[Reprinted from the American Journal of Obstetrics and Diseases of 
Women and Children, Yol. XVI., December, 1888. 
INFLAMMATION AID ABSCESS OF THE BREAST 
DURING LACTATION^gIS^ 
l/ 
• ARTHUR M. JACOBUS M.D., 
Attending Physician for Diseases of Women, Northwestern Dispensary, 
New York. 
It is not from any special fitness that I invite attention to 
the subject under discussion, nor is it with the expectation of 
suggesting anything particularly original; but it is simply 
my desire to present a general review of the subject of the 
inflammatory diseases of the breast which occur during 
pregnancy and lactation, in order to attract notice to this 
much neglected organ and its ailments. In reading the aver- 
age text-book on obstetrics and diseases of women, one will 
be surprised and dissatisfied with the brief article and general 
remarks upon the care and treatment of these affections, and yet 
it is a subject that is worthy of our profoundest thought, and 
should not be relegated to the domain of incompetent, med- 
dlesome, or conceited nurses, or friends of the patient. Again, 
upon the healthfulness of the breast depends not only the 2 
Jacobus : Inflammation and Abscess 
future health of the mother, but the health and S 
spring. Too often are valuable lives sacrificed, or started on 
life’s voyage in an unsea worthy vessel, that is certain to foun- 
der ere it is scarcely under way; simply because the breasts 
during pregnancy and lactation were improperly cared for, 
and as a consequence, the mother could not nurse her infant, 
but was obliged to resort to unnatural methods of feeding, 
which sooner or later resulted in evil consequences. In pri- 
vate practice among the better class, one does not have the 
difficulty which superstition or lack of intelligence in the 
poorer classes cause, in obstructing our well-intended efforts 
and advice; hence, inflammation or abscess of the breast is a 
much more frequent concomitant of pregnancy or lactation in 
the latter class, or dispensary patrons who have had no previ- 
ous care, than in the former. 
I must ask indulgence, therefore, if the importance of the 
subject discussed in this paper appears to be overdrawn, as my 
experience with these disorders has been considerable, though 
principally in dispensary practice, where these afflicted patients 
can be seen almost daily, suffering intensely from their in- 
flamed breasts. It is not necessary to relate here the various 
cases seen or treated, for the history of each class or sub-divi- 
sion of these diseases is much the same; but such points as 
are considered of value, and which were gained by practical 
experience, in my own practice, or that of others, will be 
worked into this article. • 
Etiology.—The causes of inflammation of the breast may 
be considered under three heads, as follows: first, the mother; 
second, the child ; third, miscellaneous. 
I. As it is the stimulus of pregnancy which determines the 
evolution of the mammary gland with the development of its 
functional activity, we must consider this condition as one of 
the primary causes of inflammation of the breast; especially 
if the patient be a primipara, or if she has not gone to full 
time, but miscarried. Inflammation following an abortion, 
however, is so infrequent, that it need scarcely be mentioned 
as a cause. 
II. As, “ during the period of its fullest physiological bloom, 
i. e., during lactation, variations in the degree of functional 
activity normally take place; moreover, as the same gland may of the Breast during Lactation. 
contain lobules which are comparatively at rest, and others, 
which are at the full height of activity,” we must also con- 
sider this unequal vascular condition and exalted activity as 
an important factor in causing the disorders which we are 
now studying. 
Ill- Previous inflammation of the breast from scarlatina or 
former lactation, or anything which may have produced gen- 
eral constitutional debility or disturbance; such as scrofulous 
or tubercular diseases, syphilis, malaria, marked anemia, puer- 
peral fever, or septicemia, exposure to cold, emotional (?) in- 
fluences, etc. 
IV. Small or retracted nipples, whether due to natural or 
other causes, and erosions or fissures of the nipple. There 
can be no question but that erosions, ulcers, and fissures of the 
nipples, are very prominent, though indirect causes of mas- 
titis. For in persons of untidy habits, or who are careless 
about washing the breast after nursing, these channels quickly 
convey septic material from their hands, the lochia, or other 
source, to the lymphatics of the mammary gland, and thus set 
up not only inflammation of the breast, but a general lymph- 
adenitis, similar to that in other parts of the body. 
The German, as well as the leading American authorities, 
consider this to be not only the most frequent, but the princi- 
pal cause of mastitis; hence they urge the early use of anti- 
septics, to insure rapid healing. These ulcers and fissures are 
generally “ caused by the constant oozing of an excessive flow 
of milk (galactorrhea), which causes a maceration of the epi- 
thelium upon the nipple,” when it becomes loosened by the 
child’s nursing very hard, or too frequently, and then small 
vesicles and erosions make their appearance, to be followed by 
fissures. These may be so small as hardly to be noticed at 
first; but they are to be suspected if the mother complains of 
much pain when the child takes the nipple. 
Y. The principal causes due to the child are, too frequent 
nursing, an unusually vigorous child with an excessive appe- 
tite, or late weaning. On the other hand, the too infrequent 
nursing by an indifferent mother may also be an exciting 
cause of mastitis, by not relieving the milk ducts at proper 
intervals. 
YI. Another possible cause is, “ if the child be suffering from 4 
Jacobus: Inflammation and Abscess 
sprue, the transfer of the o'idium albicans imparts to the wound 
of the nipple an aphthous character,” which may set up inflam- 
mation of the superficial fascia, or even extend to the gland 
itself. 
VII. To my mind, one of the most active causes of inflamma- 
tion or abscess of the breast, outside of maternal causes, is the 
frequent use of that barbarous instrument, the breast pump. 
It is just about as sensible to apply a dry cupping-glass to a 
boil, with the expectation of dispersing it, as it is to apply the 
ordinary large-mouth breast pump to a highly engorged and ex- 
ceedingly painful breast, and then expect to get relief, and not 
add fuel to the fire of impending inflammation. 
Playfair, in his excellent work on obstetrics, says, breast 
pumps and similar contrivances only irritate the breasts, and 
do more harm than good. However, there are some pumps so 
called which have but a small opening, somewhat similar to a 
“ nipple shield,” with a tube, mouth-piece, and milk receiver 
attached, to be used by the mother; these act more kindly and 
efficiently. The pumps in general use have very wide mouths 
which suck in a large portion of the breast and contract the 
tissues about the ducts, thus aggravating the trouble, with but 
little relief in lessening the quantity of milk in the breast. I re- 
call here the exploits of my early boyhood, while living in the 
country. I often had to help milk the cows, and in order to save 
time, as well as fatigue, I would introduce a small straw in 
the one orifice of the cow’s teat, when, forthwith, a rapid, 
easy flow of milk would take place. If it were not for the 
numerous small-sized orifices of the milk-ducts in the female 
nipple, small blunt-pointed gold or aluminium tubes or tro- 
cars, similar to a hypodermic needle, might, with care, be used 
in women with a similar effect. 
VIII. Finally, trauma, whether from the bite of the teeth 
or the scratch of the child’s finger nails, and injuries from 
whatever source, all add to the causes previously mentioned, 
in setting up inflammation about the mamma. 
Classification.—Inflammation and abscess of the breast, as 
it occurs in nursing women, may be divided into three groups, 
according to the part affected, as the superficial or subcutaneous 
areolar tissue, the parenchyma of the breast, or in the deep fascia 
between the gland structure and the pectoral muscles, viz.: of the Breast during Lactation. 
5 
I. Epiglandular Inflammation, or Supramammary Ab- 
scess; 
II. Parenchymatous -Inflammation, or Mammary Abscess; 
and 
III. Subglandular Inflammation, or Submammary Abscess. 
Although the inflammation generally affects these different 
parts, often the whole of the breast becomes involved, and no 
distinct implication of any special tissue can he made out. Still, 
it is desirable, when possible, to differentiate between them, 
in order that we may the more clearly read the symptoms of 
each, and thus employ intelligently the proper treatment, which 
varies somewhat for each locality. I have met with each 
variety of inflammation and abscess in the mammary region, 
and, in my own experience, as well as that of others, the supra- 
mammary is found to be the most frequent, and the paren- 
chymatous the*most serious, obstinate, and painful. 
Symptoms.— The objective and subjective symptoms of 
these affections are very apparent, and yet, unless we have a 
clear understanding of them, it will be difficult, in some cases, 
to determine the point of origin, or principal location of the 
inflammation or abscess, until after free suppuration has set in. 
The first symptoms common to each variety are congestion or 
marked turgescence of the parts, with considerable tenderness 
and “ dragging pain,” appearing about the third day after con- 
finement, or when the secretion of milk first commences. These 
may be followed by a slight rise of temperature, which, in the 
average patient, is about two degrees. If the parts be normal, 
and the child nurses properly, this slight disturbance may con- 
tinue two or three days, then subside, and lactation go on without 
further difficulty. If such should not be the case, and there be 
any constitutional dyscrasia, the mammary tissues rapidly pass 
into an inflammatory state, to be followed, perhaps, by an ab- 
scess. The right breast is more frequently attacked than the left; 
but both glands may, under certain conditions, become affected, 
when all the symptoms are very much aggravated. When the in- 
flammation continues, and suppuration supervenes, the patient 
suffers most intensely from pains and rigors, followed by a high 
fever and perspiration, which, in some instances, has been taken 
for an intercurrent attack of malaria or remittent fever. In the 
periglandular or subcutaneous variety, the symptoms are not so 6 
Jacobus: Inflammation and Abscess 
severe, as a rule, and if the inflammation does not extend to the 
gland structure, suppuration soon occurs, the abscess breaks 
through the skin in a few days, and heals up in from one to three 
weeks, without, in most instances, preventing the process of 
lactation. It is this variety which mostly originates in a Assure 
or ulcer of the nipple, or areola, or one of its numerous sebaceous 
follicles, and gradually extends to the lymphatics, subcutaneous 
fascia, or lactiferous ducts. The glandular variety is always 
ushered in with a rigor, followed by sharp lancinating pains 
and great heat in the breast. If only a part of the gland 
be affected, circumscribed nodular enlargements can be felt 
throughout the mamma; but when the whole gland is affected, 
only a large irregular mass can be made out through the tense 
superficial structures. As the inflammation advances to sup- 
puration, the secretion of mijk is arrested in the affected lobules 
the tense, angry-looking skin assumes a dusky hue, becomes 
glazed, has a peculiar greasy appearance and doughy feel, 
and pits on pressure. 
When pus has formed, the tension of the superficial parts, 
with edema, which is greatest in this variety, and deep-seated, 
but difficult fluctuation, determine its presence. When several 
foci of inflammation exist in separate lobules, they may sup- 
purate in succession, so that abscess after abscess may develop, 
and the morbid condition be protracted for weeks, and even 
months. 
When these break spontaneously, at points unfavorable for 
the discharge of pus, fistulous tracts are left, which take on 
“ waxy degeneration,” become chronic, and are very difficult 
to heal. As a result of this long-continued suppuration and 
necrosis of tissue, entire lobes may disappear, blood-vessels may 
become eroded, from which fatal hemorrhage has been known 
to occur, and, with the access of poisonous and retained air, 
septicemia may set in, from which death will often result. 
Finally, if a large milk duct be perforated, milk, mixed with 
pus, will escape, and if the abscess open externally, a milk 
fistula will occur which will be very difficult to heal before 
lactation ceases. 
The submammary variety is very rare, and when inflammation 
occurs in this loose areolar tissue, it diffuses itself beneath the 
gland structure and invariably runs into an abscess with great of the Breast during Lactation. 
7 
rapidity. “ This rare condition owes its origin, according to 
Billroth, in most, if not in all cases, to abscess formation in 
the deep-lying glandular structures, the pus perforating the 
fasciae beneath the gland.” (Lusk.) 
The pain is of a deep, heavy, throbbing character, which is 
increased by moving the arm or shoulder, as the inflammation 
extends to the axillary glands. The breast becomes prominent, 
is conical, and the whole organ is projected forward by the 
pressure from behind. It may or may not be readily movable 
upon the pectoral muscle. 
Owing to the depth at which the pus forms, it is very difficult, 
in the early stages, to detect fluctuation, until it approaches the 
surface. The abscess at last points at the lower margin of the 
gland; but if suppuration has been profuse, the pus may ex- 
tend to the circumference of the gland, or beyond. “ Stoltz is 
said to have removed from such a sac twenty ounces of 
pus.” (Lusk.) 
Treatment.—The treatment of inflammation and abscess of 
the breast is both preventive and curative, and will be so con- 
sidered in this article. 
Preventive.—When we are engaged to attend a patient in 
conflnement, our first act, after inquiring about her general 
health and bodily functions, should be to examine as bo the con- 
dition of her breasts and nipples. 
In a primipara, this should never be omitted, while in a 
multipara an examination is not so important, unless a history 
of difficulty during former pregnancies or lactation be given. 
If the nipples are found to be diseased, small, or retracted, 
advice pertinent to the case should be given. During the last 
month of gestation, it is advisable to prescribe for daily use a 
mild alcoholic or astringent lotion for the purpose of harden- 
ing the tissues about the nipple, which in some persons may 
be very delicate and easily abraded. 
Almost any astringent will answer for this, such as solutions 
of alum, tannin, lead, etc.; but I prefer for general use the 
glycerite of tannic acid, or tannin with spiritus myrcise (bay 
rum), or eau de Cologne. A common household remedy, of a 
similar nature, is made from black or green tea and brandy. 
If the nipples are retracted or small, the patient must remove 
all pressure by clothing or corsets, and then, every night and 8 
Jacobus : Inflammation and Abscess 
morning, anoint them with camphorated oil or vaseline, at the 
same time gently drawing the nipple out with the fingers. 
Country people often use for this purpose a “ pair of small 
black bottle necks ” which have been ground smooth on the 
under (or broken) side. One is placed over each nipple, and 
held in place by the clothing; these may be worn before or 
after the birth of the child, as desirable. After the birth of 
the child, we can apply it to the breast, with a fair prospect of 
increasing the length of the nipple ; but if this fails, we can 
then try a bottle in which a partial vacuum has been made by 
means of hot wrater, or else one of the small nipple shields hav- 
ing a tube and milk receiver attached, and which is intended 
to be used by the mother. 
As soon as the milk makes its appearance, we should 'per- 
sonally supervise the first attempt at nursing, and give direc- 
tions as to the importance of its regularity and frequency. It 
is well to have the mammae supported by a well-fitting sling, 
especially if there be much engorgement and tenderness. 
This will aid greatly in preventing vascular congestion. If 
there be much congestion, soothing liniments, with gentle fric- 
tion of the gland, from the base to the nipple, will help in re- 
lieving it. 
The astringent lotions may still be continued, and particu- 
larly the alcoholic, for they are both cooling and antiseptic. 
All crusts or epithelial scales, which may obstruct the orifi- 
ces of the milk-ducts, as well as dry or sour milk which may 
have remained upon the nipple after nursing, should be washed 
off (after each application of the child to the breast) with a 
warm solution of soda biborate or bicarbonate. 
When the breasts become very full of milk, owing to the 
death of the child, or a weak infant, I have found a new clay 
pipe, with a long stem and smooth bowl, well oiled, a safe in- 
strument to draw or start the milk, or even to empty the 
breast. 
With it, or the tube and nipple shield already mentioned, the 
mother can draw her own milk much safer than with a “ breast 
pump.” As a last resort, we may substitute another baby, the 
patient’s husband, nurse, or even a young puppy. 
If for any reason it becomes necessary to arrest the secretion 
of milk, in part or wholly, remedies which appear to have a of the Breast during Lactation. 
9 
specific action in this respect should be given, such as the in- 
ternal administration of strong saline laxatives, potassium 
iodide, belladonna, ergot, etc. Potassium iodide is very 
highly extolled for this purpose. Externally, I have found the 
use of an ointment composed of ungt. belladonnae and ungt. 
plumbi iodidi, equal parts, to be an excellent resolvent in 
arresting superfluous secretion or promoting the absorption of 
indurated lobules or glands. 
Curative.—Presuming we have been called to see a case 
that has passed into the stage of inflammation, or that we have 
been unable to prevent suppuration in the one that we have 
attended from confinement, we may use or continue such treat- 
ment, already outlined, as appears suitable to the existing con- 
dition. In plethoric persons, general or local blood-letting 
may also be very useful in arresting the secretion of milk or 
stage of inflammation. Every obstetrician must be aware of 
the rapid failure of milk in a mother who has had “post- 
partum ” or other hemorrhage, at or near her confinement. 
In galactorrhea, unless irritation of the nipple or breast fol- 
low, we have an effective aid in diminishing the congestion. If 
there be but little milk, and the constant oozing causes fissures 
or ulcers, this should be stopped by giving ergot internally, and 
applying tinct. benzoin co. or collodion, over the nipple between 
the nursing periods. Ulcers and fissures of the nipple are 
apparently trivial affections ; but when we witness the excruci- 
ating pain which the mother suffers while nursing her infant, 
and its accompanying worry and fever, and then recollect that 
they furnish the starting-point of most cases of mammary ab- 
scess, it behooves us to give them our closest attention. 
As one great obstacle to the healing prpcess is the nursing 
and biting of the child, the nipple should be protected during 
the act by one of the small shields invented for this purpose. 
Unfortunately, the child can rarely be induced to nurse prop- 
erly through it, and then we must try the pipe or tube previ- 
ously mentioned. If only one nipple be affected, and the 
quantity of milk not abundant, the child should be allowed to 
nurse upon the sound side only, for a period of twenty-four 
hours. When the infant is suffering from aphthae, appropri- 
ate treatment should, of course, be given. 
The ulcers or fissures about the nipple are to be touched 10 
Jacobus : Inflammation and Abscess 
with a stick of silver nitrate which, in itself, is an excellent 
antiseptic, and then apply over it tinct. benzoin co. or collo- 
dion, or even salicylic or boracic acid in ungt. zinc, benzoat. 
If the fissures are so situated that antiseptic adhesive plaster 
can be applied, healing will take place more rapidly under its 
early use. When the inflammation gives evidence of being 
severe and prolonged, the child must be removed from the 
breast, and the patient required to remain in bed until well 
over the acute stage. With the patient in bed, the parts can 
be more thoroughly at rest and elevated, thus preventing much 
of the irritation and congestion. Poultices of spongiopiline 
and hot water, ground flaxseed and chamomile, or other favor- 
ite substances, must be applied constantly, taking care that the 
breast is not exposed or chilled while changing them. Cam- 
phorated oil applied underneath the poultice will prevent this 
to a certain extent. 
If there be much local inflammation or pain in the integu- 
ment, a solution of pluinbi subacetatis, with or without opium, 
may be applied upon the surface of each poultice. 
Equalized methodical compression, with moistened absorbent 
cotton, soft sponges, or circular elastic adhesive plaster, is also 
useful where poultices cannot be properly applied, in prevent- 
ing the inflammation or causing absorption of the indurated 
tissues. Dr. W. G. Wylie advises the application of fly-blisters 
to the breast, and reports great success from their use in abort- 
ing mastitis. The foregoing measures, with internal anti- 
phlogistic remedies, such as the salts of potash, or aconite, 
quinine, and ferric chloride, will in most cases abort or resolve 
the inflammation in a few days or a week. 
Abscess.—If, after all, suppuration ensues, and an abscess 
forms, we then have to contend with the exhausted aud ago- 
nizing condition of the patient, as well as her fears of the 
knife or lancet, and resolve in our minds the question, when 
and where to open the abscess. There exists among physi- 
cians a great difference of opinion about the propriety of 
opening a mammary abscess; some believing it to be the best 
practice to let the breast alone, and leave the operation to na- 
ture ; while others advocate an early operation, as soon as pus 
can certainly be detected. I hold to the latter view, unless 
good reasons to the contrary exist, for by an early incision of the Breast during Lactation. 
11 
we shorten greatly the stage of suffering and convalescence of 
our patient, besides preventing the burrowing and extension 
of the abscess, with its resulting and numerous fistulse. In 
dispensary practice the truth of this statement can be quickly 
proven. These patients are mostly attended by filthy, so- 
called midwives, who neglect the breasts; in consequence of 
which, inflammation sets in, an abscess forms, poultices, if 
applied, are very irregularly put on, and the patient, through 
fear of the surgeon’s knife, fails to seek advice until the whole 
breast has become involved, and is one mass of sinuses or fis- 
tulae. 
These patients complete the picture of woe and suffering, 
for they are broken in health, from loss of sleep and appetite, 
and owing to the long-continued suppuration have become 
very much emaciated, suffer from rigors, hectic, alternation of 
heat and cold, and have a high temperature ranging from 
100 to 101° F. 
If these patients could have been seen early, the abscess 
might have been prevented ; or even if it had formed, prompt 
incision would have relieved the patient from pain and con- 
stitutional disturbance, prevented the abscess from enlarging, 
limited suppuration and the destruction of glandular tissue, 
and finally, secured coaptation and rest to the internal surface 
of the abscess, so that healing would have taken place much 
more speedily. When there is a prospect of the inflamed 
breast resulting in an abscess, no mention of the knife or lance 
should be made until it is “ripe,” when without further delay 
the abscess should be opened at once. If we do otherwise, we 
nedleessly excite the fear of our patient, and often lose a 
good paying one, who will suffer much, and seek the services 
of one who “ does not believe in using the knife,” but trusts 
all to nature regardless of cost. In opening an abscess, it is 
of but little use to attempt to allay the sensitiveness of the 
skin by the use of pure carbolic acid or the ether spray; but 
rather take a small, narrow, straight or curved bistoury, and 
make a perpendicular thrust or incision, radiating from the 
nipple, at the point where fluctuation is most distinct, or at the 
most dependent part of the abscess. 
The lowest part of the abscess necessarily depends on the 
position of the patient; whether the patient is to remain in a 12 
Jacobus: Inflammation and Abscess 
recumbent posture, or to walk about, and this must be consid- 
ered before making the outlet for drainage. The operation 
can be done so quickly that the patient is scarcely aware of 
the cut ere it is done, and she will not experience one fraction 
of the pain she suffers each hour before it is opened. ALter 
incising, the pus should be let out freely, so as to allow the 
walls of the abscess to collapse, but it should not be forced out 
by squeezing the sac. 
As a rule, granulating surfaces do not absorb, consequently, 
if the breast has been washed off with a solution of carbolic 
acid before incising, and the wound kept absolutely clean, 
there need be no fear of any septic condition arising. Fine 
marine oakum may be used to keep the incision or fistulse 
open, in place of drainage tubes, which often cause irritation 
and renewed inflammation. After the breast has been again 
washed with a solution of thymol ( 3 i.-O.i.), absorbent cotton 
or fine oakum should be placed over the mouth of the abscess 
to catch the subsequent discharges, and a roller bandage care- 
fully applied. If the abscess is large and discharges freely, 
the dressing should be changed night and morning, and not 
allowed to remain long enough to become septic. By these 
means, the breast will be equally compressed, the walls of the 
sac brought together, and the pus prevented from decompos- 
ing, conditions which conduce to rapid recovery. To those 
who prefer to follow Lister’s directions for opening these ab- 
scesses, I would refer to Playfair’s Obstetrics, Amer. ed., pp. 
562, 563; or the last Amer. ed. of Holmes’ Surgery. In 
old cases which come to us with the whole organ diseased and 
full of sinuses and fistulse, undergoing waxy degeneration, 
and discharging an irritant acid pus, the treatment must differ 
considerably. I11 the first place, we must cease all poulticing, 
unless the inflammation lights up again, for constant poulticing 
soddens the integument and glandular tissues, and greatly re- 
tards the process of healthy granulation and repair. Any 
remaining abscess, or pocket, which has not thorough drainage, 
must be carefully incised. If this should be in a deep gland- 
ular or vascular part, and there be fear of injuring the blood- 
vessels or lacteal duct, Hilton’s method of opening an ab- 
scess may be pursued, as follows : A careful incision is made 
with a scalpel through the integument and fascia, so as to ex- of the Breast during Lactation. 
13 
pose the tissues under which the pus lies; a director .is then 
pushed through the substance of the muscle or other tissue, 
into the cavity of the abscess, and along the groove of this 
guide, a slender dressing-forceps is pushed ; when it reaches 
the abscess, the blades are opened wide, the tissues separated, 
and free exit given to the pus. In this way hemorrhage is 
not likely to occur; but in old sinuses, ulceration or slough- 
ing of the coats of a vein or artery may occur, from which 
serious or fatal spontaneous hemorrhage is likely to result. 
This is more liable to occur in cases of long standing in pa- 
tients suffering from struma or cachexia. I recollect seeing a 
syphilitic patient recently, with mammary abscess, in whom 
hemorrhage set in so seriously that she would certainly have 
died, had not medical aid been at hand. Simple cases should 
be treated by injections of hot water, tincture of iodine, 
pressure, etc. If the hemorrhage be serious, the sac or sinus 
should be laid open and the artery ligated as usual. There is 
nothing so discouraging to patient or physician as these re- 
curring abscesses, and old sinuses which refuse to heal up; 
and unless we' can destroy their waxy or edematous granula- 
tions, or “ limiting ” pyogenic membrane, we must expect but 
little success or credit. Liquid caustics must of course be 
used, unless each sac or sinus be laid open, and for this pur- 
pose tincture of iodine, or solutions of silver nitrate, zinc 
chloride, etc., are effective agents. It is not advisable in sub- 
or glandular abscesses, to lay them open, and here, careful 
graduated compression will assist our stimulating injections. 
In hospital and dispensary practice, I have seen these waxy 
granulations or pyogenic membranes resist all treatment, 
under the most skilful surgeon’s hands, until “ Villate’s solu- 
tion (see Bartholow’s Mat. Med., or Dunglison’s Med. Dict’y), 
or “Labarraque1 s Solution” was used. I have used these, 
more especially, in sinuses extending from a necrosed hip- 
joint to the pelvic cavity or thigh, and also in old mammary 
abscesses of several months’ standing, with immediate and 
almost magical results. In fact, my enthusiasm is so great in 
behalf of these two solutions for these old sinuses, that it has 
been my main incentive in bringing the subject of abscess of 
the breast to your attention. Yillate’s solution, and that only, 
saved the life of a young boy, at the Presbyterian Hospital, 14 
Jacobus : Inflammation and Abscess 
upon whom excision of the hip-joint had been performed with 
a good’result, except that the acetabulum became involved, 
and then extensive burrowing sinuses, with waxy granulations 
set in, which nothing but this solution could destroy. Dr. C. 
K. Briddon, New York, can testify as to its efficacy in this 
and other cases. Villate’s solution, however, is painful, and 
must be diluted to about one part in two of water. Labar- 
raque’s solution (French prep’n) has been equally effective in my 
hands in mammary abscess, used about one part in eight or 
ten of water, with the syringe twice or three times a day. 
This has the advantage of not causing pain or soiling the 
clothing. It is the most active stimulant of chronic ulcers or 
sinuses that I have ever seen, and one has only to try it in 
order to believe. It was under Prof. A. C. Post’s service at 
the Presbyterian Hospital that I first became aware of its 
great healing powers. Stille’s National, and the U. S. Dispen- 
satory, also extol its virtues highly. In destroying these dis- 
ease-breeding sinuses, and rapidly healing them, we remove 
much of the danger of subsequent malignant mammary 
growths, which undoubtedly have their origin, in most in- 
stances, in the irritation set up by the inflammatory diseases 
of the breast (see S. W. Gross on “ Tumors of the Breast”). 
As the drain on the system is great, and the constitutional 
debility generally pronounced, much attention must be paid 
to general treatment; and abundance of nourishing food and 
appropriate stimulants given. 
Of remedial measures, quinine, iron, mix vomica, rnineral 
acids, and cod-liver oil are appropriate and useful. I have 
found the following mixture an excellent tonic and preventive 
of excessive suppuration in these cases: h Strychnise sulph., 
gr. ss.; Tr. ferri chloridi, f. 3 iiss.; Acid, phosphor, dilut., 
f. 3 ij.; Aquae, q. s. ad f. 1 iv. M. Signa: One teaspoonful 
in a wineglass of water after meals. 
In conclusion, it is not to be supposed that the treatment 
outlined in this paper is to be carried out entire in ordinary 
cases of lactation, or that this paper will boldly defy the im- 
putation that “ there is nothing new in it; ” but in answer, it 
is simply necessary to say, that abnormal cases of lactation 
only are referred to, and that our success in practice depends 
not so much upon new theories, as it does upon the thorough of the Breast during Lactation. 
15 
and intelligent application of the surgical skill, and well-known 
remedies, which we now possess.