HUMAN ANATOMY. 



** the bon d which the ducts < eppe 



(n persists .n other, the areofc * pre* PP^ 



fjyti^^ 



rJ^d& or nullipar* may be almost on a level with the 



areol V lc t, c .f multipart are often greatly elongated from the traction 



then ' Temporary elongation or erection of the mpp e may be caused by 



I Cumulation of the unstriped muscular tissue of the skin of the nipple and 



ec of the nipple is common, because, on the one hand, of the many folds 

 t)f it, d< .taneo\S covering, containing a number of sebaceous glands and 



elv connected to the underlying structures ; and, on the other of ^frequent 

 exposure during suckling to irritation from unhealthy discharges from the^ child s 

 :,g to epidermic maceration and to painful erosions, fissures, and ulcers. 

 ',-phyoi the mammary glandular elements is of normal occurrence after the 

 menopause,' the fibrous and iatty structure being also affected in many instances of 

 uhering of the breasts. In early life this condition may result from 

 ase, or from removal of the ovaries, and become a true deformity. 



!>crtrophy of the breast consists in an overgrowth of both the glandular and 

 the fibrous elemVnts. the latter predominating, and occurs usually between 14 and 

 30 years of age the period of greatest sexual activity. Amenorrhcea and pregnancy 

 are frequently ass< i.ited with it. 



Injection of the breast is usually carried through either the lymphatics or the 



milk ducts, most commonly during the early period of lactation ; more rarely it 



luring the other notable periods of mammary physiological excitement 



in the newly born the "witch-milk" period (vide supra) and at puberty. 



In the nursing woman the presence of fissures or abrasions of the nipple predisposes 



to lymphatic infection. Lack of cleanliness, with fermentation or decomposition of 



milk and of rutaneous secretions in the folds or crevices of the nipple, favors infec- 



i in the ampull.r of the ducts. 



If the superficial lymphatics are the channels of infection, suppuration in the 



cellulo-fatty tissue superficial to the breast may result (supramammary abscess) 



:, <>uinj4 to the lark of tension, pointing will occur early, the course of the case 



\\ill IK- rapid, and the constitutional symptoms relatively slight. If the deeper lym- 



phatics or milk ducts omvey the infection, suppuration occurs within the lobules 



(intraiuammary abscess) and spreads slowly from one to another through the inter- 



1. Imlar com As the pus is surrounded by the unyielding breast tissue 



i confined by the capsule of subcutaneous fascia and its septa, pain, tenderness, 



id other constitutional symptoms are marked and the progress of the disease 



is slow. Occasionally. by extension from an intramammary focus, the connective 



tissue lying l"tu<n th<- breast and the pectoral sheath is involved (retro, infra, or 



sub -.<-ss >. but suppuration in this region is more apt to be consecutive 



isiiallv tuberculous i. The constitutional symptoms are less 



m. iik-. 1 I'he \\hole br.-.ist is pushed forward and made more prominent. Point- 



->n of the enVct of gravity is apt to occur somewhere at the circum- 



nce of the breast, usually towards the inframaxillary region. Sometimes these 



abscesses ulcerat through the breast tissue to the subcutaneous area, making 



one inli.i. the other supramammary, connected by a narrow channel, 



a ' ^es de bouton n chemise." As the breast is thinnest 



line drawn from the stci no-clavicular joint to the nipple, it is in that region 



t the gl.md usually occurs. As the breast glandular and 



other structures, including the skin covering it is supplied chiefly by the lateral cuta- 



tt second t.> sixth intercostal nerves, pain in inflammatory or sup- 



' in th.- cued new growth, may be felt down the arm (intercosto- 



"Mld.-r-blade (posterior branches of the thoracic nerves) ; 



- posterior parietes of the thorax (intercostals) ; or up the 



: < ti'- rvkal pfexuj anastomosing with the second inter- 



f"i the evacuation of pus should be made on lines radiating out- 



