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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, 1927
Bureau Publication No. 186
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON
1928
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SINGLE COPIES OP THIS PUBLICATION MAT BE
OBTAINED UPON APPLICATION TO THE CHIL
DREN’ S BUREAU.
ADDITIONAL COPIES MAT BE
PROCURED FROM THE
DOCUMENTS,
U.
S.
SUPERINTENDENT
GOVERNMENT
OFFICE, WASHINGTON, D. C.
AT
25 C E N T S P E R C O P Y
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OF
PRINTING
CONTENTS
Letter of transmittal__________________________________________________________
Extension of the authorized appropriation for maternal and infant hygiene.
Funds available and accepted by the States_________________________ _______
Summary of State activities during 1927____________________________________
Types of work_____________________________________________________________
Personnel of the administrative staffs___________________________________
Conferences_______________________________________________________________
Permanent prenatal and child-health centers___________________________
Correction of defects_____________________________________________________
County health units______________________________________________________
Hom e visits_______ ________________________________________________________
Community and group demonstrations_________________________________
Nutrition work____________________________________________________________
Promotion of breast feeding_______________________
Prenatal care__________________________________________________
Care during and after confinement______________________________________
Midwives_________________________________________________________________ 1
Inspection of maternity and infant homes______________________________
Classes for adults in infant and prenatal care__________________________
Classes for girls in infant care ("little mothers’ classes” ) ______ jj_____
Instruction of special groups in maternal and infant care_____________
Talks and lectures__________________________________ _______________1$_____
Correspondence courses and prenatal letters___________________________
Distribution of literature_________________________________________________
Extension of the United States birth and death registration areas. _
Surveys and campaigns__________________________________________________
Organizations cooperating in maternity and infancy work____________
Some results of five years of work under the maternity and infancy a c t. _
Expansion of activities___ ________________________________________________
Increase in public knowledge of infant and maternal care_____________
Establishment of child-hygiene bureaus or divisions___________________
Increase in State appropriations for child-hygiene work_______________
Extension of the birth and death registration areas____ :______________
Reduction in infant mortality___________________________________________
Reduction in maternal m ortality________________________________________
Care at childbirth_________________________________________________________
Improvement in the care and hygiene of infants_______________________
Improvement in personnel_______________________________________________
Principal activities o f the individual States__________________________________
Alabama________________________________ ________ _________________ _ _ _ _ _ _
Arizona____________________________________________________________________
Arkansas__________________________________________ t ______________________
California__________________________________________________________________
Colorado________________________
Delaware___________________
Florida_____________________________________________________________________
Georgia___________________
Hawaii_____________________________________________________________________
Idaho_____________________________________
Indiana____________________________________________________________________
Iow a------------------------------------------------------------------------------------------------------------K ansas________________________
Kentucky___________________________________
Louisiana____ _____________________________________________________________
Maryland_________________________________________________________________
Michigan____________________________________________________________
Minnesota_______ _________________________________________________________
Mississippi_________________________________________________________________
Missouri_____________________________
M ontana_________________________________________________________________ _
Nebraska__________________________________
N evada____________________________________________________________________
New Hampshire______________________________________________
m
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Page
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IV
CONTENTS
Principal activities of the individual States— Continued.
New Jersey___________________________________________ ____________________
New M exico______________________________________________________________
New York------------------- --------------------- -— -------- ------- _ _ _ _ _ _ _ _ _ ------- 1--------North Carolina---------------------------- -------------------------------------------- {---------------North D akota-------------------------------------- ------------------ ------------ _ _ _ _ _ _ _ —
Ohio____________________ ____________ _ _ _ _ _ ------------------------------- -------------- Oklahoma______________ - - ____________ — —
------------------------------- - - —
Oregon__________________________
--Pennsylvania---------------------------------------------------------------------------------------- ----Rhode Island______________________________________ _____________ _________
South Carolina_ _ _ -------------- -------------------------------------------------------------------South D akota--------------------------------------------------------------------------------- if--------Tennessee_____________________________________________ _______________ _____
Texas_____________________________________ __________ _______________________
U tah____________ — --------------- ---------- 1 --------- — --------------------------------------Vermont----------------------Virginia___________________________________________ g-------------------- --------------Washington----------------------------------------- ------------------- ------------ ------------- If—
W est Virginia----------------------------------- -------------- ------------------- ----------------------Wisconsin------------------------------------------------------------------- ------------------- -------- W yom ing________________________________ - 1------- - - >-f - - - r -----------------Federal administration--------------------------------- ----------- >------------------------— ----------Federal staff------------------- ---------------------------------------------------- ----------------------Conference of State directors----- ------------- -------------- ---------------- ---------- - Birth registration------- ---------------------r*
Special assistance to S ta te s.--------------------------- --------------------------------------Field surveys and studies--------------- - — ---------------------- --------------------------Research and publications----------------- ------------------------------ ------------------------
P a ge
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Appen ^es.^ ^
^
f or the promotion of the welfare and hygiene of
maternity and infancy, and of supplementary legislation----------B. Administrative agencies and officers-------------------------------------------------C. Maternal and infant mortality rates-------------------------- - - - - 7 ----------- D . Publications and exhibits of the Children’s Bureau bearing upon
maternal, infant, and child welfare and hygiene-------------- ---------IL L U S T R A T IO N S
States accepting the benefits of the act ( m a p ) _ _ —
-------- _ Frontispiece.
Deaths among artificially-fed infants compared with number of deaths
expected at the mortality rates prevailing among breast-fed infants,
based on studies of 23,000 infants in eight cities----------- __
____ — ___
Counties in California in which nursing service has been instituted under
the maternity and infancy a ct------------------------------------ - - - - - - - . - - - f
-----Number of classes in maternal and infant care conducted in Indiana,
March, 1924-June, 1927, inclusive-------------------------- - - - 7- 7- - — .fiT"------Types of work done by the bureau of child hygiene and public-health nurs
ing, Michigan Department of Health, 1922- 1927— _ _ _ _ _ _ _ ----- |- — - Comparison of mortality among infants registered and infants not registered at health centers in four towns in Michigan from date of organi
zation of centers to June 30, 1927---------------------_ _—
-----Infant mortality rates (deaths under 1 year per 1,000 live births) from
specified causes; New York, 1919 -1 926—_ _ _ _ ------ - ----------- ---------- - - - - - Maternal mortality from puerperal albuminuria and convulsions (deaths
per 1,000 live births) in the State and in urban and rural districts of
Pennsylvania; 1917-1926-------------------------------- — - - - - - - - - Types of work done by the bureau of child hygiene and public-health
nursing, South Carolina Board of Health, 1922—1927_.— _ _ _ _ _ ------ Comparison of percentage change in infant m ortahty rates (deaths under
1 year per 1,000 live births) during period of cooperation under the
maternity and infancy act and similar period prior to cooperation;
counties in Virginia having maternity and infancy work and counties
having little or no maternity and infancy work----------------- --------- ------------Little mothers’ classes in W est Virginia----------------------------- - - - , - - - faicl,ng-^
Comparison of mortality rates for infants m the first year of life registered
at health centers, with rates for all infants 1 month and under 12 months
of age in three counties of Wisconsin; 1 9 2 5 -2 6 ------------------------------------------
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123
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 ,
Washington, June 25,1928.
S ir : There is transmitted herewith the report of the administra
tion of the maternity and infancy act for the fiscal year ended June
30, 1927, prepared under the direction of Dr. Blanche M. Haines,
director of the maternity and infant-hygiene division of the bureau.
Inasmuch as this is a report on the fifth year that the Federal sub
sidy has been available for this work, material supplied by the States
showing some of the results of the act are given in more detail than
in previous reports.
A s this ,report goes to press the provisional birth and death rates
lor 1927 have been made public by the Bureau of the Census, show
ing a very much greater saving of infant life in the registration area
as a whole than in any previous year. Infant mortality rates for
1927 were lower than for 1926 in 30 of the 33 States for which figures
in i
years are available. In the 33 States and the District of
Columbia in 1926, according to the Bureau of the Census, there were
1,759,429 births and 129,030 deaths of infants under 1 year of a op
|n 1927 there were 1,763,035 births and 113,391 infant deaths in the
■fame area. For the birth-registration area the infant mortality (that
is, the deaths of infants under 1 year of age per 1,000 live births)
was 64 in 1927, as compared with 73 in 1926 and 76 in 1921.
The death rate fluctuates from year to year because of temporary
and local causes. The trend or the level around which it fluctuates
is a criterion of progress. The rate for 1927 establishes a new and
very much lower level.
However, the value of parental education in the scientific care of
children can not be adequately measured by lowered death rates.
Children not only are kept alive but are in far better general physical condition as a result of better care, but no statistical comparison
of these gams is possible. The best measure of what will prove of
the greatest value to children is the extent to which practical educa
tion in child care is being made available to all parents.
A reading of this report and previous ones reveals that the types
of work undertaken, as well as the administration practices, vary
from State to State. This is because the act leaves to the
individual States the initiation and carrying out of their own plans
of work as well as the appointment o f personnel. A ll the work is
not equally good, but during the five years of Federal aid the State
programs and the quality of work have steadily improved and effec
tive cooperation between the States and local communities has be
come more general.
Respectfully submitted.
TT
■
■
Hon. James J. D avis,
G race A
bbott .
C h ie f.
Secretary of Labor.
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v
S T A T E S A C C E P T IN G T H E B E N E F IT S O F T H E A C T FO R T H E PR O M O TIO N OF T H E W E L F A R E A N D
H Y G IE N E O F M A T E R N IT Y A N D IN F A N C Y , W IT H D A T E S O F L E G IS L A T IV E A C C E P T A N C E
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[D ia g o n a l lin e s in d ica te S ta te s n o t co o p e ra tin g ]
THE PROMOTION OF THE WELFARE AND HYGIENE
OF MATERNITY AND INFANCY
The act for the promotion of the welfare and hygiene of materinfancy, known as the Sheppard-Towner Act, was passed by
the Sixty-seventh Congress and approved by the President on
November 23, 1921.1
A t the close of the fiscal year 1927 all the States except three
were cooperating under the provisions of the act, the three excep
tions being Massachusetts, Connecticut, and Illinois; and the Terri
tory of Hawaii also was cooperating, the Sixty-eighth Congress hav
ing extended to this Territory the benefits of the act.2
E X T E N S IO N OF TH E AU TH O R IZE D APPR OPR IATIO N FOR
M A T E R N A L A N D IN F A N T H Y G IE N E
Although the maternity and infancy act itself was permanent legis
lation, section 2 authorized an annual appropriation of $1,240,000 for
a five-year period only, which ended with the close of the fiscal year
1927. Believing that the authorization for appropriations should be
extended, the Secretary of Labor with the'approval o f the President
m December, 1925, recommended to the chairmen of the House and
Senate committees which had considered the measure when it was pre
viously before Congress that the appropriation in the amount origi
nally specified should be authorized for the fiscal years 1928 and 1929.
.T h e bill introduced by the chairman of the House committee
(H . R. 7555) embodying the recommendation made by the Secretary
for a two-year extension of the maternity and infancy appropriation
was favorably reported by the Committee on Interstate and Foreign
Commerce and passed the House April 5, 1926, by a vote of 218 to
44- The House bill was reported to the Senate by the Committee
on Education and Labor with an amendment providing that the
authorization should be extended for one year only. The bill did
not come to a vote in the Senate until January 13, 1927. Although
the votes recorded in connection with bringing it to a vote, such
as making the bill unfinished business, indicated that more than
two-thirds of the Senate favored the House bill, there was very
determined opposition on the part of a few Senators, so that defeat
by filibuster was threatened. To prevent this the friends of the
measure proposed that with the expiration of the two-year extension
of the authorized appropriation the act itself should be “ after
June 30, 1929, of no force and effect.” W ith this compromise amend
ment the House bill was promptly passed by the Senate and the
amendment concurred in by the House. Thus the appropriation has
been authorized for the fiscal years 1928 and 1929, and the original
act ceases simultaneously with the appropriation on June 30, 1929.3
t e x t o f th e la w see -Appendix A , p p . 1 3 5 -1 3 7 .
M2T,r|Sab1aa i . ”« , 'A?ptl l
°f *to act were th°“ » ' Ka“ “s' 0,1
3 F o r t e x t o f th is a ct (4 4 S ta t. 1 0 2 4 ) see A p p e n d ix A , p. 137.
1
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FU N D S A V A IL A B L E A N D ACCEPTE D B Y T H E ST A T E S
The funds authorized by the maternity and infancy act first
became available in March, 1922 The administration o f the funds
from that date to June 30, 1926, has been reported 4 Table 1 shows
the amounts available and the total amounts aogspM
from the appropriations for the fiscal years 1922, 1923, 1924, 1925,
and 1926, and for 1927 up to June 30, 1927.
T
abue
1 .-
-Am ounts available to States m d H aw aü from Federal maternity and
infancy funds and amounts accepted
[Statement as o f June 30,1927]
State
M axi
mum
amounts
available
from 1922
appro
priation
Am ounts accepted b y States and H a w a ii3 from
M aximum
Amounts amounts
accepted available
b y States from 1923,
1925 ap 1926 ap 1927 ap
from 1922 1924, 1925, 1923 ap 1924 ap propria
propria propria
1926, and propria propria
appro
tion 4
tion
tion
tion
tion
priation 1927 appro
priations
Dollars
Dollars
Dollars
Dollars
Dollars
Dollars
Dollars
Dollars
¡932,754.69 949,646.00 904,824. ’
477,500.00 316,554.02 31,201,725.96 716,333.40 877,122.04
25,836.95
25,836. 95 25,836.95 25,836. 95 25.836.95 25,836.95 12.253.71
10,297. 561 10,297. 56
Alabama---------5.000.
00
12,253. 71 5,000.00 12,253. 71 12,253. 71 14.000.
5,753.88 5,000.00
12,000.00
Arizona----------00
13,
500.00
16,817.
51
6,855.
75
21,817.
51
00
8.953.03 5.000.
25.470.00
Arkansas--------26,730.00
15.620.00
33.112.01 24,279.35 13,114.93
12, 731.12
(5)
10,000.00
California-------00
9,976.99 9,999.33 . 9,999.37 10.000.
16,337.20
00
7,119.83 5.000.
Colorado--------19,311.48 9,655. 74
8,114.
75
8,114.
75
Connecticut— .
11.504.01 ÏÎ,5Ô4."ÔÏ "ÎÏ,5Ô4."ÔÎ
ÏÏ,5Ô4."ÔÎ
11,504.01
11.504.01
5,503.10 5, 503.10
16.531.72
Delaware-------16,531.
72 8,621.28 16,531.72 16,531.72 16,531. 72 23.610.00
00
7,184.90 5.000.
Florida_______
29, 530.00
11,533.10 6.750.00 29,530. 55 11,000.00 15,250.00 28.490.00
5.000.
Georgia----------9,934.37
11.725.96
311,725.96
Hawaii_______
"7,912." 66 6,691.60] 9,308.40 6.000.
5,974." 30 "5,0ÓÓ.’ ÓÒ 12,912.66 6,250.00
Id a h o .—..........
19.631.03
25,"ÔÔÔ."ÔÔ
Illinois-----------(6) „ 53.739.10
29,763.62 24,995.00 26,"250. ÖÖ 25.750.00 25,"ÖÖÖ."ÖÖ 26,213.60
11,611.07 8,199.09
Indiana---------26,213. 60 26,213.60 26.213.60 26,213.60 26,213.60 16.800.00
10,423.56
10,423.
56
Iow a_________
12,097.33
21,932. 52
8,991. 51 8,991.51
Kansas_______
26.298.64 26.298.64
26.298.64 26,298.64 26.298.64 "26,"298.64
10,452.00 10.452.00
Kentucky-----17.590.60 22,127.79 22,129.80 22,129.80
22,129.80
9,057.50
5.000.
Louisiana------15,179.77
6,732.66
M a in e .............
Ì9 ,277.00 19.277.00
19,777. OT 19,277.05 "Ì9,"269.'Ó5 "Ì9,~Ì64.58
8,270.49 7,913.57
M aryland-----35,981.70
13.691.06
Massachusetts
34,74Î."ÏÎ
34.741.11 34,74Î."ÎÏ 34,"74Î."ÎÏ 34,74Ï."ÎÎ 34,"74Î."ÏÎ
13.276.07 13,253.97
26.099.65
M ichigan------26.099.65 26,009.65 26.099.65 26,099.65 26.099.65 22,076.58
10,385.44
10,385.44
M innesota----22,076.58 22,076.58
22,076.58
22,076.58
22,076.58
9,039.70 9,039.70
32,958.19
Mississippi—
25.000.
00
24,000.00
32,958.19 28,527.38 21,762. I l
12,679.67 12,473.15
M issouri-------13.700.00 13.700.00
13,701.91 13,701.91 13,701.91 13,701.91
6,238.31 6,238. 31
11
. 000.
Montana.
12.980.00
11,915.00
18,743.21 17,661.69 7,409.50
7,924.66
N ebraska_________ • 7,924. f
T otal------
¿w ^ ^ c^ ^ ^^ ^ ^ ^ t^ n fy^ fe^ m on th s o H ^ ^ ^ fls ra ^ e a r remahw^a^the time^the appropriation
act for that year was passed a full
1923 to 1927 has been $1,190,000.
^Mar 10 1924. No appropriation therefore was
Actual acceptances up to June 30,1927, are here given.
i S S S n T lS S S S w S LlXo “ I S . Howi-
were returned, to the Federal Treasury.
and 1927.
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¿h«e to d s we,, do. epeat bat
___________________ _-______________________
00
00
00
00
FUNDS AVAILABLE AND ACCEPTED BY THE STATES
T able 1.
3
Amounts available to States and Hawaii from Federal maternity and
infancy funds and amounts accepted— Continued.
State
M axi
m um
amounts
available
from 1922
appro
priation
Amounts accepted b y States and Hawaii from—
M axim um
Amounts amounts
accepted available
b y States from 1923,
from 1922 1924, 1925, 1923 ap 1924 ap 1925 ap 1926 ap
1927 ap
appro
1926, and propria propria propria propria propria
priation 1927 appro
tion
tion
tion
tion
tion
priations
N evada________
N ew Hampshire
N ew Jersey____
N ew M exico___
N ew Y o r k _____
N orth Carolina____
N orth D a k ota ..,
Ohio___________
Oklahoma______
Oregon................
P en n sy lv a n ia...
R hode Island__
South Carolina..
South D a k o ta ...
Tennessee...........
Texas__________
U tah....................
Verm ont.............
Virginia...............
W ashington____
W est V irginia...
W isconsin______
W y om in g...........
Dollars
5,174.63
5,999.61
12,119.83
6,812. 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
5,43a 57
Dollars
Dollars
5.000.
00
10,522.06
5.000. 00 12,988.31
12,119.83
31.284.55
5,812.96
12,430.33
80,041.78
10,773.47
27,259.66
5.000.
00
14,362.
74
7,187.95
48.843.46
5.000.
00
23,679.48
6,232.61
15.283.46
24,667.12
68,810.99
14,076.28
"8,797.50
21,355.65
6,436.07
14.293.11
5.000.00 25, 767.55
9,363.93
41,450.52
5.000.
00
13.030.89
12.376.90
(«)
10, 209.61
25,574.00
4,998. 70
19.149.55
5.000. 00
19,871. 74
8,995.03
27, 751. 62
4,998.87
11.311.12
Dollars
Dollars
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
27,259.66i 27,259. 66
6.000.
00
6,000.00
11.900.00 17,297.89
5.000.
00
20,934.06
8.000. 0015,283.46
68,810.20 68,810.99
4,999.86
21,355.65 21,355.65
12,844. 24 14,272.92
18,521.94 22,410.73
32,567.38 40,689. 20
6.365.00 13.000.
2, 775. 33
25,574.00 25.574.00
10,000.00 10.000.00
5.000. 00 10,000.00
27,750.44! 27,751.62
5.000.
11,00
000.
Dollars
10.522.00
12,988.31
31,284. 55
12,430.33
80,041.78
27,259.66
8.300.00
26,606.96
23.679.17
15.283.46
68,810.99
14,076.28
21.355.47
13.451.18
25, 767. 55
40,447.84
00
13.000.
4,281.36
25.574.00
Dollars
10.522.00
12,988. 31
31,284. 55
12,430. 33
80,041.78
27,259.66
8.300.00
31,400.73
23,679.48
12,395. 87
68,810.
14,076.28
21,355.65
14,293.11
25,767. 55!
35,350. 52
00
13.000.
5,000.00
25.574.00
Dollars
10.522.00
12,988.31
31,284.55
12,430.33
80,041.78
27,259.66
6.500.00
5.000. 00
23,679.48
15,283.46
68,810.99
14,076.28
21,355.65
5.000.
24.795.00
35,350.52
00
13,000.00
5.000.
25.574.00
10.000. 10.000.
00 00 5.000. 00
10,000.00 19,871. 74 19,871.74
27, 751.62 27,751.62 5.000.
6.600.00 6.600.00 7.500.00
6 V e rm o n t a ccep ted $5,0 00 , b u t i t w a s retu rn ed t o th e F e d e ra l T re a su ry .
6 ^erms
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 available
tor expenditures in that State until the close of the succeeding fiscal
vear.
Consequently 1927 funds may be accepted and expended
during the fiscal year 1928. (See pp. 33-34.)
T T r fJ ^ Q Ì 8 ^ 0^ 600011 re feren ce m ay be m ade t o ru lin g s o f th e C om p tro lle r G en eral o f the
in fa n c y Sa c t ? T re a s u ry ln reg ard to th e a p p ro p ria tio n s f o r ca rr y in g o u t th e m a te rn ity a n d
a ccru ln g w h ile th e m on ey s a re held b y th e S ta te s in u re s t o th e benc
hé a cco u n te d f o r
m id
fi ^ s a n d ° o t to t i e S ta te s a s t r u s t ^ s a n d should
ue a cco u n te d i o r a n a p a id i n t o th e U n ited S ta tes T re a s u ry a cco r d ili c iv
T h e la w (\nf*z n o t
ha
a il
ll be
Dro
r om^pHtly
v eIn
h ee m
0n
bih.ich
haldfu rn
b y ish
thed
e ,S a
tantes
gand
te S t? b
ss n
ne p
a pnpiied
lied %t o\
o th
pu
rpey
oseSh,a11
fo r w
d th
e a mboea?
u n tst eshould
nu
o tt
reSUltillg 111 larse “ “
S h e ld ^ th ^ ^ rte g
a P P rop riate an a m ou n t specifica lly eq ual t o th e a m ou nt
Dose t h r o u e t ? n t h i r der al a p p rop ria tion , m on eys a p p lied t o th e sam e purfunds1 o f th e s t a t i S Ì» a i ^ P P roP ^ a tion s m ay n o t be con sid ered as m ak in g th e a p p ro p ria te d
i ^ s e s ta b lilh fd thatq ? h l
a u tb o r ize b b y th e F ed era l a p p ro p ria tio n unless
rc is e s tà Diisned th a t the f a c t th a t th e oth er a p p rop ria tion w a s a v a ila b le fo r th e * services
an d fa c ilitie s p ro v id e d fo r in th is a c t ’ c o n tr o lle d th e S ta te le g is la tu re in m ak in g its s il c f f l ?
a p p ro p ria tio n , in w h ich ca se th ere w ou ld be ju stifica tio n fo r co n sid e rin g t h e s f m on eys in
^Jtun e12 3 n i 9 2 3 ) thG a m ou n t a p p rop ria ted b y th e S ta te is eq u a l to th e F e d e ra l a llo tm e n t.”
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00
00
00
SU M M A R Y OF ST A T E A C T IV IT IE S D U R IN G 1927
The State agency to which the administration o f the maternity and
infancy act within each State is intrusted in accordance with sec
tion 4 of the act initiates the plan of work for that State and submits
it for approval, together with a budget covering proposed expendi
tures for the period, to the Federal Board of Maternity and Infant
Hygiene.6 Previous reports of the administration of the act have
reflected the independence of the States in making and carrying out
their own plans. These have varied with climatic conditions, geo
graphical barriers and means of communication, economic conditions,
race, nativity, and density of the population, availability of medical
and nursing service, and the existing local child-health activities.
During the past year thev Federal board has had before it plans for
very different activities and different methods for carrying out the
same activities. The board’s function has been to decide, not
whether the plans o f the State bureau or division of child hygiene
are in its opinion the best possible, but whether the expenditures
proposed under the plans are “ in conformity with the provisions of
this act and reasonably appropriate and adequate to carry out its
purposes.” 7
TYPES OF W ORK
The types of work undertaken in the States under the maternity
and infancy act are quite uniformly educational. It is therefore
a logical extension of the American principle of providing free public
education for the people. In this instance education in the hygiene
of maternity and infancy is offered to parents and prospective
parents.
Practically all State work falls into one o f three classes, as follows:
1. Instruction o f the individual through any of the following
methods: Instruction of parents at itinerant conferences conducted
by physicians and nurses as to the care of the mother and child,
the same type of individual instruction in conferences at permanent
centers conducted by physicians and nurses, instruction of mothers
through home visits by public-health nurses and by demonstrations
in the home in infant and maternal care.
2. Instruction o f groups through lectures, motion pictures, slides,
charts, and exhibits; classes in infant and child care for girls 10 to 15
years of age; classes in infant care and prenatal care for mothers;
classes in infant care and prenatal care for teachers to prepare them
to include maternity and infancy instruction in their class work;
instruction of midwives in classes and groups, and to some extent
individually; graduate courses in maternity and infancy work for
0 See sec. 3 o f t h e a ct, A p p e n d ix A , p. 135.
7 See secs. 8 a n d 12 of th e a ct, A p p e n d ix A , pp. 136, 137.
4
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SUMMARY OF STATE ACTIVITIES DURING 192 7
5
nurses through State or regional conferences and institutes; grad
uate courses in pediatrics and obstetrics for physicians (usually in
conjunction with State or county medical societies).
3.
Instruction through the dissemination o f literature prepared by
the State or by the Federal Government on phases of maternal care,
infant care and hygiene, child care and management, and other
features of the work.
P E R S O N N E L O F T H E A D M IN IS T R A T IV E S T A F F S
In each State the personnel of the bureau or division administering
the maternity and infancy act is determined by the needs of the State
and the size of its budget. Physicians, nurses, dentists, or dental
hygienists, and clerks make up the major part o f the personnel.
During the fiscal year 1927 physicians directed the work in the
Territory of Hawaii and in 30 States: Arkansas, California, Dela
ware, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Mich
igan, Minnesota, Mississippi, Missouri, Montana, New Jersey, New
York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsyl
vania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Ver
mont, Virginia, Wisconsin, and Wyoming. Nurses directed the work
in 9 States: Alabama, Florida, Nebraska, New Hampshire, New
Mexico, Oregon, South Carolina, Washington, and W est Virginia.
In 5 States— Arizona, Colorado, Iowa, Louisiana, and Nevada— the
administrative heads were neither physicians nor nurses.
Including State directors,, 40 physicians on the State staffs gave
full-time service for the entire year, and 20 gave full-time service for
part of the vear. Ten additional physicians gave part-time service
(seven for the entire year, three for part of the year). Additional
physicians were employed to conduct child-health or prenatal con
ferences and to do special work. For example, New York State paid
209 physicians for occasional service.
Public-health nurses were on the staff o f every State bureau or
division. Approximately 770 nurses were employed for some period
during the year. O f these, 190 headquarters staff nurses were paid
from maternity and infancy funds for full-time service, and about the
same number were paid for part-time service, for all or part of the
year. O f the 354 county nurses whose salary was paid wholly or in
part out of maternity and infancy funds, 87 were paid for full-time
service and 267 were paid for part-time service, for all or part of
the year. The other nurses included temporary employees and
nurses who worked in towns in some cooperative relationship with
the States.
. Dentists or dental hygienists were employed for varying periods by
eight States— Iowa, Louisiana, Maryland, Mississippi, New York,
Pennsylvania, Utah, and Virginia. Supervisors and teachers of mid
wives were employed in nine States— Arkansas, Louisiana, Michigan,
Mississippi, New Jersey, New York, Pennsylvania, Tennessee, and
W est Virginia. Six States reported maternity and infant home in
spectors; other workers included lecturers, laboratory assistants,
vital-statistics workers, accountants, clerks, stenographers, motionpicture operators, and chauffeurs.
Volunteer workers were reported as giving service in 17 States.
These included physicians, dentists, nurses, and lay persons. Physi
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6
MATERNITY AND INFANCY
cians and dentists gave their services at conferences and centers. Lay
workers sponsored conferences, assisted at centers and conferences,
and did follow-up work after conferences. Many nurses gave similar
service.
CONFERENCES
Conference work has been one of the main methods of teaching
infant and child care and also prenatal care in the cooperating
States. Through the conferences many parents have received for
the first time important information on the care and hygiene of
their children, and expectant mothers have learned of the value of
prenatal care for both their babies and themselves. Some of the con
ferences have been held regularly at permanent health centers to
which children and mothers returned in successive visits for advice
or reexamination. The physicians who made examinations were
assisted by staff nurses or other cooperating nurses. In many cases
such conferences were part of the work of the county health officer
in counties to which maternity and infancy nurses had been assigned.
In contrast to conferences at permanent centers were the itinerant
conferences, which were educational to the community as well as to
the individual parents whose children were examined. Through
itinerant conferences the community learns that the health confer
ence is not a clinic for sick children nor an obstetrical clinic but an
opportunity for the mother to have explained to her how to keep her
baby and herself well by using intelligently the available medical
service and also by improving the home care she gives to her children
and herself. The staff for itinerant conferences usually consists of
a physician and a nurse. In States using trucks (such as healthmobiles or health cars) additional personnel may include chauffeurs,
motion-picture operators, and lecturers. The health cars usually
carry exhibits, films, slides, charts, and posters in addition to their
equipment for conference work. The motion pictures are shown in
the evening, and talks are given to groups while the car is in the
community. Through the medium o f health cars information on
maternal, infant, and child care may be carried to localities that
are isolated and that may not be accessible for the more usual forms
of health work. In some States a small automobile transports physi
cian, nurse, and equipment for the itinerant conferences.
Five types of conference were reported to have been held during the
year under review r Combined prenatal and child-health conferences
conducted by physicians, child-health conferences conducted by physi
cians, prenatal conferences conducted by physicians, health confer
ences conducted by nurses only (with no physician present) for both
children and expectant mothers, and dental conferences conducted by
dentists. Dental conferences, at which dentists gave information on
the development of the teeth and advice as to their care, were fre
quently conducted at the same time as the child-health conferences.
Eleven State bureaus or divisions reported a total of 1,808 com
bined prenatal and child-health conferences conducted by physicians,
at which 1,263 expectant mothers and 27,382 infants and preschool
children were examined. The number of visits reported made to
the conferences in these States by expectant mothers was 1,570 (one
State not reporting on this ite m ); and the number o f visits made by
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SUMMARY OF STATE ACTIVITIES DURING 192 7
7
children was 38,418. Child-health conferences conducted by physi
cians, at which children were examined and their mothers were given
advice, were a feature of the work in 36 States and Hawaii. There
were 21,347 such conferences, at which 136,813 infants and preschool
children were examined. Infants and preschool children made 264,270 visits to these conferences in 34 States and Hawaii; 2 States
did not report on this item. Physicians made examinations o f infants
and preschool children at child-health or combined prenatal and
child-health conferences in 42 States and Hawaii.
Prenatal conferences conducted by physicians were included in the
work of 22 States. There were 3,231 such conferences; 17,762 ex
pectant mothers were registered for these conferences in 21 States,
and 14,930 were examined by physicians in 19 States. The number
of visits made to conferences by expectant mothers was 32,274. One
State did not report the number of mothers registered, and three
States did not report the number of visits.
Health conferences were conducted by nurses (with no physician
present) in 25 States. Usually they were held in connection with
baby-weighing stations or were a feature of the work in counties to
which maternity and infancy nurses had been assigned. The number
of conferences reported held by nurses was 6,273. The number of
children reported inspected by them was 34,519, and the number of
mothers reported as having been advised on prenatal care was 8,260.
To sum up, in 43 States and the Territory of Hawaii 200,223 in
fants and preschool children were examined by physicians or advice
as to their care was given by physicians or nurses, and in 34 States
27,377 women were given prenatal advice by physicians or nurses.
Dental conferences were conducted in 16 States. The total num
ber of conferences reported by 15 of these States was 1,124, and
27,870 preschool children were reported as receiving advice on the
care of their teeth. A total of 1,664 expectant mothers were reported
advised, but only three States reported on this item.
Table 2 summarizes the conference work in the cooperating States
and the Territory of Hawaii.
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T
able
2 .— Conferences held and -permanent centers established in the States and the Territory of Hawaii cooperating under the maternity and
infancy act during the year ended June SO, 1927
Conferences conducted b y nurses
Conferences conducted b y physicians
Combined prenatal and child
health
Ex
N um pect
ber of ant
con moth
fer
ers
ences regis
tered
Visits to con
ferences b y —
N um
Chil
ber of
dren
Ex
con
regis
fer
pect Chil
tered
ences
ant
dren
moth
ers
T otal________ 1,808 1,365 27,382 1,570
124
39
96
2
6
N ew Hampshire__
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61
12
8
1,754
973
3,983
61
12
8
Chil
dren
regis
tered
N um
N um ber of
ber of con
fer
visits
ences
N um
N um Chil M oth
ber of
ber of dren ers in
con
in
con
Ex
struct
Ex
Ex
fer
fer spect
pect
ed
ed
ant N um ences
Chil pect ences pect Chil
ant
ant
m oth ber of
dren m oth
dren
moth
visits
ers
ers
ers
regis
tered
38,418 21,347 .138,322 264,270 3,231 17,762 32,274 6,273 34,519
i, 754
40
638
1,302
7,856
722
1 570
8* 118
2,353
702
1,184
8'942
5,629
15,241
891
1,570
9,178
2,353
3y808
1,184
U, 629
2i; 832
204
198
333
210
380
141
4
282
201
104
56
fi, 078
4,255
6,204
6, 571
5, 579
2, 711
69
3,097
2,376
1, 627
2,056
6, 078
4, 255
6'408
6,821
5', 579
2,711
69
3, 097
3,504
l' 676
2,056
139
4,259
4,259
2,396
33
52
3fi0
51
973
3,983
10
13
10
17
11
93
11
93
378
23
21
21
358
2,766
(2)
1
78
19
52
59
293
16
186
237
262
488
5,854
16
626
237
587 1, 086
377
488
42
(2)
75
36
16
(2)
1,063
88
(2)
3, 037
88
65
13
91
95
91
95
2
5
5
2,614
248
298
935
2, 642
<461
389
99
16
32
3,170
'435
Com
bined
pre Child
natal health Pre
natal
and
child
health
fj
8,260 73,616 5,029 1,124 1,664 27,870
4,487
12
50
6,000
467
298
1,696
(2)
16
50
235
14
4
21
2
2
1
3
9
367
47
2,353
292 21,356
887
(2)
44
(2)
687
(2)
(2)
287
(2)
(i)
105
1,358
457
(2)
80
55
4,316
490
68 1,418
29
7,000
1,790
457
26
70
(2)
1
3
(2)
5
1
12
_
10
3,170
(2)
298
389
6,356
3,417
3 311
58
6,356
3,417
(2)
128
356
149
68
852
112
2
4
1
4
1
MATERNITY AND INFANCY
States and Terri
tory cooperating
N ew centers estab
lished 1
Persons
receiving
dental
advice
Visits to
conferences
b y—
Prenatal
Child health
Conferences con
ducted b y dentists
00
SUMMARY OF STATE ACTIVITIES DURING 192 7
1 N ew permanent health centers, whose support has been assumed w holly or in part b y the respective counties or communities in the m ajority o f the States.
8 N ot reported.
8 Includes some mothers instructed in nurses’ offices.
* M a y inclftde some conferences at which physicians were present.
CO
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10
MATERNITY AND INFANCY
P E R M A N E N T P R E N A T A L A N D C H IL D -H E A L T H C E N T E R S
Permanent locally supported centers have been developed in many
communities in which itinerant conferences had been held. The itin
erant conference has shown the need for a permanent source of infor
mation on maternal and infant care, and the community has assumed
the responsibility of supplying it through establishment and support
of a permanent center.
The establishment of permanent prenatal and child-health centers
is extremely important in the development of the work for the pro
motion of the welfare and hygiene of maternity and infancy. The
local support of a center demonstrates the interest of the community
in the welfare of mothers and children of that community. When a
county has reached the point o f maintaining a center and paying
both physician and nurse for services at the center, this county has
assumed some responsibility for maternal and infant care. In many
counties in which the unit cost of the work is high and county re
sources are limited, State assistance in maternity and infancy work
will be necessary for some years, perhaps permanently, just as State
subsidies for local education have been found necessary in many
States.
Centers vary in form. The most useful centers are those supported
entirely by local funds, for which the community has assumed re
sponsibility. Local physicians and nurses conduct the conferences
in rooms equipped and maintained for the purpose, and conferences
are held regularly once a month, once a week, or oftener. Another
type is supported by the county or a local group, but the nurse
arranges for conferences at more or less regular intervals, using
whatever rooms are available, such as schoolhouses or town halls.
The nurse carries the scales with her; blankets or sheets are used
to form examining cubicles; and local physicians examine the mothers
and children. Many conferences of this type are held at regular
intervals with State staff or county health staff supplying the nurses
and physicians. I f county health departments exist the conferences
may be held in the offices of the county departments, many such
departments having a conference room for this purpose.
The regularity with which conferences are held in rural and iso
lated districts is influenced by climatic conditions and the trans
portation difficulties and also by the availability of county or State
physicians and nurses for conducting conferences. In many dis
tricts the nearest local physicians and nurses are too remote or too
few in number to make frequent conferences possible.
Complete reports of attendance at centers and amount of work
accomplished are not available owing to the fact that as soon as a
center becomes the responsibility of a community and ceases to have
State assistance or supervision i t ' may or may not send detailed
reports to the State bureau or division of child hygiene. Whether
or not a full report of the local center is regularly furnished to the
State department the State through its bureau or division continues
to keep in touch with the local work and helps in the solution of
problems that arise from time to time.
Three types of centers have been developed: Combined prenatal
and child-health centers attended by both mothers and children,
child-health centers in which children are examined and advice is
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Federal Reserve Bank of St. Louis
SUMMARY
OF
STATE ACTIVITIES DURING 192 7
H
given in regard to their care, and prenatal centers. During the year
under review a total of 319 new permanent health centers of the
three types were reported established by 26 States and thfe Territory
of Hawaii. (Table 2.) A total of 70 combined prenatal and childhealth centers were established in 13 States: A labam a,. Delaware,
Florida, Maryland, Michigan, New Mexico, New York, North Caro
lina, Oregon, South Carolina, Utah, Virginia, and Wisconsin— the
State of Utah leading with the establishment of 23 combined pre
natal and child-health centers. A total of 14 new prenatal centers
were established in 6 States: Arkansas, California, Michigan, New
Jersey, New Mexico, and New York. A total of 235 new child-health
centers were established in the Territory of Hawaii and 18 States:
Arkansas, California, Colorado, Florida, Georgia, Kentucky, Mis
souri, Montana, New Jersey, New Mexico, New York, Ohio, Oregon,
Pennsylvania, Tennessee, Texas, Virginia, and West Virginia.
C O R R E C TIO N O F D E F E C T S
A child-health conference has a twofold purpose— that of dissemi
nating information to parents on the care and hygiene of infants
and preschool children and that of examining so-called well children
and pointing out to the parents any deviations from the normal
that are found. No treatment is given, nor is remedial work done
in these conferences. I f defects or pathological conditions are
found the parents are referred for corrections to the family phy
sician so far as possible— or, in indigent cases, to community or
^county agencies or to treatment clinics if such are available. In
some States a copy of the examination report is sent to the family
physician. The method pursued of referring the parents for cor
rection of defects to family physicians and other agencies precludes
the collection of accurate data on correction o f defects unless follow
up work is undertaken; and almost none of the States has sufficient
workers on the staff to follow up all the children seen at conferences,
either to urge parents to see that corrections advised are made or to
ascertain whether corrections have been made.
Twenty States reported the approximate number or percentage
of children for whom the parents had had defects corrected. Per
centages of corrections of defects varied greatly. For example,
Indiana reported that 5,932 children had 29,086 defects, and defects
were corrected for approximately 60 per cent of the children. W is
consin reported that 6,951 children had 14,820 defects, and parents
had the defects corrected in approximately 25 per cent of the children.
C O U N T Y H E A L T H U N IT S
Under legislation recently enacted, many of the State health de
partments are successfully promoting the establishment of full-time
county health units. The minimum staff for a county health de
partment should include a full-time medical health officer, a nurse,
a sanitary inspector, and a clerk. On December 31, 1926, there were
.341 county health departments in 34 States.8 Excluding the New
8 S m illie, W . C . : “ T h e fu tu r e o f co u n ty h ea lth w ork in th e U n ited S ta te s.”
th e A m e rica n M ed ica l A s s o cia tio n , v o l. 89 (S ep t. 24, 1 9 2 7 ), pp. 1034—1038.
892°— 28------2
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J o u rn a l o f
12
MATERNITY AND INFANCY
England States, which operate local government chiefly through
townships instead of counties, only nine States had no full-time
county health units: Delaware, Idaho, Indiana, Michigan, Nebraska,
Nevada, New Jersey, North Dakota, and Wisconsin. In a number
of these the use of county funds for this purpose has not yet been
authorized.
A n impetus to county-unit organization has been developed
through plans for rehabilitation o f the areas flooded by the Missis
sippi River, by establishing in the sections of the States that were
inundated full-time county and district health services with the
assistance of the United States Public Health Service and the Inter
national Health Division of the Rockefeller Foundation. This in
crease in full-time county health departments has developed a greater
demand for county nurses, and many States have included in their
plans and budgets provisions for helping to finance maternity and
infancy nursing services in these full-time county health depart
ments as well as in counties not having full-time health departments
or having no county health organizations. Placing a maternity and
infancy nurse in the county has often been the first step in creating
an .interest in the establishment of a full-time county health depart
ment. During the year under review 354 nurses were detailed to
counties in a total or 27 States, the expense being borne wholly or in
part by the State bureaus or divisions.
The State agencies administering the funds have different methods
o f evaluating the amount of service the county nurse gives to ma
ternity and infancy work in a generalized nursing service in order
to insure that it is in proportion to the amount o f maternity and
infancy funds the nurse receives for work with mothers and children.
This has been done through the monthly reports of nurses which
show time and work given to maternity and infancy activities and
also through the observations made by State supervisors of nurses.
The following activities of county units are considered maternity
and infancy work: Home visits to mothers, infants, and preschool
children; prenatal and child-health conferences; classes for mothers,
girls, and midwives in which maternal and child care are taught;
supervision of midwives; nutrition classes; time spent in promoting
immunization of preschool children against diphtheria, typhoid fever,
and smallpox; and collecting hookworm and other laboratory speci
mens from expectant mothers and preschool children.
H O M E V IS IT S
Much of the maternity and infancy work is done by means of home
visits made by itinerant nurses from the bureau or division staffs
or by county or other local nurses paid in full or in part from mater
nity and infancy funds. The maternity and infancy program in
certain States is largely a nursing program and aims to reach par
ents with advice on the care of mother and child through the contact
of nurses with the individuals in the homes. A few States with
relatively densely populated areas have sufficiently large staffs to per
mit some regular follow-up or periodic visits. Sparsely settled
States find nurses’ visits the most feasible plan for reaching remote
and isolated settlers with information on the care of mothers and
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13
SUMMARY OP STATE ACTIVITIES DURING 192 7
children. Through the home visits the nurses teach mothers the
importance of prenatal care in its influence on their own well-being
and on that of the unborn infant. They emphasize the importance of
- breast feeding. They give instruction on the hygiene and care of
infants and preschool children. They find children and mothers
who need assistance and medical care and arrange for such care.
During the year under review 39 States and the Territory of
Hawaii reported a total of more than 721,000 home visits by nurses.
Practically all these were to expectant mothers, infants, and pre
school children in their homes; some were to mid wives. Virginia led
in the number of home visits by nurses, with a total of 88,849 visits.
Virginia also led in the number of county nurses (39) receiving some
contribution toward their salaries from maternity and infancy
funds. Pennsylvania reported 87,058 home visits by State nurses.
Pennsylvania has in its State department of health a division of
public-health nursing employing 125 to 135 nurses, whose service
covers the State. ^These nurses were paid from maternity and inrancy funds for time spent in maternity and infancy work. New
York reported 73,784 home visits. Alabama, where the county-unit
system is a major feature of the plan of work, reported 72,132 home
visits. In Rhode Island, where the program stresses conference
work and home visiting, nurses made 54,803 home visits. Georgia
reported 42,862 visits, Delaware 32,458, and North Carolina 32,041.
(Table 3.)
T able 3. Number o f visits made by nurses, number of community and group
demonstrations, and number o f counties in which maternity and infancy work
<] has been done, in the States and the Territory of Hawaii cooperating under
the maternity and infancy act, during the year ended June 30,1927
States and Territory cooperating
Total____________
Alabama_____ _
Arizona........_
Arkansas ...........
California.............
C olora d o_____
Delaware.. . . .
Florida .........
Georgia______
H awaii. _______
Idaho................
Indiana____ ______
Iowa........................
Kansas...................
K entucky_______
Louisiana________
M a ry la n d __________
M ichigan______
Minnesota____
M ississip p i..........
-M issouri_______
M ontana___________
Nebraska________
N evada_________
N ew Hampshire...............
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N um ber of coun
ties in which
m a te rn ity and
.
infancy
work has
N
um
ber
Num ber
N um ber
been done—
of home of com o f group
m
unity
visits b y
demon
demon
nurses
strations strations Since the
beginning During
of coop
1927
eration
721,159
12,674
72,132
3' 877
30
1,627
32,458
21,702
42,862
11,155
477
41
408
3,314
9,311
4,334
3,699
3,728
2,456
2,436
9,180
12,498
3,882
15
30
676
18
38
332
Num ber
of coun
ties in
State
2,460
1,884
2,937
31
14
75
58
57
3
67
149
4
44
91
98
8
120
60
23
83
87
82
111
56
73
17
10
31
6
60
55
51
3
67
117
4
43
36
49
8
86
48
23
68
75
82
36
45
59
17
10
67
14
75
58
63
3
67
161
5
44
92
99
105
120
64
23
83
87
82
114
56
93
17
10
14
MATERNITY AND INFANCY
T
able
3.— Number of visits made by nurses, etc.— Continued
States and Territory cooperating
N ew Jersey___
N ew M e x ic o ...
N ew Y o r k ........
N orth Carolina.
N orth D akota..
Ohio__________
Oklahoma_____
Oregon________
Pennsylvania . .
Rhode Island. .
South CarolinaSouth D akota..
Tennessee_____
T e x a s ...............
U tah..................
Verm ont.........
Virginia.............
Washington___
West Virginia..
Wisconsin_____
W yom ing_____
N um ber
of home
visits b y
nurses
15,314
10,322
73, 748
32,041
2,791
19,146
596
15,723
87,058
54,803
3,303
693
16,173
11,355
2,454
N um ber
of com Number
m unity o f group
demon
demon
strations strations
12
6
10
282
3,249
' 649
0)
3
297
134
7
788
96
14
52
3
1
88,849
0
12, 733
1,811
3,360
0)
0
546
38
N um ber of coun
ties in which
maternity and
infancy work h as
N um ber
been done—
of coun
ties in
State
Since the
beginning During
of coop
1927
eration
21
27
62
46
40
77
75
36
67
4
46
64
73
90
28
12
97
30
50
71
23
21
14
62
31
25
65
63
22
67
4
41
64
58
30
28
8
56
21
47
69
9
21
31
62
100
53
88
77
36
67
5
46
69
95
254
29
14
100
39
55
71
23
1 N ot reported.
C O M M U N IT Y A N D G R O U P D E M O N S T R A T IO N S
A phase of educational work carried through State programs from
year to year has been the general instruction given to the public
through actual demonstration of maternity and infancy work.
A “ community demonstration ” is usually carried on by workers
whom the State bureau or division of child hygiene details to the
community for the purpose. Assistance may be given by local physi
cians, nurses, and lay persons in some cases. The demonstration
may cover one phase or several phases of the maternity and infancy
work, and it may continue not only a few days but a few weeks or
months or even a year or more. During the year under review
12 States conducted a total of 75 community demonstrations: Arizona,
California, Delaware, Louisiana, Michigan, Missouri, Montana, New
Jersey, New Mexico, New York, South Carolina, and Vermont.
(Table 3.)
A “ group demonstration ” generally covers one or more specific
phases of maternal, infant, or child care, and is made (usually by
a nurse) in connection with a child-health conference, mothers’ class,
or other appropriate occasion, or before a group assembled for the
purpose. Group demonstrations were conducted in 30 States: A ri
zona, Arkansas, California, Colorado, Georgia, Idaho, Indiana,
Louisiana, Maryland, Michigan, Minnesota, Montana, Nebraska, New
Hampshire, New Mexico, New York, Oklahoma, Oregon, Khode
Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Ver
mont, Virginia, Washington, W est Virginia, Wisconsin, and W y o
ming. The total number of group demonstrations reported in 27
of these States was 12,574, Georgia leading with 3,882 and New Y ork
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SUMMARY OF STATE ACTIVITIES DURING 192 7
15
being next with 3,249. Three States reporting group demonstrations
did not report the number made.
N U T R IT IO N W O R K
Instruction in nutrition has been a part of conference work, home
visits, and class work. Through these agencies and through litera
ture prepared and distributed by the States definite attention was
given to breast feeding and the introduction of suitable foods into
the infant’s dietary at the proper times, also to food values and food
elements in relation to the development and growth of the infant and
the preschool child. The dietary that will supply the mother’s re
quirements in the prenatal period and the effect o f her diet on her
unborn child have received much consideration. Twenty-four States
and the Territory of Hawaii stressed nutrition in the information
given to mothers at conferences, in the homes, or through other
contacts. The Kentucky bureau of maternal and child, health and
the New York division o f maternity, infancy, and child hygiene
had nutritionists on their staffs, and these workers gave lectures
and instruction on nutrition. Georgia and North Carolina also
reported much attention to nutrition work.
P R O M O TIO N O F B R E A S T F E E D IN G
The higher death rate among infants artificially fed than among
those breast fed has directed attention to the influence of the type
of feeding on infant mortality. Thirty-two States have promoted
breast feeding through talks by the State staff or advice given at
conferences, through special literature, charts, films, and pictures on
the subject, and through advice given by nurses in visits to the homes
of expectant mothers and of mothers of newborn babies. The gen
eral educational work has included instruction of mothers as to the
importance of keeping the baby on his mother’s milk and as to
methods of maintaining her supply of milk. Special work on breast
feeding has been done in several States during the year under review.
For example, New York conducted breast-feeding campaigns in
three communities (Hornell, Ithaca, and Cortland County), and
Michigan conducted breast-feeding surveys and campaigns in 10
counties.
P R E N A T A L CARE
Early studies in the field of infant mortality showed clearly the
relation of stillbirths and of some of the deaths of infants in the
first month of life to the care, or more accurately the lack of care,
that the mother had received during the prenatal period. Analysis
of statistics of maternal deaths indicated a certain proportion of
maternal deaths during both pregnancy and confinement to be attrib
utable to conditions arising during pregnancy, and some of these
deaths could have been prevented if the conditiohs referred to were
recognized early in pregnancy. Other conditions that might influ
ence childbirth could also be recognized through antenatal examina
tions of the mother and would influence or determine obstetrical pro
cedures that would effect a saving of maternal and infant lives.
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16
MATERNITY AND INFANCY
It was thus apparent from these statistical analyses that a certain
proportion of early infant deaths, stillbirths, and maternal deaths
could be prevented by medical supervision and proper care of preg
nant women and by a thorough knowledge of conditions before the
onset of labor.
.Educational programs directed toward informing expectant
mothers of the value of prenatal care and the necessity of placing
themselves early under the supervision of their physicians would fall
short of the desired result if the family physician did not render the
service expected. The State bureaus and divisions of child hygiene
have made an effort to meet this phase of the matter through the
distribution to physicians of the Children’s Bureau bulletin, Stand
ards of Prenatal Care.9 The standards outlined in this bulletin
were formulated by a committee of leading obstetricians of the
United States. According to the ideal standards referred to, the
pregnant woman should make regular visits to her physician during
her pregnancy— once a month in the first six months, then once every
two weeks or oftener as indicated, and preferably every week in the
last two months. She may expect a complete physical examination
in an early visit, including pelvic measurements (if she has never
had a living child), a Wassermann test, abdominal and pelvic exami
nations, urinalysis, taking o f blood pressure, and advice in relation
to diet, exercise, and general and special hygiene.
Copies of the bulletin, Standards of Prenatal Care, have been re
quested for distribution among the students in medical schools, and
the best medical schools are providing class instruction in prenatal
care as well as practice through prenatal centers in connection with<
their hospitals through out-patient departments. Two States (Ken
tucky and Oregon) contribute the services o f nurses to prenatal
centers used in the training o f medical students.
It has been demonstrated that stillbirths and infant mortality
due to syphilis may be lessened by the making of Wassermann tests as
a matter of routine, followed by intensive treatment o f the syphilitic
mother as early in pregnancy as possible. Pelvic measurements may
indicate the obstetrical procedure necessary to save the life of the
infant and that of the mother. Information obtained by urinalyses
and findings as to blood pressure indicating preeclamptic conditions
may save not only the life of the mother but also that of the child.10
Declines in neonatal mortality indicate the effect o f prenatal care.
Diet and hygiene of the mother can not be correlated so clearly with
neonatal mortality, but unquestionably these influence the vitality
of the child as well as that of the mother.
The establishment of prenatal centers or clinics offers a way of
instructing women as to the need of, supervision during pregnancy
and of giving this type of care to women who otherwise could not
obtain it. Organized effort to provide prenatal care as it is now
understood seems to date from 1908, when the New York Associa
tion for Improving the Condition of the Poor and the pediatric
department of the New York Outdoor Medical Clinic began to provide
prenatal care for some of the women of New York City. Other
9 S ta n d a rd s o f P re n a ta l C a r e ; an ou tlin e f o r th e use o f p h y sicia n s. U. S. C h ild re n ’s
B u rea u P u b lica tio n N o. 153. W a s h in g to n , 1925.
10 W elz, W . E . : “ P re n a ta l ca re benefits ca u se o f p u b lic h e a lth .”
T h e N a tio n ’ s H e a lth ,
vol. 7 (F eb ru a ry , 1 9 2 5 ), pp. 93—95, 156.
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Federal Reserve Bank of St. Louis
SUMMARY OF STATE ACTIVITIES DURING 192 7
17
cities followed this lead. In a health survey of 86 cities of 40 000
population the American Child Health Association reported
that 40 of these cities in 1923 had established prenatal clinics under
tlie guidance o f physicians, and 5 had established mothers’ coninnn110!63 directe(i by tbe local nursing organizations.11 In 1919 and
1920 there were prenatal clinics in 68 of the 83 cities whose popula
tion was approximately 100,000 or over according to the 1920 census
as ascertained in the course of a survey in which the American Public
Health Association and the United States Public Health Service
o c j o p e r ^ 12 Undoubtedly the number has increased since that date.
,nehcial effect of the prenatal care given is beyond question.
It has been found that the number o f deaths of women in childbirth
the number o f stillbirths, and the number o f deaths of infants under
1 month of age are less among groups of mothers who have had
prenatal and maternity care under skilled direction than am onogr29Ps not thus supervised with which comparison has been made.1®
these prenatal clinics and centers have been found feasible in the
cities and larger towns and have been promoted in them. Prenatal
clinics have flourished when properly conducted in connection with
hospitals that give obstetrical service. Successful prenatal centers
have been established independently or combined with urban childhealth centers. Beaching the rural districts with this prenatal serv
ice is much more difficult; but during the period of operation of
the maternity and infancy act the States have been working out
methods o f making prenatal care available for rural women, and
prenatal centers are developing, though slowly. This is indicated
|by the reports from the States of the establishment through their
work of 84 prenatal centers and combined prenatal and child-health
centers m 16 States during the year under review.
.
Pren*B&l center or conference in rural districts appears espeC1W
valuable in areas in which midwives are employed and in
which the midwives will cooperate with the center in securing pre
natal care for their patients. A few States have used the itinerant
prenatal conference as a feature of their plans for rural work. The
itinerant conference is an efficient means of demonstration for pur
poses of education, but no State would consider the itinerant pre
natal conference a solution o f the problem of providing prenatal
care for rural women. Approximately 16,200 expectant mothers
were examined by physicians in conferences during the year, but
this is a relatively small proportion of the whole number of expectant
mothers, even though it represents a considerable increase over the
number o f women reached through conferences in the preceding
years.
Many States have directed their prenatal work from the point of
view that the rural mother must look to her family physician for
care at confinement and should look to him for her prenatal care.
This being the case, the problem was to instruct her to present her
self to her family physician for a complete physical examination
^9
** A H e a lth S u rv ey o f 86 C ities by t h e R esea rch D iv is io n o f th e A m e rica n C h ild H e a lth
■A ss o cia tio n , p. 116. A m erica n C hild H ea lth A s s o cia tio n , N ew Y ork , 1925.
r>
t*b e C om m ittee on M u n icip al H ea lth D ep a rtm en t P r a c tic e o f th e A m e rica n
EESSJi
A ss o cia tio n in C oop era tion w ith th e U n ited S ta tes P u b lic H e a lth S ervice.
H e a lth B u lle tin N o. 136, pp. 1 -2 , 115. W a sh in g ton , 1923.
13 Ib id ., p. 116.
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Federal Reserve Bank of St. Louis
18
MATERNITY AND INFANCY
and for early and regular supervision during pregnancy. A general
educational program through the distribution of literature and pre
natal letters, correspondence courses, and instruction in classes and
in home visits has carried this message to many women in the rural
districts. During the year under review nurses have seen in the
course of home visits approximately 40,000 expectant mothers and
have emphasized to them the importance of early consultation of the
family physician. Mothers’ classes have reached more than 26,000
women with instruction on prenatal care, prenatal letters have been
the means of instruction in prenatal care for approximately 33,000
women, and pieces of literature numbering hundreds of thousands
on the subject o f prenatal care have been distributed by the States.
Instruction in prenatal care was given also to mothers at childhealth conferences. No figures can accurately indicate the total
number of women reached with general information on prenatal
care and advice as to the great value of medical supervision during
pregnancy.
County-wide demonstrations in prenatal care have been conducted
in rural counties in New York and Michigan. The demonstration
in Tioga County, N. Y ., to which reference has been made in pre
vious reports o f the administration of the maternity and infancy
act, was continued during the year; the nurses gave instruction in
prenatal care, urged early consultation of the family physician, and
rendered nursing service at the time of delivery. In Michigan’s
three county-wide prenatal demonstrations 645 mothers were under
supervision from January 1, 1926, to June 30, 1927. In both States
the cooperation of physicians, nurses, and expectant mothers was<
excellent, and appreciation of the service was general.
C A R E D U R IN G A N D A F T E R C O N F IN E M E N T
Maternal mortality rates in the United States as compared with
other countries having comparable registration of births and deaths
have been high and are still high. W ith the information at hand
these high maternal death rates can not be attributed to any one
cause or to one group of causes. Isolation resulting in inaccessibility
of medical, nursing, or hospital care at the time of confinement and
the employment of unskilled midwives undoubtedly have contributed
to the high death rate. Women from the Old W orld cling to the
custom of employing midwives. There the midwives are trained and
supervised; but in this country relatively few of even the white mid
wives have had training that meets Old W orld standards, while the
negro midwives in the past have been almost entirely untrained.
In practically all the States in which the employment o f midwives
has been a feature of obstetrical practice, some attention has been
given to supervising, licensing, and training. Many of the Mexican
and Negro midwives of the Southern and Southwestern States have
had class instruction and have been supervised and licensed; the
.most unfit have been eliminated. (See the following section.) The.
effect of this work can be given in general terms only, as but few of
the Southern States which have had extensive midwife work have
been in the United States birth-registration area long enough to show
results of the work expressed in terms of maternal and infant
mortality rates.
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SUMMARY OF STATE ACTIVITIES DURING 192 7
19
The development of entirely new groups of attendants at child
birth, such as the nurse-midwife, has not found a place in any State
program, though unofficial agencies are conducting demonstrations.
One State (Virginia) is training “ doctors’ helpers,” groups of both
white and colored women being given short courses o f instruction to
prepare them to give assistance to physicians in their obstetrical
practice.
.
But untrained midwives and isolated mothers do not constitute the
whole problem. Available statistics indicate that hospitals and
maternity homes vary in their maternal mortality rates. Some of
the high’maternal mortality rates unquestionably are due to the fact
that such institutions receive a large number of the difficult cases.
There is a great variation in obstetrical practice in hospitals, and
their mortality rates vary widely. The segregation of obstetrical
patients is not universally observed by hospitals. The American Col
lege of Surgeons has set up standards for obstetrical hospitals
and obstetrical departments of general hospitals (see p. 4 2), and
these, together with the standards for obstetrical technique followed
by the hospitals having very low mortality rates, furnish the guide
that should be followed. The care given to obstetrical patients in
hospitals and in maternity homes is outside the scope of the work of
State agencies administering the maternity and infancy act, except
as they may inspect maternity hospitals and homes and (as in Cali
fornia, Kansas, and South Dakota) license them.
Types of obstetrical care given by physicians influence maternal
mortality rates. Obstetrical methods and technique vary with the
physician. There is a slight downward trend in the rate of deaths
from puerperal sepsis and a somewhat more marked decline in deaths
from eclampsia or convulsions, but the rate of maternal deaths due
to accidents of labor is slowly rising; possibly this may indicate a
relation between accidents of labor and operative procedure in de
livery. It has been suggested that operative deliveries may increase
the neonatal deaths due to intracranial hemorrhage.14 A study of
maternal deaths which has been begun in several States with the
assistance of the United States Children’s Bureau may contribute
to a better understanding of the influence of certain obstetrical prac
tices on mortality from puerperal causes. (See p. 130.)
M ID W IV E S
Early in the administration of the maternity and infancy act the
States recognized the importance of the type of attendant at child
birth in relation to care during and after confinement and to maternal
mortality. A number of States made surveys of attendants, par
ticularly of midwives. Many States have no midwives or only a
negligible number. Some States have a friend-and-neighbor type
of midwife assisting as best she can when physicians are remote or
inaccessible. Still other States have in their population large for
eign-born groups accustomed to employing midwives. The midwife
u See “ T h e p resen t s ta tu s o f m atern al and in fa n t h y gien e in th e U n ited S tates, by
L ee K . F ra n k el (A m e r ic a n J ou rn a l o f P u b lic H ea lth , v o l. 17, no. 12 (D ecem b er, 1 9 2 7 ),
pp. 1 2 0 9 -1 2 1 7 ), a n d “ T h e ra te o f d evelop m en t o f th e im m a tu re a n d o f th e p rem a tu re
c h ild ,” b y A a r o n C apper, M . D . (A m e rica n J ou rn a l o f D iseases o f C hildren, v o l. 35, no. 2
(F e b ru a ry , 1 9 2 8 ), pp. 2 6 2 -2 8 8 ).
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Federal Reserve Bank of St. Louis
20
MATERNITY AND INFANCY
problem loomed largest in States having a large negro population
with negro midwives as attendants at births.
A s soon as knowledge o f conditions was accumulated, many States
through legislation or regulations passed by their boards of health
sought to control or supervise the practice of midwifery. The States
having any considerable number of midwives include instruction and
supervision of midwives in their maternity and infancy programs;
and an effort is made to have the midwives registered and licensed
and to compel them to conform their practice to State regulations.
The standards for qualification to practice vary in the different
States. New Jersey requires mid wives to complete a course in a
recognized school of midwifery before they can be licensed. Some
States require registration and a license to practice. This makes
possible supervision and the revocation of licenses if occasion
warrants.
In a number of States (mostly Southern, with large negro popula
tions and many negro midwives) classes were conducted by nurses
and by physicians. During the year under review 684 classes were
organized in 12 States; 10,881 midwives were enrolled in 14 States;
and 5,977 completed the course in 12 States, some having been car
ried over from the previous year. (Table 4.) The States conduct
ing these classes were Arkansas, Delaware, Georgia, Kentucky,
Louisiana, Maryland, Mississippi, North Carolina, South Carolina,
Tennessee, Texas, and Virginia. Florida and New York did not
report the number of classes, but Florida held 1,274 class meetings
with a total attendance of 3,595, and New York held 10 class meet
ings. In many of these States registration and licensing of the
midwife depend upon her completion of the course. Some negro
graduate nurses have attended the classes and qualified as midwives.
The old, the unfit, the diseased, ignorant, superstitious, and dirty
midwives are being eliminated, and a better type of negro midwife
is being developed .
White public-health nurses conducted many of the midwife classes,
but Alabama, Georgia, Maryland, Mississippi, Tennessee, and Texas
employed in either county or State work negro nurses whose duty
consisted in part or entirely of teaching midwives. Two negro
women physicians have been employed as instructors of negro mid
wives— one on the staff of the division o f child hygiene and publichealth nursing in Tennessee, and one on the staff of the United States
Children’s Bureau; the latter was lent during the year to the State
of Georgia.
Some States reported other methods than classes for instructing
midwives. Michigan requested the friend-and-neighbor type of mid
wife to attend the classes for mothers in prenatal and infant care,
after which they were given special instruction in regard to the as
sistance they might render in childbirth. New Jersey held 92
monthly meetings of organizations of midwives with an attendance
of 1,069 and has held four annual State conferences of midwives.
Pennsylvania held two institutes for midwives with more than 200
in attendance. Several States reported that nurses gave individual
instruction to mid wives or visited them in their homes. North Caro
lina reported 1,098 visits to midwives, New Mexico 590, New York
304. South Carolina reported that 550 midwives were seen in such
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Federal Reserve Bank of St. Louis
21
SUMMARY OP STATE ACTIVITIES DURING 192 7
visits; Arkansas stated that midwives were visited but did not report
Aumbers.
Supervision is usually accomplished through State or county
nurses, though many county health officers in the South have the
power to register, license, and supervise midwives. In Pennsylvania
two staff physicians assisted by nurses have supervised and instructed
midwives in nine counties. The number of midwives under super
vision varied greatly. For example, Mississippi reported 3,500, and
Pennsylvania 521 in nine counties.
T able 4.— Classes conducted for instruction in maternal, infant, and child
hygiene reported by 36 States and the Territory of Haaoaii cooperating under
the maternity and infancy act during the year ended June 30, 1921
Mothers’ classes
States and Terri
tory cooperating
T otal________
Little mothers’ classes
Number
Num ber
of m oth Number Girls
of classes
of classes Mothers
ers com
organ enrolled pleting organ enrolled
ized
ized
course
1,196
26,356
19,998
4
5
36
18
51
25
740
293
Georgia____________
69
1,207
1,207
K en tu cky........ ........
220
79
9, 749
3, 147
9,665
3; 147
76
89
77
1,223
1,036
lj 193
856
1,036
- 151
M aryland_________
V ir g in ia .-................
51
(*)
(»)
.(')
129
2,325
58
21
2
15
5
26
52
31
291
73
147
(8>
103
8
282
70
138
370
4
3
4
3
57
60
38
5
57
42
141
59
57
105
1,901
561
611
120
495
775
80
16
(i)
12 210
1,733
323
136
Girls
Num ber
com
of classes M id
wives
pleting organ
enrolled
course
ized
22,191
18,136
2
6
26
2
4
53
108
1
751
34
112
357
40
136
300
1,915
10
125
34
M
m
136
(«)
1,915
8
234
4,689
4,689
12
291
1
(«)
121
14
O
4
41
20
44
245
6,379
35
180
6,379
30
1,199
(9
M idw ives’ classes
684
(9
(1)
1,478
'214
185
214
89
409
250
931
8
198
238
732
19
(9
2,074
216
10
82
235
1,292
5,977
1,527
1,087
398
20
37
8 219
747
17
48
2
165
848
35
165
138
12
255
3,500
96
(9
(9
1,000
275
(9
5
275
9 1,333
2,002
(‘9
216
( 13)
275
83
10,881
747
(9
(9
112
(l°)
11
M id
wives
com
pleting
course
154
693
48
576
373
41
966
499
723
123
83
1,033
57
09
1 N ot reported.
2 Nine m id wives given individual instruction.
8 Includes 182 carried over from previous year.
4 Florida held 1,274 meetings for midwives with an attendance of 3,595; N ew Jersey held 92 meetings with
an attendance of 1,069; N ew Y ork held 10 meetings.
8 Thirty-five midwives attended mother’s classes, completing the course.
6 Sixty-five hygiene classes reported with 1,500 girls enrolled and 1,162 completing the course.
i T w o infant-hygiene classes held with 79 girls enrolled, all of whom completed the course.
8 8 to 30 in each class.
8 Includes 1,058 carried over from previous year.
10 Forty infant-hygiene classes held with 902 girls enrolled and 882 completing the course.
11 M idwives given individual instruction b y county nurses.
12 Includes 105 carried over from previous year.
13 One hundred and forty-two junior clubs organized with 3,190 girls and boys enrolled.
14 Infant-hygiene classes held in public schools.
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22
MATERNITY AND INFANCY
IN S P E C T IO N O F M A T E R N IT Y A N D I N F A N T H O M E S
The licensing and supervision of maternity and infant homes is
usually done through the public-welfare departments of the States
rather than the health departments, but inspection of maternity or
infant homes or of both maternity and infant homes by the staffs of
the child-hygiene bureaus or divisions o f a number of States was
reported. Thirteen States reported inspecting 880 maternity homes,
making 1,219 inspections: California, Colorado, Kansas, Kentucky,
Nebraska, New Hampshire, New Jersey, New York, Ohio, South
Dakota, Texas, Utah, and Virginia. In California, Kansas, and
South Dakota the agency administering the maternity and infancy
act has the power to license maternity homes and hospitals as well
as to inspect. Nine States reported inspecting 823 infant homes,
making 1,926 inspections: Delaware, Kansas, Kentucky, Nebraska,
New Hampshire, New Jersey, New York, Texas, and Utah.
C L A S S E S FO R A D U L T S IN IN F A N T A N D P R E N A T A L C A R E «
Classes in which women were taught maternal, infant, and child
care were conducted in 27 States. The total number of classes re
ported organized was 1,196, the number of lessons in the course vary
ing from 3 to 24. There were enrolled 26,356 women, mostly moth
ers, and 19,998 women were reported as completing the courses.
(Table 4.) The States reporting such courses were: Arizona, A r
kansas, California, Colorado, Georgia, Indiana, Kentucky, Mary-,
land, Michigan, Minnesota, Missouri, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, Oklahoma, Oregon,
Rhode Island, South Carolina, South Dakota, Tennessee, Texas,
Utah, Virginia, and West Virginia.
Indiana continued adult classes as a major feature o f the State
program of disseminating information on prenatal and infant care.
The plan is to cover every county in the State with this type of class
work, and all but 5 of the 92 counties have been covered. Three
units composed of a physician who lectures and a nurse who organ
izes classes and gives demonstrations are working in this State.
Indiana led in the number of classes organized:—220, with an en
rollment of 9,749 women, of whom 9,665 completed a course of 5
lessons. In Michigan a unit consisting of a physician and a nurse
conducted 89 classes with an enrollment of 1,036 women, all of whom
completed a course o f 8 lessons. The classes in other States were
usually conducted by nurses, Missouri leading this group of States
with 129 classes and 2,325 women enrolled. Kentucky conducted 79
classes, with 3,147 women enrolled and completing a course of 4
lessons. South Dakota enrolled 1,901 women in 57 classes, and 1,733
women completed a course of 7 lessons. Georgia reported 69 classes
with an enrollment of 1,207 women, all of whom completed a course
of 11 lessons.
15
F o r rep ort o f in s tru ction on p ren a ta l ca re g iv e n th ro u g h co rre sp o n d e n ce cou rses and
p ren a ta l le tte r s see pp. 2 5 -2 6 .
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SUMMARY OF STATE ACTIVITIES DURING 192 7
23
C L A S S E S F O R G IR LS IN IN F A N T C A R E ( “ L IT T L E M O T H E R S ’ *
CLASSES ” )
Instruction in infant and child care was given during the year to
girls about 10 to 15 years of age in 27 States and the Territory of
Hawaii. (Table 4.) The total number of classes reported organized
was 1,199. There were 22,191 girls enrolled, and 18,136 girls com
pleted courses consisting usually of 10 to 12 lessons. The States
reporting classes were: Alabama, Arizona, Arkansas, California,
Colorado, Delaware, Florida, Georgia, Kentucky, Maryland, Michi
gan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada,
New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Oregon,
Texas, Virginia, W est Virginia, and Wisconsin. Michigan led in
the number of classes organized (291) and in the enrollment of
6,379 girls, all of whom completed the course. Kentucky reported
234 classes, with 4,689 girls enrolled and completing the course.
Ohio conducted 112 classes, with 2,074 girls enrolled, 2,002 of whom
completed the course. In Wisconsin the State board of health
awarded certificates to 4,988 girls who completed the course in infant
hygiene given in the public schools; still other girls took the course
but were not reported for the granting of certificates.
Usually the instruction was given by nurses and covered the care
of the baby and the preschool child, bathing, dressing, and feeding
the baby, regulation of his habits, methods of preparing formulas,
diet of the preschool child, and prevention of communicable diseases.
IN S T R U C T IO N O F S P E C IA L G R O U PS IN M A T E R N A L A N D
CARE
IN F A N T
Several State bureaus and divisions have deemed it wise to dis
seminate the latest information on care of mothers and infants to
special groups which in turn inform the public on maternal and
infant care and hygiene. This type of instruction has been directed
particularly toward physicians, nurses, and teachers.
Graduate or extension courses or lectures on pediatrics and obstet
rics have been conducted for physicians in a few States. These
courses usually were given in cooperation with medical schools or
extension divisions o f universities or with State or county medical
societies. During the year Alabama had a series of pediatric clinics
conducted by a pediatrician on the staff of the bureau of child hygiene
and public-health nursing; local physicians joined in a round-table
discussion of cases presented. Maryland arranged lectures in pediat
rics before six county medical societies. The lectures were given
by the director of the State bureau of child hygiene and by members
of the pediatric departments of two of the medical schools of the
State. In Oklahoma the bureau of maternity and infancy cooper
ated with the extension division of the State university in conduct
ing graduate courses in pediatrics for physicians, 32 courses of nine
weeks each being given. Kentucky arranged a graduate course in
obstetrics for rural physicians, the obstetrician being lent by the
United States Children’s Bureau, and Maryland arranged lectures
in two counties by a professor of obstetrics from the State university
medical school. New York arranged for 7 courses in pediatrics and
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24
MATERNITY AND INFANCY
3 m obstetrics in various counties at the request of county medical
societies.
Several State bureaus and divisions of child hygiene arranged or
promoted special opportunities for the public-health nurses on State
and county staffs to obtain the newest information on methods of
informing parents about maternal and child care as well as the most
advanced information on the hygiene and care of mothers and in
fants. In some States conferences were held at regular intervals
in which methods and subject matter relating to maternal and infant
welfare were discussed. In other States the field training of nurses
was arranged through supervision by the State staff or through hav
ing the nurses work in counties in which there was a well-organized
nursing service under an able supervisor. Special leave also was
arranged to afford opportunity for graduate work. A majority of
the States reported that maternity and infancy nurses on the State
staff, including the county nurses receiving maternity and infancy
funds, met the standards for public-health nurses formulated by the
committee representing the National Organization for Public Health
Nursing, the nursing section of the American Public Health Associa
tion, and the Conference of State and Provincial Health Authorities
of North America in 1924.
Instruction for teachers or normal-school students to train them
for conducting classes for girls in infant care or in infant and ma
ternal care received attention in several States. In Indiana classes
were conducted at a number of teachers’ institutes. Oklahoma or
ganized classes in which nearly 900 teachers were enrolled, more
than 700 completing a course that averaged 15 lessons. In New
Jersey a course of 10 lectures was given to the senior students of the
five State normal schools. In Wisconsin, where infant-care courses
were made a part of the public-school curriculum in 1923, the teachers
are prepared for this work by instruction in normal schools and
teacher-training departments of high schools. The staff o f the W is
consin bureau of child welfare includes an organizer and an assistant
organizer of infant-hygiene classes who devote their time to teacher
training work. There is a growing tendency in the United States
to introduce infant-care courses in continuation schools and in col
leges, and in other ways to train young women in the fundamentals
of infant care and hygiene. The cooperation of State departments
of health and of public instruction affords great opportunities for
increasing the knowledge o f the care o f infants among the next
generation of mothers.
TALK S A N D LECTURES
Information of a general character relating to the welfare of
mothers and infants was given through talks and lectures in all
except one o f the cooperating States and in Hawaii. Thirty-eight
child-hygiene bureaus or divisions reported addressing 13,442 lay
groups. (Table 5.) Additional talks or lectures on phases of ma
ternity and infancy work were given to 110 radio audiences in 18
States. Special information on maternal and infant care was trans
mitted to technically trained groups through talks and lectures.
Twenty-nine bureaus or divisions reported talks or lectures given
to 408 groups of physicians; these included addresses to dentists and
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25
SUMMARY OF STATE ACTIVITIES DURING 192 7
to health officers. Thirty-two reported special talks or lectures to
794 groups of nurses. Five States did not report the number nor
the character of audiences addressed.
T able 5.— Educational work conducted through talks and lectures, prenatal
letters, and distribution of literature in the States and Territory of Hawaii
cooperating under the maternity and infancy act during the year ended June
30, 1927
Prenatal letters
Talks and lectures
Num ber given to -
States and Territory
cooperating
Total
T otal
18,207
____ _________
California___________ _________
Kentucky ________ ___________
M ichigan_____ ____ _______ ik
M innesota__ _______ _________
Missouri T_____________________
N e b ra sk a .....................................
Oklahoma
_____ ________
...
South Dakota....................... . . .
W est Virginia._____ __________
2,023
72
103
448
421
175
285
329
13
21
770
238
6
335
93
135
133
3,697
555
770
55
107
163
211
314
214
11
444
888
529
229
28
309
182
571
1,496
36
38
126
82
571
503
93
Lay
Physi Nurses
groups
cians
408
(')
ñ
794
(>)
1
11
28
6
55
6
1
1
11
(9
48
5
3
1
2
3
15
2 40
52
3Ì
1
29
25
32
1
10
35
10
(9
(9
8
1
(9
70
80
(9
347
164
223
299
11
16
752
165
5
270
4
74
2
24
89
129
83
3,652
'489
757
41
107
159
127
312
153
18
10
11
444
849
516
2
20
18
10
10
12
0)
3
11
8
1
1
1
14
w
2
1»
1
12
385
13,442
15
(9
4
12
2
9
18
0)
39
2
Radio
audi
ences
110
(9
(9
46,217
Pieces of
literature
distrib
uted
4,403, 218
(9
1,787
5, 526
432
372
293
325
49
1,500
618
224
2,500
618
• 2,690
1,133
3,233
1,830
820
437
130
812
437
457
1,000
5,459
6, 500
7,896
875
9,719
1,025
7
21
1
15
1
3
3
1
2
24
3
1
2
11
3
(9
(9
(9
456
90
32,584
159
(9
556
1,476
33
37
116
40
Number
of sets
distrib
uted
1
(9
27
291
Number
of new
names
enrolled
l
350
512
3,876
478
3,908
2,438
10
(9
1,769
2,311
1,422
2,881
150,103
56, 783
52, 645
128,740
12,250
61,100
18,000
109,141
13,054
168, 259
53,378
1,224
56,749
18, 531
129,000
336,369
156, 982
10,000
534,848
134, 529
53,543
2,547
190,955
55,877
25,000
376,916
82,391
17,945
105,000
253,000
30,000
207,371
73, 208
34,125
40,000
27,392
49,403
11, 669
4,036
170.158
18,000
96,266
269,973
6,750
1 N o t reported.
2 Dentists.
3 Health officers’ meeting; nurses present also.
C O R R E SP O N D E N C E C O U R S E S A N D P R E N A T A L L E T T E R S
Instruction in prenatal and infant care was given to women
through correspondence courses by four States : Minnesota, Virginia,
Washington, and W est Virginia. In three of these States the les
sons were corrected and returned.
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26
MATERNITY AND INFANCY
Prenatal letters were used as a medium of instruction for expect
ant mothers in the essentials of the care and hygiene of pregnancy
by 22 States: Arizona, California, Delaware, Idaho, Kansas, Ken
tucky, Louisiana, Michigan, Minnesota, Missouri, Montana, Ne
braska, Nevada, North Carolina, Oklahoma, Oregon, South Dakota,
Tennessee, Texas, Virginia, W est Virginia, and Wisconsin. The
number of new names reported enrolled during the year was 32,584.
The number o f sets of letters reported distributed in 21 of these
States was 46,217; one State did not report the number distributed.
Oklahoma reported enrollment o f 7,896 new names and distribution
of 9,719 sets of letters. North Carolina enrolled 5,459 names and
distributed 6,500 sets of letters. (Table 5.) This service has been
greatly appreciated by the women who received the letters. Enroll
ment usually was made through the requests of the women themselves
or through requests of physicians or nurses for their patients.
D IS T R IB U T IO N O F L IT E R A T U R E
A ll the States reported distribution of literature relating to the
hygiene and care of mothers, infants, and preschool children; and
more than 4,400,000 pieces of literature were distributed during the
year under review. (Table 5.) This material consisted largely of
publications prepared by State agencies and of bulletins, folders,
dodgers, and leaflets prepared by the United States Children’s
Bureau, which were distributed directly by the States. A number
of bureaus and divisions send information on the care of the baby to
parents of infants whose births are registered in the State health
departments. Missouri reported distributing more than 500,000
pieces of literature. New York distributed approximately 377,000
pieces, Michigan more than 336,000, Wisconsin about 270,000, Okla
homa 253,000, Pennsylvania more than 200,000, and New Hampshire
almost 200,000. Indiana and Virginia each distributed approxi
mately 170,000 pieces, Minnesota more than 150,000, and Alabama
approximately 150,000. California, Georgia, Maryland, Montana,
and Ohio each distributed more than 100,000 pieces.
The greater part of the literature went directly to parents. A
relatively small amount went to physicians, nurses, teachers, and lay
persons assisting in child-health work for use in their own fields for
disseminating information on maternal and child welfare. Litera
ture provides information that is available to the most remote set
tlers. State and Federal publications on infant care, child care, and
prenatal care are treasured possessions among many isolated people.
Expressions of appreciation of information on the care of babies
that was obtained through these publications are to be found in the
files of every State agency administering the maternity and infancy
act.
E X T E N S IO N O F T H E U N IT E D S T A T E S B IR T H A N D
R E G IS T R A T IO N A R E A S
DEATH
Thirty-five States and the District of Columbia were in the United
States birth-registration area at the beginning of 1927. Before
June 30 of that year Arkansas and Tennessee had been admitted,
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SUMMARY OF STATE ACTIVITIES DURING 192 7
27
bringing the total number of States in the registration area to 37.16
Colorado, New Mexico, Oklahoma, South Carolina (which was
dropped from the birth-registration area in 1925), and Texas con
ducted campaigns to raise their registration sufficiently to obtain entry
into the birth-registration area.
Forty-two States, the Territory o f Hawaii, and the District of
Columbia were in the death-registration area at the close of the
fiscal year 1927, Arkansas having been admitted early in February,
1927. During the year Georgia and Texas passed satisfactory laws
governing the registration of births and deaths.17
Some of the States already in the area reported work to improve
birth registration still further. Many States send birth-registration
certificates to parents of babies whose births are registered in the
State department of health. Usually literature on the care of the
baby accompanied such certificates, hence registration of births pro
vided a means of reaching parents with information on the care of
their babies.
The National Committee to A id Completion of the Registration
Area before 1930 is assisting the States not in the areas by contribut
ing money, statisticians, and clerical or field workers. The com
mittee, which was formed by the American Public Health Associa*
tion, is composed of representatives from the United States Bureau
of the Census, the United States Children’s Bureau, the United
States Public Health Service, the American National Red Cross, the
United States Chamber of Commerce, the National Tuberculosis Asso
ciation, the Boy Scouts of America, and two large life-insurance
S U R V E Y S A N D C A M P A IG N S
During the year under review 34 States conducted surveys or
campaigns or both surveys and campaigns. Some were state-wide,
others were restricted to a county or group of counties or to a locality.
Frequently a campaign was conducted at the same time as a survey
in the effort to improve conditions found. Seventeen States reported
a total of 51 surveys. These related to midwives, maternal and in
fant mortality, and other conditions affecting the care of mothers,
infants, and preschool children. Twenty-nine States reported 68
campaigns. These were for promotion of birth registration, for
examination of preschool children and correction of their defects,
for immunization of infants and preschool children against diph
theria or other specified communicable diseases, for promotion of
breast feeding, and for other improvements in maternal and child
welfare and hygiene.
10 Alabama, Louisiana, and Missouri were admitted in 1927 after June 30. Georgia was
admitted in December, 1927, as of the year 1928, making a total of 41 States and the
District of Columbia in the birth-registration area, including 89.9 per cent of the total
estimated population of the United States. The seven States outside the area in January,
1928, were Colorado, Nevada, New Mexico, Oklahoma, South Carolina, South Dakota,'and
Texas. Nevada and South Dakota have not yet enacted satisfactory registration laws.
Oklahoma was admitted in April, 1928.
17 Georgia was admitted in December, 1927, as of the year 1928, making a total of 43
States in, the death-registration area, including 93.5 per cent of the total estimated popu
lation of the United States. The five States ouside the area in January, 1928,
were Nevada, New Mexico, Oklahoma, South Dakota, and Texas. Nevada and South
Dakota have not yet enacted satisfactory registration laws. Oklahoma was admitted in
April, 1928.
892°— 28----- 9
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Federal Reserve Bank of St. Louis
28
M A T E R N IT Y AND IN F A N C Y
“ Get Ready for School ” campaigns were sponsored by the parentteacher association (National Congress of Parents and Teachers) in
many States. Under their plan State and local parent-teacher groups
arranged for examination in the spring of the year for the preschool
children who would enter school in the fall. The examinations were
made by physicians in their offices and at health conferences. Cor
rection of remediable defects was urged during the summer, and im
munization against diphtheria, smallpox, and typhoid fever was
given to a large number of preschool children. A final check-up just
before school opened was also recommended as a means of encourag
ing correction of defects. The children were then ready to enter
school in the best physical condition possible, and measures to prevent
communicable diseases for which there are well-recognized immuni
zations had been taken. State agencies directing the maternity and
infancy work assisted the parent-teacher associations in their cam
paigns by supplying literature, detailing personnel to conferences,
and giving help in plans and follow-up work. Sixteen States re
ported campaigns or special assistance given to “ Get Ready for
School ” campaigns: California, Colorado, Indiana, Kentucky, Mich
igan, Missouri, Montana, Nebraska, New Hampshire, Oregon, Penn
sylvania, Texas, Utah, Virginia, W est Virginia, and Wyoming.
The celebration of May Day as Child Health Day in cooperation
with the American Child Health Association was reported by 15
States: Georgia, Indiana, Kentucky, Michigan, Missouri, Montana,
New Hampshire, New Jersey, Ohio, Oregon, Pennsylvania, Tennessee,
Texas, Utah, and W est Virginia. Some directors of State bureaus
or divisions of child hygiene served as State chairmen for the
celebration of May Day as Child Health Day.
O R G A N IZ A T IO N S
C O O P E R A T IN G IN T H E M A T E R N IT Y
IN F A N C Y W O R K
AND
The agencies administering the maternity and infancy work in
42 States and the Territory of Hawaii reported what probably is an
incomplete list of public or private organizations cooperating ac
tively with them. Most of these were state-wide. The State parentteacher association was reported as giving cooperation in 38 States,
State federations of women’s clubs in 30 States, the State league of
women voters in 19 States, the Women’s Christian Temperance
Union in 10 States. The American Red Cross assisted in 16 States,
the State tuberculosis association in 11 States, the State publichealth association in 5 States, and a State tuberculosis and publichealth association in 1 State. Four State medical societies and six
State dental societies cooperated. The extension service of the State
university or other State educational institutions cooperated in 8
States, the State department or board of education in 7, and the
State farm bureau in 3. The American Legion gave assistance in
3 States, the Society for Crippled Children in 2, the American
Association of University Women in 2, the auxiliary of the State
medical association in 3, and the auxiliary of the American Legion
in 6. In addition the following agencies were reported as cooperat
ing by at least 1 State: State department o f institutions and agencies,
Child Study Association, Visiting Nurse Association, Congress of
Mothers, Home Makers’ Club, Child Conservation League, State
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SU M M ARY O F STATE ACTIVITIES DURING 1 9 2 7
29
Charities A id Association, State Fair Association, State grange,
State legislative council of women, Council of Farm Women, Dis
abled Veterans, Psychopathic Hospital, Mormon Relief Society, Mor
mon Mission, Catholic Women’s League, and Children’s A id Society.
The States reported about 100 organizations as cooperating in the
work. I f the State branches of the National organizations are
counted separately the total number of associations or agencies
reported as cooperating was more than 200.
The cooperation and assistance given by state-wide organizations
varied. They lent trained personnel for conferences and centers;
they gave active assistance through lay workers at conferences and
m organizing conferences; they supplied groups for class instruc
tion ; and they rendered financial assistance for special pieces of
health work. Their support and approval o f the maternity and
infancy work as conducted by official agencies have had a great
influence in the development of activities for the promotion of the
welfare and hygiene of maternity and infancy, and their value has
been incalculable.
AGRIOÏÏLTÏÏEÂL & MEDIATOMI*
COLLEGE OF TEXAS L IB M B Ï
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SOME RESULTS OF FIVE YEARS OF WORK UNDER THE
MATERNITY AND INFANCY ACT
The close of the fiscal year ended June 30, 1927, terminated the
five-year period of the cooperation of State and Federal agencies
under the maternity and infancy act for which the appropriation
was originally authorized.18 A brief review of the work during this
time is therefore given before the more detailed summary of the
work of the States ,in the fiscal year 1927 is presented.
Each year since the passage of the act for the promotion of the
welfare and hygiene of maternity and infancy has seen an expan
sion of activities within the States, and an increasing number of
yStates have accepted the provisions of the act. A t the close of the
"fiscal year ended June 30, 1923, all State legislatures had met since
the passage by Congress of the maternity and infancy act, 40 States
had accepted its terms through action of their legislatures, and the
governors of these States had signed the act of acceptance. The
8 States that had not passed acts of acceptance at the close of the
first year of operation of the act were Connecticut, Illinois, Kansas,
Louisiana, Maine, Massachusetts, Rhode Island, and Vermont. The
Maine Legislature had passed an acceptance act, but the governor ^
had vetoed it. Connecticut and Kansas were still cooperating under ^
their governors’ acceptances in accordance with the section of the
maternity and infancy act permitting cooperation until six months
after the adjournment of the first regular session of the legislature
following the passage of the act.19
During the fiscal year 1925 the legislatures of Louisiana, Rhode
Island, and Vermont accepted the provisions of the act, as did also
the Territory of Hawaii, to which the benefits of the act had been
extended by action of the Sixty.-eighth Congress. Five States then
remained in the noncooperating group— Connecticut, Illinois, Kansas,
Maine, and Massachusetts. There were no additional acceptances in
the fiscal year 1926, but at the close of the fiscal year 1927 the num
ber of cooperating States had increased to 45, Kansas and Maine
haying accepted the terms of the act. Consequently, at the close
of the five-year period only three States— Connecticut, Illinois, and
Massachusetts— remained in the noncooperating group.
E X P A N S IO N O F A C T IV IT IE S
Each annual report from the States has shown growth in the work
not only through better reporting but also through more successful
adaptation of the State program to the State problems and through
expansion of activities. During the fiscal year ended June 30, 1927,
is As the funds became available Mar. 20, 1922, a few States had cooperated two or three
months more than five years when the fiscal year ended on June 30, 1927.
10 See sec. 4, Appendix A, pp. 135-136.
30
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SOME RESU LTS OF FIVE YEARS OF W O R K
31
more than 160,000 expectant mothers were reached in the 38 States
reporting on this item and more than 1,000,000 infants and preschool
children were reached in the same number of States reporting.
Maternity and infancy work in more counties within the States
was reported at the close of the fiscal year 1927 than in preceding
years. The cooperating States and the Territory of Hawaii com
prise 2,937 counties. In 2,460 (83.8 per cent) of these counties some
maternity and infancy work has been done during the period of
cooperation. Twenty-one States reported work in every county, 11
reported work in more than 90 per cent of the counties in the State,
and 9 additional States and Hawaii reported work done in more
than 75 per cent of the counties during the period of cooperation.
The number of counties in which maternity and infancy work was
carried on during the year under review was 1,884, and 9 States
reported maternity and infancy work conducted in every county.
(Table 3.) There was an extension of work to 134 more counties
in 1927 than had been reached in the same States at the end of the
fiscal year 1926. Some of the counties not yet reached are isolated,
inaccessible, sparsely populated, or unorganized. In some of them
it may possibly never be feasible or desirable to conduct a maternal
or infant welfare program. Some have been left untouched because
they are nearly or exactly coterminous with cities that have maternity
and infancy work administered by municipal agencies. Thirteen
States reported that a total of 69 counties, 5 towns, and 1 city had
taken over maternity and infancy work initiated or assisted by the
State bureaus or divisions.
The number of activities has increased each year and at the same
time the contacts with parents and children made through them.
Each succeeding year has shown a larger number of permanent
centers and a larger number of counties and communities assuming
support of maternity and infancy work. A n increasing enrollment
in mothers’ and girls’ classes is noted. Larger numbers of pamphlets
and other literature have been distributed. More home visits by
nurses were reported in 1927 than in former years. Decreases re
ported for certain activities in some States may be due to changes in
the program in line with the general trend toward improved and
more permanent types of work. From year to year the State bureaus
or divisions have curtailed certain activities and replaced them by
other forms of work, or other agencies or groups have taken over
some of the work begun by the State cooperating agency. In some
States itinerant conferences have given place to conferences at per
manent centers, the itinerant-conference work having been discon
tinued by a few States that have looked upon the itinerant confer
ence as a demonstration of the necessity for closer supervision of
mothers and infants that should result in the supplying of such
supervision by the family physician. Still other States have reduced
the number of conferences conducted by nurses with no physician
present and have gradually interested local physicians in conduct
ing health conferences if the State bureau or division of child
hygiene did not or could not provide medical service. ^The enroll
ment of midwives in classes has decreased as the midwives have re
ceived instruction and have been licensed and supervised and as
their practice has been restricted. The responsibility for instruc-
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32
M A T E R N IT Y AND IN F A N C Y
tion in infant care for girls in schools has been assumed by educa
tional departments in some States, and this has lessened the enroll
ment in classes for girls conducted by State agencies cooperating
under the maternity and infancy act.
Each year has added a new group o f parents to the sum total of
the groups of former years that have received information on ma
ternal and child care. They in turn have widened the circle of in
formed persons by imparting a measure of their knowledge to others
with whom direct contact had not been made. The extent o f the
educational work under the act can not be measured in figures. In
directly it has reached with instruction in better care of mothers
and babies many parents who have no knowledge of the act itself
or the source of their inspiration for more scientific care.
IN C R E A S E I N P U B L IC K N O W L E D G E O F M A T E R N A L A N D IN F A N T
CARE
Placing the emphasis on educational work in State programs for
the promotion of the welfare of maternity and infancy has resulted
in a great increase in public knowledge of care of infants and
mothers. This increase has been the chief result of the five years of
cooperation under the act. It has not been confined to parents but
has been extended to all groups that have had contacts with infants
and mothers or with the maternity and infancy act— including legis
lative bodies, health departments, technically trained people, lay
organizations, and finally the mothers and fathers themselves. The
effects will be cumulative. Knowledge based on sound principles may
be confined to relatively few people in one generation but becomes
the common property and knowledge of succeeding generations. The
increase in popular interest in maternal and infant welfare and the
greater attention directed to ,it by State administrative agencies dur
ing the period o f cooperation under the act will insure better care
for mothers and babies of the United States in the future than has
been available to them in the past, if the interest is sustained by
continuation and expansion of the work.
E S T A B L IS H M E N T O F C H IL D -H Y G IE N E B U R E A U S OR D IV IS IO N S
The first maternity and infancy bij.1 was introduced in the Sixtyfifth Congress July 1,1918. The Children’s Year campaign also was
inaugurated in that year, on April 6. The Chief of the Children’s
Bureau had recommended in the Fifth Annual Report o f the Chil
dren’s Bureau, for the year ended June 30, 1917, encouragement o f
public protection of maternity and infancy through Federal aid.
A ll these factors doubtless influenced interest in maternal and child
welfare and resulted ,in legislation in a number of States to establish
and maintain agencies to conduct such work. Before 1918 nine
States— Illinois, Kansas, Louisiana, Massachusetts, Montana, New
Jersey, New Mexico, New York, and Ohio— had child-hygiene bu
reaus or divisions. During 1918 three additional States— Colorado,
Florida, and Virginia— established child-hygiene bureaus.
The
original maternity and infancy bill with subsequent amendments
came up for consideration before three Congresses— the Sixty-fifth,
the Sixty-sixth, and the Sixty-seventh. I t was passed November 21,
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SOME RESULTS OF FIVE YEARS OF W O R K
1921, and became a law when signed by the President November 23,
1921.
In 1919, largely as a result of the child-welfare campaigns con
ducted by the United States Children’s Bureau in cooperation with
the women’s division of the Council of National Defense, 15 States—
Arizona, Arkansas, California, Connecticut, Georgia, Indiana, Ken
tucky, Missouri, North Carolina, Pennsylvania, Bhode Island, South
Carolina, Texas, W est Virginia, and Wisconsin— created childhygiene bureaus or divisions in their State departments of health,
and one State— Idaho— created such a bureau in its department of
public welfare. In anticipation of the passage of the maternity and
infancy act five more States— Alabama, Maine, Michigan, Missis
sippi, and Washington— established child-hygiene bureaus or di
visions in 1920; and New Mexico reorganized its system, establish
ing a division of child hygiene and public health nursing in the
bureau of public health, State department of public welfare.
In 1921 four more States— Delaware, Nebraska, Oregon, and South
Dakota— established child-hygiene bureaus or divisions. Nine States
established such agencies in 1922 after the passage of the act— Mary
land, Minnesota, Nevada, New Hampshire, North Dakota, Oklahoma,
Tennessee, Utah, and W yom ing; and Iowa organized a division of
maternity and infant hygiene in connection with the extension serv
ice of the State university. In 1925, after the extension of the bene
fits of the act to Hawaii, the Territorial board of health established
a division of maternity and infancy. Vermont has never created a
separate division in its department of public health.
Forty-seven States and the Territory of Hawaii had child-hygiene
bureaus or divisions at the close of the five-year period under discus
sion, 11 having been created following the passage of the act.
Twenty-eight States created such divisions during the consideration
o f the bill by the three Congresses, and 39 State and Territorial childhygiene divisions have been instituted since the recommendations by
the Chief of the Children’s Bureau were made in the report of 1917
for public protection of maternity and infancy and for Federal aid.
IN C R E A S E I N S T A T E A P P R O P R IA T IO N S FO R C H IL D -H Y G IE N E W O R K
The increase in appropriations for maternity and infancy work
made by the State legislatures since the passage of the act has been
notable. In a number of States in which no appropriation had
previously been made for child-hygiene work State funds were made
available for this purpose in order to match the appropriations made
by the Federal Government under the mateTnity and infancy act;
and several of the States not cooperating under the act increased
their appropriations as a result o f the public discussion of needs
which the passage of the act precipitated.
The amount of Federal funds accepted from the 1923 appropriation
was $716,333.40. A n increasing amount has been accepted from each
o f the succeeding appropriations; the amount accepted from the 1926
appropriation was $949,646. Although only $904,824.71 had been
accepted from the 1927 appropriation at the close of the fiscal year
ended June 30, 1927, this appropriation, like those preceding it, is
available for a two-year period, and the amount that will have been
accepted from it before it expires will undoubtedly exceed the amount
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34
M A T E R N IT Y AND IN F A N C Y
accepted from any previous appropriation.20 Some o f the increase in
the amounts accepted is due to the increase in the number of States
accepting the benefits o f the act and to larger State appropriations.
Among the States having no State appropriations for child-hygiene work before the year 1921 were Arkansas, Iowa, Maryland,
South Dakota, and Tennessee. Among the States that had appro
priations in 1921 and made larger appropriations after the passage of
the act were Alabama, Arizona, Georgia, Indiana, Michigan, Mis
souri, Montana, New York, South Carolina, Virginia, and Wisconsin.
Only one State, New Jersey, is appropriating less than before the
Federal funds became available.
State funds and Federal funds accepted by States have in turn been
matched by many counties or communities. In this way the circle
of resources and activities for the welfare o f mothers and babies has
been constantly extended.
E X T E N S IO N
OF THE
B IR T H
AND
DEATH
R E G IS T R A T IO N A R E A S
Accurate birth and death statistics are the foundation upon which
the superstructure of programs for the improvement of maternal
and child welfare should be built. I f registration o f births and
deaths is not at least approximately complete one of the first steps in
the program should be improvement in registration in the area con
cerned. It is obvious that workers in the field of child hygiene should
know how many babies are born and where they are. Reporting
deaths is equally important for a knowledge of the proportion of
infants dying within a given period and the causes of their mor
tality. I f any cause of infant deaths is conspicuous in a given lo
cality, the program should be directed toward combating that par
ticular cause and the factors leading to it. For instance, a better
milk supply may be needed to reduce a high infant mortality from
diarrhea and enteritis. A n increase in neonatal deaths directs atten
tion to the types of obstetrical procedure employed and the character
of the prenatal care given. A higher death rate from communicable
diseases calls for closer analysis and for immunization against the
diseases for which a method of immunization is known.
In like manner statistics as to deaths due to causes associated with
pregnancy and childbirth are a prerequisite in planning the maternity
program. A high death rate from puerperal sepsis indicates the
need for better nursing and obstetrical technique. A high death rate
from albuminuria and convulsions demands an aggressive campaign
for prenatal care. A relatively high death rate from accidents of
pregnancy may give reason for pause and an analysis of operative
obstetrical procedures.
Since the beginning of work under the maternity and infancy act
the administrative agencies in all the States not in the birth-registra
tion area have emphasized the importance of registration and have
assisted in promoting it, and States already in the area have reported
work to improve their registration.
Before the maternity and infancy act was passed 27 States were
in the birth-registration area; at the close of the fiscal year 1927 the
20The sum that had been accepted from the appropriation at the close of the fiscal year
1928 was $965,136.24.
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Wf
SOME RESULTS OP PIVE YEARS OP W O R K
35
number in the area was 37. Four were admitted in the following six
months so that at the time of writing (February, 1928) only 7 States
are outside the birth-registration area: Colorado, Nevada, New
Mexico, Oklahoma,21 South Carolina (which was dropped from the
area in 1925), South Dakota, and Texas. Two of these States—
Nevada and South Dakota— have not satisfactory registration laws.
The remaining 5 are conducting birth-registration campaigns or are
under test by the United States Bureau of the Census.
Before the maternity and infancy act was passed 34 States were
in the death-registration area. A t the close of the fiscal year 1927
8 additional States had been admitted to the area. Only 5 States
now remain outside the death-registration area— Nevada, New
Mexico, Oklahoma,21 South Dakota, and Texas. The absence of
satisfactory registration laws in Nevada and South Dakota makes
action by the legislatures of these States necessary. New Mexico,
Oklahoma, and Texas are conducting active campaigns to achieve the
90 per cent registration required by the United States Bureau of the
Census before admission to the area.
The assistance rendered within the States by members of the bu
reaus or divisions administering the maternity and infancy act and
by personnel lent by the United States Children’s Bureau to the
States conducting birth-registration campaigns has been a large
factor in the extension of the area. Workers from State bureaus or
divisions gave assistance in 10 of the 15 States that have been ad
mitted to the birth-registration area since 1921— Alabama, Arizona,
Arkansas, Florida, Georgia,22 Idaho, Louisiana, Missouri, Tennessee,
and West Virginia. Personnel was lent or other assistance given by
the United States Children’s Bureau to 5 of these States— Arkansas,
Georgia, Idaho, Louisiana, and Tennessee. Workers from State
bureaus or divisions also assisted in 6 of the 9 States admitted to the
death-registration area since 1921— Alabama, Arizona, Arkansas,
Georgia,22 Idaho, and W est Virginia.
Registration of births and deaths has been stimulated through the
previously mentioned assistance given by the Committee for the
Completion of the Registration Area before 1930.
(See p. 27.)
The cooperation of the national organizations and governmental
agencies represented on the committee has given much impetus to
the completion of the registration areas. It seems altogether pos
sible that the aim stated in this committee’s slogan “ Every State in
the birth and death registration area by 1930” may be an accom
plished fact on that date.
R E D U C T IO N IN I N F A N T M O R T A L IT Y
Mortality rates for the year 1927 are not yet available,23 but pre
liminary reports from the States indicate that the cumulative effect
o f the work of the past five years is shown in a much greater saving
o f life than has been accomplished in any previous year. W ith an
expanding registration area rates are not entirely comparable from
year to year. Fluctuations will o f course occur because of climatic,
31 Oklahoma was admitted to the birth and death registration areas Apr. 23, 1928.
22 See footnotes 16 and 17, p. 27.
, 28 Since this report was written a provisional infant mortality rate of 64.6 for A e
birth-registration area (excluding Utah) in 1927 has been announced by the U. S. Bureau
of the Census.
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36
M A T E R N IT Y AND IN F A N C Y
epidemic, and social causes from year to year. The general level
around which the fluctuations occur or the trend in the rate reflects
permanent gains or losses. The trend was downward before the
maternity and infancy funds become available. Thus the rate (that
is, the number of deaths per 1,000 live births) in the United States
birth-registration area of 1916 was 101 (with the urban rate 104 and
the rural rate 97), whereas in 1921 it was 76 (78 in urban areas
and 74 in rural areas). Many agencies contributed to this reduction.
Knowledge of the value of the child-health centers, demonstrated
in a few urban centers, was resulting in the establishment of childhygiene bureaus or divisions in the health departments of many cities
and some inadequately supported State bureaus; private societies,
especially infant-welfare societies, and the national child-health
associations were also factors. The United States Children s Bureau
from the day of its organization had stressed the importance of
reducing our unnecessarily high infant mortality rate. In 1918 and
1919, in cooperation with the women’s committee of the Council
of National Defense, the Children’s Bureau sponsored the Children’s
Year campaign, which reached practically every county in 47 States
with a more or less successful educational program in child health
and resulted in the establishment o f child-hygiene bureaus or divi
sions in 16 States. In 1918 the mortality rate was high, probahly
owing to the epidemic of influenza, but 1919 established a new low
level b( 87) for the United States birth-registration area.
It should be noted in this connection that it is easier to reduce a
high rate than a rate already low. When the rate is high, as it was
in 1916 in the United States, almost anything that is done will reduce
it, because almost everything is wrong. After the rate is lowered
the program must be carefully adapted to the ascertained facts as to
the contributing factors in the death rate. Although there was a
further reduction between 1919 and 1921 (12.6 per cent), it was
relatively less than between 1916 and 1919 (13.9 per cent). W ith new
resources made available in 1922 under the maternity and infancy act
much new work was initiated all over the country. Increasingly this
work has been placed on a factual basis of needs and has reached
a larger proportion of parents. Thus if the program is continued
its results will be reflected in future rates more than in those of
any single year that has passed. The general trend of the rates for
the birth-registration area from 1921 to 1926, the last year for which
figures are available, has been downward with 1924 the lowest,
when the rate was 71 (72 in urban areas and 69 in rural areas).
Infant-mortality figures for the birth-registration area m 1926
and in 1921 are not entirely comparable because in 1921 only 27
States were in the birth-registration area, whereas by 1926 there
were 35 (1 State was dropped from the area during this period), the
9 that had been admitted to the area including several with infant
mortality rates higher than that of the birth-registration area as a
whole, yet the general trend has been downward. The Northwestern
States, which have a relatively low infant mortality, are less popu
lous than the Southern States, which with their large negro popu
lation and other unfavorable conditions show a generally higher
rate.
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SOME RESULTS OF FIVE YEARS OF W O R K
37
In Table 6 a comparison of average infant mortality rates during
the first five years o f the operation of the maternity and infancy
act with the average rates for a comparable period before the pas
sage of the act has been made for 21 States for which figures are
available from the United States Bureau of the Census. A s Table 6
shows, there has been a decrease in the average rates o f both urban
and rural areas since 1921. Only 16 of these 21 States have cooper
ated four years or more, and only 9 of the 16 had established childhygiene bureaus or divisions before 1920. Hence much of the work
has been entirely new. Eight of these 16 States had a decrease in
mfant mortality of more than 10 per cent in the average rates
during the period of cooperation, as compared with a period before
cooperation. Child-hygiene work usually was well under way in
cities before the States had divisions of child hygiene or had started
programs in the rural districts. The cumulative effect of the work
that has been m progress for longer terms is reflected in the relatively greater decreases in the urban areas and in the States in which
State bureaus or divisions o f child hygiene had begun work before
the passage or the act.
T able 6. Comparison of infant mortality prior to operation o f the maternity
and infancy act (1917-1921, exclusive of 1918) with infant mortality during
the period of operation of the act of ( 1922-1926) in specified S ta te s;'a v e r a g e
State, urban, and rural rates per 1,000 live births2
State rate
State
States beginning to cooperate
1922, 1923:
California1______________
I n d ia n a ...____ _________
K entucky_______________
M a ry lan d..........................
M ichigan_______________
M innesota_________ ____
N ew Hampshire________
N ew York i ...... ............ .
N orth Carolina____ ____
O h io____________________
O r e g o n !...____ ______
Pennsylvania____
U tah......... ...................
Virginia___________ - ____I
Washington i ______
Wisconsin__________
States not cooperating prior
to 1925:
Connecticut»____________
Kansas^........... ............. .
M aine_____________ I I ” !
Massachusetts...............
Verm ont........................I ll
Year of
- first
cooper
1917ation
1921
1922
1922
1922
1922
1922
1922
1922
1923
1922
1922
1922
1922
1922
1922
10ü8
1922
1927
1927
1925
Urban rate
Rural rate
19221926
Per
cent
age of
de
crease
19171921
19221926
Per
cent
age of
de
crease
19171921
19221926
70.3
79.3
75.5
105.5
86.9
64.8
94.2
80.6
85. 5
84.7
58.3
98.9
71.2
87.4
61.6
76.4
68.4
68.7
70.2
90.4
75.9
58.8
81.5
69.8
80.8
71.7
54.6
84.3
64.6
80.5
56.4
68.3
2.7
13.4
7.0
14.3
12.7
9.3
13.5
13.4
5. 5
15.3
6.3
14.8
9.3
7.9
8.4
10.6
64.1
90.5
90.9
100.7
93.3
67.9
106.0
81.8
116.8
89.9
59.0
98.9
69.8
108.1
59.1
88.4
61.8
76.1
85.4
85.9
80.4
59.1
88.3
69.8
103.5
74.0
50.2
83.7
61.7
97.0
51.7
73.3
3.6
15.9
6.1
14.7
13.8
13.0
16.7
14.7
11.4
17.7
14.9
15.4
11.6
10.3
12.5
17.1
78.8
72.0
73.0
111.2
79.8
63.2
81.6
75.3
82.5
77.8
57.8
98.8
71.8
82.1
64.1
69.2
77.8
62.9
67.1
96.4
69.8
58.6
74.1
70.1
77.3
68.2
57.6
84.9
66.1
76.0
61.4
64.8
7.3
9. 2
6.9
6.3
12.3
.3
14.1
7.9
7.4
4.2
6.4
86.5
70.6
93.4
88.3
86.0
73.6
62.7
82.4
74.5
72.7
14.9
11.2
11.8
15.6
15.5
86.1
86.5
96.1
89.2
111.7
72.3
74.9
87.9
74.9
81.0
16.0
13.4
8.5
16.0
27.5
88.0
66.2
92.4
83.6
81.2
79.5
58.1
80.0
72.5
71.1
9.7
12.2
13.4
13.3
12.4
Per
cent
age of
de
crease
1J5
12.6
8 1
13.3
12.5
J J ^ S/ ^ Cted are those in the United States birth-registration area in 1917 with the exception of Cali
fs 1919^ d ° l 920On ThA1^ L 'S S ? rm+a t0t e tfhe
?£eal n +1919’ a“ d Rhode island- which was dropped from the area
fo r the States are for 1922-1926 and 1917-1921, exclusive of 1918 (when
been influenced b y the influenza epidemic) w ith the exception of California and Oregon,
^ ® reQthe rates are for the periods 1919-1921 and 1922-1926, and for N ew Y ork and Washington, where the
r a t e are for the periods 1919-1922 and 1923-1926, as these S ta te did not cooperate under the act until 1923.
2 Source: U . S. Bureau o f the Census.
3 Connecticut cooperated under the governor’s acceptance o f the act from Apr. 1, 1922, to Dec. 6, 1923,
b ut discontinued cooperation thereafter. Kansas cooperated under the governor’ s acceptance from
Apr. 1, 1922, to Sept. 22, 1923, then discontinued cooperation until 1927.
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M A T E R N IT Y AND IN F A N C Y
38
R E D U C T IO N IN M A T E R N A L M O R T A L IT Y
Although maternal mortality rates have shown little variation
during the period 1921 to 1926, there has been in general a down
ward trend during this period in the birth-registration area as a
whole and in both urban and rural areas. (Table I , Appendix C,
p 140.) The rate of maternal death for every 10,000 live births
for the whole area in 1921 was 68.2; in 1926 it was 65.6. The urban
rate in 1921 was 77.1; in 1926 it was 73.9. The rural rate m 1921
was 59.4; in 1926 it was 56.7. In 1921 the rate for white mothers
was 64.4 deaths for every 10,000 live births; in 1926 this was 61.9.
The colored rate had not materially changed; it was 107.7 in 1921
and 107.1 in 1926. (Table I I , Appendix C, p. 142.) Although the
maternal-mortality trend has been downward, at least two factors
have had a tendency to raise rather than to lower the rates for the
expanding birth-registration area. One of these has been the ex
tension of the registration area since 1921 to include nine more
States, five of whnjh had in 1926 maternal mortality rates 5 to 41
points higher than the rate for the whole birth-registration area
(Arizona, 102.5; Florida, 106.9; Montana, 80.2; W est Virginia, 70.6;
Wyoming, 93.4). A second factor influencing the rates may be
found in the careful scrutiny of death certificates for women of
childbearing age on the part of State vital-statistics divisions and
the United States Bureau of the Census as a result of the discussion
of maternal deaths that has been evoked through programs for
better care of mothers. This scrutiny has led to the assignment to
causes associated with pregnancy and childbirth of deaths previously
ascribed to other causes.
Comparison has been made in Table 7 of the maternal mortality
rates for the period of cooperation under the maternity and infancy
act and the rates for a similar period before cooperation in 16 States
that were in the United States birth-registration area in 1919 and
that have been cooperating under the act for four years or longer.
This comparison shoWs a decrease in every State. Eight of these
16 States had a decrease of more than 10 per cent in their average
rates, the decreases ranging from 14.6 per cent to 31.8 per cent. A ll
the 16 States show decreases in their urban areas and all but 1 in
their rural areas. A majority of the States had greater reduction in
the rural than in the urban areas. The decrease in the rural areas
in 11 States exceeded 10 per cent, and in 8 States it exceeded 20 per
cent, the greatest decrease being 35.9 per cent in Utah. Table 7 also
presents a comparison of average rates during the period of the
operation of the maternity and infancy act (1922-1926) with the
rates for the period 1917 to 1921 (exclusive of 1918) for 5 States not
cooperating or having cooperated for very short periods. In 1 of
these States (Vermont) there was an increase of 0.8 per cent in the
average rate; this State did not begin cooperating under the act
until 1925 and is not among those in which the early establishment
of a division of child hygiene was noted. Three of the States not
cooperating or having cooperated for short periods had a decrease in
rates in urban areas, but the decrease was less than 10 per cent, and
in 2 States in this group there was an increase in the rates in urban
areas. One noncooperating State and one State cooperating only
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39
SOME RESULTS OF FIVE YEARS OF WORK
since 1927 had reductions of more than 10 per cent in the average
rates in the rural areas.
The beneficial effect of maternity work undertaken is clearly in
dicated by these percentages. This is particularly true in the rural
areas, where the maternity program has been first initiated and
promoted by the States during the period 1922 to 1926.
T able 7.— Comparison of maternal mortality prior to operation of the maternity
and infancy act (1917-1921, exclusive of 1918) with maternal mortality dur
ing the period o f operation of the act (1922-1926) in specified S ta te s ;1 aver
age State, urban, and rural rates per 10,000 live births2
Urban rate
State rate
State
States beginning to cooperate
1922, 1923:
California1___________
Indiana........ .......................
K entucky.................... .......
M aryland............. ..............
M ichigan_______________
M innesota_____ ________
N ew Hampshire________
N ew Y ork 1_____________
N orth Carolina_________
Ohio_____ ______________
Oregon1_________________
Pennsylvania.....................
Utah______ _____________
Virginia______ ______ ___
W ashington1____________
Wisconsin______ _ ____
States not cooperating prior
to 1925:
Year of
first
coop
eration
1922
1922
1922
1922
1922
1922
1922
1923
1922
1022
Kansas 3________________
M aine_______ __________
1927
1927
58.3
76.5
77.8
Verm ont____________ ___
1925
71.5
68.8
62.4
67.0
57.6
68.5
73.9
59.5
67.8
57.7
81.4
59.8
56.6
62.6
70.5
74.6
50.8
57.3
51.0
55.1
50.6
55.5
47.0
68.9
45.9
74.6
49.1
65.0
47.2
40.1
62.8
57.0
50.0
- 8 .2
-2 3 .9
- 4 .3
-2 6 .1
-2 4 .9
-2 1 .0
+ 1 .6
-2 0 .5
- 8 .4
-1 7 .9
-2 6 .3
-1 6 .6
-3 5 .9
-1 0 .9
-2 3 .6
- 1 .6
59.6
94.2
107.1
37.2
71.1
70.3
47.8
70.1
37.6
58.7
63.8
40.1
65.9
+ 1.1
-1 7 .4
-9 .2
-1 6 .1
-6 .0
-1 6 .0
-1 9 .5
- 4 .2
-1 7 .9
-1 4 .6
-1 6 .6
-2 .0
-8 .7
- 5 .3
- 9 .3
-2 2 .1
- 8 .3
-3 1 .8
-9 .9
68.1 -1 8 .6
57.3 - 0 . 9
83.5
94.9
94.4
77.4
82.2
74.5
73.1
64.9
142.9
85.2
91.3
82.8
97.6
117.0
92.7
69.5
66.5
77.5
84.2
67.6
75.4
64.9
69.3
60.8
131.0
80.0
76.3
■80.4
55.6 - 4 .6
68.5 -1 0 .5
77.0 - 1 . 0
64.6 —6.1
72.1 + 0 .8
63.9
96.0
98.1
72.8
78.9
62.7
62.8
60.0
60.2
66.9
53.9
69.1
58.0
82.2
67.3
69.6
63.9
50.2
72.1
86.8
-2 0 .4
-1 8 .3
-1 0 .8
-1 2 .7
- 8 .3
-1 2 .9
- 5 .2
- 6 .3
-8 .3
- 6 .1
-1 6 .4
-2 .9
68.6 - 2 9 .7
105.8 - 9 .6
78.6 -1 5 .2
67.5 - 2 . 9
19221926
74.6
78.0
62.6
73.3
78.3
64.6
70.5
63.5
74.2
89.4
69.7
73.6
80.0
83.7
57.8
19221926
19171921
19221926
1922
1922
1922
1922
1923
1922
19171921
Per
centage of
in
crease
or de
crease
Per
centage of
in
crease
or de
crease
19171921
Rural rate
68.6
102.6
Per
centage of
in
crease
or de
crease
-6 .7
- 1 .9
+ 9 .2
- 5 .8
+30.0
88.2
1States selected are those in the United States birth-registration area in 1917 with the exception of Cali
fornia and Oregon, which came into the area in 1919, and Rhode Island, which was dropped from the area
in 1919 and 1920. The average rates for the States are for 1922-1926 and 1917-1921, exclusive of 1918 (when
the rates were influenced b y the influenza epidemic) with the exception of California and Oregon, where
the rates are for the periods 1919-1921 and 1922-1926, and for N ew Y ork and Washington, where the rates
are for the periods 1919-1922 and 1923-1926, as these States did not cooperate under the act until 1923.
a Source: U. S. Bureau of the Census.
s Connecticut cooperated under the governor’s acceptance of the act from Apr. 1,1922, to Dec. 6,1923,
but discontinued cooperation thereafter. Kansas cooperated under the governor’s acceptance from
Apr. 1, 1922, to Sept. 22, 1923, then discontinued cooperation until 1927.
Methods of attacking maternal mortality in the rural districts
have varied among the cooperating States in which there has been a
considerable decrease in the maternal mortality rate for the period
of cooperation. Special measures were undertaken in the States
showing the largest reduction, in addition to the general education
of women as to the importance of adequate prenatal, natal, and post
natal care. Utah, with a decline of 35.9 per cent in rural areas, was
able through the interest and cooperation of a strong church society
to establish small maternity hospitals to furnish lying-in care for
maternity cases at nominal prices. Oregon, with a decline of 26.3
per cent in rural areas, assisted in maintaining a prenatal center for
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40
M A T E R N IT Y AND IN F A N C Y
instruction purposes in the obstetrical department of the State uni
versity in order that better prenatal instruction might be available
to the students. Maryland, with a rural decrease of 26.1 per cent,
has a nursing service covering the entire State. Michigan, with a de
cline of 24.9 per cent in rural areas, has conducted several county
wide prenatal nursing demonstrations and an aggressive program of
prenatal instruction through group teaching and itinerant confer
ences. Indiana, with a rural decrease of 23.9 per cent, has covered
almost the entire State with prenatal classes. Minnesota, with a
rural decrease of 21 per cent, has provided an obstetrician to hold
prenatal conferences and to give talks on obstetrics to rural physi
cians and talks on prenatal care to expectant mothers in the rural
districts. New York, with a rural decrease of 20.5 per cent, has
conducted itinerant prenatal conferences, secured the cooperation of
local physicians for improved prenatal care, and sponsored graduate
courses in obstetrics. Ohio, with a rural decrease of 17.9 per cent,
has promoted its prenatal program through county health units.
Pennsylvania, with a rural decrease of 16.6 per cent, had a nursing
program covering every section of the State and an intensive pro
gram directed to the supervision of the midwives employed in nine
of its counties. Virginia, with a rural decrease of 10.9 per cent,
had a general educational program including “ institutes for doctors’
helpers ” in maternity work and special attention to work of negro
midwives in certain areas.
A ll the States have supplemented their educational programs for
prenatal care by distributing to pregnant women literature on pre
natal care and by distributing to physicians the Children’s Bureau
bulletin Standards of Prenatal Care.
Some States have made studies extending over periods of several
years in order to obtain precise data as to the value of medical super
vision of mothers and infants. Mortality rates for supervised
groups of mothers and infants were compared with the rates obtain
ing among similar groups not receiving such supervision. In each
case the rates for the supervised groups have been found to be sig
nificantly lower. (See pp. 66, 72, 74, 9 5-96,115-117,122-124.)
C A R E A T C H IL D B IR T H
Factors to be considered in relation to care at childbirth are (1)
type of attendant, as physician, midwife, or other person, (2) place
of confinement, as hospital, maternity home, or the patient’s own
home, and (3) nursing care. Saving o f maternal lives has been
effected. The question arises whether this is the result of better
obstetrical procedure at time of childbirth or the result of better pre
natal care. Obviously a public-health program stressing prenatal
care will not lower maternal mortality due to causes that have their
beginning at the time o f delivery and that depend upon the tech
nique observed by physicians, midwives, and nurses and in hospitals.
The direction in which work is still needed as well as the results of
work accomplished are suggested by Table 8, which shows the num
ber of maternal deaths and the rate per 10,000 live births, by causes
of death, in 1922 and 1926,
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SOME RESULTS OP FIVE YEARS OP W O R K
T able 8.— Number of maternal deaths and maternal mortality rates per 10,000
live births, by cause, in the expanding birthregistration area: 1922 and 1926
1922
Cause of death
1926
Maternal Num ber Maternal
Number
mortality of deaths mortality
of deaths
rate
rate
A ll causes..................... ................... ............ .............................
11,792
66.4
12,168
65.6
Puerperal septicemia_________________________ ________________
Puerperal albuminuria and convulsions................... ................. . . .
A ll other causes.-___________ _____________ _____________ ______
4,249
3,211
4,332
23.9
18.1
24.4
4,484
3,091
4,593
24.2
16.7
24.7
The expansion of the registration area during the years 1922 to
1926 has o f course increased the total number of maternal deaths
reported, but it is noteworthy that not only the death rate but also
the actual number of deaths from puerperal albuminuria and con
vulsions has decreased. The education of pregnant women as to the
importance of prenatal care, of more frequent urinalysis, and of
greater attention to symptoms of preeclamptic conditions is sug
gested by the lower mortality rate from puerperal albuminuria and
convulsions in 1926. The wisdom of emphasizing prenatal care in a
public-health program is clearly demonstrated by this saving of
mothers’ lives. In regard to the increase in both the number and
the rate of deaths from puerperal septicemia and all other causes of
maternal deaths (except albuminuria and convulsions) it must be
remembered that these causes o f maternal mortality are closely re
lated to the type of care received at confinement. The expansion
of the registration area may account for some o f the slight increase
in deaths from puerperal septicemia reported, but it is obvious that
deaths from this disease will have to be prevented by greater atten
tion to type of obstetrical technique and procedure.
The obstetrician, the nurse, and the hospital must be looked to for
aid in lowering the death rates due to puerperal sepsis and to acci
dents of labor; and medical and nursing schools must do their share
in training good obstetricians and obstetrical nurses. The work in
prenatal clinics conducted in connection with the medical schools
o f the University of Louisville and the University of Oregon (see
pp. 66, 98) may be credited with saving maternal lives as well as
with training obstetricians. In fact, an outstanding result of the
maternity and infancy act is the increasing attention given to obstet
rical care in medical schools, in medical-society programs, in publichealth programs, and by individual physicians.
State supervision of hospitals usually is the responsibility o f de
partments of public welfare and does not rest on State departments
of health. A t least 12 States, however, provide for inspection of
maternity hospitals or homes by the State board or department of
health (California, Colorado, Iowa, Kansas, Maine, New Hampshire,
New Jersey, Ohio, South Dakota, Texas, Utah, and Wisconsin), and
11 of these States (excepting New Hampshire) provide for licensing
by the State board or department of health. In California, Kansas,
and South Dakota the licensing is done through the agency in the
State board o f health that administers the maternity and infancy act.
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42
M A T E R N IT Y AND IN F A N C Y
The American College o f Surgeons has issued standards for obstet
rical departments of general hospitals as follows :
1. That obstetrical patients in general hospitals be absolutely segregated from
other types.
2. That a preliminary examination be made of all obstetrical patients on
admission to ascertain if there are any signs or symptoms of an infective or
contagious nature, such as influenza, tonsillitis, rash, or pus discharge of any
kind.
3. That all obstetrical patients with temperature on admission or developing
a temperature subsequently be immediately segregated.
4. That a rigid aseptic technique be observed at all times in the labor room
and in the ward.
5. That the indications for operative procedures, such as forceps, version, and
extraction, Cesarean section, induction of labor, be duly recorded and incorpo
rated in the case record prior to being carried out if time permits.
Attention to these recommendations would lead to better results
in obstetrical work, particularly in general hospitals. Even though,
as has been stated, the hospitals receive a large proportion of the
more difficult obstetrical cases and many women arrive after labor
has started and after internal examination has been made, a ma
ternal mortality rate of more than 50 per 10,000 live births is con
sidered high for a good lying-in hospital. In the best maternity hos
pitals and the best maternity services in general hospitals the rate is
very much lower, yet many hospitals show a rate much higher than
50 deaths per 10,000 live births.
Apparently the midwife is receiving a fair share of attention from
State public-health departments, with seeming improvement in this
type of attendant at births. Surveys of midwives, class instruction,
supervision of midw.ives, and encouragement of their registration in
compliance with the law have been features of maternity programs
in all States in which the midwife has been a part of the problem of
care of maternity cases. Practically all the States now know as
a result of surveys the approximate number of midwives in active
practice within their borders. On the basis of this knowledge effort
has been made to obtain the needed legislation and regulation. In
struction in the simplest and most fundamental principles of mid
wifery practice has been given by many States to groups of mid
wives. Elimination of the most unfit, old, diseased, and unclean
midwives has been reported bv many States. The type of midwives
has improved, and the numbers practicing have decreased. For
example, New Jersey reported that the percentage of births attended
by midwives decreased from 42.2 in 1919 to 20.3 in 1926. W hat
effect the work with midwives has had on the maternal death rate
can be shown only ;indirectly. Individual States that have Jower
colored maternal mortality rates and that have had good programs
in supervision and instruction of negro midwives can be cited, how
ever. For instance, Florida was admitted to the birth-registration
area in 1924 with a colored maternal mortality rate for that year of
186.9 for every 10,000 live births, and in 1926 this rate had declined
to 148.5 ; Kentucky had a colored maternal mortality rate of 185 in
1922, and in 1926 this rate had declined to 106.2; Mississippi had a
colored maternaf mortality rate o f 100.5 in 1922, and in 1926 this
rate had declined to 91.6,
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SOME RESULTS OF FIVE YEARS OF W O R K
43
IM P R O V E M E N T IN T H E C A R E A N D H Y G IE N E O F IN F A N T S
Dissemination of information on the care of infants, especially in
regard to proper feeding, has been an outstanding feature o f the
child-hygiene programs. Much of the high infant mortality of the
past was due to gastrointestinal
diseases; these are aggravated by
improper, experimental, and hap
hazard feeding of infants and by
general ignorance relating to their
care.
The bottle-fed baby was
the victim of experimental for
mulas; the chief test o f a formula
apparently was whether the infant
survived.
Scant attention was
given to normal development,
growth, and weight.
Mothers
weaned their infants if their milk
supply failed or if other difficulties
arose in breast feeding, and much
of this type of feeding was un
supervised by physicians. A fter
the passage of the maternity and
infancy act simple formulas of
cow’s milk adapted to the age and
weight of the average normal in
fant were made available to a
greatly increased number of moth
ers through State child-hygiene di
visions. It should be borne in mind
that activities under the maternity
and infancy act are especially di
rected toward reaching rural dis
tricts with information on maternal
and infant care. There were rela
tively few pediatricians in rural
areas before 1922. The education
of parents in infant care developed
a demand for supervision o f infant
feeding on the part of rural phy ARTIFICIALLY
BREAST
sicians, so that in 1926 the number
FED
FED
o f rural physicians who were giv D E A T H S A M O N G A R T I F I C I A L L Y - F E D
ing attention to infant feeding had
I NFANTS C O M P A R E D W I T H N U M B ER
OF D E A T H S E X PE CT ED AT T H E M O R
greatly increased.
TA LI TY RATES PR EVAI LI NG A M O N G
A n analysis of the monthly
B R E A S T- F E D INFANTS, BASED UPON
death rates of infants in eight
S T U D I E S O F 2 , 3 0 0 I N F A N T S IN E I G H T
cities in comparison with their
CITIES
type of feeding made by the
United States Children’s Bureau has shown that the deaths among
the infants who were artificially fed were nearly four times those that
would have been expected at the rates prevailing for the infants who
were breast fed. The mortality among the infants who were partly
892°— 28------ 4
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44
M A T E R N IT Y AN D IN F A N C Y
breast fed in this group was also slightly higher than that among
the infants who were wholly breast fed.24 (See chart on p. 43.)
The individual States and the United States Children’s Bureau
have prepared material on the importance of breast feeding for
distribution to the public, and attention has been directed in such
literature to the hygiene and care of the mother necessary to main
tain the supply of breast milk. The baby books and publications
on prenatal care all emphasize the greater life expectancy of the
breast-fed baby. Such educational work undoubtedly has contrib
uted to the decline of gastrointestinal diseases reported as a cause
of death in infants under 1 year of age.
In Table 9 a comparison of the causes o f infant mortality in 1922
and 1926 in the United States birth-registration area of 1922 (ex
cluding South Carolina) shows that in 1922 there were 12.T deaths
from gastrointestinal diseases during the first year of life for every
1,000 infants born alive, whereas in 1926 this rate had declined to
10.3— a decrease of 18.9 per cent. Formerly more infants under 1
year o f age died from gastrointestinal diseases than from any other
cause reported except natal and prenatal causes. W ith better feed
ing care and better hygiene of infants this cause of infant mortality
has taken third place, and respiratory diseases have moved from
third to second place as causes of infant deaths. A slight downward
trend in infant mortality due to natal and prenatal causes has ap
peared in the five-year period 1922 to 1926. Apparently prenatal
care is beginning to reduce the number of deaths from this group
of causes. The rise in the figures for epidemic and communicable
diseases and for respiratory diseases as causes of infant mortality,
on the other hand, suggests the need for greater attention to these
causes.
T able 9.— Comparison o f infant mortality rates ( deaths under 1 year per 1,000
live births) from certain groups o f m uses in the 1922 United States birthregistration area, exclusive of South Carolina; 1922 and 1926
M ortality rate
Change 1922 and
1926
Cause group
1922
36.2
12.7
13.7
3.9
Û.9
5.9
2.4
1926
35.1
10.3
14.2
4.8
1.1
5.6
2.3
Rate
- 1 .1
-2 .4
+ 0 .5
+ 0 .9
+ 0 .2
- 0 .3
- 0 .1
Percent
age
-3 .0
-1 8 .9
+ 3 .6
+23.1
+22.2
- 5 .1
-4 .2
.
1Includes premature birth, congenital debility, injury at birth, other diseases of early infancy, congenital
malformations, syphilis, and tetanus.
2Includes diseases of the stomach, diarrhea and enteritis, dysentery.
4 Includes bronchitis, broncho-pneumonia, pneumonia, influenza.
. . .
« Includes measles, scarlet fever, erysipelas, meningococcus meningitis, whooping cough, diphtheria,
tuberculosis of the respiratory system, tuberculosis of the meninges, other forms of tuberculosis.
6Includes convulsions, all other causes.
24 See Causal Factors in Infant Mortality; a statistical study based on investigations in
eight cities, by Robert Morse Woodbury, Ph. D., p. 90 (U. S. Children’s Bureau Publication
No. 142, Washington, 1925).
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SOME RESU LTS OF FIVE YEARS OF W O R K
45
IM P R O V E M E N T IN P E R S O N N E L
The administration of the maternity and infancy funds in the
United States brought into the State agencies as workers many tech
nically trained persons, both physicians and nurses, who had good
professional preparation but who had little or no special preparation
for public-health work in so specialized a field as maternity and in
fancy. The number of physicians, nurses, or administrators in the
United States who had had experience in maternity and infancy
work was limited; and they were in positions in cities where many
of them wished to remain. The result was that the State publichealth and maternity and infancy workers were comparatively inex
perienced in 1922. They have developed, after five years of work
under the act, into an experienced, capable, and well-trained group.
Standards for public-health workers have improved. States that
had few or no trained workers and that were obliged to bring techni
cally trained persons to their staffs from other States have developed
from recruits from their own States well-trained persons who are
able to meet the advancing standards. Practically all State bureaus
or divisions of child hygiene now require their staff nurses to meet
the standards formulated in 1924 by the committee representing the
National Organization for Public Health Nursing, the nursing sec
tion of the American Public Health Association, and the Conference
of State and Provincial Health Authorities of North America. This
result alone should have a good influence on future work in the field
of maternity and infancy.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
A summary of the work done in the individual States as reported
to the Federal office in their annual reports under date of July 1,
1927, is given in the following pages. The figures in regard to cer
tain o f the main activities have been summarized in Tables 2, 3, 4,
and 5.
ALABAM A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Montgomery.
Staff:
Director (nurse), 1 pediatrician (3 months), 4 nurses (1 part year, 1 part
time), 2 vital-statistics clerks, 1 record clerk, 1 bookkeeper (part time),
1 stenographer. Thirty-one county nurses were paid for some maternity
and infancy work.
Activities:
Child-health conferences conducted by physicians, 2,396; infants and pre
school children registered and examined, 7,856; visits to conferences,
15,241; defects found, 3,886; children having defects, 3,484. Parent^
had defects corrected in 1,336 of the children.
Prenatal conferences conducted by physicians, 358; expectant mothers
registered, 2,766; number examined, 2,292.
Conferences conducted by nurses, no physician present, 378; infants and
preschool children inspected, 2,614; mothers instructed in prenatal care,
4,487; visits to conferences by children, 6,000. In addition there were
441 office consultations with mothers.
New permanent combined prenatal and child-health centers, 3 established.
They are supported by county, State, and Federal funds.
Little mothers’ classes, many; girls enrolled, 751; number *completing
course, 125; lessons in course, 12.
All the midwives known to the county health departments are required to
report for conferences monthly or upon call. A permit to practice (for
the current year only) is issued when the health officer or nurse con
siders the applicant a reasonably safe unskilled attendant for full-term
or normal delivery. During the year under review 3,169 midwives were
under supervision, 1,087 of whom were given a 12-lesson course of
instruction.
Home visits by nurses, 72,132 (prenatal cases seen, 5,330; obstetrical cases,
48; postnatal cases, 3,539; infants, 7,025; preschool children, 3,601).
Talks and lectures, 2,023.
Literature distributed, 150,103 pieces.
Graduate courses for physicians, in 14 counties; attendance, 170. The
pediatrician on the staff conducted demonstration pediatric clinics for
local physicians. About one week was spent in each county. The
physicians brought their patients to the clinics for examination by the
pediatrician and for a round-table discussion of each case; and 339
children were examined (these are included in the number of chil
dren reported under child-health conferences). In most of the counties1
at least one meeting was held at which no patients were present, the
time being devoted to a discussion of pediatric problems. In three
counties, at the request of the physicians, an open meeting was held for
mothers, at which a talk was given on infant and child care.
46
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P R IN C IP A L A CTIVITIES OE T H E IN D IV ID U A L STATES
47
Activities— Continued.
Exhibits conducted, 12, at county and community fairs. Exhibit material
was lent twice.
Statistical studies, 3, of maternal and infant mortality, in certain areas.
Breast feeding was emphasized by the county nurses in the instruction
given to mothers and expectant mothers under their supervision.
Infants born in the State during the year, 65,336; infants under 1 year of
age reached by the work of the bureau, 7,025; preschool children reached,
3,601; expectant mothers reached, 5,330.
~
Counties in the State, 67; counties having maternity and infancy work
during the year, 31.
The following organizations cooperated in the bureau’s work: State de
partment of education, extension service of the Alabama Polytechnic
Institute, Tuskegee Normal and Industrial Institute, and the parentteacher association.
The outstanding achievement of the year was the establishment of a clear-cut
supervisory program.
SOM E R E S U L T S OF TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Stabilizing and extension of a county nursing service under supervision of the
State bureau of child hygiene and public-health nursing have been accomplished.
The number of public-health nurses has increased. Before 1922 the nursing
personnel of the health organization comprised 36 nurses (28 white, 8 negro).
At the close of 1926 there were 74 nurses (58 white, 16 negro). Of this num
ber 34 were on the maternal and infant-hygiene pay roll for full-time or parttime work.
Improvement in the control of midwives and in midwifery practice has been
noted. In 1926-27 nearly 3,200 midwives were under supervision, and a course
of instruction was given to nearly 1,100.
Registration of births has increased as a result of the state-wide campaign
m which the bureau of child hygiene and public-health nursing and county
maternity and infancy workers have assisted.25
A distinct advance has been made in the degree of intelligence with which
local statistics relating to maternal and infant welfare are being studied by
county health organizations.
As the State was riot in the birth-registration area, no statement as to reduc
tion of mortality rates can be made.
A R IZ O N A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, child-hygiene division, Phoenix.
Staff:
Director, 3 nurses (part year).
Volunteer assistants— 9 physicians, 2 dentists, 3 nurses, 10 lay persons.
Activities:
Child-health conferences conducted by physicians, 33; infants and pre
school children examined, 722; visits to conferences, 891; children having
defects, 631; defects found, 1,738. Parents had defects corrected in 208
of the children^
Conferences conducted by nurses, no physician present, 23; children in
spected, 248; mothers instructed in prenatal care, 12; visits by children
to conferences, 467.
Dental conferences conducted by dentists, 9 ; preschool children receiving
dental advice, 367.
Little mothers’ classes, 2 organized; girls enrolled and completing course,
34; lessons in course, 5.
Mothers’ classes, 4 organized; mothers enrolled and completing course, 51;
lessons in course, 4.
25 The State was admitted to the United States birth-registration area J u ly 13, 1927.
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48
M A T E R N IT Y AND IN F A N C Y
Activities— Continued.
Home visits by nurses, 4,250 (prenatal cases seen, 141; obstetrical eases, 3 ;
postnatal cases, 85; infants, 762; preschool children, 953).
Community demonstrations, 17, consisting of health conferences and follow
up work in 17 communities.
Group demonstrations, 83, on preparing and sterilizing obstetrical supplies,
making bed for confinement, bathing and dressing the baby, preparing
formulas and bottles, and giving sun baths.
Talks and lectures, 72.
Literature distributed, 56,783 pieces.
Exhibit material was lent twice.
New names registered for prenatal letters, 159.
Nutrition work was done through individual instruction to mothers of
children found to be undernourished.
Breast feeding was stressed by the nurses in their conferences with
mothers.
Infants born in the State during the year, 8,626; infants under 1 year of
age reached by the work of the division, 7,690; preschool children reached,
1,588; expectant mothers reached, 355. The division sends literature
on infant hygiene to parents of infants whose births are registered in
the State bureau of vital statistics (not including migratory families).
Counties in the State, 14; counties having maternity and infancy work
during the year, 6 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 14.
The following organizations cooperated in the division’s work: A county
medical society, women’s clubs, disabled veterans, and parent-teacher
associations.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Since the beginning of the State’s cooperation under the maternity and
infancy act efforts have been made to improve birth registration, and the State
was admitted to the United States birth-registration area in 1926.
Arizona had a higher infant mortality rate than any other State in the United
States birth-registration area in 1926. The rate for the year was 121.2. Figures
from the United States Bureau of the Census are not available prior to that
year (as the State was not in the registration area), but State figures indicate
a very much higher rate in 1922 and a decided drop in infant mortality during
the period of cooperation under the maternity and infancy act.
Since the beginning of the State’s cooperation under the maternity and
infancy act three communities have assumed the financial responsibility for
maternity and infancy work begun with maternity and infancy funds.
ARKANSAS
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene, Little Rock.
Staff:
Director (State health officer serving), 1 physician (half year), 2 nurses,
1 midwife supervisor (nurse, part year), 2 vital-statistics field workers
(part year), 1 stenographer, 1 chauffeur (part year). Eleven county
nurses were paid for some maternity and infancy work.
Activities:
Combined prenatal and child-health conferences, 124, conducted by local
physicians who volunteered their services, assisted by county nurses paid
for maternity and infancy work; expectant mothers registered and ex
amined, 61; infants and preschool children registered and examined,
1,754.
Child-health conferences conducted by physicians, 52; infants and preschool
children registered and examined, 1,570; defects found, 5,728; children
having defects, 1,556.
Prenatal conference conducted by physician, 1 ; expectant mothers registered
and receiving advice, 16.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
49
Activities— Continued.
Conferences conducted by nurses, no physician present, 21; infants and
preschool children inspected, 298; mothers instructed in prenatal care, 50.
New permanent child-health centers, 4 established as a result of advisory
assistance from the bureau. They are supported by Federal, State,
county, and private funds.
New permanent prenatal centers, 2 established as a result of the maternity
and infancy work. The are supported by Federal, State, county, and
private funds.
Little mothers’ classes, 6 organized; girls enrolled, 112.
Mothers’ classes, 5 organized; mothers enrolled, 25; lessons in course, 11.
Midwives’ group conferences, 23, in 8 counties; midwives instructed at these
meetings, 194; midwives’ classes organized by county nurses, 19; mid
wives enrolled, 398.
Home visits by nurses, 3,877 (to prenatal, obstetrical, and postnatal cases,
infants, preschool children, and midwives).
The county nurses employed for maternity and infancy work gave assist
ance in the flooded area of the State.
Group demonstrations, 30, on items in the inspection of children and the
prevention and correction of defects, at meetings of parents and teach
ers ; on feeding, bathing, and dressing the baby, at girls’ clubs.
Survey, 1, of midwives (begun in 1924, completed in the year under review).
Campaigns, 2 : (1) For immunization against typhoid fever, in 1 county.
(2) For promotion of birth and death registration, in cooperation with
the State bureau of vital statistics, in 12 counties. This work aided
greatly in raising the registration of births and deaths to the standard
required for the registration areas, to which the State was admitted
in 1927.
Talks and lectures, 103.
Literature distributed, 52,645 pieces.
Exhibits conducted, 2, at the State fair and at the meeting of the State
parent-teacher association. Films on child health were shown 18 times.
Exhibit material was lent 4 times.
Counties in the State, 75; counties having maternity and infancy work
during the year, 60; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 75.
The following organizations cooperated in the bureau’s work: State board
of education (school-enumeration and home-economics sections), State
society for crippled children, State federation of women’s Clubs, American
Legion auxiliary, State fair association, a negro-welfare organization,
and the parent-teacher association.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The admission of the State to the birth and death registration areas in 1927
followed a campaign of education instituted by the State health department
assisted by the staff of the bureau of child hygiene and other agencies.
The survey of midwives, begun in 1924 and continued to 1927, included
supervision and instruction of midwives. Many midwives not previously known
were added to the record in the course of the survey. More midwives are
working under permits, registering births, and using silver nitrate as a prophy
lactic in the eyes of the newborn since this work was begun. The midwives
carrying a fair equipment increased from 6 per cent in 1924 to 13 per cent in
1926. The number known to be practicing in 1924 was 3,289 (1,166 white, 2,023
negro). In 1926 the number was 4,158 (1,445 white, 2,713 negro). The appli
cations for permits to practice received from negroes increased from 87 per cent
of all applications in 1924 to 90 per Cent of all received in 1926.
The standards and training of public-health nurses have been improved during
the period of cooperation.
During the last months of the period much of the State was devastated by
the Mississippi River flood. Considerable assistance was given in the de
vastated areas by the county nurses employed for maternity and infancy work.
As the State was not admitted to the birth-registration area until the winter
of 1927 no statement as to reduction of mortality rates can be made.
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50
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Federal Reserve Bank of St. Louis
MATERNITY AND INFANCY
PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
51
Activities:
Child-health conferences conducted by physicians, 360 (by staff physicians,
54; by local physicians in conferences arranged by county nurses, 306) ;
infants and preschool children examined, 8,118 (by staff physicians, 1,626;
by physicians at conferences arranged by county nurses, 6,492) ; visits
to conferences, 9,178 (to conferences held by staff physicians, 1,626; to
conferences arranged by county nurses, 7,552).
Prenatal conferences conducted by physicians, 78; expectant mothers reg
istered and examined, 186; visits to conferences, 626.
Conferences conducted by nurses, no physician present, 21; infants and
preschool children inspected, 935; visits to conferences, 1,696.
New permanent child-health centers, 21 established. They are supported
by Federal, State, county, and city funds. When the bureau agrees to
give financial assistance to any locality in developing its child-hygiene
program the development of permanent child-health centers is always
part of the plan.
New permanent prenatal center, 1 established as a result of the local de
mand for prenatal care. It is supported by local funds.
Little mothers’ classes, 26 organized; girls enrolled, 357; lessons in course,
10 to 12.
Mothers’ classes, 36 (conducted by staff physicians, 22; conducted by
county nurses, 14) ; mothers enrolled, 740 (in physicians’ classes, 520;
in county nurses’ classes, 220). In addition 14 conferences for mothers
were held with an attendance of 262.
Home visits by nurses, 26,982 (to prenatal cases, 1,186; obstetrical cases,
5 ; postnatal cases, 728; infants, 10,353; preschool children, 13,609; mis
cellaneous, 1,101).
Maternity homes inspected, 249; maternity hospitals inspected, 206; in
spections made, 522 (of maternity homes, 284; of maternity hospitals,
238).
Community demonstration, 1 : A nurse was detailed to a county for three
months to carry on a child-hygiene program. She was assisted by a
staff physician, local physicians, and lay women. A child-health center
was established, a preschool drive was conducted, home visits were made,
and the correction of defects was obtained for many preschool children.
Group demonstrations, 534; on nursing care in the home, care of the baby,
preparation of food, and preparation of maternity outfit.
Campaigns, 6 : (1) For state-wide examination of preschool children and
correction of their defects before the children should enter school. In
21 counties the bureau gave supervision only, the program being carried
out entirely by local workers. (2) For prevention of trachoma, in 2>
counties. • (3) For prevention of diphtheria, in 8 counties. (4) For pre
vention of smallpox, in 3 counties. (5) For prevention of typhoid fever,
in 1 county. (6) For prevention of scarlet fever, in 1 county.
Talks and lectures, 448 (by staff, 136; by county nurses, 312).
Literatui-e prepared: Record forms, examination blanks, baby folder, follow
up cards.
Literature distributed, 128,740 pieces.
New names registered for prenatal letters, 1,787; prenatal letters dis
tributed, 5,526 sets.
Exhibits conducted, 77 (by staff, 4, at the State fair, State dairy council,
parent-teacher convention, and child-health week; by county nurses, 73).
Exhibit material was lent 16 times.
Scientific articles prepared— Prenatal Care, Leadership in Health, Before
Adolescence, Common Discomforts of Childhood.
Nutrition work was done through individual instruction.
Breast feeding was promoted by individual instruction to mothers at con
ferences, in classes, and in home visits, and by distribution of a pamphlet
on the subject.
Infants born in the State during the year, 84,100 (estimated) ; infants under
1 year of age reached by the work of the bureau, 14,076; preschool chil
dren reached, 18,939 (still others were reached through literature dis
tributed) ; expectant mothers reached, 6,898.
Counties in the State, 58; counties having maternity and infancy work
during the year, 55; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 58.
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M A T E R N IT Y AND IN F A N C Y
Activities— Continued.
The following organizations cooperated in the bureau’s work: State board
of education, American Legion, American Red Cross, federated women’s
clubs, men’s service clubs, and the parent-teacher association.
The outstanding achievement of the year was standardization and furth
improvement in the organization of the public health nursing service.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Maternity and infancy nursing service has been instituted in 31 counties
as a result of assignment of nurses to them; and organization for the service
(to start at the close of the year under review) has been completed in 3 others.
(See map on p. 50.)
Since the beginning of the State’s cooperation under the maternity and infancy
act 13 counties have assumed the financial responsibility for maternity and
infancy work begun with maternity and infancy funds.
Inspection and licensing of maternity homes and hospitals has been a duty
of the bureau of child hygiene since 1925.
The infant mortality rate has declined from 71.1 in 1922 (the year in which
the State began cooperation under the maternity and infancy act) to 62.7 in
1926. The maternal mortality rate has declined from 71.9 in 1922 to 56.4 in 1926.
CO LO R A D O
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of public instruction, child-welfare bureau, Denver.
Staff:
Director, 2 physicians (part time), 2 nurses, 1 clerk, 1 stenographer.
Temporary assistants were employed as needed.
Volunteer assistants (for 1 to 3 days’ service)— 15 physicians, 4 dentists,
7 nurses, 16 lay persons; 940 other lay persons gave occasional a ssista n t
Activities:
.
Child-health conferences conducted by physicians, 51; .infants and pre
school children registered and examined, 2,353; defects found, 7,327;
children having defects, 2,243. Parents had defects corrected in 294
of the children (reports incomplete). The conferences lasted 1 to 3
days, and several were return conferences. Improvement was noted in
the condition of the children in many communities having return con
ferences; parents had had corrections made for a number of children
whose defects had been noted at the first conference; in three towns
local groups had established child-health centers following the first con
ference; and in one community having many undernourished children
the services of a nutritionist had been obtained.
Prenatal conferences conducted by physicians, 19; expectant mothers
registered, 237; number examined, 225; visits to conferences, 237.
Dental conferences conducted by dentists, 47, in connection with the childhealth conferences; preschooL children receiving dental advice, 2,353.
New permanent child-health centers, 2 established. They are supporte
by local organizations.
Little mothers’ classes, 2 ; girls enrolled, 40; lessons in course, 12.
Mothers’ classes, 18; mothers enrolled, 293; lessons in course, 12.
Home visits by nurses, 1,627 (to prenatal cases, 123; infants, 636; pre
school children, 868).
Maternity homes inspected, 2 ; inspections made, 4.
Group demonstrations, 41, of maternity packs, preparation of food forrnu
las, and bathing and dressing the baby.
Surveys, 2 : (1) Of birth registration, in 1 town. (2) Of the adequacy o
public aid to children in their own homes. Under the State law a child
can be considered dependent six months before its birth, hence the naothej
may receive aid during the six-month period preceding the child’s bir
as well as afterward.
.
Campaign, 1 : For promotion of birth registration. Special educational
work was done, as the State is not yet in the birth-registration area.
Talks and lectures, 421.
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P R IN C IP A L ACTIVITIES OP T H E IN D IV ID U A L STATES
53
Activities— Continued.
Literature prepared: Leaflets on sunshine, diet sheets, health certificates,
literature-request cards.
Literature distributed, 12,250 pieces.
Exhibits conducted, 6, at county fairs and at State meetings of various
organizations.
Statistical studies, 2 : (1) Weights of children in San Luis and San Juan
Valleys. (2) Physicians, midwives, and other persons reporting births
in 1925. It was found that physicians had reported 18,039 births; mid
wives, 572; others, 749; and 51 certificates were unsigned.
Breast feeding was emphasized through the literature sent to mothers
when their babies were 1 to 2 weeks old.
Infants under 1 year of age reached by the work of the bureau, 3,720;
preschool children reached, 3,675; expectant mothers reached, 3,033.
The bureau sent literature on infant hygiene to parents of all infants
whose births were reported in the newspapers.
Counties in the State, 63; counties having maternity and infancy work
during the year, 51; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 57.
The staff nurses assisted in the campaign conducted by the parent-teacher
association for the examination of preschool children and correction of
their defects before they should enter school in the fall.
The following organizations cooperated in the bureau’s work: State
university, State agricultural college, State tuberculosis association,
State dental association, auxiliary of the State medical society, Colo
rado Psychopathic Hospital, American Red Cross, Women’s Christian
Temperance Union, women’s clubs, and the parent-teacher association.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Since the beginning of the State’s cooperation under the maternity and
infancy act one county and five towns have assumed the financial responsibility
for maternity and infancy work begun with maternity and infancy funds.
Improvement has taken place in the physical condition of children in the
’ State, as shown by examination made at “ return” conferences for children
examined at previous conferences. Parents had had defects corrected for a
number of children, a few child-health centers had been established by local
groups, and one community had employed a nutritionist.
As the State is not in the birth-registration area no statement as to reduction
of mortality rates can be made.
DELAW ARE
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, division of child hygiene, Dover.
Staff:
Director (physician), 9 nurses, 1 vital-statistics clerk and bookkeeper, 1
Clerk. Five physicians were employed as needed to conduct conferences
Activities:
Combined prenatal and child-health conferences conducted by physicians
39; expectant mothers registered and examined, 12; infants and preschool
children registered and examined, 973.
Child-health conferences conducted by physicians, 276; infants and preschool children registered and examined, 702; visits to conferences, 3,808.
Defects found, 598; children having defects, 405. Parents had defects
corrected in 330 of the children.
Prenatal conferences conducted by physicians, 52; expectant mothers reg
istered, 262; number examined, 251; visits to conferences, 587.
Conferences conducted by nurses, no physician present, 1,086; infants and
preschool children inspected, 2,642; mothers instructed in prenatal care
292; visits to conferences, 22,043 (by children, 21,356; by mothers 687)’
New permanent combined prenatal and child-health center, 1 established'
It is supported by Federal and State funds.
Little mothers’ classes, 4 organized; girls enrolled and completing course
136; lessons in course, 41.
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M A T E R N IT Y AND IN F A N C Y
Activities— Continued.
Midwives’ classes, 20 organized; midwives enrolled (plus those carried
over from previous year) and completing course, 219; lessons in
course, 12.
Home visits by nurses, 32,458 (prenatal cases seen, 532; obstetrical cases,
222; postnatal cases, 266; infants, 3,110; preschool children, 6,469).
Infant home inspected, 1 ; inspections made, 4.
Community demonstration, 1, in 1 town, lasting 5 days, on various phases
of maternity and infancy work.
Campaign, 1, for immunization against diphtheria, in 52 towns and 1 city;
preschool children immunized, 1,730.
Talks and lectures, 175.
Literature prepared: Diseases of children, symptoms and suggestions for
prevention, Delaware Baby Book, Diphtheria Prevention, Sunlight for
Babies, Infant Feeding, Preventive Medicine, Periodic Health Examina
tions, prenatal letters.
Literature distributed, 61,100 pieces.
New names registered for prenatal letters, 432; prenatal letters distrib
uted, 372 sets.
Nutrition work was done through individual instruction to mothers at
conferences.
Exhibit conducted, 1, at the State fair.
Statistical study, 1, of maternal mortality.
Breast feeding was emphasized at the itinerant conferences, in the work
done by the nurses, and in literature sent to expectant mothers.
Infants born in the State during the year, 4,157; infants under 1 year of
age reached by the work of the division, 3,514; preschool children reached,
10,382; expectant mothers reached, 1,372.
Counties in the State, 3 ; counties having maternity and infancy work
during the year, 3.
During the year under review the division supervised the maternity and
infancy work of community nurses who sent reports to the division.
The Delaware Antituberculosis Society and the parent-teacher association
cooperated in the division’s work: These organizations carried on a
campaign for the examination of preschool children and correction
their defects before the children should enter school.
The outstanding feature of the year’s work was the campaign for the pre
vention of diphtheria.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
During the five-year period ended June 30, 1927, children seen at conferences
had 3,850 defects corrected.
As Delaware was not in the United States birth-registration area prior to
1921 figures on maternal and infant mortality are not available from the United
States Bureau of the Census, but according to State figures the infant mortality
rate was reduced from 101.4 in 1922 to 95.9 in 1926. For the five-year period
preceding the State’s cooperation under the maternity and infancy act (19171922, excluding 1918) the average rate was 119 as compared with an average
rate of 96.4 for the five-year period since the State’s cooperation under the
maternity and infancy act— a reduction of 19 per cent. For the rural areas
of the State the reduction was slightly greater (22 per cent).
Among the causes of deaths of infants which probably more than any other
would be influenced by the care developed through instruction in proper feeding
are diarrhea and enteritis. According to the State figures the death rates of
infants under 1 year of age from these causes showed with slight variation a
downward trend from 1922 to 1926 for the State as a whole, also for both urban
and rural areas. Even in 1925, when there was an increase in the rates from
. diarrhea and enteritis throughout the country, the rate for Delaware was lower
than in any of the five years preceding the operation of the maternity and
infancy act.
As a result of the division’s work three community nurses are now carrying
on in two cities maternity and infancy work begun with maternity and infan;
funds.
The type of work done by the midwives has improved since the beginning of
the maternity and infancy work.
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PRINCIPAL ACTIVITIES OP TH E INDIVIDUAL STATES
55
F L O R ID A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Jacksonville.
Staff:
Director (nurse, part time), 12 nurses (3 part year, 9 part time), 1 auditor
(part time), 1 file clerk (part year), 1 stenographer (part time), 1
typist (part time).
Volunteer assistants, 27 physicians, 19 dentists, 120 nurses, 280 lay persons.
Activities:
Child-health conferences conducted, by physicians, 40; infants and preschool
children registered and examined, 1,184; children having defects, 787.
Prenatal conferences conducted by physicians, 59; expectant mothers regis
tered and examined, 488.
Conferences conducted by nurses, no physician present, 377; mothers in
structed in prenatal care, 887; infants and preschool children inspected,
4,461.
Dental conferences, 287, conducted by dentists who volunteered their
services.
New permanent prenatal and child-health centers, 3 established. They are
supported by a city department, local organizations, and the American
Red Cross.
New permanent child-health centers, 5 established. They are supported by
city health departments and private organizations.
Little mothers’ classes, 53 organized; girls enrolled, 300; lessons in
course, 12.
Midwives’ class meetings, 1,274; total attendance, 3,595. About 1,800 mid
wives were under supervision.
Home visits by nurses, 21,702 (prenatal cases seen, 791; postnatal cases,
210; infants, 3,259; preschool children, 4,295).
Surveys, 2 : (1) Of infant mortality, in 1 county. (2) Of birth regis
tration, state-wide.
Talks and lectures, 285.
Literature distributed, approximately 18,000 pieces.
Exhibits conducted, 10, at county fairs.
Nutrition work was done through instruction to individual mothers at
conferences and in visits to their homes.
The director assisted several local organizations in their plans for work
for maternal and preschool-child welfare.
Infants born in the State during the year, 34,439; infants and preschool
children reached by the work of the bureau, 8,952; expectant mothers
reached, 1,974. The bureau sent literature on infant hygiene to parents
of all infants whose births were reported to it.
Counties in the State, 67; counties having maternity and infancy work
during the year, 67.
The following organizations cooperated in the bureau’s work: State fed
eration of women’s clubs, State medical association, and the pao*entteacher association.
The outstanding achievements of the year were the improvement in the work
of the midwives under the supervision of the bureau, the increase in interest
in child-health conferences and in requests for them, and the greater interest
in the health of mothers and babies on the part of fathers of families, who
not infrequently accompanied their wives or brought the children to confer
ences if the mother could not bring them.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The infant mortality rate in 1924 (the year in which the State was ad
mitted to the United States birth-registration area) was 81.8 per 1,000 infants
born alive. This rate had declined to 74.8 in 1926. In 1924 the mortality rate
was 69.8 for every 1,000 white babies, and in 1926 it was 61.8. The rate for
the colored babies was slightly higher in 1926 than in 1924. In the rural areas,
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Federal Reserve Bank of St. Louis
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M A T E R N IT Y AND IN F A N C Y
however, the rate for colored babies declined from 96 in 1924 to 93.9 in 1926;
for white babies it declined from 71.6 to 60.
The maternal mortality rate likewise declined in the period 1924 to 1926.
For every 82 babies born alive in 1924 one mother lost her life from some cause
connected with pregnancy and childbirth. In other words, the maternal mor
tality rate was 121.4 per 10,000 live births. In 1926 the rate had fallen to'
106.9 per 10,000 live births. This meant that 1 mother died for every 93
babies born alive. The rate for white mothers was practically stationary,
while that for colored mothers declined from 186.9 to 148.5. In the rural areas
the rate in 1924 was 126.2 for every 10,000 live births as compared with 109.7
in 1926. For rural white mothers the rate decreased from 96.7 to 94.6, and for
colored mothers it decreased from 187.5 to 145.8.
The supervision of midwives has resulted in better midwifery practice that
in all probability has contributed to lower maternal and infant death rates.
G E O R G IA
S T A F F A N D A C T IV IT IE S I N 1927
Administrative agency:
State board of health, division of child hygiene, Atlanta.
Staff:
Director (physician), 1 physician (part year), 5 nurses (3 part year),
1 laboratory assistant, 1 stenographer, 1 chauffeur for healthmobile
(part year). Sixteen county nurses in 12 counties were paid for mater
nity and infancy work (14 full time, 2 half time) on part-salary basis.
Activities:
Child-health conferences conducted by physicians, 638 (on the healthmo
bile and in counties where public-health nurses were paid for maternity
and infancy work) ; infants and preschool children registered and
examined, 8,942; defects found in children examined on the healthmo
bile, 5,209. The healthmobile with a staff of advance agent (nurse),
physician, nurse, and chauffeur was in the field six months during the
year under review. Conferences were held on the truck during the day
In the evening public meetings were held at which talks on health were
given and motion pictures on health subjects were shown. Approxi
mately 21,000 persons were reached by the conferences and meetings.
Prenatal conferences conducted by physicians, 293; expectant mothers
registered and examined, 5,854.
Conferences conducted by nurses, no physician present, 42; infants and
preschool children inspected, 389; mothers instructed in prenatal care, 44.
New permanent child-health center, 1 established as a result of the
maternity and infancy work. It is supported by State, city, and private
funds.
Little mothers’ classes, 108 organized; girls enrolled and completing course,
1,915; lessons in course, 11.
Mothers’ classes, 69 organized; mothers enrolled and completing course,
1,207; lessons in course, 11.
Midwives’ classes, 96 organized; midwives enrolled and completing course,
747; lessons in course, 10. Following the course of instruction a mid
wives’ club was formed, and monthly meetings were held. Many of the
unfit midwives have ceased practicing, and the use of silver nitrate for
the prevention of blindness has increased greatly. (For mention of
assistance given by the United States Children’s Bureau in the work
with midwives see pp. 129-130.)
Home visits by nurses, 42,862 (prenatal cases seen, 6,220; postnatal cases,
1,431; infants, 11,084; preschool children, 6,533).
Group demonstrations, 3,882, on making maternity outfits, preparing food,
and other phases of maternal and infant care, also demonstration childhealth conferences conducted on the healthmobile.
Campaign, 1, for immunization against diphtheria, state-wide. A sufficient
quantity of toxin-antitoxin for 200 immunizations was given ^to each
county for use in immunizing preschool children. The work with these
children led parents to have their older children immunized. It war
estimated that as a result of this campaign 100,000 children were immu
nized. The State pediatric society and physicians throughout the State
cooperated in this work.
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P R IN C IP A L ACTIVITIES OP T H E IN D IV ID U A L STATES
57
Acti vities— Continued.
The division cooperated in a campaign for the observance of May Day as
Child Health Day.
Talks and lectures, 329, including talks by the healthmobile unit The
radio was used, frequently, and talks were broadcast from a station hav
ing an audience estimated at 100,000 persons. A representative from
the State board of health gave talks on child hygiene at teachers’ insti
tutes conducted by the State department of education.
Literature distributed, 109,141 pieces.
Many daily papers published articles on maternal and infant hygiene
prepared by the division.
Nutrition work was done through individual instruction to parents whose
children were examined in the healthmobile and through 325 nutrition
conferences.
Exhibits conducted, 52, at bazaars, at county fairs, and in county health
department offices.
Educational work was done to promote the registration of births.
In addition to their work included in the foregoing paragraphs the nurses
were instrumental in having defects corrected in 1,344 children and in
having 889 Wassermann tests made. They took 1,110 children to physi
cians for vaccination against smallpox and 620 for inoculation against
typhoid fever.
Infants and preschool children reached by the work of the division, 36,301;
, expectant mothers reached, 18,146.
Counties in the State, 161; counties having maternity and infancy work
during the year, 117; counties in which the division has done maternity
and infancy work since the acceptance of the maternity and infancv
act, 149.
The following organizations assisted in the division’s work: State depart
ment of education, State dental association, State league of women
voters, Women’s Christian Temperance Union, civic clubs, women’s clubs,
the parent-teacher association, and other organizations.
Among the outstanding features of the year’s program were the work with
midwives and the work done for immunization against diphtheria.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Securing the cooperation of state-wide organizations as well as of other
groups with the maternity and infancy work has developed definite improve
ments in the field of maternal and infant welfare.
The campaign for the immunization of preschool children against diphtheria,
assisted by the State pediatric society and the medical profession of the State
resulted in the giving of antitoxin to approximately 100,000 children.
The State dental association cooperated in obtaining dental corrections.
The estimated number of midwives in the State is 6,000; instruction has been
given to approximately 4,000; the midwife situation has improved since the
beginning of the maternity and infancy work.
The use of silver nitrate for the prevention of blindness in babies has
greatly increased. During the year 1,451 individuals ordered 66,457 ampoules
of this prophylactic.
As the State was not in the birth-registration area figures on maternal and
infant mortality rates from the United States Bureau of the Census are not
available.28 According to State figures there has been a marked reduction in
the infant mortality among negroes in Macon, Ga., where special work has
been done by a negro nurse.
The amount of maternity and infancy work has increased in the period of
cooperation under the maternity and infancy act. For example, in 1924 one
county nurse reported from her county 35 child-health conferences, with 266
babies in attendance, and 1,950 home visits; in 1926, 310 conferences were
reported, with an attendance of 936 babies, and 6,381 home visits were reported.
In 1924 a total of 318 prenatal cases were supervised in this county, with
_
or
In December, 1927, the State was admitted to the birth and death registration areas as
Jio.
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58
M A T E R N IT Y AN D IN F A N C Y
1,638 visits; in 1926 a total of 1,549 prenatal cases were supervised, with 2,358
home visits.
The number of Wassermann tests made for prenatal cases has increased.
In the fiscal year 1927 a physician reported for one prenatal clinic 1,172 such
tests with 14 per cent showing positive reactions. (The work at this clinic re
ceived some assistance from nurses on the staff of the division of child hygiene.)
H A W A II
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
Territorial board of health, division of maternity and infancy, Honolulu.
Staff:
Director (physician), 4 nurses, 1 stenographer. (Twelve nurses on the
Territorial board of health not paid from maternity and infancy funds
gave one or two days a week to maternity and infancy work.)
Volunteer assistants— 12 physicians, 4 nurses, 17 lay persons.
Activities:
Child-health conferences conducted by physicians, 1,302; infants and pre
school children registered and examined, 5,629; visits to conferences,
21,832.
New permanent child-health centers, 12 established, 7 of which were part
of the division’s work. Five were conducted by plantations cooperating
with the division.
Little mothers’ class, 1 ; girls enrolled, 10; number completing course, 8;
lessons in course, 6.
Home visits by nurses, 11,155 (prenatal cases seen, 77; infants, 498; pre
school children, 928).
Talks and lectures, 13.
Nutrition work was an important part of the program in the conferences
at the child-health centers. Preparation of food was demonstrated at
the health centers and also in the homes.
Scientific article prepared: “ Growth of children in Hawaii.”
Infants born in the Territory during the year, 12,296; infants under 1 year
of age reached by the work of the division, 3,003; preschool children
reached, 2,626.
Counties in the Territory, 5 ; counties having maternity and infancy work
during the year, 4 ; work is not allowed in the county containing the
leper settlement.
The division’s program during the year consisted almost entirely of childhealth conferences held regularly in child-health centers in different parts of
the islands, and of follow-up visits to the homes of the children who attended
these conferences.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E PE R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The Sixty-eighth Congress extended the benefits of the maternity and infancy
act to the Territory of Hawaii, and since April 13, 1925, the Territory has
cooperated under the act.
There was an increase in the amount of work done in the second year of
cooperation compared with that in the first year. The attendance at childhealth centers in 1926 was 10,986; in 1927, 21,832. In 1926, 14 per cent of the
infants born during the year were under supervision; in 1927, 24 per cent. A
supervising nurse was assigned to each of the four islands— Kauai, Hawaii,
rural Oahu, and Maui. This plan covers the Territory with more efficient
supervision than prior to the acceptance of the act. Figures from the United
States Bureau of the Census are not available, as Hawaii is not in the birthregistration area, but Territorial statistics show a lower infant mortality rate
among both Hawaiians and Filipinos for 1927 than for 1926. Both races have
high infant mortality rates. The rate for Hawaiians has declined 2L31 points
and that for Filipinos 61.13 points since the beginning of the maternity an
infancy work.
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PRINCIPAL ACTIVITIES OP TH E INDIVIDUAL STATES
'
59
IDAHO
S T A F F A N D A C T IV IT IE S IN 1927
¿Administrative agency:
Department of public welfare, bureau of child hygiene, Boise.
Staff:
Director (physician), 2 nurses (1 part year), 1 bookkeeper and stenogra
pher. Physicians were employed as needed to conduct conferences.
Activities:
Combined prenatal and child-health conferences conducted by physicians,
96 ; expectant mothers registered and examined, 8 ; infants and preschool
children registered and examined, 3,983; defects found in children, 7,402 •
children having defects, 3,202.
’
Home visits by nurses, 477 (infants seen, 172; preschool children, 181)
Surveys, 3 : (1) Of hospitals. (2) Of midwives. (3) Of birth registra
tion. All were state-wide.
Campaigns, 2 : (1) For promotion of breast feeding. (2) For promotion
of birth _ registration. The State was admitted to the United States
birth-registration area in the autumn of 1926. Both campaigns were
state-wide.
Talks and lectures, 21.
Literature prepared: Prenatal letters (revised), nutrition chart
Literature distributed, 13,054 pieces.
New names registered for prenatal letters, 293; prenatal letters distributed
325 sets.
Nutrition work was done through individual instruction to mothers at
conferences.
Exhibits conducted, 15, consisting of layettes, posters, charts, and litera
ture. Exhibit material prepared, charts showing causes of puerperal and
infant deaths, by counties.
Statistical studies, 2, of puerperal and infant deaths, by counties.
Breast feeding was emphasized in all individual and group instruction to
mothers.
Infants born in the State during the year, 9,612; infants and preschool
children reached by the work of the bureau, 17,390; expectant mothers
reached, 293.
Counties in the State, 44; counties having maternity and infancy work
during the year, 43; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 44.
As a result of the bureau s work three counties employed public-health
nurses.
The following organizations cooperated in the bureau’s work: State medi
cal society, State league of women voters, State legislative council of
women, State federation of women’s clubs, American Red Cross, Women’s
Christian Temperance Union, two prominent church relief societies, and
the parent-teacher association.
The outstanding achievement of the year was the admission of the State to
the United States birth-registration area.
SOME R E S U L T S O F TH E W O R K D U R IN G THE PE R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
In every county in the State maternity and infancy work has been done
during the period of cooperation under the maternity and infancy act As a
resuit of the work of the bureau of child hygiene three counties have em
ployed public-health nurses.
The State was admitted to the United States birth-registration area in the
autumn of 1926, the bureau of child hygiene having assisted in the campaign
to reach the standard of registration of births required for entry.
As the State was not in the registration area before 1926 ’ maternal and
infant mortality rates are not available from the United States Bureau of the
Census, but figures from the State indicate a lower infant mortality in 1926
ban m 1922 (the year in which the State began cooperation under the mateinity and infancy act). A declining maternal mortality rate is suggested
Was 9*2 f r i w f a V d 45 to I 9 2 r mber
892°— 28----- -5
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mater“ ‘ aeathS reportea ln the State
M ATERNITY AND IN FAN C Y
60
The bureau of child hygiene has reached all midwives practicing in the
State and they have been required to comply with the State law concerning the
practice of nddwSer
The situation in regard to the midwives has improved
since the beginning of the maternity and infancy work.
IN D IA N A
S T A F F A N D A C T IV IT IE S IN 1927
AdmStete bolrd of health, division of infant and child hygiene, Indianapolis.
StafDirector (physician), 3 physicians (2 part year), 5 nurses (4 part year),
1 exhibit director, 1 vital-statistics clerk, 1 secretary, 3 stenographers.
Other physicians, nurses, and stenographers and field assistants were
employed as needed.
Activities .health
conferenceg conducted by physicians, 204; infants and pre
school children registered and examined, 6,078; defects found, 29,086,
Xildren having defects, 5,932. Parents had defects corrected in apTvroximately 60 per cent of th6 chilcirGii.
_ _
,,
Mothers’ classes, 220 ; mothers and high-school girls enrolled plus those
carried over from previous year, 10,658; number completing course,
9 665 • lessons in course, 5. At the close of the year under review the
mothers’ class program, begun in 1924, had been conducted in all but 5
of the 92 counties of the State.
niasses for teachers were conducted at several teachers institutes.
t o u p d e m o S S K 520. Two were given in each county as part of the
mothers’ classes, others were given at county fairs, the State fair, child
T a lth week a? Winona Lake Chautauqua, and State group meetings
Campaigns 3 : (1) For immunization against diphtheria. (2) For the
state-wide observance of May Day as Child Health Day. ( )
^
examination of preschool children and correction of their defects betoL
the children should enter school.
Lherature prepared^Yitamins and Health (revised), To Mothers of In
diana, The Indiana Better Baby.
L i t e r a t u r e d i s t r i b u t e d , 168,259 p i e c e s .
„
.
w W h
Exhibits conducted, 51. These were of three types. (1) Posters, which
were displayed in connection with lectures and at State meetings of variotÎ k i n d s (2) Posters, books, and such models as that of maternity
room and the baby’s bath. (3) Large exhibits demonstrating maternity
and infancy work that communities can undertake. The most complete
exhibit of this type was conducted at the State fair.
.
The child-hygiene activities at the State fair have increased greatly siuce
the beginning of this work. The first “ better-baby
building on the
fairground was completed in 1924 ; in the year under review a new build
ing was erected from funds appropriated to the State boardof agricul
ture for this purpose by the legislature, supplemented by special funds
provided by that board. Some of its rooms are equipped for conducting
physical examination of infants and preschool children ; others contain
very complete exhibits of models, literature, charts, and posters; one
room is equipped as a day nursery, and in the adjoining playground
parents visiting the fair can leave their children. Physicians, nurses,
and other assistants were employed by the State board of agriculture to
assist the division’s physicians and nurses in conducting demonstration
conferences and in examining children for a better-baby contest. A
total of 1,274 infants were thus examined in 1926, and 1,37b were
examined in 1927.
.. . ,
,ha
Articles relating to maternity and infancy work were contributed to tne
monthly bulletin of the State board of health.
.,
._
Statistical studies, 8 : Of birth registration; of midwives; of the accident,
of pregnancy of a group of mothers ; of the maternity care received b
a group of mothers; of the mental development of a group of preschool
children ; of the nutrition of a group of preschool children ; of the dis
eases and weight records of a group of preschool children; ot tne
physical defects noted in conferences.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
61
Activities— Continued.
Breast feeding was promoted through individual instruction to mothers
at conferences and in mothers’ classes and in literature distributed.
County child-health boards organized, 11. Their purpose is to promote
the examination of preschool children and correction of their defects,
to protect them against danger of disease, and to promote their care,
N U M B E R O F C L A S S E S IN M A T E R N A L A N D I N F A N T C A R E C O N D U C T E D IN i N D I A N A .
M A R C H , 1 9 2 4 - J U N E , 1927, I N C L U S I V E
training, and proper nutrition. An effort is made to have on these
boards representatives from all the organizations conducting child-health
activities.
Infants born in the State during the year, (*¿,375; infants and preschool
children reached by the work of the division, 37,708.
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62
M ATERNITY AND IN FAN C Y
Activities— Continued.
Counties in the State, 92; counties having maternity and infancy work
during the year, 36; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 91. (One county had
had maternity and infancy work previously.)
The following organizations cooperated in the division’s work: OtherState departments, State dental association, State federation of women’s
clubs, State league of women voters, State farm bureau, American As
sociation of University Women, Women’s Christian Temperance Union,
fraternal and business organizations, and the parent-teacher association.
Among the outstanding achievements of the year were the completion of the
county-wide child-health conferences for all the 92 counties in the State, the
completion of mothers’ classes in all except 5 of the counties, the organiza
tion of the 11 county child-health boards, and the state-wide observance of
Child Health Day.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
A division of child hygiene was established in the State in 1919 and a plan
laid for an educational program in maternal and child care prior to the passage
of the act for the promotion of the welfare and hygiene of maternity and
infancy. Expansion of the program was made possible by the State’s accept
ance of the act. Education of parents in the care of infants and preschool
children through conferences has been an important feature of the program.
In the period May, 1920, to July, 1922, a total of 236 child-health conferences
were held in 36 of the 92 counties in the State. During the period of coopera
tion (1922 to 1927) a total of 777 child-health conferences were held in 82
counties. The average number of conferences per year was therefore 118
before the beginning of the State’s cooperation, whereas during the period the
average was 155. Instruction in the care of the mother before, during, and
after confinement through class instruction, lectures, and visual-education
methods has also been a main feature in the program. From March, 1924, to
the close of the year under review 853 mothers’ classes had been held i
85 counties. (See map on p. 61.)
A comparison of the average infant mortality rate for the five-year period
of the State’s cooperation under the maternity and infancy act with that
for a similar period prior to acceptance (exclusive of 1918) shows a reduc
tion of 13.4 per cent for the State as a whole, 15.9 per cent for the urban areas,
and 12.6 per cent for the rural areas. A similar comparison for the average
maternal mortality rate shows a reduction of 19.5 per cent for the State as
a whole, 18.3 per cent for the urban areas, and a slightly larger reduction
(23.9 per cent) for the rural areas.
Since the beginning of the State’s cooperation under the maternity and infancy
act several communities that conduct child-health activities without assistance
from the division have increased and extended their activities as a result of
the interest developed through the division’s work.
IO W A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of education, division of maternity and infant hygiene, Iowa
City.
?.
Staff:
.
..
. .
Director (director of the extension service of the State university serving),
3 physicians (2 part year), 6 nurses (2 part year), 1 dentist, 1 dental
hygienist, 1 social worker, 1 vital-statistics clerk, 3 stenographers.
Activities:
Child-health conferences, 198; infants and preschool children examined,
4,255; defects found, 4,672; children having defects, approximately 4,000.
Parents had defects corrected in approximately 50 per cent of the chil
dren. These conferences were conducted by the pediatric unit of th§
staff, consisting of a pediatrician, two nurses, and the social worker.
One nurse did advance work; the other nurse and the social worker did
follow-up work after the conferences. \
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
63
Activities— Continued.
Prenatal conferences, 75; mothers visiting conferences, 3,165. These con
ferences were conducted by the mothers’ health unit of the staff, con
sisting of a physician and a nurse. Talks and demonstrations were given
but no examinations were made.
’
Conferences conducted by nurses, no physician present, 99; mothers in
structed in prenatal care, 2,113.
Dental conferences, 105; preschool children receiving dental advice 1358
These conferences were conducted by the dental unit of the staff, con
sisting of the dentist, the dental hygienist, and a nurse.
Talks and lectures, 238.
Literature distributed, 53,378 pieces.
Exhibits conducted, 147, at county fairs and at prenatal conferences The
mothers health unit carried exhibit material that included layettes
obstetrical package, outfit for home delivery, patterns, and literature'
Exhibit material was lent 30 times.
Infants born in the State during the year, 44,908; infants under 1 year of
age reached by the work of the division, 1,127 ; preschool children reached
5,413; expectant mothers reached, 440.
Counties in the State, 99; counties having maternity and infancy work
during the year, 49; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 98.
The following organizations cooperated in the division’s work: State farm
bureau, State federation of women’s clubs, State dental society State
tuberculosis association, and the parent-teacher association.
The year’s program consisted almost entirely of conferences and of follow-un
work. The outstanding achievement of the year was the organization of a
State oral-hygiene bureau through cooperation with the State dental society
and the State tuberculosis association. The oral-hygiene work done by the
division among mothers and preschool children had demonstrated especially
the need and value of such a bureau.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
■
TH E M A T E R N IT Y A N D IN F A N C Y A C T
An educational maternity and infancy program in rural areas has been
conducted through infant and prenatal conferences and through lectures and
conferences with mothers on prenatal and maternity care.
Figures from the United States Bureau of the Census are not available for
maternal nor infant death rates until 1924, when the State was admitted to
the birth-registration area. There has been a drop in the maternal death
1Q94
^ aiooc l th0Ugi the infant death rate ^as increased (from 55 in
1924 to 59 m 1926, the urban rate increasing from 66 to 72 the rural rat a
from 50 to 53). In 1924 the maternal death rate for the State as a whole
was 59.8 per 10,000 live births. In 1926 the rate was 60.4. However in^he
LUr^ f eaSA e -ra-e decreased from 52.2 per 10,000 live births in 1924’ to 48 8
in 192b, and it is m the rural areas that the maternity and infancy program
has been conducted. The rates for puerperal septicemia and puerperal albumiuna and convulsions (causes which more than any others indicate the care
the mother received during pregnancy and confinement) show material decreases m the rural areas. For deaths due to septicemia the r S
rate fn
fioatbWaS
i£r e7ery. 10-0°0 live births, compared with 15.5 in 1926- for
to l £ l fn 1926a bUminUna aUd convulsions the rate dropped from 16.1 in 1924
KAN SAS
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency :
Staff^a^e k°ar^
health, division of child hygiene, Topeka.
2 nurse.s (1 for 2 months, 1 for 1 month),
2 cleikfc (1 month), 1 stenographer (2 months).
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M ATERNITY AND IN FAN C Y
64
Activities:
,
. ‘
. .
„
The act passed by the Kansas Legislature to accept the provisions of the
Federal act for the promotion of the welfare and hygiene of maternity
and infancy was signed by the governor on March 16, 1927. The funds
made available will permit an extension of the activities of the division
of child hygiene. Work was begun in May, 1927, the two months remain
ing before the close of the year under review being devoted mainly to
planning and organizing the new work.
0 ^ ‘‘{ t
Four maternity homes and 31 infant homes were inspected; 1,224 pieces
of literature and 224 sets of prenatal letters were distributed; exhibit
material was lent 12 times; 6 talks were given; and some new literature
for use in child-health conferences was prepared.
The following organizations cooperated in the division’s work: American
Legion auxiliary, State league of women voters, and the parent-teacher
association.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
SOME K f i a U L is u r
TH E m a t e r n i t y a n d IN F A N C Y A C T
The State has had a division of child hygiene since 1915 and had cooperated
for a time by virtue of the governor’s acceptance, cooperation having been
discontinued because the first legislature that met after the passage of the
act failed to accept its provisions. (See p. 30.)
The interest awakened in
maternal and child welfare by the early establishment o t the division and
the assistance rendered from April 1, 1922, to September 22, 1923, during the
period of cooperation under the governor’s acceptance had a noticeable eifect,
however on the interest in maternal and child welfare throughout the State.
The action of the 1927 State legislature accepting the provisions of the act
has made expansion of the program possible.
KENTUCKY
S T A F F A N D A C T IV IT IE S IN 1927
A d m in is tr a tiv e a g e n cy :
State board of health,
*
bu reau
of
.... ,
... T
• -n
m a t e r n a l a n d c h i l d health, Louisville.
Director (physician), 3 physicians (1 part year, l part time), 9 nurses (6
part year, 1 part time), 1 nutritionist, 2 clinical assistants (1 for 1
month), i vital-statistics clerk, 1 inspector of birth registration (part
year), 1 educational instructor (part year, part time), 1 milk inspector
(part year), 9 clerks (2 part time), 1 stenographer. Two county nurses
were paid for some maternity and infancy work.
Activities:
j
. .
„„„ .
, ,
, ~
Child-health conferences conducted by physicians, 333 (arranged by staff
nurses, -279; arranged by the two county nurses who were paid for ma
ternity and infancy work, 54) ; infants and preschool children registered,
6,204; number examined, 6,179; visits to conferences, 6,408; defects found
in children examined at conferences arranged by staff nurses, 10,686 ;
children having defects, 4,950. In addition, county health units and
nurses affiliated with the bureau conducted 451 conferences in 27 counties.
Prenatal conferences conducted by physicians, 36; expectant mothers reg
istered and examined, 1,063; visits to conferences, 3,037.
New permanent child-health centers, 10 established as a result of the ma
ternity and infancy work. They are supported by State, local, and private
funds. All child-health centers in the State cooperate with the bureau
and work under its supervision.
Little mothers’ classes, 234 organized; girls enrolled and completing course,
4,689; lessons in course, 5. Courses of 6 lectures on child care were
given by a staff physician to junior and senior students at the State
university, 6 junior colleges, 4 State .normal schools, and 2 private schools.
Mothers’ classes, 79 organized; mothers enrolled and completing course,
3,147; lessons in course, 4.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
65
Activities— Continued.
Midwives’ classes, 17 organized; midwives enrolled and completing course,
165; lessons in course, 2. Because of flood conditions in the mountains
and the destruction of roads and bridges it was not possible to conduct
as many midwife classes as in previous years. However, the midwives
were taking a more intelligent interest in their work, having better equip
ment and reporting more of the births attended.
Maternity home inspected, 1 ; inspections made, 4. A detailed study was
made of this home. As a result many changes were made in its methods
of caring for the mothers and their babies, who are kept together in the
home for three months.
Infant homes inspected, 30; inspections made, 30.
Demonstrations consisting of child-health conferences, exhibits, and lectures
were made at several county fairs.
The bureau cooperated in a compaign for the state-wide observance of May
Day as Child Health Day and in campaigns in two counties for the ex
amination of preschool children and correction of their defects before the
children should enter school.
Talks and lectures, 335.
Literature prepared: Prenatal letters, diet cards (revised), 2 pamphlets on
nutrition.
Literature distributed, 56,749 pieces. Packages of literature were fur
nished to hospitals to give to mothers in their obstetrical departments
after the fourth day of confinement.
New names registered for prenatal letters, approximately 1,500; prenatal
letters distributed, approximately 2,500 sets.
Graduate courses for physicians and for nurses were conducted by an
obstetrician lent by the United States Children’s Bureau. (See p. 129.)
A staff nurse assisted in arrangements and in the clinic work.
Nutrition classes for mothers, 2 with average attendance of 25 and of 150,
respectively; lessons in course, 6 for the first class, 9 for the second.
Lectures on nutrition of mothers and children were given to 18 other
groups and instruction was given to individual mothers also. Nutrition
work for preschool children was carried on in 8 communities by homeeconomics students under the supervision of the nutritionist, and approxi
mately 2,500 children were reached by this work.
Two health -and nursery schools for children between 3 and 5 years of
age were conducted for a period of eight weeks in two cities. The chil
dren were given a complete health examination before admission, and
their parents were instructed as to the best methods of keeping them
well. The children were helped to form good health habits, to eat the
proper kinds of food, and to rest lying down two hours each day.
Exhibits conducted, 65, of literature, charts, posters, and other material,
at meetings of county medical societies, county health officers, women’s
clubs, and parent-teacher associations and at teachers’ institutes. Ex
hibit material was lent 10 times.
Articles prepared for county newspapers and magazines, 60, relating to
maternal and infant hygiene.
Breast feeding was promoted through the talks given and literature dis
tributed.
Infants born in the State during the year, 64,290. The bureau sends diet
eards for the baby and health rules for the nursing mother to parents of
all babies whose births are registered in the bureau of vital statistics.
In the year under review approximately 60,480 mothers received this
literature. Expectant mothers reached by the work of the bureau, 19,412.
Counties in the State, 120; counties having maternity and infancy work
during the year, 86 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 120.
The staff nurses were detailed for several weeks to work with mothers and
children in the flooded areas of the State. They supervised and in
structed the mothers in feeding and caring for their children and in
caring for themselves during pregnancy. The number of infants and
preschool children cared for was estimated to be about 10,000.
The following organizations cooperated in the bureau’s work: State league
of women voters, Women’s Christian Temperance Union, women’s clubs,
and parent-teacher associations.
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66
MATERNITY AND IN FAN C Y
Among the outstanding features of the year’s work were the graduate courses
in obstetrics for physicians, in which the bureau cooperated, the courses of
lectures given at State normal schools, junior colleges, and the State university,
and the health and nursery schools conducted for preschool children.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E PE R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The death rate from causes associated with pregnancy and childbirth has
dropped in the State as a whole from 60.7 per 10,000 live births in 1922 tO' 58.4
in 1926. The rate in urban districts was 96.6 in 1922 and 74.8 in 1926 ; the
average rural rate for the five-year period 1922 to 1926 ( 55.1) was slightly
lower than that for a similar period prior to the State’s cooperation under the
maternity and infancy act (57.6).
The Louisville City Hospital gave prenatal care during 1923 to 1926 to white
mothers to whom 677 babies were bom alive and to colored mothers to whom
996 babies were born alive. Maternity and infancy funds were used to assist
this work. Two of the white mothers and two of the colored mothers died from
causes associated with pregnancy and childbirth; the maternal mortality rate
for this group who had received prenatal care was therefore 29.5 per 10,000 live
births for white mothers and 20.1 per 10,000 live births for colored mothers.
This was strikingly lower than the maternal mortality rate for the city as a
whole during this same period, which was 65.2 for white mothers and 142 for
colored mothers.
Sixteen of the 677 babies bom to the white mothers» who received care at the
hospital clinic died during the first month of life, and 39 of the 996 bom to* the
colored mothers died. The neonatal death rate for this group was therefore
23.6 per 1,000 live births for the babies of the white mothers and 39.2 per 1,000
live births for the babies of the colored mothers. These rates likewise are
considerably lower than the neonatal mortality rate for the city as a whole
during this same period, which was 38.2 for babies born to white mothers and
55.1 for babies bom to colored mothers.
Since the beginning of the State’s cooperation under the maternity and infancy
act eight counties have assumed the financial responsibility for maternity an
infancy work begun with maternity and infancy funds.
LO U ISIA N A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, bureau of child hygiene, New Orleans.
Staff *
Director, 2 physicians (1 part time), 8 nurses (6 part year), 2 dentists (1
part year), 1 midwife teacher (nurse), 1 clerk (part time), 1 stenographer.
Temporary assistants were employed as needed. Five parish 27 nurses
were paid for some maternity and infancy work.
Activities:
Child-health conferences conducted by physicians, 210; infants and pre
school children registered and examined,, 6,571; visits to conferences,
6,821; defects found, 22,784; children having defects, 6,541.
Prenatal conferences conducted by physicians, 16; expectant mothers reg
istered, 88 ; number examined, 58.
Conferences conducted by nurses, no physician present, 16; some lasted
several days; infants and preschool children inspected, 3,170; mothers
instructed in prenatal care, 457. These figures include conferences con
ducted in the flood area.
Dental conferences conducted by dentists, 80; preschool children receiving
dental advice, 4,316.
Midwives’ classes, 48; midwives enrolled plus those carried over from pre
vious year, 2,520; number completing course, 138; number still on roll,
2,482; lessons in course, 6. The midwives have improved in cleanliness
and in the use of aseptic measures. A larger number are reporting births,
requesting nitrate of silver solution, and asking to be registered.
Home visits by nurses, 408 (prenatal cases seen, 315; obstetrical cases,
12; infants, 9 ; preschool children, 72).
In Louisiana the parish is the civil division corresponding to the county in other
States.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
67
Activities— Continued.
Community demonstrations, 2, parish-wide, consisting of child-health con
ferences conducted to show the value of such work.
Group demonstrations, 127. Of these 13 were of child health conference
work, at parish fairs; 114 were on some phase of maternal and infant
care, at midwives’ classes and other group meetings.
Surveys, 2 : (1) Of midwives, in 26 parishes. (2) Of birth registration,
in 26 parishes.
Campaign, 1, for promotion of birth registration. The work for complete
registration of births, Which increased greatly after the beginning of
maternity and infancy activities, culminated in a state-wide campaign
in the year under review, in which workers from the United States
Bureau of the Census and from the United States Children’s Bureau
cooperated.
Talks and lectures, 385.
Literature prepared: Baby Book (revision begun), diet cards.
Literature distributed, 18,531 pieces.
New names registered for prenatal letters, 618; prenatal letters distrib
uted, 618 sets.
Nutrition work was done through individual instruction to mothers and
children at conferences, also in camps in the flooded area.
Exhibits conducted, 15; 13 were at the parish fairs at which demonstra
tions were made; 1 was at the International Trade Exposition (a per
manent exhibit in New Orleans) ; and 1 was in the health car of the
State department of health, which toured the State. Exhibit material
prepared— charts, posters, graphs. Exhibit material was lent 86 times.
Statistical study, 1, of maternal and infant mortality.
Breast feeding was promoted through talks to mothers at conferences,
literature distributed, and instruction given to midwives.
Infants born in the State during the year, 47,527; infants under 1 year of
age reached by the work of the bureau, 2,675; preschool children reached
7,592; expectant mothers reached, 1,065.
Counties in the State, 64; counties having maternity and infancy work
during the year, 48; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 60.
The following organizations cooperated in the bureau’s work: State tuber
culosis and public-health association, State federation of women’s clubs,
American Red Cross, local medical societies, community clubs and other
local organizations, and the parent-teacher association. Their members
assisted in planning for conferences and conducting them, brought
mothers and children to them, helped to arrange exhibits, and dis
tributed literature.
Among the outstanding features of the year’s work were the birth-registra
tion campaign and the emergency work done in May and June in parishes that
had been flooded. As the situation demanded immediate public-health work
five staff nurses were detailed to the flooded area to carry on maternity and
infancy work. They gave instruction in general health and in proper feeding
to all mothers encountered. A detailed summary of the activities in which
these nurses assisted or worked alone is as follows (such figures as are appli
cable are included in the foregoing items) :
Prenatal and maternity work:
N um ber
Prenatal casesi visited in camp______________ ,___________
195
Prenatal conferences and clinics held____ ____ 1_________
13
Visits to conferences and clinics_______ ._________________
111
Mothers instructed_______________________________________
933
Talks to groups___________________________________________
4
Attendance at talks___________________________________________ 90
Maternity cases attended_________________________ I I ____
12
Assisted with layette____________________________________
3
Expectant mothers examined by physician______________
10
Infant and preschool-child work:
Infants under 2 years of age inspected by nurse________ 1,284
Infants under 2 years of age examined by physician____
52
Preschool children inspected by nurse_!______________ ___ 1,133
Preschool children examined by physician_______________
74
Interviews concerning preschool children________________
49
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68
m a t e r n it y
and
in f a n c y
Infant and preschool-child work— Continued.
N um ber
Talks to groups______________________________________
9
Attendance at talks______________________________________
99
Mothers instructed_______________________________________
42
Preschool children receiving dental care--------------------------192
Midwife work:
Midwives interviewed in camps_________________________
23
2
Lessons given (in addition to 11 to individuals)------------Demonstrations__________________________________________
2
2
Talks to groups____________________ :-------------------------------SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F 'C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The health educational work in the State has been exceptional. The exhibits
shown in the health car operated by the State department of health, which con
sists of two Pullman cars equipped with laboratory, scientific exhibits, charts,
clowns, models, and other material covering many phases of public-health work
has much space devoted to infant and child hygiene. These cars have been
sent all over the State wherever railroads go and have brought to the rural
districts much information not otherwise accessible to such localities.
Registration of births has increased as a result of the state-wide campaign
for birth registration in which the workers of the bureau of child hygiene co
operated during a considerable period.28
Although figures from the United States Bureau of the Census on mortality
rates are not available, the State figures show since the beginning of the coopera
tion under the maternity and infancy act in 1924 a decline in both maternal and
infant mortality rates. The maternal mortality rate per 1,000 live births was
10.3 in 1924, 10.8 in 1925, and 9.4 in 1926. The infant mortality rate per 1,000
live births was 93.6 in 1924, 88.6 in 1925, and 73.8 in 1926.
The work in the flood area gave great opportunity for education in child and
maternal cafe.
Since the beginning of the State’s cooperation under the maternity and infancy
act the practice of the midwives has become much better. The advance in
aseptic measures, cleanliness, and registration of midwives and in registration*
of births by them is due directly to the work of the bureau of child hygiene.
M A R YLA N D
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, bureau of child hygiene, Baltimore.
Staff:
Director (physician), 1 health-education worker (part time), 1 clerk, 2
stenographers. Physicians and dentists were employed as needed to
conduct conferences, and temporary assistants were employed as needed.
Twenty-two county nurses (two negro) in 16 counties were paid for
some maternity and infancy work.
Volunteer assistants— 10 physicians, 3 dentists, 75 lay persons.
Activities:
Child-health conferences conducted by physicians, 380 (22 for negro
children) ; infants and preschool children registered and examined,
5,579 (white, 4,991; negro, 588) ; defects found, 7,591; children having
defects, 4,058. Parents were known to have had defects corrected in
510 of the children.
Conferences conducted by nurses, no physician present, 32; infants and
preschool children inspected, 435; mothers instructed in prenatal care,
26.
Dental conferences conducted by dentists, 55; preschool children receiv
ing dental advice, 490.
New permanent combined prenatal and child-health centers, 2 established.
They are supported by local funds. Almost every county in the State
now has one permanent health center or more.
Little mothers’ classes, 12 organized; girls enrolled, 245; number com
pleting course, 180; lessons in course, 6.
28T lie
S ta te w a s a d m itted to the b irth -re g is tra tio n area A u g . 4, 1927.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
69
Activities— Continued.
Mothers’ classes, 76 organized; mothers enrolled, 1,223; number com
pleting course^ 856; lessons in course, 8.
Midwives’ classes, 2 ; midwives enrolled, 35; number completing course,
12; lessons in course, 8. Nurses are visiting midwives so far as possible
and inspecting their bags, and fewer midwives are practicing.
Home visits by nurses, 3,314 (prenatal cases seen, 808; postnatal cases,
149; infants, 1,585; preschool children, 1,379).
Group demonstrations, 30. Of these 26 were at child-health conferences,
where mothers were shown proper methods of feeding, bathing, and
dressing the baby; 4 were at county fairs, where motion pictures, slides,
dental exhibits, and layettes were shown. Children were weighed, mea
sured, and given height and weight tags. Approximately 18,500 persons
visited these 4 demonstrations.
The bureau assisted in a survey of crippled children conducted in
Baltimore.
Talks and lectures, 93.
Literature prepared: Poster showing intervals at which children should be
examined.
Literature distributed, approximately 129,000 pieces.
Graduate courses for physicians: Lectures in pediatrics were given by the
director and by members of the pediatric departments of the medical
schools of Johns Hopkins University and of the State university, at
meetings of county medical societies, at six centers in the State, in
cluding several counties. Subjects covered were: Prevention of rickets,
syphilis in infancy and childhood, infant feeding and gastrointestinal
diseases, tuberculosis and respiratory diseases, and the physician’s part
in maintaining child health. Lectures on obstetrics were given by a
professor of obstetrics from the State university medical school, in 2
counties.
Exhibits conducted, 65. Exhibit material was lent 35 times.
Scientific articles prepared: Pediatric Material, Hazards of Rural Mothers
and Infants.
Statistical studies, 6 : Infant mortality rates for the State of Maryland
in comparison with the United States birth-registration area, 1916-1925;
infant mortality rates for the white and negro population in counties
of Maryland in comparison with those for Baltimore City, 1916-1925;
population, births, infant deaths, infant mortality rates, stillbirths,
neonatal deaths, maternal deaths, and maternal mortality rates for the
white and negro population for each of the 23 counties, by years, for
the period 1922-1926; puerperal septicemia in the 23 counties, 19171926; certain defects found in 1,842 children examined May and June,
1926; mortality rates among infants under 1 and 2 years of age from
diarrhea and enteritis in the 23 counties and in Baltimore City, 19171926; and mortality of infants under 2 years of age, by counties, for the
white and negro population, 1923, 1924, 1925.
Breast feeding was promoted by distribution of a diet card that advocated
breast feeding.
Infants born in the State during the year, 33,437; infants under 1 year
of age reached by the work of the bureau, approximately 18,000; pre
school children reached, approximately 11,000 ; expectant mothers reached,
approximately 8,000. (These figures do not cover Baltimore, which had
a city bureau of child hygiene.) The bureau sends literature on infant
hygiene to parents of all infants whose births are registered in the
State bureau of vital statistics.
Counties in the State, 23; counties having maternity and infancy work
since the acceptance of the maternity and infancy act, 23.
As a result of the bureau’s work orthopedic conferences were conducted
in one county, and child-health conferences were conducted in various
parts of the State. These were given supervisory assistance by the
bureau.
Each of two communities employed a negro public-health nurse, whom the
bureau paid for some maternity and infancy work.
The following organizations cooperated in the bureau’s work: State feder
ation of women’s clubs, State league of women voters, and fraternal
and other organizations.
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70
M ATERNITY AND IN FAN CY
Among the outstanding features of the year’s work were the more rigid
supervision of midwives, the making of urinalyses for expectant mothers in
the State laboratories, the employing of negro public-health nurses by two
communities, and the conferences held for negro infants and preschool children.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Maryland’s bureau of child hygiene was created in 1922, the State having
accepted the provisions of the maternity and infancy act in that year. The
work of the bureau has been confined to the rural areas, every county having
had some maternity and infancy work. The program has been developed
through publication and distribution of literature pertaining to the care of
the mother and baby; through child-health conferences; through supervision
of midwives; through extension of public-health nursing throughout the State
in cooperation with the bureau of child hygiene (in 1920 there were 20 publichealth nurses, in 1926 there were 45) ; through graduate lectures and demon
strations in obstetrics; through visits of nurses to newborn babies; and through
other phases of educational work.
In 1922 the maternal mortality rate in the rural areas of the State was 58.6;
in 1926 it was 42.4. For the State as a whole the rate declined from 59.4 in
1922 to 57.8 in 1926. In the rural areas the average rate from 1922 to 1926
was 50.6 as compared with 68.5 during the five-year period before the State’s
cooperation under the maternity and infancy act (exclusive of 1918), the
decrease during the period of cooperation being 26.1 per cent. For the State
as a whole the decrease was 17.9 per cent.
The infant mortality rate for the State as a whole declined from 94.1 in
1922 to 87.1 in 1926; for white infants the rate declined from 81.4 to 74.3, and
for colored infants it declined from 147.3 to 137. A comparison of the infant
mortality rates during the period of cooperation (1922-1926) with a similar
period prior to acceptance of the maternity and infancy act (1917-1921, exclu
sive of 1918) shows a reduction of 14.3 per cent for the State, 14.9 per cent
for white infants, and 14.8 per cent for colored infants. The rates for the
rural areas show the same general trend.
Care of the mother during pregnancy and confinement tends to lower the
death rates for infants who die from so-called natal and prenatal causes; that
is, premature birth, injuries at birth, etc. In the State as a whole the death
rates from the natal and prenatal group of causes dropped from 42.1 in 1922
to 39.6 in 1926; for white infants the rate declined from 39.3 to 36.1 and for
colored infants, from 54 to 53.2. For the counties, excluding Baltimore City,
the decline was more marked for the colored infants— from 58.1 to 49.7; for
the white infants the rate dropped from 37.8 to 36.1. These deaths from natal
and prenatal causes occur mostly in the first month of life, and improvement
in the care of the mother is further indicated by the reduction in the mortality
rates for infants dying in the first month of life. In the State as a whole the
rate for white infants dying under 1 month of age dropped from 38.9 in 1922
to 35.5 in 1926; for colored infants, from 56.3 in 1922 to 53.8 in 1926. In the
counties (that is, excluding Baltimore City), the decrease in the rates for
colored infants was even more marked during the same period— from 65.7 to
55.9; for white infants the decrease was from 39 to 37.4.
Excluding the “ early infancy ” group of deaths, most of which occur in the
first month of life, diarrhea and enteritis probably cause more deaths in the
first year of life than any other cause, and reduction in the rates from these
causes would indicate better understanding of feeding problems and better care
of milk. In 1922 the mortality rate from these causes was 21.6 for every
1,000 live births; in 1926 it was 14.9. For white infants the rate declined from
18.6 to 12.4, and for colored infants it declined from 34.3 to 24.7. In comparison
with the previous five-year period (excluding 1918) a marked reduction is
evident: From 1917 to 1921, inclusive, the average rate was 27.1 for the State,
24.6 for white infants, and 37.8 for colored infants; for the period of the
State’s cooperation under the maternity and infancy act the average rate was
17.7 for the State, 15.3 for white infants, and 27.7 for colored infants. In
the counties (exclusive of Baltimore City), there was also a reduction in the
death rate from diarrhea and enteritis for both white and colored infants,
although it was slightly less marked than in the State as a whole.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
71
MICHIGAN
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, bureau of child hygiene, Lansing.
Staff:
Director (physician), 2 physicians, 12 nurses (1 half year), 1 midwife
supervisor (nurse), 2 vital-statistics clerks, 1 clerk (part time), 3
stenographers.
HEALTH NURSING, M ICH IG AN
D E P A R T M E N T O F H E A L T H , 192 2- 1 92 7
Activities:
Child-health conferences conducted by physicians, 141, in 21 counties;
infants and preschool children registered and examined, 2,711; defects
found, 6,010; children having defects, 2,470 (not including 241 children
for whom defects were not tabulated).
Prenatal conferences conducted by physicians, 65; expectant mothers regis
tered, 91; number examined, 40.
New permanent combined prenatal and child-health centers, 4 established
as a result of the maternity and infancy work. They are supported
by local funds.
New permanent prenatal center— 1 established With the assistance of the
bureau. It is supported by local funds.
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72
MATERNITY AND IN FAN C Y
Activities— Continued.
.
<
Little mothers’ classes, 291 organized; girls enrolled and completing course,
6,379; lessons in course, 8.
Mothers’ classes, 89 organized; mothers enrolled and completing course,
1,036 ; 35 midwives also took the course; lessons in course, 8 .
Home visits by nurses^ 9,311 (prenatal cases seen, 1,554; postnatal cases,
645; infants and preschool children, 3,529).
Community demonstrations, 3, in 3 counties, on prenatal nursing care, to
show its value. Each demonstration was planned for a one-year period.
The work in 1 county was begun in January, 1926; in the other 2 it was
begun during the year under review. The following figures cover the
period January 1, 1926, to June 30, 1927, for the 3 counties: Expectant
mothers under supervision, 645; visits made to them, 2,593 (before de
livery, 1,660; after delivery, 933). Of these mothers 409 were under 30
years of age; hence they were reached early in their child-bearing period
and will have for future pregnancies the continued benefit of the instruc
tion received. At the close of the year under review 440 women had
been delivered, and there had been two maternal deaths among them.
The maternal mortality rate for mothers under supervision in the 3 coun
ties during the period of supervision was 49 per 10,000 live births. The
maternal mortality rate for the four-year period before this demonstra
tion (1921 to 1924) was 94 per 10,000 live births in one of these counties,
110 in another, and 176 in the third.
Group demonstrations— 66, on various phases of maternal and infant care.
Surveys, 3 : ( 1 ) Of the prevalence of goiter among children, in 4 counties;
( 2 ) of midwives, state-wide; (3) of maternal mortality, in 23 counties.
It was found that 47 of the 113 deaths studied were the result of septi
cemia and that 28 of these followed abortions.
Campaign, 1, for promotion of breast feeding, in 10 counties. Figures for
these 10 counties and 7 counties completed the previous year are as fol
lows : Of the 2,545 babies whose mothers were visited in the 17 counties
188 had never been breast fed, and 217 had been breast fed less than one
month.
Talks and lectures, 135.
Literature distributed, 336,369 pieces.
New names registered for prenatal letters, 2,690; prenatal letters distrib
uted, 3,233 sets.
Exhibits conducted, 5, at the State fair and at meetings of State and local
organizations. An exhibit on sup baths was prepared. Exhibit material
was lent 6 times.
Infants born in the State during the year, 107,869; infants under 1 year of
age reached through conferences, home visits, and other contacts 8 046*
number reached through literature, 99,398; preschool children reached’
5,341; expectant mothers reached, 7,072. The bureau sent literature on
infant hygiene to parents of all infants whose births were registered in
the State bureau of vital statistics.
Counties in the State, 83; counties having maternity and infancy work
during the year, 68 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 83.
The director served as chairman of the child-hygiene section of the parentteacher association and assisted in a campaign for the examination of
preschool children and correction of their defects before the children
should enter school in the fall. Approximately 1,000 letters were sent
to presidents of local parent-teacher associations, and more than 300
schools were pledged to carry out the campaign. The director also
served on the State committee for the observance of May Day as Child
Health Day, and reports were received of its observance throughout 37
counties and in 63 local communities.
As a result of the bureau’s work local agencies carried on many activities
for maternal, infant, and preschool-child welfare. A number of new
child-health centers were established. The bureau received reports from
0 7 QQef te-rsV
w.hli * 5 610 conferences were held. The centers reported
27,394 visits by infants and preschool children and 2,026 visits by expec
tant mothers The nurses in charge of these centers made 31,464 home
visits. Local nurses organized 129 little mothers’ classes, in which 2,908
girls were enrolled.
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Federal Reserve Bank of St. Louis
PRINCIPAL ACTIVITIES OP TH E INDIVIDUAL STATES
73
The following organizations cooperated in the bureau’s work : State
agricultural college, State grange, State child-study association, State
nurses’ association, State league of women voters, State federatimi of
women’s clubs, American Association of University Women, Daughters
of the American Revolution, Women’s Christian Temperance Union,
Legislative Council of Michigan Women, Detroit Federation of Women s
Clubs, fraternal organizations, and the parent-teacher association.
The outstanding feature of the year’s work was the initiation of a state
wide maternal-mortality study in cooperation with the State medical society.
Death rates per !,000 survivors a t I month of age
O
JO
20
30
40
Four ■towns:
13.5
29.1
pertoske,y^ Q
3 2 .4
C a d illa c :
A
1 08
33.4
H o llan d :
14.3
22.3
Ludindton:
5
25.2
39.8
Registered t \ \ \ ^
N o t registered
C O M P A R ISO N OF M O R T A L IT Y A M O N G INFAN TS RE GISTER ED AND INFANTS N O T
R E G I S T E R E D A T H E A L T H C E N T E R S IN F O U R T O W N S IN M I C H I G A N F R O M D A T E
O F O R G A N IZ A TIO N OF C E N TE R S T O JU N E 30,1927
SOM E R E S U L T S O F T H E W ^ ^ O ^ H E J E J U O D
O F ^ O O P E R A T .O H U N D E R
The major features of the State program during the period of cooperation
under the maternity and infancy act have been establishment of permanent
health centers, instruction in the importance of prenatal care, instruction of
mothers of newborn infants in hygiene and proper care of the baby, classes in
high schools and elementary schools in infant care, demonstration itinerant
conferences, campaigns to promote breast feeding and prenatal care, and im
provement in midwifery service. (See map on p. 71.)
. . .
The average infant mortality rate in Michigan for the five-year period prior
to cooperation under the maternity and infancy act (1917-1921, exclusive of
1918) was 86 9 For the five-year period of the State’s cooperation under the
maternity and infancy act (1922-1926) the average infant mortality rate
dropped to 75.9— a decrease of 11 deaths in every 1,000 live births.
There was also a material decrease in the death rate among mothers from
causes connected with pregnancy and confinement. During the period 1917 to
1921 (exclusive of 1918) the average maternal mortality rate was 78.3 tor
every 10,000 live births ; from 1922 to 1926 the average rate was 66.9. The
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Federal Reserve Bank of St. Louis
74
M ATERNITY AND IN FAN C Y
decline is particularly striking in the rural areas, the rate falling from 73.9
for the period prior to passage of the maternity and infancy act to 55.5 during
the period of cooperation under the act.
In 1921 the maternal mortality rate for the State as a whole was 68.5 for
every 10,000 live births; in 1926 it was 67.2. The urban rate increased from
71.1 in 1921 to 77.4 in 1926. The rural rate declined from 65.5 in 1921 to 51.6
in 1926— a saving of 14 mothers for every 10,000 live births. In 1921 the
infant mortality rate for the State was 78.6 for every 1,000 live births; in 1926
it was 77.2. The urban rate in 1921 was 81.2 and 81.8 in 1926. The rural rate,
on the contrary, had fallen from 75.5 in 1921 to 70.1 in 1926.
A demonstration of maternal and infant nursing service was begun in Alger
County in 1923. A comparison of the infant mortality rates for a four-year
period prior to the demonstration (1919-1922) with the four years following
the demonstration shows a reduction from 121 to 100.2— a saving of 21 infants
among every 1,000 born alive. In Calhoun County (exclusive of Battle Creek),
where a similar demonstration was made in 1923-24, the rate declined from 77.4
during the period preceding the demonstration (1919-1922) to 53 during and
after the demonstration (1923-1926)— a saving of 24 infants, among every 1,000
born alive.
The number of permanent health centers has increased from 31 in 1921 to
75 in 1926.
An evaluation of the results of health-center care has been made in four
towns having been permanent health centers— Petoskey, Cadillac, Ludington, and
Holland— by comparing mortality among babies cared for at the centers with
that for babies 1 month old and over living in the same towns but not attend
ing health centers. Babies are seldom brought to centers in the first weeks of
life— weeks during which mortality is invariably high; and rates for healthcenter babies are therefore comparable with those for infants 1 month of age
and over. In every instance the mortality among babies receiving care at
centers was much lower than that among babies not so cared for. In the
four towns combined the rate for babies registered at the centers was 13.5
and that for babies not registered was 29.1. The lowest in any town was 7,
for registered babies; whereas 22.3 was the lowest for nonregistered babies.
The highest rate for registered babies was 25.2; for nonregistered babies it
was 39.8. (See chart on p. 73.)
Education and supervision of midwives have included classes for instruction
and visits to midwives for inspection of their homes and equipment. These
measures have been directed toward raising the standards of midwives in
practice and toward eliminating unqualified midwives. In this connection it is
interesting to note that in 1921 there were 6,632 births attended by midwives
(6.9 per cent of the total births reported), whereas in 1926 there were only
3,315 births delivered by midwives (3.4 per cent of the total births reported).
Since the beginning of the State’s cooperation under the maternity and in
fancy act all except 9 of the 83 counties in the State have had little mothers’
classes conducted by nurses employed by the bureau of child hygiene. Still
other classes were conducted by nurses not paid by the bureau but receiving
equipment and advice from the bureau. In these classes girls are taught the
essentials of infant hygiene. '
Since the beginning of cooperation three counties have assumed the financial
responsibility for maternity and infancy work begun with maternity and
infancy funds.
M IN N E S O T A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, division of child hygiene, Minneapolis.
Staff;
Director (physician), 9 nurses (2 part year, 1 part time), 3 vital-statistics
clerks, 2 clerks, 4 stenographers. A physician was employed as needed
to conduct conferences. Five county nurses in one county were paid for
some maternity and infancy work.
Activities:
Health conferences for Indian children conducted by physicians, 4 ; in
fants and preschool children registered and examined, 69.
Prenatal conferences conducted by physicians, 13; expectant mothers reg
istered and examined, 95.
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PRINCIPAL ACTIVITIES OE THE INDIVIDUAL STATES
o
7'Z
Activities— Continued.
Little mothers’ class, 1 organized; girls enrolled, 35; number completing
course, 30; lessons in course, 8. Assistance was given to county, com
munity, and school nurses who taught little mothers’ classes. The divi
sion issued 228 certificates to girls completing the course during the year.
One of the nurses gave to the students in the State teachers’ colleges 25
lectures and demonstrations on methods and subject matter for little
mothers’ classes. The purpose was to prepare rural teachers to give
courses on infant care in small schools. Total attendance, 552.
Mothers’ classes, 77 organized; mothers enrolled, 1,193; number completing
course, 151; lessons in course, 8.
Home visits by nurses, 4,334. dSvo staff nurses working among the Indians
made 2,991 visits (prenatal cases seen, 142; obstetrical cases, 36; post
natal eases, 140; infants, 423; preschool children, 355). The county
nurses who were paid for maternity and infancy work made visits to 35
prenatal cases, 3 obstetrical cases, 18 postnatal cases, 96 infants, and 169
preschool children.
Group demonstrations, 676, at county fairs, prenatal conferences, mothers’
classes, and other group meetings.
Campaign, 1, for immunization against diphtheria, initiated and conducted
by the two nurses working among the Indians. Clinics were arranged
at which children were given inoculations by physicians from the Bureau
of Indian Affairs. Immunizations made, 950.
Talks and lectures, 133.
Literature prepared: The Building Years (leaflet).
Literature distributed, 156,982 pieces.
New names registered for prenatal letters, 1,133; prenatal letters distributed,
1,830 sets.
Correspondence course: Mothers registered plus those carried over from pre
vious year, 725; number completing course, 552; lessons in course, 15.
Exhibits conducted, 30, at county fairs, the State fair, State sanitary con
ference, and meeting of State federation of women’s clubs. Exhibit ma
terial prepared: Posters on milk, with standards. Exhibit material was
lent 19 times.
Expectant mothers reached through conferences, home visits, and letters,
1,370.
Counties in the State, 87; counties having maternity and infancy work dur
ing the year, 75; counties having maternity and infancy work since the
acceptance of the maternity and infancy act, 87.
The following organizations cooperated in the division’s work; State medical
association, State federation of women’s clubs, Women’s Christian Tem
perance Union, and parent-teacher associations.
The outstanding feature of the year’s work was the organization of mothers’
classes.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Minnesota began to cooperate under the maternity and infancy act in 1922.
During the period 1917 to 1921 (exclusive of 1918) the average infant mortality
rate was 64.8, whereas it was 58.8 during the period of cooperation (1922-1926).
Hence the rate for the period of cooperation was 9.3 per cent lower than that
of the previous period. For the urban areas the rate dropped from 67.9 to 59.1,
and for rural areas1it dropped from 63.2 to 58.6. There was a decrease also in
the maternal mortality rate, which declined from 64.6 for the period preceding
cooperation under the act to 53.9 during the period of cooperation— a saving
of 11 mothers for every 10,000 live births. In the urban districts the rate
declined from 74.5 to 64.9; the decline in the rural areas was even more marked,
the average rate dropping from 59.5 to 47.
Since January 1, 1924, prenatal conferences have been conducted in the rural
districts by prominent obstetricians from the University of Minnesota. The
important features of these conferences are that the attending physician is
present at the examination of his patients and that the case is discussed with
him. A talk on prenatal care is given before the assembled physicians, and a
talk on the hygiene and care of pregnancy is given to the group of expectant
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76
MATERNITY AND IN FAN C Y
mothers. More than 70 conferences of this character have been conducted, and
more than 800 mothers have been reached. In addition many physicians have
had the advantage of graduate instruction in obstetrics and -prenatal care.
Since the beginning of the State’s cooperation under the maternity and in
fancy act two counties have assumed the financial responsibility for maternity
and infancy work begun with maternity and infancy funds.
M IS SIS SIP P I
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Jackson.
Staff:
Acting director (State health officer serving part time), 1 physician, 3
nurses, 1 dental hygienist (part time), 1 midwife supervisor (part time),
1 vital-statistics clerk (part year), 1 accountant (part time), 2 stenog
raphers (1 part time), 1 typist (part time). Seven county nurses were
paid for some maternity and infancy work.
Activities:
Child-health conferences conducted by physicians, 282; infants and pre
school children registered and examined, 3,097; defects found, 3,052;
children having defects, 2,045.
Dental conferences conducted by dentists, 68 ; expectant mothers receiving
dental advice, 1,418; preschool children receiving dental advice, 7,000.
Many local dentists volunteered their services for these conferences.
Hygiene classes, 65 organized; girls enrolled, 1,500; number completing
course, 1,162; lessons in course, 12. Instruction relating to prenatal
care was given.
Midwives’ classes, 255 organized. Thirty-five hundred midwives were under
supervision, and approximately 1,000 were given an eight-lesson course
of instruction. A questionnaire was sent to all physicians of the State
asking whether they had noticed improvements in certain phases of
the midwives’ work; 75 per cent or more replied that the midwives ha
improved in personal cleanliness, in care of their equipment, in the care
of infants, in calling physicians in abnormal cases, and in reporting
births; 69 per cent replied that the midwives had improved in their care
of the mothers.
Home visits by nurses, 3,699 (to prenatal cases, 756; obstetrical cases,
304; infants, 1,341; preschool children, 1,298).
Campaigns, 2 ; (1) For promotion of birth registration. (2) For improve
ment in the practice of midwives. Both were state-wide.
Talks and lectures, 3,697.
Literature prepared: Hygiene outline.
Literature distributed, approximately 10,000 pieces.
Nutrition work was done through individual instruction and lectures to
groups.
Exhibits conducted, 20. Exhibit material was lent 100 times.
Scientific articles prepared: The Preschool Child, Midwifery.
Breast feeding was promoted through the literature distributed and the
talks given.
Infants born in the State during the year, approximately 50,000; infants
under 1 year of age reached by the work of the bureau, approximately
12,000; preschool children reached, approximately 19,000; expectant
mothers reached, approximately 4,000. The bureau sends literature on
infant hygiene to parents of infants whose births were registered in the
State bureau of vital statistics.
Counties in the State, 82; counties having maternity and infancy work
during the year, 82.
In addition to their activities reported in the foregoing paragraphs the
county nurses carried on maternity and infancy work as follows: Hold
ing conferences with individual mothers and midwives in the office of
the county health department, visiting midwives in their homes, inspect
ing midwives’ equipment, securing Wassermann tests and urinalyses,
obtaining vaccination against smallpox and inoculation against typhoid
fever for preschool children, and assisting physicians in administering
toxin-antitoxin and in making Schick tests for preschool children.
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PRINCIPAL ACTIVITIES OF TH E INDIVIDUAL STATES
77
Activities— Continued.
The following organizations cooperated in the bureau’s work: American
Red Cross, State Development Board, and the parent-teacher association.
Among the outstanding features of the year’s work were the hygiene classes
and the work with midwives.
SOM E R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
A bureau of child welfare and public-health nursing was organized in 1920,
the State was admitted to the United States birth-registration area in 1921,
and cooperation under the maternity and infancy act was begun in 1922.
Instruction and supervision of midwives began in 1921 and has been a major
feature of the State maternity and infancy program. In 1921 there were 4,209
midwives registered. Between 1921 and 1926 there were added to the list
approximately 1,000 midwives. The number registered in 1926 was 3,500;
many who were unfitted for the work have ceased to practice. The physicians
of the State have expressed the opinion, through replies to a questionnaire
sent to them, that the practice of the midwives and the type of service they
render are better.
Since the beginning of the State’s cooperation under the maternity and
infancy act five counties have assumed the financial responsibility for maternity
and infancy work begun with maternity and infancy funds.
MISSOURI
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, division of child hygiene, Jefferson City.
Staff:
Director (physician), 3 nurses (2 part year), 1 nutrition worker (1 month),
1 birth-registration visitor and child health club organizer (part time,
part year), 1 multigraph operator (part time, part year), 1 stenographer
(part time, part year). Fourteen county nurses were paid for some
maternity and infancy work.
Activities:
Child-health conferences conducted by physicians, 201; infants and pre
school children registered and examined, 2,376; visits to conferences,
3,504; defects found, 3,545; children having defects, 1,792.
Conferences conducted by nurses, no physician present, 298; infants and
preschool children inspected, 6,356; expectant mothers instructed in pre
natal care, 311 (including some mothers instructed in the office).
Dental conferences, 29, conducted by dentists who volunteered their serv
ices ; preschool children receiving dental advice, 1,790.
New permanent child-health centers, 4 established. They are supported
by Federal, State, county, and city funds.
Little mothers’ classes, 121 organized; girls enrolled, 1,478; number com
pleting course, 185; lessons in course, 12.
Mothers’ classes, 129 organized; mothers enrolled, 2,325; number complet
ing course, 58; lessons in course, 10. Many mothers attending classes
did not work for a certificate; therefore no report was made as to their
completion of the course.
Home visits by nurses, 3,728 (prenatal cases seen, 327; obstetrical cases,
68 ; postnatal cases, 160; infants and preschool children, 2,068).
Community demonstrations, 18, lasting 3 days to 2 weeks, including physi
cal examination of children, health exhibits, showing of films and slides,
and public addresses.
Surveys, 2 : (1) Of midwives, in several counties; (2) of birth registra
tion, conducted under the direction of the division by the State federa
tion of women’s clubs, in each county having a women’s club.
Campaigns, 4 : (1) For promotion of birth registration; (2) for prevention
of blindness in infants; (3) for prevention of diphtheria. »A dodger on
toxin-antitoxin treatment was sent to the parents of all infants whose
births were registered in the State bureau of vital statistics, also to all
physicians practicing in the State, many of whom requested copies to
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M ATERNITY AND IN FAN C Y
Activities— Continued.
distribute to their patients. As a part of the May Day (Child Health
Day) celebration, for which the director of the division was chairman,
immunization against diphtheria and vaccination against smallpox were
urged for all children before they should enter school. As a result of
the campaign 10,169 immunizations and 7,147 vaccinations were reported
to the division. (4) For interesting parents in having defects of chil
dren corrected through a “ six-point child ” project. Children free from
defects in vision, hearing, posture, throat, and teeth and having normal
weight were awarded buttons by the division. Nurses reported a gain
of 50 to 100 per cent over the previous year in the number of corrections
made as a result of the interest aroused. In connection with its summer
round-up the parent-teacher association advocated that every child be
come a “ six-pointer ” before entering school. Prizes were offered to the
three counties having the most “ six-point ” children in attendance at the
State fair, and the names of 9,900 “ six-point ” children were reported
to the State board of health by July 1, 1927. Pictures of these children
were to be displayed at the State fair.
Talks and lectures, 555.
_
.
.
.
Literature prepared: Protect Your Child Against? Diphtheria, Six-Point
Children.
Literature distributed, 534,848 pieces.
New names registered for prenatal letters, 820; prenatal letters distrib
uted, 812 sets.
Nutrition work was done for one month through class instruction to
mothers and preschool children. Four lessons were given to each group.
Exhibits conducted, 54, of charts, proper food and clothing for babies, baby
pen, and other material, at county fairs, the State fair, and various local
and State meetings. Exhibit material was lent 25 times.
Breast feeding was promoted through lecture work (including radio talks).
Infants born in the State during the year, 66,611; infants under 1 year of
age reached by the work of the division, 66,611; preschool children
reached, 9,800 ; expectant mothers reached, 1,365. The last two figures
are exclusive of the number reached by literature. The division sends
literature on infant hygiene to parents of all infants whose births are
registered in the State bureau of vital statistics.
Counties in the State, 114; counties having maternity and infancy work
during the year, 36; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 111.
The following organizations cooperated in the division’s work: State de
partment of education, State university, State league of women voters,
State federation of women’s clubs, State dental association, State tuber
culosis association, State public-health association, State ^nurses’ asso
ciation, State conference of social work, State street and highway safety
council, women’s auxiliary of the State medical association, American
Red Cross, Women’s Christian Temperance Union, and the parent-teacher
association.
The outstanding feature of the year’s work was the development of the
“ six-point child ” project to promote the physical examination of preschool chil
dren and to interest their parents in having defects corrected before the chil
dren should enter school.
SOM E R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State department of health assisted by the staff of the division of child
hygiene has conducted a continuous campaign for education on birth registra
tion for several years and was under test by the United States Bureau of the
Census at the close of the fiscal year 1927.29
The importance of securing correction of defects found in preschool children
examined at conferences has been emphasized by the development of the “ sixpoint child ” project, in which the State gave prizes to communities having
the largest number of preschool children meeting the six points before entering
school— that is, having teeth, throat, shearing, vision, posture, and weight nor
mal (or corrected) in accordance with a minimum standard.
26 The State was admitted to the United States birth-registration area Sept. 8, 1927.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
79
As the State was not in the birth-registration area, figures from the United
States Bureau of the Census are not available. Figures furnished by the State
show a decline in infant mortality rates from 83 in 1920 to 69 in 1925.
M ONTANA
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, child-welfare division, Helena.
Staff:
Director (physician, paid in part from maternity and infancy funds), 2
nurses (1 of them part year), 1 laboratory technician (part time), 1
vital-statistics clerk, 1 clerk (part time), 1 bookkeeper (part time).
Extra nurses were employed for short periods, and physicians were
paid nominal fees for conducting conferences. Eight county nurses
were paid for some maternity and infancy work in 11 counties. A nurse
paid by a private organization gave part time to maternity and infancy
work under the supervision of the director.
Activities:
Combined prenatal and child-health conferences conducted by physicians, 2 ;
expectant mothers registered and examined, 10 ; infants and preschool
children registered and examined, 13.
Child-health conferences conducted by physicians, 104; infants and pre
school children registered and examined, 1,627; children having defects,
approximately 1,300. Parents had defects corrected in approximately
35 per cent of the children.
Prenatal conferences conducted by physicians, 2 ; expectant mothers reg
istered and examined, 5.
Conferences conducted by nurses, no physician, present, 389; mothers in
structed in prenatal care, 58; infants and preschool children inspected,
3,417; visits to conferences, 3,545 (by mothers, 128; by children, 3,417).
New permanent child-health center, 1 established as a result of the ma
ternity and infancy work. It is supported by Federal, State, county,
and private funds.
Little mothers’ classes, 14 organized; girls enrolled and completing course,
214; lessons in course, 12.
Home visits by nurses, 2,456 (prenatal cases seen, 189; infants, 858; pre
school children, 1,378).
Community demonstration, 1, of a model child-health center conducted
during June with the assistance of the home-economics department of
the State university, groups of women from a women’s club, and the
parent-teacher association. Child-health conferences were held daily
during the first and last weeks of the demonstration. An exhibit had
been arranged, and proper foods were demonstrated daily.
Group demonstrations, 45; 4 were on maternity package and layette, 41 on
methods of making sick children comfortable with material already in the
home. Frequently in rural districts a day was given to a meeting to
which entire families came; lectures were given to parents, and inspection
was made of children.
Campaigns, 3 : (1) For birth registration. A series of articles on birth
registration was published in the newspapers, and a short story explain
ing the need of birth registration was published in two local magazines.
Leaflets on the subject were inclosed in letters mailed from the division’s
office. Personal inquiries as to whether births had been registered were
made of the parents of all infants and preschool children with whom
the nurses came in contact. (2) For observance of May Day as Child
Health Day. The director of the division was May Day chairman
for the State, and efforts were made to stimulate local communities to
arrange May Day activities and to attract the attention of the public
to the preschool child.
(3) For promotion of a preschool drive. The
director of the division served as chairman for the parent-teacher asso
ciation’s preschool drive. Efforts were made to have parents take their
children who would enter school in the fall to their family physicians
for examination and for correction of defects found.
Talks and leetureg, 770.
Literature prepared: Bulletins on prevention of contagious diseases, diet
cards (revised), biennial report.
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MATERNITY AND IN FAN C Y
Literature distributed, 134,529 pieces.
New names registered for prenatal letters, 437; prenatal letters distrib
uted, 437 sets.
Exhibits conducted, 11. Exhibit material prepared, charts and posters.
Films were lent 45 times, lantern slides 15 times, other exhibit material
once.
Statistical study: Comparison of the infant and maternal mortality rates
of the white and Indian population for 1926. The infant mortality
rate for the white population was 69.1; for the Indian population, 185.4.
The maternal mortality rate for the white population was 8.2; for the
Indian population, 6.6. (Both infant and maternal mortality rates are
based on deaths per 1,000 live births.)
Breast feeding was promoted by sending literature on the subject to
all physicians in the State.
Infants born in. the State during the year, approximately 10,000; infants
under 1 year of age reached by the work of the division, approximately
7,000; preschool children reached, approximately 25,000; expectant
mothers reached, 791. The division sends literature on infant hygiene to
parents of all infants whose births are registered in the State bureau
of vital statistics.
Counties in the State, 56; counties having maternity and infancy work
during the year, 45 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 56.
Under the general plan of field work the State was divided into three
districts with a nurse in charge of each. These nurses carried on a
general maternity and infancy program in the counties having no
county nurses; and the eight county nurses paid in part from maternity
and infancy funds worked in 11 counties.
The nurses cooperated wherever possible in a state-wide campaign against
diphtheria initiated by the State board of health; they assisted in the
immunization of 1,046 preschool children.
A loan-library service was maintained for the use of rural communities
and of public-health nurses throughout the State.
The laboratory technician examined 14,792 specimens.
The following organizations cooperated in the division’s work: State fed
eration of women’s clubs, State tuberculosis association, State league of
women voters, American Red Cross, and the parent-teacher association.
The outstanding features of the year’s work were the organization of childhealth conferences and the securing of financial cooperation in the county
nursing services supported in part by maternity and infancy funds.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State’s program has been educational, carried on through the conducting
of health conferences, teaching of classes, and distribution of literature. The
great area of the State and its sparse settlement, the difficulties of travel and
of communication due to its topography, and the climatic conditions at some
seasons have prevented the division’s direct contacts with some sections from
being frequent. Part of the plan has been to develop permanent maternity
and infancy work by paying part of a county nurse’s salary in return for
maternity and infancy work on her part. Eleven counties have been subsidized
in this way, and nine are continuing the work. Two counties have not main
tained the service. In one the county money was used to subsidize a physician,
as there was none in the whole county; the other, though not able to maintain
a county nurse, has a weekly child-health conference conducted by the county
health officer..
N EBR ASKA
S T A F F A N D A C T IV IT IE S IN 1927
Administrative 8.§6ncy i
State department of public welfare, bureau of health, division of child
hygiene, Lincoln.
StafDirector (nurse), 2 nurses, 1 maternity and infant home inspector, 1 vitalstatistics clerk, 1 stenographer. Temporary assistants were employed
as needed.
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PRINCIPAL ACTIVITIES OE TH E INDIVIDUAL STATES
81
Activities:
Child-health conferences conducted by physicians, 56; infants and pre
school children registered, 2,056; number examined, 2,049; defects found,
4,264; children having defects, 2,010. Local physicians and dentists and
some pediatricians assisted with the examinations. Parents had de
fects corrected in many of the children.
Little mothers’ classes, 2 organized; girls enrolled and completing course,
79; lessons in course, 3. The staff nurses also gave lectures and demon
strations to high-school girls on child care and the prevention of com
municable diseases.
Mothers’ classes, 21 organized; mothers completing course, 103; number hav
ing one or two lessons, 1,604; lessons in course, 4. A mimeographed les
son outline was used, and bulletins on child care and child management
were distributed. An obstetrician in one town was so impressed with
the value of the lessons given to two groups of women that he urged
all the young mothers and expectant mothers among his rural patients
to come into town to attend the course.
Home visits by nurses, 2,436 (to prenatal cases, 97; postnatal cases, 10;
infants, 880; preschool children, 1,449).
Maternity homes inspected, 75; inspections made, 75.
Infant homes inspected, 17; inspections made, 17.
Group demonstrations, 38, on bathing, dressing, lifting, and carrying the
baby, giving sun baths, and bandaging varicose veins.
Campaign, 1, for the examination of preschool children and correction of
their defects before the children should enter school. This work was
done in cooperation with parent-teacher associations and other organi
zations.
Talks and lectures, 55, at meetings of the State league of women voters
and of county, intercounty, and district federations of women’s clubs,
to rural clubs, and to senior nurses in training. As a result several local
groups planned to have classes in maternal and infant hygiene in the
coming fall and winter.
Literature prepared: R 6sum£ of State work, infant-hygiene lessons.
Literature distributed, 53,543 pieces. A list of health books was sent to
all teachers in the State.
New names registered for prenatal letters, 130; prenatal letters distributed,
457 sets.
Nutrition work was done through individual instruction to mothers at
conferences and classes and through letters.
Exhibits conducted, 4, in connection with talks and lectures. Exhibit
material was lent once.
Breast feeding was promoted by emphasis in mothers’ classes and in home
visits and by distribution of literature on the subject.
Infants born in the State during the year, 28,287; infants under 1 year
of age reached by the work of the division, 27,400; preschool children
reached, 675; expectant mothers reached, 704. A return postcard con
taining a list of publications was sent to the parents of all infants whose
births were registered in the State bureau of vital statistics.
Counties in the State, 93; counties having maternity and infancy work
during the year, 59; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 73.
The following organizations cooperated in the division’s work: State fed
eration of women’s clubs, State league of women voters, State tubercu
losis association, American Legion auxiliary, Women’s Christian Tem
perance Union, and the parent-teacher association.
Among the outstanding features of the year’s work were the classes for
women and girls, in which prenatal and infant hygiene, nutrition, and preven
tion and control of communicable diseases were stressed.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
A marked result of the cooperation under the maternity and infancy act is
the increase in the interest 'of local groups in maternal and child welfare.
Many localities are conducting child-health conferences with local physicians
making the examinations. Some of these conferences have been repeated at
fairly regular intervals, assuming in this respect some of the characteristics
of permanent centers.
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M ATERNITY AND IN FAN C Y
There is an increasing interest in and demand for class instruction in child
care for both mothers and girls.
NEVADA
S T A F F A N D A C T IV IT IE S IN 1927
A d m in is tr a tiv e a g e n c y :
State board of health, child-welfare division, Reno.
Staff:
Director, Seven county nurses were paid for some maternity and infancy
work.
Activiti6S !
Combined prenatal and child-health conferences conducted by physicians, 6 ;
expectant mothers registered, 11 ; infants and preschool children reg
istered and examined, 93.
Conferences conducted by nurses, no physician present, 356; infants and
preschool children inspected, 149; mothers instructed in prenatal care, 68 ;
visits to conferences, 964 (by children, 852; by mothers, 112) ;
Little mothers’ classes, 4 organized; girls enrolled, 89; lessons in course, 12.
Mothers’ classes, 2 organized; mothers enrolled, 31; lessons in course, 12.
Home visits by nurses, 9,180 (prenatal cases seen, 201; obstetrical cases,
18; infants, 1,192; preschool children, 1,985).
Talks and lectures, 107.
Literature distributed, 2,547 pieces.
Prenatal letters distributed, 1,000 sets.
Nutrition work was done through instruction to individual mothers at con
ferences and in visits to them in their homes.
Counties in the State, 17; counties having maternity and infancy work
during the year, 17.
. ..
The State public-health association cooperated in the work of the division,
contributing $25 per month to the salary of each of the staff nurses.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
As the State is not in the United States birth and death registration areas,
results of the maternity and infancy work can not be measured in terms of mor
tality rates. Legislation is needed to enact a model law before the State can
meet the registration requirements of the United States Bureau of the Census.
A public health nursing service covering the State has been established. The
State is divided into nursing districts, and a nurse is assigned to each district.
The great size of the State, with a relatively small population scattered at great
distances, obviously offers many obstacles to an ideal public health nursing
service; but much good has resulted and is resulting from the contacts of the
public-health nurses, infrequent though they necessarily are.
Since the beginning of the State’s cooperation under the maternity and
infancy act three counties have assumed part of the financial responsibility for
maternity and infancy work begun with maternity and infancy funds.
N E W HAMPSHIRE
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, division of maternity, infancy, and child hygiene,
Concord.
Staff:
■
Director (nurse, not paid from maternity and infancy funds), 7 nurses
(3 part year), 2 stenographers. Physicians were employed as needed to
conduct conferences.
Volunteer assistants, 137 permanent committees of lay persons.
Activities:
Child-health conferences conducted by physicians, 139; infants and pre
school children registered and examined, 4,259; defects found, 3,858;
children having defects, 2,637. Parents had defects corrected in 921 of
the children. An encouraging increase in the corrections of defects was
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
83
Activities— Continued.
a result of the coinferences. Assistance in conference arrangements, in
follow-up visits, and in obtaining corrections was given by the permanent
lay committees.
Little mothers’ classes, 41 organized; girls enrolled, 409; number completing
course, 198; lessons in course, 1 to 4.
Mothers’ classes, 15 organized; mothers enrolled, 291; number completing
course, 282; lessons in course, 3 to 4.
Home visits by nurses, 12,498 (prenatal cases seen, 455; obstetrical cases,
19; postnatal cases, 415; infants, 3,250; preschool children, 6,990). After
visits to prenatal cases cards were sent to the respective family physicians
advising them of their patients’ condition.
Maternity homes inspected, 8 ; inspections made, 8.
Infant homes inspected, 12; inspections made, 18.
Group demonstrations, 332, at conferences, classes, and other group
meetings.
Campaign, 1, for immunization against diphtheria, in 8 counties. Clinics
were held in 17 towns, at which 2,424 children were given toxin-anti
toxin. This was followed later by Schick tests. Information as to date,
place, and final result was tabulated on each child’s physical-examination
card, which was to be given to the school authorities when the child
should enter school.
Talks and lectures, 163.
Literature distributed, 190,955 pieces.
Exhibits conducted, 205. At each conference and class a complete or
partial exhibit on some phase of maternal and infant hygiene work
was displayed. Exhibits prepared: For fairs and for meetings of various
organizations. Exhibit material was lent 310 times.
Breast feeding was promoted by sending a booklet on the subject to every
prenatal ease reported to the division and by instruction given by the
nurses in home visits.
Expectant mothers reached by the work of the division, 1,127.
The division sent literature on infant hygiene to parents of all infants
whose births were registered in the State bureau of vital statistics; addi
tional literature was sent every three months until the children were
12 months old.
Counties in the State, 10; counties having maternity and infancy work
during the year, 10.
The division acted in an advisory capacity for public-health nurses in the
State and gave supervision to a few district nursing associations. The
director of the division served as State chairman for the observance of
May Day as Child Health Day and assisted local chairmen in planning
and carrying out suitable programs.
The following organizations cooperated in the division’s work: State fed
eration of women’s clubs, State tuberculosis association, American Red
Cross, and parent-teacher associations. Local physicians and nurses
gave generous assistance at conferences and in follow-up work. Women’s
organizations formed committees to promote the work, and local organi
zations furnished buildings in which to hold conferences, also desk room
for nurses.
The outstanding achievements of the year were the organization of lay
workers into permanent committees throughout the State and the large number
of conferences held and of corrections obtained as a result of their assistance.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State’s maternity and infancy program h as. been developed through
child-health conferences, through home visits, and through such educational
features as mothers’ classes and little mothers’ classes. One of the main fea
tures of the program has been the intensive prenatal work carried on in certain
localities. The results of this work demonstrate the value of prenatal super
vision and care.
In the State as a whole there was very little change in the average maternal
mortality rates for the five-year period prior to cooperation under the maternity
and infancy act (1917-1921, exclusive of 1918) and the period of cooperation
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MATERNITY AND INFANCY
(1922-1926). In localities where an intensive prenatal program was carried
on the supervision given the mother during pregnancy and confinement is’ re
flected in the lower maternal mortality rates, in the stillbirth rates, and in the
neonatal death rates.
A comparison of maternal death rates, stillbirth rates, and death rates of
infants dying in the first month of life among the supervised and nonsupervised
groups (based on figures supplied by the State) has been made for four coun
ties that have had a prenatal program over a period of years (five years for
two counties, four years for two counties). In these four counties there were
487 live births to mothers receiving prenatal care. Two of these mothers died
from causes associated with pregnancy and childbirth— a maternal death rate
of 4.1 per 1,000 live births. In the nonsupervised group there were 6,012 live
births. Fifty-one of the mothers in this group died from causes associated
with pregnancy and childbirth— a maternal death rate of 8.5 per 1,000 live
births. In the supervised group there were 10 stillbirths— a rate of 2.1 per 100
live births— compared with 193 stillbirths— a rate of 3.2—in the nonsupervised
group.
That care of the mother during pregnancy and confinement affects the
chances of survival of the baby during the first few weeks of life is an accepted
fact. In the group of babies bora alive whose mothers were supervised during
the prenatal period there were 6 deaths in the first month of life— a neonatal
rate of 12.3 per 1,000 live births— whereas in the nonsupervised group there
were 282 such deaths— a rate of 46.9.
In, other words, if the same rates had prevailed in the supervised group as
did prevail in the nonsupervised group there would have been 4 deaths of
mothers instead of 2 ; 16 stillborn babies instead of 10; and 23 babies dying in
the first month of life instead of 6.
The average infant mortality rate for the State as a whole was 13.5 per cent
lower during the period of cooperation (1922-1926) than during the preceding
period (1917-1921, exclusive of 1918). In the urban areas the decline was 16.7
per cent and in the rural areas it was 9.2 per cent.
N E W JERSEY
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, bureau of child hygiene, Trenton.
Staff:
Consultant (physician, not paid from maternity and infancy funds), 12
nurses, 5 midwife supervisors and maternity and infant boarding home
inspectors (1 part time), 2 clerks (1 part time), 3 stenographers.
Volunteer assistants— 120 physicians.
Activities:
Child-health conferences cotiducted by physicians, 736; infants and pre
school children registered and examined, 623; visits to conferences, 6,234;
defects found, 1,142; children having defects, 402. Parents had defects
corrected in 327 of the children.
Prenatal conferences conducted by physicians— 36; expectant mothers
registered, 71; number examined, 65 ; visits to conferences, 182.
Conferences conducted by nurses, no physician present, 240; infants and
preschool children inspected, 913; visits to conferences, 9,956.
New permanent child-health centers, 12 established. They are supported
by Federal and State funds.
New permanent prenatal center, 1 established, and plans made for a second.
It was decided to establish a center in an industrial community and
another in a rural community. The former was opened on June 15.
The conferences will be conducted by the local physicians, who will
rotate in their service. A uniform record card will be used. This
work has been planned for a five-year period, during which the centers
will serve a second purpose as training stations for the nurses under
the supervision of the bureau or in its employ.
Little mothers’ classes, 20 organized; girls enrolled, 250; number complet
ing course, 238; lessons in course, 10.
Mothers’ classes, 5 organized; mothers enrolled, 73; number completing
course, 70; lessons in course, 12.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
85
Activities— Continued.
Midwives’ monthly organization meetings, 92 among the 10 county asso
ciations in the State, with a total attendance of 1,069. Among the
special subjects considered at these meetings were: What a midwife
should know about venereal disease; danger signs of the prenatal period;
and how the midwives can cooperate with local official agencies.
Licensed midwives under supervision, 406, to whom 3,549 supervisory
visits were made; unlicensed midwives remaining, 6. The fourth annual
State conference of midwives was held in May with an attendance of
about 200. The percentage of births attended by midwives has de
creased from 42.2 in 1919 to 20.3 in 1926. A study made during the year
showed that 37 per cent of the midwives had attended foreign schools of
midwifery, and 63 per cent had attended American schools. The courses
were six weeks to three years long; 20 per cent of the midwives trained
in foreign countries had had a three-year course, 54 per cent had studied
more than nine months, and 26 per cent had studied less than nine
months. Of those trained in American schools only 1 per cent had
studied three years or an equivalent period, 78 per cent had studied nine
months, and 21 per cent had studied less than nine months.
Home visits by nurses, 15,314 (prenatal cases seen, 548; infants, 2,379*
preschool children, 3,115).
Maternity homes inspected, 2 8; inspections made, 148. All maternal and
infant deaths and stillbirths that occurred in these homes were thor
oughly investigated.
The uniform system for caring for the unmarried mother and her baby
established by the hospitals and the State department of health was con
tinued during the year. One of the chief objects of this system is to
prevent the early separation of mother and baby and to insure that the
baby will be breast fed.
Infant homes inspected, 249; inspections made, 745.
Community demonstrations, 12, in connection with starting a child-health
center in each community to show the value of health supervision of
infants and preschool children.
Campaign, 1, for immunization against diphtheria. This was conducted
as part of the May Day program. Preschool children immunized, 704.
Talks and lectures, 211.
Literature prepared: Chart showing essentials in development and nutrition
of children from birth to 5 years of age.
Literature distributed, 55,877 pieces.
Nutrition work was done through lectures on nutrition given in conjunction
with_ the home-economics department of the State agricultural college
to midwives at their monthly meetings.
Exhibits conducted, 5, consisting of equipment for a child-health center.
Breast feeding was stressed in all the bureau’s activities.
Courses in child hygiene consisting of one lecture a week for 10 weeks were
given to the senior students in the five State normal schools.
Work with the girls in the continuation schools of three districts of the
State was continued. The girls were taught the principles of child
hygiene.
A course of 12 lessons and demonstrations was conducted at the State
reformatory for women. This covered the essentials of prenatal care
and the care of the baby.
Infants born in the State during the year, 72,386; infants under 1 year of
age reached by the work of the bureau, 20,841; preschool children
reached, 12,261; expectant mothers reached, 4,655. About one-third of
these were reached by the work financed by maternity and infancy funds.
Counties in the State, 2 1; counties having maternity and infancy work
during the year, 21.
The following organizations cooperated in the bureau’s work: State
department of institutions and agencies, State agricultural college, State
league of women voters, State tuberculosis association, Visiting Nurse
Association, Children’s Aid Society, National Organization for the Pre
vention of Blindness, federated women’s clubs, several church and
fraternal organizations, and the parent-teacher association.
Among the outstanding features of the year’s work were the establishment of
the prenatal center and training station for nurses and the extension of childhygiene courses to all the normal schools in the State.
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MATERNITY AND INFANCY
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Features of the State’s program during the period have been regular super
vision of infants and preschool children at child-health conferences; stressing
breast feeding; supervision and licensing of midwives; inspection and supervisior
of infant and maternity homes; and development of arrangements for the care
of mothers of illegitimate infants to the end that mothers and babies may be
kept together.
As New Jersey was not admitted to the United States birth-registration area
until 1921, no figures are available for comparing infant and maternal mortality
for a period prior to the State’s cooperation under the maternity and infancy
act with a similar period since cooperation.
The State accepted the provisions of the maternity and infancy act in 1922
In that year the infant mortality rate for the State as a whole was 78 6 per
1,000 live births. In 1926 the rate was 70.1; this was 10.8 per cent lower than
that of 1922. The rates for both the urban and rural areas have been reduced
the former from 79.3 in 1922 to 69.3 in 1926, the latter from 77.1 to 71.8. The death
rates from diarrhea and enteritis— causes closely associated with improper feed
ing-show a material decrease since 1922. In that year for every 1,000 babies
born alive there was a death rate of 14.6 in the first year of life from these
causes; in 1926 the rate was 9.7.
The death rate from causes associated with childbearing has also been lowered
during the period 1922 to 1926. In 1922 the rate was 64.1 per 10,000 live
births. In 1926 it was 57.6; this was 10.1 per cent lower. The rate for urban
areas was 8.5 per cent lower (70.9 in 1922 and 64.9 in 1926). The rate for rural
areas was 14.9 per cent lower (48.3 in 1922 compared with 41.1 in 1926).
Be"tter care of the mother during pregnancy and confinement is also reflected in
tne decrease of deaths of babies from so-called natal and prenatal causes premature birth, injuries at birth, etc. In 1922 the death rate per 1,000 live births
from these causes ip the first year of life was 35.3; in 1926 it was 33.6.
N E W M E X IC O
S T A F F A N D A C T IV IT IE S IN 1927
\
Administrative agency:
State department of public welfare, bureau of public health, division of
child hygiene and public-health nursing, Santa Fe
Staff: I
Director (nurse, part time), 2 nurses, 1 vital-statistics clerk, 1 bookkeeper
(part time), 1 stenographer (part time). Seven county nurses were paid
for some maternity and infancy work.
Activities^661* assistants~ 72 Physicians, 1 dentist, 32 nurses, 662 lay persons.
Conferences conducted by nurses, physician present at some, 171; infants
and preschool children inspected, 859; mothers instructed in prenatal
care, 623; visits to conferences by children, 1,660.
New permanent combined prenatal and child-health centers, 2 established
as a result of the maternity and infancy work. They are supported bv
Federal, State, and county funds.
New permanent child-health center, 1 established as a result of the matermty and infancy work. It is supported by a local organization
New permanent prenatal center, 1 established as a result of the maternity
and infancy work. It is supported by Federal, State, and county funds.
Llioo pothers classes, 44; girls enrolled, 931; number completing course
732; lessons m course, 10.
&
Mothers classes, 26; mothers enrolled plus those carried over from previous
year, 182; number completing course, 138; lessons in course, 8
Midwives classes, 21 meetings held by one nurse. Most of the work with
midwives was done through visits to their homes, in which instruction
was given m cleanliness, the use of a prophylactic in the eyes of the
newborn, the making out of birth and death certificates, and the neces
sity or calling a physician in complicated cases.
Home visits by nurses, 10,322 (prenatal cases seen, 498; obstetrical cases
49; postnatal cases, 1,042; infants and preschool children, 4,342’ visits
to midwives, 590).
’
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
87
Activities— Continued.
Community demonstrations, 6, of maternity and infancy work for 3 to 4
months in each of 6 counties, including instruction of midwives, mothers’
classes, little mothers’ classes, home visits, promotion of birth and death
registration, and lectures before local groups.
Group demonstrations, 282, at conferences, classes, and group meetings,
on various phases of maternal and infant care.
Surveys, 3 : (1) Of hospitals ; (2) of midwives; (3) of birth registration.
Campaigns, 2 : (1) For better registration of births and deaths, in 3 coun
ties and 14 communities ; (2) for stimulation of interest in maternity and
infancy work, in several counties.
Talks and lectures, 314.
Literature prepared; Instructions to Mothers (revised), in Spanish and
English.
Literature distributed, approximately 25,000 pieces.
Nutrition work was done through individual instruction to mothers in
regard to proper combinations of food for infants and for preschool
children and the preparation of formulas according to physicians’ in
structions.
Exhibits conducted, 34, including model layette, bassinet, home-made baby
pen, baby’s bath tray, delivery bed, home-made abdominal supporter,
and T binder. Exhibit material was lent 3 times.
As the State is not in the birth-registration area, special work was done
for promoting birth registration. This included obtaining publicity in
local newspapers, registering unregistered births discovered through
child-health conferences or in home visits, getting information for birth
certificates from baptismal records, and showing midwives and parents
how to make out birth certificates for births not attended by physicians.
Breast feeding was emphasized in talks and through distribution of litera
ture at club meetings, conferences, and home visits. Proper diet for
maintaining lactation, method of expressing breast milk, and the need
for rest periods were covered in the instruction.
Infants bom in the State during the year, 10,715 ; infants and preschool
children reached by the work of the division, approximately 15,000 ;
expectant mothers reached, 587. The division sends literature on infant
hygiene to parents of all infants whose births are registered in the
State bureau of vital statistics.
Counties in the State, 31; counties having maternity and infancy work
during the year, 14; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 27.
In a community in which a staff nurse organized the work a local club
carried on monthly weighing and measuring of preschool children.
The two field nurses on the staff and the county nurses who were paid
for maternity and infancy work traveled 76,319 miles in covering their
territory during the year. Their activities included health conferences,
home visits, and demonstrations, obtaining immunizations against
diphtheria, typhoid fever, and smallpox and other prophylactic treat
ments, preparing articles on health for local papers, and registering
unregistered births and deaths.
The following organizations cooperated in the division’s work : State bureau
of child welfare, State public-health association, State federation of
women’s clubs, State league of women voters, Congress of Mothers,
and parent-teacher associations.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State is not in the United States birth and death registration areas, but
a continuous campaign of education on the importance of registration of births
and of deaths has been in progress for several years of the period of cooperation,
and improvement in registration has been observed.
Public-health work has been increased through the use of maternity and
infancy funds. The payment of county nurses’ salaries by matching county
funds with State and Federal funds has made possible in seven counties a
public health nursing service that could not be maintained otherwise.
Instruction of the Mexican midwives has been a feature of the program, and
the practice of the midwives since the beginning of the maternity and infancy
work has been much better.
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MATERNITY AND INFANCY
A greater number of expectant mothers have sought advice and literature •
teachers have shown more desire for health education; parents have reported
5eir chlldren who have had instruction in little mothers’ classes insist
that the younger children in the family be fed and dressed and form other
health habits in accordance with the nurses’ teaching-; and local physicians in
communities in which maternity and infancy work has been done report an
apparent reduction in maternal and infant mortality, attributing this to the
instruction the mothers have received in the care of themselves and their
babies.
N E W YORK
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, division of maternity, infancy, and child
hygiene, Albany.
Staff:
Director (not paid from maternity and infancy funds), 5 physicians (1 part
year), 58 nurses (36 part time), 1 dental hygienist, 1 nutritionist 2
midwife supervisors and maternity and infant home inspectors, 1 vitalstatistics clerk (part year), 1 accountant, 1 advance agent for childhealth conferences, 2 clerks, 3 stenographers, and 1 chauffeur. Two hun
dred and nine physicians throughout the State and nine county nurses
m four counties were paid for some maternity and infancy work
Activities:
Child-health conferences conducted by physicians, 1,012; infants and pre
school children registered, 6,742; number examined, 5,826; visits to conferences, 15,006; defects found, 11,324; children having defects, 5 201.
(Figures on defects are incomplete.)
Prenatal conferences conducted by physicians, 1,480; expectant mothers
registered, 4,860; number examined, 3,002 (figures incomplete) ; visits
to conferences, 22,080.
Conferences conducted by nurses, no physician present, 974; visits to con
ferences, 7,513 (by expectant mothers, 2,091; by children, 5,422).
Dental conferences conducted by the dental hygienist in. connection with
child-health conferences, 198; children examined, 2,624; number found
in need of dental attention, 1,242.
Dental conferences conducted by dentists, 141, in 2 towns in connection
with centers receiving Federal and State support; preschool children
receiving dental advice, 1,312.
New permanent combined prenatal and child-health centers, 2 established
as a result of the maternity and infancy work. They are supported by
local funds except for prenatal work in one center, which is conducted
by the division’s prenatal unit.
New permanent child-health centers, 10 established as a result of the
maternity and infancy work. They are supported by local funds
New permanent prenatal centers, 8 established as a result of the maternity
and infancy work. They are supported by local funds except for assist
ance given by the division’s prenatal unit in conducting examinations in
3 of the centers.
Little mothers’ classes, many, conducted as part of the routine at childhealth centers (no record of number receiving instruction), also by
nurses throughout the State not paid from maternity and infancy funds,
who u s ^ the outline prepared by the division, adapting it to local needs!
Certificates for those who completed the course were sent upon request
to 580 girls. Little fathers’ classes were conducted in two communities
by local nurses.
Mothers’ classes, 52 organized, with 8 to 30 mothers in each class; number
completing course, 370; lessons in course, 5. One nurse gave lectures on
mothers class subjects at 41 meetings of parent-teacher associations in
2 counties and 1 city.
Midwives’ meetings, 10, of groups for instruction by staff members; visits
made to midwives in their homes, 304.
Home visits by nurses, 73,748.
Maternity homes inspected, 122; inspections made, 122.
Infant homes inspected, 75; inspections made, 75.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
89
Activities— Continued.
Community demonstrations, 10: (1) Of prenatal nursing work, in 3 com
munities. (2) Of a maternity nursing program, in 1 county (continued
from previous year). (3) Of a maternity and infancy nursing program,
in 6 communities. One of these includes the operation of a child-health
center in Fulton (Oswego County). This demonstration is used as a
teaching center for nurses on the division’s staff and for other publichealth nurses. Newly appointed nurses are sent to this demonstration
and have an opportunity to see the handling of such problems as they
will meet in their own communities, the procedure followed at conferences
and in home visits, and the methods of recording and reporting work.
Group demonstrations, 3,249, of various phases of maternal and infant
care.
Surveys, 4 : (1) Of maternity homes. (2) Of boarding homes for chil
dren. (3) Of cases of ophthalmia neonatorum. (4) Of preschool chil
dren in an Indian reservation in cooperation with the State bureau of
education.
Campaign, 1, for promotion of breast feeding, in 3 towns (continued from
previous year).
Cooperation was given to a state-wide campaign for immunization against
diphtheria conducted by the State department of health and local
departments of health, State department of education, State medical
society, State Charities Aid Association of New York, and an insurance
company.
Talks and lectures, 214.
Literature prepared: The Sixth-Year Molar and the Baby Teeth, Making
Teeth for Baby and Keeping Mother’s Teeth, 3 leaflets on foods, report
of the division for 1926.
Literature distributed, 376,916 pieces.
Graduate courses for nurses, 7, in maternity hygiene; nurses enrolled,
136; number completing course, 104.
Graduate courses for physicians, 10 (7 in pediatrics and 3 in obstetrics).
At the request of county medical societies, specialists in these subjects
who serve as part-time consultants to the division were sent to the
various counties to conduct courses for local physicians. The usual
course of lectures in obstetrics included the following: Pathology of
pregnancy, prenatal care and management of normal labor; pathology
of labor; postpartum care. The course in pediatrics included lectures
bn periodic health examinations and preventive pediatrics; feeding
problems in infancy; malnutrition in childhood; heart disease in child
hood ; acute infectious diseases; tuberculosis in childhood.
Nutrition work was done for groups as follows: Courses of 4 lectures each
for mothers, 3 ; courses of 4 lectures each for nurses, 3 ; single lectures,
29 (to nurses, 11; to lay groups, 16; to physicians, 1 ; by radio, 1).
Lectures and demonstrations, 15 (for lay groups, 3 ; at county fairs, 10;
to home-economics teachers, 1 ; to student nurses, 1).
Exhibits conducted, 188, including store-window displays, posters, food
models, layettes, baby trays, and exhibits on nutrition. Exhibits pre
pared, screens depicting family health conferences, model midwife bag,
sun-babies model, nursery model, and nutrition exhibits. Films were
lent 111 times, layettes, trays, and other material 118 times.
Statistical studies, 2 : Of breast feeding, in 1 county; of puerperal deaths
(in progress).
Breast feeding was emphasized in all the activities of the division. Plans
were made for beginning a breast-feeding campaign in 1 county at the
close of the year under review.
Infants bom in the State during the year, 223,827; infants under 1 year
of age reached by the work of the division, 11,921; preschool children
reached, 12,499; expectant mothers reached, 13,377. The division sends
literature on infant hygiene to parents of all infants whose births are
registered in the State bureau of vital statistics and literature on pre
natal care to brides when marriage certificates are filed.
Counties in the State, 62; counties having maternity and infancy work
during- the year, 57. New York City, comprising 5 counties, has its
own maternity and infancy staff, paid in part from maternity and
infancy funds.
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MATERNITY AND INFANCY
Activities— Continued.
The' following organizations cooperated in the division’s work: New York
State Charities Aid Association, State league of women voters, State
commission for the blind, Home Bureau, women’s clubs, and the parent«
teacher association.
The outstanding achievement of the year’s work was the increase in the
child-health conferences called “ Type C consultations.” These are conducted
in counties twice yearly on a county-wide basis under the auspices of the county
medical society, the physicians who make the examinations being appointed by
the society and paid from maternity and infancy funds.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
In addition to a general State program of education in maternal and infant
care, including child-health conferences, nutrition work, graduate courses for
nurses and physicians, development of health centers, and prenatal work,
certain localities and counties in the State have had more intensive programs.
These included breast-feeding campaigns and surveys, demonstrations in pre
natal care, and special nursing demonstrations especially directed toward the
training of nurses in maternity and infancy work.
New York accepted the provisions of the maternity and infancy act in 1923
and has been in the United States birth-registration area since the establish
ment of the area in 1915.
In 1922, the year prior to the State’s cooperation under the act, the infant
mortality rate for the State was 77 per 1,000 live births. The rate declined
to 67.6 in 1925 but rose to 70.5 in 1926. The urban and rural rates had the
same general downward trend, as is shown in the following table:
Infant mortality rate per
1,000live births
State
1922.
1923.
1924.
1925.
1926.
77.0
72.1
69.2
67.6
70.5
Urban
78.3
71.2
69.6
67.9
70.4
Rural
71.7
75.7
67.3
66.1
71.2
A comparison of the average rates during the four years of cooperation under
the act (1923-1926) with the four previous years (1919-1922) shows a decrease
of 13.4 per cent for the State as a whole, 14.7 per cent for urban areas, and 6.9
per cent for rural areas.
The State’s maternal death rate in 1922 was 60.2 per 10,000 live births. In
1926 the rate was 56.5. The rate for urban areas was 62.2 in 1922 and 59.1 in
1926; for rural areas it was 51.7 in 1922 and 44.9 In 1926. The difference be
tween the average rate for the period of cooperation and that for the four-year
period preceding cooperation was considerably greater in the rural areas thau
in the urban areas, the average rate for the period of cooperation being 20.5
per cent lower than that for the preceding period for the rural areas, whereas
in the urban areas it was 6.3 per cent lower. For the State as a whole it was
8.7 per cent lower.
The maternal death rates from puerperal albuminuria and convulsions per
10,000 live births varied from 13.2 in 1922 to 11 in 1926. The average rate for
the four years preceding the operation of the maternity and infancy act was
14.5 as compared with 11.9 during the State’s cooperation under the act
(1923-1926).
Death of the baby from diarrhea and enteritis in the first year of life "is
closely related to his feeding; and instruction of the mother in proper feeding
and her faithfulness in carrying out these instructions are reflected in a lower
death rate from these causes. The death rates from diarrhea and enteritis in
New York have shown a decline since 1921. The decrease in the rate between
1923 and 1924 ( 23.9 per cent) was the largest in several years. In 1925, when
there was an increase in deaths from diarrhea and enteritis throughout the
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D etóks per*
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live b ir th
8
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
1919 19£0 J9&1 \<BZZ 1923 1924 I9£5 1926
I N F A N T M O R T A L I T Y R A T E S ( D E A T H S U N D E R 1 Y E A R P E R 1 , 000 L I V E B I R T H S )
F R O M S P E C I F I E D C A U S E S , N E W Y O R K , 191 9 - 1 9 2 6
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92
MATERNITY AND INFANCY
m
country, the rate from these diseases was slightly higher than that of 1924 but
not so high as in any year immediately preceding. The 1926 rate indicated that
the mortality from,diarrhea and enteritis again resumed its downward trend,
the rate for that year (8.1) being less than half the rate for 1920 (17.2). It is
apparent that much has been accomplished in reducing mortality from diarrhea
and enteritis. Some reduction was indicated in mortality from natal and pre
natal causes, the rate in 1926 being 10.4 per cent lower than that of 1919. The
outstanding characteristic of the rates from natal and prenatal causes is the
lack of variation from year to year, though there is a slight downward trend
(see chart on p. 91).
N O R T H C A R O L IN A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of maternity and infancy, Raleigh.
Staff:
Director (physician, part time), 1 physician, 5 nurses (1 part year), 1
clerk, 1 stenographer. Twenty county nurses who devoted full time to
maternity and infancy work were paid in part from maternity and
infancy funds.
Volunteer assistants, 25 physicians.
Activities:
Combined prenatal and child-health conferences conducted by physicians,
386; expectant mothers registered and examined, 723; infants and pre
school children registered and examined, 3,048; visits to conferences, 4,662
(by expectant mothers, 723 ; by children, 3,939). A complete record of
the number of children having defects was not kept; parents had defects
corrected in 521 of the children.
New permanent child-health center, 1 established as a result of the ma
ternity and infancy work. It is supported by State and county funds.
Midwives’ classes, 5 organized; midwives enrolled plus those carried over
from previous year, 1,333; number completing course, 1,333; lessons In
course, 6. The midwife situation has improved since the beginning of the
maternity and infancy work, and the number of midwives has diminished
approximately one-fourth.
Home visits by nurses, 32,041 (prenatal cases seen, 6,676; postnatal cases,
2,078; infants, 9,782; preschool children, 2,822; visits to midwives, 1,098).
Literature distributed, 82,391 pieces.
New names registered for prenatal letters, 5,459; prenatal letters distrib
uted, 6,500 sets.
Special nutrition work was done in two counties; 100 undernourished
infants were selected for this purpose, and their feeding was supervised
in detail by the county nurses.
Infants born in the State during the year, 82,459; infants under 1 year
of age reached by the work of the bureau, 15,752; preschool children
reached, 2,993; expectant mothers reached, 8,346.
Counties in the State, 100; counties having maternity and infancy work
during the year, 31; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 46.
An outstanding feature of the bureau’s work was the financial assistance
given by 20 counties in the support of 20 nurses who devoted full time to
maternity and infancy work. More than half the salary and expenses of
these nurses was paid by the counties. A general maternity and infancy
program was carried on, including child-health conferences, home visits, and
supervision of midwives.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
North Carolina entered the United States birth-registration area in 1917
and accepted the provisions .of the maternity, and infancy act in 1922. Dur
ing the period of cooperation under the act (1922-1926) the average infant
mortality rate was 80.8. During a similar period prior to the operation of
the act (1917-1921, exclusive of 1918) the average rate was 85.5. The same
relative differences are shown for both white and colored infants, the rate
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
93
for white infants being 69.4 during the period of cooperation and 74.1 for the
period prior to cooperation; the rate for colored infants was 105.9 compared
with 111.7. Greater average declines appear for the urban than for the rural
areas for both white and colored infants, the white rate being 12 per cent
lower in the second period than in the first in urban areas and 6.3 per cent
lower in rural areas. The rate for colored infants was 9 per cent lower in
urban areas and 7.7 per cent lower in rural areas.
The maternal mortality rates show practically the same differences in urban
and rural areas. During the period of cooperation the average urban rate
was 8.3 per cent lower, the white rate 10 per cent lower, and the colored rate
4.7 per cent lower than during the period prior to cooperation. In the rural
areas the average rate was 8.4 per cent lower, the white rate 10.4 per cent
lower, and the colored rate 6.4 per cent lower.
NORTH D AK O TA
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of public health, division of child hygiene and publichealth nursing.
Staff:
Director (physician), 1 physician (part year), 4 nurses (1 part year, 2
part time), 1 stenographer.
Activities:
Child-health conferences conducted by physicians, 208; infants and preschool
children registered and examined, 5,312; defects found, 7,903; children
having defects, 4,261.
Home visits by nurses, 2,791 (prenatal cases seen, 182; obstetrical case, 1 ;
infants, 941; preschool children, 1,667).
Surveys, 2 : (1) Of birth registration, in 1 town; (2) of preschool children,
in 1 town.
Campaign, 1, for better registration of births, in a town in which the
high infant mortality rate was believed to be due to incomplete reporting
of births. The chief local organizations helped in the campaign.
Talks and lectures, 11.
Literature distributed, 17,945 pieces.
Statistical study, 1, of maternal deaths in 1926.
Breast feeding was emphasized in the talks with mothers at all the
child-health conferences.
Infants under 1 year of age reached by the work of the division, 10,635;
preschool children reached, 4,296; expectant mothers reached, 57. The
division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.
Comities in the State, 53; counties having maternity and infancy work
during the year, 25; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 40.
The following organizations cooperated in the division’s work: State federa
tion of women’s clubs, American Red Cross, Home Makers’ Club, and
the parent-teacher association. Their members did the organization
work for the child-health conferences and assisted at the conferences.
Among the outstanding features of the year’s work were the increase in
demands from local communities for child-health conferences and the increase
in requests for literature on maternal and infant hygiene.
SOM E R E S U L T S O F T H E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
As the State was not admitted to the birth-registration area until 1924
figures from the United States Bureau of the Census are not available for
the whole period of cooperation under the maternity and infancy act. However,
for the period for which they are available the maternal mortality rates
indicate a downward trend.
The funds for maternity and infancy work are small in proportion to the
geographical extent of the State, and the demand for conferences exceeds
the ability of the staff to meet them. The chief result of the maternity and
infancy work has been the growing interest of the people in the care of mothers
and children.
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MATERNITY AND INFANCY
OHIO
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
. §L ,
State department of health, division of child hygiene, Columbus.
^t& Director (physician),89 5 nurses (1 part tim e), 1 health lecturer, 1 mater
nity and infant home inspector (nurse), 1 vital-statistics clerk, 1 finan
cial clerk (part tim e), 1 publicity writer (part tim e), 1 stenographer, 2
motion-picture operators (part year, 1 part tim e). Fifteen physicians
were GiuployGcl us* nGGdGd to conduct child-liGiiltib. confGrGncGS.
jNino
county nurses in eight counties and one city nurse were paid for full
time maternity and infancy work.
Activities i
Child-health conferences conducted by physicians, 76; infants and preschool
children registered and examined, 3,580. One copy of the findings was
given to the parents, another mailed to the family physician.
New permanent child-health centers, 18 established. They aie supported
by city boards or private organizations. Usually a nurse conducted a
conference every two weeks in each of these, the number of conference
days depending upon the community. Mothers brought their children to
be weighed, and the nurse discussed health problems with them. During
the year 21 such centers were in operation; they were open 164 times,
and 2,600 visits were made to them. Pediatricians employed by the
division conducted child-health conferences occasionally in these centers
in order to stress the importance of periodic physical examinations by the
family physician.
Little mothers’ classes, 112 organized; girls enrolled, 2,074; number com
pleting course, 2,002; lessons in course, 12.
Home visits by nurses, 19,146 (prenatal cases seen, 877; postnatal cases,
25; infants, 3,069; preschool children, 2,386).
Maternity homes inspected, 215; inspections made, 215.
Campaign, 1, for the observance of May Day as Child Health Day.
Talks and lectures, 444, including 140 in connection with the sbpwing of
health films in rural communities.
. , '
Literature prepared: Health Builders’ League Book (revised) for use m
little mothers’ classes.
Literature distributed, approximately 105,000 pieces.
Exhibits conducted, 30, at county fairs and women’s club meetings, ot
model layette, baby’s bed, and articles necessary for the baby’s bath.
Films were shown in connection with a demonstration by a nurse on the
care of the baby at 10 of the child-health conferences.
Breast feeding was emphasized in all prenatal instruction given.
The division gave supervisory assistance to local organizations doing ma
ternity and infancy work.
. „ .
„
Infants born in the State during the year, 121,767; infants under 1 year of
age reached by the work of the division, 13,171; preschool children
reached, 11,884.
|
. „
. , ,
Counties in the State, 88; counties having maternity and infancy work dur
ing the year, 65; counties having maternity and infancy work since the
acceptance of the maternity and infancy act, 77.
’1
Much maternity and infancy work that can not be reported m figures
has been done by 47 full-time county health units that cooperate with
the State health department and receive both advisory and supervisory
service from it.
The following organizations cooperated in the division s work: State league
of women voters, Child Conservation League, American Red Cross, various
civic organizations, and parent-teacher associations.
Among the outstanding features of the year’s work were the child-health
conferences for preschool children and the classes for girls.
so Resigned Jan. 1, 1927. After that date the work of the division was directed by the
chief of the division of hygiene and the chief of the division of nursing.
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95
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State has a decentralized program, maternity and infancy work having
been done in 77 of the 88 counties during the period of cooperation under the
maternity and infancy act. Full-time county health units, though working to
a great degree independently, cooperate with the State health department and
receive both advisory and supervisory service from this department. Much of
the maternity and infancy work is done by 47 full-time county health depart
ments. Rural public health nursing service has been established in 65 of the
88 counties in the State. This service ranges from one nurse in a county to
a staff of eight nurses. There are 95 city and village nursing services. A
generalized program is carried on ; child hygiene and particularly maternal and
infant hygiene are stressed. A summary of visits from 85 services in the State
shows that more than 50 per cent were related to child hygiene, as follows: To
prenatal cases, 5.4 per cent; to maternity cases, 8.9 per cent; to infants, 22.2
per cent; to preschool children, 15.6 per cent; to school children, 9.5 per cent;
to orthopedic cases, 2.4 per cent; to communicable-disease cases, 15.4 per cent;
to tuberculosis contacts, 19.8 per cent.
This work, supported by State, county, and municipal, as well as maternity
and infancy funds, is stimulated everywhere through the operation of the
maternity and infancy act.
Ohio was admitted to the United States birth-registration area in 1917 and
?nfo11/ 1!C00Perating under the Provisions of the maternity and infancy act in
1922 (having accepted its provisions in December, 1921). In 1921, just before
the operation of the act, the State maternal mortality rate was 72.2 In 1926
the rate per 10,000 live births was 67.1. In urban areas there was a reductl(f ?f f.2 pomts— from 84.9 in 1921 to 80.7 in 1926. In the rural areas the
rate m 1926 was 8.7 points lower, being 55.3 in 1921 and 46.6 in 1926. When
the period prior to cooperation (1917—1921, exclusive of 1918) is compared with
the period of cooperation (1922-1926) an even more marked difference appears.
The average rate during the period of cooperation was 17.9 per cent lower than
the average rate for the previous period in the rural areas and 6.1 per cent
lower in the urban districts.
The death rate for infants under 1 year of age per 1,000 live births showed
a greater decrease in the urban than in the rural areas. The average rate for
urban areas was 17.7 per cent lower and that for rural areas 12.3 per cent lower
during the period of cooperation than during the years immediately preceding
A nursing demonstration in prenatal care was conducted in Richland County
dur^
a three-year period, 1924 to 1926. Figures furnished by the State show
that in this county (exclusive of the towns of Mansfield and Shelby) during this
period there were 442 live births and 7 stillbirths to mothers who had received
prenatal instruction. No mothers in this group died from causes associated
with pregnancy and childbirth. In the county during this same three-year period
there were 795 live births and 28 stillbirths to mothers receiving no prenatal
instruction through the demonstration. Five of these mothers died from
puerperal causes; thus the death rate was 6.3 for every 1,000 live births. The
stillbirth rate in the group receiving care was 1.6 per 100 live births; in the
0“ <rJ group
was 3.5. In the supervised group 6 babies died in the first month
°£ uro—j 1 neonatal death rate of 13.6 per 1,000 live births compared with a rate
ml i 3 S ° r !:he ot5ler group in which 44 babies died in the first month of life.
Ine babies born to mothers who received prenatal instruction were supervised
through the first^ year of life, and the mortality rate for this group was 22.6
ror every 1,000 live births. In the group not cared for by the demonstration
the infant mortality rate was 84.3. If the rates in this group had prevailed in
i’l 6 supervised group there would have been 3 deaths of mothers instead of no
deaths; 15 stillbirths instead of 7 ; 24 neonatal deaths instead of 6 ; and 37
deaths of infants under 1 year of age instead of 10.
Comparison can be made between the rates in Belmont and Jefferson Counties
both of which are in the eastern part of the State and have similar population
and industries (largely mining and steel). Belmont County had special nursing
service under the maternity and infancy act during the two years, 1923 and 1924.
According to figures submitted by the State this county had for these two years
an average infant mortality rate of 83.2 per 1,000 live births. This is 16.3
per cent lower than the average infant mortality rate for the preceding four-year
period (1919-1922), which was 99.4. Jefferson County had no maternity and
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MATERNITY AND INFANCY
infancy nursing service, having only the general educational work done by the
bureau, and this county lowered its average infant mortality rate only 8.8 per
cent (from a rate of 111.2 in the period 1919-1922 to a rate of 101.4 in the period
1922-1926). The maternal mortality rates show similar differences: Belmont
County’s average rate was 25 per cent lower for the period 1923 to 1926 than
for the period 1919 to 1922, whereas Jefferson County’s rate was only 18.2 per
cent lower.
Comparison can be made also between the rates in Athens and Guernsey
Counties in the eastern part of the State, the former being farther south than
Belmont and Jefferson Counties. The industries of these counties are largely
mining, though there is some agriculture. Athens County had special nursing
service under the maternity and infancy act during the period 1924 to 1926.
This county’s average maternal death rate for the period 1924 to 1926 was 6.7
per 1,000 live births, a rate 21.2 per cent lower than the average rate for the
three preceding years (1921-1923), which was 8.5. Guernsey County had no
special nursing service. Its average maternal death rate was 4.8 per 1,000 live
births from 1921 to 1923 and 6.3 from 1924 to 1926— or 31.3 per cent higher.
The percentage decrease in the infant mortality rate was practically the same
in the two counties (23.5 per cent in Guernsey County and 22.4 per cent in
Athens County).
Since the beginning of the State’s cooperation under the maternity and
infancy act one county and one city have assumed the financial responsibility for
maternity and infancy work begun with maternity and infancy funds.
OKLAHOM A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of public health, bureau of maternity and infancy, Okla
homa City.
Staff:
Director (physician), 6 nurses (1 part year), 2 vital-statistics clerks (part
year), 2 clerks, 1 stenographer. Temporary assistants were employed as
needed. Five county nurses were paid for some maternity and infancywork.
Activities:
Combined prenatal and child-health conferences conducted by physicians,
87; expectant mothers registered and examined, 8 ; infants and preschool
children registered and examined, 1,046.
Child-health conferences conducted by physicians, 72; infants and preschool
children registered and examined, 1,803; defects found, 3,552; children
having defects, 1,737. Local physicians volunteered their services for
some of the conferences, others were conducted by the director of the
bureau. A new feature of the latter conferences was that each child’s
examination was recorded in duplicate, the form used being an adaptation
of the standard form prepared for the United States Children’s Bureau81
providing for yearly examinations of the child up to 6 years of age. On
one copy of the record at the top of the column for the findings of the
second examination a selected date (often the child’s next birthday) was
written and this copy was given to the mother. She was urged to take
the child to her family physician for a second examination on the desig
nated date, or immediately if corrective work was needed. Reports re
ceived from local physicians indicated that many mothers at once took
to physicians the children who needed medical attention.
Prenatal conference conducted by a physician, 1 ; expectant mothers regis
tered and examined, 4.
Little mothers’ classes, 40 organized; girls enrolled, 902; number complet
ing course, 882; lessons in course, average of 8 for white girls, 19 for
Indian girls.
Teachers’ classes in infant hygiene, 23 organized; teachers enrolled plus
those carried over from previous year, 876; number completing course,
736; number still on roll, 137; lessons in course, average of 15.
Nurses’ classes in infant hygiene, 2 organized; nurses enrolled and com
pleting course, 21; lessons in course, 16.
31 Standards for Physicians Conducting Conferences in Child-Health Centers, blank form
facing p. 6. ü. S. Children’s Bureau Publication No. 154. Washington, 1926.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
97
Activities— Continued.
Mothers’ classes, 4 ; mothers enrolled, 141; number completing course 80 •
lessons in course, 10.
’
’
Home visits by nurses, 596 (prenatal cases seen, 95; obstetrical cases 13 •
postnatal cases, 13; infants, 282; preschool children, 299).
demonstrations, 649; 26 of these were to rural and city club women
349 at little mothers’ classes, and 274 at classes for mothers, teachers and
nurses.
’
Survey, 1, of preschool children, in 3 counties. It was found in one county
that the births had been registered for only 2,438 of the 2,992 children
listed, and that only 167 of the children had been immunized against any
communicable disease. In pursuance of this survey a child-health con
ference was arranged at one of the big ranches in the State, for which
more than 1,200 children were enrolled. The examinations were made
a immber of physicians, including some of the leading pediatricians
' e. j 7u e* Unusual cases were referred to the pediatricians, with whom
the visiting physicians held consultations. The effect of the work was
far-r^chmg, and there was a general increase of interest in work
affecting the health of children.
Talks and lectures, 888, at teacher-training schools, meetings of federated
clubs and of parent-teacher associations, State and local meetings of
physicians and nurses, classes of medical students, and farm groups.
The director ^ave ab°ut 70 of these talks to a total of approximately
7,000 persons.
J
Literature distributed, 253,000 pieces.
New names registered for prenatal letters, 7,896; prenatal letters distrib
uted, 9,719 sets. Many physicians throughout the State registered their
prenatal cases for these letters.
The bureau continued its cooperation in the graduate courses in pediatrics
for physicians, begun in March, 1926, by the extension division of the
State university. A staff nurse was detailed to assist in the clinic work,
and practically the entire State was covered. Thirty-two nine-week
courses were given, each group having a weekly lecture and clinic. Four
hundred and eighty-eight physicians completed the course.
Nutrition work was done through the little mothers’ classes and the classes
conducted for mothers and teachers.
Exhibits conducted, 407, at State and county fairs, club meetings, and
classes. A plaster dental exhibit was added to the bureau’s exhibit
material through the courtesy of the State dental association.
Birth registration was urged in all classes and talks and in the prenatal
letters distributed.
Breast feeding was emphasized in the courses in pediatrics and in talks
given and through the distribution to physicians of a set of charts on
breast feeding.
Infants born in the State during the year, 55,770; infants under 1 year
of age reached by the work of the bureau, 12,959; preschool children
reached, 7,920; expectant mothers reached, 12,213.
Counties in the State, 77; counties having maternity and infancy work
during the year, 63; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 75.
■“■s u- ,r1esu^
U*e bureau’s work many schools have introduced courses in
child care, and nurses employed by communities have given more time
to maternity and infancy work.
The following organizations cooperated in the bureau’s work: State uni
versity, State agricultural and mechanical college, State department of
public instruction, Crippled Children’s Society, women’s clubs, and the
parent-teacher association. They assisted with classes, clinics, meetings
and exhibits.
SOM E R E S U LTS O F T H E W O R K D U R IN G T H E PE R IO D OF C O O P E R A T IO N U N D E R
T H E M A T E R N IT Y A N D IN F A N C Y A C T
Registration of births has increased as a result of the campaign conducted
by the State department of health, in which «the bureau of maternity and
infancy assisted.32
82 Oklahoma was admitted to the birth-registration area in April, 1928..
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M ATERNITY AND IN FAN C Y
As the State was not in the birth-registration area, no statement as to
reduction in mortality rates can be made.
The maternity and infancy program has been educational, including instruc
tion given to groups of girls, mothers, teachers, nurses, and physicians. The
graduate course in pediatrics, given since March, 1926, to physicians by the
extension division of the State university with the cooperation of the bureau
of maternity and infancy, has developed much interest in the medical care
of children. In the fiscal year ended June 30, 1927, a total of 488 physicians
took the course. In 1923 there were only 33 pediatricians in the State ; in 1926
there were 56.
Requests for literature have increased, showing a greater interest in the
welfare and hygiene of maternity and infancy ; 253,000 pieces of literature
were distributed in 1927.
"
<
Realization of the need of preparing the mother early in life for some of her
responsibilities as a home-maker is shown by the appointment of a publichealth nurse by the United States Bureau of Indian Affairs to teach child care
in 13 Indian boarding schools in the State. This nurse is supervised by the
bureau of maternity and infancy. Appreciation of the value of such instruc
tion is shown by the large number of students who have taken the course.
OREGON
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene, Portland.
Staff:
Director (physician, State health officer serving), assistant director
(nurse), prenatal supervisor (nurse, paid in part from maternity and
infancy funds), 1 clerk. Nineteen county nurses in six counties were paid
for some maternity and infancy work.
Volunteer assistants, 15 physicians, 20 dentists, 12 nurses, 100 lay persons.
Activities:
Child-health conferences conducted by physicians, 146; infants and pre
school children registered and examined, 2,350; defects found, 2,927;
children having defects, 1,334. Parents had defects corrected in approxi
mately 75 per cent of the children.
Prenatal conferences conducted by physicians, 218; expectant mothers
registered, 330; visits to conferences, 1,273.
i
The prenatal supervisor devoted her time to the out-patient prenatal clinic
of the University of Oregon Medical School, which serves as a teaching
center for medical students.
Dental conferences conducted by dentists, 51; children receiving dental
advice, 582.
New permanent combined prenatal and child-health centers, 5 established,
largely as a result of the maternity and infancy work.
New permanent child-health centers, 2 established, largely as a result of
the maternity and infancy work.
Little mothers’ classes, 11 organized; girls enrolled and completing course,
216; lessons in course, 3 to 15.
Mothers’ classes, 3 organized; mothers enrolled, 59; number completing
course, 16; lessons in course, 18.
Home visits by nurses, 15,723 (prenatal cases seen, 303; obstetrical and
postnatal cases, 106; infants and preschool children, 2,955).
Group demonstrations, 6, on set-up of traveling health center and on various
phases of maternity and infancy work.
Assistance was given in a goiter survey and in a tuberculosis survey made
by private organizations.
Campaigns, 6 : (1) For vaccination. (2) For immunization against diph
theria. (3) For immunization against scarlet fever. (4) For care of
the teeth. (5) For examination of preschool children during the summer
so that defects could be corrected before the children should enter school
in the fall. (6) For observance of May Day as Child Health Day.
Talks and lectures, 529.
Literature distributed, approximately 30,000 pieces.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
Activities— Continued.
New names registered for prenatal letters, 875; prenatal letters distributed,
1,025 sets.
Nutrition work was done through instruction at conferences and classes
and in home visits.
Exhibits conducted, 21. Exhibit material prepared: Posters, charts, slides,
and a layette. Exhibits were lent 10 times.
Scientific articles prepared, 3, on immunization and nutrition.
Statistical studies, 8 : On maternal and infant mortality, 6 ; on nursingservice costs, 2.
Breast feeding was emphasized at conferences and at classes, in home visits,
in talks given, in letters, and literature distributed.
Infants born in the State during the year, 14,568; infants and preschool
children reached by the work of the bureau, 13,100; expectant mothers
reached, 1,454. The bureau sent literature on infant hygiene to parents
of all infants whose births were registered in the State bureau of vital
statistics.
Counties in the State, 36; counties having maternity and infancy work
durving the year, 22; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 36.
The following organizations cooperated in the bureau’s work: State de
partment of education, State university medical school, State agricul
tural college, State tuberculosis association, State federation of women’s
clubs, American Red Cross, and the parent-teacher association.
Among the outstanding features of the year’s work were the development of
infant, preschool-child, and prenatal conferences, the immunization and vac
cination campaigns in certain counties, and the extension of the prenatal-clinic
work at the University of Oregon Medical School, in which the bureau cooper
ates. Throughout the State there has been increased interest in the maternity
and infancy program.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
A special feature of the Oregon program for maternity and infancy work
has been the detailing of nurses to county units. Considerable attention has
been devoted also to child health conference work, and much informative
literature has been distributed.
For several years the bureau of child hygiene has cooperated with the
medical school of the State university in a prenatal-clinic program. A full-time
nurse has been detailed to assist in the development and continuation of a
prenatal clinic, at which the medical students of the State university secure
their training in prenatal care. Physicians graduated from the university
furnish much of the medical service to both rural and urban districts of the
State. The effect of good training in obstetrics is indicated by reduced ma
ternal and infant death rates during the period of cooperation under the
maternity and infancy act. Not only the State as a whole but also the urban
and rural areas show a definite drop in the death rate of mothers from causes
associated with pregnancy and childbirth. In 1922 the State rate was 82.8 per
10,000 live births, the urban rate was 91.6, and the rural rate was 76.8. In
1926 the State rate was 59, the urban rate was 66.2, and the rural rate was 54.
Oregon was admitted to the United States birth-registration area in 1919.
Comparison of the average rate for the three-year period before the State’s
cooperation under the maternity and infancy act (1919-1921) with that for the
five-year period of cooperation (1922-1926) shows a reduction of 22.1 per
cent in the maternal mortality rate for the State as a whole, 16.4 per cent
for the urban areas, and 26.3 per cent for the rural areas.
The influence of good prenatal and confinement care is reflected further in
the lowered death rates of infants in the first month of life, deaths due largely
to prenatal and natal causes. This rate dropped from 36.9 in 1922 to 31.9 in
1926.
The infant mortality rate in the first year of life likewise shows a decline
for the State as a whole from 58.5 per 1,000 live births in 1922 to 52.5 in 1926.
The decline is more definite in the urban areas, the rate falling from 58.7 in
1922 to 39.2 in 1926. In the rural areas it declined from 58.3 in 1922 to 53.2
in 1925, but it rose again to 61.7 in 1926.
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Federal Reserve Bank of St. Louis
100
MATERNITY AND INFANCY
P E N N S Y L V A N IA
S T A F F A N D A C T IV IT IE S D U R IN G 1927
Administrative agency:
. . . . . . .
State department of health, bureau of child health, preschool division,
Harrisburg.
Staff:
.
.
., „
, i .*
Director (physician), 7 physicians (6 part year, 1 not paid from maternity
and infancy funds), 6 dental hygienists (part year), 2 midwife super
visors (physicians), 14 t o 31 vital-statistics clerks, 4 field workers (1 part
year), 3 file clerks, 2 stenographers. Ten nurses detailed to counties or
communities, doing maternity and infancy work exclusively, and 125 to 135
nurses in the public health nursing division, of the State department of
health were paid for part-time maternity and infancy work in a general
ized service.
Volunteer assistants, many physicians, nurses, and lay persons.
Activities:
. .
.
.
,
Child-health conferences conducted by physicians, 9,689; infants and pre
school children registered and examined, 15,456; visits to conferences,
85,089.
L
j
Prenatal conferences conducted by physicians, 312; expectant mothers reg
istered and examined, 1,055; visits to conferences, 2,837.
The division gave advisory service and furnished literature and record
blanks to child-health centers and prenatal centers supported by other
agencies, at which local physicians conducted 16,078 child-health con
ferences (examining 33,153 infants and preschool children) and also
5,045 prenatal conferences (examining 15,195 expectant mothers). There
were 198,487 visits to these conferences by infants and preschool children
and 65,704 visits by expectant mothers.
Two health cars staffed by physicians and nurses and carrying equipment
for conducting child-health conferences were sent out in the field in
June, 1927. (One such car had been in the field during the summer
months of 1925 and 1926.) Three of the field workers worked in advanceof the cars for many weeks; they arranged the itineraries, organized
local committees, arranged for the attendance of children by house-tohouse canvass, helped at the time of the conferences, and assisted with
follow-up work. It was estimated that parents had had defects corrected
in approximately 50 per cent of the children examined by the health-car
staff in 1925 and 1926.
New permanent child-health centers, 37 established. The nursing service
of 10 is paid for by Federal and State funds, that of 27 by funds from
other agencies.
Intensive work among midwives in the coal regions of the State, begun in
four counties in 1922 and later extended to five others, was continued.
Two women physicians supervised and instructed the midwives, using
a nine-lesson course of instruction. During the year under review, 521
midwives were under their supervision, and a number who had com
pleted the course were given further instruction. In 1926 the number of
deliveries attended by midwives in the nine counties was 6,201; the
number of maternal deaths in the practice of these midwives was 13
(a rate of 2.1, whereas the death rate for the State as a whole was 6).
An cases ending in death which a midwife had attended at any time
during the labor were counted as deaths in the midwife’s practice even
though a physician was called later and signed the death certificate.
Two institutes for midwives were held with an attendance of 206.
Home visits by nurses, 87,058.
The division cooperated in a campaign for the observance of May Day as
Child Health Day in 64 counties. A number of committees chose this
day for the opening of a child-health center, the beginning of a toxinantitoxin campaign, or the beginning of a campaign for the examination
of preschool children and correction of their defects before the children,
should enter school.
Talks and lectures, 229.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
101
Literature distributed, 207,371 pieces. ' (In addition tbe bureau of vital
statistics sent a copy of the Pennsylvania Baby Book- to each mother
with the certificate of birth notification.)
Exhibit material was lent 4 times.
The division continued to cooperate with the State bureau of vital statistics
in issuing birth-notification certificates to the parents of all infants as
fast as birth registrations were recorded. (This was begun in 1924.)
Infants born in the State during the-calendar year 1926, 207,690; infants
under 1 year of age reached by the work of the division during the
year under review, 8,397; preschool children reached, 9,556; expectant
mothers reached through conferences, 1,055. Through cooperating childhealth and prenatal centers 35,354 infants and preschool children and
15,195 expectant mothers also were reached, and many others were
reached through home visits.
Counties in the State, 67; counties having maternity and infancy work
during the year under review, 67.
In 1924 an offer was made to furnish $1,000 for the salary of a maternity
and infancy nurse to each community that would match this sum, and 11
county or community nurses have been doing maternity and infancy work
on such joint Federal, State, and local funds. At the close of the fiscal
year under review two of these communities had assumed entire financial
responsibility for the maternity and infancy work thus begun by the use
of maternity and -infancy funds and another had assumed a greater
proportion of the expense.
The following organizations cooperated in the division’s work: State league
of women voters, State federation of women’s clubs, State tuberculosis
association, Women’s Christian Temperance Union, American Red Cross,
and the parent-teacher association.
Among the outstanding achievements of the year were the holding of the two
midwife institutes and the addition of a second health car to the division’s
equipment for itinerant-conference work.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State has a large industrial population and has developed plans for
administration of maternity and infancy funds to meet the needs of industrial
and urban communities as well as of rural communities. Much of the State
rural and urban work has been interlocking. Maternal and infant welfare has
been promoted by the development of a state-wide nursing service in which
nurses are paid from maternity and infancy funds for visits to mothers and
babies, by the development of health centers supported by the State, and. by
the development of centers supported by communities, to which advisory or other
service has been given and to which actual service has been rendered by staff
nurses and physicians.
Supervision of midwives by a physician was begun in four counties in the
anthracite regions in 1922. In March, 1925, a second physician was secured,
and supervision was begun of midwives in five counties in the soft-coal region.
From the respective dates at which the work was begun in each county to
January 1, 1927, the State reported a total of 23,684 deliveries by midwives with
a maternal death rate for the 4% years of 1.43 for every 1,000 confinements.
The neonatal death rate for the same period, according to State figures, was
27.4; both these rates were lower than those for the State as a whole.
In 1922, in which year Pennsylvania accepted the provisions of the maternity
and infancy act, the State’s infant mortality rate was 88.2 for every 1,000 babies
born alive. In 1926 the rate was 82.4, or 6.6 per cent lower than in the first
year of cooperation under the act. The rate for urban areas was 8.3 per cent
lower in 1926 than in 1922, and for rural areas it was 4.6 per cent lower. The
average rates for the period of cooperation (1922-1926) and the similar pre
ceding period (1917-1921, excluding 1918) and the percentages of decrease are
shown in the following table:
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102
MATERNITY AND INFANCY
Average infant mortality rate per
1,000 live births
Area
1917-1921
(excluding
1918)
1922-1920
Percentage
o f decrease
98.9
98.9
98.8
84. 3
83. 7
84.9
14.8
15.4
14.1
State..................................................... ................
U rb a n ..____ _________________ ____ _______________
Rural ______________ . . . _ _________ .
The death rate among women from causes associated with pregnancy and
childbirth in 1921, the year before the operation of the act, was 68.3 per
10,000 live births. In 1926 the rate was 63.7. In urban areas the rate was
84.4 in 1921 and 80.4 in 1926 ; in rural areas it was 52.2 in 1921 and 46.7 in
1926. The average rate for the period of the State’s cooperation under the
act (1922-1926) shows a greater reduction in the rural areas when compared
with a similar period prior to the operation of the act (1917-1921, exclusive
of 1918) than the rates in the urban areas. The average rates and the per
centages of decrease are shown in the following table:
Average maternal mortality rate per
10,000live births
Area
1917-1921
(excluding
1918)
1922-1926
69. 7
82. 8
56.6
63. 9
80.4
47.2
State____ ____ __________ ___________
Urban________________ _____________________________
Rural__________________________________________ _
Percentage
o f.
decrease
8. 3
2.9
16.6
The rates of maternal deaths due to puerperal albuminuria and convulsions
likewise show a greater decrease in the rural areas than in the urban areas.
In the rural areas the average rate for 1922 to 1926 was 13.4 per cent lower
than that for 1917 to 1921 (exclusive of 1918), whereas in the urban areas it
was 11.6 per cent lower. ( See chart on p. 103.)
Death rates from puerperal septicemia also show a greater difference in the
rural areas than in the urban areas. The average rate for 1922 to 1926 in
the rural areas was 12.3 per cent lower than that for 1917 to 1921; in the urban
areas it was 2 per cent lower.
R H O D E IS L A N D
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, child-welfare division, Providence.
Staff:
Director (physician), 7 nurses, 1 field secretary, 1 stenographer.
Activities:
Child-health conferences conducted by physicians, 34; infants and preschool
children registered and examined, 446; defects found, 589. Parents had
defects corrected in 318 of the children.
Conferences conducted by nurses, no physician present, 123; infants and
preschool children inspected, 446; visits to conferences, 2,001,
Mothers’ classes, 4 (3 for expectant mothers) ; mothers enrolled, 57.
Home visits by nurses, 54,803 (prenatal cases seen, 1,328; infants, 4,163 ;
preschool children, 13,521).
Group demonstrations, 3, at child-health conferences, on methods of giving
sun baths, also a number in homes of mothers and of midwives.
Assistance was given in one town in the work of the State board of health
for immunization against diphtheria.
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
103
Deaths per l/)GO isv<2, births
Activities— Continued.
Talks and lectures, 28.
Literature prepared : May Day flier.
Nutrition work was done through individual instruction to mothers in
home visits.
Literature distributed, 73,206 pieces.
1917 1918 1919 I9EO 198« 1988 1983 1984 1985 1986
MAT ER NA L M OR TA LIT Y FROM PUERPERAL
( D E A T H S P E R 1, 000 LI V E B I R T H S ) IN T H E
D I S T R I C T S O F P E N N S Y L V A N I A, 1917-1926
ALBUMINURIA AND CONVULSIONS
S T A T E A N D IN U R B A N A N D R U R A L
Breast feeding was promoted through the instruction given in home visits
and through contacts made by the director of the division.
Exhibits conducted, 3, at county fairs. Exhibits were prepared on sun
baths and on the baby’s bath and toilet.
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104
M ATERNITY AND IN FAN C Y
Activities— Continued.
Infants born in the State during the year, 13,981; infants under 1 year of
age reached by the work of the division, 4,163; preschool children
reached, 13,521; expectant mothers reached, 1,328.
Counties in the State, 5 ; counties having maternity and infancy work
during the year, 4.
Among the outstanding features of the division’s work were the assistance
given in the toxin-antitoxin campaign and the general educational work done.
SOME R E S U LTS OF TH E W O R K D U R IN G TH E P E R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State has had a division of child welfare since 1919 and has cooperated
under the provisions of the maternity and infancy act since 1925. The most
important features of its program for several years have been the supervision of
infants and preschool children through their regular attendance at child-health
conferences and supervision of mothers and children through the regular visits
of public-health nurses in the homes.
The State’s cooperation under the maternity and infancy act has extended
over too short a period for the results to be measured by comparison of mater
nal and infant death rates. A downward trend, however, appears in the mor
tality rates among women from causes associated with pregnancy and child
birth, particularly in those causes which can be prevented by good prenatal and
obstetrical care— puerperal septicemia and puerperal albuminuria and convul
sions. The death rate from septicemia was 23.5 per 10,000 live births in 1923
and 17.7 in 1926; from albuminuria and convulsions, 14.5 in 1923 and 10.3 in
1926. The infant mortality rates during the same period, though variable, like
wise suggest a decline. In 1923 the infant mortality rate was 94.3; in 1926 it
was 82.
As a result of the division’s field work the situation in regard to midwives
has improved since the beginning of the State’s cooperation under the maternity
and infancy act. Unlicensed midwives have appeared before the board for
examination and license, and several who were practicing without a license have
ceased to take cases.
SO U T H C A R O L IN A
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Columbia.
Staff:
Director (nurse), 1 physician (part time), 9 nurses (5 part year), 1 milk
technician, 1 secretary-accountant, 1 stenographer. Two county nurses
were paid for maternity and infancy work (1 full time).
Volunteer assistants, 1 physician, 1 nurse.
Activities:
Child-health conferences conducted by physicians, 196; infants and pre
school children registered and examined, 3,099; visits to conferences,
3,516; defects found, 1,520; children having defects, 1,217.
Prenatal conferences conducted by physicians, 48; expectant mothers regis
tered and examined, 67; visits to conferences, 268.
Conferences conducted by nurses, no physician present, 8 ; mothers in
structed in prenatal care, 17; infants and preschool children inspected, 77;
visits to conferences, 94 (by mothers, 17; by children, 77).
New permanent combined prenatal and child-health center, 1 established
as a result of the maternity and infancy work done by staff nurses. It is
supported by private funds. Weekly prenatal conferences also were con
ducted in one county by a physician who volunteered his services.
Little mothers’ classes, many, conducted by county nurses not paid from
maternity and infancy funds, who used the course of lessons prepared by
the bureau.
Mothers’ classes, 3 organized; mothers enrolled (plus those carried over
from previous year) and completing
lessons in course,
course, 210;
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Federal Reserve Bank of St. Louis
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PRINCIPAL ACTIVITIES OE THE INDIVIDUAL STATES
105
Activities— Continued.
Midwives’ classes, 48 organized; midwives enrolled plus those carried over
from previous year, 724; number completing course, 373; lessons in
course, 10. Supervision of midwives constitutes a large part of the
work of the bureau. In addition to conducting classes the staff nurses
supervise the midwives who have had class instruction. Counties having
a public-health nurse who meets with these groups regularly are visited
only once a year by a staff nurse to check up and renew certificates.
In counties having no nursing service (in 19 of which the midwifery
instruction has been given) the staff nurse calls together the classes
every three months. At this time she spends 7 to 10 days in the county,
visiting the homes of the midwives who fail to attend classes, visiting
prenatal cases reported by physicians or midwives, and helping to plan
local work. During the year the staff nurses held 234 of these review
classes, attended by 2,270 midwives.
Home visits by nurses, 3,303 (prenatal cases seen, 432; obstetrical cases, 8 ;
postnatal cases, 393; infants, 671; preschool children, 505; midwives,
550).
Community demonstrations, 3, of a general maternity and infancy program,
in 3 counties.
Group demonstrations, 297, of preparation of maternity bed and of ob
stetrical supplies, the baby’s bath, and other phases of maternal and
infant care, to groups of mothers and classes of midwives.
Surveys, 3 : (1) Of midwives, to discover number practicing, number re
porting births, and number of. cases delivered by each midwife. (2) Of
birth registration, to discover who was responsible for incomplete report
ing of births. (3) Of diphtheria cases, to discover cause of death.
Campaigns, 2 : (1) For promotion of birth registration, in order to obtain
reentry into the birth-registration area. Constant efforts were made to
stress the importance of birth registration. Talks were given to clubs
and medical associations, posters were displayed, and physicians, mid
wives, and registrars were urged to send in reports of births. (2) For
immunization against diphtheria, in 19 counties. The director and the
staff nurses addressed meetings of parent-teacher associations and
mothers’ clubs, urging them to have children immunized against diph
theria. As a result many clinics were conducted, and several hundred
children were given toxin-antitoxin.
Talks and lectures by staff, 309.
Literature distributed, 34,135 pieces.
Assistance in organizing nutrition classes was given to county nurses by
the director and the staff nurses.
Exhibits conducted by staff, 8, at the State fair and various State and
local meetings. Exhibit material was lent 12 times.
Scientific articles prepared: Contagious Diseases in Childhood, Rickets in
Young Children, Periodic Health Examinations of Children as a Public
Health Measure.
Infants born in the State during the year, 44,563; infants under 1 year of
age reached by the work of the bureau, 40,000; preschool children reached,
2,449; expectant mothers reached, 309.
The bureau sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.
Counties in the State, 46; counties having maternity and infancy work
during the year, 41; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 46.
As a result of the work done by the bureau various local agencies under
took considerable maternity and infancy work during the year. Their
activities included the organization of toxin-antitoxin and tonsil and
adenoid clinics, the establishment of a prenatal clinic at the county
hospital, and the inauguration of weekly child-health conferences in one
county.
At the request of various local organizations nurses from the bureau’s staff
went to the respective communities to help them plan their maternity
and infancy work.
The following organizations cooperated in the bureau’s work: American
Legion, Council of Farm Women, federated clubs, a fraternal organiza
tion, and the parent-teacher association.
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Federal Reserve Bank of St. Louis
106
MATERNITY AND IN FAN C Y
Among the outstanding achievements of the year were the prenatal work
done and the improvement made in supervision of the midwives.
SOME R E S U LTS O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Results of the maternity and infancy work during the period of cooperation
can not be expressed in terms of mortality rates because the State has been both
in and out of the birth-registration area during the period of cooperation under
the act.
Much effort has been directed by the State board of health toward improving
birth registration, in which assistance has been rendered by the bureau of
child hygiene and public-health nursing. A test by the United States Bureau
of the Census for reentry into the registration area will probably be made in
the near future.
TYPES
O F W O R K D O N E BY T H E BUREAU O F C H I LD H Y G I E N E A N D PUBLI CH E A L T H N U R S I N G , S O U T H C A R O L I N A B O A R D O F H E A L T H , 1 9 2 2- 1 927
The supervision and training of midwives has been a feature of the program,
with special attention directed to the midwives’ reporting of births. The mid
wife situation has improved since tbe beginning of the maternity and infancy
work, and the number of midwives has decreased.
During the period of the State’s cooperation under the maternity and infancy
act some work has been done in every county in the State. Forty-four counties
have held child-health conferences; 40 have had midwifery instruction and
supervision ; and 19 have had campaigns for immunization against diphtheria ;
in 9 counties permanent county nursing services have been established as the
result of demonstrations of maternity and infancy work. ( See map above. )
SO U T H D A K O T A
S T A F F A N D A C T IV IT IE S D U R IN G 1927
Administrative agency ;
State board of health, division of child hygiene, Waubay.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
107
Staff:
Director (physician), 1 physician (part time, part year), 4 nurses (1 part
time, 1 part year), 1 lecturer (part time), 1 secretary, 1 stenographer
(part time). Five county nurses in two counties were paid for some
maternity and infancy work.
Activities:
Combined prenatal and child-health conferences conducted by physicians,
78; expectant mothers registered and examined, 42; infants and pre
school children registered and examined, 3,172; defects found in children,
4,806; children having defects, 2,080.
Conference conducted by nurse, no physician present, 1 ; infants and pre
school children inspected, 12. The county nurses paid for maternity and
infancy work held 107 conferences, with attendance of 944.
Dental conference, 1, conducted by dentists who volunteered their services;
preschool children receiving dental advice at conference, 150.
Mothers’ classes, 57; mothers enrolled, plus those carried over from previous
year, 2,075; number completing course, 1,733; lessons in course, 7. The
county nurses paid for maternity and infancy work held 10 mothers’
classes with an enrollment of more than 160.
Home visits by nurses, 693 (prenatal cases seen, 95; postnatal cases, 18;
infants, 319; preschool children, 261).
Maternity homes inspected, 71; inspections made, 79. Six homes were
found ineligible for licenses and were ordered closed.
Group demonstrations, 134, at mothers’ classes and girls’ clubs.
Survey, 1, of maternity homes and maternity departments of hospitals.
Campaign, 1, for immunization against diphtheria; preschool children
immunized, 4,015.
The parent-teacher association and many clubs
cooperated.
Talks and lectures, 182.
Literature prepared: Start the Baby Right, Suggestions to Mothers (re
vised).
Literature distributed, approximately 40,000 pieces.
New names registered for prenatal letters, 350; prenatal letters distributed,
512 sets.
Exhibits conducted, 40, at fairs, teachers’ association meetings, girls’ clubs,
and child-health conferences. Exhibits were lent 20 times.
Scientific article prepared: Toxin-antitoxin and its administration.
Statistical studies, 3 : Deaths of children under 5 years of age, attendants
at births, number of children to enter school in the coming fall.
Breast feeding was emphasized in mothers’ classes and in literature
distributed.
Infants born in the State during the year, 14,633; infants under 1 year of
age reached by the work of the division, approximately 15,000; preschool
children reached, 4,116; expectant mothers reached, 726. The State sends
literature on infant hygiene to . parents of all infants whose births are
registered in the State bureau of vital statistics.
Counties in the State, 69; counties having maternity and infancy work
during the year, 64; there are 5 unorganized counties whose population
consists largely of Indians under Government care.
As a result of the division’s work many local organizations conducted
health conferences for preschool children, and some of them held
mothers’ classes, using the outline and demonstration material prepared
by the division. At the request of various clubs the division supervised
a number of the child-health conferences.
The following organizations cooperated in the division’s work: State pub
lic-health association, State league of women voters, American Legion
auxiliary, American Red Cross, women’s clubs, and the parent-teacher
association.
The outstanding feature of the year’s work was the campaign for immuniza
tion against diphtheria.
SOME R E S U LTS OF TH E W O R K D U R IN G TH E P E R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
As the State has not been admitted to the United States birth and death
registration areas no statement as to reduction of mortality rates can be made.
892°— 28----- 8
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Federal Reserve Bank of St. Louis
108
MATERNITY AND IN FAN C Y
A satisfactory law for registration of deaths and births is necessary before a
test can be made by the United States Bureau of the Census for admission to
the areas. Efforts to have such legislation enacted have not yet been suc
cessful. A general educational program in maternity and infancy care has
been conducted. Licensing and inspection of maternity homes and hospital?-^,
has been assigned to the division.
TEN N ESSEE
S T A F F A N D A C T IV IT IE S D U R IN G 1927
Administrative agency:
State department of public health, division of child hygiene and publichealth nursing, Nashville.
Staff:
Director (physician, part time), 1 physician (part year), 3 nurses (part
time, 2 part year), 1 midwife teacher (physician), 2 vital-statistics
clerks (1 part year), 5 clerks (part year), 1 stenographer (part time).
Thirty county nurses in 17 counties were paid for some maternity and
infancy work.
Activities:
Child-health conferences conducted by physicians, 363; infants and pre
school children registered and examined, 3,603; visits to conferences,
3,603; children having defects, 1,374. Parents had defects corrected in
288 of the children. Many of these conferences were conducted by
county health unit physicians in the counties in which nurses were
paid for maternity and infancy work.
Prenatal conferences conducted by physicians, 8 ; expectant mothers regis
tered and examined, 21; visits to conferences, 21.
Conferences conducted by nurses, no physician present, 74; infants and
preschool children inspected, 792.
New permanent child-health centers, 8 established. They are supported
by Federal, State, and other public funds and by private funds.
Mothers’ classes, 60 organized; mothers enrolled, 561; number completing^ y
course, 323; lessons in course, 15.
^
Midwives’ classes, 50 organized; midwives enrolled plus those carried over
from previous year, 1,101; number completing course, 723; lessons in
course, 10.
Home visits by nurses, 16,173 (prenatal cases seen, 769; obstetrical cases,
51; postnatal cases, 700; infants, 1,145; preschool children, 934).
Group demonstrations, 7, of an exhibit on prenatal care, of the use of scales,
and of various phases of maternal and infant care.
Surveys, 3 : (1) Of midwives, in 10 counties. (2) Of birth registration, in
36 counties. (3) Of the incidence of diphtheria, in 6 communities.
Campaigns, 4 : (1) For promotion of birth registration, in 36 counties.
The State was admitted to the birth-registration area in May, 1927.
(2) For observance of May Day as Child Health Day, state-wide. (3)
For observance of girls’ health week, in 1 community. (4) For immuni
zation against diphtheria, in 6 communities.
Talks and lectures, 571.
literature distributed, 27,392 pieces.
Prenatal letters distributed, 478 sets.
Exhibits conducted, 18, including display of maternity bed, baby’s bath, and
baby pen. Exhibit material prepared, many posters. Exhibit material
was lent 6 times.
Statistical studies, 3, of maternal and infant mortality in certain areas.
Breast feeding was promoted through literature (763 pieces) distributed
on the subject.
In addition to their work at conferences, in home visits, and at exhibits
reported in the foregoing paragraphs the county nurses listed 112 un
reported births and 6 stillbirths, obtained 1,198 specimens of urine for
examination for expectant mothers, placed 98 infants and 98 preschool
children under medical care, had 188 conferences with individual mijJwives, and kept 700 postnatal cases under supervision.
Infants bom in the State during the year, 27,656; infants under 1 year of
age reached by the work of the division, 8,549; preschool children reached,
7,370; expectant mothers reached, 2,659.
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PRINCIPAL ACTIVITIES OF TH E INDIVIDUAL STATES
109
Activities— Continued.
Counties in the State, 95; counties having maternity and infancy work
during the year, 58; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 73.
^
The division’s work had the cooperation of the parent-teacher associations.
Among the outstanding features of the year’s work were the instruction of
midwives, to which the midwife teacher (a negro woman physician) devoted
full time, and the activities for the promotion of birth registration.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
During a period of several years the State health department has conducted
a campaign for better registration of births. Assistance was given to this work
by the division of child hygiene and public-health nursing. Special service was
rendered by the negro physician on the division’s staff, who worked among the
negro midwives showing them how to register births in addition to teaching
better midwifery procedures. The State passed the test of the United States
Bureau of the Census and was admitted to the birth-registration area in Mav.
1927.
As the State was not admitted to the birth-registration area until the spring
of 1927 no statement as to reduction of mortality rates can be made.
The State has a number of full-time county health departments, and county
nurses have been paid from maternity and infancy funds for maternity and
infancy'work.
TE X A S
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of health, bureau of child hygiene, Austin
Staff:
Director (physician), 4 nurses (1 supervising nurse, 1 advisory nurse, part
~
yeau 2 itinerant negro nurses), 1 inspector of maternity and infant
homes, 1 illustrator and publicity worker (part time, part year), 1
secretary, 1 clerk (part time), 5 stenographers. Twenty-five county
nurses were paid for some maternity and infancy work.
Volunteer assistants, 113 physicians, 118 dentists.
Activities:
Child-health conferences conducted by physicians, 357; infants and pre
school children registered, 3,209; number examined, 2,793; visits to con
ferences, 3,967; defects found, 2,927; children having defects, 1809
Parents had defects corrected in 426 of the children.
Prenatal conferences conducted by physicians, 17; expectant mothers regis
tered, 166; number examined, 122; visits to conferences, 268. In addition
262 expectant mothers were examined outside the conferences, most of
them in physician’s offices (the nurses having taken them there or having
arranged through a committee for their transportation).
Conferences conducted by nurses, no physician present, 643; mothers in
structed in prenatal care, 92; infants and preschool children inspected,
3,361; visits to conferences, 4,461 (by mothers, 382; by children, 4,079).
In addition 726 mothers were instructed in prenatal care and 1,562 chil
dren inspected at visits to the nurses’ offices.
Dental conferences conducted by dentists, 48; expectant mothers receiving
dental advice, 147; preschool children receiving dental advice, 1,260.
New permanent child-health centers, 54 established. They are supported
by county and private funds.
The nurses conducted 142 junior health clubs in which 3,190 girls and boys
were enrolled. Some training in the care of infants and young children
was included in the course.
Mothers’ classes, 38 organized; mothers enrolled, 611; number completing
j
course, 136; lessons in course, 12.
Midwives’ classes, 41 organized; midwives enrolled, 499; number complet
ing course, 123; lessons in course, 10.
Home visits by nurses, 11,355 (prenatal cases seen, 1,059; obstetrical cases,
241; postnatal cases, 1,043; infants, 2,498; preschool children, 4,121).
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Federal Reserve Bank of St. Louis
110
MATERNITY AND IN FAN C Y
Activities— Continued.
Maternity homes inspected, 93; inspections made, 260.
Infant homes inspected, 400; inspections made, 998.
Group demonstrations, 788, on various phases of maternal, infant, and pre
school-child care.
Campaigns, 7 : (1) For observance of May Day as Child Health Day, also
for the examination of preschool children and correction of their defects
before they should enter school; state-wide. (2, 3, 4) For a safe milk
supply (in cooperation with city and civic organizations), also for gen
eral clean-up and sanitation, important in reducing infant mortality;
state-wide. (5, 6) For protection of young children against communicable
diseases; in several counties. (7) For promotion of birth registration; in
several counties. The State legislature passed the model birth registra
tion law in 1927, and the bureau has assisted in the effort to raise the
registration of births and deaths to the standard required for entry into
the registration areas.
Talks and lectures, 1,496.
Literature distributed, 49,403 pieces.
New names registered for prenatal letters, 3,876; prenatal letters dis
tributed, 3,908 sets.
Nutrition work was done through a few classes in nutrition for preschool
children conducted by some of the county nurses.
Exhibits conducted, 20, mostly of literature, at county fairs. Exhibit
material prepared, 6 charts.
Infants born in the State during the year, 86,149; infants under 1 year of
age reached by the work of the bureau, 48,743; preschool children reached,
8,047; expectant mothers reached, 5,774. The bureau has sent its lit
erature on infant hygiene to parents of all infants whose births are
registered in the State bureau of vital statistics.
Counties in the State, 254; counties having* maternity and infancy work
during the year, 30; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 90.
The following organizations cooperated in the bureau’s work: State medical
association and auxiliary; State dental association, American Legion arwf
auxiliary, Women’s Legislative 'Council, and the parent-teacher associa
tion. They aided in local work and helped to promote birth registration.
The dental association made a survey that included preschool children.
Among the outstanding features of the year’s work were the state-wide cam
paign for a better milk supply and the furthering of maternity and infancy
work through the cooperation of the organizations mentioned in the preceding
paragraph.
SOME R E S U L T S O F T H E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State has passed the first stage in a program for maternal and infant
care by enacting legislation necessary for entering the registration areas, as
the legislature passed a model registration law in 1927. Plans have been made
for a campaign to bring the State into the registration areas. The bureau of
child hygiene has assisted in the work to raise the registration to the standard
required for entry into the United States birth and death registration areas.
As the State is not in the birth-registration area no statement as to reduc
tion of mortality rates can be made.
An educational program has developed interest in maternal and infant welfare
in the State.
The situation in regard to midwives has improved sinpe the beginning of the
maternity and infancy work. All the midwives in the State who are recorded
have received instruction in the reporting of births and deaths and in the use
of a prophylactic in the eyes of the newborn. In the counties in which county
nurses were employed for maternity and infancy work the midwives have been
required to take a series of lessons given by the nurse and local physicians.
UTAH
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child hygiene, Salt Lake City.
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Federal Reserve Bank of St. Louis
PR IN C IP A L ACTIVITIES OF T H E IN D IV ID U A L STATES
111
Director (physician, 1 physician' (part year), 2 nurses (1 part year), 1
dentist (part year), 1 vital-statistics clerk, 2 stenographers (1 part year),
Temporary assistants were employed as needed. Two county nurses and
4 county health officers were paid for some maternity and infancy work
in 7 counties.
Volunteer assistants, 45 physicians, 2 dentists, 2 nurses, 1,010 lay persons.
Activities:
<■
. .
Combined prenatal and child-health conferences conducted by physicians,
409 (by staff physicians, 86; by county units* 323) ; expectant mothers
registered, 82; infants and preschool children registered and examined,
4,378 (at conferences held by staff physicians) ; visits to all conferences,
10,640 (by expectant mothers, 82; by children, 10,558) ; defects found,
16,378; children having defects, 3,607 (of those examined by staff physi
cians) . Parents had defects corrected in 1,734 of the children.
Conferences conducted by nurses, no physician present, 2 ; infants and pre
school children inspected, 21.
Dental conferences conducted by dentists, 125; preschool children receiving
dental advice, 1,921.
New permanent combined prenatal and child-health centers, 23 established.
They are supported by local funds.
Mothers’ classes, 5 organized; mothers enrolled plus those carried over
from previous year, 240; lessons in course, 4 to 20. Classes were still
in progress at the close of the year under review.
Home visits by nurses, 2,454 (to prenatal cases, 52; obstetrical cases, 10;
postnatal cases, 11; infants, 462; preschool children, 1,919).
Maternity homes inspected, 6 ; inspections made, 10.
Infant homes inspected, 8 ; inspections made, 8.
Group demonstrations, 96, on various phases of maternal and child care.
In small communities demonstration health conferences were conducted.
Campaigns, 2 : (1) For examination of preschool children and correction
of their defects before the children should enter school. (2) For ob
servance of May Day as Child Health Day.
Assistance was given in campaigns for immunization against diphtheria
and for a clean milk supply conducted by the State board of health.
Talks and lectures, 36.
Literature distributed, 11,669 pieces.
.
Exhibits conducted, 3, at the State fair and at county fairs. Exhibit
material was lent 11 times.
Nutrition work was done through instruction given to the parents ot
children found to be underweight.
Breast feeding was emphasized in talks with mothers at the health conferences.
Infants born in the State during the year, approximately 14,000; infants
under 1 year of age reached by the work of the bureau, approximately
14,000; expectant mothers reached, 2,793. Work was done for preschool
children, but no complete record was kept of the number reached. The
bureau sent literature on infant hygiene to parents of all infants whose
births were registered in the State bureau'of vital statistics.
As a result of previous organization and help some of the larger com
munities in the State held 195 child-health conferences with only super
visory assistance from the bureau. At these conferences 3,388 examina
tions were made of preschool children.
^
Counties in the State, 29; counties having maternity and infancy work
during the year, 28. One county is very difficult of access for maternity
and infancy work.
„
The following organizations cooperated in the bureaus work: state farm
bureau, a prominent church relief society, and the parent-teacher asso
ciation. These organizations formed local committees to promote ma
ternity and infancy work, and the relief society gave financial assistance
also.
SOM E R E S U L T S OF T H E W O R K D U R IN G TH E P E R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The interest in maternal and infant welfare has grown during the period of
cooperation under the act. One county and a number of communities have
assumed responsibility for maternity and infancy work.
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112
M A T E R N IT Y AND IN F A N C Y
Assistance toward the: development of seven full-time county health depart
ments has been given by maternity and infancy funds in return for maternity
and infancy work.
Permanent lay groups and committees cooperate with the bureau of child
hygiene in assisting with return conferences conducted by the bureau’s staff in
the sections of the State not in a position to maintain such work as a
community.
There is a marked improvement in the physical condition of the children
throughout the State resulting from instruction in nutrition and hygiene given
to the parents. Parents are having physical defects corrected and dental care
given to their children. The child himself is being educated in health and will
be a wiser parent in the future for having received this instruction.
Utah was admitted to the United States birth-registration area in 1917 and
accepted the provisions of the maternity and infancy act in 1922. During the
period .of cooperation under the act the maternal mortality rates have been
considerably reduced, particularly in the rural areas. In these areas in 1922
the maternal mortality rate was 50.3 per 10,000 live births. The rate has
dropped steadily, and in 1028 it was 36.8— a reduction of 26.8 per cent. Com
parison with the period prior to cooperation (1917-1921, exclusive of 1918)
shows that the average rate was 35.9 per cent lower during the period of
cooperation than during the preceding period— 40.1 compared with 62.6. The
average rate for the urban areas was also lower during the period of coopera
tion than during the preceding period, although the difference was not so
marked as that for the rural areas, being 29.7 per cent lower for 1022 to 1926
than for 1917 to 1921.
In 1921, the year prior to the operation of the maternity and infancy act,
Utah had a maternal death rate of 72.6 per 10,000 live births for the State, 92.7
for urban areas, and 62.7 for rural areas. Changes in the rates since that year
are shown in the following table:
Maternal m ortality rate per
10,000 live births
Maternal m ortality rate per
10,000 live births
Year
Year
State
1921_____ _________
1922____ ___________
1923_______________
72.6
55.5
49.8
Urban
92.7
65.6
71.5
Rural
62.7
50.3
38. 2
State
1924
1925
1926
45 1
51 7
48.6
Urban
69! 8
Rural
36.8
Deaths of mothers from puerperal septicemia and from puerperal albuminu
ria and convulsions show a decided drop since 1921. In that year the rate
for the State from septicemia was 29.5 for every 10,000 live births; in 1926
it was 16. From albuminuria and convulsions the mortality rate was 15.1
in 1921 compared with a rate of 10.6 in 1926. The same general declines are
apparent in the rural areas. In 1921 the rural rate from septicemia was 20.5;
in 1926 it was 15.4. From albuminuria and convulsions the rate was 15.4 in
1921 and 8.3 in 1926. In the urban areas the rate from septicemia was 47.4
in 1921 compared with 16.9 in 1926; from albuminuria and convulsions the rate
wras practically the same in both years.
The average infant mortality rate for the period of cooperation (1922-1926)
was 9.3 per cent lower than that for the period prior to cooperation (1917-1921,
exclusive of 1918). The average urban rate was 11.6 per cent lower and the
average rural rate 7.9 per cent lower.
VERM ONT
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State department of public health, Burlington.
Staff:
Director (physician, State health officer serving), 1 nurse (part year), 1
stenographer.
Activities:
Child-health conferences conducted by physicians, 3 ; infants and preschool
children registered and examined, 85; defects found, 54; children having
defects, 41.
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P R IN C IP A L ACTIVITIES OP T H E IN D IVID U AL STATES
113
Activities— Continued.
Community demonstration, 1, begun in the previous fiscal year and con
tinued for a few months of the year under review.
Group demonstrations, 14, on care of infants and preparation of their food,
obstetrical packages, and clothing for expectant mothers.
Talks and lectures, 38; IS lectures on prenatal, infant, and child care
were given in 3 towns to a total attendance of 210 women.
Literature prepared: Daily time cards for infants and preschool children,
routine for conducting child-health conferences.
Literature distributed, 4,036 pieces.
Infants born in the State during the year, 7,015; infants under 1 year of
age reached by the department’s work, 903; preschool children reached,
975; expectant mothers reached, 808.
Counties in the State, 14; counties having maternity and infancy work
during the year, 8 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 12.
The following organizations cooperated in the department’s work: State uni
versity, State federation of women’s clubs, State league of women voters,
and the parent-teacher association.
With only one nurse and one clerk on the staff the department’s activities
in the winter months necessarily consisted largely of educational work through
demonstrations, lectures, and distribution of literature, and those in the spring
and summer consisted of efforts to stimulate local organizations to initiate
their own child-health programs. In the communities in which child-health
conferences were conducted by local groups the nurse met the committees
beforehand to help in planning the work and she attended the conferences to
give assistance during the examinations.
SOME R E S U L T S OF TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State began cooperation under the Federal maternity and infancy act
in 1925. The first work done was a demonstration in a rural area. Later
a state-wide educational program was inaugurated. The result of the maternity
and infancy work during the period of cooperation has been the development
of greater interest in the welfare of mothers and infants.
VIRGINIA
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
State board of health, bureau of child welfare, Richmond.
Staff:
Director (physician), 1 physician, 2 nurses, 1 midwife supervisor (nurse),
1 director of correspondence course (nurse), 3 clerks, 4 stenographers.
Temporary assistants were employed as needed. Thirty-nine county
nurses and 10 city nurses were paid for some maternity and infancy
work.
Activities:
Combined prenatal and child-health conferences conducted by physicians,
124; expectant mothers registered, 105; number examined, 102; infants
and preschool children registered and examined, 291; visits to confer
ences, 1,007 (by expectant mothers, 304; by children, 703).
Child-health conferences conducted by physicians, 335; infants and pre
school children registered and examined, 4,454; visits to conferences,
5,468; defects found, 9,670; children having defects, 2,990.
These conferences were conducted by staff physicians and nurses, by county
health units, and by local physicians. Emphasis was placed on the
examination of children who would enter school for the first time in
the fall. School officials cooperated in many places by making surveys
of the preschool children, thus enabling the public-health workers to get
in touch with them more easily; superintendents of schools sent letters
to parents requesting that preschool children be examined and that all
needed immunizations and corrections of defects be made before the
children should enter school. In order to stimulate interest among par
ents in having children free from defects the bureau designated as “ five-
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Federal Reserve Bank of St. Louis
114
M A T E B N IT Y AND IN F A N C Y
Activities— Continued.
point” children all who had normal vision and hearing, good teeth, and
no symptoms of trouble with tonsils or adenoids and who were less than
10 per cent underweight. These children received blue ribbons at the
county school fairs, had their pictures taken for a special album kept by*
the State board of health, or were rewarded in other ways.
Conferences conducted by nurses, no physician present, 602; infants and
preschool children inspected, 2,517; expectant mothers instructed in
prenatal care, 191; visits to conferences, 5,499 (by children, 5,055; by
expectant mothers, 444).
Dental conferences conducted by dentists, in 19 counties (number of con
ferences not reported) ; preschool children receiving dental advice, 3,283.
More children failed to qualify as “ five-point children ” because of dental
defects than for any other reason, consequently the dental-conference
work was increased.
New permanent combined prenatal and child-health centers, 9 established.
They are supported by local organizations.
New permanent child-health centers, 16 established. They are supported
by local organizations.
Little mothers’ classes, 10 organized; girls enrolled, 235; number completing
course, 154; lessons in course, 10 to 32.
Mothers’ classes, 57 organized; mothers enrolled plus those carried over
from previous year, 836; number completing course, 275; lessons in course,
6 to 24.
Midwives’ classes, 83 organized; midwives enrolled, plus those carried
over from previous year, 1,162. Number completing course, 57; lessons
in course, 8.
Home visits by nurses, 88,849 (prenatal cases seen, 3,479; obstetrical
cases, 444; postnatal cases, 5,596; infants, 10,858; preschool children,
12,145).
Maternity homes inspected, 6 ; inspections made, 6.
Group demonstrations, 52; on clothing for the expectant mother and the
baby, bathing the baby, preparing food for young children, and other
phases of maternal and infant care.
i
Surveys, 2 : (1) Of maternity care in hospitals. (2) Of breast feeding (in
progress).
Campaigns, 5 : (1) For prevention of diphtheria. (2) For prevention of
typhoid fever. (3) For prevention of smallpox. (4) For improvement
in nutrition. (5) For examination of preschool children and correction
of their defects before they should enter school. This work was done
in 30 counties and 6 towns.
Talks and lectures, 126.
Literature distributed, 170,158 pieces.
Prenatal letters distributed, 2,438 sets.
Correspondence course: Mothers registered plus those carried over from
previous year, 1,902; number completing course, 428; number having two
or more lessons, 700; lessons in the course, 12.
Five-day institutes for training “ doctors’ helpers ” were held in various
parts of the State, other agencies cooperating with the bureau. Lectures
' and demonstrations were given for five hours every day on maternal
and infant care, personal hygiene, home nursing, and community health.
The courses were intended primarily for women who wished to' give
neighborly service when necessary, but those who took the entire course
were better qualified than the average midwife and could obtain permits
to practice midwifery.
The bureau cooperated in institutes for parents, held in four communities
under local auspices. Lectures on child health formed a part of the
program.
Nutrition work was done through classes and through individual instruction
to mothers.
Exhibits conducted, 3, of infants’ clothing, bed, and tray and of graphs
showing activities of the bureau.
Statistical study, 1, of infant mortality (in progress).
Breast feeding was emphasized in all work with mothers. Demonstrations
in expressing milk from the breast were given, and the importance of
breast feeding was pointed out constantly.
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P R IN C IP A L ACTIVITIES OF T H E IN D IVID U AL STATES
115
Activities— Continued.
Infants born in the State during the year, approximately 58,000; infants
and preschool children reached by the work of the bureau, approximately
65,000; expectant mothers reached, '*5,677. The bureau sends litera
ture on infant hygiene to parents of all infants whose births are reg
istered in the State bureau of vital statistics.
Counties in the State, 100; counties having maternity and infancy work
during the year, 56; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 07.
The outstanding achievement of the year was the increased interest of the
public in health matters, as evidenced by the greater number of parents who
are taking their children to family physicians, the more numerous requests for
information on prenatal and infant care, and the additional counties con
sidering the employment of public-health nurses.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E PE R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Virginia was admitted to the United States birth-registration area in 1917
and accepted the provisions of the maternity and infancy act in 1922.
The average infant mortality rate for the State as a whole during the period
1917 to 1921 (exclusive of 1918) was 87.4 deaths per 1,000 live births. During
the period of cooperation under the maternity and infancy act (1922-1926) the
average rate was 80.5; this was 7.9 per cent lower than during the earlier period.
The average rate for white infants was 8.1 per cent lower during the period of
cooperation; for colored infants it was 6.9 per cent lower. This reduction ap
pears in the rates for both urban and rural areas; the urban areas show a
greater decrease in the rates for colored infants, whereas in the rural areas
the decrease was greater for white infants, as is shown in the following table:
Infant mortality rate per 1,000 live
births
Area
1917-1921,
excluding
1918
State____________________ ___________1........._
W hite. __________
Colored_______ _____ _________
Urban______ ______ _________
W hite. ___________
Colored_____________________
Rural___________________ _____
W hite______ ___________
Colored__________________________
87.4
74. 2
116. 5
108.1
78. 2
169. 3
82.1
73. 2
102.0
1922-1926
80.5
68. 2
108. 5
97.0
72. 4
146. 8
76. 0
67.1
96.8
Percentage
of decrease
7.9
8.1
6.9
10. 3
7.4
13.3
7.4
8. 3
5.1
The value of the work in the different communities is indicated by comparing
certain counties that had intensive programs for a period of years with other
counties in which little or no maternity and infancy work has been done, as in
the accompanying graph. Changes in infant mortality rates in Halifax County
are compared with those of Pittsylvania County (excluding Danville and
Schoolfield). These are southern agricultural counties. In Halifax County
an intensive maternity and infancy program was carried on during the entire
period of cooperation, whereas Pittsylvania County had practically no activity
of the sort. The combined rates for Accomac and Northampton Counties are
compared with the combined rates for King George, King William, Lancaster,
Richmond, and Westmoreland Counties. These are eastern counties on or near
the bay; the principal industries are agriculture and fishing. A maternity and
infancy program was conducted in both Accomac and Northampton Counties
from 1923 to 1926, but there was no work in the other group of counties. In
Wythe and Roanoke Counties (excluding Roanoke City) a maternity and
infancy program was carried on from 1922 to 1926. The combined rates for
these two counties are compared with the -rate in Washington County, which
had no such program. These three counties are in the southwestern part of
the State; stock raising is the principal industry. Wise County, which had
maternity and infancy activities from 1922 to 1926, is compared with Scott
and Lee Counties, which had no> maternity and infancy work. These three
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Federal Reserve Bank of St. Louis
116
M A T E R N IT Y AN D IN F A N C Y
Percentage
Increase
Percentage
D ecrease
Southern, co u n tie s—A g ric u ltu re
VZ
Total
W hite
Colored
vzzzzzzzzzzazzzzzz172
VZZZZW ZZZL
Eastern counties—Fishing-agriculture
T o ta l
V/hîte
Colored
u zzzzz^
m
zzzzzza
TZZZZZ^MZZZL
UZZZZZZZZZ^MZZZZZZZZZZL
Southweste rn counties—StocKraising
v/ m w A
Western mountainous counties—Mining
vzzzzmzzm
M aternity and ......
No m aternity and ib8pmbbwwb
in fan cy WorK
in fan cy w orK
Based on fig ures supplied by State division of vital statistics
C O M P A R I S O N O F P E R C E N T A G E C H A N G E IN I N F A N T M O R T A L I T Y R A T E S ( D E A T H S
U N D E R 1 Y E A R P E R 1, 000 L I V E B I R T H S ) D U R I N G P E R I O D O F C O O P E R A T I O N
UND ER T H E M A T E R N I T Y AND INFANCY AC T AND SI MI LA R PE RI OD P R IO R T O
C O O P E R A T I O N ; C O U N T I E S IN V I R G I N I A H A V I N G M A T E R N I T Y A N D I N F A N C Y
W O R K AND C OU NT I E S H AV IN G LI TTLE O R NO M A T E R N I T Y AND INFANCY
WORK
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PR IN C IP A L ACTIVITIES OE T H E IN D IVID U AL STATES
industry &r6 ***
117
wes^ern Part of the State, and mining is their principal
In general, greater decreases in the rates have prevailed in the counties or
groups of counties where intensive maternity and infancy work was done
Decreases in average infant mortality rates in counties having maternity and
infancy work varied from 7.8 per cent to 16.5 per cent. In the groups having
™ i n t e n s e maternity and infancy program the changes varied from a decrease
of 9.9 per cent m one group of counties to an increase of 4.8 per cent in another
county. It is particularly noteworthy that in the southern agricultural counfnfLThern SI^ Cial f aternity and infancy work was done the rate for colored
*w ? ?howed ? decrease of 11.2 per cent, whereas in the near-by counties
activities ^ t h e ^ S ^ h ^ mfancy. work otlier than the general educational
activities of the State there was an increase of 5.4 per cent in the average rate
for colored infants. A decrease of 4.9 per cent prevailed in the S 5u n of
eastern counties where no intensive work was done; in a group of counties
dm-eas!f
9 matera/ ty and infancy program was Conducted the
ueciease amounted to 20.2 per cent. (See chart on p. 116.)
ih e average mortality rate among mothers from causes associated with
pregrmncy and childbirth for the period 1917 to 1921 (exclusive of 19181 was
n
l
t
v
“ “ V56110-1 of O r a t i o n u™dei tte m a te ?
For urban ffli f L S <1922“ 1926)
rate was 72.1; this was 9.9 per cent lower,
and 105 8 in^1929^ 00^ ^
rate ,WaS 9 6 .per cent lower (117
1917-1921
eom paJei wtth a S 'K
K
“ Was 10'9 ^
06111 low6r <70'5
£ ablic k?altk aarsing services have been assisted by maternity and
J e r v S «id
fPr6Seat the^ are 35 full-time county services, 10 city
maternity and ¿ton e“ v o r ™ " '
giTes one-iourth
»er time to
infaney'work
“ *
tti raichoutrethp ‘ stifA
ani , Infa? cy Prof?ram bas generally increased
e s ta b lfS
in i S ' Th
u evid?nced by the increase in health centers
established and the larger number of home visits by nurses.
™o t ! ! J ! UatT
regard to midwives has improved since the beginning of the
in l926lfcontvd1
on Altbough 4>328 midwives had permits to practice
*n 4923, 0nly 125 attended 20 or more cases, and 876 attended 10 to 20 cases •
o’™55*aifPOrKed n° cases- ,As tbe older midwives cease practicing, their places
L te d that 15 rifthP Ja.t(?lh.gent women At the close of the year 1927 it was
noted that 15 of the midwives were graduate nurses, 22 had taken the “ doctor’s
helpers” course given by the bureau, and 35 were taking S e b S n W
fn ?hpn«q C?n.rse f0r mot.he5 f ’ nearly 1,200 midwives had one or more lessons
in the 83 classes organized for their instruction. In Halifax County the
cbdd welfare and the American Child Health Association cooperated
m a midwife demonstration, but unfortunately no figures are available to
express the results of this work in terms of maternal or neonatal death rates.
W A S H IN G T O N
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
8tate department of health, division o f child hygiene, Seattle,
fetarr i
Director (nurse), 1 clerk (part time), 1 accountant (part time), and 1
stenographer. Pediatricians were employed by the day to conduct childheaith conferences. Three county nurses were paid for some maternity
and infancy work.
assistants: Local physicians and dentists frequently assisted at
child-health conferences.
Activities:
Child-health conferences conducted by pediatricians, usually assisted by
local physicians, 69; infants and preschool children registered and exammed, 3,992. Local dentists assisted at more than half of the conferences
Defects found, 5,368; children having defects, 1,891. It was estimated
that parents had more than 50 per cent of the defects corrected.
Mother and baby health schools consisting of six lectures were conducted
twice in one city, and a series of eight weekly lectures was given in
another.
43
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118
MATERNITY AND INFANCY
Activities— Continued.
Home visits by nurses, many (number not recorded).
Group demonstrations, many, in connection with the child-health confer
ences and lectures, on layettes, preparation of food, making up of formu
las, and other phases of maternal and infant care.
Talks and lectures, 82.
Literature distributed, 18,000 pieces.
Correspondence course: Mothers registered plus those carried over from
previous year, 146; lessons in course, 15. Papers were corrected and
returned to those taking the course. This work was done in coopera
tion with the State university.
Exhibits conducted, 7, on diphtheria prevention. Exhibit material was
lent eight times.
A weekly news-letter on some health subject was syndicated to 200 rural
newspapers.
Breast feeding was emphasized at the child-health conferences and in
lectures.
Infants born in the State during the year, 23,909; infants under 2 years of
age reached through conferences, 1,777; preschool children reached
through conferences, 2,215. The number of children reached through
other activities was not reported.
Counties in the State, 39; counties having maternity and infancy work
during the year, 21; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 30.
The following organizations cooperated in the division’s work: State
university, State agricultural college, State medical association. State
federation of women’s clubs, and the parent-teacher association.
An outstanding achievement in the year’s work was the securing of legisla
tive appropriation for a public health nursing division. This assures the estabIsliment of a permanent public health nursing division in the State department
of health.
SOM E R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D OF C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
The State program for maternity and infancy work has been mainly one
of education through the work of public-health nurses, distribution of literature,
a correspondence course for mothers, and itinerant child-health conferences.
The conferences, at which leading pediatricians of the State have made the
examinations, have had an educational value not only for the parents of the
children but also for the general practitioners of
State.
the
Three counties have assumed the financial responsibility for maternity and
infancy Work begun with maternity and infancy funds, and a fourth county
was expected to assume such responsibility a t the close o f the year under
review.
Since 1923, when the State began cooperation under the maternity and
infancy act, the average maternal mortality rates, both urban and rural,
have been lower than the average rates for a similar period prior to coopera
tion, as the following table shows:
Average maternal mortality rate
per 10,000 live births
Area
Rural__________________________ ---------- ------------------------------------
1919-1922
1923-1926
83.7
92.7
74.0
78.6
57.0
68.1
Percentage
of decrease
18.6
15.2
23.6
Comparison of the average infant mortality rates for the same periods shows
a difference of 8.4 per cent, the rate for the State as a whole being 61.6 during
the period 1919 to 1922 and 56.4 during the period 1923 to 1926. The average
rate for urban areas was 12.5 per cent lower and that for rural areas 4.2 per
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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
119
cent lower during the period of cooperation than during the preceding period.
The infant mortality rates for the'State as- a whole have been practically sta
tionary since 1923 (varying from 56.5 to 56.2), but a decrease was shown in
1924 and 1926 in the rural rates, which were as follows: 62.2 for 1923, 60.8 for
1924, 63.7 for 1925, and 58.7 for 1926.
W E S T V IR G IN IA
S T A F F A N D A C T IV IT IE S D U R IN G 1927
Administrative agency :
State department of health, division of child hygiene and public-health
nursing, Charleston.
Staff:
Director (nurse, part time), 1 nurse, 1 midwife supervisor (nurse), 1 vitalstatistics clerk, 1 vital-statistics field worker, 2 stenographers. Twenty
county nurses and one city nurse were paid for some maternity and in
fancy work.
A ctivities :
Child-health conferences, 614, conducted by county health officers and
physicians who volunteered their services; infants and preschool children
registered and examined, 828; examinations made, 5,127; visits to con
ferences, 8,634; defects found, 4,242.
Prenatal conferences conducted by physicians, 44; expectant mothers regis
tered and examined, 37; examinations made, 68; visits to conferences, 71.
Conferences conducted by nurses, no physician present, 238; mothers in
structed in prenatal care, 195; infants and preschool children inspected,
407; visits to conferences, 1,124 (by mothers, 195; by children, 929).
Dental conferences, 20, conducted by dentists who volunteered their serv
ices; expectant mothers receiving dental advice, 99; preschool children
receiving dental advice, 373.
New permanent child-health centers, 17 established. They are supported by
State, county, and community funds.
Little mothers’ classes, 82; girls enrolled, 1,292; number completing course,
693; lessons in course, average of 12.
Mothers’ classes, 42; mothers enrolled plus those carried over from previous
year, 1,233; number completing course, 83; lessons in course, 12 (some
classes are continuous).
Home visits by nurses, 12,733 (to prenatal cases, 1,653; obstetrical cases,
158; postnatal cases, 2,095; infants and preschool children, 8,827).
Group demonstrations, 546, on various phases of maternal, infant, and pre
school-child care; 8 were before large groups of farm -women from all
parts of the State.
Surveys, 16: (1 to 15) Of health conditions, in 15 communities. Local
groups conducted these surveys under the direction of staff nurses or
county nurses, and the data obtained formed the basis for considerable
effective program planning. (16) Of midwives, in 28 counties.
Campaigns, 4 : (1) For state-wide examination of preschool children and
correction of their defects before they should enter school. (2) For a
clean milk supply, practically state-wide. (3) For safe milk and water
supply and better sanitation, important in reducing infant mortality, in
15 communities.
(4) For immunization against diphtheria, typhoid
fever, and smallpox, in 13 counties.
Talks and lectures, 571.
Literature prepared: Special Care of the Preschool Child during Winter
Months, May Day celebration program booklet, lesson outline on the
hygiene of maternity and the preschool child, diet card (revised). The
division also prepared for the department of education a course of study
in hygiene for use in the elementary schools; this included the teaching
of the care of infants and preschool children.
Literature distributed, 96,266 pieces.
New names registered for prenatal letters, 1,769; prenatal letters dis
tributed, 1,422 sets.
Correspondence course: Mothers registered plus those carried over from
previous year, 8,182; number completing course, 976.
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MATERNITY AND INFANCY
Activities— Continued.
Exhibits conducted, 29, including equipment for nursery, clothing for in
fants and expectant mothers, charts, posters, and pictures illustrating
various phases of the division’s work.
Statistical studies, 3 : Of mothers registered in correspondence course, by
counties; of maternal mortality, by causes, for 1926; of infant mortality»by age and cause, and by counties, for 1926.
Nutrition work was done through lectures to mothers’ classes and other
groups and through instruction to individual mothers. One county nurse
conducted a nutrition class in a mining region where such instruction
seemed especially needed.
Breast feeding was promoted through instruction to mothers at home visits,
in group meetings, and in the correspondence course, also through wide
distribution of literature on the subject..
The vital-statistics field worker interviewed registrars, physicians, mid
wives, undertakers, and county clerks in an effort to accomplish more
accurate reporting of births and deaths.
Infants born in the State during the year, approximately 44,000; infants
and preschool children reached by the work of the division, 27,128.
Counties in the State, 55; counties having maternity and infancy work
during the year, 47; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 50.
As a result of the division’s work local public-health nurses not paid from
maternity and infancy funds included in their work many activities
affecting maternal and infant hygiene. Among these were the following:
Child-health conferences, 290; health-study classes 1,367 (for adults, 240;
for high-school girls, 11; for elementary-school girls, 1,116); mothers’
conferences, 11; group demonstrations, 258; home visits, 17,014; immuni
zation campaigns; exhibits; and distribution of literature at county fairs
and in the course of surveys of community health.
The division gave advisory service to many local organizations.
The following organizations cooperated in the division’s work: State de
partment of education, State university (extension division, including
all farm women’s clubs), State tuberculosis association, State publichealth association, State league of women voters, State federation
women’s clubs, American Red Cross, and the parent-teacher association.
The outstanding achievement of the year was the general increase in amount
of maternity and infancy work done in the State.
SOME R E S U L T S O F TH E W O R K D U R IN G TH E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Early in the period of cooperation under the maternity and infancy act the
State department of health, assisted by the division of child-hygiene and publichealth nursing, inaugurated a campaign for more complete registration of
births. The State passed the test of the United States Bureau of the Census
and was admitted to the registration area in 1925, thus completing the first step
in a maternity and infancy program— that of knowing how many infants are
bom and die in the State.
Maternity and infancy work has been promoted by the services of county
nurses to whose salary a contribution is made from maternity and infancy
funds in return for some maternity and infancy work on their part. These
services have increased. Although no counties have assumed entire financial
responsibility for maternity and infancy work begun with maternity and infancy
funds the division is gradually decreasing the amount contributed to counties in
which the work was first organized and is beginning work in other counties.
The amount of maternity and infancy work accomplished has increased from
year to year during the period of the State’s cooperation under the act More
home visits by nurses, especially to newborn infants, are reported; a greater
number of women are enrolled for the correspondence course for mothers:
interest in the care and welfare of mothers and infants has grown; a larger
number of expectant mothers employ physicians than formerly had the advan
tage of medical supervision and care; and in still other ways there has been
development of the maternity and infancy work.
The situation in regard to midwives has improved since the beginning of the
State’s cooperation under the maternity and infancy act, and fewer unfit mid
wives are practicing.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
121
WISCONSIN
S T A F F A N D A C T IV IT IE S IN 1927
agency:
State board of health, bureau of child welfare and public-health nursing,
# dministrative
Madison.
Staff:
Director (physician), 4 physicians (1 for 1 month), 5 nurses (2 part year,
t v
part time), 1 organizer of infant-hygiene classes, 1 assistant organizer of
infant-hygiene classes, 3 vital-statistics clerks (part year), 1 bookkeeper
and filing clerk, 1 silver-nitrate clerk (part year), 1 general clerk (part
year), 1 publicity editor (2 months, part time), 2 stenographers, 3
chauffeur (part year).
Volunteer assistants, 25 physicians (approximately), 343 nurses, 147 lay
persons,
activities:
Combined prenatal and child-health conferences conducted by physicians,
457; expectant mothers registered and examined, 293; examinations
made, 317; infants and preschool children registered and examined,
8,631; examinations made, 12,180; visits to conferences, 12,497 (by
expectant mothers, 317; by children, 12,180) ; all mothers and children
were examined at each visit. Defects found in children, 14,820; children
having defects, 6,951. Parents had defects corrected in approximately
25 per cent of the children. By means of the child-welfare special a
number of conferences were held in counties that had been visited in
previous years. The child-welfare special (a motor truck equipped for
conducting prenatal and child-health conferences) carries a staff of
physicians, a nurse, and a chauffeur. Its work, begun in the rural
districts of the State in 1921, was continued through the use of maternity
and infancy funds after the State accepted the benefits of the maternity
and infancy act. By 1926 all the 71 counties in the State had been
visited, the plan being to spend at least two weeks in each county. About
75 per cent of the children examined the second time had improved
through better habits of diet and personal hygiene and the correction of
defects to which attention had been called.
New permanent combined prenatal and child-health centers, 14 established.
They are supported by Federal and State funds.
The organizer and assistant organizer of infant-hygiene classes devoted
their time to work related to the training of teachers to conduct classes in
infant hygiene in the schools of the State. Through the cooperation of
the State department of public instruction, the State board of vocational
education, and the State board of normal regents the course had been
introduced in the public-school curriculum in the fall of 1923. In schools
in which the full course is given as recommended by the bureau an
examination is held at the completion of the required number of hours
of study, and pupils receiving a grade of 75 or higher are entitled to
certificates from the State board of health. During the year under review
certificates were issued to 4,988 girls; this does not include all the girls
who took the course, as the names of those completing the course in the
large trade schools and the State normal schools were not sent in for
certificates. (The course of study for the classes and a handbook of
suggestions and helps for teachers were prepared by the bureau in 1925.)
Home visits by nurses, 1,811 (prenatal cases seen, 66; postnatal cases, 40;
infants, 787; preschool children, 2,082).
Survey, 1, of the prevalence of goiter among children.
Talks and lectures, 503, including 335 by the organizer and assistant
organizer of infant-hygiene classes to a total of 20,620 persons.
Literature prepared: Infant Hygiene Manual (revised), pamphlets on
tonsils and adenoids, report on five years’ work by the child-welfare
special.
Literature distributed, 269,973 pieces.
i
New names registered for prenatal letters, 2,311; prenatal letters
distributed, 2,881 sets.
Nutrition work was done through a nutrition institute in which the bureau
cooperated.
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122
MATERNITY AND INFANCY
Activities— Continued.
Exhibit conducted, 1, at the State fair. Exhibit material was lent 243
times.
Statistical »study, infant death rates in counties having maternity and
infancy work and those having none (completed after the close of the"^,
year under review).
h
Breast feeding was promoted through literature sent out with birth -!&
registration cards and sent also to physicians, nurses, maternity centers,
and maternity hospitals.
Infants born in the State during the calendar year 1926, 56,621; infar y
under 1 year of age reached by the work of the bureau during the y<
under review, 58,899 ; preschool children reached, 2,412 ; expectant moth
reached, 3,030. The bureau sends literature on infant hygiene to parents'
of all infants whose births are registered in the State bureau of vit
statistics.
Counties in the State, 71; counties having maternity and infancy \ « :
during the year, 69; counties having maternity and infancy work ^ fi
the acceptance of the maternity and infancy act, 71.
As a result of the work of the bureau many new health centers have oeen
established, and there has been an increased interest in the immunization
of preschool children against diphtheria and in the teaching of infanthygiene classes in rural schools.
The following organizations cooperated in the bureau’s work: State league
of women voters, State federation of women’s clubs, American Legion,
American Red Cross, Women’s Christian Temperance Union, and fraternal
organizations.
Among the outstanding features of the year’s work were the increased interest
in establishment of permanent health centers and the sending of literature on
infant hygiene to the parents of all infants whose births were registered in the
State bureau of vital statistics.
SOME R E S U L T S O F TH E W O R K D U R IN G T H E P E R IO D O F C O O P E R A T IO N U N D E R
TH E M A T E R N IT Y A N D IN F A N C Y A C T
Wisconsin was admitted to the United States birth-registration area in 19T<
and accepted the provisions of the maternity and infancy act in December, 1921.
Three features are outstanding in the State’s maternity and infancy program:
The operation of a truck called the “ child-welfare special” in the rural
districts for the purpose of conducting itinerant conferences; the establishment
of permanent centers through the use of State and local funds; and the
promotion of knowledge of the care of the baby through classes in infant care
for girls in grammar grades and high schools.
In 1921, prior to the State’s cooperation under the maternity and infancy
act, the infant mortality rate for the State was 72.1; in 1926 the rate was 69.1.
Eor urban areas the rate was 79 in 1921 and 74.2 in 1926; for rural areas it
declined from 67.9 in 1921 to 65 in 1926. Comparison of the average rate for
the period 1917 to 1921 (exclusive of 1918) with the rate for the period of
cooperation under the act (1922-1926) shows that the State rate w«s 10.6
per cent lower during the period of cooperation, the urban rate was 1 7.1 per
cent lower, and the rural rate was 6.4 per cent lower.
One of the most important features of the program has been the operation
of permanent child-health centers, to which children are brought at regular
intervals for examination. Centers have been in operation since 1923 in
certain counties in the central and southern parts of the State. The mortality
among infants of these counties has been compared with that of groups of
counties which had no permanent centers, having only the general educational
work done by the bureau. The counties contrasted are similar in composition
of population, in size, and in general in their industries. The figures on which
the rates are based were supplied by the State and are for counties exclusive
of cities of 10,000 population and over.
As a rule babies are not brought to the child-health centers during the first
few days or weeks of life; and as a high percentage of infant deaths occurs
during this period the deaths from the second to the twelfth month are used w
to demonstrate the results of care and advice given for children reached througbfT'
the centers. In a group of four counties in the central part of the State the V
average death rate from the second to the twelfth month for the four-year
period 1919 to 1922 was 26.9 per 1,000 babies surviving the first month of life:
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PFNCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
123
in the per* d during which the centers were in operation (1923-1926) the rate
was 25, r .eduction of 7.1 per cent. In a comparable group of counties having
no cer' ».s the reduction during the same period was only 2.6 per cent. In a
so.’:
i group of two counties having permanent centers the reduction in the
I n f a n t s I m o n th
a n d u n d e r 12
m on th s of age
in 3 c o u n t i e s
Infants u n d e r
\Zm o n t h s o f age
r e g i s t e r e d at
health , c e n t e r s
C O M P A R I S O N O F M O R T A L I T Y R A T E S F O R I N F A N T S IN T H E F I R S T
Y E A R O F LI FE R E G I S T E R E D A T H E A L T H C E N T E R S , W I T H R A T E S
F O R A L L I N F A N T S 1 M O N T H . A N D U N D E R 12 M O N T H S O F A G E . I N
T H R E E C O U N T I E S IN W I S C O N S I N , 1 92 5- 1 92 6
surviving the first month was 28.9 per cent, whereas in a similar group of
counties having no centers the reduction was 9.8 per cent.
Deaths from gastrointestinal diseases, which are closely related to feeding
care, show greater reductions in the counties having permanent centers than in
892°— 28----- 9
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124
MATERNITY AND INFANCY
the counties not having such centers. In the central group of counties the
average death rate from gastrointestinal diseases from the second to the twelfth
month was 32.1 per cent lower during the period 1923 to 1926 than during the
preceding four-year period (1919-1922). In the comparable group of counties
having no centers the average rate was 11.6 per cent lower. In the southern A
group of counties the rate was 51 per cent lower during the period 1923 to ^
1926 than in the previous four-year period, whereas in the counties having no
centers it was 34.2 per cent higher.
Comparison of the six counties having permanent centers with the State as a
whole for the two four-year periods shows that the percentage of decrease in
the death rate from diarrhea and enteritis in the second to the twelfth month
per 1 000 infants surviving the first month of life was 31.7 in the six counties
combined and 27.6 in the State. The rates in the counties varied from 8.9 per
1,000 survivors in 1921 to 2.8 in 1926. In the State as a whole the rates varied
from 9.8 in 1921 to 5.5 in 1926.
The markedly lower rate for infants attending centers shows the value of
supervision during the first year of life and the importance of providing
facilities for child care. The death rate in the second to the twelfth month
of life was 23 for all infants in the three counties during the years 1925 and
1926, whereas the rate for the infants who were under supervision at the childhealth centers in these counties was 6.2. ( See chart on p. 123.)
Since the beginning of the State’s cooperation under the maternity and
infancy act 20 counties have assumed the financial responsibility for maternity
and infancy work begun with maternity and infancy funds.
WYOMING
S T A F F A N D A C T IV IT IE S IN 1927
Administrative agency:
, ,il * /" ' i i
£«
State board of health, division of maternal and infant welfare, Cheyenne.
Staff:
~
.
Director (State health officer serving), 1 physician (part year), 1 vitalstatistics clerk. Six county nurses were paid for some maternity and!
infancy work in 10 counties.
Volunteer assistants, 32 physicians, 32 dentists, 39 nurses, 133 lay persons.
Activities:
^
Child-health conferences conducted by physicians, 37; infants and pre
school children registered, 782; number examined, 637; visits to confer
ences, 782; defects found, 255. A 3-day conference was held at the
State fair, the physicians having the assistance of a dentist, who made
oral examinations and recommendations; local nurses also assisted the
staff nurses on duty.
Conferences conducted by nurses, no physician present, 59; mothers in
structed in prenatal care, 450. Local dentists gave their services at a
number of these conferences.
Home visits by nurses, 3,360 (to prenatal cases, 570; postnatal cases, 86;
infants, 1,006; preschool children, 1,010; miscellaneous, 688).
Group demonstrations, 38, on the care of the baby, clothing for the baby
and the expectant mother, and other phases of maternal and infant
care.
Surveys, 2 : (1) Of a hospital on an Indian reservation (by request).
(2) Of birth registration, in part of 1 county.
Talks and lectures by staff, 93. The subjects stressed in many of these
talks were breast feeding, immunization against diphtheria, importance
of physical examination of the preschool child, the danger to the child
of communicable diseases, and the importance of sunlight for babies.
Literature distributed, 6,750 pieces.
Exhibits conducted, 4, at the State fair and group conferences, of model
layettes, maternity clothing, and equipment for care of the baby._
Breast feeding Was emphasized in all talks to mothers and in literature
distributed.
Infants born in the State during the year, 3,620; infants under 1 year of v
age reached by the Work of the division, approximately 4,000; preschool^
children reached, approximately 2,000; expectant mothers reached, 1,020.
The division sent literature on infant hygiene to parents of all infants
whose births were registered in the State bureau of vital statistics.
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PRINCIPAL ACTIVITIES OP THE INDIVIDUAL STATES
125
Activities— Continued.
Counties in the State, 23; counties having maternity and infancy work
during the year, 9 ; counties having maternity and infancy work since
the acceptance of the maternity and infancy act, 23.
s a result of the division’s work, a women’s club in one community organ
ized child-health conferences which were conducted by local physicians
ana nurses. In another community a women’s club raised sufficient funds
to employ a nurse under local auspices when the county nurse whom the
division had paid for maternity and infancy work resigned.
the outstanding features of the year’s work were the emphasis laid
importance of physical examination of the preschool child and the
obtaining of more complete birth registration.
SOME RESULTS OF »
W
«
«
™
O ^ COOPERATION UNDER
A changing personnel has interrupted the State work from time to time but
work show results- The full-time county health
assisted by a nurse detailed to it for mater
nity and infancy work. In 1922 the infant mortality rate for Casper in
ilai i° q a
T S 94; 8,.?er 1’000 live births- ln 1926 the rate had declined
v an i’nf
mi°r^al*ty rate for tbe State declined from 78.6 in 1922 (the
S admlss!on to the United States birth-registration area and
C00peratl0n under the maternity and infancy act was begun)
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FEDERAL ADMINISTRATION
FEDERAL STAFF
O R G A N IZA T IO N
The maternity and infant-hygiene division of the United States
Children’s Bureau is one of the six major divisions of the bureau. It
was created in 1922 to assist in the administration of the maternity
and infancy act. The Children’s' Bureau has depended for the
administration of the maternity and infancy act upon reports from
the States, staff visits to the States, and the annual conference of
State directors. A ll three sources have improved from year to year.
Information on the maternity and infancy work in the States is
obtained through the annual reports from the States made to the
Children’s Bureau, through special reports on the work of the county
nurses employed under the maternity and infancy act, and through
copies of monthly or other reports which directors of child-hygiene
bureaus or divisions make to the respective State health officers.
The Federal staff and the expenses of Federal administration have
been kept at a minimum. Only eight persons— three physicians, a
public-health nurse, an auditor, and three clerical workers— werej
regularly employed in the maternity and infant-hygiene division
during the entire year. The physicians on the staff included (1) the
director, who was the executive officer of the division and also acted
as consultant with the State directors in the field ; (2) an associate
physician whose duties included research, answering of special cor
respondence, and preparation of literature and a news-letter; and
(3) a negro physician who gave instruction to negro midwives in
regard to midwifery procedure and the reporting of births. Two
part-time consultants in child hygiene and a part-time consultant in
obstetrics were also on the staff. The consulting public-health nurse
has been continually in the field advising and assisting in State pro
grams and helping in birth-registration campaigns. The auditor has
audited accounts of cooperating State agencies. The regular office
staff consisted of a clerk, a stenographer-clerk, and a stenographer.
From time to time additional persons are employed as needs arise.
The medical staff, for example, was increased with the inauguration
of the maternal-mortality investigation. (See p. 130.)
S P E C IA L C O N SU L T A N T SE R V IC E
State agencies administering the maternity and infancy act fre
quently request special consulting service from the members of the
Federal staff. One of the consultants in child hygiene rendered
such services for short periods in Colorado, Delaware, and Utah,
and special service was given by a physician for a short period in
Oregon, Montana, and South Carolina. The director of the mater126
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FEDERAL ADMINISTRATION
127
nity and infant-hygiene division spent a few days in an advisory or
consulting capacity in Iowa, Maryland, Michigan, Minnesota, New
Hampshire, New York, North Carolina, North Dakota, Ohio, South
Dakota, Tennessee, Vermont, Virginia, W est Virginia, and Wiscon
sin. The part-time consultant in obstetrics conducted a graduate
course in obstetrics in Kentucky and assisted in negro health week
at Tuskegee, Ala. A physician was detailed for part of the year to
a field study in Kentucky and Virginia. The staff public-health
nurse gave consulting services on public health nursing problems in
the New England States, assisted with the Children’s Bureau ex
hibit at the Sesquicentennial Exposition in Philadelphia, and gave
advisory or consulting service in Arizona, Colorado, Idaho, Michi
gan, Missouri, Nebraska, New Mexico, New York, North Carolina,
Ohio, Vermont, Washington, W est Virginia, and Wyoming. A n
other staff nurse was assigned to special field service for a few weeks
in Nebraska, then in Louisiana, and started late in the year in South
Dakota a series of mothers’ classes.
C O N F E R E N C E O F S T A T E D IR EC TO R S
The fourth annual conference of directors of State bureaus admin
istering the Federal maternity and infancy act was held at the
Children’s Bureau in Washington, January 11, 12, and 13, 1927. It
was attended by representatives from 37 of the cooperating States
and the Territory of Hawaii and from three noncooperating States.
State supervising nurses were invited to the conference, and many
came. A total of 63 representatives from 40 States and the Terri
tory of Hawaii were in attendance.
State health officers were
present from Mississippi, Ohio, South Carolina, W est Virginia, and
Wyoming.
The subjects discussed at the conference were: Developing a per
manent rural program in prenatal and natal care; Making maternity
and infancy work permanent; Breast-feeding demonstrations; Cost
of maternity and infancy work; Evaluating maternity and infancy
work in county units; and Maternity and infancy nursing problems.
Proininent obstetricians, leaders in public health, health officers, and
nurses appeared on the program and led in the discussions of papers.
The papers read have been printed in various journals and form
part of the conference proceedings which have been published by the
Children’s Bureau. A limited number of copies are available for
distribution, as are reprints of several o f the papers read. (See
pp. 132,148.)
Through the courtesy o f Dr. J. H . Mason Knox, jr., State director
for Maryland, and the medical school of Johns Hopkins University
the members of the conference spent a day in observation of ma
ternity and infancy activities in Baltimore, Md., on January 14,
1927, the day following the conference. The arrangements included
a visit to the bureau o f child hygiene in the State department of
health, attendance at pediatric clinics and at the lectures at Harriet
Lane Home and Johns Hopkins Hospital by Dr. Paul G. Shipley
and Dr. W ilburt C. Davison; a lecture on prenatal care by Dr. J.
Whitridge Williams of Johns Hopkins Medical School, and a visit
to the nutrition laboratories in the university’s school of hygiene,
with demonstrations by Dr. E. V . McCollom and Dr. Nina Simmonds.
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128
MATERNITY AND INFANCY
The courtesy of the State director for Maryland in making the ar
rangements and extending hospitality to the members of the con
ference was thoroughly appreciated by the conference.
B IR T H R E G IS T R A T IO N
To aid promotion of birth registration in States which had regis
tration campaigns within the year the Children’s Bureau cooperated
with the National Committee to A id Completion of the Registration
Areas before 1930. The director of the maternity and infant-hygiene
division served as a member o f this committee, and at the request
of the United States Bureau of the Census and the State departments
of health members of the Children’s Bureau staff were detailed for
varying periods to 'several of the States. One staff physician assisted
in field work in South Carolina, another assisted in promoting the
registration of births attended by negro midwives in the State of
Georgia. A field nurse was detailed to Louisiana to assist in the
birth-registration campaign. A field agent of the statistical division
o f the Children’s Bureau staff was lent to Louisiana for field work
and also assisted in promoting better registration in Mississippi. The
consulting public-health nurse gave assistance in Colorado in organi
zation for that State’s registration campaign. Assistance to Arkansas
begun in the previous fiscal year through the matching of State and
Federal funds for birth-registration work was continued.
A ll members of the field staff of the maternity and infant-hygiene
division of the bureau reported on the status of birth registration in
the States they visited that were not in the area and assisted with
plans and suggestions for future campaigns.
SP E C IA L A S S IS T A N C E TO S T A T E S
From time to time States have requested assistance from the Chil
dren’s Bureau for special pieces of work within the States. Such serv
ice has been rendered when possible by detailing members of the ma
ternity and infant-hygiene division staff to assist for given periods
in definite pieces of work. A statistician from the Children’s Bureau
also gave assistance in analysis of maternal and infant mortality data
in Delaware, Indiana, Maryland, Michigan, New Hampshire, New
Jersey, New York, Ohio, Pennsylvania, Rhode Island, and W is
consin.33
A Children’s Bureau staff physician was detailed to the State of
Oregon during the latter part of the fiscal year 1926 and early part
of the fiscal year1 192T to assist in examining infants and preschool
children at conferences. She spent five weeks in the State, con
ducted 23 conferences, and examined 726 infants and preschool
children.
During a few weeks in 1927 a staff nurse assisted in organizing and
conducting child-health conferences in Nebraska, continuing this
work from the previous fiscal year. Local physicians examined the
children, and local organizations of lay persons sponsored the con
ferences. The numbeT of conferences held in the months immedi
ately preceding the close of the fiscal year previous to the year under'
review was 54, in 34 counties. Late in the summer the staff nurse
38 Assistance on such analyses for use in reporting the work of the fiscal year 1927 was
given shortly after June 30, 1927, in Kentucky, North Carolina, and Virginia.
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129
EEDEBAL AEMDsTISTEATIOiT
assisted in working out plans for continuing the conferences for
preschool children through the services o f the State itinerant nurses,
local physicians, and organizations of women, and also in organizing
/ - classes in maternal and infant hygiene, these classes to be carried
1 on by the State workers. This type of work has met with apprecia
tive response from the physicians of the State as well as from the
general public.
The city health department of Charleston, S. C., requested assist
ance with prenatal conferences. A staff physician gave some days to
stimulating interest in the prenatal conferences in the department.
Kentucky requested the services of the consultant in obstetrics for
a series of lectures on prenatal and obstetrical care before county
medical societies. The consultant spent approximately six weeks in
the State. When possible, two lectures were given before each medi
cal group— one lecture on prenatal care and one on operative or
other obstetrical procedures. Fourteen lectures were given before
county medical societies; two were given before district medical
societies each o f which included 11 counties; and one was given
before an obstetrical society. A t these 17 lectures there was an
attendance o f more than 200 physicians. Two lectures were given
to midwives with an attendance of 28 midwives. The consultant
was invited to outline the plan o f work before the State medical
association, which passed a formal vote of approval. The lecturer
had equipment to demonstrate some phases o f delivery, and a bony
pelvis and fetal doll were used in the demonstrations. The addresses
covered different phases of obstetrics. A t one meeting eclampsia
t was discussed; obstetrical deliveries was the subject o f another lec. X ture; and the use o f pituitary extract was considered. The value
of the lectures was enhanced by the excellent discussions that fol
lowed. In one meeting of physicians the establishment of a county
hospital to assist in caring for maternity cases was suggested.
The consultant gave a talk on phases of maternal care to an institute
for public-health nurses, addressed a group of negro physicians in
Tuskegee, Ala., gave a talk befoie the students o f one college, and
conferred with individual physicians and State officials.
During the year under review the Federal staff’s work with mid
wives was limited to the State of Georgia. A t the request o f the
State the negro woman physician on the staff was detailed to in
struct Georgia negro midwives and to promote their registration of
borths. Her work covered six counties; 510 midwives were located;
298 received certicates following her courses of instruction, and
Wassermann tests were made for nearly all of them. Following is
a summary o f the work done in each county:
Counties in Georgia
T otal______________________________
Troupe_______________ __________ ____ _
■Coweta_____ _______ __________ ____ _____
C obb .................................................................
Ware__________________________________
Lowndes______ __________________________
G lynn___________ ____ __________________
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M idwives Wasser
M idwives receiving
mann
located
certifi
tests
cates
made
Positive Average
reactions number
obtained of lessons
in course
510
298
293
28
139
89
78
52
88
56
88
47
31
32
60
40
79
51
28
33
63
39
6
5
2
3
6
6
Sections
having
classes
29
12
7
6
8
6
7
6
5
5
3
5
5
130
MATERNITY AND INFANCY
Following the course a strong midwives’ club was organized in
each county, and the county health officer or county nurse assisted
in maintaining the standards of midwifery the midwives had been
taught in the courses given. Those who can not read nor write are
given help in filling in birth certificates by the officers of the club
or the county health department staff.
F IE L D S U R V E Y S A N D S T U D IE S
M A T E R N IT Y -H O M E S U R V E Y
The division of child welfare in the Montana State Board of
Health requested assistance in a survey of maternity homes in the
State. A staff physician spent two weeks in Montana, making a
survey and investigating small maternity homes, of which she visited
18. The majority were private homes with no equipment for mater
nity work.
M A T E R N A L -M O R T A L IT Y S T U D Y A N D S U R V E Y
A t the conference of directors of State bureaus or divisions o f
child hygiene held in Washington in January, 1926, Dr. Robert L.
De Normandie, chairman of the consulting obstetrical committee for
the United States Children’s Bureau, presented a plan for state
wide studies of maternal mortality. A s a result of the discussion
the Children’s Bureau requested the consulting obstetrical committee
to formulate schedules, instructions, and a plan of work.
The committee recommended that the study be made in States in
which the State medical society would undertake to sponsor it and
the State health department requested it, and schedules were pre
pared for collecting data on current maternal deaths. The plan
adopted thus omitted mothers who do not die but who suffer un
necessary invalidism. Facts were to be taken from birth and death
certificates filed in the State bureau o f vital statistics, and further
information was to be obtained from the physician or midwife at
tending the woman who died, the interviewer to be a competent and
tactful physician. The information was to be collected on the
schedules soon after the death of the mother, while the details were
still fresh in the memory of the physician or midwife who had at
tended the case. The study was to be carried on for a period of two
or three years at least.
During the year under review the State medical society of Ken
tucky requested that the study be made in that State, and the State
medical societies of Virginia and Maryland indorsed the study. The
public-health departments of these States asked the Children’s
Bureau to detail interviewers to them. Special personnel was
secured, and a physician began work in Kentucky in February, 1927.
In June work was started in Virginia, and a medical interviewer
was secured to begin work in Maryland at the close of the fiscal year
under review.34
M S in ce J u n e 30, 1927, th is stu d y h a s been exten d ed to A la b a m a , M a ry lan d , M ich igan,
M in n esota , N ebraska, N ew H a m p sh ire, R h od e Isla n d , O regon, W a sh in g to n , an d W isco n sin .
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131
FEDERAL ADMINISTRATION
R E S E A R C H A N D P U B L IC A T IO N S
references
on
the
p h y s ic a l
grow th
an d
developm ent
of
the
norm al
CH ILD
A n annotated bibliography entitled “ References on the Physical
Growth and Development of the Normal Child ” was in press at the
end of the year under review and was issued in October, 1927.
Approximately 10,000 books and articles were examined with care,
and the contents of about 2,500 giving the results of original re
search (up to July 1, 1926) were abstracted so that investigators
can ascertain from the bibliography what material in the work of
their predecessors will be of assistance to them. The following sub
jects are included: General growth in weight and height, growth and
development of special parts of the body, adolescence and puberty,
standards and methods of judging physical fitness in children.
PR O G R E SS O F R IC K E T S S T U D Y
The three-year demonstration of the community control of rickets
at New Haven conducted by the Children’s Bureau in cooperation
with the pediatric department of Yale University School of Medicine
and the New Haven Department of Health was closed September
30, 1926.35 The roentgenograms made have been reviewed carefully
to insure that uniform methods of interpretation were used, and the
records of physical examinations of the group of children given
antirachitic treatment from infancy through 1 to 3 years of age have
been made ready for statistical analysis in the Children’s Bureau.
Because of lack of standards as to what can be considered normal
and because of uncertainty whether some characteristics in the bones
of very young infants included in the study really were due to
rickets or simply were evidences of normal rapid growth, it seemed
advisable to attempt to establish a standard of normality. There
fore a two-month study was undertaken in Porto Rico to obtain a
series of roentgenograms of infants born in a tropical country and
known to live much of the time out of doors and in houses whose
windows are unglazed. It was assumed that infants living under
such conditions were receiving antirachitic treatment in a natural
manner and that they would show bone growth as nearly normal as
it would be possible to find. This study was completed in February,
1927, examinations having been made of approximately 600 Porto
Rican infants 2 weeks to 2 ^ years old. The roentgenograms made
will be valuable in the further interpretation of those taken in New
Haven.
PR E N A T A L LETTERS
A series of nine prenatal letters prepared by the medical members
o f the maternity and infant-hygiene division staff were submitted
to the bureau’s consulting obstetrical committee for revision and
criticism, then mimeographed and sent to the States to be distributed
by the State bureaus or divisions if they desired to use them. Several
® See A D em on stra tion o f th e C om m u n ity C on trol o f R ic k e ts (S e p a ra te N o. 4 fro m P r o
ceed in g s o f th e T h ird A n n u a l C on feren ce o f S ta te D ire c to r s in C harge o f th e L o ca l A d m inV££at22n 2 ?
a n d lQ fa n cy A c t , 1926, U. S. C h ild ren ’ s B u re a u P u b lica tio n No.
157 , W ash in g ton , 1 9 2 6 ).
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MATERNITY AND INFANCY
States are now sending the letters to expectant mothers, and one State
has issued them in pamphlet form. The letters emphasize the value
of early consultation o f a physician by the expectant mother and the
importance of regular medical supervision during pregnancy. The
diet and hygiene of pregnancy with special reference to elimination,
and the preparation for the baby and for delivery are given atten
tion in these letters.
LE SSO N O U T L IN E S
A series o f outline lessons on the care of the preschool child for
the use of self-directed study groups were prepared by one of the
staff physicians and were sent later to the States in mimeographed
form for use in class work. The demand for study material con
cerning maternity and infancy is continually increasing, and many
States not having the personnel to prepare this welcomed the Chil
dren’s Bureau material for study groups.
N E W S -L E T T E R S
News-letters were prepared in mimeographed form and sent at
intervals to the State bureaus. The subjects included in the letters
were scientific advancement, new publications, news from State
bureaus, miscellaneous news, Federal maternity and infancy items,
and foreign news.
O T H E R P U B L IC A T IO N S
A folder entitled “ Keeping the W ell Baby W ell ” was prepared
for the bureau during the year. This presents in more attractive
form and in sufficient detail to make it much more useful, the ma
terial contained in the dodger, The Care of the Baby, previously
distributed by the bureau. The folder was issued in September,
1927. The bureau’s bulletin What- Is Malnutrition? was revised
during the year and was issued in April, 1927. Dr. D. A . Thom,
the author of the bureau’s bulletin Child Management, wrote a new
section (on enuresis) for that publication during the year, and a
revised edition of the bulletin containing the new material was issued
in November, 1927. Two of the bureau’s dodgers were issued in
revised form during the year: Books and Pamphlets on Child Care
(revised September 1, 1926) and Is Your Child’s Birth Recorded?
(revised December 1, 1926).
The Proceedings of the fourth annual conference of directors of
State bureaus administering the maternity and infancy act were
issued, and six of the papers published in this bulletin were also
made available separately as follows: The problem of compulsory
notification of puerperal septicemia; The county health organization
in relation to maternity and infancy work and its permanency;
Evaluation of maternity and infancy work in a generalized program;
Breast-feeding demonstrations; Foundation for permanent childhygiene programs in New Hampshire; and Standards for training
public-health nurses.
D IS T R IB U T IO N O F P U B L IC A T IO N S
Publications of the Children’s Bureau relating to the care and
hygiene of mothers, infants, and preschool children are distributed
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Federal Reserve Bank of St. Louis
FEDERAL ADMINISTRATION
133
free to persons requesting single copies* and limited numbers are
supplied to the States for free distribution. Definite monthly allot
ments of Prenatal Care, Infant Care, and Child Care are sent to the
States, and many States buy additional quantities from the Govern
ment Printing Office. The number of copies of the more widely used
publications distributed from the bureau in the fiscal year ended June
30,1927, was as follows:
Bulletins.— Prenatal Care, 166,399; Infant Care, 335,235; Child
Care, 60,520 36; Child Management, 63,912.37
Folders— Minimum Standards of Prenatal Care (revised), 37,179;
W h y Drink Milk? 29,052; W hat Builds Babies? 41,542; Sunlight for
Babies, 78,060; Breast Feeding, 53,965.
Dodgers.— Is Your Child’s Birth Recorded? 18,371; Feeding the
Child, 43,022; W hat Do Growing Children Need? 43,862,
Small charts.— Baby’s Daily Time Cards, 22,000 sets.
For a list of the Children’s Bureau publications bearing upon
maternal, infant, and child hygiene and welfare see Appendix D ,
pages 148 to 150.
M O TIO N P IC T U R E S A N D E X H IB IT M A T E R IA L
The films and exhibit material o f the Children’s Bureau may be
puchased or borrowed. (See p. 150.)
The fifth of the bureau’s films was in preparation during the year
under review. This is a one-reel film entitled “ The Best-Fed Baby,”
which shows the importance of breast feeding. The one-reel film,
u Sun Babies,” shows how sun baths will cure and also prevent
rickets. “ Our Children ” and “ W ell Born ” are two-reel films; the
former (made about 10 years ago) deals with child-health confer
ences, the latter (made about 5 years ago) shows the need for pre
natal care and the essentials o f such care. u Posture ” is a two-reel
film, either of the two reels being suitable for use alone also; the first
is a general introduction suitable for parents and children, the second
deals more directly with the purpose and method o f the exercises that
promote good posture.
The Children’s Bureau is producing a series of film slides on child
welfare. During the year under review a film slide entitled “ The
Preschool Days of Betty Jones ” was in preparation. This shows the
care of the preschool child. “ The Healthy Baby ” shows the care of
the baby to 2 years o f age. “ Trails That Lead to Mothers and
Babies ” illustrates the work done under the maternity and infancy
act. “ Rickets ” shows the effects of this disease and how it is pre
vented and cured. The negatives are deposited with the producing
laboratories, from which they may be purchased.
Lantern slides on “ The Care of the Baby ” and on “ Infant and
Child Welfare ” are included among the bureau’s exhibit material.
A new model dealing with proper posture for children at play and
m school was added to the models available for loan (o f the method
.
sp ecia l P a n t in g fu n d a v a ila b le f o r p o p u la r b u lle tin s in 1 92 6 w a s n o t in clu d ed
. m th e 1927 a p p ro p ria tio n , th e cu rta ilm en t n ecessa ry w a s m ade b y re s trictin g th e d istrib u
tio n o f C h ild Care, as th is b u lletin w a s b ein g rev ised .
rim I n riie fiscal y e a r en d ed J u n e 30, 1927, th e o rd e rs f o r s a le b y t h e G o v e rn m e n t P rin tin g
0 ® ° ? ™ere as fo llo w s : P re n a ta l C are, 5 1 ,0 0 0 ; I n fa n t Care, 1 1 3 ,5 0 0 ; C h ild C are, 6 5 ,0 0 0 ;
C h ild M a n a gem en t, 50,5 00 .
’
’:
*
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Federal Reserve Bank of St. Louis
134
MATERNITY AND INFANCY
of giving sun baths, of a children’s nursery, and of a maternity and
child-health center).
About 75 new wall panels were added to the supply of panels and
posters, in colors and in black and white, that are available for loan.
Exhibits have been sent on request to National, State, and local
agencies, including the American Medical Association and other
medical societies, boards of health, public-health organizations, socialservice organizations child-welfare societies, educational institutions,
fraternal societies, fairs and expositions, women’s clubs, religious
organizations, the American Red Cross, Young Men’s and Young
Women’s Christian Associations, Boy Scout troops, and Camp Fire
Girls. A total of 472 exhibit shipments were made during the year,
including 503 reels of motion pictures, 50 strips of film slides and 21
projectors, 1,556 lantern slides, 24 models, and 2,985 wall panels. A t
the close of the year under review 31 requests for future loans were
on file, some of the material being scheduled for exhibits in November
and December, 1927.
I
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A P P E N D IX E S
A P P E N D IX A .— T E X T O F T H E A C T FO R T H E P R O M O T IO N O F T H E
W E L F A R E A N D H Y G IE N E O F M A T E R N IT Y A N D IN F A N C Y A N D
O F S U P P L E M E N T A R Y L E G IS L A T IO N
[S. 1039— Sheppard-Towner A ct; Public 97— 67th Congress; 42 Stat. 224]
A n A c t F o r th e p ro m o tio n o f th e w e lfa r e an d h y gien e o f m a te rn ity and in fa n cy , a n d f o r
o th e r 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
welfare and hygiene of maternity and infancy as hereinafter provided.
Sec. 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
remains 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 e c . 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 Commissioner
of Education, and which is hereafter designated in this Act as the Board. The
Board shall elect, its own chairman and perform the duties provided 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 e o . 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. I f the legislature of
any State has not made provision for accepting the provisions of this Act the
135
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Federal Reserve Bank of St. Louis
136
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 the
adjournment of the first regular session of the legislature in such State
following the passage of this Act.
Sec. 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.
Seo. 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.
Seo. 7. Within 60 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 e c . 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: Provided, 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. I f 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 o . 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 e o . 10. Within 60 days after any appropriation authorized by this act
has been made, and as often thereafter while such appropriation remains
unexpended 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; (8) 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.
S e c . 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
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Federal Reserve Bank of St. Louis
137
APPENDIXES
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 States^ 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 shaü give notice in writing to the authority designated to represent
the State, stating specifically wherein said State has failed to comnlv with
the provisions of this act.
Seo. 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 matern
ity or infancy pension, stipend, or gratuity.
Seo. 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
m his annual report to Congress, a full account of the administration of this
act and expenditures of the moneys herein authorized.
S e o . 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,
[Public 35— 68th Congress; 43 Stat. 17]
i
' *- *
A n A c t T o exten d tlie p ro v is io n s o f certa in la w s to th e T e r r it o r y o f H a w a ii.
*
*
*
*
*
#
S ec . 3. The Territory of Hawaii shall be entitled to share in the benefits of
the act entitled “An act for the promotion of the welfare and hygiene of mater
nity and infancy, and for other purposes,” approved November 23, 1921 and amv
act amendatory thereof or supplementary thereto, upon the same terms and
conditions as any of the several States. For the fiscal year ending June 30
1925, there is authorized to be appropriated, out of any money in the Treasury
not otherwise appropriated, the sum of $13,000 to be available for apportion
ment under such act to the Territory, and annually thereafter such sum as
would be apportioned to the Territory if such act had originally included the
Territory.
*
*
*
*
*
*
*
Approved, March 10, 1924.
[Public 566— 69th Congress ; 44 Stat. 1024]
A n A c t T o a u th oriz e fo r th e fiscal y ea rs en d in g J u n e 30, 1928, a n d J u n e 30, 1929 annrop n a t io n s f o r ca rr y in g 9u t the p ro v is io n s o f th e A c t en titled “ A n A c t f o r the p ro m o tio n
K -" K S S *
“ a,or °"“r
Be it enacted by the Senate and House of Representatives of the United States
of America in Congress assembled, That section 2 of the act entitled “An act
for the promotion of the welfare and hygiene of maternity and infancy, and for
other purposes,” approved November 23, 1921, is amended by striking out the
words “ for the period of five years ” wherever such words appear in such section
and inserting in lieu thereof the words “ for the period of seven years.”
'A. S?0That said act entitled “An act for the promotion of the welfare and
■ i^ e n e
maternity and infancy, and for other purposes,” approved November
^23, 1921, shall, after June 30, 1929, be of no force and effect.
Approved, January 22, 1927.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
ì
APPENDIX B.—ADMINISTRATIVE AGENCIES AND OFFICERS
State administrative agencies and names of the executive officers for the
administration of the act for the welfare and hygiene of maternity and
infancy (as of June 30, 1927)
State (and
Territory)
Administrative agency and department
Director
I
Alabama................. Bureau o f child hygiene and public-health nursing,
State board o f health (M ontgom ery).
Arizona................... Child-hygiene division, State board of health (Phoenix)
Arkansas___ ..____ Bureau o f child hygiene, State board o f health (Little
R ock.
California________ Bureau o f child hygiene, State board of health (San
Francisco).
Colorado_______ _ Child-welfare bureau, State department of public in
struction (Denver).
C onnecticu t8........ Bureau o f child hygiene, State department of health
(Hartford).
Delaware............... Division o f child hygiene, State board of health (Dover)
Florida___________ Bureau o f child hygiene and public-health nursing,
State board o f health (Jacksonville).
Georgia__________ Division o f child hygiene, State board of health (Atlanta)
Hawaii___________ Division o f maternity and infancy, Territorial board of
health (Honolulu).
Idaho_____ _______ Bureau of child hygiene, State department of public
welfare (Boise).
Illinois 8__________ Division o f child hygiene and public-health nursing,
State department o f public health (Springfield).
Indiana__________ Division o f infant and child hygiene, State board of
health (Indianapolis).
Iowa_____________ Division of maternity and infant hygiene, State Uni
versity o f Iowa (Iowa C ity ).
Kansas................ . Division of child hygiene, State board of health (Topeka)
K e n tu ck y ........... . Bureau of maternal and child health, State board of
health (Louisville).
Louisiana.............. Bureau of child hygiene, State department of health
(N ew Orleans).
M aine____________ Division o f public-health nursing and child hygiene,
State department of health (Augusta).
Maryland________ Bureau o f child hygiene, State department of health
(Baltimore).
Massachusetts 8___ Division of hygiene, State department of public health
(Boston).
M ichigan................ Bureau of child hygiene and public-health nursing,
State department o f health (Lansing).
Division o f child hygiene, State department of health
M innesota........ .
(Minneapolis).
Mississippi_______ Bureau o f child hygiene and public-health nursing,
State board o f health (Jackson).
Missouri_________ Division of child hygiene, State board of health (Jeffer
son City).
M ontana_________ Division o f child welfare, State board of health (Helena)
Nebraska________ Division o f child hygiene, bureau o f health, State de
partment o f public welfare (Lincoln).
N evada........ .......... Child-welfare division, State board o f health (R e n o )..
N ew H am pshire.. Division o f maternity, infancy, and child hygiene,
State board o f health (Concord).
N ew Jersey............ Bureau o f child hygiene, State department of health
(Trenton).
N ew M exico_____ Division of child hygiene and public-health nursing,
bureau of public health, State department of public
welfare (Santa Fe).
N ew Y ork _______ Division of maternity, infancy, and child hygiene,
State department of health (A lb a n y ).
N orth Carolina___ Bureau o f maternity and infancy, State board of health
(Raleigh).
North Dakota____ Division o f child hygiene and public-health nursing,
State department of public health (Bismarck).
Ohio_____________ Division o f child hygiene, State department of health
(Colum bus).
1State health officer serving.
8Executive secretary.
138
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Federal Reserve Bank of St. Louis
8 State not cooperating.
4 Chief.
Jessie L . Marriner, R . N .
Mrs. Charles R . Howe.
D r. C. W . Garrison.1
Dr. Ellen S. Stadtmuller.
M rs. E . N . M athews.8
Dr. A . Elizabeth Ingraham.
Dr. Clealand A . Sargent.
M rs. Laurie Jean Reid, R . N .
Dr. Joe P. Bowdoin.
Dr. V . B . Appleton.
Dr. Ralph M . Fouch.
Dr. Grace S. W ightman.
Dr. A da E . Schweitzer.
"L
Edward H . Lauer, Ph. D .
S.
Dr. J. C. M ontgomery.
Dr. Annie S. Veech.
Agnes Morris.
Edith Soule, R . N .
Dr. J. H . M ason Knox, jr.4
Dr. Merrill E. Champion.
Dr. Lillian R . Smith.
Dr. R uth E . Boynton.
D r. F . J. U nderwood.1
D r. Irl Brown Krause.
D r. Hazel D ell Bonness.
Louise M . M urphy, R . N .
M rs. S. H . Wheeler.8
Elena M . Crough, R . N .
Dr. Julius L evy .8
D oroth y R . Anderson, R . N .4
D r. Elizabeth M . Gardiner.
Dr. H . A . Taylor.
Dr. M aysil M . Williams.
Dr. H . E . Kleinschmidt.6
6 Consultant.
6 Resigned Jan. 1, 1927.
\
139
APPENDIXES
State administrative agencies, etc.— Continued
State (and
Territory)
Administrative agency and department
Oklahoma_______
Bureau o f maternity and infancy, State department of
public health (Oklahoma C ity).
Bureau o f child hygiene, State board of health (Port
land).
Preschool division, bureau o f child health, State de
partment of health (Harrisburg).
Division o f child welfare, State board of health (Provi
dence).
Bureau o f child hygiene and public-health nursing,
State board o f health (Colum bia).
Division of child hygiene, State board of health (W aub ay).
Division of child hygiene and public-health nursing,
State department of public health (Nashville).
Bureau of child hygiene, State department of health,
(Austin).
Bureau of child hygiene, State board of health (Salt
Lake C ity).
State department of public health (Burlington) ——
Bureau o f child welfare, State board of health (R ich
m ond).
Division o f child hygiene, State department of health
(Seattle).
Division o f child hygiene and public-health nursing,
State department of health (Charleston).
Bureau of child welfare and public-health nursing,
State board of health (M adison).
Division of maternal and infant welfare and child h y
giene, State department of public health (C hey
enne).
X
Oregon..................
Pennsylvania___
Rhode Island-----South Carolina__
South Dakota___
Tennessee_______
Texas___________
Utah......................
VermontVirginia—
W a s h in g t o n W est VirginiaWisconsin____
W yom ing____
1 S ta te h ea lth officer s ervin g .
892°— 28------10
I
7
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Federal Reserve Bank of St. Louis
4 C h ief.
Director
D r. Lucile S. Blachly.
Glendora M . Blakely, R . N .7
Dr. M ary Riggs N oble.4
Dr. M arion A . Gleason.
A da Taylor Graham, R . N .
Florence E . Walker, R . N .
Dr. W . J. Breeding.
Dr. H . N . Barnett.
Dr. H . Y . Richards.
D r. Charles F . Dalton.1
Dr. M ary E. Brydon.
Ella Erikson, R . N .
M rs. Jean T . Dillon, R . N .
Dr. Cora S. Allen.
Dr. G. M . Anderson.1
7 S ta te a d v iso r y nu rse.
APPENDIX C.—MATERNAL AND INFANT MORTALITY RATES
T able I .— Trend of maternal mortality in urMn and rural districts of the
United States Urth-registration area, by States, 1915-19261
Maternal mortality rates per 10,000 live births *
State
Area______
U rban.
R ural..
1915
1916
1917
1918
1919
1920
60.8
64.1
55.3
62.2
65. 1
57.3
66.2
70.0
62.3
91.6
96.0
87.2
73.7
78.8
68.8
79.9
85.6
74.1
1923
68.2
77.1
59.4
66.4
73.2
59.5
66.5
73.8
58.7
1925
65.6
73. 5
57.6
64.7
73.5
55.5
Arizona___
Urban.
R ural..
102.5
107.6
100.6
CaliforniaU rban.
Rural ..
Connecticut.
U rb a n ...
Rural___
65.6
73.9
56.7
79.8
88.1
68.7
56.1
63.0
36.0
48.9
51.1
42.1
51.0
55.2
36.9
74.9
73.5
79.5
62.2
68.8
41.6
76.9
85.5
65.1
68.3
78.1
55.1
71.9
77.1
64.9
67.5
70.9
62.6
59.2
62.8
54.0
60.1
64.9
53.1
56.4
58.7
53.0
68.0
74.7
37.6
52.8
57.7
31.5
57.0
61.6
37.3
57.3
61.6
38.5
57.1
60.3
42.9
49.1
54.9
21.5
57.6
59.5
47.9
63.2
101.5
20.8
65.8
60.5
71.7
83.7
90.0
77.1
76.9
82.6
70.8
77.0
102.3
51.5
92.9
109.4
76.3
121.4
108.8
126.2
121.4
130.9
117.2
106.9
101. lì
109.7 ¿
D elaw are..
U rban.
R u ra l..
Florida.......
U rban.
R ural..
Idaho.........
U rban.
R ural..
56.9
75.1
54.5
Illinois____
U rban.
R u ra l..
Indiana___
U rban.
R u ra l..
72.5
87.1
64.1
103.9
124.3
91.9
84.2
102.5
73.0
87.5
104.8
75.2
85.7
56.5
63.2
66.9
57.3
64.1
71.0
53.2
61.6
69.7
48.1
58.3
64.8
46.9
65.0
69.8
56.1
66.0
84.1
53.2
64.9
77.4
55.2
58.1
66.0
51.5
60.5
80.2
43.9
64.8
81.1
50.8
59.8
79.1
52.2
55.9
81.3
45.3
60.4
87.8
48.8
Iowa______
U rban.
R ural..
Kansas.......
U rban.
R u r a l-
75.9
92.0
72.4
114.3
151.7
105.8
82.5
107.5
76.4
813
101.9
78.6
64.3
85.1
57.6
75.9
107.7
64.8
68.4
104.8
55.0
62.7
82.6
54.9
65.4
83.2
58.4
69.7
93.1
60.7
Ken tucky..
U rban.
R ural..
60.1
98.4
54.6
80.0
119.0
74.3
63.2
91.8
59.0
64.4
93.9
59.4
62.7
93.4
57.5
60.7
96.6
54.3
59.6
80.4
55.5
61.8
88.4
56.5
59.5
82.6
54.5
58.4
74.8
54.6
78.0
81.1
76.9
67.3
94.0
58.7
85.7
97.4
81.8
85.8
91.7
83.8
103.6
77.2
74.0
100.9
62.9
75.8
102.4
64.4
87.0
9.78
82.1
82.3
125.6
63.2
72.2
102.5
58.8
66.9
106.6
49.7
63.9
75.7
52.9
58.0
72.4
63.7
95.3
94.1
96.4
83.6
89.7
75.7
75.7
77.5
73.2
66.5
69.7
62.5
59.4
60.0
58.6
60.0
63.0
56.0
65.5
71.5
57.8
58! 2
74.2
37.0
57.8
69.4
42.4
70.6
74.8
50.5
74.6
78.1
54.4
65.2
68.2
47.6
67.8
73.0
37.3
62.9
67.6
33.7
64.7
69.1
38.1
63.3
66.3
44.9
64.2
66.8
47.4
70.3
82.2
54.5
65.3
63.7
72.8
71.7
55.2 1 52.6
M aine_________
Urban_____
Rural________
67.9
82.4
63.2
M arylan dUrban.
R ural..
Massachusetts___
Urban_______
Rural________
57.2
59.6
46.8
59.8
63.7
41.8
65.0
70.4
40.2
92.2
96.0
74.5
M ichigan_____
Urban........
Rural_____
66.8
72.9
61.8
68. 2
74.2
72.8
76. 3
64.0 I 72. 3
85.9
96.6
75.5
1Source:
68. 5
71.1
65.5
68.5
73.0
63.2
U . S. Bureau of the Census.
a Deaths of wom en from causes associated with pregnancy and childbirth
140
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Federal Reserve Bank of St. Louis
67.-2 ,
77.4 r
51.6 V
141
APPENDIXES
T able
I.— Trend of maternal mortality in urban and rural districts, etc.— Contd.
Maternal m ortality rates per 10,000 live births
State
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
51.9
54.3
50.8
54.6
62.2
51.0
55.7
59.7
53.7
78.3
87.6
73.9
67.4
64.4
68.8
78.5
90.2
72.2
57.2
80.8
44.2
49.5
54.1
46.8
60.2
77.2
49.8
49.7
57.7
44.6
52.8
59.7
48.4
57.4
75.9
45.5
95.3
179.8
88.3
83.2
202.1
72.7
88.1
161.9
81.6
95.1
149.4
89.6
98.3
163.1
92.1
78.7
129.7
73.6
79.1
85.9
76.9
75.5
85.2
71.9
65.6
94.5
55.5
81.1
79.6
81.6
80.2
113.9
68.5
N ew H am pshire.- 61.0
69.3
53.0
58.6
58.8
57.9
72.4
75.9
69.1
54.3
54.1
54.8
N orth Carolina___
Rural.... ..........
70.0
67.5
72.7
79.7
87.2
71.6
66.5
104.8
54.2
71.4
76.4
66.1
62.2
62.8
61.6
64.5
70.3
58.5
74.1
63.5
85.9
61.3
51.9
71.4
71.2
82.9
58.9
75.7
80.1
70.9
58.5
68.3
34.7
64.1
70.9
48.3
57.0
64.5
39.5
64.3
62.3
73.1 ■ 74.9
39.8
37.3
57.6
64.9
41.1
57.3
59.0
50.2
58.6
62.0
43.5
59.6
62.9
45.1
56.5
59.1
44.9
82.4
117.6
80.2
107.9
186.7
103,0
92.6
167.6
87.5
100.0
168.0
91.7
73.5
119.8
67.8
79.5
128.5
73.1
79.6
114.1
74.6
77.5
124.2
70.0
86.6
131.5
78.9
88.3
153.8
76.8
56.9
99.9
51.5
61.5
62.0
61.4
42.9
69.8
39.4
96.8
104.5
87.3
73.8
83.3
62,0
79.5
91.3
63.0
72.2
84.9
55.3
66.2
78.0
50.7
71.5
83.7
54.1
64.1
76.2
46.7
67.6
81.6
47.1
67.1
80.7
46.6
101.2
123.9
87.2
94.4
82.4
1Q2.8
74.3
73.1
75.2
82.8
91.6
76.8
68.7
79.2
61.9
64.9
72.8
59.6
72.3
71.7
72.7
59.0
66.2
54.0
77.6
88. 9
65.5
68.3
84.4
52.2
62.2
75.8
48.7
65.9
82.0
49.6
63.3
82.1
44.2
64.2
81.8
46.5
63.7
80.4
46.7
0
71.0
76.3
39.0
55.2
57.8
41.2
63.0
70.4
19.1
63.4
66.9
42.3
52.1
58.3
14.6
59.6
62.0
43.9
111.6
170.3
106.4
122.0
163.0
117.3
98.1
177.7
88.4
106.8
141. 4
102.4
97.1
140.3
91.8
107.8
177.9
99.5
0
0
66.2
72.8
R ural........ ....... 36.0
58.1
63. 2
36.1
63.5
69. 7
35.7
98.1
104.1
69.8
0
..........
57.1
89.2
46.7
60.2
62.2
51.7
68.2
81.9
54.6
Washington...........
63.2
89.5
54.6
62.7
65.1
52.7
104.6
111. 1
98.3
78.5
72.2
79.7
57.9
101.1
44.4
68.7
68.2
71.0
64.9
75.4
54.6
61.2
51. 9
62.8
58.0
89.9
49.1
62.4
63.9
55.9
70.1
82.4
58.6
TT t.ph
65.8
105.4
54.6
79.7
79.1
82.6
64.3
74.1
55.2
R hode Island........
71.5
101.4
63.1
57.4
56.0
63.9
71.3
80.9
59.4
Ohio_____________
77.8
74.5
81.5
1926
59.4
67.8
56.1
86.3
106.4
78.0
83.6
114.2
69.9
79.1
112.7
62.4
72.6
92.7
62.7
55.5
65.6
50.3
49.8
71.5
38.2
45.1
59.4
37.0
51.7
76.9
37.5
48.6
69.8
36.8
63.6
51.3
65.8
79.9
50.7
85.4
79.6
83.2
79.0
70.2
82.7
67.7
73.1
97.6
68.7
74.5
84.5
72.6
69.6
133.9
57.0
81.0
90.4
78.9
67.9
137.9
53.2
67.2
65.1
67.6
81.8
130.3
70.9
107.0
161.1
94.5
82.6
92.1
80.0
86. 5
133.0
73.8
70.0
113.3
58.7
71.8
111.9
61.2
74.4
99.5
67.4
65.2
100.4
55.5
70.1
95.2
63.2
79.8
122.8
67.3
73.7
86.2
63.4
98.5
103.6
93.8
86.0
100.6
71.7
92.0
99.0
84.6
77.7
86.7
69.0
78.8
84.4
73.3
66.5
70.2
62.7
70.9
85.9
55.1
60.2
69.3
50.1
75.0
89.2
59.7
63.3
117.7
50,8
70.6
129.5
57.4
Rural...............
» D ropped from the birth-registration area.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
............'............
142
MATERNITY AND INFANCY
T able
I.— Trend of maternal mortality in urban and rural districts, etc.— Contd.
Maternal mortality rates per 10,000 live births
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
57.3
58.1
56.9
59.6
68.8
54.4
48.0
62.1
39.8
67.3
82.3
57.8
58.1
73.9
48.2
55.8
66.8
48.9
58.1
69. 5
50.3
60.5
66.9
55.8
52.3
63.0
44.1
59.6
71.1
50.3
71.3
110. 6
62. 0
72. 7
113. 5
61.6
97.6
126 2
89.9
95.2
139.3
83.6
93.4
58.5
101.9
70.5
101.0
121.8
86.7
77.4
"Wyoming......... .
Urban_______
Rural________
District of Colum
bia_____________
69.7 101.4
'85.5
90.7
85.6
88.4
101.3
.1926
II.— Trend of maternal mortality, by color, in the United States births
registration area and in States having 2,000 or more colored births annually
during the period 1921 to 1925; 1915-19261
T able
Maternal mortality rates per 10,000 live b irth s3
State
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
A rea.. _________ 60.8 62.2
W hite....... ...... 60.1 60.8
Colored............ 105.6 117.9
66.2
63.2
117.7
91.6
88.9
139.3
73.7
69.6
124.4
79.9
76.0
128.1
68.2
64.4
107.7
66.4
62.8
106.8
66.5
62.6
109.5
65.6
60.7
117.9
64.7
60.3
116.2
65.6
61.9
107.1
79.8
82.4
56.7
76.9
78.2
65.0
68.3
70.7
45.1
71.9
72.8
63.1
67.5
68.8
53.6
59.2
56.7
88.5
60.1
59.6
65.8
56.4
56.4
56.1
121.4
90.0
186.9
121.4
102. 2
163.4
10fi 9
90.4
148. ñ
1915
!
W hite________
Florida..... ..............
W hite........... Colored............
Illinois___________
W hite________
Colored______
K entucky..............
63.2
61.8
111.6
64.1
61.6
137.5
61.6
59.5
108.8
58.3
56.4
100.3
65.0
63.2
104.9
60.1
56.4
108.2
80.0
75. 0
153.8
63.2
58. 5
125.0
64.4
59. 7
130.4
62.7
56. 7
147.7
60.7
53.9
185.0
59.6
54.2
153.5
61.8
57.0
130.7
59.5
53.6
138.0
58.4
54.9
106.2
68.0
61.0
97.8
95.3
85. 8
138.1
83.6
76.1
115.0
75.7
65. 9
118.3
66.5
59. 5
96.1
59.4
53.5
84.3
60.0
54.3
83.0
65.5
56.6
101.5
58.2
50.5
89.0
57.8
47.4
98.3
Mississippi_______
W hite________
Colored............
83.2
64.8
100.5
88.1
65.5
109.5
95.1
65.1
125.5
98.3
66.6
128.7
78.7
65.2
91.6
N ew Jersey_______
W hite________
Colored______
64.1
61.6
119.3
57.0
55.0
96.6
62.3
59.2
117.1
64.3
62.7
90.9
57.6
55.8
84.0
M aryland________
63.9
W hite________
56.0
Colored............ .......... 98.0
N ew Y ork_______ 58.6
W hite....... .
58.1
Colored............ 97.2
54.3
53.6
96.3
57.4
56.5
118.3
79.7
79.1
114.0
62.4
60.9
140.7
68.7
67.1
142.1
62.7
60.9
139.4
60.2
59.3
97.2
57.3
56.5
85.2
58.6
57.5
93.1
59.6
58.1
101.6
56.5
54.3
116.9
N orth Carolina___
W hite...............
82.4
68.1
114.8
107.9
94.0
139.0
92.6
82.0
117.6
100.0
86. 2
132.2
73.5
61.0
101.8
79.5
70.5
99.4
79.6
67.3
107.0
77.5
65.5
103.8
86.6
68.0
127.9
88.3
71.4
125.7
Ohio..................... .
W h ite...-.........
71.3
69.8
136.0
96.8
95.7
138.2
73.8
72.1
126.4
79.5
78.2
120.3
72.2
70.6
116.0
66.2
63.8
132.9
71.5
68.0
158.2
64.1
62.2
101.8
67.6
64.5
129.6
67.1
64.4
115.8
Pennsylvania____ 64.3 70.1
W hite________ 63.3 69.1
Colored______ 112.2 118.7
64.9
63.6
118.6
104.6
102.9
174.7
68.2
65.5
157.9
77.6
76.0
130.6
68.3
67.4
97.7
62.2
61.2
94.0
65.9
64.6
100.9
63.3
61.0
114.7
64.2
62.7
97.9
63.7
61.5
109.2
South Carolina___
97.1
111.6 122.0
98.1 106.8
W hite________
78.1
89.9
77.9
85.5
74.1
Colored______
144.2 154.0 118.1 128.0 121.8
1 Source: U . S. Bureau of the Census.
3 Deaths of mothers from causes associated with pregnancy and childbirth.
8 D ropped from the birth-registration area.
107.8
75.9
140.8
(3)
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
(3)
143
APPENDIXES
T able
II.— Trend of maternal mortality, by color, etc.— Continued.
Maternal m ortality rates per 10,000 live births
State
1915
1916
Colored______
1917
1918
1919
1920
1921
1922
1923
1924
1925
81.8
64.4
120.6
107.0
96.0
131.8
82.6
66.0
118.7
86.5
75.4
110.9
70.0
56.9
99.4
71.8
58.3
101.7
74.4
59. 7
107.8
65. 2
50.1
99.6
70.1
52. 6
109. 7
79 8
71. 2
99. 6
63.3
59. 6
125.3
70. 6
66.1
139.9
86.7
60.8
143.3
77.4
64.4
104.9
West Virginia____
W hite________
Colored______
District of Columbia_____________ 69.7 101.4
W hite________ 56.1 76.3
Colored______ 99.4 157.5
85.5
59.0
147.7
90.7
78.1
126.1
85.6
67.8
131.6
88.4
66.5
143.8
101.3
98.6
107.7
70.5
56.1
105.7
101.0
89.3
129.5
121.8
91.7
189.6
1926
T able I II .— Trend of infant mortality in urban and rural districts of the United
States birth-registration area, by States; 1915-19261
Deaths of infants under 1 year of age per 1,000 live births
State
A rea -. _______ ____________
Urban ______________
Rural_________________
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
100
103
94
101
104
97
94
100
88
101
108
94
87
89
84
86
91
81
76
78
74
76
80
72
77
78
76
71
72
69
72
73
70
Arizona___________________
Urban_________________
Rural_________________
73
74
72
121
111
125
California_________________
Urban________________
Connecticut____ __________
Urban________________
R u r a l..................... ........
1926
107
103
119
101
101
101
94
93
96
107
106
112
70
64
79
74
68
83
66
60
75
71
64
81
73
66
83
67
62
74
69
62
79
63
56
72
86
86
87
92
93
88
73
72
79
77
77
77
77
77
75
69
67
77
73
70
88
72
70
82
98
93
103
100
100
101
104
99
110
95
91
100
91
87
94
93
87
100
82
88
80
74
87
68
75
85
70
Delaware ________________
R u r a l................... ..........
Florida—____ ______________
U rban________________
R u r a l.................. ...........
Idaho_____________________
U rb a n .. _____________
Rural____ ____________
63
59
63
Illinois____________________
Urban________________
Rural_________________
Indiana______ ____ _______
Urban ____________ _
Rural_________________
86
100
78
87
104
77
79
88
74
82
96
72
71
79
66
76
81
68
82
85
77
71
75
65
73
74
70
69
68
72
67
76
61
71
78
65
65
73
59
68
75
62
72
78
68
55
66
50
56
70
50
59
72
53
I o w a .._____ _____________ _
U rban. ______________
Rural_________________
Kansas____ _____________ . .
Urban_________________
Rural........ .......................
77
98
73
80
106
73
70
88
73
92
67
63
73
59
65
79
60
63
78
57
59
70
54
62
72
58
65
76
61
K entucky________________
Urban.....................i __
R u ra l._____ __________
87
103
85
93
119
90
82
105
78
73
90
70
62
72
60
69
83
67
72
89
68
65
79
62
71
85
67
75
92
72
93
107
89
101
109
98
91
89
91
102
110
98
88
79
92
86
97
82
89
89
88
81
88
78
76
79
75
80
86
77
M aine.......... ...........................
U rban. _____________
R ural. _______________
105
109
104
108
128
102
1 Source: U . S. Bureau of the Census.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
144
MATER-STITY ANt) INFANCY
T able III.— Trend of infant mortality in urban and rural districts, etc.— Contd.
Deaths of infants under 1 year of age per 1,000 live births
1915
M aryland............. ..................
U r b a n . . ______ _____ _
R u r a l..______ _________
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
121
120
122
120
116
123
140
146
135
105
98
115
104
105
103
94
87
102
94
93
96
95
87
104
86
84
88
90
82
101
87
83
92
1926
Massachusetts.......................
Urban................... ..........
Rural__________ ____
101
103
92
100
103
87
98
99
91
113
115
104
88
90
82
91
92
83
76
76
77
81
82
76
78
78
75
68
68
66
73
73
74
73
73
72
M ichigan_________________
Urban________________
R u ra l.____ ___________
86
96
78
96
106
87
88
97
80
89
97
81
90
97
82
92
100
82
79
81
75
75
81
67
80
85
74
72
75
68
75
79
71
77
82
70
M innesota._________ ______
Urban________________
Rural_____ ____ ______
70
77
67
70
78
66
67
75
64
71
79
67
67
68
66
66
71
64
59
59
59
58
60
56
62
62
62
57
56
57
60
61
60
68
67
58
68
95
66
68
87
66
68
86
67
71
94
69
68
87
67
70
77
69
70
78
68
71
72
71
67
72
65
71
73
70
77
77
77
Mississippi________________
Urban............ ........... .....
Rural...................... .........
Montana______ ______ _____
Urban................... ..........
Rural........ ............ ..........
Nebraska________ _________
Urban..............................
Rural.... ...........................
N ew Hampshire__________
U rb a n ........................ .
Rural______ __________
110
131
89
115
133
97
110
132
86
113
124
102
93
101
85
64
86
58
59
74
54
57
71
53
57
71
53
55
68
51
58
69
54
69
68
56
88
97
78
87
95
78
80
90
69
93
102
84
80
81
78
76
87
65
79
82
75
74
74
74
79
79
77
72
71
74
70
70
69
69
68
70
70
69
72
N ew Jersey_______________
U rb a n ......... ... .............. .
Rural________ ________
N ew Y ork ..............................
Urban..............................
Rural...............................
99
102
89
91
93
85
97
98
93
84
85
77
86
88
78
75.
76
74
77
78
72
72
71
76
69
70
67
68
68
66
71
70
71
100
159
96
102
168
98
84
124
82
85
113
81
75
97
72
80
96
77
81
109
77
82
100
79
79
104
74
82
106
78
67
68
67
72
49
74
69
72
69
94
97
83
N orth Carolina.....................
Urban................... ..........
Rural...............................
N orth Dakota_____________
U rb a n .............................
Rural___ :_______ _____
Ohio_______________ ______
U rban....................... .......
92
103
79
94
100
87
Oregon. ............. ............. .
Rural____ ____________
90
94
85
83
89
74
75
76
73
72
76
65
75
75
75
67
70
62
70
71
67
76
78
72
63
69
59
62
60
63
51
50
52
58
59
58
57
53
60
54
51
55
51
48
53
39
62
97
99
95
88
86
89
88
89
87
90
87
94
79
80
77
82
81
83
82
81
83
93
94
86
85
86
79
94
94
94
80
81
73
73
74
69
82
82
82
Pennsylvania................. .......
Urban_____________ _
Rural................................
110
110
110
114
114
114
111
113
109
129
130
128
100
99
101
R hode Island............ *_____
120
118
129
111
116
93
108
109
101
126
127
118
(2)
(2)
113
139
111
116
150
112
96
127
92
93
105
91
96
117
94
102
121
99
Rural...... .........................
South Carolina.............. .......
Rural_________________
U tah.................................. —
U r b a n .................. ..........
Verm ont.............................. .
Urban_________________
R u ra l.---------- ---------------
85
116
80
93
128
86
69
66
71
64
66
63
71
74
69
71
69
72
73
69
75
69
70
68
59
61
58
64
59
67
56
49
60
85
108
81
93
119
88
85
121
79
96
117
92
78
102
73
73
98
68
76
92
73
70
78
68
72
66
74
1Dropped from the birth-registration area.
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Federal Reserve Bank of St. Louis
(2)
5
(2)
145
APPENDIXES
T
able
III.— Trend of infant mortality in urban and rural districts, etc.— Contd.
Deaths of infants under 1 year of age per 1,000 live births
State
1915
1916
Virginia___
UrbanR ural..
W ashington.
U rb a n ...
Rural__
1917
1918
1919
1920
1921
1922
1923
129
91
103
145
93
91
106
87
84
107
77
84
103
78
69
62
75
69
67
71
63
59
67
66
64
69
56
54
59
W est Virginia.
Urban___
Rural........
1924
1925
1926
82
93
79
W isconsin.
Urban.
R ural..
71
78
67
70
77
65
69
74
65
W yom ing..
U rban.
R ural..
79
104
73
80
102
73
76
78
75
85
92
District o f Colum bia.
111
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
106
97
112
85
91
83
146
MATERNITY AND INFANCY
IV.— Trend of infant mortality, by color, in the United States birth-regis
tration area and in States having 2,000 or more colored births annually during
the period 1921 to 1925; 1915-19261
T able
Deaths of infants under 1 year of age per 1,000 live births
Area______________________
W hite............................ .
Colored............................
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
100
99
181
101
99
185
94
91
151
101
97
161
87
83
131
86
82
132
76
72
108
76
73
110
77
73
117
71
67
113
72
68
111
73
70
112
70
70
73
• 74
74
77
66
66
69
71
71
77
73
73
72
67
67
70
69
69
65
63
63
65
82
70
107
74
60
105
75
62
107
W hite..........
W hite_____
1926
76
75
125
82
79
157
71
68
141
73
70
122
69
68
109
87
82
152
93
87
191
82
77
147
73
69
138
62
58
110
69
64
157
72
67
157
65
61
119
71
67
119
75
71
134
120
101
201
140
125
215
105
92
160
104
90
164
94
81
147
94
81
147
95
80
155
86
76
128
90
76
146
87
74
137
W h it e .............................
68
53
85
68
56
79
68
53
82
71
55
88
68
53
83
70
59
81
W hitel________________
74
71
139
79
76
129
72
69
124
70
67
125
69
65
125
70
67
122
W hite................ .............
121
101
209
N ew Y ork ..............................
W h it e ............................
Colored_____ ____ ____
99
98
191
94
93
169
North Carolina___________
Pennsylvania_____________
W hite..............................
C olored ..........................
110
108
184
114
113
180
91
90
176
97
95
175
84
82
151
86
85
159
75
74
138
77
76
124
72
71
121
69
68
114
68
66
119
71
68
132
100
85
133
102
85
140
84
74
109
85
73
113
75
66
95
80
70
101
81
70
106
82
70
110
79
67
105
82
71
107
92
91
158
94
92
178
90
88
157
$3
81
153
75
73
122
72
70
111
75
72
139
67
64
113
70
67
127
76
73
128
111
109
194
129
126
226
100
98
151
97
95
167
88
86
134
88
86
142
90
88
151
79
76
138
82
80
131
82
80
139
113
76
149
116
83
148
96
69
123
93
67
119
96
70
125
102
77
127
(2)
91
78
120
84
72
110
79
68
103
77
65
102
84
71
115
78
66
104
81
67
111
84
72
111
80
78
110
82
79
124
87
67
132
85
67
123
W hite......................
98
80
137
103
86
141
W hite_____ ___________
District of Columbia______
W hite_________________
C olored ..........................
111
83
173
106
83
158
97
71
160
1 Source: U. S. Bureau of the Census,
s D ropped from the birth-registration area.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
112
85
188
85
67
132
91
72
139
83
68
122
85
64
134
92
76
71
62
143 • 108
(2)
147
APPENDIXES
T able Y . — Maternal mortality rates for the United States and certain foreign
countries1
M aternal mortality rates per 10,000 live births 2
uountry
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
43
53
56
47
47
72
50
60
C hile. ___________ ____ _________
66
73
72
82
88
England and W ales. .
42
34
40
41
36
45
39
38
45
38
44
49
44
40
51
75
24
43
36
49
47
57
51
79
20
39
45
53
55
80
20
38
51
56
54
74
26
38
55
58
60
61
24
37
41
49
30
35
25
60
37
38
30
52
29
33
34
51
28
35
24
65
26
36
23
51
31
24
50
45
30
26
47
44
27
61
52
29
40
28
57
52
27
35
30
59
51
25
43
30
70
64
26
41
35
62
53
32
39
26
62
50
27
41
22
64
51
27
41
52
48
27
34
23
51
49
28
64
46
47
27
35
26
59
50
57
25
33
25
51
47
25
66
49
53
48
22
36
25
47
58
62
42
45
43
66
32
92
30
74
23
80
34
68
33
66
27
67
27
66
25
A ustralia................ ........... ..............
_________
Japan_______________ ___________
T he Netherlands 8_______________
N ew Zealand___________ _________
Scotland........... ..................... ............
United States (birth-registration
area)............. ............. —- ........ .......
U ruguay_______________ ________
61
22
62
29
1925
56
61
65
25
1 Figures from official sources.
2 Deaths of w om en from causes associated with pregnancy and childbirth.
2 Omitting from calculation of rates prior to 1924 the live-born infants w h o died before registration of
birth (Within three days of birth).
T able V I.— Infant mortality rates for the United States and certain foreign
countries1
Deaths of infants under 1 year of age per 1,000 live births
Country
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
Australia___ ________ ______
68
218
70
192
56
186
59
193
69
156
109
110
69
157
110
146
254
241
269
255
306
263
53
156
114
155
87
240
Denm ark................................
95
100
ióo
74
92
91
England and W ales_______
110
110
142
168
91
110
122
149
96
118
123
155
97
115
138
154
89
135
119
121
80
97
99
131
Hungary................... .............
264
219
215
217
158
193
77
133
83
95
115
134
76
193
129
170
127
166
129
168
85
140
77
99
85
130
92
198
69
126
166
61
141
100
165
88
283
148
83
143
69
92
96
132
79
184
66
128
163
57
44
76
50
118
79
148
56
61
57
127
95
150
79
266
148
84
150
75
107
85
109
81
193
72
126
156
170
61
40
85
50
150
98
140
60
62
53
119
100
Chile______________________
66
154
122
158
88
278
77
104
71
108
N ew Zealand.............. ..........
Scotland............................ .
Switzerland............................
United States (birth-registration area)....................
Uruguay.................................
147
160
147
170
139
173
192
189
87
50
85
51
87
48
93
48
84
45
73
51
76
48
58
67
42
77
55
124
101
145
62
70
76
94
68
64
64
63
62
126
152
76
90
97
147
70
78
107
155
65
79
100
183
65
88
102
156
70
82
92
165
63
84
54
141
90
147
64
74
100
111
101
124
94
107
101
110
87
101
86
117
76
107
79
258
146
80
155
75
85
89
105
99
168
68
119
142
179
58
40
86
139
91
1926
54
25Í
154
84
146
70
167
146
40
83
55
58
57
72
115.
73
1 Figures from official sources: Rates are for territories as constituted at date shown.
2 Omitting from calculation the deaths of infants occurring before registration (within three days of birth) .
2 Omitting from calculation prior to 1924 the deaths of infants occurring before registration (within three
days of birth).
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Federal Reserve Bank of St. Louis
A P P E N D IX D.— P U B L IC A T IO N S A N D E X H IB IT S O F T H E C H IL D R E N ’S
B U R E A U B E A R IN G U P O N M A T E R N A L , IN F A N T , A N D C H ILD W E L
F A R E A N D H Y G IE N E
B U L L E T IN S
.
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.
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, 1925. No. 156. 81 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, 1926. No. 178. 95 pp.
Proceedings of the Third Annual Conference of State Directors in Charge of
the Local Administration of the Maternity and Infancy Act (act of Congress
of November 23, 1921), Held in Washington, D. C., January 11-13, 1926.
No. 157. 209 pp.
The Physician’s Part in a Practical State Program of Prenatal Care, by
Fred L. Adair, M. D. Standards of Prenatal Care, by Robert L. De
Normandie, M. D. Separate No. 1. 20 pp.
The Nurse’s Part in a State Program of Prenatal Care, by Carolyn Conant
Van Blarcom, R. N. Separate No. 2. 8 pp.
How to Make a Study of Maternal Mortality, by Robert L. De Normandie,
M. D. Separate No. 3. 11 pp.
A Demonstration of the Community Control of Rickets, by Martha M
Eliot, M. D. Separate No. 4. 5 pp.
Stimulation of Birth Registration, by William H. Davis, M. D. Separate
No. 5. 5 pp.
The Practical Application of Mental Hygiene to the Welfare of the Child,
by D. A. Thom, M. D. Separate No. 6. 9 pp.
Nutrition in Relation to Reproduction and Vitality of the Offspring, by
Nina Simmonds, Sc. D. Separate No. 7. 11 pp.
Proceedings of the Fourth Annual Conference of State Directors in Charge of
the Local Administration of the Maternity and Infancy Act (act of Congress
of November 23, 1921), Held in Washington, D. C., January 11-13, 1927.
No. 18L 167 pp.
The Problem of Compulsory Notification of Puerperal Septicemia, by
George Clark Mosher, M. D. Separate No. 1. 13 pp.
The County Health Organization in Relation to Maternity and Infancy
Work and Its Permanency, by John A. Ferrell, M. D. Separate No. 2.
12 pp.
Evaluation of Maternity and Infancy Work in a Generalized Program, by
Jessie L. Marriner. Separate No. 3. 4 pp.
Breast-Feeding Demonstrations, by Frank Howard Richardson, M. D.
Separate No. 4. 8 pp.
Foundation for Permanent Child-Hygiene Program in New Hampshire, by
Elena M. Crough. Separate No. 5. 4 pp.
Standards for Training of Public-Health Nurses, by Elizabeth Fox. Sepa. rate No. 6. 7 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. N q. 30. 82 pp.
' ' ''1 4 8 "
........................ • -
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Federal Reserve Bank of St. Louis
J - '■
149
APPEN D IXES
Child Management (revised September, 1927), by D. A. Thom, M. D. No. 143.
47 pp.
Standards of Prenatal Care; an outline for the use of physicians. No. 153.
4 pp. (Also sample form for pregnancy record.)
Breast Feeding. No. 83. 13 pp.
Standards for Physicians Conducting Conferences at Child-Health Centers.
No. 154. 11 pp. (Also sample forms for conference record.)
How to Conduct a Children’s Health Conference. No. 23. 24 pp.
Children’s Health Centers. No. 45. 7 pp.
The Public-Health Nurse; how she helps to keep the babies well. No. 47. 7 pp.
Milk, the Indispensable Food for Children, by Dorothy Reed Mendenhall, M. D.
No. 163. 43 pp.
What is Malnutrition? (revised), by Lydia J. Roberts. No. 59. 19 pp.
Nutrition Work for Preschool Children, by Agnes K. Hanna. No. 138. 25 pp.
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.
References on the Physical Growth and Development of the Normal Child. No.
179. 353 pp.
The Hygiene of Maternity and Childhood— Outlines for Study. Separate No. 1
from Child Care and Child Welfare, prepared in cooperation with the Federal
Board for Vocational Education. No. 90. 327 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.
Habit Clinics for the Child, of Preschool A g e; their organization and practical
value, by D. A. Thom, M. D. No. 135. 71 pp.
Posture Clinics; organization and exercises, by Armin Klein, M. D. No. 164.
32 pp.
Posture Exercises; a handbook for schools and for teachers of physical educa
tion, by Armin Klein, M. D., and Leah C. Thomas. No. 165. 33 pp.
A Study of Maternity Homes in Minnesota and Pennsylvania. No. 167. 92 pp.
Recreation for Blind Children, by Martha Travilla Speakman. No. 172. 74 pp.
A Tabular Summary of State Laws Relating to Public Aid to Children in ThenOwn Homes in Effect January 1, 1925, and the text of the laws of certain
States. Revised edition. Chart No. 3. 37 pp.
Minimum Standards for Child Welfare Adopted by the Washington and Regional
Conferences on Child Welfare, 1919. No. 62. 15 pp.
LEAFLETS
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.) 8j pp.
The Trend of Maternal Mortality Rates in the United States Death-Registra
tion Area, 1900-1921, by Robert Morse Woodbury, Ph. D. (Reprinted from
the American Journal of Public Health, September, 1924.) 7 pp.
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.
What Is the Future of the Day Nursery? By Grace Abbott. (Reprinted from
Child Health Bulletin, vol. 3, no. 2, February, 1927.)
FO LD E R S
Minimum Standards of Prenatal Care (revised).
Backyard Playgrounds. No. 2.
Why Drink Milk? No. 3.
What Builds Babies? No. 4.
Sunlight for Babies. No. 5.
Breast Feeding. No. 8.
Keeping the Well Baby Well. No. 9.
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Federal Reserve Bank of St. Louis
No. 1.
150
M ATERNITY AND IN FAN C Y
DO DGERS
Books and Pamphlets on Child Care (revised). No. 1.
Is Your Child’s Birth Recorded? (revised). No. 3.
Feeding the Child. No. 8.
What Do Growing Children Need? No. 10.
S M A L L C H A R TS
Baby’s Daily Time Cards (a series of six cards, 5 by 8 inches, a different color
for each age period). Chart No. 14.
E X H IB IT M A T E R I A L 1
The Health of th^ Child Is the Power of the Nation (poster in colors, 18 by 24
inches).
Posture Standards (6 charts, 18 by 38 inches). To be purchased directly from
the Government Printing Office at 50 cents for the set of 6 or 25 cents for
the three girls’ charts or for the three boys’ charts.
Well Born. (Two-reel film, showing time 30 minutes. Titles in English or
Spanish.)
Our Children. (Two-reel film, showing time 35 minutes. Titles in English or
Spanish.)
Posture. (Two-reel film, showing time 20 minutes. Either reel may be used
alone, the first being a general introduction suitable for parents and children.)
Sun Babies. (One-reel film, showing time 15 minutes. This shows how to give
sun baths in order to prevent and cure rickets.)
The Best-Fed Baby. (One-reel film, showing time 15 minutes. This shows the
importance of breast feeding.)
Trails That Dead to Mothers and Babies. (Film slide illustrating the work
done under the maternity and infancy act.)
The Healthy Baby. (Film slide showing the care of the baby to 2 years of
age.)
Rickets. (Film slide showing the effects of the disease and how it is prevented
and cured.)
The Preschool Days of Betty Jones. (Film slide showing the care of the
preschool child.)
The Care of the Baby (50 lantern slides).
Infant and Child Welfare (54 lantern slides).
Maternity and Child-Health Center (model; weight, 109 pounds).
Children’s Nursery (model; weight, 245 pounds).
City Playground for Children (model; weight, 109 pounds).
Demonstration of Posture Exercises (model; weight, 90 pounds).
Sun Baths for Babies (model; weight, 95 pounds).
1 Detailed descriptions of the exhibit material available from the Children’s Bureau and
of the conditions and procedure of loan and purchase can he had on application to the
bureau.
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Federal Reserve Bank of St. Louis
@FedFRASER