MAMMARY GLAND, Inflammation of.
Acute inflammation of the mammary gland may be regarded practically as a disease of nursing women, and in nearly every case its cause will be found to be infection through a cracked nipple. The wise practitioner will therefore make it his business to see that any complaint of pain while the child is sucking is followed by a careful examination of the nipples and by the proper treatment of any crack, fissure, or abrasion that may be present (see Nipples). Unless he is confident of the ability of the nurse to carry out that treatment, he should insist on a dress rehearsal of it being carried out under his own eye.
1 t is common to find about the third day after delivery a condition of engorgement of the breasts, which are hard, swollen and tender, and there is often some rise of temperature and pulse. If the baby can suck vigorously, this condition quickly yields to its efforts, but if the proper emptying of the breast is not attained, owing to ineffectual attempts by the suckling, measures should he taken to relieve the congestion, as if it is allowed to persist some degree of mastitis will probably be the result. In these cases a good breast-pump is very useful, and its use should be accompanied by the application of a binder around the breasts, which may he covered with a layer of Gamgee tissue or cotton-wool so as to equalise pressure and give some elasticity. In this way the breasts are supported and engorgement is prevented. Instead of the breast-pump the nurse may be directed to massage the breasts. This operation should he performed, for the first time at least, under the eye of the physician, as nurses are prone to massage too vigorously, and in this way are likely to do harm rather than good. The nurse should anoint her hands with olive oil, and should make stroking movements, commencing from the periphery and working towards the nipple. The strength may be gently increased as the massage goes on. Pain felt by the patient is a sign that too much force is being used, and the operation should he accompanied by a sensa tion of relief and by the evacuation of a considerable amount of milk.
Should the congestion of the breast be followed by the development of a firm, hard, tender wedge-shaped area in the gland, corresponding to a lobule, with reddening of the skin over the area, the practitioner will recognise that he has to deal with a mastitis of mild form. The breast must be emptied periodically by the pump, as it is unwise to allow sucking of the affected breast for fear of the infant becoming infected. After emptying, a thick layer of cotton-wool is placed over the gland and a firm binder or bandage applied. The external application of poultices, lotions and ointments in such a condition is useless. Under the treatment recommended nearly every case of simple mastitis of this nature will get well in a day or two, and suckling may then be resumed.
in the few cases of this class which do not resolve under treatment, and in the more serious class of cases which result from infection through cracked nipples, and which seldom develop until a week or more after delivery, the inflammatory process attacks not only the gland tissue itself, but the connective tissue between and around the lobules also, and the tendency of the process is towards the formation of abscesses. The
inflammation is not limited to a wedge-shaped lobule, but a more or less rounded area of infiltration, which may involve the whole organ in bad cases, is to be made out. This area is firm and exquisitely tender; the whole breast is enlarged and tends to hang down; the skin is reddened, and when pus has formed becomes cedematious and pits on pressure. The baby should be at once taken off the inflamed breast and engorgement with milk relieved by a breast-pump.
Weaning need not be resorted to unless both breasts are affected, unless suckling with the sound breast causes great pain and engorgement in the inflamed one, or unless suppuration persists for a long time in spite of treatment. Any cracks or fissures about the nipple should be treated at once by painting with cocaine solution and then with Tr. Benzoin. Co., Nitrate of Silver (gr. x. to -,";j.), or pure Carbolic Acid. To the breast itself warm applications are soothing, and may do good by promoting the flushing of the part with blood. Cold applications and evaporating lotions should be avoided. A poultice of lint wrung out of hot saturated boracic acid solution, with a few drops of laudanum sprinkled on it and covered by oiled silk, makes a very good application. Warm lead and spirit lotion under oiled silk may be used. Linseed or bran poultices are not to be recommended, as they are too heavy and bulky, and rapidly lose heat. The most instant cry of the inflamed breast, however, is for support, and this should be given by covering thickly with cotton wadding and bandag ing or applying a binder firmly. The wadding may be put on over the poultice, and will assist in retaining heat; or the breast may be painted with Glycerin of Ichthyol (ro per cent.), or with Liniment of Chloroform and Lin. Belladonna equal parts, and the cotton-wool then applied. Quite a satisfactory method is to warm the wool in the oven and apply it thickly over the breast with a firm hinder over it, using no medicaments at all. Antiphlogistine warmed and spread thickly over the inflamed area is recommended. Bier's hyperaemic treatment applied by the aid of a special large-sized cupping-glass to include the entire breast has been very well spoken of. Constitutional treatment should not be neglected. A smart saline purge (Magnesium Sulphate or Rochelle Salt in warm water or lemonade in the morning on a fasting stomach) should be given. The diet should be light but nourishing, and fluids should be restricted to prevent too copious a secretion of milk. If there is much pain and sleep lessness a small dose of morphia may be required.