Case of carcinoma of the breast too far advanced for operation in which the use of the x-ray for nine weeks produced a marked improvement. in this ease the were applied for fifteen minutes at a tirnr for five days out of a week. The ulceration and discharge greatly dimin ished, and the axillary glands became smaller and general improvement fol lowed. Andrew Clark (Brit. Med. Jour., June 8, 1901).
Case of recurrent carcinoma of the breast which was markedly benefited by x-ray treatment. Three years before the patient had had the breast amputated. Both the sternum and the axilla were in filtrated with the recurrent growth. The rays were employed on twenty successive days, the applications lasting twenty minutes. The growth has become much smaller and the pain and ulceration have disappeared. G. H Ferguson (Brit. Med. Jour., Feb. 1, 1902).
Case of seirrhus of the breast treated I by the x-rays. The original growth was removed thirteen years, and the recur rence was first noticed five years, before the patient came under observation. Ten applications were made at intervals of about three days, the exposures lasting from ten to twenty minutes. This growth decreased from 3 inches in diam eter to inches, the ulcer became smaller, and the pain and discharge markedly lessened. At this period the patient developed a croupous pneu monia, from which she died. Peters (Brit. Med. Jour., March 1, 1902).
Case of ulcerated cancer of the breast under treatment at St. Bartholomew's Hospital, the patient when admitted hav ing a large, open, ulcerated wound of the right breast, measuring about four inches II in one diameter and five inches in the other. Treatment with x-rays was com menced on November 14th and an ex posure of ten minutes was given four limes a week, with few omissions, until January 17th. After a few days signs of healthy eicatrization began to appear around the margins of the ulcer. This continued to advance until the healing process had extended inward from the margin for a distance of fully half an inch all round. The centre of the wound gradually ceased to slough and appeared to be hr process of healing all over; but the patient being at a late stage of her illness, secondary deposits in remote parts of tire body became disagreeably evident, and the x-ray treatment was suspended in view of the hopelessness of the future of the patient. The total
number of exposures was seventeen, and it was very important to note that many were made with the ulcerated surface covered by dressings or bandages. Since the suspension of the treatment, exactly four weeks ago, the process of healing had gone on quite steadily, and at the time of the report there was a firm and healthy scar covering the whole surface, except about one square inch in the centre. This portion was also a healthy healing surface, though not yet covered by epithelium. The local effect was splendid, but there was no influence upon the spread of the disease in the remote parts of the body. II. Lewis Jones (Lancet, Feb. 22. 1902).
Removal of. Benign Tumors of the Breast.—The operation does not vary from the simpler operation used for can cer, but removal by raising the mamma as a flap from the chest-wall and extract ing the tumor from behind, first sug gested by Gaillard Thomas, may some times be used. In a case operated by T. S. K. Morton, in which a benign growth was to be removed, it was found easily feasible to turn up the breast as a flap or trap-door so as to extract the growth without leaving a disfiguring cicatrix. An incision five inches in length was made, semicircular in form, in the line of the fold formed at the junction of the lower portion of the breast-skin with that of the chest-wall. This was carried down through a consid erable amount of fat until the sheath of the pectoralis major was exposed. The loose cellular attachments of this to the capsule of the breast were then with great ease broken up by blunt dissection and an occasional snip of the scissors until the breast could be turned upward upon the chest-wall below the clavicle. The posterior wall of the capsule was now opened in a direction radial to the nipple over the tumor. This was found to be capsulated and very loosely ad herent to the pocket among the gland acini, which it had evidently formed by its movements. Blunt dissection by a forefinger freed it at a sweep at all points save the upper and outer, where a firm adhesion was discovered, which required division by the knife, but without open ing the capsule of the growth. No liga tures were required. The gland was turned down into its normal position and the skin-margins of the wound united by a subcuticular continuous silk suture.