It has already been said that in this case the lymphatic vessels deep in the glandular substance were filled with cocci (in consequence of the ery sipelatous infection). The glandular subs;ance which was met with in excessive quantity near the tumor nodules, did not differ at the borders of the lobes from amply developed glandular tissue of a mamma prepar ing for lactation.
The contents of the gland vesicles was partly mixed with colostrum bodies. The acini appeared to be extraordinarily large. In other places there was no connective tissue for wide tracts, and in those places where the epithelial cells were especially large and the gland vesicles entirely filled, the latter were bent and irregularly formed, and one would easily get the impression that he had a piece from a carcinoma of the gland before him. Whether in this case, at the beginning, only the multiple fibroma-nodules existed, and hypertrophy of the portions of the gland not included in them first developed with pregnancy, is hard to say. The case shows that growth of the connective tissue in the gland in the form of nodules, and growth of the epithelial elements, " true and false hypertrophy," (in this case in combination with the preparation for lactation), may develop at the same time.
All authors who have written of diseases of the mammary glands have mentioned double diffuse hypertrophy, though not many appear to have made special observations, and hitherto the anatomical examinations have been very meagre. So far as I can find from obtainable literature, Paget, Birkett, Schuh, Rokitansky, Klob, Beigel, Bardeleben, and Konig have not even seen such cases. The case which Virchow mentions from hid private practice does not appear to me to belong here, since the descrip tion does not at all correspond to the other cases. As more or less cer tainly belonging in this category are the cases described by Cooper, Gross and Hanley, Erichsen, Renaud, IIuston, Benoit and Monteils, Le Double, Fingerhut (?), Adams, Hey, Thomson, Manec (Gaz. des Hop., 1859, p. 45), Hess (Correspondenzblatt des Vereins nassauischer Aertze, 1859, p. 17, 49), C. G. Grabs (Hygeia, Bd. 23, p. 318. Schnzides Jahrb., Bd. 118, 1863, p. 44), Gluck (Amtlicher Bericht caber die 39 Versammtang Deutscher Raturforscher and Aertze in Giessen inz Sept., 1864. Giessen,
1865, p. 219), to which may be added both of the cases observed by me.
The following is to be said of the development and course of this con dition: Diffuse hypertrophy of both breasts is always developed at the time of the first menstruation, or soon thereafter. The age most fre quently noted is from 14 to 16 years; but in a few cases 2 or 3 years elapse after the first menstruation before hypertrophy exists (as in my two cases). The development of hypertrophy is always rapid in two or three months, and then as a rule remains in the condition reached, or it may attain a greater degree with the first pregnancy and then remain un changed; there is no such thing as a continuous and indefinite growth of it. The skin grows proportionately to the development of the gland, and is often somewhat thickened and (edematous. The nipple is not de veloped in proportion to the enlargement of the gland, but retains its usual size and becomes flat. The subcutaneous veins sometimes appear as dilated nets, though without becoming varicose. There is no pain with this condition.
Galactorrhcea is not usually combined with this hypertrophy at the time of the development of puberty; milk is formed in the hypertrophie glands if the affected person becomes pregnant. It is not certainly shown that there is any influence on menstruation and the development of the genitalia. As a rule the menses are regular, or the general constitution is proportionately spare and not well developed. In one case an ovarian cyst developed, from the rupture of which the patient died.
As to the course, it is only shown that from the weight of the breasts, the capacity for work is seriously interfered with, and that the nutrition of the patient affected with such hypertrophy is usually bad; there does not appear to be any further constitutional influence. So far as I know, death is never directly caused by thi condition. Whether the duration of life is influenced thereby is difficult to say; but it is certain that a per son has lived eighteen years after the beginning of the development of hypertrophic breasts, and perhaps there are many who have lived longer.