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Diseases Womb Uterus

cancer, menstruation, operation, time, development and pains

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WOMB (UTERUS), DISEASES OF.—The womb is one of the internal organs of generation in the female, and is suspended in the pelvis by means of broad ligaments (see pp. 167-168). It may be entirely absent, in which case menstruation does not occur, and there is no possibility of conception. If the ovaries are present, violent colicky pains, which eventually necessitate their removal, may occur at the time menstruation under normal conditions would have taken place. Disturbances in the development of the uterus generally give rise to no disorder until after the time of puberty, when menstruation fails to appear, and pain is felt. Defective development of the womb is occasionally accompanied by severe chlorosis (see AN.EMIA). General and, if necessary, also local treatment—with iron preparations, hydrotherapeutics, electricity, etc.—often influences the development of the womb to such an extent that menstruation may take place and conception be rendered possible. Occlusion or narrowing of the mouth of the womb represents limited disturbances of development. The former condition gives rise to blood-tumours of the womb ; the latter produces violent, spasmodic pains during menstruation (dysmencrrrhea), and infecundity. In case of occlusion, it is necessary to provide an artificial opening ; while in case of a narrowing of the mouth, it is sufficient to introduce a probe to widen the mouth. This causes the colicky pains to cease, and renders conception possible.

Other affections of the uterus will be considered under their separate headings in the following paragraphs.

Cancer of the Womb.—This disease, which is absolutely fatal unless an operation is performed, causes the death of a large number of women of a mature age. The affection is characterised by a morbid growth of the outermost layers (epithelium) of the mucous membrane of the uterus. The new tissue spreads throughout the body of the uterus, and destroys it ; and it may pass also to the surroundings of the NN:omb, even to the bladder and rectum. This new growth causes the appearance of cancerous nodes, varying

in size between that of an egg and that of a clenched hand. In many patients a cancerous ulcer develops as a result of an early breaking down of this new tissue ; and this ulcer likewise spreads to the adjacent parts, destroying them. Like a parasite, the cancerous proliferation affects the bodily functions, at the same time weakening the entire organism on account of the pain it causes. Haemorrhages and suppuration add to the patient's sufferings. The pains, unfortunately, do not occur until it is too late to perform a curative operation. On the other hand, hemorrhages and "leucorrhcea-like discharges—the purulent nature of the latter appears only gradually—are the accompanying symptoms of many comparatively harmless affections ; and for this reason many patients suffering from cancer of the womb are not induced by these symptoms to subject themselves to a medical examination.

The possibility of a cure of cancer of the womb exists only if the disease be recognised before the cancer has spread to the surrounding organs and tissues. The point to be borne in mind, is that the removal of the womb through the vagina (to-day an operation that is almost without danger) may result in a permanent cure only so long as the cancer is restricted to the uterus itself. The following statements may save much explanation : (1) Cancer of the womb usually begins with a slimy discharge, or with slight bleedings. These hemorrhages may at first be mistaken for increased menstruation. Pain does not occur until it is too late for a successful operation.

(2) Since cancer may spread from the womb to the surrounding parts in a comparatively short time after the onset of a discharge, and since cure by operation is then no longer possible, it is necessary for the patient to consult a physician immediately after the occurrence of the first slimy discharge or the first hTmorrhage.

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