. A practical treatise on tumors of the mammary gland: . cent., in the intercostal muscles in 1*35 per cent.,and, finally, in the ribs in 2*8 per cent. In theorder of the date of their appearance we may lookfor extension to the superficial fascia and skin in 14months, for ulceration in 20 months, for fixation to 156 EXTENSION TO LYMPHATIC GLANDS. the cliest in 22 months, and for invasion of the sec-ond breast in 32 months. These facts have an im-portant bearing upon the question of operation, towhich reference will again be made under the headof treatment. The rej)roduction of carcinoma in the
. A practical treatise on tumors of the mammary gland: . cent., in the intercostal muscles in 1*35 per cent.,and, finally, in the ribs in 2*8 per cent. In theorder of the date of their appearance we may lookfor extension to the superficial fascia and skin in 14months, for ulceration in 20 months, for fixation to 156 EXTENSION TO LYMPHATIC GLANDS. the cliest in 22 months, and for invasion of the sec-ond breast in 32 months. These facts have an im-portant bearing upon the question of operation, towhich reference will again be made under the headof treatment. The rej)roduction of carcinoma in the associatedIjnnphatic glands is one of the most practically inter-esting of its malignant features, and exerts a decidedinfluence upon the course of the disease, upon the for-mation of metastatic deposits, and upon tlie final issueafter operative procedures. As I have already stated,the loose collections of cells are partly contained in thelymph spaces of the mammary gland; and, as these arethe radicles of the lymphatic vessels one can readily Fig. Carcinoma of the Mammary Gland, the Ground Substance of -n-nicH is stainedWITH Nitrate of Silver.—a, a. Alveoli of the carcinoma filled with , h. Lymph spaces, c. Lymphatics, showing silver staining of the endothe-lium. conceive, as is so well illustrated by fig. 28 from Cor-nil and Rauvier, how easily, and, indeed, how inevita- CARCINOMA. 157 bly, tlie young epithelial elements are transported totlie lymphatic glands in the axilla and above and belowthe clavicle, where they implant themselves, prolifer-ate, and reproduce the likeness of the parent the glands are contaminated, they delay for acertain period, on the one hand, metastatic deposits,and, on the other hand, constitute new foci of localand general infection. Hence the cells of a packet ofindurated and enlarged glands behave precisely likethe primary tumor; that is to say, they invade the sur-rounding tissues and infect the adjoining glands andthe v
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