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

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LITERATURE present complication of infection which is usual, of a pyogenic character. The therapeutic procedures to combat the three cardinal symptoms are the use of caustics, as zinc chloride pastes, calcium carbide, Gellhornls acetone treatment, the live cautery as the red-hot soldering iron, the Percy cautery, or the electric cautery knife, the intravenous and subcutaneous administration of autolysins, enzymes, colloids and arsenic preparations, and finally the application of the radium and roentgen rays. If we, critically, consider the clinical results of these various methods of treatment, we must draw the conclusion that the combined use of radium and roentgen rays gives the best immediate and remote results. The latter also obviate the use of an anesthetic and a prolonged stay of the patient at a hospital, do not subject her to additional suffering and pain, and are devoid of immediate and remote dangers. The clinical results also are better and more lasting. The patient regains her working and earning capacity, is enabled to enjoy life like any well person, and an examination reveals a local healing of the disease. Radium therapy in inoperable carcinomata has in my hands not yet proved curative. i. e., to bring about an anatomical cure of the tumor, as not a single patient so far has survived a period longer than thirty months. Abbe, Degrais, Kelley and Clark, however, have reported cases which remained well eleven, nine, eight, seven and four years respectively. Generalized cancer disease is hopeless, and therefore the use of palliative measures is hardly worth while. Wie cannot hope to beneht a patient who already stands with one foot in the grave, so to speak. At times we may obtain a remarkable improvement in such cases, however. Therefore radium and roentgen rays should be given a trial even in advanced cases. This fact may be explained by our in- ability to differentiate between an extension or an infection of the parametrii and regional lymph glands. Inflammatory tumefaction becomes readily organized after radium application, on account of the local healing of the cancer growth caused thereby. My statistics show that from April 1st, 1914 to January ISE, 1917 I have treated Q9 inoperable cases of carcinomata of the uterus, bladder, urertha and rectum with radium and the roentgen ray. Seventy-one were uterine, I4 rectal and I3 bladder, urertha and prostate carcinomata. Of the uterine carcinomata 47 were inoperable and 24 inoperable recurrent carcinomata. Of the forty-seven inoperable uterine carcinomata- Six died soon after treatment .... ......... . . . 6 Seven were no-t heard from ..... ............. . . . 7 Of the remaining number twenty-one died ..... . . .21 And thirteen are living ...... .........,..... . . .13 I - 47 The time elapsed between the radium treatment and death is as follows:- One ..... ................................. 3 1 months One . . . , ,22 H One ..... , . .16 One ..... . . .12 L' Five ....... . . . 9 L One ..... . . . 7 Two ....... . , . 6 Two . . . , , , 5 ' Two . . . . , . 4 Four.... .,. 3 H One ....... .......................................... 2 The time elapsed since the radium treatment in those who are living is: One.. ............................ . . 22 months, with recurrence 8116... . . . .21 'E without ne.... . . .21 ' with H One.... . . .17 with gne... . . . .14 'i without ne.... ...12 ' with I One... . .. .IO H without One... . . . 8 with One... . . . 8 ' without H One... . . . 2 without 'K One... . . . 2 without gnc... . . . . 2 'E without H ne.. ...... .. 1 Thirteen The causes of deaths, occurring soon after beginning two from pelvic infections, and three from exhaustions due Page 184 of treatment were one from heart block to advanced disease.

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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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'semi ,z , Q' flfifii z. .VT -.z. . ,, Q fz'fI-' Qi-were J i --P' iiazw - - . -. 'fv-fb w' .gfff 'L' fi? f Q'-ax ' -. 'ft 9-.4 f ,T i W. will R N , . 1..v.........a.A.m.... ...,.-.,,., megan, .,,,, . .,,. i 'Q -' ,.h.....,,.-..... .vrr .. . H. V .. Y . . -.. ., . .., . . . . I? ij If - ' -M LITERATURE ', SQ if Of the twenty-four recurrent uterine carcinomata twelve have died, six have not been heard from fo 'a , V. 'Z and six are living. The time elapsed since the radium treatment in those who succumbed is:- I 1 Q 1 One after I7 months lr One IO .y .X Twvo zz zz ' IK 9 fl L, 5. 3 One 8 . j' 2 Three 6 H I Y l Two Q ' ' z S - I l' 1 f ' E 1 Twelve I I ' Twelve... . . . 1 Six did not report ..... ...................................... 6 is The time elapsed since radium treatment in the living is:- 'Q' 2 I ' One.. .............................. IO months, with recurrence ' ll ll - 3 1' One.. .... f ....,.........,........... without .5 f GHC zz zz 7 ., 7 z .' 4 KK I! 3 with .3 Q One.. .....,,........ . .........V ..... W ith .. L! If without 5 K One.. ........... ............. ' .,.. . . , 'al 5 One.. ....................,......,.. 2 without 'A sp l. ' .Q l Six ..... ................................................... 6 i 24 'f ' Two died soon after treatment. One from exhaustion and the other from sepsis. 5' 1 Of the rectal cases, two have not been heard from, and of the remaining twelve six have died and L' V I u a n n I . s QA 5 six are living. The respective time elapsed since .treatment 1s:- - l lf ' No report ..... ........................................ ' ..... 2 , - 1 . . gi , One died soon after iirst treatment from advanced cachexia. One after I7 months One Three L zu' IX months with recurrence wit 1 without with without without One l1V1I1g I5 One One One One One 1X Of the thirteen urinary system carcinomata seven have died and six are livin One died soon after treatment from exhaustion Two aftei 6 months One One One One ix Of those who are One One One One One One living the time elapsed and present conditions are living 24 months without recurrence Without with without without not yet examined IX Page L93 F 5 zz I2 zz I zz 6 zz . N .S 5 - s ..... ........... , ....................................... 6 . 11. it 3 - ' - . nt zz - zz ' I l zz I3 zz -I zz ,. f II w: ' zz zz - zz ll zz Z zz - zz , ,il zz 2 zz - zz 2' I S' ..... ................................................... 6 z I I4 zfi ' ' ' , l ' E- I I p ' ' .... .. ........ .,. 1 zz zz zz 52 zz af ff'-. ' zz if I zz 9 zi if 2 lil I s' ..... ...................,......................... .. 6 ,, I . . . . . - - :1 z Q zz zz - zz - I '. zz 3 zz ' zz r zz zz - zz fi A zz 2 zz N - zz A f zz Z zz ' S' ..... .... ,.... . , ................ , ................... 6 . I3 5, . I