_On the various Diseases which frequently arise in Children from
Lactation, especially when protracted._
Having thus briefly considered some of the disorders to which women are
subjected by performing the first duty imposed upon them as mothers, I
shall next advert to those which are very frequently observed in their
children from being suckled during too long a period; or in consequence
of the nurse's milk becoming either simply impoverished, or of a
positively injurious quality.
These diseases are numerous, and some of them serious, among which may
be enumerated the following; namely, vomiting, diarrh[oe]a, general
debility, scrofula, tabes mesenterica,--rickets, convulsions,
epilepsy,--and lastly meningitis, or that peculiar inflammation of the
investing membranes of the brain which gives rise to the effusion of
serum, constituting the well known and very fatal disease termed by
medical practitioners Hydrocephalus, or Hydrencephalus, and popularly
Water on the Brain.
The disease last mentioned being by far the most important, and that
chiefly referred to in the following observations, I shall commence with
a brief statement of the conclusions which my experience has led me to
form respecting it; they are the same I made public four years ago[E],
having since that time seen no reason to make any alteration in them. I
believe,
1st,--That if children be suckled for an undue length of time[F], they
will be liable in consequence to be affected with meningitis[G], or
inflammation of the investing membranes of the brain.
2dly,--That should they not become affected with the disorder in
question during or soon after the time they are thus improperly suckled,
they will nevertheless acquire therefrom a predisposition to cephalic
disease at some future period of their lives.
3dly,--That children who are suckled for an undue length of time, when
labouring under other diseases, will be much more liable to have the
head secondarily affected, than children brought up in a different
manner.
4thly,--And lastly, that the same effects will take place in infants if
suckled by women who have been delivered an undue[H] length of time;
although the infants themselves may not have been at the breast for too
long a period.
* * * * *
CASES IN ILLUSTRATION OF THE FOREGOING VIEWS.
I.
_Cases of Meningitis[I] supervening upon protracted suckling._
CASE I.
---- Wilshire, aged two years seven months, died of '_Water on the
brain_,'--_suckled twelve months_.
CASE II.
---- Park, aged one year ten months, died of '_Water in the
head_,'--_suckled fourteen months_.
CASE III.
Prince V----, aged two years and a few months, died of
_Hydrencephalus_,--_suckled until his death_. In this case I was
consulted a short time previously, and recommended the breast-milk to be
withheld--my advice was not followed.
CASE IV.
Emma Lane, aged two years, admitted at the Infirmary for Children for
_Meningitis_,--_suckled one year and eleven months_.
CASE V.
The mother of the preceding suckled another child '_a very long
period_,' and it died of '_Water on the Brain_.'
CASE VI.
Edmund Power, aged two years, _still at the breast_, admitted for
_Chronic Hydrocephalus_: the head is of great magnitude; fontanelles
open: superficial veins large and prominent.
CASE VII.
Sophia Hamley, aged one year two months, _still at the breast_, admitted
for _Meningitis_.
CASE VIII.
William How, aged one year six months, admitted for
_Meningitis_,--_suckled thirteen months_.
CASE IX.
David Hepburn, aged two years six months, admitted for
_Meningitis_,--_suckled two years four months_.
CASE X.
Samuel Hanks, aged one year nine months, admitted for
_Meningitis_,--_suckled one year eight months_.
CASE XI.
Amelia Hill, aged two years six months, admitted for
_Meningitis_,--_suckled one year nine months_.
CASE XII.
---- Hughes, died of '_Water in the head_,'--_suckled fourteen months_.
CASE XIII.
---- Ferreira, aged seventeen months, died of '_Water in the
head_,'--_suckled until its death_.
For the five following cases I am indebted to the kindness of Mr.
William Griffith, an intelligent surgeon of Eaton-street, who, having
some time ago been apprised of my peculiar views, has since directed his
attention particularly to the subject. They completely confirm my
opinions, and will have more weight with the public than any additional
evidence I could adduce from my own practice.
In the letter inclosing these cases, Mr. Griffith writes thus--'from the
observations I have been enabled to make, I am led to believe that
disease almost invariably follows protracted suckling. I may add in
conclusion, that I perfectly concur with the views which you entertain
on the subject.'
CASES XIV. XV.
'---- Jackson, residing at ----, aged two years six months, who had been
kept _at the breast twenty-two months_, was in a dying state when I was
requested to see her. The pulse was preternaturally slow--great
stupor--dilatation of the pupils, and diastasis of the bones of the
head. In six hours from the time I first saw her she died, and the
mother was desirous that the head should be examined, having lost a
child previously, in what she considered a similar manner. On removing
the scalp I found the cranium very much enlarged and altered in shape.
Between the tunica arachnoides and pia mater, there was a quantity of
water effused;--the sides and upper surface of the brain were
exceedingly soft. In the lateral ventricles there were from six to eight
ounces of water. In answer to a few questions I asked the mother, she
stated that her former child was, during the _first ten months_ of its
life, _a plump, healthy infant_,--_after that period he altered_,--the
stomach, bowels, and _head became affected_, and, in the course of a few
months, he manifested similar symptoms to those which proved fatal in
the case of his sister. He was _suckled for twenty-one months_, and
_died_ at the age of _twenty-seven months_. The mother of these children
has one other child alive, and at my urgent request it was weaned at
_nine months_,--it is now _seventeen months old, and in excellent
health_.'
CASE XVI.
'Mrs. A----, of ----, had a little boy who at _ten months old_ had nine
teeth, which were cut with little or no difficulty:--_at this time he
was in good health_,--_he was allowed the breast until nineteen months,
and at the expiration of three months more, died of Hydrocephalus_.'
CASE XVII.
'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at the
breast seventeen months old_;--the little patient is frequently
suffering from _cerebral disturbance_. I have repeatedly advised the
mother to wean it--she objects, and gives the usual reason for allowing
it to remain at the breast--viz., that she does it to _prevent becoming
again enceinte_.'
CASE XVIII.
'This day, (August 13, 1831,) a little child labouring under _cerebral
disease_ was brought to me for advice, and he appeared certainly in a
most pitiable state; he is _two years four months old_ and is _now at
the breast_,--I do not think it possible for him to survive many days.'
II.
_Cases of Meningitis, arising at an after period, in consequence of
protracted suckling._
CASE XIX.
Francis Page, aged six years, admitted for _Meningitis_,--_suckled one
year_.
CASE XX.
Henry Taylor, aged six years, admitted for _Meningitis_,--_suckled
fourteen months_.
CASE XXI.
Julia Brown, aged three years, admitted for _Meningitis_,--_suckled
thirteen months_.
CASE XXII.
James Neil, aged seven years six months, admitted for
_Meningitis_,--_suckled fourteen months_.
CASE XXIII.
Eliza Park, aged six years, laboured under _Meningitis_,--_suckled
fourteen months_.
CASE XXIV.
Charles Dale, aged five years; admitted for _Meningitis_--_suckled
thirteen months_.
CASE XXV.
Sarah Strickling, aged four years; admitted for _Meningitis_--_suckled
one year and six months_.
CASES XXVI. XXVII. XXVIII.
The mother of the last mentioned child lost three previously, with
'_water in the head_:'--all these were suckled _more than eighteen
months_.
CASE XXIX.
George Speering, aged four years; admitted for _Meningitis_--_suckled
one year and six months_.
CASE XXX.
Ann Archer, aged seven years; admitted for
_Hydrocephalus_--died--_suckled three years_.
CASE XXXI.
Cornelius Leary, aged six years; admitted for
_Meningitis_--died--_suckled eighteen months_.
CASE XXXII.
Sophia Peverel, aged three years; admitted for _Meningitis_--_suckled
two years_.
CASE XXXIII.
Maria Turley, aged four years; admitted for _Meningitis_--died--_suckled
one year three months_. This child had laboured under a previous attack,
from which she recovered under my care.
CASE XXXIV.
Robert Selkirk, aged three years six months; admitted for
_Meningitis_--_suckled thirteen months_.
CASE XXXV.
The mother of the preceding child lost another of '_inflammation of the
brain_.'--This was _suckled more than one year_.
CASE XXXVI.
Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled one
year seven months_.
III.
_Cases of Meningitis in Children who had been suckled an undue length of
time, supervening upon other complaints._
CASE XXXVII.
Arthur Lane, aged one year four months; admitted for Pneumonia, with
_an affection of the head_--_suckled fourteen months_.
CASE XXXVIII.
Sarah Ward, aged three years; admitted for Hooping-cough--_head much
affected_--_suckled one year and ten months_.
CASE XXXIX.
Thomas Donovan, aged two years two months; admitted for Hooping-cough,
with _an affection of the head_--_suckled twelve months_.
CASE XL.
Count ---- ----, aged about two years, came under my care, being then at
the breast. The head was large, fontanelle open--superficial veins more
apparent than natural. By my advice he was directly weaned, and rapidly
improved in health and appearance (the only medicine given being
occasional doses of castor oil). About twelve months afterwards, in
consequence of an imprudent exposure to cold, he was attacked with
Bronchitis, and Meningitis supervened. Leeches were applied to the head,
and other depletory measures actively employed, which were followed by
recovery.
CASE XLI.
---- Sloggat, aged thirteen months, died of _Meningitis_ supervening
upon Pneumonia--_suckled until the time of its death_.
CASE XLII.
John Scott, aged eleven months; admitted for Hooping-cough, with a
_well-marked affection of the head_--_still at the breast_.
CASE XLIII.
---- Scott, aged fifteen months,--died of 'Hooping-cough, with
convulsions,' _being then at the breast_.
CASE XLIV.
Isaac Berwick, aged one year two months, admitted for Hooping-cough,
_with an affection of the head_--_still at the breast_.
CASE XLV.
Frederick Cousins, aged three years four months, brought to me labouring
under Hooping-cough, with Meningitis, which latter terminated in
effusion. Calomel was then given every two hours, the stronger mercurial
ointment rubbed upon the temples, and blisters applied to the head. The
mercurial influence being established, a profuse discharge of urine
occurred; the pupils which had previously been _permanently_ dilated,
became once more obedient to light; sensibility was restored, and great
weakness appeared to be the only urgent symptom. The cough, however, now
returned, the head became again affected, and the child sunk. Upon
opening the head, about four ounces of fluid was found in the
ventricles[K]. This child was _suckled sixteen months_.
CASE XLVI.
Sarah Swann, aged four years six months, admitted for Hooping-cough with
convulsions,--_suckled one year_.
CASE XLVII.
Henry Harris, aged two years three months, admitted for Hooping-cough,
_with an affection_ of the head,--_suckled one year four months_.
CASE XLVIII.
Maria Hughes, aged two years, admitted for _Convulsions_ supervening
upon Hooping-cough--_suckled one year three months_.
CASE XLIX.
Thomas Benson, aged one year six months, admitted for Pneumonia, with
_well-marked affection of the head_--_suckled one year four months_.
CASE L.
Mary Kenner, aged six years, admitted for Hooping-cough, with
_well-marked affection of the head_--_suckled one year six months_.
CASE LI.
John Ennis, aged one year seven months, admitted for Bronchitis, to
which _a decided affection of the head succeeded_--_suckled one year_.
IV.
_Case of Meningitis produced in consequence of the Child being suckled
from its birth by a Woman who had at that time been delivered one Year._
CASE LII.
Ellen Willoughby, aged nine months, admitted for Meningitis; at present
suckled by a woman who has been _delivered one year and nine months_.
* * * * *
With respect to the manner in which protracted lactation causes the
complaint that forms the subject of these remarks, I formerly was
undecided; but have now no doubt whatever of its arising _secondarily_
from derangement in the functions of the abdominal viscera, occasioned
by the depraved condition of the breast-milk.
It is universally allowed among medical men that irritations in the
stomach and bowels will, through the agency of particular nerves,
produce sympathetic irritation in the brain,--that peculiar action
being thus elicited which terminates in the effusion of serum,
constituting the disease named Hydrocephalus.--'The continued irritation
of important or very sensible nerves is, perhaps,' says Mr. Burns, '_one
of the most common causes_' (of Hydrocephalus); 'hence it may follow
dentition, and _very often arises from a bad state of the chylopoietic
viscera_.'
It is also no less generally known that food of a bad quality or
improper description will produce derangements in the digestive organs.
Now, having already shewn that the milk when lactation is protracted
becomes deteriorated, it plainly appears that such milk is capable of
occasioning derangement of the chylopoietic viscera; and it being
allowed that derangement of these viscera, from any source, may give
rise to inflammation of the brain, I conceive it follows that protracted
lactation must be admitted as one cause of such effect. This train of
reasoning, therefore, from generally admitted data, seems to _prove that
Meningitis_, or inflammation of the brain, _in children can be produced
by their being suckled for too long a period_, and _that it is so
produced I assert from repeated experience_.
An accidental perusal of Mr. Dendy's able work on the cutaneous diseases
of children, published shortly after the appearance of my paper before
referred to in the Medical and Physical Journal, has recently afforded
me the pleasure of finding that the author had been led to entertain
similar general views on the subject under discussion with myself; I
have, therefore, taken the opportunity of adding that gentleman's
testimony to my own, by quoting the following passage from his work
above mentioned.
'It may be truly said, that _the infantine disease excited by milk of a
deleterious, or simply impoverished quality, "grows by what it feeds
on;"_ and we shall witness the internal debility and the infantine
disorder running their course together. Tabes is the natural consequence
of this error; but its effect is evinced by the occurrence of other
disorders. A defective degree of nutrition, as I have elsewhere stated,
predisposes the system to become influenced by comparatively slight
excitement; and thus, in addition to the direct excitement of disease,
it becomes indirectly its predisposing cause. _Under its influence the
serous_[L] and mucous _membranes become readily the seat of
inflammatory action_.'
Those who feel a difficulty in relinquishing old opinions and adopting
new views upon any particular subject, may perhaps ask how it has
happened, if inflammation of the brain from protracted suckling be so
common as the preceding observations and cases would appear to prove,
that medical men of more advanced age and far greater experience than
myself have not previously noticed the circumstance. I would observe, in
reply, that until Harvey pointed out the circulation of the blood, no
one ever suspected the existence of such a phenomenon; yet now the
wonder appears to be, not that Harvey made the discovery, but that
others had not previously done the same. Multitudes, it may be added,
and among them the great Newton, had witnessed the fall of objects to
the ground without thinking of the cause which produced their downward
tendency; the propitious moment, however, arrived--the apple fell, and
the philosopher was led to those deductions which have rendered his name
immortal. So is it with observers of every class, from those most
distinguished by intellectual superiority and its successful
application, down to the humble writer of the present observations.
Facts are continually passing before us unnoticed, till, from their
repeated coincidence, or some accidental impulse, we attempt, and
finally are enabled, to trace their origin.
Thus, until the possibility of Meningitis originating from protracted
lactation had been suggested, practitioners were, of course, unable to
notice the fact--not from its non-occurrence, but because their
unconsciousness of its existence must necessarily preclude the inquiries
from which alone its cause could be determined. Hence a practitioner may
have treated many hundred cases of water on the brain in children,
without being able to attribute any one of them to protracted suckling;
yet this is no proof that such cases did not happen, for, had he made
the requisite inquiries, very probably many among them might have been
found which had thus arisen.
Another objection that may possibly be made to my views, is, that
instances might be adduced where lactation had been persevered in for a
very long period, without any ill effects supervening. That such
frequently occur, there is no doubt; and with respect to them, I have
merely to observe, that they do not in the slightest degree invalidate
the correctness of my conclusions. As well might it be argued, that
because persons have fallen from a very great height without sustaining
any injury, or, because poisonous doses of various drugs have sometimes
been swallowed without death supervening, that, therefore, there is no
danger in jumping from a precipice, or in taking a virulent poison; or
that death never occurs from these causes. Such cases, unless far more
numerous than I imagine them, can only be regarded as exceptions to the
general rule; and, consequently, do not lessen its authority, there
being no rule without an exception.
Some practitioners, with whom I have conversed on the subject, though
willing to allow that protracted suckling, by depraving the milk, may be
the means of occasioning Meningitis in infants during or shortly after
the time they are supplied with this improper food, yet could not
conceive how it can act as a cause of that disease at some future
period; I do not myself, while attempting to account for it, discover
any pathological difficulty.
In these cases it is very probable, that although the protracted
suckling was not sufficient to produce actual Meningitis at its
conclusion, yet that it so weakened the system in general, and the brain
in particular, as to render the latter especially predisposed to
inflammatory action; and that we have reason to suppose this not only
possible, but probable, from analogy, cannot be denied, since it is
known that scrofulous children, in whom there is great laxity and
debility of habit, are inordinately liable to be affected with
Hydrocephalus, or Water in the Brain.
'Dr. Perceval observes, that of twenty-two cases of which he kept notes,
_eleven were certainly strumous children_, and _four were probably so_.'
'From my own observations,' remarks Dr. Cheyne, 'I should think this
proportion a very moderate one. When a whole family is swept away by
Hydrocephalus, I suspect _it is intimately connected with this strumous
taint_.' The testimony of Sauvages may also be adduced, who says, 'Novi
familiam cujus infantes circa sextum aetatis annum omnes periere ex hoc
morbo, _Scrofula huic effusioni ansam praebente_.' The brain, in
consequence of this local debility, may become affected from causes
which otherwise would, perhaps, have produced no injurious consequences
whatever; and hence it is, that when labouring under other diseases, and
especially Hooping-cough, those children who have been suckled too long
appear so very liable to have the head secondarily affected. It is
worthy of notice, that among the cases which have been detailed in the
foregoing pages, were fourteen in whom affection of the head supervened
during the progress of other diseases, and in ten of them the disease
was Hooping-cough.
The treatment of Meningitis arising from protracted suckling will not
differ from what is proper when it has been produced by other causes;
except that the depletory measures should not be carried to so great an
extent, as it must be remembered that the disease is existing in
constitutions _already debilitated_.
It should consist generally in the application of leeches to the
temples--cold lotions to the head--purgatives, and blisters placed
behind the ears, the discharge from which is to be kept up by means of
irritating dressings--these afford the surest chance of subduing the
malady, and in many instances, if employed sufficiently early, will have
the desired effect. It is, of course, almost superfluous to observe,
that weaning, if the child be above nine months old, must be
immediately enforced; or, if considerably younger, the diseased or
debilitated nurse ought to be exchanged for one who has a supply of
healthy milk of a corresponding age. If such cannot be procured, the
child must be brought up by hand; for, so long as it is allowed to
imbibe the noxious milk, there is little hope, in my mind, of the
medical treatment being of any great service; while on the contrary, it
is encouraging to know that many infants previously manifesting symptoms
of incipient Meningitis have completely recovered _soon after they were
weaned_[M].
When my attention first became directed to the subject, I was chiefly
struck with the ill effects resulting to the child from _protracted_
lactation, and hence supposed that cases of disease from suckling, when
continued for only a moderate period, were rarely if ever met with. More
enlarged experience, however, has now convinced me, that not only are
ill effects occasioned in children when lactation is protracted to a
very unusual extent, but that they occur sometimes, when its duration
has been merely a few months beyond what I conceive is right. Besides
which, we shall find that when from any cause whatever the nurse's milk
becomes impoverished and deteriorated, even if this take place at an
early period after delivery, the injurious effects already referred to
may be produced in the child: for improper food, whether it be bad milk
or any other inappropriate article of diet, is always calculated to
derange the functions of the stomach, bowels, and other chylopoietic
viscera, and in consequence to occasion disease.
It matters not whether the mother be originally unhealthy, and thus her
milk possess bad qualities; or whether from accidental circumstances, or
her continuing to give suck too long it becomes so: in either case the
same effect, namely, _deteriorated milk_, is produced, with the
concomitant evils to which I have alluded. This view of the matter is
corroborated by Case LII., in which true Meningitis attacked a child,
aged only nine months, who, therefore, was not suckled _too long_,--but
then the nurse of that child had been delivered _twenty-one months_,
having suckled another infant previously:--hence we may reasonably
conclude that her milk being from the beginning deteriorated, and
unadapted to the age of the child, the ill effects in this case were
produced at a much earlier period than usual.
It will be observed that I have only given _one_ instance of this latter
description; but, on considering how very rare it must be to find any
mother capable of abandoning her newly-born infant to the breast of a
woman who has already suckled another child one year, any surprise that
might be felt at the circumstance will, I am sure, immediately cease. It
must also be noticed that only among the lowest grades of society do we
find women so long after delivery performing the office of wet-nurse at
all, and those who entrust their infants to the latter are often so
peculiarly situated as to feel no interest whatever in the preservation
of their offspring: indeed I cannot but suspect that, among such,
criminal motives frequently lead to the adoption of the unnatural and
baneful practice in question.
I do not recollect to have seen a case of Meningitis from suckling
except when this process had been _protracted_, either as respects the
child or the nurse; though I by no means doubt the possibility of its
occurrence under other circumstances: but I have met with numerous
instances of other diseases produced by the palpable deterioration of
the mother's or nurse's milk at various periods after delivery; in by
far the greater number, however, of such cases, lactation had been
continued for an unusual length of time.
Vomiting, griping, and diarrh[oe]a, are so common among infants, and
arise in general from causes apparently so evident, that, unless severe
or of long duration, they rarely form the subject of minute inquiry.
Hence these complaints are, perhaps, not so often attributed to
deteriorated milk as they ought to be, although the fact of their
occasionally originating from a morbid condition of this fluid, (and
therefore from protracted lactation as one cause of the latter effect,)
is too well established to be questioned. Dr. Underwood observes, 'has
not every Physician of experience seen infants frequently thrown into
tormina immediately after coming from the _breast of an unhealthy
mother, or one who has but little milk_?'[N] and Mr. Burns states, that
if the usual periodical appearance should return, 'the milk is liable to
disagree with the child, and produce vomiting or purging;' while Dr.
Hamilton expressly mentions that diarrh[oe]a is 'not unfrequently
_occasioned by the depraved quality of the nurse's milk_.'
The two former authors merely testify to the fact of diseases being
produced by the milk, while the latter more explicitly mentions the
cause from which they proceed.
Debility, Tabes Mesenterica, and Scrofula, may also be traced to the
same origin, as every practitioner of experience must have repeatedly
observed: so may that intractable disease, termed Rickets; and it is
worthy of notice, that among the worst instances of this malady I have
seen, were two sisters, _who had been suckled for a very unusual
period_. Neither do I doubt the probability of Epilepsy being similarly
occasioned; and although, I must candidly own, I cannot produce numerous
cases in proof of the correctness of such hypothesis, yet I recollect
that of a girl affected with this complaint, respecting whom the mother
stated (and I recorded the fact at the time) that she had been '_suckled
for two years_;' and, to use her own expression, had 'never been well
since.'[O]
Convulsions arising from protracted suckling, or simply from the nurse's
milk becoming deteriorated at any period, are very common, and I have
kept notes of many such cases that have occurred in the course of my own
practice; which, however, I abstain from here inserting, being anxious
to prevent the present publication from swelling into a volume. Indeed,
the occurrence of convulsions from this cause (diseased milk) has been
mentioned by several of the best authors. Mr. North, in particular,
(whose excellent work on Convulsions should be in the hands of every
practitioner) observes--'It cannot be doubted that children suffer, that
their health is destroyed, and the foundation laid for convulsive
diseases, by _sucking unhealthy nurses_.' 'A predisposition to
convulsive affections in children may be originally produced in
consequence of their being suckled by a nurse addicted to the frequent
use of spirituous liquors. In several instances I have known children
rapidly recover their health when the nurse was changed, who had
exhibited most of the premonitory symptoms of convulsions while they
were suckled by a woman who indulged in the common vice of
gin-drinking.' And Mr. Burns also makes the following remark--'Violent
passions of the mind affect the milk still more;--it often becomes thin
and yellowish, and _causes_ colic, or even _fits_.' It is needless,
however, to say more on this topic, since it is one which no longer
admits of discussion.
The reader may now, perhaps, expect that I shall introduce a series of
practical deductions from the foregoing facts and observations; but
such is not my object upon the present occasion. I merely wish to call
the attention of practitioners and the public to the subject of these
pages, and shall thus discharge, as I conceive, an imperative duty to
society. Having mentioned what I am induced to consider a frequent cause
of inflammation of the investing membranes of the brain in children, my
undertaking is completed. The Profession does not require, and the
public would not be benefited, by the addition of lengthened
therapeutical rules; for I am convinced, there is not a greater
imposition to be found than the doctrine that non-medical persons can
treat diseases with success by means of popular systems of medicine,
'_practical_' treatises, &c. Such books have often done irreparable
mischief--certainly much more harm than good; and so far from injuring
the profits of medical practitioners (as some appear to suppose), have
greatly added to the number of their patients.
I avail myself also of this opportunity to enter my protest against the
ill-judged and mischievous practice of those patients who confide upon
many occasions in the opinion of their nurse, rather than that of their
medical attendant, and who, in consequence, often injure themselves
essentially by deceiving the latter. With respect to this mistaken
preference, Dr. Dewes has well observed--'Let it not be hastily assumed
that there is more safety in following the directions of a nurse than
those of the physician, because she may have had some experience; for it
must be quickly perceived that the calculation is much in favour of the
latter, since the nurse can attend but twelve patients per annum, while
the physician may visit many hundreds in the same period--besides, his
knowledge of the laws of the human system gives him a very decided
superiority.'
In conclusion, it is right to observe, that protracted suckling being a
custom much more prevalent among females of the lower orders than those
of a superior rank, it must follow as a necessary consequence, that
_Meningitis, and other disorders resulting from this cause, are
proportionably less frequent in private than in public practice_. This
remark, it is evident, should be remembered, in order to obviate
apparent discrepancies which otherwise might appear irreconcilable with
the opinions I have expressed. In the truth of those opinions I feel the
most perfect confidence, and cannot but hope that their promulgation
will hereafter prove extensively beneficial, since precautionary, and
even therapeutical measures may be founded upon them, which, if
uniformly adopted, will not only prevent much ill-health and suffering
to mothers, but will also afford the means of saving many children from
perishing by one of the most painful and fatal diseases to which they
are subject.
POSTSCRIPT.
Being anxious to obtain additional evidence with respect to the
production of Meningitis in children by protracted suckling, rather from
the experience of others than my own, I shall feel greatly obliged to
any practitioners who will favour me (free of postage) with either facts
or cases tending to corroborate the truth of the doctrine contained in
the preceding pages; and should I be enabled publicly to avail myself of
such communications, it is, perhaps, unnecessary to say, I shall not
neglect the opportunity of expressing my acknowledgments to their
respective authors. The intelligence and liberality characterising the
members of the medical profession generally, preclude all apprehension
on my part that the above appeal will be made in vain.
NOTES
Note A (page 1).
A dark-green substance of variable consistence, contained in the bowels
of infants at birth.
B (page 4).
I beg leave to observe that I make these statements with some confidence
as the result of personal inquiries instituted a few years ago among the
patients of two of the Lying-in Establishments of this metropolis.
C (page 8).
Since the above was written, a friend who lectures on Chemistry in the
metropolis has kindly promised me his valuable assistance in making the
experiments here suggested.
D (page 10).
In two cases where suckling was protracted to _three years_, the
subjects of this baneful practice did not equal in size an ordinary
child of half their age. One of them became idiotic, and afterwards died
of Hydrencephalus, under my care; the other was affected with Tabes
Mesenterica,--the result I did not witness--but believe the disease
terminated fatally.
E (page 25).
Vide Medical and Physical Journal for August 1827.
F (page 25).
That is, any period beyond nine or ten months.
G (page 25).
_Meningitis_,--I use this term as being more pathologically correct than
_Cephalitis_, which I formerly adopted.
H (page 26).
See the above conditional sense in which I employ this term.
I (page 26).
It is a curious fact, which I believe has not been noticed by any other
writer, that female children labouring under attacks of Meningitis are
sometimes affected with leucorrh[oe]al discharges. I have met with
several cases of this description: the children also of women subject to
leucorrh[oe]a will often, at an early age, be found affected with the
same disease. Hence it would appear that leucorrh[oe]a is occasionally
hereditary.
K (page 37).
It is unquestionable, notwithstanding the scepticism of some
practitioners on the subject, (whose opinions are entitled to
deference,) that _recovery may take place, under appropriate treatment,
in cases of Meningitis, even after effusion has unequivocally occurred_.
Preceding authors have noticed this fact, which I can confirm by my own
experience. Practitioners cannot be too frequently reminded of it, and
warned not to despair of success even in the last stage of
Hydrencephalus.
L (page 42).
For the information of the _unprofessional_ reader, I beg to observe,
that the membranes of the brain are _serous membranes_.
M (page 48).
It will be observed hereafter, that Mr. North has experienced similar
beneficial effects from the course above recommended, in cases where
_convulsions_ have been caused by _diseased milk_;--a strong
corroborative coincidence.
N (page 52).
I believe that where the milk is greatly diminished in quantity, it will
also be found deteriorated in quality.
O (page 53).
In the communication above referred to from Mr. Griffith is the
following:--'Mrs. A. has a family of four children, all of whom she
suckled for a period varying from _seventeen_ to _twenty-two
months_:--_not one of the four is healthy_.'
BY THE SAME AUTHOR,
Preparing for publication, in one small volume, 8vo.
OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the Principal
Symptoms of DISEASE in INFANTS and CHILDREN, with the best modes of
detecting them;--interspersed with Practical Observations, and intended
as a clinical guide to Students, &c. &c.
Also, in 2 vols. 8vo.
The EIGHT BOOKS of ARETAEUS of CAPPADOCIA on the Causes, Symptoms, and
Treatment of ACUTE and CHRONIC DISEASES. Translated literally from the
original Greek, and supplied with critical and explanatory Notes, Tables
of the Weights and Measures, &c. &c.
* * * * *
By the same Author,
Recently published by Longman and Co. in 8vo., boards, price 14_s._
TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in the
Years 1827-29;--intended to give some account of Russia as it is, and
not as it is represented to be.
Printed by W. CLOWES, Stamford-street.