A FINAL WORD TO THE FELLOWS AND. MEMBERS OF THE AMERICAN MEDICAL ASSOCIATION
Journal of the American Medical Association (JAMA)
The duties and responsibilities of your presidents are such as to prevent them from addressing you frequently in your open meetings. That is why I avail myself of the courtesy of the Editor of The Journal which permits me to deliver a brief valedictory to my friends all over the country and to add some remarks in connection with the subject discussed in the inaugural address1 I delivered on June 4, 1912. Advancing years have added to the greatness of the edifice called the American Medical
... erican Medical Association. It has served you, its constituents; it has benefited the American people. From year to year its scientific work has expanded and its civic importance increased. Its Judicial Council and its councils on Health and Public Instruction, Medical Education and on Pharmacy and Chemistry, have submerged scores of inferior medical schools, enlarged knowledge, opened new horizons and fastened the links between all classes of citizens. Not to lag behind my own obligations as a citizen of the land and a physician of the people, I tried a year ago to trace for you a part of the neglected congenital and earliest causes of the 17 per cent, of the early infant mortality, which trace their origin to embryonal and fetal life, and to the dangers of parturition and vicissitudes of the first days and weeks of the new-born, The vast number of infant deaths and the still greater amount of woman's invalidism and decrepitude were merely referred in part to social shortcomings, to the prevalence of the sickly incompetencv which is called charit}', to the lack of state or municipal responsibility, and to the inefficiency of medical and other service. Such service when inadequately rendered by doctors and midwives and nurses has been frequently and vociferously censured for its inefficiency. Having shared in that kind of work part of these sixty years I bow my head with the rest of us, but I do not graciously submit to the reproaches heaped on the obstetric professors who always promise the achievements they expect in future of their medical students. On tbi! other band, I cannot agree with the complaint that when professors are teaching midwives, "medical students are deprived of their teachers' lime"; Dor do I. fear with a modern author lest the midwife compete with the physician. Thai has been said in earnest, still if is only ludicrous. I want here to repeat merely the objects of English midwifery schools, which are "the care of the expectant, woman, the conduct of normal labor, the care of babies immediately after birth, and the simple principles in an urgent ease of artificial feeding." At my time of life my opportunities to do good may not be many. That is why I refer in a few sentences to my discussion a year ago on what I considered the best means of combating infant mortality. The attention this topic has aroused has been close and various. Now a vast number of papers and pamphlets and books have been written to illustrate the subject of artificial feeding of the infant. It is no longer indicated, however, to rehash the fact that no less than 20 per cent, of the babies when fed on conscientiously selected artificial food will die before the first year of their lives terminate, while only 7 per cent, will be carried off when i\'ú on human milk. In the brief space at my disposal to-day I shall not return to that topic. I also directed your attention to the many causes of death acting before and immediately after birth. many of them not counted in mortality statistics. Indeed, officially, stillbirths are in most of our states not considered at all. One of those causes is the absence of proper attendance on the mother during pregnancy, and during and immediately after labor. 1 discussed the shiftless lack of attention paid to the expectant woman and to the necessity of teaching and licensing and supervising midwives.