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Interesting Statistics in Regard to the Treatment of Cancer.

BY E. G. JONES, M. D., (Dartmouth, '71) PATTERSON, N. J.

NOTICE in the New York Medical Record of August 23, 1894, an article giving some statistics in regard to the treatment of cancer, by Dr. W. T. Bull, of New York City. These statistics apply only to cancer of the breast, and the treatment is the ordinary surgical treatment of cancer. This is a record of 75 cases treated previous to 1891. Dr. Bull has taken the usual three years' limit; that is, he is satisfied if the patient has no recurrence of the disease within three years from the date of operation.

The figures as given by him are as follows: Total number of cases treated to prior to 1891, 75; died from the operation, 3; died from recurrence or metastasis, 50; still living after recurrence, 2; died of other diseases after having passed the three years' limit without further manifestation of the cancer, 4; died of other diseases during three years following the operation, o; still living without recurrence of the cancer, January 1, 1894, 16.

According to the above statistics two-thirds of the patients that he treated died from recurrence or metastasis of the disease, and only a little over one-fourth may be considered permanently cured.

These statistics will be about the average of the ordinary surgical treatment of cancer.

In comparison with the above statistics, allow me to call your attention. to some statistics giving the results of my treatment of cancer.

The treatment was local, constitutional and supportive, and shows the difference between the medical and surgical treatment of cancer. I have selected 100 cases good and bad, external, that were treated consecutively previous to January 1, 1891: Total number of cases, 100; died under treatment, 1; died from recurrence of cancer, 2; still living with recurrence, 2; died of other diseases after having passed the three years' limit without further manifestation of the cancer, 15; died of other diseases during three years following treatment, 14; still living without any recurrence of cancer, January 1, 1895, 66.

You will notice from the statistics given above that Dr. Bull's cases as reported refer only to cancer of the breast, while the cases as reported by me, include all forms of cancer, both external and internal. Dr. Bull reports in his statistics 16 out of 75 permanently cured. In my report you have 66 out of 100 permanently cured. From my own experience of cancer,

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which has covered a period of twenty-five years, if there is a recurrence of the cancer after treatment, it is generally within a year after the treatment of the cancer.

You will notice in my report that two cases out of the 100 died from a recurrence of the cancer, and two are still living with recurrence of the

cancer.

In Dr. Bull's statistics 50 out of the 75 cases he reported died from recurrence of the cancer.

I believe that the above statistics will prove interesting reading for intelligent physicians throughout the country, and I willing to leave it to the average practitioner to decide which plan of treatment they would prefer to use in the treatment of cancer.

Temperature Charts prepared by D. T. Lainé, M. D., published by W. B. Saunders, 925 Walnut St., Philadelphia. Pads of 25, 50 cents. These charts are admirably suited for keeping record of fever cases, especially in cases where the bath treatment is employed. On the back of each chart are specific directions for giving baths according to Brand's Method. Each chart has space for four days.

Important Subject. In the October number of Gaillard's Medical Journal, Dr. Fred Byron Robinson, Professor of Gynecology in the Chicago Post-Graduate Medical College, has an earnest plea for a more thorough study of the abdominal viscera. Too little attention is paid by both teachers and students to the minute anatomy of the abdominal viscera. Dr. Robinson has spent years in dissecting these parts. Recently Messrs. E. H. Colegrove & Co., of Chicago, have issued a splendid plate of the sympathetic nervous system, based on dissections made by Dr. Robinson.

Bacteriological Laboratory.-Dr. L. E. Lemen, Denver's Health Commissioner, has succeeded in establishing a bacteriological laboratory which places our city in line with the most advanced cities in the country. Two large rooms on the fourth floor of the City Hall have been thoroughly equipped with the necessary apparatus, including a fine Leitz microscope. Dr. LaGarde will be in charge, and thorough research will be made in all cases of infectious and contagious diseases occurring in the city. The Bulletin takes pleasure in announcing that through the courtesy of Dr. Lemen, its readers will be furnished a detailed monthly report of the work of this laboratory. Physicians will, upon request, be furnished tubes with instructions for placing therein pathogenic deposits, sputa, etc., after an examination of which a report will be returned. By this means the diagnosis of diphtheria, especially, will be definitely determined in all cases.Gross Medical College Bulletin, Dec., 1894.

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Descemetitis.*

BY HERMAN SNELLEN, JR., M. D., UTRECHT, HOLLAND.

ESCEMETITIS, or serous iritis, is a distinct and well-known disease of the eye as to its symptoms. With regard to its nature opinions very much.

The earliest observers looked upon it as a disease sui generis, and according to this they called it aquo-capsulitis, keratitis punctata, or discemetitis. Later writers thought it merely a symptom of disease of the deeper parts of the eye, and as the iris is mostly more or less inflamed, they employed the name of iritis serosa.

Treacher Collins regards this disease as primarily a catarrhal inflammation of the glands of the ciliary body and Priestly Smith, following out this idea, suggests that it should be called serous cyclitis instead of serous iritis. Fuchs, also, in his treatise, describes it as a cyclitis.

Most of the recent writers are agreed that the opaque dots upon the posterior surface of the cornea are deposits of pathological productions of some parts of the uveal tract, and that they consist of cells and fibrin, and sometimes pigment granules.

I shall not enter more into details of the history of this disease, as Lawford has given an excellent resume of it in the Ophthalmic Hospital Reports (1889).

In a case I had under my care about three months ago, I made an observation which gives, I think, a new view as to the nature of this disease.

A lady, aged 28, came to see me with a very marked descemetitis of the left eye. The lower third of the cornea was dotted with specks of Also there was a similar dot on the anterior surface of the

different sizes.

iris, extending beyond the free border, and touching the lens, in this way forming a posterior synechia. This dot, although larger than those of the cornea, was one of the first to be absorbed.

After dilating the pupil there could be observed also some circumscribed opacities in the lens, which I think were of the same nature.

Vision in this eye was, after correcting a myopia of five dioptres. Intra-ocular tension was normal when the patient came, but increased considerably a few days afterwards, was normal again next day, and, in short, varied nearly every day. As after a fortnight the plus tension seemed to persist, and the cornea became hazy and the vision diminished, a sclerotomy was performed.

Read at the Annual Meeting of the British Medical Association, held at Bristol, July, 1894.

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With the aqueous humour one of the dots came out, which I examined under the microscope. I was greatly surprised to find, not a cluster of cells, but a collection of microbes. As soon as possible they were transmitted to agar-agar, where they grew, but very slowly.

Closer examination, after staining with carbol fuchsine, showed that they were very short bacilli.

Almost at the same time a young man came into the hospital with descemetitis of the right eye, from which he had already suffered for more than three months.

As in this case also a paracentesis had to be performed, great care was taken to secure one of the dots; we succeeded in doing this, but not without difficulty, as the dot proved to be very adherent to the cornea. In this instance I found the cells as described in the hand-books, but between them were microbes similar to those seen in the first case.

I did not succeed in cultivating them. I suppose that this dot was an older one than the other, as it was more adherent to the cornea, that it had attached cells, and the microbes were already dying off. The remaining dots seemed to affect the deeper layers of the cornea, causing an infiltration of the cornea, after which they were absorbed, leaving only a small cicatrix. Under internal treatment with salicylate of soda the eye became quiet, and after a month the patient left the hospital, and has not come again since.

In both cases there was, as far as could be seen, no trace of alteration in the choroid; there was a slight pericorneal injection, but no other symptom of iritis, and synechiæ were only formed where a dot had been situated.

Only a fortnight ago the lady referred to in our first case, who had left us, returned, complaining of irritation of the right eye. By focal illumination very small hazy spots were to be seen on the posterior surface of the cornea; they became denser, and soon acquired the ordinary aspect of descemetitis. Here, therefore, I had the opportunity of observing the disease in its very first beginning. I can state that it is not true that the dots are exclusively situated in a triangular arrangement on the lower third of the cornea, and several in the middle third. I am tempted to believe that the dots in the beginning often become loose, fall down, and stick again to the cornea in its lower part.

In this eye the affection ran a very rapid course. The number of opacities increased daily, the the tension became increased, and the cornea hazy as in glaucoma. A sclerotomy was performed, and we succeeded in getting one of the dots. Microscopical examination after staining showed the same microbes as in the other eye.

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The conclusions I come to are, in the first place, that descemetitis is really a disease sui generis, therefore I think it quite appropriate to take up again the old name of descemetitis instead of serous iritis or cyclitis. In the second place, that it is due to microbes growing in the anterior chamber, which by their producing toxines cause an irritation of the uveal tract. The dots are at first situated on the cornea; afterwards on the iris and lens, and may be also on the ciliary body. They contain in their early stages only microbes, but later are intermixed with leucocytes.

Whether all cases of descemetitis are due to the same cause, or whether in some cases it is a real deposit after inflammation of the deeper parts, further investigations have to decide.

Anti-Toxin Treatment of Diphtheria.-(Rice Freeman in British Medical Journal.) Three cases, aged twenty-one months, thirty-four years and thirty years, respectively, are reported, and all recovered. In the infant there was both pharyngeal and laryngeal diphtheria. It received two injections of Roux anti-toxin, one of 20 C.C. and a second of 10 C.C.

Two Cases of Preventive Inoculation of Immunized Scarlet Fever Blood Serum.-(Albert S. Ashmead in the New York Medical Record.)—One of his sons, aged seven, being stricken with scarlet fever, he inoculated on the second day two other children who had not had this disease, aged five and two years. The blood serum was taken from their older brother, aged nine years, who had had scarlet fever six years before. Two drops, taken from a blister on his breast, were used for each child, and there was one inoculation only for each. There was no real isolation-separate bedrooms during the night, but free intercourse during the day. On the ninetieth day no infection had been observed.

Announcement.-E. B. Treat, New York, has in press for early publication the 1895 International Medical Annual, being the thirteenth yearly issue of this eminently useful work. Since the first issue of this one volume reference work, each year has witnessed marked improvements; and the prospectus of the forthcoming volume gives promise that it will surpass any of its predecessors. It will be the conjoint authorship of thirty-eight distinguished contributors and specialists, from America, England and the Continent. It will contain the progress of Medical Science in all parts of the world, together with a large number of original articles and reviews by authors on subjects with which their scientific reputation is identified. In short, the design of the book is to bring the practitioner into direct communication with those who are advancing the science of medicine, so he may be furnished with all that is worthy of preservation, as reliable aids in his daily work. Illustrations in black and colors will be freely used in elucidating the text. A most useful investment for the medical practitioner. The price remains the same as heretofore, the $2.75.