With regard to the argument against the early extirpation, founded upon the possibility of the disease having affected parts in the vicinity, which have not yet evidently become diseased[134], I may observe, that, upon the same principle, we ought not to operate until the axillary glands swell; because they may be affected, although they be not yet evidently enlarged; and, therefore, may give rise to a relapse. If we only remove the single gland in the breast, which is hard, we doubtless run a great hazard of a relapse; but, I apprehend, that this ought never to be done, and that the whole of the glandular part of the breast ought to be removed at once; because we thus more certainly prevent a return of the disease, which we cannot otherwise, with any certainty, do. The additional pain is very inconsiderable; and we can derive very little advantage or benefit from leaving a part of the mamma behind. [134] Pract. Obs. on Cancerous Complaints, by Mr. Pearson, p. 50. The caustic has been proposed, instead of the knife, for the removal of cancer schirrus; but it is much less certain, more tedious, and even more painful. Instead, therefore, of recommending itself to timorous patients, this practice is still more to be dreaded than the excision, which is more terrible in anticipation, than in the actual performance of it. The caustic most commonly, and indeed almost universally, employed, is arsenic, mixed with various inert substances, and formed into a paste or ointment[135]. This has been applied in two ways; first, directly upon the skin, covering the schirrus, and then, after this is destroyed, upon the schirrus itself, destroying it layer by layer; second, directly upon the skin, and then, instead of applying it to the gland, to put it round it on the surrounding cellular substance, and by gradually destroying this round the gland, to turn out the schirrus entire. This was the practice of Mr. Guy, who gained considerable credit by his success; and, since his time, it has occasionally been performed with success by some others[136]. [135] Arsenic mixed with sulphur, and powdered crow-foot, and made into a paste with yolk of egg, forms Plunket’s composition. Mixed with forty times its weight of powder of belladona, it forms an application which some time ago was much in repute in North America. [136] Justamond on Cancers, p. 141. This gentleman relates a case, in which, by destroying the skin with lunar caustic, and then applying arsenic, he removed the gland. The arsenic, in this instance, was fused with antimony, in proportion of two parts of the first to one of the last. This was powdered and mixed with equal parts of powdered opium, and made into a liniment with yolk of egg.