j. WHITRIDGE; WILLIAMS 199 



own welfare; as experience teaches that the uterus returns to its 

 normal state more rapidly, and is less liable to become involved 

 in disease processes when the breasts are used physiologically. 

 Following the birth of the child, the same argument can be 

 used with even greater success, as we know if a woman can be 

 induced to suckle her child for a few weeks on any pretext 

 that she will continue to do so for as long as may be necessary. 

 Moreover, the tedium of nursing can be greatly diminished, if 

 one or two artificial feedings be interpolated each day, thereby 

 relieving the patient from the slavery of being obliged to return 

 home every few hours, and making it possible for her to have 

 an entire morning, afternoon or evening free whenever desir- 

 able. By the exercise of a little tact and firmness it is possible 

 to induce most private patients to do as we desire; and I can 

 recall only a single one, with an abundant supply of milk, who 

 refused, as compared with a large number who have been induced 

 to suckle their children after having repeatedly stated that noth- 

 ing would induce them to do so. 



It is generally stated by those in charge of lying-in hospitals 

 that, while one can usually persuade private patients to fulfill 

 their duty in this regard, it is impossible to do so with ward 

 patients. No doubt many women, and especially those illegiti- 

 mately pregnant, do not wish to suckle their children, as they 

 hope to get rid of them by placing them in an institution as soon 

 as born. I have been able to overcome this difficulty at the Johns 

 Hopkins Hospital by compelling all patients to retain their chil- 

 dren as long as they remain in the ward. Insistence upon this 

 rule usually kindles affection, and has resulted in many women 

 permanently keeping and suckling children, which they had orig-. 

 inally intended to "place out." 



Great good may also be accomplished by co-operation between 

 the lying-in hospital and some association interested in the care 

 of children and the propaganda for maternal nursing. In my 

 service, we have been fortunate in being able to avail ourselves 

 of the services of the Maryland Association for the Prevention of 

 Infantile Mortality. One of its workers visits the ward weekly 

 and offers each recently delivered woman to supervise the care 

 of the child after she leaves the hospital. The proposal is usually 

 thankfully accepted, and the reports which we have received show 

 that highly satisfactory results have been obtained, and indicate 

 that a surprisingly large number of women have continued to 

 suckle their children with almost ideal results. If this can be 

 accomplished here, it indicates that those who claim to be less 

 successful have not done their full duty by their patients, as they 

 have failed to insist upon the most efficient and economical means 

 of carrying out the object of this Association. 



