Benjamin E. Dailey, Georgetown College, D. C.............. F. L. Wadsworth, Ru-h Medical College.. Christian Fenger, University of Copenhagen, Denmark. Isidor Sax, Hahnemann Medical College, Chicago. F. E. Sherman, Kush Medical College.... W. C. Westerfield, St. Louis Medical College, Missouri... C. W. Burrill, Chicago Medical College..... A. B. Clark, Chicago Medical College. March 10, 1874 .. Feb., 1873 .March 9, 1871 March 5, 1877 March 14, 1836 March 12, 1837 March 29, 1871 .... Feb 3, 1869 Jan. 1867 Feb. 14, 1847 ... Feb. 24, 1877 .April 4, 1862 . Feb., 1854 .Feb. 5, 1868 Feb., 1864 Feb. 17, 1873 March 2, 1859 March, 1864 March 10, 1866 Dec. 1861 March 3, 1867 Henry T. Byford, Chicago Medical College.. Roswell Park. Chicago Medical College... Geo. Keating Dyas, Chicago Medical College.. Samuel H. Bottomley, Medical Department Lind University. Louis Brann, R. M. College.. A. W. Smith, Eclectic Medical Institute, Cincinnati, Ohio. March 12, 1872 March 21, 1876 March 13, 1873 March 21, 1876 March 21 1869 March 3, 1863 March 5, 1866 Feb. 15, 1876 May 21. 1872 Feb. 1, 1871 Feb. 13, 1852 .... Feb., 1852 .March 3, 1872 .March 14, 1871 .June, 1869 ANNOUNCEMENTS FOR THE MONTH. SOCIETY MEETINGS. Chicago Medical Society-Mondays, Nov. 5 and 19. Chicago Society of Physicians and Surgeons-Mondays, Nov.12 and 26. MONDAY. CLINICS. Eye and Ear Infirmary-2 to 4 P. M., by Prof. Holmes and Dr. Hotz. Mercy Hospital-2 to 3 P. M. Surgical, by Prof. Andrews. Rush Medical College-1:30 P. M. Medical, by Dr. Bridge. County Hospital-8 P. M. Necropsy, by Dr. Danforth. Woman's Medical College-3 P. M. Surgical, by Prof. Owens. TUESDAY. County Hospital-1:30 P. M. Medical, by Prof. Bevan; 2:30 P. M. Surgical, by Dr. Bogue. Mercy Hospital-2 P. M. Medical, by Prof. Hollister. Eye and Ear Infirmary-2 P. M. Prof. Jones. WEDNESDAY. County Hospital-1:30 P. M. Gynecological, by Prof. Fitch; 2:30 P. M. Ophthalmological, by Dr. Montgomery. Mercy Hospital-2 P. M. Eye and Ear, by Prof. Jones. Rush Medical College-4 P. M. Diseases of the Chest, by Prof. Ross. THURSDAY. Mercy Hospital-2 P. M. Medical, by Prof. Davis. Rush Medical College-1:30 P. M. Neurological, by Prof. Lyman. Eye and Ear Infirmary-2 to 4 P. M. Operations, by Prof. Holn.es and Dr. Hotz. FRIDAY. Mercy Hospital-2 P. M. Medical, by Prof. Davis. County Hospital-1:30 P. M. Medical, by Prof. Ross; 2:30 P. M., Surgical, by Prof. Gunn. Woman's Medical College-10 P. M. Ophthalmological, by Dr. Montgomery. SATURDAY. Rush Medical College-2 P. M. Surgical, by Prof. Gunn. Chicago Medical College-2 P. M. Surgical, by Prof. Andrews and Isham; 3 P. M., Diseases of Chest, by Prof. Johnson. Woman's Medical College-12 M. Gynecological, by Prof. Fitch; 3 P. M. Dermatological, Dr. Maynard. Special Clinics daily, from 2 to 4 P. M., at the South Side Dispensary, and at the Central Free Dispensary. For schedule of lectures at the colleges, apply to the college janitors. THE Chicago Medical Fournal AND EXAMINER. VOL. XXXV.-DECEMBER, 1877.-No. 6. Original Communications. AFFECTIONS OF THE NIPPLE AND BREAST INCIDENT TO EARLY LACTATION. By EDW. WARREN SAWYER, M. D., [Lecturer on Obstetrics and Diseases of Children.] (A Lecture delivered at Rush Medical College, Chicago.) GENTLEMEN,—I propose to occupy the hour in considering some of the common affections to which the breast of the woman is liable, during early lactation. I may say that the management of the breast at this time is one of your most important duties in the lying-in-room; a duty that belongs exclusively to yourselves, and which should never be assumed by the monthly nurse. On account of the obstinancy at times of these affections, their successful management becomes one of your most perplexing cares; while their effect upon the sensitive parturient woman is sometimes so grave as to oc. casion you the greatest solicitude. But I hope to show that the care of the breast during the puerperal month is suggested by a few simple principles, which I shall endeavor to impress upon you. To facilitate the study, I will speak first of the affections of the nipples, and second of the affections of which the breast proper is the seat. While this division will assist us in the class-room, you are not to infer that the separation of these affections is closely observed in practice. On the contrary, you will learn that the lesion to which the gland itself is most liable, is usually associated with, and dependent upon the affections of the nipple; and that the first cannot be remedied easily till the diseased nipple is cared for. Before enumerating the several varieties of "sore nipple,” as they are aptly called, the causation of these affections may be spoken of in a general manner. It has been often observed that women who are nursing for the first time, and those who have not nursed for a long time, are the special subjects of lesions of the nipples. This is because the cuticle covering the nipples becomes thin and tender from long disuse, when it is protected beneath the clothing from the influence of the sun and air. Some have said that women of blonde complexion are more liable to trouble from affections of the nipples than others; but I have never observed a marked difference in this respect. There is a condition, however, which is intimately concerned in provoking these lesions; viz., that of bodily filth, and this, too, often in those women whose exterior gives assurance of quite another condition. During the last days of pregnancy there usually oozes from the nipple a few drops of fatty liquid, the imperfectly formed colostrum. The skin being for a long time covered with this matter, alternately dry and macerated, becomes tender and irritated, and ready to inflame as soon as the child is put to the breast. Even before the child is born, contact with the clothing may be sufficient to excite this inflammation. Another determining cause of lesions of the nipple, is the undersize of the organ. The smaller the nipple, the greater the liability of having trouble during the first days of nursing; because the nipple is mumbled for a long time by the infant, in its efforts to keep its hold upon the organ. In this connection, I may very properly speak of the ad vantages of putting the child very early to the breast, especially if the woman has small, or retracted nipples. The nipple is larger and more prominent just after labor, and is much more readily seized by the child than at a later date. If the putting of the child to the breast be for a long time. delayed, until the breast is distended with milk, the small nipple is encroached upon, and retracted by the swelling of the breast, and seems even smaller than before, while the efforts which the child makes to draw it out will be painful and, for a long time, futile. Besides this, there is another consideration. The child is born with an instinct which enables it to nurse at the very moment of its birth. I have seen this instinct nearly extinguished by the usual delay in calling it into exercise; and the child has been forced to learn to nurse after many painful efforts. Unless an unusual degree of exhaustion of the mother positively contra-indicates such a course, I apply the child to the breast before I leave the house, during the first hour post partum. Such a procedure, as you know, has the further advantage of maintaining the uterus in a state of tonic contraction, which is the greatest safeguard against hæmorrhage after delivery. The chief exciting cause of lesions of the nipple, is the mechanical irritation to which the part is subjected during the early days of nursing, under one or more of the determining conditions, of which I have just spoken. Practically, this is the only exciting cause which operates at this time. A notion is entertained by many that certain irritating states of the secretions of the child's mouth, operate chemically in causing sore nipples. The affection called thrush, which is a fungoid exudation occurring in patches upon the tongue and inside of the cheeks, has been specially condemned, as the cause of the lesions in question. But I have never observed a single confirmation of this notion. Many women nurse a child with thrush, and escape sore nipples. And many others are the victims of these affections, whose children are free from thrush. The division of affections of the nipple into several distinct varieties, which has usually been made, is of importance only |