374 SURGERY 



I operated in 6 cases of sarcoma of the breast, in which no death 

 occurred in consequence of the operation itself. The subsequent 

 histories are all known. Four of the 6 patients were permanently 

 cured, and the remaining 2 died from a return of the disease. This 

 gives 62 % of permanent cures in sarcoma of the breast. 



Carcinoma of the breast affords a striking illustration of a disease 

 over which surgery has gained a decided victory. There is no more 

 brilliant example to show the progress of surgery during the past 

 century than is found in a study of cancer of the female breast. The 

 necessity of an investigation of carcinoma of the breast can be esti- 

 mated when it is considered that in England alone there are 7000 

 deaths annually from carcinoma, and that there are 30,000 patients 

 suffering at all times in that country from this affection, of which 

 number a large proportion involve the breast. When it is considered 

 that 50% of the cases of carcinoma of the breast die within three 

 years, and that a third die within two years, and that of all of the 

 tumors affecting the breast, 80 % consist of carcinoma, some idea 

 can be formed of the overwhelming interest and paramount im- 

 portance of this subject. The mere fact that carcinoma causes more 

 deaths in the United States in one year than the sum total of deaths 

 due to erysipelas, tetanus, hydrophobia, lighting, typhlitis, gunshot 

 wounds, joint disease, together with well-known surgical affections, 

 conveys at once an idea of the wide dimensions of this subject. 

 Carcinoma causes nearly half as many deaths in a year in the United 

 States as are caused by accidents and injuries of all kinds and de- 

 scriptions. 



Dr. Billings has demonstrated by statistics that carcinoma is a 

 disease which is slowly increasing, and that it is a cause of a larger 

 proportion of deaths in nations which have reached the highest 

 state of civilization. For example, in the United States in a year 

 there were over 13,000 deaths from carcinoma, of which there were 

 twice as many deaths among females as among males. There were 

 1387 cases of death from carcinoma of the breast alone in this coun- 

 try during the year 1880, and since then statistics show the disease 

 is still increasing. The mortality of this disease, if left unoperated 

 upon, is nearly 100 % at the present time, just as it has always been. 

 The mortality of the patients operated upon formerly was consider- 

 able, and the percentage of permanent cures very small, while now 

 the operative mortality is very small and the percentage of per- 

 manent cures is very high. 



I shall refer to my own personal experience, the results of which 

 I have already published, adding, however, that the results in the 

 more recent cases are even better; but the data in full are not pos- 

 sible to collect for many reasons, and chief among these is the three- 

 year limit of time. I have collected within a given period a series of 



