DIFFUSE HYPERTROPHY OF TIIE BREASTS.
This form of disease being so rare I think I am especially fortunate in having seen two such cases, and in having had the opportunity to examine one anatomically.
Maria S., maid servant, virgo intact a, 16 years old,oame under my ob servation in the Autumn of 1868. In November, 1867 (then 15 years old), she menstruated for the first time; until April, 1868, she had very small breasts. In June they had reached their present size (in two and a half months), then became somewhat smaller until October, when they again grew to their present size. The left breast measured 23 inches in circum ference at the base From the lower border of the third rib, where the breast began, up to the papilla was 10/ inches, and from right to left 9 inches. Right breast: periphery of base 19i inches, from the third rib to the papilla 9/ inches, and from right to left 8-1 inches. All measurements were made while the breast was dependent. The patient would not submit to an operation. I heard about one year afterwards that the girl was in ser vice and able to do light work. The breasts had become a trifle smaller.
Anna A., servant girl, came to my clinic on June 24, 1873; she was 22 years old, of strong build, always healthy in childhood, first menstruated in her fifteenth year, and was always regular. About 3 years before (in her 19th year), she noticed a striking enlargement of both breasts; this came on slowly, without pain, and without any annoyance to her.
The menses have been absent for five months, and now the breasts have grown so enormously that the patient is bent forward and is unable to work. When she came to the clinic, the breasts were so large that they reached down over the umbilicus, and were more prominent and far harder than in the first case.
Within the soft granular parenchyma of the gland on both sides could be felt hard, movable nodules the size of a fist. The nipples and areolm were deeply pigmented, the first spread out. (Unfortunately also in this case it was not noted if colostrum could be pressed from the nipples). The circumference of the left breast at its base was 23.54 inches, and of the right 20.72 inches. From the upper boundary over the nipple down to the lower boundary was 28.68 inches on the left side, 29.86 inches on the right. The greatest circumference on the left side was 32.22 in
ches, and 33 inches on the right. The skin over the breasts was what thickened but not especially adherent to the glandular tissue. Ex tensiye venous plexuses were seen through the skin. The patient had no pains in the breasts, but the weight was so great that she was obliged to remain in bed. Examination of the abdomen and genitalia showed the existence of pregnancy, at about the fifth month.
Operation on such extensive tumors was not to be thought of during pregnancy. It seemed, however, that an attempt might be made to re duce their size by compression; compression was tried at intervals for a short time with elastic bandage, but generally with ordinary cotton band ages. After a few days the right breast appeared to be softer and smaller. But the pressure of the bandage caused some excoriations in the region of the nipple, and intense erysipelas was developed on July 5th; on July 6th the patient aborted and quickly collapsed, though there was no con siderable hemorrhage, and death took place on July 7th.
Examination of the hypertrophic glands showed that true hyperplasia was present in part only, but that there were a number of large and small, soft and hard encapsulated fibromata, in which portions of the gland were inclosed, the excretory ducts of which Fere here and there dilated into branched fissures, as is usual in these tumors. Cross section of the mamma reminded me of a uterus studded with many fibromata, except that the tumors were softer and more succulent than is usually the case in uterine fibroma.
Microscopic examination of these fibro-sarcomatous nodules showed nothing especial. I will only add now that the enclosed gland-ducts contained a considerable amount of very milk-like colostrum; from which it is seen that the enclosed portion of the gland, though not markedly changed, had not lost their physiological function in pregnancy and labor. I had previously had an opportunity to make a similar observation. B. von Langenbeck amputated the breast of a woman which contained a tolerably large fibro-sarcoma which had become inflamed after labor. Numerous abscesses had formed, the woman sank very low, and the whole gland was removed with the fibroma in order to cut short the pro cess. The acini and excretory ducts in the fibro-sarcomatous tumor were all filled with milk.