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.

    40/44 page 72
    to the side; in both there was eczema in the axilla; in both there was oedema of the limb, and in one there was intense neuralgia, while in the other there was some paralysis; in both the limb was absolutely useless. I venture to think that in both these cases the operation had added materially to the patients’ sufferings. Mr. Sheild (in reply).—It often happens that a paper originates subjects for debate which were little intended by the author, and this has markedly happened upon the present occasion. My object was merely to bring out the experience of those who have been long in surgical practice as to the ultimate results of operation upon cancer of the breast. I must say the favorable cases have surprised me, and I expect many others. I feel with Mr. Treves that the time is hardly ripe for a discussion as to the comparative value of operations. I distinctly stated in my paper that I could have collected many more cases ; and if proof were needed of this, it would be found in the remarks of Mr. Heath, Mr. Barwell, Mr. Hutchinson, and others. All the surgeons were able to adduce a number of these remarkable cases, even up to the limits of twenty years and more, so that the criticism of Mr. Cheyne as to the paucity of the cases I have collected is scarcely opportune. To follow each speech in detail would be a long and tedious matter. The mass of material is very large, and the interests of the Society will be best furthered by my considering the subject as a whole, particularly drawing conclusions which seem warranted, and which may serve to increase our knowledge. In the first place, it is obvious that certain terms must be clearly defined. By “ latency ” I denote lying hidden by “ immunity ” I mean “ freedom from,” the ordiuary English acceptance of the word. “Cure” I will postpone discussing until the end. For the terms “ complete ” and “incomplete” operation I would substitute lesser and greater, as not liable to offend anyone. It is clear that the majority of the speakers rather mixed together many ideas of operating, so that the results they give must be taken in a very general sense. The type of the lesser operation is the removal of the breast, but not of necessity its outlying lobules, or the fascia, or the glands in the axilla. The type of _ the greater operation would be the removal of the mamma and its prolonga- tions, the fascia, glands, and pectoral muscles. Now speakers have inclined in their remarks towards one group or another. Sir T. Smith and Mr. Teale are examples of those who have practised the lesser type operation, and Mr. Cheyne is an example of an exponent of operations of the greater type. Mr. Heath, writing many years ago, seems to have advocated and practised a verv thorough operation, and the statement of Mr. Cheyne that in the old operation the breast was never removed'is far too absolute. We may draAv a clear conclusion
    digitised image 1
    digitised image 2
    digitised image 3