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Syphilis and Infant Feeding

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SYPHILIS AND INFANT FEEDING It may be stated, first of all, that artificial feeding of congenitally syphilitic infants born at full term is attended by only slightly greater risk than in those that. are free from this disease. In general, in order to avoid transmission to the person who nurses it, the infant should be artificially fed. Most authors, in deference to Colles' law, permit the mother who is free from syphilis to nurse her diseased child. The num ber of exceptions to this law have become so great, that Ogilvie, Finger, and myself, hold the view that infants with infectious lesions should not be permitted, off hand, to nurse their mothers. Since 75 per cent. of the exceptions to Colles' law were printiparce, I might maintain that the latter should never be exposed to the danger of infection which nursing carries with it; on the other hand, I have greater faith in Colles' immunity in the case of multiparie and permit these to nurse their syphilitic babies.

What shall be done in the case of an actively syphilitic woman who gives birth to a healthy baby? Profeta's law claims immunity against specific infection for the offspring of a syphilitic woman, and Ehrlich's investigations show that the congenital immunity of the offspring of highly immunized animals, i.e., mothers, is heightened by suckling the mother. The healthy child of a syphilitic mother has therefore only a very slight chance of becoming specifically infected during the first few months of life, even if it is nursed by its mother. A child that appears healthy at birth may therefore be permitted to nurse the syphilitic mother. The mother must be treated with mercury, and the greatest care must he exercised, as, for example, by permitting no caressing, so that the chances of transmission of the disease to the child will be reduced to a minimum.

The question will arise whether a child with syphilitic heredity shall be allowed to have a wet-nurse. The question may be considered under two conditions: (1) What shall be done if the child has symp toms of syphilis? (2) What shall be done in the case of infants that are born healthy, but have syphilitic parents? In the former case the employment of a wet-nurse must be for bidden, even if after being fully informed of the nature of the disease and its contagiousness she is willing to nurse the baby. One would have to consider here not only the infection of the nurse, but also the possibility of a further spreading of the disease through her. The only condition under which it would be permissible to give the breast to a manifestly syphilitic newborn child would be that of producing a wet nurse who had recently had syphilis.

In the second case, one can put a healthy newborn babe of a form erly syphilitic father to the breast of a wet-nurse without fear of con tagion, but the child should be most carefully watched so that it can be taken from the breast at once and treated with mercury if it shows the first symptoms suspicious of the disease.

If unfortunately a wet-nurse becomes infected with syphilis from the child she is nursing, it is the duty of the family to have her undergo antisyphilitic treatment at once, and to safeguard others by preventing her from mingling freely with the outer world. She must either be kept isolated and treated in the household in which she became infected, in which case she may continue to nurse the child that infected her; or she must be treated in an institution and the child must be fed artificially. The former course is to be preferred.

It is self-evident that one must be mindful of the possibility of others in the household being infected by the syphilitic child, and appropriate prophylactic measures must be taken. The view that has been expressed many times that congenital syphilis is less contagious than the acquired form is erroneous.

The possibility of infection of a healthy child through a wet-nurse who is syphilitic, either through previously acquired disease or through disease acquired in some manner during the nursing period, must still be considered. It is always a peculiarly embarrassing situation for the physician to find symptoms of syphilis in a wet-nurse employed for a child under his care. The nurse will always maintain that she was infected by the child, and this question must be settled first. From an examination of the child, or still more from the preceding observation of the child, it is usually not difficult to decide whether the child is syphilitic. The location and nature of the syphilitic manifestations in the nurse will, evidently, give valuable information as to whether the child was the source of her infection. One would be slow to accept the probability of transmission from the infant to the nurse, unless the latter had a chancre on the breast. The physician who examined the nurse before she was employed is very apt to be blamed for carelessness in his examination, although she may have been at that time in the first period of incubation, or in the latent period of a previously contracted disease, both of which conditions, of course, giving rise to no recogniz able signs of the disease. In any event the nurse must be dismissed at once. If the child has not yet become infected, it will probably remain free from syphilis unless it is already in the incubation period. If it is infected or is in the period of incubation, then the removal of the nurse, who ought to be given thorough antisyphilitic treatment, will, at least, lower by one the number of carriers of infection in that particular fam ily. The child taken from the breast of a syphilitic woman must under no circumstances be given to another woman to nurse, hut must be fed artificially. If the child should not thrive on artificial feeding after a number of weeks, and still remains free from syphilis, then another nurse may be employed.

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