ETIOLOGY AND STATISTICS OF TUMORS OF THE BREAST.
What we have to say in the following pages on this subject is the result of the most exact observations, which are well calculated to direct the attention here and there, but without discovering the specific causes.
That in organs which, like the mammary glands of women, stand in such close relationship with the genital apparatus, there must be very peculiar arrangements, in order, on the one hand, to be able to attain a rapid functional development, and, on the other hand, to retrograde again, is, a priori, very clear. The mammary glands, like the uterus and ovaries, are first completely developed at the time of puberty, and this is done within a few months, according as these organs have thus far grown in proportion to the other parts of the body. Then there is again a period of inactivity, and it depends upon impregnation (always a con tingency), when the uterus as well as the mammas reach the highest at tainable development with the first pregnancy. The development of these organs thus goes on in a certain measure by starts; there is now increase, eventually new growth of glandular elements, of interstitial tissue and mus cular fibres, of blood and lymphatic vessels, of nerves. The first seem tion of milk is connected with the first pregnancy, and is kept up by different women for very different periods of time according as the child is nursed by the mother for a longer or shorter time, or not nursed at all. But this seldom goes on for much over a year, and then the function ceases, the gland remaining without function until the next pregnancy, and so on.
It is very evident, at first sight, that an organ which undergoes so much change in its peculiar condition of nutrition and in its functional performance, may more easily be altered in these functions and in the anatomical changes peculiar to it, than an organ which continuously and gradually attains its natural and appointed size, and then continues to perform its functions in this way throughout the whole life. It is a priori conceivable that by this rising and falling, not only of the nutritive process, but also of the formative activity of the tissue of the organ, quantitative and qualitative disturbances, aberrations of formation and function, occur. It is again conceivable how any kind of occasional non specific excitation of the perhaps hereditarily vigorous and active forma tive strength may cause abnormal products in the form of tumors in strong women who are hindered by social circumstances from calming their sexual inclinations naturally, or who, for some reason, remain child less in wedlock.
To the explanation of this matter, statistics give a few very certain data. Unfortunately my researches in this direction do not support the above observations very satisfactorily. I might rather show that it is just as astonishing how typically and regularly the physiological functions of the mammary glands occur. Of my exact observations of 282 cases
of tumors of the breast (up to the year.1876) I can cite only two cases of adeno-fibroma whose formation was combined with the puberal develop ment of the mamma. All the other cases were after that period, though in a few cases only two or three years later. Only once have I seen a subacutely arising abscess of the mamma at the time of the development of puberty.
Just as seldom is mastitis in pregnant women (I have seen only seven cases), and still more rare is the formation of tumors during pregnancy. When there are 2 such cases in about 282 cases, there must have been some specially favorable circumstances, since several surgeons and gyne cologists whom I have asked regarding the matter, and whose observations are much more numerous than mine, had seen nothing similar.
These cases have been published in my clinical records, but on account of their rarity, I will briefly report them here: Mrs. L., 31 years old, came to me first in May, 1869. She had had two children, and in November, 1868, felt herself pregnant for the third time. All went normally until in January, 1869, she noticed a strikingly rapid and vigorously growing tumor of the left breast. It was firm and hard, and from time to time a little serum escaped from the nipple; she had uo pains. At first she paid no attention to the matter, until finally the growth of the breast became so striking, and she felt more exhausted and became emaciated; her general condition was not disturbed; there was no sign of disease of internal organs, and still emaciation increased. Finally in May, 1869, she determined to consult several Vienna surgeons. Their opinions differed; some were in favor of amputating the breast, while others were against it. When she came to me, I found the left breast as largo as a large man's head, firm, elastic, the skin over it (ede matous, the mamma freely movable on the thorax, the axillary glands not swollen. In the right breast also indurated nodules could be felt already. The patient was sparely built and emaciated. I advised against an oper ation, because I did not think it probable that she would survive amputa tion of both breasts, and to me the malignant nature of the tumor seemed so indubitable that internal metastases were soon to be expected, if they did not already exist. With me the patient consulted Dr. Carl v. Braun; it seemed to us that it was better that the patient should wait until she was confined; as the tumor had formed during pregnancy, possibly as an aberration of a physiological process, it might be hoped that with the es tablishment of the complete physiological function of the gland it might retrograde.