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144 R A D I U M
in a case of definite diagnosis of cancer of the fundus with the following
precaution to prevent sowing the field with cancer cells,—alcohol
gauze is firstpassed well within the cervix which is clamped off with
heavy clamps."
"Because of the favorable results of radium and deep x-ray therapy
in operable cases and the indications of its value in all stages of carcinoma
of the cervix, we are. at present, not using surgery in any of these cases.
We are, however, holding our final judgment in abeyance until a sufficient
time shall have elapsed for a definite comparison of the three
and five-year results of radiation in early cases to be made. Fundus
carcinoma is still treated surgically—except those in which metastases
involve areas beyond the field of operation. These cases are treated
by radium and deep x-rays."
"In the case of suspected carcinoma of the cervix a section is first
made for microscopic diagnosis. If the diagnosis was confirmed, our
method in the past has been to destroy the local growth with the cautery
and to pack the vagina with alcohol sponges which were left in place
overnight. The following day an abdominal hysterectomy was performed
with a wide dissection of the parametrium and the broad ligaments, an
iodoform drain being place well within the wound. These procedures
applied to the certainly operable period, the operation being followed
promptly by radium."
"Surgery vs. Radium and X-ray.—As to the comparison of the operative
mortality and the length of life after operation combined with
radium, with the results of radium treatment alone, few final statistics
of value have thus far been published since the majority of reporters
give results in but limited series of cases for longer periods, the periods
in the majority of the reports extending over two or three years only."
"Bumm reports 78 cases treated by radiation in 1913, 77 in 1914.
and 127 in 1915. From this large experience he recommends operation
in all cases of cancer of the cervix or fundus, in which the condition
of the patient permits. This is in marked contradistinction to the judgment
of J. G. Clark, who reports the extreme opposite opinion that radiation
is always the method of choice in the treatment of carcinoma of the
cervix, an opinion apparently shared by the Mayo Clinic as indicated
in a communication by Dr. W. J. Mayo to Dr. Skeel: 'The Wcrtheim
type of operation has today only a very small field of usefulness. Personally.
I have not done one in three years. Radium is taking the place
of the extensive operation for the cure of carcinoma of the cervix with
the exception of very early cases and it is possible that it will soon be
the method of choice in all cases, either alone or combined with operation.
For carcinoma 01 the body of the uterus, total hysterectomy is
the operation of choice.' "
"Schmitz' figures are shown in Table III.
Apparent Cures
1914-1919 inc.
1914-1918 inc.
1914-1916 inc.
Table III—Schmitz
from Radium Treatment for 2, 3 and 5 Year
Periods
Operable
7M%
60.0%
66.654
Borderline Inoperable Recurrent
54-5% 27.()r,'r 2.2fU
55-6% 21.756 0.0%
40.0% O.O^r 0.0*0