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teen inches wide, and sufficiently lorg to allow the ends to overlap each other by several inches after encircling the chest. To this are sewed two broad and short shoulder-straps, having places hollowed out of the broad piece, so that undue pressure will not be made in the axillæ. Neither splints nor starch need be used to keep the jacket from rolling upward; the configuration of the chest will always keep it smooth: just the reverse will be obtained in the abdominal bandage, in parturition. This jacket is to be drawn on like a vest, (but next the skin,) except when the shoulder-straps are secured in front by a strong pin, which is generally preferable, that we may change the position of the mammæ with ease, or that the patient may be saved the trouble of undressing when a clean one is desired.
Now suppose the abscess already well opened. If you wish to apply a poultice, let it be smoothly spread, circular, and generally thicker at the base of the gland, or otherwise, as the peculiar shape of the breast may require. When they are made thickest at their edges, the pressure on the gland will be most equalized, for the circumscribed force, acting laterally on its base, will prevent its becoming more flattened than natural, which I consider necessary to avoid when the gland is involved. Let us never lose sight of the anatomy of this organ.
When I am not using the poultice, I surround the breast with wool or cotton to fill the same indication. But what I should greatly prefer in many cases would be a thin caoutchouc bottle of globular shape, or a very large bladder, so that when partially filled with some liquid, or air, it might be semi-collapsed, and laid over the mammæ, and the bandage over it, which would insure a uniform pressure on all parts. If there be but one breast diseased, cut a sharp oval hole lengthwise with the bandage, or jacket, through which the healthy breast may protrude, having the aperture just large enough, so that there will not be undue pressure on the gland; thus the patient may give suck without inconvenience.
Now let the lower edges of the jacket be drawn firmly around the body and secured by pound pins. Then place your hand under the mammæ and poultice, and elevate them rather above the point they would occupy if the patient were in a recumbent posture. If the cavity be very great, it may be necessary to draw the breast laterally, to place the sinus or lips in a position favorable for resolution, or for the complete escape of purulent matter, or for both. Continue the pinning of the jacket from below upward, until its ends are well secured.
My rule for tightening this jacket is this: let it be as tight as the patient can comfortably bear it. If the inflammation be very acute, and the tumefaction great, a slight pressure only may be tolerated at first, but she will soon be able to bear it tighter from time to time, as the irritability, congestion, and inflammation subside.
In nearly every case this jacket should be adjusted when the patient is recumbent, for the gravity of the ponderous breast will thus be conveniently overcome. This being done, you cut an opening, if necessary, through which the nipple may protrude, having already secured one through the poultice, that the milk may be drawn with a breast-pipe or nipple-glass, by a nurse, or even the child, should the lacteal ducts not be diseased. The dressings should always be renewed speedily, and that, too, when the patient is recumbent.
By this mode of treatment I have never failed in performing a cure, in all ordinary cases, in from five to fourteen days, and the worst case I have ever seen has never required more than three weeks.
I will give only one bad case. I could give many, but I consider it unnecessary to occupy your
time. A negro girl, Bet, aged 18, good constitution, second child, and second attack of mammary abscess. When I was called in she had been laboring under this disease about six weeks. She was much emaciated, slept but little, loss of appetite, digestive apparatus very torpid, etc. The breast was of enormous bulk; three sinuses perforated the fascia and gland, each one large and deep enough to admit the whole of my forefinger; indeed, the gland appeared to be wholly disorganized. I applied the jacket, and gave simple medicines to correct the digestive organs.
No opiates were given; the mechanical pressure lessens the pain more effectually than any anodyne can. Her improvement began with the application of the jacket, and in three weeks her breast was well. I then directed her to wear the jacket one month longer, and during the time to loosen it more and more, until finally it would be no support.
Here, then, is an ignorant negress nursing herself, adjusting her jacket, with no assistance whatever.
But decidedly the greatest utility of this jacket is obtained, as I conceive, in using it as a
Whenever my patient is threatened with mammary abscess, I apply it as above, and I have never failed in attaining my object-I mean when I could apply it during that stage which Sir Astley Cooper denominates the “adhesive stage.” To be more explicit :
1st. Sir Astley is of opinion that the “draught” is the principal cause of this disease.
2d. Churchill says that sore nipples may produce it.
3d. Burns says, “Some have their breasts prodigiously distended when the milk first comes, and the hardness extends even to the axillæ. If in these cases the nipple be flat, or the milk do not run freely, the fascia, particularly in some habits, rapidly inflames. Others are more prone to have the dense substance in which the acini and ducts are imbedded, or the acini themselves, inflamed."
4th. It is not unfrequently the case that congestion and irritation will retard the period of lactation, and if abscess has previously existed, there will be great danger of its recurrence if neglected; and especially is this the case in many constitutions.
5th. Some patients have a great dread of the lancet, and will not submit to its use; then, if the abscess be small, or very deep-seated, or if there be doubt that suppuration has set up, it might be very objectionable to lance it.
Under all the above circumstances I have used the jacket with entire satisfaction, both to myself and patients. MM. Trousseau and Contour think that if pressure be continued too long when the suppuration is very active, the pus may be disseminated over a large surface. Now I am at a loss to conceive how this can readily take place when the lateral pressure at the base of the gland is equal to or greater than the vertical pressure on its apex. We must remember that well-adjusted pressure will retard purulent secretion when very copious, and generally it will even cause an absorption of what already exists. But let us at all times be governed by facts. That there may
be where the jacket would be an evil, I will not dispute, yet I have never
Emetics may fail to produce emesis in some people, whilst in others hyperemesis may be induced. Is this an argument against their use at all? Certainly not. Then, as I would use the bandage in fracture or in aneurism, to fill certain indications, so would I use it in inflammation of the breasts, whether attended or not by abscess. But shall we exclude all other remedies for the jacket? By no means. use in conjunction with it our nauseants, purgatives, opiates, tonics, alteratives, etc., and our cooling and astringent lotions, whenever indicated.
Sir Astley speaks of "the induration which sometimes continues for a long time after the abscess has healed,” and for this he recommends frictions with camphorated mercurial ointment, iodine ointment, soap liniment, with tincture of iodine, etc. Use these, if you please, in conjunction with the jacket, but the latter I would consider sufficient of itself. I ask, what is the modus operandi of friction in such indurations ? Nearly the same as mechanical pressure, they differing only in degree. But, as I before remarked, this induration is never a sequela after the proper use
of the jacket; but should it occur, I would expect to remove it by the means above detailed, and without
other agent. Permit me now to make a brief synopsis.
1st. This jacket is the best known means for using poultices and various other remedies.
2d. It is so simple in its use that the patient can treat herself after being taught the rules to be observed and the objects to be attained. Indeed, so fond do they generally become of this remedy, that they lay it aside with reluctance, even after they are well.
3d. When properly adjusted, the pain will be greatly mitigated; the patient can sleep sweetly, roll from side to side in bed, nurse, work, and can assume almost any attitude without inconvenience.
4th. It retains the diseased parts in the most favorable position possible for rapid resolution.
5th. It checks purulent secretion, and generally causes an absorption, partial or complete, of what already exists.
6th. By early resolution you avoid all the evils of a protracted case, which, in many constitutions, if they do not bring about the death of the mother or child, are nearly as intolerable.
7th. Suppose half the gland to be already destroyed : collapse the sac, and heal as speedily as possible: it is better to be crippled than martyred.
8th. Perhaps many of the tumors, and other diseases of this organ, might be cured by this process; and why not? Have we not found the common roller already removing very many diseases which were formerly the
prey of the scalpel, or which resisted all materia medica ? Need I mention aneurisms, ulcers, morbid growths, etc. ?
9th. And lastly, a certain amount of blood flowing to the breasts is necessary for a speedy and healthy secretion of milk. More or less than a given amount of arterial circulation will lessen the amount of milk secreted in a direct ratio. If there be a stasis of blood or of milk, or if the mother has lost her child, or from bad health or other causes she is compelled to dry up her breasts, or should she have more secreted than the child requires, or her health should justify, in all such cases use the jacket properly, and you will very seldom find use for your saline purgatives, low, dry diet, etc., etc.
On many occasions where mothers gave too little milk for their babes, I have quite succeeded in producing an abundance by advising them to be a little more unfashionable, to make the bodies of their dresses larger, and to remove the whalebones, so that the mamma will not be continually pressed. Such women (à la mode) you will find to give most milk during their hours of déshabille.
Prospect Hill, Christian Co., Ky., May 3, 1851.
Medical Intelligence and Reports.
From the Report prepared for the American Medical Monthly, by E. Lee Jones, M. D.
NEW YORK PATHOLOGICAL SOCIETY.
Regular Meeting, March 10, 1858. DR. E. R. PEASLEE, President.
ULCER OF STOMACH.Dr. T. C. Finnell exhibited several specimens. The first was an instance of ulcer of the stomach, occurring in a married woman, aged 22, who enjoyed good health until a year since; about which time she experienced some little pain of the stomach, and was unable to retain food for any length of time. Occasionally she would suffer from attacks of vomiting and diarrhæa. She continued in this condition, gradually emaciating, but still able to move around, until ten days since, when she was suddenly seized with a severe attack of vomiting and purging; collapse succeeded, and she died. Some of the neighbors insinuated that she might have been poisoned by her husband. This accusation led to an investigation.
AUTOPSY.—Oninspection, there was observed near the pyloric extremity of the stomach a round ulcer, about the size of a half-dollar, involving only the mucous membrane : the other tissues seemed to be normal. Around the margin of the ulceration was a considerable amount of vascularity, and the coats of the stomach were much thickened at that point. He considered it a perforating ulcer of the stomach, which had only gone far enough to involve the mucous membrane, and that, had the patient lived longer, it would have completely perforated all the coats of that organ.
Dr. Peaslee, in reply to a question from Dr. F., stated that the most common position for perforating ulcer of the stomach was in the left half, and in the anterior wall; that it was usually found in females not far from that age. He could hardly suppose a case of poisoning to be localized like that, and the thickening of the walls would indicate that the change had been going on for a long time; and it seems that nature attempted to arrest the progress of the ulcer by these means.
Dr. Griscom referred to a case in the New York Hospital, which had been diagnosticated as ulcer of stomach by his predecessors on duty; the symptoms were, for seventeen or eighteen months, pain in epigastrium and vomiting, no excitement of pulse, failing but not losing flesh rapidly, aged 25. The patient vomited almost constantly up to ten days ago,