ULCERATION OF TIIE thema frequently occurs as a complica tion of lactation particularly in primip am. Far more distressing, however, is a condition due to the fact that the co lostrum causes maceration of the epithe lium of the nipple; small vesicles appear which, if not arrested by timely treat r.. .t iupture. The erosions .1 lilt 1.0 \ red 1% ith I' t0.0.11 Ilt..0111.: \Willa normally nt. sii,1,111; being continued. the • r. an. transformed into ulcerating -. %%Lodi sunctimes involve quite ;. ,;(ort, lion of tissue. Occasionally instead of being sep r 1( ..ine (0111111(2M, and, the entire co\ eriii2; of the nipple being a raspberry-like nipple re ? Tit( se conditions are sometimes th.f.,ravatid by an unhealthy con n f the infant's mouth—which •1 always receive considerable at t- 11; It \dun mammary disorders are nt.
1 1,,tires of the nipple are exceedingly pi:tiftil, as already stated. They are frequently met with at the apex .,nd the base of nipple, where it meets arLola. In the latter case the suction child tends to tear them open, as 1%ears; hence the excruciating suffer ,ng indueLd. They usually appear the f,t,rth day, but sometimes earlier, and te marked febrile symptoms may be T realment —It is evident that the pre .. fiti,-11 here, first, of the primary and, if this is present, of the sec (.iri.lary manifestations, are indicated. S. rupidous cleanliness of the nipple will pr. vt•nt accumulation of colostrnm and Nip primary erosions; hence this should 1,L in‘i-ted upon. Both nipples should carPfully washed with a weak boric ,..1,1tion. not only after nursing, but miqr.atply beforP. and they should be ref dripd.
rnrc.at pare nui,-t, be taken during lac t to keep the child's mouth clean and the nipple carefully washed with s Jug. an/ iseptic. S,hould there be anv id,nce of a threatening mastitis nurs it:: should cease at once. AV. RICII A P.D''‘ON, Assoc. Ed., Annual, '89.1 When local lesions exist, suspension of lactation on the affected side causes them to disappear in a few days, pro vided adequate cleanliness is insured.
When but one nipple is involved, there fore, it can be allowed to rest, the other being used for suckling. A breast-pump may be used to draw the milk front the disordered breast to avoid undue ac cumulation of milk. Buccal suction, by the nurse or the husband, was formerly recommended; but, the condition of the mouth being unknown, the breast-pump is to be preferred—if kept very clean.
Simple erosions usually yield promptly to hot water and laudanum, or Goulard's extract, the nipple being kept covered with a light compress soaked in either of these solutions. At night carbolized ointment is preferable, to avoid adhesion of compress to the hard surfaces when the liquid has evaporated.
Exeoriations of the nipple occasioned by nursing. should be painted over by a solution of gutta-percha in chloroform. This application covers the excoriations with a film, which is not removed by the application of the child to the breast. Monti (Les Nouv. Rem., No. 4, 'SS).
Dermatol mixed with an equal quan tity of castor-oil used in treatment of sore nipples. It is not necessary that the breast be thoroughly cleansed before the child receives its nourishment. P. Gross man (Omaha Clinic, Oct., '91).
The slight erosion on the upper surface of the nipple, so common in primiparous nursing, women, heals readily when touched with a strong solution of nitrate of silver, while the fissures and cracks at the base of the nipple improve at once when collodion or compound tincture of benzoin is applied, and a glass nipple shield used for a clay or so, or, in the bad cases, suspension of nursing, on the afflicted breast for twenty-four hours. The women should be instructed to notify the physician as soon as one of these lesions of the nipples appears, so that active treatment may begin at once. When pus has once reached the glandular tissue, incision and drainage are neces sary. Harrison D. Jenks (Physician and Surgeon, Nov., 1900).