Ice bags surround the gland night and day. The liquids by mouth are restricted and saline cathartics given. Codeine may be administered for pain. Usually the symptoms subside without suppuration in from one to two days.
Should the inflammation persist for more than two or three days, in most cases the tissue will break down and form a mammary abscess. When it is evident that suppuration has begun, heat may be applied to the gland and the process accelerated. The abscess may be superficial or deep and will be diagnosed by a bogginess in a circumscribed area or by fluctuation. The abscess must be opened as soon as possible.
The nurse sterilizes a bistoury and a pair of long artery forceps. Lysol solution and cotton sponges are made and sterile gauze for packing. The hands are surgically prepared and rubber gloves worn. If an anæsthetic is required, gas may be used, or chloroform. The incision is made radially from the nipple so as to minimize the injury to the milk ducts. A gauze drain may be required for a few days.
In the after-care, the nurse must be scrupulously clean and not convey contagion from the breast to the woman’s genitals, to the child’s eyes, navel or vagina, nor to her own person.
Excess of milk is rare, but may be observed for a short time after the glands fill. It seldom requires treatment, but saline cathartics, restriction of fluids, and putting the child on a four-hour schedule will reduce it. Pads may be worn if it runs away freely.
Scarcity of milk is only too common. There may be enough at first and the quantity gradually diminish, or it may be deficient from the very beginning.
The faulty secretion may be due to the age of the mother, to disease (anæmia), to bad nutrition, or to overwork. It may follow a premature child. Compression of the breasts by corsets or tight dresses may prevent development. The amount of gland tissue is very important. Many women have large, fat breasts, but a small glandular development. Mental conditions, such as fright, worry, and anxiety, will diminish the flow of milk or stop it altogether.
Symptoms.—The child is fretful, goes to sleep after nursing but soon wakes up, or may nurse awhile, and then finding it useless, will cry and refuse the nipple. He loses weight and when weighed before and after feeding, the scales scarcely vary. No secretion or very little can be squeezed from the breasts. The child may be given a bottle after which he goes to sleep.
Treatment.—When the gland tissue is defective, no treatment can succeed.
The appetite must be improved by bitter tonics and the mind relieved of its anxieties, if possible. Change of scenery may help. The fluids must be increased, milk, cocoa, chocolate and gruel must be pushed, and such vegetables added as corn and beets. Oyster stews, clams, lobsters, and crabs will help. The diet must be full and nutritious with especial stress on those foods that raise the blood pressure. Malt drinks or champagne may avail in some cases. Exercise in moderation is desirable.