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+Project Gutenberg's Remarks on the Subject of Lactation, by Edward Morton
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Remarks on the Subject of Lactation
+
+Author: Edward Morton
+
+Release Date: August 16, 2007 [EBook #22344]
+
+Language: English
+
+Character set encoding: UTF-8
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LACTATION ***
+
+
+
+
+Produced by Bryan Ness, Stephen Blundell and the Online
+Distributed Proofreading Team at http://www.pgdp.net (This
+book was produced from scanned images of public domain
+material from the Google Print project.)
+
+
+
+
+
+
+
+
+
+                     REMARKS ON THE SUBJECT OF
+
+                              LACTATION,
+
+                               &c. &c.
+
+
+
+
+
+                              REMARKS
+
+                         ON THE SUBJECT OF
+
+                             LACTATION;
+
+                             CONTAINING
+
+                            OBSERVATIONS
+
+                               ON THE
+
+        HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK;
+                 THE DISORDERS FREQUENTLY PRODUCED
+                      IN MOTHERS BY SUCKLING;
+
+                                AND
+
+                    NUMEROUS ILLUSTRATIVE CASES;
+
+           PROVING THAT, WHEN PROTRACTED, IT IS A COMMON
+                       CAUSE, IN CHILDREN, OF
+
+               HYDRENCEPHALUS, OR WATER IN THE BRAIN,
+
+                                AND
+
+                     OTHER SERIOUS COMPLAINTS.
+
+
+                                 BY
+
+                    EDWARD MORTON, M.D. CANTAB.
+
+FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY
+       COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS,
+         LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY,
+                   AND TO THE ROYAL METROPOLITAN
+                  INFIRMARY FOR CHILDREN, &c. &c.
+
+
+                              LONDON:
+
+               LONGMAN, REES, ORME, BROWN, AND GREEN,
+                          PATERNOSTER-ROW.
+
+                             MDCCCXXXI.
+
+
+
+
+LONDON:
+PRINTED BY WILLIAM CLOWES,
+STAMFORD STREET.
+
+
+
+
+TO
+
+SIR HENRY HALFORD, BART., M.D., F.R.S., F.A.S.,
+
+PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON,
+PHYSICIAN TO THE KING, &c. &c.
+
+THE FOLLOWING PAGES
+
+ARE,
+
+WITH HIS PERMISSION,
+
+AND WITH
+
+A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIR
+AUTHOR, MOST RESPECTFULLY
+
+DEDICATED.
+
+
+
+
+PREFACE.
+
+
+Several cases which I witnessed led me to believe, some years ago, that
+inflammation of the brain, or its membranes, might be produced in
+children, owing to their being suckled for an undue length of time.
+Since that period, having enjoyed opportunities of observing infantile
+diseases on a much more extended scale, and my attention being expressly
+directed to the point in question, I not only became fully convinced of
+the correctness of my previous conclusions, but was induced to carry
+them still farther.
+
+My opinions on this subject were briefly drawn up and published in the
+_Medical and Physical Journal_ for August 1827, and have not passed
+altogether unnoticed by my professional brethren[1], some of whom have
+done me the honour to speak of them in flattering terms, while no one, I
+believe, has attempted to disprove the existence of the important fact I
+was the first to announce.
+
+[1] Vide Medico-Chirurgical Review, Gazette of Health, Dendy on
+Cutaneous Diseases, &c.
+
+The bare statement of that fact was, indeed, nearly all that my
+approaching departure from England, at the time last mentioned, left in
+my power: upon the present occasion I have offered arguments for, and
+endeavoured to anticipate those against, the deductions I then made
+public; and however imperfect may have been my success in either, the
+welfare of society at large is too deeply involved in the establishment
+of my opinions with respect to the custom I condemn, (if those opinions
+be correct,) for me to hesitate while again committing them to the press
+in a more extended form.
+
+These considerations, I respectfully submit, will render any apology for
+the appearance of the following pages unnecessary, and will, I trust,
+secure for them a candid and favourable reception from the Profession
+and the Public.
+
+_15, Eaton Street, Grosvenor Place,
+          October 8, 1831._
+
+
+
+
+CONTENTS.
+
+
+                          CHAPTER I.
+                                                          Page
+Of the Breast-Milk, &c. &c.                                  1
+
+
+                         CHAPTER II.
+
+On Lactation, and the Disorders frequently produced in
+Women by that process                                       14
+
+
+                         CHAPTER III.
+
+On the various Diseases which arise in Children from
+Lactation, especially when protracted                       24
+
+
+Postscript                                                  59
+
+Notes                                                       61
+
+
+
+
+ERRATA.
+
+
+Page 10, line 3, _for_ two _read_ a few.
+
+  "  52,  "  19, dele comma between the words Tabes and Mesenterica.
+
+
+Transcriber's Note: The above corrections have been applied to this
+text, in addition _headach_ has been corrected to _headache_ on page
+18, line 11.
+
+
+
+
+CHAPTER I.
+
+_Of the Breast-Milk, &c. &c._
+
+
+No sooner has the child been ushered into the world than the breasts of
+the mother pour forth their milk for its sustenance. This bland fluid is
+secreted from the blood, and varies, in quality and quantity, according
+to the time which has elapsed from delivery, being peculiarly and
+wonderfully adapted at every period to the wants of the individual for
+whose use it is destined. Thus, that first secreted, called _colostrum_,
+possesses a purgative quality evidently intended by the all-wise Author
+of our being for the purpose of removing _the meconium_[A],--a process
+which experience has sufficiently proved to be necessary for the welfare
+of the newly-born infant. Afterwards, ceasing to possess this aperient
+property, it is calculated solely for affording nutrition; and finally,
+at a certain period from delivery, it gradually becomes impoverished,
+loses its former healthy qualities altogether, and acquires others which
+are injurious to life. This important change, as above noticed,
+generally happens at a certain period after delivery; varying, however,
+somewhat in particular women, and in the same female on different
+occasions: but, from disease, or other circumstances, the milk may
+become deteriorated before the time to which reference has just been
+made. If, for instance, the mother labour under any serious disorder, it
+is universally admitted that her milk may also become unhealthy; and
+this may take place even a short interval after delivery.
+
+Although we cannot explain how the brain and nerves act, and probably
+never shall be able to do so, yet we are well aware that their influence
+is absolutely requisite for the healthy performance of every function in
+the human body.
+
+That mental inquietude will impede digestion is a fact familiar to
+almost every one; but, I believe, it is not so generally known, that it
+will with no less certainty retard and alter the nature of the secretion
+furnished by the breasts of the lactescent female. Violent affections of
+the mind will cause the milk to become thin and yellowish, and to
+acquire noxious properties: even the fond mother's anxiety, while
+hanging over the couch of her sick infant, will be sufficient to render
+it unfit for the sustenance of the object of her solicitude.
+
+The state also of the stomach and bowels and the diet of the nurse
+materially and constantly influence the nature of the lacteal secretion.
+
+The milk, besides, is liable to deterioration from another cause,
+namely, the recurrence of the usual periodical appearance--for should
+this take place in a nurse, it is agreed that her milk is liable to
+produce disorders in the child who imbibes it; which could not happen,
+if the former possessed its ordinary component parts, and retained its
+natural properties.
+
+The recurrence, moreover, of pregnancy in the lactescent female may
+render the milk of a bad quality, and will invariably lessen its
+quantity. Mr. Burns asserts that in these cases the milk 'does not
+become hurtful,' but in this opinion I must beg leave to differ from
+him; since I have repeatedly seen it, from this cause, palpably altered
+in appearance, and have observed diarrhœa and great debility produced
+in the children who were suckled with it.
+
+An almost universally received opinion among females, and, indeed, one
+very frequently entertained by members of the medical profession, is,
+that while a woman continues to nurse her infant she will not again
+become pregnant; but this, as a general proposition, is unquestionably
+erroneous; it is even doubtful whether such opinion will hold good in a
+majority of instances. The continuance of lactation will very generally,
+it is true, tend to prevent the recurrence of the periodical phenomenon;
+yet, nevertheless, it will not in every instance prevent pregnancy[B].
+Should, however, a woman with an infant at the breast again become
+pregnant, (a circumstance that very frequently occurs, and of which,
+from the _general though not invariable_ absence of those criteria by
+which this fact is accustomed to be recognised, she is not aware until
+it has made some progress,) one of two things will usually take place;
+either she will miscarry, or her milk will become impoverished in
+quality and diminished in quantity. Nor is this wonderful:--it was not
+intended by Nature that the processes of pregnancy and lactation should
+go on simultaneously, but, on the contrary, that the one should commence
+when the other had terminated; and experience sufficiently proves that
+they will not proceed well together: the reason of which, as it appears
+to me, may be easily given. During pregnancy, and particularly during
+its latter periods, the vessels of the womb gradually enlarge, and a
+much greater quantity of blood than usual is determined to that organ
+for the increase and perfection of the embryo and its appendages; which,
+after delivery, becomes transferred to the breasts to supply the
+material for the secretion of the milk: but if, during pregnancy,
+lactation be also persevered in, the blood becomes directed at the same
+time to two different parts of the body, somewhat remote from each
+other, namely, to the womb, and to the breasts; hence, neither is likely
+to receive its due proportion of this vital fluid, and, consequently,
+the functions of one or the other, or both, are liable to become impeded
+or suspended. If the breasts continue to receive a sufficient quantity
+of blood, the secretion of milk goes on properly, but the womb is
+deprived of its necessary supply; the embryo, in consequence, languishes
+and dies, and, becoming an extraneous body, is thrown off, producing
+abortion; while, on the other hand, should the womb still obtain its due
+proportion of blood, the breasts are robbed of it, and the secretion of
+milk, if not altogether suppressed, is rendered either deficient in
+quantity or deteriorated in quality.
+
+Finally, the breast-milk may become depraved and injurious by the
+process of lactation being continued too long, a practice which is,
+unfortunately, in this, as well as other countries, extensively
+prevalent.
+
+I have not yet had an opportunity of examining the breast-milk in these
+diseased conditions except by the eye, and that rarely--but even this
+slight examination has enabled me to state, that it was greatly altered
+from its natural condition;--that it was more fluid than usual, and
+changed in colour, resembling a yellowish turbid serum, instead of
+displaying its well-known bluish hue.
+
+I propose in future to attend carefully to this subject, and I would beg
+leave to recommend it as one well worthy the notice of those members of
+our profession who have made animal chemistry a particular study, having
+no doubt that they would be able, by a series of accurate experiments
+upon the breast-milk at different periods after delivery, and under
+various conditions of the mother, to collect many interesting and
+important facts--such, perhaps, as would tend very materially to augment
+our knowledge of pathology, and improve our practice in the treatment
+of certain diseases[C].
+
+We cannot but believe that the Supreme Being has done nothing without an
+infinitely wise and good object, and it is obviously our interest, no
+less than our duty, to be guided by those indications of the Divine
+purpose which are distinctly to be traced throughout the creation.
+
+It must appear evident to all who examine the matter in question, that
+the infant was intended to be nourished for the first few months of its
+existence through the medium of a fluid; because no teeth are provided
+to prepare for its use substances of a more solid description; and there
+can be no doubt that this fluid is the mother's milk;--but when the
+child has attained a certain age the teeth begin to appear, doubtless at
+the precise time when they are meant to be used; and, therefore, more
+solid food should now be given. Besides, in consequence of its new
+acquisition, the child sucks less perfectly than before, an additional
+proof that weaning ought at this period to be commenced. Indeed, the
+teeth are calculated indirectly to produce this effect themselves, the
+mother being now liable to suffer inconvenience by letting the child
+take the breast--for the latter _bites_ instead of _sucking_ the nipple,
+and the pain hence arising may, perhaps, induce the former, for her own
+sake, to discontinue a practice injurious to both.
+
+It must also be remembered, that when the teeth are usually produced,
+the milk loses its nutritious properties, and this too at a time when
+the infant from his increasing size must evidently require a more solid
+and substantial, rather than a thinner and less nourishing diet. What
+rational argument, therefore, can be offered why he should still be
+suckled? If we observe the brute creation, do any analogies appear by
+which we can defend the propriety in the human species of protracted
+suckling? by no means:--on the contrary, we find that the female animals
+soon drive away their young from their dugs; and what is, perhaps, still
+more to the purpose, I have heard stated, on good authority, as a
+well-known fact among the breeders of cattle, that if calves be allowed
+to suck beyond a few months they do not thrive, but, on the contrary,
+become lean and diseased.
+
+The belief so generally prevailing, that the longer a child is suckled
+the stronger it will become, is a prejudice, like many others concerning
+women and children, which has been handed down from mother to daughter
+for ages, and has thereby become so universally entertained and so
+deeply rooted in the minds of females, that even medical men scarcely
+venture to question its propriety. My own experience, however, compels
+me to declare, that there is not a more erroneous or mischievous
+doctrine; and I can most truly affirm, that I never yet witnessed an
+instance where protracted lactation had produced any good effect[D],
+though I have seen numerous examples (some of which will be introduced
+hereafter) where, I believe, it had been the indirect cause of death.
+
+Having thus strongly noticed the impropriety of long continued
+suckling, it will, perhaps, be proper to state my opinion as to the
+period when this process should terminate. As a general rule, at nine
+months after birth the child ought to be entirely weaned; and in no
+instance should he be permitted to suck more than ten. In many cases
+suckling may be relinquished with advantage (and occasionally it is
+absolutely necessary to discontinue it) before the time first above
+mentioned; in others, however, it may be protracted beyond it.
+
+I by no means recommend the breast-milk to be at once superseded by
+artificial food, but, on the contrary, that the child should be
+_gradually_ accustomed to such aliment from a much earlier period; the
+proportion of the latter being increased by degrees, while the
+breast-milk is diminished in a corresponding ratio. Hence we shall
+produce a double advantage; the mother will be benefited as well as the
+child--the former, by giving suck less frequently, and in smaller
+quantities at a time than usual, will have the secretion of milk
+_gradually lessened_, and, therefore all likelihood of inconvenience, as
+far as regards herself when the child is entirely weaned, will be
+completely prevented; while, on the other hand, the child being
+_insensibly estranged_ from the breast, will have become accustomed to
+his new food, so that there will be less chance of its disagreeing with
+him when it forms his sole support; and thus the danger which is
+generally apprehended from weaning will be either materially lessened or
+altogether avoided.
+
+The difficulty of bringing up infants by hand, as it is termed, is well
+known; but I suspect that the great mortality which has been recorded as
+occurring from this source is not inseparable from the practice itself,
+but arises mainly from the improper manner in which it is usually
+conducted. When it is determined to bring up an infant by hand, the
+substitute offered for the mother's milk should as nearly as possible
+resemble that fluid; and the child should be constrained to imbibe it in
+_the same manner as_ it would _the milk from the maternal breast_; that
+is, it should be _sucked_ from a bottle contrived for that purpose,
+instead of the child being gorged with it, by means of a large spoon, or
+some other equally improper instrument, as is the usual custom. It is a
+fact too palpable to be questioned, that the food generally given to
+infants brought up by hand is not only administered in an improper
+manner, but is also of an improper quality; their tender stomachs are
+daily overloaded with _solid_ instead of _liquid_ aliment, and hence
+arises the numerous train of evils which, in my opinion, produce the
+great mortality just referred to.
+
+
+
+
+CHAPTER II.
+
+_On Lactation, and the Disorders frequently produced in Women by that
+process._
+
+
+There can be no doubt that, speaking generally, a mother is bound to
+suckle her children, and that the performance of this duty is no less
+conducive to her own health than to the moral and physical welfare of
+her offspring; yet there is not a more unfounded doctrine than that
+which presumes every woman who is willing to be also capable of
+advantageously discharging the important office of a nurse.
+
+If the mother enjoy good health, and the process be not continued too
+long, it is likely to produce beneficial effects both in herself and her
+infant; but if she be of a very delicate habit--labour under any
+dangerous disease--be subject during the period of lactation to great
+affliction, or constant mental inquietude--or should the periodical
+appearance return, pregnancy occur, or suckling be continued too long,
+it may not only prove highly detrimental to herself, but may be the
+means of occasioning serious or fatal consequences to her child.
+
+In cases of extreme delicacy of constitution, lactation will often
+produce the worst effects. Many young ladies, on becoming mothers, are
+incapable of supporting the constant drain to which the wants of their
+infants subject them--they lose their good looks, become gradually
+weaker, and as their strength declines, their milk is simultaneously
+lessened in quantity, and altered in its other properties.
+
+If the suckling be still continued, their debility daily increases,
+distressing pains in the back and loins succeed; the patients become
+exceedingly nervous, as it is termed, and are unusually susceptible of
+ordinary impressions; pain in the head, often of great violence,
+follows, which, in some cases, is succeeded by delirium, in others, by
+absolute mania. Nor is this the whole catalogue of ills to which
+in such cases the unfortunate mother is subjected: the appetite
+fails, distressing languor is experienced by day, while copious
+perspirations deluge her by night, and dissipate the last remains of
+strength--producing a state which may easily be mistaken for, or
+terminate in, true pulmonary consumption;--finally, the sight becomes
+progressively weaker, until vision is almost destroyed; the eyelids
+exude a glutinous secretion, and ophthalmia itself is occasionally
+induced.
+
+These are the symptoms too often caused by lactation in delicate or
+debilitated habits, even a few months after delivery; the same also are
+observed when suckling has been injudiciously protracted beyond the
+period to which it should be confined.
+
+A few only of the foregoing symptoms may be noticed, or nearly the whole
+may present themselves, in the same patient; and when this happens,
+unless the cause which has given rise to them be at once detected, and
+appropriate treatment employed, the most serious consequences may be
+apprehended.
+
+In these cases, the first step necessary is to discontinue the suckling
+altogether: half measures will never answer. Sometimes it is proposed by
+the patient, or her friends (more usually the latter), to compromise the
+affair by feeding the child partly on spoon meat, and allowing him still
+to take the breast, though less frequently than before.
+
+This plan I uniformly object to, for the following reasons:--
+
+1st. Because the mother will not be likely to recover so long as she
+continues to suckle at all.
+
+2nd. Because her milk being necessarily of a bad quality, it cannot be
+expected that the child will derive benefit from it; but, on the
+contrary, there is every probability that his health will suffer by
+using diet of such an improper description.
+
+The obvious dependence of the foregoing symptoms upon debility will, of
+course, at once suggest to practitioners the nature of the treatment to
+be adopted: which should be such as is calculated to invigorate the
+system generally--namely, the administration of tonics, &c.
+
+Bark and its various preparations, especially the sulphate of quinine,
+with the occasional use of warm aperients (sedulously avoiding the more
+violent purgatives), will be found eminently successful; whereas,
+cupping at the nape of the neck (which I have seen prescribed for the
+headache), and other depletory measures, have proved as manifestly
+injurious.
+
+'Every disease productive of great weakness is increased by the state of
+the system which follows child-bearing. Of this description are
+consumption, dropsy,' &c. In these cases it is evident that the process
+of lactation, by adding to the debility already present, must prove
+highly injurious, and consequently should be always avoided.
+
+I have already noticed the effects which are produced upon the milk by
+the influence of mental emotions on the part of the mother, as well as
+by the recurrence of the periodical appearance; and since these are
+chiefly injurious to the child, by depraving its sustenance, their
+further consideration will be deferred till the next chapter.
+
+With respect to the remaining topic--namely, the occurrence of
+miscarriage from suckling--I am convinced that it is by no means an
+unfrequent accident, though its real cause is perhaps rarely suspected,
+having only met with one patient who considered the mishap in question
+to have arisen from keeping her child too long at the breast. Having
+already, I trust satisfactorily, explained the manner in which abortion
+is produced by the act of suckling, I shall conclude this part of my
+subject with the relation of a case that occurred in private practice,
+which so strongly corroborates many of the observations in the preceding
+and following pages, that I shall offer no apology for its introduction:
+more particularly, since the lady herself to whom it refers has
+benevolently expressed a wish for its publication, in order that those
+who become acquainted with the facts there detailed may be prevented
+from undergoing similar unnecessary sufferings:--
+
+
+CASE.
+
+Mrs. A----, a lady of delicate constitution, about twenty years of age,
+three or four months subsequent to the birth of her first child, began
+to find her milk gradually lessen in quantity; it had also much changed
+from its previous appearance, resembling at the time just stated, a
+yellowish, turbid serum. Her child became emaciated; and diarrhœa
+supervening, my professional services were required. My advice was, that
+the child should be at once weaned, and a suitable wet-nurse, if
+possible, procured--neither of which suggestions, as will shortly
+appear, were followed. I urged the necessity of this measure more
+particularly, because Mrs. A---- was daily getting thinner and weaker;
+she also complained of great pain in the head and back, and of an
+increasing dimness of sight, which made her fear she should become
+blind; but the mother-in-law of my patient being, unfortunately, of
+opinion that pregnancy in the latter would not again occur during the
+continuance of lactation, recommended that the child, although chiefly
+supported upon spoon-meat, should occasionally be allowed to take the
+breast; and this plan, notwithstanding the wish of Mrs. A---- to the
+contrary, and my own remonstrances on the subject, was adopted--the
+effects of which were to increase the mother's ailments, as well as
+those of her infant. Things went on thus for some time longer, when I
+once more endeavoured to persuade Mrs. A---- to follow my advice,
+observing, that by an opposite line of conduct she was not only injuring
+her own health, but that of her child, neither of which, I assured her,
+in my opinion, would be re-established till the latter had been weaned.
+I expressed also my complete incredulity as to the non-recurrence of
+pregnancy in consequence of her infant remaining at the breast; and I
+added--'It is my firm conviction that if you be pregnant, or should
+happen shortly to become so, you will miscarry.' About a week after
+this conversation she was suddenly seized with flooding, and what I had
+predicted took place. She now left off suckling, and in about a month,
+under suitable treatment, completely got rid of all her former
+complaints: the child also immediately began to improve.
+
+The present case clearly proves that the process of lactation will not
+_invariably_ prevent the occurrence of pregnancy, since Mrs. A---- became
+in this state, notwithstanding she continued to suckle her child: and I
+think few will be so hardy as to doubt that it was the cause of her
+miscarrying: more particularly when I mention that, at a future period,
+the same lady, during my absence abroad, being once more persuaded to
+try whether she could not avoid becoming pregnant (which was very much
+to be desired, on account of her delicate state of health) by continuing
+to perform the duties of a nurse, again suffered all the distressing
+symptoms before described, and again miscarried.
+
+This case, finally, affords evidence of the evil consequences often
+produced in children by impoverished and unhealthy milk; and of their
+speedy disappearance when the exciting cause--namely, deteriorated
+milk--is no longer afforded.
+
+
+
+
+CHAPTER III.
+
+_On the various Diseases which frequently arise in Children from
+Lactation, especially when protracted._
+
+
+Having thus briefly considered some of the disorders to which women are
+subjected by performing the first duty imposed upon them as mothers, I
+shall next advert to those which are very frequently observed in their
+children from being suckled during too long a period; or in consequence
+of the nurse's milk becoming either simply impoverished, or of a
+positively injurious quality.
+
+These diseases are numerous, and some of them serious, among which may
+be enumerated the following; namely, vomiting, diarrhœa, general
+debility, scrofula, tabes mesenterica,--rickets, convulsions,
+epilepsy,--and lastly meningitis, or that peculiar inflammation of the
+investing membranes of the brain which gives rise to the effusion of
+serum, constituting the well known and very fatal disease termed by
+medical practitioners Hydrocephalus, or Hydrencephalus, and popularly
+Water on the Brain.
+
+The disease last mentioned being by far the most important, and that
+chiefly referred to in the following observations, I shall commence with
+a brief statement of the conclusions which my experience has led me to
+form respecting it; they are the same I made public four years ago[E],
+having since that time seen no reason to make any alteration in them. I
+believe,
+
+1st,--That if children be suckled for an undue length of time[F], they
+will be liable in consequence to be affected with meningitis[G], or
+inflammation of the investing membranes of the brain.
+
+2dly,--That should they not become affected with the disorder in
+question during or soon after the time they are thus improperly suckled,
+they will nevertheless acquire therefrom a predisposition to cephalic
+disease at some future period of their lives.
+
+3dly,--That children who are suckled for an undue length of time, when
+labouring under other diseases, will be much more liable to have the
+head secondarily affected, than children brought up in a different
+manner.
+
+4thly,--And lastly, that the same effects will take place in infants if
+suckled by women who have been delivered an undue[H] length of time;
+although the infants themselves may not have been at the breast for too
+long a period.
+
+       *       *       *       *       *
+
+CASES IN ILLUSTRATION OF THE FOREGOING VIEWS.
+
+
+I.
+
+_Cases of Meningitis[I] supervening upon protracted suckling._
+
+
+CASE I.
+
+---- Wilshire, aged two years seven months, died of '_Water on the
+brain_,'--_suckled twelve months_.
+
+
+CASE II.
+
+---- Park, aged one year ten months, died of '_Water in the
+head_,'--_suckled fourteen months_.
+
+
+CASE III.
+
+Prince V----, aged two years and a few months, died of
+_Hydrencephalus_,--_suckled until his death_. In this case I was
+consulted a short time previously, and recommended the breast-milk to be
+withheld--my advice was not followed.
+
+
+CASE IV.
+
+Emma Lane, aged two years, admitted at the Infirmary for Children for
+_Meningitis_,--_suckled one year and eleven months_.
+
+
+CASE V.
+
+The mother of the preceding suckled another child '_a very long
+period_,' and it died of '_Water on the Brain_.'
+
+
+CASE VI.
+
+Edmund Power, aged two years, _still at the breast_, admitted for
+_Chronic Hydrocephalus_: the head is of great magnitude; fontanelles
+open: superficial veins large and prominent.
+
+
+CASE VII.
+
+Sophia Hamley, aged one year two months, _still at the breast_, admitted
+for _Meningitis_.
+
+
+CASE VIII.
+
+William How, aged one year six months, admitted for
+_Meningitis_,--_suckled thirteen months_.
+
+
+CASE IX.
+
+David Hepburn, aged two years six months, admitted for
+_Meningitis_,--_suckled two years four months_.
+
+
+CASE X.
+
+Samuel Hanks, aged one year nine months, admitted for
+_Meningitis_,--_suckled one year eight months_.
+
+
+CASE XI.
+
+Amelia Hill, aged two years six months, admitted for
+_Meningitis_,--_suckled one year nine months_.
+
+
+CASE XII.
+
+---- Hughes, died of '_Water in the head_,'--_suckled fourteen months_.
+
+
+CASE XIII.
+
+---- Ferreira, aged seventeen months, died of '_Water in the
+head_,'--_suckled until its death_.
+
+For the five following cases I am indebted to the kindness of Mr.
+William Griffith, an intelligent surgeon of Eaton-street, who, having
+some time ago been apprised of my peculiar views, has since directed his
+attention particularly to the subject. They completely confirm my
+opinions, and will have more weight with the public than any additional
+evidence I could adduce from my own practice.
+
+In the letter inclosing these cases, Mr. Griffith writes thus--'from the
+observations I have been enabled to make, I am led to believe that
+disease almost invariably follows protracted suckling. I may add in
+conclusion, that I perfectly concur with the views which you entertain
+on the subject.'
+
+
+CASES XIV. XV.
+
+'---- Jackson, residing at ----, aged two years six months, who had been
+kept _at the breast twenty-two months_, was in a dying state when I was
+requested to see her. The pulse was preternaturally slow--great
+stupor--dilatation of the pupils, and diastasis of the bones of the
+head. In six hours from the time I first saw her she died, and the
+mother was desirous that the head should be examined, having lost a
+child previously, in what she considered a similar manner. On removing
+the scalp I found the cranium very much enlarged and altered in shape.
+Between the tunica arachnoides and pia mater, there was a quantity of
+water effused;--the sides and upper surface of the brain were
+exceedingly soft. In the lateral ventricles there were from six to eight
+ounces of water. In answer to a few questions I asked the mother, she
+stated that her former child was, during the _first ten months_ of its
+life, _a plump, healthy infant_,--_after that period he altered_,--the
+stomach, bowels, and _head became affected_, and, in the course of a few
+months, he manifested similar symptoms to those which proved fatal in
+the case of his sister. He was _suckled for twenty-one months_, and
+_died_ at the age of _twenty-seven months_. The mother of these children
+has one other child alive, and at my urgent request it was weaned at
+_nine months_,--it is now _seventeen months old, and in excellent
+health_.'
+
+
+CASE XVI.
+
+'Mrs. A----, of ----, had a little boy who at _ten months old_ had nine
+teeth, which were cut with little or no difficulty:--_at this time he
+was in good health_,--_he was allowed the breast until nineteen months,
+and at the expiration of three months more, died of Hydrocephalus_.'
+
+
+CASE XVII.
+
+'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at the
+breast seventeen months old_;--the little patient is frequently
+suffering from _cerebral disturbance_. I have repeatedly advised the
+mother to wean it--she objects, and gives the usual reason for allowing
+it to remain at the breast--viz., that she does it to _prevent becoming
+again enceinte_.'
+
+
+CASE XVIII.
+
+'This day, (August 13, 1831,) a little child labouring under _cerebral
+disease_ was brought to me for advice, and he appeared certainly in a
+most pitiable state; he is _two years four months old_ and is _now at
+the breast_,--I do not think it possible for him to survive many days.'
+
+
+II.
+
+_Cases of Meningitis, arising at an after period, in consequence of
+protracted suckling._
+
+
+CASE XIX.
+
+Francis Page, aged six years, admitted for _Meningitis_,--_suckled one
+year_.
+
+
+CASE XX.
+
+Henry Taylor, aged six years, admitted for _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXI.
+
+Julia Brown, aged three years, admitted for _Meningitis_,--_suckled
+thirteen months_.
+
+
+CASE XXII.
+
+James Neil, aged seven years six months, admitted for
+_Meningitis_,--_suckled fourteen months_.
+
+
+CASE XXIII.
+
+Eliza Park, aged six years, laboured under _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXIV.
+
+Charles Dale, aged five years; admitted for _Meningitis_--_suckled
+thirteen months_.
+
+
+CASE XXV.
+
+Sarah Strickling, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASES XXVI. XXVII. XXVIII.
+
+The mother of the last mentioned child lost three previously, with
+'_water in the head_:'--all these were suckled _more than eighteen
+months_.
+
+
+CASE XXIX.
+
+George Speering, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASE XXX.
+
+Ann Archer, aged seven years; admitted for
+_Hydrocephalus_--died--_suckled three years_.
+
+
+CASE XXXI.
+
+Cornelius Leary, aged six years; admitted for
+_Meningitis_--died--_suckled eighteen months_.
+
+
+CASE XXXII.
+
+Sophia Peverel, aged three years; admitted for _Meningitis_--_suckled
+two years_.
+
+
+CASE XXXIII.
+
+Maria Turley, aged four years; admitted for _Meningitis_--died--_suckled
+one year three months_. This child had laboured under a previous attack,
+from which she recovered under my care.
+
+
+CASE XXXIV.
+
+Robert Selkirk, aged three years six months; admitted for
+_Meningitis_--_suckled thirteen months_.
+
+
+CASE XXXV.
+
+The mother of the preceding child lost another of '_inflammation of the
+brain_.'--This was _suckled more than one year_.
+
+
+CASE XXXVI.
+
+Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled one
+year seven months_.
+
+
+III.
+
+_Cases of Meningitis in Children who had been suckled an undue length of
+time, supervening upon other complaints._
+
+
+CASE XXXVII.
+
+Arthur Lane, aged one year four months; admitted for Pneumonia, with
+_an affection of the head_--_suckled fourteen months_.
+
+
+CASE XXXVIII.
+
+Sarah Ward, aged three years; admitted for Hooping-cough--_head much
+affected_--_suckled one year and ten months_.
+
+
+CASE XXXIX.
+
+Thomas Donovan, aged two years two months; admitted for Hooping-cough,
+with _an affection of the head_--_suckled twelve months_.
+
+
+CASE XL.
+
+Count ---- ----, aged about two years, came under my care, being then at
+the breast. The head was large, fontanelle open--superficial veins more
+apparent than natural. By my advice he was directly weaned, and rapidly
+improved in health and appearance (the only medicine given being
+occasional doses of castor oil). About twelve months afterwards, in
+consequence of an imprudent exposure to cold, he was attacked with
+Bronchitis, and Meningitis supervened. Leeches were applied to the head,
+and other depletory measures actively employed, which were followed by
+recovery.
+
+
+CASE XLI.
+
+---- Sloggat, aged thirteen months, died of _Meningitis_ supervening
+upon Pneumonia--_suckled until the time of its death_.
+
+
+CASE XLII.
+
+John Scott, aged eleven months; admitted for Hooping-cough, with a
+_well-marked affection of the head_--_still at the breast_.
+
+
+CASE XLIII.
+
+---- Scott, aged fifteen months,--died of 'Hooping-cough, with
+convulsions,' _being then at the breast_.
+
+
+CASE XLIV.
+
+Isaac Berwick, aged one year two months, admitted for Hooping-cough,
+_with an affection of the head_--_still at the breast_.
+
+
+CASE XLV.
+
+Frederick Cousins, aged three years four months, brought to me labouring
+under Hooping-cough, with Meningitis, which latter terminated in
+effusion. Calomel was then given every two hours, the stronger mercurial
+ointment rubbed upon the temples, and blisters applied to the head. The
+mercurial influence being established, a profuse discharge of urine
+occurred; the pupils which had previously been _permanently_ dilated,
+became once more obedient to light; sensibility was restored, and great
+weakness appeared to be the only urgent symptom. The cough, however, now
+returned, the head became again affected, and the child sunk. Upon
+opening the head, about four ounces of fluid was found in the
+ventricles[K]. This child was _suckled sixteen months_.
+
+
+CASE XLVI.
+
+Sarah Swann, aged four years six months, admitted for Hooping-cough with
+convulsions,--_suckled one year_.
+
+
+CASE XLVII.
+
+Henry Harris, aged two years three months, admitted for Hooping-cough,
+_with an affection_ of the head,--_suckled one year four months_.
+
+
+CASE XLVIII.
+
+Maria Hughes, aged two years, admitted for _Convulsions_ supervening
+upon Hooping-cough--_suckled one year three months_.
+
+
+CASE XLIX.
+
+Thomas Benson, aged one year six months, admitted for Pneumonia, with
+_well-marked affection of the head_--_suckled one year four months_.
+
+
+CASE L.
+
+Mary Kenner, aged six years, admitted for Hooping-cough, with
+_well-marked affection of the head_--_suckled one year six months_.
+
+
+CASE LI.
+
+John Ennis, aged one year seven months, admitted for Bronchitis, to
+which _a decided affection of the head succeeded_--_suckled one year_.
+
+
+IV.
+
+_Case of Meningitis produced in consequence of the Child being suckled
+from its birth by a Woman who had at that time been delivered one Year._
+
+
+CASE LII.
+
+Ellen Willoughby, aged nine months, admitted for Meningitis; at present
+suckled by a woman who has been _delivered one year and nine months_.
+
+       *       *       *       *       *
+
+With respect to the manner in which protracted lactation causes the
+complaint that forms the subject of these remarks, I formerly was
+undecided; but have now no doubt whatever of its arising _secondarily_
+from derangement in the functions of the abdominal viscera, occasioned
+by the depraved condition of the breast-milk.
+
+It is universally allowed among medical men that irritations in the
+stomach and bowels will, through the agency of particular nerves,
+produce sympathetic irritation in the brain,--that peculiar action
+being thus elicited which terminates in the effusion of serum,
+constituting the disease named Hydrocephalus.--'The continued irritation
+of important or very sensible nerves is, perhaps,' says Mr. Burns, '_one
+of the most common causes_' (of Hydrocephalus); 'hence it may follow
+dentition, and _very often arises from a bad state of the chylopoietic
+viscera_.'
+
+It is also no less generally known that food of a bad quality or
+improper description will produce derangements in the digestive organs.
+Now, having already shewn that the milk when lactation is protracted
+becomes deteriorated, it plainly appears that such milk is capable of
+occasioning derangement of the chylopoietic viscera; and it being
+allowed that derangement of these viscera, from any source, may give
+rise to inflammation of the brain, I conceive it follows that protracted
+lactation must be admitted as one cause of such effect. This train of
+reasoning, therefore, from generally admitted data, seems to _prove that
+Meningitis_, or inflammation of the brain, _in children can be produced
+by their being suckled for too long a period_, and _that it is so
+produced I assert from repeated experience_.
+
+An accidental perusal of Mr. Dendy's able work on the cutaneous diseases
+of children, published shortly after the appearance of my paper before
+referred to in the Medical and Physical Journal, has recently afforded
+me the pleasure of finding that the author had been led to entertain
+similar general views on the subject under discussion with myself; I
+have, therefore, taken the opportunity of adding that gentleman's
+testimony to my own, by quoting the following passage from his work
+above mentioned.
+
+'It may be truly said, that _the infantine disease excited by milk of a
+deleterious, or simply impoverished quality, "grows by what it feeds
+on;"_ and we shall witness the internal debility and the infantine
+disorder running their course together. Tabes is the natural consequence
+of this error; but its effect is evinced by the occurrence of other
+disorders. A defective degree of nutrition, as I have elsewhere stated,
+predisposes the system to become influenced by comparatively slight
+excitement; and thus, in addition to the direct excitement of disease,
+it becomes indirectly its predisposing cause. _Under its influence the
+serous_[L] and mucous _membranes become readily the seat of
+inflammatory action_.'
+
+Those who feel a difficulty in relinquishing old opinions and adopting
+new views upon any particular subject, may perhaps ask how it has
+happened, if inflammation of the brain from protracted suckling be so
+common as the preceding observations and cases would appear to prove,
+that medical men of more advanced age and far greater experience than
+myself have not previously noticed the circumstance. I would observe, in
+reply, that until Harvey pointed out the circulation of the blood, no
+one ever suspected the existence of such a phenomenon; yet now the
+wonder appears to be, not that Harvey made the discovery, but that
+others had not previously done the same. Multitudes, it may be added,
+and among them the great Newton, had witnessed the fall of objects to
+the ground without thinking of the cause which produced their downward
+tendency; the propitious moment, however, arrived--the apple fell, and
+the philosopher was led to those deductions which have rendered his name
+immortal. So is it with observers of every class, from those most
+distinguished by intellectual superiority and its successful
+application, down to the humble writer of the present observations.
+Facts are continually passing before us unnoticed, till, from their
+repeated coincidence, or some accidental impulse, we attempt, and
+finally are enabled, to trace their origin.
+
+Thus, until the possibility of Meningitis originating from protracted
+lactation had been suggested, practitioners were, of course, unable to
+notice the fact--not from its non-occurrence, but because their
+unconsciousness of its existence must necessarily preclude the inquiries
+from which alone its cause could be determined. Hence a practitioner may
+have treated many hundred cases of water on the brain in children,
+without being able to attribute any one of them to protracted suckling;
+yet this is no proof that such cases did not happen, for, had he made
+the requisite inquiries, very probably many among them might have been
+found which had thus arisen.
+
+Another objection that may possibly be made to my views, is, that
+instances might be adduced where lactation had been persevered in for a
+very long period, without any ill effects supervening. That such
+frequently occur, there is no doubt; and with respect to them, I have
+merely to observe, that they do not in the slightest degree invalidate
+the correctness of my conclusions. As well might it be argued, that
+because persons have fallen from a very great height without sustaining
+any injury, or, because poisonous doses of various drugs have sometimes
+been swallowed without death supervening, that, therefore, there is no
+danger in jumping from a precipice, or in taking a virulent poison; or
+that death never occurs from these causes. Such cases, unless far more
+numerous than I imagine them, can only be regarded as exceptions to the
+general rule; and, consequently, do not lessen its authority, there
+being no rule without an exception.
+
+Some practitioners, with whom I have conversed on the subject, though
+willing to allow that protracted suckling, by depraving the milk, may be
+the means of occasioning Meningitis in infants during or shortly after
+the time they are supplied with this improper food, yet could not
+conceive how it can act as a cause of that disease at some future
+period; I do not myself, while attempting to account for it, discover
+any pathological difficulty.
+
+In these cases it is very probable, that although the protracted
+suckling was not sufficient to produce actual Meningitis at its
+conclusion, yet that it so weakened the system in general, and the brain
+in particular, as to render the latter especially predisposed to
+inflammatory action; and that we have reason to suppose this not only
+possible, but probable, from analogy, cannot be denied, since it is
+known that scrofulous children, in whom there is great laxity and
+debility of habit, are inordinately liable to be affected with
+Hydrocephalus, or Water in the Brain.
+
+'Dr. Perceval observes, that of twenty-two cases of which he kept notes,
+_eleven were certainly strumous children_, and _four were probably so_.'
+'From my own observations,' remarks Dr. Cheyne, 'I should think this
+proportion a very moderate one. When a whole family is swept away by
+Hydrocephalus, I suspect _it is intimately connected with this strumous
+taint_.' The testimony of Sauvages may also be adduced, who says, 'Novi
+familiam cujus infantes circa sextum ætatis annum omnes periere ex hoc
+morbo, _Scrofula huic effusioni ansam præbente_.' The brain, in
+consequence of this local debility, may become affected from causes
+which otherwise would, perhaps, have produced no injurious consequences
+whatever; and hence it is, that when labouring under other diseases, and
+especially Hooping-cough, those children who have been suckled too long
+appear so very liable to have the head secondarily affected. It is
+worthy of notice, that among the cases which have been detailed in the
+foregoing pages, were fourteen in whom affection of the head supervened
+during the progress of other diseases, and in ten of them the disease
+was Hooping-cough.
+
+The treatment of Meningitis arising from protracted suckling will not
+differ from what is proper when it has been produced by other causes;
+except that the depletory measures should not be carried to so great an
+extent, as it must be remembered that the disease is existing in
+constitutions _already debilitated_.
+
+It should consist generally in the application of leeches to the
+temples--cold lotions to the head--purgatives, and blisters placed
+behind the ears, the discharge from which is to be kept up by means of
+irritating dressings--these afford the surest chance of subduing the
+malady, and in many instances, if employed sufficiently early, will have
+the desired effect. It is, of course, almost superfluous to observe,
+that weaning, if the child be above nine months old, must be
+immediately enforced; or, if considerably younger, the diseased or
+debilitated nurse ought to be exchanged for one who has a supply of
+healthy milk of a corresponding age. If such cannot be procured, the
+child must be brought up by hand; for, so long as it is allowed to
+imbibe the noxious milk, there is little hope, in my mind, of the
+medical treatment being of any great service; while on the contrary, it
+is encouraging to know that many infants previously manifesting symptoms
+of incipient Meningitis have completely recovered _soon after they were
+weaned_[M].
+
+When my attention first became directed to the subject, I was chiefly
+struck with the ill effects resulting to the child from _protracted_
+lactation, and hence supposed that cases of disease from suckling, when
+continued for only a moderate period, were rarely if ever met with. More
+enlarged experience, however, has now convinced me, that not only are
+ill effects occasioned in children when lactation is protracted to a
+very unusual extent, but that they occur sometimes, when its duration
+has been merely a few months beyond what I conceive is right. Besides
+which, we shall find that when from any cause whatever the nurse's milk
+becomes impoverished and deteriorated, even if this take place at an
+early period after delivery, the injurious effects already referred to
+may be produced in the child: for improper food, whether it be bad milk
+or any other inappropriate article of diet, is always calculated to
+derange the functions of the stomach, bowels, and other chylopoietic
+viscera, and in consequence to occasion disease.
+
+It matters not whether the mother be originally unhealthy, and thus her
+milk possess bad qualities; or whether from accidental circumstances, or
+her continuing to give suck too long it becomes so: in either case the
+same effect, namely, _deteriorated milk_, is produced, with the
+concomitant evils to which I have alluded. This view of the matter is
+corroborated by Case LII., in which true Meningitis attacked a child,
+aged only nine months, who, therefore, was not suckled _too long_,--but
+then the nurse of that child had been delivered _twenty-one months_,
+having suckled another infant previously:--hence we may reasonably
+conclude that her milk being from the beginning deteriorated, and
+unadapted to the age of the child, the ill effects in this case were
+produced at a much earlier period than usual.
+
+It will be observed that I have only given _one_ instance of this latter
+description; but, on considering how very rare it must be to find any
+mother capable of abandoning her newly-born infant to the breast of a
+woman who has already suckled another child one year, any surprise that
+might be felt at the circumstance will, I am sure, immediately cease. It
+must also be noticed that only among the lowest grades of society do we
+find women so long after delivery performing the office of wet-nurse at
+all, and those who entrust their infants to the latter are often so
+peculiarly situated as to feel no interest whatever in the preservation
+of their offspring: indeed I cannot but suspect that, among such,
+criminal motives frequently lead to the adoption of the unnatural and
+baneful practice in question.
+
+I do not recollect to have seen a case of Meningitis from suckling
+except when this process had been _protracted_, either as respects the
+child or the nurse; though I by no means doubt the possibility of its
+occurrence under other circumstances: but I have met with numerous
+instances of other diseases produced by the palpable deterioration of
+the mother's or nurse's milk at various periods after delivery; in by
+far the greater number, however, of such cases, lactation had been
+continued for an unusual length of time.
+
+Vomiting, griping, and diarrhœa, are so common among infants, and
+arise in general from causes apparently so evident, that, unless severe
+or of long duration, they rarely form the subject of minute inquiry.
+Hence these complaints are, perhaps, not so often attributed to
+deteriorated milk as they ought to be, although the fact of their
+occasionally originating from a morbid condition of this fluid, (and
+therefore from protracted lactation as one cause of the latter effect,)
+is too well established to be questioned. Dr. Underwood observes, 'has
+not every Physician of experience seen infants frequently thrown into
+tormina immediately after coming from the _breast of an unhealthy
+mother, or one who has but little milk_?'[N] and Mr. Burns states, that
+if the usual periodical appearance should return, 'the milk is liable to
+disagree with the child, and produce vomiting or purging;' while Dr.
+Hamilton expressly mentions that diarrhœa is 'not unfrequently
+_occasioned by the depraved quality of the nurse's milk_.'
+
+The two former authors merely testify to the fact of diseases being
+produced by the milk, while the latter more explicitly mentions the
+cause from which they proceed.
+
+Debility, Tabes Mesenterica, and Scrofula, may also be traced to the
+same origin, as every practitioner of experience must have repeatedly
+observed: so may that intractable disease, termed Rickets; and it is
+worthy of notice, that among the worst instances of this malady I have
+seen, were two sisters, _who had been suckled for a very unusual
+period_. Neither do I doubt the probability of Epilepsy being similarly
+occasioned; and although, I must candidly own, I cannot produce numerous
+cases in proof of the correctness of such hypothesis, yet I recollect
+that of a girl affected with this complaint, respecting whom the mother
+stated (and I recorded the fact at the time) that she had been '_suckled
+for two years_;' and, to use her own expression, had 'never been well
+since.'[O]
+
+Convulsions arising from protracted suckling, or simply from the nurse's
+milk becoming deteriorated at any period, are very common, and I have
+kept notes of many such cases that have occurred in the course of my own
+practice; which, however, I abstain from here inserting, being anxious
+to prevent the present publication from swelling into a volume. Indeed,
+the occurrence of convulsions from this cause (diseased milk) has been
+mentioned by several of the best authors. Mr. North, in particular,
+(whose excellent work on Convulsions should be in the hands of every
+practitioner) observes--'It cannot be doubted that children suffer, that
+their health is destroyed, and the foundation laid for convulsive
+diseases, by _sucking unhealthy nurses_.' 'A predisposition to
+convulsive affections in children may be originally produced in
+consequence of their being suckled by a nurse addicted to the frequent
+use of spirituous liquors. In several instances I have known children
+rapidly recover their health when the nurse was changed, who had
+exhibited most of the premonitory symptoms of convulsions while they
+were suckled by a woman who indulged in the common vice of
+gin-drinking.' And Mr. Burns also makes the following remark--'Violent
+passions of the mind affect the milk still more;--it often becomes thin
+and yellowish, and _causes_ colic, or even _fits_.' It is needless,
+however, to say more on this topic, since it is one which no longer
+admits of discussion.
+
+The reader may now, perhaps, expect that I shall introduce a series of
+practical deductions from the foregoing facts and observations; but
+such is not my object upon the present occasion. I merely wish to call
+the attention of practitioners and the public to the subject of these
+pages, and shall thus discharge, as I conceive, an imperative duty to
+society. Having mentioned what I am induced to consider a frequent cause
+of inflammation of the investing membranes of the brain in children, my
+undertaking is completed. The Profession does not require, and the
+public would not be benefited, by the addition of lengthened
+therapeutical rules; for I am convinced, there is not a greater
+imposition to be found than the doctrine that non-medical persons can
+treat diseases with success by means of popular systems of medicine,
+'_practical_' treatises, &c. Such books have often done irreparable
+mischief--certainly much more harm than good; and so far from injuring
+the profits of medical practitioners (as some appear to suppose), have
+greatly added to the number of their patients.
+
+I avail myself also of this opportunity to enter my protest against the
+ill-judged and mischievous practice of those patients who confide upon
+many occasions in the opinion of their nurse, rather than that of their
+medical attendant, and who, in consequence, often injure themselves
+essentially by deceiving the latter. With respect to this mistaken
+preference, Dr. Dewes has well observed--'Let it not be hastily assumed
+that there is more safety in following the directions of a nurse than
+those of the physician, because she may have had some experience; for it
+must be quickly perceived that the calculation is much in favour of the
+latter, since the nurse can attend but twelve patients per annum, while
+the physician may visit many hundreds in the same period--besides, his
+knowledge of the laws of the human system gives him a very decided
+superiority.'
+
+In conclusion, it is right to observe, that protracted suckling being a
+custom much more prevalent among females of the lower orders than those
+of a superior rank, it must follow as a necessary consequence, that
+_Meningitis, and other disorders resulting from this cause, are
+proportionably less frequent in private than in public practice_. This
+remark, it is evident, should be remembered, in order to obviate
+apparent discrepancies which otherwise might appear irreconcilable with
+the opinions I have expressed. In the truth of those opinions I feel the
+most perfect confidence, and cannot but hope that their promulgation
+will hereafter prove extensively beneficial, since precautionary, and
+even therapeutical measures may be founded upon them, which, if
+uniformly adopted, will not only prevent much ill-health and suffering
+to mothers, but will also afford the means of saving many children from
+perishing by one of the most painful and fatal diseases to which they
+are subject.
+
+
+
+
+POSTSCRIPT.
+
+
+Being anxious to obtain additional evidence with respect to the
+production of Meningitis in children by protracted suckling, rather from
+the experience of others than my own, I shall feel greatly obliged to
+any practitioners who will favour me (free of postage) with either facts
+or cases tending to corroborate the truth of the doctrine contained in
+the preceding pages; and should I be enabled publicly to avail myself of
+such communications, it is, perhaps, unnecessary to say, I shall not
+neglect the opportunity of expressing my acknowledgments to their
+respective authors. The intelligence and liberality characterising the
+members of the medical profession generally, preclude all apprehension
+on my part that the above appeal will be made in vain.
+
+
+
+
+NOTES
+
+
+Note A (page 1).
+
+A dark-green substance of variable consistence, contained in the bowels
+of infants at birth.
+
+
+B (page 4).
+
+I beg leave to observe that I make these statements with some confidence
+as the result of personal inquiries instituted a few years ago among the
+patients of two of the Lying-in Establishments of this metropolis.
+
+
+C (page 8).
+
+Since the above was written, a friend who lectures on Chemistry in the
+metropolis has kindly promised me his valuable assistance in making the
+experiments here suggested.
+
+
+D (page 10).
+
+In two cases where suckling was protracted to _three years_, the
+subjects of this baneful practice did not equal in size an ordinary
+child of half their age. One of them became idiotic, and afterwards died
+of Hydrencephalus, under my care; the other was affected with Tabes
+Mesenterica,--the result I did not witness--but believe the disease
+terminated fatally.
+
+
+E (page 25).
+
+Vide Medical and Physical Journal for August 1827.
+
+
+F (page 25).
+
+That is, any period beyond nine or ten months.
+
+
+G (page 25).
+
+_Meningitis_,--I use this term as being more pathologically correct than
+_Cephalitis_, which I formerly adopted.
+
+
+H (page 26).
+
+See the above conditional sense in which I employ this term.
+
+
+I (page 26).
+
+It is a curious fact, which I believe has not been noticed by any other
+writer, that female children labouring under attacks of Meningitis are
+sometimes affected with leucorrhœal discharges. I have met with
+several cases of this description: the children also of women subject to
+leucorrhœa will often, at an early age, be found affected with the
+same disease. Hence it would appear that leucorrhœa is occasionally
+hereditary.
+
+
+K (page 37).
+
+It is unquestionable, notwithstanding the scepticism of some
+practitioners on the subject, (whose opinions are entitled to
+deference,) that _recovery may take place, under appropriate treatment,
+in cases of Meningitis, even after effusion has unequivocally occurred_.
+Preceding authors have noticed this fact, which I can confirm by my own
+experience. Practitioners cannot be too frequently reminded of it, and
+warned not to despair of success even in the last stage of
+Hydrencephalus.
+
+
+L (page 42).
+
+For the information of the _unprofessional_ reader, I beg to observe,
+that the membranes of the brain are _serous membranes_.
+
+
+M (page 48).
+
+It will be observed hereafter, that Mr. North has experienced similar
+beneficial effects from the course above recommended, in cases where
+_convulsions_ have been caused by _diseased milk_;--a strong
+corroborative coincidence.
+
+
+N (page 52).
+
+I believe that where the milk is greatly diminished in quantity, it will
+also be found deteriorated in quality.
+
+
+O (page 53).
+
+In the communication above referred to from Mr. Griffith is the
+following:--'Mrs. A. has a family of four children, all of whom she
+suckled for a period varying from _seventeen_ to _twenty-two
+months_:--_not one of the four is healthy_.'
+
+
+
+
+BY THE SAME AUTHOR,
+
+
+Preparing for publication, in one small volume, 8vo.
+
+OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the Principal
+Symptoms of DISEASE in INFANTS and CHILDREN, with the best modes of
+detecting them;--interspersed with Practical Observations, and intended
+as a clinical guide to Students, &c. &c.
+
+
+Also, in 2 vols. 8vo.
+
+The EIGHT BOOKS of ARETÆUS of CAPPADOCIA on the Causes, Symptoms, and
+Treatment of ACUTE and CHRONIC DISEASES. Translated literally from the
+original Greek, and supplied with critical and explanatory Notes, Tables
+of the Weights and Measures, &c. &c.
+
+
+By the same Author,
+
+Recently published by Longman and Co. in 8vo., boards, price 14_s._
+
+TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in the
+Years 1827-29;--intended to give some account of Russia as it is, and
+not as it is represented to be.
+
+
+Printed by W. CLOWES, Stamford-street.
+
+
+
+
+
+End of the Project Gutenberg EBook of Remarks on the Subject of Lactation, by 
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+Project Gutenberg's Remarks on the Subject of Lactation, by Edward Morton
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Remarks on the Subject of Lactation
+
+Author: Edward Morton
+
+Release Date: August 16, 2007 [EBook #22344]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LACTATION ***
+
+
+
+
+Produced by Bryan Ness, Stephen Blundell and the Online
+Distributed Proofreading Team at http://www.pgdp.net (This
+book was produced from scanned images of public domain
+material from the Google Print project.)
+
+
+
+
+
+
+
+
+
+                      REMARKS ON THE SUBJECT OF
+
+                            LACTATION,
+
+                              &c. &c.
+
+
+
+
+
+                              REMARKS
+
+                         ON THE SUBJECT OF
+
+                             LACTATION;
+
+                             CONTAINING
+
+                            OBSERVATIONS
+
+                               ON THE
+
+        HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK;
+                 THE DISORDERS FREQUENTLY PRODUCED
+                      IN MOTHERS BY SUCKLING;
+
+                                AND
+
+                    NUMEROUS ILLUSTRATIVE CASES;
+
+           PROVING THAT, WHEN PROTRACTED, IT IS A COMMON
+                       CAUSE, IN CHILDREN, OF
+
+               HYDRENCEPHALUS, OR WATER IN THE BRAIN,
+
+                                AND
+
+                     OTHER SERIOUS COMPLAINTS.
+
+
+                                 BY
+
+                    EDWARD MORTON, M.D. CANTAB.
+
+FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY
+       COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS,
+         LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY,
+                   AND TO THE ROYAL METROPOLITAN
+                  INFIRMARY FOR CHILDREN, &c. &c.
+
+
+                              LONDON:
+
+               LONGMAN, REES, ORME, BROWN, AND GREEN,
+                          PATERNOSTER-ROW.
+
+                             MDCCCXXXI.
+
+
+
+
+LONDON:
+PRINTED BY WILLIAM CLOWES,
+STAMFORD STREET.
+
+
+
+
+TO
+
+SIR HENRY HALFORD, BART., M.D., F.R.S., F.A.S.,
+
+PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON,
+PHYSICIAN TO THE KING, &c. &c.
+
+THE FOLLOWING PAGES
+
+ARE,
+
+WITH HIS PERMISSION,
+
+AND WITH
+
+A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIR
+AUTHOR, MOST RESPECTFULLY
+
+DEDICATED.
+
+
+
+
+PREFACE.
+
+
+Several cases which I witnessed led me to believe, some years ago, that
+inflammation of the brain, or its membranes, might be produced in
+children, owing to their being suckled for an undue length of time.
+Since that period, having enjoyed opportunities of observing infantile
+diseases on a much more extended scale, and my attention being expressly
+directed to the point in question, I not only became fully convinced of
+the correctness of my previous conclusions, but was induced to carry
+them still farther.
+
+My opinions on this subject were briefly drawn up and published in the
+_Medical and Physical Journal_ for August 1827, and have not passed
+altogether unnoticed by my professional brethren[1], some of whom have
+done me the honour to speak of them in flattering terms, while no one, I
+believe, has attempted to disprove the existence of the important fact I
+was the first to announce.
+
+[1] Vide Medico-Chirurgical Review, Gazette of Health, Dendy on
+Cutaneous Diseases, &c.
+
+The bare statement of that fact was, indeed, nearly all that my
+approaching departure from England, at the time last mentioned, left in
+my power: upon the present occasion I have offered arguments for, and
+endeavoured to anticipate those against, the deductions I then made
+public; and however imperfect may have been my success in either, the
+welfare of society at large is too deeply involved in the establishment
+of my opinions with respect to the custom I condemn, (if those opinions
+be correct,) for me to hesitate while again committing them to the press
+in a more extended form.
+
+These considerations, I respectfully submit, will render any apology for
+the appearance of the following pages unnecessary, and will, I trust,
+secure for them a candid and favourable reception from the Profession
+and the Public.
+
+_15, Eaton Street, Grosvenor Place,
+          October 8, 1831._
+
+
+
+
+CONTENTS.
+
+
+                          CHAPTER I.
+                                                          Page
+Of the Breast-Milk, &c. &c.                                  1
+
+
+                         CHAPTER II.
+
+On Lactation, and the Disorders frequently produced in
+Women by that process                                       14
+
+
+                         CHAPTER III.
+
+On the various Diseases which arise in Children from
+Lactation, especially when protracted                       24
+
+
+Postscript                                                  59
+
+Notes                                                       61
+
+
+
+
+ERRATA.
+
+
+Page 10, line 3, _for_ two _read_ a few.
+
+  "  52,  "  19, dele comma between the words Tabes and Mesenterica.
+
+
+Transcriber's Note: The above corrections have been applied to this
+text, in addition _headach_ has been corrected to _headache_ on page
+18, line 11. Throughout the text the oe ligature has been represented as
+[oe].
+
+
+
+
+CHAPTER I.
+
+_Of the Breast-Milk, &c. &c._
+
+
+No sooner has the child been ushered into the world than the breasts of
+the mother pour forth their milk for its sustenance. This bland fluid is
+secreted from the blood, and varies, in quality and quantity, according
+to the time which has elapsed from delivery, being peculiarly and
+wonderfully adapted at every period to the wants of the individual for
+whose use it is destined. Thus, that first secreted, called _colostrum_,
+possesses a purgative quality evidently intended by the all-wise Author
+of our being for the purpose of removing _the meconium_[A],--a process
+which experience has sufficiently proved to be necessary for the welfare
+of the newly-born infant. Afterwards, ceasing to possess this aperient
+property, it is calculated solely for affording nutrition; and finally,
+at a certain period from delivery, it gradually becomes impoverished,
+loses its former healthy qualities altogether, and acquires others which
+are injurious to life. This important change, as above noticed,
+generally happens at a certain period after delivery; varying, however,
+somewhat in particular women, and in the same female on different
+occasions: but, from disease, or other circumstances, the milk may
+become deteriorated before the time to which reference has just been
+made. If, for instance, the mother labour under any serious disorder, it
+is universally admitted that her milk may also become unhealthy; and
+this may take place even a short interval after delivery.
+
+Although we cannot explain how the brain and nerves act, and probably
+never shall be able to do so, yet we are well aware that their influence
+is absolutely requisite for the healthy performance of every function in
+the human body.
+
+That mental inquietude will impede digestion is a fact familiar to
+almost every one; but, I believe, it is not so generally known, that it
+will with no less certainty retard and alter the nature of the secretion
+furnished by the breasts of the lactescent female. Violent affections of
+the mind will cause the milk to become thin and yellowish, and to
+acquire noxious properties: even the fond mother's anxiety, while
+hanging over the couch of her sick infant, will be sufficient to render
+it unfit for the sustenance of the object of her solicitude.
+
+The state also of the stomach and bowels and the diet of the nurse
+materially and constantly influence the nature of the lacteal secretion.
+
+The milk, besides, is liable to deterioration from another cause,
+namely, the recurrence of the usual periodical appearance--for should
+this take place in a nurse, it is agreed that her milk is liable to
+produce disorders in the child who imbibes it; which could not happen,
+if the former possessed its ordinary component parts, and retained its
+natural properties.
+
+The recurrence, moreover, of pregnancy in the lactescent female may
+render the milk of a bad quality, and will invariably lessen its
+quantity. Mr. Burns asserts that in these cases the milk 'does not
+become hurtful,' but in this opinion I must beg leave to differ from
+him; since I have repeatedly seen it, from this cause, palpably altered
+in appearance, and have observed diarrh[oe]a and great debility produced
+in the children who were suckled with it.
+
+An almost universally received opinion among females, and, indeed, one
+very frequently entertained by members of the medical profession, is,
+that while a woman continues to nurse her infant she will not again
+become pregnant; but this, as a general proposition, is unquestionably
+erroneous; it is even doubtful whether such opinion will hold good in a
+majority of instances. The continuance of lactation will very generally,
+it is true, tend to prevent the recurrence of the periodical phenomenon;
+yet, nevertheless, it will not in every instance prevent pregnancy[B].
+Should, however, a woman with an infant at the breast again become
+pregnant, (a circumstance that very frequently occurs, and of which,
+from the _general though not invariable_ absence of those criteria by
+which this fact is accustomed to be recognised, she is not aware until
+it has made some progress,) one of two things will usually take place;
+either she will miscarry, or her milk will become impoverished in
+quality and diminished in quantity. Nor is this wonderful:--it was not
+intended by Nature that the processes of pregnancy and lactation should
+go on simultaneously, but, on the contrary, that the one should commence
+when the other had terminated; and experience sufficiently proves that
+they will not proceed well together: the reason of which, as it appears
+to me, may be easily given. During pregnancy, and particularly during
+its latter periods, the vessels of the womb gradually enlarge, and a
+much greater quantity of blood than usual is determined to that organ
+for the increase and perfection of the embryo and its appendages; which,
+after delivery, becomes transferred to the breasts to supply the
+material for the secretion of the milk: but if, during pregnancy,
+lactation be also persevered in, the blood becomes directed at the same
+time to two different parts of the body, somewhat remote from each
+other, namely, to the womb, and to the breasts; hence, neither is likely
+to receive its due proportion of this vital fluid, and, consequently,
+the functions of one or the other, or both, are liable to become impeded
+or suspended. If the breasts continue to receive a sufficient quantity
+of blood, the secretion of milk goes on properly, but the womb is
+deprived of its necessary supply; the embryo, in consequence, languishes
+and dies, and, becoming an extraneous body, is thrown off, producing
+abortion; while, on the other hand, should the womb still obtain its due
+proportion of blood, the breasts are robbed of it, and the secretion of
+milk, if not altogether suppressed, is rendered either deficient in
+quantity or deteriorated in quality.
+
+Finally, the breast-milk may become depraved and injurious by the
+process of lactation being continued too long, a practice which is,
+unfortunately, in this, as well as other countries, extensively
+prevalent.
+
+I have not yet had an opportunity of examining the breast-milk in these
+diseased conditions except by the eye, and that rarely--but even this
+slight examination has enabled me to state, that it was greatly altered
+from its natural condition;--that it was more fluid than usual, and
+changed in colour, resembling a yellowish turbid serum, instead of
+displaying its well-known bluish hue.
+
+I propose in future to attend carefully to this subject, and I would beg
+leave to recommend it as one well worthy the notice of those members of
+our profession who have made animal chemistry a particular study, having
+no doubt that they would be able, by a series of accurate experiments
+upon the breast-milk at different periods after delivery, and under
+various conditions of the mother, to collect many interesting and
+important facts--such, perhaps, as would tend very materially to augment
+our knowledge of pathology, and improve our practice in the treatment
+of certain diseases[C].
+
+We cannot but believe that the Supreme Being has done nothing without an
+infinitely wise and good object, and it is obviously our interest, no
+less than our duty, to be guided by those indications of the Divine
+purpose which are distinctly to be traced throughout the creation.
+
+It must appear evident to all who examine the matter in question, that
+the infant was intended to be nourished for the first few months of its
+existence through the medium of a fluid; because no teeth are provided
+to prepare for its use substances of a more solid description; and there
+can be no doubt that this fluid is the mother's milk;--but when the
+child has attained a certain age the teeth begin to appear, doubtless at
+the precise time when they are meant to be used; and, therefore, more
+solid food should now be given. Besides, in consequence of its new
+acquisition, the child sucks less perfectly than before, an additional
+proof that weaning ought at this period to be commenced. Indeed, the
+teeth are calculated indirectly to produce this effect themselves, the
+mother being now liable to suffer inconvenience by letting the child
+take the breast--for the latter _bites_ instead of _sucking_ the nipple,
+and the pain hence arising may, perhaps, induce the former, for her own
+sake, to discontinue a practice injurious to both.
+
+It must also be remembered, that when the teeth are usually produced,
+the milk loses its nutritious properties, and this too at a time when
+the infant from his increasing size must evidently require a more solid
+and substantial, rather than a thinner and less nourishing diet. What
+rational argument, therefore, can be offered why he should still be
+suckled? If we observe the brute creation, do any analogies appear by
+which we can defend the propriety in the human species of protracted
+suckling? by no means:--on the contrary, we find that the female animals
+soon drive away their young from their dugs; and what is, perhaps, still
+more to the purpose, I have heard stated, on good authority, as a
+well-known fact among the breeders of cattle, that if calves be allowed
+to suck beyond a few months they do not thrive, but, on the contrary,
+become lean and diseased.
+
+The belief so generally prevailing, that the longer a child is suckled
+the stronger it will become, is a prejudice, like many others concerning
+women and children, which has been handed down from mother to daughter
+for ages, and has thereby become so universally entertained and so
+deeply rooted in the minds of females, that even medical men scarcely
+venture to question its propriety. My own experience, however, compels
+me to declare, that there is not a more erroneous or mischievous
+doctrine; and I can most truly affirm, that I never yet witnessed an
+instance where protracted lactation had produced any good effect[D],
+though I have seen numerous examples (some of which will be introduced
+hereafter) where, I believe, it had been the indirect cause of death.
+
+Having thus strongly noticed the impropriety of long continued
+suckling, it will, perhaps, be proper to state my opinion as to the
+period when this process should terminate. As a general rule, at nine
+months after birth the child ought to be entirely weaned; and in no
+instance should he be permitted to suck more than ten. In many cases
+suckling may be relinquished with advantage (and occasionally it is
+absolutely necessary to discontinue it) before the time first above
+mentioned; in others, however, it may be protracted beyond it.
+
+I by no means recommend the breast-milk to be at once superseded by
+artificial food, but, on the contrary, that the child should be
+_gradually_ accustomed to such aliment from a much earlier period; the
+proportion of the latter being increased by degrees, while the
+breast-milk is diminished in a corresponding ratio. Hence we shall
+produce a double advantage; the mother will be benefited as well as the
+child--the former, by giving suck less frequently, and in smaller
+quantities at a time than usual, will have the secretion of milk
+_gradually lessened_, and, therefore all likelihood of inconvenience, as
+far as regards herself when the child is entirely weaned, will be
+completely prevented; while, on the other hand, the child being
+_insensibly estranged_ from the breast, will have become accustomed to
+his new food, so that there will be less chance of its disagreeing with
+him when it forms his sole support; and thus the danger which is
+generally apprehended from weaning will be either materially lessened or
+altogether avoided.
+
+The difficulty of bringing up infants by hand, as it is termed, is well
+known; but I suspect that the great mortality which has been recorded as
+occurring from this source is not inseparable from the practice itself,
+but arises mainly from the improper manner in which it is usually
+conducted. When it is determined to bring up an infant by hand, the
+substitute offered for the mother's milk should as nearly as possible
+resemble that fluid; and the child should be constrained to imbibe it in
+_the same manner as_ it would _the milk from the maternal breast_; that
+is, it should be _sucked_ from a bottle contrived for that purpose,
+instead of the child being gorged with it, by means of a large spoon, or
+some other equally improper instrument, as is the usual custom. It is a
+fact too palpable to be questioned, that the food generally given to
+infants brought up by hand is not only administered in an improper
+manner, but is also of an improper quality; their tender stomachs are
+daily overloaded with _solid_ instead of _liquid_ aliment, and hence
+arises the numerous train of evils which, in my opinion, produce the
+great mortality just referred to.
+
+
+
+
+CHAPTER II.
+
+_On Lactation, and the Disorders frequently produced in Women by that
+process._
+
+
+There can be no doubt that, speaking generally, a mother is bound to
+suckle her children, and that the performance of this duty is no less
+conducive to her own health than to the moral and physical welfare of
+her offspring; yet there is not a more unfounded doctrine than that
+which presumes every woman who is willing to be also capable of
+advantageously discharging the important office of a nurse.
+
+If the mother enjoy good health, and the process be not continued too
+long, it is likely to produce beneficial effects both in herself and her
+infant; but if she be of a very delicate habit--labour under any
+dangerous disease--be subject during the period of lactation to great
+affliction, or constant mental inquietude--or should the periodical
+appearance return, pregnancy occur, or suckling be continued too long,
+it may not only prove highly detrimental to herself, but may be the
+means of occasioning serious or fatal consequences to her child.
+
+In cases of extreme delicacy of constitution, lactation will often
+produce the worst effects. Many young ladies, on becoming mothers, are
+incapable of supporting the constant drain to which the wants of their
+infants subject them--they lose their good looks, become gradually
+weaker, and as their strength declines, their milk is simultaneously
+lessened in quantity, and altered in its other properties.
+
+If the suckling be still continued, their debility daily increases,
+distressing pains in the back and loins succeed; the patients become
+exceedingly nervous, as it is termed, and are unusually susceptible of
+ordinary impressions; pain in the head, often of great violence,
+follows, which, in some cases, is succeeded by delirium, in others, by
+absolute mania. Nor is this the whole catalogue of ills to which
+in such cases the unfortunate mother is subjected: the appetite
+fails, distressing languor is experienced by day, while copious
+perspirations deluge her by night, and dissipate the last remains of
+strength--producing a state which may easily be mistaken for, or
+terminate in, true pulmonary consumption;--finally, the sight becomes
+progressively weaker, until vision is almost destroyed; the eyelids
+exude a glutinous secretion, and ophthalmia itself is occasionally
+induced.
+
+These are the symptoms too often caused by lactation in delicate or
+debilitated habits, even a few months after delivery; the same also are
+observed when suckling has been injudiciously protracted beyond the
+period to which it should be confined.
+
+A few only of the foregoing symptoms may be noticed, or nearly the whole
+may present themselves, in the same patient; and when this happens,
+unless the cause which has given rise to them be at once detected, and
+appropriate treatment employed, the most serious consequences may be
+apprehended.
+
+In these cases, the first step necessary is to discontinue the suckling
+altogether: half measures will never answer. Sometimes it is proposed by
+the patient, or her friends (more usually the latter), to compromise the
+affair by feeding the child partly on spoon meat, and allowing him still
+to take the breast, though less frequently than before.
+
+This plan I uniformly object to, for the following reasons:--
+
+1st. Because the mother will not be likely to recover so long as she
+continues to suckle at all.
+
+2nd. Because her milk being necessarily of a bad quality, it cannot be
+expected that the child will derive benefit from it; but, on the
+contrary, there is every probability that his health will suffer by
+using diet of such an improper description.
+
+The obvious dependence of the foregoing symptoms upon debility will, of
+course, at once suggest to practitioners the nature of the treatment to
+be adopted: which should be such as is calculated to invigorate the
+system generally--namely, the administration of tonics, &c.
+
+Bark and its various preparations, especially the sulphate of quinine,
+with the occasional use of warm aperients (sedulously avoiding the more
+violent purgatives), will be found eminently successful; whereas,
+cupping at the nape of the neck (which I have seen prescribed for the
+headache), and other depletory measures, have proved as manifestly
+injurious.
+
+'Every disease productive of great weakness is increased by the state of
+the system which follows child-bearing. Of this description are
+consumption, dropsy,' &c. In these cases it is evident that the process
+of lactation, by adding to the debility already present, must prove
+highly injurious, and consequently should be always avoided.
+
+I have already noticed the effects which are produced upon the milk by
+the influence of mental emotions on the part of the mother, as well as
+by the recurrence of the periodical appearance; and since these are
+chiefly injurious to the child, by depraving its sustenance, their
+further consideration will be deferred till the next chapter.
+
+With respect to the remaining topic--namely, the occurrence of
+miscarriage from suckling--I am convinced that it is by no means an
+unfrequent accident, though its real cause is perhaps rarely suspected,
+having only met with one patient who considered the mishap in question
+to have arisen from keeping her child too long at the breast. Having
+already, I trust satisfactorily, explained the manner in which abortion
+is produced by the act of suckling, I shall conclude this part of my
+subject with the relation of a case that occurred in private practice,
+which so strongly corroborates many of the observations in the preceding
+and following pages, that I shall offer no apology for its introduction:
+more particularly, since the lady herself to whom it refers has
+benevolently expressed a wish for its publication, in order that those
+who become acquainted with the facts there detailed may be prevented
+from undergoing similar unnecessary sufferings:--
+
+
+CASE.
+
+Mrs. A----, a lady of delicate constitution, about twenty years of age,
+three or four months subsequent to the birth of her first child, began
+to find her milk gradually lessen in quantity; it had also much changed
+from its previous appearance, resembling at the time just stated, a
+yellowish, turbid serum. Her child became emaciated; and diarrh[oe]a
+supervening, my professional services were required. My advice was, that
+the child should be at once weaned, and a suitable wet-nurse, if
+possible, procured--neither of which suggestions, as will shortly
+appear, were followed. I urged the necessity of this measure more
+particularly, because Mrs. A---- was daily getting thinner and weaker;
+she also complained of great pain in the head and back, and of an
+increasing dimness of sight, which made her fear she should become
+blind; but the mother-in-law of my patient being, unfortunately, of
+opinion that pregnancy in the latter would not again occur during the
+continuance of lactation, recommended that the child, although chiefly
+supported upon spoon-meat, should occasionally be allowed to take the
+breast; and this plan, notwithstanding the wish of Mrs. A---- to the
+contrary, and my own remonstrances on the subject, was adopted--the
+effects of which were to increase the mother's ailments, as well as
+those of her infant. Things went on thus for some time longer, when I
+once more endeavoured to persuade Mrs. A---- to follow my advice,
+observing, that by an opposite line of conduct she was not only injuring
+her own health, but that of her child, neither of which, I assured her,
+in my opinion, would be re-established till the latter had been weaned.
+I expressed also my complete incredulity as to the non-recurrence of
+pregnancy in consequence of her infant remaining at the breast; and I
+added--'It is my firm conviction that if you be pregnant, or should
+happen shortly to become so, you will miscarry.' About a week after
+this conversation she was suddenly seized with flooding, and what I had
+predicted took place. She now left off suckling, and in about a month,
+under suitable treatment, completely got rid of all her former
+complaints: the child also immediately began to improve.
+
+The present case clearly proves that the process of lactation will not
+_invariably_ prevent the occurrence of pregnancy, since Mrs. A---- became
+in this state, notwithstanding she continued to suckle her child: and I
+think few will be so hardy as to doubt that it was the cause of her
+miscarrying: more particularly when I mention that, at a future period,
+the same lady, during my absence abroad, being once more persuaded to
+try whether she could not avoid becoming pregnant (which was very much
+to be desired, on account of her delicate state of health) by continuing
+to perform the duties of a nurse, again suffered all the distressing
+symptoms before described, and again miscarried.
+
+This case, finally, affords evidence of the evil consequences often
+produced in children by impoverished and unhealthy milk; and of their
+speedy disappearance when the exciting cause--namely, deteriorated
+milk--is no longer afforded.
+
+
+
+
+CHAPTER III.
+
+_On the various Diseases which frequently arise in Children from
+Lactation, especially when protracted._
+
+
+Having thus briefly considered some of the disorders to which women are
+subjected by performing the first duty imposed upon them as mothers, I
+shall next advert to those which are very frequently observed in their
+children from being suckled during too long a period; or in consequence
+of the nurse's milk becoming either simply impoverished, or of a
+positively injurious quality.
+
+These diseases are numerous, and some of them serious, among which may
+be enumerated the following; namely, vomiting, diarrh[oe]a, general
+debility, scrofula, tabes mesenterica,--rickets, convulsions,
+epilepsy,--and lastly meningitis, or that peculiar inflammation of the
+investing membranes of the brain which gives rise to the effusion of
+serum, constituting the well known and very fatal disease termed by
+medical practitioners Hydrocephalus, or Hydrencephalus, and popularly
+Water on the Brain.
+
+The disease last mentioned being by far the most important, and that
+chiefly referred to in the following observations, I shall commence with
+a brief statement of the conclusions which my experience has led me to
+form respecting it; they are the same I made public four years ago[E],
+having since that time seen no reason to make any alteration in them. I
+believe,
+
+1st,--That if children be suckled for an undue length of time[F], they
+will be liable in consequence to be affected with meningitis[G], or
+inflammation of the investing membranes of the brain.
+
+2dly,--That should they not become affected with the disorder in
+question during or soon after the time they are thus improperly suckled,
+they will nevertheless acquire therefrom a predisposition to cephalic
+disease at some future period of their lives.
+
+3dly,--That children who are suckled for an undue length of time, when
+labouring under other diseases, will be much more liable to have the
+head secondarily affected, than children brought up in a different
+manner.
+
+4thly,--And lastly, that the same effects will take place in infants if
+suckled by women who have been delivered an undue[H] length of time;
+although the infants themselves may not have been at the breast for too
+long a period.
+
+       *       *       *       *       *
+
+CASES IN ILLUSTRATION OF THE FOREGOING VIEWS.
+
+
+I.
+
+_Cases of Meningitis[I] supervening upon protracted suckling._
+
+
+CASE I.
+
+---- Wilshire, aged two years seven months, died of '_Water on the
+brain_,'--_suckled twelve months_.
+
+
+CASE II.
+
+---- Park, aged one year ten months, died of '_Water in the
+head_,'--_suckled fourteen months_.
+
+
+CASE III.
+
+Prince V----, aged two years and a few months, died of
+_Hydrencephalus_,--_suckled until his death_. In this case I was
+consulted a short time previously, and recommended the breast-milk to be
+withheld--my advice was not followed.
+
+
+CASE IV.
+
+Emma Lane, aged two years, admitted at the Infirmary for Children for
+_Meningitis_,--_suckled one year and eleven months_.
+
+
+CASE V.
+
+The mother of the preceding suckled another child '_a very long
+period_,' and it died of '_Water on the Brain_.'
+
+
+CASE VI.
+
+Edmund Power, aged two years, _still at the breast_, admitted for
+_Chronic Hydrocephalus_: the head is of great magnitude; fontanelles
+open: superficial veins large and prominent.
+
+
+CASE VII.
+
+Sophia Hamley, aged one year two months, _still at the breast_, admitted
+for _Meningitis_.
+
+
+CASE VIII.
+
+William How, aged one year six months, admitted for
+_Meningitis_,--_suckled thirteen months_.
+
+
+CASE IX.
+
+David Hepburn, aged two years six months, admitted for
+_Meningitis_,--_suckled two years four months_.
+
+
+CASE X.
+
+Samuel Hanks, aged one year nine months, admitted for
+_Meningitis_,--_suckled one year eight months_.
+
+
+CASE XI.
+
+Amelia Hill, aged two years six months, admitted for
+_Meningitis_,--_suckled one year nine months_.
+
+
+CASE XII.
+
+---- Hughes, died of '_Water in the head_,'--_suckled fourteen months_.
+
+
+CASE XIII.
+
+---- Ferreira, aged seventeen months, died of '_Water in the
+head_,'--_suckled until its death_.
+
+For the five following cases I am indebted to the kindness of Mr.
+William Griffith, an intelligent surgeon of Eaton-street, who, having
+some time ago been apprised of my peculiar views, has since directed his
+attention particularly to the subject. They completely confirm my
+opinions, and will have more weight with the public than any additional
+evidence I could adduce from my own practice.
+
+In the letter inclosing these cases, Mr. Griffith writes thus--'from the
+observations I have been enabled to make, I am led to believe that
+disease almost invariably follows protracted suckling. I may add in
+conclusion, that I perfectly concur with the views which you entertain
+on the subject.'
+
+
+CASES XIV. XV.
+
+'---- Jackson, residing at ----, aged two years six months, who had been
+kept _at the breast twenty-two months_, was in a dying state when I was
+requested to see her. The pulse was preternaturally slow--great
+stupor--dilatation of the pupils, and diastasis of the bones of the
+head. In six hours from the time I first saw her she died, and the
+mother was desirous that the head should be examined, having lost a
+child previously, in what she considered a similar manner. On removing
+the scalp I found the cranium very much enlarged and altered in shape.
+Between the tunica arachnoides and pia mater, there was a quantity of
+water effused;--the sides and upper surface of the brain were
+exceedingly soft. In the lateral ventricles there were from six to eight
+ounces of water. In answer to a few questions I asked the mother, she
+stated that her former child was, during the _first ten months_ of its
+life, _a plump, healthy infant_,--_after that period he altered_,--the
+stomach, bowels, and _head became affected_, and, in the course of a few
+months, he manifested similar symptoms to those which proved fatal in
+the case of his sister. He was _suckled for twenty-one months_, and
+_died_ at the age of _twenty-seven months_. The mother of these children
+has one other child alive, and at my urgent request it was weaned at
+_nine months_,--it is now _seventeen months old, and in excellent
+health_.'
+
+
+CASE XVI.
+
+'Mrs. A----, of ----, had a little boy who at _ten months old_ had nine
+teeth, which were cut with little or no difficulty:--_at this time he
+was in good health_,--_he was allowed the breast until nineteen months,
+and at the expiration of three months more, died of Hydrocephalus_.'
+
+
+CASE XVII.
+
+'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at the
+breast seventeen months old_;--the little patient is frequently
+suffering from _cerebral disturbance_. I have repeatedly advised the
+mother to wean it--she objects, and gives the usual reason for allowing
+it to remain at the breast--viz., that she does it to _prevent becoming
+again enceinte_.'
+
+
+CASE XVIII.
+
+'This day, (August 13, 1831,) a little child labouring under _cerebral
+disease_ was brought to me for advice, and he appeared certainly in a
+most pitiable state; he is _two years four months old_ and is _now at
+the breast_,--I do not think it possible for him to survive many days.'
+
+
+II.
+
+_Cases of Meningitis, arising at an after period, in consequence of
+protracted suckling._
+
+
+CASE XIX.
+
+Francis Page, aged six years, admitted for _Meningitis_,--_suckled one
+year_.
+
+
+CASE XX.
+
+Henry Taylor, aged six years, admitted for _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXI.
+
+Julia Brown, aged three years, admitted for _Meningitis_,--_suckled
+thirteen months_.
+
+
+CASE XXII.
+
+James Neil, aged seven years six months, admitted for
+_Meningitis_,--_suckled fourteen months_.
+
+
+CASE XXIII.
+
+Eliza Park, aged six years, laboured under _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXIV.
+
+Charles Dale, aged five years; admitted for _Meningitis_--_suckled
+thirteen months_.
+
+
+CASE XXV.
+
+Sarah Strickling, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASES XXVI. XXVII. XXVIII.
+
+The mother of the last mentioned child lost three previously, with
+'_water in the head_:'--all these were suckled _more than eighteen
+months_.
+
+
+CASE XXIX.
+
+George Speering, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASE XXX.
+
+Ann Archer, aged seven years; admitted for
+_Hydrocephalus_--died--_suckled three years_.
+
+
+CASE XXXI.
+
+Cornelius Leary, aged six years; admitted for
+_Meningitis_--died--_suckled eighteen months_.
+
+
+CASE XXXII.
+
+Sophia Peverel, aged three years; admitted for _Meningitis_--_suckled
+two years_.
+
+
+CASE XXXIII.
+
+Maria Turley, aged four years; admitted for _Meningitis_--died--_suckled
+one year three months_. This child had laboured under a previous attack,
+from which she recovered under my care.
+
+
+CASE XXXIV.
+
+Robert Selkirk, aged three years six months; admitted for
+_Meningitis_--_suckled thirteen months_.
+
+
+CASE XXXV.
+
+The mother of the preceding child lost another of '_inflammation of the
+brain_.'--This was _suckled more than one year_.
+
+
+CASE XXXVI.
+
+Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled one
+year seven months_.
+
+
+III.
+
+_Cases of Meningitis in Children who had been suckled an undue length of
+time, supervening upon other complaints._
+
+
+CASE XXXVII.
+
+Arthur Lane, aged one year four months; admitted for Pneumonia, with
+_an affection of the head_--_suckled fourteen months_.
+
+
+CASE XXXVIII.
+
+Sarah Ward, aged three years; admitted for Hooping-cough--_head much
+affected_--_suckled one year and ten months_.
+
+
+CASE XXXIX.
+
+Thomas Donovan, aged two years two months; admitted for Hooping-cough,
+with _an affection of the head_--_suckled twelve months_.
+
+
+CASE XL.
+
+Count ---- ----, aged about two years, came under my care, being then at
+the breast. The head was large, fontanelle open--superficial veins more
+apparent than natural. By my advice he was directly weaned, and rapidly
+improved in health and appearance (the only medicine given being
+occasional doses of castor oil). About twelve months afterwards, in
+consequence of an imprudent exposure to cold, he was attacked with
+Bronchitis, and Meningitis supervened. Leeches were applied to the head,
+and other depletory measures actively employed, which were followed by
+recovery.
+
+
+CASE XLI.
+
+---- Sloggat, aged thirteen months, died of _Meningitis_ supervening
+upon Pneumonia--_suckled until the time of its death_.
+
+
+CASE XLII.
+
+John Scott, aged eleven months; admitted for Hooping-cough, with a
+_well-marked affection of the head_--_still at the breast_.
+
+
+CASE XLIII.
+
+---- Scott, aged fifteen months,--died of 'Hooping-cough, with
+convulsions,' _being then at the breast_.
+
+
+CASE XLIV.
+
+Isaac Berwick, aged one year two months, admitted for Hooping-cough,
+_with an affection of the head_--_still at the breast_.
+
+
+CASE XLV.
+
+Frederick Cousins, aged three years four months, brought to me labouring
+under Hooping-cough, with Meningitis, which latter terminated in
+effusion. Calomel was then given every two hours, the stronger mercurial
+ointment rubbed upon the temples, and blisters applied to the head. The
+mercurial influence being established, a profuse discharge of urine
+occurred; the pupils which had previously been _permanently_ dilated,
+became once more obedient to light; sensibility was restored, and great
+weakness appeared to be the only urgent symptom. The cough, however, now
+returned, the head became again affected, and the child sunk. Upon
+opening the head, about four ounces of fluid was found in the
+ventricles[K]. This child was _suckled sixteen months_.
+
+
+CASE XLVI.
+
+Sarah Swann, aged four years six months, admitted for Hooping-cough with
+convulsions,--_suckled one year_.
+
+
+CASE XLVII.
+
+Henry Harris, aged two years three months, admitted for Hooping-cough,
+_with an affection_ of the head,--_suckled one year four months_.
+
+
+CASE XLVIII.
+
+Maria Hughes, aged two years, admitted for _Convulsions_ supervening
+upon Hooping-cough--_suckled one year three months_.
+
+
+CASE XLIX.
+
+Thomas Benson, aged one year six months, admitted for Pneumonia, with
+_well-marked affection of the head_--_suckled one year four months_.
+
+
+CASE L.
+
+Mary Kenner, aged six years, admitted for Hooping-cough, with
+_well-marked affection of the head_--_suckled one year six months_.
+
+
+CASE LI.
+
+John Ennis, aged one year seven months, admitted for Bronchitis, to
+which _a decided affection of the head succeeded_--_suckled one year_.
+
+
+IV.
+
+_Case of Meningitis produced in consequence of the Child being suckled
+from its birth by a Woman who had at that time been delivered one Year._
+
+
+CASE LII.
+
+Ellen Willoughby, aged nine months, admitted for Meningitis; at present
+suckled by a woman who has been _delivered one year and nine months_.
+
+       *       *       *       *       *
+
+With respect to the manner in which protracted lactation causes the
+complaint that forms the subject of these remarks, I formerly was
+undecided; but have now no doubt whatever of its arising _secondarily_
+from derangement in the functions of the abdominal viscera, occasioned
+by the depraved condition of the breast-milk.
+
+It is universally allowed among medical men that irritations in the
+stomach and bowels will, through the agency of particular nerves,
+produce sympathetic irritation in the brain,--that peculiar action
+being thus elicited which terminates in the effusion of serum,
+constituting the disease named Hydrocephalus.--'The continued irritation
+of important or very sensible nerves is, perhaps,' says Mr. Burns, '_one
+of the most common causes_' (of Hydrocephalus); 'hence it may follow
+dentition, and _very often arises from a bad state of the chylopoietic
+viscera_.'
+
+It is also no less generally known that food of a bad quality or
+improper description will produce derangements in the digestive organs.
+Now, having already shewn that the milk when lactation is protracted
+becomes deteriorated, it plainly appears that such milk is capable of
+occasioning derangement of the chylopoietic viscera; and it being
+allowed that derangement of these viscera, from any source, may give
+rise to inflammation of the brain, I conceive it follows that protracted
+lactation must be admitted as one cause of such effect. This train of
+reasoning, therefore, from generally admitted data, seems to _prove that
+Meningitis_, or inflammation of the brain, _in children can be produced
+by their being suckled for too long a period_, and _that it is so
+produced I assert from repeated experience_.
+
+An accidental perusal of Mr. Dendy's able work on the cutaneous diseases
+of children, published shortly after the appearance of my paper before
+referred to in the Medical and Physical Journal, has recently afforded
+me the pleasure of finding that the author had been led to entertain
+similar general views on the subject under discussion with myself; I
+have, therefore, taken the opportunity of adding that gentleman's
+testimony to my own, by quoting the following passage from his work
+above mentioned.
+
+'It may be truly said, that _the infantine disease excited by milk of a
+deleterious, or simply impoverished quality, "grows by what it feeds
+on;"_ and we shall witness the internal debility and the infantine
+disorder running their course together. Tabes is the natural consequence
+of this error; but its effect is evinced by the occurrence of other
+disorders. A defective degree of nutrition, as I have elsewhere stated,
+predisposes the system to become influenced by comparatively slight
+excitement; and thus, in addition to the direct excitement of disease,
+it becomes indirectly its predisposing cause. _Under its influence the
+serous_[L] and mucous _membranes become readily the seat of
+inflammatory action_.'
+
+Those who feel a difficulty in relinquishing old opinions and adopting
+new views upon any particular subject, may perhaps ask how it has
+happened, if inflammation of the brain from protracted suckling be so
+common as the preceding observations and cases would appear to prove,
+that medical men of more advanced age and far greater experience than
+myself have not previously noticed the circumstance. I would observe, in
+reply, that until Harvey pointed out the circulation of the blood, no
+one ever suspected the existence of such a phenomenon; yet now the
+wonder appears to be, not that Harvey made the discovery, but that
+others had not previously done the same. Multitudes, it may be added,
+and among them the great Newton, had witnessed the fall of objects to
+the ground without thinking of the cause which produced their downward
+tendency; the propitious moment, however, arrived--the apple fell, and
+the philosopher was led to those deductions which have rendered his name
+immortal. So is it with observers of every class, from those most
+distinguished by intellectual superiority and its successful
+application, down to the humble writer of the present observations.
+Facts are continually passing before us unnoticed, till, from their
+repeated coincidence, or some accidental impulse, we attempt, and
+finally are enabled, to trace their origin.
+
+Thus, until the possibility of Meningitis originating from protracted
+lactation had been suggested, practitioners were, of course, unable to
+notice the fact--not from its non-occurrence, but because their
+unconsciousness of its existence must necessarily preclude the inquiries
+from which alone its cause could be determined. Hence a practitioner may
+have treated many hundred cases of water on the brain in children,
+without being able to attribute any one of them to protracted suckling;
+yet this is no proof that such cases did not happen, for, had he made
+the requisite inquiries, very probably many among them might have been
+found which had thus arisen.
+
+Another objection that may possibly be made to my views, is, that
+instances might be adduced where lactation had been persevered in for a
+very long period, without any ill effects supervening. That such
+frequently occur, there is no doubt; and with respect to them, I have
+merely to observe, that they do not in the slightest degree invalidate
+the correctness of my conclusions. As well might it be argued, that
+because persons have fallen from a very great height without sustaining
+any injury, or, because poisonous doses of various drugs have sometimes
+been swallowed without death supervening, that, therefore, there is no
+danger in jumping from a precipice, or in taking a virulent poison; or
+that death never occurs from these causes. Such cases, unless far more
+numerous than I imagine them, can only be regarded as exceptions to the
+general rule; and, consequently, do not lessen its authority, there
+being no rule without an exception.
+
+Some practitioners, with whom I have conversed on the subject, though
+willing to allow that protracted suckling, by depraving the milk, may be
+the means of occasioning Meningitis in infants during or shortly after
+the time they are supplied with this improper food, yet could not
+conceive how it can act as a cause of that disease at some future
+period; I do not myself, while attempting to account for it, discover
+any pathological difficulty.
+
+In these cases it is very probable, that although the protracted
+suckling was not sufficient to produce actual Meningitis at its
+conclusion, yet that it so weakened the system in general, and the brain
+in particular, as to render the latter especially predisposed to
+inflammatory action; and that we have reason to suppose this not only
+possible, but probable, from analogy, cannot be denied, since it is
+known that scrofulous children, in whom there is great laxity and
+debility of habit, are inordinately liable to be affected with
+Hydrocephalus, or Water in the Brain.
+
+'Dr. Perceval observes, that of twenty-two cases of which he kept notes,
+_eleven were certainly strumous children_, and _four were probably so_.'
+'From my own observations,' remarks Dr. Cheyne, 'I should think this
+proportion a very moderate one. When a whole family is swept away by
+Hydrocephalus, I suspect _it is intimately connected with this strumous
+taint_.' The testimony of Sauvages may also be adduced, who says, 'Novi
+familiam cujus infantes circa sextum ætatis annum omnes periere ex hoc
+morbo, _Scrofula huic effusioni ansam præbente_.' The brain, in
+consequence of this local debility, may become affected from causes
+which otherwise would, perhaps, have produced no injurious consequences
+whatever; and hence it is, that when labouring under other diseases, and
+especially Hooping-cough, those children who have been suckled too long
+appear so very liable to have the head secondarily affected. It is
+worthy of notice, that among the cases which have been detailed in the
+foregoing pages, were fourteen in whom affection of the head supervened
+during the progress of other diseases, and in ten of them the disease
+was Hooping-cough.
+
+The treatment of Meningitis arising from protracted suckling will not
+differ from what is proper when it has been produced by other causes;
+except that the depletory measures should not be carried to so great an
+extent, as it must be remembered that the disease is existing in
+constitutions _already debilitated_.
+
+It should consist generally in the application of leeches to the
+temples--cold lotions to the head--purgatives, and blisters placed
+behind the ears, the discharge from which is to be kept up by means of
+irritating dressings--these afford the surest chance of subduing the
+malady, and in many instances, if employed sufficiently early, will have
+the desired effect. It is, of course, almost superfluous to observe,
+that weaning, if the child be above nine months old, must be
+immediately enforced; or, if considerably younger, the diseased or
+debilitated nurse ought to be exchanged for one who has a supply of
+healthy milk of a corresponding age. If such cannot be procured, the
+child must be brought up by hand; for, so long as it is allowed to
+imbibe the noxious milk, there is little hope, in my mind, of the
+medical treatment being of any great service; while on the contrary, it
+is encouraging to know that many infants previously manifesting symptoms
+of incipient Meningitis have completely recovered _soon after they were
+weaned_[M].
+
+When my attention first became directed to the subject, I was chiefly
+struck with the ill effects resulting to the child from _protracted_
+lactation, and hence supposed that cases of disease from suckling, when
+continued for only a moderate period, were rarely if ever met with. More
+enlarged experience, however, has now convinced me, that not only are
+ill effects occasioned in children when lactation is protracted to a
+very unusual extent, but that they occur sometimes, when its duration
+has been merely a few months beyond what I conceive is right. Besides
+which, we shall find that when from any cause whatever the nurse's milk
+becomes impoverished and deteriorated, even if this take place at an
+early period after delivery, the injurious effects already referred to
+may be produced in the child: for improper food, whether it be bad milk
+or any other inappropriate article of diet, is always calculated to
+derange the functions of the stomach, bowels, and other chylopoietic
+viscera, and in consequence to occasion disease.
+
+It matters not whether the mother be originally unhealthy, and thus her
+milk possess bad qualities; or whether from accidental circumstances, or
+her continuing to give suck too long it becomes so: in either case the
+same effect, namely, _deteriorated milk_, is produced, with the
+concomitant evils to which I have alluded. This view of the matter is
+corroborated by Case LII., in which true Meningitis attacked a child,
+aged only nine months, who, therefore, was not suckled _too long_,--but
+then the nurse of that child had been delivered _twenty-one months_,
+having suckled another infant previously:--hence we may reasonably
+conclude that her milk being from the beginning deteriorated, and
+unadapted to the age of the child, the ill effects in this case were
+produced at a much earlier period than usual.
+
+It will be observed that I have only given _one_ instance of this latter
+description; but, on considering how very rare it must be to find any
+mother capable of abandoning her newly-born infant to the breast of a
+woman who has already suckled another child one year, any surprise that
+might be felt at the circumstance will, I am sure, immediately cease. It
+must also be noticed that only among the lowest grades of society do we
+find women so long after delivery performing the office of wet-nurse at
+all, and those who entrust their infants to the latter are often so
+peculiarly situated as to feel no interest whatever in the preservation
+of their offspring: indeed I cannot but suspect that, among such,
+criminal motives frequently lead to the adoption of the unnatural and
+baneful practice in question.
+
+I do not recollect to have seen a case of Meningitis from suckling
+except when this process had been _protracted_, either as respects the
+child or the nurse; though I by no means doubt the possibility of its
+occurrence under other circumstances: but I have met with numerous
+instances of other diseases produced by the palpable deterioration of
+the mother's or nurse's milk at various periods after delivery; in by
+far the greater number, however, of such cases, lactation had been
+continued for an unusual length of time.
+
+Vomiting, griping, and diarrh[oe]a, are so common among infants, and
+arise in general from causes apparently so evident, that, unless severe
+or of long duration, they rarely form the subject of minute inquiry.
+Hence these complaints are, perhaps, not so often attributed to
+deteriorated milk as they ought to be, although the fact of their
+occasionally originating from a morbid condition of this fluid, (and
+therefore from protracted lactation as one cause of the latter effect,)
+is too well established to be questioned. Dr. Underwood observes, 'has
+not every Physician of experience seen infants frequently thrown into
+tormina immediately after coming from the _breast of an unhealthy
+mother, or one who has but little milk_?'[N] and Mr. Burns states, that
+if the usual periodical appearance should return, 'the milk is liable to
+disagree with the child, and produce vomiting or purging;' while Dr.
+Hamilton expressly mentions that diarrh[oe]a is 'not unfrequently
+_occasioned by the depraved quality of the nurse's milk_.'
+
+The two former authors merely testify to the fact of diseases being
+produced by the milk, while the latter more explicitly mentions the
+cause from which they proceed.
+
+Debility, Tabes Mesenterica, and Scrofula, may also be traced to the
+same origin, as every practitioner of experience must have repeatedly
+observed: so may that intractable disease, termed Rickets; and it is
+worthy of notice, that among the worst instances of this malady I have
+seen, were two sisters, _who had been suckled for a very unusual
+period_. Neither do I doubt the probability of Epilepsy being similarly
+occasioned; and although, I must candidly own, I cannot produce numerous
+cases in proof of the correctness of such hypothesis, yet I recollect
+that of a girl affected with this complaint, respecting whom the mother
+stated (and I recorded the fact at the time) that she had been '_suckled
+for two years_;' and, to use her own expression, had 'never been well
+since.'[O]
+
+Convulsions arising from protracted suckling, or simply from the nurse's
+milk becoming deteriorated at any period, are very common, and I have
+kept notes of many such cases that have occurred in the course of my own
+practice; which, however, I abstain from here inserting, being anxious
+to prevent the present publication from swelling into a volume. Indeed,
+the occurrence of convulsions from this cause (diseased milk) has been
+mentioned by several of the best authors. Mr. North, in particular,
+(whose excellent work on Convulsions should be in the hands of every
+practitioner) observes--'It cannot be doubted that children suffer, that
+their health is destroyed, and the foundation laid for convulsive
+diseases, by _sucking unhealthy nurses_.' 'A predisposition to
+convulsive affections in children may be originally produced in
+consequence of their being suckled by a nurse addicted to the frequent
+use of spirituous liquors. In several instances I have known children
+rapidly recover their health when the nurse was changed, who had
+exhibited most of the premonitory symptoms of convulsions while they
+were suckled by a woman who indulged in the common vice of
+gin-drinking.' And Mr. Burns also makes the following remark--'Violent
+passions of the mind affect the milk still more;--it often becomes thin
+and yellowish, and _causes_ colic, or even _fits_.' It is needless,
+however, to say more on this topic, since it is one which no longer
+admits of discussion.
+
+The reader may now, perhaps, expect that I shall introduce a series of
+practical deductions from the foregoing facts and observations; but
+such is not my object upon the present occasion. I merely wish to call
+the attention of practitioners and the public to the subject of these
+pages, and shall thus discharge, as I conceive, an imperative duty to
+society. Having mentioned what I am induced to consider a frequent cause
+of inflammation of the investing membranes of the brain in children, my
+undertaking is completed. The Profession does not require, and the
+public would not be benefited, by the addition of lengthened
+therapeutical rules; for I am convinced, there is not a greater
+imposition to be found than the doctrine that non-medical persons can
+treat diseases with success by means of popular systems of medicine,
+'_practical_' treatises, &c. Such books have often done irreparable
+mischief--certainly much more harm than good; and so far from injuring
+the profits of medical practitioners (as some appear to suppose), have
+greatly added to the number of their patients.
+
+I avail myself also of this opportunity to enter my protest against the
+ill-judged and mischievous practice of those patients who confide upon
+many occasions in the opinion of their nurse, rather than that of their
+medical attendant, and who, in consequence, often injure themselves
+essentially by deceiving the latter. With respect to this mistaken
+preference, Dr. Dewes has well observed--'Let it not be hastily assumed
+that there is more safety in following the directions of a nurse than
+those of the physician, because she may have had some experience; for it
+must be quickly perceived that the calculation is much in favour of the
+latter, since the nurse can attend but twelve patients per annum, while
+the physician may visit many hundreds in the same period--besides, his
+knowledge of the laws of the human system gives him a very decided
+superiority.'
+
+In conclusion, it is right to observe, that protracted suckling being a
+custom much more prevalent among females of the lower orders than those
+of a superior rank, it must follow as a necessary consequence, that
+_Meningitis, and other disorders resulting from this cause, are
+proportionably less frequent in private than in public practice_. This
+remark, it is evident, should be remembered, in order to obviate
+apparent discrepancies which otherwise might appear irreconcilable with
+the opinions I have expressed. In the truth of those opinions I feel the
+most perfect confidence, and cannot but hope that their promulgation
+will hereafter prove extensively beneficial, since precautionary, and
+even therapeutical measures may be founded upon them, which, if
+uniformly adopted, will not only prevent much ill-health and suffering
+to mothers, but will also afford the means of saving many children from
+perishing by one of the most painful and fatal diseases to which they
+are subject.
+
+
+
+
+POSTSCRIPT.
+
+
+Being anxious to obtain additional evidence with respect to the
+production of Meningitis in children by protracted suckling, rather from
+the experience of others than my own, I shall feel greatly obliged to
+any practitioners who will favour me (free of postage) with either facts
+or cases tending to corroborate the truth of the doctrine contained in
+the preceding pages; and should I be enabled publicly to avail myself of
+such communications, it is, perhaps, unnecessary to say, I shall not
+neglect the opportunity of expressing my acknowledgments to their
+respective authors. The intelligence and liberality characterising the
+members of the medical profession generally, preclude all apprehension
+on my part that the above appeal will be made in vain.
+
+
+
+
+NOTES
+
+
+Note A (page 1).
+
+A dark-green substance of variable consistence, contained in the bowels
+of infants at birth.
+
+
+B (page 4).
+
+I beg leave to observe that I make these statements with some confidence
+as the result of personal inquiries instituted a few years ago among the
+patients of two of the Lying-in Establishments of this metropolis.
+
+
+C (page 8).
+
+Since the above was written, a friend who lectures on Chemistry in the
+metropolis has kindly promised me his valuable assistance in making the
+experiments here suggested.
+
+
+D (page 10).
+
+In two cases where suckling was protracted to _three years_, the
+subjects of this baneful practice did not equal in size an ordinary
+child of half their age. One of them became idiotic, and afterwards died
+of Hydrencephalus, under my care; the other was affected with Tabes
+Mesenterica,--the result I did not witness--but believe the disease
+terminated fatally.
+
+
+E (page 25).
+
+Vide Medical and Physical Journal for August 1827.
+
+
+F (page 25).
+
+That is, any period beyond nine or ten months.
+
+
+G (page 25).
+
+_Meningitis_,--I use this term as being more pathologically correct than
+_Cephalitis_, which I formerly adopted.
+
+
+H (page 26).
+
+See the above conditional sense in which I employ this term.
+
+
+I (page 26).
+
+It is a curious fact, which I believe has not been noticed by any other
+writer, that female children labouring under attacks of Meningitis are
+sometimes affected with leucorrh[oe]al discharges. I have met with
+several cases of this description: the children also of women subject to
+leucorrh[oe]a will often, at an early age, be found affected with the
+same disease. Hence it would appear that leucorrh[oe]a is occasionally
+hereditary.
+
+
+K (page 37).
+
+It is unquestionable, notwithstanding the scepticism of some
+practitioners on the subject, (whose opinions are entitled to
+deference,) that _recovery may take place, under appropriate treatment,
+in cases of Meningitis, even after effusion has unequivocally occurred_.
+Preceding authors have noticed this fact, which I can confirm by my own
+experience. Practitioners cannot be too frequently reminded of it, and
+warned not to despair of success even in the last stage of
+Hydrencephalus.
+
+
+L (page 42).
+
+For the information of the _unprofessional_ reader, I beg to observe,
+that the membranes of the brain are _serous membranes_.
+
+
+M (page 48).
+
+It will be observed hereafter, that Mr. North has experienced similar
+beneficial effects from the course above recommended, in cases where
+_convulsions_ have been caused by _diseased milk_;--a strong
+corroborative coincidence.
+
+
+N (page 52).
+
+I believe that where the milk is greatly diminished in quantity, it will
+also be found deteriorated in quality.
+
+
+O (page 53).
+
+In the communication above referred to from Mr. Griffith is the
+following:--'Mrs. A. has a family of four children, all of whom she
+suckled for a period varying from _seventeen_ to _twenty-two
+months_:--_not one of the four is healthy_.'
+
+
+
+
+BY THE SAME AUTHOR,
+
+
+Preparing for publication, in one small volume, 8vo.
+
+OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the Principal
+Symptoms of DISEASE in INFANTS and CHILDREN, with the best modes of
+detecting them;--interspersed with Practical Observations, and intended
+as a clinical guide to Students, &c. &c.
+
+
+Also, in 2 vols. 8vo.
+
+The EIGHT BOOKS of ARETÆUS of CAPPADOCIA on the Causes, Symptoms, and
+Treatment of ACUTE and CHRONIC DISEASES. Translated literally from the
+original Greek, and supplied with critical and explanatory Notes, Tables
+of the Weights and Measures, &c. &c.
+
+
+       *       *       *       *       *
+
+
+By the same Author,
+
+Recently published by Longman and Co. in 8vo., boards, price 14_s._
+
+TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in the
+Years 1827-29;--intended to give some account of Russia as it is, and
+not as it is represented to be.
+
+
+Printed by W. CLOWES, Stamford-street.
+
+
+
+
+
+End of the Project Gutenberg EBook of Remarks on the Subject of Lactation, by 
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+Project Gutenberg's Remarks on the Subject of Lactation, by Edward Morton
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
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+
+Title: Remarks on the Subject of Lactation
+
+Author: Edward Morton
+
+Release Date: August 16, 2007 [EBook #22344]
+
+Language: English
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+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LACTATION ***
+
+
+
+
+Produced by Bryan Ness, Stephen Blundell and the Online
+Distributed Proofreading Team at http://www.pgdp.net (This
+book was produced from scanned images of public domain
+material from the Google Print project.)
+
+
+
+
+
+
+</pre>
+
+
+
+
+
+<h1>REMARKS ON THE SUBJECT OF LACTATION,<br /><br />
+
+<small>&amp;c. &amp;c.</small></h1>
+
+
+<hr style="width: 65%;" />
+
+
+<h1><small>REMARKS<br /><br /></small>
+
+<small><small><small><small>ON THE SUBJECT OF<br /><br /></small></small></small></small>
+
+LACTATION;</h1>
+
+<p class="title"><small>CONTAINING</small><br /><br />
+
+<big>OBSERVATIONS</big><br /><br />
+
+<small>ON THE</small><br /><br />
+
+HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK;<br />
+THE DISORDERS FREQUENTLY PRODUCED<br />
+IN MOTHERS BY SUCKLING;<br /><br />
+
+<small>AND<br /><br /></small>
+
+NUMEROUS ILLUSTRATIVE CASES;<br /><br />
+
+<small>PROVING THAT, WHEN PROTRACTED, IT IS A COMMON<br />
+CAUSE, IN CHILDREN, OF<br /><br /></small>
+
+HYDRENCEPHALUS, OR WATER IN THE BRAIN,<br /><br />
+
+<small>AND<br /><br /></small>
+
+OTHER SERIOUS COMPLAINTS.</p>
+<hr style="width: 20%;" />
+<p class="title">BY</p>
+
+<h2><small>EDWARD MORTON, M.D. <span class="smcap">Cantab.</span></small></h2>
+
+<p class="title"><small>FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY<br />
+COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS,<br />
+LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY,<br />
+AND TO THE ROYAL METROPOLITAN<br />
+INFIRMARY FOR CHILDREN, &amp;c. &amp;c.</small></p>
+<hr style="width: 20%;" />
+<h3>LONDON:</h3>
+
+<p class="title">LONGMAN, REES, ORME, BROWN, AND GREEN,<br />
+PATERNOSTER-ROW.<br /><br />
+
+<small><small>MDCCCXXXI.</small></small></p>
+
+
+<hr style="width: 65%;" />
+
+
+
+<p class="title"><small><small>LONDON:<br />
+<span class="smcap">Printed by William Clowes,<br />
+Stamford Street.</span></small></small></p>
+
+
+<hr style="width: 65%;" />
+
+
+
+<p class="title"><small>TO</small><br /><br />
+
+<span class="smcap">Sir</span> HENRY HALFORD, <span class="smcap">Bart.</span>, M.D., F.R.S., F.A.S.,<br /><br />
+
+<small>PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON,<br />
+PHYSICIAN TO THE KING, &amp;c. &amp;c.</small><br /><br />
+
+THE FOLLOWING PAGES<br /><br />
+
+<small>ARE,<br /><br />
+
+WITH HIS PERMISSION,<br /><br />
+
+AND WITH<br /><br />
+
+A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIR<br />
+AUTHOR, MOST RESPECTFULLY</small><br /><br />
+
+DEDICATED.</p>
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_vii" id="Page_vii">[Pg vii]</a></span></p>
+<h2><a name="PREFACE" id="PREFACE"></a>PREFACE.</h2>
+
+
+<p>Several cases which I witnessed led me
+to believe, some years ago, that inflammation
+of the brain, or its membranes,
+might be produced in children, owing to
+their being suckled for an undue length of
+time. Since that period, having enjoyed
+opportunities of observing infantile diseases
+on a much more extended scale, and my
+attention being expressly directed to the
+point in question, I not only became fully
+convinced of the correctness of my previous
+conclusions, but was induced to carry
+them still farther.</p>
+
+<p>My opinions on this subject were briefly
+drawn up and published in the <i>Medical
+and Physical Journal</i> for August 1827,
+and have not passed altogether unnoticed<span class='pagenum'><a name="Page_viii" id="Page_viii">[Pg viii]</a></span>
+by my professional brethren<a name="FNanchor_A_1" id="FNanchor_A_1"></a><a href="#Footnote_A_1" class="fnanchor">[1]</a>, some of
+whom have done me the honour to speak
+of them in flattering terms, while no one,
+I believe, has attempted to disprove the
+existence of the important fact I was the
+first to announce.</p>
+
+<div class="footnote"><p><a name="Footnote_A_1" id="Footnote_A_1"></a><a href="#FNanchor_A_1"><span class="label">[1]</span></a> Vide Medico-Chirurgical Review, Gazette of Health, Dendy
+on Cutaneous Diseases, &amp;c.</p></div>
+
+<p>The bare statement of that fact was,
+indeed, nearly all that my approaching
+departure from England, at the time last
+mentioned, left in my power: upon the
+present occasion I have offered arguments
+for, and endeavoured to anticipate those
+against, the deductions I then made public;
+and however imperfect may have been my
+success in either, the welfare of society at
+large is too deeply involved in the establishment
+of my opinions with respect to
+the custom I condemn, (if those opinions
+be correct,) for me to hesitate while again
+committing them to the press in a more
+extended form.</p>
+
+<p><span class='pagenum'><a name="Page_ix" id="Page_ix">[Pg ix]</a></span></p>
+
+<p>These considerations, I respectfully submit,
+will render any apology for the appearance
+of the following pages unnecessary,
+and will, I trust, secure for them
+a candid and favourable reception from
+the Profession and the Public.</p>
+
+<p>
+<i>15, Eaton Street, Grosvenor Place,</i><br />
+<span style="margin-left: 6em;"><i>October 8, 1831.</i></span><br />
+</p>
+
+<hr style="width: 65%;" />
+
+<h2>CONTENTS.</h2>
+
+
+
+
+<p>&nbsp;</p>
+
+<div class='center'>
+<table border="0" style="width: 65%;" cellpadding="4" cellspacing="0" summary="">
+<tr><td class="title" colspan="2">CHAPTER I.</td></tr>
+<tr><td align='right' colspan="2"><small>Page</small></td></tr>
+<tr><td align='left'>Of the Breast-Milk, &amp;c. &amp;c.</td><td align='right'><a href="#Page_1">1</a></td></tr>
+<tr><td colspan="2">&nbsp;</td></tr>
+
+<tr><td class="title" colspan="2">CHAPTER II.</td></tr>
+<tr><td colspan="2"><small>&nbsp;</small></td></tr>
+<tr><td align='left'>On Lactation, and the Disorders frequently produced in<br />
+Women by that process</td><td align='right'><a href="#Page_14">14</a></td></tr>
+<tr><td colspan="2">&nbsp;</td></tr>
+
+<tr><td class="title" colspan="2">CHAPTER III.</td></tr>
+<tr><td colspan="2"><small>&nbsp;</small></td></tr>
+<tr><td align='left'>On the various Diseases which arise in Children from<br />
+Lactation, especially when protracted</td><td align='right'><a href="#Page_24">24</a></td></tr>
+
+
+<tr><td colspan="2"><small>&nbsp;</small></td></tr>
+
+<tr><td align='left'>Postscript</td><td align='right'><a href="#Page_59">59</a></td></tr>
+
+
+
+<tr><td align='left'>Notes</td><td align='right'><a href="#Page_61">61</a></td></tr>
+
+</table></div>
+
+
+
+
+
+
+
+
+<hr style="width: 65%;" />
+
+<p class="title"><a name="ERRATA" id="ERRATA"></a>ERRATA.</p>
+
+
+<p>
+Page <a href="#Page_10">10</a>, <!--line 3,--><i>for</i> two <i>read</i> a few.<br />
+<br />
+Page <a href="#Page_52">52</a>, <!--&nbsp; "&nbsp; 19,-->dele comma between the words Tabes and Mesenterica.<br />
+</p>
+
+<div class="transnote">
+<p>Transcriber's Note: The above corrections have been applied to this text, in addition to:</p>
+
+<p>Page <a href="#Page_18">18</a>, <!--line 11,--><i>headach</i> corrected to <i>headache</i>.</p>
+</div>
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_1" id="Page_1">[Pg 1]</a></span></p>
+<h2><a name="CHAPTER_I" id="CHAPTER_I"></a>CHAPTER I.</h2>
+
+<h3><i>Of the Breast-Milk, &amp;c. &amp;c.</i></h3>
+
+
+<p>No sooner has the child been ushered into the
+world than the breasts of the mother pour
+forth their milk for its sustenance. This bland
+fluid is secreted from the blood, and varies, in
+quality and quantity, according to the time
+which has elapsed from delivery, being peculiarly
+and wonderfully adapted at every period
+to the wants of the individual for whose use
+it is destined. Thus, that first secreted, called
+<i>colostrum</i>, possesses a purgative quality evidently
+intended by the all-wise Author of our
+being for the purpose of removing <i>the meconium</i><a href="#Note_A" class="fnanchor">[A]</a>,&mdash;a
+process which experience has sufficiently
+proved to be necessary for the welfare
+of the newly-born infant. Afterwards, ceasing
+to possess this aperient property, it is
+calculated solely for affording nutrition; and<span class='pagenum'><a name="Page_2" id="Page_2">[Pg 2]</a></span>
+finally, at a certain period from delivery, it
+gradually becomes impoverished, loses its
+former healthy qualities altogether, and acquires
+others which are injurious to life. This
+important change, as above noticed, generally
+happens at a certain period after delivery;
+varying, however, somewhat in particular
+women, and in the same female on different
+occasions: but, from disease, or other circumstances,
+the milk may become deteriorated
+before the time to which reference has just
+been made. If, for instance, the mother labour
+under any serious disorder, it is universally
+admitted that her milk may also become
+unhealthy; and this may take place even a
+short interval after delivery.</p>
+
+<p>Although we cannot explain how the brain
+and nerves act, and probably never shall be
+able to do so, yet we are well aware that their
+influence is absolutely requisite for the healthy
+performance of every function in the human
+body.</p>
+
+<p>That mental inquietude will impede digestion
+is a fact familiar to almost every one;<span class='pagenum'><a name="Page_3" id="Page_3">[Pg 3]</a></span>
+but, I believe, it is not so generally known,
+that it will with no less certainty retard and
+alter the nature of the secretion furnished by
+the breasts of the lactescent female. Violent
+affections of the mind will cause the milk to
+become thin and yellowish, and to acquire
+noxious properties: even the fond mother's
+anxiety, while hanging over the couch of her
+sick infant, will be sufficient to render it unfit
+for the sustenance of the object of her solicitude.</p>
+
+<p>The state also of the stomach and bowels
+and the diet of the nurse materially and constantly
+influence the nature of the lacteal
+secretion.</p>
+
+<p>The milk, besides, is liable to deterioration
+from another cause, namely, the recurrence of
+the usual periodical appearance&mdash;for should
+this take place in a nurse, it is agreed that
+her milk is liable to produce disorders in the
+child who imbibes it; which could not happen,
+if the former possessed its ordinary component
+parts, and retained its natural properties.</p>
+
+<p>The recurrence, moreover, of pregnancy in<span class='pagenum'><a name="Page_4" id="Page_4">[Pg 4]</a></span>
+the lactescent female may render the milk of
+a bad quality, and will invariably lessen its
+quantity. Mr. Burns asserts that in these
+cases the milk 'does not become hurtful,' but
+in this opinion I must beg leave to differ from
+him; since I have repeatedly seen it, from
+this cause, palpably altered in appearance,
+and have observed diarrh&#339;a and great debility
+produced in the children who were
+suckled with it.</p>
+
+<p>An almost universally received opinion
+among females, and, indeed, one very frequently
+entertained by members of the medical
+profession, is, that while a woman continues
+to nurse her infant she will not again
+become pregnant; but this, as a general proposition,
+is unquestionably erroneous; it is
+even doubtful whether such opinion will hold
+good in a majority of instances. The continuance
+of lactation will very generally, it is
+true, tend to prevent the recurrence of the
+periodical phenomenon; yet, nevertheless, it
+will not in every instance prevent pregnancy<a href="#Note_B" class="fnanchor">[B]</a>.
+Should, however, a woman with an infant at<span class='pagenum'><a name="Page_5" id="Page_5">[Pg 5]</a></span>
+the breast again become pregnant, (a circumstance
+that very frequently occurs, and of
+which, from the <i>general though not invariable</i>
+absence of those criteria by which this fact
+is accustomed to be recognised, she is not
+aware until it has made some progress,) one of
+two things will usually take place; either she
+will miscarry, or her milk will become impoverished
+in quality and diminished in quantity.
+Nor is this wonderful:&mdash;it was not intended
+by Nature that the processes of pregnancy and
+lactation should go on simultaneously, but, on
+the contrary, that the one should commence
+when the other had terminated; and experience
+sufficiently proves that they will not
+proceed well together: the reason of which, as
+it appears to me, may be easily given. During
+pregnancy, and particularly during its latter
+periods, the vessels of the womb gradually
+enlarge, and a much greater quantity of blood
+than usual is determined to that organ for
+the increase and perfection of the embryo
+and its appendages; which, after delivery,
+becomes transferred to the breasts to supply<span class='pagenum'><a name="Page_6" id="Page_6">[Pg 6]</a></span>
+the material for the secretion of the milk:
+but if, during pregnancy, lactation be also
+persevered in, the blood becomes directed at
+the same time to two different parts of the
+body, somewhat remote from each other,
+namely, to the womb, and to the breasts;
+hence, neither is likely to receive its due proportion
+of this vital fluid, and, consequently,
+the functions of one or the other, or both, are
+liable to become impeded or suspended. If
+the breasts continue to receive a sufficient
+quantity of blood, the secretion of milk goes
+on properly, but the womb is deprived of its
+necessary supply; the embryo, in consequence,
+languishes and dies, and, becoming an extraneous
+body, is thrown off, producing abortion;
+while, on the other hand, should the
+womb still obtain its due proportion of blood,
+the breasts are robbed of it, and the secretion
+of milk, if not altogether suppressed, is rendered
+either deficient in quantity or deteriorated
+in quality.</p>
+
+<p>Finally, the breast-milk may become depraved
+and injurious by the process of lactation<span class='pagenum'><a name="Page_7" id="Page_7">[Pg 7]</a></span>
+being continued too long, a practice
+which is, unfortunately, in this, as well as
+other countries, extensively prevalent.</p>
+
+<p>I have not yet had an opportunity of examining
+the breast-milk in these diseased conditions
+except by the eye, and that rarely&mdash;but
+even this slight examination has enabled
+me to state, that it was greatly altered from
+its natural condition;&mdash;that it was more fluid
+than usual, and changed in colour, resembling
+a yellowish turbid serum, instead of displaying
+its well-known bluish hue.</p>
+
+<p>I propose in future to attend carefully to
+this subject, and I would beg leave to recommend
+it as one well worthy the notice of those
+members of our profession who have made
+animal chemistry a particular study, having
+no doubt that they would be able, by a series
+of accurate experiments upon the breast-milk
+at different periods after delivery, and under
+various conditions of the mother, to collect
+many interesting and important facts&mdash;such,
+perhaps, as would tend very materially to
+augment our knowledge of pathology, and<span class='pagenum'><a name="Page_8" id="Page_8">[Pg 8]</a></span>
+improve our practice in the treatment of certain
+diseases<a href="#Note_C" class="fnanchor">[C]</a>.</p>
+
+<p>We cannot but believe that the Supreme
+Being has done nothing without an infinitely
+wise and good object, and it is obviously our
+interest, no less than our duty, to be guided by
+those indications of the Divine purpose which
+are distinctly to be traced throughout the
+creation.</p>
+
+<p>It must appear evident to all who examine
+the matter in question, that the infant was
+intended to be nourished for the first few
+months of its existence through the medium
+of a fluid; because no teeth are provided to
+prepare for its use substances of a more solid
+description; and there can be no doubt that
+this fluid is the mother's milk;&mdash;but when
+the child has attained a certain age the teeth
+begin to appear, doubtless at the precise time
+when they are meant to be used; and, therefore,
+more solid food should now be given.
+Besides, in consequence of its new acquisition,
+the child sucks less perfectly than
+before, an additional proof that weaning<span class='pagenum'><a name="Page_9" id="Page_9">[Pg 9]</a></span>
+ought at this period to be commenced. Indeed,
+the teeth are calculated indirectly to
+produce this effect themselves, the mother
+being now liable to suffer inconvenience by
+letting the child take the breast&mdash;for the latter
+<i>bites</i> instead of <i>sucking</i> the nipple, and the
+pain hence arising may, perhaps, induce the
+former, for her own sake, to discontinue a
+practice injurious to both.</p>
+
+<p>It must also be remembered, that when the
+teeth are usually produced, the milk loses its
+nutritious properties, and this too at a time
+when the infant from his increasing size must
+evidently require a more solid and substantial,
+rather than a thinner and less nourishing diet.
+What rational argument, therefore, can be
+offered why he should still be suckled? If
+we observe the brute creation, do any analogies
+appear by which we can defend the propriety
+in the human species of protracted suckling?
+by no means:&mdash;on the contrary, we find that
+the female animals soon drive away their
+young from their dugs; and what is, perhaps,
+still more to the purpose, I have heard stated,<span class='pagenum'><a name="Page_10" id="Page_10">[Pg 10]</a></span>
+on good authority, as a well-known fact among
+the breeders of cattle, that if calves be allowed
+to suck beyond a few months they do not thrive,
+but, on the contrary, become lean and diseased.</p>
+
+<p>The belief so generally prevailing, that the
+longer a child is suckled the stronger it will
+become, is a prejudice, like many others concerning
+women and children, which has been
+handed down from mother to daughter for
+ages, and has thereby become so universally
+entertained and so deeply rooted in the minds
+of females, that even medical men scarcely
+venture to question its propriety. My own
+experience, however, compels me to declare,
+that there is not a more erroneous or mischievous
+doctrine; and I can most truly
+affirm, that I never yet witnessed an instance
+where protracted lactation had produced any
+good effect<a href="#Note_D" class="fnanchor">[D]</a>, though I have seen numerous
+examples (some of which will be introduced
+hereafter) where, I believe, it had been the
+indirect cause of death.</p>
+
+<p>Having thus strongly noticed the impropriety<span class='pagenum'><a name="Page_11" id="Page_11">[Pg 11]</a></span>
+of long continued suckling, it will,
+perhaps, be proper to state my opinion as to
+the period when this process should terminate.
+As a general rule, at nine months after birth
+the child ought to be entirely weaned; and
+in no instance should he be permitted to suck
+more than ten. In many cases suckling
+may be relinquished with advantage (and
+occasionally it is absolutely necessary to discontinue
+it) before the time first above mentioned;
+in others, however, it may be protracted
+beyond it.</p>
+
+<p>I by no means recommend the breast-milk
+to be at once superseded by artificial food, but,
+on the contrary, that the child should be
+<i>gradually</i> accustomed to such aliment from a
+much earlier period; the proportion of the
+latter being increased by degrees, while the
+breast-milk is diminished in a corresponding
+ratio. Hence we shall produce a double advantage;
+the mother will be benefited as well
+as the child&mdash;the former, by giving suck less
+frequently, and in smaller quantities at a time
+than usual, will have the secretion of milk<span class='pagenum'><a name="Page_12" id="Page_12">[Pg 12]</a></span>
+<i>gradually lessened</i>, and, therefore all likelihood of
+inconvenience, as far as regards herself when
+the child is entirely weaned, will be completely
+prevented; while, on the other hand,
+the child being <i>insensibly estranged</i> from the
+breast, will have become accustomed to his
+new food, so that there will be less chance of
+its disagreeing with him when it forms his
+sole support; and thus the danger which is
+generally apprehended from weaning will
+be either materially lessened or altogether
+avoided.</p>
+
+<p>The difficulty of bringing up infants by
+hand, as it is termed, is well known; but I
+suspect that the great mortality which has
+been recorded as occurring from this source
+is not inseparable from the practice itself, but
+arises mainly from the improper manner in
+which it is usually conducted. When it is
+determined to bring up an infant by hand, the
+substitute offered for the mother's milk should
+as nearly as possible resemble that fluid; and
+the child should be constrained to imbibe it
+in <i>the same manner as</i> it would <i>the milk from the<span class='pagenum'><a name="Page_13" id="Page_13">[Pg 13]</a></span> maternal breast</i>; that is, it should be <i>sucked</i> from
+a bottle contrived for that purpose, instead of
+the child being gorged with it, by means of a
+large spoon, or some other equally improper
+instrument, as is the usual custom. It is a
+fact too palpable to be questioned, that the
+food generally given to infants brought up by
+hand is not only administered in an improper
+manner, but is also of an improper quality;
+their tender stomachs are daily overloaded
+with <i>solid</i> instead of <i>liquid</i> aliment, and hence
+arises the numerous train of evils which, in
+my opinion, produce the great mortality just
+referred to.</p>
+
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_14" id="Page_14">[Pg 14]</a></span></p>
+<h2><a name="CHAPTER_II" id="CHAPTER_II"></a>CHAPTER II.</h2>
+
+<h3><i>On Lactation, and the Disorders frequently produced in
+Women by that process.</i></h3>
+
+
+<p>There can be no doubt that, speaking generally,
+a mother is bound to suckle her children,
+and that the performance of this duty
+is no less conducive to her own health than to
+the moral and physical welfare of her offspring;
+yet there is not a more unfounded
+doctrine than that which presumes every
+woman who is willing to be also capable of
+advantageously discharging the important
+office of a nurse.</p>
+
+<p>If the mother enjoy good health, and the
+process be not continued too long, it is likely
+to produce beneficial effects both in herself
+and her infant; but if she be of a very delicate
+habit&mdash;labour under any dangerous
+disease&mdash;be subject during the period of lactation
+to great affliction, or constant mental<span class='pagenum'><a name="Page_15" id="Page_15">[Pg 15]</a></span>
+inquietude&mdash;or should the periodical appearance
+return, pregnancy occur, or suckling be
+continued too long, it may not only prove
+highly detrimental to herself, but may be the
+means of occasioning serious or fatal consequences
+to her child.</p>
+
+<p>In cases of extreme delicacy of constitution,
+lactation will often produce the worst
+effects. Many young ladies, on becoming
+mothers, are incapable of supporting the
+constant drain to which the wants of their
+infants subject them&mdash;they lose their good
+looks, become gradually weaker, and as their
+strength declines, their milk is simultaneously
+lessened in quantity, and altered in its other
+properties.</p>
+
+<p>If the suckling be still continued, their debility
+daily increases, distressing pains in the
+back and loins succeed; the patients become
+exceedingly nervous, as it is termed, and are
+unusually susceptible of ordinary impressions;
+pain in the head, often of great violence,
+follows, which, in some cases, is succeeded
+by delirium, in others, by absolute<span class='pagenum'><a name="Page_16" id="Page_16">[Pg 16]</a></span>
+mania. Nor is this the whole catalogue of
+ills to which in such cases the unfortunate
+mother is subjected: the appetite fails, distressing
+languor is experienced by day, while
+copious perspirations deluge her by night,
+and dissipate the last remains of strength&mdash;producing
+a state which may easily be mistaken
+for, or terminate in, true pulmonary
+consumption;&mdash;finally, the sight becomes
+progressively weaker, until vision is almost
+destroyed; the eyelids exude a glutinous
+secretion, and ophthalmia itself is occasionally
+induced.</p>
+
+<p>These are the symptoms too often caused
+by lactation in delicate or debilitated habits,
+even a few months after delivery; the same
+also are observed when suckling has been injudiciously
+protracted beyond the period to
+which it should be confined.</p>
+
+<p>A few only of the foregoing symptoms may
+be noticed, or nearly the whole may present
+themselves, in the same patient; and when
+this happens, unless the cause which has
+given rise to them be at once detected, and<span class='pagenum'><a name="Page_17" id="Page_17">[Pg 17]</a></span>
+appropriate treatment employed, the most
+serious consequences may be apprehended.</p>
+
+<p>In these cases, the first step necessary is
+to discontinue the suckling altogether: half
+measures will never answer. Sometimes it is
+proposed by the patient, or her friends (more
+usually the latter), to compromise the affair
+by feeding the child partly on spoon meat,
+and allowing him still to take the breast,
+though less frequently than before.</p>
+
+<p>This plan I uniformly object to, for the
+following reasons:&mdash;</p>
+
+<p>1st. Because the mother will not be likely
+to recover so long as she continues to suckle
+at all.</p>
+
+<p>2nd. Because her milk being necessarily
+of a bad quality, it cannot be expected that
+the child will derive benefit from it; but, on
+the contrary, there is every probability that
+his health will suffer by using diet of such an
+improper description.</p>
+
+<p>The obvious dependence of the foregoing
+symptoms upon debility will, of course, at
+once suggest to practitioners the nature of<span class='pagenum'><a name="Page_18" id="Page_18">[Pg 18]</a></span>
+the treatment to be adopted: which should
+be such as is calculated to invigorate the
+system generally&mdash;namely, the administration
+of tonics, &amp;c.</p>
+
+<p>Bark and its various preparations, especially
+the sulphate of quinine, with the occasional
+use of warm aperients (sedulously
+avoiding the more violent purgatives), will
+be found eminently successful; whereas,
+cupping at the nape of the neck (which I
+have seen prescribed for the headache), and
+other depletory measures, have proved as
+manifestly injurious.</p>
+
+<p>'Every disease productive of great weakness
+is increased by the state of the system
+which follows child-bearing. Of this description
+are consumption, dropsy,' &amp;c. In
+these cases it is evident that the process of
+lactation, by adding to the debility already
+present, must prove highly injurious, and
+consequently should be always avoided.</p>
+
+<p>I have already noticed the effects which are
+produced upon the milk by the influence of
+mental emotions on the part of the mother,<span class='pagenum'><a name="Page_19" id="Page_19">[Pg 19]</a></span>
+as well as by the recurrence of the periodical
+appearance; and since these are chiefly injurious
+to the child, by depraving its sustenance,
+their further consideration will be
+deferred till the next chapter.</p>
+
+<p>With respect to the remaining topic&mdash;namely,
+the occurrence of miscarriage from
+suckling&mdash;I am convinced that it is by no
+means an unfrequent accident, though its
+real cause is perhaps rarely suspected, having
+only met with one patient who considered the
+mishap in question to have arisen from keeping
+her child too long at the breast. Having
+already, I trust satisfactorily, explained the
+manner in which abortion is produced by
+the act of suckling, I shall conclude this part
+of my subject with the relation of a case that
+occurred in private practice, which so strongly
+corroborates many of the observations in the
+preceding and following pages, that I shall
+offer no apology for its introduction: more
+particularly, since the lady herself to whom
+it refers has benevolently expressed a wish
+for its publication, in order that those who<span class='pagenum'><a name="Page_20" id="Page_20">[Pg 20]</a></span>
+become acquainted with the facts there detailed
+may be prevented from undergoing
+similar unnecessary sufferings:&mdash;</p>
+
+
+<h3>CASE.</h3>
+
+<p>Mrs. A&mdash;&mdash;, a lady of delicate constitution,
+about twenty years of age, three or four
+months subsequent to the birth of her first
+child, began to find her milk gradually lessen
+in quantity; it had also much changed from
+its previous appearance, resembling at the
+time just stated, a yellowish, turbid serum.
+Her child became emaciated; and diarrh&#339;a
+supervening, my professional services were
+required. My advice was, that the child
+should be at once weaned, and a suitable
+wet-nurse, if possible, procured&mdash;neither of
+which suggestions, as will shortly appear,
+were followed. I urged the necessity of this
+measure more particularly, because Mrs. A&mdash;&mdash;
+was daily getting thinner and weaker; she
+also complained of great pain in the head
+and back, and of an increasing dimness of
+sight, which made her fear she should become<span class='pagenum'><a name="Page_21" id="Page_21">[Pg 21]</a></span>
+blind; but the mother-in-law of my patient
+being, unfortunately, of opinion that pregnancy
+in the latter would not again occur
+during the continuance of lactation, recommended
+that the child, although chiefly supported
+upon spoon-meat, should occasionally
+be allowed to take the breast; and this plan,
+notwithstanding the wish of Mrs. A&mdash;&mdash; to
+the contrary, and my own remonstrances on
+the subject, was adopted&mdash;the effects of which
+were to increase the mother's ailments, as well
+as those of her infant. Things went on thus
+for some time longer, when I once more endeavoured
+to persuade Mrs. A&mdash;&mdash; to follow
+my advice, observing, that by an opposite line
+of conduct she was not only injuring her own
+health, but that of her child, neither of which,
+I assured her, in my opinion, would be re-established
+till the latter had been weaned.
+I expressed also my complete incredulity as
+to the non-recurrence of pregnancy in consequence
+of her infant remaining at the breast;
+and I added&mdash;'It is my firm conviction that
+if you be pregnant, or should happen shortly<span class='pagenum'><a name="Page_22" id="Page_22">[Pg 22]</a></span>
+to become so, you will miscarry.' About a
+week after this conversation she was suddenly
+seized with flooding, and what I had predicted
+took place. She now left off suckling, and
+in about a month, under suitable treatment,
+completely got rid of all her former complaints:
+the child also immediately began to
+improve.</p>
+
+<p>The present case clearly proves that the
+process of lactation will not <i>invariably</i> prevent
+the occurrence of pregnancy, since Mrs. A&mdash;&mdash;
+became in this state, notwithstanding she continued
+to suckle her child: and I think few
+will be so hardy as to doubt that it was the
+cause of her miscarrying: more particularly
+when I mention that, at a future period, the
+same lady, during my absence abroad, being
+once more persuaded to try whether she could
+not avoid becoming pregnant (which was very
+much to be desired, on account of her delicate
+state of health) by continuing to perform
+the duties of a nurse, again suffered all the
+distressing symptoms before described, and
+again miscarried.<span class='pagenum'><a name="Page_23" id="Page_23">[Pg 23]</a></span></p>
+
+<p>This case, finally, affords evidence of the
+evil consequences often produced in children
+by impoverished and unhealthy milk; and
+of their speedy disappearance when the exciting
+cause&mdash;namely, deteriorated milk&mdash;is
+no longer afforded.</p>
+
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_24" id="Page_24">[Pg 24]</a></span></p>
+<h2><a name="CHAPTER_III" id="CHAPTER_III"></a>CHAPTER III.</h2>
+
+<h3><i>On the various Diseases which frequently arise in Children
+from Lactation, especially when protracted.</i></h3>
+
+
+<p>Having thus briefly considered some of the
+disorders to which women are subjected by
+performing the first duty imposed upon them
+as mothers, I shall next advert to those which
+are very frequently observed in their children
+from being suckled during too long a period;
+or in consequence of the nurse's milk becoming
+either simply impoverished, or of a
+positively injurious quality.</p>
+
+<p>These diseases are numerous, and some of
+them serious, among which may be enumerated
+the following; namely, vomiting, diarrh&#339;a,
+general debility, scrofula, tabes mesenterica,&mdash;rickets,
+convulsions, epilepsy,&mdash;and
+lastly meningitis, or that peculiar inflammation
+of the investing membranes of the
+brain which gives rise to the effusion of serum,<span class='pagenum'><a name="Page_25" id="Page_25">[Pg 25]</a></span>
+constituting the well known and very fatal
+disease termed by medical practitioners Hydrocephalus,
+or Hydrencephalus, and popularly
+Water on the Brain.</p>
+
+<p>The disease last mentioned being by far the
+most important, and that chiefly referred to
+in the following observations, I shall commence
+with a brief statement of the conclusions
+which my experience has led me to
+form respecting it; they are the same I made
+public four years ago<a href="#Note_E" class="fnanchor">[E]</a>, having since that
+time seen no reason to make any alteration in
+them. I believe,</p>
+
+<p>1st,&mdash;That if children be suckled for an
+undue length of time<a href="#Note_F" class="fnanchor">[F]</a>, they will be liable in
+consequence to be affected with meningitis<a href="#Note_G" class="fnanchor">[G]</a>,
+or inflammation of the investing membranes
+of the brain.</p>
+
+<p>2dly,&mdash;That should they not become affected
+with the disorder in question during or soon
+after the time they are thus improperly
+suckled, they will nevertheless acquire therefrom
+a predisposition to cephalic disease at
+some future period of their lives.<span class='pagenum'><a name="Page_26" id="Page_26">[Pg 26]</a></span></p>
+
+<p>3dly,&mdash;That children who are suckled for an
+undue length of time, when labouring under
+other diseases, will be much more liable to
+have the head secondarily affected, than
+children brought up in a different manner.</p>
+
+<p>4thly,&mdash;And lastly, that the same effects will
+take place in infants if suckled by women who
+have been delivered an undue<a href="#Note_H" class="fnanchor">[H]</a> length of
+time; although the infants themselves may
+not have been at the breast for too long a
+period.</p>
+
+<hr style='width: 45%;' />
+
+<h3>CASES IN ILLUSTRATION OF THE FOREGOING
+VIEWS.</h3>
+
+
+<h3>I.</h3>
+
+<h3><small><i>Cases of Meningitis</i><a href="#Note_I" class="fnanchor">[I]</a> <i>supervening upon protracted
+suckling.</i></small></h3>
+
+<h4>CASE I.</h4>
+
+<p>&mdash;&mdash; Wilshire, aged two years seven months,
+died of '<i>Water on the brain</i>,'&mdash;<i>suckled twelve
+months</i>.</p>
+
+<h4>CASE II.</h4>
+
+<p>&mdash;&mdash; Park, aged one year ten months, died of
+'<i>Water in the head</i>,'&mdash;<i>suckled fourteen months</i>.<span class='pagenum'><a name="Page_27" id="Page_27">[Pg 27]</a></span></p>
+
+<h4>CASE III.</h4>
+
+<p>Prince V&mdash;&mdash;, aged two years and a few
+months, died of <i>Hydrencephalus</i>,&mdash;<i>suckled until his
+death</i>. In this case I was consulted a short time
+previously, and recommended the breast-milk to
+be withheld&mdash;my advice was not followed.</p>
+
+<h4>CASE IV.</h4>
+
+<p>Emma Lane, aged two years, admitted at the
+Infirmary for Children for <i>Meningitis</i>,&mdash;<i>suckled
+one year and eleven months</i>.</p>
+
+<h4>CASE V.</h4>
+
+<p>The mother of the preceding suckled another
+child '<i>a very long period</i>,' and it died of '<i>Water
+on the Brain</i>.'</p>
+
+<h4>CASE VI.</h4>
+
+<p>Edmund Power, aged two years, <i>still at the
+breast</i>, admitted for <i>Chronic Hydrocephalus</i>: the
+head is of great magnitude; fontanelles open:
+superficial veins large and prominent.</p>
+
+<h4>CASE VII.</h4>
+
+<p>Sophia Hamley, aged one year two months,
+<i>still at the breast</i>, admitted for <i>Meningitis</i>.<span class='pagenum'><a name="Page_28" id="Page_28">[Pg 28]</a></span></p>
+
+<h4>CASE VIII.</h4>
+
+<p>William How, aged one year six months, admitted
+for <i>Meningitis</i>,&mdash;<i>suckled thirteen months</i>.</p>
+
+<h4>CASE IX.</h4>
+
+<p>David Hepburn, aged two years six months,
+admitted for <i>Meningitis</i>,&mdash;<i>suckled two years four
+months</i>.</p>
+
+<h4>CASE X.</h4>
+
+<p>Samuel Hanks, aged one year nine months,
+admitted for <i>Meningitis</i>,&mdash;<i>suckled one year eight
+months</i>.</p>
+
+<h4>CASE XI.</h4>
+
+<p>Amelia Hill, aged two years six months, admitted
+for <i>Meningitis</i>,&mdash;<i>suckled one year nine
+months</i>.</p>
+
+<h4>CASE XII.</h4>
+
+<p>&mdash;&mdash; Hughes, died of '<i>Water in the head</i>,'&mdash;<i>suckled
+fourteen months</i>.</p>
+
+<h4>CASE XIII.</h4>
+
+<p>&mdash;&mdash; Ferreira, aged seventeen months, died of
+'<i>Water in the head</i>,'&mdash;<i>suckled until its death</i>.<span class='pagenum'><a name="Page_29" id="Page_29">[Pg 29]</a></span></p>
+
+<p>For the five following cases I am indebted
+to the kindness of Mr. William Griffith, an
+intelligent surgeon of Eaton-street, who, having
+some time ago been apprised of my peculiar
+views, has since directed his attention
+particularly to the subject. They completely
+confirm my opinions, and will have more
+weight with the public than any additional
+evidence I could adduce from my own practice.</p>
+
+<p>In the letter inclosing these cases, Mr.
+Griffith writes thus&mdash;'from the observations
+I have been enabled to make, I am led to
+believe that disease almost invariably follows
+protracted suckling. I may add in conclusion,
+that I perfectly concur with the views
+which you entertain on the subject.'</p>
+
+<h4>CASES XIV. XV.</h4>
+
+<p>'&mdash;&mdash; Jackson, residing at &mdash;&mdash;, aged two
+years six months, who had been kept <i>at the
+breast twenty-two months</i>, was in a dying state
+when I was requested to see her. The pulse
+was preternaturally slow&mdash;great stupor&mdash;dilatation<span class='pagenum'><a name="Page_30" id="Page_30">[Pg 30]</a></span>
+of the pupils, and diastasis of the bones of
+the head. In six hours from the time I first saw
+her she died, and the mother was desirous that
+the head should be examined, having lost a child
+previously, in what she considered a similar manner.
+On removing the scalp I found the cranium
+very much enlarged and altered in shape. Between
+the tunica arachnoides and pia mater,
+there was a quantity of water effused;&mdash;the
+sides and upper surface of the brain were exceedingly
+soft. In the lateral ventricles there were
+from six to eight ounces of water. In answer to a
+few questions I asked the mother, she stated that
+her former child was, during the <i>first ten months</i>
+of its life, <i>a plump, healthy infant</i>,&mdash;<i>after that
+period he altered</i>,&mdash;the stomach, bowels, and <i>head
+became affected</i>, and, in the course of a few months,
+he manifested similar symptoms to those which
+proved fatal in the case of his sister. He was
+<i>suckled for twenty-one months</i>, and <i>died</i> at the age
+of <i>twenty-seven months</i>. The mother of these
+children has one other child alive, and at my
+urgent request it was weaned at <i>nine months</i>,&mdash;it
+is now <i>seventeen months old, and in excellent health</i>.'<span class='pagenum'><a name="Page_31" id="Page_31">[Pg 31]</a></span></p>
+
+<h4>CASE XVI.</h4>
+
+<p>'Mrs. A&mdash;&mdash;, of &mdash;&mdash;, had a little boy who
+at <i>ten months old</i> had nine teeth, which were cut
+with little or no difficulty:&mdash;<i>at this time he was in
+good health</i>,&mdash;<i>he was allowed the breast until nineteen
+months, and at the expiration of three months
+more, died of Hydrocephalus</i>.'</p>
+
+<h4>CASE XVII.</h4>
+
+<p>'Mrs. T&mdash;&mdash; lost a child of Hydrocephalus,
+and has an infant <i>now at the breast seventeen
+months old</i>;&mdash;the little patient is frequently suffering
+from <i>cerebral disturbance</i>. I have repeatedly
+advised the mother to wean it&mdash;she
+objects, and gives the usual reason for allowing
+it to remain at the breast&mdash;viz., that she does it
+to <i>prevent becoming again enceinte</i>.'</p>
+
+<h4>CASE XVIII.</h4>
+
+<p>'This day, (August 13, 1831,) a little child
+labouring under <i>cerebral disease</i> was brought to
+me for advice, and he appeared certainly in a
+most pitiable state; he is <i>two years four months
+old</i> and is <i>now at the breast</i>,&mdash;I do not think it
+possible for him to survive many days.'<span class='pagenum'><a name="Page_32" id="Page_32">[Pg 32]</a></span></p>
+
+
+<h3 class="moretop">II.</h3>
+
+<h3><small><i>Cases of Meningitis, arising at an after period, in consequence
+of protracted suckling.</i></small></h3>
+
+<h4>CASE XIX.</h4>
+
+<p>Francis Page, aged six years, admitted for
+<i>Meningitis</i>,&mdash;<i>suckled one year</i>.</p>
+
+<h4>CASE XX.</h4>
+
+<p>Henry Taylor, aged six years, admitted for
+<i>Meningitis</i>,&mdash;<i>suckled fourteen months</i>.</p>
+
+<h4>CASE XXI.</h4>
+
+<p>Julia Brown, aged three years, admitted for
+<i>Meningitis</i>,&mdash;<i>suckled thirteen months</i>.</p>
+
+<h4>CASE XXII.</h4>
+
+<p>James Neil, aged seven years six months, admitted
+for <i>Meningitis</i>,&mdash;<i>suckled fourteen months</i>.</p>
+
+<h4>CASE XXIII.</h4>
+
+<p>Eliza Park, aged six years, laboured under
+<i>Meningitis</i>,&mdash;<i>suckled fourteen months</i>.</p>
+
+<h4>CASE XXIV.</h4>
+
+<p>Charles Dale, aged five years; admitted for
+<i>Meningitis</i>&mdash;<i>suckled thirteen months</i>.<span class='pagenum'><a name="Page_33" id="Page_33">[Pg 33]</a></span></p>
+
+<h4>CASE XXV.</h4>
+
+<p>Sarah Strickling, aged four years; admitted
+for <i>Meningitis</i>&mdash;<i>suckled one year and six months</i>.</p>
+
+<h4>CASES XXVI. XXVII. XXVIII.</h4>
+
+<p>The mother of the last mentioned child lost
+three previously, with '<i>water in the head</i>:'&mdash;all
+these were suckled <i>more than eighteen months</i>.</p>
+
+<h4>CASE XXIX.</h4>
+
+<p>George Speering, aged four years; admitted
+for <i>Meningitis</i>&mdash;<i>suckled one year and six months</i>.</p>
+
+<h4>CASE XXX.</h4>
+
+<p>Ann Archer, aged seven years; admitted for
+<i>Hydrocephalus</i>&mdash;died&mdash;<i>suckled three years</i>.</p>
+
+<h4>CASE XXXI.</h4>
+
+<p>Cornelius Leary, aged six years; admitted for
+<i>Meningitis</i>&mdash;died&mdash;<i>suckled eighteen months</i>.</p>
+
+<h4>CASE XXXII.</h4>
+
+<p>Sophia Peverel, aged three years; admitted
+for <i>Meningitis</i>&mdash;<i>suckled two years</i>.<span class='pagenum'><a name="Page_34" id="Page_34">[Pg 34]</a></span></p>
+
+<h4>CASE XXXIII.</h4>
+
+<p>Maria Turley, aged four years; admitted for
+<i>Meningitis</i>&mdash;died&mdash;<i>suckled one year three months</i>.
+This child had laboured under a previous attack,
+from which she recovered under my care.</p>
+
+<h4>CASE XXXIV.</h4>
+
+<p>Robert Selkirk, aged three years six months;
+admitted for <i>Meningitis</i>&mdash;<i>suckled thirteen months</i>.</p>
+
+<h4>CASE XXXV.</h4>
+
+<p>The mother of the preceding child lost another
+of '<i>inflammation of the brain</i>.'&mdash;This was <i>suckled
+more than one year</i>.</p>
+
+<h4>CASE XXXVI.</h4>
+
+<p>Eliza Ferreira, aged five years; admitted for
+<i>Meningitis</i>&mdash;<i>suckled one year seven months</i>.</p>
+
+
+<h3 class="moretop">III.</h3>
+
+<h3><small><i>Cases of Meningitis in Children who had been suckled
+an undue length of time, supervening upon other complaints.</i></small></h3>
+
+<h4>CASE XXXVII.</h4>
+
+<p>Arthur Lane, aged one year four months;<span class='pagenum'><a name="Page_35" id="Page_35">[Pg 35]</a></span>
+admitted for Pneumonia, with <i>an affection of the
+head</i>&mdash;<i>suckled fourteen months</i>.</p>
+
+<h4>CASE XXXVIII.</h4>
+
+<p>Sarah Ward, aged three years; admitted for
+Hooping-cough&mdash;<i>head much affected</i>&mdash;<i>suckled one
+year and ten months</i>.</p>
+
+<h4>CASE XXXIX.</h4>
+
+<p>Thomas Donovan, aged two years two months;
+admitted for Hooping-cough, with <i>an affection of
+the head</i>&mdash;<i>suckled twelve months</i>.</p>
+
+<h4>CASE XL.</h4>
+
+<p>Count &mdash;&mdash; &mdash;&mdash;, aged about two years, came
+under my care, being then at the breast. The
+head was large, fontanelle open&mdash;superficial veins
+more apparent than natural. By my advice he
+was directly weaned, and rapidly improved in
+health and appearance (the only medicine given
+being occasional doses of castor oil). About
+twelve months afterwards, in consequence of an
+imprudent exposure to cold, he was attacked with
+Bronchitis, and Meningitis supervened. Leeches
+were applied to the head, and other depletory<span class='pagenum'><a name="Page_36" id="Page_36">[Pg 36]</a></span>
+measures actively employed, which were followed
+by recovery.</p>
+
+<h4>CASE XLI.</h4>
+
+<p>&mdash;&mdash; Sloggat, aged thirteen months, died of
+<i>Meningitis</i> supervening upon Pneumonia&mdash;<i>suckled
+until the time of its death</i>.</p>
+
+<h4>CASE XLII.</h4>
+
+<p>John Scott, aged eleven months; admitted for
+Hooping-cough, with a <i>well-marked affection of
+the head</i>&mdash;<i>still at the breast</i>.</p>
+
+<h4>CASE XLIII.</h4>
+
+<p>&mdash;&mdash; Scott, aged fifteen months,&mdash;died of
+'Hooping-cough, with convulsions,' <i>being then at
+the breast</i>.</p>
+
+<h4>CASE XLIV.</h4>
+
+<p>Isaac Berwick, aged one year two months, admitted
+for Hooping-cough, <i>with an affection of the
+head</i>&mdash;<i>still at the breast</i>.</p>
+
+<h4>CASE XLV.</h4>
+
+<p>Frederick Cousins, aged three years four
+months, brought to me labouring under Hooping-cough,<span class='pagenum'><a name="Page_37" id="Page_37">[Pg 37]</a></span>
+with Meningitis, which latter terminated
+in effusion. Calomel was then given every two
+hours, the stronger mercurial ointment rubbed
+upon the temples, and blisters applied to the
+head. The mercurial influence being established,
+a profuse discharge of urine occurred; the pupils
+which had previously been <i>permanently</i> dilated,
+became once more obedient to light; sensibility
+was restored, and great weakness appeared to be
+the only urgent symptom. The cough, however,
+now returned, the head became again affected,
+and the child sunk. Upon opening the head,
+about four ounces of fluid was found in the ventricles<a href="#Note_K" class="fnanchor">[K]</a>.
+This child was <i>suckled sixteen months</i>.</p>
+
+<h4>CASE XLVI.</h4>
+
+<p>Sarah Swann, aged four years six months,
+admitted for Hooping-cough with convulsions,&mdash;<i>suckled
+one year</i>.</p>
+
+<h4>CASE XLVII.</h4>
+
+<p>Henry Harris, aged two years three months,
+admitted for Hooping-cough, <i>with an affection</i> of
+the head,&mdash;<i>suckled one year four months</i>.<span class='pagenum'><a name="Page_38" id="Page_38">[Pg 38]</a></span></p>
+
+<h4>CASE XLVIII.</h4>
+
+<p>Maria Hughes, aged two years, admitted for
+<i>Convulsions</i> supervening upon Hooping-cough&mdash;<i>suckled
+one year three months</i>.</p>
+
+<h4>CASE XLIX.</h4>
+
+<p>Thomas Benson, aged one year six months,
+admitted for Pneumonia, with <i>well-marked affection
+of the head</i>&mdash;<i>suckled one year four months</i>.</p>
+
+<h4>CASE L.</h4>
+
+<p>Mary Kenner, aged six years, admitted for
+Hooping-cough, with <i>well-marked affection of the
+head</i>&mdash;<i>suckled one year six months</i>.</p>
+
+<h4>CASE LI.</h4>
+
+<p>John Ennis, aged one year seven months, admitted
+for Bronchitis, to which <i>a decided affection
+of the head succeeded</i>&mdash;<i>suckled one year</i>.<span class='pagenum'><a name="Page_39" id="Page_39">[Pg 39]</a></span></p>
+
+
+<h3 class="moretop">IV.</h3>
+
+<h3><small><i>Case of Meningitis produced in consequence of the Child
+being suckled from its birth by a Woman who had at
+that time been delivered one Year.</i></small></h3>
+
+<h4>CASE LII.</h4>
+
+<p>Ellen Willoughby, aged nine months, admitted
+for Meningitis; at present suckled by a woman
+who has been <i>delivered one year and nine months</i>.</p>
+
+<hr style='width: 45%;' />
+
+<p>With respect to the manner in which protracted
+lactation causes the complaint that
+forms the subject of these remarks, I formerly
+was undecided; but have now no
+doubt whatever of its arising <i>secondarily</i> from
+derangement in the functions of the abdominal
+viscera, occasioned by the depraved
+condition of the breast-milk.</p>
+
+<p>It is universally allowed among medical
+men that irritations in the stomach and
+bowels will, through the agency of particular
+nerves, produce sympathetic irritation<span class='pagenum'><a name="Page_40" id="Page_40">[Pg 40]</a></span>
+in the brain,&mdash;that peculiar action being thus
+elicited which terminates in the effusion of
+serum, constituting the disease named Hydrocephalus.&mdash;'The
+continued irritation of important
+or very sensible nerves is, perhaps,'
+says Mr. Burns, '<i>one of the most common causes</i>'
+(of Hydrocephalus); 'hence it may follow
+dentition, and <i>very often arises from a bad state
+of the chylopoietic viscera</i>.'</p>
+
+<p>It is also no less generally known that food
+of a bad quality or improper description will
+produce derangements in the digestive organs.
+Now, having already shewn that the milk
+when lactation is protracted becomes deteriorated,
+it plainly appears that such milk is
+capable of occasioning derangement of the
+chylopoietic viscera; and it being allowed
+that derangement of these viscera, from any
+source, may give rise to inflammation of the
+brain, I conceive it follows that protracted
+lactation must be admitted as one cause of
+such effect. This train of reasoning, therefore,
+from generally admitted data, seems to <i>prove
+that Meningitis</i>, or inflammation of the brain, <i>in<span class='pagenum'><a name="Page_41" id="Page_41">[Pg 41]</a></span> children can be produced by their being suckled for
+too long a period</i>, and <i>that it is so produced I assert
+from repeated experience</i>.</p>
+
+<p>An accidental perusal of Mr. Dendy's able
+work on the cutaneous diseases of children,
+published shortly after the appearance of my
+paper before referred to in the Medical and
+Physical Journal, has recently afforded me
+the pleasure of finding that the author had
+been led to entertain similar general views on
+the subject under discussion with myself; I
+have, therefore, taken the opportunity of adding
+that gentleman's testimony to my own, by
+quoting the following passage from his work
+above mentioned.</p>
+
+<p>'It may be truly said, that <i>the infantine
+disease excited by milk of a deleterious, or simply
+impoverished quality, "grows by what it feeds on;"</i>
+and we shall witness the internal debility and
+the infantine disorder running their course
+together. Tabes is the natural consequence
+of this error; but its effect is evinced by the
+occurrence of other disorders. A defective
+degree of nutrition, as I have elsewhere stated,<span class='pagenum'><a name="Page_42" id="Page_42">[Pg 42]</a></span>
+predisposes the system to become influenced
+by comparatively slight excitement; and thus,
+in addition to the direct excitement of disease,
+it becomes indirectly its predisposing cause.
+<i>Under its influence the serous</i><a href="#Note_L" class="fnanchor">[L]</a> and mucous
+<i>membranes become readily the seat of inflammatory
+action</i>.'</p>
+
+<p>Those who feel a difficulty in relinquishing
+old opinions and adopting new views upon
+any particular subject, may perhaps ask how
+it has happened, if inflammation of the brain
+from protracted suckling be so common as
+the preceding observations and cases would
+appear to prove, that medical men of more
+advanced age and far greater experience than
+myself have not previously noticed the circumstance.
+I would observe, in reply, that
+until Harvey pointed out the circulation of
+the blood, no one ever suspected the existence
+of such a phenomenon; yet now the wonder
+appears to be, not that Harvey made the discovery,
+but that others had not previously
+done the same. Multitudes, it may be added,
+and among them the great Newton, had witnessed<span class='pagenum'><a name="Page_43" id="Page_43">[Pg 43]</a></span>
+the fall of objects to the ground without
+thinking of the cause which produced their
+downward tendency; the propitious moment,
+however, arrived&mdash;the apple fell, and the philosopher
+was led to those deductions which
+have rendered his name immortal. So is it
+with observers of every class, from those most
+distinguished by intellectual superiority and
+its successful application, down to the humble
+writer of the present observations. Facts
+are continually passing before us unnoticed,
+till, from their repeated coincidence, or some
+accidental impulse, we attempt, and finally
+are enabled, to trace their origin.</p>
+
+<p>Thus, until the possibility of Meningitis
+originating from protracted lactation had
+been suggested, practitioners were, of course,
+unable to notice the fact&mdash;not from its non-occurrence,
+but because their unconsciousness
+of its existence must necessarily preclude
+the inquiries from which alone its cause
+could be determined. Hence a practitioner
+may have treated many hundred cases of
+water on the brain in children, without being<span class='pagenum'><a name="Page_44" id="Page_44">[Pg 44]</a></span>
+able to attribute any one of them to protracted
+suckling; yet this is no proof that
+such cases did not happen, for, had he made
+the requisite inquiries, very probably many
+among them might have been found which
+had thus arisen.</p>
+
+<p>Another objection that may possibly be
+made to my views, is, that instances might
+be adduced where lactation had been persevered
+in for a very long period, without any
+ill effects supervening. That such frequently
+occur, there is no doubt; and with respect to
+them, I have merely to observe, that they do
+not in the slightest degree invalidate the correctness
+of my conclusions. As well might
+it be argued, that because persons have fallen
+from a very great height without sustaining
+any injury, or, because poisonous doses of
+various drugs have sometimes been swallowed
+without death supervening, that, therefore,
+there is no danger in jumping from a precipice,
+or in taking a virulent poison; or that
+death never occurs from these causes. Such
+cases, unless far more numerous than I imagine<span class='pagenum'><a name="Page_45" id="Page_45">[Pg 45]</a></span>
+them, can only be regarded as exceptions
+to the general rule; and, consequently,
+do not lessen its authority, there being no rule
+without an exception.</p>
+
+<p>Some practitioners, with whom I have conversed
+on the subject, though willing to allow
+that protracted suckling, by depraving the
+milk, may be the means of occasioning Meningitis
+in infants during or shortly after the
+time they are supplied with this improper
+food, yet could not conceive how it can act as
+a cause of that disease at some future period;
+I do not myself, while attempting to account
+for it, discover any pathological difficulty.</p>
+
+<p>In these cases it is very probable, that
+although the protracted suckling was not
+sufficient to produce actual Meningitis at its
+conclusion, yet that it so weakened the
+system in general, and the brain in particular,
+as to render the latter especially predisposed
+to inflammatory action; and that
+we have reason to suppose this not only
+possible, but probable, from analogy, cannot
+be denied, since it is known that scrofulous<span class='pagenum'><a name="Page_46" id="Page_46">[Pg 46]</a></span>
+children, in whom there is great laxity and
+debility of habit, are inordinately liable to be
+affected with Hydrocephalus, or Water in
+the Brain.</p>
+
+<p>'Dr. Perceval observes, that of twenty-two
+cases of which he kept notes, <i>eleven were certainly
+strumous children</i>, and <i>four were probably
+so</i>.' 'From my own observations,' remarks
+Dr. Cheyne, 'I should think this proportion
+a very moderate one. When a whole family
+is swept away by Hydrocephalus, I suspect
+<i>it is intimately connected with this strumous taint</i>.'
+The testimony of Sauvages may also be adduced,
+who says, 'Novi familiam cujus infantes
+circa sextum &aelig;tatis annum omnes periere
+ex hoc morbo, <i>Scrofula huic effusioni ansam
+pr&aelig;bente</i>.' The brain, in consequence of this
+local debility, may become affected from
+causes which otherwise would, perhaps, have
+produced no injurious consequences whatever;
+and hence it is, that when labouring
+under other diseases, and especially Hooping-cough,
+those children who have been suckled
+too long appear so very liable to have the<span class='pagenum'><a name="Page_47" id="Page_47">[Pg 47]</a></span>
+head secondarily affected. It is worthy of
+notice, that among the cases which have been
+detailed in the foregoing pages, were fourteen
+in whom affection of the head supervened
+during the progress of other diseases, and in
+ten of them the disease was Hooping-cough.</p>
+
+<p>The treatment of Meningitis arising from
+protracted suckling will not differ from what
+is proper when it has been produced by other
+causes; except that the depletory measures
+should not be carried to so great an extent, as
+it must be remembered that the disease is
+existing in constitutions <i>already debilitated</i>.</p>
+
+<p>It should consist generally in the application
+of leeches to the temples&mdash;cold lotions
+to the head&mdash;purgatives, and blisters placed
+behind the ears, the discharge from which is
+to be kept up by means of irritating dressings&mdash;these
+afford the surest chance of subduing
+the malady, and in many instances, if
+employed sufficiently early, will have the desired
+effect. It is, of course, almost superfluous
+to observe, that weaning, if the child
+be above nine months old, must be immediately<span class='pagenum'><a name="Page_48" id="Page_48">[Pg 48]</a></span>
+enforced; or, if considerably younger,
+the diseased or debilitated nurse ought to be
+exchanged for one who has a supply of healthy
+milk of a corresponding age. If such
+cannot be procured, the child must be
+brought up by hand; for, so long as it is allowed
+to imbibe the noxious milk, there is little
+hope, in my mind, of the medical treatment
+being of any great service; while on the contrary,
+it is encouraging to know that many
+infants previously manifesting symptoms of
+incipient Meningitis have completely recovered
+<i>soon after they were weaned</i><a href="#Note_M" class="fnanchor">[M]</a>.</p>
+
+<p>When my attention first became directed
+to the subject, I was chiefly struck with the ill
+effects resulting to the child from <i>protracted</i>
+lactation, and hence supposed that cases of
+disease from suckling, when continued for
+only a moderate period, were rarely if ever
+met with. More enlarged experience, however,
+has now convinced me, that not only are
+ill effects occasioned in children when lactation
+is protracted to a very unusual extent,
+but that they occur sometimes, when its duration<span class='pagenum'><a name="Page_49" id="Page_49">[Pg 49]</a></span>
+has been merely a few months beyond
+what I conceive is right. Besides which, we
+shall find that when from any cause whatever
+the nurse's milk becomes impoverished and
+deteriorated, even if this take place at an early
+period after delivery, the injurious effects
+already referred to may be produced in the
+child: for improper food, whether it be bad
+milk or any other inappropriate article of
+diet, is always calculated to derange the
+functions of the stomach, bowels, and other
+chylopoietic viscera, and in consequence to
+occasion disease.</p>
+
+<p>It matters not whether the mother be originally
+unhealthy, and thus her milk possess
+bad qualities; or whether from accidental circumstances,
+or her continuing to give suck
+too long it becomes so: in either case the
+same effect, namely, <i>deteriorated milk</i>, is produced,
+with the concomitant evils to which I
+have alluded. This view of the matter is corroborated
+by Case <span class="smcap">LII.</span>, in which true Meningitis
+attacked a child, aged only nine months,
+who, therefore, was not suckled <i>too long</i>,&mdash;but<span class='pagenum'><a name="Page_50" id="Page_50">[Pg 50]</a></span>
+then the nurse of that child had been
+delivered <i>twenty-one months</i>, having suckled
+another infant previously:&mdash;hence we may
+reasonably conclude that her milk being from
+the beginning deteriorated, and unadapted to
+the age of the child, the ill effects in this case
+were produced at a much earlier period than
+usual.</p>
+
+<p>It will be observed that I have only given
+<i>one</i> instance of this latter description; but,
+on considering how very rare it must be to
+find any mother capable of abandoning her
+newly-born infant to the breast of a woman
+who has already suckled another child one
+year, any surprise that might be felt at the
+circumstance will, I am sure, immediately
+cease. It must also be noticed that only
+among the lowest grades of society do we find
+women so long after delivery performing the
+office of wet-nurse at all, and those who entrust
+their infants to the latter are often so
+peculiarly situated as to feel no interest whatever
+in the preservation of their offspring:
+indeed I cannot but suspect that, among such,<span class='pagenum'><a name="Page_51" id="Page_51">[Pg 51]</a></span>
+criminal motives frequently lead to the adoption
+of the unnatural and baneful practice in
+question.</p>
+
+<p>I do not recollect to have seen a case of
+Meningitis from suckling except when this
+process had been <i>protracted</i>, either as respects
+the child or the nurse; though I by no means
+doubt the possibility of its occurrence under
+other circumstances: but I have met with
+numerous instances of other diseases produced
+by the palpable deterioration of the mother's
+or nurse's milk at various periods after delivery;
+in by far the greater number, however,
+of such cases, lactation had been continued
+for an unusual length of time.</p>
+
+<p>Vomiting, griping, and diarrh&#339;a, are so
+common among infants, and arise in general
+from causes apparently so evident, that, unless
+severe or of long duration, they rarely form
+the subject of minute inquiry. Hence these
+complaints are, perhaps, not so often attributed
+to deteriorated milk as they ought to
+be, although the fact of their occasionally
+originating from a morbid condition of this<span class='pagenum'><a name="Page_52" id="Page_52">[Pg 52]</a></span>
+fluid, (and therefore from protracted lactation
+as one cause of the latter effect,) is too well
+established to be questioned. Dr. Underwood
+observes, 'has not every Physician of
+experience seen infants frequently thrown
+into tormina immediately after coming from
+the <i>breast of an unhealthy mother, or one who has
+but little milk</i>?'<a href="#Note_N" class="fnanchor">[N]</a> and Mr. Burns states, that
+if the usual periodical appearance should
+return, 'the milk is liable to disagree with
+the child, and produce vomiting or purging;'
+while Dr. Hamilton expressly mentions that
+diarrh&#339;a is 'not unfrequently <i>occasioned by
+the depraved quality of the nurse's milk</i>.'</p>
+
+<p>The two former authors merely testify to
+the fact of diseases being produced by the
+milk, while the latter more explicitly mentions
+the cause from which they proceed.</p>
+
+<p>Debility, Tabes Mesenterica, and Scrofula,
+may also be traced to the same origin, as
+every practitioner of experience must have
+repeatedly observed: so may that intractable
+disease, termed Rickets; and it is worthy of
+notice, that among the worst instances of this<span class='pagenum'><a name="Page_53" id="Page_53">[Pg 53]</a></span>
+malady I have seen, were two sisters, <i>who had
+been suckled for a very unusual period</i>. Neither
+do I doubt the probability of Epilepsy being
+similarly occasioned; and although, I must
+candidly own, I cannot produce numerous
+cases in proof of the correctness of such
+hypothesis, yet I recollect that of a girl
+affected with this complaint, respecting whom
+the mother stated (and I recorded the fact at
+the time) that she had been '<i>suckled for two
+years</i>;' and, to use her own expression, had
+'never been well since.'<a href="#Note_O" class="fnanchor">[O]</a></p>
+
+<p>Convulsions arising from protracted suckling,
+or simply from the nurse's milk becoming
+deteriorated at any period, are very common,
+and I have kept notes of many such cases
+that have occurred in the course of my own
+practice; which, however, I abstain from
+here inserting, being anxious to prevent the
+present publication from swelling into a volume.
+Indeed, the occurrence of convulsions
+from this cause (diseased milk) has been mentioned
+by several of the best authors. Mr.
+North, in particular, (whose excellent work<span class='pagenum'><a name="Page_54" id="Page_54">[Pg 54]</a></span>
+on Convulsions should be in the hands of
+every practitioner) observes&mdash;'It cannot be
+doubted that children suffer, that their health
+is destroyed, and the foundation laid for convulsive
+diseases, by <i>sucking unhealthy nurses</i>.'
+'A predisposition to convulsive affections in
+children may be originally produced in consequence
+of their being suckled by a nurse
+addicted to the frequent use of spirituous
+liquors. In several instances I have known
+children rapidly recover their health when
+the nurse was changed, who had exhibited
+most of the premonitory symptoms of convulsions
+while they were suckled by a woman
+who indulged in the common vice of gin-drinking.'
+And Mr. Burns also makes the
+following remark&mdash;'Violent passions of the
+mind affect the milk still more;&mdash;it often
+becomes thin and yellowish, and <i>causes</i> colic,
+or even <i>fits</i>.' It is needless, however, to say
+more on this topic, since it is one which no
+longer admits of discussion.</p>
+
+<p>The reader may now, perhaps, expect that
+I shall introduce a series of practical deductions<span class='pagenum'><a name="Page_55" id="Page_55">[Pg 55]</a></span>
+from the foregoing facts and observations;
+but such is not my object upon the
+present occasion. I merely wish to call the
+attention of practitioners and the public to
+the subject of these pages, and shall thus
+discharge, as I conceive, an imperative duty
+to society. Having mentioned what I am induced
+to consider a frequent cause of inflammation
+of the investing membranes of the
+brain in children, my undertaking is completed.
+The Profession does not require, and
+the public would not be benefited, by the
+addition of lengthened therapeutical rules;
+for I am convinced, there is not a greater
+imposition to be found than the doctrine that
+non-medical persons can treat diseases with
+success by means of popular systems of medicine,
+'<i>practical</i>' treatises, &amp;c. Such books
+have often done irreparable mischief&mdash;certainly
+much more harm than good; and so
+far from injuring the profits of medical practitioners
+(as some appear to suppose), have
+greatly added to the number of their patients.</p>
+
+<p>I avail myself also of this opportunity to<span class='pagenum'><a name="Page_56" id="Page_56">[Pg 56]</a></span>
+enter my protest against the ill-judged and
+mischievous practice of those patients who
+confide upon many occasions in the opinion
+of their nurse, rather than that of their medical
+attendant, and who, in consequence, often
+injure themselves essentially by deceiving the
+latter. With respect to this mistaken preference,
+Dr. Dewes has well observed&mdash;'Let
+it not be hastily assumed that there is more
+safety in following the directions of a nurse
+than those of the physician, because she may
+have had some experience; for it must be
+quickly perceived that the calculation is
+much in favour of the latter, since the nurse
+can attend but twelve patients per annum,
+while the physician may visit many hundreds
+in the same period&mdash;besides, his knowledge
+of the laws of the human system gives him
+a very decided superiority.'</p>
+
+<p>In conclusion, it is right to observe, that
+protracted suckling being a custom much
+more prevalent among females of the lower
+orders than those of a superior rank, it must
+follow as a necessary consequence, that<span class='pagenum'><a name="Page_57" id="Page_57">[Pg 57]</a></span>
+<i>Meningitis, and other disorders resulting from this
+cause, are proportionably less frequent in private
+than in public practice</i>. This remark, it is evident,
+should be remembered, in order to
+obviate apparent discrepancies which otherwise
+might appear irreconcilable with the
+opinions I have expressed. In the truth of
+those opinions I feel the most perfect confidence,
+and cannot but hope that their promulgation
+will hereafter prove extensively
+beneficial, since precautionary, and even
+therapeutical measures may be founded upon
+them, which, if uniformly adopted, will not
+only prevent much ill-health and suffering to
+mothers, but will also afford the means of
+saving many children from perishing by one
+of the most painful and fatal diseases to which
+they are subject.</p>
+
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_59" id="Page_59">[Pg 59]</a></span></p>
+<h2><a name="POSTSCRIPT" id="POSTSCRIPT"></a>POSTSCRIPT.</h2>
+
+
+<p>Being anxious to obtain additional evidence
+with respect to the production of Meningitis
+in children by protracted suckling, rather
+from the experience of others than my own,
+I shall feel greatly obliged to any practitioners
+who will favour me (free of postage)
+with either facts or cases tending to corroborate
+the truth of the doctrine contained in
+the preceding pages; and should I be enabled
+publicly to avail myself of such communications,
+it is, perhaps, unnecessary to
+say, I shall not neglect the opportunity of
+expressing my acknowledgments to their
+respective authors. The intelligence and
+liberality characterising the members of the
+medical profession generally, preclude all
+apprehension on my part that the above
+appeal will be made in vain.</p>
+
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_61" id="Page_61">[Pg 61]</a></span></p>
+<h2><a name="NOTES" id="NOTES"></a>NOTES</h2>
+
+
+<h3 class="moretop"><a name="Note_A" id="Note_A"></a>Note A (page <a href="#Page_1">1</a>).</h3>
+
+<p>A dark-green substance of variable consistence, contained
+in the bowels of infants at birth.</p>
+
+<h3 class="moretop"><a name="Note_B" id="Note_B"></a>B (page <a href="#Page_4">4</a>).</h3>
+
+<p>I beg leave to observe that I make these statements
+with some confidence as the result of personal inquiries
+instituted a few years ago among the patients of two of
+the Lying-in Establishments of this metropolis.</p>
+
+<h3 class="moretop"><a name="Note_C" id="Note_C"></a>C (page <a href="#Page_8">8</a>).</h3>
+
+<p>Since the above was written, a friend who lectures on
+Chemistry in the metropolis has kindly promised me his
+valuable assistance in making the experiments here suggested.</p>
+
+<h3><a name="Note_D" id="Note_D"></a>D (page <a href="#Page_10">10</a>).</h3>
+
+<p>In two cases where suckling was protracted to <i>three
+years</i>, the subjects of this baneful practice did not equal
+in size an ordinary child of half their age. One of them
+became idiotic, and afterwards died of Hydrencephalus,
+under my care; the other was affected with Tabes Mesenterica,&mdash;the
+result I did not witness&mdash;but believe the
+disease terminated fatally.</p>
+
+<h3 class="moretop"><a name="Note_E" id="Note_E"></a>E (page <a href="#Page_25">25</a>).</h3>
+
+<p>Vide Medical and Physical Journal for August 1827.<span class='pagenum'><a name="Page_62" id="Page_62">[Pg 62]</a></span></p>
+
+<h3 class="moretop"><a name="Note_F" id="Note_F"></a>F (page <a href="#Page_25">25</a>).</h3>
+
+<p>That is, any period beyond nine or ten months.</p>
+
+<h3 class="moretop"><a name="Note_G" id="Note_G"></a>G (page <a href="#Page_25">25</a>).</h3>
+
+<p><i>Meningitis</i>,&mdash;I use this term as being more pathologically
+correct than <i>Cephalitis</i>, which I formerly adopted.</p>
+
+<h3 class="moretop"><a name="Note_H" id="Note_H"></a>H (page <a href="#Page_26">26</a>).</h3>
+
+<p>See the above conditional sense in which I employ
+this term.</p>
+
+<h3 class="moretop"><a name="Note_I" id="Note_I"></a>I (page <a href="#Page_26">26</a>).</h3>
+
+<p>It is a curious fact, which I believe has not been noticed
+by any other writer, that female children labouring under
+attacks of Meningitis are sometimes affected with leucorrh&#339;al
+discharges. I have met with several cases of
+this description: the children also of women subject to
+leucorrh&#339;a will often, at an early age, be found affected
+with the same disease. Hence it would appear that leucorrh&#339;a
+is occasionally hereditary.</p>
+
+<h3 class="moretop"><a name="Note_K" id="Note_K"></a>K (page <a href="#Page_37">37</a>).</h3>
+
+<p>It is unquestionable, notwithstanding the scepticism of
+some practitioners on the subject, (whose opinions are
+entitled to deference,) that <i>recovery may take place,
+under appropriate treatment, in cases of Meningitis, even
+after effusion has unequivocally occurred</i>. Preceding
+authors have noticed this fact, which I can confirm by my
+own experience. Practitioners cannot be too frequently
+reminded of it, and warned not to despair of success even
+in the last stage of Hydrencephalus.<span class='pagenum'><a name="Page_63" id="Page_63">[Pg 63]</a></span></p>
+
+<h3 class="moretop"><a name="Note_L" id="Note_L"></a>L (page <a href="#Page_42">42</a>).</h3>
+
+<p>For the information of the <i>unprofessional</i> reader, I beg
+to observe, that the membranes of the brain are <i>serous
+membranes</i>.</p>
+
+<h3 class="moretop"><a name="Note_M" id="Note_M"></a>M (page <a href="#Page_48">48</a>).</h3>
+
+<p>It will be observed hereafter, that Mr. North has
+experienced similar beneficial effects from the course
+above recommended, in cases where <i>convulsions</i> have
+been caused by <i>diseased milk</i>;&mdash;a strong corroborative
+coincidence.</p>
+
+<h3 class="moretop"><a name="Note_N" id="Note_N"></a>N (page <a href="#Page_52">52</a>).</h3>
+
+<p>I believe that where the milk is greatly diminished in
+quantity, it will also be found deteriorated in quality.</p>
+
+<h3 class="moretop"><a name="Note_O" id="Note_O"></a>O (page <a href="#Page_53">53</a>).</h3>
+
+<p>In the communication above referred to from Mr.
+Griffith is the following:&mdash;'Mrs. A. has a family of four
+children, all of whom she suckled for a period varying
+from <i>seventeen</i> to <i>twenty-two months</i>:&mdash;<i>not one of the
+four is healthy</i>.'</p>
+
+
+
+<hr style="width: 65%;" />
+<p class="title">BY THE SAME AUTHOR,</p>
+
+
+
+<div class="figcenter" style="width:55%;">
+<p class="center">Preparing for publication, in one small volume, 8vo.</p>
+<p><big>OUTLINES of INFANTILE SEMEIOLOGY; or, an</big><br />
+Arrangement of the Principal Symptoms of DISEASE in INFANTS<br />
+and CHILDREN, with the best modes of detecting them;&mdash;interspersed<br />
+with Practical Observations, and intended as a clinical guide to Students,<br />
+&amp;c. &amp;c.</p></div>
+
+<p>&nbsp;</p>
+<div class="figcenter" style="width:55%;">
+<p class="center">Also, in 2 vols. 8vo.</p>
+
+<p><big>The EIGHT BOOKS of ARET&AElig;US of CAPPADOCIA</big><br />
+on the Causes, Symptoms, and Treatment of ACUTE and CHRONIC<br />
+DISEASES. Translated literally from the original Greek, and supplied<br />
+with critical and explanatory Notes, Tables of the Weights and Measures,<br />
+&amp;c. &amp;c.</p></div>
+
+<p>&nbsp;</p>
+<div class="figcenter" style="width:55%;">
+<p class="center">By the same Author,<br />
+
+Recently published by Longman and Co. in 8vo., boards, price 14<i>s.</i></p>
+
+<p><big>TRAVELS IN RUSSIA, and a RESIDENCE at ST.</big><br />
+PETERSBURGH and ODESSA in the Years 1827-29;&mdash;intended to<br />
+give some account of Russia as it is, and not as it is represented to be.</p>
+</div>
+
+<hr style="width: 20%;" />
+
+<p class="title"><small><small>Printed by <span class="smcap">W. Clowes</span>, Stamford-street.</small></small></p>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
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+</pre>
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+</body>
+</html>
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+Project Gutenberg's Remarks on the Subject of Lactation, by Edward Morton
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: Remarks on the Subject of Lactation
+
+Author: Edward Morton
+
+Release Date: August 16, 2007 [EBook #22344]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK LACTATION ***
+
+
+
+
+Produced by Bryan Ness, Stephen Blundell and the Online
+Distributed Proofreading Team at http://www.pgdp.net (This
+book was produced from scanned images of public domain
+material from the Google Print project.)
+
+
+
+
+
+
+
+
+
+                      REMARKS ON THE SUBJECT OF
+
+                            LACTATION,
+
+                              &c. &c.
+
+
+
+
+
+                              REMARKS
+
+                         ON THE SUBJECT OF
+
+                             LACTATION;
+
+                             CONTAINING
+
+                            OBSERVATIONS
+
+                               ON THE
+
+        HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK;
+                 THE DISORDERS FREQUENTLY PRODUCED
+                      IN MOTHERS BY SUCKLING;
+
+                                AND
+
+                    NUMEROUS ILLUSTRATIVE CASES;
+
+           PROVING THAT, WHEN PROTRACTED, IT IS A COMMON
+                       CAUSE, IN CHILDREN, OF
+
+               HYDRENCEPHALUS, OR WATER IN THE BRAIN,
+
+                                AND
+
+                     OTHER SERIOUS COMPLAINTS.
+
+
+                                 BY
+
+                    EDWARD MORTON, M.D. CANTAB.
+
+FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY
+       COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS,
+         LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY,
+                   AND TO THE ROYAL METROPOLITAN
+                  INFIRMARY FOR CHILDREN, &c. &c.
+
+
+                              LONDON:
+
+               LONGMAN, REES, ORME, BROWN, AND GREEN,
+                          PATERNOSTER-ROW.
+
+                             MDCCCXXXI.
+
+
+
+
+LONDON:
+PRINTED BY WILLIAM CLOWES,
+STAMFORD STREET.
+
+
+
+
+TO
+
+SIR HENRY HALFORD, BART., M.D., F.R.S., F.A.S.,
+
+PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON,
+PHYSICIAN TO THE KING, &c. &c.
+
+THE FOLLOWING PAGES
+
+ARE,
+
+WITH HIS PERMISSION,
+
+AND WITH
+
+A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIR
+AUTHOR, MOST RESPECTFULLY
+
+DEDICATED.
+
+
+
+
+PREFACE.
+
+
+Several cases which I witnessed led me to believe, some years ago, that
+inflammation of the brain, or its membranes, might be produced in
+children, owing to their being suckled for an undue length of time.
+Since that period, having enjoyed opportunities of observing infantile
+diseases on a much more extended scale, and my attention being expressly
+directed to the point in question, I not only became fully convinced of
+the correctness of my previous conclusions, but was induced to carry
+them still farther.
+
+My opinions on this subject were briefly drawn up and published in the
+_Medical and Physical Journal_ for August 1827, and have not passed
+altogether unnoticed by my professional brethren[1], some of whom have
+done me the honour to speak of them in flattering terms, while no one, I
+believe, has attempted to disprove the existence of the important fact I
+was the first to announce.
+
+[1] Vide Medico-Chirurgical Review, Gazette of Health, Dendy on
+Cutaneous Diseases, &c.
+
+The bare statement of that fact was, indeed, nearly all that my
+approaching departure from England, at the time last mentioned, left in
+my power: upon the present occasion I have offered arguments for, and
+endeavoured to anticipate those against, the deductions I then made
+public; and however imperfect may have been my success in either, the
+welfare of society at large is too deeply involved in the establishment
+of my opinions with respect to the custom I condemn, (if those opinions
+be correct,) for me to hesitate while again committing them to the press
+in a more extended form.
+
+These considerations, I respectfully submit, will render any apology for
+the appearance of the following pages unnecessary, and will, I trust,
+secure for them a candid and favourable reception from the Profession
+and the Public.
+
+_15, Eaton Street, Grosvenor Place,
+          October 8, 1831._
+
+
+
+
+CONTENTS.
+
+
+                          CHAPTER I.
+                                                          Page
+Of the Breast-Milk, &c. &c.                                  1
+
+
+                         CHAPTER II.
+
+On Lactation, and the Disorders frequently produced in
+Women by that process                                       14
+
+
+                         CHAPTER III.
+
+On the various Diseases which arise in Children from
+Lactation, especially when protracted                       24
+
+
+Postscript                                                  59
+
+Notes                                                       61
+
+
+
+
+ERRATA.
+
+
+Page 10, line 3, _for_ two _read_ a few.
+
+  "  52,  "  19, dele comma between the words Tabes and Mesenterica.
+
+
+Transcriber's Note: The above corrections have been applied to this
+text, in addition _headach_ has been corrected to _headache_ on page
+18, line 11. Throughout the text the oe ligature has been represented as
+[oe].
+
+
+
+
+CHAPTER I.
+
+_Of the Breast-Milk, &c. &c._
+
+
+No sooner has the child been ushered into the world than the breasts of
+the mother pour forth their milk for its sustenance. This bland fluid is
+secreted from the blood, and varies, in quality and quantity, according
+to the time which has elapsed from delivery, being peculiarly and
+wonderfully adapted at every period to the wants of the individual for
+whose use it is destined. Thus, that first secreted, called _colostrum_,
+possesses a purgative quality evidently intended by the all-wise Author
+of our being for the purpose of removing _the meconium_[A],--a process
+which experience has sufficiently proved to be necessary for the welfare
+of the newly-born infant. Afterwards, ceasing to possess this aperient
+property, it is calculated solely for affording nutrition; and finally,
+at a certain period from delivery, it gradually becomes impoverished,
+loses its former healthy qualities altogether, and acquires others which
+are injurious to life. This important change, as above noticed,
+generally happens at a certain period after delivery; varying, however,
+somewhat in particular women, and in the same female on different
+occasions: but, from disease, or other circumstances, the milk may
+become deteriorated before the time to which reference has just been
+made. If, for instance, the mother labour under any serious disorder, it
+is universally admitted that her milk may also become unhealthy; and
+this may take place even a short interval after delivery.
+
+Although we cannot explain how the brain and nerves act, and probably
+never shall be able to do so, yet we are well aware that their influence
+is absolutely requisite for the healthy performance of every function in
+the human body.
+
+That mental inquietude will impede digestion is a fact familiar to
+almost every one; but, I believe, it is not so generally known, that it
+will with no less certainty retard and alter the nature of the secretion
+furnished by the breasts of the lactescent female. Violent affections of
+the mind will cause the milk to become thin and yellowish, and to
+acquire noxious properties: even the fond mother's anxiety, while
+hanging over the couch of her sick infant, will be sufficient to render
+it unfit for the sustenance of the object of her solicitude.
+
+The state also of the stomach and bowels and the diet of the nurse
+materially and constantly influence the nature of the lacteal secretion.
+
+The milk, besides, is liable to deterioration from another cause,
+namely, the recurrence of the usual periodical appearance--for should
+this take place in a nurse, it is agreed that her milk is liable to
+produce disorders in the child who imbibes it; which could not happen,
+if the former possessed its ordinary component parts, and retained its
+natural properties.
+
+The recurrence, moreover, of pregnancy in the lactescent female may
+render the milk of a bad quality, and will invariably lessen its
+quantity. Mr. Burns asserts that in these cases the milk 'does not
+become hurtful,' but in this opinion I must beg leave to differ from
+him; since I have repeatedly seen it, from this cause, palpably altered
+in appearance, and have observed diarrh[oe]a and great debility produced
+in the children who were suckled with it.
+
+An almost universally received opinion among females, and, indeed, one
+very frequently entertained by members of the medical profession, is,
+that while a woman continues to nurse her infant she will not again
+become pregnant; but this, as a general proposition, is unquestionably
+erroneous; it is even doubtful whether such opinion will hold good in a
+majority of instances. The continuance of lactation will very generally,
+it is true, tend to prevent the recurrence of the periodical phenomenon;
+yet, nevertheless, it will not in every instance prevent pregnancy[B].
+Should, however, a woman with an infant at the breast again become
+pregnant, (a circumstance that very frequently occurs, and of which,
+from the _general though not invariable_ absence of those criteria by
+which this fact is accustomed to be recognised, she is not aware until
+it has made some progress,) one of two things will usually take place;
+either she will miscarry, or her milk will become impoverished in
+quality and diminished in quantity. Nor is this wonderful:--it was not
+intended by Nature that the processes of pregnancy and lactation should
+go on simultaneously, but, on the contrary, that the one should commence
+when the other had terminated; and experience sufficiently proves that
+they will not proceed well together: the reason of which, as it appears
+to me, may be easily given. During pregnancy, and particularly during
+its latter periods, the vessels of the womb gradually enlarge, and a
+much greater quantity of blood than usual is determined to that organ
+for the increase and perfection of the embryo and its appendages; which,
+after delivery, becomes transferred to the breasts to supply the
+material for the secretion of the milk: but if, during pregnancy,
+lactation be also persevered in, the blood becomes directed at the same
+time to two different parts of the body, somewhat remote from each
+other, namely, to the womb, and to the breasts; hence, neither is likely
+to receive its due proportion of this vital fluid, and, consequently,
+the functions of one or the other, or both, are liable to become impeded
+or suspended. If the breasts continue to receive a sufficient quantity
+of blood, the secretion of milk goes on properly, but the womb is
+deprived of its necessary supply; the embryo, in consequence, languishes
+and dies, and, becoming an extraneous body, is thrown off, producing
+abortion; while, on the other hand, should the womb still obtain its due
+proportion of blood, the breasts are robbed of it, and the secretion of
+milk, if not altogether suppressed, is rendered either deficient in
+quantity or deteriorated in quality.
+
+Finally, the breast-milk may become depraved and injurious by the
+process of lactation being continued too long, a practice which is,
+unfortunately, in this, as well as other countries, extensively
+prevalent.
+
+I have not yet had an opportunity of examining the breast-milk in these
+diseased conditions except by the eye, and that rarely--but even this
+slight examination has enabled me to state, that it was greatly altered
+from its natural condition;--that it was more fluid than usual, and
+changed in colour, resembling a yellowish turbid serum, instead of
+displaying its well-known bluish hue.
+
+I propose in future to attend carefully to this subject, and I would beg
+leave to recommend it as one well worthy the notice of those members of
+our profession who have made animal chemistry a particular study, having
+no doubt that they would be able, by a series of accurate experiments
+upon the breast-milk at different periods after delivery, and under
+various conditions of the mother, to collect many interesting and
+important facts--such, perhaps, as would tend very materially to augment
+our knowledge of pathology, and improve our practice in the treatment
+of certain diseases[C].
+
+We cannot but believe that the Supreme Being has done nothing without an
+infinitely wise and good object, and it is obviously our interest, no
+less than our duty, to be guided by those indications of the Divine
+purpose which are distinctly to be traced throughout the creation.
+
+It must appear evident to all who examine the matter in question, that
+the infant was intended to be nourished for the first few months of its
+existence through the medium of a fluid; because no teeth are provided
+to prepare for its use substances of a more solid description; and there
+can be no doubt that this fluid is the mother's milk;--but when the
+child has attained a certain age the teeth begin to appear, doubtless at
+the precise time when they are meant to be used; and, therefore, more
+solid food should now be given. Besides, in consequence of its new
+acquisition, the child sucks less perfectly than before, an additional
+proof that weaning ought at this period to be commenced. Indeed, the
+teeth are calculated indirectly to produce this effect themselves, the
+mother being now liable to suffer inconvenience by letting the child
+take the breast--for the latter _bites_ instead of _sucking_ the nipple,
+and the pain hence arising may, perhaps, induce the former, for her own
+sake, to discontinue a practice injurious to both.
+
+It must also be remembered, that when the teeth are usually produced,
+the milk loses its nutritious properties, and this too at a time when
+the infant from his increasing size must evidently require a more solid
+and substantial, rather than a thinner and less nourishing diet. What
+rational argument, therefore, can be offered why he should still be
+suckled? If we observe the brute creation, do any analogies appear by
+which we can defend the propriety in the human species of protracted
+suckling? by no means:--on the contrary, we find that the female animals
+soon drive away their young from their dugs; and what is, perhaps, still
+more to the purpose, I have heard stated, on good authority, as a
+well-known fact among the breeders of cattle, that if calves be allowed
+to suck beyond a few months they do not thrive, but, on the contrary,
+become lean and diseased.
+
+The belief so generally prevailing, that the longer a child is suckled
+the stronger it will become, is a prejudice, like many others concerning
+women and children, which has been handed down from mother to daughter
+for ages, and has thereby become so universally entertained and so
+deeply rooted in the minds of females, that even medical men scarcely
+venture to question its propriety. My own experience, however, compels
+me to declare, that there is not a more erroneous or mischievous
+doctrine; and I can most truly affirm, that I never yet witnessed an
+instance where protracted lactation had produced any good effect[D],
+though I have seen numerous examples (some of which will be introduced
+hereafter) where, I believe, it had been the indirect cause of death.
+
+Having thus strongly noticed the impropriety of long continued
+suckling, it will, perhaps, be proper to state my opinion as to the
+period when this process should terminate. As a general rule, at nine
+months after birth the child ought to be entirely weaned; and in no
+instance should he be permitted to suck more than ten. In many cases
+suckling may be relinquished with advantage (and occasionally it is
+absolutely necessary to discontinue it) before the time first above
+mentioned; in others, however, it may be protracted beyond it.
+
+I by no means recommend the breast-milk to be at once superseded by
+artificial food, but, on the contrary, that the child should be
+_gradually_ accustomed to such aliment from a much earlier period; the
+proportion of the latter being increased by degrees, while the
+breast-milk is diminished in a corresponding ratio. Hence we shall
+produce a double advantage; the mother will be benefited as well as the
+child--the former, by giving suck less frequently, and in smaller
+quantities at a time than usual, will have the secretion of milk
+_gradually lessened_, and, therefore all likelihood of inconvenience, as
+far as regards herself when the child is entirely weaned, will be
+completely prevented; while, on the other hand, the child being
+_insensibly estranged_ from the breast, will have become accustomed to
+his new food, so that there will be less chance of its disagreeing with
+him when it forms his sole support; and thus the danger which is
+generally apprehended from weaning will be either materially lessened or
+altogether avoided.
+
+The difficulty of bringing up infants by hand, as it is termed, is well
+known; but I suspect that the great mortality which has been recorded as
+occurring from this source is not inseparable from the practice itself,
+but arises mainly from the improper manner in which it is usually
+conducted. When it is determined to bring up an infant by hand, the
+substitute offered for the mother's milk should as nearly as possible
+resemble that fluid; and the child should be constrained to imbibe it in
+_the same manner as_ it would _the milk from the maternal breast_; that
+is, it should be _sucked_ from a bottle contrived for that purpose,
+instead of the child being gorged with it, by means of a large spoon, or
+some other equally improper instrument, as is the usual custom. It is a
+fact too palpable to be questioned, that the food generally given to
+infants brought up by hand is not only administered in an improper
+manner, but is also of an improper quality; their tender stomachs are
+daily overloaded with _solid_ instead of _liquid_ aliment, and hence
+arises the numerous train of evils which, in my opinion, produce the
+great mortality just referred to.
+
+
+
+
+CHAPTER II.
+
+_On Lactation, and the Disorders frequently produced in Women by that
+process._
+
+
+There can be no doubt that, speaking generally, a mother is bound to
+suckle her children, and that the performance of this duty is no less
+conducive to her own health than to the moral and physical welfare of
+her offspring; yet there is not a more unfounded doctrine than that
+which presumes every woman who is willing to be also capable of
+advantageously discharging the important office of a nurse.
+
+If the mother enjoy good health, and the process be not continued too
+long, it is likely to produce beneficial effects both in herself and her
+infant; but if she be of a very delicate habit--labour under any
+dangerous disease--be subject during the period of lactation to great
+affliction, or constant mental inquietude--or should the periodical
+appearance return, pregnancy occur, or suckling be continued too long,
+it may not only prove highly detrimental to herself, but may be the
+means of occasioning serious or fatal consequences to her child.
+
+In cases of extreme delicacy of constitution, lactation will often
+produce the worst effects. Many young ladies, on becoming mothers, are
+incapable of supporting the constant drain to which the wants of their
+infants subject them--they lose their good looks, become gradually
+weaker, and as their strength declines, their milk is simultaneously
+lessened in quantity, and altered in its other properties.
+
+If the suckling be still continued, their debility daily increases,
+distressing pains in the back and loins succeed; the patients become
+exceedingly nervous, as it is termed, and are unusually susceptible of
+ordinary impressions; pain in the head, often of great violence,
+follows, which, in some cases, is succeeded by delirium, in others, by
+absolute mania. Nor is this the whole catalogue of ills to which
+in such cases the unfortunate mother is subjected: the appetite
+fails, distressing languor is experienced by day, while copious
+perspirations deluge her by night, and dissipate the last remains of
+strength--producing a state which may easily be mistaken for, or
+terminate in, true pulmonary consumption;--finally, the sight becomes
+progressively weaker, until vision is almost destroyed; the eyelids
+exude a glutinous secretion, and ophthalmia itself is occasionally
+induced.
+
+These are the symptoms too often caused by lactation in delicate or
+debilitated habits, even a few months after delivery; the same also are
+observed when suckling has been injudiciously protracted beyond the
+period to which it should be confined.
+
+A few only of the foregoing symptoms may be noticed, or nearly the whole
+may present themselves, in the same patient; and when this happens,
+unless the cause which has given rise to them be at once detected, and
+appropriate treatment employed, the most serious consequences may be
+apprehended.
+
+In these cases, the first step necessary is to discontinue the suckling
+altogether: half measures will never answer. Sometimes it is proposed by
+the patient, or her friends (more usually the latter), to compromise the
+affair by feeding the child partly on spoon meat, and allowing him still
+to take the breast, though less frequently than before.
+
+This plan I uniformly object to, for the following reasons:--
+
+1st. Because the mother will not be likely to recover so long as she
+continues to suckle at all.
+
+2nd. Because her milk being necessarily of a bad quality, it cannot be
+expected that the child will derive benefit from it; but, on the
+contrary, there is every probability that his health will suffer by
+using diet of such an improper description.
+
+The obvious dependence of the foregoing symptoms upon debility will, of
+course, at once suggest to practitioners the nature of the treatment to
+be adopted: which should be such as is calculated to invigorate the
+system generally--namely, the administration of tonics, &c.
+
+Bark and its various preparations, especially the sulphate of quinine,
+with the occasional use of warm aperients (sedulously avoiding the more
+violent purgatives), will be found eminently successful; whereas,
+cupping at the nape of the neck (which I have seen prescribed for the
+headache), and other depletory measures, have proved as manifestly
+injurious.
+
+'Every disease productive of great weakness is increased by the state of
+the system which follows child-bearing. Of this description are
+consumption, dropsy,' &c. In these cases it is evident that the process
+of lactation, by adding to the debility already present, must prove
+highly injurious, and consequently should be always avoided.
+
+I have already noticed the effects which are produced upon the milk by
+the influence of mental emotions on the part of the mother, as well as
+by the recurrence of the periodical appearance; and since these are
+chiefly injurious to the child, by depraving its sustenance, their
+further consideration will be deferred till the next chapter.
+
+With respect to the remaining topic--namely, the occurrence of
+miscarriage from suckling--I am convinced that it is by no means an
+unfrequent accident, though its real cause is perhaps rarely suspected,
+having only met with one patient who considered the mishap in question
+to have arisen from keeping her child too long at the breast. Having
+already, I trust satisfactorily, explained the manner in which abortion
+is produced by the act of suckling, I shall conclude this part of my
+subject with the relation of a case that occurred in private practice,
+which so strongly corroborates many of the observations in the preceding
+and following pages, that I shall offer no apology for its introduction:
+more particularly, since the lady herself to whom it refers has
+benevolently expressed a wish for its publication, in order that those
+who become acquainted with the facts there detailed may be prevented
+from undergoing similar unnecessary sufferings:--
+
+
+CASE.
+
+Mrs. A----, a lady of delicate constitution, about twenty years of age,
+three or four months subsequent to the birth of her first child, began
+to find her milk gradually lessen in quantity; it had also much changed
+from its previous appearance, resembling at the time just stated, a
+yellowish, turbid serum. Her child became emaciated; and diarrh[oe]a
+supervening, my professional services were required. My advice was, that
+the child should be at once weaned, and a suitable wet-nurse, if
+possible, procured--neither of which suggestions, as will shortly
+appear, were followed. I urged the necessity of this measure more
+particularly, because Mrs. A---- was daily getting thinner and weaker;
+she also complained of great pain in the head and back, and of an
+increasing dimness of sight, which made her fear she should become
+blind; but the mother-in-law of my patient being, unfortunately, of
+opinion that pregnancy in the latter would not again occur during the
+continuance of lactation, recommended that the child, although chiefly
+supported upon spoon-meat, should occasionally be allowed to take the
+breast; and this plan, notwithstanding the wish of Mrs. A---- to the
+contrary, and my own remonstrances on the subject, was adopted--the
+effects of which were to increase the mother's ailments, as well as
+those of her infant. Things went on thus for some time longer, when I
+once more endeavoured to persuade Mrs. A---- to follow my advice,
+observing, that by an opposite line of conduct she was not only injuring
+her own health, but that of her child, neither of which, I assured her,
+in my opinion, would be re-established till the latter had been weaned.
+I expressed also my complete incredulity as to the non-recurrence of
+pregnancy in consequence of her infant remaining at the breast; and I
+added--'It is my firm conviction that if you be pregnant, or should
+happen shortly to become so, you will miscarry.' About a week after
+this conversation she was suddenly seized with flooding, and what I had
+predicted took place. She now left off suckling, and in about a month,
+under suitable treatment, completely got rid of all her former
+complaints: the child also immediately began to improve.
+
+The present case clearly proves that the process of lactation will not
+_invariably_ prevent the occurrence of pregnancy, since Mrs. A---- became
+in this state, notwithstanding she continued to suckle her child: and I
+think few will be so hardy as to doubt that it was the cause of her
+miscarrying: more particularly when I mention that, at a future period,
+the same lady, during my absence abroad, being once more persuaded to
+try whether she could not avoid becoming pregnant (which was very much
+to be desired, on account of her delicate state of health) by continuing
+to perform the duties of a nurse, again suffered all the distressing
+symptoms before described, and again miscarried.
+
+This case, finally, affords evidence of the evil consequences often
+produced in children by impoverished and unhealthy milk; and of their
+speedy disappearance when the exciting cause--namely, deteriorated
+milk--is no longer afforded.
+
+
+
+
+CHAPTER III.
+
+_On the various Diseases which frequently arise in Children from
+Lactation, especially when protracted._
+
+
+Having thus briefly considered some of the disorders to which women are
+subjected by performing the first duty imposed upon them as mothers, I
+shall next advert to those which are very frequently observed in their
+children from being suckled during too long a period; or in consequence
+of the nurse's milk becoming either simply impoverished, or of a
+positively injurious quality.
+
+These diseases are numerous, and some of them serious, among which may
+be enumerated the following; namely, vomiting, diarrh[oe]a, general
+debility, scrofula, tabes mesenterica,--rickets, convulsions,
+epilepsy,--and lastly meningitis, or that peculiar inflammation of the
+investing membranes of the brain which gives rise to the effusion of
+serum, constituting the well known and very fatal disease termed by
+medical practitioners Hydrocephalus, or Hydrencephalus, and popularly
+Water on the Brain.
+
+The disease last mentioned being by far the most important, and that
+chiefly referred to in the following observations, I shall commence with
+a brief statement of the conclusions which my experience has led me to
+form respecting it; they are the same I made public four years ago[E],
+having since that time seen no reason to make any alteration in them. I
+believe,
+
+1st,--That if children be suckled for an undue length of time[F], they
+will be liable in consequence to be affected with meningitis[G], or
+inflammation of the investing membranes of the brain.
+
+2dly,--That should they not become affected with the disorder in
+question during or soon after the time they are thus improperly suckled,
+they will nevertheless acquire therefrom a predisposition to cephalic
+disease at some future period of their lives.
+
+3dly,--That children who are suckled for an undue length of time, when
+labouring under other diseases, will be much more liable to have the
+head secondarily affected, than children brought up in a different
+manner.
+
+4thly,--And lastly, that the same effects will take place in infants if
+suckled by women who have been delivered an undue[H] length of time;
+although the infants themselves may not have been at the breast for too
+long a period.
+
+       *       *       *       *       *
+
+CASES IN ILLUSTRATION OF THE FOREGOING VIEWS.
+
+
+I.
+
+_Cases of Meningitis[I] supervening upon protracted suckling._
+
+
+CASE I.
+
+---- Wilshire, aged two years seven months, died of '_Water on the
+brain_,'--_suckled twelve months_.
+
+
+CASE II.
+
+---- Park, aged one year ten months, died of '_Water in the
+head_,'--_suckled fourteen months_.
+
+
+CASE III.
+
+Prince V----, aged two years and a few months, died of
+_Hydrencephalus_,--_suckled until his death_. In this case I was
+consulted a short time previously, and recommended the breast-milk to be
+withheld--my advice was not followed.
+
+
+CASE IV.
+
+Emma Lane, aged two years, admitted at the Infirmary for Children for
+_Meningitis_,--_suckled one year and eleven months_.
+
+
+CASE V.
+
+The mother of the preceding suckled another child '_a very long
+period_,' and it died of '_Water on the Brain_.'
+
+
+CASE VI.
+
+Edmund Power, aged two years, _still at the breast_, admitted for
+_Chronic Hydrocephalus_: the head is of great magnitude; fontanelles
+open: superficial veins large and prominent.
+
+
+CASE VII.
+
+Sophia Hamley, aged one year two months, _still at the breast_, admitted
+for _Meningitis_.
+
+
+CASE VIII.
+
+William How, aged one year six months, admitted for
+_Meningitis_,--_suckled thirteen months_.
+
+
+CASE IX.
+
+David Hepburn, aged two years six months, admitted for
+_Meningitis_,--_suckled two years four months_.
+
+
+CASE X.
+
+Samuel Hanks, aged one year nine months, admitted for
+_Meningitis_,--_suckled one year eight months_.
+
+
+CASE XI.
+
+Amelia Hill, aged two years six months, admitted for
+_Meningitis_,--_suckled one year nine months_.
+
+
+CASE XII.
+
+---- Hughes, died of '_Water in the head_,'--_suckled fourteen months_.
+
+
+CASE XIII.
+
+---- Ferreira, aged seventeen months, died of '_Water in the
+head_,'--_suckled until its death_.
+
+For the five following cases I am indebted to the kindness of Mr.
+William Griffith, an intelligent surgeon of Eaton-street, who, having
+some time ago been apprised of my peculiar views, has since directed his
+attention particularly to the subject. They completely confirm my
+opinions, and will have more weight with the public than any additional
+evidence I could adduce from my own practice.
+
+In the letter inclosing these cases, Mr. Griffith writes thus--'from the
+observations I have been enabled to make, I am led to believe that
+disease almost invariably follows protracted suckling. I may add in
+conclusion, that I perfectly concur with the views which you entertain
+on the subject.'
+
+
+CASES XIV. XV.
+
+'---- Jackson, residing at ----, aged two years six months, who had been
+kept _at the breast twenty-two months_, was in a dying state when I was
+requested to see her. The pulse was preternaturally slow--great
+stupor--dilatation of the pupils, and diastasis of the bones of the
+head. In six hours from the time I first saw her she died, and the
+mother was desirous that the head should be examined, having lost a
+child previously, in what she considered a similar manner. On removing
+the scalp I found the cranium very much enlarged and altered in shape.
+Between the tunica arachnoides and pia mater, there was a quantity of
+water effused;--the sides and upper surface of the brain were
+exceedingly soft. In the lateral ventricles there were from six to eight
+ounces of water. In answer to a few questions I asked the mother, she
+stated that her former child was, during the _first ten months_ of its
+life, _a plump, healthy infant_,--_after that period he altered_,--the
+stomach, bowels, and _head became affected_, and, in the course of a few
+months, he manifested similar symptoms to those which proved fatal in
+the case of his sister. He was _suckled for twenty-one months_, and
+_died_ at the age of _twenty-seven months_. The mother of these children
+has one other child alive, and at my urgent request it was weaned at
+_nine months_,--it is now _seventeen months old, and in excellent
+health_.'
+
+
+CASE XVI.
+
+'Mrs. A----, of ----, had a little boy who at _ten months old_ had nine
+teeth, which were cut with little or no difficulty:--_at this time he
+was in good health_,--_he was allowed the breast until nineteen months,
+and at the expiration of three months more, died of Hydrocephalus_.'
+
+
+CASE XVII.
+
+'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at the
+breast seventeen months old_;--the little patient is frequently
+suffering from _cerebral disturbance_. I have repeatedly advised the
+mother to wean it--she objects, and gives the usual reason for allowing
+it to remain at the breast--viz., that she does it to _prevent becoming
+again enceinte_.'
+
+
+CASE XVIII.
+
+'This day, (August 13, 1831,) a little child labouring under _cerebral
+disease_ was brought to me for advice, and he appeared certainly in a
+most pitiable state; he is _two years four months old_ and is _now at
+the breast_,--I do not think it possible for him to survive many days.'
+
+
+II.
+
+_Cases of Meningitis, arising at an after period, in consequence of
+protracted suckling._
+
+
+CASE XIX.
+
+Francis Page, aged six years, admitted for _Meningitis_,--_suckled one
+year_.
+
+
+CASE XX.
+
+Henry Taylor, aged six years, admitted for _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXI.
+
+Julia Brown, aged three years, admitted for _Meningitis_,--_suckled
+thirteen months_.
+
+
+CASE XXII.
+
+James Neil, aged seven years six months, admitted for
+_Meningitis_,--_suckled fourteen months_.
+
+
+CASE XXIII.
+
+Eliza Park, aged six years, laboured under _Meningitis_,--_suckled
+fourteen months_.
+
+
+CASE XXIV.
+
+Charles Dale, aged five years; admitted for _Meningitis_--_suckled
+thirteen months_.
+
+
+CASE XXV.
+
+Sarah Strickling, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASES XXVI. XXVII. XXVIII.
+
+The mother of the last mentioned child lost three previously, with
+'_water in the head_:'--all these were suckled _more than eighteen
+months_.
+
+
+CASE XXIX.
+
+George Speering, aged four years; admitted for _Meningitis_--_suckled
+one year and six months_.
+
+
+CASE XXX.
+
+Ann Archer, aged seven years; admitted for
+_Hydrocephalus_--died--_suckled three years_.
+
+
+CASE XXXI.
+
+Cornelius Leary, aged six years; admitted for
+_Meningitis_--died--_suckled eighteen months_.
+
+
+CASE XXXII.
+
+Sophia Peverel, aged three years; admitted for _Meningitis_--_suckled
+two years_.
+
+
+CASE XXXIII.
+
+Maria Turley, aged four years; admitted for _Meningitis_--died--_suckled
+one year three months_. This child had laboured under a previous attack,
+from which she recovered under my care.
+
+
+CASE XXXIV.
+
+Robert Selkirk, aged three years six months; admitted for
+_Meningitis_--_suckled thirteen months_.
+
+
+CASE XXXV.
+
+The mother of the preceding child lost another of '_inflammation of the
+brain_.'--This was _suckled more than one year_.
+
+
+CASE XXXVI.
+
+Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled one
+year seven months_.
+
+
+III.
+
+_Cases of Meningitis in Children who had been suckled an undue length of
+time, supervening upon other complaints._
+
+
+CASE XXXVII.
+
+Arthur Lane, aged one year four months; admitted for Pneumonia, with
+_an affection of the head_--_suckled fourteen months_.
+
+
+CASE XXXVIII.
+
+Sarah Ward, aged three years; admitted for Hooping-cough--_head much
+affected_--_suckled one year and ten months_.
+
+
+CASE XXXIX.
+
+Thomas Donovan, aged two years two months; admitted for Hooping-cough,
+with _an affection of the head_--_suckled twelve months_.
+
+
+CASE XL.
+
+Count ---- ----, aged about two years, came under my care, being then at
+the breast. The head was large, fontanelle open--superficial veins more
+apparent than natural. By my advice he was directly weaned, and rapidly
+improved in health and appearance (the only medicine given being
+occasional doses of castor oil). About twelve months afterwards, in
+consequence of an imprudent exposure to cold, he was attacked with
+Bronchitis, and Meningitis supervened. Leeches were applied to the head,
+and other depletory measures actively employed, which were followed by
+recovery.
+
+
+CASE XLI.
+
+---- Sloggat, aged thirteen months, died of _Meningitis_ supervening
+upon Pneumonia--_suckled until the time of its death_.
+
+
+CASE XLII.
+
+John Scott, aged eleven months; admitted for Hooping-cough, with a
+_well-marked affection of the head_--_still at the breast_.
+
+
+CASE XLIII.
+
+---- Scott, aged fifteen months,--died of 'Hooping-cough, with
+convulsions,' _being then at the breast_.
+
+
+CASE XLIV.
+
+Isaac Berwick, aged one year two months, admitted for Hooping-cough,
+_with an affection of the head_--_still at the breast_.
+
+
+CASE XLV.
+
+Frederick Cousins, aged three years four months, brought to me labouring
+under Hooping-cough, with Meningitis, which latter terminated in
+effusion. Calomel was then given every two hours, the stronger mercurial
+ointment rubbed upon the temples, and blisters applied to the head. The
+mercurial influence being established, a profuse discharge of urine
+occurred; the pupils which had previously been _permanently_ dilated,
+became once more obedient to light; sensibility was restored, and great
+weakness appeared to be the only urgent symptom. The cough, however, now
+returned, the head became again affected, and the child sunk. Upon
+opening the head, about four ounces of fluid was found in the
+ventricles[K]. This child was _suckled sixteen months_.
+
+
+CASE XLVI.
+
+Sarah Swann, aged four years six months, admitted for Hooping-cough with
+convulsions,--_suckled one year_.
+
+
+CASE XLVII.
+
+Henry Harris, aged two years three months, admitted for Hooping-cough,
+_with an affection_ of the head,--_suckled one year four months_.
+
+
+CASE XLVIII.
+
+Maria Hughes, aged two years, admitted for _Convulsions_ supervening
+upon Hooping-cough--_suckled one year three months_.
+
+
+CASE XLIX.
+
+Thomas Benson, aged one year six months, admitted for Pneumonia, with
+_well-marked affection of the head_--_suckled one year four months_.
+
+
+CASE L.
+
+Mary Kenner, aged six years, admitted for Hooping-cough, with
+_well-marked affection of the head_--_suckled one year six months_.
+
+
+CASE LI.
+
+John Ennis, aged one year seven months, admitted for Bronchitis, to
+which _a decided affection of the head succeeded_--_suckled one year_.
+
+
+IV.
+
+_Case of Meningitis produced in consequence of the Child being suckled
+from its birth by a Woman who had at that time been delivered one Year._
+
+
+CASE LII.
+
+Ellen Willoughby, aged nine months, admitted for Meningitis; at present
+suckled by a woman who has been _delivered one year and nine months_.
+
+       *       *       *       *       *
+
+With respect to the manner in which protracted lactation causes the
+complaint that forms the subject of these remarks, I formerly was
+undecided; but have now no doubt whatever of its arising _secondarily_
+from derangement in the functions of the abdominal viscera, occasioned
+by the depraved condition of the breast-milk.
+
+It is universally allowed among medical men that irritations in the
+stomach and bowels will, through the agency of particular nerves,
+produce sympathetic irritation in the brain,--that peculiar action
+being thus elicited which terminates in the effusion of serum,
+constituting the disease named Hydrocephalus.--'The continued irritation
+of important or very sensible nerves is, perhaps,' says Mr. Burns, '_one
+of the most common causes_' (of Hydrocephalus); 'hence it may follow
+dentition, and _very often arises from a bad state of the chylopoietic
+viscera_.'
+
+It is also no less generally known that food of a bad quality or
+improper description will produce derangements in the digestive organs.
+Now, having already shewn that the milk when lactation is protracted
+becomes deteriorated, it plainly appears that such milk is capable of
+occasioning derangement of the chylopoietic viscera; and it being
+allowed that derangement of these viscera, from any source, may give
+rise to inflammation of the brain, I conceive it follows that protracted
+lactation must be admitted as one cause of such effect. This train of
+reasoning, therefore, from generally admitted data, seems to _prove that
+Meningitis_, or inflammation of the brain, _in children can be produced
+by their being suckled for too long a period_, and _that it is so
+produced I assert from repeated experience_.
+
+An accidental perusal of Mr. Dendy's able work on the cutaneous diseases
+of children, published shortly after the appearance of my paper before
+referred to in the Medical and Physical Journal, has recently afforded
+me the pleasure of finding that the author had been led to entertain
+similar general views on the subject under discussion with myself; I
+have, therefore, taken the opportunity of adding that gentleman's
+testimony to my own, by quoting the following passage from his work
+above mentioned.
+
+'It may be truly said, that _the infantine disease excited by milk of a
+deleterious, or simply impoverished quality, "grows by what it feeds
+on;"_ and we shall witness the internal debility and the infantine
+disorder running their course together. Tabes is the natural consequence
+of this error; but its effect is evinced by the occurrence of other
+disorders. A defective degree of nutrition, as I have elsewhere stated,
+predisposes the system to become influenced by comparatively slight
+excitement; and thus, in addition to the direct excitement of disease,
+it becomes indirectly its predisposing cause. _Under its influence the
+serous_[L] and mucous _membranes become readily the seat of
+inflammatory action_.'
+
+Those who feel a difficulty in relinquishing old opinions and adopting
+new views upon any particular subject, may perhaps ask how it has
+happened, if inflammation of the brain from protracted suckling be so
+common as the preceding observations and cases would appear to prove,
+that medical men of more advanced age and far greater experience than
+myself have not previously noticed the circumstance. I would observe, in
+reply, that until Harvey pointed out the circulation of the blood, no
+one ever suspected the existence of such a phenomenon; yet now the
+wonder appears to be, not that Harvey made the discovery, but that
+others had not previously done the same. Multitudes, it may be added,
+and among them the great Newton, had witnessed the fall of objects to
+the ground without thinking of the cause which produced their downward
+tendency; the propitious moment, however, arrived--the apple fell, and
+the philosopher was led to those deductions which have rendered his name
+immortal. So is it with observers of every class, from those most
+distinguished by intellectual superiority and its successful
+application, down to the humble writer of the present observations.
+Facts are continually passing before us unnoticed, till, from their
+repeated coincidence, or some accidental impulse, we attempt, and
+finally are enabled, to trace their origin.
+
+Thus, until the possibility of Meningitis originating from protracted
+lactation had been suggested, practitioners were, of course, unable to
+notice the fact--not from its non-occurrence, but because their
+unconsciousness of its existence must necessarily preclude the inquiries
+from which alone its cause could be determined. Hence a practitioner may
+have treated many hundred cases of water on the brain in children,
+without being able to attribute any one of them to protracted suckling;
+yet this is no proof that such cases did not happen, for, had he made
+the requisite inquiries, very probably many among them might have been
+found which had thus arisen.
+
+Another objection that may possibly be made to my views, is, that
+instances might be adduced where lactation had been persevered in for a
+very long period, without any ill effects supervening. That such
+frequently occur, there is no doubt; and with respect to them, I have
+merely to observe, that they do not in the slightest degree invalidate
+the correctness of my conclusions. As well might it be argued, that
+because persons have fallen from a very great height without sustaining
+any injury, or, because poisonous doses of various drugs have sometimes
+been swallowed without death supervening, that, therefore, there is no
+danger in jumping from a precipice, or in taking a virulent poison; or
+that death never occurs from these causes. Such cases, unless far more
+numerous than I imagine them, can only be regarded as exceptions to the
+general rule; and, consequently, do not lessen its authority, there
+being no rule without an exception.
+
+Some practitioners, with whom I have conversed on the subject, though
+willing to allow that protracted suckling, by depraving the milk, may be
+the means of occasioning Meningitis in infants during or shortly after
+the time they are supplied with this improper food, yet could not
+conceive how it can act as a cause of that disease at some future
+period; I do not myself, while attempting to account for it, discover
+any pathological difficulty.
+
+In these cases it is very probable, that although the protracted
+suckling was not sufficient to produce actual Meningitis at its
+conclusion, yet that it so weakened the system in general, and the brain
+in particular, as to render the latter especially predisposed to
+inflammatory action; and that we have reason to suppose this not only
+possible, but probable, from analogy, cannot be denied, since it is
+known that scrofulous children, in whom there is great laxity and
+debility of habit, are inordinately liable to be affected with
+Hydrocephalus, or Water in the Brain.
+
+'Dr. Perceval observes, that of twenty-two cases of which he kept notes,
+_eleven were certainly strumous children_, and _four were probably so_.'
+'From my own observations,' remarks Dr. Cheyne, 'I should think this
+proportion a very moderate one. When a whole family is swept away by
+Hydrocephalus, I suspect _it is intimately connected with this strumous
+taint_.' The testimony of Sauvages may also be adduced, who says, 'Novi
+familiam cujus infantes circa sextum aetatis annum omnes periere ex hoc
+morbo, _Scrofula huic effusioni ansam praebente_.' The brain, in
+consequence of this local debility, may become affected from causes
+which otherwise would, perhaps, have produced no injurious consequences
+whatever; and hence it is, that when labouring under other diseases, and
+especially Hooping-cough, those children who have been suckled too long
+appear so very liable to have the head secondarily affected. It is
+worthy of notice, that among the cases which have been detailed in the
+foregoing pages, were fourteen in whom affection of the head supervened
+during the progress of other diseases, and in ten of them the disease
+was Hooping-cough.
+
+The treatment of Meningitis arising from protracted suckling will not
+differ from what is proper when it has been produced by other causes;
+except that the depletory measures should not be carried to so great an
+extent, as it must be remembered that the disease is existing in
+constitutions _already debilitated_.
+
+It should consist generally in the application of leeches to the
+temples--cold lotions to the head--purgatives, and blisters placed
+behind the ears, the discharge from which is to be kept up by means of
+irritating dressings--these afford the surest chance of subduing the
+malady, and in many instances, if employed sufficiently early, will have
+the desired effect. It is, of course, almost superfluous to observe,
+that weaning, if the child be above nine months old, must be
+immediately enforced; or, if considerably younger, the diseased or
+debilitated nurse ought to be exchanged for one who has a supply of
+healthy milk of a corresponding age. If such cannot be procured, the
+child must be brought up by hand; for, so long as it is allowed to
+imbibe the noxious milk, there is little hope, in my mind, of the
+medical treatment being of any great service; while on the contrary, it
+is encouraging to know that many infants previously manifesting symptoms
+of incipient Meningitis have completely recovered _soon after they were
+weaned_[M].
+
+When my attention first became directed to the subject, I was chiefly
+struck with the ill effects resulting to the child from _protracted_
+lactation, and hence supposed that cases of disease from suckling, when
+continued for only a moderate period, were rarely if ever met with. More
+enlarged experience, however, has now convinced me, that not only are
+ill effects occasioned in children when lactation is protracted to a
+very unusual extent, but that they occur sometimes, when its duration
+has been merely a few months beyond what I conceive is right. Besides
+which, we shall find that when from any cause whatever the nurse's milk
+becomes impoverished and deteriorated, even if this take place at an
+early period after delivery, the injurious effects already referred to
+may be produced in the child: for improper food, whether it be bad milk
+or any other inappropriate article of diet, is always calculated to
+derange the functions of the stomach, bowels, and other chylopoietic
+viscera, and in consequence to occasion disease.
+
+It matters not whether the mother be originally unhealthy, and thus her
+milk possess bad qualities; or whether from accidental circumstances, or
+her continuing to give suck too long it becomes so: in either case the
+same effect, namely, _deteriorated milk_, is produced, with the
+concomitant evils to which I have alluded. This view of the matter is
+corroborated by Case LII., in which true Meningitis attacked a child,
+aged only nine months, who, therefore, was not suckled _too long_,--but
+then the nurse of that child had been delivered _twenty-one months_,
+having suckled another infant previously:--hence we may reasonably
+conclude that her milk being from the beginning deteriorated, and
+unadapted to the age of the child, the ill effects in this case were
+produced at a much earlier period than usual.
+
+It will be observed that I have only given _one_ instance of this latter
+description; but, on considering how very rare it must be to find any
+mother capable of abandoning her newly-born infant to the breast of a
+woman who has already suckled another child one year, any surprise that
+might be felt at the circumstance will, I am sure, immediately cease. It
+must also be noticed that only among the lowest grades of society do we
+find women so long after delivery performing the office of wet-nurse at
+all, and those who entrust their infants to the latter are often so
+peculiarly situated as to feel no interest whatever in the preservation
+of their offspring: indeed I cannot but suspect that, among such,
+criminal motives frequently lead to the adoption of the unnatural and
+baneful practice in question.
+
+I do not recollect to have seen a case of Meningitis from suckling
+except when this process had been _protracted_, either as respects the
+child or the nurse; though I by no means doubt the possibility of its
+occurrence under other circumstances: but I have met with numerous
+instances of other diseases produced by the palpable deterioration of
+the mother's or nurse's milk at various periods after delivery; in by
+far the greater number, however, of such cases, lactation had been
+continued for an unusual length of time.
+
+Vomiting, griping, and diarrh[oe]a, are so common among infants, and
+arise in general from causes apparently so evident, that, unless severe
+or of long duration, they rarely form the subject of minute inquiry.
+Hence these complaints are, perhaps, not so often attributed to
+deteriorated milk as they ought to be, although the fact of their
+occasionally originating from a morbid condition of this fluid, (and
+therefore from protracted lactation as one cause of the latter effect,)
+is too well established to be questioned. Dr. Underwood observes, 'has
+not every Physician of experience seen infants frequently thrown into
+tormina immediately after coming from the _breast of an unhealthy
+mother, or one who has but little milk_?'[N] and Mr. Burns states, that
+if the usual periodical appearance should return, 'the milk is liable to
+disagree with the child, and produce vomiting or purging;' while Dr.
+Hamilton expressly mentions that diarrh[oe]a is 'not unfrequently
+_occasioned by the depraved quality of the nurse's milk_.'
+
+The two former authors merely testify to the fact of diseases being
+produced by the milk, while the latter more explicitly mentions the
+cause from which they proceed.
+
+Debility, Tabes Mesenterica, and Scrofula, may also be traced to the
+same origin, as every practitioner of experience must have repeatedly
+observed: so may that intractable disease, termed Rickets; and it is
+worthy of notice, that among the worst instances of this malady I have
+seen, were two sisters, _who had been suckled for a very unusual
+period_. Neither do I doubt the probability of Epilepsy being similarly
+occasioned; and although, I must candidly own, I cannot produce numerous
+cases in proof of the correctness of such hypothesis, yet I recollect
+that of a girl affected with this complaint, respecting whom the mother
+stated (and I recorded the fact at the time) that she had been '_suckled
+for two years_;' and, to use her own expression, had 'never been well
+since.'[O]
+
+Convulsions arising from protracted suckling, or simply from the nurse's
+milk becoming deteriorated at any period, are very common, and I have
+kept notes of many such cases that have occurred in the course of my own
+practice; which, however, I abstain from here inserting, being anxious
+to prevent the present publication from swelling into a volume. Indeed,
+the occurrence of convulsions from this cause (diseased milk) has been
+mentioned by several of the best authors. Mr. North, in particular,
+(whose excellent work on Convulsions should be in the hands of every
+practitioner) observes--'It cannot be doubted that children suffer, that
+their health is destroyed, and the foundation laid for convulsive
+diseases, by _sucking unhealthy nurses_.' 'A predisposition to
+convulsive affections in children may be originally produced in
+consequence of their being suckled by a nurse addicted to the frequent
+use of spirituous liquors. In several instances I have known children
+rapidly recover their health when the nurse was changed, who had
+exhibited most of the premonitory symptoms of convulsions while they
+were suckled by a woman who indulged in the common vice of
+gin-drinking.' And Mr. Burns also makes the following remark--'Violent
+passions of the mind affect the milk still more;--it often becomes thin
+and yellowish, and _causes_ colic, or even _fits_.' It is needless,
+however, to say more on this topic, since it is one which no longer
+admits of discussion.
+
+The reader may now, perhaps, expect that I shall introduce a series of
+practical deductions from the foregoing facts and observations; but
+such is not my object upon the present occasion. I merely wish to call
+the attention of practitioners and the public to the subject of these
+pages, and shall thus discharge, as I conceive, an imperative duty to
+society. Having mentioned what I am induced to consider a frequent cause
+of inflammation of the investing membranes of the brain in children, my
+undertaking is completed. The Profession does not require, and the
+public would not be benefited, by the addition of lengthened
+therapeutical rules; for I am convinced, there is not a greater
+imposition to be found than the doctrine that non-medical persons can
+treat diseases with success by means of popular systems of medicine,
+'_practical_' treatises, &c. Such books have often done irreparable
+mischief--certainly much more harm than good; and so far from injuring
+the profits of medical practitioners (as some appear to suppose), have
+greatly added to the number of their patients.
+
+I avail myself also of this opportunity to enter my protest against the
+ill-judged and mischievous practice of those patients who confide upon
+many occasions in the opinion of their nurse, rather than that of their
+medical attendant, and who, in consequence, often injure themselves
+essentially by deceiving the latter. With respect to this mistaken
+preference, Dr. Dewes has well observed--'Let it not be hastily assumed
+that there is more safety in following the directions of a nurse than
+those of the physician, because she may have had some experience; for it
+must be quickly perceived that the calculation is much in favour of the
+latter, since the nurse can attend but twelve patients per annum, while
+the physician may visit many hundreds in the same period--besides, his
+knowledge of the laws of the human system gives him a very decided
+superiority.'
+
+In conclusion, it is right to observe, that protracted suckling being a
+custom much more prevalent among females of the lower orders than those
+of a superior rank, it must follow as a necessary consequence, that
+_Meningitis, and other disorders resulting from this cause, are
+proportionably less frequent in private than in public practice_. This
+remark, it is evident, should be remembered, in order to obviate
+apparent discrepancies which otherwise might appear irreconcilable with
+the opinions I have expressed. In the truth of those opinions I feel the
+most perfect confidence, and cannot but hope that their promulgation
+will hereafter prove extensively beneficial, since precautionary, and
+even therapeutical measures may be founded upon them, which, if
+uniformly adopted, will not only prevent much ill-health and suffering
+to mothers, but will also afford the means of saving many children from
+perishing by one of the most painful and fatal diseases to which they
+are subject.
+
+
+
+
+POSTSCRIPT.
+
+
+Being anxious to obtain additional evidence with respect to the
+production of Meningitis in children by protracted suckling, rather from
+the experience of others than my own, I shall feel greatly obliged to
+any practitioners who will favour me (free of postage) with either facts
+or cases tending to corroborate the truth of the doctrine contained in
+the preceding pages; and should I be enabled publicly to avail myself of
+such communications, it is, perhaps, unnecessary to say, I shall not
+neglect the opportunity of expressing my acknowledgments to their
+respective authors. The intelligence and liberality characterising the
+members of the medical profession generally, preclude all apprehension
+on my part that the above appeal will be made in vain.
+
+
+
+
+NOTES
+
+
+Note A (page 1).
+
+A dark-green substance of variable consistence, contained in the bowels
+of infants at birth.
+
+
+B (page 4).
+
+I beg leave to observe that I make these statements with some confidence
+as the result of personal inquiries instituted a few years ago among the
+patients of two of the Lying-in Establishments of this metropolis.
+
+
+C (page 8).
+
+Since the above was written, a friend who lectures on Chemistry in the
+metropolis has kindly promised me his valuable assistance in making the
+experiments here suggested.
+
+
+D (page 10).
+
+In two cases where suckling was protracted to _three years_, the
+subjects of this baneful practice did not equal in size an ordinary
+child of half their age. One of them became idiotic, and afterwards died
+of Hydrencephalus, under my care; the other was affected with Tabes
+Mesenterica,--the result I did not witness--but believe the disease
+terminated fatally.
+
+
+E (page 25).
+
+Vide Medical and Physical Journal for August 1827.
+
+
+F (page 25).
+
+That is, any period beyond nine or ten months.
+
+
+G (page 25).
+
+_Meningitis_,--I use this term as being more pathologically correct than
+_Cephalitis_, which I formerly adopted.
+
+
+H (page 26).
+
+See the above conditional sense in which I employ this term.
+
+
+I (page 26).
+
+It is a curious fact, which I believe has not been noticed by any other
+writer, that female children labouring under attacks of Meningitis are
+sometimes affected with leucorrh[oe]al discharges. I have met with
+several cases of this description: the children also of women subject to
+leucorrh[oe]a will often, at an early age, be found affected with the
+same disease. Hence it would appear that leucorrh[oe]a is occasionally
+hereditary.
+
+
+K (page 37).
+
+It is unquestionable, notwithstanding the scepticism of some
+practitioners on the subject, (whose opinions are entitled to
+deference,) that _recovery may take place, under appropriate treatment,
+in cases of Meningitis, even after effusion has unequivocally occurred_.
+Preceding authors have noticed this fact, which I can confirm by my own
+experience. Practitioners cannot be too frequently reminded of it, and
+warned not to despair of success even in the last stage of
+Hydrencephalus.
+
+
+L (page 42).
+
+For the information of the _unprofessional_ reader, I beg to observe,
+that the membranes of the brain are _serous membranes_.
+
+
+M (page 48).
+
+It will be observed hereafter, that Mr. North has experienced similar
+beneficial effects from the course above recommended, in cases where
+_convulsions_ have been caused by _diseased milk_;--a strong
+corroborative coincidence.
+
+
+N (page 52).
+
+I believe that where the milk is greatly diminished in quantity, it will
+also be found deteriorated in quality.
+
+
+O (page 53).
+
+In the communication above referred to from Mr. Griffith is the
+following:--'Mrs. A. has a family of four children, all of whom she
+suckled for a period varying from _seventeen_ to _twenty-two
+months_:--_not one of the four is healthy_.'
+
+
+
+
+BY THE SAME AUTHOR,
+
+
+Preparing for publication, in one small volume, 8vo.
+
+OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the Principal
+Symptoms of DISEASE in INFANTS and CHILDREN, with the best modes of
+detecting them;--interspersed with Practical Observations, and intended
+as a clinical guide to Students, &c. &c.
+
+
+Also, in 2 vols. 8vo.
+
+The EIGHT BOOKS of ARETAEUS of CAPPADOCIA on the Causes, Symptoms, and
+Treatment of ACUTE and CHRONIC DISEASES. Translated literally from the
+original Greek, and supplied with critical and explanatory Notes, Tables
+of the Weights and Measures, &c. &c.
+
+
+       *       *       *       *       *
+
+
+By the same Author,
+
+Recently published by Longman and Co. in 8vo., boards, price 14_s._
+
+TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in the
+Years 1827-29;--intended to give some account of Russia as it is, and
+not as it is represented to be.
+
+
+Printed by W. CLOWES, Stamford-street.
+
+
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