must be used with great caution, therefore, and the breast must be carefully washed with soap and water before the child is allowed to suck after this preparation has been applied. Cover it over with two or three thicknesses of soft linen.

These measures I have always found successful where the case has not been in its worst form; if, however, such a case should occur (fortunately they are very rare), and the treatment is of no avail, the flow of milk not checked, and the health of the mother decidedly and seriously affected, the child must be weaned, and the milk dispersed. This becomes absolutely necessary for the mother's safety.

Sect. 3.-Milk Abscess, or Bad Breast.

There is no evil that can arise in the lying-in room more dreaded by the patient than 'a bad breast.' And the reason why it so frequently occurs is, either that false delicacy and fear on the part of the patient lest the breast should be examined almost constantly induce her to submit its management to the nurse; or, the nurse herself supposing she is equal to the task, the medical attendant is not consulted until so much mischief is done that he can but in part repair it. Inadequate means are thus advised and persevered in, until the time for the successful application of the proper remedies is irretrievably lost.

The fact is, that there is no inflammatory complaint which requires more judicious and active treatment than that which attacks this organ. On this account, not a moment is to be lost in temporising; for an impression must be made, and that quickly, on the disease, or all efforts will be unavailing. And

again, I must add that there is too frequently a want of perseverance and conformity, on the part of the nurse, to the prescriptions of the medical man, after he has seen the breast. Both these circumstances, then, should be counteracted by the good sense and vigilance of the patient.

But she cannot accomplish this desirable purpose, unless some hints are given her upon the subject. This is what I now propose, not to enter upon a full detail of the treatment of mammary abscess, but only to point out in what the general management consists, that she may be able to carry out fully the intentions of her medical adviser, so that they may not be thwarted by ignorance on the one hand, or a want of proper diligence and perseverance on the other.

Inflammation of the breast, terminating in abscess, may take place at any period of nursing; but it is more readily excited within a month after delivery. It sometimes occurs after a first delivery, upon the first coming of the milk; most frequently, however, about the third or fourth week.

1. How to prevent a bad breast upon the first coming of the milk.

About the third day after delivery, in a first confinement, and occasionally in subsequent confinements also, the breasts become hard, swollen, and very soon painful. And as the process of the secretion of the milk proceeds, the breasts, more swollen than ever, appear to be made up of large and extremely hard lumps or knots, and become very heavy and very tender. After a time the milk is at its height,' as it is termed; and if the breasts be fomented or gently pressed, a small quantity of milk will be seen oozing

from the nipples.

breast, the act of

When the infant is placed at the suckling will be attended with some degree of pain, but followed by considerable relief; and as the milk flows, the hardness will diminish, the general swelling subside, and the milk being freely and frequently drawn off, the feelings of the patient will become more comfortable, and all pains removed ; the breasts will be distended only when some few hours have elapsed since they were drawn, and thus lactation will be established.

This is the usual mode. But it may happen that, from some mismanagement, from the flatness of the nipple, or because some cause prevents the milk running freely, the distension of the breast is not relieved; it gets harder, heavier, larger, extending into the armpits, and more painful than ever; inflammation ensues; a bad breast is threatened. To prevent this the following treatment should be adopted :

The bowels should be kept relaxed by saline aperients; the thirst allayed by effervescing saline draughts, and no other fluid taken; the breast fomented every third hour for five minutes, with flannels wrung out of warm water; tenderly rubbed with a liniment warmed, and composed of one ounce and a half of soap liniment and three drachms of laudanum, and afterwards each breast completely enveloped in a large and well-applied warm bread-and-water poultice. And last of all, the breasts must be supported by a large silk handkerchief passed under each, and then tied over the neck, so as entirely to prevent their hanging by their own weight.

After the above measures have been pursued perseveringly for six-and-thirty hours-and the principal points to which the attention of the mother should be

directed are, the regular fomentation of the breasts, the gentle friction with the liniment, the application of the warm large poultices, well-made, not so dry that they will irritate, and not so moist that they will make her wet and miserable, and, last of all, though not least, the well-applied support-after these means have been efficiently employed for six-and-thirty or eightand-forty hours, the breasts will begin to mend, great FIG. 8.

relief will be experienced after the application of the poultices, and, when taken off, that part which was next the nipple will be found saturated with milk. From this time they must be drawn regularly by the attendant, or by means of a pump. The little diagram represents an exceedingly convenient form of breastglass, either for self-use or otherwise, as most convenient. By it the breast can be relieved at a time

1

1 The Editor takes this opportunity of thanking Mr. Charles Maw, of the well-known firm of Maw, Son, and Thompson,

when the infant would be too weak to effect this, even if it were wise to allow it to try. The extreme swelling and tension having somewhat subsided, the child will be able to grasp the nipple and draw the milk, and, if regularly applied, prevent any injurious accumulation.

If the breasts subsequently continue lumpy and hard, the liniment should still be rubbed in every four hours, and in the intervals a piece of flannel, soaked in some of it, warmed, should be laid over the breast, which is then to be covered by a piece of oiled silk, to prevent evaporation, and keep the part nicely moist. And thus, by proper management, abscess, or bad breast, at this period, may and ought to be prevented.

2. How to prevent a bad breast when threatened about the third or fourth week, or afterwards.

This complaint much more frequently occurs about three or four weeks after delivery, or even after the female has left the lying-in room. It is at this time generally caused, either by the direct application of cold, by the pressure of the stays, or as a consequence of sore nipples. I have elsewhere pointed out how the latter may be avoided, or, if produced, cured.

And here I would observe that the moment any uneasiness, heat, tension, or anything like a lump forming in the bosom is felt, or that the child has the slightest difficulty in drawing the milk, the medical man should at once be informed of it, instead of the time being wasted in trying this little remedy or that.

Aldersgate Street, for his kindness and assistance in the selection of many instruments recommended in this book, as also for the loan of the casts from which the illustrations have been printed.