J. WHITRIDGE WILLIAMS 201 



This being the case, I am inclined to believe that the best we 

 can do for such children is to admit them for a short time to a 

 specially equipped observation ward in a well conducted hospital, 

 where they can be given every possible care, and afterwards, in 

 case a negative Wasserman reaction shows that they are free from 

 syphilis, to place them under supervision in the homes of poor 

 women who are ready for a moderate compensation to suckle 

 and care for them as their own. 



(e). Condition of the mother at the time of discharge. Many 

 obstetricians feel that they have discharged their full obligations 

 to their patients as soon as the first weeks of the puerperium have 

 elapsed. I consider, however, that they have not been fulfilled 

 until it is possible to discharge the patient in good health and 

 with her genitalia in such condition as will offer a reasonable 

 guarantee for future child-bearing. 



With this object in view, every patient should be subjected to a 

 careful examination three or four weeks after delivery in order 

 to detect the presence of any abnormality. At that time retro- 

 displacements of the uterus readily yield to appropriate treat- 

 ment; while, if not recognized until they give rise to symptoms 

 at a later period, operative interference will usually be necessary 

 for their cure. Lacerations of the cervix and perineum should be 

 recognized and repaired if necessary. Similar precautions should 

 be taken after the occurrence of abortion, and are particularly 

 necessary if the condition were complicated by infection. 



Routine examination of this kind is essential not only in the 

 immediate interests of the patient, but also for its bearing upon 

 future pregnancies. Many women date the beginning of their ill 

 health to the first labor or miscarriage, and I know of no means 

 so fruitful in preventing invalidism as the prompt recognition and 

 treatment of such abnormalities. Moreover, their persistence is 

 a frequent cause of future sterility, subsequent abortion or pre- 

 mature labor, as well as of some of the more serious complications 

 of labor such as placenta praevia with its ominous prognosis 

 for the child. If we can stretch the conception of the prevention 

 of infantile mortality to this extent, I know of no other prophylac- 

 tic measure by which the life of so many children can be saved. 



