The Practitioner Volume 74 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1905 edition. Excerpt: ...most important branch then traverses the diaphragm to the right of the middle line, with the inferior vena cava, to enter the glands above the diaphragm on the right side. In this way cancer of the stomach may infect the right pleura. Either side may be infected by the growth involving the under surface of the diaphragm and then spreading through. The gland is situated at the level of the seventh cervical vertebra just above the thoracic duct as it curves over the apex of the pleura, before it joins the outer side of the intemal jugular vein. The anterior mediastinal glands, into which the diaphragm drains on the right side, pass into the right lymphatic duct, and thus may infect the right gland, and on the left side they open into the thoracic duct. The disturbances of the lymphatic circulation produced by the respiratory movements would account for the backward infection of the stemomastoid gland from the thoracic duct on its course to the veins, and for the occurrence being only occasional. Malignant disease only grows along small lymphatics, as a solid column, and therefore spreads by contiguity; it is only in the large vessels that emboli of malignant cells are carried on to a distance. GROWTH IN LEFT SUPRACLAVICULAR GLANDS SECONDARY TO STOMACH. Jane F., aet. 5 3.----Admitted under Dr. Pye-Smith, in 1888, for nodules of growth in the skin, behind the left sternomastoid and in the right axilla. There is also a tender tumour above and to the left of the umbilicus. She ultimately died, and the primary growth was in the stomach. Among more recent cases I havevnoted, the retro-sternomastoid gland has been involved twice in connection with the stomach, once each in connection with oesophagus, mediastinum, and pancreas. GROUP A.----SEVEN...