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Contents
Introduction
Section A: Ich meine, …
Theme 1: Gesellschaftliche Entwicklung in Deutschland
1 Natur und Umwelt
1.1 Das Umweltbewusstsein
1.2 Das Recycling
1.3 Erneuerbare Energie
1.4 Nachhaltig leben
2 Bildung
2.1 Das Bildungswesen und die Situation von Studenten
2.2 Sitzenbleiben
2.3 Die Berufsausbildung
3 Die Welt der Arbeit
3.1 Das Arbeitsleben in Deutschland und die Arbeitsmoral
3.2 Deutsche Unternehmen und Industrien
Theme 2: Politische und künstlerische Kultur im deutschen Sprachraum
4 Musik
4.1 Wandel und Trends
4.2 Der Einfluss der Musik auf die populäre Kultur
5 Die Medien
5.1 Fernsehen, Digital-, Print- und Onlinemedien
5.2 Der Einfluss auf Gesellschaft und Politik
6 Die Rolle von Festen und Traditionen
6.1 Feste, Feiern, Sitten, Traditionen
6.2 Regionale Feste und Traditionen
6.3 Die Ursprünge der Feste und Traditionen
6.4 Die soziale und wirtschaftliche Bedeutung von Festen und Traditionen heute
Section B: Film and literature
Theme 3: Immigration und die deutsche multikulturelle Gesellschaft
7 Die positiven Auswirkungen von Immigration
7.1 Der Beitrag der Immigranten zur Wirtschaft
7.2 Der kulturelle Beitrag
8 Die Herausforderungen von Immigration und Integration
8.1 Maßnahmen von Gemeinden und örtlichen Behörden
8.2 Ausgrenzung und Entfremdung aus der Sicht von Immigranten
9 Die staatliche und soziale Reaktion auf Immigration
9.1 Der Rechtsextremismus
9.2 Politische Annäherung an Gastarbeiter, Immigranten und Asylbewerber
9.3 Die öffentliche Meinung
Theme 4: Die Wiedervereinigung Deutschlands
10 Die Gesellschaft in der DDR vor der Wiedervereinigung
10.1 Die Arbeit in der DDR
10.2 Wohnungswesen
10.3 Kommunistische Prinzipien
10.4 Das Verhältnis zum Westen
11 Ereignisse vor der Wiedervereinigung
11.1 Der Zusammenbruch des Kommunismus
11.2 Der Fall der Berliner Mauer
12 Deutschland seit der Wiedervereinigung
12.1 Migration von Ost nach West
12.2 Arbeitslosigkeit in der früheren DDR
12.3 Auswirkungen auf Schulen in Deutschland
Section C: Research and presentation
Section D: Welches Wort soll ich wählen?
Section E: Zeitausdrücke
Introduction
This new Edexcel edition of WortfürWortbrings further revisions to reflect recent changes in the Edexcel AS and A-level examination specifications and contemporary topics.
The core of the book consists of vocabulary lists relating to four major Edexcel themes, each of which is divided into three sections, each covering a topic from the Edexcel specification. These are divided further into specific social and cultural topics. At the start of each topic there is a red box of revision vocabulary, followed by a list of single vocabulary items in alphabetical order, finishing with longer phrases to provide a context and a ‘feel’ for the way language is used; you can, of course, extract individual nouns or verbs from this to use in a different context.
At the end of each topic you will find (a) some useful websites, which deal with or provide links to aspects of the particular topic, and (b) two or three exercises based on the relevant topic, which practise the vocabulary listed therein, together with some strategies to help you to learn it.
General sections A–E are either new or updated:
• Section A: Ich meine, … lists words and short phrases for use in discussions (under ‘A1 Einfache Ausdrücke / Simple expressions’), then longer items for use in written work (under ‘A2 Längere Ausdrücke / Longer phrases’).
• Section B: Film and literature contains a range of vocabulary to support essay-writing on film and literature which will be useful for the essay you have to write on your chosen film or piece of literature.
• Section C: Research and presentation contains three extra lists on the topics of Sport and Politics, which are not included in
the Edexcel specification. Should you choose one of these topics for the Individual Research Project (examined orally), the vocabulary could give you useful support.
• Section D: Welches Wort soll ich wählen? lists key words for which English speakers often find it difficult to select the most appropriate German equivalent.
• Section E: Zeitausdrücke provides some useful time phrases.
The topics covered match those in the Edexcel A-level specification and as such it is ideal to use alongside any textbook for the course, particularly in order to prepare for your oral examination. All themebased vocabulary has been included with the aim of using it in an oral register.
Alternatively, this book can be used as a study aid to extend the breadth of your vocabulary on each of the topics covered, although it is not a dictionary or an encyclopaedia.
Learning vocabulary
Building one’s active vocabulary quickly and efficiently (which also means remembering it!) is a major concern. Here is one technique for doing so. Always learn vocabulary at the beginning of a work session while you are still fresh.
1 Sit in a quiet place. No background music for this work!
2 Read each German–English pair of words or phrases aloud, twice, including gender and plural forms (for nouns), concentrating hard on the spelling.
3 After five pairs, cover up the English side of the page, and repeat the five pairs aloud again.
4 As stage 3, but this time cover the German side. Write the words out.
5 After 20 pairs, repeat stage 4. Repeat stages 3 and 4 after two hours, and again the next day. Give yourself a written test.
With practice, you will be able to learn 20–30 words in 10–15 minutes, and remember almost all of them weeks later.
Developing your vocabulary
Language is constantly changing. Jot down new words and expressions as you hear or read them; try to use the items in conversation or writing while they are still fresh.
Abbreviations in this book
Acc Accusative
adj. noun noun which works like an adjective conj conjunction
itr intransitive verb jdm. jemandem; shows that the verb or preposition takes the dative jdn. jemanden; shows that the verb or preposition takes the accusative nt neuter
o.s. oneself
pej pejorative
pf perfect tense
pl plural sing singular
s.o. someone sth. something
tr transitive verb
* perfect tense formed with sein
The vowel changes of strong verbs are given in brackets after the infinitive, e.g. geben(i-a-e).
Feminine forms of professions etc. are, for simplicity’s sake, only included where they vary from the usual addition of -into the masculine form.
Where there are closely related alternative spelling forms, e.g. die FakeNewsand dieFakenews, only the version recommended by Duden is listed.
PaulStocker
Useful websites
One word of warning: when you search on Google, many of the websites that appear are blogs and tend to be less accurate in terms of spelling and grammar. It is, therefore, advisable to refer to websites of recognised newspapers, magazines or governmental sites, which will be more reliable.
Most translation websites and many online dictionaries are very poor, and lack the detail you need to make informed decisions. These dictionaries have been found to be among the best: OnlineWörterbücher Onlinedictionaries
Answers to the end-of-topic activities can be found at: www.hoddereducation.co.uk/A-level-vocab
Section A
Ich meine, …
A1 Einfache
Ausdrücke
A1.1 20 Grundausdrücke
Simple expressions
20basic expressions
außerdem apart from that; moreover das mag sein, aber … that may be true, but… das stimmt (nicht) that’s (not) true deswegen that’s why eigentlich actually einerseits / andererseits on the one / the other hand erstens firstly es geht um … it’s a question of… ich bin dafür / dagegen, dass … I’m in favour of / against… ich meine, … I think that… im Großen und Ganzen on the whole im Vergleich zu … in comparison to… jeder weiß, dass … everyone knows that… meiner Meinung nach in my opinion natürlich of course normalerweise normally sicher certainly Was hältst du von …? What do you think of…? Wie kommst du darauf? What makes you think that? zum Beispiel (z. B.) for example (e.g.)
A1.2 Erstens, zweitens Firstly, secondly am Anfang / zu Anfang initially das Pro und Kontra the pros and cons erstens, zunächst first/ly schließlich finally später later von vorn from scratch, from the beginning zum Abschluss in conclusion zweitens secondly
A1.3 Dazu kommt noch … Whatis more,… auch also dazu in addition und dazu kommt noch, dass … and, what is more,… nicht nur …, sondern auch … not only…, but also… übrigens incidentally, by the way was ich eigentlich sagen wollte, ist … what I actually mean is… weiterhin in addition
A1.4 Zum Beispiel For example beispielsweise for example (e.g.) bekanntlich it is known that das heißt (d. h.) that is (i.e.) es stimmt, dass … it is true that… folgendermaßen as follows in Bezug auf (+Acc) with reference to in diesem Zusammenhang in this context nämlich viz., namely die Tatsachen the facts unter anderem (u. a.) among other things wie such as
A1.5 Weil
Because
also, daher therefore, so da (conj) since, as dadurch, deshalb, deswegen in that way, because of that, that is why
das hatte zur Folge, dass … the result of this was… das liegt daran, dass … that’s because… folglich consequently, as a result schon die Tatsache, dass … the very fact that… schon weil … if only because… solange (conj) as / so long as soweit ich weiß as / so far as I know Ursache und Wirkung cause and effect wegen (+Gen) because of (sth.)
A1.6 Vor allem
Above all, notably
ausgerechnet, als / wenn … just when… ausgerechnet er he of all people ausnahmslos without exception äußerst extremely bei Weitem (das Beste) by far and away (the best) bei Weitem nicht (so gut wie) nowhere near (as good as) besonders; zumal in particular; especially as betonen to emphasise durchaus absolutely, definitely eben; halt just, simply es steht fest, dass … what is sure is that… ganz und gar completely, utterly genau das especially this hauptsächlich notably, mainly in jeder Hinsicht in every respect keineswegs not at all, not in the least möglichst (bald) as (soon) as possible
umso mehr, als all the more, considering / as umso wichtiger all the more important (das musst du) unbedingt (machen) (you) really (must do that)
unbestritten ist, dass … it’s not disputed that… völlig, vollkommen completely das Wichtigste ist … the key issue is…
A1.7 Da habe ich Zweifel I’m notso sure
abgesehen davon, dass … quite apart from the fact that… allenfalls; bestenfalls at best allerdings even so / mind you angeblich supposedly, allegedly auf den ersten Blick at first sight bis zu einem gewissen Grad(e) to some extent da habe ich Zweifel I have my doubts there einigermaßen to some extent es kommt darauf an, was … it depends on what… es sei denn, … unless… gewissermaßen in a way ich habe den Eindruck, dass … my impression is that… kaum hardly keinesfalls under no circumstances lediglich merely, simply praktisch; quasi virtual(ly) relativ relatively selbst wenn even if teilweise partly vermutlich presumably Zweifel (pl) ausdrücken to express doubts, reservations
A1.8 Im Vergleich In comparison
ähnlich (+Dat) similar to, like als je zuvor than ever before ebenso likewise genauso just the same genauso wichtig just as important
Kannst du das näher erklären? Can you explain that more fully? noch wichtiger ist … even more important is… noch (bedeutender) (even) more (significantly) sogar even (more) sowie as well as vergleichen (ei-i-i) to compare verglichen mit (+Dat) (when) compared with A1.9 Im Gegenteil
On the contrary aber however jedoch however alternativ alternatively andernfalls alternatively auf der einen / anderen Seite on the one / other hand außer (+Dat) apart from da haben Sie schon Recht, aber … you are right there, but…
dabei at the same time / into the bargain dagegen on the other hand das hat damit nichts zu tun that has nothing to do with it das ist aus der Luft gegriffen that has nothing to do with the facts
das stimmt auf keinen Fall that’s absolutely untrue doch however / though (andto contradictanegativequestion orstatement)
egal ob … it doesn’t matter whether… es ist fraglich, ob … it’s questionable whether…
es ist unvorstellbar, dass … it’s inconceivable that… es kann sein, dass … it may be true that… freilich admittedly immerhin all the same in der Tat in fact in Wirklichkeit in reality, in actual fact mag sein, aber … (inf) that may well be, but… na schön, aber … that’s all very well, but… obwohl (conj) although praktisch in practice in der Praxis in practice problematisch dabei ist … the problem with it is… sonst otherwise stattdessen instead trotz (+Gen) in spite of trotzdem; dennoch nevertheless, despite this überhaupt anyway während (conj) whereas was … angeht, as for…, wer das glaubt, … anyone who believes that… zugegeben; zwar admittedly
A1.10 Meiner Meinung nach In my opinion
daran gibt es keinen Zweifel there can be no doubt about that du musst doch einsehen, dass … you must agree that… es geht darum, ob … it is a question of whether… es geht um (+Acc) it is a question of (sth.) es ist offensichtlich, dass … it is obvious that… es versteht sich von selbst, dass … it is obvious that…
es steht fest, dass … it is certain that… größtenteils in the main
im Allgemeinen in general im Grunde genommen basically, essentially in der Regel as a rule klar clearly kurz gesagt in brief kurz und gut in a nutshell offensichtlich evidently ohne Zweifel undeniably selbstverständlich of course Was sagst du zum Problem von …? What’s your view on the problem of…?
Welche Einstellung hast du zu …? What’s your attitude to…?
Wie ist deine Meinung? What’s your opinion? zweifellos doubtless
A1.11 Schließlich Finally
Das sage ich auch! I think so too! die beste Lösung the best solution ehrlich gesagt to be honest with you es ist alles andere als … it is anything but… es ist schade, dass … it is a pity that… es ist unbegreiflich, dass … it is inconceivable that… es scheint, als ob … it would seem that… Ganz meine Meinung! That’s just what I think!
Genau! Exactly! glücklicherweise fortunately ich bin davon überzeugt, dass … I’m convinced that… ich schlage vor, (dass …) I suggest (that…) leider unfortunately mir scheint es so, als ob … it seems to me that… offen gestanden quite frankly ohnehin anyway schlicht und einfach plainly and simply
Schlüsse ziehen (irreg) to draw conclusions So ist es! That’s right! zu einem Kompromiss kommen* (o-a-o) to reach a compromise zum Schluss in conclusion
A1.12 Weitere nützliche Ausdrücke Other usefulphrases
an sich actually, on the whole dadurch in that way, because of that dafür in return, in exchange irgendjemand someone or other irgendwann (at) some time or other irgendwas something (or other) irgendwie somehow (or other) irgendwo(hin) (to) somewhere or other meistens mostly, more often than not mindestens at least nach und nach bit by bit ohne Weiteres straight away, without a second thought sozusagen so to speak stellenweise in places, here and there teilweise partly, in part unerhört incredible, outrageous ungewöhnlich unusual(ly) vielleicht perhaps wahrscheinlich probably was … betrifft as far as…is concerned weitgehend largely
A2 Längere Ausdrücke Longerphrases
aus diesem Grund for that reason
das geht uns alle an it concerns us all ein umstrittenes Problem a controversial issue es fehlt oft an (+Dat) there is often a lack of… es steht außer Zweifel, dass … it is beyond doubt that… ich bin davon überzeugt, dass … I am convinced that… im Gegenteil on the contrary um ein einzelnes Beispiel zu nennen to take a single example wenn man alles in Betracht zieht all things considered wenn wir es genauer betrachten if we look at it more closely wir dürfen nicht vergessen, dass
we must not forget that…
A2.1 Einleitung Introduction alle sind sich darüber einig, dass … everyone is agreed that…
an dieser viel diskutierten Frage scheiden sich die Geister opinions are divided on this vexed question angenommen, dass … assuming that… darüber wird heftig diskutiert it has provoked a lot of discussion das Für und Wider the pros and cons das Pro und Kontra the pros and cons die Auseinandersetzung über (+Acc) the argument about… die Meinungen über (+Acc) … gehen weit auseinander opinions about…differ widely eine heftige öffentliche Diskussion auslösen to arouse intense public debate eine heikle Frage a thorny question es ist zum Thema geworden it has become an issue es wird oft von anderen Themen in den Hintergrund gedrängt it is often pushed into the background by the other issues gehen wir davon aus, dass … let’s assume that…
in vielerlei Hinsicht in many respects Ist das zu rechtfertigen? Can this be justified?
Kritiker bemängeln, dass … critics point out that… man gewinnt häufig den
Eindruck, dass … one often gets the impression that… man könnte meinen, dass … one might think that… plädieren für (+Acc) to speak up for wir begeben uns auf gefährliches Terrain we’re entering a minefield wir müssen uns damit auseinandersetzen, was … we must tackle the problem of what…
A2.2 These
Arguments
for auf viel Kritik stoßen* (ö-ie-o) to encounter a great deal of criticism auf Widerstand stoßen* (ö-ie-o) to meet with resistance dank (+Genor Dat) thanks to darauf wollen wir später zurückkommen we shall return to this later das Auffallende ist, dass … the striking thing is that… das muss man als wichtiges
Anliegen erkennen this must be recognised as an important area of concern das Problem hat besorgniserregende Ausmaße erreicht the problem has reached worrying proportions die Folgen werden leicht unterschätzt it is easy to underestimate the consequences die Lage … the situation… erregt weiterhin Besorgnis continues to cause concern wird dadurch erschwert, dass … is made worse by… wird schlechter is getting worse die Sache auf die Spitze treiben to bring matters to a head
es ist leicht zu ersehen, dass … it is easy to see that… es ist nicht zu leugnen, dass … one cannot deny that… es wird zunehmend erkannt, dass … it is increasingly recognised that…
etwas stimmt nicht mit (+Dat) … there’s something wrong with… vom politischen Standpunkt aus gesehen from the political point of view was Sorgen (pl) bereiten sollte, ist … what should cause concern is… wir legen zu viel Wert auf (+Acc) … we attach too much importance to…
A2.3 Antithese Arguments against allerdings sollte man … however, we should… dagegen lässt sich einwenden, dass … one objection to this is that…
das ist nur selten der Fall that is only rarely the case das ist zum Scheitern verurteilt it is condemned to failure das sollte man mit einem gewissen Argwohn betrachten one should view this with some mistrust die Gründe sind noch nicht endgültig geklärt
the reasons have not yet been fully explained die Sache hat einen Haken there is a snag dies will nicht heißen, dass … this does not mean that… dieser Auffassung kann ich nicht zustimmen I cannot accept this view einer Sache (Dat) im Weg stehen (irreg) to be a stumbling block to sth. er geht von falschen Voraussetzungen aus he is arguing from false assumptions es erwies sich als falsch it turned out to be wrong es gibt keinen Anlass zu (+Dat) / für (+Acc) … there are no grounds for…
es kann leicht vorkommen, dass … it can easily happen that…
ganz abgesehen davon … quite apart from that… geschweige denn … not to mention…
man könnte annehmen, dass … one might assume that… seine Argumente kann man nicht für bare Münze nehmen you can’t take his arguments at face value wir können uns der Tatsache nicht verschließen, dass …
we cannot ignore the fact that…
A2.4 Gründe angeben Giving reasons
aller Wahrscheinlichkeit nach by the law of averages / in all probability
aus folgenden Gründen for the following reasons aus politischen Gründen for political reasons gelten (i-a-o) für to be true of das gilt auch für … the same is also true of… das kann man an einem Beispiel verdeutlichen / belegen an example will illustrate this die Sache auf die Spitze treiben (ei-ie-ie)
to bring matters to a head
die Statistik macht deutlich, dass … the statistics show clearly that…
die Zahl wird auf … geschätzt the number is estimated at… es ist erwiesen, dass … it is a proven fact that… es wird geschätzt, dass … it is estimated that… in dieser / mancher Hinsicht in this / many respect(s) laut Bundeskanzler according to the Federal Chancellor (= Prime Minister) laut (+Genor Dat) Gesetz according to the law man muss darauf hinweisen, dass … one must point out that… man vergleiche … let us compare… nach Erkenntnissen (+Gen) according to the findings of…
nach fachmännischen Schätzungen according to expert estimates wie oben erwähnt as mentioned above
A2.5
Schlussfolgerungen ziehen
Drawing conclusions
alles in allem all things considered das Entscheidende dabei ist … the decisive factor in this is… das ist erst möglich, wenn … that is only possible if… das kleinere Übel the lesser evil die Aufgabe ist es / besteht darin, … the task is,… die richtigen Prioritäten setzen to get one’s priorities right die Stichhaltigkeit des Arguments the validity of the argument diese Einzelmaßnahmen müssen mit (+Dat) … gekoppelt sein these individual measures must be linked to… ein Ziel im Auge behalten (ä-ie-a) to keep an aim in mind einfache Lösungen gibt es nicht there are no easy solutions es bleibt uns nichts anderes übrig, als … we have no alternative but to… es lässt sich daraus schließen, dass … we can conclude from that that… es verlangt eine Veränderung unserer Einstellungen
it demands a change in our attitudes ich bin der Ansicht, dass … I think that… man kommt unweigerlich zu dem Schluss, dass … one is forced to the conclusion that… man sollte sich vor Augen halten, dass … we should not lose sight of the fact that… Tatsachen ins Auge sehen (ie-ae) to face the facts um diesen Gefahren vorzubeugen in order to avert these dangers
um dieses Ziel zu erreichen to achieve this goal zum Scheitern verurteilt condemned to failure
Theme 1 Gesellschaftliche Entwicklung in Deutschland
1 Natur und Umwelt
der Abfall ( e) rubbish das Abwasser sewage die Atomenergie / die Kernkraft atomic energy aussterben* (i-a-o) to die out, become extinct dreckig / schmutzig dirty
die Energie / die Energiequelle (n) energy / energy source
Energie sparen to save energy entwickeln (tr) to develop die Erderwärmung global warming das Erdöl oil erneuerbar renewable die Folge (-n) consequence die fossilen Brennstoffe fossil fuels
die Gefahr (-en) danger gefährlich / gefährden dangerous / to endanger die Gewässer (pl) lakes and rivers die Industrie (-n) industry
die Katastrophe (-n) catastrophe der Klimawandel climate change
die Konsumgesellschaft consumer society die Luft air
der Müll rubbish, waste
nachhaltig / die Nachhaltigkeit sustainable / sustainability das Ökosystem eco-system recyceln (pfhat … recycelt) to recycle schaden (+Dat) / schädlich to damage / damaging schützen vor (+Dat) to protect from die See (-n) / das Meer (-e) sea Strom erzeugen to produce electricity die Umwelt environment die Umweltbelastung (-en) damage to the environment umweltfreundlich environmentally friendly der Umweltschutz environmental protection verbieten (ie-o-o) to ban der Verbraucher (-) consumer verschmutzen / belasten to pollute die Verschmutzung pollution wegwerfen (i-a-o) to throw away zerstören to destroy
1.1 Das Umweltbewusstsein
Environmental awareness
Die Probleme Theproblems ausbeuten / die Ausbeutung to exploit / exploitation die Auswirkung (-en) effect die Autoabgase car exhaust fumes, gases bedrohen / die Bedrohung (-en) to threaten / threat die Dürre (-n) drought entstehen* (irreg) durch (+Acc) to result from freisetzen to release die Gefährdung (+Gen) danger (to) das Gift (-e), vergiften poison, to poison konsumieren to consume, use verbrauchen to consume, use krebserregend carcinogenic (adj)
das Risiko (plRisiken) risk rücksichtslos / die Rücksichtslosigkeit
thoughtless / thoughtlessness der Schadstoff (-e) contaminant / pollutant die Überbevölkerung overpopulation umweltfeindlich damaging to the environment der Umweltsünder (-) polluter der Umweltverstoß ( e) action damaging to the environment der Verbrennungsmotor (-en) internal combustion engine vergeuden / verschwenden to waste vergiften to poison vernichten / zerstören to destroy verpesten to pollute verschmutzen to pollute verseuchen to pollute belasten to pollute
vom Menschen ausgelöst / verursacht man-made wenn zu ihrer Rettung nichts unternommen wird if nothing is done to save them
Die Luftverschmutzung Airpollution die Emission (-en) emission (of gas etc.) die Geschwindigkeitsbegrenzung (-en) speed limit das Gift (-e) / giftig poison / poisonous das Kohlendioxid carbon dioxide, CO2 der Kohlenstoff carbon der Krebsauslöser (-) / krebserregend cancer-causing agent / carcinogenic (adj) das Ozonloch hole in the ozone layer
Another random document with no related content on Scribd:
(scirrhus) as of epithelioma. Eczema of the nipple is to be regarded with suspicion, especially when occurring after the menopause. Until diagnosis is fairly established it is best treated with soothing applications. So soon as the cancerous stage has been determined the breast should be removed. (See Plate XXVI.)
Other forms of malignant or border-land tumors which occur upon the skin are chimney-sweeper’s cancer, paraffin cancer, and that met with in aniline workers. Chimney-sweeper’s cancer was the name applied to epithelioma of the scrotum occurring among a class of laborers whose occupation is now almost entirely extinct. It began usually as papilloma and merged into epithelioma. Among workers in paraffin and coal-tar factories there is an analogous lesion, the result of surface irritation, the skin becoming dry, thickened, covered with acne-like pustules, and then with papillomas which ulcerate and frequently change over into true epitheliomas.
Sarcoma. Melanoma.
—Only the outer layers of the skin are truly epiblastic. In the depths of the integument mesoblastic elements enter largely, and from these various forms of sarcoma may develop. These have already been treated in the chapter on Tumors. They may be single or multiple, and a general disseminated sarcomatosis is occasionally observed. It corresponds to miliary tuberculosis, but presents many distinctive lesions in the skin, by which it may be easily recognized. A form of multiple pigmented sarcoma involving the hands is represented in Fig. 109. These growths are almost always tender on pressure and more or less painful. They coalesce and finally form fatal lesions.
—This term was introduced by Virchow, who made it cover all pigmented growths. By common consent it is today limited to tumors of the skin and uveal tract which contain pigment; metastases may occur in any or all of them. They occur as malignant degenerations of nevi, moles, and other small growths. Pathologists are still disputing as to whether they should be considered sarcomas or endotheliomas. The coloring matter which they contain is amorphous, finely granular material, lying between the cells in moles, but occurring free in the tissues and blood and even in the urine. It is soluble in strong alkalies, from which it can be recovered as melanic acid, containing a small proportion of sulphur.
Of its origin nothing is positively known. It seems to be generally accepted that the deposit of pigment is not of itself a causative agent of the growth of the tumor, but that the growth of cells and their pigmentation are coincident processes. Johnston has offered much evidence lately to the effect that growths from nevi are really of endothelial origin. Hutchinson has described melanotic whitlow. (See below, the Nails.)
Melanoma is a pigmented ulcerating neoplasm, which possesses at first only a local malignancy like that of rodent ulcer; the more it assumes the endotheliomatous type of growth the more it tends to disseminate and to prove fatal.
The melanoma arising from a mole or nevus, thus known as melano-endothelioma, begins to increase in size and becomes more full, as well as to assume a darker tint. For a variable time it is a single, rather firm, gradually growing, flat tumor, rarely ulcerating, but sometimes exuding a thin dark fluid. Suddenly there appears rapid local spread as well as dissemination. The latter may be first noted in the adjoining lymph nodes. Thus numerous secondary tumors may be felt in and beneath the skin, at first colorless, becoming more or less rapidly pigmented. Metastasis may take place to every organ in the body, but usually the liver and lungs—less often the brain—are involved. In one case known to the writer the heart was a mass of nodules of this same secondary character.
Another expression of the same serious condition is seen in a lesion called by the French malignant lentigo, which also begins with pigmented spots, on the feet of old men, sometimes upon the face. These lesions cause thickening of the skin and early ulceration.
Rodent ulcer, which is one form of epithelioma, occasionally assumes the melanotic type, and is called melano-epithelioma.
Fibrosarcoma of hands. (Hardaway.)
The most marked collection of pigment in the human body, within small space, is along the uveal tract within the eye, and orbital melanomas are not infrequent. Beginning within the sclerotic they rapidly perforate this dense membrane and spread to adjoining tissues, while dissemination and metastasis occur early and rapidly.
Treatment.
—For melanoma there is but one successful treatment, and this is successful only when practised early, i. e., complete excision or destruction. Every mole, nevus, or other skin lesion which shows the slightest tendency to changes noted above should be promptly excised, along with a wide area of its surrounding tissue. It may be thus possible to make a radical cure. Neither x-rays nor any other less radical method of treatment will have the slightest effect. The treatment of any case left to itself until mistake in diagnosis is impossible will probably be of little avail.
SKIN APPENDAGES; HAIR AND NAILS.
The only lesions of the hair and hair follicles that concern the surgeon are those which have been described under the head of Syphilis of the Skin, or some of the congenital growths, such as plexiform neuroma, lymphangioma, etc., whose surfaces are frequently pigmented and hairy, and may call for excision, along with the underlying tumor.
The Nails.
—Onychia implies any disturbance of the nail border and matrix. Simple onychia occurs frequently in the fingers of marasmic children. It is evidenced by softening and swelling of the skin around the nail, by more or less pain, disturbance of circulation beneath the nail, which becomes finally loosened, sometimes leaving a foul ulcer. This ulceration may extend and involve nearly the whole finger. It may occur in one or in several fingers. Lesions of this kind are regarded as local infections, occurring usually in vitiated constitutions. It is a common expression or complication of syphilis; when of such origin it yields readily to treatment; at other times it is often slow and tedious. Except in specific cases, where mercurials locally and internally will usually be
sufficient, the treatment should be radical and should consist of thorough exposure of the ulcerating and fungous surfaces, thorough curetting, and the use of suitable caustics and antiseptic dressings.
Onychia Maligna.
—Onychia maligna implies, according to some writers, a more distinctive type of phlegmonous lesion, while the term has also been applied to malignant ulcers, sometimes pigmented (see Melanoma above) and sometimes of more ordinary type. In either type of lesion granulation tissue may be exuberant and fungating, and it is possible that at times there will be doubt in diagnosis. The finger-tips, with their peculiar tactile sensibility, should never be sacrificed unnecessarily, yet any malignant lesion calls for amputation of the finger.
Ingrowing Toenail.
—This is due almost invariably to ill-fitting footwear, the toes being crowded into too narrow shoes, with too high heels. The real lesion is not so much an excessive growth of the nail as overgrowth and overriding of the skin margin around the matrix. It is painful and annoying, sometimes even disabling. The maceration of a perspiring foot in a warm and tight shoe serves to aggravate the difficulty. Palliative treatment is afforded by chiropodists and quacks, who pack cotton beneath the edge of the nail and keep patients under treatment for indefinite periods, never remedying the footwear and never curing the case. In simple cases it is usually sufficient to excise a portion of reasonably healthy skin on either side of the terminal phalanx, in order that by cicatricial contraction the skin may be drawn away from the nail border. Serious and long-standing cases are best treated by avulsion of the nail, which may be usually performed under local anesthesia or by the aid of nitrous oxide gas. The blade of a knife or scissors is driven under the centre of the nail sufficiently to ensure its passing completely beneath the hidden matrix. The nail is then split in the middle, each half seized at its split border by strong forceps, and by a rapid movement torn loose from its bed. The border of the skin should be scraped, after which a simple dressing suffices, providing the operation has been performed with proper antiseptic precautions.
TATTOO MARKS.
Many an individual is tattooed in youth who would gladly be relieved of the discoloration later in life. Tattoo marks are difficult to erase. The following is a method attributed to Ohmann-Dumesnil: “Wash the skin with soap and water, then with eight or ten fine cambric needles, tied together and dipped in glycerole of papoid, tattoo the stained skin, driving the needles into the tissues so as to deposit the digestive in the corium, where the carbon is located. Repeat as necessary. The pigment is liberated by the digestant.”
C H A P T E R X X V I I I .
SURGICAL DISEASES OF THE FASCIÆ; APONEUROSES; TENDONS AND TENDON SHEATHS; MUSCLES AND BURSÆ.
Fasciæ and aponeuroses are such non-vascular and indifferent tissues that they have practically no primary diseases, except such fibrous and malignant tumors as have their origin in them; nevertheless they suffer in a variety of morbid processes. They lose vitality and break down under the influence of both acute and chronic septic infections. By virtue of their resistant structure, when they slough they break down slowly and the process ends usually with the help of scissors and forceps. Many an old suppurating lesion, especially of the hand and foot, is kept active by the fact that dense, fibrous tissue remains concealed, which ought to have separated. Under these circumstances free incisions should be made and all necrotic tissue trimmed away.
Pus which has formed beneath these fibrous investments will give pain largely in proportion to the intensity of the process and the unyielding character of the fasciæ; hence the urgency of early incision in case of deep phlegmon. Moreover, the direction of least resistance may cause pus when confined to travel where its presence is most undesirable, as from the neck beneath the deeper muscle planes down into the thorax. When pus escapes from beneath firm tissue it is usually by a small opening, after which it may spread out again beneath the skin before finally escaping. This condition has been called “collar-button abscess.” Care should be exercised in opening the superficial collection not to miss the small opening. The fascia must be split sufficiently to permit of thorough cleaning out of whatever collection there may be beneath it.
In the presence of cicatricial contraction of the skin, in shortening of muscles by chronic spasm, as in wryneck, or in certain deformities —for instance of the foot—numerous signs of a shortening or
contraction of fasciæ and aponeuroses are seen. In many instances of club-foot it thus becomes necessary not merely to divide tendons but to make extensive incisions through the plantar aponeurosis or elsewhere, in order to release sufficiently the parts whose extension is desired. Underneath the joint contractures which have been produced by burns and their resulting scars similar conditions will be found, which in old and extensive cases constitute bridles of dense tissue that make it almost impossible to release the parts.
DUPUYTREN’S CONTRACTION.
Dupuytren’s contraction presents the most serious and insidious appearance of slow but almost irresistible contraction of fibrous elements which the human body presents. It is produced by contraction of the palmar fascia, with its numerous minute prolongations, rather than by flexor tendons. It is seen in the hands of men who from the nature of their occupations are subject to much irritation of the palmar surface. It begins nearly always in the fourth or fifth fingers, but may spread to and involve all the digits and even the thumb. The view held by Adams and others that it is a chronic hyperplastic inflammation, with scar-tissue contraction of the palmar fascia and of the adjoining connective and fatty tissue, which does not involve them evenly, but only at certain points, is correct, at least when small nodules may be felt in the palm which are the precursors of the disease. Either hand may be affected, but generally both are involved. It is found in from 1 to 2 per cent. of those who depend upon their hands for their support. Deformity may proceed to pressure dislocation and finally to ankylosis. Its causation then is very obscure; it is rarely the result of definite injury, but follows continued irritation of the surface. It seems to have a local origin, and yet it is frequently associated with the gouty diathesis to such an extent that the prolonged use of alkalies will relieve some cases. The first significant sign of the condition is the formation of small nodules in the palm of the hand, as stated, and this usually precedes the finger contraction by a year or two.
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Dupuytren’s contraction. (Adams.)
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Dupuytren’s contraction of palmar fascia, showing contracted fingers. (Burrell.)
Treatment.—There is considerable difficulty in treating these cases satisfactorily. Cooper advised subcutaneous division of the tense bands and forcible stretching of the fingers; this rarely proves sufficient. Adams advocated multiple sections made with a small tenotome, which is more effective. The best method is that of Kocher, which consists in excision of the fascial bands by longitudinal incisions along the cords, and the dissection of the skin from the underlying fascia. The cord is carefully dissected, with its
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prolongations and then completely removed, while the margins of the skin wounds are closed with sutures. The more thoroughly the dissection is performed the more satisfactory the result. The fingers should be straightened and kept from contraction by the use of a mechanical device. In desperate cases the entire skin of the palm has been removed, with the diseased fascia, and a plastic operation made with skin taken from the thigh or the chest, the flap being sutured in place but not detached completely for ten to twelve days. Two somewhat allied conditions involving the hand and the foot are the so-called lock or trigger-finger and hammer-toe
LOCK OR TRIGGER-FINGER.
Lock or trigger-finger implies a peculiar obstruction to free movement of the finger, which requires extra effort and then is overcome quickly, as if a knot had been slipped through a small opening. It is supposed to be due to a thickening of the tendon at some point, as by a small fibroma, which becomes entangled along the course of the sheath, through which it is moved with difficulty. It is probably due to a local irritation, as in the case of Dupuytren’s contraction. Injury to the tendon sheath may also produce a similar condition.
Treatment.
—Should it fail to respond to rest and massage the sheath should be opened and the cause of the difficulty sought out and removed.
HAMMER-TOE.
Hammer-toe produces deformity with more or less ankylosis. An angle is formed between the first and second phalanges, and the tip of the toe is made to bear more than its proportion of weight. This deformity is in large degree due to the use of shoes which are too short. In consequence there will develop over the protruding joint a corn or bunion.
Treatment.
—Should the trouble come on in childhood the toes should be fastened to a straight splint and shoes for a time abandoned, while later they should be properly adapted to the
needs of the case. In troublesome cases complete excision of the involved joint gives satisfactory results.
SURGICAL DISEASES OF THE TENDONS AND TENDON SHEATHS.
TENDOSYNOVITIS.
Acute inflammation of a tendon sheath is known as tendovaginitis or tendosynovitis. It always implies an infection, and occurs about the hands and feet. It is a frequent complication of felons. Many felons begin in such a manner that it is difficult to decide which part of the fibrous structures of the finger is first involved. Infection having once occurred within a tendon sheath will travel rapidly until it meets with a natural barrier. The frequency of these lesions makes it important to recall here the anatomy of the tendon sheaths of the hand. There is a common palmar tendon cavity, which connects with the thumb and little finger and the space above the annular ligament, but communication with the first, second, and third fingers is ordinarily destroyed. This accounts for the apparent vagaries of cases where infection beginning in the thumb spreads to the little finger before the others are involved. It will also show the location where incisions should be made.
Cicatricial contraction and deformity resulting from consequences of neglected phlegmon and osteomyelitis of hand (Lexer )
Suppurative Tendosynovitis.
—Suppurative tendosynovitis needs prompt intervention, as adhesions may result from retention of exudate, or lest necrosis of tendon occur from perversion of its nutritive supply. Ordinarily it is the result of a local infection, perhaps through a small, trifling surface irritation, but it results occasionally as a metastatic expression of gonorrhea, or distinct septic infection. A gonorrheal tendosynovitis is, however, less likely to suppurate, but more likely to assume the plastic form and interfere with function by producing adhesions between a tendon and its sheath. The combination of virulent bacteria and susceptible tissues will produce local destruction in almost as short a time as in the appendix. The pain is intense, because of the inelasticity of the structures.
—Every appearance of this kind calls for early incision, by which not only the skin but the tendon sheath as well should be freely incised. An incision at either end of the involved sheath, with flushing and drainage, may save a tendon and preserve function. Incision should not be delayed, as destruction may have occurred and deformity be the result. When the common palmar sheath is involved a long incision from the base of the index finger, around the base of the thumb and up the wrist to a point considerably above the annular
Suppurative tendosynovitis (felon), with sloughing tendons and necrotic bone Unfortunately poulticed for two weeks. (Lexer.)
Treatment.
Chronic Tendosynovitis. ligament, will afford considerable relief. It will, moreover, shorten the time of ultimate restoration of function.
—Chronic tendosynovitis may be the result of rheumatism, in which case it assumes the plastic form, or of gonorrhea; the same being true of a tuberculous invasion, which may vary much in intensity. In the subacute forms the deposition of tubercles may lead to a plastic outpour which, being detached by constant motion of the parts, is broken into masses whose minute portions become rounded off by friction and condensed by time, and appear as the so-called “melon-seed or rice-grain bodies.” Some of the same material may be found adherent to the walls of such a cavity In slower forms there is less tendency to plastic outpour, but much more to the formation of granulation tissue, such as is seen in tuberculous lesions in all parts of the body. When, therefore, a case of this general character presents we have the signs of local tuberculosis, or of dropsy of the tendon sheaths, with
the fluctuation somewhat modified by the presence in the fluid of rice-grain or melon-seed bodies. Should, in such a case, an acute infection be added we will have the chronic symptoms merged suddenly into acute. A tendovaginitis of this type appears as a ridge or swelling along the course of one or more tendons. It will be elastic and fluctuate in proportion to the distention of the sheath. When the palmar bursa is involved there is usually, in the palm of the hand, a bag of fluid which may be forced above the wrist by pressure, while frequently the little bodies above described are recognizable by the sensations (crepitus) which they produce. The plastic type rarely proceeds to suppuration or ulceration unless secondarily infected. The granulation type proceeds to ulceration and destruction.
Treatment.
—Treatment of the rheumatic and gonorrheal forms is at first rest, with later passive and forced motion, in order to break up adhesions and prevent their re-formation. If one wait too long he meets with great difficulty in these efforts and the cases become exceedingly tedious. Forcible motion should be practised under nitrous oxide anesthesia and should be repeated every two or three days. Meanwhile massage should be employed. If pain or reaction be extreme ice-cold applications should be applied. Extreme swelling may be combated by the use of a rubber glove. If this be worn, ichthyol-mercurial ointment should be used beneath it, in order to promote absorption.
Treatment of the tuberculous cases is often disappointing. Nonoperative measures afford but temporary benefit, while operation to be effective should be thorough. It should consist of free incision, with exposure in whole or in part of the affected channel or cavity, thorough cleaning out of its contents, removal of all edematous or tuberculous tissue or granulations, and the use of an antiseptic as strong as it can be employed.
The new opsonic serum treatment, now being placed on trial as this work goes to press, promises much in the treatment of all these septic affections, though detailed statements would be premature.
It was a step in advance in surgical technique when Stromeyer and Dieffenbach, in 1842, introduced the method of subcutaneous division of tendons and aponeuroses, and showed how easily contracted tendons could be lengthened by tenotomy. From their time until somewhat recently tenotomy has held its place in the treatment of various deformities, and until Anger, Gluck, Hoffa, and others have taught the surgical profession what can be done by various plastic and suture methods in overcoming defects and atoning for loss of function in paralyzed muscles. To the surgery of tendons and muscle terminations have been added the further resources of tendon suture, i. e., tenorrhaphy, and tendoplasty, by which latter something more than the mere suture is meant, i. e., the plastic rearrangement and grafting of tendons one upon another.[20]
[20] The method of transplanting one tendon upon another is to be credited to Nicoladoni, who perfected it in 1882. Later it fell into disuse, but was revived in this country, especially by Goldthwait, of Boston, in 1896.
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Illustrating various methods of dealing with tendons in tendoplasty (After Vulpius )
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Tendon suture is practised as an emergency measure when one or more tendons has been accidentally divided, this being considered now as much a part of the surgeon’s duty as to close any other part of the wound. No additional resource or expedient is needed, it being necessary only to observe the principles of asepsis, which should be maintained in every case. A tendon raggedly divided should be cleanly cut and its edges brought together with formalin-gut or freshly boiled silk. A series of divided tendons should be treated after the same fashion, matching the ends as closely and completely as possible. After uniting the tendon ends, if the case be clean, the tendon sheath should be closed and the parts put at rest, in such a position that no tension is made upon the injured sinew until it is seen to have united.
