j[56 DISEASES OF THE UTEKUS. 



tightly adherent to the tissues underlying it. As Waldeyer has it, 

 the mucous membrane seems to be tacked down by the ingrowing 

 epithelial sprouts, which penetrate the tissues beneath them like so 

 many brads. After it has attacked the vagina and surrounding 

 connective tissue, the recognition of cancer is easy. 



When the period of ulceration sets in, a series of grave and often 

 very distressing symptoms arise. The leucorrhoea becomes more 

 profuse, and somewhat sanguinolent (like meat-washings), and final- 

 ly, by admixture of gangrenous particles, acquires an ichorous char- 

 acter, and assumes a darker dirty-brown or greenish-black color, 

 and emits so foul and putrid an odor as to disgust not only the 

 neighbors but the patient herself. Haemorrhage is rarely absent. 

 In the beginning there is merely an augmentation of the menstrual 

 flow, but the bleeding afterward becomes irregular, and is often 

 the first symptom which alarms the patient. Elderly women, how- 

 ever, are prone to ascribe such bleedings to the irregularities com- 

 mon at the menopause, and hence give themselves little concern 

 over it. Only in cases of hard cancer is haemorrhage ever absent. 

 It is most profuse in the papillary form. Notwithstanding its fre- 

 quence and abundance, which often reduces the patient to the low- 

 est stage of anaemia, a fatal haemorrhage is rare. 



The abdominal and lumbar pains are sometimes insignificant 

 throughout the disease ; while at other times the patient suffers in- 

 describable agony, especially during the night. This violent pain 

 does not depend upon the ulceration, but upon extension of the can- 

 cerous growth into the connective tissue and other parts of the body, 

 and appears to be due to pressure of the indurated mass upon the 

 nerve-twigs which it encloses. Besides this, there may be sharp 

 pain from pressure set up by a secondary peritonitis, arising from 

 the irritation of the cancerous nodules. Finally, the pain may as- 

 sume a paroxysmal form a uterine colic in consequence of an ob- 

 structed outflow of blood and secretion from the womb. Incessant 

 and painful urinary irritability indicates invasion of the bladder, 

 while a suppression of the urine makes it probable that the ureters 

 are occluded by the growth. Obstinate constipation, followed by 

 tenesirius, haemorrhoids, and diarrhrea, indicates an implication of 

 the rectum. 



Prior to the stage of ulceration the general health of the patient 

 is fairly comfortable ; afterward she grows pale, anaemic, cedema- 

 tous, and emaciated, and the countenance often presents that dirty- 

 yellow coloring so commonly seen in cancer, although not a trust- 

 worthy sign of it. The more frequent tne bleedings, the more 

 profuse the discharge, and the more constant and severe the pain, 



