“The sub-cutaneous inflammation, if circumscribed, differs in nothing from a common phlegmon, and requires the same treatment. It is not easy to resolve it, but a tepid poultice will do this, if it can be done; if not, it brings it forward. When it bursts, the poultice should be exchanged, in a day or two, for mild dressings.
“The inflammation of the fascia, if light, is marked by some little tension of the breast, with erythema of the skin over the affected portion. There is considerable fever, but not much pain, and the disease is likely to yield to tepid fomentations and a purgative, if the milk can be drawn off freely. If the fascia be more extensively or severely inflamed, the breast swells quickly, and this distention adds to the disease, which, indeed, is often caused, at first, by distention of the fascia. The pain is great, and the fever considerable. The inflammation never is confined to the fascia, but is communicated either to the sub-cutaneous cellular substance above it, or to the parts below it, usually to the former, and after, at the same time, to the latter.
“When the deeper parts are affected, the inflammation may be more or less prominent in the lactiferous ducts, or a cluster of acini; or often in that dense, peculiar kind of substance, which is their medium of union, or in those fatty packets which are sometimes met with in the gland. Often it seems to commence in one of the sinuses near the nipple, and, spreading, involves the surrounding cellular substance. In this case, it becomes prominent, and seems as if quite superficial. Milk is not secreted by those acini which have suffered. Matter presently forms, and spreads under the fascia with much distraction; and when, at last, after long suffering, the abscess gives way, much pus is discharged, with pieces of slough, chiefly consisting of portions of fascia. Usually, there is a considerable degree of fever attending the complaint, and the pain is often severe, especially when the breast is extensively affected.”
Treatment.—A great variety of methods have been adopted for the prevention and cure of inflamed breasts. This affection is often brought on, doubtless, by carelessness, neglect of drawing the milk from the parts sufficiently often in the beginning, excessive fatigue, seeing too much company, too much care and anxiety of the mind, overfeeding, hot and stimulating drinks, feather beds and pillows, overheated rooms, want of attention to bathing and cleanliness, and last though not least, excessive drugging; these are among the more prominent of the causes of inflamed breasts.
The first and most important consideration, then, is to avoid, if possible, the disease. Mothers, and all of you who hope or expect to become mothers, if you wish to save yourselves a great deal of needless pain and suffering, a great deal of restlessness at night; if you wish to avoid one of the most troublesome and disheartening affections to which the female system is ever liable, I warn you in the strongest feelings of sympathy and regard for your sex, that you avoid, so far as is possible in the nature of things, the CAUSES of this terrible disease.
But some have poor, feeble, scrofulous constitutions, and cannot by any possibility avoid the inflammation of which I am speaking; and, do what we will—the best that, in the nature of things, can be—the breast must, I think, in some cases inflame, suppurate, and break. An accidental blow, likewise, so slight that it would scarcely be felt upon almost any other part of the system, may cause a mammary inflammation and abscess. And, worst of all, to think of many a poor mother who has so poor a habitation, is so much oppressed by the cares and perplexities of domestic life, and has such poor care and nursing that she is always in great danger of suffering with inflamed breasts.
The treatment of this affection, therefore, is a matter for the serious consideration of both parents and physicians; and, as I before remarked, a great variety of methods have been adopted for this end.
We should remember that we are to treat an INFLAMMATION, and that the plain principle of treating all inflammations, of whatever grade or kind, when of acute character, is the antiphlogistic or anti-inflammatory plan. By what means and to what extent to use these means, are circumstances in which the skill, tact, and good judgment of the physician are to be exercised.
A very common error has been to treat too much locally in this disease. This is, in fact, a very common fault in medical practice generally. I have no doubt that many an inflamed breast has been rendered worse than it otherwise would have been by the too great amount of local means employed. In many such cases, doubtless, the breast has been made worse than it would have been had no treatment whatever been employed.
As soon, therefore, as the patient begins to experience a chill coming upon her, with pains in the back, limbs, etc., together with a general uneasiness and restlessness, and, perhaps, with an inflammation already commenced in one or both of the breasts, no time should be lost in setting at work resolutely to combat the approaching evil. The sooner we act, and the more prompt and resolute in the treatment, the greater the chance of preventing an abscess. We give the rubbing wet-sheet, if there is not already too much fever, the tepid shallow-bath, with a good deal of friction; a general cold bath, if the patient is not too weak; the packing sheet, the wet girdle, wet compresses upon the breasts, injections of tepid water, and follow up the applications as much and as often as the symptoms may demand. Above all, the patient should not be worried by a multitude of ignorant and careless, though, perhaps, well-meaning friends, who each and all insist that some particular poultice, or some favorite “cure-all” of theirs will certainly arrest the difficulty, if the patient will but condescend to use it, and that if she keeps on with the water, it will certainly cause the breast to break. How exceedingly foolish, ignorant, and prejudiced are the multitude in regard to these things! Every practitioner of water well understands how much we have to encounter in society, because of the prevailing ignorance of the most common remedial uses of the greatest and most abundant of all curative agents which God has given to man.