ANALYSIS OF THIRTY-NINE CONSECUTIVE MAMMARY CASES

10 nection with the dilatations and contractions of the cervix which belong to parturition, neither of the patients referred having borne children. The mucous membrane, however, becomes relaxed by recurring catamenial plethora. The relaxed membrane folds upon itself, tenesmus is thence set up, as upon a foreign body in the cervical canal, and the loosened membrane is gradually forced downward. Then exalted nutrition of the mucous membrane and of the submucous connective tissue follows upon the recurring plethora. The hypertrophied textures offend more and more as their growth increases, and the polypoid character of the tumour, as it extends beyond the uterine orifice, becomes marked more and more distinctly. The literature of uterine affections does not present, so far as I am familiar with it, any well-marked cases of the kind now delineated. Doubtless such cases have often occurred before, and will often occur again. It is highly desirable, therefore, that these morbid outgrowths shall henceforward entirely satisfactory. This affection is produced, I think, by engorgement of the be recognised by gynaecologists, and their etiology and It clearly has no con- pathology securely established. mucous membrane of the cervix uteri.

before removal, its walls enclosed, and were held together by a tolerably firm connective tissue, andyet by manipulation the envelope could be flattened out, a nodule only of the connective tissue, more dense than the rest, remaining on the surface of the envelope after the other portions had been unfolded. In another case of like nature, the tumour was small but easily recognised, the cervical canal being large and the uterus itself very low in position. The patient was stil[ menstruating, the periodic discharges, however, being long continued each time, and very profuse. In this case the stronger solution of perchloride of iron was repeatedly applied to the abnormal growth, and to the circumjacent mucous membrane. These applications were followed by the introduction of an intra-uterine stem pessary, and vaginal injections of cold water were employed. The pessary was worn for some months. The result of this treatment was as

to

the male ward, with side room, twenty patients. ANALYSIS OF THIRTY-NINE CONSECUTIVE eighteen, In addition to the foregoing list there was the usual number MAMMARY CASES of chronic mammary abscesses with sinuses, all of which terminated satisfactorily. Average age of patients at time OPERATED ON DURING SEVEN YEARS IN THE WESTERN of operation, forty-eight years four months. Average stated FROM INFIRMARY, GLASGOW, NOVEMBER, 1875, duration of disease at the date of operation, omitting case TILL NOVEMBER, 1882. of Mrs. B-, which was a secondary scirrhus, about BY ALEX. PATTERSON, M.D., F.R.C.S. ED. twenty months, and leaving out one male case, seventeen months. Right side affected in the proportion of twentyON Nov. 1st, 1875, three small wards in the Western Infirmary two to seventeen left. Average number of days in hospital were opened and placed under my charge. Collectively they twenty-eight and a half ; deducting the number of days contained nineteen beds, six only of which were for females. before operation the average is twenty-five days from date

On Jan. 4th, 1881, through the kindness of the managers, two exceedingly handsome new wards in the Freeland wing placed a were a. my disposal; the emale ward accommodates

placed

of operation to dismissal. Pain in many cases absent from first observation of disease until time of operation. Heredity, retraction of nipple, involvement involve-nent of axillary glands, and

retraction

11

points, are not recorded in a sufficient number to admit of reliable averages being made. The practice carried out in the foregoing series of cases was

some

of

other

cases

The operations were slowly performed. After as follows. separating the skin from the gland tissue, including the tumour, an incision was made around the superior half of

circumference down to the fibres of the great

muscle, .

and the

mass

pectoral

premature children. She was married very early, soon after the age of fourteen, and had had eleven children before the present one. The milk appeared on the third day, without much febrile disturbance. The treatment was general ; iron and quinine on account of the debility, and vaseline locally. Park-road, Liverpool.

or

torn, not dissected, off the muscle ;

axillary glands were always removed. All bleeding points observed were tied, and ordinary silver sutures PENETRATING WOUND OF THE ORBIT; were used in bringing the edges of the wound together. BULLET LODGED IN THE BRAIN. The arm of the side operated upon was thrown across the chest and fixed there, with the object of relaxing the skin and BY A. EMRYS-JONES, M.D., great pectoral, and keeping the wound as nearly as possible SURGEON TO THE ROYAL EYE HOSPITAL, MANCHESTER. free from disturbance. This practice was followed until the woman left the hospital. When any tendency to bronchitis ON Monday, Nov. 6th, I was summoned in a great hurry existed the patient was placed sitting up in bed, or as nearly to see a case in consultation with myfriend Mr. W. Armstrong, so as possible, immediately after the operation. So far as I of Harpurhey, who informed me that a boy, aged fourteen, can learn a fatal termination in mammary operations occurs either from pneumonia, pyaemia, or erysipelas, or from ex- a few hours previously had been handling a revolver, the haustion. By operating under the spray and dressing anti- contents of which had been discharged into the orbit, and septically, pyaemia may be prevented; the dragging which most likely into the brain. The boy was evidently in pain, tends to erysipelatous inflammation may be inmost cases and it was deemed advisable to give him a few drops of avoided by fixmg the arm in front of the chest, and pneuto make an examination ; but chloroform before proceeding monia may be averted by keeping the patient as much as as he took the first few sniffs he struggled violently, possible in the sitting posture trom the date of the operation, just and then fell into a state of collapse, and, in spite of all that that the as well as by carefully avoiding draughts and seeing could he done, he did not breathe again, although the action windows next to the woman’s bed are kept closed during the of the heart kept up for some time. The antiof an east wind. cases were all treated prevalence On Nov. 8th we made a post-mortem examination, and septically, and only four or five required any stimulants. found the following appearances :-The eyeball was extenThe most promising cases of scirrhus for removal-that is to sively ruptured, and internally a large irregular opening, say, those in which the longest interval of good health may about half an inch in extent, at the junction of the ethmoid elapse before the return of the disease-are those met within and sphenoid bones, and continuous with the opening a large spare women of advanced age, with a slow pulse, and in hole extending through the cerebral convolutions to within whom the tumour has grown slowly. The more rapidly the an inch of the posterior boundary, where we found the bullet. has taken the will be the return after place, growth speedier The track was filled with blood, and the debris of bone operation. Fat wheezv patients are, in my experience, the carried along with the bullet. There was extensive hoemor. most unpromising subjects, and require the greatest care; into the adjacent parti and the ventricles. We found of patients for any rhage they are, in fact, amongst the the other organs healthy. all surgical operation. No case of scirrhus existing in both affected

worst class

time has come under my observation. distinctly of opinion that scirrhus of the mamma is purely local disease. Glasgow.

mammae I am never a

at the

same

Manchester.

A Mirror OF

BULLOUS ERUPTION OF A PECULIAR CHARACTER. BY RICHMOND

HOSPITAL BRITISH

PRACTICE,

AND

FOREIGN.

LEIGH, M.R.C.S. ENG.,

SURGEON TO THE ST. GEORGE’S HOSPITAL FOR DISEASES OF THE SKIN, LIVERPOOL.

M. W—, aged thirty-three, very healthy, was affected by a peculiar eruption five days after parturition. It appeared as bullse of irregular shape and size, varying from It was not a quarter of an inch to about one inch in size. or other or preceded by redness, pain, sign symptom. But

Nulla autem est alia pro certo noscendivia, nisi quamplurimas et morborum et dissectionum historias, tum aliorum tum proprias collectas habere, et inter se comparare.—MORGAGNI De Sed. et Caus. Morb., lib. iv. Proœmium.

ST. THOMAS’S HOSPITAL. LARGE AXILLARY ANEURISM; LIGATURE OF THE CLAVIAN ARTERY; RECOVERY.

(Under

the

care

of Sir WM.

SUB-

MAC CORMAC.)

FoR the following notes we are indebted to Dr. W. A. for the absence of redness, the appearance was that of a the Duncan, for saw which it was taken a who house-surgeon. blister, by surgeon The patient, a man aged forty-nine years, was admitted case early. As the bulæ burst, there was some slight on Aug. 21st, 1882. He had been healthy, and had followed rawness from the loss of epithelium, but not beyond the the of a occupation carpenter. He was of very stout habit margin of the builae, and also some slight soreness and purulent discharge from the friction of the clothes, but no pain of body and florid complexion. Formerly, for six years he existed from other cause throughout the course of the disease. had been a soldier, and served during the Crimean camThe height of the eruption was reached about three or four At Scutari, in 1856, he suffered from an attack of days from its commencement, and fresh balloe appeared at paign. inflammation of the lungs, for which he was bled and intervals in its course for over a week. After the discharge of the contained fluid the buHae dried up gradualty with cupped. In 1857 he had a chancre and bubo, and some little reddening, rawness, or discharge, except where irritated weeks later his body was covered with a rash. He remained

by rubbing. Accompanying the eruption was an eczematous well till 1875, when he strained his right arm at his work, affection of the eyes and lip, which remained after the and lost the use of it for a time. The power was gradually disappearance of the former. The trunk was the only part regained, but a small lump about the size of a walnut affected, and with the exception of a portion of the buttocks, was soon discovered in the rigbt axitla. Of this he took only on the anterior aspect, which was irregularly covered little notice, as it occasioned him but trifling uneasiness. A by the eruption from the neck to the groins. The duration month before admission he again strained the arm, and the of the complaint was abut fourteen days. It was probably tumour now began to increase much more rapidly, especially of neurotic orgin, the result of "cold," but no nerve region during the week previous to admission; the skin over it was specially marked out. There was no fever, and the became ecchymosed in places, and the man suffered some general health was unaffected, except that there was some pain and numbness down the arm, which became considerlittle debility more than usual. No history of syphilis was ably swollen. When he first came under observation at the hospital elicited, and the woman had had no abortions, or stillborn