File:Modern surgery, general and operative (1914) (14596177937).jpg

Identifier: modernsurgerygen1914daco (find matches)
Title: Modern surgery, general and operative
Year: 1914 (1910s)
Authors: Da Costa, J. Chalmers (John Chalmers), 1863-1933
Subjects: Surgery Surgery, Operative
Publisher: Philadelphia, London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ys and soon becomediseased, the glands above the clavicle often enlarge, and the arm may swell.Growth may arise within the chest, either by lymph regurgitation from the a.xil-lary and subclavian glands, or directly through the chest walls to pleura andlung or to mediastinal glands. Oelsner and Poirier showed that there is a lymphtract running from the breast to glands within the thorax, passing through thegreat pectoral muscle and the fourth interspace at the level of the costochon-dral articulation (Primrose, in Amer. Jour. Med. Sci., Jan., 1913). For-tunately, these glands are not frequently involved, a circumstance whichmay be accounted for by the atrophy of this channel in senUe mammas,in which cancer usually develops (Poirier) (Primrose, Ibid.). Retraction ofthe nipple is present in over one-hal,f of the cases. It occurs when the growthis near the nipple, and is due to the contracting fibrous tissues of the tumorpulUng on the milk-ducts. If the growth is far away from the nipple,
Text Appearing After Image:
Fig. 1002.—Carcinoma of right breast. Lesion first noticed sLx months before photograph was made. a dimple is apt to form on the skin of the breast because of the pulling uponthe suspensory fibers. Neither retraction of the nipple nor a cutaneous dimpleproves the existence of cancer. One or both may be noted in a breast con-taining a scar (from a wound or a healed abscess), in tuberculosis of the breast,and in mammary syphilis. The dimple is not due to adhesion between thetumor and the skin. It is noted even when the tumor is far away from the skin.It may not be obvious unless the gland is moved to and fro or unless the skinover the breast is pushed in various directions. When this is done it becomesevident that the skin, at a certain point, is held inward. The dimple is avery valuable early symptom. Glandular enlargement in the axilla soon follows the appearance of ascirrhus; the glands become very hard and adherent. In over 60 per cent,of persons the glands of the axilla are felt

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