and accompanying the commencement of lactation very frequently is carried too far, and merges into pathological congestion, and this again into inflammation. When inflammation arises from this cause, it will almost invariably be mastitis, or glandular inflammation. This sort of congestion may occur later, but usually it is in the puerperal condition. Another sort of congestion, which often runs into inflammation of the glands, is brought about by sexual intercourse in very excitable nursing women. I think I have known several instances of this kind. Other passions, as anger, may be succeeded by like results. Vascular excitement from stimulants will endanger the breasts in puerperal women, also. External causes may give origin to similar sorts of inflammation, as bruises from blows, tight lacing, stays of whalebone, &c. These last are productive of a good many cases. Not unfrequently our patient gets up well from the effects of labor, and the first time she dresses to go out, pinches her excitable gland with lace-strings, or punches it with the end of a piece of whalebone during the whole of her round of fashionable calls, and comes home with the breast excited to inflammation. Cold, acting partially upon the person, as the feet, the breasts themselves, or even upon the general surface, repels the blood to the already blood-loaded gland, producing congestion as the first step of inflammation. Other external causes operate upon the nipple and surface of the breast, irritate the skin, or destroy its integrity, &c. The child often sucks off the epidermis, and by thus abrading the nipple, ulceration is brought about.

Allowing milk or saliva to remain in contact with the delicate skin of the nipple, or areola, long enough to undergo decomposition, too often is the cause of ulceration, more especially when the saliva of the child is rendered poisonous by the existence of aphthous incrustation upon the tongue, gums, and roof of the mouth. The cracks so often found upon the nipples, I think, are almost invariably produced by the habit of allowing the fluids deposited upon the delicate skin to slowly evaporate, and thus carry off, or otherwise neutralize, the sebaceous unction of these parts, which is intended to keep the cuticle pliant and soft.

There is a class of causes which I am disposed to call pathological, very prolific of grave mammary diseases. One affection may act in producing another. Thus, ulceration of the nipple

prevents proper efforts to draw the milk from the reservoirs; they become distended to a degree that causes inflammation; or the ulceration on the top of the nipple, by the swelling it causes in the intertubular issue, lessens the diameter of the tubes, or entirely closes up their mouths, so that milk cannot find its way out, or be drawn, accumulation results, and inflammation follows. Cracks, of course, will do the same; or, again, the inflammation originating on the nipple, may creep down the lining membrane of the milk-tubes into the reservoirs, or even farther, through the ramification of the radicles of these ducts, to the substance of the gland itself. In either of these localities, suppurative inflammation may arise, and proceed through all its most aggravated forms. Contiguity of inflamed parts may awaken inflammation in other parts. Integumentary inflammation may extend to the reservoirs or glands, by spreading from one tissue to another. There can be but little doubt that acute, and, in most cases, chronic inflammation of the lymphatic glands, is generally secondary to inflammation and ulceration of the nipple and areola. It would probably be too strong an assertion to make, to say that inflammation of the lymphatic glands always has its origin in this way; for in cases of strong predisposition to this disease-and there are numerous instances of that kind-it would probably arise without much cause of excitement. Certainly, I cannot be mistaken in supposing that I have seen several such cases.

Anatomical causes of inflammation of the breast exist to a great extent. They are sometimes congenital and hereditary; but I think, for the most part, brought about by improper dressing. The flat, undeveloped, or retarded nipple, is one form of anatomical peculiarity which prevents the perfect performance of suckling, as is represented in Fig. 18. The retention of milk will lead to milk abscess. Nursing is often impracticable in this breast. Fig. 19 represents a breast with a very broad but extremely short nipple, entirely too large for a child's mouth, and so short as to add to the difficulty of prehension. Fig. 20 represents a breast with scarcely a trace of the peculiar, warty, tissue-like nipple, simply pouched slightly where the nipple ought to be; or, a very small nipple, where the milk-tubes seem to be bound in such a contracted bundle as not to allow free egress to the milk, is represented in Fig. 21. These four specimens of nipples, which we

often meet with, are almost impracticable. The first and third quite so; and the second and fourth so difficult that we are generally driven to the necessity of abandoning it after the best di

rected efforts to make the breast available. The danger to breasts furnished with such nipples is, that the milk will not be properly evacuated, and that milk abscess will result. In Fig. 22 we have

Fig. 19.

Fig. 20.

Fig. 21.

a nipple large enough to be easily apprehended and drawn by the child, but it is too constricted at the base. The milk-tubes, upon entering it, turn too acute an angle. A little swelling of the subareolar tissue from retention of the milk will stop them entirely up, so that the milk will not pass out. In order the better to illustrate what I mean, I add a sectional view of this kind of breast

and nipple. At a, the milk-reservoirs may be seen contracting at the nipple, forming the milk-tubes, which turn abruptly upward and even a little outward. This will be made still plainer by

turn.

It speaks

giving what I call a model breast and nipple, Fig. 23. for itself. The nipple is slightly conical, the base being larger than the apex. I add also a sectional view of this breast. As will be seen, the milk-tubes are free from pressure everywhere. Their entrance into the nipple is by a slight curve instead of an angular The milk will flow spontaneously from this kind of breast, and there can be no accumulation in the reservoirs. In nipples represented by Fig. 22, one danger is that milk, saliva, and mucus will collect in the groove around the base, decompose, and thus induce mammillitis with its attendants and consequences. This could not well occur in the case of Fig. 23. There is no lodgingplace; the nipple would be wiped clean of all these accumulations by the mouth, and return of the breast inside the clothing of the mother. The shape of the mamma may predispose it to disease, but not in so striking a manner. The more conical a breast the

better. A flat sessile mamma is more likely to inflame. Although the above-mentioned varieties of nipples are not the only ones predisposing to mammary abscess, yet by drawing the attention of

the profession to the subject thus distinctly, it is believed there will be no difficulty in recognizing adverse anatomical peculiarities whenever they do occur.

It might be appropriate to examine into the cause of these anatomical differences in the shape of this interesting organ, but the length of the subject will not allow me to indulge in this direction. Like all other formations, the nipple would doubtless differ under the same circumstances in different persons naturally, but I think there is no doubt much of the deficiency is produced by tight lacing, and the pressure made directly upon the nipple for a series of years during its development.

More regard to dressing, as well as education, is bestowed upon fitting the young lady to get married, than to perform her functions properly after getting married.