BY L. HALLOCK, M. D., NEW YORK.

The secretion of milk after parturition, although a normal and healthy function is so often affected by various disturbing causes, as to require careful and discriminating attention from the physician. The first nursing is usually attended for several days with painful distension of the breasts, more or less soreness of the nipples, and sufficient constitutional disturbance to deserve the designation of “ Milk Fever.” These symptoms are less marked in each subsequent lactation, so that women, after nursing their first or second child, often suffer hardly the slightest general disturbance in re-establishing the function. This remark, however, does not apply with equal propriety to the local irritation occasioned by nursing, for many mothers suffer as severely from soreness of the nipples with their later children as with the first. This is usually attributed to constitutional irritability or a psoric diathesis, but is sometimes seen in women enjoying-, the most perfect general health, both before and after parturition. An instance of this kind I am now attending in a woman of uncommon health and vigor, never affected with a cutaneous eruption; who, though nursing her sixth child, is suffering the same painful process of excoriation, fissures and exquisite tenderness that has been endured with each preceding infant. The treatment of sore nipples is usually required only during the first 3 or 4 weeks of lactation, after which they gradually acquire a callous hardness and insensibility, which renders subsequent nursing an easy and pleasurable function.

The topical application of Arnica I find in many cases all that is necessary for the speedy relief of sore nipples, when it fails after having been kept applied for 3 or 4 days, I usually resort to demulcent or oily applications, after which astringents as solutions of Alum, Zinc, and especially the Nitrate of silver, are often useful if not indispensable.

Chamomilla, Calcarea and Silicea have seemed to me the most valuable of our internal remedies, each of which may often be usefully applied to the suffering organ. Bryonia given two or three times a day after the abatement of after-pains, is useful in preventing painful distention and soreness of the breasts, and usually secures an alvine evacuation about the 5th or 6th day after delivery, which is quite as soon as that function is required, as is shown by the uniform and speedy recovery of women whose bowels are thus left undisturbed, and who thereby escape the dangers of prolapsus, hemorrhoids and prostration from the early administration of cathartics.

Perhaps the most troublesome and formidable disease connected with Lactation, is aphthous stomatitis or nursing sore mouth. This affection seems due, not so much to inflammation of the mucous surface, as to general exhaustion from protracted or excessive lactation. It occurs only after the woman has been some time nursing when the system begins to suffer the debilitating effects of the discharge.

Its invasion is more or less early in different women, according to the difference in constitutional vigor, and ability to endure the daily drain of milk. Hence its first symptoms are not those of follicular inflammation, but these are preceded by signs of weakness and exhaustion, such as a dragging, aching pain between the shoulders during the act of nursing, soon followed by a sense of emptiness and sinking at the stomach. If these symptoms receive proper attention by sustaining the mother with porter, milk-punch, eggs, and a generous, invigorating regimen, the threatened disease may be averted, but if disregarded, other sufferings soon follow; the patient loses her appetite for solid food, while the thirst (which we believe is generally increased during the period of nursing) become more urgent, the face acquire a pallid, ashy hue, headache, giddiness on rising, nervous irritability, slight fever and nocturnal sweating succeed. During the progress of these symptoms, the edges of the tongue become red and tender, and aphthous spots appear, not diffused in numerous white specks as in the aphthae of children, but in distinct spots on the tongue, gums and lining of the mouth, each encircled by an inflamed border and becoming a distinct ulcer: These often spread and enlarge to the size of a 5 or 10 cent piece, attended with salivation often profuse and offensive, and with painful swelling of the submaxillary and neighboring glands. In favorable cases the ulcers, after a time, gradually heal as the general condition improves, but are often followed by others usually less extensive.

In the worst cases we have seen the ulcers progressed in depth and extent over nearly the whole buccal membrane, attended with copious discharge of thick bloody mucus and such exquisite tenderness of the mouth and throat as to permit only the use of the blandest fluids and these in sparing quantity; the general state of the patient being exhausted by the double process of wasting discharge and insufficient nourishment, she lay pale and white as her pillow, reduced to an alarming extremity of feebleness and prostration.

The successful treatment of this form of the disease requires the prompt removal of its cause by the immediate weaning of the child. Without this we believe no treatment will avail to prevent the mother from sinking by early exhaustion or by more tardy pulmonary decline. Of the various remedies recommended, Merc. sol., Nat. muriat., and Nitric acid are most useful in the early period or the milder forms of the disease, and in the severe forms, especially when connected with a strumous or psoric diathesis, Arsenic, Carb. veg., Conium, Iodine and Sulphur. Applications of Nitrate of Silver and Tinct. Iodine, often diminish the sensibility of the sores and seem to promote their cicatrization. Two aggravated cases complicated with painful diarrhea and other indications of an extension of the disease into the alimentary canal were much improved by the Chlorate of Potass, five grains given 3 or 4 times a day in watery solution. From some other employment of this medicine we can recommend it as peculiarly useful in similar ulcerations of the mucous membrane, especially when occurring in asthenic conditions of the general system.

Much difference exists in the quantity of milk secreted by different women. While some mothers, including those of a light and delicate organization, furnish a full supply for their infants, others apparently rigorous and healthy, secrete little or none, the fulness and soreness of their breasts after an abortive effort of a few days subside, and the gland returns to its normal condition. Others are able to furnish a partial supply for a few weeks and are then compelled to relinquish nursing entirely. The cause of this deficient function it is difficult to determine, being often seen in women with full, well formed breasts and in good general health. The only peculiarity I have noticed respecting these cases is, that they have occurred in women who have married late in life or begun child-bearing beyond the usual age.

The annals of medicine record many anomalies respecting the function of lactation; as that of nursing by women in advanced age, a grandmother, years after having nursed her own children, being again able to perform the office to her grandchild and furnish it with an abundant supply of wholesome milk; of Virgins never impregnated, and even of Males, furnishing fair specimens of the lacteal fluid. But such cases, if they ever occurred, we must regard as freaks of nature, interesting only for their rarity and apparent impossibility.

A few instances of wholesome long-continued lactation have come within my notice. In two families I attend, one wet nurse has supplied two children in succession, nursing the first nearly two years until the birth of the second and then performing the office to the last until the usual age of weaning. In both cases the second child seems as healthy and vigorous as the first. In another family with which I am acquainted, the mother had no milk for her 9 or 10 children and one woman continued the office of wet nurse for a period of eight years, supplying successively four healthy boys with an abundance of milk, all of whom are now vigorous, well grown men.

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