With Compliments of lhe Author. 
IgPITH ELIO M A.&.gER VIXOtE RI. 
a/ 19 
I® 
sK 
Amputation with Paquelin's Thermo-Cautery. 
I 
H. P. V. WILSON, M. D., 
Vice-President of the American Gynecological Society, Surgeon in 
Charge of the Woman's Department of the Baltimore 
Union Protestant Infirmary, Etc., Etc. 
Reprint from the Maryland Medical Journal for December, 1878. 
BALTIMORE: 
.J. H. FOSTER & CO., STEAM PRINTERS AND 
No 9 South Charles Street. 
-1878.- epithelioma of the cervix uteri, amputation 
WITH PAQUELIN'S THERMO-CAUTERY. 
(Read before the Baltimore Academy of Medicine, October 15th, 1878-) 
BY H. P. C. WILSON, M. D., VICE PRESIDENT OF THE AMERICAN GYNE- 
COLOGICAL SOCIETY, SURGEON IN CHARGE OF THE WOMAN'S 
DEPARTMENT OF THE BALTIMORE UNION PROT- 
ESTANT INFIRMARY, ETC() ETC. 
Since cancer occurs three times as often in women as in men, 
and three times as often in the uterus, as in any other organ of 
the body, nothing can be of more interest to the gynecologist, 
than any suggestion which throws light on the therapeutics of 
this disease. It is so forbidding to all physicians ; such a terrror 
to all patients; so disgusting to all attendants ! 
We feel how hopeless our efforts are in behalf of the poor 
sufferer, on whom this malady has fixed its relentless grasp ; and, 
despairing of cure, we only grope in darkness for something to 
palliate the disease, and soothe the patient in her painful progress 
to the grave ; something to make life more bearable ; something 
to make its victim less loathsome. 
It is for these reasons that I bring before the Academy of 
Medicine, this evening, a cancerous cervix uteri, amputated with 
Paquelin's Thermo-Cautery ; hoping that in this instrument we 
may have a valuable addition to the very few agents, now in our 2 
Epithelioma of the Cervix Uteri. 
possession, for eradicating cancer of the neck of the uterus in its 
incipiency, or modifying it in its advanced stage. 
It will be seen that this cervix was amputated for epithelioma 
involving only the neck; and, although the disease evidently 
began eight months before, the body of the uterus, and all peri- 
uterine tissues were free, and the general health unimpaired. We 
therefore hope for permanent eradication of the disease. 
But from its facility of manipulation as a cautery, we hope from 
this instrument beneficial results in arresting hemorrhage ; in 
safely removing sloughing and decomposing tissue ; in diminish- 
ing offensive odors ; and in prolonging life, even in those cases 
which must terminate in death. 
On the 19th of September 1878, I was asked by Dr. Milten- 
berger to see Mrs. K. in consultation with him. I found her 
looking in good health, 46 years of age, rather corpulent, present- 
ing little, if any, of the cancerous cachexy, and emiting nothing 
of the cancerous odor. She gave the following history. 
She was 17 years old before she first menstruated, and it was 
then established with some difficulty. From that time to Janua- 
ry last, (twenty nine years) she was regular, and without pain 
with her menses. Fifteen years ago she was treated by another 
physician for what he called " ulcerated womb," and had some 
menorrhagia for a few months. Since then menstruation has 
been perfectly regular and comfortable. In January last she 
missed her menses for the first time since established. They 
returned in February, and to the day of my seeing her, she has 
never been free from hemorrhage. At times there would escape 
clear blood-sometimes large clots of blood-occasionally profuse 
gushings of water discolored with blood, and now and then, a 
dirty meat-washing discharge ; but all discharges were remarka- 
bly exempt from offensiveness. She had some pain from time to 
time, through her loins and lower abdomen, but not enough to 
keep her from sleeping under bromide of potash. She had been 
married twenty-six years, and never been pregnant. 
Dr. Miltenberger had diagnosed cancer of the uterus. By a 
careful digital and speculum examination, I confirmed his diag- 
nosis. ZZ P. C. Wilson. 
3 
The body of the uterus was of normal size and feel-presenting 
no undue hardness, nor fixation in its position. The neck was 
much enlarged, and presented different features in different sections. 
The right side of the cervix, from a few lines distant from the os, 
was in a state of well marked ulcerative epithelioma ; while the 
portion just around the os, and extending over about two thirds 
of the left side of the cervix, was hard and nodulated, and in the 
stage of commencing vegetating epithelioma. Deep down in 
the cervical parenchyma, beneath the vegetating epithelioma, ex- 
tended a condition of induration, which may have been this or 
some other variety of cancer; for it must be remembered that 
one form of cancer differs from another, only in the amount of 
fibrous, cellular, or gelatinous tissue, which predominates in each 
particular instance, and these differences are of more interest to 
the pathologists, than to the general practitioner, since the ter- 
mination of each variety must be the same if left unarrested. 
About one third of the left and posterior half of the cervix, near 
the vaginal junction, had a healthy mucous membrane, and no 
subjacent hardness. The peri-uterine cellular tissue was perfectly 
healthy. 
In passing, let me remark, that the gentlest manipulation of 
the cervix, produced profuse hemorrhage, and my examination 
was not satisfactory, till frequent and liberal spongings with vine- 
gar, arrested the bleeding. This use of vinegar was suggested 
to me by my friend Dr. J. P. White, of Buffalo, and I can confi- 
dently recommend it in place of water, for cleansing a cancerous 
surface preparatory to inspection. 
With the body of the uterus healthy in size, density, fixation 
and position, with the peri-uterine locality free from disease, 
with a portion of the cervical mucous membrane, and subjacent 
tissue not yet involved,-1 did not hesitate to recommend ampu- 
tation of the cervix, as the only means likely to save the woman's 
life, and in this opinion my distinguished colleague was in full 
accord. 
On the 7th of October, 1878, after taking a liberal drink of 
brandy, the patient was chloroformed by Dr. Miltenberger, and 
on a table, in Sims' position, with Sims' speculum, held by my 4 
Epithelioma of the Cervix Uteri. 
nurse, and with Dr. Griffith as my right harfd assistant, I pro- 
ceeded to remove the whole cervix up to the vaginal junction. 
All the ragged edges were neatly trimmed with the cautery knife, 
and much of the substance of the cervix, above the vaginal junc- 
tion, was peeled out with the same, till at the end of the opera- 
tion, the cervix presented the appearance of a hollow cone, with 
the little end extending up to, or within the internal os. In this 
way I am sure, all malignant ramifications were removed. 
A pledget of cotton, soaked in MonseH's . olution of sub-sul- 
phate of iron and glycerine (one part to three), was applied to 
the stump. The vagina was accurately tamponed, and the 
patient lifted into bed, and given an eighth of a grain of morphia, 
and twenty grains of bromide of potash, after nausea from chlor- 
oform had ceased. The iron was used as an antiseptic: the gly- 
cerine to lubricate the parts, and prevent the iron from collecting 
into indurated, insoluble masses ; and the tampon to guard against 
any possibility of primary or secondary hemorrhage. 
The patient is now in her tenth* day, and it is remarkable how 
exempt she has been from all constitutional disturbance. Her 
pulse has at no time been above eighty-six, nor her temperature 
above ninety-eight. She has had little or no pain, but complained 
for a day or two of much soreness about the pelvis, lower abdo- 
men and thighs. The tampon and iron dressings were removed 
on the third day, and the vagina washed out daily thereafter, 
with warm water containing carbolic acid. The seat of amputa- 
tion presents a healthy granulating surface. 
To mention some of the difficulties which occurred to me in 
the use of Paquelin's thermo-cautery for amputating the cervix, 
may not be uninteresting to the gentlemen present, who have 
never used the instrument for this purpose. I shall counteract 
most of these difficulties in a second operation of the kind, and 
may help others to do the same. 
The greatest difficulty to be overcome, was to prevent the steel 
shaft of the knife from burning the walls of the vagina, while its 
hot, curved, platinum point, was swept around the cervix, in the 
act of amputating close up to the vaginal junction, 
♦At the end of four weeks she is up and well. H. P. C. Wilson. 
This difficulty was overcome, first, by surrounding the shaft 
with wood, and securing it against splitting and dropping off, by 
twisting a piece of wire around it near either extremity, and 
causing the wire to bury in the wood. It was secondly, to a 
great extent overcome, by fixing a strong pair of bull-dog forceps 
in the cervix, and pulling it away from the vaginal wall, in the 
opposite direction from each successive point of incision. 
A second difficulty which I encountered, was in the amount of 
hemorrhage, which continued up to the point of severing the 
cervix. I supposed that by passing my cauterizing knife over 
the bleeding surface, I should effectually control all loss of blood, 
but with each plunge of the knife into the cervix, blood for a 
moment came freely, and sponging was necessary, before making 
each incision. 
True the loss of blood was small, but I had supposed I should 
lose none ; and the amount was important, only as it obscured 
vision, as to the point of proper application of my knife, or gen- 
erated steam by coming in contact with the heated cautery. 
Blood or steam in the vagina equally obscured vision. No doubt 
this bleeding was due to heating my knife too hot, and amputat- 
ing too rapidly. From the first cut to the last, occupied ten or 
twelve minutes, and was done so rapidly to insure the vagina 
against the long continuation of such intense heat. 
A third difficulty which I experienced was in not having enough 
assistants. I had three, but wanted a fourth to keep the vagina 
free from blood, while I applied my knife with one hand, and 
manipulated the forceps with the other. Four assistants are 
always needed for this operation with this instrument. One to 
give the anaesthetic ; one to hold the speculum ; a third to man- 
age the thermo-cautery; and a fourth to sponge and render gen- 
eral assistance. 
I never blessed the name of Sims more, or thought more of 
how much gynecology owed to his genius, than in this operation. 
If he had done nothing in his life, but given us " Sims' position," 
and "Sims' speculum," his name should go down to posterity 
among the immortal ; for in no other position, and with no other 
speculum, could I have swung about the cervix, and manipulated 
5 6 
Epithelioma of the Cervix Uteri. 
my knife and made a thorough clean operation, without injury 
to the vagina. 
This was my first operation for malignant disease of the uterus, 
with Paquelin's thermo-cautery, and I was greatly impressed with 
the beauty and thoroughness of its work. It not only does all 
that any ecraseur can do, but it does it under the guidance of an 
intelligent hand and eye, and thereby avoids the accidents, which 
may follow the ecraseur. with the most skilful management. It 
does more. After removing the whole cervix up to the vaginal 
junction, it can accurately peel out any suspicious malignant 
remains, which may extend up the cervix, above the vaginal 
junction, as was done in the present instance. 
By the history of this case it will be seen, that there was almost 
entire absence of constitutional symptoms, and that the disease 
was confined to a limited locality. It had not advanced so far, 
that it could not be accurately identified as epithelioma, that form 
of malignant disease which is most slow to involve the general 
system, and least apt to recur in its present, or some other locality, 
if thoroughly removed ; and hence I was led to give a favorable 
prognosis for an operation in its immediate and remote results. 
Appropriate here are the words of our distinguised countryman, 
Dr. T..Gaillard Thomas, when he says : " in the commencement 
of each variety of malignant disease the pathological differences 
would be easily recognized ; but as epithelioma advances, and 
the subjacent tissues become involved, a differentiation would 
often become, not only difficult, but impossible." 
In this single case, we find epithelioma, in the stage of ulcera- 
tion, on one portion of the cervix ; epithelioma, in the stage of 
commencing vegetation, on another portion of the cervix; and 
epithelioma, (or some other variety of cancer) involving a limited 
portion of the parenchyma of the cervix. With a little further 
progress, we might have been puzzled in our diagnosis of the 
particular form of cancer to which this belonged. Hence the 
importance of an early examination of the uterus, in all cases of 
unusual hemorrhage, or any other abnormal symptoms; that 
malignant disease if present, may be promptly recognized, for an 
accurate diagnosis, as well as prognosis. By a little delay we H. P. C. Wilson. 
7 
may be mystified in both, and lose the only opportunity for life, 
by removing the disease in its inception. 
If the general practitioner, was as prompt to examine a woman's 
uterus, as he is to examine any other portion of her body, under 
the slightest suspicion of disease; the maladies of that organ 
would be universally discovered in their acute form ; life would 
be saved in many cases where it is now lost; drugs would be 
kept from stomachs into which they are so uselessly poured, and 
the struggles of the gynecologist with chronic disease, would not 
be so long, and often so fruitless. 
No portion of the female organism is subjected to as many 
shocks and strains, as the uterus and its appendages; no organs 
in her body are entitled to as much and frequent disease, The 
ovaries are congested, and graaffian vesicles are ruptured once 
every month ; the womb is monthly pouring out blood, and 
frequently subjected to the racks of labor, or the shocks of 
abortion; the vagina and its adjuncts endure the excesses of the 
marital relation ; all the pelvic organs are in a monthly state of 
overexcitement, and thereby ready to take on disease under the 
slightest provocation ; and yet, even in these days of gynecologi- 
cal advancement, many general practitioners ignore the uterus in 
their explorations, or interview it only at the eleventh hour, when 
numerous diagnoses have failed, and a multitude of drugs have 
been given for nought. 
The profession at large must learn to change in this respect, or 
their patients will soon learn to change their physician. The 
mothers who bore us, have wombs, as well as stomachs, ovaries 
as well as livers, and vaginas as well as throats ; and these organs 
peculiar to woman, must not be neglected, or excluded, as seats 
of disease. 
Strange as it may seem in these days of enlightenment, I very 
recently heard a distinguished practitioner of medicine say, that 
he did not " believe in examinations of the womb and its appen- 
dages." Although his views are extreme, they are reechoed in a 
less degree, by many of the profession ; and yet these gentlemen 
would think it very inexcusable in any one to prescribe for a 
patient, suffering with the symptoms of throat disease, without a 8 
Epithelioma of the Cervix Uteri. 
careful examination of the throat; but this is what they are doing, 
every day for the uterus. 
Because it is more disagreeable to examine a uterus than a 
throat, men must not shrink from their duty to know promptly, 
that they may arrest promptly, uterine disease. They must rea- 
lize that it is as proper to examine the vagina and Womb, as the 
mouth and throat, and thus being always watchful of these pecu- 
liarly impressible organs in the female, guard against those 
chronic diseases which render so many lives miserable all their 
days. It is rare for me to see a case of uterine disease, which 
has not been in existence from two to ten years.