Remarks on advances in the treatment of cancer of the cervix uteri / by Herbert R. Spencer, M.D., consulting obstetric physician to University College Hospital.

  • Herbert Ritchie Spencer
Date:
[1928?]
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Licence: In copyright

Credit: Remarks on advances in the treatment of cancer of the cervix uteri / by Herbert R. Spencer, M.D., consulting obstetric physician to University College Hospital. Source: Wellcome Collection.

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    engaged, of which I need only mention that of Thies on immunization by cancer-albumin and implantation of cancer; and of Blair Bell on the treatment of the disease by lead, which he brought before this Society in 1926: it is too soon to pronounce an opinion on the value of this treatment, but its dangers have been pointed out by its originator. For the present, at any rate, the treatment of cancer of the cervix resolves itself into removal of the growth by operation or by radiation. Operative Treatment. Passing over the destruction of the growth by caustics or cautery and the simple removal of the cervix (first carried out by Osiander5 in 1801), the operative treatment may be divided into high amputation of the cervix and vaginal and abdominal hysterectomy. 1. High Amputation of the Cervix. High amputation of the cervix, preferably by the electric cautery introduced by Byrne, is an excellent treatment for early cases, especially in elderly patients; it is free from risk and permits the continuance6 and the subsequent occurrence of pregnancy,7 in which respects it is superior to any form of hysterectomy. In patients operated on before the menopause it is sometimes followed by stenosis and dysmenorrhoea until the menopause occurs; yet even these patients have better general health than those who have been deprived of uterus and ovaries. I have watched such a patient for twenty-five years after the amputation, during which she has been able to fulfil her conjugal duties without trouble; in this respect also high amputation is superior to any kind of extended hyster¬ ectomy. It is the fashion to neglect this operation; but, in the case of an early cancer in an elderly subject, it is, in my opinion, the best means of operative treatment at our disposal. 2. Vaginal Hysterectomy. (a) Simple vaginal hysterectomy was first successfully performed in this country by James Blundell on February 12th, 1828. Various are the methods of carrying it out. The use of the cautery, which I have constantly employed, has, I think, some advantages in lessening the haemorrhage at the operation and the frequency of recurrence of the growth. The whole operation is carried out with the cautery; but it is generally necessary to tie the uterine arteries and the broad ligaments. The vaginal operation has a very low rate of immediate mortality, and it has the advantages over the extended operation that it does not interfere with marital intercourse, nor, like the abdominal operation, give rise to scar-hernias. The minimal risk of the operation renders it of great value in enfeebled or aged patients. The superiority of the recovery over that after abdominal hysterectomy is so marked that it is surprising that there exist gynaecologists who never perform the operation. (b) Extended vaginal hysterectomy consists in a more