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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    elusions which appear worth stating. I found that out of seventy-two cases in private practice which I followed to the end, although about half sank within three years, the other half lived from live to ten years, and Mr. Sheild’s paper points out how patients may live even for twenty years. These are facts which must help us very much in our clinical work. With respect to the operation, I do not like the terms “complete” and “ incomplete,” for if we can show that the so-called incom- plete operation is the better of the two it is the proper treatment to pursue. The word “ incomplete ” rather suggests that the surgeon ought to have done something which he has omitted. I must admit that the average operation which I perform is the so-called incomplete one, for it has never been my habit in all cases to clear out the axilla and to take away all the connective tissue right down to the floor of the axilla; and I am not at all prepared to say that my results are worse than those that I know of where the so-called complete operation has been carried out. I take away everything I can see or feel to be diseased; I always cut into the axilla to explore it, but I do not dissect it in every instance. I agree with Mr. Teale that even where recurrence has taken place after the operation it has rarely been in the direction of the axilla or in glands, but it has generally been connected with the skin and subcutaneous tissue, possibly just below the axilla or in the scar itself. I have always found a kind of consolation when I have not taken away the glands to find that the recurrence has occurred, not in the line of the lymphatics but elsewhere, so I am not disposed to agree with those who assert that under all circumstances what the author calls the complete operation should be performed. I believe that the results of his incomplete opera- tion are as satisfactory as those of the complete. In operations undertaken on women fairly advanced in years, as Mr. Teale has pointed out, we now can and do operate with comparative safety in a way that was impossible twenty-five years ago, in consequence of the antiseptic treatment of wounds'. I think', especially in hospital practice, where one has an opportunity of watching the practice of others, the routine method of ‘per- forming the “ complete ” operation has added to the mortality of operations on the breast. I may say that I have never yet removed the whole pectoral muscle, and I do not think I am ever likely to. A case which requires such extensive measures is probably one that would be better left alone. I have often removed the anterior surface of the muscle with the fascia, fairly extensively eveu, but I have never divided it wholly and taken it away, nor am I convinced that such is the right thing to do. With all respect to the author, deviating a little from what he has said in respect of the natural history of cancer. I should like to note that cancer is not always a progressive 6*°