The other three cases were in women of the better classes, about forty years old, tolerably strong, one unmarried, the others widows. In two the pains were principally in the upper and outer part of the breast, in the other deep down; the pain was partly spontaneous, partly caused by pressure. The very largely developed breasts had a nodular feel. When one of the breasts was taken by the sides or above and below, it gave the impression of containing a large nodular tumor; but when felt from other directions there was no such tumor to be felt. All three patients believed.
that they had or were going to have cancer. It was only by careful ex amination and earnest persuasion that they could be quieted for a short time. The pains, especially before the menstrual epoch, were often so great and tormenting as to prevent sexual intercourse, and at night they could not lie on the affected side. The three women were healthy, not only as regards their genital organs, but also in other respects; they were intelligent women and in no way hysterical. Immediately before each menstrual epoch, as already stated, the pains were most intense, and also after emotional disturbances. No locally applied anodyne, had any effect upon the pains, which sometimes disappeared completely during the day, though there seemed to be no especial cause for this. Cold compresses, elevation of the breast at night and the recumbent position were the only things that eased the pains and gradually brought about a more comfort able condition.
Finally, there is a third class of cases in which there are neuralgic pains sudden and typical, without any changes noticeable in the breasts on palpation. I have already expressed the belief that these are perhaps cases of intercostal neuralgia with radiation to the anterior part of the thorax. Eulenberg appears to share this opinion, to which Rom berg and Hasse are also inclined.
From his rich experience Velpeau (the disease seems to be strikingly frequent among French women) gives the following statistical data. Within four years he saw forty cases of neuroses of the breast, twenty-one of the right, seventeen of the left and two of both breasts. Of these women 15 were 30 years of age; 7 were from 31 to 40 years; 8 were from 41 to 50 years; 7 were froth 51 to 70 years; 3 were over 70 years.
In ten cases there was slight thickening of the glandular tissue (leger emptilement, nodosite8), and in thirty, there were no recognizable changes.
As regards the treatment of neuralgia of the breast, it has been of little benefit in those cases in which there was no recognizable tumor. With increasing age, and especially with cessation of the menses, these neuralgias seem to disappear, or, at least, to be less troublesome. Exact observations as to the complete cure by time are wanting; it would be of importance to collect them. Though all authors assume a relationship
between these neuralgias and the genital system, there are no definite statements as to which forms of disease of the genital organs produce the neuralgias; and in by far the greater number of cases no such relation ship has been shown either theppeutically, clinically or anatomically. As to the relation of mammary neuralgia to hysteria there are few therapeuti cal means called for, for hysteria is not too frequently amenable to thera peutic treatment. From the impression which I have of hysterical persons, they are all to be considered more or less psychopathic. Congenital dis position, developed by education and other external circumstances, gener ally lies at the bottom of those conditions which we collectively denote as hysteria. As with many other unimportant functional disturbances, the appearances on the part of the genital system may be as frequently a symptom as a cause of the general diseased condition. That, in the treat ment of neuralgia of the mamma, an assurance of freedom from danger plays no inconsiderable part is especially noted by the experienced Velpeau. The more the patients are occupied with their household' affairs, busy from early till late, the less will they think of their pains. Physical fatigue in otherwise healthy persons will always cause sleep. Pure func tional nervous troubles are very rare among the working classes, and are never completely developed. As slight as is the power of the physician of really effecting a complete psychical cure in hysteria, except perhaps in special institutions, just so slight is his power in a series of these cases. While in two of the cases observed by me, assurance that there was no risk acted favorably, in the third case it was completely in vain.
As regards medicinal treatment, most authors do not fail to enumerate a number of external and internal remedies, though as a rule with the caution that the result is uncertain. Cataplasms and ice, leeches and iron with quinine, compression of the breasts, and complete freedom of the breasts by loosening the corsets, purgatives and opium, all have been used. Plasters and inunctions of belladonna, hyoscyamus, cicuta, stra monium, aconite, veratrin, chloroform. The same drugs have been given internally, and to them must be added arsenic, quinine, colchicum, cannabis indica, bismuth, zinc, calomel, preparations of antimony, etc., etc. There is nothing else to do in such a stubborn affection than to use some of these means in one form or another for a time. The appearance of continuous exertion on the part of the physician is a source of alleviation and comfort to the patient. As regards the subcutaneous injection of morphia, I would advise that it be omitted in these cases, as the morphine habit would probably be induced.