File:The practice of surgery (1910) (14779952205).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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he keloidundergoes malignant degeneration. The treatment of keloid is far from satisfactory. The obvious measureis to excise the tumor with a wide margin, in the hope of replacing itby a narrow linear scar. Unfortunately, in many cases a new keloidappears at the site of the new scar. I have seen some excellent resultr;follow the long-continued use of the a^-rays after excision of the growth. Every hospital has on its list of chronic patients some of thesecases of keloid,—patients who return year after year to have their .SURGERY OF THE SKIM 817 deformities iniprovod if possible,—upon wiioiu the surgeon comes tolook with ever-increasin dismay. Malignant degeneration of scars and ulcers occurs in variousparts of the body. Marjolin described the condition half a century ago,and Da Costa wrote of it again in 1903 (Marjolins ulcer). The termis applied to chronic ulcers which have undergone malignant changes.Cicatricial tissue also may undergo similar changes. Lupus and syphilis
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Fig. 509.—Keloid (Massachusetts General Hospital). are among the etiologic factors. The ulcer takes on malignant charac-teristics about its margins, and these malignant changes, when oncestarted, may progress rapidly. The ulcers edges become hard andelevated; the granulations large and hemorrhagic; there is often greatpain and a fine bloody discharge; the adjoining h^mph-nodes becomeinvolved, and the ulcer runs the characteristic malignant course.The treatment is obvious—a prompt and wide excision. 52 CHAPTER XXVIIITUMORS In this chapter I propose to discuss briefly the subject of tumors,although by so doing I must viohite the promise in my introductionthat I would not deal in this work with matters of general pathology. Tumors, however, belong esentially to surgery as distinguished frommedicine. Except when hopeless—and who may say what is hopeless?—tumors have no place in medical wards or under the care of theinternist. A distinguished American surgeon recently said to me: I

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