REGIONAL SURGERY The Brain.—Surgery of the brain (see BRAIN, SURGERY OF) is directed to the opening of abscesses and the removal of tumours. Considerable advance in the localization of the latter has led to a higher percentage of satisfactory results and a number of dramatic cures. It must, however, be appreciated that some tumours are so closely incorporated with the brain that their removal is impracticable or inconsistent with the survival of the patient. For these cases an operation of decompression is carried out which consists in removing a considerable area of bone from the skull to allow the brain to expand beneath the scalp. Such operations are directed to relieve the patient of headache and to save the sight. Operations on the spinal cord and nerves (see SPINAL COLUMN, SURGERY OF) are generally used for cases of injury; in the case of the former to relieve pressure, and in the latter to suture the cut ends of the nerve. Tumours may form in or about the cord, and their position can now be recognized.
(see HEART AND LUNG, SURGERY OF).—The chest has always been considered a difficult area for the surgeon to work in. The presence of negative pressure in the pleural sac leads to the collapse of the lung when the chest wall is opened, and enterprise in the direction of radical surgery has on this account been limited. With the introduction of anaesthesia by intubating the larynx and pumping air containing ether under positive pressure into the lung, intrathoracic operations are now made with safety.
(see GOITRE).—Operations on this essential ductless gland are carried out for simple and malignant tumours and also for disorders of secretion. In exophthalmic goitre, the gland becomes hyper-active and though the condition may in some measure be controlled by administration of iodine, the removal of half or even more of the gland has proved the most successful method of treating severe cases. At one time, operations of this character were associated with a high mortality, but with im proved methods of pre-operative treatment and of anaesthesia the results have been much more satisfactory. The operations for simple tumour are straightforward and call for little comment; in those instances in which the whole gland is removed for malig nant disease the complete loss of thyroid solution thereby en tailed must be made up for subsequently by the regular ad ministration of thyroid extract (cf. myxoedema).
(see MAMMARY GLAND, DISEASES OF).—This organ especially in the female, may develop simple tumours (adenoma), or undergo a change classified as chronic mastitis; it is a rela tively common seat of cancer (q.v.). The simple tumours appear as a rule before middle age and are easily recognized and removed. Chronic interstitial mastitis is essentially a disease of the middle aged ; though in itself not a very serious condition, there is little question but that its more severe forms predispose towards cancer. On these grounds removal of one or both breasts for the condition is very often carried out. Cancer of the breast is rare before middle age and is most commonly met with between forty-five and sixty-five. Usually it starts as a painless hard nodule in the breast ; it causes no signs of inflammation nor does it interfere in any way with the muscular system. On this account an early growth may be missed by an unobservant patient. The surgical treatment of cancer in this organ has proved strik ingly successful in cases in which a radical operation is carried out before secondary deposits have appeared elsewhere. The outlook in cases in which operation is undertaken at a later stage is very much less hopeful. The operation current at the present time for cancer is a thorough one, and consists of removing the whole breast with the overlying skin and underlying muscle. The armpit is freely opened up and the lymphatic channels from the breast and the glands into which they drain are cleanly removed. The value of X-rays and radium in the treatment of breast cancer is becoming more clearly defined ; there is no doubt that a certain type of X-ray and the gamma rays of radium are able to kill cancer cells locally, and both methods have considerable value in dealing with local recurrent growth and as prophylactic measures (see RADIOLOGY ; RADIOTHERAPY ; RADIUMTHERAPY).