Over 20,000 women die in childbirth each year in the United States, and about 100,000 infants, and more or less permanent injury from parturition is almost general in mothers. The mortality in the trenches during the present great war is 2 per cent.; the mortality of infants during the first year is 14 per cent. Very much of this mortality and invalidism is attributable to lack of skill in the licensed unfit. We commonly deem parturition merely a physiological process, and for that reason the state permits ignorant midwives and quacks to take upon themselves with impunity the responsibility and the risks of delivery. It is difficult to draw the line between normal and abnormal parturition, but every labor, as women now are in civilized countries, should be regarded as a grave surgical operation, and the indications that must be met in a surgical operation are likely to occur in almost any parturition. The strength of the patient, the condition of the heart, lungs, kidneys, and blood, sepsis and antisepsis, the nature and technic of the various operations that may be required, and the complications that may arise, are all to be understood and met conscientiously. No physician who has any regard for morality and his own reputation now will accept an obstetrical case unless he has had the woman under frequent observation for months before delivery. If the mother or child dies because of the bungling or surgical uncleanness of the physician or midwife,--and unfortunately such deaths occur almost hourly,--this physician or midwife is guilty of murder. There may be an abnormality of the uterine or abdominal muscles used in parturition, a disproportion between the parturient canal and the child, or various accidents of labor; and these conditions are so frequent in occurrence and so grave that their removal requires great medical skill, fine discernment, quick and exact judgment, and often decidedly courageous purpose.