ES 
~ But it does not often happen, that the operation is advised, 1 
this mode of practising is admissible. In general, before a practitione 
recommends amputation of a breast, and still more frequently, befor 
a patient consents to it, a considerable portion of the external tegu- 
ments are so much diseased, as to render it necessary to remove 
them along with the glandular part of the mamma ; or if the skin is 
not actually diseased, it commonly adheres so much to the most 
minent part of the breast, that it cannot be separated from it. In 
either of these circumstances, some portion of the skin must be re- 
moved along with the mamma; and the easiest method of doing it is 
this: a longitudinal incision should be made in the manner I have 
advised, through such parts of the teguments as are perfec’ 
sound, while that portion of the skin that is diseased, or which 
adheres firmly to the glandular parts of the breast, should be sepa- 
rated from the sound skin by a circular or oblong incision, with 
which the longitudinal cut ought to communicate ; and this being 
done, the operation is to be finished by dissecting off every, part that 
is indurated, along with that portion of the skin which in this man- 
ner has been surrounded with an incision, such as I have mentioned. 
In the after state of the sore, a material difference takes place be- 
tween the operation that I have now described, and that in which ~ 
there is no necessity for removing any portion of the skin. Wher 
none of the skin is removed, the divided teguments, on being drawn 
together, cover the sore completely ; an adhesion commonly takes 
place over the whole ; and the cicatrix that ensues is inconsiderable ; 
but when any portion of the skin is removed, a sore is always left, 
which not only renders the cure tedious in proportion to the quanti- 
ty of skin that is taken away, but the cicatrix is necessarily of 
the same size; by which much tenderness and irritability is left in 
the site of the disease, which has some influence in making it re- 
turn. 
The sore that remains after the operation, should be treated with 
the mildest dressings. When any hemorrhagy takes place from the 
surface of the sore, and is not removed, on the larger arteries being 
secured with ligatures, dry lint should be applied for the first dress- 
ing ; but for all the after dressings, lint covered with any emollient 
ointment should be preferred. Mild emollients never give pain, 
which dry lint is apt to excite. as 
I have hitherto been supposing that the disease occupies the 
mamma only ; but the lymphatics leading from the breast to the arm- 
pit, are also often indurated, and likewise the glands in the arm-pit 
itself. In some instances, too, a number of diseased glands are — 
found to run from the breast to the collar bone, and to spread in con- 
siderable clusters along both the upper and under edges of that bone. 
In such circumstances, the amputation of the mamma itself must be _ 
managed inthe manner I have already advised ; but besides this, an 
incision should be made throughthe skin and cellular substance, from 
terminate in the principal cut produced by the removal of the mamma. — 
‘hus, when the glands in the arm-pit are enlarged, alt! 
inight frequently be pulled out,either separately or conn 
by a hook insinuated below the sound skin, at the sore in 
z 
the further extremity of every cluster of hardened glands, and made to ae 
