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By D. de Moulin

The 3rd Breast melanoma operating convention of the Breast melanoma Cooperative team of the ecu association for examine on remedy of melanoma, to be held in Amsterdam on April 27-29, 1983, was once the main purpose for penning this ebook. It was once feh brief assessment of the most pathogenetic conceptions and healing rules that have offered themselves with reference to mammary melanoma during Western heritage , will help to attract a extra entire photograph of the place we stand this day. it isn't effortless to make a decision which rules, even if discarded, deserve but to be remembered and which authors from the previous can be thought of to be really consultant of the medical weather in their age. Twenty centuries have produced a great deal of rules and the variety of clinical authors who complex, or rejected, or changed, or revived them, is absolutely uncountable. So the historian has to make a selec­ tion and offerings are perforce subjective and open to feedback. In penning this publication i attempted to refer to unique resources within the unique language up to attainable. those assets weren't constantly strictly clinical on account that I aimed toward putting the matter of malignant breast sickness - which would function a paradigm of melanoma in most cases - in a slightly wider context. For the historical past of medication isn't just a heritage of principles, but additionally that of individuals, of associations, of society.

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38 Fig. 15. Pectorallymph drainage according to Mascagni. The concept of 'metastasis' still seems to have been somewhat alien to GiovanniBattista Morgagni (1682-1771), the great eighteenth-century pathologist. 16. / •• ', /- .. '" Ji ... - ~- " I;";' ,> --- --- - Internal mammary lymph nodes, described by P. Camper. to the thoracic cage at the spot where ribs had come to be exposed some time after the amputation of a cancerous breast. On another occasion he noted the presence of a great lump of 'scirrhous tubercles' in the ipsilateral axilla.

On the whole, German surgery lagged behind somewhat in the eighteenth century. The textbooks of Lorenz Heister (1683-1758), professor in Altdorf and Helmstedt, successively, and of August Gottlieb Richter (1742-1812) in Göttingen, did much to remedy that situation. In Vienna, Gerard van Swieten (1700-72) should be recalled in particular, not only because he was the founder of the famous medical school in the Austrian capital, but also because he translated and commented upon the Aphorisms of his preceptor professor Herman Boerhaave (1668-1738) in Leyden, who had enjoyed a world-wide reputation as a clinical teacher.

If the lump had not yet penetrated the skin, the chief consideration was, of course, to distinguish between benign or malignant types of scirrhus and between scirrhus and scrofula - tuberculosis of the breast being by no means a rare occurrence at the time. 93 It was also important to decide whether the tumour had a local origin - trauma, inflammation, milk retention - or whether it resulted from an internal cause, such as a general corruption of humours, suppression of menstruation or melancholy.

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