bury has met with some cases in his own private practice, in which he has adopted it, and no doubt done ample justice to it, but in which it has failed. Still it has proved a very successful method on the whole, and certainly very much more successful than any other." P. 135.

The subject of Lecture VII. is sero-cystic tumours of the female breast. This is the most complete account of the disease that we have met with. This affection was improperly termed by Sir A. Cooper "hydatid disease of the breast," its pathological character being quite distinct from true hydatid formations, which occasionally occur in the female mamma. The first perceptible indication of the disease is a globular tumour imbedded in the glandular structure of the breast, and to a certain extent moveable underneath the skin. Sometimes there is only one such tumour; at other times there are two or three, or many more. In most instances the disease is confined to one breast. There seems to be little doubt that the cysts are originally formed by a dilatation of the lactiferous tubes. The diagnosis is generally easy, but occasionally the tumour is so deeply seated, that even a very experienced person may not at once recognise its nature in the first instance, and may be led to suppose that it is a medullary tumour or a chronic abscess, or any thing else, rather than what it really is. It occurs at the middle period of life, and is more common in single than in married women. The pathological history of the disease is thus described:

"First: A greater or less number of membranous cysts are generated in the breast, containing serum. The latter is at first of a light yellow colour, and transparent, but afterwards becomes of a darker colour, and opaque. There is reason to believe that these cysts are formed by a dilatation of portions of some of the lactiferous tubes.

"Secondly: Morbid growths or excrescences are generated from the inner surface of one or more of these cysts, projecting into their cavities. These excrescences seem to consist of albumen or fibrine, which, after some time (if not immediately,) becomes organized. They are covered by a thin delicate membrane, which is reflected over them from the inner surface of the cyst; but whether they are originally formed between two layers of the membrane of the cyst, or whether they are at first mere deposits of fibrine or albumen on the inner surface of the cyst, a thin membrane being formed on their surface afterwards, remains to be determined by future observations.

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Thirdly: There is some reason for believing that a similar growth of fibrinous substance may take place from the external surface of the cysts, connecting different cysts with each other; but this point also may, perhaps, require to be illustrated by further investigations.

"Fourthly: Under certain circumstances the cysts become completely filled up by the morbid growths, so that their cavities are obliterated, the tumour being thus converted into a solid mass, in which, however, the remains of the cysts are perceptible; and this is the prelude to a still further change, in which the greater part of the cysts have wholly disappeared, a solid mass of an indistinctly laminated texture occupying their place.

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Fifthly: If one of the membranous cysts be artificially laid open, or if it burst from over-distension with serum, the fibrinous excrescence, from its inner surface being no longer restrained by the pressure of the skin, increases in size, and protrudes externally in the form of a fungus, giving to the tumour a new and more formidable character.

"In this last stage of the disease, it is evident that spreading ulceration, sloughing, and hæmorrhage, the usual results of an ulcer occurring in a diseased

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SERO-CYSTIC TUMOURS OF THE BREAST.

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structure, must ensue, for which our art furnishes no other means of cure than the removal of the affected parts by a surgical operation." P. 149.

In the early stage of this disease, the treatment recommended, is the application of a stimulating embrocation to the skin. In the majority of cases thus treated, the tumour or tumours have entirely disappeared; in others, without disappearing altogether, they have become very much reduced in size; and, in only a few instances, in which the treatment was not very rigidly pursued, it was productive of no manifest advantage. The application generally employed is the following:

"R. spiritûs camphorati, spiritûs tenuioris, āā. 3 iijss; liquoris plumbi diacetatis, 3j.; fiat embrocatio.

"I have directed the patient to soak a piece of flannel, once folded, in this embrocation, and to apply it so as to cover that part of the breast in which the tumour is situated, renewing the application six or eight times in the day and night, until the skin becomes inflamed; then to omit the application for two or three days, but to resume the use of it as soon as the inflammation has subsided. The period of time during which it is necessary to pursue this method of treatment varies in different cases. In some, all that can be desired is accomplished in the course of three or four weeks; in others, it must be continued, with occasional intermissions, for some months. Other stimulating applications may be occasionally substituted for that which I have just mentioned. Several blisters may be applied in succession; each of them being kept open for a few days with the savine cerate; or a solution of 3j. of iodine in 3j. of alcohol may be applied to the skin once or twice daily, by means of a large camel's hair brush. On the whole, however, I am led to believe that the embrocation is more efficient than any thing else." P. 153.

But this simple treatment is wholly inefficient after the growth of solid substance has commenced. In this more advanced period of the disease, no good is to be expected, except from the removal of the entire breast; and such an operation may be had recourse to with every prospect of success, the disease being entirely local. Sir B. Brodie states that it undoubtedly is not malignant. It may go on to inflammation and ulceration, and the ulcer may spread and slough and bleed, but it does not contaminate the constitution. He adds, however, "still, I am not prepared to say that it may not, under certain circumstances, and in peculiar constitutions, assume a malignant character; this being no more than may happen to almost any morbid growth." That it may in an advanced stage acquire a true carcinomatous character we have no doubt whatever; but we believe that this is only an occasional, and not a common, result of the disease.

In Lectures VIII. and IX. Sir B. Brodie treats of Varicose Veins and Ulcers of the Legs, the formation and pathological causes of which, he describes with his usual accuracy. We find nothing, however, but what is well known to practical surgeons. In speaking of the application of plaster in these cases he recommends the soap plaster spread on the fungus or amadon used for the lighting of cigars. Being to a certain degree elastic, it admits of being applied in a single piece and makes a very uniform pressure. This plaster is sold by Mr. Weatherfield, in Henrietta-street, Covent-garden. Sir B. Brodie states that, in private practice, he frequently recommends a bandage which is made of stocking web, which, we quite agree with him, is very convenient, being easily applied, and making a very

equal pressure indeed, for comfort and efficiency, we believe this bandage to be far preferable to the best made elastic stockings. He adds, that it cannot well be used by the poorer classes of society, being more expensive in the first instance, and being also good for nothing after it has been washed a few times. This is a mistake. A coarser kind of bandage well adapted for poor persons may be purchased for a shilling, and it will last six months, and bear washing many times. Sir B. Brodie gives no countenance to operations on the vena saphena, and mentions cases in which, after division of, or after tying this vein, the patients have died from venous inflammation. He remarks

"There are indeed no circumstances here to justify the performance of a dangerous operation. You may perform such operations to get rid of a disease still more dangerous, but you have no right to perform an operation attended with such a degree of danger as can be appreciated, in order to get rid of a disease which is not dangerous; and no one can say that varicose veins belong to the class of dangerous diseases. But still there is another reason against having recourse to this operation. I do not believe, from what I have formerly seen, that it permanently benefits the patients. It is true that they appeared to go out of the hospital much relieved; but where I had the opportunity of seeing them one or two years afterwards, I always found them as bad as ever. Indeed I am by no means certain that the benefit which the patients appeared to derive, in the first instance, was the result of the operation; and I am more inclined to believe that it arose from their having been necessarily kept for some time in bed in the horizontal posture. Patients with varicose veins always seem to improve under these circumstances. But I may observe further, that there appears to be no reason why, in ordinary cases of varicose veins, the obliteration of the saphena should do any good, and that there are better grounds for believing that it will do harm. I have already explained to you that pressure on large venous trunks causes an obstruction of the blood in passing through them, and that this is one common cause of varices." P. 186.

Lecture X. contains some interesting observations "on the Cases of Scirrhous Tumours of the Breast which require an Operation." Sir B. Brodie notices the difference of opinion that has existed amongst surgeons of eminence as to the propriety of operating in scirrhous disease of the mamma, and after insisting on the importance of removal of the entire mamma in cases in which an operation is considered desirable, he remarks, "you may divide scirrhous tumours of the breast into two classes: one, where there is a conversion of the gland of the breast itself into the scirrhous structure, there being no well-defined margin to it; the other, where there is a scirrhous tumour imbedded in what appears to be otherwise a healthy breast, as if it were altogether a new growth, there being a well-defined boundary to it." In the first order of cases, the operation not only never succeeds in making a permanent cure, but it rather hastens the progress of the disease. The patient dies within two or three years, and probably much sooner, from an effusion of fluid into the cavity of the pleura. In another order of cases, where the skin is contaminated, there is no chance of the operation making an ultimate or permanent cure. The retraction of the nipple and tucking in of the skin are also regarded as unfavourable symptoms, and forming objections to the operation. The presence of indurated glands in the axilla, the adhesion of the scirrhous tumour to the pectoral muscle or ribs, indications of malignant disease in

1846.]

USE OF MERCURY IN SYPHILIS.

13

other organs, are all circumstances sufficient to forbid an operation with a view to an ultimate cure. Having taken away these cases, there are very few left in which it is right to propose an operation as affording a chance of permanent cure. An operation is proper in cases free from the ob jections here mentioned. It may be performed, too, with a still better prospect of success in cases of scirrhous tumour unconnected with the breast though attached to it, and also in cases of scirrhous tumour of the nipple. Our author remarks that there may be circumstances which justify the surgeon in performing the operation for the removal of a scirrhous tumour of the breast, not in the expectation of a permanent cure, but with the view to afford the patient a respite and relief from present suffering, and he mentions several cases in which life appeared to have been prolonged by an operation.

"Of course you are here called upon to exercise no small degree of discrimi nation; and especially you should reject altogether those cases in which the skin is distinctly contaminated by the disease, whether it be that there are scirrhous tubercles in it, or that it be converted into the brawny structure which I have formerly described. In neither of these cases will the patient obtain even a res pite by submitting to an operation." P. 206.

Sir B. Brodie observes that the operation is not free from danger, and admits that he has lost patients after it. He adds, however, "But where the breast is small; where the patient is otherwise healthy, and not much advanced in life; and where you do not starve the patient either before the operation or after it; and are also careful that there shall be as little loss of blood as possible ;-there the danger of the operation is comparatively trifling."

Lecture XI. is on Corns and Bunions, a subject which Sir B. Brodie has not disdained to treat of—and though these affections have been described by fashionable chiropodists in handsome quarto works, we believe that the brief observations of Her Majesty's Serjeant-Surgeon contains the best description of them, and the best directions for their relief and cure which have hitherto been published. Those of our readers who may suffer from corns or bunions, or who may wish for information as to their causes and treatment, cannot do better than read this lecture.

In

The subject considered in Lecture XII. is one of considerable interest— the administration of mercury in cases of syphilis. We are glad to perceive that Sir B. Brodie rejects the notion of treating this disease without mercury, and of mercury aggravating the disease instead of curing it. Experience proves to him that we have hitherto found no remedy having the same power of extinguishing the venereal poison as mercury. answer to the objection that it may do great harm, he justly remarks, "In this there is nothing at all remarkable, for (with the exception, perhaps, of sarsaparilla,) I do not know any medicine capable of doing great good, that may not, under certain circumstances, operate as a poison. I saw a gentleman very nearly killed by an over-dose of quinine : others have died in consequence of the imprudent exhibition of the iodide of potassium; and others have been killed by arsenic. A remedy that is strong enough to do good is almost invariably strong enough to do harm, if it be not used

properly." He states that mercury is not to be given as a matter of course in all cases of syphilis; but the general rule is, that it should be given. We think this remark might have been qualified by the addition of "in the primary and secondary stages of the disease," for, in tertiary syphilis, we quite agree with Ricord, that mercury is generally inapplicable. Sir B. Brodie next describes several conditions in which it would not be right to give this remedy. In reference to the best mode of administering it, he, in common with most good practical surgeons, gives the preference to inunction in cases where the symptoms of syphilis are not of the very mildest character. He seems to think that we have rather gone back than advanced in the treatment of this disease, and that the mercurial treatment as employed by the late Mr. Pearson during the greater part of his life, was as nearly perfect as possible, and that it was much more successful than the less careful treatment of modern practitioners. There is cer tainly much force in these remarks. If mercury be necessary, it should be given so to affect the system as to eradicate the disease, or it will do more harm than good. If the constitution cannot bear this action of the remedy, then do not give it at all. No advantage is gained in attempt. ing to get rid of the disease or to keep the symptoms under by small doses of mercury. They become more confirmed and more difficult of cure when the disease is treated in this way, and there are other remedies which are more efficacious as palliatives, and at the same time do less injury to the system than mercury. Our author's observations on the treatment of syphilis in infants are deserving of attention.

"Children are sometimes born with syphilis, the father or mother having been affected with it. The child looks thin, and is of small size; and, instead of thriving, becomes thinner and thinner. At the end of three weeks it is covered by a red, scaly eruption; there are aphthæ in the mouth, with chaps about the lips and the anus. The symptoms are well marked, and tell you at once the nature of the disease. I have tried various ways of treating such cases. I have given the gray powder internally to the child, or some kind of mercury to the wet nurse. But the mercury given to the infant by the mouth gripes and purges severely; that given to the wet nurse cannot be depended on; and at all events the latter is a very cruel and scarcely justifiable practice. The mode in which I have treated such cases for some years past is this: I have provided a flannel roller, on one end of which I have spread some mercurial ointment,-say a drachm, or more; and I have applied the roller, thus prepared, not very tight, round the knee; repeating the application daily. The motions of the child produce the necessary friction: and the cuticle being thin the mercury easily enters the system. This causes neither griping nor purging ; in a child it does not even in general cause soreness of the gums; but it cures the disease. Very few of those children ultimately recover in whom the mercury has been given internally; but I have not seen a single case in which this other method of treatment has failed." P. 245.

As mercurial fumigations have been recommended by a modern writer on Syphilis, our readers will like to know the opinion of this method of treatment entertained by Sir B. Brodie. He states, "I have used the mercurial vapour-bath with success in several cases where it was my object at once to affect the system; but I have found that Mr. Pearson's objection to it is very well founded; namely, that it is difficult in this way to regulate the mercurial action. You may affect the system too much, or