Medicine: The Case of Senora R.

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A trim little woman of 52, in a neat linen dress and high-heeled shoes, clip-clopped across a marble floor in Havana's Comodoro Yacht Club last week and faced a combined audience of Cuban doctors and members of the cruising Pan American Medical Association.— Dr. Jose A.

Schutte asked her to raise her hand as far as she could. Without difficulty or hesitation, Senora R. shot her right hand straight in the air over her head. With no sign of pain, she reached her fingertips almost down to her ankle.

It was hard to believe that this was the patient of whom Dr. Schutte had just showed clinical pictures. Thirteen months ago, Senora R., wife of a Havana street-cleaner, was near death from a recurrence of cancer (an operation for breast removal four years earlier had failed to eliminate all the disease sites). Hormone and X-ray treatments were of no further avail.

So deep was the infiltration of cancer cells that Senora R. could not open her mouth, turn her head, or lift her arm from the bedclothes, and she needed morphine several times a day.

The Swedish Method. Dr. Schutte, a hormone specialist, discussed the case with Neurosurgeon Jorge A. Picaza. They decided that Senora R. might be relieved by a drastic operation developed by two Swedish doctors: removal of the pituitary gland. The Swedes thought it offered promise in some forms of cancer.

A master gland that secretes many of the body's most important hormones, the pituitary is hidden in a pocket of bone beneath the brain and behind the eyes, as though nature had done her best to protect it from injury — or from the surgeon. Several ways of getting at it have been devised, but none is fully satisfactory. Dr. Picaza reported that he followed the general lines of the Swedish method—In a two-hour operation at the Institute of Radium of Mercedes Hospital, he lifted a flap of bone almost three inches square from Senora R.'s forehead. With the frontal lobe of the brain pushed aside, he worked past a barrier of optic nerves to cut the stalk by which the pituitary hangs from the hypothalamus.

With spoon-ended forceps, Dr. Picaza removed the pituitary, piece by piece. Trying to make sure that no part of the gland would be left to regenerate, he cauterized the inside of the pocket thoroughly with formaldehyde.

Three Hormones. Senora R. withstood the operation amazingly well. Within a week the pain of her cancer had gone and she needed no more morphine. Dr. Schutte now supplies only three hormones as substitutes for those produced or governed by the pituitary: cortisone, desoxycorti-costerone and thyroid. Today, 95% of the outward signs of her cancer have disappeared.

The Havana doctors did not try to forecast how long this freedom may last. Neither did they say that it is the direct result of removal of the pituitary. However, until hormones became available from factories to replace the body's products, it would have been impossible for a patient to live for a year without a pituitary. Senora R. has not only survived; she runs a neat home for her family and does all her own housework.