Surgery : its theory and practice / by William Johnson Walsham.

William Walsham

Date:: 1889

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

802/864 page 786

$756 ated in tlie circumference of the Lrcast, there may be no retraction, or the retraction may occur only on one side; whilst when the cancer begins as an infiltration of the nipple itself, the latter will be harder and more prominent than natural. On raising the arm and drawing the finger-tips transversely across the inner side of the axilla, a hard cord or cords—infiltrated lymphatic vessels—may often be felt extending from the tumoui- into the axilla,' while in the space_ itself large glands will be discovered if the case is sufficiently advanced. The glands are at first soft, single, and distinct, later, hard and matted together, forming an indurated irregular mass which is often adherent to the chest-walls and in advanced cases extends as high as can be felt beneath the clavicle. In the supraclavicular space the enlarged glands may sometimes be detected, first as a mere fulness, subsequently as distinct swellings. After the skin over the tumour has given way, an ulcer with sinuous, irregular, everted, and indurated edges, and a foul, cavernous, irregular, and indiu'ated base is formed, from which is exuded a foul- smelHug and sanious discharge. The skin around is indurated from infiltration with the growth; or distinct, circumscribed, hard nodules of carcinoma are scattered here and there through it. Diaqnosis.—When the above signs are present there is no difficulty in pronouncing as to the natiu'e of the disease. In the earlier stages, however, whilst the tumour is still small and has not yet become adlaerent to the skin or to the pectoral muscle, where the breast is large and there is no retraction of the nipple and as yet there is no enlarge- ment of the axilhuy glands, the cliaguosis from an inno- cent tumour, a tense cyst, or lobular inflammation will be, to say the least, difficult. The age of the patient, the rate of gi'owth, and the history of the case must then to a great extent be relied on for distinguishing it. ]5ut where the patient, as is occasionally the case, is young, the diagnosis may then be impossible without making an incision into the growth, a proceeding which, \mdcr such circumstances, after the difficulty has been explained to the patient, is not onlj' justifiable but imperatively called for. Rarer forms of srirrJius ii) the hrcud are occasionally met with. Thus—1. Tlie cinicer may begin as a general infiltration of the entire gland, wlien its course is usually very rajiid; 2, it may chiefly affect tlic skin, the whole side of the chest in sTich a case becoming infiltrated, hai-d, brawny and leathery in consistency, a condition .some-$

Surgery : its theory and practice / by William Johnson Walsham.

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