Hemorrhages from the breast sometimes take place idiopathically, at others as vicarious efforts at menstruation. There is a peculiar sympathy between the pelvic organs of women and the mammary glands, and the latter evince this in more than one way, becoming sometimes extremely tender or swollen at the menstrual period, or at other times peculiarly sensitive or even neuralgic, while at times congestion will proceed to the point of hemorrhage. These conditions do not require particular attention, but are not to be confused with a bloody discharge that may occur later in life, in connection with certain forms of malignant disease occurring in the interior of the breast.
Fig. 524
Idiopathic hypertrophy of breasts in a girl of sixteen. (Bebee.)
There exist the widest differences in development of the breasts in different individuals. The term “breast” is used intentionally, since the difference is not so much in the actual glandular development as in the surrounding connective tissue and fat. Thus a plump breast may contain very little more secreting structure than one apparently ill-developed. Nowhere outside the uterus save in the breast do such compensatory changes take place under the stimulus of pregnancy. In fact, a mammary gland in preparation for lactation is a physiological adenoma. At conclusion of lactation there is absorption and atrophy from disuse, usually not to the original degree, although in some instances the fatty tissue disappears irregularly and leaves the breasts in quite different shape from their originals. In this way the breasts may become exceedingly pendulous, so much so as to lead to pain and soreness from traction, and to call for their support.
Idiopathic hypertrophy of one or both breasts is a rare deformity, occurring usually in the young, sometimes in girls, involving them to an indefinite degree, but in some producing enormous overgrowth, with corresponding deformity. For such hypertrophy no known cause has been assigned. [Fig. 524] illustrates an instance of this character in a young girl, occurring under the observation of my colleague, Dr. Bebee.
INJURIES TO THE BREAST.
These consist largely of contusions to which, from their positions, the breasts are peculiarly exposed, and these may be followed by hemorrhage, by extensive ecchymosis, or by any of the consequences of infection. They may also be followed by more or less permanent induration. The fact that in the course of time certain contusions of the breast are followed by development of cancer is incontestable, although the relation which may exist between the accident and the neoplasm has not yet been made clear. The breasts are also subject to the same possibilities of injury as other parts of the thorax, which has been considered in the previous chapter. The nipples are more often injured by efforts of the nursing infant, or by the friction of ill-fitting stays or rough clothing, than in any other way. These injuries, at first of a minor character, are not infrequently followed by serious results, erysipelas, septic infection, or tuberculosis being conveyed through trifling abrasions thus inflicted.
The nipple of a nursing woman once excoriated, or its surface broken, is kept constantly liable to maceration and surface infection. In this way a trifling lesion may result in a linear ulcer known as a fissure (“cracked nipple”), or in a more extensive involvement. These fissured nipples are very erethistic, and great pain is caused by each attempt at nursing. On this, account the mother postpones the act as long as possible, and until her breast has become overdistended, the result being injury to the breast itself, with a greater possibility of infection and of subsequent abscess formation.
The slightest excoriation of the nipple, under any circumstances, should lead to the adoption of every precaution for its cleansing and protection. Both before and after nursing it should be carefully washed, while, after removal of the child from the breast, it should be carefully dried and dusted with dry boric acid or a similar antiseptic. Any abrasion which fails to heal should be treated with silver nitrate. More pronounced abrasions and ulcers should be cocainized, then cauterized, and afterward treated as above. Finally in extreme cases it may be necessary to discontinue nursing and allow the breast to dry. If this policy be adopted it should be applied to both breasts, for such is the sympathy between them that the use of one gland seems to stimulate the other. The local use of such preparations as belladonna ointment, etc., is to be avoided. Pressure, rest, and the care above described afford more relief.