In Huston's case death followed from inflammation and ichorous ulcer ation after contusion (it is said in the report, from acute hectic fever, though it would now be described as septic fever), in one of my cases from erysipelas. In Griih's case the patient died 18 years after the beginning of the disease, which developed in her fifteenth year, from rupture of an ovarian cyst. The formation of abscesses and fistules is noted in Griih's and Hess's cases, and there was also some swelling of the axillary glands.
Only in these last cases were there accurate anatomical examinations made. In the necropsical account of Huston's case it is said, (Am. Jour. of the Med. Sciences, No. XXVIII., August, 1834, p. 3), that no particular diseased condition was found in the breasts, no collection of fluid, no tumor, only an enlargement of all parts of the gland: " The adipose and cellular tissues as well as the whole glandular apparatus, were enormously enlarged, but no appearance of disease or exudation of fluid was percep tible. In short, a healthy structure was found, whose only anomaly was its mammoth proportions." We cannot expect any exact microscopical ex amination as far back as 1834. C. G. Gras writes of the case on which he made an autopsy that the tumors were as hard as scirrhus, and con sisted microscopically of compactly pressed bundles of connective tissue fibres. Hess said that in the breasts extirpated by him no trace of gland ular tissue could be found. What I found, in the second case related, has been mentioned above. It is very probable that in most cases there is a similar condition; it might be concluded from the very frequent men tion that hard nodules are found in these breasts that the combination with fibro-sarcoma is very frequent. How long the hypertrophic tissue ex ists as such, and whether it is finally supplanted by connective tissue and fat, we do not know; but I believe this to be probable.
Many therapeutic measures have been tried in these cases, chiefly com pression and iodide of potassium, but without result. The introduction of a seton (Thomson) is certainly not to be advised; it might result very dangerously, and even in the most favorable cases, the consequence would be a purulent breaking down of the tissue immediately surrounding the seton, and there would be no noteworthy diminution. Mance, Hess, and Gluck have performed amputation of both breasts in such cases with suc cess; the two breasts were always removed at different times. One of these patients afterwards became pregnant, and had a normal labor; neither during pregnancy nor after labor was there any swelling or red ness in the region of the cicatrix. Whether such hypertrophic breasts would retrograde if the women became pregnant and nursed their chil dren for a long time, there are, so far as I know, no observations; in my second case the observation was unfortunately interrupted by the death of the patient from erysipelas.
As concerns the cases which, especially in older literature, are described as colossal hypertrophy of one breast in women of midde ago, there is no doubt from the description that they were large cysto-sarcomata, of which we have already spoken, as this sometimes attains an enormous size. The cases in which marked galactorrhiea is connected with unilateral so-calted hypertrophy, as the case of Lotzbeck, ( Wiener Med. WbcheuAch., 1854). the case from V. von Brun's clinic, and that of Elirenhaus., (Berlin.
Alin. Wochenschr., 1870), probably belong to the category of so-called galactoceles, of which mention has been made.