five nurses affected with different acute or chronic diseases, and it will be observed that conclusions full of interest have been the result.

Generally it may be stated that in all acute diseases the quantity of milk is very much diminished. Indeed, if the fever is very acute, the secretion becomes completely dried up.

By optical analysis, M. Donné has discovered that in congestion of the breast the milk resumes the characters of the colostrum. Granular bodies are also observed in it, and aggregations of globules united by

mucous.

In abscesses of the breast, which involve the glandular tissue itself, as well as in sub-mammary abscesses opening in front, or in mammary abscesses properly so called, globules of pus, recognizable by their roughened outline, &c., are observed.

By means of chemical analysis, it is observed that in diseases, whatever their nature may be, the proportion of the solid constituents increases at the same time that the proportion of water diminishes. From the analysis recorded below, the fact appears more decided in chronic diseases than in acute febrile disorders. But this increase of the amount of the solid constituent principles of the milk constitutes a serious alteration, which frequently produces indigestion and consecutive attacks of enteritis in the child.

In twenty-seven cases in which the milk of nurses labouring under chronic diseases was analysed, MM. Vernois and Becquerel arrived at the following results:

On the other hand, in eighteen cases of acute febrile disease:

In addition, the following is a table in which each of the diseases mentioned above is given more in detail, with the means for each particular disease.

DISEASED NURSES.

SUMMARY OF THE INFLUENCE OF CHRONIC DISEASES IN PARTICULAR ON THE COMPOSITION OF THE MILK.

SUMMARY OF THE INFLUENCE OF SOME ACUTE FEBRILE DISEASES IN PARTICULAR.

な

The quantity of this liquid may also be estimated by the sensation experienced by the nurse at the moment of lactation. This sensation is known under the name of the draught of milk. In fact, women, whose milk is very abundant, feel it ascend in proportion as the child sucks; their breasts become distended, and it flows away in abundance from the breast which is unoccupied.

We shall conclude this study of woman's milk by some practical considerations, which closely result from what has been just stated. Supposing the choice of a nurse is about to be made, the information we have now acquired will be of the greatest service. In order to be perfect, she should fulfil the following conditions: 1, she should be in good health; 2, of a robust constitution, and of a bilio-sanguine or lymphatico-sanguine temperament; 3, she should be a mother for the second time at least; 4, from twenty to twenty-five years of age; 5, she should have been confined at nearly the same period as the birth of the nursling about to be confided to her. When these conditions are fulfilled, the milk cannot fail to be suitable; but it may be equally good although some of these conditions may be wanting; so that, without neglecting the examination of the nurse, the characters of her milk should often be studied before passing a final judgment.

Here the question presents itself: by what signs, and by what means, may we recognize the quantity and the qualities of the milk?

It is a difficult matter to measure the quantity of the milk of a nurse. It may be approximably obtained by the observation of the child which sucks. If it makes considerable efforts, if it often seeks the breast, it is in consequence of the milk being in insufficient quantity. If the repasts are soon finished, and if it is contented with making only a small number of them in a day, and especially if the milk trickles from its lips, then it is abundant. The approximation can be obtained in a still more definite manner, by the method of M. Natalis Guillot, who weighs the child before and after being put to the breast. The difference in weight indicates the quantity of milk swallowed. Each time it is nursed it should draw from one ounce and a half to five or seven ounces and a half from the breast; but any quantity of milk below one ounce and a half is insufficient for the requirements of nutrition.

There are two methods of appreciating the qualities of the milk, optical or chemical analysis, which enable us to ascertain the proportions of the elements of this liquid.

By means of optical analysis, the richness and the perfect elaboration

of the milk may be determined; that is to say, the quantity of globules

or of cream which it contains, and, further, the greater or less size under which the fatty matter presents itself.

The study of the globules is very much facilitated by the microscope.

Their number is in relation with the richness and the nutritive qualities of the milk. The more globules it contains, the more substantial is this liquid; the caseum and the sugar being often in proportion to the quality of the milk globules, which represent the fatty or butyraceous portion. Too many or too few globules is an equally unfortunate ebules

circumstance.

The size of the globules is of the greatest importance.

When the microscope presents to us very small globules, or globular ro dust so to speak, it is to be presumed that the milk is imperfectly elaborated; when it shows us globules of too large a size, the milk is indigestible.

means.

The richness of the milk may be further determined by various The appearance alone may give us a general idea of it: thus the milk is so much the more suitable as it is more opaque and dull. The microscope will afford a rather more precise idea of the volume and of the quantity of the globules.

Lastly, two instruments have been proposed in order to measure, with more or less exactness, the richness of the milk; understanding, by this term, only the proportion of butter it contains, a proportion which, moreover, does not invariably follow that of the caseum. One of these instruments, called the lactometer, has been invented to allom measure the thickness of the layer of cream. It is founded on the fact, that when milk is left to itself it becomes separated into two layers, the upper of which, due to the aggregation of the milk globules, constia Fred. tutes cream; now the quantity of cream represents the richness of the milk, at least as regards the fatty matters. The lactometer consists of uten a tube divided into 100 parts; after having filled it with milk and allowed it to rest twenty-four hours, in order that the separation may be complete, the number of degrees occupied by the cream is noted. Milk of good quality contains about three parts of cream in 100. Another and a more correct method is that of M. Donné, and bears l the name of lactoscope; it measures the opacity of the milk, which, is p known to be proportional to the quantity of butter or cream.

Forder

"The lactoscope consists of an eye piece, composed of two concentric tubes, fixed one upon the other by a screw. Each tube bears a flat glass; the two glasses may, by means of a turn of the screw, be brought into. perfect contact. The relative position of the tube is indicated at this instant by the coincidence of a zero placed upon one of them, opposite a small arrow engraved on the other; the space generated between the glasses, in proportion as the tubes are unscrewed, is indicated by a division traced on the circumference of the internal tube. As the inclination of the screw is very slight, it will be understood that the division marked on the circumference will readily permit the appreciation of the quantities, however small; since, for example, this circumference,

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.

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

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 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

C 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