Remarks on the Subject of Lactation Part 1

Remarks on the Subject of Lactation.

by Edward Morton.

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 pa.s.sed 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 antic.i.p.ate 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._

CHAPTER I.

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

No sooner has the child been ushered into the world than the b.r.e.a.s.t.s of the mother pour forth their milk for its sustenance. This bland fluid is secreted from the blood, and varies, in quality and quant.i.ty, 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 circ.u.mstances, 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 r.e.t.a.r.d and alter the nature of the secretion furnished by the b.r.e.a.s.t.s 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 quant.i.ty. Mr. Burns a.s.serts 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 diarrha 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 circ.u.mstance 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 quant.i.ty. 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 quant.i.ty 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 b.r.e.a.s.t.s 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 b.r.e.a.s.t.s; 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 b.r.e.a.s.t.s continue to receive a sufficient quant.i.ty 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 b.r.e.a.s.t.s are robbed of it, and the secretion of milk, if not altogether suppressed, is rendered either deficient in quant.i.ty 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 nouris.h.i.+ng diet. What rational argument, therefore, can be offered why he should still be suckled? If we observe the brute creation, do any a.n.a.logies 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 quant.i.ties 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 subst.i.tute 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 const.i.tution, 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 quant.i.ty, 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 appet.i.te 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 pract.i.tioners 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:--