Clinical lectures and essays / by Sir James Paget ; edited by Howard Marsh.

  • James Paget
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures and essays / by Sir James Paget ; edited by Howard Marsh. Source: Wellcome Collection.

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    bed ; not allowed to retain their refuse; and mere bigness must not be taken for plethora. For the over-fat are certainly a bad class, especially when their fatness is not hereditary, but may be referred in any degree to their over-eating, soaking, indolence, and defective excretions. ‘The worst of this class are such as have soft, loose, flabby, and yellow fat, and I think you may know them by their bellies being pendulous and more prominent than even their thick subcutaneous fat accounts for; for this shape tells of thick omental fat and, I suppose, of defective portal circulation. I know no operations in which I more nearly despair of doing’ good, than in those for umbilical hernia or for compound fractures in people that are over-fat after this fashion. Nothing short of the clearest evidence of necessity or of great probable good should lead you to advise cut- ting operations in people of this kind. Do _ lthotrity for them rather than lithotomy ; incline against ampu- tations for even bad compound fractures; and, wherever you can—as, for instance, for cutaneous cysts, hemor- rhoids, and the smalier examples of scirrhous mammary cancers,—use caustics rather than the knife or ligature. All these warnings must be doubled for the intempe- rate. One does, indeed, sometimes meet with habitual drunkards who pass safely through the perils of great operations ; but these are rare exceptions to the rule, ac- cording to which one may reckon that the risks of all operations mcrease with the increasing degrees of habitual intemperance. I think you will find that a habit of slight intemperance is much worse than occasional great ex- cesses; that regular soaking is worse than irregular carous-
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