CARCINOMA.
On account of its danger, its frightful torments, by which death is hastened, and on account of its frequency, cancer of the breast is so well known, not only to physicians, but also to the laity, that every woman who feels a hardening of the breast is at once filled with anxiety lest a cancer may develop from it. It is therefore readily understood why the study of tumors finally leads up to the question, How can we recognize cancer of the breast at its very beginning? How can we stop its develop ment? Added to this, when we have removed a rapidly growing tumor of the breast, is the question: Can we, from its external appearance, or by microscopic or chemical analyses, recognize whether this tumor is a cancer, or how soon and where it will recur? In this the question is transferred from clinical into anatomical territory; The answer which anatomy gives cannot, from the nature of the case, correspond always to the claims of the clinician; the latter has a prepared, symptomatic, path °gnomic model; the former must first develop such, but he can only build gradually, for the methods of examination formerly employed were too in complete to obtain clear, morphological views. But these have increased, during the last twenty years, to such a degree of clearness that they offer at least as strong points of support as the developed clinical experiences of many hundred years. We may perhaps say that the clinical and ana tomical picture covers the field of tumors quite definitely. It was in former time snecessary not only to separate those tumors which were not carcinoma, as has been done in previous sections, and then to make it clear that, included in those separated, there are also recurring tumors, but it was also necessary to form new, positive anatomical pictures of car cinoma. It was also particularly important to give an exact analysis of the clinical course and further development of the different tumors at the same time with that of their anatomical structure, so as to make more and more precise the different situations of the recurrences and the man ner of their appearance.
In the section on etiology more exact data were given as to the time at which carcinoma of the breast appears; it will only be said here that these tumors develop between the ages of :35 and 40 years; they seldom arise before the age of 30 or after the age of 55. As regards the rare cases in which mammary carcinoma has developed before the age of pu berty, and from this time to the twenty-fifth year, they all appeared in the period when the diagnosis of tumors was very incomplete. Birkett mentions a case of " cancer developed in the mammary region " in an eight year old girl; I am inclined to believe that it was a sarcoma (he himself says that cancer of the breast is rare before the thirty-eighth year). The same applies to the cases of Carmichael and Everard Home, who are said to have observed cancer of the breast (bi-lateral) in the twelfth and fifteenth years, (cited by Gross without giving the source.) Cancer of the breast always begins as a partial induration or hard nod ule in the gland, and is never distinctly movable within the glandular tissue, as are fibromata. It is usually not distinctly limited from the neighboring tissue to the touch; examination is ordinarily painless; firmer pressure sometimes causes stabbing sensations. In many cases the induration is developed painlessly and is discovered by accident, when it is already as large as a walnut; but in most cases the women become aware of the commencing disease by the lancinating pains, which occur spon taneously; it sometimes happens that such sensations precede the palpable induration for months. Still I would not place too much dependence upon this (especially here in Vienna, where the women, and particularly the Jewesses, have strikingly largely developed mamnue), because such sensations in the breasts of women between thirty and forty years of age are very frequent at the time of menstruation, without there being, on that account, any prospect of carcinoma.