Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929
Date:
1902
Catalogue details

Licence: In copyright

Credit: Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P. Source: Wellcome Collection.

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    tion were made by the abdominal route, and were in most instances miserable failures, but the primary success which followed operative endeavours conducted through the vagina completely revolutionised the methods of dealing with this disease surgically, and the complete extirpation of the cancerous uterus soon replaced the unsatisfactory niggling operations such as scraping, cauterising, and partial amputation of the cervix. It soon became clear that the complete removal of a cancerous uterus, though it was attended by a low mor¬ tality in skilled hands, was followed by very unsatisfactory remote results, and this led to a more thorough inquiry into the nature, course, and modes by which cancer of the uterus destroyed its victims. From careful studies con¬ ducted in the wards and laboratories, the indications for performing hysterectomy in cases of uterine cancer can be fairly well formulated. CoMcer of the cervix uteri.—Without laying down any hard and fast rules it may be stated that in suitable cases, the uterus is best removed in this disease by the vaginal route as it enables the surgeon to excise the tissues about the cervix uteri widely, and at the same time enables him to avoid the bladder, the ureters, and rectum. In order to secure a good result it is of the highest importance to make a very careful selection of the cases. The disease should be limited to the cervical tissues ; and the broad ligaments should be free from any suspicion of infiltration. These are matters which cannot be satisfac¬ torily determined by the finger alone, but by examination under an anaesthetic; it is surprising how often a case seems favourable for operation when digitally explored, and yet woefully disappoints the surgeon when the parts are exposed with the help of a speculum in a good light. My hospital experience shows that out of one hundred consecutive patients with cancer of the neck of the uterus, about 5 pei cent, are favourable subjects for the purposes of operation.. No doubt many think that I am too exclu¬ sive m selecting cases for operation, but I am satisfied that