Results in 1000 Cases of Extended Vaginal Operation for Cancer of the Cervix. *

Results in 1000 Cases of Extended Vaginal Operation for Cancer of the Cervix.* By Professor Dr. L. ADLER. \Villielminahospital Vienna. You all know that at the beginning of this century ’IVertheim’s method of operating on carcinoma of the cervix, by the abdominal route, spread through the world, and the vaginal route was to a great extent abandoned. Not so, however, in the clinic of niy teacher Schauta. Here we tried consequently to work out and 10 extend the technique of the vaginal operation in the hope by Schauta that it would compare favourably in its cure results, with the abdominal method, which certainly seemed an excellent operation but was followed by an enormous mortality. About 15 years ago some gynzcologists dissatisfied kvith the high mortality, and not quite satisfied with the end result of tlie Wertheim operation began to treat operable cases with radium or X-rays which the French gynzecologists had previously advised. So Kronig, Doderlein, Seitz, \Yintz, Menge IIeymann in Stockholm, and temporarily Bumm, advised the radioligical treatment of tlie cancer without operation. This question has been lvidely discussed but so far \vithout definite results. Those who practised radiation were for a long time handicapped by the fact tliat it was a new method, and they maintained that as the technique of radiation had not been fully worked out, it should not be compared with the results of the well developed surgical technique. No\\., after 15 to 20 years these three methods, having survived their infancy, have arrived at a certain maturity, so it seems fair to compare the results of all three. You know that in speaking of the results of treatment, we make a difference between the temporary curet i l l five years-and the permanent cure after five years. T h e agreement of five years was made because, in spite of recurrences coming after that period, their number is relatively small. In Germany, and i n our country, we differentiate between the relative and the absolute cures, and speak of relative cure \\-lien we compare the number of patients cured with those operated upon. This percentage being chiefly dependent on the number of cases an operator thinks apt for operation, it is necessary to give the percentage of operability.. T h e absolute cures indi-