The prophylaxis and treatment of internal diseases : designed for the use of practitioners and of advanced students of medicine / by F. Forchheimer.

  • Forchheimer, F. (Frederick), 1853-1913.
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: The prophylaxis and treatment of internal diseases : designed for the use of practitioners and of advanced students of medicine / by F. Forchheimer. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    per cent recover; therefore, about three per cent of all cases of brain tumor can be cured by operation. It is a notorious fact that the mortality from surgical operations that is deduced from such statistics as have been referred to is always greater than is represented by the figures, simply because a large number of fatal or unsuccessful cases are not reported. At present, then, we cannot look upon surgical intervention with any great amount of enthusi- asm. And yet this operation is indicated when medical treatment fails, as giving to the patient the only chance of recovery. Moreover, we can con- fidently expect that as the technique of surgeons improves the results will be somewhat more favorable. Contraindications to the operation are found in an inaccessible localization where vital functions are involved; tumors of the pons, the medulla, the base of the brain, the basal ganglia, and those deep in the hemispheres are included here. As to the cerebellum, tumors may be operated on, and have been oper- ated on successfully. Upon the whole the motor area is best suited for obtain- ing the best operative results. The nature of the tumor as regards malignancy should be taken into consideration, but unfortunately in a majority of cases this cannot be determined before the operation. Secondary tumors should not be operated on, except for palliation. Carcinoma, multiple tubercles, and gliomata are the least favorable for operation; sarcomata, cysts, and solitary tubercles the most favorable. The size of the tumor may be a contraindication to radical removal, but as much of the tumor as can be ablated should be removed, first because of the palliative effect which occurs as a rule, and secondly, because a number of cases are on record in which a further reduction in size followed the operation (Erb, Oppenheim). INFANTILE CEREBRAL PALSIES Prophylaxis.—The prevention of acute infections and the treatment of syphilis in the pregnant woman should receive some attention here. The treat- ment of prolonged labor, whatever be the cause, is the principal prophylactic measure that should be insisted upon. On the other hand, a certain number of cases have resulted from trauma, the result of the application of the forceps; but in the cases that have come under my observation, the greater number was produced by protracted labor, not by instrumental delivery. Treatment.—Medical.—At the onset the proper treatment of convulsions (q. v.) is imperative, for the convulsive act adds to the danger from increase of local damage. It should be noted also that after any infantile convulsion the attending physician does well to take into consideration the possibility of the development of infantile cerebral palsy. Little can be done by medicine in this disease. Tonics of various kinds may be indicated. Nux vomica or strychnine should be used in very small doses only after the symptoms of the onset have subsided. Potassium iodide and mercury are without value unless there is a syphilitic lesion, and then only in so far as this lesion itself permits of improvement by their administration; it will be seen, then, that very few cases of this.disease can be beneficially affected by this medication. The medical treatment of epilepsy with the bromides is also very unsatisfactory in cerebral palsy; the administration of opium or of chloral hydrate frequently does more good than that of the