Iconograms : a collection of colored plates illustrating interesting surgical conditions / explanatory text, with special reference to diagnosis and treatment, by Faxton E. Gardner.

Gardner, Faxton E. (Faxton Eugene), 1878-

Date:: [1913]

Credit: Iconograms : a collection of colored plates illustrating interesting surgical conditions / explanatory text, with special reference to diagnosis and treatment, by Faxton E. Gardner. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$iilidiil wliicli I lie siii'.ycon li;is even a va,u-iio siis|)icioii oi' inaliiniaiK-y I urns dill to he maligna 111. I li'in'c, we must deem malignant every breast tumor the character of which does not establish beyond doubt its non-malignancy, and ad aironlinjrly. 'J'lie great aiiatoiiiiral rcaluic of iioii-inalignant tumors is encap- sulation. A perfectly well liinilcil growth, movable in the gland tissue, non-adhcroTit In any sliinliiro, is likely to he l)eni.gn. Any tiiinor tliat is IVIt to send offsliools in glandular tissue is cancer. The diagnosis of ehrouir interstitial mastitis is particularly dillicuit; perha])s only because there exist between this coiidilion and cancer intimate relations not as yet elucidated. Microscopical examination of an excised piece must be performed in all doubtful cases; and if even the microscope (as will ha])pcn sometimes) is unable to give a definite answer, the breast must bo removed. Eather remove a chron- ically inflamcil ln-rasl than give cancer too long a chance. Sarcoma occuis at an eai-lier age and has a fairly typical appear- ance (Figs. 29 and 30); but a mistake in diagnosis is not very impor- tant, since liotli conditions, sarconui and cancer, call for the same treatment. The same may be said of infiltrating forms of tuberculosis of the breast, which are not exceedingly rare. Trea tmeni The treatment of bi-east carcinoma is radical excision of the whole breast and itsprocesses as early as jxissihle with removal of the pectoralis major and minor muscles, and complete cleaning out of the axillary glands {Ilahted's or WiUy Mciicr\s technique). As in all operations for cancer, squeezing of the breast during re- moval must be carefully avoided, so as not to spread cancerous seed over the operative wound. In fact, recurrences are much more com- mon in the scar than anywhere else. If small, they can he excised again. Operation is coiitraindieated in all cases with extensive dissem- ination in the skin, diffuse infiltrating cancer, (■a)iccr en cuirasse (Figs. 15 and 16), also when the supraclavicular glands are involved, in slow growing scirrhus of \'ei'>' old i)eople, and in cases where organic metastases ai-e pi-esent. X-ray treatment is good in the post-operative period, but cannot cure cancer without operation. A carcinomatous nodule ma.v disin- tegrate and disapjiear under its influence, and sui-face epidennization occur, but the canccr(nis pi-ocess continues in the deeper tissues. The$