WOUNDS OF THE MAMMiE.—SPONTANEOUS HEMORRHAGE AND CONGESTION.—ERYSIPELAS.
On account of the toughness and elasticity of the tissue, a blunt instrument must strike with enor mous force before it can produce a wound, and even then the injury to the ribs and lungs will be of much more importance than the wound of the mamma.
Burns of the skin covering the breast and nipple are more frequent, partly from the pouring over the body of hot fluids, partly from burning of the clothing. The general treatment of burns is applicable to these cases.
The nipple may be entirely destroyed or obliterated by cicatricial changes following burns, as well as by ulcerative processes. These cases have hitherto been so seldom observed, that we have no experience as to what would occur in such a breast, the glandular tissue of which may be entirely normal, in case pregnancy should supervene. It is probable that such a gland would at first secrete milk, but as there could be no excre tion, the secretion would either cease and the gland subsequently atrophy, or suppuration would occur, with the formation of numerous abscesses; at least this is the case in other acinous glands, as the parotid after liga tion of Steno's duct. Operative measures would avail nothing, since, even if, by removal of the remains of the nipple, the mouths of the ducts could be again opened, they are so small that they would not remain patent.
Kicks on and bruises of the breasts occur frequently, but are usually of no immediate consequence. Sometimes they cause subcutaneous and intraglandular hemorrhages, which run the same course as in other regions of the body, being usually absorbed spontaneously. If the blow was a severe one, inflammation and subsequent abscess may result. If the extravasation has formed a cavity, it may be encapsulated and trans formed into a cyst or fibrous tumor, which may be a long time in dis appearing.
Extravasations of blood into the mamma also occur without external wounds, especially in girls and young women subject to dysmenorrhoea and amenorrhoea; this has been observed by Cooper, Velpeau and Birkett, and is doubtless a so-called vicarious menstruation, though not so frequent as in other parts of the body. Such extravasations are usually absorbed,
without further consequences; they are generally entirely painless, but are, in a few cases, accompanied by a feeling of tension in the breasts. Applications of lead-water, infusion of camomile, etc., may be ordered if medicinal treatment be desired. If the hemorrhage is more severe and causes great pain, a light compress is the most rational means of afford ing relief.
Dentu and Verneuil describe cases of sudden swelling of the mam mary glands, with induration (engorgement, selerenze pklegnzasique tem potwire), which occur in old women, and disappear after a few weeks or months; some of these women had arthritis.
When erysipelas ambulans attacks the breast, the diagnosis is easily made. An erysipelatous rash, primarily originating on the mamma, may spread from fissures in the nipple, as to the nature of which there may be at first some doubt. Great sensitiveness to superficial touch, sharp limits of the rash, slight tension of the glandular mass with a high eruptive fever will make the .diagnosis in one or two days. Infection of wounds of the nipple, especially in lying-in houses, through unclean matters from the mouth of the child, by aphthEe, are the most frequent causes; so also fright, digestive troubles and cold. The treatment of true erysipelas of the mamma: is that of the disease generally. Nursing should be pro hibited, as in so severe a disease the secretion of milk will be interrupted at all events the milk of an erysipelatous woman may be injurious to the child.