Polygalactia. This condition is exceedingly common. The treatment has been referred to on page 355. Its main features are compression and support of the breast by a mammary binder, the administration of laxatives, the regulation of the diet, and the evacuation of the superabundant quantity of secretion. Hyperlactation is more frequently met with among the poorer classes. Infants are nursed far longer than they should be, either from the fact that it is difficult to provide food for another mouth or because of the prevalent belief that lactation grants immunity from impregnation. Women have been known to nurse their children up to the second or third year. Some women and certain races do it with impunity. Spanish wetnurses suckle three or four successive children in one family. Japanese women habitually nurse their children for five or six years. Hyperlactation, however, usually leads to serious results in the women who fall under the care of physicians in this and most civilized countries. The patient becomes exceedingly weak and presents all the symptoms of a serious constitutional disease. The quantity of blood is diminished-oligemia. The woman grows pale and thin; there are loss of appetite, constant headache, pain in the back, indisposition to make any physical effort, and the whole nervous system is more or less seriously deranged. Cramps in the muscles of the neck and upper extremities occur frequently; they appear often during the day and last for varying periods. The application of the child to the breast often originates an attack. There is especial danger in women of tuberculous tendeneies of originating phthisis. The treatment of hyperlactation is simple and effective. The child must at once be weaned, and the mother's strength restored by a nutritious diet, tonic remedies, and, if possible, change of air. Galactorrhea. By this term is meant a flow of milk from the breasts not necessarily excited by the suckling child, and commonly continued long after the usual term of lactation. The quantity of milk excreted may vary from a few grams to seven liters in the twenty-four hours. 1 Usually, both breasts are involved; sometimes the flow is confined to one side. The cause of the anomaly is unknown. It has been attributed to a relaxation or paralysis of the circular muscular fibers surrounding the milk-ducts, but, as Winckel remarks, this, in the majority of cases, is an effect and not a cause. There is a case recorded, however, of galactorrhea in the left breast, associated with the left hemiplegia occurring after child-birth. 2 The affection is one com 1 Winckel," Path. u. Therap. des Wochenbettes," p. 440. 2" Trans. London Obstet. Soc. for 1887," xxix. There is a monly of long duration, extending often over years. case reported in which, for thirty years, there was an uninterrupted flow of milk from the breasts of a woman who, at the time the report was made, had reached her forty-seventh year. Curiously enough, this long-continued drain upon the system had had no injurious effect upon the woman's health, which remained excellent. Another anomalous feature in the case was that the return of the catamenia increased for the time the discharge of milk.1 I have seen a woman who had had galactorrhea for eleven years after a miscarriage at the fifth month. Her health remained perfectly good. The usual effect of a long-continued discharge of milk from the breasts is most unfavorable upon the individual's health. It is the same that any long-continued discharge produces upon the constitution. The general debility from this cause is known as "tabes lactea." The same condition may be seen in extreme cases of polygalactia and in hyperlactation. Treatment.—The most prominent feature in these cases is the stubborn resistance that they offer, as a rule, to treatment. There are two measures, however, which can usually be depended upon to give relief-firm compression of the mammary gland and the administration internally of iodid of potassium. It should be remembered, moreover, that in many cases the milk secretion stops spontaneously with the return of menstruation, 2 and that in a certain proportion of cases a treatment adapted to securing a discharge of blood from the uterus has been successful in curing galactorrhea. Routh 3 advocates Simpson's plan of introducing a piece of caustic within the uterus for securing this result. Abegg was successful in two instances in stopping the galactorrhea by the use of warm douches, which brought about a return of the menses. Electricity has been recommended to secure the proper contraction of the sphincter muscles of the lactiferous ducts. The long-continued administration of ergot has been successful, and its use is rational. The experiments of Roehrig 4 have demonstrated that drugs which bring about an increased arterial pressure in the breasts promote milk secretion, while those which lower arterial tension tend to diminish or even abolish the function. Chloral was shown to be peculiarly powerful in diminishing the quantity of milk; therefore, this drug is also worthy of a trial. Belladonna internally, or as a local external application, is usually employed as a routine practice, but 1 Green, quoted by Gibbons, "A Case of Galactorrhea (unilateral)," ibid. 2 Gibbons' case; Abegg's cases; in two cases, under the care of Depaul, the galactorrhea was arrested by the recurrence of pregnancy. 3 Discussion on Gibbons' paper, loc. cit. 4 Quoted by Gibbons. it is of doubtful utility. It has been declared that antipyrin, in 21⁄2-grain doses, three times a day, diminishes milk secretion. 1 Qualitative Anomalies in the Milk.—The most important factor influencing the constitution of the milk is the diet. A fatty diet diminishes the quantity of milk. A vegetable diet diminishes the casein and fat, and increases the sugar. A diet rich in meat increases the fat and casein, but diminishes the sugar. A scanty diet diminishes all the solid constituents of the milk except the albumin. The commonest anomaly in the constitution of the milk, in my experience, is a deficiency of fat and an excess of casein. In one of my patients, in each of three confinements there has been a milk of only 0.8 per cent. fat and 3 per cent. albuminoids. Usually this disordered condition of the milk can not be remedied. In a few instances, however, qualitative anomalies may be corrected by dietetic management. The effect of emotions upon the constitution of the milk has already been referred to. Baranger Baranger 2 quotes a good example: A nursing woman saw her husband threatened by a soldier armed with a saber. Directly afterward she gave suck to her child. It seized the nipple at first with avidity, then refused it, became violently convulsed, and died. Every practising physician has seen, at least to some degree, examples of the change produced in the milk by mental impressions. Becquerel and Vernois found that under the influence of emotion the milk of a woman contained more water, very much less fat, and somewhat more casein than was found in the mammary gland of the same individual under ordinary circumstances. Almost all acute febrile affections not only diminish the mammary secretion, but produce some change in its constitution and make it indigestible. This is most marked in the prodromal period. If a chill occurs, the lacteal secretion is suspended almost entirely for from twelve to twenty-four hours. The germs of some discases pass from the mother's organism into her milk; this is undoubtedly true of tuberculosis. It is probable that the germs of malaria find an exit from the body in this way. Septic micro-organisms may contaminate the milk from the breast, although the mammary gland itself is free from inflammation. Karlinski has reported a fatal infection of the 1 "Bull. gén. de Thérap.," June, 1888. 2 Les Contre-indications et Obstacles à l'Allaitement maternal," "Thèse de Paris," 1884. 3" Zur Etiologie der Puerperal-Infektion der Neugeborenen," "Wien. med. Wochenschr.," 1888. new-born from the milk of a puerpera with septic fever. milk were found staphylococci. In the Women under the influence of mercurialism or saturnism excrete milk of abnormal quality, dependent, perhaps, as much upon the anemia associated with these conditions as upon the excretion of the drug itself. The influence of syphilis upon the constitution of the milk is not yet known. It has been asserted that there is no change in the milk of syphilitic women. Vernois and Becquerel, on the other hand, affirm that there are wellmarked alterations in the relative proportions of the different ingredients in the milk from syphilitic women. Under ordinary circumstances colostrum-corpuscles may be detected in human milk for the first eight or ten days after delivery. There are certain conditions in which a return of these corpuscles may be noted. They reappear sometimes upon the return of menstruation, during acute mastitis, or in any other acute affection during lactation. Of twenty-three examinations. made by Truman 1 to investigate this point, colostrum-corpuscles were found present in the following cases: In a primipara for four weeks after the birth of a premature infant; in a woman who was suckling her four-month-old baby; in a non-pregnant woman whose infant, born twenty-six months before, had been weaned for ten months; in a non-pregnant woman who had been married three and a half years; ever since marriage, for a week before menstruation, the breast filled with milk, in which were colostrum-corpuscles; in a nursing woman who had never been able to use her right breast during lactation. Her last child was twelve months old. In the milk which could be squeezed out of the right breast colostrum-corpuscles were discovered. Another case was one of chronic ovaritis. Twenty-three months had elapsed since the last labor, and eleven since weaning. The milk which exuded from the breast contained colostrum-corpuscles. In the breast of a woman fifty-six years old, which was removed for carcinoma, about a teaspoonful of milk was found, very rich in colostrum-corpuscles. This woman's youngest child was eight years old. In a case of galactorrhea which had persisted for four years these bodies were also discovered. The presence of colostrum-corpuscles in the milk is not a proof, therefore, of a recent delivery. Diseases of the Mammary Glands.-Areola.-The glands of Montgomery may be inflamed, and their infection may lead to mammary abscess. Treatment.—Infection of the areolæ should be avoided by 1 "British Med. Jour.," 1888, ii, p. 947. |