If we examine the age at which the great majority of cases of cancer occur, we shall find still further proof of their connection with the sexual system. The average age at which this disease makes his appearance is about the forty-eighth year. This of course brings the disease in immediate relation with he change of life. And in fact there is little reason to doubt that the change of life. And in fact there is little reason to doubt that the various causes which so afflict the female economy as to result in the development of this disease, find their culminating point at this climacteric period. All of the proving influences already mention may concentrate their forces as it were at this period; and produce such cancerous disease at or soon after the cessation of the menses as they could not have done before.
And this disease may be developed dint he uterus or in the breast, or in some other part or organ, under the influence of other local provoking causes; or under the influence of what may be tempted a reduplicated hereditary predisposition. For example, a woman of cancerous constitution whose mother had cancer of the womb, will be so much the more like to have this dyscrasia in here own case developed in. the dame organ. and at this time, than those who have remained single; although may case of the latter sort are recorded. And, in. his country, this form of disease is such more prevalent in the Southern than in the Northern States. It has been observed that at the South the same constitutional dyscrasia assumes the form of uterine cancer, which at the South the same constitutional dyscrasia assumes the form of uterine chance, which at the North would, at an earlier period of life, have been developed in the form of pulmonary phthisis.
CANCER OF THE UTERUS-The preceding discussion of cancer in general, will obviate the necessity of he more than a very brief account of the particularly forms and varieties of his disease sit in which cancer appears in the uterus, breast or other organs. The most common form may be slow and insidious or very rapid in its in is development, according as it attacks the older or he younger females; and it is usually the least amenable to treatment. In fact, unless it can be diagnosed in its earlier states, and properly treated from the very first, the prospect of doing any more than to relieve and prevent suffering and so perhaps prolong life, is more than doubtful. Scirrhus of the womb passes through two general stage and thus may appear to the physician on his first examination, under either of its two forms. These are the primary form of induration and the secondary form of induration and the secondary roam of ulceration.
The Indurated, non-ulcerated Cancer of the Uterus-This disease almost invariably attacks the cervix; but in some rare cases it is found primarily in. the fundus or body of he uterus itself. From the view we have taken of he nurture of the cancerous affection, it will be natural to include, as it taught by high authority on this subject, that the disease doses not spring form a previous ad different form of inflammation with or without induration. But that cancer is sui generis, that it arises as it were on a general constitutional foundation all its form own, seated built up and developed ulcer the influences of special provoking causes.
And from its remarkable tendency to a fatal termination, it become most important to determine the existence of the disease at the earliest possible moment;l but this is no less difficult than it is desirable. For where the indurated form of cancer attacks females at the critical age or more advanced period of life, its onset is gradual and insidious; and t is liable to be confounded with the induration which may result from benign inflammation. And where it attacks younger females it may develop itself symptoms as would would to an examination of the affect organ.
Disease of he uterus of much less importance than cancer may give rise to much more strongly marked symptoms “I must again repeat, that my own experience, as well as the analyses of that of others, lead me to the conclusion, that cancerous growths of he uterus in the incipient or non-ulcerated stage of their development, are always indolent, and give rise to no symptoms sufficiently decided to induce patient to complain or to seek advice. Thus we under the notice of the conscientious practitioner, who never uses the speculum without serious reasons for so f doing. Easy as it is, of the disease, it is often very difficult to distinguish it in the commencement, from a simple induration of a benign character in the lower portion of the uterus. The diffused swelling so the affected part, with a considerable hardness and complete absence of sensibility the appearance of the disease at the critical age and the impossibly of referring he commencement of the affection to an anterior labor, may be regarded as characteristic signs of the commencement of cancer. And there is no doubt but that in many cases, especially of women who still menstruate the cancer is very rapid in its growth and progress; and so may attain considerable size and present extensive induration and adhesion to the surroundings parts before its existence is suspected. add even then the result of vaginal exploration are said to the insufficient to distinguish in a certain manner a chronic engorgement for the vaginal portion of the cervix uteri from a scirrhous induration. A careful study of all the symptoms and conditions of the patient will be absolutely essential in order either to determine the nature of disease or to decide upon the appropriate remedy.
As it is of the utmost importance to distinguish cancer of the womb at the earliest possible period, we gather from other writers the records and summary of symptoms which may appear before the cancer advances to the ulcerated stage. Among the earliest symptoms, are: “Leucorrhoea alone or combined with menorrhagia; aching in the back; and seems of heaviness in the hypogastrium; dull pain in the top of the thighs; with bearing down; then there occurs darting lancinating pain between the pubes and the sacrum, or in the course of the vagina, with a sensation f flowing heat, more or less frequently experienced, and often attended with dysuria and mucous disposition from the uterine; itching of the vulva; which is affected with a kind of flabby selling or with erysipelatous inflammation; pain in coitus; dyspeptic symptoms prevail, such as flatulence, heart- burn, sometimes vomiting and sympathetic cutaneous eruptions. Or the appetite may at first be very greatly increase,-and the digestion excellent,-or with attacks of indigestion from over- eating. “In the course of the disease, retention of urine frequently occurs, requiring the use of the catheter; or incontinence of urine may taken place.
The first symptoms generally are: menstrual irregularities, a temporary increase of the menstrual flow; leucorrhoea, which is either continued or lasts for a short time only,-white or yellowish, sometimes changing to a reddish color after intercourse, or after any other local irritation sense of weight at the hypogastrium, with pressure on the rectum, or on the urinary organs; still and emission o urine sometimes more painful and always more or less difficult; disagreeable sensation during intercourse; occasional transitory shooting stitches, especially at the period of the menses, or after physical or moral excitement; transitory pulling in the loins or groin and hysterical ailments; haemorrhoidal distress; alternate occasional transitory shooting stitches especially at the period of the menses, or after physical or oral excitement; transitory pulling in. the loins or groin and hysterical ailments; haemorrhoids distress; alternate distention and caving in of he abdomen, etc. Sometimes we discover even at this period, slight swellings or indurations of the womb, occupying rather the neck than the body of the womb, with a soft of irregularity in the have of the neck. These symptoms may remain unchanged for a long time; but as soon s cancer has openly set in, the neck and event he body of the uterus, and likewise the lips of the so tincae are swollen, hard knotty, lobed and more or less red, but smooth and not sore, covered with bloody mucus, or with pure blood, painful to pressure and sometimes accompanied by engorgement of the ovaries. In some cases there is only a single sailorly circumscribed tumor, the seat and extent of which may be discovered by an examination through the rectum; in most cases there are several tumors, when cancer does involve the body of the uterus, it may be distinguished from fibrous tumor by its presenting a hard swelling of the whole uterus, -and by the adhesions to the adjacent parts, which attend such malignant indurations.
In attempting at the earliest possible period of diagnosis of a supposed cancerous affection of he uterus, we should consider:
1. The portion of the womb affected; the vaginal portion of he cervix being the most likely to be attacked by scirrhus.
