Treatment Issues in 1901

1JAMA 100 YEARS AGO: A New Method of Treatment for Inoperable Carcinoma of the Breast 03/21/2001; Journal of the AMA

IMPORTANT EDITOR'S NOTE: This article is dated June 15, 1901.

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 oophorectomy, 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.

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