DEFECTS OF DEVELOPMENT. — Short, depressed, and otherwise imperfectly-de veloped nipples — generally the result of corset-pressure—are frequently the seat of inflammatory disorders during a period of lactation and should be care fully watched.
Out of 525 in childbed only one-half could suckle thoroughly in the first two weeks. The development of the nipple bore a direct relation to the value of the breast as a secretory organ. Wiedow (Centralb. f. Gyntik., .No. 29, '95).
The undue suction to which they are necessarily submitted, the delicacy of the tissues, any abnormal condition of the milk, the augmented flow of saliva which the increased efforts of the infants in duce, all tend to start a folliculitis. This soon develops into ulcerative fissures that become excruciatingly painful. They bleed easily and may cause, through the suffering induced, general and even men tal disorders quite out of proportion to their cause. Small abscesses may follow and greatly compromise the value of the nipple: an efficient portion of the appa ratus of lactation.
Treatment.— These complications should be anticipated. Some time before parturition the nipple should be manip ulated daily, the aim being to bring blood to them and to increase their nutrition by gentle efforts to encourage their protrusion. Buccal or instrumental suction is recommended by many ac coucheurs. They should be washed daily with a weak boric-acid solution and carefully dried. The manipulation gradually accustoms the nipple to me chanical irritation and by the time tbe infant is born they are better able to stand that involved in the suckling proc ess.
Free use of alcohol as a wash for the nipples during the last month of preg nancy recommended. In case a fissure should develop a nipple-shield should be used, and if it persist the fissure should be thoroughly cauterized. Auvard (L'Union 1\-I-6d., July 19, '88).
Depressed and useless nipples have been operated upon as follows:— An assistant, with a pair of vulsella forceps, seizes the nipple and drags it out to a length somewhat greater than natu ral; the operator, with a pair of curved scissors, beginning, at a point about Vs inch from the apex, excises a diamond shaped piece of skin, extending out on the breast about 21/2 inches and about 'A to inch broad at its centre. The
fat is cleaned aw ay down to the fascia, which protects the duets from injury. Three such areas of denudation are made. Beginning in the denuded area. a catgut suture is passed in and out throngh the fascia, purse-string fashion, emerging at the point of entrance and encircling the base of the newly-designed nipple. This is now tied snugly, and, if properly passed, will hold the nipple out well after the vulsella has been removed. The de nuded areas are now covered (as is the catgut suture and its knot) by drawing the skin of the diamond-shaped incision together with silk. A dressing is then applied so as to keep the breasts as much at rest as possible, when union by first intention is usually found to have oc curred. Treatment must not cease with the w ithdrawal of the sutures, but the nipples must be protected by a suitable shield. Axford (Annals of Surg., Apr., '89).
Following method has proved success ful in prevention of sore nipples:— 3 Lanolin (Liebriech), 1 ounce. Dispense in glass or porcelain screw-cap jar.
Sig.: For external use every night.
Patient begins its use from four to six weeks before the expected date of confinement and continues until delivery. Every night at bed-time a small portion of lanolin is thoroughly worked into each nipple with the thumb and fingers. In the morning it is removed by a soft nail brush which is well-soaked. The nipple should be brushed with lukewarm water and any mild, pure soap (preferably a white soap), giving it a thorough lath ering for three or four minutes. It should afterward be rinsed with fresh water and dried as after ordinary bath ing. J. Milton Mabbott (N. Y. Med. Jour., Sept. 10, '98).
Instrument for stimulating and irri tating the maim-tire employed with bene fit. It consists of a large hollow hemi sphere inclosing the entire breast, with art aspirating bulb. Every morning the in strument is applied and the breast as pirated. As soon as pain is felt the aspi ration is stopped and the apparatus is left in place for twenty or thirty minutes.
This treatment is used in the following four classes of cases: (I) undeveloped breasts; (2) obstinate vomiting of preg nancy; (3) debility in young girls at the period of puberty; and (4) cblorosis. Dumas (Jour. de MM. de Faris, 19, vi, '98).