DISEASES OF TILE NIPPLE AND AREOLA.
When the child in nursing wounds the nipple, especially at its base, and the mother, despite the intense pain, continues to nurse the child without taking necessary precautions, deep, penetrating, chink-like ulcers are formed. In such cases nursing from the injured breast must cease entirely, or a nipple-shield must be used. As prophy lactic against such wounds, the nipples should be washed with cold water, with astringent solutions or with alcoholic washes. For an already ex isting fissure, touching it with lunar caustic, although very painful, is one of the best remedies; applications of lead-water, of weak solutions of nitrate of silver, etc., may be used. Repeated washing of the fissure with a 5% solution of carbolic acid is also to be recommended. Of course any application must be carefully washed off before the child is again put to the breast.
Further practical rules regarding remedies to be used in the disturb ances of lactation are to be found in works on midwifery. Especially comprehensive is the treatment of puerperal inflammations of the nipple given by Winckel.
Inflammatory softening of the nipple, with ulceration and fungus granulations, which may also be due to nursing, are to be treated by appli cations of lunar caustic and astringent fomentation. Aphthous disease of the oral mucous membrane of the child is not infrequently the cause of ul cerative processes on the nipple of the mother or nurse. While there are many kinds of Schizomycetes (Vibrio, Bacterium, Leptothrix, Coccus and Straptcoccus) in the child's mouth and on unclean nipples, according to Haussmann, the Soor-pitz (oidium albicans, probably identical with oidium lactis) which can be planted alternately from the mouth of the child to the nipple, and vice versa, is capable in either place of provoking inflam mation. Syphilitic ulcers also occur on the nipples, primary as well as
secondary, the latter in the form of broad condylomata. General as well as local antisyphilitic treatment must be instituted, and lactation must be absolutely forbidden, when such ulcers are found on a nursing woman.
The nipple and areola are sometimes attacked by chronic eczema, the cause of which may be uncleanliness, though in most cases this is un known. This eczema of the nipple, which is not infrequently bilateral, is very obstinate to treatment; the remedies used may have to be changed frequently before a cure is effected. Local measures alone seem to be effectual. Careful and repeated ablutions of cold water are often suffi cient, but when the young epithelium is regenerated, it must be protected for a long time with fat (glycerine, oil, cerate), or a relapse will occur. Astringent salves, especially of zinc, lead and white precipitate, best made with starch and glycerin, are of benefit, especially when the crusts have been carefully softened and removed. At times, every kind of moisture is harmful, and good results are obtained by the careful dusting of the parts with zinc-powder (white oxide of zinc with an equal amount of starch). More severe measures, such as the use of soaps, tar, etc., which are very useful in other torpid forms of chronic eczemas, are of no avail in the treatment of eczema of the nipples.
Tumors of the nipple and areola are very rare; slowly developing epi thelial carcinoma has been observed. Russel and Lebert have seen atheroma of the areola, which was probably developed from the areolar glands.