19th January 2018, Volume 131 Number 1468

Reported by L. E. BARNETT, F.R.C.S., Professor of Surgery, Otago University, and P. D. CAMERON, M.D., Radiologist, Dunedin Hospital

February 1918 

NOTES BY L. E. BARNETT

J.W.M., aged 34, weighing 11st. 12lb., consulted me on 12th August, 1913, complaining of numbness and weakness, swelling, and duskiness of right arm, noticed for nine months. Within the last few days he became aware of a lump growing in the region of the right shoulder and root of the neck. On examination an irregular rounded mass the size of a medium potato, hard and somewhat fixed, can be made out in the right supraclavicular region extending towards the back, also an indefinite swelling underneath the pectoral muscles just below the clavicle and fixed to the thorax, and several enlarged glands in the right axilla.

An exploratory operation was performed on 16th August, 1913, the idea being to carry out the removal of the whole upper limb, clavicle and scapula (forequarter amputation) if feasible. On dividing the pectoral muscles it was found that an extensive mass of what looked like sarcomatous growth was infiltrating the ribs and intercostal muscles and pleura and reaching deep into the axilla and under clavicle. I then decided to abandon all idea of radical operation, and simply removed a piece of the tumour for microscopic investigation and closed the wound. Dr. W. S. Roberts, Pathologist to the University, reports as follows: “The growth is a sarcoma with round and slightly spindle cells, accompanied by a homogeneous and also a fibrous stroma with a tendency to an alveolar arrangement.”

I gave a bad prognosis, but thought I would try and do something to stay the onward progress of a malady ordinarily so tragic in its methods of attack.

On the eleventh and fourteenth day after the operation I administered into the buttocks .45 gramme of neosalvarsan. I may say, however, that there was no syphilitic history or manifestations, and I gave arsenic because I think it sometimes has a good effect in malignant diseases. After seven weeks from the operation I noted, however, that the shoulder lump and axillary swellings were decidedly larger, and I arranged that Dr. Cameron should apply the small quantity of radium that was available at that time, making up for the smallness of quantity by the duration of the exposure (about twelve hours).

From this date a slow but steady improvement set in. I saw him from time to time and was very gratified to find the tumour masses obviously shrinking. The swelling and discolouration of the hand and arm also subsided. I last saw him three months ago, on 24th August, 1917; he had just married and was on his honeymoon tour. He weighed 12st. 4lb., and was the picture of health. His affected arm was perfectly restored in all its functions, and there was no sign of the tumour; one gland about the size of a large broad bean could be felt in the axilla.

In the course of many years one comes across, at rare intervals, remarkable cases of improvement or disappearance of tumour formations. Occasionally such cases are of a granulomatous, possibly syphilitic, nature. The case here recorded, I feel convinced, was a sarcoma, and I ascribe its disappearance to the marvellous powers of radium, which, though it often disappoints—perhaps more often than not—is nevertheless a substance destined to play a very prominent part in the treatment of new growths.

NOTES BY P. D. CAMERON

J.W.M., sent to me by Dr. Barnett with a diagnosis of inoperable sarcoma, right shoulder region, and a request to administer a large dose of radium.

On 7th October, 1913, applied the two radium applicators so as to get a crossfire effect towards the centre of the tumour for twelve hours, the rays from each applicator being filtered through thin rubber, one sheet tea lead, six sheets of black paper, and a layer of lint.

The applicators are each of 500,000 activity, containing 10 m.g. radium bromide in the one case, radium bromide transformed into the sulphate in the other, the former being in an ebonite box with mica window, the latter a varnish apparatus.

J.W.M. was asked to report again in five weeks’ time, but I did not see him again till 5th July, 1915.

On this date he told me that the mass commenced to subside eight days after treatment, and that it had completely disappeared in six weeks. He has been working hard and feels thoroughly well.

On examination there was no trace of the tumour and no difference from a normal chest could be detected.

In the axilla there was still a small gland about the size of a little finger nail and soft.

I am of opinion that the disappearance of the tumour was due to the radium application, and this is in accordance with the experience of others as expressed in the latest report of the Radium Institute, London, to 31st December, 1916, where it was stated, “The result in cases of sarcoma if treated before dissemination into the internal viscera was usually good.” And “The response of lympho sarcoma was very remarkable, the growths commencing to shrink within a few days of the termination of the treatment and rapidly disappearing.”