Papilloedema in Emphysema

surgeons carry out the radical operation on cancers of the breast associated with enlarged supraclavicular glands provided the glands are mobile and not fixed to form a supraclavicular mass.All the evidence points to the danger of any form of surgical treatment in these patients.Opera- tive intervention at this advanced stage can only hasten the patient's end.Stage IV.-This group comprises cases with distant meta- stases in bones, viscera, or lungs.These patients are unsuited for any form of active treatment other than hormonal.X rays, however, may help in the relief of pain caused by secondary deposits in bone, particularly when the metastatic process is confined to a solitary deposit-for example, a single vertebra.Although the ultimate prognosis is grave, some of these patients survive for long periods with well- controlled x-ray treatment.The pain of brachial neuritis caused by a supraclavicular mass of glands is similarly relieved. The Operative Mortality of Radical MastectomyThe operation of radical mastectomy is not yet obsolete.Until it is, operative mortality and morbidity must be reduced to a minimum.Cade (1948) has collected the figures of 22 British surgeons.There were 11,014 radical mastectomies, with 182 deaths-a mortality of 1.65%.In my series of 170 consecutive radical mastectomies there was no operative death-that is, no patient died within one month of operation or while still in hospital. Summary and ConclusionIt is more than half a century since Halsted first practised his operation for cancer of the breast.While much has been achieved since then by individual effort it is well to remember that a busy surgeon cannot expect to see many more than 500 patients with cancer of the breast.Spread as they must be over 30 to 40 years, conclusions arising from this experience can come only slowly.It would seem that we have now reached a stage in the history of this disease when it would be of great advantage to be able to test different combinations of surgery and radiotherapy and hormone methods of treatment upon groups of patients on a scale large enough to make the trials of value.Collaboration between individual surgeons as well as between surgeons and radiotherapy centres would make such investigations possible.Collaboration before treatment and the pooling of results after- wards would provide the volume of material which is necessary if expert independent statistical analysis is to be of value, as it can be, in determining future lines of treatment and in deter- mining them within a reasonable span of time.Early diagnosis is the key to the problem of treatment of breast cancer.No significant improvement in treatment need be expected until there is wider knowledge of the.basic clinical fact that there is no outward visible change in the appearance of the breast in early malignant disease.