Reprinted from the New York, Medical Journal 
for October If 1893. 
THE EARLY TREATMENT OF CARCINOMA UTERI. 
By HOWARD A. KELLY, M. D., 
PROFESSOR OF GYNECOLOGY AND OBSTETRICS IN THE 
JOHNS HOPKINS UNIVERSITY ; 
GYNECOLOGIST AND OBSTETRICIAN TO THE JOHNS HOPKINS HOSPITAL. 
The large number of hopeless cancer cases constantly 
applying to me for relief have induced me for the past 
three years to adopt certain stringent rules with regard to 
my own patients, which I have taught for the same period 
in my lectures at the Johns Hopkins Hospital. 
The end in view is twofold—first, by treating cervices 
liable to become cancerous, and thus prevent the formation 
of this neoplasm, and, secondly, to detect cancer of the 
cervix at a sufficiently early date to successfully eradicate 
the disease. 
1. It is the duty of the obstetrician to see each patient 
at his office from two to three months after her confinement, 
and there to examine and make a careful record of the con- 
dition of the pelvic structures, stating accurately what 
lesions have been produced by the confinement. 
2. Cervical lacerations should be carefully described, 
noting the position and depth of the tear and the appear- 
ance of the lips. Lacerations require no treatment when 
the lips are thin, uninfiltrated, and lie together. Thick, in- 
filtrated, and everted lips associated with cervical catarrh 
Copyright, 1893, by D. Appleton and Company. THE EARLY TREATMENT OF CARCINOMA UTERI. 
call for depletory treatment followed by repair of the la- 
ceration. 
3. Every woman who has passed thirty-five years of age 
and has borne a child should have this examination made 
without delay by a competent physician, and if the cervical 
lips do not appear perfectly sound she should be kept under 
observation and examined at intervals of from six to eight 
months. 
4. Every woman over thirty-five, with a cervical tear, 
should be examined at least once a year for ten years, or 
longer, if the appearance of the lacerated area is not per- 
fectly healthy. 
5. These rules apply with special force to patients 
whose family history shows a marked inclination to can- 
cerous diseases. 
If these rules are conscientiously observed there is not 
a shadow of doubt but that thousands of lives would be 
saved yearly in this country alone by timely interfer- 
ence with a disease so markedly local and accessible in its 
origin. 
I feel that while we are searching for a cure for cancer, 
the line of progress in the immediate future for the gynae- 
cologist is clearly in the direction of prophylaxis and an- 
ticipation, either preventing or discovering the malady in 
its earliest stages.