As regards the temperature of the applications, local and general, we do no violence to the system. Should we persevere sufficiently, we could cure almost any fever or inflammation with water at 80° Fah., a temperature so mild that the most delicate child can bear it.
One thing in particular should be remembered: the patient should not be bundled up closely, and have a great deal of warm bed-clothing, under the impression that a cold will be taken if such measures are not adopted. We almost always find patients heating and injuring themselves in this way. But it should always be remembered, that when a fever or inflammation is already present, it is not possible to take an additional cold.
As for local applications upon the breasts, fine wet linen cloth should be used constantly. As to the temperature, I think it best to consult the patient’s feelings merely. It is, perhaps, best to alternate somewhat; sometimes to apply warm or tepid cloths, at other times cold. I think a change is often good; at any rate, we should keep the parts constantly wet.
The wet cloths are covered with dry ones, or flannels, if necessary; but if there is great heat in the part, it is best to leave the compresses uncovered, so that by evaporation a much greater amount of heat may be thrown off. Sometimes the breast becomes so heavy and painful, that it is a great comfort to the patient to have it suspended in a sling.
I have already hinted how important it is to keep the milk well drawn. The mouth of an adult person is one of the best means, and the infant is often able to do good service in this way. Some get along pretty well with a tobacco pipe. But the instruments generally found in the shops are illy suited to their object. One form, the suction-pump, is an invaluable piece of mechanism, provided the glass that fits upon the breast be of the right shape, and have an opening sufficiently large to admit a man’s thumb. Generally, they are much too small, causing a good deal of pain when used; but if they are of the right make, they will draw the breast with more comfort and less pain than the infant itself.
Before the breasts are drawn, they should be well washed, for this will always help the milk to flow; and in connection with this subject, there is one highly interesting and instructive fact in regard to bathing. Thus, a patient may be in a condition in which, in consequence of the inflammation present, no milk whatever can be obtained. But we give the patient a good ablution of the whole body, even a simple tepid-bath, and directly we may succeed in getting milk; and in some instances it is made actually to drop of itself from the breasts. Even the washing of the breasts alone will sometimes cause it thus to flow.
Should an inflamed breast ever be opened after the matter has once formed? The most common practice has been to do it. Dr. Gooch, however, who is high authority with the profession, speaking of this disease in that state in which the matter approaches the surface, says: “Will you open the abscess? If you do, you will relieve your patient from suffering, and by the evacuation of the matter the constitutional disturbance ceases; but the wound will not heal so soon, and the maturation of the abscess will not be so complete as if the whole process were left to nature.” I have myself opened them at the request of patients in some instances; but I have become convinced that it would have been better, in the end, not to do it.
Dr. Burns tells us—although he recommends opening the abscess—that the puncture is liable to be followed by a troublesome oozing of blood from the wound, and that in one instance he knew the hemorrhage to prove fatal.
After the abscess has burst, there is for some time a discharge of purulent matter, which is not unfrequently mixed with milk. The utmost cleanliness should be observed, and a considerable amount of general, as well as local treatment should be kept up until the healing is fully effected.
Thus, then, in the use of water, locally and generally applied, together with the proper adaptation of the other hygienic means, I consider that we have a remedy which far surpasses all others in that troublesome affection of which I am treating; a remedy which, if it cannot always cure the inflammation without an abscess, will yet so much mitigate it, so much promote the healing, and so much support the patient’s strength, that mammary abscess, if it must occur—and I think, do what we will, in some few instances such must be the case—it is yet stripped of its greatest horror, and rendered, generally, a comparatively trifling affair. Such has been my own experience, and such, I think, will be found to hold good wherever the water-treatment is faithfully and skillfully applied.