EXAMINATION OF THE BREASTS After a consideration of the general status we should proceed to make a special examination of the breast and the milk. A microscopical and chemical examination of the latter need not be undertaken, since it neither gives important results nor appears to show, especially in a practical way, the significant peculiarities in the composition of the milk. At the most, the presence of the colostrum corpuscles would show that the breast was engorged.
The only real object of the examination is to get an idea. of the functional capacity of the glands. But just as it is difficult in a single examination to reach a satisfactory conclusion hi regard to the general physical fitness of the wet-nurse, and this indeed forms the foundation of one's decision, so is it absolutely impossible to determine the quality of the milk. Neither the form nor the size of the breast is decisive. It is customary to consider the conical breast more productive than the spherical; but this rule has a great many exceptions. Nor can the size of the breast influence one's judgment. The accumulation of subcu taneous fat around the central mass of fibrous connective tissue may he the chief cause of the greater dimension of the organ, and palpation is of little avail, because though one may feel the lobular gland tissue he cannot know how thick the stratum is. As a matter of fact, those breasts which contain a rich parenchyma. will be less resistant than will those which have considerable connective tissue. In this connec tion it is well to remember that the nurse to be examined, in order to deceive, may not put the child to the breast for a long time, so that the full breast, will be larger and firmer than normal. The ability to produce a stream of milk soon after the child has nursed, which has so often been pointed out as significant, means very little.
In short, external examination, palpation, and efforts to produce a flow of milk are not sufficient to prove the productiveness of the breast, even when examined by an expert. The only suitable method is by
weighing a child, preferably that of the nurse, both before and after it has been nursed. If this is done with suitable scales, for a sufficient time (at least a day), it forms an absolute objective proof of the func tional activity of the breast and the amount of milk produced, without possibility of error.
In order to avoid overlooking a single factor, it is best in examining a wct-nurse lo follow a certain scheme, something like the following: me entire Ludy must he exposed, 1. AD:1111/1( W110/1 Mati OW child horn; how many other children; iniscar riagt s (syphilis); anerstry (tuberculosis).
II. Examination of the whole body. Vermin (hair of head and pubes); skin, chest, and abdominal organs.
III. Infectious Diseases; namely: Syphilis.—Phary /Ix: Perforations, scars, angina specifica. Ncek: Leuko derma• liattacks: Exanthernaut. :taus acnital.s: Papules (con dylomata lam). Lym phatic glands: Cervical, Cuhital, Gonorrhu2a.—Examination for gonococci from cervix and urethra. Tuberculosis.— ScaN front childhood. Cervical glands. Articular sur faces of hones. .Auscultat ion of apices of lungs. Tuberculin reaction.
IV. Examinat 'on of breasts: Nipplrs.
Qua at uy of milk.—(a) Estimation according to form, palpation, and pro duct ion of a flow of milk (possibility of engorgement to be consid ered). (b) Accurate proof of function by nursing.
V. Examination of children of wet-nurse (beware of deception): Condition of nourishment.
Syphilis.
An indirect conclusion may be drawn as to the suitability of the wet-nurse by the appearance of her child. -If it is well nourished, with a weight and development normal for its age, it is proper to assume that the foster-child will find sufficient nourishment. It is nevertheless well to remember, in all conclusions which are based upon the condition of the nurse's child, that a strange child may be shown, a deception which is frequently encountered. We must therefore not depend too much upon impressions obtained in this way.