AGALACTIA. — From a, priv., and xaV,t, milk.
Definition..—Absence of the mammary secretion after parturition. The term is generally understood as meaning defect ive lactation, especially as to quantity.
Symptonis.—Absence of the mammary secretion after labor is rarely observed. The appearance of milk may be delayed days and even weeks, but evidence of functional activity usually appears, al though frequently the quantity secreted is insufficient or the quality of the milk is not of a character to afford sufficient or proper nourishment to the infant.
Statistics of 126 lying-in women :n the obstetrical wards of the Halle clinic from February to May, 1895, inclusive. Out of the 126 cases, 83 (or 65.9 per cent.) had sufficient milk when discharged be tween the tenth and twelfth days. Buch mann (Centralb. f. Gynak., No. 25, '96).
Deficiency of secretion may occur from the start and continue throughout the entire period of lactation, or it may be normal in amount at first and gradually diminish.
Etiology. — Heredity is a prominent factor in case of true agalactia. Puech has reported the case of a woman who had given birth to thirteen children, but whose breasts, though normal, had never yielded milk. Her mother, who had given birth to twenty-three children, had likewise • been absolutely sterile as regards the secretion of milk.
Case of complete agalactia in a woman, aged 25, primipara, whose mother is living and in good health, having borne 9 children, 3 of whom are now living; 4 died at about five years of age, 1 at eight, and 1 at twelve months. The patient is the eighth child, and says her mother has often told her that in none of these puer peria had she any milk, although the breasts were natural in appearance. The patient has one married sister, who at 25 years gave birth to a full-term child, and she never had a drop of milk for her baby. J. Ives Edgerton (Med. News, Feb. 6, '97).
General ill health in which anTrnia plays the leading role is the most fre quent cause of retarded, defective, or imperfect lactation. Lack of confidence, on the part of the mother, of her ability to nurse; excitement, fatigue, highly spiced food, overfeeding, and insufficient sleep may be mentioned as the most fre quent auxiliary factors.
Injudicious dressing whereby the are compressed, the pressure interfering with their circulation and proper nutrition, is a frequent cause of deficient lactation. Advanced age, especially in women who have suffered frequently from miscarriages, may also be included among the etiological fac tors. The habit of weaning early or avoiding lactation tends to cause atrophy of the breasts and to repress the lacteal secretion.
Prolonged suckling, specific affections, and iodide of potassium are also consid ered as causes of mammary atrophy, and, therefore, of deficient lactation powers.
Intercurrent affections, especially when acute, frequently arrest the flow of milk. High fever, when temporary, usually causes diminution of the secre tion for the time being, and it may act as the primary factor of gradual cessa tion.
Pathology. — When there is total ab sence of mammary secretion, both breasts are usually affected. When the secretion is only defective, the involvement of the glands in the pathogenic process, local or general, is usually unequal, one mamma being less productive than the other. Large breasts, owing to the quantity of adipose tissue present, are more likely to be agalactic than the smaller and thinner ones. The ducts and glands are usually found deficient in number and size, while the adipose tissue or the fibrous strorna is unduly abundant.
Treatment.—The first indication is to carefully inquire into the cause of the condition. In the majority of cases there is general deficiency in the per formance of metabolic processes due to general physical apathy. The patient should, therefore, be provided with nutritious food and appropriate tonics, especially strychnine, which is peculiarly effective in these cases. 1 The bowels should be regulated by proper dieting and massage or exercise rather than by laxatives, and it is highly desirable that there should be at night uninterrupted sleep for six hours for mother and child.