Indications for operation in disease of the internal organs / Authorized English translation by Keith W. Monsarrat.

  • Schlesinger, Hermann, 1866-1934.
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: Indications for operation in disease of the internal organs / Authorized English translation by Keith W. Monsarrat. 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.

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    to the probability of uraemia, although the possibility of the simultaneous development of a renal inflammation and a cerebral tumour must be borne in mind, and has occurred in several instances which have been under my observation. Multiple sclerosis is rarely likely to be confused with tumour; it is distinguished from the latter by the absence of optic neuritis, persistent headache and stupor, by the absence of percussion-tenderness of the skull, and by the presence of definite spinal phenomena. INDICATIONS FOR OPERATION. Operation may be undertaken :— 1. For the radical extirpation of the growth. 2. For the relief of symptoms by some palliative procedure. Indications for extirpation are met with only in a restricted number of cases. They may be said to be present when the diagnosis of tumour is definite, when localization is possible, and the tumour is in a situation accessible to the knife. Eradication is possible when the tumour is circum- scribed and of moderate dimensions. With regard to acces- sibility, Bruns has placed the different parts of the brain in the following order : (i) The Rolandic region ; (2) The speech centres ; (3) The frontal lobes ; (4) The occipital lobes ; (5) The temporal lobes. These are also the areas, lesions of which may be diagnosed earliest and most definitely, and when the signs of tumour are clear the prognosis of operation is relatively good. With regard to tumours of the cerebellum, although they are often accessible, the results of operations for their removal have been hitherto so bad that one is forced to agree with Oppenheim and Bruns, that operation is not advisable in most cases. Operation is also inadvisable when the tumour is situated in other situations than those enumerated above, and at the base ; the prognosis quoad vitam is, at present at any rate, most unfavourable. It is usually impossible to be sure beforehand whether a tumour has originated in brain, meninges, or bone ; from the point of view of operation this point is unimportant, if its situation as regards the brain can be definitely ascertained, nor will a supposed subcortical position of the tumour in the regions mentioned alter the indications for operative interference. With regard to the diagnosis of the nature of a growth,