613. A mother ought not, unless she intend to devote herself to her baby, to undertake to suckle him. She must make up her mind to forego the so-called pleasures of fashionable life. There ought, in a case of this kind, to be no half-and-half measures; she should either give up her helpless babe to the tender mercies of a wet-nurse, or she must devote her whole time and energy to his welfare—to the greatest treasure that God hath given her.
614. If a mother be blessed with health and strength, it is most unnatural and very cruel for her not to suckle her child—
615. Oh, if a mother did but know the joy that suckling her infant imparts, she would never for one moment contemplate having a wet-nurse to rob her of that joy—
616. Lamentable, indeed, must it be, if any unavoidable obstacle should prevent a mother from nursing her own child!
617. As soon as the patient has recovered from the fatigue of the labor—that is to say, in about four or six hours—attention ought to be paid, more especially in a first confinement, to the bosoms.
618. In a first confinement, there is, until the third day, but very little milk; although there is usually on that day, and for two or three days afterward, a great deal of swelling, of hardness, of distention, and of uneasiness of the breasts, in consequence of which, in a first confinement, both care and attention are needed.
619. If there be milk in the breast, which may be readily ascertained by squeezing the nipple between the finger and the thumb, the infant should, at first, be applied—not frequently, as some do, but at considerable intervals, say until the milk be properly secreted—every four hours; when the milk flows, the child ought to be applied more frequently, but still at stated times.
620. To wash away any viscid mucus from the nipple, or any stale perspiration from the bosom, let the breasts and the nipples, before applying the baby, be first sponged with a little warm water, and then be dried with a warm, dry, soft napkin; for some infants are so particular that unless the breasts and the nipples be perfectly free from mucus and from perspiration, they will not suck. If after the above cleansing process there be any difficulty in making him take the bosom, smear a little cream on the nipple, and then immediately apply him to it.
621. If the breasts be full, hard, knotty, and painful, which they generally are two or three days after a first confinement, let them be well but tenderly rubbed every four hours, either with the best olive oil (a little of which should, before using it, be previously warmed, by putting a little of the oil in a teacup on the hob by the fire) or with equal parts of olive oil and of eau de Cologne, which should be well shaken up in a bottle every time before it be used.
622. On the third day, more especially after a first confinement, the breasts are apt to become very much swollen, painful, and distended. If such be the case, it might be necessary, for a few days, to have them drawn, once or twice daily, by a woman who makes it her business, and who is usually called either a breast-drawer, or, in vulgar parlance, a suck-pap. A clean, sober, healthy, respectable woman ought to be selected. There is, in nearly every large town, one generally to be found who is at the head of her profession. Such a one should be chosen.
623. If the bosoms be more than usually large and painful, in addition to assiduously using the above liniment, apply to the breasts, in the intervals, young cabbage-leaves, which should be renewed after each rubbing. Before applying them, the “veins” of the leaves, with a sharp knife, must be cut smooth, level with the leaf. It will require several, as the whole of the breast ought to be covered. The cabbage-leaves will be found both cooling and comfortable. Each bosom should then be nicely supported with a soft folded silk handkerchief, going under each breast and suspending it; each handkerchief should then be tied at the back of the neck, thus acting as a kind of sling.
624. The patient ought not, while the breasts are full and uncomfortable, to drink much fluid, as it would only encourage a larger secretion of milk.
625. When the milk is at “its height,” as it is called, she ought every morning, for a couple of mornings, to take a little cooling medicine—a Seidlitz powder—and, every four hours, the following effervescing mixture:
To make a mixture. Two tablespoonfuls to be taken, with two tablespoonfuls of the Acid Mixture, every four hours, while effervescing.
The best way of taking the above effervescing medicine is to put two tablespoonfuls of the first mixture into a tumbler, and two tablespoonfuls of the acid mixture into a wineglass, then to add the latter to the former, and it will bubble up like soda-water; she should instantly drink it off while effervescing.
626. In two or three days, under the above management, the size of the bosoms will decrease, all pain will cease, and the infant will take the breast with ease and comfort.
627. Second and succeeding confinements.—If the breasts are tolerably comfortable (which in the second and in succeeding confinements they probably will be), let nothing be done to them except, as soon as the milk comes, at regular intervals applying the child alternately to each of them. Many a bosom has been made uncomfortable, irritable, swollen, and even sometimes gathered, by the nurse’s interference and meddling. Meddlesome midwifery is bad, and I am quite sure that meddlesome breast-tending is equally so. A nurse, in her wisdom, fancies that by rubbing, by pressing, by squeezing, by fingering, by liniment, and by drawing, she does great good, while in reality, in the majority of cases, by such interference she does great harm.
628. The child will, in second and in succeeding confinements, as a rule, be the best and the only doctor the bosoms require. I am quite convinced that, in a general way, nurses interfere too much, and that the bosoms in consequence suffer. It is, of course, the doctor’s and not the nurse’s province in such matters, to direct the treatment; while it is the nurse’s duty to fully carry out the doctor’s instructions.
629. There is nothing, in my opinion, that so truly tells whether a nurse be a good one or otherwise, as the way she manages the breasts; a good nurse is judicious, and obeys the medical man’s orders to the very letter; while, on the other hand, a bad nurse acts on her own judgment, and is always quacking, interfering, and fussing with the breasts, and doing on the sly what she dare not do openly: such conceited, meddlesome nurses are to be studiously avoided; they often cause, from their meddlesome ways, the breasts to gather.
630. Let the above advice be borne in mind, and much trouble, misery, and annoyance might be averted. Nature, in the majority of cases, manages these things much better than any nurse possibly can do, and does not, as a rule, require helping. The breasts are sadly too much interfered and messed with by nurses, and by nurses who are, in other respects, tolerably good ones.
631. A mother ought to suckle her baby at stated times. It is a bad habit to give him the bosom every time he cries, regardless of the cause; for be it what it may—over-feeding, griping, “wind,” or acidity—she is apt to consider the breast a panacea for all his sufferings. “A mother generally suckles her infant too often—having him almost constantly at the bosom. This practice is injurious both to parent and to child. For the first month he should be suckled about every hour and a half; for the second month, every two hours; gradually, as he becomes older, increasing the distance of time between, until at length he has the breast about every four hours. If he were suckled at stated periods he would only look for it at those times, and be satisfied.”[113]
632. A mother frequently allows her babe to be at the bosom a great part of every night. Now, this plan is hurtful both to her and to him; it weakens her, and thus enfeebles him; it robs them both of their sleep; and generates bad habits, which it will be difficult to break through; it often gives the mother a sore nipple and the child a sore mouth.
633. It is surprising how soon an infant, at a very early age, may, by judicious management, be brought into good habits; it only requires, at first, a little determination and perseverance: therefore a nursing mother ought at once to commence by giving the child the breast at stated periods, and she should rigidly adhere to the times above recommended.
634. A mother should not, directly after taking a long walk, and while her skin is in a state of violent perspiration, give her baby the bosom; the milk being at that time in a heated state, will disorder the child’s bowels, or it may originate in him some skin disease, and one which it might be difficult to cure. She ought, therefore, before she gives him the breast, to wait until the surface of her body be moderately cool. Let her be careful the while not to sit in draughts.
635. A nursing mother ought to have her dress, more especially her stays, made loose and comfortable.
636. A gathered breast sometimes arises from the bones of the stays pressing into the bosom; I should, therefore, recommend her to have the bones removed.
637. If a lady be not in the habit of wearing a flannel waistcoat, she ought at least to have her bosoms covered with flannel, taking care that there be a piece of soft linen over the nipples.
638. I should advise a nursing mother to provide herself with a waterproof nursing apron, which may be procured either at any baby-linen establishment or at an india-rubber warehouse.
639. A nursing mother ought to live plainly; her diet should be both light and nourishing. It is a mistaken notion that at these times she requires extra good living. She ought never to be forced to eat more than her appetite demands; if she be, either indigestion, or heartburn, or sickness, or costiveness, or a bowel complaint will ensue. It is a folly at any time to force the appetite. If she be not hungry, compelling her to eat will do her more harm than good. A medical man, in such a case, ought to be consulted.
640. The best meats are mutton and beef; veal and pork may, for a change, be eaten. Salted meats are hard of digestion; if boiled beef, therefore, be eaten, it ought to be only slightly salted. It is better, in winter, to have the boiled beef unsalted; it is then, especially if it be the rump, deliciously tender. Salt, of course, must be eaten with the unsalted meat. High-seasoned dishes are injurious; they inflame the blood, and thus they disorder the milk.
641. Some persons consider that there is no care required in the selection of the food, and that a nursing mother may eat anything, be it ever so gross and unwholesome; but, if we appeal to reason and to facts, we shall be borne out in saying that great care is required. It is well known that cow’s milk very much partakes of the properties of the food on which the animal lives. Thus, if a cow feed on swedes, the milk and the butter will have a turnipy flavor. This, beyond a doubt, decides that the milk does partake of the qualities of the food on which she feeds. The same reasoning holds good in the human species, and proves the absurdity of a nursing mother being allowed to eat anything, be it ever so gross, indigestible, or unwholesome. Again, either a dose of purgative medicine given to her, or greens taken by her at dinner, will sometimes purge the baby as violently, or even more so, than it will herself.
642. Even the milk of a healthy wet-nurse acts differently, and less beneficially, upon the child than the mother’s own milk. The ages of the mother and of the wet-nurse, the ages of her own and the latter’s infant, the constitutions of the one and of the other, the adaptability of a mother’s milk for her own particular child—all tend to make a foster-mother not so desirable a nurse as the mother herself. Again, a mother cannot at all times get to the antecedents of a wet-nurse; and, if she can, they will not always bear investigation.
643. With regard to the ages of the mother and of the wet-nurse—for instance, as a wet-nurse’s milk is generally a few weeks older than the mother’s own milk, the wet-nurse’s milk may, and frequently does, produce costiveness of the bowels of her foster-child; while, on the other hand, the mother’s own milk, being in age just adapted to her babe’s, may and generally does keep her own infant’s bowels regular. The milk, according to the age of the child, alters in properties and qualities to suit the age, constitution, and acquirements of her baby—adapting itself, so to speak, to his progressive development. Hence the importance of a mother, if possible, suckling her own child.
644. A babe who is suckled by a mother who lives grossly is more prone to disease, particularly to skin and to inflammatory complaints, and to disease which is more difficult to subdue.
645. Do not let me be misunderstood: I am not advocating that a mother should be fussily particular—by no means. Let her take a variety of food, both animal and vegetable; let her from day to day vary her diet; let her ring the changes on boiled and stewed, on grilled and roast meats; on mutton and lamb and beef; on chicken and game and fish; on vegetables, potatoes, and turnips; on broccoli and cauliflower, on asparagus and peas (provided they are young and well boiled), and French beans. “The maxim of the greatest importance in reference to the materials of human food is, mixture and variety—a maxim founded, as has been stated, upon man’s omnivorous nature. Animal and vegetable substances, soups and solid meat, fish, flesh, and fowl, in combination or succession, ought, if due advantage is to be taken of the health-sustaining element in food, to form the dietary of every household.”[114]
646. But what I object to a nursing mother taking are—gross meats, such as goose and duck; highly-salted beef; shell-fish, such as lobster and crab; rich dishes; highly-seasoned soup; pastry, unless it be plain; and cabbages and greens and pickles, if found to disagree with the baby; and any other article of food which is either rich, or gross, or indigestible, and which, from experience, she has found to disagree either with herself or with her child. It will be seen, therefore, from the above catalogue, that my restrictions as to diet are limited, and are, I hope, founded both on reason and on common sense.
647. A moderate quantity—say a tumblerful—either of fresh mild ale or of porter will generally be found the best beverage both for dinner and for supper. There is much more nourishment in either ale—home-brewed—or in porter, than in wine; therefore, for a nursing mother, either ale or porter is far preferable to wine. Wine, if taken at all, ought to be used very sparingly, and then not at the same meal with the porter or ale. In the higher ranks of life, where a lady is in the habit of drinking wine, it is necessary to continue it, although the quantity should not be increased, and ought never to exceed a couple of glasses—dry sherry being the best wine for the purpose.
648. A nursing mother is subject to thirst. When such be the case, she ought not to fly either to beer or to wine to quench it; this will only add fuel to the fire. The best beverages will be either toast and water, milk and water, barley-water, barley-water and new milk (in equal proportions), or black tea, either hot or cold. Cold black tea is a good quencher of thirst.
649. A lady who is nursing is at times liable to fits of depression. Let me strongly urge the importance of her abstaining from wine and from all other stimulants as a remedy; they would only raise for a time her spirits, and then would depress them in an increased ratio. Either a drive in the country, or a short walk, or a cup of tea, or a chat with a friend, would be the best medicine. The diet should be good and nourishing; plenty of bread and plenty of meat should be her staple food, in addition to which Du Barry’s Arabica Revalenta, made either with fresh milk or with cream and water, is, in these cases, most useful and sustaining. The best time for taking it is either for luncheon or for supper. A lady subject to depression should bear in mind that she requires nourishment, not stimulants,—that much wine and spirits might cheer her for the moment, but will assuredly depress her afterward. Depression always follows overstimulation; wine and spirits therefore, in such a case, if taken largely, are false and hollow friends. It is necessary to bear the above facts in mind, as there are many advocates who strongly recommend, in a case of this kind, a large consumption of wine and brandy. Such men are, at the present moment, doing an immense deal of mischief; they are, in point of fact, inducing and encouraging drunkenness.
650. Spirits—brandy, rum, gin, and whisky—are, during suckling, injurious; I may even say that they are insidious poisons to the parent, and, indirectly, to the child.
651. When an infant is laboring under an inflammatory complaint, a nursing mother ought not to take stimulants, such as either ale or wine. In a case of this kind, toast and water will, for her dinner, be the best beverage, gruel for her supper, and black tea—not coffee, as it would be too stimulating—both for her breakfast and tea.
652. Out-door exercise during suckling cannot be too strongly insisted upon; it is the finest medicine both for babe and mother. Whenever the weather will admit, it must be taken. It is utterly impossible for a nursing mother to make good milk, unless she do take an abundance of exercise and breathe plenty of fresh air.
653. Whatever improves the health of the mother, of course at the same time benefits the child: there is nothing more conducive to health than an abundance of out-door exercise. It often happens that a mother who is nursing seldom leaves her house; she is a regular fixture; the consequence is, both she and her babe are usually delicate and prone to sickness.
654. A mother ought not, immediately after taking exercise, to nurse her infant, but wait for half an hour. Nor should she take violent exercise, as it would be likely to disorder the milk.
655. Carriage exercise, if the weather be hot and sultry, is preferable to walking; if that be not practicable, she ought to have the windows thrown wide open, and should walk about the hall, the landings, and the rooms, as she would by such means avoid the intense heat of the sun. Although carriage exercise during intensely hot weather is preferable to walking exercise, yet, notwithstanding, walking must, during some portion of the day, be practiced. There is no substitute, as far as health is concerned, for walking. Many ailments that ladies now labor under could be walked away; and really it would be a pleasant physic—far more agreeable than pills and potions!
656. Good habits are as easily formed as bad ones. A mother, when in bed, ought always to suckle her child while she is lying down. The sitting up in bed, during such times, is a fruitful source of inflammation and of gathering of the breasts. Of course, during the day the sitting-up position is the best. Let me caution her not to nurse her baby in a half-sitting and half-lying posture; it will spoil her figure, disturb her repose, and weaken her back.
657. Passion is injurious to the mother’s milk, and consequently to the child. Sudden joy and grief frequently disorder the infant’s bowels, producing griping, looseness, etc.; hence, a mother who has a mild, placid temper generally makes an excellent nurse, on which account it is a fortunate circumstance that she is frequently better-tempered during suckling than at any other period of her life; indeed, she usually, at such times, experiences great joy and gladness.
658. The happiest period of a woman’s existence is, as a rule, when she first becomes a mother. “The pleasure of the young mother in her babe is said to be more exquisite than any other earthly bliss.”[115]
659. It is an old and, I believe, a true saying, that the child inherits the temper of his mother or of his wet-nurse. This may be owing to the following reasons: If the mother or the wet-nurse be good-tempered, the milk will be more likely to be wholesome, which will, of course, make him more healthy, and consequently better-tempered.
660. While, on the other hand, if the mother or the nurse be of an irritable, cross temper, the milk will suffer, and will thus cause disarrangement to his system; and hence ill health and ill temper will be likely to ensue. We all know the influence that good or bad health has on the temper.
661. An important reason, then, why a nursing mother is often better-tempered than she is at other times is, she is in better health, her stomach is in a healthier state:
There is an old and a true saying, “that it is the stomach that makes the man,” and if the man, the woman:
662. Hear what Shakspeare says of the functions of the stomach. The stomach is supposed to speak (and does it not frequently speak, and in very unmistakable language, if we will but only listen to its voice?):
663. I strongly recommend a nursing mother to attend to her household duties. She is never so happy, nor so well, as when her mind is moderately occupied at something useful. She never looks so charming as when she is attending to her household duties—
664. I do not mean by occupation the frequenting of balls, of routs, or of parties: a nursing mother has no business to be at such places; she ought to devote herself to her infant and to her household, and she will then experience the greatest happiness this world can afford.
665. One reason why the poor make so much better nursing mothers than the rich is the former having so much occupation; while the latter, having no real work to do, the health becomes injured, and in consequence the functions of the breasts suffer; indeed, many a fashionable lady has no milk at all, and is therefore compelled to delegate to a wet-nurse one of her greatest privileges and enjoyments.
666. What would not some rich mother give for the splendid supply of milk—of healthy, nourishing, life-giving milk—of the poor woman who has to labor for her daily bread!
667. What is the reason that wealthy ladies so frequently require wet-nurses? The want of occupation! And from whom do they obtain the supply of wet-nurses? From the poor women who have no lack of occupation, as they have to labor for their daily food, and have in consequence the riches of health, though poor in this world’s goods—
Bear this in mind, ye wealthy, and indolent, and pampered ladies, and alter your plans of life, or take the consequences, and still let the poor women have the healthy, the chubby, the rosy, the laughing children; and you, ye rich ones, have the unhealthy, the skinny, the sallow, the dismal little old men and women who are constantly under the doctor’s care, and who have to struggle for their very existence! “Employment, which Galen calls ‘nature’s physician,’ is so essential to human happiness, that Indolence is justly considered as the mother of Misery.”[120]
668. Occupation, then—bustling occupation, real downright work, either in the form of out-door exercise, or of attending to her household duties—a lady, if she desire to have a good breast of milk, ought to take; if, in point of fact, she wishes to have healthy children. For the Almighty is no respecter of persons. And he has ordained that work shall be the lot of man and of woman too! It is a blessed thing to be obliged to work. If we do not work, we have all to pay a heavy penalty, in the form of loss of both health and happiness. “For work is the grand cure of all the maladies and miseries that ever beset mankind—honest work, which you intend getting done.”[121]
669. A mother who is listless and idle, lolling either the greater part of every day in an easy-chair, or reclining on a sofa in a room where a breath of air is not allowed to enter, usually makes a miserable and a wretched nurse. She is nervous, dyspeptic, and emaciated; having but little milk, and that little of a bad quality, her baby is puny, pallid, and unhealthy, and frequently drops into an untimely grave. Occupation, then, with fresh air and exercise, is indispensable to a mother who is suckling.
670. The Nipple.—A good nipple is important both to the comfort of the mother and to the well-doing of the child.
671. One, among many, of the ill effects of stays and of corsets is the pushing-in of the nipples; sore nipples, and consequent suffering, are the result. Moreover, a mother thus circumstanced may be quite unable to suckle her infant; and then she will be severely punished for her ignorance and folly; she will be compelled to forego the pleasure of nursing her own children, and she will be obliged to delegate to hirelings her greatest privilege! Ladies who never wear stays have much better nipples, and more fully-developed bosoms; hence such mothers are more likely to make better nurses to their babies. There is no doubt that the pressure of the stays on the bosom tends both to waste away the gland of the breast (where the milk is secreted), and to cause the nipple either to dwindle or to be pushed in, and thus to sadly interfere with its functions. I should strongly advise every mother who has daughters old enough to profit by it, to bear this fact in mind, and thus to prevent mischief when mischief might be prevented, by not allowing them, when young, to wear stays.
672. Treatment of very small and drawn-in nipples.—The baby ought to suck through the intervention of an india-rubber teat fastened on a boxwood shield, or through an india-rubber teat and shield, made entirely of india-rubber.[122] The india-rubber teat must, before it is used, be softened by dipping it in warm but not in hot water. I have known many mothers able to suckle their children with this contrivance who otherwise would have been obliged either to have weaned them, or to have procured the assistance of a wet-nurse. The above aid, in the generality of instances, will enable the infant to suck with ease. After this has for a time been used, the nipples will be so improved as to render the continuance of it unnecessary. Of course I do not advise the use of an india-rubber teat until a fair trial has been given by applying the babe at once to the nipple; but if he cannot draw out the nipple, then, rather than wean him, or than employ a wet-nurse, let the teat be tried.
673. Remember, as soon as the nipple be sufficiently drawn out, which in all probability it will in a few days, the teat ought to be dispensed with. In such a case, when the infant is not at the breast, Dr. Wansbrough’s Metallic Nipple Shields should be worn. Small and bad nipples have, by the wearing of these shields, frequently been drawn out and made good ones; the dress will suffice to keep them in their places.
674. Sore nipples.—If a lady, during the latter few months of her pregnancy, were to adopt the plan recommended at page 162, paragraph 353, sore nipples, during the period of suckling, would not be so prevalent as they now are.
675. A sore nipple is frequently produced by the injudicious custom of allowing the child to have the nipple almost constantly in his mouth. Stated periods for suckling, as recommended at paragraph 631, ought to be strictly adopted. Another frequent cause of a sore nipple is from the babe having the thrush. It is a folly to attempt to cure the nipple without at the same time curing the mouth of the infant.
676. Treatment.—One of the best remedies for a sore nipple is the following powder:
Mix,—A pinch of the powder to be frequently applied to the nipple.
677. Dr. A. Todd Thomson’s—my old preceptor—remedy for sore nipple is a very good one; it is as follows:
To be well mixed together in a mortar to make a powder, of which a pinch should either be sprinkled over the nipple, or it may be applied to the part by means of a camel’s-hair brush every time directly after the child has done sucking. Let the brush, covered with the dry powder, gently sweep over the sore nipple.
As there is nothing in either of the above powders injurious to the infant, the powder, before applying him to the breast, ought not to be wiped off; indeed, either the one or the other of the powders (the former one especially, as it contains borax) is likely to be of service in preventing or in curing the sore mouth of the child.
678. If the above powders should not have the desired effect (efficacious though they usually are), “a liniment composed of equal parts of glycerin and of brandy” (say a vial containing two drachms of each) ought to be tried, which must be shaken up just before using. It should, by means of a camel’s-hair brush, every time directly after the baby has been suckled, be painted on the nipple. A piece of either old soft cambric or lawn, about the size of the palm of the hand, snipped around to make it fit, ought then to be moistened in the glycerin and the brandy, and should be applied to each of the sore nipples, and worn (until they are cured) whenever the child is not at the breast. These applications will be found of much service and of great comfort, and will act as nipple shields, protecting and healing the nipples. A soft sponge of warm water may be gently applied to the nipple just before putting the child to the bosom.
679. If the above remedies should not succeed in curing the sore nipple, then she ought to try Dr. Wansbrough’s Metallic Nipple Shield (as recommended previously for small and drawn-in nipples), and should, whenever the babe is not sucking, constantly wear it on the nipple. It is very cooling and healing, and keeps off all pressure from the clothes. It will frequently cure a sore nipple when other remedies have failed. The shield may be procured of any respectable surgical-instrument-maker.
680. Cracked and fissured nipples.—Sometimes the nipple is sore from having either cracks or fissures upon it. These cracks or fissures may attack any part of the nipple, but are very apt to form where the nipple joins the breast; and, when very severe, an ignorant nurse, who is always fond of dealing in the marvelous, declares that the child has nearly bitten the nipple off! Treatment.—Now, the best remedy for a cracked and fissured nipple is for the infant, until the cracks and fissures are cured, to suck through the intervention of an india-rubber teat and shield; and every time, directly after the babe has been put to the nipple, to apply to the parts affected either neat brandy or the glycerin and brandy liniment, as I have before recommended. When the child is not at the breast, Dr. Wansbrough’s Nipple Shields should be worn; the dress will keep them in their places.
681. Another cause of a sore nipple is from the mother, after the babe has been sucking, putting up the nipple wet. She, therefore, ought always to dry the nipple—not by rubbing it, but by dabbing it with either a soft cambric or lawn handkerchief, or with a piece of soft linen rag (one or other of which ought always to be at hand), every time directly after the infant has done sucking, and just before applying either of the above powders or liniment to the nipple.
682. When the nipple is very sore, a mother, whenever the child is put to the bosom, suffers intense pain. This being the case, she had better suckle him through the intervention of an india-rubber teat, properly fastened on a shield, as before recommended. See page 276, paragraph 672. But she ought never to use an india-rubber teat unless it be absolutely necessary—that is to say, if the nipple be only slightly sore, she should not, on any account, apply it; but there are cases where the nipple is so very sore that a mother would have to give up nursing if the shield and teat were not used; these, and very small and drawn-in-nipples, are the only cases in which an india-rubber teat and shield is admissible.
683. A nursing mother is sometimes annoyed by the milk flowing constantly away, making her wet and uncomfortable. All she can do under such circumstances is to wear nipple-glasses, and to apply a piece of flannel to the bosom, which will prevent the milk from chilling her, and will thus do away with the danger of her catching cold, etc.
684. The breast.—A mother ought, before applying the infant to the bosom, to carefully ascertain if there be milk. This may readily be done by squeezing the nipple between the finger and the thumb. If there be no milk, she must wait until the milk be secreted, or serious consequences both to her and to him might ensue: to the former, inflammation and gathering of the bosom, and sore nipples; to the latter, thrush, diarrhœa, and eruptions on the skin.[123]
685. If there be a supply of milk in the breast, and if still the child will not suck, the medical man’s attention ought to be drawn to the fact, in order that he may ascertain whether the child be tongue-tied; if he be, the mystery is explained, and a trifling, painless operation will soon make all right.
686. If the bosoms be full and uneasy, they ought, three or four times a day, to be well although tenderly rubbed with olive oil and eau de Cologne (equal parts of each, mixed in a vial). Some nurses rub with their fingers only. Now, such rubbing does harm. The proper way to apply friction is to pour a small quantity of the oil and eau de Cologne—first shaking the bottle—into the palm of the hand, the hand being warm, and then to well rub the breasts, taking care to use the whole of the inside of the hand.
687. After the bosoms have been well rubbed, each ought to be nicely supported with a large, soft, folded silk handkerchief; each handkerchief must pass under each breast and over the shoulders, and should be tied at the back of the neck, thus acting as a sling.
688. If the bosoms be very uncomfortable, young cabbage-leaves (with the “veins” of each leaf cut level to the leaf) ought, after each application of the oil and eau de Cologne, to be applied; or a large warm white-bread-and-milk and olive oil poultice ought to be used, which must be renewed three or four times a day. The way to make the poultice is as follows: A thick round of bread should be cut from a white loaf; the crust should be removed, the crumb ought to be cut into pieces about an inch square, upon which boiling-hot new milk should be poured; it ought to be covered over for ten minutes; then the milk should be drained off, and the olive oil—previously warmed by placing a little in a teacup on the hob—should be beaten up by means of a fork with the moistened bread until it be of the consistence of a soft poultice. It ought to be applied to the bosom as hot as it can comfortably be borne.
689. Gathered breast.—A gathered bosom, or “bad breast” as it is sometimes called, is more likely to occur after a first confinement and during the first month. Great care, therefore, ought to be taken to avoid such a misfortune. A gathered breast is frequently owing to the carelessness of a mother in not covering her bosoms during the time she is suckling. Too much attention cannot be paid to keeping the breasts comfortably warm. This, during the act of nursing, should be done by throwing either a shawl or a square of flannel over the neck, shoulders, and bosoms.
690. Another cause of a gathered breast arises from a mother sitting up in bed to suckle her baby. An infant ought to be accustomed to take the bosom while he is lying down; if this habit be not at first instituted, it will be difficult to adopt it afterward. Good habits may be taught a child from the very earliest period of his existence.
691. A sore nipple is another fruitful cause of a gathered breast. A mother, in consequence of the suffering it produces, dreads putting the baby to it; she therefore keeps him almost entirely to the other bosom. The result is, the breast with the sore nipple becomes distended with milk, which, being unrelieved, ends in inflammation, and subsequently in gathering.
692. The fruitless attempt of an infant, to procure milk when there is very little or none secreted is another and a frequent cause of a gathered bosom. Dr. Ballard, in his valuable little work before quoted, considers this to be the principal cause of a gathered breast; and, as the subject is of immense importance, I cannot do better than give it in his own words, more especially as he has the merit of originating and of bringing the subject prominently before his professional brethren. He says: “This (mammary abscess or gathered breast) is another form of disease entirely referable to the cause under consideration [fruitless sucking]. In the case last related, the formation of mammary abscess [gathered breast] was only just prevented by arresting any further irritation of the breast by suckling; and since I have kept careful notes of my cases, I have observed that in all instances of abscess there has been abundant evidence of a demand being made upon the gland for a supply of milk beyond that which it had the power of secreting. If the child only has been kept to the breast, then it has suffered with disordered bowels; but in the majority of cases an additional irritation has been applied; the commonly-received doctrine that a turgid breast is necessarily overloaded with milk, leads mothers and nurses to the use of breast-pumps, exhausted bottles, or even the application of the powerful sucking powers of the nurse herself, to relieve the breasts of their supposed excess; and it is this extraordinary irritation which, in the majority of cases, determines the formation of an abscess [gathering]. Sometimes these measures are adopted to remove the milk when a woman is not going to suckle, and then an abscess not unfrequently is established. I have previously alluded to the mistake into which mothers and nurses are led by the appearance of a swollen breast; it is not evidence that the gland can secrete freely, and it is in this turgid state that the excessive irritation tells most severely. This hyperæmic [plethoric] condition seems to be a step toward inflammation, and the irritation supplies that which is wanting to complete the process. If a woman will only remove the child from the breast directly the act of sucking produces pain, she may be pretty sure to avoid abscess. So long as the milk can be obtained there is no pain.” The above most valuable advice deserves great attention, and ought to be strictly followed.
693. How is a patient to know that she is about to have a gathered bosom?—There are two forms of gathered breast; one being of vast and the other of trifling importance. The first, the serious one, consists of gathering of the structure of the gland of the breast itself; the latter, merely of the superficial part of the bosom, and ought to be treated in the same manner as any other external gathering, with warm poultices.
694. In the mild or superficial kind of gathered bosom, the mother may still persevere in suckling her child, as the secreting portion of the breast is not at all implicated in the gathering; but in the severe form, she ought not, on any account whatever, to be allowed to do so, but should instantly wean her child from the affected side. The healthy breast she may still continue to nurse from.
695. The important form of a gathered breast I will now describe: A severe gathered bosom is always ushered in with a shivering fit. Let this fact be impressed deeply upon my reader’s mind. This shivering is either accompanied or followed by sharp lancinating pains of the bosom. The breast now greatly enlarges, becomes hot, and is very painful. The milk in the affected bosom either lessens or entirely disappears. If the child be applied to the breast (which he ought not to be), it gives the mother intense pain. She is now feverish and ill; she loses her strength and appetite, and is very thirsty.
696. A medical man must, at the very onset of the shivering fit, be sent for; and he will, in the generality of instances, be able to prevent such a painful and distressing occurrence as a gathered breast. If twelve hours be allowed to elapse after the shivering has taken place, the chances are that the gathering cannot altogether be prevented; although even then it may, by judicious treatment, be materially lessened and ameliorated.
697. We sometimes hear of a poor woman suffering dreadfully for months, and of her having a dozen or twenty holes in her bosom! This is generally owing to the doctor not having been sent for immediately after the shivering; I therefore cannot too strongly insist, under such circumstances, upon a mother obtaining prompt assistance, not only to obviate present suffering, but, at the same time, to prevent the function of the breast from being injured, which it inevitably, more or less, will be, if the important form of gathering be allowed to take place.
698. When a nursing mother feels faint, she ought immediately to lie down and to take a little nourishment; either a crust of bread and a draught of ale or of porter, or a glass of wine, or a cup of tea with the yelk of an egg beaten up in it, either of which will answer the purpose extremely well. Brandy, or any other spirit, I would not recommend, as it will only cause, as soon as the immediate effects of the brandy are gone off, a greater depression to ensue; not only so, but the frequent taking of brandy might become a habit—a necessity which would be a calamity deeply to be deplored!
699. A mother is sometimes faint from suckling her child too often, she having him almost constantly at the bosom. So long, of course, as she continues this foolish practice, she must expect to suffer from faintness.
700. Aperients, etc. during suckling.—Strong purgatives, during this period, are highly improper, as they are apt to give pain to the infant as well as to injure the mother. If it be absolutely necessary to give an aperient, the mildest, such as a dose of castor oil, should be chosen.
701. If she cannot take oil, then she should apply it externally to the bowels as a liniment, as recommended at page 144.
702. An enema, either of warm water, or of gruel, oil, and table salt,[124] applied by means of a good self-injecting enema apparatus, is in such a case an excellent—indeed, the very best—method of opening the bowels, as it neither interferes with the digestion of the mother nor of the child.
703. The less opening medicine, whatever be the kind, a mother who is suckling takes, the better will it be both for herself and for her babe. Even castor oil, the least objectionable, during suckling, of aperients, if she once begin to take it regularly, the bowels will not act without it, and a wretched state of things is established. No, if the bowels will not act, an enema is by far the best remedy; you can never do any harm, either to the mother or to the babe, by the administration of an enema; it will neither induce future constipation, nor will it interfere with the digestion of the mother, nor with the bowels, nor with the health of the infant.
704. When a lady who is nursing is habitually costive, she ought to eat brown instead of white-bread. This will, in the majority of cases, enable her to do without an aperient. The brown bread may be made by mixing one part of bran and three parts of fine wheaten flour together, and then making it in the usual way into bread. Treacle instead of butter on the brown bread increases its efficacy as an aperient.
705. Either stewed prunes or stewed French plums are an excellent remedy to prevent constipation. The patient ought to eat, every morning, a dozen or fifteen of them. The best way to stew either prunes or French plums is the following: Put a pound, either of prunes or of French plums, and two tablespoonfuls of raw sugar, into a brown jar; cover them with water, put them into a slow oven, and stew them for three or four hours. Both stewed rhubarb and stewed pears often act as mild or gentle aperients. Muscatel raisins, eaten at dessert, will oftentimes, without medicine, relieve the bowels.
706. A Bee-master in The Times, or, as he is usually called, The Times Bee-master, has satisfactorily proved that honey—pure honey—is most wholesome and beneficial to the human economy. He recommends it to be occasionally eaten in lieu of butter for breakfast. Butter, in some localities, and in some seasons of the year, is far from good and wholesome.
707. The Germans are in the habit of eating for breakfast and for tea a variety of fruit jams instead of butter with their bread. Now, if the bowels be costive, jam is an excellent substitute for butter. The Scotch, too, scarcely ever sit down either to breakfast or tea without there being a pot of marmalade on the tables. English ladies, in this matter, may well take a leaf out of the books of the Germans and of the Scotch.
708. A basinful of gruel, made either with Robinson’s Patent Groats, or with the Derbyshire oatmeal, sweetened with brown sugar, every night for supper will often supersede the necessity of giving opening medicine. A tumblerful of cold spring water—cold from the pump—taken early every morning, sometimes effectually relieves the bowels. Coffee ought to be substituted for tea for breakfast, as coffee frequently acts as an aperient, more especially if the coffee be sweetened with brown sugar. A glass of sherry should be taken every day during dinner, as, if the bowels be sluggish, it sometimes stimulates them to action. I should strongly recommend a patient, in such a case, to eat a great variety of food, and to let the vegetable element predominate. Much meat encourages constipation. Fruit—Muscatel raisins especially—farinaceous food, coffee, and a variety of vegetables, each and all incite the bowels to do their duty.
709. Although a nursing mother ought, more especially if she be costive, to take a variety of well-cooked vegetables—such as potatoes, asparagus, broccoli, cauliflower, French beans, stewed celery, and turnips; she should avoid eating greens, cabbages, and pickles, as they would be likely to affect the baby, and might cause him to suffer from gripings, pain, and “looseness” of the bowels.
710. The “wet compress” is another excellent method of opening the bowels. The way of applying it is as follows: Fold a large napkin a few thicknesses until it is about half a foot square; then dip it in cold water and place it over the bowels; over which apply either oilskin or gutta-percha skin, which should be, in order to exclude the air, considerably larger than the folded napkin. It should be kept in its place by means of either a bolster-case or a broad bandage, and must be applied at bedtime, and ought to remain on for three or four hours, or until the bowels be opened.
711. Let me again—for it cannot be too urgently insisted upon—strongly advise a nursing mother to use every means in the way of diet, etc., to supersede the necessity of the taking of opening medicine, as the repetition of aperients injures, and that severely, both mother and child. Moreover, the more opening medicine a person swallows, the more she requires; so that if she once get into the habit of regularly taking aperients, the bowels will not act without them. What a miserable existence, to be always swallowing physic!
712. If a lady, then, during the period of suckling, were to take systematic exercise in the open air; to bustle about the house and to attend to her household duties; if she were to drink, the moment she awakes in the morning, a tumbler of cold water, and every day during dinner a glass of sherry; if she were to substitute brown bread for white bread, and coffee for tea at breakfast, and brown for white sugar; if she were to vary her food, both animal and vegetable, and partake plentifully of sound ripe fruit; if she were to use an abundance of cold water to her skin; if she were, occasionally, at bedtime, to apply a “wet compress” to her bowels, and to visit the water-closet daily at one hour; if she were—even if the bowels were not opened for four or five days—not to take an aperient of any kind whatever, and avoid quacking herself with physic; in short, if she would adopt the above safe and simple remedies, which are in the reach of all, she would not suffer so much from costiveness, which is frequently the bane, the misery, and the curse of her existence! But then, to get the bowels into a proper and healthy state, it would take both time and trouble; and how readily can a couple of pills be swallowed, and how quickly they act, and how soon they have to be repeated; until at length the bowels will not act at all unless goaded into action, and the pills become a necessity! Oh, the folly and the mischief of such a system!
713. There is an old saying, “that a woman should carry her child nine months, and should suckle him nine months.” It is well known that the first part of the old adage is correct, and experience has proved the latter to be equally so. If a babe be weaned before he be nine months, he loses that muscular strength which the breast-milk alone can give; if he be suckled after he be nine months, he becomes flabby, weak, and delicate. “It is generally recognized that the healthiest children are those weaned at nine months complete. Prolonged nursing hurts both child and mother; in the child, causing a tendency to brain disease, probably through disordered digestion and nutrition; in the mother, causing a strong tendency to deafness and blindness. It is a very singular fact, to which it is desirable that attention were paid, that in those districts of Scotland—viz., the Highland and insular—where the mothers suckle their infants from fourteen to eighteen months, deaf-dumbness and blindness prevail to a very much larger extent among the people than in districts where nine or ten months is the usual limit of the nursing period.”[125]
714. The time, then, when an infant ought to be weaned.—“This, of course, must depend upon the strength of the child, and upon the health of the mother: nine months on an average is the proper time. If she be delicate, it may be found necessary to wean him at six months; or if he be weak, or laboring under any disease, it may be well to continue suckling him for twelve months; but after that time the breast will do him more harm than good, and will, moreover, injure the mother’s health.”[126]
715. If he be suckled after he be twelve months old, he is generally pale, flabby, unhealthy, and rickety; and the mother is usually nervous, emaciated, and hysterical. A child who is suckled beyond the proper time, more especially if there be any predisposition, sometimes dies either of water on the brain, or of consumption of the lungs, or of mesenteric disease.
716. The manner in which a mother ought to act when she weans her child.—“She must, as the word signifies, do it gradually—that is to say, she should by degrees give him less and less of the breast, and more and more of artificial food; she ought, at length, only to suckle him at night; and lastly, it would be well for the mother either to send him away, or to leave him at home, and for a few days to go away herself.”[127]
717. “A good plan is for the nurse to have in the bed a half-pint bottle of new milk, which, to prevent it from turning sour, has been previously boiled, so as to give a little to the child in lieu of the breast. The warmth of the body will keep the milk of a proper temperature; and will supersede the use of lamps, of candle-frames, and other troublesome contrivances.”[128]
718. If the mother be not able to leave home herself, or to send her child from home, she ought then to let the child sleep in another room, with some responsible person—I say responsible person, for a baby must not be left to the tender mercies of a giggling, thoughtless young girl.
719. If the mother, during the daytime, cannot resist having her child in the room with her, then I should advise her to make a paste of aloes—that is to say, let her mix a little powdered aloes with a few drops of water, until it be of the consistence of paste—and let her smear it on the nipple every time just before putting him to the breast; this will be quite enough for him; and one or two aloe applications to the nipple will make him take a disgust to the bosom, and thus the weaning will be accomplished. A mother need not be afraid that the aloes will injure her baby; the minute quantity he will swallow will do no harm; for the moment he tastes it, the aloes being extremely bitter, he will splutter it out of his mouth.
720. Another application for the nipple, to effect weaning, is wormwood. There are two ways of applying it, either (1) by sprinkling a very small pinch of powdered wormwood on the nipple; or (2) by bathing the nipple with a small quantity of wormwood tea just before applying the babe to it—either the one or the other of these plans will make him take a dislike to the breast, and thus the weaning will be accomplished. Wormwood is excessively bitter and disagreeable, and a slight quantity of it on the nipple will cause an infant to turn away from it with loathing and disgust—the wormwood, the minute quantity he will taste, will not at all injure him. Wormwood was in Shakspeare’s time used for the purpose of weaning: