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mations have already been mentioned； these are among the largest tumors。 Scrotal tumors are recorded that weighed over 200 pounds； and a limb affected with elephantiasis may attain an astonishing size。 Delamater is accredited with a report of a tumor that weighed 275 pounds； the patient only weighing 100 pounds at death。 Benign tumors will be considered first。
Pure adenoma of the breast is a rare growth。 Gross was able to collect but 18 examples； but closely allied to this condition is what is known as diffuse hypertrophy of the breast。 In some parts of the world； particularly in India and Africa； long； dependent breasts are signs of beauty。 On the other hand we learn from Juvenal and Martial that； like ourselves； the Greeks detested pendant and bulky breasts； the signs of beauty being elevation； smallness； and regularity of contour。 In the Grecian images of Venus the breasts are never pictured as engorged or enlarged。 The celebrated traveler Chardin says that the Circassian and Georgian women have the most beautiful breasts in the world； in fact the Georgians are so jealous of the regular contour and wide interval of separation of their breasts that they refuse to nourish their children in the natural manner。
The amount of hypertrophy which is sometimes seen in the mammae is extraordinary。 Borellus remarks that he knew of a woman of ordinary size； each of whose mammae weighed about 30 pounds； and she supported them in bags hung about her neck。 Durston reports a case of sudden onset of hypertrophy of the breast causing death。 At the postmortem it was found that the left breast weighed 64 pounds and the right 40 pounds。 Boyer successfully removed two breasts at an interval of twenty…six days between the two operations。 The mass excised was one…third of the total body…weight。
Schaeffer speaks of hypertrophied mammae in a girl of fourteen； the right breast weighing 3900 grams （136 1/2 oz。） and the right 3500 grams （122 1/2 oz。）。 Hamilton reports a case of hypertrophied glands in a woman of thirty…two； which； within the short space of a year； reached the combined weight of 52 pounds。 They were successfully excised。 Velpeau； Billroth； and Labarracque have reported instances of the removal of enormously hypertrophied mammae。 In 1886 Speth of Munich described a hypertrophy of the right breast which increased after every pregnancy。 At the age of twenty…six the woman had been five times pregnant in the space of a little over five years； and at this time the right breast hung down to the anterior superior spine of the ilium。 It weighed 20 pounds； and its greatest circumference was 25 inches。 There was no milk in this breast； although the left was in perfect lactation。 This case was one of pure hypertrophy and not an example of fibro…adenoma； as illustrated by Billroth。 Warren figures a case of diffused hypertrophy of the breast which was operated on by Porter。 The right breast in its largest circumference measured 38 inches and from the chest…wall to the nipple was 17 inches long； the circumference at the base being 23 inches； the largest circumference of the left breast was 28 inches； its length from the chest…wall to the nipple was 14 inches； and its circumference at the base 23 inches。 The skin was edematous and thickened。 Throughout both breasts were to be felt hardened movable masses； the size of oranges。 Microscopic examination showed the growth to be a diffused intracanalicular fibroma。 A peculiar case was presented before the Faculty at Montpellier。 The patient was a young girl of fifteen and a half years。 After a cold bath； just as the menses were appearing； it was found that the breasts were rapidly increasing in size； she was subsequently obliged to leave service on account of their 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 gland； not larger that a hen's egg； will do more damage to the trachea than will a large tumor； such as that shown by Senn； after Bruns。 When a tumor has attained this size； pressure…symptoms are often relieved by the weight of the tumor making traction away from the trachea。 Goiter is endemic in some countries； particularly in Switzerland and Austria； and appears particularly at the age of childhood or of puberty。 Some communities in this country using water containing an excess of calcium salt show distinct evidences of endemic goiter。 Extirpation of the thyroid gland has in recent years been successfully practiced。 Warren has extirpated one lobe of the thyroid after preliminary ligation of the common carotid on the same side。 Green practiced rapid removal of the tumor and ligated the bleeding vessels later。 Rose tied each vessel before cutting； proceeding slowly。 Senn remarks that in 1878 he witnessed one of Rose's operations which lasted for four hours。 Although the operatic technic of removal of the thyroid gland for tumor