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U. S. DEPARTMENT OF LABOR
JAMES J. DAVIS. Secretary

CHILDREN’S BUREAU
GRACE ABBOTT. Chief

THE PROMOTION OF THE WELFARE
AND HYGIENE OF MATERNITY
AND INFANCY
THE ADMINISTRATION OF THE ACT OF CONGRESS
OF NOVEMBER 23, 1921

FISCAL YEAR ENDED JUNE 30, 1925

Bureau Publication No. 156

WASHINGTON
GOVERNMENT PRINTING OFFICE

1926


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AT

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i\

B ound by TEXAS BOOKBINDERY, DALLAS, TEXAS

Date

CONTENTS
Letter of transmittal______________________________ ._____________
Introduction_______________________ ;_________ ____________________
Funds available under the act______ 1______________________ ___
The Federal Board of Maternity and Infant Hygiene______________
State administration_________
Summary of State activities___ ___________________________
Child-health conferences____________________
Child-health centers—___________________ _______ __________
County health units_________________________________ »___
Home visits-_______________________________ ___ ____ _____
Nutrition work___________________________________________
Dental hygiene.^____________ '__________________________ 9
Correction of defects__ _______________________________ „__
Prenatal care__________!_______________ sc______ — _______
Care during confinement__________________________________
Midwives___ ______________________________________
Inspection of maternity and infanthomes_____________ _______
Instruction of mothers_____________________________________
Little mothers’ classes___________________________:H_______ _
Birth and death registration_____________________________
General educational work_____________________
Personnel of the administrative staffs_______________________
Principal activities of the individualStates____ _________
Alabama_____ 1_____________ ______________________________
Arizona_________________
Arkansas__________________________ 1________ ._____________
California_____________________________________________
Colorado___________________________________________
Delaware_______________ _________ _____ 0 ___,____________
Florida—*__________________
Georgia___ •_________________ —____ _—__________________
Idaho________________________________ 1________________ __
Indiana_____..._____________________________________ _______
Iowa_____________________________________________________
Kentucky____________:__ 3 _________ ___ ____________ _____ _
Louisiana________________________________________________
Maryland__ I___.______ ___________ ;______ ___ ,_____________
Michigan__________________________*______________________
Minnesota_______________________ ________________________
Mississippi___ _______ _________________________________ s___
Missouri__ _____________________ _______ 1_______ __________
Montana____________________________—________ __________ 44
Nebraska___________________ —1____ ,___________ _________
Nevada_______________ ___________ ____ ;_________ i___ _____
New Hampshire—____________________________
New Jersey_______________________________________________
New Mexico_________ I_____________________ ______________
New York-----------------------------North Carolina_____________ 3k__ _______ ___ 'l___J___ _____
North Dakota_______________ ——_________________________
Ohio______________ - __________________ ___ ____ ^ ________
Oklahoma_______
Oregon— ^-------------------------------------------------j____ _____ ~ ~STPennsylvania__________________________________________
in


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IV

CONTENTS

State administration—Continued.
Page
Principal activities of the individual States—Continued.
53
Rhode Island---------------------------------------------------------- --------54
South Carolina--------------------------.-Ji— WË*-*-------------------------55
South Dakota------------------ ------------------ -------------- --------------55
Tennessee______________ —------ --------------- ----------- « -----------56
Texas__________________ !--------- _Jl__-------------------------------57
Utah__________________ ___________________ _________ $----58
Vermont______________________ w-------------------------------- -—
58
Virginia---------------- —— ------------------------ ----------------------- 59
Washington_____________________________ — — t t i A -------- •—» 60
West Virginia-------------------------------------------- --------------- —
61
Wisconsin-------------------——’---------- —--------->------------ -----------61
Wyoming------------ —--------------- -— ------------ wr--------- *-----------63
Federal administration-------------------------------— — <?-—
----- ----63
Federal staff------------------------------------------—
-----------m
63
Conference of State directors---------------------- -— --------- — ---------64
Research and educational work----------------------------------------4^ -—
Standards for physicians conducting conferences in child64
health centers----------------------------%
---------------- —--------------65
Standards of prenatal care------------------------- ---------------- -—?—
65
Community control of rickets---------------- —---------------------------66
Rickets in children in the District of Columbia— ------------_____
66
Stillbirths and neonatal deaths--------- 1.----------------------------------Neonatal and maternal mortality in Tennessee in relation to
67
the attendant at birth------------:— ---------------------------------1—
Infant and maternal morbidity and mortality in. Idaho----------- , 67
67
The effect of posture on physical fitness—---------------------------68
Care for crippled children---------- — —-------------- —----------- 4 —
68
Milk, the indispensable food for children------ --- --------------68
Nursing-service demonstration in Utah------------ •---------------- —
68
Educational work among midwives in New Mexico------------—
69
Educational work among midwives in Tennessee and Georgia69
Prenatal letters.--------------------------------- ------— --------—- - —
69
News-letters------------- -------- ------ ----- ----------------- —•------- t*—
69
Publications----------------------------------- 7- --------— »—----------f*4j|
70
Motion pictures, lantern slides, and exhibit material-----— '•— •—
Appendixes:
- ,
A. —Text of the act for the promotion of the welfare and hygiene
73
of maternity and infancy--------------------------------- - —— -----76
B. —List of administrative agencies and officers-------------------A—
78
C.—Maternal and infant mortality rates.— -------------- —------— —
X).—Publications of the Children’s Bureau bearing, upon maternal,
80
infant, and child welfare and hygiene----------------- —----------MAPS
States accepting the benefits of the act-------------------------- —----- - Frontispiece
The birth-registration area (1925)----------------------- — ------ — —
The death-registration area (1925)---------------------------------- - - --------—
Child-health and prenatal conferences and centers-------------------------—
18


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LETTER OF TRANSMITTAL
U . S . D e p a r t m e n t of L abor,
C h il d r e n ’s B u r e a u ,

,

,

f
Washington February 11 1926.
: There is transmitted herewith a report of the activities under­
taken for the promotion of the welfare and hygiene of maternity
and infancy under the act of Congress of November 23, 1921, during
the fiscal year ended June ‘30, 1925.
Respectfully submitted.
TT
T
_
.
G race A bbott , Chief.
Hon. J a m es J . D a v is ,
Secretary of Labor.
S ir


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HYGIENE OF MATERNITY AMD INFANCY, WITH DATES OF LEGISLATIVE ACCEPTANCE

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[Diagonal lines indicate States not cooperating]

THE PROMOTION OF THE WELFARE AND HYGIENE
OF MATERNITY AND INFANCY
INTRODUCTION

The act for the promotion of the welfare and hygiene of mater­
nity and infancy of November 23, 1921, popularly known as the
Sheppard-Towner Act, makes available to the States Federal funds
to aid in reducing maternal and infant mortality and in promoting
the health of mothers and infants.1
A t the close of the fiscal year 1925 all the States except Connecti­
cut, Illinois, Kansas, Maine, and Massachusetts were cooperating
under the provisions of the act. By action of the Sixty-eighth Con­
gress its benefits had also been made available to and accepted by
the Territory of Hawaii ; and official requests, not yet acted upon by
Congress, have been received from Alaska and Porto Rico.
FUNDS AVAILABLE UNDER THE ACT

The funds authorized by the maternity and infancy act became
available in March, 1922. The administration of the funds from
that date to June 30, 1924, has been reported.2 The accompanying
table shows the amounts available, the total amounts accepted by the
States from the appropriations for the fiscal years 1922, 1923, and
1924, and the amounts accepted to June 30, 1925, from the appro-'
priation for the fiscal year 1925.
Under the terms or section 2 of the maternity and infancy act
so much of the amount apportioned to any State for any fiscal year
as remains unpaid to such State at the close thereof shall be avail­
able for expenditures in that State until the close of the succeeding
fiscal year.” 8 $
.
2
f2,otnot®. b -table, p. 2. For text of the law see Appendix A, pp. 73-75.
... e Welfare and Hygiene of Maternity and Infancy. TJ. S. Chil­
l i 1} 8 5,Vreau Publications Nos. 137 and 146. Washington, 1924 and 1925.
T7nliprit S to ^ n^erCif a ^ / ef1ereilce
be made to rulings of the Comptroller General of the
andinfancy ac?^^
7 1 egard to the appropriations for carrying out the maternity

h e n e ^ nf J T ^ tfe S« ^ cruins whUe ^ m o n e y s are held by the States inures to the
benent of the united States as owner of the funds and not to the States as trustees and
should be accounted for and paid into the United States Treasury accordingly
The
interest8 hnt S T i * ! 6’ however, that the money shall be held by the States and bear
but shall be promptly applied to the purpose for which furnished, and the
®°ould hot be furnished in amounts necessarily resulting in large sums being
held and thus bearing interest.” (May 12, 1922.)
} he State fails to appropriate an amount specifically equal to the
amount of the allotment authorized by the Federal appropriation, moneys applied to the
same purpose through other State appropriations may not be considered as making the
appropriated funds of the State equal to the allotments authorized by the Federal appro­
priation unless it is established that the fact that the other appropriation was available
tor the services and facilities provided for in this a c t ’ controlled the State legislature in
nmking its specific appropriation, in which case there would be justification for considermoneys in determining that the amount appropriated by the State is equal to
the Federal allotment.” (June 23, 1923.)

1

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2

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Amounts available1 to S tates2 from Federal maternity and infancy funds and
amounts accepted3
[Statement as of Dec. 31,1925]

States

M axim um A m ounts
am ounts
aeeeptedavailable
b y States
from 1922 from 1922
appropria­ appropria­
tio n 4
tio n

A labam a_______ $10,297. 56
6,753.88
A rizona________
8,953.03
A rkansas_______
C alifornia______ 12,731.12
7,119. 83
Colorado ______
8,114. 75
C onnecticut____
5,503.10
D elaw are_______
7,184. 90
F lo r id a ........... .
Georgia________ 11,533.10
I d a h o ____ ____
Illinois_________
In d ia n a ________
Iow a___________
K ansas________
K e n tu ck y ______
M aryland ____
M assachusetts. „
M ichigan______
M innesota___ _
M ississippi_____
M issouri ______
M o n ta n a _______
N ebraska______
N ev ad a________
N ew H am pshire.
N ew Jersey.........
N ew M e x ic o .....
N o rth C aro lin a..
N o rth D a k o ta ...
O hio....... ............
O klahom a______
Oregon_________
Pennsylvania___
R hode Isla n d ___
South C aro lin a ..
South D a k o ta ...
T e n n e s s e e .......
Texas__________
U ta h __________
V erm ont _____
Virginia ______
W ashington........
W est V irginia__
W isconsin______
W y o m in g ..........
T o t a l ___

5,974.30
19,631. 03
11,611. 07
10,423. 56
8,991. 51
10,452. 00
9,057.50
6,732.66
8,270.49
13,691. 06
13,276.07
10,385.44
9,039.70
12,679. 67
6,238.31
7,924. 66
5,174. 63
5,999.61
12,119.83
5,812.96
28,429.70
10; 773.47
6,459.36
17,993.41
9,575.88
6,767.35
24,672. 69
6,363.54
8,798.54
6,436.07
10,274.35
15,520.41
6,013.85
5,795.09
10,209. 61
8,060. 58
8,302.16
10,938. 04
5,438.57
4?7,500. 00

M axim um
am ounts
available
from 1923,
1924, 1925,
an d 1926
appropria­
tions .

Amounts accepted b y States from— .

1923 appro­ 1924 appro­ 1925 appro­ 1926 appro­
priations
priations priations 5 priations 6

$25,836.95
12,253.71
21,817.51
33,112.01
16,337.20
19,311.48
11,504.01
16,531. 72
29,530.55
(2)
12,912. 66
53,739.10
29,763.62
26,213. 60
21,932. 52
26,298. 64
22,129.80
15,179.77
19,777.05
35,981. 70
34,741.11
26,099. 65
¿2,076.58
32,958.19
13,701. 91
18,743. 21
10,522.06
12,988.31
31,284. 55
12,430.33
80,041. 78
27,259. 66
14,362.74
48,843.46
23,679. 48
15,283. 46
68,810.99
14,076. 28
21,355. 65
14,293.11
25,767. 55
41,450.52
13,030.89
12,376. 9C
25,574. 0C
19,149. 55
19,871. 74
27,751. 62
11,311.12

$25,836.95
5,000.00
6,855. 75
24,279.35
9,976.99
9,655. 74
11,504.01
8,621. 28

$25,836.95
12,253.71
16,817. 51
13,114.93
9,999.33

$25,836.95
12,253.71
13,500. 00
15,620. 00

$25,836.95
5.000. 00

10,000.00

26,730.00
5.000.

11,000.00

11,504. 01
16,531.72
15,250. 00

6,250. 00

11,504; 01
5, 000. 00
5.000.
5.000.

7,912.66

11,504.01
16,531.72
28,490.00
11,725.96
5,691.60

24,995.00
26,213. 60
12,097.33
26,298. 64

26,250.00
26,213.60

25,750. 00
26,213.60

25,000.00
26,213.60

26,298.64
20,190.60

26,298. 64
22,129.80

26,298. 64
5,000.00

19,277.05

"19,277.05

19,277.00

19,277.00

34,741.11
34.741.11
26,099. 65
26.099.65
22,076. 58
22,076. 58
28,527.38
21,762.17
13,701.91
13,701.91
17,661. 69
7,409.50
5.000.
00
10,522.
00
5.000. 00 12,988.31
31,284.55
31,284. 55
12,430. 33 12,236.40
80,041.78
27,259. 66
27,259. 66

34.741.11
25.974.65
22,076.58
31.000.
13,701. 91
11,915.00
10,522. 00
12,988.31
31,284.55
12,43ft 33
80,041.78
27.259.66
7.400.00
43.843.46
23,679.48
15,283. 46
68,810. 99
14,076. 28
21.355.47
14.293.11
25,767. 55
41! 450. 52
13.000.
5,000.00
25,574. 00
27,751. 62
6.600.00

34,741.11
26,000.00
17,038.29
005.000.
13.700.00
8,845.00
10, 522.00
12,988.31
31,284. 55
12,430.33
80,041.78
27,259. 66
5.000.
5.000. 00
23,679.48
5.000. 00
68,810.99
5.000. 00
13.200.00
5.000. 00
5.000. 00
35,350.52
005.000.
5.000. 00
25.574.00
005.000. 00
19,871. 74
5.000.
5.000.

316,554. 02 21,190,000.00

716, 333.40

958,644.81

732,197.96

$10,297.56.
5,000.00
5,000.00
(6)
5,000.00
8,114.75
5,503.10
5,000. 00
6,750. 00
5,000.00
(6) •
8,199.09
10,423. 56
8,991. 51
10,452. 00
7,913.57
13,253.97
10,385.44
9,039.70
12,473.15
6,238. 31
7,924.66
5,000.00
5,000.00
12,119. 83
5,812.96
10,773.47
5,000.00
7,187.95
5,000. 00
6,232.61
24,667.12
8,797. 50
6,436.07
5,000.00
9,363. 93
5,000. 00
(6)
10,209.61
4,998.70
5,000.00
8,995. 03
4,998. 87

6,000.00

11,900. 00
5.000. 00
8. 000. 00
68,810. 20
21,355.65
12,844.24
18,521.94
32,567. 38
6,365.00
25,574. 00

10,000. 00

5,000.00
27,750. 44
' 5,000.00

6,000.00
22,000.00
20,934.06
15,283.46
68,810.99
4,999.86
21.355.65
14.293.11
22,410. 73
40,689. 20
13.000. 00
2,775.33
25,574.00
10. 000. 00
10, 000. 00
27,751. 62

11,000.00

884,452.34

10. 000.
10, 000. 00

12,000. 00

8.000.

1 Under the terms of the act each State accepting receives $5,000 outright; additional funds are granted if
matched—$5,000 to each State and balance of the appropriation distributed among the States on the basis of
population.
2 On M ar. 10,1924, the benefits of the act were extended to Hawaii. The amount available for 1925 and
1926 is $11,725.96, thus increasing the total available to the States and to Hawaii from $1,190,000 to
$1,201,725.96.
8 A mounts shown are the amounts actually accepted b y the States through D ec. 31,1925, less refunds of
unexpended balances returned to the Federal Treasury as of Dec. 31,1925.
4 Owing to th e fact th at only a few months of the 1922 fiscal year remained at the tim e the appropriation
act for that year was passed a full appropriation was not made.
6 The 1925 funds are available un til July 1,1926, and the 1926 funds until July 1,1927. Actual acceptances
through D ec. 31,1925, are here given.
8 California and Illinois accepted the full amount available, and Vermont accepted $5,000. However,
these funds were not spent but were returned to the Federal Treasury.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

3

THE FEDERAL BOARD OF MATERNITY AND INFANT HYGIENE

Section 3 of the act creates a Federal Board of Maternity and
Infant Hygiene, to consist of the Chief of the Children’s Bureau,
the Surgeon General of the Public Health Service, and the United
States Commissioner of Education. At its first meeting (April,
1922) this board elected as its chairman the Chief of the Children’s
Bureau, who has continued to serve in that capacity.
Section 8 of the act provides that to receive the benefits of the
act detailed plans for carrying out the provisions of the act within
the State must be submitted to the Children’s Bureau and be subject
to approval by the board. I t is specified, however, that “ if these
plans shall be in conformity with the provisions of this act and
reasonably appropriate and adequate to carry out its purposes they
shall be approved by the board.” (Sec. 8, Appendix A, p. 74.)
Ih u s plans originate in the States and are administered by the
States. The policy of the Federal board has been to consider each
plan in the spirit of the act, and it has not attempted to control or
influence the activities to be undertaken. I t has interpreted the term
u infancy ” as ending with the preschool period, which means that
the funds are not available for work with school children, and has
ruled that Federal funds or State funds used in matching Federal
funds can not be expended in subsidies to private agencies.


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STATE ADMINISTRATION
SUMMARY OF STATE ACTIVITIES

Activities previously begun have spread over a greater territory,
and many new activities have been initiated. Continued progress
in the maternity and infancy work is thus indicated by the reports
from the States. The aim of these activities centers as heretofore
in better infant care, to be accomplished through the instruction of
mothers; better care for mothers, to be accomplished through wider
instruction in regard to the importance of skilled supervision during
pregnancy, childbirth, and the lying-in period; and the stimulation
of medical and nursing facilities in order that adequate maternity
and infancy supervision may be available to a greater proportion of
the population than at present.
The programs undertaken in the different States have of necessity
varied considerably because of varying conditions in the States.
The individual communities need, in general, to be helped in deter­
mining what standards they should set for themselves, and in
organizing their own resources. To have communities educated to
the point of demanding and making use of medical, dental, and
nursing service is a necessary prerequisite to the improvement of
such service and to its initiation in regions where little or none is
yet available.
The difficulty of carrying the benefits of a maternity and infancy
program to all parts of a State or region involves some problems yet
to be solved. Frequently there is a natural tendency to direct a
large part of any work of this nature toward that part of the com­
munity which presumably would not be able to pay for medical
attention or nursing service, in spite of the fact that any educational
work is assumed to be done for the general public, regardless of the
financial status of those instructed. In one city the result of this
was noted recently in connection with the fact that the death rate
among the infants of foreign parentage and in the poorer parts of
the community has been reduced by more than one-half within the
last few years, while in the sections of the community consisting of
people who presumably could afford the services of a physician the
infant death rate has been rising. In other words, the indigent
portion of the community had learned the value of medical super­
vision for their children, but the members of this same community
who apparently enjoyed better economic conditions had not been
taught the importance of such supervision at all.
Environmental factors play so large a part that the results of a
maternity and infancy program toward reducing infant mortality
are constantly affected by them, and the general public health of a
community must be touched directly or indirectly by the maternity
and infancy work because the welfare of the child depends so greatly
on its immediate surroundings. Instructing mothers about the
4


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

5

importance of feeding pure milk to children and also the care of it
in the home leads to a demand for a pure-milk supply. In several
States surveys were made or other work done toward improving
local milk supplies. Immunization against diphtheria constituted
part of the program in some States, as in Michigan, Missouri, .and
New Mexico, because of local conditions or other reasons.
Success in maternity and infancy programs depends largely on the
interest and cooperation of the medical profession, as represented by
State and county medical societies and by the individual members of
the profession throughout each State'. I t is the policy of the ad­
ministrative staffs in the States to lay the plans of work projected
for any locality before the physicians as the first step in undertaking
work in that locality. . Help has been given generously by local
physicians, who appreciate the importance of this fundamental edu­
cational work; and the reports submitted by the States have made
very frequent mention of the assistance received from local physi­
cians and from the medical societies. Some States have paid physi­
cians for services in connection with local work; but many physicians
hav§ given their services; and some have assisted in child-health
conferences in towns at some distance from their homes, having only
their traveling expenses paid. Leading pediatricians and obstetri­
cians have served as consultants on many occasions and have given
instruction which has been extremely valuable. Dental societies and
local dentists have shown equal generosity and appreciation of the
aims of the work.
Very effective support has been given by women’s clubs, men’s and
women’s fraternal organizations, commercial organizations, parentteacher associations, and by educators throughout the country. Such
cooperation is desirable for any health program, and it is especially
vital in the promotion of the scientific care of children. The interest
of the entire adult population, not alone the fathers and mothers of
individual children, must be enlisted, if the best results are to be
obtained. For this reason the interest and sympathy of “ lay work­
ers ” is to be sought quite as seriously as that of the professional ele­
ment in the community.
In the outlines of activities in the cooperating States (see pp.
19-62) usually mention has been made of the number (sometimes
only estimated) of volunteer workers who gave their services. Some­
times no mention was made, if the number was small—although it
may here be noted that there were but nine States whose reports made
no specific mention of volunteer assistance. In some States the method
of organization of such workers permitted the enrollment of a larger
number (as in Michigan and Texas). In round numbers it may be
stated that the volunteer service of more than 12,000 persons was
reported.
CHILD-HEALTH CONFERENCES

The reports of the States show that more than 18,000 child-health
conferences were held by the State agencies administering the Fed­
eral funds during the fiscal year ended June 30, 1925, at which ap­
proximately 290,800 examinations of infants and preschool children
were made.


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6

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The child-health conference is the great teaching agency as to
the general care of children, their diet, and both minor and serious
defects which have not been recognized. The State agencies admin­
istering the act have held itinerant or “ demonstration ” conferences
in order to acquaint local communities with the work which could
be accomplished, and help has been given through the loan of per­
sonnel. Since demonstratibn conferences and permanent childhealth centers indicate to the people of the community the value of
constant medical supervision for their children,, the persons who
bring their children to conferences consult local physicians more
frequently thereafter, to the great benefit of the children. In a
number of States the use of an automobile or truck equipped for the
holding of child-health conferences has been found advisable for
the initiation of the work. Regions not otherwise easily accessible
may be reached by this method, especially during the summer
months. The incidental educational value is also to be taken into
consideration, since an automobile thus equipped attracts attention
all along its route, and the possibilities of examination and advice
are suggested to persons who might not otherwise consider them.
The combination of actual conference work with a showing of
health films later in the day, or the giving of talks by staff members
to audiences easily and informally assembled, has been found suc­
cessful in the course of such automobile work. Some of the States
which have reported use of “ healthmobiles,” “ health movie
trucks,” or “ health caravans” are Arkansas, Florida, Georgia,
Maryland, Pennsylvania, South Carolina, and Virginia.
CHILD-HEALTH CENTERS

One objective in the States is state-wide establishment of perma­
nent, locally supported child-health centers accessible to all the
population in need of instruction regarding the care and welfare
of their children. Although infant or children’s health centers or
opportunities for conferences had been established in the larger
cities in many of the States before 1922, a county-wide service
had been provided in only a few places, although it has been
recognized that health centers or itinerant conferences are good
teaching agencies. In this discussion a permanent health center
means an established place and time at which a physician and
a nurse are present for the examination of well children and for
the instruction of mothers on the essentials in the feeding and care
of infants and preschool children. The establishment of 506 new
permanent child-health centers in the fiscal year under review has
been reported by the cooperating States.
COUNTY HEALTH UNITS

Some States have used the county as the local administrative
unit. A brief period of demonstration of the work by the State or
of assistance from State and Federal funds is very frequently fol­
lowed by a decision of the county to assume part of the responsi­
bility, and ultimately the counties or local communities take over
the work if sufficient local appreciation has been aroused. Some
States have sent a maternity and infancy nurse to a community

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for a specified period to initiate a maternity and infancy program,
the work to be taken over entirely by the community as the demon­
stration thus made commands general approval.
When a county nurse has been jointly paid from maternity and in­
fancy funds and local funds she has usually done generalized public
health nursing work, records being kept of the time spent on ma­
ternity and infancy work so that proper division of funds might
be made. I t has seemed advisable to coordinate the maternity and
infancy program with the other work and resources of the respective
States in the interest of economy. Obviously, advantage should be
taken of all available resources, public and private, which will for­
ward the actual accomplishment of improved care for mothers and
babies. Furthermore, it is advisable to have the demonstration work,
whether in connection with general infant welfare, prenatal work,
or nutritional education, conducted, so far as possible, upon a scale
of expenditure commensurate with that scale upon which the respec­
tive communities could conduct it upon their own responsibility.
The only exception which it is believed should be made to this rule
is in carrying on some new piece of work with a view to determining
scientifically the results obtained.
HOME VISITS

Home visits form an important part of the work of county and
other field nurses. Almost all these nurses are supplied with inex­
pensive cars, which make it possible for them to reach almost any
home in their respective territories where a visit is desirable. The
purpose of these visits is to advise the mother on some point of
maternal or child care and to demonstrate practical methods of
carrying out her own or physicians’ instructions.
The nurse who visits in a home has an opportunity to see the living
conditions of the family, and her instruction and advice in regard
to matters of maternal and infant hygiene and the welfare and
health of the young children are the more valuable when her demon­
strations are made with the equipment which the home affords.
The lack of formality attending such a visit encourages the mother
to ask questions more freely and mention her problems more readily
than is always the case at even the most informal conference. By a
visit to the home the nurse is often able to interest the parents in
having corrections made of defects noted when their children were
examined at child-health conferences. Home visits are especially
useful in regions where the isolation of smaller communities and of
individual homes makes it difficult to assemble groups for con­
ferences.
.
In some communities the policy has been adopted of having the
nurse call at the home of each newborn baby as soon as its birth is
registered.
Since a visit may or may not include a demonstration it is not
possible to report accurately the number of home visits and home
demonstrations as separate items. There was an approximate total
of 300,000 visits and demonstrations, the numbers reported by Ala­
bama, New Jersey, New York, North Carolina, Ohio, and Virginia
indicating that those States in particular made intensive use of this
method of teaching.

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NUTRITION WORK

I t is difficult to separate nutrition work from the other activities
of the physicians and nurses. Instruction relating to the nutrition
of the mother and her child during the prenatal and breast-feeding
periods and of the older infant and preschool child is so important
that some discussion of these problems is usually included whenever
contacts are made with mothers in home visits, in mothers’ classes, at
conferences, and at demonstrations and exhibits of all kinds. Five
States—Kentucky, Michigan, Missouri, New York, and Ohio—re­
ported the employment of a nutrition specialist. These women were
used in various ways: To write bulletins; to give talks to groups; to
hold nutrition classes; to discuss their own diets and the diets of
their children with individual mothers at conferences; to give dem­
onstrations at fairs and conferences; to work on special studies and
surveys, etc. In addition to the nutrition work of their own staffs,
several States reported cooperation with the extension division of
the State university or agricultural college. Such cooperation is
most valuable, as it strengthens the work of both groups in the
community.
The importance of an adequate and carefully selected diet for a
mother during pregnancy is receiving growing recognition as more
exact knowledge of the results of a deficient diet are seen in the
condition of the child and of the mother. Through the- distribution
of diet lists and other printed material and through individual
advice in prenatal visits, classes, and conferences this information
was being extended throughout all the States in the development of
their prenatal work. The value of breast feeding in the reduction
of infant morbidity and mortality has been so clearly demonstrated
that instruction of the mother concerning the importance of main­
taining her milk supply and of breast feeding her baby was em­
phasized in all the States. Four States—Arizona, Idaho, Minne­
sota, New York—reported that a special campaign had been under­
taken to increase the proportion of mothers who nursed their babies.
When the child begins taking solid food he starts acquiring the
food Habits that will persist throughout his life. If nutrition work
can be done for the preschool child, it should prevent much of the
malnutrition seen among school children. Since it is impossible to
win the interest of the child himself (except of the older preschool
child), the instruction must be given to the mother; and for this
reason the formal nutrition class found to be most effective with
school children is difficult to use for younger children. Instruction
given to individual mothers at conferences or home visits and to
informal groups of mothers and their children of preschool age
were the most usual plans for this work. Fourteen States—Arizona,
Delaware, Florida, Kentucky, Louisiana, Maryland, Michigan, Mis­
souri, Montana, New Jersey, North Carolina, Ohio, Pennsylvania,
Texas—reported having had nutrition classes. Some groups of
mothers met several times for a series of lessons; sometimes a single
group meeting constituted a class. General talks on food selection
and demonstrations of food preparation were both given in these
classes. A method used by a few States was to have the nutrition
work given by a specialist at the child-health conferences, either in
the form of a practical demonstration or as individual instruction

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given to each mother. In other States the groups met primarily for
nutrition work, often in the home of some member of the group.
Many of the States that did not have nutrition classes gave similar
instruction in their mothers’ classes or little mothers’ classes.
DENTAL HYGIENE

Dental attention given to preschool children was reported in con­
nection with the general physical examination of children at con­
ferences in most of the States in which dental examination was
mentioned as included in the maternity and infancy work. Dental
conferences or clinics were reported by 15 States, and more than
13,000 children were given attention at a total of 330 such confer­
ences. In Pennsylvania assistance in this phase of the work was
given by a division of the State department of health which regularly
devotes most of its attention to dental care for children of school
age.
Full-time dentists or dental hygienists were reported as on the
staffs of only two States. In the other States reporting dental con­
ferences or clinics the work was done by dentists volunteering their
services or employed for short periods of time. Frequent mention
was made in State reports of the generous cooperation of local
dentists when child-health conferences were held in their com­
munities. In Virginia, especial emphasis was put on dental hygiene
work, 2,033 preschool children having been reached during on© sixmonth period.
Dental care during pregnancy and the nursing period has not as
yet been given the attention which is admittedly desirable. How­
ever, the importance of care of the teeth is emphasized in prenatal
conferences and literature dealing with prenatal care.
CORRECTION OF DEFECTS

I t has been observed that defects noted in the last preschool year
are more or less permanent and therefore cumulative. This em­
phasizes the importance of examination of the child before entrance
in school. For example, a tabulation of the 24,229 pathological
conditions and defects noted in the examination of 12,344 children
in Michigan shows a steadily increasing number of defects per ©hild
from the first to the sixth year ranging from 1.2 defects per child
for children in their first year to 3 defects per child for children
over 5 years of age.
I t has been difficult to ascertain the number of corrections made
of defects noted at conferences. A report is seldom obtained unless
a nurse visits the child’s home to inquire whether the physician’s
advice in regard to correction has been complied with, although
some parents bring their children to return conferences to exhibit
the improvement resulting from correction of the wrong conditions
which had been pointed out to them. Some discussion of correction
and percentages is included in the outlines of the work in Alabama,
Arizona, Colorado, Indiana, Iowa, Missouri, Nebraska, New Jersey,
Wisconsin, and Wyoming in later pages of this report.
Attention to goitrous conditions was mentioned in the reports
which were received from Colorado, Michigan, and South Dakota.
Special orthopedic work or investigation with regard to the need

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

for orthopedic work or provision for it were reported in Montana,
Ohio, and South Carolina, legislation on the subject having been
enacted in the last-mentioned State.
PRENATAL CARE

A total of 3,781 prenatal conferences has been reported for the
fiscal year under review. More than 36,000 visits were made by
mothers to these conferences. The establishment of 65 new perma­
nent prenatal centers was also noted, and increasing attendance
has seemed to be recognized as generally apparent. One of the diffi­
culties incurred in the successful conducting of prenatal centers has
been the reluctance of women to attend meetings at all public in
nature, and their reticence in asking questions after they had
conquered their unwillingness to appear at the meetings. This is
gradually being overcome, but the prenatal program in many States
must still be fundamentally educational for the general population
as well as for the individual women who are reached through con­
ferences, visits from nurses, or through the mediqm of correspond­
ence. Many women not only have no medical supervision during
pregnancy but have little or no medical care during confinement.
Women need more instruction in the importance of placing them­
selves under the care and observation of a competent physician
early in the period of pregnancy. This instruction is being given
through prenatal letters, pamphlets, and leaflets distributed from
State bureaus and the United States Children’s Bureau, visual edu­
cation, group teaching, and talks which the nurses have with in­
dividual mothers. That proper prenatal care reduces the number
of stillbirths, lessens the danger of maternal mortality and the
danger of death of the child in early infancy, and promotes the
health of both mother and child are facts as yet but dimly compre­
hended by the general public. I t is generally conceded that the
greater part of the infant deaths occurring in the first month of
life are due to natal and prenatal causes.
In Michigan it was found that the prenatal center with the best
attendance (except those in Detroit) was one which functioned in con­
nection with a hospital. This suggested that the hospital can be a
suitable place for a permanent prenatal as well as an infant center.
Consequently whenever it was feasible the effort was made to establish
such centers in connection with hospitals having a maternity-bed ca­
pacity of not less than 10. An incidental advantage in this procedure
was that the women learned to appreciate the value of the hospital as
a place of confinement. The work so far has been in connection
with private hospitals only. In one of the counties the county
nurses advised or persuaded the women to consult physicians early
in pregnancy, thus laying the foundation for eventual establishment
of prenatal clinics or centers.
CARE DURING CONFINEMENT

One problem in regard to care at confinement and care after con­
finement arises from popular lack of appreciation of the nature of
childbirth. Persons who would unhesitatingly seek a physician and
hospital services for a comparatively minor operation do not realize

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that pregnancy, confinement, and the lying-in period all require the
most careful medical supervision. Examples are all too frequently
noted of cases in which the father was the only attendant at birth,
or in which only a well-meaning neighbor was summoned. Still­
births, neonatal deaths, and maternal deaths can be lessened by pre­
natal care and by better care at confinement. The study of maternal
mortality published by the Children’s Bureau (see p. 80) shows that
a very high percentage of the losses of mothers’ lives is due to
preventable causes. Work for prevention of the unnecessary deaths
in childbirth is, therefore, imperative. At the same time it must be
conceded that mothers who desire medical attention are to some
extent in positions where they are quite as unable to obtain it as are
mothers who do not appreciate—or can not persuade their families
to appreciate—its advantages. People who live in sparsely settled
regions are occasionally cut wholly off from access to the outside
world, and sometimes travel is rendered difficult, if not entirely im­
possible, by heavy snowfalls or impassability of roads.
Another problem in regard to confinement is the difficulty of
obtaining medical attention and nursing care for those who desire
it. There are many examples of communities a considerable number
of miles from a physician, and of districts having but one or two
physicians to serve the communities within a large radius. Some
communities must in fact ignore the need of medical attention be­
cause the nearest physician is so very remote. I t goes without saying
that where individual physicians are rare the likelihood of obtaining
hospital facilities is even rarer. One of the items which thus pre­
sents itself for serious consideration is the need for well-conducted
small hospitals for confinement cases. Whether these should be
county hospitals, and how their establishment and maintenance
should be provided for and their facilities put within the reach of
persons of moderate or scanty means, are still questions to be
answered.
In the meantime the standards of medical care for home confine­
ments should be raised, and more adequate nursing care immediately
thereafter should be arranged for. One suggestion is offered in the
effort mentioned in New Hampshire (see p. 44) to find in each village
women who could be trained to assist their neighbors as a temporary
improvement in the situation. I t is also possible to make clear in
literature, as well as in personal contacts made by persons engaged
in maternity and infancy work, the value of a physical examination
of the mother six weeks after confinement. Such examination, point­
ing out the need for attention and care, may help to avert many
cases of invalidism. The work done in the way of lecturing before
medical societies and other groups in New York through the help
of the “ regional consultants ” of the division of maternity, infancy,
and child hygiene of that State is worthy of mention in this connec­
tion (see p. 46). Stressing prenatal-conference work in the State
programs and obtaining the services of specialists for this work has
been found advantageous, especially good results having been real­
ized in Minnesota (see p. 38). The problem of midwife service for
confinement cases is discussed in the following section of this report,
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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
MIDWIVES

The progress in acquiring definite information on the number
and character of midwives practicing legally or illegally has con­
tinued, as also the work of instructing, supervising, and registering,
and the elimination of the unscrupulous and unfit.
Surveys were begun in Alabama and West Virginia. Especially
active work was done in Arizona, Florida, Georgia, Kentucky,
Louisiana, Maryland, Michigan, Mississippi, New Jersey, New
York, Pennsylvania, Tennessee, and Texas. Pennsylvania extended
its work into three more counties of the coal-mining districts.
Michigan completed its survey and is developing a state-wide sys­
tem of instruction, as is Georgia, where a negro physician on the
staff of the Children’s Bureau has been working among the negro
midwives. The effort in Georgia is not to eliminate the negro mid­
wife but to concentrate on her physical fitness and education. In
regard to work in New Mexico see pages 68-69.
California and South Dakota expect to acquire added data on
their local midwifery situation through the new activity of their pro­
grams—the inspection and licensing of maternity homes.
The holding of classes for midwives was reported in 20 States,
more than 400 being held, more than 10,600 midwives being en­
rolled for instruction, and more than 8,000 reported as completing a
somewhat formal course.
As the nation-wide survey of the midwife situation progresses,
it becomes apparent that although the initial inquiries reveal that
the number practicing is greater than the original estimate, later
data show a diminution in both the number of midwives and their
activities following instruction, supervision, or registration of the
midwives, accompanied by the education of the mother in the hy­
giene of infancy and maternity. A lessening in their totals is re­
ported by 22 States, notably Alabama (in Birmingham), Michigan,
New Jersey, New York, Pennsylvania, South Carolina,- and Vir­
ginia. In New Jersey 30,000 cases were delivered by midwives in
1919 and 17,645 in 1924. In New York the midwives reported 16
per cent of the births in 1916 and 8 per cent in 1924—a decrease of
nearly 1 per cent a year. In Michigan 2,000 more births were
reported in 1924 than in 1921, yet the percentage of midwife at­
tendance dropped from 6.9 per cent in 1921 to 4.4 per cent in 1924.
Virginia has reduced its total number of midwives from 9,500 to
about 5,000, and South Carolina from 6,000 to about 3,000.
INSPECTION OF MATERNITY AND INFANT HOMES

The authority to license maternity homes or lying-in hospitals
and boarding homes for children is vested in other bureaus of some
State boards of health than those designated to administer the act
for the promotion of the welfare and hygiene of maternity and in­
fancy, and in some is vested in other State boards than those dealing
with health (as boards of public welfare, charities, and corrections).
The obtaining of licenses is required in 31 States and the District
of Columbia. The supervision which the licensing authority exer­
cises over the institutions licensed varies from a mere right to in­
spection to scrupulous and detailed regulation of the standards to

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be maintained and the records to be kept. Inspection of maternity
homes by the child-hygiene bureaus of 11 States was reported, a
total of 464 inspections being made. This included 261 in Ohio,
where a satisfactory situation now obtains in regard to this matter
(see p. 50), and 78 in Texas, where attention was focused upon the
situation in order to accomplish some improvement. Inspection of
infant homes was reported by 8 States, with a total of 623 inspec­
tions made, 344 of these being in New Jersey and 213 in Texas.
INSTRUCTION OF MOTHERS

Classes for the instruction of mothers were reported by all but 11
of the States, more than 1,400 classes being held and more than
31,500 women attending them. Details in regard to method or aims
were mentioned by Florida (see p. 28) ; Indiana has a parential pro­
gram of education through mothers’ classes which is well adapted
to a State having many private physicians and nurses (see p. 31).
Work among racial groups was done in some States, as among In ­
dian mothers in Minnesota and for Negroes in some of the Southern
States. The primary work in mothers’ classes is education of women
in regard to prenatal care, then care at confinement, and lastly the
general care of both the mother and the baby. The aim is both to
impart thé essentials of maternal and child care and to instill appre­
ciation of the importance of early and continuous medical supervi­
sion for both mother and child. Very great improvement in the
care and feeding of young children has taken place within the last
quarter of a century, and although the number of mothers who have
really learned the elements of healthy physical life for their chil­
dren is still perhaps only a minority of the population, a majority
of the mothers respond willingly to efforts to teach them at least the
more fundamental matters which they should know in order to give
their children a better chance for physical health.
In lieu of class instruction, or in addition to it, considerable edu­
cation of mothers has been accomplished by the distribution of
printed or mimeographed prenatal letters. In fact the wide distri­
bution of prenatal letters is one of the most practical and inexpensive
methods of initiating maternity and infancy work and accomplish­
ing a certain amount of public-health education. The letters can be
very cheaply prepared, they reach the individual, they are passed
from hand to hand, generally with a high degree of appreciation.
I t has been found that women in the early months of pregnancy
will send for prenatal letters when they are reluctant or unwilling
to attend a group meeting or a center or conference. Yet the educa­
tion accomplished by these letters is very great. The use of pre­
natal letters was specifically mentioned by 18 States, the numbers
varying from 612 in one State to 24,952 in another, 27,142 in another,
and 43,420 in another. • The reports from the States did not always
show definitely whether the series or the individual letters were indi­
cated by the numbers given. One State reported that 4,213 series
were sent out. In many States a large proportion of the addresses
came from physicians who wrote requesting that the letters be sent
to their patients or be furnished to them for distribution among their
patients.

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More detailed instruction and also more individual advice and
assistance can be given by correspondence courses than by a series
of letters to which no reply is expected. The correspondence courses
given in the States vary, however, from a formal course (in which
each lesson is to be written out by the student, sent in for correction
and criticism, and returned for further study) to an informal
correspondence with individual mothers who write for more detailed
advice or explanation of some topics discussed in the prenatal letters
which they have received and whose queries can not be adequately
answered by the forwarding of a suitable pamphlet. In Minnesota
it was observed that this method of instruction was successful in
reaching rural women. In Virginia it seemed that the method of
correspondence brought about a more free exchange of questions
and answers than was always possible at personal interviews. The
State of Washington also mentioned a satisfactory use of the cor­
respondence system.
LITTLE MOTHERS' CLASSES

The holding of little mothers’ classes was reported by 23 States
with a total of more than 1,300 classes. I t should also be noted that
instruction in infant care has become a part of the State’s educa­
tional program in at least one State (see Wisconsin, p. 61). Such
teaching of young girls is important as affecting not only the stand­
ards of care of the next generation of mothers and their infants
but also as having an immediate effect upon the welfare of the chil­
dren. The older girls often have almost the entire care of their
younger brothers and sisters after school hours. Such u mothers’
helpers ” have full opportunity to demonstrate all the information
which they can acquire at classes on infant care. One nurse noted
an instance, for example, of a sixth-grade girl who showed her
foreign-born mother how to prepare and use boric-acid solution for
the new baby’s eyes ; who urged that the baby should not be rocked
and that the automatic cradle (which rocks the baby while the
mother is engaged in farm chores) should be tied to prevent its
rocking; and who advised that the baby should sleep alone at night
as well as in the day,
BIRTH AND DEATH REGISTRATION

I t is obvious that in order to make a suitable outline of the most
immediately needed maternity and infancy work in a given com­
munity there is need of access to accurate vijtal statistics. Conse­
quently, as will be noted in the outlines of activity in the individual
States (pp. 19-62)j most of the States have given some attention
to improving the registration of births and deaths. In Kentucky,
for instance, one member of the staff devoted full time to this work
(see p. 34), and in Mississippi a well-worked-out campaign and
check-up were conducted (see p. 39). Especial attention has also
been concentrated upon this matter in States not yet included in the
birth and death registration areas (see figs. 1 and 2).


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Fig. 1.—The birth-registration area (1925). Thirty-three States and the Dis­
trict of Columbia, including 75.9 per cent of the total estimated population
of the United States, have satisfactory registration laws and actually
register at least 90 per cent of the births. In 11 States there are good
registration laws which have not been in force long enough to bring registra­
tion up to 90 per cent. Four States have laws that can not and do not
secure good registration of births. The years in which States entered the
birth-registration area are indicated

F ig. 2.—The death-registration area (1925). Forty States and the District of
Columbia, also 24 registration cities in nonregistration States, including 89.4
per cent of the total estimated population of the United States, have satisfac­
tory registration laws and actually do register 90 per cent of the deaths. In
four States there are good registration laws which have not been in force long
enough to bring registration up to 90 per cent. Four States have laws that
can not and do not secure good registration of deaths. The years in which
States entered the death-registration area are indicated

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

In connection with death registration the investigation of still­
births may frequently lead to the obtaining of more accurate data.
The fact that stillbirth is given as a cause of death would indicate
a further cause or condition which should be ascertained. A letter
of inquiry to the physician who handled the case might enable a
more précise classification of some cases to be made. The character
of the attendant at birth (physician or midwife) seems to have a
relation to the infant mortality rates in certain areas. Employment
of midwives is often associated with poverty or with the isolation
of families or communities and the lack of hospital or other pro­
vision not only for confinement cases but also for the care of in­
fants who are ill. Epidemics, the character of the milk supply
and the water supply, crop failures, droughts', and the like have
also an effect.
>
The figures for 1924 given by the United States Bureau of the
Census indicate a substantial drop in the infant death rate for both
urban and rural communities in the United States birth-registration
area. If it is true that the infant death rate is an index to the
standards of living in a community, as has been urged, it would
follow that instruction on general standards of living should be
included among preventive measures. This applies to both com­
munities and individual homes. Undesirable conditions are found
in rural communities as well as in cities. The isolation of rural
communities sometimes permits the continuance of conditions of
living that would not be tolerated in cities, where the crowded
condition has compelled more drastic regulation, although it is
true that the rural child is favored by its more natural conditions
of living.
GENERAL EDUCATIONAL WQRK

I t is frequently emphasized that all the work done by the agencies
administering the Sheppard-Towner Act is fundamentally educa­
tional in purpose and in result, no matter how varied the methods
of accomplishing the education may be. Thus the work in the
centers and in the itinerant conferences, also the home visits of
the nurses, achieves a direct contact with the mothers, so that in­
formation is imparted directly to each individual. Instruction on
special subjects is given to groups by way of mothers’ classes, little
mothers’ classes, nutrition classes, and classes for midwives, as has
already been outlined under those respective subjects in previous
pages of this report. Assistance in educational work among racial
groups has continued to be necessary in some States ; as, for example,
work among Indians in Minnesota, among Mexicans in Arizona,
and among Negroes in Southern States having a large Negro popu­
lation.
Lectures, addresses, and informal talks to audiences varying from
small groups of professional persons to large audiences of popular
character were given by one or more members of the administra­
tive staffs in 42 States. The total number was more than 13,500.
Large numbers were reported by several States, as 1,980 by Indiana,
1,198 by Kentucky, 952 by Texas, 809 by Ohio, 789 by Montana,
and 705 by Florida. Illustration of lectures by slides and films was
mentioned for a number of States and the use of radio in a few.


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y isual insfructi011 by means of films dealing with prenatal care
and child health, generally without accompanying lecture if the
film was long or of semipopular type, was given very widely. In
addition to the Children’s Bureau films (see p. 70) other films are
being prepared and used with success, and an advantage in this
kind of instruction is that it can easily be added to the work of
cooperating agencies for public instruction. Lending the film is a
simple process, and its showing is generally appropriate in connecwith education on matters of general health and sanitation,
lh e distribution of informative literature has been an important
pliase of the work. Many bulletins and leaflets áre distributed dii V r(îm the Sta*e a.dministratiye offices in response to requests
made by local organizations, physicians, and individual mothers. A
very large number are given out on the occasion of exhibits at State
and county fairs and other places of public assembly where attention
may properly be called to maternal, infant, and child welfare.
Copies are also given to the homes in which nurses make visits, and
these bulletins are not only read conscientiously for the most part
but loaned m the neighborhood, and sometimes painstakingly copied
by mothers who do not realize that they could obtain copies of
their own without financial outlay. More than 2,000,000 bulletins
and leaflets were distributed by the cooperating States; and, inasmuch as an attempt was made to avoid the inclusion of figures on
distribution of brief or not strictly informative material, it is be­
lieved that this figure greatly understates the actual number of
pamphlets placed m the hands of persons who would profit by them
and were eager to receive them. Children’s Bureau publications
(see p. 69) constituted a great part of the literature distributed,
and m many States these were supplemented by pamphlets or leaflets prepared by the States for special uses within their borders
or m certain localities. Spanish editions were prepared for popu­
lations where the Spanish-speaking element was preponderant or
seemed m need of spècial assistance.
Posters, charts, diet cards, and similar informational material not
coming within the category of publications were also prepared in
very large numbers in some States and widely used.
Exhibit material has continued to be a convenient medium for
instruction of the general public as well as for small and specialized
groups. Posters, charts, samples of clothing suitable for the pre­
natal period and for early infancy, simple home equipment for the
care of infants, and material covering the care of mothers, babies
and preschool children have been prepared for special occasions and
for loan purposes. Loan material has been used until it was liter­
ally worn out and then replaced and kept in circulation. In numer­
ous instances the women’s clubs and other local organizations coop­
erated generously m the preparation of exhibit material as well as
m arranging for as wide publicity as possible.
PERSONNEL OF THE ADMINISTRATIVE STAFFS

Since there is great variance in the size of the budget and the kind
of work undertaken m the different States there is also much vari-


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Federal Reserve Bank of St. Louis

00

O Prenatal conferences
Q New chi Id-health centers established
¿S .

New prenatal centers established

F ig. 3 .—Distribution of the 18,154 child-health and 3,781 prenatal conferences held and of the 506 new permanent
child-health centers and 65 new permanent prenatal centers established as reported by the cooperating States

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

CD Chi Id*health conferences

T H E W E L F A R E A N D H Y G IE N E OF M A T E R N IT Y A N D I N F A N C Y

19

ance in the personnel of the administrative staffs. Following are
the main facts according to figures submitted by the States for the
period January 1 to June 30, 1925:
There were 56 physicians devoting their entire time to work upon
the State staffs, and 16 were giving part time. A physician was
director in 27 States and a nurse in 10 States (Alabama, Delaware,
Florida, New Hampshire, New Mexico, Oregon, South Carolina,
West Virginia, Wisconsin, Wyoming). In 6 4 the director was neither
a physician nor a nurse. In 5~ States (Colorado, Idaho, Mis­
sissippi, New Mexico, South Carolina) the only physicians on
the staff devoted but a part of their time to the work. On only 9
staffs (in Arizona, Delaware, Florida, Nebraska, Nevada, New
Hampshire, Vermont, West Virginia, Wyoming) were there no phy­
sicians, the medical work in these States being done by physicians
volunteering their services or receiving a small honorarium for
examination work at conferences or detailed by State boards of
health.
Every State5 employed public-health nurses, the largest num­
ber reported by any one State as giving their entire time to the
work being 38 in New York. New Jersey reported 26, North Caro­
lina 19, Georgia 18, Michigan 12. The number of nurses giving
part-time service was, of course, larger, especially in States where
a division of work between two or more bureaus or between State
or local and Federal staffs was feasible. Pennsylvania reported 124
part-time nurses, Virginia 48, Texas 25, Alabama 22, and Tennessee
22. The total number of nurses reported as full-time workers on
the State staffs was 252, the total number of part-time workers 383.
In some States it seemed advisable to have the nurses devote them­
selves to the maternity and infancy program exclusively; others had
a generalized program, some arrangement being made with the coun­
ties or local communities, especially in rural sections, for a specified
portion of the nurse’s time, this portion to be paid for from
Sheppard-Towner funds.
Dentists or dental hygienists were on the staff as full-time workers
in Iowa and as part-time workers in Mississippi. Other States
employed dentists for short periods as they were needed. Four
nutrition workers were reported as giving their full time. Among
other workers noted in the State reports were lecturers, laboratory
technicians, and social workers. The clerical staffs varied in accord­
ance with the amount of office work to be done.
PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES

A summary of the work done in the cooperating States, as re­
ported semiannually to the Federal office, is given in the following
pages (see also distribution, fig. 3). These indicate the main lines
of activity and the special pieces of work undertaken. Very little
work has been done in the larger centers except for demonstration
or training purposes, the chief effort being directed toward reaching
4 In Io w a th e directo r is a m em ber o f th e S ta te u n iv e r s ity fa c u lty (se e p. 3 2 ). In N ew
m ate r n ity an d in fa n c y program w a s a d m in iste re d th rou gh tw o bureaus, w hich
had th eir sep a ra te a d m in istr a tiv e sta ffs and did in d ep en d en t w ork. A n u rse w a s director
o t one o f th e se bureaus, a so cia l w orker o f th e o th er (see p. 4 5 ).
6 E x ce p t V erm ont, in w h ich th e coop eration under th e a c t did n o t begin u n til n ea r
ehd o f th e y ea r (se e p. 5 8 ).

the


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Federal Reserve Bank of St. Louis

20

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

the rural population, the more isolated groups, and special elements
in need of education or assistance. Since rural work is propor­
tionately costlier than city work, the State is justified in making
a greater contribution toward this than toward the work in cities,
as it does for school work and for taxation in general. Therefore,
the States are attempting faithfully to carry out the spirit of the
act by initiating and carrying on the work in this more difficult field.
The enumeration of the staff is made according to the State re­
ports for the last half of the year, and is thought to be representative
of the average number of workers employed throughout the year.
The words “ part-time ” indicate that the worker’s time was divided
between maternity and infancy activities and other work, only a part
of the total salary being paid from maternity and infancy funds.
The following table summarizes the educational work done by
States cooperating under the maternity and infancy act in the fiscal
year ended June 30, 1925, as reported in the outlines of principal
activities of these States:


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N ew permanent
centers established

Classes organized for the instruction of—

Mothers

States cooperating
Childhealth

All States
Alabama_____________________________
Arizona_____________________________
Arkansas.
California....................... ________________
Colorado_____________________________
Delaware_____________________________
Florida..............................................................
Georeia
Idaho..................................................................
Indiana
......................................
Iow a______ _______ *__________________
K entucky____________________________
Louisiana___________ ________________
M aryland.........................................................
M ichigan_____________________________
M innesota__________ ________________
M ississippi.......................................................
Missouri_____________________________
M ontana___________ ____ ____________
Nebraska...... ..................................... _......... ■
Nevada__________________ ____ _______
N ew Ham pshire.. ....................................
N ew Jersey......................... .............. ............
N ew M exico__________________________
N ew Y ork.................................................. .
North Carolina.......... ............................. .......
North Dakota______________ ________
Ohio...................... .................... ........................
O klahom a..____ ______________________
Oregon..............................................................

Prenatal

Childhealth

18,154

3,781

506

595
209
167
55
86
797
176
245
17
119
328
643
213
283
273
27
257
146
1, 033
95
269
64
0
25
236
359
127
62
232
254

594

1

40

2
31
13
4
ê
10

0

93
0

140

Prenatal Number
of
classes

A ttend­
ance

Number
of
classes

Enroll­
m ent

1,403

31,529

412

10,693

1,362

1

25

88

8 173

g

10

160

65
8
1

8

0)
328
98
17
106
42
0

90

0
0

22
20
7
758
93
8< 43

2
5

0
0

31
5

6
1
1
2
17
30
16
2

18
0

1

16
127
133
195

0

1
10
16
1

4
13

0
242
0

0
0

805
20

0
1,084

0
0

2
11

0

301
0
0

364

1,737
1,316

0

0

2, 606

0

(?)

13! 173

60,000
77,300
85.000
13.500

5 ,055

21
210
2,902
2, 600

1

2
115

14, 855

0
1,681

36
26
7

0

3,157
0
75
219
0
0

2,195,000

0

16, 649

0 68

299,100

0

207

116

110
20

11
285 'i
126

0

0
7
55

0
0

10
480

4
1
95
(8)

0
0

90
36

57
9
20
8

7

0

150.000

2,630

0

116, 500
10.500
73,200

2,802

0

25,700
6,800
156.000
80^ 600
50.000
11.000

0
0

95

018,100

0

150, 000

0
0

47 760
28! 569

6
10, 387
15
178
28
2
27
14
1.904
8 See detailed statement in the o u tlin e of activities of this State.
* Prenatal conference work was done in conjunction w ith child-health conferences.

2,500
177, 700
125.000
15,800
5,000

0

21

1
2
7
4
i Extension work in pediatrics and obstetrics conducted b y specialists.
3 E stim ated or approximate number.


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1
168

0
0

374
14
6
1
8
8

Extension isits by
Pam ­
Number courses or 1Vnurses
phlets and
of nu­
to
give
clinics
leaflets
trition
for
dis­
instruc­
classes
physi­
tion in
tributed2
cians 1
homes
Number
of classes
Little
mothers

M idw ives

THE WELFARE AND HYGIENE OE MATERNITY AND INFANCY

Conferences held

Summary of educational work done by States cooperating under the maternity and infancy act during the fiscal year ended June SO, 1925, as
reported in the outlines of the principal activities of these States—Continued
N ew permanent
centers established

Childhealth

i

-

7 084
457
172
836
234
872
43
383
113

Prenatal

Childhealth

468

59

194
< 64

6

(3)

* 54

89
6
24
222
CO

Prenatal Number
of
classes

Attend­
ance

31
5

529
67

164
(3)
(3)

2,274
(3)
329
0
(3)

(3)

(3)

16
144
50
7
3
12
3
14

a See detailed statement in the outline of activities of this State.

Number
of
classes

1

1
3

(3)

27

(3)

Enroll­
ment

Number
of classes

386

32

183

2,206

29

31
36

513
605

88
104
4

(3)

2

Little
mothers

M idwives

Mothers

States cooperating

•r

Classes organized for the instruction of—

(3)

Extension Visits by
Pam­
Number courses or nurses phlets and
to give
clinics
of nu­
leaflets
instruc­
for
trition
dis­
tion in
classes
physi­
tributed
homes
cians

350,000

(3)

4,164
952
13, 312
61

2,296
67,175
(3)

(3)

211

8,479
3,165
7,158

4 Prenatal conference work was done in conjunction w ith child-health conferences.

28,000
8,000
13,000
41,200
13,600
218, 000
8,500
103, 500
(3)

THE WELFARE AND HYGIENE OF MATERNITY AND

Conferences held

to

HH

3
1=1
(►
o%

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ALABAMA

Administrative agency:
x
StaffState b°ard °f health’ bureau of child hygiene and public health nursing.
Director (nurse), 4 staff nurses (1 negro; 3 part time), 22 county nurses
(19 part time), 3 clerks, pediatrician for 1 month, additional clerical
assistants as needed.
Activities:
Child-health conferences—595, at which 12,299 examinations were made.
Report was made of the correction of 823 defects which had been noted
by examining physicians.
Pediatric clinics—a demonstration and lecture course for local physicians
was conducted for one month by a prominent pediatrician employed for
this special work. Pediatric clinics were held in five counties and at­
tended by 130 physicians; 302 infants and preschool children were exam­
ined in these demonstration clinics.
Prenatal conferences 594, with an attendance of 622 women reported for
the 173 conferences which were held during the last half of the fiscal
Also 3,043 prenatal cases were referred for medical examination
&na advice, and 5,940 home visits were made by county nurses to expectant mothers during the first half of the year. During the last half
of the year county nurses had 2,162 prenatal cases under supervision and
made 9,038 home visits to these mothers.
- .
Midwives’ classes—in 18 counties in the first half of the year, with an
enrollment of nearly 600. In the second half-year 8 classes were held,
with an enrollment of 173. Individual instruction was given to several
hundred midwives, and a total of 1,281 were under supervision. A card
ln/ ^ o made of the midwives practicing in 12 counties showed a total
ot 583, of whom 466 were negroes. The health officers in 18 counties
were giving attention to the midwife situation.
Mother’s class—it;
Little mothers’ classes—8, the instruction being given to 174 high-school
pupils.
Home visits—45,384 (in addition to the prenatal visits reported under
prenatal conferences), made by the county nurses to advise mothers on
the care of infants and preschool children.
New permanent child-health center established—-I.
Lectures and addresses—256, to audiences totaling 18,749. Almost the
entire time of the negro nurse on the staff was devoted to lecture work'
among the negroes.
An exhibit was prepared and shown at the State fair. A primer of hygiene
was compiled for use in special classes for the State department of education
As a result of the educational work of the State bureau two counties not
heretofore doing maternity and infancy work have made appropriations for
a county health service which includes maternal and infant hygiene activities
ARIZONA

Administrative agency:
State board of health, child-hygiene division.
Staff:
Director (nonprofessional), 5 nurses, 1 clerk.
Activities:
Child-health and prénatal conferences—200, with' 3.676 examinations
or inspections of children. Whenever possible, the services of a local physician were obtained. Otherwise the nurse weighed and measured the
children, pomting out to the mothers such cases as should be referred to
the family physician. Parents were having defects corrected, though
slowly. Report was made of 203 corrections, but it is understood that
23


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

others were also made. Histories were taken for the prenatal eases,
and consultation with physician and an examination were recommended.
Upon request the nurse placed the name, of expectant mothers upon her
list for home visits. Each of the 5 nurses on the staff was assigned a
district of one or more counties and did her own preliminary organ­
ization and follow-up work. Each one engaged in as many kinds of
maternity and infancy work as were practicable in her district—the pro­
gram necessarily depending upon the territory to be covered and the
population.
_ . „
Mothers’ classes—97 class sessions, with a total attendance of 1,555
women.
Little mothers’ classes—46 class sessions. These were held among com­
munities whose population was largely Mexican.
Group demonstrations and exhibits-—101. These included exhibits at
county fairs and demonstrations on preparation for confinement and
care of mother and baby.
.
TJL i
Home demonstrations and home visits—-1,234 home demonstrations, includ­
ing the preparation of obstetrical packages, care of mother and baby
after confinement, bandaging for varicose veins, bath in bed, and ex­
pression of breast milk. In these home demonstrations the mother sees
her individual problem solved in her own home and with the things she
must use, which are often of the most primitive character. In addi­
tion to special demonstrations 5,602 home visits were made to infants,
6,085 to preschool children, 908 to prenatal cases and 578 to postnatal
cases.
Maternity homes inspected—4.
Infant home inspected—1.
New prenatal centers established—8.
Lectures and addresses by members of State staff—243.
Campaigns—3, including 1 on breast feeding, 1 on birth registration, to
arouse interest in the model law for vital statistics before the legisla­
ture (which was enacted into law in March), and 1 on “ Get ready for
school.”
Volunteer assistance was given by 96 physicians, nurses, and lay workers.
Midwives were given individual instruction, and as much supervision was
exercised as was possible without the existence of legal authority. Most of the
midwives appreciated this service. The field nurses visited patients with many
of them, making demonstrations of proper care and distributing literature.
Some of the more objectionable individuals have ceased to practice, and all
seem more particular about complying with the regulations. One of the great­
est difficulties in the situation is the fact that many of the Mexican midwives
can not read nor write. The Spanish-speaking nurse on the staff has in con­
sequence very heavy work.
A few nutrition classes were conducted.
Some work has been done on a survey of infant mortality, continuing a com­
parative study of statistics of infant mortality begun in 1920.
A Spanish translation was made of the infant-feeding charts already in use
in English, and copies were printed by the State board of health. Distribution
was made of about 60,000 pieces of printed matter in English and Spanish,
ranging from the Federal bulletins such as Child Care to charts on infant
feeding and notices of public-health regulations.
Prenatal letters were distributed upon application from mothers, also to
addresses sent by physicians, the field nurses, county home demonstration
agents, and midwives. The mailing list was increased by 350 names.
ARKANSAS

Administrative agency:
State board of health, bureau of child hygiene.
Staff:
Director (physician), 3 staff nurses, 3 county nurses (part time), 1 mid­
wife inspector (nurse), 1 clerk, 1 chauffeur.
Activities *
Child-health conferences—167, at which 5,255 children were examined.
The use of the “ healthmobile ” was continued, and districts not pre­
viously visited were sought out. A physician and 2 nurses composed the
staff of the traveling health unit, the chauffeur for the truck carrying
the apparatus serving as operator of the motion-picture machine and as

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

25

mechanician for the electrical sanitary exhibit which was usually set up
in one corner of the history-taking room at the conference. An average
of 16 conferences were planned for each county, with about two weeks’
preparatory work in each community done by one of the nurses. As­
sistance was often given by lay women, who made house-to-house can­
vasses to make appointments for the mothers to have their children ex­
amined.
At the close of a very successful piece of work in a mountain county a gen­
eral clinic was held at which specialists in each particular line of work do­
nated their services. Examinations were made of crippled children (34), eye
cases (63), and chest cases (26). Most of these cases had come under obser­
vation at child-health conferences. The county medical society met the same
day to observe the work of the specialists and to hold consultations concern­
ing cases.
Prenatal conferences—40 with an attendance of 163.
Mothers’ classes—37 group demonstrations, with 925 women attending,
were held during the first half of the year.
Midwife classes—10, with an enrollment of 160 women, and with an
average attendance varying from 4 to 35, according to the size of
the group. These classes were held monthly in 7 counties by the local
public-health nurses.
Midwife conferences—75. The midwife supervisor visited 46 counties
for the first time, holding 42 conferences. She made return visits to
20 counties, holding 33 follow-up conferences, and attended 4 classes
held by local nurses. It is an indication of a cooperative^ spirit on the
part of some of the midwives that one. rode 15 miles on horseback to
attend a meeting, another walked 7 miles, and one drove in from an
adjoining county in a wagon. It is believed that very nearly all the
midwives practicing in the State have been located, and some raising
of their standards is evident. Letters are regularly sent to midwives
who fail to attend meetings. The establishment of monthly classes and
inspection by local nurses have been the greatest contributions to the
work during this period. Standardization of equipment and class
material was another noteworthy item. Price lists of equipment were
supplied to all midwives, and the response was very good.
New permanent child-health centers established—2.
New permanent prenatal center established—1.
Lectures and addresses by staff members—424.
Exhibits—there were 111 showings of films, including many to college
students, and the food exhibits and posters were shown 167 times. A
sanitary exhibit was shown 120 times. A poster display was arranged
at the State fair.
Literature distributed—77,320 pieces. Articles were prepared also for
county weeklies and State daily newspapers.
During January and February when the roads were difficult the nurses *
compiled birth and death data from records of the bureau of vital statistics
concerning 18 counties in which the traveling unit was planning to work.
Much field work was done for the bureau of vital statistics in each county
visited in connection with midwife instruction. A negro nurse was employed
to assist the midwife supervisor in a special campaign for birth and death
registration in counties having a large negro population. An intensive educa­
tional program was conducted in 16 counties (a test was being conducted
by the Federal Census Bureau).
An effort was made to stimulate counties to promote a nursing service and
to standardize and correlate these services with a State bureau of publichealth nursing.
CALIFORNIA

Administrative agency:
.
State board of health, bureau of child hygiene.
Staff:
Director (physician), 1 physician, 3 staff nurses, 20 county nurses (15
part time), 4 clerks.
Activities:
Child-health conferences—55, at which 1,600 examinations were made.
In addition, the county nurses assisted with more than 20,000 examina­
tions of children coming to the local child-health centers (this number
includes the examinations in the preschool drive reported in the fol
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26

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

lowing paragraph) and gave instruction to approximately 1,500 prenatal
and postnatal cases. It has been found advisable to start conferences
with a local staff, if possible; the State staff usually works with the
local physicians only to the extent of initiating some new health center
or assisting in a preschool drive.
... . abJ
A preschool drive was conducted in 31 of the 58 counties in the State, the
object being to have all children who would enter school in the fall given a
complete physical examination so that all defects might receive attention before
the beginning of the school year. The drive was conducted with the aid ot
more than 363 local physicians, 111 dentists, 178 nurses, and 481 lay workers.
By June 30 the State bureau had received record cards of over 6,000 physical
examinations, and it was estimated that when all the cards had been received
they would show that at least 10,000 children had been examined. This is
the second preschool drive which the State has conducted, and one of its
encouraging features was that in a number of communities the value^ of the
previous year’s work was so thoroughly appreciated that the second drive was
started locally without any new impetus from the State bureau.
‘
Home visits—5,055 homes were visited by the nurses during the first halt
of the year for the purpose of advising mothers concerning the care ot
themselves and their children. The number during the last half of the
year was not reported.
New child-health centers established—31.
Prenatal letters—distributed to 4,213 prospective mothers, nurses, and
physicians.
_
Diet lists'and an outline for study classes for mothers were prepared tor
PrillLectures and addresses by staff members—287 before audiences totaling
approximately 16,600 persons.
,,
As a means of promoting complete birth registration a roster of physicians
was prepared, and every birth certificate filed with the State bureau of vital
statistics was credited to the attendant signing the certificate. After a period
of four months had elapsed an initial set of letters was sent out notifying
the physician of the number of births he had registered and asking for a
check with his own list so that unregistered births might appear m the
records of the vital-statistics bureau.
’ \ \ "
Volunteer assistance—in addition to the volunteer assistance given in the
preschool drive 10 physicians, 13 nurses, and 60 lay persons assisted in
other work, and cooperation was given by 30 State home demonstration
Literature distributed—more than 85,000 pamphlets.
_
„.
Exhibits and demonstrations—8, held mostly in connection with fairs,
and State and local meetings. An exhibit on prenatal care was installed
at the University of California to Le used in connection with the course
for public-health nurses.
COLORADO

Administrative agency:
Department of public instruction, child welfare bureau.
StafDirector (nonprofessional), 2 physicians (part time), 2 nurses, 1 midwife
supervisor (nurse), 2 clerks. Additional medical assistants as needed
for special work.
*Child-health conferences—86, at which 4,109 examinations were made.
A unit for the conducting of child-health conferences had been organized
the previous year, consisting of members of the child-welfare adminis­
trative staff, representatives of the State board of health, the extension
division of the university, the State dental association, and the State
tuberculosis association. Prenatal cases also were given instruction.
The bureau interested officials of the State psychopathic hospital m the
maternity and infancy work, so that they decided to join the bureau group
going out for all conferences. In 5 conferences where 743 children were exam­
ined 84 cases were referred to these psychiatrists, and much constructive work
was done. The correctional follow-up work was very good. For instance, fol­
lowing the usual procedure in the bureau, just one month after a regular


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

27

conference was held in one town a nurse from the child welfare bureau returned
and arranged for a follow-up clinic at which 33 tonsil and adenoid operations
were performed. Three physicians and one nurse drove the 93 miles to this
town and held the clinic in the sehoolhouse. One room of this had been
arranged for an operating room, one for a boys’ ward, and one for a girls’
ward. The children were kept in this improvised hospital until it was consid­
ered safe to let them return home. The parents who could pay for the service
did so. For the others there was no charge.
Midwives’ classes—2, with an enrollment of 21. There are few midwives
in the State. They are located whenever possible and urged to study
and take the State examinations.
Mothers’ classes—31, with 805 women attending.
Dental clinics—34, at 16 of which 1,434 children received dental care; the
number receiving care at the remaining 18 was not reported. These
were held in cooperation with the State dental association.
Exhibits—A complete duplicate of the traveling health clinic was made
with dolls and exhibited in the windows of the chamber of commerce in
Colorado Springs. This same exhibit was afterwards used in countyfair demonstrations. It created considerable' interest and much favor­
able comment. Even the midwife Was given a prominent place in the
pictured clinic. Maternity and infancy exhibits were prepared and
shown at the annual meeting of the State medical association, the State
conference of social work, and some other organizations.
Campaigns—on birth registration and prevention of goiter.
Surveys—2. One was of the general health and well-being of the unsuper­
vised rural child as compared with that of the supervised city child; the
other was in regard to the type of feeding received by the supervised
city child and the rural child to ascertain the percentage of each that are
breast fed exclusively, receive supplemental feedings, or are bottle fed
exclusively.
These surveys have been made through examination of children
brought to the traveling clinic where they were given their first exami­
nation, the mothers never having had any previous instruction on the
diet or care of the baby. These children were placed against the same
number of supervised city children whose mothers had often had pre­
natal care and whose babies had been at the center weekly until 2 years
of age. The State bureau also gathered data on the condition of the
teeth of children with rachitic chests as compared with the same number
of children from the same district who had no rachitic deformities.
New permanent child-health centers established-^—13.
Lectures and addresses by State staffs—196. In connection with State
agricultural-college groups lectures were given to 28 groups, and arrange­
ments were made to attend 13 teachers’ institutes. A three-day institute
for the chairmen of all the State welfare stations was held immediately
before the National Conference of Social Work. It is believed that this
will be productive of excellent results. Films and slides were used on a
a number of occasions.
Literature distributed—3,500 copies of Federal publications (in addition to
the quota), 10,000 diet sheets and diet books.
Volunteer assistance—Given by 96 physicians, 27 nurses, 22 dentists, and
more than 500 lay workers.
DELAWARE

Administrative agency:
State board of health.
Staff:
Supervisor of nurses (part time), 13 community nurses (part time), 2
clerks (part time), 1 milk inspector (part time), 1 sanitary engineer
(part time).
Activities:
Child-health conferences—797, at which 21,028 examinations were made.
Continued corrections were obtained in every locality. The interest: and
cooperation of parents were observed to be increasing.
Prenatal conferences—93. The number of women attending was not
recorded.
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Midwives’ classes—11 class groups with an enrollment of 210. Two state­
wide meetings attended by 182 midwives were held. Improvement in
reporting births has been noted, also in the midwives’ standards of per­
sonal hygiene and their use of equipped bags. Many who were ineffi­
cient have ceased to practice. The supervision from the State depart­
ment has reduced the number of unlicensed midwives and brought about
an improvement in those practicing.
Mothers’ classes—5, with 20 women attending.
Little mothers’ classes—2.
Nutrition class—1 .
Community demonstrations—2.
Home visits—14,856. Demonstration of the proper selection and prepara­
tion of food was an especial objective.
New permanent child-health centers established—4. The centers have had
weekly conferences in rural districts and daily ones in city locations.
Lectures and addresses by staff members—90.
Exhibits—graphs, charts, and exhibit material were prepared for use at
clubs and fairs, and films were shown frequently.
Literature distributed—Several hundred Federal bulletins each month. A
State health bulletin was printed and widely used.
A better milk supply was made the object of some campaign work.
Volunteer assistance was given by 3 physicians and approximately 30 lay
workers.
FLORIDA

Administrative agency:
State board of health, bureau of child welfare and public-health nursing.
Staff:
Director (nurse), 7 nurses (1 part time), 2 clerks (1 part time), 1 auditor
(part time).
Activities:
Child-health and prenatal conferences—128 conferences for white children
with 2,326 examinations made; 48 for negro children with 3,147 exami­
nations made. At the conferences 1,366 white mothers and 1,402 negro
mothers were given instruction on prenatal care.
Midwives’ classes—134 class meetings for white midwives and 358 for
negroes. Altogether 2,902 midwives received instruction, and 2,024 com­
pleted the prescribed course and received “ certificates of fitness.”
Most of the undesirable midwives have ceased practicing. The follow-up
work when a midwife reported stillbirths had an excellent effect upon
the work and the attitude of the midwives, and physicians were being
called more promptly if abnormalities or unusual difficulties were to be
dealt with.
In place of the usual mothers’ classes it has been found advisable to hold a
more informal kind of meeting termed “ neighborhood institutes,” in order to
obtain the desired attendance and arouse the interest of the women whom it
is the aim to reach. There were 625 such meetings, at which the total attend­
ance was 11,088. More than one-half were for negroes. The method of
procedure was as follows :
The nurse who was to make a demonstration of maternity and infancy work
first sought out a woman willing to offer her house for the occasion. The
woman herself invited friends and neighbors, being left in control of the
matter of who might attend, unless she asked the nurse to extend invitations.
The mothers were instructed in prenatal, postnatal, and child care. When pos­
sible, more than one meeting of the same group was held. The nurse began
her talk on preparation for confinement by telling the assembled women that
she wished to help them to learn to improvise in order to save money. She
showed them how to use material at hand, even the contents of the rag bag, in
their preparation before she suggested expending a single penny. This proved
more productive of results than permitting the nurse to carry with her an
equipment the very excellence of which discouraged mothers who could not
afford one so complete.
During one month a different type of neighborhood institute from the one
generally held was conducted in two counties. Several points in each county
were covered, the same program being conducted in each place. In addition to
the State nurse, who talked on maternal and infant hygiene, these institutes


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were attended by the county nurse, who talked on home hygiene and sanitation,
the home demonstration agent, who talked on the family wardrobe, the county
nutrition worker, who attended to the details of the noon meal during which
the women were taught food values and proper menus for a well-balanced diet,
and the county welfare worker, who gave talks on household economics.
Dental clinics—38, of which 9 were for negroes.
Demonstrations—6, in connection with local activities, such as child-health
conferences, local fairs or celebrations. The demonstrations covered
feeding of infants, preparation for confinement, care of maternity cases,
the use of silver nitrate in the eyes of the newborn, preparation of ma­
terial to be used (such as solutions, pads, etc.).
New permanent child-health centers established—10.
Campaigns—during negro health week and the first week of May a special
campaign was carried on to interest parents in the periodic examination
of infants and preschool children. Constant efforts have been made to
improve birth registration. More than 1,000- unreported births were
recorded and birth certificates issued.
Lectures and talks by staff members—705, to both white and negro audi­
ences, in rural ancb urban localities. Films were shown by the movie
truck in 49 rural districts before audiences totaling approximately 10,500
persons.
'■
Literature distributed—about 10,700 mothers’ manuals, midwives’ manuals,
and bulletins on the feeding of children, and 7,430 pieces of miscellaneous
material during the last half of the fiscal year. For the first half year
numbers were not reported.
Maternal and infant hygiene work was gradually being made a part of the
work of the county and community nurses and was regularly so done in 10
counties. The beginning was made by having them assist the State staff in
conferences and in reporting conditions found.
GEORGIA

Administrative agency:
State board of health, division of child hygiene.
Staff:
Director (physician), 1 physician, 5 staff nurses (1 negro), 13 county
nurses (5 negro), 1 laboratory worker, 2 clerks.
Activities:
Child-health conferences—245, at which 12,956 examinations were made.
At individual conferences 9,714 children were reached during a six-month
period.
Prenatal conferences—140, with an attendance of 6,657 women, of whom
2,267 received physical examinations. By individual conferences 6,593
other women were reached.
The healthmobile has been of great value in stimulating interest in both
prenatal and child-health conferences. Although lack of funds permitted its
operation during a part of the year only, 17 counties were visited, and with­
out exception larger groups assembled than had been expected. The showings
of films in the evenings of conference days were attended by almost the entire
populations of the various communities.
Midwives’ classes—many, with 2,600 women completing the course.
At its annual meeting in Augusta in May the State medical association
passed a resolution requesting that the State board of health adopt rules and
regulations and arrange for the instruction of midwives under the general
supervision of members of the association or other physicians. The division
of child hygiene at once prepared rules and regulations for this purpose; and
after approval by the medical association they were adopted by the State board
of health, thereby becoming as binding as statutory law. This first step taken
in the State to control midwife practice has greatly facilitated the instruction
of midwives and regulation of their practice. More than 4,000 midwives
(mostly negroes) are registered in the State, and many more who are not
registered have been practicing. It is estimated that one-third of the babies
born in the State are not attended by physicians, but recently the midwives
have been calling physicians more frequently in complicated cases and have
been sending patients for examination at any indication of difliculty. Mid­
wives’ clubs have been organized, with the possession of a certificate that the
course of instruction has been satisfactorily completed requisite for member-


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

ship. At the monthly club meetings a local physician, the registrar, or some
other interested person gives a talk on some subject connected with the work.
In general the attitude of the midwives has been commendable. They have
seemed eager to receive instruction, have obtained equipment, and have im­
proved in their standards of personal hygiene. (For mention of assistance
given by the Federal office in the work with midwives see p. 69).
Mothers’ classes—in 9 counties, with 1,084 women attending. Home demon­
stration agents have cooperated with the maternity and infancy nurses
by giving the nutrition instruction in these classes. The Parent-Teacher
Association also has been active in this work.
Little mothers’ classes—115 classes, with an enrollment of 2,657 girls in
9 counties. The course consisted of 10 lessons, followed by a special
demonstration by the nurse, who then held an examination, awarding
a certificate and pin to each girl who passed the examination.
New permanent child-health centers established—10.
New permanent prenatal centers established—8.
Lectures and talks by staff members—677. Films were used on a number
of occasions. The presentation of maternity and infancy work to local
women’s clubs, parent-teacher associations, and men’s civic and profes­
sional clubs aided in arousing a wider interest in the activities through­
out the State.
The awarding of certificates to girls who had finished the classes in infant
care was made the occasion for a number of community demonstrations. The
girls presented a play showing the proper and improper ways of bathing and
dressing a baby, how to weigh it and why it should be weighed, how to
pasteurize milk and prepare an infant-feeding formula. After the play motion
pictures were shown. These demonstrations were well attended and helped
considerably in showing the community what maternity and infancy work is.
The State division observed the first week in May as child-health week
and interested a number of communities in having a demonstration. In coun­
ties employing a public-health nurse the demonstration lasted five days and
included health conferences, health plays given by the children, talks on
child care by local physicians, and in a few instances health parades. In
communities not having a nurse the women’s clubs were interested in present­
ing a program.
Home demonstrations—8,598. Visiting the homes to demonstrate proper
nursing care or to follow up mothers and children who have attended
conferences forms a large part of the work of the county nurses. Nurs­
ing care is given only as a demonstration to teach some member of
the family how to do for the patient what the nurse has done.
Group demonstrations—group demonstrations were also conducted by
the State staff nurses and county nurses. These were usually held in
the home of some woman in the community or arranged for through a
club. The groups were limited to 15 women, and the demonstrations
consisted of home-nursing technique, food preparation, making, packing,
and sterilizing of obstetrical kits, making of layettes, bathing of the
baby, and milk modification.
Literature distributed—25,717 bulletins within the first half year. The
number distributed during the last half year was not reported. These
included Federal publications, also a pamphlet prepared by the State
pediatric society entitled “ The Georgia Baby* Book.” Physicians and
women’s organizations assisted in the distribution.
Ampoules of silver nitrate distributed—6,549.
Constant efforts were made to stimulate birth registration and to arouse
public interest in this matter. After March 1 certificates were sent to parents
who registered their children’s births.
As a result of the work of the State division, a number of counties em­
ployed public-health nurses.
IDAHO

Administrative agency:
Department of public welfare, bureau of child hygiene.
Staff:
Director (physician, part time), 2 nurses, 1 clerk.
Activities:
Child-health and prenatal conferences—17, at which 1,538 examinations
of children and 181 prenatal and postnatal examinations were made by


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37 local physicians. Requests for return conferences were received from
nearly every community visited, but lack of medical help on the State
staff made it impossible to hold successive conferences in any one
community.
Home visits—1,681. These were made in homes from which persons had
attended conferences to ascertain whether the suggestions made by the
examining physicians had been followed. It was found that 232 defects
had been corrected and many more were being corrected at the time
the nurse called in the home. The extent of the territory and smallness
of the field force prohibited a second call in these homes. If one could
have been made the report of defects corrected would have been con­
siderably greater.
Midwife supervision—so far as has been ascertained, 29 midwives are
practicing in the State. A copy of the law concerning midwifery was
mailed to each with a personal letter requesting her cooperation in
improving the standards. Only 6 of these women had special training,
23 had no training; 7 worked with physicians only, 22 worked inde­
pendently. It was found that 14 used no prophylactic in the eyes of
the newborn.
The principal causes of deaths of children under 5 years of age were tabu­
lated for the State (on the basis of the figures for the years 1923 and 1924),
and an effort was made to ascertain the causes of the premature births and the
stillbirths so far as information was obtainable from the physicians whose
names appeared on the death certificates. The da.ta from the 200 replies
were tabulated. More than five-eighths of the 200 cases were ascribed to
prenatal conditions.
A study was also made of the amount of medical attention received by 100
mothers who died during the puerperal period, not of a selected group, but
100 deaths in the order in which they were received by the State bureau of
vital statistics during 1923 and 1924. Only 17 of the 100 mothers had had pre­
natal care for a period of one month or longer.
Some campaign work was done for better birth registration and also in regard
to breast feeding.
Talks and lectures by staff members—39, to audiences totaling nearly
1,200 persons.
Literature distributed—approximately 6,800 pieces. These included bul­
letins on How to Correct Constipation in the Preschool Child, Daily
Outline for the Preschool Child, How. to Correct Enuresis, and the Fed­
eral bulletins on Prenatal Care, Infant Care, and Child Care.
Prenatal letters—distributed to 612 women.
Volunteer assistance was given by 37 physicians, 21 nurses, and 138 lay
workers.
INDIANA

Administrative agency:
State board of health, division of infant and child hygiene.
Staff:
Director (physician), 3 physicians, 4 nurses, 1 exhibit director, 1 field
clerk and organizer, 1 secretary, 4 clerks.
Activities:
Child-health conferences—119, at which 3,937 examinations wfere made.
A special survey was made in two counties (La Porte and Newton)
to determine the situation in regard to correction of defects which had
been noted by physicians making examinations in conferences. For La
Porte County the percentage of defects corrected was 36.9; for Newton
County it was 48.4. Much general improvement was noted in health
and habits.
Mothers’ classes—374, with 16,649 women enrolled.
The major feature of the program for the entire year was the mothers’
classes. Three units (each consisting of a physician and a nurse) were in
the field conducting the classes. The class work consisted of three lessons
given by the physician and two demonstrations given by the nurse. The em­
phasis was placed on prenatal care and preparation for home confinement
though one lesson was devoted to the care of the baby in its first year and
one lesson to the preschool child. Usually a circuit included two counties.
Weekly lessons were given to each group in the circuit, and the work was


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arranged to take in all sections of the county with 8 to 14 classes in each.
The nurse usually gave demonstrations before class groups in one county
while the physician lectured before the groups in an adjoining county. Bach
was equipped with a car and material for illustrating her share of the work.
Motion pictures were a feature of the work. While the physician gave the
last lecture of the series the nurse entered the next community to arouse in­
terest in the classes. Letters with a questionnaire were also sent to the secre­
tary of the county medical society, the county health officer, and the local
physicians. Newpaper publicity was obtained, and mimeographed outlines
of the lectures distributed. Women prominent in organization work were
asked to serve as county and township chairmen. An attempt was made to
have the course continued by local physicians.
Lectures and talks by staff members—1,980. Motion pictures were widely
shown, and a number of charts were also loaned for exhibit purposes at
county fairs and on other occasions.
*
Exhibits and projects—child-health week at Winona Lake Chautauqua,
better-baby contest at the State fair, lectures on care of the baby and
motherhood to girls at home-economics school, model maternity and
infancy center in new baby building at State fair, exhibits shown at
coUfity fairs and other meetings, exhibit prepared for American Medical
Association meeting in Chicago, shown at State conference of charities
and corrections, also at Illinois League of Women Voters’ meeting in
Chicago. Other exhibits were shown at Peoria, 111.; Lafayette, Ind.;
Biennial Council of the General Federation of Women’s Clubs, West
Baden. Ind.; National Education Association at Indianapolis, Ind.
Exhibits were also shown before local, State, and National groups.
Literature distributed—156,044 pamphlets, etc.
There are fewer than 200 midwives in the State, and these are mostly in two
districts whose population is largely foreign. The mothers have been learning
that they should demand skilled attention.
Volunteer assistance was given by 44 physicians, 19 nurses, and more than
500 lay persons. Efficient cooperation was given by nearly every state-wide
women’s organization, including parent-teacher associations, and by a number
of men’s fraternal and professional organizations.
IOWA

Administrative agency;
State University of Iowa, division of maternity and infant hygiene.
Staff;
' . . T
Director (Ph. D.), 4 physicians, 5 nurses, 1 dentist, 1 dental hygienist,
3 clerks, 1 social worker.
Iowa is the only State in which the administration of the maternity and
infancy act is under the State university. The work is done by the division
of maternity and infant hygiene of the extension division, which is governed
by a* advisory council made up of members of the faculty of the university,
particularly the college of medicine, and the director of the extension division,
who is also director of the division of maternity and infant hygiene.
The principles underlying the State’s program are:
1. Federal and State grants always have as their primary objective the
stimulation of local communities to learn how to do certain things which need
to be done, and then by virtue of this knowledge to encourage these communi­
ties to make provision for doing these things without Federal or State aid.
2. The program therefore must be essentially educational.
3. The particular objective in this field is to awaken people to an apprecia­
tion of thie importance of the public-health problem and then to stimulate
communities to organize their resources to meet that problem.
4. Absolutely basic to the success of any public-health program is the situa­
tion in which adequate medical and dental service of the highest type shall
be within reach of every person.
_
. .
5. To render such trained medical and dental service effective, however, it is
necessary that the general public shall be educated to make use of such
service to the fullest extent. The individual must be brought to see that he
owes it to society to be healthy.


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Activities:
Child-’health conferences—328, at which 6,789 examinations were made.
Special effort was made to reach children in need of medical attention.
The service was limited to diagnosis, and for treatment of defects' the
parents were referred in every case to their family physician, who was
advised concerning the conditions found by and from the central office.
After a reasonable interval during which corrections should have been
made a staff nurse visited the community to follow up the cases. Al­
though there was great variation, from 40 to 90 per cent of the cases
were reported as placed under the care of family physicians.
Prenatal conferences—328, with an attendance of 6,235 women. In con­
nection with the child-health conferences, both group meetings and indi­
vidual conferences on prenatal care were held with mothers and ex­
pectant mothers by women physicians. In connection with the fieldactivities committee of the State medical society and the department of
obstetrics of the college of medicine of the University of Iowa, the divi­
sion prepared and sent to the physicians of the State a brief series of
minimum essentials1of prenatal care.
Dental clinics—109, with 4,063 children receiving care.
Literature distributed—81,600 bulletins, including 50,000 copies of a bulle­
tin on children’s teeth.
Lectures and talks by State staff—288.
A correspondence course for nurses was partly compiled, and a series of
prenatal letters was made ready for the printer.
Several exhibits and sets of exhibit material were prepared or purchased.
A special study was made of the birth and death statistics for those counties
in which conferences were held.
There has been inaugurated a program of active cooperation with the State
medical and dental societies, primarily through their respective committees,
in an attempt to make available to the general practitioners the best tech­
nique and latest advances in the fields of obstetrics, pediatrics, and oral
hygiene.
KENTUCKY

Administrative agency:
State board of health, bureau of maternal and child health.
Staff:
Director (physician), 3 physicians (1 part time), 7 staff nurses (1 part
time), 18 county nurses (one-fourth time), 1 nutrition worker, 1 in­
spector of birth registration, 1 publicity agent, 7 clerks (1 part time).
Activities:
Child-health conferences—643, at which 9,971 examinations were made.
The itinerant staff conducted 252 of these conferences in 68 counties
with the aid of local physicians. The others were held in permanent
child-health centers in counties having a part-time maternity and infancy
nurse. During the last half of the year 2,731 mothers (including 309
expectant mothers) were instructed at health conferences. The number
for the first half year was not reported. Most of the work of the
itinerant staff was of a demonstration character in counties where there
was no public-health nurse, with the nurse and physician remaining in
the county from two to six weeks. There are in the State 98 counties
having no permanent public-health worker, and many of these counties
are mountainous and isolated without much hope of permanent health
work for many years.
Prenatal conferences—98, with 3,005 examinations given.
Surveys—The number of preschool children was ascertained for 32 coun­
ties. A complete survey was made of the number and location of mid­
wives in the State, and the names were indexed by counties.
Campaigns—in regard to a pure-milk supply in two localities.
Midwives’ classes—36, with an enrollment of 297, of whom 136 completed
the course. The midwife situation in general has improved, and the
attitude of the midwives toward the efforts made for the sake of raising
their standards has become better as they have appreciated more fully
the value of instruction.
Mothers’ classes—18, with 364 women attending.
L ittle mothers’ classes— 116,


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Nutrition classes—4, conducted by the nutrition worker, including health
habits and food selection for mothers of preschool children, also classes
for young girls in nutrition and health for themselves and young
children.
\
Community demonstrations—45.
Infant homes inspected—2. An orphanage was also inspected.
New permanent child-health centers established—14.
New permanent prenatal centers established—2. Cooperation in the work
of the prenatal clinic in the city hospital of the University of Louisville
by having one of the State staff nurses act as registrar has been con­
tinued.
Four special demonstrations of child-health conferences were held for negro
physicians in Louisville.
An especial effort was made to improve the registration of births. The
birth-registration inspector visited 203 local registrars in 19 counties in
order to stimulate more complete and more accurate registration. Results
of the work have been noted in the increased number of births reported and
also in the quality of the certificates, especially from the midwives, who as
a rule are uneducated and who submit very incomplete and illegible certifi­
cates. The personal visit is especially necessary for the instruction of mid­
wives who can not read. A total of 66,923 copies of birth certificates were
sent to mothers of infants born since the beginning of the calendar year.
Lectures and talks by staff members—1,198.
Literature distributed—approximately 50,000 pamphlets, diet cards, and
the like. Many informational articles were also prepared and distributed
•
for publication in magazines and county and other newspapers. Hun­
dreds of posters were also prepared and distributed.
Prenatal letters—4,124 distributed.
Volunteer assistance was given by 462 physicians, 35 nurses, and 984 lay
workers.
LOUISIANA 6

Administrative agency:
State board of health, bureau of child hygiene.
Staff:
Director (nonprofessional), 4 physicians (1 part time), 4 nurses, 1 midwife
supervisor, 2 clerks. Dentists were employed as needed.
Activities:
Child-health conferences—213, at which 10,660 examinations were made.
Prenatal conferences—17, with an attendance of 494 women. These were
held in connection with child-health conferences. Instruction and advice
were given, but no examinations were made.
Midwives’ classes—82 class meetings with a total attendance of 905, of
whom 295 completed the course. Some improvement has been made
in the registration and equipment of midwives and in their use of
silver-nitrate solution. - A survey of the midwives in one county showed
that 140 were practicing, whereas only 64 had previously been listed.
Mothers’ classes—52 class meetings with a total attendance of 531.
Dental clinics—in 15 towns. More than 200 days’ work was done, and
more than 4,000 children were examined.
Nutrition class—1, held in connection with a child-health conference.
Exhibits—13, at county fairs and the State fair.
Home demonstrations—324, to midwives and to expectant mothers.
Permanent child-health centers—6 , established by parish health units.
Weekly conferences were held in these, and 3,023 examinations were
made.
Permanent prenatal centers established—5 established by parish health
units. Weekly conferences were held in these, and 245 mothers at­
tended.
Lectures and talks by staff members—125. A number of informational arti­
cles were prepared for newspapers also. Exhibits were prepared for
several occasions, including two medical conferences. A set of educational
charts and several films were widely loaned.
8 L o u isia n a a ccep ted th e b en efits o f th e a c t J u ly 14, 1924,


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Literature distributed—10,997 bulletins on infant care, prenatal care, and
child care; also several hundred pieces of other literature, including
diet lists, cards, and lessons for midwives.
Prenatal letters—898 sent to expectant mothers. When these were first
issued copies were sent to all parish health oflicers with a letter asking
for their assistance in reaching all prenatal cases. Many of them cooper­
ated by furnishing lists of names.
MARYLAND

Administrative agency:
Department of health, bureau of child health.
Staff:
Director (physician), 10 county nurses (part time), 2 clerks, 1 director of
health education. Additional medical and dental assistants for special
work, as needed.
Activities:
Child-health conferences—283, at which 5,528 examinations were made.
Later correctional work in about 25 per cent of the cases was reported.
During the summer months a healthmobile staffed by a woman physician,
one or two nurses, and a chauffeur was sent from county to county.
Child-health conferences were conducted in each community visited.
No separate prenatal conferences were held. Expectant mothers received
advice on prenatal care at child-health conferences or from the nurses who
made home visits. The importance of prenatal care was also emphasized
through the midwives’ classes.
Sample obstetrical packages were prepared through the cooperation of fhe
obstetrical department of the University of Maryland and sent to each of the
county nurses.
Midwives’ classes—26, with an enrollment of 110 women, 108 of whom
completed the course. All but 1 of these classes were held in 2 counties.
Mothers’ classes—6, with 68 women attending, and 10 additional classes,
for which attendance was not reported.
Little mothers’ classes—11.
Dental clinics—-33, with 466 children receiving care. Two complete port­
able dental outfits were purchased and made available to counties on
request. Dental examinations of preschool children were made by local
dentists in connection with health conferences held on the healthmobile
.
(one part of the automobile being equipped with a portable dental
outfit). About half the simpler cases were corrected at once. A com­
mittee of the State dental association assigned several of its members
to assist in this work.
Nutrition classes^—95.
Group demonstrations and exhibits—65, held at county fairs and various
group meetings. They included demonstration of a miniature model
health center, artificial-feeding outfit, bathing outfit, and layette and
showing of motion pictures.
Home demonstrations—285. These included demonstrations of the care of
mother and baby, how’to bathe the baby and to prepare its food.
Maternity home inspected—1.
New permanent child-health center established—1.
Lectures and talks by staff members—45, also 1 radio talk. Informational
service in support of the bureau’s program through articles for county
papers, lantern slides, motion pictures, and the radio has been given
considerable attention through assistance given from the State division
of public-health education.
Literature distributed—several thousand pamphlets on subjects pertaining
to infant and maternal hygiene.
The bureau supplied to the local registrars in 11 counties (having publichealth nurses) postal cards for reporting the name and address of the newborn
infant, the parents, and the physician or midwife reporting. These cards were
mailed to nurses or health officers as soon as births were reported. The
nurses visited as promptly as possible all infants delivered by midwives.
Those delivered by a physician were visited if the physician so requested.
Volunteer, assistance was given by 10 physicians, 3 dentists, 11 nurses, and
100 lay workers.


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t h e w elfare a n d h y g ie n e of m a t e r n it y a n d in f a n c y

MICHIGAN

Administrative agency:
Department of health, bureau of child hygiene and public-health nursing.
Staff:
Director (physician), 3 physicians, 12 nurses, 1 nutrition worker, 5 clerks
(1 part time), 1 organizer, additional medical assistants as needed.
Activities:
Child-health conferences—273, at which 4,922 children were examined.
The child health conference unit was in the field continuously (except
for vacation periods) during the entire year.
Prenatal conferences—106, with an attendance of 272, and 59 women ex­
amined.
The itinerant prenatal-conference unit consisting of a prenatalist (physi­
cian), nurse, and nutrition worker (with a car), conducted prenatal, infant,
and preschool children’s conferences with preference given at all times to the
prenatal work. Exactly twice as many examinations of prenatal cases were
made in the last half of 1924 as in the first half. Fewer group talks on pre­
natal care were given in the later period, these having been succeeded by indi­
vidual conferences. The policy was never to examine a prenatal patient with­
out the consent of the physician engaged for the confinement. The nutrition
worker gave instruction to each mother at conferences on the general nu­
trition for the children and especially stressed the nutrition of the expectant
mother in relation to the development of the unborn child and preparing for
and maintaining lactation. The nutrition worker reached 2,850 mothers
through ¿individual conferences in the prenatal clinics.
Every staff worker was instructed to stress prenatal ,care no matter in what
phase of the work she was engaged. The only exception to this rule was the
little mothers’ classes. For instance, 6 of the 12 lessons in the mothers’ classes
were devoted to prenatal care f and the importance of medical supervision dur­
ing the period of pregnancy was impressed upon all the women attending these
classes. When noting cases of deficiency diseases in children the infant clinician
neglected no opportunity of pointing out to the mothers the relation between
deficiency diseases and the lack of proper prenatal care. This was especially
important in this State, since it lies in the goiter belt, and it was necessary
to inform many mothers who were so affected that they should have had iodine
treatment during pregnancy.
Midwives’ classes—7, with an enrollment of 20, all of whom completed
the course.
Mothers’ classes—127, with 1,737 women attending.
Little mothers’ classes—285, with an enrollment of 6,391.
A county maternity and infancy nursing program was demonstrated in one
community by a State nurse.
Home visits—1,561, in which instruction in infant and prenatal care was
given.
Inspection was made of seven hospitals which give maternity care.
A survey in regard to breast feeding was made in four counties, and cam­
paign work done for its promotion.
Campaign work for immunization against diphtheria was done in four
counties.
The infant epidemiologist who had previously studied enteritis cases for
the bureau made a special study of the scarlet-fever cases in one county in
which 27 preschool children were among those who had contracted the disease.
The findings were tabulated and graphed.
The midwife survey undertaken in the previous year was completed. The
midwife inspector interviewed the midwives throughout the State (1,364 mid­
wives in 83 counties). A mailing list was made of more than 1,500 midwives,
and 1,301 of these sent in birth reports. The inspector found that very few
of the midwives had any technical training. Some had been taught in Euro­
pean midwife schools, a few were registered nurses, a few were practical
nurses, and others were simply good neighbors. Only 13.2 per cent had re­
ceived diplomas, and 1,167 had no training. Although some of the areas in
which they were practicing were sparsely settled the services of a physician
could usually be obtained. Exceptions must be made in the case of certain
districts noted; for example, one in which there were but two physicians in a
county 150 miles long. It was ascertained that midwife attendance had de­
creased 2.5 per cent in the three years of the work. The demand for midwife


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service was noted especially among certain un-Americanized foreign groups.
The women attending births in the remote and sparsely settled communities
were largely of American stock and were frequently among the best in the com­
munity. They would prefer that a physician be called if this could be done.
New permanent child-health centers established—8. The number of ex­
aminations of infants made at centers (outside Detroit and Grand
Rapids) reporting during the year was 28,037.
New permanent prenatal center established—1. The number of examina­
tions of mothers at centers (outside Detroit and Grand Rapids) report­
ing during the year was 1,580.
Lectures and talks by staff members—601. A number of radio talks were
given.
An article was contributed monthly to the State medical journal; also articles
for the State public-health bulletin and other publications.
Literature distributed—many thousand Federal pamphlets, as well as
many thousand diet cards and much literature prepared by the State
bureau. The bimonthly news-letter went to approximately 5Q0 nurses
and committee women.
Prenatal letters—27,142 distributed.
Exhibit material—30 maps and charts were prepared for loan on request;
also many slides, posters, and 12 books of photographs for class use.
Study was made of the relations of the birth and death statistics (compiled
in the bureau of vital statistics) to the infant mortality of the State. The 7,088
infant deaths in 1924 were tabulated by age groups and causes of death. A
tabulation of the physical findings in the examination of 12,344 infants and
preschool children was made by age groups and sex groups. The summary
showed that ( 1 ) physical defects are more common in boys than girls ;v ( 2 )
physical defects are accumulated, increasing in frequency to the sixth year;
(3) rachitic conditions lead in frequency of defects, followed in frequency by
defective tonsils and adenoids, then by underweight, closely associated with
artificial feeding.
The work of women in the extensive beet fields of the State has been
observed to have a relation to the infant mortality rates, this rate being high
in the areas where women are employed in beet culture.
Birth-registration certificates were sent to the parents of all infants whose
births were registered in the State department of health, and each was accom­
panied by a leaflet giving information on infant care. This message on infant
care reached approximately 98,000 families, or the parents of every child whose
birth was registered in the State. This the parents received when the child
was about 6 weeks old.
-I r S 1Unteer assistance was given by about 200 physicians, 200 nurses, and
1,500 local women. It has been possible to organize a general central commit­
tee consisting of State presidents of organized groups of women, including
representatives from the various women’s fraternal orders and the parentteacher association. Generally the State commissioner of health appointed a
local chairman for the county organization, selecting from among the women
ni the counties who were members of the women’s groups represented on the
State committee. The county committees were also in position to support the
initiation of county nursing service. Assistance was thus given by 14 state­
wide cooperating women’s groups.
MINNESOTA

Administrative agency:
State department of health, division of child hygiene
Staff:
Director (physician), 5 staff nurses, 9 county nurses (6 part time), 1
educational agent ,(half time), 9 clerks (3 part time), additional medical
assistants as needed for special work.
Activities:
Child-health conferences—27, at which 665 examinations were made. Of
these 12 were for Indian children, with more than 296 examinations
made.
Prenatal conferences—42, with 613 mothers attending.
The prenatal work was conducted in two or three counties simultaneously
ana a series of conferences held in each one. When the. conferences were com­
pleted in one group of counties they were begun in another. Before the holding

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

of the conferences the director of the State division met with the physicians
of the county and discussed plans with them. Then a prenatal nurse from the
State staff was detailed to the county to work up the conference by arousing
local interest and to prepare for the coming of the field unit which was to con­
duct it. Prenatal cases were located through the aid of physicians, club
women, and church workers.
The policy of having the conferences conducted by some of the most promi­
nent obstetricians in the State was continued, and their work was especially
appreciated by the local physicians, who took advantage of the opportunity for
consultation clinics provided. Each woman attending the conference was given
a complete physical examination, a report of which was sent to her physician
if she had already placed herself under the care of one. If she had not yet
decided upon the physician to care for her confinement, the report card was
sent to the county nurse, if there was one, with the request that it be given to
the physician whom the woman finally employed. The State prenatal nurse
remained in the community for a short time to do follow-up work with the
women examined. After the conferences a general meeting of the women in
the community was held at which the visiting obstetrician gave a talk on the
hygiene of pregnancy, and if possible an educational film on prenatal care was
shown.
Mothers’ classes—133 sessions, with 1,316 women enrolled. Of these
classes 40 were held for Indians, with an enrollment of 109. An exhibit
and demonstration were included at each class.
Little mothers’ classes—126. Special classes for Indian girls were held
in two localities. Instruction in method of teaching little mothers’
classes was given to senior students in three of the State teachers’
colleges and to students in the home-economics department of the Uni­
versity of Minnesota. A four-day institute on methods of teaching little
mothers’ classes and infant and maternity classes, consisting of lectures
by members of the State university faculty and demonstrations by nurses
of the division, was held for public-health nurses. In the winter six
regional conferences were held for rural public-health nurses, with an
attendance of 126.
Group demonstrations—197, to farm-bureau clubs, to community women’s
organizations, and at county fairs.
Home demonstrations—3,829, of which 1,712 were made by Indian nurses.
New permanent child-health centers established—8.
Lectures and talks by staff members—125.
Literature distributed—more-than 150,000 pamphlets and leaflets on sub­
jects pertaining to maternal and infant hygiene.
Prenatal letters—950 sample sets, 14,466 letters to mothers.
Correspondence course—to a registry of 2,043 women. An analysis of the
registrants for the correspondence course during a two-year period
showed that more than 80 per cent were mothers and about 60 per cent
were under 30 years of age. The fact that 80 per cent were residents
of towns whose population is less than 5,000 indicates that this method
of instruction reaches the rural women.
The monthly reports of births sent by hospitals were checked against the
original birth reports sent by physicians, and 589 unreported births were
noted. Although the percentage of unreported births is not large, the
value of checking the reports is indicated.
In an effort to encourage mothers to nurse their babies and to determine
what percentage of the mothers in small towns and rural districts do nurse
their babies, breast-feeding slips were sent to the mothers of all new babies
in two counties in the State. These counties were selected because of their
high infant mortality rates. To a card which was sent was attached a brief
questionnaire for the mother to fill out and return to the State office, indicating
how long she had nursed her baby and the reason if she had discontinued. It
was planned to send an additional card to these mothers when the baby reached
the age of 6 months and then that of 9 months. At the close of the campaign
a report will be written on the data obtained.
Work with the Chippewa Indians was a feature of the maternity and in­
fancy program. The figures relating to Indian infants at conferences and
the class work with Indian girls and mothers (which have been given under


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those subjects) show better attendance and results than are usually obtained
in work with Indian populations. This, no doubt, is due to the fact that two
Indian nurses were employed to do maternity and infancy work among the
Indians and that a large part of their work was done by home visits and
demonstrations. The work was begun through aid given by the American
Child Health Association (which was not able to continue the aid). During
the second half of the fiscal year the Minnesota Federation of Women’s Clubs
contributed toward the nurses’ salaries.
MISSISSIPPI

Administrative agency :
State board of health, bureau of child hygiene and public-health nursing.
Staff:
Director (physician, half time), 5 staff nurses (1 part time), 8 county
nurses (6 part time), 1 supervisor of oral hygiene (part tim e),.l labora­
tory technician, 6 clerks (4 part time).
Activities :
«
#
Child-health conferences—257, at which 7,433 examinations were made.
Local dentists assisted in the examination work.
Midwives’ classes—1,215 sessions. The course of eight lessons was com­
pleted by 728 women. The district nurses covering the State spent about
two months in each county giving fundamental instruction to midwives,
about 99 per cent of whom are negroes and 95 per cent unable to read
or write. The county health officers have given constant cooperation
in the work. The services of midwives are clearly necessary, because
there are only about 1,600 physicians in thé State and only 1,000 doing
obstetrical work. Improvement was noted in the midwives’ standards
of work and of personal and home cleanliness and in their knowledge
of use of the equipment given to them. County midwife meetings were
held in about 82 counties. Midwives’ community clubs and county
midwives’ associations were organized in a number of places and regu­
lar meetings held. At the beginning of the calendar year 3,355 mid­
wives in the State were actively engaged in practice. Permits to prac­
tice were held in 1922 by 4,209 midwives. Very few permits have been
revoked, but many midwives have ceased to practice.
Home visits—2,630 within the second half year. Of this number 546
were to prenatal cases, 994 to infants, and 1,090 to preschool children.
The number of visits made in the first half of the year was not reported.
The county maternity and infancy nurses engaged in all phases of the
work, emphasis being placed on whichever project seemed most important at
the time. As a result of the educational work done by the State bureau a
number of counties employed their own county nurses, who gave a large part
of their time to maternity and infancy activities.
Prenatal work was done by visits by public-health nurses in the homes,
visits to the office of the public-health nurse, group conferences from time to
time, and the distribution of literature on prenatal care.
The laboratory technician made throat cultures, urinalyses, Wassermann
tests, examinations for intestinal parasites, and other laboratory tests.
One special piece of work done by the division of vital statistics -was made
possible by thé use of maternity and infancy funds. A medical student was
employed during the summer to check birth and death registration. He worked
in seven counties and made 1,651 calls in homes, 52 to midwives, 36 to regis­
trars, and 89 to physicians. Calls were also made on firms selling caskets
to ascertain whether they were registered with the bureau of vital statistics,
and visits were made to cemeteries in company with a local resident to learn
the names of persons buried within the last six months. The list was later
checked against the names reported by the local registrar. In the seven
counties 358 births and 96 deaths had not been reported.
Lectures and talks by staff members—approximately 400.
Literature distributed—many Federal, State, and other publications, also
birth certificates.
A short letter describing the work of the bureau was prepared weekly for
the newspapers of the State.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
MISSOURI

Administrative agency:
State board of health, division of child hygiene.
Staff:
Director (physician), 1 physician, 2 staff nurses, 3 county nurses, 1 nutri­
tion worker, 3 clerks, additional medical and nursing assistants for
special work as needed.
Activities:
Child-health conferences—146, at which 4,161 examinations were made.
The correction of defects which had been noted at conferences averaged
17 per cent, and in some communities was 30 per cent.
Prenatal conferences—90, with an attendance of 2,298.
Mothers’ classes—195 class groups, with 3,157 women enrolled. This has
been one of the most important phases of the work of the county
nurses. The course of 10 lessons was given to any group of women in
the county who requested it. When the course was completed an infant
clinic was usually held.
kittle mothers’ classes—95. In some communities this has been a vacation
activity for school girls, but a number of junior high schools have made
the work a compulsory course.
Dental clinics—5, with 258 children receiving care.
Nutrition classes—90. These were arranged on a county basis, each county
selected being allotted one month for the work. Before the State nutri­
tion worker’s arrival in the county the county health department arranged
for group meetings for mothers in at least six different communities of
the county. In this manner the nutrition worker could give a series of
four lessons to each group. The subjects discussed with the mothers
were food selection, food habits, scoring lessons on usual diet, proper
diet for expectant mothers, diet in overweight and underweight, and diet
in constipation.
Group demonstrations—51, conducted at county fairs, community home­
comings, farm picnics, and on other occasions. Among the subjects were
preparation of artificial food, nursing care, and preparation for home
confinement. Some talks on child care were given and educational films
and slides were shown.
Home demonstrations—3,633, given by the county nurses. They included
the following: Preparation of a feeding formula, home pasteurization
of milk, care of the newborn baby, postpartum care, preparation of lay­
ette, preparation of sterile obstetrical pack for home delivery, and many
other problems which the mothers desired to take .up with the nurse.
A birth-registration campaign was made the feature of the observance of
child-health day on May day. A chairman of May-day activities was appointed
by the State board of health and an executive committee consisting of the
county superintendent of schools, county health officer, and president of the
county medical society was organized in each county. This committee enlisted
the cooperation of interested organizations in the county. Each county worked
through its school districts, and a complete report of births in that district in
1924 was made on forms furnished by the State board of health. All forms
were returned to the bureau of vital statistics and the names checked against
the records on file. If the bureau of vital statistics found a birth not regis­
tered, a letter was sent to the physician or midwife who had delivered the
child requesting that the birth be registered as soon as possible. This cam­
paign aroused much interest in birth registration. It is believed that when
the next Federal check is made Missouri will be admitted to the birth-regis­
tration area.
New permanent child-health centers established—6.
Lectures and talks by staff members—190.
Literature distributed—116,546 pamphlets, leaflets, etc.
Prenatal letters—6,126 distributed.
Exhibit material—5 health films were loaned to 25 communities. A
sterile obstetrical pack was also made, with mimeographed instructions
for its preparation.
An intensive six-month campaign for diphtheria immunization was con­
ducted, during which 3,397 children were treated. Local physicians aided
by giving talks on the prevention of diphtheria, and two films on the subject
were loaned to communities requesting them.


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Because of the stimulation of interest through the work of the division
four counties raised funds for the employment of county nurses, and the last
session of the legislature passed a law giving county courts authority to
appropriate money for public health nursing work.
MONTANA

Administrative agency:
State board of health, division of child welfare.
Staff:
Director (physician), 3 staff nurses (part time), 5 county nurses (part
time), 1 laboratory assistant (part time), 2 clerks.
Activities:
Child-health conferences—1,033, at which 14,124 examinations were made.
Attendance of mothers was not reported for the first half year; 4,922
mothers were reported as attending the conferences during the second
half year, and 406 of these were given advice on prenatal care.
Mothers’ classes—582 meetings, with a total attendance of 7,771 women.
Little mothers’ classes—58 meetings.
Nutrition classes—36.
Demonstrations to groups—113, on maternity care, infant care, etc., to
large groups in various communities, also at fairs and farmers’ short
courses.
Hothe demonstrations—24.
A demonstration of the efficacy of a permanent child-health center was
made in one of the smaller communities of the State.
Maternity homes inspected—19.
New child-health center established—1.
Lectures and talks by staff members—789.
Members of the staff have given courses in maternity and infancy work
to student nurses at hospital training schools and to persons enrolled in
the farmers’ short courses at the State agricultural college.
Provisional lists were compiled of maternity homes, midwives, crippled
children, and feeble-minded children.
Literature distributed—10,515 copies of Federal pamphlets, also many
State publications, diet cards, score cards, and birth-registration cer­
tificates.
Prenatal letters—809 sent out.
Exhibit material—films, slides, posters, sample layettes, and maternity
packs were loaned on request to communities or responsible agencies.
Four traveling libraries were constantly in use, loaned to study clubs
and others.
Silver-nitrate ampoules distributed—4,106 to midwives, maternity homes,
and hospitals.
The State has been divided into four districts, each assigned to a publichealth nurse, who supervised and coordinated the work of all nurses in her
district and showed to communities and counties the need for maternity
and infancy work and its value. The size of the districts made it im­
possible to cover them except in the most general way. For example, one
district contains 15 counties in which a nurse may travel for miles without
coming to any dwelling. In one county of this district there are no railways,
telegraph facilities, nor telephones. In some other counties there are no
hospitals nor nurses.
NEBRASKA

Administrative agency:
Department of public welfare, division of child hygiene.
Staff:
Director (nonprofessional), 2 nurses, 1 part-time social worker, 1 stenog­
rapher, 5 vital-statistics clerks (temporary), additional nurses em­
ployed as needed for special work.
Activities:
.
Child-health conferences—95, at which 4,763 examinations were made.
The percentage of corrections made in pursuance of conferences was
estimated to be 75. Local people were relied upon to arrange for the


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health conferences and to supply clerical and other assistance necessary
to make the programs successful. Follow-up home calls were made on
many defective children.
Mothers’ classes—4, with 75 women attending.
Group demonstrations—41. Many of these were given before or after a
child-health conference to groups of club women or mothers’ clubs and
others invited in. for the occasion. The demonstrations included prepa­
ration for confinement, the making and sterilizing of material, and
preparation of bed for delivery. Talks were given on child feeding and
child care. One to three days were given to a community.
Maternity homes inspected—39.
Infant homes inspected—20.
Lectures and talks by staff members—39.
Prenatal letters—distributed extensively on the request of physicians; a
few distributed by nurses and others.
Literature distributed—73,188 bulletins, many diet charts, height and
weight tables, etc. A letter was sent to every home in the State in which
a baby had been born, within the year, and the services of the division
were offered. These letters went to the most isolated homes in the sand
hills, as well as to palatial city homes, and replies have been received
from both. This enabled the division to distribute a large amount of
literature in response to individual requests.
Volunteer assistance was given by 120 physicians who made examinations at
conferences, 8 nurses who also assisted at conferences, and 123 club women
whose cooperation was very helpful.
Some excellent work among the Indians in the northeastern part of the State
was done by an Indian field nurse.
NEVADA

Administrative agency:
State board of health, child-welfare division.
Staff:
Executive secretary (nonprofessional), 7 nurses (part time).
Activities:
Child-health and prenatal conferences—269, at which 1,671 examinations
were made of children, and 58 mothers were given instruction.
Dental care—given to 100 children.
Mothers’ classes—13, with 219 women attending.
Little mothers’ classes—57.
Home visits—2,802 within the last half of the year, of which 262 were
to prenatal cases, 81 to maternity cases, 890 to infants, 1,164 to pre­
school children, 11 to midwives, and 394 miscellaneous. The number
for the first half of the year was not reported.
Demonstrations—78, on bathing the baby, proper clothing, arrangement of
bed and sleeping room, preparation of feeding formulas, etc. A demon­
stration of a model health center was put on for three days during a
meeting held by a State organization.
New child-health center established—1.
Lectures and talks by staff members—119.
Literature distributed—bulletins and other printed material.
Prenatal letters—distributed as part of the routine work of the staff.
Some service was given by the nurses of the division to all counties in the
State except two, the inclusion of which was planned for an early date.
NEW HAMPSHIRE

Administrative agency:
State board of health, division of maternity, infancy, and child hygiene.
Staff:
Director (nurse), 6 nurses, 3 clerks (2 part time), additional medical
assistants as needed for special work.
Activities:
Child-health conferences—64, at which 2,085 examinations were made. It
was possible to have a third as well as a second conference in some
towns. A dentist assisted at some of the later conferences. An interest­
ing development in conference work in a mountain county was the exami­
nation of children in their homes by conference physicians, on several

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occasions when violent rains prevented the mothers from bringing their
children for examination on the conference date. The physician went
to the homes, accompanied by the State nurse, and was able to give a
complete examination to nearly every child in the town in which con­
ferences had been planned.
Prenatal conferences—22, with an attendance of 373 women. Individual
conferences were held with 1,829 women.
The demonstration which for two years has been conducted in Manchester
by a nurse giving her full time to this work was to be concluded within two
months after the close of the fiscal year under review. The program has been
as follows: The mother was registered with the nurse as early in pregnancy
as possible, and if she was not under a physician’s care she was advised to
place herself under medical supervision at once. If she had already done this
the nurse continued on the case only with the physician’s consent. The routine
care included group conferences, visits to the homes, tests of blood pressure
and of urine. Trained nursing care was urged for every case, and it was
possible to provide it through cooperation of local agencies. After the birth
of the baby one or more visits were made, as circumstances required, and the
mother was advised to have a postpartum examination six weeks after de­
livery. The group conferences were held weekly and attended not only by the
prenatal and postnatal cases, but by interested mothers, grandmothers, young
women contemplating wifehood and motherhood, and those considering nurs­
ing as a profession. A course of nine lessons was given, including instruction
regarding the hygiene of pregnancy, preparation for confinement, proper food
and clothing for mother and baby, preparation of obstetrical package, im­
portance of breast feeding, and the value of periodic physical examinations
of the baby. The work resulted in a decided' reduction in the number of still­
births and the number of deaths of infants under 1 month of age in the super­
vised section of the city, in comparison with the figures from those sections
where no prenatal work was being done.
Emergency obstetrical packages made by the women’s clubs of the city were
placed on sale at five drug stores and one child-health center.
Mothers’ classes—53 class meetings, with a total attendance of 1,333 (in
addition to the weekly classes in Manchester).
Little mothers’ classes—9.
Dental clinics—4, with 61 children receiving care.
Demonstrations and exhibits—59 at conferences, medical societies, publichealth meetings, and county fairs. These included exhibits of an ob­
stetrical outfit, proper clothing for the expectant mother, the baby’s
outfit and food, utensils for modification of milk, and arrangement of
room and bed for confinement. A nurse was in charge to explain and
demonstrate the exhibit.
Home demonstrations—254. Among the subjects were: The 24-hour care
of the baby; bathing; care of cord; proper cleansing of scalp; method
of putting on a yarn truss; massage after infantile paralysis; instruc­
tion to mothers of children wearing casts; preparation of modified milk,
barley water, vegetable soups, and various foods for babies and small
children; the way to give a sun bath; the making of layettes; prepara­
tion of the baby’s tray and basket; making of the obstetrical package;
and preparation of -room for confinement. Instruction was given to
some member of the family in regard to bedside care of mother and
baby, as well as of older children.
Maternity homes inspected—18.
Infant homes inspected—35.
New permanent child-health centers established—2.
Lectures and talks by staff members—179. On four occasions the nurses
were asked to explain the work before men’s clubs. Three of the medi­
cal societies also requested such talks and passed formal resolutions of
approval.
Literature distributed—more than 150,000 copies of bulletins, diet slips,
prenatal letters, weight charts, etc. After the first bulletin had been
sent to a mother the successive bulletins appropriate for the age of her
child were sent at intervals of three months.
In many rural towns, especially in the northern part of the State, there are
no nurses to care for mothers during confinement, and some have also no
86304°—26-----4

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THE w elfare a n d h y g ie n e of m a t e r n it y a n d in f a n c y

physicians within 40 miles. The nurses doing maternity and infancy work
have attempted to find in such towns one or two women who could give some
time for service at confinement and for a short time after, and to teach them
some of the things most necessary for them to know.
The work with the preschool child attracted much favorable attention. The
superintendent of schools attended many of the child-health conferences and
gave his time and the use of his car for the transportation of mothers and
small children who otherwise would have been unable to attend the confer­
ences. Cooperation in the work of the division was received from 22 publichealth nurses employed by various agencies. The nursing agencies employing
public-health nurses have begun to take an active interest in the work for
the preschool child; and the division’s records have been made use of by
many of the nursing organizations and all of the Red Cross nurses. In order
that these nurses might visit in the home and give advice to the mother the
division sent to those nurses each month the names and addresses of infants
born in their respective'territories.
Volunteer assistance was given by 210 lay workers.
NEW JERSEY

Administrative agency:
Department of health, bureau of child hygiene.
Staff:
Director (physician), 15 staff nurses (2 part time), 13 county nurses,
7 clerks.
Activities:
Child-health conferences—weekly at the child-health centers (of which
the State has between 90 and 100 ), at which 38,260 examinations were
made. It is estimated that about 60 per cent of the defects noted at
conferences were corrected.
Prenatal conferences—20, with an attendance of 203.
Little mothers’ classes—20.
Nutrition classes—7,' for mothers of preschool children, held in coopera­
tion with the State department of agriculture.
Home demonstrations—17,427 in the second half year, on the bathing
and dressing of the baby, the care of a sick baby, etc.
New permanent child-health centers established—-17.
New permanent prenatal center established—1.
Midwife classes—98 meetings, with a total attendance of 1,267 women.
A continuous check-up is maintained in regard to unlicensed midwives.
A total of 386 midwives were practicing during the year, and their delivery
of some 18,000 infants is recorded. The number of midwives of foreign birth
is large, and the foreign-born population of this largely industrial State are
prejudiced against physicians, preferring midwife service. The number of
midwives has been decreasing with the raising of the standards which resulted
from the law enacted in 1919 requiring midwives to be licensed and registered.
For the convenience of the bureau of child hygiene the State was divided
into 12 sections with a district supervisor in each district. Any stillbirths
or puerperal deaths which occurred in each of these were ascertained through
the cooperation of the State bureau of vital statistics, and a statement con­
cerning all cases investigated was obtained from the physician, hospital, and
midwife, and from the patient’s family. These statements were transmitted
to the board of medical examiners. Two cases of puerperal death were con­
sidered to constitute cause for the revocation of a midwife’s license. There
is also the lesser penalty of revocation of license for a given period for repeated
minor offenses. It has been noted that the standards of the midwives’ work'
are improving, and they have cooperated with those making efforts in their
behalf. Campaign work was done among them to demonstrate the value of
ability to make urinalyses.
Maternity homes inspected—23.
Infant homes inspected—344.
Lectures and talks by staff members—285.
Exhibits—arranged for a number of fairs and health weeks.
Literature distributed—-preschool and prenatal leaflets, midwife-instruc­
tion folder, cards, etc. (number not reported).
Campaign work was done to induce the hospitals in the State to arrange
to keep infants with their mothers if either the child or the mother was a
patient in the hospital.

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In 25 communities the nurses carried on demonstration child-hygiene pro­
grams for the purpose of inducing these communities to assume the financial
responsibility for a nurse.
Volunteer assistance was given by 96 physicians (who made the examina­
tions at the child-health conferences).
NEW MEXICO

A7
Administrative agency:
Department of public welfare, bureau of public health, division of child
hygiene and public-health nursing.
Staff:
Director (nurse, part time), 3 physicians (part time), 5 county nurses (3
part time), 5 clerks (3 part time). Additional medical assistants for
short periods as needed for special work.
Activities *
Child-health conferences—25, at which 354 children were examined.
Prenatal conferences—7, with an attendance of 18. Because the districts
in which the nurses worked are thinly settled it was impracticable to
bring groups of mothers and children together for conferences. The
nurses could do more effective work by visiting the mothers in their own
homes.
Each of two nurses was assigned to a county for a period of three or four
months to put on a demonstration program in an effort to interest the local
community in initiating its own maternity and infancy program. The other
three nurses carried on a maternity and infancy program in connection with the
work of the county health units to which they were assigned. All county nurses
included maternity and infancy work in their programs. The health officers in
these counties also gave half time to maternity and infancy work.
Home visits—3,412, of which 347 were to prenatal cases and 2,865 to in­
fants and preschool children.
Midwives’ classes—7, with an enrollment of 10. Instruction was also given
to 135 midwives in their homes. The midwife situation has greatly
improved with the Federal assistance given in this manner (see p. 68 ).
Little mothers’ classes—8, with an attendance of 59.
Group demonstrations—11, most of them before groups of club women.
Among the subjects were the making and putting on of abdominal T and
breast binders; the making of a bed for delivery, using rubber and draw
sheets and newspaper pads; the articles required for confinement and
the postnatal period; and the bathing, dressing, and care of a newborn
baby.
,
. . „
Home demonstrations—211. These included nursing, care of sick infants,
as the giving of enemas, taking temperature, feeding with a medicine
dropper, etc.; the preparation of artificial food; and the care of mothers
after delivery. The isolation of patients and the disinfection of con­
taminated articles were especially stressed in one community that had
a severe diphtheria epidemic among the children of all age groups, and
here a nurse administered toxin-antitoxin for 103 infants and preschool
children.
'
Lectures and talks by staff members—118. Two films were also used.
Literature distributed—2,517 bulletins, and the like. Forty-eight press
articles were prepared and distributed.
Volunteer assistance was given by 22 physicians, 3 nurses, and 32 lay workers.
NEW MEXICO

B7
Administrative agency:
State department of public welfare, bureau of child welfare.
Staff (all part time) :
Director (social worker), 1 social case worker, 1 stenographer.
Activitififf •
The maternity and infancy work was done in connection with children’s
agencies and directly with unmarried mothers and illegitimate children.
7 See footnote 4, p. 19.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

General educational work was done in regard to the importance of keeping
the unmarried mother and her child together at least through the nursing
period, and in reference to placing children for adoption.
During the fiscal year under review (after which period all activities under
the Federal maternity and infancy act in this State were concentrated in the
bureau of public health) the bureau of child welfare under its maternity and
infancy program handled 94 cases. In these cases of mothers and young
children such questions were involved as the establishment of paternity, the
securing of financial support by other means (thereby enabling the mother
to keep her child), adoption, institutional care for children, and care in sickness.
NEW YORK

Administrative agency:
Department of health, division of maternity, infancy, and child hygiene.
Staff:
Director (physician), associate director (physician), executive clerk, 4
physicians, 23 staff nurses (and 24 part-time maternity and infancy
community nurses employed from Sheppard-Towner and local funds),
3 county nurses, 2 midwife inspectors (nurses), 1 organizing field
agent, 1 office manager, 4 clerks, 8 stenographers, 1 advance agent, 1
chauffeur.
Activities:
.
Child-health conferences—236, at which 4,895 children were examined.
In addition to the conferences conducted by the State staff, 2,049 con­
ferences w6re conducted in local communities where the staff was partly
supported by maternity and infancy funds, with 17,694 children attend­
ing and 6,027 physical examinations made. The State units conducted
the child-health conferences in communities most likely to continue
them on a local basis after one or two demonstrations by the State unit.
Prenatal conferences—758 (including 608 in New York City). The
local staffs, partly supported by maternity and infancy funds, held
1,488 additional conferences, with 8,406 women in attendance and
3,116 examined. A nurse organized the prenatal conferences conducted
by the State unit, making the preliminary arrangements, calling on
prospective patients, and obtaining the permission of physicians for
patients’ attendance. She also made the follow-up visits on patients
who attended the conferences, unless there was a local nurse who could
do this work.
New permanent prenatal centers established—10.
Mothers’ classes—242 class groups, with a membership of 2,606.
New permanent child-health centers established—30. At the close of
the fiscal year there were 28 centers supported partly by maternity
and infancy funds. In addition there were 108 supported entirely by
municipal or private funds. These received advisory and supervisory
service from the State division and made reports to it.
In 28 communities child-health consultations were held regularly monthly
or twice monthly throughout the year by part-time physicians who received
an honorarium from Federal funds.
Another type of part-time medical assistance has been the holding of
so-called “ type G ” consultations where children are examined in the smaller
communities twice yearly, the physicians making the examinations being
paid $15 per diem from Federal funds. Within the fiscal year 21 such
consultations were held in 21 communities with 37 physicians and 518 persons
in attendance. A new development of the type G consultations occurred where
a county medical society sponsored the holding of such consultations, deter­
mined the place where they should be held, and appointed physicians from
the society to make the examinations. These physiciaus were also paid $15
per diem, and the work was carried on on a county-wide plan. Eleven con­
sultations were held by 23 physicians with 184 in attendance. Other county
societies considered taking up this type of work, and progressive development
of this feature was expected.
Sixteen specialists in obstetrics and pediatrics served as regional consultants;
for the division, receiving a small per diem compensation. They addressed1
medical societies and other groups of physicians in various parts of the State,,
conducting pediatric clinics and graduate courses in obstetrics and pediat­
rics. During the year they gave two courses in obstetrics, consisting of:
six lectures on prenatal care, postpartum care, management of normal labor,,

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pathology of pregnancy (two lectures), and pathology of labor, to county
medical societies; and a clinical group of physicians on Long Island gave one
course of pediatric clinics. The course in pediatrics covered natural feeding,
artificial feeding, nutritional disturbances, tuberculosis and cardiac diseases in
young children, posture or office orthopedics, and protective inoculations.
Six community demonstrations were made, as follows:
1. Early in 1925 it was decided to undertake a rural maternity-hygiene
demonstration in Tioga County in cooperation with the Maternity Center Asso­
ciation of New York and the Tioga County Medical Society, which appointed
an advisory medical committee. Two nurses were first assigned to this field
to make home visits on prenatal cases reported to them by physicians, to
organize group conferences for instruction in maternity hygiene, to do what
delivery service could be handled, and to give such postpartum care as might
be required by the physicians. Within the first six months of the year 123
patients had been referred to the nurses for general maternity instruction and
care, and it was found necessary to add a third nurse for the work. The
establishment of three centers was considered, but only one of these centers
was put into operation (at Owego). This was fully equipped with teaching
and exhibit material.
2. After hearing a lecture on breast feeding by one of the regional con­
sultants the Cortland County Medical Society voted for a demonstration on a
county-wide basis in Cortland County, and a nurse was assigned to the work
in April.
3. At the request of the Tompkins County Medical Society a breast-feeding
demonstration was started in Ithaca, N. Y., in March. The nurse visited each
physician, acquainting him with the idea of the demonstration and offering to
assist in any difficult feeding cases he might have. Lectures and demonstra­
tions in regard to breast feeding, relation of nurse to physician, methods of
maintaining breast feeding, the difficulties affecting mother and baby, and
technique of manual expression were given to the nurses in training at the
Ithaca Hospital; and a lecture was also given to graduate nurses.
4. In Hornell a breast-feeding demonstration covered six months. There
were 127 babies registered, of whom 106 completed the six-month period on
the breast (98 per cent were on the breast at the end of the first month and
84 per cent at the end of the sixth month).
5. At the termination of a six-month demonstration nursing service in May,
1925, the Freeport good-health clinic, supported by a fraternal organization,
was organized and began operation with a resident nurse on duty, the State
nurse being withdrawn. One nurse administered the work, doing clinical and
follow-up work for maternal, infant, and child hygiene, and assisting the
county tuberculosis nurse at a monthly clinic. An office assistant performed
the clerical work, assisting in dental and other clinics if necessary. The
State division supervised the work and the keeping of the records. The health
officer, who was chairman of the public-health committee of the county medical
society, supervised the clinical staff. The office, waiting room, nurses’ con­
ference and exhibition room, dental room, and examining room for two physi­
cians were completely furnished with the equipment necessary for a first-class
maternal and child-health center. The average attendance at consultations
for infants and preschool children was five; that for a dental clinic four.
6 . On April 3 the associate director of the division presented the matter of a
model child-health and prenatal center to the members of the Fulton Academy
of Medicine, who later unanimously voted foy such a service and appointed
a medical advisory committee to work with the nurse or nurses detailed to this
work. About the middle of April a nurse was detailed to Fulton and began
organization. The committee directing the activities of the local child-welfare
nurse assigned her to service with the State nurse. The service was started
with the idea of establishing a model program with a view to the reduction
of the infant and maternal death rates and also developing model nursing
procedures so that finally the center might be used for teaching purposes.
Except for consultations by physicians most of the program was in operation
by the end of the fiscal year under review. On requests from physicians the
nurse made prenatal and postpartum visits, and gave some delivery service.
There is much need of breast-feeding work in the city. That part of the pro­
gram was vigorously promoted, and the nurses in charge received good coopera­
tion from the local physicians. By the end of the year 124 feeding cases
^yerp recorded as under supervision.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

In the cities of Cohoes, Amsterdam, and Fulton, and. in Rensselaer County
(including the city of Troy) surveys were made of the conditions affecting
the mortality and morbidity of mothers and infants.
A breast-feeding campaign in Nassau County was brought to a close Decem­
ber 31, 1924. Visits were made to 2,815 babies who were born between
January 1, 1923, and April 1, 1924. Of all the babies under observation
92.1 per cent were breast fed at the end of the first month, 59.6 per cent were
kept on the breast nine months or more, 70.9 per cent of the babies who died
were being artificially fed at time of death, and 50 per cent of these died
from digestive disorders. American mothers comprised the largest group of
mothers and had the lowest percentage of infants breast fed for nine months.
A campaign for better reporting of cases of puerperal sepsis was instituted
early in the year, and a questionnaire and special letters were sent out to
all physicians and hospital superintendents in the State* This material was
also necessary for the purpose of making a study of the problem of puerperal
sepsis, which is still too large a factor in the maternal mortality of New York
State. An important feature in this campaign was the issuance of a list of
pathological conditions which are reportable as cases as well as deaths under
the heading of puerperal sepsis. This list was made of pocket size so that
physicians making out case reports or death returns could refer to it and in
this way have the returns come in to the department properly classified as
puerperal sepsis.
As a result of the educational and demonstration work of the State division
many local communities undertook similar work by the use of local funds and
initiated .permanent work of various kinds. Local campaigns to educate
mothers in the importance of breast feeding of babies have been undertaken,
mothers’ health clubs have been formed, one local public health nursing service
was begun, and many local child-health and prenatal conferences were held.
The State division gave financial assistance toward the employment of a
full-time public-health nurse for one year or longer in one community having
high infant death rates. Three other communities were selected for similar
service to begin when qualified nurses could be found. The State consultant
nurses supervised and assisted these nurses.
Home visits by nurses—10,326 to give individual instruction on prenatal
or postpartum care; 37,443 to give instruction on breast feeding and
the care of infants and preschool children.
Lectures and talks by staff members—299. A lecture course for nurses
and physicians, consisting of four lectures on nutrition, was given
eleven times by a nutrition specialist to about 300 physicians and
nurses.
Work among the midwives of the State was done by the two midwife super­
visors. Three new midwives’ clubs were organized (locally) and tentative
plans made for others.
Literature distributed—17,875 copies of Federal bulletins, 71,486 • State
pamphlets, also 2,100 reports of the division, 86,277 diet cards, etc.
Exhibits—layette and tray exhibits, consisting of Chase doll, two com­
plete layettes, baby’s toilet tray and mother’s tray, set of posters illus*r
trating baby’s bath, were prepared and shown at 60 county fairs. More
than 15,000 persons were reached by demonstrations, and more than
3,000 interviews on individual problems of maternity and child care
were held by nurses in this connection. This material was also con­
stantly used by nurses teaching mothers’ health clubs and conducting
health conferences.
NORTH CAROLINA

Administrative agency:
State board of health, bureau of maternity and infancy.
Staff:
Director (physician), 1 physician, 3 staff nurses, 16 county nurses 1 clerk
Activities:
’
Child-health conferences—359, at which 3,097 examinations were made.
Prenatal conferences—93, with an attendance of 2,519 women
Midwives’ classes—55, in the second six months, with an enrollment oJ
480. The course was completed by 752 women in the year.
Mothers’ classes—68 class meetings, with a total attendance of 4123
women.
¡§$#5“
Nutrition classes—450 class meetings for preschool children

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-28,569, at which mothers were advised on some phase of
the hygiene of maternity and infancy. This is one of the major features
of the work of the county nurses.
New permanent child-health centers established—16
New permanent prenatal centers established—16.
Lectures and talks by staff members—70 reported during one half year
Literature distributed—more than 125,000 pamphlets and leaflets height
and weight charts, diet cards, etc.
’
Prenatal letters—43,420 sent out.
The maternity and infancy work in North Carolina was done largely on
the county unit plan, the expenses being borne jointly by the State bureau
and the county. The nurse did maternity and infancy work exclusively
m accordance with a program outlined by the State bureau. She assisted
m the establishment of infant and prenatal centers, helped to conduct infant
and prenatal conferences, visited the mothers in their own homes, conferred
with those who called at her office, and taught midwives in accordance with
an outline which has been adopted by the county medical societies. The con­
ferences for mothers and children were conducted by local pTiysicians some
ot whom were paid for this service (others giving their time). (A countv
program is always undertaken for a year.)
No nurse was detailed to a county until she had completed a course of
framing under one of the State supervising nurses and satisfied the director
of the bureau of maternity and infancy that she thoroughly understood the
program to be undertaken. Her work was supervised by the State supervising
nurses.
,
&
NORTH DAKOTA

Administrative agency:
Department of public health, division of child hygiene and public-health
nursing.
Staff:
Director (physician), 1 nurse, 1 clerk.
Activities:
Child-heaith conferences—127, at which 2,817 examinations were made.
Many of the conferences were return visits to communities in which
conferences had been held last year. In these places it was found
that an encouraging number of the defects noted by the examining
physician at the conference of the previous year had been corrected
Prenatal conferences—43 in the first half-year and a number in the
second half-year in conjunction with child-health conferences.
Assistance was given in the birth-registration campaign in the first six
months of the year. North Dakota entered the birth and death registration
areas in December, 1925, as a result of the campaign.
New permanent child-health centers established—2.
New permanent prenatal center established—1.
Lectures and talks by staff members—69.
Literature distributed—15,846 pamphlets.
Volunteer assistance was given by 22 physicians, 19 nurses, and 336 lay
workers. The physicians cooperated throughout the State, and much of the
success of the conference w;ork was due to their support in creating local
interest as well as their aid at the conferences. Local organizations were
helpful in preparing for the conferences.
The child-health conferences held annually in connection with the State
fair have aroused so much interest that a special building was planned for
the accommodation of future conference work at the fairs.
OHIO

Administrative agency:
Department of health, division of hygiene.
Staff:
Director (physician), 1 physician (part time), 4 staff nurses (1 part
time), 8 community nurses, 1 nutrition worker, 1 inspector of maternity
homes (part time), 4 clerks (2 part time), 1 lecturer (part time), 1
publicity worker (part time).


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities:
Child-health conferences—62, at which 2,405 examinations were made.
The work of the division of hygiene has been supported and furthered
by a large group of specialists from the Ohio Medical Association.
Physicians in various parts of the State responded generously to re­
quests for assistance, sometimes all those in a community being present
at the conference held there.
The major piece of work undertaken was five community demonstrations of
the value of maternity and infancy work in the public-health field. One of
the determining factors in selecting the community in which to carry on the
demonstration was a high local maternal and infant death rate. Two maternity
and infancy nurses from the State staff were assigned to a public-health unit
in each community. Each nurse in the unit divided her time between ma-s
ternity and infancy work and general public health, the equivalent of the full
time of the maternity and infancy nurses being made up by the entire group.
More than the required amount of time was invariably given to maternity and
infancy work. At the health centers operated in these five community demon­
strations 519 prenatal cases, 1,971 infants, and 1,120 children of preschool
age were registered during the last half of the year.
Home visits—10,387, of which 1,359 were to prenatal cases, 5,927 to in­
fants, and 3,101 to preschool children.
Nutrition classes—6.
Maternity-hospital inspections—-261, _ There are approximately 200 ma­
ternity hospitals in the State. The term “ maternity hospital ” is ap­
plied to small institutions whose capacity is not inore than 2 to 8 beds,
as well as to the large and well-known hospitals. These hospitals pro­
vide 2,265 beds for maternity purposes alone. All are licensed and
inspected annually by the State department of health. They are required
to make detailed reports and to conform to the regulations adopted by
the department. Because of such statutory authority it has been pos­
sible to eliminate most of the questionable homes and to compel a raising
of the standards of care.
Surveys—2. In one of these it was found that 40 per cent of the districts
covered had no regulations concerning the production and distribution
of milk. The other survey was in regard to the midwife situation in
the State.
Lectures and talks by staff members—794, to an attendance of 107,950.
Fifteen radiophone messages on the prevention of deformities in children
were also sent out.
One piece of educational work thought to be far-reaching in its effects was
done in connection with county fairs. Exhibits and motion pictures were
shown and lectures given in a tent especially equipped for the purpose to
audiences totaling about 75,000.
Maternal and infant mortality statistics were compiled for 1923 and 1924.
OKLAHOMA

Administrative agency:
Department of health, bureau of maternity and infancy.
5
Staff:
Director (physician), 7 nurses, 7 clerks (4 part time).
Activities:
Child-health conferences—232, at which 5,710 examinations were made.
Prenatal conference—1. In addition 2,614 mothers were reached through
individual interviews.
Mothers’ classes-—15, with 178 women attending.
Little mothers’ classes—28.
In the last half of the year the bureau began the work of popularizing
the course in child care and training which was added to the public-school
curriculum in 1923. The combination semiproject-drill-demonstration method
•was used. From the problem “ given a cross baby in the home, what can
little sister learn to do to help mother care for it?” were formulated five
lessons: Namely, the infant’s layette and dressing the baby, the baby’s bath,
the baby’s bed, and the nursery corner, the feeding of a normal baby, and
first aid and home nursing. The demonstrations were first introduced as
supplementary to the theoretical course in child care and training taught in
the normal schools. After the State department of public instruction had

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approved the idea a one-week course was given to every high-schoql and
junior high school girl in two county seats. Here they received the hearty
approval of the teachers, parents, the State department of public instruction,
and the medical profession. The girls called upon local physicians (with
whom the nurses had already planned the work) for special information con­
cerning infant feeding, bathing, etc.
Home demonstrations—641.
New permanent child-health centers established—2.
New permanent prenatal center established—1, in connection with one
of the child-health centers.
A nurse’s institute was held for two weeks in July in the senate chamber
of the State capitol. Beside the routine instruction addresses were given by
the heads of various prominent state-wide organizations and State depart­
ments of Oklahoma and other States.
In five counties an investigation was made to ascertain what physicians were
not reporting births and deaths, and why.
In two counties and in two cities the number of preschool children was
ascertained by the name, age, sex, nationality, character of attendant at
birth, and registration of birth.
Work done over a wide territory had to be arranged and executed very
methodically to get the best results. For example, one nurse, by covering
her district of 13 counties twice in less than three months, was able to super-’
vise child-health conferences in 33 different points, promote 41 public-health
meetings, and plaice exhibits on display in 10 places. Approximately 20
children were examined by appointment at each place. On her first trip
the nurse arranged with the county home demonstration agent to sponsor the
conferences through her clubs and with the local physicians to make the
examinations. On her second trip she set up and took down the conference
equipment, weighed and measured the children, and also took histories when
no local nurse was available. The public-health talks were given by various
members of the State department of health and by local physicians.
In a part of the State where more work had been done the conferences were
usually arranged by local clubs. Although most of the 100 or more children
brought to each of these conferences were from families of higher economic
status than those of the rural sections, they seemed quite as badly nourished,
largely through their parents’ ignorance of proper nutrition.
A complete set of exhibit material was supplied to each nurse. An item
mentioned incidentally in the report of a nurse in charge of a child-care exhibit
at a State fair emphasized the necessity for nutritional education. The schools
of the town had been dismissed for one afternoon so that the school children
could visit the exhibit, and the nurse reported that as she finished explaining
it to the children, having “ the tiniest ones on a bench up in front,” she shook
hands with each one “ as each pledged he would no longer drink coffee or tea.”
The most interesting fact about it all was that the mothers said the children
stuck to their pledges.
Literature distributed—5,000 copies of each of several Federal, State, and
other publications. Some new pamphlets prepared by the bureau during
the year were: The Mother To Be, Dental Hygiene for Mother and
Child, The Confinement Room and the Sterile Obstetrical Package, Diet
Card for the Expectant and Nursing Mother.
Prenatal letters—approximately 4,000 sent out.
Lectures and talks by staff members—401.
Volunteer assistance was given by 210 physicians, 2 dentists, 10 nurses, and
510 lay workers.
OREGON

Administrative agency:
State board of health, bureau of child hygiene.
Staff:
Director (physician, serving 8 months), assistant director (nurse, serving
4 months), 9 county nurses (part time), 1 clerk.
Activities:
Child-health conferences—42 held in counties having a maternity and in­
fancy nurse with 1,126 examinations made; 47 held in other counties
with 1,522 examinations made. The director also served as a medical
director for the Portland Visiting Nurse Association, which conducted
165 conferences at which 2,106 children were examined.

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Prenatal conferences—168 (held in Portland), with an attendance of 915.
These were held in cooperation with the department of obstetrics of the
Oregon Medical School, which supplied the medical service and equip­
ment, and with the Visiting Nurse Association of Portland, which at­
tended to the follow-up work in the homes. The bureau of child hygiene
supplied the prenatal supervisor. The public library and other organiza­
tions furnished the place in which to hold the conferences (together with
the necessary heating and lighting), also the preliminary announcement
and publicity work.
Mothers’ classes—2, with 27 women attending.
Little mothers’ classes—14.
A dental clinic was established in one county unit and, with the help of
nurses, 5,420 children were given dental examinations.
Home visits—1,628 concerning child welfare, 276 to maternity and pre­
natal cases, in five counties.
New child-health centers established—7.
New prenatal centers established—4.
Lectures and talks by staff members—99. Radio courses were broadcast
through the State university and agricultural college.
Prenatal letters—817 complete sets distributed.
Literature distributed—Federal and other publications.
The bureau cooperated with the State university in preparing and conduct­
ing a correspondence course in prenatal and infant work.
Certificate receipts for birth registration were issued. The causes of infant
and maternal deaths in 1923 and 1924 were compiled, and the findings tabulated
and prepared for publication.
Volunteer assistance was given by 30 physicians, at least 50 nurses, and more
than 100 lay workers.
PENNSYLVANIA

Administrative agency :
Department of health, bureau of child health, preschool division.
Staff :
Director (physician), 3 physicians (2 part time), 2 staff nurses, 124 county
and community nurses (part time), 2 midwife inspectors (physicians),
11 clerks, additional dental and medical assistants as needed for special
work.
Activities :
Child-health conferences—7,054, at which 12,542 children were examined.
The number of visits made by children to these centers was more than
64,000. Correction wras reported of 11,583 defects noted. In the 225
non-State centers (those operated with other than State nurses officiat­
ing) 59,812 children were examined, about 250,000 visits to the centers
being made.
New permanent child-health centers established—59.
By means of three workers kept constantly in the field the State division
served in an advisory capacity both the State and non-State centers. Record
forms and literature for distribution were furnished them, and all made re­
ports of their work to the State division, no matter by what agency they were
conducted.
A health and dental car, staffed at first by two physicians, two dental
hygienists, two nurses, and a driver, later by four or five physicians and three
to five nurses, was put into the field on June 1 to work during the summer
months. The car was sent into local communities and child-health conferences
held in each place visited. County committees were organized to have charge
of publicity and the arrangements for the conferences. In June visits were
made to 24 towns in one county, and examinations were made of 1,172 chil­
dren. Dental hygiene was a special feature of the work, 697 children having
their teeth cleaned by the dental hygienists. Plans were made for close
follow-up work with thé cooperation of local chairwomen and nurses to try
to obtain the maximum number of corrections of defects found at the con­
ferences.
Prenatal conferences—468. These were held weekly at 9 State centers
and 79 non-State centers. The conferences at State centers were at­
tended by 249 mothers and the conferences ht non-State centers by
12,000 mothers,


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Home visits—more than 6,000 to prenatal cases within one six-month
period.
Little mothers’ classes—32, conducted in parochial schools during one
six-month period.
A beginning of nutrition work has been made by some of the State nurses.
The work of immunization against diphtheria which had been begun was
continued in the first half of the fiscal year under review, 21,799 ampoules of
toxin-antitoxin having been supplied for use.
Intensive work with midwives was done in seven counties by two staff physi­
cians. In four of the counties the work had been begun in 1922; in the other
three the first work was done during the fiscal year under review. In this
group of counties were about 3S6 midwives, each of whom automatically be­
came a member of the class conducted in her territory. Besides instructing
them in class groups the physicians also visited them in their own homes. The
State nurses in these counties visited all cases attended by midwives, and the
physicians visited to investigate the deaths of mothers or of babies within the
first week of life. Statistics kept for the four counties in which the work was
first undertaken showed that during the calendar year 1924 the number of
births attended by midwives was 6.2 per cent of the total births in one county,
11.7 in the second, 18.1 in the third, and 25.1 in the fourth. The total number
of deliveries by midwives in the four counties was 5,482, and the number of
maternal deaths was 13. This number included deaths of all women whom a
midwife had attended, even though a doctor was called in later and signed the
death certificate.
The accomplishments of the work have been the obtaining of better delivery
methods, the elimination of unlicensed women from practice, and the establish­
ing of an esprit de corps among the women, especially in two counties! where
they organized a midwife league.
A number of vital-statistics clerks were employed to prepare the birthnotification certificates sent out to mothers on receipt of birth-registration data.
Greater accuracy in registration resulted, inasmuch as parents were interested
in causing any needed corrections to be made, and a wider appreciation of the
value of registration was manifested. The clerks made separate compilations
of infant and maternal mortality statistics for the seven counties in which
special work with midwives was being carried on.
Seven communities having high infant death rates accepted the division’s
offer to contribute $1,000 during a 12-month period to the support of a publichealth nurse if the balance of the expense were met locally. The nurses, de­
voted to maternity and infancy work an amount of time proportionate to the
State’s share of the total budget. The object was to demonstrate the value of
the work so that the community would assume full financial responsibility for
a local maternity and infancy program.
Literature distributed—more than 350,000 pamphlets, also dodgers, diet
lists, record forms for health centers, and a large number of bulletins in
foreign languages.
Lectures and talks by staff members—141, with an attendance of 16,332
persons.
Local physicians to the number of 375 assisted in the examination work at
the State centers, and more than 300 assisted at the non-State centers, some
volunteering their services, others accepting a small honorarium. Excellent
local cooperation from lay workers was received.
RHODE ISLAND ®

Administrative agency:
State board of health, division of child welfare.
Staff:
Director, 4 nurses, 1 field secretary, 1 stenographer.
Activities:
Child-health conferences—2 each week. The number of children examined
was not reported.
Home visits—4,164, made by the staff nurses.
Lectures by staff members—4
The field secretary met incoming trans-Atlantic steamers to inspect the chil­
dren under 5 years of age.
8 R hode Isla n d a ccep ted th e benefits o f th e a c t in A p ril, 1925. T he rep ort subm itted
covers th e w ork done in th e rem ainder o f th e fisca l yea r (M ay and J u n e) 1925.


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THE WELFARE AND HYGIENE OF M a Te BNITY AND INFANCY
SOUTH CAROLINA

Administrative agency:
State board of health, bureau of child hygiene and public-health nursing.
Staff:
'
Director (nurse), 1 physician (part time), 4 staff nurses (2 part time),
1 county nurse, 1 midwife supervisor (nurse), 3 clerks; mechanician and
motion-picture operator as needed.
Activities:
Child-health conferences—457, at which 7,046 examinations were made.
The child-health truck revisited communities which it had previously
entered. Many parents who had had the defects of their children cor­
rected brought the children to the return conference to show that the
advice given had been followed.
• Prenatal conferences—194, with an attendance of 1,258.
Mothers’ classes—31, with 529 women attending.
Little mothers’ classes—29.
Home visits—952, made by one nurse in one county in which she worked
for the entire year. The number of visits made by the other nurses was
not reported, but home visiting was a part of the work of all the nurses.
New permanent child-health centers established—6.
The State nurses were loaned to counties for periods of three months at
the request of the respective county medical societies. Frequently a local
organization, such as the parent-teacher association or some club, asked the
county medical society to make the request. The nurses held mothers’ classes
and conferences for infants and preschool children, instructed midwives, and
made home visits. Invariably this demonstration work created an agitation
for permanent work, and many counties employed public-health nurses. Gener­
ally a county appropriation was made to finance such work, but there were
also instances in which a part of the expense the first year was borne by
federated clubs or the parent-teacher association.
Lists of births and deaths were compiled in an effort to determine which
places in the State had the highest death rate. Birth certificates accompanied
by letters were sent to mothers when the birth of a child was reported.
The motion-picture outfit which works under the department of rural sani­
tation used films supplied by the bureau of child hygiene, and it showed on
each occasion at least one film concerning maternity and infancy work. The
films'were shown almost exclusively in rural districts, usually in a schoolhouse or church. Among the audiences, who came in buggies or riding on mules
from places many miles away, were many persons who had never seen a
motion picture before.
Care for crippled children was obtained through the cooperation of an ortho­
pedist who attended a number of the child-welfare conferences, rioting about
100 cases needing correction in the 30 counties visited, and prevailed upon the
State legislature to take legal action looking toward the treatment of crippled
children.
Midwives’ classes—183, with an enrollment of 2,206 women, of whom 844
completed the course. Much improvement has been noted among the
midwives. They have tried to raise the standards of their practice and
to profit by the instruction given them. The county health departments
have had the midwives report monthly to have their obstetrical bags
inspected, to receive fresh supplies, and to report concerning the cases
which they attended within the month. At the end of the fiscal year
there remained only 11 counties in which the midwives had not been
taught. All the nurses included midwife teaching in their work, and
the midwife supervisor divided her time between work with the mid­
wives and general maternity and infancy activities. In one county an .
effort was made to ascertain the number of births reported by mid­
wives, the number of stillbirths, and other information relating to the
midwife situation.
Exhibits dealing with proper diet for infants and young children were
prepared for nine county fairs. Posters and sample layettes were loaned to
health services, clubs, and colleges.
Lectures and talks by staff members—130, to 4,622 persons.
Literature distributed—more than 28,000 pamphlets, leaflets, etc. A library
for mothers and nurses was prepared and kept in circulation.


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SOUTH DAKOTA

Administrative agency:
State board of health, division of child hygiene.
Staff:
Director (physician), 2 staff nurses, 5 county nurses (part time), 1 clerk,
1 lecturer (part time).
Activities:
Child-health conferences—292, at which 4,604 examinations were made.
Fifty-two conferences were return visits to communities in which con­
ferences had been held the previous year. Reports were received of the
correction of defects for 623 children. At each conference an oppor­
tunity for a prenatal examination was given to mothers. Prospective
mothers were in attendance at 64, and 107 examinations were made.
Mothers’ classes—5 were begun in June with 67 women attending. An
outline of a standard book on prenatal care was made, and mimeo­
graphed copies were furnished to the class members for use as a text­
book. The last two lessons consisted of demonstrations on preparation
for confinement, and care of the newborn baby. A small engraved
certificate was given to each mother who attended the entire series of
lessons.
Home demonstrations—34 within the first half year (number during
remainder of year not reported). These included demonstrations of
preparation for confinement, infant and child care, etc.
A state-wide survey of maternity homes was in progress. It is believed that
the law enacted in 1925 providing for the licensing and inspection of maternity
homes by the State board of health will result in a raising of the standards
in such institutions.
Each birth report received was verified and corrected under the supervision
of the director. A birth certificate and suitable literature were sent to each
mother as soon as the reports had been verified.
A study of 7,514 birth reports to ascertain the type of attendant at confine­
ment showed that 6,574 births had been attended by physicians, 180 by mid­
wives, 323 by some other attendant; and that 437 had no attendant.
Tabulations were made of the causes of maternal deaths in 1923; causes
of deaths during first, second, and third weeks of life ; causes of deaths during
first, second, third, and fourth years of life; causes of stillbirths and premature
births.
Lectures and talks by staff members—142 illustrated with films and slides,
24 not illustrated.
Literature distributed—more than 8,000 bulletins by mail and others at
State and county fair exhibits.
Prenatal letters—sent to 1,248 addresses.
Exhibits were prepared and used at the State fair and six county fairs.
TENNESSEE

Administrative agency:
Department of public health, division of maternal and infant hygiene.
Staff:
Director (physician), 2 staff nurses, 26 county nurses (22 part time),
2 clerks.
Activities:
Child-health conferences—172, at which 2,457 examinations were made.
The county nurses organized conferences and assisted in them.
Midwives’ classes—31 class groups, with an enrollment of 513 negro
women, of whom 232 completed the course. These numbers include the
classes organized and taught by the negro physician detailed to the
. State by the Federal Children’s Bureau (see p. 69) ; the county nurses
assisted in the work. Ampoules of silver-nitrate solution were distrib­
uted free to the midwives. An increased interest on the part of the
midwives in the welfare of the mothers and babies attended by them
was evident. One midwife arranged to have 18 of her patients bring
their babies to a child-health conference.
Little mothers’ classes—88.
Demonstrations—69 within one half year, given by county nurses to
groups of mothers, usually on some phase of maternal and child care.


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THE WELFARE AND HYGIENE OE MATERNITY AND INFANCY

Home visits—13,312, of which 2,410 were to prenatal cases, 2,156 to post­
partum cases, 5,888 to infants, and 2,858 to preschool children.
New permanent child-health centers established—16.
The greater part of the maternity and infancy work has been done on the
county unit plan, 26 counties being supplied with a public-health nurse and
the cost of the service in most counties being borne jointly by maternity and
infancy and local funds.
The isolation of much of the population in certain regions (as in some
mountainous parts of the State) has made the work difficult almost in propor­
tion as the need of it has been extreme. Prejudice against preventive measures
for smallpox and diphtheria, disregard of quarantine precautions, and lack of
medical treatment greatly increase the death and disease rates due to the
frequent epidemics.
Inasmuch as the State is not in the birth-registration area, a survey and
campaign to stimulate interest in birth registration was undertaken. Work
was done in five counties, in three of which it had been completed by the
end of the fiscal year. Local committees gave effective cooperation and help.
The county nurses also did general educational work on the need and value
of birth registration. The interest aroused in one county was such that a
local bank offered to deposit $1 to the credit of each baby whose birth cer­
tificate was filed with the health department.
Lectures and talks by staff members—53.
Literature distributed—more than 13,000 pamphlets relating to maternal
and child care, instructions to midwives (see p. 69), and prenatal letters.
TEXAS

Administrative agency:
State board of health, bureau of child hygiene.
Staff:
Director physician), 4 staff nurses, 25 county nurses (part time), 5
nurse assistants, 1 inspector of maternity and infant homes, 8 clerks
(1 part time), 1 illustrator.
Activities i
Child-health conferences—836, at which 8,320 examinations were made/
The correction of 184 defects was reported for the second half yeaj.
Prenatal conferences—more than 3,000 mothers were reached by in­
dividual and group conferences.
Midwives’ classes—36, with an enrollment of 605 women, of whom 234
completed the course. The midwife survey previously reported as in
progress was completed, and classes were undertaken in accordance
with the findings. The Negro and Mexican midwives were very eager
to learn, but the foreign-born white midwives were reached with more
difficulty. Silver-nitrate solution was supplied free to all of the mid­
wives.
Mothers’ classes—164 class groups with a total attendance of 2,274
women.
Little mothers’ classes—104 class groups.
Dental clinics—102, with 552 children receiving care.
Nutrition classes—61 class groups.
Demonstrations and exhibits—223, at fairs and various group meetings. A
literature exhibit was prepared for use at parent-teacher association sum­
mer institutes at State normal schools.
Home demonstrations—855, on preparation for confinement, the preparing
of food for infants, and other subjects related to prenatal and child' care.
Maternity homes—78 inspections made.
Infant homes—213 inspections made. As a result of the efforts of the
inspector the conditions in both infant and maternity homes have greatly
improved.
Campaigns—80, for improved milk supplies and more complete birth regis­
tration.
Surveys—13, of midwives and general sanitary conditions.
New1 permanent child-health centers established—144, at which county
nurses held monthly conferences. A local committee was responsible for
assisting the nurse.
New permanent prenatal center established—1.


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Lectures and talks by staff members—145 by office staff and 807 by field
nurses.
Literature distributed—41,180 pamphlets on infant care (within last half
of the year).
Prenatal letters distributed—24,952 in the last half year.
A correspondence course in public-health nursing was conducted by the
superintendent of nurses, and a circulating library was maintained for the use
of nurses in the field.
When a birth was registered a letter was sent to the mother offering her
literature. By this method a contact was made with many mothers who could
be given help and instruction.
*
Generous cooperation was given by more than 700 physicians and more than
2,000 lay workers. Efficient lay cooperation was available through the organiza­
tion of an advisory council composed of one or two physicians, representatives
from each of the state-wide women’s organizations such as the nurses’ asso­
ciations, the affiliated women’s clubs, and others. Representatives of the bureau
of child hygiene attended the State meeting of each of these bodies and planned
with them the work to be undertaken on behalf of the bureau’s maternity and
infancy program for the year. The principle was carried out similarly with
the district and county organizations, and finally the community ones, so that
all had definite places on the “ county nursing committee” and worked for the
accomplishment of one or more items on the program. The men’s fraternal and
professional organizations were approached later, and likewise gave notable
assistance. The schools were good sources for efficient lay workers, the teachers
having proved very helpful.
UTAH

Administrative agency:
State board of health, bureau of child hygiene.
Staff:
Director (physician), 1 physician (part time), 1 staff nurse, 3 county nurses
(part time), 2 clerks.
Activities:
Child-health conferences—234, at which 7,972 examinations were made.
Prenatal conferences—54, held in conjunction with child-health conferences,
with an attendance of 130 expectant mothers who were given instruction
on prenatal care.
Mothers’ classes—55 sessions with a total attendance of 1,112 women during
the last half of the year. The number attending in the first half year
was not reported.
Little mothers’ classes—4.
Home demonstrations—123, on layettes, infant care, the preparation of
infant and child diets, etc.
Home visits—2,296.
Maternity homes inspected—7.
Infant home inspected—1.
New permanent child-health centers established—50.
Tabulations were made of the results of the 11,562 examinations made
at 386 child-health conferences held in 25 counties by the State staff or by
local forces. These tables showed such facts as the number of children
coming to the conferences for the first time, the number of children returning
for examination, and the number and kind of defects found. Correction was
recorded of 1,409 of the 14,681 defects noted. ;
Surveys were made in two counties to ascertain sanitary conditions, health
resources, social agencies, etc., of each town in the county. This information
was used in formulating plans of work in these two counties.
Lectures and talks by staff members—241.
Literature distributed—13,594 Federal and State bulletins.
Charts, posters, slides, and other exhibit material have been prepared for
fairs and meetings of various organizations. New graphs have been made
showing the trend of infant mortality and morbidity rates in the State. These
have been exhibited in the State offices and at other places where they might
be of interest to the public.
Volunteer assistance was given by 75 physicians, 20 dentists, 28 nurses, and
722 lay workers. In so large a State the best method of work for the com­
paratively small staff seemed to be to have one of the staff nurses go into a


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

community and, after noting general health conditions and other relevant facts,
confer with the various clubs, churches, and other organizations, to interest
them in the establishment of a health center. The next step was to have
them appoint a temporary committee to prepare for the later arrival of a
member of the medical profession, or a nurse, to give a demonstration of child- .
health work. These demonstrations were given good publicity in advance,
and the attendance was excellent. The visitors then were asked whether the
examinations of their children were of value, and whether they cared to
make the organization permanent. The term permanent organization serves
merely to indicate that some one is responsible for keeping the work going
in the long intervals which must elapse between the visits of members of
the State staff. The local physicians were expected to conduct the conferences
and were requested to report the number of children examined, types of de­
fects found, etc. If possible the conferences were held in public-school build­
ings. The establishment of the 50 new permanent child-health centers was
a result of this work.
VERMONT

Vermont accepted the benefits of the act in the latter part of February,
1925. The sum accepted was the unmatched allotment of $5,000. Owing to
lateness in starting work and the difficulty in obtaining the desired personnel
for the administrative staff the only work done within the fiscal year under
review was to purchase supplies, except that some statistical studies of
maternal and infant mortality were made for use in connection with the
planning of the work.
VIRGINIA

Administrative agency:
State board of health, bureau of child welfare.
Staff:
Director (physician), 1 staff physician, 3 staff nurses (1 part time), 47
county and community nurses (part time), 1 midwife supervisor (nurse),
director of mothers’ correspondence course (nurse), motion-picture op­
erator, 6 clerks, dentists as needed for special work.
Activities i
Child-health conferences—872, at which 16,744 examinations were made.
In counties having a maternity and infancy nurse the county nurses
assisted at more than 1,500 child-health conferences and 707 toxinantitoxin clinics.
Home visits—67,175, of which 5,756 were to prenatal cases, 8,085 to post­
partum cases, 36,900 to infants, and 16,434 to preschool children.
Prenatal conferences—89, with an attendance of 522, held in six counties
having maternity and infancy nurses.
Mothers’ classes—27, with an attendance of 329.
Dental clinics—held in 28 counties and 2 cities the first half of the year,
.with 2,346 dental examinations made. In the last half of the year 10
clinics were held and 324 examinations made.
Midwives’ classes—159 sessions, with a total attendance of 1,171, con­
ducted by the county and community nurses and the State supervisor
of midwives. A printed course of instruction (consisting of eight leasons) was furnished to the nurses that the class work might be uni­
form throughout the State. In the classes the necessity of cleanliness
was emphasized, also the proper use of eye drops, the necessity of
reporting of births, the danger of making internal examinations and
giving drugs, and the importance of being able to recognize dangerous
symptoms so that the midwife could call a physician when necessary.
The nurses reported that the unfit midwives were being eliminated,
their places being taken by younger women anxious to receive all the
training possible and willing to put .the instructions into practice.
Maternity homes inspected—7 (the total number in the State). Informa­
tion was obtained concerning equipment of the homes, method of han­
dling cases, and the kind of care given mother and baby.
New permanent child-health centers established—7.
New permanent prenatal clinics established—-2.


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A great part of the work was done by nurses employed jointly by the county
or community and the State bureau. The State bureau contributed $500
toward the salary and expense of the nurse in return for which she devoted
one-fourth of her time to maternity and infancy work. Generally the amount
of time greatly exceeded this, sometimes as much as half time being given to
maternity and infancy work. In all communities where public-health nurses
were employed there was a tendency to work out of the school-child group
back into the preschool-age group.
Institutes on child training were held for parents in five towns, each institute
lasting four or five days. Since the establishment of correct health habits is
affected by the child’s mental, social, and moral training, the object of these
institutes was to discussi with parents the whole subject of child training and,
if possible, to outline standards and policies for a child-training program.
To meet to some extent the need of trained nursing care in the home for
minor illnesses and for persons unable to afford a trained nurse, an effort was
made to interest hospitals in opening schools for training **nursing attendants.”
One such school was opened, the period of training to be one year.
Plans were also made for a short course to be held at the University of
Virginia during the summer to train physicians’ helpers. The course as planned
consisted of 15 lectures and demonstrations on maternity care, home nursing
personal hygiene, and community health.
Lectures and talks by staff members—215.
Literature distributed—more than 218,000 pamphlets, leaflets, etc.
Mothers correspondence course—255 women completed the course, and the
number still on the list July 1 was 746. The accomplishments! of the
second year’s work have been encouraging. More than twice as many
students (1,141) enrolled as had enrolled the previous year.
The motion-picture outfit visited 28 counties, 1 city, 30 colleges and schools
^n , ^e^ ral meetln?s of organizations. A total of 333 showings of various
health films were given to audiences totaling more than 71,000 persons.
WASHINGTON

Administrative agency:
Department of health, division of child hygiene.
Staff:
Director (physician), 1 staff nurse, 1 county nurse, 3 clerks (1 part time),
1 publicity worker (part time).
'
Activities:
Child-health conferences—43 in rural communities, at which 3,799 exam-,
inations were made. The division cooperated with one of the depart­
ment stores m Seattle in holding a weekly child-health conference. The
number of examinations at these conferences was about 70 each week.
■
,
lectures on prenatal and child care was given in connection
with the conferences.
Prenatal conferences—6, with an attendance of 250.
Mothers’ classes—31 class sessions, with a total attendance of 1,125
Dental conferences—4. Examinations were made by dentists who volun­
teered their services.
S°me siight improvements appeared in infant feeding in the rural communi­
ties. The physical examinations indicated the widespread neglect of vaccina­
tion and of toxin-antitoxin administration, the prevalence of rickets, adenoids
tonsil enlargement and infections, of goiter in certain localities, and of dentai
caries. However, definite improvement in correction of dental caries was noted
n i t i . l 6?
Was ™lde ,in *hree counties to develop mother and baby schools,
although this was difficult since the work depended upon the time which local
physicians could give to it. Demonstrations concerning infant care, confine­
ment needs, and proper nutrition formed part of the course.
Group demonstrations—17, on various phases of child care, in connection
with the mother and baby health schools.
New child-health centers established—3.
dir®ct°r of the division aided in conducting a series of pediatric pro^ J he "°™ty ,, £ $ cal societies, arranged by the infant-welfare
committee of the State medical association.
Permanent organizations to serve as child-hygiene committees were being
formed in all counties. These included county health officers, county nurses
86304°—26-----5


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where available, local physicians, presidents of parent-teacher associations,
county federations of women’s clubs, and other lay workers.
An article was prepared every week to syndicate for 197 newspapers, and
articles were prepared every month for several magazines.
Correspondence course—257 women were registered at the close' of the
year.
Lectures and talks by staff members—120.
Literature distributed—more than 8,500 bulletins distributed.
Exhibits were provided for two communities, also for nurses’ institute;
various conventions of women’s organizations, and county fairs. A special
diphtheria-prevention exhibit was prepared.
WEST VIRGINIA

Administrative agency:
Department of health, division of child hygiene and public-health nursing.
Staff:
Director (nurse), 2 staff nurses, 5 county nurses, 3 clerks, 1 vital-statistics
field worker.
Activities:
Child-health conferences—276, at which 6,011 examinations were made.
Prenatal conferences—24, with an attendance of 59.
Mothers’ classes—260 sessions, with a total attendance of 5,191.
Little mothers’ classes—228 sessions, with a total attendance of 3,239.
Group demonstrations—24, on making and sterilizing an obstetrical bundle,
bathing the baby, preparing a feeding formula, arranging the confine­
ment bed, etc.
Home visits—8,479.
Correspondence course—to a registry of 4,747 mothers. Physicians from
all parts of the State registered their prenatal cases for this course.
New permanent child-health centers established—12.
New permanent prenatal clinic established—1.
Lectures and talks by staff members—123.
As a result of the work of the State division local communities were initiat­
ing their own maternity and infancy work. Many communities conducted
preschool child-health conferences; and in five counties and one city the
local health workers conducted correspondence courses for mothers, the
material being furnished by the child-hygiene division.
The films “ Well Born” and “ Our Children” were used in a number of
communities; also loaned to county health units and other organizations.
Posters and slides were also used.
Articles were prepared monthly for 104 newspapers and weekly for 38
dailies, and one radio talk was prepared.
Surveys of the birth registration, death rate, deliveries, infant feeding, and
general sanitation were made in several counties, and the health conditions
of the preschool children were studied in one county.
A three-week course in maternal and infant hygiene was given at each
of the three State negro normal schools in July and August to about 100
teachers. Weekly lectures were given to the entire student body of one school.
Members of the division staff gave to nurses in hospital training schools seven
courses on public-health nursing, consisting of lectures and demonstrations
designed to give the pupil nurses some knowledge of the preparation for
public health nursing work and of its opportunities. Maternal, infant, and
preschool-child work were taken up in detail. These short general courses
were given in the hope that some of the pupil nurses would enter upon publichealth nursing.
An outline was prepared for the use of communities in organizing childhealth conferences. The reasons for such a conference were stated, with
mention of the defects most frequently found and brief explanation of the
bad results which defects left uncorrected have upon a child’s future physical
condition. Suggestions were given on the duties and responsibilities of the
registration committee and other committees. Many copies of this were dis­
tributed by nurses among the persons likely to be interested and capable of
giving efficient help in preparation for a conference and its successful conduct.
Women who had had experience in teaching and in business were sought as
aids in the clerical side of the work and as special assistants. An effort
was made to form a representative public-health association in every com
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munity where there was a public-health nurse. Special effort was made dur­
ing the summer to have children who would enter school for the first time
in the approaching fall examined and defects corrected.
Forms for a survey questionnaire, application blanks, permits, pledge card,
rules, and information for midwives were prepared to carry out the require­
ments of a law requiring registration and licensing of all persons practicing
midwifery in the State, which the legislature passed in May, 1925.
WISCONSIN

Administrative agency:
State board of health, bureau of child welfare and public-health nursing.!*
Staff:
Director (nurse), 4 physicians (2 part time), 5 nurses (1 part time), 8
clerks (1 part time), 1 organizer of infant-hygiene classes.
Activities:
Child-health conferences—383, at which 11,708 examinations were made.
Prenatal conferences—222.
Little mothers’ classes—211, in which 4,240 girls were enrolled.
Through the work of the organizer of infant-hygiene classes the little
mothers’ classes have become a recognized course in infant hygiene in the
schools of the State. This has developed through the cooperation of the State
department of public instruction with the bureau of child welfare and publichealth nursing, which has made it mandatory for teachers to include a mini­
mum of 10 lessons on infant hygiene in the seventh and eighth grades as rapidly
as the teachers become prepared for the work. The organizer of infant-hy­
giene classes gave demonstration lessons to teachers in State and county nor­
mal schools and other groups of teachers, instructing approximately 2,545
student teachers in 25 training schools. An outline for the 10-hour instruction
in infant hygiene was prepared for the use of teachers. During the winter
months the staff nurses assisted in the teaching of infant-hygiene classes in
the schools. The larger State normal schools and county normal schools have
included in their curriculum the instruction for teaching such classes.
Infant homes inspected—7.
New permanent child-health centers established—3.
New permanent prenatal centers established—3.
Home visits—3,165 within the last half year, of which 1,752 were made to
infants, 1,276 to preschool children, and 137 to expectant mothers.
Lectures and talks by staff members—256.
Literature distributed—84,890 pamphlets, 18,625 birth-card letters.
Prenatal letters—9,475 to 2,119 expectant mothers. A sample set of pre­
natal letters with blanks for reporting names and addresses of expectant
mothers was sent to all physicians in the State who had reported two or
more births in 1924. There were 957 names sent in by 138 physicians.
Exhibit material—sets of posters were loaned 309 times, films and slides
38 times, and sample layettes 13 times.
Volunteer assistance was given by approximately 20 nurses and 18 individual
lay workers, in addition to many women’s clubs, parent-teacher associations,
and other organizations.
WYOMING

Administrative agency:
Department of public health, division of maternal and infant welfare and
child hygiene.
Staff:
Director (nurse), 4 county nurses (1 part time), 1 clerk.
Activities:
Child-health and prenatal conferences—113, at which 2,708 examina­
tions of children were made. Physicians from near-by towns were
employed for 8 rural conferences. Lectures on prenatal and infant
care were given at the conferences, 1,500 mothers being reached within
the first half of the year (the number for the last half not being
reported). The mothers were interested in knowing the exact condi­
tion of their children and in having defects corrected. However, the
child in the rural section may have to be taken a long distance to a
dentist. Several counties have no hospitals, many local physicians have
no facilities for the simplest surgery, and only four cities in the State


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have eye, ear, nose, and throat specialists. Although the data ob­
tained were very incomplete, encouraging indirect reports were re­
ceived of corrections made.
Mothers’ classes—195 sessions, with a total attendance of 1,343. The
course consisted of six classes and demonstrations, four talks on pre­
natal care, and two on the care of the newborn child, emphasizing
breast feeding. In each community in which child-health conferences
were held the State workers tried to interest some group in forming a
study class on child care, advising them to consult their local physicians
and dentists concerning programs. Pamphlets and an outline for the
course were furnished by the State bureau.
A continuous mothers’ health conference "was held at the State fair.
Home visits—7,158, including 1,046 to prenatal cases and 4,759 to infants
and preschool children. All the field nurses except one worked in coal
or oil camps or’ among industrial groups. They urged the women to
place themselves under the care of a physician early in pregnancy.
In some communities far from physicians they found that the mothers
visited their physicians early and kept in touch with them by letter or
other means of communication.
New permanent child-health centers established—14.
Lectures and talks by staff members—90.
Literature distributed—many Federal bulletins. Copies of pamphlets on
prenatal care and the care of children were given to each mother at
child-health conferences, and leaflets on breast feeding and the care of
the baby were sent to the mother of each baby whose birth was regis­
tered. Literature was also supplied to mothers’ circles, libraries, phy­
sicians, and hospital officials who requested pamphlets for distribution
to their obstetrical patients.
Volunteer assistance was given by 75 physicians, 30 dentists, 57 nurses,
and 205 lay workers.


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FEDERAL ADMINISTRATION
FEDERAL STAFF

For the administration of the maternity and infancy act the
United States Children’s Bureau added to its already existing six
major divisions a division of maternity and infant hygiene, to consist
of a director and an associate director, a consulting public-health
nurse, an accountant, a secretary, and a stenographer.9 In 1924 a
negro physician was employed for investigation and educational
work among negro midwives. The acting medical director or other
staff phvsicians have visited the States for conferences with direc­
tors and observation of field work; also for conferences with phy­
sicians, public-health nurses, and groups of interested persons not
belonging to the medical or nursing profession.
For the second half of the year two nurses were added to the staff
for special work in cooperation with the States.
The consulting public-health nurse visited the State supervisors
of nurses in the States in an advisory capacity, observing field work
in rural districts and bringing to each State the experience of the
others. She spent periods of time in some States helping to initiate
maternity and infancy demonstration work and gave addresses at
institutes for nurses.
The accountant has visited all the States accepting Federal funds
and has audited the accounts of all cooperating State agencies.
CONFERENCE OF STATE DIRECTORS

A conference of directors of State bureaus administering the Fed­
eral maternity and infancy act was held at the Children’s Bureau
in Washington, October 8 to 10, 1924. Representatives were pres­
ent from 36 cooperating States, and from 1 State not cooperating.
The entire time was devoted to discussion of ways and means of
improving and extending the work. The following topics were
discussed: Prenatal care, confinement care in rural areas, methods
of forming permanent child-health centers, nutrition work, dental
care, stimulation of interest in counties which have not previously
had a public-health program, the utilization of lay workers and lay
organizations, reduction of the infant death rate, methods of obtain­
ing the services of specialists for rural communities, specialized and
generalized work for nurses, methods of obtaining cooperation from
local physicians and dentists, methods of transferring responsibility
for child-health conferences over to their respective communities, the
contents of a well-rounded program of maternal and infant hygiene
work, methods of obtaining correction of defects noted at confer­
ences in rural communities, the use of local newspapers in maternity
and infancy work, mothers’ classes, maternity homes.
9

See 4 2 S ta t. 1 3 5 , sec s. 3 - 6 (A p p en d ix A , pp. 7 3 -7 5 o f th is r e p o r t).

63

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The following reports of committees were submitted to the con­
ference and accepted by it :
1. Report of committee on achievements under the SheppardTowner Act :
Wide diversity in the development of child hygiene in the States and vary­
ing local conditions make it impossible to judge the work of the States by the
same tests. It is essential that the program be laid out along lines that are
known to have brought results and that it be scientifically carried out; that
the cooperation of all groups who can contribute to the success of the program
be enlisted.
Object: To make available to mothers and fathers information as to
Scientific care of mothers and babies. (1) Extensive work: To reach the
whole State with general information. (2) Intensive work: Demonstrations
of prenatal, infant, and preschool conferences, county nurse activities; having
county or local communities assume work which has been initiated.
Results: Measured by the extent of the program under way, how much
of the State has been covered with extensive work, how much intensive work
has been undertaken? How much permanent work is under way?
The extent of information available on which judgment as to effectiveness
of work can be made: (1) Reduction of infant and maternal mortality rates;
(2) reduction of morbidity; (3) evidence of increased physical fitness.

2. Report of committee on cooperation with the medical profes­
sion:
The committee requests that it may remain a standing committee to study
further ways and means of engaging the interest and cooperation of the
medical profession. It is the sense of this committee that the work of the
various States under Federal maternity and infancy funds has been estab­
lished with full recognition of the importance of this cooperation and has been
carried on with ethical procedure; that the cooperation and participation of
physicians in the work is constantly on the increase and that, therefore,
while this committee has at this time no resolution to present, it takes
occasion to urge redoubling of effort in this direction so that we may secure
a better and more sympathetic understanding of maternity and infancy work
as carried on under the Federal provision.

Upon motion of one of the directors it was voted that the
Children’s Bureau be asked to work out standards of prenatal care
for the use of physicians and standards for physicians conducting
conferences in child-health centers.
I t was decided by the conference that a committee of directors
should be appointed to take charge, with the cooperation of the
Federal office, of detailed plans for the next annual conference of
directors.
RESEARCH AND EDUCATIONAL WORK
Standards for physicians conducting conferences in child-health centers.

In pursuance of the request made by the conference of directors
of State bureaus that the Children’s Bureau formulate and make
available a statement of standards for the conducting of childhealth conferences the standing advisory committee of pediatrists
appointed for the Children’s Bureau by the American Pediatric
Society, the pediatric section of the American Medical Association,
and the American Child Health Association cooperated with the
director of the child-hygiene division of the bureau in the prepara­
tion of such an outline of standards. Assistance was also given by
professors of pediatrics in two universities and the director of one


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of the State bureaus. The pamphlet contains sample forms for
history taking and for the recording of six complete physical exam­
inations; and these forms can be purchased in quantities from the
Government Printing Office (see pp. 80, 81). The use of these forms
will make conclusions drawn from comparison of facts ascertained
in one county, State, or district with those ascertained in another
proportionately more valuable.
Standards of prenatal care.

A t the conference of State directors it was likewise suggested that
a committee from various parts of the country be appointed to
draw up standards of prenatal care for the use of physicians at
clinics and also in private work. The Children’s Bureau accepted
the suggestion and requested a prominent obstetrician to organize
such a committee. The work of this committee of 11 obstetricians
has been embodied in a concise, simple, workable outline of the
points essential for inclusion in the standards of prenatal care.
Although the committee appreciated that no group of physicians
would agree without qualifications on any set of standards such as
was attempted, they felt that the pamphlet, as approved in its
final form by each member of the committee, covers the essential
points in prenatal care which all physicians should be called upon
to give their patients. A sample outline for recording obstetrical
histories is included, and copies of this form can be purchased in
quantities from the Government Printing Office (see pp. 80, 81).
Community control of rickets.

An attempt is being made by the child-hygiene division of the
Children’s Bureau, in cooperation with the pediatric department
of Yale University School of Medicine and the New Haven De­
partment of Health, to demonstrate that rickets can be eradicated
from a community. The demonstration district selected consists
of three wards (population about 13,000) in New Haven, Conn.
At the close of the fiscal year under review, 21 months had been
devoted to this study (which was to be continued for another year).
Within this period 480 of the 568 infants bom in the demonstra­
tion district have been examined. Although certain of the cases
were closed because the families moved away, or were not coopera­
tive, or for other reasons, 352 cases were actively carried. A total
of 3,229 examinations have been made, and 3,069 X-ray examina­
tions. A partial analysis of the records kept on the group of in­
fants bom within the year ending August 15, 1924, indicates a
very mild degree of rickets in 96 per cent of these babies when
clinical and X-ray diagnoses, are both considered. On X-ray ex­
amination alone 89 per cent of the infants have shown a slight de­
gree of rickets; on clinical examination alone, 83 per cent. The
X-ray manifestations of rickets appeared in 90 per cent of the
children before 6 months of age, in 65 per cent before 4 months
of age, in 12 per cent before 2 months of age, and in 53 per cent
during the third and fourth months. Only 4.5 per cent of the
group who cooperated in every respect have shown more than this
exceedingly mild degree of rickets. Approximately 30 per cent,
however, of the control group (552 children living in the district


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t h e w elfare a n d h y g ie n e of m a t e r n it y a n d in f a n c y

and 213 infants living outside the district) have shown moderate or
marked rickets.
By the use of sunlight and cod-liver oil the mild form of rickets
can apparently be controlled and deformities prevented. Treat­
ment for its control must be begun before the second month of
life. Analysis of the X rays taken on the group of infants who
were given cod-liver oil and sun regularly shows that the same
degree of control of the disease had been obtained by this group
at 13 months of age as had been reached spontaneously by the con­
trol group at 25 months of age. Analysis of the clinical manifesta­
tions of rickets for these same two groups, however, shows not more
than 4 per cent with moderate deformities in the treated group in
contrast to 38 per cent with moderate or marked deformities in
the untreated group. If rickets does not develop beyond this first
degree it has no apparent effect on the infant’s general health.
Rickets is intimately associated with growth, and the appearance
of the rachitic process during the first four months of life (when
most active growth is taking place) is not extraordinary. The rate
of growth of the infant undoubtedly influences the time of appear­
ance of the disease, premature infants (who grow very rapidly) being
notoriously rachitic from the earliest month of life. Large rapidly
growing breast-fed infants almost uniformly show definite evidences
of rickets in the early months. The investigations show a slight
degree of early rickets to be well-nigh universal in climates of the
North Temperate Zone; and without the use of preventive measures
rickets will advance to a moderate or marked degree of severity
in approximately 30 per cent of the children, with resulting de­
formities and lowered resistance to infection.
An investigation of the normal growth and development of in­
fants from birth to 2 years is being made with the same group of
children. A correlation of physical growth with general health and
a study of the actual growth of bone as shown by the X-ray photo­
graphs will be included in the report.10
Rickets in children in the District of Columbia.

A study has been made for the Children’s Bureau of rickets in
the children in the District of Columbia. The report deals with
nutrition and X-ray studies, and with clinical findings. Some sta­
tistical data will be included.
Stillbirths and neonatal deaths.

An investigation of stillbirths and neonatal deaths was begun in
1923 (at the University of Minnesota) for the maternity and in­
fancy division of the Children’s Bureau. The examinations deal
with deaths which occurred at various times during gestation as well
as shortly after birth. I t appears from the study that the same
factors which cause death before birth are mainly responsible for
deaths occurring within the first few days of life. Toxemias of preg­
nancy, birth injuries, and infections are the main causes of neonatal
deaths, infection being conspicuous after the fourth day of life.
10

A p relim in a ry rep ort o f th e first 18 m o n th s’ w ork w a s p resen ted a t th e an n u al
m e e tin g o f th e A m erican M edical A sso c ia tio n an d pu b lish ed in th e jo u rn a l o f th is a sso ­
c ia tio n . R ep rin ts m ay be o b ta in ed from th e U . S. C hild ren’s B u reau (s e e p. 8 0 ) .


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Prematurity, alone or associated with other causes, is an especially
noticeable reason for neonatal deaths. I t is evident that better care
during the prenatal period, confinement, and after birth, is neces­
sary in order to diminish the deaths from such preventable causes.
Neonatal and maternal mortality in Tennessee in relation to the attendant at
birth.

At the request of the State department of health in Tennessee
the Children’s Bureau has made through its statistical division a
study of birth and death certificates in six counties of the State to
ascertain the infant and maternal mortality rates as affected by
the type of attendant at birth. “ Loss rates ” as well as neonatal
rates were obtained, since the stillbirth rate as well as the neonatal
and the maternal mortality rate may be influenced by the care a
mother receives before the birth of the child and at its birth. These
loss rates were computed on all reported stillbirths and deaths
under 1 month of age. For the six counties the total loss rate per
1,000 births was 77.2; for births attended by physicians the rate was
72.8; attended by midwives, 82.8 (by white midwives, 51.5; by negro
midwives, 106.5). Because the more incomplete registration of still­
births and miscarriages than of live births would necessarily influ­
ence the rate for all losses, the mortality rate for infants dying un­
der 1 month of age is probably more significant that the figures show­
ing total losses. The neonatal death rate for the birth-registration
area in 1922 was 39.7 per 1,000 live births. For the six counties
surveyed in Tennessee the rate was 38.5. For infants attended at
birth by physicians the rate was 34; for infants attended at birth
by midwives the rate was 48.7 (attended by white midwives, 35; by
negro mid wives, 60.1).
Infant and maternal morbidity and mortality in Idaho.

At the request of the Idaho Department of Public Welfare the
Children’s Bureau made, through its statistical division, an analysis
of State statistics for 1924 in order to test birth registration and to
measure the extent of infant and maternal mortality in Idaho. This
State has not yet been admitted to the birth-registration area, and it
was found that although there was excellent birth registration in
many counties, laxity in the enforcement of the registration law in
other counties gave the State as a whole a lower percentage of regis­
tration than that required for admission to the area. The infant
mortality rate as based on State statistics was 56, indicating that
Idaho may be accorded the same favorable position in 'regard to
infant mortality as that generally shown for States of the Pacific
Northwest. When maternal mortality was considered, however, the
position was found to be less advantageous, as high maternal losses
were shown for a number of the counties.
The effect of posture on physical fitness.

A study of the effect of posture training on the physical fitness of
preschool and school children has been conducted during the past
two years for the Children’s Bureau. Standards of excellent, good,
fair, and poor posture for different types of children were estab­
lished. The report will discuss the findings in detail and treat of
methods of teaching posture to children. Inasmuch as little scien-


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tific work has previously been done in this field, this work should
prove of immediate practical value.
Care for crippled children.

The Children’s Bureau has undertaken a survey of the provision
for crippled children, with especial attention to methods of locating
these children and to the nature and extent of preventive measures
in their behalf, in eight States representing different sections of the
country and including both rural and densely populated regions.
Examination will also be made of the laws for the benefit of crippled
children in these States and the method's of their administration;
the public provision for clinic, hospital, and convalescent care; and
noteworthy private institutions and agencies for crippled children.
Milk, the indispensable food for children.

A revision has been made of the Children’s Bureau publication
entitled “ Milk, the Indispensable Food for Children.” This points
out that milk is essential not only for the normal, healthy develop­
ment of infants but also for children of all ages, for pregnant and
nursing mothers, and for the sick. A table showing the vitamin
content of various forms of milk, compiled with the assistance of
physicians and dietitians who have given especial attention to milk,
has been added in connection with the revision, and the list of refer­
ences has been brought fully up to date.
Nursing-service demonstration in Utah.

At the request of the Utah State Board of Health, the Children’s
Bureau began a demonstration of a county maternity and infancy
nursing service in Piute, Garfield, and Kane Counties, in the southern
part of Utah, in March, 1925.11 The purpose was to show the value
of public-health work and the desirability of establishing permanent
health units. The program included mothers’ classes dealing with
prenatal care, postpartum care, care of infants and small children,
and the prevention of communicable disease; cooperation in the
child-health and prenatal conferences held under the State bureau
of child hygiene and home follow-up work in connection with them;
toxin-antitoxin clinics; the introduction of iodized salt for the pre­
vention of goiter; maintenance of a health center and rest room at
the local county fair. Emphasis was laid upon the need of fresh
fruits and vegetables in the daily diet, bringing about the raising
of larger and more diversified family truck gardens and in some
instances the canning of more extensive supplies for winter use.
Educational* work among midwives in New Mexico.

At the request of the New Mexico Board of Public Welfare the
Children’s Bureau gave assistance in the work of the bureau of public
health in New Mexico by means of an educational campaign among
midwives, beginning in February, 1925.12 The counties selected for
the organization of classes and for work to stimulate the more com­
plete registration of births were Dona Ana, Valencia, McKinley,
and Eddy. The population to be dealt with was very largely of
Mexican origin. The larger mining camps were selected as centers
11

T he d em o n stra tio n w a s concluded N ov. 15, 1925.
■“ T h is d em o n stra tio n co n tin u ed a fte r th e clo se o f th e fisca l y e a r un d er review .


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for classes, together with other villages or towns in which it was
possible to assemble the midwives. Some women walked or drove
many miles to attend classes, but it was also found necessary to give
much instruction to individual midwives in their own homes, or
occasionally even in the homes of their patients at the time of de­
livery. The county health officers cooperated especially in locating
the midwives, in explaining to them the State law regarding prac­
tice of midwifery, the midwives’ responsibility, the cooperation
expected from them, and the help obtainable from the State depart­
ment. Local physicians assisted by giving talks to the classes, as a
part of the course of instruction. Certificates were presented to
women who completed courses, and the county health officer planned
to exercise as much continuing supervision over these midwives as
would be possible.
Educational work among midwives in Tennessee anu Georgia.

The investigation and educational campaign among negro mid­
wives in which the negro physician on the staff of the Children’s
Bureau has cooperated with the Tennessee Department of Public
Health, undertaken the previous year, was continued. These mid­
wives were found to be more numerous than had been supposed.
In the first two counties in which work was undertaken, where
the negro population is proportionately less than in many others,
200 negro midwives were discovered to be practicing, although only
710 from the whole State had been registered with the bureau of
vital statistics. Classes were organized, and many individuals were
also visited and interviewed- A 12-page mimeographed syllabus
of instructions for midwives was prepared and given to each mid­
wife who could be reached with it. Similar work was also done
in Georgia in cooperation with the State board of health. Objec­
tives were the instilling of a willingness to comply with the law
and an understanding of its requirements, the eradication of
superstitious practices, emphasis upon cleanliness in connection with
deliveries, and instruction in proper methods of practice. The
Negro Medical Association of Georgia gave consideration to the
problem of the negro midwife and cooperated most sympathetically;
and assisted by holding prenatal clinics for the benefit of the mid­
wives’ patients.
Prenatal letters.

A series of prenatal letters was prepared for the use of State
bureaus which desire to have copies printed or mimeographed
with the addresses of the respective bureaus for distribution within
these States.
News-letters.

News-letters were sent a’t intervals to the State bureaus to convey
to them such items of interest as were received from time to time
at the Federal office. Foreign news was included, also mention
of recent publications, news from the State, bureaus, and personal
items of interest in regard to members of their staffs.
Publications.

A number of Children’s Bureau publications bear directly upon
the hygiene of mothers, infants, and preschool children. There


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

is a constant demand for the series of bulletins issued for mothers.
During the fiscal year under review 167,056 copies of Prenatal
Care were distributed, 235,618 copies of Infant Care, 145,682 copies
of Child Care, and 31,320 copies of Child Management (in the
last three months of the year) .13 These figures include distribution
in response to requests from individuals and organizations, as well
as from State bureaus. At no time during the year, however, has
the Children’s Bureau been able to meet the demands for its pub­
lications. The reduction in the size of editions (as compared with
those of 1923-24) and consequent curtailment of distribution, were
due to the great increase in cost of printing and to the fact that
the allotment to the Children’s Bureau for printing was only slight­
ly larger in 1925 than in previous years. (An increase of $7,500
in the bureau’s printing allotment for the year 1926 has been made
by Congress for the specific purpose of increasing the supply of
these popular bulletins.) A number of States have purchased
copies o f these bulletins directly from the Government Printing
Office, in addition to quotas supplied free; 14 and others have re­
printed them wholly or in part.
The bulletin entitled “A Study of Maternity Homes in Pennsyl­
vania and Minnesota” was completed during the fiscal year under
review and is now being printed.
Folders were distributed as follows: Minimum Standards of Pre­
natal Care (revised), 29,397 copies; Why Drink Milk? 33,641 copies.
Dodgers were distributed as follows: Books and Pamphlets on
Child Care, 18,702 copies; Is Your Child’s Birth Recorded, 27,833
copies; Breast Feeding, 28,642 copies; Bottle Feeding, 54,604 copies;
Feeding the Child, 41,447 copies; The Care of the Baby, 45,202
copies; What Do Growing Children Need? 69,437 copies.
For a more detailed list of these publications and other bulletins,
charts, and reprints issued by the Children’s Bureau see Appendix
D, pages 80-81.
Motion pictures, lantern slides, and exhibit material.15

The Children’s Bureau has produced three films which may be
borrowed or purchased, and two sets of slides which may be bor­
rowed on the same terms as its films. These are being widely used
not only by the State bureaus administering the maternity and
infancy act but by medical societies, nursing organizations, and
organizations of other than professional character, also to some
extent by State universities.
13

M arch, 1 9 25, w a s th e d a te o f issu a n c e o f C hild M anagem ent. S in ce th is b u lle tin pre­
s e n ts in sim p le fo rm th e la t e s t s c ie n tific in fo rm a tio n o n th e tr e a tm e n t o f fe e d in g prob­
lem s, je a lo u sy , fea r, anger, a nd h a b it fo rm a tio n in g en eral, i t hag been m uch in dem and.
F o r in sta n c e , a com m end atory e d ito r ia l in one le a d in g m e tr o p o lita n d a ily brou gh t over
1,0 0 0 in d iv id u a l req u ests fo r th e b u lletin from both p a r e n ts and ed u cators. Over 4 5 0
req u ests h a v e been receiv ed fo r an a rra n g em en t o f m a ter ia l from th e b u lle tin prepared fo r
u se a s a sy n d ic a te series by n ew sp a p ers. A d d itio n a l se c tio n s on disobedience, ly in g , and
s te a lin g h a v e been in co rp o ra ted in th e second ed itio n .
u In 1 924 th e s a le s o f th e s e b u lle tin s a t th e G overnm ent P r in tin g Office w e r e a s f o l­
l o w s : P r e n a ta l Care, 2 6 ,4 6 6 ; I n fa n t C are, 8 8 ,7 1 9 ; C hild Care, 3 7 ,000. In 1925 th e sa le s
w ere e stim a te d by th e S u p erin ten d en t o f D o cu m en ts a s f o ll o w s : P r e n a ta l C are, 4 0 ,0 0 0 ;
I n fa n t C are, 1 0 0 ,0 0 0 ; C hild Care, 5 0 ,0 0 0 ; C hild M anagem ent, 8 ,0 0 0 (a fte r M a rc h ).
D e ta ile d d escrip tio n o f film s, slid e s, an d e x h ib it m a ter ia l and o f co n d itio n s an d pro­
ced ure fo r borrow in g a n d p u rch a se c a n b e had o n a p p lic a tio n to th e C h ild ren ’s B ureau .

18


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

71

“ Our Children” is a two-reel film showing the efforts of a com­
munity to make itself safe for babies. A representation of a childhealth conference is incorporated in the story. “ Well B orn” is a
two-reel film presenting simply and convincingly the essentials of
prenatal care, woven into sufficient narrative material ta hold the
interest of a popular audience. (These films may be purchased
with Spanish titles, and one print of each film with the Spanish
titles is also available for loan.) “ Posture” is a two-reel film suit­
able for physicians, physical-education teachers, athletic directors,
-and recreation leaders, and also for general audiences. Either reel
may be used alone, the first being a general introduction especially
suitable for parents and children. One set of 50 slides shows the
care of the baby. The other set (54 slides) deals with infant and
child welfare.
The Children’s Bureau is producing a series of film slides for use
in automatic and hand film projectors. The negatives of these films
are deposited with the producers, and prints are for sale by them
(details may be learned on application to the Children’s Bureau).
The film slide entitled “ Trails that Lead to Mothers and Babies”
illustrates the work done under the maternity and infancy act. “ The
Healthy Baby ” shows the essentials of good care for the baby from
birth to the age of 2 years. “ Rickets” shows the effects of this
disease and how it is prevented and cured.
The Children’s Bureau has a number of posters, wall maps, and
series of panels for loan, and two sets of posters for free distribu­
tion. The titles of some series of posters especially Suitable for use
in connection with maternity and infant or preschool hygiene and
welfare work are as follows: Food for the Growing Child, Infant
Welfare, the Food Composition and Caloric Value of Different
Articles of Food, Maternal and Infant, Mortality Charts.
A model of a prenatal and child-health center, and a model nur­
sery have been prepared during the fiscal year under review and
have already been widely used.
For further details see ]3age 81 of report.


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APPENDIXES
APPENDIX A.—TEXT OF THE ACT FOR THE PROMOTION OF THE
WELFARE AND HYGIENE OF MATERNITY AND INFANCY
[S. 1039—Sheppard-Towner Act; Public 97—67th Congress; 42 Stat. 135]
A n A ct F o r tn e p rom otion o f th e w elfa re and h y g ien e o f m a ter n ity an d in fa n c y , and for
o th er pu rp oses

Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled, That there is hereby authorized to
be appropriated annually, out of any money in the Treasury not otherwise
appropriated, the sums specified in section 2 of this Act, to be paid to the
several States for the purpose of cooperating with them in promoting the wel­
fare and hygiene of maternity and infancy as hereinafter provided.
S ec. 2. For the purpose of carrying out the provisions of this Act, there is
authorized to be appropriated, out of any moneys in the Treasury not other­
wise appropriated, for the current fiscal year $480,000, to be equally appor­
tioned among the several States,, and for each subsequent year, for the period
of five years, $240,000, to be equally apportioned among the several States in
the manner hereinafter provided : Provided, That there is hereby authorized
to be appropriated for the use of the States, subject to the provisions of this
Act, for the fiscal year ending June 30, 1922, an additional sum of $1,000,000,
and annually thereafter, for the period of .five years, an additional sum not to
exceed $1,000,000 : Provided further, That the additional appropriations herein
authorized shall be apportioned $5,000 to each State and the balance among the
States in the proportion which their population bears to the total population
of the States of the United States, according to the last preceding United States
census; And provided further, That no payment out of the additional appro­
priation herein authorized shall be made in any year to any State until an
equal sum has been appropriated for that year by the legislature of such State
for the maintenance of the services and facilities provided for in this Act.
So much of the amount apportioned to any State for any fiscal year as re­
mains unpaid to such State at the close thereof shall be available for expendi­
tures in that State until the close of the succeeding fiscal year.
S eo. 3. There is hereby created a Board of Maternity and Infant Hygiene,
which shall consist of the Chief of the Children’s Bureau, the Surgeon General
of the United States Public Health Service, and the United States Commis­
sioner of Education, and which is hereafter designated in this Act as the
Board. The Board shall elect its own chairman and perform the duties pro­
vided for in this Act.
The Children’s Bureau of the Department of Labor shall be charged with
the administration of this Act, except as herein otherwise provided, and the
Chief of the Children’s Bureau shall be the executive officer. It shall be the
duty of the Children’s Bureau to make or cause to be made such studies,
investigations, and reports as will promote the efficient administration of
this Act.
S ec . 4. In order to secure the benefits of the appropriations authorized in
section 2 of this Act, any State shall, through the legislative authority thereof,
accept the provisions of this Act and designate or authorize the creation of a
State agency with which the Children’s Bureau shall have all necessary powers
to cooperate as herein provided in the administration of the provisions of this
Act : Provided, That in any State having a child-welfare or child-hygiene divi­
sion in its State agency of health, the said State agency of health shall admin­
ister the provisions of this Act through such divisions. If the legislature of
any State has not made provision for accepting the provisions of this Act the

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

governor of such State may in so far as he is authorized to do so by the laws
of such State accept the provisions of this Act and designate or create a State
agency to cooperate with the Children’s Bureau until six months after thé
adjournment of the first regular session of the legislature in such State follow­
ing the passage of this Act.
S ec . 5. So much, not to exceed 5 per centum, of the additional appropriations
authorized for any fiscal year under section 2 of this Act, as the Children’s
Bureau may estimate to be necessary for administering the provisions of this
Act, as herein provided, shall be deducted for that purpose, to be available
until expended.
S ec. 6. Out of the amounts authorized under section 5 of this Act the Chil­
dren’s Bureau is authorized to employ such assistants, clerks, and other per­
sons in the District of Columbia and elsewhere, to be taken from the eligible
lists of the Civil Service Commission, and to purchase such supplies, material,
equipment, office fixtures, and apparatus, and to incur such travel and other
expenses as it may deem necessary for carrying out the purposes of this Act.
S ec . 7. Within sixty days after any appropriation authorized by this Act has
been made, the Children’s Bureau shall make the apportionment herein pro­
vided for and shall certify to the Secretary of the Treasury the amount esti­
mated by the bureau to be necessary for administering the provisions of this
Act, and shall certify to the Secretary of the Treasury and to the treasurers of
the various States the amount which has been apportioned to each State for
the fiscal year for which such appropriation has been made.
S ec . 8. Any State desiring to receive the benefits of this Act shall, by its
agency described in section 4, submit to the Children’s Bureau detailed plans
for carrying out the provisions of this Act within such State, which plans
shall be subject to the approval of the board : ProvidedX, That the plans of the
States under this Act shall provide that no official, or agent, or representative
in carrying out the provisions of this Act shall enter any home or take charge
of any child over the objection of the parents, or either of them, or the person
standing in loco parentis or having custody of such child. If these plans shall
be in conformity with the provisions of this Act and reasonably appropriate
and adequate to carry out its purposes they shall be approved by the board
and due notice of such approval shall be sent to the State agency by the chief
of the Children’s Bureau.
S e c . 9. No official, agent, or representative of the Children’s Bureau shall
by virtue of this Act have any right to enter any home over the objection of the
owner thereof, or to take charge of any child over the objection of the parents,
or either of them, or of the person standing in loco parentis or having custody
of such child. Nothing in this Act shall be construed as limiting the power
of a parent or guardian or person standing in loco parentis to determine what
treatment or correction shall be provided for a child or the agency or agencies
to be employed for such purpose.
S ec. 10. Within sixty days after any appropriation authorized by this Act
has been made, and as often thereafter while such appropriation remains un­
expended as changed conditions may warrant, the Children’s Bureau shall
ascertain the amounts that have been appropriated by the legislatures of the
several States accepting the provisions of this Act and shall certify to the
Secretary of the Treasury the amount to which each State is entitled under
the provisions of this Act. Such certificate shall state (1) that the State has*
through its legislative authority, accepted the provisions of this Act and des­
ignated or authorized the creation of an agency to cooperate with the Chil­
dren’s Bureau, or that the State has otherwise accepted this Act, as provided
in section 4 hereof ; (2) the fact that the proper agency of the State has sub­
mitted to the Children’s Bureau detailed plans for carrying out the provisions
of this Act, and that such plans have been approved by the board; (3) the
amount, if any, that has been appropriated by the legislature of the State for
the maintenance of the services and facilities of this Act, as provided in sec­
tion 2 hereof ; and (4) the amount to which the State is entitled under the pro­
visions of this Act. Such certificate, when in conformity with the provisions
hereof, shall, until revoked as provided in section 12 hereof, be sufficient
authority to the Secretary of the Treasury to make payment to the State
in accordance therewith.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

75

S ec. 11. Each State agency cooperating with the Children’s Bureau under
this Act shall make such reports concerning its operations and expenditures
as shall be prescribed or requested by the bureau. The Children’s Bureau
may, with the approval of the board, and shall, upon request of a majority of
the board, withhold any further certificate provided for in section 10 hereof
whenever it shall be determined as to any State that the agency thereof has
not properly expended the money paid to it or the moneys herein required to.
be appropriated by such State for the purposes and in accordance with the
provisions of this Act. Such certificate may be withheld until such time or
upon such conditions as the Children’s Bureau, with the approval of the board,
may determine ; when so withheld the State agency may appeal to the Presi­
dent of the United Stafts who may either affirm or reverse the action of the
Bureau with such directions as he shall consider proper: Provided, That
before any such certificate shall be withheld from any State, the chairman of
the board shall give notiee in writing to the authority designated to represent
the State, stating specifically wherein said State has failed to comply with
the provisions of this Act.
S ec. 12. No portion of any moneys apportioned under this Act for the benefit
of the States shall be applied, directly or indirectly, to the purchase, erection,
preservation, or repair of any building or buildings or equipment, or for the
purchase or rental of any buildings or lands, nor shall any such moneys or
moneys required to be appropriated by any State for the purposes and in ac­
cordance with the provisions of this Act be used for the payment of any
maternity or infancy pension, stipend, or gratuity.
S ec. 13. The Children’s Bureau shall perform the duties assigned to it by
this Act under.the supervision of the Secretary of Labor, and he shall include
in his annual report to Congress a full .account of the administration of this
Act and expenditures of the moneys herein authorized.
S ec. 14. This Act shall be construed as intending to secure to the various
States control of the administration of this Act within their respective States,
subject only to the provisions and purposes of this Act.
Approved, November 23, 1921.
86304 —26----- 6


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APPENDIX B.—LIST OF ADMINISTRATIVE AGENCIES AND OFFICERS
State administrative agencies and names of the executive officers for the
administration of the act for the promotion of the welfare and hygiene of
maternity and infancy (as of June 30, 1925)
m
Department and executive officer

State
Alabama.
Arizona.
Arkansas___
California___
Colorado____
C onnecticut

1

Delaware----Florida_____
Georgia.
H aw aii..
Id a h o ...
Illinois i.
Indiana_________
Iowa____________

1

K ansas _________
Kentucky_______
L ouisiana^____ _

1

M a in e _________
M aryland................
Massachusetts ! . . .
M ieh igan ................
M innesota........ .....
M ississippi.............
M issouri........ .........
M ontana........... .
Nebraska________
N e v ad a ...............
N ew Hampshire. .
N ew J e rse y ..........
N ew M exico2.

Division and director

State board of health, Dr. S.W . W elch_ Bureau of child hygiene and public-health
nursing, Jessie L.M arriner, R . N .
State board of health, Dr. F . T . Fahlen.. Child-hygiene division, M rs. Charles R .
Howe.
State board of'health, Dr. C. W . Garri­ Bureau of child hygiene, Dr. Margaret
Koenig, associate director.
son.
State board of health, Dr. Walter M . Bureau of child hygiene, Dr. Ellen S.
Stadtmuller.
Dickie, secretary.
Department of public instruction, Mrs. Child-welfare bureau,Mrs. E . N . M athews,
executive secretary.
Mary C. C. Bradford, superintendent.
Department of health, Dr. Stanley H . Bureau of child hygiene, Dr. A . E . Ingra­
ham.
Osborne.
State board of health, Dr. Arthur T. Marie T . Lockwood, R . N ., supervisor of
nurses.
D avis, executive secretary.
State board of health, Dr. R . C. Turck— Bureau of child welfare and public-health
nursing, Laurie Jean Reid, R . N .
State board of health, Dr. T . F . Aber­ D ivision of child hygiene, Dr. Joe P. Bowdoin.
crombie.
Board of health, Dr. F . E . Trotter,
president.
Department of public welfare, D avid Bureau of child hygiene, Dr. F . W .
Almond.
Burrell.
Department of public health, Dr. Isaac D ivision of child hygiene and publichealth nursing, Dr. R . C. Cook, acting
D . Rawlings, director.
director.
State board of health, Dr. William F. D ivision of infant and child hygiene, Dr.
Ada E . Schweitzer.
King.
State University of Iowa, Dr. Walter A. D ivision of maternity and infant hygiene,
Edward H . Lauer, Ph. D .
Jessup, president.
State board of health, Dr. M ilton O. D ivision of child hygiene, Lillian Fitz­
patrick, R . N .
Nyberg, secretary.
State board of health, Dr. A . T.M cC or­ Bureau of maternal and child, health, Dr.
Annie S. Veech.
mack.
State board of health, Dr. Oscar Dowling, Bureau of child hygiene, AgnesMorris.
president.
Department of health, Dr. C. F. Ken­ Division of public-health nursing and child
hygiene, E dith Soule, R . N .
dall, commissioner.
Department of health, Dr. John S. F ul­ Bureau of child hygiene, Dr. J. H . Mason
Knox, jr., chief.
ton, director of health.
Department of public health, Dr. Eugene Division of hygiene, Dr. Merrill E . Cham­
pion.
R . K elley, commissioner.
Department of health, Dr. Richard M . Bureau of child hygiene and public-health
nursing, Dr. Blanche M . Haines.
Olin, commissioner.
State Department of health, Dr. A. J. D ivision of child hygiene, Dr. R uth E.
Boynton.
Chesley.
State board of health, D n F. J. Under­ Bureau of child hygiene and public-health
nursing,M ary D . Osborne, R . N ., super­
wood.
vising nurse.
•
State board of health, Dr. James Stewart, Division of child hygiene, Dr. Irl Brown
Krause.
secretary.
State board of health, Dr. W . F. Cogs­ D ivision of child welfare, Dr. Frances Sage
Bradley, acting director.
well.
Department of public welfare, Judge Division of child hygiene, M rs. C. H .
England.
Lincoln Frost.
State board of health, Dr. S. L. Lee, Child-welfare division,M rs. S. H . Wheeler,
executive secretary.
State board of health, Dr. Charles D un­ D ivision of maternity, infancy, and child
hygiene, E lenaM . Crough, R . N .
can.
Department of health, Dr. H . B. C ostill. Bureau of child hygiene, Dr. Julius Levy,
consultant.
Board of public welfare, Mrs. Francis C. Bureau of public health, Dr. G. S. Luckett;
division of child hygiene and publicWilson, president.
health nursing, Dorothy R . Anderson,
R. N.; bureau of child welfare, Margaret
Reeves.

l These States were not cooperating.

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3See footnote 4, p. 19.

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

State
N ew York_______
North Carolina__
North D akota.— .
Ohio____________
Oklahoma_______
Oregon__________
Pennsylvania____
Rhode Island.........
South C arolina....
South Dakota........
Tennessee_______
Texas___________
Utah.................
V e r m o n t...._____
V irginia.._______
Washington_____¡'j
West Virginia____
Wisconsin_______
Wyoming_______

Department and executive officer

77

Division and director

Department of health, Dr. M . Nicoll, D ivision of maternity, infancy, and child
commissioner of health.
hygiene, Dr. Florence L. M cKay.
State board of health, Dr. W. S. Rankin. Bureau of m aternity and infancy, Dr.
H. A . Taylor.
Department of public health, Dr. A. A. Division of child hygiene and public-health
Whittemore.
nursing, Dr. M aysil M . Williams.
Department of health, Dr. J. E. Monger. D ivision of hygiene, Dr. R . G. Leland,
chief.
Department of health, Dr. Carl Puckett, Bureau of maternity and infancy, Dr.
commissioner of health.
Lucile S. Blachly.
State board of health, Dr. Frederick D . Bureau of child hygiene, Glendora M .
Strieker.
Blakely, R . N ., assistant director.
Department of health, Dr. Charles H. Bureau of child health, Dr. J. B . McCreary;
Miner.
preschool division, Dr. M ary Riggs
Noble, chief.
State board of health, Dr. B. U . Rich­ Division of child welfare, Dr. Marion A .
ards, secretary.
Gleason.
State board of health, Dr. James A. Bureau of child hygiene and public-health
Hayne, State health officer.
nursing, Ada Taylor Graham, R . N .
State board of health, Dr. P. B. Jenkins, D ivision of child hygiene, Dr. Clara E .
superintendent.
Hayes.
Department of public health, Dr. E. L. D ivision of maternal and infant hygiene.
Bishop, commissioner of health.
Dr. E. A. Lane, superintendent.
State board of health, Dr. H . O. Sap- Bureau of child hygiene, Dr. H. N . Barnett.
pington.
State board of health, Dr. T. B . Beatty, Bureau of child hygiene, Dr. H . Y . Rich­
State health commissioner.
ards.
Department of public health, Dr.
Charles F . D alton, secretary.
State board of health, Dr. E. G. Williams. Bureau of child welfare, Dr. Mary E .
Brydon.
Department of health, Dr. Paul A. Division of child hygiene, Dr. George
Turner.
Mohr.
Department of health, Dr. W . T. Hen- Division of child hygiene and public-health
shaw.
nursing, Mrs. Jean T . Dillon, R. N .
State board of health, Dr. C. A . Harper.. Bureau of child welfare and public-health
nursing, Mrs. Mary P. Morgan, R . N .
Department of public health, Dr. G. M . D ivision of maternal and infant welfare and
Anderson.
child hygiene, Louise Buford, R . N .


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

APPENDIX C.—MATERNAL AND INFANT MORTALITY RATES
T able

I.—Trend of maternal mortality in the United States ’birth-registration
area, by States, 1915—19241
Maternal mortality rates in the birth-registration area in—
State
1915

Area_____ _____________
Connecticut______ ___________

6.1
5.6

1916

6.2
4.9

M a in e.____ _________________

6.8

M assachusetts...............................
M ichigan____________________
M innesota____ ______________

5.7
6.7
5.2

5.5

N ew Hampshire_____________

6.1

7.2

N ew York___________________

5.9

5.4

Pennsylvania________________
Rhode Islan d ._______________

6.4

6.6

7.0
5.8

6.1

7.8

Vermont..........................................

District of Columbia...................

7.0

1Source: U . S. Bureau of the Census.


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7.8
6.4

6.0
6.8

10.1

1917

1918

1919

1920

1921
•

9.2

7.4

8.0
7.7

5.1

7.5

8.0
6.2

6.8

7.2

10.4

8.4

8.7

6.9

7.6

11.4

8.4
6.4
8.5
7.6
7.5
9.3
7.9

6.4
6.3
7.4
6.7
6.5
6.9
5.7
9.5

6.6

6.0
6.8
6.7

6.5
7.4
5.6

8.0
8.6
9.5
9.2

8.6
7.8

8.2
6.3
8.6
8.4
7.1
7.7
6.7

6.8
6.8

5.3
6.3 .

7. Í
6.6
8.0 7.1 o. 2
5.9
5.7
8.0 6.2 6.9 6.3
8.2 10.8 9.3 10.0 7.3
7.4
7.1
9.7
8.0 7.2
10.1 9.4 7.4
10.5
6.8 7.8 6.8
6.5
7.1
6.3
9.8
(2)
(*)
12
.2 9.8
11.2
5.9
8.6 8.4 7.9 7.3
6.3
8.0 8.0 7.0 7.3
8.2 10.7 8.2 8.6 7.0
7.4
9.9
8.6 9.2 7.8
5.7
6.0 4.8 6.7 5.8
9.1
8.5
8.8 10.1
8.5
7.0

7.8

’ J Dropped from the birth-registration area.

1922

1923

1924

6.6

6.7

6.6

7.2
5.7

6.7
5.7
8.4

5.9
5.7
7.7

6.3

6.4
6.5

6.6
6.6
7.6

6.1
7.6
5.9

6.8

6.9
4.9
8.3
7.9
5.8
6.5
6.4

6.0
8.0
6.6
8.3
6.2

5.5
10.7
5.5
7.4
7.2
7.9
5.6
7.1
7.1

12.1
6.2
5.8
6.0
6.8 6.3
6.0 6.2
8.7
8.2
6.0 6.6
6.5
6.5
5.0
9.5

6.3
7.0

6.0
8.8

6.6
6.1
6.2

7.5
5.8
7.4
5.7
5.7

6.3

5.9
7.7
5.7
6.4
6.5
6.3
6.3

8.0
7.2
6.9

6.6
6.3
9.7
5.0
7.0
7.4
6.7
5.8
7.3

10.8
4.5
8.1
6.5
7.1

6.0
9.8
10.1 12.2
J

79

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
T able

II.—Trend of infant mortality in the United States birth-registration
area, by States, 1915-1924 1
In fan t m o rtality rates in th e birth-registration area in—
1915

Area___________________
C alifornia..._________________
Connecticut______________ _
D elaw are............ .....................
Florida................................. ...........
Illinois_____________ _________
Indiana____________ _________
Iowa...................................'...........
Kansas........... ........................... .
Kentucky.......................................
M aine.__________ ___________
M aryland___________________
M assachusetts..............................
M ichigan_____ ______________
M innesota___ _____ ________ •_
M ississippi............................ .........
M ontana____ _____________. . .
Nebraska____________________
N ew Hampshire______ _______
N ew Jersey....................................
N ew York___________________
North Carolina____ __________
North D akota_______________
Ohio_________ ____ __________
Oregon...........................................
Pennsylvania.................. ............
Rhode Island________________
South C arolina.................. .........
U tah___________ ____________
Vermont____________________
Virginia____________ _______ _
W ashington..................... .........
Wisconsin___________________
Wyoming___________________
District of Colum bia................

100 101
101

107

\
105

108

1917
94

1918

101

1919

86

70

71

73
98

100

73
77
104

76
67

82
. 71

65
69

67
69
95
82
71
65
55
59
65
81

87

79

82

71

77
87
93

80
93

70
82
91
105

73
73

63

101

102

90
67

104
91
92

66

94
76
79
59

94
81
75
58

63
72
89
95
78
80
62

88
86

59
87
74
75
75'

70
57
80
79
77
80

71
57
93
72
72
81

83
62
97

51

72
58

75
57
90
94
96
59
76
84

110

113

93

99

94

91

97

84
84

111

88

64

100 102
92

106

77

71
77

86

115

111

76

86

110

93

76

66

1923

107

67

85

1922

94

121 120
100 98
96
88

110 114
120 111

1921

74
92

70

70

1920

87

140
113
89
71

101
86

1 Source: U . S. B ureau of th e Census.


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1916

94

108

129
126

69
85
98
69
78

64
93
103
69
79

97

112

90
63

100

88

68

88

(2)
113
71
85
91
63
80

0116

66

55

85

91

83

71
96
84

77

93
96
73
78

72

2 D ropped from th e birth-registration area.

86

68

88

85
93
69
73
77
62
71
79
85

68

57

70
80
92

1924

86
68

72
57
71
67
55
80
70
69
82
67
67
54
79
80

102
64
70
78
56
65
64
76

80

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

APPENDIX D.—PUBLICATIONS OF THE CHILDREN’S BUREAU (AND
REPRINTS) BEARING UPON MATERNAL, INFANT, AND CHILD
WELFARE AND HYGIENE
BULLETINS

The Promotion of the Welfare and Hygiene of Maternity and Infancy—Report
of the administration of the act of Congress of November 23, 1921, for
the period March 20, 1922, to June 30, 1923. No. 137. 42 pp.
The Promotion of the Welfare and Hygiene of Maternity and Infancy—Report
of the administration of the act of Congress of November 23, 1921, for fiscal
year ended June 30, 1924. No. 146. 56 pp.
Prenatal Care, by Mrs. Max West. No. 4. 41 pp.
Infant Care (revised). No. 8. 118 pp.
Child Care—The Preschool Age, by Mrs. Max West. No. 30. 82 pp.
Child Management, by D; A. Thom, M. D. No. 143. 24 pp.
Habit Clinics for the Child of Preschool A ge; their organization and practical
value, by D. A. Thom, M. D. No. 135. 71 pp.
Standards of Prenatal Care; an outline for the use of physicians. No. 153.
4 pp. (also sample form for pregnancy record.)
Standards for Physicians Conducting Conferences at Child-Health Centers.
No. 154. 11 pp. (also sample forms for conference record.)
Nutrition Work for Preschool Children, by Agnes K. Hanna. No. 138. 25 pp.
The Nutrition and Care of Children in a Mountain County of Kentucky, by
Lydia Roberts. No. 110. 41 pp.
Physical Status of Preschool Children, Gary, Indiana, by Anna E. Rude, M. D.
No. 111. 84 pp.
Children of Preschool Age in Gary, Indiana.—Part I, General Conditions Affect­
ing Child Welfare, by Elizabeth Hughes; Part II, Diet of the Children,
by Lydia Roberts. No. 122. 175 pp.
Causal Factors in Infant Mortality; a statistical study based on investigations
in eight cities, by Robert Morse Woodbury, Ph. D. A consolidated report of
the Children’s Bureau studies in this field. No. 142. 245 pp.
Maternal Mortality; the risk of death in childbirth and from all diseases caused
by pregnancy and confinement, by Robert Morse Woodbury, Ph. D. No. 158.
163 pp.
A Tabular Summary of State Laws Relating to Public Aid to Children in Their
Own Homes in Effect January 1, 1925, and the text of the laws of certain
States. Revised Edition. Chart No. 3. 37 pp.
REPRINTS

The Control of Rickets; a preliminary discussion of the demonstration in New
Haven, by Martha M. Eliot, M. D. (Reprinted from the Journal of the
American Medical Association, Aug. 29, 1925, vol. 85, pp. 656-661.) 19 pp.
Causes and Prevention of Antenatal, Intranatal, Postnatal, and Neonatal
Deaths,'by Fred L. Adair, M. D., and William A. O’Brien, M. D. (Reprinted
from Transactions of the Second Annual Meeting, American Child Health
. Association, October, 1924.) 10 pp.
Decline in Infant Mortality in the United States Birth-Registration Area,
1915 to 1921, by Robert Morse Woodbury, Ph. D. (Reprinted from the
American Journal of Public Health, May, 1923.) 7 pp.
Economic Factors in Infant Mortality, by Robert Morse Woodbury, Ph. D.
(Reprinted from the Quarterly Publication of the American Statistical Asso­
ciation, June, 1924.) 19 pp.
Federal Aid for the Protection of Maternity and Infancy, by Grace Abbott.
(Revised reprint from the American Journal of Public Health, September,
1924.) 8 pp.
Posture Standards; a survey on the relationship of posture to physical fit­
ness, by Armin Klein, M. D., and Leah C. Thomas. (Reprinted from the
Child Health Magazine, November, 1924.) 4 pp.
The Midwife Problem in the United States, by Anna E. Rude, M. D. (Re­
printed from The Journal of the American Medical Association, Sept. 22,
1923, vol. 81, pp. 987-992.) 15 pp.
The Trend of Maternal Mortality Rates in the United States Death-Registra­
tion Area, 1906-1921, by Robert Morse Woodbury, Ph. D. (Reprinted from
the American Journal of Public Health, September, 1924.) 7 pp.


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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

81

Westergaard’s Method of Expected Deaths as Applied to the Study of Infant
Mortality, by Robert Morse Woodbury, Ph. D. (Reprinted from the Quar­
terly Publication of the American Statistical Association, September, 1922.)
12 pp.
CHARTS

Deaths Under 1 Year of Age, by Cause of Death.
Deaths Under 1 Year of Age, by Monthly Age Groups.
Decline in Infant Mortality, from Selected Causes, 1915-1921.
Decrease in Summer Deaths, 1915-1920; deaths under 2 years of age from
diarrhea and enteritis.
Infant-Mortality Thermometer; deaths under 1 year of age per 1,000 live
births.
Maternal-Mortality Thermometer; deaths from puerperal causes per 1,000 live
births.
Relative Mortality among Artificially and Breast Fed Infants; deaths among
artificially-fed infants compared with number expected at mortality rates
prevailing among breast-fed infants.
Summer Peak of Infant Deaths; deaths under 2 years of age from diarrhea
and enteritis.
DODGERS

Books and Pamphlets on Child Care. No. 1.
Is Your Child’s Birth Recorded? (Revised).
Bottle Feeding. No. 5.
Feeding the Child. No. 8.
The Care of the Baby (revised). No. 9.
What Do Growing Children Need? No. 10.

No. 3.

FOLDERS

Minimum Standards of Prenatal Care (revised). No. 1.
Why Drink Milk? No. 3.
What Builds Babies? No. 4.
Sunlight for Babies. No. 5.
BLANK FORMS

Pregnancy Record.
Infant and Preschool Conference Record.

o


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