NIPPLES, Sore.
The treatment of sore nipples begins during the pregnancy, when the patient's breasts, especially if she is a primipara, should be examined, and measures taken to remedy any defects in the form of the nipple that may be present. Depressed nipples should be drawn out daily in the later months of pregnancy, and a wooden nipple shield may be worn constantly in the hope that the nipple will be induced to project through the opening in its centre.
Soreness is almost invariably due to cracks or chaps on the surface of the nipple, and the nurse and doctor should be on the lookout for the appearance of these, as they are only too frequently the forerunners of mastitis and mammary abscess. To prevent their formation the nipple should be sponged with boracic acid solution, washed off with warm water before nursing, and after nursing it should be again sponged and carefully dried with a soft clean rag. Some authorities recommend that the baby's mouth should be wiped out with a clean rag wet with boracic lotion before itis given the breast. NVlicri the cracks or fissures have developed a pieceof lint soaked in saturated boracic acid solution should be kept on the nipple during the interval between the times of nursing and the breast sponged clean of the solution with warm water before the baby is suckled. A glass nipple shield should be worn, and great care should he taken that the shield is cleansed after using, and kept lying in boracic acid lotion until it is next required, the lotion being washed away with boiled water before use. If it is difficult for the child to obtain enough milk through the shield, the perforations in the rubber teat should be enlarged by passing a hot wire through them. If the fissures refuse to heal up under this treatment, the
nipple should be painted with a 5 per cent. solution of cocaine and then with Friar's Balsam, glycerin and tannin or nitrate of silver (io grs. to i oz.). The chemical used must he washed off the breast with boiled water before the child takes it. Sometimes acute pain is complained of by the mother when the child is sucking, and no fissure or crack can be found to account for it. This usually occurs in neurotic women, and can only be combated by moral influence. Patience, time and a placebo will often overcome it.
Should it become necessary for any reason to remove the child from the breast, measures must be taken to relieve the engorgement of that organ and to put a stop to the secretion. Nothing gives more relief than the judicious employment of massage, as detailed under Mammary Gland, Inflammation of (q.v.). Failing this, a hreast-pump may be used occasion ally. The breasts should be firmly bandaged, but many patients find this irksome, and there is no objection to the application of the time-honoured belladonna plaster except its messiness. A circular plaster should be cut to cover the breast, with a hole in the centre for the nipple, and the edge nicked deeply to allow of the plaster lying snugly over the whole organ. A smart purge of Epsom salt should be given, and it is well to follow this up by giving one or two teaspoonfuls of the salt every morning on a fasting stomach for a week. The amount of fluid taken should be re stricted.—R. J. J.