Amputation of the female breast / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: Amputation of the female breast / by W.W. Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    waiting uutil it is a general trouble—this should be the rule. This is not the rule among all of us doctors, I am sorry to say ; but let the real truth be known to the general public, say to the women of this country, If you have such a lump in the breast, go and con- sult the best surgeon you can find. If he pronounces it even pos- sibly a cancer, instant operation should be done, and it should be left entirely to him whether he will remove only the tumor or the whole breast, and clean out the axilla after he has cut into the tumor.'' If the tumor is local in the beginning it does not stay so. It will grow either externally towards the skin or internally towards the chest-wall. The little lump, which has been discovered very likely in bathing, the skin being at first freely movable over it, will gradually increase in size and will grow towards the surface, becom- ing adherent, then purplish and red, and finally ulcerate. It grows also inwards toward the chest-wall; will invade the pectoral fascia and pectoral muscles; then becomes adherent to the ribs and the intercostal muscles. But besides this direct growth outwardly and inwardly there is extension by the lymphatics. Sarcomata in- volve distant parts of the body through the blood, but carcinomata always invade distant parts through the lymphatics. This is another reason for urging early operation before this invasion from the breast in all directions where the lymphatics run. First of all, the disease extends to the glands in the axilla. Of course, it affects the ordinary glands in the axilla, but you must examine also espe- cially the glands which lie along the great pectoral muscle ; perhaps two or three will lie in the intermuscular plane between the pecto- ralis major and minor and in the space of Mohrenheim, that is to say, the space between the pectoralis minor and the clavicle. It is a point sometimes overlooked that after vou have amputated the breast, you can easily break up the layer of connec- tive tissue between the pectoral muscles simply with the fingers, and reach the coracoid process. Between the upper border of the pectoralis minor and the clavicle, in this space of Mohrenheim, there often exist one or two isolated glands which are infiltrated and enlarged. You may do the best operation in the world accord- ing to the best rules, and yet if you leave these infected glaud.s you leave a fire burning that will burn down the house.