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

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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,

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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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1:---.aa ' 44.f..-am .. ,,.,.:.,,..,,Q.'-w.-..h-:aw was car 1.v,,,a:,1..:.- .wc :fu:..1,.4W.nf,-flu-...v - e-- f--1-f:----av.:-L fwfr-arf:-.:1Kwf1fwQ-KAP Zlibe LITERATURE life nf a flilehical Svtuhent Man is born of woman, Some position on earth to iillg But success is never known to him Without the presence of will. Somefreap success for their reward, Some fall into the hands of Fate, Some are visited by the angel of death, Which calls at every rnan's gate. Some live to ascend a lofty height, Some reach the halls of fame, But sooner or later the time will come, When we will all be classed the same: Man, as I say, is born of woman, And has some position to fill, His talent will lead him to his calling, If it's only supported by will. Perhaps this talent supported by will, Gives him a desire to be, A visitor of the sick and afflicted, And adds to his name M. D. Inliuenced by this he enters school, To have his young mind fed, Oni the honorable science of medicine, I And to live the life of a Med.7' To live a life that's very hard, A harder you should not find, For he's called upon both day and night, W To exercise his mind. Day by day he comes and goes, Regardless of heat and cold, He's blessed with a spirit cheerful and gay, With a heart that is 'qrue and bold. The way of a medical student is hard, The life he lives is tough, Heis kept in all kinds of places, And fed on all kinds of stufl. Heis fed on breads that are hard 'and dry, On pumpkins, prunes and stew, Potatoes and rabbit dumplings, And steak that he cannot chew. He's confronted with man trials Y And temptations which would lead him astray, But he's blest with a manly principle, Which helps him to cast them away. But day by day the months roll off, And the session comes to an end, He returns to home and loved ones, The summer months to spend. Page 187