Fifty cases of primary carcinoma of the lung have
been described and it has been found that:1. Carcinoma of the lung occurred practically
always in people over 40.2. It was 7 times as common in males as in
females.3. In 22 per cent of cases it occurred in people
who had had a cough for a number of years.4. Pleural effusion appeared in 12 per cent of
the cases.5. Clubbing of the fingers occurred in 22 per cent
of the cases and it appears probable that
carcinoma of the lung alone can cause it.6. The symptoms of greatest importance for diagnosis
were cough, haemoptysis, dyspnoea, pain in the
chest and loss of weight. They occurred
fairly early in most of the cases.7. The physical signs of greatest importance for
diagnosis were those suggesting collapse of
lung tissue, by the time these were present
the disease was too advanced for surgery to be
successful.8. Examination of the sputum for carcinoma cells
was a very valuable aid in diagnosis and it
deserves to be used more than it is at present.9. The radiographical appearance of collapse of
lung tissue is very suggestive of carcinoma
of the lung Eby the time this was apparent in
the radiograms the disease was too advanced
for surgery to be successful.10. Bronchoscopy was the most valuable method of
diagnosis. It revealed the exact site of the
growth which is important when the possibility
of pneumonectomy is being considered. It also
furnished conclusive proof of the nature of the
growth. It should be done at the earliest
possible moment whenever the symptoms are at all
suspicious of carcinoma of the lung. If this
is done there is hope that we will be able to
diagnose the condition at an early stage more
frequently. It is the duty of all medical
practitioners to send cases at the earliest
possible moment.11. The Sedimentation rate was considerably raised
in every case except one in which it was
estimated but it is not of great value in
diagnosis because of the large number of diseases
which can cause a raised blood sedimentation rate.12. None of the cases in this series was cured. The
only hope of cure at present lies in early
diagnosis. We can only hope to diagnose the
minority of cases early enough for surgery to be
successful. One of the difficulties is that
patients often ignore symptoms for a long time
before seeking medical advice and this can only
be partly overcome by warning the public of the
danger of neglecting them. A certain number
of cases do come to us soon after the development of symptoms and we must be prepared to
call in the aid of the radiologist, pathologist
and bronchoscopist when we hear suspicious
symptoms in spite of the fact that there are
no abnormal physical signs. Every patient over the age of 40
with a cough which does not improve with
treatment after a week or so should be subjected to the routine accessory methods of
diagnosis. If this is done we would
discover more cases at a stage in which surgery
would be successful
