NEURALGIA OF THE MAMMA.—MASTODYNIA.
By it we understand general, more or less violent pains in a breast, seldom in both, without the presence of inflammation or a tumor. Yet most authors speak of certain abnormalities of the breasts, which they have found in these cases, and which they bring into connection with these " neuralgias." Since I have had very little experience with this affection, I must make use of the contributions of other authors. At the present, it is no longer allowable to speak of " neuralgias," if we have in mind only small growths, which upon touch and movement may be not only very painful them selves, but are also radiating centres of the most intense eccentric pains. Every new growth may accidentally enter into such a connection with a sensitive nerve as to cause such results. Some of the cases described by -Utley Cooper as " Irritable tumor of the breast," as well as many other observations of small painful tumors of the breast, which are here and there said to be the causes of " neuralgias," must be shut out of the terri tory of pure neuroses; we could just as well include painful carcinoma of the breast under neuralgia. Gross says that the affection occurs at any time after puberty, and that it is especially frequent in girls and women between the ages of fifteen and twenty. It is a very intense pain, as if caused by electricity, and shoots through the whole breast, into the shoulder, the axilla, and sometimes down into the elbow and finger. Sometimes there is a certain periodicity in the pain, it always increasing just before the menstrual period. The sensitiveness of the skin over the mamma is at times so great that even the movements of the clothing cause attacks of pain. As a rule, they are persons of nervous temperament who are, without a certain determining cause, attacked by this affection. The breasts of such persons are usually normal, but they often have an uneven, granular feel, as though there were a great many small tumors scattered around in them; these are probably slight indurations of the connective tissue around the single lobules, which come and go in different parts of the gland without any known cause.
Both Gross and Erichsen, whose descriptions are identical, consider the affection to be always connected with some alteration of the genital organs, and that the affected women belong to the hysterical class.
Velpeau, who paid a great deal of attention to this affection, and who is entitled to the greatest consideration on account of the large number of cases which he fully describes, distinguishes tumeurs neuromatiques et nodosites, douleurs nturalgiques et douleurs, tumeurs imaginaires. This appears to me the most correct division. The hard nut-sized tumors accompanied by radiating pains, already stated, must at all events be separated from the category of neuralgias, though the similarity of the radiating pain of these small tumors to that of a neuralgic attack is so marked, and, indeed, is sometimes complete. Treatment in these cases is very simpler the tormenting pains are quickly allayed by the removal of these small tumors.
In a second category must be placed those cases in which the separate lobules of the gland are felt with unusual distinctness, sometimes as if indurated, accompanied by tormenting pains in the breast, which are seldom widely radiated. I have seen four such cases.
The first case was that of a woman, of the lower middle-class, forty years of age. She had had several children and was very hysterical. So long as she was busily occupied she did not complain; but towards even ing and at night there was no end to her complaints. She pointed out with great precision separate spots in the breast as the points of origin of the pains, which she described, not as neuralgic attacks, but as a con tinual pressure, burning and stabbing, which were unbearable on account of their persistence. Both Schuh and von Pitha had several times ex cised painful parts of her breast, and the patient asserted that, after each operation, she was better for a long time. When she consulted me, the pains were only violent above and towards the axilla. Although I thought that she was either simulating, or was to a certain extent psychopathic, on account of her persistence and that of her family. I twice excised at the places which she indicated as the points of origin of the pain. Of the nodules previously felt or of the apparently indurated lobules, nothing could be found; moreover, there was no gland-tissue to be found, only ordinary adipose tissue, containing no more than the usual amount of connective tissue. I finally refused further operation, and do not know what became of the woman.