, or of bleeding occurring at an earlier time of life between the men strual periods. Early diagnosis, of course, also depends partly on the pro fession. Especially important is the general recognition of the gravity of the symptom just mentioned. It is equally important also to bear in mind that patients suffering from cancer of the uterus may, and generally do, for a relatively long period, look quite well. They may be well nourished, or not in frequently even excessively fat; and. as regards the aspect of the face, they may appear to be in perfect health. A. H. N. Lewers (Lancet, Jan. 5, 1901).
Deciduoma Malignum.—Malignant de generation of the placental part of the chorion sometimes takes place, giving rise to a growth that has, as yet, not been sufficiently studied to enable us to give it a definite place in pathology. At pres ent most authors consider it as a carci noma of the chorion that seems to in volve mainly the ectodermal and syncitial layers. It is composed of polymorphous and giant epithelial cells imbedded in connective tissue.
It more often originates after labor or interrupted pregnancy, either uterine or extra-uterine, or after the expulsion of an hydatidiform mole.
It is characterized by extreme malig nancy, rapidly invading the uterine walls and broad ligaments and producing met astatic deposits in distant organs.
–The symptoms are abun dant, repeated hemorrhages, offensive discharges, and rapid enlargement of the uterus. When occurring near a labor or abortion, the uterus seems to remain en larged, and a curettage to remove the supposed remains of the placenta pro duces only temporary relief.
The treatment consists in an early hysterectomy, the rapid de velopment leaving no time for hesitation or delay. If the uterus is not much en larged, it may be removed by vaginal section; but, if much enlarged and soft ened, by the abdominal method.
Sarcoma of the Uterus.—Sarcoma of the uterus occurs as a papillary or poly poid growth on the cervix, as a diffuse growth on the endometrium, and as an interstitial tumor.
The disease is very rare, and may occur at any age.