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Les diagrammes suivants lllustrent la mdthode. 1 2 3 4 5 6 *fc/. ^ ,a|!|s;jii®SS**^W«S®*«*^^ €■ KO A CASE OF DIFFUSE HYPERTROPHY OF THE BREASTS. BY JAMES BELL, M.D., Professor of Clinical Surgery, McGiil University ; Surgeon to the Royal Victoria Hospital, Montreal. ReimnUd from the Montreal Mtdical Journal, October, 1899. li: h i I'" '" v g i f s ^ ' * '*' " ' "' ' '" ' ^ iJ'"w- 'i' -mn) '» . ' i iji ' ,. "^ •^.JB "'m r V' l .^ AlWffJillli ! , J.IWIMI*^ JJiVW*"^"* 1, '■ .; » .. ■-■ i ':■.'. .<,,Qv'' :"^' ::r»-^' A CASE OF DIFFUSE HYPEftTituPllY OF THE BUKASTS * BY James Bell, M.D , Professor of Clinical Surgery, McGill University ; Surgeon to the Royal Victoria Hospital, Montreal. This patient, a healthy, well-developed and well-nourished French- Canadian girl, seventeen years of age, from a country district, was admitted to the Eoyal Victoria Hospital, on the 3rd of August, 181)9, with enormous hypertrophy of both breasts, as shown in the accompany- ing photographs. She was of a healthy family, with no known patho- logical heredity. She began to menstruate at the age of fifteen, but that function liad always been somewhat irregular both in the duration of the period and the length of the interval, though otherwise normal. Her colour was good, and nothing abnormal was found about any of the organs with the exception of a slight trace of albumin in the urine. The breasts were very large, painless, and moderately pendulous. On palpation, the sensation communicated to the hand was that of a partially filled sac of fluid containing freely moveable, hard, fleshy masses. Just below the nipple of the left breast, was a patch of ulceration as large as a half-dollar coin, the result of pressure gangrene. Large vems ramified over the surfaces of both breasts. She had first noticed in November, 1898, that the breaf ts were large, but it was only in March, 1899, that the enlargement became very marked. From that time they had increased in size very rapidly, but without pain. The ulceration had begun two weeks before admission. The left breast was removed on August 7th, and weighed 6^ pounds. The right was removed on August 26th, and weighed 5 pounds and 13 ounces. The skin over the surface of each breast was greatly thinned ,f and the subcutaneous cellular tissue much condensed, so that it was dis- , sected ofiE with difficulty. The underlying connective tissue was also much condensed. On section, there appeared to be a general hypertrophy of both glandular and fibrous tissues, and all the tissues were very firm. Professor Adami kindly examined sections from the left breast, and the following are extracts from his report : — " It is not pure hypertrophy of the gland tissue, though that must be present, but is cssenijally, I take it, an orderly hyperplasia of the fibrous tissue, — granuloma of tbe same. The abundant connective tissue between the alveoli is too pexfcctly formed to allow the condition to be spoken of * Read by title at the Meeting of the Canadian Medical Association, Toronto September Ist, 1809. ■gil WHulW i mU ! ! .miUU lUfl'l diMriMB4*M>Mk^«»w(Ma»M> '<»■*• '•ffffj^mofm!'. p f; P as fibromatous. If I may use the term, there is here a ' cheloid ' oveir- growth of the conuective tissue." This condition, though somewhat rare, is well known, and is described in most surgical works and monographs upon the diseases of the female breast. I quote the following sentence from Dennis (System of Sur- gery, Vol. IV., page 895) : — " The disease has been known according to Selbet since the time of Galen, and has been described by Velpeau, Billroth, and others." It generally occurs in young girls, and is symme- trical, and though no definite cause can be assigned for it, it is thought to be in some way associated with the function of the genital organs, and is therefore often attributed to masturbation, etc. As for treatment, nothing can be done to arrest the hypertrophy once it has begun and removal of the breasts soon become^ necessary on account of their great size, , ',,,■, ';X^,.. I ;;;^V:V;^i^!S &^ ! afeaa a ! aisia3a ' ;aaffl«SM^^ — -— - — ' j>aittami:stt ! »n«i-' iniinii I ■iiilililfilitWitf' ''tlTf "•'" ^^f»l^^5P"?W" ««^- T" id* ovea:- described le female 1 of Sur- [)rding to Velpeau, s symme- ) thought gans, and reatment, egun and leir great «#"^. l M»»i i iiii < *i* i « ' f iniw*-r i ffl i v^i i tii^ i i^^ '- -T^ ^^^-fSi^amt FV \\ : : ». mm ^.A^.i^'i..tm-»m -1 "