continued in tolerable health, without suffering from diarrhoea, until, 4. Congestion and inflammation of the breast are sometimes the causes of an alteration of the milk which differs from the preceding, and which may prove very prejudicial to the child. I refer to the contamination of this liquid with pus. Abscesses of the breast formed in the very tissue of the mammary gland often destroy some glandular lobules, and lay open the lactiferous conduits. These ducts thus remain gaping in the midst of the abscess, /19 incessantly absorbing the pus contained in its interior, and carrying it outwards through the orifices of the breast, where it mixes with the kung milk derived from the other portions of the gland. is kad The microscope very readily detects this alteration of the milk which was first pointed out by M. Donné, who relates several examples of it in his work. Its existence has been very frequently verified since that period, and it is impossible not to accept it as an incontestible fact. It is almost unnecessary to observe that such a disease of the nurse may exercise the most pernicious influence over the health of the child. The symptoms which thence result are at present undetermined, they Ck appear to be concentrated on the mucous membrane of the alimentary canal. Thus digestion becomes disturbed, the child vomits and has diarrhoea. However, in cases very nearly similar, in women whose breast was the seat of an inflammatory and phlegmonous process, M. Dubois has seen erysipelas and gangrenous abscesses make their appearance in the child, especially in the scrotum, which have rapidly terminated in death. It is true that in these women no microscopical analysis of the milk was made, and it cannot be stated that it contained pus, which is, however, exceedingly probable. However this may be, it remains proved that the milk proceeding from an inflamed breast, whether it contains pus or whether it does not, is excessively prejudicial to children.* 144 5. Lastly, we must refer to a particular state of some females, in which the milk flows mixed with a certain quantity of blood. This phenomenon, a very extraordinary one, if there be no mistake in its interpretation, which it is impossible to believe, has never been yet met with in women. M. Donné has occasionally met with it in animals. * Donné, Cours de microscopie. This physician has discovered in the reddish milk of two asses a certain ever number of blood globules, recognizable by their form and by their di colour, soluble in ammonia, placed in the midst of the milk globules. This alteration is not met with in women; and, in the case in which human it was believed to be observed, this blood was not formed simultaneously J with the milk in the interior of the breast, it proceeded from the exterior, and from a fissure of the nipple. But the accidental mixture of blood and milk, so frequently in fissure in of the nipple, must not be confounded with the natural mixture which would be the result of the alteration of the secretion of the liquid. One of these phenomena is purely local and without effect on the health of the child; the other on the contrary, is allied to a general disposition of the nurse which is assuredly very serious, but the character of which us we cannot precisely determine, since it has not been observed in the human species. then hav. From the preceding considerations, it results that the diseases of the littl nurse, accompanied by an alteration of the milk, appreciable to our means of investigation, have not an immediate action, particular and special immedia to each of them, over the health of children. In the child, these affections have for a common result the insufficiency of nutrition,t, followed by the irritation of the alimentary canal, characterized by colic, vomiting, and diarrhoea. Although they may be accompanied by the alteration of the milk, described under the terms of richness or ti Euch of concentration, caused by its alteration and by the elements of the colostrum, sometimes by pus, their effect is not less the same. The out all symptoms which are developed are always seated in the alimentary tend the canal, and their nature is always similar. Thus, then, the vigour of the constitution and the normal individualitate modification, which are in relation with the rich and copious secretion of a milk too abundant in solid principles, are included in the same Ailieuten category as the diseases which determine the impoverishment and the concentration of this liquid, in regard to the influence of these general Qual dispositions of the nurse on the health of the children. The same is the case with inflammatory diseases, with pleurisy, pneumonia, &c. duling Their immediate influence is similar to that of the septic diseases, as Kulviim puerperal and typhus fever. Moreover, if the diseases referred to, exercise a pernicious influence over the secretion of the milk, it must not be believed that they will invariably disorder the health of the children; very often indeed, the nursling experiences no injury from sucking the nurse who is ill. Thus, I have seen women attacked with acute articular rheumatism, incapable of holding their child themselves which was presented to their breast; die others who were affected with pneumonia, with phthisis, with puerperal fever, with typhoid fever, &c., with or without any alteration of the rotues milk, who did not cease to suckle their child, which did not appear to suffer from it. the child There are great individual differences in this respect. A child may suffer under the influence of its nurse's milk, probably in a manner quite different from another which might be in its place. A woman came under my notice who menstruated during lactation, and suckled at the same time her own child and a strange child; the latter was indisposed where an at each menstrual epoch, had colic and diarrhoea; the former experienced nothing of the kind. hile With these facts before us, which are so often contradictory, and of a nature to shake the conviction which should be entertained on the heblox. subject of the influence of nurses on their children, what is to be done and on what shall we decide? We must act with prudence, and when a nurse is indisposed, it is best to wait and observe what takes place in the nursling. If serious symptoms on the part of the alimentary canal appear, lactation should be suspended until further orders, and the child confided to a fresh nurse, if the state of the former does not rapidly improve. 2ND CLASS. Immediate influence of diseases of the nurse, without alteration of her milk. This denial conceals our ignorance. It is evident that if a nurse, whose milk presents no appreciable modification, is capable of producing bad symptoms in the nursling, it is certain her milk is altered in a way that we are not able to detect. In fact the milk is the necessary intermedium of this morbid influence. It is impossible to deny the existence of indiscernible alterations of this fluid, when we can ourselves determine them at will, by the introduction of medicinal substances into the economy. The dose of to a grain of the proto-iodide of mercury, administered every day to the nurse, suffices to cure syphilis in the child, although we have never been able, by the most minute analysis, to succeed in detecting traces of this substance in the milk. Consequently, if we can modify the qualities of the milk, without being able to perceive it otherwise than by the physiological and therapeutical results, there is reason to believe in the existence of 2 unknown and inappreciable alterations of this liquid, when they are demonstrated to us by a phenomenon as certain as the disease of the child, supervening at the time of derangement in the health of the nurse. However this may be as regards those indescribable alterations of the milk, which exist in nurses who are a prey to moral or nervous affections, or in women whose constitution is subject to a certain cachexia, scrofulous, or syphilitic-what concerns us is, to determine which amongst these morbid dispositions are immediately prejudicial to children. Moral affections, and the nervous agitation of nurses, have sometimes the greatest influence over the nutrition of children; but this influence ! is far from being constant, and should be considered, in my opinion, ren as being quite exceptional. The mother and the nurse who are not attached to their nursling urter or make indifferent nurses; their milk does not flow with abundance, as in mothers devoted to their child; they do not experience the internal use commotion known under the term of the draught of the milk, and which takes place at the sight, or at the thought alone, of those to the Child whom they may soon give suck. The child suffers, and its development esults is retarded-fortunate, indeed, if it does not fall ill. These are the results of the indifference and of the weariness which may be felt in fulfilling the duties of nurse. Emotions of all kinds, violent anger, deep grief, and, in general, all the passions, rapidly change the composition of the milk, and may render it immediately injurious to children. Thus, a nurse, while yet alarmed at the danger her husband had just experienced in a quarrel with a soldier who had drawn his sabre against him, and from whom she had snatched this weapon, gave her breast to her child, eleven months old, and in good health; the child took it soon quitted it convulsed-and died in a few minutes.* The case related by Deyeux and Parmentier of a lady subject to nervous attacks, who, on these occasions, observed her milk altered and viscous like the white of an egg, is well known. It is not stated what was the result of this nourishment on the child, but it may be supposed that lactation had been interrupted, for a milk of this composition could not be otherwise than dangerous. These sudden alterations of the milk, which are frequently inap-preciable, and the nature of which is unknown-often determine convulsions. l the latter. Emotions Gear or Aufir Rod. Thus, I have seen a very nervous lady, much agitated in the hot season by the electrical condition of the atmosphere, and especially by a storm, who could not give the breast to her child without almost endurs immediately communicating to it a considerable agitation, which several times amounted to convulsive spasm. She thought it prudent to suspend the lactation when she found herself in such a state, and the symptoms were no longer observed in the child. It is related that a very lascivious young woman observed the child which she suckled fall into violent convulsive movements each time she gave herself up to coitus. This fact appears to justify the aphorism of Galen: A Venere omnino abstinere jubeo omnes mulieres quae pueros lactant. But numerous examples, on the other hand, tend to demonstrate that the influence of venereal pleasures is not always Case * Ann. de litt. medic. Britan.; and Guérard, Dictionnaire de médecine; art. LAIT. Single Coitus. Is not a Chunch Arcido agniest so injurious. Numerosissimas vidi mulieres, quae singulis fere annis feliciter pariebant, licet ubera praeberent infantibus.-Van-Swieten. There are, moreover, practitioners who go much further, and who even recommend, for the sake of the nurse, to grant her the satisfaction of seeing her husband. Certum est occulta desideria pejora et magis noxia esse, quam plena honestarum fœminarum gaudia, et rarum moderatumque Veneris usum. -Platner. We cannot irrevocably decide this question from certain particular facts, without running the risk of falling into error. Sexual congress can only be immediately dangerous in some nurses whose excitement is extreme, and whose senses are But what should absolutely forbid it capta exceedingly impressionable. is, that pregnancy, which is not perceived until some time after, is often the result of it, and that, as we have seen, the state of the milk anwhich usually accompanies this condition, being frequently injurious to the nurslings, we are obliged to confide them to another nurse. The premature reappearance of the menses is a phenomenon which gives mothers much uneasiness. A great influence over the health of children was formerly attributed to it; but this is not generally the case. It is a question which cannot be decided à priori for all women, hand which should be decided by the observation of each of them. Thus, I have asked nurses many questions on this subject, to discover if they had their monthly periods in the antecedent lactations, and if their child appeared to suffer from it. I have, on the other hand, observed a great number of nurses who had the premature return of the menses, and I have arrived at these results: 1st. That the menses reappear in one third of the women between the fifth and seventh month of lactation. 2nd. That frequently the women have only their menses once, which indicates aptitude for conception; they then become pregnant, and the menses do not appear again. 3rd. That the generality of children do not appear to suffer from this state of the Y nurse. 4th. There are some who at this time have colic, slight rest lessness, and sometimes a mild diarrhoea. 5th. That others, and these not present appreciable changes to our means of investigation. Sommerring relates a very curious instance which, if it were more frequent, would appear to demonstrate the impossibility of opposing the He desire of nature with regard to lactation by the mother. The milk of a hingerie woman who suckled her own children without inconvenience produced convulsions in other children.-Andral, Leçons Orales. This fact will , not assuredly destroy the habit so readily acquired of trusting children |