Both fissure and crack may affect the top, the side of the apex, or the base of the nipple. They may be either longitudinal or circular. The entire nipple must be kept under observation and the instant a raw surface is detected, _treatment_ must begin. [Illustration: Fig. 109.—A standard nipple shield. (American Text Book.)] Compound tincture of benzoin, liberally applied, is a favorite and successful remedy. Our routine is to apply a paste made of equal parts of castor oil and subnitrate of bismuth. This is put on after the child nurses, and must be removed carefully before the next nursing. Sometimes the child’s stools become black and constipated and the trouble may be traced to imperfect removal of the bismuth preparation. Whatever medication is used, the nipple must be protected from injurious friction by the clothing. This is best done by the hat-shaped lead nipple shield, which is placed over the nipple and held in place by a light binder. The shield should be boiled before use. To protect the nipple during nursing, a glass shield may be used for a day or so, but not long enough for the babe to get accustomed to it, else he will form a habit hard to break. This shield must be taken apart after use, washed and kept in saturated solution of boric acid until the next nursing. If all these measures fail, the fissure must be touched with a nitrate of silver stick once, or have a 2 per cent solution of nitrate of silver applied night and morning. It may be necessary to take the child from the breast for a day or so, in which case he nurses the other breast and the side with the bad nipple is pumped. The care of the nipple is highly important since the apprehension and the actual pain of each nursing may prevent sleep, destroy the appetite, and diminish the milk. If begun early, most fissures will heal in twenty-four to forty-eight hours. =Mastitis.=—From three to five per cent of lying-in women have mastitis in the European clinics, but the records in America show a much smaller number. The disease occurs most frequently in blondes and in primiparas. It is most apt to appear during the first two weeks, when the congestion accompanying the new mammary function produces a stasis that favors the growth of germs, which may enter through the abrasion or fissures of the nipple produced by zealous activity of the child’s gums. But it may also occur when the child’s first teeth come and the nipple is again exposed to injury. At times it is impossible to find a plausible excuse for its occurrence. Mastitis is usually described in three forms: The (a) parenchymatous or glandular type, which affects the substance of the gland or the enveloping connective tissue; in (b) subcutaneous mastitis the connective tissue beneath the skin is attacked; and in (c) the sub-glandular variety, the infection finds a lodging between the gland and the chest wall.