The Maternal Management of Children, in Health and Disease - Thomas Bull

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      The first thing to which a medical man looks, is the general health of the woman; next, the condition of her breast, the quality of her milk its age and her own; whether she is ever unwell while nursing; and, last of all, the condition and health of the child.

      IS THE WOMAN IN GOOD HEALTH?—Her general appearance ought to bear the marks of a sound constitution, and ought to be free from all suspicion of a strumous character; her tongue clean, and digestion good; her teeth and gums sound and perfect; her skin free from eruption, and her breath sweet.

      WHAT IS THE CONDITION OF THE BREAST?—A good breast should be firm and well formed; its size not dependent upon a large quantity of fat, which will generally take away from its firmness, giving it a flabby appearance, but upon its glandular structure, which conveys to the touch a knotted, irregular, and hard feel; and the nipple must be perfect, of moderate size, but well developed.

      WHAT IS THE QUALITY OF THE MILK?—It should be thin, and of a bluish- white colour; sweet to the taste; and when allowed to stand, should throw up a considerable quantity of cream.

      WHAT IS ITS AGE?—If the lying-in month of the patient has scarcely expired, the wet-nurse to be hired ought certainly not to have reached her second month. At this time, the nearer the birth of the child, and the delivery of its foster-parent, the better: the reason for which is, that during the first few weeks the milk is thinner and more watery than it afterwards becomes. If, consequently, a new-born infant be provided with a nurse, who has been delivered three or four months, the natural relation between its stomach and the quality of the milk is destroyed, and the infant suffers from the oppression of food too heavy for its digestive power.

      On the other hand, if you are seeking a wet-nurse for an infant of four or five months old, it would be very prejudicial to transfer the child to a woman recently delivered; the milk would be too watery for its support, and its health in consequence would give way.

      THE NURSE HERSELF SHOULD NOT BE TOO OLD!—A vigorous young woman from twenty-one to thirty admits of no question. And the woman who has had one or two children before is always to be preferred, as she will be likely to have more milk, and may also be supposed to have acquired some experience in the management of infants.

      INQUIRE WHETHER SHE IS EVER UNWELL WHILE NURSING?—If so, reject her at once. You will have no difficulty in ascertaining this point; for this class of persons have an idea that their milk is renewed, as they term it, by this circumstance, monthly; and, therefore, that it is a recommendation, rendering their milk fitter for younger children than it would otherwise have been. It produces, however, quite a contrary effect; it much impairs the milk, which will be found to disagree with the child, rendering it at first fretful—after a time being vomited up, and productive of frequent watery dark green motions.

      Last of all, WHAT IS THE CONDITION OF THE CHILD?—It ought to have the sprightly appearance of health, to bear the marks of being well nourished, its flesh firm, its skin clean and free from eruptions. It should be examined in this respect, particularly about the head, neck, and gums.

      If a medical man finds that both mother and child answer to the above description, he has no hesitation in recommending the former as likely to prove a good wet-nurse.

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      The regimen of a wet-nurse should not differ much from that to which she has been accustomed; and any change which it may be necessary to make in it should be gradual. It is erroneous to suppose that women when nursing require to be much more highly fed than at other times: a good nurse does not need this, and a bad one will not be the better for it. The quantity which many nurses eat and drink, and the indolent life which they too often lead, have the effect of deranging their digestive organs, and frequently induce a state of febrile excitement, which always diminishes, and even sometimes altogether disperses, the milk.

      It will be necessary then to guard against the nurse overloading her stomach with a mass of indigestible food and drink. She should live as much as possible in the manner to which she has been accustomed; she should have a wholesome, mixed, animal and vegetable diet, and a moderate and somewhat extra quantity of malt liquor, provided it agree with her system.

      A very prevailing notion exists that porter tends to produce a great flow of milk, and in consequence the wet-nurse is allowed as much as she likes; a large quantity is in this way taken, and after a short time so much febrile action excited in the system, that instead of increasing the flow of milk, it diminishes it greatly. Some parents, however, aware of this fact, will go into an opposite extreme, and refuse the nurse even that which is necessary. Either excess is of course wrong. It is difficult in general terms to say what ought to be considered a proper daily allowance, but some is in general necessary; and whenever a woman has been used to drink malt-liquor, she will rarely make a good wet-nurse if she is denied a reasonable quantity of that beverage. Good sound ale sometimes agrees better than porter. It may be well here to remark, that in London, I frequently meet with severe cases of diarrhoea in infants at the breast, fairly traceable to bad porter, which vitiating the quality of the milk, no medical treatment cures the disease, until this beverage is left off or changed, when it at once disappears.

      The nurse should take exercise daily in the open air. Nothing tends more directly to maintain a good supply of healthy milk, than air and exercise; and the best wet-nurse would soon lose her milk, if constantly kept within doors. Sponging the whole body also with cold water with bay-salt in it every morning, should be insisted upon, if possible: it preserves cleanliness, and greatly invigorates the health. United with this, the nurse should rise early, and also be regularly employed during the day in some little portion of duty in the family, an attendance upon the wants of the child not being alone sufficient.

      An amiable disposition and good temper are very desirable. A violent fit of passion may exert so peculiar an influence in changing the natural properties of the milk, that a child has been known to be attacked with a fit of convulsions after being suckled by a nurse while labouring under the effects of a fit of anger. The depressing passions frequently drive the milk away altogether. It is hence of no small moment, that a wet-nurse be of a quiet and even temper, and not disposed to mental disturbance.

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      Extreme delicacy of constitution, diseased condition of the frame, defective secretion of milk, and other causes, may forbid the mother suckling her child; and unless she can perform this office with safety to herself, and benefit to her infant, she ought not to attempt it. In this case a young and healthy wet-nurse is the best substitute; but even this resource is not always attainable. Under these circumstances, the child must be brought up on an artificial diet "by hand,"—as it is popularly called.

      To accomplish this with success requires the most careful attention on the part of the parent, and at all times is attended with risk to the life of the child; for although some children, thus reared, live and have sound health, these are exceptions to the general rule, artificial feeding being in most instances unsuccessful.

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      It should be as like the breast-milk as possible. This is obtained by a mixture of cow's milk, water, and sugar, in the following proportions:—

      Fresh cow's milk, two thirds;

       Boiling water, or thin barley water, one third;

       Loaf sugar, a sufficient quantity to sweeten.

      This is the best diet that can be used for the first six months, after which some farinaceous food may be combined.

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