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.

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    resembles them only at an early stage. But it is precisely at this stage that a correct diagnosis is all important for treatment. We should also remember (as Ruge and Veit have pointed out) that these conditions may be at once the result of chronic inflammation and the starting-point of malignant disease. The statement of the patient that the symptoms have existed for a long time, should not throw us off our guard. In all Import- cases in which a patient over forty years of age seeks advice ivith symptoms p™^ referable to the pelvis, a careful examination should be made. We may Examina- thus accidentally discover carcinoma in an early stage, while still within Cancer, the possibility of radical treatment. If the carcinomatous infiltration be general, it cannot be distinguished, except by microscopical examination, from chronic induration. When localised, the diseased part is distinctly marked off from the adjoining tissue, shows a difference in its level, and is of a slightly yellow colour with granular yellowish-white inequalities.1 Where there is only suspicion of carcinoma, there is no harm in excising a portion of the suspected part and submitting it to microscopic investi- gation. A careful examination per rectum of the pelvic cellular tissue should always be made as mentioned above. A superficial ulcerating epithelioma might be mistaken for a simple erosion, but has thickened infiltrated edges. The latter may, however, pass into the former. Condylomata on the cervix simulate epithelioma, but they disappear under appropriate treatment. Syphilitic ulceration produces sometimes deep excavation, even a rectal fistula. This at the first glance might be taken for carcinoma, but more careful examination and inquiry into the history of the case will remove all doubt. Small myomata are more sharply defined than a carcinomatous nodule of the same size, because the surrounding tissue is not infiltrated. A tuberculous ulcer is distinguished by its softer, more velvety surface and smoother edges; there is usually tuberculosis present elsewhere in the body. If a piece be excised, giant cells and in some cases bacilli can be detected. When a small submucous fibroid or a cervical polypus has ulcerated, it presents appearances similar to an ulcerating carcinomatous nodule. The former however is firmer, and fragments cannot be broken off by the finger-nail, while the latter is friable and breaks down easily. The possibility that carcinoma may be first noticed during the puer- Carcinoma perium should be remembered. In such a case it is more likely to be pliei!e in the body of the uterus, as cancer of the cervix hinders conception, perium. Even in the body, it is rare in the puerperium ; and cases described as such are usually Deciduoma malignum (v. Chap. XLIII). 1 Stratz—Zur Diagnose ties beginnenden Cavcinomsan der Portio : Zeits. f. Gel), u. Gyn., Bd. xiii., S. 89.