The operative surgery of malignant disease .. / with the co-operation of James Berry ... W. Bruce Clarke ... Alban Doran ... Percy Furnivall ... Walter Jessop ... H.J. Waring.

  • Sir Henry Butlin, 1st Baronet
Date:
1900
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Licence: In copyright

Credit: The operative surgery of malignant disease .. / with the co-operation of James Berry ... W. Bruce Clarke ... Alban Doran ... Percy Furnivall ... Walter Jessop ... H.J. Waring. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    operating surgeons who take a similar gloomy view. I do not know when I have been so disagreeably affected as I was during the debate on Mr. Sheild's paper at the Royal Medical and Chirurgical Society (Transactions, vol. Ixxxi. p. 193,1898). The opinion expressed by a number of leading surgeons was that operation for cancer of the breast is but palliative, at the best. Once cancer, always cancer! If, after the operation, a woman does not die of cancer of the breast, she will certainly do so of cancer of some other part of the body. This kind of high Calvinism in regard to cancer is exceed- ingly unfortunate, for it leads to the deferring of operations which ought to have been performed far earlier; it leads to hopelessness on the part of the patient; it leads to the ])er- formance of insufficient operations; and it is very difficult to combat successfully. If a patient lives ten or fifteen years without recurrence, the case was not one of cancer. If a patient dies of some other disease eight or ten years after a successful operation for cancer, there is no doubt the disease would have recurred had the individual lived longer. As to the three-years' limit, it is far too short, as the cases collected by Sheild have plainly shown. To the first of these objections we are now able to reply with accurate accounts of the general and microscopical character of the disease. To the second, there is really no reply : it is a woman's argument. The third must be dealt with more at length. The three-years' limit is a purely arbitrary period of proba- tion. If a patient is well at the end of three years after the last operation for malignant disease, and there is no sign of recurrence or of dissemination of the disease, that patient is spoken of as cured by the operation. I think the limit was first suggested by Volkmann. It is very generally adopted in estimating the final results of operations for cancer. It is founded on a sufficiently wide experience. For example, take the figures quoted by Gross from Von Winiwarter. In 203 cases of recurrence of cancer alter operation in different parts of the body, the disease recurred in 180 before the end of the first year, in fifteen between the end of the first and second years, in six between the end of the second and third years, only in two after the end of the third year was past, and only in one per cent, after the end of the third year from the