On the nature and development of cystic tumours of the breast / by James F. Goodhart.

  • Goodhart, James Frederic, 1845-1916.
Date:
1872
Catalogue details

Licence: Public Domain Mark

Credit: On the nature and development of cystic tumours of the breast / by James F. Goodhart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    pathology, the reader is referred to a paper in the Medico-Chir- urgical Transactions of 1864, by Dr Wilson Fox, who first showed the true nature of such growths. Dr Braxton Hicks also, towards the close of 1864 (Guy’s Hospital Deports), pointed out the similar- ity which exists between ovary and breast in regard to growth. Dr Hicks, however, describes the papules found in the ovary as all becoming follicular by a softening down in their centres, and com- pares their development with that of adenocele, which, he says, is known to be formed in the same way. Herein, then, I differ from him in saying that, in the majority of cases, the follicles of the latter are not formed inside the papilla, but outside it, by the help of others; inside it the vessels run, and the septa of the growth are formed. If, then, these cystic tumours in the ovary are glandular, as many of them are allowed to be, it is hard to see why the presence of cysts in the breast should preclude the possibility of the presence of gland structure, as MM. Cornil and Ranvier would have us believe. Analogous formations are also met with in the lip, scalp, intestine, and some nasal polypi, as described by Billroth. Except in the latter case, it is also important to note that the tumours are usually solid and not cystic: the bearing of this upon the question of growth will be touched upon again shortly. Now, in all these regions, one constant condition exists in the presence of cavities or tubes of gland structure. What, then, is the relation between tube and cyst, and what that between cyst and growth ? Taking the latter part of the question first, we may refer to the fact, that one of the greatest obstacles to growth is continuous pressure; we may then not unfairly infer the exact con- verse of this, and say that one of the greatest incitements to growth is the existence of space in which to grow. This, indeed, is a physiological axiom, which hardly needs to be stated. Every one has noticed the behaviour of granulations on a free surface, or that of new growth towards natural cavities, such as the bladder or vagina. Surely the unrestrictedness of these is due to their free- dom from surrounding hindrances; and though such instances can only be adduced as evidence of unlimited extension when once the process has commenced, still, what is favourable to a colony as a whole, must be favourable to a majority of the individual units; and therefore it may be argued that cysts, constant as I believe them to be in the earlier stages of these tumours, act as incite- ments to growth. The fact that they always occur about gland tubes suggests how the space which is necessary is obtained. One can hardly imagine any condition more likely to be constantly affording temporary or permanent occlusions of ducts, and there- fore cysts, than the ramifications of tubular glands and their terminal caeca. Mr Birkett^ gives details of one case in which a dilated ' Guy’s Hospital Reports, 1855. Art. “ Adenocele.”