Volume 1

Atlas of clinical surgery : with special reference to diagnosis and treatment for practitioners and students / by Ph. Bockenheimer ; English adaptation by C. F. Marshall.

Philipp Bockenheimer

Date:: [1908]

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Atlas of clinical surgery : with special reference to diagnosis and treatment for practitioners and students / by Ph. Bockenheimer ; English adaptation by C. F. Marshall. 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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$tion. In cases where the supra-clavicular glands are extensively affected, permanent cures are hardly ever obtained, even after radical operations including sec- tion of the clavicle and ligation of the axillary vein; so that it is best to abandon the operation. Also tumors which are adherent to the ribs, and fixed glandular tumors extending to the axilla are unsuitable for operation, for the recurrence generally takes place before the patient has recovered from the operation. Operation is also contra-indicated in cases of severe cachexia, in the atrophic slow-growing forms met with in old people, in cases with metastatic growths in the lung, liver and bones (often leading to sponta- neous fracture of the neck of the femur.) In the region of the head metastatic carcinomas are sometimes inoperable. Owing to their circumscribed encapsuled formation with soft contents they may be confounded with atheromatous cysts. According to Schimmelbusch they arise in this form through em- bolism of cancer cells, and thus form encapsuled freely movable nodules. [The first brain tumor operated upon was an en- capsulated metastatic carcinoma resulting from a mammary cancer.] In cases of inoperable carcinoma the X-rays may lead to epidermization, especially in the ulcerated forms, after previous removal of the ulcerated parts. In discharging cancers powdered charcoal or chlo- ride of zinc may be used locally, and high doses of morphia internally. Cases hitherto reported as cured by X-rays are fallacious. No doubt a carcinomatous nodule may disintegrate and* disappear under the action of the X-rays, but there is always a further growth in other parts—^glands and internal organs. As regards cas- tration for advanced mammary carcinoma in women, further experience is required. Doyen's serum treatment of cancer has so far given no results.$