Aëtius gives from Leonidas the following description of the operation on cancerous mammæ. Laying the patient in a supine position, he says, I make an incision into the mammæ above the cancer, and immediately apply a cautery until an eschar be produced to stop the bleeding. I then make another incision deep into the substance of the mamma, and again burn the parts, and so proceed—first cutting and then burning alternately, in order to restrain the bleeding. In this way there is no danger of hemorrhage. After the amputation is completed I again burn the parts until they are quite dry. The first burnings are for the sake of the bleedings, and the last with the intention of eradicating the disease. (xvi, 45.) This operation, described in nearly the same words, occurs in Soranus. (61.) He says, when the disease is scrofulous the burning may be omitted. (Ibid.)
Avicenna mentions that after the excision of a cancerous part the actual cautery may be required. And yet, he adds, there may be danger from the burning provided the part affected be near any vital organ. (iv, 3, 2.)
Rhases says, that they who make an incision into a cancerous part merely produce ulceration thereof, unless it be so seated that the disease can be completely removed and the parts afterwards burned. (Ad Mansor. vii, 9.) In another work he expresses himself rather favorably of excision and burning. (Contin. xiii.)
Haly Abbas approves of the operation when the cancer is seated in the mammæ or extremities. He recommends us to allow the part to bleed until all the melancholic humour is evacuated, and says nothing of the cautery or ligature. (Pract. ix, 12.)
Albucasis says that he never saw a case of cancer cured unless the tumour was small and recently formed. He directs us, when the operation is attempted, to cut out the tumour by the roots, and if the hemorrhage from any vein be profuse to stop it by the cautery. (Chirurg. ii, 53.)
Serapion expresses himself rather diffidently of excision. (v, 24.)
Soranus gives a full account of scirrhous breast distinct from the cancerous. He states that when the whole breast is scirrhous and adheres to the chest, the excision of the sound parts from the diseased ought not to be attempted; but when only the extremity of the breast, or only the half of it is hardened, he approves of amputation without burning, there being no danger of bleeding in this case as in cancer. (66.)
SECT. XLVI.—ON MALE BREASTS RESEMBLING THE FEMALE.
As at the season of puberty the breasts of females swell up, so in like manner those of the males also swell to a certain extent; but for the most part they subside again. In some cases, however, having acquired a beginning they go on increasing, owing to the formation of fat below. Wherefore, as this deformity has the reproach of effeminacy, it is proper to operate upon it. Having, therefore, made a lunated incision below the breast, and dissected away the skin, we unite the parts by sutures. But if, as in women, the breast incline downward, owing perhaps to its magnitude, we make in it two lunated incisions, meeting together at the extremities, so that the smaller may be comprehended by the larger, and dissecting away the intermediate skin, and removing the fat, we use sutures in like manner. But if, through mistake, we should cut away too little, we must again remove what is redundant, and apply the remedies for fresh wounds.