CHOICE OF A WET-NURSE The choice of a wet-nurse by a physician is a difficult and responsi ble task, which unfortunately is underestimated. Numerous condi tions are to be considered, in order to do what is proper from both an ethical and a hygienic point of view. The greatest care must be taken in this investigation, because many important things (e.g., syphilis) are often difficult to discover, as it is impossible to depend upon the statements of either the wet-nurse or the person who recommends her. Neither tells the truth; both have an interest in hiding many defects and bringing into prominence the desirable qualities, the one in order to secure her commission, the other to make sure of employment.
The following rules should be rigidly followed : (1) The whole uncovered body must be examined. (21 An examination of the child of the wet-nurse must be insisted upon. In relation to this point one must always be especially careful that some other child is not substituted.
Make sure that the nurse is free from vermin. Their presence need not discourage one, providing the nurse is otherwise acceptable, espe cially since good wet-nurses are very difficult to secure, but one should use antiparasitics systematically and energetically. Nor should we allow ourselves to be prejudiced by superficial blemishes (defective teeth, emaciation).
After settling these less important points our attention should be directed to a careful examination of the body, in order to determine whether the nurse answers to the two requirements which need not necessarily be demanded of the mother but \villa must be absolutely insisted upon in the nurse: (1) She must be strong and well and free from all contagious diseases. (2) She must possess a sufficient supply of milk.
In relation to the above points T might state, by way of illustration. that a mother suffering from epilepsy can often nourish her child, while the disease in a wet-nurse would be an absolute contraindication. Im portant distinctions exist in relation to syphilis, which will be noted on.
After a general idea of the physical condition of the wet-nurse who applies has been secured, attention should be directed above all else to the uncertain symptoms of tuberculosis, syphilis, and gonorrhea. These three infeettus diseases are so wide spread that they are of very great importance in the examination of the nurse, since the child is especially susceptible to inoculation by the virus of these diseases.
Tuberculosis.— Frequently the previous history will give us a sufficient clue. Beyond this, one should examine for scars at the usual sites of tuberculosis in children, the region of the glands of the neck and about the joints. It is hardly necessary to call attention to the im
portance of the auscultation of the apices of the lungs. Lighter grades of tuberculosis, which are not apparent may be detected by the tuberculin reaction. Injections should be 'node every other day, if no reaction occurs, of one to five milligrams. The temperatut c should be taken every two hours. The reaction is positive if the temperature reaches 0.5° C. (0.9° F.) higher than the maximal temperature of the previous day.
If one were to exclude front such duties all women who show this reaction it would mean that about a third would have to be declared useless. It is not necessary, however, to be so rigorous, as inactive encapsulated colonies give a reaction, even though there is no danger of infection. It is only necessary to exclude those wet-nurses who give clinical evidences (crepitation at the apex) at the time of the elevation of the temperature.
Syphilis. — In regard to the special signs of syphilis, it may be necessary to consult the special text books on syphilology. Here we can only notice especially important points. Above all, the child of the wet-nurse should be examined, for it often shows characteristic lesions even when the mother has none or at most only suspicious symp toms. The pharynx of the applicant should be examined for perfora tions and scars of gummatous processes, papules in the mucous mem brane of the mouth, and specific tonsillitis, which shows itself as a sharply defined redness. On the neck we find the lencoderma of syphilis: on the buttocks an extensive exanthem. The anal and genital regions should be examined for condylomata Iota. Lastly, the lymph-glands are ex amined. Multiple indolent swellings, especially of the inguinal, cubital, and cervical glands, are always suggestive. A verified suspicion of syphilis renders a woman unfit as a wet-nurse.
As little as one desires to have a syphilitic wet-nurse for a healthy child, it is just as undesirable to give a syphilitic child to a healthy nurse, and it should be considered a crime to make such an arrangement know ingly, Allusion to these conditions unfortunately appears not to be superfluous, since primary lesions of the nipples in wet-nurses are not UnCOM111011.
Gonorrluea is only satisfactorily diagnosed by the presence of the gonococcus. The secretion from the cervix, as well as that of the urethra, must he carefully examined. A single examination often leads to a mistaken diagnosis.
Because of the great importance of syphilis and of gonorrhrea, and of the difficulties of diagnosis, especially of the former, consultation with a dermatologist should be considered.