Medical reprints with original essays : home, foreign, and colonial, illustrated.
- Date:
- 1897
Licence: Public Domain Mark
Credit: Medical reprints with original essays : home, foreign, and colonial, illustrated. 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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![sively as the first case, but much more so than the second. ' At the fundus the uterine ’wall is an inch in thickness and chiefly consists of this new growth. In one place only an eighth of an inch of muscular tissue remains. Near the internal os the growth has not encroached upon the muscular tissue so extensively, and the cervix is not at all invaded. Microscopical examination of the growth shows it to have the same structure as in the other two cases. There are ' irregular invasions into the muscular tissue, and here and there, deep in the muscular coat, isolated patches of glands are found, conforming in general to normal utricular glands. There are no evidences that the new growth has gone beyond the uterus, although in one place, at the fundus, it has very closely approached the peritoneal coat. Diagnosis is malignant adenoma. Case IV.-—A married woman, aged forty, had suffered from pain in the back and iliac regions for three years. During the six months previous to her admission to the hospital pain had become much worse and she had rapidly lost flesh, and fer three months had had a foul discharge. Menstruation had been normal. Examination under ether revealed an enlarged uterus, retroverted and adherent. Both appendages were prolapsed and adherent to the uterus. A hard mass was felt on each side of the uterus. Microscopic examination of the curettings removed at the time of the examination under ether show a great mass of glands lined by several layers of epithelium, but always preserving a general adenomatous structure. On account of the infiltration on the sides of the uterus extirpation was not attempted. Patient died two months later. No post-mortem examination was made. In this case, of course, it is impossible to be certain that there was no carcinomatous growth in or about the uterus, but i a large amount of material was removed at the curettings which only showed the structure of malignant adenoma. These four cases, as examples of malignant adenoma of the uterus, present some interesting points. The anatomical I structure of the new growth in all of them is the same. They all present more active and destructive changes than do cases of simple glandular hyperplasia, and they all differ ^’anatomically from cases of cancer. Cases I and II are in- teresting because the adenomatous growth in the uterus is associated with carcinoma in the ovary. Case II was interesting because of the association of the ' new growth with a uterus filled with fibro-myomata. Cases I and III show well the encroachment of the new growth upon the neighbouring tissue and the preservation of the gland type in these invasions. Even in Case I, where the adenomatous growth has spread beyond the uterus, the in- vaded part of the vaginal wall consist of glands more nearly like normal uterine glands than those in the uterus. In all of the cases the cervical mucous membrane was not invaded. Summary .—There occurs in the uterine mucous membrane a moderate glandular hypertrophy and hyperplasia, associated with chronic inflammation, which is entirely distinct from any tumours in the same region. The glands are simply more tortuous and more numerous, and the lumen is larger, but their general structure is the same as that of normal utricular glands. More marked examples of glandular hyperplasia occur which often simulate clinically malignant neoplasms. They often occur near the menopause, may cause severe haemor- rhages, and impair the general health. Sometimes they have [ to be curetted several times before the condition disappears. Anatomically these latter cases are characterized by an excessive number of glands, but the epithelium does not show any marked tendency toward proliferation, and there is still a large amount of stroma left in which inflammatory changes : are going on. There is an increased number of stroma cells and an infiltration with leucocytes; there are new blood-vessels, and oftentimes interstitial haemorrhages occur. The whole picture is one of inflammation, in which the glands are increasing in number simply as part of the general inflam- mation. Some of these more marked cases probably do become malignant, and therefore a careful microscopical examination of all curettings should be made. Although a positive diagnosis between adenomatous hyper- plasia and adenoma may not always be made from the curettings, yet it is possible in the large majority of cases to form a conclusion of sufficient accuracy. Adenomata occurring in the uterine mucosa are tumours consisting almost eutirely of glands which conform in general to the normal gland type. There is very little interglandular tissue, and, while there may be an inflammation going on, it is entirely subsidiary to the main process—i.e., growth of new glands. The epithelium lining the alveoli shows a tendency to proliferate, but a lumen or the suggestion of a lumen exists. Adenomata in the uterus are always malignant, because they invade neighbouring tissues and recur unless completely removed. Adenoma in the uterus, although it may represent a tran- sitional step between simple glandular hyperplasia and car- cinoma, certainly often develops to a high degree without losing the anatomical characteristics of adenoma. Adencma usually, perhaps always, begins in the body of the uterus, and does not involve the cervical mucous membrane; and, while it invades the muscular layers and eventually goes beyond the uterus, it remains confined to the mucous membrane longer than carcinoma does. It might be described as spread- ing around in the mucous membrane rather than burrowing through the different layers, and thus quickly involving other parts. Compared with carcinoma of the uterus clinically7, we find that adenoma of the uterus usually occurs later in life than carcinoma, and lasts longer without causing cachexia. Fre- quently7 we get a history of irregular haemorrhages for several years, during which time the patient has been curetted several times without permanent relief. Pain and discharge are not such prominent symptoms in adenoma as in carcinoma. The enlargement of the uterus is more marked in adenoma. The prognosis in adenoma after removal is better than in carcinoma, because from its manner of growth complete extirpation of the growth is more certain. The treatment for adenoma of the uterus should be the same as for carcinoma. LACTOPEPTINE IN THE TREATMENT OF MALARIAL ENTERITIS. By W. Forbes-Leslie, M.B. and C.M. Aberd. [An Original Article, specially written for Medical Reprints.] In an article which I wrote for Medical Reprints about a year ago I pointed out the efficacy of Lactopeptine in the treatment of malarial fever. Since then I have been able to extend my experience to its action in the course of malarial enteritis. This is a disease of the alimentary canal which stands midway between enteric fever and the enteritis of cholera. It has many sy7mptoms in common with what we call summer diarrhoea in this country, but is distinguished by a number of well marked features, and in the slow recovery the patients make after the disease has expended itself. It is very common in malarious districts, and is more or less epidemic, In this it resembles dysentery, to which it has a great affinity. I have seen cases described as dysentery which in my opinion could only have been subacute cases of malarial enteritis. Undoubtedly dysentery is a form cf malaria; but it produces intense inflammation, followed by ulceration and destruction of the deeper tissues, while death takes place from perforation in most cases. The gastric mucous membrane is rarely affected. On the other hand in malarial enteritis there is a general superficial inflammation extending from the stomach to the lower bowel produced by- irritation of the poison. It never concentrates itself upon certain points with the formation of ulcers, and pain is only the result of excessive peristaltic action. As I have said, it is more or less epidemic. Indeed some authorities consider malarial fever itself epidemic and recommend prophylactic measures. It is true that as civilization advances it recedes before it. It is true that when freshly broken up the ground reeks with the poison, but as the measure of cultivated land increases the fever diminishes, showing that treatment by such means is of undoubted value. , There are also some of its forms which generate a true epidemic power under certain conditions. Yellow fever, a low form of malaria, and cholera malaria, and indeed true cholera itself which seems to be affiliated to it, if not truly evolved from it, are highly epidemic. Malarial enteritis is also infectious. Its type changes under the two-fold influences of climate and constitution. Some- times it is so severe that death takes place in a few hours, in other cases a fatal termination is rare except in children ox- old persons. Death in the acute form takes place from shock in the early stages, in the subacute from exhaustion conse- quent upon the discharges from the bowel. These last consist at first of natural faeces ; later they become watery, frequent, contain blood corpuscles, epithelial cells, mucus, and small particles of undigested food. The most interesting epidemic in my experience was on board ship on my way to Africa. There were three hundred passengers struck down one afjer the other, together with nearly all the officers and crew, by](https://iiif.wellcomecollection.org/image/b2247464x_0007.jp2/full/800%2C/0/default.jpg)
