In a discussion before the same Society in 1896 (on Byrne’s paper) vaginal hysterectomy was discussed. While Boldt, Dudley, and Baldy claimed excellent results, Segond is known to have had but 5 relative cures (2–5 years) in 80 cases. Mundé saw a rapid return in all his 25 cases. Polk had recurrence in every one of 50 cases. Byrne collected notes of 283 operations by ten men, and the results were as follows: died, 7 per cent; life prolonged, 11 per cent; and became worse, 82 per cent.
In the Transactions for 1912 (Discussion of Neal’s paper, Wertheim’s operation) Bovee stated that only 10 per cent of cancers of the cervix were operable. Polak had no survivors from operations, although four were living from Byrne’s cautery method. Chalfant had 3 cures (6 years) in 30 cases. In general the saving of life was offset by the high operative mortality. Later I shall report two remarkable cases of very extensive cancer of the cervix which have entirely recovered, with normal cervix, without operation.
In regard to operative results in cancer of the stomach there are relatively few satisfactory statistics. W. J. Mayo reported recently (Levin, Hoffman “Statistics of Mortality,” etc., 1915, p. 210) on 996 cases of carcinoma of the stomach. Of these 344 cases only were operable and of the latter 25 per cent remained cured five years and over, after operation. In other words, about 9 per cent of cases of carcinoma of the stomach can be cured by surgery at the hands of Mayo, how much less in the hands of most other surgeons? Against such success must be opposed the analysis of 1,000 cases of cancer of the stomach by Friedenwald (Amer. Jour. Med. Sci., November, 1914). He states “of the entire number, operations were performed in 266 instances; of these there is not one patient living.” But few lived more than a year after operation; the majority died within the first six months.
In cancer of the gall bladder several good operators have reported that there have been absolutely no good results.
In cancer of the rectum there is a high operative mortality and very questionable ultimate curative results; indeed, there are very few reliable statistics in regard to this. In 27 perineal and sacral operations Mayo reports 7 per cent primary mortality, and in 44 abdominal and combined abdominal and perineal operations 20 per cent operative mortality. Tuttle reports a higher operative mortality. While there are no available data in regard to the duration of life after operation, it is well known that the disease usually recurs, and in many a colostomy is performed, with all its distressing features and very intangible results.
Time does not admit, nor is it necessary for me to go further into the brave but futile attempts which have been made by surgeons to cure such cases of cancer as can be reached by the knife, which, as we have seen by the testimony of many foremost in their ranks, has been found ineffective to a very great degree. In addition to the locations just mentioned there are many others where the attempt has been made to eradicate the disease surgically, but either with results quite as unsatisfactory as those mentioned, or much worse. Thus cancer of the tongue, palate, esophagus, cardiac orifice of stomach, liver, gall bladder, pancreas, small intestine, bladder prostate, etc., also of the brain and spinal cord, are most unfavorable, and both the operative mortality and end results are disheartening. All surgeons agree that at least 50 per cent of all cancers are inoperable, so that in all the reports concerning the results of operations this must be taken into consideration, and the real percentage of cures of cancer by surgery must be divided into at least one half. Thus, if operative surgery yields an average of 25 per cent of apparent cures in all cases operated on, this would mean only 12.5 per cent of all cases of cancer. This, considering the late recurrences often not traced, bears out the commonly received opinion that about 90 per cent of all patients once attacked by cancer die of the disease.
Surely the outlook for surgery, borne out by the steadily rising general mortality from cancer, is most unpromising, and one naturally turns to medicine, to know if there is not some means of modifying the system so that there shall not be this tendency to malignant tissue change, so destructive to life. In my former lectures I attempted to show that all experience and biochemical laboratory studies looked this way, and in a later lecture I shall hope to show that by dietary, hygienic, and medicinal measures the disease can be and has been checked repeatedly, and cancer cured without surgical operation. The permanence of the cure depends, of course, upon the continued faithful adherence of the patient to the means and measures which caused the dissipation of the tumor. For no one can doubt but that, if the real cause is met and kept in check by prolonged proper measures, the disease will not and cannot redevelop.
Do not misunderstand me and think that I claim that each and every case of cancer, in any stage, can be cured. Alas, my sad experience with the many deaths from recurrent and inoperable cancer, especially in the New York Skin and Cancer Hospital, has taught me the contrary, and I have often been appalled at the impotence of human endeavor; although even these patients have often been grateful for the amount of benefit and relief afforded by proper measures, and in my former lectures I reported to you several such cases. But I do assert that the total percentage of cures in reasonable cases is far, far greater under the line of treatment I am presenting to you than under that most commonly employed.
LECTURE IV
INOPERABLE AND RECURRENT CANCER; METASTASIS; THE BLOOD IN CANCER
We saw in our last lecture that surgery had failed to check the rising mortality of cancer, and that during the year 1915, in the United States Registration Area, the death rate had augmented from 79.4 to 81.1, or an increase of 1.7 persons in every 100,000 living; this was a greater increase than the average rise in the death rate for the preceding five years which was only 1.2 points. This, moreover, occurred during a still active period of laboratory research, with wide publicity as to cancer control, by education as to the benefit of early operation, and with active and skilful surgery.