. Modern surgery, general and operative. Sci., Jan., 1913). For-tunately, these glands are not frequently involved, a circumstance whichmay be accounted for by the atrophy of this channel in senile mammae, inwhich cancer usually develops (Poirier) (Primrose, Ibid.). Retraction of thenipple is present in over one-half of the cases. It occurs when the growthis near the nipple, and is due to the contracting fibrous tissues of the tumorpulling in the milk-ducts. If the growth be far away from the nipple, a dimpleis apt to form in the skin of the breast because of the pulling upon the sus-pensory f
. Modern surgery, general and operative. Sci., Jan., 1913). For-tunately, these glands are not frequently involved, a circumstance whichmay be accounted for by the atrophy of this channel in senile mammae, inwhich cancer usually develops (Poirier) (Primrose, Ibid.). Retraction of thenipple is present in over one-half of the cases. It occurs when the growthis near the nipple, and is due to the contracting fibrous tissues of the tumorpulling in the milk-ducts. If the growth be far away from the nipple, a dimpleis apt to form in the skin of the breast because of the pulling upon the sus-pensory fibers. Neither retraction of the nipple nor a cutaneous dimple provesthe existence of cancer. One or both may be noted in a breast containing ascar (from a wound or a healed abscess), in tuberculosis of the breast, and inmammary syphilis. The dimple is not due to adhesion between the tumor andthe skin. It is noted even when the tumor is far away from the skin. Itmay not be obvious unless the gland be moved to and fro or unless the skin. Fig. 1088.—Recurrent carcinoma. Cancer en cuirasse. over the breast be pushed in various directions. When this is done it becomesevident that the skin, at a certain point, is held inward. The dimple is avery valuable early symptom. Glandular carcinoma in the axilla soon follows the appearance of a scirrhusalthough there may be no palpable enlargement for a considerable time. Theglands become very hard and adherent. In over 60 per cent, of persons theglands of the axilla are felt to be enlarged when the patient first comes for treat-ment. Because the surgeon cannot feel enlarged glands is no proof that they donot exist. As a matter of fact, the glands are usually involved within twomonths of the beginning of the disease, but the involvement can rarely bedetected externally until months later. Enlargement of the axillary glands isfollowed by enlargement of the glands in the posterior cervical triangle and inthe mediastinum. Herbert Snow has show
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