198 WHAT THE: OBSTETRICIAN CAN DO 



the cord, instead of the primitive and crude methods so generally 

 used. 



Formerly, lockjaw played a prominent part in the production 

 of infantile mortality, and among the negro population of the 

 South often led to the loss of 25 per cent of all newly born chil- 

 dren. In this case, likewise, infection with the tetanus bacillus 

 occurred through the stump of the umbilical cord, and was due to 

 dirty dressings and general filth. Following the application of 

 surgical principles in this regard the complication has entirely 

 disappeared from lying-in hospitals and the practice of intelligent 

 physicians, but it still causes many absolutely preventable deaths 

 among the lower classes. 



Very exceptionally, in lying-in hospitals, newly born children 

 may be infected with pemphigus, or even impetigo, by means of 

 underclothing which has not been satisfactorily sterilized. As 

 such conditions may end fatally, care should be taken that the 

 underclothes are of such a character as to be susceptible of ster- 

 ilization,, othewise economy in this regard may result in prevent- 

 able deaths. 



(c). Insistence upon maternal nursing: Aside from the purely 

 technical skill involved in effecting delivery in difficult cases, there 

 is no means by which the obstetrician can so successfully prevent 

 infantile mortality as by insistence upon the duty of the mother 

 to suckle her child. 



Before this Association it is not necessary to dwell upon the 

 value of breast milk as the ideal food for infants, so that I shall 

 limit my remarks to pointing out what the obstetrician may 

 accomplish in this respect. I feel that he can probably do more 

 than any other class of medical men, not excepting the paediatri- 

 cian, to persuade the young mother to suckle her child, and thus 

 become a centre for educating others. 



As has been indicated in the preceding section, the obstetrician 

 should see that proper means are employed during the last months 

 of pregnancy to prepare the nipples to withstand the strain of 

 suckling. This is most important, not only for its direct physical 

 effect, but even more so for its educational and suggestive influ- 

 ence ; as it serves to impress the prospective mother strongly with 

 the idea that she is expected to feed her child, and that she must 

 be prepared to take some trouble to do so. Not infrequently 

 the patient may regard such precautions as useless, on the ground 

 that she does not expect to nurse her child. In this event, it 

 is not always advisable to lay down the law too strongly, but 

 instead one should make the patient feel that she will be ex- 

 pected to do so only for a short time and then only for her 



