THE URINOGENITAL ORGANS 



Vessels and Nerves. The arteries supplying the mammary gland are derived from the 

 perforating branches of the internal mammary, the long thoracic branches of the axillary, 

 and branches from the intercostals. The veins describe an anastomotic circle around the base 

 of the nipple, called by Haller the circulus venosus. From this large branches transmit the blood 

 to the circumference of the gland and end in the axillary and internal mammary veins. The 

 lymphatics of the mammary gland (Fig. 562) and mammary region have been previou.-ly 

 described (pp. 785 and 807). The nerves are derived from the fourth, fifth, and sixth inter- 

 costal nerves, and sympathetic filaments from the thoracic cord pass to the breast along the 

 branches of the intercostal nerves. 



Applied Anatomy. Occasionally the mammary gland undergoes enormous hypertrophy. 

 This may occur in any age, even in the virgin. The physiological enlargement of puberty may 

 become excessive or the physiological enlargement of pregnancy and lactation may continue 

 and increase after the termination of lactation. The chief elements in the enlargement are fat 

 and connective tissue, and it is doubtful if there is extensive reproduction of glandular tissue. 



Abscess of the breast may occur at any age, but is most common by far in nursing women. 

 The portals are opened to infection by a crack in the nipple and bacteria are carried inward 

 by the lymph vessels. In some cases the pus gathers beneath the skin (supramammary absrftw), 

 in others in the breast tissue (intramammary abscess). In rare cases pus gathers beneath the 

 breast (retromammary abscess}. In intramammary abscess the pus burrows through the fibrous 

 septa or fascia and forms numerous channels, and such a channel is constricted in hour-glass 

 shape at the point where it passes through fascia or a fibrous septum. 



SECONDARY AREOLA 



CONCENTRIC 

 RIDGES 



FIG. 1192. Nipple and areola of a virgin. (Testut.) 



FIG. 1193. Nipple and areola? of a preg- 

 nant woman. (Testut.) 



In every patient suffering from abscess the nipple should be examined for a sore or crack, and 

 the area when found should be treated antiseptically. A supramammary abscess should be 

 opened by an incision radiating from the nipple. 



In intramammary abscess follow the advice of Sheild: Open the abscess by an incision radi- 

 ating from the nipple, insert the index finger, and when possible pass it to the bottom of the 

 abscess and carry the tip from the depths of the abscess to as near the surface as possible. At this 

 point make a counter opening. The finger breaks down septa which cause constriction and thus 

 converts the tracking sinuses into one large cavity. 1 Drain by tubes. 



A retromammary abscess is opened by an incision, following the outline of the breast at the 

 thoracomammary junction, the finger being pushed through the incision and up under the gland. 



Tuberculosis of the breast may occur, and if it does, cold abscess is apt to form. The best 

 treatment is removal of the gland and the associated lymph nodes. 



Chronic mastitis is a condition of mammary fibrosis,' most common in neurotic single women, 

 and apt to be associated with ovarian or uterine disease. 



Malignant dermatitis or Paget's disease of the nipple is a chronic condition consisting of epi- 

 thelial proliferation, induration, desquamation, and ulceration, and it is apt to be followed bv 

 epithelioma. 



Chancre of the nipple is occasionally met with. 



Secondary and tertiary syphilitic lesions are seen upon the skin of the breast, the nipple, and 

 the areola. 



^ Cysts and tumors are common in the breast. There may be cystic degeneration of the gland 

 in women near the menopause (involution cysts); a lacteal cyst; a hydatid cyst; an adenoma 



1 Diseases of the Breast. By A. Marmaduke Sheild. 



