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.

    6/12 (page 4)
    group, the child in the third. Coining now to the treatment of the cases included in the second group of our classification,—those in which the dis- ease is discovered after the fourth month and remains Iwiited to the cervix—the conditions are more complicated and demand more serious consideration. Here we recognize the possibility of accomplishing that most desirable object, the saving of the lives of both mother and child, and our efforts should be directed to that end. With these cases our course should be to keep the woman under the closest observation for a time and subject her to frequent examinations. If it is evident, after several inspections, that the disease is progressing with such rapidity that it will advance to an inoperable stage before the child has reached the period of viability, the possibility of saving both lives no longer exists, and that of the child must be sacrificed. Immediate ablation of the uterus is now demanded. In this class of cases the supravaginal route is chosen, and the operation is a Porro, continued to complete ex- tirpation. If, on the other hand, we find the disease to be progressing but slowly, •so that it is plain that the mother’s ■cause will not suffer materially by a few weeks’ delay, postponement should be recommended. Should we thus feel justified in deferring operation until the completion of the seventh month, or later, if pos.sible, Cesarean section, followed by complete removal of the uterus, may result in rescue of the child and at the same time accom- plish for the mother all that could have been hoped for from an earlier operation. The nece.ssity for the prac- tice of this plan grows more im- perative as the ca.se approaches the end of the normal period of gestation, so that it becomes a plain duty to give to the child, after it has reached the time of probable viability, as many days of intrauterine life as may be consisten t with the safety of the mother. The re.spon.sibility in this class of cases is especially serious. Though at no period of gestation is the life of the fetus to be lightly considered, or sacrificed save from the conviction that the step is necessary for the rescue of the mother, yet the claims of the child upon us grow more pressing as fetal life advances. On this account the mother should, and usually will, take some hazard upon herself for the sake of her unborn offspring. I wish to append a report of three cases of cancer of the cervix, compli- cated by pregnancy, successful!} treat- ed by operation. Two of these were of the kind de- scribed in the first group of our classi- fication and the other belonged to the second. They are briefly as follows : Case I. Mrs. P., referred by Dr. Devany, of Wakefield, Va. Consulted me July 29, 1S97. Age, 26. Married seven years. Two children, youngest four years old. Dates her trouble from birth of last child. At this delivery a laceration was produced. Ever since has had more or less trouble, such as bearing down pains, backache, vaginal discharge, sometimes severe itching of external parts. Is now and then melancholy and nervous. All symptoms increased during men- struation. Menstruation, which had been regular, did not appear the middle of May as expected. The ordinary signs of pregnancy developed in proper order, believing herself jnegnant she was mys- tified by a constant bloody' discharge, on account of which she consulted Dr. Devany. Examina- tion revealed a three and a half months’ J'reg- nancy. The cervix was occupied by carcinoma- tous growth involving nearly the entire vaginal portion. Microscopical findings verified the diagnosis and immediate operation was pro- posed.