An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![hai)s prescnitinp; tliepoonliar AN artv,eanlillo\\ or surface mentiono(l,an(l es])ecially if the subnuixilhiry <fhiiids are enlarged, the disease may be safely considered car- cinomatous. Or, again, an obstinate fissured ulcer, often scabbed over, forms in the same situation, discharging a watery matter, ^s\i\\ induration extending in all directi(uis for full one-fourth to one-half of an inch, involving notoidy the mucous and cutaneous tissues, but all the structures of the lij); perhaps in addition the j)atient states that the disease first a])peared as a Avart Avhich had been picked off or cauterized—/. e. had been irritated, not destroyed. Epithelioma of the tongue may appear at an earlier age, and in from three to six months will often reach a considerable size in the rarer form, -where the disease appears as a hardened, non- inflauuMl mass on the free border of the tongue—not uncommonly near a broken tooth—its surface eventually becoming fissured, ulcerated, and painful. Or, again, there may be merely an indolent, slowly-extending, unhealthy ulcer with indurated base and margins situated as just mentioned. Although the diagnosis between carcinoma and tubercle or syphilis of the tongue is often difficult, coex- isting syphilitic lesions or old scars of the tongue, with antisyphilitic treatment, will usually settle the question, while signs of tubercle elsewhere ought to arouse grave doubt of the carcinomatous nature of the ulcer. Further diag- nostic points are given in the section on Syphilis. Warts on the hands or scrotum, or elsewhere, in elderly chimney-sweeps or in coal-tar- or paraffin-workers should be vicAved with suspicion, especially if they are growing and if their bases are becoming indurated, because in such cases, sooner or later, an unhealthy ulcer, discharging foul matter, usually forms, presenting all the clinical evidences of epithelioma. It hardly needs to be said that epithelioma is evidently induced by persistent irritation, since the localities where it occurs are subjected to frequent slight traumatisms, and the occupations which give rise to it supply constant sources of mechanical and chemical irritation. Local recurrence is common after operation as a consequence of imperfect removal of the disease, and death in these cases, as Avell as in those not operated upon, results from the exhaustion incident to ulceration and hemorrhage rather than to dissemination, which, as has been already pointed out, is of rare occur- rence. 2. Cylindrical- or Columnar-celled Epithelioma.—This is a less common form of carcinoma than the spheroidal-celled or the squamous-celled varieties, and originates from either the cylindrical surface epithelium of a mucous membrane or that of its glands, closely imitating these structures in microscopical appearance; no cell-nests are found. These growths form indurated, infiltrating masses in the walls of the organs attacked, and vary much in the rapidity of their course, producing considerable stenosis of the lumen of such hollow viscera as the rectum and small intestines, which may ter- minate life by producing more or less intestinal obstruction ; ulceration occurs early. Dissemination throughout the liver, lungs, and other organs occurs, as a rule, only after infection of the intervening lymph-glands. (See Diseases of the Intestines and Rectum.) Seats of Predilection.—The rectum, uterus, and intestinal tract. Diagnosis.—This is to be made by attention to certain secondary results, which will be found detailed in the sections on Diseases of the Intestines and Rectum. Treatment of the Carcinomata.—The first question to be answered is, Can this case be treated radically, or does it admit only of palliation ? If it can be treated radically, the whole organ should be excised, including as much](https://iiif.wellcomecollection.org/image/b21217014_0275.jp2/full/800%2C/0/default.jpg)
