As concerns the rise in the scale up to the fiftieth year, the especial frequency of carcinomas of the mamma is certainly not to be disproved, and it is claimed for the series set up for comparison that they are abso lutely valid as regards the disposition of age to carcinomatous affection. From the fiftieth year onward the mortality of mankind increases so rap idly that from the smaller number of cases observed, we must not con clude that the disposition to the disease in question absolutely decreases. We see fewer women with carcinomas of the breast, and in fact, fewer carcinomatous patients from fifty to seventy years old, because there are in fact fewer people of this age living than there are of thirty to fifty years old. The numbers of the second half of the above series have there fore only a relative importance.
Though my observations regarding fibroma, sarcoma and adenoma are few, still they show some striking proportions as regards the age at which they appear; these proportions may be briefly examined.
Of the prominently fibromatous tumors there originated: 6 in the second decennium, 9 in the third, 4 in the fourth.
12 of these 19 tumors originated between the seventeenth and twenty fifth years. Of the cysto-sarcomas and adenomas there originated: 1 in the second decennium, 4 in the third, 8 in the fourth, 5 in the fifth, 1 in the sixth.
The two bilateral colossal hypertrophies, which I observed, originated in the sixteenth and nineteenth years of life, in the first case in a Virgo intacia, and in the second, menstruation began at the fifteenth year; then the hypertrophy developed, during which the patient became preg nant; she aborted in the fifth month in consequence of erysipelas, and died. In the first case no anatomical examination was made, so that we can only make a probable diagnosis of diffuse adenoma; in the second case there was a colossal fibromatous growth combined with diffuse adenoma. Of all these tumors, not even one originated before the development of puberty. According to these observations the third decennium especially predisposes to fibromas, the fourth to cysto-sarcomas, and the fifth to carcinomas. If one will connect this with the development and function of the gland it may be said: in the second and third decennium, there is an especial tendency to an excessive growth of the fibroid layer, which encloses the short-branched terminal vesicles of the virgin breast. In the
fourth decennium this layer is also very much disposed to exuberant growth, though the degeneration more easily passes over into the soft forms of sarcoma, and is partly connected with simple hyperplasia, partly with cystoid degeneration of the lacteal vesicles and lacteal ducts; through the always more or less striking growth of the epithelium thus taking place, these neoplasms are very nearly related to the carcinomas, which somewhat later come more and more into the foreground, and finally occupy the ground almost alone.
As to the frequency of the occurrence of the different forms of tumors of the mammary glands as regards one another and the cases taken gene rally at a clinic, I can state the following from my own observations.
While I was assistant at the Berlin clinic, I noted within six years 150 tumors of the breast, of which 130 (86 per cent.) were carcinomatous, and 20 (14 per cent.) non-carcinomatous.
In seven and a half years, in Zurich, there occurred 51 tumors of the female mammary gland, of which 49 (96.08 per cent.) were carcinoma tous, and 2 (3.92 per cent.) non-carcinomatous. In nine years in Vienna I saw 239 tumors of this kind, 196 of which (82 per cent.) were carcino matous, 43 (18 per cent.) non-carcinomatous. From this it seems that in Zurich benign tumors of the breast were very rare, the differences for Berlin and Vienna being unimportant. A summing up of these observa tions shows: Of 440 tumors of the breast 375 (82 per cent.) were carcino matous, and 65 (18 per cent.) non-carcinomatous.
As regards the frequency of the occurrence of tumors of the breast in the surgical clinics from which my observations are taken, it is seen that in Berlin 5 per cent., in Zurich 1.2 per cent., and in Vienna 4.4 per cent. of all the female patients had tumors of the breast. From these numbers I can neither conclude that these tumors are especially rare in Zurich, nor that they are especially frequent in Berlin. It should be remem bered that in the Canton's hospital in Zurich, even though not exclu sively, yet few other women than those from Canton Zurich are received, while in the Berlin and Vienna clinics are cases from the most remote regions of Germany and Austria.