PATHOLOGY OF THE NURSING WOMAN General Diseases. — Only such disturbances will be considered here as are peculiar to the healthy nursing woman. The first thing to be considered is constipation, that ever-present complaint of the nurs ing woman. I cannot but attribute the presence of this trouble, to a great extent, to the senseless regime which is oftentimes prescribed by the physicians themselves. The favorite insipid unappetizing diet of the nursing woman which produces but little peristaltic action; the perfectly incomprehensible prohibition of the use of fruit, together with a decrease in general activity, may be considered the etiological factors. Indeed, the use of large quantities of cow's milk, expedient as a matter of diet, often causes disagreeable constipation.
diet should be regulated. Food rich in cellulose should be given (fruit, vegetables. lentils, huckleberries), and proper exercise should be ordered. If a laxative is necessary, castor oil should be avoided, since this, like other fat products, is taken up in the produc tion of the milk. This far no particular bad effects have been noted from its use, but it always seems better to use some of the many other evacuants, preferably a mineral salt.
Diseases of the Breast.—The very painful nodes which are the result of stasis border upon a pathological condition. The treatment, a com plete emptying of the breast, is suggested by the etiology. Binding helps to relieve the condition.
Far more painful are the fissures, which are usually very much dreaded; they are as a general rule circularly arranged and are not always easily seen, but the great pain on nursing makes the diagnosis certain. The had effects of these are felt in various ways. At first, the act of nursing is accompanied by great distress, but later, and this is the most important, the glands become infected by way of the fissures. The treatment must be first directed against the harmful effects of nurs ing. For this, particularly on account of the very severe pain, the child is allowed to nurse with a nipple shield, which does not always satisfy it. Where the distress is very great it may become necessary to put the child only to the sound breast and completely to empty the diseased one manually. The healing process is assisted by applications of nitrate of silver of six to ten per cent. solution, or the use of a salve composed of: Argen. ...... gr. xv
Bats. pertly. 10 O..... . iiss Ling. ..... .ad 100. ......q s. iii Or tannin-alcohol, which is composed of : Spir. rectificatiss .ad M. Sig.—Apply frequently.
The French particularly recommend orthoform. A dusting powder or a ten per cent. alcoholic solution is used, rubbing it in for half an hour and then carefully washing it off.
Mastitis.—Inflammations of the lactating glands are often pro duced by bacteria, especially the staphylococci or the streptococci, the point of entrance being as a rule the fissures or cracks of the nipples. Accompanying an increase of temperature, the breast becomes pain fully hardened, in spite of the attempt to empty it. Later the infiltra tion becomes increased, the skin begins to redden, and soon the fluctua tion shows that purulent disintegration has begun. If this is not opened multiple perforations often occur spontaneously. In neglected cases, the whole organs becomes infiltrated and inflamed, pus being discharged from numerous openings.
Therapy.—In inflammations of the breast, prophylaxis is of the greatest significance. Where there are no points of entrance for bac teria there can be no inflammation. The slightest crevices in the nipple, therefore, to say nothing of the fissures, should be treated with the greatest care. If a proper technic is carried out infections \vill surely be avoided.
If the condition is already present we should attempt to secure restitution by hydropathic applications and bandaging. Frequently this regime will accomplish the result. But when abscess formation has already begun, incisions should be made, and care should be taken to make these radially in order not to wound unnecessarily the numerous milk-ducts. Drainage tubes or strips of iodoform gauze should be placed in the incisions. Good results have also recently been obtained by the Bier suction apparatus.
Mastitis is Not Necessarily a Contraindication to long as there are no pus corpuscles found in the milk, the child may be allowed to nurse. In other cases, where the pain from stasis in the inflam matory tissue is especially severe, it \vill be necessary to empty the breasts manually as far as possible, regardless of the quality of the milk.
On the healthy breast, nursing must, of course, be continued. It often happens that the productive power is so greatly increased that it is sufficient for the nourishment of the child.