away. Indeed, this is so much the case, that in op 
no skin has been removed, cures will sometimes be accor 
a few days, which, by the removal of much skin, in the usual 
performing the same operation, would be protracted to many wee! 7} 
ormonths. Noskin need be removed on the supposition that, from 
its previous distention, there will be a wtipiéra bain of it; for its 
elastic power is such that it will contract to the size ofthe sore. 
In proceeding to the operation, the patient must be firmly seated in 
an arm chair, her head being supported with a pillow by an assis-— 
her arms are properly secured by an assistant on 
tant behind, whilst 
each side of her; or she may be placed upon a table, which 
better than any other position; in this m more 
secured ; faintings are less apt to occur, and the sur 
with more ease through every part of ‘the operation, 
In the first place, I shall suppose the operation to be me 
for a schirrus of the breast, or mamma, while the skin is still sound, 
and without adhering to the parts beneath. In these circumstances, 
an incision should be made with a scalpel, through the skin and cel- 
lular substance, from one extremity of the tumor to the other ; taking 
care to direct the scalpel so that it may avoid the nipple, by carry- 
ing it an inch or so to one side of it. When the disease has extenc 
ed, as it sometimes does, beyond the mamma, towards the breast 
bone, as this commonly throws the longest diameter of the tumor 
across the body, this -external incision should be made in a direc- 
tion corresponding to the length of the tumor, by making it to com- 
mence at one side of the mamma, and terminate at the other; but 
when the mamma alone is diseased, the external incision should ran 
in a perpendicular direction, commencing at the upper part of the 
tumor, and finishing at the most depending point of it. By this 
means, any matter that may form during the cure, is freely discharg- 
ed; which does not happen when the incision runs in a transverse 
direction, unless the lower portion of the teguments is afterwards divi- 
ded from above, downward ; which in such cases, should always be 
done ; for, although in some instances, a cure is easily obtained, 
even where this precaution. is not kept in view ; yet, in general, some 
inconvenience would ensue from a neglect of it. 
The skin and cellalar substance being thus freely divided, are now 
to be separated from the diseased parts below by a slow and steady 
dissection ; and this being accomplished, the teguments should be 
kept asunder by assistants, till all the glandular part of the breast is 
dissected from the breast muscle, and other parts with which they 
‘ate connected. With a view to preserve the breast ‘muscle as much 
@s possible from being cut by the scalpel, the arm of the affected — 
use Should be extended somewhat above a horizontal direction 
ll the fibres of this muscle are kept in as 
en happens, indeed, that the dis 
