Previous pregnancies have a marked influence on the qualities. of the milk; women who have already had children (one or two, better. for example) make better nurses than primiparæ; their milk is both more abundant and more rich; on the contrary, it becomes a hun impoverished after too frequent pregnancies.

The following is the table of means furnished by the analyses of MM. Vernois and Becquerel, and, as will be perceived, the result of the analyses confirm my assertion:

is Doviti.

Modifications from constitution, temperament, and age. All that is known on this subject may be reduced to the statement that the most robust nurses are generally preferable to the more delicate ones, and that women of a lymphatic temperament possess more abundant milk than women of a sanguine, or bilio-sanguine tempera-owl ment. As regards age, well-developed women, neither too young nor too old, have the best milk.

I subjoin a table by MM. Becquerel and Vernois, from which we may learn the influence of the constitution of nurses on the composition of the milk. It is a curious fact that the women noted as being of a feeble constitution, present the richest milk, and one which approaches closer to milk in its normal state.

Strong constitution.
1032.97

Specific gravity.
Water

Solid constituents

Sugar

Butter

Caseum

Salts

911.19

88.81

32.55

25.96

28.98

1.32

Feeble constitution.
1031.90

887.59

112.41

42.88

28.78

39.21

1.54

The following table exemplifies the influence of age, and suggests the preference that should be given to nurses from twenty to thirty-five years:

.(

From all these analyses, which represent so many means deduced from particular observations, and also from many others which I am unable to bring forward, it results that in the physiological state of the nurse, the milk is more or less modified as to the proportion of its elements, without departing much from the limits fixed by normal means. Still, by the comparison of the different analyses, and by the aid of a little reflection, we may deduce certain propositions which constitute so many laws as to the relative changes in the elements of milk in comparison with each other. This MM. Vernois and Becquerel have very judiciously accomplished. Thus

"When the quantity of the elements of the milk is raised, the increase principally affects the water, the sugar, and the caseum.

"When, on the contrary, the quantity of the elements is lowered, the diminution principally affects the salts and the butter.

“When the sugar or the salts increase or diminish, the specific gravity does not vary.

"When the butter and the water increase, the specific gravity is lowered; and when these two elements diminish, it becomes materially raised.

The increase in the quantity of the caseum also increases the specific gravity; its diminution makes it vary but little.

"When the whole quantity of the solid constituents of the milk increases comparatively to the quantity of water, the specific gravity is increased.

"Whenever the four solid constituent elements of the milk have increased in proportion, the water has diminished in quantity; and vice versa."

The elements of the milk are not mutually combined together, and there exists no constant and regular proportion, as to the quantity in which they are produced. The element in which the greatest increase is evinced should be ascertained, and so with the other elements, in order to establish the degree of relative importance attached to each element.

Hitherto no one has been able, either from the study of the specific gravity, or from that of the butter- which has been attempted by means of the lactoscope, and of the microscope-to give a correct idea of the richness of the milk. These means enable us to state if the milk contains little or much water-if it contains more or less butter, and that is all. MM. Becquerel and Vernois have succeeded much better; they have demonstrated, by experience, that the quantitative analysis of the elements of milk can alone enable us to appreciate its qualities.

MODIFICATIONS OF THE MILK FROM PATHOLOGICAL CAUSES. Various moral and pathological circumstances may act on the lacteal

secretion as they act on all other secretions; the milk may be rapidly changed in quantity and in the proportion of each of its constituent principles; hence result different degrees of general abundance, or of the richness and poverty in this secretion.

Three kinds of influences exercise a very decided action on the quantity and on the proportion of the elements of the milk. These are, oral. 1stly, those of substances introduced accidentally or with food into petions, the stomach; 2ndly, those of the moral affections; 3rdly, those of diseases, properly so called.

Changes effected by medicinal or other substances.

Some kinds of colouring matter, such as madder, pass into the milk, another appears to become developed there in some of the ruminantia I refer to the blue matter, analogous to indigo in its physical

and chemical qualities, which sometimes forms a layer on the milk of cows or of sheep whose constitution is disposed thereto, and which have

been fed on saint-foin.

The bitter principles of wormwood, the odorous principles of garlic of thyme, the purgative principles of hyssop, pass into the milk.

But what concerns us most is, to discover if medicinal substances pass into the milk, and may thus be transmitted from the mother to the child.

M. Péligot, in his experiments upon asses, has detected the iodide of potassium in their milk, after the sixth day of administration; he has also discovered therein chloride of sodium and other salts.

This

Se

ion.

[Simon (Op. Cit., p. 60) has sought in vain for ferrocyanide of potassium in the milkedet of women who were suckling, and to whom he had given it in doses of six drachms. After the lapse of two days, twenty-three grains of the iodide of potassium were given to the same woman, but no traces of this salt could be detected in the milk. Simon also attempted in vain to detect sulphate of magnesia in the milk of a woman who was suckling, and to whom he had administered it in a sufficient dose to act as a laxative.

Herberger has detected iodide of potassium in the milk of women. Day has, on several occasions, observed the ordinary indication of iodine on the addition of zyloidin, or of starch, and a drop or two of nitric acid, to the urine of infants at the breast, during the period of the mother taking three grains of iodide of potassium thrice a day-a convincing proof that the salt had entered the milk. There can be no reasonable doubt that mercurial preparations do enter the milk, although they have never been detected there. The effects of mercurial preparations in infants when administered to the mother are undoubted, and the salutary effect of the milk of animals to which this agent has been given.-M. A. Lebreton, Journ. des Connoisseurs Medico Chirurg., tom. iv., p. 200. Orfila believes that by acting on a sufficient quantity, and making use of the most delicate process, mercury may be discovered.-P.H.B.]

Changes produced by moral affections.

Facts tending to demonstrate the fatal influence which fright, anger, or nervous attacks exert on the quality and quantity of the milk are

Sached

Especially

32

HYGIENE OF INFANTS.

[Part I. everywhere to be found, but we are completely ignorant of the kind of change which this secretion undergoes in such circumstances-changes often sufficiently powerful to cause the immediate death of the nursling, of which an example has been cited.

Fu Sufs It is the same with the mammary gland as with the lachrymal and some other glandular organs situated on the surface of the body; it is intimately connected with the energy and agitations of moral

life.

When the mother experiences violent moral emotions, the child which she is suckling is restless, ill at ease, and is sometimes seized with convulsions. This unfortunate accident may be prevented by drawing on the milk contained in the breast at the time of the moral impulse, and allowing the child to suck only when the mother has recovered her former tranquillity.

[The influence of mental emotion on the milk cannot be better illustrated than by the following case, related by Tourtual (Praktische Beihräge zur Therapie der Kinder-Krankheiten, Münster): "During Easter, 1821, a carpenter of this place * (Munster) quarrelled with a soldier, who was billetted on him, when the latter fell upon him with his drawn sword. The carpenter's wife, at first, trembled with fear and horror; then, suddenly throwing herself between the combatants, she wrested the sword out of the soldier's hand, broke it, and flung it away. Some neighbours, attracted by the noise, hastened to the spot, and separated the men. The mother, while thus violently excited, and while this mad uproar still continued, took up her child from the cradle where it was playing, and gave it the breast. The infant was in perfect health, and had never had a moment's illness. After some minutes it became restless, and left off sucking; it panted and sank dead in its mother's lap. A quarter of an hour had scarcely elapsed when I saw the child. It was as though sleeping undisturbed in its cradle, and the body had not yet lost its natural heat. I applied immediately all the resources of my art (although I could not understand how death could take place so rapidly from such a cause), but in vain.” Broadhurst (Medical Times, p. 106, 1854) relates the following case: "E. B., aged seventeen, when a child of nine months' old, her mother, who was still suckling her, received the unexpected intelligence of the death of her father at sea, and was naturally much affected on hearing the report. A few days later, she was alarmed by her child shuddering and fainting in her arms, without any apparent cause. The attacks were repeated, returning at short intervals, and terminated in convulsions; the toes were drawn downwards and the feet inwards, and the hands were clenched. At two years of age these fits became less frequent, and assumed the ordinary character of epileptic attacks. The extensors and adductors of the feet, and the flexors of the fingers, were slightly but permanently retracted.

"So many instances are now on record in which children that have been suckled a few minutes after the mothers have been in a state of violent rage or terror, have died suddenly in convulsive attacks, that the occurrence can scarcely be set down as a mere coincidence; and certain as we are of the deleterious effects of less severe emotions upon the properties of the milk, it does not seem unlikely that in these cases the bland nutritious fluid should be converted into a poison of rapid and deadly operation.”—CARPENTER (Manual of Physiology, 2nd edit., p. 509).—P.H.B.]

Thus Parmentier and Deyeux relate that in a woman, when labouring

under nervous attacks, the milk became in less than two hours almost transparent, and, moreover, viscid like the white of an egg, and resumed its natural qualities only after the cessation of the attacks.

In a case of this kind, MM. Becquerel and Vernois managed to collect the milk and analyse it.

This diminution in the solid constituents of milk, and especially of butter, together with the increase in the amount of water, is a very curious fact, and one worthy of the greatest attention.

It is, moreover, known, and Burdach* assures us, that cows give less milk when they are milked by an unknown hand. According to Schubler, they do not furnish any when they have been ill-treated by the milker, or when they are surrounded by a great number of strangers. As there is no muscular apparatus in the breast, this diminution in the flow of milk cannot be attributed to it. It is entirely an involuntary huuks.

effect, which depends at first on the repugnance of the animal causing the blood to flow in less quantity into the mammary glands, which become less active, and afterwards on a sort of closure of the excretory orifices by the erectile tissue which surrounds them.

It is also a fact that the sight of the nursling, the idea of seeing it at the breast, and the joy which certain mothers thence experience, exercise a moral influence over the secretion of the milk entirely independent of their will. They feel the draught of milk as soon as they behold their child, or if they think of it too deeply; and in a woman who saw her child fall to the ground, the flow of milk ceased, and did not reappear until the child, having quite recovered, attempted to take the breast. Change caused by diseases properly so called.

That the lacteal secretion becomes altered by disease is incontestable, but until the present time the nature of this change was not known. M. Donné has described those only which may be observed by means of the microscope, in two morbid conditions, viz., those of congestion and abscess of the breast. The results published by this physician will be presently stated. In the other diseases of the nurse (and they are numerous) the modifications in the composition of the milk have been but slightly investigated. MM. Vernois and Becquerel have progressed in this new and promising path; they have analysed the milk of forty

* Traité de Physiologie; Paris, 1839; t. iv, p. 397.

D