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no pain whatever in either mamma, but she does not appear so lively as girls of her age, but indeed, on the contrary, is heavy and dull. In other respects, there is nothing peculiar in this young lady's case.

"I am, SIR, your obedient servant,
"W. D. JONES.

"The local treatment of this case consists in the application of a suspensory bandage from the back of the neck, under each breast, to produce artificial support; and the principle which is to be observed in the constitutional treatment of this malady, is to increase and to support the menstrual secretion; and for this purpose the exhibition of different forms of Steel united with Aloes, will be found the most efficacious medicine.

"The Ferrum Ammoniatum-the Mistura Ferri Composita-the Carbonate of Iron, will be the forms of Steel which, united with Aloes, will be most beneficial; and if the biliary secretions be any way defective, the Pil. Hyd. Sub. Comp., or the Hyd. cum Creta, will be the best medicines." 71.

Women who have led a life of celibacy to the age of 30 or 35 years, whose menstrual secretion has become very defective, and who are subject to severe fluor albus, are liable to have their breasts enlarged, not pendulous, each lobe of the gland being distinctly felt, moving freely, one on the other. Both breasts are affected; but one generally more than the other, accompanied with occasional pain, especially at the menstrual period, the catamenia being slight, pale, and of short duration. The breast, after being sometime enlarged, begins to waste; and, in a few years, it is in a great degree absorbed. The treatment consists in restoring, if possible, the menstrual secretion by the means already alluded to, and by the use of the warm hip-bathby the local application of leeches where there is pain, and by the emplastrum ammon. cum hydrarg.

CHAP. VIII-SCROFULOUS SWELLING OF THE BREAST.

In young women who have enlargement of the cervical glands, scrofulous tumours sometimes, though rarely, form in the breasts unattended by pain-are distinctly circumscribed-very smooth on the surface-and scarcely tender on pressure. They are indolent, varying with the state of the constitution, diminishing as it improves, and increasing as it degenerates. They can only be discriminated from the simple chronic inflammation of the breast by the absence of tenderness, and by the existence of other diseases of a similar kind in the absorbent glands of other parts of the body. They are unattended with danger, never degenerating into malignancy. They require no operation- though our author has seen amputation performed from ignorance of the true nature of the disease.

The treatment in this case consists in improving the constitution by a warm and dry atmosphere-by an equally regulated temperature-by tepid sea-bathing-by gentle and regular exercise-by animal food of the most digestible kind-by milk-and by a farinaceous dieta diet which shall nourish without exciting feverish heat, or calling much upon the powers of digestion.

"The best medicines are Carbonate of Iron and Rhubarb; the Hyd. cum Creta with Rhubarb; a grain of blue Pill, and two or three grains of Quinine; Infusion of Calumba with Rhubarb and Soda; for I conclude it will be admitted by every one who deserves the title of a Surgeon, that we possess no specific remedy for this disease, but we are required to assist the digestive powers, make better blood, and convey it to the system by an increased vigour of the constitution.

"Local treatment avails but little: a stimulating plaister or a lotion to the tumour, when the health is improved, may excite the absorbents to remove it." 75.

CHAP. IX.-IRRITABLE TUMOUR OF THE BREAST.

The mamma is liable to become irritable without any perceptible swelling, as well as to form an irritable tumour, composed of a structure unlike that of the gland itself, and apparently of a specific growth. In the great majority of instances it occurs between the age of 16 and 30 years; and never, as far as our author has observed, before the age of puberty.

"When the complaint affects the glandular structure of the breast, there is scarcely any perceptible swelling, but one or more of its lobes becomes exquisitely tender to the touch; and if it be handled, the pain sometimes continues for several hours. The uneasy sensa tion is not confined to the breast alone, but it extends to the shoulder and axilla, to the inner side of the elbow, and to the fingers; it also affects that side of the body even to the hip; the patients cannot sleep on that side, and the pain is sometimes so severe as to prevent even their resting on the diseased side; and the weight of the breast in bed in some instances occasions intolerable pain.

"Patients also state that heat and cold frequently succeed each other in the breast; and it would seem the pain resembles that in the Tic-douloureux, darting like electricity through the part, and through the neighbouring nerves. When the pain is most severe, the stomach sympathizes, and vomiting is produced. The suffering is very much increased prior to menstruation; is somewhat relieved during the period, and decreased after its cessation. There is no external mark of inflammation, as the skin remains undiscoloured.

"In some cases only a small portion of one breast is affected; in others the whole, and not unfrequently both of the breasts.

"This painful state remains for months, and even for years, with little intermission; but it has no malignant tendency: and an operation, where there is no distinct tumour, must be entirely out of contemplation.

"Besides this irritable and painful state of a whole, or part of the breast, a tumour sometimes is found distinctly circumscribed-highly sensitive to the touch-acutely painful at intervals, more especially prior to menstruation-very moveable-often not larger than a pea, seldom exceeding the size of a marble: generally one only exists, but in other cases there are several similar swellings." 78.

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Although they continue for years, they vary but little in size. Sir A. has never seen them suppurate-they sometimes disappear spontaneously. Upon dissection they are found to consist of a solid and semi-transparent substance, with fibres interwoven in it, but without any regular distribution. He has not been able to trace any filament of nerve into them. They seem to be productions of the cellular membrane of the part rather than of the glandular structure. The diagnosis is not difficult. The pain-the tenderness to the slightest touch-the suffering which succeeds examination; these distinguish it from the hydatid, the chronic mammary tumour, and the scirrhous and fungous tubercle. The disease is met with in persons of an irritable and nervous temperament, in whom there is excessive irritability of the system, accompanied with diminished power. The menstrual secretion is generally very deficient-in a few cases morbidly copious-very rarely perfectly regular. The fluor albus is a frequent concomitant of this complaint. The patient generally traces the disease to some blow, or injury from pressure on the part. The treatment consists in lessening the irritability of the system-in lulling the local suffering-and in restoring the defective or diminished menstruation The best local remedy is the application of a plaister composed of equal parts of soap cerate and extract of belladonna; or a poultice with solution of belladonna and bread. Oil-silk worn on the breast, or a hare-skin, or some other fur, by exciting perspiration, aids in soothing VOL. X. No. 20.

53

and tranquillizing the part. Leeches may be applied when the pain is excessive, but if too frequently used, they induce debility, and increase irritability. As constitutional remedies, calomel, opium, and conium should be given for a time, with an occasional aperient, and then the following is recommended by our author.

R Extr. Conii.

Pap. äa. gr. ij.

Stramonii. (e Semin.) gr. ss.

Misce fiat pilula bis terve in die sumenda.

The half grain of stramonium is sometimes too strong, and may be diminished. To restore the uterine secretion, Sir A recommends the carbonas ferri, the ferrum ammoniatum, or the mistura ferri composita, combined with aloes. The hip-bath at 100 or 105° is beneficial. No operation is necessary.

CHAP. X.-ECCHYMOSIS OF THE BREAST.

Allied to the irritable breast is a bruised appearance in this organ, occurring at each menstrual period, and accompanied with exquisite sensibility, pain, and tenderness.

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arm.

"The symptoms of this complaint are as follow:-It occurs in girls who are in most instances under twenty-two years of age. It is preceded by severe pain in the breast and The extravasation of blood begins a few days before menstruation, and it appears principally in a large spot, as if a severe blow had been inflicted. Smaller and less vivid spots may also be observed in other parts of the breast: it is sometimes a concomitant of an unusually large bosom. The part is exquisitely tender to the touch, and the pain with which it is accompanied, passes down along the inner side of the arm to the ends of the fingers. It disappears a week after menstruation, in some cases; but in others, when it is more severe, it continues until the next time the patient is unwell. It looks like the ecchymosis which often succeeds the application of leeches; or like the extravasation of blood under the skin, which occurs in the arm after bleeding, when the opening in the skin has been smaller than that in the vein.

"It is a curious occurrence, strikingly shewing the strong sympathy which subsists between the uterus and breast: for it is evidently the effect of the great determination of blood to the bosom just prior to the period of menstruation; and it indicates excessive irritability of the constitution, as well as the great delicacy and debility of the blood-vessels, which are unable to support this sudden determination which such sympathy produces.

"This complaint is entirely anattended with danger; but being accompanied with diminished, irregular, and sometimes profuse uterine secretion, and by considerable debility and irritability of the constitution, two objects must be kept in view in its treatment:-the one is, by different forms of Steel medicines, to increase the quantity, and render regular the menstrual discharge; and the other, to augment the strength of the system, by the Infusion of Roses with Sulphate of Quinine.

"As to local treatment, the best application is the Liquor Ammonia Acetatis, with Spirits of Wine, in the proportion of five ounces of the former, and one of the latter."

Several cases are detailed in illustration, but these we need not dwell on. We have now exhibited a very full analysis of the letter-press of this valuable volume, but the plates constitute, of course, the most important portion of the work, and are admirably executed. Every surgeon of respectability in the profession will place these plates in his library, for constant

reference, when the subject of mammary diseases is under his consideration. In respect to the description, pathology, and didactic precepts contained in the letter-press, we hope we have done some service to the great mass of the profession by wide circulation of them in every direction. We shall look with great interest to the second part of the work, embracing cancer and other malignant diseases of the human mamma.

VIII.

TRANSACTIONS OF THE MEDICAL AND PHYSICAL SOCIETY OF CALCUTTA. Vols. II. and III. Calcutta. 1826-1827.

The gregarious propensities of mankind, the thirst for knowledge, and those social ties which are drawn tighter by distance from the solum natale," have operated so strongly upon the minds of our professional brethren beyond the Ganges and Euphrates, that a medical society has not only been formed there, but volumes of transactions are elaborated with a fecundity and rapidity which form a singular contrast with the sterile and slow gestations (if we may use the expression) of certain ancient societies in the mother-country! We have not taken so much notice of these volumes, perhaps, as they deserved-chiefly, however, because a considerable proportion of their contents are of only local interest, which local interest will be sufficiently promoted by the Oriental circulation of the volumes themselves. It is our intention, nevertheless, to make our European and transatlantic readers acquainted with all those articles in the said volumes, which bear on the general scope of our science, and therefore shall proceed at once to work.

ART. I.—ON DIARRHEA HECTICA. By Mr. J. TYTLER.

If pulmonary consumption carries off a great proportion of the European population, it would appear from Mr. Tytler, that a disease hitherto but little noticed, and never regularly described, commits equal ravages among the native inhabitants of India. Mr. Tytler has given it the name of “ DIARRHEA HECTICA," because, like its synonymous fever," it seems to obtain habitual possession of the constitution, to operate upon it with scarcely any perceptible intermission, and, in general, to defy the most powerful remedies."

"It is, perhaps, not an exaggeration to say, that of the total deaths among the lower orders of the natives of Hindostan, three fourths are the effect of this disease, either idiopathic or as a terminating symptom. It is the scourge of crowded jails, and of hospitals

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filled with harassed and fatigued Sipahees, and is the great avenue through which the swarms of naked and famished paupers and miserable infants that occupy the native bazars are continually vanishing." 1.

This disease is most common about the middle and end of the rainy season, and in the intensity of the cold weather. In the rainy season the transitions of temperature are very abrupt, and the effects of climate, Mr. T. observes, are greatly assisted by the quantities of raw and indigestible vegetables which the natives eat and give to their children. Another effect of

this error in diet is the production of incredible quantities of round worms in the bowels--forty or fifty of which are sometimes voided at once-and occasionally two or three creep into the stomach and are discharged by vomiting. Mesenteric disease is also common. The common history of Diarrhoea Hectica is as follows:

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A native, previously in apparent good health, is observed to appear languid, and unable to perform his usual labour When questioned, he allows that he feels weak, but denies having any disease. On examination, his pulse is found feeble, and a little accelerated; and at last he will state himself to have two watery stools in the course of the day, and two or three in the night. Shortly after this, his body begins to appear emaciated; calves of his legs, particularly, fall away. The flesh, more especially about the wrists, has a peculiarly flabby and inelastic feel, as if the muscles had lost their tone, and the skin, like a loose bag, were too large to contain their diminished bulk the cuticle peels off in patches, chiefly about the abdomen, fore-arms, and lower parts of the legs, so as to give the skin a faint mottled appearance. Collections of black sordes appear scattered up and down the body, which, with a little care, may be washed off, leaving the skin beneath of its usual colour, so as to induce a belief that they are the consequences of the neglect of cleanliness, produced by the languor always accompanying the malady. Nothing particular is observ able in the perspiration, except perhaps its being more scanty than usual. In the course of the disease, the pulse generally becomes more natural; though low and weak, it is slow and regular. The tongue also is quite clean, rather more so, indeed, than usual, and gener ally continues so all through the complaint; but the appetite begins to be impaired, the patient leaves half his common quantity of food uneaten, and complains that what he eats will not digest He now confesses that pet chely' he has a looseness; that he has three or four stools in the course of the day, and as many in the night; on examining these, they are found to consist of a semi-liquid matter of two seemingly heterogeneous ingredients, one a pulpy mass approaching to a grey colour, the other of bright yellow, intermixed with the former in streaks. To these are added occasionally, but not always, small quantities of blood. The stools are very copious, and have a peculiar odour, quite different from that of natural fæces, and indeed so distinctly their own, that I could almost engage to tell from the smell of an apartment, whether it contained a patient labouring under Diarrhoea Hectica. In this state matters go on for days and weeks, even sometimes for months; emaciation increasing, the appetite and strength diminishing, and the stools becoming more numerous, especially during the cold of the night. Then the feet, the hands, and at last the face, begin to become adematous; the abdomen sinks; the eye loses its healthy lustre, the red vessels disappear from the conjunctiva, and it assumes that pearly whiteness so well known in phthisis, and long protracted disease of the liver. It is also frequently dimmed by a sordid exudation from the eyelids. Then the appetite totally disappears, scarcely any food is taken at all; and the patient, before too weak to walk, is now unable to sit up: he passes the greatest part of his time in a state of dozing, during which his eyes are always half open, probably from weakness of the sphincters; the cornes is hid beneath the upper eyelid, and the white conjunctiva only appears. From this state of imperfect slumber, the patient, as long as his strength lasts, is perpetually roused to evacnate the contents of his irritable and restless bowels, which become more and more copious

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