Treatment of cancer of the cervix of the uterus complicated by pregnancy / by George Ben Johnston.

  • Johnston, George Ben, 1853-1916.
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Treatment of cancer of the cervix of the uterus complicated by pregnancy / by George Ben Johnston. 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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    3 positive and constant, as contrasted with the second group, in which our method of procedure is variable and can be arrived at in each instance only after intelligent judgment, founded upon the consideration of numerous details. (2) While possessing the above point in common when con- trasted with the second group, when compared with each other we find that our first and third groups are exactly opposite in the result sought and in the method of their management. For this reason the indications for treat- ment can best be brought out by de- parting from our order of enumera- tion and considering the third group immediately after the first. The treatment of the first group of cases—t/iose in luhich the ca7icer ap- pears before the termination of the fourth month of pregna7icy a7id is Iwiited to the ce/'vix—is apparent. At this early stage of pregnancy no thought of sav- ing the life of the child can be enter- tained, and our sole consideration must be the welfare of the mother. We are, therefore, to proceed ex- actly as we would in dealing with a cervical cancer in a non-pregnant uterus. Hysterectomy is to be promptly performed, preferably by the vaginal route. Usually at this stage of pregnancy the uterus can be easily removed per vagina77i. Should the caliber of the vagina, or the exist- ence of .some other obstacle, not ad- mit of this method, total hysterectomy by the high route must be resorted to. In the third group of cases—those 771 7vhich, 7'egardless of the stage of preg- 7ia7icy, the disease has exte7ided to the vagt7ia, a7id possibly 7ieiq^hbori7ig struc- tiires, re7ide7'i7ig the condition hioperable —the indications, while equally as ob- vious as in the first group, lead to the adoption of exactly an opposite course and our efforts are entirely in behalf of the child. The disease having reached an inoperable stage, it is likely that the pregnancy is well ad- vanced, except in those rare cases in which the cancer existed prior to con- ception. In either case the outlook for the mother is utterly hopeless. Our endeavor here must be to sustain her until the end of the term, if pos- sible, or at least until the child has reached a viable age. During this time it is essential that she be kept under closest surveillance; for, in spite of our efforts, intervention may be demanded at any moment on ac- count of exhaustion or hemorrhage or to forestall premature expulsion. If we are successful in carrying the wo- man to term, the delivery then by na- tural channel is fraught with such formidable dangers—laceration, hem- orrhage, infection, peritonitis—that Cesarean section should always be re- sorted to as less perilous. Should de- livery before term be unavoidable, on account of the exigencies above men- tioned, Cesarean section should be performed where there is the slightest chance of securing a viable child, and it is also the only method to be adopted prior to such time, if it be ap- parent that the passage of even an un- developed fetal head through the dis- eased cervix would end in fatal hemorrhage or poisoned wound of the peritoneum. Our course in dealing with each of the two cla.sses of cases thus far con- sidered was clearl)^ indicated by the conditions, and the unavoidable sacri- fice of a life in each instance left us unhampered in our efforts to rescue the other—the mother in the first