454 CLINICAL APPLIED ANATOMY. 



third, fourth, and fifth intercostal spaces to the nodes lying in 

 the anterior mediastinum. Some from the uppermost part of 

 the gland may pass directly to the glands situated above the 

 clavicle. 



From this diffusion of lymph from the mamma, it is easy 

 to understand how impossible it is to be sure that the whole 

 of the disease has been eradicated, when even every lymph 

 node in the axilla and subclavicular region has been extirpated. 

 Apparently also in certain cases the lymphatic vessels of one 

 gland communicate with those of the opposite side across the 

 middle line. " Cancer en cuirasse," or the hide bound infiltra- 

 tion of the skin, is due to the passage of carcinomatous cells 

 along the connective tissue lymphatics from the gland to the skin, 

 and the spread of the growth through the subcutaneous lymph 

 network. This infiltration may possibly be precipitated by the 

 nearest chain of lymphatic glands becoming saturated as it were 

 by malignant deposit or even by the blockage of lymphatic 

 pathways by the removal of the axillary glands. 



The extreme swelling of the upper limb often seen in the later 

 stages of carcinoma of the mamma is likewise due to the blockage 

 of lymphatics by malignant deposit. 



Death may sometimes be brought about by direct extension of 

 the growth through the thoracic wall to the pleura, a malignant 

 pleurisy supervening which speedily exhausts the sufferer. 



Secondary malignant deposits in bones during the course of 

 mammary carcinoma are explained by blood transmission. 



