The treatment of acute inflammation of the breasts in child-bed con sists in ordering rest in bed, and antiphlogistic diet so long as the patient has any fever. The breast should be bandaged secundum arlem, and lightly pressed against the thorax. Whether nursing should continue in such cases depends upon the situation and extent of the inflammation. In abscesses antero-posterior to the gland, the milk may be normal in quality, although smaller in quantity. If it be not too painful, nursing may be countenanced or even recommended, if the gland becomes so dis tended as to increase the pain. If, however, the inflammation be seated in the gland itself, nursing had best be abandoned, at least from the affected breast; should the gland become very much distended, it may be emptied with the breast-pump. If nursing be carried on with the affected breast, we can only apply almond oil, and warm cataplasms to allay the intense pain and to hasten the formation of the abscess, or else use wadding. If lactation be interrupted, we may apply gray mercurial ointment or iodine ointment. In England there is a preference for bella donna. Leeching is not to be recommended; it only mitigates the pain temporarily and often irritates the skin very much. The application of an ice-bag to the affected breasts may, under certain conditions, be tried, but it is seldom tolerated by the patient, and may give her a serious cold. In order to rapidly arrest the secretion of milk, we usually employ cathar tics (ol. ricini, magnes. sulph., sod. sulph., or small doses of calomel) and seldom fail in our efforts; the internal administration of potassic iodide is also highly recommended to quickly arrest the secretion of milk. Massage of the breast, practised by many midwives for this purpose, is very painful, may increase the inflammatory process and is feared by many women, because they believe it makes the breasts ever afterward flabby and dependent. Winkel states that in the Dresden Lying-in Institute, out of one hundred and thiry-six cases of puerperal mastitis, ninety-one (67 per cent.) recovered by absorption.
Velpeau says that the antero- and retro-mammary abscesses should be opened early, that of the gland itself never. The first recommendation is certainly right, and usually relieves the patient greatly; we may often evacuate enormous quantities of pus from the abscesses posterior to the gland; the spontaneous openings are usually too small to allow of a proper escape of pus and rapid healing of the abscess. We may also open the abscesses in the gland, when the pus is close under the surface of the skin, but not earlier. The opening should always be made with the knife, as I can see no advantage in using any of the pastes in these cases, and the small hole made by a trocar is not sufficient. In rare cases, abscesses of the mamma contain a foul-smelling pus mixed with gas, without any communication with the pleural cavity; the causes of this are unknown. Velpeau reports a few such cases. I have found on opening these ab scesses that the pus is always odorless; later, when suppuration has lasted lot some time, the secretion has a sour smell. This decomposition, of pus we can now avoid by careful antiseptic treatment. This method seems also to have a marked influence on the course, and at times on the spread of the affection, and the suffering patient is certainly spared a great deal of pain by it. Recent experiences have proven the good results
of these methods, and I cannot too strongly advise that every physician make himself acquainted with them. The breast is' at first carefully cleansed with soap, and then with a weak carbolic acid or thymol solution. The incision should be made in the direction of the radius of the gland, about .39 inches long, and down to the pus focus, and must be immedi ately followed by the insertion of a drainage tube, which is kept from slipping in by a safety-pin. Gentle pressure is then made upon the gland, so as to force the pus out through the drainage tube; the breast is again washed with some disinfecting solution, the patient being in the recum bent position; the whole breast is covered in with Lister-gauze, waterproof dressings over this, and then over all, especially below and towards the axilla, is placed a large quantity of salicyl-jute, and the whole dressing is then fastened with a bandage extending over the entire thorax from the neck to the umbilicui. The surgeon should not neglect to place wadding over the nipple of the sound breast, and to place sufficient wadding under the breast, so that it will not come in contact with the thorax. A quan tity of wadding must also be placed in the axilla on the unaffected side. When the dressing has been completed by a gauze bandage, a jacket of oil-silk is placed over it. If the abscess is very large and sinuous, it is well to renew the bandage after the lapse of twenty-four hours, and then to allow the second bandage to remain on from three to five days; but if the abscess is not very large, the first bandage may remain on for several days. The minute details of this dressing will not be regretted, when the interests of the patient are considered. The rest given to the inflamed organ, th., even compression, the prevention of pus-decomposition, the complete emptying of the pus through the drainage tube, the excellent absorption of the pus by the Lister-gauze, all these contribute to a pain less and easy course, and lead to a relatively early healing even in severe cases. If, after the first or second dressing, no more pus is drained away, the dressing should be again renewed as before, allowed to remain three or four days, and after its removal the abscess will be found to be almost entirely healed. A deviation from this method is only allowable when there is a renewal of the fever and pain under the dressing; the dressing must then be taken off, and, in all probability, another superficial abscess will be found, which must be opened and drained. This may occur again and again, though there can never be such destruction of the gland as under the old expectant and timid measures, by which the patients suffered unspeakably, and the process continued for months, until it was finally necessary to make large incisions and break down all partitions between the abscesses, in order to bring the matter to a favorable con clusion, by which means the gland was usually destroyed for the greater part and disfigured by cicatrices.