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Syphilis, foundlings, and wetnurses in nineteenth-century Italy.

I, the undersigned mayor of the Town of Camugnano, certify that the married couple Gaetano Cesarini and Domenica Puccetti find themselves in such penurious condition that they do not know how they are going to live.

I further certify that the only cause that has reduced them to this condition is having contracted the venereal disease years ago as a result of the nursing, on the part of the above-mentioned Domenica Puccetti, of a foundling from the Foundling Home of Bologna.

The couple used to work plots of land owned by others, but because of the long illness they contracted they have had to abandon this work in the fields and live on public charity.(1)

Each year in Europe in the centuries of the modern period, many tens of thousands of babies were abandoned and made their way into the highly developed system of foundling homes. Torn away from their mothers, the infants faced difficult odds in surviving in a world where artificial feeding generally meant death.(2) Their only real hope of living to see their first birthday was to find a woman able to nurse them and willing to put them to her breast. And so it was that wherever there were foundling homes, from Portugal to Russia, Italy to Ireland, foundling home officials devoted much of their energies to recruiting lactating women to nurse their little wards.(3)

In most places at most times, the foundling homes sponsored a dual system of wetnursing, one based inside the foundling home itself and one outside it. The goal almost everywhere was to place the infant with a lactating woman in the woman's own home, typically in the countryside. The only alternative was to keep the children in the foundling home, but this was deemed undesirable for a variety of reasons. First of all, it was impractical. In foundling homes such as Paris, Lisbon, Madrid, Vienna, Milan, or Florence, where thousands of babies were abandoned each year, the prospect of keeping them all in the foundling homes was unrealistic. Finding lactating women willing to serve as internal wetnurses to multiple babies was always difficult, and indeed, expedients were sometimes relied upon of forcing unwed mothers to serve periods of servitude as internal wetnurses. Officials also recognized that hygienic conditions in the foundling homes were inferior to those outside; the large number of babies sharing a limited number of wetnurses quickly passed diseases around. Moreover, officials complained that the poor women who could be induced into wetnurse service in the foundling homes lacked the robust and healthy condition necessary to insure adequate nutrition for the infants.

As a result, efforts were made to find women willing to take the abandoned babies to their homes and able to nurse them. In order to keep the child alive until such placement could occur, a limited number of wetnurses were lodged in the foundling home itself, often nursing two or more infants at a time.

The consequences of not being able to place the infants with external wetnurses can be seen from those cases where few such placements were made. A dramatic example comes from Naples, one of Europe's largest foundling homes in the modern period, yet one which often lacked the financial resources (or political resolve) to pay for what would have been a massive system of foster child placement. Between 1801 and 1840, 81,758 children were left at the Naples foundling home; of these 81% died before reaching their first birthday.(4) Even in the best of cases, however, keeping the abandoned children alive was a desperate struggle, and typically the foundlings suffered an infant mortality rate twice as high as the already high rate found among the rest of the population.(5)

Well aware that the survival of the foundlings was linked to their ability to place the children quickly with women in their own homes, foundling home officials devoted a great deal of their efforts and a significant part of their large budget to recruiting external wetnurses. The incentive provided was a monthly wage that the foundling home paid such women. The wage attracted women from poorer rural households where the extra money - especially in its regularity and its cash form - was most welcome. Foundling homes continued to pay the women to keep the child even after the period of wetnursing (typically 12 months) was completed, although the monthly payments declined after the child was weaned.(6)

Women from the countryside were almost everywhere preferred over city women, for rural communities were regarded as healthier for children and life there less corrupt than the city. Although desperate to attract such women, foundling home officials were also concerned that any woman who asked to take in a child be closely examined to make sure that she would be suitable. In the foundling homes of Italy (referred to as ospizi), women needed to bring a variety of documentation with them, including a certificate of good moral standing provided by their parish priest, and either a death certificate of their most recently born child (indicating their lactational status) or their most recent child's birth certificate indicating that the child was old enough to be weaned (foundling homes frowned on women nursing a foundling in addition to their own child, fearing that former would suffer). Finally, a foundling home physician performed a physical examination of the woman, both to ensure her general health and nutritional status, and to specifically examine the quantity and quality of her milk.(7)

For poorer, rural women throughout large parts of Europe, and especially those who lived within a couple of days journey to a foundling home, taking in a foundling had substantial attractions. Yet these attractions had long been balanced by a great fear, for the women who became wetnurses were aware that they were putting themselves at risk for contracting a terrible disease, the risk of syphilis.

In recent years a great deal has been written about the history of infant abandonment in Europe, with studies in France, Italy, Spain, Portugal, Ireland, England, Russia, Greece, and elsewhere.(8) And yet to date the relationship between infant abandonment and syphilis has remained unexplored, despite the fact that from Spain to Russia the fear of syphilis played a major role in the functioning of the foundling system, and had grave consequences both for the placement and survival of the infants and for the health of the women who took them in.(9) In the pages that follow, we examine the role that syphilis played, focusing on the case of the foundlings of Bologna in the nineteenth century.

Syphilis Contagion and Foundlings(10)

Syphilis only entered Europe with the dawn of the modern era and, appropriately for our story, apparently did so in Italy. The first reports of an outbreak of syphilis come to us in the wake of the occupation of Naples by the mercenary army of Charles VIII, king of France, in 1495. As the army made its way north the first accounts of the new disease began to appear, and its link to sexual contact was immediately understood. When the mercenaries were demobilized in the summer of 1495 and returned to their countries of origin, the disease quickly spread throughout much of the rest of Europe. The virulence of the disease, the severe disfigurement it caused, and its sexual nature produced great horror.(11)

It was not long before the first cases of congenital syphilis were noted, that is, babies suffering from syphilis were born. The exact origin of the infection in such cases, however, remained a matter of debate for centuries. In addition to the theory that it was the syphilitic mother who passed the disease to her offspring in utero or in delivery,(12) the complementary theory that syphilis was passed directly via the sperm of a syphilitic father remained popular from the sixteenth through the nineteenth century, and was only discredited in the twentieth.(13) Many physicians believed that both maternal and paternal routes of transmission were possible.

Yet in addition to transmission by coitus, and transmission through birth, it soon became evident that syphilis could also be spread through non-sexual forms of direct contact. At the center of this concern was the transmission of syphilis between wetnurse and baby. In 1505, Cataneus argued that a syphilitic wetnurse could pass the disease to her nursling through her milk and advised against allowing such a woman to nurse one's child. Before long, physicians warned of the dangers of transmission in the other direction as well. In 1553, Musa Brassavole concluded that in addition to the danger of a syphilitic wetnurse infecting a child through her milk there was the danger that an infected child would pass the disease to its wetnurse.(14)

Recognizing these dangers, foundling home officials faced dual concerns: protecting healthy foundlings from infected wetnurses, and protecting healthy wetnurses from syphilitic foundlings. As for the former, the medical examination required of all women who applied to receive a foundling to nurse included a careful inspection for the signs of syphilis - both evidence of a primary (vaginal) chancre or a secondary rash or sore. Given the difficulty of making a diagnosis with the tools available at the time, it is certain that many cases were missed. However, it was the latter issue - that of the syphilitic status of the infant - that proved more consequential for foundling home officials.

The key problem stemmed from the fact that it was difficult to tell whether a newborn baby was syphilitic. There were some signs that might appear at birth, including low birth weight and poor complexion, and, sometimes within a few days nasal discharge, a prominent rash on the face, palms or soles, evidence of spleen enlargement, jaundice or anemia. But not all syphilitic babies showed such symptoms. Moreover, many of the ways that syphilis first manifested itself were not in themselves distinctive - given the diagnostic tools of the time-and could be attributed to other illnesses.

The most influential European text on congenital syphilis of the mid-nineteenth century, P. Diday's Traite de la syphilis des nouveau-nes et des enfants a la mamelle (1854), reported on the timing of the appearance of earliest symptoms in 158 cases: 86 occurred within the first month, 45 in the second month, and another 15 in the third month. An additional 12 infants showed their first symptoms only after three months of age.(15)

Most cases of transmission of syphilis between nursling and wetnurse involved contact between the woman's nipple and the baby's mouth. Syphilitic children often developed sores around their mouths that could infect the woman through some imperfection of her skin. Women with such syphilitic sores around their nipples, in turn, could pass them on to children they were nursing through cuts or sores in the child's mouth.(16)

For foundling home officials, the implications of the delay in the appearance of the first symptoms among babies with congenital syphilis were chilling. If they had to wait two or three months to determine if an infant was syphilitic, and could not send the babies out to wetnurses before that time, they realized that most of the abandoned children - though themselves free of syphilis - would die without ever making it out of the foundling home. On the other hand, every time they sent a young infant out to a wetnurse, they ran the risk of infecting the woman and, through her, her husband and small children. This raised not only moral and financial questions of responsibility, but also jeopardized the foundling horne's ability to find women willing to nurse the newborns. Indeed, reports of women contracting syphilis from their nurslings led to periodic crises involving women returning their charges to the foundling home, and others refusing to take new nurslings in. Such a case is documented for the large foundling home of Florence in 1760, and regularly recurred through the rest of the eighteenth and the whole of the nineteenth century in Italy.(17)

Contemporaries viewed the danger represented by the foundlings in the remote areas in terms of their larger image of the corrupt city poisoning the pure countryside, images that can be found from Russia to Italy.(18) Rural Italian doctors, reporting on cases of local women contracting syphilis from foundling nurslings, regularly claimed that aside from such a mode of transmission the incidence of syphilis in the countryside was rare, a sentiment found in France as well.(19)

Yet by later in the nineteenth century, defensive foundling home doctors and administrators went on the counterattack, claiming that their foundlings were being made into the scape goat for the decline in morals in the countryside. Typical was the report of the two doctors in charge of Bologna's foundlings, who, in 1885, recounted that over the previous four years, they had diagnosed 49 certain cases of infantile syphilis among the abandoned babies. For some of these, they noted, the first signs of syphilis had come only after 14 or more months of age, and in these, "one might well suspect that they were not born with it, but contracted it" from their wetnurses. The doctors went on to add: "the foundlings alone should not be blamed for the diffusion of syphilis in the countryside," and gave as evidence "the growing ease and frequency with which the peasants are able to be in contact with Bologna, from which they return with venereal diseases."(20)

Bologna though was not unusual in facing the drama created by the spread of syphilis among the wetnurses. And it was a drama that in many respects grew over the course of the nineteenth century, linked by contemporaries to the growth of the cities and its evils. Not surprisingly, it was Italy's political center, Rome, and its major industrial center, Milan, that encountered the greatest problem. The Rome foundling home reported that in the period 1871-1876, of the 7457 babies left there, 984 were treated for congenital syphilis, of whom 947 died. The Milan foundling home, over the years 1889-1898, placed 12,730 infants with external wetnurses. Of these 686 were reported to have developed syphilis and, most strikingly, 171 wetnurses were reported to have been infected with syphilis by their foundling nurslings.(21)

Struggling with Syphilis at the Bologna Foundling Home

Established in the thirteenth century and in its present massive building complex since the fifteenth, the Bologna Foundling Home was widely known as the "Bastardini," reflecting the origins of almost all its charges. Founded originally in a monastery and located in a city that since the early sixteenth century was part of the Papal States, the Bologna Foundling Home was closely linked to the Church although its governing board consisted of both local lay elite and clergy. Over the years, the ospizio accumulated a large endowment, as wealthy patrons sought supernatural benefit by making provisions for the institution in their wills. However, the large flow of foundlings and the cost of placing them with wetnurses and foster families meant that resources were never sufficient and ospizio officials continually lobbied for more funds from local authorities.(22)

The Bologna Foundling Home operated in a way that was typical of most foundling homes throughout Italy and elsewhere in Europe, admitting infants anonymously, nourishing them initially in the complex through a core of internal wetnurses, and placing them rapidly with women from the countryside who, attracted by the monthly payment, came to the ospizio to take a child home to nurse. Babies were typically left at the foundling home by the midwives who delivered them, although in the case of those born in more distant parts of the Bologna hinterland, town officials often brought them in to the city. Protection of the honor of the unwed mothers dictated that their identity should not be recorded, and likewise no information was sought on the children's fathers.

Over the centuries the numbers of babies left at the Bologna ospizio waxed and waned. In the latter half of the seventeenth century numbers increased, followed by a gradual decline through much of the eighteenth century. In 1680, for example, 393 infants were left at the Bologna foundling home, a number not reached again until the nineteenth century. During French occupation at the turn of the nineteenth century and until 1814, the number of abandoned babies rose sharply, to about 450 per year, declining gradually to around 350 in the 1830s before rising to almost 700 per year in the late 1870s in a city then having 120,000 inhabitants and about 3200 birth per year.(23) These trends, then, were not immediately affected by the fall of the Papal regime in Bologna in 1859 and the establishment in 1861 of the secular Kingdom of Italy.

Foundling home officials were painfully conscious of the fact that the survival of the babies in their charge depended on having them nursed from as early an age as possible. They knew well that lacking adequate numbers of healthy wetnurses lodged in the ospizio itself, and lacking a speedy process of placing the children with external wetnurses, they were consigning most of the foundlings to an early death. Indeed, when placement became slower in the early part of the nineteenth century, over 70% of the babies were dying in their first year, generally in the first few months.(24) As placement rates improved, the proportion dying in their first year gradually declined, down to 37% by 1869-70.

But, eager as they were to place the newborns with wetnurses, the officials could never escape a terrible fear, the fear of infecting wetnurses with syphilis, and in this they faced the same conundrum as their colleagues throughout much of Europe.

Typical of their deliberations over this matter was the discussion of the Commission (i.e., the executive council) of the Bologna Foundling Home on January 5, 1852. Officials were in receipt of a medical certificate from a doctor o(a hill town stating that two local sisters, Maria and Rosalia Venturi, had contracted syphilis by nursing the same infected foundling, Luigi, born on June 15, 1851, and subsequently returned to the foundling home. The minutes noted: "This correspondence, while on the one hand of concern to the Commission because of the terrible consequences that have affected whole families; on the other imposes on us the greatest obligation to use all means possible to prevent future ruinous cases of this kind." As a first step, they ordered an investigation into the number of recent cases of syphilis among the foundlings.(25)

The alarming results of this inquiry were reported to the Commission 11 days later. The ospizio doctor reported that in the two previous years a total of 58 infants had been returned to the ospizio from their rural wetnurse because they had developed symptoms of syphilis. About 800 infants had been abandoned at the foundling home in that period, but as only 720-740 of them had been placed, this meant that almost a tenth of the infants being placed with rural wetnurses had turned out to be syphilitic.(26) Aside from the moral and financial implications of this fact, it was clear that were the extent of the problem known to the rural population, the ospizio's ability to attract rural wetnurses might be severely undermined. The Commission concluded: "We see ever more clearly the necessity of devising radical new measures to avoid having children who are affected by this terrible disease go out of the Foundling Home to bring ruin to entire families." The doctor was directed to study the matter and report back with his recommendations.(27)

Meanwhile, in Florence, when the Ministry of the Grandduchy of Tuscany received word in 1854 that over the previous 16 months 133 women had reported contracting syphilis from nursing babies they had been given by the Florentine foundling home, the Minister declared that if the Grandduke had known that this would be the result, he would never have recommended sending the foundlings out to the women of the countryside.(28) Florence foundling home officials responded by informing the Ministry of all the precautions they were already taking to prevent the spread of syphilis, and later argued that a number of the women who blamed the ospizio for their disease had in fact themselves been previously infected and indeed had transmitted syphilis to the healthy foundlings they had nursed. This was a theme that foundling home officials everywhere would take up.(29)

In Bologna, as elsewhere, rural women infected by syphilis turned to the foundling home for financial help. In 1850, for example, officials received a plea from Luigi Piguatta, from a nearby hill town, asking for aid "so that he could place his wife, afflicted with a very advanced and dangerous case of venereal disease (as shown by the Medical Certificate), in some hospital or at least to provide him with the means of aid necessary to allow her to be treated as well as possible at home, because she now finds herself in the most deplorable state of misery." The petition went on to state that he was turning to the foundling home because "the above-mentioned disease was transmitted to his wife by a newborn from the Foundling Home, who after eight months living with them had to be returned to the Foundling Home in such a revolting state that the Foundling Home doctor himself marveled at how he had been able to hold on so long."(30)

Over the next two decades, while the Bologna ospizio physicians continued to look for signs of syphilis on the babies abandoned there, and to keep these children in a special part of the ospizio, they continued to send out all other babies as soon as they could. In 1866, for example, 24 women, on average, served as internal wetnurses in the ospizio at any one time, nursing an average of 37 babies. But since about 600 babies in all were left there that year, foundling home officials were under pressure to get the newcomers placed quickly. A report on the situation at the end of 1867 added another wrinkle: it was necessary, the author reminded the authorities, "to have a syphilitic wetnurse ready to take care of the syphilitic nursling." This was the best way the ospizio could deal with the foundlings who showed clear signs of congenital syphilis: without nursing they would die, yet they could not be given to a healthy woman to nurse.(31)

In 1877, in response to the large numbers of cases of wetnurse infection in the rural areas surrounding Milan, the Prefect of Milan issued an order to all mayors of the province. They were to see to it that every foundling up to three months of age living in their community be visited once a week by the town doctor to check for signs of syphilis.(32)

Like the Bologna foundling home officials, those in Milan were also concerned about the rising cost of payments to the women who had contracted syphilis while nursing the foundlings. Milan paid from 5 to 30 lire per month to each affected woman, the size of the payment varying by the seriousness of the case and the number of family members who had contracted the disease.(33) Not only was it common for a woman so afflicted to infect her husband, but often her younger children, still nursing, also became syphilitic.(34) Moreover, the common practice of sharing wetnursing responsibilities among family members (as seen in the Bologna case of the two sisters above), meant that other women and their families might be infected by the same baby. In one (albeit extreme) Milan case in 1892, for example, a single syphilitic foundling infected four women who in turn gave the disease to five of their children. The foundling home provided financial assistance to all of them.(35)

Indeed, over the last three decades of the nineteenth century, the Bologna foundling home was paying on average 4000 lire per year in payments to wetnurses who had contracted syphilis from the babies.(36)

Concern both for this cost and for the human tragedies caused by the spread of syphilis to rural wetnurses led to a request by a provincial commission for more information from the foundling home about the nature and extent of the problem. The result was a report in January 1884 prepared by Dr. Cesare Belluzzi, director of medicine for the Bologna ospizio and its associated maternity hospital. Belluzzi's response was typical of foundling home physicians of the period in taking a defensive tone, in particular in rejecting any responsibility on the part of the foundling home for the spread of syphilis to wetnurses. He began by recalling that "the question of impeding the spread of syphilis by way of the nursing of foundlings is of ancient origin and very difficult solution, since this disease, inherited from the parents, may not only manifest itself in the first days of life, but often after two or three months, and sometimes only after six or nine months." Yet, Belluzzi warned, keeping the foundlings in the ospizio until it could be known that they were not syphilitic, "as some not well versed on the subject would propose, would require a facility ten or twenty times larger and, moreover, would lead to such a horrifying level of mortality ... as to be unthinkable." Therefore, he concluded, "some cases of the spread of syphilis from the foundlings to the wetnurses are unfortunately inevitable."

The doctor went on to list all the measures taken by the ospizio to minimize this danger. A growing number of the babies left at the foundling home were coming from the maternity hospital annexed to the ospizio, founded in 1861, where many unwed women came to give birth. All such women were closely examined for signs of syphilis. Belluzzi, however, sounded the warning that even in cases where the woman was found to be healthy, there could be no assumption that the child was free of congenital syphilis, for one could not be sure that the child had not been infected by the father's sperm, and the father was never identified.

Midwives from both city and countryside were instructed "that every time they take to the ospizio a child born to a woman whom they have found to be affected by a disease of the genital organs, they not forget to warn [the authorities] at the time they present the baby." The foundling home had recently devised a form for the midwives to fill out for this purpose. Indeed, later in 1884, the director of the Bologna Foundling Home sent out a circular to mayors of all rural communities in the province announcing the continuation and redesign of the form, which was to be completed by every midwife bringing a foundling to the ospizio. Four questions were to be answered regarding the mother, who would remain anonymous: 1) Is she currently infected with syphilis? 2) If she cannot be declared infected, is there some suspicion? 3) Was she ever infected in the past? 4) Had she ever in the past had any suspicious illness?(37)

Once the foundlings were admitted to the ospizio, other precautions were taken. The recruitment of internal wetnurses was carried out principally among the unmarried women who gave birth in the ospizio's maternity hospital. In order to become regular wetnurses in the ospizio they had to pass a careful inspection and be free from even the suspicion of syphilis. These women, in turn, were to be given only those babies whose origins gave rise to no suspicion of syphilis and who presented no physical symptom of the disease. "The nurses and the wetnurses are expressly and repeatedly reminded," the doctor stated, "that each woman give her milk only to those children who have been directly entrusted to her, without exchanging the babies among themselves."

The potential wetnurses who came from the maternity hospital and who were diagnosed with syphilis were taken to the hospital ward at the ospizio, where the syphilitic infants and other babies suspected of having syphilis were also taken. The women nursed these children, although when there were not enough syphilitic wetnurses, the infected babies were given artificial feeding. Those children who were suspected of having syphilis but who showed no definite signs of the disease were also kept in this unit, but given only artificial feeding to avoid the possibility that an uninfected child would become infected by a syphilitic wetnurse.

If, then, rural wetnurses were contracting syphilis, the doctor argued, it was not the ospizio's fault. Rather, "it happens due to the negligence of the wetnurses themselves, who do not bring [the babies] back to the ospizio, as they were told to do, as soon as they present some suspicious sign, but also unfortunately due to the fact that some town doctors either do not visit the children promptly when they are called, or diagnose the first symptoms as simple cases of dermatitis."

Belluzzi noted that the women who came to the ospizio to take in an infant often beseeched the doctors to give them healthy babies. To this request, he wrote, the doctors always responded "that at the time of their departure the children appear healthy, but that beyond that nothing can be guaranteed, because generally they don't know the mother, and never know who the father is. And they repeat that should the baby present any sign of illness, [the woman] should return the child to the ospizio." The women were especially warned to look for any sign of infection around the mouth or genitals. Women who returned babies who showed signs of syphilis could not be given a new infant to nurse immediately, as they often requested. They were told to wait 10-15 days and only if they showed no incipient sign of syphilis were they given another child.

The foundling home doctor concluded his report by defending the ospizio against two separate cases of women who claimed to have contracted syphilis by nursing foundlings. This defense echoes themes found in many subsequent cases. In one case the doctor accused rural families who had contracted syphilis not only of using the foundlings as "scapegoats", but in fact covering up for having themselves infected the healthy child. In the other, he denied that the foundling in question had ever suffered from syphilis (having died from some other ailment) and hence claimed that the child could not have transmitted syphilis to the wetnurse.(38)

The following decade saw a growing number of disputes between the foundling home and rural families over responsibility for the spread of syphilis, and a greater tendency of the complainants to take their case to civil court.

In 1892, following a number of other such cases, Amalia Bagnacavalli and her husband, of the rural community of Vergato, brought just such a suit against the Bologna ospizio. They claimed that Amalia had contracted syphilis from a foundling that the ospizio had given her - a foundling whom she did not initially want to take because it looked so sickly. The child, diagnosed as syphilitic a few days later by the town doctor of Vergato, was returned to the ospizio, and shortly thereafter Amalia developed signs of syphilitic sores around her nipples. Before long, her own three-year-old child, who had begun to nurse again, died after showing symptoms of syphilis, and her husband too had become infected. In a series of lengthy briefs lawyers for the ospizio argued that the foundling had not in fact been syphilitic, and that even if she had been the ospizio should bear no legal responsibility for the infection, as their staff had followed proper procedures.

Although the initial trial court ruled in favor of the ospizio, an appeals court, in April 1894, overturned that verdict and ruled the ospizio responsible, directing it to make a monthly payment to Bagnacavalli and her husband.(39) This ruling, coming on top of other such suits, prompted a crisis. In order to avoid further liability, and probably also to reassure potential wetnurses, the ospizio took an action they had long opposed: they would now not send foundlings out of the ospizio until they had reached their third month.

The catastrophic result of the new policy for the foundlings is evident from the ospizio medical report covering 1898: infant mortality had gone up dramatically. In all, 474 newborns were left at the Bologna ospizio that year, of whom 59% died before their first birthday. But in fact the situation was even worse, for 132 of the babies had been born at the maternity hospital and in most such cases the mothers were now being required to nurse their own babies for the first three months. For those children whose mothers were not present to nurse them - that is those who were consigned to three months of bottle feeding - 74% died before reaching their first birthday.(40)

Conclusions

Writing of the foundling home system in Russia in the nineteenth century, David Ransel noted that the foundling traffic "though unusual among the trades operated by peasants, turned one of the money flows between city and village in the direction of the countryside." Observing that for the villages that were heavily involved in the foundling trade, these payments were a major source of nonfarm income, he concluded provocatively: "Whether or not this income was ultimately worth the costs to the villagers remains a question. Involvement in the trade exposed the villagers to a variety of harmful social and demographic consequences whose exact measure cannot be taken."(41)

In Italy, as in Russia, along with the money that the cities sent to the peasants of the countryside came an unwelcome gift in the form of syphilis. As Ransel observed, the exchange fit well into the image of the evil city using its allures to spread its poison to the wholesome countryside. We are not yet in a position to state with any certainty whether the extent of this contagion from foundling to rural wetnurse increased from the fifteenth through the nineteenth centuries, or even whether it did so over the course of the nineteenth century, when the number of abandoned children peaked in a number of countries. However, what is clear in the Italian case is that the infection of rural wetnurses by syphilitic foundlings came increasingly over the nineteenth century to be seen as a major public health problem, and one with dire consequences for the foundling homes themselves.

Various factors likely account for this change, which began under the ancien regime but which picked up speed with the establishment of the new Italian state in 1861. The new secular state in general devoted greater attention to problems of public health, and especially by the last decade of the century the spread of suffrage and the rise of the socialist movement had led to greater political concern for the well-being of the peasant population. These changes were being reflected in the legal sphere as well, where illiterate peasants came to have some chance of taking on major public institutions in court and winning, based on claims to rights of protection from harm.

Yet, if the efforts of the foundling home officials to deny responsibility for the spread of syphilis to the rural women who took in their little charges seem morally abhorrent to us today, we should not forget that they were motivated in no small part by a concern for the welfare of the babies entrusted to their care. No one knew better than the doctors and officials of the nineteenth-century foundling homes the price that the abandoned babies would pay for changing the system to ensure that rural women were not given syphilitic children to nurse. For every woman who would be saved, many children would die.

Departments of Anthropology and History Providence, RI 02912

ENDNOTES

This research was supported by National Science Foundation grant SBR-9515424. The author would like to thank Adanella Bianchi for her aid in the archival work in Bologna on which much of this article is based.

1. Archivio storico della Provincia di Bologna, Fondo Ospedale degli Esposti di Bologna, Corpo Amministrativo Centrale degli Ospedali (CACO), b. 4, dated 22 November 1889.

2. This only changed in most of Europe with the dawn of the twentieth century when pasteurization of milk became widespread.

3. The reasons for the concentration of foundling homes in the Catholic countries of Europe, and their relative rarity in the Protestant countries, is discussed in David I. Kertzer, Sacrificed for Honor (Boston: Beacon, 1993), 16-17.

4. based on figures provided in Giovanna Da Molin, Nati e abbandonati (Bari: Cacucci, 1993), 92.

5. On foundling infant mortality, see David I. Kertzer and Michael J. White, "Cheating the angel-makers: Surviving infant abandonment in nineteenth-century Italy" Continuity & Change 9 (1994): 451-480.

6. The number of years such payments were made varied greatly, but most commonly ranged from seven to fifteen. On the lives of foundling children, see Kertzer, Heather Koball, and White, "Growing up as an abandoned child in nineteenth-century Italy," History of the Family 2 (1997): 211-28.

7. On the subject of recruiting external wetnurses, see Kertzer, Sacrificed, 144-53.

8. Among these are: J. Boswell, The kindness of strangers (New York, 1988); M. Capul, Abandon et marginalite (Toulouse, 1989); G. Da Molin, Nati e abbandonati (Bari, 1993); R. Fuchs, Abandoned children (Albany, 1984); V. Hunecke, I trovatelli di Milano (Bologna, 1989); D. Laplaige, Sans famille a Paris (Paris, 1989); D. Ransel, Mothers of misery: Child abandonment in Russia (Princeton, 1988); J. Robins, The lost children: a study of charity children in Ireland, 1700-1900 (Dublin, 1989); and J. Sherwood, Poverty in eighteenth-century Spain: the women and children of the Inclusa (Toronto, 1988).

9. On Russian foundlings and the fear of syphilis, see Ransel, Mothers, 298.

10. I would like to thank Dr. Stanley Aronson, Dean of Medicine Emeritus, Brown University, and Dr. Edward Hook III, of the infectious disease department at the University of Alabama, Birmingham, Medical School, for their advice on syphilis transmission. However, responsibility for the interpretation articulated in this article is mine alone.

11. Claude Quetel, History of Syphilis, trans. by Judith Braddock and Brian Pike (Cambridge, UK, 1990), 9-11. A debate continues to rage regarding the origins of syphilis, with scholarly opinion now predominantly on the side of a New World origin. In this view, Spanish sailors traveling with Columbus brought syphilis back with them from the Caribbean.

12. The theory of the transmission of syphilis from the mother to the child during delivery itself, like the theory of transmission from the father's sperm and that from the mother's milk, was only shown to be erroneous with the beginning of the twentieth century.

13. Quetel, History, 131, 165.

14. P. Diday, A Treatise on Syphilis in New-Born Children and Infants at the Breast, transl. by G. Whitley (New York, 1883), 5, 7.

15. Diday, Treatise, 103.

16. Diday, Treatise, 40-43.

17. For Florence see G. Bruscoli, Lo Spedale di Santa Maria degl'Innocenti (Florence, 1900), 101 and G. Di Bello, Senza nome ne famiglia (Florence, 1989), 35.

18. David Ransel, Mothers, 298, writes: "the hue and cry about the spread of syphilis ... drew strength from the powerful metaphor of the corruption of national life by the diseased city."

19. Diday, Treatise, 153.

20. Emmanuele Bruers and Giovanni Berti, "Rendiconto medico statistico pel quadriennio 1879-1882," Bullettino delle Scienze Mediche di Bologna series 6, 15 (1885): 14, 25-6.

21. Enrico Raseri, "I fanciulli illegittimi e gli esposti in Italia," Annali di Statistica series 2, 19 (1881), 15; Laura Pellegrini, "L'esposizione dei fanciulli a Milano da 1860 al 1901," in Mariagrazia Gorni and Laura Pellegrini, Un problema di storia sociale: L'infanzia abbandonata in Italia nel secolo XIX (Florence, 1974), 189.

22. For the history of the Bologna Foundling Home, see Kertzer, Sacrificed, and F. Giusberti, Materiali per la storia dell'ospedale degli esposti di Bologna (Bologna, 1982); M. Fanti, "L'ospedale di San Procolo o dei bastardini ira medioevo e Rinascimento," in Amministrazione provinciale di Bologna ed., I bastardini: patrimonio e memoria di un ospedale bolognese (Bologna, 1990), 7-38; A. Bianchi, "'L'elemosina di un bambino': practica e controllo dell'abbandono all'ospedale dei Bastardini (secc. XVI-XVIII)," Sanita e Storia 2 (1989): 35-54; and Bianchi, "La 'famiglia' dell'ospedale tra XVI e XVIll secolo," in I bastardini, 39-52.

23. Fronzoni, "Una ruota," 64; Comune di Bologna, Ripartizione statistica, Annuario statistico 1970 (Bologna, 1971): 23.

24. Kertzer and White, "'Cheating," 451-80.

25. "Estratto della Radunanza del giorno di Lunedi' 5 Gennaro 1852," Archivio storico della Provincia di Bologna, Fondo Ospedale degli Esposti di Bologna, Allegati agli atti della Commissione Amministrativa (ACA), b. 81, fasc. 28 feb. 1853.

26. Given imperfect diagnostic techniques at the time, some of these cases may well not have been syphilis.

27. "Estratto della Radunanza del giorno di Venerdi' 16 Gennaro 1852," ACA, b. 81, fasc. 28 feb. 1853.

28. Again, how many of these women had in fact contracted syphilis from their foundling nurslings is not known. Not only might some unknown number of them have contracted syphilis in the usual way - through intercourse - and blamed it on the foundlings, but a certain number may have been misdiagnosed.

29. Bruscoli, Lo Spedale, 147.

30. "Luigi Piguatta....", ACA, b. 80, fasc. 6 nov. 1850.

31. "Relazione sull'Ospizio degli Esposti di Bologna, 21 Dic. 1867," CACO, b. 2, fasc. 1868.

32. Pellegrini, "L'esposizione," 185.

33. At the same time, agricultural and industrial workers earned about 1.5 lire per day for men and 1 lire per day for women; Kertzer and Dennis Hogan, Family, Political Economy, and Demographic Change (Madison, 1989), 37. The foundling home paid external wetnurses 9 lire per month.

34. It appears that many cases of the transmission of syphilis from recently infected women to their own children occurred because, following the return of the sickly foundling to the ospizio, the woman prompted her long weaned child to nurse again in order to keep her milk flowing and hence permit her to return to the foundling home later for a new child.

35. Ibid., 185-6.

36. Gianna Pomata, "Madri illegittime tra ottocento e novecento: Storie cliniche e storie di vita," Quaderni Storici 44 (1980): 537n47.

37. "Informazioni chieste dalla Provincia intorno a casi d'infezioni sifilitiche contratte da balie di esposti, 18 Dicembre 1884," CACO, anno 1884, titolo n. 13, rubrica n. 15.

38. "Provvedimenti contro la diffusione della sifilide alle balie di esposti, 16 Gennajo 1884," CACO, anno 1884, titolo n. 13, r. 15.

39. The series of legal documents are found in CACO, b. 5 (1891-1895), tit. 13, r. 9.

40. "1898 - Statistica sull'allattamento artificiale e slattati," CACO b. 6, tit. n. 13, r. n. 7, anno 1900.

41. Ransel, Mothers, 301.
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Date:Mar 22, 1999
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