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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.) + + + + + + +</pre> + + + + + +<h1>REMARKS ON THE SUBJECT OF LACTATION,<br /><br /> + +<small>&c. &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, &c. &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, &c. &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, &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> </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, &c. &c.</td><td align='right'><a href="#Page_1">1</a></td></tr> +<tr><td colspan="2"> </td></tr> + +<tr><td class="title" colspan="2">CHAPTER II.</td></tr> +<tr><td colspan="2"><small> </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"> </td></tr> + +<tr><td class="title" colspan="2">CHAPTER III.</td></tr> +<tr><td colspan="2"><small> </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> </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>, <!-- " 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, &c. &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>,—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—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 diarrhœa 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:—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—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.</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—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;—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—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:—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—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—labour under any dangerous +disease—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—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—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—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.</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:—</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—namely, the administration +of tonics, &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,' &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—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<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:—</p> + + +<h3>CASE.</h3> + +<p>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<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—— 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<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—— +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—namely, deteriorated milk—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, 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,<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,—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,—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,—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,—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>—— Wilshire, aged two years seven months, +died of '<i>Water on the brain</i>,'—<i>suckled twelve +months</i>.</p> + +<h4>CASE II.</h4> + +<p>—— Park, aged one year ten months, died of +'<i>Water in the head</i>,'—<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——, aged two years and a few +months, died of <i>Hydrencephalus</i>,—<i>suckled until his +death</i>. In this case I was consulted a short time +previously, and recommended the breast-milk to +be withheld—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>,—<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>,—<i>suckled thirteen months</i>.</p> + +<h4>CASE IX.</h4> + +<p>David Hepburn, aged two years six months, +admitted for <i>Meningitis</i>,—<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>,—<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>,—<i>suckled one year nine +months</i>.</p> + +<h4>CASE XII.</h4> + +<p>—— Hughes, died of '<i>Water in the head</i>,'—<i>suckled +fourteen months</i>.</p> + +<h4>CASE XIII.</h4> + +<p>—— Ferreira, aged seventeen months, died of +'<i>Water in the head</i>,'—<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—'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>'—— Jackson, residing at ——, 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—great stupor—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;—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>,—<i>after that +period he altered</i>,—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>,—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——, of ——, had a little boy who +at <i>ten months old</i> had nine teeth, which were cut +with little or no difficulty:—<i>at this time he was in +good health</i>,—<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—— lost a child of Hydrocephalus, +and has an infant <i>now at the breast seventeen +months old</i>;—the little patient is frequently suffering +from <i>cerebral disturbance</i>. 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 <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>,—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>,—<i>suckled one year</i>.</p> + +<h4>CASE XX.</h4> + +<p>Henry Taylor, aged six years, admitted for +<i>Meningitis</i>,—<i>suckled fourteen months</i>.</p> + +<h4>CASE XXI.</h4> + +<p>Julia Brown, aged three years, admitted for +<i>Meningitis</i>,—<i>suckled thirteen months</i>.</p> + +<h4>CASE XXII.</h4> + +<p>James Neil, aged seven years six months, admitted +for <i>Meningitis</i>,—<i>suckled fourteen months</i>.</p> + +<h4>CASE XXIII.</h4> + +<p>Eliza Park, aged six years, laboured under +<i>Meningitis</i>,—<i>suckled fourteen months</i>.</p> + +<h4>CASE XXIV.</h4> + +<p>Charles Dale, aged five years; admitted for +<i>Meningitis</i>—<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>—<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>:'—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>—<i>suckled one year and six months</i>.</p> + +<h4>CASE XXX.</h4> + +<p>Ann Archer, aged seven years; admitted for +<i>Hydrocephalus</i>—died—<i>suckled three years</i>.</p> + +<h4>CASE XXXI.</h4> + +<p>Cornelius Leary, aged six years; admitted for +<i>Meningitis</i>—died—<i>suckled eighteen months</i>.</p> + +<h4>CASE XXXII.</h4> + +<p>Sophia Peverel, aged three years; admitted +for <i>Meningitis</i>—<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>—died—<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>—<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>.'—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>—<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>—<i>suckled fourteen months</i>.</p> + +<h4>CASE XXXVIII.</h4> + +<p>Sarah Ward, aged three years; admitted for +Hooping-cough—<i>head much affected</i>—<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>—<i>suckled twelve months</i>.</p> + +<h4>CASE XL.</h4> + +<p>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<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>—— Sloggat, aged thirteen months, died of +<i>Meningitis</i> supervening upon Pneumonia—<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>—<i>still at the breast</i>.</p> + +<h4>CASE XLIII.</h4> + +<p>—— Scott, aged fifteen months,—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>—<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,—<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,—<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—<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>—<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>—<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>—<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,—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, '<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—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—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 ætatis annum omnes periere +ex hoc morbo, <i>Scrofula huic effusioni ansam +præbente</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—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<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>,—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:—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 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<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 +diarrhœa 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—'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—'Violent passions of the +mind affect the milk still more;—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, &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.</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—'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.'</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,—the +result I did not witness—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>,—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 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.</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>;—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:—'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>:—<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;—interspersed<br /> +with Practical Observations, and intended as a clinical guide to Students,<br /> +&c. &c.</p></div> + +<p> </p> +<div class="figcenter" style="width:55%;"> +<p class="center">Also, in 2 vols. 8vo.</p> + +<p><big>The EIGHT BOOKS of ARETÆUS 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 /> +&c. &c.</p></div> + +<p> </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;—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> + + + + + +End of the Project Gutenberg EBook of Remarks on the Subject of Lactation, by +Edward Morton + +*** END OF THIS PROJECT GUTENBERG EBOOK LACTATION *** + +***** This file should be named 22344-h.htm or 22344-h.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/2/3/4/22344/ + +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.) + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. 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