increased size, and finally the deformity was so great
as to compel her to keep from the public view. The circumference of the
right breast was 94 cm. and of the left 105 cm.; the pedicle of the
former measured 67 cm. and of the latter 69 cm.; only the slightest
vestige of a nipple remained. Removal was advocated, as applications of
iodin had failed; but she would not consent to operation. For eight
years the hypertrophy remained constant, but, despite this fact, she
found a husband. After marriage the breasts diminished, but she was
unable to suckle either of her three children, the breasts becoming
turgid but never lactescent. The hypertrophy diminished to such a
degree that, at the age of thirty-two, when again pregnant, the
circumference of the right breast was only 27 cm. and of the left 33
cm. Even thus reduced the breasts descended almost to the navel. When
the woman was not pregnant they were still less voluminous and seemed
to consist of an immense mass of wrinkled, flaccid skin, traversed by
enormous dilated and varicose blood-vessels, the mammary glands
themselves being almost entirely absent.

Diffuse hypertrophy of the breast is occasionally seen in the male
subject. In one case reported from the Westminster Hospital in London,
a man of sixty, after a violent fall on the chest, suffered enormous
enlargement of the mammae, and afterward atrophy of the testicle and
loss of sexual desire.

The names goiter, struma, and bronchocele are applied indiscriminately
to all tumors of the thyroid gland; there are, however, several
distinct varieties among them that are true adenoma, which, therefore,
deserves a place here. According to Warren, Wolfler gives the following
classification of thyroid tumors: 1. Hypertrophy of the thyroid gland,
which is a comparatively rare disease; 2. Fetal adenoma, which is a
formation of gland tissue from the remains of fetal structures in the
gland; 3. Gelatinous or interacinous adenoma, which consists in an
enlargement of the acini by an accumulation of colloid material, and an
increase in the interacinous tissue by a growth of round cells. It is
this latter form in which cysts are frequently found. The accompanying
illustration pictures an extreme ease of cystic goiter shown by Warren.
A strange feature of tumors of the thyroid is that pressure-atrophy and
flattening of the trachea do not take place in proportion to the size
of the tumor. A small tumor of the middle lobe of the gl