" When the swelling,t 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 entirely fills the cyst so as to convert it into a solid tumour, which ultimately protrudes ex ternally as a fungous growth, afid presents a new and formidable appearance. " In this last stage of the disease,* it is evident that spreading ulceration, sloughing and hwmor rhage, the usual results of an ulcer occurring in a diseased structure, must ensue, and that no remedy is likely to be °garly 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 hydatidt 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,"; 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 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 14 lbs. 10 oz. 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 he 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. ons 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 hiematodes.