A manual of midwifery / by Alfred Lewis Galabin.

Date:
1904
Catalogue details

Licence: In copyright

Credit: A manual of midwifery / by Alfred Lewis Galabin. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    nipple. Both excoriations and fissures may bleed. The child then swallows the blood with the milk, and may vomit it again afterwards. It will also be passed per rectum, and thus constitute one of the forms of meloena in the infant. Both excoriations and fissures are apt to cause great agony in suckling, and make the mother dread the application of the child to the breast. Even a very minute fissure may cause this intense suffering; and hence it is necessary to make a very careful examination wlienover pain in suckling is complained of. These conditions of the nipple are among the most important causes of inflammation and abscess of the breast. Propln/la.rin.—During ])regnancy the nipples should be washed fro(|uentl3’, and the epithelium should not be allowed to accumu- late, so as to leave tender spots on its detachment. In primipara3, especially if the nipples are tender, it is desirable to harden the skin before delivery by washing with spirit or a solution of tannin. I )uring lactation, the nipjfles should be carefully washed and dried after each time of suckling. Trentmenl.—'I’ho lotion recommended by Playfair, consisting of half an ounce of sulphurous acid, half an ounce of glycerine of tannin, and an ounce of water, often does great good. The fissures or excoriations may also be touched once a day with a solution of nitrate of silver (gr. x. ad Bi.). Some recommend touching with the s(jlid stick of nitrate of silver. Eordyce Barker recommends the a|)plication of the compound tincture of benzoin. It is rre(|ucntly found that less ])ain is produced if the child sucks through a glass nipple-shield, fl’his plan does not, however, answer so well for fissures at the base as for excoriations at the apex of the nipple. If the fissures or excoriations do not other- wise heal, suckling with the affected breast should be discontinued for a day or two. This will generally allow them to heal without putting an end to lactation altogether. Mastitis :—Mammary abscess.—At the time when the secretion of the milk commences it is common, especially in primipane, for the breasts to become unequally swollen, knotty, and painful. This condition arises from obstructions in the lacteal ducts, pi’cventing a free outflow of the seci’etion. When the child has been lost, and the breasts are therefore not relieved by its sucking, the glands may be more uniformly affected in a similar way. In either case, the condition may amount to actual inflam- mation. There may be elevation of temperature and jiulse, as well as local pain, swelling and tenderness, and sometimes even rigors occur. Thickened lymphatics may be traced, running to the axilla, and the axillary glands may become swollen. It is very rare, however, for this form of inllammation, without other cause, to go on to the formation of abscess, and it almost always ends in resolution.