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U. S. DEPARTMENT OF LABORJAMLS J. DAVIS, Serctary

CHILDREN'S BUREAUGRACE ABBOTT.Chid

THE PROMOTION OF THE WELFAREAND HYGIENE OF MATERNITY

AND INFANCYTHE ADMINISTRATION OF THE ACT OF CONGRESS

OF NOVEI\{BER 23. I92I

FISCAL YEAR ENDED JUNE 30,1928

I

Bureau Publication No. 194

, UNITED STATLS

GOVERNMENT PRTNTING OFFICE

VASHINGTON: 1929

For salc by thc Supcrintcndcnt of Demcnts, Warhington, D. C. . Pricc 30 ccntr

Provided by the Maternal and Child Health Library, Georgetown University

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CONTENTS

Page

Letter of transmittal- vrrIntroduction- IFunds avaiiabie and acceoted bv the States-Summary o f S la te ac t iv i t les du i ing 1928- -

Personnel of the administrat ive staffs--------

1558

t2t21 3141 5161 a

Defects found at conferences-Countv heaith deoartments and countvHome visits-Local demonstrations of ma-ternitv ana

nurses_ - _

Provided by the Maternal and

i.r*cv i,;;g;;;; - - - -: ----Promotion of breast feedins-Prenata l care- - -Care durins and after confinement-Inspection bf maternity and infant homes-------Midwives-Classes for adults in infant and nrenatal car€--------Classes for eir ls in infant and chi ld care-------Instruct ionbf special groups in maternal and infant care-----------Talks and lectures- - -Prenatai Ietters and corresoondence courses-Distr ibution of l i terature- -Extension of the United States birth and death registration areas----Surve5's and campaigns- - ------- - -Maternal-rnortalitv studv- -Exprnsion of act ir : i t ies- --Organizations cooperating in the maternity and infancy rvork-------

Summary of results of operation of the maternity and infancy act-- -----Work x'ith racial sroups-Extension of the birth-and death resistrat ion areas--------Prosress in education of midwives----Reduction of morbidity and prevention of disease--The in fan t mor ta l i t v ra te - - - - - - - -The maternai mortal i tv rate-- - -- -- - -Letters from parents and physicians, and reports from field nurses---

Principat activitiei of tne individual States duririg 1928--A l a b e m a - - - - - - - - - -A r i zona - -A r k a n s a s - - - - - - - - - -Ca l i f c rn i a - - - -Co lo rado - - - - -Delarvare-Flor ida -Georsia - -Han'a i i -I d a h o . -I nd i a na - -Iow:r - -Kansas -K e n l u c k y - - - -l , o u i s i a n a - - - - - - - - -M a i n e - - - - - - -

181818192020202 l22232323,.L, A

2626282829D I

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Child Health Library, Georgetown University

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gCONTENTS

Principal activities of the individual states during l928-Continued. Paso--- :Nf l ;yd;d--- :-------- 80Mi.fiie';-- - - 83Minne"so ta - - - - - - - - - - - - - - 86Irlir.ir.ippi- - - 88Mir*" i i - - - - - 90Montana----- 93Nebraska- 95Nevada- - - - - - 98N"* t t " - -p t t t i .e - - - - - - - - - - 99N;; i;;-;_New Mexi'co- 105New York- L07N o r t h C a r o l i n a - - - - - - - - - - - 1 1 0N o r t h D a k o t a - - - - - - - - - - - - 1 1 2Ohio- _ _ 114Oklahoma---- Il7o G ; ; : - _ : _ _ _ - _ _ - - _ - - - - - l l eFe"ittyi"a"iu - 123Rhodd Island r27S o u t h C a r o t i n & - - - - - - - - - - - L 2 9Souttt Drt otu 132Tennegsee---- I34T e x a s - - - - - - 1 3 6u t t i t - - - - - - - - 1 3 9Vermont---- - 141vi.ti;ia----- 142Wa:hilgt""- - L45w"tfTi.si"ir- r47Wisconsii- -- - 149wt";Gs--- - r52

Federai admiiistration- -, - - L54Federa l s ta f i - - - - - - - - 154b;"f;i;;; oi State directors---- r54Promoti,on of birth registration- 155Sp""iut uuuittance to Siates------- 156Ai*"ur"tt and publications--------- 757

Appendixes:- - A. Text of the act for the promotion of the welfare and hygiene of

maternity and infancy, and of supplementary legislation------B. Administrative agencies and officers- -C. Maternal and infant mortalitv rates--------D, Publications and exhibite of the Children's Bureau bearing upon

maternal' infant, and child welfare and hygiene--

ILLUSTRATIONS

States acceptins the benefits of the act (map)-------Old and n6w t"ypes of midwife, South Car2lina: 1. Midwives of the old

tvpe. 2. A -niidn'ife

of the new t-vpe' 3. At the institute for negroiidwives. 4. A nurse midwife 1g-raduate of Bellevue l{ospital) w-hoserved as instructor in the institute --facing

Tvoe of home in a sparselv settled State (New Mexico) into which litera--ture oo infant anti pren-atal care is sent; children (Missouri) successful

i:r a six-point comletition (adjudged normal or corrected- i! 'r'ision,

hearing, t^hroat, teet'h, posture, ind weight); and a class for India! Sirls(Nebri'sta) in infant bird childcare

De'atfrs of infants under I year of age from aII causes and deaths under 1year of age from diarrhei and ent-eritis, per 1,0O0 live births; Delan'are,L92t-1927 _-_-

Trend of maternal mortal i ty; Indiana, l9l l-1927-Distr ibution of 182 chi ld-hei ' l th conferences in Kansas, 1927-28--------InJant mortality rates, by counties; Maine, 1920 and 1927 - -Counties receiving aici f<ir nursing services and distribution of maternity

and infancy *'ork, by counties, Montana-------Distributionbt cnita-n-eatth conferences and classes for women and girisl

Nebraska, L927-28 - - - - -

ro,1166168

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Distribution of maternity and infancy work, by counties; Nerr. Mexico,1922-t928___- 10{

Trend of infant mortality; Oregon, 1919-1927--- L20Trend of maternal mortality; Oregon, 1919-1927--- l2lDeaths of infants under I year of age from all causes and from diarrhea

and enteritis, per 1,000 live births; Pennsylvania, 1915-1927-- L24Deaths of children under 5 years of age from diphtheria, per 100,000 esti-

mated population of these'ages; Pennsylvania, 1915-1927 - I25Distribution of prenatal and child-health centers, by countiesl Wisconsin,

1927-28___-__ 151


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LETTER OF TRANSMITTAL

U. S. DnpaRrMElqtf oF LABoR,Crrrr,onnx's Bunnau,

Washington, Ju,tru 8, 1928.Sm: There is transmitted herewith the repo'rt oi the" adininistra-

tion of the maternity and infancy act for the fiscal year ended June30, 1928, prepared irnder the di-r.ection of Dr. Blanche II. Haines,director of the maternitv and infant-hvgiene tlivision of the bureau.

Bespectfully submitteil

Ifon. Jauns J. Davrs,Secreta;ryt of L&or.

Gnacp Annorr, (hief.


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THE PROMOTION OF THE WETFARE AND HYGIENEOF MATERNITY AND INFANCY

Congress in J-anuary,

INTRODUCTION

At the close of the fiscal year 1928 all the States in the lJnionexcept three,r also the Territory of Hawaii, wele cooperating underthe firovisions of the act for the promotion of the welfaie and

-hygiene

of inaternity and infaney knbrsn as the Sheppard-Towneilct,which was $assed by the Sixty-teuenth Congress and approved bythe Presidei,t on N6vember 2d. 1921. and wdLs extended to includ-eHawaii on March 10, L924.

The appropriatiori authorized by the act-was $1,240,000 for a5-year p6iioa ending with the clos"e of the fis-cal yeir 1927. This

1929.and at the same the providing for theJune 30, L929.'?

FUNDS AVAILABLE AND ACCEPTED BY THE STATES

The funds authorized bv the maternitv and infancv act first becameavailable in March, 192d. The administration of-the funds fromthat date to June 50,, Lg27, has been reported.3 Table 1 shows theamounts available and the total amounts accepted by the States fromthe appropriations for the fiscal years 1922 to 7928.

period was extended by a bill which passed C)ongress in J-anuary,i927, atthorizing the appropriation fbr the fiscaf years -1928 arici1929'and at the"same tirne froviding for the repeal of the act on

lConnecticut, I lUnois, Massachtsetts.2F.or text of'the ects'of Congress ln regard tg tbe promotion of the $elfare and hygiene

of matern i ty and ln fancy 6ce Append ix A . p . t t t3 .- " tne Pro ino t lon o f t t r -e \ \e l fa i? r and t l yg iene o f l la te rn i ty and lD fancy . Un i ted Sta les

children,s Bureau Publications Nos. 137,146, 156, 178, and 186. Wasbington, 192+-1928.

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5

SUMMARY OF STATE ACTIVITIES DURING 1928

General educational work has been continued in the cooperatingStates during the year ended June 30, 1928. fnstruction has beengiven to individual parents at health conferences and in their homeslinformation has be6n disseminated to members of the medical andnursing professions. teachers. mothers, young girls, and midwives;and literature relatins to maternal and infant care has been widelvciistributed.

Besides increasinE the scope of these activities a number of Stateshave also put emphisis on oiher types of work directed against vari-ous factori adverie to the health oT mothers and babies. .fimons suchspecial activities were efiorts to increase the use of silver nitrate forplevention of ophthalmia neonatorum and the use of toxin-antitoxinfor prevention of tliphtheria in younE children. Assistance hasbeen-given toward the- investigatioi andlregulation of milk suppliesin reiions havins hich infani mortalitv ri 'tes due to diarrheir'andenterltis. The a'[tem"pt to reduce nratdrnal mortality, particularlythe deaths from puerleral sepsis, has continued, especiaily throughthe instruction, supervision, and legulation of midwives and theelimination of fhos6 found unfit to piactice.

PERSONNEL OF THE ADMINISTRATIVE STAFFS

The needs of the State and the size of its budeet determine notonly the amount and to a, great degree the kinds of work to be donebuf also the number and tyfe of per-sonnel employed in condueting thework. Physieians, nurses. dentists or dental hviienists, nutritioiists,social worliers. teaehers. and clerical workers" were on the staffs ofthe State bureaus and divisions of child hvgiene.

In all exeept 4 of the 45 States accepliirg the Drovisions of theSheppard-Towner Act the administratioir is*lodged in the State de-partment of health. and the head of the health department is ineverv ease a phvsician.

llrith referi,nce to the four. exceptions: Nebraska ancl New llexicohave no State department of heaith, and the administration of thoact in these two States is in the bureau of health of the State depart-ment of public welfare, the head of the bureau of health berng rneach Stafe a phvsician. fn Colorado the administration of the-actwas given bv^the State legislature to an alreadv existine bureau ofchild-welfar'e in the State-department of educalion: two" nhvsiciansare _emp_Joygd by this bureau for the maternal and infant-hygienework. fn Iowa the legislature gave the administration to the ex-tension_department of t-he State Tniversity of Iowal the faculty ofthe medical school of the universitv constitute the medical advilorveommittee. and physicians on. the s-taff of the maternity and infancy(lrylsron ot tne extenslon servrce supervrse the wor.k.

F


{6 TITE wELFARE AND ITYGIENE OF MATERNITY AND INFANCY

During the year under review physicians were in immediate chargeof the #ork-iusuallv as dir.ectoi's bf the maternitv and infancy orchild-health rlivisioni of the State department of he"alth-in 30 of the45 cooperating States: Arkansas, California, Delaware, Georgia,Idaho, Indiana, Kansas, Kentucky, Maryland, Michigan. I{inncsota,l\Iississippi, Missouri, Ilontana, N"ew Jer"sey, New'York, North Caro-lina, Ndr^th'Dakota. Ohio, Oklahoma, Ore"gon, Penn.y[vania. Rhodefstaird, Tennessee, iexas''Utah, Vermont,"Virginia, iVisconsin, andWyoming. Nurses directed the work in the

-Territory of Hawaii

an"d in 1b States-Alabama, Florida, Maine, Nebraska,"Nerv llamp-shire, New Mexico, South Carolina, South Dakota, \Yashington,and West Virginia; while in 5 States-Arizona, Colorado, Iowa,Louisiana. anilNevada-the administrative hea,ls of the divisionswere neitlier phvsicians nor nurses. In ail these States except the4 previously rieitioned, however, the clivision was part of a depart-m6nt of treitttr. headed bv a phviicirn.

fncluding State direct,irs faill from maternity and infancv funds,36 r:hvsicia"ns saye full time ior the whole vear ind 25 gave ftrll timefor pirt of thE year. Thirteen gave part-time service Tor the ctrtireycai and seten" gave part-time" serv-ice for part of the year. Inaddition manv physicians were employed for occasional service orby the clav ifi i3 Stat".: Coloradol Delu*ur", Indiana, Louisiana,Marfland," tr'fissouri, Montana, New Hampshire, New York, Ohio.I]tah. \rirsinia. and Washinston. In Nlaryland 60 phvsicians rvereemployed 6y th'e day; in Ne# York 292 rver"e employed for occasionals.ruice at c"onferen,lei; in Montana 16 were e-flo5}.d for occasionalservice at conferences: and Washington employed 12 pediatriciansbv the dav to conduct ;hild-health cdnferenc6s. " Thirtyi5sven Statesaird Hao'iii had physicians on their stafrs. fn 33 States and Harvaiithe physicians w'er6 paid from maternity and infancy funds. In 5others-Arkansas, New Jersey, New York, Vermont, and'lVyoming-salaries were paih from oth"ei State funds for the servic"es of Themedical directors, the State heaith ofrcers in 3 of these States-Arkansas, Vermont, and Wyoming-acting as directors. In the 45cooperating States and the Teruit"ory of Hawaii approximaLely 500physicians were employed for varying periods during the year.

The services rendered by physicians include general administration,conducting of child-health anh prenatal confErences and classes formothers. and other educational work for promotion of the healthof moth6rs and children and prevention of dliseases to which they areparticularly subject.

Public-health nurses were employed in the Territory of Hawaii anclthe 45 cooperatlng States, either as members of the State headquartersstaff or ori detaillo counties. Not includins the 390 nnrses detailedLo counties, approximatelv 425 nurses seried during the year onState headquaifers stafis for varying periods of mat"ernity "and in-fancv work. In +g States and th6 Tirritorv of Hawaii nut:ses servedon t6e State headquarters stafi. In 36 States and Hawaii 146 nurseswere employed for full-time service the entire year. Ninety-sixnurses were employed for full time a part of the year, 6 for parttime the entire year', and 2I for part time during fart bf the vear.fn Coloraclo ad?itional nurses dere employed b-"y ihe day, and inPennsylvania 740 to 150 State nurse. *eri faid fiom materirity andinfancy funds for time spent in maternity arid infancy work. Nurses


6SUMMARY OF STATT ACTrVIIIES DI]:RING 1928 7

have served as administratorsof bureaus or divisions of child hygiene,as supervisors and advisers of county and; field nurses, and asinstructors of midwives. They visited preschool children and ex-pectant mothcrs in their homesf and through these visits they lssistedin the development of prenatal and child-healtlt centet's. They in--.pected mateinit.y and infant homes, conducted demonstrations Iniirfant and prenital care and campaigns to promote breast feeding,assisted with birth-registration campaigns, made surveys, and organ-ized manv tvpes of work.

A ferv"sr"aies ernplo.yed dentists and dental hygienists to promoteoral hygien" a.ong the expectant mothers and

"preschool children.Three"d-entists and-a dentai hveienist save full {ime for the entirevear (in lowa, Louisiana, New-York, aid Utah). Five dentists andhve di'ntal hvuienists save full-time service parf of the Year, and onedental nviienisf gave"part-time service the

-entire year. Eighl den-

trsts werilnrployEd by the day in Maryland.The supervision and" instruct"ion of midwives has been an important

feature of the work, particulariy in the South, and mtny staff andcounty nurses include it in theii regular progiams. tr'our midwifesupe.i'isots and teachers were emplo"yed for full-time service duringthe entire year in three States. Three of these -su-pe_rvisors werephvsicians,"and the fourth was a nurse (not included among thebhvsicians and nurses mentioned in the foregoing paragraphs). Aiifdh was enrployed for full-time service part of tlie yerr -in anotherState, a sixth fbr part-time service the 6ntir-e year in still anotherState. Nine nurses-served as supervisors and instructors of midwivesand also as inspectors of maternity andinfant homes in Nerv Jers^ey.

Inspectors oi maternitv and infant homes were employed in fiveStatei. In California, Ohio, and Texas four inspectors wer-e emplo;'edfull time during the year. Nebraska emplo-yed a part-time inspector{or the entire fear.

-New Jersey employed nine nurses as both in-

spectors of maternity and infanf hom6s and supervisors of midwives,ui h". been stated. "

The child-hvsiene bureaus and divisions generallY have used theirfunjs to emplbi physicians and nurses or ot-her trained field rvorkersand have *iitt[airreh small clerical stafrs. A total of 165 clerks and"stenosraphers were paid from maternity and infancy funds 'luringthe r-'ear.^under revi6w. In 36 States aird the Terri[ory of Harr-aii118 u'ere employed full time. 28 rvere employed full time for part ofthe vear. utt,i fS were emploYed part time foi the rvhole year' EightStatls-Arizona, Idaho,-Louisiina, Missouri, New Jersey,. Oregon,south Dakota, and Tennessee-had only part-year or part-t_ime clert-cat ana stenographic assistants paid lrbm riaternity and_ infancyfunds. One Slate-Nevada-had no stenographers nor clerl<s on ttsrnai*rnitv and infaney staff. Fifty additioial workers were-reported,i;;i;diri nutritionis"ts, lecturers, statisticians, and chaufreurs forchild-n'elfare trucks.-

-*"nty States leported approximately 7.000 volunteer assistantsas eivini their services to t6e matetnity and infancy. work. Thesevolilnteeis included phvsicians, dentists, nurses' and lay persons'Pennsvlvania reported iuch services of approximately 1,000 ph.vsi-cians."and Utali the services of approximately 1,000 volunteers,including physicians, dentists, nurses, and lay persons.


TEE WELFARE AND EYGIENE OF MATERNITY AND INFANCY

gThe total number of workers paid in rvhole or in part from ma-

ternity and infanc.y funds in the cooperating States and Hawaiiduring the year uider review *as ap-proxim"ately 1,600, of whom353 were emploved full time for the entire vear. This number is instriking cont-ras"t to the large number of volirnteer workers who gavefreely 5f thei. time to proriote the work for mothers and childr,iir.

CONFERENCES

Child-health eonferenees have provided the main channel throughwhich trained professional workeis have been able to give to parentsinformation irregard to the care, hygiene, and healtE of their chil-dren. Through conferences the problems in the care of expectantmothers'have been given speeial attention also.

As in previous years, five types o{ conference have been held:Child-health conferences, prenatal conferences, and combined pre-natal and child-health conferences (all conducted by physicians),conferences conducted by nurses, an<i dental conferericei donducteciby dentists. Conferences were held in permanent centers and in theheadquarters of the local health departments. Itinerant conferenceswere conducted by traveling units of physicians and nurses trans-ported by means of trucks containing an examining room andequipped with supplies,. or automobiles were used to transport physi-cians,, nursef: and supplies to a temporary center or quarters arrangedror tne conference.

During the year under review 7,341 combined prenatal and child-health c"onferences were conducteil bv physician's in eisht States:Delaware, Nevada, New York, Noith earolina, Soulh Dakota,Tennessee. Iltah. and'W'isconsin. At the conferences 4.283 expectantmothers were refrstered. 3,?89 were examined. and 23.273 visi-ts weremade-by_ them to the conferences. The num6er of infants and pre-school children registered was 34271. the number examined was34,2M, and 47r42L-visits were made by children to conferences ofthis type.

Child-health conferences were conducted bv physicians in theTerritory of^Harnaii and 41 States: Alabama, Ariiona, Arkansas,California, Colorado, Delaware, Florida, Georgia, Idaho, Indiana,Iowa, Kansas, Kentucky, Louiliana, Dlaine, Iiaryland, Nlichigan,Minnesota, Mississippi, Missouri, Montana, l{ebraska, Nbvada, ffiew$ampsh_i1g, New Jersey, New Mexico, New York, North Dakota,Ohio, Oklahoma. Ore"sbn. Pennsvlvdrnia. Rhode' Island. SouthCaroiina, Tennessee, Te-xas. Vermoirt, Virlinia. Washjneton. WestVirginia, and Wyoiring. Altogether'19,84:0 suih conferEnces wereheld-, 132,618 infirnts and preschool chiidren were registered, and185,622 were examined. One State that reported 8.03$'children ex-amined did not report the number resisteied. Th'e children mad.e298,468 visits to the conferences.

Prenatal conferences rnere conducted by physicians in 18 States:Alabama, Arkansas. - California, Colorbdb,

- Delaware, tr'lorida.

Georgia, Kentucky, Llaryland, Michigan, trfississippi, Nbw Jerscy,NewY6r\, Oregon, Penirsylvania, Siuth Carolina,^Tennessee, andTexas. The number of conferences held was 2,002 j A,ffa expectantm.others were reported registered and 10,440 were ex'amined-. One


fiSUMMARY OF STATE ACTrVITINS DI]3.NIG 1928 9

State reported 2,998 mothers examined but did not report the numberregistered. The number of visits to the conferen?es was 14.258.

l{urses conducted 11,580 health conferences ( with no phvsician ires-ent_) in the^Territoly o_f Tlawaii and 2? States: Alabima, Ariiona,Arkansas,_Californrg, Colorado, Delaware, Florida, Georgia, Idaho,Kansas, Kentut'ky, Louisiana, .N{aine, Maryland, Missouri, XIontana.Nevada. Nerv Jeriey, New Mexico, New York, North Caroiina, Ohio,South Carolina, Te"nnessee, Texas, Virginia, ind lVyoming. At theconferences 72,565 infants and prelchoo] children weie insp"ected. and7^,L22 expectant mothers x'ere ieported instructed in preiratal care.C.hildren made 129,117 visits, arid expectant mothers made 10,266Irslts to the conterences.

Dentists conducted 851 dental confer€nces in 15 States: Arizona,A_rkans.as, Ca_lifornia, tr'lorida, Georgia, Iowa, Louisiana, Maryland,Ifississippj, New Hampshire, Neri Mexico, Oklahoma, Oregon.Texas, and Utah. At 768 of these conferences 180 expectant motherswe.re_ given dental .examination and advice, and 21,413 preschoolchildren were examined, advice being given on dental care-and oralhygiene. One State did not reporl Ihe number of mothers andchildlen attendins the conferencei.

In the 45 coopeiating States and the Territorv of Hawaii a total of219.866_ infants- and pr"eschool chilclren were ex"amined by physiciansat child-health confdrences and combined prenatal and "chil<i-healthconferences. Including with this nnmber thelchildren inspected bvnurses and those receiv-ins examinations bv dehtists. 813.84i infandsand preschool children we"re reported as under supervision at confer-ences-.during the year. ' Pennsylvania led in the'number of chi ldrenexamined aT conferences-19.2i9: New York was next rvith 13.841.Alabama. Indiana. New Jersey. North Carolina. and Utah each re-ported more than i0,000 childr6n examined at conferences.

The total number of expectant mothers examined bv phvsieians atprenatal conferences and i:ombined prenatal and clrild'-hbaith confer-ences in the 22 States reporting was I4r229. Including with this num-ler those advised at conTereneis held by nurses and b! dentists 2I,bZldxpectant mothers received advice on io-" phase of prenatal care atthese conferences.l In the number of expectant mothers examinedat conferences New York State led with +,{24; Georgia was next with2.998.

A feature of the yearts work was the extension of prenatal carethrough prenatal coriferences to the patients of colored ioid*ites. Itn'as p-ossible through these conferen'ces to place under antisvphilitictreatTnent many expectant mothers whose Wassermann reacti6is n'ereposrtrve.

Table 2 summarizes the conference work in the cooperating Statesand the Territory of Harvaii.

.rThis. f lgure may lnvolre some duplication, as some of the same persons may haveat [enoeo con le rcnces o f d r [e ren t typcs .

48278"_29_2


10 TITE wELFARE AND HYGIENE OT. MATERNITY AND INFANCY

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12 TEE wELFARE AND ITYGIENE oF MATERNITY AND INFANoY

PERMANENT' PRENATAL AND CHILD.IIEALTE CENTERSFrequent,ly after demonstration by an itinerant child-health or

prenatal_conference _a_permanent locally supported center, open onregular days for healthconferences, is eitabiiihed. To be successfula center requires not only the services of physicians and public-health nurses but also tde interested support" of the comriunity.lVith the developrnent of full-time coundv^health departments tlienecessary personnel to conduct centers becomes available in these de-partments. Thus it has been possible to establish new centers incommnnities less urban than tliose able to maintain centers in theearlier 1'ears of maternit,y and infancy rvork. Three tynes of centerhave. been. developed: Cbmbined prenatal and child-health centers,to ri'hich both mothers and childien come for examination ancl adjvice; child-health centers, ,for conferences for children only; andprenatal ce_nters, for conferences with expectant mothers.

The total number of new permanent hialth centers of these threetypes established during the yea-r under review was 822. (Table 2.)Opportunity for examination of infants and preschool chiidren rvasgiven-in 395 and for examinat ion and adviee' for expectant mothersin 120. The increase from 84 new centers providing opportunitiesfor prenatal conferences in 192? to 120 centirs of th"is 6daracter in1928 is the notahle feature in the development of permanent centers.In 13 States-Alabam_a, .\rkansls_, Gebrgia. nlaryland. Michigan,nfontana,. f** Yrypshire, .r*ew Yorl<, N6rth Carblina. Ohio, fen.nessee, I tah, and wisconsin-103 new combinecl prenatal and chilcl-health centers rrere established. rn the Territory of Hawaii and18 States-California,_Florid . Georgia, I(entucky. Lo'isiana. ]Iis-sottri, lfont.ana*-^\e_w Hampsh_ire, Ne"w Jersey. New yorli. Oregon.Pennsylr-alia, Rlgde. I.slan4-, Tennessee, Tesis. Virginia. Washing-ton, and l\rest Virginia-2}2 new permanent' child-heaith centeisrrere established. In 8 States-Coloiado, Georgia, Kentuckv, Mary-land, ll ichigan, Ifississippi, New Jersey, and"New yorlil iZ nervprenatal centers rrere est-ablished. rn tlie number of nerv combinedprenatal and child-health centers established durinE the vear utahled n-ith 33 and \\'isconsin was second with 20. Fennsvivania re-ported the establishnent of 36 new child-healtll centers, ihe largestnumber any State reported. Louisiana and lVest Yirginia werenext,, each wlth 21, and Texas reported 20. Georgia and li{ississippieach leported 4 new prenatal ceniers.- complete reports oif attendance anil work at these centers are not

LlT"I. available _beeause a center that has become thoroughly estab-iished ceases to be an activity of the State department"of"health,though tlie State bureau or division of child hygiene generallv con-tinues to,give advisory service and helps in"the .oiution oi ntryproDrems tna[ may anse.

DEFECTS FOUND AT CONFERENCESAs the chief purpbse of the child-health conferences is to promore

the hygiene and rvelfare of infants and preschool ehildren eveiv effortis mede to arouse the parents, interesf in the correction of ?iefectsand of deviations from-the normal that may be founcl in their chil-dren. The chiidr-en invitecl to the conferenles are the so-callecl wellbabies or apparentiy normal children. It is not fhe purpose of the


*:ff

SUMMAR.Y OF STATE ACTWITTES DTIRMTG 1928 13

conference to Eive attention to sick children. If any ehild attendingis found to bE obviouslv ill the parents are urged to consult theirfamilv physician immediately. However. mani so-called u'ell chil-dr.n Ioi. iefects that need cbrrection. Thirtv-eight States reportedfinding that 110,507 infants and preschool children had one or moredefectE. and a total of 28?.019 defects rvere recorded in 38 States.o.winc'to the limited numbers of field workers on the staff-. of theSrate'bureaus and divisic'ns of child hygiene it was not possible tofollorv up all clrildren examined at conferences who were found tohave <leficrs. though 20 States reported the number or percentage ofclefects larown to have been correcled. Arkansas reported the largestnumber of children having defects corrected; 3.352 correctrons weremade for 3.508 children having defects. Oregon reported ̂ that pa.r-ents had corrections made for approximatelv ?5 per-cent of the chil-dren founrl to have defects. fofua estimated (on the basis of reportsof nurses n'ho did follow-up work) that corrections were made forannroximatelv ?4 per cent of the cliilclren found to have defects. TheState of Was'hine{on estimated that corrections were made for two-thirds of such chiidren.

COUNTY HEALTH DEPARTMENTS AND COUNTY NURSES

DurinE the Year ttnder review 29 States reported nllrses detailed tocounties, communities. or cities. Six States reported 16. county nursespaid for full-time maternity and infanc.y serviie the entire year. NineStut.. reported 22 county nrtrses paitl fbr full-time service-part of theyear. Seventeen Statei repolted 159 count.y nurses l raid {or 1, l r t -iime service for the entire year, and 2* States ieported 193 nurses paidfor part-time maternity aid infancy se11-ic.e part of the vear. A totalof 390 county nurses i'ere paid foi full-time or part-time matcrnityand infancv"service. 11 othir nurses were detailed to cities, and 28rvere detailed to other local communities. The States detailing nLlrsesto counties, communities, or cities durine the year rrere Alabnma,Arkansas. California. Georgia, Kansas, Kentucky. Louisiana. nlary-land. Mississippi, Il issouti, trlontana, Nevada, New ]Iesieo. NewYorli. Nolth

-Carolina. Ohio, Oklaltoma, Oregon, Pennsylvania,2

Soutli Carolina, South' Dakota. Tennessee, Texas. Utah, Virginia,Washington, West Virginia, \\'isconsin, ancl \Yyoming.

The bstablishment of futt-time countv health departrnenk olcounty health units has cattsed a demand for the services of countynursei. The bureaus and divisions of child hygiene in many Stateshave included in their plans assistance to county health unitsthroughpavment in rvhole or in part front maternity "and infaney frrnds ofihd salar ies of nurses det i i led to count ies. The amount of the salaryassumed by the State maternity and infancy agency has been in pro-portion to"the amount of time'spently the nrirses"in maternity--andinfancy work. fn a few States reimbursement has been on the basisof services rendered b.y both the countY physieians and the nttrscs.

In several States niuch of the State trellth work is decentralized,being conducted through the county health departments. Thus pre-natal letters and literature are distributed from the departments,

,Not inc lud ing tbe 140 to 150 nurses in the pub l ic hpa l th nurs ing d iv is ion o f t l l e S ta lcdepar tment o f hda l th in PeDns] lvan ja . wLo were pr id in par t f rom matern i ty and iD fancyfunds.


#T4 THE wELFARE AND HYGIENE oF MATERNITY AND INFANCY

and mid'wives are instructed, supervised, and licensed by them. Thesecounty units have made possible the establishment of permanentcenters for prenatal and child care in the smaller communities anclhave increased the opportunities for contact with mothers and chil-dren, particularly through nurses' visits in the homes.

In a?dition to"nurses -detailed

to county health departments Statenurses have been detailed to counties not h'avins count'v health denart-ments, to torvns or communities, and to a fErv citi6s to develbp amaternity and infancy program.

.As opportunities for field experience in county work in connectionwith training centels for county health departirents have increasecland nurses have been admitted-to the training centers. some of thecggnty -nurses now entering the work have liad the advantages ofthis training-which now includes maternity and infancy wor[.

HOIIE YISITS

Visits of public-health nurses to homes have been a feature of{rlaternity and infancy programs in -40 States and the Territory ofIfarvaii.

- The nurses have lnstructed expectant mothers on the care

they should obtain for themselves and their unborn babies and havemade information available to parents on the care and hygiene oftheir children. Either State itafr nurses or nurses aetiited tocolnties, communities, or cities have made 700,981 visits to homes.Virginia rep_orted_ 118.576. the largest number reporred by any oneState. .In l{ew Jersey 97,961 vislts were made io homei. in"NewYork 64,612, and in Rhode Island b3.605. most of which were madeut regular intervals to chi ldren under supervision. Onlv fourStates-Indiana, North Dakota, South Dakota. and Vermont-aianot include home visiting in their work; one-Washinston-clid notreport rvhether this type of work was done. (Table B.)-

T;ant-n 3.-Num,ber of oi,sits maile by nurses, nunber of conlmunit.Ul and, groupilemomstrations, and number of auntics in which matorndtg a,nd, infancgr ttorkhas been d,one, in the Sta.tes a,nd, tho Tenitorg of Eawai,i, cooperati,ng uniterthe nxatentitq and, infanry act, during the gear erd,ed June 50, 19Zg

Number of counties-

ln which maternitvand infancy worFhas been done-States snd Territory cooperating

2,074Alabama

i z,aztool 4; :

1 t D1 5 81 5 8

1 6 7I r6q

1 4 41 9 1

327

6256293

67

42l

50,0819,0416, 08r

20,u4961

3 1 , 6 9 15, 333

24, 96814,017

811

Provided by the Maternal and Child

I sioce tneDuring beginning

19?8 of co-

] operarron

Health Library, Georgetown University

SUMMARY OF STATE ACTWITIES DTIRING 1928

TAgrn 3.--&-zm,ber of oisits matle by nurses, etc.---Continued

Number of couties-

15fi

IIomevisits

bynurses

Com-mumtYdemon-

strations

In which maternityand infancy workhas been dons-

States and Tenitory cooperatilgGroupdemon-strations

Duringt928

Since thobeginning

of co-operauon

105t20

15

79

82

3982

102l146240

687732675

46

646025

3966z2

991051200416B838782

114m93t710

62100

887736675

466995

251mt4

1m39

a

20 1200 |2i1 I622 |45 1

453 I5 t

32562r350

3, 3988,6746,1625,005

7586,0895,4123, 9r3l, 9323,893

I l, 87197, 9614,29r

64,61233,473

99105t20621523838782

112m90t710

31624919

7736675

466595

11528t3oa

507 l

I Not reported.

LOCAL DEMONSTRATIONSiFII{A'TERNTTY AND TNFANCY

Fifteen States-Arizona. Colorado, Georgia, Kentucky. I'ouisiana,Michisan. Missouri, New Jersey, New Mexiio, New York, Oklahomat-S"rlh'C"i"tina. Viieinia, and Wi sconsin---<oirducted 17 1 commu nitydemonstrations'during tlie year under reyiew. Most of these werematernitv and infancy nursinf{ programs conducted in a county or;;;;"ity during vaiying peiiods.-W.hen the support of a demon-stration was assumed"bf the county, as frequently oc99ry9$, th9

llrogram thus became a permanent piece of work. In 1928 l\lrssouni""Er"t*A++ community demonstrations, the largest numler reportedbv any one State during the vear. The Missouri type ot_demonstra-ti"on utuallv consisted o"f an dducational program in-child health, in-cludins ledtures. films, special exhibits, dnd child-health conferencesA;;fis-t;;.k o'. tottg"t.' N"* York r6ported s7 communit-y demon-;;;ti;;, -o.t of th-em demonstration^s of maternity,.and infancy

""".i"g ior which responsibility has been assumed by the communi-

ties. (Table 3.)

t-


616 THE wELFARE AND HYGIENE oF MATERNITY AND INFANoY

Thirtv-four States-Arizona, Arkansas, California, Colorado, tr'lor-ida, Georgia, Indiana, Kansas, Kentuckv, Louisiana, Maine, Maryland,Michiganl Minnesota. nl issouri , ) loniana, Nebrasl<a, Ner"adai NewHampshire, Nerv Jersey, New Mexico. Nerr York. Ohio, Oklahoma,Oreg6n, Rhode Island, South Caroliira, South Dakota, Tennessee,Texas. Utah. West Virsinia. Wisconsin. and trVvomins'-conducted11,906 group demonstraTions on specific'phases oi prenatal or childeare. .\-erv York leported the lalsest numtier. 3.22i. and Texas rvasnext with 1,492. (Table 3.) This type of demonstration includedgeneral care of the'baby. bathing. c lot i r ing ( ia.yettes), and the prepa-iation of foods and formulas; dEmonstrat"ions before midwives'(sichas preparat ion for del ivery of the mother rnd her care).ster i l iz ingdrelsings and pads.the caie of the babv. inclu, l ing care'of the cordand caie of the eyes. the makins of simple appliances. such as an im-provised bed for-the baby, delii-ery pads from nervspapers, and bed-pans from newspapers. and manv olher speeial srrbject-, such as care6f tne breasts and'manual expreision of 6reasr mi l i<.

Exhibits of foods ancl lectirres on preparation of foods and theirvalue are frequent15'a featrrre of u local derrronstrat ion. Al l the Statebureaus and divis ions of c lr i ld h.vgiene gi ve information on properfood for the expectanl mother, rhE infai l r , and the preschool 'chi l r l .Three States-Kentucky, Maine, and Nerv York-eniplov rrutrition-ists. In the other cooperating States nutrition is streised at confer.ences, in talks, and lectures, and in the nurses' r.isits to homes.

PROMOTION OF BREAST FEEDING

Emphasis on the importance of mother's milk for intants has con-tinued. fn manv States the efforts to inform mothers of the im-portance of maintaining their supplv of milk have reached the pro-fortions of_a campaignTor breasf feeaing. In two States-Michiganand New York-brJast-feeding survels" antl campaigns were con-ducted in .certain counties. Other States deperideii upon talks,lectures, conferences, nurses' visits, Iiterature, ancl demonstrations toinform expectant and nursing mothers of the greater chance for lifeand healt[ of the breast-fed]baby comparea ivitn that of the babyrvho is bottle fed.

The State reports indicate that the proportion of infants who arebreast fed vari6s in different sections oi ttr-e United States. Coloradoreported that among 1,401 babies examined at conferences 1,203 werebreast fed. Delawire estimated that approximately 50 per cent ofthe babies in the State are breast fed. Kansas reported 2.868 breastfed among 3,750 examined at conferences. Kentirckv r.enorted thatpracticall! ail rural mothers nurse their babies and eslimited that ?5per cent of the babies in the State are breasb fed. nlichigan reportedthat a survey eompleted in seven counties showed 7 per ient never tohave been bieast fed and many of the remaining 93^per cent to havebeen- lveaned, early. Minnesota reported abouf 85 per cent breastfed, basing this edtiinate on a survey of trvo countici. -[{issouri re-ported that 53 per cent of 3,594 babi"es examined at conferences werebreast fed at least six months. Nerv llampshire estimated 5? percent breast fed at birth, 43.5 per cent at 1 month of age, 24.8 per cEnt


{SUMMAIiY OF STATT ACTIVITIES DIIRING 1928 17

at 3 months of age, and 15.1 per 9e.1! at 6 months' New York re-

; ;" i ; that of bib;e. at tending chi ld-health centers in New YorkUrii- iz,i[z *et. btea-"t fed, r,"eo+ were breast and bottle fed, and

aOdO *d". bottle fed. Soutli Carolina estimated at_ Ieast 90 per cent; i ih" but i" . to be breast fed and reported a tendency to,cont inrre;;"asi f;;dilg too long-12 months- i1 lnalY instances' South Dakotaestirated th;t 60 per-cent of the babies iir the State are breast fed'

""a Vi"gi"ia estiriated ,that 52 pe.r cent are breast fed. The State

of Wash-inston reported information on 1,507 children showing 44

o., ..rl erTtirely breast fed, 33 Per cent partly trreast fed. and 24

;;; ;;;i artificill lv fed. West Virginia reporied that record cards5i-rt"...hool childien showed a higi- percenlage t^o have. been breastt.ai

"rJ Wl.consin estimated thai g0 per cen-t of the children who

attended the health centers were breast fed...'C;"rdi;g to tne.e t"port. the proportion of babies breast fed until

***ing tifie was higlier in many bf the Southern States than in;;;; N-"rit;.t Stot"rl Facrors responsible for these valiations in

olr"L"tus." of breast-fed babies in difierent sections include local andi:u.iut .,i.torn.; types of advice given to mothers -and expectant^ot6".. by f a mil v irhysicians. pedi atricians. aqq hca I th.d.epa rtmen-l s :;J it; a""t"r-iriutlon of the mother to pro.vide.her child with her

"*" -ift. ihe effect of educational woik is indicated !y the. hi-eh

;;;p;i;" of breast feeding (90 per cent) reported by Wiiconsin forihebabies supervised in the health centers.

PRENATAL CARE

A varietv of activities have contributed to the information of theolrbti". of drothers. and of fathers on the importance of prenatal care.in-u i"* .rre st i l lb ir th lates and infant-and nraternal mortal i t5rrates reflect the efrect of the care or the lack of care the expectantmother receives.-

Expect"nt motherq have been informed of the importance of pre-trutui^care through lnst luct ion-given by n_urses. in vis i ts to theirilo-..,-iti.ough cfild-health conf irenees cbnduct ed_ b1' _ph5'sicians andnur. . . . in n.hTch the Ialue of prenatal care to the chi ld rvas discusse, l .ihrough itinerant prenatal coln{erences and permanent prenatal cen-i..r, Tn,,orgh claises and correspontlence courses conducted formothers. an? through the distributlon of prenatal letters and litera-ture. County-wide demonstrations in prenatal care also wel'e con-ducted in New York and Nlichigan. Through tlese activities150.000 expectant mothers lvere reached in 37 of the cooperating.States reDortins during the year ended June 30, 1928. Seven Statesand the ferrito"ry of Hawaii rlid not report the number.of expectantmothers reached"through these activities. One State did not reportwork done among expectant mothers.

ExnectanL moih"rs'*ere urged to place themselves under the careand supervision of their phys'riians-early i1 the period of pregnancy'The a<ivisabi l i ty of report ing to the physician at regular intervalsand of having frequent urinulyses was explarned to them.


fi18 TTIE wELFARE AND EYGIENE oF MATER,NITY AND INFANCY

CARE DURING AND AFTER CONFINEMENT

hospitals. -the

type.of hosliitalcare available, and the types of caregiven by the attendants.ren by tne attendanf,s.

The State bureaus and divisions of child hygiene.or w-elfare havecontinued efrorts to'i nditions surrounding the care ofcon[rnueq ellorrs Io rmprove conolfions surroundlng tne care oI\yomen at the time of childbirth. Several States have included in

The care that women receivefluenced by the accessibility of

durinE and after confinement is in-the seivices of physicians, nurses, or

their maternity and infancy activities the licensing and inspection ofhospitals accepting maternity cases and the inspe"ction of maternityhomes. Graduaticourses in obstetrics have bee^n arranged for rrhv-sicians in several States, and the continuance of instruclion. reEuli-tion. and supervision of midwives was reported by a number ofStates.

INSPECTION OF MATEBMTY AND INFANT HOMES

In three States-California, Kansas. and South Dalrota-the child-hygiene bureaus or divisions inspect and license maternity homes andhospitals. During the year under review 1,394 offieial br unofficialiirspe.c{io_np were inade

-of t.308 maternr-ty homes or hospitals by

the child-hygiene bureaus of 14 States-Cllifornia, Coloraho, Kan-sjl!, Kentucky, Nebraskal, New Hampshire, New Jersev, New'York,Ohio, South'Dakota, Tennessee, Teias, Utuh, and Virsinia. OneState-Georgia-reported 441 homes inspeeted but did not report thenumber of inspectibns. During the sahe lrriod 1.538 inspeetionswere made of 1.383 infant homes bv the child-hveiene burieaus of10 States: Idaho, l(ansas^.- Kenlucky. Nebraska.' i\ew Hampshire,New Jer.qey,_New Y_ork, Ohio, Tennessee. and Texas. Georgia re-ported. ?SL homes inspected but did not report the number ofinspections.

MIDWTT'.ES

Worl< to improve midwives has been continued bv manv States._Nu..*. and physicians have been assigned to this woiL by tire child-hygiene bureaus and divisions or by ihe personneI of eoirntv lrealthdepartments. I-n. some places the ilasses-conducted in earlier yearsof maternity and infancy work have been succeeded by regular super-vipiog by field worl<eri and regular meetings of midivives, ciubswhich State or county. supervisois of midwivds attend. During theyear en_ded June 30, 1928, classes numbering 1,653 were orgailizeclin 11 States: Arl<ansas, Fl,orida, Georgia,--Kentucl<y, Loirisiana,JY.aryland, {o$h C^arolina, South' Caroli-na, Tennesse6,' Texas, andVirginia. A few States did not report the number of classes or-ganized. (Table a.) The number bf midwives reported enrolledwas 10,056; the number reported as completing the c6urse was 1,5g4.Some States did not repoit the numbeicomp"leting the course,'anclin a number of States.tlie worli was continuous insf,ead of consist,insof a definite number of lessons. In the States reporting number oJlessons 6 to L0 were usually given.

Provided by the Maternal and Child Health Library, Georgetown Universify

6 SUMMARY OF STATE ACTIVITIES DURING 1928 19

Ilstn 4.-Closses conil,ucted for i,nstruction, itt, nlaternal, i,nf atft, and, ch,ild, h,g-lliene reporteal, bg 39 States and tlve f er'ritorA of Eawaii cooperattng und,er thematerrurtq and i,nfancy act iluring Urc year end,eil June 30, 1928

Clses for mothers ClNes for girls Clmses for midwives

States and Terri-tory cooperating Classos

organ-ir,ed

Girlsemollod

Class€sorgan-ized

II id-wlves

en-rolled

Mid-wlvescom-

pletingcours6

1, 594I, 280 23,661

Alabama-- - - - - - - - - 101

49ta

19

- 497

(r)1, 650

62

u108811412

641.I

158

1, 5r4i4

385321175358

-4;e6s

84

4881184461662fi632686

321r)

1623r3

(ii -

oiiaA r l z o n a - - - - - - - - - - - -

Arkansas- - - - - - - - - - -Ca l i fo rn ia - - - - - - - - - -Co lorad .o- - - - - - - - - - -De laware- - - - - - - - - - -F l o r i d a - - - - - - - - - - - - -Georg ia - - - - - - - - - - - - -I lawa i i - - - - - - - - - - -I n d i a n a - - - - - - - - - - - -Kentucky- - - - - - - - - -Lou is iana- - - - - - - - - -Ma ine- - - - - - - - - - - - -

NebraskaN e v a d a - - - - - - - - , - - -New Ilampshire----New Jersey- - - - - - - - -New Mex ico- - - - - - - -New York- - - - - - - - - -North Carolina-----O h i o - - - - - - - - - - - - - - - -Oklaboma- -- - - - - -- -O r e g o n - - - - - - - - - - - - -Rbode Island-------South Caroline-----Soutb Dskota------Tennessee- -- -------T e m - - - - - - - - - - - - - -T T r o h

V e r m o n t - - - - - - - - - - -V i rs in ia - - - - - - - - - - - -\ \ e s l \ l r g l n l a - - - - - -Wiscons in - - - - - - - - - -'Wyomi lg -

- - - - - - - - -

4gl

2,V307999 it

3 3 ,432l, 76466

-- i14i

..-----.o

54998

. . -. -;;;-- . . - . ; ;

l0

18

108------i

4,1o

53

_-----;

- - - - i t1 i

"---ar'6

18

m46

l o

84c)(Dc)

2504n

198-

t;ca-534

c)-- -- -

ii8( t r)

I(u)

2104

33r 0 7

7V2a18876176

s3272

3 l2,342

- - ' u l ' na- - - - t - -

--------t---------_:_ -:- _ _l_: _- __ _ _ _

% l a i-----ii-l-----iii

15 |

41e

::-:- ---l--:- -----40

1 4

::- __:: -l_ - __:.:::I

ryoc" ' ^ i

3 158- (ii--c)

-- - -338

I Not reDorted.r io ctaiiel i:bntinued from previous year witb 185 midwives emolled (including 3 euolled during year

under review).3 Includes some eanied oser from pr€vioN year,{ lncludes 1,710 sirls in l0 colleges where coure wN giveu.s 50 midwives enJolled in clret for women completed tbe cous.6 I orgaDizations meeti!g monthly; membersbip 399; total att€ndmce, l '042.? lncludes 15 csnied over from previoE year.6 Includes 45 bol$.e Includes 4 clres-for boys-and gtb in public schools. 1

il IisHff: l3t iTili9.s;sirt""trlst'i'lf#Jr"ii;*"* to 100 hish.school sirrs in strorber towtr; l tesson to63 normal-school students.

13 Infant-hygiene classes are conducted in tbe puh!ic scbools.rr Conducte"d by a member of the Unit€d States Children's Bureau stafi lent to the Stat€.

CLASSES FOR ADULTS IN INFANT AND PRENATAL CARE

r\Iothers'classes, or classes for women in jnfant ald-p^renatal^ca-re,were conductecl iri 31 States: Arizona, Arkansas, California, Colo-rado, I)ela-ware, Georgia, Indiana, I,ouisiana.. M-aine,-Ifarylald'Mi ctrigan, Minnesot a. Mi siouri, Nebraska. _Nevada. New IIam psh i re,New Jeriey, New lVfexico, New York, Ohio, Oklahoma, Oregon,

"ffi -

| i,,oiieii'l---ifd


ff20 -

rnn wELFARE AND EycrENE oF MATERNTTy AND rNFANcy

Rhode Island, South Carolina, South Dakotan Tennessee, Texas.LTtah. Virginia, lVest Virginia, and Wyoming. These States organ-ized 1.318 classes; 29,637 wonen were enrolled in classes in the30 States reporting enrollrnent, and 18.409 completed the course inthe 21 States rrporting on this point. The nurnber of lessons varied;usually 6 to 10 rvere given. Indiana led in this work with ?,824women enrolled, Ilissouri was next. with 7,570, and California thirdwith 2.030. Georgia, I{ichigan, Minnesota, }dew York, and lVestVirginia each enrolled more than 1,000 women in such classes durjngthe 5'ear ended June 30, 1928. (Table 4.)

CLASSES FOR GIRLS IN INFANT AND CIIILD CARE

Giris 10 to L5 years of age were instructed in classes in infant andchild care in the Territory of Hawaii and 31 States: Alabama,Arizona. Arkansas.. Cali f ornia, Colorado, Del arn'are, Georgia, Ha waii,Louisiana. Maine, Maryland. I\Iichigan, I issour.i, Montana, Nebraska,Ngvada, Ne'w Hampshire. New Jersey, New Mexico, New York, Ohio,Oklahoma, Oregon, South Carolina, South Dakota,'Iennessee, Texas,Vermont, I-irginia, Wesr Virginia, \fisconsin, and Wyoming. Thenumber of classes organized rvas 1,286, the number of girls enrolled23,66L, and the number completing the course 10,985.

-The number

of lessons in the course varied I several States gave 24 to 30, butusually 70 to 72 were given. Georgia had an enrollment of 4,968girls, the largest number enrolled in any one State. Michigan wasnext with an enrollment of 3,605. Ohio and Texas each enrollid morethan 2,000 girls. and Alabama, Virginia, and lVest Virginia each en-rolled more than 1,000. (Table 4.) A nurnber of States conductedsuch classes in connection with the public schools. A few, as Ohioand Oklahoma, included bo5's in sorne of the classes. In Wisconsinthe classes in infant and child cal-e are now a parb of the reprularpublic-school curriculunl.

rNsrRucrroN oF r"p*.$tkr*3?HBr rN MATERNAL AND

Ph;'sicians, nurses, and teachers have been among the specialgroups instructed in maternal or infant care in the Statds coopeiatingttnder the maternitSr and infancy act. In four States-Kentuclry-.New York, Oklahoma, and Tenneisee-graduate courses in pediatrilJand also in obstetrics have been conducted for. phvsicians. Public-health nurses have received special instruction- through institutesand other group meet ings, through loan [ ibrar ies, and through t ra in-ing centers. Teachels havc been g iven inst ruet ion in in f ln t andmaternal care to prepare them to conduct similar worlr in the schools;Kansas, l{erv Jersey, Oklahoma, and Wisconsin have conductedcourses for teachers. fndiana conducted such courses in 10 colleges.Fathers have been iqcluded in a few of the adult groups receir.inginstruction in maternal and infant care.

TALKS AND LECTURES

Information relating to rnaternal. infant. and chilcl care andhygiene lvas given through talks ancl lectures in the Territory of


SUMMARY OF STAfE ACTTVITIES DIIRING 1928 2L#

Han'aii and ail except one of the States cooperating under the ma-ternitv and infancv

-act. A total of 23.033 talks and lectures rvere

given"in 1928 20,0i3 were addressed to lay groups. Special lecturesor talks were given to nurses and physicians-?21 to nurses in 36States and Haivaii, 352 to physicians in 29 States (this number in-cludes a ferv to dentists). (Table 5.) Radio talks were broadcast106 times in 1? States i Coiorado, Georgia, Iowa, I(ansas, Ifaine,Mart'land. Michigan, Minnesota, Missouri, Nebraska, New York,Ohi6, Oregon, Pe"nnsylvania, Tennessee, Vii'ginia, and Washington.

PRENATAL LETTERS AND CORRESPONDENCE COURSES

fnformation on prenatal care and preparation for confinement rvassent to expectant mothers through a series of prenatal letters (usuallynine in number, one mailed each month) b"v 2a States-Arizona,California, Delaware, Idaho, Kansas. Kentuckl'. T,ouisiana. Nlqlne,Michigan, Minnesota, Missouri, Montana, Nebraskq, Nevada, NewHamphiie, North Carolina, Oklahoma, Oregon, South Carolina,Souti Dakota, Tennessee, Utah,lYest Viiginia,-and \Yisconsin. Thenumber of new na,mes enrolled in these States during the year underreview was 37.532. and the number o{ sets of letters distributed was35,721. North Carolina reported 9,522 new names enrolled, thelaigest number enrolled by any one State. Oklahoma was next'with7,220 new names enrolled. (Table 5.)

Correspondence courses were conducted by four States: Minnesota,Virginiai'Washington, and West Virginia". Instruction was givenin b"oth maternal a.-nd infant care throrfh these courses.

'Irnrv,5.-Educational ,tpork conducteitr tlwough' talks alLil leetures, pronatal' let-tet's, d,nd rli,stri.bution of litdeture in tlle States anil Ten'itorg of Hawaii'cooperating under the moternity and infancy act (luring tILe Aear enileil JuneJ0, l92S

Talks and lectues

Number giYen tr

Prenatal letters

Setsdistrib-uted

l

t - ' .r leces

of litera-ture dis-tributed

i

I

( r )64, 435

131,27392, 10810, 60047,75834,032

105, 8752, 6007,096

176,47373, 600

2r2 ,376317,55933, 26S

425,016127, 850359,047

gtates and Territory coopsrating

Celi fornia- - - - - - - -C o l o r a d o - - - - - - - - -

MarylandMichigan.

I Not reported.

**.". l*.to";.Rsdiosudi-encqs

Newnarnes

en-rolledFFv-

slclaDs

352 ss,zzt \. a,tzo,zaz23, 033

r,60186

863102tn90

r66382

20, 0t3

c)33

85477

I 10st E 2| 14iI s4sl 6

I aio16039

92798423585I

600(')- - ; , ;

:i:- - - ; i '

1, 850645

e;oei

,

l52

I7

I

,I

l&

Aa

t Includ€s talks to dentists.


*,F

22 THE wELFARE AND rryGrENE or' ITATERNTTy AND INFANov

T.trlln 5.-Eil.ucational, umk conilucteil, throu,glt, talks and l,eatu.res, efc.-Contd.

Talks and lectures Prena-tal letters

States and Territory coolPratingNumber giv€n to-

Levgroups

i36,207

5841 , 1 1 9

32

It-

Total II Pl'Y-

I srcrans

Radioaudr-ences

22220557

_ _ l270,71250, 000

780, 4502 1 1 , 1 1 685, 0552, 380

132,2t465,00035, 189

302, 9E9I27,29017,937

227.500383, 88550,000

1,17,90237, 36860, 00023, 63850, 35166, 53625, 0007,692

22E, 836r 8 , 1 1 474, 583

413, 19110, 907

4162 , M r

118

0)

8{ | 2, sio12 | 40,1

n l 1 3 4

3 529n t 392

2

11336

681?9

c)

- - - - - - t - - - , - , - .9,522 4, 191

-.-.-'----.-.-.7,220 5,2251 ,046

i 1 , 017

--------------.-- - - - - - - - l 1 0

634 i 722416 | 416

l

66s I itdI--'-----t--------

.---.--.1----....1,677 I 1 ,285

17440

I 5195 331

tv230

15816

546424n736

13190

6966 143

150

114m

i . . . . . .l -l - - - -i - - - - - - -I RI . :

l ' ot - - - - - - -t - - - - - - -l ( DI

t Not reported.I During 6 months.r Includos 28 to dentists.

! Report incomplete; includes 1 to dentists.6 Includes I to dentists.

DISTRIBUTION OF LITERATURE

All the eooperating States (except one) and the Territory ofHawaii report-ed dist"ributing iiterature relating to the care andhygiene of-mothers, infants, ind preschool children (including bothSia-te and Federal'publications). Ilore tlian 6.000,000 pieEes ofliterature were distributed by the Territory and the 44'Stat,js report-i.tg. (Table 5.) Nineteen States each reported distributing morethan 100,000 pieces durins the year under review. Missouri led witha distributiof of ?80,450liecei. Maine was next with 425,046 pieces,and Wisconsin third with 413.191.

Twenty-trvo States-Arizona. Colorado, Delaware, Florida, Kan-sas, Kentucky, Maryland. Michigan, Mississippi, Missouri, Montana,New Hampshire, New Mexico, New York, Nbrth Dakota, Pennsyl-vania. South Carolina, South Dakota. Utah, Virginia, Wisconsin,and Wyoming-and the Territory of Hawaii sent literature on thecare of the baby to the parents of all babies whose births were regis-tered in State bureaus or divisions of vital statistics. In two States-Rhode Island and New Jersev-literature was distributed bv thepublic-health nurses rvho visited the neu born babies. A few otherStates sent a birth-registration card with an offer to supply literature


#SUMMARY Or' STATE ACTrVITIES DITRING 1928 23

on request. Marvland, Missouri, and New York sent literature exceptfor ba'bies born in the iarge cities. Reports received indicate that lii-erature on infant care was sent to the parents of half the babies bornduring the year.

ExrENsroN o" tsB"Y$Hx&3sffi$frtRrH AND DEArE

Fi'r'e States-Alabama, Georgia, Louisiana, Missouri, and Okla-lioma-were admitted to the United States birth-resistrat on areadurins the vear under review.3 This made 42 States and the Districtof Col"umbiir in the area on June 30, 1928, and included 91.3 per centof the total estimated population of the United States. Two States-Georsia and Oklahoniai-were admitted to the LTnited States death-registration area during the year under review.3 This made 44St"ates and the District-of Colirmbia in the area on June 30, 1928,and included 95.4 per cent of the total estimated population of theUnited States. The staffs of the State child-hygiene bureaus anddivisions gave assistance in all the States admitt-e-d to the birth anddeath registration areas, and they were actively assisting to increasethe reEistration in States not admitted.

SURYEYS AND CAMPAIGNS

During the vear under review 48 surveys of conditions relating tomaternal" and" infant rvelfare were made in 25 States-Alaba"ma,Alkansas, California, Colorado, Delarvare, Georgia, ldaho. Kansas,Kentucky, Louisiana,' Maryland. l{ichigan, }finnesota, New Hamp-shire, Nd# Jersey, New }Ieiico, Nerv Yoik, North Dakota, Oklahom^a,Oregon, South Dakota, Tennessee. Virginia, IVest Virginia, and Wis-.onsin.

' These included slrrveys of hospitals, midx'ive{ milk srrpplies,

maternal and infant mortalitv. and various other matters affectingthe welfare of mothers and cliiidren.

A total of 68 campaigns, either state-wide or restricted to countiesor smaller areas] were reported by 29 States: Arkansas, California,Colorado, Delarvare, Georgia, Indiana, Iowa, Kansas, Kentuclgt,Maine, I4aryland, liichigai,

'Ifinnesota, Miss6uri, Nebraska, Ne#

Ilampshire, I{ew Mexico, New Yorli, Ohio, Oklahoma, Oregon, RhodeIslan?l, Soirth Carolina, South Dakota,' Tennessee, Teias, IJtah,Washington, and West Yirginia. They included campaigns forbetter milk supplies, for more complete registration of births, forcxtension of maternity and infancy rvork through the establishmentof county and community nursing service, other improvements inconditioris relating to the welfare-of mothers and babies, and tt getready for school t) campaigns for the preschool child.

MATERNAL.IITORTALITY STUDY

Prosress has been made in the studv of maternal deaths in thecalend"ar years L927 and 1928. During the year under review thestudy 'lvas under wav in L2 States: Alabama, Kentucky. If{aryland,Micliigan, Minnesoti, Nebraska, Nerv Hamfshire, Oregotr, ithodti

3 Three more Statesrado in August andNevada was admitted


were admitted after the close of the flscal year under review (Colo.South Carolina in October, 1928, aud Nevada ir April, 1929).to the death-registration alea also in April, 1929.

Library, Georgetown University

ff24 TEE wELFAnE AND ITYGrENE oF MATER,NITY AND INFANoY

Island, Virginia, Washington, and Wisconsin. Three other States-California, North Dakgta, and Oklahoma-made plans to begin thestudy after the close of the fiscal year under revtew.

In all these States the study is being made in cooperation with theState departments of health" (on the" r'equest of tire State medicaisocieties) and in cooperation with the

-Ilnited States Children's

Rureau. Physicians assigned by the bureau are taking the sehedulesin 9 States: Alabama, Sentucky, Ifaryland, Nebraska, New Hamp-shire, Oregon, Rhode Island, Virginia, and \Yashington. ThrieStates-llichigan. Minnesota, and Wisconsin-ar.e usinf the servicesof physicians on their o'wn stafis.a The tabulations will be made bythe Chi ldren's Bureau. (See p. 15?.)

EXPANSION OF ACTTVITIES'Ihe 45 cooperating States and the Territory of Hawaii contain

2,953 counties or parishes. During the periocl of their cooperationunder- the maternity and infancy "act so^rne maternity and'infancyworlr lras been done in 2.67I of these counties. During'the vear underreview some maternity and infancy work n'as done iil 2,0?4 counties.1l'rvenfy-ssyen- St_ates reported maternity and infancy u'ork in everycounty since thc beginning of their cooieration untle"r the act. Drrrl-ing tlic 1'ear under:revieri maternity anr.l infancv rvork n'as tlonc inevery county in 14 States. The woil< has been extended during theyear to 211 countiesl there \yas an increase of 16 counties in thecooperating States due to the increase in the number of States coop-er{ing uncler the- act and reporting work in the year.

Twenty-three States repoited 171 counties or communities as ,assuming (s.ingg thebeginning of their cooperation under the act)the responsibi l i ty for materni t .y and infancv work ini t iated oiassisted by the State child-hysiene bureaus or divisions. and oneother Star-e reported ? countiei"as assuming the responsibility exccptthat cliniciani from the State stafi save'assistance. This"in turnreleased funds for extension of work Io other counties or for rrse innew activities.

oRGANrzArroNS coopEF1f,t}$HJ"r MArERNrry AND

The support given to the State agencies administerinE the mater-nity and infancy act by state-wide drganizations and g.:oups as n'ellas by their locai component groups li-as made it possible to extendactivities to new fields and to include larser numbers of mothers andinfants in the scope of the worli than n'oilld have been nossible with-out the cooperation of such organizations. Types oT coouerationhave varied from formal approval and indor-"ement of the maternitvand infancy act bv groups io actual assistance in activities of th"eState program by physicians, dentists, and nurses at conferences anclcenters. frinancial assistance or support o,f pieces of worl< begununder the act has also been undertaR6n by private as well ar pullic

a In the fall of 19?8 Califomla antl Oklahoma besan the collection of data in resard to1028 materna l deatbs and Nor th Dakota the co l lec t ion o f da ta in resar t l to 1C27 and l928maternal deaths. The child-hygiene bureaus and diyisions of these- States wii i make thestudy with tlreir own staffs.


-

6 SUMMARY OF STATE ACTIYITfES DURING 1928 25

asencies. State and local associations have sponsored special act'ivi-ti"es and given assistance to them. The cooperating state-wide or-sanizatiois have included during 1928 other State departments orEuteaur. professional groups, rvomen's organizations, and fraternaland service organizati"ons.

- Forty-four States reported- cooperation

received from s-tate-wide organizalions, and one reported cooperationfrom local groups. The l-erritory of Hawai,i report-ed cooperationfrom organizati6ns and also frorrr the physicians and nurses of thesusar plantations.

ilo.iv States reported assistance from the State parent-teacherassociafion (usually in connection with the preschool round-up),the State federatioir of women's clubs cooperated in 29 States, theState leasue of women voters in 21 States, and the American Redcross in-i5 states. The extension service of state universities orstate colleses and the state tuberculosis association each was re-ported as a;sistinE in 13 States. Eleven States reported cooperationbv the State depirtment of education and 11 by the State medicalassociation. Trio States reported cooperation given by the Statemedical association's commitlee on maternal welfare.

Assistance by the State Woman's Christian Temperance Ulion andassistance bv the State dental societv were each reported by 7 States,the Ameriean Legion auxiliary by 6-States. and the American I*g-tgtbv 5 States. Fo"ur States reiorted cooperation by the State public-lr"ealth associat,ion, and one-State by the State public-health andtuberculosis association.

Two States reported cooperation from each of the followingorganizations: American Ast'ociation of University Women' wonlen'sou?ilia"v of the state medical association, business and professionalwomen'J club. State nursest association, and X'arm Bureau. In ad-dition the foilowing agencies- were reported as^coop-erati-ng.by atIeast one State: Stati child-welfare department, State board of char-ities and corrections, State board of health (Colorado), State univer-sitv. State asricultural college, polvtechnic institute. psychopathicnoipitat. Staie fair associat-i,on,- men's service clubs, Society forCri'ppled Children. visiting-nurse agsociation, Mormon 1lission and1vloiiron Relief Societv. boird of missions, Joint Legislative Council,State health council,- State chamber of commerce, Young }Ien'schristian Association, Young Women's christian Association, Needle-work Guild, fraternai associition, State chapter of -the Daughters ofthe American Revolution, State grange' Statl board of control, Statedevelopment board, rural womei-'s clubs, Council of Jewish \\romen,catholic Daushters of America, state association of social workers,schools, churihes, county medical societies, many local clubs andsocieties. and school officials.

48279'-2s--3

---


€'

SUMMARY OF RESULTS OF OPERATION OF THEMATERNITY AND INFANCY ACT

The extension of tr'ederal funds to the States and Territory accept-ine the plovisions of the materni lv and infancy act matle expansionof"activities possible in States th"at already hi,l child-h1'giine bu-rleaus or cliviiions as well as in the 10 States and the Terlitorv inwhich guch agencies w€re created after the passage of the act. Manyof the already existing child-hygiene bureaus and divisions werehardly more lhan nominal and"h"ad very inadequate funds. Evenin th6se States that did not accept Federal funcls immediately afterthe passage of the act in 1921 the^matterwas a subject for disdussion,and larger State appropriations for child-hygiene work were made.This rvas the immediate result of wider interest in the education ofthe public as to the possibilities and importance of public-healthwork for mothers and babies. The statement holds true not onlv forStates that later accepted the provisions of the act but also foi' thethree States that have not accepted its provisions.

In L918, when the firpt maternity ancl infancy bill was introducedin Congress, infant-hygiene work

-was in progiess mainly in urban

areas. Its wide extension to rural areas has been coincident withinterest in the maternity and infancy bill and operation of thematernity and infancy act in the large majority of the States. Pro-gralns of maternal n-elfare in rural areas have been deyeloped largelywithin this 10-year period.'

WORK WITE RACIAL GROUPS

Our complex population is a factor that has influenced infant andlraternal mortality rates in the United States. Practicallv everyState has initiateci lrork directed torvard the problems of a"specifi"cforeign-born people or racial group that has-composed partbf itspopulation. Michigan, New Jersey, Nerv Yolk, and Penns.ylvaniahave given attention to the regulation, supervision, and insfrrrctionof rvhite mid'wives who deliver irany of'the^recent immigrants amongthe white women. Nurses also visited the homes of-foreisn-borimothers and gave instruction in rnaternal. infant. and chil=d care.Rhode Island stafi workers met incoming steame.i and establishedcontacts with incoming foreign-born mothers and babies.

The States of the Southwest, as Arizona, California, I{ew Mexico,and Texas, h_ave given special attention to the Spanish-speakingpopulat ion. Li terature on maternal, infant, and cnitd care wastranslated into Spanish for distribution among the Spanish-Ameri- lr

1 See Some Results of Five Years of Work under the Maternity and Infancv Act in TheI'romotion of the Welfarc and Hygiene of }laterDity and Infancy, Iriscal Ienr 192?, pp.3Ho (U. S. Children's Bureau Publication r\o. 186; Washington,-1928).

26

r -*.,**

Provided by the Maternal and child Health Library, Georgetown university

! 1 , , ! l l ; r - , ! , = , I : , i - = i t j l a j - . ; a . . 1 n i i l : r i ' ; : = L : : r i i - . r l l i r E ' ; i i i ' i : . , : . a f F 1 i ' N : : l - a i . : i i :

i , . _ : = : : . ; = . _ - 1 , : . : 1 . , ! ! - i i l ! , : . I : ' , i ; . : a . , 1 r i r i : - L i G i r A L r L i i S * i i l i r _ L f v ; E H r l : j F t r A L j r ' . ' i - , c

t ' !


; ; : ' i - = f r . l ' . ! a i i ' ; i ' - : F 3 . 1 - : : - : : : - i : - - l - i i l j ; , 1 . I - : : \ - ; , i . - i l r ! l i l : ! l ' i i l i . , ' ; ! r i J t l : : ' T i . - i , r i - =O l i : : - i : - i r ' . , i T i i ; r r P i i f i ; i 1 l : i ' L ( - . i i . : r , , : f . - l , _ : : ; l - l r : : : , . r : i l : l : f l . j F : l : . _ , , r j : _ l _ a : : . _ - - i : r - : i i , i : I i . =F . . \ l i ' ; : ( - a r l ' : l : : - ! i l i , ; i n , + r : ) , j : . : = - - : : \ : ; i : . ' ; l , i r , . : : . L _ . ; n 1 : 1 5 ; ; 1 i i , i . i ; ! r i r : r : : j L : 1 i . ] i : - . =- 4 ! : ' l i ! : : . T i : . . - i i . = , t _ - r : r : T - i l i l : i i : l . . ; : i l ] ! t : ; . r . , : r - : , . . - L : : : r - . , ] r . : : i . ; - j = : : . ; , ! - ; q r - - , i i r : j r - : . , . i :: ' l i l . i . 1 : l l - : ' . ! l - r i ' 1 { r ! _ - i - i : r :

' i:


# RESUT,TS OF OPERATTON OF ITATERNTTY AND INFANCY ACT 27

can and Mexican popuiations in Arizona, California, and Nervnfexico. Nurses in all these States visited the homes of Spanish-speaking families and gave instruction in infant and maternal cate.In Nelv Mexico special attention rras given to the instruction of theSpanish-speaking midrvives who attend the Spanish-American andIlexican women.

Certain States have dpne special l'ork lvith the Indians throughc( ,operat ion rv i t l r the Urr i ted States Indian Se|v i r .e . . l \ l innesoG,Nebrasl<a. and Oklahoma have conducted classes in infant care amongIndian sirls. Michigan. Ifinnesota. and }fontana have concluctedhealth cdnferences foi Indian babies and prescliool chilclren. Minne-sota emploved Indian nlrrses for full-t ime maternitv and infancv

. rvorli o" tt e Indian reservations. Nebraska detailed i public-healtlrnulse for fu l l - t i rne wor l i anrong Indians, and other States have g ivenoccasional service to Indians rtithin their borders.

In the Territory of Halvaii the difierent racial groups have beenconsiclered in the planning of the maternity and infancy rvork.Health conferences^ regulaily conclncted at

"centers ha'r'e "reached

Hal.aiian. Fil ipino, Japanese, Chinese, Portngriese, and Americanchildren. Some of these racial groups had estremely high infantmortalitv rates. and reductions have been obseryed since the con-ference frork rv'as begun.

Practically all the-states with large negro populations have madeefforts to improve the hygiene and cire of-negro mothers and babies.To the s_upervision, regulation, and instruction of negro midn'ives-

.: ts in Alabama, Arkansas, Delaware, Florida, Georgia, Kentucliv,Louisiana, Ifaryland, I l ississippi, North Carolina, South Carolina,Tennessee. Texas. Virginia. and \Yest Virsinia-mav be ascribedsome of ihe redriction" in maternal and inTant mort"alitv rates in'given

areas." Special instruction in hygiene and nutrition has been gir..en to

negro women in X'lorida. Maryland has conducted child-heClth con-fei6nces among the negroes thrbugh the employment of negro phrsi-cians for the purpose.- Mississipi-i has conducted classes in ttygi.neand infant care for negro girls. Prenatal care was given negrowomen who attended the prenatal conferences at the coiirty centers.South Carolina has proviided a four weeks' course of pra"ctical in-struction in nursing-care, nutrition. and bedside instru'ction in ob-stetrics for negro iridwives. Tennessee employed a negro womanphysician _to su-pervise and instruct negro miclwives, who in ad-dition conducted health conferences for negto infants and preschoolchildren. Virginia conducted institutes

-for midwives and for

tt doc-torst helpers t' for neElro women. Negro nurses have served onthe State stafr or are detailed to county wdrk in a number of States.inclu r]_ing Alabama, Georgi a, Maryland, nlississi ppi, South Carolin a,and Texas. In Texas thi work of tne'Slate it iner;nt nesro nurses'wasso applec iated t l ta t the negroes of one county r r ised the necessar .vfunds to maintain a negro nurse. The neqro nul'ses emplovecl arreusual ly wel l t ra inet l in nurs ing schools and ihrougl i the i r d i rb" t cotr -tact in the homes assis t in imIrov ing srandards oT l iv ing, sani tat ion,and hygiene among the peopl6 of th6ir race.

.L--


# 28 TITE IvELFARE AND HYGIENE oI. MATERNITY AND INFANCV

EXTENSION OF THE BIRTH AND DEATII REGISTRATION AREAS

Since the close of 1922 (the 6.rst vear of operation of the maternitvaird infancy act) 13 States have been admitted to thc United Statesbirth-registratioii area-Alabama, Arizona, Alliansas, Florida,Georgia, Idaho, Iorva, Louisiana, tr{issouri. North Dal<ota, Oklahoma,Tennessee, and \Yest Yirginia-and 8 States have been admitted tothe death-registrat ion area: Alabama, Arizona, Arl<ansas, Georgia.Iou'a, North Daliota, Oklahoma, and l\rest Virginia. The staffs o{tlie State divisions and bureaus of child hvqiene have aided in thecampaigns for better registration of births ind deaths in every State(except Iowa) admitted to the area since 1922. (See footnote 3,p. 23, for States admitted since June 30, 1928.) .

PROGRESS IN EDUCATION OF MIDWIVES

Classes for midwives. conducted bv nurses. have been a feature ofthe maternitv and infancv work sincd funds lvere first made avaiiableto the StateJ under the Federal maternity and infancy act. Most ofthese classes have been for negro women. They have included in-struction in the hygiene of pri'gnancy. the neeeisity for cleanliness,the preparation for delivery, the metliod of conducting delivery, theimportance of calling a physician for complicated cases, the use of aprophylactic in the eyes of the newborn, and the general care of thenewborn. Practical demonstrations formed part of the course inmany of the classes and included the making and sterilizing of pads,dressings, and supplies needecl at confinement, prepalation of theobstetrical bed, bathing the mother, and caring for the baby. fn atleast one State the technique of deliverv was demonstrated by theuse of a manikin. This work has been valuable in imnrovinE the'standarcls of practice among the midrvives and eliniinatin'g those-rrhorvere unfit, although it has not given the midrvives any practicaltra.ining under supervision in the technique of conducting a normaldeliverv.

State directols of the maternity and infancy work in some parts ofthe country recognize that social and economic conditions make themidwife necessary in their States for many vears to come. Conse-quently several of the directors are seeking "a ituanr of making avail-able courses for midwives that will com6ine theoretical inst-ructionand practical experience in midwifery. Considerable progress inthis fvpe of worE has been made in Kentuckv and South Clrolna.In K<intucky a three monthst intensive course in midwifery for whitemidwives rr"as inaugurated a little more than a year ago"at a smallhospital in a mountain section that has facilities for training three ata tiine. Eight women had completed the course by June 30,1928. antimany otherE were awaiting admission. fn South Carolina a begin-ning rvas made in 7927 by tlre provision of a training course for negromid"wives. The hospitai of a-negro school was lent"for this purpose,a local physieian volunteered his services for all deliveries. and anurse fr6ni the stafi of the State bureau of child hygiene and public-health nursing had general charqe of the course. In 1928 the insti-tute rvas conducted for a longer iieriod and on a more estensive scale,about 30 midrvives being registered for each of the three months ofthe institute, A negro-graduate of the Bellevue Hospital training


j'

#NESULTS OF OPERATION OT XI. {TERNITY AND INFANCY ACT 29

:chool for midwir.'es was employed to assist the nurse in charge, andtacir nurse on the bureau staff was assignecl to the work for a 2-rveek

1,cr io t l . The same physic ian n 'ho volunte 'ered h is serv ices l l re prc-ieding year deliver",i the abnormal cases and the negro nurse-miclivifetl ie niimal cases. An out-patient department rras organized,-thestudent midrvives going rvith^an instluctor to delirer patien-ts in theirliomes and give pbstpiitum care. Exam_inations rveie held and cer-tificates n'er'e arva-rcled to those wlto passed.

In 1925 Vireinia began to condu-ct l,-rveek institutes for tt doctorstIrelners." rvhich rvere a[tended by midvives as well as bv other women.Ttr6 .o.i".. has consisted each vdar of lectures bv phvsiiirrns and otheresl icr ts on l real th subiects. n- i ih par t icu lar emphis i l on mrternal andinfant l tys iene and o i i r ract ica l demonstrat ions of some of the sub-i t 'c ts conls idercd. Senire ' .e inst i tu tes are tonductet l for s 'h i te andIor negro ll'omen,

In t'gZ6 Tennessee employecl a negro \\'oman pliysician to conductc lusses for negro mi t lwives,-ant l th iJwork is s t i l l in p logless. .

The midl' i Ie nroblem is'bv no means confined to the South.. Inthe North and \Yest many ri'omen, mostlY of foreign birth, are at-tended at confinement bi midn'ives. In the

-lYes[ manv sparsely

settled sections do not hdve the services of a physician. and the ex-pectant rnother must look to a friendly neighboi to act as midrvifeit the time of confinement.

In Nerv Jersey (in n-hich staie the midwives must be graduates ofa legal ly inct rporated school of midrs i {er ' .y cr of a matern i ty i rospi ta l,, ' ,nto,-*d l-,v f lre State boald of inedicai esamitrers) arrangements',lleie made in 1928 for an advanced course for licensecl midrvives atr l re , t rerscv Ci tV Hospi ta l . The course l \ 'as arranged to p|ov ide prac-t ica l t ra in ing" in th 'e matern i tv r rar4s. nurserv. - labor and del ivc |vrooms, anf l c lassroorn of the hospi ta l , one weel< to bo s l rcnt_ in eachtlenartment. Althoueh onlv 3 riridrviYes could be accommodatecl intlre ho"pitrrl at one tir;c, 1+ completed tlte cottrse riuling the. year.

In tgZZ Pcnnsvlvania employed two wotnen ph.r'sicians (cne for a.hort ncriod. onli-) to dev.rte iuII t ime to tcrchirig and srtpervisingthe miclwives in iour counties in the coal regions. Later another\voman physician was emplo5'ed, and 10 counlies are no-,Y coverecll-,v this woik. Its extent ii iniicatea bv the fact that 7.134 deliverieswere reDorted as attended. bV michvives in nine of these counties i1

1927. iln th" tenth county"the nork hacl been in progress only a

sliort tiine.) Onlv nine m"aternal deaths were repoitetl among the\fomen attended by the midwives, though all deaths of rnothers at-

tencled l_,v mitlrvivds at ftny time chrring-confinemcnt wcre ctlttnted as:i;rih; ir ithe midwives' piactice even ii a physician also attended the

case ancl signed the deatir certif icate.

REDUCTION OF }IORBIDITY AND PREVENTION OF DISEASE

statisties on nro|biditv are not available escept fr.rr certain report-

, ,b le d iseas.s or in lhe"evenL of specin l s tu, l ies. Consequent ly" no

ltrecise statcmcnt can be made inregard to maternal and infant

i " " "U;J i t . " ;brr t . ns mor. ta l i tv pre.uppnicr . morbi t l i ty rn. l .usurr l lY fo l -

Iows an i ' l lness. mortality rat"i are some jndex of morbirl i ty. There-

i " r " i t l . "

h i i u . .un,pt lon that lower mrrernal and infant morta l i ty

.ut." ""fl""t

fewer ilinisses of both mothels and babies. There can be

>-.


ff 30 TITE wELFARE AND ITYGIENE OF }IATERNITY AND INFANCY

no question that better care and hygiene for mothers and childrenhave added to the sum total of hu"man well-beins and of humanhappiness.

Many States have included among their maternity and infancyactivities special preventive work. Some of this has been directeclagainst diseases that cause high mortality rates for children, somea[ainst diseases that, though iot fatal, cduse physical handicaps oriripairments. The inspect'ion, supervision, and iegulation of

-milk

supplies has been one of these special activities in sone States. Theimpbrtance of sun baths and cod-liver oil in the prevention ancl cureof-rickets has been stressed in the conference rvork, in nurses' visitsto the homes, and in the literature distributed. The collection bymaternitv anil infancy workers of specimens for examination forhookworin and other p'arasites has contributed to improyement inthehealth of small childien. Arnpules of nitrate of silver fol prophy-laxis against ophthalmia neonatorum have been distributed free toattendants at childbirth in manv States. or the distribution has beenpromotecl through financial assi-stance.

'The use of the prophylactic.

esoecially by midwives, has increasecl greatly, and where data havebeen obt"ainable the indications are tha"t bliriciness {rom ophthalmianeonatorum has clecreased considerably.

State divisions and bureaus of child hyqiene have contributed toand assisted in toxin-antitoxin campaigni

-and have emphasized the

necessitv for immunization of the year-old infanL and the preschoolchild against diphtheria. Many hive included preventine

'mea.uret

against"diphtheiia, smallpox, and typhoid fevei in the '( get readyfor school " campaigns for the preschool child. A lower incidencefor such diseases ap"pears to hal'e {olloived aggressive campaigns ofthis character.

Goiter prevent ion has been'an objcct ive in certain Stntes havinga high in6idence of goiter, as those bn the Great Lakes and certainRoc[v Mountain Stites.

-Utah and Michigan have been especially

activ6 in surveys of goiter and efiorts for [revention. In J^arruary,1924, tbe Michigan State Department of Health made analyses ofrvater supplies i"n the State and found insuff.cient iodine for "human

requirements in aII samples examined. At the same time a surveywas made of the prevalence of goiter among school children in fourcounties, and the field stafi of physicians Jrnd nurses of the Statebureau of child hygiene and public-health nursing was lent to aid inthe survey, with the understanding that any preventive programshould inclirde the prevention of goiler in the &pectant mottrer.

-The

data obtained in the four counties were as follows:

Iodinecontent

perbil l ion

parts ofwaier

Percent-age inci.dence of

goiteramongschool

chirdrenexamined

None.0. 057.308 . 7 0

64.455. 632.726.0


&RESUI,TS OF OPERATION OF ]VIATERNITY AND INFANCY ACT 31

A state-wide edrtcational campaign for the use of iodized salt onthe table and in cooking was insiitu-ied bv the l\Iichisan Deparrmenr<-,f Health, resulting in the very seneral irse of iodizid salt'not onlvin ll iclrigan but alio in other Stites of the Great Lakes reqion. Aresurvey of trvo of the counties (lYexford and Midland)

-in 1g28

showed that in Wexford_C-ounty the percentage of goiter had droppedfrom 55.6 in 192-l to t7.2 in lgZg ind in I{idland Counrv it^haddropped from 32.7 in 1924 to 8.8 in 1928. It rcas learned inihis sur-r ey thatiodi.zed salt w_ag. ir;ed-in_91 per cent of the homes of the pub-lic-school children in I\Iidland County. According to physician^s inHouglrton County, babies born with goiter were iot uirc6mmon be-fole the goiter-prevention work, but to date the interested physicianslia'e not seen a single case of congenital goiter when the mother hasrrsed iodine. rn view of the impa-irmentlo health in later life fromthyroid-gland disturbances and^the menace to life itself in the con-genital type of goiter, also the strain on the thvroid gland of therrrother during pregnanc.y, the information obtairied bv'the two sur-veys and the confirmation of the worth of the preveitive measuresshould- be of great value in decreasing maternal and infantnrorbiditv.'9

THE INFANT MORTALI'T'Y RATE

rnfant mortality rates for the whole registration area as of rv27ale not strictlv cornparable with the rates for the area as of 1922 be-canse of the admission of 11 States to the birth-reEistration area be-trveen January 1, 1923, and December 31. 1927. The"re was a reductionin the infant mortality r-ates for the birth-registration area" or rg2ras compared with that of 7922. (See Tables iII and IV. AppendixC, pp. I72.774.) In 1922 the mortal i ty rate (deaths of infanis 'rrnderl year of agg.per^l .000. l ive bir ths) was 76; in 1927 the rate was 65,a saving of 11 infants in every 1,000 born alive for the whole area.In 7927, 24,50A babies who would have died if the rate of 1922 hadcontinued surr-ived their first year of life. A somewhat Ereater re-t luc( ion al)pears i f t l re States that n 'ere in the area and re"mained infrom 7922 through 1927 are considered. (Table 6.) The birth_registration area of 1922 included B0 statis and tlie District ofColumbia. One State (South Carolina) was dropped from the birth-registration area in 1925. Three of ihe B0 states have never co-operated with the Federal Government under the maternitv ancl in-fancy act and 3 others began cooperating in the later yea"rs of theoperation of the act.^A

comparison of infant mortal i ty rates in the expanding bir th-registration area for white and eoiored babies shows a re"ductionamong both groups in 7927 as eompared with 1g22. The rate for thearea as a whole was 73 for white babies in 7g22 and 61 in 192?. Forcolored babies the rate was 110 in 1v22 and 100 in 1g27. rn eachof the states that were in the birth-registration area in rg22 and rg2|and that had more than Zp00 colored births annually' the raie for

. t Kimball,_o.. P. : The Eflicieney and safety of the prevention of Goiter. Journal of the

f.?1"d,?1: ,1';Si:i'r^'if:'T.f"';,"1""' ,?"k,"T? "'..t"18?iJ:;"',%i ff; jiar5.i.l:'rl;irqrTn 1 1 t O

""i"3,?lTl",li1a,'itlliJt,"5i?j:"vniiu,llli'"'$Hln$iii#f,0,;rt""y"j;fi:', *"* york, North

Provided by the Maternal and Child Health Litrrary, Georgetown University

# 32 TITE \\TELFARE AND TTYGIENE OF I\TATERNITY AND INFANCY

botir white and eolored babies was lower tn 1927 than in 1922, ̂exce-ptil N";a[ C;rolina and Virginia. In these trvo States the rate for the.ofor.Jot ' .cup was highcr in 1927. (Ttble lV, ApPentl ix C, p ' 174')-An

ut i . l f . ls of t l ie pr incipal groups of causes of infant mortal iLyto" ih" Stdtes in the birth-resistiatjon area in 1922 (excluding South-C-"il""J

.ioi.r-s a lower r.atd in 1927 than in 1922 for eac-h g'oup ofcauses eicept external causes_ (for r-hich the late n'as the sams infrolfr n"ut:tll The gleatest reduction is shorrn in the group of gastro-intesr'inal diseases,"rvitir a rate of l2.i per 1.000 live births in 1922-"4 S.i i-nL927. Respiratorv diseases siood next l'ith a rate of 13'?ii 1SZZ comparecl ivith tO.g"in tgZ7. The rates clue to deaths fronnatal and pienatal causes generally_ showed^ slight decreases fromTsZz tt 19fi; the 1927 figuie (33'?"deaths of !1!a1!s per 1,000 livebirths) rvas 6.9 per cent loner than that for lg22 (36.2).

Tlnr,o G.-lnfiant mu'talit11r rates (il'eaths of infants uildcr l-lle-ar of alle pcr1,000 litebirtns), bU siecified, groups of causes, in tlrc Unite:1 S^tates birtl'-rcgistratLon area Qsbf 1922,' ezclusir:e of So'utlL ('aroltna; 1922-192'l

Caues of death 192?

A l l c e u s e s - - - - - - - -

36212.713. 73 . 9. 9

9 45 . 9

64. 0

8 . I10. 33 . 5. 9

2 . 25 . 2

I Icc lud ins Ca l i fo rn ia , connect icu t , De lsware , l l l i ro is , tnd iana, Krnsas . Kcntuck l r . , \ la ine , -Mcrv land '

"l"t*Lt':t;#',cli-:1,",'JSllit'3'.1,)iit:'.Ki,)l,ilj?i'l;.)iliff5ii t"'t'll?liiilllci.;Iil,.rii::i':

i" i io*-irt it.. i ,. l ' , i ,- i i 'r:o-i irg, anri thd Irisrrict oi Columbia. These are rl l the States thal $crc :D lhobii l h.resjsl rat ion area every year from 1922 Lo lgn '"'t

6;fiJ; ;;e-ature blritr, congenital debilit,v, injudes Bt birtlr, other Ciseases of euly infancv, con-eenital malfoimstions, s!'phil is, tetaDus'

3 Iociuds diseroes of tbe sromach, dianbea and enterit is,^dysntery.{ Includes bronchitis, bronchopnemonia, pneumonla'.Iniluenzs.. i ; ; i ;A ; ; memic i , l car le t fe ie r . whoop idr cough, d iph thcr ia , e rys ipe las , men incococcus .men inc i t i s ,

tuberculosis of the respiraiory s-vstem, tuberculosis of ttle Benings, othcl IoIms ot tuberculosls.6 Includes conrulsions and other caN6 of death.

Recluction in infant nroltality clue to cliarrhea antl enteritis and toresrrit,atorv diseases leflects the-work done in clisseminating informa-tion on tlre irnportance of breast feeding and the p,roper preparation ofsimule formuias of cow's nri l l<. the value of good routine in the . 'areof tiru baby. sunshine. fresh air, and the introduction into the infant'sc l ie tarv of" the r isht foods at the r ight t ime. Reduct ion in morta l i tyfrom natal and frenatal causes in1SZT also reflects the wider knorvl-e,lCe of the careof the l.,aby, the prenatal care the mother receives.an-d a ,.^reater attention to care at time of childbirth.

The'sti l lbirth rates have remained practically the same for every

vear flom L922 to 7927 for the expanding birth-registration area.The stillbirth rates per 1,00 live births flot \922 to 1927 were asfo l lows: 792211923:) and t924,3.9; 1925 and 1926,3.8; 1927,3.9.

THE }IATERNAL DIORTALITY RATE

The maternal moltalitv rate for the birth-registration area in1922 was 66.4 (deaths of

'mothers from puerperaf causes per 10,000

li le births) : in 1927 the rate was 64.7. The reduction in maternal

n26

t;*10. 3

I 74.24 . 3

I 1 . rI 2 . 3

5 . 6

1924

70.3-10. I1 1 . 9

1 . 02 . 3D . O

76. 6

3 5 . ,12. 513. I

I " g


gRESULTS OF OPERATION OF M.{TERNITY AND INFANCY ACT 33

rnortalitv was larqeiY in the rural areas, the rate being 59.5 in 1922,"a ff.ditt I}2T-lu iaving of 4 mothers per L0.000 li 'e births in therural areas in 1927 as conr-pared with 192^2. During the same periodirr"-*""t"titv rate for urLan mothers increased from 73.2 to 74.8.'lhe materna'l rnortalitv rates for the 29 States that 'ivere in the areaitgiB, and. remained in the area throughIg2T were 65.4 in 1922 ancl67.9 in 1927. (Table 7.).

TArrra 7.-Matertufll mortalita ro,tes (deaths of m.otlwrs front, y,rtterperal, causestrcr 10.000 l ire birthsl, blJ c/tu,se of death. in. tho IJnited' Stales birth.t 'egtslnt-' l ion

orea as tt f 19J2,t en' lusire of Soull t , (aroltna; l9J2-19'! ;

I rnctudins california, co_nnectieut, Dera*are, nrinois, rndiana,ffsff,s#-fi:tili$t?tlk*,:,r"tlt$;

^il+;y*fll:.1'Flitfrlf8il,ll S,?!;)l}!T'f*|r&*l;'h1?$ *,-0, urah, \ e,-dnr, Virginia. $'ssbri"ii"ti. il i irioiititi, wyomiirg, anaiL'fDlitricr oiCotu:riuia. These were all the states rhat sere in tholriith-r'egistrarion irea'every yes from 1922to Lgn-

In 18 of the 29 States the maternal mortality rate for the State asa wlrole Il,as lolyer in 1927 than in 1922, in ? States the rate washisher, and in 4 states it was practically the sarne. In these last trvogr-o.,p., however, 6 of the 1i States had lower rates in the ruralireas in 1927 than in 7922.

Conrparison of maternal mortality among the groups of white andcolored mothers for the birth-registration area sho$'s a slight tlotvn-ward. trend in the rates for white mothers. The rates for coloredmothers have shor.n no tendency to decline but rvere higher in L927than they were in 1922. These rates were as follows:

,Uaternal moriatity rdtes (dectlLs ,i*T,lXfrrrl.,

f ron, puerperal, causes pcr 10,000

UDited States birth-registration area- - - - - - - - - - - - - - - -\Yhite populationC o l o r e d p o p u l s t i o n - - - - . . - - - - - - , . ,

64.759. 4

1 1 3 . 3

Of the 11 States that were in the birth-registration area in 1922and 1927 and that had 2.000 or more colored births annuallv the;;;";;i -"tt"ttt"

""t" fo. the colorecl population was lo*'er in

1C2I than in 1922'in 6. hisher in {, and the iame in 1. Among thervhite population the rate- was lower in t927 than in 1922 in 9 ofthese S1a[es and the same in the remaining 2.

The rvhite and colored lates for 1922 -and

1927 arc not entirelycomparable, owing to recent immigration into \orthern States ofn,,-^be.s of southein negroes rvho ardnot yet adjusted and acclimated.'Ihe admission to the

-birth-reqist'ration area of a number of the

L-_


1 uo.*c2 .8

106.8 j


*34 TEE WELFARE AND ITYGIENE OF MATERNITY AND INFANCY

Southern States n'ith high mortality rates for colored mothers hasulro inflo"ttced the rate Jor the area as a whole. It is inter_estingio

"oiu that seven States (Florida, Kentucky, Maryland, Nerv Jersey,

t_ttrio- Virsinia. and \Veit Virginia) show reduction in maternalmortatity i '*orrg the colored pofulation. In several of these Statesaitentiori has beEn given to the sirpervision and instruction of coloredmidrvives.

The maternal mortalitv rate due to puerperal septicemia, the prin-cipal cause of maternal dcaths, has-not-decreased' That drre topuerperal albuminuria and convulsions, the second most frequent^cau.e

of ma,ternal deaths, has decreased. from 17.6 per 10,000 livebirths tn 1922 to 14.9 int927. There are slight decreases in ratesdue to accidents of pregnancy and accidents of labor.

The decrease inihe.-matcrnal mortalit.y rate has therefore beendue primarilv to a loweling of the morfalitv rate from puelperalalbudrinuria

-and convttlsions, a cause afleeted by prenatal care'

'Ihat this reduction reflects the effect of the educational work in re-gard to the importance of prenatal care condttcted.by the States and6t ttre literature on standirds of prenatal care that has been dis-tributed by them seems a justifiable conclusion.

LErrERs FRoM PARENTSFf$g)D"^fiIfJg! "s

AND REPoRrs FRol\I

The human side of materttitv and infancv rvorli and what it meansto the individual parents is il lustrated by the lett_ers of _appreeiationthat have been reciived bv the State directors and the United StatesChildren's Bureau from iiterested and grateful fathers anci mothersand from appreciative physicians. The reports of rnaternit.r'.anr1infancy nuriei tell of tr-ng6dies, adventures, and successful achieve-rnent.

- Excerpts from lettlrs and reports follorv: n

LETTERS FROM MOTEERS TO STATE DIRECTORS

From West Virginia:Just a n'ord of appreciation and thanks for your letters, brimful of sug-

gestions, aid, encouragement, and cheer. Each and every one I have reatl anrlieread carefully, and I am striving to the best of my ability to follorv -vourgood advlce which has helped ure thus far, and trust that you, the department'and our state rvill be slightly repaid when my baby's birth certificate has beenreturned, and through the subsequent years of our liYes'u

The mother's training course should be continued by all means. It is a greatwork; it is especially helpful to farm women' There are many who do notpay aitention, 6ut it is a great benefit to those that do' I could not get alongwiinout your helpful pamphlets and bulletins. The county nurses- should bemore in number and. more homenursing courses should be organized."

From Michigan:I appreciate greatly the material sent to me from the State departTent of

healtf-and attribute,;in part, a healthy term of pregnancy and a lovely babygirl to its helpful suggestions. The contents of the monthly letters and bulle-Iins is put in such a reassuring manner that it takes away the dread of the

4 A few of these letters were teceived after the close of the fiscal year -192-8.-6 This was from a womall who wai enrolled in the correspondenie school for motbers.

fler babv had iust arrived.oThis-letter-was fornardeal by a nurse to the State superYising nurse.


a RESULTS OF OPERATION OF MATER"NITY AND INFANCY ACT 35

\Vhen people stop me on the street and ask me the whys and wherefores ofmy so obiiously healthy baby I always say " He's a Government baby"' givingali crer-lit to your bulletin (Infant Care). I was lucky enough not to know:rultl)ing about babies before and not to haYe any relatiYes who thought theydiLl.

From Pennsylvania:\\'ili -vou kindly send to the address below your booklet on fnfant Care? My

b:ibl'is 19 months old, and I have found ttre advice therein invaluable.

From Oregon:\\-ords can not express what a great help the little booklet called fnfant

Cnre has been in our home. We have had wonderful results with our baby byfullorving the booklet.

From }lissouri:I am writing you in regard to the two books whieh I have received from your

officos. I have in my possession one entitled " Prenatal Care " and another" IDfant Care." These books are so precious to me that I can not part witheither of them, so am taking this opportuuity to ask you a favor. Would it bellossible for your ofrce to send a friend of mine either of these books or both, asrhey would certainly be a help to her from both points of view? * t * Shen'anted to borrow them, but they are almost as close to me as my Bible.

LETTERS FROM PEYSICIANS TO STATE DIRECTORS

From Pennsylvania:A few months ago you were kind enough to send me a suplty of bureau pub-

Iications 4 and 8 [Prenatal Care end Infant Care]. I wonder if I could pr+viril upon you to send me a r*'hole lot of them- They turned out to be the mostlvonderful help to my primipara eases that I have had in my 23 years of prac'tice. They have bec.ome famous in this part of tbe eountry, and I am havingto tlorrow them back to lend again and again as there are not enough to giveeach case & new one.

tr'rom Ohio:It has been my eustom to give every conflnemmt patient a copy of this book

(Prenatal Care) and at the time the baby is born the book on Infant Care. Iuse 40O or 50O of these a year.

coming of the flrst baby, whieh is such a- m-)'stery. Before my marriage Itaughl in tire - junior high schooi of this city, in the .homeeconomicrsai,partment. \ve organized the little mothers' league in the nilth gratle forihiee iemesters and Tolloweil the lessons as outlined by the State department ofhealth. Looking back, I feel that the work has been a wonderful aid to mein caring tor my babl.. If the girls received as rnuch beneflt from their work asI have lhe resirlt rvill be far-reaching in the bettering of the care of infants.I \yish that the importance of this work in the home could be more fullyreiLlized in instlucting our school girls. The effort put forth by your depart-rnent is intleett splendid. My physician recommends highly your material onlrretratal and infant care and has it sent to quite a number of his patients. Iit,ink tri- rvise in cloing this, for expectant mothers have such terrifying thingstolcl to thern that they need something authentic or the subiect at hand to keepa healthy mind.

Ilaby - is 8 weeks old and gaining steaclily' She has not had a sickmoment since her arrival, for which we are so thankful.

From New York:I l'ish to thanl{ you for the baby book you sent me last year. Now f have a

friend who has used this about half the time but lives in -, 15 miles fromhere, and it makes it very inconvenient for her and myself 4lso WiIl youplease sencl her one, or me another one? IIer name is trIrs. S.

i

I

From lllinois:Please send me 12 copies of booklet fnfant Care, bureau publieation No.

(revised). This is one of Lhe best booklets I har.e read on this subject, andam desirous of securing these copies for some of my patients.

E_


8I


j

€ 35 TrrE 'WELFARE AND ITYGIENE oF MATDRNITY AND INFANcY

From Michigan:On behalf cf the - County lledical Society we wish to thank ]'ou for

your notable assistance in the conduct of the recent children's cliDic. Withoutyour direction in daily conduct of the clinic it rvould hlve been impossible tohold i t .

Sincerely yours,

secretarY, - c**t, u*oir\' Pohu,r.

LETTER AND ORAL NEPOBT FROM FATHERS

From California:As I hale recently become a dad to a wonderful babl' girl, I am n'onderilg

if J'ou would be so kind as to send me )'our booklets, Baby Care, Child llanage-ment, and Child Care.

My brother has received his copies, and r.r1nn lookirg over them I disco'r-eledsomething contained in it that applied to rny baby (difficulties of the nulsini;luiod). lYe decided before re:rding the boolilet that we would immediately putit on a bottle, not taking irrto consideration that the baby is but 3 rveelis old, non'l1'e can readily understand rvhy she raises a rumpus frequently. So personailyI thitik the booklet is rvorth its rveight in gold.

From Kansas:A father brought his baby of approximately 1 vear of age to one

of the conferenc-es. The "trita

n'ai examineJ and founcl "to be inperfect condition. Since it is rather unusual for a father alone tobring a little baby to a conference the physician in charge conr.ersedwith him rvith a vierv to getting some light on the case. The youngfather said that the infant's mother had died at birth and he hadimmediately taken charge of his child; had read all the literature hecould procure on the care and feeding of infants. FIe bathes andrlresses the baby in the morning before leaving it in the care of hismother for the"day. He takes"entire charge olf it during his unem-ployed hours and"at night-it had not been separated from him asingle night since its birth.

EDPORTS FROM NURSES IN TIIE FIELD

From Oregon:A county nurse begins her report with the statement that the out-

standing aceomplishment in one county has been the establishmenton a, permanent iocally supportecl basis of monthly child-health con-ferences in two small torvns. t' These,t' she says, tt are conductecl inB- by the local doetors and in R- by one doctor until hisdeparture and then by another. In B- all clinic appointmentsar6 made in advance"throush the B- Chamber of'Co-rrr"r..".In R- the county agent's office arranges appointrnents. Someof the outs ic le doctors rvho have condueted c l in ics fo l us are fnamingtour]. An interesting feature of the 3-day clinic during the D

-

Countv fair conduci*ed bv Doctor H. ivas the fact" that it wasfinanced bv the R- 2114 g- chambers of commerce. theD- ibunty court, and the public-health association. The clinicat the tri-corintv State picnic conducted by Doctor B. was financedbv the countv granges.tt^

" Another nirrie says : " The tn'o outstanding events in child-welfare

work in U- Cgunty 1verc the surnmei'rouncl-up clinics spon-sored by the parent-teacher association and the infant and preschool


RESULTS OF OPERATION OF MATERNITY AND INFANCY ACT 37g

clinics held in seven towns, at which 3?9 infants and preschoolchilt lren n'ere examined.t'

The report from another countv where the rvork had been reor-ganized ieacls: " Owing to the high infant moltality rate in thisiountv a series of infani and preschool clinics rvas the fi lst plan madoby th"e nulse for her summer program. lVith the assistlnce of a.iini"iun and the field. supervifor Trom the State board of health,clinics rvere held in five towns. They were u'ell attended and muchappreciated by parents."

From Yirginia:-We startecl back to about 3 p. m', and about 3 miles from

Ieceivetl a maternity call.? To reach the place we had to walk 1 mile straightup the ruountain through a creek bed, there being no road' Fortunately, therestre rocks enough to protect our feet from the water' Reachitlg the home,1\'e \yere invited. into the patient's room in l1'hich thele lvere 13 women, 3 babies'and husbttrrl in attendance. We found the woman irr a critical condition. Afteran examination was made and a ferv orders given doctor and I returDed to

to get a ferv things needed----ether, chloroform, and so forth. \Ye had acheese sandrvich and a cup of coffee, returning to the patient as sooD as possibleto flnd the same number in attendance. The doctor and. I had a strenuousnight, and at 2 a. m., flnding it was impossible to accomplish results in the home,ttecided the patient would have to be taken to the hospital. The doctor askedme to stay with the patienl and go'lvith her to the hospital the next morning,while he v'ould go home and make arrangements to get a motor car or anengine, and get a fev hours' rest in the meantime.

iV.' irnprovised a stretcher *'ith green poles and quilts, making the patientcomforttble on them with hot-lvater bottles, and so forth. \Ye started l'ithftiur to " pack " her to the main road rvhere a motor car was provided to tnkeus over the mountain. Before the men had gone very far their burden becametoo heavy, and the sister and I had to relieve tl'o of the men; they in turn re-lieyed the other two. On the rvay to the road we passed the home where hertwo children rvere staying. They \\'ere screaming, " Please let me see rnymothel," but fearing overexcitement to the mother we begged them to be quiet'telling them that their mother n'ould be all right. We reached the road antlfound doctor rvaiting in his car. IIe insisted on my going over in the car w-ithhim rather than in the motor car rvith the pBtient, as it I'as so very cold' butI could not think of the poor soul going over that mountain alone with no otherbut men to Iook after her, so I went 'with her, for rvhich she was so Srateful.We reached at 10 a. m., and the patient rva-s taken at once to the oper'ating room, but in spite of all efrorts she died that evening'

IC became my duty to break the news to the husband, and I don't knorvrvhat the poor soul would have done had I not been with him. EIe harl onlymoney enough to pay his board at the clubhouse and to bul' one ticket home.I went with him to the company's store, arranged for the easket, and the storemanager gave the material for the shroud to the local Red Cross committee'and one of the Iadies made the shroud that night- The husband calne to methe next morning rvith tears in his eyes and said, " Miss M., I haven't the moneyrvith me to pay for the body to be taken home." I tolcl him not to bother'that I \\'as attending to that, but before I could get to the offce the storemanager had already attended to it. The people of - certainl-v came tothe rescue in time of need antl clid everything they could to help me and thispoor man. The bocly was not taken home, as it rvas too far to " pack " thecasket up the mountain, but was taken to the home of a friend in -.I left orders n'ith the husband that the casket shouial not be opened until Icould get there, as rve had no unclertaker, antl later in the day I attendedto this matter.

The day of the funeral I was called upon to do the only thing left in that linervhich I had not done---<onduct the funeral services. This done, I turned myattention to the lvelfare of the husband an(l children.

? Though tbe maternity and infancy nurse does not as a rule give bedside care, she issometimes called upon to assist the rural physician in an emergeucy.


38 TIIE WELFARE AND ITYGIENE OF MATER.NITY AND INFANCY

#In visiting on one of our back-river roads about 10 miles from - I met

a $'oman in the road, and, as I usually do, I stopped and asked her if she knewof any young chilclren under 2 J,ears or any young women who lvere expectingto become mbthers. I told her I *'as from the State board of health' and shesnid, " l 'hen )'ou go, to see llrs. J.'s baby, for she is a girl that is in love withthe State boalcl of health. She took a correspondence course bef,ore her babycarne and knerv just ho$' to do everythiug for her baby when he arrived." Icalled and found Mrs. J. an itleal young mother; the bab.v is flne, is 5 monthsold, ancl lveighs 15 poundB, is breast fed, and in perfect health.

From Texas:Last month I rttendecl a matemity case $-hich provc'd to bc the fortieth great

graldchilcl of one of the oldest pioneers of this county. Tire oid lady is ovet'I0 yeat's olcl but is quite splightly for her age, l'hiclt .she pr'oved by vtsiting thelittie nervcomer. Like all o1d people, she lires in the past, but shorvcd that shehatl an e1.e fof nerv things also. She apploved of the sunshine flooding hergrandriaughter's room and dweit for some time on the fact that she had tospenA hei time after her conflnement in a dark room so that the baby wouldnot get sore eyes. She thought it wondefful that the iioctors had found outthat briglit Iight would not bring on any sore e]'es.

I har-e found the champion infant feeder in my county. I had a child-

licalth conlereuce in - a small Iural columunity, and 22 childran attended.A father. brought an 11-month-old boy to the confefence. llhe bab5' is a picture

of health arrd lras perfect. I asked the father about the baby's care. Hesairl iris rvife clietl soolt after the baby came aud he had been caring for the

babl . He tokl me how he ster.ilized the bottles and prepared the footi. He

also brought his two small daughtels to be inspected. The children r.vere all

I'ell carecl for. * * i The mothers said it was a slam on them because

he did a better job than they clid. He hired a man to do his farm $'ork so be

could care for his children.

The smal1 clinics rvere held in a home, hall, school, whichever seemed to bemost cerltrally located and conYenient. The hours were from 1 to 5. Thedoctors n'ele asked to come at 2. At that time we had finished the prelintinaryrrork and the children wele readJ' to be examined. When the;v practicalll'' allarrived it one time I found it erceedingly bard to keep them from crowdinginto the doctor's office at one time, although I numbe|ed their cards. I foundit necessary to have a doorkeeper to keep them out. It is much better to haveone child ri-ith his parents in with the doctor at one time, especially since westripped them to th-e waist. Another difficulty \4'as in teaching the lay- helperstrow to fill out blanks correctll.. some of them never hatl done any health workbefore, and it made it very iard. I \fished that I could do it all by myself,but that rvas impossible. i am hoping to have the same ones back in the fall'and then it will be much easier. * * * I feel most grateful for the heartycooperation of both the medical and dental professions. Without an exceptionthey all said: " This is a most important rvork and should be carried on every-rvhere." If only the parents rvill do what is advised and not put.it off' I trieclto impress the iollowlup committee s'ith the importance of securing correctionsfirst ior the lleneflt of the child, secold for the good of the school, to preventso many repeaters, as an example to other parents, aljIl for the -furthering ofpublic health in tirat and surrounding ct-rmmunities' Even our future rouncl-ups clepend on the outcome of this one. \\'e want to prove to the doctors andclentists that it is not time wasted.

From South Carolina:we are much indebtecl to Doctor l[., of .-, whose generous. eoope:ation

\yas one of the big factois in our success. He attended all deliveries and tookii-" 1o-.ipruio d""tails to the class when he thought -such explanation could beunderstood. In this way he gave them a great deal of very valuable instruction.


RESULTS OF OPEI]ATION OF I\IATERNITY AND INFANCY ACT

At one of rny recent infant and pleschool conferences there rvere ser-eralmothels who had been visited and getting the advisory letters and had beenunder the doctor's care for the nine nonths of pregnancy. The babies of thesemothers scored 100 per cent. One mother reniarked, " I attt'ibute aU this fobeing under the doctor's ancl nurse's care before my baby arrived."

One of m5' trfexican mothers has had twins. She is 26 years old and thismalies eight children. She says she has had much benefit from the prenatalletters she is getting in Spanish. She has tried to observe the directionsregarding diet and rest, and her preparations for her conlinement shorved thatshe had reaily understood tbe letters, and the twins are fine children.

One white midwife is so anxious to keep up rvith the classes that she is nowattending the colored midrvife class. We had four visitors this month at ourcolored midwife class. We had four visitors this month at our regular classmeeting.

39"*.{


0

PRTNCTPAL Acrrvlrtffifr$JTBf NDIVIDUAL srArES

A summary of the work done in the individual States as reportedto the tr'ederil office in their annual reports covering the fisca1 year1928 is given in the following pages. The figures in regard to certainc;f the main activities have been summarized in Tables 2,3r 4, and 5.

The outline of activities for each State is preceded by statements inregard to the administrative agency, funds expended, and staff ofthe agency durins the vear under review. The sums of money re-ported expended Ire nof the same as the amounts accepted from-eachappropriation during the two years it is available. They are insteadthe actual expenditures during the fiscal year ended June 30, 1928, in-cluding any unexpended balances carried over from the previousvear.'

1 See footnote 4, Table 1, p. 3,

40


I

ALABAMA

STAFF AND ASTIVITIES IN 1928

Administrative agency :- * State board if h-eafth, bureau of chil6 hygiene and. public'health nursrng'

MontgomerY.Funds expeiaed: X'ederal, $25,836.95; State, $20,836.95; total, $46'673'9O'Staff:.--*-iiirector

(nurse), 2 nurses, 2 vital-statistics clerks, 1 bookkeeper (part

time), 1 stenographei iiritty-two county nurses were paid in part from

maternity and infancY funds.Activities :-

child-health conferences conducted by physicians-1,856; infants- and pre"

school childr€n registered anal eraririned-11,6o1 ; visits to corrferences-14,919.

OJtects found in children examined at conferences-1,471; children-havingdefects-1,2as trepoi.iincompfete;. Parents had defects corrected in 664

of the children.Prenatal confer.ences cronductetl by physicians-346; exllectant motbers

registered and examined-2,113; -visits

to conferences-4'092'Conf"erences conducth by nuises,'no pbysicia! present---387 ; .children in-

spected--393; molhers instructed in prenatal care-1,251 ; vrsits to con-ferences by children-630'

New permanent combined prenatal anal chilat-health centers-11 establishedb.v iounty health units. hhey are supported by county, State, and mater-nity anA-infancy funds, also'by the Rockefeller Foundation'

Cfasses for girls in care bf infairts anrl preschool children-101 organized;- girtJenrot'ieO-1,b14; number completing course--53 (report inconiplete).

Midrvives under superyision-93?, in the eounties having county healthclepartments (maiy of which had nurses paid in part from maternityund iofaocy funds). In a number of the counties monthly conferencesfor midwiv-es rvere held at the offree of the county health departDlent orat designated points in the county. These were supplemented bypersonalintervi6rvs at ihe office or in the midrvives' homes' Courses of 12 lessonsrvere given to some midwiYes. Permits to practice midwifery are grantedfor tbe eurrent I'ear only.

Elome visits by nurses--5q081 (prenatal cases seen, 5,409; obstetrical cases,33; postnatil cases, 5,258; infants, 8,69? ; preschool chi-ldrgl' 3,777)'

surv'ey-r, of maternal mortality, in cooperation with the Unitecl statesChildren's Bureau and with the indorsement of the State medical society,the cost of the work being pairl in pa.rt by the state and in part by theUnited States Children's Bureau.

Talks and lectures-1,601.iilerature distributeti-many pamphlets on maternal and chilcl care (no

record kept of number of Pieces).IJreasl feedlng was stressed by the county nurses in talks given to groups

and in the instruction given in lisits to homes.Infants born in the state during the t'ear-65.385; infants and preschool

children reached-by home visits, 12,414; by conferences' 11'601 ; ex-pectant mothers reached-17.063.

Co'unUes in the State--67; tounties in which maternity and infancy ,workwas done cluring the year--$2; counties in which materaity and infancywork has been done iince the.acceptance of the maternity and lnfancyact---33.

The fouowing organizations cooperated in the bureau's rvork: Alabama- Fotl'te"nnidlnstitute (extelsion service), State board of education, Statechild-welfare departm'ent, committee on maternal welfare of the statemedical association. and the parent-teacher association'

48278.-29-4 4 1


4f

42 THE WELFARE AND ITYGIENE OF MATERNITY AND INFANCY

Among the outstanding features of the year's rvorli n'el'e tlte ertcnsion ofmaternity and infanc}'work in 11 counties through the organization of countyhealth departrnents, cooperation in the establishment of a traittiltg station fornurses, health officers, and sanitary inspectors, and the beginDing of the studyof maternal mortality in cooperation $'ith the United States Chilclrel's Bureau'

TYPES OF WORK AND SOME RESULTS

The bureau of chil.d hygiene and publie-health nursing was established in theState board of health in 1920. The State accepted the provisions of the mater-nity and infancy act thlough the governor's acceptance on January 4' 1922' l'hisrvas followed by legislative acceptance approved by the governor on February74, t9%.

A public-health nurse has directed the rvork, assisted in the later years bysupervising feld nurses. An increasing number of public-health nurses in countynealth departments (32 in the year under review) have been paid ftom maternityand infancy funds for maternity and infancy l'ork.

Coopelation has been established rvith other blanches of tlte State goYern-ment (the board of education and the child-welfare department), the AlabanaPolj'technic Institute, State and county medical societies, and the parent-teacherassociat ion.

i\Iuch of the maternity and infancy work has been conducted through thecoutrty health departments. The county health offcers, assisted by the public-health nurses, examined and advised expectarrt mothers ancl examined infantsand preschool children in bealth conferences. The sauitary inspectors connetteclwith county health departments also contributed services. Visits to homes ofnothers and clriklren b1' the county nurses hare been a marked feature of theprogram. County health departments have supervised and regulated the mid-lvives rvithin the coufnes of their counties.

The campaign for promotion of birth registration conducted in the flscalyear 192?, to which assistance rvas given by State maternity and infancy*'orkers. terminated in the State's admission to the l-'nited States birtir-registration area in July, 1927.

An active interest in the welfare of mothers and babies is indicatecl by thestudy of materlal mortality being made in the State, the expansion of thematernity arrd infancy program through the addition of new county healtlrCepartments, and the improvement that has been brought about ill the wol'k ofthe midwives.

As the State did not enter the birth-registratiott area until 1927, flgures forinfant and maternal mortality rates are availeble from the United States Bureauof the Census for that ygar only, as follows:

Infant mmtilitu rates (ilzaths of i*fants unitpr 7 Aear of oge per 1,000 liaebirttu), 1927

MoteTnatr mnrtality rates (death.s of mothers from puerperal' eau-ses 'per 10,000Iiue births), 1927

State-------- 79.6White ------- - 62.5Colored------ - 111.6Urba,n------- - 110.2Rural------------------, 73.2

oa

ax")R '

62


&

ARIZONA

STAFF AND ACTIVITIES IN 1928

Administrative agency :Itute board 6f health, chiict-hygiene division, Phoenlx.

tr'unds expended: Federal, $?,711.66; State, $7,253.71; total, $14,965'37'Staf f :

Director, 5 nurses (2 part year). Stenographic assistantsas funds permitted.

Volunteer assistants-4 physicians.

were employed

Activi t ies:Child-health conferences eonducted by physicians-56; infants and pre-

school children registered and examinetl-9O5; visits to conferences-1,083.

conferences contlueted by nurses, no physician prese!t--42;. children in-spected--410; mothers instructed in prenatal care-23; visits to confer-ences by children--684; visits by mothers---41.

Defects founcl in children examined at conferences-1,037; children havingdefects-537. Parents had defects corrected in 409 0f the children.(1.his figure includes defects corrected in children inspected at conferencesconducted by nurses only as well as in children examined by phys.icians')

Dental conference-1 ; pre-school chilclren receiYing deDtal examination-3?.Classes for girls in iaie of infants and pre-cchool children---4 organized;

girls enrolled-?4; number completing course-3z; lessons in course--4 to 10.

classes for mothers--17 organized; mothers enrolled and completingcourse---407. The number of lessons in the courses varied.

I{ome visits by nurses-9,041 (prenatal cases seen, 348; obstetrical cases,15 ; postnatal cases, 203; infants, 820; pre-"chool children, 787), ,.

Comirirnity demonstrations-31, of a malernity and infancy public healtltnursing-program. The work included health conferences, home visits,class instruction, lectures, and group demonstrations.

Qroup demonstrations-1?8, on preparation and sterilization of obstetricalsuiplies, prepalation of bed fot confinement, bathing patient- in bed,batfimg and

-dressing the baby, giving sun baths, preparing formu]as'

banrluges, and dressings, caring for bottles, and caring for eyes, ears, andnose of child.

Talks and lectures-86. .l}"Literature distributed--{'1,435 piecesryNew names registered for prenatal letters-600; prenatal letters distrib'

uted--460 sets.Nutrition work was done through classes and individual instruction given

at conferences and ih home visits.Exhibit material was lent three times.Breast feeding was stressed in class instruction, in

and in visits made in homes.literature distributed,

Infants born in the State during the t'ear-€,436; infants under 1 yearof age reached by the work of the division'--8,611; preschool chilclrenreached-1,772 ; expectant mothers reached-976.

The division sends literature on infant hygiene to parents of all infantsrvhose births are reg:istered in the State bureau of vital siatistics (exceptin case of tourists or families of migratory laborers)'

Counties in the State-l4; counties in which maternity and infancy workwas done during the year-?; counties in whilh maternity and infancywo|k has been done since the acceptance of lAe maternity and infancyact-14.

The fotlorving organizations cooperated in the division's work: Women'sclubs, church relief societies, and the parent-teacber association.

As a result of the division's work in one community specialists held threeclinics for the correctioD of defects of children, with the indorsement ofthe local physicians.

43

F -


TI{E W.ELFARE AND EYGIENE OF IIATEBNITY AND INFANCY

TTPES OF WORK AND SOME RESULTS

The child-hygiene division was established in the State board of health in1919. The State accepted the provisions of the maternity and infancy actthrough the governor's acceptance oD December 23,7921. This was followedby legislative acceptance approvecl by the governor on }Iarch 13, 1923.

The same director has been in charge of the rvork of the division during theperiod of cooperation with the Ilederal Government. Three to flve staff rrurseshave been assigned to. field work in the past ferv 1'ears.

The division has had cooperation from n'omen's organizations, the parent-teacher association, and church relief societies, and assistance from lay andprofessional volunteer workers.

Expansion of activities in the maternity and infancy work, particularly in theactivities conducted by the nurses. has marked the program. Home visits madeby nurses were more than doubled in 1928, when 9,041 visits were made. ascompared rvith 1927, rrhen 4,250 visits were matle. In 1927 the number of newnames of expectant mothers registered for prenatal letters was 159; during1928 the number increased to 600.

One goal in the division's work rvas bringing the State into the United Statest'irth and death registration areas. This rvas aceomplished in 1926, A resultof entrance into the registration area has been the possibility of reaching rvithliterature on infant care all parents whose babies' births are registered in theState depertment of health.

State figures show a downward trend in infant mortality rates since 1920,although the rate announced by the United States Bureau of the Census washigher in 1927 (130 per 1,00O live births) than in 1926, the first year for whichCerisus Bureau figures were available (121). A Iarge ancl constarrtly changinggroup of foreign laborers within the State has created a difficult health probiem.Thi-s situation is no doubt one of t-he factors giving to the State a higher. infarltmortality rate than that of any other State in the registration arrea, arid itaccourits for some fluctuation in rates.

The number of maternal deaths declined in 1927 as compared with 1926.The maternal mortality rate for 1926 was 102.5 per 10,000 tive births; the I'atefor 7927 rvas 89.

44^a{


6€

ARKANSAS

STAFF AND ACTTVITIES IN 1928

-{r'l ministra I ive agencl' :State board of health, bureau of child hygiene, Little Roe\'

f:untli expenOed : Federal, $14,634.68 ; State, $13,214.79; total' $27,879'47'Staff:

Director ( state health ofrcer serving), 2 nurses (1 for 9 months) ' 1 lecturerand field \yorker, 1 stenographer. Twenty-six eounty nurses were paid itlpart from maternity and infancy funds.

Activities:chikl-health conferenees condueted by physicians-434; infants and pre-

school children registered antl examined-9'?77.Defects found in chiltlren exaruined at conferences-6'394; children having

defects-3.508. Parents hatl defects corrected in 3.352 0f the children.Prenatal conferences conducted by physicians-S7; erpectant mothers regis'

tered-602 ; number examined-112.conferences conducted by nurses, no physician present-249; chilclren in-

srrected-7.280; mother's instructed in prenatal care-108; visits to con-ferences by mothers-4?0.

Dental conierenees-l0. conducted by ilentists who yolunteered theirservices ; preschool children receiving dental examination-411'

Nerv permanent combined prenatal and chilcl-health centers-16 establi-shedas i result of the maternity and infanc]' work. They are supllortcd bymaternity and infancy, county, and private funds.

Classes foi girls in care of infants and pre-school children-76 organizeci;girls enrolled-3S5: lessons in course-24.

Classes for mothers-1O8 organized; mothers enrolled-372classes for midrvives-314 orgarrized; midwires enrolled plus those canied

over from previous year-2,618. The regular course of instruction in-cludes 6 topics rvhich may be dividect into 2 or more lessons. The course isenlarged a,s the midwives shorv capability for more atlvanced instruction.

Elome visits by nurses-6.081 (to prenatal cases, 551; obstetrical cases, 28;postnatal cases,774; infants, 2,60O; presehool childr€n' 2,128) .

Ddmonstrations-26, consisting of parades' psgeants' and plays emphasizingsome phase of the child-health proglam.

Group demonstrations-457, of maternity outfits, prepamtion of food forchildren. and nursing eare of mothers and children in the home.

Surveys-2: (1) Of midwives. (2) Of birth registration. Both *'ere state-n'ide.

Campaign-1, for the examination of. preschool children and eorrection oftheir defects. About one-tttird of the counties were thoroughly organizedfor this campaigrr, and practieally all of them carried on some n'ork,rnuch of which wa-s done by local organizations. Many physical examina-tions, corrections of defects, immuuizations against diphtheria, inocuia-tions against typhoid fever, and vaceinations against smallpor resulted.

Talks and lectures--863.Li1 erature distributed-131,2?3 pieees.Nutrition work was done through individual iustnrction to mothers of pre-

school children.Exhibits conducted-344. Exhibit material preparedt-posters, model bed

for demonstration purposes at heatth conferences,'dental exhibit. Ex-hibit material rvas lent twent]'-five times.

Breast feeding was stressed in instruction given to expectant mothers andto midwives.

Infants born in the State during the year-4\,772; infants under 1 year ofage reached by the work of the division--4,727 (exclusive of tho-sereached by literature distributed) ; preschool children reached-5,300(exclusive of those reached by literature distributed) ; expectant mothersreached-1.196.

^ <


46 THE WXLFARE AND EYGIENE OF MATERNITY AND INFANCY

4Activities-Continued.

Counties in the State-?5; counties in which maternity and infancy workwas done during the year-62; counties in which maternity and infancyrvork has been done since the acceptance of the maternity and infancyact-?5.

Since the beginning of the State's cooperatlon under the maternity andinfaney act 2 counties have aszumed the responsibility for maternity andinfancy work begun with maternity and infancy funds.

The following organizations cooperated in the bureau's work: State boardof education (hom+economics section), State university (extension serv-ice), State federation of women's clubs, State society for crippled chil-dren, State fair association, women's auxiliary of the State medicalsociety, American Legion, American Legion auriliary, Woman's ChristianTemperance Union, and the parent-teacher association. They assisteclwith surveys, health eonferenees, classes for girls, establishment of heattheenters and clinies of various kinds, and provided means for the correc-tion of defects of many children.

Among the outstanding features of the year's work was the extension of thematernity and infancy program in 20 new county health departments.

TYPES OT'WORK AND SOME BESULTS

The bureau of chilcl hygiene was established in the State board of health in1919, The State accepted the provisions of the maternity and infancy actthrough the governor's acceptance on January 20, 7922. This was follorvedby legislative acceptance approved by the governor on tr'ebruary g, 1g28.

A physician usually has directed the maternity and infancy work. Durirgseveral years the State health officer has been the actiDc director.

In the earlier years of cooperation under the act a general program of educa-tion was conducted by means of itinerant child-health conferences, distributiouof literature, work with midwiveg and an active campai$l for better registra-tion of births.' since the Mississippi flood in the spring of.f.927 the state health departmenthas been developing many full-time county health departments, with a vierv torebabilitation and improved sanitation. work with flre child-health truckpaved the way for establishing these health dellartments. A full-time meclicaldirector, one or two county nurses, a sanitary inspector, and sometimes astenographer comprise the usual county health department personnel. llanynurses as well as health officers are sent to the training station at rndianoki,Miss., for a month's intensive training before being assigned to county healthdepartments, nluch of the maternal and infant-hygiene program rvas con_ducted through the activities of nurses paid in trxrrt from matirnity and infancyfunds, who were assigled to county health departments for materrrity andinfancy worli. During the year under review the 26 nurses thus employed anddetailed to eounty health departments represented an increase of 1-b over thepreceding year; fewer workers werc employed on the State staff in 192g.

Immunizations of chiidren against diphtheria, smallpox, and typhoid fever,conducted largely by county health departments, were among ihe activitiesin tire State during the year under review.

Cooperation has been maintained with other branches of the State govern-ment (the bureau of education and the State university), and with women'sorganizations, the parent-teacher association, tb3 American Legion ancl itsauxiliary, the state fair association, and the statdsociety for crippled chilclren.Physicians, dentists! and lay p€rsons also have given volunteer iervices.

An outstanding result of the work has been the inelusion of Arkansas inthe united states birth and death registration areas in 1927, after an activeeducational campaign in which the bureau of child hygiene assisted.

The midwives are kept under supervision, ancl lmprovement in theirstandards of practice has been noted. They now assist their patients insecuring prenatal care. and in having urinalyses made.

As the State was not admitted to the registration area until early in 1g2?figures from the United States Bureau of the Census for compuiation ofmortality rates are available only for that year. The infant mortality ratein 1927 was 61 per 1,000 live births for the State as a whole, 82 in urban areas,and 59 in rural areas. The maternal mortality rate in 1g2? was 8g.T per10,000 live births in the State as a whole, 134,5 in the urban areas. and Ab,g iarural areas.


,4{

CALIFORNIA


Administrative agency lState department of public health, bureau of child hygiene, San n'rancisco.

Funds expeuded: n'ederal, $29,7fr7.89; State, $21,600.34; total, $51,308.23.Staff:

Director (physician), 3 physicians (2 part year, 1 of these part time), 1nurse, 2 maternity-home inspectors, 1 vital-statistics clerk (part year),1 f inancial clerk (palt . t ime),1 mail ing clerk,2 stenographers (1 partyear,1 part t ime). Twenty-nine county nurses in 19 counties were paidwholly or in part from maternity and infancy funds.

\rolunteer assistants{i0 physicians, I dentists, 29 nurses, 290 lay persons.Activities:

Child-health conferences conducted by physicians-5S3; infants and pre-school children registered and examinerJ--:1,779; visits to conferences-10,984.

Prenatal conferences conducted by physicians-102; expectant mothers reg-istered and examined-706; visits to conferences-1,347.

Conferences corrducted by nurses, no physician preseut-712; childreninspected-1,2!X.

Dental couferences-53; preschool children receiving dental examination-7.210.

New permanent child-health centers-17 established as a result of thematernity and infancy work, Tbey are supported by city or county aDdmaternity and infancy funds. Women's clubs cooperate.

Class€s for girls in care of infants and preschool children---49 organized;g-irls enrolled and completing coursF-321 ; lessons in course-16.

Classes for mothers-Sl organized; mothers enrolled-2,03O; number eom-Irleting course-1,650; lessons in course-5 to 8.

Ifume visits by nulses-20,844 (prenatal cases seen, 557; obstetrical cases,27 ; postnatal cases, 381 ; infants, 3,391 ; preschool children, 5,407).

llaternity homes and hospitals inspected-352; inspections made--651.Group demonstrations-601, on home nursing, preparation of food, and

various other phases of maternal and infant care.Surveys-3: (1) Of couuty hospitals. (2) Of birth registration. (3) Of

maternal mortality. All were state-wide.Campatgns--4: (1) tr'or statewide examination of preschool children and-

correction of their defects before the children should enter school. (Z)tr'or prevention of diphtheria, in 5 counties. (3) n'or prevention of small-pox, in 4 counties. (4) X'or prevention of typhoid fever, in 1 county.

Talks and lectures-1O2, to audiences totaling more than 9,000 persons.Literature prepared-Physical Standards for Childrenl set of postnatal

letters, ILiterature distributed-92,108 pieces.New names registered for prenatal letters-1,492; prenatal letters dis-

tributed-3,107 sets.A 1-day institute for nurses on maternity and infancy work and obstetrical

riursing was conducted by a prominent obstetrician, and assistance wasi:iven in organizing two institutes of public-health nursing at the Uni-rersity of California. 'A lday institute for physicians on prenatal careand the organization and aims of prenatal clinics was conducted by thesame obstetrician.

Nutrition work was done through 20 nutrition classes attended by 231persons, also by individual instruction at classes of other types, andat health conferences.

II

IIIIi

47


ff48 TIIE WELTi'ARE AND IIYGIXNE OT' MATERNITY AND INI'ANCY

Activities-Continued.Exhibits conducted-29, at State and local meetings. Exhibit material

prepared-prenatal and infant train in which the stations along theroad begin with Prenatal Care and Birth Station, followed by episodes inthe flrst year of life, as Orange Juice, and Sun Baths, with small dollsused for illustratron. Exhibit material was lent twenty-three times.

Articles prepared-Value of I{ealth EducntioD, " Escuelita."Breast feeding was stressed through literature distributed, individual in-

struction siven to mothers, and demonstrations made at nurseg institutesand classei for rbothers

Infants born in the State during the calendar year 1927-8i1,334; infantsunder 1 year of age reached by the work of the bureau during the yearunder review (exclusive of those relched by literature distributed)-8,551; preschool children reaclred (exclusive of those reached by literaturetlistributed)-10,561 ; expectant mothers reached-4,370.

Counties in the State-58; counties in which maternity and infancy workwas clone during the year-56; counties iu which maternity and infartcywolk has been done since the acceptance of the maternity and infancyact-58.

Since the beginning of the State's cooperation under the maternity andinfancy act 12 counties have assumed the responsibility for maternityand infancy work begun with maternity and infancy funds.

The following orgauizations cooperated in the bureau's work: State tuber-culosis societJ, State league of women voters, American Association ofUniversity Women, American Red Cross, feclerated'women's clubs, men'sservice elubs, and the parent-teacher association.. They assisted in cam-paigns and cooperated with the county Durses who were paid in part fronmaternity and infancy funds. Among the children examined at confer-ences reported in the foregoing paragraphs many were examined in the" Get ready for school " drive sponsored by the National Congress ofParents and Teachers.

Among the outstanding features of the year's work were the petliatric servicegiven by the stafr ptrysicians, the better organization of the maternity andinfaney nursing s€rvice, and the fact that the campaign work to have preschoolchiltlren examined before entering school has been assumed by the parent-teacher association.

TYPES OF WORK AND SOIIE BESULTS

The bureau of child hJ'giene was established in the State department of publicheatth in 1919. The State accepted the provisions of the maternity and intancyact through the governor's acceptance ou April 3,7922. This was followed byIegislative acceptance approved by the governor on April 30, 1923.

A metlical director, assisted by a relatively small eentral staff and an increas-ing staff of fielcl nurses, has been in cbarge of the work. One of the chieffeatures of the program has been the expansion of public-health nursing in theState. One feature of this expa,nsion has been the assumption of flnancialresponsibility for maternity and infaucy work by 12 counties. During the ]'earuncler revierv 29 county nurses, as compared with 20 in 1925, were paid rvhollyor in part from maternity and infancy funds. Only I of the 58 counties in theState were without soms form of publie bealth nursing sen'ice at the close ofthe flscal year 1928.

A noteworthy feature of the State program has been the effort to examine thepreschool children of the State before they enter school. During 1928 examina-tions wele eonducted in 49 counties, an increase over former years,

The inspection and supervision of maternity homes and hospitals, which ls aduty of the Statebureau of child hygiene, bas been greatly extended, the numberof inspections having increased from 2?1 in 1926 to 522 in 79ZI and,651 in 1928.The etrect of this work seems to have been reflected in lower maternal mortalityrates,

The free distribution of nitrate of silver for the prevention of ophthalmianeonatorum rvas begun in the Stste in 1915. Maternity and infancy funds hav(,been contributed since 1927. llhe distribution has been chiefly to mid'wives andto sm:rll materuity homes. The 38 cases of ophthalmia neonatorum reported in1924 were the highest number reported for any one J'ear during the period 1915to 7927, inclusive, The 13 cases reportetl in 1927 were the lowest number ofcases reported for any one year in this period.


4 PRINCTPAT, ACTn'/TTTES OF INDTVIDUAL STATES, 1928 49

cooperation has been given by prominent state organizations of women, the

A;;; i . ; ; Red closs, rna Srate tuberculosis soeietv,.?Lg mqn's,service clubs'

ing parent-teacher 6ssocialion has assumed responsibility for the drive for

examinations of the preschool child.--fniaiit mortality has declined from ?1 babies dying in the flrst year of life

to"-Lvery 1,000 bo-rn alive in 1922, when the State bega! qoopelating under the

*ut"rniiv and infancy act, io oz in 1g27, a saving of 9 babies in every 1,000 in

1927 as compared \ilith 1922'--Ti; ;;t"'ilai mortatity rate has declined during the period of _cooperation

fr;;il-g l)eaio,ooct tiu"-nirths in 79u2 to 5?.6 in 7s27, ̂ layinq^g! 14 mothers'iious to" eiery 10,000 five birtfrs. The rural rate \vas 64.9 in 7922 and 52.2 in

L927: the urban rate was ??.1 in' ].:922 and 61.3 in 1927.

IlIL


#

COLORADO

Administrative agenct:'

srAFF AND acrrvlTlEs rN 1928

State department of public instruction, child-welfare bureau, Denver.Funds expended: Federal, $10,00O; State, $5,00O; total, $15,000.Sta f f :

Director, 3 physicians (part time, 1 two months), 3 nurses (2 part year),1 clerk, 1 stenographer. An adclitional physician and additional nursess-ere employed as needed.

Volunteer assistants giving occasional help--48 physicians, 23 dentists, 20nurses, 600 lay persons.

Activi t ies:Child-health conferences conducted---41, in 30 towns; infants and pre-

scbool children registered and eramined-1,401.The orgrnization work for the conferences was dolle by the University of

Colorado through its department of organization, Tbe staff of theconference unit consisted of the director of the bureau, a pecliatrician,a nurse, and a clerk, also representatives of the State board of health,tlre State tuberculosis association, the State dentai association, and thepsychopathic hospital of the State university.

Defects found in children examined at coufereuces-4,l27: childlen havingrlefects-1,255. Parents had defects corrected iu 594 of the chilclren.

Prenatal conferences conducted by physicians-16; expectant mothersregistered and examined-162.

Conferences conducted by nurses, no physician present--42; chiidreninspected-771.

Nex' permanent prenatal center-1 established as a result of the mateniityand infancy rvork. It is supported by a city health department but usesrecorrls and literature furnished b]'the State child-$'elfare bureau.

Classes for girls in care of infants and preschool children-33 organized;gills enrolled-175; number completil)g course-162; lessons incour-qe-12.

Classes for mothers-14 organized; mothers enrolled plus those carried overfrom previous year--86; number completing cours#2; Iessons incourse-10.

Home visits by nurses-961 (prenatal cases seen, 65; obstetrical case, 1 ;infants, 279; preschool children, 616).

Comruunity demonstrations---4, of maternity and infancy public-healthnursing. All tyere county-wide.

Group demonstrations-G, on various phases of maternal and infant care.Sur-veys-2: (1) Of pubiic bealth nursingserviceinthe State. (2) Dental,

in 1 torrn.Canrpaigns-2: (1) For promotion of birth regist|ation.' (21 For the

examination of preschool children and correction of their defects beforethe children should enter school. Both l'ere state-wide.

Talks and lectures-127.Literature prepared-record cards, leaflet on enuresis.Literature distributed-10,600 pieces.The State agricultural college conclucted nutrition classes following ttre

chilcl-health conferelces of the chilcl-.rvelfure division, using the reportsand record cards of the children eranined as a basis in selectine childrenfo l the c lasses .

Exhibits conducted-z, at State and county fairs and at various meetings.Exhibit material prepared-posters shorving literature on matern:rl and

infant care available from the bureau. Exhibit uraterial rvas lent fivetirnes.

:Colorado was admitted to the United States birth-registratlon area in August; 1928.50


PRTNCIPAL ACIMTTES OF TNDMDUAL STATES! 1928 51&

Activities---Continuerl.Breast feeding was stressed in the instruction gtven to mothers at con-

ferences aotl itt the literature sent to mothers of infants whose birthswere reportecl in the newspapers.

Infants uncler 1 year of age reacbed by the work of the bureau during ttle- y"u" encled Jine 30, i928---4,031; preschool children reached--9,9?0;exfiectant tnothels reached-3'000.

lfhe'bureau sends literature on infant hygiene to parents of all infantswhose births are report€d in the newspapers.

counties in the state--63; counties in lvhich maternity and infancy workrvas rlone during the yetrr-29; counties iD which maternity and infancyrvork has beerr doue iince the acteptance of the meternity and infancy

srl:: a?,?' beginning of the state,s cooperation under the mater'ity anrrinfancy actone county has assumed the responsibility for maternity andinfancy work.

As a reiult of the bureau's work chilal-health conferences were conductedby local personnel in several towns, and two prenatal clinics wereorganized.

Thelollowing organizations cooperated in the bureau's work: State boarclof health, state university and its psychopauric hospital. state_agricul-tural college, state dental association, state tuberculosis association, atldthe parell-teacher association. They assisted by detailing. persotrnelto th-e child-health eonferelces and by conducting nutrition classes.

Among the outstanding features of the year's work was the assistance givetrto the St'ate bureau of vital statistics in a birth-registration campaign conductedto qualify the state for admission to the united states birth-registration area.

TYPES OF WORK A}iD SOME RESULTS

The chikl-welfare bure&u, in which the administration of the maternity aldiniancy act is vestd, was established in the State department of publicinstruction in 1918.

The state accepted the provisions of the maternity and infancy act throughthe governor's acceptance on January g,7gn. This was followed by legislativeacceptance approved by the golernor on April 30' 1923.

TIie same-4irector, assisted by nurses, has had charge of the work dulingthe pel'iod of cooperation under the act.

Itinerant child-health conferences conducted by physicians have been animportant feature of the progTan, through which lnforruation given by skilledprofessional Dten has reacbed many remote sections of the State.-

cooperation has been maintaiued *'ith the state board of health and stateeducaiional institutions, the State medical society and the deDtal and tuber-culosis associations. the American Red cross, women's organizations, and theparent-teacher association.

ntany denonstrations have been conducted at fairs and other assemblies.The distribution of literature to parents of all infants whose birtlis are

reported in the newspapers has been a feature of the work for the last twoyears,

Durilg approximately two years the child-welfare bureau has cooperatedrvith the vital-statistics bureau of the State department of health in effortsto bring the State into the United States birth-registration area. A campaignof education in regard tO registratiou was conducted by staff nurses and otherworkers on the bureau's staff. Educational work was done through fairs, andregistration of many births $'aS secured. The campaign continued until theclose of the year under review.

As the State was uot in the birth-registration area during the year urlderrevie'lv, no statement as to mortality rates can be made.

LProvided by the Maternal and Child Health Library, Georgetown University

#

DELAWARE


Administrative agency :State board of health, rlivision of child h}'giene, Dover.

Funds expended: n'ederal, $12,909,73; State, $8,188.20; total, $21,097.93.Staff:

Director (physician), 9 nulses, 1 vital-statistics clerk and bookkeeper, 1stenographer. Seven physieians were employed as needed to conductconferences.

Ac t i r i i i es :Combined prenatal and child-health eonferences conclucted by physicians-

44 (some held more than one session); expectant mothers regi-qtered. anrlexamined-18; infants and preschool children registered and examined-422; r'isits to conferences bI- expectant mothers-39; visits by infantsand preschool cliildren-3,972.

Child-health conferences conducted by physicians-3O2 (some held morethan one session) ; infants and preschool children registered and ex-amined-1.688 ; visits to conferenees-72,462.

Defects found in children examined at conferences-1,691 ; children havingdefects-1.272. Parents had rlefects corrected in 851 of the children.

Prenatal conferences conducted by physicians-52; expectant mothers reg-istered-212; number examinerl-z01 : visits to conferences-34.1.

Conferenees eonducted by nurses, no physician present-1,049; chiltlreninspected--4.155; mothers instructed in prenatal care-210; visits to con-ferences by children-24,370; visits by mothers-521.

Classes for girls in care of infants and preschool children-19 organ-ized ; girls enrolled-l|5S; number completing course-313 ; lessons incourse-12.

Classes for mottrer-s-72 organized; mothers enrolled-99;course-10. The classes were still in progress at the closeuntler review.

Classes for midwives-16, continued from previous fiscal year (tlie ciassesare continuous) ; midwives enrolled-1S5; lessons in cour-se--6.

Ilorne visits by nurses-31,691 (prenatal cases seen, 399; obstetrical cases,107; postnatal cases, 425; infants, 2,206; presehool children, 4,770) .

Survey-1, to ascertain the names and ages of children in all the torvns inthe State and to gather data eoncerning the milk and water supply andgeneral sanitation, important in redueing infant mortality.

Campaigns-3: (1) X'or immunization of preschool children against diph-theria; 316 eonferences were conrluctetl, ancl 1,571 preschool childrenwere immunized. (2) For promotion of breast feeding. (3) X'or pe-riodic health examination of infants and preschool children. All werestate-wide.

Tllks and lectures-9O.Literature prepared-babt' book and diphtheria pamphlet, revised.Literature distributed--47,758 pieces.New names registered for prenatal letters---472; prenatal letters distrib-

uted-369 sets.Exhibits conducted-2, at fairs, each lasting 5 days. Exhibit material

prepared-charts, maps, and graphs. Dxhibit material was lent threetimes.

Scientific articles prelrared-Resuits of Health Work, Diphtheria Preven-tion, Infant and I\{aternal Mortality, Results of Survey of Chilclren andHealth Conditions in Thirteen Towns.

Statistical studies made-maternal mortality; infant mortality amongs-hite artd cclored, by counties; amount of milk consumed in 1 county.

52

lessons inof th(] year


#pnrNcrpAl, AcTrvrTrEs oF TNDMDUAL STATES, 1928 53

Activiiies-Contin ued.Bleast feeding was stressecl in talks before medical societies and nurses

and in the instruction given at health centers and in home visits. It wasestirnated that only about half the infants in the State are breast fed.

Infants born in the State during the year-4,281; infants under 1 year ofage reached by the work of the division-approximately 4,300; preschoolchildren reached-10,185; expectant mothers reached-1,112.

The alivi-sion sends literature on infant hygiene to parents of all lnfantswhose births are registered in the State bureau of vital statistics. Duringthe year under review literature on maternal and infant care was sentalso to all expectant mothers whose names were reported to the divisionby physicians, midwives, State nurses, and the W'ilmington Yisiting Nur"Association.

Counties in the State-3: counties in which naternity and infancy worklvas done during the year-3.

The foliowing organizations cooperated in the rlivision's work: DelawareAntituberculosis Society,

'Wilmington Yisiting Nurse Association, and the

parent-teacher association.Among the outstanding features of the year's work wele the campaign for

promotion of breast feeding and the survey of children in all the towns of theState.

TY?ES OF WOBK AND SOME NESULTS

The present division of chiltl hygiene in the State board of health is anoutgrowth of the State child-welfare eommission e-stablished in 1921. TheState accepted the provisions of the maternity and infancy act through legisla-tive enactment approved by the governor on April 7,7921, in anticipation ofthe passage of the act by the Fetleral Congress.

A full-time medical director was securecl in 1926 to direct and supervise theffeld work and fleld staff. During the past two years nine tturses have gir-enfull-time service, and five to seven physicians have given part-tirne service tothe improvement of maternal and infant hygiene in the Sttrte.

Cooperation has been maintained n'ith the Delaware Antituberculosis Associa-tion and the parent-teacher assoeiation, and lfas establishetl in 1028 with theWilmington Visiting Nurse Association.

A relatiyely large number of visits to conferences were made by childrenduring the year under review, and two-thirds of the number found to hareclefects had the defects corrected.

A survey in the to$ns of the State with high infant mortality to secure thenames of children and to ascertain the condition of milk and water supplieswas an important feature of the program in view of the high death rate dueto diarrhea and enteritis.

Campaigns for irnrnunization against diphtheria have been conducted thelast three years beginning *'ith seyen districts in 1926 and extending over theentire State in 198. In the three years 3,615 ehildren received toxin-antitoxin.

It \yas estimated that 5O per cmt of the babies were artificially fed, ancl in1928 breast feeding, the importance of which had already been stressed atitinerant eonferenees and in the literature distributed. was made the subjectof a speeial statFwide campaig:l.

The parents of every baby whose birth is registered receive information onthe care of the baby through the Baby Book, diet cards, and book on diseasesof children. A considerable number of the expectant mothers in the State arealso reached with some form of instruetion oD the ralue of prenatal care'

The State consists of only three eounties, and it has been possible to conducta more intensive program than in States witb larger areas. The effect of theintcnsive work is reflected in the retluetion of both the infant and the materllalmortality rate; 29 fewer babies ln every 1,0O0 born alive died in 7927 than in1922, and,7 fewer mothers died for every 10,00O babies born alive in 1927 thanin 1922.

The infant mortality rates'per 1,0O0 live births for the years 7922 to 1927were as fol lows: \922,100; 1923, 1O4i 7V24, 95; 1925, 91; 1926' 93i 7927,7]-.This decrease was due pa.rtly to the general decline ftom 7922 to 1927 in theinfant mortality from diarrhea and enteritis, the 1927lower than that of 1922. The rates for the individual1922, 26.1; 1923, 18.1; 1924, 18.1 ; 1V25, 21; 1926, 17.1;

rate being 59 per eent]'ears were as follows:1927, 10.8.

Provided by the Maternal and Chitd Health Library, Georgetown University

54

ls0

70

60

50

40

30

THE \MELI'ARE AND HYGIENE OF MATER,NITY AND INFANCY

ff

t009080

4!. 9arro

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, r n l r l

t92t )922 f 9e3 |.9e4 |925 t926 t927€ounce: United Statea Bureau of the Census bel-awa?e was admitzed to tha United States birth-re$istration aroa in t92t)

Deaths of infants under 1 year of age ftom all causes and deaths under 1 year ofage from diarrhea and enterit is, per 1,000 live births; Delaware, 7927-1927

The maternal mortality rates per 1O.000 live births for the years 7922 to 7927\rere as fol lows: 1922, 65.8; 1923, 83.7; 1921, 76.9; 1925,77:1926, V2.9;7927,58.6. The decline in maternal mortality has been largely in the rurerl districts.lfhe rural rate in 1922 was 71.7 deaths for every 10,O00 live births, whereasin 1927 it had droppecl to 32.6. The urban maternal mortality rate was higherin 1927 than in 1922.


/g

FLORIDA

STAFT'AND ACTIYTTTES IN 1928

.Adrninistrat ivo agencY: -'---Siut" foord

"of health, bureau of chiltl hygiene and public-health nursing'

Jacksonville.l 'u"Os-ex-pe"Aed:n'ederai,$13,90?.86;Statg,$74,222'83;total,$28,130'69'Staff:

Director (nurse, part time),7 nurses (3 pa$ time, l for 1 month)' 1 au-- Oit*-tputt ti;a), 1flle ctert, l stenographer (part time), 1 tvpist (p:rrt

t ime) .Yolunteer assistants_,68 physicians, 16 dentists, 105 nurses, 319 lay persons.

Activi t ies:'^'--CfriiO-it"olth conferences condueted by physicians--?5; infants arrd preschool--.nifa.""

registered and examined-1,?68; number having defects-1'339.

Prenatal corrf"erences conducted by physicians--43; expectant mothers leg-

istered and examined-?09.Conferences conducted bY nurses'

sDected--+,543.Dcrltal conferences-S3 eondueted'

of nreschool children receiving

no physician present-255; children iu-

The numbers of expectant mothers anddental eramination were not recorded

separately.xew pe.manent child-health center-1 established as a result of the mater'-

nit! antt infancy rvork. It is supported by private funds'CfaiJes for midwives-937 organized; midwives enrtllled plus those carriecl--over

from previous yearj,432; lessons in-course-4' The 1'611 mid'*li:", oo* recorded as practicing in the State are being supervised,enrolled in classes, and gilen instruetion.

Ilome visits by nurses-5,333 (prenatal caseq seen, 675; postnatal cases,165; infants, 1,844; preschool children' 2'609).

Grouo demonstrations-€7, of various phases of infant care. Two tables- n.r iuhicn were exhibited articles that are harmful and articles that arenetprut in the care of the baby were used in connection with thesedemonstr:rtion s.

Talks and leetures-16,6.Literature distributed--34,032 pieces'Nutrition work was done through instruetion given to mothers at eonfer-

ences and in home visitsErhibit material prepared-posters, draperies showing health rules, health

pictures, and diets.Breast feeding \1'as promoted through educational work with mothers.Infants b6rn ln the State during the year-34,061; infants and preschool

children reachetl by the work of the bureau-12,134; expectant mothersreached-1,493.

The bureau 'sends

Iiterature on infant hygiene to parents of all lnfantswhose births are registered in the state bureau of vital statistics if theparents are known to be able to rmd.

Coiunties in the State-62; counties in which maternity and infancy workwas done during the Year-47.

Since the beginning of the State's eooperation under the maternity andinfancy aci nine iounties have assumed the responsibility f-or maternityr"O i"tnncy rvork begun with nlaternity ancl infanc)' funds.s

As a result -ot

tfte bui'eau's work county nurses not paid by maternityand infaney funds conducted child-health conferences in four countie'r.The bureau gave advisory assistance to local organizations conc.luctingmaternity and infancY work.

sAnother county appropriated funds for maternity and lnfancy work immediately after

the close of the year uDder leview. bb


TITE WELFARE AND EYGIENE OF MATERNITY AND INFANCY

Activities-Continued.The following organizations cooperated in the bureau's work: State fed-

eration of women's clubs, State medical association, State dental associa-tion, State public-health association, American Legion, nlorida Businessand Professional Women's Club, fraternal and civic organizations, andthe parent-teacher association. They assisted in organizing conferences,rendered clerical assistance at the conferences, transported mothersand babies to and from conferences, contributed money for defrayingexpenses of conferences, assisted with publicity, and helped to securecounty and State appropriations.

TYPES OF WOBtr AND SOME NESULTS

The bureau of child hygiene and public-health nursing was established inthe State board of health in 1918. The State aceepted the provisions of thematernity and infancy act through the governor's acceptance on trebruary 8,7,922. This was followed by legislative acceptance approved by the governoron June 8, 1923.

The same nurse director has been in charge of the work since cooperationunder the act was begun, assisted in the fleld by a staff of nurses from theState bureau. Volunteer assistance has been given by many physicians, dentists.public-health nurses, and lay persons. Cooperation has been established withan increasing number of professional and lay groups, which now include Statemedical, dental, and public-health associations, women's organizations, civicclubs, the American Legion, and the parent-teaeher association.

IXmphasis has been placed on child-health conferences, visits to mothers ancliufants in their homes, and instruction and supervision of midwives.

At the beginning of cooperation uuder the maternity and infancy act morethan 4,000 $omen iD the State were practicing as midwives. At the closeof the year under review the number known to be practicing had been reducedto 1,611, and much improvement was noted in their practice. Physicians noware called frequently by midwives for difficult or abnormal deliveries. Nitrateof silver for use in prevention of blindness in the nervborn, which is rlistributedfree through the use of maternity and infaney funds, is regularly requesteclby the midrvives.

. The devastating hurricane that swept the State within the period of coopera-tion interrupted the routine of the maternity and infancy proglam ancl ailcledgreatly to the adverse influences affecting the lives and health of mothels andchildren. Yet in the face of this disaster both infant and maternal mortalityrates have shown reduction in 1927 compared with 1924 (the year of the State sadrnission to the birth-registration area).

In 1924 the number of infants who died under 1 year of age in every 1,0&)born alive was 82. In 79Zl the number was 67, a saving of 15 babies in every1,000 in 1927 compared with 1924. Both urban and rural areas shared in thLreduction. In urban areas the mortality rate for colored infants was 22 per centlo\yer in 1927 than in 1924; for white infants it was 12 per cent lower. In therural areas the reverse condition obtained, the rate for white infants being 22per cent lower in 1927 than in 1924, whereas for colored infants it was only.7 per cent lower.

The number of mothets dying for every 10,000 babies born alive in 1924 was121; in 1927 the number x'as 110, a saving of 11 mothers per 10,0oo live births.The reduction affected both urban and rural areas, though the situation was notthe same for the white and the colored womm. rn urban areas the rate was 10per cent lower for li'hite mothers in 1927 than in 1924, and 3 per cent higher forcolored mothers, In rural areas it was 6 per cent higher for white motf,ers and23 per cent lower for colored mothers.

oo4.g


6

GEORGIA

STAFF AND ACTIYTTIES IN 1928

Administrative ageney :State tnarcl of health, division of child hJ'giene' Atianta'

n'unds expended: n'ederal, $28,159.73; State, $23'991'.37; total' $52'151.10.Staff:

Director (physician, part time), 1 physician (part year)' 6 nurses (5 partyenr), 1 lpboratory assistant (part time.1, 1 stenogrlrpher, 1 clerk-typist(part l'ear), 1 chaufreur (part year). Seventeen county nurses lverepaiO tr, l - maternit) 'and infancy funds (2 part t ime, 7 part year).

Acti'r'ities:Child-healtli conferenees conducted bJ' physicians-1,234; infants and pre-

schooi chiltlren examined-8,033. Ilany of these conferences \YeI'e con-ducted in the " healthrnobile," l'hich traYeled til'ough rural communitiesin 21 counties with a sttrff of a ph5'sician, a nurse, and a chaulTeur. Afterthe visit of the " healthmobile " in eaclt county a p€rmanent maternityand infancy committee x-as organizeri to do follow-up rvorli.

Defects found in children examined zrt conferences (January-July' 1928)-11,982.

Plerratal conferences contlucted by physicians---3?8; expectant mothersexaminetl-2.098.

Conferences contlucted by nurses, no physician present-107; children in-spected-421 ; mothers instructed in prenatal care-7O; visits to confer-ences by children-605.

Dental conferences (Januar]'-July, 1928)---41; expectant mothets receivingdental examination-77; preschrx)l children receiving dent:rl exirmitra-tion-101.

Nerv pelnranent combined prenatal arrd chikl-health centers-2 establishedas a result of the maternity and infancl'work. They are supported b)'maternitJ'and infanc)- funds antl by county funds.

Nerv permanent child-health center-1 e-stablished as a result of the ma-territy and infancy work. It is supported b] maternity and infancy fundsand by eount)' funds.

New permanent prenatal centers--4 established as a result of the mater-nity and infancy work. The)' are supportetl by maternity ancl infancyfunds and by eounty funds.

Classes for girls in crlre of infants and preschool chilclren-191 organized;girls enrollecl-4,963 ; lessons in eourse-12.

Classes for mothet's-66 organized ; mothers enrolled-1,904; number eont-pleting coutse-2SS; number still on roll-1,716.

Classes for ruirirlives-l9-1 organizetl (excluding 15 organized by a physicianlent by the United States Children's Bure:ru) ; midwives enrolletl-1,764;number completiDg course--S21 ; lessons in course-1O. Permanent mid-wives' c'iubs were organized in each county in n'hich classes rvere conducted.

Ilome f isits b.v nurses-24,968 (prenatal cases seen, 4,457; obstetrical cases,96 (report incomplete) ; postnatal cases, 1,883; infants, 5,939; preschoolchildren, 3.888 ) .

l\{aternity homes inspected---441 (report incomplete).fnfant homes inspected-?31 (report incomplete).Cornmunity denronstrations-19, of a nmternit]' and infancy public health

nursing program.Group demonstrations-633, to groups of mothers, expectant mothers, ancl

mldwir-es. In addit ion 3.205 demonstrat iotrs were made for indir iduals.Surveys-3: (1) Of midrvives. (2) Of birth registrat ion. (3) Of 7

hospitals.Campaigns-8: (1) For observance of ltay Day as Chilcl E[ealth Day,

state-wide. (2) n'or immunization of children against diphtheria, state-wide. (3) n'or examination of preschool children and correction of their48278'-2$--5 57


TITE $'ELFARE AND EYGIENE OF MATERNITY AND INFANCY

Activities-Continued.defects before the children should enter school, in 1 county. (4, 5'6) n'or interestiDg yt,ung girls in organizations for health work' in Lcounty. (?) For dental care for chiidren, in 1 city. (8) f'or promotionof negro health, in 1 citY.

Talks and lectures-3S2.Literature distributed-105,875 pieces.A graduate course for nurses in maternity and infancy rvork was conducted

in Atlanta in cooperation with Ernory University.Nutrition work rvus done through individual instruction and through

cla-sses conducted by a rlietitian detailed by the State univelsity to the" healthmobile " operated by the division in rural districts.

Exhibits conducted-64.Article preptrred-The Mitlwife Problem. Material for ne$''(papers and

for radio broadcasting was also prepared.Breast feeditrg was promoted by litel'ature distributed on .the subject.Infants born in the Shtte during the caleudar year 1927-61,636; infants

under 1 year of age reached by the work of the division during the yearunder review-13,709 ; preschool childreu reached-12,956; expectantmothers reached-15,563.

Counties in the State-161 ; counties in which maternity anrl infancy workwas done during the year-?7; c'ounties in rvhich maternity and infancyT!'ork has been done since the acceptance of the maternity and infancyact-160.

Since the beginning of the State's cooperation under the maternity andinfancy act three counties have assumed the responsibility for maternityand infancy work begun with maternity and infancy funds.

The follorving state-wide organizations cooperated in the division's work:State department of edtlcation, St:rte league of ll'omen voters, Woman'sChristian Temperance Union, State federation of women's clubs, fra-ternal and professional organizations, and the parent-teacher association.Ifrime demonstrntion agerlts also cooperated. The assistance consistedmainly in arranging for conferences and other educational work on thematernity and infancJ' ProgTam.

An outstanding achievement of the year wrs the cotttacts made *'ith mothersin rural sections of the StaLe.

TYPES OF WOBK AND SOME RESULTS

The division of child hygiene lvas established in the State board of health in1919. The gorernor accepted the provisions of the maternity aud infancy act onX'ebnrary 73,7922. This rvas follorved by legislative acceptanee approved by thegovernor on August 16. 1922.

A physician has directed the t'ork, another ph5.sician has acted as elinicianon the " healthmobile," and State staff nurses have servetl in a supervisory capac-ity and assistcd in special field worli. The number of public-health nurses paidrvholly or in part from maternity and infanc.r' funds and detailed to counties isgratiually increasing, t having beeu added in each of the last two J'ears to the15 that \Yere reported for 1926.

Coop€ration has been maintained with the State department of education,professional and fraternal organizations, women's organizations, and the parent-teacher association.

Emphasis has been placed on child-health conferences made possible throughthe use of the " healthmobile " and on the establishment of permanent centers incounties in which public-health Durses were stationed. Numerous prenatal con-ferences hale been conducted, and many lisits to the homes of mothers andchildren have been includetl in the work of the nurses.

\York rvith the negroes has been deveioped through activities of negro nursesin conducting prenatal conferences and instructing negro midwives. It isestiniated that more tban 5.000 midrvives are iu the State; by January 1, 1928,4,661 had beeu located. Through the efforts of the division a large numberof midwives have received instruction during the period of cooperation andhave macle application for certificates of fitness to practice. Many who wereunfit lrave ceased to take cases. By January 1, 1928, 2.17]. lnad obtained certifi-cates, 1,529 had failed to qualify for certiflcates, and 661 rvere still uninstructed.To receive a certiflcate, each midrvife must attend a school of instruction for10 periods and must pass a satisfactory exrmination. She must have a nega-

584

Provided by the Maternal and Child Health Library, Georgetown university

ry

PhINCIPAI, ACTIVITIES O]I INDIVIDUAL STATES, 1928 59

tive reaction from the Wassermann test, must be vaecinated against smallpor,must agree to abide by the regulations promulgated by the State board ttf health,and must undertake to report all births promptly to the local registrar ofvital statistics. Ampules of nitrate of silver are distributed free, and midrvivesare required to use this prophylactic in the eyes of the nervborr. The follow-up rvork with midn'ives has been difficult, and there are problems yet to bemet. But that the midwives constitute an indispensable group is indicatedby the fact that they delivered 31.4 per cent of the total births reported inthe State in 7927.

The State has been both'in and out of the death-registration area duringthe period of cooperatiou. It rvas dropped in 1925 owing to the lack ofsatisfactory legislation. This was secured in 1926, and the State was read-mitted to the death-registration area for 1928, being admitted to the birth-registration arer the same J'ear. The staff of the division of child hygieneassisted in the campaign to accomplish entry. The work with the midwivesin securing better registration of births.\1as an important feature of thecampaign.

Owing to the recent admission of the State to the birth-registration areainfant and matemal mortality rates are not available from the United StatesBureau of the Census. That irnproveruent has occurretl in rnaternal rvelfare,at least, is indicated by the improvernent in the tJpe of midwives uorv practicingand in the character of their rvork.


#

HAWAII

STAFF AND ACTIYITIDS IN 1928

Administrative agency:Territorial boald of health, division of maternity and infancy, Honolulu.

Funds expended: tr'ederal, $72,224.43; State, $6,725.96; total, $18,950.39.Staf f :

Director (nurse, for 10 months,10 days; physic ian, for 1 month,21 days),18 nurses (14 part year, part t ime), 1 stenographer.

\-olunteer assistauts-26 physicians, 20 lay persons.Activities :

Child-health confelences conducted by physicians-1,O01; infants and pre.school children registered atrd examined-5,022; visits to conferences-20.216.

Couferences contlucted by riurses, no phl sician plesent-23.4; children in-spected-925 ; visits to conferences by childreu-3,624.

Nerv permanent chikl-he:rith cellters-12 est:rblisltetl as a result of the ma-ternity and infarrcy rrork. They are sulrported by maternity and infancyfunds and by private funds.

Classes for git'ls in care of infants aud pt'eschttot children-4 organizetl ;girls enrolle<l-S4; rumber completing courS€-37; Iessons irr course-10.

Home visits by nurses-14,017 (prenatal cases seen, 160; ittfants, 1,507;preschoq-l childlen, 4.q1 ).

Literature distributed-2.60O pieces.Nutrition rvork rvas done through individual instruction to mothers at

conferences and in home visits.Breast feeding n'as stlessed in the in-struction given at conferences and in

home visits.Infants born in the Territory during the year-11,54i3: infants untler 1 year

of age reached by the work of thg di\'l-si6r)-3,074; preschttol childrenreachetl-2,873.

The dirision s€nds literature on infant hygiene to parents of ali infantsrrhose births are registered in the Ten'itorial bureau of vital statisticsif tLrg parents are known to be able to read.

Couniels in the Territoly-5; counties in l'hich naternity anrl infancyrr.-ork \I'as done during the Jeal'--+. The remaining county is thc lepersettlenrent.

The nurses on the division's staff as-qisted at confL'rences contlucted bylocal organizat iorrs.

Trvo mission orgarrizations cooperirted in the division's *'ork, lending roomsin n'hich child-health conferc.nces s-ele contlucted.

The outstanding feature of the year's work was its reorganization by whichall the nurses orr the staff of the board of health were enabled tt-r devote parttime to maternity and infancy work.


The Sixty-eighth Congress extended the benefits of the maternity and infancyact to the Tell'itory of Hawaii. A rlivision of maternity and infancy wasestablished in the Territorial boarcl of health in 192i-r. The l'erritorl' acceptedthe lrrovisiotts of the act through the goveuror's acceptlnce on April 7, lmLThis rvas follorvetl bJ' legislative acceptiince approved by the governor onApril 13. 1925.

Irr the filst two )'eals of cooperzrtion with the l'erler:rl Government a meclicaltlirt,ctor had chalge of the work. llore leceutly rr nuLse has been itt r:harge.The same plans of r rganizltion aud lield work have coutiliued through theperiod of cooperation, a staff of rrurses (18 in 1928) rvorking under the directionanc! supervision of the director.

60


g

PRTNCTPAL AcrrvrrrEs oF TNDTVTDUAL STATEST 1928 61

Cooperation has been given by two mission organizations and by plantation

omciais, irrcluiling managlrs, physicians, ancl nurses. A number of physicians

Irave given volunteer: services at conferences and centers'- 'Jlhe" plan of work stresses the organiz:rtion of health centers, in whit:h con-

sultatiolns for infants and prcschooi chilclren may be conducted and ̂ to whicbretrrrn visits may be made. This insufes a continuous program of informationlo parents on iniant ancl (lhild care and continuous supervi-sion of the childrenattinaing the centers. Since 1925, when the work begtrn, 8f).centers-have beenestrrblished in the Territory. The rlivision of mater'llitl' alld infancy has chargeof 48 centers, and 32 uricler the auspices of the plantations are assisted by therlivision in many waYs.

The children- uxd-er supervision represeDt matty racial gloups, includingHawaiians. Japanese, chinese, Filipinos, antl caucasiaus. some of the raceshave very high infant mortality rates.-

er tfr. Teiritory is not in fhe Unitecl States birth-registration area figuresare not available irom the United State-s Bureau of the Census, but Territorialmortality rates indicate a decrease in infant mortality in 1927 compaled with1925. I; 1925 the infant mortality rate was 1Gl; in 1927 the rate was 96.

ln \927 the mortality among Ilawaiian babies rvas higher thatt that amongbabies of the other races in the lftrritory. ths ferritorial flgures, however,snuw a reduction in the rates for Hawaiiau babies in 1927, when 237 died in theflrst year of life in every 1,000 born alive,.rYhereas 258 tlied in 1925, a savingin fSDZ of 21 babies in every 1,000 live births. The rate for Filipino babiesalso shows a definite reduction; in 1925, 287 babies in every 1,00o born alivediert Uefore reaching their first birthalay, and i1 1927 the rate \Yas 226, or 6lbabies saved as compared with 1925. The fact that more thildren attendedcenters and conferences in 192? thau in precetliug years and that more exp€c'iant mothers were given instruction undoubtedly led to better lrealth conditions.


#

IDAHO

STAFF AND ACTIVITIES IN T928

Administrative agency: State departmenthygiene, Boise.

tr'unds expended: n'ederal, $8,098.54; State,

of public welfare, bureau of child

$2,732.21; total, $10,830.75.Sta f f :

Director (physician, part year),2 physicians (part year,1 part t ime),2 nurses, 1 stenographer-clerk (part year).

Volunteer assistants at child-health conferences-l5 physicians, 227 nursesand lay persons.

Activi t ies:Child-health conferences conducted by physicians.-33; infants and pre-

school children registered and examined-7,451.Defects found in children examiued at conferences-z,?91 ; children having

defects-1,1611. (n'ollow-up work to ascertain whether defects llad beencorrected had not been conpleted at the close of the year.)

Conferences conducted by trurses, no physician present-13; children in-spected-279 ; mothers instructed in prenatal pare-39; visits to confer-ences by rnothers-E2.

Home visits by nurses-811 (prenatal cases seen,20; iufauts,357; preschoolchi ldren, 619).

Infant homes insp€cted-z; inspections nade-2.Surveys-3: (1) Of 57 hospitals. (2) Of midwives, state-wide. (3) Of

crippled children, state-wide.Talks and lectures---39.Literature prepared-prenatal letters (revised), diet lists.Literature distributed-T.096 pieces.Nerv names registered for prenatal letters-474; prenatal letters distribu-

ted---499 sets.Nutrition work was done through individual instruction at conferences and

in home visits.Exhibits conducted---46, of posters on prenatal and infant care and on

clothing for the baby. Exhibit material prepared----thart of infarrtand maternal nlortality, by counties.

Statistical studies nade---{auses of maternal deaths, by counties ; causesof infant deaths, by counties.

Breast feeding was stressed in the iustruction given at conferences anclin home visits.

Infants born in the State during the year-9,971; infants under 1 yearof age reached by the work of the bureau-1,591 ; preschool childrenreached-1,803 ; expectant mothers reached-S72.

Couttties in the State---44; counties in which ruaternity and infancy workwas done during the year-27; counties in which maternity and infancywork has been done since the acceptance of the maternity and infancyact---14.

The following organizations cooperated in the burean's work: State merticalsociety, State tuberculo-qis association, federated rl'onten's clubs, AmericanRed Cross, joint legislative council, and the parent-teacher association.They arranged for and assisted at chilcl-health corrferences. Amongthe children exainined at corrferenccs l'eported in the foregoirrg para-graphs ti7 were examined in the " Get ready for school " drive sponsoreclby the National Corrgress of Parents and Teacliers.

The outstanding achievemeltt of the year was the reduction of the infantmortality rate fron 63 Irer 1,0OO live births ir 1926 to b0 ju 1922,

62


4V

PRTNCIPAT, ACTTVTTTES OF INDrVrDuAr, STATES' 1928 63

TYPDS OF WORK AND SOME RESULTS

The bureau of ehilcl hygiene was established in the state department ofpotrti" *uttu"e in 1g19. ihe Statt accepted the provisions of^the_ Taternity'antl

infancy act through the governor's acceptance on Jailuary 23,1922. This*u" fottot*A by legislative aCceptance approved 5y the governor on March 13,as23.

A small staff consisting of a physician and two nurses has conducted thematerTity and infancy work, rvith the assistarlce of professional and lay volun'teer wor-kers and wiih excellent cooperation from the State medical society'the state tuberculosis association, the American Red cross, women's organi-zations, the parent-teacher association. and the joint legislative_council.

Information relating to maternal and infant care has been disseminated toa great extent through chilcl-health conferences, which have' been the chiefact"ivity of the bureau. A special feature of the work for the year eDded June30, 1928, was the survey of 57 hospitals in the State.

Through the work of the state departmenL of publie welf.are, to which thebureau of ctritrt hygiene gave assistance, the State was admitted to the birth-registration area in 1926.

Figures from the united States Bureau of the census showetl a markedreduction in infaDt mortality in 7927, with a rate of 50 infants under 1 yearof age dying in every 1,000 born alive, as compared with the lxevious year,in whicb the rate was 63. Owing to the recent admission of tie State intothe birth-registration area figures from the Bur€au of the census are availablefor these two years onlY.

The maternal mortality rate has not declined. In 1926 the rate n'as 56.9deaths of mothers iu ever]' 10,00O live births; in 7927 the rate was 60.

40

l l l lO Annual rates

r Trend l9 l l -1927

r t t l|9|t 19|2 J9|3 |914 |9|5 19|6 19|7 t9l8 |9|9 1920 |9?| |g??|923|924|9?5 |926 |927

Source: State f i$ures

AreDd of maternal mortality; Indiana' 1911-1927

t00

90o.c

teo-oo).z 70

60

50

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G


*

INDIANA


Administrative agency:State board of health, division of infant

Funds expended: X'ederal, $32,300.59; State,Staff:

and child hygiene, Indianapolis.$19,020.14; total, $51,320.73.

Director (physician),4 physieians (1 part year), 4 nurses (1 part year) '1 vital-statistics clerk, 1 exhibits director, 1 secretaly, 2 clerks (partyear),3 stenographers. Temporary assistants were employed as needed.

Activities :Child-health conferences conducted by physicians-413; infants and pre-

school chiltlren registerecl-11,S74 ; number examined-11,838; visits toconferences-11,888.

Defects found in children examined at conferences--45,213; children hav-ing defects-11.350.

Classes for mothers and young women-141 organized i mothel's and youngF'omen enrolled plus those carried over frotn previous year-7,908; num-ber completing course-?,824; lessons in course-5. These figures include1.71O students enrolled in classes conducted in 10 colleges.

Group tlemonstrations-3O5, on various phases of maternal and ehild careCampaigrrs-4: (1) For rrbservance of trIay Dly as Chikl Health Day.

state-rride. l\Iay Day is regarded as the culmination and also renewalof the year's chilri-health activities, and preparation for May Day in1923 rlas carried on to some extent durillg the entire year. Celebrationsincluding parades, pageants, s'indon' displays, motion pictures, andspeeches were conducted throughout the State. The division receivedreports of county, community, and group programs, and additioual townsand communities planned program-s but did not submit formal relnrts.

. The lla]' Day slogan was " Better children for our Nation-a betterNation for our children." (2) X'or imnunization of children againstdiphtheria. (3) For periodic health examination of preschool children.(4) For the examination of preschool children and correctiorl of theirdefects before the chilrlren should enter school.

Talk,s and lecture-q--885.Literature distributed-176.473 pieces.Nutrition n'ork rras done through instruction given at classes and at health

conferences.Exhibits conrlucted-37, at various State ancl locrrl meetings, the most

important being at the State fair. Through the State board of agricul-ture the State has provided special buildings to hou-se the division'sactivities for ptomotion of interest iu child care and development. Anexhibit consisting of posters, moclels, and motion pictures rvas shown,and physical examinations and mental tests were given to 1,376 infantsand preschool chilriren. Exhibit material prepared-posters, charts,maps, and models. Exhibit material n'as lent twelve times.

Scientific articles prepared-Fetal and Neonatal llortality; Poliomyelitis;Tuberculosis, ir }fenace to the Infant and Runabout Toddler.

Statistical studies made (mostly based on records of mothers and childrenattencling conferences)-breast feeding; lutrition; clefects; defects fol-lowing childhood infectiorrs; eye rlefects ; amount of milk consumed byinfants and pre-school children: mental development; prenatal, obstetric,and postnatal cdre; live births and accidents of pregnancy.

Breast feeding was promoted through instruction given at conferences andclasses, and through literature clistributed on the subject.

fnfants born in the State during the year-61.692; infants under 1 yearof age reached by the work of the division-S,S01 ; preschool childrenreached-16,874.

64


{

PRINCIPAL ACTrVITIES OF INDI1ADUAL STATEST 1928 65

Activities-Continued,Counties in the State-92; counties in which maternity and infancy work

was done during the year-5S; counties in which maternity aud infancys'ork has been done since the acceptance of the maternity and infallcyact-91. (One county hacl hacl maternity aud infancy work previously.)

The division promoted the organization of county child-health boardscomposed of public-health workers and of ufficial representatives ofmedical, dental, and nursing associations and local lay organizutions.The purpose of these boards is to bring eYery child to his first day ofschool in good health by: (1) Upto-date knowledge of his condition;(2) correct nutrition, care, and training; (3) protection from diseasedangers; (4) correction of defects; (5) provision of suitable environ-ment.

The following organizations cooperated in the division's work: Otherdivisions of the State board of bealth, State board of charities and correc-tion, State board of education (home-economics and attendance depart-ments), State university (extension service), State clental association,State medical association, State health council, Purdue Llnivelsity (agri-cultural extension), State child-welfare association, Sfitte tuberculosisassociation, State chamber of commerce, American Legion, State leagueof women voters, State federation of women's clubs, Young }Ien's andYoung Women's Christian Associations, the parent-teacher association,other professional and fraternal organizations, schools, and churches.

The outstanding achievement of tbe year was the creation of a statewitleinterest in better liealth standards.


The division of infant and child hygiene was established in the State boardof health in 1919. The State accepted the provisions of the maternity andinfancy act through the governor's aceeptance on X'ebruary 9, 1522. This wasfollowed by legislative acceptance approved by the governor on llarch 3, 1923.

The same medical director has had charge of the work since the beginning ofcooperation under the act, and the continuity of the program therefore has notbeen interrupted. The staff has included three to four units, each composed ofa physician and a nurse who conduct work in tbe field.

The division has had the beueflt of cooperation from a number of Statedepartments and organizations, county and city officials, professlonal groups,the parent-teacher association, women's and men's organizations, and girls' andboys'clubs

,Three major activities have marked the progress of the work: First, child-health conferences conducted by units composed of physicians and nurses wereextended to every eounty in the State. These were followed by instruction inprenatal, infant, and child care given to groups of mothers and to college stu-dents. Classes for mothers were also held in every county. The units then-began conclucting conferences for preschool ehildren. Iluch attention has beengiven to education and information of tbe public through exhibits, charts, andother forms of publicity,

The infant mortality rate has declined. reaching in 1927 the lowest rate sincethe State has been in the United States birth-registration area. The infant andalso the maternal mortality rates for 1921 (the year preceding the State'scooperation under the act) and for 7927 were as follows:

Infant mortali,tg rqtes (ileaths of infants under 1 gear of age 'per 1,000 Iircbirth s)

7927 tg27State-------- 77 59

Urban------- 79 63Rural ------------ 66 55

Moterytal, moftalitll rates (deaths of m.others from puerperal causes per 10,000Iiae births)

1921 1C17State-------- ------_---- 63.6 85.7

I l rban- - - - - - - _______ 85 .7 81 .1Rural ------- _-- -_- 56.5 52.7

X'or the trcnd of maternal mortality from 1911 to 7927 see the graph onpage &3.


s

IOWA

STAFF AND ACTIYITIES IN 192E

Administrative agency:state board of eaiucation, rlivision of maternity and infant hygiene, Iowa

CitY.Funds expended: tr'ederal, $21,085.31 ; State, $21,213.60; total, $42'298'91'Staff:

Director (director of the extension service of the state university serving),1 physician, 4 nurses, 1 dentist, 1 tlental hygienist (2 months), 1 socialw6rter, 1 specialist in chill welfare, 1 vital-statistics clerk, 3 stenog-raphers.

Ac;lvities:chilcl-health conferences conclucted by physicians--181; infants and pre'

school children registered and examined-4'274'Defects found in chiklren examined at conferences-4,458; chililren having

defects-3,532. Reports made by the'nurses n'ho followed up the childrenexamine6 at confelences durilg the past flve years shorved that 73.9per cent of the children having defects had the defects conected, wereimproved, or \\'ere under active treatment.

Dentirl cooferences-1g; preschool children receiving dental examination-306,

" trIothers' health day " conferences-l49 ; attendance-?'582 (5,752 women'1,550 high-school girls, 262 fathers, 18 physicians). These conferenceswere coiductetl bi a physiciar a'd nurse from the division and \YeIearranged in cooperation with local rr.omen's clubs and parent-teacherassoci;tions. Lectures rvere giverr and slides, films, nnd charts shownon prenatal and infant eare; axhibits rrete made of clothing for motherand baby, obstetrical package, and preparations for home delivery.

Home visit's by nurses-325 (infants seen, 180; preschool chiltlren, 145)-Campaign-1, in cooperation with the parent-teacher associatir-rn, in 1

counti, for examination of rural preschool children and correctiou oftheir defects before the children should enter school.

Talks and lectures-214.Literature distributed-73,600 pieces.Graduate courses in oral hygiene for nur-qes-?; attendance-45.Dxhibits conducted-136, at fairs anrl " mothers' health day " conferences.Infants born in the State during the year-44'296; infants under 1 year

of age reached by tJre work of the divi-sion-2.1Xi (exclusive of thosereaehed by literatirre distributecl) ; preschool children reached-3,206 (ex-clusive of those reached by literature distributed); expectant mothersreached-1,012.

The division cooperates with the state botrd of health in sending litera-ture on infant hygiene to parents of all infants'whose births are registeredin the State bureau of vital statistics.

Counties in the State-99; counties in which maternity ancl infancy workwas done during the year-52; couuties in which maternity and infancywork has been hone since the acceptance of thc maternity and infancyact-99.

The following organizations cooperated in the division's work: Statedental society, State tuberculosis association, State farm bureau, andthe parent-teacher association. Arnong the children examined at confer-encei reported in the foregoing paragraphs 845 were examined in the

"Get reidy-for school" drive sF)Ilsored by the National Congress ofPare[ts and Teachers.

66


,6'&

PRINCIPAL ACTIVITIES OT' INDTVIDUAL STATES, 1928 67


A division of maternity and infant hygiene was establishect in 1922 in theextension division of the State university, which is under the control of theState board of education. l'he State accepted the provisions of the maternifyand infancy act through the goverDor's acceptance on January 27,7922. Thiswas followed by legislative acceptance approved by the governor on April 2,1923.

The same director has had charge of the nolk during flre entire period ofcooperation. Phy-sigi2na, dentists, and nurses have served on the division'ss14ff.1 and cooperation has becn given by State and" county medical societies,the state dentai society, the tuberculosis association, the paient-teacher associa-tion, the State farm bureau, and women's organizations.

Distribution of 182 child-bealth conferences in Kansas, \927_29

- The prograrn has stressed both prenatal and chikl-health conferences, whichhave been itinerant in eharacter. oral hygiene has also received mucli atten-tio! through dental conferenees for preschool chiklren. I\rothers' meetings, inwhich instruction in infnnt and prenatal care is given by physicians andnurses, have been well attended.

There has been no appreciable change in infant mortality rates since flrestate was admitted to the united States birth-registratidn ut*

-in rgz+.

l{aternal mortality rates hare declined in the rural aieas, in which 82 mothersdied for every 1O.000 live births in 192i1, whereas 46 dieci in 7927, aiaving of6 rural mothers for every 10,00o babies born alive in 7927 compared with 1924.Much informatio! in regard to prenatal care has reached the'rurai populationthrough prenatal conferenees and mothers' health day conferen6s.- wrricnfathers also attended;- apparenily this work is reflected-in tne aeciu6 in tnerural maternal mortalitt rate.

ilI

IL-


&

KANSAS

STAFF AND ACTIYITIES IN 1928

Administrative agenc)- :State board of health, division of child hygiene, Topeka.

l'unds expendetl: Federal, $15,261.76; State, $10,000; total' $25,261.?6'Staff:

Director (physician),3 nurses (1 for l month), l vi tal-stat ist ics clerk,1 stenoeiiapher, 1 clerk. Four county nurses were- paid in part from

. maternity and infancy funds.Yolunteer assistants-7 pltysicians, 1O lay persons.

Activities:Chilcl-health conferenees conducted by physicians-1?5; infants and pre'

gcirool chiltlren registered and examined---3,750. Assistance rvas givenat the conferences by 1?7 local physicians, 63 dentists, 155 nurses, and679 lay persons. The number of mothers attending rvas 3,353; the num-ber of fathers attending rvas 368; approximate number of other visitors,4.315.

Defects founcl in children examined at conferences-4,674; children havingdefects-2,0O8.

Conferences conducted by nurses, no physician present-T; children in-spected-137; visits to conferences-1S0.

Classes in maternal and infant hygiene rvere contlucted in three Stateteachers' colleges to prepare students to teach the subiect to girls in theseventh and eighth gt'ades. Similar courses n'ere contluctetl in threeother schools and a house-keeping center. Students enrolled-m,ore tharl200; alerage number of lessons in course.-5.

Ilome visits by nurses-521 (prenatat cases seen, 152; infants' 155; pre-school cl-tildren, 336).

l\Iaternity hones inspected-6 ; inspections made-12.Infant homes inspeeted-54 ; inspections made-108.Group demonstrations-20, at the classes conducted in the State teachers'

colleges.Survels-3: (1) Of midrlives. Nurses visited the ferv midwiles linown

to be practicing in the State and founcl most of them fairly well quali-fied to hanclle normal cases. The number of midwives in the State isdecreasing yearly. (2) Of birth registration, to assist the State dili-sion of rital statistics. The nurses called on local registrars of vitalstatistics and checked the birth reports. n'ifteen counties were com-pleted. Yisits rvere made also to phlsicians to enli-st their interest inthe prompt reporting of births attended by them. (3) Of health con-ditions among mothers and children on an Indian reserration (not eom-pleted at the elose of the year under re't'ierv). The nurses also assistedin a venereal-disease survey conducted by the State health officer.

Campaign-1, to have preschool children qualify as " $pointers " through-out the State. To qualify, the children must have normal vision, hearing,teeth, throat, posture, antl rveight, be raccinated against smailpox, andbe immunized against tl'phoid fever and diphtheria. At a picnic for9-point children sponsoretl by one county health unit on trIa}- Da]' inobsert'ance of Child Health Day more than 1,200 9-point children werepresent.

Talks and lectures-53.Literature prepaled-Ifr]thers' Manual (reviseal), g-point pamphlet, set

of 4 diet cards.Literature distributed-212,376 pieces.New names reglstqred for prenatal letters-73; prenatal

uted-355 ,sets.

68

letters distrib'


4t

-

PRINCIPT\L ACTMTIITS Ot ' INI) IYIDII IL STATESI 1928

Act ivities-Continued.Nutrition work was clone through individual instruction at health

conferences.axhibits conducted-6. Exhibit material preparecl-charts on contagious

cliseases. Exhibit material rras lent eight times.Breast feetling \\'as stressed in the iilstructioli gileD t0 mo'thers itt

conferenees,Infants born in the state during the l-ear-35.234; infants under 1 year

of age reachetl by the work of the division-itpproximately 35'OOO:presc-hool children rea'cheil-2,815; expect2rnt mothers leached-approxi-mately 70O.

The division sends literature on infant hygiene to parents of all infantswhose births are registered in the State bureau of vital statistics'

Counties in the State-105; counties in which maternity and infancywork was done during the ]'ear-105.

The following organizations cooperatd in the division's work: Statefederation irf women's clubs, State leagrre of women voters' AmericanLegion auxiliary, fair associations, anti the parent-teacher'association.Among the chilclren exatnined at conferences reported in the foregoingparagiaphs 25O were exarnined in the " Get ready for school " drivesponiored by the Nationtll Cc)ngress of Parettts and Teacilers.

Among the outstanding features of the yeat's work were the child-healthconferenc€s co.nducted and the classes in maternal and infant hygiene taughtat the State teachers' colleges.


The division of ehiltl hygiene was established in the State boarcl of healthin 1915. This was one of the earliest among the State divisions or bureausof chilal h]'giene or welfare established in the United States. The State acceptedthe provisions of the maternitj and infancy act through the governor's ae-eepttnee on January 4, 1922, but the next State legislature thtt met failedto enaet legislative aeceptance. and cooperation ceased in september, 1923. In1g27 the state again aecepted the provisions of the act. through legislatiortapproved by the governor on NIarch 16, 1927. An expanding program has been

fiossible as a result of the larger funds available.- Since eafly in 1927 the stafr has consisted of a medical director and two

staf nurses. The medical director in addition to his executive n'ork has givenmuch time to the field work, conducting conferenees and giring addresses. Thetwo nurses have been almost constantly in the fleld. arranging and assistingat conferences and giving courses in infant care. x'our nurses paicl in paltfrom maternity and infancy funds have been detailed to countie-s. The distri-bution of the conferences conclucted<ne of the major aetivities in the field-is shown in the map on page 67. Another phase of the n'ork done directlyn'ith the children is the $point campaign.

A notable feature of the program was the instruction in infant care andprenatal care given at three State teachers' colleges, Western University' andseveral schools. Education in infant care is also promoted through thedistribution of literature to parents.

The clivision of child hygiene is charged with the inspection of institutions'orphanages, and boarding homes where infants are kept as well as with inspec-tion of maternity homes. In these institutions approximately 2'200 childrenreceive care.

The division has had the benefit of cooperation from eounty health depart-mentS. fair associationS, women'S organization-s, and the parent-teacher associa-tion, and of volunteer service from many physicians, dentists, nurs€s' and layworkers.

Infant mortality rates were lower in 7927 than in any other year since theState was admittetl to the birth-registration area. In 1917' the )'elr of theState's admission to the area, the infant mortality rate was 77; in 1926 it was65; and in 1927 it had dropPed to 55.

The maternal mortality rate rvas lower in 1927 than in any previous yearsince the State \yas admitted to the birth-registration area, with the exceptionof 1924, when it was practically the same. In 1917, the year of the State'sadmission to the area, the rate was 75.9 for every 10,000 live births; in 1926the rate was 69.7 i Lr 7927 it had declited to 63,1.

69


ff

KENTUCKY

STAT'F AND ACTIVITIES IN 1928

Administrative agency :State board of health, bureau of maternal ancl ehild health, Louisville.

tr'unfls slpended: X'ederal, $26,298.64; State, gz1.,n\.M; total, 847,597.%,Sta f f :

Direetor (physieian), 4 physicians (3 part year, 1 part time), 8 nurses (2part year,1 part t ime),2 nutr i t ionists (1 part year),1 milk inspector(part tine, part year), 1 birth-registration clerk, 1 vital-statistics clerk,l stenographer, S clerks (2 part time). Two county numes were paidin part from maternity and infancy funds.

Activities:Child-health conferences condueterl by physicians-266; infants and pre-

school children registered and examined-4,192.Defects found in children examined at eonferences-5,121 ; children hav-

ing defects---3,216. Parents hnd defects corrected in 50O of the children.Prenatal confereuces conducted by physicians-14; exp€ctlnt mothers reg-

istered-50 ; numb€r examined---49; visits to conferences-11O.Conferences conducted by uurses, uo physician present-2O5; children in-

spected-2,450; mothers instructed in prenatal car#5.New pe.rmauent child-health centers-12 established as a result of the ma-

ternity and infancy nork. They are supported by the State board ofhenlth and by county funds.

New permaneDt prenatal center-1 established as a result of the maternityand infancy work. It is supported by local funds. Cooperation in thework of the prenatal clinic in the city hospital of the University ofLouisville bV having one of the State staff nurses act as registrar hasbeen continued.

Courses of lectures including child. care and the essentials of prenatalcare were given to groups of juniors and seniors in all the private schools,junior colleges, and State normal schools in the State.

Classes for midwive s-15 organized; midwives enrolled and eompletingcourse-231 ; lessons in course-2. A three months' intensive couise foiwhite women in midwifery and child training was begun at a smallhospital in a mountain section, where there are faeilities for trainingthree midwives at a time. Eight women had completed the course attlie close of the year under review, and many others were n'aiting foradmission.

Elome visits by nurses-350 (prenatal c?ses seen, 102; obstetrical cases, 10;postnatal cases, 5O; infants, 200; preschool children, 25O).

lllaternity homes inspected--4 ; inspections made---4.Infant homes inspected---3 ; inspeetions made-3.Community demonstrations---4, in 4 counties. A maternity and infancy

nurse was detailed. to each county for a period of 6 weeks to eonductan intensive maternity and infancy public health nursing program in aneffort to interest the county in employing a pubtic-health nurse.

Group demonstrations-2O0, on various phases of child etrre, at child-health conferences. Films, po6ters, and a nutrition exhibit were used.in connection with these demonstrations.

Survey-l, in 1 county, to ascettain the number of expectant mothers andto urge them to attend the netvly established prenatal center.

The bureau is cooperating in a study of materrr:rl mortality being con-clucted in the State by the United States Children's Bureau with theindorsement of the State meclical society.

Campaign-l, state-wide, to have children qualify as 5-point blue-ribbonchildren by being free from defects in eyes, ears, nose, and throat andbeing of lQrmal n'eight. In Louisville, where the bureau cooperated7o


:

aPRINCIPAL ACTIVITIES OF INDIVIDUAL STATES. 1928 7T

ActiIi t ies-Conti nued.with a number of local organizations in the work, the campaign cul-minated in a Child Health Day program, and 7,000 children rvho hadmet blue-ribbon staulards were reviewed in a city park by the mayor anda group of representative citizens. Twenty-fve other communities rc-ported blue-ribbon camPaigns.

Talks and lectures-1,112.Literature prepared-Blue Ribbon Standards, diet cards, and child-health

literature revised and brought up to date.Literature distributed---317,559 pieces.New names registerecl fot prenatal letters-1,85o; prenatal letters dis-

tributed-4,000 sets.A graduate course for Durses, consisting of lectures and demonstrations,

ias conducted at the a'nual meeting of county public-health uursesand nurses on the staff of the bureau'

A gratluats course fol physicians in pediatrics and obstetrics \\'as arrangedi-n connection n'ith au annual 2-week clilic at the University of Kentucky.Lectures alld demorstrations were given by members of the staff of thebureau of maternal and child health.

Nutrition *'ork was done through nutrition classes and individual in-struction to mothers. classes orgauized-35; children enrolled-1,020.A summer health and nursery school for preschool children was con-ducted for 8 weeks in 1 city, t'ith an enrollment of 27 children.

'ductect for 6 weeKs rn r clty, Tl 'r ltr an ellroluleut ur zl uuuursu.

Exhibits conducted-25, consisting of a food and nutrition exhibit,rhibits conducteal-25, consisting of a food and nutrition exhibit, posters,and literature, at State and local meetings and at county fairs. Exhibitmaterial prepared-nutrition exhibit, with display of. correct- foods;sun-bath suits; and posters on proper feeding. Exhibit material waslent fifty-two times.

Statistical studies mad-results of prenatal cnre of prospective mothersdeliveries attended by them.attending a prenatal clinic; midwives and

In 1927 the 2,096 midwives iu the Statefollows:

Number of midwives attending-1 delivery ------ ?0O2 del iveries----------------------------------------- --- 2i53 deliveries-- --- 2094 deliveries-- --- 135

' 5 del iveries------------ ------ 10;6-10 deliveries----------- ---- 33011-14 del iveries---------- ---- 15515 deliveries or more----- ---- 187

Breast feediug was stressed in literature distributed aDd in instructiongiven to intlividuals.

Thl bureau serves as a clearing house for all child-health activities in theState, rendering advisoiy service to local organizations and supervisoryservice to public-health nurses and full-time county health units receiv-ing State aial. One staff Durse gave her full tile to organizing permanentch]t6-healtb rvork and supervising cbild-bealth celters established underine neatth units. Amonglhe activities conducted by county public-healthnurses who received adyisory and supervisorl' assistauce from the bureauwere the following classes, for rvhich an outline issued by the bureau wasused : ( 1) Classes for girls-5S organized, with an attendance of 325 girls'The course consisted of 24 lessons, and the instruction given covered careand feedins of the baby and health habits. (2) Qlasses for mothers-- 27organized, with an attendance of 408 mothers. The course consisted ofis"te""ooi, and the instruction given colered the essential features ofprenatat care, the necessity of having a ph,ysician for delivery, simpleiome nursing, ancl the care of the infant and preschool c-hild.

As a result of ahe bureau's s.ork city health departments and county nurses-developed the 5-point blue-ribbon standards for school children, and

ma"V "nifO-nealtd

conferences were conducted by tocal health^com=ittees.fnFant! born in the State during the year-approximately 60,00O; infants--u"Oe"

1 year of age reached by the work of the bureau-approximatelyOZ,OOO; preschool- chil<lren reached-approximately 65,000; expectantmothers reached-22,450.

fne"6"""uu .."4" fit"i'utore on infant hygiene to parents of 1ll infantswhose birtus are reg:istered -in the state bureau of vital statistics.

atten( led 11,57C del ivct ' ies, as


TITE .WELFARE

AND HYGIENE OF MATERNITY AND INFANCY

k:g Activities-Continued.Counties in the State-120; counties in wliich maternity and infancy lvork

rvas done durirrg the year-120.Since the begirning of the State's cooperation under the maternity and

infancy act 40 couuties have assumed the responsibility for maternityand infancy rrork begun with maternity and infancy funcls.

The follox'ing organizations cooperated in tlre bureau's t'ork: State leagueof rvomen voters, State federation of women's ciubs, local women's clubs,fraternal orgnnizations, and the parent-teacher assirciation. Among thechildren examined at health conferences reported in the foregoing para-graphs 2.@2 s'ere examinerl in the " Get ready for school " drive sponsoredby the National Congless of Parents and Teachers.

Among the outstanding features of the I'ear's work were the developmentof the 5-point blue-ribbon stanclards for chiltiren anrl the adoption of thesestandards by a majority of the counties carr5'ing on health rvork.


The bureau of matemal and child health was established in the Stateboard of health in 1919. The State accepted the prolisions of the maternityand iufancy act through legislative ellaettllert approved by the governor clntrIarch 2:1, 1922.

The same medical director has been in charge of the rvorli of the bureau fromthe beginning of cooperation $'ith the tr'ederal Government. Physicians, nurses,nutritionists, and an educational instructor hale servetl on the staff. Nursespaid in part from maternitJ' and infancy funds have been detailed to counties.

Cooperatio4 has been given by women's organizations, the parent-teacherassociation, Iren's serrice clubs, and fraternal and religious organizations,which have assisted in child health conference'work and in the establishment ofchild-health cerrters.

Importattt featules of the program have been the conclucting of chilcl-heatthconferences, the establishment of permanent health centers, instruction ofspecial groups in prenatal and chilrl care (inclutling classes for mothers and

: cla-s-ses fot girls in infant care), in-struction of midrrives (including a tlainingcenter for mourtain mid'n'ives), ancl a provision through a prenatal center ofinstructiotl and clinicrrl experience for unclergradurte students iri the medicalschool of the University of Louisville.

Nitrate of -qilrer has been tlistrilruted free to physicians and midwives throughthe use of naternity and infancy funds. A marketi reduction in ophthalmianeonatorum has re-sulted from its u"e.

It has been the ptactice to sen(l literature on infant antl child care ancl careof the nursing mother n'ith certificates of registration to parents of all infantsTr'ht-r'*e birtlrS are registered.

An irnportant feature of the work has been the assumption of local respon-sibility for the maternity and infancy work in 40 counties. These countieshave assumed the support of the nork, but the bureau continues to renderadvisory service.

The study of maternal mortrlity being made in the State by the UnitedStates Chilclrert's Bureau with the indorsement of the State medical society isexpected to furnish valuable information that will aid in planning furthermaternity and infancy work.

The effect of the matelnal and infant welfare program is apparent in reduc-tions in maternal and infant mortality rates during the period of the State'scooperation under the materllity and infancl- act. Tht: rates in 1927 were thelowe-st for both mothers and infants since 1917, the ]'ear in which the Statewas admitted to the Unitetl States birth-registration area. The infant andmaternal mortality rates for 1922 (the year in n'hich cooperation was begun)and iu 1927 $'ere as follorvs:

Infant mnrtal. i t l l rates (deaths of infants under 711ear of age, pcr .1,000l ire births)

7C22 1527State-------- 69 61

Urban ---____ 88 7IRur:r l------- 67 59

Provided by the

72

Maternal and Child Health Library, Georgetown University

&

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1928 73

Materno,l m.ortalitA retes (d,eaths of nLotluers from. puerperal, ca.uses per 70,000Iioe births)

1922 t927State ______-_ _,__ 60. T 49.4

Urban - - - - - - - _______ 96 .6 62 . -Rura l - - ,__- - ________ 54 .3 46 .5

These figures show a saving in mothers' anal babies' iives in urban andrural areas as well as in the State as a whole. The mortality rate in theState was 30.6 per cent lo$'er for eoloretl infants in 7927 than in 7V2,; forwhite infants it was 9.4 per cent lower. The mortality rate from puerperalcauses was 41.3 per cent lower for colored nlothers in 1$27 than in lV22; forwhite mothers it was 16 per cent lower. In urLran areas the mortality ratefor colored mothers was 64.2 per cent lower in 1927 than in 1$22, and inrural areas it was 28.2 per cent lower. The effect of the prenatal clinic atthe Louisville Hospital, rvhich is conducted with the cooperation of the bureauof maternal and child health, se€rns to be clearly shown by the markeddecline in the urban rnortality rate among colored mothers.

48278.-29-6

Provided by the Maternal and Child Health Litrrary, Georgetown University

44t,

LOUISIANA


Administrative agency :State department of health, bureau of chilcl hygiene, New Orleans.

tr'unds expended: n'ederal, $19,400.69; State, $14,400.69; total, $33,801.38.Staff:

Director (part t ime),3 physicians (2 part -vear, l part t ime),7 nurses(3 part year),3 dentists (2pafi year), 1 midwife teacher (part year),1 r 'ecord cierk (part t ime), 1 stenographer (part year). Six parish'rlurses were paid in part from maternity an(l infancy funds. Additionalphysicians, a dentist, and a nurse were employed for conference andorganization worh as needed.

Activities :Child-health conferences conductecl by physicians---484; infants and pre-

school chilclren registered and. examined-S,881 ; visits to conferenees-11,421.

Defects found in children examined at conferences-30.268: children hav-ing defects-9,474.

Confereilces condurted by nurses, no physician present-97; childreninslrctecl-1.926 ; nothers instructed in prenatal care-489.

Dcntnl conferences-196 ; preschool children receiving dental examination-9.468.

New permanent child-health centers-21 established in connection withpnrish health units as a resu'lt of the matemity and infancy work.Thel are zuppofted by State and parish funds and by the fnternationalFlealth Division of the Rockefeller X'oundation.

Classes for girls in care of infants and preschool children--$ organizedigills enrolled-163; lessons in course-3O. These classes were organizedas pnrt of the maternity and infant-hygiene program for the coloredpopnlation in trvo communities. Several lessons were €iiven by a colorednurse from the hureau's staff, and the classes n'ere then turned over tolocal workers.

Clrsses for nrothers-5 (,rganized: mothers enrolletl-116. Three of theclasses n-ere for colored nothers, 63 of whom completed an intensiveeourse of 4 lessons. The other two classes. for tvhom the course wasdilided into 12 lessons, s'ere still in progress at the close of the yearunder relierv.

Classes for nidn'ives-?4 organized; midwives enr.olled plus those carriedoyer from previous I'ear-?68; number completing course-154; lessonsin course---6.

lTome visits by nurses-3.398 (prenatal cases seen, 721; postnatal cases,3: infants,541 : preschool chi ldren,620). Visits to midwives-1,513.

Comnrunity dernonstrations-5, of a maternity and infant-hyeiene publichealth nttrsing program. Ts'o were for colored members of the com-ntunitl'.

Group tlemonstrations-251, at mid.s.ives' classes, mothers' classes, andgir ls ' classes.

Surveys-3: (1) Of mids'ives, in 8 parishes. (2) Of preschool children,in I palish, to rcgister thom for conferences. (3) Of infants, in 1 town,to give instruction concelnins their care and feeding.

Talks and lectnres-98-l (at <.hild-health conferences, 164; to groups in-terestetl in birth registration. 235; to groups of exlrcctant mothers,13O; to comnrunitv dnbs nnfl other organizations and groups, 455).

Literature distributed-33,269 pieces,

a In Louisiana the parish is the civil division corresponding to the county in othergtates.

, A

I


&PRINCIPAI] ACTIVITIES OF INDIYIDUAI, STATES, 1928 I D

Activities-Continued.New narnes registered for prenatal letters--645; prenatal letters dis'

tributed-645 sets.Nutrition worh was done through individual instruction given at con-

ferences and in home r-isits.Exhibits conclucted-37. One rvas on the heatth car of the State boarcl of

health, lvhich toured the State. This consists of t\\'o Pullman carsequipped rvith ltrboratory, scientitic exhibits, charts, clo\Yns, modelsand otlier material covering rnany phases of public-health rr-ot'k, includ'ing child hy.qiele. The others were at fairs and at various neetings.

Exhibit material prepared-charts, posters, ciothing, and footl modelsExhibit material was lent fort}--nine times.

Articles prepared-Care of tsaby in Flot \Yeather, \\:h5' g1ti14."n Refuseto Play, Whooping Cough, Infantile Paraiysis, Yincent's Angina, IraXDaI'.

Statistical studies-births attencled by ph]'sicians and micll'ives in parisireshaving health units; maternal ancl infant mortal i t-v in these parishes;deaths of infants under 1 year of age, by age group and color.

Breast feeding \\'as stressed in instruction gilen at conferences, in litera'ture distributed, and in motion pictures shos'n. ]Iidq-ivcts \\-ere spe-cially instructed in the irnportance of breast feerling.

Infants born in the State durirrg the year-40,-100; infants uncler 1 yearof age reached by the $'ork of the bureau-i1,694; prcscltooi childrenreaclted-13,993 ; expectant rDothers reached-1;855.

Parishes in the State-44; parishes in which maternity and infancy $'orkrvas done during the year'-€7; parishes in n'hich maternity and infancy$'ork has been done since the acceptance of the matelnity and infancyact-62.

Since the begrnning of tlie State's cooperation under the maternity andinfancy act 24 parishes hale assume(l the responsibility for maternityand infancy work begun rvith maternity and infancy funds.

The follol'ing organizations cooperated in the bureau's rvork: State federa-tion of rvomen's clubs, the State parent-teacher association anil localassociations, business and professional rvomen's clubs, State and localpublic-health and tuberculosis ussociations, NeN Orleans NeedleworkGuild, and community club,s. They assisted by planning for and )relpingat child-health conferences, urging registration of births, and distribut-ing literature. The Needlework Guilcl furnished laJ.-ettes to needymothers. Among the children examinetl at conferences reported in theforegoing paragraphs 348 *'ere examined in the " Get ready for school "drive sponsored by the National Congress of Parents and Teachers.

Among the outstanding features of the year's work $'ere the increases inthe number of dental conferences conclucted and in the number of preschoolchildren examined at health conferences.


The bureau of chiid hygiene $'as establishetl in the State department ofhealth in 1912. Louisiana was the first State to establish such a bureau. TheState accepted the provisions of the maternity and infancy act through legis-lative enactment applored b-v the governor on July 1-1, 1924. Tiris permittcdan expansion of the bureau's activities.

The work of the buleau during the period of cooperation n'ith the X'ederalGovernment has been in charge of a director with considerable previous experi-enee in public-health work. A central staff cf ph1'sicians, nurses, and dentistshas conducted child-health conferences, dental conferences, and other educa-tional work in the field, and four to six nurses paid in part from materuity rlndinfancy funds have been detailed to parish health units the past few years.

Cooperation has been given by State and local public-health and tuberculosisassociations, women's organizations. and community clnbs. The parent-teacherassociation assumed the responsibility for " preschool drives."

Features of the program have been the holding of health conferences andthe establishment of permanent child-health centers, work done with midwives,assistance given to establishment of full-tine health units, and efforts rnacle todevelop permanent maternity and infancy work in communities. Some re-sults of the n'ork are shown by the number of permanent child-health centersestablished during thg year ended June 30, 1928 (27), ancl the number of


s76 TIIE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

parishes (24) that assumed flnancial responsibility for maternity and infaneyrvork begun rvith maternity and infancy funds.

The use of nitrate of silver in the eyes of the newborn has increased.Tire bureau has assisted in the free distribution of ampules of this prophylacticsince 1925 and estimates that 90 per cent of the midwiles no\v make use of it.

The State was admitted to the United States birth-registration area in1927, the bureau's assistanee in the campaign to aceomplish entry having beenone of its major activities. l\fortality rates are available from the UnitedStates Bureau of the Census for that year only. Infant mortality rates (deathsof infants under 1 year of age per 1,000 live births) for 7927 were 77 for theState as a whole, 89 for urban areas, and 73 for rural areas. Maternalmortality rates (deaths of mothers from puerperal causes per 10,000 livebirths) were 90.9 for the State as a whole, 123.2 for urban areas, anal 77.1for rural areas.


&

MAINE


Administrative agencY :S t a t e t l e p a r t n r e n t o f h e a l t h , d i v i s i o n o f p u b l i c - h e a l t h n u r s i n g a n . l c h i l d

hygiene, Augusta.f'unAslipenaed:

"neOerat, $14,V26'/'r2; State' $10'000; total' $24'526'52'

Staf i :Director (nurse'

supervisor, 12(11 months) '

Activi t ies:


not naitl from uratertt ity and irrfancy funds)' 1 nurseri*-"I-ip"i i frear. s for i mortth or less) ' I xulrit ionistclerk, 1 stenographer (part j'ear)'

b:nitrr-ueattrr conferences conducted by,plrysicians who.- *.i"i"".-Sf; infants ancl preschool children registered

1,027; visits to conferences-1,169'n#..t

'tirri"O in ctritaren exaruinea at conferences-1'0S9 ; children having

defects--614.Coi"i"i"*.""- colductecl by rturses, 1o physician present-92; children"Y.n-s;il;d--413; -otn""* instructed in prenatal care-16; Yisits to con-

i"t'"".". by chiklren--631 ; visits by r-nothers-20'

classes for gi.Is in care-oi'infants an4 preschool children--41 organiz.ed;"'ilril e".oriea---r;os; number completing course-34'1 ; lessons in course-

12.Cfusse" for mothers-5 organized; mothers ennrllecl-96' Each of the flve-;;;;p";"4

monthlv to sludv child crre and prenatal care'

I l o m e v i s i t s b y n u r s e s - € , 6 7 + { P r e n a t a l c a s e s s e e r r ' 2 4 8 : o b s t e t r i c a l c a s e s '-fg; posinatal

"ases, +5;' intanis, 1,122; pleschool cbildren' 2'857)'

c.o-up- ae*onstrations_-d22, at iairs and at meetings of farm-bureau

erourls and other orgallized groups.c,,?iiiii::i. Io".'"n..";i"""" Jr ln"y Day as chikl Flenuh Day. state$'ide."-O-f,e

tiunArea ana nine iorini rep6rted-or wrote to the division in regard

t" in"i. iocal ceteb-raiions, ana -many

others carried out tl program but

did not submit a report.Talks and lectures-262.iit*"lri"

-pr"pur"a_nieals for the Growing child, sugge_sticgs for the

"-i;;;;[, bi"tior r:noerweights, Di"t for- ovenleights' Foods That Should

ne paien Each Day, Food for the X'amily'Literature distributed-425.046 pieces'"X"*

"u*"" registered io. p""irat"f letters--1,151; prenatal letters dis'

tributecl-1.313 sets'N;6ttt;; work was done through instruction given in talks, home visits,^';J^;;"i;;;;."..

bGi,t'""irfiion classes riere conducted for student

nur-ses.n"iiiiiii*' conducted-255, at conferences, fairs, and celebratio-ns of 1\{ay*

oai-u" cirild Health Day. Exhibit material prepared-model nursery.

eaiitio"uf exhibit material was purchasecl so that each nurse might

tuo"- poii""", films, material nee&erl at child-health conferences, and

articlei for clenonstrating layette, care of the mother at conflnement'

u"O "u."

of the bab.v. nihifiit material was lent nearly two hundred

t i m e s , f o r d e m o n s t r a t i o n s o f i n f a n t c a r e i n s c h o o l s , f o r t h e u s e o fo"gon'irotio"i conducting class work, and-for fairs and conferences'

Brea"st fee6ing was streJserl in talks and in advice given to exBectant

mothers.fnla"ts tror in the State during the year-approximately 16.000; infants-;;d;t

i yeu. ot ug"*."u"rt"J-rv-inb work^t'f the division-3'408; pre-

rcir*r cnira""n reaihed-3,2?1 ; expectant mothers reached-1'561'77

volunteered theirand examined-


}fff

78 TITE wEI,FARE AND ITYGIENE oF MATER.NITY AND INFANOY

A ctivi ties-Continued.Letters offering literature on infant hygiene n'ere sent with the

certificates to parents of all infants whose births were registeredState bureau of vital statistics. Iu response to these letters 2,227ers lequested such literature.

Counties iD the State-16; counties in u'liich maternity and infancywas done during the year-15.

birthin themoth-

work

The dir-ision's rvork has stimulatecl other organizations to put gte-ater em-phasis on rvork for expectant mothers and preschool children. Occasion-ally the nurses hare conducted conferences for organizations.

The State public-health association and the American Iled Cross cooperatedin the division's work.

' TYPES OF WORK AND SOME RESULTS

The dilision of pubiic-health nursing aud child hygiene was established inthe State dellartment of health in 1920. Tlre governor and councii did notaccept Federal funds when the funds became available in 1922, but appropriatedfrom the State contingent fund $5,0fi) to carry on the work nntil the Statelegislature coukl trke action. The legislature of 1923 voted to match $10.000of tire l-ederal funds available, but the govemor vetoed the measure. How-eyer, an appropriation of $10,000 a Jear for two years was granted to maintainthe dirision. Finally the provisions of the maternity and iltfancy act $'ereaccepted through legi-slative enactrnel)t approYed by the got-ernor on Aplil 12,7927. Since that time an expansion of the maternity and infancy program hasbeen possible.

A nurse not paid froru maternity and infancy funcls directs the work of thedilision. Duling the flscal year 1928 the stalt (expanded to include 13 public-health nurses aud a nutritionist) reached all except one of the counties in theState with some phase of maternit5' and infancy rvork, aud eight counties hadnurses assigned to t lrem.

The nurses and the nutritionist have stressed in their contacts the importanceof attention to the nutrition of children. Nurses hu\'e had opportunity to em-phasize this in their risits to the homes of mothers and preschool children, thetalks they hale given, the demonstrations nade. and the exhibits conductecl.The nurses also arranged the child-health conferences at which local physiciansmade examinations as well as conducting a number of ctrnferences at whichthey themselves inspected children.

Classm for girls and women in infant and child care, conduct€d by nurses,have been an effective method of impafting information on this subject. Lit-erature on infant hygiene has also been wiclely distributed through requestsfrom parents of infants n'hose births were refistered.

The division has had the benetit of cooperation from the State public-healthassociation and the -{uerican Iied Cross.

l\Iaternity and infanc]' funds ha\'e been uscd for the free distribution ofnitrate of silver to Drevent blindness in the ne\\'born.

There has been a dos'urvard trend in the infant mortality rate since flreorganization-of the division. Tire number of infants under 1 jear of age clyingin e'r-ery 1,000 born alive in 1920 (the year in l'hich the clivision was estab-lished) rvas 1O2; in 1927 this number rvas 80. A comparison of infant mortalityby eounties for 1920 and 1927, ba-sed on State figures, shorvs flrat in 1g20 Bcountics had rates abor e 100 and 11 coultios ha(l rates higher ilran the presentState rate of 80. The lorvest rate in any county in 1920 1vas 61.4. in 7927only 1 county had an infant mortality rate above 10O, and ,oniy b had ratesabole 80. One county had reached the lorv rate of 21.2 and another the com-paratively low rate of 47.1. Intensive l'ork is now under way to reduce theinfant mortality rate in tho county in which more ilran 100 babies died intheir first year of life.

For maternal mortality the general trend has been dorvnl'arrl since 1.g20.In that year the rate of maternal deaths per 10,000 live births ll'as g4.g;in 7V27 it was 79.5.


€PRINCTPATT ACTTVTTTES OF TNDTYIDUAT, STATEST 1928 79

rN

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3 g g s e g; r t t t : i6 r l r r . ;o o o o o <o o € F € >

isnssn

N


I

MARYLAND


Administrative ageney :State department of health, bureau of child h)'grene, Baltimore.

Funds expended: l-ederal,927,158.36; State,915,113.84; total,942,2i2.20.StalT:

D i rec tor (ph) 's ic ian) ,1 phys ic ian (par t year ) ,1 nurse (par t year ) ,1health-education u'orker (part tirre), 2 stenographers, 2 clerks (1 parttime), 1 chauffeur (part )'ear). Sixty physicians and eight dentists wereemployed as needed to conduct conferences. Twenty county nurses lverepaid in part from maternity and infancy funds.

Volunteer assistants-10 physicians, 2 dentists, 95 Iay persons.Activi t ies:

Child-health conferences conductecl by physicians--440; infants and pre-school children registered and examined--0,402 I visits to conferences-7,745.

Defects found in children examined at conferences-8,22b; children havingdefects-5,224; parents had defects corrected in 1,085 of the children.

Prenatai conference conducted by physician-1; expectant mothers regis-tered and examined-3. The prenatal-conference work was not begununtil .lune, 1928.

Conferences conducted by nurses, no physician present-32; childrenweighed and measured-Z77 ; mothers illstructed in prenatal care-16b;visits to conferences by ciritdren-320; visits by mothers-201.

Dental conferences-53; preschool children receiving dental examination-527.

New permanent combined prenatal and chiltl-health centers-2 establishedas a result of the maternity and infanc5r wrirk. .Ihey are sup.por.ted bymaterllity and infancy funds and by local funds.

New permanent prenatal center-1 established as a result of the mater-nityand infancy work. It is supported by maternity and infancy funds andby Iocal funds.

Clas-ses for girls in care of infants and preschool children-g organizetl;girls enrolled and completing coursr-161 ; lessons in course--8.

Classes for mothers---49 organizetl ; mothers enrollerl-226; number com-pleting course--521; lessons in eourse-S.

Classes for midwives-2 organized; midwives enrolled and completingcourse-?; lessons in coulse-S. Informal instruction rvas given to smallgroups of midwives in several counties.

Ilome visits by nurses--$,462 (prenatal cases seen, 876; postnatal cases,534 ; infants, 1.935 ; preschool children, 2,268).

Group demonstrations--45, at child-health conferences and meetings.Surve]'-l, of children who were to enter school in the fall. This was

made in cooperation with pzrrent-teacher associations, county superin-tendents of schools, and public-health nurses.

'Ihe bureau is cooperatiDg tvith the United States Cbildren's Bureau ina study of maternal mortality being made in the State with the indorse-ment of the State medical society.

Campaign-1, for the state'rvide observance of IIay Day as Child HealthDay.

Talks and lectures-.93.Literature prepared-Sound Teeth Are n'aithful Guardians of Your Child's

Health, Diet for the Young Child, Diet for the Expectant l\tother.Literature distributed-127,850 pieces-Nutrition work was dolle through nutrition classes conclucted by the county

nurses who were paid in part from maternity and infancy funds.

80


A.ff


PRINCIPAL ACTIVITIES OF INDIWDUAI, STATES. 1928

Activities-Continued.Exhibits conducted-?5, corrsisting of motiou picture-s, posters, dental

exhibit-q. nnd baby clothing. Exhibit material prepared-motion'picturefilm depicting the work of the bureau of child hJ'giene. Exhibit materialwas lent fort1'-five times.

Statisticat stutlies made---causes of infant mortality, b]' groups accordingto the international classification, indicating percentage of total andrates per 1,000 live births in each group for llarylancl in eomparisonwith those for the United States birth-registration area for 1910-1915 antlfor 192G-1924 and for thc' counties in comparison witir Baltintore city(rvhite and colored separatelJ) for 1921-1926; obstetrical sel'vice in thecounties in comparison with Brrltimore city-attendance of physicians andof midrvi'r-es at births (rvhite and colored), and rates for 1917-1926; still-births and rates for the counties in comparison l'ith Baltimore city for1922-1926; maternal nortality from puerperal catlses in three groups:(1) Eclampsia, (2) septicemia, (3) al l other causes, in the counties,in Baltimore city, and in ttre State (white and colored) for 1917-1926;ne€rro death rates, by :Lge groups, in comparison with rates for rvhitepopulation in the same age groups, for 1916-1925.

Breast feerling \yas pronoted b] instruction gilen to mothers at child'health cc-rnferences and in home visiLq.

Infants born in the State cluring the year-16,261 (exclusive of thoseborn in Baltimore city, in which the Statc bureau does no rvork trs thecity has its o$'n bureau of child hygiene) ; infants under 1 year ofage reached by the s'ork of the bureau-approximately 14,000; preschoolchildren reacltcd-betrveen 5,000 and 6,000; expectant mothers reached-apl)rorimately 4,500.

The bureau sen(ls literature on infant h5.giene to parents of all infantsl'hose births are registered in the State bureau of vital statistics.

Counties in the State-23; counties in rvhich maternity and infancy workwas dorre during the 1'ear-23.

Except for the serlices of physicians from the bureau's staff, sevencounties now carr)' on tlteir os-n maternity and infancy work.

As a result of the bureatr's l-orli child-health conferences and dental con'ferences were conductetl uncler loeal auspices in a nurnber of counties.

The follorving organizations coop€ratd in the bureau's Nork: State federa-tion of women's clubs, State league oi \r'onlell voters, service clubs, antlparent-teacher associations. They assisted at conferences and in thesurvey of preschool r:hildren. Atnong the children examined at con-ferences reported in the foregoing paragraphs 3,379 rvere examined inthe " Get ready for school " drir-e sponsored. by the National Congressof Parents and Teachers.

Among the outstanding achievements of the year were the reductions ininfant mortality and in maternal mortality.


The bureau of child hygiene was established in the State department ofhealth in 1922. The State accepted the provisiotrs of the maternitl* andinfancy act through legislative enactment approved by the governol on April13. 1922.

The sane physician has directetl the work duriug the entire period ofcoop€ration unrler the act. This has assuretl continuity of plans. Public-health nurses paid in part from maternitl antl inf4ncy funds have been assignedto counties for maternity and infancl' work. the numb€r so detailed havingincreased from 3 in 1924 to 20 in 1928. A number of physicians and dentistshave been employed by the clay to assist in conference work (6O physiciansand 8 dentists during 1928).

Cooperation has been maintained with fraternal and rvomen's organizations,service clubs, and parent-teacher: associations.

The bureau's work is in the counties outsicle Baltimore. An importantfeature of the prograrn has been the tlistribution of literature o'n infant andmaternal care. The Chilclren's Bureau folder Keeping the WelI Baby WeUis sent to all mothers, additional literature is sent on the receipt of birth-report cards from registrars of vital statistics, and nearly all newly married

81

82 TIIE WEI,FARE AND HYGIENE OF MATERNITY AND INFANCY

* eouple,s outside Baltimore are reached by the bureau's pamphlet on horrre mak-ing. Other mnjor activities are ltoure visits made b.v nurses, corrferenees con-ducted b)' ph1'sicians and dentists, and \I'ork do'nc with midtvives.

Silver nitrate for use in the prelention of ophthalmia neonatorum is dis-tributed from the bureau to physicians and midwives.

Cooperation in the maternal-mortality study sponsored by the State medicalsociety, which is being made in the State by the United States Children'sBureau, is a feature of rvork in tlle later period of cooperation rvith the tr'ederalGovernment. Another nore recent tlpe of $'ork is the development of con-ferences and centers'conducted by negro physicians and nurses from thebureau's staff among the people of their own race.

The results of the program are reflected in the reduction in both maternaland infant mortalitJ' in 1927 compared with 1921 (the year before c,ooperatiouwas begtrn), with greater reduction in rural than in urban areas.

The infant and maternal mortality rates for 1921 and 1927 for the Stateas a whole'for the white and the colored population ancl for urban and ruralareas were as follows:

Infamt mortality rates (ileath,s of infatuts und,er 7 year of age Wr 1,000 liuebirths\

L92L 7927State-------- 94 81

White------- 81 68Colored------ .-- --_. 147 134Urban------- 87 81

White------- 80 71Colored--_-_- __- 725 726

Rural------- ___-*__ 102 81\Vhite-- 82 MColored------ __- 165 744

Matemal, martalitA rates (death^\ of mnthers from, puerperal causes per 10,000' lbe birtlts)

1921 7527Sta te- - - - - - - - - - - - - - - 66 .5 57 .5

\Yhite------- ------- 59. 5 53.9Co lored- - - - - - - - - - - - . 96 . 1 71 .9L'rban_______ -__-__- 69.7 73.5

Whi te - - - , - - - - - - 65 .6 71 .3Clolored------ --. 92.6 82.8'

Rural--------- ----- 62.5 36.5\Yhite------- --- 51. O 30.1Colored------ --. 98.8 59.2

The reduetion in the infant mortality mte in the rural areas is noticeableamong both the white and the crrlored population, the rate for the white infantsbeing 22 per cent lower in 19Zl than in 1921 ancL that for the colored infants12.7 per ceut lower.

The matemal mortality rates in the rural areas show even greaterThe rate for white mothers was 41 per cent lower in 1927 than incolored mothers it was 40.1 per cent lower.


reduction.1921; for


6

MICHIGAN


Administrative agency:State department of health, bureau of chiltl hygiene and public-health

FundsStaff:

nursing, Lansing.expended : Fecleral, $32,381.39; State, $27,534.27 ; total, $59'915.66.

Director (physician), 2stenographers, 1 clerk,

physicians, 9 nurses, 2 vitai-statistics clerks, 21 mail clerk (part trme).

Child-health conferences conducted by physicians-22; infants ancl pre-school chilclren registered and examined--4&3.

Defects found in childlen examinett at corifereuces--1,525; chilclren havingdefects-614.

Prenatal c<rnfereuces contlucted by ptt-vsicians-11 ; expectant mothers reg-istered-16; number examinerl-12; visits to conferences-114'

Nerv permanent combined prellatal and chil(l-health centers-6 establishedas i result of the maternity and infancy rvork. They are supported bylocal funds.

New pertttanent prenatal center-1 established as a result of the maternityand infancy work. It is supported by local funds.

Classes for glrls in care of irrfarrts and preschool children-158 trganized;eirl,q enrol-Ied anrl comlrleting course-3,605; lessons in course-10' Pub-girl,s enrofed and completing course-3,605; lessons in course-10' Pub-iic-health nurses noL pald trom maternity and infarrcy funds but receivingiic-health nurses noL pald trom maternity and infarrcy funds but receivingadvisory assistance fiom the bureau orgarrizetl 146 classes with an enroll-ment of 2,658 girls.

Classes for rvomen-98 organizetl ; \Yomen enrolled-1,300 (including 50ruitlwives) ; nuntber completiug course-1,080; lessons in course-6.

Self-directetl study clttbs-236 rneetilgs; total atterndartce---1,595 women.The purpose of these clubs was to asslst womel] to iuform thenselves inthe iuudarrrentals of prertatal, infent, and child care. Tire clubs v'ereorganized by a staff rturse, Iocal orgatrizations being used as a nucleuswlienever possible. At the flrst meeting lcaders were choseu for each ofthe six lessous, and a copy of the Michigarr llother's }lirnual rvas givento each meruber. Acltlitiolal refereuce Inaterial wits given to the leaders'and the rnethotl of preparirrg each lesson rras discussed with them. Localphysicians frequently led the discussious oll prellatal and infant care'antl toczrt health officers discussed the control of comutunic:rble diseases.Demonstration rtraterial was lent by the bureau.

Eome visits by nurses-5,06 (prenatal cases seen, 600; obstetrical cases'3; E)strlatal cases, 150; infarrts, 2,&11; prescbool clrildren, 355).

Community demonstrations-3, in 3 couuties, of a prenatal nursing program(1 coltiuued from the previous Jear was completed in December, 192'7).Lists of expectant mothers li,'ere obtained from physicians and otherinterestetl persons. Calls were made on these $'omen, and the hygieneof preguarrcy rvas explainecl and the importance of regttlar medicalsup6rvisioo stressed. A complete history of each case \!'as taken andimmediatety serrt to the physician n'ho rvas to attend the mother atconfinemeui. Subsequent calls were made on an aYerage of once zl monthor more often if any rianger symptoms appeared, such symptoms beingreported to the physician irnmediatell'. DuriDg the yea-r' unde-r review568 prospective moihers rvere under supervision, and 1.867- calls (1.'226p"enital, 641, postnatal) r'ere made. The nurses continued their visitsto the motheri until the infants rvere 6 rveeks old. Ily the close of theyear under review there had been 508 deliveries (iDcludirrg al] deliveriesin the counties iu which rvork had been begun in the previous year),antl only 1 of the mothers under superYisiou had died. of the 477 babies

83


84 TITE \YELFARE AND TTYGIENE OI ]\,IATERNITY AND INFANCY

S Activities-Continued.born alive to these mothers 3'15 were breast fed, 71 were partly breastfed. The ploportion of breast-fed babies indicates the. appreciation ofadvice on bexefits of breast feeding givett by the nurses.

Group clemonstrations-'153, of obstetrical kit, bed for home delivery, bottlefeeding, aud tire baby's bath.

Survey-1, of maternai mortatity, state-wicle (continued from the previousJ'ear in cooperation rvith the United States Chiidren's Bureau). Thecauses of death for ttre 819 cases studied by the close of the year underrevielv were as follorvs :

Number ofdeaths

Total_______ 819

Puerperal septicemia--- --------- 35,Puerperal albuminuria ntrd colvulsiolls---- ------ 167Puerperal hernolrhage-- 95Accidents of pregnancY 79Accidents of labor----- 57Embolus, sudden death, etc---- 53Causes follorviug chiltlbirth (rrot oUrerwise stated) I

Campaigns-3: (1) For promotion of breast feecling, in 12 counties' Callswere macle on the mothers of 1,671 babies, and advice was given as tothe tdvantages of breast feeding. (2) For the examination of preschoolchildren ald correctiou of their defects before the children should enterschool. As chairman of child hygietre for the State parent-teacherassociation the director of the buleau was able to stimulate local parent-teacher associatious to register for this canrpaign, and 290 participated.l\fost of the examinations of children rvele made by local physicians.(3) For the observance of llay Day as Child Ilealth Day. The directorserved as chairman of this campaigu.

Talks and lectures-257, to audierces totaling 10,964 persons'- Literature prepared--outlines for course of study for self-directed study

clubs.Literature distributed-359,0-17 pieces.Nerv names registered for preuatal letters-3,094; prenatal letters dis'

tributed-3,497 sets.NutritioD work ,n-as done through tallis giTell to classes for women &nd

classes for girls.Exhibits collducted-12, at fairs arrd meetings. Erhibit material pre'

pared--.charts on rraterDal nortality, la)'ettes, obstetrical kits, Drethodof giving sun baths. Ilxhibit mtrterial lt25 lsnt thilty times.

Statistical -study made-maternal-mortalit)' data secured to JuIy 7, 1g?3,in the sur-Yey reported in a foregoing paragraph.

Breast feeding was pronoted by the bleast-feedixg campaign in 12 countiesand by instruction givel to mothers in conferences and classes.'

Infants born in the State during the year-97,167; ittfants under 1 yearof age leached by the work of the but'eau-101,641 ; preschool childrenreached-1,038; expectant mothers reached-7,500 (exclusive of thosereached by distributiott of 59,59) pamphlets on prelatal care)'

The bureau sends literature on infarlt hylrene to pareuts of all infantsrvhose births are reg'istered in the State bureau of vital statistics.

Counties in the State-83; counties in rvhich maternity and irifancy workwas doDe during the year'-T9; counties ir which matertiity and infancylvork has beell done since the acceptance of the maternity and infancyact---83.

Since the beginning of the State's cooperation under the maternity andinfarrcy act two counties have assurned the reslxrusibility for naternityand infincy work begun rvith materrtity attd infancy funds.

The bureau gar'6 supcrvisol'y rssistauc€ to local organizations doingmaternity and infancy work.

The following organizations cooperated iI] the bureau's work: State depad.ment of public ilstruction, State agricultural college (extension service),State grange, State league of *.omen voters, State federation of women'sclubs, State chilcl-stud1' asscrcizrtiolr, State nurses' association, AmericanAssociation of University W<rmen, \Yoman's Christian Ternperance Union,Daughters of the American Reyolution, Legislative Council of Michigan

Provided by the Maternal and child Health Library, Georgetown Universify

#PRTNCTPAL ACTMTTES Op TNDMDUAL STATES, 1928 85

Activities-Con tinuerl.'Women. Detroit tr'ederation of Women's Clubs, rvomen's fratemal organi'

zations, and the parent-teaclrer associatittn. Amottg tlte children exam-ined at conferences I'eported in the foregoing paragraphs 200 wereexamined in the " Get l'early for school " drive sponsored by the NationalCongress of Parents and Teachers.

The outstanding feature of the year's work was the maternal-mortality Study,which was continued ftom the previous flscal year and which has met withexcellent cooperatioD frour the physiciang of the State'


The bureau of chilct hygiene and public-health nursing was established inthe State rlepartment of healtlt in 1920. The governor aecepte'd the provisionsof the maternity and infaDcy act on January 72,79t2. This was follorved bylegislative acceptance approved by the governor on llay 21, ].923.

A physician has directed the work, rvith the aid of a central staff ofph]'sicians and nurses rriho have conducted various tJ'pes of field activities. As-

I sistaoce has been given by a Slate commiltee of heads of state-$' ide orgatt iza-I tions of women l'ho sponsor the program. meeting on the caII of the director ofI the bureau and giving advice. County committees composecl of representativesI of the same orgauizations of lvomerr slx)nsor and aid the work in counties andI communities.I The program has varied as the rvork has progressed. In the earlier yearsI of cooperation wiih the X'ederal Government itineraut chiid-health conferences,I itinerant prerratal corrferences. organization of permanent health cetlters, aI sur-vey rrnd superr-ision of midwives, and instruction in infant care for schoolI girls in the upper grades were stressetl. A survey of the incidence of goiter inI four counties rvas followed by a statervide campaigr for its prelention \\hichI includetl special attention to the prevention of congenital goiter. In later yearsI sume of these activities have gilen place to demonstrations of prenatal nurs-I ing, eountl-wide breast-feeding surveys, and instruction of groups of womenI (including mids'ives) in prenatal care and the care of infants and children. AI recent feature of the program still in progr€ss is the study of maternal deaths.I f:ne sending of literature on the care of the baby with a certificate of regis-I tration to the parents of all infants whose births are registered has put infor-I mation on the early care of the baby in the hands of the parents prompUy.I tne effect of the program i-q reflected in los'er infant mortality rates for theI State in 1927 as compared $'ith'1921, the l'ear in which Congress passed theI maternitJ' and infailcy act. The State's infant mortality rate for 1927 was theI lowest sinee its admission to the United States birth-registration area in 1915,

I The infant and maternal mortality rates for 1921 and 1927 were as follows:tI tnfant mnrt&IitA rates (ileath"s of infants un(kr 1Aear of age per 1,000 UlfrI births)I to" 1e27

I state----------- Tg cf iI Urba t r - - - - - - - - - 8 l ?0

I Rura l - - - - - - - - 75 64II Moternal TnrtalilV rates (ileauts of m,others from' puerperal causes per 10,000I l iue births)I tnrt te27I s ta te - - - - - - - - - - - - - - - - - - - 6s .5 63 .0I t r rban- - - - - - - - - - - - - - - - - - - 71 .1 77 .6

I Rura l - - - - - - - - - - - - - - 65 . 5 53 . 5

I fne markedly lon-er rural maternal mortality rate may be due in part to theI fact that more rural mothers are employing physicians. trIidwives relrcrtedI A,eez births in 1921, whereas in' 1927 they relxrrted 2,859 births.I

IIII

l-


/:ff

MINNESOTA


Administrative agency :State departirenf of health, division of child irygiene, trtinn-e-apo^l1s'-

tr'unris expentled: n'edelal, $32,339.92; State, $21'099.65; total, $53'439'57'Staf f :

Director (ph)'sician, parts r r l i s t i c s f i e l r l agon l . 2clelk, 2 geueral clerks

Activities :

children registered ald examinetl-'95.Defects found in clildren examinecl al conferences-76; children having

defects-57.The tlivision issuetl ccrtificates to 1.365 girls who were leported as com'

pleting thc. course il 34 classes in infant antl child cale conducted bylocal ieachers and nurses, who used the llotlrercraft Nlanual prepaledby tlie division.

Cour-ses for teacllers on methocls of teaching classes for girls iu infant andchild care n'ere given at the State teachers' colieges. Classes orgalized-33 ; students registered-357; lessons il course-3 to 5'

Classes for mothers---42 organized; mothers enrolled plus those carriealover flom previ<-rus year-1.91'1 ; number completing course-515' !"*'sons in course-8. Atitlitional classes were coDducted by local public-health nurses not paid from maternity and infancy funds-

Home visits by nut's-es-?5S (to prenattil cases, 34; obstetrical cases, 16;postnatal cases, 67; infauts, 381; preschool chi lcl len' 260).

Group demonstrations---5, of the material on maternal and infant careavailable ft'on the division.

Strrvey-1, of maternal deaths in the State, 7527-28 (not completed). -Campirign-1, for the observance of llay Day as Child Health--Day.

fnrcrugtr the IIay Day activities clubs and other groups included. discus'sious of flris work in their progl'ams and rvere lesponsible fot distribut-iug literature anrl acquainting their valious communities with the StateproglarD of mrrte'nrit"v atrd infancy work.

Talks aurl lectules-108-Litelature prepaled-Sunlight and Cod-Liver Oil.Literature distributed-270,112 pieces.New nauies registered for pt'enatal letters-1,181 ; prenatal letters distrib'

uted-1.181 sets.A corlespontleDce Cou|se Consisting of 15 leSsons rvas ConduCted for mothers.

During the J'ear under review 897 rvomen registered for the course, and223 n-ire on the roll from tbe previous year. The number completingthe course rvas 689. IIole than 8,000 women have takeu the coursesince it n'as beguu about four )'eal's ago in cooperation vvith the Stateunirersity.

A 4-lecturg coulse in matemity and infancy work n'its giYen to a class ofpublic-lienlth ilulses. 2 lectures $-ere given to the senior hospital nursesin St. Paul ancl to those in llinneapoiis, and a 12-lecture course in mater'nal alrcl chikl hygiene t'as given to students in the State university. Alecture with t.xhibit of the tlivi-sion's material was given before thestuclents of errch ciass in the'university medical col lege.

Exiiibits coniluctod-^+9. at State antl county fairs and at various meetings.Exhibit matet'ial preparetl---<harts on maternal and infant mortality.Exhibit material rvas lent 53 times.

86

time), 1 physician (part year) ' 9 nurses, 1 v. i tal 'r i ral-strt ist ics clerks, 4 stenograpners' L marl lng

(part t ime).

Child-health confelences conducted by physicians-B ; infants and preschool


,f

ff


Act iv i tie-q-C o n t inue d.-----Articles prepared-sheppartl-To$'ner \York in nlinnesota, llaj' Day-Child

Healtli Day. Sgme As,ects of Preve'table Deatls i. Minnesota, WhereImproverlerit Mlst Coltre in Out' Ilfaut lfortaliti' ftate, ltaternal Etlu-cation in }linrresota. \\Iork of the Child-Hl'gicne l)ivision'

Staiistical stuclies made-natetnal mortality, 1010-i927, by causes; infantmortality, 1910-1926, by causes.

Counties iir' the St:rte-8i I counties in r'r'hiclt maternit)' ald iufancy workwas done during the lear-72; counties in rrhich maternit j 'and infancylyork has been <lone since the acceptance of the maternity al]d infancyact--87.

since the bcginning of the state's cooperation untler the ntzrternit). andinfancy acC two cou'ties have assumed the lesponsillility fol maternityancl infancy rvork begun l'ith maternity and inflncy furtrls.

Public-health nurses thioughout the State (inclutling those not paid frotnmaternity and infancy frinds) refer prospective mothers to the diyisionfor prenatal letters or literature.

The following or.ganizations cooperated in the division's work: stftte lloar(loi control,'-Staie department of educatio', State university -(exteusiontlivision), State league of women voters, state fetleratioit of $'omen'sclubs, American Retl Cross, American Legion auxiliary, and parent-teacher associations.

The outstanding feature of the year's work wars the developmeni of themothers' cla-sses, ivhich rvere conducte(l in Iarious parts of thc State and liaalfar-reaching results in the edncation of nothers.


The statc acceptecl the proYisions of the maternity and infancy act throughlegislative enactment approved by the governor on April 20, 1921._ The divisionoichitd hygiene was eifablishetl in the State department of health in 1922 to

PRTNCTPAL ACTTVTTTES OF TNDTVTDU-{L STATES, 1928 a /

administer the funds that had been accepted.lfhe -staff of the division since its establishmcnt hrls ittclutletl a

director, several staff nurses, and occasional or part-tiine phJ'sician"s.medical

the tr'ederalthrough cor-of literatureantl nurses.

to the reser-couDties ofthe as-sump-and iufancy

Yaluable cooperation has been given to the division by ottrer officia-l stateagencies (the clepartment of education, state board of control, antl stateuiiversityj, tbe S[ate medical associatiol, rvomen's grganizations, the AmericanLegion auxiliary, and the parent-teacher association'

The State program from the beginning of cooperation withGovernment has stressed educatiou in infant and prenatal carerespondenee cours€s for mothers, prenatal letters, distribgtionon maternal. infant, and child care, and lectures by ph}'siciansWork with the Indians through Indian and other nurses detailedvations has been a feature of the program. The cletailittg tonurses paicl in part from maternity antl infancy funds has led totion by two couuties of the financial responsibility for matelnitywork.

The year enrlerl June 30, 1928, h:rs been marked bJ' some changes in theprogram. including gl€ater iuterest in surveys and instructiorr of groups.iltaises for rnothers conducted by the staff nurses have reached about 400 moremothers in 1928 than in 192? with informatiorr on prenatal, infant, ancl childcare. The state-n'ide suryey of maternal mortality sponsored by the stntemedical society rvas in progress during 1928 (the clata to be tabulatetl rviththe cooperation of the united States ohilclren's Bureau), and a 'r-aluable sta-tistical study of maternal mortality and infant mortality, by causes, was made.A breast,feeding survey in two counties showed that about 85 per cent of thebabies rvere breast fed.

The infant mortality rate (deaths of infants under 1 ]'ear of age per 1'000live births) for 1927 was 52, a nt-'w low rate for the State; the rate for 1926was 58. The rate of 58 also obtained in 19T2, the year iil rvirich the divisionof child hygiene rvas organized.

The maiernal mortality rate also was lower in 7927 than in 1922. The rateof maternal deaths per 10.000 live births in 1922 was 49'5; in 7927 it was 44.4.

In the opinion of the State medical director the nunlber of \Yomen usingthe educatibnal material has defilitely ilcreased, and the interest will prob-ably be maintained through nurses and physicians.


.6,ff

MTSSISSIPPI

STAFF AND ACTIYITIES IN T928

Administrative agency :State board of health, bureau of child hygiene and public.health nursing,

Jackson.X'unds expended: X'ederal, $17,659.02; State, $10,914.47; total, 928,573.49.Staff:

Director (State health officer serving part time), 2 nurses, 1 dentalhygienist (part tine), 1 midwife super:visor (ptrrt time), 1 vital-statisticsclerk, 1 accountant (part time), 3 stenographers (2 part time). Ninecounty nurses in six counties were paid in full or in part from Daternityand infancy funds.

Activities:Child-health conferences conducted b.v physieians-2154; infants and pre.

school children registered and examined---4,344.Defeets found in children examined at conferences-4,4l9; children havins

defects-2,500. Parents rrere knowD to hare hacl defects corrected. in371 of the children.

Prenatal conferenres conducted by physicians-l4; expectant mothers reg-istered and exarnined-252; visits to conferences--144.

Dental conferences-161 ; preschool chilclren receiviDg dental examina-tion-3.338.

New perrlarrent prenatal centers--4 establishetl. They are sup,ported bycounty funds.

Ilygiene classes--16o organized in schools; pupils enrolled---4,000; numbercompleting course und receiving certiflcates frorn the State board ofhealth-3.627 (3,5$J girls, 38 boys) ; Iessons in course-1Z. Instructionin care and needs of infants and preschool children and in trirenatalcare was included in the course.

Work n'ith midwive,q was done through midwives' clubs assistetl by thecounty public-health nurses in counties having such ser-vice and by theheadquarters stafi in other counties. Each club has a leader ancl asecretary and holds a monthly meeting, a report of which is sent to thebureau. The nurses who conduct midwives' classe,s use an outline anda manual supplied by the bureau. On January 1, 1g?3, there were inthe State 3,437 midwives (mostly colored) in active practice and 200whose permits were pending.

Elome visits by nurses-6,08t) (to prenatal cases, 1,213; obstetrical caws.Zl0; infants, 2,014; preschool children, 2,522,),

Talks and leetures-6,f17.Literature prepa.red-leaflets on sun baths, on breast feecling, and on

motherhoo,cl.Literature distributed-approximately 5O.00O pieces,Nutrition work n'as included in the activities of all nurses.Exhibits rrrnductetl-in 81 countieg at meetings of midwives' elubs, at v,hich

po€ters on maternal and infant health werre shown, In addition, motionpictures of all phases of the bureau's rvork rvere shorr-n by the motion_picture truck in five counties.

Infants and preschool children reached through literature distributed_approximately 10O,00O; expectant nrothers reaehed-1,171 (exclusive ofthose reached by literature distributed). Approxirnately 10,00O pieees ofliterature on prenatal care and motherhood were distributed.

The bureau sends literature on infant hrgiene to parents of all infantswhose births are registered in the State bureau of vital statistics.

Counties in the State-S2; counties in rvhich maternity and infancy workwas rlone during the year--S2.

Since the beginning of the State's cooperation under the maternity andinfancy act eight counties have assumetl the responsibility for mat-ernity-and infancy work begun with maternity and infancy funds.

All the full-time county health departments in the stafe inclutle maternityand infancy rvork in their programs,

88


*FRINCIPAL ACTTVITIES OF INDIVIDUAL STATES. 1928

Activities-Continued.The bureau rendered supervisory service to local health organizations

doing rnaternal and infant-hygiene rvork.The follorving organizations cooperated in the bureau's I'ork: State league

of women voters, State tlevelopment board, fraternal organizations, andparent-teaclrer associations. 'Ihey gave financial assistance and hetpedto stimulate local rvorii.

An outstanding feature of the year's rvork rvas the organization of hygieneelasses in the schools and the instruction given through these to the 11,000pupils enrolled.

TYPES OF WORK AND SOME RESULTSI

The bureau of child hygiene snd public-health nursing was established inthe State board of health in 1920. The State accepted the provisions of thematernit)' and infancy act through legislative enactment approved by thegovernor on ]Iarch 28,7922.

A physician has directed the rvork during the entire perioel of cooperationrvith the Federal Government, assisted by a small staff including nurses,a dental hygienist, and clerical \vorkers. Seven to nine nurses paid in fullor in part from maternity and infancy funtls have been detailed to countyhealth departments to condur:t maternity and infancy rvork under supervisionof the State staff nurses.

The bureau has had the ltenefit of cooperation frorn the State deyelopmentboard, the American Red Cross, fraternal and wumen's organizations, antlparent-teacher associations. The proetram \yas furthererl by the adoption in18 cities of the standard milk ordinance as promoted by the Unitetl StatesGolernment. This insured in these communities a better milk supply-rvhichhas a direct bearing on infant health.

Emphasis in the State rvork has been placerl on hygiene classes organizetlin the public schools, in rvhich instruction in the care of infants and preschoolchildren was included. The fact that during the year untler review 4,00O pupilsenrolled for the course indicates a gratif]'ing response to the opportunitiesoffered.

\York with midrvives has occupied a pr()rnillent place in the State program.A survey made in 1921 and 1922 showed that 4,209 were praeticing in the State.These women all obtained permits to practic:e, and the State staff nurses havekept them under supervisiorr and hare given them instruction. Through aquestionnaire sent to physicians it was found that the physicians have ob-served improvement in the midwives' cleanliness, in the number calling physi-cians in abnormal cases, in their care of mothers and infants. their ecurpmenr.reporting of births, and refen'ing of cases for prenatal and postnatal exami-nations.

The infant mortality rate has remained practically stationary. Though therehas been considerable fluctuation in the maternal death rate, this rate waslower in 1927 in both urban and rural areas than in 1921 (the year before theoperation of the maternity and infancy act). The rates for the rvhite and thecolored mothers in the State as a whole and in rural areas likewise were lowerin 1927 than in 1921. In the urban areas, however, though the rate for rvhitemothers declined considerably, that for colored mothers $'as slighily higher in1927 than in 1921. The maternal rn.ortality rates for 1921 and 192? in theState as a whole and in urban and rural areas \vere as follows for the whiteand the colored population:

Maternal nortalitg rates (deaths of moth,ers from, puerperatr causes per 10,000Lire births)

1921 1927Sta te- - - - - - - - 95 .3 86 .7

Whi te - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 711.4 61 .1Colored ---------- 120.3 111.4Urban - - - - - - - - - - - - 1?9.8 158.1

lYhite------- __ 187.2 1]-7.6Colored______ _ 217.4 221.5

Rural ------- &9.3 ?8.8lYhite-___-,- _ 82.4 Eg.zColored__-___ _ 174.2 tA2.4

48278"-29-7

89


#

MISSOURI


division of chilcl hygiene, Jefferson City.$21,000; State, $21,00O; total, $42,000.

Administrative agency:State board of health.

Furrds experrded : X'ederal,f i taff :

Director (physician), 1 physician (part ye.ar),3 nurses (2 part year),1 stenoglapher (part year), 1 birth-registration itrvestigator (part year,part time), 1 multigraph operator (part tirne). Fourteen countJ'nurseswere paid in pat.t fron maternity and infancy funds.

Yolurteer assi,qtants-1.47 county and city health officers, 29 nurses, approxi-mately 15O lay persons.

Activi t ies:Child-health confererces conducted by physicians-484; infants and pre-

school childreD registe"red and examined-T,gTg; visits to corrferences_9,718.

Defects fould in children examined at conferences-11,240; children havingdefects---4,496. Parents were known to have had defects corrected in15 l}er cent of the children.

Confere'ces conducted by nurses, no physician present-g40; childreninsnected-16.221 ; mothers ilstmcted

-ir prenatail ca'e*?Zg j visits to

_ colfererices by childlen-82,442; visits by mothers-1,884.Nerv permalent chiid-health centers---4 establisher_l as a result of

uatcrnit}' tnd infancy rvorli- -a-hey are supported by maternityinfancy funds and by locat public and private iunds.infancy funds and by locat public and private iunds.asses fol girls in care of infants and nrpschonl ahiclasses fol girls in care of infants and preschool children--42 organrzed,;girls enrollecl-4|3S; nuniber receivirrg celtificates-94 ; lessons in Eour,"e--72. To be entitled to a certificate a girl must attencl at least 10 classesand must pass al cxamirration covering the, entire course.

classes for mothers-337 organized; mothers enrollecl plus those carriedover from plevious year-8,020; numbel completing course___3,820; ies.sons in course-usually 10.

rrome visits by nurses-5,442 (prenatal cases seen, bgb; obstetrical cases.25: postnntal ci lses. 204; infants and preschool chi ldrerr, B,?94).

communitS demollstration,s---44, con-sisting of conferences for 'oreschool

chiltlren, health talks, exhibits, and group demonstr:rtions. The programusually lasted a week or longer. special children's cases were discussedin conferences rvith local physicians at the closc of the demonstrations.

Group demonstrations-958, of sun suits, homemade beds for babies, thebaby's bath, and other items of infant care, at chilcl-health conferencesand classes for mothers.

Campaign-1, to hale preschool children qualify as ..6-poirrters ,' and" g-pointers." To qualify as " 6-pointer.s " the children hacl lo bc free frorndefects in vision, hearing, throat, teeth, posture, and weight. To qualifyas " 9-pointers " the children also had to have their births reeistered.be immunized ngir inst diphtherin. and be vaceinated against shal lpox.n'orty-six counties used this plan for interesting parents in having theirchildren examined and any defects corrected before the children shouldenter school. A total of 13,134 6-point arvards and 16,564 9-point badgeswere issued by the division during the year under revierv.

Talks and lectures-606.Literature prepared-Health Habits of Preschool Children, County public

Health Nursing, Sun Baths.Literature distributed-780,450 pieces.New names registered for prenaral letters-925; prenatal letters distrib-

uted-712 sets.

90

theand


IPRINCIPAL ACTTVITIES OF INDIVIDUAL STATDS, 1928 91

Activities-Continued.Exhibits conducted-g, at fails and

graphs on infant death rate andress of campaign for " 6-point "twenty-five times.

meetings. Dxhibit material prepared-diphtheria decline, map showing prog-children. Exhibit material was lent

Scientific article prepared-Prevention of Blindness.Statistical studl' made-infant mot'talit-v, in 1 county.Breast feeding r^'as stres-ced at all child-health conferences and in a lec-

ture given at the annual State putllic-health meeting. Of the 3,594 in-fants examined, 1,920 (approximately 53 per cent of the total number ex-amined) were breast fed at least 6 rnonths.

Infants born ln the State during the year'---66,401 ; infant-s undet: 1 yearof age reached by the wolk of the division-43,195; preschool childrenreached-26,994; expectant mothers reached-2,298 (exclusive of thosereached through literature distributed).

The bureau sends literature on infant hygiene to palents of all infantswhose births are registered in the State bureau of vital statistics (ex.cept those born in the three largest cities irr the Strte).

Counties ir the State-11-l: courties itr nhich matelnity and infaney workwas done during the year-53; counties in which matemity and infaneywork has been done since the acceptance of the matenrity and infancyact-172.

As a result of the diyision's work three new cr-rmmuuity nursing seryiceswere started.

The following organizations cooperated ir-r the division's n'ork; Statefederation of rromen's clubs, State league of women voters. State tuber-culosis society, State agricuitut'al college (extension division), Woman'sChristian Temperance Union, and the parent-teacher association. {Iheyassrsted with publicity in the campaign for 6-point and 9-poirrt childrenand in advocating full-time county nurses. About 20 per cent of thechildren exatnined at health conferences were examined in the " Getready for school " drive sponsored by the National Congress of Parentsand Teachers.

Among the outstanding achievements of the year were the results accrom-plished by campaigrs for 6-point and 9-point childlen and the admission of theState to the United States birth-registrrtion area.


The division of child hJ'giene rvas established in the State hoard of healthin 1919. The governor accepted the provisions of the maternity and infancyact on January 17,7922. This q'as followed by legislative acceptance approvedby the governor on l\{arch 21,7923.

A r.elatively small central staff of physicians and nurses direct and supervisethe field activities and conduct child-health conferences. n'ourteen nurses naidin part from maternity and infancy funds were detailetl to counties during 1g27and 1928.

The number of full-time county health units has increased as a result ofrehabilitation of the areas flooded by the Mississippi River, and the nursespaid in part from maternity and infancy funds have *.orked especially in thecounties having such units.

Cooperation of county ancl city health officers and public-health nurses notpaid from maternity and infancy funds has permitted extension of ure rvorkand has increased its efficiency. Cooperation has also been given by the Statedepartment of education and State educational institutions. the American RedCross, State medical, dental, tuberculosis, public-heaith, aud rrurses' associations.State conference of social n'ork, State street and highrvay safety council,*'omen's organizations, and the pareut-teacher association.

One of the objectives of the State program which has Lreen attained rvas theadmission of the State to the United States birth-registration area. Anoilrerobjective has been the reaching of all parents in the State with informationon infant care. This is accomplishecl by sending literature on infant hygieneto parents of all infants whose births are registered (with the exception ofthose born in the cit ies of St. Louis, Kansas City, and St. Joseph).

An extension of the effort to have all pleschool children qualify as .,6-pointers'l and " g-pointers " has marked the rvork during 1928. The reportingof 9,900 6-point children to the State board of health in 192?, and the arva|diin 1928 to 13,134 6-point cliildren and the issuance of 9-point badges to 16,b64


#92 THE WELFARE AND ITYG1XNE OF MATERNITY AND INFANCY

children indicate the success of the 6-point and g-point work. The pelcentageof defects corrected in the 46 counties using this plan for -qtimulating the cor-rection of physical defects rlas more thal twice that in the other counties in1928.

Extension of other features of the work has marked the fiscnl year 1928.tr'or example, classes for mothers increased in numbers, also the number ofmothers taking the courses. The number of counties having maternity andinfancy rvork during the year incleased.

Maternity and infancy funds *'ere used in July, 1926, for the purchase ofmaterial for preparing nitlate of silver ampules; the expense of manufactureand distribution has been paid from other State funds. These ampules aredistributed free to physicians on request, and 10,063 ampules were distributedduring 1928. Thirty-one cases of ophthalmia neonatorum were reported duringl-925, but only 25 during 1927.

1\fortality rates are availabie for the State from the Unitect States Bureauof the Census for 1927, the year of the State's admission to the registrationarea. The infant mortality for that tiear \\'as 60 per 1,000 live births, and thematernal mortality was 67.4 per 10,000 live bir.ths.

Counties receiving aid for nursing services and distributioD of maternity ald infancywork, by counties, I lontana

m :3i"T'i;ri: :t?g I !,:{ f"'f 'e rietd starr'

m 3 gi.ii,&iST"""t' ? oir, EBa.".r ri erd stsff,O CoJn i ies a ided in nurs i^ f€erv ices ,

Jangaly lt l9?3 - June 30; l92A


A{

MONTANA


Administrative agency:State board of Uebtttr, child-welfare division, Helena'

n""J* eipi"aed: Federal, $12,568.36; State, $8,700; total' $21'268'36'Staff:"-*-birector (physician),3 nurses (part t ime,2 part J-ear), l vi tal-stat ist ics-

Er.rt. i^ nbotteei'er (part time), 1 stenogr.zrpher. Ph}'sicians were

employed as needd to contluct conferences' Eleven county nurses wcre

paiO i" part from materDity anri infancy funds'Aetivi t ies:---

Child-health conferences conducted by physicians-158; infants antl pre-

school children registeretl and examined-1,72'l'ctritorerr havirlg aetictu-i,srs. parents had defects corrected in 216 of

the children (report incomplete).Conferences conauciea bli nuirses,'no physician present---328; chilciren in--

*p-."t"a_z,zgg; motheis i:nstructed inlrenatal care-135 ; visits to co'-

ferences bY children--3,183.Newpermanentcombinedprenatalancl^chi lr l . trealthcerrter- lestabl ished-';;

; result of the 'raternity an4 infancy rvolk. It is supported by

m-aternity and infancy funds and by p^rivate funds'N;-p;;;;"ent child-fiealth centeri-3 established as a result of the-

matirnity and inlancy' n'orf. They - a.e supported by maternity antl

ioiuo.y iunds and by a private organization'Cfa-s."s-io. Siits in ca"e oi irfants-an4 preschool childrel-€ organized;

girls enrolled-ll8; leryq4q il course-lz'EEme r.isits by nuries--3,913 (prenatal_cases seen, 213; obstetrical cases'

4: uostnatai cases, 46;' infants, 1,905; preschool childrtl' 2'092)'

Gt'oun deurt,n51 121i6as-9J.Talki anct lectures-1,l24'Literature distributed-211,116 pieces' -N;;: ;;;"- registered fr,r prenatal letters-774; prenatal ]etters dis-

tributed-7?4 sets.Nuirition s'ork rvas done through individual instructiotl'-dir.ii-its

"o"Aucted-?0, at conierences aDd fairs. Eshibit material lvas-

I;t four times. Ilotion-picture fllms wer.e lent one hundred anal seYenty-

Dine times.ei-itLirce 'ttas given to the State bureau of vital statistics in making a--.o-pf"1"

study of the rital statistics of the State'foioirt l tu"t, i1 ' tne State during the year-g,yJJ;infants lnder-I year of--"ge-le"cfr"cl

by the rvork of the clivision-3,2!6; pre,school, children

r 'ea-c t re t l -6 ,665;erpec tan tnro thers reached_1,1 :2 . (The.se f ig r r resdonot include crriraien and expectant mothers reached by literature dis-

tributecl. )ffre-Oi.:isiiin sencls literature on infant hygiene to parents of all. infants

rilose births are registeretl i^ the State buteau of vital statistics.C,ounties in the StatJSG; counties in s'ltich maternit)' antl infancy work

\.as tlone during the J.ear-.39; counties in whitlhnaternity ancl infancyryolii has been 4one iince t1e acceptallce of the mate'rnitl' and irfancy

act-ii6.s i n c e t r r e b e g i n n i n g o f t h e s t a t e ' s c o o p e r a t i o n u n d e r t ] r e n a t e r n i t y a n t l

infancy act t$-o Eountl". have assumeel th€ responsibility for maternitT

antl irifancy rvorli begun rvith maternity and infancy funds'.t" u

"o*"it oi tnn dioiSon's work cirill-health collfefeuces N-ere condtrcted

\yeekl), in one county b-v local -l-orkers, eight clesses., for. girls in

care bf infants and 'preichool

chiltlren \vith an eDrollment of 772girls $,ere organizecl [r]v lurses not paitl froDr Dtaternity aDcl infancy

93


&94 TTTE WEI,FARE AND TTYGIENE OF MATERNITY AND INFANCY

Activities-Continued.funds, and the tuberculosis nurse n the Rlackfeet Indian Reservationcarried on an extensive child-hygiene program.

The rlivision ga\.e some supervision to tile rvork of public-health nursesemployed by the State tuberculosis association ard other organizations.

The lollorving orqanizations cooperated in the division's rvork: Statetuberculosis association, State federation of women's clubs, AmericanRed Cross, atttl the parent-teacher association' Among the childrenexamined at conferences reported in the foregoing paragraphs 167 wereexamined in the " Get reacly for school " drive sponsored by the NationalCongress of Parents and Teachers.

An outstanding feature of the year's rvork was the promotion of courtypulr l ic health nursiug sen' ices.


The child-welfare division was establishetl in the State boaral of health in1917. The governor acceptecl the provisions of the maternity and infancy actori tr'ebruari 9,1522. This rvas followed by legislative acceptance approved bythe governor on Nlarch 1ti, 1923.

A physician has directed the work of the division, and two to three nurseson the divisiorr's staff have done field rvork. Local physicians have beenemployed to conduct conferences, and nurses paicl in part from maternity andinfrncv fnnr' ls (11 in -1928) have been detai led to counties.infancy funds (11 in 1928) have been detailed to count

Cross. the Stateparent-te:rcher

Cooperation has been maintained I'ith the American Redtuberculosis association, rvomen's organizations, and theassociation.

l.he proglam has been characterized by child-health colfereuces conductedby phyiicians and nurses. promotion of nursing services through.assistancein nnancing county nurses has provided a medium of education in infant andprenatal care. Tlie sencling of literature on infant care to mothers of infants-whose

births are registered has been a means of carrying to remote districtsvaluable assistance in providing intelligent care for young blbies'

Through the use of maternit-r- and infancy funds ampules of nitrate of silverare distiibuterl free for the use of physicials antl midrvives in preventingophthalmia neonatorum.

Both infant and maternal mort:rlity rates were lower for 1927 than theywere for 1922, tlTe year in which the State began cooperation with t\9 n'ederalGovernment un4er ihe provisions of the maternity and infancy act. The infantmoltality rate in 192i rvas the lo*-est siDce the State \yas admitted to theUnited Strrtes birth-registration area. The number of infants dying in theirf rst year of life was ?0 for every 1.000 boln alive irr 1922, whereas it was 66 in1927.- The maternal mortalitt' rate per 10.000 live births rvas 79.7 in 1-s22'but it rvas 66.3 in 192?. This rvas a saYing of 13 ruothers for every 10,00O Iivebirths in the state in 1927 as eompared with 1922. The saving in the lives ofrural mothers was even greater; 23 rural mothers rvho would have died at therate prevailing in 1922 survived for every 10'0O0 live births in 1927.

n'oi.map sh6rvilg the counties receiving aitl for lursing services and the dis'tributiol bf uraternity and infalcy rvork, by counties, see page 92.

t


I

NEBRASKA


Administrative ageney :State department of public welfare, bureau of health, division of ehild

hygiene, Lincoln.Funds expendecl: Federal, $11,0O0; State, $6,000; total, $17,000.Staff:

Director (nurse), 3 nurses (1 part year), 1 inspeetor of maternity andinfant homes (part time), 1 vital-statisties elerk, 1 stenographer.

Volunteer assistarrts-120 physieians, 94 dentistE 20 nurses, 392 laypersons.

Activi t ies:Child-health conferences-1O0 (90 eonducted by physieians r,l'ho volunteered

their services, 1O conducted by a ph]'sician lent to the State by the UnitedStates Children's Bureau) ; infant-s arrd preschool children registeredand examined--3,465 ; visits to conferenees--3,475.

Defects found in childreu examined at conferences-S,S30; children havingdefects--2,90O.

Clas,qes for girls in care of infants and preschool children-1S organized;girls enrolled--446; lessons in course---4. Most of these classes wercconducted in high schools in n-hich the horne-economics in-shug1.tarranged for the course to be given. One class was conducted at anIndian school rvhich had an enrollment represellting many tribes.

Classes for mothers--il? organized; mothers enrolled-between 600 and700; number completing course-164 ; lessons in course--4.

Home viSits by nurses-1,932 (prenatal cases seen, 119; postnatal cases, 9,'infants, 933; preschool children, 871).

Maternity homes inspected-96; inspections made-96.Infant homes inspected-13 ; inspections m:rde-13.Group demonstrations-264, of bathing the baby, applying bandages, pre-

paring maternity bed, preparing tent for croup and diphtheda cases, andvarious other phases of maternal and child care.

The division is cooperating in a stud1' of maternal mortalit]' being con-ducted in the State by the Lrnited States Children's Bureau with theindorsement of the State medical society.

Campaign-1, in cooperation x'ith the State parent-teacher as-sociation,for examination of presehool children and correction of their defectsbefore the children should enter school in the fall. In connection withthe observance of IIay Day as Child Health Day the division preparedand distributed literature to help in stimulatiug and planning localprograrns.

Talks and lectures-42.Literature prepared-The Optimal Child (folder).Litelature distributed-S5.O55 pieces. A nimeographed summary of the

State vital statistics was sent to all practicing physicians with a lettertelling them of the literature available from the division. In responsemany requests for bulletins $'ere received, also names of expectantmothers to whom literature was to be sent. Copies of Standards ofPrenatal Care6 were furnished to two medical schools, arrd sets ofchild-hygiene bulletins lt'ere furnished to the setrior nurses in all nurses'trai lr ing schools.

New names registered for prenatal letters-691; prenatal letters dis-tributed-711 sets.

5 Standards of Prenatal Care; an outl ine forBureau Publication No. -153. \Yashington, 1C25.

the use o f phys ic lans . U. S . Ch i ld ren 's

95


# 96 TrrE wELpAITE AND TIYcTENE 01' 1\[ATErl,NlrY AND rNl'ANcY

Actir-i ties-Contitrued.Nutlition $'ork was done through individual instruction at health eonfer-

ences and irr horrie visits. lnstmction in nutrition n'as inciuded in theclasses for mothers and for girls.

Exhibit rnaterial preparetl-photographs and posters. Two attraetive bmk-lets rverc made sltowirig health literature for parents that could beobtained from the divisiou. These, with mimelgraphed lists of theavailable publications, were placed in two large stores dealing in infantclothing. A nuruber of requests for literature were received from ex-pectant mothers as a result of this exhibit. Exhibit material was lentsix tines.

Brea-qt feecling wrs stressed in class and individual instruction to mothersand in litelature distlibuted.

Infants born in tlre St:rte during the calendar year 7927-27,866; infantsunder 1 year of age reached by the work of the division during the yearended Jure 30, 1923-10,7T2; pteslc,hool children reached-10'117 ; ex-pectant mothers reached-€19.

The division sends reply post cards, which may be used in requestingcopies of literature orr child care, to paretlts of all infants whose birthsare registered in the State bureau of vital statistics.

Counties in tlie State-93; counties irr which maternity and infaney workwas done during the year-82; cottnties in I'hich maternity and ilfancyrvork has been done since the acceptance of the maternity and infancyact-9O.

As a result of the maternity and infancy work bimonthly ehild-health con-ferences have been ittaugurated in two towns in one county.

The division -.upcn-ised child-health conferences and classes conducted bylocal olganizati0ns.

The follor,r'ing organizations eooperated in the division's work: State uni-versity (extension service), State nedical association, State league ofwomen voters, federated and rural women's clubs, American Legionauxiliary. American Red Cross, State and local \Yorlan's Christian Tem-perance Unious, county medical societies, county fair boards, churchsocieties, nrothers' clubs, a fraternal organization, the State parent-teacher asso'ciation, and local parent-teacher associations. These or-ganizatiorrs sponsored child-health conferences and classes for mothersand for girls. Among the children examined at conferences reg)rted inthe folegoing paragraphs 2,117 were examined in the " Get ready forschool " drive sg.rnsored by the National Congress of Parents and Teach-ers. Excellent coop€ration was also given by the State superintendentof public instruction, county and town superintendents of schools, in-stmctors in horne economics, and countl' public-health Durses. Thedirector of the cliild-hygiene division was appointecl State chairman ofpublic health for the State federation of women's clubs This gaveunusual opg)ftunity to make contacts with the women's clubs and hasincleased their interest in community-health activities.

An outstanding feature of the year's work was the increase in class work forwomen and for high-schcol girls.

TYPES OF \fORK AND SOME RESULTS

A division of child hygiene was established in 1921 in the bureau of healthof the State department of public welfare. The governor accepted the provi-sions of the maternity and infancy act on X'ebruary 8, 1922. This was follorvedby legislative acceptance approved by the governor on April 11, 1923.

Chauges in plans have occurred as a result of changing directors. SinceJull', 1925, a nurse has been in charge of the work. Duling the early years ofcooperation emphasis was placed on work with the Indians, a full-time workerbeing detailed to the reservations. During the later years work has continuedwith the Indians, but it has been done through the work of the three staffnurses. The social worker on the staff has served as inspector of maternityand infant homes.

The division has had the beneflflof cooperation from the American RedCross. Stale and county medical assoeirrt ions, and t lre State tuberculosis asso-ciation, women's organizations, and the parent-teacher association; also county,


&

pRrNcrpArr AcrrvrTrEs oF TNDWIDUATT STATES, 1928 97

school, church, fraternal, and other organizations. Cooperation and specialvolunteer assistance in the program have been given by a large number ofphysicians, dentists, nurses, and lay persons.

Childiealth conferences, particularly for the preschool ehild, have beenmarked featules of the more recent work. with incleasing numbers of confer-ences held and of infants and preschool chiidren examined. nlore classes folgirls in infant care and for women in infant and maternal cale have beenorganized, efforts having been made also to reach the more isolated commuui-ties with class instruction as well as througlr the nur.ses' visits to homes. Notonly has the work expanded geoglaphically, but more mothers and infants arebeing reaclied each year.

The division's cooperation in the study of maternal mortality, which issponsored by the State medical associatiou and is being made in the State bythe United States Children's Bureau, rviU lay a fouudation for future worklooking toward the further reduction of materral mortality.

The State has sholvn relatively low infant and maternal mortality ratessinc€ it was adnitted to the united states birth-registration area in 192-0. But

a nerv low infant mortality rate nrarked the yearI year of age died in every 1,000 born alive.

1927, n'hen 51 infants under

Materrral mortality rates have fluctuated from year to J-ear. The rate forthe State as a rvhole has not declined since 1922,-but this is due to the factthat the urban maternal death rate rose while the rural rates tr.ere practicallythe same in 7gn and 1927.

The infant and maternal mortality rates for the state as a whole and forurban and rurai areas in 7g22, (the ]'ear in whicir cooperation with the FecleralGovernmerrt rvas begun) and 192T were as follows:

Intant mortali.ty rotes (deaths of irlfallts urui.er 7 Aear ofbirtlLs\

State

age per 1,000 lioe

7922 192757 5171 6053 48

Urban-Rural

Itoternal m(trtali'ta rates (ileaths of mothers tronr puerperal causes yter 10,000li,.e birtlls)

rgzz Lg27State________ ___-_______ iS.O ig.2

Urban- - * - -_ - _______ S9.9 91 .bRurar _______ _______ 49.1 4g. S

Distribution of childhealth confercnces and classes for $omen and girls; Nebraska,1927-28


6'

NEVADA. STAFF AND ACTIVITIES IN 1928

A4ministrative agency :Strte board of health. child-welfare division, Reno.

X'unds expended: Federal, $8,845.26; State, $5,299.38; total, $14,144.64'S ta f f :

Director. tr'ive county nurses were paid from maternity and infancyfor approximately two-thirds of their time.

funds

Activi t ies:Combined prenatal and child-health conferences conducted by a physician

lent to the division by the Uuited States Children's Bureau-4; exp€ctantmothers registered aud examined-2; infants and preschool childrenregistered arid examined-36.

Chilcl-health conferences conductecl by a ph5'sician lent to the State by theUnited States Chiidren's Bureau-10; infants and preschool childrenregistered and examined-2O3.

Corferences conducted bI- nurses, no physician present-103; children in-spectecl-I93; mothers instructed in prenatal care-*53.

Classes for girls in care of itrfants and preschool children-14 organized;girls enrolled-166.

Classes for mothers-1O organized; mothers enrolled-142.Ilome visits by rrurses-3,E93 (prenatal cases seen,81 ; obstetrical case, 1;

postnatal cases, 12; infants, 231; preschool children, 249).Group dc'monstrations--86, of various phases of materual and infant care.Liierature distributed-2,380 pieces.Prenatal letters distributed-1S4 sets.Infants under 1 year of age reached by the work of the divislon-38O;

preschool children reached-304; expectant mothers reached-approxi-urately 200.

Counties in the State-1?; counties in which maternity and infancy workwas done during the year-1?.

Since the beginning of the State's cooperation under the maternity andinfancy act two counties have assumed part of the respr'rnsibility forrnaternity and infancy work begun with maternity and iDfancy funds.

The Nevada Public Health Association cloperat€d in the clivision's rvork,contributing $25 per month to the salary of each uurse employed by thedivision.


The chiid-welfare division was established in the State board of health int922. The governor accepted the provisions of the maternity and infancy acton IIay 72,7922. This rvas followed by legislative acceptance approved by thegovernor on l\{arch 2,7923.

The same director has had charge of the work since the beginning of coopera-tion under the act. The State is divided into five lursing districts, and to eachdistrict is assigned a nurse, trvo-tlrirds of whose salary is paid from maternityand infancy funds. The fnancial coopertrtion of the Nevada Public IIeaIthAssociation has been of great help in the expansion of the work.

The State program has been marked by instructive visits of nurses to homesof mothers and infants and by conferences for children held by nurses, in whichchildren *'ere inspected by the nurses and information and literature rvere givento the mothers. Instruction in infant and prenatal care for classes of mothersand in infant care for classes of girls has been continued as in previous years.

The chief result of the rvork has been the interest developed in the welfareand hygiene of mothers and children antl the responsibility assumed by com-munities for work begun *'ith maternity and infancy funds.

As the State is not in the birth-iegistration area no statement as to mortalityrates can be made. Legislation is necessary to provide suitable registrationdistricts for registering births and deatbs.

98


A€

NEW EAMPSEIRE

STAFF AND ACTryITIES IN 1928

Administrative agency:State board of health, division of maternity, infancy, and child hygiene,

Concord.Funds expended: n'ecleral, $12,477.76; State, $7,988.31 ; total, $20,460'0?.Staff:

Director (nurse, not paid from maternity and infancy funds), 6 nurses(part I'ear), 2 stenographers. Physicians were employed as needed toconduct conferences.

Activities:Chikl-health conferences condueted by physicians-1O-l ; infants and pre-

school childrel registered and examinett-3,38'1 ; visits to conferences-3,388.

Defects founcl in children examined at conferences-2,4itrS; children havingdefects-1,772. Parents had defects corrected it 714 of the children,and 797 childrel were untler treatment at the close of the year underreview.

Dertal conference-1, conducted by a dentist who volunteered his services;preschooi children receiving dental examination-l2.

New pernanent cornbined prenatal and child-health centers-z establishedas a result of the maternity and infancy work. They are supported byprivate funds.

New permanent child-health center-l established as a result ttf thematernity and infancy work. It is supported bJ' a local club.

Classes for girls in care of infants and preschool children-20 organized;girls enrolled and completing course-250; lessons in course-l to 6.

Cla-sses for mothers-15 organized; mothers enrolled and completingcourse-260; lessons in course--4.

Ilome visits by nurses-11,871 (prenatal cases seen, 308; obstetrical cases,10; postnatal cases, 229; infants, 2,284; preschool chi ldren, 6,607).

Marernity homes inspected-26: inspections madc-26.Infant homes inspected-44 ; inspections made--49.Group demonstrations-3l2, of correct postqre, preparation of food, mater-

nity pnckages, anal other items of maternity, iufant, and child care, atconferences and classes. Demonstrations to individuals in homes and atconf erences-822,

Survey-1, of breast feeding in rural sections of tbe State, which showedthe folkrwing results : Itrfants breast fed at birth-57 per cent; breastfed at 1 month---43.5 per cent ; breast fed at 3 months--24.8 per cent;breast fed at 6 months-l5.1 per cent.

Campaign-1; for immunizrttion against rliphtheria (continuerl from previ-ous year) in 13 towus. Approximately 2,500 clrildren were immunized bythe State epidemiologist and local physicians, the immunization treat-ment to be followed within a year by the Schick test.

lfalks and lectures--416.Literature prepaled-Home llaking, Posture, Care of Chilcl from 2 to B

Years of Age, prenatal letters, diet carcls, list of publications.Literature distributed-182.21-1 pieces.Nerv names registered for prenatal letters-5-l0; prenatal letters distributed

(during six months)-1.451 sets.Nutrition rvork was done thlough intlividual instruction at conferences and

in home visits and through some class work.Exhibits corducted-2Oo, at conferences, fairs, and meetings. Exhibit ma-

terial prepared-posters, proper clothing for preschool children and ex-pectant mothers, suitable toys for young children. Exhibit material \yasIent one hundred and ten times.

99


s lOO 'tgN rvELFARE AND EYGIENE OF MATERNITY AND INFANCY

Activities-Contilrueil'Breast fet:tling \\-as promotecl by the breast-feeding survey-' individual rvork

rvith 'r,tlteis a.ci physicians, and literature Sent to the parents of allinfants rvhose births \\-ere registered.

Inftrnts born iu tire State during the year-E,?7! ; infauts ur{ler .l- yeaf--oi uge reacletl by the rvork of tlre division-S,172 ; preschool children

reached-7,067 ; expectant mothers reached-2,500The tlilision'sentls literature on ilfant hypene to parents of all infants

$llose births aie registeretl in the state bureau of vital statistics.Counties in tlie Stat;10; counties in rvhich nraternity and. lnfancy work

\\'as ilone tluring the j-ear-l-O.In er-er5' to1'n in ir.hicl conferences or classes v'ere conclucted a permanent

conimunity chiIrl-health committee consisting of health officers, physicians,nurses, sc.ho,rl superintenclents, clergymen, and representatives of clubs\Yas organized.

The follorving organizations cooperated in the division's work: state uni-versity iextenslon service), Slate tuberculosis association, State federa-tion of Tl.omen's clubs, State league of women Yoters, state farm bureau,American Legion au*iliary, American Red Cross, ard the pareqt-teacherr-"*.iotiotr.

-They assisted by sponsoring the health activities, f.urnishing

roo'rs foL conferences and. asslsting at them, cqnducting exhibits, anddoiug follorv-uD \rorli.

Among the outstanding features of the year's work \4'ere the expansion of theprenrtai'['orli, in that (iistril)utior of prenatal letters rvas addetl tct tile activi-'iies

atready carrietl 6rr, and the educational work in preparation for parenthood

bJ' ueans of the ciasses for girls.

IYPES OF WORK AND SOME N,ESULTS

The State aecepted the provisions of the maternity and infancy :Lct througltlegislatir.e enactnrent approled by the governor on April,l!,7?21.-. The.divisionoi maternitl-, infancy, and cnitd. hygiene was established in the State board ofhealth in 1922.- -a

p"rruc-lr"alth nurse has served as director of the division. Additionalou.sci hriue selr'ed on the State staff, and physicians have been employed as

"""a"0 to collduct conferences. The rnajority of the State staff Durses have

receivecl training at the trIaternity center Association in Nerv York city. or-gaDization of the State into li'r-e nursing districts with a staff nurse assignedi.o eactr district grves an ali-Iear nursirtg service to every section of the State.i:nli111gtr the rvo-r'k of these nrirses an4 that of p€rmanent commu[it_y child-healtdcommittees organized in the towns education in maternal and infantwelfare has been greatly promoted'

Excellent coopeiatio* i' carrying out the State program has been giYen bygroups and intlii'idurrls in adt.lition to the comnunity comrrrittees. CIub. n'Orneniiot" rpunro.ed health activities; parent-teacher associations have assisted inthe g'oiii rvith preschool children antl in organizing self-directed study groups;Stote tube.coloiis lurses, Recl Cross nurses, and other public-health nurses inilre state have helped at conferences and in folloN'-up rvolk; and farm-bureau

rcnderecl assi-stauce to the program in various ways.Ttie physicians of the State have given of their time and effort freely. The

president-of the state medical society i! connection with plans for a studybf Draternal mortrrlity recently issued a letter to the physicians of the Statesaying: ,,As presideni of the New Ilampshire l\Iedical Society I wish to call

f.our "attentioir to the very important effort which is being made to reduce the

;aternal anrl infant rloitaliiy in our State. 1\tuch good work has alreadybeen accomplished througlr oui State boarcl sf health in helping to educate thepublic concernilrg pl'enatal and maternal care."'

During 1928 emphasis was placed on maternity work, on sending prenataltetters to expectant mothers, and on Urgirrg the mothers to have prenatal care.Expectant mlrthers rvere advised to nurse their babies, and promotion of breastfeeding rvas a prominent feature of the year's program.

a.eents have assiste,al lvith eshibits and gilen talks on nutrition. Local oflicialsnf nif ips anr] fosns hale coonerated bV furnishing rooms and bUildings for Con-oi cities and tos.ns hale cooperated by furnishing rooms and buildings Jor con-ferences and ai(ling in the transportation of children to and from conferenccs.of cities and to\rns hale cooperated by

One group of torvn officials apprbpriates $10O each year for follow-up.work to

"o.""-o ...i""o,.fion of defects- Roth Dublic and private social agencies have"".oti

.,o^..""tion of defects. Both public and private social agencies have


*PRTNCTPAT, ACTTVTTTES Ol' TNDrVTDUAT, STATES, 1928 101

'work for prevention of diphtheria was contiuued, with -the_ immunization ofapproximately %bO0 chitdren, about the same nnmber as in the previous year.iliss work was likervise c.ontinued, also the seDding of literature on the careof the baby to parents of infants rvhose births are registered.

rne infant mortality rate for 1921, the year of acceptance of the provisionsof the maternity and infaney act, was 8? infants under 1 year of age dyingin every 1,000 born alive. In 1927 the rate had declined to 69, the Iowest ratein the Listory of the State, which meant a saving of 18 babies in every 1,000born alive as compared with 1921, the year before the state began cooperationrrith the Federal Government.

The infant mortality rates from 1921 to 1927 were as follows: 1921' 87;75?12,80; 1923, 93 ;1924,8O;1925,76;192O 79; 1927, 69.

The maternal mortality rate has fluctuated from year to year. In 192? itwas 64.8 per 10,000 live births, an improvemeDt oYer the rate of the precedingyear (75.7).


.*:#

NEW JERSEY

srirn .c,No AcTryrrrrs rN 1928

Administrative agency:State department of health, bureau of child hygiene, Trenton.

X'unds expended: Fecleral, g2?,0O0; State, 926,284.bb; toial, g53,2g4.bb,Staff:

The Federal and state matcrnity arrd infa'cy funds constituted less thanhalf the bureau's budget cluriu.q ilre year under revicrv, so that the staffwas paid from matelnity and infancy funds for only a part of the year.All the follorving stafr were paid frout nratelnity antl infancy funds forsome portion of the year: 33 nurses (3 serving as assistant snpervisors,9 serving as in-stluctors and supervisors of midwives and inspbctors ofmaternity and infant hones), 1 publicity r:le'rk, 1 vital-statistics clerk.2 stenogrrrphers, I clerk. The director (physician, palt time) was notpaid from Dtaternity and iDfancy funds.

Activities :Child-health conferences cronducted by physicians who volunteerecl their

services-1,760; infauts ancl preschool children registeled alrd examined-10.89-1 ; risits to conferences-20,472.

Defects found in children examined at conferenees-g,610; children havingdefects-2.466. Parents hacl dcfects corrected in 1,835 of the chilclren.

-

Prenatal confelences conduc-ted by physicizrns-G2; expectant mothers reg_istered and extmine(l-129 ; .r-isits to conferences--401.

Conferences conducted by nurses, no physician present---43g; children. inspectetl-2.63f ; visits to corrferences-10.586.

the maternity and infancy work. They are supporteO U;iinfancy fullds arld by State funds.

New permanent prenatal centers--3 established, parily asmaternity and ilfancy work. They are supportecl byinfancy funds and by State funcls.

classes for girls in care of infants and preschool children---46 organizecl;girls enrolletl-{i32; rrumber completing course---420; lessons in iourse_10. The State department of health issued certificates to the eirls$'ho completed the course. Classes were also conducted for the sirG incontinuation schools in three distr icts of the State.

Courses in child hygiene were given in the five State normal schools. bothin the regular term and in the summer schools.

a course of 12 le'qsons and demonstrations rvas given at the state reforma-tory for $'omen. The essentials of prenatal care ancl the care of thebaby rvere taught.

class for mothe.s-l organized; mothers enrolled a.d completing course-tr5; lessons in course-6.

The- 9 - midn'ives' organizations in the State helrt monthly meetings, atwhich a course of lectures was given by physicians.

- All pueiperal

deaths in cases that a midwife had attenclecl at ar)y tirne werb iniesti_gated. An advanced cource for licensed midrvivei n'as arranged in

New pernanent child-health centers-12 establi-shetl, pa.rtly asas a result ofmaternity and

a result of thematernity and

cooperation with the Jersey City Hospital to pr,rvide practical tiainingLuu l ' s r4 ( ru r r wr rs rue durscJ u tLy nuspr la r LU f ] ro l t ' roe prac l l ca l t ra rnrngin the hospital's l)laternity warcls, nursery, laboi and d.elivery rooms, anciclassrooms, one week being spellt in each clepartuent. During the yeat,departuent. During the yeat'under review 14 nridwives completed the coui_*e.

Ifonre visits by nurses--9?,961 (prenatal cases seen, 2,202; infants, 14,101;preschool chi ldren, 7,585; v is i ts to midwives-2,408).

Mate'rnity honres inspected-32; inspections made-1bb. AII maternal andinfant tleaths and stillbirths occurring in the liomes n'ere investigated.

Infant homes inspected-250; inspections mads-929,

102


&

PRTNCIPAT, AcrrVrTrES oF rNDrvrDuAL STATES' 1928 103

Activities-Continued.community demonstrations-3, to show the value of prenatal care; 2 were

in citiesl 1 in a rural county; 151 prenatal cases were under supervisionin 1 of the city demonstraiions, 69 in the other. n'igures were not re-norted for the demonstration in the rural county.

drbup demonstrations-16, of the vxlue of infant and preschool-child care- in preventirrg physical defects in later life. These were conducted beforehealth officeis, pirent-teacler associations, federated r!'omen's clubs, andother groups.

Survey-i1, ii 3 cou'tiqs, to determine the neecl of child-hygiene nurses andthe districts in which to place them.

In connection with the observance of trIay Day as Child Health Day asp€cial effort was made to have chililren immunized against diphtheria.Pirescliool conferences were arranged in 35 communities, and 7,039 pre-school children wete immunized.

Talks and lectures-2,641.Literature distributed-approximately 65,00O pieces.Nutrition classes-+l contluctecl. The extension service of the State agri-

cultural college eooperated by giving lectures on nutrition.Exhibits conducted-1?, at State and county fairs, farmers' picnics, and

various me€tings.Exhibit material prepard-charts sbowing neonatal, infant, and materllal

mortality rates and larious child-hygiene activities.Statistical studies madHeonatal mortality, matemal mortality'Breast feeding lvas stressed in the instruction given to mothers in home

visits.Infants born in the State during the year-72,799; infants under 1 year of

age reached. by the work of the bureau-19,341 (exclusive of those reachedby literature distributed) ; pleschool children reached-15,446 (exclusileof those reached by literature distributed) ; expectant mothers reached-4,675.

Counties in the State-21 ; counties inwas clone during the Year-21.

lvhich materrrity anil infaircy lvork

At the close of the year under relierv child-hygiene nurses in 325 communi-ties were beiltg paid from local funds.

In most of the school districts in the State in rvhich there were child-hygienenurses special eonferences for children rsho would enter school in the fallwere held during the spring months. The school medical inspector madeexaminations, and the nurses did follow-up work during the summer toencourage parents to have corrections made before the children shouldenter school.

The follon'ing organizations cooperated in the bureau's work: State agri-cultural eollege (extension service). State league of rvomen voters, feder-ateal women's clubs, National Council of Jewish Women, several fra-ternal organizations, and the parellt-teac'her association' Among thecbiklren examined. at child-health c"onferenees reported in the foregoingparagraphs 2,084 n'ere examinetl in the "Get ready for-school" drivesponsored by the National Congless of ParenLs and Teachers.

Among the outstanding achieYements of the year wele the clevelopment of theprenatafdemonstration begun in the previous_year and the beginning of three-others

(otre not financcd from maternity ancl infancy funds), the inaugurationof the graduate coulse for midrvives, and the extension of child-hygiene workto 40 actclitional communities.


The bureau of ehiltl hygiene was established in the State department of healthin 1915. The state accepted the provisions of the maternity and infaney actthrough legislative enactment appxoved b1'the governor on DIarch I7,7Un.Durin"g the entire period of cooperation with the Federal Government the Stateapprotriation has been more than tq'ice the a-rnouDt of the' Federal funds.-ttre

ra-e medical dire6tor has been in charge of the work of the bureauthroughout the period of coolleraticn. The staff has included nurses who haveserved as countt nurses, supervisors of midwives, instmctors in infant and pre-natal care, and inspectors of maternity and infant homes'

llhe bureau has had the benefit of cooperation from tlte state departmentof institutions and agencies and the State agricultural college, the State tuber-


#

lM TITE wELFARE AND EYGIENE oF MATI]R.NITY AND INFANCY

culosis association, several social-service, ehureh, and fraternal organizations,women's organizations, and the parent-teacher association.

The program has included visits to homes by nurses, child-health conferencesat child-health centers, efforts to increase flre number of child-health centers,expansion of community child-health work, attention to improving the practiceof midwives, inspection jlf iufarrt al)d mrttemity homes, a demo,nstiation-in pre.natal care, and speciul instructiou in preuatal and. child care to the women inthe State reformatory.

Notable among the achievements has been the increase in the number ofc-hild-welfare centers, the extension of ehild-health work to new communities,the increase in the number of public-health nunies employed in child-healthwork, the increase in numbers of babies supervised, and the'provision of oppor-tunities for the midwives to improve their practice-which hals included in iiai-tion to supervision and midwives' conferences a course of instruction for mid-wives in the Jersey City Hospital.

Tnfant mortality has shown a downward trend since 1g22, when ?g infantsu3der 1 year-of age died in every 1,000 born alive. In 7927 tte number was 61,the lowest since the state entered the united states birth-registration area.Though there has been no rlecided drop ln ilre neonatal death rlte some reduc-tion has been effected during this period. Deaths during the flrst monih of lifeQepend to a grmt.extent on the care of the mother duiing pregnancy. anO con_llqryglf - Ac,cording !o thg Ftalq fl€iures the neonatal Oeatti ra-te was BZ.2 per1'000 live births in 1922 ald 33.8 in 7g27, a reduction of 9.1 per cent. Althorighthe reduction is small it is encouraging, as this period is t^he most difficult tocontrol.

Fluctuations in mater-n-al mortality rates have occurretl from year to year,bgt-lh^g rltg-f.or Tvzt (62.6 per 10,00o live births) *u. u"w'riitie terow tnatof 1922 (41.1). The m_aTimur! rate of the period (6+.8)"occurreC-in fSZf,the minimum in 1923 (57), The rates for 792+ and ig26'were B2.B and 87.6,respectiYely.

I Pnenatal and child-he6lth conference6

O Dental conferencesO Prenatol andchitd-

health centers(E Cbeses;n;nfant care

for jiirls and motheraA Classee for midwiv€*

and individuot instruetion

E Homevisits bynur3esto iftfant3 and ox-P€Ct6nt moth€.6

@ Countiea @vered6vvork sf staFl nurs€i

Distribution of maternity anal iDfancy work, by counties; New Merico. fgZ2_lgZB


4F

NEW MEXICO

STAFF AND ACTIVIfIES IN 1928

Administrat ive agency :State department of publie welfare, bureau of public health, division of

child hygiene and public-health nursing, Sante Fe.X'unils expended : n'ederal, $12,?49.79; State, $7,503.121' total, $20,252.97.Staff:

Director (nurse),2 nurses,2 vital-stat ist ics clerks (1 part t ime),1 book-keeper (part year, part time), 1 stenographer (part time). n'our countynurses were paid in part from maternity and infancy funds.

Volunteer assistants-a number of physicians, 4 dentists, 34 nurses, 451lay persons.

Activi t ies:Child-health conference conductecl by physicians-1; infants and preschool

children registered and examined---41.Defects found in children examined at the confererce---4t; children having

defects-25.Conferences conducted by nurses, physicians present at some---,l3; children

inspected-541 ; mothers instrueted in prenatal care-52.Dental conferences-2 ; preschool children receiving dental examination--60.Classes for girls in care of infants and prescirool cliildrerr-35 orgzrnized;

girls enrolled-686; number completing course--677; lessons in course-10.

Classes for mothers-S organized; mothers enrolled (plus those carriedover from previous year) and completing course-91; lessons incourse-8.

lflidwives' classes-2 meetings conducted, rvith attendance of ?1. Themidrvives were irrstructed in the importance of calling a physician forunusually long or complieated cases, in the prepalation of supplies fordelivery, in the care of the baby, in the use of a prophylactic in the eyesof the ne\1born, and in the filling out. ()f birth certificates. Many mid-wives living in isolated districts were given similar instruction in theirown honles by the nurses.

Home visits by nurses---4,291 (prenatal cases seen, 420; maternity cases,422;infants and preschool chi ldren,2.902; r- isi ts to nidrvi les, 245).

Community demonstrations-7, of a maternity and infancy public healthnursing program lasting 3 to 4 months, in 7 counties. Special emphasiswas placed on birth aDd death registration to bring the State into theUnited States birth and death registration areas.

Group demonstrations-262, of phases of prenatal, obstetrical, postnatal,and infant care at classes, conferences, and meetings of various organi-' za t ions .

Surveys-2: (1) Of birth registration, in 11 counties. (2) Of 2 hospitals.Campaigns-2: (1) n'or promotion of birth regiistration, statewide. (2)

F or immunization against ciiphtheria, in 4 counties.Talks and lectures-11S, to audiences totaling 4,850 persons.Literature distributed--35.189 pieces.Nutrition work was done through instruction to individual mothers.Exhibits conducted-27, including layette, baby's bath tray, equipment

for preparing food formulas, baby pen, and various kinds of home-madebaby beds. Exhibit material was lent twice.

Breast feeding was promoted through instructlon in visits made to homes,in talks given, and in literature distributed.

fnfants born in the State during the year-10,751 reported; infants under1 year of age reached by the work of the division-10,751 ; expectantmothers reached-562.

The division sends literature on infant hygiene to parents of all infantsn'hose births are resistered in the State bureau of vital statistics.

48278._29_8 ro'


&

106 TITE wELFARE AND ITYGIENE oF MATERNITY AND INFANCY

Activities-Con tinuecLCounties in the Stats-81 ; counties in which maternity and infaney work

*'as done during the year-14; counties in which maternity and infancywork has been done since the acceptance of the maternity and infancyact-31.

Since the beginning of the State's cooperation under the maternity andinfancy act two counties have assumed the responsibility for maternityand infancy work begun with maternity and infancy funds.

As a result of the division's work many county nurses not paid frommaternity and infancy funds and mauy school nurses included maternityand infaney work in their programs. They conducted 39 child-healthconferences with an attendance of 323 infants and preschool childrenand 10 prenatal conferences with an attendance of 53 women, made1.993 hotue lisits, and conductecl 98 home denionstratiuns.

The division gave adyisory and supervisory assistance to local organizationsdoing maternity and infancy work.

The followiug organizations cooperated in the division's work: State bureauof child welfare, State federation of women's clubs, State league of'women voter$ State public-health association, Congress of Mothers,and the parent-teacher association,

Among the outstanding features of the year's work were the efforts made toimprove birth legistratiou aud the fact that a nurse paid in part from maternityand infancy funds in one county was enabled, through the county's employmentof a school nursg to devote her entire time to matemity and infancy s'ork.


The division of chilcl hygiene and public-health nursing was established inthe bureau of public health of the State department of public welfare in 1920.The State accepted the provisions of the maternity and infancy act throughlegislative enactment approved by the govelDor on trIarch 11, 1921. nlom thebeginning of the State's cooperation until July 1, 1925, the !'ederal funds weredivided between the bureau of publie health and the bureau of ctrild welfare,both in the State depa.rtment of publie welfare. An expansion of the programhas been possible since aII maternity and infancy worli has been directed by oneState agency.

A nurse has directed the maternity and infancy work in the division of ehildhygiene and public-health nursing. Two staff nurses hale assisted in the gen-eral field work, and nurses paid in palt from maternity and infancy funds(four in 1923) have been assigned to counties.

The program has been mainly one of public-health nursing characterized byvisits to the homes of infants, children, and expectant mother.s. The nursesalso have conducted classes for girls in infant and child care and elasses formothers in infant aDd prenatal care. Work with midrvives has been continued,and efrorts have been increased to improve birth and death registration in theState.

Every county in the State has had some Dhase of maternity and infancy work,such as prenatal conferences, infant and preschool-child conferences, classes forgirls in infant car.e, classes or personal instruction for midwives, home visits bynurses, work for promotion of birth registration, and group and county surveys.Considering the,large area of the State, the difficulty of access to many countiesdue to barriers of mountains, rivers, and deserts, and the diffieuity of communi-cation due to the polyglot character of the population a creditable amount ofwork has been accomplished. (Amcrng the inhabitants are native Amelicans.Spanish Anericans, Mexicans, and Indians, and in the mining region Negroesand immigrants from the south of Europe.)

As the State has not been admitted to the Ullited States birth-registrationarea, no statement as to mortality rates can be nade.

X'or the distribution of maternity and infancy work iri the counties of theState from 7922 to 1928, see map on page 1O4.


*

NEW YORK


Administrative agency:S t a t e d e p a r t m e n t o f h e a l t h , c l i v i s i o n o f m a t e r n i t y ' i n f a n c y ' a n d c h i l d

hygiene, AlbanY.FunAs-exlrrend'ed: Federal, $91,455'55; State, $88,?17'46; total' $180'173'01'Staff:" - *^^Di ree tor (phys ic ian ,no tpa id f rommatern i tyand in fancy fq lAs) '10phy '

sicians tZ irart year,5-part t ime),43 nurses (1 !a-rt-t iTe'.15 part year) '

r J""t"i rryir""ist,-i niitiitionist,'2 vitrrl-statistics clerks (1 part time),

1 booklieepcr, 1 ;,r.,;;"; ognrrt'(to" heaiilr conferelces), 2 clerks, 3

stenographers, f -oiio" rri.tui'e orrerator, 1 chanffeur' Twenty-six-county

and community nu.ses were paitl in part from maternity and' infancy

funds . l twot runc t redandn ine ty - two-phys ic ians throughdut theSta tewere paid for occasional service.

vit ies:Co-Ui""O prenatal and child-health conferelces conducted by phy.sictltlts-

1,102; eipectant motners registered-2,529 ; number examined-2'215;i;l;;i*

-irnd prescnoot ctritdren registered and examined-2'784; visits

io corrfe""rrces by expectant motheis-21,461 ; visits by infants and pre'

school children-3,262-Cfriia-neaitf, confere'ces conducted by physieians--772; infants and pre--

t.frooi .ftifOren registererl-15,19?; rrumber examined-11,O57'n"f*tr fou"O in

"tr1tAi"o examined at child-health conferences-19,997;-;iil.;;;;ing

6efects-7,716. Parents had defects corrected in 539 of

the chi l t l ren (report ineomplete).p"""nt"i conferenc-e conductedby physicians--359; expectant mothers^regis'-

T;A-t"zs3 ; -number

examin-ed--2,1@; visits to conferences-2'494'Co"'i".e"d*-.onclucterl lly n.rses, no frh):sician present-614; children in-'".p-""1"O-g,816;

motheis instmcted in prelataf care--311 ; visits to con-f6rences by children-5'638; visits by rnothers-565'

p.;r;;;;i-"frlO-"e" receiving dental examination by the dental hygienist-

3,652.New permanent combined prenatal and chikl-health centers--8 establisherl

as a result of the materiity anil infancy work or as part of communitya""ro"iiioiio"s colclucied by the division's staff. They are supported by

local public funds'N"w pei-a"eni chilrt-health centers-9 established as a result of the ma--'i;diit;;d

infancy $,ork or as part of community -demonstratio-ns con-

;;;l"d ;t ltre diviiion's staff. Thev are supported bv-local funds' -Xfri permd"ent pren.tal centers-2 estahlished as part of commuli-t' dem-^

o".itrutio"" condueterl by the division's staff. They are supported by local

nublic and Private funds.CriJr"t"t*-eiris-in caie of infants and preschool children-15 organized;-^;i;1_

*roitu4_s23 ; number completing course-198; lessons in course-E to go.

Ciir.".""to" mothers-1g8 organized; mothers enrolted plus th-ose carried--oi."" t"o", previo*s year-2122; nun.rber completing cour-qe-950;^lessons

i"-."*jS. ,,F.mily-health conferences" were eonductecl in 92 com-,oooitie.; the course oi instmction consisted of 8 lessons on the healtir of

ifte tamify, rvith speci.l empha-sis on tlie care of mothers ancl children.

Home visits Ly nurses-38,198 (prenatal-c-a,ses seert, 2,427; obstetdcal cases,-Zi+; postnaial cases, 2'37?; infants,5,2pO;^preschool chi ldren, 7,O55)' Iu

uOaitio" 26,414 home .visiis

were made for $'hich no lecord was kept

of number of cases seen.fraaie*iiv homes inspectetl-83 ; inspections made-34'

L07


&108 TTIE \\TEI,FARE AND ITYGIENE OF MATDRNITY AND INFANCY

Activities-Continued.Boarding horne-s for infants and preschool children inspected-?O; inspec-

tions macle-186.Community tlemonstrations--3? (some continued from previous year), of

maternity arrd infancy public-health nursing, prenatal nursing, and breastfecrling. Se.r-en rvers countl.-rvitle, 30 colered a city or Comrnunity. Themateririty ancl irrfarrcy public health uursirrg demonstratio,n -in onc cityserved aiso as a teaching center for nurses on the State staff and othernurses who rrished to obtain experience in this fleld of public-healthwork. During the year four counties antl five cities anrl communitiesassumed the iesponsibility for work begun in these demonstrations.

Group demonstratibns-appioximately 3,900, on I'al'ious phases of maternaland infant care- Individual demonstrations were made for women at-tending prenatal conferences and for midwives.

Survey-1, of hospitals taking maternity eases.Campaign-l, for promotion bf breast feecling, in 1 city.and its- vicinity.

AIi th; staff nuries assisted also in a statewide campaign condueted bythe state department of health to have children immunized againstdiphtheria.

Talks and lectures-232.Literature distributed---302,969 pieces,Gracluate courses in maternity antl infancy work for nurses---4; nurses

ertrolled-5S; number receivirtg certificates--47.Gratluate courses for phl'sicials--G (2 in petliatrics, 4 in obstetrics).

Courses in petliatrics, each consisting of 6 lectures, were given in 2counties, courses in obstetrics were given in 3 counties, and 3 lecturescompleting a course in obstetrics begun in the previous year were givenin 1 county.

Nutrition work was done through courses, classes, and lectures.Iixhibits contlucted-3?. Exhibit material preparetl-baby's

kitchenette. Dxhibit material was lent 151 times.Stati-stical study made-puerperal deaths (in progress during

fiscal year, completed during year under revic'w).Breast f'eeding was emphasized in all the activities of the division, especi-

ally in the campaign anrl the demollstration on this subject, in instruc-tion given to mothers at prenatal eonferences, and in the instructiongiven to staft tturses and local nurses who attended the division'stea<:hing center for nurses.

Infants born in the State during the year-224,338: infants under 1 yearof age reached by the wolk of the division---8,309; preschool childrenreached-15,-106; expectant mothers reached-14,297. (AlI figures areexclusive of children and expectant mothers reached by literature')

The division sends literature on infant hygiene to parents of all infantslvhose births are registered ln the State bureau of vital statistics'

Counties in the State-62; counties in which maternity ancl infancy workwas done during the year--62.

Since the beginning of the State's cooperation under the maternity andinfancy act seven counties hare assumed the responsibility for maternityand infancy work begrrtt lrith maternity and infancy funds.

"A,s a result of the tlivision's work Child Health Da-v and Child Health'Week programs were conductecl by nurses throughout the State. Localnurses conducted demonstrations at fairs in 33 counties, using demon-stration material furnished by the division.

The following organizations cooperated in the division's work: Statemedical association. State dental association. Stnte federation ofwomen's clubs, State league of women voters, Nelv York State CharitiesAid Associatiou, Home Bureau, Catholic Daughters of America' twofraternal organizations, ehambers of commerce, and the parent-teacher:rssociations. Among the children examined at conferences reportedin the foregoing paragraphs 226 were examitrecl in the " Get ready forschool " drive sponsored by the National Congless of Parents andlfeachers.

Among the out-qtanding achievements of the -vear were the assumption byseven local communities of the responsibility for maternity andbesun with maternit)' and infancl' funds and the provision atcenter for giving instruction in maternity and infancy work tothan those paid from maternity and infancy funds.

traveling

previous

infancy workthe teachingnurses othet


6PRINCTPAI, ACTI\TITIES OF INDTVIDUAL STATES, 1928 109


A rlivision of maternity, infancy, and child hygiene has existed in the Statedepartment of health since 1914. The State accepted the provisiols of thematernity and infancy act through legislative enactment approved by thegovernor on NIay 25, 1923, Thus a larger appropriation was made availableto the division, and an expansion of the program followed.

A physician has directed the work of the division during the entire periodof cooperation. Assistance has been given by a ltrrge State staff, includingphysicians, nurses, a dental hygienist, and a uutritionist, many of rvhom arepaid from maternity and infancy funds and who are detailed to counties andcommunities to conduct demonstrations relating to materrlity aud infancy work.

The division has had the benefit of cooperation from the State medical anddental associations, the New York State Charities Aicl Association, the Stateeommission for the blind, several statewide organizations of women, fraternaland religious bodies, chambers of commerce, and parent-teacher associations.

All the counties in the State have had some phase of materttity and infancywork in each of the past few years, and information on the care of the babyhas been sent to the parents of babies whose births were registeretl. Groupshave been reached with special class instruction-girls with instruction in itifantcare, mothers with instruction in prenatal ancl infant care, physicirtns withgraduate courses in pediatrics and obstetrics, and public-health nurses withextension courses and with practical experience in a teaching center formaternity and infancy nursing.

A unique feature of the State program has been the developmetit of com-munity demonstrations; 37 such demonstrations (some lasting for a cottsiderableperiod) were in progress during the period of cooperation under the act. Thesewere sometimes in a community only, sometimes on a county-wide basis. Theyhave varied in scope, including several breast-feeding demotlstfations. materrlityand prenatal nursing demonstrations, and maternity and infancy nursing demon-strations (one conducted as a teaching center). This method of promotingmaternal and infant welfare has made the work intensive iu the areas in whichit has been conducted, and the appreciation of its value is shorvn by the factthat the financial support of four of the county and five of the communitydemonstrations has been assumed by the eounties and commuttities, while partof the financial responsibility has been assumed by several others.

Infant mortality rates declined from 72 per 1,000 live births in 1923, the firstyear of the State's cooperation under the maternity and irtfancy act, to 59 in1927, the lowest rate in the history of the State. l'his rate is 27 per centlower than the rate for the four-year period prior to coopelation (1919-1922)'which rvas 81.

Maternal mortality has not declined in the State since 1923. The rate forurban areas was higher in 1927 than in 1923, and that for rural areas waspractically the same. Some improvement, however, is seen in the rates whena comparison is made with the four-year period prior to cooperation. tr.or thatperiod (1919-1922) the rate was 63.5 per 10,000 live births; for the period ofcooperation (7U23-7927) ttre rate was 58.5, or 7.9 per eent lower.


a


NORTE CAROLINA

STAFF AND ACTIVITIES IN T928

Administrative agency :State board of health, bureau of maternity and infaney, Raleigh.

X'unds expended : X'ederal, 825,744,74; State, 924b75.77; total, $48,817.91.Staff:

Director (physician), 5 nurses, 1 stenographer, 1 mailing clerk. Twentycounty nurses were paid in part from maternity and infancy funds.

Volunteer assistants-36 pbysicians.Activities:

Combined prenatal and child-health eonferences conducted by physicians-5,173; expectant mothers registeled and examined-7,24g; iniants andpreschool children rcgistercd and examined-ll,77g; visits to confereneesby children-13,537. (These flgures include some individuar conferencesheld in county health departnrent off,ces in counties in $..hich nurseswere paid in part from maternity and infancy funds.)

Parents had defects couected in 1,051 of the childreneonferences conducted by physicians,

Conferences conductecl liy rrurses, no physician present-4,b30; ehildreninsqected--8.227; mothers instructed in prenatal care-Z@;- visits toconferences by ehildren-10,283; visits by mothers-1,14g. (These figuresinclude some individual conferences in county health department ohces,in counties in which nurses were paid in part from maternity andinfancy funds.)

New permanent combined prenatal and child-health center-l establishedas a result of the maternity and infancy work. It is supported by Stateand county funds.

Classes for miclwives-2| organized, in 6 counties ; midwives enrolled- ?16;number completing criurse-18O: lessons in course--S.

Ilonle vi-qits by nurs('s-33,4?3 (prenatal cases seen, 4,?86; postnatal eases,5,262 ; infants, 74,m7; preschool children, 8,889).

Talks and lectures were given to mothers at group conferences. Total at-tendance--0,784.

Literature distributed-127,2g0 rrieces.New.- names rrcgistered for prenrrtal letters-g,822; prenatal letters dis-

tributcd---4,191 sets. Furl sets had not J-et been sent-f'r names regiiteredin the last half of the year under r"eview.

Nutrition rvork was done through individual instruction by stafr andcounty nurses.

Breast f_eedi-ng was stressed in pa.mphlets on the subject, of which 11,gg3rvere distributed.

Infants borrr in the State during the year-82,098; infants uncler 1 year ofage _reachefl by the work of ilre bureau-B3,gg1 ; presehool cirildren

^ reached-37,609 ; expeetant mothers reached-16,2)6.counties in the state-100; counties in r'liich maternity and infancy work

was_ done during the year---40; eounties in which malernity and infancywork has been done since the acceptanc€ of the maternity and infaDcyact-49.

as a result of the bnreau's maternity and infancy work public-health nursesnot paid front maternity and infnncy funfts included mater.nity andinfancy work in their progr4nrs in seven counties.

the- folkr*'ing organizations cooperated ilr the bureau's work: state boardof education, State board of_ charities 2nt1 publie welfare, State coUeggof agriculture and engineering (home-tlem6nstration aepirtment)- an'Othe parent-teacher association. They assistetl in the preschoot-chiio indnutrition work arrd iu the work with miclrvives. Atrioirg the childrcn ex-ami'etl at conferences reported i' the foregoing paraglaphs ?,gb2 wereexamined in the " Get ready for school " drive sponsorea bv tue NiuonatCongress of Parents and Teachers.1r0

examined. at the


4PRINCIPAL ACTMTIES OF INDTVIDUAL STATES, 1928 111


The bureau of maternity and infancy was establishetl in the state board of

neatin in 1g19. The goo".lno. accepted the pro,visions of the maternity and in'

iiriv r"t-b" Ivlarch"l6, 1922 This was followed by legislative accreptance

apprbved by the governor on March 5, MJ.i -6oi"ir

"oi"&tot Itu" been in charge of the work, .ancl a qmall of-'i

meOicit clirector has been in charge of the work,.ancl a small group or

rtun """.e"-nas

given advisory service in the fielcl activities. The outstandingi"utu"e of the administration"has been the detailing of an increasing.numberof full-time maternity a.td irrfatrcy nurses to counties. During each of the past

two years 20 counties have had,such "9]li.e:Cobperation has been given to theprogram

government, the State college of agriculture tr by other branches of the Stateand ergireering, aDd. the parent-

teacher association.--rne -u:o. activities during the period of cooperation ha\'e been child-health

"oot"".*j* conducted by both phyiicians antl nurses,.nurses' visits to mothers

u"O -frufri"t

in their hom6s, anclilltnrction and supervision of colored midwives

by the nurses.-"Th;; was a slight reduction in infant mortality ig 19X. compared,with 1922

ttnJyear in whidn cooperation under the act was begun)' The rate in 7V22

ti'ii. S"0 ld""ths of infarits untler 1 year of age per 1,000 live births); in 19?7

the rate was 79.- ihe maternal cleath rate was lower in 19?7 than in 7922 in both urban and

"o*ut-*"u.; the difference, howe\-er, was greater in the rural areas (21,8 per

"uuil ifru" in urban areas (12.6 per cent). In the rural areas the rate for

lotn'*nii" and color€d mothers wis lower in 1927 than in 7972; in the urbanareas reduetion was aplnrent for the white group orrly. . The rates for t]le Stateu. u *frot" ancl for urir-an and rural areas ir 1922 and 1927 were as follows:

Matrnal mortalitg rates (d.eaths of moth,ers front puer\teratr causes per 10,000I'i'tte b'irth,s)

1922 7927

State-------- 79.5 65' 6U.nu" ---------------------- tZS' f !12'gRural------- 73.1 57.2


6

NOBTE DAKOTA


Administrative agency :state departnre't of public health, division of chilcl hygiene and publie-

health nulsing, Bismarck.tr'un-ds expended: X'ederal, 96,600; State, g1,600; total, g8,200.Staff:

Director (ptysician), 1 physician (19 months), 1 nurse (part year), 1stenographer.

Aetivities:child-health conferences eondu_cted by p!rysjc!ags-16?; infants and pre-

school children registered and examined---b,006. e nrimler of "ip""rro,mothers attended these conferences ancl were glven aovice on-prenatat

care,Defects found in children examined at eonferences--s,41g; children having

defects-3,5&1.Sur[e1--1, of birth registration, in 1 city.Talks and lectures-1?.Literature distributed-1?,g87- pieees. pamphlets on prenatal care weresupplied to physici-ans for their patients, and pamphietJ o"-i"iunt ca."were furnished to.hospitals for mothers of infants

^toi.n in Tne

-nospitars.

Exhibit conducted-1, at the meeting of the state educadon u..r"ffioo.,Statistieal study made-nraternal deaths in the State in fgZi.

- ----

Breast feeding was stressed in the instruction given to motne"s at healthconferences.rnfants born in the state_ durils the year-14,19g; infants under 1 year otage_ reached by the s'ork of the division-approximatery 18!00; pr"escnoot

children reached-8,961.The division sends literarure on infant hygiene to parents of alr infantsrthose births are registered in the st-a-te bureau of-"iior-"ioii*ti"u.

copies of the pamphlets on prenatal care were mailecl also io-uit'p"r.oo*whose marriage certificates were recorded in the state bu.d;- dt oitatstatistics during the year. Eactl fra-nhlet was accompanied by a letter^ mentioling other literature availa6le fiom the division.'counties in the stats-b3; counties in which maternity and infancy worx.was done during the year-22;was oone ounng tne year_22i Counties in which maternity ana infancywork has been done since the acceDtance of the marprnifv qnrl infonav

act-42.acceptance of the maternity ancl infanc!

The followi

kers' clubs, and the par-

re following-organizations cooperated in the tlivision,s work: state andfl-lstrict medicnl societies, American nea c.oss,- *omen,s federatecl el'bs.ursLrruL ueurcirr socrefres' amerlcan }ted oross, women's federated clubs.woman's christian 'renrperance

u'ior, tromefrakers' crubs. anr,r the nsr-

munity, but all later conferences were organized nv tocai Grso*,;"ti;everything was in readiness when tho Sti-ia -,.+o-o--^ rlni+ o,-:-^reyerything was in readiness when the staie coufer-ence .r"^ii u".ii"iThe outstanding fe-atrrrm of rha voor'o '-nrr. -^-^!n9 oqt5tan_ding features of_rhe yeafs work were the chitd-health eonferencesand the distribution of more than i4,000 copies of u pu*p-nf& * l;f;;;;o.u.

en-t-teacher association. .Th,eV sponsorea conterenc;; ;;a;'.Jild]; ffi-tributing literature. physiciani, county scnoor superioiJ"ai"t",-aJacoulJty.nurses also gaye generous assistance. A nurse from tne oGision-,sstaff. did the organization work for the first conference held in each com-

TY?ES OF WORK AND SOME RESULTS

The division of child ql.qiele a-nd pubric-hearth nursing nas established in thestate dep:rrtment of nulrlic hmlth -in

19t.--i]e go\-efl]or acrrepted the pro_tisirrns of the materDity ana i'fa.cy a"to.iJr""u"y g, rg2,. This was followedb5' legislative acceptance approved by tle goi'e;or on March 2. lgx|.It2


4.ff

pRrNcrpAL ACTTVTTTES OF rNDrVrDUAr, STATES, 1928 113

A medical director has directed the field l\'ork and eonducted most of it withthe assistance of nurses. Additional physicians have been employed for shortperiods.-

Cooperation has been given by State and district medical societies, the Ameri-can Red Cross, rvomert's organizations, and the parent-teaclrer association.

Itinerant child-health conferences have been a notable feature of the work.Distribution of literature has been a means of reachittg many parents. TheChiltlren's Bureau bulletin Infant Care has been mailed to parents of all infantswhose births were registered in the State bureau of vital statistics. Physicianswere supplied with the bureau's bulletin Prenatal Care, and many requestedcopies for their patients.

Apparentty the work of the staff, Iimited though it has been, is reflected inthe lo'lver maternal and infant mortality rates for 1927 eompared I'ith 1924'the year in rvhich the State was admitted to the United States birth-registrationarea, The maternal mortality rate for the entire State was 56.9 per 10'000live births in 1924 and 51 in 1927; the rural rate s'as 51.5 in 192t1 and i13 in 1927.The infant mortality rate in 1924 rvas 67 (deaths of infants under 1 year of agein every 1,000 born alive) ; in 1927 it was 63, the lowest rate since the Statewas admitted to the United States birth-registration area.


&

. OHIO


Administrative ageney:State department of health, division of chiltl hygiene, Columbus.

X'unds expended: n'ederal, 929,649.72; State, 922,645.85; total, 852,2Xj.57.Staff:

Director (physician, not paid from maternity and infancy funds), 1 phy-sician, 5 nurses (1 part time), 1 maternity-home inspector (nurse), 1lecturer, 1 rital-statistics clerk, 1 publicity elerk (part time), l- flnancialclerk (part time), 1 general clerk, 2 motion-picture operators. Twenty-one county nurses in 10 counties and one city nurse were paid in partfrom maternity and infancy funds. Physicians were employed by theday as needed.

Actlvi t ies:Child-health conferences conducted by physicians-S5; infants and pre-

school children registered and examined-3,828.Defects found in children examined at conferences-5,S0o; children having

defects-3,786. Parents had about 17 per cent of the defects correeted,Conferences condnr:tcrl by nulses, no phJ'siciar) preselt-204; chiklren ln-

spected-2,826 ; rnothers instructed in prenatal care-6o; visits to con-ferences by mothers-224.

New pennanent combined prenatal ancl child-health centers-4 establishedas a result of the maternity and infancy work. They are supported bylocal boftrds of health.

Classes in care of infants and preschool children95 organized; pupils enrolled-2,152 girls, 45eourse-2,089; Iessons in course-14.

Home visits by nur-ses-12.262 (prenatal casespreschool children, 2,621).

( health bui lders' Ieagues) -boys; number completing

seen, 510; infants, 2,240;

Provided by the

Maternity homes inspected-20S; inspections made--263.Infant homes inspected-16; inspections made-21.Group demonstration-c--+, at meetings of regional parent-teaeher associa-

tions and federations of rvomen's clubs.Campaign-1, for obserr,'ance of llay Day as Child Health Day. The direc-

tor of the division lvas lllay Day chairman for the State. A total of 10bcelebrations l-ere held. As a result of this campuign many preschoolchildren were given physical examination, and a number of local child-hygiene councils n'ere formed.

Talks and lecture-s---440,349 of which nere given by the lecturer on thebureau's staff at grange meetings, farm n'omen,s club meetings. farmers'institutes, teachers' institutes, schools, colleges, anrl groups from theYoung llen's Christian Association and Young \yomen's Christian Asso-ciation.

Literature prepared-The Care of the Baby (textbook for health builders'leagues ) .

Literature distributetl-227,50o pieces.Exhibits conducted-19, of n-hich 18 were at county fairs. Exhibit material

prepared-posters and fiims.Statistical. study made-maternal and infant mortality, by cases receiving

instruction in prenatal cilre and €ses not receiving ihis-service.Breast feeding was promoted through instmctioD given in home visits.The division do€s not send literature on infant hygiene to parents of infants

ryhose births are register€d in the state bureau of Iital statistics, asnearly all local boards of health mail or deliver birth certifcates and lit-erature upon receipt of the birth nolice.

114

Maternal and Child Health Library, Georgetown University

1g

PRTNCTPAL ACATVTTTES OF TNDTVTDUAL STATES, 1928 115

Activities-Continuecl.Counties in the State-S8; eounties in which materrrity and infancy work

was done during the year-68; counties in rvhich mrternity and infancyworh has been done since the acceptance of the maternity and infancyact--:iT.

Since the beginning of the State's cooperation under the materliity andinfancy act six counties and two cities har,e assumed the responsibilityfor maternity and infancy work begun with maternity ancl infancy funds.

Advisory service bJ' means of visits was giveu to all nur-sing services inthe State. Repolts submitted bJ' local boards t.tf healtlt shttw an increasein the child-hygiene work done by means of nursiltg visits.

The following orgalizations cooll€rated in the division's lvork: AmericanRed Cross, State league of women voters, public-irealth lertgues, and par-ent-teacher associations. AU the children exarnined at conferences con-ducted by physicians reported in the foregoing paragraphs were examinedin the " Get ready for school " drire spottsored by the parent-teacher asso-ciation.

One maternity and infancy nurse \vas sent with another nurse to do reiiefwork in the mine regions. 'Ihey were able in conjunction with localpublic-health nurses to give special care and attention to mothers andsmnu children and to act as a clearing house for medical and nursingservice. Several huldred visits were mude to pletiatal and postnatalceses and to inf:tnts.

Among the outstanding features of the year's $'ork was the active partiei-pation of local boards of health in the child-hygiene program, the child-hygienework thus being extended uude| local auspices to ileny conlrnunities. Much ofthe division's work has been directed toward iuitiution of these local progrrms


The division of child hygiene was establishecl in tlie State clepartment ofhealth in 1915. The governor accepted the provisions of the matertiity andinfancy act on December 27. 1921. This ri'as followed by legislative acceptauceapproyed by the governor on April 24,1923.

A physician has directed the materuity and infancy work since the beginningof coop€ration under the act. The State strrff has included pirysicians, public-health nurses, one of whom served as inspector of maternity homes, a lecturer,clerical assistants, al)d motion-pictul'e operzltors. An increasing number ofpublic-health nurses paid in part from maternity and infancy funds have beendetailed to counties, 10 counties antl 1 city receiyiug the services ttf L1 suchnurses during 1928.

Cooperation has been given by the American Red Cross, public-health leagues,women's organizations, and parent-teacher associations.

X'ull-time couDty health departments luve been developed to a greater extentin Ohio than in any oth('r State. Through this plan pubiic-liealth work in theState has been decentralized, and much maternity and infancy work is con-clucted through the county health departrnents, though ft'rv of tht'rn leceivematernit]' and infancy funds. Because of the typ€ of adninistration throughcounty health departments there have been mnny vi-cits by nurses to homes. Itis estimnted that through nurses' visits prenatal instl'uction was given to 11 percent of the mothers to rvhom chilclren hatl lieen bor-t cluring the 1'ear endetlJune 30, 1928. For the same period 23 per cent of the nursing service inrural communities and 51 per cent of the same service in cities is estimated tohave been child-hygiene rr'ot'k. The State st:tff g:rvt' atlvisory atitl supervisoryservice and other assistance to the county departments, inspectecl mrtternityand infant homes, and contributed to the tlissemitt:ltion of knowiedge orr publichealth through lectures, exhibits, and motion pictures.

Ilaternity and infancy funtls hale been rtsetl since 1922 for the prepnration:rnd distribution of amDules of nitrate of silvel to be usetl as u lrropltylltctic inthe eJes of the nervborn. Ophtlialmia neonatoruln has ilecreased in the State.

Some results of tire maternity anrl infzrncy \r'ork are sltorr.n by the fact thatsince the 5egilning of cooperation six c:otrnties antl tl 'o cities have assumed theresponsibility for *'ork begun r.vith materDity and iufancy funds.

The infant and rDaternal mortality rate.s decliuetl in both urban and ruralareas in 1927 compared rvith 1921 (the year prior to tlie operation of the act)and the 1927 rates established nel. low records.


6&

116 THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Inlant ntortali,tlt rates (tleaths of itufeilts un(I.ir 7 Uear of age Uer 1,000 I'ioabirths)

L921 1527state-------- 75 62

Urban- - - - , - - - - - - - - - - - - - - - - - - - - - - - - 76 URural - 73 59

Maternal, mortality rotes (ileath.s of mothers fronl f)uerperal causes per 10'000Iio"e Ut'rths)

' 7927 1927State-------- ----------- 72.2 61.9

Urban- - - - - - - - - - - - - - - - - ' - - - - - - - - - - - - - - - - - - - - , - S+.S 75 .9Rural ------- ------- 55. 3 40.6


6

OKLATIOlllA


AdministratiYe agency :State department of public health,

boma City,F'untls expended: l'ederal, $17,818.86;StalT:

Director (physician), 6 nurses (1 part year,year), 1 stenographer. tr'ire county nursesternity and infaric}' funcl,s, and a nurse paidof Indian Affairs worked among the IndiansState bureau of maternity and infancy'

Aetivities:

part time), 3 clerks (2 Partwere paid in part from ma-by the United States Bureauunder the supervision of the

Chilal-health conferences conductecl b5' physicians-111'; infants and pre-school children registered antl examinecl-2,267.

Defects founil in children examined at c.onferences-5,823; children havingdefects-2,06O.

Dental conference-1; preschool children receiving dental examination-eq,

Classes for girls and boys ln care of infants and preschool children-4organized; girls and boys enrolled and completing course-135; lessonsin course--3 to 5.

Classes for Indian girls in care of infants and preschool children-28 organ-ized ; girls enrolled---415 ; number completing course--399; lessons incourse-9 to 18.

Classes for mothers---4 organizerl; mothers enrolled-1O2 ; number complet-ing course-96; lessons in course-5 or 6.

Classes for teachers in infant hygiene-3 organized; teachers enrolled plusthose carned over from preYious year-159; number completing course-143; number still on roll-16; lessons in cour'se-1S.

Home visits by nurses-1,495 (prenatal cases seen, 168; obstetrical cases'13; postnatal cases, 105; infants. 798; preschool chi ldren, 1.?8'f).

Group demcrnstrations-140, of dental hygiene, physical examirtatior ofinfants and preschool children, and various phases of maternal and infantcare.

Community derrtonstrations-4, of a rttaternity and infancy public healthnursing program, illcluding child-health conferences, classes for mothers,and classes for girls.

Surveys--4: (1) Of hospitals, in 30 counties. (2) Of midn'ives, in 30counties. (3) Of birth registration, in 30 counties. (4) Of preschoolchildren, in 3 towns and 1 village.

Campaign-1, for prevention of summer diarrhea among babies, in 2counties.

Talks and lectures-5lg.Literature prepared-Six Safe Rules for Saving Babies.Literature distributecl-S83.S85 pieces.Nerv names registered for prenatal letters-7,22o; prenatal letters dis-

tributed-5,225 sets.Graduate courses in obstetrics and in pediatrics were conducted by an

obstetricinn and a lrcdiatrician lent to the State b-v tlte Uniteil StatesOhildren's Bureau. The State bureau of maternity and infattcy dicl theorganization rvolk for these ctturses and assisted the physicians in everyrvay po'ssible.

Nutrition work \\'as done through instmction given in talks and at groupdemonstrations and in instruction to indiviclual mothers at conferences.

Exhibits conrlucted-5?, at county and State fairs ancl at meetings ofteachers, parent-teacher associations, and other orgattizations. Exltibitmaterial ivas preparetl ou dental hygiele antl on tlle functions of thebureau. Erhibit material was lent six times.

1'77

bureau of maternity and infancy, Okla-

State, $18,679.48; total, $36,498.34.


I118 TITE wELFARE AND ITYGIENE OF MATERNITY AND INFANCY

Activities-Continued,Statistical studies made-infant mortality in 7927, in 14 counties and 5

cities; deaths from dinrrhea of infants and preschool children in 1927,in 77 counties and 5 cities.

Breast feedirlg was stressed in literature distributed, talks given, anclexhibits conducted, and in tlte gracluate courses in pediatrics,

Infants born in the State during the year-47,709 live births reported;infants under 1 J'ear of age reached b1 the work of the bureau-6,899;preschool children reached-7,637; expectant mothers reached-7,266.

Counties in tlre.State-??; counties in \vhich maternity and infancy workwas done during the year-77.

As a result of the bureau's work county nurses have given more time tomaternity and infancy rrork, a heaith center for colored children wasstarted in one torvn, and classes in child c8re lvere taught in a numberof public schools by home-economics teachers.

The follo*'ing organizations cooperated in the bureau's work: Stateuniversity (extension service), State agricultural and mechanical col-lege (rural-extension service), State fealeration of women's clulis, andparent-teacher associations.

An outstanding achievement of the year was the aclmission of the State tothe United States birtlt-registration area.

TYPES OF WORK AND SOME RDSULTS

The bureau of maternity and infancy l'as established in the State departmentof public health in 1922. I'he governor accepted the provisions of the maternityand infancy act on December'17, 1921. This was followed by legislative accept-ance approved by the governor on llarch 31, 1923.

During the early yeals of cooperation rvith the Federal Government the workwas in charge of a nonprofessional director', but since 1.925 a physician hasdirectetl the work. The State stalt has ircluded six lield Dulses the past threeyears, and in addition five nurses paid ir) part fron maternity and infancyfunds were detailed to courty health departments.

Cooperation has been given in the State ploglam by State educatioDal institutions, by women's organizations, and by pareut-teacher associations.

Emphasis has been place(l on disseuination of information relating to mater-nal and child care through distribution of literature and p1s1,r1t, letters, throughother forms of publicity, and through ittstruction of special groups in speciaiphases of maternal and infant care. Classes in infant care have been conductedfor girls (including Indian girls) and also for boys, likewise classes in prenataland child care for mothers, and classes iu infant and child care for teachers.Graduate courses in both pediatrics and obstetrics have been arranged forphysicians.

Child-health conferences ancl r-isits of public-health nurses have been featuresof the educational rvork with parents.

Nitrate of silver for the plevention of ophtltnlmia neonatorum is distributedthrough the use of maternity and infancy funds.

A campaign for entry into the United States birth-registration alea was con-ducted by the State departmettt of pubiic health, and assistance rvas given tothe campaign by the staff of the bureau of maternity and infatrcy. The StateF'as admitted to both the birth and death registration areas in April, 1928.

As the State $'as so lecently admitted to the registration areas no statementas to mortality rates cau be made.


6

OREGON

Administrative agency:

srAFF aND acrlYrrlEs IN 1928

--ltut" noara 6t health, bureau of chiltt hygiene, Portlantl.

Funrls expentlecl: Iretleral, $13,117.41 ; State, $12,313.09; total, $25'430'50'Staff :

Director (State health officer serving), 1 physician (part year' part time)'1 prenatal supervisor (nurse),2 nur"ses (1 part year)' 3 stenographers(p-art year).

-Other clerical assistants were employed as needed' - Seven-

teen cou.tty nurses in six counties were paid in part from maternity anrlinfancy funds.

Yolunteer assistants-54 physiciaDs, 32 dentists, 26 nurses, 593 lay persons.Activities:-

chilcl-health conferences conducted. by physieians---326; infants and pre-school children registered--€,532; number examined-3,52O; visits to con-ferenees--4,348.

Defeets found iD children examined at conferences-4'237; childrendefects-1,890. Parents had defects corrected in approximatelycent of the children.

Prenatal confereuces conducted by physicians-137; expectant mothersregistered---419 ; number ex:rmined-393 ; visits to conferencqs-1,516.

Dental conferences---40; preschool children receiving dental examination-534.

New permanent child-health centers---6 established as a result of the ma-ternity and infancy work. They are supgrrted by lrsnl fut6..

classes for girls in care of infants and preschool chiitlren-17 organized;girls enrolled-223 (report incomplete) ; nurnber completinglreport incomplete) ; lessons in course-12. A course of 25personal hygrene rtnd child development and care was giren

having?5 per

course-221lectures inalso to the

girls of the junior and senior high schools in one county.Classes for mothers-2 organized; mothers enrolled-2S.Ilome visits by nurses-5.128 (prenatal cases seen, 773; obstetrical cas€s'

204 ; postnatal cases, 534 ; infants, 1,125 ; pre-school children, 2,80i ) .Group demonstrations-298, on various phases of matemal and infant care,

mostly in connection with classes for girls.Surveys-4: (1) Of hospitals, in one county. (2) Of birth registration'

in one county. (3) Of health conditions, made n'ith the cooperation ofwomen's clubs, in the larger communities of the State. ('1) Of infantmofiality, in one county.

The bureau is cooperating in a study of maternal mortality being con-ducted in the State by the United States Children's Bureau w'ith theindorsement of the State medical society.

Campaigrs-7: (1) For child-Iiealth conferences, in all eounties exceptthose having county health units (in progress). (2) X'or child-health con-ferences. in one county haYiug a county health unit. (3) For the ob-servance of nlay Day as Chiltt Health Day, statewiale. (4) n'or pasteuri-zation of milk, ln two counties. (5) For the establishment of clentalclinics, in one county. (6) For immunization of presehool childrenagainst contagious diseases, in four counties. (7) For prevention of in'fantile paralysis, in trvo counties.

Talks antl lectures--331 (report incomplete).Literature distributed-approximately 5o,ffi0 pieces.New names registered for prenatal letters-1,O46; prenatal letters dis-

tributed-1,017 sets.Nutrition work was done through class instruction and through instruc-

tion given to individual mothers at child-health conferences.1 1 9


A.ff

I2O TEE wELFARE AND HYGrENE OF MATERNITY AND INFANCY

Aetivities-Continued.Exhitrits conducted-100, at fairs and at celebrations of May Day as Child

Health Day, also at weekly health-center exhibits (conducted by theprenatal supervisor). Exhibit material prepared-sutt suit, preparationof delivery room, baby kit, po-ster-s. Exhibit material was lent five times.

Articles prepared-Rai-.ing Baby a X'ull-Time Job, When to Begin GettingReadl' 1s1 School, May Dul'-Child Health Day, Are You Worthy ofIour Chikl's Colfidence? Diphtheria Irntrunization, Livm Saved byImmunization, Infantile I'aralysis iu Oregon, Aftelcare of Infantile Pa-rirlysis, Infantile P:rralysis Is on flre Increase.

Statistical studies made-neonatal deaths and eclampsia, nursing costs,tinre distribution in health work, appraisal of health work, physicians'flndings at health conferences, cotrective wotli reportecl for childrenexanrined, neonatal deaths, 7gT2-19n.

Breast feeding \ras stresseal in instruetion given in letters, literature,home visits, classes, leetures, and conferences.

l2s

t009000

70

60

50

40

30

l9l9 l9?0 l92l 192? 1923 .19e4 1925 t926 19?-7

Source: U. S. Buneau of the CensusTrencl of infant mortality; Oregon, 1919-1927

fnfants born in the State during the year-14,518; infants under 1 yearof age reached by the work of the bureau-2;625; preschool childrenreached-5,439 ; exp€ctant mothers reached-2,7ffi.

The bureau sends to parents of all infants whose births are registeredin the State bureau of vital statistics a notification of registration ofbirth accompanied by a letter offering guidance as to the care ofyoung chi ldren.

Counties in the State-36; counties in which maternity and infancy work wasdone during the year--32; counties in *'hich maternity and infancy workhas been done since the acceptance of the maternity and infancy act---36.

As a result of the maternity and infancy n'ork health centers have beenorganized in every county in which a county nurse is employed. Thebureau gave supervisory service to local organizations doing maternityand infancy work.

(t,t+)L-o(!

oQo

Lc)o-o+)6E

20

The following organizations eooperrated indepartment of education, State universityagricultural colle'ge, State medical societ.y,tuberculosis association. State orsanization

the bureau's work: State(extelsion service), State

State dmtal society, State

State federation of women's clubs. Ameriean Red.for p'ublic-health nursing,led. Cross, and the parent-and the parent-

teacher association.

\ ./


A,{

PR,INCIPAIJ ACTTVITIES OF INDIVIDUAL STATES' 1928 12I

A seneral increase of interest in prenatal and po,stnatal work throughoutthe s-tate was evidenced by requests received by the bureau for prenatal andDostnatal letters and for advice and iiterature on mater-nal, infant, and childcare,


fhe bureau of chiltl hygiene was established in the State board of health in!Y21,. The State aecepted the provisions of the maternity anil infancy actthrorrsh leoislativp enaetment annroved bv the governor on Decembet 24,7927.through tegislative enaetment approYed by the governor on

The work of the bureau has'been utrder medical supervir'I'he work of the tlureau lras been urltter meorcal supervlsron rrour rne uelirr-ning of cooperation rvith the n'ederal Government; the State health officer has

nder medical supervision from the beginbegin-

directed the work in the past few years, a nulse serving as assistant director. Arrumber of public-health nurses paid in part from maternity and infancy fundswere detailed to counties for maternity and infancy work. Durittg the yearwere detailed to counties for maternity and infancy work. Durittg the yearuuder revierv, as in the previous year, six courrties receiveil such service.

t 25

l9l9 1920 l92l lgP? l9?3 1924 1925 19?6 l9?TSource: U.5. Bureau oftho Consus

Trentl of maternal mortality; Oregon, 1919-1927

Ttre division has had the benefit of cooperation from the state department ofedueation and State educational institutions, the State medieal and dentalsocieties, tuberculosis association, and organization for public-health nurses, theAmeriean Red Cross, women's organizations, and the parent-teacher associa'tion, and of professional and lay assistance from volunteer n'orkers.

Itinerant child-trealtlr conferences n'ere features of the earlier programs.Emphasis continues to be placed ott conference work, but this is now accom-plished through the examinations marle at health centels and in county healthdepartments, both of which hare increasetl in number. Nurses detailed to coun'tiei have made more infant and prenatal nursing visits than lYere possibleformerly.

A full-time maternity and infancy nurse has been assigned for service atthe prenatal clinic of the State university medical school, which has furnishedprenatal clinical material and instruction for undergraduate medical students.

Improvernent in maternal and infant care ltas been promoted by the distribu-tion of instructive literature through the bureau of child hygiene.

Oregon is one of the States that have had a relatively low infant mortalityrate. lYhen it was adrnitted to the lrnited States birth-registration area in 1919the rate was 63 (deaths of infants under 1 year of age F'er 1,000 live bitths).

48273"_2c-9

aJ.lJL

-oo

.:oooc > '

;0)o-d

oE

t009080

70

6o

50

40

30

?0

\\

\

\


&T22 THE .WELFARE AND EYGIENE oT, MATERNITY AND INFANoY

The trend has been downward during tne perioA of eooperation. In 1921 (theyear before cooperation under fhe act was begun) the rate was 51 i in 7927it was 48, the lowest point in the nine years the State had been in the registrationarea.

The maternal mortality rate also showed a downward trend from 74.3per 10,000 live births in 1921 to 63.6 in 1927. The reduction in mate'rnalmortality is due in great part to decrease in both puerperal septicemia andpuerperal albuminurla and convulsions. The rate in 7922 for puerperal septi-cemia was 27.4 Wr '10,000 live births; in 7927 it had declined to 21.9. fn7922 t!a,e rate for albuminuria and eonvulsions was 24; in 1927 it was 14.4,a saving of 10 mothers from this cause for every 10,000 babies born alive.It would seem that the excellent training in prenatal care provided for themedical students at the prenatal clinic through the cooperation of the Statedepartment of health with the State university medical school is reflected inthe reduction of deaths from albuminuria and convulsions.

Information upon the basis of which plans may be made for further attackon the problem of maternal mortality will bc available as a result of the studyof this subject being made in the State by the Iinited Stlrtes Chiklren's Bureau(with the cooperation of the State bureau of chfld hygiene and the indorsemerrtof the State medical society).


ff

AdministratiYe ageney :

PENNSYLVANIA

STAFT AND ACTIYITIES IN T928

of health, Lrureau of child health, preschool division,State departmentElarrisburg.Elarrisburg.

Funds expended: Federal, $75,735.98; State, $63,810.99; total, $139,546.97.

Director (physician), 8 physicians (1 part time, 6 for two months or less),4 dental hygienists (for 3 months), 2 midwife supervisors (ph;gsicians),3 field workers, 1.4 vital-statistics clerks, 2 stenographers, 3 clerks. Elevencommunity nurses and 14O to 150 nurses in the public health nursingdivision of the State department of health were paid in part from tna-ternity and infancy funds.

Yolunteer assistants-more tban 850 physicians, many nurses and laypelsons.

Aetivities:Child-health conferences conducted by physicians-6.246 (6,113 at child.

health centers, 133 on the health cerrs) ; infants and preschool childrenregistered and exalrined-19,219 (12,033 at child-health centers, 7,18Gon the health cars) ; visits to conferences-9?.152 (80.366 to healthcenters,7,186 to the health cars). Two cars, each staffetl by two physi-cians, two dental hygienists, and two nurses and equipped for healtheonferences, which were sent out in the fieltl in June, 192?, continuedtheir work during JuIy and August of tltat year, and again went into thefield in June, 1928.

A complete recold was not kept of the number of children having defectsand the number of corrections made. Ilowever, the correction of 5,544defects was repolted for children attending"the child-health centers, anclit rvas estimated that about 5O per cent of the children had defects cor-rected following the e\aninations nade on the health cars.

Prenatal conferences conductetl by physicians-310; expectant mothersregistered and examined-329 ; visits to conferences-1,513.

The division gave advisory service and furnished literature and recordblanks to child-health centers and prenatal centers supDorted by otheragencies, at \vhich physicians conductetl 9.358 child-health conferences(examining 30,654 infants and preschool children), and 4,462 prenatalconferences (examining 14,027 expectant mothers). Infants antl pre-school children nrade 214,564 visits to these conferences, and expectantmothers maile 62,365 r'isits.

Nel' permanent child-health centers-36 established. The nursitrg serviceof 15 is pirid for by Irederal and State fuDds; that of 21, by funds fromother agencies.

fntensive work among midwives was continued ln nine counties in thecoal regions of the State and was extended to one more county. 'Ihemidwives were supervised and given a course of instruction by twowomen physicians. The number of licensed midwives untler supervisionto December 31,7927, rvas 511. They attended 7,734 deliveries in 1V27:there lvere I materl)al deaths among the women attended by them, or amaternal mortality rate of 1.3 per 1,(fi deliveries. All deaths of mothersfrom causes associated with childbirth rvhich a midwife had attendedat any time during the labor were counted as deaths in the midwife'spractice even though a physician was called later and signed the deathcertificate. Three institutes for midwives were held, the program (inwhich both physicians and nurses participated) being conducted partlyin English, partly in other languages for the benefit of the \,vomen whodid not understand Enslish.

123


&I24 TrrE wnLFARE AND rtyGrENE oF l\[ATBRNrry aND TNFANCv

Activities-Continued.Elome vi-qits by nurses---43,903 (to prenatal cases, 2,106; postnatal cases,

7,314; infants and preschool children, 3-1,483).Talks and lectures-122.Literature prepared-llanual for Expectant Mothers, Baby Book (revised).Literature ttistributed-147,902 pieces.Campaign-l, state-wide, for observance of May Day as Child Eealth Day.

The aim was to have permanent child-health activities culminate in thespecial celebrations or to make the celebration the starting point forother worth-while projects. Elealth officers of both public and privateorganizations, school officials, churebes, motion-picture theaters, news-

200

f 0I876r9l5 1916 l9r7 r9r8 t9r9 l9e0 t92t t922 r9a3 r9Z4 t925 t9?6 t927

Sourca: United Stateg Bureau ofthe Census.Deaths of infants under 1 year of age from all causes and from dlarrhea and interit is,

per 1,000 live births; Pennsylyania, 1915-1927

papers, merchants, dairJ'men, and valious clubs and fraternal organi-zations cooperated, Proclamations, slogans, posters, radio talks, q,'indowdisplays, and news articles were employed in arousing interest in thecampaign. Local celebrations by groups, communities, and counties in-cluded drives to have preschool children examined and their defectscorrected before the children should enter school, toxin-antitoxin cam-paigns, plays, pagents, parades, weight check-ups, health clowns, exhibits,and demonstrations. Reports of celebrations were received from 52 ofthe 67 counties in the State. Programs were conducted in 384 com.

200

r50

t00908070

60

50

t50

r00908070

60

50

4040

30

20

t 0I87

6

A I<vPes

: ,oF^ ,a

\j €ni.

b;(\t


6'PRINCIPAT, ACTIVITIES OF INDIVIDUAL STATES, 1928 I25

Activities-Continued.munities, 15,599 infa_nts and preschool children were given physicalexamination, 440 children were vaccinated against smalrp"ox, ana 5s,orochildren were immunized against diphtheria.

Exhibits conrlucted-2. Exhibit matefial prepare-d-basket crib, spot maps,charts, and diagrams.

Ar_ticles . preplared-Birth Registration, a problem for popular rnterest ;L1w9{ng the rnfant Mortality Rate'in pennsvlvania ; ne^ports ot ctrita-Health wo'k; Maternity and rnfancy work in pennsylvania under theSheppard-Towner Act; Health-Car Work in pennsylvaiia.

rnfants born alive in the state during the calendar year 7g27_210,0g8;infants under'l.year^9f.qqg reachear by the rvork ofihe division duringthe year ended June 30, 1928-26-,882; preschool chitdren rmched_2g,g16Jexpectant mothers reached-16,020. (Report incomplete.)

The division sends literature ori infant hyir.iene to iarents of all infantswhose bitths are registered i' the state bureau oi vitat statiitics. co-operation with the bureau of vital statistics in sending uirtn ceititieatesto the parents of all infants as soon as births were r.egistererl was con.tinued in the year under review.

200 400

t50

r0090807060

50

4A

r50

r0090BO70

60

50

40

30

20f9l5 t9t6 tgl? r9r8 l9t9 t92o l9?t tgz? tg?3 lg2+ ,ges .!,z7 tgz?Source: UniLed states Bureau oftha Census

Deaths of childron under 5 years of age from diphtheria, per 100,000 estimatedpopulation of these ages; I 'enn8ylvania, 191i_1927

counties in the state---67; counties in which maternity a.d infancy workwas done during the year-62.

since tbe beginning of the state's cooperation under the naternity andinfancy act six comrnunities have assumed the responsibility for mat"ernityand^ infarley n'ork begun with maternity aud infarrcy funds'.le follo'wing organizatious cooperated in the division's work: American

__ano rnraney F.ork begun with maternity aud infancy funds.The follo'rving organizatious cooperated in the division's wr

Red Cross, Woman's Christian Temperance Union. State lerRed Cross, Woman's Christian Temperance Union, State league of *o-"oyoters, state tuberculosis society, the parent-teacher associati-on, and manylocal organizations.

^ Among the oufstanding features of the yeat's work were the three institutesfor midwives, the organization of the prescirool worli as part of the chiki HealthDay celebration, the visiting of postnatal cases among midwives' patients, theeraminations made on the healtf cars, and the promoiion of Uirtn ]egistration.

\\


*126 TITE WELFARE AND HYGIENE OF MATERNITY AND INFANCY


The bureau of child health, of which the preschool division is a part, rvasestablislied in the State department of heaith in 1919. The governor acceptedthe provisions of the maternity and infancy act on Januaty 18,1922. Tilis wasfollowed by legislative acceptance approved by the governor on llay 31, 1923.

A physician has directed tbe work of the division through the entire periodof cobperation with the X'etlerai Goverrrtment. Other membels of the staff havebeen physicians, nurses, and dental hygienists. Approximately 150 nurses inthe public health nurslng division of the State department of health have beenpaid from maternity and infancy funds on the basis of actual time spent onmaternity and infancy work. Nursing services in cornmunities also have re-ceived small paynrents for the promotion of maternal and infant hygiene. Manyphysicians have been paid for services at centers ( as the examinatiolt of expectantmothers, infants, and preschool children at conferences), and many others havegiven volurteer service of similar character. Nurses have given generous a-ssist-ance, and conmittees of lay pelsons have helped at centers aDd sponsored them.

Cooperation has been maintained with the Americarr Recl Cross, the Statetuberculosis society, women's olganizations, and the parettt-teacher association.

An important activity of the dirision has been the establishment of prenataland child-health centers, whose support (except for the .salary of the nursein some cases) is provided by local funds; also assistance in the local organizu-tion of such centers-to which literature and recortl forms are furnisherl. Atthe close of the flscal year 1928 apDroximately 400 centers, conducted under va-rious auspices, were in operation in the State.

The conducting of itinerant childhelrlth conferences by means of two ltealthcars rvith suitable equipmerrt has been continued, the staff consisting ofphysiciarrs, deltal hygienists, aDCl nurses. Otlrer features of the rvork ltar-ebeen the regulation, instruction, and supervision of white midrvives, r'hich hasnow been extended to 10 counties in the qral regions of the State; the conduct-ing of an extensive antidiphtheria campaign; and the mtiliug of litelature onthe care of the baby to parents of all trabies whose births are registered.

Maternity and infalcy funds have been used since 1f)26 to provide for the freerlistribution of ampules of nitrate of silver to be used in the prevention ofblindness in tire nen'born.

Results of the program ale indicated by tire downward trend in infantmortality rates. The rate in 1922, the yeir in which the State began coopera-tion under the maternity and infancy act, was 88 infants under 1 ye.ar of agedying in every 1,000 born alive. In 1927 the rate rvas 69, the lowest inftrnt mor-tality rate ever recorded in the State. This meant a saving of 19 babies inevery I,{XJO born alive in 1927 that $'ould }rave died if the 1922 r'ate had prevailed.

The maternal mortality rate for the State as a rvliole has nc,t decretrsed,though the rrte for rural areas declined from 48.7 per 10,000 iive births in


*

RHODE ISLAND


Administrative ageney:State board of health, division of chilct rvelfare, providence.

Funds expended: X'ederal, 914,0?6.28; State, $9,026.2g; total, g28,1b2.b6.

Directorretary.

\rolunteerActivi t ies:

(physician), 8 nurses (2 part year), 1 stenographer, 1 field sec-

assistant-l physician.

child-health conft"rences co_nducted by physicians-210; infants and pre-school chilth'en registered-668; nuntjer. examined-522; visits- to iu"_ferences-3,664.

Defects found in c:hilrlren examinetl at conferences-664; children havingdefects--625 (including some chilclren who were not examineO & nhr.t:cians but were inspeciecr by a nurse wh, listed defects). pare"nti naodefects cor.rected in 355 of the children.

New pennanent child-hetlth centers-B established as a result of the mater-nity and infancy work. Ifhey are supported by loeal ou"".irrg o.eu;ira_tions and_ rrraternity ancl infancy funcli. confeieoces i" o"e-c-en"te-" w"recondLrrted weeEly by a-rocal phvsician who volu.teereo rriJiervici, utt""atteuding the first confer.ence heltl at the center.

class for mothers-1 organizecl ; mothers enrolled-1g; lectures in course--b.Ifome visits by nurses-58,60i.Group demonstrations-.-2. on nlethod of giving sun baths.oampaign-1, for immulizatiorr against diphiheria (continued from previ-

ous year).The division is_cooperating in.a study of maternal mortality being concluctedru the sttrte by ilre unitetl states Children's Bureau witir the inclorsement

of the State medical society.Talks and lectures-30.Liter'ature distributect--BT.36g pieees.Nutrition rvork was done thrrugh individual instruction to mothers inhome visits.Exhibit ^conducted-1, of a. clay nrrrsery at a county fair. The nursery wasopen fronr 10 a. m. to 11.30 p. m., ancl chiklren'eoulO Ue teff ait aLv inc.re of the staff n,r'ses- iu_ charge. Exhibit -at""i,ii p*pii"o:_iri,iJt.r_

tions of the division's fleld work, ,,Time card ,' fil;. -

E;;init ,iioi"ii"rwas lent seyen times.Infants bo.n in the State during thg year_13,Bg6; infants untler 1 year ofage_reached by the work_of the rlivision-4,8c2 (exclusive or-trro.J J"uin"abv literature rlistributed); preschool crriih-re. reactreo-9,956-l;;;ro;""

of.those reached bv literntur:e distributedl ; Lipectant n otie.s ii""i.o_7.422.The bureau ser)ds riterature on infant hygiene to parents of all infants wholive within ilre districts covered byt;tr;;es; it atso supplied litera-

::,1,""i" all nursing orgiurizations"in ahe--Si;te during- ti,"-T"""

""i""revlew.Coulties in the State-b; counties in

was clone cluring the year_b.which maternity and infancy work

Among the outstanding achievements of the

ffiiT;'L::; 'L-ii'i'i'iripitr,e.ro ,i,.0lii i.a'iir#1i ,T:'i"rt"T:X?tff'"*#,:3iIYPES OF WORK AND SOME RESULTS

The division of child werfare was estabrished in the state board of health

"ll1?. ,Jlf"p,l*"^;r-"^".":l:q ge__l{9"jqi;;i:-;; th" maternity and infancy acthrough legislatir:e enactment apprbved rrv tn" goi""";;;;"i;rii'i 7:"i6;i:.127


A&

I28 TITE WEI,FARE AND ITYGIENE OF MATERNITY AND INFANCY

A medical tlirector assisted by a staff of public-health nurses has conductetl

tne prograrn for maternal atrd infant welfare. The program_ has been_ch.aracter-ir"O-rr:f,-""p"*ision of infants through the nurses' visits in homes and the work

of the-medical director at child-health conferences'"^O"rirg iL" year uoder review cooperation w-as given by local nursing organ'

irutio"s -i"

thl establishment of peimanent child-health centers and in their

maintenance.* i;il;A;rm of intensive supervision. -is reflected in the deeline of the infant

-o"iuriiv iaie from the high point ot 108 per 1,000 live births in 1917 (before

In" aioi."io" of chil6 welfare qlas established) to 67 in 197-the lowest rate the

Stutu nu. shown since it was admitted to the United States birth-registrationir*.

-Crre-"ute in 1918, immediately preceding the establishment of the divi-

*i"", *u. ""usually

hig| on accouni o1 the influenza epidemic.. In 1925 (the

;;; il;hi.n tne" Stale began cooperationunder the materrrity and -infancy;;tt 11g rate rvas TB, a neri low rate for the State. The rate of 67 for 1927

^uri". a saving of 6 babies in every 1,000 born rlive in 7927 as compared with

igZS a"a a .aiing of 41 babies in -every

1,000 born alive in 1927 as compared

";itl iglz, before"the division was established and medical and nursing super-

vision begun.llateriat mortality rates have not declined during the, Pjlriotl of coop€ration.

f" fdZf the rate wi.s b2.1 per 10,000 live births; in 1927 the _rate. rvas 64.1.

ir," si"av of maternal moriality being macle i' the State will furnish a basis

for intensive effort toward reduction of this rate.


€

SOUTII CAROI]INA

STAFF AND ACIIVITIES IN 1928

Administrative ageney :State board of health, bureau of cbiltl hygiene and publie-health nursing,

Columbia,Funds expended: n'ederal, $18,060.58; State $16,355.65; total, ii34,416.23.Sr afl' :

Director (nurse),2 physicians (part t ime, 1 part year), 12 nurses (7 for 2months or less), 1 teehnieian (1% months), 1 vital-statistics clerk, 2stenographers. One county nurse was paicl from maternity and infancyfunds.

Volunteer assistant-1 physician.Activities :

Childltealth conferences conducted by physicians-1Z3; infants ancl pre-school children registered and examined-2,77L; visits to eonferences-2,888.

Defects found in c.hildren examined at conferences-2,607; children havingdefects-1,682.

Prenatal conferences conducted by phl'sicians-36; expectant mothers regis-tert rl ancl examirred-99; visits to conferences-237.

Conferences cotrducted by nurses, no physician present-6; mothers in-structed in preratal care-1? ; visits to conferences-54.

Classes for girls in care of infants and preschool children-9 organized;girls eur'oiled-160 ; number cornpleting course-11S ; lessons in course-10.

Classes for mothers-G organized ; mothers enrolled-87; number complet.ing course-33; lesson-s in c.ourse-8 to 22.

Clirsses for midrvives-24 organized; midrvives enrolled plus those carriedover from previous year-31? ; number c{mpleting course-1O4; Iessc.rnsin course-10 to 12. During the )'ear under review the nurses also held336 revierv classes attended by 3,292 midl'ives.

A one-l)lonth institute for midwives was heltl in July, lgZl, at the hospitalof a colored school lent for tlie purllose by its trustees. A nurse fronrthe bureau's staff organized the institute and conducted it with theassistance of the other staff lurses, each of whom was assigned to thework three to seven days, and of a colored nurse, who was pa.id by aprivate organizatiorr. The entire cost of the institute (excluding salaries)was covered by a charge of $10 for room and board for the midwivesand of $1 per day for the instructor nurses. County nurses and othermaternity and infancy fleld nurscs were aslied to send to the institutesome of the better-eclucated and more intellisent midwives in theirdistricts; and 27 rnidwives whose ages ranged from 17 to 56 years andwho represented 13 counties registered for. the course. The lridwiveswere divided into thlee sections, responsible for the nursing, the kitchenand dining room, and the laundry, respectively. The whole group haddaily classes in midwifery and in home hygiene and care of the sick.All the rnidwives attended all the deliveries of pa.tients from the hospi-tal's prenatal clinic that were conducted irr the hospital. A localphysician who volunteered his services delivered these patients. As aresult of this institute so many applications rvere received from midr.r'ivesfor a similar course that it was decided to conduct an institute for threemontirs irr 1928, beginning in June. About 30 midrvives registered foreach of the three months. A colored nurse who was a graduate of ilreBellevue Hospital Tlaining School for trfidwives was employed to assistthe riur-se in charge, and each of the bureau's staff nurscs was assignedto the work for a 2-week period. The same physician who volunteeredhis services the preceding year delivered the abnormal cases antl thecolored nurse-midwife the normal cases that the midwives attended for

129


#'130 TgE WELFARE AND ITYGIENE OF MATERNITY AND INFANCY

Activities-Continued.instruction. An out-patient department was olganized, and an ittstructorwas seut with two student midwives to deliver patierts in their houtesand t-o gi\'e postparturn care.

Home visits by trurses-6,030 (prenatal cases seen, 300; obstetrical20; postilatal cases, 160; infants, 751; preschool children, 2,O43).

Community dernoustrations-8, lasting 1 to 3 motrths, of a maternityinfancy public health nursing program, in 8 counties.

Group demonstrat"ious-?5, of various phases of llaternal and childbefore midwives' classes and lay groups.

Campaign-1, for promotion of birth registratiou, state-rvide.ETalks and lectures-158.Literature prepared-Products of South Carolina (a bulletin on maternal

and chi ld care).Litelature distributerl--S0,0Oo pieces.Nutrition work was done through instruction given at mothers'

and in talks to other groups.Exhibit conducted-l. at the State fair. Exhibit material was lent

times.Breast feeding was promotecl by distribution of litelature on the subject.

It is estimated that at least 90 per cent of the children born in the Stateare breast fed.

fnfants born in the State during the year--42,737: infants under 1 yearof age reached by the work of the bureau-25.000; preschool chiidreureached-2,573 (exclusive of those reachetl by literature distributed) ;expectant mothers reached-2.500.

The bureau sends literatule on infant hygiene to parents of all infantswhose births are registered in the State bureau of vital statistics.

Counties in the State---46; counties in which maternity and infancy workwas done during the year-46.

Since the beginning of the State's eoop€r'ation under the matelnity andinfancy act nine counties have assumed the responsibility for maternityand infancy work begun with maternity and infancy funds.

As a result of the bureau's work much luaterality and iufancy \qork wasdone by industrial nurses and county nurses not paid from materrlity andinfancy funds. At the suggestion of the district maternity and infancynurse a mothers' club in one town organized a toxin-antitoxin ciitiic. atwhich almost the entire preschool populatirur was immunized. Three per-manent health centers orgarized by a matemity and infancy nurse inanother town wele being equipped by local orgarrizations.

The following organizations cooperated in the bureau's work: State federa-tion of women's clubs, American Legion, Council of Farm lYomen, andthe parent-teacher association. Among the children examined at confer-ences reported in the foregoing patagraphs 628 were exarDined in the" Get ready for school " drive sponsoretl by the National Congress ofParents and Teachers.

The outstanding feature of the year's work rvas the institutes condueted formidwives in the summer months.


The bureau of ehild hygiene and public-health nursing rras established in theState board of health iu 1919. The governor acceptetl the. plovisions of thematernity and infancy act on December 31, 1921. This was followed bylegislative acceptance approved by the govelnor on tr{arch 11,7922.

A nurse has had immecliate charge of the rvork of the bureau, assisted bya ccntral staff of nurses, and physicians have been paid for part-time services.A county nurse' paid from maternity anrl infancy fuuds has bee'n tletailerl forfull-time matertlitJ' and infaucy work for the past few years. A physiciangave volunteer service at a prenatal center.

Cooperation has been tirairrtairrecl with the American Legion, women'sorganizations, and the parent-teacher associatioD.

'Ihe program of work has inclucled child-health conferences, prenatal corr-ferences, classes in infant and clrild care for girls, classes for mothers, arldvisits to the homes of mothers ancl babies bv nublic-health nulses.

6 South Carolina was aalmitted to thc United Ststes birth-registration area i l Octobcr,1928.


cases,

ancl

care,

classes

twenty

6 PRINCIPAI, ACTI\TITIES OF INDIVIDUAL STATES, 1928 131

A major feature rvas the instruction antl supervision of negro midwives'

fts-effec"t-is i"clicated fy ttre iact that the midrives' bags noware clean ancl

nronerlv eouipr-re<I, atso by 1ltai. tt"* pride in their work and their conscientious

il;;td*';;'6i.iit..-"ii,.oush tne delelopment of the prenatal center for

iHr,*r'""rt"bli=il; iu-i9z6,"an institute for negro r,nittrvives-was developed'

iirilrir?i"ii rr"-i--!io.ii ut actual cteliveries by a physician. This work marks

u O"puit".n in "tfri instruciion of uegro midwives and offers suggestions for

i^pi.6oo-"nt in the trailing of this large and unskilled but still necessarT

group.- I.i'e State has been both in and out of the United States birth-re-gistration

urnu a"i.i"g ine period oi cooperation und_er _the maternity and infancy act,

n-""i"i-fr""'" rtroipea from the area in 1925. A coltinuous campaign for

rear'lm"ission has beel conducted, and in this the bureau has given coop€ration

anrl assistance.As the State was not readmitted to the birth-regrstration area until after

theclose of the fiscal year 1928 no statemetrt as to mortality rates can be

made.

i

- -


/&

SOUTH DAKOTA.


Administrative ageDcy:State board of health, division of ehild hygiene, lVaubay.

tr'unds expended: Total, $7,325.18 (all Federal).Staff:

Director (nurse). Two physicians. 4 nurses, 1 lecturer (part time), antl1 secretary were employed for short periods. Two county nurses tvelepaid iu paft from materrity and irrfancy funds.

Aetivi t ies:Combined prenatal and child-health eonferences conducted by physicians-

49; expectant mothers registered antl examined-1S; infants and pre-school children rt-'gisteretl anrl examined-1,476.

Defects found in children examined at conferences-4,77|; children havingdefects-1.391.

Lessons ln care of infants and preschool children were given to 194 girlsin 2 higtt schools and 1 normal school.

Classes for mothers-2 organized; mothers enrolled (plus those carrietlover frorn previous .rear) and completing course-25?; lessons incourse-?.

l\Iaternity homes inspected-tl; inspections mad#3.Group demonstrations-3S, of layette, prepa.ration of room for confinement,

preparation and sterilization of obstetrical supplies, explanation ofanatomical charts, and foods antl other things neerlecl by grorving children.

Survels-2: (1) Of all maternity homes and maternity departments ofhospitals in the State. (2) Of the extent of infantile paralysis ln theStnte.

Campaign-1, for obserrance of trlay Day as Chilrl Healt] Day. CircularIetters asking for local cooperati(,n \\'ere sent out, ancl assistance wasgiven in planning local programs and health conferences. tr{any childrenrvere given physical examinations at the conferences organized. Theextension department of the State college of agriculture made plans toindicate a day in its yearly progr$m for such observance of May Day.

Talks and lectures-16.Literature prepared-Mother's Book (new edition).Literature distributed-23,638 pieces.Ne$' names registerecl for prenatal letters-634; prenatal letters dis-

tributed-?22 sets. Letters were sent to rll the physieians in the Stateadyising them that the division had prenatal letters and literature fordistribution and inclosing eards for use in requesting copies of the pre.natal letters for their patients. I\{any physicians took advantage ofthis service.

Nutrition \\'ork was done through the distribution of diet slips entiiled" Food Suitable for the Gros' ing Child."

Eshibit condncted-1. at the State fnir. of frosters, motion pictures, layette,and room for ths baby. Exhibit material was lent eleven times.

Statistical studies made-births, by attendants at birflr : stillbirths. deathsof infants under 1 month of age, and deaths untler b l-ears, by causes;deaths of motlrers from causes associated s-ith childbirth.

Breast feeding was stressed in literature distributed, talks given, andinstruetjon gilen to intli.,'idual nlother,q at conferences.

rnfants born in the state during the i-ear-l3.9o2 reporterl; infants uncler1 ]'ear of age reached by the s-ork of the clivision-g,114; preschoolchildren reached-1.287; expectant mothers reached-?O5.

The division sencls l i terature on infant hygiene to parents of al l infants*-bose births are registerecl in tht' State bureau of vital statistics.

Couuties in the State-64 organized. 5 unorganizerl 0argely of Indian popu.lation uDder Government care) ; counties in which maternity and infancy132


6 PRINCIPAIJ ACTIVITIES OF INDTVIDUAL STATES! 1928 133

Acf ivities-Con tin uetl.work was done cluring the year-54 organized, 1 unorganized; countiesin which maternity and infarrcy work has been done since the acceptanceof the maternity and infancy act-64 organized, 1 unorganized.

Since the beginning of the State's coopcration under the maternity andinfancy act two counties have assumed the responsibility for maternityand infancy work begun with maternity and infancy funds.

As a result of the division's work health conferences for preschool childrenwere conducted in 6 torvns, with an attendance of 532, and 2 countl nursesnot paid from maternity and infancy funds conducted mothers' classes.

The division gave supervisory assistance to lmal organizations, assistedthem in securing personnel, and supfilied literature for distribution.

Flom reports frorn child-health conferences it is estimated that 66 percent of the babies are breast fed.

The following organizations cooperated in the division's work: State col-lege of agriculture (extension service), State medical assoeiation, State

. tuberculosis association, State league of women voters, State federationof women's clubs, State graduate nurses' association, American Legionand its auxiliary, and the parent-teacher association. They assisted witlthealth conferences, mothers' cla-sses, and the campaign for the observarrceof May Day as Child Ilealth Day.


The division of child hygiene was established in the State hoard of healthln 1921. The governor accepted the provisious of the maternity and infancy acttn X'ebruary 10,7922. This was followed by legislative aeceptanee aBprovedby the governor on March 2,1923.

A medical director rvas in charge during the earlier years; later a publie-health nurse directed the u-ork. Staff nurses have been employed, and nursespaid in part from maternity and ilfancy funds have been detailed to couuties.

llhe division 1n-s ltad the benefit of cooperation from the State college ofagriculture, the State medical, tuberculosis, public-health, and graduate nurses'associations, the American Red Cross, the American Legion and its auxiliary,women's organizations, and the parent-teacher association.

Child-health conferenees and combined prenatal and childiealth conferenceseondueted by ph).-qicians have been a prominent feature of the program. Classesfor mothers in infant aDd prenatal care also hale been included.

The inspection of maternity homes and hospitals accepting maternity casesbas been a duty of the division for several years through legislation assigningthe responsibitity for licensing and inspection to the State board of health.

Since 1924 maternity and infancy funds have been used for the free distribu-tion of ampules of nitrate of silrer for use in the eyes of the nervborn. Returnsfrom birth certificates indicate that this prophylactic is geilerally used.

Through the sending of literature on infant care to the parents of babies whosebirths are registered instructiou iD the care and hygiene of the baby is madeavailable to practically all parents rvho can read.

During 1928 two counties assumed the financial responsibility for the ma-ternity and infancy nurses detailecl to them.

The educational work and general program established were continued duringthe year ended June30,1928, though tlrere \ras a curtailment of funds in1927.

The effect of the propgam is shorvn b-v the increase in requests by women forliterature relating to prenatal, infant, and child care. It is shon'n also by thestatements of man-v physicians that fewer women now wait until they are inlabor to send for medical assistance; tbis the physicians attribute to the educa-tional program in prenatal care.

lfhe State is not in the birth and death registration area-s. Legislation isnec€ssary to meet the requirements of the United States Bureau of the Censusfor admi-ssion. Maternal and infant mortality rates based on figures from theBurmu of the Census consequently are not available.

l

,t

I

II

I

IL


g

TENNESSEE

STAFF AND ACTIYTTIES IN T928

Administrative agency:St-ate department of public health, division of ehild hygiene and public-

health rrursing, Nashville.n'unds expended : n'ederal, 921,b28.18; State, g1g,021.72i total, 940,b44.90.Staff:

Director (physician, part time), 1 physician (11 months), B nurses (2 partyear, part time),1 supervisor of midwives, l accountant,1 stenographer(part time). Twenty-nine county nurses in 18 counties were paidln part

. .- , from maternity and infancy funds.Activi t ies:

co_mbined prenatal ancl chiltl-health eonferences condueted by physicians-9; expectant mothers registered and examined-16; infants aird preschoolchildren registered and eramined-29; visits to conferences by expectantmothers-18; visits by children--48.

Child-health conferences conducted by physicians-10?; infants and pre-- sehool children registered-3,S93; number examinedj,2b6.Defects found in chiklren examinetl at conferences--4,5b3; chiltlren having

defects-2.141. Parents had defects corrected in 1g6 of the children( report incomplete) .

Prenatal conferences conducted by physicians-12; expectant mothersregistered and examined-b7.

co'ferences conducted by nurses, no physician present-Gb; children in-__ spected-2,146 ; mothers instructed in prenatal care--g?g.Nerv permanent combined prenatal and chiltl-health centers-2 establishetl

as il result of the maternity and infancy work. They are supported bythe county health unit, colored women's federated clubs, midwives' crubs,and volunteer workers.

Nerv permanent child-health center-l established as a result of the mater-^-nity and infancy work. It is supported by State and county funds.classes for girls in care of infanls and pr-eschool chiltlren--]2 organized;

girls enrolled and completing course---3f; lessons in course-13.Classes for mothers---rl organized; mothers enrolled plus those carried

from previous year-121 ; lessons in course--{.classes for midrrives-14 organized; midrvives enrolled plus those carried

over from previous year-?b3; les.sons in course---6. liost of these mid-$rves were enrolled in the classes conducted by the State supervisorof midrvives, which had not been completed at the'close of the yeair underreview' rn classes conducted by county nurses, wrro had onlj a limited

_ tenitory to cover, 28 midwives completed the course.Elome-visits by nurses-4,405 (prenatal cases seen, gb1;_ 1,008: infants, 1.4{6; preschool children, 2,108).lllaternity home inspected-1 ; inspection made-l.Infant home inspected-l ; inspection made-1.Group demonstrations-33, of vision test for presehool children, equipmenr

for r_nidwives, maternity supplies and layette, the use or sitver-riit.atesolution in the eyes of the newborn, and other phases of maternal andinfant care.

postDatal cases,

Surveys-2: (1) Of midwives, in 24goiter, in 36 counties. As a resultvey of the prevalence of goiterHealth Service.

counties. (2) Of the prevalence ofof the goiter survey a state-wide sur-


was made by the United States public

Campaigns-3: (1) n'or the otservance g,f May Day as Chilct Health Day.{,2.)' _{or-checking the registration of births of children ,"u*iueO atcnr l r l -bea l th conferences in : l count ies . (B) I . .o r 15s organ iza l ion o feorlbined ciilcl-hygiene conferences and tuberculosis clinics for children,in 15 counties.tu


Ag

pRrNCrPArr AcrrvrrrEs oF TNDTYIDUAL STATES, 1928 135

Activities-Continued.Talks ancl lectures-546, to aucliences totaling 14,2i02 persons'

Litc,rature distributed-50,351 pieces.New ,rnrres regstereO foi pre.natal letters-416; prenatal letters distrit>

utod---416 sets.C.iaout"

"oor*es in obstetrics anal pediatrics were conducted at the health-

officers, coilferelrce helrl in cooperatiorr with Vanderbilt University.Nutrition work was done throug[ inclividual iustruction o'f mothers.nirrinitt concluctecl-19, includirrg posters, rtlotion p ctures, and models'

at fairs and at various meetiDgs. Exhibit material ]ras lent twenty'

five tines.statistical stucly made-maternal and infant mortality, 1916-192i6' inelusive.

sreast feetling -was

emphasized through the tlistribution of 2,45O pamphlets- otr tnu subj"ect ancl t'hrough instruclion glven to nothers at conferences

ancl in home visits.fo|ints born in the State during the year-54,057;-infants und-er l year--o}-ig"

reached UV tfre work ;f the'division-1,535; preschool chilalren

reaci'etl-2,969' ; eipectant mothers leached-9G9'Ctiunties in tne Stat6-95; counties in which maternity ancl infanev work

' -';;;"6io." Ar.irg tne year-64; counties in which maternity and infancy

*oit fras been done lince the-acceptance of the maternity and infancy

act-96.The following organizations ecroperaletl in the clivision's work: state--Oepartment-ot

e,lucuGoo, Stat*--"di-l association, State conference of

soiiot *ort , State teOerition of women's elulx, and the parent-teacher

association.' e-oog-tne children examined at conferenc*s reported itr

the foregoing guiu-g.apis, 1?l were_ examined in the " Get ready for

sehool,' drive spo;soi.d' by tnu Nfltional congress of Paretrts and

Teachers.TYPES OF WORK AND SOME RESULTS

The clivision of child hygiene and public-heallh nursing was establisledl in

th; i;"i;'J"iu"t*""i ot pubtic health ln 1922- The governor aceepted lhq prq

;G;;;1 ih; maternity'and infancy aet on April 73,7922. This was followed

by legislative acceptance approYed b-y the-gov-ernor on l\farch 24,1923'-""pfriSciu"s

have'directedihe work of th1 division during most^-of the period

"t^.-o".,pui"iio", and additional-physicians have.served on the staff, also public-

n"uiin- oo"*"*. Changes in Stafe administration have brought ttbout some

"n"irg".l" ifre staf aiO in the progr,am ̂ of work. Nurses have been detailed to

""""iiu. and paid from maternity and infancy funds ill proportion to the amount

of time spent on maternity and infancy^work'--tire oiiirion has had the advantage of cooperation from the State department

ot-eaucation and from state-witle professional and lay orqanizations -(medicalas.o"iu1io", conference of social work, federation of women's clubs, and parent'

teacher association).-'Cnt-Stotu staff nurses have given arlvlsory and supervisory services to the

"o""tv publicJrealth nurses. In addition to the usual nursing program con-

A""t"A by the nurses tletalled to counties, itinerant child-health conferences

we"e conhu.tecl by a physician. Tlie negro woman physician on_ the staff in-

*li""t"A-u"a supervised the negro midwives and heftl crhild-health conferences

;;;-th;t;c;;es.^ st" also contlucted a campaign among the people of her own

race for better registration of births and deaths''-ii"i;ilat anct infancy funtls have been used sinee 1926 for the free distri-

bution of ampules of nitrate of silver."-'i'h; ;;"ip"'ign for admission to the Unitetl States bifth-registration area, in

*fri"fr tfr" div'ision assisted, resulted in the State's admission to the area ln

1i27. As the State was not admitted to the area until 1927, figures from theU""it"A States Bureau of the Census are avtilable for that year only. Theiritant mortality rate for the State as a whole was ?1 deaths in everi 1,000ii;-bt"til In urban areas the rate was 86; in rural areas it rvas 67. Ifhemaie.nat mortality rate for the State as a whole was 71 per 10,00O live births'fn urban areas the rate was 120.3; in rural areas it was 56.2.


g

TEXAS

Atlministrative agency:

srAFF aND acrrvrrr'S rN 1928

State department of hmlth, bureau of <rhild hygiene, Austin,I.-unds expended: n'ederal, 933,413.28; State, 934,609.64; total, 968,0"2.92.Staff:

Director (phy-rician),4 nurses (1 part year), l inspector of maternity andinfalt homes, 1 secretary, 4 stenographers, 1 mail clerk (half time),Ttlenty-seven county nursss were paid for half-time mateniity and in-fancy rvork (8 part I 'ear).

Yolunteer assistants--491 physicians ancl dentists. b1 nurses.Ac t i r i l i es :

Child-health couferences eonducted by physicians-€83; infants and pre-school childrerr registered-5,05T ; number examinecl---4,g94: visits to con-ferences-6.€3.

Defects found in childr.en examined at c<hferences-6,462; chiltlren havingdefects-3,852 Parents had defects corrected in 448 of the children.

Prenatal conferences conducted by phjsicians-22; expectant mothers regis-tered-62; number examined-144 (at eonferences, ?; in their homes,137) ; r'isits to conferences-l-13.

Conferences crrnducted by nurses, no physician present-536; children in-spected-3.521 ; mothers instructed in prenatal care-87; visits to con-ferences by children-7,738; visits by mothers-1,0b?. In addition 2,80behildren rrere inspected individually in the nurses' offices, and 2gb motherswere similarly instructed in prenatal eare.

Parents had 794 defects corrected in the children inspected by nurses.Dental conferences-G5; expectaDt mothers reeeiving dental examination-

73; preschool children receiving dental examination-2,772.New permanent child-health centers-2o established as a result of the ma-

ternity and infancy rvork. They are supported by county funds andmaternity and infancy funds.

Classes for girls in care of infants and preschool children-1O4 organized;giris enrolled-2,342; number completing course-1,801 ; lessons in iourse-12.

Classm for mothers-53 organized; mothers enrollerl-g32 : number com-pleting course-267; lessons in course-12.

classes for midwives-]5 orgauized; mids'ives enrolled plus those carriedoyer from previous year-918; number completing course--{b; lessonsin cours+*10.

Ilome visits by nurses-13,582 (prenatal eases seen, 1,886; obstetxical cases,260; postnatal cases, 772; infants, 3,0?2; preschool children, b,146).

Maternity bomes inspected--45; inspections macle-Td.Infant homes inspected-199; inspectioDs made-22?.Group demonstrations-1.492, on various phases of maternal and child care,

to groups of mothers, midrvives, teachers, and children.Campaigns--6: (1) For promotion r'f birth registration, state.wide. (21

tr'or observance of May Day as Child Health Day, in g counties, (gitr'or examination of preschool children and correction of their defects

, before the children sbould enter school, in 28 counties. (4) For vaccina-tion against smallpox, immunization against diphtheria, and inoculationagainst t)'phoid fever, in 8 counties. (b) F.or improvement in sanitation,important in reducing infant mortality, in 5 counties. (6) F.or enumera-tion of midwives, in 17 counties.

Talks and lectures---424.Litera_ture prepared---outline of study courses on care of the expectant

mother.

aoo


ff


PRTNCTPAL ACTrVrrrEs oF TNDWTDUAL STATEST 1928 137

Activities-Conti n ued.Iriterature distlibuted-S6.536 pieces'ffi[tti;-.ir,.."r-ri cond".t"',i by county nurses; enroll'rerit-197 pre-

school children.Exlribits conducted_28; acltlitional exhibits were conductetl by the county

nurses. Exhibit t"ui6"iuf p""pared--4 sets of charts showing the types

of literature ai.titiir"i"a^rrT-irr"-stut" department of health. Exhibit

mr t te l ' i i l [ $ ' l s len l s ix ty - t iVe l i t t tes 'Bre:lst fee(ling.to"

".pi,..ized il hcrlth clubs ttrught by the cou^rttl- nurses'

In fan tsborn in thes ta te t lu r ing theyear -92 ,1?0repor tec l ; ^ in fan ts r rnder1 year of rge

""ti.rt"i ;;' 'f" *"itt 9i the bureau--43'220; pteschool

.ttitotl"n .eac"rtea-i-0,+9rl ; "expectant m others reached-7'381'

rne--nureau s.'u,ts teiiui'i-io-irirrents of ail iuflnts whose births are reg-

isterecl in the staie bureau'of vital st:rtistics, advising them that litera-

ture on child ctre may be htrd upon request'counties in ttre staieiii+l

""ii"ti"" in.which maternity antl infancy work

\\,as done ,lur.tns iire i;il-6n; ctru'ties i. rvhich nr.te'rity nutl ilflncy

worli has bee[ ckrne since the accL'ptil]ce of tlte lratelnitJ altl infanc]'

act- l15.S i n c e t h c b e g i n n i n g o f t } r e S t a t e , s c o o p e r a t i o t r r r r i d e t t l r e m a t e r n i t y a n d

intancy act tlvo iounties have assumetl the responsibi-lity_ for maternity

uoa itttut.y *otk b.goo rvith maternity and infancy funcls'

The bureau organized i Stote hcalth council, outlineti.the org;tnization of

county health counciis for organizations intcrested in beaith work' ancl

cilstriijuted outlines for stutly courses to these groups'

The follorving n.go"jzution. .oi,pn"ut"o in the bureau's rvorli: state medical

association ana irliitiary, Siate league of women voters, State dental

association, a*er:ican i"gion and auxiliary. women's Legisl:rtive council'

""4

-pui""i-t"o.frn.*it"i"-lntio"J. fn" Strrte rlental ass.cirttio'- mlde a

suryey that iricl;;]ea- p;sahool chitdren. The auxiliary of the state

medical associatiin-i.iu"i,.O cnltO-neattn councils and parent teacher

association stuoy-circtis. Other assistance was siven in gglducting the

fiitli-registratloir campaign and irr securing the cooperxtioll- of county

pufiic-freaftfr oo"."J--'ettiong the chiltlren exaniinetl at child-healtlr con-

ferences reported in the foregoing paragraphs' 1'231 were examined in the. .Get ready forschoo l ' ' campaign .poo.o 'edby theNat iona lCongressofParents and Teachers.

Among the outstanding features of the year's work were the results accom-

plished iu the campaigi conductetl in coopcratiorr *'ith the prrent-teacher

associations.TYPES OF WORK AND SOME RESULTS

llhe bureau of chiltl hygiene was established in the State department of

h e a l t h i n l g l g . r n e g o v e r " " o . a c c e p t e r l t h e . p r o v i s i o n s o f t h e m a t e t n i t y a n di,iii-r"V act on F.ebruoii ZO, tgZZ. fnis -rv,r"..tjttowed by legislative acceptance

apptovetl by lhe governor on February 24' lC23'A medical director rras uee" li.

"tro.g" of ilre work of the bureau. x{aternal

and infant rvelfare nu, n"u" pro*ote,I through the activities of a number of

ioi,,iv- n""."s who arJ fiia il- part from naternitl' antl infancy funds, and

" *i"litli' smnll central'st:rff of

-ou.set. Two negro itinerant nurses who work

;ith th;;"F -idwioe. and with other persols among their own race are on

the State staff.""ilth";;;tt and State lvorkers had the benefit of cooperation-from the

State meaicai society u"-a ii. auxitiary alcl the State dental association, the

l*""i.u" Legion aitA -lis

ro"itia.y, -

women's organizatiols, parent-teacher

assoeiations, and home demonstration agents'-"i{;6i,I; ieuto."s of the work have been the establishment of ntany new

o".i"un"nt chila-health -centers,

increase in -the dissemination of i.formation

il;;;;;;i;"*-tni"rgt the distribution of the pamphlet prepared on that

.ofr:-"ii iiut.-*iAe "u-p?iq",,

t91 the promotion of 6irth and death registration

""d- fo" improvement iir the milk supbly ancl in sanitation, the great irlcrease

i" -iSzS

in ihe number of counties in-wnicn maternity and infancy work was

iil,r*,-in" ;cet ready for school,, ca-mpaign, and the assumption by two

""rrii* "f the financial respoilsibility foi maternity and infancy work begun

with maternitY and infancY funds.

482780_29-10

6'138 TEE wELFARE AND TTYGIENE oF MATEBNITY AND INFANoY

In 1921 the State legislature passed a law requiring the use of nitrate ofsilver in the eyes of the newborn. Since tle State has cooperated. underthe maternity and infancy act 3,697 midwives have received instruction whichhas ineluded directions for the use of nitrate of silver as well as iqformatiorrconcerning the importance of birth registration.

As the State is not in the Unitecl States birth-registration area no state-ment as to maternal and iafant mortality rates can be made,


6

UTAII


Administrative agencj' :- -SJate boarcl tif he-alth, bureau of child hygiene, Salt Lake City' - -

Funds expended: F.ederal, g13,000; State, $1,080.59 (for first half of fiscalyear only) ; total, $14,080.59.

Staff:-----Director (physician), 1 nurse, 1 dentist, 1 vital-statistics clerk' 1 stenog'-;;p6."nbur

pn!-sicians were employed as needed to conduet confer-

e n ^ c e s . F ' o u r c o u r r t y n u r s e s a n d o n e c o u n t y h e a l t h o f f i c e r r v e r e p a i d i npart from maternity and infancy funds.

Vflunteer assistantslapproximately 1,000 physicians' nurses' dentists, and

Iay Persons.Aetivi t ies:----Coi"nineA

prenatal a1d child-health conferences conducted by physicians-

526; exptctant mothers registered-180;. infants and preschool children,"gi'rt"".a-r0,9?; chilclren examinecl-10,900; visits to -c.onferences by

""-p..tu"t mothels-184; visits by infants and preschool chjldren-13'633.

Defects found in children examined at conferences-18,?99; children having- O"ie"ti--S,bZS. Parents had defects corrected in 2,056 of the chilrlren.

Dental conferences-125; expectant mothers receiving dental examina'- iio"-ZS; preschool children receiving dental examination-2,885' Inuddition'11-6 chilclren rvere given dental examinatio[ outsicle conferenees.

Nerv pernanent combined prenatal and child-health centers-33 establislieda s ^ a r e s u l t o f t h e m a t e r n i t y a n c l i n f a n e y w o r k . T h e y a r e s u p p o r t e d b ylocal funds.

classes for mothers--€ organized; mothers enrolled plus those carried oYerfrom previous year-192; number eompleting course--158'.

Home v-isits by nurses-1,900 (prenatal cases seen, 165; obstetrical cases'11; postnatal cases, 21; infants, 493; preschool chi ldren, 1'039)'

tr{aterriity homes inspected-5; inspections made-9.C"oup O6monstrations-122, of valious phases of maternal and chilcl care.Camiaigns-B: (1) n'or examination of preschool ctrildren and correction

of^their dcfects before they should enter school. (2) For observanceof May Day as Child Health Day. (3) For immunization againstdiphtheria and vaccination against smallpox. Assistalce_was-given iuthis campaign, which was conductecl by the State board of health'

Talks and lectures-2g?.Literature preparecl-Infantile Paralysis, Epidemic cerebrospinal Menin'

eitis.Liierature clistributed-25,000 pieces.Nerv names registered foi prenatal letters-665 ; preratrrl letters distrib-

uted---429 sets.Nutrition work was done through instruction given to gpoups of mothers at

many of the chikl-health i-onferences and to individual mothers ofchildren having nutritional defects.

Exhibit conducted-1, at the State fair, including fllms, posters' patternsfor layette and baby clothes, with demonstrations of feeding methods,dentai care, and irnmunization against diphtheria. 9xhibit materialprepared-posters, clothing for mother and baby. Exhibit material waslent tn'elve times.

Breast feetling was promoted by instruction given to mothers at conferencesand by literature distributed.

Infants -born

in the state ciuring the year-approximately 13,500; infants-lnd presclrool chiklren reach6tl by the rvork of the bureau-approxi-

mately 25,000; expectant mothers reached-1,010'139


6 140 TITE wELFARE AND IIYGIENE OF MAIERNITY AND INFANCY

Activities-Continued.The bureau sends literature on infant hygiene to parents of all infants

whose births are registeretl in the State bureau of vital statistics'counties in the State-2g; counties in which maternity and infancy work

was done during the year-25; counties in which maternity and infancywork has been d.one since the accelltance of the materrrity and infancyact-28.

since the beginning of the state's cooperation under the maternity andinfancy aci orre'clunty has assume<l tlre resposibility for -maternity andinfancy work begun with maternity and infancy funds.

As a res-utt of the bureau's wolk a number of communities in 11 countiesconducted 144 chilcl-health conferences without assistance from the statestaff; 1,857 infants and preschool children were given physical exami-nation; the total number of exauinations made was 2,942' and the num-ber of corrections of physical defects reported was 234.

The bureau rendered supervisory assistance to local organizations con-ducting matelnity and infancy work.

Prominelt church relief societles and the parent-teacher association cooperated in the bureau's work. They assisted at health centers and atdental conferences, lent maternity bundles, and helped to secure t}te namesof exp€ctant mothers,

The outstanding achievement of the year was the number of conectionsreported of physical defects found in child|en exanined at health conferences.


. The bureau of child hygiene was established in the state boarcl of health in7922. The governor accepted the provisions of the maternity and infancy acton January-23,1922. This was followed by legislative accept&Dce approvd bythe governor on X'ebruary 28,1:923.

A medical tlirector has hacl charge of the work, assisted in the fielcl by anurse and a dentist. l[aternity and infancy funds have been used to assistin maintaining county health units, in which both county heallh officers andcounty nurses have promoted maternal and infant welfare. valuable coopera-tion has been given by the parent-teacher association, church relief societies, anda farm organization.

Numerous chilcl-health conferences have been conducted in the full-time countyheaith units and by the director of the bureau. I\Iany permanent contbinednrenatal and child-health centers have been established, at which return antlrecular conferences were held. A large number of dental conferences alsohave been held in the last two years.

Infant mortality rates show a downward trend from 79?2 to 7927. Thelowest infant moitality rate eYer recorded in the State was reached in 79t1,rvhen 54 ilfalts un4ei 1 year of age tlied in every 1,00O born alive. In 1922(the year in which cooperation with the Federal Government was beguu) therate rvas 69: tbat is, 15 more babies died in every 1,000 born alive in 1922 thandied in 1927.

llatelnal mortality rates showed a dorvnrvard trend from ftr22 to 192fi,iuclusive, but 1927 was marked by a rise ir this rate.


4

YERMONT


Administrative ageney :State department of Publie

Funds expended: Total, $5'00OStaff:

health, Burlington.(all Federal).

Director (physician, State health ofrcer sewing), 1 nurse, 1 stenogtapher.

Activities:----Cttila-rtealth eonferences crgnalueteal by physieians--22; infants and.preschool

children registered and examined--688; visits to conferences-649.De-fects to""d in children examined at conferences-957; children having

defects--455.classes for girls in care of infants and presehool ehildren-5 organizetl;-

ii"ts ett"otied and completing course--55; lessons in course-5'Tatks and lectures-36. Many of these were illustrated by slides'Literature distributed-7,692 pieces.Breast feeding was stressed in the literature distributed and in all talks on

infant care.Infants born in the state during the yeat-7,312; infants under 1 year of

age reached by the work of the department-98 at conferences, 7,073 bybirth certificates; preschool children reached-589'

The department sencls literature on infant hygiene to parents. of infantswhose births are registered in the state bureau of vital statisties wheuthe parents request it from the list of available literature sent to them.

Countiies in the Btate-14; counties in which maternity and infancy workwas done during the Year-13'

The following organizaiions cooperated in the department's maternity andinfancy work: Federated women's clubs, parent-teaeher associations,mothers' elubs, and home-bureau groups. They assisted at conferencesand lectures and helped to bring the maternity and infancy work to theattention of tbe publie.


The governor accepted the provisions of the maternity and infancy act onJanuary 24, 1922, but the Federal allotment of $5'000 was returned to theFederai Treasury. Three years later the State again aeeepted the provisionsof the act, through legislative enactment approved by the governor on February20. 1:g%. Officiai action has not been taken to create a child-hygiene division orbureau in the State department of health.

The maternity and itrfancy funds available in the State are administereddire{tly by the State health officer, v'ho directs the maternity and infancy workwith a staff eonsisting of a nurse and a stenographer.

The program has not been continuous. In the first full year of the State'scooperation uncler the act a nurse conducted a demorlstration in a limited numberof rural eommunities. This rvas follon'ed by a state-n'ide educational programand an increasing number of child-health conferences. llhe sending of a birih-registration certificate, together rvith a letter offering literature and aclvice, tothe parents of every infallt whose birth was registered \\'as one phase of theeducational program. The year 1928 was marked by an expanding program inmaternal and child hygiene.

Cooperation has been maintainecl rvith women's organizations, the parent-teachel association, and home-bureau groups. fhe homebureau groups fre'quently arranged for the chiltl-health conferences and lent their officers tosgrnsor them.

Usually the effects of a health program are eumulative and are not at oDc€apparent, and Vermont is no exception to this rule.-there

has been a slight decline in infant mortality during the State's briefperiod of cooperation. The infant mortality rate in 1925 was 72 (deaths ofinfants under 1 year of age per 1.0O0 tile births) ; in 7927 tlte rate rras 70.

The maternal mortality rate has not declined cluring the period 1925 to 7927.In 1925 it was 67.9 (deaths of mothers from puerperal causes per 10,000 livebirths), and in 1927 it was 72.6.

141


{

VIRGINIA


Administrative ageney :State department of health, bureau of chitd health, Richmond.

Fun^ds expended: X'ederal, $2d,ET4; State, g2}d7t; total, 946,148.Staff:Director (physician),1 physician, B dentists (part year),8 nurses (1 part

year), 1 midr'ife supervisor (nurse), 1 supervisor of mothers' corre_spondence course (nurse), + sterlogrtphers, B clerks. Temporary assist_ants rvere employed as .eetled. tr'ifty cou^ty nurses and ten city nurses

. .. . \-\'ere paid ir part from maternity and infanCy funds.Activi t ies:

chikl-health conferences conducted by physicians-146; infants and ple-school children registered ancl examinerl-2,g7g. Irany local physicianscooperated by making examinations at these conferences. As ii ivas notpossible to examine all school entrants at the conferences conducted bythe bureau au endeavor had been made in 1926 to interesl parints intaking their children to a priyate physician for a physical efaminntionbefore the chilcl should enter school. The cooperatitin bt supei'intenaentsof. schools, physicians, and parents harl been einfsteo ana tiie e"p"rimenttried on a small scale. The sane pla' rvas followed in four'aoorrtiu,and one city in the summer of 1g2?, with the result that about one-thirdof the school entrants in three counties, more than nine-tenths in anotnercounty. ancl approximately oue-half of the school entrants in the citywere examined,

Defects found in chiltlren eramined at conferences-b.2}7; chiklren havingdefects-2,500. Emphasis was placed on the examintrtioi of chirtlren whowould enter school for the flrst time in the coming fall, so the majorityof the chiklren exami'ed were 5 and 6 years of ag.-e. The deniisG maoedental examination of 1,4it3 children at ihese confe-rences,

conferences conrlucted _by .urses, no physicia' p."s"ol---3+z; childreninsp-ected--4,167; nothers -instructecl iir pre'atal'care-r,oobi o-irit, toconf ereuces by children---4,80b.

Nerv permanent chiltl{ealth centers-13 established as a result of theraternity and i'fancy .'ork. TheJ- are supported ry maier'itv ana

- infanc). funds and by local organizationscla-sses for girls in care of -infants qrrl. preschool children-12 organized;girls e^nrolled-7,417 ; number completing course-g4; tessors in-EJu.r"-

10 to 32.classes for mothers-23 orga.nized ; rnothers enrolled--47g; lessons in

course-10 to 82.Classes for midwives-40 organizerl. in 20 counties; midn,ives

254; lessons in cour,se-S. Thc midrvife supervisoi conductecl8 counties aucl assistetl nurses in colrlucting classes in 12eounties.

enrolled-classes inatlditional

Ho.qe_visits by nurses-118,b?6 (prenatal cases seen, 1,444; postnatrU cases,__1.337: i l l fants. 4,187 ; preschool-chi lclren, g,B2g).Ilaternity homes inspccted---4 ; itspections macle___4.uommunit}' dem(,nstralion-1, of a maternity and infancy public health

nursing program, in B counties.Survey-1, state-wide, tf ho,<pittrr facilities available for maternity care.Th-e buretru i.s cooll€rating iti u study of materllal nior.tality beiri* J""_ducted in the srate bv the tr.ited states children's n"i""", ii;iFr, in"indorsement of the State n:rerlical society.Talks and leetures-181.I-iterature prelrarerl-Fee^ding^ilie Irrfaut, The Baby (revised),Literature distributed--228,836 pieces.

r42


€

III

I

pRrNcrpAL acrrvrTrEs oF TNDrVTDUAL STATES, 1928 L43

Activities-Continued.A corresporrrlerrce course for mothers was eonducted, for which 1,812

wonlel erlrollcd cluring the year (p1us 823 carried over from previous]'ear) ; lessons in co.ulse-lt divided into t\Yo sectioris, for eithet' ofwhich r.vonen may register if tliey do rrot wish to take the whole course;rumber' of wollrell corrtleting 12 lessons--435; many others completedone of tlie 6-lesson sections.

Trvo institutes for " doctors' helpers " were conducted, one at the Uni-versity of \rirginia (for white n'omen), one at the Virginia Normaland Iutlustrial Institute (for colored women). The daily 5-hour ses-sions wele divitled into periotls of two hours for l)taternity and infantcare, two hours fo: demonstrations in hotne nursing, ancl one hour forpersonrl hygiene. Physiciaus frtlm the University of Virginia MedicalSchool aDtl local ph]'siciaus in Petersburg cooperated by giving lectures.Attendance-55 (15 white wonrel, 4O colored wometr).

The bureau cooperated in parents' institutes held in six comtttunitiesund€r local auspices.

Statisticnl study made*infurt mortalitl', 1917-1922, as courpared with thatof 1922-192,7. in 23, courttics.

Breast feedilg was emphasizetl thrcugh instruetion given to mothers bythe rrurses, through a paper on the subject pt'esented to the Statemedical society. ard through use of a breast-feeding slogan on thebureau's stati0neIy.

The bureau sends liter:rture on infant hygiene to parents of all infantswhose birtirs are registeted in the Strte bureau of vital statistics.

Counties in tire State-100; counties in rvltich materllity and infaneywork was done during the J'e:rr-54; coulltios in which titaferuity andinfancy work has been done sil<e the accoptance of the maternity andinfancy act-97.

Since the beginning of the State's cooperrtion under the maternity andiuftncy act one countl- has lssuutetl the responsibility for nraternityand infancy wo'rk begun with maternity and itifancy funds.

The following orgarrizations coopet'ated in the bureau's rvcrk: State leagueof wornen votefs, ar.h-isory contuittee of the State medical society, Vir-ginia Polytetfhnic Illstitute (home-economics extension serrice), Coop-emtive Education Association, alxl the Arnericirn Red Cross.

An outstancling feature of the yezrr's program ri'as the furtherance of thework nnrde possible through the cooperatiorr of locitl physicians and of theadvisory comutittee of the Strtte metlic.tl society.


The bureau of child health was established ir the State department of healthin 1918. The State uccepted tlte provisions of the maternity and infancy actthrough legislative enactrnent approved by the governor on X'ebmary 27,7922.

The same rnedical directol has been irt chalge of tire work during the entireperiod of cooperation with the l'ederai Goverutuent. A small central staff con-sisting of an additionrl physiciau antl three nurses has conducted the generalfleld work the past few years.

Ilaternity and infancy funtls have been granted to counties and communitiesto assi-qt with the salary and expenses of publiq-health nurses who have givenpart of their services to maternity and infancy work. X'orty to 50 nurses havebeeir ttrus emploJ.ed in courrties and 10 in citie-q in 1927 antl 1928.

The burenu has had the a,.lvillrt:rse of cooperation by the Stlte meclical society,the Virgrnia Polytechnic Institute, and the Cooperirtive I}lrication Association(tirrough its clivisiorr supelintenclents), the American Red Cross, and the Stateleague of $'olneil voters.

IJe<rruse 60 public-health nurses were corrtributing some services to the rna-ternity rnd infaricy work cluling 1923 their visits to homes of nothers and in-fants were especially prominent in the utaternity and infancy program of theState. Instruction to special groups, mothers' correspondence courses, classesfor miclwives, and institutes for " doctors' helpers " disseurinated further infor-mation on materntrl and child care.

Literrture on infnnt care, including that sent to parents of all infants whosebirths rvere rcgistered, has reached an increasing number of persons within thepasr few years.


**

I44 THE wELFARE AND HYGIENE oF MATERNITY AND INFANOY

The study of maternal rnortality sponsored by the State medical society,which is being rnade in the State by the United States Children's Bureau rviththe cooperation of the State bureau of child health. is exnected to fnrnishvaluable infonlration.

first(75

1922 tS277 1 . 8 6 1 . 55 8 . 3 4 7 . 9

101. 7 93.6111.9 to4 .zBt.z 49.6

The infant rnortality rate has fluctuated during ilre period 1g22year of the State's cooperation under the act) to 1927, the rate inper 1,000 lile trirths) being slightly lo\yer than that in \922 (77).

( the1927

The maternal death rate sholvs a material decrease, ttre 1g2? rate being thelo-west since virginia w:as admitted to the united States birth-registration area.The rates for both white and colored mothers $'ere lo$,-er in 1g2T than in 1g22.The rates for both ut'ban and rural areas were also lower in 1g2? than in1922 (6.9 per cent lower for urban 4reas and 19.1 per cent lorver for ruralareas), as is shown by the follorving figures:

Moternal, m,ortalitA rates (ileaths of ntoth,ers from puerperal, cmrses per 10,000lit;e births)

State--------White-------Colored------Urban-------Rural -------


ff

WASIIINGTON


Administrative agency:State departmeni of health, rlivision of publie-health nursing anal child

hygiene, Seattle.Funds eipencled: Total, $5,000 (all n'ederal).Staff:

Director (nurse, not paid from maternity and infaney funds)' 1 stenog-rapher, i clerk (part time). Twelve physicians were empioyed as neededto-conduct conferences. One county nurse was paid from maternity andinfancy funds (half year).

Activities:Chilct-health conferences conducted by physieians-?4; infants anrl pre-

school children registered and examined--3,152. Lecal dentists madedental examinations at these eonferences.

Defects found in children examined at conferences--4,788; children havingdefects-1,979. Parents had approximately two-thirds of the defectscorrected.

New permanent child-health centers-9 established as a result of thematernity and infancy work. They are supported by local organizltions.

Group tlemonstrations-at about a third of the child-health conferences,of layettes, proper footls, preparetion of formulas, and the giving ofsun baths.

The rli'r-ision is cooperating in a study of maternal mortality belng con-ducted in the State by the United States Children's Bureau with theindorsement of the State medical society'

Campaigns-2: (1) tr'or prevention of diphtheria, in 3 counties. Planshave been formulated for a state-wide campaign for prevention ofdiphtheria. (2) For vaccination against smallpox, state-wide.

A state-wide May Day program was sponsor€d by the division, features ofwhich were health demonstrations, lectures, chiltl-health conferences'window displays, and radio talks.

Talks ancl lectures-90. Some of these were given by pediatricians beforecounty medical societies to emphasize the value of periodic health exami-nations of children and were intended to stimulate local communities toconduct child-health conferettces at regular interYals.

Literature distributed-18,114 pieces.A 15-lesson correspontlence course for mother-q was conducted through the

extension bureau of the State univerrqity; mothers registered (including48 cauied oyer from previous year)-126.

Nutrition work was done through instruction to individual mothers atcorrferences. The extension service of the State agricultural college co'operated in the nutrition work, specialists conducting a number of nutri-tion classes for mothers of preschool children.

Exhibits conductetl-approximately 55, on nutrition, sanitation, antl hy-giene, at fairs antl chiltl-health conferences. 'Ihe motiotl-picture lilmSun Babies was shown twenty-eight times. Exhibit material was lentfourteen times.

Breast feeding rvas stressed in all ctmferences and lectures' Inforuationin regard to feeding was secured for 1,507 of the infants examined at thecotiferenc€rs: 44 per cent \\'ere breast fed, 33 per cent partly breast fed'and 24 per cettt artificially fed.

Infants born in the State during the year-23,M3; infants under l year of. age reached by the rvork of the division-1,106 (exclusive of those reached

by literature distriliuted) ; preschool children reached-2,046 (exclusiveof those reaclred by literature distributed).

L45


$146 THE wELFABE AND EYGIENE oF MATERNITY AND INFANCY

Activities-Continued.Counties in the State--39; eounties in whieh matemity and infaney work

\\'as_ d-one-during the ymr-25; counties in which matcrnity and infancywork has been done since acceptance of the maternity :rnd infancy act-85.

Since the beginning of the State's cooperation urrtler the mateinity andinfaney act flve cou.ties ha'e as-sumed flre reslxrnsibility for maternityand iDfancl' rvork begun $'ith materr)ity and infancy furrds.

As a result crf the cli'ision's s'ork three $'eight aud measuremmt clinicscorrdu{ited by lay'gftrups supervised by nurses rrere established, classes ininfa.nt feeding $:ere begun in connection with rveight ancl measurementclirtics in several counties, courscs of lectures for mothers n'ere given inthree citits, ancl classes for mothers \\'ere conducted in tlvo ruial com-munities.

The follorring organizations crxrperated in the dilision's rvork: state asri-cultural colk'ge, state medical asstrciation. american Red cross, statefederation of rvomen's clubs, p-areut_teacher associations, ancl preschoolcircles. l'heir ccroperation 6.6nfi"1"d largely of sponsoring child_healthconferences or assisting l-ith them.

Among the out,standing features of the year's work were the campaigns forplelentiolr- of diphfheris antl smallpox, the initiation of a study of miternalmortality i:r-cooperation rviLh ilie Unitetl States Chiltlren's Bureau, and iecturesby pediatricians before county medical societies.


- The division of public-health nursing and child hygicne was establishedin the state departnrent of health in 1920. The State aicepted the provisionsof the materDit]' and ilfancy act through legislative enactment approved by thegolernor on l{arch 16, 1923.

During the first few years of cooperation with the n'ederal Government aph.v.sician directed the work of the clivision. Later a nurse served as director.Prrrmir:r:nt pediatricians have been emplol'ed on a part-time basis to conductchild-health confererrces and to lecture to countl' mehical societies on maternaland infant hygiene. Nurses paid from mlternity and infaniy funds havebeer: detailed to counties in a generalized nursing service. Thii has resultedin the assumption by five counties of the mairrtenance of this type of nursilgser vrce.

'rhe division has had the benefit of cooperation from the state universityanrl the State agricultural college, the Ameiican Red Cross, the State merlicalassrrciation, women's organizations. and parent-teacher associations.'l'he major feature of the child-hygiene program has been the developmentof interest in infant and child care thrOugh chilcl-health conferences aDdthrough visits to mothers, infants, and preschool childreu by the public-healilrnur,ces.

l'he eg-ect of the program is reflected in the decline of the infant mortalityrates. The rate for 1927 was the lowest the state has had since it enteredthe birth-registration area (in 1917). In 1g22, the year before coop€ration underthe, maternity and infancy act, 62 babies under 1 year of age-died irr every1,000 born alive, whereas in 1922 the rate was b0, a saving of 12 babies inevery 1.000 bont alive in 1927 comnared with 1g22.

?lre maternal mortality rate bas fluctutted from year to year. ln 7g22the rate was 78.8 (puerperal deattrs per 10.000 live births), whereas in 1927the rate was 66.5. The lowest rate (60.2) was that of 192b. In no yearsince the state's cooperation under the maternity and infancy act has thedeath rate from puerperal causes been so high as it was in 1922. Informationfurtrishitlg a basis for further effort towarcl reclut.tion of matemal nortalityn'ill no d.ubt be forthcoming from the study of maternal mortality norv inprogress in the State.


fi

WEST VIRGINIA


Adnrin istrat ive agency :Sttte tlcpartment of health, division of child hygiene

ing, Charleston.Funrls eipended : Irederal, $18,474.42; State, $14,871.74 ;Staff :

ancl publie-health nurs-

total, $33,286.16.

Diroctor (nurse, part time),1 nurse, l vital-statistics field rvo|ker, I vital-statistics clerk,-1 auditor (2 months, part time), 1 steDograpler, 1 clerk.T$erity-t\,to.ou'ty lurses i' lti counties were paid in full or in part frournaternity and infancy funds.

Activi t ies:Chikl-health confereuces contlucted by physicians-454; infants and pre

school children rcgisterecl and examinecl--3,557; visits to conferences-5,516.

New perrnanent child-heat,h a*111srs-21 establishecl as a result of thematelnity and infancy work. 'Ihey ars supported by n'ederal' State, andcounty funds.

Classes'for girls in care of infants and preschool children-83 organized;girls enroll,ed-1,212; number conrpleting course-351 (report incomplete) ;lessons in course-12 to 16.

Classes for rltothers-53 organized; mothers enrolled plus those carricd overfrom lxevious year-1,507; number completing coul"se-more thau l]35(report incolrplete) ; lessous in course-4 to 12.

Ilome visits by nurses-12,814 (prenatal cases soen, 1,428; obstetrical cases,?2 ; postrratal cases, 1,1i09; infalt ts and preschool chi ldren, 6,308).

Group tlemtinstrations-32O, of various phases of maternal and infant care.Sulveys-2: (1) Cost of metlical cale. (2) Comnuttity htalth couditions

affecting children.Campaigns-5: (1) For clear-r milk supply. (2) X'or exatlination of pre-

school clrildren altd correctiol of their defects befote the cltilclreu shouldenter school. (3) For obst'rvance of llay Day as Child Health Day'(4) li'or ilrmuuizltiorr against diphtheria and scarlet fever, inoculationagainst typhoial fever, and vaccination against snrallpox. (5) n'or earlydiaguosis of tuberculosis.

Talks and lectures-696.Literatule prepared-Irrenatal letters, form for community-health survey,

outline for orgtrnizution of child-health cuferences, outline for orgauiza-tion of nutritioll wot'k, scole sheet for nutrition prograill.

Literature distributed-74,583 pieces.New narDes registered for pt'enatal lctters-1,677 ; prellatal letters dis-

tributed-1,285 sets.A correspontlence course for mothers was coltrlucted, for which 6,84'1 womeu

were erir'olled (plus 7,206 carried over frorn previttus 1'ear). TIte courseconsisted of letters and Iiterature conceruiug the prcnatal and preschoolperiods sellt at intervals; it differed from the usual correspontlence coursein tbat aDswers to qucstions were not sent in by the m{}thers. WhertexpectaDt mothers registe| for the course they are serlt flrst a series olfive prenatal letters a n'eek apart. nlany of the fuu-time county healthofficers send letters to parents of nervborn infants upon receipt of birthcertificates, offering to enroll the mothers for this colll'se.

rlilutrition 'work rvas done tiirough riutrition classes and individual worklvith mothers, through the motherhood correspoldence course, attd iuhome visits. Plans have been made to launch a state-wide tlutritionprogram in cooperatiol wiUr other State agellcies.

Dxhibits crlrducted-2. The division s'as also t'epresented in 5 exhibitconducted by tle bureau of public-health education of the State departement of health. Exhibit matefial s-as lelt 8 times.

747


&148 TEE wELFARE AND EYGmNE oF MATER,NITY AND INFANCY

Activities-Continued,.Statistical studies made-maternal and presehool-ehild deaths, by counties;

public health nursing activities; women enrolled for motherhood corre-spondence course, by counties.

Breast feeding was ernphasized in talks and lectures given and irr literaturedistributed.

Infants born in the State during the year-approximately 45,000; infantsand preschool children reached by the work of the division-approxi-rnately 16,fi)0; expectant mothers reached-approximatellr 3,100.

Counties in the State-55; counties in which maternity and infancy workwas done during the year-39; counties in n'hich maternity and infaneyworli has been done since the acceptance of the nraternity and infancyact-50.

Since the beginning of the State's cooperation under the maternity anclinfancy act one city has assumed the responsibility for maternity andinfancy work begun with maternity and infancy funds.

As a result of the division's work farrn women's clubs organized and con-ducted child-healtlr conferences throughout eight counties. Local physi-cians made the examinations, and. a nurse from the division's staffassisted at the conferences.

The division rendered advisory and supervisory assistance to local organi.zations upon requesL

The following organizations cooperatd in the division's work: Statedeparturent of education, State university (extension division). Statetuberculosis associrrtiorr, State league of rvomerr voters, farm wornen'sclubs, and the parent-teacher association.


The division of child hygiene ancl public-health nursing was established inthe State department of health in 1919. The governor accepted the provisionsof the maternity and infancy act on February 6, 1922. This rvas followed bylegislative acceptance approved by the governor on April 13, 1923.

The same nurse has directed the work of the division during the entire pe.riodof cooperation, with the assistance of one or more nurses and clerical workers.An increasing number of public-health nurses (22 in 1928) have been detailetlto couuties and paid from maternity and infancy funds in proportion to theamount of time given to maternit)' and infancy work.

Cooperation has been maintained with other branches of the State government(the (lepartment of education and the State university.y, $'ith the Slate tuber-culosis ilssociation, women's organizations, and the parent-teacher association.

Emphasis rvas placed on child-health confer€nces, classes for mothers ininfant and maternal care, classes for girls in infaut eare, motherhood corre-spondence courses, establishment of centers, and exter)sion of rvork through thedeveiopment of county health departments and placing of county nurses.

Nitrate of silver for use in the prevention of ophthalmia neonatorum has beendistributed free by the use of maternity and infancy funds since 1926,

The division has assisted in campaign work for the State's admission to theUnited States birth and death registration areas, rvhich was accomnlished in7925. The infant mortality rate was 80 in 1925 and T2 in 1922; that ii, g fewerbabies died in every 1,000 born alive in 1927 than in 1925. The maternal mor-tality rate (puerperal deaths per 10,0O0 live births) for the State as a wholewas 61.5 in 1927 as compared with 63.3 in 1925. The rate in rural areas was50.8 in 1925 and 46.8 in 1927; in urban areas the rate was 11?.2 in 192b and130.3 in 1927.


#

WISCONSIN


Administrative agency:state board

-ot neattn, bureau of child welfare and public-health nursing'

I\Iadison.tr'unds expended: f,'ederal, $29,303.55; State, $22,?51 '62i total, $52'055'17'Staff:' --

I i i rector (physician),4 physicians (1 part year),4 nurs-es' 1 or,ganizerof intanl-hygiene cours-es-(part year), 1 clemonstrator of infant-hygieneclasses, 1 lublicity erlitor (pari year), 1 vital-statistics fleltl lvorker'2 vital-statistics clerks (part iear) , 1 bookkeeper and filing clerk, 1 silver-nitrate clerk (part yeai), f general clerk. 2 stenographers-' One countynurse was paid in part from maternity aud infancy funds'

Volunteer assistants-28 physicians, 171 nurses, 162 lay p€rsons'Activities:---

ComfrineA prenatal and child-health conferences con6ucted by physicians-434; expictant mothers registered and examined-272; infants and pre-school chilclren registered and examined---6.824; visits to conferences byexpectant mothers-3O3; visits by infants, and preschoo^l ch-tldren-11,43?.

Defe^cts found in cbildren examined at conferences--€,123; children havingdefects---6.065. Parents had defects corrected in approximately one-thirdof the children.

New permanent combined prenatal and child-health centers-2o estabiishedas

-a result of the bureau's maternity and infancy work. They are sup-

ported by local, State, and maternity and iqfancy funds-. - Six of theseienters were the outgr.owth of demonstratiou child-health conferencesconducted periodically by the bureau.

The promotio^n of infant-hygieDe courses in the schools of the state hasbee^n continued. Two s'orkers gave full time to this activity (one forhalf the year only). Demonstration courses were given in selectedschools, and wherever the teBcher approved boys as well as girls wereincluded in the classes. Demonstlation classes were given also beforerural mothers' clubs, and the clubs in turn sponsored the introduction ofthe course in tlre schools in their respective communities. 'Ihe course isgiven in many of the schools of the State, and as in former -vears theState boartl of health issned certificates to pupils completing tlie course.During the year 4,901 pupils completed the course in schools that re-ported to the State board of health. Certrficates are not issued to stu-dents above high-school grades.

Ilome visits by nurses-1,i0 (prenatal cases seen' 48; postnatal cases,53;infants, 464; preschool children, 7,2M).

Community demonstration-1, of prenatal care and care of the pr€schoolchild in a public health nursing program, covering 1 county.

Group demonitrations-295, to students, teachers, women's clubs, and othergroups, on various phases of infant and preschool-child care.

Surveys-2: (1) Of birth registration, state-rvide. From November' 1927'a fleld worker colered the State, county by county. Local registrnrs,clergymen, and newspaller editors were iuterviewed' and the importanceof birttr recistration was stressed. (2\ Of maternal mortality. InSeptember, 192?, the State medical society passed a resolution indorsinga proposed intensive study of maternal deaths. One physician wasAetaiteO to give. full time to this work, which rvas begun late in Feb-ruary, 1928. By the close of the fiscal yeat 172 deaths had been studied.

Talks and lectures-143.Literature prepared-pamphlets on goiter (revised)' diet charts, prenatal

letters.Literature clistributecl-413,191 pieces.

149


150 TITE wELFARE AND ITYGIENE oF I\IATERNITY AND INFANcY

6 Activities-Continuecl.New names registered for prenatal letters-2,390; prerratal letters dis-

tributed--3,168 sets.Exhibits conducted--S, consisting of layettes, Iiterature, and posters at the

State fair and fve county fairs. Exhibit material prepared-spot maps,graphs.

Breast feeding was stressed in individual instruction to mothers at healthcenters, in lectures, and in the literature that was sent to parents witheach birth-registration card. About 90 per cent of the children whoattended the health centers \\'ere breast fed.

Infants under 1 year of age reached by the work of the bureau-62,680;preschool childlen reached-5,343; expectant mothers reached-8,488.

The bureau sends literrture on infant hygiene to parents of all infantswhose births are registered in the State bureau of vital statistics.

Ccunties in the State--?1 ; counties in rvhich mlternity and infancy workwas done during the year--{6; couDties in which maternitl' ancl infancywork has been done since the acceptance of the maternity and infancyact-71.

Siuce the beginning of the State's cooperation under the matemity andinfuucy act 22 counties and communities have assumed the resnonslbilitvfor ntaternity and infancy n'rrrk begun with mltt ,rnity antl infancy fundi.

As a result of the bureau's rvork m:rny p€rmanent child-health centers wereestablished by local agencies, and county-rvicle campaigns for the pre.vention of goiter and diphtberia were begun iu a number of counties.

The follorving organizations coopernted in ilre bureau's work: State fed-eration of women's clubs, State federation of colored women's elubs, Stateleague of wonlen voters,,the America' Red Cross, and the pareut-teacherassociation. These organizatiorrs helped tu flnunce p,rmanent healthcentels and referred names of mothers to the bureau for nrenatalirrstruct iou.

Among the outstanding aehievements of the year were the securing of con-tinuetl local support for health centcrs already eshrblished aud the arriugementwith local communities to assume responsibility for other centers whiah hadpreviously been operated by the bureau.


The bureau of child welfare and public-health nursing was establishedState board of health in 1919. The governor accepted the provisionsmaternity and infancy act on December 22, 1921. This n'as followed bytive acceptance approved by the goverrror on tr{ay 18, 1923.

The program of maternal and infant welfare is conducted by a State staffgf physicians, ngrses, and other workers. Cooperation has been given by locallay groups and by various state-wide organizations of women (both white andcolored), the American Red Cross, and the parent-teacher association. Coopera-tion betrveen the State departme.nts of health and of public instructior hasmade possible the introduction of courses of infant hygiene in the curriculumof the public schools. One or two organizers or instructors from the staff ofthe bureau of ehild welfare and public-health nursing have been detailecl toorgarrize the classes in the schools and to give instruction in infant care toteachers who conduct the course. A special effort has been made to include thework in both graded and rural schools.

Early in the history of the State administration of maternity and infancyfunds a " child-n'elfare special." or health ttuck, was placed in the field to carrya physician and nurse who rvould examine chiklren and disseminate informationon child and materDal care in the rural districts. The special was retired fromservice in October, 1927. This itinerant service, together with the organizinganrl conducting of demonstration centers by the State staff, has resulted in theestablishmerrt of many permanent child-health and prenatal centers, some ofwhich are now supported by local funds. The number of permanent centersorganized has increased each year; 20 were formed in'1928. Cooperation oflocal women's groups has made their fnancing possible.

In October, 7927, a study of naternul deaths, inclorsed by the State medicalsoeiety, rvas begun in the State. The llnited States Chilclren's Blreau rvillcooperate in tabulating, analyzing, and publishing the data collected.

The State began free distribution of nitrate of ,silver for the nrevention ofophthalmia neonatorum in 1911, ancl maternity and iufancy funtls have been

in theof the

legisla-


#' PRINCIP^{L ACTN-ITIES OF INDTVIDUAL STATES, 1928 151

used to assist in the distribution of this prophylactic since 1923. A survey madebefore this date shorved ophthlilmia neonatorum to be the cause of blindness of25 per cent of the total number of children in the schools for the biind, Nosurvey has beeu rnade ,since, but reports indicate that the number of such caseshas decleased at lexst 75 per cent.

The infant mortalitJ. rate in 1917 (the year in which the State was admittedto the United States lrirth-registration area) was 78 infants under 1 ].ear ofage dying in every 1,000 born alive. The infant mortrlity rate in 1g2T rvas

O Centers supported by rnaterni ty and infancy fun{sE C e n t e r g s u o o o r t e d l o c a l l v@ Centers suf fonted locat t ! except that examiha-

t i ons a re made by S ta t€ s t a f f phys i c i ans


€

WYOMING

Adniinistrative agency:

srAFF AND Acrlvrrl's I\ 1928

State department of public health, dir-ision of maternal and infant welfare,Cheyeitne.

Funds expended: Federal, $5,057.12; State, $5,000; total, $10,057.12.Staff:

Dilector (State health offieer ser"ving)' 1 vital-statistics clerk,(part year). Five county llurses were paid from maternity andfunds (part year).

Yohuteer assistaDts--4g physicians, 15 dentists, 15 nurses, 06 lay

1 clerkinfancy

persons.Activi t ies:

CLild-health conferences conducted by physicians-54; infants and pre'school children registered and exaurined-7,252.

Defects found in children examined at conferences-631.Conferences conducted by nurses, no physician present-?; mothers

in9-67.Classes for girls in care of infants and preschool children-10 organized

by a nurse lent to the division by the United States Children's Bureau;girls enrolled-147; number completing courss-106; lessons in course-€.

Classes for mothers-72 organized by a nurse lent to the diYision by theUnited States Children's Bureau; mothers enrolled---4&3; number com-pleting course-33S; lessons in course--6.

Home visits by nurses-3.373 (to prenatal cases,401 ; obstetrical cases, 19;Ircstnatal cases, 258; infants, 908; preschool children, 1p08; and follow-up visits to other agencies-579).

Group demonstrations-22, of various phases of maternal and infant care.The State health offcer made a special efrort to impress upon all persons

with whom he came in contact at various health conferences over theState the urgency of immunization ag:rinst diphtheria, inoculation againsttyphoid fever, and vaccination against smallpox.

Talks and lectures-150.Literature prepared-several articles on imurunization. These were dis-

tributed at eonferences and by the nurses.Literature distributed-approximately 10,900 pieces.Nutrition work was done through talks and the distributlon of literature.Breast feeding was stresed in instruction given at conferences and in

home visits.Infants born in the State during the year-4,456; infants under 1 year of

age reached by the work of the division (exclusive of those reached byliterature distributed)-908; preschool children reached-1,208; expec-tant rnotherp reached-approximately 400.

The nulses working in rural areas checked the registration of births of theinfants rvith wliorn they came in contact and had births registered andcertificates issued for those not registered; they were appointed deputyregistrars for this puq)ose.

The division sends literature on infant hygiene to parents of all infantswhose births are registefed in the State bureau of vital statistics.

Counties in the State-23; counties in which maternity anti infaucy workrvas done duriug the year-22; counties in which maternity and infancywork has been doue since the acceptance of tlie maternity and infancyact-23.

The parent-teacher association and other organizations (not reportecl byname) cooperated in the division'-< work.

Among the outstanding features of the year's work were the stressing of theimportarrce of hJ'gicle rrork fol rural chiltllerr and of the need for imrnrutizationagiirrst iliphthelia, inoculation against typhoitl fever, and vaccination agailtstsmallpox.

1 R O


6pRrNcrpAL ACTTVTTTES OF TNDTVTDUAL STATES, 1928 153

TYPES' OF WORK AND SOME RESULTS

The division of maternal and infant welfare was establishecl in the Statedepartment of health in 1922. The governor accepted the provisions of thematernity and infancy act orr January \6, 1922. This was followed by legisla-tive acceptance approved by the governor on n'ebruary 20,7923.

Changes in the State administration and resulting changes in the pe.rsonnelof the State department of health hav(] interrupted the continuity of the mater-nity and infancy program.

Early in 1927 plans ri'ere made to cover the State with a nursing service byassigning several counties to eaeh of the nurses, with the exception of onecounty which had a full-time county unit and to which a nurse paid by ma-terlity alrd illfancy funds had bc-en detailed. tr'ive nurses paid from ma-ternity and infancy funds were assigned to the field work, and a nurse lent bythe United States Children's Bureau assisted. The program of work for thenurses included visits in the homes of infants, preschoul children, and expectant

1 mothers, arranging for child-health conferences, improving birth registration,I giving instmction to classes or groups of girls in infant and child care and toI groups of rvomen in infant and prenatal eare, and disseminating informationL on the importance of immunization against diphtheria, vaccination againstI smalll,rox, ard inoculation against typhoid fever. The flve nurses have continuedI tnis program in 1928. under the direction of tbe State health officer.I tne division has had the benefit of cooperation from the parent-teacher asso-I ciation, womer's clubs, and several other organizations, and of volunteer assist-I ance frorn a number of professional and lay workers.I f:ne sending of literature on infant care from the division of maternal andI infant welfare to parents of all children whose births are registered waS con.I tinued during 1928.I In 1922, the first year of the State's cooperation under the maternity andI infancy act, ?9 babies in every 1,000 born alive died in their flrst year of life;

I in 1927, 69 died irr their frst year.

| 48278"-29-11IIII

I

I

1_


#

FEDERAL ADMINISTRATION

FEDERAL STAFF

The maternity and infant-hygiene division of the Unitcd StatesChi ldrenrs Bureau,,one of i ts hajor t l iv is ions, was created in lg2Ito assist in the administration of tlie maternitv and infancv act. Thebureau- has keirt in touch rvith the work of the States throrigh reportsfrom the States, stafr visits to the States. and the annual C-onferenceof directors of the State bureaus and divisions in charse of the localadministration of the_act. Reports from the States includqd budgetsand pla^ns sub_mitted for appror.al to the Federal lJoard of Materiityano prans suDmltand Infant Hygiand lnfant Hygiene, an annual repor t on act iv i t ies, and semiannualfinancial repoitl iopies.of nront'hly or.-othe-r reports macle by thedirectors to their resirective State irealth ofrcers also are rec"eivedfrom many States.

During the vear under review 10 persons (4 phvsicians. 2 uubl ic-health nyrlef:-an auditor, and 3 cl'erical worl<eri; were regularlygmployed _full time in the maternity and infant-hygiene dlvisiori.Seven additional physicians were employed as the maternal-mor-tality studv was be^guh in suecessive StateJ. (See p. 1bT).- The physieians on the stafr included: (1) The direct6r, who was

lhe execut ive off icer of the divis ion and l iho gave consult ing serviceto State directors in the field; (2) an assoEiate pliysiciai, whoseduties included research, consultint service, ans*ering of'special<'orrespondence, and preparation of literature and a*news-l-etter;(3)_a physician in special charge of details of the materrlal-mortalitystudy being conducted by the bureau; and (4) ,a negro physiciari,wh,o gave instruction to negro midrvives in regard to midu'ifery pro-c9du1e and the reporting of births. Trvo part-time consultairti inchild hygiene and-a part"-time consultant in^ obstetrics were also onthe bur-eiu's stafr. The public-health nurses advised and assistetl inState programs and in campaigns for the plomotion of birth regis-tration an--d did other speciai pi"eces of field^rvork as lequested byiheStates. The auditor his audited the accounts of cooperating Stateagencies. The regular office staff consisted of a secretary a-nd twost--enographers.

CONFERENCE OF STATE DIRECTORS

The fifth annual conference of directors of State bureaus anddivisions administerins the F ederal maternity and infancv act washeld at the Children'J Bureau in Washington, April 2 to 6, 7928.Represeltatives attended from 43 cooperating States and the'Terri-tory of Hawaii. State health officers ivere pr6sent from five States-Arkansas, Michigan, Oregon, Utah, and lVyoming. In addition tothe 35 diiectors a nirmbei of associate directors, Jrpervising nurses,and other members of the State bureaus and dii'isio:ns rvere-present.Represeltatives from the three noncooperating States also alttendeclthe conference, likewise a numhr of reprrsentatiyes from private

154


{organizations for the furtherance of child rvelfare or hygiene or re-latld pulposes. 'Ihe total number of persons present- was 82, notincluding field workers of the maternity and infant-hygiene divisionwho rettirned to Washinston for the cbnference and biher membelsof the Chilclren's Bureau stafl. This annual eonference has beenextremely valuable in developing a better understanding of maternaland infant hygiene, methodi oflooperating with local"communities,and infant hygiene, methods of cooperating with local communities,and methocls of interesting parents in better care for their children,also in solvins prokrlenis of office administration.also in solving problenis of office administration.

The fir 'st three davs of the conference were (The fir'st three davs of the conference were devoted to discussionof the fol lorving gen"eral subjects: Care during delivery and confine-rnent. reduction of the maternal and infant mortalitv rates in rural

FEDERAL ADMINISTRATION 155

confine-rnent, reduction e mateinal and infant mortality-rates in ruralareas of certain States, reports on phases- of maternity cqle in twoforeign countries, causes and ion of neonatal mortality, prog-forergn countrres, causes and preventron of neonatal mortahty, prog-ress of the studv of maternal'mortalitv. and general administrativenroblems. Medbers of the Childrents" ilureau"'s consultins commit-problems. Mcnibels of the Children's-Bureau-'s eonsulting commit-prolllems. -Lvlembers or the uhrldren's ljureau's consultrng commrt-tees on pediatrics.and on,obstetri$; and other prominent p--hysicians,

several of the papers read.

leaders in public health, health officers, and nurses took part in thet)rogran) and tliscussions. The rrapels. some of which have beenfrinted in professional journals,^fo.m part of the confet'ence pro-ceedings to be published by the Children's Bureau. A limited num-ber of'copies will be ao-iilable for distribution, also reprints of

seral or tne papers leao.The fourth day of the conference was spent in Philndelphia visit-- l r . ^ / . \ L : l l - ^ - i ^ t f ^ ^ - i + - l ^ + r L ^ : . . - , : r ^ . : ^ ^ ^ 4 T \ - t f ^ . . - ^ - l / - r l ^ : l l -ing tlre Childrenis Hospital at the_invitation of pr, Hgyvald Childs

Cirpenter, the repru;entative of the Arnerican Child Health Asso-ciation on'the burtauts consulting pediatric.committee. The formal

The fiIth day of the conference was devoted to a round-table dis-cussion in Washington of field and statistical problems connectedwith the maternal-rnortality study. This was participated in bv 15

is ted 5f 'a

leetur"e and denronstrat ion onpart of the program consisted of a lecture and demonstration onprevention of children's diseases and inspection of the well baby,bv Doctor Carpenter: a lecture and demonstration on the mentalby Doctor Carpenterl a lecture and demonstration on the mentaeiamination of

-an infant. bv Mrs. Dorothv K. Hallorvell. nsvcholoeiamination of-an infant, try -Mrs. Q91o!.hy.K. Hallorvell, psycholo-examrnarron or an lnranf,. ov !rrs. IjorotnY r\. fiauoweu. psvl

gist of the Philadelphia Chiidren's Aid Society; ancl a lectur"e illus-trated rvith lantern slides on supervision of the health of depenclentchildren, by Mr. J. Prentice Murphy, execuLive secretary of thePhi ladel uhia Chi ldren's Buleau.Phi ladel phia Chi ldren's Bureau.

The fifth dav of the confelencussron ln

maternal-rnortality study. This was participated in by 15wrth the maternal-rnortalrty study. lhrs was partlclpatect m hy l5leplesentatives of States and by mernbers of the Childlen's Bureaustaff who are conducting this study in several States.

PROMOTION OF BIRTII REGISTRATION

The Children's Bureau has continued cooperation with the NationalCommittee to Aid Completion of the Registration Area before 1930by assisting in the promotion of birth registration in States havingregistration campaigns within the year under review. The directorof"the maternitf aid infant-hygiene division is a member of thecommittee, and at the request of the llnited States Bureau of theCensus and of the respective State departments of health the ChiI-dren's Bureau detailed members of its staff to several States forvarying periods. One staff phvsician assisted in promoting the reg-istr"atiri ir^of births attended by negro midtvives in Ceorgia a"nd T.*dl.


^fly

156 TITE wELFARE AND ITYGIENE oF M.{TERNITY AND INFANOY

TJre consulting publicJrealth nurse gave assistance in Oklahoma andlater in Texas during nearly half the year under review. A memberof the statistical division oi the Children's Bureau was lent to Col-orado. Oklahoma. and Texas for field rvork in connection with cam-paigns for improvernent of birth registration in those States.

SPECIAL ASSISTANCE TO STATES

Special consulting service from members of the Children,s Bureanstaff is frequently requested by State bureaus and divisions of childhygiene or ' -welfare.

'During"the vear under review a total of 41

visits were made to States 6v phviicians and nurses from the ma-ternity and infant-hygiene aivisi<in to advise with members of theStale-stafrs regarding the materni ty and infancv prosram or thematernal-mortality study. The directsr of the maieriniti and infant-hygiene _d_ivis.ion ipenb

-short peliods in Colorado, Idiho, Kansas,

I,Ialne, M_ichiga4, -trIontang:

i{ebraska, Nevada, New Hampshire,Oregon, Rhod^e TFIand, U!ah, W-ashington, West Virginii, andIV-r'oming, conferring with State administrators and revieiving typesof work in these States. Special trips in the intelest of maleiriityrnd infancy work weremade to ll l ino-is,1\[ar.yland, New York, Ohi6,Tennessee,-and West Virginia. The

'physician in charse bt rn.

details of the field work of the maternal-inortality study"save con-sulting service in Alabarna, California, Kentucky,"Michigai, Minne-sota_, Nebraska, Oregon, \' irginia, Washingtdn, and-Wisconsin.Eight physicians employed for varying periods.in the il)aternal-mortality study.were lent to Alabaha, Kentucky, trlaryland, r\e-braslra, Oregon, Rhode Island, Virginia, and Washington.

Assistance from the Children's Bureau is frequenily sought byindividual States for special pieces of work undertak"en or"unclerconsideration. and seveial members of the maternitv and infant-hygiene division or other divisions of the bureau havd been detaileclto give service during the past year. One of the consultants inchild hygiene assisted fn conducting demonstration ch ild-health con-ferences for a short period in Nevada. Later he conducted demon-stration child-health conferences before groups of phvsicians andlocal medical societies at 25 points in the"Stat-e, with^ air enrollmentof 367 physicians; 480 physicians and 80 other visitors n'ere in at-tendance. Another consultant lectured and assisted at a public-health conference in \Yest Virsinia. The consultant in obstetricsconducted a course in obstetriciin Oklahoma for phvsieians duringln entire month. The number of physicians enr<illed was 352, thetotal attendance of physicians was^54"5, and 131 nurses (and a'fervother visitors) cam6 fbr the lectures.

' The midrvife initructor (a

negro woman'physician) conducted courses of instruction for negiomi-dwives in G^eoigia and Texas, aided promotion of birth registi.a-tion in those States. and assisted at th-e Tuskesee health inifitute.A staff nurse taushi classes for mothers in Souih Dakota and con-ducted. a demonstiation maternity and infancy nursing service (cov-ering several counties) in lVyoming. The_consulting public-healthnurse gave consultins nursrnE servrce in Kansas. North Carolina.nurse gave consulting nursing service in Kansas,North Dakota. South Carolina, Texas. and VernNorth Dakota, Sout

ins serv.ice in Kansas. North Carolina.Iin'a, Texas. and Vermont and assisted

rvith the birth-registration campaigns in Oklahoma and Texas. A


757FIiDENAI, AI)NIINISTRA'IION4

{statistician from the Children's Bureau gave assistance in anah'sisof maternal and infant mortality figuresin Kentucky, North Ciro-lina, and Virginia, and another'member o{ the statiitical division,sstaffassisted in promoting birth registration in Colorado, Oklahoma,and Texas.

tr-requent assistance has been received from the bureauts two con-sulting committees-the pediatric committee and the obstetrical com-mittee-rrliose members have given generously of their time andth.<,'nght to .r'arious questions of .importance arising in conneetionwrlh Invest lgattons ,unclertaken by the bureau (as the mater.nal_nrorta. l i ty stut ly), putr l icat ions p]a{.nqd or in preparat ion, and pr.oLr-lcms laid befr- ,re {he burearr bv indiyidual States-.

RESEARCII AND PUBLICATIONS

STUDY OF MATERNAL MORTALITY

.The.study .of . matelnal rnortal i ty _(for which a plan of work,schedules. and instructions wele made in 192G by

-the consulting

obstetrical committee of the Children's Bureau at t"he lequest of th.eJ.,,ureau. folloning discussion of the project at the 1926'conference

I nf directors.of State burearrs and divis ions of chi ld hvgiene) n.asI y3der lay_in 12 Stat_e_s during the vear up4er reviewlAlabarna,I Kentuclry. I laryhn.J, . iUichigan, Minnesota, Nebraska, New Harnu-I shire. O'egon, Rhode Island. Virginia, \ \ raslr ington, ant l Wisconsin.I Plans for beginnilg the ltl..ty uitft tl ie close of tl,e fiscrl year l02sI were adopted in thiee additional States: California, Nortd Dul<ota,I and ol<lahoma. rn each of these states tire rvork rvas undertal<eriI at the request of the state board of health and with the intiorsemenrI of the state medical societv or associat ion. Facts in the bir th andI death certificates filcd in the State bureaus of vital statistics afiortlI the preliminary data, and the State b_ureaus.are giving generousI etroperat ion in wo.k involved in this phase of the;tudv: "Furtrrer

I information is obtained bv medical -investigators

who are inter-I viewing the physician, micl*'ife, or other aitendant at birth forI every woman who has died in childbirth rvithin the two years selectedI for t l re period of the stud.v-January, 1927, to Januar"y. lg}g. TheI hospital record is also secirre.l fo1 airy of these wnmeti having hos-I pital care. In three Siates tlre physiCians conductins the studv areI members of_th.e stafls .f the sratt! bureau or division of,child hyg"iene;I rrrembers of the Children's Bureau staff have been assisned io theI u'ork in. the-remaining nine- States-.' fnforrnation conEerning ap-I proximately 7,000 deaths will have been obtained when this in"vesti-I Sation.is cgmp^l-elgd. The data r,ill be compiled, analyzed, and pub-

I l ished by the Chi ldren's Bureau.

I STUDY OF NEONATAL MORTALITY

I _ An investigation to obtain certain basic facts in regarcl to neonatar| {eafhs is being made for the Children,s Bureau. Pi6liminary studyI to determine methods and schedules was begun in January. 1OZS, ii,

! cooperat ion with the pet l iatr ic, obstetr ical , ind pathological depart-

r

I orlljl""lliftll,lt',,\lit* ?,1"0?lta,t""rurf;.t$ti!*--,,f;-nhr"i"io"" rrom the starrs or the ch'd-

I.


kg 158 TITE wELFARE AND TYGTENE oF MATER,NITY AND INFANCY

ments of the school of medicine of Yale l]niversitv. At the close ofthe year under review 100 newborn infants had'been examined onthe -firsb day of life and reexamined on approximately the third,tenth, fourteenth,ând forty-second days.

^Complete pathologicai

study was nratle of 8 infanti who died within thelr firsi 42 darTs oflife. Reexamination at 1 year of age will be made. To faciiitatestatistical analysis the det-ails of tne examinations. tosether withfamily, prenatal, natal, and postnatal histories, are'beiig recordedon carefully planned schedules. Effort has been made I,o includeall,data that may possibly throw light on any of the obscure illnessesor ulrs perrod.

STUDY OF RICKETS

The material collected in a three-year demonstration of eommunitycontrol of rickets at New llaven, Cbnn., conducted. by the ChildrentBureau in-cooperation irith the pediatric departmerit of yale Uni-versity School of Medicine and the New Haven Department ofHealth has been in process of analysis during the vearênded June30, 1928. Careful study is being made of the significance of the mild-est forms of rickets as- well as of the more sevdre and obvious formsin relation to the growth, nutrition, diet. and seneral health anddevelopment of the child. Cod-liver oil and Sunlieht are beinsstudied in relation to the prevention and control of ri6kets, and cas"estudies of certain group: of children are being^made.

This study has furnished a IIhis study has furnished a larger number of riintgenoErams show-ing the centers of ossification in the wrists of childrtn u"n.let b yearsof ase than have been a.vaila.hle for strrdv q.nd fha riinfocn^('rqmq

yearsol ng3 than have been available for study, and the r,iintgenogramsafford a valuable sour,ce for 4-etermining more exactly the'begi"nningafrord a valuable source for determining more exactly. the"begi-nningof the growth of the bone. Therefore it connection with the"seneraianalysis the number of ossification centers in the wrist ha"s beenstudied in relation to age, sex, race (negro or white) height, weight,and rickets.

, Statiltical ?"qlyg5 i,s Q1nS.m1de of the material obtained in astudy of rickets ii Porto Rico-in Januarv and Februarv. LgZi. Thetabulat ion of the material of fhe el inirnl 'nnd R,i infoon"p-ominofi^.o

cKeLS ln rOrf,O fi,lCo ln a, anUafv alof the material of the clinicaf antabulation of the material of the clinica[ and R6nteen-eiaminations

and the interviews with the mothers of the 584 childien under B vears3 yearsof age who were e-ramined is practically completed. ^q..

"flia*nborn in a tropical country and kiown to live much of the time out ofdoors and in houses wh6se windows are unglazed probablv receiveantirachitic treatment in a natural manner aid ha,re as norinal bonegrorrth as it would be possible to find. the riintsenograms shouldestablish a standard of _nbrmality valuable in the f-urthEr interpreta-tion of those made in New Haven. The rrintgenoglam diagnosis for509 of the children was normal. Marked acti?e

"i?tets *u.-uoour"n,

].o1.1 of thê 584 (about.h3t{ "t

yhg"l were- under l_year,if 'qgg).Lo" f ;f ih; r8a'iqbHi'i"fff';+ +fltrhi::';#:f i:#ixrru:jlEvidence of very slight rickets definitelv under control"appeared"frirEvidence of 'ery $ig.h.t rickets definitely under control"appeared-f6rthree children, and eiidence of moderate"healed rickets fori'fifih child-(who until three months before the examination had lived in NewYork City.). Tot ?Q.!tt" rtintgenogram diagnosis was douftfut.diasnosis was doubtful.r ur ̂ vrr.y,r. -F or ' . u f ,ne rontgenogram dlagnosls was doubttul,' I 'he

nutr i t ion of the chi ldren was on the whole"only fair. The dietsr r rE uuurruruu ur Lt lu ut l l lur .er l was on tne wnole oIuV fa l r . lne drets

91,lheir mothers,, as indica.ted by that o1 thg day beiore ttre inte.view,were forrnd to be generally p"oor; onlv 10 p6r cent were rut"d u.


FEDEB"{IJ ADMINISTRATION

REII\TION OF POSTTJRE TO PEYSICAL FITNESS

159I

sood.40 per cent as fair, and 50 per cent as poor or,very pooi. Theinadtiquaiv of the diets of both mothers and children is of interest inview 6f the almost neglieible amount of rickets found among thesePorto Rican children.

- -{nalvsis of the children's growth in relation

to diet, rickets, and sunlighf is being made and r,i.ill be included inthe report.

STILLBIRTES AND NEONATAL MORTALITY IN MINNEAPOLIS

Tabulation of the findinss of approximatelv 1,000 stillbirths andneonatal deaths in Minneipolis, Ii{inn., is beiirg made by the ChiI-dren's Bureau in cooperatioir with the Univel'sity of-Minnesota. Thematerial includes grbss and microscopic findings o{ tlle autopsies ofstillborn infants a-id of infants who died within the first two weeksof life. The history of the mothers' previotts pregnancies is part ofthe record, as well is the history of the pregnancies resulting- in thechildren that eame to autopsy"and the-detlils of labor and puer-perium. The prenatal caro^ received will be studied in relation toihe autopsy fin^clings.

The report of the 2-year study of the results of posture training in& sroup of childtett 5io 18 veais of age made in elementarv sch-oolsoftheisea, Mass., has been ebmpleted and witt be published as one ofthe bureau's bulietins. These^children did not differ from otherchildren in the sehool except that they were given special training inposture in addition to the iesular nhysical-educatioir exercises in-theiurriculum. Changes observed in ih'e physical characteristics of thechildren rvho received posture training a'.e".n-pated with those foundamong ehildren of similar nationality and ag-e distribution in otherroomi of the same grade of the school i'ho recejved no special training.

CARE OF THE PRESCIIOOL CHILD_LESSON MATERIAL

A series of outline lessons on the care of the preschool child forthe use of self-directed study clubs, some of wh-ich were preparedby_the p.a,ter4ity and infant-hygiene. division of the bureau.and dis-tiibuted in mimeographed form in the previous year, rvere issued inconvenient printed form during the vear under review. fn additionto the list irf references the sJt coniains nine lesson leaflets on thefollowing subjects: Health examination, physical defects, teeth, nu-trition, food likes and dislikes, posture, need of sunshine and openair, behavior, and protection against communicable diseases.

NEWS-LETTEB

Several news-letters were preparetl in mimeographed form and sentat intervals to the State bureaus and divisions of child hygiene orwelfare. fncluded in these news-Ietters were abstracts of reportsof scientific worl< in fields germane to maternity and infanev ivork,brief reviews of new publieitions, items of inter6st reported 6v Stat6bureaus and divisioni and bv the Federal division of maternity andinfant hygiene, and news fr6m foreign fields of related work.


#160 TET WELFARE AND HYGIENE oF MATERNITY AND INFANOY

DISTRIBUTION OF PUBLICATIONS

Publications of the Children's Bureau relatinE to the care andhygiene of mothers, infants, and preschool childien are distributedfree to persons requesting single copies, and limited numbers are sentto the States for free distribution. Durins the vear under review

ons requestrng slngle copres, and lrmrted numbers are sentes for free distribution. _ During the year u-nder re_view

a total of 1a total of 1,262.4?,I popular prrblications were distributed to mothers.l\{onthly allotmentsôi Prenâtal Care, fnfant Care, and Child Carel\lonthly allotmerts of Prenatal Care, fnfant Care, and Child Careare suppl icd to State bureaus and divis ions of chi ld l rvsiene or wel-fale. al io to a ferv countv arrt l c i tv boards of healt .h. ' I [ "nu Statesare suppl tcd to State bureaus and d iv is ions of ch i ld l rvs iene or wel-fale, alio to a ferv.county and city boards of health.'"-t latry Statesbuy adrlitional copies frorn the Govelnment Printing Office. Fromuuy auLuLruuar copres }r'orn tlte uovel'nment ffrntlng Lrmce. -r romthe dates of their publication rnore than 8,000,000 of these three bulle-tins and of Child }fanagement-the next most popular bulletin-have been distributed. The bureau's distribution- of these bulletinsand others of the more rvidely used publications during the ycarended June 30. 1928. was as fril lows:

ênded June 30. 1928. was as follows:

Bul,tetins.-Prenatal Care. 159.?9?tal Care, 759,7W; fnfant Care, 419,950; ChildCare, 144.519; Child l{anagement, 48,473,2

Folders.-\finimum Standards of Prenatal Care. 4G.202; WhvP"iqk Milk? 3!,238; IVhat Builds Babies? 59,459i Sunlight forDrink Mi lk? 34,238; What Bui lds Babies? 59,459; Sunl ight forI3.apjes,94,,882; Breast Feeding, 56,7L1;I{eeping the Well Baby Well,84,775.- DoQgqs. , Books and Pamphlets on Child Care, 9,150;Child's Birth Recorded? 12.a46: FeedinE the Child.'19.:452:Growins Children Need? 2ffib1.

SmatT charls.-Baby's Daily Time Cards, 26,818 sets.

Is YourWhat Do

MOTION PICTURES AND EXEIBIT MATERHL

The Childrents Bureau has posters, motion pictures, fllm stripsfor use in automatic and hand proiectors, and other exhibit nrateriâlthat may be borrowed. (See p. f7S.; During the year 855 ship-ments of exhibits wele sent oi request to int-ernational, Nationril,State, and local agencies, including-the American trIedical Assccia-tion and other metlical societies, lublic-health serviees. boards ofhealth, child-welfare societies, frat-ernal societies, educational insti-tutions, Ygung _\l'omen's and' Young lVlen's Christian Associations,the Anrerican Red Cross,.Boy Sc6ut Troops, Camp Fire Girls,women's c\rbs, parent-teacher associations, sbeial-serviee organrza-tions, and State

ând county fairs.

At'the request of the American l\{edical Association the burearlco_oper_ated with, the association in the preparation of a set of 10colored posters dealing with such-su-bjects as-prenatal eare. birth reg-istration, brerrst feeding, care of the baby, and diet. The posteiswill be distributed by loth organizationsl' Several other ne'w setsof posters were added to the harreau's collection, and permissionto^ reproduce severa.l of the bureau's posters was granted to a numberof State tuberculosis associations anri educationa'l institutions.

ru l rs up l r lH ou f , o r p r ln f , a par t o I Tng yenr .by the Covernment Pr in t ing Of f i ce in the 0serPrenatal Care, 55,000; Inlant Care, 130,0(?8,700.

Provided by the Maternal and Child Health Librarv.

2 The wlde distrihution of Tnfant Care wrs mnde nossiblp throuch a sDecial annronriation: . the . purpose. The- compara t ive ly l jm i l .d { l i s t r ib l l t i ' )n o f Ch i ld t r t in rgem"nr rvas duefor-the- purpose. The comparatively l imitert disiribution oi Cfi ia ff inagem-e^nT

-to its b,eing out of print a part of the year. The orders for sale of these fourby the Government Printing Office in the flseal year ended June :10, 1028, were as

bulletlnsfo l los 's :

to i l s bc ing ou t o f p r in t a par tby the Covernment Pr in t inc 'Of f iPrenatal Care, 55,000; Inlant

n the 0sea l year end.d ,Tune i lQ, 1 lre , 130.00O; r -h i l , l ( r r re , 93 ,500;

hese four bul

, 33,500; Chilt l \Ianagement,

Georgetown University

FEDERAIJ ADMINISTRATION l rtl4

1F

The bureau ploducetl cluring the vear a new L-reel-motion picture'

Tli"";i"j-i.;; 'n;[;, to il lustrate the ad.vrrrrtages of breast feeding

over artificial feedingl 'il";;;p";Fg

t1e scdnarlo- alcl producing

the fiIm the bureau ha-cl the cobp&ation of.the New York Sfate lloard

;i"H;;ith ;il;;gh trrJ ai"""t"i oiil" aiuirion o{ maternitl'. inf 'ncv.

and child hygiene *;1h;';;i.tu"c" of one of its consultants $'lio

is a well_kno,nrr- p"ciu^tri.i. -

,tani"e s.as given also by a pediatrist

from Oreson $llo t*1"'u"ttto;ity ;l bredit feedins' -Befbre

being

;i#J,l i"h;ni--*ur't."i"*.a-Jt ihe 1928 conferelnce-of State di-

rectors of maternity;il1;i;;tt1v;ttl The bureau also produced

a new film strip ".tii i la"i. 'fi;

P**i"oI Davs of Betty Jones,"'which shows ttt"

"r.utiiilt of t""" tor the preschool child'


Y



{

APPENDIXES

APPENDTX A.-TEXT OF. TEE ACI qqlq-THE PROMqTIO.N-^O-F TIrE"wElb;i lE-iNo -nvcfnNE-oF

uatnnNrrY AND TNFANCY ANDOT' SUPPINMENTARY LEGISLATION

tS.103$-Sheppa.rd-TownerAct;Publicg?---67thCongress;42Stat'2241

An Act tr'or the promotion of the welfare ,ttLtnt"gl:""

of maternity and lnfancy' and for

Be it erwcteil,ba ttve senate anil Eouse of Representatioes of the unt'teil' states

of America in Conqress issembkil,, That there is hereby authorized to be appro-

ii.i-*li' rriri,i1v,'ir"i i rl uoy -on"y in the. Treasury not or herwise appropri a ted,

in" *"-r "r*"in-eO

in sectiori 2 of this Act. to bepaid to the several States for the

i""i"*".t' .-*p"*ii"g *itn them in promoting the welfare and hygiene of-maternity

ancl infancg as hereinafter provided'Src. 2. tr'or tne purpoJeli ca*ii"g out the provisions of this Act' ,there is

auinoii^,r to be appropiitea, out or inv mgngy,s in the Treasury not othern'ise

approp.iateO, for -tie -""o""1

flscal ve-ar $480,000, to be equally apportiored

;;-"rr; tne ""oe"ar

states,in(l to" ea"n ^subsequent year, fo_r the period of five

vir-*, SzZb.oOo, to f" "qoutry

apportioned -amonc the several States in the man-

iei n".Li""t1lr proviaeri: pioptaba, That there_is hereby- authorized to be appro-ptiuT"i-toi: the use ot tne Siates, -qulri-ect.to the provisionl^9f^lli* Act' for the

ffi;i-rea; enoi"g .luo" ao, rsdi,'an aitoitio-nar sum of $1'P9'q9t gd.,annuallvln*""uitu", for th6 period oi ni" ,.1*t., an ad6itional sum not to exceed $1'00O'00O :

Fiiit,l"i-i"rtner,inat tne aOOitio"til appropriations herein authorized shall be

;ppili"".d gr,Orjo to "uJn

S[ut" and the balance among the ltgteq in the pr]

pbition which their p"p"iutio" b":rrs to the totrl_popu-lalion of the S-tates of the

Ltiil-J Stut"i, u..o':Oiirg-to rn" last preteding tinileO States census: Antl pro-

on a t*tnrr. rnut "o-

puv*"ni ou^i of the additional appropriation berein

u"tiotir"A snatt fe maaein"a"V year to any State until an equal sum.bas been

appropriateO for that Vear by tire tegistatuie of.such State for the maintenance

oi^the services and facilities provided for in this Act'so much of the amouni"rip"ifilreo io any State for any fiscal year as.remains

""f,uiA in *h.State at in6-aose thereof shall be available for expenditures in

th;t State until the close of the succeeding flscal year'Sro B. There is u*""uv

""&1"O a goa*"6 of liaternity attl -Infant Ilygiene'

wnictr snatt cousist ot tn! Cnief of the Chilttren's Bureau, the Sur.geon General

6fin" u"it"o states Public-rrealth Service, and the united st:ltes Commissioneroi il.io.utio", anO wnicn is nu.*tt"" tlesignatetl in this Act as the Board. The

so"-",I =dif'eteci its oort .nai*-un and-perform the duties provided for in

this Act.l'he chiltlren's Bureau of the Department of Labor shall be charged with the

aAminist"aiio' of this e"t, "i*piu*

herein otherwise_provided, and t!re,Chief of

the Chitdren's Bur€au .nufin" in. exeeutive officer. It shatt b€ the duty of the

Children's liureau to t"ut.-o" "u"ie

to le made such studies, investigations, and

r"p*ts as will promote the efficient administration of this Act'Spc.4. In order to.""ir*-in" benetrts of the {ppflpriations_authorized in

section 2 of this ect, ani SGte sna[, lfrrougn the t-egistatlve authority.thereof'u".-"pt ine p"ovisions oi"tnis ect anO desig,ate or afrthorize the creation of a

st 6;t;"y with which the children's Bureau shall have all necessary Ircwers;;;p&;t" as Uerein p.ooiAo1 in the atlministratio. of the provisions of this

11;i, ii"uti"A,That in i"V Si"t"lutinga chiltl-welfare or child-hvgiene division

i" ii. Stut" a!"r,"y "t

n"iftl, the saidlstate agency of hea_lth.shall administer

6" ;il"i-i;";]t iii* e"iini6"iU tuch tlivision^s. If the legislature of anv State

i;-""t macte provision-io" u""-.frti"g the provisions of this Act thelloYetnor of

il;h Sdt" *a^V io so tar as ne ls aritnorlred to do so by the laws of such State

".."pi-iri" provisions oi tnis Act and desigrat€ or create a State agency to

163


6164 TITE wELFARE AND HYGIENE oF MAT.URNITY AND INFANCY

coop€rate with the child|en's Bureau until six months after the atljour-nment ofthe first reg;ular session of the legislature in such State following the passageof this Act.

Src. 5. So much, not to erceed 5 per centum, of the additional appropriationsauthorized for any fiscal year under sectioli 2 of this act, as ilrc children'sBureau may estimate to be necessary for aclministering the provisions of thisact, ils herein provided, shall be cleducted for that purpose, to be availableuntil expended.

Ssc. 6. Out of the amounts authorized under section b of this aet the Chil-dren's Bureau is authdrized to employ such assistants, clerks, and other per-sons in the District of Columbia and elsewhere, to be ttrken from the eligiblelists of the Civil Service Comrnission, and to purehase such supp;lies, material,equipment, office fixtures, and appa.ratus, and to incur such tiavel and othercxpenses as it may deem necessary for carrying out the pulposes of this act.

Sr,c. 7. Within 60 days afrer any appropriation authoriZed try this act hasbeen_Iade, the Children's Bureau shall make the apportionment herein pro-vided for and shall certify to the secretary of the Ti'easury the amount esti.nated by the llureau to be rrecessal'y for administeling the provisions nfthis act, and shall certify to the secretary of the Treasury and to the treasurersof the various states the amount which has been apportioned to each state forthe fiscal year for whieh sueh appropriation has been made.

Snc. & AnI State rlesiring to receiye the benefits of this act shall, by itsagenc)' describerl in section 4, submit to the children's BureRu detailed plansfor-carrying out the provisions of this act within such state, which plansshall be subject to the approyal of the board: prm.iderl, That th'e plans of theStates under this act shall provide that no official, or agent, or re^presentativein carryirrg_out the proyisions of this act shnll enter any home or take chargeof any child over the objection of the pa.rent-s. or either of them, or the personstanding i1 loe.o parentis or having eustorly of such ehild. rf these plans shallbe -in -conformity with the provisions of this act and reasonably dpplopriateand adequate to carry out its purposes they shall be trpproved by ihe i;ard anddue n-ot-ice of sueh approval shall be sent to the stafe agency by the chief ofthe Children's Bureau.

src. 9. No official, agent, or representative of the children's Bureau shallby virtue of this aet have any right to enter any home over the obj;tion of theo$'ner thereof, or to take-charge of any child ol'er the objection oi the parents,or either of them, or of the person standing in loco parentis or having^custodyof such child. Nothing in this aet shall be crnstrued as limiting tf,e lnwerof a parent or guardian or person -qtanding in loco parentis to det6rmine rvnattreatment or conection shall be provided for a child or the ageney or agenciesto be employed for such purtrrcse.

sEc. 10. within 6o days, after any appropriation authorized by this acthas beel made, and as often thereaftei-wfiile such appropriatio"n remainsunexpended as ehanged conditions may warrant, the chililre^n's Bureau shallascertain the amounts that have been appropriaied by the legislaturei ot tt

"several states_ accepting the provisions of this act and shal'i certify to tnesecretary of the Tr€asury'the amount to \r-hich each state is u"tiii&r

""a""the prorrisions of this act- sueh certificate shall state tii inai inu siutu nu.,through its legislative authority, accepted the provision.'of thi*;iu]ro a"oignated or authorized tle creation of an ngeniy to eooperate wiih ttre crril-dren's Bureau, or that the state has otherrise accepted-this act, as provideclin.sec-tion 4 he^reof ; (2) the fact that the proper agenev of the state

^has sutr-.

mitted to tie children's Bureau detailed pians torlarrying ootihe"provisionsof this acr, and that such plans have been approved ry Tne uou"ai- igr i l reamounl i f any' that has been appropriated by-fhe tegislature ol ine'siate torthe maintenance of the serviees-and facilitiei of thi"" ;;t;;r ilrti;..r;

"*-tion 2 hereof ; and (4) the amount to rvhich the State is eritiiied-u"a-.-.-tnu b.,r.visions of this act. Such certificate, when in eonformity witn irre provisionshereof,. shall, _until reloked as provided in section-iz n"re"t,--L-'*rfficicntauthority to the secret4ry of the Treasury to malie pay-e"i ti id* stutu ioaccordance therewith.

Src. 11. Each State ageney cooperating with the Children,s Bureau untlerthis act shall make such relrrrts conceriing its operations and expendituresas shalr be prescribed oI requesteal by the bureau. The childrent Bureaumay, witlt the approval of the board, and shall, ulxrn request of a majority ofthe board, withhold any further ceriiflcate provided for in section 10 hereof


APPENDIXES 165ty

whenever it shall be determined as to any state that the ageney thereof has

iiol-p"upe"fv expended the money paid to it or the moneys herein required to-fi"-"iprlpriuterl by such State ioi the purl;6ses and in accordanee with the

nrntisi , ,o" of this act. Su<.h cert i f i<,ale rnay be n' i thheld unti l such t ime orfiiro"iu"ri contlitiols as the Chilclren's Bureau, rvith the approval of the board'-li a"te"*i"e ; when so *.ittlheld the State agency may appeal to the Presi-Oent of the Unite<I St:rtes who may either affirn or reverse the action of thebureau rvith such directions as he shall consider proper: Prouiile.d' Tlo.atfui"i" u"V such certificate shall be withheld fr,m any State, the chairrnan ofthe boarcl shall give notice in lYriting to the authority designated to reflres€ntttre State, statin'g speciflcally wherein said State has failed to comply withthe prorisions of this act.---Sr-*

lZ. No portion of any moneys apportioned under this act for the benefitof llre States itratt be appliett, directly or indirectly, to the purchase, erection,preservation, or r-epair bi any building or b-uiltlings or equipment. or for the

furchase or rental of any buildings or lanals. nor shall any such moneys orioo..5.. required to be appropriatecl by any State for the purposes and in ac-*"Au""o noith the provisions of this act be used for the payment of &ny matern-ity or infancy pension, stipentl, or gratnity' -

Ssc. 18. tire CnilAren's- Bureau snatl perform the duties assigned to it bythis act untler the supervision of the Secietary of Labor' 4nd !e s\all inelude

in his annual report io Congress a full acco.nt of the administration of this

act and expenditures of the moneys herein authorized.Sec. 14. This act shall be conitrued as intending to secure to the various

States control of the administratioD of this act within their respectiYe States,Bubject only to the provisions and purposes of this act.

Approved, November ?3, L927.

lPubtic SHSth Congress; 43 Stat. 171

A n A c t T o e x t e n d t h e p r o v l s l o n s o f c e r t a i n ] a w s t o t h e T e r r i t o r y o f l l a w a i i .* * * * *

Src. 3. The Territorj' of Ha$'aii shall be entitled to share in the benefits ofthe act entitled .,An act for the promotion of the rvelfare nnd hygiene o,f_ mater-i-ity nnA infatrcy, and for othei purposes," approve6 November 23, 1921, and

any act amenclatory thereof or supplementary thereto, upon the-^same terrnsancl conclitions as any of the several^

-states. For the fiscal yenr entlingJrtne 30,

igtS, 6rn"e is authorized to be appropriated. ou-t of any mo.ne-y_ in-the Treasury

"it-btfr"r*i." appropriated, the'sun of $13.00O to be available for apportion-

ment under such act to tlre Territory, and annually thereafte,r slch sum as*o"ia 6" upportionecl to the Territori if such act had originally includetl the

Territory.

Approred, I\larch 10, 1924.

[Public 56G--69th Congress; 44 Stat. 10241

Au Act To authorize for the fiscal years endi-ng.June.30, 1928, and June,30,-1929, appro--;;i;iio;loacairying oui t-rr" p"6oiiioni of Tle-.lct eirtitled "An Act for the-.promotion

5i-triJweftn"eind nigi""e"oi f,^aiiiiiitv ""0-in-tancy,

and for other purposes," approvedNovember 23, 1921, and for other purposes.

Be it eurcteil bg the senate anil Eouse of Representa.tites of the ani,teil' statesof-interica im C6ngress assenr,bled. That-section 2 of the act entitled "An acti6" trr" p.o*otion df the rvelfare and h]-giene of. maternity ancl infaltcy, and forottr"i po.po.es," approved November ye, $Zt, is amended by strikjng out theworals',,frir the peiioa ot fire years" n'hereler such rvot'ds appear in such sec-tion and lnsertiig i. Iieu ther6.f the \\'ords " for the periocl of seven -years."

snc. z. tnat saio act entitleo "An act for the promotion of tbe lveltare and

hy;L;toir"aternity anri infancy, and for o-ther purposes," appro'ed N.vembe.mi1|rZl,, shall, after June 3o, 1929, be of no force and effcct'

Approvecl, JanuarY 22, a927.


,4:*r

APPENDIX B.-ADMINISTRATIYE AGENCIES AND OFFICERS

state ailministrath;e agencies &nd, names of the ereeutioe offieers far the a,dttin-istr-ation. of the aet for the promotion, of th,e welfare antl hllgiene of maternitganil infancg (as of June 30, lgZB)

State (and Administrstiye agency and department

Alabama-- - - - - - - - - - -

A r i z o n a - - - - - - - - - - - - -

Arkanss---- - - - - _ - _

Ca l i fo rn ia - - - - - - - - - -

Co lorado- - - - - - - - - - - -

Connecticut 3- - -----

De laware- - - - - - - - - - -

F l o r i d a - - - - - - - - - - - - -

Kansas---- -- - -- -----

Kentucky--- - - - - ----

Mis is ipp i - - - - - - - , - -

Misou i - - - - - - - - - - - -

Montana- - - - - - - - - - - -

Nebraska- - - - - - -___-

N e Y a d a - - - - - - - - - - - -New I lampshte- --

Bureau of cbild hygiene and public-healtb nursine._State board of health (Montgomery.l.Cbild-hygiene division, Staia bo;id of bealtb

(PhGnix).Bueau of child hygiene, State boud of bealth (Liftle

E M F ) -

uru:Xfl""J;f#siene, state department of healthChild-welfcre bureau, State department of pub)ic

lnstructlon (I)enver)-Bureau of child bygiene, State department of healrh

(l lartford).Dirision of child hygiene, State board of health

{ uo \ e r ) .Bureau of child h,\ giene aDd public-health nusins.

Srate boed of halth lJacksonsil le).Disision of chiJd blgiene, Stale board of health

Jessie L. Marriner, R. N.

Mrs. Charles R. Elowe.

Dr. C. 'W. Garrison. I

Dr. Ellen S. Stadtmuller.

Mrs. Estelle N. Matbews. t

Dr. A. Elizabeth Ingraham.

Dr. Clealand .{. Sargent.

Ms. Laurie Jsn Reid, It. N.

Dr. Jre P. Bowdoin.

Mabel V. Smyth, R. N.

Dr. Emily F. Bolcom.

Dr. Grac€ S. $-ightman.

Dr. Ada E. Schweitzer.

Edward fI. Lauer, Ph. D.

Dr. J. C. tr{ontgomery.

Dr. Annie S. Veech.

Agns Monis.

Edith L. Soule, R. N.

Dr. J. II. Mason Knox, jr. I

Dr. trferri l l E. Champion.

Dr. LiUian R. Smith.

Dr. E. C. I lartley.

Dr. F. J. Underv-ood.1

Dr. Irl Brown Krause.

Dr. Ilazel Dell Bonness.

Louise M. Murphy, R. N.

I\Irs. S. H. Whmler.2Mrs. I\fary D. Davis, R. N.

Dr. Julius Irevy.o

Dorothy R. Anderson, R. N.{

Dr. Elizabeth M. cardiner.

Dr. George Coll ins.

(Atlanta).Division of maternity and inlancy, Territorial board

of health (Ilonolulu).Bursu of

welfare

of health (Ilonolu-lu).ur€u of.child hygiene, State department of publicwelfare (Boise).

Division of child hygiene and publie-healtb nursiDs.State department of Dublic health (Snrinsficld I

-State deparrmentbf public bealth (Sprjnsfieldi." '

Divisio.n o_f inlan! and child h] gieDe, Siateloard of

New Jer rey- - - - - - - - -

health (Indianamlis).Division of mateinity and infant ht giene, Stare

l niversity of lowa, State board of education l loraCity).

Di:ision of child hygiene, Stat€ board of hcalrh( r 'op€Ea).

Bureau of matornal and child health, State board ofhealth (Inuisville).

Bw:au of child hygiene, State department of health(New OrlsN).

Division of public-health numing and child hi.siene .State department of h€lth (Auguta).

Bueau of child hygiene, State depart ment of healt h(Baltimore).

Divisior _of hygiene, Stat€ department of publichealth (Boston).

Bureau of child bygiene and public-health nursine.State department of hcalth (Laroing).

Dir-isioD of child hygiene, Sta[e dcl)strieo t of health(trI inneapolis).

Bueau of cbild hygiene and public-health nursine.State board of healrh (Jacksbn).

DivisioD gf ehild hlgiere, Starc board of health (Jef-rerson L tty).

Child-welfse diyision, State board of health (Hel-

Division of ch-ild hyglene, buresu of health, State de-^par-tment of public selfare (Lincoln).!h i ld -seuare d iv is ion , S ta te board o f hea l th (Reno)_

: !"'';13 i fi, fl SlTlilJ; i3i1",:"',ail t c b i I d h vsien e'

B?rr-efllof child hygiene, State debartment of health

Division of cbild hl.giene aDd public-health nursine.

fi yf.?il"".t"o,t:Xi"neal1}, s ta t e d e par t m e n r o f pp [-Div is ion-of materDi ty, infancy, and chi ld hysiene._ state de,partment of healt.h (Albany).Bureau of Daternity and infaocy, Siate board ofhealtb (Raleish).

New Mex ico- -___


&APPENDIXES

State (and Territory Administrative agency and departDent

167

Director

Dr. Maysil M. williams'

Dr. J. A, Frank.o

Dr. Lucile S, BlacblY.

Dr. Frederick D. Stricker.r

Dr. Mary Riggs Noble.l

Dr. Marion A. Gleason.

Ada Tgylor Graham, R. N'

Ftorenco E. Walker, R. N.

Dr. W. J. Breeding.

Dr. H. N. Barnett.

Dr. II. Y. Richards.

Dr. Charles F. Dalton'rDr. Mary E. Brydon.

Mrs. MBry Louiso Allon'R. N.T

Mrs. Jean T. DilloD, R. N.

Dr. Cora S. Allen.

Dr. w. E. Esssed.l

state a(l,rninistratil)e agenei,es anfi, names of tfue coeantioe o'\frcer, for th'e a'Imin-

istration of the act for"iii irinotion-of 't.he

lrqtfare and, tlAgigr.e of mnterni'tV

and, infaniV (as of .June

30, 1928)-Continued

Division of child bvgieno and public-health nusing'- btaii Oepertneni-ot public hmlth (Bismar+).. .

Division oi cbild hvgiene, State depsrtment or healtn(Columbus).

Bumu of marternity 8nd infancy, Stat€ departmentof nublic health (Oklahoma CitY).

Bur&u of child hvgiene, St&te boBrd of health (Porl'-land).

pr-dsf,ool division, bureau of child health, State de-Dartment of bealth (Harrisbug).

Division of child welfa're, St'ate board ot bealth(ProYidence).

B;;;u of child hvgiene and public-healtb nursing'State bo8rd of bealtb (Columbis).

Division of child hygiene' Stat€ boord oI bealth(11 aubov).

oivSion oi bUa bvgiene and public-health nursing'I oioision oi bUa bygiene gnd public-health nursirg'i

- -staG oiparrmenibf public health (Nasbville).. .'

Bureau ofchild bvgiiene' Stace department of healtn(Austin).

Bireau of'child bygiene, Stste board of bealth (SaltLake City).

State depsriinent of public health (Bulington) -.- - -Bumu of cbild h€lth, st8te board ot health ( Klcn-

mond).oGL-ioi-of oublic-bealth nursirg 8nd cttild bygiene'

Stste deD;rtment of bealth (Sesttle).Division oi cbild bvclene 8nd public-beslth numing,

Starc departmeni of besltb (Cbarlestou).Bure:u of'cbild welf$e Md public'bealtb nuBing'

Stst€ bosd of heslth (Iladison).Division of matemal and infant welfare, Stato de

partment of public hesltb (Cbeyenne).

t State health ofncer sorvinS'2 Erecutivo socretarY.a State not cmp€ralrng.{ Cbief.! Consultant.o Acting cbiet


III

t


t9

APPENDIX C._MATERNAL AND INFANT MORTALITY RATES

United States birth.regdstratiom ar,eo ; 7975-7927 1

Desths of mothers from puerperal causes per 10,000 live births

1915 1917 ry/2 1927l9?'1916

64.774.855.3

N . O

73.9& . /

79.985. 674. r

68.277. L59.4

66. 573. 8s . 1

66. 473.259. 5

65. 860. 5

66.084.153.2

68.6s . /56. 5

87.97.82.

| 85.7 II s7.4 |r 81 .8 |CeDsus.

78. 86E. 8

9r.696.087.2

ffi.270.062.3

62.265. I

60.864.1oo. d

79.6110. 273.2

89.0

74.9

89.7134. 585. I

o / . D61. 352.2

oo. J

57.245.4

58. 685.232. 6

56. 458. 753. 0

57.6CY. D

47.5

92.9r09.476.3

67.570. I62.6

57.36r. 6s . c

7r. I

64.9

57.O61. 6

64. t7r. 053.2

64.9

68.104.

59.80.DO-

__:-

/4. ut07.764. E

m.796. 654.3

o6

I

E4.01.78.

M.93.59.

82. 5107- 576.4

63.291. 859. 0

68. 378. ID. I

52.8

76.9a . JN - l

79.888. 168.7

62.268,841. 6

74.973.579. 5

51.0

36. I

€ . 9ot - I

42.1

56.163.036.0

California

Conneeticut-------Urban- - - - - - - - -

68. 074.7d / . o

6 / . C

104. 875.2

85. 8 | 84.891.7 t103.683.8 i 77. 2

_:::: : t_::: :- l__::: .

Rura l - - - - - - - - - - - -

83. 790,077 .1

63. 2101. 520. 8

"__.__l__.:_:I.....1_.:...I

_--___l:-:-__

I------t------' " i - ' - -..___t._.._:

I------t------------t------

I:-:_::l:_::::----t------'--t------

I' ::-- -[-::::ur.n l rr.o82.4 | 8r.r63. 2 I 76.9tes Bureau r

109. I97 .8

115.2

60. 062.959.6

63. 540. I

oD. /81. 152. I

58 .9E9. 140.0

63.184. 6u.4

I47

oI5

08I

i101.

l'*'I 56.

lu,|33| 56.

64 .881. 150.8

60. 487. 848.8

69. 793- Iff i .7

& . J64. 846. I

60. 5w.24i,.9

6r. 669. 748. I

58. 166. 0OI. D

59. 879. 1

7oI

8

,

80

6

5

.081

63.266.9

,57 .3

0

84.u2.

03. I. 3

91 .9

m . Y8t. 345.3

65. 483.258.4

7

49.462.146. 5

m . 9t?3.277.1

58.474.854. 6

66. I106. 649.7

59. 582.6u . 5

1U2.558.8

14.3 64.38 5 t57.6

62.793.457.5

74.O100.962.9

105.8

80.0t19.074.3

79. 5

60.0

, ^ %

m. 164. I53. r

+'s. r54.9

59.262. 8540

57. I60.34 9 0

168


#APPENDIXES 169

TABLE I.-Mdterno.l, mortalit!! ru,tes, bll States, in urltan an(L rural, al,btricts of thnU nited, Btat cs birt h-regi,stt' ation, area ; 19 1 5-1927 -Continued

Deaths of mothers from puerperal causes per 10,000 livc births

State

rere I 1e2o 1923 t926

IVlryland - - - -- - - - - - - l- - - - --Urban- - - - - - - - - - - l - - - - - -Rua l - - - - - - - - - - - - l - - - - -

63. Ii5 .752.9

59.8

41.8

8 . 272.864.0

54. 662.251. 0

83. 689.7

73.2

74.678. I54.4

93.297.76 / . D

78.590.272.2

66.569.762.5

57.475.945. 5

78.7t29.773. 6

63. 777.732.6

52.859.748.4

98. 3i63. I92.1

M . 769. r38. r

72 .8

49.7

44.6

95. 1r49. 489. 6

60.063.056.0

62.967. 6

70. 382.254.5

ffi.277 .249. 8

88. 161. I81 . 6

406

803

502

5L8

21

59.60.58.

68.73.

49.il.46.

83.

68. 571. r65. 5

57.280. 844.2

9 5 . 3179. 888. 3

59.291. 548. 8

64. 858. 87r .3

62. 670.744.3

60. 663. 149. 6

65. 6112.3

l tx .8

!4.275.780.170.9

D / . D

64.941. I

f r .o59. I44.9

88. 3153. 8?6.8

6 1 . 975. I4 0 . 6

75. OoD. ,

64_ 083. 344.4

64. I71. I2r. o

42.969. 839.4

67.180. 746. 6

59.066.254.0

80. 446.7

59. 662.043.9

72.37r.7727

&4.281. 846. 5

32. I58. 314.6

65. 571.5D / . 6

o l . D

73.5

68. 0

53. 5

58. 274 .237.0

63.366. 344.9

57. 86S. 442.4

64.266. 847.4

trIaschusctts--- - - - -l 57.2U r b a n - - - - - - - - - - - l 5 9 . 6R u a l - - - - - - - - - - - - l 4 6 . 8

l \ I i ch igan- - - - - - - - - - - - l 66 . 8U r b a n - - - - - - - - - - - l 7 2 . IRusl----- ------- | 6r. 8

70. 674.850. 5

77.283. 271.0

/ J . 6

83. 3620

68. 28 1 . 954. 6

l r . 6

65.268. 247- 6

63.067.235.2

67.277.45r. 6

51. I

50. 8

44.443. I45.2

86. 7158. I78.8

i1 " " '. _ _: _:l-:_ - _ - i_ _ _ _ _

67.480.857. I

66. 3102.8

DJ. '

80. 2r13. I68.5

Nebraska---- - -- -- -- -Urban- - - - - - - - - - -R u r a l - - - - - - - - - - -

New Elampshire-----Urbsn- - - - - - - - - - -R u a l - - - - - - - - - - -

New Jersey----------Urban- - - - - - - - - - -R u a l - - - - - - - - - - -

New York- - - - - - - - - - -Urban- - - - - - - - - - -R u a l - - - - - - - - - - -

North CaroliDa------t . l rban- - - - - - - - - - -R u r B l - - - - - - - - - - -

61. 069. 353. 0

a l . o

101.463.1

76.466. l

65 .8105. 454. 6

62262. 861. 6

s . D68. 3u.76 2 765.1

t10 . E67.8

8 1 . 179. 681. 6

89.246.7

71.282.958.9

64. 374.939.8

59.662.945. 1

86.6

7E.9

6 1 . 562. 06 1 . 4

58. 658.8

7 : ' - 475.969.1

54. 354.154. 8

6 /

68. 271. 0

rm.0168.091. 7

Nor th Dakota- - - - - - -Urban- - - - - - - - - - -R u r a l - - - - - - - - - - -

51. 0105. 043. 0

96. 8104. 5E7. 3

98. r101. I6S.8

79. 591. 363.0

. 4824

102 8

7 2 2&{ .9

74.373. I

68. 384. 452.2

71. o76.339.0

98.1t77 .7E8. 4

67.681. 6

Oregon- - - - - - - - - - - - -Urbsn- - - - - - - - - -Rura l - - - - - - - - - -

Pennsylvania---- - - -Urban- - - - - - - - - -R u a l - - - - - - - - - -

Rbode Island-------U r b a n - - - - - - - - - -R u r a l . - - - - - - - - -

South Carolina- ----L r rban- - - - - - - - - -R u a l - - - - - - - - - -

r0r.2r?B.987.2

64. 374.1

ffi.272.83 6 , 0

8?.458. 6

58. I6 3 . 236. I

64. I75 .154.6

63. 569. 7

l(x.6I r 1 .198. 3

88. I65. 5

t n . 0163. 0117. 3

_ _ - _ - - i _ _ - _ _ _ i _ _ - _ -i------t------r-----

, Dropped from the United States birth-registration uea,

48274"_2C_12


ff

170 THE wELFAEE AND HYGIENE oF MATERNITY AND INFANoY

\ABr,E I.-Ma,terlta,l mortal,itq ra,tes, b11 States, in urban and rural, distriats of thaUnited Btq,tes birth-regi,strati"om are& ; 19 15-1927 -Continued

Deaths of mothers from puerperal causes per 10,000 live bifths

NN 1926

48.669.836.8

79.8122.867. 3

1925 tyxt

6r.251. I62. 8

/6 . )

72.275.7

63. 651. 365. 8

8r. 8130. 370. I

73.786.263.4

70. 0rr3. 3s . /

86 .769. 0

79.1t72.762.4

70.282.767.7

86. 5r33.0

/ d . d

92. 099.0E4.6

45. I59. 437. 0

81. 0s0. 478. I

CD. J

oc. D

50. 3

74.584.572.6

72.692.762.7

97. 668. 7

65.2r00. 4oc. c

70.985.9oJ. I

49.8

38. 2

69. 633.957. 0

74.499. 567.4

66. 570.262.7

71. 811. I61.2

78. 884.4

s . r69. 550. 3

1 1 3 . 561. 6

5E. 173. I48.2

76. I

67. Ir37. I53.2

63. 3117.750.8

95.2139. 383. 6

& . /

75.089. 259.7

67.2oo, I

o / . o

75.4100.06r.2

72.6133. 059.2

61. 5104.249. 5

06. 568. 164.7

70. 195.263. 2

w.269. 350.1

Wash ing ton- - - - - - - - -U r b a n - - - - - - - - - - -R u r a l - - - - - - - - - - -

West V i rg in ia - - - - - -U r b a n - - - - - - - - -R u r a l - - - - - - - , - -

Wyoming- - - - _ -_-___Urban- - - - - - - - - - -R u r a l , - - - - - - - - - -

District of Columbia-

67. 342.3o / . 6

55. 866. 848. I

110. 662.0

70.5

97. 6. 2

89. I

2 r .E

60. 566. IaD. 6

70.6129. 557.4

59. 67r . I50. 3

93.458. 5

101.9

77.4

52.363. 044. I

o l . o

130.346. 8

52. 856.250. 0

87.2r25. O79. 0

88. 4 101. 3 80 .3

Tesr,o Il.-Maternal mortality ,'ates, bllt eatror, in thc United States birth,-regis-tra,tisn d,rea anil in States lwr;ing 2,000 or n6rre cnloreiX births anmuallll;1915-792? 1

Dsths of mothem from puerperal carxes per 10,000 liye births

rgn

66. 462. 8

106. 8

l**t;

1926

68.2M . 4

t07.7

o / . D68.853. 6

I Souce: United States Bur€au of the Census., Noi sbown for yetrs in which the number of colored births was loss thau 2,000,

m.3116. 2

65.661. I

107. I

M . 759. 4

113 .3

79.862.5

1 1 1 . 6

55. 653. 0

1r0. 2

68. 370.745. 1

71.972.463. I

63.261. E11. 6

0)

59.2ffi.788. 5

m. I59. 665.8

12t.4

163. 4

(r)

58. 356. 4

l m . 3

N . O

58.4t2L.2

65. 063.2

104. I

64.862.4

134. 564,0

1 1 1 . 0

83. 6114.269. I

79. 683. 279.0

82. 692. L80. 0

86. 3106. 478.0

79. Sf f i .785. 4

107.01 6 1 . 194. 5

98. 5103. 693. E

tg23 | 1924

66.5 | 65 .662.6 I 60 .7

l @ . 5 [ 1 7 . 9

r l9 l

I6r. 05 9 . 5

108. 8

5E. Ioo, d

96. 2


*.€ APPENDIXES L7l

Turlu Il.-Ma.ternal runrtalitll rates, by color', im the Uniteil, States birtlureois-tratiotl area anil, in States hatsing 2,000 or nLoro aol,areil, births annuallg;1915-1927-aorrtinued

Dsths of mothen from puerperal c8uses per 10,000 liye births

1926 rcn

59. 654.2

l s . D

7I0

60.53.

62.7m . /

t47.7

u . 459. 7

r30. 4

63. 258.5

125. 0

80.075.0

153.8

o a , d

9&3

5 9 . 4tu .D84.3

(r)

m . o59. 596. I

e)

75.765. I

[8 .3

!?

60. 064.383. 0

49. 445. 3

108. 6

90. I69. 8

125. 8

D , . 553.971. I

60.658. 0

125.5

DD. O

50. 898.9

64. 06r. 6

111. 6

c)

86. 366.0

r30.6

6 1 . 857.0

130. 7

58. 454.9

106. 2

59. 553. 6

138.0

78.765.29r,6

l \ I ississippi - -- - - ---- - l- -- -- -Whi te - - - - - - - - - - - l - - - - - -Co lored - - - - - - - - - l - - - - - -

*t*.,ffHi; - - - - - - - - - - - - - : --.

Lou is ians- - - - - - - - - - -White -- - - - - - - - - -C o l o r e d - - - - , - - - -

Mary land- - - - - - - - - - -Whito - - - - - - - - - - -C o l o r e d - - - - - - - - -

Mich igan- - - - - - - - - - - -Whi te - - - - - - - - - - -Co lored- - - - - - - - -

Colored-

North Carolina-----Whi te - - - - - - - - - -co lo rod- - - - - - - -

O h i e - - - - - - - - - - - - - - -W h i t e - - - - - - - - - -C o l o r e d , - - - - - - -

Pennsylvania----- --W h i t e - - - - - - - - - -Colored---- - - - --

South Carolina-----

C o l o r e d - - - - - - - - -

New York- - - - - - - - - - -Whi t€ - - - - - - - - - - -Co lored- - - - - - - -

83.264.8

100.5

YO. J

71.4120. 3

68

62" 760. I39.4

79.779.1

114 0

58.250. s89.0

oJ. I

61. I126.9

98. 366.6

L23.7

DD, C

101. 5

65. 363. 8

tL6.2

95. I65. I

3t3

I55

70,69.

LzL

88.65.

6i. I59. 6

104. 0

88. 3

125.7

67. IM . 4

115. 8

6I6

60I

656

58.101.

86.68.

Ln.

67.M.r29.

I

65I

558

62.659. 3

109.659.17,

58.

93.

77.

57,055. 096. 6

56.585. 2

79.6

r07.0

64 I61. 6

119. 3

ffi.259 .397.2

752

63.61.

&.262.797.9

c)

64. I62.2

101, 8

61. 0114.7

r07 .875.9

140.8

6I. 547.993. 6

or- o58.9

103.8

79. 87t.299.6

70. 666. r

13S. S

I67

363

783

70.

109.

63.59.

125.

86.60.

65.250.199. 6

64. 362.7s0. I

67.265. I

110. 4

J / . O

55. 884.0

m . D54.3

116. I

64.4104.9

68.066.1

123,4

67.463. 6

130.7

s.ca.

58 .658. 197- 2

107. I94. 0

6?.460.9

140.7

92.6E Z 0

It7. 6

111. 678. 1.u .2

82. 666. 0.r8. 7

85. 667.8

6 & 767. I

14?- |

100. 0ffi.2

L3Z2

79. 57 & 2

120. 3

77.676.0

130. 6

rn.089.9

154.0

. : : . -86. 575.4

l r0 . I

88. 466. 543.8

| 7r.5l 6 & 0

i158. 2

| 65.9l o r o

l1oo. e

| 9 7 . 1| 74 .1

lr2r. 8

I

l__-:_l;, ̂I 59.7

i107. 8

I

l_ _:::.1----101.0I 89.3

112e. 5

55

8I

0

850

8e

7

517

i 7e.i 70.

ml ' -

66.63.

1132.

I ur.| 61 .I 94.

l,*.I ai.lt?8.I

: - : --t " .I eq-

i101.I-1----

: l : : : :I

| 33:F*.

73.561. 0

r0r. 8

70. 6116. 0

68.367.497.7

98.177.9

118. I

; ; ;56. I99. 4

;;; ;98. 6ro7.7

8I

2

I

7Z126.

68.65.

87

oo

7

9695..3&

64.963.618. 6

39. 0

u.363. 3

1L2.2

70.169. I

1 1 8 . 7

White- --- -- - - -- -Colorod----- - -- --

71 . 058. 7

134.8

District ofWhit€

69. ?&. I90 .4

9 t c91.789. 6Co lorsd- - - - - - - - - -

, Not shown for yesrs in which tbe Fumber of colored birtbs was less than 2,000.t Droppod from the birth-rsgistration sea.


6' 772 TIIE wELFARE AND HYGIENE OF MATERNITY AND INFANCY

TABLE Ill.-fnfant martality rotes, by Btates, im ttrban anitr ru'al' il,istricts of. tlr"e [Jni.teil, States birtlv-registratiaru area; 7915-192'l'

Deaths of infants under 1 year of age Der 1,000 live births

1916 I 1917

10110894

768072

7874

869181

878984

Delavare- - - - - - - - - - -Urban- - - - - - - - - - -Rura l - - - - - - - - - - - -

F lo r ida- - - - - - - - - - - - - -Urban- - - - - - - - - - -Rua l - - - - - - - - - - - -

Ida t ro - - - - - - - - - - - - - - - -Urban- - - - - - - - - - -Rural----- - -- - -- -

I l l i n r i s - - - - - - - - - - - - - - -U r b a n - - - - - - - - - - -Rra l - - - - - - - - - - - -

. . - . . -105r09104

101103

869678

----.-16128LO2

t2ltm

100103E7

96r06E7

IDdiana------ -- - - - --Urban- - - - - - - - - -Rua l - - - - - - - - - - -

I o w s - , - - - - - - - - - - - -Urban- - - - - - - - - -Rura l - - - - - - - - - - -

K a n s s - - - - - - - - - - - - -Urban- - - - - - - - - -Rura l - - - - - - - - - - -

Kentucky- - - - - - - - - -U r b m - - - - - - - - - -Rua l - - - - - - - - - - -

Lou is iaDa- - - - - - - - - - -Urban- - - - - - - - - -Rural----- -- -- - -

Ma iue- - - - - - - - - - - - - -Urban- - - - - - - - - -Rua l - - - - - - - - - - -

Msy land- - - - - - - - - -Urban- - - - - - - - - -Rura l - - - - - - - - - - -

93L0789

120116

98m91

889780

I Source: United Stats Buroau of tho Consus,


t9271926

72

70

1923

78M

647762

7r

69

618259

62

70

59o r66

a1

7L

6967

50b

50

646466

5963m

6750

62

617 l r59

7789

808677

818181

oo65u687064

8086

w83c2

8270

7679l o

90a2

101

74

757S

62

696777

9591

100

828880

6683

10499

110

727082

9387

100

758570

635963

696872

727868

72OJ

65

6 l

t o9272

8 2 t 7 r8 5 1 7 57 7 t 6 5

7 r l 6 5

_ _ _ _ - l a

6 3 1 5 97 8 1 7 05 7 1 5 4

7 8 1 7 36 5 t 5 9

721 658 9 t 7 96 8 t 6 2

898988

9587

104

7878l o

8085

8l8878

868488

686866

7508

APPENDIXES

Deaths of infants under 1 year of age per 1'000 liYe births

L73#

l'-lsr.e Ilf.-lnfont nrcvrtalit!! rates, by States, i,n, urbam and rural' il'tstriats oft h e U niteal, St ates birth,-reristrat ion area ; 19 1 5-192?-Continued

State1915 1 9 1 6 1 1 9 1 7 1 1 9 1 8 1921 LqB1920

66

64u707866

676866

5657

9469

626262

688667

s6056

688766

595959

689566

697068

9868

n9t

69l o

78r02

7995

524854

678864

60ffi57

665870

DI

604E

69

66

616162

595962

79t06

6347oo

626459

484748

58

58

70

69

_: _::77

cv6656

7982' tD

6972

707l

8210678

69

69

a o7872

523962

828183

828282

. !?

606160

688767

Rurar------------i I I I*"",j1f,1;---.::----:i:-----i-:-:--l------i----" 6 7 1 7 1

72 t 73

9 7 1 9 5801 768 1 t 8 7

6 4 1 5 98 6 1 7 45 8 t U

8 8 1 8 ?

7 8 1 7 8

6 5 1 7 0

s l s6 8 t 6 96 r l 5 4

/ d l N

7 2 1 6 e l 6 87 1 1 7 0 t 6 888

78

&

81

747474

I D

7674

I D

w

707868

809069

7979

7872

m96

7I72

n t7Ls

93tu84

7 2 1 7 0 1 6 97 1 1 7 0 1 6 87 4 1 6 9 1 7 0

848577

8412482

m9485

6959

10099

101

e)

7 6 1 6 7 1 6 6

8 1 t 8 2 t 7 9

7 7 1 ? 9 1 7 4l 0 9 l 1 0 0 1 1 0 4

$ l z 5 l t z l 7 5 1 6 7 1 7 o8 s l 7 6 1 7 6 1 7 5 1 7 0 l 7 17 4 1 7 3 1 6 5 1 7 5 1 6 2 1 6 7

o o l 5 0 1 5 e l 6 3 1 5 l l 4 86 3 1 5 2 1 5 8 1 6 0 1 5 5 1 5 3

6 2 1 5 1 1 5 8 1 5 7 1 5 4 1 5 l

979995

8 8 1 8 8 1 9 0 1 7 9 1 8 28 6 1 8 e l 8 7 1 8 0 1 8 18 s l s 7 l 9 4 1 7 7 i 8 3

7 3 1 6 9

e ) | e3 l 85 94u94

8 0 l 7 38 1 t 7 4

71

69

8512179

OI

10687

i l 6 1 e 6 l $ l e 6 l 1 0 2 1 e )r f i | 1n I r05 | I17 | 121 l - - - - -rr2 | 92 I 9I I 94 | 99 l-----

7 l6972

96Lt792

84ro7

7l8667

545454

70657l

758972

645967

707868

7893

596158

769273

849880

, Dropped from the United States birth-rcgistration area,


*:g

I74 TEE wELFABE AND EYGTENE oF MATERNITY AND INFANcY

TABI.E rrr.-In.fant mortalit.y.rates, bE states, in urban anil, rural, (tristrints oft he Ltnited, Bt ates bi.rth-re gistiat ion area ; 19 1 s-19g2-coniinued'

De&ths of infants under I year of age por 1,000 live births

Dosths of infants undsr I year of ago per 1,mO livo births

1925

72 168 1u l I

l

'rarr-r rv.-lnfant mortari,ty ra.tes,^bu^6)Ior, in the (iruited states birth.registra_tion area and, im states ioring'zdoo ar kiri'catorea itiii"ir*i|ita-; lgrs-1927'

Stato

Area- - - - - -__ ____-____White- _ - - -- -_ _ _-Colored----_- - -- _ l i 7

101oa

161

7l67

113

696965

60105

122,

6866

119

7l67

t19

70r07

7l68

t4t

6563

140

656l

1r9

86

r28

72

726

Ii - - -

i--I. : :

: : - .

. - . .

..!:I8

ts

. : . -l 41 2

ll

I lers

I re16

] rerz

I rsra I rore I rozo I rezr- - t - i - -'u"'f'."09"',i_1:_____:-:1.__:__1.-____r BBI B?l gsl ffl gg

Ku&_--________l |

?51 r , | 6? I un I b6west ,v^ i rs in ia-- - - " I - l _ _ __ l__ - ] _____l____ l_ -__

i;;;i.__..___._._j___...l_:__:_ :_.___1._:_:.1:-___:l_::::_l_:::-:I r t ' isconsin.------ ' - l | : : l ; t l ssl tr l #l igili,?lf..--.---.:-1.:----1._._ ., 6e I 67 | 7, I 6s I 68wvspinc'.--------''--'- t----::l:-::::l:-::-:l-:::.-l-.----1.-----

tl?3i.:..:___::l__,_:_l_:::__,______l__. t._ .l_ .. l_._pistrict of corunbial___rul 106 |

ez I

rD I

u |

,r I s3

,n rlrnu tga 1925 1926 Lgzt

621 57b 8 l b r6 5 1 6 2

7 r l 7 07 8 1 7 76 z l 6 5

t n l 80lM | 1U27 3 1 7 3

I8 5 1 9 2

565261

5650M

EO93

67

64

645167

87

56il

829370

697465

78l o

85

50

53

72E469

69615E

6964

68

6763

M

62


stato l-_t-I 1sr5

I 1e16

Deaths of infants under I year oI ago per 1,000 live births

19181917 1919 1920 192I L922 1923 Lg,!. 1925 1926 79E1

-i- llU iss iss ippi - - - - - - - - - - - - - - - - l - - - - -

wh i r e - - - - - - - - - - - ' - - - - - - l - - - - -colored---- - - - - - - i -

IM i ssou r i - - - - - - - - - - - - - l - - - - - - l - - - - -

\ 4 h i t e_ __ -_______ l___ - -_ l - - - - -colored----------l - -

I --

n'\lfrli8I--- - -:::::l-:--:-l-::::colored ---------l

INew York- - - - - - - - - - - l 90 I 94

\ l h i te - - - - - - - - - - - l 98 | 93co lo red- - - - - - - - - - l te l

| 16e

N o r l h c a r o l i n a - - - - - - l - - - - - l - - - - -$ h i t e - - - - - - - - - - - 1 - - - - - - l - - - - -colored--------- j I

O h i o . - - - - - - - - - . - - - . - - - - - - l - - - - -Wb i t € - - - - - - - - - - - l - - - - - - l - - - - _Colored---- - - - . - - l - - - - - l - - - -

t lPennsylvania.- - - - - - - l 110 I t14

\{h i te--- - - - - - - - - l r08 I 1r3colored----------l 184

I 180

South cBrol ina- - - - - - l - - - - - - l - - - - -$ ' b i t e_ _ _ ________ l -___ - - l __ -_ -colored---- - - - - - - l

IT e n n m - - - - - - - - - - - l - - - - - - l - - - - -

\4'hite_ _ _ - - _ _ __ _ _l- _ -_ __l-___-colored---- - - - - - - l

| - - -

unti.f F,i;- - - --:-:-:-l--:-:-l:::-:c o l o r e d - - - - - - - - - - l -

| - - - -

West V i rg io i8 - - - - - - - l - - - - - - l - - - - -W h i t e _ _ _ _ _ _ _ _ _ _ _ l - _ _ _ _ - l - _ - _ _anlorart I

68

85

68oo79

68

82

iL5588

685383

70ov81

67m/ 6

60o l

LLz

6158

113

59

109

79m

109

6260

103

6967

lLz

(3)

74

139

74138

6695

73ln

8886

134

9669

tr,]

79

7m

77

tu

8070

101

7270

111

8886

742

93

119

7269

L

72

l2l

8170

106

72139

9088

151

9670

7067

1

6968

114

8270

110

64113

7976

138

tv277

69m

68

119

7967

105

7067

tn

8280

131

(3)

7067

7?2

68132

82

lU

, o

128

8280

139

9190

10085

133

9291

15E

Iu109194

9795

775

1U285

140

94s2

17E

7mIzx

8482

rot

8474

109

9088

157

1m98

151

11376

149

8685

159

85

8381

153

9795

767

11683

148

7 lM

107

62106

70101

6849

109

9880

137

1Gi86

l4l

9178

120

u110

796E

103

7765

102

u115

7866

104

8167

lr l

8078

110

8767

r32

8472

111

8279

t24

U67

LZI

1068:l

158

11r I83 I

173 ]

w7l

160

t7285

188

8567

t32

9172

139

8368

8564

134

927L

143

ro62

108

6APPENDIXES 175

3 Droppod from the United States birth-registration area.

Tenl,n Y.-lafant nnc)rtolitu rates (ileaths of infants under 7 Aear of age per1,000 liae births) fronL st)ecifr.ed causes in the erpanding birth,-registratiomarea; 7915-1927

Cause of dsth 1916 I 1917 1918

Trelr lV.-fnfant mortal,ita rLteq, tt!/ color, in the flniteil States birtih-registnl-tion area (nd in Stateehal)ing 2,000 or ntore colored births annuollg; 1915-199?-Continued

Ile20 l

I- l0 .9 ir . 0 l1 . 77 .e l3 . 2 |1 . 2 |

14.96 . 2 |7 . 7 i

19.4 i3 . 7c)

l

192370r,rg2l L927

o.7

0.65 .82.30 .57 .8o . o2 . 4

16. 84 . 82 . O

1 . 21. 1

8 . 3L 9

1 . 2n .06 .38 .8

19. I3 . 80)

L . 4

9 . 53 . 9t . 4. 0

6 . 810.219. 34 . 20)

t . 21 . 6z 69 . 94 . 2l . a

6 . 411. 8r8. 54 . 20)

r . u

2 . L9 . 01 . 9r . 4

0 . 90 . 91 . 06 . 2

1 . 013. 56. I4 . 4

17.94 . 2

0 .80 .87 . 27 .83 . 00 .8

Lt.76 .33 . 9

18. I4 . 5

0 . 80 . 7l . I7 . 82 . 90 . 8

l l . 5D . J

4 . 017. 84 . 62 . 6

778I66

25

I

0.0.0.6.z0.1 .6.a

7.

0.60 .60.88 .02 .90 .59 . 76 . 2

t7 .74 .9

9 .06 .59 .3

23 . 3c)

Source: U. S. Bureau of the Census.r Included with congenital d€bility.


,tdt

176 TITE wELFARE AND EYGIENE oF MATERNITY AND INFANoY

TArLE Vl.-.Ilaterrwl nnrtal,ity rates for the United r\tutes anrl certain forei,gncountries'

Deaths of mothers ftom pueq)eml caus€s per 10,000 livo birtbs

Countryr9i9 I 1920 l92l ts22l rc23l1924 7926

:,

l?--3S-

44

i:383052

--to--to-64

9230

t Figures from offcial sources.2 Erclusiye of Quebec from l92l to 1925.

- .l gxgitling frop calcglation of rates prior to 1924 the live-born infants who died before registration ofbirth (within 3 days of birth).

' The United States birth-registr8tion area hos erpanded during this period from 10 States in 1915 to41 States in 19t.

T-rnl,r YII.-Inlant mortalitu rates for the .aniled States and certain foreigncountr ies'

D€atbs of ilfrDts under I y€ar of age per 1,000 live birtbs

Country1916 r9r7 | r9r8l l9l9i lynl wL !.9/2, rc24lr925lrg2f tczT

5650566t33

4t

50m2830264i

2750

. - -436525

58606l31

JO

OJ

48

5045n

5844

-48

6625

56u74332638

52I482734

D 1

49a50u46

4$6727

OJ

ii58

264I

40-3249

i,:n4256

5227

6,n

446630

lg?B

o l

L2795

15079

266148u

150

10785

10981

19372

I156t7010161408550

15098

14060627 l

108

6 ll4l10016588

28314883

143699296

1327S

18466

18163-et- 41'7650

11879

148&6l

r04

I&l t415587

w-85

140i79985

13092

rs69

I166-ei-4,

D

101L15$270

94

66 I154 il n l158 IR A I

n8 lI'-i i-l

r33 |$ l9 b I

r15 Ir34 I76 It * l

-ire-lt * l

-_::_l-I--;8-l 'I-5i- |

r4l Ie0 l

147 |64 I74 176 I

107 I

68

12fi

76s0

100l l l

- id '1 ._- : :-io2

l--__:%1 l - - - - -

84 l - - - - -146 l____-7 0 1 7 0

54 l_ -__-

::.__l-_"__102 l_____r02 I 87167 l_____7 4 t _ _ - _ _

146 l_ - - -_8 8 t 9 66 r l - - - - -40 l_____851 78

rf4l rn8 3 1 8 9

_::__t_:___5 7 1 5 773 t 659 3 l _ _ _ - _

I Figus from omcial [email protected] Excluive of Quebec from 1921 to 1925.3 OmittinC lrom calculation ttle deaths of iniants occurring b€fore registration (within 3 days of birth).

5060

l o

'-2i'

43364932

-28

2465

%'--6t-

il

n8034

47575l79

-n39

49N

-%

36

5l'rr'6451noo6833


€

APPENDIX D._PUBLICATIONS AND EXHIBITS OF TIIE CHILDREN'SBUREAU BEARING UPON MATERNAL, INFANT, AND CHILD WEL-FARE AND IIYGIENE

BULLETINS

The Promotion of the Welfare and Hygiene of 1\Iaternity and Infancy-Reportof the administration of the act of C,ongtess of November 23,1921, for theperiod March 20,7922, to June 30, 1923. No. 137. 42 pp.

The Promotion of the Welfare and Hygiene of l\{aternity and Infancy-Reportof tlre administration of the act of Congress of November 23,7921, for flscalI-ear ended June 30, 1924. No. 146. 56 pp.

The Promotion of the \\'elfare and Hygiene of l\taternity and Infancy-Reportof the adninistration of the act of Congress of November 23, !921', for flsealyear ended June 30, 1925. No. 156. 81 pp.

The Promotion of the'Welfare and Hygiene of Maternity and Infancy-Reportof the administration of the act of Congtess of November 23, 1921, for flscalyear ended June 30, 1026. No. 178. 95 pp.

Tne Promotion of the IVelfare and Hygiene of Maternity and Infancy-Reportof the administration of the act of Congress of November %, 7927, for flscalyear ended June 30, 1927. No. 186. 150 pp.

Proceedings of the Third Annual Conference of State Directors in Charge ofthe Local Administration of the Maternity and Infancy Act (act of Congtessof November 23, 7921), Ileld in Washington, D. C., January 11-13, 1926.No. 157. 209 pp.

The Physician's Part in a Practical State Frogram of Prenatal Care, byn'red L. Adair, M. D. Standards of Prenatal Care, by Robert L. DeNormandie, Df. D. Separate No. 1. 20 pp.

The Nurse's Part in a State Program of Prenatal Qare, by Carolyn ConantVan Blarctrm, R. N. Separate No. 2. 8 pp.

IIow to Iuake a Study of l\faternal Mortality, by Robert IJ. De Normanalie,M. D. Separate No. 3. 11 pp.

A Demonstration of the Community Control of Rickets, by nlartha 1\I.Elirtt, trI. D. Separate No. 4. 5 pp.

Stimulation of Birth Registration, by William II. Davis, trI. D. SeparateNo. 5. 5 pp.

Tbe Practical Application of l\Iental H-vgiene to the Welfare of the Child,by D. A. Thom, II. D. Separate No. 6. 9 pp.

Froeeedings of the Fourth Annual Conference of State Directors in Charge ofthe Local Administration of the I\faternity and Infancy Act (act of Congressof November 23, 7927), Held in Washington, D. C., January 11-13, 1927.No. 181. 167 pp.

The Problem of Compulsory Notification of Puerperal Septicemia, by GeorgeClark ll{osher, II. D. Separate No. 1. 13 pp.

llhe County Health Organization in Relation to trIaternity and InfancyWork and Its Permanency, by John A. n'errell, M. D. Separate No. 2,12 pp.

Evaluation of ltfaternity and Infancy Work in a Generalized Program, byJessie Ir. Marriner. Separate No. 3. 4 pp.

Breast-X'eedingi Demonstrations, by X'rank Howard Richardson, M. D.Separate No.4. 8 pp.

Standalds for Training of Public-Elealth Nurses, by Elizabeth X'ox. Sepa-rate No. 6. ? pp.

Prenat.al Care, by trIrs. I\Iax West. No. 4. 41 pp.

L l I


€L78 TITE wELFARE AND EYGITNE OF MATERNITY AND INFANoY

Infant Care (revised). No. 8. 118 pp,Chikl Care-The Preschool Age, by Mrs. Max West. No. 30. 82 pp.Chilrl 1\{anagement (revised September,7927),by D. A. Thom, }I. D. No. 143.

47 pp.Standards of Prenatal Care; an outline for the use of physicians. No. 153.

4 pp. (Also sample form for pregrrancy record.)Standards for Physicians Conducting Conferences at Child-Health Centers.

No. 154. 11 pp. (Also sample forms for conference record.)IIow to Conduct a Chiklren's Ilealth Conference. No. 23. 24 pp.Chilclren's Health Centers. No. 45. 7 pp.The Public-Health Nurse; how she helps to keep the babies well. No. 47. 7 pp.I\[ilk, the Indispensable X'ood for Children, by Dorothy Reed Mendenhall, ]I. D.

No. 163. 43 pp.'What Is Malnutrition? (revised) by Lydia J. Roberts. No. 59. 19 pp.

Nutrition Work for Preschool Children, by Agnes K. Hanna. No. 138. 25 pp.ll{aternal Mortality; the risk of death in childbirth and from all diseases

eaused by pregnaney anrl confinement, by Robert Illorse Woodbury, Ph. D.No. 158. 163 pp.

Referenees on the Physieal Gro\sth and Deyelopnent of the Normal Child. No.179. 353 pp.

The Il.vgiene of Maternity and Childhood-Outlines for Study. Separate No. 1from Child Care and Child \Yelfare, prepared in cooperatiou with the X'ederalBoard for Vocational Edueation. No. 90. 327 pp.

Causal Factors in Infant Mortality; a statistieal study based on investigationsin eight cities, by Robert Morse Woodbury, Ph. D. A consolidated report ofthe Children's Bureau studies in this feld. No. 142. 245 pp.

Ilabit Clinics for the Child of Preschool Age; their organization and practicalvalue, by D. A. Thom, It. D. No. 135. 71 pp.

Posture Clinics; organization and exereises, by Armin Klein, M. D. No. 1611.32 pp.

Posture Exercises; a handbook for schools and for teachers of physical educa-tion, by Armin Klein, M. D., and Leah C. Thomas. No. 165. 33 pp.

A Study of l\Iaternity flomes in Minnesota and Pennsylvania. No. 167. 92 pp.Recreation for Blind Children, by Martha Travilla Speakman. No. 171. 74 pp.A Tabular Summary of State Laws Relating to Public Aid to Children in Theil

Own Ifomes in Efieet January 1, 1929, and the text of the laws of certainStates. Third edition. Chart No. 3. 37 pp.

llfinimum Standards for Chilcl \Yelfare Adopted by the Washington andReglonal Conferences on Child Welfare, 1919. No.62. 15 pp.

Llst of Psycbiatric Clinics for Cbildren in the United States. No. 191. 28 pp.

LEAFLETS

Dconomie F'aetors in fnfant l\Iortality, by Robert lllorse Woodbury, Ph. D.(Reprinted from the Quarterly Publication'of the American Statistical Asso-ciation, June' 1924.) 19 pp.

X'ederal Aid for the Protection of lllaternity and Infancy, by Graee Abbott.(Revised reprint from the American Journal of Public Eealth, September,7924., 8 pp.

The Trend of Maternal Mortality Rates in the Unitetl States Death-Registra-tion Area, 1900-1921, by Robert Morse Woodbury, Ph. D. (Reprinted fromthe Ameriean Journal of Public IIeBltb, Septemb€r, 1924.) 7 pp.

Westergaard's lllethod of Expected Deaths as Applied to the Study of InfantMortality, by Robert Morse lVoodbury, Ph. D. (Reprinted from the Quar-terly Publieation of the American Statistieal Association, September, 1922.)12 pp.

What Is the Future of the Day Nursery? By Grace Abbott. (Reprinted fromChild Health Bulletin, vol. 3, no. 2, February, 1927.)

Transverse Lines in X-Ray Plates of the Long Bones of Children, by MarthaM. Eliot, 1lI. D., Susair P. Souther, 1\I. D., and E. A. Park, M. D. (Reprintedfrom Bulletin of the Johns Eopkins Hospital, vol. 41, no.6 (December, 1927),pp. 36+488.)


179g

APPDNDIXES

Lesson Material on Care of the Preschool Child:No. 1. Your Child's Ilealth Examination.No.2. Your Child's Physical Defects.No.3. Your Child's Teeth.No.4. Your Child's Nutrition.No.5. Your Chiltl's X'ood Likes ancl Dislikes.No.6. Your Chiltl's Posture.No.?. Your Child's Need of Sunshine and Open Air.No.8. Your Chiltl's Behavior.No. 9. Protecting Youd Child against Communicable Diseases.References on Prenatal, Infant, ancl Child Care, and Chikl Management.

The Children's Bureau i what it is, what it has done, and what it is doing forthe children of the Unitecl States.

List of Publications, Jauuary 2,7g?g.List of Exhibits.

TOLDERS

Illinimum Standards of Prenatal Care. No.Baekyard Playgrounds. No. 2.Why Drink Milk? No. 3.What Builds Babies? No. 4.Sunlight for tsabies. No. 5.Breast Feeding. No. 8.Keeping the Well Baby \Mell. No. 9.Out of Babyhood into Chidhood. No. 10.Why Sleep? No. 11.

DODGENS

Books aud Pamphlets on Chilcl Care (revisecl). No. 1.Is Your Child's Birth Reeorded? (revised)' No. 3.

SMALL CEABTS

Baby's Daily Time cartls (a series of six cards, 5 by 8 inches, a different colorfor each age period up to 2 years). Chart No. 14.

EXEIBIT MATERHL1

fnfant Welfare (10 posters in colorg 22 by 28 inches).The Flealth of the Child Is the Power of the Nation (Fster in colors, !8 by 24

inches ) .. posture Standards (6 charts, 18 by 38 inches), To be purchased clirectly from

the Government Printing Office at 5O cents for the set of six, or 25 eents forthe ihree girls' charts or for the tJrrce boys'charts

Well Born. ('I'wereel film, showing time 30 minutes. Titles in English orSpanish. Made in 1923.)

Ouf Children. (Tworeel fllm, showing time 35 minutes. Tifles in English orSpanish. Made in 1917.)

; Postule. (Two-reel film, Showing time 20 miDutes. Either reel may be used_) alone, tlte first being a general introduetion suitable for pa.rents and children.)

t -". Sun Babies. (One-reel fi1m, showing time 15 lrinutes. This shows how to give

' sun baths in oraler to preYent and cure rickets.)- The Best-f,.ed Baby. (one-reel film, showing time 15 minutes. This shows the

importance of breast feeding.)Trails Tnat Lead to Mothers and Rabies. (n'ilm strip illustrating the work

done under the matet'nity and infancy act.)The Ilealthy Baby. (Film strip showing the care of the baby to 2 years of age.;Rickets. (l'ilm strip showing the effects of the disease and how it is prevented

aud cured.)

1 A tlescriDtive l ist of Children's Bureau erhibits containing a statement of the condi-tions and piocedurc of loao and purcllase can be had on application to the bureau.


6180 TEE WELFARE AND EYGIENE OF MATERNITY AND INFANCY

The Preschool Days of Betty Jones. (Filmschool child.)

strip showing the c;rre of the pre

showing the method ofTeaching the Old Midwife New Tricks. (Film stripinstruction used in classes for midwives.)

The Care of the Baby (50 lantern slides).Infant and Child'lVelfare (54 lantern slides).Maternity antl Child-Ilealth Center (model; weight, 109 pounds).Children's Nursery (rnodel; s'eight, 2-15 pounds).City Playgxrund for Children (model; weighL, 109 pounds).Sun Baths for Babies (model; weight,95 pounds).


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