Some practitioners, with whom I have conversed on the subject, though willing to allow that protracted suckling, by depraving the milk, may be the means of occasioning Meningitis in infants during or shortly after the time they are supplied with this improper food, yet could not conceive how it can act as a cause of that disease at some future period; I do not myself, while attempting to account for it, discover any pathological difficulty.
In these cases it is very probable, that although the protracted suckling was not sufficient to produce actual Meningitis at its conclusion, yet that it so weakened the system in general, and the brain in particular, as to render the latter especially predisposed to inflammatory action; and that we have reason to suppose this not only possible, but probable, from analogy, cannot be denied, since it is known that scrofulous children, in whom there is great laxity and debility of habit, are inordinately liable to be affected with Hydrocephalus, or Water in the Brain.
'Dr. Perceval observes, that of twenty-two cases of which he kept notes, eleven were certainly strumous children, and four were probably so.' 'From my own observations,' remarks Dr. Cheyne, 'I should think this proportion a very moderate one. When a whole family is swept away by Hydrocephalus, I suspect it is intimately connected with this strumous taint.' The testimony of Sauvages may also be adduced, who says, 'Novi familiam cujus infantes circa sextum ætatis annum omnes periere ex hoc morbo, Scrofula huic effusioni ansam præbente.' The brain, in consequence of this local debility, may become affected from causes which otherwise would, perhaps, have produced no injurious consequences whatever; and hence it is, that when labouring under other diseases, and especially Hooping-cough, those children who have been suckled too long appear so very liable to have the head secondarily affected. It is worthy of notice, that among the cases which have been detailed in the foregoing pages, were fourteen in whom affection of the head supervened during the progress of other diseases, and in ten of them the disease was Hooping-cough.
The treatment of Meningitis arising from protracted suckling will not differ from what is proper when it has been produced by other causes; except that the depletory measures should not be carried to so great an extent, as it must be remembered that the disease is existing in constitutions already debilitated.
It should consist generally in the application of leeches to the temples—cold lotions to the head—purgatives, and blisters placed behind the ears, the discharge from which is to be kept up by means of irritating dressings—these afford the surest chance of subduing the malady, and in many instances, if employed sufficiently early, will have the desired effect. It is, of course, almost superfluous to observe, that weaning, if the child be above nine months old, must be immediately enforced; or, if considerably younger, the diseased or debilitated nurse ought to be exchanged for one who has a supply of healthy milk of a corresponding age. If such cannot be procured, the child must be brought up by hand; for, so long as it is allowed to imbibe the noxious milk, there is little hope, in my mind, of the medical treatment being of any great service; while on the contrary, it is encouraging to know that many infants previously manifesting symptoms of incipient Meningitis have completely recovered soon after they were weaned[M].
When my attention first became directed to the subject, I was chiefly struck with the ill effects resulting to the child from protracted lactation, and hence supposed that cases of disease from suckling, when continued for only a moderate period, were rarely if ever met with. More enlarged experience, however, has now convinced me, that not only are ill effects occasioned in children when lactation is protracted to a very unusual extent, but that they occur sometimes, when its duration has been merely a few months beyond what I conceive is right. Besides which, we shall find that when from any cause whatever the nurse's milk becomes impoverished and deteriorated, even if this take place at an early period after delivery, the injurious effects already referred to may be produced in the child: for improper food, whether it be bad milk or any other inappropriate article of diet, is always calculated to derange the functions of the stomach, bowels, and other chylopoietic viscera, and in consequence to occasion disease.
It matters not whether the mother be originally unhealthy, and thus her milk possess bad qualities; or whether from accidental circumstances, or her continuing to give suck too long it becomes so: in either case the same effect, namely, deteriorated milk, is produced, with the concomitant evils to which I have alluded. This view of the matter is corroborated by Case LII., in which true Meningitis attacked a child, aged only nine months, who, therefore, was not suckled too long,—but then the nurse of that child had been delivered twenty-one months, having suckled another infant previously:—hence we may reasonably conclude that her milk being from the beginning deteriorated, and unadapted to the age of the child, the ill effects in this case were produced at a much earlier period than usual.
It will be observed that I have only given one instance of this latter description; but, on considering how very rare it must be to find any mother capable of abandoning her newly-born infant to the breast of a woman who has already suckled another child one year, any surprise that might be felt at the circumstance will, I am sure, immediately cease. It must also be noticed that only among the lowest grades of society do we find women so long after delivery performing the office of wet-nurse at all, and those who entrust their infants to the latter are often so peculiarly situated as to feel no interest whatever in the preservation of their offspring: indeed I cannot but suspect that, among such, criminal motives frequently lead to the adoption of the unnatural and baneful practice in question.
I do not recollect to have seen a case of Meningitis from suckling except when this process had been protracted, either as respects the child or the nurse; though I by no means doubt the possibility of its occurrence under other circumstances: but I have met with numerous instances of other diseases produced by the palpable deterioration of the mother's or nurse's milk at various periods after delivery; in by far the greater number, however, of such cases, lactation had been continued for an unusual length of time.
Vomiting, griping, and diarrhœa, are so common among infants, and arise in general from causes apparently so evident, that, unless severe or of long duration, they rarely form the subject of minute inquiry. Hence these complaints are, perhaps, not so often attributed to deteriorated milk as they ought to be, although the fact of their occasionally originating from a morbid condition of this fluid, (and therefore from protracted lactation as one cause of the latter effect,) is too well established to be questioned. Dr. Underwood observes, 'has not every Physician of experience seen infants frequently thrown into tormina immediately after coming from the breast of an unhealthy mother, or one who has but little milk?'[N] and Mr. Burns states, that if the usual periodical appearance should return, 'the milk is liable to disagree with the child, and produce vomiting or purging;' while Dr. Hamilton expressly mentions that diarrhœa is 'not unfrequently occasioned by the depraved quality of the nurse's milk.'