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.

  • 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 Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    local recurrence, ifc must also be remembered that up till recently balf of tbese local recurrences took place during the first three months after the operation, and over 80 per cent, during the first year. Halsted has drawn a distinction between what he terms local recurrence and regional recurrence. By local recurrence he means recurrence actually in the track or area of the wound; by regional recurrence he implies recurrence in the neighbourhood, or in glandular areas which were not included in the first operation. Such a distinction is, however, extreme]y difficult to carry out, and it must often be impossible to determine whether a particular nodule has appeared in the track of the former operation or in its immediate vicinity. As a matter of fact, Halsted's regional recurrences imply an imperfect operation just as much as his local recurrences do; they simply mean that the operation has not been sufficiently extensive, no doubt in many cases because it was impossible. Hence, I prefer to group both these so-called local and regional recurrences together under the heading of external recurrences, and in my own statistics I speak of two sets of recurrences, namely, external recurrences in the wound, its vicinity, or the glands, and internal or metastatic deposits. Cases of cure of cancer of the breast by operation were very rare in former times, and even at the present moment it is with miiny not so much a question of cure as one of prolongation of life: if cure happens to take place, it is a lucky and more or less unex- pected result. The prolongation of life by the old operation is variously estimated at from 8 to 13 months, but this is really longer than it should be by reason of the fact that some of the patients have lived several years and have thus raised the average. Excluding cases which have passed beyond the three-year limit, I do not think that the prolongation of life by the old imperfect operation is on an average more than from six to eight months, though at the present time, where recurrence takes place after the more thorough operation, this prolongation seems to be con- siderably increased. In looking back over old literature one is very much struck by the great rarity of cure, and the very desponding view which surgeons took of the chances of permanent freedom after operation. Velpeau only knew of 20 cases which had been cured, and it is by no means certain that all of these were cases of cancer. Many of the older surgeons state that they have not known a single
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