pulse was quite weak, and a hypodermic of strychnine was given. At 8 p. m., ten hours after the operation, the temperature was 105.6°. The child had nursed a little twice. since the operation, but had cried at intervals as if in pain. I here show you photographs of the child taken before the operation, Cut No. 1.

At 8 a. m. the next day, twenty-two hours after the operation, the temperature was 105.2°, respiration very rapid, and the child was very restless. Ice was kept on the head almost continually. A hypodermic of strychnine was again given. At 3 p. m. the temperature had gone down to normal, but rose again in the evening to 100.2°. This irregular temperature line is noticed on the chart, and

will be seen to range between 99.5° and 105.2°, until the fourteenth day after the operation, when it remained nearly normal. The child began to nurse more each day and although it cried occasionally on account of pain, it showed undoubted signs of improvement three days after the operation. About the fifth day after the operation there appeared to be a redness around the scalp sutures. There was some little pus later. Part of this subcutaneous tissue sloughed, but the parts became healthy after a time and healed with some scar formation.

This sudden rise of temperature after the operation can only be accounted for because of the irritation to the heat

Cut No. 2, taken about two months and a half after the operation, shows the result. It shows the scar tissue and line of suture.

At the present time the child seems to be quite well, but it has not entirely overcome the effects of the weighty tumor, as it does not have all the power to control the head that an ordinary child of its age should have. The size of the opening in the cranium has not perceptibly decreased.

HYPERTROPHY AND INFLAMMATION OF THE MALE BREAST

A. R. COLVIN, M. D.

St. Paul

Tumors of the male breast, although less common, occur in as great variety, as in the female, and furnish the same difficulty of diagnosis. I wish to report two cases of mammary enlargement in the male:

The first one in a patient aged 45 enjoying good health and with nothing in his past history bearing upon the condition, first noticed a swelling in the right breast in December, 1899. The only sensation felt in the breast was that of prickling. The breast was uniformly enlarged measuring about two inches in diameter and threefourths of an inch in thickness, was disc-shaped, very hard, and surface even. It could be moved freely over the underlying muscles, but the skin was indefinitely adherent to it. There were no enlarged glands in the axilla. Three weeks later a piece was removed under local anesthesia, and submitted to microscopic examination, and a report of carcinoma returned. A more radical removal was then undertaken. About four months later the patient felt a prickling sensation in the left breast, and enlargement took place in it. Upon examination the condition was found to be very much as in the breast first affected. On the left side, however, there were several enlarged glands in the axilla. One of these was removed for examination, the findings being chronic inflammation. This breast was also removed, and a histological diagnosis of carcinoma made.

A short time after this a physician conversant with the case just reported, showed me his own breasts. They

were at that time in very much the same condition as the one above described, except that they were quite tender. They remained hard and tender for a month or two, then became larger and softer, to eventually decrease in size, and return, as far as naked eye appearance goes, to a normal condition. The doctor's wife was pregnant, and the enlargement subsided coincidently with the birth of the child. He tells me that he is nauseated in the early months of his wife's pregnancy.

The development of the male breast up to the time of puberty is the same as that of the female. At this time the female breast undergoes further development, while that of the male comes to a standstill. Retrogressive changes begin in the male at 30; after this time histological examination in the line of the nipple shows only two or three ducts, supported by a few strands of connective tissue between the ramifications of which is a rich supply of fat. The gland is a very rudimentary affair, indeed, and with the naked eye the gland tissue is barely perceptible.

The atrophied female breast after the menopause still shows acini in lobules and dense fibrous tissue.

The histological findings in the case above reported are as follows:

The increase in size is found to be due to increase of both epithelial and connective-tissue elements, the epithelial parts consisting of ducts lined with multiple layers of cubical cells. In places the epithelial proliferation amounts almost to papillary growths into the lumen, and in these places the cells approach the columnar type. The lumina of the ducts are in places filled with the cellular detritus, seen in so many pathological conditions of the mammary gland. The stroma consists first of a fibrocellular connective tissue and of a loosely meshed, very cellular tissue whose intercellular substance takes the stain poorly. This tissue surrounds the ducts in a circular manner in unusually large amount. It corresponds to the periductal and intralobular tissue which exists