Professor Meigs regards it as a matter of great consequence, in the application of nitrate of silver, to touch only the granulations, and not the skin itself. His method is, to take a fine camel’s-hair pencil, and dipping it in a solution of the nitrate, to carefully pencil the granulations only. The edge of a large feather, or the feather end of a goose quill, could very well be made to answer the same purpose. It is certain that this application will in many cases give relief, more or less, to sore nipples, as it does to sore lips and other parts; but, as before remarked, it sometimes makes them worse, and we have as yet no rule by which to determine beforehand as to what cases it will be applicable, and what cases not. Those who choose can experiment for themselves. I myself prefer the water-dressings; yet there is no good reason why the two may not be combined, if that is thought best. A solution of twenty grains of the nitrate to an ounce of pure water, is a good proportion in which to use it.
I have already spoken of cleanliness as a prophylactic means in the management of the nipples; and I would here again urge upon the attention of all who are interested in the subject, the exceeding great importance of this observance. Never should a child be nursed without the mother at once, on its leaving off, taking a sponge or soft linen cloth, and making the part perfectly clean, and afterward dry. This may appear a matter of small importance to some, but it is the attention to these small matters that go to make up the great sum of health. Professor Meigs, who admits the great frequency of sore nipples in his own practice, tells us of the method of one of the Philadelphia nurses, Mrs. De Groot, “a most sensible woman, in whose prudence and knowledge of her business he could confide,” and who informed him that the nipple rarely becomes sore under her management, which is as follows: “As soon as the child has left the nipple, Mrs. De Groot cleanses it with a bit of moistened linen. She dries it perfectly, and then, taking the mamilla (nipple) between the thumb and two fingers, she gently compresses it, with a view to assist it in disengorging its capillary vessels, that are rendered turgid by the suction. As soon as she has rendered it soft and flexible again, she covers it thick with fine arrow-root powder, and keeps it in that way perfectly dry. I do not remember,” continues the Professor, “that the ladies she has nursed for me have, any of them, suffered from this annoying disorder.”
Almost any dry substance, of an inert or harmless nature, such as Indian meal, or rye, or wheat flour, would answer as well as the flour of arrow-root to dry the nipple. I mention this fact for the reason that in many parts of the country arrow-root is not easy to be obtained.
The cracks or gaping ulcers of the nipples may be often helped very materially by acting upon a well-known principle of surgery. Wherever in the living body there is a gaping wound, the healing process is found to be facilitated by retaining the parts in close connection. Thus in a common cut or wound, when the edges are separated, we apply stitches or adhesive plaster to bring the parts into closer union, so that in the granulating or reparative process, nature has much less to accomplish. The greater the space to be filled by a new growth, the longer the time required, and the contrary. On this principle, then, of bringing the parts into closer union, thus giving nature a less amount of work to perform, a cracked nipple may often be benefited very much. A delicate strip, or better, if we can manage it, delicate strips of plaster may be applied in such a way as to shorten the reparative process a good deal. Besides, too, the sore part is thus shielded from the action of milk or other deleterious substances that might otherwise come in contact with it. But the plaster has in it no healing property whatever; nothing at all in its nature which can aid the granulations. It only acts as a mechanical agent in keeping the parts in a more favorable condition for healing. The ulcer should be made as clean as possible before any such measure is resorted to.
I should mention particularly, before closing this subject, that bathing the breasts and nipples daily and often, in cool or cold water, before confinement, has a most salutary effect in hardening the parts, and rendering them less liable to inflammation and soreness of whatever kind. So too, indeed, we say of general bathing, and all habits which tend to the improvement of the general health. Always, the better the condition of the general system, the less liable to disease its local parts.
LETTER XXXVI.
INFLAMMATION OF THE BREAST.
Structure of the Mammary Gland—Nature and Causes of Inflamed Breast—Means of Prevention and Cure.
It is very common in midwifery-practice to encounter swelling and inflammation of the breast, more commonly within a few days of delivery. In the majority of cases, this inflammation is managed without much difficulty; but in some cases it would appear that the part must suppurate, or break, as we say, forming what we call the mammary or milk abscess. This is one of the most troublesome things women are ever brought to endure; but however much pain and discomfort milk-abscess may cause the patient, it never kills; and yet the patient may be kept for months in the sick room, suffering from the affection more than tongue can tell.
Inflammation of the breast may come on at any time during lactation. It is more common, however, in the earlier than the later parts of the period. The nursing mother cannot, however, at any time be too careful in all matters pertaining to health, since a little imprudence is sufficient, in many cases, to induce this affection. In multitudes of instances it has been brought on by some apparently trifling carelessness, when, with a little forethought and self-denial, perhaps, months of pain, suffering, and discouragement might have been avoided.
In order to understand the management of the female breast during lactation, it is necessary that we should know what it is, its anatomical structure, and its physiological functions.