A good breast yields for months at a time from 1000 to 1500 Gin. (1 to 1?, qts.) of milk daily in many women, however, it is very easy to increase this production through adequate measures, such as the application of more children to the breast, and by increasing the amount of nourishment. In our hospitals, for example, we have numer ous wet-nurses who daily secrete from 3000 to 4000 Gin. (3 to 4 qts.) of milk, or even more, and can therefore care for a large number of children. On the other hand, there are often women whose breasts secrete much less, and this secretion must be stimulated by diligent nursing; so that if the milk is not sufficient for the nourishment of the child, it will he a desirable addition to the mixed nourishment.
Menstruation; Pregnancy. —Considering the close relationship which the secretion of milk bears to the germinal glands, it is to be expected that the return of menstruation, or the occurrence of pregnancy, both of which are usually absent during lactation will cause some effect. As a matter of fact, the secretion is very apt to become less in either case, but this is soon followed again by an increased functional activity, if nursing goes on without interruption. There is no change in the quality of the milk, and no ill effect on the child, and therefore no reason for weaning the child. This is especially true in the case of mens truation, which with absolutely no foundation has been considered by laymen and many physicians a signal for weaning. As regards preg nancy, it is advisable to wean the child, since the disturbances are not always absent from pregnant women, and observation has shown that children nursing from mothers who are pregnant are often not well nourished.
The duration of lactation is seemingly unlimited. So long as the mother continues nursing, so long will the secretion continue, and it can be continued for years. If other nourishment is increased, how ever, there is less demand for the breast-milk and it consequently decreases.
Ability to Nurse. —in the last ten years a most pessimistic idea has been prevalent in regard to the ability of women to nurse their children, but it is now recognized that the idea that the woman of to day has not the ability to nurse is fallacious. In energetically and S VS t c nia ically conducted lying-in hospitals all mothers can nurse their babies (squally \veil, and for the most part women are not prevented from nursing their children by any inability to do so, but for a variety of other reasons. Social conditions, housework, etc.., are allowed to interfere, or other more or less foolish reasons, such as the very trivial considerations of sociability and pleasure; or the mother considers her too or she fears she \vill become so fleshy as to lose her figure. On many !mints she is poorly advised in numerous
ways, particularly by badly informed midwives.
It is the duty of the physician above all things to disseminate knowl edge of the laws of health. While it is true that in the deeply rooted superstitions of former times the number of contraindications to nursing was legion. one is able to assert at the present time that there is no con dition which absolutely forbids it. The general health of the individual as such, and not the presence of this or that disease, must decide the matter. The presence of tuberculosis is perhaps the only absolute con traindication, and it might be advisable in general so to consider it. Sometimes, however, upon close examination of all the conditions it might appear best to allow even a tuberculous mother to nurse.
Special considerations should be given to syphilis, in order to cor rect the very widespread and momentous mistakes. Two possibilities may arise: (1) the mother is syphilitic: and (2) the mother is free from syphilis, the child being inoculated by the father alone. In the first case it is easy to understand that to forbid nursing would be without reason. As regards the second. we would refer law of Cones, which is accepted without question. This law is, that the mother of a child which is infected with syphilis by the father is herself immune. It would be inadvisable also to prevent the mother from nursing the child in those cases where it is of special importance to provide it with the natural nourishment. and where the taking of a wet-nurse is out of the question (see chapter on Syphilis. by llochsinger).
All other diseases, such as acute febrile and infectious affections, are not absolute contraindications. Usually it is possible to continue the nursing without injury to either party.
But above all, the often expressed fear of the mother that her strength will he insufficient must he overcome. In cases where the appetite and the amount of nourishment are sufficient to make up for the loss resulting from the milk secretion, nursing will in no way affect adversely the general condition of health, but will inure likely be bene ficial. Indeed, it is a well-known fact that nursing women usually thrive. and even take on more fat than they themselves wish. And in propor tion as the general condition improves, they lose such ailments as were present in the beginning, such as backache, dizziness, feelings of weak ness, etc.