While this method is of value in closely-diagnosticated cases, the operator must not be tempted to use it where there is the least doubt of the non-ma lignant character of the disease.
Tuberculosis of the Breast.
There are two characteristic varieties of mammary tuberculosis: the dissemi nated nodular form and the confluent. The nodular variety is characterized by the development of single or multiple hard nodules, only slightly painful and at first non-adherent to the skin. The process is exceedingly chronic, and only after the lapse of several years do the nodules break down and form suppurat ing fistulas. The confluent variety is characterized by a more acute onset, greater pain, and rapid enlargement of the breast. It is more common than the nodular variety. Retraction of the nipple has been reported in two cases. If the disease extends to the axillary glands, it pursues a much more rapid course than in the mammarygland. Oc casionally the tuberculous process leads to the formation of a cold abscess, but this is rare, and never occurs before puberty. In many cases it is impossible to establish a diagnosis of tuberculosis; but, when the disease is far advanced or there are foci of the same trouble in other organs, the diagnosis is compara tively easy. (A. E. Halsted and E. H. le Count [Annals of Surg., Dec., '98].) —The symptoms of tuber cular mastitis are pain and tumor. The tumor may consist of one or more nod ules, firm, hard, and freely movable with the gland. The skin may be freely mov able over the growth, but frequently is attached. The nipple may or may not
be retracted, and occasionally the entire breast becomes involved in one large, nodular, unyielding, brawny mass. The diagnosis is usually difficult, and is most important when the differentiation be tween tuberculosis and carcinoma is im perative. Under certain conditions it is impossible to distinguish them clinically. The infallible means of differentiation are the microscope and bacteriological culture. The axillary lymphatics are enlarged in three-fourths of all second ary cases; in other instances axillary in volvement may be apparently absent; occasionally cervical glands are also in fected. (C. C. 'Warren [Med. Rec., Oct. 1, '98].) —Of the cases of tubercu losis of the mammary gland, 39 per per cent. occur in females. The disease is most common between the ages of twenty and thirty-five. Mammary tuber culosis may be primary, depending on infection through the milk-ducts or fis sured nipples; or secondary, the disease extending from contagious foci in the chest (C. C. Warren). According to Iteerink (Belt. zur klin. Chir., B. 13, 1, '95), extension from surrounding structures is the commoner method.
—The treatment of pri mary mammary tuberculosis, as recom mended by A. E. Halsted and E. 11. le Count (inc. cit.), consists in complete re moval of the breast and axillary glands. In the rare cases of cold abscessscs these I may be aspirated and iodoform emulsion injected.