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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. 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.