Ulceration of the skin gradually follows near the nipple; the edges of the sore are raised, everted and puckered. The surface is of a bluish-red color. A purulent, ichorous fluid, of a faint, fetid odor, is secreted; hæmorrhage may ensue, and the patient sinks from exhaustion. The average time occupied by a scirrhus in reaching its full development is from two to three years. When the ulcerative stage has once begun, the system is soon broken, and the disease proves fatal in from six months to two years. The older the individual is at the first appearance of scirrhus, the more slowly does it pass through the various stages of its growth. The axillary lymphatic glands are also in most cases found swollen, hard, and infiltrated with cancerous matter. The pectoral muscles, ribs and costal cartilages are also found more or less involved; and a secondary affection of the pleura and lung is not unfrequent. We may also look for œdema of the extremity on the affected side, caused towards the termination of the disease by direct interference with the venous circulation. The encephaloid form occurs earlier in life, and commonly runs a more rapid course. Its margin is less defined, the base of the tumor being diffused among the healthy cellular membrane, or other parts where it may be situated. It differs from scirrhus also in this: that the disease may advance to ulceration without any affection of the glands of the axilla. The Male Mammæ. The structure of the male mammæ resembles that of the female gland, though in a rudimentary state; hence we may find anomalies and morbid conditions in them similar to those found in the latter. An increased number of mammæ have been met with. Hypertrophy sometimes occurs. There have been well authenticated instances of the secretion of milk by men. The male breast may be the seat of non-malignant and malignant growths. Cancers, simple cysts, compound cysts, and other tumors occur, but exceptionally. PART IV. MISCELLANEOUS SUBJECTS. CHAPTER I. OF THE PERIOSTEUM AND BONES. Section I. OF THE PERIOSTEUM. [=Notice=: degree of vascularity; thickness; density; detached or adhered; effusions beneath; serum or pus; ulcerative destruction of; condition of bone beneath, etc.] =Inflammation= of the periosteum occurs in the vicinity of chronic ulcers; as essential to the reproduction of bone after fractures; in consequence of syphilis or its mercurial treatment; in rheumatism; and as a manifestation of a scrofulous cachexia.