In view of all the difficulties by which the problem is surrounded, the uncertain results which have attended some of the most intelligent and sincere efforts in that direction, he would be foolish indeed who ventured to dogmatize upon the reduction of the infantile death-rate, or the best methods to be adopted toward that end. There are, however, certain well-established facts, certain verities, upon which I would insist. It is perfectly obvious, for instance, that every child should be ushered into the world with loving tenderness, and with all the skill and care possible. The slightest blunder of an incompetent, unskilled midwife may involve fatal consequences to mother or child, or such injuries as are irreparable.[153] So that the very first principle upon which everybody agrees, theoretically at least, involves the need of important legislative reform providing for the supervision of midwives, and the establishment of a system of training and education without which no midwife should be allowed to practise. That such a law would have the effect of materially lowering the rate of infant mortality, as well as that of mothers, no one who has ever given the matter serious consideration can doubt. From personal observation, and the testimony of gynecologists and obstetricians of large experience, I am satisfied that this reform alone would save many hundreds of lives each year, alike of mothers and infants. It is appalling to think of the large number of ignorant women who are practising as midwives. Many of them have no conception of the importance of their work; they are often dirty and careless, as well as ignorant of the first principles of obstetrical science. Knowing nothing of the need or value of antiseptic precautions, they are responsible for thousands of cases of blood-poisoning every year, and because they are ignorant of the methods of restoring asphyxiated infants they kill thousands of babes in the passage from the wombs of their suffering mothers.[154]