Eczema of the nipples is sometimes taken for simple erosions, but it yields to the same measures. The salicylic acid ointment is also of value.
When fissures are present, the same measures are indicated, but in addition stimulation by means of nitrate of silver is required. The nipple being washed and carefully dried, the mitigated stick, finely pointed, is gently applied to each fissue; the moisture within the latter affords precisely that needed to obtain the best effects from the remedy. Care should be taken not to touch the surface of the nipple.
In the treatment of fissured nipple, when the cracks are at all extensive, ex cellent results can be secured by the ap plication of an ointment made up of equal parts of castor-oil and subnitrate of bismuth. Before application, the nip ple and surrounding skin should be care fully cleansed and disinfected, and then the ointment should be smeared on plen tifully. If it is necessary for the child to nurse from the affected nipple, it can be allowed to do so without the necessity of removing the ointment from the nipple.
For engorgement and pain in the mam mary gland itself, which often accom panies fissured nipple, excellent results obtained from the use of an application of lead-water and laudanum, which is applied by means of a cloth covering the whole breast, renewed at frequent inter vals and kept in place by a suitable mam mary binder. If the child can be nursed from the other breast alone it is safer to draw the milk from the affected gland by means of a breast-pump until the cure is almost complete. If it is necessary that the child should nurse from the cracked nipple, a glass nipple-shield with a rubber tip must be employed. B. C. Hirst (Univ. Med. Mag., Mar., '9I).
Orthoform dressings successfully used in fissured breasts. The technique of the 1 dressing is very simple. The powdered orthoform is dusted over the entire wound, and the latter is covered with a compress bearing a layer of the remedy. Over this is placed a layer of absorbent cotton, and finally rubber sheeting, the whole being kept in place by a bandage. In a few minutes the patient who has up to then felt incessant pains at the affected part, experiences considerable relief. Every time before nursing the child, the dressing is removed, the breast washed with warm boric-acid water, dried, and then the child put to the breast. At the first sucking some pains
are felt, but these rapidly subside, and after the nursing is over, the breast is again washed mith boric-acid water, dried, and the same orthoform dressing applied. The analgesic effect of the orthoform being very durable, it suffices to renew the dressing at first twice daily, then, as the wound begins to eieatrize and the pains disappear, once only per day.
Besides its analgesic effect, orthoform exercises in the wound an action at once siccative and antiseptic, which favors cicatrization. In 29 cases personally treated, the cure was brought about in from four to five days on the average, the patients continuing to nurse the chil dren. This method of treatment pos sesses the great advantage of being in nocuous to both mother and child, be cause the orthoform is entirely free from any toxic property. Teisseire (Sem. Med., xviii, p. ccxxvi).
In fissure of the nipple N.-tinting the nipple three or four times daily with a solution of permanganate of potassium, 2 to 5 per cent., causes the fissures to dis appear in less than a week. Considerable smarting is caused at first, but this soon disappears. Before nursing the breasts should be washed with warm sterilized water, and a compress covered with a permeable cloth applied. Dombrowski (Le Progres Mkl., Jan. 7, '99).
Orthoform in saturated alcoholic solu tion procures anaesthesia and complete relief from pains. The solution is placed on a compress over the fissure in the nipple and allowed to remain for fifteen minutes. M. Oui (Caz. Hcbdom. de MiRI., etc., June 3, 1900).
When both nipples are affected, the infant should be given the breast as ,; t it. i.e., as long as thethe pressure of the • • t . Prior to each nursing the .1 .t I carefully washed and a t it.1 it. mployed to protec, .
,,,f.] t sometimes shows evidence of -r refusis to suck through fl , 1•11 1 tile patience usually con • - t it s tuation. .1 glass shield with • 1, 1,..1,1-rialqr tip is to be preferred. lr ult1 Iscpt scrupulously clean and I imintdiately before and after if the infant refuses to use the •ii.. %%I.tting the latter with sweetened ,knerallv acts as an inducement.
(- uhdial measures already,' indicated rt tilt n resorted to.
Mastitis.—Three forms of inflamma t n of the mammary gland are recog , the zit)cutancous, the submamrp«:r.... and the parenchymatous.