Note 44 — PART SECOND. OF PARTICULAR SURGICAL SUBJECTS. (continued 6)

[Encysted tumours of the breast containing milk are sometimes met with. They are commonly produced by closure of one or more lactiferous ducts, either from the effusion of lymph, or some other accidental formation, or from external pressure. The swelling, which generally arises during the early months of lactation, may be globular, ovoidal, or pyriform, and rarely exceeds the size of an orange. It is almost always attended with a peculiar sense of distention, and distinctly fluctuates under the finger. On cutting into it the contents are found to be of a whitish colour, and of the consistence of milk, cream, or whey; the quantity ranging from a few drachms to several ounces.

A most singular and instructive case of this disease is reported by my distinguished friend, Professor Parker, in the New-York Medical Gazette, for January, 1842. The woman, who was thirty years of age, was the mother of five children, the youngest nine months old, and had always enjoyed good health. The swelling occupied the right breast, and was first noticed about three months after her confinement: it was free from pain, and without tenderness on pressure. The skin was a little more vascular than in the sound state, the veins were enlarged, and there was evident fluctuation. The child had nursed from both breasts. With a trocar, not less than three quarts of milk were drawn off at one operation! Professor Parker requested the woman to wean her child, and to return to his clinique in a week. At the expiration of this period the fluid had reaccumulated to the amount of three pints. In a fortnight thereafter it was evacuated a third time, but in what quantity is not stated. Since then, as the professor has recently informed me, he has not heard from his patient; and it is, therefore, uncertain how much, if any, she has been benefited by the operations in the way of a permanent cure.

Small swellings of this kind rarely require any treatment beyond the application of some stimulating embrocation, to promote the absorption of the effused fluid. When the accumulation, however, is very large, as in the case above mentioned, it will be necessary not only to evacuate the milk, but to obliterate, if possible, the sac. This may be done, I conceive, either by stimulating injections, such, for example, as are used for the radical cure of hydrocele, by the introduction of the seton, or by laying open the tumour, and wearing a tent. In the former case, which, on the whole, I should prefer, assistance might be derived from methodical compression. Diminishing the quantity of milk by weaning the child would be an important preliminary step.—ED.]