Cancer of the womb : its symptoms, diagnosis, prognosis, and treatment / by Frederick John McCann.

  • McCann, Frederick John, 1889-
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: Cancer of the womb : its symptoms, diagnosis, prognosis, and treatment / by Frederick John McCann. Source: Wellcome Collection.

    10/12 (page 122)
    CANCER OF THE WOMB, by Frederick John McCann, M.D. (Edin F.R.C.S. [Eng,), M.R.C.P. (Lond.). 122 CANCER OF THE WOMB Clinical History. Deciduoma may occur at any age during the child-bearing period, and has been observed by me* in a woman after the menopause (see Case i). As already mentioned, it may occur after labour at term, abortion, or hydatidiform mole. Fifty per cent, of the cases have been observed to follow a hydatid mole ; hence it is necessary on the occurrence of haemorrhage following this condition, or any obscure symptoms, to examine the interior of the uterus and any scrapings which may be removed by the curette. In more than one half of the cases the first indication is the appearance of vaginal or vulval metastases, usually not noted until some weeks or months after the puerperium. But the repeated and profuse uterine bleeding should give rise to suspicion, and when the uterus is explored and curetted the presence of the characteristic tissue on microscopic examination settles the diagnosis. Profound anaemia is exhibited by the patient, and in the late stages cachexia. The discharge becomes foetid and watery, and the patients exhibit signs of septic absorption accompanied by rigors and elevation of tempera¬ ture. Cough, dyspnoea, and expectoration of blood point to the presence of pulmonary metastases, although these signs may be entirely absent. Case i.—A sallow-complexioned woman, set. 53, was sent to me by Dr. Batson, of Dorking. She was admitted into the Samaritan Hospital on March 21st, 1902. She had had ten children. Her last pregnancy, nine years previously, terminated at the third month. Eighteen months before her admission into the hospital her menstrual periods ceased, and no blood loss was noticed until October, 1901, when a sudden gush of blood came from the vagina, followed by continuance of the flow for one day. This free haemorrhage recurred every four or five days until three weeks before admission, when only a brown discharge was noticed. The severity of the haemorrhage necessitated her confinement to bed during its progress. She had no pelvic pain, but had been losing flesh. Bimanual examination.—The uterus was found to be enlarged to about the size of a three months’ pregnancy. The enlargement was uniform and soft in consistence. The uterus was freely movable. A small fleshy polyp was growing from the external os uteri. Slight uterine haemorrhage followed the examination. The uterine cavity was explored under anaesthesia on March 24th, 1902. When I passed a uterine sound into the cavity blood literally poured out of the uterus. An iodoform gauze plug was employed to arrest the bleeding, and as I had not obtained the consent of the patient for hysterectomy she was returned to bed. I have never seen the non-gravid uterus bleed so freely as it did in this patient. She had informed me that at home the haemorrhage was most alarming and very difficult to control.* Two days later, with her consent, I performed vaginal hysterectomy. The uterus was plentifully supplied with blood-vessels, and on removal * McCann, ‘Journ, of Obstet. and Gyn. of the British Empire,’ March, 1903.