The objects and limits of operations for cancer : with special reference to cancer of the breast, mouth and throat, and intestinal tract : being the Lettsomian Lectures for 1896 / by W. Watson Cheyne.

Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The objects and limits of operations for cancer : with special reference to cancer of the breast, mouth and throat, and intestinal tract : being the Lettsomian Lectures for 1896 / by W. Watson Cheyne. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    mortality after the perineal operation seems to be about 8 per cent., after the sacral operation from 18 per cent, to 20 per cent., but tlie results vary much, in the hands of different surgeons, probably in accordance with the selection of cases and the after treatment of the wounds, and in both instances it can in all like- lihood be somewhat reduced in the future. As matters stand, however, we have to contrast colotomy, in which the mortality is practically nil, with excision, where the mortality varies from 5 to 20 per cent. Let us next consider the results, and I shall not weary you with elaborate statistics, but take as examples three papers in which the cases are detailed, and which, therefore, I have been able to control and work out myself. I had intended to inflict another Table on you, and my friend, Dr. Macan, has spent a good deal of time in hunting up results for me, but as I found that I had no time to go at all fully into the matter, I gave up the project. 1. Kocher's statistics, as given by Arndt, show 35 cases of radical operation with 10 deaths, a mortality of 28 per cent. Excluding the last three years, as we did in the breast, we have 25 cases with seven deaths (28 per cent.), 11 recurrences (44 per cent.), and seven without recurrence (28 per cent.). In four of the recurrent cases, however, marked benefit was obtained, for two were again operated on and remained well three and eight years subsequently, while in two the recurrences were very late, three and five years respectively. The seven which did not recur had been free for 3y^, 5yf, 6^Vi ^tIj 13j, ]6^, and 16^ years. To .summarise this result, 14, or 56 per cent., did not benefit by the operation, while 11, or 44 per cent., did benefit to a marked degree. 2. Take Czerny's statistics as given by Heuck and Loewinsohn (I do not include Schmidt's report, because most of his cases are too recent). These statistics do not include any sacral operations; 41 cases, three deaths (7 per cent.), 21 early recurrences (61 per cent.), eight late recurrences from 17 months up to five and a half years (16 per cent.), four well over six years (9 per cent.), two died within the first year without recurrence. Thus there was no benefit in 24 cases (58 per cent.), and marked benefit in 14 (34 per cent.). 3. Konig's statistics, as given by Hildebrand, represent perineal and sacral operations, and comprise 64 cases with 21 deaths (38 percent.). Leaving out the last three years, we have 34 cases
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