the ages of forty and fifty. It is sometimes met with in women of
twenty; and the younger the individual the more malignant is the
disease. Married life seems to have no effect as regards the incidence
of the disease, but it often happens that a breast which gave trouble
during the period of suckling becomes later the subject of cancer;
in other cases there is a clear history of the attack having followed an
injury. It is, thus, as if inflammatory changes in the breast were
the direct cause of a later cancerous invasion. Though it is impossible
to affirm that heredity has a great influence in the incidence of cancer,
it is, nevertheless, remarkable that the members of certain families
are unusually prone to the disease.
The chief feature of a cancerous tumour of the breast is its great hardness. The technical name for the growth is scirrhus (Gr. σκίρος, or σκίρρος, any hard coat or covering, stucco), from its stony hardness. The tumour consists of a dense framework of fibrous tissue, with groups of cancer-cells in the spaces. The malignancy of the disease depends upon the cells, not upon the fibrous tissue. In young subjects the cells predominate, but in old ones the contraction of the fibrous tissue throughout the breast compresses and destroys the cells, and this sometimes to such an extent that there is at last nothing left at the site but contracted fibrous tissue, all trace of malignancy having disappeared. This variety of the disease is found in old people, and is called atrophic cancer.
The cells of a cancerous breast are apt to be carried by the lymphatics to the lymphatic glands in the arm-pit, and by the bloodstream to the spinal column and to other parts of the skeleton, and sometimes to the liver, which thus becomes large and hard, or to the other breast.
As the fibrous tissue around the tumour becomes invaded by the new growth it undergoes contraction (much as a string becomes shorter when it is wetted), and as this shortening of the fibrous bands increases the nipple may be retracted, and the breast may be closely bound down to the chest-wall; and, further, the skin overlying the tumour may be drawn in towards the tumour so as to form a conspicuous dimple. Later, the nutrition of this patch of skin may be so interfered with that it mortifies or breaks down, and thus a cancerous ulcer is produced. This ulcer slowly spreads, and its floor is covered with a discharge in which septic micro-organisms undergo cultivation; in this way the ulcer becomes highly offensive. By the use of antiseptic lotions and a frequent change of dressings, however, all unpleasant smell can be checked or prevented. As the ulcer extends it is apt to implicate large blood-vessels, so that serious, and sometimes alarming, haemorrhages take place. And if the breast had previously been in pain, the bleeding is likely to give great relief. But repeated haemorrhages bring on increasing exhaustion, and thus materially hasten the end.
There is at present only one trustworthy treatment for cancer, and that is its free removal by operation. The entire breast and the nipple must be sacrificed. At the present day the operation itself is not a “dreadful” one. To be successful it must be very thorough, and it must be done early. The patient, being under an anaesthetic, feels nothing, and the subsequent dressings of the wound are attended with scarcely any pain. There need be but a couple of days of confinement to bed, and when the wound has soundly healed the patient may be encouraged to use her arm. Should there be recurrence of cancerous nodules in or about the wound, their removal should be promptly and widely effected. The writer has records of one case in which between the first operation and the last report there was a space of over twenty-nine years, and another of fifteen years. Each of these patients had one extensive operation, and four or five smaller operations for dealing with recurrences. Each of them, however, might be considered unlikely subjects for further return.
For a superficial cancer the X-rays may be of service, but many applications of the rays are likely to be needed, and the case may possibly refuse to yield to their influence, and, after loss of valuable time, the disease may have eventually to be removed by the knife. The great advantage which the treatment by the knife offers over every other method is that the growth can be cleanly, efficiently and promptly removed, and, with it, all the affected lymph-spaces, and the lymphatic glands which are secondarily implicated.
As regards the value of radium in the treatment of cancer of the breast, the high expectations which were somewhat widely associated with this newly-found element early in 1909 must be said to have been unjustified by any precise results. Injections of radium salts have been made into the substance of a cancer, and tubes of aluminium containing the salt have been introduced into the growth, but no deep cancer has thereby been cured. Radium has also been exposed again and again on the surface of the affected breast, but similarly with no great result. Unfortunately, whilst one is experimenting in the treatment of an operable cancer, the epithelial cells of the growth may be making their way towards distant parts, where no rays or emanations could possibly reach them. Whatever may be the future of radium as a therapeutic agent in the treatment of cancer of the breast, it is certain that, on the facts as known at the beginning of 1910, the only safe course is to remove the breast by direct operation, together with the associated lymph-spaces and lymphatic glands. And if this is done promptly and thoroughly cancer of the breast will come more and more into the class of curable diseases. (E. O.*)
MAMMEE APPLE, South American or St Domingo Apricot, the fruit of Mammea americana (natural order Clusiaceae), a large tree with opposite leathery gland-dotted leaves, white, sweet-scented, short-stalked, solitary or clustered axillary flowers and yellow fruit 3 to 6 in. in diameter. The bitter rind encloses a sweet aromatic flesh, which is eaten raw or steeped in wine or with sugar, and is also used for preserves. There are one to four large rough seeds, which are bitter and resinous, and used as anthelmintics. An aromatic liqueur distilled from the flowers is known as eau de créole in the West Indies, and the acrid resinous gum is used to destroy the chigoes which attack the naked feet of the negroes. The wood is durable and well adapted for building purposes; it is beautifully grained and used for fancy work.
MAMMON, a word of Aramaic origin meaning “riches.” The etymology is doubtful; connexions with a word meaning “entrusted,” or with the Hebrew matmon, treasure, have been suggested. “Mammon,” Gr. μαμωνᾶς (see Professor Eb. Nestle in Ency. Bib. s.v.), occurs in the Sermon on the Mount (Matt. vi. 24) and the parable of the Unjust Steward (Luke xvi. 9–13). The Authorized Version keeps the Syriac word. Wycliffe uses “richessis.” The New English Dictionary quotes Piers Plowman as containing the earliest personification of the name. Nicholaus de Lyra (commenting on the passage in Luke) says that Mammon est nomen daemonis. There is no trace, however, of any Syriac god of such a name, and the common identification of the name with a god of covetousness or avarice is chiefly due to Milton (Paradise Lost, i. 678).
MAMMOTH (O. Russ. mammot, mod. mamant; the Tatar word mama, earth, from which it is supposed to be derived, is not known to exist), a name given to an extinct elephant, Elephas primigenius of Blumenbach. Probably no extinct animal has left such abundant evidence of its former existence; immense numbers of bones, teeth, and more or less entire carcases, or “mummies,” as they may be called, having been discovered, with the flesh, skin and hair in situ, in the frozen soil of the tundra of northern Siberia.
The general characteristics of the order Proboscidea, to which the mammoth belongs, are given under that heading. The mammoth pertains to the most highly specialized section of the group of elephants, which also contains the modern Asiatic species. Of the whole group it is in many respects, as in the size and form of the tusks and the characters of the molar teeth, the farthest removed from the mastodon type, while its nearest surviving relative, the Asiatic elephant (E. maximus), has retained the slightly more generalized characters of the mammoth’s contemporaries of more southern climes, E. columbi of America and E. armeniacus of the Old World. The tusks, or upper incisor teeth, which were probably smaller in the female, in the adult males attained the length of from 9 to 10 ft. measured along the outer curve. Upon leaving the head they were directed at first downwards, and outwards, then upwards and finally inwards at the tips, and generally with a tendency to a spiral form not seen in other elephants.
It is chiefly by the characters of the molar teeth that the various extinct modifications of the elephant type are distinguished. Those of the mammoth (fig. 2) differ from the corresponding organs of allied species in great breadth of the crown as compared with the length, the narrowness and crowding or close approximation of the ridges, the thinness of the enamel, and its straightness, parallelism and absence of “crimping,” as seen on the worn surface or in a horizontal section of the tooth. The molars, as in other elephants, are six in number on each side above and below, succeeding each other from before backwards. Of these Dr Falconer gave the prevailing “ridge-formula” (or number of complete ridges in each tooth) as 4, 8, 12, 12, 16, 24, as in E. maximus. Dr Leith-Adams, working from more abundant materials, has shown that the number of ridges of each tooth, especially those at the posterior end of the series, is subject to individual variation, ranging in each tooth of the series within the following limits: 3 to 4, 6 to 9, 9 to 12, 9 to 15, 14 to 16, 18 to 27—excluding the small plates, called “talons,” at each end. Besides these variations in the number of ridges or plates of which each tooth is composed, the thickness of the enamel varies so much as to have given rise to a distinction between a “thick-plated” and a “thin-plated” variety—the latter being most prevalent among specimens from the Arctic regions. From the specimens with
