TUMOURS. 



tuberculated, or medullary farcoma, it is particularly necef- 

 fary to abftain from doing any thing which may irritate the 

 part. 



Of the Operation of remomng a difeafed Breafl, and Tumours 

 in general. — The operation of cutting away a difeafed breaft, 

 is done nearly in the fame manner as the removal of tumours 

 in general, and is indicated whenever the part is atfefted with 

 an incurable difeafe, which admits, however, of being en- 

 tirely removed with the knife. When the breaft is affefted 

 withfcirrhus, or ulcerated cancer, the imprudence of tamper- 

 ing with the difeafe cannot be too feverely cenfured. Were 

 the diforder unattended with a continual tendency to increafe, 

 feme time might properly be dedicated to the trial of thofe 

 internal remedies, and external applications, which have ac- 

 quired any charafter for doing good in thefe unpromifing 

 cafes. But, unfortunately, by endeavouring to cure the 

 difeafe by medicine, we only afford time for it to increafe in 

 magnitude, and, at length, to attain a condition, in which 

 even the knife cannot be employed fo as to take away the 

 whole of the difeafed parts. When the cafe is marked by 

 the charafteriftic features of fcirrhus, the fooner the tumour 

 is cut out the better. There are alfo fome malignant kinds 

 of farcoma to which the female breaft is fubjeft, which 

 cannot be removed at too early a period after their nature 

 is fufpedled or known. Indeed, though there is not equal 

 urgency for the operation when the tumour is only an in- 

 dolent, fimple, fatty, or farcomatous difeafe, yet as all thefe 

 tumours are continually growing larger, and little fuccefs 

 attends the attempt to difperfe them, the practitioner Ihould 

 never devote much time to the trial of unavailing medicines 

 and applications, and let the fwelling attain a fize, which 

 would require a formidable operation for its excifion. Be- 

 fides, every fimple, fleftiy, or fatty tumour, is always ac- 

 companied with a certain hazard of changing into a malig- 

 nant or cancerous one. 



Certainly there are many fwellings and indurations of the 

 breaft, which it would be highly injudicious and unneceffary 

 to extirpate, becaufe they generally admit of being dif- 

 cvifted. Such are many tumours which are ciAeA fcrophu- 

 lous, from their affefting patients of this pecuhar conilitu- 

 tion : fuch are nearly all thofe indurations which remain 

 after a fudden and general inflammatory enlargement of the 

 mamma : fuch are moft other tumours which acquire their 

 full iize in a few days, attended with pain, rednefs, &c. : 

 and of this kind, alfo, are the hardnefles in the breaft, occa- 

 iioned by the mammary abfcefs. 



In the removal of all tumours, their malignant or can- 

 cerous nature makes it neceflary to obferve one nnportant 

 caution in the operation ; viz. not to reft fatisfied with cut- 

 ting away the tumours juft at their circumference ; but to 

 take away alfo a confiderable portion of the fubftance in 

 '.vhich they lie, and with which they are furrounded. In 

 cutting out a cancerous breaft, if the operator were to be 

 content with merely differing out the difeafe, juft where 

 his eyes and fingers might equally lead him to fuppofe its 

 bijundary to be fituated, there would ftiU be left behind 

 uhite difeafed bands, which radiate from the tumour into 

 the furrounding fat, and which would inevitably occafion a 

 relapfe. In a vaft proportion of the cafes alfo in which 

 cancer of the breaft unfortunately recurs after the operation, 

 it is found that the (Icin is the part in which the difeafe 

 makes its reappearance. Hence the great prudence of 

 taking away a good deal of it in every cafe fufpefted to be 

 a truly fcirrhous or cancerous difeafe. This may alfo be 

 done fo as not to prevent the important objefts of uniting the 

 wound by the firft intension, and covering the whole of its 

 farface with found integuments. So frequently does can- 



cer recur in the nipple, whenever ii does recur any where, 

 that many of the beft modern operators always make a point 

 of removing this part in every inftance in which it is judged 

 expedient to take away any portion of the fl{in at all. The 

 furgeon, indeed, would be inexcufeable, were he to negleft 

 to take away fuch portion of the integuments cover- 

 ing fcirrhous tumours, as is evidently affefted, appearing 

 to be difcoloured, puckered, and clofely attached to the 

 difeafed lump beneath. Nor ftiould any gland in the axilla, 

 at all difeafed, nor any fibres of the peftoral mufcle, in the 

 fame ftate, be ever left behind. There is no doubt that 

 nothing has ilamped operations for cancers with difrepute, 

 fo much as the negleft to make a free removal of the flcin 

 and parts furrounding every fide of the tumour. Hence 

 the difeafe has frequently appeared to recur, when, in faft, 

 it liad never been thoroughly extirpated ; the difeafe, though 

 entirely a local affeftion, has been deemed a conftitutional 

 one ; and the operation frequently rejefted as ineffeclual 

 and ufelefs. 



But, ftrongly as we have urged the prudence, the necef- 

 fity of making a free removal of the ftiin covering, and of 

 the parts furrounding every cancerous or malignant tumoiur, 

 the fame plan may certainly be regarded as unneceffary, and 

 therefore unfcientihc, in moft operations for the removal 

 of fimple, fatty, or fleftiy tumours. However, even in the 

 latter cafes, when the fwelling is very large, it is better to 

 take away a portion of (l<in ; for otlierwife, after the exci- 

 fion of the tumour, there would be a redundance of integu- 

 ments, the cavity of which would only ferve for the lodg- 

 ment of matter. The loofe fuperfluous {km, alfo, would lie 

 in folds, and not apply itfelf evenly to the parts beneath, fo 

 as to unite favourably by the firft intention ; nor could the 

 line of the cicatrix itfelf be arranged with fuch nice eveii- 

 nefs as it might be, were a part of the redundant /Itin taken 

 away at the time of operating. 



The beft method of removing a difeafed breaft is as fol- 

 lows : The patient is ufually placed in a fitting pofture, 

 well fupported by pillows and affiftants ; but the operator 

 would find it equally convenient, if not more fo, to re- 

 move the tumour with his patient in a recumbent pofition ; 

 and it certainly is better whenever the operation is likely to 

 be long, or much blood to be loft, which circumftances are 

 very apt to bring on fainting. We remember that Mr. 

 Abernethy, in his leftures, uTed to recommend the latter 

 plan ; which, however, without the fanftion of any great 

 name, or authority, poffefles fuch obvious advantages, as 

 will always entitle it to approbation. 



Tlie arms ftiould be confined back, by placing a ftick 

 between them and the body, by which means the fibres of 

 the great peftoral mufcle will be kept on the ftretch, a ftatc 

 moft favourable for the diffedion of the tumour off its fur- 

 face. The ftick alfo prevents the patient from moving her 

 arm about, and interrupting the progrcfs of the eperation. 



When the tumour is not large, and only a fimple farcoma, 



free from mahgnancy, it will be quite unneceffary to remove 



any of the fkin, and of courfe this need only be divided by 



one incifion, of a length proportionate to the tumour. 



The cut muft be made with a common diffcfting knife ; 



and, as the divifion of the parts is chiefly accompliftied with 



the part of the edge towards the point, the inftrument will 



be found to do its office beft when the extremity of the 



ed<Te is made of a convex ftiape, and this part of the blade 



is turned a little back, in the way in which diffcfting^ knives 



are now often conftrufted. The direftion of the incifion 



through the fl<in (liould be made according to the grcateft 



diameter of the tumour to be removed, by which means it 



will be moft cafily diffefted out. 



The 



