Two Cases of Carcinoma of the Uterus. 
BY J. T. JELKA, M. D., HOT SPRINGS, ARK., 
Professor of Surgical Diseases of Genito-Urinary Organs, College of Physicians 
and Surgeons, Chicago, III. 
[Reprinted from the Journal of the State Medical Society of Arkansas, Feb- 
ruary, 1891. Read at the Fifteenth Annual Session, Little Rock, May 14-16, 1890.] 
Case I. In June, 1889, I was consulted by Mrs. P. She is a 
woman 53 years of age; occupation, housewife; and mother of 
one child. Never had any miscarriages. She ceased to menstru- 
ate several years ago, and has been in robust health all her life. 
In April, 1889, she was very much frightened by a dog, and 
ran quite a little distance to get away from him. In a few 
hours she was attacked by a severe hemorrhage. In June, 
1889, she had another hemorrhage, and sent for me. Upon 
inquiry I found she had not suffered with pain in the pelvis. 
On making a vaginal examination I found a carcinoma of the 
anterior lip of the cervix, slightly ulcerated. I explained the 
nature of the trouble to her husband, and advised a surgical 
operation. Some time elapsed before consent was obtained. 
In July I invited Drs. W. H. Barry, M. G. Thompson and 
Linda Barry, of Hot Springs; Dr. T. H. Bates, of Brinkley, 
Ark., and Dr. Thompson, of Ocala, Fla., to go with me to 
make vaginal hysterectomy. The day previous I had sent her 
word to eat nothing after partaking of her breakfast. 
Dr. Gaines commenced to give her chloroform, and in a few 
minutes she vomited quite a quantity of peaches. I stopped 
the operation on account of this, fearing impaction of some of 
the.particles of fruit in larynx. 
September 8, I again visited her to make total extirpation 
of the uterus, and took with me the above named gentlemen, 
with the exception of Dr. T. H. Bates. Drs. M. G. Thomp- 2 
son and W. H. Barry had charge of the anesthetic. The 
vagina and uterus were both quite small, the latter retroflexed 
and freely movable. In order to get room in which to operate 
I enlarged the vaginal opening by freely incising it on each 
side. With vulsellum forceps I drew the uterus down towards 
the vaginal outlet, and divided the mucous membrane in 
front of the anterior lip, then proceeded to dissect between 
the bladder and uterus until I reached the peritoneum. The 
same thing was done on the posterior portion. The citl de 
sac was opened with scissors and dissection continued with 
handle of scalpel. By traction on the cervix the uterus was 
drawn down. When the dissection had been carried high up 
on the body of the uterus, I clamped each broad ligament 
with a pair of Billroth’s large hemostatic forceps, and with 
scissors divided the tissues between the forceps and uterus up 
as far as the end of the forceps, when another pair was applied 
and the tissues again cut. This I continued until ten pairs of 
forceps were applied and the fallopian tubes were reached. 
These I ligated with braided antiseptic silk, and cut them 
loose from the uterus. These sutures were passed around the 
tubes by means of a Peasle needle. I did not open. the 
peritoneum until the tubes were cut loose from the uterus, but 
simply enucleated the uterus from it by dissection. 
Throughout the operation thorough antiseptic precautions 
were used. Patient lost two ounces of blood. About 
one hour was required to complete the operation. Strips of 
iodoform gauze were placed between the handles of the for- 
ceps, the lateral incisions in the mouth of vagina closed with 
silk sutures, an antiseptic dressing of sublimated cotton and 
carbolized gauze applied, and patient put to bed in very good 
condition. * 
Her urine was drawn with a cathter by Linda Barry, a 
medical student, three times a day. At the end of forty-eight 
hours the forceps were removed and vagina irrigated with 
sublimate solution, i to iooo, and another antiseptic dressing 
applied. This was changed as often as soiled by the discharge 
from the vagina. 3 
Patient never suffered from shock or fever, and was well in 
-about three weeks. I made the mistake of not cutting off short 
the ligatures placed around the fallopian tubes, and when I 
undertook to remove them I was compelled to desist and cut 
them off short. 
February 8, 1890.—Mrs. P. has had slight show of blood, 
and upon vaginal examination I found a bleeding and slightly 
hardened nodule in right angle of the vaginal roof, at the point 
where the right fallopian tube had been cut off, and where the 
ligature had been left. 
Case II. I was called by Dr. J. H. Gaines to see Miss M. 
S., aged 42 years. 
I found her suffering from repeated severe hemorrhages 
from the vagina which left her but little strength. 
Upon vaginal examination I found an extensive ulcer in- 
volving the posterior lip of the uterus as far up as the internal 
os. The uterus was retroflexed, enlarged and fixed in the 
pelvis. 
I diagnosed cancer of cervix, with involvement of the body 
of the uterus and broad ligaments. 
The fixedness of the uterus precluded its entire removal, 
and so we advised removing the disease as far as possible by 
means of curette, scissors and cautery. This was attempted, 
and we found the tissues of the uterus infiltrated to a great 
degree with the cancerous material. This was removed as far 
as possible, the actual cautery applied to the raw and bleeding 
surface, and the cavity packed with iodoform gauze. 
She made a good recovery from the anesthetic, and in two 
weeks was up and about the house. 
She died in a few months from disease of the kidneys, albu- 
minuria, followed by suppression of urine.