On Certain Causes of Mammary Cancer
Authors: C. H. Moore
Journal: BMJ (1869)

improved, and are nearly free from moist rdles.On the 9th of May, we sent him to the Convalescent Hospital at Southport.In speaking of this man's case when it occurred, I said that, although I believed it to be one of gangrene of the lung, connected with a low form of pneumonia, yet the symptoms might possibly be connected with tubercular deposit.As you will now learn, we subsequently had an opportunity of seeing the condition of the lung.The man was readmitted into the hospital on the 2nd January, 1868.He told us that, after his discharge in May, I867, le remained tolerably well, and quitefreefromfetid expectoration for about four months, when the fetor returned, and continued, more or less, up to his readmission.We found dulness over the right lung, with coarse rdles, and gurgling at the apex.There were, also, coarse rd6es and bronchial breathing at the back.The expectoration was copious and very fetid, and the breath was fetid.He was ordered carbonate of ammonia and bark, a chlorine gargle, and eight ounces of brandy daily, with beef-tea and milk.He did not improve under the treatment.His pulse was quick, 120to 130; he had profuse perspirations; he slept badly; but the fetor became somewhat less, although it did not disappear.The ammonia was continued till the Ioth, when quinine was ordered, but, on the 13th, the ammonia was resumed.The brandy was continued, and opium was given at bedtime, almost every night.He died on the 14th, and the body was examined on the following day.The left lung was emphysematous throughout.The right lung had a large gangrenous cavity at the upper part, the walls of which were soft and easily broke down.A small part of the anterior edge of the lung was emphysematous.The remainder of the lung was the seat of chronic grey hepatisation, and, on section, there was a copious flow of purulent matter.The areolar tissue between the lobules was much thickened.There were no tubercles.These cases will tend to shew you the kind of pneumonia with which gangrene is usually associated.It is a very unfrequent sequence of the acute form, and it probably rarely occurs except in connection with some cachectic state of the system.The diagnosis of gangrene of the lung turns on the peculiar fetor of the breath and expectoration.Neither the general symptoms nor the physical signs present any pathognomonic features.The prostration is usually very great, and quite out of proportion to the physical signs.The pulse generally becomes very rapid and feeble, the face sunken, and the aspect anxious.In the treatment of the disease, you must be guided by the general condition of your patient,.and you must give stimulants, tonics, and mourishment in proportion to the depression which exists.The medi- cines to be most relied on are carbonate of ammonia, quinine, chlorate of potash, and the mineral acids.In the cases I have referred to, especially in those of R. and F., I gave a considerable quantity of brandy; and from the success of the treatment in R.'s attack, and the first attack of F., you may be encouraged to hope for a favourable issue even in the most unfavourable-looking cases.