EARLY DIAGNOSIS OF CANCER OF THE 
UTERUS. 
A (l‘aper read before the Cincinnati Obstetrical Society, June 14i 2^94j 
BY 
EDWIN RICKETTS, M.D., 
CINCINNATI. 
It is not my intention, in this paper, 
to ask you to consider the latest dis- 
covery of a startling nature in pathology 
by “trotting out” another little beast 
of a formidable appearance, at least on 
the microscopical slide, with a personal 
desire that it might be added to the al- 
ready extensive “ Bacteriological Mena- 
gerie.” Instead I bring for your con- 
sideration an old subject, trusting that 
the discussion may be fruitful in causing 
not a few earliest possible diagnoses, 
which I take to be the greatest and 
foremost step in doing an operation, 
that when done early promises more 
than does a late operation. 
Cancer of the uterus is abroad in the 
land, and every member of this society 
has had these cases referred to him by 
the attending physician, with both pa- 
tient and physician desirous of as much 
comfort as possible by the prolongation 
of life, if a cure cannot be hoped for. 
We have cases reported in which an 
early diagnosis of cancer of the breast, 
followed by prompt extirpation of the 
gland, with non-recurrence even after 
five, ten, or more years. Why are we 
not to expect better results for as early 
an extirpation of the cancerous uterine 
globe, in which the disease is known to 
develop more slowly than in any other 
portion of the body ? 
We, as operators with some cause 
for complaint, say to the general practi- 
tioner, who sees these patients previous 
to consulting us, that we do not see 
them early enough to offer a procedure 
that promises the most in the way of 
relief, if not a cure; while the general 
practitioner has the best of the argu- 
ment when he asks justly for more light 
—that is, how is he to see these cases 
earlier, and when once seen how is he to 
be able to make the earliest diagnosis ? 
1. Let him impress upon the minds 
of every adult married female that may 
consult him that cancer of the uterus is 
more liable to make its appearance be- 
tween thirty-five and fifty years of age. 
2. That a leucorrhea followed by a 
watery discharge, that soon becomes 
red, and in time offensive, staining the 
linen a dirty, yellowish-red, are symp- 
toms demanding prompt consultation 
with the family physician as soon as the 
first named makes its appearance. 
3. That he may have at his command 
three common and yet all-important 
aids, viz., those of sight, smell and 
touch. With these special senses prop- 
erly educated, he seldom need be at a 
loss to make the required early diag- 
nosis. Such a practitioner will not 
make a hurried, casual examination 
through unloosened skirt-bands and at- 
tempt to excuse himself by telling the 
patient that she is “ having her change 
of life,” and will be all right soon. 
With prompt action on the part of 
the patient and physician, operators can 
offer a cure in a number of cases by 
means of the vaginal or the combined 
hysterectomy, with a desired prolonga- 
tion of life in the remainder. 
The physician possessing a normal 
nose, one index finger, one middle 
finger, one or two eyes, is peculiarly 
fortunate as to expense, for they cost 
not a thing. True, they do not glisten 2 
Ricketts: Early Diagnosis of Cancer of the Uterus. 
so brightly, nor possibly do they im- 
press the laity so profoundly, as the 
attractive recently imported microscope 
that is so kaledioscopic, even in the 
hands of our trans-Atlantic myopic 
brethren, who are giving special atten- 
tion to pathology as seen through the 
microscope. The operator should not 
attempt the work of the pathologist in 
connection with his work, nor should he 
be microscopist to himself. 
For convenience we will divide the 
uterus into three sections. 
1. The neck—that portion protrud- 
ing from the upper end of the vaginal 
tube and into it, and which stands al- 
most erect. 
2. The attached—that tissued parti- 
tion that separates the vaginal tube from 
the abdominal cavity. 
3. The fundus—that portion of the 
uterus that lies within the lower por- 
tion of the abdominal cavity, save being 
covered by peritoneum. 
Early cancer of the uterine neck can 
be felt and seen without dilatation of 
the uterine canal, in part or entire, and 
it can be seen and felt near the begin- 
ning of the leucorrheal discharge; 
while cancer beginning in the attached 
or fundal portion is not recognized until 
the leucorrhea and watery discharge is 
accompanied by the smelling discharge, 
unless the uterine cavity has been 
dilated as soon as a suspicious discharge 
begins. 
Cancer beginning in the cervix 
spreads more rapidly to the attached and 
fundal portion; beginning in the at- 
tached or fundal portion it spreads to 
the neck; this latter form is longer 
amenable to treatment. 
In multiparous cervices cancer is 
more easily recognized, while trauma is 
credited as the main exciting cause. In 
the non-multiparous uterus, in which 
cancer begins at the attached or fundal 
portion, we can not consider trauma as 
the main cause. With the earliest pos- 
sible diagnosis of cancer, be it situated 
in the neck, attached or fundal, or be it 
found in all three localities at the same 
time, pregnancy should not be enter- 
tained by the primary or secondary 
uterine possessor nor by the physician. 
Under such circumstances it becomes a 
highly offending member, just as much 
so as a cancerous eye, an osteo-sarcoma 
or a malignant mammary gland. 
Cancer is a new growth, and in time 
breaks down; there is never any attempt 
at repair of the invaded tissue; it goes 
from bad to worse. There is a highly 
reddened condition of the tissue sur- 
rounding the growth, while the growth 
and surrounding tissue are tender and 
in a short time bleed easily when the 
probe, speculum or finger comes in con- 
tact with the same. The growth and 
surrounding tissue are engorged with 
blood, and when breaking down takes 
place depletion helps to reduce the size 
of the parts. The same is true with 
cancer located and breaking down in 
the attached or fundal portion. 
Do what you may in internal medi- 
cation, with local application of reme- 
dies, the loss of tissue as the result of 
cancer is never to be replaced by healthy 
tissue. In the very early stage the mem- 
brane covering the suspicious growth is 
smooth, while beneath it and through it 
the sense of touch alone will reveal the 
character of the nodule that soon, if the 
uterus is allowed to remain, is to prove 
so sexdous. In the early stage of the 
developing nodule the membrane cover- 
ing the same is of a pink-white color, 
while that covering the surrounding 
tissue is somewhat of a deeper red; 
pressure of any kind gives pain. 
Cancer located on the neck may look 
and feel like hard or soft nodules, or 
granular erosions may surround the os 
externum, but it differs with cancer, as 
it has a soft edge, while the mucous 
membrane has high points scattered and 
gradually sloping around within the 
soft border; it bleeds easily but does 
not slough, and with no treatment soon 
shows signs of repair. 
The walls of a cancer nodule on the 
verge of breaking down are formidable, 
while its middle is depressed and the 
body catacombed, the result of slough- 
ing. 
In a follicular cervix the needle or 
bistoury will differentiate by a puncture 
of the follicles; you can rub any scarlet 
patch without causing the same to bleed. 
Be the cancer located in the neck, 
attached or fundal portion, the first and Ricketts: Early Diagnosis of Cancer of the Uterus. 
3 
second cardinal symptoms, those of 
leucorrhea followed by watery dis- 
charge, are present. Later, as the 
result of breaking down, the character- 
istic odor makes its appearance; with 
such a change of symptoms present, not 
complicated by a non-malignant polyp, 
cancer should be promptly diagnosed. 
So soon as a leucorrheal discharge, 
with or without cancer of the cervix 
being made, followed by a watery dis- 
charge, with the first detectable odor 
that is not the result of non-malignant 
polypus, vaginal hysterectomy, with or 
without the combined method, is the 
only procedure to be considered. 
With a cancerous deposit in which 
the characteristic bloody, watery, bad- 
smelling discharge has existed from 
three to six months as a result of the 
breaking down cancerous tissue, nothing 
can be promised in a cure, but much 
can be promised in comfort to the pa- 
tient, with possible prolongation of life, 
especially in cases where cancer begins 
in the attached or fundal portion of the 
uterus. 
In the diagnosis of this disease, the 
microscopic aids have been disappoint- 
ing—even misleading; if under the 
present delayed early diagnosis of the 
uterus, as a result of depending too 
much and too long upon the micro- 
scope, we are to make our escape, it is 
to be by intelligently feeling and seeing 
early, along with the earliest possible 
detection by smell. 
DISCUSSION. 
Dr. A. W. Johnstone: This is a 
most important subject, and I know 
every one of you are sitting here think- 
ing of cases. I was thinking of a case 
that I saw years ago, before such a 
thing as total extirpation of the uterus 
was even thought of; had we known 
then what we know now the life 
of that patient would probably have 
been prolonged, but I doubt whether it 
would have been saved. I speak of it 
to illustrate the rapidity of growth. I 
saw the case in 1884. The patient was 
large and fleshy, and had no consti- 
tutional symptoms of any description, 
but had a pain about the uterus. I 
found what I thought was a little fibroid 
of the uterus. In less than a week I 
saw her again; she had a little hemor- 
rhage, and sticking in the mouth of the 
uterus was a little polypus. Micro- 
scopical examination showed it to be 
cancerous. In less than three weeks it 
had filled the cavity. It was a simple 
ordinary carcinoma. The thing to do in 
carcinoma is to remove it as clean as 
you can. However, it is so insidious 
that sometimes before it breaks down or 
there is any smell the case is gone, 
and you will find it involving the lym- 
phatics and almost in a hopeless con- 
dition. If the patient is a little stupid 
and pays no attention to herself, the 
slight symptoms may be overlooked and 
you will not be called until it is too 
late. That has been my experience, and 
I suppose always will be the experience 
of all of us. 
Some of you know my ideas about 
carcinoma. It has been a fad of mine 
for some time, and my ideas have crystal- 
lized down to the view that it is due 
more to the failure of the trophic nerves 
than to anything else. You know they 
are totally different from the adult tissue, 
and it is a trite saying that carcinoma is 
simply a return to the fetal state. Years 
ago I studied this in the lymph glands, 
and it is really beautiful to see that the 
transformation of them is very similar 
to the process of the manufacture of 
bone. After studying it all over I have 
come to the conclusion that it must be 
some failure of the trophic nerves. I 
remember about a year ago, while walk- 
ing home from the Academy with Dr. 
Conner, after a discussion in which 
there had been nothing said as to the 
cause, I suggested this idea to him, and 
he said: “ Yes, and you will see more 
than that if you study your cases closely. 
You never saw a case of cancer in your 
life that was not preceded by some 
nervous strain. This is frequently the 
death of a husband or child, or financial 
reverses.” And he quoted Grant’s case 4 
Ricketts: Early Diagnosis of Cancer of the Uterus. 
as an example, where he had climbed 
to the highest pinnacle in the United 
States, and his son had wrecked him, 
and he said: “ That is a typical case of 
cancer, and you will always find them 
preceded by some terrific nervous strain.” 
So I believe that carcinoma is due—and 
sarcoma to a certain extent, too—to a 
failure of the trophic nerves; that this 
storage-battery is exhausted in old 
people, so we do not have the central 
control. The cancer is found in the 
remnants of the fetal structure; in the 
ovary it usually occurs in hilum, which 
is really the remnant of the second set 
of kidneys, which should have shrunken 
up and been only scar tissue. How- 
ever, there is where the carcinoma is 
likely to appear. In the uterus, it is in 
the cervix, just after the uterus passes 
out of its usefulness. The same way 
with the breast, where it is most likely 
to occur at the menopause. 
There is another thing you may urge 
against the etiology of carcinoma. I 
remember years ago, as a boy, one thing 
that I read in either the London Lancet 
or British Medical Journal, that gave 
a clue to the development of carcinoma. 
Some surgeon of the British army, in 
the foothills of the Himalayas, came 
in contact with the Hindoos. In their 
clothes they have a foolish habit of 
carrying a little bit of charcoal, and 
when cold they just squat down on it so 
as to bring it against the thighs or chest. 
In this way scars are produced, and he 
gave a list of two or three hundred 
carcinomas coming out of these scars on 
the thighs and chest, localities where 
we never hear of it in other parts of the 
globe. The scars are kept irrigated con- 
stantly by the charcoal being carried 
under the clothes and giving off fumes 
and irritative gases. 
I believe in every part of our body 
we have a nerve coming from the trophic 
centre, whether this is in the stomach 
or the cerebro-spinal system, which 
keeps the tissues of the body regulated. 
With that cut off, the tissues are apt to 
do their own sweet will, and the ten- 
dency is to go back to the fetal state. I 
believe we are a great republic, with a 
great central control, and every nerve in 
the body has to have a certain control. 
When this is cut offv the cells go back 
to the original state. You may say this 
is all theory and of no practical good, 
and you cannot convert it into dollars. 
I believe you can; it is not time for that 
yet. 
I have one case which I have fol- 
lowed carefully and thoroughly. I do 
not feel I should as yet make a report of 
it, but I will tell you what I have seen. 
There is no mistake about it being a 
cancer; it came to me with a terrific 
ulceration, and was so diagnosed by 
two men in New York City. I opened 
the abdomen to take it out, but found a 
big chunk of a cancer involving the 
right ureter; I closed it up and quit. I 
then went to work to increase her nerve 
force if possible, and at the same time 
cleansed the vagina daily with the per- 
oxide of hydrogen. Whether it was the 
disinfection or the manifest improve- 
ment of the woman’s condition, I do 
not know, but that ulcer healed and 
skin grew over it. But the nodule con- 
tinued growing. I have been working 
on the case over a year, and the gentle- 
man from New York, whom I had pre- 
viously seen, said he thought she would 
be under the sod long ago. The cancer 
has not been arrested, except to the ex- 
tent that the frightful itching and the 
boils she had about the labia have all 
ceased; the growth of the cancer has 
not been arrested, but the ulceration 
was arrested. 
This is a line along which I have 
been working for some time, and I hope 
some day we will have something; I 
beg of all of you to go to work along 
that line, restoring the nerve-force of 
the patients, so that if we get them up 
we can keep them from coming back. 
I remember my old professor saying 
that the day is coming when we will 
cure cancers with the hypodermic 
syringe, and I must say there may be 
something in it. 
I can only congratulate the essayist 
upon the paper of the evening, and it 
will be my intention to follow his in- 
structions as far as possible, and take 
them out as soon as possible. Some 1 
have cut out, and now after ten or 
twelve years they have not returned. 
The longest case of cancer I know of Ricketts: Early Diagnosis of Cancer of the Uterus. 
5 
was in a very young fellow, a medical 
friend of mine, two years younger than 
I am. He had yellow fever, and in the 
delirium bit his tongue. He was an 
interne in the Charity Hospital of New 
Orleans. He had Bright’s disease after- 
ward, and this sore place he afterward 
went to doctoring, and a nasty granular 
tissue sprung up. It was cut out and 
examined, and he was told it was cancer. 
He came home, but was still kept down 
with the Bright’s disease. He dragged 
on for six months or a year, and this 
thing sprang up again. I cut out a 
funnel-shaped piece all around it and 
sent it to a doctor in New York, and he 
said there was no doubt but it was 
cancer. He then weighed about 130 
pounds, and now will weigh about 230. 
Most of the cases I have treated thus 
have done about that way. I believe if 
we ever get carcinoma under control it 
will be principally through the nervous 
system. 
Dr. C. D. Palmer: I believe every 
member here is obliged for the elucida- 
tion, theory and facts given us by Dr. 
Johnstone. The theory is very plausible; 
there is undoubtedly considerable fact 
in it. What is true in the case of Gen- 
eral Grant is probably true in many 
other cases. The nervous condition has 
much to do with producing cancer. One 
of the most potent agents we have to 
control cancer is arsenic; the Fowler’s 
solution is probably the best remedy we 
possess for the treatment. It has its in- 
fluence upon the nervous system, and 
will control the cancer better than any 
other remedy we can give. It is also a 
potent, but not safe, remedy to apply 
topically. 
While the paper was being read by 
Dr. Ricketts there occurred to my mind 
a means of diagnosis, mentioned years 
ago, which I think is of value. I am 
not disposed to discount anything he has 
said as to the value of the special 
senses, sight, taste, touch and smell, or 
the use of the microscope, which is 
probably the best of all. But a gentle- 
man in Germany a good many years ago 
spoke of the reliability of the dilatation 
produced by the sponge in the diagnosis 
between hyperplastic induration and 
the induration from a cancerous growth. 
The former will yield eventually and be 
dilated, whereas the latter will not 
yield, and will remain while the parts 
around dilate. However, I believe the 
microscope is the best means we have to 
determine cancer, and should be used in 
every case of doubt. 
Dr. A. B. Isham: I came down to- 
night to listen to the practical paper 
which has been read upon the early 
diagnosis of cancer, and not to offer any 
remarks; but since you were so kind as 
to call upon me, I may say that we 
cannot diagnose cancer upon the dis- 
charges, or the smell, or the induration 
of the cervix, because we may have all 
these conditions from specific disease of 
the cervix and of the body of the 
uterus. There occur to me now three 
cases in which there was the most 
offensive smell it is possible to conceive 
of, and which in this particular were 
equal to any cases of cancer I have ever 
met with, where there was a thickened 
condition of the cervix from tears due 
to parturition, where all the varied 
forms of the discharges met with in 
cancer were present, and where there 
was no positive evidence of specific 
trouble, but simply a suspicion. They 
were all cured by specific medication. 
I think Dr. Johnstone’s remarks, in 
reference to cancer being due to a dis- 
turbance of the trophic nerves, are 
directly to the point, for carcinoma is 
nothing more than cell proliferation, 
and where there is an affection of the 
trophic nerves cell nutrition may run 
riot. Perhaps we may sometimes find 
a remedy to control nerve action among 
the glandular extracts. 
In conclusion, I wish to make an in- 
quiry suggested by the paper, and that 
is whether there is a specific cancer cell, 
a cell that microscopically admits of no 
doubt of its being carcinomatous in its 
nature. 
Dr. Rufus B. Haul: I did not ex- 
pect to speak on this subject. If the 
theory of our friend Dr. Johnstone is 
true, how do we account for the large 
number of cases coming under observa- 
tion with cancer in various parts of the 
body, in which the patient has no indi- 
cation of any marked nervous derange- 
ment in any way? I am not question - 6 
Ricketts: Early Diagnosis of Cancer of the Uterus. 
ing the truth of the theory, but ask this 
for information. I am not giving special 
study to this subject, as he is, but 
while listening to his interesting remarks 
I can recall many cases of cancer of the 
uterus and cancer of the breast in which 
the patient was otherwise in apparent 
health. And then, again, he recited the 
fact that this followed so frequently 
after nervous strain or some great men- 
tal stress or misfortune. I think the 
large majority of cases of cancer coming 
under my observation have occurred in 
patients without unusual mental strain, 
anxiety or worry. I do not believe the 
majority of cases are found in patients 
who have passed through such anxiety 
or strain as would make that a factor in 
the production of disease. I congratu- 
late Dr. Johnstone upon his theory, and 
hope he will work out a problem that 
will be of value to us all, but the fact 
that we occasionally see cancer in these 
patients I do not think is sufficient to 
enable us to make that a factor in the 
diagnosis of cancer. We occasionally 
do see cancer in these patients. Where 
the disease is far advanced, we see the 
patients suffering with nervous mani- 
festations, but ao we see it early in the 
disease so marked as to make it a factor 
in the production of the disease itself? 
I don’t want to say this in the spirit of 
criticism, but as a matter of fact coming 
under my observation, and I would like 
to ask Dr. Johnstone if he has any ex- 
planation why this is so. 
Dr. Johnstone: The reason is Dr. 
Hall has not studied his cases close 
enough. What I mean is mental anxiety 
and worry, and not brain trouble or any 
manifestation of hysterics, but some- 
thing that is giving the mind all it can 
possibly stand. When Dr. Conner first 
sprung this idea upon me I was like 
Dr. Hall, and did not think there was 
much in it. Since then, however, I 
have not let one of these cases go away 
from me without a careful questioning, 
and every one of them have a skeleton. 
This is true in nearly all of these cases. 
Now, I did not expect to speak of this, 
but expected to write a paper on it. 
While this may not be the correct line, 
it may lead us on to find something 
of practical value. Since Dr. Conner 
called my attention to the universal 
worry of these people, and he spoke of 
it as a general surgeon, I have made a 
practice of winning the confidence of 
these patients, and in every case I have 
found a skeleton in the closet worrying 
the soul out of them. 
But there is another thing, and that 
is heredity. How many of these people 
may inherit this tendency? It was the 
old idea that cancer was as hereditary 
as consumption. The heredity of con- 
sumption now is found to be only a 
weakening, by which we cannot fight 
the bacilli. Some people may stand 
worry better than others, and others 
may be comparatively weak. But then 
on top of it all we may find something 
else. At one time we thought there 
was only one Bright’s disease; we may 
yet find that there are a dozen different 
kinds of cancer. The nerve idea cer- 
tainly deserves close study. Certainly 
those fellows in the Himalaya Moun- 
tains cannot have much worry, but in 
those cases there is enough constant 
irritation to produce it. But you think 
of an old psoriasis, which goes on year 
after year, and you would think if any- 
thing would kill out the nerve centre it 
would be that. These cases develop dc 
novo almost. 
The doctor was asking the present 
condition of cancer, and what we know 
about it microscopically. In 1888 I 
published a paper on the growth of the 
cancer in the lymphatic cells, which 
bears directly upon this question. The 
round cells simply melt together, just as 
they melt in the formation of bone. 
You know Miller’s idea—but it is too 
long to give you—regarding the calcifi- 
cation and decalcification, and the lay- 
ing down of the Haversian system, etc. 
The round cells, I think, spring from 
the connective tissues, and wander 
around, and in turn run into the Haver- 
sian system. Until then you do not 
have the complete formation of the 
cancer nest. The round cells have fre- 
quently gone on ahead. They are the 
robbers that set up the rebellion; they 
have gotten out in the connective tissue 
spaces, and there you find it beginning. 
It is not the cancer nest, but it is this 
round cell we must get rid of. The Ricketts: Early Diagnosis of Cancer of the Uterus. 
7 
key is to get ahead of that round-celled 
invasion, for that is what makes the 
cancer grow. The nest is as the ashes 
after the fire has passed. 
Dr. Hall: I want to discuss the 
discussion and not the paper. I still 
disagree with Dr. Johnstone. For every 
case of that kind coming under my 
observation, in which there was a well- 
marked predisposing cause, at least a 
half-dozen cises have been under my 
observation in which there was no such 
cause. I do not agree with the doctor, 
but do not oppose the theory. 
I want to emphasize one point in 
Dr. Rickett’s paper, and that is the fact 
that these cases are referred to the oper- 
ator so often for operation or diagnosis 
when the patient is beyond any oper- 
ation—that is, the disease has passed so 
far that any operation is out of the ques- 
tion. In my paper before the American 
Association of Obstetricians and Gyne- 
cologists last year upon this subject I 
referred to that point. For each oper- 
able case sent in by physicians there are 
about ten who are past any operation. 
That has been about the ratio ever since 
that paper was written. Nearly all the 
cases have been under observation for 
months, but the physician in charge, 
not feeling certain as to the nature of 
the case, is afraid of making a blunder. 
Now, that ought to be righted in some 
way, and ought to be righted by the 
members of this society. Let the family 
physicians know that we are not going 
to criticise them if they refer to us a 
suspected case of cancer. They are 
afraid they will be criticized, and it will 
affect their reputation. Although I am, 
of course, free to say no man would do 
that, yet it is done. 
Dr. Chas. Bonifield: I remember 
reading in the London Lancet or the 
British Medical Journal, a lecture in 
which this was spoken of, but a fatal 
objection to it in my mind is that it is 
not particularly in nervous people we 
see cancers. If that were the cause, it 
seems to me it would be in these slight, 
nervous women that we would most 
often find it, but we more frequently 
find it in the fleshy, phlegmatic people. 
If you come to put down care and 
trouble as the cause for the disease, you 
can find it for almost every disease we 
have to treat. It has been very fre- 
quently brought forward as a cause for 
Bright’s disease, and has always seemed 
to me more truly a cause for that than 
for cancer. There are very few people 
but have a skeleton in the closet, and if 
we question them close enough we will 
find either a little one or a big one. 
Dr. Ricketts: It seems things go 
in spurts, even surgery, and at present I 
have no less than fifteen or twenty cases 
of cancer under observation, and in the 
last few days it seems to me every case 
I have examined has been cancer. 
Now, while I hope the time will 
come when we will have made known 
to us the true cause of cancer, yet while 
they are hunting for that cause I propose 
to be one of the number to advocate the 
earliest possible diagnosis of cancer of 
the uterus, on common-sense principles, 
and urge the earliest possible extirpa- 
tion of that cancerous nodule. While 
we have our friends who are ready to 
theorize, and I will admit they are 
working on lines that are commendable, 
yet I have been asked even lately by 
physicians, “ will you ell us how we 
are to get hold of these cases earlier, and 
when we get hold of them how are we 
to know they are to be operated upon ? ” 
Dr. Johnstone spoke of the women 
knowing about it. All women cannot 
be made to diagnose these, and the 
general practitioners cannot be expected 
to carry microscopes around in their 
saddle-bags. As I stated, there are 
three things given to man that do not 
cost him much, and yet I think they 
have been overlooked to a great extent; 
in other words, the cart has been put 
before the horse, and I feel justified in 
saying that these cases must be gotten 
at earlier. In this house to-night there 
is a patient in whom I propose to extir- 
pate the uterus for prolongation of life 
and as a palliative measure, and for 
nothing else. The patient is begging 
for comfort.. 
In regard to the theory of Dr. 
Johnstone, I call to mind quite a num- 
ber of cases of cancer, and while I can 
recall a number of them who are very 
nervous subjects, yet I can call up a 
number of cases in as jolly subjects as I 8 
Rick K i rs: Early Diagnosis of Cancer of the Uterus. 
know of, and in which I have been un- 
able to unearth anything to indicate that 
they had suffered from any depression 
of any kind. I look at it in this way, 
that we must get at these women in 
some way; I do not care whether it 
comes through the microscope or what, 
but get them so they will promptly con- 
sult their physicians when they have 
this leucorrheal discharge followed by 
the watery discharge, which may be 
productive of a bad odor, and then I 
believe we will have made a step in the 
treatment of cancer such as we have 
never made heretofore. 
REPRINTED FROM THE 
CINCINNATI LANCET-CLINIC, 
August 25, 1894.