2O4 The Mamma 



Contraction of the new elements of the breast causes so much 

 compression of the mammary tissues as to impede the return of blood 

 from the skin of the pectoral region, so that the superficial veins are 

 dilated and conspicuous, and the affected gland is even smaller than 

 the other. The lymph-channels running from the breast to the axil- 

 lary lymphatics are often invaded, and, like the glands themselves, 

 should be cleared away. When the scirrhus is situated to the sternal 

 side of the breast the axillary glands are involved later than when it 

 is to the outer side. In the former case the glands in the anterior 

 mediastinum are specially likely to be involved, and they may there 

 form an enormous tumour against the heart or lung. 



Abscess may occur in the breast or in the loose connective tissue 

 superficial to or beneath it ; from the rapidity with which the tension 

 of the sensory nerves is produced, it is accompanied with much pain. 

 A sub-mammary abscess, if left to itself, is likely to point near the 

 anterior axillary fold. Hypertrophy is a multiplication of the normal 

 elements throughout the breast, and adenoma (aS^v, gland) is a 

 'chronic mammary tumour' of the normal cellular elements of the 

 gland in a bed of fibrous tissue. Cystic disease (serous) is due to the 

 dilatation of ducts or of lymph-spaces throughout the gland. 



When a suckling woman has an abscess in one breast she ought 

 at once to wean the child, as putting it to the sound breast inevitably 

 causes physiological disturbance and irritation of the affected one. 



In amputating the breast the arm should be abducted, so as to 

 tighten the integument and the pectoralis major. A semi-elliptical 

 incision is then made on either side of the nipple in a direction 

 towards the armpit, so that the axillary glands can be extracted by a 

 slight extension of the wound. It does not matter whether the upper 

 or the lower incision is made first. It is important, in operating for 

 cancer, that the whole of the gland and the nipple be taken away, even 

 if only a part be involved. After operation the arm should be fixed to 

 the side, and even when the wound is perfectly healed the arm should 

 be worn in a sling, so as to ensure rest. 



In the newly-born child, whether male or female, the mamma 

 often contains a watery epithelial wreckage which looks like milk, and 

 on rare occasions this pent-up secretion determines inflammation and 

 suppuration. 



THE SPINAL COLUMN 



Spinabifida. A vertebra has three primary centres of ossification, 

 two for lamina: and one for body. The lamina: are fused in the root 

 of the spinous process. If development be arrested the spinal canal 

 remains unenclosed posteriorly, the membranes with the cerebro- 

 spinal fluid bulging as a soft tumour. The defect is found most often 

 in the lumbar and sacral region, for there the lamina: are last ossified. 



