506 PEDIATRICS 



in the art of obstetrics to such an extent that it has become pos- 

 sible by Cesarean section not only to save the fetus of a living, 

 but also of a dead mother, for the fetus in her may survive the 

 dying woman. 



But after all, many a baby would be better off, and the world 

 also, if it had died during labor. There are those, and not a few, 

 who are born asphyxiated on account of interrupted circulation, 

 compression of the impacted head, or meningeal or encephalic 

 hemorrhage, which destroys many that die in the first week of life. 

 Those who are not so taken away may live as the result of pro- 

 tracted asphyxia only to be paralytic, idiotic, or epileptic. Many 

 times in a long life have I urged upon the practitioner to remember 

 that every second added to the duration of asphyxia adds to the 

 dangers either to life or to an impaired human existence. Be- 

 sides fractures, facial or brachial paralysis, cephalhematoma and 

 hematoma of the sterno-cleido mastoid muscle, gonorrheal ophthal- 

 mia, with its dangers to sight and even life, may be daily occur- 

 rences in an obstetrician's life. All such cases prove the insuffi- 

 ciency of knowledge without art, or of art without knowledge, 

 and the grave responsibility of the practical obstetrician. To lose 

 a newly-born by death causes at least dire bereavement; to cripple 

 his future is not rarely criminal negligence. 



Within a few days after birth the obstetrician or the pediatrist 

 has the opportunity of observing all sorts of microbic infections, 

 from tetanus to hemorrhages or gangrene, and the intense forms of 

 syphilis. Not an uncommon disease of the newly-born and the very 

 young is nephritis. It is the consequence, in many cases, of what 

 appears to be a common jaundice, or of uric acid infarction, which 

 is the natural result of the sudden change of metabolism. The 

 diverticula of the colon, as described by Hirschsprung and Osier, 

 and what nearly 40 years ago I characterized as congenital consti- 

 pation, which depends on the exaggeration of the normally excessive 

 length of the sigmoid flexure, belong to the same class. Their 

 dangers may be avoided when they are understood. Of the infec- 

 tious diseases of the embryo and the fetus, it is principally syphilis 

 that should be considered; amongst the acute forms variola and 

 typhoid are relatively rare. 



What I have been permitted to say is enough to prove the inti- 

 mate interdependence and connection between pediatrics and the 

 diseases of the fetus with embryology and teratology, obstetrics, 

 and some parts, at least, of social economics. 



After birth there are anomalies and diseases which are encountered 

 in the infant and child only. There are also, common to all ages, 

 though mostly found in children, such as exhibit a symptomato- 

 logy and course peculiar to them. The first class, besides those 



