A Monthly Record of Medicine and Surgery. Published by MEDICAL DIAL J. W. MACDONALD, M. D., F. R. C. S. E. C. K. BARTLETT, M. D Editor. A. W. ABBOTT, M. D. Associate Editor. J. P. BARBER, M. D. C. H. HUNTER, A. M., M. D. J. H. STUART, A. M., M. D. W. A. HALL, M. D. S. A. BROWN, M. D. A. H. TUFTS, M. D. (Sioux Falls, S. D.) COMPANY A. B. CATES, A. M., M. D. (All of Minneapolis.) E. H. MCINTYRE, M. D. Assistant Editor. J. FRANK CORBETT, M. D. H. JEFFERSON, O'BRIEN, M. D. (West Superior, Wis.) Medical contributions respectfully solicited from Regular Physicians. The editor or publishers will not be responsible for the opinions expressed by correspondents. No attention paid to annoymous communications. Reprints furnished only at actual cost. Entered in the Post Office at Minneapolis, Minnesota, as Second Class Matter. SUBSCRIPTION PRICE United States, Canada and Mexico, per annum, in advance, $1.00 1.50 N. B. Matter for the reading pages should reach office of pnblication on the 20th of the preceding month and display advertising on the 25th, to insure attention. Vol. 5. MINNEAPOLIS, MINN., OCT. 1, 1903. No 10. of the teeth, not to mention many other good results to the general system, which would surely follow a better care of the oral cavity. In the suit of Mrs. Ada Nichols against Dr. George G. Eitel of Minneapolis, for an operation in which it was alleged that the doctor, while she was under the influence of an anesthetic and contrary to an agreement with the surgeon, she was disfigured for life, "under color of an employment to merely make an incision to heal a soreness." Dr. Eitel, in his answer, denied these allegations of the complaint and alleged that Mrs. Nichols had a cancer which at her special request he removed in the regular manner universally approved by skillful surgeons. Judge Brooks has ordered judgment for Dr. Eitel on the ground of statute of limitations, more than two years having elapsed before commencing her case. Hamline Medical College Commence ment. The opening lecture of the Medical Department of Hamline University was given on Thursday evening, Sept. 17th, at the college building by Prof. Charles W. Malchow, M. D., before the Faculty, the students, and other friends. of the college. The address is given in full in this number of the Dial, and speaks for itself. It will be evident to the reader that Dr. Malchow has profited by the course of study and discipline he has so thoroughly outlined for the medical student to follow to insure success. Dr. Malchow is a graduate of this medical school in the class of 1894. The Present Day Treatment of Carcinoma of the Breast. It is interesting to look back over the past quarter of a century and note the changes which have taken place in the operative treatment of carcinoma of the female breast. While it was generally admitted that excision might greatly prolong life, if not actually lead to a radical cure, it was also believed that such happy results were rare and therefore exceptional. Gross in his edition of 1872, after weighing the statistics on the subject uses these words: "To sum up the whole matter, it may confidently be asserted that the knife, if it does any good at all, is only a means of temporary relief, generally, indeed, of a very transient character." The operation in vogue at that time. was spoken of by Gross as "generally a very easy and simple affair." It consisted ir making an eliptical incision, if possible in the direction of the fibres of the pectoralis major muscle. Care was taken to preserve enough skin to allow parts to come together without stretching in order to secure, if pos sible, union of the wound by first intention. The first improvement on this simple technique was suggested by Charles H. Moore in a paper read in 1867 before the Royal Medical and Chirurgical Society of London, in which he urged the importance of removing together with a diseased breast any tissue adjoining the breast which is even approached by the disease, e. g., skin, fat, lymphatics and the pectoral muscles. This paper was followed ten years later by that of Mitchell Banks of Liverpool, which dealt in a more practical manner with the involvement of neighboring texture. He insisted that whenever there was found an appreciable disease in the breast, the axillary lymphatics and glands were to be regarded as already involved, and whether enlarged glands could be felt or not, the fatty and glandular contents of the axilla should be systematically removed in every case as a part of the removal of a cancerous breast. For the next step we are indebted to the German Surgeons Volkman and Küster the former in 1882 and the latter in 1883 advocating the dissection from the surface of the pectoralis major of the fascia covering it. In the United States about the same period Gross (the younger) was working along the same lines. Not satisfied with removing the fascia covering the pectoralis major, Herdenhain became convinced that the carcinomations process pervaded the whole breast in which any part was affected and at the German Surgical Congress in 1889 argued that it was impossible to remove the fascia without leaving some fragments of it which contained the disease. The muscle as well as the fascia covering it, the parts overlying the muscle and the axillary contents must be removed in every case of excision of the breast for carcinoma. Halstead, availing himself of the advances made in England and Germany, devised the operation which has taken. his name, and as a further means of getting rid of all diseased tissue removed a considerable portion of the skin over and about the morbid growth and in many cases invaded the region above the clavicle. He published in 1894 the results of his operations at Johns Hopkin's Hospital. Dr. Lewis Stephen Pilcher (Annals of Surgery, September 1903) gives the results of his experience in fifty cases operated on in accordance with the views of the most advanced surgery. He classifies his cases according to the extent of the operative procedures resorted to as follows: I. Ablation complete to apex of axilla, without removal of any pectoral muscle. Two cases. 2. Ablation complete to apex of axilla with removal of pectoralis major muscle only. Eleven cases. tained. Of the thirteen cases in classes I and 2 four have remained well to the present time, periods of from eight to ten years; three more enjoyed a period of immunity lasting for six years, and then in each case developed renewed cancerous disease; in three others evidences of recurrence in distant regions, showed themselves within three years after the operation, in two of the cases there was local recurrence. When it is borne in mind that these operations were not so radical as they might have been, the results are encouraging. In class 3 both pectoral muscles were removed owing to the advanced stage of the disease another necessity of facilitating the thorough removal of the of the axillary contents. Twelve cases fell into this class and their course is very instructive. One lived 54 years after the operation free from recurrence and then died of acute pneumonia at the age of Seventy. Two others are well at the present time, 3 years and 3 years and 4 months respectively after the operation. One is living 51⁄2 years after operation, but with slowly advancing recurrence in axilla and above the clavicle. One other is living 3 years after operation without external recurrence, but with evidence of cancer of liver. Six patients have died at periods varying from 1 to 51⁄2 years after operation. In all but one of these the disease first reappeared in the supra clavicular region. So frequently did the disease spread to the lymph glands above the clavicle that Dr. Pilcher has come to the belief that the supra clavicular lymphatic tissues are diseased in all cases in which the glands at the apex of the axilla are markedly affected and if such is the case the proper thing for the surgeon to do it to open up the supra clavicular spaces and clean them out in the same manner as is done with the axilla. One of the most important points in the treatment of cancer cases is the early recognition of the disease and this should be followed by prompt action. Of the fifty cases reported by Dr. Pilcher 37 had postponed application for surgical relief after they had become aware of the existence of the disease for periods varying from six months to three years or more. Original Articles Opening Lecture of the Medical Department of Hamline University by Prof. Chas. W. Malchow, M. D. Mr. Dean, Members of the Faculty, It has fallen to my lot to address you upon this occassion, and, inasmuch as this is the opening of another session in an institution for learning, it seems fitting to consider at this time the question of the "Acquistion of Knowledge", and more especially the cultivation of a familiarity with the technicalities so requisite to the proper equipment for the practice of medicine. In the remarks to follow, I hope to avoid moving about in a very small circle and trust that what I may say will not appear quite so ridiculous and senseless as did the remark of the diplomatic Irishman with his pig, who, when the weight of the porker was made known to him, replied "well, he don't weigh as much as I thought he did- but then I didn't think he would". There may be a grain of truth in this diction: "There is nothing new under the sun", but this indisputable fact remains, that there are as yet a great many things that are new to us, and there is still very much for all of us to learn. mentally and morally, by reason of heredity, environment and education. Over the first of these we have no control; the second permits of but partial variation, while the third is more largely the result of our own volition. Knowledge is cognizance, information or knowing, if you please. We know nothing- except that which we have learned, and our knowledge consists of what we have acquired by personal experience together with that which has been imparted to us by others. The beneficent author of our being intended that we should be social creatures and receive the greatest and most important part of our knowledge by the information of others. If we were compelled to rely upon our own individual personal experience for information regarding diseases, most of us who still survive would scarcely know the name of the great majority of human affections. All knowledge is not equally useful. but it may be said that none is altogether useless. together useless. To acquire knowledge it is necessary that we possess a receptive capacity, and have in addition a retentive ability. Memory is that faculty of the mind which enables us to retain and reproduce past impressions. It is therefore necessary. that we must first of all be impressionWe are what we are, physically, able, or have a receptive capacity. The |