220 MEDICAL SCHOOLS AND INFANT MORTALITY 



children. Too few institutions treating children are under control, 

 or even under the supervision or advice of medical schools. 



The possibility of using obstetric services for instruction in 

 pediatrics as covering the conditions of the first few weeks of 

 life has apparently been overlooked, though it would be a 

 great mistake to have the teaching done by an obstetrician, 

 judging from the feeding practiced by the specialized obstetrican. 

 Speaking of obstetrics, it is hard to realize that "more than 6,000 

 women die annually in the United States during confinement," 

 according to the Council. The prevention of a part of this tre- 

 mendous mortality, in number at least, if not in percentage, would 

 be possible if the teaching of obstetrics were on a higher plane. 



"Thirty per cent, of the blind are so because of the insufficient 

 knowledge of the obstetrician." This, again, is on the authority 

 of the Council. The common midwife has made a better record 

 in the matter of ophthalmia neonatorum than the medical attend- 

 ant in the City of New York and in Massachusetts, though 

 not in Maryland. Have tjie teachers of obstetrics present- 

 ed the importance of this ophthalmic duty to the child, to 

 their students? The annual loss of mothers during child birth 

 i? in itself at the bottom of no small part of the infant deaths 

 that are roughly classed as due to artificial feeding. 



The most difficult phase of pediatrics is infant feeding. Pos- 

 sibly that is the reason that so many colleges do not approach 

 the subject. Even Johns Hopkins has no required course in 

 infant feeding, nor indeed is it impossible for a student to gradu- 

 ate from this most excellent school without any particular train- 

 ing in pediatrics, for the subject is merely rated as an elective 

 in the curriculum. 



Infant feeding should not be taught dogmatically with a lot 

 of formulae arranged in some incomprehensible manner like an 

 algebraic formula and as soon forgotten. The principles of infant 

 feeding should be given. There should be ample instruction 

 didactically and clinically, in the method of varying the con- 

 stituent parts of milk, so as to adjust them to the age and diges- 

 tive capacity of the indivdual children under observation. The 

 evidences of incorrect feeding should be taught from a study of 

 the vomitus and the stools, not merely theoretically in a lecture 

 room. At the present there is too much dogmatism in the teach- 

 ing of infant feeding, and too little teaching students how to 

 feed. The result is shown in the general ignorance of prac- 

 titioners upon the subject of infant feeding. Sufficient emphasis 

 is not placed upon the dangers of artificial feeding. The high 

 mortality among children not breast fed should be given promi- 

 nence and men should be encouraged to continue babies on the 



