Malignant newgrowth in childhood. I. Malignant disease of the uterus, ovary, and vagina in children / by William A. Edwards.

  • Edwards, William A. (William Aloysius), 1860-1933.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Malignant newgrowth in childhood. I. Malignant disease of the uterus, ovary, and vagina in children / by William A. Edwards. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    rienced hands, particularly those hands that have learned to know that when peritonitis is present the intestines move en masse, as it were, and do not quickly glide under the fingers as the healthy gut will. A note of warning must be sounded here in regard to the danger of mistaking a partially filled bladder for a tumor or a peritoneal exudation. The means of guarding against this error is self-evident; I only mention it because those of us who are teaching sometimes see the younger practitioner fall into error. We must also guard against mistaking a pus collection or serous accumulation for a filled bladder. Let us for a moment consider the anatomical peculiarities of the female pelvic organs in children. The sacrum and in consequence the rectum are almost straight. One will miss the well-known hollow of the sacrum, and the large lax ampullar distention does not exist. In young children, those w^ho have not walked much, the bladder is about the size and shape of an egg, the base downward, and its site is almost purely abdominal. As the child walks more the bladder sinks lower in the pelvis, but until about puberty it can readily be displaced into the abdominal cavity by an examining finger, so loose is its attachment. The infantile uterus has but little body; it is practically a thin cord made up mostly of the cervix which at first appears unduly bulky. It lies comparatively high in the pelvis, but can be rolled between the fingers and the symphysis pubis. In young children the ovaries are at the side of the pelvis close to the external iliac artery: the pulsation of this vessel is one of the guides for their location, the other being the sickle-shaped uterosacral ligaments. It is to be understood that these landmarks are subject to as many variations in the child as in the adult. The usual variation is a higher location, but we must remember those cases of congenital prolapse of the uterus to which I have called attention,® and we must distinguish this prolapse from congenital hypertrophic elongation of the cervix. The prolapse may be of any degree, and is usually without marked symptoms; indeed, some of the children have performed the functions of the bladder and rectum in a normal manner. These cases of congenital prolapse are likely to be associated with lumbosacral spina bifida and rectal ectropion, often with clubbed feet, sometimes with hydrocephalus and hypertrichosis. Other causative factors have been thought to be an abnormally large size of the pelvis, an enlargement of the uterine body or cervix or of the entire organ, and increased abdominal pressure; such a case for example as that of Stepkowski,^ who saw a woman, aged twenty-five years, with complete prolapse of the uterus and vagina ^ Cyclopedia of the Diseases of Cliildren, Keating and Edwards. ^ Ghz. lek in Przegl. Cliir., la Gynio., 1897, No. 1.