washed the linen of one who had died of puerperal fever; the next
lying-in patient she nursed died of the same disease; a third nursed by
her met with the same fate, till the neighborhood, getting afraid of
her, ceased to employ her. The disease has been known, according to Dr.
Gooch, to occur in some wards of a hospital, while the others were at
the same time free from it. Dr. Blundell, who is certainly very high
authority, while he admits that this fever may occur spontaneously, and
that its infectious nature may be plausibly disputed, affirms, that in
his own family he had rather that those he esteemed the most should be
delivered, unaided, in a stable—by the manger side—than that they should
receive the best help in the fairest apartment, but exposed to the
vapors of this pitiless disease. Gossiping friends, wet-nurses, monthly
nurses, the practitioner himself—these are the channels by which, in Dr.
Blundell’s estimation, the infection is principally conveyed.
Some authors contend, also, that it is only through the influence of the
imagination, or by sympathy, that puerperal fever becomes more prevalent
by times than ordinarily; and there can be but little doubt that these
causes operate to a greater or less extent in communicating the malady.
If a weak and nervous patient fears it, and especially if it is
prevailing epidemically in the neighborhood in which she resides, she is
much more liable to an attack than if she had no thoughts whatever of
the disease. It is, moreover, under such circumstances more likely to
prove fatal than when it occurs sporadically.
Fortunately, however, the question of contagion does not at all affect
the treatment of this terrible malady. All agree that it is an
inflammatory disease which demands, under all circumstances, at our
hands, an antiphlogistic or anti-inflammatory treatment. There can be no
two opinions on this point; and it is a circumstance worthy of the most
particular remark, that we have in water-treatment the most abundant of
therapeutic resources by which to combat inflammation of whatever name
or grade—resources more potent and effective, a hundred-fold, than any
other ever known to man.
LETTER XXXV.
OF SORE NIPPLES.
This Complaint is a very common one—Its Causes—Methods of Prevention and
Cure.
Excoriated or sore nipples are very common, as every one acquainted with
matters of childbirth knows. “You can have at present,” says Professor
Meigs to his class of young men, “no idea of the vexations that women
endure in nursing their children in the month, from sore nipples: a
complaint so common, that I am always surprised when I hear one of my
patients say she does not suffer from it.” “The nurses and doctors,”
says Dr. Gooch, “have a long list of remedies for this complaint; but it
is in general obstinate, and the remedies are ineffectual; in attempting
to cure it, you are rowing against the stream; as long as the cause,
namely, the action of the child’s mouth in sucking, is renewed at short
intervals, local applications are of little use.”
What, when, are we to do with sore nipples? an affection apparently so
trifling, and yet one which causes an amount of suffering that can be
adequately appreciated only by those who are brought to endure it? Are
we to suppose that it is the order of nature that women should thus
suffer in that most important matter, the rearing of their young? Do we
find any analogy in nature by which we are led to such a conclusion? It
is very plain, I think, that we do not. All mammiferous animals, when
left to themselves, nourish their young without disease or pain. Thus,
too, would it be with the human species, did we, as the animals, live in
accordance with the natural laws.
Let us look, then, for the causes here concerned.
1. _The general Condition of the System._—In consequence of the
ill-governed habits of the generality of females, both in pregnancy as
well as at other times, a great amount of morbid matter is formed in the
system. Too much food is eaten generally, and of improper kinds. The
blood, fluids, and secretions of the system generally are in an impure
state. Thus it is, that when a small wound or abrasion is made, the part
does not readily heal. A drunkard’s system often becomes so impure that
he festers and dies of a mere pin-scratch. Thus we see that the
condition of the living body may be modified at pleasure to an almost
indefinite extent. Women, particularly, who are, or who ever expect to
be pregnant, cannot be too particular—cannot take too much pains, in
order to preserve a pure and healthy state of the general system. Depend
upon it, this will tell when they come to that ever-important period of
nursing the new-born babe.
2. _Cleanliness._—Many, no doubt, get sore nipples, in great part,
because of their want of attention to cleanliness. Wash the nipples
often, and keep them at all times most scrupulously clean, if you wish
to prevent them becoming diseased. Nowhere is it more necessary that
this ever-important duty should be strictly observed.
3. _The Dress._—It is said that the Greek women were in the habit of
supporting their bosoms by a certain contrivance called _strophium_, and
the Roman women by one called _fascicola_, which were not at all liable
to compress or countersink the nipple, as carpenters would say. The
breast should always be left free to grow in all its parts; and if there
had never been any corsets, busks, or tight dresses among us, we should
not meet that troublesome affection, the countersink of the nipple. If
young ladies could know how great an amount of suffering they are
rendering themselves liable to, when they compress their bodies in this
way, they would, I am sure, one and all, avoid that which can do them no
good at the time, and must end in inevitable harm. Sad is it to think
that they have never been taught on the subject; their mothers are not
acquainted with it, nor are there any popular works treating of these
matters from which they can gain the information which would prove of
such signal benefit to them. It is, then, with feelings of earnest
regard for the condition of the sex, that I prepare this work for those
who stand in so much need of that information which it attempts to put
forth.
With the view of drawing out the nipple more effectually, it is
sometimes asked of the physician, whether it is not advisable to have
the breasts drawn by a young puppy, or by a friend, before the birth
takes place? An objection to this practice is, that in consequence of
the sympathy that exists between the breasts and the womb, exciting the
former before the time of the full period of pregnancy might, or,
rather, would cause pains in the latter before the proper time; in other
words, premature labor would be likely to result. Besides, it is the
order of nature that drawing the breast be practiced only after the
birth has been accomplished. Nothing whatever can be gained by drawing
the breast before delivery.
Sore nipple may arise from a variety of causes. The breast sometimes
becomes so inflamed, so hard, so obstinate—all, perhaps, in spite of the
best that we can do—that it is found impossible to extract any milk
whatever from the lactiferous tubes. Under such circumstances the
frequent sucking of the nipple by the child, or, what is worse, by the
use of the miserable instruments which have been contrived for drawing
the breast, it is often made very sore. At other times, too, the
patient’s system appears to be in a state highly calculated to favor
cracking or chapping of the surface, such as we observe in many persons,
who, when they commence bathing, find their hands and feet becoming very
sore. These are always evidences of impurity in the body, and the proof
of this fact is found in the circumstance, that if they set resolutely
at work to renovate their health by the hydropathic treatment, they
become cured of the symptoms, just in proportion as they become firmer
and more vigorous in general health.
We need not expect to remedy sore nipples to any great extent so long as
the breast remains inflamed. We must first cure the breast, and then
with reasonable care and attention the nipple will soon heal of itself.
But if the general system is at fault, the blood impure, and the skin at
any moment, on the application of a little moisture, liable to crack,
then our object should be to employ such a course of constitutional
treatment as is calculated to improve the system generally. Sore nipple
often consists “in a long, narrow ulcer, wide as a horse-hair, and a
sixteenth of an inch long; this ulcer is so small, that it requires a
good light to see it; and even then it often cannot be detected, except
by bending the nipple over to the opposite side, which discloses it.”
This ulcer is often so exceedingly painful, that the mother is unwilling
to nurse the child as often as it should be done; thus exposing her to
the evils of an over-distended and inflamed breast; and we may judge
something of the anguish which the poor patient endures, when we see the
tears streaming from her eyes every time the child attempts to nurse. We
see, too, how difficult it must be, in many cases, to cure this kind of
sore nipple, since every time the child takes it into its mouth it holds
and stretches the part, thus causing the crack to become larger and
worse.
A great variety of the so-called remedial substances have been tried for
the cure of this affection. I would not say that none of the ointments,
washes, powders, etc., which have been thus employed have any good
effect. But one thing I am confident of, which is, that the
water-dressing, that is, fine linen compresses or lint, wet in the
purest and softest water, and often changed, to prevent their becoming
too warm, in connection with appropriate constitutional treatment, will
be found the best that can be resorted to.
Some have recommended very highly the use of nitrate of silver in curing
sore nipple. Sometimes, perhaps often, it seems to work well, but by
high authority in the profession it is affirmed that in many cases the
disease is only made worse; nor has any rule been ascertained by which
it can be determined beforehand as to whether harm or good will be the
result in any given case.
Professor Meigs regards it as a matter of great consequence, in the
application of nitrate of silver, to touch only the granulations, and
not the skin itself. His method is, to take a fine camel’s-hair pencil,
and dipping it in a solution of the nitrate, to carefully pencil the
granulations only. The edge of a large feather, or the feather end of a
goose quill, could very well be made to answer the same purpose. It is
certain that this application will in many cases give relief, more or
less, to sore nipples, as it does to sore lips and other parts; but, as
before remarked, it sometimes makes them worse, and we have as yet no
rule by which to determine beforehand as to what cases it will be
applicable, and what cases not. Those who choose can experiment for
themselves. I myself prefer the water-dressings; yet there is no good
reason why the two may not be combined, if that is thought best. A
solution of twenty grains of the nitrate to an ounce of pure water, is a
good proportion in which to use it.
I have already spoken of cleanliness as a prophylactic means in the
management of the nipples; and I would here again urge upon the
attention of all who are interested in the subject, the exceeding great
importance of this observance. Never should a child be nursed without
the mother at once, on its leaving off, taking a sponge or soft linen
cloth, and making the part perfectly clean, and afterward dry. This may
appear a matter of small importance to some, but it is the attention to
these small matters that go to make up the great sum of health.
Professor Meigs, who admits the great frequency of sore nipples in his
own practice, tells us of the method of one of the Philadelphia nurses,
Mrs. De Groot, “a most sensible woman, in whose prudence and knowledge
of her business he could confide,” and who informed him that the nipple
rarely becomes sore under her management, which is as follows: “As soon
as the child has left the nipple, Mrs. De Groot cleanses it with a bit
of moistened linen. She dries it perfectly, and then, taking the mamilla
(nipple) between the thumb and two fingers, she gently compresses it,
with a view to assist it in disengorging its capillary vessels, that are
rendered turgid by the suction. As soon as she has rendered it soft and
flexible again, she covers it thick with fine arrow-root powder, and
keeps it in that way perfectly dry. I do not remember,” continues the
Professor, “that the ladies she has nursed for me have, any of them,
suffered from this annoying disorder.”
Almost any dry substance, of an inert or harmless nature, such as Indian
meal, or rye, or wheat flour, would answer as well as the flour of
arrow-root to dry the nipple. I mention this fact for the reason that in
many parts of the country arrow-root is not easy to be obtained.
The cracks or gaping ulcers of the nipples may be often helped very
materially by acting upon a well-known principle of surgery. Wherever in
the living body there is a gaping wound, the healing process is found to
be facilitated by retaining the parts in close connection. Thus in a
common cut or wound, when the edges are separated, we apply stitches or
adhesive plaster to bring the parts into closer union, so that in the
granulating or reparative process, nature has much less to accomplish.
The greater the space to be filled by a new growth, the longer the time
required, and the contrary. On this principle, then, of bringing the
parts into closer union, thus giving nature a less amount of work to
perform, a cracked nipple may often be benefited very much. A delicate
strip, or better, if we can manage it, delicate _strips_ of plaster may
be applied in such a way as to shorten the reparative process a good
deal. Besides, too, the sore part is thus shielded from the action of
milk or other deleterious substances that might otherwise come in
contact with it. But the plaster has in it no healing property whatever;
nothing at all in its nature which can aid the granulations. It only
acts as a mechanical agent in keeping the parts in a more favorable
condition for healing. The ulcer should be made as clean as possible
before any such measure is resorted to.
I should mention particularly, before closing this subject, that bathing
the breasts and nipples daily and often, in cool or cold water, before
confinement, has a most salutary effect in hardening the parts, and
rendering them less liable to inflammation and soreness of whatever
kind. So too, indeed, we say of general bathing, and all habits which
tend to the improvement of the general health. Always, the better the
condition of the general system, the less liable to disease its local
parts.
LETTER XXXVI.
INFLAMMATION OF THE BREAST.
Structure of the Mammary Gland—Nature and Causes of Inflamed
Breast—Means of Prevention and Cure.
It is very common in midwifery-practice to encounter swelling and
inflammation of the breast, more commonly within a few days of delivery.
In the majority of cases, this inflammation is managed without much
difficulty; but in some cases it would appear that the part must
suppurate, or break, as we say, forming what we call the mammary or milk
abscess. This is one of the most troublesome things women are ever
brought to endure; but however much pain and discomfort milk-abscess may
cause the patient, it never kills; and yet the patient may be kept for
months in the sick room, suffering from the affection more than tongue
can tell.
Inflammation of the breast may come on at any time during lactation. It
is more common, however, in the earlier than the later parts of the
period. The nursing mother cannot, however, at any time be too careful
in all matters pertaining to health, since a little imprudence is
sufficient, in many cases, to induce this affection. In multitudes of
instances it has been brought on by some apparently trifling
carelessness, when, with a little forethought and self-denial, perhaps,
months of pain, suffering, and discouragement might have been avoided.
In order to understand the management of the female breast during
lactation, it is necessary that we should know what it is, its
anatomical structure, and its physiological functions.
In structure, the breast is a conglomerate gland, and consists of lobes
which are held together by a dense and firm cellular tissue; the lobes
are composed of lobules, and the lobules of minute cæcal vesicles, the
ultimate terminations of the excretory ducts.
Near the center of each breast there is a small projection of the
tegumentary coverings, constituting what is called the nipple; this is
surrounded by an areola or border, having a colored tint.
Before conception, this areola is of a pink color; after conception it
assumes a brownish hue, which deepens in color as pregnancy advances.
This brownish tint continues through life.
About the nipple there are a considerable number of sebaceous follicles,
which secrete a peculiar fatty or oily substance for the protection of
the delicate skin about the part. During the period of nursing, these
follicles become increased in size, having the appearance of pimples
projecting from the skin. The sebaceous or fatty secretion from these
follicles serve, during lactation, to shield the delicate part from the
action of the saliva of the child’s mouth.
The milk-tubes, or excretory ducts, as they are anatomically named, are
usually ten to fifteen in number; and as many as twenty-one is said to
have been found in a single breast. These tubes commence by small
openings at the apex of the nipple, and passed inward parallel with each
other toward the central part of the breast, at which place they become
enlarged, and branch off in every direction throughout the mammary
gland; these communicate in some way with the blood-vessels of the part,
and, by a peculiar and wonderful provision of nature, the milk is formed
from the blood within them. Among and about the milk-tubes, there are
many adipose cells, more or less numerous, and more or less filled in
different cases, giving to the part its peculiar rotundity and softness.
The milk-tubes are capable of supplying a quantity of milk greater or
less, as the case may be. With some persons, an immense quantity is
secreted; at a single time a pint or more of milk may be drawn with a
breast-tube from a single breast. But we are not to suppose that all
this amount of milk is contained within the ducts at the time we
commence drawing it; a small portion may be there, but the greater part
is secreted after we commence. After a time the power of the gland to
produce it being exhausted, the milk ceases to flow; but after nature
has been allowed to rest an hour or two, it again recovers its
milk-giving power, and is ready to furnish it liberally, as before. A
good cow has an udder, which, if we were to cut it off, could readily be
put into a small pail; and yet this same cow is capable of giving milk
enough at a single milking to fill two or three pails of the same size.
This shows us how admirably fitted these organs are for pouring out that
material which is so necessary for the sustenance of the young: a
material, simple as it may appear, yet one which art and science, with
all their boasted pretensions, cannot at all imitate. The chemist can
tell us that milk is composed of a mixture of water, albumen, casein,
and oil, which we call cream; but all the chemists in the world cannot
make a drop of milk, or any thing that, in physiological properties,
will at all compare with it.
The breasts are abundantly supplied with nerves and blood-vessels, and
it must be evident that so great a functional power as that which is
exerted by the mammary gland during lactation, must be supported by a
great quantity of blood and nervous force. Hence it is, that during
nursing, the breasts are supplied with a much larger amount of blood,
and are much larger in volume than at other times. In this wonderful
fact, as in many others of the living body, we see the ever-beautiful
order of nature, in adapting her means to her ends. If every thing
happened by chance, we might just as soon find the breasts containing
less blood when milk is needed, as more. But the doctrine of chance is
too palpably absurd to need comment.
_Symptoms of Inflammation of the Breast._—A day or two, or a few days
after delivery, we often find the patient apparently so well and in such
good spirits that we conclude there is no further need of our
attentions. But in a day or two more we are sent for in great haste
perhaps. We go, and find the patient downcast, dispirited, and evidently
enough sick. We inquire as to what has been the matter. The patient
tells us she has been attacked with a chill, in spite of which she could
not get warm for one or two hours, or perhaps longer; just such a chill
as would be experienced in the coming on of an ague, or any other fever,
or some inflammation.
“Inflammation of the breast,” according to a very accurate writer, Dr.
Burns, “may be divided into three species, according to its seat—the
sub-cutaneous cellular substance, the fascia, and the glandular
substance.
“It may take place at any period of nursing, but is most readily excited
within a month after delivery. It may be caused by the direct
application of cold, engorgement from milk, the irritation of excoriated
nipples, mental agitation, etc. Some have the breasts prodigiously
distended when the milk first comes, and the hardness extends even to
the axillæ. If, in these cases, the nipple be flat, or the milk does not
run freely, the fascia partially, in some habits, rapidly inflames.
Others are more prone to have the dense substance, in which the acini
and ducts are imbedded, or the acini themselves, inflamed.
“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.