AFFECTIONS OF THE BREAST: THE MILK SUPPLY.
Cracks and Fissures of the Nipples are a common cause of much suffering after child birth. These are to be avoided by regular nursing, by carefully bathing the nipples after each nursing with cold water and drying them, and by the use of some agent which will toughen the skin, of which the best is glycerine of tannin, or glycerine of borax. It is not a matter of wonder if a mother suffers from tender nipples who permits her child to be con tinually at the breast, so that one nipple or another is constantly in the child's mouth.
Sonic mothers suffer from such an excessive flow of milk that the dress is continually wet and the breast continually in a milk -bath. This will naturally make the skin tender and readily crack. Keeping the breasts as dry as possible, and limiting the flow of milk, if pos sible, by dieting, are the remedies. If the nipples are hacked and painful, the use of a nipple shield during nursing gives much relief, the other treatment already indicated being employed.
It is needful to bathe off, with cold water, the tannin and glycerine or other application before putting the child to the breast.
Abscess or "Gathered Breast" often re. sults from ligglected cracks and painful nipples. The breast becomes full and swollen and pain ful, especially over one part, which also becomes hard. The breast should be treated as recom mended under milk-fever, first with the iced water, and then, if it fails, with hot water applications. A brisk dose of opening medicine (seidlitz-powder) should be given. If matter forms, it must be "let out" by the abscess being opened, and should on no account be allowed to burst.
Whenever the breasts are large and swollen, great relief is given by a bandage passing under the affected breast and over the opposite shoulder, so as to support it.
It is also necessary to keep down the swell ing of the breasts as much as possible by regu lar removal of the milk. If this is not pro perly done by the child, a breast-exhauster, or breast-pump, must be secured at once, and the milk must be frequently drawn off by its means. The exhauster and its mode of appli cation are ;shown in Plate XXXI. It is advis
able to apply the exhauster every two hours or so, to remove by its means small quantities of milk frequently rather than to attempt to remove a large quantity at one time. if this is done, and the other measures advised are adopted, threatened inflammation of the breasts will often be speedily subdued.
Defective Supply of is some times due, during the first few days of nursing, to the mother's own anxiety lest she should not have enough milk for her child, the anxiety acting as a hindrance to the milk production by nervous influence. Good nourishing food, with a plentiful supply of liquids, specially hot milk, and at the same time such measures as are likely to stimulate the breast, such as friction with warm oil, are almost certain to overcome the difficulty, along with perfect regularity in putting the child to the breast.
Excessive Supply of Milk is met by op posite measures, a dry diet, at longer intervals, and support and gentle pressure over the breasts by a firm bandage. The bandage should be broad enough to cover the whole breast, and a small opening on each aide should permit the nipple of each side to pass through. If this is insufficient, the whole breast may be painted, except the circle round the nipple, with extract of belladonna, made thin enough with glycerine; a square of gamgee, with a sufficiently large opening in the centre, is then put on and firmly secured by means of the broad bandage.
To Stop the Production of Milk, the mea sures noted in the immediately preceding para graph should be taken. In addition, of course, the child would not be put to the breast, except to draw just sufficient to relieve the mother, though a breast-exhauster would be best for this purpose. Also a brisk dose of saline medicine—seidlitz, effervescing saline, Hunyadi Janos water, or Epsom or Glauber's salts— should be given. If these steps are insufficient, a dose of 10 grains iodide of potassium, given in wine-glassful of water, and repeated every six or twelve hours for three or four doses will probably be effectual.