If the condition of the breasts becomes too painful, the liquids by mouth are reduced to the last degree, saline cathartics are given until frequent watery stools result, one or more ice bags are applied to each breast and codeine sulphate may be given at night. The child nurses every four hours only. Williams was the first to show that no tight binder is necessary, but only a supporting bandage. The tight binder is a cruel and useless barbarism that has been abandoned by progressive physicians. No massage is allowed; no pumps; no irritation whatever, and in twenty-four hours the trouble has disappeared. Hot dressings to the breast are equally archaic. They should _never_ be applied to any breast unless it is desired to hasten suppuration. If the child dies, or for any reason can not nurse (inverted nipple, cleft palate, harelip) and it becomes necessary to dry up the milk, the treatment for “caked breast” is continued. After twenty-four hours the breasts are comfortable and rarely give trouble again. _Cracks, Fissures and Abrasions of the Nipple._—The care of the nipples should be inaugurated about six weeks before labor, as elsewhere described: The nipple must be inspected and its possibilities determined, early in pregnancy, if possible, for many varieties of badly shaped and ill-developed nipples exist which may make nursing difficult or impossible. Imperfect nipples especially are predisposed to fissure and crack, and will require extreme care on the part of the nurse. She should inspect them before and after each nursing and sedulously use cleanliness and asepsis in her management. In normal and tranquil as well as in neurotic women, the nipple may become so sore as absolutely to preclude nursing, and this entails much additional work on the nurse and mother, as well as considerable peril for the child. The condition usually begins as a fissure or crack, and is accompanied by much pain. It is serious, furthermore, in another aspect since all breaks in the surface of the nipple are avenues of infection that may result in mastitis. The child may produce fissures or abrasions by rubbing the nipple with his mouth, by pulling too hard, or by the habit of holding it in his mouth and macerating it with his gums when he has finished nursing. [Illustration: Fig. 108.—Examples of imperfect nipples. (American Text Book.)] The child must not be left at the breast after he has nursed, but the nipple should be gently removed from the child’s mouth by passing one finger in beside the nipple. Fissures and abrasions usually occur within ten days if at all. Abrasions or erosions are due to the wearing away of the epithelial covering of the nipple in patches more or less extensive. Thin-skinned blonde women suffer more than those with dark, dense oily skins. A _fissure_ is a distinct separation of tissue that goes deeply into the underlying substance. A _crack_ is a long abrasion which may deepen into a fissure.