256 



MAMMARY GLANDS. 



" In proportion as the malignant fungus is 

 recent and of small dimensions, is the diffi- 

 culty of diagnosis from the hydatid cyst, for 

 the fungus, as I have before said, ordinarily 

 commences on the interior of a cyst containing 

 a fluid, from the vascular lining of which it 

 hangs like a fringe, and it is common to find 

 more than one, often several contiguous cysts, 

 in the early stage of the disease. As the fungi 

 grow, the cysts burst and are blended in the 

 same mass. From this account it will appear 

 that there is sufficient analogy between the 

 hydatid and fungoid disease in its incipient 

 state to require more aids to diagnosis than 

 those derived from manual examination. We 

 sometimes meet with puzzling analogies in 

 these diseases." 



" The relation of medullary sarcoma," says 

 Miiller, " to scirrhus or carcinoma simplex is 

 displayed by the fact that after amputation of a 

 scirrhous breast, real fungoid tumours may oc- 

 cur in other parts, as many observations of Zaup- 

 taft, Cruveilhier, and others abundantly shew. 

 This affinity is further illustrated by microscopic 

 examination, which shews that many structures 

 comprehended under the generic term of fungus 

 medullaris differ greatly from each other, and 

 have nothing in common but the softness of 

 their texture." Miiller therefore employs the 

 term fungus medullaris " as a collective name 

 for different forms or stages of developement 

 of soft cancer, which undergo imperceptible 

 transitions into each other." The following are 

 the varieties for a knowledge of the minutiae 

 of which we must refer our readers to the 

 original. 



" 1. Carcinoma medullare, abounding in 

 roundish formative globules which make up 

 the greater part of the medullary mass, though 

 intersected by a delicate fibrous net-work. 



" 2. Carcinoma medullare, with an exceed- 

 ingly soft cerebriform base composed of pale 

 elliptical bodies without caudate appendages. 



" 3. Carcinoma medullare, with caudate or 

 spindle-shaped corpuscules. 



" Carcinoma fusciculalurn (syn. hyacinum.) 

 Among the structures commonly included 

 under the name fungus medullaris, are some 

 altogether fibrous in their texture, and which 

 correspond with other forms of that disease 

 only in the softness of their tissue. The 

 fibrous structure of these growths is immedi- 

 ately evident on breaking or dividing them ; 

 when torn they do not crumble, but are readily 

 rent in the direction of the fibres. If ex- 

 amined under a microscope they display nei- 

 ther the cellular globules of other varieties of 

 carcinoma, nor the caudate corpuscules which 

 give a fibrous appearance to some forms of fun- 

 gus medullaris." 



Mr. Travers, in the paper previously referred 

 to, says that " certain anomalous morbid 

 changes, as large fungous excrescences and 

 deep cavernous fetid ulcers, are now and then 

 the sequelae of tumours in the female breast 

 which are in a loose and slovenly classification 

 termed cancerous. They are not so; but they 

 are almost as incapable of being conducted 

 to a curative termination as if they were; their 



progress can scarcely be said to affect the health, 

 being remarkable for its slowness and freedom 

 from pain." He also describes an excoriation 

 of the integument around the nipple gradually 

 extending over the breast, accompanied by an 

 ichorous exudation which remains in the same 

 incurable state many years, and ultimately 

 throws up a broad toad-stool fungus exquisitely 

 irritable and much disposed to bleed. Itaffects 

 neither the glands nor health." 



Melanosis or black cancer has been met with 

 in the breast, but we believe never as a primary 

 disease, the breast having been attacked sub- 

 sequently to other tissues. Breschet, in his 

 treatise on this disease, gives a representation 

 of it in this organ. There is a preparation of 

 it in the museum of Bartholomew's Hospital. 

 It is considered by Miiller as " merely a variety 

 of cancerous degeneration, and terminates in 

 the same way as other forms of carcinoma." 



" Microscopic examination," says Miiller, 

 " detects two forms of melanotic structure. 

 In both instances the basis of the structure is 

 formed of a fibrous network, the stroma of me- 

 lanosis, within the meshes of which the mela- 

 noid matter is deposited. This matter is gene- 

 rally composed of cells, filled with yellowish 

 or blackish green granules. These cells are 

 and always continue to be free, never becoming 

 coherent. Their forms are very various. Many, 

 indeed most, are round, oval, or irregular; 

 some are elongated ; a few actually caudate, 

 terminating at one or both extremities in a 

 point or in a fibril. Still more rarely the cells 

 present several points. They are real pigment 

 cells." This author discovered in one of the 

 larger cells a nucleus with its nucleolus, in- 

 dependently of the pigment granules. We 

 cannot conclude this article more satisfactorily 

 than by quoting from the same accurate ob- 

 server, Mr. Travers, of whose observations we 

 have already so fully availed ourselves. 



" No description can comprehend all the 

 varieties of tumour to which this organ is liable, 

 nor does any share of experience enable the 

 nicest observation to suggest an infallible clue 

 to their nature. We have sometimes only 

 manipulation to depend upon, which is an art 

 imperfectly cultivated by scientific surgeons. 

 Cases now and then arise about which the 

 most accurate observers are liable to error. 

 True it is this does not frequently happen in 

 the distinction between innocent and malignant 

 growths. The several species of innocent tu- 

 mours already enumerated may all be distin- 

 guished from scirrhus with comparatively little 

 difficulty ; but if any doubt exists we must 

 consider the age, habits, and circumstances of 

 the patient. For example, we should ascertain 

 if marks of scrofula are present ; if the uterine 

 functions are regular and healthy ; if the tu- 

 mour can be referred to violence in the com- 

 mencement, which from the exposed situation 

 of the organ is far from uncommon ; if more 

 than one lump exists in the same breast; if 

 both breasts are infected ; if painful, the cha- 

 racter of the pain ; if any absorbent glands are 

 altered in the neighbourhood and how. How 

 many cases of breast tumour are in the recol- 



