Vaginal hysterectomy for malignant disease of the uterus / by J.E. Janvrin.

  • Janvrin, J. E. (Joseph Edward), 1839-1911.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Vaginal hysterectomy for malignant disease of the uterus / by J.E. Janvrin. 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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    an operation which has a wide enough field for its work and which should be kept within its own legitimate limits. Perhaps as cases multiply and fuller and even more satisfactory statistics accumulate as to the ultimate results in such cases as are now pretty generally operated upon the field of operation will be extended so as to include cases of invasion of the bladder and rectum. This is a point which at present has hardly been touched upon in practice, and therefore we have no statistics upon which to urge the operation in such cases. Of the different forms of epithelioma of the cervix uteri undoubt- edly the so-called cylindrical variety is by far the most frequently met with, and it has a decided tendency to diffuse itself from the cervix proper upward into its cavity and to the body of the uterus. Next in frequency is the pavement variety involving for a long time only the mucous membrane of the cervix or of the vagina. In several cases which have come under my observation it has seemed to me to have begun upon the cervix and subsequently to have been transferred to the upper portion of the vaginal mucous membrane simply by attrition and absorption. Here then we have .a new focus for the extension of the disease. It is however a most fortunate thing that the conservative resources of nature are now called into play, and a deposit of healthy newly formed connective tissue proliferation takes place in the vaginal wall, thus for a time separating the disease from the lymphatics of the cervix and vagina. Physical examination shows the mucous membrane only of the vagina involved, the vaginal wall not at all thickened and no infiltration of any kind underneath the wall, either of lymphat- ics or cellular tissue. In such cases of beginning invasion of the vagina the operation of vaginal hysterectomy gives the most hope- ful outlook as to non-recurrence of the disease, provided sufficient of the vaginal wall is removed at the time of the operation. This is best accomplished by making, at the beginning of the operation a circular incision through the vaginal wall at least three-fourths of an inch below the diseased surface dissecting upwards and ligat- ing any vessels requiring it, and then as you reach the level of the cervix go on in the usual method and extirpate the uterus, tubes and ovaries. I have had two such cases, one done over three years ago, and another early in the present year. There has been no return of the disease in either case. Diagnosis.—The diagnosis of epithelioma of the os or cervix is easily made. Generally irregular haemorrhages first draw the atten- tion of the patient. The hard deposit at the base of the disease, its