- Email: [email protected]
CARDIOSPASM
629 It is perhaps only by finding out these things, which as you will appreciate, is bound to take many years, that the problem of cancer will eventually be solved. " If when ... grows up, she does not wish to cooperate in this matter, she can either ignore the post-card, which, after two years without a reply, will not be sent again, . or she can write and tell us not to send her any more ; but I hope that she, like you, will feel that by helping in this matter she is really doing her bit, and at such small cost, to alleviate human suffering and advance
CARDIOSPASM
-
SIR,—In his article of April 2, Sir Adolphe Abrahams says: " To him [the psychologist] cardiospasm symbolises an insult the patient cannot swallow." all due respect to a great teacher, may I quote a prove that the psychologist may be right ?
With to
case
Some months ago I saw a Welsh girl who had had difficulty swallowing solids for the past three years. Her story was The day her mother died, she was very upset as follows. and her doctor gave her a tablet to take. As she went to swallow it, "I felt as though it was going to stick in my I took it out and said silly little tablet, I can throat. easily swallow it,’" and she did so with some water. The next day while eating lunch she again got the same feeling that she could not swallow. This feeling got worse as the weeks and months went by. In addition she had no desire to go out or mix with people. When she came to see me she had a flask of water in her handbag that she always carried to help her swallow. She proved to be a good hypnotic subject and she was regressed to the day her mother died. I said to her, when she was open to suggestion, that she could not swallow... the fact that her mother died ... the mere thought of it stuck in her throat. I elaborated on this and finally she understood why and how her trouble began. Being convinced she was cured, I gave her a bun to- eat, which she ate with the greatest of ease and smiling all the while. When she was awakened she kept on eating. in
knowledge."
in similar vein, and with appropriate modifications, will be sent to adults. I, Sir, can see no other way in which this mattervital to the welfare of the human race-can be settled. That the results of this experiment cannot be seen by anyone reading these lines makes it all the more important that we should start now, and be sure of answering at least one fundamental question about human breast cancer by the year 2030. H. J. B. ATKINS Director of Surgery, Guy’s Hospital. London, S.E.1.
A
letter
-
SIR,—The annotation in your issue of March 12 tempts me to try to express certain perplexities which have troubled me for many years. Harnett1 said that " actuarially it
91-03%
of
stage 3b."
I heard from her on three occasions, and she never looked back ; she was completely cured. A. P. MAGONET. London, W.1.
was
found that radical
five-year expectation of life ranging from normal in stage 1 down to 68-4% of normal in
mastectomy
gave
a
He added that after local
mastectomy alone the
five-year expectation of life ranged from 97-63% of normal in stage 1, to 70% of normal in stage 3b. Of 703 patients
submitted to radical mastectomy, 312 survived for five years and 22 died " without cancer." Of 133 patients submitted to local mastectomy, 52 survived for five years and 16 died without cancer." If patients dying without cancer are we are left- with 681 submitted to radical mastectomy, omitted, - of whom 312, or nearly 46%, survived for five years, and 117 treated by local mastectomy, of whom 52, or just over 44%, survived.
CANCER OF THE BREAST
"
SIR,—Animal experiments show that for carcinoma of the breast to develop in the mouse, it is necessary that suckling should have taken place from a mother, or foster-mother, capable of transmitting a virus-like material known as the milk factor. If mice are not so suckled carcinoma of the breast does not develop. I am anxious to start a long-term-very long-terminvestigation into this matter in the human subject, and for this purpose I wish to collect the names and addresses of female children or adults of whom it is known that they have never suckled at a human breast. Family doctors and obstetricians may know of such cases where, because of the death of the mother, or for other reasons, it can be absolutely guaranteed that the child has never consumed milk from a human source. (" Humanised milk" does not, of course, count.) If, with the permission of the appropriate person, doctors would be kind enough to forward the name, age, and address of such a child or adult, together with the name of her surviving parent or guardian in the case of a child, such an investigation could be put into operation. The card or letter should be addressed to the secretary of the mastitis clinic, Guy’s Hospital, London, S.E.l. It is hoped by this means to collect the names and addresses of a large series of females who could not have received the human " milk factor," if such exists ; and the investigation would proceed as follows. On receipt of the name, the child’s parent or guardian would receive the following letter.
Here, surely, is food for thought. Unfortunately, as I hope to show later, the figures are vitiated by the grouping under " local mastectomy " of 83 patients in whom the
axillary lymph-nodes were also excised. elapsed since Halstead introduced his radical operation. Masses of statistics have been published, but can we yet say what is the best surgical treatment in the various stages ? It is disquieting to find a report in the British Journal of Cancer for September, 1948, based on one system of grading, and a discussion
Fifty
"
Dear ..., Dr.... has, with your permission, sent me the of who, he assures me, has not been nursed by her mother or by a foster-mother. Doctors believe now - that such children, when they grow up, may be less likely to develop name
...
serious disease of the breast than other people, and this possibility you might regard as making up for the lack of what is otherwise the best method of nursing a baby. Nevertheless, it is vitally important that this theory should be tested out, and I should be most grateful to you for your cooperation which might in the future save many lives. All that I should do is to send you, once a year, a stamped addressed post-card asking you whether there has been a change of address or whether ... has now left home. When she grows up and leaves home, I or my successor will keep in touch with her in this way, and after explaining to her that we believe that she is less likely to suffer from serious breast disease than her friends, ask her whether she will reply- year by year on an addressed card as to whether she is still free--as we expect-from any trouble in the breast. ’
years have
at the British Medical Association in the same year based on a different system. They agree that in stage 1 the tumour is confined to the breast only, but is the absence of axillary metastases to be decided by clinical examination, or on histological examination of an odd suspicious gland, or on a thorough and painstaking If only a local mastecsearch by a morbid anatomist ? tomy is performed, who can say that no secondary glands are present ? Every early stage-2 case‘ which is grouped as stage 1 must tend to impair the survival-rate in both groups. The surgeon who fails to perform the widest possible operation in cases deemed operable may be regarded as a heretic ; yet in spite of an occasional success, my experience has been that a radical operation in a relatively advanced case appears often to shorten the life of the patient. It seems that operative measures today tend to- be less heroic than those of our fathers. Sir Cecil Wakeley2 admits to performing only a local mastectomy in cases where the breast is small and the tumour in an inner quadrant. Here one may note with interest that Harnett finds that the situation of the tumour has little bearing on the prognosis. Everyone is agreed that the radical operation gives reasonably good results in stage-1 cases ; yet at the B.M.A. discussion the ten-year survival-rates recorded by recognised experts varied from 65 % to 91 %. So variable are the manifestations of this dire disease that the statistical results of individual operators are of limited value. In a long surgical career I have operated on several hundred cases of cancer of the breast.. With difficulty 1. 2.
Harnett, W. L. Brit. J. Cancer, 1948, 2, 212. Wakeley, C. Brit. med. J. 1948, ii, 631.
CARDIOSPASM
-
SIR,—In his article of April 2, Sir Adolphe Abrahams says: " To him [the psychologist] cardiospasm symbolises an insult the patient cannot swallow." all due respect to a great teacher, may I quote a prove that the psychologist may be right ?
With to
case
Some months ago I saw a Welsh girl who had had difficulty swallowing solids for the past three years. Her story was The day her mother died, she was very upset as follows. and her doctor gave her a tablet to take. As she went to swallow it, "I felt as though it was going to stick in my I took it out and said silly little tablet, I can throat. easily swallow it,’" and she did so with some water. The next day while eating lunch she again got the same feeling that she could not swallow. This feeling got worse as the weeks and months went by. In addition she had no desire to go out or mix with people. When she came to see me she had a flask of water in her handbag that she always carried to help her swallow. She proved to be a good hypnotic subject and she was regressed to the day her mother died. I said to her, when she was open to suggestion, that she could not swallow... the fact that her mother died ... the mere thought of it stuck in her throat. I elaborated on this and finally she understood why and how her trouble began. Being convinced she was cured, I gave her a bun to- eat, which she ate with the greatest of ease and smiling all the while. When she was awakened she kept on eating. in
knowledge."
in similar vein, and with appropriate modifications, will be sent to adults. I, Sir, can see no other way in which this mattervital to the welfare of the human race-can be settled. That the results of this experiment cannot be seen by anyone reading these lines makes it all the more important that we should start now, and be sure of answering at least one fundamental question about human breast cancer by the year 2030. H. J. B. ATKINS Director of Surgery, Guy’s Hospital. London, S.E.1.
A
letter
-
SIR,—The annotation in your issue of March 12 tempts me to try to express certain perplexities which have troubled me for many years. Harnett1 said that " actuarially it
91-03%
of
stage 3b."
I heard from her on three occasions, and she never looked back ; she was completely cured. A. P. MAGONET. London, W.1.
was
found that radical
five-year expectation of life ranging from normal in stage 1 down to 68-4% of normal in
mastectomy
gave
a
He added that after local
mastectomy alone the
five-year expectation of life ranged from 97-63% of normal in stage 1, to 70% of normal in stage 3b. Of 703 patients
submitted to radical mastectomy, 312 survived for five years and 22 died " without cancer." Of 133 patients submitted to local mastectomy, 52 survived for five years and 16 died without cancer." If patients dying without cancer are we are left- with 681 submitted to radical mastectomy, omitted, - of whom 312, or nearly 46%, survived for five years, and 117 treated by local mastectomy, of whom 52, or just over 44%, survived.
CANCER OF THE BREAST
"
SIR,—Animal experiments show that for carcinoma of the breast to develop in the mouse, it is necessary that suckling should have taken place from a mother, or foster-mother, capable of transmitting a virus-like material known as the milk factor. If mice are not so suckled carcinoma of the breast does not develop. I am anxious to start a long-term-very long-terminvestigation into this matter in the human subject, and for this purpose I wish to collect the names and addresses of female children or adults of whom it is known that they have never suckled at a human breast. Family doctors and obstetricians may know of such cases where, because of the death of the mother, or for other reasons, it can be absolutely guaranteed that the child has never consumed milk from a human source. (" Humanised milk" does not, of course, count.) If, with the permission of the appropriate person, doctors would be kind enough to forward the name, age, and address of such a child or adult, together with the name of her surviving parent or guardian in the case of a child, such an investigation could be put into operation. The card or letter should be addressed to the secretary of the mastitis clinic, Guy’s Hospital, London, S.E.l. It is hoped by this means to collect the names and addresses of a large series of females who could not have received the human " milk factor," if such exists ; and the investigation would proceed as follows. On receipt of the name, the child’s parent or guardian would receive the following letter.
Here, surely, is food for thought. Unfortunately, as I hope to show later, the figures are vitiated by the grouping under " local mastectomy " of 83 patients in whom the
axillary lymph-nodes were also excised. elapsed since Halstead introduced his radical operation. Masses of statistics have been published, but can we yet say what is the best surgical treatment in the various stages ? It is disquieting to find a report in the British Journal of Cancer for September, 1948, based on one system of grading, and a discussion
Fifty
"
Dear ..., Dr.... has, with your permission, sent me the of who, he assures me, has not been nursed by her mother or by a foster-mother. Doctors believe now - that such children, when they grow up, may be less likely to develop name
...
serious disease of the breast than other people, and this possibility you might regard as making up for the lack of what is otherwise the best method of nursing a baby. Nevertheless, it is vitally important that this theory should be tested out, and I should be most grateful to you for your cooperation which might in the future save many lives. All that I should do is to send you, once a year, a stamped addressed post-card asking you whether there has been a change of address or whether ... has now left home. When she grows up and leaves home, I or my successor will keep in touch with her in this way, and after explaining to her that we believe that she is less likely to suffer from serious breast disease than her friends, ask her whether she will reply- year by year on an addressed card as to whether she is still free--as we expect-from any trouble in the breast. ’
years have
at the British Medical Association in the same year based on a different system. They agree that in stage 1 the tumour is confined to the breast only, but is the absence of axillary metastases to be decided by clinical examination, or on histological examination of an odd suspicious gland, or on a thorough and painstaking If only a local mastecsearch by a morbid anatomist ? tomy is performed, who can say that no secondary glands are present ? Every early stage-2 case‘ which is grouped as stage 1 must tend to impair the survival-rate in both groups. The surgeon who fails to perform the widest possible operation in cases deemed operable may be regarded as a heretic ; yet in spite of an occasional success, my experience has been that a radical operation in a relatively advanced case appears often to shorten the life of the patient. It seems that operative measures today tend to- be less heroic than those of our fathers. Sir Cecil Wakeley2 admits to performing only a local mastectomy in cases where the breast is small and the tumour in an inner quadrant. Here one may note with interest that Harnett finds that the situation of the tumour has little bearing on the prognosis. Everyone is agreed that the radical operation gives reasonably good results in stage-1 cases ; yet at the B.M.A. discussion the ten-year survival-rates recorded by recognised experts varied from 65 % to 91 %. So variable are the manifestations of this dire disease that the statistical results of individual operators are of limited value. In a long surgical career I have operated on several hundred cases of cancer of the breast.. With difficulty 1. 2.
Harnett, W. L. Brit. J. Cancer, 1948, 2, 212. Wakeley, C. Brit. med. J. 1948, ii, 631.