Remarks on the Subject of Lactation Part 4

_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, const.i.tuting 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 dent.i.tion, 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 a.s.sert 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 pa.s.sage 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 relinquis.h.i.+ng 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 circ.u.mstance. 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. Mult.i.tudes, 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 cla.s.s, from those most distinguished by intellectual superiority and its successful application, down to the humble writer of the present observations.

Facts are continually pa.s.sing 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, pract.i.tioners 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 pract.i.tioner 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 pract.i.tioners, 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 a.n.a.logy, 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 s.e.xtum 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 const.i.tutions _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 circ.u.mstances, 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 circ.u.mstance 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 circ.u.mstances: 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 diarrha, 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 diarrha 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 pract.i.tioner 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 pract.i.tioner) 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 pa.s.sions 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 pract.i.tioners 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 pract.i.tioners (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 a.s.sumed 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 peris.h.i.+ng 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 pract.i.tioners 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 inst.i.tuted 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 a.s.sistance 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.