Reprint from NEW ENGLAND MEDICAL MONTHLY, August, 1885. LAWS OF/MATERNITY. BY NATUAN ALLEN, M.D., LL.D., OF LOWELL, MASS. rilHERE is a large class of facts which, JL for discussion and a better understand- ing, seem to come, more properly than any- where else, under the heading of this pa- per. These facts are so constantly pass- ing under the observation of medical men, and entering into their studies, that they should bo more thoroughly understood. Connected with these laws, there are some problems not easily solved, and, while we may not bo able to throw much light upon them, we may start inquiries which will lead to important results. Our aim in the present discussion will be of a suggestive nature, but far from ex- hausting the subject. The laws of maternity are based upon physiology, and, as we have been accus- tomed to interpret their operations for ma- ny years, we are not inclined at first to call in question their correctness. Their performance may be normal or abnormal, without our discovering exactly where tho true line runs. Wo see a great difference in the action of these physiological laws, and that some work far better than others, but we do not stop to ascertain the cause. One of the most important of these mater- nal laws is that tho mother should nurse her offspring—that she should furnish a proper and healthful supply of milk. It is a primary law of nature that when it makes a demand, it invariably furnishes a supply. If there are found exceptions to this general law, there must bo some well-grounded cause. When Sir Astley Cooper, fifty years ago, wrote his great work upon the H Anatomy and Diseases of the Breast,” he took it for granted that all women could nurse their offspring, except in case of dis- ease or malformation. After discussing the great advantages, both to the mother and the child, from nursing, ho admits there are exceptions to this practice in these words : “ Some women are prevent- ed from suckling by want of milk ; some by want of strength; some from a defi- ciency of the nipple, but too frequently it is the result of caprice, the fear of troub- le, the dread of spoiling the figure and from anxiety to avoid the confinement which it enforces; and in some, from the contrary desire of having many children.” These sentiments of Sir Astley Cooper have been the prevailing opinions of the profession, both in Europe and in this coun- try. Of course, a large latitude has been given to opinions on the subject. It is impossible to find out exactly to what ex- tent the ability in mothers exists at the present day to nurse ; then, the practice does not always correspond with the abil- ity, as some prefer to employ u wet nur- ses,” and others who might probably nurse, resort, for various reasons, to feeding bv hand or the use of the bottle. Besides, the course pursued in this matter, varies very much with different classes in the community, according to convenience, fashion and means. But there can be only one opinion among physicians and others, which is, the moth- er should nurse her offspring,—this is a natural law, and in a normal state of phys- iology, the interests of both the child and the mother demand it. The excuses for not observing this law are so many, and so obscure and complicated that it is very difficult to determine, when and how far they are justifiable. There are women 2 who, on account of weaknesses and dis- eases, should not attempt to nurse ; this physicians and all good judges will sanc- tion, but others decline, whoso excuses will not bear examination. The laws of maternity are here frequently trifled with and violated in a shocking manner. Nature in its normal state or highest development, has made ample provision, in the organization of woman for nursing her offspring. But, in order to provide this nourishment, pure in quality and abund- ant in quantity, she must have a well-bal- anced organization, especially a good de- velopment of the lymphatic and sanguine temperaments, together with vigorous and healthy digestive organs. The mammary and other glands should be neither too large nor too small. If there is a great predominance of the brain and the ner- vous system, and a constant strain is made upon these parts, thus requiring a large amount of nutrition, there will be a fail- ure in lactation. It has long been observed that there are great differences among women as to qualifications for nursing; some furnish an abundance of milk, some only a par- tial supply, while others furnish scarcely any. Why should there exist such differ- ences ? Why should not the primary causes be more thoroughly investigated? It is surprising how ignorant or indifferent the profession itself is on this subject. In confirmation of this statement we make a quotation from an address before a large body of physicians, by a Professor of Ob- stetrics and Diseases of Women in one of the oldest and largest medical schools in the country. Says this professor : u Why do American born females make such poor wet nurses compared with the immigrant from Ireland or Germany ? After nearly thirty years of practice, I cannot answer the question. That it is the fact, few practitioners in our cities and large towns doubt. Allow that some women with us, as with foreigners, object to being bound to their children’s call, yet the mass of American females are totally unable to act the wet-nurse with success.” This acknowledgement was made some years since, but similar statements and in- quiries have been made in our hearing by physicians who have had a largo obstetric business for many years, and were thor- oughly posted in other departments of medical practice. Instead of studying into the physiology of women, and in- quiring what there was in their organiza- tion that made these differences, atten- tion has been directed almost exclusively to the means of providing an artificial supply. The ingenuity of chemists and physicians has been taxed to the utmost to invent a substitute for breast-milk. Experi- ments have been tried over and over again upon this and that preparation. The manufacture and sale of “ Infant Food,” has become a great business. At first the milk of the cow was the chief de- pendence, but on account of the difficulty of obtaining this just when wanted, in qual- ity and quantity to suit, and because the demand rapidly increased, resort has been had to artificial preparations. These are now advertised and pushed into the mar- ket the same as quack medicines. Some of them have a great sale and large profits are made in the trade. Upon making inquiry, a retail druggist in our own city named over twenty-five different preparations of infant food, with which he was conversant, and as other localities might have different kinds, the whole number must be much larger. It was mentioned that this food cost some families near a hundred dollars to rear an infant. If the mother could nurse the in- fant, all this expense would bo saved, be- sides an immense amount of care and la- bor in preparing the food and taking care of bottles. Connected with this part of the discus- sion, it may be proper to say a word on the use of the bottle. Formerly different sizes and kinds of bottles were used, by simply attaching a nipple to the mouth. 3 again asked the question. Now, if this failure in nursing occurred only occasion- ally, here and there in a woman, as it for- merly did in New England, or as it now does among women of foreign nationality, it would not ho so strange, nor would it attract so much attention. But when the failure occurs in the great majority of mothers,—when only now and then one can fully nurse her offspring, what does it mean ? And when too, this failure is relatively increasing every year, what can he the cause ? And, what is to he the re- sult, if this change is to increase more and more ? A satisfactory answer or explanation to these questions is not easy. Sir Astley Cooper, in describing the growth or evolu- tion of the mammary gland from the four- teenth year of age to twenty, gives the caution that there should not be allowed any extended pressure or restraint which could prevent its natural growth, as a good development here constituted one of the most marked signs of womanhood. It would seem that this has been a prevail- ing sentiment among all classes of people, from the attempts to supply by artificial means, what nature has failed to accom- plish. From the writings of Sir Astley Cooper and of others, wherein they have attempt- ed to give reasons why women did not or should not nurse, it is generally accounted for by some malformation or positive weakness or disease. This, of course, would apply to exceptional cases which arc found only here and there. But when the failure is general—when it includes the great majority of women,—women who have good health and no organic disease,— what can be the cause f It is very evi- dent, the failure does not originate from a single cause, or from the agency of one individual, but the causes must be of a general character, applicable more or less to all. We here propose a theory or mode of explaining these anomalous facts, which is Some twenty-five years ago, a Mr. S. M. Burr, of Boston, got a patent upon a new style of bottle, imitating the form of the breast, with a small rubber pipe,—four or five inches long, and the nipple fastened to the end of this pipe. This was a great improvement upon the old practice, and the demand for these bottles increased to such an extent that from the best informa- tion we can obtain, the sales in the Boston market alone have amounted, in some years, to seventy-five thousand and up- wards. In reply to a letter for information, from Whitall, Tatum & Co., one of the lar- gest manufacturers of bottles in the United States, dated New York, June 24, 1885, they write, “ As a rough estimate we should consider that the number of nurs- ing bottles annually used in this country, would not fall short of ten thousand gross, and may greatly exceed that. The num- ber of bottles used would not, however, indicate accurately, the number of fami- lies using them, as some with care would use one, while others would have ten.” While we cannot ascertain the exact num- ber of families, or the relative proportion, who use nursing bottles, it is evident that the number is very large, and is every year increasing. Two facts should be borne in mind, that no such demand formerly exist- ed, and cannot be found at the present time among any other people or nation. The great change in this matter of nurs- ing, between the women of the present day and their mothers, and grand moth- ers, and then, the contrast in this respect, compared with the Irish, English, and German women, excite much curiosity and inquiry. The women of no race or nation in the history of the world, in such large numbers, as far as we can learn, have ever reached such an anomalous relation in re- spect to offspring. It is not at all surpris- ing that such a class of facts should call out many inquiries,—What does it mean ? llow can we account for it ? Nurses, and the mothers themselves have, again and 4 radical and fundamental. It is based upon a rational and sound physiology, we be- lieve, and harmonizes perfectly with all its laws. It is more than thirty years since this theory, combined with other issues, broke upon our mind, and no small amount of study and reflection has served only to confirm its truth. If the views we enter- tain upon this and kindred topics, should ultimately be proved true, language can- not express their value or importance. In order to understand this theory, cer- tain principles of physiology and the chan- ges to which they are subjected, must pass under a careful review. The function of lactation is a part of the organism upon which the great law of propagation is bas- ed. The Creator, we believe, has estab- lished in physiology a normal standard, based upon perfectionism of structure and function, which constitutes the ground- work of most important laws. The secret of this standard consists in the balance or harmony of all parts of the body. There must not be an extreme development, either excessive or deficient, in any one class of organs. Now, the nearer the body, in all its parts, approaches this standard in its structure and function, the greater the advantages it possesses for the production and support of children. If the brain and nerve tis- sue predominate altogether, over the mus- cular and lymphatic temperament, it is decidedly unfavorable to the family rela- tion. It should be borne in mind that the constant exercise of any part of the body, increases its size and strength. Then, by the law of inheritance, the organs that are relatively the largest, and have the most vitality, are transmitted in a similar and, perhaps, in an intensified form, so that the evil increases in each generation. Thus the organization of our New Eng- land women has, for two or three genera- tions, been passing through important changes. We do not find in them that largeness of size, that fullness of outline, that harmony of proportion and physical strength which existed in their mothers and grand-mothers. Our young women, as a general thing, have not been trained up to house-work or physical exercise of any kind, that develop and strengthen the muscles and give power of endurance. At the same time, the lymphatic and sanguine temperaments are not developed in propor- tion to the nervous. This disproportion operates unfavorably upon the maternal relations. This general failure in nursing cannot arise from local causes—from any difficul- ty with the nipple or breast alone. The evil is not confined to an individual, nor to any class of persons. The causes must be general and have become constitutional. There must be some changes in the phys- ical system of women which interfere with the maternal functions in this direction. No law in physiology is better established than that when particular parts or organs of the body are constantly exercised, they increase in size, strength and vitality, at the expense of other parts, from which nourishment is withdrawn. In this way, may not a class of organs, or one tempera- ment become altogether too active and predominant over others ? Is it not pos- sible that the development of the body may become, one-sided and fail, more or less, in discharging functions which na- ture intended? May not such changes apply more effectually to the organization of woman, as she is charged with extra or specific duties? Inasmuch as a portion of her organism is not indispensable for the support of her life, would not this part be likely to suffer first and most? If a careful survey was made of the anatomy and physiology of our women becoming mothers, what should we find? What, as to the nipple and mammary gland in their adaptation for nursing ? Besides, in order to furnish a sufficient supply of milk, there must be a good appetite and strong digestive organs, which are not common in such cases. But there is gen- erally found a marked predominance of the 5 nervous temperament, together with great sensitiveness throughout the whole system, which has always #been considered unfa- vorable for the production of milk. If all the physical qualities described in books as essential to a good wet-nurse, were brought into comparison with those of Yankee mothers, we shall find a great fail- ure in this respect. Let us compare the physical development of our women with those of the Irish, Scotch, English, and German women. What flat and narrow chests in the former, what a want of full- ness and plumpness of body, what small and weak muscles, what a failure in the accumulation of adipose tissue as well as in the development of the lymphatic sys- tem generally ! These qualities are close- ly identified with the laws of maternity. Perhaps, if a more general application of these laws be made, it will throw new light upon the subject. What is the de- sign and adaptation of v'oman’s organiza- tion with reference to family life ? The fact was established some years since, from a careful examination of over one hundred thousand oases in the Registration Reports of Scotland, that married women bearing children, live longer, on an average, and have better health than those who are child- less. In fact, all history proves that in the case of women, married life and the produc- tion of children tend to promote health and prolong life. This is necessary for the perfection of her organization and the highest development of her character. It accords, moreover, with physiological laws in a normal state. It should be borne in mind that these facts have been established only where these laws have been properly observed. Abundant illustrations of such facts may be found at the present day in Great Brit- ain, and once existed in New England. While physiology is the same that it ever was, we have good reason to believe that important changes have taken place in woman’s organization. If nature designed that woman should bear children, and nurse them too,—if her organization was what it ought to he, the process should agree with her constitution and health. Accord- ingly, among the Germans, English, Ir- ish, Scotch and Americans, we find women having a large number of children, who seem to improve in their organization, and good looks—certainly do not break down nor early grow old. Such examples are very common in the old country, and are not infrequent here with the foreign ele- ment. Such instances, too, were very common formerly in New England. But, what a change in this respect do we find in the present state of society ? Where do we find women from 30 to 40 years of age,—mothers of numerous chil- dren,—who have good health and the probabilities of its continuance to old age? Such an instance is certainly very rare. While, on the other hand, howr many wo- men in having two or three children, break down in their constitution and health ? How many in having only one ? And for some reason, many have none! Now, what is it that makes these differences ? There must be, somewhere, a cause for these differences. It cannot arise from race, nationality, climate, or any external circumstances, neither can it come from the will-power of the individual. The cause must originate, we believe, in difference or change in organization. In one class of cases physiological laws are favorable to certain results ; in the other class, theso laws are not so favorable, and there are greater difficulties in the way of their ob- servance. What, then, is the type or character of the organization most favorable ? There is in physiology, we believe, a normal standard, adapted to bring about the high- est and best results. The secret of this standard consists in harmony of parts, or a well-balanced organization. In other words, all the organs of the body should be so fully and evenly developed that each shall perform its own respective function without help or hindrance from the others. 6 The great law of human increase, we be- lieve, is based upon this type or standard, and, consequently, marked deviations from this type impair, more or less, the execu- tion of this law. Unfortunately, large numbers, if not a majority of our New England women, at the present day, are suffering by means of deviations from this standard. The variations from this normal stan- dard have their effect upon health in the pregnant state, in the changes and prepar- ations that nature makes for the confine- ment, and in its recuperative powers after- wards. No one thing is more noticeable than the great differences which mark the various stages of this process, as one wo- man after another passes through it. Admit that a great deal depends upon external agencies, upon care, nursing, etc.—but a powerful influence comes from the organi- zation itself. In some cases, the forces of nature all work in favor, but, in others they do not seem to aid or hold out so well. But the most important change of all in maternal relations is in the decline of the birth-rate. It is well-known that this, in New England, has fallen off surprisingly within fifty years. From registration re- ports and other sources, it can be safely sta- ted the birth-rate of our strictly American is not half as large as it was fifty or sixty years ago, and bears about the same proportion to that of the Irish, English, and German women. The birth-rate of France is the lowest of any European na- tion, but ours is lower than even the French—the lowest of any civilized peo- ple on the globe. Now, what does this low birth-rate mean, and how can it he explained ? It has been assumed by some writers that our American women are as fertile as the women of other nation- alities, and that what makes the great difference in birth-rate, and increase of children, are the “ arts of prevention and destruction.” Admitting there has been, and is still a great amount of this inhuman, unnatural practice, it cannot account for the whole difference. There are multi- tudes of married persons, we believe, who have never resorted to any such practices. If the sworn testimony of parties could be taken on the subject, it might show a very large majority clear of any such charge. This point is wrapt in such privacy—in such impenetrable secresy, that it is impos- sible to get at the real facts. But the question may very properly bo asked, why should there be such a desire or determination to prevent offspring ? If there was only now and then a woman disposed to do such a thing, it would not seem so strange, but when great numbers among all classes, do it, and some repeat- edly, without apparently any misgivings or compunctions of conscience, what does it mean ? How can we account for such a deliberate course of conduct—so unnat- ural and so inhuman ? The “love of offspring” constitutes one of the most important of the maternal re- lations. It is the noblest and purest of all the instincts or affections in woman. It was wisely designed that this “ love of offspring” should become a leading fea- ture in female character. Accordingly, we find among the women of all nations, this affection very predominant, and the more enlightened and Christian a people are, the purer and stronger should be this attachment. But what is unfortunate and strange, we find certain influences in soci- ety operating to stifle, to suppress, and crush out this natural affection ! It may be truly said this instinct is dying out in New England. This is manifest as shown in the indiffer- ence of mothers about nursing the child ; in the unwillingness to assume the respon- sibility of taking care of children as a mother; in creating a public sentiment that it is unpopular and unfashionable to have a large family. Connected with this sentiment is another creeping into popular favor among our young people,—that the bearing and rearing of children be- long to low life and is degrading ! Such 7 a sentiment is shocking, but there is good reason to believe that it prevails extensive- ly, and bids fair to increase more and more. 'I'he cause of this decline in the birth- rate in New England is a question of grave importance. It has been observed that the higher civilization reaches and the greater the cultivation of the mind, the birth-rate declines in a corresponding ra- tio. All history, it is said, establishes this fact. Now, why is this, and what is the reason ? Is it not because the mind is ex- ercised too much at the expense of the body ? There are, undoubtedly, other factors, but this must be the principal cause. Upon the same principle, let not only the brain but certain other parts of the body bo unduly exercised, thereby withdrawing nutrition from other parts, and we have a one-sided, abnormal devel- opment of the system. In this change from unequal exercise, supposing those parts that are particularly active in the functions of propagation should Become checked in their development, and weak- ened in strength and vitality, may we not have an organization similar to that which characterizes a large majority of New Eng- land women? If only here and there one was found thus organized, the effects would not be so perceptible in society, nor so se- rious in final results. These changes of organization must have great influence on the family. All the laws of maternity sustain, in some way, an intimate relation to this institution. What effect, then, will these changes have upon the family ? This question opens up a subject of vast importance. Wo can refer to only a few points. Divorces con- stitute the greatest foe of the family. What strengthens and cements the ties between husband and wife so much as children ? What makes home so attract- ive and binds together a family so closely as the living evidences of the parental re- lation ? It is a significant fact that in a vast majority of divorced cases, there are no children, or only one or two. It is very seldom that a divorce ever occurs where there is a large family. It will re- quire some changes, besides what legisla- tion can effect to prevent divorces. Another serious evil is, that a great predominance of the nervous temperament does not prove favorable to a good tem- per or kindly disposition, especially when things in a family do not move along pleas- antly or prosperously. Again ; with this ill-balanced, or one- sided organization, there are greater phys- ical weaknesses, more dependence upon domestic help and liabilities to illness and disease. By such means the interests of the family suffer in a variety of ways. Another point, and not the least in im- portance is, the effect these changes of organization have upon the sexual propen- sity itself. The questions here raised cannot be regarded as unimportant. The writer is fully sensible that, in this discussion he has entered upon new ground, and that his views are radical in their charac- ter. He has felt for a long time that there were grave evils growing out of the viola- tion of physiological laws, which threaten the best interests of society. It is the special duty of medical men to investigate these evils, and do all in their power to correct them. In this paper inquiries and sugges- tions have been the leading features, and not pronounced opinions or attempts to settle great principles. Neither the profession nor the public are prepared to entertain definite views on the subject. There must be first, investi- gation, discussion, and criticism. No one realizes more fully than the writer what immense difficulties surround these ques- tions. Before they are fully settled, gen- erations may come and go. But what- ever changes may occur in physical organ- ization, and however men shall differ in their opinions, the great laws of physiolo- gy, which God has established for the government and highest welfare of his creatures, will remain unchanged.