MASTODYNIA IRRITABLE BREAST. 337 



intercostal space ; it corresponds to the point of division of the inter- 

 costal nerve ; from it the nerves pass toward the surface. The third 

 point is near the sternum between the costal cartilages in the upper 

 intercostal nerves, in the lower ones it is in the epigastric region some- 

 what outward from the median line ; it is called either the sternal or 

 epigastric point, and corresponds to the place where the terminal 

 branches of the intercostal nerves approach the skin. These usually 

 very circumscribed points are generally so sensitive to pressure, that 

 the patient cries out as soon as they are touched. The patients 

 often discover the points themselves, and voluntarily point out their 

 position to the physician, and, as the pain very much resembles that 

 from a contusion, they are sure they must have struck themselves 

 somehow. This constant pain is increased by deep inspiration, cough- 

 ing, sneezing, occasionally also by moving the arms, as well as by 

 touching the points ; and attacks of lancinating pain are excited, which 

 generally start from the vertebral point and pass anteriorly along the 

 intercostal space ; occasionally they pass forward and backward from 

 the lateral point. Hard pressure often relieves the pain. Romberg 

 tells of a man whose coat had become threadbare at the point where 

 he was in the habit of pressing his hand. The frequent complication 

 of intercostal neuralgia with herpes zoster is very interesting, although 

 just as obscure as the disturbances of nutrition in the parts supplied 

 by other nerves affected with neuralgia. The disease runs a very 

 irregular course ; it usually develops slowly and passes off gradually 

 after variable duration. Occasionally it is very obstinate and hangs 

 on for years. 



For the treatment of intercostal neuralgia we would advise the re- 

 peated application of blisters to the points douloureux, and particular- 

 ly the employment of the induced, or, still better, of the constant, cur- 

 rent of electricity. During the treatment any anomalies of constitution 

 are to be looked after, and, where the pain is very severe, morphia 

 should be used internally or subcutaneously as a palliative. 



CHAPTER IX. 



MASTODYNIA IRRITABLE BREAST (Cooper). 



IT is doubtful whether mastodynia be a neuralgic affection of the 

 branches of the intercostal nerves going to the mammary gland, or 

 of the nervi supraclaviculares anteriores. According to Romberg's 

 excellent description, women, about the period of puberty, or from 

 then to the thirtieth year, without any perceptible cause, become sen- 

 sitive to the slightest touch at one or more points over the mammarv 



