the cupping of the skin was due to the cicatrix of an old abscess which had existed twenty-two years previously. Under tonic treatment this patient rapidly recovered, all induration of the breast disappearing. It is interesting to observe, however, that this patient reappeared one year subsequently with a genuine cancerous disease of the left or opposite breast, which went on rapidly to develope and to destroy life.

Case 6.-Chronic Induration and Suppuration of the Breast simulating Cancer, in a Woman aged 64.-Hannah N., a married woman, aged 64, came under my care at Guy's Hospital in October, 1859, for some affection of her right breast. It had been coming on for about six weeks, the glands having become gradually hard and painful. When I saw her, the breast was generall much indurated and formed a globular firm swelling; manipulation caused some pain. The nipple was slightly retracted. The axillary glands were free from disease. The skin over the tumour was mobile and healthy. The tumour moved freely upon the parts beneath. The local symptoms, together with the age of the patient, and the total absence of any external signs of injury or history of accident, were enough to excite the idea of the tumour being cancerous; but it was not so; for in about a week pus escaped from the nipple, and, in another, fluctuation was felt deeply seated below the nipple. The abscess was opened, and in about a month a good recovery ensued.

Case 7.-Chronic Inflammation of the Breast in a Single Woman, simulating Cancer.-Ellen A., aged 56, a single healthy woman, came under my care at Guy's Hospital, on July 3rd, 1865, for some affection of the left breast. It had been coming on for about three weeks without any known cause; the breast gradually becoming hard and painful. When I saw her, the whole gland was infiltrated with some new product, inflammatory or otherwise. It was indurated and tender on manipulation. There was no enlargement of the axillary glands. The nipple was completely drawn in, and out of sight. The skin over the breast was healthy and the tumour moved freely upon the parts beneath. The case was one of a doubtful kind; the age of the woman and the local symptoms raised a suspicion of its being of a cancerous nature, and yet its progress had been somewhat too rapid for the generality of such cases. On inquiry, also, it was found out that the retracted nipple was a congenital condition. Tonics were given and the case was watched. In a fortnight distinct evidence of inflammation of the skin appeared with indistinct fluctuation. In another week an abscess was opened, and rapid convalescence followed.

Case 8.-Chronic Abscess in Breast with Retracted Nipple.-Sarah M., a childless married woman, aged 20, came under my care at Guy's Hospital, on December 30th, 1863, for some enlargement of the left breast. It had been gradually coming on for eight months, after a blow. The swelling was accompanied with a dull pain, and the gradual retraction of the nipple. When I saw her the breast was clearly much enlarged, the whole gland forming a firm semi-elastic tumour; the nipple had completely disappeared. The skin over the tumour was healthy, as were the axillary glands. The gradual enlargement of the breast with retracted nipple might probably have induced a surgeon, who put too much value in such symptoms, to suspect a cancer, although the age of the patient and the history of a blow forbad the entertainment of such an idea. The case turned out to be one of a chronic abscess. It was opened, and a good recovery took place.

Case 9.-Chronic Inflammation of the Breast simulating Cancer: Recovery. Mary R., a married woman aged 41, the mother of nine children, came under my care at Guy's Hospital, on Aug. 25th, 1864, for some affection of her right breast. It had been coming on for about nine months, and was accompanied with pain. The gland had been gradually becoming larger and harder, and the nipple had been slowly retracting. When coming under observation, the breast appeared as a firin globular enlargement and the nipple was quite out of sight. The tumour moved freely upon the parts beneath, and the skin over it was quite free. There was no enlargement of the axillary glands. The age of the woman and the general appearance and condiLIX.-15

tion of the breast indicated the presence of a cancer; and to those who looked upon the retracted nipple as a definite sign of such a disease, the diagnosis would have been complete. On inquiry however, into the history of the case, it was elicited that the induration of the breast had gradually appeared after her last confinement, in which she lost her child, nine months previously; and that the possibility of the disease being of a chronic inflammatory nature was rendered probable. This view of the case turned out to be the right one; for in the course of one month an abscess appeared which was opened near the nipple, and in three months a recovery was declared. The nipple, however, continued somewhat retracted.

Remarks.-There would be no difficulty in quoting other cases to illustrate more fully the subject of this communication; but I trust I have brought forward sufficient to indicate the quarter in which some of the difficulties of diagnosis are to be found, and the means by which errors of diagnosis are to be avoided. I have pointed out how, in cases of chronic inflammation of the breast-gland, nearly every local symptom found in cancer may be simulated and how necessary it is for the surgeon to make a careful inquiry into the history of every case, to understand how each symptom is produced, and to weigh the value of every point before giving a diagnosis. I think that I have demonstrated that local symptoms will constantly mislead when taken by themselves, and that they can only be correctly interpreted by the antecedent points connected with their history. In all the examples of disease which I have just brought forward, the surgeon would doubtless have been misled, had he trusted to local symptoms, and had he failed to inquire into the facts touching the history of the cases from an early period; for, in many of the examples, the symptoms which appeared characteristic of cancer turned out fallacious, and were due either to a congenital condition of the parts, or to an old or recent inflammatory affection.

I trust I have also demonstrated, by the quotation of cases, the value of an exploratory puncture with a needle into the centre of certain cases of tumour, when the nature of the disease is doubtful. In cancerous cases, the puncture will do no harm; in inflammatory cases, it will dispel the doubt. It will often turn doubt into certainty, and save errors of diagnosis, as well as of practice.

By way of conclusion, I will observe that cancers generally attack the breasts of women during the functional decline of the mammary gland, that is after 40 years of age, and inflammatory affections during the period of its functional activity; that nearly every local symptom of cancer may be simulated by chronic inflammation of the breast; and that the careful consideration of the history of the case will alone enable us to escape error. cases of disease of the breast, let it be therefore our rule to inquire into the history of the case, and the gradual development of the symptoms, before giving a diagnosis; and, in certain doubtful cases, let it be our practice to explore the tumour by means of a needle before giving an opinion, and certainly before we act upon it.

In all

By adopting, or rather acting upon, these suggestions, we shall often be saved from serious errors; we shall render our practice more certain, and consequently more successful.-British Med. Journal, Dec. 12, 1868, p. 601.

ADDENDA.

102. AN IMPROVED SYRINGE-PIPE FOR HYPODERMIC

INJECTION.

By Dr. THOMAS BUZZARD, Assistant-Physician to the National Hospital for the Epileptic and Paralysed.

66

Those of us who are most favourably disposed towards the hypodermic injection of drugs are yet obliged to allow that our patients not unfrequently object very strongly to the pain occasioned by the introduction of the syringetube. And we sometimes find it as hard to convince such persons that they are not being hurt as the shoemaker did to prove to Lord Foppington that his shoe was not too tight. "Your lordship," he said, may please to feel what you think fit; but that shoe does not hurt you. I think I understand my trade!" A syringe-tube which I have lately had made will, I hope, do something to extend the hypodermic method by the facility and the comparative painlessness of its introduction. The ordinary syringe-tube, it will be remembered, is of gold or silver gilt, and is tubular to the very end, which is sharpened as well as the somewhat soft material allows. Steel tubes of the same form are sometimes employed, but they quickly corrode and get choked. It occurred to me that it was quite unnecessary for the syringe-pipe to be tubular throughout, and that a gold tube might with advantage be fitted with a solid steel spear-point of the best form for penetrating the skin. At my request, Messrs. Meyer and Meltzer, of Great Portland-street, have attached a triangular steel prism to the ordinary gold tube, and thus constructed an instrument which pierces the skin as easily as the "glover's" needle, which is preferred to all others, by many surgeons, and which the termination of the tube closely resembles. The advantages of incorrodibility in its tubular portion, and sharpness of point are thus combined. The point is wiped by simply passing it between the thumb and finger.-Lancet, March 20, 1869, p. 397..

103.-HYPODERMIC MEDICATION IN GOITRE.

Prof. A. LUCKE, of Berne, reports in the Berlinea Klin. Wochenschrift, No. 25, 1868, a very interesting case of this disease cured by the subcutaneous injection of tinct. iodinii fort. (1:8). He made the injections at several spots, and at intervals of eight days. He began with four to five drops, and at last got up to two Paraz's syringes full. Until the larger quantities were used, no local or general reaction followed; and only then could iodine be detected in the urine. After four months' treatment, the patient was so far improved that only a few very hard small knots could be felt where the tumours had been.

In the October number for 1867 of the Archives Générales, Dr. A. Luton de Oviens publishes the results of a similar treatment; he gives the account of eight cases which were more or less perfectly cured; in one case suppuration occurred.

Luton and Lücke mention two successful cases in which the same treatment

was applied for the cure of chronic enlargement of the lymphatic glands.Medical Press and Circular, Jan. 20, 1869, p. 63.

104. THE SUBCUTANEOUS INJECTION OF ATROPINE.

A country practitioner sends the subjoined note:

"The following facts, in connexion with the subcutaneous injection of the sulphate of atropia, may be interesting to some of the readers of the Practitioner. Shortly after the practice was introduced, I commenced it with a patient, and for the last eight years have daily used it for the same person. I dissolve three grains in half an ounce of distilled water, and this suffices for exactly fourteen injections. The toxic effects of the drug are confined to a dryness in the throat, a difficulty of swallowing for four or five hours after, if attempted, and dilatation of the pupils; nearly always, however, sleep follows in a few minutes. There is no waste of the atropia solution, except what must adhere to the inside of the barrel of the syringe. Owing to the danger said to exist (in books and periodicals) in giving the atropia, except in very small doses to commence with, I have only used it (and that once) in two other cases-doses the same as in the first instance: Acute lumbago; pain removed in half an hour; toxic effects well developed; quite cured. Subacute lumbago of some three months' duration-toxic effects very slight; remedial the same."-Practitioner, Feb. 1869, p. 126.

105.-ON DISINFECTION WITH CARBOLIC ACID VAPOUR. By Dr. JAMES B. RUSSELL, Physician to the City of Glasgow Fever Hospital.

[Any agent employed to purify the air in such a place as a fever or cholera hospital, or sick-room in a private house, where the case is one of an infectious nature, should be one which is respirable without injury or irritation to the lungs. Chlorine and sulphurous acid gas are inapplicable as being both very obnoxious. It occurred to Dr. Russell to try carbolic acid, and the method he employed is thus alluded to in the "Report on Cholera Hospitals," incorporated in the "Report of the City of Glasgow Fever Hospital for 1866-7."]

"Having observed how readily carbolic acid distributed itself through the atmosphere of a room along with steam, I placed in each ward a gas evaporating stand, by means of which the steam of a solution of the acid and water was constantly thrown off." (p. 35.) The arrangement thus alluded to was simply a stand, supporting a small tin vessel containing carbolic acid and water, having beneath a Bunsen's burner supplied with gas by a flexible tube. This stood on the table in the centre of the ward; and the nurse was instructed to supply water when required. and acid so that a little might always be seen still undissolved. In the temporary hospital at Greendyke, American stoves were used for heating, and the vessel was simply placed in the round aperture provided on the top of each. By this means the moisture so necessary where such stoves are employed was also supplied to the atmosphere. The device thus adopted for cholera hospitals was continued in the City of Glasgow Hospital when it reverted to its original use-the treatment of fever. As perceived by the sense of smell, the effect was a mild odour of carbolic acid in all parts of the wards. What benefit accrued to the patients and attendants can hardly be estimated. That the agent was present to a degree sufficient to be obnoxious to animal life was shown by the circumstance that, during the hot summer of 1868, the flies, which were so numerous and annoying in wards not so fumigate, were only occasionally seen in wards furnished with the evaporating apparatus. Flowers placed on the window-sills were not affected, but pendant plants hung from the joists immediately over the table referred to above soon died.

Recently I improved the arrangement by adopting porcelain instead of tin basins, which were soon perforated by the action of the gas-jet externally and the acid internally. I also added a small flat porcelain cup, containing the pure acid, so as to combine with the evaporation of the aqueous solution the evaporating influence of a. water-bath. The result has been very greatly to increase the amount of the disinfectant circulating in the atmosphere. It is strongly perceptible in every part of a ward 48 feet long by 20 wide. As to the practical benefit of this process, I have already stated that I am unable to say this or that has been the result. In the first place, this much may safely be asserted, that no harm can be done. The odour is aromatic and agreeable to most persons, though not to all. Some find it repugnant. It is in this direction we must look for the benefit-in the cleansing of the air for the use of attendants and patients, not in the "cutting short" of disease in individual cases. By this, and disinfecting powders in the nightstools, with good ventilation, it may be made quite certain that the poisonous effluvia of one patient will not reach another. Dr. Lemaire proves by every variety of experiment that water containing a hundredth of the acid is sufficient to destroy all the small noxious animals, and that a thousandth will arrest and prevent putrid fermentation " (p. 208). In particular he shows that the mere vapour of a few drops of the pure acid at the bottom of “ a large jar in direct communication with the atmospheric air" will soon cause the mould on a piece of putrid flesh exposed to the air in the jar "to droop and wither" (p. 59). Although fully alive to the importance of the use, in hospitals, of an agent so inimical to the lower forms of life, Dr. Lemaire does not suggest any method of constantly supplying it to their atmosphere. The simple plan described in this short notice effects this thoroughly. I am induced to make a memorandum of it, because, there being no doubt of the efficiency of carbolic acid as a disinfectant, an easy method of disseminating it is alone requisite to ensure its more frequent use in circumstances which so often occur, in which not one isolated act of disinfection is required, but a continuous process. Such circumstances are found in hospitals, we may say in all hospitals, but especially those in which lesions of surface exist, such as surgical and lying-in hospitals; and those in which infectious diseases are treated, such as fever, small-pox, &c. In those institutions a permanent apparatus ought to be contrived. Private practitioners also frequently require this perpetual atmospheric disinfection. Fumes from chloride of lime or open vessels of carbolic acid are not very efficient; and the evolution of chlorine or sulphurous acid is both difficult to control and very disagreeable, and in the better class of houses also detrimental to metal surfaces. It would, on the other hand, always be easy to devise some modification of the water-bath method of distributing carbolic acid. A porcelain cup placed on the round aperture of the globe above the gas jet, having afloat in it another much smaller cup containing pure acid, or a large basin of boiling water renewed from time to time, and bearing a common saucer full of pure acid on its surface, suggest themselves as two out of several plans which might be adopted. My friend Dr. Wood Smith lately used a common retort stand and evaporating dish, with flexible tube and gas jet, during the progress of a virulent case of diphtheria in private. I am not aware that this idea has been systematically carried out in any hospital but that which I attend. It has been partially tried in the Town's Hospital, and in the fever-house, Royal Infirmary.-Glasgow Med. Journal, Feb. 1869, p. 210.

106.-NEW VAPORIZER FOR CARBOLIC ACID.

Messrs. SALT, of Birmingham, have constructed a very ingenious and welldesigned apparatus for the vaporization of carbolic acid. It consists of a receptacle for the acid, covered by a finely-perforated lid. Beneath the receptacle is an air chamber, and beneath this chamber is a recess for a spiritlamp. Two or three tablespoonfuls or more of carbolic acid (if in the liquid