General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley.

  • Billroth, Theodor, 1829-1894. Allgemeine chirurgische Pathologie und Therapie. English
Date:
1881
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Licence: Public Domain Mark

Credit: General surgical pathology and therapeutics : in fifty-one lectures / by Theodor Billroth ; translated from the fourth German edition, with the special permission of the author, and revised from the eighth edition, by Charles E. Hackley. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    ns well as iny own, incline to the latter view. I decided!}^ prefer the operation with the knife or scissors, because I then know exactly what I remove and I can judge more certainly if all the diseased part has been excised. lienee, I regard the operative removal of cancer as well as of other tumors to be i)referable as a rule. But where there is a rule there are exceptions. In very old, an:emic, or timid patients, caustics may be employed, and, if the treatment be continued till all the diseased portion is destroyed, the result Avill be favorable. Physio- logically caustics would have some advantages; for it is supposable that the cauterizing fluid may enter the finest lymphatic vessels, and thus more certainly destroy the local disease. But this does not oc- cur readily, because the tissue with which the caustic comes in contact instantly combines with it, and its further flow is thus prevented. Formerly it was asserted that recurrence did not take place so soon after the use of caustic as after operation with the knife, but this has not been confirmed; hence I only maintain the above ex- ceptions. For a caustic I ]3refer chloride of zinc to all others for destroying cancers; you may use it as paste or as caustic arrows. If it is a sur- face you wish to cauterize, to equal parts of powdered chloride of zinc and flour you add enough water to make a paste, which you apply to the surface. If you desire to eauterize more deeply, you mix one part of chloride of zinc with three parts of flour or gum and some water, and let them form a cake and dry; this may readily be cut u]i into small pointed cylinders half a centimetre or more in thickness; with a lancet you make an opening in the tumor and press the caus- tic arrow into it; you repeat tliis operation till the tumor is perforated with arrows at about three quarters of an inch distance from each other. In four or five hours this cauterization is followed by moderate, often by very severe pain, which you may greatly modify by giving a subcutaneous injection of morphine directly after the cauterization; the next day you find the tumor changed to a w’hite slough. This becomes detached after five or six days, earlier in soft tumors, later in hard ones. If the cauterization has extended far enough into the healthy parts, after the detachment of the eschar there is left a good granulating w^ound, which soon cicatrizes; if the carcinomatous mass again grow'S, the paste or arrow^s should be again applied, etc. These cauterizations are occasionally very painlul and uncertain as regards the extension of the caustic, but they occasionally arc advantageous. Other celebrated caustics arc ^ ienna jiaste, arsenic paste, butter of antimony, chloride of gold, etc.; iodide of jiotash, chromic acid, concentrated solutions of chloride of zinc, fuming nitric acid, sulphuric acid, etc., are less employed.