Nov. 9th. Our patient, thus far, is exceeding our most sanguine hopes. I will continue notes as taken from my book:

Nov. 7th, 3 P.M., pulse 120; tongue somewhat dry and red at tip, with thirst; no nausea. 5 P.M., saw patient with Dr. Charlton; commenced the use of ess. beef, which relishes well; removed bandage, wound looking well; have decreased the opii to 1 gr. every four hours; tongue dry and slightly coated. Nov. 8th, 3 A.M., patient resting well; tongue more natural; pulse 135. 7 A.M., pulse 130. 10 A.M., removed bandage, wound looking good, with very slight suppuration; pulse 130; commenced the use of Tilden's f. ext. veratrum viride, 2 min. every two hours, continuing 1 gr. opii every four hours; patient cheerful and happy; continues use of beef ess. and crust coffee; tongue moist. Nov. 9th, 8 A.M., have continued above treatment through the night; patient rested well; slight sweating when sleeping; complains of some flatus; gave 3 gr. carb. soda; pulse 110, with all other symptoms favorable; have discontinued use of verat. viride. I would here state that I have emptied the bladder regularly. 5 P.M., saw patient with Drs. Buckley and Charlton; removed bandage, wound looking healthy; slight suppuration, healing mostly by first intention; pulse 120; tongue moist; skin cool. Nov. 10th, 7 A.M., patient has rested well through the night; pulse 120; tongue slightly dry; has no pain; have given through the night opii, as usual, with verat. viride, every four hours; patient feels well and cheerful; thinks she has grounds for hope that she will recover; there is but slight distension of abdomen.

Nov. 12th. Our patient is prospering finely; thus far, everything looks favorable for a recovery. Her pulse this morning is 84; tongue moist and clean; the only disagreeable symptom is wind in the bowels. I moved them yesterday, and shall give another injection this morning. I have continued treatment with opii and verat. viride, the same as at first, also anise-seed tea. I am giving her all the nourishment she will take in a liquid form.

Nov. 14th.-Our patient is still doing well, has no fever, nor any unpleasant symptoms. I have moved the bowels: I used simply an injection of soapsuds with a little turpentine. She begins to eat toast and some roast potato, with a good supply of beef essence. The wound is looking well; the superior one-half is entirely healed. I have removed one pin and two sutures; shall

remove one pin to-day. I have continued treatment same as formerly.

Nov. 17th. Our patient is gaining as fast as could be expected. The wound is healing gradually, the superior one-half is entirely closed, the other is suppurating some. I have removed two of the pins and the three sutures, the others I shall allow to remain for a few days. I am treating her now with opium and quinine, 1 gr. each, every four hours. Her pulse is about 110 per minute, soft; tongue clean and good; skin soft and moist; and all appearances favorable. We have strong hopes of a recovery; I am giving her plenty of nourishment.

4

Nov. 19th. Our patient is gaining as fast as we could hope for; she begins to have an appetite for food. I am continuing treatment with opium and quinine; the wound is healing slowly. I have not removed the two lower needles, yet the stump looks well. I have moved her bowels with injections about every other day; they have moved once without any medicine whatever. I see nothing to hinder a favorable termination.

Nov. 22d.-Dear Sir: Your favor of 19th was duly received. I will first answer your questions: 1st. There has not been any hemorrhage whatever from the stump or wound. 2d. There has not been distension of the abdomen at any time of any account; she only complained one day of flatus.

She is now getting along as well as could be asked for: has a good appetite, feels cheerful, and says she wants to sit up. I have removed three of the pins; I thought it was best to allow the lower one to remain for a few days, yet the stump is about on a level with the abdomen. I am giving her quinine with reduced doses of opium.

February 14th.—Both patients have completely recovered from the operation, and are in good health.

Case 3. Mrs. R, aged 31 years, is the mother of four chil dren, her last being six months old. Immediately after getting up from confinement with the youngest, she perceived a tumor in the abdomen, which rose above the umbilicus. Since first discovered, it has grown quite rapidly, until now, April 10th, 1863, it reaches to the ensiform cartilage, fills the abdomen to great distension, and causes her much suffering. Upon examination the tumor was pronounced ovarian multilocular dropsy. She desired to be re

lieved of it in any way that might be deemed best. After consultation with Prof. N. S. Davis, ovariotomy was determined upon, and the 15th instant appointed for the time. The patient was prepared by taking tinct. ferri chl. gtt. xxv, three times a day, good, full diet, and a soluble condition of the bowels preserved by an injection once a day. At the time appointed, the operation was performed in presence and by the assistance of Drs. Davis, Shumway, Bartlett, Cheeney, and four medical students. The chloroform, although very carefully administered, caused so great prostration and difficulty of breathing that much apprehension was felt for her safety.

There was one large cyst from which about ten pounds of thick serum was removed by the trochar canula, after a small opening through the linea alba had been effected in the usual way; but the other cysts, which were very numerous, were small, and filled with such thick fluid that it would not flow through the largest instrument. The opening was enlarged, in consequence of this fact, to about nine inches in length, when the tumor was turned out of its bed of intestines and removed from the abdominal cavity. Some adhesions, which were not very firm, were overcome by disruption, one only requiring the ecrasseur; but what embarrassed the operator most was the great fragility of the walls of the small cysts. These were so tender that the manipulations necessary to remove the mass caused rupture of some of them, and the consequent effusion of their contents into the peritoneal cavity in spite of all care to avoid it. The pedicle was thick and very vascular, hence it was thought best to tie it with a double ligature, as in the two last cases. The wound was dressed with silver pins as usual. The operation, which occupied about forty minutes, was completed at 3 o'clock P.M. The temperature of the room during the operation was about seventy degrees, and the atmosphere rendered moist by evaporation from boiling water. The shock of the operation, or the effect of the chloroform, left her quite depressed. The pulse was low and weak; the surface pale and unnaturally cool. Dr. Bartlett remained with her. At 4 o'clock and after, he gave her a teaspoonful of brandy in some water every half hour. He gave her also at that hour morph. sul., gr. th, as she commenced complaining of pain in the location of the wound. The morphia was administered every half hour also until the pain was relieved, which occurred at 5.30 P.M. The brandy was continued

all night every half hour, and the morphia every three hours in same doses as before mentioned. Her extremities, which were too cool, were wrapped in warm, dry flannel. At 1 A.M., 16th, the urine was drawn through the catheter. 8 o'clock A.M., pulse 85; surface natural, tongue moist and clean, spirits good, and the patient in every way comfortable, except occasional nausea.

The bladder was again evacuated, the brandy discontinued, and one tablespoonful of beef essence every two hours. At 1.45 P.M., pulse same in number, but stronger and fuller; some serum oozing from the wound; the skin moist, but a little too warm; some pain in the back and wound; tongue somewhat red on the tip and edges, and coated over the central part white; some thirst, which has never been urgent. Take ice and small quantity of ice-water, continue beef essence, and take 1th grain sul. morph. often as necessary for pain.

8.15 P.M., patient restless; countenance anxious; pulse 120, firm, but not full; skin moist, but too warm; pain in the back; abdomen somewhat distended. The patient complains of urgent thirst, and expresses doubt about recovery. Morphia sul., gr. every four hours; use the catheter every eight hours; give ice ad libitum; beef essence as before.

8 A.M., 17th, tongue moist, red at edges and tip, white fur in centre; pulse 120; respiration 32 per minute; still thirsty and restless, with pain, requiring the morphia as above directed. The abdomen is more distended and tympanitic. The wound continues to discharge serum, which is becoming somewhat fœtid. Continue treatment, with the addition of brandy, as much as the patient can be induced to take with ice-water.

11.30 P.M., tongue dry; pulse 140; respiration 32 per minute; cheeks and extremities cool; body hot and moist, particularly the abdomen; pain in back more considerable; abdomen greatly distended; the patient complains of great weakness, approaching to syncope; treatment continued. I forgot to mention that soon as the abdomen began to increase in size, it was covered with linseedmeal poultices, which were kept moist and warm up to the time of her death. The patient continued to sink; the abdomen to increase in size until it was enormously distended. She expired on the 18th, at 5 o'clock P.M. We could not procure a post-mortem examination, but I think there is no doubt that peritoneal inflammation was the cause of death.

CHAPTER XXVII.

DISEASES OF THE MAMMÆ.

AND

DISEASES OF THE BREAST-ACUTE INFLAMMATION-SEAT OF THE DISEASEINFLAMMATION OF NIPPLE OF LYMPHATIC GLANDS OF BREAST-MILK ABSCESS, OR INFLAMMATION OF MILK RESERVOIRS-SYMPTOMS DIAGNOSIS GLANDULAR INFLAMMATION, OR MASTITIS PROPER-MODE OF BEGINNING-SYMPTOMS AND DIAGNOSIS-CAUSES OF INFLAMMATION OF THE MAMME, PHYSIOLOGICAL, PATHOLOGICAL, AND EXTERNALTREATMENT OF INFLAMMATION OF NIPPLE, CHAPS, ULCERATION, ETC., PREVENTIVE, PALLIATIVE, AND CURATIVE-TREATMENT OF INFLAMMATION OF LYMPHATIC GLANDS-TREATMENT OF MILK ABSCESS, PREVENTIVE AND CURATIVE-ANTIPHLOGISTIC MEANS, POULTICES, ETC.-CHRONIC INFLAMMATION OF THE BREAST-OFTEN OBSCURE-SYMPTOMS AND COURSE-DURATION-TIME OF OCCURRENCE, AND KIND OF PATIENTSDIAGNOSIS-ORDINARY AND DIFFERENTIAL-PROGNOSIS-TREATMENT, GENERAL AND LOCAL-MASTALGIA, A TRUE NEURALGIC AFFECTION

TIME OF OCCURRENCE-KIND OF PATIENTS AFFECTED-SYMPTOMS AND DIAGNOSIS-PROGNOSIS-TREATMENT, GENERAL AND LOCAL-AGALACABSENCE OF MILK-CAUSES-OBSTINACY-TREATMENT, LOCAL OF OCCURRENCE-EFFECTS ON

TIA, OR
AND

GENERAL-GALACTORRHOEA-TIME

THE GENERAL HEALTH-CAUSES-PROGNOSIS-TREATMENT, GENERAL AND LOCAL-CANCER OF THE BREAST-KIND OF PATIENTS AFFECTEDPORTION OF THE BREAST DISEASED-SYMPTOMS AND COURSE PURSUED -PAIN, HARDNESS, IRREGULARITY, AND FETOR OF DISCHARGE-CONSTITUTIONAL SYMPTOMS-CANCEROUS CACHEXIA-DIAGNOSIS-FROM TUMORS OF

BENIGN CHARACTER-FROM CHRONIC INFLAMMATION-PROGNOSIS VERY UNFAVORABLE-CAUSES-PALLIATIVES, GENERAL-TONICS, ALTERATIVES, ETC.-NO RADICAL CURE, PERHAPS QUESTION OF AMPUTATION-HARDLY ADVISABLE.

INFLAMMATION attacks the mammæ of infants, children, and youth of both sexes, and of women childless or senile; but in the present paper, I desire to confine myself to the subject as manifested in the pregnant, puerperal, and lactiferous conditions of females, the conditions in which the mammæ are functionally active, or preparing for the discharge of their duty.

Inflammation may invade the tissue in and about the breasts, as 1st. The involucra.