Imagens das páginas
PDF
ePub

to wet nurses, but it may at least teach us that it is not an indifferent matter to confide them to the first woman who presents herself. In fact, nurses possess, with their individuality of race, constitution, and temperament, an individuality of milk, the qualities of which are more or less advantageous to the health of the children, according to the women who furnish it.

Nurses are sometimes attacked by inflammatory or septic diseases, which are not accompanied by the changes in the milk mentioned in the preceding chapter. In this case these diseases have no influence over the health of the children, which is then only accidentally disturbed. Thus I have seen pneumonia attack a child which had not ceased to suck its mother, who was labouring under a violent attack of erysipelas of the face, with delirium, and whose milk was not altered. I have witnessed

a similar circumstance in another child, whose mother had a slight Case khu

puerperal fever; but, in contradistinction, I may cite a third case much more singular, in which a woman labouring under puerperal arthritis the Susten of the knee, tolerably well in other respects, and without very intense febrile reaction, continued to give the breast to a child who had t suppurating arthritis of the right shoulder, which was confirmed by the austurilis antopsy. At the time this occurred I had not thought of studying the alterations of the milk, and I did not examine that of this nurse, so that I am unable to state if this fact is well placed in this chapter. However, I have considered it right to mention it, for it may be presumed that the examination of the milk would not have accounted for the formation of a simultaneous arthritis in the mother and in the child.

[ocr errors]
[ocr errors]
[ocr errors]

Certain diseases of the skin in the mother or in the nurse become Art. transmitted to the child by direct contact. Of this there is no doubt, but it is difficult to determine if the the transmission is effected by means of the milk. This is not probable, for I have seen many women who had non-specific cutaneous affections, and who did not transmit any disease to their child. I have only observed the contrary phenomenon once, which must be explained as a simple coincidence until other and similar facts permit us to deduce different conclusions. The nurse referred to had eczema of the breast for many years, which she could not get rid of, and which developed itself all over the body of her Ichild when four months old.

Lastly, we arrive at a very important class of the diseases of nurses, the immediate influence of which, on children, is far from being determined. I refer to the influence of constitutions and of certain cachexia in which

the milk presents no alteration. Scarcely any examples have been int observed of children who have been suckled by nurses of scrofulous, scorbutic, or syphilitic constitution becoming affected with symptoms Drake depending on these various morbid states. The existence of these/ symptoms as the results of the constitutional state of the nurse may Sereka

[ocr errors]

tectation even be denied; they should only be received as coincidences. In fact, if we carefully observe children of good race, suckled by a woman of scrofulous temperament, even very marked, we neither find in the external condition, nor in the health, phenomena which can lead to the belief that it is scrofulous. If the lactation should have any influence, it will be only perceived at a later period.

As to syphilis, no fact demonstrates in a decided manner its transmission by lactation. Constat hodie fere inter omnes, cirus venereum neutiquam per lac ad infantes transferri.-Wagner. We may believe in this transmission, but it will be difficult to furnish any satisfactory proofs of it. At first the milk of syphilitic women Justus, does not present characters different from the milk of women in good health (Donné); if it is altered it would be by a virus, of which not even one has yet been detected. Lastly, if we carefully examine the cases of syphilis which have been attributed, or which we feel disposed to attribute to infection by the milk, it will be seen that this is not the case, and that the mode of propagation is entirely different. we almost invariably discover in the nurse a chancre, the pus of which, transferred by the hands, by the linen, and by repeated contact, has finally been absorbed, and produced in the mouth and on the body a similar chancre, the origin of the venereal disease.

In fact,

In these cases there is a true inoculation of which the chancre is the primary phenomenon, and is at the same time, the cause of the secondary symptoms. It is generally in this way that the transmission of syphilis to children takes place.

The influence of the spyhilitic cachexia is not then immediate, for syphilis does not appear to be transmitted by lactation; it may, on the contrary, exert a more remote influence, and it is not impossible that it has an intimate relation with the development of scrofulous disease.

To sum up, then, it is observed that certain dispositions of the mind, moral affections, passions, and some diseases of the nurse which are not accompanied by a modification of the milk, sometimes exert an immediate and grave influence on the health of the children.

This influence is even in general more injurious than the influence of diseases with alteration of the milk. All children are not affected by it with the same facility; there are some even who do not feel it.

The want of affection of certain mothers for their children, the extreme distaste they have for the duties of lactation, are prejudicial to the physical development of the nurslings.

Fear, anger, continual anxiety, very deep grief, are sometimes the cause of very considerable derangements on the part of the alimentary canal and especially of the nervous system. The latter are especially observed in the midst of violent passions, and particularly under

1

the influence of venereal pleasures. Convulsions in the children are the most usual manifestation of this state in nurses.

Menstruation is sometimes the cause of colic, vomiting, and diarrhoea; but these phenomena are rare.

The state of the constitution, the temperaments, and cachexia, do not appear to possess any immediate influence over the health of the children. If these diseases possess any action, it can only be a very

remote one.

3RD CLASS. Immediate influence of diseases of the nurse in consequence of contact with the child.

[ocr errors]

We have just studied the action of certain diseases of the nurse on the child, whether there be an appreciable alteration of the milk, or, on the contrary, whether this liquid presents nothing particular. But Yuse he other diseases of the nurse may be communicated to the child by infection or by contact, and here it is no longer in her exclusive quality as nurse, that she transmits a certain disease, it is by the same mode as any strange person would do who might carry the germ of this identical disease. We shall not insist further on this point: we shall Mary T.my simply state that in this manner, scabies, ophthalmia, diphtheritis, small-pox, cholera, and, according to my observations, primary syphilis, el dian and the disposition to erysipelas in cases of puerperal fever, &c., may be transmitted. In all these cases lactation should be interrupted and en.

another nurse obtained.

REMOTE INFLUENCE OF MORAL AND PHYSICAL AFFECTIONS OF
THE NURSE OVER THE HEALTH OF THE CHILDREN.

This influence is much more difficult to determine than those which, up to the present time, have fallen under our consideration. We have nothing to observe, in this respect, which has not been pointed out by all authors. It will be readily understood that my researches on this subject are limited, for they require a practice and an experience which few persons can possess, and the acquisition of which the short duration of human existence prevents. In fact, however extensive the practice of a medical man may be, he will never have a sufficiency of patients whom he has had under notice from birth to an advanced age, to form a firm and sufficiently decided conviction on the subject under consideration. The most he can do is to express his doubts; if he be prudent, he will not go further.

Α

very evident remote influence over the constitution and the character of the children was formerly attributed to the milk. Thus, it was believed that children nourished with cow's milk were more indolent and less cheerful than those who had been brought up with goat's milk.

It was also admitted that the character and the passions of the

[ocr errors]

nurse may be transmitted to the child by the milk. Sylvius has formally declared it.* But, as Desormeaux observes, if it is true that the nature of the milk, which depends on the physical and moral Can constitutions of the nurse, exercises an immediate influence over the health and the constitution of the nursling, so as to modify its intellectual

Suhhut and moral development, it is not correct to maintain that it possesses a remote influence over the character of the individual, for too many facts prove the contrary. When this transmission takes place, the child receives it much more surely from imitation of the manners of its nurse, and from the education she has given it.

[ocr errors]

We must now consider the remote influence of certain diseases of

Chysical nurses over the future health of children, and learn what is the ulterior

action of the milk of women labouring under nervous affections, epilepsy in particular; or a syphilitic, cancerous, scorbutic, and scrofulous cachexia, and especially pulmonary phthisis. Unfortunately we possess no facts which decide these questions. It is truly by chance that a woman thus diseased is taken to serve as nurse, and it is impossible for us to hazard an opinion on this point. However, if some of these affections of the nurse, and not of the mother, do not appear to us to possess a very evident influence on the future state of the children, ignorant as we are on this point, we must at least regard them as possessing a very prejudicial influence, and change the nurse as soon as their existence is recognized.

ON CHANGING THE NURSE.

The considerations relating to the influence of the constitution, and the antecedent and actual diseases of the nurse on the health of the

children, here find their application. There is only one means of remedying the inconveniences and dangers which may result from the bad disposition of nurses; they should be replaced by others in a better state of health.

When should the nurse be changed, and how should it be done? These are questions which the practitioner is often called upon to decide.

We have already spoken of the choice of a nurse; consequently we shall only here occupy ourselves with the circumstances which may necessitate such a change. If, on the one hand, what has been stated on the influence experienced by the child in the course of the diseases and the indispositions of its nurse, is borne in mind, and on the other the rather numerous contradictory facts which combat this influence, it will be seen that it is not possible to determine precisely the cases in which the nurse should be discharged, and the diseases which necessitate it. All depends on the observation

* Tract de morb. infant., ch. xlii.

of the patients; for an indisposition or
a disease of the nurse,
which is fatal to one child, may not be so dangerous to another. This
is what I have observed in women, menstruating at the sixth, seventh,
and eighth months of lactation, who, together with their own child,
suckled a strange infant. At the time of menstruation, one of them
experienced colic and diarrhoea, the other had nothing of the kind.
It is not impossible that the same may hold good as regards the
influence of a certain number of the affections of the nurse.

[ocr errors]

Consequently, when a nurse falls ill, or when she perceives her menses return prematurely, she should not be too hastily replaced. Lo It is necessary to wait a little, so as to ascertain the nature of the evil, its influence over the composition of the milk, and its action on the health of the child. It is then necessary to decide. Till then, we must be contented in giving the child the breast less frequently, and in supplying its wants by the feeding bottle, filled with good cow's milk, and by thin light soups if the child is old enough to take them.

When the disease of the nurse is a serious one, and threatens to prolong itself; when its nature is unfavourable; when the milk is altered; and, lastly, when the child presents gastric disturbance or has other sufficiently serious symptoms, so as to make it appear likely that may become more decidedly indisposed, we should no longer hesitate; the change of the nurse is indispensable to the health of the child.

it

All these precautions are necessary, so as not to discharge, without good reason, a nurse who knows the habits of the nursling, and with whom we are satisfied in every other respect. This change does not of itself present any danger, and having lost the first nurse, we may, as I have had occasion to do, successively engage two or three others, until we met with a very suitable one.

[ocr errors]
[ocr errors]

When the nurse is to be replaced, we should, as M. Donné recommends, keep her in ignorance of this determination, and before Kurse us acquainting her with it, wait until the new choice has been made. Then it is well not to interpose any interval between discharging and replacing her; so that she cannot cause the child to suffer in any way from the anger which this proceeding may excite in her.

ON THE INFLUENCE OF DISEASES OF THE CHILD ON THE
NURSE.

If the newly-born infant can receive, from a wet nurse, the germ of various contagious diseases, it can also, by reciprocity, transmit to her some of the diseases which afflict it. Accidents of this nature are relatively more rare, but they still exist in considerable number. Only, in this case, lactation has nothing to do with their manifestation. The transmission of the diseases of the child to the nurse takes place in virtue of ordinary pathogenic laws of the adult:

[ocr errors]
« AnteriorContinuar »