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Show 126 or [HE OPERATION ron (DANGEROUS Easiest, COMMENCEMENT or THE DISEASE. 192' ~ the tuberculated state of the lungs, an occasional excitement is only wanting to give vigour to the latent disease. This kind of reasoning would deter me from extirpating tumours situated in the substance of the gland, leaving the gland itself CHAPTER VII, behind. The tumour must be very free and insulated, and superficial, which I would cut out without taking the breast OF THE OPERATION FOR CANCEROUS BREAST. along with it : for when such tumours have followed from blows, or kicks of the child, is there not reason to fear that a similar effect may follow to other parts of the breast, in conWhilst other glands sequence of cutting, bruising with the fingers and tying ligatures on the glandular substance 9 continue their function uninterruptedly, this depends upon the state of the womb : its action by remote sympathies, is at one One of two things is proved by every day's experience, that either the disease apparent in one part is a mark and sign of time called forth, and again left for an interval to subside ; and, finally, at the age of from forty to fifty, its function is some general predisposition in the surrounding parts, or the contamination from the centre of disease precedes all evidence entirely suppressed. Were we to take the instances of the womb and breasts, we should say that a cessation of accustomed action were ill to bear ; and that the part exposed to it is apt to fall into cancer. The perfect reliance which, within the last thirty years has been placed on the excision of the mamma, for the entire extirpation of the cancer, is in the present day considerably diInin~ ished. And in the late publication of Mr. Home, on cancer, the opinion of the older profes‘or Munro, published in the Edinburgh Medical Essays, is confirmed, that after an opera» of the commencement of diseased action in the surrounding parts. The disease generally begins at the period of the cessation of rl‘nn mamma is a gland almost peculiar in this, that it 4...- .4-r-n --~-' -' . 1"- "- r-«rr» "-'~("" _. .~~--* ww; .m- ,-‘2.I~ .n-szurev‘ ~9- has not a continued action and secretion. the menses. About that period the menses flow irregularly; sometimes intermit, and sometimes are accompaned with an unusual flooding. It is the same unequal action in the breast, which brings so many women to the surgeon, with swellings, and powerful stinging, and throbbingas. This being neglected, the breast becomes indurated, irregular, and knobby ; or, the general swelling subsiding, there is left a firm body in some tion performed too late, the disease is aggravated, or runs a more rapid course than it otherwise would have done. Per- part of the gland, the origin and centre of all the future mischief, Sometimes the disease arises in a distinct tumour, as fre- haps the explanation of this is, that where parts are left unex~ tirpated, which have a tendency or disposition to the disease. quently a small portion of the gland becomes diseased, having a knotty, but not a circumscribed feeling. the operation acts as a blow would do, or any other violent cause of increased action or inflammation, fostering and bring ing forward the diseasea‘e. Often, I believe, the gland is like * If there be swelling and tension of the breast, and throbbing pain, as of iiifiammation, then I would give a pretty smart purge, repeated more gently within the week, and afterwards continue with small doses of calomel. Bleed with leeches, repeatedly at intervals, and then apply a vinegar poulr 3 The cancerous action is unlike in its progress to that of the common in» flammations, which spread more quickly along the surface from cell to cell. it consolidates as it advances, and I conceive that the condensation of the cellular membrane by the inflammation which follows the operation, afford: a more easy progress to the course of the cancerous action too, (or the ziq. ammon. acct.) or in a duller and less active state ot' the gland, I would, after leeching or cupping, foment, and repeatin g this, anoint with camphor and mercurial unction, or cainphoratcd spirit. Some use The hemlock poultice. But in short, our endeavour should be, after lowering and keeping down the general action of the gland, to excite the surface 70 ucticn and still more to relieve the glandular body |