MAMMARY GLANDS. 



253 



mal or globular. Cellulous hydatids are sim- 

 ple bags containing fluid. " The breast gra- 

 dually swells," says Sir A. Cooper,* " and in 

 the beginning is entirely free from pain or 

 tenderness; it becomes hard, and no fluctu- 

 ation can then be discovered in it ; it con- 

 tinues slowly growing for months and even 

 years, sometimes acquiring very considerable 

 magnitude, the largest I have seen having 

 weighed nine pounds ; but in other cases, al- 

 though the bosom was quite filled with these 

 bags, yet it never exceeded twice the size of 

 the other breast." After a time fluctuation 

 may be felt and the cutaneous veins enlarge, 

 but the breast continues free from pain and the 

 constitution does not suffer. The tumour is 

 moveable and pendulous, in some cases in- 

 volving the whole gland, in others only a small 

 portion. 



" When the swelling,-}- and the breast in 

 which it is situated, are examined, it is found, 

 upon a careful dissection, that the interstices 

 of the glandular structure itself, and the ten- 

 dinous and cellular tissue connecting it, are in 

 a great measure filled with fibrous matter, 

 poured out by a peculiar species of chronic 

 inflammation, but in some instances a bag is 

 formed into which a serous, or glairy, or some- 

 times a mucous fluid is secreted, according to 

 the degree of inflammation attending it, and 

 this fluid, from its viscidity and from the solid 

 effusion which surrounds, as well as from the 

 cyst being a perfect bag, cannot escape into 

 the surrounding tissues ; but by its quantity, 

 its pressure, and by the gradual yielding of the 

 bag, it becomes of a very considerable size ; 

 and vast numbers of these cysts are found to 

 occupy each part of the breast, producing and 

 supporting a continued but slow irritation, and 

 occasioning an effusion of fibrous matter, by 

 which the breast forms an immense tumour 

 consisting of solid and fluid matter. Within 

 these bags of fluid, hydatids hang by small 

 stalks." " The size of these cells varies from 

 the head of a pin to that of a musket-ball." 

 " When the tumour requires removal for this 

 disease, it is necessary to take away all the 

 hardened and swollen parts of the breast, for 

 they have cysts, or cells, formed in them ; and 

 if any cyst be suffered to remain, it will still 

 continue to grow, and the remaining part of 

 the breast to form an hydatid tumour. The 

 great solace to the patient in this disease is, 

 that as it does not contaminate other structures, 

 there is no danger of its extending by absorp- 

 tion, of its producing any complaint beyond 

 the breast, or of its affecting other parts of the 

 body ; nor have I seen it seated in both breasts 

 at the same time." 



Sir B. Brodie} has pointed out an important 

 feature in the development of certain cysts in 

 the breast, which are different from the true 

 hydatid. This consists in the generation of a 

 morbid growth or excrescence from their in- 

 terior, which becoming organized sometimes 



* Illustrations of the Diseases of the Breast, by 

 Sir A. Cooper, 1829. Part i. p. 21. 

 t Page 22, op. cit. 

 t Medical Gazette, Feb. 21, 1840. 



entirely fills the cyst so as to convert it into a 

 solid tumour, which ultimately protrudes ex- 

 ternally as a fungous growth, and presents a 

 new and formidable appearance. " In this 

 last stage of the disease,* it is evident that 

 spreading ulceration, sloughing and haemor- 

 rhage, the usual results of an ulcer occurring 

 in a diseased structure, must ensue, and that 

 no remedy is likely to be of any service to the 

 patient, except the removal of the affected 

 parts by surgical operation." The operation is 

 not recommended in the early stages of the 

 disease, as these cysts sometimes become ab- 

 sorbed previously to the development of the 

 fibrous tissue. As the disease is merely local 

 the operation is wholly unattended with danger. 

 The term by which Sir B. Brodie designates 

 these tumours is that of " sero cystic tumour 

 of the breast." It appears probable that the 

 bladder scirrhus of Dr. Benedict is nothing 

 more than this form of hydatid disease. 



" The third species of hydatidf which is 

 found in the breast is the animal or globular, 

 and which consists of a bag containing a fluid, 

 which has no vascular connection with the 

 surrounding parts ; and it produces within its 

 interior a multitude of bags similar to itself. 

 It is in fact a true entozoon similar in every 

 respect to that found in the brain of sheep and 

 in many other organs of the human frame." 



" When one of these hydatids,"J says Sir 

 A. Cooper, " is produced in the breast, an in- 

 flammation is excited by it, and a wall of 

 fibrine surrounds it, it feels hard, and from the 

 small size of the hydatid a fluctuation cannot 

 be discovered ; but as the hydatid grows, 

 although the quantity of solid matter increases, 

 yet as the fluid in the hydatid becomes more 

 abundant, a fluctuation in the centre of the 

 tumour may be ultimately perceived." 



The disease is not malignant, and if a sim- 

 ple puncture and evacuation of its contents 

 should not prove effectual in dispersing it, may 

 be removed without danger. 



The chronic mammary tumour occurs early 

 in life and unconnected with any diseased state 

 of constitution. " It grows," according to 

 Cooper, " from the surface of the breast rather 

 than from its interior, and it therefore generally 

 appears to be very superficial, excepting if it 

 spring from the posterior surface of the breast, 

 when it is deep-seated and its peculiar features 

 are less easily discriminated." These tumours 

 are unconnected with the glandular structure of 

 the breast. Dr. Warren relates a case in which 

 he removed one of these tumours from a young 

 woman, who four years after the operation 

 nursed an infant from the same breast. They 

 are extremely moveable, frequently begin with- 

 out pain, and continue many years without 

 exciting any uneasiness. They vary in size, 

 have a lobulated character, and are invested in 

 a fibrous membrane. " Although these tumours 

 are not in their commencement malignant, and 



* Page 842, loc. cit. 

 t Page 45, op. cit. 

 t Loc. cit. page 48. 



4 Surgical Observations on Tumours, Boston, 

 1837, p. 211. 



