DEVELOPMENT IN NINETEENTH CENTURY 373 



neck, one of which was larger than a child's head, necessitating a 

 deep and dangerous dissection, which exposed the large cervical 

 vessels. In another case the tumor was situated about the femoral 

 vessels. Some of the tumors were removed in the presence of alarm- 

 ing hemorrhage and involved a most formidable operation. Thus, 

 in sarcoma of glands with 100 % mortality, the permanent cure 

 amounted to 83.3 % in the 12 cases. 



Sarcoma of bone in previous years has been attended with a fright- 

 ful mortality until surgery, with modern technic, has come to the 

 rescue of these unfortunate sufferers. Butlin records 78 cases of 

 subperi osteal sarcoma, of which the results in 28 cases were unknown, 

 and in 6 cases more the patients had not reached the three-year limit 

 of time, which leaves 44 cases in which the full subsequent histories 

 are known. Of these 44 cases, 14 died of the operation and 29 from 

 recurrences, which leaves but 1 permanent cure in the 44 cases. There 

 are thus 78 cases in which the operation was performed; 14 of the 

 patients died from the immediate effects of the operation, which 

 gives 18% mortality for the operation itself, and of the 44 patients 

 whose full subsequent histories are known, there was but 1 per- 

 manent cure, or 2 %. In my list I reported 21 cases of subperiosteal 

 sarcoma of bone in which an operation was performed, 1 of which was 

 an amputation of the hip-joint, and the patient died from the im- 

 mediate effects of the operation. This gives only 5 % mortality for 

 the operation itself. The histories of 4 are unknown. In the remain- 

 ing 17 cases of the original 21 cases in which the results are known, 

 there are 3 deaths, 1 of which has just been referred to as a result 

 of shock, and 14 cures beyond the three-year limit of time, which 

 gives 82 % of permanent cures. This is in marked contrast to Butlin's 

 statistics, which records only 2% of permanent cures. 



Sarcoma of the breast is a disease that formerly was most fatal. 

 Modern surgery has accomplished much in reducing the terrible 

 death-rate. Butlin, in his book on malignant disease, gives no results 

 either as to mortality or as to permanent recoveries. Williams, in 

 his book, reports 10 cases of sarcoma of the breast, in which no deaths 

 occurred in consequence of the operation itself. The subsequent 

 histories of only 2 out of the 10 cases are known. Death occurred in 

 the 2 cases within 2 years from the date of the operation. The per- 

 centage of permanent cures, therefore, amounts to zero, since no 

 patient recovered so as to be free from the disease for a period of 3 

 years. It is to be regretted that nothing is known of the 8 cases since 

 among the list; there may be some cases of permanent cure. It is 

 unfortunate that these cases have been lost sight of, since no statistics 

 of permanent cure can be recovered unless the result is known. 

 Gross reports 91 cases operated upon, of which 12 were permanently 

 cured, giving 13 % of permanent cures. 



