ACUTE MAMJIITIS. 579 



important point is to wash out the interior of the gland, and even 

 the acini as far as possible, with antiseptic fluids. Practically this is 

 difficult to effect, because such irrigation must be performed a.septi- 

 cally, and cannot properly be left to the cowmen. 



In current practice, therefore, one often has to be content with 

 stripping the udder every hour. Milk clots which accumulate in the 

 sinuses and galactophorous canals are broken down by soft pi-essure, 

 and withdrawn with more or less difficulty. By repeated milking they 

 are prevented from accumulating in the galactophorous sinus and canals, 

 a very important point. Neglect of this precaution enables the colonies 

 of micro-organisms to develop uninterruptedly in the culs-de-sac, where- 

 upon the coagula formed of caseine obstruct the excretory channels and 

 complications develop despite all external treatment. 



By repeated friction of the udder as in milking the advantages 

 that would be produced by washing out the gland from the direction 

 of the acini are secured, and thus the ascending infection is checked. 

 The diseased udder must always be emptied before making anti- 

 septic injections, which would otherwise be useless. 



Should the practitioner decide to face the practical difficulties of in- 

 jections, he must take care that his instruments are aseptic ; that the 

 solutions employed are always at or about bodily temperature ; that 

 these solutions are incapable of irritating even tissues so tender as the 

 epithelium of the acini or of the galactophorous canals ; and, finally, that 

 the drugs employed will not coagulate the milk within the gland. 



Bearing in mind these points, the practitioner will do well to re- 

 strict himself to the use either of boiled water, physiological salt 

 solution ('9 per cent.) ; alkaline 3 per cent, solution of borate of soda ; 

 or -05 per cent, of fluoride of sodium. Every precaution having been 

 taken, from 12 to 20 ounces of liquid can be injected into each 

 quarter, according to its size. The solutions should be made to pene- 

 trate as far as possible into all portions of the gland l>y gently 

 manipulating the parts, and should again be withdrawn in about a 

 quarter of an hour. 



It must always be remembered that failure to observe the above 

 precautions may make matters worse instead of better, and therefore 

 that intra-mammary injections can only be of value when carried out 

 by a skilled person. 



In otherwise hopeless cases there remains as a last resort total or 

 partial ablation of the mamma. This operation is advisable in cases 

 of diffuse gangrene, or of intense massive suppuration, where there is 

 imminent danger of death from infection. 



Directions for its performance will be found in Moller and Dollar's 

 "Eeo-ional Surgery" (uniform with the present volume), p. 454. 

 "" pp 2 



