Sarcoma of the Arm, Circa 1874

The Anesthesia Era: 1845–1875


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“Sarcomas are rare, malignant tumors, consisting of only 1% of all neoplasms. Bone sarcomas represent about half of sarcomas.”

The text and photographs on this page are excerpted from a four-volume series of books titled Oncology Tumors & Treatment: A Photographic History, by Stanley B. Burns, MD, FACS. The photos below are from the volume titled “The Anesthesia Era: 1845–1875.” To view additional photos from this series of books, visit burnsarchive.com.

 The face of this young man mirrors the suffering typical in bone sarcoma patients of the 19th century. Surgery was so dangerous and cancer treatment so haphazard, patients often did not present themselves until the disease was far advanced. Surgeons knew that only wide excision offered any chance of a cure, although infection killed most patients in the postoperative period. This frightened, cachexic patient consented to surgery for the removal of his massive arm tumor when the lesion became extremely painful. He died in the postoperative period.

It was not until the 19th century that bone and soft-tissue tumors were distinguished from other cancers. Alexis Boyer, MD (1757–1833), coined the word “osteosarcoma” in describing bone tumors. Astley ­Paston Cooper, MD (1768–1841), the most important surgeon in London in the first quarter of the 19th century, was a pioneer in vascular, ear, and experimental surgery. Among his achievements was dividing bone tumors into two groups: intramedullary and extramedullary. In 1829, John Lobstein, MD (1777–1835), described soft-tissue sarcomas that arise in the retroperitoneal space. A major step forward in differentiating bone tumors was also made in 1829, with the publication of a text on cancer by Joseph C.A. Recamier, MD (1774–1852). He was the first to recognize the process of metastasis and separated primary bone tumors from metastatic tumors. Rudolf L.C. Virchow, MD (1821–1902), the legendary founder of cellular pathology (1858), set in motion a new way of looking at the body as a “cell state.” Between 1863 and 1867, he wrote his main thesis on cancer, Die Krankhaften Geschwulste. He was the first to recognize the sarcomas as connective tissue cancers, separating them into six major types: fibrosarcoma, gliosarcoma, melanosarcoma, myxosarcoma, chondrosarcoma, and osteosarcoma. One of his few mistakes was his theory of the connective-tissue origin of carcinoma. In 1872, Moritz Kaposi, MD (1837–1902), described “idiopathic multiple hemorrhagic sarcoma.” During the 20th century, numerous other connective tissue cell types were identified as sources of sarcoma.

Sarcomas are rare, malignant tumors, consisting of only 1% of all neoplasms. Bone sarcomas represent about half of sarcomas. Treatment of bone and soft-tissue sarcomas requires specific pathologic diagnosis, but it wasn’t until the 1970s that histologic analysis became reliable enough to make differential diagnosis accurate. ■

Excerpted from Oncology Tumors & Treatment, A Photographic History, The Anesthesia Era: 1845–1875 by Stanley B. Burns, MD, FACS. Photographs courtesy of Stanley B. Burns, MD, and The Burns Archive.



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