196 WHAT THE: OBSTETRICIAN CAN DO 



antiseptic times, and is now the safest place in which one can 

 be delivered. I am convinced that the poorest women in the free 

 wards receive absolutely better treatment than wealthy patients 

 in their own homes, not to speak of the opportunity for rest, 

 the freedom from anxiety, and the instruction which they receive 

 in the care of their children. 



We are prone to forget how great the improvement has been 

 along these lines. Formerly from 3 to 10 per cent, of all women 

 delivered in lying-in hospitals died from puerperal infection, as 

 compared to a fraction of 1 per cent, in their own homes; at 

 present, however, the conditions are reversed and fewer women 

 now die in hospital than in private practice. This is in great 

 part due to the fact that an appreciation of the great value of 

 the aseptic conduct of labor has not yet permeated to the poorer 

 type of physician, and still less to the midwife. 



We hear a great deal of the necessity for improving the status 

 and mode of education of the midwife; and, while perfectly 

 willing to admit all of her imperfections, I am, nevertheless, some- 

 what sceptical of the good which may be accomplished in this 

 respect in this country. I am inclined to believe that in the larger 

 cities her gradual annihilation should be our aim, although I 

 am not so certain that it will be advisable in poor and sparsely 

 settled country districts. On the other hand, judging by my 

 own experience, I believe that the ordinary midwife does no 

 more harm, if as much as the poorly trained doctor. While 

 it is true that she causes a certain number of deaths by infec- 

 tion, yet the latter will kill many more patients by ill judged 

 and unnecessary operative interference. I, therefore, consider that 

 this Association can accomplish more good, and do it more 

 quickly, by agitating for better obstetrical training for medical 

 students throughout the country, than by attempting to regulate 

 the midwife problem. 



IV. AFTER LABOR. Following the birth of the child, the ob- 

 stetrician may contribute greatly to the prevention of infantile 

 mortality not only by meeting such medical and surgical com- 

 plications as may arise, but also by insisting upon certain edu- 

 cational measures. 



(a). Prompt repair of injuries to the child. Immediately fol- 

 lowing its delivery, the child should be examined thoroughly for 

 the purpose of detecting any abnormality or injury, as it may 

 happen that the prompt recognition and treatment of such con- 

 ditions may be the direct means of saving life or preventing 

 chronic invalidism. This is especially necessary after difficult op- 

 erative labors in order to detect the presence of fractures or de- 

 pressions of the skull. In times past such injuries were regarded 



