which, speaking broadly, presides over the muscles of mastication, and which (for it has been traced downwards to the level of the lower portion of the olivary body) is thus brought into exact accord with the facial and hypoglossal. At first the most dangerous symptoms were cardiac and respiratory, and this imperfect action of the heart and lungs is exactly what takes place after section of the pneumogastrics in one of the lower animals. Then its inhibitory action on the heart is thus removed. Here, therefore, the nerve affected would seem to have been the vagus, and that, too, at its nucleus rather than in its course.

Finally, as to the saliva, a partial paralysis of the chorda tympani, and a withdrawal of its influence from the sub-maxillary gland, might, by overturning the normal balance between it and the sympathetic, produce a flow of thick and tenacious, instead of normal, saliva, and so relegate the phenomenon to the same site as the others-that is to say, a minute space on the floor of the fourth ventricle and upper portion of the medulla oblongata.

II. On Amputation of the Cancerous Breast. By ROBERT LEE, M.D., F.R.S.

ON the 29th September, 1843, I received the following letter from Sir Benjamin Brodie:—

"MY DEAR SIR,

BROME PARK, NEAR DORKING, SURREY;
September 29th, 1843.

"Will you be so kind as to inform me whether you have any experience as to what would happen to a woman who, having lost both her breasts, was delivered of a child? Would the constitution suffer from the entire loss of the apparatus for secreting milk under such circumstances ?

"Believe me to be, dear Sir,

"Yours always truly,

"B. C. BRODIE."

In reply to this note I enclosed the history of the following

case copied from my journal, 9th September, 1828. It is entitled "A case of a pregnant woman whose mamma had been extirpated."

"9th September, 1828.-A woman, about 40 years of age, in the last month of pregnancy, applied at the Westminster General Dispensary this morning for a midwife to attend her during her labour. She stated that both mammæ had been removed for a cancerous affection several years ago, and that since their removal she had borne five children, which she had brought up by hand, and who were all now in good health. Previous to the extirpation of the mamma, which was performed in Ireland, she had borne two children. She stated that her mother, and, I think, one of her sisters, had been destroyed by cancer of the breast, and that she becoming alarmed for herself in consequence of the appearance of hard painful tumours in both her mamma (breasts), consented to have them removed, which was accordingly done by a surgeon in Ireland. The glands had been completely removed, and the cicatrices were distinct. Since the operation she has enjoyed excellent health. During gestation nothing unusual is experienced in the situation of the breasts, but the second day after confinement there is an unusual fulness in the parts, and in the glands of the axilla, similar to what occurs after delivery, where the secretion of milk is about to take place."

I have not since met with any precisely similar case, but I have seen a very considerable number of cases where the breast was removed for cancer when there was no cancer, and a still greater number have come under my observation in which I have prevented the operation being performed. This has happened repeatedly in women suffering from a fear of cancer in consequence of a parent or relative having died from the disease. In all these cases the fears entertained proved groundless.

On the 13th of March, 1871, I saw a lady, 41 years of age, whose right breast had been amputated five years before in opposition to the opinion of a distinguished hospital surgeon. The enlargement which had been going on during five years had never been accompanied with much pain. The weight of the breast removed was one pound and three quarters. The disease has not returned, and the cicatrix, and the glands of the axilla, and all the parts around, now present a perfectly healthy appearance.

Since the operation she has had two children, and during pregnancy has suffered from violent fits of hysteria, and after delivery unusual fulness in the parts and in the glands of the axilla has taken place as in the last case, as if the secretion of milk was about to take place.

All surgeons of experience acknowledge that the removal of a cancerous breast is attended with pain and danger. The mortality has been estimated at one in ten, but I have not ascertained that the operation in cases where breasts were not affected with cancer, but only suspected to be so, proved fatal, from which I have been inclined to conclude that the removal of a healthy is much less dangerous than that of a cancerous breast.

Great difference of opinion has prevailed among the most eminent surgeons on the propriety of amputating the cancerous breast in any stage of the disease. Some have recommended the operation in almost all cases, even in the earliest stages, before it was possible to establish a satisfactory diagnosis. Formidable objections can be urged against the practice of operating early in cancerous diseases of the mammæ, the uterus, and all the other organs of the human body. Attempts have recently been made to revive the practice, at one time very general in Paris, of cutting away the os and cervix uteri, or destroying them with potassa fusa, with the view of arresting the progress of cancer, when cancer did not exist.

"The late Mr. Cline and Sir Everard Horne, both men of great experience and sound judgment," says Sir Benjamin Brodie, "would scarcely ever consent to the removal of a scirrhous tumour of the breast under any circumstances; whereas I have known other very experienced surgeons who were in favour of an operation even in the great majority of cases. And not only has there been the difference of opinion between different individuals, but I have known the opinion of the same individual to differ at different periods. I remember a surgeon, whom I esteem as a great master of his art, saying that he had almost determined that he would never perform this operation again, and yet that very surgeon, some three years afterwards, recommended the operation in a case in which I thought it would fail. This discrepancy of opinion only shows the difficulty of the subject."

Cases of Hysteria with Sneezing. By ROBERT LEE, M.D., F.R.S. (Read January 24, 1871.) [A short abstract

of this paper was printed at page 324 of the previous number of the Proceedings."]

CASE 1.-A young lady who had reached the age of maturity, but had never menstruated, was suddenly seized with violent fits of sneezing, and the discharge of a large quantity of thin fluid from the nostrils. No cause could be assigned for these attacks, which sometimes occurred after short intervals, and continued until it was feared that the patient would die from exhaustion. I saw her in consultation with Dr. Chambers, Sir B. Brodie, and other eminent physicians and surgeons then in London, and all the remedies they suggested were tried without any sensible effect in mitigating the violence of the fits. Some of the most characteristic symptoms of hysteria were also observed in the progress of the disease, which lasted several months, globus hystericus, sense of suffocation, laughing and crying, palpitation of the heart, and after the fits the escape of large quantities of clear urine from the bladder. The fits of sneezing became more and more violent, and when there was no prospect of the patient being relieved by any medical treatment, and her parents were in a state of despair, the catamenia suddenly appeared, and all the symp. toms immediately vanished.

CASE 2.—Mrs. M—, aged 40, August 23rd, 1868, married eight years and never pregnant. Menstruation commenced without much pain at 14, and symptoms of hysteria soon after, which have continued ever since. She has suffered much from pain low down in the back and down the thighs, and there has been much irritation about the bladder. She has consulted many physicians and surgeons about the sterility, and various methods of treatment have been had recourse to without any effect. The catamenia have been regular. Several practitioners have referred the barrenness to some obstruction in the os and cervix uteri, and they have been dilated with bougies of different sorts, and at last cut open with a hysterotome. Other practitioners referred the sterility to displacement of the uterus, and the finger and many mechanical

contrivances were used for months to rectify these displacements, but without effect. Internal uterine pessaries were afterwards employed, but no child made its appearance.

The patient was afterwards sent to Kreutznach, and on her way thither she consulted a physician at Frankfort, who reported that retroversion of the uterus in a high degree still existed. She remained at Kreutznach, and drank the waters and used the baths. One day when going into a bath, she had a violent fit of sneezing and running from the nostrils, and the hysterical symptoms have been worse ever since, and she has often had swelling of the throat and of the eyelids.

Mrs. M— returned home worse than she went. Being anxious for a family, she then went to Edinburgh and consulted a physician, who introduced a metallic pessary, which was allowed to remain until the irritation produced by it was intolerable. He told her "she had got a loose kidney.”

The sneezing has gone on ever since she was at Kreutznach, and she has had a paroxysm every time the feet have been put into cold water.

The patient then consulted a practitioner who has acquired a great reputation for the successful removal of ovarian tumours. He inquired if there was gout in her family, "he fancied she was suffering from gout," and he recommended her to go to Vichy; she did not go however there, but went to some warm baths among the Pyrénées.

In this lady I could discover no organic disease or displacement of the uterus to account for the sneezing or the sterility. I could not hold out any hope that the barrenness would ever be removed. In Rotten Row, when looking at the splendid carriages and horses, she was often seized with violent fits of sneezing, which were sometimes louder than the snorting of the horses. She returned home to Scotland on my recommendation; her husband being anxious to put an end to all further experiments or attempts to procure for him a son and heir.

Postscript.-In the cases of hysteria now related there appeared to be an intimate connection between the uterine system and the brain, spinal cord, and the whole nervous system of the body. These cases have been presented to the Society for the purpose of