REMARKS ON THE SUBJECT OF LACTATION, &c. &c. REMARKS ON THE SUBJECT OF LACTATION; CONTAINING OBSERVATIONS ON THE HEALTHY AND DISEASED CONDITIONS OF THE BREAST-MILK; THE DISORDERS FREQUENTLY PRODUCED IN MOTHERS BY SUCKLING; AND NUMEROUS ILLUSTRATIVE CASES; PROVING THAT, WHEN PROTRACTED, IT IS A COMMON CAUSE, IN CHILDREN, OF HYDRENCEPHALUS, OR WATER IN THE BRAIN, AND OTHER SERIOUS COMPLAINTS. BY EDWARD MORTON, M. D. CANTAB. FELLOW OF THE CAMBRIDGE PHILOSOPHICAL SOCIETY, AND MEMBER OF TRINITY COLLEGE; CANDIDATE OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON; LATE PHYSICIAN TO THE WESTERN DISPENSARY, AND TO THE ROYAL METROPOLITAN INFIRMARY FOR CHILDREN, &c. &c. LONDON: LONGMAN, REES, ORME, BROWN, AND GREEN, PATERNOSTER-ROW. MDCCCXXXI. LONDON:PRINTED BY WILLIAM CLOWES, STAMFORD STREET. TO SIR HENRY HALFORD, BART. , M. D. , F. R. S. , F. A. S. , PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, LONDON, PHYSICIAN TO THE KING, &c. &c. THE FOLLOWING PAGES ARE, WITH HIS PERMISSION, AND WITH A GRATEFUL SENSE OF THE HONOUR THUS CONFERRED UPON THEIRAUTHOR, MOST RESPECTFULLY DEDICATED. PREFACE. Several cases which I witnessed led me to believe, some years ago, thatinflammation of the brain, or its membranes, might be produced inchildren, owing to their being suckled for an undue length of time. Since that period, having enjoyed opportunities of observing infantilediseases on a much more extended scale, and my attention being expresslydirected to the point in question, I not only became fully convinced ofthe correctness of my previous conclusions, but was induced to carrythem still farther. My opinions on this subject were briefly drawn up and published in the_Medical and Physical Journal_ for August 1827, and have not passedaltogether unnoticed by my professional brethren[1], some of whom havedone me the honour to speak of them in flattering terms, while no one, Ibelieve, has attempted to disprove the existence of the important fact Iwas the first to announce. [1] Vide Medico-Chirurgical Review, Gazette of Health, Dendy onCutaneous Diseases, &c. The bare statement of that fact was, indeed, nearly all that myapproaching departure from England, at the time last mentioned, left inmy power: upon the present occasion I have offered arguments for, andendeavoured to anticipate those against, the deductions I then madepublic; and however imperfect may have been my success in either, thewelfare of society at large is too deeply involved in the establishmentof my opinions with respect to the custom I condemn, (if those opinionsbe correct, ) for me to hesitate while again committing them to the pressin a more extended form. These considerations, I respectfully submit, will render any apology forthe appearance of the following pages unnecessary, and will, I trust, secure for them a candid and favourable reception from the Professionand the Public. _15, Eaton Street, Grosvenor Place, October 8, 1831. _ CONTENTS. CHAPTER I. PageOf the Breast-Milk, &c. &c. 1 CHAPTER II. On Lactation, and the Disorders frequently produced inWomen by that process 14 CHAPTER III. On the various Diseases which arise in Children fromLactation, especially when protracted 24 Postscript 59 Notes 61 ERRATA. Page 10, line 3, _for_ two _read_ a few. " 52, " 19, dele comma between the words Tabes and Mesenterica. Transcriber's Note: The above corrections have been applied to thistext, in addition _headach_ has been corrected to _headache_ on page18, line 11. CHAPTER I. _Of the Breast-Milk, &c. &c. _ No sooner has the child been ushered into the world than the breasts ofthe mother pour forth their milk for its sustenance. This bland fluid issecreted from the blood, and varies, in quality and quantity, accordingto the time which has elapsed from delivery, being peculiarly andwonderfully adapted at every period to the wants of the individual forwhose use it is destined. Thus, that first secreted, called _colostrum_, possesses a purgative quality evidently intended by the all-wise Authorof our being for the purpose of removing _the meconium_[A], --a processwhich experience has sufficiently proved to be necessary for the welfareof the newly-born infant. Afterwards, ceasing to possess this aperientproperty, it is calculated solely for affording nutrition; and finally, at a certain period from delivery, it gradually becomes impoverished, loses its former healthy qualities altogether, and acquires others whichare injurious to life. This important change, as above noticed, generally happens at a certain period after delivery; varying, however, somewhat in particular women, and in the same female on differentoccasions: but, from disease, or other circumstances, the milk maybecome deteriorated before the time to which reference has just beenmade. If, for instance, the mother labour under any serious disorder, itis universally admitted that her milk may also become unhealthy; andthis may take place even a short interval after delivery. Although we cannot explain how the brain and nerves act, and probablynever shall be able to do so, yet we are well aware that their influenceis absolutely requisite for the healthy performance of every function inthe human body. That mental inquietude will impede digestion is a fact familiar toalmost every one; but, I believe, it is not so generally known, that itwill with no less certainty retard and alter the nature of the secretionfurnished by the breasts of the lactescent female. Violent affections ofthe mind will cause the milk to become thin and yellowish, and toacquire noxious properties: even the fond mother's anxiety, whilehanging over the couch of her sick infant, will be sufficient to renderit unfit for the sustenance of the object of her solicitude. The state also of the stomach and bowels and the diet of the nursematerially and constantly influence the nature of the lacteal secretion. The milk, besides, is liable to deterioration from another cause, namely, the recurrence of the usual periodical appearance--for shouldthis take place in a nurse, it is agreed that her milk is liable toproduce disorders in the child who imbibes it; which could not happen, if the former possessed its ordinary component parts, and retained itsnatural properties. The recurrence, moreover, of pregnancy in the lactescent female mayrender the milk of a bad quality, and will invariably lessen itsquantity. Mr. Burns asserts that in these cases the milk 'does notbecome hurtful, ' but in this opinion I must beg leave to differ fromhim; since I have repeatedly seen it, from this cause, palpably alteredin appearance, and have observed diarrhœa and great debility producedin the children who were suckled with it. An almost universally received opinion among females, and, indeed, onevery frequently entertained by members of the medical profession, is, that while a woman continues to nurse her infant she will not againbecome pregnant; but this, as a general proposition, is unquestionablyerroneous; it is even doubtful whether such opinion will hold good in amajority of instances. The continuance of lactation will very generally, it is true, tend to prevent the recurrence of the periodical phenomenon;yet, nevertheless, it will not in every instance prevent pregnancy[B]. Should, however, a woman with an infant at the breast again becomepregnant, (a circumstance that very frequently occurs, and of which, from the _general though not invariable_ absence of those criteria bywhich this fact is accustomed to be recognised, she is not aware untilit has made some progress, ) one of two things will usually take place;either she will miscarry, or her milk will become impoverished inquality and diminished in quantity. Nor is this wonderful:--it was notintended by Nature that the processes of pregnancy and lactation shouldgo on simultaneously, but, on the contrary, that the one should commencewhen the other had terminated; and experience sufficiently proves thatthey will not proceed well together: the reason of which, as it appearsto me, may be easily given. During pregnancy, and particularly duringits latter periods, the vessels of the womb gradually enlarge, and amuch greater quantity of blood than usual is determined to that organfor the increase and perfection of the embryo and its appendages; which, after delivery, becomes transferred to the breasts to supply thematerial for the secretion of the milk: but if, during pregnancy, lactation be also persevered in, the blood becomes directed at the sametime to two different parts of the body, somewhat remote from eachother, namely, to the womb, and to the breasts; hence, neither is likelyto receive its due proportion of this vital fluid, and, consequently, the functions of one or the other, or both, are liable to become impededor suspended. If the breasts continue to receive a sufficient quantityof blood, the secretion of milk goes on properly, but the womb isdeprived of its necessary supply; the embryo, in consequence, languishesand dies, and, becoming an extraneous body, is thrown off, producingabortion; while, on the other hand, should the womb still obtain its dueproportion of blood, the breasts are robbed of it, and the secretion ofmilk, if not altogether suppressed, is rendered either deficient inquantity or deteriorated in quality. Finally, the breast-milk may become depraved and injurious by theprocess of lactation being continued too long, a practice which is, unfortunately, in this, as well as other countries, extensivelyprevalent. I have not yet had an opportunity of examining the breast-milk in thesediseased conditions except by the eye, and that rarely--but even thisslight examination has enabled me to state, that it was greatly alteredfrom its natural condition;--that it was more fluid than usual, andchanged in colour, resembling a yellowish turbid serum, instead ofdisplaying its well-known bluish hue. I propose in future to attend carefully to this subject, and I would begleave to recommend it as one well worthy the notice of those members ofour profession who have made animal chemistry a particular study, havingno doubt that they would be able, by a series of accurate experimentsupon the breast-milk at different periods after delivery, and undervarious conditions of the mother, to collect many interesting andimportant facts--such, perhaps, as would tend very materially to augmentour knowledge of pathology, and improve our practice in the treatmentof certain diseases[C]. We cannot but believe that the Supreme Being has done nothing without aninfinitely wise and good object, and it is obviously our interest, noless than our duty, to be guided by those indications of the Divinepurpose which are distinctly to be traced throughout the creation. It must appear evident to all who examine the matter in question, thatthe infant was intended to be nourished for the first few months of itsexistence through the medium of a fluid; because no teeth are providedto prepare for its use substances of a more solid description; and therecan be no doubt that this fluid is the mother's milk;--but when thechild has attained a certain age the teeth begin to appear, doubtless atthe precise time when they are meant to be used; and, therefore, moresolid food should now be given. Besides, in consequence of its newacquisition, the child sucks less perfectly than before, an additionalproof that weaning ought at this period to be commenced. Indeed, theteeth are calculated indirectly to produce this effect themselves, themother being now liable to suffer inconvenience by letting the childtake the breast--for the latter _bites_ instead of _sucking_ the nipple, and the pain hence arising may, perhaps, induce the former, for her ownsake, to discontinue a practice injurious to both. It must also be remembered, that when the teeth are usually produced, the milk loses its nutritious properties, and this too at a time whenthe infant from his increasing size must evidently require a more solidand substantial, rather than a thinner and less nourishing diet. Whatrational argument, therefore, can be offered why he should still besuckled? If we observe the brute creation, do any analogies appear bywhich we can defend the propriety in the human species of protractedsuckling? by no means:--on the contrary, we find that the female animalssoon drive away their young from their dugs; and what is, perhaps, stillmore to the purpose, I have heard stated, on good authority, as awell-known fact among the breeders of cattle, that if calves be allowedto suck beyond a few months they do not thrive, but, on the contrary, become lean and diseased. The belief so generally prevailing, that the longer a child is suckledthe stronger it will become, is a prejudice, like many others concerningwomen and children, which has been handed down from mother to daughterfor ages, and has thereby become so universally entertained and sodeeply rooted in the minds of females, that even medical men scarcelyventure to question its propriety. My own experience, however, compelsme to declare, that there is not a more erroneous or mischievousdoctrine; and I can most truly affirm, that I never yet witnessed aninstance where protracted lactation had produced any good effect[D], though I have seen numerous examples (some of which will be introducedhereafter) where, I believe, it had been the indirect cause of death. Having thus strongly noticed the impropriety of long continuedsuckling, it will, perhaps, be proper to state my opinion as to theperiod when this process should terminate. As a general rule, at ninemonths after birth the child ought to be entirely weaned; and in noinstance should he be permitted to suck more than ten. In many casessuckling may be relinquished with advantage (and occasionally it isabsolutely necessary to discontinue it) before the time first abovementioned; in others, however, it may be protracted beyond it. I by no means recommend the breast-milk to be at once superseded byartificial food, but, on the contrary, that the child should be_gradually_ accustomed to such aliment from a much earlier period; theproportion of the latter being increased by degrees, while thebreast-milk is diminished in a corresponding ratio. Hence we shallproduce a double advantage; the mother will be benefited as well as thechild--the former, by giving suck less frequently, and in smallerquantities at a time than usual, will have the secretion of milk_gradually lessened_, and, therefore all likelihood of inconvenience, asfar as regards herself when the child is entirely weaned, will becompletely prevented; while, on the other hand, the child being_insensibly estranged_ from the breast, will have become accustomed tohis new food, so that there will be less chance of its disagreeing withhim when it forms his sole support; and thus the danger which isgenerally apprehended from weaning will be either materially lessened oraltogether avoided. The difficulty of bringing up infants by hand, as it is termed, is wellknown; but I suspect that the great mortality which has been recorded asoccurring from this source is not inseparable from the practice itself, but arises mainly from the improper manner in which it is usuallyconducted. When it is determined to bring up an infant by hand, thesubstitute offered for the mother's milk should as nearly as possibleresemble that fluid; and the child should be constrained to imbibe it in_the same manner as_ it would _the milk from the maternal breast_; thatis, it should be _sucked_ from a bottle contrived for that purpose, instead of the child being gorged with it, by means of a large spoon, orsome other equally improper instrument, as is the usual custom. It is afact too palpable to be questioned, that the food generally given toinfants brought up by hand is not only administered in an impropermanner, but is also of an improper quality; their tender stomachs aredaily overloaded with _solid_ instead of _liquid_ aliment, and hencearises the numerous train of evils which, in my opinion, produce thegreat mortality just referred to. CHAPTER II. _On Lactation, and the Disorders frequently produced in Women by thatprocess. _ There can be no doubt that, speaking generally, a mother is bound tosuckle her children, and that the performance of this duty is no lessconducive to her own health than to the moral and physical welfare ofher offspring; yet there is not a more unfounded doctrine than thatwhich presumes every woman who is willing to be also capable ofadvantageously discharging the important office of a nurse. If the mother enjoy good health, and the process be not continued toolong, it is likely to produce beneficial effects both in herself and herinfant; but if she be of a very delicate habit--labour under anydangerous disease--be subject during the period of lactation to greataffliction, or constant mental inquietude--or should the periodicalappearance return, pregnancy occur, or suckling be continued too long, it may not only prove highly detrimental to herself, but may be themeans of occasioning serious or fatal consequences to her child. In cases of extreme delicacy of constitution, lactation will oftenproduce the worst effects. Many young ladies, on becoming mothers, areincapable of supporting the constant drain to which the wants of theirinfants subject them--they lose their good looks, become graduallyweaker, and as their strength declines, their milk is simultaneouslylessened in quantity, and altered in its other properties. If the suckling be still continued, their debility daily increases, distressing pains in the back and loins succeed; the patients becomeexceedingly nervous, as it is termed, and are unusually susceptible ofordinary impressions; pain in the head, often of great violence, follows, which, in some cases, is succeeded by delirium, in others, byabsolute mania. Nor is this the whole catalogue of ills to whichin such cases the unfortunate mother is subjected: the appetitefails, distressing languor is experienced by day, while copiousperspirations deluge her by night, and dissipate the last remains ofstrength--producing a state which may easily be mistaken for, orterminate in, true pulmonary consumption;--finally, the sight becomesprogressively weaker, until vision is almost destroyed; the eyelidsexude a glutinous secretion, and ophthalmia itself is occasionallyinduced. These are the symptoms too often caused by lactation in delicate ordebilitated habits, even a few months after delivery; the same also areobserved when suckling has been injudiciously protracted beyond theperiod to which it should be confined. A few only of the foregoing symptoms may be noticed, or nearly the wholemay present themselves, in the same patient; and when this happens, unless the cause which has given rise to them be at once detected, andappropriate treatment employed, the most serious consequences may beapprehended. In these cases, the first step necessary is to discontinue the sucklingaltogether: half measures will never answer. Sometimes it is proposed bythe patient, or her friends (more usually the latter), to compromise theaffair by feeding the child partly on spoon meat, and allowing him stillto take the breast, though less frequently than before. This plan I uniformly object to, for the following reasons:-- 1st. Because the mother will not be likely to recover so long as shecontinues to suckle at all. 2nd. Because her milk being necessarily of a bad quality, it cannot beexpected that the child will derive benefit from it; but, on thecontrary, there is every probability that his health will suffer byusing diet of such an improper description. The obvious dependence of the foregoing symptoms upon debility will, ofcourse, at once suggest to practitioners the nature of the treatment tobe adopted: which should be such as is calculated to invigorate thesystem generally--namely, the administration of tonics, &c. Bark and its various preparations, especially the sulphate of quinine, with the occasional use of warm aperients (sedulously avoiding the moreviolent purgatives), will be found eminently successful; whereas, cupping at the nape of the neck (which I have seen prescribed for theheadache), and other depletory measures, have proved as manifestlyinjurious. 'Every disease productive of great weakness is increased by the state ofthe system which follows child-bearing. Of this description areconsumption, dropsy, ' &c. In these cases it is evident that the processof lactation, by adding to the debility already present, must provehighly injurious, and consequently should be always avoided. I have already noticed the effects which are produced upon the milk bythe influence of mental emotions on the part of the mother, as well asby the recurrence of the periodical appearance; and since these arechiefly injurious to the child, by depraving its sustenance, theirfurther consideration will be deferred till the next chapter. With respect to the remaining topic--namely, the occurrence ofmiscarriage from suckling--I am convinced that it is by no means anunfrequent accident, though its real cause is perhaps rarely suspected, having only met with one patient who considered the mishap in questionto have arisen from keeping her child too long at the breast. Havingalready, I trust satisfactorily, explained the manner in which abortionis produced by the act of suckling, I shall conclude this part of mysubject with the relation of a case that occurred in private practice, which so strongly corroborates many of the observations in the precedingand following pages, that I shall offer no apology for its introduction:more particularly, since the lady herself to whom it refers hasbenevolently expressed a wish for its publication, in order that thosewho become acquainted with the facts there detailed may be preventedfrom undergoing similar unnecessary sufferings:-- CASE. Mrs. A----, a lady of delicate constitution, about twenty years of age, three or four months subsequent to the birth of her first child, beganto find her milk gradually lessen in quantity; it had also much changedfrom its previous appearance, resembling at the time just stated, ayellowish, turbid serum. Her child became emaciated; and diarrhœasupervening, my professional services were required. My advice was, thatthe child should be at once weaned, and a suitable wet-nurse, ifpossible, procured--neither of which suggestions, as will shortlyappear, were followed. I urged the necessity of this measure moreparticularly, because Mrs. A---- was daily getting thinner and weaker;she also complained of great pain in the head and back, and of anincreasing dimness of sight, which made her fear she should becomeblind; but the mother-in-law of my patient being, unfortunately, ofopinion that pregnancy in the latter would not again occur during thecontinuance of lactation, recommended that the child, although chieflysupported upon spoon-meat, should occasionally be allowed to take thebreast; and this plan, notwithstanding the wish of Mrs. A---- to thecontrary, and my own remonstrances on the subject, was adopted--theeffects of which were to increase the mother's ailments, as well asthose of her infant. Things went on thus for some time longer, when Ionce more endeavoured to persuade Mrs. A---- to follow my advice, observing, that by an opposite line of conduct she was not only injuringher own health, but that of her child, neither of which, I assured her, in my opinion, would be re-established till the latter had been weaned. I expressed also my complete incredulity as to the non-recurrence ofpregnancy in consequence of her infant remaining at the breast; and Iadded--'It is my firm conviction that if you be pregnant, or shouldhappen shortly to become so, you will miscarry. ' About a week afterthis conversation she was suddenly seized with flooding, and what I hadpredicted took place. She now left off suckling, and in about a month, under suitable treatment, completely got rid of all her formercomplaints: the child also immediately began to improve. The present case clearly proves that the process of lactation will not_invariably_ prevent the occurrence of pregnancy, since Mrs. A---- becamein this state, notwithstanding she continued to suckle her child: and Ithink few will be so hardy as to doubt that it was the cause of hermiscarrying: more particularly when I mention that, at a future period, the same lady, during my absence abroad, being once more persuaded totry whether she could not avoid becoming pregnant (which was very muchto be desired, on account of her delicate state of health) by continuingto perform the duties of a nurse, again suffered all the distressingsymptoms before described, and again miscarried. This case, finally, affords evidence of the evil consequences oftenproduced in children by impoverished and unhealthy milk; and of theirspeedy disappearance when the exciting cause--namely, deterioratedmilk--is no longer afforded. CHAPTER III. _On the various Diseases which frequently arise in Children fromLactation, especially when protracted. _ Having thus briefly considered some of the disorders to which women aresubjected by performing the first duty imposed upon them as mothers, Ishall next advert to those which are very frequently observed in theirchildren from being suckled during too long a period; or in consequenceof the nurse's milk becoming either simply impoverished, or of apositively injurious quality. These diseases are numerous, and some of them serious, among which maybe enumerated the following; namely, vomiting, diarrhœa, generaldebility, scrofula, tabes mesenterica, --rickets, convulsions, epilepsy, --and lastly meningitis, or that peculiar inflammation of theinvesting membranes of the brain which gives rise to the effusion ofserum, constituting the well known and very fatal disease termed bymedical practitioners Hydrocephalus, or Hydrencephalus, and popularlyWater on the Brain. The disease last mentioned being by far the most important, and thatchiefly referred to in the following observations, I shall commence witha brief statement of the conclusions which my experience has led me toform respecting it; they are the same I made public four years ago[E], having since that time seen no reason to make any alteration in them. Ibelieve, 1st, --That if children be suckled for an undue length of time[F], theywill be liable in consequence to be affected with meningitis[G], orinflammation of the investing membranes of the brain. 2dly, --That should they not become affected with the disorder inquestion during or soon after the time they are thus improperly suckled, they will nevertheless acquire therefrom a predisposition to cephalicdisease at some future period of their lives. 3dly, --That children who are suckled for an undue length of time, whenlabouring under other diseases, will be much more liable to have thehead secondarily affected, than children brought up in a differentmanner. 4thly, --And lastly, that the same effects will take place in infants ifsuckled by women who have been delivered an undue[H] length of time;although the infants themselves may not have been at the breast for toolong a period. * * * * * CASES IN ILLUSTRATION OF THE FOREGOING VIEWS. I. _Cases of Meningitis[I] supervening upon protracted suckling. _ CASE I. ---- Wilshire, aged two years seven months, died of '_Water on thebrain_, '--_suckled twelve months_. CASE II. ---- Park, aged one year ten months, died of '_Water in thehead_, '--_suckled fourteen months_. CASE III. Prince V----, aged two years and a few months, died of_Hydrencephalus_, --_suckled until his death_. In this case I wasconsulted a short time previously, and recommended the breast-milk to bewithheld--my advice was not followed. CASE IV. Emma Lane, aged two years, admitted at the Infirmary for Children for_Meningitis_, --_suckled one year and eleven months_. CASE V. The mother of the preceding suckled another child '_a very longperiod_, ' and it died of '_Water on the Brain_. ' CASE VI. Edmund Power, aged two years, _still at the breast_, admitted for_Chronic Hydrocephalus_: the head is of great magnitude; fontanellesopen: superficial veins large and prominent. CASE VII. Sophia Hamley, aged one year two months, _still at the breast_, admittedfor _Meningitis_. CASE VIII. William How, aged one year six months, admitted for_Meningitis_, --_suckled thirteen months_. CASE IX. David Hepburn, aged two years six months, admitted for_Meningitis_, --_suckled two years four months_. CASE X. Samuel Hanks, aged one year nine months, admitted for_Meningitis_, --_suckled one year eight months_. CASE XI. Amelia Hill, aged two years six months, admitted for_Meningitis_, --_suckled one year nine months_. CASE XII. ---- Hughes, died of '_Water in the head_, '--_suckled fourteen months_. CASE XIII. ---- Ferreira, aged seventeen months, died of '_Water in thehead_, '--_suckled until its death_. For the five following cases I am indebted to the kindness of Mr. William Griffith, an intelligent surgeon of Eaton-street, who, havingsome time ago been apprised of my peculiar views, has since directed hisattention particularly to the subject. They completely confirm myopinions, and will have more weight with the public than any additionalevidence I could adduce from my own practice. In the letter inclosing these cases, Mr. Griffith writes thus--'from theobservations I have been enabled to make, I am led to believe thatdisease almost invariably follows protracted suckling. I may add inconclusion, that I perfectly concur with the views which you entertainon the subject. ' CASES XIV. XV. '---- Jackson, residing at ----, aged two years six months, who had beenkept _at the breast twenty-two months_, was in a dying state when I wasrequested to see her. The pulse was preternaturally slow--greatstupor--dilatation of the pupils, and diastasis of the bones of thehead. In six hours from the time I first saw her she died, and themother was desirous that the head should be examined, having lost achild previously, in what she considered a similar manner. On removingthe scalp I found the cranium very much enlarged and altered in shape. Between the tunica arachnoides and pia mater, there was a quantity ofwater effused;--the sides and upper surface of the brain wereexceedingly soft. In the lateral ventricles there were from six to eightounces of water. In answer to a few questions I asked the mother, shestated that her former child was, during the _first ten months_ of itslife, _a plump, healthy infant_, --_after that period he altered_, --thestomach, bowels, and _head became affected_, and, in the course of a fewmonths, he manifested similar symptoms to those which proved fatal inthe case of his sister. He was _suckled for twenty-one months_, and_died_ at the age of _twenty-seven months_. The mother of these childrenhas one other child alive, and at my urgent request it was weaned at_nine months_, --it is now _seventeen months old, and in excellenthealth_. ' CASE XVI. 'Mrs. A----, of ----, had a little boy who at _ten months old_ had nineteeth, which were cut with little or no difficulty:--_at this time hewas in good health_, --_he was allowed the breast until nineteen months, and at the expiration of three months more, died of Hydrocephalus_. ' CASE XVII. 'Mrs. T---- lost a child of Hydrocephalus, and has an infant _now at thebreast seventeen months old_;--the little patient is frequentlysuffering from _cerebral disturbance_. I have repeatedly advised themother to wean it--she objects, and gives the usual reason for allowingit to remain at the breast--viz. , that she does it to _prevent becomingagain enceinte_. ' CASE XVIII. 'This day, (August 13, 1831, ) a little child labouring under _cerebraldisease_ was brought to me for advice, and he appeared certainly in amost pitiable state; he is _two years four months old_ and is _now atthe breast_, --I do not think it possible for him to survive many days. ' II. _Cases of Meningitis, arising at an after period, in consequence ofprotracted suckling. _ CASE XIX. Francis Page, aged six years, admitted for _Meningitis_, --_suckled oneyear_. CASE XX. Henry Taylor, aged six years, admitted for _Meningitis_, --_suckledfourteen months_. CASE XXI. Julia Brown, aged three years, admitted for _Meningitis_, --_suckledthirteen months_. CASE XXII. James Neil, aged seven years six months, admitted for_Meningitis_, --_suckled fourteen months_. CASE XXIII. Eliza Park, aged six years, laboured under _Meningitis_, --_suckledfourteen months_. CASE XXIV. Charles Dale, aged five years; admitted for _Meningitis_--_suckledthirteen months_. CASE XXV. Sarah Strickling, aged four years; admitted for _Meningitis_--_suckledone year and six months_. CASES XXVI. XXVII. XXVIII. The mother of the last mentioned child lost three previously, with'_water in the head_:'--all these were suckled _more than eighteenmonths_. CASE XXIX. George Speering, aged four years; admitted for _Meningitis_--_suckledone year and six months_. CASE XXX. Ann Archer, aged seven years; admitted for_Hydrocephalus_--died--_suckled three years_. CASE XXXI. Cornelius Leary, aged six years; admitted for_Meningitis_--died--_suckled eighteen months_. CASE XXXII. Sophia Peverel, aged three years; admitted for _Meningitis_--_suckledtwo years_. CASE XXXIII. Maria Turley, aged four years; admitted for _Meningitis_--died--_suckledone year three months_. This child had laboured under a previous attack, from which she recovered under my care. CASE XXXIV. Robert Selkirk, aged three years six months; admitted for_Meningitis_--_suckled thirteen months_. CASE XXXV. The mother of the preceding child lost another of '_inflammation of thebrain_. '--This was _suckled more than one year_. CASE XXXVI. Eliza Ferreira, aged five years; admitted for _Meningitis_--_suckled oneyear seven months_. III. _Cases of Meningitis in Children who had been suckled an undue length oftime, supervening upon other complaints. _ CASE XXXVII. Arthur Lane, aged one year four months; admitted for Pneumonia, with_an affection of the head_--_suckled fourteen months_. CASE XXXVIII. Sarah Ward, aged three years; admitted for Hooping-cough--_head muchaffected_--_suckled one year and ten months_. CASE XXXIX. Thomas Donovan, aged two years two months; admitted for Hooping-cough, with _an affection of the head_--_suckled twelve months_. CASE XL. Count ---- ----, aged about two years, came under my care, being then atthe breast. The head was large, fontanelle open--superficial veins moreapparent than natural. By my advice he was directly weaned, and rapidlyimproved in health and appearance (the only medicine given beingoccasional doses of castor oil). About twelve months afterwards, inconsequence of an imprudent exposure to cold, he was attacked withBronchitis, and Meningitis supervened. Leeches were applied to the head, and other depletory measures actively employed, which were followed byrecovery. CASE XLI. ---- Sloggat, aged thirteen months, died of _Meningitis_ superveningupon Pneumonia--_suckled until the time of its death_. CASE XLII. John Scott, aged eleven months; admitted for Hooping-cough, with a_well-marked affection of the head_--_still at the breast_. CASE XLIII. ---- Scott, aged fifteen months, --died of 'Hooping-cough, withconvulsions, ' _being then at the breast_. CASE XLIV. Isaac Berwick, aged one year two months, admitted for Hooping-cough, _with an affection of the head_--_still at the breast_. CASE XLV. Frederick Cousins, aged three years four months, brought to me labouringunder Hooping-cough, with Meningitis, which latter terminated ineffusion. Calomel was then given every two hours, the stronger mercurialointment rubbed upon the temples, and blisters applied to the head. Themercurial influence being established, a profuse discharge of urineoccurred; the pupils which had previously been _permanently_ dilated, became once more obedient to light; sensibility was restored, and greatweakness appeared to be the only urgent symptom. The cough, however, nowreturned, the head became again affected, and the child sunk. Uponopening the head, about four ounces of fluid was found in theventricles[K]. This child was _suckled sixteen months_. CASE XLVI. Sarah Swann, aged four years six months, admitted for Hooping-cough withconvulsions, --_suckled one year_. CASE XLVII. Henry Harris, aged two years three months, admitted for Hooping-cough, _with an affection_ of the head, --_suckled one year four months_. CASE XLVIII. Maria Hughes, aged two years, admitted for _Convulsions_ superveningupon Hooping-cough--_suckled one year three months_. CASE XLIX. Thomas Benson, aged one year six months, admitted for Pneumonia, with_well-marked affection of the head_--_suckled one year four months_. CASE L. Mary Kenner, aged six years, admitted for Hooping-cough, with_well-marked affection of the head_--_suckled one year six months_. CASE LI. John Ennis, aged one year seven months, admitted for Bronchitis, towhich _a decided affection of the head succeeded_--_suckled one year_. IV. _Case of Meningitis produced in consequence of the Child being suckledfrom its birth by a Woman who had at that time been delivered one Year. _ CASE LII. Ellen Willoughby, aged nine months, admitted for Meningitis; at presentsuckled by a woman who has been _delivered one year and nine months_. * * * * * With respect to the manner in which protracted lactation causes thecomplaint that forms the subject of these remarks, I formerly wasundecided; but have now no doubt whatever of its arising _secondarily_from derangement in the functions of the abdominal viscera, occasionedby the depraved condition of the breast-milk. It is universally allowed among medical men that irritations in thestomach and bowels will, through the agency of particular nerves, produce sympathetic irritation in the brain, --that peculiar actionbeing thus elicited which terminates in the effusion of serum, constituting the disease named Hydrocephalus. --'The continued irritationof important or very sensible nerves is, perhaps, ' says Mr. Burns, '_oneof the most common causes_' (of Hydrocephalus); 'hence it may followdentition, and _very often arises from a bad state of the chylopoieticviscera_. ' It is also no less generally known that food of a bad quality orimproper description will produce derangements in the digestive organs. Now, having already shewn that the milk when lactation is protractedbecomes deteriorated, it plainly appears that such milk is capable ofoccasioning derangement of the chylopoietic viscera; and it beingallowed that derangement of these viscera, from any source, may giverise to inflammation of the brain, I conceive it follows that protractedlactation must be admitted as one cause of such effect. This train ofreasoning, therefore, from generally admitted data, seems to _prove thatMeningitis_, or inflammation of the brain, _in children can be producedby their being suckled for too long a period_, and _that it is soproduced I assert from repeated experience_. An accidental perusal of Mr. Dendy's able work on the cutaneous diseasesof children, published shortly after the appearance of my paper beforereferred to in the Medical and Physical Journal, has recently affordedme the pleasure of finding that the author had been led to entertainsimilar general views on the subject under discussion with myself; Ihave, therefore, taken the opportunity of adding that gentleman'stestimony to my own, by quoting the following passage from his workabove mentioned. 'It may be truly said, that _the infantine disease excited by milk of adeleterious, or simply impoverished quality, "grows by what it feedson;"_ and we shall witness the internal debility and the infantinedisorder running their course together. Tabes is the natural consequenceof this error; but its effect is evinced by the occurrence of otherdisorders. A defective degree of nutrition, as I have elsewhere stated, predisposes the system to become influenced by comparatively slightexcitement; and thus, in addition to the direct excitement of disease, it becomes indirectly its predisposing cause. _Under its influence theserous_[L] and mucous _membranes become readily the seat ofinflammatory action_. ' Those who feel a difficulty in relinquishing old opinions and adoptingnew views upon any particular subject, may perhaps ask how it hashappened, if inflammation of the brain from protracted suckling be socommon as the preceding observations and cases would appear to prove, that medical men of more advanced age and far greater experience thanmyself have not previously noticed the circumstance. I would observe, inreply, that until Harvey pointed out the circulation of the blood, noone ever suspected the existence of such a phenomenon; yet now thewonder appears to be, not that Harvey made the discovery, but thatothers had not previously done the same. Multitudes, it may be added, and among them the great Newton, had witnessed the fall of objects tothe ground without thinking of the cause which produced their downwardtendency; the propitious moment, however, arrived--the apple fell, andthe philosopher was led to those deductions which have rendered his nameimmortal. So is it with observers of every class, from those mostdistinguished by intellectual superiority and its successfulapplication, down to the humble writer of the present observations. Facts are continually passing before us unnoticed, till, from theirrepeated coincidence, or some accidental impulse, we attempt, andfinally are enabled, to trace their origin. Thus, until the possibility of Meningitis originating from protractedlactation had been suggested, practitioners were, of course, unable tonotice the fact--not from its non-occurrence, but because theirunconsciousness of its existence must necessarily preclude the inquiriesfrom which alone its cause could be determined. Hence a practitioner mayhave treated many hundred cases of water on the brain in children, without being able to attribute any one of them to protracted suckling;yet this is no proof that such cases did not happen, for, had he madethe requisite inquiries, very probably many among them might have beenfound which had thus arisen. Another objection that may possibly be made to my views, is, thatinstances might be adduced where lactation had been persevered in for avery long period, without any ill effects supervening. That suchfrequently occur, there is no doubt; and with respect to them, I havemerely to observe, that they do not in the slightest degree invalidatethe correctness of my conclusions. As well might it be argued, thatbecause persons have fallen from a very great height without sustainingany injury, or, because poisonous doses of various drugs have sometimesbeen swallowed without death supervening, that, therefore, there is nodanger in jumping from a precipice, or in taking a virulent poison; orthat death never occurs from these causes. Such cases, unless far morenumerous than I imagine them, can only be regarded as exceptions to thegeneral rule; and, consequently, do not lessen its authority, therebeing no rule without an exception. Some practitioners, with whom I have conversed on the subject, thoughwilling to allow that protracted suckling, by depraving the milk, may bethe means of occasioning Meningitis in infants during or shortly afterthe time they are supplied with this improper food, yet could notconceive how it can act as a cause of that disease at some futureperiod; I do not myself, while attempting to account for it, discoverany pathological difficulty. In these cases it is very probable, that although the protractedsuckling was not sufficient to produce actual Meningitis at itsconclusion, yet that it so weakened the system in general, and the brainin particular, as to render the latter especially predisposed toinflammatory action; and that we have reason to suppose this not onlypossible, but probable, from analogy, cannot be denied, since it isknown that scrofulous children, in whom there is great laxity anddebility of habit, are inordinately liable to be affected withHydrocephalus, or Water in the Brain. 'Dr. Perceval observes, that of twenty-two cases of which he kept notes, _eleven were certainly strumous children_, and _four were probably so_. ''From my own observations, ' remarks Dr. Cheyne, 'I should think thisproportion a very moderate one. When a whole family is swept away byHydrocephalus, I suspect _it is intimately connected with this strumoustaint_. ' The testimony of Sauvages may also be adduced, who says, 'Novifamiliam cujus infantes circa sextum ætatis annum omnes periere ex hocmorbo, _Scrofula huic effusioni ansam præbente_. ' The brain, inconsequence of this local debility, may become affected from causeswhich otherwise would, perhaps, have produced no injurious consequenceswhatever; and hence it is, that when labouring under other diseases, andespecially Hooping-cough, those children who have been suckled too longappear so very liable to have the head secondarily affected. It isworthy of notice, that among the cases which have been detailed in theforegoing pages, were fourteen in whom affection of the head supervenedduring the progress of other diseases, and in ten of them the diseasewas Hooping-cough. The treatment of Meningitis arising from protracted suckling will notdiffer from what is proper when it has been produced by other causes;except that the depletory measures should not be carried to so great anextent, as it must be remembered that the disease is existing inconstitutions _already debilitated_. It should consist generally in the application of leeches to thetemples--cold lotions to the head--purgatives, and blisters placedbehind the ears, the discharge from which is to be kept up by means ofirritating dressings--these afford the surest chance of subduing themalady, and in many instances, if employed sufficiently early, will havethe desired effect. It is, of course, almost superfluous to observe, that weaning, if the child be above nine months old, must beimmediately enforced; or, if considerably younger, the diseased ordebilitated nurse ought to be exchanged for one who has a supply ofhealthy milk of a corresponding age. If such cannot be procured, thechild must be brought up by hand; for, so long as it is allowed toimbibe the noxious milk, there is little hope, in my mind, of themedical treatment being of any great service; while on the contrary, itis encouraging to know that many infants previously manifesting symptomsof incipient Meningitis have completely recovered _soon after they wereweaned_[M]. When my attention first became directed to the subject, I was chieflystruck with the ill effects resulting to the child from _protracted_lactation, and hence supposed that cases of disease from suckling, whencontinued for only a moderate period, were rarely if ever met with. Moreenlarged experience, however, has now convinced me, that not only areill effects occasioned in children when lactation is protracted to avery unusual extent, but that they occur sometimes, when its durationhas been merely a few months beyond what I conceive is right. Besideswhich, we shall find that when from any cause whatever the nurse's milkbecomes impoverished and deteriorated, even if this take place at anearly period after delivery, the injurious effects already referred tomay be produced in the child: for improper food, whether it be bad milkor any other inappropriate article of diet, is always calculated toderange the functions of the stomach, bowels, and other chylopoieticviscera, and in consequence to occasion disease. It matters not whether the mother be originally unhealthy, and thus hermilk possess bad qualities; or whether from accidental circumstances, orher continuing to give suck too long it becomes so: in either case thesame effect, namely, _deteriorated milk_, is produced, with theconcomitant evils to which I have alluded. This view of the matter iscorroborated by Case LII. , in which true Meningitis attacked a child, aged only nine months, who, therefore, was not suckled _too long_, --butthen the nurse of that child had been delivered _twenty-one months_, having suckled another infant previously:--hence we may reasonablyconclude that her milk being from the beginning deteriorated, andunadapted to the age of the child, the ill effects in this case wereproduced at a much earlier period than usual. It will be observed that I have only given _one_ instance of this latterdescription; but, on considering how very rare it must be to find anymother capable of abandoning her newly-born infant to the breast of awoman who has already suckled another child one year, any surprise thatmight be felt at the circumstance will, I am sure, immediately cease. Itmust also be noticed that only among the lowest grades of society do wefind women so long after delivery performing the office of wet-nurse atall, and those who entrust their infants to the latter are often sopeculiarly situated as to feel no interest whatever in the preservationof their offspring: indeed I cannot but suspect that, among such, criminal motives frequently lead to the adoption of the unnatural andbaneful practice in question. I do not recollect to have seen a case of Meningitis from sucklingexcept when this process had been _protracted_, either as respects thechild or the nurse; though I by no means doubt the possibility of itsoccurrence under other circumstances: but I have met with numerousinstances of other diseases produced by the palpable deterioration ofthe mother's or nurse's milk at various periods after delivery; in byfar the greater number, however, of such cases, lactation had beencontinued for an unusual length of time. Vomiting, griping, and diarrhœa, are so common among infants, andarise in general from causes apparently so evident, that, unless severeor of long duration, they rarely form the subject of minute inquiry. Hence these complaints are, perhaps, not so often attributed todeteriorated milk as they ought to be, although the fact of theiroccasionally originating from a morbid condition of this fluid, (andtherefore from protracted lactation as one cause of the latter effect, )is too well established to be questioned. Dr. Underwood observes, 'hasnot every Physician of experience seen infants frequently thrown intotormina immediately after coming from the _breast of an unhealthymother, or one who has but little milk_?'[N] and Mr. Burns states, thatif the usual periodical appearance should return, 'the milk is liable todisagree with the child, and produce vomiting or purging;' while Dr. Hamilton expressly mentions that diarrhœa is 'not unfrequently_occasioned by the depraved quality of the nurse's milk_. ' The two former authors merely testify to the fact of diseases beingproduced by the milk, while the latter more explicitly mentions thecause from which they proceed. Debility, Tabes Mesenterica, and Scrofula, may also be traced to thesame origin, as every practitioner of experience must have repeatedlyobserved: so may that intractable disease, termed Rickets; and it isworthy of notice, that among the worst instances of this malady I haveseen, were two sisters, _who had been suckled for a very unusualperiod_. Neither do I doubt the probability of Epilepsy being similarlyoccasioned; and although, I must candidly own, I cannot produce numerouscases in proof of the correctness of such hypothesis, yet I recollectthat of a girl affected with this complaint, respecting whom the motherstated (and I recorded the fact at the time) that she had been '_suckledfor two years_;' and, to use her own expression, had 'never been wellsince. '[O] Convulsions arising from protracted suckling, or simply from the nurse'smilk becoming deteriorated at any period, are very common, and I havekept notes of many such cases that have occurred in the course of my ownpractice; which, however, I abstain from here inserting, being anxiousto prevent the present publication from swelling into a volume. Indeed, the occurrence of convulsions from this cause (diseased milk) has beenmentioned by several of the best authors. Mr. North, in particular, (whose excellent work on Convulsions should be in the hands of everypractitioner) observes--'It cannot be doubted that children suffer, thattheir health is destroyed, and the foundation laid for convulsivediseases, by _sucking unhealthy nurses_. ' 'A predisposition toconvulsive affections in children may be originally produced inconsequence of their being suckled by a nurse addicted to the frequentuse of spirituous liquors. In several instances I have known childrenrapidly recover their health when the nurse was changed, who hadexhibited most of the premonitory symptoms of convulsions while theywere suckled by a woman who indulged in the common vice ofgin-drinking. ' And Mr. Burns also makes the following remark--'Violentpassions of the mind affect the milk still more;--it often becomes thinand yellowish, and _causes_ colic, or even _fits_. ' It is needless, however, to say more on this topic, since it is one which no longeradmits of discussion. The reader may now, perhaps, expect that I shall introduce a series ofpractical deductions from the foregoing facts and observations; butsuch is not my object upon the present occasion. I merely wish to callthe attention of practitioners and the public to the subject of thesepages, and shall thus discharge, as I conceive, an imperative duty tosociety. Having mentioned what I am induced to consider a frequent causeof inflammation of the investing membranes of the brain in children, myundertaking is completed. The Profession does not require, and thepublic would not be benefited, by the addition of lengthenedtherapeutical rules; for I am convinced, there is not a greaterimposition to be found than the doctrine that non-medical persons cantreat diseases with success by means of popular systems of medicine, '_practical_' treatises, &c. Such books have often done irreparablemischief--certainly much more harm than good; and so far from injuringthe profits of medical practitioners (as some appear to suppose), havegreatly added to the number of their patients. I avail myself also of this opportunity to enter my protest against theill-judged and mischievous practice of those patients who confide uponmany occasions in the opinion of their nurse, rather than that of theirmedical attendant, and who, in consequence, often injure themselvesessentially by deceiving the latter. With respect to this mistakenpreference, Dr. Dewes has well observed--'Let it not be hastily assumedthat there is more safety in following the directions of a nurse thanthose of the physician, because she may have had some experience; for itmust be quickly perceived that the calculation is much in favour of thelatter, since the nurse can attend but twelve patients per annum, whilethe physician may visit many hundreds in the same period--besides, hisknowledge of the laws of the human system gives him a very decidedsuperiority. ' In conclusion, it is right to observe, that protracted suckling being acustom much more prevalent among females of the lower orders than thoseof a superior rank, it must follow as a necessary consequence, that_Meningitis, and other disorders resulting from this cause, areproportionably less frequent in private than in public practice_. Thisremark, it is evident, should be remembered, in order to obviateapparent discrepancies which otherwise might appear irreconcilable withthe opinions I have expressed. In the truth of those opinions I feel themost perfect confidence, and cannot but hope that their promulgationwill hereafter prove extensively beneficial, since precautionary, andeven therapeutical measures may be founded upon them, which, ifuniformly adopted, will not only prevent much ill-health and sufferingto mothers, but will also afford the means of saving many children fromperishing by one of the most painful and fatal diseases to which theyare subject. POSTSCRIPT. Being anxious to obtain additional evidence with respect to theproduction of Meningitis in children by protracted suckling, rather fromthe experience of others than my own, I shall feel greatly obliged toany practitioners who will favour me (free of postage) with either factsor cases tending to corroborate the truth of the doctrine contained inthe preceding pages; and should I be enabled publicly to avail myself ofsuch communications, it is, perhaps, unnecessary to say, I shall notneglect the opportunity of expressing my acknowledgments to theirrespective authors. The intelligence and liberality characterising themembers of the medical profession generally, preclude all apprehensionon my part that the above appeal will be made in vain. NOTES Note A (page 1). A dark-green substance of variable consistence, contained in the bowelsof infants at birth. B (page 4). I beg leave to observe that I make these statements with some confidenceas the result of personal inquiries instituted a few years ago among thepatients of two of the Lying-in Establishments of this metropolis. C (page 8). Since the above was written, a friend who lectures on Chemistry in themetropolis has kindly promised me his valuable assistance in making theexperiments here suggested. D (page 10). In two cases where suckling was protracted to _three years_, thesubjects of this baneful practice did not equal in size an ordinarychild of half their age. One of them became idiotic, and afterwards diedof Hydrencephalus, under my care; the other was affected with TabesMesenterica, --the result I did not witness--but believe the diseaseterminated fatally. E (page 25). Vide Medical and Physical Journal for August 1827. F (page 25). That is, any period beyond nine or ten months. G (page 25). _Meningitis_, --I use this term as being more pathologically correct than_Cephalitis_, which I formerly adopted. H (page 26). See the above conditional sense in which I employ this term. I (page 26). It is a curious fact, which I believe has not been noticed by any otherwriter, that female children labouring under attacks of Meningitis aresometimes affected with leucorrhœal discharges. I have met withseveral cases of this description: the children also of women subject toleucorrhœa will often, at an early age, be found affected with thesame disease. Hence it would appear that leucorrhœa is occasionallyhereditary. K (page 37). It is unquestionable, notwithstanding the scepticism of somepractitioners on the subject, (whose opinions are entitled todeference, ) that _recovery may take place, under appropriate treatment, in cases of Meningitis, even after effusion has unequivocally occurred_. Preceding authors have noticed this fact, which I can confirm by my ownexperience. Practitioners cannot be too frequently reminded of it, andwarned not to despair of success even in the last stage ofHydrencephalus. L (page 42). For the information of the _unprofessional_ reader, I beg to observe, that the membranes of the brain are _serous membranes_. M (page 48). It will be observed hereafter, that Mr. North has experienced similarbeneficial effects from the course above recommended, in cases where_convulsions_ have been caused by _diseased milk_;--a strongcorroborative coincidence. N (page 52). I believe that where the milk is greatly diminished in quantity, it willalso be found deteriorated in quality. O (page 53). In the communication above referred to from Mr. Griffith is thefollowing:--'Mrs. A. Has a family of four children, all of whom shesuckled for a period varying from _seventeen_ to _twenty-twomonths_:--_not one of the four is healthy_. ' BY THE SAME AUTHOR, Preparing for publication, in one small volume, 8vo. OUTLINES of INFANTILE SEMEIOLOGY; or, an Arrangement of the PrincipalSymptoms of DISEASE in INFANTS and CHILDREN, with the best modes ofdetecting them;--interspersed with Practical Observations, and intendedas a clinical guide to Students, &c. &c. Also, in 2 vols. 8vo. The EIGHT BOOKS of ARETÆUS of CAPPADOCIA on the Causes, Symptoms, andTreatment of ACUTE and CHRONIC DISEASES. Translated literally from theoriginal Greek, and supplied with critical and explanatory Notes, Tablesof the Weights and Measures, &c. &c. By the same Author, Recently published by Longman and Co. In 8vo. , boards, price 14_s. _ TRAVELS IN RUSSIA, and a RESIDENCE at ST. PETERSBURGH and ODESSA in theYears 1827-29;--intended to give some account of Russia as it is, andnot as it is represented to be. Printed by W. CLOWES, Stamford-street.