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Child-Welfare Special
A suggested method of reaching
Rural Communities

Children’s Year Follow-up Series No. 5

Bureau Publication No. 69

U. S. Department of Labor
Children’s Bureau
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

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Object------------------------------------ -—*— ^4---------— ---------------------------Equipment_____________________ '--------- --------------- ----------------- -------Personnel_____________ L--------—------------ ---------------------------------------Method----------------------------------------------------- ----------------------------------Findings--------------- --------------------- —-----------------------------------------------Attitude of the public------ :------------------ ------------------------------------------Conclusions______________________ *-----------------■;-------------------------------


Faces page.

Plate I.


Exterior of the Special------------ ------------------------------------------Interior of the Special-----------------:------------------------------- |-----A school for mothers------------------------------ ;----------------------------A typical parking place--------- 1----------------------The Special parked in the school grounds-----------------------------A well-baby clinic inside the Special------------------------------------A family from a near-by dairy farm attending the town con­
ference _____________________________
A town family at the conference----------------------------------------Waiting to be examined-----------Keeping the interest during the examination------------------------A group at a rural conference awaiting examination----------------After the examination-----------:-------------- ------------2 — _*----------8
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j Suggested Method of Reaching Rural Communities}
The lack of resistance shown by our country boys in the canton­
ments and under forced physical strain, and the reports of recog­
nized authorities as to the relative prevalence of defects among rural
as compared with urban children, are too significant to be ignored.
Rural studies made by the Children’s Bureau point also to the fact
that the country child, in spite of his many natural advantages, is
laboring under a handicap which it is possible to remove.
The very isolation which theoretically protects rural children
from many ills renders difficult and expensive that skilled advice
which every mother needs in the rearing of her family. To a large
extent this is being secured for the city mother, but individual States
and the Federal Government are concerned with the problem of
bringing to the mothers of country children (who comprise threefifths of the children in the United States) a reasonable amount of
help, and of insuring to the 18,000,000 girls and boys living iii rural
areas a fair chance of growing into happy, useful citizens.
With this end in view the Children’s Bureau is trying the experi­
ment of a movable child-welfare station, which can take to the rural
districts a certain amount of instruction and, it is hoped, create a
demand for more. I t is possible also that this experiment may fur­
nish a practical suggestion to States wishing to give their own rural
populations similar help.
In the Children’s Year campaign, carried on during the war under
the direction of the Children’s Bureau and the Council of National
Defense, traveling “ Specials ” of one sort or another were tried by
a number of organizations as a means of reaching the rural child.
Reports of these specials indicated that they were an exceptionally
fine educational medium.
It was said of a truck used in Cleveland, Ohio, and the surround­
ing towns:
The Children’s Special caused people in all walks of life to think about baby
conservation. It was a popular publicity feature and so became educational
1 By Frances Sage Bradley, M. D. • Inquiries for further information may be addressed to
the Children’s Bureau, United States Department of Labor, Washington, D. C.

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by catching the attention of all sorts of people. The mother who naturally
shuns the baby-welfare center had for once the center brought to her in so
attractive a form that she was deeply interested and immediately became a
convert to the policy of seeking help from the center whenever the baby needed

From Connecticut came the statement:
Perhaps the most far-reaching accomplishment of the Baby Special was the
arousing of the small and rural communities to their need for child-welfare
work. Before the coming of the Special, many of these communities had
thought their children were well taken care of because they had plenty of
fresh air and milk. Many of the towns that were so apathetic and indifferent
now realize that these things alone do not make for healthy and strong children,
and a number are making plans for permanent child-welfare agencies.

The Child-Welfare Special is the name of the big Government
truck that is being used as a movable child-welfare station for the
purpose of carrying to remote regions the gospel of child hygiene.
It was built especially for this purpose, though following in a gen­
eral way the construction and equipment of the traveling dispensaries
used in Cleveland, Ohio; Vermont; Connecticut; New York; and
Michigan; and especially of that used by the Chicago Tuberculosis
Institute in Cook County, 111.
The truck weighs 4 tons, has a 35-horsepower engine, and a body
mounted on a 1-ton chassis. I t stands 6 feet 4 inches high and
measures (inside) 6 by 9^ feet. As can be clearly seen in Plate I,
there is across the rear, beneath, a box containing a tent, 9 by 9 feet
in size, three cots, and a goodly supply of Army blankets for the use
of the staff when it is necessary to camp out. At each of the front
corners, extending lengthwise, are smaller boxes; one contains tools
for the repair and upkeep of the car, together with 100 feet of electric
wiring; the other contains household utensils—ladder, ax, spade,
broom, collapsible pails, and cooking vessels.
Outside, the truck is a battleship gray in color, with the name
“ Child Welfare Special, Children’s Bureau, U. S. Department of
Labor,” painted in bright blue letters on each side. The interior is
enameled white, thus adding to the appearance of space and neat­
ness. As to equipment, it is amazing to see the ingenious and com­
plete arrangements which would do credit to many a city childwelfare station.
The main body, 6 by 9 | feet, is used for a conference room and is
fitted up for the examination of children. Available space is in­
creased by utilizing as a front dressing room the chauffeur’s cab and
by letting down for a rear dressing room an adjustable annex
which folds into the truck while in transit. A glimpse into this rear
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dressing room is given in Plate II. This increases the size of the
truck to 6 by 14| feet. These dressing rooms afford complete privacy
by means of sliding doors and substantial shades. Comfortable
stools for mothers with babies are provided. There is an entrance at
one end of the truck and an exit at the other, thus avoiding the con­
fusion and congestion that would result if visitors were obliged to
retrace their steps.
During the day the truck is well lighted by means of four windows,
2 feet square, on each side of the car. These are placed sufficiently
high to be beyond the reach of prying eyes and are further pro­
tected, as are the glass inclosures of the front and rear dressing
rooms, by heavy shades matching in color the outside of the truck.
For night work the truck is equally well lighted by two electric
systems, one for a current of 6 volts supplied by the truck’s own
batteries, and the other for 110 volts furnished from a convenient
local building. Two heaters supplied from the latter source keep
the Special comfortable in moderate weather. In very cold weather,
a kerosene heater adds to the comfort of the rear dressing room dur­
ing the early morning hours.
There is an excellent water supply, provided by a 15-gallon tank
placed above the chauffeur’s seat and piped to a stationary washstand
in a front comer of the ear. The washstand is equipped with a
faucet and drainpipe. The space above the chauffeur’s seat is further
utilized for the storage of exhibit material, consisting of a projec­
tion machine, films, stereopticon slides, and miniature models show­
ing good ways to bathe, clothe, and feed young children. There
is also a large roll of panels, charts, and posters illustrating various
phases of child welfare.
Above the wheel housing on one side are cabinets and closets for
the storing of an astonishing supply of bulletins and leaflets for dis­
tribution. These consist of the publications of the Children’s Bureau
and other Government departments, and also of those of the State
board of health of the State visited. There are also filing cases for
records, reports, and the like. Occupying similar space on the oppo­
site side of the truck is a table for the examination of children, the
space under the table being filled with large drawers for smocks,
sheets, and small blankets for the protection of children during ex­
amination; and smaller drawers for stethoscope, tongue depressors,
and a stock of celluloid toys for the diversion of timid children. At
one end of the conference room are a measuring apparatus and
standard scales, adjusted to ounces and provided with an automati­
cally adjustable scale pan for children too young to stand.
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The staff required to do this type of work to the best advantage
must consist of—
First. A woman physician, preferably a pediatrician with a keen
appreciation of social service and public-health methods. She must
have also a practical working knowledge of rural people and con­
ditions, understanding their resources and their limitations.
Second. A public-health nurse, especially trained in the care of
children, and with the social sense well developed. She must have
also a working knowledge of dietetics and keep herself informed
as to the foods available in the small rural home.
Third. An advance agent, a person capable of representing her
department creditably. She must be able to address prominent citi­
zens or groups, must be a good organizer; at the same time, when
her advance work is over, she must be a valuable addition to the staff
of the Special, demonstrating the exhibit, supervising the efforts of
the committee to keep things running smoothly in the waiting room,
and assisting in the clerical work necessary at the end of the day,
editing the more or less elaborate medical records kept for statistical
purposes. About two weeks before the close of the study in one
county, it is necessary for the advance agent to pave the way in the
next district, thereby avoiding expensive delays of the Special and
its staff.
Fourth. An expert chauffeur, capable of repairing the truck and
keeping it in perfect condition; of running the projection machine
and of making himself generally useful. Under his guidance, the
staff must hold itself in readiness at any time to lend a hand in
bridge building, road construction, electrical engineering, and the
I t is suggested that the staff of such a project be selected with a
view to their special fitness for this kind of work; that they be prac­
tical, adaptable, with a thorough understanding of rural people and
conditions and with an ever-present sense of humor to tide them
over the rough places. Above all, they must have an abiding faith
in the worth of their work and be prepared to offer results accom­
plished as a measure of their ability.
The method adopted by the Child-Welfare Special is to accept the
invitation of a State board o f health which is interested in cooperat­
ing with the Children’s Bureau in working out a method of securing
better conditions for its children. The fact that there are now di­
visions of child hygiene in 32 State boards of health, as compared
with 6 before January 1, 1917, is significant of a belated but wide­
spread determination to give the child a square deal.
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In selecting the counties to be visited, the proportion of rural
population, the conditions of the roads, and the probability of se­
curing local cooperation are the main considerations. The advance
agent, who travels two weeks in advance of the car, arranges the
itinerary, attends to the publicity, and organizes local committees to
take charge of the work. Her first step is to consult the local medical
society and explain the nature of the work. She then calls together a
county child-welfare committee. With the aid of its members, an
itinerary is mapped out, and local committees are organized in the
communities to be visited. So far as possible, the agents work
through the local child-welfare committees formed during Children’s
These committees are furnished explicit written instructions cov­
ering the following points:
A comfortable and level site must be chosen for parking the Spe­
cial, near a public building which affords an available room. This
room is to be used for the demonstration of*panels and models above
referred to; it must be at least 20 feet long, for the testing of the
vision and hearing of children of suitable age; it must be supplied
with drinking water and toilet facilities; and must serve as a wait­
ing room for mothers and children. Such a room is pictured in
Plate II I , while Plates IV and V show typical parking places. The
waiting is reduced to a minimum by requiring the committee to make
appointments for those desiring a conference (allowing three chil­
dren to the hour), thereby relieving the doctor, the mothers, and
the children of all unnecessary delay. The waiting room is, of
course, to be cleaned, lighted, and heated by local effort. The com­
mittees are asked also to make a canvass of their districts before the
Special arrives, in order that everyone may understand the purpose
of the conferences. Each committee member has her field of work
clearly defined. A number of women are asked to serve as hostesses
during the conference—receiving mothers and babies, and explaining
the exhibit material.
The agent then distributes her cuts and other publicity material
for the newspapers, printed instructions for the child-welfare comTnittees, copies of the announcements that ministers are asked to
make from their pulpits, and posters advertising the coming of the
Special. She visits city and county officials, social agencies, editors,
teachers, physicians, clergymen, farm advisers, county demonstrators,
business men, and other representative citizens and explains the
purpose of the visit of the car.
An itinerary is arranged, completely covering the county. A stop
of a week or more is planned for the county seat and two or three
days for each of the smaller settlements.
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As a result of this work of the advance agent, the staff finds every­
thing in readiness on the arrival of the Special. The staff can then
at once take the charts and exhibit material out of their boxes and set
them up in the waiting, room—of which a member of the hostess
committee is put in charge. At opportune times the doctor and nurse
give brief talks to groups of waiting mothers, using the exhibit ma­
terial as a means of illustration. The films and slides are shown only
at prearranged evening meetings.
I t must be clearly understood that the Special is an educational
and not a clinical demonstration and that no treatment or prescrip­
tions are given; that sick children are not to be brought; and that
those showing the slightest symptoms of communicable disease are
debarred from the conference—even a severe cold disqualifying the
child. Examinations are limited to children of preschool age. No
treatment is given, but the doctor gives each parent a written record
of the child’s condition, together with any recommendation she has
to make. The examination of each child takes about 20 minutes.
Plate V I shows a youngster being put through his paces. He is ap­
parently more interested in the camera than in the celluloid toys pro­
vided for him.
In summer, mothers are asked to bring a sheet, and in winter a
shawl or small blanket, for the comfort of children during examina­
tion, though a stock of these is kept on hand for the accommodation
of forgetful mothers. Attention to all these details adds materially
to the comfort and convenience of those concerned and keeps the ma­
chinery of the conference running smoothly.
After the work of the advance agent is completed, the Special arriyes—greeted always with the most enthusiastic welcome. Its fol­
lowing begins on the outskirts of the town, increasing steadily un­
til by the time the big truck swings into the public square it is sur­
rounded by practically the entire floating population. Thus escorted,
its parking place is sought and may prove to be near a church, a
school, a railway station, or the rear of a country store—with boxes
of soap or shoes and cases of side meat for seats. In one small town
the staff of the Special was surprised to find a Young Women’s
Christian Association room, while at another an ex-pool room provedto be the only available place. The walls and green-topped tables
covered with sheets exhibited the panels and models to excellent
advantage; and while it is probable that the old habitues hardly rec­
ognized it in its new capacity, they would assuredly admit that never
in its palmiest days had the pool room been used by a larger or more
enthusiastic company.
Plate V II shows a family coming in from a dairy farm to attend
the conference held in town, while Plate V III illustrates a town
family within easy reach of the conference.
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A children’s health conference as used in this experiment is a modi­
fication of the children’s health conference employed by the Children’s
Bureau in its rural work for the past few years. Here, however, one
family at a time is received into the truck to confer with the doctor
in regard to the difficulties encountered in rearing a family. The con­
ference room affords the same privacy as the physician’s own consulta­
tion room, and the physician attempts to give the most practical pos­
sible advice, referring suitable cases to available sources of relief—
private or public. Especially is the effort made to point out to parents
where they are succeeding and where failing in their efforts to secure
the best possible results in the physical development of their children.
The nurse receives the family and secures the history, including
nationality and occupation of parents, facts as to their literacy, the
schooling of the children, and the incidence of all illnesses, with ages.
One by one the children are stripped, weighed, and measured by the
nurse, wrapped in a sheet or blanket, and brought to the examination
Here the attention of the parents is called to the relative height
and weight of the child, and to the fact that this is a fair index of his
physical condition. Next, they are asked to observe the general con­
dition, the texture of skin and fnuscle, and, particularly, the posture
of the child. Winged scapulae, rounded shoulders, and a contracted
chest are typical of the rural child; and the average parent, who has
accepted this as an inherited and inevitable trait, receives with interest
the suggestion that swimming, or daily exercise on a trapeze or on the
horizontal limb of a tree, might improve the position of the pliable
little shoulders and incidentally increase the breathing capacity.
Then, poor teeth are shown to be associated with poor bone de­
velopment ; and further search is made for their possible results in
the development of diseased tonsils, infected cervical glands, rheu­
matism, and that common complaint of country children—indiges­
tion. Usually the mother has never associated these circumstances,
and the care of children’s teeth has been considered a superfluous re­
finement of city life. I t is astonishing to see the amount of interest
aroused in a child by the unexpected possession of his own tooth­
brush and tube of paste. Mothers may be convinced that it is no
more difficult to teach a child the care of his teeth than of his face
and hands. Local dentists also lend a practical impetus by giving
an initial cleaning to the teeth.
Next in order may be poorly formed ankles and a tendency to flat
foot,, which have usually escaped the attention of the parents, who
can not understand why Johnny u runs over ” his shoes or complains
of pains up the back of his legs.
Inquiries are made as to the cause of a distended abdomen, and
the parents are shown that, instead of being a matter of family jest,
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this is a real defect for which they are responsible. That simplicity
and regularity of feeding are essential to the well-being of the child
is usually quite foreign to the tradition of the rural parent, however
systematic and intelligent he may be in the feeding of his stock. It
is necessary for the examining physician to know just what foods
are available, especially during the winter season, in order to give
practical advice upon this important point. In many sections the
making of wholesome bread is an unknown art; the small farmer is
poorly equipped for keeping green vegetables; and in certain sec­
tions the Special has found even milk well-nigh impossible to procure.
The vision and hearing of the older children are also tested; many
children are found unknowingly handicapped by a defective eye or
ear. This seriously retards their progress in school and is a cause
of discouragement and failure.
In addition to the detailed information secured on a card kept for
statistical purposes a record is given the parents, checking defects
found in each child, with written suggestions for improved hygiene
or, when indicated, with recommendations to seek skilled assistance.
Each mother upon leaving the truck is given practical, helpful
literature. In localities having a county nurse it is possible to effect
close cooperation; the results of the examinations give the nurse a
contact with families which she otherwise would not have.
I t is believed that the majority of parents leave the conference
room with an honest intention of living up to their good resolutions
to follow the suggestions given, and it is probable that a reasonable
amount of follow-up work would prove the soundness of one doctor’s
experience that money spent in infant hygiene brings in bigger
returns than along any other public health line.
I t is not the purpose of this leaflet to make a statistical report of
this experiment. I t may be said, however, that the Special has been
in constant service since July 11, 1919, and has visited five strictly
rural counties, none having more than one town exceeding 2,500
inhabitants. One was in a mining section and the other four were
agricultural. All were lowland counties, with the exception of one,
which was in the foothills of the Alleghenies. One county was fairly
prosperous, the parents in a position to provide everything necessary
for the well-being of their children. The people of the other coun­
ties were, however, distinctly limited in their resources, more from
custom than from necessity. In one district, where grazing was poor
and the feeding of cows expensive, the majority of the children *were
given tea and coffee instead of milk. In an adjoining section, where
it was the custom to keep cows, the better nutrition of the children
was a testimony to the value of milk as a tissue builder.
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By far the commonest defects found were decayed teeth and poprly
•developed bones; next in frequency were palpable cervical glands
and enlarged tonsils—often the latter were seriously infected. Mal­
nutrition was next in order, though this point must be tactfully han­
dled, for any mother resents the supposed inference that her child is
not sufficiently fed, while often quite the contrary is true—the diffi­
culty being that the food is badly chosen, poorly prepared, and fed
at unsuitable hours.
The Special examines from 100 to 150 children a week, coming
perhaps in closer and more responsive contact with the families of
those children than is possible to the average busy physician who
sees them rarely except when ill. The interest of the parents and
their eagerness to learn suggest that with a reasonable amount of
educational work on the part of the State and county boards of
health a repetition of these defects in later children might be avoided.
Especially would this seem hopeful with intelligent follow-up work.
In not one of the counties visited was there any knowledge of the
extent or the significance of their infant mortality.
Attitude of the public.
A report from the doctor in charge of the Special says:
The Special has the distinct advantage of at once gripping public interest.
This may seem spectacular from the professional point of view, but it gets re­
sults. It is believed that the ground can be covered better by the Special than
in any other way; that its better equipment will make for better results, than
any method tried to date; that its usefulness is directly in proportion to the
ability of the physician in charge to make her public realize that she is merely
demonstrating the need of periodic examinations and a method of providing
opportunity for such examinations. She must bear in mind that the examina­
tions she gives are merely an incident and not the object of the Special—that her
most important function is to stimulate and aid in the organization of per­
manent follow-up work by the community.

One of the most gratifying experiences of the Special has been
the cordial cooperation which it has had. County medical societies,
latent during the war, revived to discuss the possibility of securing
permanent follow-up work. Local doctors assisted generously by
making laboratory tests, X-rays, microscopic examinations, and by
aiding in the placing of children requiring special care—such as
orthopedic or tuberculor cases, children suffering from trachoma, or
those retarded mentally.
The physicans were often the stanchest friends of the Special,
frequently with a train of small patients in their wake. In one
town two physicians—brothers—kept their automobile and' chauffeur
busy during a two days’ conference, bringing to and from the Special
mothers living at a distance who otherwise might not have been
able to attend. Dentists were equally helpful—one examined the
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teeth of all the school children and treated gratuitously those not
able to bear the expense, and two others of another county divided
the work of that section between them, cleaning and treating the
.teeth of county school children and bringing the expense well within
the parents’ means.
If the interest aroused is a gauge of the success of the Special, the
experiment has indeed been successful. The response from parents
has been especially gratifying. Excerpts from reports give an in­
dication of the reception the Special usually receives. The report of
the first conference reads:
In spite of the fact that the thrashing season was at its height, the doctor
and nurse were almost overwhelmed with the crowd of mothers, fathers, and
habies. Examinations lasted until late into the evening.

Another report says:
All through the afternoon and evening this routine continued. The dressing
rooms were constantly occupied; the doctor and nurse paused only for a
hasty supper—yet the fathers and mothers continued to wait, i t seemed as
though they Ead been saving their questions for years against just such an
occasion as this. The visitors were all English-speaking people, all deeply con­
cerned over the welfare of their children, and all determined that the Govern­
ment doctor should not leave the community before their children had been
examined. Mothers unable to be served in the afternoon came back after
supper, accompanied by their husbands. These men, some of them still covered
with chaflE and dust, had spent a hot day behind a thrashing machine—
yet they patiently awaited their turn and listened carefully to the doctor’s

Requests were received to present to the fiscal courts of two coun­
ties the proposition of a public-health nurse. A group of farmers in
one county asked to have explained to them the meaning of child
welfare and promptly recognized its practical similarity to their own
experience in stock raising. A group of miners requested a member
of the staff of the Special to suggest a method whereby their wives
might be helped to care more successfully for their children.
I t is frequently asked if the bureau intends to follow up the work
of the Special by efforts of a more permanent character. The un­
derlying theory of the bureau is that if a Government agency such
as the Children’s Bureau investigates, reports, and demonstrates, the
conscience and power of the local community can be depended upon
to undertake any local action necessary. The bureau believes that
the follow-up work done by the community itself has more lasting
results and arouses far more local interest than anything attempted
by an outside agency.
As a result of the service of the Special, several communities are
already employing public-health nurses, in some instances supple-
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meriting a nest egg left over from Red Cross funds and in others
raising the entire amount by public subscription. In one town a
sensible women’s committee refused liberal contributions from pub­
lic-spirited men, preferring, they said, to have everyone share in the
responsibility and the privilege of supporting this service. Instead,
they asked $1 from everybody and got it. In another county the
group of miners mentioned above raised at one meeting between $700
and $800 and agreed to supply the remainder needed in order to give
their wives the help to which they are entitled. Mill operatives were
interested. Women’s clubs, parent-teacher associations, and espe­
cially Red Cross chapters saw an outlet for their war-time energy
and zeal for service and took up, with the keenest interest, provision
for our own children.
Schools also recognized the presence of a physical defect as a
real handicap, not only to the individual pupil, but also to the
class as a whole; and the senior class of a normal school deter­
mined to urge upon the parents of their prospective pupils a thor­
ough examination before beginning their school life and an annual
inspection thereafter. Many children were sent or brought by
their teachers, who wished help in classifying difficult cases. In ­
terest in the physical examination of children was shown by teachers
on every side, and the Special was swamped by requests to examine,
if not all, at least selected cases in each grade.
The interest of the children was unqualified. Something of this
interest is indicated in Plates IX and X and none of the children
there pictured appears in the least frightened. Occasionally, small
children had been frightened by the gruesome tales of older boys,
hinting at vaccination, tonsillectomy, extraction of teeth, etc., but
they were invariably won over by a simple statement of the details
and the purpose of the work. Often the Special found itself sur­
rounded at the end of a busy day by disappointed applicants for
examination. One little boy returned so often to the truck that it
became necessary to resort to parental restraint to curb his enthu­
siasm. A tiny girl insisted upon being brought a second time to
the Special to “ show off ” the gayly decorated cuff by which the staff
and her mother had conspired to stiffen her elbow and break the
habit of thumb sucking. Other children were breaking themselves
of mouth breathing by putting narrow strips of court plaster on
their lips at night, under the protection of their bed covers. Many
children entered with zest into certain exercises suggested as cor­
rective measures, and stoical adherence to wholesome dietaries, were
reported by mothers heretofore helpless in their efforts. One father
complained that his boy was drinking the cow dry; other fathers,
that the children were robbing the calves. Hundreds of height and
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weight charts were distributed,2 and it is safe to assume that the
eagerness of mothers and children to gain that half pound a month
will develop a new use for the scales of the crossroads store.
The interest of mothers was assured, the only difficulty being to
keep up with the eagerness of their demands. Occasionally the
mother was found who resorted to ingenious subterfuges to inveigle
a more exclusive examination of her child—in her own home, for
example. Finding this impossible, she philosophically sought an
appointment, bundled up the baby, and joined her more democratic
neighbors. Town women often sent their cars for distant mothers
and children and, upon occasion, gave up their own appointments to
mothers who lived remote from medical aid. Often it was neces­
sary to limit the examination to one child from a family, the mother
being allowed to choose the one with whom she most needed help.
Mothers were most ingenious in attempts to circumvent this edict.
A foster mother was secured for a second child, long enough to have
him examined; and reputed twins (a double birth being accepted as
a single child) were brought. Usually, however, the women were
most generous and helpful and recognized the fact that the Special
hoped, not to examine every child in the county, but to demonstrate
the need and the method by which counties might secure for them­
selves such a service.
After eight months’ continual service of the Child-Welfare Special,
it seems fair to judge as to (1) the value of a motorized activity for
child-welfare work in rural counties; (2) the mechanical advantages
and disadvantages of the plan; and (3) the expense of the project.
1. The value of a motorized activity for cMld-ivelfare work in
rural countie9.—I t is probable that an impetus to permanent welfare
work was given more promptly, more thoroughly, and effectually by
means of a motorized activity than would have been possible by more
conventional methods. The Special brought to a county a definite,
vigorous message concerning the welfare of the children' of that
county. The coijnty was instantly and keenly interested.
A general response was inevitable because the Special visited every
community large and small, and not a man, woman, or child was
allowed to escape the spell of the more or less spectacular appeal. I t
is difficult to imagine a county covered so promptly and completely
by any other method.
The success of the method must be judged by the results ac­
complished. The Special began service July 11,1919. I t has visited
2 Table of Heights and Weights of Children, prepared by the Children’s Bureau, U. S.
Department of Labor. Averages are given for births, for 3 months, for every month from
6 to 48, and thereafter for every year up to 16.
Federal Reserve Bank of St. Louis



five counties in three central States. None of these counties had a
full-time health officer; none had medical inspection of school chil­
dren. One county shared a nurse with a local tuberculosis associa­
tion. One county had excellent consolidated schools; one had a home
demonstration agent; and all had county agents employed jointly
by the county and United States Department of Agriculture. In no
county had there been any expression of municipal obligation con­
cerning the well-being of their children, or any effort made to insure
proper physical or mental development.
The prevalence of malnutrition and the presence of defects which,
according to Dr. T. W. Wood, handicap 75 per cent of our children
are believed to be for the most part remediable, if not preventable.
It is inconceivable that this condition is due to intentional neglect
on the part of parents or communities; it is due rather to the fact that
heretofore it has been impossible to bring, especially to rural com­
munities, a knowledge of existing conditions or of the fact that
trained assistance is necessary in rearing sound, vigorous chil­
dren. The evolution of the public-health nurse offers a solution of
this problem. Trained not only in the care of disease but also in its
prevention, with a working knowledge of hygiene, of Sanitation,
and of practical dietetics, especially as related to children—she is
the logical forerunner and later assistant of the full-time health
officer which every county needs.
For that reason, the Child-Welfare Special has felt that the pub­
lic-health nurse was perhaps the most practical agency of relief
in these rural counties. Before leaving the first county, the Special
had the satisfaction of seeing an excellent nurse installed, with a
car—to insure county-wide service.
In the second county visited, two nurses were employed within 30
days of the departure of the Special.
In the third county, a mining section seriously affected by strikes,
one nurse has been employed and money raised for two more.
The fourth county is still maintaining, in conjunction with the
Tuberculosis Association, its county nurse for whom the Special is
in nowise responsible. The assurance is forthcoming, however, that
a second nurse will be employed as soon as one can be found. The
Special had the privilege in this county of aiding in crystallizing
public opinion concerning a trial milk clinic, where all children
found 4 pounds or more under suitable weight for their height are
given milk twice a day in addition to a lunch brought from their
homes or furnished at moderate price in the school. Markedly good
results from this experiment have overridden a certain amount of
antagonism and converted all unbelievers.
Federal Reserve Bank of St. Louis



The fifth and last county visited by the Special was at the time
of the visit in the throes of an influenza epidemic, following a worse
one last year and an epidemic the year before of spinal meningitis.
Three successive times the lives of many have been lost and the
health and vigor and resistance of many more have been undermined,
as shown by our study.
2. The mechanical advantages and disadvantages of the flan.—The
mechanical advantages of a movable child-welfare station consist of a
better equipment of the Special than would be available in the average
small town—both for facilitating the work of the conference and for
securing the comfort of the personnel. In many communities there are
no hotel accommodations; in such cases three can sleep comfortably
in the truck, one across each end and one lengthwise in the confer­
ence room; or the tent is easily set up—though, as a matter of fact,
the staff usually preferred sleeping out in the open. The ample
water supply and a compact nest of aluminum cooking utensils and
solid alcohol render the family wholly independent. A certain
amount of canned goods is kept on hand, and the efforts of the en­
terprising chauffeur, browsing around the neighborhood, are always
rewarded with success.
The disadvantages of the method consist of the facts that the truck
is necessarily bulky, is top-heavy, andis not entirely independent in
the matter of roads. The first objection it is impossible to obviate
without greatly limiting its usefulness. The second objection can
be partially remedied by reducing the height 5 or 6 inches. This
would still allow ample headroom. The third is a disappearing
objection, good roads steadily bringing in closer touch our rural and
urban communities.
After eight months’ trial of the truck, certain improvements natu­
rally are indicated. A larger engine would materially increase its
pulling power up steep hills and through heavy sand; a different
style of window and a wooden roof (instead of a glass one) for
the rear annex would offer better protection from wind and rain;
a more satisfactory heating system is being considered in order to
make the Special independent of climate or season. I t is believed,
however, that most of these difficulties may be met.
3. The expense of the project.—The initial cosh of the truck was
$5,000 with an extra $500 for certain interior conveniences extra fur­
nishings added later. This has been slightly increased since cold
weather by the addition of rubber weather stripping across the win­
dows and by the purchase of two electric heaters ($12 each).^ The
chauffeur has done practically all the repair work except rebuilding
the rear box containing the tent and bedding. This box was too deep
from top to bottom and dragged when going down a steep embank-
Federal Reserve Bank of St. Louis



ment. The item of gasoline has been surprisingly small. During the
first few months of travel through a level country, the Special aver­
aged 11 miles to the gallon, but in rough, hilly sections the average
was 8 or 9 miles.
After all, the expense of the activity can be measured only by the
value of the results accomplished, and it is a question as to whether
or not the same amount of money can be spent to better advantage in
other ways. The Children’s Bureau is not urging a movable childwelfare station for city work nor yet for work in remote mountain
districts, but this method is suggested for the consideration of States
wishing to reach quickly, thoroughly, and effectually their rural
inhabitants—separated as they are in our country by vast stretches
of territory, yet segregated into small towns and communities whose
name is legion.





Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis