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Title: Remarks on the Subject of Lactation
Author: Morton, Edward
Language: English
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                     REMARKS ON THE SUBJECT OF

                              LACTATION,

                               &c. &c.



                              REMARKS

                         ON THE SUBJECT OF

                             LACTATION;

                             CONTAINING

                            OBSERVATIONS

                               ON THE

        HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK;
                 THE DISORDERS FREQUENTLY PRODUCED
                      IN MOTHERS BY SUCKLING;

                                AND

                    NUMEROUS ILLUSTRATIVE CASES;

           PROVING THAT, WHEN PROTRACTED, IT IS A COMMON
                       CAUSE, IN CHILDREN, OF

               HYDRENCEPHALUS, OR WATER IN THE BRAIN,

                                AND

                     OTHER SERIOUS COMPLAINTS.


                                 BY

                    EDWARD MORTON, M.D. CANTAB.

FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY
       COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS,
         LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY,
                   AND TO THE ROYAL METROPOLITAN
                  INFIRMARY FOR CHILDREN, &c. &c.


                              LONDON:

               LONGMAN, REES, ORME, BROWN, AND GREEN,
                          PATERNOSTER-ROW.

                             MDCCCXXXI.



LONDON:
PRINTED BY WILLIAM CLOWES,
STAMFORD STREET.



TO

SIR HENRY HALFORD, BART., M.D., F.R.S., F.A.S.,

PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON,
PHYSICIAN TO THE KING, &c. &c.

THE FOLLOWING PAGES

ARE,

WITH HIS PERMISSION,

AND WITH

A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIR
AUTHOR, MOST RESPECTFULLY

DEDICATED.



PREFACE.


Several cases which I witnessed led me to believe, some years ago, that
inflammation of the brain, or its membranes, might be produced in
children, owing to their being suckled for an undue length of time.
Since that period, having enjoyed opportunities of observing infantile
diseases on a much more extended scale, and my attention being expressly
directed to the point in question, I not only became fully convinced of
the correctness of my previous conclusions, but was induced to carry
them still farther.

My opinions on this subject were briefly drawn up and published in the
_Medical and Physical Journal_ for August 1827, and have not passed
altogether unnoticed by my professional brethren[1], some of whom have
done me the honour to speak of them in flattering terms, while no one, I
believe, has attempted to disprove the existence of the important fact I
was the first to announce.

[1] Vide Medico-Chirurgical Review, Gazette of Health, Dendy on
Cutaneous Diseases, &c.

The bare statement of that fact was, indeed, nearly all that my
approaching departure from England, at the time last mentioned, left in
my power: upon the present occasion I have offered arguments for, and
endeavoured to anticipate those against, the deductions I then made
public; and however imperfect may have been my success in either, the
welfare of society at large is too deeply involved in the establishment
of my opinions with respect to the custom I condemn, (if those opinions
be correct,) for me to hesitate while again committing them to the press
in a more extended form.

These considerations, I respectfully submit, will render any apology for
the appearance of the following pages unnecessary, and will, I trust,
secure for them a candid and favourable reception from the Profession
and the Public.

_15, Eaton Street, Grosvenor Place,
          October 8, 1831._



CONTENTS.


                          CHAPTER I.
                                                          Page
Of the Breast-Milk, &c. &c.                                  1


                         CHAPTER II.

On Lactation, and the Disorders frequently produced in
Women by that process                                       14


                         CHAPTER III.

On the various Diseases which arise in Children from
Lactation, especially when protracted                       24


Postscript                                                  59

Notes                                                       61



ERRATA.


Page 10, line 3, _for_ two _read_ a few.

  "  52,  "  19, dele comma between the words Tabes and Mesenterica.


Transcriber's Note: The above corrections have been applied to this
text, in addition _headach_ has been corrected to _headache_ on page
18, line 11.



CHAPTER I.

_Of the Breast-Milk, &c. &c._


No sooner has the child been ushered into the world than the breasts of
the mother pour forth their milk for its sustenance. This bland fluid is
secreted from the blood, and varies, in quality and quantity, according
to the time which has elapsed from delivery, being peculiarly and
wonderfully adapted at every period to the wants of the individual for
whose use it is destined. Thus, that first secreted, called _colostrum_,
possesses a purgative quality evidently intended by the all-wise Author
of our being for the purpose of removing _the meconium_[A],--a process
which experience has sufficiently proved to be necessary for the welfare
of the newly-born infant. Afterwards, ceasing to possess this aperient
property, it is calculated solely for affording nutrition; and finally,
at a certain period from delivery, it gradually becomes impoverished,
loses its former healthy qualities altogether, and acquires others which
are injurious to life. This important change, as above noticed,
generally happens at a certain period after delivery; varying, however,
somewhat in particular women, and in the same female on different
occasions: but, from disease, or other circumstances, the milk may
become deteriorated before the time to which reference has just been
made. If, for instance, the mother labour under any serious disorder, it
is universally admitted that her milk may also become unhealthy; and
this may take place even a short interval after delivery.

Although we cannot explain how the brain and nerves act, and probably
never shall be able to do so, yet we are well aware that their influence
is absolutely requisite for the healthy performance of every function in
the human body.

That mental inquietude will impede digestion is a fact familiar to
almost every one; but, I believe, it is not so generally known, that it
will with no less certainty retard and alter the nature of the secretion
furnished by the breasts of the lactescent female. Violent affections of
the mind will cause the milk to become thin and yellowish, and to
acquire noxious properties: even the fond mother's anxiety, while
hanging over the couch of her sick infant, will be sufficient to render
it unfit for the sustenance of the object of her solicitude.

The state also of the stomach and bowels and the diet of the nurse
materially and constantly influence the nature of the lacteal secretion.

The milk, besides, is liable to deterioration from another cause,
namely, the recurrence of the usual periodical appearance--for should
this take place in a nurse, it is agreed that her milk is liable to
produce disorders in the child who imbibes it; which could not happen,
if the former possessed its ordinary component parts, and retained its
natural properties.

The recurrence, moreover, of pregnancy in the lactescent female may
render the milk of a bad quality, and will invariably lessen its
quantity. Mr. Burns asserts that in these cases the milk 'does not
become hurtful,' but in this opinion I must beg leave to differ from
him; since I have repeatedly seen it, from this cause, palpably altered
in appearance, and have observed diarrhœa and great debility produced
in the children who were suckled with it.

An almost universally received opinion among females, and, indeed, one
very frequently entertained by members of the medical profession, is,
that while a woman continues to nurse her infant she will not again
become pregnant; but this, as a general proposition, is unquestionably
erroneous; it is even doubtful whether such opinion will hold good in a
majority of instances. The continuance of lactation will very generally,
it is true, tend to prevent the recurrence of the periodical phenomenon;
yet, nevertheless, it will not in every instance prevent pregnancy[B].
Should, however, a woman with an infant at the breast again become
pregnant, (a circumstance that very frequently occurs, and of which,
from the _general though not invariable_ absence of those criteria by
which this fact is accustomed to be recognised, she is not aware until
it has made some progress,) one of two things will usually take place;
either she will miscarry, or her milk will become impoverished in
quality and diminished in quantity. Nor is this wonderful:--it was not
intended by Nature that the processes of pregnancy and lactation should
go on simultaneously, but, on the contrary, that the one should commence
when the other had terminated; and experience sufficiently proves that
they will not proceed well together: the reason of which, as it appears
to me, may be easily given. During pregnancy, and particularly during
its latter periods, the vessels of the womb gradually enlarge, and a
much greater quantity of blood than usual is determined to that organ
for the increase and perfection of the embryo and its appendages; which,
after delivery, becomes transferred to the breasts to supply the
material for the secretion of the milk: but if, during pregnancy,
lactation be also persevered in, the blood becomes directed at the same
time to two different parts of the body, somewhat remote from each
other, namely, to the womb, and to the breasts; hence, neither is likely
to receive its due proportion of this vital fluid, and, consequently,
the functions of one or the other, or both, are liable to become impeded
or suspended. If the breasts continue to receive a sufficient quantity
of blood, the secretion of milk goes on properly, but the womb is
deprived of its necessary supply; the embryo, in consequence, languishes
and dies, and, becoming an extraneous body, is thrown off, producing
abortion; while, on the other hand, should the womb still obtain its due
proportion of blood, the breasts are robbed of it, and the secretion of
milk, if not altogether suppressed, is rendered either deficient in
quantity or deteriorated in quality.

Finally, the breast-milk may become depraved and injurious by the
process of lactation being continued too long, a practice which is,
unfortunately, in this, as well as other countries, extensively
prevalent.

I have not yet had an opportunity of examining the breast-milk in these
diseased conditions except by the eye, and that rarely--but even this
slight examination has enabled me to state, that it was greatly altered
from its natural condition;--that it was more fluid than usual, and
changed in colour, resembling a yellowish turbid serum, instead of
displaying its well-known bluish hue.

I propose in future to attend carefully to this subject, and I would beg
leave to recommend it as one well worthy the notice of those members of
our profession who have made animal chemistry a particular study, having
no doubt that they would be able, by a series of accurate experiments
upon the breast-milk at different periods after delivery, and under
various conditions of the mother, to collect many interesting and
important facts--such, perhaps, as would tend very materially to augment
our knowledge of pathology, and improve our practice in the treatment
of certain diseases[C].

We cannot but believe that the Supreme Being has done nothing without an
infinitely wise and good object, and it is obviously our interest, no
less than our duty, to be guided by those indications of the Divine
purpose which are distinctly to be traced throughout the creation.

It must appear evident to all who examine the matter in question, that
the infant was intended to be nourished for the first few months of its
existence through the medium of a fluid; because no teeth are provided
to prepare for its use substances of a more solid description; and there
can be no doubt that this fluid is the mother's milk;--but when the
child has attained a certain age the teeth begin to appear, doubtless at
the precise time when they are meant to be used; and, therefore, more
solid food should now be given. Besides, in consequence of its new
acquisition, the child sucks less perfectly than before, an additional
proof that weaning ought at this period to be commenced. Indeed, the
teeth are calculated indirectly to produce this effect themselves, the
mother being now liable to suffer inconvenience by letting the child
take the breast--for the latter _bites_ instead of _sucking_ the nipple,
and the pain hence arising may, perhaps, induce the former, for her own
sake, to discontinue a practice injurious to both.

It must also be remembered, that when the teeth are usually produced,
the milk loses its nutritious properties, and this too at a time when
the infant from his increasing size must evidently require a more solid
and substantial, rather than a thinner and less nourishing diet. What
rational argument, therefore, can be offered why he should still be
suckled? If we observe the brute creation, do any analogies appear by
which we can defend the propriety in the human species of protracted
suckling? by no means:--on the contrary, we find that the female animals
soon drive away their young from their dugs; and what is, perhaps, still
more to the purpose, I have heard stated, on good authority, as a
well-known fact among the breeders of cattle, that if calves be allowed
to suck beyond a few months they do not thrive, but, on the contrary,
become lean and diseased.

The belief so generally prevailing, that the longer a child is suckled
the stronger it will become, is a prejudice, like many others concerning
women and children, which has been handed down from mother to daughter
for ages, and has thereby become so universally entertained and so
deeply rooted in the minds of females, that even medical men scarcely
venture to question its propriety. My own experience, however, compels
me to declare, that there is not a more erroneous or mischievous
doctrine; and I can most truly affirm, that I never yet witnessed an
instance where protracted lactation had produced any good effect[D],
though I have seen numerous examples (some of which will be introduced
hereafter) where, I believe, it had been the indirect cause of death.

Having thus strongly noticed the impropriety of long continued
suckling, it will, perhaps, be proper to state my opinion as to the
period when this process should terminate. As a general rule, at nine
months after birth the child ought to be entirely weaned; and in no
instance should he be permitted to suck more than ten. In many cases
suckling may be relinquished with advantage (and occasionally it is
absolutely necessary to discontinue it) before the time first above
mentioned; in others, however, it may be protracted beyond it.

I by no means recommend the breast-milk to be at once superseded by
artificial food, but, on the contrary, that the child should be
_gradually_ accustomed to such aliment from a much earlier period; the
proportion of the latter being increased by degrees, while the
breast-milk is diminished in a corresponding ratio. Hence we shall
produce a double advantage; the mother will be benefited as well as the
child--the former, by giving suck less frequently, and in smaller
quantities at a time than usual, will have the secretion of milk
_gradually lessened_, and, therefore all likelihood of inconvenience, as
far as regards herself when the child is entirely weaned, will be
completely prevented; while, on the other hand, the child being
_insensibly estranged_ from the breast, will have become accustomed to
his new food, so that there will be less chance of its disagreeing with
him when it forms his sole support; and thus the danger which is
generally apprehended from weaning will be either materially lessened or
altogether avoided.

The difficulty of bringing up infants by hand, as it is termed, is well
known; but I suspect that the great mortality which has been recorded as
occurring from this source is not inseparable from the practice itself,
but arises mainly from the improper manner in which it is usually
conducted. When it is determined to bring up an infant by hand, the
substitute offered for the mother's milk should as nearly as possible
resemble that fluid; and the child should be constrained to imbibe it in
_the same manner as_ it would _the milk from the maternal breast_; that
is, it should be _sucked_ from a bottle contrived for that purpose,
instead of the child being gorged with it, by means of a large spoon, or
some other equally improper instrument, as is the usual custom. It is a
fact too palpable to be questioned, that the food generally given to
infants brought up by hand is not only administered in an improper
manner, but is also of an improper quality; their tender stomachs are
daily overloaded with _solid_ instead of _liquid_ aliment, and hence
arises the numerous train of evils which, in my opinion, produce the
great mortality just referred to.



CHAPTER II.

_On Lactation, and the Disorders frequently produced in Women by that
process._


There can be no doubt that, speaking generally, a mother is bound to
suckle her children, and that the performance of this duty is no less
conducive to her own health than to the moral and physical welfare of
her offspring; yet there is not a more unfounded doctrine than that
which presumes every woman who is willing to be also capable of
advantageously discharging the important office of a nurse.

If the mother enjoy good health, and the process be not continued too
long, it is likely to produce beneficial effects both in herself and her
infant; but if she be of a very delicate habit--labour under any
dangerous disease--be subject during the period of lactation to great
affliction, or constant mental inquietude--or should the periodical
appearance return, pregnancy occur, or suckling be continued too long,
it may not only prove highly detrimental to herself, but may be the
means of occasioning serious or fatal consequences to her child.

In cases of extreme delicacy of constitution, lactation will often
produce the worst effects. Many young ladies, on becoming mothers, are
incapable of supporting the constant drain to which the wants of their
infants subject them--they lose their good looks, become gradually
weaker, and as their strength declines, their milk is simultaneously
lessened in quantity, and altered in its other properties.

If the suckling be still continued, their debility daily increases,
distressing pains in the back and loins succeed; the patients become
exceedingly nervous, as it is termed, and are unusually susceptible of
ordinary impressions; pain in the head, often of great violence,
follows, which, in some cases, is succeeded by delirium, in others, by
absolute mania. Nor is this the whole catalogue of ills to which
in such cases the unfortunate mother is subjected: the appetite
fails, distressing languor is experienced by day, while copious
perspirations deluge her by night, and dissipate the last remains of
strength--producing a state which may easily be mistaken for, or
terminate in, true pulmonary consumption;--finally, the sight becomes
progressively weaker, until vision is almost destroyed; the eyelids
exude a glutinous secretion, and ophthalmia itself is occasionally
induced.

These are the symptoms too often caused by lactation in delicate or
debilitated habits, even a few months after delivery; the same also are
observed when suckling has been injudiciously protracted beyond the
period to which it should be confined.

A few only of the foregoing symptoms may be noticed, or nearly the whole
may present themselves, in the same patient; and when this happens,
unless the cause which has given rise to them be at once detected, and
appropriate treatment employed, the most serious consequences may be
apprehended.

In these cases, the first step necessary is to discontinue the suckling
altogether: half measures will never answer. Sometimes it is proposed by
the patient, or her friends (more usually the latter), to compromise the
affair by feeding the child partly on spoon meat, and allowing him still
to take the breast, though less frequently than before.

This plan I uniformly object to, for the following reasons:--

1st. Because the mother will not be likely to recover so long as she
continues to suckle at all.

2nd. Because her milk being necessarily of a bad quality, it cannot be
expected that the child will derive benefit from it; but, on the
contrary, there is every probability that his health will suffer by
using diet of such an improper description.

The obvious dependence of the foregoing symptoms upon debility will, of
course, at once suggest to practitioners the nature of the treatment to
be adopted: which should be such as is calculated to invigorate the
system generally--namely, the administration of tonics, &c.

Bark and its various preparations, especially the sulphate of quinine,
with the occasional use of warm aperients (sedulously avoiding the more
violent purgatives), will be found eminently successful; whereas,
cupping at the nape of the neck (which I have seen prescribed for the
headache), and other depletory measures, have proved as manifestly
injurious.

'Every disease productive of great weakness is increased by the state of
the system which follows child-bearing. Of this description are
consumption, dropsy,' &c. In these cases it is evident that the process
of lactation, by adding to the debility already present, must prove
highly injurious, and consequently should be always avoided.

I have already noticed the effects which are produced upon the milk by
the influence of mental emotions on the part of the mother, as well as
by the recurrence of the periodical appearance; and since these are
chiefly injurious to the child, by depraving its sustenance, their
further consideration will be deferred till the next chapter.

With respect to the remaining topic--namely, the occurrence of
miscarriage from suckling--I am convinced that it is by no means an
unfrequent accident, though its real cause is perhaps rarely suspected,
having only met with one patient who considered the mishap in question
to have arisen from keeping her child too long at the breast. Having
already, I trust satisfactorily, explained the manner in which abortion
is produced by the act of suckling, I shall conclude this part of my
subject with the relation of a case that occurred in private practice,
which so strongly corroborates many of the observations in the preceding
and following pages, that I shall offer no apology for its introduction:
more particularly, since the lady herself to whom it refers has
benevolently expressed a wish for its publication, in order that those
who become acquainted with the facts there detailed may be prevented
from undergoing similar unnecessary sufferings:--


CASE.

Mrs. A----, a lady of delicate constitution, about twenty years of age,
three or four months subsequent to the birth of her first child, began
to find her milk gradually lessen in quantity; it had also much changed
from its previous appearance, resembling at the time just stated, a
yellowish, turbid serum. Her child became emaciated; and diarrhœa
supervening, my professional services were required. My advice was, that
the child should be at once weaned, and a suitable wet-nurse, if
possible, procured--neither of which suggestions, as will shortly
appear, were followed. I urged the necessity of this measure more
particularly, because Mrs. A---- was daily getting thinner and weaker;
she also complained of great pain in the head and back, and of an
increasing dimness of sight, which made her fear she should become
blind; but the mother-in-law of my patient being, unfortunately, of
opinion that pregnancy in the latter would not again occur during the
continuance of lactation, recommended that the child, although chiefly
supported upon spoon-meat, should occasionally be allowed to take the
breast; and this plan, notwithstanding the wish of Mrs. A---- to the
contrary, and my own remonstrances on the subject, was adopted--the
effects of which were to increase the mother's ailments, as well as
those of her infant. Things went on thus for some time longer, when I
once more endeavoured to persuade Mrs. A---- to follow my advice,
observing, that by an opposite line of conduct she was not only injuring
her own health, but that of her child, neither of which, I assured her,
in my opinion, would be re-established till the latter had been weaned.
I expressed also my complete incredulity as to the non-recurrence of
pregnancy in consequence of her infant remaining at the breast; and I
added--'It is my firm conviction that if you be pregnant, or should
happen shortly to become so, you will miscarry.' About a week after
this conversation she was suddenly seized with flooding, and what I had
predicted took place. She now left off suckling, and in about a month,
under suitable treatment, completely got rid of all her former
complaints: the child also immediately began to improve.

The present case clearly proves that the process of lactation will not
_invariably_ prevent the occurrence of pregnancy, since Mrs. A---- became
in this state, notwithstanding she continued to suckle her child: and I
think few will be so hardy as to doubt that it was the cause of her
miscarrying: more particularly when I mention that, at a future period,
the same lady, during my absence abroad, being once more persuaded to
try whether she could not avoid becoming pregnant (which was very much
to be desired, on account of her delicate state of health) by continuing
to perform the duties of a nurse, again suffered all the distressing
symptoms before described, and again miscarried.

This case, finally, affords evidence of the evil consequences often
produced in children by impoverished and unhealthy milk; and of their
speedy disappearance when the exciting cause--namely, deteriorated
milk--is no longer afforded.



CHAPTER III.

_On the various Diseases which frequently arise in Children from
Lactation, especially when protracted._


Having thus briefly considered some of the disorders to which women are
subjected by performing the first duty imposed upon them as mothers, I
shall next advert to those which are very frequently observed in their
children from being suckled during too long a period; or in consequence
of the nurse's milk becoming either simply impoverished, or of a
positively injurious quality.

These diseases are numerous, and some of them serious, among which may
be enumerated the following; namely, vomiting, diarrhœa, general
debility, scrofula, tabes mesenterica,--rickets, convulsions,
epilepsy,--and lastly meningitis, or that peculiar inflammation of the
investing membranes of the brain which gives rise to the effusion of
serum, constituting the well known and very fatal disease termed by
medical practitioners Hydrocephalus, or Hydrencephalus, and popularly
Water on the Brain.

The disease last mentioned being by far the most important, and that
chiefly referred to in the following observations, I shall commence with
a brief statement of the conclusions which my experience has led me to
form respecting it; they are the same I made public four years ago[E],
having since that time seen no reason to make any alteration in them. I
believe,

1st,--That if children be suckled for an undue length of time[F], they
will be liable in consequence to be affected with meningitis[G], or
inflammation of the investing membranes of the brain.

2dly,--That should they not become affected with the disorder in
question during or soon after the time they are thus improperly suckled,
they will nevertheless acquire therefrom a predisposition to cephalic
disease at some future period of their lives.

3dly,--That children who are suckled for an undue length of time, when
labouring under other diseases, will be much more liable to have the
head secondarily affected, than children brought up in a different
manner.

4thly,--And lastly, that the same effects will take place in infants if
suckled by women who have been delivered an undue[H] length of time;
although the infants themselves may not have been at the breast for too
long a period.

       *       *       *       *       *

CASES IN ILLUSTRATION OF THE FOREGOING VIEWS.


I.

_Cases of Meningitis[I] supervening upon protracted suckling._


CASE I.

---- Wilshire, aged two years seven months, died of '_Water on the
brain_,'--_suckled twelve months_.


CASE II.

---- Park, aged one year ten months, died of '_Water in the
head_,'--_suckled fourteen months_.


CASE III.

Prince V----, aged two years and a few months, died of
_Hydrencephalus_,--_suckled until his death_. In this case I was
consulted a short time previously, and recommended the breast-milk to be
withheld--my advice was not followed.


CASE IV.

Emma Lane, aged two years, admitted at the Infirmary for Children for
_Meningitis_,--_suckled one year and eleven months_.


CASE V.

The mother of the preceding suckled another child '_a very long
period_,' and it died of '_Water on the Brain_.'


CASE VI.

Edmund Power, aged two years, _still at the breast_, admitted for
_Chronic Hydrocephalus_: the head is of great magnitude; fontanelles
open: superficial veins large and prominent.


CASE VII.

Sophia Hamley, aged one year two months, _still at the breast_, admitted
for _Meningitis_.


CASE VIII.

William How, aged one year six months, admitted for
_Meningitis_,--_suckled thirteen months_.


CASE IX.

David Hepburn, aged two years six months, admitted for
_Meningitis_,--_suckled two years four months_.


CASE X.

Samuel Hanks, aged one year nine months, admitted for
_Meningitis_,--_suckled one year eight months_.


CASE XI.

Amelia Hill, aged two years six months, admitted for
_Meningitis_,--_suckled one year nine months_.


CASE XII.

---- Hughes, died of '_Water in the head_,'--_suckled fourteen months_.


CASE XIII.

---- Ferreira, aged seventeen months, died of '_Water in the
head_,'--_suckled until its death_.

For the five following cases I am indebted to the kindness of Mr.
William Griffith, an intelligent surgeon of Eaton-street, who, having
some time ago been apprised of my peculiar views, has since directed his
attention particularly to the subject. They completely confirm my
opinions, and will have more weight with the public than any additional
evidence I could adduce from my own practice.

In the letter inclosing these cases, Mr. Griffith writes thus--'from the
observations I have been enabled to make, I am led to believe that
disease almost invariably follows protracted suckling. I may add in
conclusion, that I perfectly concur with the views which you entertain
on the subject.'


CASES XIV. XV.

'---- Jackson, residing at ----, aged two years six months, who had been
kept _at the breast twenty-two months_, was in a dying state when I was
requested to see her. The pulse was preternaturally slow--great
stupor--dilatation of the pupils, and diastasis of the bones of the
head. In six hours from the time I first saw her she died, and the
mother was desirous that the head should be examined, having lost a
child previously, in what she considered a similar manner. On removing
the scalp I found the cranium very much enlarged and altered in shape.
Between the tunica arachnoides and pia mater, there was a quantity of
water effused;--the sides and upper surface of the brain were
exceedingly soft. In the lateral ventricles there were from six to eight
ounces of water. In answer to a few questions I asked the mother, she
stated that her former child was, during the _first ten months_ of its
life, _a plump, healthy infant_,--_after that period he altered_,--the
stomach, bowels, and _head became affected_, and, in the course of a few
months, he manifested similar symptoms to those which proved fatal in
the case of his sister. He was _suckled for twenty-one months_, and
_died_ at the age of _twenty-seven months_. The mother of these children
has one other child alive, and at my urgent request it was weaned at
_nine months_,--it is now _seventeen months old, and in excellent
health_.'


CASE XVI.

'Mrs. A----, of ----, had a little boy who at _ten months old_ had nine
teeth, which were cut with little or no difficulty:--_at this time he
was in good health_,--_he was allowed the breast until nineteen months,
and at the expiration of three months more, died of Hydrocephalus_.'


CASE XVII.

'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at the
breast seventeen months old_;--the little patient is frequently
suffering from _cerebral disturbance_. I have repeatedly advised the
mother to wean it--she objects, and gives the usual reason for allowing
it to remain at the breast--viz., that she does it to _prevent becoming
again enceinte_.'


CASE XVIII.

'This day, (August 13, 1831,) a little child labouring under _cerebral
disease_ was brought to me for advice, and he appeared certainly in a
most pitiable state; he is _two years four months old_ and is _now at
the breast_,--I do not think it possible for him to survive many days.'


II.

_Cases of Meningitis, arising at an after period, in consequence of
protracted suckling._


CASE XIX.

Francis Page, aged six years, admitted for _Meningitis_,--_suckled one
year_.


CASE XX.

Henry Taylor, aged six years, admitted for _Meningitis_,--_suckled
fourteen months_.


CASE XXI.

Julia Brown, aged three years, admitted for _Meningitis_,--_suckled
thirteen months_.


CASE XXII.

James Neil, aged seven years six months, admitted for
_Meningitis_,--_suckled fourteen months_.


CASE XXIII.

Eliza Park, aged six years, laboured under _Meningitis_,--_suckled
fourteen months_.


CASE XXIV.

Charles Dale, aged five years; admitted for _Meningitis_--_suckled
thirteen months_.


CASE XXV.

Sarah Strickling, aged four years; admitted for _Meningitis_--_suckled
one year and six months_.


CASES XXVI. XXVII. XXVIII.

The mother of the last mentioned child lost three previously, with
'_water in the head_:'--all these were suckled _more than eighteen
months_.


CASE XXIX.

George Speering, aged four years; admitted for _Meningitis_--_suckled
one year and six months_.


CASE XXX.

Ann Archer, aged seven years; admitted for
_Hydrocephalus_--died--_suckled three years_.


CASE XXXI.

Cornelius Leary, aged six years; admitted for
_Meningitis_--died--_suckled eighteen months_.


CASE XXXII.

Sophia Peverel, aged three years; admitted for _Meningitis_--_suckled
two years_.


CASE XXXIII.

Maria Turley, aged four years; admitted for _Meningitis_--died--_suckled
one year three months_. This child had laboured under a previous attack,
from which she recovered under my care.


CASE XXXIV.

Robert Selkirk, aged three years six months; admitted for
_Meningitis_--_suckled thirteen months_.


CASE XXXV.

The mother of the preceding child lost another of '_inflammation of the
brain_.'--This was _suckled more than one year_.


CASE XXXVI.

Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled one
year seven months_.


III.

_Cases of Meningitis in Children who had been suckled an undue length of
time, supervening upon other complaints._


CASE XXXVII.

Arthur Lane, aged one year four months; admitted for Pneumonia, with
_an affection of the head_--_suckled fourteen months_.


CASE XXXVIII.

Sarah Ward, aged three years; admitted for Hooping-cough--_head much
affected_--_suckled one year and ten months_.


CASE XXXIX.

Thomas Donovan, aged two years two months; admitted for Hooping-cough,
with _an affection of the head_--_suckled twelve months_.


CASE XL.

Count ---- ----, aged about two years, came under my care, being then at
the breast. The head was large, fontanelle open--superficial veins more
apparent than natural. By my advice he was directly weaned, and rapidly
improved in health and appearance (the only medicine given being
occasional doses of castor oil). About twelve months afterwards, in
consequence of an imprudent exposure to cold, he was attacked with
Bronchitis, and Meningitis supervened. Leeches were applied to the head,
and other depletory measures actively employed, which were followed by
recovery.


CASE XLI.

---- Sloggat, aged thirteen months, died of _Meningitis_ supervening
upon Pneumonia--_suckled until the time of its death_.


CASE XLII.

John Scott, aged eleven months; admitted for Hooping-cough, with a
_well-marked affection of the head_--_still at the breast_.


CASE XLIII.

---- Scott, aged fifteen months,--died of 'Hooping-cough, with
convulsions,' _being then at the breast_.


CASE XLIV.

Isaac Berwick, aged one year two months, admitted for Hooping-cough,
_with an affection of the head_--_still at the breast_.


CASE XLV.

Frederick Cousins, aged three years four months, brought to me labouring
under Hooping-cough, with Meningitis, which latter terminated in
effusion. Calomel was then given every two hours, the stronger mercurial
ointment rubbed upon the temples, and blisters applied to the head. The
mercurial influence being established, a profuse discharge of urine
occurred; the pupils which had previously been _permanently_ dilated,
became once more obedient to light; sensibility was restored, and great
weakness appeared to be the only urgent symptom. The cough, however, now
returned, the head became again affected, and the child sunk. Upon
opening the head, about four ounces of fluid was found in the
ventricles[K]. This child was _suckled sixteen months_.


CASE XLVI.

Sarah Swann, aged four years six months, admitted for Hooping-cough with
convulsions,--_suckled one year_.


CASE XLVII.

Henry Harris, aged two years three months, admitted for Hooping-cough,
_with an affection_ of the head,--_suckled one year four months_.


CASE XLVIII.

Maria Hughes, aged two years, admitted for _Convulsions_ supervening
upon Hooping-cough--_suckled one year three months_.


CASE XLIX.

Thomas Benson, aged one year six months, admitted for Pneumonia, with
_well-marked affection of the head_--_suckled one year four months_.


CASE L.

Mary Kenner, aged six years, admitted for Hooping-cough, with
_well-marked affection of the head_--_suckled one year six months_.


CASE LI.

John Ennis, aged one year seven months, admitted for Bronchitis, to
which _a decided affection of the head succeeded_--_suckled one year_.


IV.

_Case of Meningitis produced in consequence of the Child being suckled
from its birth by a Woman who had at that time been delivered one Year._


CASE LII.

Ellen Willoughby, aged nine months, admitted for Meningitis; at present
suckled by a woman who has been _delivered one year and nine months_.

       *       *       *       *       *

With respect to the manner in which protracted lactation causes the
complaint that forms the subject of these remarks, I formerly was
undecided; but have now no doubt whatever of its arising _secondarily_
from derangement in the functions of the abdominal viscera, occasioned
by the depraved condition of the breast-milk.

It is universally allowed among medical men that irritations in the
stomach and bowels will, through the agency of particular nerves,
produce sympathetic irritation in the brain,--that peculiar action
being thus elicited which terminates in the effusion of serum,
constituting the disease named Hydrocephalus.--'The continued irritation
of important or very sensible nerves is, perhaps,' says Mr. Burns, '_one
of the most common causes_' (of Hydrocephalus); 'hence it may follow
dentition, and _very often arises from a bad state of the chylopoietic
viscera_.'

It is also no less generally known that food of a bad quality or
improper description will produce derangements in the digestive organs.
Now, having already shewn that the milk when lactation is protracted
becomes deteriorated, it plainly appears that such milk is capable of
occasioning derangement of the chylopoietic viscera; and it being
allowed that derangement of these viscera, from any source, may give
rise to inflammation of the brain, I conceive it follows that protracted
lactation must be admitted as one cause of such effect. This train of
reasoning, therefore, from generally admitted data, seems to _prove that
Meningitis_, or inflammation of the brain, _in children can be produced
by their being suckled for too long a period_, and _that it is so
produced I assert from repeated experience_.

An accidental perusal of Mr. Dendy's able work on the cutaneous diseases
of children, published shortly after the appearance of my paper before
referred to in the Medical and Physical Journal, has recently afforded
me the pleasure of finding that the author had been led to entertain
similar general views on the subject under discussion with myself; I
have, therefore, taken the opportunity of adding that gentleman's
testimony to my own, by quoting the following passage from his work
above mentioned.

'It may be truly said, that _the infantine disease excited by milk of a
deleterious, or simply impoverished quality, "grows by what it feeds
on;"_ and we shall witness the internal debility and the infantine
disorder running their course together. Tabes is the natural consequence
of this error; but its effect is evinced by the occurrence of other
disorders. A defective degree of nutrition, as I have elsewhere stated,
predisposes the system to become influenced by comparatively slight
excitement; and thus, in addition to the direct excitement of disease,
it becomes indirectly its predisposing cause. _Under its influence the
serous_[L] and mucous _membranes become readily the seat of
inflammatory action_.'

Those who feel a difficulty in relinquishing old opinions and adopting
new views upon any particular subject, may perhaps ask how it has
happened, if inflammation of the brain from protracted suckling be so
common as the preceding observations and cases would appear to prove,
that medical men of more advanced age and far greater experience than
myself have not previously noticed the circumstance. I would observe, in
reply, that until Harvey pointed out the circulation of the blood, no
one ever suspected the existence of such a phenomenon; yet now the
wonder appears to be, not that Harvey made the discovery, but that
others had not previously done the same. Multitudes, it may be added,
and among them the great Newton, had witnessed the fall of objects to
the ground without thinking of the cause which produced their downward
tendency; the propitious moment, however, arrived--the apple fell, and
the philosopher was led to those deductions which have rendered his name
immortal. So is it with observers of every class, from those most
distinguished by intellectual superiority and its successful
application, down to the humble writer of the present observations.
Facts are continually passing before us unnoticed, till, from their
repeated coincidence, or some accidental impulse, we attempt, and
finally are enabled, to trace their origin.

Thus, until the possibility of Meningitis originating from protracted
lactation had been suggested, practitioners were, of course, unable to
notice the fact--not from its non-occurrence, but because their
unconsciousness of its existence must necessarily preclude the inquiries
from which alone its cause could be determined. Hence a practitioner may
have treated many hundred cases of water on the brain in children,
without being able to attribute any one of them to protracted suckling;
yet this is no proof that such cases did not happen, for, had he made
the requisite inquiries, very probably many among them might have been
found which had thus arisen.

Another objection that may possibly be made to my views, is, that
instances might be adduced where lactation had been persevered in for a
very long period, without any ill effects supervening. That such
frequently occur, there is no doubt; and with respect to them, I have
merely to observe, that they do not in the slightest degree invalidate
the correctness of my conclusions. As well might it be argued, that
because persons have fallen from a very great height without sustaining
any injury, or, because poisonous doses of various drugs have sometimes
been swallowed without death supervening, that, therefore, there is no
danger in jumping from a precipice, or in taking a virulent poison; or
that death never occurs from these causes. Such cases, unless far more
numerous than I imagine them, can only be regarded as exceptions to the
general rule; and, consequently, do not lessen its authority, there
being no rule without an exception.

Some practitioners, with whom I have conversed on the subject, though
willing to allow that protracted suckling, by depraving the milk, may be
the means of occasioning Meningitis in infants during or shortly after
the time they are supplied with this improper food, yet could not
conceive how it can act as a cause of that disease at some future
period; I do not myself, while attempting to account for it, discover
any pathological difficulty.

In these cases it is very probable, that although the protracted
suckling was not sufficient to produce actual Meningitis at its
conclusion, yet that it so weakened the system in general, and the brain
in particular, as to render the latter especially predisposed to
inflammatory action; and that we have reason to suppose this not only
possible, but probable, from analogy, cannot be denied, since it is
known that scrofulous children, in whom there is great laxity and
debility of habit, are inordinately liable to be affected with
Hydrocephalus, or Water in the Brain.

'Dr. Perceval observes, that of twenty-two cases of which he kept notes,
_eleven were certainly strumous children_, and _four were probably so_.'
'From my own observations,' remarks Dr. Cheyne, 'I should think this
proportion a very moderate one. When a whole family is swept away by
Hydrocephalus, I suspect _it is intimately connected with this strumous
taint_.' The testimony of Sauvages may also be adduced, who says, 'Novi
familiam cujus infantes circa sextum ætatis annum omnes periere ex hoc
morbo, _Scrofula huic effusioni ansam præbente_.' The brain, in
consequence of this local debility, may become affected from causes
which otherwise would, perhaps, have produced no injurious consequences
whatever; and hence it is, that when labouring under other diseases, and
especially Hooping-cough, those children who have been suckled too long
appear so very liable to have the head secondarily affected. It is
worthy of notice, that among the cases which have been detailed in the
foregoing pages, were fourteen in whom affection of the head supervened
during the progress of other diseases, and in ten of them the disease
was Hooping-cough.

The treatment of Meningitis arising from protracted suckling will not
differ from what is proper when it has been produced by other causes;
except that the depletory measures should not be carried to so great an
extent, as it must be remembered that the disease is existing in
constitutions _already debilitated_.

It should consist generally in the application of leeches to the
temples--cold lotions to the head--purgatives, and blisters placed
behind the ears, the discharge from which is to be kept up by means of
irritating dressings--these afford the surest chance of subduing the
malady, and in many instances, if employed sufficiently early, will have
the desired effect. It is, of course, almost superfluous to observe,
that weaning, if the child be above nine months old, must be
immediately enforced; or, if considerably younger, the diseased or
debilitated nurse ought to be exchanged for one who has a supply of
healthy milk of a corresponding age. If such cannot be procured, the
child must be brought up by hand; for, so long as it is allowed to
imbibe the noxious milk, there is little hope, in my mind, of the
medical treatment being of any great service; while on the contrary, it
is encouraging to know that many infants previously manifesting symptoms
of incipient Meningitis have completely recovered _soon after they were
weaned_[M].

When my attention first became directed to the subject, I was chiefly
struck with the ill effects resulting to the child from _protracted_
lactation, and hence supposed that cases of disease from suckling, when
continued for only a moderate period, were rarely if ever met with. More
enlarged experience, however, has now convinced me, that not only are
ill effects occasioned in children when lactation is protracted to a
very unusual extent, but that they occur sometimes, when its duration
has been merely a few months beyond what I conceive is right. Besides
which, we shall find that when from any cause whatever the nurse's milk
becomes impoverished and deteriorated, even if this take place at an
early period after delivery, the injurious effects already referred to
may be produced in the child: for improper food, whether it be bad milk
or any other inappropriate article of diet, is always calculated to
derange the functions of the stomach, bowels, and other chylopoietic
viscera, and in consequence to occasion disease.

It matters not whether the mother be originally unhealthy, and thus her
milk possess bad qualities; or whether from accidental circumstances, or
her continuing to give suck too long it becomes so: in either case the
same effect, namely, _deteriorated milk_, is produced, with the
concomitant evils to which I have alluded. This view of the matter is
corroborated by Case LII., in which true Meningitis attacked a child,
aged only nine months, who, therefore, was not suckled _too long_,--but
then the nurse of that child had been delivered _twenty-one months_,
having suckled another infant previously:--hence we may reasonably
conclude that her milk being from the beginning deteriorated, and
unadapted to the age of the child, the ill effects in this case were
produced at a much earlier period than usual.

It will be observed that I have only given _one_ instance of this latter
description; but, on considering how very rare it must be to find any
mother capable of abandoning her newly-born infant to the breast of a
woman who has already suckled another child one year, any surprise that
might be felt at the circumstance will, I am sure, immediately cease. It
must also be noticed that only among the lowest grades of society do we
find women so long after delivery performing the office of wet-nurse at
all, and those who entrust their infants to the latter are often so
peculiarly situated as to feel no interest whatever in the preservation
of their offspring: indeed I cannot but suspect that, among such,
criminal motives frequently lead to the adoption of the unnatural and
baneful practice in question.

I do not recollect to have seen a case of Meningitis from suckling
except when this process had been _protracted_, either as respects the
child or the nurse; though I by no means doubt the possibility of its
occurrence under other circumstances: but I have met with numerous
instances of other diseases produced by the palpable deterioration of
the mother's or nurse's milk at various periods after delivery; in by
far the greater number, however, of such cases, lactation had been
continued for an unusual length of time.

Vomiting, griping, and diarrhœa, are so common among infants, and
arise in general from causes apparently so evident, that, unless severe
or of long duration, they rarely form the subject of minute inquiry.
Hence these complaints are, perhaps, not so often attributed to
deteriorated milk as they ought to be, although the fact of their
occasionally originating from a morbid condition of this fluid, (and
therefore from protracted lactation as one cause of the latter effect,)
is too well established to be questioned. Dr. Underwood observes, 'has
not every Physician of experience seen infants frequently thrown into
tormina immediately after coming from the _breast of an unhealthy
mother, or one who has but little milk_?'[N] and Mr. Burns states, that
if the usual periodical appearance should return, 'the milk is liable to
disagree with the child, and produce vomiting or purging;' while Dr.
Hamilton expressly mentions that diarrhœa is 'not unfrequently
_occasioned by the depraved quality of the nurse's milk_.'

The two former authors merely testify to the fact of diseases being
produced by the milk, while the latter more explicitly mentions the
cause from which they proceed.

Debility, Tabes Mesenterica, and Scrofula, may also be traced to the
same origin, as every practitioner of experience must have repeatedly
observed: so may that intractable disease, termed Rickets; and it is
worthy of notice, that among the worst instances of this malady I have
seen, were two sisters, _who had been suckled for a very unusual
period_. Neither do I doubt the probability of Epilepsy being similarly
occasioned; and although, I must candidly own, I cannot produce numerous
cases in proof of the correctness of such hypothesis, yet I recollect
that of a girl affected with this complaint, respecting whom the mother
stated (and I recorded the fact at the time) that she had been '_suckled
for two years_;' and, to use her own expression, had 'never been well
since.'[O]

Convulsions arising from protracted suckling, or simply from the nurse's
milk becoming deteriorated at any period, are very common, and I have
kept notes of many such cases that have occurred in the course of my own
practice; which, however, I abstain from here inserting, being anxious
to prevent the present publication from swelling into a volume. Indeed,
the occurrence of convulsions from this cause (diseased milk) has been
mentioned by several of the best authors. Mr. North, in particular,
(whose excellent work on Convulsions should be in the hands of every
practitioner) observes--'It cannot be doubted that children suffer, that
their health is destroyed, and the foundation laid for convulsive
diseases, by _sucking unhealthy nurses_.' 'A predisposition to
convulsive affections in children may be originally produced in
consequence of their being suckled by a nurse addicted to the frequent
use of spirituous liquors. In several instances I have known children
rapidly recover their health when the nurse was changed, who had
exhibited most of the premonitory symptoms of convulsions while they
were suckled by a woman who indulged in the common vice of
gin-drinking.' And Mr. Burns also makes the following remark--'Violent
passions of the mind affect the milk still more;--it often becomes thin
and yellowish, and _causes_ colic, or even _fits_.' It is needless,
however, to say more on this topic, since it is one which no longer
admits of discussion.

The reader may now, perhaps, expect that I shall introduce a series of
practical deductions from the foregoing facts and observations; but
such is not my object upon the present occasion. I merely wish to call
the attention of practitioners and the public to the subject of these
pages, and shall thus discharge, as I conceive, an imperative duty to
society. Having mentioned what I am induced to consider a frequent cause
of inflammation of the investing membranes of the brain in children, my
undertaking is completed. The Profession does not require, and the
public would not be benefited, by the addition of lengthened
therapeutical rules; for I am convinced, there is not a greater
imposition to be found than the doctrine that non-medical persons can
treat diseases with success by means of popular systems of medicine,
'_practical_' treatises, &c. Such books have often done irreparable
mischief--certainly much more harm than good; and so far from injuring
the profits of medical practitioners (as some appear to suppose), have
greatly added to the number of their patients.

I avail myself also of this opportunity to enter my protest against the
ill-judged and mischievous practice of those patients who confide upon
many occasions in the opinion of their nurse, rather than that of their
medical attendant, and who, in consequence, often injure themselves
essentially by deceiving the latter. With respect to this mistaken
preference, Dr. Dewes has well observed--'Let it not be hastily assumed
that there is more safety in following the directions of a nurse than
those of the physician, because she may have had some experience; for it
must be quickly perceived that the calculation is much in favour of the
latter, since the nurse can attend but twelve patients per annum, while
the physician may visit many hundreds in the same period--besides, his
knowledge of the laws of the human system gives him a very decided
superiority.'

In conclusion, it is right to observe, that protracted suckling being a
custom much more prevalent among females of the lower orders than those
of a superior rank, it must follow as a necessary consequence, that
_Meningitis, and other disorders resulting from this cause, are
proportionably less frequent in private than in public practice_. This
remark, it is evident, should be remembered, in order to obviate
apparent discrepancies which otherwise might appear irreconcilable with
the opinions I have expressed. In the truth of those opinions I feel the
most perfect confidence, and cannot but hope that their promulgation
will hereafter prove extensively beneficial, since precautionary, and
even therapeutical measures may be founded upon them, which, if
uniformly adopted, will not only prevent much ill-health and suffering
to mothers, but will also afford the means of saving many children from
perishing by one of the most painful and fatal diseases to which they
are subject.



POSTSCRIPT.


Being anxious to obtain additional evidence with respect to the
production of Meningitis in children by protracted suckling, rather from
the experience of others than my own, I shall feel greatly obliged to
any practitioners who will favour me (free of postage) with either facts
or cases tending to corroborate the truth of the doctrine contained in
the preceding pages; and should I be enabled publicly to avail myself of
such communications, it is, perhaps, unnecessary to say, I shall not
neglect the opportunity of expressing my acknowledgments to their
respective authors. The intelligence and liberality characterising the
members of the medical profession generally, preclude all apprehension
on my part that the above appeal will be made in vain.



NOTES


Note A (page 1).

A dark-green substance of variable consistence, contained in the bowels
of infants at birth.


B (page 4).

I beg leave to observe that I make these statements with some confidence
as the result of personal inquiries instituted a few years ago among the
patients of two of the Lying-in Establishments of this metropolis.


C (page 8).

Since the above was written, a friend who lectures on Chemistry in the
metropolis has kindly promised me his valuable assistance in making the
experiments here suggested.


D (page 10).

In two cases where suckling was protracted to _three years_, the
subjects of this baneful practice did not equal in size an ordinary
child of half their age. One of them became idiotic, and afterwards died
of Hydrencephalus, under my care; the other was affected with Tabes
Mesenterica,--the result I did not witness--but believe the disease
terminated fatally.


E (page 25).

Vide Medical and Physical Journal for August 1827.


F (page 25).

That is, any period beyond nine or ten months.


G (page 25).

_Meningitis_,--I use this term as being more pathologically correct than
_Cephalitis_, which I formerly adopted.


H (page 26).

See the above conditional sense in which I employ this term.


I (page 26).

It is a curious fact, which I believe has not been noticed by any other
writer, that female children labouring under attacks of Meningitis are
sometimes affected with leucorrhœal discharges. I have met with
several cases of this description: the children also of women subject to
leucorrhœa will often, at an early age, be found affected with the
same disease. Hence it would appear that leucorrhœa is occasionally
hereditary.


K (page 37).

It is unquestionable, notwithstanding the scepticism of some
practitioners on the subject, (whose opinions are entitled to
deference,) that _recovery may take place, under appropriate treatment,
in cases of Meningitis, even after effusion has unequivocally occurred_.
Preceding authors have noticed this fact, which I can confirm by my own
experience. Practitioners cannot be too frequently reminded of it, and
warned not to despair of success even in the last stage of
Hydrencephalus.


L (page 42).

For the information of the _unprofessional_ reader, I beg to observe,
that the membranes of the brain are _serous membranes_.


M (page 48).

It will be observed hereafter, that Mr. North has experienced similar
beneficial effects from the course above recommended, in cases where
_convulsions_ have been caused by _diseased milk_;--a strong
corroborative coincidence.


N (page 52).

I believe that where the milk is greatly diminished in quantity, it will
also be found deteriorated in quality.


O (page 53).

In the communication above referred to from Mr. Griffith is the
following:--'Mrs. A. has a family of four children, all of whom she
suckled for a period varying from _seventeen_ to _twenty-two
months_:--_not one of the four is healthy_.'



BY THE SAME AUTHOR,


Preparing for publication, in one small volume, 8vo.

OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the Principal
Symptoms of DISEASE in INFANTS and CHILDREN, with the best modes of
detecting them;--interspersed with Practical Observations, and intended
as a clinical guide to Students, &c. &c.


Also, in 2 vols. 8vo.

The EIGHT BOOKS of ARETÆUS of CAPPADOCIA on the Causes, Symptoms, and
Treatment of ACUTE and CHRONIC DISEASES. Translated literally from the
original Greek, and supplied with critical and explanatory Notes, Tables
of the Weights and Measures, &c. &c.


By the same Author,

Recently published by Longman and Co. in 8vo., boards, price 14_s._

TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in the
Years 1827-29;--intended to give some account of Russia as it is, and
not as it is represented to be.


Printed by W. CLOWES, Stamford-street.





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This effort is time consuming and expensive, so in order to keep providing
this resource, we have taken steps to prevent abuse by commercial parties,
including placing technical restrictions on automated querying.

We also ask that you:

+ Make non-commercial use of the files We designed Doctrine Publishing
Corporation's ISYS search for use by individuals, and we request that you
use these files for personal, non-commercial purposes.

+ Refrain from automated querying Do not send automated queries of any sort
to Doctrine Publishing's system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a
large amount of text is helpful, please contact us. We encourage the use of
public domain materials for these purposes and may be able to help.

+ Keep it legal -  Whatever your use, remember that you are responsible for
ensuring that what you are doing is legal. Do not assume that just because
we believe a book is in the public domain for users in the United States,
that the work is also in the public domain for users in other countries.
Whether a book is still in copyright varies from country to country, and we
can't offer guidance on whether any specific use of any specific book is
allowed. Please do not assume that a book's appearance in Doctrine Publishing
ISYS search  means it can be used in any manner anywhere in the world.
Copyright infringement liability can be quite severe.

About ISYS® Search Software
Established in 1988, ISYS Search Software is a global supplier of enterprise
search solutions for business and government.  The company's award-winning
software suite offers a broad range of search, navigation and discovery
solutions for desktop search, intranet search, SharePoint search and embedded
search applications.  ISYS has been deployed by thousands of organizations
operating in a variety of industries, including government, legal, law
enforcement, financial services, healthcare and recruitment.



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