Chicago School of Medicine and Surgery - Medicos Yearbook (Chicago, IL)

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Page 182 LITERATURE when When the days of school are over, When with our books We are done, When the Springtime brings the clover, And the Graduations come. When no longer We meet for classwork, When from reciting We are free, When no regrets for exams in our minds, And our teachers We no longer see. When the school spirit no longer cheers us, When the glamor of school is goneg When our classmates no longer greet us, And We meet none the Whole day long. When this is our realizaticn. When our destinies are far and Wide, When We've severed our school relations, And companionship found and tried. When alone, Will you get lonely, . Will. school memories be the same, Will you Wish then for the privelege, only To clasp a classmate's hand again. ' Will you long then for the present, Wlith its friendly congenial air, lurk Will the memories be as pleasant, i As now prevails most everywhere. Will you long then just a little, For your classmates, pal, and friend, For the privileges that are ours now And the joys therewith attend. Whenisuch, dear classmates, is your subject, Then you surely can depend, That you'll find a mutual interest- That friendship of friend for friend. W. R. C. ,....,.., .-. ..,.,,... ..,.,,.,.,.,,. -.-,.,-...,..,:g......-,..,...,.,,-...- V. .1 .,.,. -.v ,ua .g.,......,-.. .-.. ,..i -...W Va. .,..,, .,-,.,,.,,,,,,,,,f,V.,,,, , ,,-. ...ng-ff---.

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S., PROFESSOR AND HEAD OF THE DEPART- MENT OF GYNECOLOGY, CHICAGO COLLEGE OF MEDICINE AND SURGERY It is necessary for the scientific treatment of carcinoma of the pelvic organs to determine by a painstaking examination whether the disease is CID localized in the organ in which it originated, Czj widely disseminated into neighboring tissues and organs by an extension of the growth beyond the boundaries ofthe Organ and the formation of metastases, Cglgeneralized by transplantation of carcinoma elements into distant organs, or whether Q45 an existing cachexia, a secondary anemia or other con- stitutional diseases exist, rendering the patient a poor surgical risk. We may say that the disease is either in the first, second or third stage and complicated or un- complicated by the fourth. These considerations are equally applicable to primary as well as recurrent carcinomata. If the tumer is in the Hrst stage, it may be successfully eradicated, in the second stage, the treatment can only be palliative, in the third stage, the disease is absolutely hopeless and incurable, while an existing complicating disease as diabetes, tuberculosis, chronic Bright's disease, chronic heart disease, advanced cachexia and severe secondary anemia, render a carcinoma conditionally curable if they can be removed by appropriate treatment. It is often impossible to determine correctly the different stages of carcinomata of the pelvic organs. Besides a careful bimanual examination we must invariably make use of rectal palpation and indirect inspection ofthe organs by the aid of speculae and endoscopes, as the proctoscope, cystoscope, uteroscope and urethroscope. If we are still in doubt, we must resort to an exploratory laparotomy to establish the true status of the disease, particularly to determine operability from inoperability. A carcinoma in the first stage is one which may be completely and safely removed by an extended radical abdominal panhysterectomy according to the technique evolved by Freund, Stimson, Polk Clark Rumpf Ries, W'erthe1rn and Bumm The percentage of operability varies widely in the hands of different surgeons It may however, be stated that It has been very much extended, due to the fact that such operations, at present, are followed by combined radium and roentgen ray applications with the justifiable hope that the rays may remove such parts of the tumor which the knife could not eradicate and that they also, offer a formidable prophylactic towards recurrences The latter amount to 6C per cent during the first year following the operation without the use of prophylactic raying According to Kroenig and Gauss, Doederlein and Bumm the percentage of recurrences during the first year has been decidedly reduced by the prophylactic application of radium rays Scherer found that 48 of 58 cases which had been subjected to a radical operation and treated prophylactically with radium, were free from any recurrences after three years Kelly and Burnham report IO cases treated bv a radical extended operation followed with prophylactic radium raying Two are well more than three years, one well more than two years, four well more than one year, and thre w ll more than six months I have observed I3 Operable cases that were radically operated and afterwards treated with radium and the roentgen ray These cases were under my care between April IST, 1914 and April Ist, IQI6 Four of the patients have died one four months after operation, on eighteen month one one year, one four months Two patients were not heard from One is well tw nty two months without recurrence, one twenty eight months without recurrence, one twenty months without re currence, one nineteen months without re urrence, one one year without recurrenc , and on ten months without recurrence, that is, six out of thirteen patients are living without a recurrence after more than one year Some of these patients were really inoperable and subjected to a surgical excision with the hope that actino therapy would destroy any remaining carcinoma elements The number of these inoperable cases out of the thirteen is fiye of which one is ahve for twenty one months and free of a recurrence to date Surgical operations for the removal of cancerous growths, therefore, should be followed by an efficient course of radium and roentgen radiation, a procedure adopted at present in every progressive surgical clinic on this continent The purpose of such rayings IS two fold, first, to attempt the removal of any carcinoma tissue accidentally left behind and second, to prevent recurrences after surgical re movals of the tumor The treatment for inoperable carcinomata is a symptomatic one and intends to relieve the patient from the hemorrhage, the foul discharge and the pain, and incidentally the anemia and cachexia The latter results from the insomnia, anorexia, constipation and subsequent loss of weight and the ever X Read at the anuary IQI7, meeting of the South Side Branch of the Chicago Medical Society Page 183 l l A .- 4 , ii . . . . . . . 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