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Show 130 LYMPHATIC cruns msmsnn. when there is a solid heavy tumour, which moves the whole breast, the operation should not be delayed. When as yet the tumour has given no pain, when the sur~ rounding parts are of a natural looseness, and sound, it is con- sidered as not having yet assumed the cancerous action. But when there is pain in the tumour, which is in the breast, es‘ pecially if the tumour increases in size, and fixes to the surrounding parts, then are the surrounding parts, as well as the tumour, diseased; and, in operating, we should cut as Wide of the apparent disease as possible. we shall often have occasion to say to a patient, " that we " are afraid the disease has gone too far, and that the operation " may not only not eradicate the disease, but may somewhat. 4‘ accelerate its progress. But if the disease has not advance d ‘4 so far as we apprehend, and of this we are by no means com- " petent decidedly to judge, then an operation gives you safei,‘ try: and in these circumstances, you must. yourself judge .. or us. EXTIRPATION OF THE BREASL OPERATION. Tm; patient should be seated on the edge of a strong table, and inclined backwards on pillows, the nurse supporting her head, and a woman before her to prevent her slipping from the table. The surgeon takes his station on the diseased side of the patient. Instruments-~are scalpcls, hooks, and three or four tenacu= lums, the common dressing-case, sponges, lint, compresses, split cloth and broad bandage, adhesive straps, and wine. The first incisions should include the nipple and areola : these are useless when the breast is away. The first incision should begin near the edge of the pectoral muscle, towards the axilla, and be brought down on the outside of the areola, and in the direction of the fibres of the pectoral muscle, passing with a very slight curve an inch and a. half beyond the base of the breast below, or, perhaps, further. This depends much on the form of the gland : only it is to be remembered, that it the intcguments are not fully laid open at first, the surgeon LYZ‘H'KVXTXC CLANDS. finds it necessary to turn out the skin upon his lunicldes with Lose before the breast ulcerates, the lymphatic glands be: some affected ; and, when diseased, their progr ess is rapid. if the disease of the breast be above the nippl e, the glands towards the clavicle are in the greatest dange r of partak~ mg of the disease: it between the nipple and stern um (which great force, and is very apt to cut tlu‘ough the flap ! In taking is not frequently the case), then the gland s in the intercostal spaces, near the sternum, are to be exam ined with accuracy; converging to the tract of the first, unite them below. Our next step is to dissect ofi‘ two lateral flaps of the integri- and if the tumour be seated close to the nipple and below it. or between the nipple and the axilla, then the 0lands of the. axilla are to be most particularly attended toss. 0 It the glandsvin the axilla have occasionally enlarged, and ments from the outer hemisphere of the tumour; in doing again subsuled,1t is more favourable than when thcv bar? become hard and enlarged by a slow and uniform ptovrc ss, The 0lands in both sides should be examir.ed r and compared. «‘3 tor often the lymphatic glands are naturally large. ' See Mr. Home. on cancer up the arteries, too, he finds himself poking in a deep sac, from which it is ditlicult to clear the blood. Beginning the second incision as the first, but deviating at an acute angle from its direction, we come on the inside of the areola, and then again which, no vessels of consequence will throw out their blood ; and this may be done right and left without rule. But in our further dissection, we must previously have de: termined whether there be disease in the axilla. If there be no diseased glands in the axilla, we may then be. gin to dissect out the upper corner of the gland. As soon as we have penetrated deep, the external mammary artery, which supplies the breast, will probably spring : Icon. rcivc that it should, be tied not". Proceeding to dissect thr- |