Advice to a wife and mother in two parts

by Pye Henry Chavasse

690. Another cause of a gathered breast arises from a mother sitting up in bed to suckle her baby. An infant ought to be accustomed to take the bosom while he is lying down; if this habit be not at first instituted, it will be difficult to adopt it afterward. Good habits may be taught a child from the very earliest period of his existence.

691. A sore nipple is another fruitful cause of a gathered breast. A mother, in consequence of the suffering it produces, dreads putting the baby to it; she therefore keeps him almost entirely to the other bosom. The result is, the breast with the sore nipple becomes distended with milk, which, being unrelieved, ends in inflammation, and subsequently in gathering.

692. The fruitless attempt of an infant, to procure milk when there is very little or none secreted is another and a frequent cause of a gathered bosom. Dr. Ballard, in his valuable little work before quoted, considers this to be the principal cause of a gathered breast; and, as the subject is of immense importance, I cannot do better than give it in his own words, more especially as he has the merit of originating and of bringing the subject prominently before his professional brethren. He says: “This (mammary abscess or gathered breast) is another form of disease entirely referable to the cause under consideration [fruitless sucking]. In the case last related, the formation of mammary abscess [gathered breast] was only just prevented by arresting any further irritation of the breast by suckling; and since I have kept careful notes of my cases, I have observed that in all instances of abscess there has been abundant evidence of a demand being made upon the gland for a supply of milk beyond that which it had the power of secreting. If the child only has been kept to the breast, then it has suffered with disordered bowels; but in the majority of cases an additional irritation has been applied; the commonly-received doctrine that a turgid breast is necessarily overloaded with milk, leads mothers and nurses to the use of breast-pumps, exhausted bottles, or even the application of the powerful sucking powers of the nurse herself, to relieve the breasts of their supposed excess; and it is this extraordinary irritation which, in the majority of cases, determines the formation of an abscess [gathering]. Sometimes these measures are adopted to remove the milk when a woman is not going to suckle, and then an abscess not unfrequently is established. I have previously alluded to the mistake into which mothers and nurses are led by the appearance of a swollen breast; it is not evidence that the gland can secrete freely, and it is in this turgid state that the excessive irritation tells most severely. This hyperæmic [plethoric] condition seems to be a step toward inflammation, and the irritation supplies that which is wanting to complete the process. If a woman will only remove the child from the breast directly the act of sucking produces pain, she may be pretty sure to avoid abscess. So long as the milk can be obtained there is no pain.” The above most valuable advice deserves great attention, and ought to be strictly followed.

693. How is a patient to know that she is about to have a gathered bosom?—There are two forms of gathered breast; one being of vast and the other of trifling importance. The first, the serious one, consists of gathering of the structure of the gland of the breast itself; the latter, merely of the superficial part of the bosom, and ought to be treated in the same manner as any other external gathering, with warm poultices.

694. In the mild or superficial kind of gathered bosom, the mother may still persevere in suckling her child, as the secreting portion of the breast is not at all implicated in the gathering; but in the severe form, she ought not, on any account whatever, to be allowed to do so, but should instantly wean her child from the affected side. The healthy breast she may still continue to nurse from.

695. The important form of a gathered breast I will now describe: A severe gathered bosom is always ushered in with a shivering fit. Let this fact be impressed deeply upon my reader’s mind. This shivering is either accompanied or followed by sharp lancinating pains of the bosom. The breast now greatly enlarges, becomes hot, and is very painful. The milk in the affected bosom either lessens or entirely disappears. If the child be applied to the breast (which he ought not to be), it gives the mother intense pain. She is now feverish and ill; she loses her strength and appetite, and is very thirsty.

696. A medical man must, at the very onset of the shivering fit, be sent for; and he will, in the generality of instances, be able to prevent such a painful and distressing occurrence as a gathered breast. If twelve hours be allowed to elapse after the shivering has taken place, the chances are that the gathering cannot altogether be prevented; although even then it may, by judicious treatment, be materially lessened and ameliorated.

697. We sometimes hear of a poor woman suffering dreadfully for months, and of her having a dozen or twenty holes in her bosom! This is generally owing to the doctor not having been sent for immediately after the shivering; I therefore cannot too strongly insist, under such circumstances, upon a mother obtaining prompt assistance, not only to obviate present suffering, but, at the same time, to prevent the function of the breast from being injured, which it inevitably, more or less, will be, if the important form of gathering be allowed to take place.

698. When a nursing mother feels faint, she ought immediately to lie down and to take a little nourishment; either a crust of bread and a draught of ale or of porter, or a glass of wine, or a cup of tea with the yelk of an egg beaten up in it, either of which will answer the purpose extremely well. Brandy, or any other spirit, I would not recommend, as it will only cause, as soon as the immediate effects of the brandy are gone off, a greater depression to ensue; not only so, but the frequent taking of brandy might become a habit—a necessity which would be a calamity deeply to be deplored!

699. A mother is sometimes faint from suckling her child too often, she having him almost constantly at the bosom. So long, of course, as she continues this foolish practice, she must expect to suffer from faintness.