Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour.

  • Hart, D. Berry (David Berry), 1851-1920.
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Manual of gynecology / by D. Berry Hart and A.H. Freeland Barbour. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    549/806 (page 489)
    On making a vaginal examination, the finger feels the enlarged, Vaginal thickened, irregular, everted lips of the cervix spreading like a mush- tionJnma room in the vagina (described by Malgaigne as champignons can- cereux ). Sometimes a distinct tumour is present, the form of which is sufficiently indicated by the term cauliflower excrescence (see fig. 252). In other cases the finger feels an irregular ulcerated surface in the position of the cervix, soft and friable with hard and unyielding margins. The examining finger is stained with blood, and the odour of the dis- charge cannot fail to be recognised. If there is any doubt as to diagnosis, Fig. 252. Cauliflower Excrescence growing from the Cervix Uteri {Sir J. Y. Simpson). a fragment should be removed and examined microscopically. The appearance of a fibrous stroma with alveoli which contain irregular cells of an epithelial type with one or more large nuclei, will confirm the diagnosis of carcinoma. The value of the microscope in the diagnosis of cancer has given rise to considerable differ- ence of opinion. While Williams2 and Griffith 2 emphasise its usefulness, Thornton s and Herman lay more stress on clinical observation, the former showing the risks of partial operation, as he characterises the snipping off of portions for microscopic examination. Clinical observation, corrected and supplemented by microscopic examination, is best. While microscopic examination may not in many cases be of value, in a certain proportion of cases it is conclusive ; and its utility comes in just at that early period where clinical investigation feels its weakness. The microscopical examination of scrapings removed by the curette is of much less value than of pieces excised, for although the histological 1 Op cil. 2 Early Diagnosis of Cancer of the Uterus: Brit. Med. Jour., 1S96, Vol. i., p. 264. 3 The Early Diagnosis of Malignant Disease, etc. : Brit. Med. Jour., 1S96, Vol. i., p. 2C1. also Jessett on the Early Diagnosis of Malignant Disease : Brit. Gyn. Jour., 1896-97, p. 327. See