MAMMARY GLAND, DISEASES OF. Inflammation of the breast (mastitis) is apt to occur in a woman who is suckling, and is due to the presence of septic micro-organisms, which, as a rule, have found their way into the milk-ducts, the lymphatics or the veins, through a crack, or other wound, in a nipple which has been made sore by the infant's vigorous attempts to obtain food. Especially is this septic inflammation apt to occur if the nipple is depressed, or so badly formed that the infant has difficulty in feeding from it. The inflamed breast is enlarged, tender and pain ful, and the skin over it is hot, and perhaps reddened. The woman feels ill and feverish, and she may shiver or have a definite rigor if the inflammation is passing on to the formation of an abscess. The abscess may be superficial to, or beneath, the breast, but it is usually within the breast itself. The infant should at once be weaned, the milk-tension being relieved by the breast-pump. Fomentations should be applied under waterproof jaconette, and the breast should be evenly supported by a bandage. Belladonna and glycerine should be smeared over the breast, with the view of checking the secretion of milk, as well as of easing pain. On the first indication that pus is collecting, an incision must be made to prevent extension of the disease. As the discharge begins to cease, firm strapping of the breast will prove useful.
Chronic Eczema of the breast may occur, but when present around the nipple of a woman late in life, with perhaps, localized ulceration, it is known as Paget's Disease and has a sinister sig nificance, for it indicates that the superficial layers of the true skin are in all probability infiltrated with cancer. Hence, when eczema about the nipple refuses to clear up in a few days under the influence of soothing treatment, it is well to insist on the removal of the entire breast. The nipple is retracted in most of these cases, which, however, are not often met with.
Chronic Mastitis is not very uncommon in women who are past middle age. The part of the breast involved is enlarged, hard, and more or less tender and painful. It is sometimes impossible clinically to distinguish this disease from cancer. True, the tumour is not so definite or so hard as a cancer, nor is it attached to the skin, nor to the muscles of the chest wall, and if there are any glands secondarily enlarged in the arm-pit they are not so hard as they may be in cancer. But all these are questions of degree, and the indications given for a diagnosis of cancer indicate also that the disease is so advanced as to have reduced the chance of successful operation to a minimum. Moreover, it is highly in advisable to leave it to time to clear up the diagnosis, for a chronic mastitis, innocent at first, may become cancerous, while cancer and chronic mastitis often co-exist in the same breast.
Hence the only safe course is removal of the breast, and some authorities recommend that this course should be adopted in every case of chronic mastitis.
Fibro-adenoma.—A simple glandular tumour is apt to be found in the breasts of youngish women, who may possibly give an account of some blow or other injury; there may, however, be no history of injury. The tumour is smooth, rounded or oval, and lies loose in the midst of the breast ; as a rule it is not tender.
It is not associated with enlarged glands in the arm-pit. The tumour had best be removed, though innocent, for such growths may become cancerous later.