successful, as I have found it to be on numerous other occasions since that time.

During the process of cure of sore nipples, very great comfort is obtained by causing the child to suck through an artificial nipple, made by covering a proper shield of pewter with the prepared teat of a heifer. Such artificial nipples are prepared in great perfection. and sold by the apothecaries in this city. They prevent the direct contact of the child's gums and tongue with the diseased organ, and thus allow the parts to heal with great celerity in some instances. It sometimes happens that the child refuses such a nipple; but in the great majority of cases the infant takes it well, and the pain and inflammation soon afterwards disappear. There is also a variety of shields or caps for covering the nipples, in order to prevent them from being pressed or rubbed by the dress of the patient.

When the breasts are filled with milk, their lactiferous tubes are liable to over-distension to such a degree as to excite in them an inflammatory action. They are also, in this state, liable to injury from the pressure of a tight dress, or from the use of a dress so loose as to allow the heavy organ to be suspended by its own tissues, a thing painful and irritating to the last degree; or the breast is exceedingly liable to be injured by the mother lying upon it in her sleep, or by the child bruising it by bumping its head against it. Lastly, as I have already said, the irritation of a sore on the end of the nipple is readily propagated along the course of the milk-tubes into the substance of the breast, so as to produce there a more or less violent inflammation. Cold and damp air, to which the woman sometimes imprudently exposes the organ while in the act of suckling the child, especially if while in a state of perspiration, is a pretty frequent cause of the difficulty; and, indeed, there are to be met not a few females who possess what may with great propriety be called an irritable breast, and to such a degree that the slightest exciting cause, as cold, pressure, distension, or the like, establishes the inflammatory action at once. Some people are so plagued with frequent attacks of milk-fever or weed, that they are compelled to wean the child, in order to get rid of the milk and the irritability which it brings along with it. I know & lady who has had the breast so irritable that, whatever cause happened to excite a too active movement of the blood in the vessels would seem sufficient to establish so great an affluxion to the breast as to inflame it to her great distress, trouble, and disappointment.

The Student ought to be made to understand that, after entering upon the practice of physic, he will very often be called on to give his opinion for nursing women, whom he will find complaining of

headache, pain in the back and limbs, with a very frequent, full, and hard pulse; these symptoms having been ushered in with a chilly fit of one or two hours' duration. He will rarely fail, under such circumstances, to make at once a correct diagnosis, if he asks the question, whether there is pain in one of the mammary glands; and if answered in the negative, let him not give up the inquiry, but let the gland be pressed betwixt the thumb and fingers. If there is any soreness there, it will in this way be readily detected. A small lump is very likely to be found, as big as a nutmeg or larger, which alone is sufficient cause and explanation of so much constitutional disturbance. The inflammation and obstruction of a single galactophorous tube are sufficient to produce chill, fever, cephalalgia, and pains in the limbs, like those of break-bone fever.

Whenever this milk-fever, or fever arising from an irritated state of a part of the mammary gland, is very great, the patient ought to be bled. Eight or twelve ounces will mostly be enough for one operation; a smart purgative should be afterwards given; the patient directed to put a poultice of milk and bread upon the painful part of the breast, and to keep her bed. It would be most unfortunate for her to refrain from suckling the child, which ought to go to the breast whenever it is found to fill up with its milk.

In the course of a few hours after the bleeding and the operation of the cathartic, fifty or sixty leeches should be applied near the painful part, unless the local disorder should by that time be greatly reduced in intensity.

These leechings are highly useful, and ought to be repeated daily in those cases which seem not to require or admit of the employment of the lancet, but which at the same time demand the local abstraction of blood. In one patient here, I had a large number of leeches applied to the breast; they were useful, but did not cure the pain and obstruction. The leeching was repeated seven times before the inflammation gave way. In a subsequent confinement, they were applied nine times before they succeeded in relieving the distended, hardened, and painful tissue of the breast.

It may be said, the mammary gland is suspended upon the skin in front of the thorax: whenever it becomes heavy from engorgement or from obstruction of its milk-tubes, it tends to fall downwards from its weight, and in doing so the natural relations of mutual tension of its integral parts are disturbed, I might say destroyed. To explain myself fully, I will say that the gland is dragged, pulled by its weight, and that the nerves and blood vessels of supply are put uneasily and even

pathogenically to the strain, just as happens to the testis in a hernia humoralis.

As I think no surgeon would, at the present day, treat a hernia humoralis without the aid of a suspensory bandage, so I am equally sure no thoughtful practitioner would undertake to treat a violent case of mammary inflammation or mammary abscess without providing some proper means of suspending the organ, or preventing its fall downwards. A fasciola or strophium of some sort should be resorted to in every such case; and I advise the Student to make use of a fasciola or strophium consisting of a strip of patent adhesive plaster, sixteen or eighteen inches long, and little more than an inch in width. Let one end of this adhesive strip be carried far back and high up under the axilla, and fixed to the skin there; then let the breast be raised up by the hand to its normal position, and while so supported, let the plaster strip be brought round underneath the hemisphere, and carried upwards until the end applies itself as high as the opposite clavicle. One such strip will be in many cases found sufficient to cure even a violent inflammation of the mammary gland, just as a considerable orchitis is often cured by a suspensory bandage alone.

I exhort the Student of Medicine to make himself well acquainted with the uses of the breast, the nature and sources of its circulation; its innervation and absorption, as well as its secreting office, to fully prepare himself to combat the ills that menace those who confide to his skill and conscientiousness the preservation of their health in the lying-in room. It is difficult to conceive the amount of poignant distress, depression of spirits, and actual illness attendant upon some of those cases of mammary abscess which, from beginning to end, occupy months, besides ruining the gland, to the great detriment of the pa tient in future confinements. A mammary abscess, which is a very serious matter, demanding a conscientious regard to the fulfilment of all the duties incumbent on the practitioner in the case, is often treated with neglect and indifference.

Lying-in women being mostly managed by their monthly nurses or friends, it is difficult for the physician to make either the patient or her attendant understand the true wants of these cases. I am sure that a great proportion of the mammary abscesses that I have met in my life, have been the direct results of over-distension of the milktubes; nor can I well understand that one, or a dozen galactophorous tubes, or milk reservoirs, as large as swan-quills, should be filled with milk to their utmost capacity, for several hours, without determining in their mucous and fibrous structures a hyperæmic and hyperneuric condition, to result in inflammation. But such inflammation passes through

such tissues to the gangue or basement of cellular tela by which they are invested; heat, swelling, pain, and redness of the parts follow such engorgement in the course of a few minutes, or certainly in the course of a very few hours: this condition is likely to be aggravated by the increased distension which a failure to draw off the milk, whether from ignorance or timidity, invariably produces.

I believe the Student cannot possibly become too vigilant and anxious to explore, and understand the mischievous tendency of the engorgement now spoken of: he should give such directions as to emptying the breast, either by the aid of the nipple-tube, the breast-pump, or other method, as may save his patient from the distress of a mammary abscess.

A mammary abscess for a lying-in woman is a great misfortune; it almost deserves to be called a catastrophe; and for a woman, indeed, who has had a bad constitution, or one with a strumous habit, or one prone to tuberculosis, a mammary abscess is a circumstance replete with alarm and danger. If the suppuration be very deep-seated, it sometimes happens that many days, or even weeks, are passed before the matter of the abscess makes its way to the surface. In the mean time, a constant fever, exhausting perspirations, and a state of the constitution that can only be truly characterized as hectical, attends the painful and reluctant progress of the suppuration outwards. But, suppuration, when it takes place, often attacks several of the different loculi in which the independent packets and bundles of the milk-tubes, and the granules of the gland, exist; so that a woman is affected with an abscess which is really multilocular in its nature, and which, when evacuated, allows the cavity to be converted into winding and many-celled sinuses, difficult to cure, and often lasting for weeks and months. I need not allude to the exhaustion, the pain, the hectical fever, and the wasting discharges of suppuration. It is, indeed, a deplorable circumstance for a lying-in woman to be attacked with a mammary abscess, and particularly as regards the great domestic vexations often produced by it. The young child is often the victim of such an accident, and the whole household is in some instances kept in a state of disquietude for au entire year, by the dissatisfaction engendered from the necessity of frequently changing the wet-nurse brought in either to relieve the woman herself, or to preserve the child from the risks connected with its artificial alimentation.

An abscess is a circumscribed cavity containing pus. One of the chief causes of the pain that attends it is the tension, and it is desirable that its character as abscess should be abolished as soon as it may be done conformably with the interests of the patient. When the sac

is opened by a bistoury, or by the natural process of absorption, it ceases to be an abscess and becomes a deep ulcer; the tension and pressure are, thenceforth, either greatly lessened or wholly removed. In the treatment of mammary abscess, however, it appears to me not desirable, in general, to draw off the matter from a great depth below the tissues, because, in doing so, the fistula, through which the matter escapes, and which is made by the lancet, is almost sure to become sinuous, and convert the abscess into a fistulous ulcer. Hence, I should deem it advisable, in the conduct of such cases, to wait rather longer than in some other abscesses, for the rising of the pus to a point near enough to the surface to obviate this risk.

During the progress of the suppuration, great comfort is obtained, first, from supporting the gland by means of the adhesive fasciola, or strophium; and secondly, from dressing it with emollient poultices. I think that poultices are more useful if they contain the petals of chamomile, or hops, or crushed onions; for the use of these agents, as it appears to me, serves to prevent the formation of those eczematous blotches and patches which are apt to follow the simple poultice of bread and milk, of flaxseed, of slippery elm, or other emollients. I do not think that anything can be more suitable for the treatment of this part of the case than the poultice composed of equal parts of slippery elm flour, flaxseed meal, or crumbs of bread and chamomile petals. As soon as the breast is opened, whether spontaneously or by the surgeon, poultices may be abandoned, and a practice introduced of compressing the breast against the arch of the ribs by long narrow strips of adhesive plaster, which cross it in various directions, take firm hold on the thorax to compress it, and hold it still. The effect of the compression is to counteract the development force of the still remaining uncured inflammation of the tissues.

There is no antiphlogistic that can compare with the power of mechanical compression for cases in which it is possible to adjust it; and it is possible to adjust it for the female breast. Every day, during the treatment, and indeed several times a day, a delicate. cereole, made of cerecloth, should be introduced into the opening, and conducted to the bottom of the tube or sac. If the cereole be not disproportionately large, it gives no pain, and its withdrawal is followed by gushes of pus or sanies, whose detention in the bottom of the tube or sac reconverts the malady, restoring it to the nature of an abscess, for an abscess is a circumscribed cavity filled with pus.

It appears to me, that, managed in this way, there will be found few samples of gathered breast obstinately to resist the treatment.

In many instances where the suppuration makes its way to the sur