MILK FISTULA. 



569 



MILK FiSTULiE. 



Causation. Any accidental injury to the udder which establishes 

 connection between the galactophorous canals or the galactophorous 

 sinus and the exterior may give rise to milk fistuhe, if the injury 

 occur during lactation. 



Apart from lactation these wounds may be grave, though if care- 

 fully treated they heal without compHcation. During lactation, on 

 the contrary, the milk escapes permanently from the injured spot, 

 cicatrisation cannot occur, and a fistula forms. 



Symptoms. The principal sjanptom is the permanent discharge of 

 milk. The fistula may be large or small, according to circumstances. 

 In rare instances it is 

 situated on the udder 

 itself, but it is com- 

 monest on the teat. 

 Milk may escape in 

 mere drops or, on the 

 other hand, in con- 

 siderable quantities. 



Diagnosis. The 

 diagnosis presents no 

 difficulty. 



Prognosis. The 

 prognosis is grave so 

 far as the loss of milk 

 is concerned, although 

 the lesion has no 



effect on the general health. It is particularly serious, however, l)ecause 

 it may cause the interior to become infected, and an acute parenchy- 

 matous mammitis may thus he set up. It must also be borne in mind 

 that old fistulae are much more difficult to obliterate than recent ones. 



Treatment is much more troublesome than might at first be thought, 

 the great obstacle to repair being the continual secretion and discharge 

 of milk. 



At first, attempts should be made to re-establish and render permanent 

 the natural method of discharge. This can be effected by inserting an 

 aseptic milk catheter and fixing it in position with a little pitch bandage. 



The course of the fistula is then cleansed, curetted, and rendered 

 aseptic in some way, as for example by washing with boiled salt solution 

 and dilute hydroxyl. 



As there is little hope of obliterating the fistula by merely suturing 

 the skin, its course should first be closed by passing one or two deep 



Fig. 238. — Milk flstulae. 1, Deep suture — schema show- 

 ing the course of the suture ; FL, base of the fistula ; 

 S, suture ; 2, superficial interrupted suture. 



