If, on the other hand, the mammitis is of the interstitial type, with severe subcutaneous œdema, extending over the belly and towards the perineum, good results often follow deep firing in points over the swollen region. The points should be widely spaced, venous branches being avoided. In this way numerous ducts are formed by which the toxic and septic liquid which causes the œdema is enabled to escape.
This method of treatment can be supplemented by the simultaneous use of antiseptic ointments.
Finally, in mammitis of the parenchymatous type, where there is no marked tendency to invade the interstitial tissue, the most important point is to wash out the interior of the gland, and even the acini as far as possible, with antiseptic fluids. Practically this is difficult to effect, because such irrigation must be performed aseptically, and cannot properly be left to the cowmen.
In current practice, therefore, one often has to be content with stripping the udder every hour. Milk clots which accumulate in the sinuses and galactophorous canals are broken down by soft pressure, and withdrawn with more or less difficulty. By repeated milking they are prevented from accumulating in the galactophorous sinus and canals, a very important point. Neglect of this precaution enables the colonies of microorganisms to develop uninterruptedly in the culs-de-sac, whereupon the coagula formed of casein obstruct the excretory channels and complications develop despite all external treatment.
By repeated friction of the udder as in milking the advantages that would be produced by washing out the gland from the direction of the acini are secured, and thus the ascending infection is checked.
The diseased udder must always be emptied before making antiseptic injections, which would otherwise be useless.
Should the practitioner decide to face the practical difficulties of injections, he must take care that his instruments are aseptic; that the solutions employed are always at or about bodily temperature; that these solutions are incapable of irritating even tissues so tender as the epithelium of the acini or of the galactophorous canals; and, finally, that the drugs employed will not coagulate the milk within the gland.
Bearing in mind these points, the practitioner will do well to restrict himself to the use either of boiled water, physiological salt solution (·9 per cent.); alkaline 3 per cent. solution of borate of soda; or ·05 per cent. of fluoride of sodium. Every precaution having been taken, from 12 to 20 ounces of liquid can be injected into each quarter, according to its size. The solutions should be made to penetrate as far as possible into all portions of the gland by gently manipulating the parts, and should again be withdrawn in about a quarter of an hour.
It must always be remembered that failure to observe the above precautions may make matters worse instead of better, and therefore that intra-mammary injections can only be of value when carried out by a skilled person.
In otherwise hopeless cases there remains as a last resort total or partial ablation of the mamma. This operation is advisable in cases of diffuse gangrene, or of intense massive suppuration, where there is imminent danger of death from infection.