LETTER XXXV.. Of Sore Nipples.

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.