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A NEW METHOD OF TREATMENT FOR INOPERABLE CARCINOMA OF THE BREAST.

A NEW METHOD OF TREATMENT FOR INOPERABLE CARCINOMA OF THE BREAST. The industry with which the study of carcinoma is being pursued raises the hope that we shall before long be made familiar with its causative agent and be thereby provided likewise with the means for its prevention and possibly also for its cure. The attainment of these objects is especially to be desired, inasmuch as carcinoma is one fortunately of a gradually lessening number of diseases in the face of whose treatment the physician stands almost hopeless and helpless. It is true that early and adequate surgical removal will in a gratifying proportion of cases be attended with permanent cure, but only time can then bring assurance that all morbid tissue and cells have been removed and that metastasis has not already occurred and recurrence or even re-development will not take place. For these reasons any method of treatment, however startling and unusual that promises amelioration, if not cure, and does not unduly imperil the safety of the patient should receive respectful and considerate attention, especially if it emanate from a reputable source. A suggestion along these lines has recently been made by Mr. Cecil H. Leaf, assistant surgeon to the London Cancer Hospital1 with regard to treatment of cases of carcinoma of the breast that are unsuited for operation. He points out that with the exception of oöphorectomy, conjoined with the administration of thyroid extract, the measures heretofore employed have had little effect in checking the onward progress of the disease and that even by this means, although the growth may be temporarily arrested, no permanent good is effected, signs of renewed activity again becoming apparent after a time. The principle proposed by Mr. Leaf consists in an attempt not to destroy the carcinoma cells, but to prevent them or the agent that causes the multiplication from passing along the lymphatics and invading the internal organs. For this purpose he applies over the new-growth or the recurrent nodules a large vulcanite shield adapted accurately to the skin and including as large an area of surface as possible. The shield is fitted at the bottom with a gauze India-rubber inflatable tube exactly similar to that of an ether-inhaler, and at the surface it is provided with a small tap to which can be adjusted any ordinary air-pump, so that the air in the apparatus can be thoroughly exhausted. By this means a force is provided that it is hoped will as long as it is in action constantly restrain the noxious agent from passing to the deeper lymphatics and thus prevent or delay dissemination. A glass window in the top of the shield will permit observation of the degree of suction that is being made. The apparatus should be worn as nearly constantly as possible. In addition, absolute rest for the arm on the affected side is insisted upon, to favor quiescence in the lymph-stream. The existence of ulceration is considered an advantage rather than a contraindication to the treatment, as the cells and juice are then more readily drawn to the surface and gotten rid of entirely. In the absence of ulceration it is encouraged by the constant use of boric-acid fomentations, which soften the fibrous tissue that is present, so that the channels in which the cells and carcinoma-juice travel become less constricted and the suction is then rendered more effective. It might even be advisable to make multiple punctures or incisions. Three illustrative cases are reported in which the treatment was employed, but in none had sufficient time elapsed to permit of any but a tentative opinion; nor is any statement made as to the histologic characters of the neoplasm. The cases to which the treatment is thought to be adapted comprise those with ulcerating schirrus adherent to the pectoral muscles and enlargement, matting together and adhesions of the axillary glands, and those in which after one or more operations recurrence has taken place in the pectoral muscles or the lymph-glands or both. 1. Edinburgh Med. Journal, May, 1901, p. 452. JAMA. 1901;36:1707-1708 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

A NEW METHOD OF TREATMENT FOR INOPERABLE CARCINOMA OF THE BREAST.

JAMA , Volume 285 (11) – Mar 21, 2001
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A NEW METHOD OF TREATMENT FOR INOPERABLE CARCINOMA OF THE BREAST.

Abstract

The industry with which the study of carcinoma is being pursued raises the hope that we shall before long be made familiar with its causative agent and be thereby provided likewise with the means for its prevention and possibly also for its cure. The attainment of these objects is especially to be desired, inasmuch as carcinoma is one fortunately of a gradually lessening number of diseases in the face of whose treatment the physician stands almost hopeless and helpless. It is true that early...
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Publisher
American Medical Association
Copyright
Copyright © 2001 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.285.11.1410
Publisher site
See Article on Publisher Site

Abstract

The industry with which the study of carcinoma is being pursued raises the hope that we shall before long be made familiar with its causative agent and be thereby provided likewise with the means for its prevention and possibly also for its cure. The attainment of these objects is especially to be desired, inasmuch as carcinoma is one fortunately of a gradually lessening number of diseases in the face of whose treatment the physician stands almost hopeless and helpless. It is true that early and adequate surgical removal will in a gratifying proportion of cases be attended with permanent cure, but only time can then bring assurance that all morbid tissue and cells have been removed and that metastasis has not already occurred and recurrence or even re-development will not take place. For these reasons any method of treatment, however startling and unusual that promises amelioration, if not cure, and does not unduly imperil the safety of the patient should receive respectful and considerate attention, especially if it emanate from a reputable source. A suggestion along these lines has recently been made by Mr. Cecil H. Leaf, assistant surgeon to the London Cancer Hospital1 with regard to treatment of cases of carcinoma of the breast that are unsuited for operation. He points out that with the exception of oöphorectomy, conjoined with the administration of thyroid extract, the measures heretofore employed have had little effect in checking the onward progress of the disease and that even by this means, although the growth may be temporarily arrested, no permanent good is effected, signs of renewed activity again becoming apparent after a time. The principle proposed by Mr. Leaf consists in an attempt not to destroy the carcinoma cells, but to prevent them or the agent that causes the multiplication from passing along the lymphatics and invading the internal organs. For this purpose he applies over the new-growth or the recurrent nodules a large vulcanite shield adapted accurately to the skin and including as large an area of surface as possible. The shield is fitted at the bottom with a gauze India-rubber inflatable tube exactly similar to that of an ether-inhaler, and at the surface it is provided with a small tap to which can be adjusted any ordinary air-pump, so that the air in the apparatus can be thoroughly exhausted. By this means a force is provided that it is hoped will as long as it is in action constantly restrain the noxious agent from passing to the deeper lymphatics and thus prevent or delay dissemination. A glass window in the top of the shield will permit observation of the degree of suction that is being made. The apparatus should be worn as nearly constantly as possible. In addition, absolute rest for the arm on the affected side is insisted upon, to favor quiescence in the lymph-stream. The existence of ulceration is considered an advantage rather than a contraindication to the treatment, as the cells and juice are then more readily drawn to the surface and gotten rid of entirely. In the absence of ulceration it is encouraged by the constant use of boric-acid fomentations, which soften the fibrous tissue that is present, so that the channels in which the cells and carcinoma-juice travel become less constricted and the suction is then rendered more effective. It might even be advisable to make multiple punctures or incisions. Three illustrative cases are reported in which the treatment was employed, but in none had sufficient time elapsed to permit of any but a tentative opinion; nor is any statement made as to the histologic characters of the neoplasm. The cases to which the treatment is thought to be adapted comprise those with ulcerating schirrus adherent to the pectoral muscles and enlargement, matting together and adhesions of the axillary glands, and those in which after one or more operations recurrence has taken place in the pectoral muscles or the lymph-glands or both. 1. Edinburgh Med. Journal, May, 1901, p. 452. JAMA. 1901;36:1707-1708

Journal

JAMA – American Medical Association

Published: Mar 21, 2001

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