194 WHAT THE OBSTETRICIAN CAN DO 



often be secured by the induction of labor, before the dispro- 

 portion has become so extreme as to necessitate radical interfer- 

 ence. 



(e). Rest and Food for Poor Women. Pinard and others 

 have clearly shown that the size of the child is to some extent de- 

 pendent upon the general nutrition of the patient and the character 

 of work which she performs during the last months of pregnancy. 

 If the food is insufficient or the work excessively hard, small pre- 

 mature children are frequently born ; whereas, if over-exertion is 

 avoided and a liberal diet supplied, normal children are born at 

 the proper time. 



My own observations show definitely that the children of well- 

 to-do patients weigh considerably more than those of free patients 

 in the hospital wards. This difference is particularly marked in 

 colored women, many of whom either from ignorance or lack of 

 thrift are imperfectly nourished, and we find that their children 

 weigh from one-half to three-quarters of a pound less than the aver- 

 age white child of well-to-do parents. This, however, is not an un- 

 mixed evil, and may even be looked upon as a compensatory pro- 

 cess ; for, otherwise, owing to the greater prevalence of contracted 

 pelves among the blacks, labor would prove extremely disastrous 

 if their children attained the same size as in white women of 

 the upper classes. 



(f). Preparation of the breasts for suckling: One of the 

 most important functions of the obstetrician during the latter 

 months of pregnancy is to see that the nipples are so treated as to 

 render them suitable for suckling, provided the milk supply is 

 satisfactory. Too great stress cannot be laid upon this point, 

 not so much on account of the actual effect upon the breasts, 

 but because of its suggestive and educational influence upon the 

 prospective mother. In my experience, the mere fact that the 

 patient knows that the physician expects her to suckle her baby, 

 if possible, is a potent means of persuading many women to 

 do so who would otherwise seriously object to it. More will 

 be said upon this point, however, when we take up the care 

 of the woman and child after delivery. 



III. AT THE TIME OF LABOR. By proper management at this 

 time, and by educating the poor to make more extensive use of 

 lying-in charities, the obstetrician can contribute markedly toward 

 still further diminishing the unnecessary loss of foetal life. 



(a). Substitution of radical operative interference for brute 

 force in the treatment of difficult labor: Until the rational em- 

 ployment of aseptic surgical technique had rendered the major 

 obstetrical operations comparatively safe, our only resource in 

 the presence of serious disproportion between the head and the 



