*

Paullini, in his second "Century ;" and the Bishop of Cork,† relate instances of the lacteous secretion being abundant in men. Cardanit enumerates the circumstance of a young woman, who had never been impregnated, whose breasts yielded milk, on their being excited with the stings of nettles. Dr. Stack, and Dr. Montègre,|| have detailed cases of copious lactation accidentally re-produced in aged women: to these the present writer will add some account of a woman who gave suck to children, from the twenty-fifth uninterruptedly to the seventy-second year of her age: this person is still alive and accessible to examination.

1. Dr. Stack's History. Elizabeth Brian was examined by Dr. S. and another gentleman, at her house in Tottenham-court, in

1733: she was then in the sixty-eighth year of her age; and for more than 20 years she had not given birth to a child. Her breasts were "full, fair, and void of wrinkles; but her face was very much withered, her cheeks and mouth vastly sunk in, her eyes red and running with a clammy humour." Upon pressing her right breast at the Doctor's desire," she fairly squeezed out milk which gathered in small drops at three of the lactiferous ducts terminating at the nipple." Having himself carefully dried the nipple with his handkerchief, Dr. S. made her repeat the experiment, and it had the same result. About four years previous to this examination, E. B.'s daughter, being obliged to be absent for a considerable time, left a babe she was then suckling, in the care of its grandmother: the old woman "finding the child froward for want of the breast, applied it to her own, barely in order to

Chr. Fr. Paullini; Observationum Medico-Physicarum Centuria IV. Francoforti, 1706.

Philosophical Transactions, Vol. XLI. p. 813; for 1739-1741. Phil. Trans. abridged, Vol. IX. Part III. p. 208. Medical Essays and Observations, abridged from the Philosophical Transactions, by S. Mikles, M.D. Vol. II. p. 426, 1745.

Girolamo Cardani; De Rerum Varietate Libri Septendecim, Lib. VIII. Cap. 43. Basiles, 1557.

§ Thomas Stack, M.D. Philosophical Transactions, Vol. XLI. for 1739-1741, p. 140. Phil. Trans. abridged, Vol. IX. Part III. p. 206. Mikles. Medical Essays, Vol. II. p. 368. In Phil. Trans, Vol. IX. for 1674, p. 100, there is a "Relation of Women of 60 and 66 years of age giving suck to children."

|| Antoine François Jenin de Montègre, D.M. Gazette de Santé, 1810, of which Journal Dr. M. was Editor, from 1810 to 1818; he died in Hayti, 4th September, 1818; his excellent "Traité Analytique de toutes les Affections Hemorrhoidales," is analyzed in the Medico-Chirurgical Journal, Oct. 1818.

of milk." This having been repeated several times, a son of E. B.'s, now grown a man, perceiving that the young one swallowed something from the nipple, "begged leave of his mother to try if she had not milk: his experiment succeeded, and he drew milk out of the same breast from which he had been weaned above twenty years; for seventeen or eighteen years previously his mother had not given suck to any child. Two years afterwards, E. B.'s daughter had another babe; whereupon its grandmother weaned the first, and commenced suckling the new-born infant. "In my presence," says the Doctor, "this infant took the nipple with as much eager ness and seeming delight as I ever perceived in a child of two years old; and at it plainly performed the actions of suction and deglutition: the two children, both girls, are, as to constitution, such as I could wish to the dearest friend; plump, and firm in flesh; in complexion, cleanly, fair and healthy; and in temper, brisk and sprightly, considering the mean diet of their nurse. When this good woman came to town," the Doctor adds, "which near two years since, her milk abounded to that degree in both breasts,

was

that, to convince the unbelieving, she would frequently spout it above a yard from her: a particular which, among others, the good man and woman of the house, and others of the neighbourhood likewise, assured me of. Now her left breast is run dry, and she has no great quantity in the right; but what there is, is as good milk as one may desire in a nurse. The poor woman seems perfectly honest and artless, and even inchines strongly to dotage: she very religiously throws the whole upon a miracle."

II. Dr. Montègre's History. Having collected a number of analogous facts, Dr. M. published them in the 'Gazette de Santé,' in connexion with the following, which came under his own observation. "La Femme Charles," a delicate female, had male twins in 1810, but from the great weakness of her

constitution, she could hardly supply one of them with milk; and, in consequence of extreme poverty, was unable to procure the services of a nurse. Affected by this discouraging embarrassment, says Dr. M., her mother, took one of the infants and put it to her own breast, which the babe instantly seized and began to suck. This ingenious grandmother was then in the sixty-fifth year of her age, and had been twenty-nine years a widow. At first her breasts yielded a fluid, in small quantity; but in a few days, her infantine grandchild drew from them an abundance of healthy milk. This tender nurseling continued for two and twenty months to be nourished at its grandmother's breasts; and throughout all that period was more vigorous than its brother who imbibed his sustenance from their common parent.

III. Dr. K.'s History. Judith Waterford lives in the village of Thringston, on the Forest, between Ashby-de-la-Zouch and Loughborough, Leicestershire. At this time (December, 1831), she is in her eighty-first year, and though infirm, her constitution has singularly retarded the advances of old age. Through life, this woman has been the

active and laborious inmate of a peasant's cottage; her person is short and well-proportioned: at one time she weighed about 14 stone: her temperament is the neurosanguineous, distinctly marked. The peculiar circumstances of her history being extensively known in the district where she resides, she has been visited by many clerical, medical, and other curious inquirers.

J. W. had two husbands. Previously to her first marriage, her menstrual secretion appeared at regular periods: it continued nine days usually, and was very profuse, but preceded and accompanied with little pain or disturbance of the system. After this went, it returned only nine times, at distant and irregular intervals; and on each of these occasions it was abundant, without causing any perceptible diminution of her milk.

J. W. was first married in 1777; her first child was born in May, 1778; and from that

period till May, 1825, her lacteous secretion

never in the least subsided. Besides giving her breast freely and frequently to the young ones of her neighbours, she suckled six childhildren of her own by her first husband, and eight nurselings: she had two miscarriages. Her first confinement was followed by an excessive uterine discharge, which continued three weeks and induced considerable debility. No infant, however vigorof milk; and in consequence, she often had ous, was ever nearly able to use her supply

her "breasts drawn" to the amount of two quarts in a day: her belief is, that, in general, she could have suckled four lively children, at the same time. Many attempts were made, even under medical direction, to suspend the secretion of her milk; but they all utterly failed. Her breasts often became tense and painful; and, for the removal of this state, she had them well rubbed with butter made from the cream of her own milk; this process was invariably advantageous. Sometimes about a pint of this cream was collected, and the butter it yielded was white, and soft as lard, with a sweet taste. Judy took much food, and seldom had recourse to medicine; it is her boast, indeed, that " she never paid a shil

ling in her life for doctoring, for the sake of her health;" her bowels generally were torpid, often constipated.

J. W. was a widow nearly three years and gave suck to her own and other children during the whole of that period. She had one still-born child to her second Husband. Her breasts even now retain a size quite extraordinary, and the axillary glands are occasionally large. Soon after the disappearance of her milk, in 1825, her health became more variable, her energies gradually failed, and her voice, which still is strong, lost its natural strength. Her actual powers of mind seem to have experienced little change; she continues "heart-whole;" her appetite is considerably impaired; she wishes to eat often, but takes little food at one time; her sleep is disturbed and unrefreshing, and a cough gives her occasional annoyance; her pulse is full, soft, not quick, and resistant. For many months, she has been slightly troubled with those periodical disturbances by which menstruation is preceded.

Although Judy's milk ceased, for a time, in 1825, it repeatedly appeared in minute quantities during the five subsequent years; but, since the Autumn of 1830, the secretion of this fluid has been constant, and, if encouraged (she thinks), would be sufficient to nourish a child; from attempting this, however, she is deterred by the idea, that "it would soon be the end of her."

December 6th, 1831. This day, being in the middle of her 81st year, Judy readily filled a small spoon with her milk, by squeezing her left breast frequently with the hand. This milk was rich and sweet, and not different from that yielded by young and healthy mothers.

Here, then, are the remarkable circumstances of a woman who menstruated during lactation-who suckled children uninterruptedly through the full course of fortyseven years-and who, in her eighty-first year, has a moderate but regular secretion of milk.

LXII.

ANEURISM, FROM WOUND OF THE BRACHIAL ARTERY IN VENÆSECTION.*

"FOUR forms of aneurism may arise in the bend of the arm from a wound of the brachial artery (sometimes the radial) in venesection, aneurismal varix, varicose aneurism, diffused and circumscribed false aneurism. Respecting the treatment of the last two, considerable difference of opinion exists among practical surgeons, some contend that both require operation, while others maintain their curability by compression.

The advocates for the operation have not as yet decided upon the precise situation where the vessel should be secured, nor upon the mode of securing it, some apply a ligature upon the vessel above the aneurism, and depend upon the absorbents for the removal of the tumour, whilst others open the aneurism and tie the artery above and below the wound.

The supporters of the mode by compression have not agreed either upon the place where the compressing force should be applied, nor upon its degree; some direct violent pressure to be made upon the vessel above the aneurism to obliterate its canal, whilst others are content to apply very slight pressure to the tumour itself.

In the midst of such conflicting opinions, we must appeal to facts, before we can arrive at any thing like a satisfactory conclusion.

CASE 1.-Circumscribed Traumatic Aneurism-Cure by Compression.

John Miley, æt. 27, applied at Stevens' Hospital on the 11th October, 1828, with circumscribed aneurism of the brachial artery in the bend of the arm. The tumour was firm, pulsatory, about the size and shape of a pigeon's egg, apparently intimately connected with the artery. It was diminished by pressure, and regained its size on its removal. The radial pulse was weaker on that side than on the other. The integ uments presented a small cicatrix.

* Dublin Journal, No. II.

The

patient had been bled by a blacksmith thirteen days previously. The patient observed "the beating tumour" on the removal of the bandage several days afterwards. The case appeared a fair one for the employment of compression.

"The patient was immediately confined to bed, the limb placed upon a pillow, some cathartic mixture prescribed, and sixteen ounces of blood abstracted from the opposite

arm.

The next day, a thin compress of wetted lint was laid upon the aneurism, and a roller bandage applied from the fingers to the bend of the arm, in the manner recommended by Genga, care being taken that the compression should not extend above the aneurism, the turns of the bandage over

the aneurism were very loosely applied. The patient was desired to keep the compress constantly moistened with cold water, and to take a draught containing two drops of tincture of digitalis every sixth hour. Two days subsequently, the bandage was opened and re-applied, the draught was continued, and he had sixteen ounces of blood taken from the opposite limb.

On the 7th day, the aneurism felt more solid, and did not diminish so sensibly when compressed. The bandage was reapplied, and a compress of sponge substituted for the lint. The digitalis continued, and other treatment as before.

On the 12th day, the aneurism appeared sensibly diminished, and much more solid; the pulsation in it was less distinct, whilst that at the wrist appeared more full. Bandage continued; the turns which passed over the compress being applied more firmly than before. Pulse 66. Patient is in perfect health, but complains much of the strict antiphlogistic regimen which he is compelled to observe. He was ordered to take a draught, containing thirty drops of tincture of digitalis, every second hour.

In the evening his pulse was down to 38. He did not complain of nausea or giddiness, The draughts were discontinued.

On the 14th day, the digitalis was administered in doses of twenty drops every sixth hour.

VOL. XVII. No. 33.

On the 20th day, the tumour was not larger than a marble, perfectly hard and without pulsation. The radial pulse beat firmly, and nearly as full as on the opposite limb. The bandage was re-applied, the compressing force being increased. Digitalis omitted. Antiphlogistic treatment still persevered in.

On the 30th day, there was no trace of the aneurism; the brachial artery could be felt pulsating strongly beneath the cicatrix in the integument, and the radial pulse appeared as full as that of the opposite limb.

On examining the patient eighteen months subsequent to his dismissal from the Hospital, no trace of the aneurism could be cicatrix strongly; the pulse at the wrist felt detected, the artery pulsated beneath the perfectly natural, and he stated that he had not suffered the slightest inconvenience from the arm in pursuing his very laborious occupation."

CASE 2. Circumscribed AneurismCompression-Cure.

Terence M'Evoy, æt. 25, was admitted into Dr. Stevens' Hospital March 2d, 1829, with circumscribed aneurism at the bend of the arm. The tumor was distinctly circumscribed, fully as large as a turkey's egg, pulsating, uniformly elastic, except at its anterior part, where it felt soft and pulsated most strongly. Pressure on the brachial artery stopped its pulsation but did not diminish its size. An artery of considerable magnitude ran over its anterior surface, but did not seem to be connected with it. The integuments were healthy; an old cicatrix was observable on the centre of the swelling. Nine months previously he had been bled, and, on removing the bandages three days afterwards, he noticed a small pulsating tumour. The treatment so nearly resembles that adopted in the preceding case, that we need not stop to particularize its items. On the 50th day there was no trace of the aneurism, the artery which had been wounded could be felt pulsating strongly

19

beneath the cicatrix at the bend of the arm, and the vessel which ran across the tumour (the radial) appeared perfectly natural.

aneurism will become diffused, as took place in the third case.

It is probable, if not certain, that the opinion hitherto entertained respecting the obliteration of the artery at the part wounded,

John Byrne, æt. 35, admitted February 25th, 1830, with circumscribed aneurism of the brachial artery, produced by wound of the vessel in venesection five weeks previously. The tumour was oval, as large as an orange, adhering intimately to the brachial artery, solid at the base, soft and elastic in the centre. On compression of the brachial artery the tumour lost its pulsation, and became softer.

The same treatment was adopted as in the former cases, and, on the eighth day, the tumour appeared more solid. The pressure was re-applied with more firmness. He passed a restless night, and on the following morning complained of great pain in the tumour and arm. The aneurism was found to be no longer circumscribed, but to extend along the inner edge of the biceps muscle, towards the axilla, for several inches. The whole swelling, particularly the upper part, was soft and fluctuating; the pulsation throughout not very distinct; in short, it was now a case of diffused aneurism. In consultation, it was determined to treat it as a wounded artery. The tumour was fairly opened into, the coagula turned out, the artery tied above and below the wound in it. The ligatures were thrown off on the twelfth day, and, on the 30th, he left the hospital, quite well.

"It is manifest, from the foregoing cases, that the form of aneurism to which pressure is most applicable, and in which it is most likely to effect a cure, is that of circumscribed false aneurism, unattended by inflammation either of the sac or surrounding parts.

It is equally obvious, that the pressure should be applied to the tumour alone, and not to the artery above, and that the degree of pressure be slight until the diminished pulsation and solidity of the tumour indicate that coagula fill the sac, otherwise the

without foundation. The pulsation beneath the cicatrix remained strong and natural, after the absorption of the tumour in both cases, and in a case of circumscribed false ing, which Mr. Wilmot cured by pressure, several years ago, in Jervis-street Hospital, the artery continues to pulsate strongly beneath the cicatrix to this day.

aneurism in the bend of the arm from bleed

The utility of combining Valsalva's mode of treating internal aneurisms with gentle pressure on the tumour itself, was well exemplified in these cases."

LXIII.'

ABSCESS OF THE LIVER-PUNCTURE

DEATH.

JOHN EVANS, æt. 28, a sailor, admitted Jan. 5, under Dr. Elliotson, with a great but circumscribed tumefaction over the hepatic region, extending to the umbilical, with fluctuation at its lower part. The pulse was full and irregular. He had been for five years engaged in a voyage to and from the West Indies, and for the last five had been trading between London and Bourdeaux. He had been ill for 12 months, and attributed his complaint to exposure to cold and inclement weather. He was first attacked with bilious vomiting, and acute pain in the right hypochondriac region, the whole surface becoming of a saffron hue.

Hirud xx. regi. hepatis-cal. gr. v. o. n., ol.

ric. o. m.

"6th. Continues the same.

"A linseed meal poultice ordered to be applied to the abdomen, and six grains of calomel to be given every night: to be kept on milk diet.

11th. Complains of very acute pain over the region of the liver.

Twelve leeches were ordered to be applied immediately to the part affected, and one grain