Immunity and latency after operations for reputed cancer of the breast / by A. Marmaduke Sheild.

  • Sheild, Arthur Marmaduke.
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: Immunity and latency after operations for reputed cancer of the breast / by A. Marmaduke Sheild. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    unfair to tlie authors of the operation. If an engineer builds a bridge we call it by his name, even though he may never have laid a brick; we do not call it by the name of one of the masons. In this case Heideuhain and Stiles have not only described the pathology and mode of spread of breast cancer, but have told us exactly what must be done as regards operation in full detail, and it should therefore be called the Heidenhain-Stiles operation if the name of any individual is to be given to it. If, however, you insist on giving the artificer’s name to it, be sure to take the one who has priority, and not the one whose paper happened to attract your attention. Heideuhain and Stiles have both put their views into force, and long before Halsted wrote the operation was being done in Germany, in Grriefswald and other places. I myself published a full account of it with cases remaining well after three years in the ‘ British Medical Journal ’ months before Halsted. As I have said before, however, if a name is to be given to it, it]should be called the Heidenhain-Stiles operation, after the men to whom the whole credit of it is due. Dr. Norman Moore.—It appears to me that the pure patho- logical aspect of the question has been too much neglected in this discussion. I have heard such expressions as “ prone to another attack,” “a second attack of cancer,” and so on. Now how many examples can any one here produce of a second attack of cancer? I have never seen post mortem what I should consider as a second attack of cancer. I have never seen a patient whose breast has been removed some time before die of an entirely different cancer, say a cancer of the pylorus. I have never heard of such a case in my own experience. If that be so it has an important bearing on this question. If cancer originates—and in this discussion the speakers seem to have lost sight of Waldeyer’s view that cancer arises from some special epithelium,—if it be true that in no case is a second epithelium attacked, the whole inquiry resolves itself into a question how far the disease has proceeded from the original focus. There are two ways, of course, in which it may proceed from that original focus. It may grow directly, and those in favour of an extensive operation would say that they remove all the local growth. The other form of extension is that further into the body, the old metastasis, a word of which many people have not considered the true nature; I think it would be much better unused. What is it? It is merely the point at which some cells proceeding from the original growth have stopped. If the cells have started, if they have got, into the chest or body, extensive as may be the operation, they still reappear. All surgeons have spoken pretty clearly in that direction, they have not given us the slightest grounds for knowing in any particular case of cancer of the breast whether