A many centuries, a few recent years are included to summarize accomplishments and failures. A historical evaluation provides insight and hope that future improvements will put an end to the controversy over the management of breast cancer. Excellent historical reviews of the surgical treatment of breast cancer have been published by Banks, ' Power,lo Cooper,3 and Lewison.8 The records of Egyptian medicine, inscribed on thin sheets of papyrus, go back several thousand years B.C. and contain a few observations on mammary swellings or lumps. The deciphered records do not indicate whether cancer was differentiated from benign or inflammatory lesions. Also, there was very little information about treatment, but there was one recorded instance of excision of a breast mass.
After 500 B.C., when first the Greeks and later the Romans predominated in the field of medicine, certain hard breast lumps with "roots" in the surrounding tissues were considered serious. They were designated as cancer because the configuration resembled sea-crabs. When sharp surgical instruments became available, local excisions were performed. Success was limited even though determined only by the lack of local recurrences. When surgery was not advised or was refused by patients who wished to have intact breasts, cauterization and caustics containing arsenic or zinc chloride became popular forms of local, conservative treatment. There were no cures and few, if any, favorable results.
Such treatment continued until the 16th century when French and Italian physicians began to do wider local excisions. By the end of that century, hard lumps noted in the adjacent axilla were considered to be an extension of the roots from the breast lesion. According to Power,lO it was Jean L. Petit who advised removal of these lymph nodes.
During the 17th and 18th centuries, scientific discoveries as well as normal and patho-~~