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diff --git a/22344.txt b/22344.txt new file mode 100644 index 0000000..a63d074 --- /dev/null +++ b/22344.txt @@ -0,0 +1,1864 @@ +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. 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