Observations on Human Lactation

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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