MAMMARY GLANDS. 



255 



Mr. Travers, at St. Thomas's Hospital, the other 

 in the private practice of Mr. South ; the for- 

 mer I inspected in company with that gentle- 

 man. The post-mortem appearances were 

 interesting from the immense crop of white hard 

 tubercles which were found studding the pleura 

 costalis. 



Dr. Benedict considers that " the primary 

 skin disease can be removed almost always with 

 a favourable result if the operation is performed 

 previous to enlargement of the neighbouring 

 glands, disease of the parenchyma of the mam- 

 ma, or constitutional fever." 



The ordinary scirrhus of the mamma in its 

 early stages usually presents itself to the sur- 

 geon as a hard tumour, situated in not on the 

 glandular substance of the breast. At first it 

 is comparatively moveable, but it cannot be 

 moved independent of the structure which sur- 

 rounds it, and in the progress of development it 

 soon contracts adhesions by means of root-like 

 prolongations with the whole mamma. Its 

 surface varies, not decidedly nodulated nor yet 

 uniformly smooth ; not tender to the touch, 

 though it may be the seat of sharp lancinating 

 pains. As the tumour increases, its adhesions 

 extending on all sides, the nipple becomes 

 drawn in, and its most prominent surface as- 

 sumes a dusky hue. The constitution now 

 begins to suffer, the glands in the axilla enlarge, 

 and at this period there is no difficulty in dis- 

 tinguishing the nature of the disease. In its 

 early stage it might be confounded with a 

 tumour which Mr. Travers in his paper just 

 referred to has thus described : " There is a 

 tumour met with in the breasts of young women, 

 more like a shelled walnut in point of size and 

 nodosity than any thing to which I can com- 

 pare it. It is of a stony hardness, and it is not 

 reduced by regulated equal compression, mer- 

 cury, iodine, or blisters. It is an enlargement 

 and partial cohesion of the lactiferous tubes in 

 a cluster, in one or more places, and which dis- 

 position in a less degree pervades the ducts 

 throughout the organ." The absence of lanci- 

 nating pains, constitutional disturbance, and 

 the peculiar countenance attendant on malig- 

 nant disease, assist the surgeon in his diagnosis. 

 The earlier period of life at which it makes its 

 appearance is also a circumstance worthy of 

 attention. 



Miiller describes scirrhus, or carcinoma, sim- 

 plex (syn. carcinoma fibrosum)as "irregular in 

 form,* not lobulated, hard and resisting the 

 knife, and presenting, when divided, a greyish 

 appearance which has but very little similarity 

 to cartilage. Whitish bands are not invariably 

 present. Scirrhus of the mammary gland oc- 

 casionally shews, here and there, whitish fila- 

 ments, some of which are hollow, and contain a 

 colourless, whitish or yellowish matter. Pro- 

 bably this appearance of white filaments is the 

 result of thickening of the walls of the lacti- 

 ferous tubes and lymphatics, and this idea is 

 confirmed by the absence of these filaments 

 from scirrhus of non-glandular parts. The 

 mass of scirrhus is composed of two substances, 



the one fibrous, and the other grey and granu- 

 lar." The fibrous substratum is composed of a 

 very irregular net-work of firm bundles of fibres. 

 The grey consists of microscopic, formative 

 globules, but slightly adherent to each other; 

 they are transparent hollow cellules, from 

 0.0048 to 0.00166 or 0.00130 of an English 

 inch in diameter, some of them exhibiting a 

 distinct nucleus. They have no connection 

 with the fibrous structure." 



Carcinoma reticulare, Miiller says,* " occurs 

 more frequently than carcinoma simplex. On 

 making a section of it, it may be immediately 

 distinguished from the latter by the white reti- 

 culated figures intersecting the grey mass, which 

 are perfectly evident to the naked eye. It ac- 

 quires a large size more readily than carcinoma 

 simplex, and is further distinguished from its 

 tendency to assume a lobulated form. It some- 

 times approaches the consistence of scirrhus, 

 at other times it is softer and more nearly re- 

 sembles fungus medullaris." Though its con- 

 sistence varies, its structure always remains the 

 same, and with the exception of cancer alveo- 

 laris, no form of carcinoma can be so readily 

 distinguished. 



Carcinoma alveolare, though usually found in 

 the stomach, occasionally attacks the breast, and 

 a very good specimen of it is deposited in the 

 museum of St. Thomas's Hospital. This dis- 

 ease, like the former one, consists of innumera- 

 ble white fibres and lamina crossing each other 

 in all directions, and having their interspaces 

 occupied by cells which vary in size from that 

 of a grain of sand to that of a large pea. For 

 the history of the development of this and other 

 forms of cancer see PRODUCTS, MORBID. 



Soft cancer, fungus h<tnatodes,and medullary 

 carcinoma, areoneand the same disease. Itforms 

 a soft elastic swelling, giving something of the 

 sensation to the fingers of deep-seated fluid, 

 increases rapidly, and is seldom confined to any 

 single organ in the body. It occurs earlier in 

 life than scirrhus, and is more decidedly a con- 

 stitutional disease. " The tumour with which 

 alone this is liable to be confounded," says Mr. 

 Travers, " is the hydatid breast, as it is called, 

 and there is sufficient resemblance in the 

 rounded outline, the elastic resistance, the ab- 

 sence of glandular affection, the distressing in- 

 conveniences of size, weight, and distension, 

 the turgid veins and livid discoloration of the 

 surface, to create some hesitation. But in the 

 medullary disease it seldom happens that the 

 health is not affected, whereas in the hydatid 

 breast it is undisturbed ; the figure of the me- 

 dullary tumour is less uniform, being marked 

 by dark tuberous elevations and immovably 

 fixed to the side by the prolongations of the 

 diseased growth in one or more parts of its cir- 

 cumference ; whereas the hydatid tumour, not- 

 withstanding its oftentimes enormous bulk, is 

 globular and remains perfectly detached and 

 pendulous. The main distinction is that the 

 mammary gland is not, in my experience at 

 least, the seat of the medullary or fungoid dis- 

 ease as it is of the hydatid. 



West's Translation, 41. 



Page 45, loc. cit. 



