Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman.

  • Quervain, F. de (Fritz), 1868-1940.
Date:
1913
Catalogue details

Licence: Public Domain Mark

Credit: Clinical surgical diagnosis for students and practitioners / by F. de Quervain ; translated from the 4th ed. by J. Snowman. 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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    impossible to diagnose a cyst. But this is of no importance, so far as treatment goes, because a tumour which can be localized ought to be operated upon, if surgically feasible. Traumatic cephalo-hydrocele, a special variety of cerebral cyst, is referred to later on. Another special variety of cerebral cyst consists of non-traumatic, separate cystic accumulations in the soft meninges, especially in the vicinity of the cerebellum. Like the corresponding changes in the spinal cord, they possess all the symptoms of tumour, and their diagnosis can only be established at the operation. (4) NEW GROWTHS AND TUMOURS OF GRANULATION TISSUE. If there is absolutely nothing pointing to abscess, pachymeningitis or cyst, we have to think of a growth within the skull, viz., neoplasm, tubercle or giunina. As already stated, the possibility of a new growth is not excluded by a preceding injury. This is well illustrated by a case described by Friedrich, wherein an injury suggested the presence of a fibroma in the frontal lobe, but the essential symptoms were of psychical origin. We now have to discuss the nature of the tumour which may be present. It would be ideal if we could infer it from the clinical symptoms. But as gummata and solitary tubercles are not in- frequently extirpated in mistake for new^ growths, it is evident that we have not yet attained this ideal. The most important considera- tion for the diagnosis is offered by the general course of the illness. As a rule a tumour grows steadily on, whereas a gumma presents intermissions in its course, which, therefore, will probably be irregular and capricious. The previous history and the systematic examination of the patient will afford us more information. Careful attention must be paid to everything which may give a definite lead to the diagnosis, without seizing exclusively on any one point. Severe, rapidly and steadily increasing symptoms will therefore suggest a malignant growth, even if the patient has a tubercular family history. The fact that the patient has had syphilis will not preclude a diagnosis of tumour or tubercle, if there is definite evidence pointing thereto. Again, a patient who has for some time been exhibiting symptoms of tumour, but has just recovered from syphilis, is obviously not the subject of a gumma. Too much importance is not to be attached to a negative history of syphilis, in view of the fact that patients may be genuinely ignorant of having suffered, especially if they have been victims of lues insontium. A positive Wassermann reaction is very significant, though it only means that the patient has had syphilis and is not