Chapter XV: Part VII: The Change of Life (7)

The room during confinement should be kept quiet. Too many persons must not be allowed in it, as they contaminate the air, and are apt by their conversation to disturb the patient, either exciting or depressing her. So soon as the head is born, it should be immediately ascertained whether the neck is encircled by the cord; if so, it should be removed or loosened. The neglect of this precaution may result fatally to the infant, as happened a short time since in our own practice; the infant, born a few minutes before our arrival, being found strangled with the cord about its neck. It is also of importance at once to allow of the entrance of air to the face, to put the finger in the mouth to remove any obstruction which may interfere with respiration, and to lay the babe on its right side, with the head removed from the discharges. The cord should not be tied until the infant is heard to cry. The ligature is to be applied in the following manner:--A piece of bobbin is thrown around the navel-string, and tied with a double knot at the distance of three fingers' breadth from the umbilicus; a second piece is tied an inch beyond the first, and the cord divided with the scissors between the two, care being taken not to clip off a finger or otherwise injure the unsuspecting little infant, as has occurred in careless hands more than once. When the child is separated from the mother, a warm blanket or a piece of flannel should be ready to receive it. In taking hold of the little stranger, it may slip out of the hands and be injured. To guard against this accident, which is very apt to occur with awkward or inexperienced persons, always seize the back portion of the neck in the space bounded by the thumb and first finger of one hand, and grasp the thighs with the other. In this way it may be safely carried. It should be transferred, wrapped up in its blanket, to some _secure_ place, and never put in an arm-chair, where it may be crushed by some one who does not observe that the chair is already occupied. The head of the child should not be so covered as to incur any danger of suffocation.

ATTENTION TO THE MOTHER.

When the after-birth has come away, the mother should be drawn up a short distance--six or eight inches--in bed, and the sheet which has been pinned around her, together with the temporary dressing of the bed removed, a clean folded sheet being introduced under the hips. The parts should be gently washed with warm water and a soft sponge or a cloth, after which an application of equal parts of claret wine and water will prove pleasant and beneficial. We have also found the anointing of the external and internal parts with goose grease, which has been thoroughly washed in several hot waters, to be very soothing and efficient in speedily allaying all irritation. This ought all to be done under cover, to guard against the taking of cold. The chemise pinned up around the breast should now be loosened, and the woman is ready for the application of the bandage, which is to be put on next the skin. If properly and nicely adjusted, it will prove very grateful. The directions for making it have already been given. In order to apply it, one half of its length should be folded up into plaits, and the mother should lie on her left side; lay the plaited end of the bandage underneath the left side of the patient, carrying it as far under as possible, and draw the loose end over the abdomen; then let the mother roll over on her back upon the bandage, and draw out the plaited end. If the abdominal muscles are much relaxed and the hip-bones prominent, a compress of two or three towels will be wanted. The bandage should be first tightened in the middle by a pin applied laterally, for strings should never be employed. The pins should be placed at intervals of about an inch. The lower portion of the bandage should be made quite tight, to prevent it slipping up. The mother is now ready to be drawn up in bed upon the permanent dressing: this should be done without any exertion on her part. A napkin should be laid smoothly _under_ the hips (never folded up), to receive the discharges. If she prefer to lie on her left side, place a pillow behind her back.

ATTENTION TO THE CHILD.

The baby may now be washed and dressed. Before beginning, everything that is wanted should be close at hand, namely a basin of warm water, a large quantity of lard or some other unctuous material, soap, fine sponge, and a basket containing the binder, shirt, and other articles of clothing. First rub the child's body thoroughly with lard. The covering can only be removed in this way; the use of soap alone will have no effect unless the friction be so great as to take off also the skin. The nurse should take a handful of lard and rub it in with the palm of the hand, particularly in the flexures of the joints. In anointing one part, the others should be covered, to prevent the child from taking cold. If the child is thus made perfectly clean, do not use any soap and water, because the skin is left in a more healthful condition by the lard, and there is risk of the child's taking cold from the evaporation of the water. But the face may be washed with soap and water, great care being taken not to let the soap get into the child's eyes, which is one of the most frequent causes of sore eyes in infants. The navel-string is now to be dressed. This is done by wrapping it up in a circular piece of soft muslin, well oiled, with a hole in its centre. The bandage is next to be applied. The object of its use is to protect the child's abdomen against cold, and to keep the dressing of the cord in its position. The nature, shape, and size of the binder have been described. It should be pinned in front, three pins being generally sufficient. The rest of the clothing before enumerated is then put on.

The child is now to be _applied to the breast at once_. This is to be done, for three reasons. First, it very often prevents flooding, which is apt otherwise to occur. Secondly, it tends to prevent milk fever, by averting the violent rush of the milk on the third day, and the consequent engorgement of the breast and constitutional disturbance. The third reason is, that there is always a secretion in the breast from the first, which it is desirable for the child to have; for it acts as a cathartic, stimulating the liver, and cleansing the bowels from the secretions which fill them at the time of birth. There is generally sufficient nourishment in the breasts for the child for the first few days. The mother may lie on the one side or the other, and receive the child upon the arm of that upon which she is lying. If the nipple be not perfectly drawn out so that the child can grasp it in its mouth, the difficulty may be overcome by filling a porter-bottle with hot water, emptying it, and then placing the mouth of the bottle immediately over the nipple. This will cause, as the bottle cools, a sufficient amount of suction to elevate the sunken nipple. The bottle should then be removed and the child substituted,--a little sugar and water or sweetened milk being applied, if necessary, to tempt the child to take the breast.

FURTHER ATTENTION TO THE MOTHER.

The patient should be cleansed every _four or five hours_. A soft napkin, wet with warm soap and water, should for this purpose be passed underneath the bed-clothing, without exposing the surface to a draft of air. After using the soap and water, apply again the dilute claret wine and the goose grease. Much of the safety of the mother depends upon the observation of cleanliness. The napkin should not be allowed to remain so long as to become saturated with the discharges.

The mother should maintain rigidly the recumbent position for the first few days, not raising her shoulders from the pillow for any purpose, and should abstain from receiving visitors, and from any social conversation for the first twenty-four hours.

For the first three or four days, until the milk has come and the milk fever passed, the mother should live upon light food,--oatmeal gruel, tea and toast, panada, or anything else of little bulk and unstimulating character. Afterwards the diet may be increased by the addition of chicken, lamb, mutton or oyster broth, buttered toast, and eggs. The object of light nourishment at first is to prevent the too rapid secretion of milk, which might be attended with evil local and constitutional effects. If, however, the mother be in feeble health, it will be necessary from the outset that she shall be supported with nourishing concentrated food. _Beef-tea_ will then be found very serviceable, particularly if made according to the following recipe:--Take a pound of fresh beef from the loins or neck. Free it carefully from all fat. Cut it up into fine pieces, and add a very little salt and five grains of unbroken black pepper. Pour on it a pint of cold water, and _simmer_ for forty minutes. Then pour off the liquor, place the meat in a cloth, and, after squeezing the juice from it into the tea, throw it aside. Return to the fire, and boil for ten minutes.

After the first week, the diet of the lying-in woman should always be nutritious, though plain and simple. The development of the mammary glands, the production of the mammary secretion, and the reduction which takes place in the size of the womb, all require increased nourishment, that they may be properly performed.

After the third or fourth day _the dress should be changed_. The dress worn during labor, if our directions have been carried out, will not have been soiled. The clothing should be changed without uncovering the person, and without raising the head from the pillow. Pull the bed-gown from over each arm, and draw it out from under the body. Then unfasten the chemise in front and draw it down underneath her so that it can be removed from below, as it should not be carried over the head. Place her arms in the sleeves of the clean chemise, throw its body over her head, and, without lifting her shoulders from the bed, draw it down. Then change the bed-gown in the same manner.

In changing the upper sheet, it should be pulled off from below, and the clean one carried down in its place from above, underneath the other clothing, which can be readily accomplished by plaiting the lower half. In introducing a clean under-sheet, one side of it should be plaited and placed under the patient, lying on her left side; when she turns on her back, the plaits can then be readily drawn out. These directions, though apparently trivial, are important. The object is to guard against the great danger to which the mother is exposed by sitting up in bed for even a few minutes during the first week.

_Cathartic medicine_ should not be administered the first, the third, or any other day after confinement, unless it is needed. If the patient is perfectly comfortable, has no pain in the abdomen, no headache, and is well in every respect, she should be let alone, even if her bowels have not been moved. If a laxative be called for, citrate of magnesia is much pleasanter and equally as efficacious as the castor-oil so frequently administered on this occasion.

TO HAVE LABOR WITHOUT PAIN.

Is it possible to avoid the throes of labor, and have children without suffering? This is a question which science answers in the affirmative. Medical art brings the waters of Lethe to the bedside of woman in her hour of trial. Of late years chloroform and ether have been employed to lessen or annul the pains of childbirth, with the same success that has attended their use in surgery. Their administration is never pushed so as to produce complete unconsciousness, unless some operation is necessary, but merely so as to diminish sensibility and render the pains endurable. These agents are thus given without injury to the child, and without retarding the labor or exposing the mother to any danger. When properly employed, they induce refreshing sleep, revive the drooping nervous system, and expedite the delivery.

They should never be used in the absence of the doctor. He alone is competent to give them with safety. In natural, easy, and short labor, where the pains are readily borne, they are not required. But in those lingering cases in which the suffering is extreme, and, above all, in those instances where instruments have to be employed, ether and chloroform have a value beyond all price.

MORTALITY OF CHILDBED.

_The number of the pregnancy_ affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. A woman having a large family, therefore, comes into greater and increasing risk as she bears her ninth and successive children.

_The age of the woman_ also affects the mortality accompanying confinement. The age of least mortality is near twenty-five years. On either side of this, mortality increases with the diminution or increase of age. The age of the greatest safety in confinement therefore corresponds to the age of greatest fecundity. And during the whole of child-bearing life, safety in labor is directly as fecundity, and _vice versâ_. Hence modern statistics prove the correctness of the saying of Aristotle, that 'to the female sex premature wedlock is peculiarly dangerous, since, in consequence of anticipating the demands of nature, many of them suffer greatly in childbirth, and many of them die.' As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. This we have already pointed out in speaking of the age of nubility.

_The sex of the child_ is another circumstance affecting the mortality of labor. Professor Simpson of Edinburgh has shown that a greater proportion of deaths occurs in women who have brought forth male children.

_The duration of labor_ also influences the mortality of lying-in. The fatality increases with the length of the labor. It must be recollected, however, that the duration of labor is only an inconsiderable part of the many causes of mortality in childbirth.

WEIGHT AND LENGTH OF NEW-BORN CHILDREN

The average weight of infants of both sexes at the time of birth is about seven pounds. The average of male children is seven and one-third pounds; of female, six and two-thirds pounds. Children which at full term weigh less than five pounds are not apt to thrive, and usually die in a short time.

The average length at birth, without regard to sex, is about twenty inches, the male being about half an inch longer than the female.

In regard to the relation between the size of the child and the age of the mother, the interesting conclusion has been arrived at, that the average weight and length of the mature child gradually increases with the age of the mother up to the twenty-fifth year. Mothers between the ages of twenty-five and twenty-nine have the largest children. From the thirtieth year they gradually diminish. The first child of a woman is of comparatively light weight. The first egg of a fowl is smaller than those which follow.

The new-born children in our Western States seem to be larger than the statistics show them to be in the various States of Europe, and apparently even than in our Eastern States. In the Report on Obstetrics of the Illinois State Medical Society for 1868, it is stated that Quincy, Ill., produced during the year six male children whose average weight at birth was thirteen and a quarter pounds, the smallest weighing twelve pounds, and the largest seventeen and a half, which was born at the end of four hours' labor, without instrumental or other interference. A recent number of a Western medical journal reports the birth at Detroit, in February last, of a well-formed male infant twenty-four and a-half inches long, weighing sixteen pounds. The woman's weight, _after labor_, is stated as only ninety-two pounds. An English physician delivered a child by the forceps which weighed seventeen pounds twelve ounces, and measured twenty-four inches. These are the largest well-authenticated new-born infants on record.

DURATION OF LABOR.

The length of a natural labor may be said to vary between two and eighteen hours. The intervals between the pains are such, however, that the actual duration of suffering, even in the longest labor, is comparatively very short. The first confinement is much longer than subsequent ones.

The _sex_ of the child has some influence on the duration of labor. According to Dr. Collins of the Lying-in Hospital of Dublin, the average with _male_ births is one hour and four minutes longer than with _female_. The _weight_ of the child also affects the time of labor. Children weighing over eight pounds average four hours and eight minutes longer in birth than those of less than eight pounds weight.

STILL-BIRTHS.

The statistics of nearly fifty thousand deliveries which occurred at the Royal Maternity Charity, London, show a percentage of nearly five still-born, or one in twenty-seven.

There are more boys still-born than girls. We have already spoken of the fact that male births are more tedious, and that a larger number of males die in the first few years of life than females. This series of misfortunes has been attributed to the large size which the male foetus at birth possesses over the female.

IMPRUDENCE AFTER CHILDBIRTH.

After the birth of the child at full term, or at any other period of pregnancy, the womb, which had attained such wonderful proportions in a few months, begins to resume its former size. This process requires at least six weeks after labor for its full accomplishment. Rest is essential during this period. A too early return to the ordinary active duties of life retards or checks this restoration to normal size, and the womb being heavier, exposes the woman to great danger of uterine displacements. Nor are these the only risks incurred by a too hasty renewal of active movements. The surface, the substance, and the lining membrane of the womb are all very liable, while this change from its increased to its ordinary bulk is occurring, to take on inflammation after slight exposure. The worst cases of uterine inflammation and ulceration are thus caused. A 'bad getting-up,' prolonged debility, pain, and excessive discharge, are among the least penalties consequent upon imprudence after confinement. It is a mistake to suppose that hard-working women in the lower walks of life attend with impunity to their ordinary duties a few days after confinement. Those who suffer most from falling of the womb and other displacements are the poor, who are obliged to get up on the ninth day and remain upright, standing or walking for many hours with an over-weighted womb. Every physician who has practised much among the poor, has remarked upon the great frequency of diseases of the womb, which is to be attributed to the neglect of rest, so common among them, after childbirth. If this be true of vigorous women accustomed to a hardy life, how much more apt to suffer from this cause are the delicately nurtured, whose systems are already, perhaps, deteriorated, and little able to resist any deleterious influences!

A mother should remain in bed for at least two weeks after the birth of the child, and should not return to her household duties under a month; she should also take great pains to protect herself from cold, so as to escape the rheumatic affections to which at this time she is particularly subject. If these directions were generally observed, there would be less employment for physicians with diseases peculiar to women, and fewer invalids in our homes.

TO PRESERVE THE FORM AFTER CHILDBIRTH.

This is a matter of great anxiety with many women; and it is proper that it should be, for a flabby, pendulous abdomen is not only destructive to grace of movement and harmony of outline, but is a positive inconvenience.

To avoid it, be careful not to leave the bed too early. If the walls of the abdomen are much relaxed, the bed should be kept from two to three weeks. Gentle frictions daily with spirits and water will give tone to the muscles. But the most important point is to wear for several months a _well-fitting_ bandage--not a towel pinned around the person, but a body-case of strong linen, cut bias, setting snugly to the form, but not exerting unpleasant pressure. The pattern for this has already been given.

THE MOTHER.

_MATERNAL DUTIES AND PRIVILEGES._

It has been well said by Madame Sirey, that women who comprehend well their rights and duties as mothers of families, certainly cannot complain of their destiny. If there exists any inequality in the means of pleasure accorded to the two sexes, it is in favor of the woman. The mother who lives in her children and her grandchildren has the peculiar privilege of not knowing the grief of becoming old.

'So low down in the scale of creation as we can go,' says Professor Laycock of Edinburgh, 'wherever there is a discoverable distinction of sex, we find that maternity is the first and most fundamental duty of the female. The male never in a single instance, in any organism, whether plant or animal, contributes nutrient material.'

Among the Romans, it was enacted that married women who had borne three children, or if freed-women, four, had special privileges of their own in cases of inheritance, and were exempted from tutelage. Juvenal has recorded the reverence paid in Rome to the newly-made mother, and the sign by which her house was designated and protected from rude intruders, namely, by the suspension of wreaths over the door.

At various times, and in different countries, legislators have made laws discriminating in favor of matrons, justly regarding the family as the source of the wealth and prosperity of the State.

Louis XIV. granted, by the edict of 1666, certain pensions to parents of ten children, with an increase for those who had twelve or more.

NURSING.

So soon as the infant is born, it ought to be placed at the breast. From this source it should receive its _only_ nourishment during the first four or six months, and in many cases the first year, of its life. The child which the mother has carried for nine months and brought with suffering into the world, still depends upon her for its existence. At the moment of its birth her duties to the infant, instead of ceasing, augment in importance. The obligation is imposed upon her of nourishing it with _her own_ milk, unless there are present physical conditions rendering nursing improper, of which we are about to speak. It is well known that the artificial feeding of infants is a prominent cause of mortality in early life. The foundlings of large cities furnish the most striking and convincing proof of the great advantages of nursing over the use of artificially-prepared food. On the continent of Europe, in Lyons and Parthenay, where foundlings are wet-nursed from the time they are received, the deaths are 33.7 and 35 per cent. In Paris, Rheims, and Aix, where they are wholly dry-nursed, their deaths are 50.3, 63.9, and 80 per cent. In New York city, the foundlings, numbering several hundred a year, were, until recently, dry-nursed, with the fearful and almost incredible mortality of nearly one hundred per cent. The employment of wet-nurses has produced a much more favorable result. Therefore, if for any reason the mother cannot nurse her own child, a hired wet-nurse should be procured. This brings us to the consideration of

HINDRANCES TO NURSING, AND WHEN IT IS IMPROPER.

Women who have never suckled often experience difficulty in nursing, on account of the sunken and flat condition of the nipple. We have pointed out the causes of this depression, and how by early attention before the birth of the infant it may be prevented. If, however, these precautions have been neglected, and it is found that the nipple is not sufficiently prominent to be grasped by the child's mouth, it may be drawn out by a common breast-pump, by suction with a tobacco-pipe, by the use of the hot-water bottle in the manner described, or by the application of an infant a little older. Neither the child nor the mother should be constantly fretted in such cases by frequent ineffectual attempts at nursing. Such unremitting attention and continual efforts produce nervousness and loss of sleep, and result in a diminution of the quantity of the milk. The child should not be put to the breast oftener than once in an hour and a half or two hours. By the use of the expedients mentioned, the whole difficulty will be overcome in a few days.

_Delay in applying the child to the breast_ is a common cause of trouble. After it has been fed for several days with the spoon or bottle, it will often refuse to suck. When nursing is deferred, the nipple also becomes tender. For these reasons, as well as the others detailed in our directions for the care of the new-born infant, the child should always, in say from two to three hours after labor, be placed at the breast.

_Ulcerated and fissured nipples_ should be treated by the doctor in attendance. As it is highly desirable, and nearly always possible, to avoid them, we would again call attention to the manner of doing so, indicated in a previous article. Fissured nipples sometimes do harm to the infant, by causing it to swallow blood, disturbing in this way the digestion. But all these local interferences with nursing can generally be obviated in the course of a few weeks, and rarely entirely prevent the exercise of this maternal pleasure and duty.

But there are certain _physical conditions which necessitate the employment of a hired wet-nurse_, or weaning. If the mother belongs to a consumptive family, and is herself pale, emaciated, harassed by a cough, and exhausted by suckling, wet-nursing is eminently improper. A temporary loss of strength under other circumstances should not induce a mother at once to wean her child; for it is often possible, by the judicious use of tonics, nourishing food, and stimulants, to entirely restore the health with the child at the breast. It should always be recollected, however, that the milk of those in decidedly infirm health is incapable of properly nourishing the child. Professor J. Lewis Smith of New York quotes, in his recent work on Diseases of Children, several instructive cases which show the danger sometimes attending suckling, and which may imperatively demand its discontinuance. 'A very light-complexioned young mother, in very good health, and of a good constitution, though somewhat delicate, was nursing for the third time, and, as regarded the child, successfully. All at once this young woman experienced a feeling of exhaustion. Her skin became constantly hot; there were cough, oppression, night-sweats; her strength visibly declined, and in less than a fortnight she presented the ordinary symptoms of consumption. The nursing was immediately abandoned, and from the moment the secretion of milk had ceased, all the troubles disappeared.' Again: 'A woman of forty years of age having lost, one after another, several children, all of which she had put out to nurse, determined to nurse the last one herself. This woman being vigorous and well built, was eager for the work, and, filled with devotion and spirit, she gave herself up to the nursing of her child with a sort of fury. At nine months she still nursed him from fifteen to twenty times a day. Having become extremely emaciated, she fell all at once into a state of weakness, from which nothing could raise her, and two days after the poor woman died of exhaustion.'

It does not always follow, that because the mother is sick the child should be taken from the breast. It is only necessary in those affections in which there is great depression of the vital powers, or in which there is danger of communicating the disease to the child. In the city, where artificially-fed infants run great risks, extreme caution should be exercised in early weaning.

_Inflammation of either of the breasts_ necessitates the removal of the infant from the affected side, and its restriction to the other. As the inflammation gets well and the milk reappears, the first of it should always be rejected, as it is apt to be thick and stringy, after which nursing may be resumed.

RULES FOR NURSING.

The new-born child should be nursed about every second hour during the day, and not more than once or twice at night. Too much ardor may be displayed by the young mother in the performance of her duties. Not knowing the fact that an infant quite as frequently cries from being overfed as from want of nourishment, she is apt to give it the breast at every cry, day and night. In this manner her health is broken down, and she is compelled perhaps to wean her child, which, with more prudence and knowledge, she might have continued to nurse without detriment to herself. It is particularly important that the child shall acquire the habit of not requiring the breast more than once or twice at night. This, with a little perseverance, can readily be accomplished, so that the hours for rest at night, so much needed by the mother, may not be interfered with. Indeed, if the mother does not enjoy good health, it is better for her not to nurse at all at night, but to have the child fed once or twice with a little cow's milk. For this purpose, take the upper third of the milk which has stood for several hours and dilute it with water, in the proportion of one part of milk to two of water.

In those cases in which the milk of the mother habitually disagrees with the infant, the attention of the doctor should at once be called to the circumstance. A microscopic examination will reveal to the intelligent practitioner the cause of the difficulty, and suggest the remedy.

It may be well here to mention--as, judging from the practice of many nurses and mothers, it seems to be a fact not generally known or attended to--that human milk contains _all that is required_ for the growth and repair of the various parts of the child's body. It should therefore be the sole food in early infancy.

INFLUENCE OF DIET ON THE MOTHER'S MILK.

Certain articles of food render the milk acid, and thus induce colicky pains and bowel complaints in the child. Such, therefore, as are found, in each individual case, to produce indigestion and an acid stomach in the mother, should be carefully avoided by her.

_Retention of the milk in the breasts_ alters its character. The longer it is retained, the weaker and more watery it becomes. An acquaintance with this fact is of practical importance to every mother; for it follows from it, that the milk is richer the oftener it is removed from the breast. Therefore, if the digestion of the child is disordered by the milk being too rich, as sometimes happens, the remedy is to give it the breast less frequently by which not only is less taken, but the quality is also rendered poorer. On the contrary, in those instances in which the child is badly nourished and the milk is insufficient in quantity, it should be applied oftener, and the milk thus rendered richer.

The milk which last flows is always the richest. Hence, when two children are nursed, the first is the worse served.

INFLUENCE OF PREGNANCY ON THE MILK.

Menstruation is ordinarily absent, and pregnancy therefore impossible, during the whole course of nursing, at least during the first nine months. Sometimes, however, mothers become unwell at the expiration of the sixth or seventh month; in rare instances, within the first five or six weeks after confinement. When the monthly sickness makes its appearance without any constitutional or local disturbance, it is not apt to interfere with the welfare of the infant. When, on the contrary, the discharge is profuse, and attended with much pain, it may produce colic, vomiting, and diarrhoea in the nursling. The disturbance in the system of the child ordinarily resulting from pregnancy in the mother is such that, as a rule, it should be at once weaned so soon as it is certain that pregnancy exists. The only exceptions to this rule are those cases in the city, during the hot months, in which it is impossible either to procure a wet-nurse or to take the child to the country to be weaned. In cold weather an infant should certainly be weaned, if it has attained its fifth or sixth month, and the mother has become pregnant.

INFLUENCE OF THE MOTHER'S MIND OVER THE NURSING CHILD.

We have spoken, in treating of mothers' marks, of the influence of the mother's mind upon her unborn offspring. The influence of the maternal mind does not cease with the birth of the child. The mother continues during the whole period of nursing powerfully to impress, through her milk, the babe at her breast. It is well established, that mental emotions are capable of changing the quantity and quality of the milk, and of thus rendering it hurtful, and even dangerous, to the infant.

_The secretion of milk may be entirely stopped_ by the action of the nervous system. Fear, excited on account of the child which is sick or exposed to accident, will check the flow of milk, which will not return until the little one is restored in safety to the mother's arms. Apprehension felt in regard to a drunken husband, has been known to arrest the supply of this fluid. On the other hand, the secretion is often augmented, as every mother knows, by the _sight_ of the child, nay, even by the _thought_ of him, causing a sudden rush of blood to the breast known to nurses as the _draught_. Indeed a strong desire to furnish milk, together with the application of the child to the breast, has been effectual in bringing about its secretion in young girls, old women, and even men.

Sir Astley Cooper states that 'those passions which are generally sources of pleasure, and which when moderately indulged are conducive to health, will, when carried to excess, alter, and even entirely check the secretion of milk.'

But the fact which it is most important to know is, that _nervous agitation may so alter the quality of the milk as to make it poisonous_. A fretful temper, fits of anger, grief, anxiety of mind, fear, and sudden terror, not only lessen the quantity of the milk, but render it thin and unhealthful, inducing disturbances of the child's bowels, diarrhoea, griping, and fever. Intense mental emotion may even so alter the milk as to cause the death of the child. A physician states, in the _Lancet_, that, having removed a small tumour from behind the ear of a mother, all went on well until she fell into a violent passion. The child being suckled soon afterwards, it died in convulsions. Professor Carpenter records in his Physiology two other fatal instances: in one, the infant put to the breast immediately after the receipt of distressing news by the mother, died in her arms in the presence of the messenger of the ill-tidings; in the other, the infant was seized with convulsions on the right side and paralysis on the left, on sucking directly after the mother had met with an agitating occurrence. Another case of similar character may be mentioned. A woman while nursing became violently excited on account of a loss she had just met with from a theft. She gave her child the breast while in an intense passion. The child first refused, but ultimately took it, when severe vomiting occurred. In the course of some hours the child took the other breast, was attacked at once with violent convulsions, and died in spite of all that could be done for it.

The following cases are related by Professor Carpenter as occurring within his own knowledge. They are valuable as a warning to nursing mothers to avoid all exciting or depressing passions. A mother of several healthy children, of whom the youngest was a vigorous infant a few months old, heard of the death from convulsions of the infant child of an intimate friend at a distance, whose family had increased in the same manner as her own. The unfortunate circumstance made a strong impression on her mind, and being alone with her babe, separated from the rest of her family, she dwelt upon it more than she otherwise would have done. With her mind thus occupied, one morning, shortly after nursing her infant, she laid it in its cradle, asleep and apparently in perfect health. Her attention was soon attracted to it by a noise. On going to the cradle she found it in a convulsion, which lasted only a few moments, and left it dead. In the other case, the mother had lost several children in early infancy, from fits. One infant alone survived the usually fatal period. While nursing him, one morning she dwelt strongly upon the fear of losing him also, although he appeared to be a very healthy child. The infant was transferred to the arms of the nurse. While the nurse was endeavouring to cheer the mother by calling her attention to the thriving appearance of her child, he was seized with a convulsion, and died almost instantly in her arms. Under similar circumstances, a child should not be nursed by its mother, but by one who has reared healthy children of her own and has a tranquil mind.

An interesting illustration of the powerful sedative action of the mother's milk--changed in consequence of great mental distress--upon the impressible nervous system of the infant, is furnished by a German physician. 'A carpenter fell into a quarrel with a soldier billeted in his house, and was set upon by the latter with his drawn sword. The wife of the carpenter at first trembled from fear and terror, and then suddenly threw herself furiously between the combatants, wrested the sword from the soldier's hand, broke it in pieces, and threw it away. During the tumult, some neighbors came in and separated the men. While in this state of strong excitement, the mother took up her child from the cradle, where it lay playing and in the most perfect health, never having had a moment's illness. She gave it the breast, and in so doing sealed its fate. In a few minutes the infant left off sucking, became restless, panted, and sank dead upon its mother's bosom. The physician, who was instantly called in, found the child lying in the cradle as if asleep, and with its features undisturbed; but all his resources were fruitless. It was irrevocably gone.'

Professor William A. Hammond of New York mentions, in a recent number of the _Journal of Psychological Medicine_, several instances, from his own practice, of affections in the child caused by the mother's milk. 'A soldier's wife, whilst nursing her child, was very much terrified by a sudden thunderstorm, during which the house where she was then quartered was struck by lightning. The infant, which had always been in excellent health, was immediately attacked with vomiting and convulsions, from which it recovered with difficulty.' 'A lady, three weeks after delivery, was attacked with puerperal insanity. She nursed her child but once after the accession of the disease, and in two hours subsequently it was affected with general convulsions, from which it died during the night. Previous to this event it had been in robust health.'

Again, Dr. Seguin of New York relates, in his work on Idiocy, a number of cases of _loss of mind_ produced by the altered state of the mother's milk. 'Mrs. B. came out from a ball-room, gave the breast to her baby, three months old: he was taken with spasms two hours after, and since is a confirmed idiot and epileptic.'

'In a moment of great anxiety Mrs. C. jumped into a carriage with her suckling, a girl of fifteen months, so far very intelligent and attractive. The child took the breast only once in a journey of twenty miles, but before arriving at destination she vomited several times, with no interruption but that of stupor, and after an acute fever the little girl settled down into the condition of a cripple and idiot.'

The celebrated physician Boerhaave mentions the milk of an angry nurse as among the causes of _epilepsy._

These facts show the importance of a placid mind and cheerful temper in the mother while nursing.

POSITION OF THE MOTHER WHILE NURSING.

The habit of nursing a child while sitting up in bed or half reclining upon a lounge is a wrong one. Such a position is injurious to the breasts, hurtful to the woman's figure, and apt to cause backache. When in bed, the mother ought always to be recumbent while the child is at the breast, held upon the arm of the side upon which she lies. When out of bed, she should sit upright while nursing.

QUANTITY OF MILK REQUIRED BY THE INFANT.

The amount of milk furnished every day by a healthy woman has been estimated at from a quart to three pints. An infant one or two months of age takes about two wine-glassfuls, or three ounces, every meal; that is, as it sucks every two hours, excepting when asleep, about five half-pints during the twenty-four hours. When it attains the age of three months, it thrives well on five meals a day, the quantity taken at each meal then, the stomach being more capacious, amounting to about half a pint. A child above three months of age ordinarily requires three pints daily.

A healthy mother is fully capable of furnishing this quantity of milk per day, and of affording the child all the nourishment it needs until four or six months after birth.

The quantity of the mother's milk varies according to many circumstances. It is most abundant and also most nutritious in nursing women between the ages of fifteen and thirty; least so, in those from thirty-five to forty. There is likewise a great difference in different women in this respect; and in the same woman varying conditions of health influence the amount of milk secreted.

THE QUALITIES OF A GOOD NURSING MOTHER

are well described by Professor J. Lewis Smith. 'The best wet-nurses are usually robust, without being corpulent. Their appetite is good, and their breasts are distended, from the number and large size of the blood-vessels and milk-ducts. There is but a moderate amount of fat around the gland, and tortuous veins are observed passing over it. Such nurses do not experience a feeling of exhaustion, and do not suffer from lactation. The nutriment which they consume is equally expended on their own sustenance and the supply of milk. There are other good wet-nurses who have the physical condition described, but whose breasts are small. Still the infant continues to suck till it is satisfied, and it thrives. The milk is of good quality, and it appears to be secreted mainly during the time of suckling. Other mothers evidently decline in health during the time of nursing. They furnish milk of good quality and in abundance, and their infants thrive; but it is at their own expense. They themselves say, and with truth, that what they eat goes to milk. They become thinner and paler, are perhaps troubled with palpitation, and are easily exhausted. They often find it necessary to wean before the end of the usual period of lactation. There is another class whose health is habitually poor, but who furnish the usual quantity of milk without the exhaustion experienced by the class just described. The milk of these women is of poor quality. It is abundant, but watery. Their infants are pallid having soft and flabby fibre.'

OVER-ABUNDANCE OF MILK.

An excessive amount of milk often distends the breasts of those women who are prone to have long and profuse monthly sickness. It is also apt to occur in those subject to bleeding piles. It may be produced by any excitement of the womb or ovaries, and by over-nursing. In these cases there is usually a constant oozing away and consequent loss of milk. The mother is troubled by this over-flow, because it keeps her clothing wet; and the child suffers because of the unnutritious, watery character of the milk under such circumstances.

This over-abundant supply may be moderated and the quality improved by diminishing the quantity of drink, and by the use of preparations of iron. Fifteen drops of the muriatic tincture of iron, taken three times a day in a little sweetened water, through a glass tube, will be useful. It will lessen the amount of the milk, and make it richer. So soon as these objects are accomplished, the medicine should be discontinued; as, if taken too long, it may so much diminish the milk as to necessitate weaning. The application of a cloth, wrung out in cold water, around the nipples is also of value. It is to be removed so soon as it becomes warm, and reapplied. In those cases in which the trouble seems to be not so much an over-supply as an inability to retain the milk, the administration of tonics addressed to the nervous system, and the local use of astringents and of collodion around the nipples, will overcome the difficulty; but these remedies can only be employed successfully by the physician. And to him alone should be entrusted the use of those medicines which directly diminish the amount of milk secreted within the breasts. The expedients we have mentioned are the only ones which can be safely employed by the mother herself in this annoying affection.

SCANTINESS OF MILK.

Some mothers have habitually an insufficiency of milk. They are most numerous in large cities, and among working women whose daily occupations require a separation from the infant. Indigestion, and the want of a proper amount of nourishing food, cause a diminution in the quantity of milk. So also do over-feeding and gormandizing. Age lessens the secretion of milk, as has been already mentioned. Those who first bear children late in life, have less milk for them than they who begin earlier. In some cases want of milk in the breasts seems to be due to its reabsorption. In such instances it may make its appearance at distant parts. Thus, a case has been recorded of the coughing up of milk following sudden arrest of the secretion, and others in which it presented itself as an exudation in the groins.

In the treatment of a scanty formation of milk, one of the best measures which can be resorted to is the frequent application of the child to the breast. In addition, the flow may be increased by milking the breasts by means of the thumb and finger, suction through a tobacco-pipe, or the breast-pump, or by the use of another infant. Friction of the breasts, and forcible drawing upon the nipples, will make them sore, and so irritate them as to defeat the object in view. A change of scene, fresh air, and outdoor exercise, attention to personal cleanliness, and the improvement of the general health, all increase the quantity, and produce a favourable effect upon the quality, of the milk. A sojourn at the sea-side often promotes an abundant secretion of milk. The diet should be regulated by the condition of the constitution. By those who are weak and pale, a large proportion of meat is required. On the contrary, those who are full-blooded and corpulent should restrict the amount of their animal food, and take more exercise in the open air. Oatmeal gruel enjoys a reputation for increasing the flow of milk. A basin of it sometimes produces an immediate effect. The same is true of cow's milk. Porter or ale once or twice a day, in those with reduced systems and impaired digestion and appetite, will be found useful. Anise, fennel, and caraway-seeds, given in soup, act sometimes as stimulants upon the secretion of milk. The application of a poultice made from the pulverized leaves of the castor-oil plant is a most efficient remedy when milk fails to make its appearance in the breast in sufficient quantity after confinement.

WET-NURSING BY VIRGINS, AGED WOMEN, AND MEN.

As a rule, the secretion of milk is limited to one sex, and in that is confined to a short period after childbirth. But there are many cases on record of the flowing of milk in women not recently mothers, in girls before the age of puberty, in aged women, and even in individuals of the male sex. In such instances, the secretion is induced by the combined influence, acting through the nervous system, of a strong desire for its occurrence, of a fixed attention towards the mammary glands, and of suction from the nipples.

Travellers among savage nations report many examples of such unnatural nursing. Dr. Livingstone says he has frequently seen in Africa a grandchild suckled by a grandmother. Dr. Wm. A. Gillespie, of Virginia records, in the _Boston Medical and Surgical Journal_, the case of a widow, aged about sixty, whose daughter having died, leaving a child two months old, took the child and tried to raise it by feeding. The child's bowels became deranged, and being unable to procure a nurse, and her breasts being large and full, he advised her to apply the child, in hopes milk would come. She followed his advice perseveringly, and, to her astonishment, a plentiful secretion of milk was the result, with which she nourished the child, which afterwards became strong and healthy. A similar instance, still more remarkable, is recorded of a woman at seventy years, who twenty years wet-nursed a grandchild after her last confinement.

Cases of nursing in the opposite extreme of life are also well authenticated. The distinguished French physician Baudelocque has related that of a deaf and dumb girl, eight years old, who, by the repeated application to her breast of a young infant, which her mother was suckling, had sufficient milk to nourish the child for a month, while the mother was unable to nurse it on account of sore nipples. The little girl was shown to the Royal Academy of Surgery on the 16th of February, 1783. The quantity of milk was such, that by simply pressing the breast it was made to flow out in the presence of the Academy, and on the same day, at the house of Baudelocque, before a large class of pupils. Again, an interesting case is known of a young woman, who, in consequence of the habit of applying the infant of her mistress to her breast in order to quiet it, caused a free secretion of milk. In the Cape de Verde Islands, it is stated that virgins, old women, and even men, are frequently employed as wet-nurses. Humboldt speaks of a man, thirty-two years old, who gave the breast to his child for five months. Captain Franklin saw a similar case in the Arctic regions. Professor Hall presented to his class in Baltimore a negro, fifty-five years old, who had been the wet-nurse of all the children of his mistress.

Instances of powers of _prolonged nursing_ in mothers are not uncommon. Indeed it is the habit among some nations to suckle children until they are three or four years of age, even though another pregnancy may intervene, so that immediately one child is succeeded at the breast by another. In those who have thus unnaturally excited the mammary glands, an irrepressible flow sometimes continues after the demand for it has ceased. Dr. Green published, some years ago, in the _New York Journal of Medicine and Surgery_, the case of a woman, aged forty-seven, the mother of five children, who had had an abundant supply of milk for _twenty-seven years_ consecutively. A period of exactly four years and a half occurred between each birth, and the children were permitted to take the breast until they were running about at play. At the time when Dr. G. wrote, she had been nine years a widow, and was obliged to have her breasts drawn daily, the secretion of milk being so copious. When, therefore, it is desirable, on account of the feebleness of the child, to protract the period of nursing, a wet-nurse should relieve the mother at the end of twelve or fifteen months.

RULES FOR CARE OF HEALTH WHILE NURSING.