DEVELOPMENT IN NINETEENTH CENTURY 375 



116 cases of tumors of the breast, 19 of which were not operated 

 upon, leaving 97 cases in which the breast was amputated. In the 

 97 cases of amputation there was but one death, thus giving a mor- 

 tality of a little over 1%. The one fatal case was due to the presence 

 of hemophilia and is a death that might have occurred in connection 

 with any other operation, no matter how insignificant in character. 

 This death can therefore with propriety be excluded as far as bearing 

 upon the mortality of this special operation, and if so, there is an 

 unbroken series of 96 consecutive operations without a death. In 

 addition to the reduction of the mortality of the operation from as 

 high as 23 % recorded by Billroth to a zero, there was no case of pye- 

 mia, septicemia, or erysipelas of the 97 cases of amputation of the 

 breast. Twenty-three cases of sarcoma and other tumors than cancer 

 must be eliminated in order to compute the percentage of permanent 

 cures of pure carcinoma of the breast. These cases of sarcoma of the 

 breast are discussed in connection with the subject of sarcoma. Of 

 the 74 cases of pure carcinoma of the breast, the subsequent histories 

 of 41 are known. Three of these patients have not reached the three- 

 year limit of time, although they are still alive and free from the 

 disease; there remain 38 cases, therefore, of pure carcinoma of the 

 breast in which the full subsequent histories are known. In these 

 38 cases there are 17 cases in which a permanent recovery has taken 

 place. This gives 45 % of permanent cures. Among these 38 patients 

 whose histories are known there were but 2 local recurrences, which 

 gives but a little over 5 % of local recurrences. Since the publication 

 of this series I have had 15 consecutive cases of pure carcinoma of the 

 breast with no mortality from the operation itself. Of these 15 

 cases, 1 died several weeks following the operation from hemo- 

 philia, in which the major joints w r ere filled with blood, and the 

 greater part of the body was affected with subcutaneous hemor- 

 rhages. Two of the 15 have not yet reached the three-year limit of 

 time. There are, therefore, 13 cases in which the full subsequent 

 histories are known; 2 of these patients died from a recurrence of 

 the disease and 1 from hemophilia, as stated before, and the remain- 

 ing 10 have passed the three-year limit time. This gives 77 % of 

 permanent cures in cancer of the breast in the last 15 consecutive 

 cases. I believe the last 15 consecutive cases will yield even better 

 results. At all events, the mortality was zero and the permanent 

 cures seem likely to be higher than 77 %. Modern surgery has much 

 of which to be proud in connection with amputation of the breast, 

 since the frightful mortality of a century ago has been replaced by 

 a steadily increasing percentage of permanent cures. In the future 

 even the present favorable percentage of permanent cures will be 

 increased as early and more radical operations are practiced. 



In 1820 Sidney Smith, the great literary genius of his time, 



