Cancer of the womb : its symptoms, diagnosis, prognosis, and treatment / by Frederick John McCann.

  • McCann, Frederick John, 1889-
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: Cancer of the womb : its symptoms, diagnosis, prognosis, and treatment / by Frederick John McCann. Source: Wellcome Collection.

    9/12 (page 101)
    CANCER OF THE WOMB, by Frederick John McCann, M.D. (Edin.), F.R.C.S. (Fng.), M.R.C.P. (Loud.). TREATMENT OF INOPERABLE UTERINE CANCER ioi The object of this treatment is to burn out those portions of the growth which are not reached by the sharp spoon and to arrest thoroughly all haemorrhage. It may be necessary, in order to prevent burning of the vaginal walls, to remove the specula or retractors and place them in cold lotion. After the application of the cautery the crater-like cavity should be tightly plugged with iodoform gauze, or previous to the plugging should be filled with a powder composed of equal parts of boric acid and tannic acid. The danger attending this treatment is small if the precautions already mentioned are taken, but it should only be undertaken by those practised in vaginal surgery. Even although the peritoneum is opened, no harm has followed in my own cases. There is obvious danger in applying the cautery to the interior of the uterus where cancer affects the body, and it is well to ascertain by means of the finger what is the thickness of the uterine wall at various levels, in order to guard against the risk of penetrating through the wall into the peritoneal cavity. It is noteworthy that after this operation there is frequently con¬ siderable diminution in the pain from which the patient has suffered. The gauze should be removed in three to four days, and, if necessary, re-introduced in order to keep the surface dry. No douching is employed, the slough being permitted to separate gradually whilst the patient is kept in bed. When the separation has occurred, and there is no other contra-indication, she may be permitted to leave her bed. A variety of medicaments have been employed to diminish the size of the cavity, and, if possible, to produce cicatrisation. Strong tincture of iodine (iodi pura, I part; sp. rectificat., 8 parts) may be used to swab out the cavity, which is afterwards packed with iodoform gauze. This method of treatment is not painful, and may be carried out in the consulting-room. It should be repeated every two or three days until the cavity is thoroughly cleaned and diminished in size, and, in certain cases, only a slightly blood-tinged, watery dis¬ charge remains, which has lost all odour. This method is of special utility in cancer commencing in the interior of the cervix, and produces a good effect through the action of the alcohol as well as the iodine. The plan which is now so frequently adopted is the employment of chloride of zinc, which was popularised by Marion Sims.* Sims operated as follows: After curetting the cancer, the bleeding was stilled by “ perchloride of iron wool,” and then tampons of wool soaked in a watery solution of chloride of zinc (2—3) were packed into the cavity and left for four or five days. In order to protect the vagina from the caustic, wool tampons soaked in bicarbonate of soda were employed. Bicarbonate of soda ointment (sodi bicarb., 1 ; vaselin, 4) may also be used. Many modifications have been suggested, but it is necessary to vary the technique according to the circumstances of each case ; for if the disease is close to the bladder, rectum, or peritoneum of Douglas’ pouch, it is not wise to leave the caustic in situ too long, as there is no * ‘ Araer. Journ. of Obstet.,’ vol. xii.