Observations on Human Lactation

Table of contents :
Title Page
Copyright
Declaration
Table of Contents
Acknowledgements
Preface
I: The Collection of Milk Samples
II: Physiological Variations in the Composition of Milk
III: Individual Differences in the Yield and Composition of Milk
The Extent of the Variation
The Variation in the Functional Capacity of the Breast
The Relationship of the Age, Physique and Nutritional Status of the Mother to the Yield and Composition of Her Milk
The Effect of Differences in the Yield and Composition of Milk on the Infant's Weight Gain and the Duration of Breast Feeding
Appendices
Appendix I
Appendix II
References

Citation preview

Cl3S1!2VJ.flCIW

H1IUN

6 e.m. a .m . 6.67 6 .6 7 6.23 6 .2 3 5 .7 2 5.72

6.12 6 .1 2 6 .1 2 6.12 6.45 6 .4 5 5.,48 5 .4 8 4 .8 0 4-~ 6 .3 7 6.Yl 6 .7 1 6.71 6 .7 1 6.71 6.44 6 .4 4 5 .9 6 5.96 6 .1 6 6.16 6 .4 6 6.1.h 6.57 6 .5 7 6 .6 4 6.64 6 .6 8 6.68

a .ra . 10 e.m.

6.53 6 .5 3 6 .1 6 6.16 6 .0 9 6.09 66.17 .1 7 6.19 6 .1 9 6 .0 2 6.02 5 .9 6 5.96

4.64 4 .6 4

6 .1 8 6.18 6.~5 6 .8 5 6.44 6 .4 4 6 .3 0 6.30 5.41 5 .4 1 6 .3 7 6.'J"I 6.67 6 .6 7 6.54 6 .5 4 6.)0 6 .3 0 6.33 6 .3 3 6.33 6 .3 3 6.37 6 .3 7 66.Y/ .3 7 6.Y/ 6 .3 7 6 .6 8 6.68

o.n 6.85 6 .8 5

-29-2 9I X .A . TABLE IX.A.

Case. C ase.

28 42 172 27 4.3 43 172 34 172 3.3 33 37 '3'1 40 41 172 39 172 38

7 7 8

.35 35

21

151 163 115 74

40 47 48 1$ 49 50

139 75

50 135

102

-

Mean

379 266

368

316 295 405 281 ~l 327 '216 276 256

402 281 ~l 319 265 250

-pt:} 309 372 m 35.3 353 281 481 "81 294 257 717 277 316 .316 360 ~ 284 ~ 34.3 343 267 245

3 39.7 3'J9.7

.336.5 3 36.5

3 2 8 .0 328.0

3 2 6 .6 326.6

3].6.7 3 1 6 .7

268 26e 231

254 221

275

270 -no

Zl.J 213

203 203 216

214

266 225 218 214 190

)60 360 288 28~ 483 I.P3 4'.35 435 .35.3 353 )01 301 525 295 255 294 2~ 286 388 ~ 287 336 290 260

Mean !Mu

138 lJe

-y}') 392 '271 277 420 Jt2J 441 361 287 m 497 2(),3 293 260 '2flJ 308 ~ 305 414 2S4 284 312 m 273 260 2&J

.33

6 6 6

50

p.m . 10 p.m.

66 p.m. p .m .

a .m . 6 a.m.

.33 4 4 4 5 5 6 6

HITROGEH g/lOO mlm l. NITROGD - M M&llOO

2 p.m p.m..

Day. 3

TOTAL

209 182 194

a .m . 10 a.m.

363

398 39A

364 314 470 301 238 2.38

207 m

218 Zl.8 207 '20'1

181 l"'l 2()0 200 147

lSJ 183 192 195 U1 141

178 ?06 206 195 144

2 0 2.8 202.a

2 0 0 .8 200.8

2O4 .8 204.8

~3 283 321 .321 378 3'm 367 '367

:?90 290 575

265 253 288 ~

321 m.

.355 355 274

2?.3 2^3

21.3 213 200

147

1A6 186 1~ 189 178 19.3 193 HI 141

202 2 0 2 •.3.3

1 9 9 .2 199.2

1?9 179 19.3 193 189 ~

-3 0 -30TABLE IX .B .

NON PROTEIN NOB PRO'l'EIN

NITROGEN Mp /IO O ml. m l. NrrROGEJI - Mg/100

Caae.

Day-. D ay.

6 a..m. a .in .

a .m . 10 a.m.

28

3 3 4 4 5 5 6 6 6 6 7 77 8

74 74 48 J.s 81 68 &1 61 6.3 63 63 69 91 54 80 60 65

68 50 60 68 61 60 55 73 83 63 65 57 52

75 49

67.5 6 7 ,5

662.7 2 .7

69 47

68 ~

42 43 172 34 172

" 40 41

172 39 172 38

35 35

138 151

16.3 115 74

102

139 75

!tu

21 37 Y7

40 47

48

49 50 50 5Q 13'5 135

2 p.m. p .m .

64

65

62 57

65

72 67 80 55 71 71 84 84

73 70

71

78 7S

70 70 69 54 65 65 70

667.7 7 .7

65.8 6 5 .8

64.5 64

62 54

63

JJ', 48 55 45

40

55.9 55 .9

55.l 55

45 39 'J9 41 a

62

32

54.5 5 4 .5

53.5 53 .5

55~.3 8 .3

60

74

63 63

72 7'50 52 81 63 6?. 62 60 56 48 39 'J9

55 59

62 53

10 10 1];,.a.

52 71 52 62

(x, 66

4.3 43 59 62 52 42 62 5.3 53

60 70

6 p.m. p jn

69 68 6S

63 65

60 68 6S

52 53 62

44 52

76 5.3 53 62 6?

65 34 62

- 31-

200

II)

~ IS 1..J ..J ..J

•••..•

~

.......,_ _ _ _ _ _ _ _ _ _ _ I

···•·•·•....

I 100

0 ..J

"'>-

········... ···········

············ ... ······

.····· ....·····

········ ............. n

’•••n

MI LK

~

...I

~

so 50-

n

6 A.M. A. M.

FIGURE

IV : IVs

i

10 IO

i

P.M. 22 P . M. FEEDING FEEDING

i------------------- 1— 6

Mean dil.ll'Dal the milk. d iu r n a l vvariaticn a r i a t i o n in i n th e yyield i e l d of of m ilk .

Curve milk the Ourve I rrepresents e p r e s e n ts m ilk fran from th e 221st 1 s t dday ay of of

lactation milk. l a c t a t i o n or o r later, l a t e r , and Oarve II I I eBrlier e a rlie r m ilk .

IO 10

-3 2 -32-

5

4

_j

:l:

ol Q

~

C,

FAT:

i:..:

..... •·

...... .. ~··

......... ······ ................. ......

I

························· n

_..,··

2 ~ 2-

II--

~6I A,M. 6 A.M.

I------------------- 1------------------- 1------------------r-

10 IO

. M. 22 PP.M.

66

IO 10

FEEDING FEEDING

FIGURE Vs V:

milk. Mean dm:rnal. d iu r n a l vvariaticn a r i a t i o n iin n tthe h e ffat a t cc>

/ 600 600 --

•

400 400

> >< Cl Q I I ~-

-,/

•

✓

_J

,--h-* Is

/

0

~

~

•

/

/ 200 2 0 0 --

•

.

PRIMIGRAIIIDAE P R I M I G R A V I D A E ••

/ .

MULTIGRAIIIDAE M U L T I G R AVI DAE

o0 BREAST BREAST

XVII!? FIGURE XVII

• /

100 IOO

3 00 300

200

ENLARGEMENT ENLARGEMENT

IN

400 400

PREGNANCY PREGNANCY

500 500 ({ML.) ML . )

The rrelat.ianfilip e l a t i o n s h i p ooff m ilk yyie1d i e l d on e 77th th milk an th the

pos~pirtm p o s t- p a r t u n day d ay tto o tthe h e enlargement e n la rg e m e n t of o f th e the breest 'Which b re a st w hich ooccurred c c u rre d dduring u rin g ppregnancy. re g n a n c y .

!be The rregression e g r e s s io n lline i n e ffor o r pprimipirae rim ip a ra e iia s su p erim p o sed . auperimpoSMl.

0 O

--9292-

D;legµss1m ~ SLasuaaloB. Although an um.doubted A lth o u g h tthere h e r e Iis s an n d o u b ted ccorrelation o r r e l a t i o n bbetween etw een th e ssiN i z e ooff the

milk tthe h e llactating a c t a t i n g bbreast r e a s t and iits ts m ilk pproduction ro d u c tio n 1n i n hhospital, o s p i t a l , th e sscatter c a tte r the vide iis s w ide and tthe h e ppredictive r e d i c t i v e 11Blue v a lu e ffor o r an in d i v i d u a l breast b r e a s t iis s oobviou.acyb v io u s ly individual low. lo w.

Figure F ig u re XVI ddoes o es ssuggest, u g g e s t, how ever, t'that h a t tthe h e ssmallest n a l l e s t bbreeats re a s ts hoW9Ver,

or

have a coelling have e i l i n g o f pperf'omance erfo rm an ce on th e 77th th dday. ay. the the IIn n vview iew oof'f th e ddifferences iffe re n c e s w hich m ust ooccur c c u r bbetlo'9en etw een ssubj u b je c ts 1n in \lhich must ecta th e aactual c t u a l shape e cchest hest w a l l , tthe h e rresults e s u l t s oof'f m easurem ent oot f the shape ootf th the wall, measurement

mt

breaBt b r e a s t ssize i z e aare r e nnot o t satr:1.ctly' t r i c t l y co m p arab le, b u t th e e91T0r r r o r in v o lv e d iia s canpersbl.e, the involved pprobably ro b a b ly sllght s l i g h t 1n i n rrelation e l a t i o n tto o tthe h e llarge a r g e ra n g e ootf vvalues a lu e s ffor o r breast b re a st range saim. iz e .

Again, A gain, tthe he m ilk oao.t.pat u tp u t an n y ggivan iv e n dday ay iia s nnot o t nnecessarily e c e s s a rily milk cm aany

the eequivalent q u iv a le n t tto o th e bbreast's r e a s t ’ s ppotential o t e n t i a l yyield, i e l d , ssince in c e iit t may hhave av e a

cconsiderable o n s id e r a b le rreAerve e s e r v e which iit t ddoes o es nnot o t em:hibit x h i b i t 1n i n th e aabeE111ce b se n c e o~f the

demand. an aappropriate p p r o p r ia te dem and.

An aartificial r t i f i c i a l demand, such s tthe h e sstrippi!Jg trip p in g aich aas

ootf bbreAsts r e a s t s bby y m anual eexpressicn, x p r e s s io n , may oorr may o t pprovide ro v id e tthi■, h i s , aalthough lth o u g h manual ma.v nnot

Waller W a lle r (1950) cclaimed la im e d tthat h a t tthe h e bbreast r e a s t ccould o u ld bbe e bbrought ro u g h t tto o maximum max1mm pproductivity r o d u c t i v i t y dduring u rin g tthe h e f.f'irst i r s t week a c t a t i o n t'bJ" y tthi h i s■ m eans. veek ootf llactatim mean.a.

Hov91191' Sydow Sydov (1952) hbas However a s shown a dclose o s e caorrelatim o r r e l a t i o n betw een th e m ilk 'bet\Man the milk

m tthe 6th ooutput u tp u t an h e 6t h dday ay and e su b se q u e n t ssuccess u c c e s s ootf llactatiai, a c t a t i o n , so end th tha subsequent ao milk tthat hat m ilk ooutput u tp u t 1n i n hhospital o s p i t a l ccan an bbe e aaccepted c c e p te d ss a s ooff aatt lleast e a s t some SCl!llt the vvalue a lu e 1n i n iindicating n d i c a t i n g th e ttrue r u e ccapBcity a p a c ity ooff th e bbreast. re a s t. the IIt t iis s ddi.tf'icult i f f i c u l t tto o iinterpret n t e r p r e t th e slltrlking t r i k i n g rralationahip e l a t i o n s h i p betw een the between

feeding Luealcy''s bbreast r e a s t ssize iz e and bbreast r e a s t fe e d in g 1n i n Lus s k y 's sseries, e r i e s , saiuce in c e oonq n ly hhBlf a lf

-93-9 3 -

those ootf tthe h e bbest e s t ggroup, ro u p , th ose w ith "large" " la r g e " bbreasts, r e a s t s , llett e f t hhospital o s p i t a l blreaet re a st 'With the ffeeding, e e d in g , in i n ccontrast o n t r a s t tto o th e ooverall v e r a l l hhospital o s p i t a l bbreast r e a s t fe e d in g rrate a t e iin n feeding tthis h i s ccomtry o u n try of o f betwAell betw een SO $0 and 90 ppar e r cent. c e n t.

of' Health, of H e a lth , 1951). 1951) •

(Report the Ministry (R e p o rt of o f th e M in is tr y

It I t is i s uunlikely n l i k e l y tthat h a t lree.st b r e a s t size s i z e was e ally, c n ly , 'Wall th the

evan th the mejor oorr even e m a jo r ffactor a c t o r in v o lv e d . involved. must Two aaspoote s p e c t s oorf bbrooet r e a s t sBise iz e m ust be b e kapt k e p t iin n mind* minds

one iis s tthe he

milk mid th the the aability b i l i t y tto o pproduce ro d u ce m ilk and e oother t h e r th e aabillty b i l i t y tto o sstore t o r e iit. t.

The 'lbe

mall W'ill sm a l l bbreeet re a st w i l l suffer s u f f e r a ddouble o u b le ddisability, i s a b i l i t y , an d below e rta in and belov a ccertain

ei ty may become becane critical. s i zze, e , tthis h i s lack la c k of o f storage s to ra g e ca:p1ci c a p a c ity c ritic a l.

an Such 1!111

\IRS d demonstrated eeffect f f e c t was e m o n stra te d dduring u rin g tthe h e ddiscussicn is c u s s io n oof'f ddiurnal i u r n a l vvar.iatton; a ria tio n ;

mmiber 74., 74, w vith ssnbject u b je c t number ith aa bbreast r e a s t ssize i z e oof'f oonly n ly 530 m l. pproduced ro d u ced aabout bout 5)0 ml. 120 ml. milk ee.ch fe m l. oof'f m ilk aatt each e d in g * feoding1,

tthat h a t iis, s , th e am ount ooff m ilk iin n tthe he the amount milk

breast b r e a s t at a t ssay a y 2 p.m., p .m ., &ftar a f t e r ftour o u r hhours o u rs secreticn, s e c r e tio n , was 120 ml. m l. and we 120 end

at at 6 6 a.m., a .m ., a.f'tar a f t e r eight e ig h t hhours o u rs secreticn, s e c r e t i o n , th e amount was no m ore, the more, clearly c l e a r l y indicating i n d i c a t i n g an a n uupper p p e r limit l i m i t tto o stare.ge s to r a g e capicity. c a p a c ity . ~ne The ra g e ootf bbreast r e a s t ccape.city a p a c ity may, in i n ppa.rt, a r t , emcplain x p la in th e ggradual ra d u a l the feeding vhich ffalling a l l i n g oof'f' f f 1n i n bbreast r e a s t fe e d in g w hich ooccurs c c u rs dduring u rin g tthe h e ccourea o u rs e ootf th e the

f'irst tvo m months, f i r s t two onths, since s in c e llactation a c ta tio n w i l l become utmsatie.factory n s a t i s f a c t o r y when will \lhen an en outgroYll the iinfent n f a n t hhas a s outgrow n th e suppq su p p ly w hich th e breast b r e a s t can secrete s e c r e t e or o r store. s to re . \l'bich the

'll:le The degree d e g re e of o f bbreast r e a s t anlargmient e n la rg e m e n t occurring o c c u r rin g during d u rin g ppregnsney-, re g n a n cy , v\hh ich ic h iis s pprobably ro b a b ly due tto o changes n th e ff'unctional u n c tio n a l ttieeu.e i s s u e aalme, lo n e , would ohanP"ee iin the woald bbe e eexpected x p e c te d tto o 11hov show a hhigh ig h ccorrel.aticn o rre la tio n w ith llactaticn a c t a t i o n pperfornmoe, e rfo rm an c e, 'With

must the aalthough lth o u g h iit t m ust be b e stressed s t r e s s e d aagain g a in tthat h a t th e rrell'lllti, e s u l t s from ham so ao few

-94-9 4-

can oonly tentative. ssubjects u b j e c t s can n ly bbe e te n ta tiv e *

fl)ita ti t a ffar o r in c r e a s e 1n i n ssize i z e aare r e ooff increese

cCCl!lparative o m p a ra tiv e vvalue a lu e oonly', n ly , and 1n i n no se n s e aabsolute b s o lu t e m easurem ents ooff th e sense measurements the ggland la n d iit1!18lt; ts e lf;

inarease must much ootf tthe h e in c re a se m ust bbe e due to t h e r ch an g es, to oother changes,

such aaas in increased these such c r e a s e d vvascularity, a s c u l a r i t y , bJt b u t th e s e aare r e llikely i k e l y tto o ppuallel a ra lle l

the grovth thee gglandular cclose~ l o s e l y th e grow th ooff th la n d u la r ttis9118. is s u e . measu.remmt The m easurem ent ooff th e eanlargemm1t n la rg e m e n t ooff th e bbreast r e a s t dduring u rin g tthe he the the 'Whole w hole ccourse o u rs e ooff ppregnancy reg n an cy iis, s , i1n n ppractice, r a c t i c e , eextremely x tre m e ly ddiffiaul.t, iffic u lt, ss:lnoe in c e women aare r e nnot o t uusually s u a l l y seen n t i l th e tthird h ird m onth, bby y w hich sem umtil the month, which time 900l8 e tim e some n la rg e m e n t ooff th e bbreast r e a s t hhas a s aalready lr e a d y ooccurred.J c c u r re d ; 9nlargemmt the

iin n ffact, a c t,

it i t iis s uusaally s u a l l y cclaimed la im e d tthat h a t th e m ost rrapid a p id eanl.argemmt n la rg e m e n t ooccurs c c u rs dduring u rin g the most the th e ftlret i r s t tthree h r e e oorr ftt:Mr our m o n th s. IIKmtha.

The amount ooff eanlargsment n la rg e m e n t w hich i1s■ vhich

missed, hOW9Ver, should to tthe m is s e d , how ever, sh o u ld bbe e pproportional r o p o r tio n a l to h e ttotal o t a l blraast r e a s t eenlarg&n la r g e ­

sment, the m e n t , pprovided ro v id e d tthat h a t th e m easurem ents aare r e made aatt aapproximately' p p ro x im a te ly th e mea911ramenta tha same sstage ta g e ooff ppregnana,y, re g n a n cy , so h a t ffor o r a cCKl!lp8rat1ve o m p arativ e sstmy tu d y 1t i t iia s ao tthat pprobab]Jr ro b a b ly no sseri0t1s e r io u s ddisadvantage is a d v a n ta g e tto o have m isse d th e ffirst i r s t two o n th s. misl!l8d the ~ m mantha. A llarge a r g e sBCale c a le iinveatir n v e s t i g aatian t i o n ooff m easurem ents dduring u rin g th e eentire n tire mAB8Urementa the

will be rrequired ppregnancy re g n a n cy w i l l be e q u ir e d tto o eestablish s t a b l i s h tthe h e pprecise r e c i s e ppattem a t t e r n ooff ee.,largemmt. n la rg e m e n t.

The s~gestim u g g e s tio n tthat h a t th e m ost rrapid a p i d eenl.argment n la rg e m e n t ooccurs c c u rs the most

the aatt th e bbeg1nning e g in n in g ooff ppregnancy reg n an cy iis s pprobably ro b a b ly ffallacious a l l a c i o u s ssince in c e iit t iia s bbased a se d on ssubjective u b je c tiv e im p re s s io n s ooff ddisc