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then spread with a ring sensation over the patella, and ran down the outer side of the leg and over the heel and along plantar surface to end in the fourth toe. A band was felt over the eyes, and whole right side of the face was numb. Right side of tongue and throat were also numb.

Paralysis of right corner of mouth. Lower lip would fall. Could not whistle. Tongue was paralyzed. Could not keep food between teeth. Deglutition was interfered with. Increased respirations. Phonation was interfered with. Disturbed sensation in arm.

plete paralysis. Right leg became paretic. Foot dragged. Could not walk. Improved under treatment. Has now band sensation over eyes.

September (1895) tremor appeared in neck. This was followed by an improvement in paresis of neck muscles (sterno-cleido-mastoid especially). Had some paresis of leg muscles. Foot turned outward. March, 1896. Symptoms: Arm heavy; tremor in arm and hand. Can pick up objects only with difficulty by right hand. Has to fix all fingers except index and thumb. Has brush sensation in left hand. No tremor in lower extremity. Six months later, while visiting in a neighboring city, the patient died suddenly.

CASE 2. Joseph H., a University dispensary patient, 1894; white, married; aged fifty-three. Family history good; father living at eighty, mother died at fifty; previous history of good health. Denies having had syphilis. Four years before had noticed first symptom. Patient pale and anemic; mental condition fairly good; amnesic aphasia; ophthalmoplegia (polio-encephalitis superior); third nerve paralysis; paralysis of the right vocal cord. Paralysis of orbicularis oris, muscles of the tongue and of the pharyngeal muscles. Sensation not involved. Examination of eye showed atrophy of optic nerve and an old choroiditis.

He was treated with iodide of potassium, bichloride of mercury, strychnia, and occasional doses of phenacetin and caffeine; latter for headache, which was considerable. Treatment relieved temporarily the headache, but had no influence on the nervous disease. He was treated for about three months and then lost sight of. The case was syphilitic, I think, to a certainty.

CASE 3. W. S. F., aged fifty-seven or sixty; 4, 1897. Had been ailing for about a year.

January 6, 1897, to July
Married man; always

temperate; no syphilis. Muscular weakness; no paralysis. Taste

impaired; tongue flabby; protruded with difficulty; lips flabby and paretic. Could not whistle. Food kept between the teeth with difficulty. The paralysis extended rapidly, involving the muscles of phonation and deglutition. The patient became prostrated in the extreme, and died in coma. His treatment was faradism, galvanism, iodide of potassium, bichloride of mercury, strychnia, atropia, rest.

LOUISVILLE.

MASTITIS TREATMENT BY BANDAGING AND REST.*

BY J. B. JACKSON, M. D.

There are probably few physicians who have not felt the need of more certain methods for arresting inflammation and suppuration of the puerperal breast. The use of very gentle friction with oil, the withdrawal of milk in sufficient quantities to relieve distension of the glands, belladonna plaster, cold application, hot fomentation, camphor, bees' wax plaster, local treatment of sore or fissured nipples, supporting the breast in a sling, abstinence from fluids and liquid food, the internal administration of saline laxatives have long been considered measures more or less important in the treatment of this painful, wearing affection.

The impressive lesson which fourteen years of entirely different experience have taught prompt me in presenting my treatment of the puerperal breast. In the beginning of my practice and for three years after, my cases of painful or inflamed breast were milked, sucked (sometimes pumped), the sucking usually done by an old negro whose mouth was about as aseptic as the mouth of one of our sewers. it may be the country is ransacked for a young pup, which when applied to the breast places his fore feet against the inflamed gland and pulls back as though he was swinging to a leather strap, and the mother is held and pleaded with to hold a stiff upper lip and endure it.

Or

Probably few physicians are exempt from some such experience, and I need not portray the anguish of the patient nor describe the permanent injury which may result to the nursing breast from even a short attack of suppurative mastitis.

In 1884 I changed my treatment for this affection. Since then the results of an entirely different plan have not only been most satisfac

* Read before the Southern Kentucky Medical Association, 1898.

tory, but they have led me to investigate certain questions the correct solution of which can not fail to have a most important bearing on the subject of treatment.

If we inquire into the habits of the domestic brute mammalia, particularly the cat, bitch, and ewe, we find that although frequently deprived of their young while the secretory function of the mammary gland is at its height, yet they are comparatively exempt from mammary abscess. The examples of suppurative inflammation occur principally with the cow and horse after manipulative interference by the zealous owner.

When the mare loses her foal her breasts fill with milk, are tender under pressure and painful on movement; if she were allowed to do as she pleased, she would doubtless move about very little for a few days, after which her breasts would gradually return to a condition approaching their natural state of quiescence; but she is often kept before the plow and required to work, while the owner seeks to mitigate the bad effects of prolonged exercise by an occasional milking.

Cats and dogs so often deprived of their progeny immediately after delivery, being less valued than the horse and not required to labor, are left to pursue their own inclinations. They receive little or no attention from their owners, and are generally allowed to get well without the development of either inflammation or abscess.

While we can scarcely apply to woman all principles which govern the physical conditions and requirements of the higher forms of mammalian brute creation, there is certainly enough similarity between them to admit the claim that what is beneficial or injurious to one may, to a certain extent, be advantageous or prejudicial to the other.

My experience in the management of painful and inflamed breasts for the past fourteen years, and since my treatment has become so simplified, tends to prove that the importance which I attach to rest. and non-interference as elements so greatly favoring a speedy recovery from mammary troubles in certain animals applies with equal if not greater force to the human female.

If the human breast or any portion of it at any stage of its functional activity becomes indurated, swollen, and painful to the touch, we must determine by inquiry and examination if the fullness and pain be due to simple lacteal distension or to the presence of inflammation. If the whole breast is enlarged and painful, rotund in form, soft to the touch, yet somewhat tender under pressure, associated with a sore

nipple or occurring in the absence of any fissure or excoriation of this part, the condition is probably simply due to an accumulation of milk in the lacteal ducts and acini, and is the direct result of neglected nursing.

This form of lacteal engorgement may exist wholly independent of inflammation of the gland, and is, of course, easily cured by correcting the habits as regards nursing. On the other hand, the mother may inform us that the child has been applied with the accustomed regularity, but that it failed to derive the usual satisfaction from nursing; that after nursing a degree of fullness remained. She may also tell us that the nipple has troubled her, that for a day or two it has pained her more or less severely while nursing, and that this pain afterward extended to a portion of the breast which is now exquisitely sensitive under pressure, and perhaps also red and indurated. If in addition to these symptoms the patient has experienced a marked rigor or chill, attended or followed by more or less acceleration of the pulse and elevation of temperature not accounted for in any other way, we shall have good reason for suspecting the existence of mastitis in one form or another. The absence of redness or any inflammatory blush of the skin over the part thus affected at this early stage does not preclude the possibility of mastitis.

In parenchymatous mastitis, which is the most common form, the inflammatory stage may be well established before this symptom is present. It may, as in that somewhat rare form of mastitis known as subglandular, be absent throughout the entire course of the disease.

The degree and nature of constitutional symptoms which attend the development and course of mastitis are also quite variable. On one hand, they may be so mild as to escape observation; on the other, as in the case of highly nervous women, they sometimes occur in connection. with the slightest peripheral irritation or as an accompaniment of the simple lacteal engorgement, wholly independent of inflammation or suppuration.

In this way a very slight attack of mastitis may, in one case, be attended by a pronounced chill and a short period of high temperature, while in another extreme and prolonged inflammation and suppuration it will be attended by a slight chill and a not very marked, although continued, elevation of temperature.

Mammary troubles often develop during the first puerperal week, when the constitutional symptoms accompanying them can scarcely

be distinguished from those which so frequently arise from other causes. In such instances we must base our diagnosis upon the local condition, with such assistance as we are able to bring from carefully noting the absence of symptoms indicating a pelvic or other cause.

Having discovered the existence of an inflammatory movement in the breast of any grade of severity or at any stage of advancement short of the formation of an abscess, I at once interdict nursing, friction, pumping, fomentation, in fact every local measure excepting such as are calculated to secure complete rest of glands, rest from passive motion, rest from secretion, and rest from pain. All these conditions can immediately be secured for the patient.

Envelop the affected gland in absorbent cotton; take a plain roller bandage ten yards in length and two and a half inches wide; have the patient to sit up, and drop her clothing to her waist. Assuming that the right breast is the seat of mastitis, apply the dressing by lifting the affected gland with the bandage, carrying it over the left shoulder for two or three times, thence around the waist below the left breast and arm and over the right shoulder, thence under the left breast and over the right shoulder once or twice, thence around the chest over the sternum above each gland, bringing the bandage across the right breast or affected gland; continuing this until the affected gland is completely covered. The nipple of the unaffected gland should be left out for the child to nurse. The whole gland should be enveloped in absorbent cotton same as the affected gland, which can easily be separated to expose the nipple.

When this dressing is complete it will resemble the figure 8. The bandage should be pinned with safety pins at each point where it is likely to slip, which will require about two dozen pins. This dressing may be left for twenty-four or forty-eight hours, after which time it. should be removed and reapplied, making it tighter each time. Experience has taught me that ninety per cent of the cases of mastitis treated in this way will get well without suppurating.

The gland should be carefully examined at each dressing, and, if there is any formation of pus, the patient should at once be anesthetized and free incision made at the most dependent point of the abscess; the index finger being aseptic should then be introduced into the abscess cavity and all pockets of pus, if there be any, broken up, then washed out with peroxide of hydrogen and packed with iodoform gauze, then rebandage. This dressing may be changed every forty

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