mucous texture of these tumours; and occasionally, as in case 4th, the ulceration extends more deeply. If the above symptoms exist in combination with severe lancinating pains in the region of the uterus, there will be grounds for believing that a morbid action has begun either in the uterus or polypus, for the removal of which our best directed efforts will prove unavailing. Still, if no very palpable evidence of malignancy can be obtained by examination, we ought not, even under the above doubtful circumstances, to refuse our patients the chance of an operation." 429.

Two cases are given, in one of which the uterus was extensively diseased, and, in the other, considerably thickened at the part whence the polypus arose; but we need not do more than allude to them here. Our author observes, that when the root of a polypus does not drop off soon after the pedicle has been divided by ligature, a secondary tumour is sometimes formed, possessing an irregular oblong shape, growing more rapidly than the previous polypus, and seldom displaying so dense a structure. This secondary tumour may have its surface smooth and polished by the action of the uterus, but it wants that covering of mucous membrane which always invests a true polypus. The paper ends with the relation of a case, where simple polypus grew from an uterus excessively diseased, and with it ends this full but we hope not unprofitable, analysis. The subject of uterine polypi has been clearly discussed by Dr. Macfarlane, and the reader of his paper can scarcely fail to derive instruction from its careful perusal.

VII.

By Sir Astley

ILLUSTRATIONS OF THE DISEASES OF THE BREAST. Cooper, Bart. F. R. S. Sergeant-Surgeon to His Majesty-Consulting Surgeon of Guy's Hospital, &c. &c. In two Parts-Part I. Quarto, pp. 89, with nine beautifully-coloured Plates, containing numerous Figures. Longman and Co. Feb. 1829.

WHEN We recollect that hardly a ten-millionth part of the actual and useful experience of the profession is transmitted to posterity, or passes beyond the individual who first acquired it—when we reflect how very few indeed of those who honestly record what they know, have yet the gift of accurate perception, and the power of legitimate deduction, we may, or at least we should, be grateful to those eminent men in our profession, who, having passed a long period in unlimited practice, employ and amuse the leisure hours of mature age, in faithfully perpetuating the fruits of their observation for the benefit of their successors and of mankind at large. Such a man is Sir Astley Cooper. That the tide of fame and fortune which rolled upon him for a quarter of a century, till he was obliged to fly from it, should call up a moderate quantum of envy, is just as natural, nay, is as physically certain, as that the meridian sun should draw forth a halo of exhalations from a marshy soil. That Sir Astley Cooper is a pattern of infallibility—a genius of universal acquirement--a prodigy of learning-in short, an "admirable Creighton" of the age or of the profession, we are very far from asserting. There have been no such perfect characters of late, even among those who satirize the author of the volume before us. But we look upon Sir Astley VOL. X. No. 20.

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as a man endowed with very good natural capacity-as possessing great zeal in the prosecution of surgical science-unequalled physical powers-assiduous observation-and what are better (in these days) than briliant genius or superlative talent,-HONESTY and VERACITY! The clinical facts and practical precepts of Sir Astley Cooper, will be quoted and acted upon, long after the marble monument erected over his mortal remains shall have been mouldered into dust by the invisible waves of TIME, that "Edax rerum," beneath which all material fabrics must fall.

It is not generally known, but it will ultimately be made patent, that throughout a professional experience, unequalled in any age or country, the author of the volume before us has constantly employed most able artists to make accurate drawings of all important morbid structures which presented themselves to his view, or with the living symptoms of which he became acquainted--and this independently of preserving a great proportion of the said morbid structures in spirits. The consequence is, that Sir Astley Cooper possesses a collection of drawings infinitely surpassing that of any other surgeon in the profession. To make these available and useful to his brethren, through the medium of the press, is at once honourable to the individual, and beneficial to the public. We know not a more enviable occupation, in age, than that of perpetuating, for the good of posterity, the labours of youth. This task our author is now pursuing, while actually in the prime of life, and in the entire possession of every faculty:-in proof of which we shall, at once, proceed to an analytical delineation of the splendid volume before us-as far, at least, as the letter-press is concerned. We regret, indeed, that we cannot convey to our readers an adequate conception of the beauty and fidelity of the plates, which will only enrich the libraries of the more opulent members of the profession. We shall, however, endeavour to diffuse the practical descriptions and precepts of our experienced author over as wide a space as possible, through the instrumentality of the periodical press.

The work is dedicated, in a short but energetic address, to B. Harrison, Esq. Treasurer of Guy's Hospital;-and in the preface Sir A. informs us that he has divided these illustrations of mammary diseases into two parts -the malignant and non-malignant. It is with the latter class that the present volume is occupied Our author thinks it right to observe, however, that although, he has here confined himself to the description of diseases which are not malignant, and which do not arise from a vitiated state of the system, contaminating the parts in their neighbourhood, or even at a distance from their original seat, yet that

"Some of these swellings, when they have existed long in a dormant state, will have alterations produced in them by changes of the constitution, by which their extirpation may be rendered necessary, for malignancy may be lighted up in them by constitutional disease-by anxiety of mind-and by the cessation of the menstrual secretion.”—Preface.

The work is divided into ten chapters, which we shall examine seriatim.

CHAP. I-INTRODUCTORY.

In this chapter our author expatiates on the advantages which may be derived from the examination of morbid structures, and from a comparison of external symptoms with internal appearances.

Although we may not be able to cure some diseases, it is still a great advantage to be able to discriminate the remediable from the irremediable cases the dangerous from the slight-those requiring the knife from those which do not demand so formidable a resource-and such as admit of a trifling operation from those that call for one of extreme severity.

The female breast is liable to almost all the diseases of other structures, besides some peculiar to itself. Yet, the uninformed surgeon is too apt to chime in with the vulgar opinion, and to confound all swellings of the mamma under the general term of Cancer. An examination of the diseased parts, after operations, shews the great variety which prevails in the nature and appearances of these swellings-and proves that, instead of their being all of one family, many genera of tumours actually exist. Some are the effect of acute, some of chronic inflammation-others of a specific action, malignant or harmless. It is therefore the surgeon's duty to discrim inate these differences in the living body-which can only be done by a knowledge of what is revealed in the parts removed by operations, or the bodies of the dead. The following descriptive sketch is in Sir Astley's characteristic style, and is such a faithful copy from nature, that it will be instantly recognized as such, by every surgeon of the least experience.

"I have scarcely witnessed a stronger expression of delight than that which has illuminated the features of a female-perhaps the mother of a large family dependant upon her for protection, education, and support-who, upon consulting a Surgeon for some tumour in her bosom, and expecting to hear from him a confirmation of the sentence she had pronounced upon herself, receives, on the contrary, an assurance that her apprehensions are unfounded. Pale and trembling, she enters the Surgeon's apartment, and baring her bosom, faintly articulates-Sir, I am come to consult you for a Cancer in my breast;-and when, after a careful examination, the Surgeon states, he has the pleasure of assuring her that the disease is not cancerous-that it has not the character of malignancy-that it is not dangerous, and will not require an operation; the sudden transition from apprehension to joy brightens her countenance with the smile of gratitude; and the happiness of the moment can hardly be exceeded, when she returns with delighted affection to the family, from which she had previously considered herself destined soon to be separated by death, with the alternative only of being saved by a dubious and painful operation." 4.

Our talented author divides mammary diseases into three classes-1mo. those resulting from common inflammation, acute or chronic-2ndo. complaints arising from a peculiar or specific action, but not malignant, or tending to contaminate contiguous structures-3tio. those diseases which are not only founded on local, malignant, and specific actions, but which are connected with a peculiar and unhealthy state of the constitution. By a malignant complaint, our author means a local diseased action, which not only affects the parts in which it is originally situated, but contaminates those contiguous. He considers it as resulting from a morbid state of the constitution, and it is frequently accompanied by a similar disease in other, and even remote parts of the body.

"The first of these classes comprehends the acute inflammation of the organ, as the milk abscess: the chronic inflammation, which remains for a length of time in a state of indolent swelling, and often terminates after a lapse of weeks or months in an indolent abscess; and, thirdly, a lacteal tumour, in which a chronic inflammation is followed by an obstruction in one of the lactiferous tubes, and produces a large lacteal or lactiferous swelling.

"In the second class of diseases of the breast we find several species of tumour, and they are as follow:

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:

1st, the Hydatid:-2d, the Chronic Mammary Tumour;-3d, the Ossific;-4th, the Adipose;-5th, Large and pendulous Breast:-6th, the Scrofulous ;-7th, the Irritable Breast;-8th, Ecchymosis of the Breast.

“In the third Class we find the two malignant diseases, which consist of the scirrhous and fungous tubercle." 5.

CHAP. II.-EFFECTS OF COMMON INFLAMMATION IN THE BREAST.

The symptoms and treatment of acute inflammation in this organ do not differ materially from that in other structures, excepting in the severity of suffering which it produces.

"It is adhesive in the first stage, suppurative in the second, and ulcerative in the third. A firm and sensitive swelling of the whole or part of the mammary gland is produced in the first stage; and the dense cellular or fascial membrane with which it is enveloped, and by which all its parts are united, not easily yielding to the inflammatory swelling, often occasions most excessive suffering. The serous and fibrous portions of the blood are poured into, and fill the interstices of the inflamed structure, and the latter thus produces the solid swelling To this enlargement succeeds a blush of inflammation upon the surface of the breast; throbbing, pulsatory, and very acute pain follows it; a particular prominence and smoothness are observed at one part of the tumour, with a sense of fluctuation from the presence of matter. The constitution is also highly irritated, which is evinced by the occurrence of shivering, succeeded by heat, and profuse perspiration. Over the most prominent part of the swelling the cuticle seperates, ulceration follows in the cutis, and the matter becomes discharged through the aperture thus produced." 8.

The foregoing process requires from ten to twenty days for its completion. Sir A considers the principal cause of this phlogosis to be the rush of blood to the breast, or " milk-draught," as it is called, when the infant is first put to the bosom. There are many other operative causes, however, as exposure to cold, the efforts of the child, the obstinacy of the nurse in not putting the child early to the breast,—and the too early introduction of stimulating liquors into the stomach of the mother.

"The best mode of treatment in these cases is to use, in the adhesive stage, a lotion of one ounce of spirit of wine, and five ounces of water, or of liquor plumbi dilutus to the part, and to purge the patient, by giving repeated doses of castor oil, or sulphate of magnesia. But if the patient suffer from the cold produced by the evaporation of the spirit, a simple tepid poultice may be substituted for it, occasionally applying leeches to the swelling, still recollecting that the chief dependence is upon purging." 9.

When matter is forming, poppy-fomentations and poultices must be employed-and anodynes should be given to mitigate pain. As to the question, should mammary abscess be opened or suffered to burst? the following is the reply. If the abscess be quick in its progress, anterior in its site, and unattended with severe sufferings, let it take its course. If the abscess be deep-seated-tedious-attended with great pain and much irritative fever, perspiration and insomnolency-discharge the matter by the lancet-But we should not penetrate with this instrument through a thick covering of the abscess, as such an opening would not succeed in establishing a free discharge.

A quick succession of abscesses sometimes takes place in the breast, and

leads to very protracted sufferings. Here opium aud quinine will be required. Sometimes an abscess is produced at a great depth in the breast, and discharges itself by different apertures, forming sinuses of various ex

tent.

"Now and then a deep-seated abscess forms between the posterior surface of the breast and the ribs, which, when it breaks, leaves a sinus which leads to the ribs. An exfoliation of part of the rib afterwards occurs, occasioning a very protracted suffering; and in these cases, as well as in the former, injecting the diluted acids is the best practice." 11.

These milk- abscesses are not always entirely devoid of danger. Sir. A. once attended a lady of very delicate constitution, and who lay-in while under great anxiety of mind, in consequence of her husband being imprisoned. A milk abscess took place-discharged large quantities of matterand then, instead of healing, the whole breast became excessively swollena true fungoid excrescence appeared-and this disease destroyed her life. If the abscess be small, the child may be put to that breast as well as to the other; but if the mamma be much involved in disease, the infant should be kept to the sound mamma, while the diseased one should be drawn by the nipple-glass.

"These abscesses are sometimes the result of soreness in the nipples, which appears in three forms first, in simple excoriation; secondly, in deep cracks at the junction of the nipple with the areola; and thirdly, in deeper ulceration of the nipple itself, by which a part of it is removed. The suffering from these sores is often sufficiently great to prevent the frequent application of the child to that bosom, which leads to a great accumlation of milk, and to a degree of distention which occasions inflammation. To prevent this, the breast should be drawn ; but the sooner the child can be restored to it, the better. The best application to the sore nipple is a solution of borax in water, in the proportion of a drachin of borax, three ounces and a half of water, and half an ounce of spirit of wine. Some use solutions of alum, some the sulphate of zinc, and some the supernatant liquor of a mixture of the liquor calcis with the submuriate of mercury. Also to prevent the nipples from becoming sore, to which many women are extremely subject, it is right to wash them some time before the lying-in with strong brine, which hardens the cuticle, and renders it less prone to ulceration and inflammation." 13.

CHRONIC ABSCESSES.

The abscesses already described usually pass through their stadia in from three to five weeks; but, under chronic inflammation, an abscess is sometimes produced, which, from the slowness of its progress, and the absence of common inflammatory symptoms, is supposed to be a malignant tumour, and to require an operation.

"In proof of this, a woman was sent to me from Sussex who had a tumour in her breast, which I was requested to remove; and when she was seated before me for that purpose, found, upon examining the swelling with attention, a fluctuation in its centre surrounded by a wall of hardness, with tenderness in the centre upon pressure. I therefore put a lancet into the seat of the fluctuation, to discover the nature of the fluid, and a considerable quantity of purulent matter was discharged through the orifice.

"I was also requested to see an out-patient at Guy's Hospital, who had a swelling in her breast with a fluctuation in its centre, which had existed several months, into which when a lancet was put, a large quantity of matter was discharged. Although there was no discoloration, and the swelling had existed several months, yet I thought it contained