372 SURGERY 



while the contributions of Shrady and of Mudd to cancer of the tongue 

 are most exhaustive. 



Malignant tumors are now often cured by radical operations. A 

 century ago these cases presented a frightful mortality. In the course 

 of the development of surgery, owing to anesthesia and antiseptics, 

 more radical operations are permissible, and cures are now effected 

 where formerly death was the inevitable result. The study of sar- 

 coma is fraught with great interest on account of the meager know- 

 ledge, and of its great importance owing to the fact of the terrible 

 mortality which attends the disease. Sarcoma of bone inevitably 

 terminates in death, and its early recognition and its complete 

 removal are subjects which are worthy the profound study of the 

 surgeon. Sarcoma, in the large majority of cases, is a disease more 

 deadly in its nature than any other variety of malignant tumor. Its 

 unprecedented rapidity of growth, its widespread metastases, its 

 insidious development, its uncertainty of early diagnosis, its absolute 

 certainty to kill, make this disease a subject of paramount importance. 

 In this address a study of the varieties, the etiology, and the dia- 

 gnosis has no place. The prognosis concerns us only. 



The prognosis in sarcoma is as gloomy as can be imagined. It is 

 a disease which destroys life rapidly unless arrested by amputation. 

 The prognosis may be modified as regards time by the situation and 

 the particular cell variety of the sarcoma. In whatever way we look 

 at the prognosis it is serious. On the other hand a radical amputation 

 may rescue a patient's life, even in the cases of the most malignant 

 variety. I shall refer to some statistics already published by others, 

 and present the result of my own personal work, as evidence of the 

 progress which surgery has made within the past quarter of a century. 

 For purposes of illustration the malignant tumor known as sarcoma 

 will be first considered. 



Sarcoma of glands is a malignant tumor concerning which reliable 

 statistics are very meager. The great English authority, Butlin, 

 states that he fails to discover a single case of permanent recovery 

 after operation. In my list there have been 12 cases of sarcoma of 

 the glands up to 1895, the subsequent histories of which are all 

 known. There have been some cases since that date; but sufficient 

 time has not elapsed since operation in some of the cases, and unre- 

 liable histories in some other cases, prevent the tabulation of these 

 cases subsequent to 1895. The principle of cure is the essential 

 feature, and the data up to 1895 have been most carefully investigated. 

 This may be said of all the cases of sarcoma. In these 12 cases, re- 

 covery occurred in every case but one, thus giving 83.3% of per- 

 manent cures beyond the three-year limit of time. In these 11 suc- 

 cessful and permanently cured cases of sarcoma of the glands, there 

 were some which were very large. In two the tumors involved the 



