192 WHAT THE OBSTETRICIAN CAN DO 



for the condition rests with the patient, who has already received 

 abundant warning; although it may become the duty of the 

 physician to give advice concerning the prevention of concep- 

 tion in order to prevent such an eventuality. 



II. DURING PREGNANCY. If the term prevention of infantile 

 mortality can be understood to include the various measures 

 which may be taken to increase the probability of a satisfactory 

 outcome of pregnancy and the birth of a normal child, the 

 obstetrician has abundant opportuntities for giving such advice. 



(a). Hygiene of Patient: The general hygiene of the patient 

 should be carefully supervised and such rules laid down for her 

 guidance as are most likely to result in the birth of a healthy 

 child. This should include advice concerning the diet, the care 

 of the excretory organs, and the general mode of life. It is 

 highly important to insist upon the pregnant woman obtaining 

 abundant rest and sparing herself as much as possible. This is 

 particularly important among the lower classes, as it is well 

 known that hard labor during the latter months of pregnancy 

 tends to its premature termination and to the birth of puny and 

 undersized children. Likewise, care should be taken that the 

 women abstain from working in factories where arsenic, phos- 

 phorus and similar substances are used, as to do so exposes 

 them to a much greater liability towards premature labor. 



(b). Treatment of threatened abortion and premature labor: 

 Wherever an abortion is threatened, it would seem axiomatic that 

 the obstetrician should exert every effort to prevent its occurrence. 

 The patient should be put to bed, carefully watched and sub- 

 jected to appropriate treatment, which in many cases will avert 

 the danger. In other cases, however, the symptoms may persist, 

 or may recur after having temporarily subsided, and the question 

 arises as to how long one is justified in attempting to avert what 

 appears to be inevitable. Formerly, it was taught that treat- 

 ment should be persisted in until the emergency had passed, or 

 the abortion had actually occurred. At present, however, in- 

 creased knowledge concerning the important part played by cer- 

 tain foetal deformities in the causation of abortion makes it 

 questionable whether such a procedure is altogether justifiable, 

 and whether it would not be better to allow Nature to take her 

 course after a reasonable attempt at prevention had been made. 



As syphilis and chronic nephritis are the most frequent causes 

 of repeated premature labor, it naturally follows that the treat- 

 ment of such conditions in the pregnant woman offers a wide 

 field for the prevention of infantile mortality, as it is only 

 by such means that one can hope for the birth of a viable child. 



