- Email: [email protected]
PROGNOSIS IN MALIGNANT DISEASE.
818 on a large scale without compulsion. This was the decision taken, by a large majority, at the Tenth International Labour Conference in Geneva in June, 1927, and it was confirmed by the International Conference of Unions of Mutual Benefit Societies and Sickness Insurance Funds which was held in Brussels in October, 1927. The decision of the Conference was in the following terms : " The most effective form of systematic provident effort for preventing and remedying the loss of productive power in the workers consists in compulsory insurance, which may be usefully supplemented by voluntary thrift." It would seem that the function of voluntary insurance in the past has been to explore the ground and prepare the way for large national schemes based on the principle of compulsion, and that its function in the future will be to provide means for voluntary thriftt supplementing the provision made by compulsory
The duration of the disease before the axillary glands become involved is definitely longest in the group of low
histological malignancy, and palliative operations give more prolonged benefit even in advanced cases. It is especially in those cases in which dissemination has occurred, but to a moderate degree, that the value of histology in estimating prognosis is best seen. Of ten such patients belonging to the low and medium malignancy groups, four were alive and
well at the time the records were taken, whereas of eight patients in the high malignancy group there were no survivors. It is to be hoped that Mr. PATEY and Dr. SCARFF will continue their work, for it seems to be based on sound lines and to have definite possibilities. The experimental study of cancer has shown that individual tumours differ from one another in their biological characters, their rate of growth, and their behaviour on transplantation. There is no reason to suppose that the spontaneous insurance: human carcinomata differ from the experimental tumours in all being built to the same pattern; they PROGNOSIS IN MALIGNANT DISEASE. also have their individual character which is more THE results of treatment in malignant disease are, rigid and of greater importance than the reaction called forth in the tissues of the host. The amount on the whole, so unsatisfactory that there is a natural of stroma and the degree of cellular infiltration are tendency to shirk any attempt at prognosis in individual cases. Every surgeon, of course, can of little value in estimating the growth energy of the point to instances where his intervention has been tumour. It is the malignant cell itself to which we completely successful; were it not so, indeed, his must look for information, and though it may not task would be intolerable ; but he would be the first be permissible to speak of the correlation of structure to acknowledge that his results depend a great deal to function in the malignant growths it is clear that on factors of which he is ignorant. Of two apparently the structure of a carcinoma has a fairly definite identical cases, treated in exactly the same way, one relation to its biological activity. may be restored to health, permanently or for a number of years, while the other may terminate PUNCTATE BASOPHILIA. fatally in a few months. In attempting to estimate THE nature and significance of the little blue points the chances of recovery, the extent of the disease is naturally of the first importance. Involvement of in red blood corpuscles which stain with the nuclear the neighbouring lymph nodes makes the prognosis component of methylene-blue-eosin stains in an grave, and further extension makes it practically ordinary dried blood nim have been the subject of a hopeless. But what is to be said of those cases in good deal of controversy. Found in small numbers which there is no obvious dissemination?It is above in a variety of abnormal bloods, they have long been all in this group that the position of the surgeon is known to have a special, though not an invariable, Is he justified in offering the patient association with lead poisoning, and the whole matter so difficult. the encouragement which is so desirable, or must he is reviewed in the last number of the Jou,nwl of still refrain from offering any but the most guarded Pathology and Bacteriology (192R, vol. zi., p. 277) opinion ?‘ Mr. D. H. PATEY and Dr. R. W. SCARFF by Dr. R. W. BROOKFIELD, of Liverpool, who has have attempted to answer the question in reference worked at the changes produced in the blood by the to that very difficult tumour, carcinoma mammae, administration of colloidal lead in the treatment of and have brought forward results which are at least malignant disease by Prof. BLAIR BELL. An intraencouraging. The number of cases investigated by venous dose of lead causes an immediate anaemia them is small, being only 50, but, on the other hand, by the direct action of the metal on the red corpuscles ; they were all operated on by the same surgeon and to this the bone-marrow responds by regenerating red were investigated by the same individual, so that cells, often very actively, and in consequence the variations due to the personal idiosyncrasy of the circulating blood shows many immature corpuscles observer is reduced to a minimum ; the period elapsing which appear as polychromasic cells in dried films, between the operation and the time of recording the and as reticulated cells if they are stained wet with result ranges from three to seven years, which is a vital stain such as cresyl blue. Punctate basophilic a reasonably long interval, and the records are (or stippled) cells appear at the same time, roughly in complete in every case. In estimating the degree parallel with the polychromasic cells. Dr. BROOKof malignancy of the tumours, they have adopted a FIELD produces a variety of evidence to -show that histological classification based largely on the work stippled cells are in fact polychromasic cells altered of GREENOUGH, and have relied upon the degree of by the action of lead. All the stages from typical dedifferentiation of the tumour cells and the apparent reticulation to typical stippling can be produced by rate of growth as evidence of malignancy. After staining fresh regenerating blood with varying careful consideration of all the available facts the concentrations of cresyl blue, and he quotes the tumours were grouped into three divisions according pertinent observation of KEY, who showed that lead to the degree of malignancy which they were believed poisoning produced less punctate basophilia in normal in those whose blood contained to possess, and were then subjected to analysis in rabbits than the light of the subsequent clinical histories. It many immature red cells as the result of repeated It seems, indeed, quite doubtful becomes apparent from an examination of the data haemorrhages. that the authors were justified in their classification, whether stippled cells occur as such in the circulating for their figures show a progressive deterioration in blood ; .several observers have noticed in men and the clinical results as the index of malignancy rises. animals poisoned with lead that their number
The duration of the disease before the axillary glands become involved is definitely longest in the group of low
histological malignancy, and palliative operations give more prolonged benefit even in advanced cases. It is especially in those cases in which dissemination has occurred, but to a moderate degree, that the value of histology in estimating prognosis is best seen. Of ten such patients belonging to the low and medium malignancy groups, four were alive and
well at the time the records were taken, whereas of eight patients in the high malignancy group there were no survivors. It is to be hoped that Mr. PATEY and Dr. SCARFF will continue their work, for it seems to be based on sound lines and to have definite possibilities. The experimental study of cancer has shown that individual tumours differ from one another in their biological characters, their rate of growth, and their behaviour on transplantation. There is no reason to suppose that the spontaneous insurance: human carcinomata differ from the experimental tumours in all being built to the same pattern; they PROGNOSIS IN MALIGNANT DISEASE. also have their individual character which is more THE results of treatment in malignant disease are, rigid and of greater importance than the reaction called forth in the tissues of the host. The amount on the whole, so unsatisfactory that there is a natural of stroma and the degree of cellular infiltration are tendency to shirk any attempt at prognosis in individual cases. Every surgeon, of course, can of little value in estimating the growth energy of the point to instances where his intervention has been tumour. It is the malignant cell itself to which we completely successful; were it not so, indeed, his must look for information, and though it may not task would be intolerable ; but he would be the first be permissible to speak of the correlation of structure to acknowledge that his results depend a great deal to function in the malignant growths it is clear that on factors of which he is ignorant. Of two apparently the structure of a carcinoma has a fairly definite identical cases, treated in exactly the same way, one relation to its biological activity. may be restored to health, permanently or for a number of years, while the other may terminate PUNCTATE BASOPHILIA. fatally in a few months. In attempting to estimate THE nature and significance of the little blue points the chances of recovery, the extent of the disease is naturally of the first importance. Involvement of in red blood corpuscles which stain with the nuclear the neighbouring lymph nodes makes the prognosis component of methylene-blue-eosin stains in an grave, and further extension makes it practically ordinary dried blood nim have been the subject of a hopeless. But what is to be said of those cases in good deal of controversy. Found in small numbers which there is no obvious dissemination?It is above in a variety of abnormal bloods, they have long been all in this group that the position of the surgeon is known to have a special, though not an invariable, Is he justified in offering the patient association with lead poisoning, and the whole matter so difficult. the encouragement which is so desirable, or must he is reviewed in the last number of the Jou,nwl of still refrain from offering any but the most guarded Pathology and Bacteriology (192R, vol. zi., p. 277) opinion ?‘ Mr. D. H. PATEY and Dr. R. W. SCARFF by Dr. R. W. BROOKFIELD, of Liverpool, who has have attempted to answer the question in reference worked at the changes produced in the blood by the to that very difficult tumour, carcinoma mammae, administration of colloidal lead in the treatment of and have brought forward results which are at least malignant disease by Prof. BLAIR BELL. An intraencouraging. The number of cases investigated by venous dose of lead causes an immediate anaemia them is small, being only 50, but, on the other hand, by the direct action of the metal on the red corpuscles ; they were all operated on by the same surgeon and to this the bone-marrow responds by regenerating red were investigated by the same individual, so that cells, often very actively, and in consequence the variations due to the personal idiosyncrasy of the circulating blood shows many immature corpuscles observer is reduced to a minimum ; the period elapsing which appear as polychromasic cells in dried films, between the operation and the time of recording the and as reticulated cells if they are stained wet with result ranges from three to seven years, which is a vital stain such as cresyl blue. Punctate basophilic a reasonably long interval, and the records are (or stippled) cells appear at the same time, roughly in complete in every case. In estimating the degree parallel with the polychromasic cells. Dr. BROOKof malignancy of the tumours, they have adopted a FIELD produces a variety of evidence to -show that histological classification based largely on the work stippled cells are in fact polychromasic cells altered of GREENOUGH, and have relied upon the degree of by the action of lead. All the stages from typical dedifferentiation of the tumour cells and the apparent reticulation to typical stippling can be produced by rate of growth as evidence of malignancy. After staining fresh regenerating blood with varying careful consideration of all the available facts the concentrations of cresyl blue, and he quotes the tumours were grouped into three divisions according pertinent observation of KEY, who showed that lead to the degree of malignancy which they were believed poisoning produced less punctate basophilia in normal in those whose blood contained to possess, and were then subjected to analysis in rabbits than the light of the subsequent clinical histories. It many immature red cells as the result of repeated It seems, indeed, quite doubtful becomes apparent from an examination of the data haemorrhages. that the authors were justified in their classification, whether stippled cells occur as such in the circulating for their figures show a progressive deterioration in blood ; .several observers have noticed in men and the clinical results as the index of malignancy rises. animals poisoned with lead that their number