254 



MAMMARY GLANDS. 



they continue for many years free from the 

 disposition to become so, yet if they remain 

 until the period of the cessation of menstruation 

 they sometimes assume a new and malignant 

 action." The breast is not exempted from the 

 deposit of either cartilaginous or ossific matter, 

 and tumours of this character are occasionally 

 developed in its substance. 



The breast is occasionally enlarged by hyper- 

 trophy of the adipose tissue. A tumour of 

 this kind, removed by Sir Astley Cooper, is 

 preserved in the Museum of St. Thomas's 

 Hospital, which weighed 14lbs. lOoz. The 

 whole structure of the mamma also has been 

 found hypertrophied and the breasts enormously 

 increased in dimensions without being appa- 

 rently the subject of any disease. That all- 

 pervading poison of some constitutions the 

 scrofulous tubercular matter does not leave 

 the mamma exempt from its influence. Sir 

 Astley says that these tumours " can only be 

 distinguished from the simple chronic inflam- 

 mation of the breast by the absence of tender- 

 ness, and by the existence of other diseases of 

 a similar kind in the absorbent glands of other 

 parts of the body." They produce no danger- 

 ous effects, and do not degenerate into malig- 

 nancy. 



" The breast is liable to become irritable 

 without any distinct or perceptible swelling, as 

 well as to form an irritable tumour composed 

 of a structure unlike that of the gland itself, 

 and which therefore appears to be of a specific 

 growth." " When the complaint affects the 

 glandular structure of the breast, there is scarcely 

 any perceptible swelling, but one or more of 

 its lobes becomes exquisitely tender to the 

 touch, and if it be handled the pain sometimes 

 continues for several hours." " There is no 

 external mark of inflammation, as the skin 

 remains undiscoloured." " Besides this irrita- 

 ble and painful state of a whole or part of the 

 breast, a tumour sometimes is found distinctly 

 circumscribed, highly sensitive to the touch, 

 acutely painful at intervals, more especially 

 prior to menstruation, very moveable, often not 

 larger than a pea, seldom exceeding the size of 

 a marble ; generally one only exists, but in 

 other cases there are several similar swellings." 



" Although they continue for years they vary 

 but little in size. I have never seen them 

 suppurate. They sometimes spontaneously 

 cease to be painful, and sometimes disappear 

 without any obvious cause. Upon dissection 

 they are found to be composed of a solid and 

 semi-transparent substance, with fibres inter- 

 woven with it, but without any regular distri- 

 bution, and I have not been able to trace any 

 large filament of a nerve into them." " The 

 pain with which this tumour is accompanied, its 

 tenderness to the slightest touch or to pressure 

 of any kind, the suffering which succeeds ex- 

 amination, distinguish it from the hydatic, the 

 chronic mammary tumour, and the scirrhous 

 and fungous tubercle." 



The malignant or incurable diseases of the 

 breast may be classed under two heads, scirrhous 

 carcinoma or cancer, and fungus haematodes. 



Scirrhus has been again subdivided into 



genera by different authors, some in relation to 

 their external appearances and situation, others 

 in accordance with their internal structure. 

 Dr. Benedict, Professor in the University of 

 Breslau,* in giving the following arrangement 

 has rather pursued the former plan: 1st. Cu- 

 taneous cancer. 2d. True scirrhus; consist- 

 ing of 1. Nodulated scirrhus; 2. Lard-like 

 scirrhus ; 3. Bladder scirrhus. 



Miiller, in his late work on cancer, which has 

 been translated by Dr. West, describes the 

 different kinds of carcinoma to which the breast, 

 in common with other organs, is liable, not in 

 reference to their seat whether cutaneous or 

 glandular, but in accordance with their intimate 

 structure; and to scirrhus, medullary sarcoma, 

 carcinoma alveolare, and carcinoma melanodes 

 of former authors, has added carcinoma reticu- 

 lare and fasciculatum. To these we shall return 

 a little further on, dwelling previously on a 

 form of cancer which is not very common but 

 highly important in a practical point of view 

 to the surgeon. 



" Cutaneous cancer of the breast," says Dr. 

 Benedict, p. 39, " deserves to be particularly 

 noticed, because most surgeons frequently con- 

 found it with the common cancer, from which 

 it, however, materially differs. It never springs 

 in the substance of the organ, but always and 

 solely in the surface of the skin, and most 

 probably from fat and adipose glands of the 

 same. Its form is similar to that of cancer in 

 the face and eyelids, and arises in the same 

 way. At first there is nothing but a little knot, 

 wart, or hard little spot somewhere upon the 

 skin of the breast. This place begins gradually 

 to redden and then passes into a stage of ulcera- 

 tion. The swelling which has hard edges and 

 a hard base spreads out, increasing both in 

 depth and width so as to advance from the skin 

 into the substance of the gland, not passing- 

 far, and only very gradually destroying the 

 breast. The glands of the axilla are not 

 attacked so early as in carcinoma of the gland 

 itself, and the hectic fever which ultimately 

 destroys the patient developes itself after a 

 much longer period. 



Mr. Travers (Med. Chir. Trans, vol. xvii.) 

 also describes this cutaneous cancer in the fol- 

 lowing words : " There is a cancerous tubercle 

 of the skin which appears upon the breast as 

 in other parts, connected with a remarkable 

 change in the texture of the skin. The affection 

 of the skin is, I believe, primary. It consists 

 of a brawning induration with extension of the 

 areolse, a coarseness such as this texture pre- 

 sents when viewed through a magnifier, and 

 which gives it a resemblance to pig's skin. 

 Isolated tubercles of various sizes appear at con- 

 siderable distances apart: the texture of the 

 subjacent cellular membrane is enormously 

 thickened and has a cartilaginous hardness; and 

 the breast when the skin undergoes this change 

 upon that organ is early and immoveably fixed to 

 the chest.'' I have drawings of two cases of the 

 kind : one which occurred in the practice of 



* Bemerkunpen iiber die Krankheitcn tier Brust- 

 uncl Achsel-Drliscn. Breslau, 1825, 4to. p. 59. 



