655 
characteristics of this milk are low specific gravity (1.024 to 1.027) 
and cream only 2 to 4 per cent. In such cases the quality of the 
milk is so poor and the quantity so small that it is manifestly im- 
possible to nourish the child by it. 
In other instances the variation from the normal is not so great: 
i. e., specific gravity 1.028 to 1.030, cream 4 per cent, with fairly 
abundant quantity. In such cases we may hope to improve the 
quality of the milk by appropriate measures. These are adequate 
rest for the mother at night, fresh air, nourishing food, and gentle 
exercise. The anaemia usually present may be improved by malt 
extracts and preparations of iron. If this condition is dependent 
upon conditions incidental to the lying-in period, the outlook is 
usually good. If. on the other hand, it is the result of constitu- 
tional debility or neurotic diathesis, improvement may only be tem- 
porary, necessitating the weaning of the child, not only in its own 
interests, but those of the mother as well. 
Abundant milk of poor quality . — This condition is sometimes seen 
in anaemic subjects who have been taking large quantities of malt or 
alcoholic beverages in the hope of improving their milk supply. In 
such cases the quantity may be so abundant that the breasts are pain- 
fully full at nursing times and between them may flow away sponta- 
neously. Clinical examination shows low specific gravity and very 
low fat. 
Owing to the grade of hydremia accompanying these conditions, 
very little improvement can be expected to ensue from treatment, and 
nursing should be discontinued. 
Wet nursing . — The milk of another healthy woman is the best sub- 
stitute for material nursing when the mother’s supply has failed. 
Expense and the difficulty of obtaining a good wet nurse in this 
country are countervailing circumstances. The wet nurse should be 
a perfectly healthy woman free from syphilis or tuberculosis. A 
careful physical examination should be made to ascertain these points. 
Her breasts should be well developed and at nursing time be tense and 
full. A good amount of glandular tissue should be present in the 
breast and pains taken to be assured of that point. The nipple 
should be of normal development and free from cracks or fissures. 
Her blood should be rich, as it is impossible for an aneemic woman to 
give good milk. 
Contrary to what is usually supposed, it is by no means necessary 
that her milk should correspond in age to that of the child. She 
should, however, have been a nursing mother long enough to be able 
to demonstrate by the condition of her child that she has plenty ‘of 
good, nutritious milk. To this end her child should always be in- 
spected before her acceptance. Alien accepted she should be given 
a fair chance to adjust herself to her novel surroundings before decid- 
