Pain and tenderness referrable to the enlarged spleen are frequent but not constant symptoms. Dyspnoea is a symptom more or less prominent, produced by enlargement of the spleen and liver. General dropsy occurs soon or later in the majority of cases. In the case referred to, the dropsical condition was found to exist only in the lower extremities. It may occur independent of any disease of the heart or kidneys.

The temperature is found to be above the normal, ranging from 100° to 102° Fahr. in most cases. The patient is liable to have exhaustive hemorrhages, epistaxis sometimes proving the immediate cause of death.

In the subject under discussion, extravasations of blood were found beneath the skin on the trunk and extremities.

The diagnostic points, or symptoms, between this disease and leucocythæmia are the enlargement of lymphatic glands, and the fact that there is not an increase in the white blood corpuscles sufficient to constitute that affection. The glands that are affected in this disease do not undergo the process of suppuration characteristic of scrofula.

When the disease has advanced to a stage that a diagnosis is positive, the prognosis is unfavorable. In cases where there is profuse hemorrhage and anasarca, or, where pyrexia is well marked, the disease proves rapidly fatal. Some intercurrent affection may be the immediate cause of death. Prominent such affections are diseases of the kidneys, or pressure among of enlarged glands upon some important part. Irrespective of these causes, the disease proves fatal by slow asthenia. Various remedies have been suggested in the treatment of this disease, but little benefit seems to have been derived from their administration.

Tonics and alteratives seem to give the most satisfactory results. Perhaps among our best agents are the iodide of potassium and the various preparations of iron.

The removal of the tumors, or their dispersion by any local treatment, would not strike at the root of the disease.

The patient should receive alimentation as abundant and

all sanitary measures available. Even should we not succeed in arresting the progress of the disease, we may at least improve the general condition and prolong the life of the patient.

[XL.]

MAMMARY ABSCESS-ITS CAUSES AND TREATMENT. BY JOHN TASCHER, M. D., CHICAGO, ILL.

Nearly every physician, who has been in practice any length of time, has been called upon to treat a mammary abscess, and I will venture to say that, if called early enough to apply abortents, such as are recommended in the text-books, has failed nine times out of ten to abort them. Unfortunately for my patients, such has been my experience, and especially in cases where there had been a previous mammary abscess.

The recurrence of mammary abscesses following each parturient stage in some women, is readily accounted for when we take into consideration that more or less of the glandular structure is destroyed in every instance where there is an abscess of the mammary gland, thereby wholly or partially closing up some of the lactiferous conduits and obstructing the free passage of milk, following the next stage of parturition, and if not re-absorbed, causes congestion, which rapidly terminates in inflammation and abscess.

In primaparæ, mammary abscesses are usually caused from secretory excitement, or when more milk is secreted than is necessary to satisfy the wants of the child. A portion of the milk remains in the breast, producing a condition known among the laity as "caked breast," which usually terminates in an abscess, if the milk is not drawn by artificial means or otherwise.

Women of a scrofulous diathesis are very liable to abscesses of the mamma. During the last two years, I have adopted the following treatment in mammary abscesses, with gratifying results: I order the milk drawn off with a breast-pump every two or three hours, and support the glands with a suspensory bandage, fastened around the neck; a roller bandage passed around the thorax, over the region of the glands, three or four times, keeps the suspensory bandage in place, and, if judi

The same end may be attained by the method recommended by Prof. Howe, which consists in supporting the gland with adhesive straps applied, so as to support and at the same time make uniform pressure on the gland. A judicious support of the gland by either method relieves the pain and favors resolution. As a local discutient, I have the entire surface of the gland, except the nipple, painted five or six times a day with the following:

R. Sulph. of atropia.....

Collodion........

M. Sig. For external use only.

.gr. iv.
Zii.

This solution has a threefold action. The first action of the atropia is that of a local stimulant to the circulation of the gland, thereby relieving its congested state; also pain, by removing capillary pressure from the nerves that supply it. Its second action is to suppress the secretion of milk, a condition necessary in all cases where we desire to abort the abscess. The collodion, by virtue of its contractility, makes uniform pressure over the entire surface of the mamma. The physician

should always bear in mind, when using this application, that atropia is readily absorbed by the skin, and that some are more susceptible to its action than others. Hence, if it produces constitutional effects, the quantity of atropia must be decreased.

When applied in the incipient stage of a mammary abscess, so far as my experience goes, it has never failed to abort it. Even when the formation of pus is eminent, it relieves pain and localizes the abscess.

Where I fail to abort the abscess by the above means, I apply poultices to hasten suppuration. As soon as pus is formed, I make a free incision parallel with the milk ducts for exit of the pus, after which I order a weak solution of carbolic acid, injected into the cavity three or four times a day, until it is filled up by granulation.

During the forming stage, if the fever runs very high, I give veratrum or aconite in the usual doses. When suppuration sets in, tonics are indicated-sulphate of quinia, iron, soups,

SELECTED.

No Bacteria in Diphtheria.

BY ROLLIN R. GREGG, M. D., BUFFALO, N. Y.

I desire to call the attention of the profession to a few points in connection with bacteria, which have not had the consideration that they ought, or, indeed, which have never hitherto received any consideration from the profession. They are as follows:

First. There is not the slightest difference to be found recorded by the best observers between the three classified forms of so-called bacteria in diphtheria, namely, spherical, rod-like and spiral, and the three exactly corresponding forms of coagulating fibrine, namely, granular, thread-like and spiral. Spherical bacteria, so called, are exactly like the molecular granules of fibrine, or the particles which the latter always first organizes into when it begins to coagulate. Rod-like bacteria are exactly like the threads or fibrils of fibrine, formed by the union of its granules into fibrils, in the next step in its coagulation; and spiral bacteria are exactly like the spirals into which the fibrils of fibrine always contract when the clot of blood contracts, and into which they contract when they organize into false membranes in connection with any inflammatory disease, unless said fibrils secure attachments of their ends that hold them straight. And yet, no observer of these assumed bacteria appears ever to have stopped for a moment to consider whether his alleged bacterial forms might not be the long and well-known forms of coagulating fibrine, which are always found existing in the same positions and under precisely the same circumstances that bacteria are said to be found in diphtheria.

Second. Wherever blood congests, as a result of disease or other cause, there the fibrine very soon commences to coagulate, first into granules, then these join together to form fibrils, and the latter contract into spirals, unless prevented by the attachment of their ends as just stated.

Lehmann, Vol. I, p. 312, says, in speaking of the coagula

ess goes on within the vessels of the living organism as soon as the blood ceases to circulate."

Wood, "Practice of Medicine," Vol. I, p. 28, says of the exudation and organization of fibrine in connection with inflammation : "As it first escapes, it is a homogeneous, formless, transparent fluid; but, very soon afterward, if examined by the microscope, it is found to contain multitudes of fibrils," and "great numbers of minute granules of different sizes." (The italics in both quotations are my own.)

Third. Hence, as will be seen, we have the proof from Lehmann, that wherever the blood stagnates—as it always does under established congestion or inflammation-there is where the fibrine of the blood commences at once to coagulate; and, the proof from Wood, that those parts where all observers say their bacteria are found in the greatest profusion—namely, in all congested and inflamed parts are the very parts where the granules and fibrils of fibrine are found in the greatest profusion; only Wood ought to have referred to the granules first and the fibrils last, instead of the reverse, to have had his description conform to the fact exactly as it occurs.

Fourth. Therefore, those who make the unnatural claim of the presence of bacteria, or vegetable organisms in the same parts where the exactly corresponding forms of fibrine develop rapidly and in great numbers, must show us the clearest distinctions between these two sets of forms, and wherein they differ; also, something of the proportions of each in the part, or they must wholly withdraw their unnatural claim, and allow the natural fact to take its place. Some allowance must certainly be made for the existence and presence, in congested parts, of these forms of fibrine in every case of diphtheria (which has never yet been done), before we can understand the disease fully and scientifically.

Fifth. Fibrine is always in excess in the blood in an diphtheria, and all the false membranes of the disease are composed of fibrine. So, also, are all the heart-clots, or thrombi and emboli of diphtheria composed of fibrine. Then, if all the so-called bacteria of diphtheria, also, are nothing but coagulated particles of fibrine, in the successive steps of its organization