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THE

PHILADELPHIA POLYCLINIC

A WEEKLY JOURNAL, PUBLISHED BY THE PHILADEL-

PHIA POLYCLINIC AND COLLEGE FOR

GRADUATES IN MEDICINE

AND

EDITED BY A COMMITTEE OF THE FACULTY

VOL. VII.
WITH THE RECORD OF THE PHILADELPHIA COUNTY MEDICAL SOCIETY

FOR 1898

PHILADELPHIA

1898

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REMOVAL OF CERTAIN BENIGN BREAST TUMORS BY THOMAS' TRAP-DOOR

INCISION AND HIDDEN CICATRIX METHOD.

BY THOMAS S. K. MORTON, M.D.

Professor of Surgery in the Philadelphia Polyclinic. In the New York 'Medical Journal of ink line just mentioned, until the thoracic April, 1882, page 337, Dr. T. Gaillard muscles are reached. From these the Thomas, under title “On the Removal of mamma is now dissected away until the line Benign Tumors of the Mamma without of dissection represents the chord of an arc Mutilation of the Organ," described a new extending from extremity to extremity of operation by means of which tumors of a the semi-circular incision. The lower half benign nature, especially the adenomata of the mamma which is now dissected off is, of young girls, and, again, especially those after ligation of all bleeding vessels, turned growths situated in the lower quadrants of upward by an assistant and laid upon the the organ could be safely and easily re chest walls just below the clavicle. An inmoved without mutilation of the glandular cision is then made upon the tumor from structure or the infliction of an observable underneath, by the bistoury, a pair of short cicatrix. He holds that the operation is en vulsellum forceps firmly fixed into it, and, tirely inappropriate for malignant tumors or while traction is made by these, its connecfor very large or very small benign growths. tions are snipped by scissors, the body of He reported twelve cases in which he had the tumor being closely adhered to in this most successfully and satisfactorily applied process, and the growth is removed. All the procedure. These included : fibromata, hemorrhage is then checked and the breast lipomata, cysts, and adenomata, which va put back into its original position." ried in size from a hen's egg to that of a The outer or cutaneous surface of the duck, or a little larger.

breast is uninjured, and the only alteration His description of the operation is as fol. of the organ is the possible depression over lows, “ The patient'standing erect and the the site of removed tumor. Dr. Thomas mamma being completely exposed, a semi- recommended glass-tube drainage, and the circular line is drawn with pen and ink ex close approximation of the skin edges by actly in the fold which is created by the fall fine silk stitches introduced close to the of the organ upon the thorax. The line en wound margins by means of round sewing circles the lower half of the breast at its needles so as to avoid as much as possible all junction with the trunk. As soon as it has cicatrices. He was agreeably disappointed dried, the patient is anesthetized, and with in most of his cases to find that not the the bistoury the skin and areolar tissues are slightest depression or deformity was subsecut through, the knife exactly following the quently to be found. " The only sign of

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