MAMMARY GLANDS. 
_ 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 
- 
i 
: 
4 
; 
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- 
_ tury, iodine, or blisters. It is an enlargement 
pi 
mae 
SS 
thee 
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- 
_~ (syn. carcinoma fibrosum) as “irregular in 
»* 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, 
* West’s Translation, 41. 
255 
the one fibrous, and the other grey and granu- 
lar.” The fibrous substratum is composed of a 
very irregular net-work of firm bu nde 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 alobulated 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 Propucts, Morsrp. 
Soft cancer, fungus hematodes,and medullary 
carcinoma, are oneand the same disease. It forms 
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. 
* Page 45, loc. cit. 
