first a small sinus, only, existed; but, by degrees, an indolent
ulcer took its place, which never healed. State at the time
of operation :—“ The breasts are both very large and pendulous
: on the right, the nipple cannot be distinguished, its
place being occupied by a deep and irregular ulcer, somewhat
larger than a crown-piece ; the edges are hard, much inverted,
and present a dark glazed appearance; the surrounding skin
is livid, puckered and drawn inwards. A circumscribed, stony
hardness exists all about the ulcer, and attaches it to the substance
of the breast. None of the neighbouring glands are
contaminated. Her constitution has not suffered mueh from
the disease : her appetite is good, and she sleeps well, unless
when disturbed occasionally by. stings of pain.” The case
being deemed favorable for operation, the entire breast, with a
considerable portion of integument, was removed, and the lips
of the incision were afterwards brought together by sutures
and adhesive plaster. The wound healed almost by the first
intention. The woman lived for five years after without having
sustained any return of the eaneer, either in the breast or
other part of the body ; and died, then, of bronchitis. The
preparation shows the disease to have been a genuine, ulcerated
carcinoma.—Dr. Houston.
F. c. 806. Large scirrhous tumor of the breast, removed by
Dr. Houston. Case:—a tall, thin woman, aged thirty-nine,
married, but without having had children, received a trifling
injury in her right breast: little inconvenience was felt
from it at the time, but in about two months, she accidentally
discovered a small tumor in the situation of .the injury; it was
about the size of a hazel-nut, hard and moveable, but not
painful. It remained stationary for four weeks; and then,
without any new exciting cause, took on a rapid tendency to
enlargement, and gave rise to a constant pain, aggravated,
especially at night, by stings darting through the breast.
State, on admission into hospital, twelve months after the
first notice of the tumor :—“ The site of the right mamma is
occupied by a tumor,—large, firm, heavy, and inelastic : its
base is well defined, and it is slightly moveable; the integuments
retain their natural feel and colour over one half; but,
on the other, they are rough, hard, and livid, and in this
latter situation she feels a burning pain. The nipple is nearly
invisible, being drawn in, and hid by the surrounding prominence
; and it has discharged a thin, reddish fluid, for some
time. At the axillary side, the tumor is not so well defined,
and there are three or four enlarged glands in this region.
Her health has suffered much within the last two months;
she has palpitations on making any exertions, difficulty of
breathing, and a feeling of tightness about the chest; but, to
the stethoscope, the lungs appear clear and unobstructed : the
uterine functions are regular.” Yielding rather to the urgent
solicitations of the patient, than from any hopes of effecting a
permanent cure, the entire breast, together with several enlarged
glands in the axilla, were removed, and the integuments
closed over by sutures and adhesive plaster, with a
view to union by the first intention. The woman left hospital
in six weeks after the operation,—the wound perfectly
healed, and her health greatly re-established. As regards the
issue of this case, it is certain that, at the expiration of three
years, she was alive, and had sustained no relapse. The preparation
shows the parts removed in the operation: the tumor
weighs five pounds: the mammary gland, and surrounding
cellular membrane, are converted into one uniform, homogeneous
mass of dense carcinoma. Superficially, the integuments,
though diseased, are not adherent to the tumor; on
the deep surface, the pectoral muscle is joined to it by a
morbid adhesion. The diseased glands may be seen at B. a. 6.
—Dr. Houston.
F. c. 807. A faithful drawing of the foregoing,- exhibiting *
the appearances which the breast and axillary glands presented
in the recent state.—Idem.