In cases which come under treatment early and in which the abscess has been opened, the abscess cavity should never be injected with strong irritating solutions, for, in puerperal mastitis, the pus is rarely ever de composed ; consequently there is nothing to disinfect or deodorize. It is different, however, in those cases in which there is already a spontaneous opening, or in which insufficient incisions have been made without anti septic precautions; in these cases, the pus has already become acid, and has acquired irritating qualities through the lactic or butyric acid which it contains. These cases can be treated more conservatively than was formerly possible, when nothing more could be done than to make large radial incisions. We operate, as described before, but dilate the opening to about 1 inch, so that the finger, and with it the nozzle of an irrigating tube can be introduced: the cavities are now washed out with a three per cent. solution of carbolic acid until the solution returns tolerably clear; then the thin walls between the abscesses are broken down so that they all communicate one with another, the pus and the carbolic acid solution are expressed, and large drainage tubes are placed in the different openings. The whole is then dressed as advised above, and in these cases we may also attain most striking and rapid results. It is scarcely necessary to say that an anesthetic is required in such cases.
It is by no meats always the fault of the physician when such cases of apparently neglected mastitis fall into the hands of the clinical surgeon. Women resent, for various reasons, the interference of the physician in cases of mastitis. In the first place most women of the poorer and mid dle classes wish to nurse their children is long as possible, on the one hand, so as not to have to buy food, for milk is dear at times in large cities, and difficult to obtain in good quality; on the other hand, and this is the chief reason, they do not wish to become again so soon.
Many women are not willing to use any means which will interfere with the secretion of milk, and, in spite of the physician's orders, they will continue to nurse the child from the affected breast, suffering the most intense pain, with the idea that the inflammation has been caused by milk-stasis and that it will disappear if the milk is withdrawn. Among the better classes there are still other reasons for the avoidance of the knife; the women believe that the cicatrix from a spontaneously opened abscess will be less noticeable than that from a knife. Young women, es pecially, fear cicatrices on the upper half of the breast, since they will be visible with low-cut dresses. Finally, as in all cases of suppuration, the patients dread the pain of the incision, more so because they have become unusually sensitive on account I f the pain of the inflammation. Since also there are many patients (and many physicians) who dread anesthesia, and since in the country it is difficult for the physician to make a daily visit to assure and advise the patient, the reasons for non surgical treatment are so numerous that we cannot wonder at its non employment. But it is culpable in the physician to repeatedly irritate and torment these patients with small incisions, which, without drainage and antiseptic compression bandaging, are of no more use than sponta, neous openings; and we cannot wonder that after six or eight such " operations," these women lose all faith in their physician.