The Inhibition of Painful Breast Engorgement in the Puerperium with Stilbestrol *

The problem of relieving the pain and discomfort of breast engorgement in the puerperium, espiecially in the non-nursing mother, has been an unsatisfactory one. The unhappiness of the patient and the not infrequent complications of cellulitis and abscess formation have led to the application of many and varied therapeutic measures. Heretofore the measures employed, such as tight breastbinding, restriction of fluids, saline cathartics, ice-packs, hot-packs, massage, and injections of camphor in oil, have in themselves been as discomforting as the breast engorgement. At present a physiological approach toward the solution of this difficulty gives great promise of success in a very high percentage of cases. This has become possible through a better understanding of the physiology of lactation and of hormonal therapy. Though painful engorgement of the breasts is said to be caused by lymphatic and venous stasis' and not by distention of the ducts with milk, we know from clinical observation that with evacuation and drainage of the milk the pain and stasis will quickly subside. There appears to be a cause and effect relationship between these two phenomena. If we could, therefore, prevent over-distention of the ducts we might possibly prevent congestion, stasis, and pain. In the physiology of lactation two factors play a related role. The first, a hormonal one, which initiates lactation, and the second, a neurogenic one, which maintains lactation. The hormonal factor involves stimulation of the breasts by the ovarian hormones (estrogen and progestin) and by the lactogenic principles of the anterior lobe of the hypophysis. The neurogenic factor is stimulated by suckling or by pumping of the breasts. This latter factor affords a mechanical stimulus, the lack of which permits a cessation of the milk supply. The release of lactogen only occurs when the inhibiting effect of estrogen is withdrawn. This withdrawal occurs only after delivery. If our conception of the physiology of lactation is correct it