QUANTITY OF MILK SECRETED. 981 



to the quantity of crystallizable matter (sugar) which it contains. Cases of 

 the clrio-ioit* secretion of milk are not numerous ; and in no instance is there 

 any proof that the elements of the fluid were p re-existent in the blood. 

 Same of the most curious are those in which it has been poured out from a 

 gland in the groin ; but it is probable that this was in consequence of the 

 existence of a real repetition, in that place, of the true mammary structure; 

 this being the situation of the mammae in many of the inferior animals, of 

 which the homologues in man are usually undeveloped. 1 



819. Of the quantity of Milk ordinarily secreted by a good Nurse, it is 

 difficult to form a correct estimate ; 2 since the amount which can be arti- 

 ficially drawn, affords no criterion of that which is secreted at the time of 

 the "draught" ( 722). The quantity which can be squeezed from either 

 breast at anyone time, and which, therefore, must have been contained in its 

 tubes and reservoirs, is about two ounces. The amount secreted is greatly 

 influenced by the mental and physical condition of the female, and also by 

 the quantity and character of the ingesta. In regard to the influence of the 

 mental state upon this secretion, ample details have already been given 

 ( 722, 790). With respect to the physical state most favorable to the 

 production of an abundant 'supply of this important fluid, it may be stated 

 generally, that sound health, a vigorous but not plethoric constitution, reg- 

 ular habits, moderate but not fatiguing exercise, and an adequate but not 

 excessive amount of nutritious food, furnish the conditions most required. 

 It is seldom that stimulating liquors, which are so commonly indulged in, 

 are anything but prejudicial ; and even where, as sometimes unquestionably 

 happens, an improvement in the condition both of mother and infant is the 

 immediate result of the moderate employment of them, it is questionable 



1 The following is a more unequivocal case of vicarious secretion; and it is pecu- 

 liarly interesting as exhibiting the injurious effects of the reabsorption of the secre- 

 tion, and the relief which the system experienced when it was separated from the 

 blood by the new channel. "A lady with a delicate constitution (with a predisposi- 

 tion to pneumc-nia) was prevented from suckling her child, as she desired, by the fol- 

 lowing circumstance. Soon after her delivery she had a severe fever, during which 

 her breasts became very large and hard; the nipples were swollen and firm; and 

 there was evidently an abundant secretion of milk; but neither the sucking of the 

 infant, nor any artificial means could draw a single drop of fluid from the swollen 

 glands. It was clear that the milk-tubes were closed ; and as the breasts continued 

 to grow larger and more painful, purgatives and other means were employed to check 

 the secretion of milk. After three days the fever somewhat diminished, and was re- 

 phiced by a constant cough, which was at first dry, but soon after was followed by the 

 expectoration of simple mucus. After this, the cough diminished in severity, and 

 the expectoration became easy ; but the sputa were no longer mucous, but were com- 

 pi'sed of a liquid, which had all the physical characters of genuine milk. This con- 

 tinued for fifteen days ; the quantity of milk expectorated amounting to three ounces 

 or more in the twenty-four hours. The breasts gradually diminished in size; and 

 by the time that the expectoration ceased, they had regained their natural dimen- 

 sions. The same complete obstacle to the flow of milk from the nipples recurred 

 after the births of four children successively, with the same sequelae After the sixth, 

 she had the same symptoms of fever, but this time they were not followed by bron- 

 chitis or the expectoration of milk; she hud in their stead copious sweatings, which, 

 with other severe symptoms, reduced her to a cachectic state, and terminated fatally 

 in a fortnight." (Bulletino delle Scienze Mediche, April, 1839; and Brit, and For. 

 Med. Review, Jan. 1840.) 



2 For an estmate by M. Guillot, founded on the comparative weight of the Infant 

 before and after lactation, see L'Union Medieale, -1852, No. 16. The total amount 

 considered by Mons. Guillot to be usually drawn in the twenty-four hours, varies from 

 32 oz. to 64 oz. (apoth. ) ; but his estimates are vitiated by the extraordinary frequency 

 of the lactations observed, the infant being put to the breast from 25 to 30 times in 

 the twenty-four hours. 



