CANCER OF THE WOMB. 157 



so much the sooner does the general health of the patient give way. 

 There is also almost always a derangement of the stomach, with 

 loss of appetite and loathing of food, and a tendency to nausea 

 which contributes to break down the strength ; and it is often hard 

 to determine whether the vomiting is due to a sense of disgust, or 

 arises from gastric catarrh or gastric irritation reflected from the 

 genital organs, or from the effect of ursemic poisoning. 



Ulceration usually first attacks the inner surface of the lips of 

 the os. After this has once begun and loss of substance has taken 

 place, the diagnosis by digital and ocular examination is no longer 

 difficult. One source of error might be the destruction of the va- 

 ginal portion of the cervix by that very rare form of ulcer (ulcus 

 phagedwnicum corrodens) first described by Clarke, and identified 

 with certainty in a few instances only by Klebs and .Focrster, and 

 the cause of which is still unknown. In a doubtful case, nothing 

 but the microscopic examination of an extirpated portion of the 

 cervix can determine whether the base of the ulcer contains traces 

 of carcinoma or not. But, after all, the prognosis of a corroding 

 ulcer is scarcely better than that of cancer ; for our experience has 

 shown that neither by the strongest caustics, nor even by the hot 

 iron itself, can the ravages of the latter be checked and the ulcer 

 healed. 



As we do not generally know how long the latent stage of cancer 

 has existed, its duration can rarely be stated with certainty. Dating 

 from the time of first discovery, Gusseroio estimates that most pa- 

 tients succumb in about a year or a year and a half. Yet there are 

 examples of a rapid course of only a few months, and others again 

 of several years' duration. Death usually takes place from exhaus- 

 tion, or else the patient dies of complications. These are acute or 

 chronic uraemia, gradual or perforative peritonitis, miliary carci- 

 nosis of the peritonaeum, septicaemia, dysentery, diphtheritic inflam- 

 mation of the vagina or bladder, pneumonia, or (what is more rare) 

 embolism of the pulmonary artery, embolic gangrene of the lungs, 

 fatty degeneration of the heart, pyelonephritis, or pylephlebitis as 

 a consequence of putrid thrombosis of the portal vein. 



TREATMENT. The treatment of cancer of the womb is essen- 

 tially surgical, and an operation, although it very rarely cures the 

 patient, yet affords the only chance of effecting even a temporary 

 improvement. Unfortunately, the malady is seldom brought under 

 treatment until the vagina has become implicated, or until so much 

 of the cervix is involved that an amputation can no longer be made 

 through healthy tissue. Yet even then the operation is justified as 

 affording a last chance for prolonging life. This is best done by 



