J. WHITRIDGE WILLIAMS 193 



(c). Prophylaxis of toxaemic conditions which may cause 

 foetal or maternal death : Under this head are included the pre- 

 eclamptic and nephritic toxaemias, eclampsia and several other less 

 well-known conditions. As far as maternal mortality is con- 

 cerned, eclampsia is at present the most serious condition which 

 the obstetrician is called upon to treat, and yet this is insignific- 

 ant when compared with the foetal death rate associated with 

 it. Fortunately, the disease is usually preceded by well de- 

 fined and readily recognized premonitory symptoms pre-eclamp- 

 tic toxaemia which generally yield to intelligent treatment. 

 Accordingly, one of the prime duties of the obstetrician is to de- 

 tect and treat such conditions at the earliest possible moment, 

 in the hope of preventing an eclamptic attack. With this in 

 view, he should impress upon his patients the necessity for 

 the examination of the urine at frequent and stated intervals. By 

 so doing, it is possible to restrict greatly the occurence of eclamp- 

 sia, and thereby markedly reduce both foetal and maternal mor- 

 tality. 



(d). Detection of disproportion between the size of the child 

 and the pelvis: Formerly it was believed that pelvic deformity 

 occurred extremely rarely in this country, but with the rapid 

 development of urban life and its attendant unhygienic surround- 

 ings, it has become much more common, particularly in the 

 colored race. Contracted pelves were noted in 8 per cent, of the 

 white and 33 per cent, of the colored women delivered in the 

 Johns Hopkins Hospital ; and, while the disproportion in most 

 cases was not sufficiently great to cause serious trouble, yet in 

 many instances it was so pronounced as to necessitate radical 

 operative interference to save the life of the child. Therefore, the 

 physician should subject all women coming under his charge to 

 a routine examination some time before labor, in order to detect 

 this or other abnormalities, and, being thus forwarned, to be 

 prepared to resort at the proper time to whatever operation may 

 be necessary. Thus, Caesarean section done at an appointed 

 time at the end of pregnancy is almost devoid of danger, but 

 becomes very serious when performed upon patients who have 

 become exhausted by prolonged labor. 



Moreover, equally serious disproportion may exist when the 

 child is excessively large and the pelvis normal. The obstetrician 

 should always bear such a possibility in mind, although unfortu- 

 nately our means of ascertaining the exact size of the child 

 are not as accurate as we could wish. Such a complication is 

 frequently associated with a prolongation of pregnacy, and should 

 be suspected whenever labor fails to set in within a reasonable 

 time after the calculated date. In such cases a live child may 



