Abstract of a paper on excision of the breast for cancer / by W. Watson Cheyne.

  • Cheyne, William Watson, Sir, 1852-1932.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Abstract of a paper on excision of the breast for cancer / by W. Watson Cheyne. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    very simple method, which I must refer to as it is one of great practical value in determining during the course of an operation not only whether the whole breast but also whether the whole disease has been removed. Mr. Stiles found that when a cut surface on which masses of cells—e.g., epithelial masses—were present was first washed free from blood, then immersed for fiv^e minutes in a 5 per cent, solution of nitric acid and then washed under the tap for five minutes, the epithelium was readily differentiated from the other tissues by the naked eye, presenting the appearance of dull white spots or masses, while the fat becomes yellow and the fibrous tissues swell up and become semi- transparent. By treating the breast in this way after removal it is easy to determine whether lobules of the breast or nodules of cancer haVe been cut through. In practice, as soon as the breast is removed, it is handed over to an assistant, who puts it through the above process while the operator is going on with the dis- section of the axilla. By the time the axilla has been thoroughly cleated out the breast is ready for inspection and can be carefully examined before closing the wound, and if any portion of breast tissue or of disease is detected the remaining part is at once sought for and freely removed. I have always used this plan since Mr. Stiles told me of it; and in one very advanced state I found by means of it that I had cut through a nodule of disease in the fat at the outer border of the axilla, which I would certainly have overlooked otherwise, and on searching I found the rest of the nodule and removed it. Mr. Stiles’ nitrid acid method is also applicable to tumours elsewhere; and in one case, where I was removing an epithelioma on the inner side of the cheek, and involving the lower jaw, I detected by means of it a narrow strand of disease running backwards beneath the ramus of the jaw, which I had not observed on dissecting away the growth. I consider this method a very valuable addition to our operative means, the only objection to it being, I think, the length of time that it takes. In the case of the breast it is necessary to cut off the breast from the axillary fat before clearing out the contents of the axilla in order to have it tested, whereas I find that I can get the axillary fat and glands away much more readily by leaving the breast attached, the weight of the mamma hanging over the side pulling down the axillary contents more easily than can be done by the hand. This is, however, a minor objection, and Mr. Stiles may perhaps be able to meet it. To return now to the extent of the breast, it is found to reach laterally in all directions, especially upwai’ds and towards the axilla, much farther than has been supposed, and it is impos- sible to remove it completely by the small elliptical incision figured in the older text-books. In order to take away the breast'com- pletely it is necessary that the incisions should extend beyond it at each end, and that a large amount of skiu, I believe an amount