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The chief purpose of this department is to supply information to the
clinic medical officers about cases where the success of breast-feeding is
in doubt, and to try to obtain improvement when it is found defective.
The patients dealt with are only a fraction of those requiring help,
and we get the impression that successful breast-feeding is less common
than it used to be. A large proportion of young mothers who might be
expected to nurse their babies with ease, require to supplement the feeds
with artificial milk after a few weeks. Although improvement is obtained
quite often, much of this work is disappointing. When lessons in the
management of nursing are all that is needed, or when some minor defect
in the baby's health or behaviour exists, a few days' attendance corrects
matters. More often the failure is already complete, or too far advanced
to be overcome, for there is no reliable means known of restoring the
yield of milk once it has declined for more than a short time. Yet there
is often a history of a satisfactory start, and a little more care devoted to
teaching the mothers those points on which success depends and to
a warning where the dangers of failure lie, would seem to have been all
that was needed. By the time the woman is anxious for advice, because
she is aware the baby is not thriving, lactation has often declined beyond
the point where we can effect any material improvement with the means
.at our disposal. We have then to be content with prescribing suitable
supplementary or bottle feeds and showing how they should be prepared.
It is particularly striking how many referred to this department are
women whose report from a lying-in ward stated that breast-feeding was
proceeding satisfactorily on their discharge from hospital. The women
themselves were also under the impression that lactation was well established.
Yet within a week or two the feeding is all to pieces. It would
seem, therefore, that 10 or 14 days after delivery is too early to warrant
a forecast of success, especially when the time has been spent in the
restful circumstances which an institution provides. Our work would