DISCUSSION 225 



children were the ones against whom criticism should be directed for 

 the lack of time and opportunity in the course of study. I rather ques- 

 tion the wisdom of such criticism. Dr. Wile, I think, went to the extreme 

 in that. It is not that the teachers of diseases of children would not like 

 to have more time, greater facilities, better opportunities to elaborate 

 on these preventive measures, but it is impossible to accomplish better 

 results in a short time and with limited means. As a rule the teachers 

 of diseases of children are careful, skillful men, who comprehend the 

 magnitude of the social problem as well as the details of their teaching 

 and, as far as I have been able to observe, the students who are going 

 out comprehend these things in a greater measure than we might infer 

 from the very enthusiastic paper we have just heard. It is impossible to 

 give the department of diseases of children all the time they want just 

 as it is impossible to give all these other specialties all the time they 

 want. But, I do think that a creditable showing is being made in prac- 

 tically all of the medical schools in the way that they are training the 

 young physicians in prophylaxis and in recognizing the wide and far- 

 reaching importance of the proper care of infants. 



Dr. Wile (closing): I trust that Dr. Welch has not misunderstood 

 that I am advocating that institutions put in departments of public health 

 simply for the purpose of teaching the lessons regarding infant mortality. 

 This is an essential part of the work belonging to a department treating 

 of the diseases of children. Inasmuch as between 40 and 50 per cent, of 

 infantile deaths are preventable, the stress of pediatric teaching should 

 be placed upon preventive medicine. The same condition does not hold 

 as true among the other diseases taught in other departments of medicine. 



As to the amount of ophthalmia neonatorum occurring among the babies 

 delivered by midwives being less than among those delivered by doctors, 

 I may say that possibly it is due to the fact that podiatrists do not 

 lecture about the care of the eyes of the new-born. This is only lightly 

 touched upon in the department of obstetrics. Consequently if the teacher 

 of pediatrics considered the importance of preventive medicine, there 

 would probably be greater attention given to the necessity for prevention 

 of eye infections of the new-born. 



As to the criticism of Dr. Hoskins, regarding his experience in the 

 investigation of various medical institutions, I found that the average 

 amount of time given in a course of pediatrics in the United States 

 was sixty to seventy-five hours ; the longest, 125 hours ; the smallest, none. 

 I am not blaming individuals for the lack of instruction in preventive 

 pediatrics; I am criticising schools that fail to give this course in their 

 curriculum. 



