“0 BOTANIC PHYSICIAN. 
_ the le; and, in some instances, even to the bone met — 
se as — Tn such cases, as all the diseased parts must be : 
removed, we should not hesitate to use every necessary freedom with > 
the breast muscle, as well as every other part to which the mamma 
_ adheres ; but whenever the removal of the disease can be accom- . 
plished without injuring these parts, it ought undoubtedly to be done. 
On the mamma, or breast, being removed, the operator should ex- 
amine with much accuracy, not only the surface of the sore, but the — 
parts beneath the edges of the divided skin; and if any indurated 
glands are discovered, they should all be removed. In this part of 
~ _ the operation, much care and attention is requisite : for unless all 
* the diseased glands are removed, no advantage will bederived from it. 
_ Thave desired that the whole glandular part of the mamma should 
_ be removed. Even where a small portion of it only is diseased, the 
whole should in general be taken away; for no good purpose cal 
be answered by a portion of it being left; and in’ many instances, 
where this had been done, mischief ensues from the disease making 
its appearance again in some parts of the glands which remain. 
en, indeed, it is found that a single loose gland only is diseased, 
it may be taken out without in juring the rest of the breast ; but whem 
ever the disease is extensive, the whole mamma should be removed. — 
_ The next step in the operation, is, to secure the divided arteries; _ 
and it should always be done with a tenaculum, or a small sharp — 
pointed hook. As the arteries of the mamma are frequently small 
and numerous, much attention is necessary to discover them. All — 
the coagulated blood should be effectually cleared away with a 
_ Sponge and warm water ; and if the patient is faint, a glass of wine & 
or some other cordial should be exhibited ; by which means, small 
branches of arteries are discovered, which would otherwise escape 
notice, and which, if neglected, might induce much hazard and dis- 
The blood vessels being thus secured, and the surface of the sore 
cleared of blood, the divided t uments should be brought together; — 
and in order to secure them with accuracy in their situation, ligatures 
should be introduced at those points where they are most likely to 
answer the purpose. Slips of adhesive plaster may sometimes be 
employed instead of ligatures, in slight cases, 
_ Insecuring the teguments in this manner, care must be taken to 
leave all the ligatures of the arteries hanging an inch or two out of 
the wound, so'that they may be withdrawn in a few days; which iB 
general may be easily and safely done when they have been applied 
with the tenaculum. bi 
In order to promote the adhesion of the teguments to the parts 
beneath, moderate pressure should be applied over the whole by — 
means of the napkin and bandage. But before applying it, the parts 
should all be covered with a piece of soft lint, spread with any emol- 
“sap 
