THE FUNCTIONAL CAPACITY OF THE NURSE AND NEEDS OF THE CHILD In the choice of a nurse, the first thing to consider, as has already been pointed out, is whether or not there is a abundant supply of milk. Sometimes, and that not seldom, this overabundance may lead to faulty conditions, which are not likely to be discovered without complete knowledge of the subject, and which may lead to abnormal conditions of the nurse or the nursling.
In the usual run of cases it often happens that a newborn child which needs very little nourishment, or a sick, weakly child, is given to a nurse who has full lactating breasts. In either case the child is not able to empty the breasts. and if no other measures are taken the inevi table result is a stasis and a loss of the gland function. The nurse is dismissed because she "has no milk." But if care had been taken of the productive functions of the glands, things would not have come to such a pass. The child would have had a good foster-mother, and the latter would not have been deprived of her milk. Wrong has been clone to both parties.
The possibility of such an occurence must be kept constantly in mind, so long as the child, for either physiological or pathological rea sons, does not take sufficient nourishment. In such eases it is necessary to empty the glands with the breast-pump or by massage. I would ad vise, as the must important and best means, the additional application of the nurse's own child; which, for ethical reasons soon to be given, cannot be urged too strongly. By this means the child is able to con tinue nursing.
On the other hand, it may easily happen that the child drinks more than is desiral)le for its age, when the wet-nurse has nursed for a long time, since the milk then flows more readily. If we are not able to regu late the amount of the meal by means of the scales, the anomaly will first be noticed when any digestive disturbance appears. It is then often
argued that the milk of the nurse is not suitable, while the indisposition is only due to overfeeding.
From such facts we might learn that we should never fail to deter mine definitely by weight the amount taken by the child at each feeding.
I cannot refrain from bringing up two points, even though I know that the regard for ethics and social justice will usually prevent the physician from making mistakes. It is well to remember that when the nurse's child is taken from the mother's breast it becomes a prey to all the dangers that threaten the artificially fed babe; and, furthermore, that it runs additional risk from the fact that it often !Toes from the mother's care to that of an untrustworthy care-taker. As a matter of fact, the mortality among the children of wet-nurses is very great. This is well illustrated by the fact that during the siege of Paris the death rate among the infants showed a decided falling off in those districts from which the Parisian ladies usually obtained their wet-nurses, owing to the fact that during this time the mothers remained with their chil d•en. Again let me suggest the advisability of taking the child with the mother, a plan which for reasons given above may often be of direct benefit to the foster-child.
The nurse herself is often directly injured by being deprived of her milk through thoughtless treatment or by being regardlessly dismissed in a short time. So that whereas she might have been in the position to support herself and her child for months. her pay as nurse enabling her to hire a proper care-taker for her child, they are now. both mother and child, without means of support and are liable to suffer want. The child as usual suffers most, as it is young and has less power of resistance.