Technique of Nursing. —The first preparations for nursing should be made early in pregnancy. Since good nipples are a condition sine qua non for successful nursing, the care of the nipples should begin in the last weeks of pregnancy. _Moreover, since only the prominent nipples arc the most desirable (Plate 1), we endeavor to improve all flat or depressed nipples by systematic suction or manipulation; with depressed nipples our efforts are most liable to be unsuccessful, however. If the skin of the nipple is very tender the condition may be bettered by cold sponging, or by the application of tannin-alcohol (see recipe in the section on Diseases of the Breast, below).
The greatest technical difficulties are to be overcome in the first clays after birth. At this time the application of the child to the breast is especially trouble some, not only because the mother is inexperi enced, but also because it. is necessary for her to remain in the un comfortable dorsal po sition on account of the pelvic organs. She must give the breast to the child lying down, while she turns a little to one side with some assistance. Later she nurses the child in a sitting posture, and to best advantage on a low seat, so that the hand that holds the head of the child rests upon the elevated knee. The other hand seizes the breast in supina lion, so that the thumb rests upon the upper surface. The thumb is then able to keep the breast far enough away from the face so that the child's nose is left. free for breathing. Only in this way is it pos sible to secure undisturbed nursing.
When lactation is completely developed it is only necessary to see that the breast is completely emptied and that no stasis occurs. In this connection, the mother should be warned not to nurse the child at ran dom from either breast, so that it takes a little from each but does not empty either completely. Where there is a moderate amount of milk which is sufficient for the nourishment of the child, and this is usually the normal condition, it is especially advisable to allow the child to nurse as a rule at only one breast. Only in the first weeks, when lacta tion is not yet at its height, would an exception he made to this. If in spite of this it happens that there is an engorgement of the breasts, due to the fact that the child does not drink as much as usual on account of some slight disturbance of the digestive tract, the breasts must he emptied artificially. The most comfortable of doing this is to put another child to the breast, but this method can not always be resorted to; then nothing remains except to use the breast-pump. or (what I prefer), removal of the secretion by manipulation.
Usually no difficulty arises in weaning. since lactation disappears
gradually. Restoration is seld oat accelerated by the numerous favorite remedies. The difficulties arising from engorgements of the breasts are overcome by the application of breast-binders and by light massage with applications of oil.
Hygiene of the Nursing Woman. —The mode of life of the nurs ing woman should hardly he different from that of any other woman. The clothing should be so designed that there is no pressure upon the breasts, and that these may he easily exposed. The clothing approved for the wet-nurses employed in the Infants' Home at Dresden (Plate 3, Figs. a to j.) allows plenty of room for the breast, which can be easily exposed, and when closed it gives sufficient protection to the mother.
Bodily movements and a moderate amount of work not only do no harm, but are necessary for a good general condition. The anxiety about physical changes is very much exaggerated, since neither the quan tity nor the quality of the milk is affected in such conditions. Moderate sexual intercourse may be allowed, as forbidding it would not prevent it.
The breast itself must be kept warm and clean. Before and after the application of the child the nipples should be washed in sterile water or with weak boraeie acid solution. warning should be given against the obnoxious and dangerous habit of moistening the nipples with the secretions of the mouth.
Many old and„ unfortunately, only too deeply rooted notions in regard to the rules for the nourishment of nursing women should be abandoned. In earlier times it was honestly believed, appa rently on account of certain characteristics (e.g.. their white color) that soups, gruels, and broths of all kinds were especially suitable for the production of milk, and while these unattractive foods were recom mended to the nursing woman, appetizing and highly spiced foods of various kinds were forbidden, since it was feared that they might have a harmful effect on the secretions. This regime is not only unnecessary but directly harmful, since the monotony and lack of flavor spoil the appetite.
A nursing woman may eat whatever she pleases. Unprejudiced observations always go to show that the production of milk is in a large measure independent of the nourishment taken. In regulating the diet of a nursing woman it is only necessary to remember that the body looses daily with the milk about one litre of fluid and 750 calories of heat, and that this loss must again be made up; the diet should be as abundant and tasty as the nursing woman is accustomed to take. The great need of fluids must not be forgotten. Cow's milk is especially recom mended as a drink.