Uterine Cancer in the Early 1900s: An Era Gone By

Sally’s Story

Bending over to pick up the spoon she had dropped, Sally felt dizzy, her head spun, and she almost toppled over. Sitting down on the dining room chair, she braced herself between it and the table. The metal of the table felt warm and sticky under her fingers, and her legs felt slippery from the sweat building up between them and the plastic of the chair.

Blood dripped from under her and onto the floor, forming a trail on the mint-green linoleum. Fear consumed Sally as she tried to process what was happening. She had heavy periods, but this was more blood than she had ever seen. Pain shot through her pelvis, causing her to gasp. She held her breath as the wave of pain peaked, then slowly eased off enough so that she could gather herself. Then another wave of pain consumed Sally, and she sat there helpless, unable to move as tears fell down her cheeks and onto her apron.

Sally’s oldest son came into the kitchen after school to find his mother still sitting at the table, her head down on her right arm, the other hanging to her left side. “Mom!” he hollered as he slipped in the blood on the floor. Catching himself, he got nauseated as he took in the scene. Trembling, he picked his mother’s head up gently and looked at her face, “Mom! Wake up!” was all he could muster; the words froze in the hot air. Sally opened her eyes and looked at her son. He delicately laid her head back down and ran out the door to get help.

Lying in the hospital bed, Sally felt helpless and hopeless. She had been in the hospital for several weeks now in preparation for a hysterectomy. They had found her to have uterine cancer, and since it was early enough in the cancer development, the surgeon told her that he could perform the surgery as soon as she was strong enough. She had lost a lot of weight, and she could feel her hip bones protruding as she lay on her back.

Sally had dozed off after they had scrubbed her abdomen multiple times, and when she opened her eyes, she found herself in the operating room. Several nurses in white uniforms were laying things out on a table, arranging white porcelain bowls, folding towels, etc. One of the nurses came over to her smiling, “Hello Sally, good morning. Your surgery is scheduled to take place very soon, just relax and try to remain calm”, the nurse instructed her.  Sally shivered and looked out the window at the bright morning sun. 

Uterine Cancer Then and Now

In our present medical environment, the use of pelvic exams associated with annual pap smears has decreased the number of women with uterine cancer. In fact, uterine cancer is rare. The survival rate for those with uterine cancer that hasn’t spread anywhere is high. Research has shown that decreasing risk factors for uterine cancer is done by maintaining a good weight and remaining active. 

In the early 1900s, Uterine cancer was on the increase, as seen in the following picture.

From 1850 to 1908, the number of women with uterine cancer went from around 480 to 1000. They recognized that catching uterine cancer early was the key. The question asked by the author is, “How can we reach women with cancer of the uterus in this early and curable stage?”. She goes on to say that education is the key, just as we would say today, with the nurse being the tip of the spear in the education process.

For the advanced cases, the abdominal panhysterectomy or the Wertheim method was the operation of choice. The Wertheim method includes removing the following: uterus, parametrium (between the uterus corpus and pelvic side wall around the uterine artery), pelvic lymph nodes, lady partsl cuff, fallopian tubes, upper lady parts, broad ligaments, and regional lymph nodes.

Preparation for Major Surgery According to Macfarlane, in 1918

1. Careful examination of the mouth, lungs, heart, blood vessels, blood, and urine
2. If the patient’s hemoglobin is below 50%, B/P over 150, rales in their lungs, and mouth offensive from decayed teeth, they are a poor surgical risk, and it may take weeks to get them ready
3. The day before the surgery- Admit the patient to the hospital, and they are allowed to drink lots of water and eat a light dinner. 
4. After dinner, they get a sponge bath or tub bath, and then the abdomen is scrubbed for 10 minutes with sterile gauze, hot sterile water, and tincture of green soap. 
5. Shave the abdomen with a sterile razor, wash with sterile water, then 70% alcohol.
6. Dry with sterile gauze, apply sterile gauze dressing, and wrap a binder over the abdomen with the sterile dressing underneath. 
7. At 9 pm give ½ oz of castor oil
8. Day of surgery, give a high soap suds enema followed by a douche of bichloride solution 1:8000. Send urine specimen to lab
9. 2 hours before the operation, take the binder off and paint the abdomen with iodine, then apply new sterile dressing and binder
10. Dress the patient in sterile clothes, wrap in a sterile sheet, and put them in a wheelchair to take them to the operating room

The operating room in the picture from 1918 looked much different than it does today. A picture is included so that you can get an idea of what it looked like for a minor and a major surgery. 

Minor Surgery 1918

Major Surgery 1918

Women like Sally found out about cancer of the uterus, or any other female part, by symptoms that developed. Screening hadn’t been developed and education of the female patient was just beginning. This peek into an Era Gone By has helped us to understand the medical and surgical care of the female patient in the early 1900s.

Reference/Resources

Catharine Macfarlane: Reference Hand-Book of Gynecology for Nurses, Third Edition