224: DISCUSSION 



which stirred the audience as I have rarely seen an audience stirred. I 

 recall a plea for training students in refraction. There is not a sub- 

 ject one will interest himself in that may not seem equally important. 

 We cannot send the student out adequately trained in any subject; the 

 most we can hope to do is to give him broad general principles and put 

 him in a way to continue his education. He will not by any possibility 

 be adequately trained in preventive medicine or in any aspect of it when 

 he passes from the medical school, but he should be in a position to know 

 the importance of the subject, and if his interest lies in that direction, 

 he should be in a position to carry out those functions; he should be in 

 a position, in other words, to carry on his education. Then it would 

 be a great misfortune if a medical school without adequate facilities 

 pretended to send its students out trained in these subjects; pretended to 

 train men in public health. I should not like to see the Johns Hopkins 

 announce a diploma of training in general health. We need larger 

 resources. These results cannot be obtained without a provision of 

 adequate facilities. A hospital for sick children should be provided for 

 the use of the medical school. Such a hospital, I believe, would be of 

 far more service to the community if it establishes a relation with the 

 medical school, but experience shows how difficult this is. At the Hopkins 

 we do not consider that our department of pediatrics is now ade- 

 quate, but we hope that with the opening of the hospital for children, 

 we shall have something excellent to show in the way of pediatrics. 



Dr. Frank Warner, Columbus, O.: I was a little surprised at 

 the statement of the speaker that the record of the midwife in New 

 York in the prevention of ophthalmia neonatorum was better, than that 

 of the physician. And while he was making that statement, and urging 

 that better teaching be provided it occurred to me that inasmuch as 

 there has already been a considerable amount of teaching in all medical 

 colleges to the physicians, or to the students who are to become physi- 

 cians, in the prevention of disease if this is to be the result, that with 

 this teaching already instituted, the physcian does worse than the 

 untrained midwife, what are we going to look for when the teaching 

 is still greater? 



If the midwife does better than the physician it is unfortunate. I can- 

 not think this is the universal experience everywhere. It would be 

 poor encouragement to study if it were true. Physicians should see to 

 it that every case of obstetrics they attend receives sufficient subsequent 

 attention not to permit such a charge to justly stand against them. A 

 poor patient is entitled to careful and consciencious after care. If the 

 physician gives this his results should show better than the midwives'. 

 With proper care it will. 



Dr. S. Josephine Baker, New York: In regard to ophthal- 

 mia neonatorum there are fewer cases in New York among the midwives 

 than among the physicians. One reason, perhaps, that can account for 

 that is the fact that during the past two years the midwives have been 

 required to use silver nitrate solution in the eyes of all new born babies, 

 and as far as I have been able to investigate, I find that this practice 

 is not so prevalent among the medical profession. That may have some- 

 thing to do with the condition as it exists at the present time. We do 

 not know of all the cases, but as far as we do know of them, and we 

 investigate the midwife situation pretty thoroughly, there are fewer cases 

 among the practice of midwives than among the practice of the doctors. 



Dr. W. D. Hoskins, Indianapolis: It seems to me that there 

 should be some exceptions to the statement that teachers of diseases of 



