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246 R a d i u m
laboratory, 9. or 3 per cent proved to be adenocarcinoma, the remainder.
183. or 95 per cent, being squamous in character. All the cases which
have shown no recurrence, after three years, were of the squamous group.
As to the age and type of growth, the youngest case, 12 years, showed
adenocarcinoma, while the ages of the other cases, in this group, all
ranged between forty and fifty years.
A study of the location and extent of growth on admission furnishes
several points of interest. These facts have been established, in all
but the few classed as inoperable, by pelvic and rectal examination
under a general anesthetic, and. in the cases where excision was done,
by direct observance at operation and subsequent study in the laboratory.
In only 48 cases the lesion was confined to the cervix alone; in 40. it
had extended into the vaginal walls, while in 103 it was decided that
the surrounding parametria! tissues were involved. Of the 16 cases alive
over three years without recurrence. 11 showed cervical involvement
only; four showed extension to the vaginal walls, and one case beginning
extension into the parametrium. Of the cases in which recurrence
took place after three years, all but one originally had involvement of
cervical tissue only. Thus, in these cases traced, a favorable prognosis
depended very materially on whether or not the growth was limited to
the cervix.
Type of Procedure.—As stated previously, the type of procedure in
handling these cases of carcinoma of the cervix has varied considerably
from time to time during the eleven years covered by the report. Before
the use of radium cases were divided into two groups,—the operable
and the inoperable.—the latter being treated onlv palliatively, or with
chemicals such as acetone. The operable group had either the classical
Wertheim type of operation, or a complete hysterectomy, with rather
wide excision of the broad ligaments; and both of these were, as a rule.
combined with cauterization cf the cervix. The latter was accomplished.
in some cases by the actual, or hot, cautery, and in others by the Percy
method. In an intermediate group of cases excision was not attempted.
but the cervix alone was subjected to cauterization by one of the two
methods mentioned above.
After the adoption of the use of radium in 1917. a number of cases
were still treated by these procedures, but soon thereafter the presentday
methods were develo|>ed as follows. Extremely early cases are still
considered operabie and receive radiation with the clement both before
and after excision. A varying period of from two to six weeks is
allowed to elapse between the primary radiation and hysterectomy, and
here a modified Wertheim, with exposure of the ureters in their lower
course, or a rather wide complete hysterectomy is done. Postoperative
radiation in the healed vaginal vault is begun before the patient leaves
the hospital, and is continued later, if the original extent of the growth
seems to warrant it. The average preoperative application of radium
is 2400 milligram-hours within ihe cervical canal and growth.—while the
average postoperative dose is 1000 milligram-hours. The element itself
is used in silver and brass capsules.—one 50 and two 25 milligram tubes.
At present the inoperable cases are treated by repeated radiation of the
growth,—the primary application usually being 2400 milligram-hours:
and those following depending upon subsequent examination, and the
possibility of vesicovaginal aid rectovaginal fistulae.
Table I show* the 201 cases grouped according to the type of op-