J. WHITRIDGE WILLIAMS 197 



as irremediable and treated expectantly, with the result that 

 many of the children died during the first few days of life, 

 while others, which appeared to do well at the time, later de- 

 veloped serious troubles resulting from brain injury, such as 

 idiocy, epilepsy and various paralyses. 



The investigations of Gushing, Commandeur and others have 

 shown that such consequences may be avoided by certain opera- 

 tive procedures, and have taught us that the newly born child 

 can survive most radical operations upon its skull and brain. 

 For this reason, all babies presenting head injuries should be 

 promptly seen by a competent surgeon, who should be encouraged 

 to operate upon them in the hope of saving life or averting seri- 

 ous after-consequences. Occasionally, even in children who have 

 sustained no visible injury, symptoms indicative of compression 

 of the brain or of increased intra-cranial tension may appear a 

 few days after birth. They should likewise be referred to the 

 surgeon, as a properly performed decompression operation or 

 the removal of a blood clot may save life or prevent the sub- 

 sequent development of epilepsy or various paralyses. 



In the past many physicians hesitated to take such action, as 

 they felt that the condition might be attributed to unskillful 

 treatment on their part. We now know that such is not the case, 

 as in many instances serious intra-cranial haemorrhage may occur 

 after comparatively easy spontaneous labor. I feel very strongly 

 that surgical interference of this kind can be consistently recom- 

 mended, as it will save many children who formerly perished; 

 more particularly, as we know that death is not the worst termi- 

 nation, as many children who survive without operation later 

 develop into idiots, epileptics or worse. 



(b). Prevention of infections of the newly born: On this 

 occasion it is scarcely necessary to refer to the wonderful de- 

 crease in blindness following the prophylactic employment of 

 Crede's instillations, and the prompt and radical treatment of 

 gonorrheal ophthalmia. I wish, however, to insist particularly 

 upon the necessity for the aseptic treatment of the stump of 

 the umbilical cord as a means of preventing infantile mortality. 

 Prior to the introduction of antiseptic precautions, thousands of 

 children died each year in the large lying-in hospitals from in fee- 

 ton arising from the umbilical stump, and a small number still 

 perish, notwithstanding every precaution. On the other hand, in 

 the practice of many midwives and poorly trained physicians the 

 death rate from this cause is still unabated, and the condition 

 should be suspected whenever children die in the first days of 

 life without symptoms indicative of some well marked disease. 

 This mortality is almost entirely preventable, and can be done 

 away with by employing modern aseptic technique in the care of 



