THE ANIMAL PARASITES OF THE MAMMARY GLANDS.
Accepting every possible case as belonging really to the echinococci, there are perhaps not more than 20 known in literature. I have mostly practised in regions in which echinococci were indeed of the greatest rarity, and I have never seen such a worm in the breast. But even in Iceland, where echinococci are so frequent, physi cians assert that their occurrence in the breast is of the greatest rarity. I take the following from the excellent work of Haussman. The statistics hitherto compiled from the literature on the subject are not to be re garded as of great value. It is understood that rare cases are much oftener published than commoner ones. So when Bergmann reckons, that out of 102 cases of echinococci on the whole surface of the body, 15 were in the mammary glands, these numbers do not give us much infor mation as to the true frequency of its occurrence. Boecker's' statistics are based on more correct grounds. Of 4:70 persons treated in the Berlin Charite in 10 years, 33 were affected with echinococci; 14 of these were women, and in not one of these was the echinococcus in the mamma. According to Leuckart the echinococcus of man comes from the taania echinococcus of the dog. The development in the mamma proceeds very slowly; according to Leuckart's researches, an echinococcus requires about 5 months to form a vesicle as large as a walnut. Of course the growth of the parasite will encounter more or less resistance according to the laxity or firmness of the mammary tissue. Blows and other irritations would tend to accelerate the growth. Where exact anamnestic data are obtained they show. that the process is very different under these circumstances. In a case operated upon by Birkett, the breast containing the hydatid was doubly as large as the other, and the enlargement was discovered 8 months previously. In a case seen by Cooper the hydatid was as large as a filbert,
and had existed 11 months. In Le Dentu's case, the tumor, the existence of which had been known for 2 years, was as large as an egg, and in Henry's case it had attained in 3 years the size of a walnut. In one case the echinococcus had a diameter of 3 to 4" after 6 to 11 years growth. Ac. cording to Bergmann, the echinococci thus far observed in the breast have never exceeded the size of a hen's egg or the fist.
Hitherto only one mother vesicle has been formed in the mamma, and this in daughter vesicles developed in only a few cases; most of them were sterile. We often search in vain in the fluid for hooklets. Suppuration around the vesicle, especially after traumatism, has been several times ob served, giving the appearance of a cold abscess; in a few cases also the lymphatic glands of the axilla are swollen.
Echinococci give rise to the same symptoms as cysts; they cause no pain, and scarcely a temporary feeling of tension. Hydatid fremitus is never observed in them, probably because it was not particularly sought for. It is probably more of an accident, when the diagnosis of echino coccus is made before puncture. It is known to be characteristic of the transparent watery fluid, that it is free from albumin; only when the echinococcus dies is albumin sometimes transuded into the sac, or when the pus formed around the sac becomes mixed with the fluid in the vesicle.
When the diagnosis has been established by puncture, the worm may be killed by the injection of iodine, and the cyst then shrinks to a certain extent. But it is a far simpler and shorter operation to incise the con nective tissue sac, allow the echinococcus vesicle to escape, drain the sac, compress it and thus cause adhesion.