A clinical treatise on diseases of the breast / by A. Marmaduke Sheild.

  • Sheild, A. Marmaduke (Arthur Marmaduke)
Date:
1898
Catalogue details

Licence: Public Domain Mark

Credit: A clinical treatise on diseases of the breast / by A. Marmaduke Sheild. Source: Wellcome Collection.

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    the sternal margin of the mamma. A certain number of the lymphatic channels of the inner quadrant of the mamma ac- company the perforating vessels to the lymphatic ganglia of the anterior mediastinum. The main bulk of the lymphatic channels, however, perforate the snbmammary pectoral fascia and join the axillary glands. The communication between these glands and the submammary lymph spaces is very free, and affords a strong argument for the removal of the axillary lymphatic tissue hi operations for cancer. Three more practical points may here be adduced. The free distribution of lymphatics in the skin, and their communication with the lymphatics of the parenchyma, necessitate a very free removal of integument over a cancerous tumour. The pectoral fascia may surgically be considered as a sponge-like lymphatic highway, and every scrap of this structure should be most carefully removed. The glands at the root of the neck, or just below the clavicle, may, in exceptional instances, be affected apart from the inter- vening chain in the axilla. The axillary lymphatic glands are practically directly continuous with the axillary cusp of mammary gland tissue. Stiles, in his important paper, also calls attention to the fact that the axillary glands in obese women frequently undergo fatty degeneration, being converted into yellow lumps, readily mistaken for fat only. By micro- scopical examination he claims to have established the fact that the stringy cords, so often detected reaching iip into the axilla in cases of cancer, are not indurated lymphatics, but really mammary tissue and ducts. It is well for the surgeon to clearly understand that the lymphatic distribution in the skin of the breast, and beneath it, and the communica- tions with the axillary lymphatic tissues, are remarkably free and widely spread. It is well not to be too strongly influenced by anatomical researches, and the practical fact remains that the axillary glands may be, and commonly are, implicated in carcinoma of any part of the mamma. The communication between the perforating lymphatics and the mediastinal glands and lymphatics of the pleura is very important, and from analogy there is reason to fear that these structures may be implicated in cases of cancer of the breast far earlier than is generally known or believed. Incurrence of the disease, and