LONG-LASTING IMMUNITY AFTER EXCISION OF CARCINOMA OF THE BREAST.
DR. CHARLES N. Down, in accordance with the suggestion of the President of the Society, last spring, that members should show some of the cases who have lived for many years after having had cancers excised, at the last meeting had shown a man who was operated on five years before for an epithelioma in volving the entire lower lip, and who showed no signs of a re currence. He now showed three patients who were operated on seven and one-half, five and one-half, and four and one-half years ago, respectiveTy, for carcinoma of the breast, and who have remained free from a recurrence.
The first patient was a woman, sixty-two years old, who was operated on June 23, 1893, for a tumor of the left breast which was first noticed about six months before, and had grad ually attained the size of a hen's egg. It was not attached to the skin or fascia, and there was no evident axillary involvement. The breast was removed by Volkmann's method, and the axilla was cleaned out. The pathologist reported that the growth was a carcinoma of the scirrhous type. The patient made an unevent ful recovery, and has remained well up to the present time, with the exception of the development of a spot of leukoplakia on the tongue, which showed no malignancy on microscopical examina tion.
The second patient was a woman of forty-five, who was operated on May 16, 1895, for a recurrent nodule in the scar of a previous operation on the right breast. The nodule had first been noticed seven months before, and had been removed by an other surgeon a month later. There was an indurated area about the scar, and there were enlarged lymph nodes in the axilla which subsequently proved to be carcinomatous, with areas of coagula tion necrosis. The Halsted operation was done in this and the woman has remained entirely free from recurrence.
In the third the growth, which was very extensive, was removed on April 27, 1896. Seventeen months before, the pa tient had first noticed a small nodule in the right breast, and five months later it was removed by another surgeon under cocaine. It quickly recurred, and was removed under chloroform four months previous to her admission to the hospital. It again re curred, growing very rapidly, and was slightly painful. When Dr. Dowd first saw her there was an inflamed and indurated mass about the size of a small orange on the right side of the chest, extending from the second to the fourth ribs, and two and one half inches outward from the junction of the ribs and cartilages. It was very firm and seemed to be closely attached to the chest wall. The glands in the axilla were involved. Halsted's opera tion was done, a large area was skin grafted, and the woman has remained free from all signs of a recurrence.
DR. CURTIS said it was rather interesting to note that the first patient shown by Dr. Dowd, upon whom the older operation of Volkmann had been done without removal of the pectorals, had remained entirely free from a recurrence. It showed that it was unnecessary in every instance to do the extreme radical opera tion.