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

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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

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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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::r::.:-,:::r::-cr:f1-fue.v.:-:q-.c:- ' ' -f an rw:-,fi - 'nw---is-H V:-1: -wf-n-:-U1f'- .,..,: .,.,..,,..,.,..,.-,--1--s:f:v..,,,,,,1-,, LITERATURE C I have stated that the clinical results of ray treatment of inoperable pelvic carcinomata compare favorably with the hitherto customary treatment of cauterization of such cases. The comparativ value must be based on a comparison of results obtained by these various methods. Fifty-three cases of inoperable uterine carcinomata were treated with the Percy method from February ISK, 1914, to July ISK, 1916, at the Mayo clinic. In about 80 per cent. of these cases freedom was obtained for about nine to eighteen months. Seeley reports the post-operative history of twenty three patients treated with the Percy method. Of these, fifteen are dead and eight are living. Of those who died, one lived nineteen months, one eleven, one ten, eight four to eight, and four less than four months. Gessner observed that one-fifth of the cases treated with the cautery were not benefitted by the procedure. About one-half showed marked improvement, while in the remainder of the cases the hemorrhages disappeared but the discharge continued. The general state of health was improved, therefore, in about 75 per cent. The average expectancy of life was about two hundred and twenty- four days, i. e., seven and one-half months. Gebauer reports the following results in 58 cases: Death ensued within the first half year in seven patients, within the second half in nineteen, during the second year in twenty-five, during the third year in four, during the fourth year in one and during the fifth year in one. Kelly reports 213 cases of cancer of cervix treated between January Ist, 1909 to January Ist, 1915, I4 operable and 199 inoperable or inoperable recurrent cases. Of the I4 operable cases, IO were operated and treated prophylactically with radium- 2 well more than 3 years ' I ff fl If 2 If lf If If I if 4 3 H 6months Four operable carcinomata were treated with radium only. All are well, 2 more than 3 years and 2 more than one year. H Of 199 inoperable cases, 56 are clinically cured, 109 markedly improved and 37 note improved. Of 50 clinically cured cases, originally inoperable. 2 are well more than 3 years 4 rc fc rr than 2: cr I7 fr H rc cz I cr . IO H H H H 6 IT1Ol'1'Cl'1S Eighteen cases of originally recurrent cancers are clinically cured and have remained well 1 more than 6 years I H lx ll II ll -ll 42 ff IO CC Cl I CC 5 6 months , Of the fifty-twoinoperable uterine cancers of which I have complete records of the duration of life since the radium treatment, extending over a period of three years, 33 died, 20 during the first half, 9 during the second half, 3 during the second year and one during the third year, while of those living, 7 are in the first half, 6 in the second half and 6 in the second year. The average duration of life is eight months and seven days. Gebauer lost SI cases during the first two years, and I have so far lost 33. We may, therefore state that the expectancy of life after radium therapy is somewhat higher than after cautery. U Improvement in the technique of acting therapy is possible. I cannot see where an advantage could be gained from the exclusive use of 'radium emanation in lieu of radium salts or large massive doses of say 200 to 1,000 mgrm. of radium element. Even the use of 100 mgrm. is detrimental to the patient, considering the primary constitutional reaction and the remote destruction of tissue. Rectal tenesmus and pain, diarrhea, bladder irritation and nausea are much severer than in cases where the same milligramage is given but with smaller amounts. Definite amounts cause destruction of healthy tissue. If 50 mgrm. X-rays cause a burn in eight hours, then 100 mgr . x-rays concentrated within the same area will cause a like destruction within less than three hours. The ideal of radiotherapy must be to obtain results by causing degeneration of the malignant cells and not destruction of tissue, either pathological or normal. The amount of milligrams of radium element to be employed in a given case should not be based on the quantity a radium therapeutist might possess, but on the actual extent of the carcinoma, to be determined by a painstaking and thorough examination of the pelvic organs. I look forward to the development of a more rational technique to bring about better results. This should consider the perfection of radium applicators and proper surgical procedures to aid in the insertion of the radium and to assist the action of the rays. As far as economical considerations are concerned, radium treatment should not be any more expensive to the patient than any of the other palliative measures advised. I have attempted to bring the matter of radium-therapy before you in an impartial manner. If other workers in the field can challenge my careful observations and painstaking work by demonstrating better results, I am only too willing to submit to their criticism and profit thereby. I consider the result achieved so important that the profession should encourage the radium workers by a more general adoption of the treatment in their cancer cases. Prophylactic radium treatment increases greatly the efficacy of the operative procedure, and the application of radium constitutes the best palliative measure which we can offer to the unfortunates suffering from inoperable pelvic carcinomata. Page 186 ' I ngvxzzx-gan l l l i I I 1 l in 1 il l as-.w..J,