72. THE FUNCTION OF THE BREASTS
THE doctrine cannot be too strongly enforced that every healthy mother should nurse her own offspring. The reasons for this may be inferred from the constitution of the female organisation, and from the fact that no preparation of food can ever from any but an approximation to the mother’s milk. After the birth of the child nature continues to secrete an excess of nutrient matter; but this excess is transferred from the uterine system to the breasts, where it is secreted in the from of milk for the nourishment of the young offspring. Eighteen months is the usual period during which the child should be supported by the mother, nine months previous to birth, and about nine months after. The female organs are so arranged that in carrying on the functions of reproduction one portion relieves the other. During gestation the breasts enjoy comparative repose, the development and growth of the infant devolving upon the uterus. After birth this responsibility is transferred to the breasts, the uterus resting for a time from the process of utero-gestation.
Pretexts for Non-Nursing. Many ladies seek for professional sanction of wean their infants after a few weeks’ nursing, and some even to shirk the duty entirely. The demands made by the toilet, the pleasures of the table, fashionable society, late hours, or other forms of dissipation, render nursing inconvenient and distasteful. The disposition to evade this great natural duty should be strenuously opposed, for non-nursing deprives a mother of one of the most pleasurable and soothing duties of maternity, and it robs the infant of its inalienable right to breast-milk, laden with all the riches of its mother’s affection, while exposing it to the dangers of artificial substitutes.
Care of the Breasts. Much inconvenience and suffering may be obviated by paying proper attention to the breasts during pregnancy. For two or three of the last months they should be specially bathed with cold water every morning, and left perfectly dry. If the breasts are painful, hard, and much distended, two thicknesses of old linen, wrung out of cold water, way be placed over them, and covered with oiled silk. A kind of sling should then be formed by means of a handkerchief or band secured at the back of the neck, and so arranged as to support the breast. Only a sparing quantity of fluids should be permitted.
73. DIET FOR THE NURSING MOTHER.
A woman does not require extra good living when nursing but discrimination in the selection of her food is necessary; still she should feed well. If she eats slowly, she may be sufficient to satisfy hunger, but it is important that she should not overload the stomach, or partake of indigestible food, which would occasion intestinal derangement, to the injury of the infant as well as herself. The meal hours should be regular, and late dinners or suppers avoided.
To prove that the kind of food taken by the mother powerfully influences the quality of the breast-milk, it is only necessary to cite the well-known fact that the quality of cow’s milk is mainly determined by the food on which the animal livers. Thus a cow fed on swedes produces milk and butter having the flavour of turnips; showing that the milk partakes of the qualities of the food on which she feeds. The same holds good in regards to the human species, and proves the impropriety of a nursing mother being allowed to eat anything unwholesome or indigestible.
Experience has taught mothers that if they eat anything acid, and partake freely of fruits and vegetables, the milk brings on colic in the infant and causes diarrhoea. Mothers who nurse their infants must therefore often practise self-denial in eating and drinking for the sake of their offspring.
It is not intended to suggest by these remarks that a nursing woman should be excessively particular as to her food. Animal food, varied from day to day-beef, mutton, chicken, game, and fish, and any kind of vegetables that has not been found to disagree with herself or her infant, may be eaten, but such kinds of meat as goose, quick, salted beef, shell-fish, rich or highly seasoned dishes, pastry, etc., should not be taken. Greens, cabbage, fruit, and any other articles of food which the mother has found to disagree with herself or child, must also the avoided.
Milk-and-water, barley-water, toast-and-water, or even cold water, in small sips, is the best of appease the thirst to which the nursing mother is sometimes subject; but beer or wine tends rather to increase thirst.
Violent Exercise and Mental Depression Deteriorate the milk. Women who are nursing are liable to fits of depression. The best remedy is a short, pleasant walk, or drive in the country. Healthy exercise in the fresh air admirably promotes cheerfulness and serenity of spirits. On no account should wine or stimulants be resorted to, for they only raise the spirits for a short time, and cause increased subsequent depression, to remove which fresh and augmented supplies of stimulants would be required. The society of cheerful friends is often a useful stimulus; but visiting must be done within prudent limits, or it will weary and harass the mother, and diminish or deteriorate the supply of breast-milk.
Regimen of Wet-Nurses. The regimen and diet of wet-nurses should be as nearly as possible like those she has been previously accustomed to. A woman accustomed to active duties and frugal diet is certain to suffer in her health if she suddenly relapses into a life of indoor idleness, and has a too abundant supply of food, and takes such beverages as ale stout, or wine. A wet-nurse taken from industrial pursuits should continue to perform at least light duties, or take a large amount of regular out-of-door exercise. The use of stimulants is injurious, and if taken to cause a good supply of milk will result in disappointment, and bring on indigestion and a host of evils from which the infant is sure to suffer. If the child does not steadily grow and increase in weight the nurse should be changed. (See Section 71.)
If there be a choice of nurses of otherwise equal capacity, preference may be given to one of dark complexion, for it has been found that the milk of the brunette is richer in each of the organic constituents than that of the blonde.
In the interest of healthy women employed as wet-nurses, we state here that a syphilitic infant ought not to be nourished from their breasts. The nurse who suckles such a child incurs enormous risk; for many an unsuspecting woman has acquired syphilis from her nursling. Artificial lactation, if properly carried out, may, in such a case, be an excellent substitute for the breast.
74. STATED HOURS OF NURSING.
A habit very generally prevails, on the part of the mother, of giving the infant the breast too frequently; a habit prejudicial alike to the mother and child. It may be laid down as a rule, that for the first month the infant should be sucked about every two hours and a half during the day, and every four hours during the night; the intervals should be gradually lengthened until about the third month, when it should have the breast only every three or four hours during the day, and about every sixth hour at night. Eleven during the earliest period of infancy a child will acquire regular habits in this respect, by judicious management on the part of the mother. By giving the breast only at regular stated times, the mother will be able to the proper rest and hours of uninterrupted sleep, which can scarcely be enjoyed by those who have fallen into the bad habit of permitting the infant to be at the breast during a considerably part of every night, or of offering it to the child whenever it cries of manifests any uneasiness.
75. DEPRESSED AND SORE NIPPLES
Depressed Nipples. During the first pregnancy an examination should be made either by the medical attendant or a skilful nurse to ascertain whether the nipples are of the proper size and shape, for in many instances they are deficient, or have been so thoroughly compressed by tight clothes, that, after confinement, nipples can hardly be said to exist.
TREATMENT. A very simple and efficient measure to elongate the nipple is to tie a piece of woollen thread or yarn tow or three times around its base, after having pulled it gently out with the fingers. It should be tied sufficiently tight to keep the nipple prominent, but not enough to interrupt s the circulation. The woollen threads may be worn several weeks without inconvenience. The daily application of the pump to the breast, taking the nipple within its chamber, and exhausting the air by withdrawing the piston, elongates the nipple. The nipple should be retained within the chamber for about fifteen minutes each time. After the use of the pump an application of arnicated water, or of diluted glycerine, should be made to the nipple and surrounding part, to prevent excoriations. The same result may be secured by suction, twice a day, by the husband or nurse. An imperfectly developed nipple may be much improved by this method, if intelligently carried out. The measures adopted to elongated the nipple should be commenced two or three months before labour, and if necessary continued, in a modified form, during the commencement of lactation.
Sore Nipples. In some cases, if the preparatory treatment just suggested be adopted, sore nipples will be prevented. But where there is a tendency to excoriation and soreness, and in women of fine sensitive skin, the nipples and the breasts around should be bathed several times daily with lotion made by adding twenty drops of the tincture of Arnica 1 (If there is a predisposition to Erysipelas in the patient, Hamamelis lotion will be preferable, and may be applied in the same manner.) to a tumbler of water. We can testify to the entire success of this application in a very large number of cases we have treated. The lotion should be applied after each time of suckling, and the nipple moistened with saliva or mucilage before again allowing the child to suck. Another local remedy for sore nipples Glycerine of Verbascum Vir.- 5 drops of Verbascum Vir. to 3ij of Glycerine.
In obstinate cases, in which the complaint appears to be owing to constitutional causes, one of the following remedies is often required: Calcarea, Mercurius, Graphites, Lyco., Silica., or Sulph., Silica. is especially recommended for retracted nipples.
Painful Nipples. Phellandrium. Pain left in the nipple after each application of the child.
Croton Tig. Neuralgic pain shooting through from the point of the nipple of the shoulder-blade.
ACCESSORY AND PREVENTIVE MEANS. Small compresses, wrung our of the cold water, are very useful, especially if the nipples are sore, hot, and burning. In order to prevent sore nipples, they should be washed over gently with tepid water immediately after the child has been nursed, tenderly dried by means of soft linen, or a fine towel, and then dusted with superfine wheat- fluor, or finely powdered starch. As before recommended, the entire breast should receive daily morning ablution, with water, cold, if the patient can bear it, but if not, tepid may be used for several times, gradually reducing it to cold. The infant should only be allowed to suck at certain periods say every third or fourth hour, as previously directed. The habit of permitting the infant to have the nipple almost constantly in the mouth very frequently leads to tenderness and soreness. The child’s mouth should be examined, and if found to be suffering from Thrush, the treatment recommended in the Manual on the Diseases of Infants and children should be at once adopted. In the meantime the nipple should be washed with a solution of Borax (x grains to an ounce of water).
76. SORE MOUTH OF NURSING MOTHERS
This is an affection from which nursing women occasionally suffer. It consists of inflammation of the lining of the mouth, which is covered with very small ulcers; these cause stinging nd burning sensations, and a cheese-like matter exudes form them. A profuse flow of saliva is also frequently present. The predisposing cause is the scrofulous cachexia. Now and then it proves in intractable disorder.
MEDICINAL TREATMENT. Arsenicum, Borax., Calcarea c., Eup. A., Hydrastis., Mercurius, Murex Ac., Acid nitricum, Sulphur Ac.
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Arsenicum. If ulceration becomes extensive, and there be burning pain in the mouth, with red glazed tongue.
Borax. Is an excellent remedy in the early stage of the malady.
Mercurius. Corroding ulcers with swollen gums, foetid breath, and profuse flow of saliva.
Nitric Acid. On the failure of Mercurius this remedy should be had recourse to.
LOCAL TREATMENT. Borax (x grains to ox.j water), Carbolic Acid (z3aa to z3iss olive oil), Hydrastis (iij grains to z3ij water), Calendula (j to z3iv water), are the various kinds of gargles and washes that have been found most useful as palliatives while the medicines are affecting the necessary blood-changes.
ACCESSORY MEASURES. Acidulated drinks lemonade, etc. and very valuable. Vegetable and animal food in due proportion, with wholesome ripe fruits, oranges, grapes, roasted apples, etc. Fruits containing vegetable acids are often alone curative, and are usually very grateful to patients. Weaning, travel, change of climate, etc., may be necessary in exceptional cases.
77. DETERIORATED MILK.
If the various suggestions we have offered in this Manual are faithfully carried out, there will seldom be cause for complaint of bad milk.
METHODS OF INVESTIGATING THE MILK. As a ready method of judging of the quantity and quality of the milk an inspiration of the breasts of the mother or nurse should be made. The breasts should be firm and pear-shaped, and covered with blue veins. Pressure on the gland should excite the flow of milk, while should be opaque, of a dull white colour, and under the microscope present fat globules of fair size. The number of these globules in indicative of the amount of caseine and sugar present in the milk. On a piece glass a drop of good milk maintains its globular form, and does not readily run off the glass. Poor milk, deprived of its solids, lacks these qualities, and run off on the least inclination of the glass. Obviously, however, the most satisfactory test of the excellency of the milk is furnished by observation of the child. If he sucks vigorously, finishing with the milk running over his lips, and requires a meal but three or four times in the day, we may conclude that the milk is sufficient in quantity. But if the frequently desires the breast, sucks with effort or spasmodically, now and then desisting and crying, the milk may be considered insufficient. As a further test of the quantity of the milk the infant may be weighed immediately before and after a meal; the difference in the weight should be three or four ounces.
SYMPTOMS. Vomiting after each act of sucking, or refusing to suck, generally indicates bad milk. When the milk is deprived of its due proportion of solids and becomes watery, it fails to afford the requisite nourishments; on the other hand, if the solids are in excess, it gives rise to ingestion.
CAUSES. Acute and chronic diseases in a nursing mother tend, in various ways, to impair the quality of her milk. Nursing during either of the extreme of age yields generally only innutritious milk. Menstruation, and also pregnancy, deteriorate the milk supply; and although occasionally children nursed under these conditions may appear not to suffer, it is obvious that the active functions of the breasts and of the womb cannot go on healthily at the same time. Emotional disturbance and violent exercise exert great influence on the milk secreted; and if children are nursed immediately, extreme convulsions, and even fatal results, may follow. The effects diet on the milk of nursing ladies have already been referred to.
MEDICINAL TREATMENT. Aconite, Calcarea C., Chamomilla, Ignatia, Nux V., Pulsatilla, Silicea, Sulphur
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Aconitum. The presence of any febrile symptoms would delicate the employment of this remedy.
Calcarea C. Thin, watery condition of milk; delicate constitution.
Nux Vomica. When the deterioration can be traced to the use of alcohol; in cases of the Nux temperament.
Pulsatilla. Alcoholic cases of the Pulsatilla temperament.
ACCESSORY MEASURES. Every means should be adopted to improve the patient’s health by suitable food and abundance of pure air, and by placing hair beyond the reach of household and other cares and anxieties.
78. INSUFFICIENT SUPPLY OF MILK.1
1 In an interesting paper on “The Modifications which Human Milk undergoes in Consequence of Insufficient Food,” read before the Academic des Sciences by M. Decaisne, he remarked that most of the observations that have hitherto been published upon this subject have been made on animals, but the siege of Paris furnished him with the opportunity of examining it in women. Upon an examination of the milk of forty-three suckling women living upon insufficient food, he concluded as follows: 1. The effects as observed in women are very analogous to those produced in animals. 2. They vary according to constitution, age, hygienic conditions, etc. 3. Insufficient alimentation always induces, in varying proportions, a diminution in the amount of butter, caseine, sugar, and salts while it generally increases that of the albumen. 4. In three-fourths of the cases the proportion of albumen was found to be in an inverse ratio to that of the caseine. 5. The modifications in the composition of the milk by means of a reparative alimentation are always manifested in a remarkable manner in four or five days.
CAUSES. The quantity of milk various greatly in different women, but when it is insufficient for the nourishment of the child, the cause may be traced to imperfection in the mother’s health, and measures should, if possible, be adopted to correct this, so that after a subsequent labour she may be able to furnish the infant with sufficient milk.
MEDICINAL TREATMENT. Agnus, Castus, Asafoetida, and of milk, the first two medicines when the cause of the deficiency is undiscovered, the last when the deficiency is the result of haemorrhage, diarrhoea, leucorrhoea, etc.
The external application of the castor-oil plant (Ricinus. Communis) has been used by some physicians with great Success. A strong decoction is applied hot by means of soft rags, and retained until the milk is secreted copiously.
ACCESSORY MEANS. Warmth always favours the secretion of milk. The diet is important, and should be nutritious and digestible. Good cocoa is very useful, improving the quality and increasing the quantity of the mother’s milk, and we have known it to succeed after other means had failed. During the whole period of nursing this nourishment beverage will be found highly conductive to the health of both mother and child.. When the quantity of milk cannot be increased to meet the requirements to the child, mixed nursing must be adopted according to the directions given in the Section on hand-feeding. It is important that the mother should suckle her baby during the day, and have it fed by the bottle at night. This arrangement permits the mother to enjoy a good night’s sleep, which in itself favours the secretion of milk.
79. SUPPRESSED MILK
CAUSES. Exposure to cold, powerful emotions of the mind, or any circumstances which causes febrile symptoms.
MEDICAL TREATMENTS. Aconite, Bryonia, Calcarea C., Chamomilla, Coffea, Plus., Zincum met. M.
INDICATION FOR THE PRINCIPAL REMEDIES.
Aconitum. In all cases attended with feverish symptoms, especially if from cold.
Bryonia. Is useful where there are stitching pains in the chest or side.
Chamomilla. If the suppression has arisen from a sudden mental emotions, particularly anger.
Coffea. Where there is unusual restlessness or sleeplessness.
Pulsatilla. Partial or entire suppression, without febrile symptoms. This remedy exerts a healthy influence over the constitution in almost every departure from the normal course during the whole period of nursing.
ACCESSORY MEANS. When the distention and irritation have been relieved by medicine, the milk which has been arrested with generally flow quite freely. Should the discharge continue imperfect, the breast-pump may be used, or, which is better, a strong child may be applied.
METHOD FOR PROMOTING THE FLOW OF MILK. In all cases when the flow of milk is tardy, the following pain for accelerating it will be found to be available and safe; Take a decanter and fill it with boiling water, when it is thoroughly hot, suddenly empty it, and place it on the breast, with the nipple in the neck of the bottle. The gradual cooling of the decanter will create vacuum, the nipple will be gently pressed into it without pain, and the atmospheric pressure on the breast will, in almost every instance, cause the milk immediately to flow. The experiment may safely be repeated after a short interval if does not happen to be successful at first. Care must the taken and protect the breast, by covering the mouth of the decanter with leather or thick flannel. A hole made in the centre of this will keep the nipple in its proper place.
80. EXCESSIVE SECRETIONS OF MILK.
Occasionally the secretion of milk may be so abundant and continuous as to become a serious tax on the constitution, so that the mother’s health soon gives way. Loss of appetite, debility, dragging sensations, or pain in the back and chest, and if the symptoms continue unchecked, Hectic-fever and premature death from the so-called “Nurses” Consumption.”