NON-PUERPERAL, ACUTE AND SUBACUTE MASTITIS.
Outside of its periodic function it has no marked tendency toward inflammatory processes. When such processes occur, their only known causes are rubbing of the nipple against the clothes, pressure, blows and falls upon the gland; in some cases there is no particular cause to be assigned. These inflammations never equal in intensity or duration the puerperal mastitis; they sometimes result in abscesses, but these ab scesses seldom develop with marked phenomena and always remain iso ated ; their course is usually subacute. Mastitis may develop in newly born children, even to the age of puberty, and at times during pregnancy.
The mastitis of the newly-born is manifested by a painful swelling of one or both breasts, with reddening of the skin and secretion of thin milk; the functional and then the inflammatory irritation of the glandu lar tissue become more prominent. The cause of this affection, which attacks equally children of both sexes, both in private practice and in lying-in hospitals, is not known. Fomentations of lead-water will usually cause this subacute and generally non-febrile affection to disap pear quickly; still there are some cases in which suppuration occurs. The abscess must be opened as soon as it is developed, and the skin over it becomes thin. Children rarely die of this form of mastitis, when taken in hand early, but when a progressive phlegmon developes, as is but rarely the case, the condition of the little patient becomes dangerous.
At the beginning of puberty a subacute mastitis sometimes occurs, consisting of considerable swelling of the glandular tissue with slight pain and at times a slight secretion of milk. The gland feels tolerably hard,
like a disc under the skin. There is often a history of a blow or rubbing. The induration usually disappears rapidly under inunctious of iodine oint ment; suppuration occurs but seldom.
Subacute inflammations with formation of abscess after puberty and unconnected with pregnancy are very rare. The course is more tedious and less painful than in puerperal mastitis; such inflammations are mostly circumscribed indurations of the gland, and may be dissipated by the use of compresses, cataplasms, iodine ointment and rest in bed; sometimes however abscesses occur which slowly soften to a common focus. Such abscesses should not be opened until the surrounding induration is re duced to a minimum, or we may wait until spontaneous evacuation occurs. Of the seven cases of this kind which I have seen, two underwent resolu tion and five suppurated. Inflammation of the mammary glands occurs also at times during pregnancy. Nunn mentions seven cases. I have seen four cases of unilateral mastitis in women six to nine months preg nant. The course was subacute, and in all four cases an abscess was developed slowly. One of these cases was unfortunately infected with diphtheria at my clinic; abortion and diphtheritic endometritis followed and carried off the patient.