Page images
PDF
EPUB

ceration, and would seem to effect its destructive agency by encroaching upon and spoiling the uses of the organs, necessary for the sustentation and prolongation of life.

Now it will be found, in the investigation of the peculiarities of cancer, that although the distinctions of scirrhous, epithelial, medullary, and colloid, are useful and wise, and practical, and founded on natural laws; nevertheless there are cases in which these different forms pass into each other, and in which all these peculiarities may be seen affecting the same patient. These cases of combination are sufficiently rare to make the distinctions valuable in practice, especially as marking in a great measure the degree of malignancy attachable to each case; but they at the same time show the common character of all these forms of disease.

It remains to be noted that, both in the scirrhous and in the medullary form of the disease, but more especially in the former, cysts, or apertures containing serum and occasionally blood, will form within the substance of the tumour, or around it, and that these cysts may again be filled by solid cancerous growth proceeding from their inner walls. These cystic formations are always multiple, and in very rare instances the primary form of a cancerous tumour. They are developed in the course of the growth of a scirrhous or medullary tumour, and it would only be misleading and confusing the student to attempt to place them in a class by themselves. There may be no harm in employing the terms cysto-scirrhous, and cysto-medullary; but I would rigidly exclude the term cystic alone, from the nomenclature of any of the cancerous tumours, seeing that so many tumours not

cancerous would be necessarily included in such a term; and the confusion we are now only gradually sweeping away would be indefinitely prolonged. Passing from this general description of cancer, which was necessarily introduced to avoid repetition, we will now direct our attention to its developement in the different tissues and organs of the body; and to the differences between it and those other morbid products which in some measure simulate it, and are not infrequently mistaken for it, by those who are not skilled in the diagnosis of these tumours. The order of precedence I shall adopt will be governed by the relative frequency of the disease in the particular organ.

CHAPTER IV.

THE BREAST.

THE female breast is beyond all others the most frequent seat of cancer. It is likewise subject to tumours, and other painful affections which result from lactation, or from the intimate sympathetic association it has with the uterus and ovaries in all their important functions.

Even in the new-born infant we see occasionally a swelling beneath the small nipple, with a surrounding blush of the congested vessels. The experienced nurse sucks the part, and she tells you that she obtains veritable milk by so doing. At any rate we know that the swelling subsides in consequence, and no permanent effects remain. I am not aware that cancer has ever been seen in the breast before puberty. At or about that period, it is not an uncommon thing to see a girl with a very painful swelling beneath the nipple, which gives great uneasiness to herself and her female friends, and sometimes continues to be a source of trouble for a long time. I have sometimes seen an abscess result from the high vascular action which has been set up. My own experience in these cases leads me to think that such a result is unfortunate, as it may endanger the future functional action of this important gland; and because appropriate treatment, timely employed, will

always ward off such a termination. Cooling lotions instead of hot poultices should be advised, and when the inflammation has subsided, the part should be shielded by some simple unirritating plaster spread on thick brown leather. The peculiarities of the constitution will of course require to be attended to, and tonics or aperients administered according to the necessities of the case. Although the gland may remain enlarged for many months in these young girls, it always subsides upon the regular establishment of the menstrual flow, and I have never seen it degenerate into cancer. The probable result is that the nipple will be inverted, and when the time comes for performing the function of lactation, a difficulty is experienced by the infant in applying its wonderful powers of suction, and so we may get bad secondary results from the nonperformance of the natural functions of the breast.

Supernumerary nipples, like supernumerary fingers and toes, are curious freaks of nature, which need not arrest our attention. Young ladies are, however, sometimes urgent to have such a peculiarity removed before marriage, and as it is very readily effected, and no harm can ensue, I have yielded to the wishes of the patient, and, with a pair of sharp scissors, snipped off a pendulous second nipple, which was attached to the original one. The softness and vascularity of the extra growth are sufficient indications of its innocent nature. Many cases of these extraordinary developments are on record, and recently a very interesting one has been communicated to the medical journals by my friend Dr. Greenhow, of the Middlesex Hospital.

Mammary abscess in connection with child-bearing

E

and lactation is often a serious and always a very painful event. It may or may not depend on sore nipples, and I have sometimes seen it follow a blow. Owing to the looseness of the tissues, an abscess in this region does not obtain that compact character which is observed in other parts of the body, so that the matter burrows in various directions, and many sinuous openings may result instead of one. The hardness which accompanies mammary abscess is very considerable in some cases, but seeing that it is diffused over the whole breast, and does not communicate to the hand the sensation of a circumscribed tumour, there need be no fear of mistaking this for a scirrhus.

It is always very difficult to cure a milk abscess in one breast whilst the other is kept in action. The cases I am accustomed to see are those of persons who have generally undergone the usual treatment for many weeks or months, and to whom, therefore, decided remedies must be applied. Weaning the child is the first and most absolute requirement, without which no remedies will avail. Then if there be much inflammation, cold lotions or iced water should be substituted for the usual hot poultices, and the constitution should be supported by good diet, with wine or beer, and quinine with acids. The inflammation will thus subside, and the sinuses will be disposed to diminish and close. I would especially observe that probing the sinuses is a most injurious and utterly useless proceeding, which should be entirely abandoned. Injecting them also with stimulating lotions is of questionable advantage. When the inflammatory action has ceased, if the breast be covered with a stout leather plaster of

« PreviousContinue »