If the female be advanced in life, or very weak, or if she becomes pregnant, it may be better to procure a nurse than to attempt to stimulate the flow at all. The appearance of the menses need not occasion a suspension of nursing, unless it evidently deranges the secretion of the milk, or affects the health of the mother; in either of which cases the child should be weaned at once.
Engorgement of the Breasts.—The breasts are liable to become swollen, or engorged, from colds, blows, hard nursing from the child, over feeding, and from soreness or excoriations preventing them being fully emptied. This state may occur at any time, but is most frequent a few days after delivery. In general there is no danger from it, unless it be very bad or continues too long; it may then inflame and discharge, or become permanently hardened. To prevent such accidents the breasts should always be sufficiently emptied, either by the child or by artificial means, and every precaution should be used against cold or violence. Constipation must also be guarded against, and the diet and drink must be carefully observed, so that it be not too feeding, or too stimulating. Warm fomentations or poultices may also be used when the breasts are painful, and a Dover's Powder may be given at night, after bathing the feet in warm water, to promote perspiration.
Inflammation of the Breasts.—This is only a more advanced stage of the previous malady, produced by the same causes, and by want of timely attention. Like simple swelling, it may arise at any time during nursing, but is more frequent a few days after delivery. As soon as the inflammation commences the breasts become red, swollen, and excessively tender, particularly at one point, which soon begins to project like a nipple, if the disease is not stopped, and at last bursts and discharges the contained pus. Sometimes the inflammation is comparatively superficial, and extends only over a small portion of the surface, but at other times it goes deep and spreads wide. In proportion to its extent is the severity of the symptoms, which are those of inflammation in general, such as headache, thirst, fever, general uneasiness, and cutting pains in the part affected.
As soon as the abscess is formed and can be plainly discovered, it is usual to open it immediately, because the longer it remains the more extensive it becomes, and the larger portion of the breast becomes diseased. It is necessary however to be certain, before making an opening, that it is really an abscess on which we are going to operate, for sometimes a healthy part of the breast feels very much like one, and a mistake may easily be made; in fact such a mistake has often been made, and by men of experience too. In the early stage of the inflammation every effort should be used to prevent an abscess from forming, by the use of purgatives, sweating medicines, low diet, cooling drinks, and warm fomentations over the whole chest. Some females practice cold fomentations over the breasts, and with good success, in the commencement of the inflammation, but it may increase the difficulty with others, and, so far as I have seen, is no more generally useful than the other method. The warm bath all over the body is also very serviceable in a number of cases.
It usually happens however, in spite of every precaution, that matter will form, and its discharge become necessary. As soon as this is evident, it should be promoted as much as possible, by hot fomentations and poultices, till the head of the abscess is sufficiently distinct for it to be safely opened. While the swelling is going on the pain is often very severe, and it should be eased as much as possible, by using laudanum in the fomentations, or by putting on an opium plaster. After an abscess has opened and discharged, it should be kept open for some time, by little pledgets of lint, to prevent its closing up too soon, otherwise a portion of the matter may be shut in by the wound healing over it, and another abscess will form. Warm poultices and lotions should also be used afterwards, to promote the discharge as much as possible, but they should not be used after it has evidently begun to cease naturally. In short every means pointed out should be used energetically in the first stage, to prevent the gathering, but if it takes place in spite of them, then it should be hastened and discharged as early as possible, to prevent its extending. After this, when it has evidently all escaped, the wound may be suffered to heal, and the patient must be enjoined to be very careful in future, for the same accident will be very liable to reappear.
Sometimes these abscesses become very extensive, and remain for a long time. I have known ten or twelve on one breast, and I have known them to continue open for many months. When this is the case it is much to be deplored, as it is very likely indeed to destroy the breast, and may even lead to more serious results. Attention therefore cannot be bestowed upon them too early or too unremittingly, particularly if the female be scrofulous, or of a very full habit. Sometimes the inflammation attacks both breasts, and at other times only one, in which case every effort should be exerted to prevent its extending to the other. In many persons the same side is always affected, and becomes a scape-goat as it were for the other.
When the means used succeed in scattering the swelling, its dispersion is usually followed by some critical discharge, such as diarrhœa, or a great flow of urine, or even by profuse perspiration, which shows how nature operates in removing the diseased matter, and cautions us not rashly to check such discharges.
It is a very serious matter for the swelling to indurate or harden, as it sometimes will, without either scattering or dispersing, as it is then constantly liable to become worse again, besides destroying the structure of the gland. Every means should therefore be used to prevent this, by promoting its dispersion or discharge, in the way already pointed out. It is also very good in these cases to bathe frequently with alum water, or decoction of white oak bark, or even to rub on some of the Ointment of Hydriodate of Potassa, diluted with an equal weight of fresh lard. A piece as large as a hickory nut may be well rubbed on twice a day, for three or four days, but it should be stopped immediately the swelling begins to subside, and not used again unless it still remains or again increases. In many cases pretty frequent friction, with the hand anointed with a little oil, will be all sufficient, especially if a hot fomentation be used afterwards.
Excoriations, or Cracks in the Breasts.—The annoyance from this cause is sometimes very great, the pain which is experienced when the child begins to nurse being so acute that it is impossible for the mother to allow it to remain. Frequently I have known it compel weaning much earlier than was desirable, and sometimes it has even been so bad, that the dress could scarcely be borne against the breasts. The precise cause of this liability to crack is not known, nor do we know of any certain means to prevent it. In many cases however I have known it prevented, to a great extent, by having the nipple gently sucked, very frequently, for six weeks or two months before childbirth. This hardens it, and if a wash of borax water be also used, after each time, it will be gradually prepared for its proper use. Our means of curing this troublesome affection are very limited, and frequently everything fails that is tried. The mucilage of Quince seed, prepared by bruising and boiling them in a small quantity of water, rubbed over the sores with a soft feather, immediately after nursing, often does much good. The mucilage from the tender tops of young sassafras sometimes succeeds better than that from the Quince, and a bruised leaf from the large horse-shoe Geranium, laid on like a poultice, is sometimes better than either. A good lotion may also be made with a quarter of an ounce of borax, and a tea-spoonful of laudanum, to half a pint of warm water, to be used frequently during the day. Some females use a wash made of saleratus, with considerable benefit, and others find relief from one made of nut galls, or white oak bark. Most of these means however are well known, and many others also, which, like them, sometimes succeed and often fail. The artificial nipple, or shield, should be tried if none of these means succeed, and frequently it will enable the mother to allow the child to nurse, though it may not altogether prevent the pain.
It not unfrequently happens that the child's mouth may be diseased, particularly with apthæ, or thrush, and this may possibly keep up the excoriations; in like manner the state of the breasts may also influence the mouth, and therefore the condition of each should be well ascertained when anything is the matter with either.