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Michael Underwood, 1819, Treatise on the Diseases of Children

Volume III.

Introduction.

On the Properties of Human-Milk.

 

If facts are the basis of sound reasoning and the source of improvements in science, they will be assiduously cultivated by every investigator of the laws of nature; persuaded that, however misapplied for a season, they must eventually confirm his maxims, or correct his mistakes. In this persuasion, the author's attention has been repeatedly awakened by various publications, but especially by some later observations upon Human-Milk, by Dr. Clarke of Dublin. [1]

Such a subject, while it arrests the speculation of the natural philosopher, will further claim the physician's attention in regard to the influence which the diet of infants must ever have on their health, especially that nourishment which Nature herself hath, in every climate, provided for them, at their birth: for it is only from a due acquaintance with this, that Art is likely to supply the fittest substitute when the natural cannot be procured. Nor can the inquiry be deemed superfluous in a treatise embracing both the means of prevention and cure of their diseases, nor form an improper Introduction to this volume. And it being Dr. Clarke's express design to dispute not only some of the supposed constituent parts and properties of breast-milk; and especially that of any true curdy principle; but also various ill effects conceived to be produced by it in sucking infants, and the means of relief; I seem to be compelled to take some notice of that work. Indeed, the spirit of inquiry, manifested in the Essay is truly laudable, and the experiments set on foot are worthy the notice of every practitioner in medicine; not to add, that the establishment of the fact [2] whatever it may be, is likely to become of general use; though practitioners, it is presumed, will not readily agree with Dr. Clarke in regard to the extent to which he carries his sentiments, any more than in all the inferences he would draw from it.

Indeed, when his observations fell in my way, I was, from the first, not a little surprised at the confidence with which he opposed a sentiment almost universally adopted; and I determined assiduously to investigate the matter for myself. For this, I knew, (as one of the physicians to a lying-in hospital,) I had opportunities equal to those of Dr. Clarke, and I pleased myself with the idea of being, at any rate, a certain gainer; as I should, at least, get at a fact must in the result be favourable to my general pursuits. I must acknowledge, that I was inclined to suspect the doctor had been mistaken in toto, until repeated experiments, by various means, and under a variety of circumstances convinced me, that there is certainly much less curd in human-milk than had been commonly supposed, and that whatever the precise quantity might be, it is not very easily detected by runnets and acids; since in far the greater number of experiments made upon fresh milk, not the least could be perceived, though in a few, I seemed to be satisfied at the time, that there was a small portion of true curd. [3]

Surprised as I indeed was at the first result of these experiments, threatening the subversion of an opinion entertained for ages, which how unfounded soever, had been but little suspected; no sooner did the essence of the fact appear to be established, by demonstrating the paucity of the curd, than my wonder not only ceased, but I conceived there was every reason to imagine that human-milk should be very much of the nature Dr. Clarke had supposed; though he should over-rate the results of his experiments, or his inferences be unfounded; as I have since proved to be the case. It may be suspected, indeed, that a partiality for a mode of practice that myself and many others had long taken up, might naturally render me anxious to support it at any rate, and to accommodate every fact to my prejudices. However this may be, I found that the attempt, in the present instance, required very little pains or application, and terminated in the perfect satisfaction of my own mind, since the like stubborn things (which are met with every day in the treatment of infants) cannot be accounted for but in the way I have all along done; and must evidently demonstrate the existence of an acid in the first-passages of infants, of what nature soever the food may be on which they are supported. How this attempt was executed is now of very little importance to lay before the reader, since the mode and number of experiments I have since made on human-milk, prove to a demonstration the constant presence of curdy or true cheesy principles, and must therefore totally subvert the principal arguments and inferences of Dr. Clarke, were they much more specious than they are. I shall therefore enter no further into such arguments wherewith a long experience has furnished me, respecting the tendency to acidity in the first passages of infants, (which became so necessary upon the supposition of there being no curdy principles in human milk,) than the acknowledged small proportion of true curd may seem to demand; though, (as above hinted) these might be sufficient to prove the point, were there even no curd at all to be discovered in human-milk. The smallness of its proportion, however, with the resistance it offers to acids, as justly stated by Dr. Clarke, is still in my opinion as agreeable to reason, as the experiments upon which the sentiment is founded appear to be conclusive.

Mankind, during infancy, is certainly amongst the most feeble of all animals that are nourished in the like mode by the parent, and is liable to more complaints, especially to disorders of the alimentary canal. It is reasonable, therefore, to conceive, that his aliment should be of the most easy digestion, light, thin, and very nutricious; at once affording as little labour to the stomach as possible, and easily convertible into chyle or blood. We accordingly find human-milk, though very thin, exceedingly nutricious, owing to the great proportion of the fat or buttery part, and of a saccharine whey, with which it abounds. It is also easier of digestion than other milks, owing to the smaller quantity of curd it contains; which, while it is less nutricious than the other parts, is also much more difficultly digested, or converted into chyle. And this I am now persuaded is really the case; human milk certainly contains less curd than other milks; and the public is much indebted to the researches of Dr. Clarke, as far as they may have led to the establishment of this fact: but let us be careful that we do not draw as unjust inferences from truth, as have been supposed to arise from error. [4]

For does it follow, that if a theory be somewise erroneous, our practice must necessarily be wrong? I think not; (or Hippocrates or Galen must lose much of their clinical renown) being persuaded of that experience, and the closest attention to facts, will confirm the general mode of practice enforced in the several editions of this work, and in some part before recommended by Harris and his followers. -- Let us, however, consider the arguments and inferences alledged by Dr. Clarke against the hypothesis of a prevailing acidity in infants, and noxious coagulation of the milk, [5] which writers on their complaints have uniformly established; and contrary to Dr. Clarke, conceive to be a principal source of their complaints.

Not that they attribute almost all the diseases and fatality amongst infants to that source alone, as Dr. Clarke has imagined; who does not allow due weight to other co-operative circumstances they mention, considering them merely as predisposing causes; particularly the extreme delicacy of their frame. For it is certainly through this extreme delicacy, that infants sink under complaints, which to adults are often little more than inconveniences, and prove in some respects an advantage, by exempting such habits from the more dangerous disorders of athletics [6]; yet are adults of such habits distressed in the like manner with infants, and are unable to take milk as a meal; it is always turning acid in their stomachs, and is frequently thrown up greatly coagulated, and very sour.

The atony of infants, therefore, whilst it is a predisponent cause, proves likewise an occasion of the severity of their complaints, and of the great fatality attending them; and this fatality arises from disorders of the stomach and alimentary canal: for how very few infants die in the first months, in whom these parts are not, both at first and last, the evident seat of disease; and with what difficulty are many others preserved from similar complaints, especially children brought up by hand?

Having premised these things, and illustrated the nature of the debate, let us proceed to the particulars stated by Dr. Clarke; who having pursued this important subject at some length, and given his arguments every due advantage, I beg leave to bespeak the reader's pardon, if in following him through it, I should seem diffuse, if not tautological, in purposely stating diversified views of facts, in order more clearly to exhibit their decided result.

The first Observation of Dr. Clarke that I shall notice, regards, the fact in question, and upon which he grounds his objections both to the concurrent sentiments and practice of writers on the diseases of infants.

"Women's milk, (says Dr. Clarke,) in a healthy state, contains no coagulable, mucilaginous, or cheesy principles, or that it contains so very little as not to admit of sensible proof."

Coagulating principles, unless that term be used in a very precise and limited sense, every nurse must have frequently observed, at least in their effects; since large flakes frequently appear in the matter thrown up from the stomach of unhealthy infants. Whether these congelations be owing to some small portions of curd, or cheesy principle the milk certainly contains, (which may possibly be too small to account for their frequency and quantity;) or to an oil, fat, or butter, is not of importance to the fact. For human-milk certainly contains a much larger proportion of cream, or fat, than cow's milk does, as is evident both from the natural, as well as an artificial separation of it by different kinds of acids; and from whence result certain coagulations. [7] And perhaps, this as I shall have occasion to remark, might serve to account for the symptoms of acidity, and the rancid and acid matter so prevalent in infants, and for the various effects of absorbent, alkaline, and lightly cordial remedies, without a reference to any true curdy principles in human milk; which it is presumed, however, Dr. Clarke in this place precisely intends.

I proceed, therefore, to observe, that the assertion of Dr. Clarke, as to this great point in question, is, in no view, strictly just; since it is insisted, that there certainly is a portion of true curd in human milk; which as Dr. Young has remarked, separates spontaneously. Dr. Clarke in his remark upon this observation, I know not why, concludes, that it is stated by Dr. Young merely as "matter of opinion, and not the result of any experiment." Nothing further, however, is necessary than to make it, and to wait a sufficient time for the result; no particular degree of heat being necessary, in any of the various experiments I have made, though so stated by Dr. Young. But whence it is, that runnets, acids, and spirits do not always separate any very sensible quantity of this curd in the course of eight and forty hours, as they constantly do from cow's milk, and wherefore a much longer time seems to be necessary for its spontaneous separation, I am not chymist enough to offer any opinion, and therefore confine myself to the fact: observing, however, that this peculiarity is, doubtless, to answer some wise purpose; and very probably, may be a principal reason of women's milk agreeing so much better with infants, than the milk of every other animal, and it is hoped, may in time furnish some very useful practical observations.

Dr. Clarke's next Observation relates to the time, in which human milk becomes sour: upon which he remarks thus:

"If we find human-milk out of the body so very slow in running into an acescent state, does it not afford strong presumptive evidence, that the milk of nurses cannot be so very prone to run into acidity in the stomach of infants as authors endeavor to persuade us?"

To this it may be replied, that though human-milk, out of the body, does not, indeed, run into an acescent state so soon as cow's milk does, (and for the full establishment of this fact also, we are much indebted to Dr. Clarke;) yet I think, that Experience, (which must be allowed to be full as good evidence as any Experiments can be) as fully demonstrates, that like many other milks, and most vegetables, it is much more disposed to occasion acidity in the stomach, than food prepared from pure animal juices. Moreover, it is not usually so slow in acquiring an evident acidity, even out of the body, as might be conceived from some experiments Dr. Clarke has industriously made, and I doubt not as fairly reported; for at the end of four days, and even sooner, I have sometimes met with it full as sour to the taste as cow's milk, kept the same length of time, though this is not usually the case; [8] and when become putrid (by that test) which I have known it to be in ten days, it has been equally so with cow's-milk. [9] And surely it is not imagined, that human, or any other milk, remains on the stomach long enough to become acid from that spontaneous separation of parts which takes place in the dairy; and wherefore the question is not so much in what time it will become so, as to what degree, or by what means, this change may be effected: and in these respects, it is found to differ little from the milk of quadrupeds. For though runnet does not always separate true curd in any sensible quantity from breast-milk, out of the body; yet, not only will it render human-milk as acid as it doth cow's milk, but true curd also being found in the pukings of infants when most vexed with acidity, (as will be stated in its place) seems to demonstrate the means of its separation, as well as the fact and degree.

Dr. Clarke, indeed speaks of human milk kept in a phial for more than two years, at the end of which time it was become only moderately acid; whereas I have often found it very sour, according to his own criteria with chemically stained paper, in four or five days; so that one would be led to suspect, that like putrid waters, the milk must have depurated itself by some kind of fermentation. And though it was rather ludicrously that this idea first occurred to my mind, I have been since disposed to think, that both human and other milks, when preserved from the air, are capable of such changes; having observed both women's and cow's milk, at the end of many weeks, become entirely without taste or odour. [10] The latter kept on my mantle-piece, over a large fire, has not been fetid at the end of five days, and was by no means more offensively acid to the taste, than I have known human-milk become in four days. And it is further worthy of remark, that out of several parcels of human milk, preserved under precisely similar circumstances, some become very sour and even putrid to the taste, several days before the others seemed to be at all changed. And as this variety occurred under repeated experiments, it may assist in accounting both for the frequency of bowel complaints in some sucking infants which other children are free from, and for the frequent good or bad effects of a change of milk, whether occasional or more permanent: and 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?

In regard to the means by which this acescency may be produced, we know very well, how very small a portion of the prepared calf's stomach is requisite for making sufficient runnet to separate the curd from a large quantity of milk, and communicate acescency to the whey; and is it at all improbable, that the infantile gastric juices, assisted by the natural action of the stomach, by surrounding and mixing with the milk in every point, may operate much more powerfully upon it, and dispose it to become so sour and curdy, [11] as to offend that organ, if it should not soon pass into the intestines? [12] which it is presumed it ought always to do. Moreover, acidity seems to be one of the states into which all animal and vegetable substances naturally, or very frequently run, [13] in the course of digestion, or fermentation, equally constantly with that putridity or fetor which precedes their dissolution, or separation into first principles; and therefore in a certain degree, probably ought to take place in the stomach or small intestine, as the fetor does in the lower bowels. The latter is never so great in infants as it is in older subjects, though adults should for a time live only a vegetable or milk diet. A principal reason, probably, is, that the bile is weaker in infants; but being at the same time a less powerful corrector of acidity, it is likely, they may be, on that account more disposed to the latter; and, perhaps, ought to be. Nor can I see, wherefore that very probable evidence of an abundant acidity in the first passages of infants arising from the very sour smell, and curdy appearance of both the vomitings and stools of many infants, and the uniform relief afforded them by a proper use of absorbent and alkaline remedies, should not have much more weight in the argument, than can be brought against it from experiments made on human-milk, out of the body, and its acknowledged indisposedness to turn sour so soon as cow's-milk: for we know, with what extreme caution we ought to apply both chemical and physiological experiments to the explanation of the phenomena of diseases. Not to insist again in this place upon the idea already suggested, that breast milk is not supposed to remain long enough on the stomach to separate into curd spontaneously, in the manner of cow's milk kept in a dairy; it is sufficient to advert to facts; both the smell and curdy appearance mentioned above, and the relief afforded by medicine, being exactly alike in all indisposed sucking infants, as in children who are brought up by hand, although the latter, are, indeed, more frequently afflicted with such bowel complaints. The great difficulty also of adapting food to infants brought up by hand, and the frequent recurrence of all the ordinary symptoms of indigestion, with the relief frequently afforded them by the substitution of broths for cow's milk, may serve to strengthen the idea of a disposition in the first passages to generate wind and acidity in the digestion of their food, and to coagulate every kind of aliment capable of coagulation by the gastric juices, especially if not in their most natural and sane state.

But as so much of Dr. Clarke's argument turns upon there being very little or no curd in human milk, it may be asked is it, indeed, a well ascertained fact, that the flakey matters brought off the stomach of infants nourished by cow's milk, is usually proper curd, any more than that ejected by children nourished at the breast? for it is possible it may be the fat or buttery part, or only a very small portion of proper curd, in the one case as well as the other: and if so, the whole force of the Doctor's arguments, and his consequent objections to the popular plan of treatment, may, possibly, fall to the ground; for the symptoms, complaints, and remedies, in both cases, it has been said, are the same, and are well accounted for by a supposed prevalent acidity in the first-passages, and a proneness of their contents to be, in some sort, curdled by it. [14] Of the generation of an acid in the stomach, however, I have incontestible proofs in several instances, in the pukings of infants nourished only by breast-milk, which changed blue paper red, upon being applied to it the moment they were brought off the stomach.

For the like certain detection of true curd, I endeavoured for some time together to make experiments at the hospital, upon the pukings of infants nourished only at the breast; but either the nurses there did not attend sufficiently to it, or the quantity they could preserve was always too small, or too much blended with other matters to ascertain, with precision, whether they contained any true curd or not. But since that time an opportunity presented in private practice, in an infant who I was well assured was nourished only by the breast. Having sucked very plentifully, the child became sick, and throwing up a mouthful of strong curd, I took up a lump of it, about the size of a nutmeg which adhered together firmly, and was pretty free from other matters; leaving behind in the basin a larger quantity divided into small portions, and too much entangled with a viscid phlegm to answer my purpose. The portion I took out, together with some slimy matter adhering to it, weighed twenty grains, and when separated from every thing that could be squeezed from it, or evaporated by heat, exhibited one grain of hard, caseous matter, which exposed to the flame of a candle, burned, and smelt like coarse cheese: but being before divested of all its oil or butter, was incapable of being melted. And according to similar experiments made upon human curd, dried in different degrees, I imagine that the above mentioned portion previous to its being reduced to the consistence of hard cheese, might contain six or eight grains of soft curd.

I think this may be considered as a decisive proof, that the gastric juice can separate curd from breast-milk in the stomach of infants, and I believe is no uncommon thing; [15] nor was it long before I met with another instance equally satisfactory. This infant at eight months old was attacked with severe peripneumonic symptoms, which were at that time epidemic among children; and several times threw up curdy matters soon after taking the breast, which was its only nourishment. The nurse twice preserved the cloth upon which they had been received, from which I scraped them, and after properly pressing and drying them, I found, that about the one-third part turned out to be pure caseous matter, burning in a candle, and insoluble like the former and in this hard and dry form, weighed a grain and a half. [16]

Now, if by the above, and other arguments and facts, it should appear, that human milk, from whatever cause, does actually become both sour and curdy, in different ways, and that infants are frequently injured by it; the less disposed thereto it may naturally be, the more we may, indeed, be led to admire the wisdom of Providence, that women's milk should, in that respect, differ from the milk of many other animals; yet mere presumptive evidence against its frequently turning sour, in the stomach of infants, cannot invalidate the fact of this sometimes being the case, and may, possibly, much oftener than has been discovered, or suspected.

Dr. Clarke himself, indeed, seems to be aware that there may be reasons for such a supposition, and therefore says:

"In the adult state, we know that there are few morbid causes less noxious to the human body than acidity, and few more subject to the controul of medicine."

This position though in a certain sense, a very fair one, is not wholly so, when taken with all the inferences which Dr. Clarke would deduce from it: for if the acidity be very great, and the cause permanent, (as is sometimes the case,) though alkalis may be administered in sufficient quantity to neutralize the acid, the acidity returns again, and prevails even for years, (as every physician well knows,) in spite of the use of every kind of alkali, of columba-root, bark, steel and other tonics, unless the state of the stomach be changed by them, and the digestive powers strengthened. Indigestion naturally produces acidity, and is increased by it, as we see in many pregnant women, and in various affections of the stomach, particularly when it is diseased in a morbid way. -- A gentleman who died of a scirrhus in the stomach, which I afterwards examined, was tormented for the last six months of his life, with an incessant acidity; which though often relieved, especially at the beginning, by magnesia, aqua kali, natron ppt. and other similar remedies, was never for one hour entirely removed; so that he spat up acid matters all the day long, and died, after a very tedious illness, perfectly emaciated, though he took a sufficient quantity of food of different kinds.

Dr. Clarke goes on to make further concessions:

"But granting (says he) such acidity to prevail in infants, we are in possession of many harmless medicines (called absorbents) capable of neutalizing acids, and thus forming innocent compounds."

We have, indeed, many useful remedies in such cases, but none that will certainly remove the complaint, either in infants or adults, until the state of the stomach be changed; which in infants is often effected by time. For comparatively light as the evils of a disposition to acidity most certainly are, when it is light or transient, it becomes even in adults a source of manifold infirmities, when depending upon some permanent cause, as has been above stated, which cannot fail occasioning an almost daily return of every troublesome symptom. A viscid phlegm also, instead of a harmless compound, often results from the alkaline remedies and natural acid, (commixed, as they may be with other heterogeneous matter,) which though insipid, is very indigestible; and at other times, a more offensive acrid matter is formed in the stomach of many adults, and is with difficulty got rid of where the digestion is weak; and is continually adding to the complaint. Every practitioner must have met with many such cases; and from one more immediately under my eye, whereby I was for a long time witness to the effect of an atonic state of the stomach, I can speak very confidently to this point. This patient was of a spare and delicate habit, very sober, and remarkably free from almost every complaint but those immediately arising from a weak stomach, as it is called. This sensible organ, however, was easily put out of order, especially by butter, vegetables, milk, and similar things disposed to generate wind or acescency in their digestion, and was at such times loaded with acidity; which though often corrected by alkalis and absorbents, the stomach would, at other times, eject matters in so very acrid a state as would instantly render the fauces of a deep scarlet hue, produce soreness of the throat, falling of the palatum molle, excessive hoarseness, and some difficulty in swallowing, which would remain for many hours. After long vomiting, a bitter matter would come up, sometimes of a light, at others, of a deep green colour; but rarely yellow, though evidently bilious. Sometimes, upon taking alkalis and absorbents previously to vomiting, the acid would be neutralized, at others, no quantity would render the juices bland; but instead of an acid, a heavy, acrid, and most viscid phlegm would be ejected, inflaming or flaying the fauces, in the manner just mentioned, and in this state no kind of medicine had any good effect; though previous to the acid matter (the source of the complaint) being changed into this acrid state, alkalis and absorbents very frequently prevented vomiting; which however, nothing could do after the contents of the stomach lost their acidity, and became acrid: so far were they from being usually converted into a harmless compound. It was only after being many years tormented in this way, and having daily recourse to alkaline and absorbent remedies, columba and bark joined with steel, and other powerful tonics, with exercise and a scrupulous attention to his diet, that he was sensible of any abiding amendment; [17] though from the great benefit he at length received, by a strict adherence to such a plan, it may be presumed he had no morbid affection of the stomach, though they had been often suspected.

Excess of acidity, and an acrid, ropy phlegm are, indeed, the well known attendants on an imperfect digestion, and will recur in many adults, feed on whatever they may; [18] though the evil must, doubtless, be increased by certain kinds of aliments; and of that class are those administered to infants. If adults, therefore of a similar habit to that just now stated, though in the end often restored to perfect health, may continue for a long time greatly tormented, whilst the most powerful correctors of acidity, and known tonics are had recourse to; and if improper food be occasionally received into the stomach, the complaints will at such times be greatly aggravated; wherefore should it be supposed, that delicate infants must always be restored, if the breast-milk, as well as other nutriments on which they may feed, be confessedly, to a certain degree, disposed to add to the complaint? And can it be urged from any experiments made on human-milk, or will Dr. Clarke or others affirm, that it is so utterly unlike every other milk, and even so much more ant-acid than animal food, that it has nothing in it likely to become sour, (save in a few weakly children,) by an admixture of the gastric juice?

I now proceed to Dr. Clarke's remarks respecting the green colour sometimes observed in infant stools. Dr. Clarke doubts of the existence of the supposed predominant acid, of which that colour has been imagined to afford some evidence, because, he says, common acids do not give that tinge to the bile out of the body, and that only mineral acids give it a green colour.

But as some kinds of acids can produce this effect, it cannot surely be proved, that the natural acid of the stomach and bowels cannot effect the like; especially when it is considered, that in adult persons affected with dyspepsia, bitter matters of a green colour are frequently ejected after very acid vomitings, as it has just now been remarked. And though as Dr. Clarke observes in a quotation from Sydenham, "porraceous matters, are ejected by children who have been over-purged or vomited, and by healthy adult persons when sea-sick;" yet the like appearances under such circumstances can scarcely destroy the conclusion; since all such violent agitations of the chylopoetic viscera, by disordering and perverting their due and natural action, upon which the same state of their secretions indubitably depends, may sufficiently account for the sudden forming of acid, acrid, or any other unnatural and unhealthy gastric juice, as well as for the vomiting up of bile, which in its passage will certainly be mixed with it and be somewise changed from its natural color. And, indeed, Sydenham's reasoning upon this subject, a little further on, is of a similar kind, though expressing himself in the language of that day, he attributes this foreign, or morbid secretion, to a confusion of the animal spirits; which, indeed, for any thing I know, may be a remote cause of it. It should likewise be considered as of some importance in the argument, that it is during the time that infants appear to be affected by a predominant acid in the first passages, that the dejections and vomitings are of this green colour. Upon the whole, therefore, the prevalently sour smell of some infant stools, which Dr. Clarke thinks so very nugatory an argument, seems to afford much better evidence of the presence of an acid, that his arguments can be against the change of colour by this mean. Moreover, I may affirm, that the green stools of sucking infants, and even of some stools that are of a bright yellow colour, do certainly contain an acid; having detected it under repeated experiments made with blue paper, the instant the stoolshave come away; [19] however it might turn out in the experiments made by Dr. Clarke. And I may therefore, possibly, be allowed in my turn, to express some surprise at the confident manner in which Dr. Clarke has taken upon him to dispute the fact.

But Dr. Clarke observes further, that,

"Those writers who have laid the greatest stress on such appearances in infancy, do not pretend to apply the information to be derived from thence to the treatment of the diseases of adults."

I, probably, do not fully comprehend the import of this observation; for the information, mutatis mutandis is most certainly applicable, and the complaints of each arising from acidity are capable of cure or relief, in the same way, viz. by alkalis, tonics, and aromatics, with a well adjusted diet. I have intimated, that the doctrine is partially applicable, because the bile of adults being more exalted and acrid, or otherwise stronger, (if I may so speak,) may not upon meeting with the like acid, change their stools just to the same colour of those of infants; nevertheless, the stools of adult persons, tormented with acidity, especially under peculiar aggravations, are of a much paler colour, than those of people of much stronger digestive powers, and as I have always thought, through a deficiency, or ill concocted state of the bile. And here it may not be improper to consider the very material circumstance of the very different diet to which adults are addicted, as well as the medicines they may take; which, it is well known, often affect the colour and smell both of the stools and urine in the course of a few hours, as the stools of infants (though ever so green before) are changed in their colour upon taking rhubarb, saffron, and similar medicines; [20] while the diet of infants being perfectly simple, the contents of the bowels are likely to acquire no other colour than that of the bile itself, (as is actually the case in a healthy child,) or such as through their accidental property may be chemically induced by the admixture. Not to add, that the urine in healthy adults is usually of a much deeper colour than that of infants, and is also not infrequently occasioned by a certain diet as well as by medicines; and varies with them. And perhaps it may be from a similar natural tendency to a very dark colour, that we find the first stools of infants are not truly green, though often of a greenish-black; nevertheless, there is sufficient acidity in their gastric juices to occasion the stools voided previous to infants taking any kind of food, to tinge blue paper red, (as I have found by careful experiments,) though such stools contain a very large proportion of bile.

These observations, it is imagined, may apply to Dr. Clarke's remarks in regard to the colour of the stools of adult persons, vexed with acidity, which he says are not of a green colour like those of infants. And in respect to ejections from the stomach when so tinged, it seems to have been a constant remark, that bile lodged there has been diluted by an acid; to both of which, physicians are in the habit of administering their appropriate remedies.

Dr. Clarke goes on to say:

"Upon the whole, I hope it will appear probably to the generality of readers, that predominant acidity in the first-passages is by no means so general, as to be considered as the only, or even principal source of infantile disorders; that such a morbid cause may now and then occur in infancy, as in adult age, from a weakness of the stomach, costiveness, or improper food, can admit of no doubt."

This inference is surely far from being made out from all that has been advanced -- but let us consider of what the arguments consist. "Human milk out of the body, does not turn acid so soon as cow's-milk does; (but cow's milk requires twenty-four hours or more; a much longer time than the milk remains on the stomach;) nor the common acids curdling the milk of quadrupeds produce scarce any sensible curd from human milk; (though the quantity is certainly greater than Dr. Clarke has supposed;) that only mineral acids will tinge the bile of a greenish colour; and that in the adult state few morbid causes are less noxious than acidity, or more under the control of medicine;" (though it has been proved but partially so.) To conclude from hence, that acidity in the first-passages ought not to be considered as so general a cause of infantile complaints, or to be of such dangerous consequences as it may usually have been imagined, doe snot appear for me to be perfectly founded; nor to be evidence sufficient to subvert the arguments and evidence adduced in support of that sentiment, in connexion with the acknowledged atony of infants. It is true, indeed, that ex nihilo hihil fit -- if there be no curdy principles in human milk, no species of acid in the stomach can bring curd out of it; yet may the combination of an acid and milk offend the stomach otherwise. It has been observed, that all common vegetables, butter, and even bread, are often very imperfectly digested by adult persons with a stomach overcharged with acidity, yet is no part of such an aliment necessarily converted into any thing like true curd; though the stomach in all such persons is as certainly offended by the curdling of cow's-milk.

Nevertheless, I have hinted long ago, [21] that simple acidity may not, in the first instance, or in a general way, be necessarily so injurious as some writers have contended, and that infants suffer more severely from an acrid matter, (less capable of correction by absorbents, than by aromatics,) which, though it originates from a predominant acid, generally becomes so very offensive in conjunction with some other cause, be that a peculiar atony, or otherwise; robust children being always far less disordered, though not wholly free from some of the vexatious symptoms of acidity. Upon the whole, however, I am persuaded, that acidity is accidentally, and in fact a frequent cause of mischief, and that because it is so constant a consequence, and further aggravation, of digestion, in such adults as have what is called a week stomach. For it is, perhaps, only in adults of a lax fibre, approaching to the atony of infants, and not in athletics, that we meet with that morbid source which Dr. Clarke observes sometimes occurs in adult persons. And if the stomach, or digestion of infants be naturally weak, why should we not expect to find them peculiarly liable to acidity and its consequences? the state of the stomach being certainly the grand source of general good, or bad health, at every age. And, indeed, were I to say no more than that infants, in proportion to the greater weakness of their digestion, must be more disposed to acidity than adults, with many of whom a milk diet always disagrees, (and is the infant's constant nourishment) it were saying a great deal towards subverting the whole that has been advanced by Dr. Clarke against its prevalency, in connexion with the general atony of all young infants, being a principal source of their complaints. [22]

Dr. Clarke concludes by observing, that "the young of all the ruminant animals, fed on milk of a much more acescent nature, suffer no inconvenience from this source." To such laconic arguments, I think it may b fairly replied, that many ruminant animals can eat, and digest, bones; and hop about likewise when their own bones are broken or dislocated without manifest injury, or much expression of pain. And in this view I might adduce the remark, made elsewhere, [23] on the rank which animals severally hold in the scale of beings; it being very evident, that besides the ground of comparative health and disease arising from the bulk and strength of various animals, there is that of their several ranks in that scale, commencing with man, the head, and extending from the invaluable sheep, the cow, or the horse, to the lowest of our domestic animals, and to reptiles; the more noble and useful (from whatever cause) being, I believe, uniformly subject to the most and severest disorders. Thus the fragile worm daily survives some kind of injuries, which the sturdy ox could not; while the delicate infant would sink under that, which the lamb could with safety endure. -- But what should we learn, on the present occasion, by pursuing such comparisons? "Man (said one) is not a fly" -- no, nor yet a tiger. -- Such arguments, at best, are very equivocal, and one might be set against the other without end. We do not, for instance, suspect that quadrupeds in a state of pregnancy, are tormented with acidity or heartburn any more than their young are from the curdy principles of the milk by which they are nourished; but we are certain that many breeding women are afflicted with such complaints for a great length of time, feed on whatever they may. It is confessed also, that the milk of quadrupeds abounds with cheesy principles, and that human-milk contains a far less proportion; (or according to our author, none capable of sensible proof;) here then is a glaring disparity in the very point at issue; and from which the inference drawn by Dr. Clarke, (were even his experiments conclusive) does not seem more natural, than the observation already advanced on the wisdom of providence in abating of that quality in human milk, because a greater propensity to acidity, or excess of a cheesy principal, must, from the atony of infants, render such a quality peculiarly noxious to them.

It has been observed, however, that I can myself no longer entertain any doubt of the existence of this principle in breast-milk, though it may vary in its quantity and consistence; nor hesitate to insist, that the result of my experiments on human-milk, and infantile group-stools, (which it has been said, do stain blue paper, red) completely overturns all that Dr. Clarke has advanced, to the entire satisfaction of my own mind: but as our contradictory assertions, (as to facts,) cannot satisfy those who have not made the like experiments, I have submitted the matter in a way of fair argument, and appear to the discernment of the reader.

Since these observations on Dr. Clarke's Essay were drawn up, I have, however, been able to adduce a testimony which I conceive will not generally be disputed, and with which many of my readers may possibly have been well acquainted before I was. Had I met with it sooner, it would, probably, have saved me a great deal of trouble; but the Histoire et Mémoires de la Société Royale de Médicine, année 1790, might not perhaps have fallen in my way to this day, if my good friend Dr. Andrij of Paris had not made me a present of it; though long after I had completed my experiments on human-milk. It were needless in this place to quote, in detail, the experiments there recorded; it must be sufficient to give tables of their result, [24] and to say that they accord exactly with my own, referring to the volume itself for an ample account of the modes of investigation, further properties, and component parts of various milks there specified, demonstrated by numberless experiments, and upon multiplied authorities.

To sum up the whole, then, upon Dr. Clarke's own principles, and forbearing for the present to insist either upon my own experiments, or upon others, it may be fairly urged, that in disorders of the first passages, the matters ejected both by vomiting and stools are frequently flakey, and coagulated, and sometimes curdy; that they have a sensibly sour smell; and that the stools are often of a green colour, very numerous, and attended with griping pains. That these symptoms and complaints are removed by such remedies as are allowed to correct acidity in other instances, or are mitigated in a greater or less degree, as long as such medicines remain in, and are acting on the stomach and bowels, and mixing with their contents. That moreover every kind of ailment which during its digestion, is alike peculiarly disposed to produce acidity, both in the adult and infant states, always increases the above symptoms; breast-milk, however, (from a healthy nurse) the peculiar food of infants, being less commonly found hurtful to them, because more thin and lighter on the stomach than most other food, and having less of that true curd found in most other milks. But whenever human-milk happens to disagree, the symptoms are exactly the same as in infants brought up by hand; though in other instances, a recourse to it, (or even asses-milk,) frequently proves a remedy, for children whose bowels have been disordered from being previously nourished by the spoon. And though this fact may indeed fairly prove it to be far less disposed to turn curdy and acid than cow's milk, and farinaceous substances; yet the circumstance of sucking children being often afflicted in precisely the same manner, and relieved by the same medicines with children brought up by hand, equally demonstrates the cause of their complaints to be exactly similar; and that human-milk, when mixed with the gastric juice, is disposed to turn acid, and its component parts to separate improperly, or, perhaps, too hastily, as in adults whose digestion is bad. And that on these accounts, the milk becomes curdy, occasioning indigestion and wind, which jointly irritate the nervous coat of the stomach and bowels, and produce complaints that endanger the infant's life, unless remedied by the known correctors of acidity. Nor are these effects, by any means, rare occurrences, or confined to tender and delicate infants, as Dr. Clarke would insinuate: and on this head I may venture to appeal to his own, and every practitioner's experiment, as well as to the mortality in the Dublin Lying-in hospital. [25] It may be added, that disposition to these complaints often continues as long as infants remain at the breast, or live on any other milk diet, but are diminished as soon as they take freely of animal food; and that this change does not depend merely on their more advanced age, but on the alteration of the diet, is pretty evident from the like advantages being often obtained by allowing them a little broth, once or more every day, at a much earlier age.

Such then are the facts in regard to the diet, the alvine discharges, and complaints of the first-passages during infancy; and such are the effects of certain medicines known to correct or abate acidity; and to what shall they be attributed or what can be more naturally inferred from these premises, than that there certainly is an acescent tendency in the gastric juices of infants, (useful, no doubt, upon the whole,) and a quality in every kind of milk disposing it to be curdled or coagulated, and become acrid by the admixture? To these observations might be added that of infants being so very rarely attacked with fever, however severe or continued their pains, or other complaints may be; and though many good reasons, might, doubtless, be given for this exemption, yet none can exclude the well known aphorism of the father of physic, before quoted, nor be more appropriate to the occasion than that maxim, "acidum eructantes non sunt pleuritici."

I have no desire to enter into a formal dispute with any man, much less to contend for mere opinions irrelative to practical truth; [26] but should any persons be determined to dispute both the inferences and facts I have advanced, let them, at least, tell us what it is that so uniformly acts as an acid might be expected to do, curdling or thickening the contents of the stomach, offending the bowels, producing green and sour-smelling stools, with other symptoms of indigestion recurring so uniformly in delicate infants: effects which nothing could ever be contrived totally to prevent, nor can any thing so uniformly relieve as ant-acids or absorbents. May it not justly be presumed to be something not easily distinguished from what we term an acid in atonic adults? How much less injurious, however, this disposition may be than that tendency to putrescency prevailing in the latter, induced by a very different diet, and a more exalted bile necessary to digest it, may be fairly presumed; and upon which, it has been noticed, I have already given my own sentiments at large, even in former editions of this work. It may, however, be just remarked in this place, that it might, possibly, be fairly urged, that infants must, therefore, either be exempt from their share of the infirmities of human nature, (unless infected by their parents, with scrofula, lues, &c.) or be peculiarly liable to disorders arising from acidity in the first passages; which are confessedly amongst the slightest evils, and at the same time a probable occasion of their escaping those of a more dangerous tendency.

I conclude, therefore, with observing, that as indebted as the Public is, and particularly gratified as I am, but the pains and researches of Dr. Clarke, I cannot but insist that his inductions are neither properly made out by experiments, nor supported by the arguments he has advanced: nor is it, perhaps, perfectly certain, what essential difference there may be between every possible combination with human-milk out of the body, and its natural mixture with the gastric juice in the stomach of an infant. What changes the temperature and action of that viscus whether mechanical, or chemical, may be capable of producing, cannot for certain, be either proved or disproved from mere speculation; so that whatever opinion we may form, must remain very problematical, any further than matter of fact may discover their operation, in the different stages of digestion, both in atonic and athletic subjects. But, in fine, whether under all, or any particular circumstances, any of the gastric juices be precisely what chemists would term an acid; or whether the offensive matters, under an imperfect digestion, be usually of the nature of curd, butter, or phlegm; or whatever theory Dr. Clarke, or others, may from his researches be justified in advancing, at some future period, cannot weaken the force of any fair inference from the facts. The author of this work, indeed, ardently wishes, that a practical improvement may be made of every discovery: but whatever the improvements may be, it does not seem likely from the above impartial statements, that the treatment of infantile disorders recommended by him, and in many particulars very generally adopted for the last half century, will undergo any essential alteration. [27]

Footnotes

[1] Observations on the properties commonly attributed to Human-Milk; on the changes it undergoes in digestion, and the diseases supposed to originate from this source in infancy. Transactions of the Royal Irish Academy, anno 1786.

[2] Dr. Rutty, indeed, made the like experiments in the year 1762, and Professor Young since, though with a less decided opinion, from similar results: and it is presumed, that the experiments made in consequence of the present inquiry, have set this matter in its true and proper light.

How to account for the difference of opinion from the same experiments, or for their seemingly different results, consistently with the honour of those who profess to have made and reported them, with equal attention and integrity, may be less difficult, perhaps than might be imagined. In regard to the principle point in debate, however, I conceive, that some gentlemen have taken certain congelations for true curd, without putting them to the proper test; whilst others, from the like neglect, have overlooked small portions of it, which have been blended with other matters; but especially have too much neglected one obvious though less common mode of discovering it; or in the few experiments they have made in that way, have not allowed sufficient time for the curd to form; as will hereafter appear.

[3] Mr. Navier long ago, and Dr. Ferris in his Harveyan Dissertation, at Edin. anno 1782, have adopted this sentiment.

[4] I am sorry to find Dr. Clarke expressing a suspicion that his opinion may not be readily embraced by other physicians. There are, doubtless, many who are glad to collect facts from any quarter, and to entertain truth in every form, and such will always be open to every well supported inference from them.

[5] By the term coagulation, or curdy matter, made use of in this and other places, it is not meant to assert, that the milk always separates into proper curd; it having been granted, that although it certainly does contain true curd, it is not so readily separated by acids (out of the body) as the curd of quadrupeds is; but as human-milk abounds with an oily or buttery part, it is disposed to jelly or coagulate into a pretty firm mass offensive to an infant's stomach. And this kind of coagulation also takes place out of the stomach, from an admixture of an acid with human milk, equally as with cows.

[6] Acidum eructantes non sunt pleuritici. Hippocrates.

[7] It is notorious, that adults affected with dispepsy, through an abundance of acid in the stomach, cannot digest much butter; and when they exceed their usual quantity, their stomach ejects slimy matters offensively acid.

[8] Dr. Clarke also takes notice of a variety in this respect.

[9] It is worthy of remark, that so far from human-milk being usually disposed to be much changed by long keeping, as Dr. Clarke has observed, it has not always become putrid before I have thrown it away; but that (about three quarters of a pint) which I kept in a basin at the hospital, only a fortnight, for the purpose of collecting the curd by a spontaneous separation, had rendered the room, for more than a week, sensibly offensive to every one who entered it; and was so very fetid when I strained it off, that the matron who assisted me, being less accustomed to putrid effluvia than I have been, was disgusted by it exceedingly.

[10] In further vindication of the above sentiments, the author may, at least, offer the following statement; for the accuracy of which the reader's implicit credit is requested. It respects several potions of human and cow's milk, with observations on their changes taken precisely as dated below.

On one portion, preserved in a phial, and well corked, it is noted --

Human milk, procured, Nov. 22, 1790.

Nov. 25 Now, rather tart to the taste;

Nov. 26 very sour;

Nov. 27 not fetid to the taste;

Nov. 28 smells very fetid;

Nov. 29 fetid taste;

1791, Jan. 1. very fetid, now.

I examined this milk just before this volume went to the press, (in March 1795, not having noticed before for near a twelvemonth;) and found it turned of a dirty brown color, and smelling exceedingly fetid.

Another portion of human mik, procured within a few days of the above-mentioned, and preserved in a phial, no better corked, did not at this time smell at all fetid, nor disagreeably acid, although it had so smelt and tasted, a long time before; was not changed in its colour like the former, but seemed merely to have undergone the natural separation into curd and whey.

(I carefully examined these two portions of milk, Nov. 11th 1797; and found them in nowise changed since the former examination in March 1795.)

(While this work was in the press May, 1799, I examined these portions again, and could be sensible of no change, though they had then been in the phials more than nine years.)

A portion of cows milk drawn a month after the first-mentioned, I found at this time (March 1795) changed exactly in like manner in its colour, and decidedly more offensively fetid in smell.

(This portion on the 11th. Nov. 1797, was still most decidedly more offensively fetid in smell than the human milk.) (May 1799, it was in the same state.)

Human-milk drawn a few days after the cow's, was at the same time found preserving its color having only separated into curd and whey, and without the least acid, or putrid smell, and having no more acid taste, than cow's milk, drawn in summer, usually has on the second day; nor was there any noise or fermentation to be perceived from hastily drawing out the cork, as there was from both the human and cow's milks which had changed their colour.

(On Nov. 11th, 1797, this portion also continued in the state above described. And in May 1799, it was nowise changed.)

[11] It is elsewhere observed, that the separation of the curd from the whey is the natural process of digestion.

[12] In proof of the powerful operation of the gastric juices, while in the stomach, I may here advert to the well-known fact of that viscus being frequently found corroded a few hours after death, (as I have myself seen it;) and I imagine, it is generally, though not universally, believed to this day, that the corrosion has taken place subsequent thereto, and that the gastric juices have only acted upon that part, as they would upon any other animal substance divested of the vital principle.

[13] Perhaps this may not be the proper and natural course of digestion, as Dr. George Fordyce has taken great pains to demonstrate; yet are the first-passages in most people so disposed at times, that through indigestion, acid matters are very commonly formed. And it is worthy of remark, that the late Mr. John Hunter always found the gastric juices lightly acid in every healthy animal that he examined.

[14] That the acid of the stomach is capable of forming proper curd I have no doubt, having noticed it frequently, and sometimes in large portions. And indeed, I have one of those still by me, preserved in spirits, of above an inch in length, and half an inch in thickness, which was many years ago puked up by an infant I was attending; but whether the child was brought up by hand, or not, I do not now at all recollect. -- While the present edition was in press, another little patient threw up a like piece.

[15] By this mean it is, as I have elsewhere remarked, that in the ordinary course of digestion, the thicker parts are always separated from the whey; but as breast-milk abounds with oil or butter, the viscid matters thrown up often appear more like clotted cream than true curd; nevertheless, either from the milk remaining from an undue time in the stomach; or from an excess of acidity; or perhaps other circumstances concerned in digestion not always known to us, the separation of the component parts becomes sometimes more complete, and true curd appears. How far this may be owing to infants being in an ill state of health, to fever in particular; or simply to weak digestive powers, and a depraved state of the gastric juice; time and attention to their complaints may possibly discover: but at present I am inclined to think, that the gastric juices, (which are at all times lightly acid) always possess this property, as they certainly do of separating the curdy part of cow's milk, if it should happen to stay a sufficient time on the stomach. This we also know to be the case with many adults.

[16] My reason for evaporating the soft parts of the curdy matter so completely, by exposure to a strong heat; was to demonstrate beyond all doubt that it contained true curd, by bringing it to the state of the coarsest kind of cheese, in which there is no oil or butter.

[17] This, perhaps, might be further promoted, by his becoming now full forty years of age.

[18] I conceive, that this habitual acid affords a too great, and improper stimulus to the glands of the stomach, exciting both a superabundant and morbid secretion. By this means, the gastric juice is often-times rendered extremely viscid, (in the manner of the secretion from Sneider's membrane from the stimulus of a cold,) or afterwards becomes thus tenacious from mixing with the acid, and ill digested contents of the stomach. This seems probable, from the vast quantities of this viscid and acrid matter which it has been observed, people long vexed with acidity will sometimes throw off the stomach for hours altogether, and frequently for several successive days.

[19] These experiments were made before witnesses at the British Lying-in Hospital.

[20] Spinnages and other things impart their colour to the stools of young children, in a way they do not do to healthy adults, (thought to dyspaeptie adults they do;) and perhaps, from their digestive powers being weaker.

[21] In the very first edition of the subsequent Tract.

[22] Since the former edition of this work, and subsequent to two or three letters passing between us, Dr. Clarke has offered a few observations on some infantile complaints in the last volume of the Transactions of the Royal Irish Academy. All that concerns the present debate is, an observation on green stools voided by an infant he was attending, and a very curious observation it is; the nurse having informed him, that they became of a yellow colour after the cloths had lain some time in a corner of a room: and this report the Doctor offers to the consideration of those who conceive the green colour to depend on some acidity in the first-passages; which he thinks the above change may render further suspicious.

That the stools of infants, not in perfect health, though voided of a bright yellow colour, will turn green upon being kept twelve, or twenty-four hours, must have been observed by every one conversant with sick children, but I must confess that I never before have heard of green stools turning yellow, whatever the infant's complaint may have been. I have now been in the habit of paying attention to children's stools for many years; and in various instances, when not in daily attendance, a great number of cloths have often been preserved, for two or three days, for my inspection; so that, were such a change common, I am persuaded I could not have failed to notice it. What the particular cloths shewn to Dr. Clarke might meet with "on the floor, in a corner of the room," to account for such a change; or what other unusual occurrence there might be in their previous washing, I can say nothing to; therefore for the present shall only remark, that such important appearances ought to be frequently observed and substantiated in some better manner than the report of an individual nurse, and on a single occasions, before any argument can be founded on them to subvert the fair inference from innumerable facts.

[23] Vol. I, pages, 7, 8. Note.

[24] The annexed Table.

[25] See the note at the close of this Introduction.

[26] Still less have I been induced to dwell so long on this subject from any offence taken at Dr. Clarke, who has conducted himself very respectfully toward me in our epistolary debate; but the more respectable his character is in the eye of the public, the more it became me to intrude on my readers' patience in order to established the sentiments I have so long entertained, and he has attempted publicly to subvert.

[27] Dr. Clarke concludes with expressing a hope, that a system of practice more rational than the present may be struck out. -- What has been the precise mode of practice, or its success in Ireland, I can guess only from Dr. Clarke's statement in regard to the Dublin Lying-in Hospital; where, passing by those years in which an epidemic is said to have raged among the children, the number of deaths has ever been far beyond the average in the British Lying-in Hospital, in London, where the old plan of treatment is pursued.

In support of this assertion, I submit the following statement of the two hospitals, and it is presumed, not an unfair one, being copied from the printed accounts of that in Dublin, and from certain outlines drawn up, on another occasion, by Dr. Clarke himself; and contrasted by other corresponding extracts from the British Lying-in Hospital, subsequent to those quoted by the Doctor. [28]

And first, from his own statement it appears, that in the old Lying-in Hospital in Dublin [29], (reckoning from its first institution, when, probably, the furniture was new and there existed no peculiar remote causes of disease) out of 3,746 infants, 241 died within the month; that is, between six and seven in every hundred: but that in the British Lying-in Hospital (though confessedly a very old and ill-contrived edifice), reckoning likewise from its first institution, the Doctor reports that only 146 died, out of 3,611; which is only four to the hundred.

After this period the epidemic commenced [30], and the fatality greatly increased; the Doctor then remarks, that after proper means were taken to remove the remote causes of that fatal disease, only 419 infants died out of 8,033 births; that is, from five to six in every hundred.

It appears from the printed accounts of the hospital, that this period is taken from the year 1783 to 1788, inclusive. But the like accounts of the British Lying-in Hospital, during the very same years, report that, out of 3,374 children born there, only 95 died; which is under three in each hundred.

But to render these calculations more immediately applicable to Dr. Clarke's observations on the treatment of infants, I shall to these six years, add the Dublin account of the three succeeding ones, thereby increasing the above period to nine. During these years, the number of deaths was, indeed amazingly decreased, so that the endemic, especially during the three last, seems to have entirely given way; and it being also during this period, that Dr. Clarke had taken up his new theory both of the nature of human-milk, and the early diseases of infants, a comparison of the number of deaths in the two hospitals, and any inference from it, will be brought to a fair issue. It appears then, that from the year 1783 to 1791, 12,688 children were born in the Dublin Lying-in Hospital, out of which, 593 died which is as 4 two-fifth's in a 100. But, in the British Lying-in Hospital, during the same years, 5,233 children being born, only 112 died; which is but little more than two in each hundred. In the last of the above years (as well as during many former ones) only two children died in the British Lying-in Hospital, out of 627 born there; and in the year before that, no more than five out of 630, (which number also was not exceeded in several preceding years, [31]) and during the last year only one infant died; and seems to prove almost to demonstration, that the entire management of infants in that hospital, as well as the practice of the present day, must be rational and judicious; and is far from calling for a total subversion of the principles by which they have always been regulated.

I add, that in the British Lying-in Hospital, from the year 1759, (being that in which the hospital in Dublin was instituted,) to the year 1791, the average of children's deaths has been under three in the hundred; but that in the hospital in Dublin, during the seven most successful years it ever experienced, (either previous, or subsequent to the endemic) the average is above four; though the mothers, usually, remain there only a fortnight, but those in the British Lying-in Hospital, three weeks, and sometimes a month.

I have been at pains of stating this average, in the two hospitals, at different periods, that the reader might be competent to judge, caeteris paribus, of the probable better practice; and may see for himself, that, if the management of new-born infants, or the treatment of their disorders, has been of late any wise influenced in Dublin by Dr. Clarke's new theory, it has not, hitherto, to say the least of it, any great claim to the practitioner's attention, on the score of its success.

[28] For their respective accuracy, it is not to be expected that we should either of us be answerable, as much must depend upon the report of inferior officers; but, on my own part, no wilful or suspected misstatement is offered.

[29] See Transactions of the Royal Irish Academy, anno 1789.

[30] See Nine-Days-Disease, vol. I., pages 156, 157.

[31] So that the number of infants dying in the British Lying-in Hospital, under three weeks old, is usually far less than that of still-born children, as Dr. Clarke seems to notice with some surprize, in regard to one of the London hospitals he has occasion to mention; but as it indeed ought to be every where, at that early period. -- If small things may be compared with great, it may be added here, that speaking from memory, I have reason to think, that in my private practice, during the last five years, I have not lost more than three infants under a month old; which is much below the average of still-born children, that has fallen to my lot, and of which I have an exact register. In allusion to this remark, as well as to add my mite to assist the inquiries of other calculators, I annex the following statements taken from the registers of the hospital:--

Infants Still-born

During the first ten years... one in 32.

" the second ten years... one in 37.

" the third" ... one in 26.

" the fourth " ... one in 19.

It hence appears, that the average of still-born children has been as 1 to 28.

The Average of Deaths,

During forty years, has been, one in 34.

During the last eight years, [32] one in 84.

The Average of Twins,

During forty-eight years, one in 86.

Boys to girls as 17 to 16.

[32] It appears from the hospital register, that during the last five and twenty years, the average of deaths has been considerably lessened, and also that a small proportion of infants has died in the last eight than at any period since the first institution of the Charity; and it may, perhaps, be fairly conjectured, through improvements made in the management of infants, which was not formerly so fully consigned to Physicians.

 


A Comparative Analysis

of the

Milk of Women, the Cow, Goat, Ass, Sheep, and the Mare;

By M. Boyssou, of Aurillac, in Upper-Auvergny.

 

Quantity of Milk

Names of the several Animals

Their Nourishment, &c.

Ages of the Milks

Quantity of Butter

Quantity of Cheesy Matter

Quantity of Saccarrine Salt

Quantity of Extract

Produce or Extract in Bal. Mariae.

One mark pound Weight. (8 Ounces.)

Woman's milk

Inhabitant of a City

7 months

4 drachms, 48 grains

1 drachm, 48 grains

6 drachms, 48 grains, in 4 crystallisations

1 drachm

1 ounce, 8 grains

Ditto

Cow's milk

Fresh Pasturage

6 weeks

3 drachms, 45 grains

5 drachms, 51 grains

4 drachms, 40 grains, in 5 crystallisations

1/2 drachm

9 drachms, 42 grains

Ditto

Goat's milk

Ditto

3 months

4 drachms, 24 grains

7 drachms, 48 grains

3 drachms, in 4 crystallisations

1/2 drachm

2 ounces, 16 grains

Ditto

Ass's milk

Ditto

2 months

10 grains

2 drachms, 16 grains

6 drachms, 16 grains, in 6 crystallisations

1 drachm

7 drachms, 12 grains

Ditto

Sheep's milk

Ditto

3 months

5 drachms, 40 grains

7 drachms, 30 grains

3 drachms, in 4 crystallisations

1/2 drachm

2 ounces, 16 grains

Ditto

Mare's milk

Ditto

2 months

6 grains

2 drachms, 48 grains

4 drachms, 48 grains, in 5 crystallisations

2 drachms, 36 grains

7 drachms, 12 grains

 

A Comparative Analysis, by Abrah. Van-Stripriaan Luissio, Physician to the Dauphin; and Nicol. Bondt, Physician, at Amsterdam.

 

Scale 100.

Cream.

Butter.

Cheese.

Sugar.

Cow's milk.

4 - 1/16

2 - 11/16

8 - 15/16

3 - 1/16

Woman's

8 - 11/16

3

2 - 11/16

7 - 5/16

Goat's

7 - 15/16

4 - 0/16

9 - 1/8

4 - 3/8

Ass's

2 - 15/16

--

3 - 5/16

4 - 1/8

Sheep's

11 - 0/16

5 - 13/16

15 - 5/8

4 - 5/16

Mare's

15/16

--

1 - 5/8

9 - 1/16


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Created 7/30/97 / Last modified 7/30/97
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