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
Catalogue details

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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    VlV Now a few words of advice about the local treatment of cancer- ous ulcers which are not, or at least are no longer, suited for opera- tion. In some of these cases the proliferation of the cancerous mass from the wound is enormous, and it often annoys and debilitates the patient; here we may make partial cauterizations or employ the hot iron; by the palliative destruction of the proliferating mass, we occa- sionally attain tolerably good results. The chief indication for treat- ment in these patients is suppuration of the ulcer, which is occasionally horridly fetid, and sometimes the pain. For preventing the disagree- able secretion, the hot iron is a good remedy; the smell may be les- sened by compresses wet with chlorine-water or purified acetic acid, creosote, carbolic acid, permaaganate of potash, sprinkling with pow- dered charcoal. The latter readily absorbs gases, as you know from chemistry, and is here an excellent remedy; unfortunately, it dirties the wound, so that we aljstain from its frequent use; For the pain of carcinomatous ulcers, narcotics have been applied locally, as by sprink- ling on powdered opium; but, when injected subcutaneously or given i nternally, the narcotics act more certainly; hence at last Ave always resort to morphine for these poor patients. I particularly enjoin on you patience in caring for and alleviating the sufferings of these unfor- tunates ; it is indeed sad for the physician to be able to do so little good in these cases, but still you must not abandon them. BRIEF REMARKS ABOUT THE CLINICAL DIAGNOSIS OF TUMORS. I cannot take it amiss if you are at first somewhat confused by what I have said to you about tumors ; if it will encotirage you, I may acknowledge that formerly it was the same with me when I was in your ])resent position. Only long study and practice in the differen- tial diagnosis of tumors, for which there is opportunity in the clinic, render it possible to attain any certainty on this difficult point. The consistence of the tumor and its appearance, its relation to the parts around, its locality, the rapidity of its growth, and the age of the pa- tient, are the points from which we start in judging ; sometimes one, sometimes another, of these ]3oints gives the decision. Let us take an example : A man about fifty years old comes to you, ruddy and strong for his age; for many years he has had a tumor on the back, which formerly gave him no trouble ; it has only been inconvenient since it has reached nearly the size of a child’s head. The tumor is elastic, soft but not tense or fluctuating, movable under the skin; the latter is un- changed; there has never been pain in the tumor, nor is anv caused by the examination. In this case the diagnosis is very cas}^: from 47