TUMOURS. 



The axillary glands may always be taken out, without the 

 leaft rifle, if the plan purfued by Default in France, and fir 

 Cliarles Blicke, and other eminent furgeons in this country, be 

 adopted. The method alluded to is, after dividing the (kin 

 covering the gland, and freeing the indurated part from its 

 lateral conneftions, to tie its root, or bafe, with which it is con- 

 nefted, with the parts on the fide towards the cavity of the 

 axilla. Then the indurated gland itfelf may be fafely cut 

 off juft above the ligature. Were the gland cut off in the 

 firft inftance, the artery which fupplies it with blood would 

 be exceedingly difficult to tie, on account of its deep fituation ; 

 and, by reafon of its (hortnefs and vicinity to the heart, it 

 would bleed almoft like a wound of the thoracic artery it- 

 felf. In this way, there is alfo not the leaft hazard of in- 

 juring the latter veffel. It would be a great improvement 

 in the mode of operating for the removal of thefe glands, 

 if furgeons were always to make the patient lie down, with 

 the arm placed in fuch a pofition as would let the light 

 fall into the axilla. How much the fteps of the operation 

 would be facilitated in this way, we need not attempt to 

 explain. 



The above direftions will enable a furgeon to remove tu- 

 mours in general. They apply alfo in a great meafure to 

 encyfted tumours ; but in the latter cafes, particular care 

 mull be taken not to wound the cyft, as it then collapfes, 

 and the difleftion of it out is much more difficult. One half 

 of each ligature is always to be cut ofF before dreffing the 

 wound. The edges of the incifion are to be brought to- 

 gether with ilrips of adhefive plafter ; and, before this 

 can be done with eafe, the ftick confining the arm back 

 muft be removed, and the os brachii brought forward, fo 

 as to relax the pectoral mufcle and integuments of the 

 breaft. No futures (hould ever be employed, as they are 

 ufelefs, painful, and irritating. The wound being clofed 

 with ilicking plafter, and a pledget of fimple cerate, a com- 

 prefs of folded linen, or flannel, may be put over the 

 dreffings ; thefe are to be fecured with a broad piece of 

 linen, which is to encircle the cheft, be faftened with pins 

 or ftitches, and kept from flipping down by two tapes, one 

 of which is to go from behind forward, over each (houlder, 

 and be Hitched to the upper part of the bandage both in 

 front and behind. The arm on the fame fide as that on 

 which the operation has been done, ftiould be kept at reft 

 in a fling : every motion of the limb muil evidently difturb 

 the wound by putting tbe great peftoral mufcle into aftion, 

 or rendering its fibres fometimes tenfe, fometimes relaxed. 



In the article Surgery, we have adverted to the plan of 

 cutting off both ends of the ligatures applied to the arte- 

 ries, with a view of lelTening the quantity of extraneous 

 fubftance in the wound, and rendering union by the firil ni- 

 tention more probable. This method has been tried by 

 Mr. Lawrence after operations on the breaft, and alfo by 

 ■M. Roux and profeffor Delpech in France, who all make 

 favourable reports of the praftice. 



The removal of tumours from the neck is frequently an 

 operation of dehcacy and difficulty, efpecially when the 

 exaft attachments and depth of the fwellings are not pre- 

 cifcly known. The many large arteries in this part of the 

 body, and its being the fituation of the carotid artery, and 

 internal jugular vein, are confiderations which ought to deter 

 every furgeon who is not an anatomift, from venturing to 

 cut away fwellings from the neck, particulai-ly fuch as have 

 bafes extending more or lefs deeply, and not very moveable. 

 Unfortunately for the man who is deficient in anatomical 

 . knowledge, the neck is as common a fituation for tumours 

 requiring the ufe of the knife, as any part which can be 

 Specified. 

 . Vol. XXXVl. 



One of the boldeft operations, for the removal of a tu- 

 mour from the neck, was that lately performed by Mr. Wil- 

 ham Goodlad, furgeon at Bury, in Lancafhire, and recorded 

 in the feventh volume of the Medico-Chirurgical Tranfac- 

 tions, p. 112. In order to do away the danger of hemor- 

 rhage from arteries, this gentleman began with tying the 

 trunk of the carotid artery : fome conception of the nature 

 of the whole proceeding may be formed from the view which 

 the wound prefented after the entire fwelling had been re- 

 moved. " The whole fterno-maftoid mufcle was cxpofed, 

 and its fibres diffefted clean, except about half an inch 

 from its infertion into the clavicle. The wound ex- 

 tended backwards from behind the maftoid procefs to the 

 trachea anteriorly, but became narrowed in the direftion 

 of the mufcle at the lower part of the neck. The fub- 

 maxillary gland was expofed, and about one-fifth of its 

 fubftance, not appearing healthy, was removed. The 

 digaftric and the greater part of the mylo-hyoideus were 

 expofed, the ramus of the jaw was only covered by 

 periofteum, except where covered by the maffeter mufcle, 

 part of which, not appearing liealthy, was difTecled 

 away. The whole of the condyloid procefs of that bone 

 was laid bare in the fame manner, and behind it the ptery- 

 goid mufcles were alfo expofed. The membrane of the 

 cheek was only covered by a cellular fubftance, wliich did 

 not appear healthy ; but fufficient fliin was favcd to cover 

 the zygoma. The parotid gland was entirely removed !" 



This, which is one of the boldeft operations on record, 

 proved fuccefsful, the wound having completely Iiealed in 

 ten weeks, and no recurrence of the tumour having followed. 

 See Abernethy's Claffification of Tumours. Delpech 

 Precis Elementaire des Maladies reputees Chirurgicales, 

 tom. iii. Cooper's Diftionary of Praftical Surgery. Me- 

 dico-Chirurgical Tranf. vol.vii. pt. I, &c. 



Tumour, among Animals, is a preternatural fwelling or 

 enlargement in any part, arifirig either from an external in- 

 jury, or an internal caufe. Tumours in them are of feveral 

 different kinds, according to the nature of the caufes. 



Where tumours or fwellings are caufed by external ac- 

 cidents, fuch as blows, bruifes, and other fuch means, they 

 ffiould at firft be treated with reftringent applications ; fuch 

 as having the parts bathed frequently with warm vinegar or 

 verjuice ; and where they will admit of bandage, a flannel 

 wetted with the fame fliould be rolled or laid on, and 

 faftened by it. When by this method tlie tumour or fwell- 

 ing does not give way and fubfide, a poultice made with 

 red-wine lees, ftrong-beer grounds, and oatmeal, or with 

 vinegar, oil, and oatmeal, fliuuld be applied, efpecially when 

 on the lego ; either of which applications may be nled and 

 continued twice a day after bathing the parts in the above 

 manner, until the fwelling abates, when, in order to wholly 

 difperfe them, the vinegar (hould be changed for campho- 

 rated fpirits of wine ; to four ounces of which, one of 

 Ipirit of fal ammoniac may be added; or they may be 

 bathed with a mixture of two ounces of crude fal ammo- 

 niac boiled in a quart of chamber-ley, twice a day, and 

 cloths dipped in the fame be put on them. Fomentations, 

 too, made by boiling wormwood, bay-leaves, and rofemary, 

 with a proper quantity of fpirits, are not unfjrequently of 

 ufe in a high degree. 



However, in bruifes where tiiere may be extravafated 

 blood, which is not taken up or difpcrfed by thefe means, 

 the fliorteft and moft convenient 'way is to open the (Icin, 

 and to let out the grumqus blood. 



The critical tumours or fwellings in horfcs or otiicr 

 animals, which terminate fevers, or other difcafes, (hould by 

 no means be difperfed, except, when m the horfc, they tall 



3 E "PO'' 



