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U. S. DEPARTM ENT OF LABOR
JAMEIS J. DAVIS, Secretary

CHILDREN’S BUREAU
G RAC E ABBO TT. 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 30,1928

Bureau Publication N o. 194

U N ITE D STATES
G OVERN M EN T PR IN TIN G OFFICE
W ASHINGTON : 1929

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CONTENTS
Page

Letter of transmittal__________________________________________________
Introduction__________________________________________________________
Funds available and accepted by the States_________________________ _
Summary of State activities during 1928____________________________
Personnel of the administrative staffs_____________________________
Conferences______________________________________________________
Permanent prenatal and child-health centers______________________
Defects found at conferences_____________________________________
County health departments and county nurses. ___________________
Home visits_______________________ ______________________________ _
Local demonstrations of maternity and infancy programs_________
Promotion of breast feeding______________________________________
Prenatal care____________________________________________________
Care during and after confinement_______________ ________________
Inspection of maternity and infant homes________________________
Midwives________________________________________________________
Classes for adults in infant and prenatal care__________________ _
Classes for girls in infant and child care___________________________
Instruction of special groups in maternal and infant care__________
Talks and lectures________________________________________________
Prenatal letters and correspondence courses_______________________
Distribution of literature____________ _______________________
Extension of the United States birth and death registration areas...
Surveys and campaigns___________________________________________
Maternal-mortality study________________________________________
Expansion of activities________________________________________
Organizations cooperating in the maternity and infancy work_____
Summary of results of operation of the maternity and infancy act_____
Work with racial groups__________________________ ;______________
Extension of the birth and death registration areas_______________
Progress in education of midwives____________________________ ____
Reduction of morbidity and prevention of disease______________. . .
The infant mortality rate_________________________________________
The maternal mortality rate____________________________________ _
Letters from parents and physicians, and reports from field nurses.
Principal activities of the individual States during 1928______ _________
Alabama_______________________________________________
Arizona________________________________________________________ _
Arkansas______________________________________ __________________
California_____________________________________________________
Colorado______________________________________________ _____ _____
Delaware___________________________________________
Florida___________________________________
Georgia__________________________________________________________
Hawaii_______________________________
Idaho__________________________________________________
Indiana________________________________
Iowa____________________________________ _____ _______________
Kansas_____________________________________________________
Kentucky_________________________________________________
Louisiana___________________________________________ ___
Maine_________________________________

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CONTENTS

Principal activities o f the individual States during 1928— Continued.
Maryland_________________________________________________________
Michigan__________________________________________________________
Minnesota_________________________________________________________
Mississippi________________________________________________________
Missouri______________________>___________________________________
Montana____________________ ____________________________ _________
Nebraska__________________________________________________________
Nevada_____________________ _____________________________________
New Hampshire________ __________________________________________
New Jersey________________________________________________________
New M exico_______________________________________________________
New Y ork_________________________________________________________
North Carolina____________________________________________________
North Dakota_____________________________________________________
Ohio_______________________________ _______________________________
Oklahoma___ _____________________________________________________
Oregon_________________________________________ __________________
Pennsylvania______________________________________________________
Rhode Island______________________________________________________
South Carolina____________________________________________ _______
South Dakota_____________________________________________________
Tennessee___________________ ______________________________________
Texas_______________ _____________________________________________
Utah___________________ *_________________________ 2 _______________
Vermont______________________________________ ________ ___________
Virginia___________________________________________________________
Washington_______________________________________________________
West Virginia_____________________________________________________
Wisconsin______________________________ ___________ _______________
Wyoming_________________________________________________________
Federal administration_________________________________________________
Federal staff______________ ________________________________________
Conference of State directors_______________________________________
Promotion of birth registration____________________________________
Special assistance to States_________________________________________
Research and publications_________________________________________
Appendixes:
A. Text of the act for the promotion of the welfare and hygiene of
maternity and infancy, and of supplementary legislation______
B. Administrative agencies and officers_____________________________
C. Maternal and infant mortality rates____________________________
D. Publications and exhibits of the Children’s Bureau bearing upon
maternal, infant, and child welfare and hygiene_______________
ILLUSTRATIONS
States accepting the benefits of the act (map)__________________________
Old and new types of midwife, South Carolina: 1. Midwives of the old
type. 2. A midwife of the new type. 3. At the institute for negro
midwives. 4. A nurse midwife (graduate of Bellevue Hospital) who
served as instructor in the institute_____________________________ facing
Type of home in a sparsely settled State (New Mexico) into which litera
ture on infant and prenatal care is sent; children (Missouri) successful
in a six-point competition (adjudged normal or corrected in vision,
hearing, throat, teeth, posture, and weight); and a class for Indian girls
(Nebraska) in infant and childcare_____________________________ facing
Deaths of infants under 1 year of age from all causes and deaths under 1
year of age from diarrhea and enteritis, per 1,000 live births; Delaware,
1921-1927___________________________________________________________
Trend of maternal mortality; Indiana, 1911-1927_______________________
Distribution of 182 child-health conferences in Kansas, 1927-28________
Infant mortality rates, by counties; Maine, 1920 and 1927______________
Counties receiving aid for nursing services and distribution of maternity
and infancy work, by counties, Montana_____________________________
Distribution of child-health conferences and classes for women and girls;
Nebraska, 1927-28_________________________ __________________T______

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CONTENTS

Di1922-1928

maternity and infan°y work, by counties; New Mexico,

Trend of infant mortality; Oregon, ¡919-^19271 III III II
Trend of maternal mortality; Oregon, 1919—1927__ 11II _ I _ _ 11Z11
Deaths of infants under 1 year of age from all causes and from'diarrhea
and enteritis, per 1,000 live births; Pennsylvania, 1915-1927________
Deaths of children under 5 years of age from diphtheria, per 100,000 esti
mated population of these ages; Pennsylvania, 1915-1927
1927 28°° ° f Prenatal and child“health centers, by counties; Wisconsin,

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LETTER OF TRANSMITTAL

U. S. D e p a r t m e n t

op L abor ,
C h il d r e n ’ s B u r e a u ,

_
.
”
Washington, July 8, 1928.
,
• -there is transmitted, herewith the report of the administra
tion o f the maternity and infancy act for the fiscal year ended June
30, 1928, prepared under the direction of Dr. Blanche M . Haines,
director o f the maternity and infant-hygiene division of the bureau.
Respectfully submitted.

Hon.

G race A
J am es J . D

a v is ,

Secretary of Labor.

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bbott ,

C h ief.

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X
THE PROMOTION OF THE WELFARE AND HYGIENE
OF MATERNITY AND INFANCY
INTRODUCTION
A t the close of the fiscal year 1928 all the States in the Union
except three,1 also the Territory of Hawaii, were cooperating under
the provisions of the act for the promotion of the welfare and hygiene
of maternity and infancy known as the Sheppard-Towner Act,
which was passed by the Sixty-seventh Congress and approved by
the President on November 23, 1921, and was extended to include
Hawaii on March 10, 1924.
The appropriation authorized by the act was $1,240,000 for a
5-year period ending with the close of the fiscal year 1927. This
period was extended by a bill which passed Congress in January,
1927, authorizing the appropriation for the fiscal years 1928 and
Â 1929 and at the same time providing for the repeal of the act on
June 3 0 ,1929.2

FUNDS AVAILABLE AND ACCEPTED B Y THE STATES
¡P

The funds authorized by the maternity and infancy act first became
available in March, 1922. The administration of the funds from
that date to June 30, 1927, has been reported.3 Table 1 shows the
amounts available and the total amounts accepted by the States from
the appropriations for the fiscal years 1922 to 1928.
1 Connecticut, Illinois, Massachusetts.
2 F or text o f the acts o f Congress in regard to the prom otion o f the welfare and hygiene
o f m aternity and infancy see Appendix A , p. 163.
8 The Prom otion o f the W elfare and Hygiene o f M aternity and Infancy. United States
Children's Bureau Publications Nos. 137, 146, 156, 178, and 186. W ashington, 1924-1928.

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fcO

T a b l e 1.— Am ou n ts available to States and H a w a ii fro m Federal maternity and infancy fu n d s and amounts accepted 1

States and Territory cooperating

Total________________________________

Oklahoma............................................................

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Amounts accepted by States and Hawaii3 from—

Maximum

Maximum
amounts
available
from 1922
appropri
ation 2

Amounts
accepted by
States from
1922 appro
priation

able from 1923,
1924,1925,1926,
1927, and 1928
appropriations

1923 appro
priation

1924 appro
priation

1925 appro
priation

1926 appro
priation

1927 appro
priation

$477,500.00

$316,554.02

3$1,201,725.96

$716,333.40

$877,122.04

$932,754.69

$947,959.59

$977,866.97

$919,075.78

10,297. 56
5, 753.88
8,953.03
12,731.12
7,119.83
8,114.75
5,503.10
7,184.90
11,533.10

10,297.56
5,000.00
5,000.00
(*)
5,000.00
8,114.75
5,503.10
5,000.00
6,750.00

25,836.95
12,253.7l
21,817.51
33.112.01
16,337.20
19,311.48
11,504.01
16,531.72
29,530.55
3 11,725.96
12,912.66
53,739.10
29,763.62
26,213.60
21,932.52
26,298.64
22,129.80
15,179.77
19,777.05
35,981. 70
34i 741.11
26,099.65
22,076.58
32,958.19
13,701.91
18,743.21
10,522.06
12,988.31
31,284.55
12,430.33
80,041.78
27,259.66
14,362. 74
48,843.46
23,679.48

25,836.95
5,000.00
6,855.75
24,279.35
9,976.99
9,655. 74
11,504.01
8,621.28
11, 000.00

25,836.95
12,253.71
16,817.51
13,114.93
9,999.33

25,836.95
12,253. 71
13,500.00
15,620.00
9,999.37

25,836.95
5,000.00
14,000.00
26,730.00
10, 000.00

25,836.95
12,253.71
12, 000.00
23,941.58
10, 000.00

25,836.95
12,253.71
21,817.51
29,130.00
5,000.00

11,504.01
16,531.72
15,250.00

11,504.01
16,531.72
29,530.00
9,933.93
9,308.40

11,504.01
16,531.72
29,530.55
11,725.96
6, 000.00

11,504.01
16,531.72
29,530.55
11,725.96
7,500.00
25,000.00
26,213.60
20, 000.00
26,298.64
5,000.00
5,000.00
19,277.00
34,741.11
26,099.65
5,000.00
30,000.00
13,700.00
11, 000.00
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

5,974.30
19,631.03
11,611.07
10,423.56
8,991.51
10,452.00
9,057.50
6,732.66
8,270.49
13.691.06
13.276.07
10,385.44
9,039.70
12,679.67
6,238.31
7,924.66
5,174.63
5,999.61
12,119.83
5,812.96
28,429.70
10,773.47
6,459.36
17,993.41
9,575.88

5,000.00

8,199.09
10,423.56
8,991.51
10,452.00
7,913. 57
13,253.97
10,385.44
9,039. 70
12,473.15
6,238.31
7,924.66
5,000.00
5,000,00
12,119.83
5,812.96
10,773.47
5,000.00
7,187.95
5,000.00

6,250.00

7,912.66

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

24,995.00
26,213.60
12,097.33
26,298.64

26,250.00
26,213.60

25,750.00
26,213.60

25,000.00
26,213.60

26,298.64
17,590.60

26,298.64
22,127. 79

26,298.64
21,664.27

19,277.05

19,269.05

Ï9, Ï64. 58

19,277.00

25,000.00
26,213.60
16,800.00
26,298.64
22,129.80
15,000.00
19,277.00

34,741.11
26,099.65
22,076.58
28,527.38
13,701.91
17,661.69
5,000.00
5,000.00
31,284.55
12,430.33

34,741.11
26,099.65
22,076.58
21,762.17
13,701.91
7,409.50
10,522.00
12,988.31
31,284.55
12,236.40
80,041.78
27,259.66
6, 000.00
17,297.89
20,934.06

34,741.11
26,099.65
22,076.58
24,000.00
13,701.91
11,915.00
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

34,741.11
26,099.65
22,076.58
25,000.00
13,700.00
12,980.00
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

34,74Ï. Ï1
26,099.65
22,076.58
32,958.19
13,700.00
11, 000.00
10,522.00
12,988.31
31,284.55
12,430.33
80,041.78
27,259. 66
7,200.00
32,500.00
23,679.48

27,259.66
6, 000.00
11,900.00
5,000.00

1928 appro
priation *

THE WELFARE AND HYGIENE OF MATERNITY AND

[Statement as of June 30, 1928]

*Zj

>
*

6,767.35
24,672.69
6,363.54
8, 798.54
6,436.07
10,274.35
15,520.41
6,013.85
5,795.09
10,209.61
8,060.58
8,302.16
10,938.04
5,438.57

6,232.61
24,667.12
8,797.50
6,436.07
5,000.00
9,363.93
5,000.00
({)
10,209.61
4,998. 70
5,000.00
8,995.03
4,998.87

15,283.46
68,810.99
14,076.28
21,355. 65
14,293.11
25,767. 55
41,450. 52
13,030.89
12,376.90
25,574.00
19,149.55
19,871.74
27,751.6211,311.12

8, 000.00
68,810.20
21,355. 65
12,844.24
18,521. 94
32,567.38
6,365.00
25,574.00
10, 000.00
5,000.00
27,750.44
5,000.00

15,283.46
68,810.99
4,999.86
21,355. 65
14,272.92
22,410.73
40,689. 20
13,000.00
2,775.33
25,574.00
10, 000.00
10, 000.00
27,751.62
11, 000.00

15,283.46
68,810.99
14,076.28
21,355.47
13,451.18
25,767.55
40,447.84
13,000.00
4,281.36
25, 574.00
10, 000.00
10, 000.00
27,751.62
6,600.00

11,966.83
68,810.99
14,076.28
21,355.65
14,285.10
25,767. 55
35,350. 52
12,279.23
4,937.38
25,574.00
10, 000.00
19,871. 74
27,751.62
6,600.00

15,283.46
68,810.99
14,076.28
21,355.65
5,000.00
25,767.55
35,350.52
13,000.00
5,000.00
25,574.00
5,000.00
19,871.74
27,751.62
7,500.00

15,283.46
68,810.99
14,076.28
21,355.65
5.000.
24.035.00
41,450.52
13,000.00
5.000.
25.574.00
5.000. 00
19,871.74
27,751.62
5.000.

’ Underthe terms of the act each State accepting receives $5,000 outright; an additional $5,000 is available to each State if matched; the balance of the appropriation is distributed
r t h e gF e d e r S e “
S
SSne 30^928 populatlon- Amounts shown “ accePted are the amounts a<*ually accepted by the States less
! S^ing toi he
tha* only a
mohthsof the 1922 fiscal year remained at the time the appropriation act for that year was passed a full appropriation was not made
to the S t a t e n each yelr f r o S w f f l M b t e t a
»
'
appropriation therefore was available to that Territory in 1923 and 1924. The total amount available
,, 4 Actual amounts accepted to June 30,1928, are given here. These funds are available until July 1,1929, as under the terms of the maternity and infancv act C42 Stat 224 sec 21
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 expenditures in that State until the
close of the succeeding fiscal year.” Payments from the 1928 appropriations will be made to many of the States during 1929. As both the oririnalactSthe^annm nriatfom unde?

fdetc™orotf% Urn 9,3? 9 ^ :M ^ C o m p .S .
General ° f ^ United ^
haS ^
^
n0 iUndS ™ r i a i ^ t e d e r
8 California and Illinois accepted the full amount available, and Vermont accepted $5,000. However, these funds were not spent but were returned to the Federal Treasury.

FUNDS AVAILABLE AND ACCEPTED BY STATES

Oregon.............
Pennsylvania..
Rhode IslandSouth Carolina
South Dakota.
Tennessee.......
Texas.............
Utah...............
Vermont.........
Virginia______
Washington___
West Virginia..
Wisconsin____
Wyoming_____

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SUMMARY OF STATE ACTIVITIES DURING 1928
General educational work has been continued in the cooperating
States during the year ended June 30, 1928. Instruction has been
given to individual parents at health conferences and in their homes;
information has been disseminated to members of the medical and
nursing professions, teachers, mothers, young girls, and midwives;
and literature relating to maternal and infant care has been widely
distributed.
Besides increasing the scope of these activities a number of States
have also put emphasis on other types of work directed against vari
ous factors adverse to the health of mothers and babies. Among such
special activities were efforts to increase the use of silver nitrate for
prevention of ophthalmia neonatorum and the use of toxin-antitoxin
for prevention of diphtheria in young children. Assistance has
been given toward the investigation and regulation of milk supplies
in regions having high infant mortality rates due to diarrhea and
enteritis. The attempt to reduce maternal mortality, particularly
the deaths from puerperal sepsis, has continued, especially through
the instruction, supervision, and regulation of midwives and the
elimination of those found unfit to practice.
PERSONNEL OF THE ADM IN ISTRATIVE STAFFS

The needs of the State and the size of its budget determine not
only the amount and to a great degree the kinds of work to be done
but also the number and type of personnel employed in conducting the
work. Physicians, nurses, dentists or dental hygienists, nutritionists,
social workers, teachers, and clerical workers were on the staffs of
the State bureaus and divisions of child hygiene.
In all except 4 of the 45 States accepting the provisions of the
Sheppard-Towner A ct the administration is lodged in the State de
partment of health, and the head of the health department is in
every case a physician.
W ith reference to the four exceptions: Nebraska and New Mexico
have no State department of health, and the administration of the
act in these two States is in the bureau of health of the State depart
ment o f public welfare, the head of the bureau of health being in
each State a physician. In Colorado the administration o f the act
was given by the State legislature to an already existing bureau of
child welfare in the State department of education; two physicians
are employed by this bureau for the maternal and infant-hygiene
work. In Iowa the legislature gave the administration to the ex
tension department of the State University of Iow a; the faculty of
the medical school of the university constitute the medical advisory
committee, and physicians on the staff of the maternity and infancy
division of the extension service supervise the work.
5

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the

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

During the year under review physicians were in immediate charge
of the work— usually as directors of the maternity and infancy or v >
child-health divisions of the State department of health— in 30 or the r^L
45 cooperating States: Arkansas, California, Delaware, Georgia,
Idaho, Indiana, Kansas, Kentucky, Maryland, Michigan, Minnesota,
Mississippi, Missouri, Montana, New Jersey, New York, North Caro
lina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode
Island, Tennessee, Texas, Utah, Vermont, Virginia, Wisconsin, and
Wyoming. Nurses directed the work in the Territory of Hawaii
and in 10 States— Alabama, Florida, Maine, Nebraska, New Hamp
shire, New Mexico, South Carolina, South Dakota, Washington,
and W est Virginia; while in 5 States— Arizona, Colorado, Iowa,
Louisiana, and Nevada— the administrative heads of the divisions
were neither physicians nor nurses. In all these States except the
4 previously mentioned, however, the division was part of a depart
ment of health, headed by a physician.
Including State directors paid from maternity and infancy funds,
36 physicians gave full time for the whole year and 25 gave full time
for part of the year. Thirteen gave part-time service for the entire
year and seven gave part-time service for part of the year. In
addition many physicians were employed for occasional service or
by the day in 13 States: Colorado, Delaware, Indiana, Louisiana,
Maryland, Missouri, Montana, New Hampshire, New York, Ohio,
Utah, Virginia, and Washington. In Maryland 60 physicians were
employed by the day; in New York 292 were employed for occasional
service at conferences; in Montana 16 were employed for occasional JL,
service at conferences; and Washington employed 12 pediatricians *
by the day to conduct child-health conferences. Thirty-seven States
and Hawaii had physicians on their staffs. In 33 States and Hawaii
the physicians were paid from maternity and infancy funds. In 5 ^
others— Arkansas, New Jersey, New York, Vermont, and Wyoming— ™
salaries were paid from other State funds for the services of the
medical directors, the State health officers in 3 of these States—
Arkansas, Vermont, and Wyoming— acting as directors. In the 45
cooperating States and the Territory of Hawaii approximately 500
physicians were employed for varying periods during the year.
The services rendered by physicians include general administration,
conducting of child-health and prenatal conferences and classes for
mothers, and other educational work for promotion of the health
of mothers and children and prevention of diseases to which they are
particularly subject.
Public-health nurses were employed in the Territory of Hawaii and
the 45 cooperating States, either as members of the State headquarters
staff or on detail to counties. Not including the 390 nurses detailed
to counties, approximately 425 nurses served during the year on
State headquarters staffs for varying periods of maternity and in
fancy work. In 43 States and the Territory of Hawaii nurses served
on the State headquarters staff. In 36 States and Hawaii 146 nurses
were employed for full-time service the entire year. Ninety-six
nurses were employed for full time a part of the year, 6 for part
time the entire year, and 21 for part time during part of the year.
In Colorado additional nurses were employed by the day, and in
Pennsylvania 140 to 150 State nurses were paid from maternity and
infancy funds for time spent in maternity and infancy work. Nurses

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SUMMA&Y OF STATE ACTIVitlES DtJEIEG 192 8

have served as administrators of bureaus or divisions of child hygiene,
as supervisors and advisers of county and; field nurses, and as
instructors of midwives. They visited preschool children and ex
pectant mothers in their homes, and through these visits they assisted
in the development of prenatal and child-health centers. They in
spected maternity and infant homes, conducted demonstrations in
infant and prenatal care and campaigns to promote breast feeding,
assisted with birth-registration campaigns, made surveys, and organ
ized many types of work.
A few States employed dentists and dental hygienists to promote
oral hygiene among tne expectant mothers and preschool children.
Three dentists and a dental hygienist gave full time for the entire
year (in Iowa, Louisiana, New York, and U tah). Five dentists and
five dental hygienists gave full-time service part of the year, and one
dental hygienist gave part-time service the entire year. Eight den
tists were employed by the day in Maryland.
The supervision and instruction of midwives has been an important
feature of the work, particularly in the South, and many staff and
county nurses include it in their regular programs. Four midwife
supervisors and teachers were employed for full-time service during
the entire year in three States. Three of these supervisors were
physicians, and the fourth was a nurse (not included among the
physicians and nurses mentioned in the foregoing paragraphs). A
fifth was employed for full-time service part of the year in another
State, a sixth for part-time service the entire year in still another
State. Nine nurses served as supervisors and instructors o f midwives
and also as inspectors of maternity and infant homes in New Jersey.
Inspectors of maternity and infant homes were employed in five
States. In California, Ohio, and Texas four inspectors were employed
full time during the year. Nebraska employed a part-time inspector
for the entire year. New Jersey employed nine nurses as both in
spectors of maternity and infant homes and supervisors of midwives,
as has been stated.
The child-hygiene bureaus and divisions generally have used their
funds to employ physicians and nurses or other trained field workers
and have maintained small clerical staffs. A total of 165 clerks and
stenographers were paid from maternity and infancy funds during
the year under review. In 36 States and the Territory of Hawaii
118 were employed full time, 28 were employed full time for part o f
the year, and 19 were employed part time for the whole year. Eight
States— Arizona, Idaho, Louisiana, Missouri, New Jersey, Oregon,
South Dakota, and Tennessee— had only part-year or part-time cleri
cal and stenographic assistants paid from maternity and infancy
funds. One State— Nevada— had no stenographers nor clerks on its
maternity and infancy staff. F ifty additional workers were reported,
including nutritionists, lecturers, statisticians, and chauffeurs for
child-welfare trucks.
Twenty States reported approximately 7,000 volunteer assistants
as giving their services to the maternity and infancy work. These
volunteers included physicians, dentists, nurses, and lay persons.
Pennsylvania reported such services of approximately 1,000 physi
cians, and Utah the services of approximately 1,000 volunteers,
including physicians, dentists, nurses, and lay persons.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The total number of workers paid in whole or in part from ma
ternity and infancy funds in the cooperating States and Hawaii
during the year under review was approximately 1,600, of whom
353 were employed full time for the entire year. This number is in
striking contrast to the large number of volunteer workers who gave
freely of their time to promote the work for mothers and children.
CONFERENCES

Child-health conferences have provided the main channel through
which trained professional workers have been able to give to parents
information in regard to the care, hygiene, and health of their chil
dren. Through conferences the problems in the care of expectant
mothers have been given special attention also.
A s in previous years, five types of conference have been held:
Child-health conferences, prenatal conferences, and combined pre
natal and child-health conferences (all conducted by physicians),
conferences conducted by nurses, and dental conferences conducted
by dentists. Conferences were held in permanent centers and in the
headquarters of the local health departments. Itinerant conferences
were conducted by traveling units of physicians and nurses trans
ported by means of trucks containing an examining room and
equipped with supplies, or automobiles were used to transport physi
cians, nurses, and supplies to a temporary center or quarters arranged
for the conference.
During the year under review 7,341 combined prenatal and childhealth conferences were conducted by physicians in eight States:
Delaware, Nevada, New York, North Carolina, South Dakota,
Tennessee, Utah, and Wisconsin. A t the conferences 4,283 expectant
mothers were registered, 3,789 were examined, and 23,273 visits were
made by them to the conferences. The number of infants and pre
school children registered was 34,271, the number examined was
34,244, and 47,421 visits were made by children to conferences of
this type.
Child-health conferences were conducted by physicians in the
Territory of Hawaii and 41 States: Alabama, Arizona, Arkansas,
California, Colorado, Delaware, Florida, Georgia, Idaho, Indiana,
Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan,
Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, North Dakota,
Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, Tennessee, Texas, Vermont, Virginia, Washington, West
Virginia, and Wyoming. Altogether 19,840 such conferences were
held, 182,618 infants and preschool children were registered, and
185,622 were examined. One State that reported 8,033 children ex
amined did not report the number registered. The children made
298,468 visits to the conferences.
Prenatal conferences were conducted by physicians in 18 States:
Alabama, Arkansas, California, Colorado, Delaware, Florida,
Georgia, Kentucky, Maryland, Michigan, Mississippi, New Jersey,
New York, Oregon, Pennsylvania, South Carolina, Tennessee, and
Texas. The number of conferences held was 2,002; 8,153 expectant
mothers were reported registered and 10,440 were examined. One

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SUMMARY OF STATE ACTIVITIES DURING 1 9 2 8

State reported 2,998 mothers examined but did not report the number
registered. The number of visits to the conferences was 14,258.
Nurses conducted 11,580 health conferences (with no physician pres
ent) in the Territory of Hawaii and 27 States: Alabama, Arizona,
Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho,
Kansas, Kentucky, Louisiana, Maine, Maryland, Missouri, Montana,
Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio,
South Carolina, Tennessee, Texas, Virginia, and Wyoming. A t the
conferences 72,565 infants and preschool children were inspected, and
7,122 expectant mothers were reported instructed in prenatal care.
Children made 129,117 visits, and expectant mothers made 10,266
visits to the conferences.
Dentists conducted 851 dental conferences in 15 States: Arizona,
Arkansas, California, Florida, Georgia, Iowa, Louisiana, Maryland,
Mississippi, New Hampshire, New Mexico, Oklahoma, Oregon,
Texas, and Utah. A t 768 of these conferences 180 expectant mothers
were given dental examination and advice, and 21,413 preschool
children were examined, advice being given on dental care and oral
hygiene. One State did not report the number of mothers and
children attending the conferences.
In the 45 cooperating States and the Territory of Hawaii a total of
219,866 infants and preschool children were examined by physicians
at child-health conferences and combined prenatal and child-health
conferences. Including with this number the children inspected by
nurses and those receiving examinations by dentists, 313,844 infants
and preschool children were reported as under supervision at confer
ences during the vear.1 Pennsylvania led in the number o f children
examined at conferences— 19,219; New York was next with 13,841.
Alabama, Indiana, New Jersey, North Carolina, and Utah each re
ported more than 10,000 children examined at conferences.
The total number of expectant mothers examined by physicians at
prenatal conferences and combined prenatal and child-health confer
ences in the 22 States reporting was 14,229. Including with this num
ber those advised at conferences held by nurses and by dentists 21,531
expectant mothers received advice on some phase o f prenatal care at
these conferences.1 In the number of expectant mothers examined
at conferences New York State led with 4,324; Georgia was next with
2,998.
A feature of the year’s work was the extension of prenatal care
through prenatal conferences to the patients of colored midwives. It
was possible through these conferences to place under antisyphilitic
treatment many expectant mothers whose Wassermann reactions were
positive.
Table 2 summarizes the conference work in the cooperating States
and the Territory of Hawaii.
’ This figure may involve some duplication, as some o f the same persons may have
attended conferences o f different types.

48278°— 29------ 2

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T a b l e 2. — Conferences held and permanent centers established in the States and the Territory o f H aw aii cooperating under the maternity and
infancy act during the year ended J une 30, 1928

Combined prenatal and
child health
States and Territory
cooperating
Ex
Num pect
ber ant
of
con moth
ers
fer regis
ences tered

Total______________

Arkansas________________

lowa-------------------------------

Minnesota_______________
Mississippi_______________
Nebraska.... .........................

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Visits to
conferences
Num
by—
ber
Chil
of
dren
con
regis Ex
tered pect Chil fer
ences
ant
moth dren
ers

1,856
56
434
583
41
302
422
39 3,972
75
1,234
1,001
33
4i a
181
175
266
484
85
440
22
3
254
484
158
100
::::::::::::

Persons re
ceiving den
tal advice

Visits to
conferences
by— .

Prenatal

ComNum
Num Chil Moth
binedber
ber
pre- Child Pre
ers
dren
of
of
Ex
natal health
in
in
Num pect
natal
Ex con Ex
con
and
Chil Num ber ant Num fer spect struct
fer pect Chil child
ed
Chil pect
ed
of moth ber
ber
dren
ant
ences
ant
ences
health
dren moth
of
con ers
of
regis
moth dren
tered visits fer regis visits
ers
ers
ences tered

7,341 4,283 34,271 23,273 47,421 19,840 182,618 298,468 2,002 8,153 14,258 11,580 72,565

Alabama— ......... ...............

Delaware...... .......................

Child health

Conferences con New health centers
established 1
ducted by dentists

11,601
905
3,777
7,779
1,401
1,688
1,768
(2)
5,022
1,451
11 874
4,274
3' 750
4,192
9) 881
1,027
6) 402
' 683
95
4,344
7,979
l) 724
3,465

14,919
1,083
3,777
10,984
1,401
12,462
1,768
(2)
20,216
1,451
11,888
4,274
3)750
4)192
11)424
1,169
7)145
683
95
4,344
9.718
1.7241
3,475

346 2,113

4,092

602
706
162
212
709
(2)

602
1,347
162
344
709
(2)

87
102
16
52
43
378

110

3
16

114

252

444

387
42
249
712
42
1,049
255
107
234
13

393
410
7,280
1,294
771
4,155
4,543
421
925
279

7
205
97
92
32

137
2,450
1,926
413
277

840 16,221
328 2,799

7,122 129,117 10,266
630 1,251
41
684
470
7,280
1,294 (2)
771
521
210 24,310
4,543
605 (2)
70
3,624
82
279
39

1,251
-28
108
(2)

65
481
16
165

180
2,450
1,926
631
320

65
481
2C
201

851

180 21,413

103

202

11
1
10
53

37
411
1 1,240

83
341

(2)
(2)
377 3 101

306

196

9,468

527

778 32,442 1,334
135.........
135 3, is:

1
4

12
21

1
1
1

4
3

THE WELFARE AND HYÔÏËNË OF MATERNITY AND ÏNFANOY

Conferences conducted by nurses

Conferences conducted by physicians

w
4

1,102
55; 173

526

434
W yom ing..........................

103

493

359 2,233

439
<43
2,494
614
«4,530

2,634
'541
3,316
8,227

204

2,826

137
310

419
329

1,516
1,513

237

12
22

57
62

57
113

129

401

342

4,167

10, 536
52 (2)
(»)
311 5,638
565
700 10,283 1,149
60

2,826

224

879
87

879
2,146
7,738 1,057

1,609

4,305 1,609

6
65 2,146
536 3,521

493

1
«40

322
534

65
125

73 2,172
29 2,885

1
12

3
1

4
6
36
3
2
33

(3)

1
20
13
9
21

20
7

1New permanent health centers, whose support has been assumed wholly or in part by the respective counties or communities in the majority of the States.
3 Not reported.
3 During the second 6 months, January to June, 1928,
< May include some conferences at which physicians were present.
3 Includes some individual conferences.
• Includes 6 conducted in connection with child-health conferences.

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SUMMARY OF STATE ACTIVITIES DURING 192 8

49
9

203
10
203
104 3,384 3,388
1,760 10) 894 29,472
1
41
41
772 15,197 (2)
2,529 2,784 21,461 3,262
1,248 11,773 l' 248 13i 537
167 5,006 5,006
85 3)828 3)828
111 2,267 2,267
326 3) 532 <348
6,246 19,219 87,552
' 210
663 3,664
128 2,774 2)888
18 1,476
18 1,476
29
18
68
107 3,893 3,893
16
383 5,057 6)428
184 13,633
180 10,927
22
638
649
146 2,979 2,979
74 3,152 3) 152
454 3'557 5)516
272 6,824
303 11,437
54 1,252 1,252
2

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

PERM AN EN T P R E N A TA L A N D C H ILD-H EALTH CENTERS

Frequently after demonstration by an itinerant child-health or
prenatal conference a permanent locally supported center, open on
regular days for health conferences, is established. To be successful
a center requires not only the services of physicians and publichealth nurses but also the interested support o f the community.
W ith the development of full-time county health departments the
necessary personnel to conduct centers becomes available in these de
partments. Thus it has been possible to establish new centers in
communities less urban than those able to maintain centers in the
earlier years of maternity and infancy work. Three types of center
have been developed: Combined prenatal and child-health centers,
to which both mothers and children come for examination and ad
vice; child-health centers, for conferences for children only; and
prenatal centers, for conferences with expectant mothers.
The total number of new permanent health centers of these three
types established during the year under review was 322. (Table 2.)
Opportunity for examination o f infants and preschool children was
given in 305 and for examination and advice for expectant mothers
in 120. The increase from 84 new centers providing opportunities
for prenatal conferences in 1927 to 120 centers of this character in
1928 is the notable feature in the development of permanent centers.
In 13 States— Alabama, Arkansas, Georgia, Maryland, Michigan,
Montana, New Hampshire, New York, North Carolina, Ohio, Ten
nessee, Utah, and Wisconsin— 103 new combined prenatal and childhealth centers were established. In the Territory o f Hawaii and™
18 States— California, Florida, Georgia, Kentucky, Louisiana, Mis
souri, Montana, New Hampshire, New Jersey, New York, Oregon,
Pennsylvania, Rhode Island, Tennessee, Texas, Virginia, W ashing
ton, and W est Virginia— 202 new permanent child-health centers
were established. In 8 States— Colorado, Georgia, Kentucky, Mary
land, Michigan, Mississippi, New Jersey, and New York— 17 new
prenatal centers were established. In the number of new combined
prenatal and child-health centers established during the year Utah
led with 33 and Wisconsin was second with 20. Pennsylvania re
ported the establishment of 36 new child-health centers, the largest
number any State reported. Louisiana and W est Virginia were
next, each with 21, and Texas reported 20. Georgia and Mississippi
each reported 4 new prenatal centers.
Complete reports of attendance and work at these centers are not
always available because a center that has become thoroughly estab
lished ceases to be an activity of the State department of health,
though the State bureau or division of child hygiene generally con
tinues to give advisory service and helps in the solution of any
problems that may arise.
DEFECTS FOUND A T CONFERENCES

A s the chief purpose of the child-health conferences is to promote
the hygiene and welfare of infants and preschool children every effort
is made to arouse the parents’ - interest in the correction of defects
and of deviations from the normal that may be found in their chil
dren. The children invited to the conferences are the so-called well
babies or apparently normal children. It is not the purpose of the

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SUMMARY OF STATE ACTIVITIES DURING 192 8

conference to give attention to sick children. I f any child attending
is found to be obviously ill the parents are urged to consult their
family physician immediately. However, many so-called well chil
dren have defects that need correction. Thirty-eight States reported
finding that 110,507 infants and preschool children had one or more
defects, and a total of 287,019 defects were recorded in 38 States.
Owing to the limited numbers of field workers on the staffs of the
State bureaus and divisions of child hygiene it was not possible to
follow up all children examined at conferences who were found to
have defects, though 20 States reported the number or percentage of
defects known to have been corrected. Arkansas reported the largest
number of children having defects corrected; 3,352 corrections were
made for 3,508 children having defects. Oregon reported that par
ents had corrections made for approximately 75 per cent of the chil
dren found to have defects. Iowa estimated (on the basis o f reports
of nurses who did follow-up work) that corrections were made for
approximately 74 per cent of the children found to have defects. The
State of Washington estimated that corrections were made for twothirds of such children.
COUNTY HEALTH DEPARTM ENTS AN D COUNTY NURSES

During the year under review 29 States reported nurses detailed to
counties, communities, or cities. Six States reported 16 county nurses
paid for full-time maternity and infancy service the entire year. Nine
States reported 22 county nurses paid for full-time service part of the
year.
Seventeen States reported 159 county nurses paid for parttime service for the entire year, and 24 States reported 193 nurses paid
for part-time maternity and infancy service part of the year. A total
of 390 county nurses were paid for full-time or part-time maternity
and infancy service, 11 other nurses were detailed to cities, and 28
Were detailed to other local communities. The States detailing nurses
to counties, communities, or cities during the year were Alabama,
Arkansas, California, Georgia, Kansas, Kentucky, Louisiana, Mary
land, Mississippi, Missouri, Montana, Nevada, New Mexico, New
York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania,2
South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia,
Washington, W est Virginia, Wisconsin, and Wyoming.
The establishment o f full-time county health departments or
county health units has caused a demand for the services o f county
nurses. The bureaus and divisions of child hygiene in many States
have included in their plans assistance to county health units through
payment in whole or in part from maternity and infancy funds of
the salaries of nurses detailed to counties. The amount of the salary
assumed by the State maternity and infancy agency has been in pro
portion to the amount o f time spent by the nurses in maternity and
infancy work. In a few States reimbursement has been on the basis
of services rendered by both the county physicians and the nurses.
In several States much of the State health work is decentralized,
being conducted through the county health departments. Thus pre
natal letters and literature are distributed from the departments,
2 N ot including the 140 to 150 nurses in the public health nursing division o f the State
department o f health in Pennsylvania, who were paid in part from maternity and infancy
funds.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

and midwives are instructed, supervised, and licensed by them. These
county units have made possible the establishment of permanent
centers for prenatal and child care in the smaller communities and
have increased the opportunities for contact with mothers and chil
dren, particularly through nurses’ visits in the homes.
In addition to nurses detailed to county health departments State
nurses have been detailed to counties not having county health depart
ments, to towns or communities, and to a few cities to develop a
maternity and infancy program.
A s opportunities for field experience in county work in connection
with training centers for county health departments have increased
and nurses have been admitted to the training centers, some of the
county nurses now entering the work have had the advantages of
this training— which now includes maternity and infancy work.
HOME VISITS

Visits of public-health nurses to homes have been a feature of
maternity and infancy programs in 40 States and the Territory of
Hawaii. The nurses have instructed expectant mothers on the care
they should obtain for themselves and their unborn babies and have
made information available to parents on the care and hygiene of
their children. Either State staff nurses or nurses detailed to
counties, communities, or cities have made 700,981 visits to homes.
Virginia reported 118,576, the largest number reported by any one
State. In New Jersey 97,961 visits were made to homes, in New
York 64,612, and in Rhode Island 53,605, most of which were made
at regular intervals to children under supervision. Only four
States Indiana, North Dakota, South Dakota, and Vermont— did
not include home visiting in their work; one— Washington— did not
report whether this type of work was done. (Table 3.)
Number o f visits made by nurses, number o f community and group
demonstrations, and number o f counties in which m aternity and infancy work
has been done, in the States and the T erritory o f Hawaii cooperating under
the m aternity and infancy act, during the year ended June SO, 1928

T able 3.

Number of counties—

States and Territory cooperating

Home
visits
by
nurses

Com
Group
munity
demon demon
strations
strations
In State

In which maternity
and infancy work
has been done—
Since the
During beginning
1928
of co
operation

Total ...........
Alabama_____
Arizona______
Arkansas___
California-.
Colorado_____
Delaware_____
Florida...... ..........
Georgia.............
Hawaii........ ......
Idaho.................
Indiana.....................

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700,981

2,953

2,074

50,081
9,041
6,081
20,844
961
31,691
5,333
24,968
14,017
811

32
7

2,671

457
601

75
58
63

67
161

14
75
58
58
3
67
160

44
92

21
53

305

SUMMARY OP STATE ACTIVITIES DURING 192 8
T able 3.— Number o f visits made by nurses, etc .— Continued
Number of counties—

States and Territory cooperating

Home
visits
by
nurses

Com
Group
munity demon
demon- strations
In State
strations

In which maternity
and infancy work
has been done—
Since the
During beginning
of co
1928
operation

325
521
350
3,398
8,674
6,462
5,005
758
6,089
5,442
3,913
1,932
3,893
11,871
97,961
4,291
64,612
33,473
12,262
1,495
5,128
43,903
53,605
6,030

Utah

.....................-

4
5
3
44

3
7
37

4,405
13,582
1,900
118,576
f)
12,814
1,110
3,373

20
200
251
622
45
453
5
958
95
264
86
312
10
262
3,221
3
140
298
2
75
33
33
1,492
122

1
0)
1

320
295
22

99
105
120
64
16
23
83
87
82
114
56
93
17
10
21
31
62
100
53
88
77
36
67
5
46
69
95
254
29
14
100
39
55
71
23

52
105
120
37
15
23
79
72
82
53
39
82
17
10
21
14
62
40
22
68
77
32
67
5
46
55
64
60
25
13
54
25
39
66
22

99
105
120
62
15
23
83
87
82
112
56
90
17
10
21
31
62
49
42
77
77
36
67
5
46
65
95
115
28
13
97
33
50
71
23

i Not reported.

LOCAL DEMONSTRATIONS OF M ATERN ITY AN D IN FANCY
PROGRAMS

Fifteen States— Arizona, Colorado, Georgia, Kentucky, Louisiana,
Michigan, Missouri, New Jersey, New Mexico, New York, Oklahoma,
South Carolina, Virginia, and Wisconsin— conducted 171 community
demonstrations during the year under review. Most o f these were
maternity and infancy nursing programs conducted in a county or
community during varying periods. When the support of a demon
stration was assumed by the county, as frequently occurred, the
program thus became a permanent piece o f work. In 1928 Missouri
conducted 44 community demonstrations, the largest number reported
by any one State during the year. The Missouri type o f demonstra
tion usually consisted of an educational program in child health, in
cluding lectures, films, special exhibits, and child-health conferences
during a week or longer. New York reported 37 community demon
strations, most of them demonstrations of maternity and infancy
nursing for which responsibility has been assumed by the communi
ties. (Table 3.)

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16
s

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Thirty-four States— Arizona, Arkansas, California, Colorado, Flor
ida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland,
Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New
Hampshire, New Jersey, New Mexico, New York, Ohio, Oklahoma,
Oregon, Rhode Island, South Carolina, South Dakota, Tennessee,
Texas, Utah, W est Virginia, Wisconsin, and Wyoming— conducted
11,906 group demonstrations on specific phases of prenatal or child
care. New York reported the largest number, 3,221, and Texas was
next with 1,492. (Table 3.) This type of demonstration included
general care of the baby, bathing, clothing (layettes), and the prepa
ration of foods and formulas ; demonstrations before midwives (such
as preparation for delivery of the mother and her care),sterilizing
dressings and pads, the care of the baby, including care of the cord
and care of the eyes, the making of simple appliances, such as an im
provised bed for the baby, delivery pads from newspapers, and bedpans from newspapers, and many other special subjects, such as care
of the breasts and manual expression of breast milk.
Exhibits of foods and lectures on preparation of foods and their
value are frequently a feature of a local demonstration. A ll the State
bureaus and divisions of child hygiene give information on proper
food for the expectant mother, the infant, and the preschool child.
Three States— Kentucky, Maine, and New York— employ nutrition
ists. In the other cooperating States nutrition is stressed at confer
ences, in talks, and lectures, and in the nurses’ visits to homes.
PROMOTION OF BREAST FEEDING

Emphasis on the importance of mother’s milk for infants has con
tinued. In many States the efforts to inform mothers of the im
portance of maintaining their supply of milk have reached the pro
portions of a campaign for breast feeding. In two States— Michigan
and New York— breast-feeding surveys and campaigns were con
ducted in certain counties. Other States depended upon talks,
lectures, conferences, nurses’ visits, literature, and demonstrations to
inform expectant and nursing mothers of the greater chance for life
and health of the breast-fed baby compared with that of the baby
who is bottle fed.
The State reports indicate that the proportion o f infants who are
breast fed varies in different sections or the United States. Colorado
reported that among 1,401 babieS examined at conferences 1,203 were
breast fed. Delaware estimated that approximately 50 per cent of
the babies in the State are breast fed. Kansas reported 2,363 breast
fed among 3,750 examined at conferences. Kentucky reported that
practically all rural mothers nurse their babies and estimated that 75
per cent of the babies in the State are breast fed. Michigan reported
that a survey completed in seven counties showed 7 per cent never to
have been breast fed and many of the remaining 93 per cent to have
been weaned early. Minnesota reported about 85 per cent breast
fed, basing this estimate on a survey of two counties. Missouri re
ported that 53 per cent of 3,594 babies examined at conferences were
breast fed at least six months. New Hampshire estimated 57 per
cent breast fed at birth, 43.5 per cent at 1 month of age, 24.8 per cent

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SUMMARY OF STATE ACTIVITIES DURING 192 8

at 3 months of age, and 15.1 per cent at 6 months. New York reported that of babies attending child-health centers in New York
City 23,242 were breast fed, 5,694 were breast and bottle fed, and
8,006 were bottle fed. South Carolina estimated at least 90 per cent
of the babies to be breast fed and reported a tendency to continue
breast feeding too long— 12 months in many instances. South Dakota
estimated that 66 per cent of the babies in the State are breast fed,
and Virginia estimated that 52 per cent are breast fed. The State
of Washington reported information on 1,507 children showing 44
per cent entirely breast fed, 33 per cent partly breast fed, and 24
per cent artificially fed. W est Virginia reported that record cards
of preschool children showed a high percentage to have been breast
fed, and Wisconsin estimated that 90 per cent of the children who
attended the health centers were breast fed.
According to these reports the proportion of babies breast fed until
weaning time was higher in many of the Southern States than in
some Northern States. Factors responsible for these variations in
percentages of breast-fed babies in different sections include local and
racial customs; types of advice given to mothers and expectant
mothers by family physicians, pediatricians, and health departments;
and the determination of the mother to provide her child with her
own milk. The effect of educational work is indicated by the high
proportion of breast feeding (90 per cent) reported by Wisconsin for
the babies supervised in the health centers.
PR E N A TA L CARE

A variety of activities have contributed to the information of the
public, of mothers, and of fathers on the importance of prenatal care.
In a measure stillbirth rates and infant and maternal mortality
rates reflect the effect of the care or the lack of care the expectant
mother receives.
Expectant mothers have been informed of the importance of pre
natal care through instruction given by nurses in visits to their
homes, through child-health conferences conducted by physicians and
nurses, in which the value of prenatal care to the child was discussed,
through itinerant prenatal conferences and permanent prenatal cen
ters, through classes and correspondence courses conducted for
mothers, and through the distribution of prenatal letters and litera
ture. County-wide demonstrations in prenatal care also were con
ducted in New York and Michigan. . Through these activities
150,000 expectant mothers were reached in 37 of the cooperating
States reporting during the year ended June 30, 1928. Seven States
and the Territory of Hawaii did not report the number of expectant
mothers reached through these activities. One State did not report
work done among expectant mothers.
Expectant mothers were urged to place themselves under the care
and supervision of their physicians early in the period of pregnancy.
The advisability of reporting to the physician at regular intervals
and of having frequent urinalyses was explained to them.

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the

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

CARE DURING A N D A F T E R CONFINEMENT

The care that women receive during and after confinement is in
fluenced by the accessibility of the services of physicians, nurses, or
hospitals, the type of hospital care available, and the types of care
given by the attendants.
The State bureaus and divisions of child hygiene or welfare have
continued efforts to improve conditions surrounding the care of
women at the time of childbirth. Several States have included in
their maternity and infancy activities the licensing and inspection of
hospitals accepting maternity cases and the inspection of maternity
homes. Graduate courses in obstetrics have been arranged for phy
sicians in several States, and the continuance of instruction, regula
tion, and supervision of midwives was reported by a number of
States.
INSPECTION OF M ATERN ITY AND IN FA N T HOMES

In three States— California, Kansas, and South Dakota— the childhygiene bureaus or divisions inspect and license maternity homes and
hospitals. During the year under review 1,394 official or unofficial
inspections were made of 1,308 maternity homes or hospitals by
the child-hygiene bureaus of 14 States— California, Colorado, Kan
sas, Kentucky, Nebraska, New Hampshire, New Jersey, New York,
Ohio, South Dakota, Tennessee, Texas, Utah, and Virginia. One
State— Georgia— reported 441 homes inspected but did not report the
number of inspections. During the same period 1,538 inspections
were made of 1,383 infant homes by the child-hygiene bureaus of
10 States; Idaho, Kansas, Kentucky, Nebraska, New Hampshire,
New Jersey, New York, Ohio, Tennessee, and Texas. Georgia re
ported 731 homes inspected but did not report the number o f
inspections.
M IDW IVES

W ork to improve mid wives has been continued by many States.
Nurses and physicians have been assigned to this work by the childhygiene bureaus and divisions or by the personnel of county health
departments. In some places the classes conducted in earlier years
o f maternity and infancy work have been succeeded by regular super
vision by field workers and regular meetings of midwives’ clubs
which State or county supervisors of midwives attend. During the
year ended June 30, 1928, classes numbering 1,653 were organized
in 11 States: Arkansas, Florida, Georgia, Kentucky, Louisiana,
Maryland, North Carolina, South Carolina, Tennessee, Texas, and
Virginia. A few States did not report the number o,f classes or
ganized. (Table 4.) The number of midwives reported enrolled
was 10,056; the number reported as completing the course was 1,594.
Some States did not report the number completing the course, and
in a number of States the work was continuous instead of consisting
of a definite number of lessons. In the States reporting number of
lessons 6 to 10 were usually given.

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SUMMARY OF STATE ACTIVITIES DURING 192 8

T able: 4.— Classes conducted for instruction in maternal, infant, and child hy

giene reported by 39 States and the T erritory of Hawaii cooperating under the
m aternity and infancy act during the year ended June 30, 1928
Classes for mothers
States and Terri
tory cooperating

Total..............
Alabama__________
Arizona................
California_________
Colorado.-..............
Delaware_________
Florida...................
Georgia....................
Hawaii____. . . . . .
Indiana____ ______
Kentucky________
Maine____________
Maryland................
Michigan_________
Minnesota...........
M ississippi.._____

New Hampshire___
New Jersey----------North Carolina____

South Carolina-----Texas_______ _____
Virginia__________

Classes for girls

Classes for midwives

Mothers Classes
Girls
Classes Mothers complet
Girls complet Classes
organ
organ enrolled
organ
ing
enrolled
ing
ized
ized
ized
course
course
1,318

29,637

18,409

1,286

23,661

10,985

1,514
74
385
321
175
358

53
32
(i)
321
162
313

17
108
81
14
12

407
372
2,030
79
99

407
Sfj
1,650
62

101
4
76
49
33
19

1,904

288

<7,824

4,968
84

(')

7141

191
4

<7,824

5
5
49
98
42

116
96
726
51,300
1,567

63
521
1.080
515

6
41
9
158

163
603
161
3,605

344
161
3,605

337

7,570

3,370

37
10
15
1
g
108

(l)

164

142
260
15
76
1,684

260
15
791
950

42
6
18
14
20
46
35
15

488
118
446
166
250
632
686
323

1
4
2
1
6
2
4
53
3

4
102
28
18
87
61
76
932
72

95
8 32
17

82,197
550

33
M267

160
(U)
31
2,342

23
53

478
1,049

13 12

463

(I)

267
3158
(')
0)
338

(17)

2
104
5
42
83
(12)
7310

55
1,447
1,212
147

(7)
If

1,653

Mid
wives
en
rolled

Mid
wives
com
pleting
course

10,056
(0

1,594
0

314

2,436

(2)
937
194

(2)
33, 432
1,764

15
74

231
689

(f
821

231
154

250
420
. 677
198

276

180

2,089
534
0

237

104

31
1,301

14
15

311
419

28
65

55
94

254

118
(if

106

7Not reported.
216 classes continued from previous year with 185 midwives enrolled (including 3 enrolled durmg year
under review).
3 Includes some carried over from previous year.
4 Includes 1,710 girls in 10 colleges where course was given.
3 50 midwives enrolled in classes for women completed the course.
69 organizations meeting monthly; membership 399; total attendance, 1,042.
7 Includes 15 carried over from previous year.
8 Includes 45 boys.
11Includes 4 classes for boys and girls in public schools.
10 Includes 196 carried over from previous year.
n 2 lessons to 31 high-school girls in 1 town; 2 lessons to 100 high-school girls in another town; 1 lesson to
63 normal-school students.
72 Infant-hygiene classes are conducted in the public schools.
73 Conducted by a member of the United States Children’s Bureau staff lent to the State.

CLASSES FOR ADULTS IN IN FA N T A N D PRE N A TA L CARE

Mothers’ classes, or classes for women in infant and prenatal care,
were conducted in 31 States: Arizona, Arkansas, California, Colo
rado, Delaware, Georgia, Indiana, Louisiana, Maine, Maryland,
Michigan, Minnesota, Missouri, Nebraska, Nevada, New Hampshire,
New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon,

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Rhode Island, South Carolina, South Dakota, Tennessee, Texas,
Utah, Virginia, W est Virginia, and Wyoming. These States organ- " W *
ized 1,318 classes; 29,637 women were enrolled in classes in the
30 States reporting enrollment, and 18,409 completed the course in
the 21 States reporting on this point. The number of lessons varied;
usually 6 to 10 were given. Indiana led in this work with 7,824 p f
women enrolled, Missouri was next with 7,570, and California third
with 2,030. Georgia, Michigan, Minnesota, New York, and West
Virginia each enrolled more than 1,000 women in such classes during
the year ended June 30, 1928. (Table 4.)
CLASSES FOR GIRLS IN IN FA N T A N D CHILD CARE

Girls 10 to 15 years of age were instructed in classes in infant and
child care in the Territory of Hawaii and 31 States: Alabama,
Arizona, Arkansas, California, Colorado, Delaware, Georgia, Hawaii,
Louisiana, Maine, Maryland, Michigan, Missouri, Montana, Nebraska,
Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio,
Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas,
Vermont, Virginia, W est Virginia, Wisconsin, and Wyoming. The
number of classes organized was 1,286, the number of girls enrolled
23,661, and the number completing the course 10,985. The number
of lessons in the course varied; several States gave 24 to 30, but
usually 10 to 12 were given. Georgia had an enrollment o f 4,968
girls, the largest number enrolled in any one State. Michigan was
\
next with an enrollment of 3,605. Ohio and Texas each enrolled more
than 2,000 girls, and Alabama, Virginia, and W est Virginia each en- *
rolled more than 1,000. (Table 4.) A number of States conducted
such classes in connection with the public schools. A few, as Ohio
and Oklahoma, included boys in some of the classes. In Wisconsin
the classes in infant and child care are now a part of the regular
public-school curriculum.
INSTRUCTION OF SPECIAL GROUPS IN M A TE RN AL AND
IN FA N T CARE

Physicians, nurses, and teachers have been among the special
groups instructed in maternal or infant care in the States cooperating
under the maternity and infancy act. In four States— Kentucky,
New York, Oklahoma, and Tennessee— graduate courses in pediatrics
and also in obstetrics have been conducted for physicians. Publichealth nurses have received special instruction through institutes
and other group meetings, through loan libraries, and through train
ing centers. Teachers have been given instruction in infant and
maternal care to prepare them to conduct similar work in the schools;
Kansas, New Jersey, Oklahoma, and Wisconsin have conducted
courses for teachers. Indiana conducted such courses in 10 colleges.
Fathers have been included in a few of the adult groups receiving
instruction in maternal and infant care.
TALKS AN D LECTURES

Information relating to maternal, infant, and child care and
hygiene was given through talks and lectures in the Territory of

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SUMMARY OP STATE ACTIVITIES DURING 1928

Hawaii and all except one of the States cooperating under the maA ^ te rn ity and infancy act. A total of 23,033 talks and lectures were
;given in 1928; 20,073 were addressed to lay groups. Special lectures
or talks were given to nurses and physicians— 721 to nurses in 36
^
States and Hawaii, 352 to physicians in 29 States (this number ineludes a few to dentists). (Table 5.) Kadio talks were broadcast
106 times in 17 States: Colorado', Georgia, Iowa, Kansas, Maine,
Maryland, Michigan, Minnesota, Missouri, Nebraska, New York,
Ohio, Oregon, Pennsylvania, Tennessee, Virginia, and Washington.
PRE N A TA L LETTERS AN D CORRESPONDENCE COURSES

Information on prenatal care and preparation for confinement was
sent to expectant mothers through a series of prenatal letters (usually
nine in number, one mailed each month) by 24 States— Arizona,
California, Delaware, Idaho, Kansas, Kentucky, Louisiana, Maine,
Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New
Hampshire, North Carolina, Oklahoma, Oregon, South Carolina,
South Dakota, Tennessee, Utah, W est Virginia, and Wisconsin. The
number of new names enrolled in these States during the year under
review was 37,532, and the number of sets of letters distributed was
35,721. North Carolina reported 9,522 new names enrolled, the
largest number enrolled by any one State. Oklahoma was next with
7,220 new names enrolled. (Table 5.)
Correspondence courses were conducted by four States: Minnesota,
Virginia, Washington, and W est Virginia. Instruction was given
in both maternal and infant care through these courses.
T able 5.— JEducational work conducted) through talks and lectures, prenatal let

ters, and distribution o f literature in the States and T erritory o f Hawaii
cooperating under the m aternity and infancy act during the year ended June
30, 1928
Talks and lectures
Number given to—

States and Territory cooperating
Total

Total.

23,033

Alabama...
Arizona___
Arkansas...
California..
Colorado...
Delaware. .
Florida___
Georgia___
Hawaii.......
Idaho_____
Indiana___
Iowa______
Kansas___
Kentucky..
Louisiana..
Maine____
M arylandMichigan..

1,601
86
863
102
127
90
166
382
7
39
885
* 214
53
1,112
984
262
93
257
1 Not reported.

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Prenatal letters

Phy
Lay
sicians Nurses groups

352

l
5
3
2
6
4
5

2
12
* 35
8
35
2

721

2
4
22
15
2
17
3
1

3
7
4
150
23
8

20,073

Radio
audi
ences
106

83
854
77
109
82
145
349
6
37
870
160
39
927
984
235
85
248

Pieces
of litera
New
ture dis
Sets
names distrib tributed
en
uted
rolled

37,532
600

35,721

460

1,492

3,107

472

369

474

499

73
1,850
645
1,151

355
4,000
645
1,313

3,094

3,497

12
2
4
6
1

1 Includes talks to dentists.

6,176,232

64,435
131,273
92,108
10;600
47, 758
34,032
105,875
2,600
7,096
176,473
73,600
212,376
317,559
33, 269
425.046
127,850
359.047

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

T able 5 .— Educational w ork conducted through talks and lectures, etc. — Contd.
Talks and lectures
Number given to-

States and Territory cooperating
Total

Minnesota______________ ____ ___
Mississippi............................
M issouri.......................__j_____ fi
Montana.______ _____________
Nebraska.............. __................
Nevada........................................
New Hampshire........... ...........
New Jersey...... ........... ......... ..
New M exico.. _______
New York_______________ ____
North Carolina...... ............ ...........
North Dakota. __________ ____ _
Ohio......................... ................
Oklahoma________________
Oregon............ ................. ........
Pennsylvania_____________
Rhode Island___________________
South Carolina..... ....................
South Dakota.._____ _____
Tennessee.......... ............
Texas______________________
Utah......................................
V erm ont............ ............................
Virginia................ ......................
W ashington................. ..........
West Virginia.....................
Wisconsin____________
Wyoming_________ ____ ____ ____
1Not reported.
3 During 6 months.
4 Includes 28 to dentists.

Prenatal letters

Phy
Lay
sicians Nurses groups

108
6,277
606
1,124
42
416
2,641
118
232
(i)
17
440
<519
«331
122
30
158
16
546
424
297
36
131
90
696
« 143
150

22
20
5
5
7

73
6,207
'584
1,119
32

12
84
3
64

404
2,550
' 115
161

1
14
29
37

2
2
27
66

14
423
485
210
121
29
134
15
529
392
292
35
113
36
681
79
0)

50
12
2
7

1
20
1
3
20

4
13
12
5

1
10
22
15
48

17
15
0

Radio
audi
ences

Pieces
of litera
New
ture
dis
Sets
names
distrib tributed
en
uted
rolled

1,181

925

712

691
7il
184
540 3 1,451

(i)

9,522

4,191

17
1

l| 046

l ’ 017

684
416

416

665

429

g
15

1 677
2, 390

3^ 168

270,112
50.000
780,450
211,116
85,055
2,380
182,214
65.000
35,189
302,989
127,290
17,937
227.500
383,885
50.000
147,902
37,368
60,000
23,638
50,351
66,536
25,000
7,692
228,836
18,114
74,583
413,191
10,907

5 Report incomplete; includes 1 to dentists.
« Includes 1 to dentists.

DISTRIBUTION OF LITERATURE

A ll the cooperating States (except one) and the Territory of
Hawaii reported distributing literature relating to the care and
hygiene of mothers, infants, and preschool children (including both
State and Federal publications).
More than 6,000,000 pieces of
literature were distributed by the Territory and the 44 States report
ing.
(Table 5.)
Nineteen States each reported distributing more
than 100,000 pieces during the year under review. Missouri led with
a distribution of 780,450 pieces, Maine was next with 425,046 pieces,
and Wisconsin third with 413,191.
Twenty-two States— Arizona, Colorado, Delaware, Florida, Kan
sas, Kentucky 2 Maryland, Michigan, Mississippi, Missouri, Montana,
New Hampshire, New Mexico, New York, North Dakota, Pennsyl
vania, South Carolina, South Dakota, Utah, Virginia, Wisconsin,
and Wyoming— and the Territory of Hawaii sent literature on the
care of the baby to the parents of all babies whose births were registered in State bureaus or divisions of vital statistics. In two States—
Rhode Island and New Jersey— literature was distributed by the
public-health nurses who visited the newborn babies. A few other
States sent a birth-registration card with an offer to supply literature

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SUMMARY OF STATE ACTIVITIES DURING 192 8

,
W

on request. Maryland, Missouri, and New York sent literature except
for babies born in the large cities. Reports received indicate that lft! erature on infant care was sent to the parents of half the babies born
during the year.
EXTENSION OF THE UNITED STATES BIRTH AN D DEATH
REGISTRATION A REAS

Five States— Alabama, Georgia, Louisiana, Missouri, and Okla
homa— were admitted to the United States birth-registration area
during the year under review.3 This made 42 States and the District
of Columbia in the area on June 30, 1928, and included 91.3 per cent
of the total estimated population of the United States. Two States—
Georgia and Oklahoma— were admitted to the United States deathregistration area during the year under review.3 This made 44
States and the District of Columbia in the area on June 30, 1928,
and included 95.4 per cent of the total estimated population o f the
United States. The staffs of the State child-hygiene bureaus and
divisions gave assistance in all the States admitted to the birth and
death registration areas, and they were actively assisting to increase
the registration in States not admitted.
SURVEYS AND CAMPAIGNS

During the year under review 48 surveys o f conditions relating to
maternal and infant welfare were made in 25 States— Alabama,
Arkansas, California, Colorado, Delaware, Georgia, Idaho, Kansas,
Kentucky, Louisiana, Maryland, Michigan, Minnesota, New Hamp
shire, New Jersey, New Mexico, New York, North Dakota, Oklahoma,
Oregon, South Dakota, Tennessee, Virginia, W est Virginia, and W is
consin. These included surveys of hospitals, midwives, milk supplies,
maternal and infant mortality, and various other matters affecting
the welfare of mothers and children.
A total of 68 campaigns, either state-wide or restricted to counties
or smaller areas, were reported by 29 States: Arkansas, California,
Colorado, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky,
Maine, Maryland, Michigan, Minnesota, Missouri, Nebraska, New
Hampshire, New Mexico, New York, Ohio, Oklahoma, Oregon, Rhode
Island, South Carolina, South Dakota, Tennessee, Texas, Utah,
Washington, and West Virginia. They included campaigns for
better milk supplies, for more complete registration of births, for
extension of maternity and infancy work through the establishment
of county and community nursing service, other improvements in
conditions relating to the welfare of mothers and babies, and “ get
ready for school ” campaigns for the preschool child.
M ATERN AL-M O RTALITY STUDY

Progress has been made in the study of maternal deaths in the
calendar years 1927 and 1928. During the year under review the
study was under way in 12 States: Alabama, Kentucky, Maryland,
Michigan, Minnesota, Nebraska, New Hampshire, Oregon, Rhode

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th e

w elfare

an d

h y g ie n e

m a t e r n it y

an d

in f a n c y

Island, Virginia, Washington, and Wisconsin. Three other States—
California, North Dakota, and Oklahoma— made plans to begin
study after the close of the fiscal year under review.
In all these States the study is being made in cooperation with the
State departments of health (on the request of the State medical
societies) and in cooperation with the United States Children’s W
Bureau. Physicians assigned by the bureau are taking the schedules
in 9 States: Alabama, Kentucky, Maryland, Nebraska, New Hamp
shire, Oregon, Rhode Island, Virginia, and Washington. Three
States— Michigan, Minnesota, and Wisconsin— are using the services
of physicians on their own staffs.4 The tabulations will be made by
the Children’s Bureau. (See p. 157.)
EXPANSION OF ACTIVITIES

The 45 cooperating States and the Territory of Hawaii contain
2,953 counties or parishes. During the period of their cooperation
under the maternity and infancy act some maternity and infancy
work has been done in 2,671 of these counties. During the year under
review some maternity and infancy work was done in 2,074 counties.
Twenty-seven States reported maternity and infancy work in every
county since the beginning of their cooperation under the act. Dur
ing the year under review maternity and infancy work was done in
every county in 14 States. The work has been extended during the
37ear to 211 counties; there was an increase of 16 counties in the
cooperating States due to the increase in the number of States coop
erating under the act and reporting work in the year.
Twenty-three States reported 171 counties or communities as
assuming (since the beginning of their cooperation under the act)
the responsibility for maternity and infancy work initiated or ^
assisted by the State child-hygiene bureaus or divisions, and one ^
other State reported 7 counties as assuming the responsibility except
that clinicians from the State staff gave assistance. This in turn
released funds for extension of work to other counties or for use in
new activities.
ORGANIZATIONS COOPERATING IN THE M ATERN ITY AND
IN FA N C Y W ORK

The support given to the State agencies administering the mater
nity and infancy act by state-wide organizations and groups as well
as by their local component groups has made it possible to extend
activities to new fields and to include larger numbers of mothers and
infants in the scope of the work than would have been possible with
out the cooperation of such organizations. Types of cooperation
have varied from formal approval and indorsement of the maternity
and infancy act by groups to actual assistance in activities of the
State program by physicians, dentists, and nurses at conferences and
centers. Financial assistance or support of pieces o f work begun
under the act has also been undertaken by private as well as public
* In the fall o f 1928 C alifornia and Oklahoma began the collection o f data in regard to
1928 maternal deaths and North Dakota the collection o f data in regard to 1927 and 1928
maternal deaths. The child-hygiene bureaus and divisions o f these States w ill make the
study with their own staffs.

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SUMMARY OF STATE ACTIVITIES DURING 192 8

agencies. State and local associations have sponsored special activi
ties and given assistance to them. The cooperating state-wide or
ganizations have included during 1928 other State departments or
bureaus, professional groups, women’s organizations, and fraternal
and service organizations. Forty-four States reported cooperation
received from state-wide organizations, and one reported cooperation
from local groups. The Territory of Hawaii reported cooperation
from organizations and also from the physicians and nurses of the
sugar plantations.
Forty States reported assistance from the State parent-teacher
association (usually in connection with the preschool round-up),
the State federation of women’s clubs cooperated in 29 States, the
State league of women voters in 21 States, and the American Red
Cross in 15 States. The extension service of State universities or
State colleges and the State tuberculosis association each was re
ported as assisting in 13 States. Eleven States reported cooperation
by the State department of education and 11 by the State medical
association. Two States reported cooperation given by the State
medical association’s committee on maternal welfare.
Assistance by the State W oman’s Christian Temperance Union and
assistance by the State dental society were each reported by 7 States,
the American Legion auxiliary by 6 States, and the American Legion
by 5 States. Four States reported cooperation by the State publichealth association, and one State by the State public-health and
tuberculosis association.
Two States reported cooperation from each o f the following
organizations: American Association of University Women, women’s
auxiliary of the State medical association, business and professional
women’s club, Stale nurses’ association, and Farm Bureau. In ad
dition the following agencies were reported as cooperating by at
least one State: State child-welfare department, State board of char
ities and corrections, State board of health (Colorado), State univer
sity, State agricultural college, polytechnic institute, psychopathic
hospital, State fair association, men’s service clubs, Society for
Crippled Children, visiting-nurse association, Mormon Mission and
Mormon Relief Society, board of missions, Joint Legislative Council,
State health council, State chamber of commerce, Young Men’s
Christian Association, Young Women’s Christian Association, Needle
work Guild, fraternal association, State chapter of the Daughters of
the American Revolution, State grange, State board of control, State
development board, rural women’s clubs, Council of Jewish Women,
Catholic Daughters of America, State association of social workers,
schools, churches, county medical societies, many local clubs and
societies, and school officials.
48278°— 29----- 3

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SUMMARY OF RESULTS OF OPERATION OF THE
MATERNITY AND INFANCY ACT
The extension of Federal funds to the States and Territory accept
ing the provisions of the maternity and infancy act made expansion
of activities possible in States that already had child-hygiene bu
reaus or divisions as well as in the 10 States and the Territory in
which such agencies were created after the passage of the act. Many
of the already existing child-hygiene bureaus and divisions were
hardly more than nominal and had very inadequate funds. Even
in those States that did not accept Federal funds immediately after
the passage of the act in 1921 the matter was a subject for discussion,
and larger State appropriations for child-hygiene work were made.
This was the immediate result of wider interest in the education of
the public as to the possibilities and importance of public-health
work for mothers and babies. The statement holds true not only for
States that later accepted the provisions of the act but also for the
three States that have not accepted its provisions.
In 1918, when the first maternity and infancy bill was introduced
in Congress, infant-hygiene work was in progress mainly in urban
areas. Its wide extension to rural areas has been coincident with
interest in the maternity and infancy bill and operation of the
maternity and infancy act in the large majority of the States. Pro
grams of maternal welfare in rural areas have been developed largely
within this 10-year period.1
WORK W ITH R AC IAL GROUPS

Our complex population is a factor that has influenced infant and
maternal mortality rates in the United States. Practically every
State has initiated work directed toward the problems of a specific
foreign-born people or racial group that has composed part of its
population. Michigan, New Jersey, New York, and Pennsylvania
have given attention to the regulation, supervision, and instruction
of white midwives who deliver many of the recent immigrants among
the white women. Nurses also visited the homes of foreign-born
mothers and gave instruction in maternal, infant, and child care.
Rhode Island staff workers met incoming steamers and established
contacts with incoming foreign-born mothers and babies.
The States of the Southwest, as Arizona, California, New Mexico,
and Texas, have given special attention to the Spanish-speaking
population. Literature on maternal, infant, and child care was
translated into Spanish for distribution among the Spanish-Ameri1 See Some Results o f Five Years o f W ork under the M aternity and Infancy A ct in The
Prom otion o f the W elfare and Hygiene o f M aternity and Infancy, Fiscal Year 1927, pp.
3 0 -45 (U. S. Children’ s Bureau Publication No. 186, W ashington, 1928).

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ft MIDWIVES OF THE OLD TYPE. 2. A MIDWIFE OF THE NEW TYPE. 3. AT THE INSTITUTE
FOR NEGRO MIDWIVES. 4. A NURSE MIDWIFE (GRADUATE OF BELLEVUE HOSPITAL) WHO
SERVED AS INSTRUCTOR IN THE INSTITUTE
26

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TYPE OF HOME IN A SPARSELY SETTLED STATE (NEW MEXICO) INTO WHICH LITERATURE
ON INFANT AND PRENATAL CARE IS SENT; CHILDREN (MISSOURI) SUCCESSFUL IN A SIXPOINT COMPETITION (ADJUDGED NORMAL OR CORRECTED IN VISION. HEARING.
THROAT, TEETH. POSTURE, AND WEIGHT); AND A CLASS FOR INDIAN GIRLS (NEBRASKA)
IN INFANT AND CHILD CARE
27

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RESULTS OF OPERATION" OE MATERNITY AND INFANCY ACT

can and Mexican populations in Arizona, California, and New
Mexico. Nurses in all these States visited the homes of Spanish
speaking families and gave instruction in infant and maternal care.
In New Mexico special attention was given to the instruction of the
Spanish-speaking midwives who attend the Spanish-American and
Mexican women.
Certain States have done special work with the Indians through
cooperation with the United States Indian Service. Minnesota,
Nebraska, and Oklahoma have conducted classes in infant care among
Indian girls. Michigan, Minnesota, and Montana have conducted
health conferences for Indian babies and preschool children. Minne
sota employed Indian nurses for full-time maternity and infancy
work on the Indian reservations, Nebraska detailed a public-health
nurse for full-time work among Indians, and other States have given
occasional service to Indians within their borders.
In the Territory of Hawaii the different racial groups have been
considered in the planning of the maternity and infancy work.
Health conferences regularly conducted at centers have reached
Hawaiian, Filipino, Japanese, Chinese, Portuguese, and American
children. Some of these racial groups had extremely high infant
mortality rates, and reductions have been observed since the con
ference work was begun.
Practically all the States with large negro populations have made
efforts to improve the hygiene and care of negro mothers and babies.
To the supervision, regulation, and instruction of negro midwives—
as in Alabama, Arkansas, Delaware, Florida, Georgia, Kentucky,
Louisiana, Maryland, Mississippi, North Carolina, South Carolina,
Tennessee, Texas, Virginia, and West Virginia— may be ascribed
some of the reduction in maternal and infant mortality rates in
given areas.
Special instruction in hygiene and nutrition has been given to
negro women in Florida. Maryland has conducted child-health con
ferences among the negroes through the employment of negro physi
cians for the purpose. Mississippi has conducted classes in hygiene
and infant care for negro girls. Prenatal care was given negro
women who attended the prenatal conferences at the county centers.
South Carolina has provided a four weeks’ course of practical in
struction in nursing care, nutrition, and bedside instruction in ob
stetrics for negro mid wives. Tennessee employed a negro woman
physician to supervise and instruct negro midwives, who in adconducted health conferences for negro infants and preschool
children. Virginia conducted institutes for midwives and for
doctors helpers ’ for negro women. Negro nurses have served on
the otate staff or are detailed to county work in a number of States,
including Alabama, Georgia, Maryland, Mississippi, South Carolina,
and lexas. In Texas the work of the State itinerant negro nurses
appreciated that the negroes of one county raised the necessary
funds to maintain a negro nurse. The negro nurses employed are
usually well trained in nursing schools and through their direct con
tact in the homes assist in improving standards of living, sanitation,
and hygiene among the people of their race.

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THE

welfare and hygiene of maternity and infancy

EXTENSION OF THE BIRTH AND DEATH REGISTRATION A REAS

Since the close of 1922 (the first year of operation of the maternity*
and infancy act) 13 States have been admitted to the United States
birth-registration area— Alabama, Arizona, Arkansas, Florida, ,JJl
Georgia, Idaho, Iowa, Louisiana, Missouri, North Dakota, Oklahoma,
Tennessee, and W est Virginia— and 8 States have been admitted to
the death-registration area: Alabama, Arizona, Arkansas, Georgia,
Iowa, North Dakota, Oklahoma, and W est Virginia. The staffs of
the State divisions and bureaus of child hygiene have aided in the
campaigns for better registration of births and deaths in every State
(except Iowa) admitted to the area since 1922. (See footnote 3,
p. 23, for States admitted since June 30, 1928.)
PROGRESS IN EDUCATION OF MIDWIVES

Classes for midwives, conducted by nurses, have been a feature of
the maternity and infancy work since funds were first made available
to the States under the Federal maternity and infancy act. Most of
these classes have been for negro women. They have included in
struction in the hygiene of pregnancy, the necessity for cleanliness,
the preparation for delivery, the method of conducting delivery, the
importance of calling a physician for complicated cases, the use of a
prophylactic in the eyes of the newborn, and the general care of the
newborn. Practical demonstrations formed part of the course in ,
many of the classes and included the making and sterilizing of pads, J L
dressings, and supplies needed at confinement, preparation of the <
obstetrical bed, bathing the mother, and caring for the baby. In at
least one State the technique of delivery was demonstrated by the
use of a manikin. This work has been valuable in improving the
standards of practice among the midwives and eliminating those who W
were unfit, although it has not given the midwives any practical
training under supervision in the technique of conducting a normal
delivery.
State directors of the maternity and infancy work in some parts of
the country recognize that social and economic conditions make the
midwife necessary in their States for many years to come. Conse
quently several of the directors are seeking a means of making avail
able courses for midwives that will combine theoretical instruction
and practical experience in midwifery.
Considerable progress in
this type of work has been made in Kentucky and South Carolina,
In Kentucky a three months’ intensive course m midwifery for white
midwives was inaugurated a little more than a year ago at a small
hospital in a mountain section that has facilities for training three at
a time. Eight women had completed the course by June 30,1928, and
many others were awaiting admission. In South Carolina a begin
ning was made in 1927 by the provision of a training course for negro
midwives. The hospital of a negro school was lent for this purpose,
a local physician volunteered his services for all deliveries, and a
nurse from the staff of the State bureau of child hygiene and publichealth nursing had general charge of the course. In 1928 the insti
tute was conducted for a longer period and on a more extensive scale,
about 30 mid wives being registered for each of the three months of
the institute. A negro graduate of the Bellevue Hospital training

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RESULTS OF OPERATION OF MATERNITY AND INFANCY ACT

school for midwives was employed to assist the nurse in charge, and
each nurse on the bureau staff was assigned to the work for a 2-week
f period. The same physician who volunteered his services the pre
ceding year delivered the abnormal cases and the negro nurse-midwife
the normal cases.
A n out-patient department was organized, the
“
student midwives going with an instructor to deliver patients in their
homes and give postpartum care. Examinations were held and cer
tificates were awarded to those who passed.
In 1925 Virginia began to conduct 1-week institutes for “ doctors’ •
helpers,” which were attended by midwives as well as by other women.
The course has consisted each year of lectures by physicians and other
experts on health subjects, with particular emphasis on maternal and
infant hygiene and of practical demonstrations of some o f the sub
jects considered.
Separate institutes are conducted for white and
for negro women.
In 1926 Tennessee employed a negro woman physician to conduct
classes for negro midwives, and this work is still in progress.
The midwife problem is by no means confined to the South.
In
the North and West many women, mostly of foreign birth, are at
tended at confinement by midwives.
In the W est m any' sparsely
settled sections do not have the services of a physician, and the ex- pectant mother must look to a friendly neighbor to act as midwife
at the time of confinement.
In New Jersey (in which State the midwives must be graduates of
a legally incorporated school of midwifery or of a maternity hospital
approved by the State board of medical examiners) arrangements
were made in 1928 for an advanced course for licensed midwives at
the Jersey City Hospital. The course was arranged to provide prac
tical training in the maternity wards, nursery, labor and delivery
rooms, and classroom o f the hospital, one week to be spent in each
department. Although only 3 midwives could be accommodated in
the hospital at one time, 14 completed the course during the year.
In 1922 Pennsylvania employed two women physicians (one for a
short period only) to devote full time to teaching and supervising
the midwives in four counties in the coal regions. Later another
woman physician was employed, and 10 counties are now covered
by this work. Its extent is indicated by the fact that 7,134 deliveries
were reported as attended by midwives in nine of these counties in
1927. (In the tenth county the work had been in progress only a
short time.) Only nine maternal deaths were, reported among the
women attended by the midwives, though all deaths of mothers at
tended by midwives at any time during confinement were counted as
deaths in the midwives’ practice even if a physician also attended the
case and signed the death certificate.

REDUCTION OF M ORBIDITY AND PREVENTION OF DISEASE

Statistics on morbidity are not available except for certain reportable diseases or in the event of special studies. Consequently no
^
precise statement can be made in regard to maternal and infant
j) morbidity; but, as mortality presupposes morbidity and usually fol
lows an illness, mortality rates are some index o f morbidity. There
fore it is a fair assumption that lower maternal and infant mortality
rates reflect fewer illnesses of both mothers and babies. There can be

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THE

w elfare

and

h y g ie n e

m a t e r n it y a n d

in f a n c y

no question that better care and hygiene for mothers and children
have added to the sum total of human well-being and of human}*#*^
happiness.
.
Many States have included among their maternity and infancy
activities special preventive work. Some of this has been directed , W|
against diseases that cause high mortality rates for children, some
against diseases that, though not fatal, cause physical handicaps or
impairments. The inspection, supervision, and regulation of milk
supplies has been one of these special activities in some States. The
importance of sun baths and cod-liver oil in the prevention and cure
of rickets has been stressed in the conference work, in nurses visits
to' the homes, and in the literature distributed. The collection by
maternity and infancy workers of specimens for examination for
hookworm and other parasites has contributed to improvement in the
health of small children. Ampules of nitrate of silver for prophy
laxis against ophthalmia neonatorum have been distributed free to
attendants at childbirth in many States, or the distribution has been
promoted through financial assistance. The use of the prophylactic,
especially by midwives, has increased greatly, and where data have
been obtainable the indications are that blindness from ophthalmia
neonatorum has decreased considerably.
State divisions and bureaus of child hygiene have contributed to
and assisted in toxin-antitoxin campaigns and have emphasized the
necessity for immunization of the year-old infant and the preschool
child against diphtheria. Many have included preventive measures \
against diphtheria, smallpox, and typhoid fever in the “ get ready ^
for school ” campaigns for the preschool child. A lower incidence
for such diseases appears to have followed aggressive campaigns of
tins character.
Goiter prevention has been an objective in certain States havin gr^
a high incidence of goiter, as those on the Great Lakes and certain
Rocky Mountain States. Utah and Michigan have been especially
active in surveys of goiter and efforts for prevention. In January,
1924, the Michigan State Department of Health made analyses of
water supplies in the State and found insufficient iodine for human
requirements in all samples examined. A t the same time a survey
was made o f the prevalence of goiter among school children in four
counties, and the field staff of physicians and nurses of the State
bureau of child hygiene and public-health nursing was lent to aid in
the survey, with the understanding that any preventive program
should include the prevention of goiter in the expectant mother. The
data obtained in the four counties were as follows :

County

Houghton County.
Wexford C ou n tyMidland County ~
Macomb County ~

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Iodine
content
per
billion
parts of
water

None.
0.05
7.30
8.70

Percent
age inci
dence of
goiter
among
school
children
examined
64.4
55.6
32.7
26.0

RESULTS OF OPERATION OF MATERNITY AND INFANCY ACT

A state-wide educational campaign for the use of iodized salt on
the table and in cooking was instituted by the Michigan Department
of Health, resulting in the very general use of iodized salt not only
in Michigan but also in other States of the Great Lakes region. A
resurvey of two of the counties (W exford and Midland) in 1928
showed that in W exford County the percentage of goiter had dropped
from 55.6 in 1924 to 17.2 in 1928 and in Midland County it had
dropped from 32.7 in 1924 to 8.8 in 1928. It was learned in this sur
vey that iodized salt was used in 91 per cent o f the homes of the pub
lic-school children in Midland County. According to physicians in
Houghton County, babies born with goiter were not uncommon be
fore the goiter-prevention work, but to date the interested physicians
have not seen a single case of congenital goiter when the mother has
used iodine. In view o f the impairment to health in later life from
thyroid-gland disturbances and the menace to life itself in the con
genital type of goiter, also the strain on the thyroid gland of the
mother during pregnancy, the information obtained by the two sur
veys and the confirmation of the worth o f the preventive measures
should be of great value in decreasing maternal and infant
morbidity.2
THE IN FA N T M ORTALITY R ATE

Infant mortality rates for the whole registration area as of 1927
are not strictly comparable with the rates for the area as of 1922 be
cause of the admission of 11 States to the birth-registration area be
tween January 1,1923, and December 31,1927. There was a reduction
in the infant mortality rates for the birth-registration area of 1927
as compared with that of 1922. (See Tables I I I and I Y , Appendix
C, pp. 172,174.) In 1922 the mortality rate (deaths of infants under
1 year of age per 1,000 live births) was 76; in 1927 the rate was 65,
a saving of 11 infants in every 1,000 born alive for the whole area.
In 1927, 24,500 babies who would have died if the rate of 1922 had
continued survived their first year o f life. A somewhat greater re
duction appears if the States that were in the area and remained in
from 1922 through 1927 are considered.
(Table 6.)
The birthregistration area of 1922 included 30 States and the District of
Columbia. One State (South Carolina) was dropped from the birthregistration area in 1925. Three of the 30 States have never co
operated with the Federal Government under the maternity and in
fancy act and 3 others began cooperating in the later years o f the
operation of the act.
A comparison of infant mortality rates in the expanding birthregistration area for white and colored babies shows a reduction
among both groups in 1927 as compared with 1922. The rate for the
area as a whole was 73 for white babies in 1922 and 61 in 1927. For
colored babies the rate was 110 in 1922 and 10G in 1927. In each
of the States that were in the birth-registration area in 1922 and 1927
and that had more than 2,000 colored births annually3 the- rate for
4 Kimball, O. P : T heE fficien ey and Safety o f the Prevention o f Goiter. Journal o f the
American Medxeal Association, vol 91 No. 7 (Aug. 18, 1928), pp. 454-460. See also
e lî^ O 1, ^ourna*
-^merican M edical Association, vol. 91, No. 22 (Dec. 1, 1928),
8 California, Illinois, Kentucky, Maryland, Mississippi, New Jersey, New York, North
Carolina, Ohio, Pennsylvania, Virginia, and the D istrict o f Columbia.

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3 2

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

both white and colored babies was lower in 1927 than in 1922, except
in North Carolina and Virginia. In these two States the rate for the
colored group was higher in 1927. (Table I V , Appendix C, p. 174.)
An analysis of the principal groups of causes o f infant mortality
for the States in the birth-registration area in 1922 (excluding South
Carolina) shows a lower rate in 1927 than in 1922 for each group of
causes except external causes (for which the_ rate was the same in
both years). The greatest reduction is shown in the group of gastro
intestinal diseases, with a rate o f 12.7 per 1,000 live births in 1922
and 8.1 in 1927. Respiratory diseases stood next with a rate of 18.7
in 1922 compared with 10.8 in 1927. The rates due to deaths from
natal and prenatal causes generally showed slight decreases from
1922 to 1927; the 1927 figure (38.7 deaths of infants per 1,000 live
births) was 6.9 per cent lower than that for 1922 (36.2).
T a b l e 6.—Infant

mortality rates (deaths of infants under 1 year of age per
1,000 live inrths), by specified groups o f causes, in the United States oirtliregistration area as o f 1922,1 exclusive of South Carolina; 1922-1927
C a u ses o f d ea th

A l l c a u s e s . . . ........................................................................ ..
N a t a l a n d p r e n a t a l ca u s e s 2............................................................
G a s tr o in t e s t in a l d isea ses 3............ ..................................... .............
R e s p ir a t o r y d isea ses 4----------------------------------------------------------E p id e m i c a n d c o m m u n ic a b le d isea ses 8 ----------- -------------E x te r n a l c a u s e s -------- ------------------------------------------------ .............
U n k n o w n o r ill-d e fin e d d is e a s e s . ------------------------------------A l l o t h e r c a u s e s 6____________________________________________

1922

1923

1924

1925

1926

1927

7 5 .7

76.6*

7 0 .3

7 1 .8

7 3 .3

6 4 .0

3 6 .2
12 .7
13 .7
3 .9
.9
2 .4
5 .9

3 5 .9
1 2 .5
13.9
5 .3
.9
2 .3
5 .7

35 .3
10.1
11 .9
4 .3
1 .0
2 .3
5 .6

3 5 .0
1 2 .0
1 2 .2
3 .6
1 .0
2 .2
5 .8

3 5 .1
10.3
1 4 .2
4 .8
1 .1
2 .3
5. 6

3 3 .7
8 .1
10.3
3 .5
.9
2 .2
5 .3

1 Including California, Connecticut, Delaware, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland,
Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey,
New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Virginia, Wash
ington, Wisconsin, Wyoming, and the District of Columbia. These are all the States that were in the
birth-registration area every year from 1922 to 1927.
2Includes premature birth, congenital debility, injuries at birth, other diseases of early infancy, con
genital malformations, syphilis, tetanus.
aIncludes diseases of the stomach, diarrhea and enteritis, dysentery.
4Includes bronchitis, bronchopneumonia, pneumonia, influenza.
. .
♦Includes measles, scarlet fever, whooping cough, diphtheria, erysipelas, meningococcus meningitis,
tuberculosis of the respiratory system, tuberculosis of the meninges, other forms of tuberculosis.
6Includes convulsions and other causes of death.

Reduction in infant mortality due to diarrhea and enteritis and to
respiratory diseases reflects the work done in disseminating informa
tion on the importance of breast feeding and the proper preparation of
simple formulas of cow’s milk, the value of good routine in the care
of the baby, sunshine, fresh air, and the introduction into the infant’s
dietary of the right foods at the right time. Reduction in mortality
from natal and prenatal causes in 1927 also reflects the wider knowl
edge of the care of the baby, the prenatal care the mother receives,
and a greater attention to care at time of childbirth.
The stillbirth rates have remained practically the same for every
year from 1922 to 1927 for the expanding birth-registration area.
The stillbirth rates per 100 live births for 1922 to 1927 were as
follows: 1922,1923, and 1924, 3.9; 1925 and 1926, 3.8; 1927, 3.9.
THE M ATERNAL M ORTALITY RATE

The maternal mortality rate for the birth-registration area in
1922 was 66.4 (deaths of mothers from puerperal causes per 10,000
live births); in 1927 the rate was 64.7. The reduction in maternal

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RESULTS OF OPERATION OE MATERNITY AND INFANCY ACT

mortality was largely in the rural areas, the rate being 59.5 in 1922
and 55.3 in 1927— a saving of 4 mothers per 10,000 live births in the
rural areas in 1927 as compared with 1922. During the same period
the mortality rate for urban mothers increased from 73.2 to 74.8.
The maternal mortality rates for the 29 States that were in the area
in 1922 and remained in the area through 1927 were 65.4 in 1922 and
61.9 in 1927. (Table 7.)
Maternal mortality rates ( deaths of mothers from puerperal causes
per 10,000 live births), by cause o f death, in the United States birth-registra
tion area as of 1922,1 exclusive of South Carolina; 1922-1927

T able 7.

Causes of death
All causes___________
Accidents of pregnancy........ .
Puerperal hemorrhage___
Other accidents of labor.
Puerperal septicemia______
Puerperal albuminuria and convulsions
All other causes___________

1922

1923

1924

1925

1926

1927

65.4

65.7

63.9

64.1

64.8

61.9

6.5
6.5
7.6
23.7
17.6
3.4

6.8
6.6

6.0
6.6
6.6

5.8

7.0
7.0
7.4
23.9
16.3
3.2

5.9

7.6
25.2
16.1
3.6

24.2
16.8
3.7

6.6

7.0
24.3
16.8
3.5

6.8

6.9
23.9
14.9
3.3

1Including California, Connecticut, Delaware, Illinois, Indiana, Kansas, Kentucky, Maine Maryland
Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey’
New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Virginia Wash
ington, Wisconsin, Wyoming, and the District of Columbia. These were all the States that were in the
birth-registration area every year from 1922 to 1927.

In 18 of the 29 States the maternal mortality rate for the State as
a whole was lower in 1927 than in 1922, in 7 States the rate was
higher, and in 4 States it was practically the same. In these last two
groups, however, 6 of the 11 States had lower rates in the rural
areas in 1927 than in 1922.
Comparison of maternal mortality among the groups of white and
colored mothers for the birth-registration area shows a slight down
ward trend in the rates for white mothers. The rates for colored
mothers have shown no tendency to deoline but were higher in 1927
than they were in 1922. These rates were as follows:
Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births)
1922
United States birth-registration area
White population____
Colored population___

66.4
62.8
106.8

1927
64.7
59.4
113.3

O f the 11 States that were in the birth-registration area in 1922
and 1927 and that had 2,000 or more colored births annually the
maternal mortality rate for the colored population was lower in
1927 than in 1922 in 6, higher in 4, and the same in 1. Among the
white population the rate was lower in 1927 than in 1922 in 9 of
these States and the same in the remaining 2.
The white and colored rates for 1922 and 1927 are not entirely
comparable, owing to recent immigration into Northern States of
numbers of southern negroes who are not yet adjusted and acclimated.
I he admission to the birth-registration area of a number of the

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T H E W E L F A R E A N D H Y G IE N E

OP M A T E R N I T Y A N D I N F A N C Y

Southern States with high mortality rates for colored mothers has
also influenced the rate for the area as a whole. It is interesting
to note that seven States (Florida, Kentucky, Maryland, New J e rs e y ,(^
Ohio, Virginia, and W est Virginia) show reduction in maternal
mortality among the colored population. In several of these States ^
attention has been given to the supervision and instruction of colored
midwives.
The maternal mortality rate due to puerperal septicemia, the prin
cipal cause of maternal deaths, has not decreased. That due to
puerperal albuminuria and convulsions, the second most frequent
cause of maternal deaths, has decreased from 17.6 per 10,000 live
births in 1922 to 14.9 in 1927. There are slight decreases in rates
due to accidents o f pregnancy and accidents of labor.
The decrease in the maternal mortality rate has therefore been
due primarily to a lowering of the mortality rate from puerperal
albuminuria and convulsions, a cause affected by prenatal care.
That this reduction reflects the effect of the educational work in re
gard to the importance of prenatal care conducted by the States and
o,f the literature on standards of prenatal care that has been dis
tributed by them seems a justifiable conclusion.
LETTERS FROM PAREN TS AND PHYSICIANS AND REPORTS FROM
FIELD NURSES

The human side of maternity and infancy work and what it means
to the individual parents is illustrated by the letters o f appreciation
that have been received by the State directors and the United States f
Children's Bureau from interested and grateful fathers and mothers
and from appreciative physicians. The reports of maternity and
infancy nurses tell of tragedies, adventures, and successful achieve- ^
ment. Excerpts from letters and reports follow : 4
L E T T E R S F R O M ^ O T H E R S T O S T A T E D IR E C T O R S

From W est Virginia:
Just a word of appreciation and thanks for your letters, brimful of sug
gestions, aid, encouragement, and cheer. Each and every one I have read and
reread carefully, and I am striving to the best of my ability to follow your
good advice which has helped me thus far, and trust that you, the department,
and our State will be slightly repaid when my baby’s birth certificate has been
returned, and through the subsequent years of our lives.5

The mother’s training course should be continued by all means. It is a great
work; it is especially helpful to farm women. There are many who do not
pay attention, but it is a great benefit to those that do. I could not get along
without your helpful pamphlets and bulletins. The county nurses should be
more in number and more home-nursing courses should be organized.6

From Michigan:
I appreciate greatly the material sent to me from the State department of
health and attribute, in part, a healthy term of pregnancy and a lovely baby
girl to its helpful suggestions. The contents of the monthly letters and bulle
tins is put in such a reassuring manner that it takes away the dread of the
4 A few o f these letters were received after the close o f the fiscal year 1928.
6 This was from a woman who was enrolled in the correspondence school for mothers.
H er baby had ju st arrived.
6 This letter was forwarded by a nurse to the State supervising nurse.

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R E S U L T S OF O P E R A T IO N OF M A T E R N I T Y A N D I N F A N C Y A C T

coming of the first baby, which is such a mystery. Before my marriage I
taught in the ---------- junior high school of this city, in the home-economics
department. We organized the little mothers’ league in the ninth grade for
three semesters and followed the lessons as outlined by the State department of
health. Looking back, I feel that the work has been a wonderful aid to me
in caring for my baby. If the girls received as much benefit from their work as
I have the result will be far-reaching in the bettering of the care of infants.
I wish that the importance of this work in the home could be more fully
realized in instructing our school girls. The effort put forth by your depart
ment is indeed splendid. My physician recommends highly your material on
prenatal and infant care and has it sent to quite a number of his patients. I
think him wise in doing this, for expectant mothers have such terrifying things
told to them that they need something authentic on the subject at hand to keep
a healthy mind.
Baby — ----- is 8 weeks old and gaining steadily. She has not had a sick
moment since her arrival, for which we are so thankful.

From New Y ork:
I wish to thank you for the baby book you sent me last year. Now I have a
friend who has used this about half the time but lives i n --------- -, 15 miles from
here, and it makes it very inconvenient for her and myself, also. W ill you
please send her one, or me another one? Her name is Mrs. S.

When people stop me on the street and ask me the whys and wherefores of
my so obviously healthy baby I always say “ He’s a Government baby,” giving
all credit to your bulletin (Infant Care). I was lucky enough not to know
anything about babies before and not to have any relatives who thought they
did.

From Pennsylvania:
Will you kindly send to the address below your booklet on Infant Care?
baby is 19 months old, and I have found the advice therein invaluable.

From Oregon:
Words can not express what a great help the little booklet called Infant
Care has been in our home. W e have had wonderful results with our baby by
following the booklet.

From Missouri:
I am writing you in regard to the two books which I have received from your
offices.
I have in my possession one entitled “ Prenatal Care” and another
“ Infant Care.” These books are so precious to me that I can not part with
either of them, so am taking this opportunity to ask you a favor. Would it be
possible for your office to send a friend of mine either of these books or both, as
they would certainly be a help to her from both points of view? * * * She
wanted to borrow them, but they are almost as close to me as my Bible.
L E T T E R S F R O M P H Y S IC IA N S T O

S T A T E D IR E C T O R S

From Pennsylvania:
A few months ago you were kind enough to send me a supply of bureau pub
lications 4 and 8 [Prenatal Care and Infant Care]. I wonder if I could pre
vail upon you to send me a whole lot of them. They turned out to be the most
wonderful help to my primipara cases that I have had in my 23 years of prac
tice. They have become famous in this part of the country, and I am having
to borrow them back to lend again and again as there are not enough to give
each case a new one.

From Ohio:
It has been my custom to give every confinement patient a copy of this book
(Prenatal Care) and at the time the baby is born the book on Infant Care. I
use 400 or 500 of these a year.

From Illinois:
Please send me 12 copies of booklet Infant Care, bureau publication No. 8
(revised). This is one of the best booklets I have read on this subject, and I
am desirous of securing these copies for some of my patients.

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THE WELFARE AND HYGIENE OP MATERNITY AND INFANCY

From Michigan:
On behalf of the
County Medical Society we wish to thank you for
your notable assistance in the conduct of the recent children’s clinic. Without
jour direction in daily conduct of the clinic it would have been impossible to^
hold it.
Sincerely yours,
---------------------- , M. D.,

S ecretary, ---------- County Medical Society.
LETTER AND ORAL REPORT FROM FATHERS

From California:
As I have recently become a dad to a wonderful baby girl, I am wondering
it you would be so kind as to send me your booklets, Baby Care, Child Manage
ment, and Child Care.
My brother has received his copies, and upon looking over them I discovered
something contained in it that applied to my baby (difficulties of the nursing
period)
W e decided before reading the booklet that we would immediately put
it on a bottle, not taking into consideration that the baby is but 3 weeks old, now
we can readily understand why she raises a rumpus frequently. So personally
I think the booklet is worth its weight in gold.

From Kansas:

A father brought his baby of approximately 1 year of age to one
of the conferences. The child was examined and found to be in
perfect condition. Since it is rather unusual for a father alone to
bring a little baby to a conference the physician in charge conversed
with him with a view to getting some light on the case. The young
father said that the infant’s mother had died at birth and he had
immediately taken charge of his child; had read all the literature he
could procure on the care and feeding of infants. He bathes and
dresses the baby in the morning before leaving it in the care of his
mother for the day. He takes entire charge of it during his unem
ployed hours and at night— it had not been separated from him a
single night since its birth.
REPORTS FROM NURSES IN THE FIELD

From Oregon:

A county nurse begins her report with the statement that the out
standing accomplishment in one county has been the establishment
on a permanent locally supported basis of monthly child-health con
ferences in two small towns. “ These,” she says, “ are conducted in
B ---------- by the local doctors and in R------------by one doctor until his
departure and then by another. In B---------- all clinic appointments
are made in advance through the B ---------- Chamber of Commerce.
In R------- — the county agent’s office arranges appointments. Some
of the outside doctors who have conducted clinics for us are [naming
four]. A n interesting feature of the 3-day clinic during the D ---------County fair conducted by Doctor H . was the fact that it was
financed by the R---------- and B ---------- Chambers of Commerce, the
B ---------- County court, and the public-health association. The clinic
at the tri-county State picnic conducted by Doctor B. was financed
by the county granges.”
Another nurse says: “ The two outstanding events in child-welfare
work in U ---------- County were the summer round-up clinics spon
sored by the parent-teacher association and the infant and preschool

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RESULTS OF OPERATION" OF MATERNITY AND INFANCY ACT

elinics held in seven towns, at which 379 infants and preschool
children were examined.”
The report from another county where the work had been reor
ganized reads: “ Owing to the high infant mortality rate in this
county a series of infant and preschool clinics was the first plan made
by the nurse for her summer program. W ith the assistance of a
clinician and the field supervisor from the State board of health,
clinics were held in five towns. They were well attended and much
appreciated by parents.”
From Virginia:
We started back to ---------- about 3 p. m., and about 3 miles from ______
received a maternity call.7 To reach the place we had to walk 1 mile straight
up the mountain through a creek bed, there being no road. Fortunately, there
were rocks enough to protect our feet from the water. Reaching the home
we were invited into the patient’s room in which there were 13 women, 3 babies'
and husband in attendance. W e found the woman in a critical condition. After
an examination was made and a few orders given doctor and I returned to
—
to get a few things needed— ether, chloroform, and so forth. W e had a
cheese sandwich and a cup of coffee, returning to the patient as soon as possible
to find the same number in attendance. The doctor and I had a strenuous
nignt, and at 2 a. m., finding it was impossible to accomplish results in the home
decided the patient would have to be taken to the hospital. The doctor asked
me to stay with the patient and go with her to the hospital the next morning,
while he would go home and make arrangements to get a motor car or an
engine, and get a few hours’ rest in the meantime.
We improvised a stretcher with green poles and quilts, making the patient
comfortable on them with hot-water bottles, and so forth. W e started with
four to pack her to the main road where a motor car was provided to take
us over the mountain. Before the men had gone very far their burden became
too heavy, and the sister and I had to relieve two of the men; they in turn re
lieved the other two. On the way to the road we passed the home where her
two children were staying. They were screaming, “ Please let me see my
mother,” but fearing overexcitement to the mother we begged them to be quiet
telling them that their mother would be all right. ’We reached the road and
found doctor waiting in his car. He insisted on my going over in the car with
him rather than in the motor car with the patient, as it was so very cold, but
I could not think of the poor soul going over that mountain alone with no other
but men to look after her, so I went with her, for which she was so grateful
We reached---------- at 10 a. m., and the patient was taken at once to the oper
ating room, but in spite of all efforts she died that evening.
it became my duty to break the news to the husband, and I don’t know
what the poor soul would have done had I not been with him. He had only
money enough to pay his board at the clubhouse and to buy one ticket home
I went with him to the company’s store, arranged for the casket, and the store
manager gave the material for the shroud to the local Red Cross committee,
and one of the ladies made the shroud that night.. The husband came to me
the next morning with tears in his eyes and said, “ Miss M., I haven’t the money
with me to pay for the body to be taken home.” I told him not to bother
that I was attending to that, but before I could get to the office the store
manager had already attended to it. The people o f ---------- certainly came to
the rescue in time of need and did everything they could to help me and this
poor man. The body was not taken home, as it was too far to “ pack ” the
casket up the mountain, but was taken to the home of a friend in ______ .
I left orders with the husband that the casket should not be opened until I
courn get there, as we had no undertaker, and later in the day I attended
to this matter.
The day of the funeral I was called upon to do the only thing left in that line
which I had not done— conduct the funeral services. This done, I turned my
attention to the welfare of the husband and children.
_ L T £ 0Ugh the m aternity and infancy nurse does n ot as a rule give bedside care, she is
sometimes called upon to assist the rural physician in an emergency.

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T H E W E L F A R E A N D H Y G IE N E

OF M A T E R N I T Y A N D I N F A N C Y

In visiting on one of our back-river roads about 10 miles fr o m ---------- I met
a woman in the road, and, as I usually do, I stopped and asked her if she knew ,
of any young children under 2 years or any young women who were expecting
to become mothers. I told her I was from the State board of health, and she y
said, “ Then you go to see Mrs. J.’s baby, for she is a girl that is in love with
the State board of health. She took a correspondence course before her baby
came and knew just how to do everything for her baby when he arrived.” I
called and found Mrs. J. an ideal young mother; the baby is fine, is 5 months
old, and weighs 15 pounds, is breast fed, and in perfect health.

From Texas:
Last month I attended a maternity case which proved to be the fortieth great
grandchild of one of the oldest pioneers of this county. The old lady is over
90 years old but is quite sprightly for her age, which she proved by visiting the
little newcomer. Like all old people, she lives in the past, but showed that she
had an eye for new things also. She approved of the sunshine flooding her
granddaughter’s room and dwelt for some time on the fact that she had to
spend her time after her confinement in a dark room so that the baby would
not get sore eyes. She thought it wonderful that the doctors had found out
that bright light would not bring on any sore eyes.

I have found the champion infant feeder in my. county. I had a childhealth conference i n ---------- , a small rural community, and 22 children attended.
A father brought an 11-month-old boy to the conference. The baby is a picture
of health and was perfect. I asked the father about the baby’s care. He
said his wife died soon after the baby came and he had been caring for the
baby. He told me how he sterilized the bottles and prepared the food. He
also brought his two small daughters to be inspected. The children were all
well cared for. * * * The mothers said it was a slam on them because
he did a better job than they did. He hired a man to do his farm work so he
could care for his children.

(
The small clinics were held in a home, hall, school, whichever seemed to be
most centrally located and convenient. The hours were from 1 to 5. The
doctors were asked to come at 2. At that time we had finished the preliminary
work and the children were ready to be examined. When they practically all
arrived at one time I found it exceedingly hard to keep them from crowding
into the doctor’s office at one time, although I numbered their cards. I found
it necessary to have a doorkeeper to keep them out. It is much better to have
one child with his parents in with the doctor at one time, especially since we
stripped them to the waist. Another difficulty was in teaching the lay helpers
how to fill out blanks correctly. Some of them never had done any health work
before, and it made it very hard. I wished that I could do it all by myself,
but that was impossible. I am hoping to have the same ones back in the fall,
and then it will be much easier. * * * I feel most grateful for the hearty
cooperation of both the medical and dental professions. Without an exception
they all said: “ This is a most important work and should be carried on every
where.” I f only the parents will do what is advised and not put it off. I tried
to impress the follow-up committee with the importance of securing corrections
first for the benefit of the child, second for the good of the school, to prevent
so many repeaters, as an example to other parents, and for the furthering of
public health in that and surrounding communities. Even our future round
ups depend on the outcome of this one. W e want to prove to the doctors and
dentists that it is not time wasted.

From South Carolina:
W e are much indebted to Doctor M., o f ---------- , whose generous^ cooperation
was one of the big factors in our success. He attended all deliveries and took
time to explain details to the class when he thought such explanation could be
understood. In this way he gave them a great deal of very valuable instruction.

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R E S U L T S OF O P E R A T IO N OF M A T E R N I T Y A N D I N F A N C Y A C T

At one of my recent infant and preschool conferences there were several
mothers who had been visited and getting the advisory letters and had been
under the doctor’s care for the nine months of pregnancy. The babies of these
mothers scored 100 per cent. One mother remarked, “ I attribute all this to
being under the doctor’s and nurse’s care before my baby arrived.”

One of my Mexican mothers has had twins. She is 26 years old and this
makes eight children. She says she has had much benefit from the prenatal
letters she is getting in Spanish. She has tried to observe the directions
regarding diet and rest, and her preparations for her confinement showed that
she had really understood the letters, and the twins are fine children.

One white midwife is so anxious to keep up with the classes that she is now
attending the colored midwife class. W e had four visitors this month at our
colored midwife class. W e had four visitors this month at our regular class
meeting.

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r
PR IN C IPAL A C T IV IT IE S OF T H E IN D IV ID U A L ST A T E S
D U R IN G 1928
A summary of the work done in the individual States as reported
to the Federal office in their annual reports covering the fiscal year
1928 is given in the following pages. The figures in regard to certain
of the main activities have been summarized in Tables 2, 3, 4, and 5.
The outline of activities for each State is preceded by statements in
regard to the administrative agency, funds expended, and staff of
the agency during the year under review. The sums of money re
ported expended are not the same as the amounts accepted from each
appropriation during the two years it is available. They are instead
the actual expenditures during the fiscal year ended June 30,1928, in
cluding any unexpended balances carried over from the previous
year.1
1 See footnote 4, Table 1, p. 3,

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A LABAM A
S T A F F A N D A C T I V I T I E S I N 1928

Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Montgomery.
Funds expended: Federal, $25,836.95; State, $20,836.95; total, $46,673.90.
Staff:
Director (nurse), 2 nurses, 2 vital-statistics clerks, 1 bookkeeper (part
time), 1 stenographer. Thirty-two county nurses were paid in part from
maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 1,856; infants and pre
school children registered and examined— 11,601; visits to conferences—
14,919.
Defects found in children examined at conferences— 1,471; children having
defects— 1,248 (report incomplete). Parents had defects corrected in 664
of the children.
Prenatal conferences conducted by physicians— 346; expectant mothers
registered and examined— 2,113; visits to conferences— 4,092.
Conferences conducted by nurses, no physician present— 387; children in
spected— 393; mothers instructed in prenatal care— 1,251; visits to con
ferences by children— 630.
New permanent combined prenatal and child-health centers— 11 established
by county health units. They are supported by county, State, and mater
nity and infancy funds, also by the Rockefeller Foundation.
Classes for girls in care of infants and preschool children— 101 organized;
girls enrolled— 1,514; number completing course— 53 (report incomplete).
Midwives under supervision— 937, in the counties having county health
departments (many of which had nurses paid in part from maternity
and infancy funds). In a number of the counties monthly conferences
for midwives were held at the office of the county health department or
at designated points in the county. These were supplemented by personal
interviews at the office dr in the midwives’ homes. Courses of 12 lessons
were given to some midwives. Permits to practice midwifery are granted
for the current year only.
Home visits by nurses— 50,081 (prenatal cases seen, 5,409; obstetrical cases,
33; postnatal cases, 5,258; infants, 8,697; preschool children, 3,717).
Survey— 1, of maternal mortality, in cooperation with the United States
Children’s Bureau and with the indorsement of the State medical society,
the cost of the work being paid in part by the State and in part by the
United States Children’s Bureau.
Talks and lectures— 1,601.
Literature distributed— many pamphlets on maternal and child care (no
record kept of number of pieces).
Breast feeding was stressed by the county nurses in talks given to groups
and in the instruction given in visits to homes.
Infants born in the State during the year— 65,385; infants and preschool
children reached— by home visits, 12,414; by conferences, 11,601; ex
pectant mothers reached— 7,063.
Counties in the State— 67; counties in which maternity and infancy work
was done during the year—32; counties in which maternity arid infancy
work has been done since the acceptance of the maternity and infancy
act— 33.
The following organizations cooperated in the bureau’s work: Alabama
Polytechnic Institute (extension service), State board of education, State
child-welfare department, committee on maternal welfare of the State
medical association, and the parent-teacher association.
48278°— 29-

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4 2

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

Among the outstanding features of the year’s work were the extension of
maternity and infancy work in 11 counties through the organization of county
health departments, cooperation in the establishment of a training station for
nurses, health officers, and sanitary inspectors, and the beginning of the studyf
of maternal mortality in cooperation with the United States Children’s Bureau.
T Y P E S O F W O R K A N D SOM E R E SU LT S

The bureau of child hygiene and public-health nursing was established in the
State board of health in 1920. The State accepted the provisions of the mater
nity and infancy act through the governor’s acceptance on January 4,1922. This
was followed by legislative acceptance approved by the governor on February
14, 1923.
A public-health nurse has directed the work, assisted in the later years by
supervising field nurses. An increasing number of public-health nurses in county
health departments (32 in the year under review) have been paid from maternity
and infancy funds for maternity and infancy work.
Cooperation has been established with other branches of the State govern
ment (the board of education and the child-welfare department), the Alabama
Polytechnic Institute, State and county medical societies, and the parent-teacher
association.
Much of the maternity and infancy work has been conducted through the
county health departments. The county health officers, assisted by the publichealth nurses, examined and advised expectant mothers and examined infants
and preschool children in health conferences. The sanitary inspectors connected
with county health departments also contributed services. Visits to homes of
mothers and children by the county nurses have been a marked feature of the
program. County health departments have supervised and regulated the mid
wives within the confines of their counties.
The campaign for promotion of birth registration conducted in the fiscal
year 1927, to which assistance was given by State maternity and infancy
workers, terminated in the State’s admission to the United States birthregistration area in July, 1927.
An active interest in the welfare of mothers and babies is indicated by the (
study of maternal mortality being made in the State, the expansion of the
maternity and infancy program through the addition of new county health
departments, and the improvement that has been brought about in the work of
the midwives.
r
.
r
As the State did not enter the birth-registration area until 1927, figures for
infant and maternal mortality rates are available from the United States Bureau
of the Census for that year only, as follows:

Infant mortality rates ( deaths of infants under 1 year of age per 1,000 live
births), 1927
State— ..___________________,___________________________ ,_______
W hite-______ |>____________________________________________
Colored_______________________
Urban_____________________
Rural__________________________________

64
55
82
77

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births), 1927
State----------------------------------------------------------------------------------------- 79 . 6
W hite________________ yif___________ — ___________________ 62. 5
Colored________________________________________________
111.6
Urban---------------------------------------------------------------------------------- 110.2
Rural____ _____ ___________________________________ I______ 73 .2

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ARIZON A

S T A F F A N D A C T IV IT IE S I N

1928

Administrative agency:
State board of health, child-hygiene division, Phoenix.
Funds expended: Federal, $7,711.66; State, $7,253.71; total, $14,965.37.
Staff:
Director, 5 nurses (2 part year). Stenographic assistants were employed
as funds permitted.
Volunteer assistants— 4 physicians.
Activities:
Child-health conferences conducted by physicians— 56; infants and pre
school children registered and examined— 905; visits to conferences—
1,083.
Conferences conducted by nurses, no physician present— 42; children in
spected— 410; mothers instructed in prenatal care— 28; visits to confer
ences by children— 684; visits by mothers— 41.
Defects found in children examined at conferences— 1,037; children having
defects— 537. Parents had defects corrected in 409 of the children.
(This figure includes defects corrected in children inspected at conferences
conducted by nurses only as well as in children examined by physicians.)
Dental conference— 1 ; preschool children receiving dental examination— 37.
Classes for girls in care of infants and preschool children— 4 organized;
girls enrolled— 74; number completing course— 32; lessons in course—
4 to 10.
Classes for mothers— 17 organized; mothers enrolled and completing
course— 407. The number of lessons in the courses varied.
Home visits by nurses— 9,041 (prenatal cases seen, 348; obstetrical cases,
15; postnatal cases, 203; infants, 820; preschool children, 787).
Community demonstrations— 31, of a maternity and infancy public health
nursing program. The work included health conferences, home visits,
class instruction, lectures, and group demonstrations.
Group demonstrations— 178, on preparation and sterilization of obstetrical
supplies, preparation of bed for confinement, bathing patient in bed,
bathing and dressing the baby, giving sun baths, preparing formulas,
bandages, and dressings, caring for bottles, and caring for eyes, ears, and
nose of child.
Talks and lectures— 86 .
Literature distributed— 64,435 pieces.
New names registered for prenatal letters— 600; prenatal letters distrib
uted— 460 sets.
Nutrition work was done through classes and individual instruction given
at conferences and in home visits.
Exhibit material was lent three times.
Breast feeding was stressed in class instruction, in literature distributed,
and in visits made in homes.
Infants born in the State during the year— 8,436; infants under 1 year
of age reached by the work of the division— 8,611; preschool children
reached— 1,772; expectant mothers reached— 976.
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics (except
in case of tourists or families of migratory laborers).
Counties in the State— 14; counties in which maternity and infancy work
was done during the year— 7 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 14.
The following organizations cooperated in the division’s work: Women’s
clubs, church relief societies, and the parent-teacher association.
As a result of the division’s work in one community specialists held three
clinics for the correction of defects of children, with the indorsement of
the local physicians.
43

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4Digitized
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Federal Reserve Bank of St. Louis

THE

W E L F A R E A N D H Y G IE N E

OF M A T E R N I T Y A N D I N F A N C Y

TYPES OF W ORK AN D

SOM E R E SU L T S

The child-hygiene division was established in the State board of health in
1919. The State accepted the provisions of the maternity and infancy acti
through the governor’s acceptance on December 23, 1921. This was followed
by legislative acceptance approved by the governor on March 13, 1923.
The same director has been in charge of the work of the division during the
period of cooperation with the Federal Government. Three to five staff nurses
have been assigned to field work in the past few years.
The division has had cooperation from women’s organizations, the parentteacher association, and church relief societies, and assistance from lay and
professional volunteer workers.
Expansion of activities in the maternity and infancy work, particularly in the
activities conducted by the nurses, has marked the program. Home visits made
by nurses were more than doubled in 1928, when 9,041 visits were made, as
compared with 1927, when 4,250. visits were made. In 1927 the number of new
names of expectant mothers registered for prenatal letters was 159; during
1928 the number increased to 600.
One goal in the division’s work was bringing the State into the United States
birth and death registration areas. This was accomplished in 1926. A result
of entrance into the registration area has been the possibility of reaching with
literature on infant care all parents whose babies’ births are registered in the
State department of health.
State figures show a downward trend in infant mortality rates since 1920,
although the rate announced by the United States Bureau of the Census was
higher in 1927 (130 per 1,000 live births) than in 1926, the first year for which
Census Bureau figures were available (121). A large and constantly changing
group of foreign laborers within the State has created a difficult health problem.
This situation is no doubt one of the factors giving to the State a higher infant
mortality rate than that of any other State in the registration area, and it
accounts for some fluctuation in rates.
The number of maternal deaths declined in 1927 as compared with 1926.
The maternal mortality rate for 1926 was 102.5 per 10,000 live births; the rate
for 1927 was 89-

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Federal Reserve Bank of St. Louis

ARK AN SAS
STAFF AND

A C T I V I T I E S IN

1928

Administrative agency:
State board of health, bureau of child hygiene, Little Rock.
Funds expended : Federal, $14,634.68; State, $13,244.79; total, $27,879.47.
Staff:
Director (State health officer serving), 2 nurses ( l f o r 9 months), 1 lecturer
and field worker, 1 stenographer. Twenty-six county nurses were paid in
part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 434; infants and pre
school children registered and examined— 3,777.
Defects found in children examined at conferences— 6,394; children having
defects— 3,508. Parents had defects corrected in 3,352 of the children.
Prenatal conferences conducted by physicians— 87; expectant mothers regis
tered— 602 ; number examined— 112 .
Conferences conducted by nurses, no physician present— 249; children in
spected— 7,280; mothers instructed in prenatal care— 108; visits to con
ferences b y mothers— 470.
Dental conferences— 10, conducted by dentists who volunteered their
services ; preschool children receiving dental examination— 411.
New permanent combined prenatal and child-health centers— 16 established
as a result of the maternity and infancy work. They are supported by
maternity and infancy, county, and private funds.
Classes for girls in care of infants and preschool children— 76 organized;
girls enrolled— 385 ; lessons in course— 24.
Classes for mothers— 108 organized ; mothers enrolled— 372.
Classes for midwives— 314 organized; midwives enrolled plus those carried
over from previous year— 2,613. The regular course of instruction in
cludes 6 topics which may be divided into 2 or more lessons. The course is
enlarged as the midwives show capability for more advanced instruction.
Home visits by nurses— 6,081 (to prenatal cases, 551; obstetrical cases, 28;
postnatal cases, 774; infants, 2,600; preschool children, 2,128).
Demonstrations— 26, consisting of parades, pageants, and plays emphasizing
some phase of the child-health program.
Group demonstrations— 457, of maternity outfits, preparation of food for
children, and nursing care of mothers and children in the home.
Surveys— 2 : (1) Of midwives. (2) Of birth registration. Both were state
wide.
Campaign— 1, for the examination of preschool children and correction of
their defects. About one-third of the counties were thoroughly organized
for this campaign, and practically all of them carried on some work,
much of which was done by local organizations. Many physical examina
tions, corrections of defects, immunizations against diphtheria, inocula
tions against typhoid fever, and vaccinations against smallpox resulted.
Talks and lectures— 863.
Literature distributed— 131,273 pieces.
Nutrition work was done through individual instruction to mothers of pre
school children.
Exhibits conducted— 344. Exhibit material prepared— posters, model bed
for demonstration purposes at health conferences, dental exhibit. Ex
hibit material was lent twenty-five times.
Breast feeding was stressed in instruction given to expectant mothers and
to midwives.
Infants born in the State during the year— 41,772; infants under 1 year of
age reached by the work of the division— 4,727 (exclusive of those
reached by literature distributed) ; preschool children reached— 5,300
(exclusive of those reached by literature distributed) ; expectant mothers
reached-—1,196.
45

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued^
Counties in the State— 75; counties in which maternity and infancy work
was done during the year— 62; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancyf
act— 75.
Since the beginning of the State’s cooperation under the maternity and
infancy act 2 counties have assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.
The following organizations cooperated in the bureau’s work: State board
of education (home-economics section), State university (extension serv
ice), State federation of women’s clubs, State society for crippled chil
dren, State fair association, women’s auxiliary of the State medical
society, American Legion, American Legion auxiliary, Woman’s Christian
Temperance Union, and the parent-teacher association. They assisted
with surveys, health conferences, classes for girls, establishment of health
centers and clinics of various kinds, and provided means for the correc
tion of defects of many children.
Among the outstanding features of the year’s work was the extension of the
maternity and infancy program in 2 0 new county health departments.
TYPES OF W ORK AND

SOM E R E SU L T S

The bureau of child hygiene was established in the State board of health in
1919. The State accepted the provisions of the maternity and infancy act
through the governor’s acceptance on January 20, 1922. This was followed
by legislative acceptance approved by the governor on February 9, 1923.
A physician usually has directed the maternity and infancy work. During
several years the State health officer has been the acting director.
In the earlier years of cooperation under the act a general program of educa
tion was conducted by means of itinerant child-health conferences, distribution
of literature, work with midwives, and an active campaign for better registra
tion of births.
Since the Mississippi flood in the spring of 1927 the State health department
has been developing many full-time county health departments, with a view to
rehabilitation and improved sanitation. Work with the child-health truck
paved the way for establishing these health departments. A full-time medical
director, one or two county nurses, a sanitary inspector, and sometimes a
stenographer comprise the usual county health department personnel. Many
nurses as well as health officers are sent to the training station at Indianola,
Miss., for a month’s intensive training before being assigned to county health
departments. Much of the maternal and infant-hygiene program was con
ducted through the activities of nurses paid in part from maternity and infancy
funds, who were assigned to county health departments for maternity and
infancy work. During the year under review the 26 nurses thus employed and
detailed to county health departments represented an increase of 15 over the
preceding year; fewer workers were employed on the State staff in 1928.
Immunizations of children against diphtheria, smallpox, and typhoid fever,
conducted largely by county health departments, were among the activities
in the State during the year under review.
Cooperation has been maintained with other branches of the State govern
ment (the bureau of education and the State university), and with women’s
organizations, the parent-teacher association, the American Legion and its
auxiliary, the State fair association, and the State society for crippled children.
Physicians, dentists, and lay persons also have given volunteer services.
An outstanding result of the work has been the inclusion of Arkansas in
the United States birth and death registration areas in 1927,'after an active
educational campaign in which the bureau of child hygiene assisted.
The midwives are kept under supervision, and improvement in their
standards of practice has been noted. They now assist their patients in
securing prenatal care and in having urinalyses made.
As the State was not admitted to the registration area until early in 1927
figures from the United States Bureau of the Census for computation of
mortality rates are available only for that year. The infant mortality rate
in 1927 was 61 per 1,000 live births for the State as a whole, 82 in urban areas,
and 59 in rural areas. The maternal mortality rate in 1927 was 89;7 per
10,000 live births in the State as a whole, 134.5 in the urban areas, and 85.9 in
rural areas.

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Federal Reserve Bank of St. Louis

CALIFORNIA
STAFF AND

A C T IV IT IE S IN

1928

Administrative agency:
State department of public health, bureau of child hygiene, San Francisco.
Funds expended: Federal, $29,707.89; State, $21,600.34; total, $51,308.23.
Staff:
Director (physician), 3 physicians (2 part year, 1 of these part time), 1
nurse, 2 maternity-home inspectors, 1 vital-statistics clerk (part year),
1 financial clerk (part time), 1 mailing clerk, 2 stenographers (1 part
year, 1 part time). Twenty-nine county nurses in 19 counties were paid
wholly or in part from maternity and infancy funds.
Volunteer assistants— 60 physicians, 9 dentists, 29 nurses, 290 lay persons.
Activities:
Child-health conferences conducted by physicians— 583; infants and pre
school children registered and examined— 7,779; visits to conferences—
10,984.
Prenatal conferences conducted by physicians— 102; expectant mothers reg
istered and examined— 706; visits to conferences— 1,347.
Conferences conducted by nurses, no physician present— 712; children
inspected— 1,294.
Dental conferences— 53; preschool children receiving dental examination—.
1,240.
New permanent child-health centers— 17 established as a result of the
maternity and infancy work. They are supported by city or county and
maternity and infancy funds. Women’s clubs cooperate.
Classes for girls in care of infants and preschool children— 19 organized;
girls enrolled and completing course— 321; lessons in course— 16.
Classes for mothers— 81 organized; mothers enrolled— 2,030; number com
pleting course— 1,650; lessons in course— 5 to 8.
Home visits by nurses— 20,844 (prenatal cases seen, 557; obstetrical cases,
27; postnatal cases, 381; infants, 3,391; preschool children, 5,407).
Maternity homes and hospitals inspected— 352; inspections made— 651.
Group demonstrations— 601, on home nursing, preparation of food, and
various other phases of maternal and infant care.
Surveys— 3 : (1) Of county hospitals. (2) Of birth registration. (3) Of
maternal mortality. All were state-wide.
Campaigns— 4: (1) For state-wide examination of preschool children and
correction of their defects before the children should enter school. ( 2 )
For prevention of diphtheria, in 5 counties. (3) For prevention of small
pox, in 4 counties. (4) For prevention of typhoid fever, in 1 county.
Talks and lectures— 102, to audiences totaling more than 9,000 persons.
Literature prepared— Physical Standards for Children, set of postnatal
letters.
Literature distributed— 92,108 pieces.
New names registered for prenatal letters— 1,492; prenatal letters dis
tributed— 3,107 sets.
A 1-day institute for nurses on maternity and infancy work and obstetrical
nursing was conducted by a prominent obstetrician, and assistance was
given in organizing two institutes of public-health nursing at the Uni
versity of California. A 1-day institute for physicians on prenatal care
and the organization and aims of prenatal clinics was conducted by the
same obstetrician.
Nutrition work was done through 20 nutrition classes attended by 231
persons, also by individual instruction at classes of other types, and
at health conferences.

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Federal Reserve Bank of St. Louis

THE

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

Activities— Continued.
Exhibits conducted— 29, at State and local meetings. Exhibit material
prepared— prenatal and infant train in which the stations along the
road begin with Prenatal Care and Birth Station, followed by episodes inj
the first year of life, as Orange Juice, and Sun Baths, with small dolls
used for illustration. Exhibit material was lent twenty-three times.
Articles prepared— Value of Health Education, “ Escuelita.”
Breast feeding was stressed through literature distributed, individual in
struction given to mothers, and demonstrations made at nurses’ institutes
and classes for mothers.
Infants born in the State during the calendar year 1927— 84,334; infants
under 1 year of age reached by the work of the bureau during the year
under review (exclusive of those reached by literature distributed)—
8,551; preschool children reached (exclusive of those reached by literature
distributed)— 10,561; expectant mothers reached— 4,370.
Counties in the State— 58; counties in which maternity and infancy work
was done during the year— 56; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 58.
Since the beginning of the State’s cooperation under the maternity and
infancy act 12 counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following organizations cooperated in the bureau’s work: State tuber
culosis society, State league of women voters, American Association of
University Women, American Red Cross, federated women’s clubs, men’s
service clubs, and the parent-teacher association. They assisted in cam
paigns and cooperated with the county nurses who were paid in part from
maternity and infancy funds. Among the children examined at confer
ences reported in the foregoing paragraphs many were examined in the
“ Get ready for school” drive sponsored by the National Congress of
Parents and Teachers.
Among the outstanding features of the year’s work were the pediatric service
given by the staff physicians, the better organization of the maternity and f
infancy nursing service, and the fact that the campaign work to have preschool
children examined before entering school has been assumed by the parentteacher association.
TYPES OF W ORK AND

SO M E R E SU L T S

The bureau of child hygiene was established in the State department of public
health in 1919. The State accepted the provisions of the maternity and infancy
act through the governor’s acceptance on April 3, 1922. This was followed by
legislative acceptance approved by the governor on April 30, 1923.
A medical director, assisted by a relatively small central staff and an increas
ing staff of field nurses, has been in charge of the work. One of the chief
features of the program has been the expansion of public-health nursing in the
State. One feature of this expansion has been the assumption of financial
responsibility for maternity and infancy work by 12 counties. During the year
under review 29 county nurses, as compared with 20 in 1925, were paid wholly
or in part from maternity and infancy funds. Only 9 of the 58 counties in the
State were without some form of public health nursing service at the close of
the fiscal year 1928.
A noteworthy feature of the State program has been the effort to examine the
preschool children of the State before they enter school. During 1928 examina
tions were conducted in 49 counties, an increase over former years.
The inspection and supervision of maternity homes and hospitals, which is a
duty of the State bureau of child hygiene, has been greatly extended, the number
of inspections having increased from 271 in 1926 to 522 in 1927 and 651 in 1928.
The effect of this work seems to have been reflected in lower maternal mortality
rates.
The free distribution of nitrate of silver for the prevention of ophthalmia
neonatorum was begun in the State in 1915. Maternity and infancy funds have
been contributed since 1927. The distribution has been chiefly to midwives and
to small maternity homes. The 38 cases of ophthalmia neonatorum reported in
1924 were the highest number reported for any one year during the period 1915
to 1927, inclusive. The 13 cases reported in 1927 were the lowest number of
cases reported for any one year in this period.

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Federal Reserve Bank of St. Louis

P R I N C I P A L A C T IV IT IE S OP I N D IV ID U A L S T A T E S ,

Cooperation has been given by prominent State organizations of women, the
American Red Cross, the State tuberculosis society, and men’s service clubs.
The parent-teacher association has assumed responsibility for the drive for
examinations of the preschool child.
Infant mortality has declined from 71 babies dying in the first year of life
for every 1,000 born alive in 1922, when the State began cooperating under the
maternity and infancy act, to 62 in 1927, a saving of 9 babies in every 1,000 in
1927 as compared with 1922.
The maternal mortality rate has declined during the period of cooperation
from 71.9 per 10,000 live births in 1922 to 57.6 in 1927, a saving of 14 mothers’
lives for every 10,000 live births. The rural rate was 64.9 in 1922 and 52.2 in
1927; the urban rate was 77.1 in 1922 and 61.3 in 1927.

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Federal Reserve Bank of St. Louis

1928

COLORADO
STAFF AND

A C T IV IT IE S

1928

Administrative agency:
State department of public instruction, child-welfare bureau, Denver.
Funds expended: Federal, $10,000; State, $5,000; total, $15,000.
Staff:
Director, 3 physicians (part time, 1 two months), 3 nurses (2 part year),
1 clerk, 1 stenographer. An additional physician and additional nurses
were employed as needed.
Volunteer assistants giving occasional help— 48 physicians, 23 dentists, 20
nurses, 600 lay persons.
Activities:
Child-health conferences conducted— 41, in 30 towns; infants and pre
school children registered and examined— 1,401.
The organization work for the conferences was done by the University of
Colorado through its department of organization. The staff of the
conference unit consisted of the director of the bureau, a pediatrician,
a nurse, and a clerk, also representatives of the State board of health,
the State tuberculosis association, the State dental association, and the
psychopathic hospital of the State university.
Defects found in children examined at conferences— 4,527; children having
defects— 1,255. Parents had defects corrected in 594 of the children.
Prenatal conferences conducted by physicians— 16; expectant mothers
registered and examined— 162.
Conferences conducted by nurses, no physician present— 42; children
inspected— 771.
f
New permanent prenatal center— 1 established as a result of the maternity
and infancy work. It is supported by a city health department but uses
records and literature furnished by the State child-welfare bureau.
Classes for girls in care of infants and preschool children— 33 organized; .
girls enrolled— 175; number completing course— 162; lessons
in
course— 1 2 .
Classes for mothers— 14 organized; mothers enrolled plus those carried over
from previous year— 8 6 ; number completing course— 62; lessons in
course— 10 .
Home visits by nurses— 961 (prenatal cases seen, 65; obstetrical case, 1 ;
infants, 279; preschool children, 616).
Community demonstrations— 4, of maternity and infancy public-health
nursing. All were county-wide.
Group demonstrations— 6 , on various phases of maternal and infant care.
Surveys— 2 : (1) Of public health nursing service in the State. (2) Dental,
in 1 town.
Campaigns— 2 : (1) For promotion of birth registration.2 (2) For the
examination of preschool children and correction of their defects before
the children should enter school. Both were state-wide.
Talks and lectures— 127.
Literature prepared— record cards, leaflet on enuresis.
Literature distributed— 10,600 pieces.
The State agricultural college conducted nutrition classes following the
child-health conferences of the child-welfare division, using the reports
and record cards of the children examined as a basis in selecting children
for the classes.
Exhibits conducted— 7, at State and county fairs and at various meetings.
Exhibit material prepared— posters showing literature on maternal and
infant care available from the bureau. Exhibit material was lent five
times.
2 Colorado was adm itted to the United States birth-registration area in August, 1928.
50

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Federal Reserve Bank of St. Louis

P R I N C I P A L A C T IV IT IE S OP IN D IV ID U A L S T A T E S ,

1928

Activities— Continued.
Breast feeding was stressed in the instruction given to mothers at con
ferences and in the literature sent to mothers of infants whose births
were reported in the newspapers.
Infants under 1 year of age reached by the work of the bureau during the
year ended June 30, 1928— 4,031; preschool children reached— 3,970;
expectant mothers reached— 3,000.
The bureau sends literature on infant hygiene to parents of all infants
whose births are reported in the newspapers.
Counties in the State— 63; counties in which maternity and infancy work
was done during the year— 29; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 58.
Since the beginning of the State’s cooperation under the maternity and
infancy act one county has assumed the responsibility for maternity and
infancy work.
As a result of the bureau’s work child-health conferences were conducted
by local personnel in several towns, and two prenatal clinics were
organized.
The following organizations cooperated in the bureau’s work: State board
of health, State university and its psychopathic hospital, State agricul
tural college, State dental association, State tuberculosis association, and
the parent-teacher association. They assisted by detailing personnel
to the child-health conferences and by conducting nutrition classes.
Among the outstanding features of the year’s work was the assistance given
to the State bureau of vital statistics in a birth-registration campaign conducted
to qualify the State for admission to the United States birth-registration area.
TYPES OF W O RK AND

SOM E R E SU L T S

The child-welfare bureau, in which the administration of the maternity and
infancy act is vested, was established in the State department of public
instruction in 1918.
The State accepted the provisions of the maternity and infancy act through
the governor’s acceptance on January 9, 1922. This was followed by legislative
acceptance approved by the governor on April 30, 1923.
The same director, assisted by nurses, has had charge of the work during
the period of cooperation under the act.
Itinerant child-health conferences conducted by physicians have been an
important feature of the program, through which information given by skilled
professional men has reached many remote sections of the State.
Cooperation has been maintained with the State board of health and State
educational institutions, the State medical society and the dental and tuber
culosis associations, the American Red Cross, women’s organizations, and the
parent-teacher association.
Many demonstrations have been conducted at fairs and other assemblies.
The distribution of literature to parents of all infants whose births are
reported in the newspapers has been a feature of the work for the last two
years.
During approximately two years the child-welfare bureau has cooperated
with the vital-statistics bureau of the State department of health in efforts
to bring the State into the United States birth-registration area. A campaign
of education in regard to registration was conducted by staff nurses and other
workers on the bureau’s staff. Educational work was done through fairs, and
registration of many births was secured. The campaign continued until the
close of the year under review.
As the State was not in the birth-registration area during the year under
review, no statement as to mortality rates can be made.

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Federal Reserve Bank of St. Louis

DELAW ARE
STAFF AND

A C T IV IT IE S IN

1928

Administrative agency:
State board of health, division of child hygiene, Dover.
Funds expended: Federal, $12,909.73; State, $8,188.20; total, $21,097.93.
Staff:
Director (physician), 9 nurses, 1 vital-statistics clerk and bookkeeper, 1
stenographer. Seven physicians were employed as needed to conduct
conferences.
Activities:
■Combined prenatal and child-health conferences conducted by physicians—
44 (some held more than one session) ; expectant mothers registered and
examined— 18; infants and preschool children registered and examined—
422; visits to conferences by expectant mothers— 39; visits by in fa n t s
and preschool children— 3,972.
Child-health conferences conducted by physicians— 302 (some held more
than one session) ; infants and preschool children registered and ex
amined— 1,688; visits to conferences— 12,462.
Defects found in children examined at conferences— 1,691; children having
defects— 1,272. Parents had defects corrected in 851 of the children.
Prenatal conferences conducted by physicians-—52; expectant mothers reg
istered— 212; number examined— 201: visits to conferences— 344.
Conferences conducted by nurses, no physician present— 1,049; children
inspected— 4,155; mothers instructed in prenatal care— 210; visits to con- f
ferences by children— 24,310; visits by mothers— 521.
Classes for girls in care of infants and preschool children— 19 organ
ized ; girls enrolled— 358; number completing course— 313; lessons in
course— 12 .
Classes for mothers— 12 organized; mothers enrolled— 99; lessons in
course— 10. The classes were still in progress at the close of the year
under review.
Classes for midwives— 16, continued from previous fiscal year (the classes
are continuous) ; midwives enrolled— 185; lessons in course— 6 .
Home visits by nurses— 31,691 (prenatal cases seen, 399; obstetrical cases,
107; postnatal cases, 425; infants, 2,206; preschool children, 4,710).
Survey— 1, to ascertain the names and ages of children in all the towns in
the State and to gather data concerning the milk and water supply and
general sanitation, important in reducing infant mortality.
Campaigns— 3 : (1) For immunization of preschool children against diph
theria ; 316 conferences were conducted, and 1,571 preschool children
were immunized. (2) For promotion of breast feeding.
(3) For pe
riodic health examination of infants and preschool children. All were
state-wide.
Talks and lectures— 90.
Literature prepared— baby book and diphtheria pamphlet, revised.
Literature distributed— 47,758 pieces.
New names registered for prenatal letters— 472; prenatal letters distrib
uted— 369 sets.
Exhibits conducted— 2 , at fairs, each lasting 5 days. Exhibit material
prepared— charts, maps, and graphs. Exhibit material was lent three
times.
Scientific articles prepared— Results of Health Work, Diphtheria Preven
tion, Infant and Maternal Mortality, Results of Survey of Children and
Health Conditions in Thirteen Towns.
Statistical studies made— maternal mortality; infant mortality among
white and colored, by counties; amount of milk consumed in 1 county.
52

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Federal Reserve Bank of St. Louis

PKINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 192 8

Activities— Continued.
Breast feeding was stressed in talks before medical societies and nurses
.
and in the instruction given at health centers and in home visits. It was
\
estimated that only about half the infants in the State are breast fed.
Infants born in the State during the year— 4,281; infants under 1 year of
age reached by the work of the division— approximately 4,300; preschool
children reached— 10,185; expectant mothers reached— 1 ,112 .
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics. During
the year under review literature on maternal and infant care was sent
also to all expectant mothers whose names were reported to the division
by physicians, midwives, State nurses, and the Wilmington Visiting Nurse
Association.
Counties in the State— 3 ; counties in which maternity and infancy work
was done during the year— 3.
The following organizations cooperated in the division’s work: Delaware
Antituberculosis Society, Wilmington Visiting Nurse Association, and the
parent-teacher association.
Among the outstanding features of the year’s work were the campaign for
promotion of breast feeding and the survey of children in all the towns of the
State.
TYPES OF W ORK

AND

SO M E R E SU LT S

The present division of child hygiene in the State board of health is an
outgrowth of the State child-welfare commission established in 1921. The
State accepted the provisions of the maternity and infancy act through legisla
tive enactment approved by the governor on April 7, 1921, in anticipation of
the passage of the act by the Federal Congress.
A full-time medical director was secured in 1926 to direct and supervise the
field work and field staff. During the past two years nine nurses have given
full-time service, and five to seven physicians have given part-time service to
the improvement of maternal and infant hygiene in the State.
Cooperation has been maintained with the Delaware Antituberculosis Associa
tion and the parent-teacher association, and was established in 1928 with the
Wilmington Visiting Nurse Association.
A relatively large number of visits to conferences were made by children
during the year under review, and two-thirds of the number found to have
defects had the defects corrected.
A survey in the towns of the State with high infant mortality to secure the
names of children and to ascertain the condition of milk and water supplies
was an important feature of the program in view of the high death rate due
to diarrhea and enteritis.
Campaigns for immunization against diphtheria have been conducted the
last three years beginning with seven districts in 1926 and extending over the
entire State in 1928. In the three years 3,615 children received toxin-antitoxin.
It was estimated that 50 per cent of the babies were artificially fed, and in
1928 breast feeding, the importance of which had already been stressed at
itinerant conferences and in the literature distributed, was made the subject
of a special state-wide campaign.
The parents of every baby whose birth is registered receive information on
the care of the baby through the Baby Book, diet cards, and book on diseases
of children. A considerable number of the expectant mothers in the State are
also reached with some form of instruction on the value of prenatal care.
The State consists of only three counties, and it has been possible to conduct
a more intensive program than in States with larger areas. The effect of the
intensive work is reflected in the reduction of both the infant and the maternal
mortality rate; 29 fewer babies in every 1,000 born alive died in 1927 than in
1922, and 7 fewer mothers died for every 10,000 babies born alive in 1927 than
in 1922.
The infant mortality rates per 1,000 live births for the years 1922 to 1927
were as follows: 1922, 100; 1923, 104; 1924, 95; 1925, 91; 1926, 93; 1927, 71.
This decrease was due partly to the general decline from 1922 to 1927 in the
infant mortality from diarrhea and enteritis, the 1927 rate being 59 per cent
lower than that of 1922. The rates for the individual years were as follows:
1922, 26.1; 1923, 18.1; 1924, 18.1; 1925, 24; 1926, 17.1; 1927, 10.8.

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Federal Reserve Bank of St. Louis

T H E W E L F A R E A N D H Y G IE N E

OF M A T E R N I T Y A N D I N F A N C Y

Source: United States Bureau ofthe Census (Del
aware was adm itted to the United States birthre^istration area in I92l)
Deaths o f infants under 1 year o f age from all causes and deaths under 1 year o f
age from diarrhea and enteritis, per 1,000 live b ir th s ; Delaware, 1921—1927

The maternal mortality rates per 10,000 live births for the years 1922 to 1927
were as follows: 1922, 65.8; 1923, 83.7; 1924, 76.9; 1925, 77; 1926, 92.9; 1927,
58.6. The decline in maternal mortality has been largely in the rural districts.
The rural rate in 1922 was 71.7 deaths for every 10,000 live births, whereas
in 1927 it had dropped to 32.6. The urban maternal mortality rate was higher
in 1927 than in 1922.

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FLORIDA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Jacksonville.
Funds expended: Federal, $13,907.86; State, $14,222.83; total, $28,130.69.
Staff:
Director (nurse, part time), 7 nurses (3 part time, 1 for 1 month), 1 au
ditor (part time), 1 file clerk, 1 stenographer (part time), 1 typist (part
time).
Volunteer assistants— 68 physicians, 16 dentists, 105 nurses, 319 lay persons.
Activities :
Child-health conferences conducted by physicians— 75 ; infants and preschool
children registered and examined— 1,768 ; number having defects— 1,339.
Prenatal conferences conducted by physicians— 43 ; expectant mothers reg
istered and examined— 709.
Conferences conducted by nurses, no physician present— 255 ; children in
spected— 4,543.
Dental conferences— 83 conducted. The numbers of expectant mothers and
of preschool children receiving dental examination were not recorded
separately.
New permanent child-health center— 1 established as a result of the mater
nity and infancy work. It is supported by private funds.
Classes for midwives— 937 organized ; midwives enrolled plus those carried
over from previous year— 3,432; lessons in course— 4. The 1,611 mid
wives now recorded as practicing in the State are being supervised,
enrolled in classes, and given instruction.
Home visits by nurses— 5,333 (prenatal cases seen, 675; postnatal cases,
165; infants, 1,844; preschool children, 2,609).
Group demonstrations— 87, of various phases of infant care. Two tables
on which were exhibited articles that are harmful and articles that are
helpful in the care of the baby were used in connection with these
demonstrations.
Talks and lectures— 166.
Literature distributed— 34,032 pieces.
Nutrition work was done through instruction given to mothers at confer
ences and in home visits.
Exhibit material prepared— posters, draperies showing health rules, health
pictures, and diets.
Breast feeding was promoted through educational work with mothers.
Infants born in the State during the year— 34,061; infants and preschool
children reached by the work of the bureau— 12,134 ; expectant mothers
reached— 1,493.
The bureau sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics if the
parents are known to be able to read.
Counties in the State— 67 ; counties in which maternity and infancy work
was done during the year— 67.
Since the beginning of the State’s cooperation under the maternity and
infancy act nine counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.8
As a result of the bureau’s work bounty nurses not paid by maternity
and infancy funds conducted child-health conferences in four counties.
The bureau gave advisory assistance to local organizations conducting
maternity and infancy work.

3Another county appropriated funds for maternity and infancy work immediately after
the close o f the year under review.
55

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Federal Reserve Bank of St. Louis

THE

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

Activities— Continued.
The following organizations cooperated in the bureau’s work: State fed
eration of women’s clubs, State medical association, State dental associa
tion, State public-health association, American Legion, Florida Business?
and Professional Women’s Club, fraternal and civic organizations, and
the parent-teacher association. They assisted in organizing conferences,
rendered clerical assistance at the conferences, transported mothers
and babies to and from conferences, contributed money for defraying
expenses of conferences, assisted with publicity, and helped to secure
county and State appropriations.
TYPES OF W ORK AND SOME RESULTS

The bureau of child hygiene and public-health nursing was established in
the State board of health in 1918. The State accepted the provisions of the
maternity and infancy act through the governor’s acceptance on February 8 ,
1922. This was followed by legislative acceptance approved by the governor
on June 8 , 1923.
The same nurse director has been in charge of the work since cooperation
under the act was begun, assisted in the field by a staff of nurses from the
State bureau. Volunteer assistance has been given by many physicians, dentists,
public-health nurses, and lay persons. Cooperation has been established with
an increasing number of professional and lay groups, which now include State
medical, dental, and public-health associations, women’s organizations, civic
clubs, the American Legion, aind the parent-teacher association.
Emphasis has been placed on child-health conferences, visits to mothers and
infants in their homes, and instruction and supervision of midwives.
At the beginning of cooperation under the maternity and infancy act more
than 4,000 women in the State were practicing as midwives. A t the close
of the year under review the number known to be practicing had been reduced
to 1,611, and much improvement was noted in their practice. Physicians now
are called frequently by midwives for difficult or abnormal deliveries. Nitrate
of silver for use in prevention of blindness in the newborn, which is distributed
free through the use of maternity and infancy funds, is regularly requested
by the midwives.
The devastating hurricane that swept the State within the period of coopera
tion interrupted the routine of the maternity and infancy program and added
greatly to the adverse influences affecting the lives and health of mothers and
children. Yet in the face of this disaster both infant and maternal mortality
rates have shown reduction in 1927 compared with 1924 (the year of the State’s
admission to the birth-registration area).
In 1924 the number of infants who died under 1 year of age in every 1,000
born alive was 82. In 1927 the number was 67, a saving of 15 babies in every
1,000 in 1927 compared with 1924. Both urban and rural areas shared in the
reduction. In urban areas the mortality rate for colored infants was 22 per cent
lower in 1927 than in 1924; for white infants it was 12 per cent lower. In the
rural areas the reverse condition obtained, the rate for white infants being 22
per cent lower in 1927 than in 1924, whereas for colored infants it was only
7 per cent lower.
The number of mothers dying for every 10,000 babies born alive in 1924 was
121; in 1927 the number was 110, a saving of 11 mothers per 10,000 live births.
The reduction affected both urban and rural areas, though the situation was not
the same for the white and the colored women. In urban areas the rate was 10
per cent lower for white mothers in 1927 than in 1924, and 3 per cent higher for
colored mothers. In rural areas it was 5 per cent higher for white mothers and
23 per cent lower for colored mothers.

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GEORGIA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, division of child hygiene, Atlanta.
Funds expended: Federal, $28,159.73; State, $23,991.37; total, $52,151.10.
Staff:
Director (physician, part time), 1 physician (part year), 6 nurses (5 part
year), 1 laboratory assistant (part time), 1 stenographer, 1 clerk-typist
(part year), 1 chauffeur (part year). Seventeen county nurses were
paid from maternity and infancy funds (2 part time, 7 part year).
Activities:
Child-health conferences conducted by physicians— 1,234; infants and pre
school children examined— 8,033. Many of these conferences were con
ducted in the “ healthmobile,” which traveled through rural communities
in 21 counties with a staff of a physician, a nurse, and a chauffeur. After
the visit of the “ healthmobile ” in each county a permanent maternity
and infancy committee was organized to do follow-up work.
Defects found in children examined at conferences (January-July, 1928) —
11,982.
Prenatal conferences conducted by physicians— 378; expectant mothers
examined— 2,998.
Conferences conducted by nurses, no physician present— 107; children in
spected— 421; mothers instructed in prenatal care— 70; visits to confer
ences by children— 605.
Dental conferences (January-July, 1928)— 41; expectant mothers receiving
dental examination— 77; preschool children receiving dental examina
tion— 101 .
New permanent combined prenatal and child-health centers— 2 established
as a result of the maternity and infancy work. They are supported by
maternity and infancy funds and by county funds.
New permanent child-health center— 1 established as a result of the ma
ternity and infancy work. It is supported by maternity and infancy funds
and by county funds.
New permanent prenatal centers— 4 established as , a result of the mater
nity and infancy work. They are supported by maternity and infancy
funds and by county funds.
Classes for girls in care of infants and preschool children— 191 organized;
girls enrolled— 4,968; lessons in course— 12.
Classes for mothers 66 organized; mothers enrolled— 1,904; number com
pleting course— 288; number still on roll— 1,716.
Classes for midwives— 194 organized (excluding 15 organized by a physician
lent by the United States Children’s Bureau) ; midwives enrolled— 1,764;
number completing course— 821; lessons in course— 10. Permanent mid
wives’ clubs were organized in each county in which classes were conducted.
Home visits by nurses 24,968 (prenatal cases seen, 4,457; obstetrical cases,
96 (report incomplete) ; postnatal cases, 1,883; infants, 5,939; preschool
children, 3,888).
Maternity homes inspected— 441 (report incomplete).
Infant homes inspected— 731 (report incomplete).
Community demonstrations— 19, of a maternity and infancy public health
nursing program.
Group demonstrations—633, to groups of mothers, expectant mothers, and
midwives. In addition 3,205 demonstrations were made for individuals.
Surveys— 3 ; (1) Of midwives.
(2) Of birth registration.
(3) Of 7
hospitals.
Campaigns— 8 : (1) For observance of May Day as Child Health Day,
state-wide
(2) For immunization of children against diphtheria, state
wide. (3) For examination of preschool children and correction of their
48278°— 29------ 5
57

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Federal Reserve Bank of St. Louis

THE

w elfare

and

h y g ie n e

m a t e r n it y a n d

in f a n c y

Activities— Continued.
defects before the children should enter school, in 1 county.
(4, 5,
6 ) For interesting young girls in organizations for health work, in I
county. (7) For dental care for children, in 1 city. ( 8 ) For promotion''
of negro health, in 1 city.
Talks and lectures— 382.
Literature distributed— 105,875 pieces.
A graduate course for nurses in maternity and infancy work was conducted
in Atlanta in cooperation with Emory University.
Nutrition work was done through individual instruction and through
classes conducted by a dietitian detailed by the State university to the
“ healthmobile ” operated by the division in rural districts.
Exhibits conducted— 64.
Article prepared— The Midwife Problem. Material for newspapers and
for radio broadcasting was also prepared.
Breast feeding was promoted by literature distributed on the subject.
Infants born in the State during the calendar year 1927— 61,636; infants
under 1 year of age reached by the work of the division during the year
under review— 13,709; preschool children reached— 12,956; expectant
mothers reached— 15,563.
Counties in the State— 161; counties in which maternity and infancy work
was done during the year— 77; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 160.
Since the beginning of the State’s cooperation under the maternity and
infancy act three counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following state-wide organizations cooperated in the division’s work:
State department of education, State league of women voters, Woman’s
Christian Temperance Union, State federation of women’s clubs, fra
ternal and professional organizations, and the parent-teacher association.
Home demonstration agents also cooperated. The assistance consisted
mainly in arranging for conferences and other educational work on the.
maternity and infancy program.
An outstanding achievement of the year was the contacts made with mothers
in rural sections of the State.
TYPES OF WORK AND SOME RESULTS

The division of child hygiene was established in the State board of health in
1919. The governor accepted the provisions of the maternity and infancy act on
February 13, 1922. This was followed by legislative acceptance approved by the
governor on August 16, 1922.
A physician has directed the work, another physician has acted as clinician
on the “ healthmobile,” and State staff nurses have served in a supervisory capac
ity and assisted in special field work. The number of public-health nurses paid
wholly or in part from maternity and infancy funds and detailed to counties is
gradually increasing, 1 having been added in each of the last two years to the
15 that were reported for 1926.
Cooperation has been maintained with the State department of education,
professional and fraternal organizations, women’s organizations, and the parentteacher association.
Emphasis has been placed on child-health conferences made possible through
the use of the “ healthmobile ” and on the establishment of permanent centers in
counties in which public-health nurses were stationed. Numerous prenatal con
ferences have been conducted, and many visits to the homes of mothers and
children have been included in the work of the nurses.
Work with the negroes has been developed through activities of negro nurses
in conducting prenatal conferences and instructing negro midwives. It is
estimated that more than 5,000 midwives are in the State; by January 1, 1928,
4,661 had been located. Through the efforts of the division a large number
of midwives have received instruction during the period of cooperation and
have made application for certificates of fitness to practice. Many who were
unfit have ceased to take cases. By January 1, 1928, 2,471 had obtained certifi
cates, 1,529 had failed to qualify for certificates, and 661 were still uninstructed.
To receive a certificate, each midwife must attend a school of instruction for
10 periods and must pass a satisfactory examination. She must have a nega-

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1928

tive reaction from the Wassermann test, must be vaccinated against smallpox,
must agree to abide by the regulations promulgated by the State board of health,
and must undertake to report all births promptly to the local registrar of
I vital statistics. Ampules of nitrate of silver are distributed free, and midwives
1 are required to use this prophylactic in the eyes of the newborn. The follow
up work with midwives has been difficult, and there are problems yet to be
met. But that the midwives constitute an indispensable group is indicated
by the fact that they delivered 31.4 per cent of the total births reported in
the State in 1927.
The State has been both in and out of the death-registration area during
the period of cooperation. It was dropped in 1925 owing to the lack of
satisfactory legislation. This was secured in 1926, and the State was read
mitted to the death-registration area for 1928, being admitted to the birthregistration area the same year. The staff of the division of child hygiene
assisted in the campaign to accomplish entry. The work with the midwives
in securing better registration of births was an important feature of the
campaign.
Owing to the recent admission of the State to the birth-registration area
infant and maternal mortality rates are not available from the United States
Bureau of the Census. That improvement has occurred in maternal welfare,
at least, is indicated by the improvement in the type of midwives now practicing
and in the character of their work.

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H A W AII
STAFF AND ACTIVITIES IN 1928

Administrative agency:
Territorial board of health, division of maternity and infancy, Honolulu.
Funds expended: Federal, $12,224.43; State, $6,725.96; total, $18,950.39.
Staff: ■
Director (nurse, for 10 months, 10 days; physician, for 1 month, 21 days),
18 nurses (14 part year, part time), 1 stenographer.
Volunteer assistants— 26 physicians, 20 lay persons.
Activities *■
Child-health conferences conducted by physicians— 1,001; infants and pre
school children registered and examined— 5,022; visits to conferences—
20,216.
Conferences conducted by nurses, no physician present— 234; children in
spected— 925 ; visits to conferences by children— 3,624.
New permanent child-health centers— 12 established as a result of the ma
ternity and infancy work. They are supported by maternity and infancy
funds and by private funds.
Classes for girls in care of infants and preschool children— 4 organized;
girls enrolled— 84; number completing course— 37 ; lessons in course— 10.
Home visits by nurses— 14,017 (prenatal cases seen, 160; infants, 1,507;
preschool children, 481).
Literature distributed— 2,600 pieces.
Nutrition work was done through individual instruction to mothers at
conferences and in home visits.
p
Breast feeding was stressed in the instruction given at conferences and in
home visits.
Infants born in the Territory during the year— 11,543; infants under 1 year
of age reached by the work of the division— 3,074; preschool children
reached— 2,873.
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the Territorial bureau of vital statistics
if the parents are known to be able to read.
Counties in the Territory— 5 ; counties in which maternity and infancy
work was done during the year— 4. The remaining county is the leper
settlement.
The nurses on the division’s staff assisted at conferences conducted by
local organizations.
Two mission organizations cooperated in the division’s work, lending rooms
in which child-health conferences were conducted.
The outstanding feature of the year’s work was its reorganization by which
all the nurses on the staff of the board of health were enabled to devote part
time to maternity and infancy work.
TYPES OF W ORK AND SOME RESULTS

The Sixty-eighth Congress extended the benefits of the maternity and infancy
act to the Territory of Hawaii. A division of maternity and infancy was
established in the Territorial board of health in 1925. The Territory accepted
the provisions of the act through the governor’s acceptance on April 7, 1924.
This was followed by legislative acceptance approved by the governor on
April 13, 1925.
In the first two years of cooperation with the Federal Government a medical
director had charge of the work. More recently a nurse has been in charge.
The same plans of r rganization and field work have continued through the
period of cooperation, a staff of nurses (18 in 1928) working under the direction
and supervision of the director.

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

Cooperation has been given by two mission organizations and by plantation
officials, including managers, physicians, and nurses. A number of physicians
have given volunteer services at conferences and centers.
The plan of work stresses the organization of health centers, in which con
sultations for infants and preschool children may be conducted and to which
return visits may be made. This insures a continuous program of information
to parents on infant and child care and continuous supervision of the children
attending the centers. Since 1925, when the work began, 80 centers have been
established in the Territory. The division of maternity and infancy has charge
of 48 centers, and 32 under the auspices of the plantations are assisted by the
division in many ways.
The children under supervision represent many racial groups, including
Hawaiians, Japanese, Chinese, Filipinos, and Caucasians. Some of the races
have very high infant mortality rates.
As the Territory is not in the United States birth-registration area figures
are not available from the United States Bureau of the Census, but Territorial
mortality rates indicate a decrease in infant mortality in 1927 compared with
1925. In 1925 the infant mortality rate was 104 ; in 1927 the rate was 96.
In 1927 the mortality among Hawaiian babies was higher than that among
babies of the other races in the Territory. The Territorial figures, however,
show a reduction in the rates for Hawaiian babies in 1927, when 237 died in the
first year of life in every 1,000 born alive, whereas 258 died in 1925, a saving
in 1927 of 21 babies in every 1,000 live births. The rate for Filipino babies
also shows a definite reduction; in 1925, 287 babies in every 1,000 born alive
died before reaching their first birthday, and in 1927 the rate was 226, or 61
babies saved as compared with 1925. The fact that more children attended
centers and conferences in 1927 than in preceding years and that more expec
tant mothers were given instruction undoubtedly led to better health conditions.

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IDAHO
STAFF AND ACTIVITIES IN 1928

Administrative agency: State department of public welfare, bureau of child
hygiene, Boise.
Funds expended: Federal, $8,098.54; State, $2,732.21; total, $10,830.75.
Staff:
Director (physician, part year), 2 physicians (part year, 1 part time),
2 nurses, 1 stenographer-clerk (part year).
Volunteer assistants at child-health conferences— 15 physicians, 227 nurses
and lay persons.
Activities:
Child-health conferences conducted by physicians— 33; infants and pre
school children registered and examined— 1,451.
Defects found in children examined at conferences— 2,791; children having
defects— 1,163. (Follow-up work to ascertain whether defects had been
corrected had not been completed at the close of the year.)
Conferences conducted by nurses, no physician present— 13; children in
spected— 279; mothers instructed in prenatal care—39; visits to confer
ences by mothers— 82.
Home visits by nurses— 811 (prenatal cases seen, 20; infants, 357; preschool
children, 619).
Infant homes inspected— 2 ; inspections made— 2 .
Surveys— 3 : (1) Of 57 hospitals. (2) Of midwives, state-wide. (3) Of f
crippled children, state-wide.
Talks and lectures— 39.
Literature prepared— prenatal letters (revised), diet lists.
Literature distributed— 7,096 pieces.
New names registered for prenatal letters— 474; prenatal letters distribu
ted—499 sets.
Nutrition work was done through individual instruction at conferences and
in home visits.
Exhibits conducted— 46, of posters on prenatal and infant care and on
clothing for the baby. Exhibit material prepared— chart of infant
and maternal mortality, by counties.
Statistical studies made— causes of maternal deaths, by counties; causes
of infant deaths, by counties.
Breast feeding was stressed in the instruction given at conferences and
in home visits.
Infants born in the State during the year—-9,971; infants under 1 year
of age reached by the work of the bureau— 1,591; preschool children
reached— 1,803; expectant mothers reached— 872.
Counties in the State— 44; counties in which maternity and infancy work
was done during the year— 2 1 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 44.
The following organizations cooperated in the bureau’s work: State medical
society, State tuberculosis association, federated women’s clubs, American
Red Cross, joint legislative council, and the parent-teacher association.
They arranged for and assisted at child-health conferences. Among
the children examined at conferences reported in the foregoing para
graphs 67 were examined in the “ Get ready for school ” drive sponsored
by the National Congress of Parents and Teachers.
The outstanding achievement of the year was the reduction of the infant
mortality rate from 63 per 1,000 live births in 1926 to 50 in 1927.
62
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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

TYPES OF WORK AND SOME RESULTS

A small staff consisting of a physician and two nurses has conducted the
maternity and infancy work, with the assistance of professional and lay volun
teer workers and with excellent cooperation from the State medical society,
the State tuberculosis association, the American Red Cross, women’s organi
zations, the parent-teacher association, and the joint legislative council.
Information relating to maternal and infant care has been disseminated to
a great extent through child-health conferences, which have been the chief
activity of the bureau. A special feature of the work for the year ended June
30, 1928, was the survey of 57 hospitals in the State.
Through the work of the State department of public welfare, to which the
bureau of child hygiene gave assistance, the State was admitted to the birthregistration area in 1926.
Figures from the United States Bureau of the Census showed a marked
reduction in infant mortality in 1927, with a rate of 50 infants under 1 year
of age dying in every 1,000 born alive, as compared with the previous year,
in which the rate was 63. Owing to the recent admission of the State into
the birth-registration area figures from the Bureau of the Census are available
for these two years only.
The maternal mortality rate has not declined. In 1926 the rate was 56.9
deaths of mothers in every 10,000 live births; in 1927 the rate was 60.

S ou rce:

S ta te fig u res
Trend o f maternal m orta lity : Indiana, 1911-1927

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Federal Reserve Bank of St. Louis

IN DIAN A
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, division of infant and child hygiene, Indianapolis.
Funds expended: Federal, $32,300.59; State, $19,020.14; total, $51,320.73.
Staff:
Director (physician), 4 physicians (1 part year), 4 nurses (1 part year),
1 vital-statistics clerk, 1 exhibits director, 1 secretary, 2 clerks (part
year), 3 stenographers. Temporary assistants were employed as needed.
Activities:
Child-health conferences conducted by physicians— 413; infants and pre
school children registered— 11,874; number examined— 11,838; visits to
conferences— 11 ,888 .
Defects found in children examined at conferences— 65,213; children hav
ing defects— 11,350.
Classes for mothers and young women— 141 organized; mothers and young
women enrolled plus those carried over from previous year— 7,908; num
ber completing course— 7,824; lessons in course— 5. These figures include
1,710 students enrolled in classes conducted in 10 colleges.
Group demonstrations— 305, on various phases of maternal and child care.
Campaigns— 4: (1) For observance of May Day as Child Health Day,
state-wide. May Day is regarded as the culmination and also renewal
of the year’s child-health activities, and preparation for May Day in
1928 was carried on to some extent during the entire year. Celebrations
including parades, pageants, window displays, motion pictures, and
speeches were conducted throughout the State. The division received
reports of county, community, and group programs, and additional towns
and communities planned programs but did not submit formal reports.
The May Day slogan was “ Better children for our Nation— a better
Nation for our children.”
(2) For immunization of children against
diphtheria. (3) For periodic health examination of preschool children.
(4) For the examination of preschool children and correction of their
defects before the children should enter school.
Talks and lectures— 885.
Literature distributed— 176,473 pieces.
Nutrition work was done through instruction given at classes and at health
conferences.
Exhibits conducted— 37, at various State and local meetings, the most
important being at the State fair. Through the State board of agricul
ture the State has provided special buildings to house the division’s
activities for promotion of interest in child care and development. An
exhibit consisting of posters, models, and motion pictures was shown,
and physical examinations and mental tests were given to 1,376 infants
and preschool children.
Exhibit material prepared— posters, charts,
maps, and models. Exhibit material was lent twelve times.
Scientific articles prepared— Fetal and Neonatal Mortality; Poliomyelitis;
Tuberculosis, a Menace to the Infant and Runabout Toddler.
Statistical studies made (mostly based on records of mothers and children
attending conferences)— breast feeding; nutrition; defects; defects fol
lowing childhood infections; eye defects; amount of milk consumed by
infants and preschool children; mental development; prenatal, obstetric,
and postnatal care; live births and accidents of pregnancy.
Breast feeding was promoted through instruction given at conferences and
classes, and through literature distributed on the subject.
Infants born in the State during the year— 61,692; infants under 1 year
of age reached by the work of the division— 8,801; preschool children
reached— 16,874.
64

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

Activities— Continued,
Counties in the State— 92; counties in which maternity and infancy work
was done during the year— 53; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 91. ("One county had had maternity and infancy work previously.)
The division promoted the organization of county child-health boards
composed of public-health workers and of official representatives of
medical, dental, and nursing associations and local lay organizations.
The purpose of these boards is to bring every child to his first day of
school in good health by: (1) Up-to-date knowledge of his condition;
(2) correct nutrition, care, and training; (3) protection from disease
dangers; (4) correction of defects; (5) provision of suitable environ
ment.
The following organizations cooperated in the division’s work: Other
divisions of the State board of health, State board of charities and correc
tion, State board of education (home-economics and attendance depart
ments), State university (extension service), State dental association,
State medical association, State health council, Purdue University (agri
cultural extension), State child-welfare association, State tuberculosis
association, State chamber of commerce, American Legion, State league
of women voters, State federation of women’s clubs, Young Men’s and
Young Women’s Christian Associations, the parent-teacher association,
other professional and fraternal organizations, schools, and churches.
The outstanding achievement of the year was the creation of a state-wide
interest in better health standards.
TYPES OF WORK AND SOME RESULTS

The division of infant and child hygiene was established in the State board
of health in 1919. The State accepted the provisions of the maternity and
infancy act through the governor’s acceptance on February 9, 1922. This was
followed by legislative acceptance approved by the governor on March 3, 1923.
The same medical director has had charge of the work since the beginning of
cooperation under the act, and the continuity of the program therefore has not
een interrupted. The staff has included three to four units, each composed of
a physician and a nurse who conduct work in the field.
The division has had the benefit of cooperation from a number of State
departments and organizations, county and city officials, professional groups,
the parent-teacher association, women’s and men’s organizations, and girls’ and
boys’ clubs.
Three major activities have marked the progress of the work: First, childhealth conferences conducted by units composed of physicians and nurses were
extended to every county in the State. These were followed by instruction in
prenatal, infant, and child care given to groups of mothers and to college stu
dents. Classes for mothers were also held in every county. The units then
began conducting conferences for preschool children. Much attention has been
given to education and information of the public through exhibits, charts and
other forms of publicity.
’
The infant mortality rate has declined, reaching in 1927 the lowest rate since
the State has been in the United States birth-registration area. The infant and
also the maternal mortality rates for 1921 (the year preceding the State’s
cooperation under the act) and for 1927 were as follows:

Infant mortality rates ( deaths of infants under 1 year of age per 1,000 live
births )
State---------------------------------------------------------------------------Urban---------------- ----------------------- ----------------------- _
E ural-------------------------------

1921

1927

79
66

63
55

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births)
1921

1927

State----------------------------------------------------------------------------- 6 8 .6
Urban---------------*--------------------------------------- ------------- 85.7
Rural------------- ------- --------------------------------*—
56. 5

65.7
81.1
52.1

For the trend of maternal mortality from 1911 to 1927 see the granh on
page 63.
^

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IO W A
STAFF AND ACTIVITIES IN 1928

Administrative agency:
,
,,
.
_
State board of education, division of maternity and infant hygiene, Iowa
Funds expended: Federal, $21,085.31; State, $21,213.60; total, $42,298.91.
Staff:
J
‘
,
L L
Director (director of the extension service of the State university serving),
1 physician, 4 nurses, 1 dentist, 1 dental hygienist (2 months), 1 social
worker, 1 specialist in child welfare, 1 vital-statistics clerk, 3 stenog
raphers.
Activities *
Child-health conferences conducted by physicians—181; infants and pre
school children registered and examined— 4,274.
Defects found in children examined at conferences— 4,458; children having
defects— 3,532. Reports made by the nurses who followed up the children
examined at conferences during the past five years showed that 73.9
per cent of the children having defects had the defects corrected, were
improved, or were under active treatment.
Dental conferences— 19; preschool children receiving dental examination—
306
“ Mothers’ health day” conferences— 149; attendance— 7,582 (5,752 women/
1,550 high-school girls, 262 fathers, 18 physicians). These conferences
were conducted by a physician and nurse from the division and were
arranged in cooperation with local women’s clubs and parent-teacher
associations. Lectures were given and slides, films, and^ charts shown
on prenatal and infant care; exhibits were made of clothing for motherand baby, obstetrical package, and preparations for home delivery.
Home visits by nurses— 325 (infants seen, 180; preschool children, 145).
Campaign— 1 , in cooperation with the parent-teacher association,^ in 1
county, for examination of rural preschool children and correction of
their defects before the children should enter school.
Talks and lectures— 214.
Literature distributed— 73,600 pieces.
Graduate courses in oral hygiene for nurses— 7 ; attendance— 45.
Exhibits conducted— 136, at fairs and “ mothers’ health day ” conferences.
Infants born in the State during the year—44,296; infants under 1 year
of age reached by the work of the division— 2,126 (exclusive of those
reached by literature distributed) ; preschool children reached— 3,206 (ex
clusive of those reached by literature distributed) ; expectant mothers
reached— 1 ,012 .
| .
The division cooperates with the State board of health In sending litera
ture on infant hygiene to parents of all infants whose births are registered
in the State bureau of vital statistics.
_
Counties in the State— 99; counties in which maternity and infancy work
was done during the year— 52; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
__^99
The following organizations cooperated in the division’s work: State
dental society, State tuberculosis association, State farm bureau, and
the parent-teacher association. Among the children examined at’ confer
ences reported in the foregoing paragraphs 845 were examined in the
“ Get ready for school” drive sponsored by the National Congress or
Parents and Teachers.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

TYPES OF WORK AND SOME RESULTS

A division of maternity and infant hygiene was established in 1922 in the
extension division of the State university, which is under the control of the
State board of education. The State accepted the provisions of the maternity
and infancy act through the governor’s acceptance on January 21 1922 This
was followed by legislative acceptance approved by the governor on April 2,
The same director^ has had charge of the work during the entire period of
cooperation. Physicians, dentists, and nurses have served on the division’s
+ £ a ^ aIld,3C0 ?Pf ratl-i>n kas been given by State and county medical societies
the State dental society, the tuberculosis association, the parent-teacher associa
tion, the State farm bureau, and women’s organizations.

Distribution o f 182 child-health conferences in Kansas, 1927—28

The program has stressed both prenatal and child-health conferences which
finnGth S? 1^in1era,ni 111 character. Oral hygiene has also received much attentrnn through dental conferences for preschool children. Mothers’ meetings in
which instruction in infant and prenatal care is given by physicians knd
nurses, have been well attended.
* physicians and
There has been no appreciable change in infant mortality rates since the
State was admitted to the United States birth-registration are! ^n 1924
Maternal mortality rates have declined in the rural areas, in which 52 mothers
a
eVft ry 1? ’000 llve births in 1924, whereas 46 died in 1927, a saving of
6 rural mothers for every 10,000 babies born alive in 1927 compared w?th 1924
m rTgard to Prenatal care has reached the rural population
through prenatal conferences and mothers’ health day conferences w h ic h

mno S t y PE

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ntly tWS WOrk ls reflected in “ e 'JecIto4 ln tie

K AN SAS
STAFF AND ACTIVITIES IN 1928

Administrative agency:
, ,
.
„
,
State board of health, division of child hygiene, Topeka.
Funds expended: Federal, $15,261.76; State, $10,000; total, $25,261.76.
Director (physician), 8 nurses (1 for 1 month), 1 vital-statistics clerk,
1 stenographer, 1 clerk. Four county nurses were paid in part from
maternity and infancy funds.
Volunteer assistants— 7 physicians, 10 lay persons.
Activities:
,
. .
, it.
Child-health conferences conducted by physicians— 175; infants and pre
school children registered and examined— 3,750. Assistance was given
at the conferences by 177 local physicians, 63 dentists, 155 nurses, and
679 lay persons. The number of mothers attending was 3,353; the num
ber of fathers attending was 368; approximate number of other visitors,
4 345.
Defects found in children examined at conferences— 1,674; children having
defects— 2,008.
Conferences conducted by nurses, no physician present— 7 ; children in
spected— 137; visits to conferences-—180.
Classes in maternal and infant hygiene were conducted in three fetate
teachers’ colleges to prepare students to teach the subject to girls in the
seventh and eighth grades. Similar courses were conducted in three (
other schools and a house-keeping center. Students enrolled— more than
2 0 0 ; average number of lessons in course— 5.
Home visits by nurses— 521 (prenatal cases seen, 152; infants, 155; pre
school children, 336).
Maternity homes inspected— 6 ; inspections made— 12.
Infant homes inspected— 54; inspections made— 108.
,
Group demonstrations— 20, at the classes conducted in the State teachers
colleges.
Surveys— 3* (1) Of midwives. Nurses visited the few midwives known
to be practicing in the State and found most of them fairly well quali
fied to handle normal cases. The number of midwives in the State is
decreasing yearly. (2) Of birth registration, to assist the State division of vital statistics. The nurses called on local registrars of vital
statistics and checked the birth reports. Fifteen counties were completed. Visits were made also to physicians to enlist their interest in
the prompt reporting of births attended by them. (3) Of health conditions among mothers and children on an Indian reservation (not pompleted at the close of the year under review). The nurses also assisted
in a venereal-disease survey conducted by the State health officer.
Campaign— 1, to have preschool children qualify as “ 9-pointers ” through
out the State. To qualify, the children must have normal vision, hearing,
teeth, throat, posture, and weight, be vaccinated against smallpox, and
be immunized against typhoid fever and diphtheria. At a picnic for
9-point children sponsored by one county health unit on May Day m
observance of Child Health Day more than 1,200 9-point children were
present.
Talks and lectures'— 53.
Literature prepared— Mothers’ Manual (revised), 9-point pamphlet, set
of 4 diet cards.
Literature distributed— 212,376 pieces.
, . ..
,. . . .
New names registered for prenatal letters— 73; prenatal letters distrib
uted— 355 ¡sets.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

Activities— Continued.
Nutrition work was done through individual instruction at health
conferences.
Exhibits conducted— 6 . Exhibit material prepared— charts on contagious
diseases. Exhibit material was lent eight times.
Breast feeding was stressed in the instruction given to mothers at
conferences.
Infants born in the State during the year— 35,234; infants under 1 year
of age reached by the work of the division— approximately 35 ,0 0 0 ;
preschool children reached— 2,815; expectant mothers reached— approximately 700.
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— 105; counties in which maternity and infancy
work was done during the year— 105.
The following organizations cooperated in the division’s work: State
federation of women’s clubs, State league of women voters, American
Legion auxiliary, fair associations, and the parent-teacher association.
Among the children examined at conferences reported in the foregoing
paragraphs 250 were examined in the “ Get ready for school ” drive
sponsored by the National Congress of Parents and Teachers.
Among the outstanding features of the year’s work were the child-health
conferences conducted and the classes in maternal and infant hygiene taught
at the State teachers’ colleges.
TYPES OF WORK AND SOME RESULTS

The division of child hygiene was established in the State board of health
in 1915. This was one of the earliest among the State divisions or bureaus
of child hygiene or welfare established in the United States. The State accepted
the provisions of the maternity and infancy act through the governor’s ac
ceptance on January 4, 1922, but the next State legislature that met failed
to enact legislative acceptance, and cooperation ceased in September, 1923! In
1927 the State again accepted the provisions of the act, through legislation
approved by the governor on March 16, 1927. An expanding program has been
possible as a result of the larger funds available.
Since early in 1927 the staff has consisted of a medical director and two
staff nurses. The medical director in addition to his executive work has given
much time to the field work, conducting conferences and giving addresses. The
two nurses have been almost constantly in the field, arranging and assisting
at conferences and giving courses in infant care. Four nurses paid in part
from maternity and infancy funds have been detailed to counties. The distri
bution of the conferences conducted— one of the major activities in the field—
is shown in the map on page 67. Another phase of the work done directly
with the children is the 9-point campaign.
A notable feature of the program was the instruction in infant care and
prenatal care given at three State teachers’ colleges, Western University, and
several schools.
Education in infant care is also promoted through the
distribution of literature to parents.
The division of child hygiene is charged with the inspection of institutions,
orphanages, and boarding homes where infants are kept as well as with inspec
tion of maternity homes. In these institutions approximately 2,200 children
receive care.
The division has had the benefit of cooperation from county health depart
ments, fair associations, women’s organizations, and the parent-teacher associa
tion, and of volunteer service from many physicians, dentists, nurses, and lay
workers.
Infant mortality rates'were lower in 1927 than in any other year since the
State was admitted to the birth-registration area. In 1917, the year of the
State’s admission to the area, the infant mortality rate was 77; in 1926 it was
65; and in 1927 it had dropped to 55.
_ The maternal mortality rate was lower in 1927 than in any previous year
since the State was admitted to the birth-registration area, with the exception
of 1924, when it was practically the same. In 1917, the year of the State’s
admission to the area, the rate was 75.9 for every 10,000 live births; in 1926
the rate was 69.7; in 1927 it had declined to 63.1.

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KENTUCKY
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of maternal and child health, Louisville.
Funds expended: Federal, $26,298.64; State, $21,298.64; total, $47,597.28.
Staff:
Director (physician), 4 physicians (3 part year, 1 part time), 8 nurses (2
part year, 1 part time), 2 nutritionists (1 part year), 1 milk inspector
(part time, part year), 1 birth-registration clerk, 1 vital-statistics clerk,
1 stenographer, 8 clerks (2 part time). Two county nurses were paid
in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 266; infants and pre
school children registered and examined— 4,192.
Defects found in children examined at conferences— 5,121; children hav
ing defects— 3,216. Parents had defects corrected in 500 of the children.
Prenatal conferences conducted by physicians— 14; expectant mothers reg
istered— 50; number examined— 49; visits to conferences— 110.
Conferences conducted by nurses, no physician present— 205; children in
spected— 2,450; mothers instructed in prenatal care— 65.
New permanent child-health centers— 12 established as a result of the ma
ternity and infancy work. They are supported by the State board of
health and by county funds.
New permanent prenatal center— 1 established as a result of the maternity
and infancy work. It is supported by local funds. Cooperation in the (
work of the prenatal clinic in the city hospital of the University of
Louisville by having one of the State staff nurses act as registrar has
been continued.
Courses of lectures including child care and the essentials of prenatal
care were given to groups of juniors and seniors in all the private schools,
junior colleges, and State normal schools in the State.
Classes for midwives— 15 organized ; midwives enrolled and completing
course— 231; lessons in course— 2. A three months’ intensive course for
white women in midwifery and child training was begun at a small
hospital in a mountain section, where there are facilities for training
three midwives at a time. Eight women had completed the course at
the close of the year under review, and many others were waiting for
admission.
Home visits by nurses— 350 (prenatal cases seen, 102; obstetrical cases, 10;
postnatal cases, 50; infants, 200; preschool children, 250).
Maternity homes inspected— 4 ; inspections made— 4.
Infant homes inspected— 3 ; inspections made— 3.
Community demonstrations— 4, in 4 counties. A maternity and infancy
nurse was detailed to each county for a period of 6 weeks to conduct
an intensive maternity and infancy public health nursing program in an
effort to interest the county in employing a public-health nurse.
Group demonstrations— 200, on various phases of child care, at childhealth conferences. Films, posters, and a nutrition exhibit were used
in connection with these demonstrations.
Survey— 1, in 1 county, to ascertain the number of expectant mothers and
to urge them to attend the newly established prenatal center.
The bureau is cooperating in a study of maternal mortality being con
ducted in the State by the United States Children’s Bureau with the
indorsement of the State medical society.
Campaign— 1, state-wide, to have children qualify as 5-point blue-ribbon
children by being free from defects in eyes, ears, nose, and throat and
being of normal weight. In Louisville, where the bureau cooperated
70

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

Activities— Continued.
with a number of local organizations in the work, the campaign cul
minated in a Child Health Day program, and 7,000 children who had
met blue-ribbon standards were reviewed in a city park by the mayor and
a group of representative citizens. Twenty-five other communities re
ported blue-ribbon campaigns.
Talks and lectures— 1,112.
Literature prepared— Blue Ribbon Standards, diet cards, and child-health
literature revised and brought up to date.
Literature distributed— 317,559 pieces.
New names registered for prenatal letters— 1,850; prenatal letters dis
tributed— 4,000 sets.
A graduate course for nurses, consisting of lectures and demonstrations,
was conducted at the annual meeting of county public-health nurses
and nurses on the staff of the bureau.
A graduate course for physicians in pediatrics and obstetrics was arranged
in connection with an annual 2-week clinic at the University of Kentucky.
Lectures and demonstrations were given by members of the staff of the
bureau of maternal and child health.
Nutrition work was done through nutrition classes and individual in
struction to mothers. Classes organized— 35; children enrolled—-1,020.
A summer health and nursery school for preschool children was con
ducted for 8 weeks in 1 city, with an enrollment of 27 children.
Exhibits conducted— 25, consisting of a food and nutrition exhibit, posters,
and literature, at State and local meetings and at county fairs. Exhibit
material prepared—-nutrition exhibit, with display of correct foods;
sun-bath suits; and posters on proper feeding. Exhibit material was
lent fifty-two times.
Statistical studies made— results of prenatal care of prospective mothers
attending a prenatal clinic; midwives and deliveries attended by them.
In 1927 the 2,096 midwives in the State attended 11,579 deliveries, as
follows:
Number of midwives attending—
1 delivery-------------------------------------------------------------------------------700
2 deliveries____________________;-------------------------------------------- 275
3 deliveries__________________________________________________ 209
4 deliveries__________________________________________________ 135
105
5 deliveries_________________
6-10 deliveries--------------------------330
11-14 deliveries______________________________________________155
15 deliveries or more_____ ___________________________________187
Breast feeding was stressed in literature distributed and in instruction
given to individuals.
The bureau serves as a clearing house for all child-health activities in the
State, rendering advisory service to local organizations and supervisory
service to public-health nurses and full-time county health units receiv
ing State aid. One staff nurse gave her full time to organizing permanent
child-health work and supervising child-health centers established under
the health units. Among the activities conducted by county public-health
nurses who received advisory and supervisory assistance from the bureau
were the following classes, for which an outline issued by the bureau was
used: (1) Glasses for girls— 58 organized, with an attendance of 325 girls.
The course consisted of 24 lessons, and the instruction given covered care
and feeding of the baby and health habits. (2) Classes for mothers— 27
organized, with an attendance of 408 mothers. The course consisted of
18 lessons, and the instruction given covered the essential features of
prenatal care, the necessity of having a physician for delivery, simple
home nursing, and the care of the infant and preschool child.
As a result of the bureau’s work city health departments and county nurses
developed the 5-point blue-ribbon standards for school children, and
many child-health conferences were conducted by local health committees.
Infants born in the State during the year— approximately 60,000; infants
under 1 year of age reached by the work of the bureau— approximately
62,000; preschool children reached— approximately 65,000; expectant
mothers reached— 22,450.
The bureau sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.

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TH E WELFARE AND HYGIENE OF MATERNITY AND IN FAN C Y

Activities— Continued.
Counties in the State— 120; counties in which maternity and infancy work
was done during the year— 120 .
Since the beginning of the State’s cooperation under the maternity and
infancy act 40 counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following organizations cooperated in the bureau’s work: State league
of women voters, State federation of women’s clubs, local women’s clubs,
fraternal organizations, and the parent-teacher association. Among the
children examined at health conferences reported in the foregoing para
graphs 2,002 were examined in the “ Get ready for school ” drive sponsored
by the National Congress of Parents and Teachers.
Among the outstanding features of the year’s work were the development
of the 5-point blue-ribbon standards for children and the adoption of these
standards by a majority of the counties carrying on health work.
TYPES OF WORK AND SOME RESULTS

The bureau of maternal and child health was established in the State
board of health in 1919. The State accepted the provisions of the maternity
and infancy act through legislative enactment approved by the governor on
March 24, 1922.
The same medical director has been in charge of the work of the bureau from
the beginning of cooperation with the Federal Government. Physicians, nurses,
nutritionists, and an educational instructor have served on the staff. Nurses
paid in part from maternity and infancy funds have been detailed to counties.
Cooperation has been given by women’s organizations, the parent-teacher
association, men’s service clubs, and fraternal and religious organizations,
which have assisted in child health conference work and in the establishment of
child-health centers.
Important features of the program have been the conducting of child-health
conferences, the establishment of permanent health centers, instruction of
special groups in' prenatal and child care (including classes for mothers and
classes for girls in infant care), instruction of midwives (including a training
center for mountain midwives), and a provision through a prenatal center of
instruction' and clinical experience for undergraduate students in the medical
school of the University of Louisville.
Nitrate of silver has been distributed free to physicians and midwives through
the use of maternity and infancy funds. A marked reduction in ophthalmia
neonatorum has resulted from its use.
It has been the practice to send literature on infant and child care and care
of the nursing mother with certificates of registration to parents of all infants
whose births are registered.
An important feature of the work has been the assumption of local respon
sibility for the maternity and infancy work in 40 counties. These counties
have assumed the support of the work, but the bureau continues to render
advisory service.
The study of maternal mortality being made in the State by the United
States Children’s Bureau with the indorsement of the State medical society is
expected to furnish valuable information that will aid in planning further
maternity and infancy work.
The effect of the maternal and infant welfare program is apparent in reduc
tions in maternal and infant mortality rates during the period of the State’s
cooperation under the maternity and infancy act. The rates in 1927 were the
lowest for both mothers and infants since 1917, the year in which the State
was admitted to the United States birth-registration area. The infant and
maternal mortality rates for 1922 (the year in which cooperation was begun)
and in 1927 were as follows:

Infant mortality rates ( deaths of infants under 1 year of age per 1,000
live Mrths)
State_____
Urban
Rural.

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-------------------------------------jg._______
------- -------------------------------------------------------------------------------------------

1922

1927

69
83
67

61
71
59

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

Maternal mortality rates (deaths of mothers from puerperal causes per 10,000
Uve Mrths)
\

1922

1927

State_____________ ____________ _______________________ _ 60.7
Urban____________________________________________ 96.6
Rural_____________________________________________ 54.3

49.4
62.1
46.5

These figures show a saving in mothers’ and babies’ lives in urban and
rural areas as well as in the State as a whole. The mortality rate in the
State was 30.6 per cent lower for colored infants in 1927 than in 1922; for
white infants it was 9.4 per cent lower. The mortality rate from puerperal
causes was 41.3 per cent lower for colored mothers in 1927 than in 1922; for
white mothers it was 16 per cent lower. In urban areas the mortality rate
for colored mothers was 64.2 per cent lower in 1927 than in 1922, and in
rural areas it was 28.2 per cent lower. The effect of the prenatal clinic at
the Louisville Hospital, which is conducted with the cooperation of the bureau
of maternal and child health, seems to be clearly shown by the marked
decline in the urban mortality rate among colored mothers.
48278°— 29----- 6

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Federal Reserve Bank of St. Louis

(
LOU ISIAN A
STAFF AND

A C T IV IT IE S IN

1928

Administrative agency:
State department of health, bureau of child hygiene, New Orleans.
Funds expended: Federal, $19,400.69*; State, $14,400.69; total, $33,801.38.
Staff:
Director (part time), 3 physicians (2 part year, 1 part time), 7 nurses
(3 part year), 3 dentists (2 part year), 1 midwife teacher (part year),
1 record clerk (part time), 1 stenographer (part year). Six parish 4
nurses were paid in part from maternity and infancy funds. Additional
physicians, a dentist, and a nurse were employed for conference and
organization work as needed.
Activities:
Child-health conferences conducted by physicians— 484; infants and pre
school children registered and examined— 9,881; visits to conferences—•
11,424.
Defects found in children examined at conferences— 30,268; children hav
ing defects— 9,474.
Conferences conducted by nurses, no physician present— 97; children
inspected— 1,926; mothers instructed in prenatal care— 489.
Dental conferences— 196; preschool children receiving dental examination—
9,468.
New permanent child-health centers— 21 established in connection with
parish health units as a result of the maternity and infancy work.
They are supported by State and parish funds and by the International
Health Division of the Rockefeller Foundation.
Classes for girls in care of infants and preschool children— 6 organized;
girls enrolled— 163; lessons in course— 30. These classes were organized
as part of the maternity and infant-hygiene program for the colored
population in two communities. Several lessons were given by a colored
nurse from the bureau’s staff, and the classes were then turned over to
local workers.
Classes for mothers— 5 organized; mothers enrolled— 116. Three of the
classes were for colored mothers, 63 of whom completed an intensive
course of 4 lessons. The other two classes, for whom the course was
divided into 12 lessons, were still in progress at the close of the year
under review.
Classes for midwives— 74 organized; midwives enrolled plus those carried
over from previous year— 768; number completing course— 154; lessons
in course— 6 .
Home visits by nurses— 3,398 (prenatal cases seen, 721; postnatal cases,
3 ; infants, 541; preschool children, 620). Visits to midwives— 1,513.
Community demonstrations— 5, of a maternity and infant-hygiene public
health nursing program. Two were for colored members of the com
munity.
Group demonstrations— 261, at midwives’ classes, mothers’ classes, and
girls’ classes.
Surveys— 3 : ( 1 ) Of midwives, in 8 parishes. (2) Of preschool children,
in 1 parish, to register them for conferences. (3) Of infants, in 1 town,
to give instruction concerning their care and feeding.
Talks and lectures— 984 (at child-health conferences, 164; to groups in
terested in birth registration, 235; to groups of expectant mothers,
130; to community clubs and other organizations and groups, 455).
Literature distributed— 33,269 pieces.
4 In L ouisian a the p arish is the c iv il d iv is io n corresp on d in g to the coun ty in other
States.
74

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

Activities— Continued.
New names registered for prenatal letters— 645; prenatal letters dis
tributed— 645 sets.
Nutrition work was done through individual instruction given at con
ferences and in home visits.
Exhibits conducted— 37. One was on the health car of the State board of
health, which toured the State. This consists of two Pullman cars
equipped with laboratory, scientific exhibits, charts, clowns, models;
and other material covering many phases of public-health work, includ
ing child hygiene. The others were at fairs and at various meetings.
Exhibit material prepared— charts, posters, clothing, and food, models.
Exhibit material was lent forty-nine times.
Articles prepared— Care of Baby in Hot Weather, Why Children Refuse
to Play, Whooping Cough, Infantile Paralysis, Vincent’s Angina, May
Day.
Statistical studies— births attended by physicians and midwives in parishes
having health units; maternal and infant mortality in these parishes;
deaths of infants under 1 year of age, by age group and color.
Breast feeding was stressed in instruction given at conferences, in litera
ture distributed, and in motion pictures shown. Midwives were spe
cially instructed in the importance of breast feeding.
Infants bom in the State during the year— 40,400; infants under 1 year
of age reached by the work of the bureau— 3,694; preschool children
reached— 13,993; expectant mothers reached— 1,855.
Parishes in the State— 64; parishes in which maternity and infancy work
was done during the year— 37; parishes in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 62.
Since the beginning of the State’s cooperation under the maternity and
infancy act 24 parishes have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following organizations cooperated in the bureau’s work: State federa
tion of women’s clubs, the State parent-teacher association and local
associations, business and professional women’s clubs, State and local
public-health and tuberculosis associations, New Orleans Needlework
Guild, and community clubs. They assisted by planning for and helping
at child-health conferences, urging registration of births, and distribut
ing literature. The Needlework Guild furnished layettes to needy
mothers. Among the children examined at conferences reported in the
foregoing paragraphs 348 were examined in the “ Get ready for school ”
drive sponsored by the National Congress of Parents and Teachers.
Among the outstanding features of the year’s work were the increases in
the number of dental conferences conducted and in the number of preschool
children examined at health conferences.
TYPES OF WORK AND SOME RESULTS

The bureau of child hygiene was established in the State department of
health in 1912. Louisiana was the first State to establish such a bureau. The
State accepted the provisions of the maternity and infancy act through legis
lative enactment approved by the governor on July 14, 1924. This permitted
an expansion of the bureau’s activities.
The work of the bureau during the period of cooperation with the Federal
Government has been in charge of a director with considerable previous experi
ence in public-health work. A central staff of physicians, nurses, and dentists
has conducted child-health conferences, dental conferences, and other educa
tional work in the field, and four to six nurses paid in part from maternity and
infancy funds have been detailed to parish health units the past few years.
Cooperation has been given by State and local public-health and tuberculosis
associations, women’s organizations, and community clubs. The parent-teacher
association assumed the responsibility for “ preschool drives.”
Features of the program have been the holding of health conferences and
the establishment of permanent child-health centers, work done with midwives,
assistance given to establishment of full-time health units, and efforts made to
develop permanent maternity and infancy work in communities. Some re
sults of the work are shown by the number of permanent child-health centers
established during the year ended June 30, 1928 ( 2 1 ), and the number of

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THE WELFARE AND HYGIENE OF M ATERNITY AND IN FAN C Y

parishes (24) that assumed financial responsibility for maternity and infancy
work begun with maternity and infancy funds.
The use of nitrate of silver in the eyes of the newborn has increased.
The bureau has assisted in the free distribution of ampules of this prophylactic;
since 1925 and estimates that 90 per cent of the midwives now make use of it.
The State was admitted to the United States birth-registration area in
1927, the bureau’s assistance in the campaign to accomplish entry having been
one of its major activities. Mortality rates are available from the United
States Bureau of the Census for that year only. Infant mortality rates (deaths
of infants under 1 year of age per 1,000 live births) for 1927 were 77 for the
State as a whole, 89 for urban areas, and 73 for rural areas. Maternal
mortality rates (deaths of mothers from puerperal causes per 10,000 live
births) were 90.9 for the State as a whole, 123.2 for urban areas, and 77.1
for rural areas.

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Federal Reserve Bank of St. Louis

M AINE
STAFF AND ACTIVITIES IN 1928

Administrative E^GUcy •
.
State department of health, division of public-health nursing and child
hygiene, Augusta.
■ ' .
„
Funds expended: Federal, $14,926.52; State, $10,000; total, $24,926.52.
Staff:
„ . . ..
Director (nurse, not paid from maternity and infancy funds), 1 nurse
supervisor, 12 nurses (part year, 3 for 1 month or less), 1 nutritionist
(1 1 months), 1 clerk, 1 stenographer (part year).
Activities:
. . .
,
,
,
.
.
Child-health conferences conducted by physicians who volunteered their
services— 85; infants and preschool children registered and examined—
1,027; visits to conferences— 1,169.
Defects found in children examined at conferences— 1,089; children having
dofccts__014#
Conferences conducted by nurses, no physician present— 92; children
inspected— 413; mothers instructed in prenatal care— 16; visits to con
ferences by children— 631; visits by mothers— 20.
Classes for girls in care of infants and preschool children— Unorganized;
girls enrolled— 603; number completing course— 344; lessons in course—
Classes for mothers— 5 organized; mothers enrolled— 96. Each of the five
groups met monthly to study child care and prenatal care.
Home visits by nurses— 8,674 (prenatal cases seen, 248; obstetrical cases,
13; postnatal cases, 45; infants, 1,122; preschool children, 2,857).
Group demonstrations— 622, at fairs and at meetings of farm-bureau
groups and other organized groups.
Campaign— 1, for observance of May Day as Child Health Day, sitate-wide.
One hundred and nine towns reported or wrote to the division in regard
to their local celebrations, and many others carried out a program but
did not submit a report.
Talks and lectures— 262.
Literature prepared— Meals for the Growing Child, Suggestions for the
Lunch, Diet for Underweights, Diet for Overweights, Foods That Should
Be Eaten Each Day, Food for the Family.
Literature distributed— 425,046 pieces.
New names registered for prenatal letters— 1,151; prenatal letters dis
tributed— 1,313 sets.
Nutrition work was done through instruction given in talks, home visits,
and conferences. Eight nutrition classes were conducted for student
nurses.
Exhibits conducted— 255, at conferences, fairs, and celebrations of May
Day as Child Health Day. Exhibit material prepared— model nursery.
Additional exhibit material was purchased so that each nurse might
have posters, films, material needed at child-health conferences, and
articles for demonstrating layette, care of the mother at confinement,
and care of the baby. Exhibit material was lent nearly two hundred
times, for demonstrations of infant care in schools, for the use of
organizations conducting class work, and for fairs and conferences.
Breast feeding was stressed in talks and in advice given to expectant
mothers.
Infants born in the State during the year— approximately _16,000 ; infants
under 1 year of age reached by the work of the division— 3,408; pre
school children reached— 3,271; expectant mothers reached— 1,561.

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THE WELFARE AND H YGIENE OF M ATERNITY AND IN FAN C Y

Activities— Continued.
Letters offering literature on infant hygiene were sent with the birth
certificates to parents of all infants whose births were registered in the
State bureau of vital statistics. In response to these letters 2,221 moth-{
ers requested such literature.
Counties in the State— 16; counties in which maternity and infancy work
was done during the year— 15.
The division’s work has stimulated other organizations to put greater em
phasis on work for expectant mothers and preschool children. Occasion
ally the nurses have conducted conferences for organizations.
The State public-health association and the American Red Cross cooperated
in the division’s work.
TYPES OF WORK AND SOME RESULTS

The division of public-health nursing and child hygiene was established in
the State department of health in 1920. The governor and council did not
accept Federal funds when the funds became available in 1922, but appropriated
from the State contingent fund $5,000 to carry on the work until the State
legislature could take action. The legislature of 1923 voted to match $10,000
of the Federal funds available, but the governor vetoed the measure. How
ever, an appropriation of $10,000 a year for two years was granted to mflintqip
the division. Finally the provisions of the maternity and infancy act were
accepted through legislative enactment approved by the governor on April 12,
1927. Since that time an expansion of the maternity and infancy program has
been possible.
A nurse not paid from maternity and infancy funds directs the work of the
division. During the fiscal year 1928 the staff (expanded to include 13 publichealth nurses and a nutritionist) reached all except one of the counties in the
State with some phase of maternity and infancy work, and eight counties had
nurses assigned to them.
The nurses and the nutritionist have stressed in their contacts the importance
of attention to the nutrition of children. Nurses have had opportunity to em
phasize this in their visits to the homes of mothers and preschool children, the
talks they have given, the demonstrations made, and the exhibits conducted.
The nurses also arranged, the child-health conferences at which local physicians
made examinations as well as conducting a number of conferences at which
they themselves inspected children.
Classes for girls and women in infant and child care, conducted by nurses,
have been an effective method of imparting information on this subject. Lit
erature on infant hygiene has also been widely distributed through requests
from parents of infants whose births were registered.
The division has had the benefit of cooperation from the State public-health
association and the American Red Cross.
Maternity and infancy funds have been used for the free distribution of
nitrate of silver to prevent blindness in the newborn.
There has been a downward trend in the infant mortality rate since the
organization of the division. The number of infants under 1 year of age dying
in every 1,000 born alive in 1920 (the year in which the division was estab
lished) was 102; in 1927 this number was 80. A comparison of infant mortality
by counties for 1920 and 1927, based on State figures, shows that in 1920 3
counties had rates above 100 and 11 counties had rates higher than the present
State rate of 80. The lowest rate in any county in 1920 was 61.4. In 1927
only 1 county had an infant mortality rate above 100 , and only 5 "had rates
above 80. One county had reached the low rate of 24.2 and another the com
paratively low rate of 47.1. Intensive work is now under way to reduce the
infant mortality rate in the county in which more than 100 babies died in
their first year of life.
For maternal mortality the general trend has been downward since 1920
In that year the rate of maternal deaths per 10,000 live births was 84 8 in 1927 it was 79.5.
* ’

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PRINCIPAL. ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

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Federal Reserve Bank of St. Louis

M ARYLAN D
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, bureau of child hygiene, Baltimore
i^nds expended: Federal, $27,158.36; State, $15,113.84; total, $42,272.20.
(Physician), 1 physician (part year), 1 nurse (part year), 1
fimMh"idUhCat^*n W?rkef (part time)> 2 stenographers, 2 clerks (1 part
1 ,chauffeu1r (Part year). Sixty physicians and eight dentists were
co“ duet conferences. Twenty county nurses were
paid in part from maternity and infancy funds.
Activities^601* a ssistan ts— 10 Physicians, 2 dentists, 95 lay persons.

Ch^

alt^ ° nieren?es conducted by physicians— 440; infants and pre
school children registered and exam ined-6,402; visits to conferencJs-

D dfS t i 011ioo in children examined at conferences— 8,225; children having
defects 5,224; parents had defects corrected in 1,035 of the children
P +L^i>al c° nferen(:e conducted by physician— 1 ; expectant mothers regisS l Junde ei^ 2 ?lned__3' The prenatal'Conference work was not begun
conducted by nurses, no physician present— 3 2; children
weighed and measured— 277; mothers instructed in prenatal care— 165 •
visits to conferences by children— 320; visits by mothers— 201.
Dented conferences— 53; preschool children receiving dental examination—
N

m i S S r S , c° mbinefd prenatal and child-health eenters- 2
established
as a result of the maternity and infancy work. They are supported by
maternity and infancy funds and by local funds.
•
y

NeandP1n7anncv11Lniknatfi1 10BnteIL’ "':L. established as 'a result of the maternity
bydlocal fundT k' ^
supP°rted
maternity and infancy funds and
Classes for girls in care of infants and preschool children— 9 organized;
girls enrolled and completing course— 161; lessons in course— 8 .
Classes for mothers— 49 organized; mothers enrolled— 726; number com
pleting course— 521; lessons in course— 8 .
C1nnf,eL f 0i .
12 organized; midwives enrolled and completing
course 7 ; lessons in course— 8 . Informal instruction was given to small
groups of midwives in several counties.
H ome visits by nurses— 6,462 (prenatal cases seen, $76; postnatal cases,
o3 4 , infants, 1,935; preschool children, 2,268).
Group demonstrations— 45, at child-health conferences and meetings.
Survey 1, of children who were to enter school in the fall
This was
made in cooperation with parent-teacher associations, county superin
tendents of schools, and public-health nurses.
The bureau is cooperating with the United States Children’s Bureau in
a study of maternal mortality being made in the State with the indorse
ment of the State medical society.
Campaign 1 , for the state-wide observance of May Day as Child Health
Day.
Talks and lectures— 93.
Literature prepared— Sound Teeth Are Faithful Guardians of Your Child’s
Health, Diet for the Young Child, Diet for the Expectant Mother.
Literature distributed— 127,850 pieces.
Nutrition work was done through nutrition classes conducted by the county
nurses who were paid in part from maternity and infancy funds.

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PRINCIPAL. ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

Activities— Continued.
Exhibits conducted— 75, consisting of motion pictures, posters, dental
exhibits, and baby clothing. Exhibit material prepared— motion-picture
]
film depicting the work of the bureau of child hygiene. Exhibit material
was lent forty-five times.
Statistical studies made— causes of infant mortality, by groups according
to the international classification, indicating percentage of total and
rates per 1,000 live births in each group for Maryland in comparison
with those for the United States birth-registration area for 1910-1915 and
for 1920-1924 and for the counties in comparison with Baltimore city
(white and colored separately) for 1921-1926; obstetrical service in the
counties in comparison with Baltimore city— attendance of physicians and
of midwives at births (white and colored), and rates for 1917-1926; still
births and rates for the counties in comparison with Baltimore city for
1922-1926; maternal mortality from puerperal causes in three groups:
(1) Eclampsia, (2) septicemia, (3) all other causes, in the counties,
in Baltimore city, and in the State (white and colored) for 1917-1926;
negro death rates, by age groups, in comparison with rates for white
population in the same age groups, for 1916-1925.
Breast feeding was promoted by instruction given to mothers at childhealth conferences and in home visits.
Infants born in the State during the year— 16,261 (exclusive of those
born in Baltimore city, in which the State bureau does no work as the
city has its own bureau of child hygiene) ; infants under 1 year of
age reached by the work of the bureau— approximately 14,000; preschool
children reached— between 5,000 and 6,000; expectant mothers reached—
approximately 4,500.
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 in which maternity and infancy work
was done during the year— 23.
Except for the services of physicians from the bureau’s staff, seven
counties now carry on their own maternity and infancy work.
As a result of the bureau’s work child-health conferences and dental con
ferences were conducted under local auspices in a number of counties.
The following organizations cooperated in the bureau’s work: State federa
tion of women’s clubs, State league of women voters, service clubs, and
parent-teacher associations. They assisted at conferences and in the
survey of preschool children. Among the children examined at con
ferences reported in the foregoing paragraphs 3,379 were examined in
the “ Get ready for school ” drive sponsored by the National Congress
of Parents and Teachers.
Among the outstanding achievements of the year were the reductions in
infant mortality and in maternal mortality.
TYPES OF WORK AND SOME RESULTS

The bureau of child hygiene was established in the State department of
health in 19221. The State accepted the provisions of the maternity and
infancy act through legislative enactment approved by the governor on April
13, 1922.
The same physician has directed the work during the entire period of
cooperation under the act. This has assured continuity of plans. Publichealth nurses paid in part from maternity and infancy funds have been assigned
to counties for maternity and infancy work, the number so detailed having
increased from 3 in 1924 to 20 in 1928. A number of physicians and dentists
have been employed by the day to assist in conference work (60 physicians
and 8 dentists during 1928).
Cooperation has been maintained with fraternal and women’s organizations,
service clubs, and parent-teacher associations.
The bureau’s work is in the counties outside Baltimore. An important
feature of the program has been the distribution of literature on infant and
maternal care. The Children’s Bureau folder Keeping the Well Baby Well
is sent to all mothers, additional literature is sent on the receipt of birthreport cards from registrars of vital statistics, and nearly all newly married

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

couples outside Baltimore are reached by the bureau’s pamphlet on home mak
ing. Other major activities are home visits made by nurses, conferences con
ducted by physicians and dentists, and work done with midwives.
Silver nitrate for use in the prevention of ophthalmia neonatorum is dis-f/
tributed from the bureau to physicians and midwives.
Cooperation in the maternal-mortality study sponsored by the State medical
society, which is being made in the State by the United States Children’s
Bureau, is a feature of work in the later period of cooperation with the Federal
Government. Another more recent type of work is the development of con
ferences and centers conducted by negro physicians and nurses from the
bureau’s staff among the people of their own race.
The results of the program are reflected in the reduction in both maternal
and infant mortality in 1927 compared with 1921 (the year before cooperation
was begun), with greater reduction in rural than in urban areas.
The infant and maternal mortality rates for 1921 and 1927 for the State
as a whole for the white and the colored population and for urban and rural
areas were as follows:

Infcmt mortality rates ( deaths of infants under 1 year of age per 1,000 live
births)
1921

State----------------------------------------------------------------------------White------------------------------------------------------------- L____
Colored________________________________________
Urban--------------White----------------------------------------------------Colored_______________________________________
Rural--------------------------------------------------------------------White-------------------------------------------------------------Colored-----------------------------------------------------------

94
81
147
87
80
125
102
82
165

1927

81
68

134
81
71
126
81
64
144

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births)
State______________________
White_____________________________________________
Colored___________________________________________
Urban____________________________________________
White________________________________________
Colored-------------------- 1________________________
Rural-----------------------------------------------------/._________
White_____ __________________________________
Colored_______________________________________

1921

1927

66.5
59.5
96.1
69. 7
65. 6
92. 6
62. 5
51.0
98. 8

57.5
53.9
71. 9
73. 5
71.3
82. 8
36. 5
30.1
59.2

The reduction in the infant mortality rate in the rural areas is noticeable
among both the white and the colored population, the rate for the white infants
being 22 per cent lower in 1927 than in 1921 and that for the colored infants
12.7 per cent lower.
The maternal mortality rates in the rural areas show even greater reduction.
The rate for white mothers was 41 per cent lower in 1927 than in 1921; for
colored mothers it was 40.1 per cent lower.

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M ICHIGAN
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, bureau of child hygiene and public-health
nursing, Lansing.
Funds expended: Federal, $32,381.39; State, $27,534.27; total, $59,915.66.
Staff:
Director (physician), 2 physicians, 9 nurses, 2 vital-statistics clerks, 2
stenographers, 1 clerk, 1 mail clerk (part time).
Activities:
Child-health conferences conducted by physicians— 22; infants and pre
school children registered and examined— 683.
Defects found in children examined at conferences— 1,525; children having'
defects— 614.
Prenatal conferences conducted by physicians— 11; expectant mothers reg
istered— 16; number examined— 1 2 ; visits to conferences— 114.
New permanent combined prenatal and child-health centers— 6 established
as a result of the maternity and infancy work. They are supported by
local funds.
New permanent prenatal center— 1 established as a result of the maternity
and infancy work. It is supported by local funds.
Classes for girls in care of infants and preschool children— 158 organized;
girls enrolled and completing course— 3,605; lessons in course— 10. Pub
lic-health nurses not paid from maternity and infancy funds but receiving
advisory assistance from the bureau organized 146 classes with an enroll
ment of 2,658 girls.
Classes for women— 98 organized; women enrolled— 1,300 (including 50
midwives) ; number completing course— 1,080; lessons in course— 6 .
Self-directed study clubs— 236 meetings; total attendance— 4,595 women.
The purpose of these clubs was to assist women to inform themselves in
the fundamentals of prenatal, infant, and child care. The clubs were
organized by a staff nurse, local organizations being used as a nucleus
whenever possible. At the first meeting leaders were chosen for each of
the six lessons, and a copy of the Michigan Mother’s Manual was given
to each member. Additional reference material was given to the leaders,
and the method of preparing each lesson was discussed with them. Local
physicians frequently led the discussions on prenatal and infant care,
and local health officers discussed the control of communicable diseases.
Demonstration material was lent by the bureau.
Home visits by nurses— 5,005 (prenatal cases seen, 600; obstetrical cases,
3 ; postnatal cases, 150; infants, 2,641; preschool children, 355).
Community demonstrations— 3, in 3 counties, of a prenatal nursing program
(1 continued from the previous year was completed in December, 1927).
Lists of expectant mothers were obtained from physicians and other
interested persons. Calls were made on these women, and the hygiene
of pregnancy was explained and the importance of regular medical
supervision stressed. A complete history of each case was taken and
immediately sent to the physician who was to attend the mother at
confinement. Subsequent calls were made on an average of once a month
or more often if any danger symptoms appeared, such symptoms being
reported to the physician immediately. During the year under review
565 prospective mothers were under supervision, and 1,867 calls (1,226
prenatal, 641 postnatal) were made. The nurses continued their visits
to the mothers until the infants were 6 weeks old. By the close of the
year under review there had been 508 deliveries (including all deliveries
in the counties in which work had been begun in the previous year),
and only 1 of the mothers under supervision had died. Of the 477 babies
83

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TH E WELFARE AND HYGIENE OP MATERNITY AND IN FAN C Y

Activities— Continued.
born alive to these mothers 345 were breast fed, 71 were partly breast
fed. The proportion of breast-fed babies indicates the appreciation of
advice on benefits of breast feeding given by the nurses.
Group demonstrations— 453, of obstetrical kit, bed for home delivery, bottlj}
feeding, and the baby’s bath.
Survey— 1, of maternal mortality, state-wide (continued from the previous
year in cooperation with the United States Children’s Bureau). The
causes of death for the 819 cases studied by the close of the year under
review were as follows:
Number of
deaths

Total___________________________________________________
Puerperal septicemia----------------------------------------------------------------Puerperal albuminuria and convulsions----------------------------------Puerperal hemorrhage--------------------------------------------------------------Accidents of pregnancy------------------------Accidents of labor--------------------------------------------------Embolus, sudden death, etc-----------------------------------------------------Causes following childbirth (not otherwise stated)---------------

819
359
167
95
79
57
53
9

Campaigns— 3 : (1) For promotion of breast feeding, in 12 counties. Calls
were made on the mothers of 1,671 babies, and advice was given as to
the advantages of breast feeding. (2) For the examination of preschool
children and correction of their defects before the children should enter
school. As chairman of child hygiene for the State parent-teacher
association the director of the bureau was able to stimulate local parentteacher associations to register for this campaign, and 290 participated.
Most of the examinations of children were made by local physicians.
(3) For the observance of May Day as Child Health Day. The director
served as chairman of this campaign.
Talks and lectures— 257, to audiences totaling 10,964 persons.
Literature prepared— outlines for course of study for self-directed study (
clubs.
Literature distributed— 359,047 pieces.
New names registered for prenatal letters— 3,094; prenatal letters dis
tributed— 3,497 sets.
Nutrition work was done through talks given to classes for women and
cI&ssgs for girls.
Exhibits conducted— 12, at fairs and meetings. Exhibit material pre
pared— charts on maternal mortality, layettes, obstetrical kits, method
of giving sun baths. Exhibit material was lent thirty times.
Statistical study made— maternal-mortality data secured to July 1, 1928,
in the survey reported in a foregoing paragraph.
Breast feeding was promoted by the breast-feeding campaign in 12 counties
and by instruction given to mothers in conferences and classes.
Infants born in the State during the year— 97,167; infants under 1 year
of age reached by the work of the bureau— 101,641; preschool children
reached— 1,038; expectant mothers reached— 7,500 (exclusive of those
reached by distribution of 59,590 pamphlets on prenatal care).
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— 83; counties in which maternity and infancy work
was done during the year— 79; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 83.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The bureau gave supervisory assistance to local organizations doing
maternity and infancy work.
The following organizations cooperated in the bureau’s work: State depart
ment of public instruction, State agricultural college (extension service),
State grange, State league of women voters, State federation of women’s
clubs, State child-study association, State nurses’ association, American
Association of University Women, Woman’s Christian Temperance Union,
Daughters of the American Revolution, Legislative Council of Michigan

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1 9 2 8

Activities— Continued.
Women, Detroit Federation of Women’s Clubs, women’s fraternal organi
zations, and the parent-teacher association. Among the children exam
ined at conferences reported in the foregoing paragraphs 200 were
examined in the “ Get ready for school ” drive sponsored by the National
Congress of Parents and Teachers.
The outstanding feature of the year’s work was the maternal-mortality study,
which was continued from the previous fiscal year and which has met with
excellent cooperation from the physicians of the State.
TYPES OF WORK AND SOME RESULTS

The bureau of child hygiene and public-health nursing was established in
the State department of health in 1920. The governor accepted the provisions
of the maternity and infancy act on January 12, 1922. This was followed by
legislative acceptance approved by the governor on May 24, 1923.
A physician has directed the work, with the aid of a central staff of
physicians and nurses who have conducted various types of field activities. As
sistance has been given by a State committee of heads of state-wide organiza
tions of women who sponsor the program, meeting on the call of the director of
the bureau and giving advice. County committees composed of representatives
of the same organizations of women sponsor and aid the work in counties and
communities.
The program has varied as the work has progressed. In the earlier years
of cooperation with the Federal Government itinerant child-health conferences,
itinerant prenatal conferences, organization of permanent health centers, a
survey and supervision of midwives, and instruction in infant care for school
girls in the upper grades were stressed. _A survey of the incidence of goiter in
four counties was followed by a state-wide campaign for its prevention which
included special attention to the prevention of congenital goiter. In later years
some of these activities have given place to demonstrations of prenatal nurs
ing, county-wide breast-feeding surveys, and instruction of groups of. women
(including midwives) in prenatal care and the care of infants and children. A
recent feature of the program still in progress is the study of maternal deaths.
The sending of literature on the care of the baby with a certificate of regis
tration to the parents of all infants whose births are registered has put infor
mation on the early care of the baby in the hands of the parents promptly.
The effect of the program is reflected in lower infant mortality rates for the
State in 1927 as compared with 1921, the year in which Congress passed the
maternity and infancy act. The State’s infant mortality rate for 1927 was the
lowest since its admission to the United States birth-registration area in 1915.
The infant and maternal mortality rates for 1921 and 1927 were as follows:

Infant mortality rates ( deaths o f infants under 1 year o f age per 1,000 Uve1
births)
1921

State
____ ____
Urban _
R u r a l __

1927
68

70
64

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births )
State ___
Urban _
Rural _

______
_

________

1921
68.5
71.1

1927
6 8 .0

77.6
53.5

The markedly lower rural maternal mortality rate may be due in part to the
fact that more rural mothers are employing physicians. Midwives reported
6,632 births in 1921, whereas in 1927 they reported 2,859 births.

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Federal Reserve Bank of St. Louis

MINNESOTA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
.
.
.
State department of health, division of child hygiene, Minneapolis.
Funds expended: Federal, $32,339.92; State, $21,099.65; total, $53,439.57.
Staff:
„
„ .£ .
Director (physician, part time), 1 physician (part year), 9 nurses, 1 vitalstatistics field agent, 2 vital-statistics clerks, 4 stenographers, 1 mailing
clerk, 2 general clerks (part time).
Activities:
Child-health conferences conducted by physicians— 3 ; infants and preschool
children registered and examined— 95.
Defects found in children examined at conferences— 76; children having
defects 57
The division issued certificates to 1,365 girls who were reported as com
pleting the course in 34 classes in infant and child care conducted by
local teachers and nurses, who used the Mothercraft Manual prepared
by the division.
Courses for teachers on methods of teaching classes for girls in infant and
child care were given at the State teachers’ colleges. Classes organized •
33; students registered— 357; lessons in course— 3 to 5.
Classes for mothers— 42 organized; mothers enrolled plus those carried
over from previous year— 1,914; number completing course— 515. Les- j
sons in course— 8 . Additional classes were conducted by local public- (
health nurses not paid from maternity and infancy funds.
Home visits by nurses— 758 (to prenatal cases, 34; obstetrical cases, 16;
postnatal cases, 67; infants, 381; preschool children, 260).
Group demonstrations— 5, of the material on maternal and infant care(
available from the division.
Survey— 1, of maternal deaths in the State, 1927-28 (not completed).
Campaign— 1, for the observance of May Day as Child Health Day.
Through the May Day activities clubs and other groups included discus
sions of this work in their programs and were responsible for distribut
ing literature and acquainting their various communities with the State
program of maternity and infancy work.
Talks and lectures— 108.
Literature prepared— Sunlight and Cod-Liver Oil.
Literature distributed— 270,112 pieces.
New names registered for prenatal letters— 1,181; prenatal letters distrib
uted— 1,181 sets.
A correspondence course consisting of 15 lessons was conducted for mothers.
During the year under review 897 women registered for the course, and
223 were on the roll from the previous year. The number completing
the course was 689. More than 8,000 women have taken the course
since it was begun about four years ago in cooperation with the State
university.
A 4-lecture course in maternity and infancy work was given to a class of
public-health nurses, 2 lectures were given to the senior hospital nurses
in St. Paul and to those in Minneapolis, and a 12-lecture course in mater
nal and child hygiene was given to students in the State university. A
lecture with exhibit of the division’s material was given before the
students of each class in the university medical college.
Exhibits conducted— 49, at State and county fairs and at various meetings.
Exhibit material prepared— charts on maternal and infant mortality.
Exhibit material was lent 53 times.

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PRINCIPAL. ACTIVITIES OP INDIVIDUAL STATES, 192 8

Activities— Continued.
Articles prepared— Sheppard-Towner Work in Minnesota, May Day— Child
Health Day, Some Aspects of Preventable Deaths in Minnesota, Where
Improvement Must Come in Our Infant Mortality Rate, Maternal Edu
cation in Minnesota, Work of the Child-Hygiene Division.
Statistical studies made— maternal mortality, 1910-1927, by causes; infant
mortality, 1910-1926, by causes.
Counties in the State— 87; counties in which maternity and infancy work
was done during the year— 72; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 87.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
Public-health nurses throughout the State (including those not paid from
maternity and infancy funds) refer prospective mothers to the division
for prenatal letters or literature.
The following organizations cooperated in the division’s work: State board
of control, State department of education, State university (extension
division), State league of women voters, State federation of women’s
clubs, American Red Cross, American Legion auxiliary, and parentteacher associations.
The outstanding feature of the year’s work wa*s the development of the
mothers’ classes, which were conducted in various parts of the State and had
far-reaching results in the education of mothers.
TYPES OF WORK AND SOME RESULTS

The State accepted the provisions of the maternity and infancy act through
legislative enactment approved by the governor on April 20, 1921. The division
of child hygiene was established in the State department of health in 1922 to
administer the funds that had been accepted.
The staff of the division since its establishment has included a medical
director, several staff nurses, and occasional or part-time physicians.
Valuable cooperation has been given to the division by other official State
agencies (the department of education, State board of control, and State
university), the State medical association, women’s organizations, the American
Legion auxiliary, and the parent-teacher association.
The State program from the beginning of cooperation with the Federal
Government has stressed education in infant and prenatal care through cor
respondence courses for mothers, prenatal letters, distribution of literature
on maternal, infant, and child care, and lectures by physicians and nurses.
Work with the Indians through Indian and other nurses detailed to the reser
vations has been a feature of the program. The detailing to counties of
nurses paid in part from maternity and infancy funds has led to the assump
tion by two counties of the financial responsibility for maternity and infancy
work.
The year ended June 80, 1928, has been marked by some changes in the
program, including greater interest in surveys and instruction of groups.,
Classes for mothers conducted by the staff nurses have reached about 400 more
mothers in 1928 than in 1927 with information on prenatal, infant, and child
care. The state-wide survey of maternal mortality sponsored by the State
medical society was in progress during 1928 (the data to be tabulated with
the cooperation of the United States Children’s Bureau), and a valuable sta
tistical study of maternal mortality and infant mortality, by causes, was made.
A breast-feeding survey in two counties showed that about 85 per cent of the
babies were breast fed.
The infant mortality rate (deaths of infants under 1 year of age per 1,000
live births) for 1927 was 52, a new low rate for the State; the rate for 1926
was 58. The rate of 58 also obtained in 1922, the year in which the division
of child hygiene was organized.
The maternal mortality rate also was lower in 1927 than in 1922. The rate
of maternal deaths per 10,000 live births in 1922 was 49.5; in 1927 it was 44.4.
In the opinion of the State medical director the number of women using
the educational material has definitely increased, and the interest will prob
ably be maintained through nurses and physicians.

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Federal Reserve Bank of St. Louis

MISSISSIPPI
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Jackson.
Funds expended: Federal, $17,659.02; State, $10,914.47; total, $28,573,49.
Staff:
Director (State health officer serving part time), 2 nurses, 1 dental
hygienist (part time), 1 midwife supervisor (part time), 1 vital-statistics
clerk, 1 accountant (part time), 3 stenographers (2 part time). Nine
county nurses in six counties were paid in full or in part from maternity
and infancy funds.
Activities:
Child-health conferences conducted by physicians—254; infants and pre
school children registered and examined— 4,344.
Defects found in children examined at conferences— 4,459; children having
defects'— 2,500. Parents were known to have had defects corrected in
371 of the children.
Prenatal conferences conducted by physicians— 14; expectant mothers reg
istered and examined— 252; visits to conferences— 444.
Dental conferences— 161; preschool children receiving dental examina
tion— 3,338.
New permanent prenatal centers— 4 established. They are supported by
county funds.
Hygiene classes— 160 organized in schools; pupils enrolled— 4,000; number
completing course and receiving certificates from the State board of
health— 3,627 ( 3,589 girls, 38 boys) ; lessons in course— 12. Instruction
in care and needs of infants and preschool children and in prenatal
care was included in the course.
Work with midwives was done through midwives’ clubs assisted by the
county public-health nurses in counties having such service and by the
headquarters staff in other counties. Each club has a leader and a
secretary and holds a monthly meeting, a report of which is sent to the
bureau. The nurses who conduct midwives’ classes use an outline and
a manual supplied by the bureau. On January 1, 1928, there were in
the State 3,437 midwives (mostly colored) in active practice and 200
whose permits were pending.
Home visits by nurses— 6,089 (to prenatal cases, 1,273; obstetrical cases,
280; infants, 2,014; preschool children, 2,522).
Talks and lectures— 6,277.
Literature prepared— leaflets on sun baths, on breast feeding, and on
motherhood.
Literature distributed— approximately 50,000 pieces.
Nutrition work was included in the activities of all nurses.
Exhibits conducted— in 81 counties, at meetings of midwives’ clubs, at which
posters on maternal and infant health were shown. In addition, motion
pictures of all phases of the bureau’s work were shown by the motionpicture truck in five counties.
Infants and preschool children- reached through literature distributed—
approximately 100,000; expectant mothers reached— 1,171 (exclusive of
those reached by literature distributed). Approximately 10,000 pieces of
literature on prenatal care and motherhood were distributed.
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—-82; counties in which maternity and infancy work
was done during the year— 82.
Since the beginning of the State’s cooperation under the maternity and
infancy act eight counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
All the full-time county health departments in the State include maternity
and infancy work in their programs.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 192 8

Activities—Continued.
The bureau rendered supervisory service to local health organizations
doing maternal and infant-hygiene work.
|

The following organizations cooperated in the bureau’s work: State league
of women voters, State development board, fraternal organizations, and
parent-teacher associations. They gave financial assistance and helped
to stimulate local work.
An outstanding feature of the year’s work was the organization of hygiene
classes in the schools and the instruction given through these to the 4000
pupils enrolled.
’
TYPES OF WORK AND SOME RESULTS

The bureau of child hygiene and public-health nursing was established in
the State board of health in 1920. The State accepted the provisions of the
maternity and infancy act through legislative enactment approved bv the
governor on March 28, 1922.
J
A physician has directed the work during the entire period of cooperation
with the Federal Government, assisted by a small staff including nurses
a dental hygienist, and clerical workers. Seven to nine nurses paid in full
or in part from maternity and infancy funds have been detailed to county
health departments to conduct maternity and infancy work under supervision
of the State staff nurses.
The bureau has had the benefit of cooperation from the State development
board, the American Red Cross, fraternal and women’s organizations, and
parent-teacher associations. The program was furthered by the adoption in
18 cities of the standard milk ordinance as promoted by the United States
Government. This insured in these communities a better milk supply— which
has a direct bearing on infant health.
. Emphasis in the State work has been placed on hygiene classes organized
public schools, in which instruction in the care of infants and preschool
children was included. The fact that during the year under review 4,000' pupils
¡enrolled ^or
course indicates a gratifying response to the opportunities
offered.
Work with midwives has occupied a prominent place in the State program.
A survey made in 1921 and 1922 showed that 4,209 were practicing in the State
These women all obtained permits to practice, and the State staff nurses have
¡kept them under supervision and have given them instruction. Through a
Questionnaire sent to physicians it was found that the physicians have ob
served improvement in the midwives’ cleanliness, in the number calling physi
cians in abnormal cases, in their care of mothers and infants, their equipment
reporting of births, and referring of cases for prenatal and postnatal exami
nations.
The infant mortality rate has remained practically stationary. Though there
has been considerable fluctuation in the maternal death rate, this rate was
lower in 1927 in both urban and rural areas than in 1921 (the year before the
operation of the maternity and infancy act). The rates for the white and the
colored mothers in the State as a whole and in rural areas likewise were lower
m 1927 than in 1921. _ In the urban areas, however, though the rate for white
mothers declined considerably, that for colored mothers was slightly higher in
1927 than in 1921. The maternal mortality rates for 1921 and 1927 in the
State as a whole and in urban and rural areas were as follows for the white
and the colored population:

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births)
State___________

White_____
Colored___
Urban_____
White__
Colored.
Rural______
W hite-_
Colored.
48278°— 29----- 7

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Federal Reserve Bank of St. Louis

1921

1927

915.3
71.4
120.3
179.8
157.2
217.4
88.3
62.4
114.2

86.7
61.1
111.4
158.1
117.6
221.5

78.8
53.2
102.4

MISSOURI
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, division of child hygiene, Jefferson City.
Funds expended: Federal, $21,000; State, $21,000; total, $42,000.
Staff:
Director (physician), .1 physician (part year), 3 nurses (2 part year),
1 stenographer (part year), 1 birth-registration investigator (part year,
part time), 1 multigraph operator (part time). Fourteen county nurses
were paid in part from maternity and infancy funds.
Volunteer assistants— 147 county and city health officers, 29 nurses, approxi
mately 150 lay persons.
Activities:
Child-health conferences conducted by physicians— 484; infants and pre
school children registered and examined— 7,979; visits to conferences—
9,718.
Defects found in children examined at conferences— 11,240; children having
defects— 4,496. Parents were known to have had defects corrected in
15 per cent of the children.
Conferences conducted by nurses, no physician present— 840; children
inspected— 16,221; mothers instructed in prenatal care— 778; visits to
conferences by children— 32,442; visits by mothers— 1,334.
New permanent child-health centers— 4 established as a result of th (/
maternity and infancy work. They are supported by maternity and
infancy funds and by local public and private funds.
Classes for girls in care of infants and preschool children— 42 organized;
girls enrolled— 488; number receiving certificates— 84; lessons in course—
12. To be entitled to a certificate a girl must attend at least 10 classes
and must pass an examination covering the entire course.
Classes for mothers— 337 organized; mothers enrolled plus those carried
over from previous year— 8,020; number completing course— 3,370; les
sons in course— usually 10.
Home visits by nurses— 5,442 (prenatal cases seen, 595; obstetrical cases,
25; postnatal cases, 204; infants and preschool children, 3,794).
Community demonstrations— 44, consisting of conferences for preschool
children, health talks, exhibits, and group demonstrations. The program
usually lasted a week or longer. Special children’s cases were discussed
in conferences with local physicians at the close of the demonstrations.
Group demonstrations— 958, of sun suits, homemade beds for babies, the
baby’s bath, and other items of infant care, at child-health conferences
and classes for mothers.
Campaign— 1, to have preschool children qualify as “ 6-pointers” and
“ 9-pointers.” To qualify as “ 6-pointers ”'the children had to be free from
defects in vision, hearing, throat, teeth, posture, and weight. To qualify
as “ 9-pointers” the children also had to have their births registered,
be immunized against diphtheria, and be vaccinated against smallpox.
Forty-six counties used this plan for interesting parents in having their
children examined and any defects corrected before the children should
enter school. A total of 13,134 6-point awards and 16,564 9-point badges
were issued by the division during the year under review.
Talks and lectures— 606.
Literature prepared— Health Habits of Preschool Children, County Public
Health Nursing, Sun Baths.
Literature distributed— 780,450 pieces.
New names registered for prenatal letters— 925; prenatal letters distrib
uted— 712 sets.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1928

Activities— Continued.
^
Exhibits conducted 9, at fairs and meetings. Exhibit material prepared
graphs on infant death rate and diphtheria decline, map showing prog
ress of campaign for “ 6-point ” children. Exhibit material was lent
twenty-five times.
Scientific article prepared— Prevention of Blindness.
Statistical study made— infant mortality, in 1 county.
Breast feeding was stressed at all child-health conferences and in a lec
ture given at the annual State public-health meeting. Of the 3,594 in
fants examined, 1,920 (approximately 53 per cent of the total number ex
amined) were breast fed at least 6 months.
Infants bom in the State during the year— 66,401; infants under 1 year
of age reached by the work of the division—43,195; preschool children
reached— 26,994; expectant mothers reached— 2,298 (exclusive of those
reached through literature distributed).
The bureau sends literature on infant hygiene to parents of all infants
Wh?Sfi.^>ir^ S ar? reS1stered in the State bureau of vital statistics (exeept those born in the three largest cities in the State).
Counties in the State 114; counties in which maternity and infancy work
was done during the year— 53; counties in which maternity and infancy

act— 112S been d° ne SinCe the accePtance

the maternity and infancy

As a result of the division’s work three new community nursing services
were started.
The following organizations cooperated in the division’s work- State
federation of women’s clubs, State league of women voters, State tuber
culosis society, State agricultural college (extension division), Woman’s
Christian Temperance Union, and the parent-teacher association. They
assisted with publicity in the campaign for 6-point and 9-point children
aad ln advocating full-time county nurses. About 20 per cent of the
children examined at health conferences were examined in the “ Get
ready for school ” drive sponsored by the National Congress of Parents
and Teachers.
the outstanding achievements of the year were the results accomState&toYh
an.d 9-P?int children and the admission of the
fetate to the United States birth-registration area.
TYPES OF WORK AND SOME RESULTS

^ TiGiadiV™ 0n ° f cM d ll^ iene was established in the State board of health
in 1919. The governor accepted the provisions of the maternity and infancv
act on January 17, 1922 This was followed by legislative acceptance approved
by the governor on March 24, 1923.
/* F
w v u
alativ®iy. ,s.ma11 c-]entrai stafe of Physicians and nurses direct and supervise
the field activities and conduct child-health conferences. Fourteen nurses naid
and ai928r° m maternity a M infancy fuads were detailed to counties during 1927
The number of full-time county health units has increased as a result of
rehabilitation of the areas flooded by the Mississippi River, and the nurses
paid m part from maternity and infancy funds have worked especially in S
counties having such units.
p
y
Cooperation of county and city health officers and public-health nurses not
paid from maternity and infancy funds has permitted extension of the work
and has increased its efficiency. Cooperation has also been given by the State
department of education and State educational institutions, the American Red
Cross, State medical, dental, tuberculosis, public-health, and nurses’ asSffiati nni
State conference of social work, State street and h ig h ^ T l f e t T c o n n c ” ?
women’s organizations, and the parent-teacher association.
council,
One of the objectives of the State program which has been attained was the
adnnssion of the State to the United States birth-registration area Another
objective has been the reaching of all parents in the State with in io fm a tS
on infant care. This is accomplished by sending literature on infant hygffine
to parents of all infants whose births are registered (with the exceptfon of
those born in the cities of St. Louis, Kansas City, and St. Josephl
An extension of the effort to have all preschool children qualify as “ 6™
and 9-pointers ” has marked the work during 1928. The reporting
?n
t0„-M e State, br d of health in 1827la n d t S
S
m 1928 to 13,134 6-pomt children and the issuance of 9-point badges to 16 564

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

children indicate the success of the 6-point and 9-point work. The percentage
of defects corrected in the 46 counties using this plan for stimulating the cor^
rection of physical defects was more than twice that in the other counties in
1928.
Extension of other features of the work has marked the fiscal year 192*.
For example, classes for mothers increased in numbers, also the number of
mothers taking the courses. The number of counties having maternity and
infancy work during the year increased.
Maternity and infancy funds were used in July, 1926, for the purchase of
material for preparing nitrate of silver ampules ; the expense of manufacture
and distribution has been paid from other State funds. These ampules are
distributed free to physicians on request, and 10,063 ampules .were distributed
during 1928. Thirty-one cases of ophthalmia neonatorum were reported during
1925, but only 25 during 1927.
Mortality rates are available for the State from the United States Bureau
of the Census for 1927, the year of the State’s admission to the registration
area. The infant mortality for that year was 60 per 1,000 live births, and the
maternal mortality was 67.4 per 10,000 live births.

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Federal Reserve Bank of St. Louis

M O N TA N A
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, child-welfare division, Helena.
Funds expended: Federal, $12,568.36; State, $8,700; total, $21,268.36.
Staff:
Director (physician), 3 nurses (part time, 2 part year), 1 vital-statistics
clerk, 1 bookkeeper (part time), 1 stenographer. Physicians were
employed as needed to conduct conferences. Eleven county nurses were
paid in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 158; infants and pre
school children registered and examined— 1,724.
Children having defects— 1,318. Parents had defects corrected in 216 of
the children (report incomplete).
Conferences conducted by nurses, no physician present— 328; children in
spected— 2,799 ; mothers instructed in prenatal care— 135; visits to con
ferences by children— 3,183.
New permanent combined prenatal and child-health center— 1 established
as a result of the maternity and infancy work. It is supported by
maternity and infancy funds and by private funds.
New permanent child-health centers— 3 established as a result of the
maternity and infancy work. They are supported by maternity and
infancy funds and by a private organization.
Classes for girls in care of infants and preschool children— 6 organized;
girls enrolled— 118; lessons in course— 12.
Home visits by nurses— 3,913 (prenatal cases seen, 213; obstetrical cases,
4 ; postnatal cases, 46; infants, 1,905; preschool children, 2,092).
Group demonstrations— 95.
Talks and lectures— 1,124.
Literature distributed— 211,116 pieces.
New names registered for prenatal letters— -774; prenatal letters dis
tributed— 774 sets.
Nutrition work was done through individual instruction.
Exhibits conducted— 70, at conferences and fairs. Exhibit material was
lent four times. Motion-picture films were lent one hundred and seventynine times.
Assistance was given to the State bureau of vital statistics in making a
complete study of the vital statistics of the State.
Infants born in the State during the year— 9,905; infants under 1 year of
age reached by the work of the division— 3,226; preschool children
reached— 6,665; expectant mothers reached— 1,122. (These figures do
not include children and expectant mothers reached by literature dis
tributed. )
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 in which maternity and infancy work
was done during the year— 39; counties in which
maternityandinfancy
work has been done since the acceptance of the
maternityandinfancy
act— 56.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the division’s work child-health conferences were conducted
weekly in one county by local workers, eight classes for girls in
care of infants and preschool children with an enrollment of 112
girls were organized by nurses not paid from maternity and infancy
93

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OP MATERNITY AND INFANCY

Activities— Continued.
.
funds, and the tuberculosis nurse ,on the Blackfeet Indian Reservation
carried on an extensive child-hygiene program.
j
The division gave some supervision to the work of public-health nurses.-J
employed by the State tuberculosis association and other organizations/
The following organizations cooperated in the division’s work: State
tuberculosis association, State federation of women’s clubs, American
Red Cross, and the parent-teacher association. Among the children
examined at conferences reported in the foregoing paragraphs 167 were
examined in the “ Get ready for school ” drive sponsored by the National
Congress of Parents and Teachers.
An outstanding feature of the year’s work was the promotion of county
public health nursing services.
TYPES OF WORK AND SOME RESULTS

The child-welfare division was established in the State board of health in
1917. The governor accepted the provisions of the maternity and infancy act
on February 9, 1922. This was followed by legislative acceptance approved by
the governor on March 16, 1923.
A physician has directed the work of the division, and two to three nurses
on the division’s staff have done field work. Local physicians have been
employed to conduct conferences, and nurses paid in part from maternity and
infancy funds (11 in 1928) have been detailed to counties.
Cooperation has been maintained with the American Red Cross, the State
tuberculosis association, women’s organizations, and the parent-teacher
association.
^
, , ,
The program has been characterized by child-health conferences conducted
by physicians and nurses. Promotion of nursing services through assistance
in financing county nurses has provided a medium of education in infant and
prenatal care. The sending of literature on infant care to mothers of infants
whose births are registered has been a means of carrying to remote districts
valuable assistance in providing intelligent care for young babies.
. . . .
/
Through the use of maternity and infancy funds ampules of nitrate or silver,
are distributed free for .the use of physicians and midwives in preventing
ophthalmia neonatorum.
Both infant and maternal mortality rates were lower for 1927 than mey
were for 1922, the year in which the State began cooperation with the Federal
Government under the provisions of the maternity and infancy act. _ The infant
mortality rate in 1927 was the lowest since the State^ was admitted to the
United States birth-registration area. The number of infants dying in their
first year of life was 70 for every 1,000 born alive in 1922, whereas it was 66 in
1927. The maternal mortality rate per 10,000 live births wa£ 79.1 m 1922,
but it was 66.3 in 1927. This was a saving of 13 mothers for every 10,000 live
births in the Stats in 1927 as compared with 1922. The saving in the lives of
rural mothers was even greater; 23 rural mothers who would have died at the
rate prevailing in 1922 survived for every 10,000 live births in 1927.
For map showing the counties receiving aid for nursing services and the distribution of maternity and infancy work, by counties, see page 92.

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NEBRASKA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public welfare, bureau of health, division of child
hygiene, Lincoln.
Funds expended: Federal, $11,000; State, $6,000; total, $17,000.
Staff:
Director (nurse), 3 nurses (1 part year), 1 inspector of maternity and
infant homes (part time), 1 vital-statistics clerk, 1 stenographer.
Volunteer assistants— 120 physicians, 04 dentists, 20 nurses^ 302 lay
persons.
Activities:
Child-health conferences— 100 (00 conducted by physicians who< volunteered
their services, 10 conducted by a physician lent to the State by the United
States Children’s Bureau) ; infants and preschool children registered
and examined— 3,465; visits to conferences— 3,475.
Defects found in children examined at conferences— 8,830; children having
defects— 2,900.
Classes for girls in care of infants and preschool children— 18 organized;
girls enrolled— 446; lessons in course— 4. Most of these classes were
conducted in high schools in which the home-economics instructor
arranged for the course to be given. One class was conducted at an
Indian school which had an enrollment representing many tribes.
Classes for mothers— 37 organized; mothers enrolled— between 600 and
700; number completing course— 164; lessons in course— 4.
Home visits by nurses— 1,032 (prenatal cases seen, 110; postnatal cases, 0 ;
infants, 033; preschool children, 871).
Maternity homes inspected— 06; inspections made— 06.
Infant homes inspected— 13; inspections made— 13.
Group demonstrations— 264, of bathing the baby, applying bandages, pre
paring maternity bed, preparing tent for croup and diphtheria cases, and
various other phases of maternal and child care.
The division is cooperating in a study of maternal mortality being con
ducted in the State by the United States Children’s Bureau with the
indorsement of the State medical society.
Campaign— 1, in cooperation with the State parent-teacher association,
for examination of preschool children and correction of their defects
before the children should enter school in the fall. In connection with
the observance of May Day as Child Health Day the division prepared
and distributed literature to help in stimulating and planning local
programs.
Talks and lectures— 42.
Literature prepared— The Optimal Child (folder).
Literature distributed— 85,055 pieces. A mimeographed summary of the
State vital statistics was sent to all practicing physicians with a letter
telling them of the literature available from the division. In response
many requests for bulletins were received, also names of expectant
mothers to whom literature was to be sent. Copies of Standards of
Prenatal Care5 were furnished to two medical schools, and sets of
child-hygiene bulletins were furnished to the senior nurses in all nurses’
training schools.
New names registered for prenatal letters— 601; prenatal letters dis
tributed— 711 sets.
5 Standards o f Prenatal C a re ; an outline for the use o f physicians.
Bureau Publication No. 153. W ashington, 1925.

U. S. Children’ s
95

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Federal Reserve Bank of St. Louis

THE

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

A ctivities— Continued.
Nutrition work was done through, individual instruction at health confer
ences and in home visits. Instruction in nutrition was included in the
classes for mothers and for girls.
Exhibit material prepared— photographs and posters. Two attractive book
lets were made showing health literature for parents that could be
obtained from the division. These, with mimeographed lists of the
available publications, were placed in two large stores dealing in infant
clothing. A number of requests for literature were received from ex
pectant mothers as a result of this exhibit. Exhibit material was lent
six times.
Breast feeding was stressed in class and individual instruction to mothers
and in literature distributed.
Infants born in the State during the calendar year 1927:—27,866; infants
under 1 year of age reached by the work of the division during the year
ended June 30, 1928— 10,722; preschool children reached— 10,117; ex
pectant mothers reached—-819.
The division sends reply post cards, which may be used in requesting
copies of literature on child care, to parents of all infants whose births
are registered in the State bureau of vital statistics.
Counties in the State— 93; counties in which maternity and infancy work
was done during the year— 82; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 90.
As a result of the maternity and infancy work bimonthly child-health con
ferences have been inaugurated in two towns in one county.
The division supervised child-health conferences and classes conducted by
local organizations.
The following organizations cooperated in the division’s work: State uni
versity (extension service), State medical association, State league of
women voters, federated and rural women’s clubs, American Legion
auxiliary, American Red Cross, State and local Woman’s Christian Tem
perance Unions, county medical societies, county fair boards, church
societies, mothers’ clubs, a fraternal organization, the State parentteacher associatidn, and local parent-teacher associations. These or
ganizations sponsored child-health conferences and classes for mothers
and for girls. Among the children examined at conferences reported in
the foregoing paragraphs 2,117 were examined in the “ Get ready for
school ” drive sponsored by the National Congress of Parents and Teach
ers. Excellent cooperation was also given by the State superintendent
of public instruction, county and town superintendents of schools, in
structors in home economics, and county public-health nurses. The
director of the child-hygiene division was appointed State chairman of
public health for the State federation of women’s clubs. This gave
unusual opportunity to make contacts with the women’s clubs and has
increased their interest in community-health activities.
An outstanding feature of the year’s work was the increase in class work for
women and for high-school girls.
TYPES OF WORK AND SOME RESULTS

A division of child hygiene was established in 1921 in the bureau of health
of the State department of public welfare. The governor accepted the provi
sions of the maternity and infancy act on February 8, 1922. This was followed
by legislative acceptance approved by the governor on April 11, 1923.
Changes in plans have occurred as a result of changing directors. Since
July, 1925, a nurse has been in charge of the work. During the early years of
cooperation emphasis was placed on work with the Indians, a full-time worker
being detailed to the reservations. During the later years work has continued
with the Indians, but it has been done through the work of the three staff
nurses. The social worker on the staff has served as inspector of maternity
and infant homes.
The division has had the benefit of cooperation from the American Red
Cross, State and county medical associations, and the State tuberculosis asso
ciation, women’s organizations, and the parent-teacher association; also county,

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 19 2 8

school, church, fraternal, and other organizations. Cooperation and special
volunteer assistance in the program have been given by a large number of
physicians, dentists, nurses, and lay persons.
co“ f erences, particularly for the preschool child, have been
marked features of the more recent work, with increasing numbers of confer
ences held and of infants and preschool children examined. More classes for
girls in infant care and for women in infant and maternal care have been
organized, efforts having been made also to reach the more isolated communi
ties with class instruction as well as through the nurses’ visits to homes Not
only has the work expanded geographically, but more mothers and infants are
being reached each year.
e
The division’s cooperation in the study of maternal mortality, which is
association and is being made in the State by
Childrens Bureau, will lay a foundation for future work
iooking toward the further reduction of maternal mortality.
The State has shown relatively low infant and maternal mortality rates
since it was admitted to the United States birth-registration area in 1920. But

Distribution o f child-health conferences^am Tclasses fo r women and g ir ls ; Nebraska,

a
1(iW inf?.nt, ^ ortality rate parked the year 1927, when 51 infants under
1 year of age died in every 1,000 born alive
aer
mortality rates have fluctuated from year to year. The rate for
a wll° le has not declined since 1922, but this is due to the fact
the s a m e ^ ^ f n d 1927.eath **** ^

wWle the rural rate® were Practically

..J55? D
1“ i ant a? d mat^rnal mortality rates for the State as a whole and for
u ban and rural areas in 1922 (the year in which cooperation with the Federal
Government was begun) and 1927 were as follows:
federal

Infant mortality rates ( deaths o f infants under
births)

year of age per 1,000 live
1922
57
71
53

State_______
Urban..
Rural __

Maternal mortality rates (

1927
51
60
48

deathso f mothers from, puerperal cause
live births)

State______
Urban.
Rural.

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Federal Reserve Bank of St. Louis

1922
58.0
89.9
49.1

1927
59.2
91.5
48.8

NEVADA
S T A F F A N D A C T IV IT IE S IN

1928

Administrative agency:
State board of health, child-welfare division, Reno.
Funds expended: Federal, $8,845.26; State, $5,299.38; total, $14,144.64.
Staff:
Director. Five county nurses were paid from maternity and infancy funds
for approximately two-thirds of their time.
Activities i
Combined prenatal and child-health conferences conducted by a physician
lent to the division by the United States Children’s Bureau— 4 ; expectant
mothers registered and examined— 2 ; infants and preschool children
registered and examined— 36.
Child-health conferences conducted by a physician lent to the State by the
United States Children’s Bureau— 10; infants and preschool children
registered and examined— 203.
Conferences conducted by nurses, no physician present— 103; children in
spected— 493; mothers instructed in prenatal care— 53.
Classes for girls in care of infants and preschool children— 14 organized;
girls enrolled— 166.
Classes for mothers— 10 organized; mothers enrolled— 142.
Home visits by nurses— 3,893 (prenatal cases seen, 81; obstetrical case, 1;
postnatal cases, 12; infants, 231; preschool children, 249).
Group demonstrations— 86, of various phases of maternal and infant care.
Literature distributed— 2,380 pieces.
Prenatal letters distributed— 184 sets.
#
»
f
Infants under 1 year of age reached by the work of the division— 380?
preschool children reached— 304; expectant mothers reached— approxi
mately 200.
Counties in the State— 17; counties in which maternity and infancy work
was done during the year— 17.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed part of the responsibility for
maternity and infancy work begun with maternity and infancy funds.
The Nevada Public Health Association cooperated in the division’s work,
contributing $25 per month to the salary of each nurse employed by the
division.
TYPES OF WORK AND SOME RESULTS

The child-welfare division was established in the State board of health in
1922. The governor accepted the provisions of the maternity and infancy act
on May 12, 1922. This was followed by legislative acceptance approved by the
governor on March 2, 1923.
The same director has had charge of the work since the beginning of coopera
tion under the act. The State is divided into five nursing districts, and to each
district is assigned a nurse, two-thirds of whose salary is paid from maternity
and infancy funds. The financial cooperation of the Nevada Public Health
Association has been of great help in the expansion of the work.
The State program has been marked by instructive visits of nurses to homes
of mothers and infants and by conferences for children held by nurses, in which
children were inspected by the nurses and information and literature were given
to the mothers. Instruction in infant and prenatal care for classes of mothers
and in infant care for classes of girls has been continued as in previous years.
The chief result of the work has been the interest developed in the welfare
and hygiene of mothers and children and the responsibility assumed by com
munities for work begun with maternity and infancy funds.
As the State is not in the birth-registration area no statement as to mortality
rates can be made. Legislation is necessary to provide suitable registration
districts for registering births and deaths.

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NEW HAMPSHIRE
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, division of maternity, infancy, and child hygiene,
Concord.
Funds expended: Federal, $12,471.76; State, $7,988.31; total, $20,460.07.
Staff:
Director (nurse, not paid from maternity and infancy funds), 6 nurses
(part year), 2 stenographers. Physicians were employed as needed to
conduct conferences.
Activities:
Child-health conferences conducted by physicians— 104; infants and pre
school children registered and examined— 3,384; visits to conferences—
3,388.
Defects found in children examined at conferences— 2,448; children having
defects— 1,772. Parents had defects corrected in 714 of the children,
and 797 children were under treatment at the close of the year under
review.
Dental conference— 1, conducted by a dentist who volunteered his services;
preschool children receiving dental examination— 12.
New permanent combined prenatal and child-health centers— 2 established
as a result of the maternity and infancy work. They are supported by
private funds.
New permanent child-health center— 1 established as a result of the
maternity and infancy work. It is supported by a local club.
Classes for girls in care of infants and preschool children— 20 organized;
girls enrolled and completing course— 250; lessons in course— 1 to 6.
Classes for mothers— 15 organized; mothers enrolled and completing
course— 260; lessons in course— 6.
Home visits by nurses— 11,871 (prenatal cases seen, 308; obstetrical cases,
10; postnatal cases, 229; infants, 2,284; preschool children, 6,607).
Maternity homes inspected— 26 ; inspections made— 26.
Infant homes inspected— 44; inspections made— 49.
Group demonstrations— 312, of correct posture, preparation of food, mater
nity packages, and other items of maternity, infant, and child care, at
conferences and classes. Demonstrations to individuals in homes and at
conferences— 822.
Survey— 1, of breast feeding in rural sections of the State, which showed
the following results: Infants breast fed at birth— 57 per cent; breast
fed at 1 month— 43.5 per cent; breast fed at 3 months— 24.8 per cent;
breast fed at 6 months— 15.1 per cent.
Campaign— 1, for immunization against diphtheria (continued from previ
ous year) in 13 towns. Approximately 2,500 children were immunized by
the State epidemiologist and local physicians, the immunization treat
ment to be followed within a year by the Schick test.
Talks and lectures— 416.
Literature prepared— Home Making, Posture, Care of Child from 2 to 6
Years of Age, prenatal letters, diet cards, list of publications.
Literature distributed— 182,214 pieces.
New names registered for prenatal letters—-540; prenatal letters distributed
(during six months)— 1,451 sets.
Nutrition work was done through individual instruction at conferences and
in home visits and through some class work.
Exhibits conducted— 200, at conferences, fairs, and meetings. Exhibit ma
terial prepared— posters, proper clothing for preschool children and ex
pectant mothers, suitable toys for young children. Exhibit material was
lent one hundred and ten times.

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100

THE

w elfare

and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

Activities— Continued.
Breast feeding was promoted by the breast-feeding survey, individual work A
with mothers and physicians, and literature sent to the parents of all J
infants whose births were registered.
1
Infants born in the State during the year— 8,772; infants under 1 year
of age reached by the work of the division— 8,772; preschool children
reached— 7,067; expectant mothers reached— 2,500.
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— 10; counties in which maternity and infancy work
was done during the year— 10.
In every town in which conferences or classes were conducted a permanent
community child-health committee consisting of health officers, physicians,
nurses, school superintendents, clergymen, and representatives of clubs
was organized.
The following organizations cooperated in the division’s work: State uni
versity (extension service), State tuberculosis association, State federa
tion of women’s clubs, State league of women voters, State farm bureau,
American Legion auxiliary, American Red Cross, and the parent-teacher
association. They assisted by sponsoring the health activities, furnishing
rooms for conferences and assisting at them, conducting exhibits, and
doing follow-up work.
Among the outstanding features of the year’s work were the expansion of the
prenatal work, in that distribution of prenatal letters was added to the activi
ties already carried on, and the educational work in preparation for parenthood
by means of the classes for girls.
TYPES OF WORK AND SOME RESULTS

The State accepted the provisions of the maternity and infancy act through
legislative enactment approved by the governor on April 14, 1921. The division
of maternity, infancy, and child hygiene was established in the State board of
health in 1922.
A public-health nurse has served as director of the division. Additional
nurses have served on the State staff, and physicians have been employed as
needed to conduct conferences. The majority of the State staff nurses have
received training at the Maternity Center Association in New York City. Or
ganization of the State into five nursing districts with a staff nurse assigned
to each district gives an all-year nursing service to every section of the State.
Through the work of these nurses and that of permanent community childhealth committees organized in the towns education in maternal and infant
welfare has been greatly promoted.
Excellent cooperation in carrying out the State program has been given by
groups and individuals in addition to the community committees. Club women
have sponsored health activities; parent-teacher associations have assisted in
the work with preschool children and in organizing self-directed study groups;
State tuberculosis nurses, Red Cross nurses, and other public-health nurses in
the State have helped at conferences and in follow-up work; and farm-bureau
agents have assisted with exhibits and given talks on nutrition. Local officials
of cities and towns have cooperated by furnishing rooms and buildings for con
ferences and aiding in the transportation of children to and from conferences.
One group of town officials appropriates $100 each year for follow-up work to
secure correction of defects. Both public and private social agencies have
rendered assistance to the program in various ways.
The physicians of the State have given of their time and effort freely. The
president of the State medical society in connection with plans for a study
of maternal mortality recently issued a letter to the physicians of the State
saying: “As president of the New Hampshire Medical Society I wish to call
your attention to the very important effort which is being made to reduce the
maternal and infant mortality in our State. Much good work has already
been accomplished through our State board of health in helping to educate the
public concerning prenatal and maternal care.”
During 1928 emphasis was placed on maternity work, on sending prenatal
letters to expectant mothers, and on urging the mothers to have prenatal care.
Expectant mothers were advised to nurse their babies, and promotion of breast
feeding was a prominent feature of the year’s program.

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1 9 2 8

101

Work for prevention of diphtheria was continued, with the immunization of
-approximately 2,500 children, about the same number as in the previous year.
Class work was likewise continued, also the sending of literature on the care
"of the baby to parents of infants whose births are registered.
! The infant mortality rate for 1921, the year of acceptance of the provisions
of the maternity and infancy act, was 87 infants under 1 year of age dying
in every 1,000 born alive. In 1927 the rate had declined to 69, the lowest rate
in the history of the State, which meant a saving of 18 babies in every 1,000
bom alive as compared with 1921, the year before the State began cooperation
with the Federal Government.
The infant mortality rates from 1921 to 1927 were as follows: 1921, 87;
1922, 80; 1923, 93; 1924, 80; 1925, 76; 1926, 79; 1927, 69.
The maternal mortality rate has fluctuated from year to year. In 1927 it
was 64.8 per 10,000 live births, an improvement over the rate of the preceding
year (75.7).

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NEW JERSEY
STAFF AND ACTIVITIES IN 1928

Administrative agency :
State department of health, bureau of child hygiene, Trenton.
Funds expended : Federal, $27,000 ; State, $26,284.55 ; total, $53,284.55.
Staff:
The Federal and State maternity and infancy funds constituted less than
half the bureau’s budget during the year under review, so that the staff
was paid from maternity and infancy funds for only a part of the year.
All the following staff were paid from maternity and infancy funds for
some portion of the year : 33 nurses (3 serving as assistant supervisors,
9 serving as instructors and supervisors of midwives and inspectors of
maternity and infant homes), 1 publicity clerk, 1 vital-statistics clerk,
2 stenographers, 1 clerk. The director (physician, part time) was not
paid from maternity and infancy funds.
Activities :
Child-health conferences conducted by physicians who volunteered their
services— 1,760; infants and preschool children registered and examined—
10,894 ; visits to conferences— 20,472.
Defects found in children examined at conferences— 9,610 ; children having
defects— 2,466. Parents had defects corrected in 1,835 of the children.
Prenatal conferences conducted by physicians— 62; expectant mothers reg
istered and examined— 129 ; visits to conferences— 401.
*
Conferences conducted by nurses, no physician present— 439; children^
inspected— 2,634 ; visits to conferences— 10,536.
New permanent child-health centers— 12 established, partly as a result of
the maternity and infancy work. They are supported by maternity and
infancy funds and by State funds.
New permanent prenatal centers— 3 established, partly as a result of thé
maternity and infancy work. They are supported by maternity and
infancy funds and by State funds.
Classes for girls in care of infants and preschool children— 46 organized ;
girls enrolled— 632; number completing course— 420; lessons in course—■
10. The State department of health issued certificates to the girls
who completed the course. Classes were also conducted for the girls in
continuation schools in three districts of the State.
Courses in child hygiene were given in the five State normal schools, both
in the regular term and in the summer schools.
A course of 12 lessons and demonstrations was given at the State reforma
tory for women. The essentials of prenatal care and the care of the
baby were taught.
Class for mothers— 1 organized ; mothers enrolled and completing course—
15 ; lessons in course— 6.
The 9 midwives’ organizations in the State held monthly meetings, at
which a course of lectures was given by physicians. All puerperal
deaths in cases that a midwife had attended at any time were investi
gated. An advanced course for licensed midwives was arranged in
cooperation with the Jersey City Hospital to provide practical training
in the hospital’s maternity wards, nursery, labor and delivery rooms, and
classrooms, one week being spent in each department. During the year
under review 14 midwives completed the course.
Home visits by nurses— 97,961 (prenatal cases seen, 2,202; infants, 14,101;
preschool children, 7,585 ; visits to midwives— 2,403 ).
Maternity homes inspected— 32 ; inspections made— 155. All maternal and
infant deaths and stillbirths occurring in the homes were investigated.
Infant homes inspected— 250 ; inspections made— 928.

102

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PRINCIPAL ACTIVITIES OE INDIVIDUAL STATES, 19 2 8

103

Activities— Continued.
Community demonstrations— 3, to show the value of prenatal care; 2 were
in cities, 1 in a rural county; 151 prenatal cases were under supervision
in 1 of the city demonstrations, 69 in the other. Figures were not re
ported for the demonstration in the rural county.
Group demonstrations— 10, of the value of infant and preschool-child care
in preventing physical defects in later life. These were conducted before
health officers, parent-teacher associations, federated women’s clubs, and
other groups.
Survey— 1, in 3 counties, to determine the need of child-hygiene nurses and
the districts in which to place them.
In connection with the observance of May Day as Child Health Day a
special effort was made to have children immunized against diphtheria.
Preschool conferences were arranged in 35 communities, and 7,039 pre
school children were immunized.
Talks and lectures—-2,641.
Literature distributed— approximately 65,000 pieces.
Nutrition classes— 4. conducted. The extension service of the State agri
cultural college cooperated by giving lectures on nutrition.
Exhibits conducted— 17, at State and county fairs, farmers’ picnics, and
various meetings.
Exhibit material prepared— charts showing neonatal, infant, and maternal
mortality rates and various child-hygiene activities.
Statistical studies made— neonatal mortality, maternal mortality.
Breast feeding was stressed in the instruction given to mothers in home
visits.
Infants born in the State during the year— 72,799; infants under 1 year of
age reached by the work of the bureau— 19,341 (exclusive of those reached
by literature distributed) ; preschool children reached— 15,446 (exclusive
of those reached by literature distributed) ; expectant mothers reached—
4,675.
Counties in the State—21; counties in which maternity and infancy work
was done during the year— 21.
A t the close of the year under review child-hygiene nurses in 325 communi
ties were being paid from local funds.
In most of the school districts in the State in which there were child-hygiene
nurses special conferences for children who would enter school in the fall
were held during the spring months. The school medical inspector made
examinations, and the nurses did follow-up work during the summer to
encourage parents to have corrections made before the children should
enter school.
The following organizations cooperated in the bureau’s work: State agri
cultural college (extension service), State league of women voters, feder
ated women’s clubs, National Council of Jewish Women, several fra
ternal organizations, and the parent-teacher association. Among the
children examined at child-health conferences reported in the foregoing
paragraphs 2,084 were examined in the “ Get ready for school ” drive
sponsored by the National Congress of Parents and Teachers.
Among the outstanding achievements of the year were the development of the
prenatal demonstration begun in the previous year and the beginning of three
others (one not financed from maternity and infancy funds), the inauguration
of the graduate course for midwives, and the extension of child-hygiene work
to 40 additional communities.
TYPES OF W ORK AND SOME RESULTS

The bureau of child hygiene was established in the Stat^ department of health
in 1915. The State accepted the provisions of the maternity and infancy act
through legislative enactment approved by the governor on March 17, 1922.
During the entire period of cooperation with the Federal Government the State
appropriation has been more than twice the amount of the Federal funds.
The same medical director has been in charge of the work of the bureau
throughout the period of cooperation. The staff has included nurses who have
served as county nurses, supervisors of midwives, instructors in infant and pre
natal care, and inspectors of maternity and infant homes.
The bureau has had the benefit of cooperation from the State department
of institutions and agencies and the State agricultural college, the State tuber-

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104

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

culosis association, several social-service, church, and fraternal organizations
women’s organizations, and the parent-teacher association.
has included visits to homes by nurses, child-health conferences^
at child-health centers, efforts to increase the number of child-health centers MA-1
expansion of community child-health work, attention to improving the practice
,
or midwives, inspection of infant and maternity homes, a demonstration in prenatal care, and special instruction in prenatal and child care to the women in
the State reformatory.
Notable among the achievements has been the increase in the number of ^
child-welfare centers, the extension of child-health work to new communities,
the increase in the number of public-health nurses employed in child-health
work, the increase in numbers of babies supervised, and the provision of oppor
tunities for the midwives to improve their practice— which has included in addi
tion to supervision and midwives’ conferences a course of instruction for mid
wives in the Jersey City Hospital.
Infant mortality has shown a downward trend since 1922, when 79 infants
under 1 year of age died in every 1,000 born alive. In 1927 the number was 61,
State en.tered the United States birth-registration area.
t ere
decided drop in the neonatal death rate some reducbeen effected during this period. Deaths during the first month of life
depend to a great extent on the care of the mother during pregnancy and conK * figures the neonatal * * t h rate w L S7 2 Z
U000 live births m 1922 and 33.8 in 1927, a reduction of 9.1 per cent. Although
control UCtl°n 1S Sma11
is encouraSing, as- this period is the most difficult to
, Fluctuations in maternal mortality rates have occurred from year to year
S ? 7 (6 2 ? Per 10'MO llTO birth9>
very mtle ¿ C
Orat
or 1922 (64.1). The maximum rate of the period (64.3) occurred in 1925
the minimum in 1923 (57). The rates for 1924 and 1926 were 62.3 and 57 6'
respectively.

a AO
'DA'

□•O

'DA a A

BA©

GUADALUPE

©cr
• ■▲o

□®o

■ ▲0

' DA'

■ Prenatal and childhealth conferences
O Dental conferences
• Prenatal and childhealth centers
© Classes in infant care
for <£irls and mothers
A Classes for midwives,
and individual instruc
tion
□ Home visits by nurses
to infants and ex. peat a rrt mothers
EZ3 Counties covered by
■work of s ta ff nurses

□•o

■ ▲0

Distribution o f maternity and infancy work, by cou n ties; New M exico, 1922-1928

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Federal Reserve Bank of St. Louis

N E W M EXICO
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public welfare, bureau of public health, division of
child hygiene and public-health nursing, Sante Fe.
Funds expended: Federal, $12,749.79; State, $7,503.12; total, $20,252.91
Staff:
Director (nurse), 2 nurses, 2 vital-statistics clerks (1 part time), 1 book
keeper (part year, part time), 1 stenographer (part time). Four county
nurses were paid in part from maternity and infancy funds.
Volunteer assistants— a number of physicians, 4 dentists, 34 nurses 451
lay persons.

Activities:
Child-health conference conducted by physicians— 1 ; infants and preschool
children registered and examined— 41.
Defects found in children examined at the conference— 48; children having
defects— 25.
&
Conferences conducted by nurses, physicians present at some— 43; children
inspected— 541; mothers instructed in prenatal care— 52.
Dental conferences— 2 ; preschool children receiving dental examination— 60.
Classes for girls in care of infants and preschool children— 35 organizedgirls enrolled— 686; number completing course— 677; lessons in course—
Classes for mothers— 8 organized; mothers enrolled (plus those carried
over from previous year) and completing course— 91; lessons in
course— 8.
Midwives’ classes— 2 meetings conducted, with attendance of 21. The
midwives were instructed in the importance of calling a physician for
unusually long or complicated cases, in the preparation of supplies for
d?1i l ery’ in, tke care of the baby, in the use of a prophylactic in the eyes
of the newborn, and in the filling out of birth certificates. Many mid
wives living in isolated districts were given similar instruction in their
own homes by the nurses,
H 4 oo Tisj t s , by curses— 4,291 (prenatal cases seen, 420; maternity cases,
422; infants and preschool children, 2,902; visits to midwives 245)
Community demonstrations—7, of a maternity and infancy public health
nursing program lasting 3 to 4 months, in 7 counties. Special emphasis
was placed on birth and death registration to bring the State into the
United States birth and death registration areas.
Group demonstrations 262, of phases of prenatal, obstetrical, postnatal,
and infant care at classes, conferences, and meetings of various organi
zations.
&
Surveys— 2 : (1) Of birth registration, in 11 counties. (2) Of 2 hospitals
Campaigns 2: (1) For promotion of birth registration, state-wide. (2)
For immunization against diphtheria, in 4 counties.
Talks and lectures— 118, to audiences totaling 4,850 persons.
Literature distributed—35,189 pieces.
Nutrition work was done through instruction to individual mothers
Exhibits conducted— 27, including layette, baby’s bath tray, equipment
tor preparing food formulas, baby pen, and various kinds of home-made
baby beds. Exhibit material was lent twice.

Breast feeding was promoted through instruction in visits made to homes,
in talks given, and in literature distributed.
Infants born in the State during the year— 10,751 reported; infants under
1 year of age reached by the work of the division— 10,751 ; expectant
mothers reached— 562.
F

The division sends literature on infant hygiene to parents o f all infants
whose births are registered in the State bureau o f vital statistics.
48278°— 29------8

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Activities— Continued
Counties in the State— 31; counties in which maternity and infancy work
was done during the year— 14; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 31.
f
Since the beginning of the State’s cooperation under the maternity and'
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the division’s work many county nurses not paid from
maternity and infancy funds and many school nurses included maternity
and infancy work in their programs. They conducted 39 child-health
conferences with an attendance of 323 infants and preschool children
and 10 prenatal conferences with an attendance of 53 women, made
1,993 home visits, and conducted 98 home demonstrations.
The division gave advisory and supervisory assistance to local organizations
doing maternity and infancy work.
The following organizations cooperated in the division’s work: State bureau
of child welfare, State federation of women’s clubs, State league of
women voters, State public-health association, Congress of Mothers,
and the parent-teacher association.
Among the outstanding features of the year’s work were the efforts made to
improve birth registration and the fact that a nurse paid in part from maternity
and infancy funds in one county was enabled, through the county’s employment
of a school nurse, to devote her entire time to maternity and infancy work.
TYPES OF WORK AND SOME RESULTS

The division of child hygiene and public-health nursing was established in
the bureau of public health of the State department of public welfare in 1920.
The State accepted the provisions of the maternity and infancy act through
legislative enactment approved by the governor on March 11, 1921. From the
beginning of the State’s cooperation until July 1, 1925, the Federal funds were
divided between the bureau of public health and the bureau of child welfare,
both in the State department of public welfare. An expansion of the program
has been possible since all maternity and infancy work has been directed by one
State agency.
A nurse has directed the maternity and infancy work in the division of child
hygiene and public-health nursing. Two staff nurses have assisted in the gen
eral field work, and nurses paid in part from maternity and infancy funds
(four in 1928) have been assigned to counties.
The program has been mainly one of public-health nursing characterized by
visits to the homes of infants, children, and expectant mothers. The nurses
also have conducted classes for girls in infant and child care and classes for
mothers in infant and prenatal care. Work with midwives has been continued,
and efforts have been increased to improve birth and death registration in the
State.
Every county in the State has had some phase of maternity and infancy work,
such as prenatal conferences, infant and prescliool-child conferences, classes for
girls in infant care, classes or personal Instruction for midwives, home visits by
nurses, work for promotion of birth registration, and group and county surveys.
Considering the large area of the State, the difficulty of access to many counties
due to barriers of mountains, rivers, and deserts, and the difficulty of communi
cation due to the polyglot character of the population a creditable amount of
work has been accomplished. (Among the inhabitants are native Americans,
Spanish Americans, Mexicans, and Indians, and in the mining region Negroes
and immigrants from the south of Europe.)
As the State has not been admitted to the United States birth-registration
area, no statement as to mortality rates can be made.
For the distribution of maternity and infancy work in the counties of the
State from 1922 to 1928, see map on page 104.

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NEW YORK
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, division of maternity, infancy, and child
hygiene, Albany.
Funds expended: Federal, $91,455.55; State, $88,717.46; total, $180,173.01.

Staff:
Director (physician, not paid from maternity and infancy funds), 10 phy
sicians (2 part year, 5 part time), 43 nurses (1 part time, 15 part year),
1 dental hygienist, 1 nutritionist, 2 vital-statistics clerks (1 part time),
1 bookkeeper, 1 advance agent (for health conferences), 2 clerks, 3
stenographers, 1 motion-picture operator, 1 chauffeur. Twenty-six county
and community nurses were paid in part from maternity and infancy
funds. Two hundred and ninety-two physicians throughout the State
were paid for occasional service.

Activities:
Combined prenatal and child-health conferences conducted by physicians—
1,102; expectant mothers registered— 2,529; number examined— 2,215;
infants and preschool children registered and examined— 2,784; visits
to conferences by expectant mothers— 21,461; visits by infants and pre
school children— 3,262.
Child-health conferences conducted by physicians— 772; infants and pre
school children registered— 15,197; number examined— 11,057.
Defects found in children examined at child-health conferences— 19,997;
children having defects— 7,716. Parents had defects corrected in 539 of
the children (report incomplete).
Prenatal conference conducted by physicians— 359; expectant mothers regis
tered— 2,233 ; number examined— 2,109; visits to conferences— 2,494.
Conferences conducted by nurses, no physician present— 614; children in
spected— 3,316; mothers instructed in prenatal care— 311; visits to con
ferences by children— 5,638; visits by mothers— 565.
Preschool children receiving dental examination by the dental hygienist—
3,652.
New permanent combined prenatal and child-health centers— 3 established
as a result of the maternity and infancy work or as part of community
demonstrations conducted by the division’s staff. They are supported by
local public funds.
New permanent child-health centers— 9 established as a result of the ma
ternity and infancy work or as part of community demonstrations con
ducted by the division’s staff. They are supported by local funds.
New permanent prenatal centers— 2 established as part of community dem
onstrations conducted by the division’s staff. They are supported by local
public and private funds.
Classes for girls in care of infants and preschool children— 15 organized;
girls enrolled— 323 ; number completing course— 198; lessons in course—
8 to 30.
Classes for mothers— 108 organized; mothers enrolled plus those carried
over from previous year— 2,122 ; number completing course— 950; lessons
in course— 8. “ Family-health conferences ” were conducted in 92 com
munities ; the course of instruction consisted of 8 lessons on the health of
the family, with special emphasis on the care of mothers and children.
Home visits by nurses— 38,198 (prenatal cases seen, 2,427; obstetrical cases,
734; postnatal cases, 2,377; infants, 5,200; preschool children, 7,055). In
addition 26,414 home visits were made for which no record was kept
of number of cases seen.
Maternity homes inspected— 33; inspections made— 34.
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Activities— Continued.
Boarding homes for infants and preschool children inspected— 70; inspec
tions made— 186.
Community demonstrations:— 87 (some continued from previous year), of
maternity and infancy public-health nursing, prenatal nursing, and breast
feeding. Seven were county-wide, 30 covered a city or community. The
maternity and infancy public health nursing demonstration in one city
served also as a teaching center for nurses on the State staff and other
nurses who wished to obtain experience in this field of public-health
work. During the year four counties and five cities and communities
assumed the responsibility for work begun in these demonstrations.
Group demonstrations— approximately 3,200, on various phases of maternal
and infant care. Individual demonstrations were made for women at
tending prenatal conferences and for midwives.
Survey— 1, of hospitals taking maternity cases.
Campaign— 1, for promotion of breast feeding, in 1 city and its vicinity.
All the staff nurses assisted also in a state-wide campaign conducted by
the State department of health to have children immunized against
diphtheria.
Talks and lectures— 232.
Literature distributed— 302,989 pieces.
Graduate courses in maternity and infancy work for nurses— 4 ; nurses
enrolled— 58; number receiving certificates— 47.
Graduate courses for physicians— 6 (2 in pediatrics, 4 in obstetrics).
Courses in pediatrics, each consisting of 6 lectures, were given in 2
counties, courses in obstetrics were given in 3 counties, and 3 lectures
completing a course in obstetrics begun in the previous year were given
in 1 county.
Nutrition work was done through courses, classes, and lectures.
Exhibits conducted— 37. Exhibit material prepared— baby’s traveling
kitchenette. Exhibit material was lent 151 times.
Statistical study made— puerperal deaths (in progress during previous
fiscal year, completed during year under review).
Breast feeding was emphasized in all the activities of the division, especi
ally in the campaign and the demonstration on this subject, in instruc
tion given to mothers at prenatal conferences, and in the instruction
given to staff nurses and local nurses who attended the division’s
teaching center for nurses.
Infants born in the State during the year— 224,336; infants under 1 year
of age reached by the work of the division— 8,309; preschool children
reached— 15,406; expectant mothers reached— 14,297. (All figures are
exclusive of children and expectant mothers 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— 62; counties in which maternity and infancy work
was done during the year— 62.
Since the beginning of the State’s cooperation under the maternity and
•infancy act seven counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the division’s work Child Health Day and Child Health
Week programs were conducted by nurses throughout the State. Local
nurses conducted demonstrations at fairs in 33 counties, using demon
stration material furnished by the division.
The following organizations cooperated in the division’s work: State
medical association, State dental association, State federation of
women’s clubs, State league of women voters, New, York State Charities
Aid Association, Home Bureau, Catholic Daughters of America, two
fraternal organizations, chambers of commerce, *and the parent-teacher
associations. Among the children examined at conferences reported
in the foregoing paragraphs 226 were examined in the “ Get ready for
school ” drive sponsored by the National Congress of Parents and
Teachers.
Among the outstanding achievements of the year were the assumption by
seven local communities of the responsibility for maternity and infancy work
begun with .maternity and infancy funds and the provision at the teaching
center for giving instruction in maternity and infancy work to nurses other
than those paid from maternity and infancy funds.

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TYPES OF W ORK AND SOME RESULTS

1 A division of maternity, infancy, and child hygiene has existed in the State
department of health since 1914. The State accepted the provisions of the
maternity and infancy act through legislative enactment approved by the
governor on May 29, 1923. Thus a larger appropriation was made available
to the division, and an expansion of the program followed.
* A physician has directed the work of the division during the entire period
of cooperation. Assistance has been given by a large State staff, including
physicians, nurses, a dental hygienist, and a nutritionist, many of whom are
paid from maternity and infancy funds and who are detailed to counties and
communities to conduct demonstrations relating to maternity and infancy work.
,The division has had the benefit of cooperation from the State medical and
dental associations, the New York State Charities Aid Association, the State
commission for the blind, several state-wide organizations of women, fraternal
and religious bodies, chambers of commerce, and parent-teacher associations.
All the counties in the State have had some phase of maternity and infancy
work in each of the past few years, and information on the care of the baby
has been sent to the parents of babies whose births were registered. Groups
have been reached with special class instruction— girls with instruction in infant
care, mothers with instruction in prenatal and infant care, physicians with
graduate courses in pediatrics and obstetrics, and public-health nurses with
extension courses and with practical experience in a teaching center for
maternity and infancy nursing.
A unique feature of the State program has been the development of com
munity demonstrations; 37 such demonstrations (some lasting for a considerable
period) were in progress during the period of cooperation under the act. These
were sometimes in a community only, sometimes on a county-wide basis. They
have varied in scope, including several breast-feeding demonstrations, maternity
and prenatal nursing demonstrations, and maternity and infancy nursing demon
strations (one conducted as a teaching center). This method of promoting
maternal and infant welfare has made the work intensive in the areas in which
sit has been conducted, and the appreciation of its value is shown by the fact
that the financial support of four of the county and five of the community
demonstrations has been assumed by the counties and communities, while part
of the financial responsibility has been assumed by several others.
Infant mortality rates declined from 72 per 1,000 live births in 1923, the first
year of the State’s cooperation under the maternity and infancy act, to 59 in
1927, the lowest rate in the history of the State. This rate is 27 per cent
lower than the rate for the four-year period prior to cooperation (1919-1922),
which was 81.
Maternal mortality has not declined in the State since 1923. The rate for
urban areas was higher in 1927 than in 1923, and that for rural areas was
practically the same. Some improvement, however, is seen in the rates when
a comparison is made with the four-year period prior to cooperation. For that
period (1919-1922) the rate was 63.5 per 10,000 live births; for the period of
cooperation (1923-1927) the rate was 58.5, or 7.9 per cent lower.

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NORTH CAROLINA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of maternity and infancy, Raleigh.
Funds expended: Federal, $25,744.14; State, $22,573.77; total, $48,317.91.
Staff:
Director (physician), 5 nurses, 1 stenographer, 1 mailing clerk. Twenty
county nurses were paid in part from maternity and infancy funds.
Volunteer assistants— 36 physicians.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
5,173; expectant mothers registered and examined— 1,248; infants and
preschool children registered and examined— 11,773; visits to conferences
by children— 13,537. (These figures include some individual conferences
held in county health department offices in counties in which nurses
' Were paid in part from maternity and infancy funds.)
Parents had defects corrected in 1,051 of the children examined at the
conferences conducted by physicians.
Conferences conducted by nurses, no physician present— 4,530; children
inspected— 8,227; mothers instructed in prenatal care— 700; visits to
conferences by children— 10,283; visits by mothers— 1,149. (These figures
include some individual conferences in county health department offices,
in counties in which nurses were paid in part from maternity and
infancy funds.)
New permanent combined prenatal and child-health center— 1 established
as a result of the maternity and infancy work. It is supported by Stateand county funds.
Classes for midwives— 24 organized, in 6 counties; midwives enrolled— 276;
number completing course— 180; lessons in course— 6.
Home visits by nurses— 33,473 (prenatal cases seen, 4,736; postnatal cases,
5,262; infants, 14,291; preschool children, 8,839).
Talks and lectures were given to mothers at group conferences. Total at
tendance— 9,784.
Literature distributed— 127,290 pieces.
New names registered for prenatal letters— 9,522; prenatal letters dis
tributed— 4,191 sets. Full sets had not yet been sent for names registered
in the last half of the year under review.
Nutrition work was done through individual instruction by staff and
county nurses.
Breast feeding was stressed in pamphlets on the subject, of which 11,883
were distributed.
Infants born in the State during the year— 82,098; infants under 1 year of
age reached by the work of the bureau— 33,991; preschool children
reached— 37,600; expectant mothers reached— 16,206.
Counties in the State— 100; counties in which maternity and infancy work
was done during the year— 40; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 49.
As a result of the bureau’s maternity and infancy work public-health nurses
not paid from maternity and infancy funds included maternity and
infancy work in their programs in seven counties.
The following organizations cooperated in the bureau’s work: State board
of education, State board of charities and public welfare, State college
of agriculture and engineering (home-demonstration department), and
the parent-teacher association. They assisted in the preschool-child and
nutrition work and in the work with midwives. Among the children ex
amined at conferences reported in the foregoing paragraphs 7,852 were
examined in the “ Get ready for school ” drive sponsored by the National
Congress of Parents and Teachers.

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TYPES OF WORK AND SOME RESULTS

The bureau of maternity and infancy was established in the State board of
health in 1919. The governor accepted the provisions of the maternity and in
fancy act on March 16, 1922. This was followed by legislative acceptance
approved by the governor on March 5, 1923.
A medical director has been in charge of the work, and a small group of
staff nurses has given advisory service in the field activities. The outstanding
feature of the administration has been the detailing of an increasing number
of full-time maternity and infancy nurses to counties. During each of the past
two years 20 counties have had such service.
Cooperation has been given to the program by other branches of the State
government, the State college of agriculture and engineering, and the parentteacher association.
The major activities during the period of cooperation have been child-health
conferences conducted by both physicians and nurses, nurses’ visits to mothers
and babies in their homes, and instruction and supervision of colored midwives
by the nurses.
There was a slight reduction in infant mortality in 1927 compared with 1922
(the year in which cooperation under the act was begun). The rate in 1922
was 80 (deaths of infants under 1 year of age per 1,000 live births) ; in 1927
the rate was 79.
The maternal death rate was lower in 1927 than in 1922 in both urban and
rural areas; the difference, however, was greater in the rural areas (21.8 per
cent) than in urban areas (12.6 per cent). In the rural areas the rate for
both white and colored mothers was lower in 1927 than in 1922; in the urban
areas reduction was apparent for the white group only. The rates for the State
as a whole and for urban and rural’areas in 1922 and 1927 were as follows:

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births)
State_____
Urban
Rural-

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1922

1927

79.5
128.5
73.1

65.6
112.3
57.2

NORTH D A K O TA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public health, division of child hygiene and publichealth nursing, Bismarck.
Funds expended: Federal, $6,600; State, $1,600; total, $8,200.
Staff:
Director (physician), 1 physician (1% months), 1 nurse (part year), 1
stenographer.
Activities:
Child-health conferences conducted by physicians— 167; infants and pre
school children registered and examined— 5,006. A number of expectant
mothers attended these conferences and were given advice on prenatal
care.
Defects found in children examined at conferences— 6,419; children having
defects— 3,554.
Survey— 1, of birth registration, in 1 city.
Talks and lectures— 17.
Literature distributed— 17,937 pieces. Pamphlets on prenatal care were
supplied to physicians for their patients, and pamphlets on infant care
were furnished to hospitals for mothers of infants born in the hospitals.
Exhibit conducted— 1, at the meeting of the State education association.
Statistical study made— maternal deaths in the State.in 1927.
Breast feeding was stressed in the instruction given to mothers at health
conferences.
Infants born in the State during the year— 14,198; infants under 1 year of
age reached by the work of the division— approximately 15,000; preschool
•
children reached— 3,961.
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.
Copies of the pamphlets on prenatal care were mailed also to all persons
whose marriage certificates were recorded in the State bureau of vital
statistics during the year. Each pamphlet was accompanied by a letter
mentioning other literature available from the division.
Counties in the State— 53; counties in which maternity and infancy work
was done during the year— 22; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 42.
The following organizations cooperated in the division’s work: State and
district medical societies, American Red Cross, women’s federated clubs,
Woman’s Christian Temperance Union, homemakers’ clubs, and the par
ent-teacher association. They sponsored conferences and assisted in dis
tributing literature. Physicians, county school superintendents, and
county nurses also gave generous assistance. A nurse from the division’s
staff did the organization work for the first conference held in each com
munity, but all later conferences were organized by local persons, so that
everything was in readiness when the State conference unit arrived.
The outstanding features of the year’s work were the child-health conferences
and the distribution of more than 14,000 copies of a pamphlet on infant care.
TYPES OF WORK AND SOME RESULTS

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A medical director has directed the field work and conducted most of it with
the assistance of nurses. Additional physicians have been employed for short
^periods.
Cooperation has- been given by State and district medical societies, the Ameri
can Red Cross, women’s organizations, and the parent-teacher association.
Itinerant child-health conferences have been a notable feature of the work.
Distribution of literature has been a means of reaching many parents. The
Children’s Bureau bulletin Infant Care has been mailed to parents of all infants
whose births were registered in the State bureau of vital statistics. Physicians
were supplied with the bureau’s bulletin Prenatal Care, and many requested
copies for their patients.
Apparently the work of the staff, limited though it has been, is reflected in
the lower maternal and infant mortality rates for 1927 compared with 1924,
the year in which the State was admitted to the United States birth-registration
area. The maternal mortality rate for the entire State was 56.9 per 10,000
live births in 1924 and 51 in 1927; the rural rate was 51.5 in 1924 and 43 in 1927.
The infant mortality rate in 1924 was 67 ( deaths of infants under 1 year of age
in every 1,000 born alive) ; in 1927 it was 63, the lowest rate since the State
was admitted to the United States birth-registration area.

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OHIO
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, division of child hygiene, Columbus.
Funds expended: Federal, $29,649.72; State, $22,645.85; total, $52,295.57.
Staff:
Director (physician, not paid from maternity and infancy funds), 1 phy
sician, 5 nurses (1 part time), 1 maternity-home inspector (nurse), 1
lecturer, 1 vital-statistics clerk, 1 publicity clerk (part time), 1 financial
clerk (part time), 1 general clerk, 2 motion-picture operators. Twentyone county nurses in 10 counties and one city nurse were paid in part
from maternity and infancy funds. Physicians were employed by the
day as needed.
Activities:
Child-health conferences conducted by physicians— 85; infants and pre
school children registered and examined— 3,828.
Defects found in children examined at conferences— 5,800; children having
defects— 3,786. Parents had about 17 per cent of the defects corrected.
Conferences conducted by nurses, no physician present— 204; children in
spected— 2,826; mothers instructed in prenatal care— 60; visits to con
ferences by mothers— 224.
New permanent combined prenatal and child-health centers:— 4 established
as a result of the maternity and infancy work. They are supported by
local boards of health.
Classes in care of infants and preschool children (health builders’ leagues) —
95 organized; pupils enrolled— 2,152 girls, 45 boys; number completing
course— 2,089; lessons in course— 14.
Home visits by nurses— 12,262 (prenatal cases seen, 510; infants, 2,240;
preschool children, 2,621).
Maternity homes inspected— 208; inspections made— 263.
Infant homes inspected— 16; inspections made— 21.
Group demonstrations— 3, at meetings of regional parent-teacher associa
tions and federations of women’s clubs.
Campaign— 1, for observance of May Day as Child Health Day. The direc
tor of the division was May Day chairman for the State. A total of 105
celebrations were held. As a result of this campaign many preschool
children were given physical examination, and a number of local childhygiene councils were formed.
Talks and lectures— 440, 349 of which were given by the lecturer on the
bureau’s staff at grange meetings, farm women’s club meetings, farmers’
institutes, teachers’ institutes, schools, colleges, and groups from the
Young Men’s Christian Association and Young Women’s Christian Asso
ciation.
Literature prepared— The Care of the Baby (textbook for health builders’
leagues).
Literature distributed— 227,500 pieces.
Exhibits conducted— 19, of which 18 were at county fairs. Exhibit material
prepared— posters and films.
Statistical study made— maternal and infant mortality, by cases receiving
instruction in prenatal care and cases not receiving this service.
Breast feeding was promoted through instruction given in home visits.
The division does not send literature on infant hygiene to parents of infants
whose births are registered in the State bureau of vital statistics, as
nearly all local boards of health mail or deliver birth certificates and lit
erature upon receipt of the birth notice.
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Activities— Continued.
Counties in the State— 88; counties in which maternity and infancy work
was done during the year— 68; counties in which maternity and infancy
K
work has been done since the acceptance of the maternity and infancy
i
act— 77.
Since the beginning of the State’s cooperation under the maternity and
infancy act six counties and two cities have assumed the responsibility
for maternity and infancy work begun with maternity and infancy funds.
Advisory service by means of visits was given to all nursing services in
the State. Reports submitted by local boards of health show an increase
in the child-hygiene work done by means of nursing visits.
The following organizations cooperated in the division’s work: American
Red Cross, State league of women voters, public-health leagues, and par
ent-teacher associations. All the children examined at conferences con
ducted by physicians reported in the foregoing paragraphs were examined
in the “ Get ready for school ” drive sponsored by the parent-teacher asso
ciation.
One maternity and infancy nurse was sent with another nurse to do relief
work in the mine regions. They were able in conjunction with local
public-health nurses to give special care and attention to mothers and
small children and to act as a clearing house for medical and nursing
service. Several hundred visits were made to prenatal and postnatal
cases and to infants.
Among the outstanding features of the year’s work was the active partici
pation of local boards of health in the child-hygiene program, the child-hygiene
work thus being extended under local auspices to many communities. Much of
the division’s work has been directed toward initiation of these local programs.
TYPES OF WORK AND SOME RESULTS

The division of child hygiene was established in the State department of
health in 1915. The governor accepted the provisions of the maternity and
infancy act on December 27, 1921. This was followed by legislative acceptance
Approved by the governor on April 24, 1923.
A physician has directed the maternity and infancy work since the beginning
of cooperation under the act. The State staff has included physicians, publichealth nurses, one of whom served as inspector of maternity homes, a lecturer,
clerical assistants, and motion-picture operators. An increasing number of
public-health nurses paid in part from maternity and infancy funds have been
detailed to counties, 10 counties and 1 city receiving the services of £1 such
nurses during 1928.
Cooperation has been given by the American Red Cross, public-health leagues,
women’s organizations, and parent-teacher associations.
Full-time county health departments have been developed to a greater extent
in Ohio than in any other State. Through this plan public-health work in the
State has been decentralized, and much maternity and infancy work is con
ducted through the county health departments, though few of them receive
maternity and infancy funds. Because of the type of administration through
county health departments there have been many visits by nurses to homes. It
is estimated that through nurses’ visits prenatal instruction was given to 11 per
cent of the mothers to whom children had been born during the year ended
June 30, 1928. For the same period 23 per cent of the nursing service in
rural communities and 51 per cent of the same service in cities is estimated to
have been child-hygiene work. The State staff gave advisory and supervisory
service and other assistance to the county departments, inspected maternity
and infant homes, and contributed to the dissemination of knowledge on public
health through lectures, exhibits, and motion pictures.
Maternity and infancy funds have been used since 1922 for the preparation
and distribution of ampules of nitrate of silver to be used as a prophylactic in
the eyes of the newborn. Ophthalmia neonatorum has decreased in the State.
Some results of the maternity and infancy work are shown by the fact that
since the beginning of cooperation six counties and two cities have assumed the
responsibility for work begun with maternity and infancy funds.
The infant and maternal mortality rates declined in both urban and rural
areas in 1927 compared with 1921 (the year prior to the operation o f the act)
and the 1927 rates established new low records.

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116

the

WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Infant mortality rates ( deaths of infamts under 1 year of age per 1,000 live
births)
1921

State_____
Urban.
Rural

75
76
73

1927

62
64
59

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live births )
1921

1927

State_________________________________________________ - 72.2
Urban_______________ _____________________________ 84.9
Rural____________________________________________ 55. 3

61. 9
75.9
40. 6

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OKLAHOMA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public health, bureau of maternity and infancy Okla
homa City.
’
Funds expended: Federal, $17,818.86; State, $18,679.48; total, $86,498.34
Staff:
Director (physician), 6 nurses (1 part year, part time), 3 clerks (2 part
year) 1 stenographer. Five county nurses were paid in part from matermty and infancy funds, and a nurse paid by the United States Bureau
ot Indian Affairs worked among the Indians under the supervision of the
State bureau of maternity and infancy.
Activities:
Child-health conferences conducted by physicians— 111; infants and pre
school children registered and examined— 2,267.
Defects found in children examined at conferences— 5,823; children having
defects— 2,060.
*
Denta! conference— 1 ; preschool children receiving dental examination—
Classes for girls and boys in care of infants and preschool children— 4
organized; girls and boys enrolled and completing course— 135 • lessons
in course— 3 to 5.
’
Classes for Indian girls in care of infants and preschool children— 28 organ
ized; girls enrolled— 415; number completing courser-399; lessons in
course— 9 to 18.
Classes for mothers— 4 organized; mothers enrolled— 102; number complet
ing course— 96; lessons in course— 5 or 6.
Classes for teachers in infant hygiene—3 organized; teachers enrolled plus
those carried over from previous year— 159; number completing cou rse143 ; number still on roll— 16; lessons in course— 18.
H ? ^ er 3 S tS*b? nurses— 1,495 (prenatal cases seen, 168; obstetrical cases,
Id, postnatal cases, 105; infants, 798; preschool children 1284).
Group demonstrations 140, of dental hygiene, physical examination of
infants and preschool children, and various phases of maternal and infant
Community demonstrations— 4, of a maternity and infancy public health
nursing program, including child-health conferences, classes for mothers
and classes for girls.
’
Surveys 4 : (1) Of hospitals, in 30 counties. (2) Of midwives in 30
counties. (3) Of birth registration, in 30 counties. (4) Of preschool
children, in 3 towns and 1 village.
P
Campaign 1, for prevention of summer diarrhea among babies in 2
counties.
Talks and lectures— 519.
Literature prepared— Six Safe Rules for Saving Babies
Literature distributed— 383,885 pieces.
N tribufed— 5 ^ t e S * 1 fOT Prenatal letters— 'T,220; prenatal letters disGraduate courses in obstetrics and in pediatrics were conducted by an
obstetrician and a pediatrician lent to the State by the United States
Children s Bureau. The State bureau of maternity and infancy did the
organization work for these courses and assisted the physicians in everv
way possible.
J
Nutrition work was done through instruction given in talks and at group
demonstrations and in instruction to individual mothers at conferences.
Exhibits conducted 57, at county and State fairs and at meetings of
teachers, parent-teacher associations, and other organizations. Exhibit
material was prepared on dental hygiene and on the functions of the
bureau. Exhibit material was lent six times.
117

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118

THE WELFARE AND HYGIENE OE MATERNITY AND INFANCY

Activities— Continued.
Statistical studies made— infant mortality in 1927, in 14 counties and 5
cities; deaths from diarrhea of infants and preschool children in 1927
in 77 counties and 5 cities.
Breast feeding was stressed in literature distributed, talks given, an
exhibits conducted, and in the graduate courses in pediatrics.
Infants born in the State during the year— 47,709 live births reported;
infants under 1 year of age reached by the work of the bureau— 6,899;
preschool children reached— 7,637; expectant mothers reached— 7,266.
Counties in the State— 77; counties in which maternity and infancy work
was done during the year— 77.
As a result of the bureau’s work county nurses have given more time to
maternity and infancy work, a health center for colored children was
started in one town, and classes in child care were taught in a number
of public schools by home-economics teachers.
The following organizations cooperated in the bureau’s work: State
university (extension service), State agricultural and mechanical col
lege (rural-extension service), State federation of women’s clubs, and
parent-teacher associations.
An outstanding achievement of the year was the admission of the State to
the United States birth-registration area.
TYPES OF WORK AND SOME RESULTS

The bureau of maternity and infancy was established in the State department
of public health in 1922. The governor accepted the provisions of the maternity
and infancy act on December 17, 1921. This was followed by legislative accept
ance approved by the governor on March 31, 1923.
During the early years of cooperation with the Federal Government the work
was in charge of a nonprofessional director, but since 1925 a physician has
directed the work. The State staff has included six field nurses the past three
years, and in addition five nurses paid in part from maternity and infancy
funds’ were detailed to .county health departments,
.
.
Cooperation has been given in the State program by State educational msti- A
tutions, by women’s organizations, and by parent-teacher associations.
Emphasis has been placed on dissemination of information relating to mater
nal and child care through distribution of literature and prenatal letters, through
other forms of publicity, and through instruction of special groups in special
phases of maternal and infant care. Classes in infant care have been conducted jQf
for °lrls (including Indian girls) and also for boys, likewise classes in prenatal
and&child care for mothers, and classes in infant and child care for teachers.
Graduate courses in both pediatrics and obstetrics have been arranged for
^ Child-health conferences and visits of public-health nurses have been features
of the educational work with parents.
Nitrate of silver for the prevention of ophthalmia neonatorum is distributed
through the use of maternity and infancy funds.
A campaign for entry into the United States birth-registration area was con
ducted by the State department of public health, and assistance was given to
the campaign by the staff of the bureau of maternity and infancy. The State
was admitted to both the birth and death registration areas in April, 1928.
As the State was so recently admitted to the registration areas no statement
as to mortality rates can be made.

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OREGON
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of child hygiene, Portland.
Funds expended : Federal, $13,117.41 ; State, $12,313.09 ; total, $25,430.50.
Staff:
Director (State health officer serving), 1 physician (part year, part time),
1 prenatal supervisor (nurse), 2 nurses (1 part year), 3 stenographers
(part year). Other clerical assistants were employed as needed. Seven
teen county nurses in six counties were paid in part from maternity and
infancy funds.
Volunteer assistants— 54 physicians, 32 dentists, 26 nurses, 593 lay persons.
Activities :
Child-health conferences conducted by physicians— 326; infants and pre
school children registered— 3,532 ; number examined— 3,520 ; visits to con
ferences— 4,348.
Defects found in children examined at conferences— 4,237 ;~children having
defects— 1,890. Parents had defects corrected in approximately 75 per
cent of the children.
Prenatal conferences conducted by physicians— 137 ; expectant mothers
registered— 419 ; number examined— 393 ; visits to conferences— 1,516.
Dental conferences— 40; preschool children receiving dental examination—
534.
New permanent child-health centers— 6 established as a result of the ma
ternity and infancy work. They are supported by local funds.
Classes for girls in care of infants and preschool children— 17 organized ;
girls enrolled— 223 (report incomplete) ; number completing course— 221
(report incomplete) ; lessons in course— 12. A course of 25 lectures in
personal hygiene and child development and care was given also to the
girls of the junior and senior high schools in one county.
Classes for mothers— 2 organized ; mothers enrolled— 28.
Home visits by nurses— 5,128 (prenatal cases seen, 773; obstetrical cases,
204; postnatal cases, 534; infants, 1,125; preschool children, 2,807).
Group demonstrations— 298, on various phases of maternal and infant care,
mostly in connection with classes for girls.
Surveys— 4: (1) Of hospitals, in one county. (2) Of birth registration,
in one county. (3) Of health conditions, made with the cooperation of
women’s clubs, in the larger communities of the State. (4) Of infant
mortality, in one county.
The bureau is cooperating in a study of maternal mortality being con
ducted in the State by the United States Children’s Bureau with the
indorsement of the State medical society.
Campaigns— 7 : (1) For child-health conferences, in all counties except
those having county health units (in progress). (2) For child-health con
ferences, in one county having a county health unit. (3) For the ob
servance of May Day as Child Health Day, state-wide. (4) For pasteuri
zation of milk, in two counties. (5) For the establishment of dental
clinics, in one county.
(6) For immunization of preschool children
against contagious diseases,xin four counties. (7) For prevention of in
fantile paralysis, in two counties.
Talks and lectures— 331 (report incomplete).
Literature distributed— approximately 50,000 pieces.
New names registered for prenatal letters— 1,046; prenatal letters dis
tributed— 1,017 sets.
Nutrition work was done through class instruction and through instruc
tion given to individual mothers at child-health conferences.

119

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120

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

Activities— Continued.
Exhibits conducted— 100, at fairs and at celebrations of May Day as Child
Health Day, also at weekly health-center exhibits (conducted by the
prenatal supervisor). Exhibit material prepared— sun suit, preparation^
of delivery room, baby kit, posters. Exhibit material was lent five times.
Articles prepared— Raising Baby a Full-Time Job, When to Begin Getting
Ready for School, May Day— Child Health Day, Are You Worthy of
Your Child’s Confidence? Diphtheria Immunization, Lives Saved by
Immunization, Infantile Paralysis in Oregon, Aftercare of Infantile Pa
ralysis, Infantile Paralysis Is on the Increase.
Statistical studies made— neonatal deaths and eclampsia, nursing costs,
time distribution in health work, appraisal of health work, physicians’
findings at health conferences, corrective work reported for children
examined, neonatal deaths, 19212-1927.
Breast feeding was stressed in instruction given in letters, literature,
home visits, classes, lectures, and conferences.

S o u rc e : U. S. Bureau of the Census
Trend o f infant m o rta lity ; Oregon, 1919—1927

Infants bora in the State during the year— 14,518; infants under 1 year
of age reached by the work of the bureau— 2,625; preschool children
reached— 5,439; expectant mothers reached— 2,700.
The bureau sends to parents of all infants whose births are registered
in the State bureau of vital statistics a notification of registration of
birth accompanied by a letter offering guidance as to the care of
young children.
Counties in the State— 36; counties in which maternity and infancy work was
done during the year—3 2 ; counties in which maternity and infancy work
has been done since the acceptance of the maternity and infancy act— 36.
As a result of the maternity and infancy work health centers have been
organized in every county in which a county nurse is employed. The
bureau gave supervisory service to local organizations doing maternity
and infancy work.
The following organizations cooperated in the bureau’s work: State
department of education, State university (extension service), State
agricultural college, State medical society, State dental society, State
tuberculosis association, State organization for public-health nursing,
State federation of women’s clubs, American Red Gross, and the parentteacher association.

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P R IN C IP A L . A C T IV IT IE S OF I N D IV ID U A L S T A T E S , 1 9 2 8

121

A general increase of interest in prenatal and postnatal work throughout
the State was evidenced by requests received by the bureau for prenatal and
ostnatal letters and for advice and literature on maternal, infant, and child
ire.

TYPES OF W ORK AND

SO M E R E SU L T S

The bureau of child hygiene was established in the State board of health in
j.1921. The State accepted the provisions of the maternity and infancy act
^through legislative enactment approved by the governor on December 24, 1921.
The work of the bureau has been under medical supervision from the begin
ning of cooperation with the Federal Government; the State health officer has
directed the work in the past few years, a nurse serving as assistant director. A
number of public-health nurses paid in part from maternity and infancy funds
were detailed to counties for maternity and infancy work. During the year
under review, as in the previous year, six counties received such service.

Source; U.S. Bureau of the Census
Trend o f maternal m o rta lity ; Oregon, 1919-1927

The division has had the benefit of cooperation from the State department of
education and State educational institutions, the State medical and dental
societies, tuberculosis association, and organization for public-health nurses* the
American Red Cross, women’s organizations, and the parent-teacher associa
tion, and of professional and lay assistance from volunteer workers.
Itinerant child-health conferences were features of the earlier programs.
Emphasis continues to be placed on conference work, but this is now accom
plished through the examinations made at health centers and in county health
departments, both of which have increased in number. Nurses detailed to coun
ties have made more infant and prenatal nursing visits than were possible
formerly.
A full-time maternity and infancy nurse has been assigned for service at
the prenatal clinic of the State university medical school, which has furnished
prenatal clinical material and instruction for undergraduate medical students.
Improvement in maternal and infant care has been promoted by the distribu
tion of instructive literature through the bureau of child hygiene.
Oregon is one of the States that have had a relatively low infant mortality
rate. When it was admitted to the United States birth-registration area in 1919
the rate was 63 (deaths of infants under 1 year of age per 1,000 live births).
48278°— 29---- ^9

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122

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The trend has been downward during the period of cooperation. In 1921 (the
year before cooperation under the act was begun) the rate was 51; in 1927
it was 48, the lowest point in the nine years the State had been in the registration
area.
Jw
The maternal mortality rate also showed a downward trend from 74.3
per 10,000 live births in 1921 to 63.6 in 1927. The reduction in maternal
mortality is due in great part to decrease in both puerperal septicemia and
puerperal albuminuria and convulsions. The rate in 1922 for puerperal septi
cemia was 27.4 per 10,000 live births; in 1927 it had declined to 21.9. In
1922 the rate for albuminuria and convulsions was 24; in 1927 it was 14.4,
a saving of 10 mothers from this cause for every 10,000 babies born alive.
It would seem that the excellent training in prenatal care provided for the
medical students at the prenatal clinic through the cooperation of the State
department of health with the State university medical school is reflected in
the reduction of deaths from albuminuria and convulsions.
Information upon the basis of which plans may be made for further attack
on the problem of maternal mortality will be available as a result of the study
of this subject being made in the State by the United States Children’s Bureau
(with the cooperation of the State bureau of child hygiene and the indorsement
of the State medical society).

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PEN NSYLVAN IA
S T A F F A N D A C T IV IT IE S IN

1928

Administrative agency:

8 H a rr'S b S nent “ * h6“' “ 1’ bUr6aU ° f CWId health- ' ,resch»»1 «¡Melon.
s S t a e5cp<mded: FederaI- *78,735.98; State, $63,810.99; total, $139,546.97.
° 4 6, w „ i I>1hysld'itl.) ’ 8 Physicians (1 part time, 6 for two months or lessl
4 dentai hygienists (for 3 months), 2 midwife supervisors in h v s iH « S ’
3 field workers, 14 vital-statistics clerks, 2 s t e n o g r a ? S r 3 c l e ^ Efevpn
community nurses and 140 to 150 nurses in the public health nnretina-

S T a n d m?anoatetn n rrtment ° ' bealtt Were PaM ta part from “ a!
V pTr“ Ms. ass,stants- more
Activities:
C h M lir “ n t o f m
re stsm rT S

r Z

850 physicians, many nurses and lay
, h“S

SASLSgS

by ^ ' ' » » 0 - 6 , 2 4 6

(6,113 at child-

'TS^S&SSTSS^

centem,
tw ’ p f '•
mans, two dental hygienists, and two nurses and eoulpned for° health
conferences, which were sent out in the Held ?n J u T 1927 S n tln n S
M

r f t n e ' i m " 17 “ d AUg” St ° f “ “ “ V * “ d a^
W h tT n m S
rec?rd was not kept of the number of children having defects
ber of corrections made. However, the correction ^ 5 544
defects was reported for children attending the ¿hild-heith centers
rtZ ?
ab° at 50 per cent of the chiidren had d < S S S
rected following the examinations made on the health cars
Prenatal conferences conducted by physicians— Rin- ^n^.Vo„ c ^ ^
registered and pTuminmi «on. • .V
„s oiu, expectant mothers
m,
,. . eu ana examined— 32a; visits to conferences__ 1

SB
as» ■
Jirsass
S

123

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124

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

Activities— Continued.
Home visits by nurses— 43,903 (to prenatal cases, 2,106; postnatal cases,'
7,314; infants and preschool children, 34,483).
}
Talks and lectures— 122.
Literature prepared— Manual for Expectant Mothers, Baby Book (revised).
Literature distributed— 147,902 pieces.
Campaign— 1, state-wide, for observance of May Day as Child Health Day.
The aim was to have permanent child-health activities culminate in the
special celebrations or to make the celebration the starting point for
other worth-while projects. Health officers of both public and private
organizations, school officials, churches, motion-picture theaters, news-

200
150

100
90
80
70
60
50

40
30

10
9

8
7

6
1915

1916

1917

1918

1919

1920

1921

1 9 2 2 1923. 1 9 2 4 1 9 2 5

1926

1 92 7

5ourca: United S tates Bureau of thè Census
Deaths o f infants under 1 year o f age from all causes and from diarrhea and interitis,
per 1,000 live b ir th s ; Pennsylvania, 1915—1927

papers, merchants, dairymen, and various clubs' and fraternal organi
zations cooperated. Proclamations, slogans, posters, radio talks, window
displays, and news articles were employed in arousing interest in the
campaign. Local celebrations by groups, communities, and counties in
cluded drives to have preschool children examined and their defects
corrected before the children should enter school, toxin-antitoxin cam
paigns, plays, pagents, parades, weight check-ups, health clowns, exhibits,
and demonstrations. Reports of celebrations were received from 52 of
the 67 counties in the State. Programs were conducted in 334 com-

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125

PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1928

Activities— Continued.
munities, 15,599 infants and preschool children were given physical"
examination, 440 children were vaccinated against smallpox, and 33,610
children were immunized against diphtheria.
Exhibits conducted— 2. Exhibit material prepared— basket crib, spot maps,
charts, and diagrams.
Articles prepared— Birth Registration, a Problem for Popular Interest;
Lowering the Infant Mortality Rate in Pennsylvania; Reports of ChildHealth Work; Maternity and Infancy Work in Pennsylvania under the
Sheppard-Towner A c t; Health-Car Work in Pennsylvania.
Infants bom alive in the State during the calendar year 1927— 210,033;
infants under 1 year of age reached by the work of the division during
the year ended June 30, 1928— 26,882; preschool children reached— 28,916;
expectant mothers reached— 16,020. (Report incomplete;)
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics. Co
operation with the bureau of vital statistics in sending birth certificates
to the parents of all infants as soon as births were registered was con
tinued in the year under review.

2oa
150

100
90
80
70
60
50
40

20
1915

1916

1917

1918

1919

1920

192!

1922

1923

1924

1925 1927

1 92 7

Source; United States Bureau of the Census
Deaths o f children under 5 years o f age from diphtheria, per 100,000 estimated
population o f these a g e s ; Pennsylvania, 1915—1927

Counties in the State— 67 ; counties in which maternity and infancy work
was done during the year— 67,
Since the beginning of the State’s cooperation under the maternity and
infancy act six communities have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following organizations cooperated in the division’s work : American
Red Cross, Woman’s Christian Temperance Union, State league of women
voters, State tuberculosis society, the parent-teacher association, and many
local organizations.
Among the outstanding features of the year’s work were the three institutes
for midwives, the organization of the preschool work as part of the Child Health
Day celebration, the visiting of postnatal cases among midwives’ patients, the
examinations made on the health cars, and the promotion of birth registration.

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126

THE

w e l f a r e a n d h y g ie n e

op m a t e r n it y a n d in f a n c y

TYPES OF WORK AND SOME RESULTS
The bureau of child health, of which the preschool division is a part,
established in the State department of health in 1919. The governor acceptèd
the provisions of the maternity and infancy act on January 18, 1922. This was
followed by legislative acceptance approved by the governor on May 31,1923.
A physician has directed the work of the division through the entire period
of cooperation with the Federal Government. Other members of the staff have
been physicians, nurses, and dental hygienists. Approximately 150 nurses in
the public health nursing division of the State department of health have been
paid from maternity and infancy funds on the basis of actual time spent on
maternity and infancy work. Nursing services in communities also have re
ceived small payments for the promotion of maternal and infant hygiene. Many
physicians have been paid for services at centers (as the examination of expectant
mothers, infants, and preschool children at conferences), and many others have
given volunteer service of similar character. Nurses have given generous assist
ance, and committees of lay persons have helped at centers and sponsored them.
Cooperation has been maintained with the American Red Cross, the State
tuberculosis society, women’s organizations, and the parent-teacher association.
An important activity of the division has been the establishment of prenatal
and child-health centers, whose support (except for the salary of the nurse
in some cases) is provided by local funds ; also assistance in the local organiza
tion of such centers— to which literature and record forms are furnished. At
the close of the fiscal year 1928 approximately 400 centers, conducted under va
rious auspices, were in operation in the State.
The conducting of itinerant child-health conferences by means of two health
cars with suitable equipment has been continued, the staff consisting of
physicians, dental hygienists, and .nurses. Other features of the work have
been the regulation, instruction, and supervision of white midwives, which has
now been extended to 10 counties in the coal regions of the State ; the conduct
ing of an extensive antidiphtheria campaign; and the mailing of literature on
the care of the baby to parents of all babies whose births are registered.
Maternity and infancy funds have been used since 1926 to provide for the free
distribution of ampules of nitrate of silver to be used in the prevention of
blindness in the newborn.
Results of the program are indicated by the downward trend in infant
mortality rates. The rate in 1922, thè year in which the State began coopera;
tion under the maternity and infancy act, was 88 infants under 1 year of age
dying in every 1,000 born alive. In 1927 the rate was 69, the lowest infant mor
tality rate ever recorded in the State. This meant a saving of 19 babies in
every 1,000 born alive in 1927 that would have died if the 1922 rate had prevailed.
The maternal mortality rate for the State as a whole has not decreased,
though the rate for rural areas declined from 48.7 per 10,000 live births in
1922 to 44.4 in 1927.

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RHOD E ISLAN D
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, division of child welfare, Providence
Funds expended: Federal, $14,076.28; State, $9,076.28; total, $23,152.56.
Director (physician), 8 nurses (2 part year), 1 stenographer, 1 field sec
retary.
Volunteer assistant— 1 physician.
Activities:
Child-health conferences conducted by physicians— 210; infants and preferences^3 664 registered— 663; number examined— 522; visits to conDefects found in children examined at conferences— 664; children having
defects 625 (including some children who were not examined by phvsicmns but were inspected by a nurse who listed defects). Parents had
defects corrected in 355 of the children.
New permanent child-health centers— 3 established as a result of the mater
nity and infancy work. They are supported by local nursing organiza
tions and maternity and infancy funds. Conferences in one center were
conducted weekly by a local physician who volunteered his services after
attending the first conference held at the center.
Class for mothers— 1 organized; mothers enrolled— 18; lectures in course— 5
Home visits by nurses— 53,605.
Group demonstrations— 2, on method of giving sun baths
Caousayear71’ ^

—
If.'

immunization against diphtheria (continued from previ-

The division is cooperating in a study of maternal mortality being conducted
in the State by the United States Children’s Bureau with the indorsement
of the State medical society.
m
Talks and lectures— 30.
Literature distributed— 37,368 pieces.
N home°visitsrk ^

d0ne through individual instruction to mothers in

Exbibit „condu.cted— i, of a day nursery at a county fair. The nursery was
open fjom 10 a. m. to 4.30 p. m., and children could be left all dav in
care of the staff nurses in charge. Exhibit material preparwl— illustra
tions of the division s field work, “ Time card ” film. Exhibit material
was lent seven times.
L material
Infants born in the State during the year— 13,396; infants under 1 vear of
age reached by the work of the division— 4,392 (exclusive of those reached
o ^ i r atUr\ d^
ted> ’ Prescb° o1 children reached— 9,956 (exclusive
1422
reached by Uterature distributed) ; expectant mothers reached—
ThliveUwithineth i d £ ? i ? re ° n in? i t bygiene t0 Parents of all infants who
on the dlstncts covered by staff nurses; it also supplied literaievtew
“ nUrSJng
‘ n the State’ during t h e y S under

C°wasled »e t o i f f f ^ a r ^

“ 63 “ “ WWch matcrnity and lldW

Among the outstanding achievements of the year were the camnais-n
death^ates.011 agai” St dll>lltheria and tha

of ^ I n t e n t and m aT erS

TYPES OF WORK AND SOME RESULTS
' i n "m o ^ T h e 11S

Was established in the State board of health

through* legislatii^^ifactoent

~
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128

THE

w e l f a r e a n d h y g ie n e of m a t e r n it y a n d

in f a n c y

A medical director assisted by a staff of public-health nurses has conducted
the program for maternal and infant welfare. The program has been character
ized by supervision of infants through the nurses’ visits in homes and the work
of the medical director at child-health conferences.
r
During the year under review cooperation was given by local nursing organ
izations in the establishment of permanent child-health centers and in their
maintenance.
.
The program of intensive supervision is reflected m the decline of the infant
mortality rate from the high point of 108 per 1,000 live births in 1917 (before
the division of child welfare was established) to 67 in 1927— the lowest rate the
State has shown since it was admitted to the United States birth-registration
area. The rate in 1918, immediately preceding the establishment of the divi
sion, was unusually high on account of the influenza epidemic. In 1925 (the
year in which the State began cooperation under the maternity and infancy
act) the rate was 73, a new low rate for the State. The rate of 67 for 1927
means a saving of 6 babies in every 1,000 born alive in 1927 as compared with
1925 and a saving of 41 babies in every 1,000 born alive in 1927 as compared
with 1917, before the division was established and medical and nursing super
vision begun.
Maternal mortality rates have not declined during the period of cooperation.
In 1925 the rate was 52.1 per 10,000 live births; in 1927 the rate was 64.1.
The study of maternal mortality being made in the State will furnish a basis
for intensive effort toward reduction of this rate.

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SOUTH CAROLINA
STAFF AND ACTIVITIES IN 1928
Administrative agency:
State board of health, bureau of child hygiene and public-health nursing,
Columbia.
Funds expended: Federal, $18,060.58; State $16,355.65; total, $34,416.23.
Staff:
Director (nurse), 2 physicians (part time, 1 part year), 12 nurses (7 for 2
months or less), 1 technician (1 % months), 1 vital-statistics clerk, 2
stenographers. One county nurse was paid from maternity and infancy
funds.
Volunteer assistant— 1 physician.
•
Activities t
Child-health conferences conducted by physicians— 128; infants and pre
school children registered and examined— 2,774; visits to conferences—

2,888.

Defects found in children examined at conferences— 2,607; children having
defects— 1,682.
Prenatal conferences conducted by physicians— 36; expectant mothers regis
tered and examined— 99; visits to conferences— 237.
Conferences conducted by nurses, no physician present— 6 ; mothers in
structed in prenatal care— 17; visits to conferences— 54.
Classes for girls in care of infants and preschool children— 9 organized;
girls enrolled— 160; number completing course— 118; lessons in course— 10.
Classes for mothers— 6 organized; mothers enrolled— 87; number complet
ing course— 33; lessons in course— 8 to 22.
Classes for midwives— 24 organized; midwives enrolled plus those carried
over from previous year— 317; number completing course— 104; lessons
in course— 10 to 12. During the year under review the nurses also held
336 review classes attended by 3,292 midwives.
A one-month institute for midwives was held in July, 1927, at the hospital
of a colored school lent for the purpose by its trustees. A nurse from
the bureau’s staff organized the institute and conducted it with the
assistance of the other staff nurses, each of whom was assigned to the
work three to seven days, and of a colored nurse, who was paid by a
private organization. The entire cost of the institute (excluding salaries)
was eovered by a charge of $10 for room and board for the midwives
and of $1 per day for the instructor nurses. County nurses and other
maternity and infancy field nurses were asked to send to the institute
some of the better-educated and more intelligent midwives in their
districts; and 27 midwives whose ages ranged from 17 to 56 years and
who represented 13 counties registered for the course. The midwives
were divided into three sections, responsible for the nursing, the kitchen
and dining room, and the laundry, respectively. The whole group had
daily classes in midwifery and in home hygiene and care of the sick.
All the midwives attended all the deliveries of patients from the hospi
tal’s prenatal clinic that were conducted in the hospital. A local
physician who volunteered his services delivered these patients. As a
result of this institute so many applications were received from midwives
for a similar course that it was decided to conduct an institute for three
months in 1928, beginning in June. About 30 midwives registered for
each of the three months. A colored nurse who was a graduate of the
Bellevue Hospital Training School for Midwives was employed to assist
the nurse in charge, and each of the bureau’s staff nurses was assigned
to the work for a 2-week period. The same physician who volunteered
his services the preceding year delivered the abnormal cases and the
colored nurse-midwife the normal cases that the midwives attended for
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130

th e w elfare and

h y g ie n e of m a t e r n it y a n d

in f a n c y

Activities— Continued.
instruction. An out-patient department was organized, and an instructor,
was sent with two student midwives to deliver patients in their horned
and to give postpartum care.
Home visits by nurses— 6,030 (prenatal cases seen, 300; obstetrical cases,
20; postnatal cases, 160; infants, 751; preschool children, 2,043).
Community demonstrations— 8, lasting 1 to 3 months, of a maternity and
infancy public health nursing program, in 8 counties.
Group demonstrations— 75, of various phases of maternal and child care,
before midwives’ classes and lay groups.
Campaign— 1, for promotion of birth registration, state-wide.6
Talks and lectures— 158.
Literature prepared— Products of South Carolina (a bulletin on maternal
and child care).
Literature distributed— 60,000 pieces.
Nutrition work was done through instruction given at mothers’ classes
and in talks to other groups.
Exhibit conducted— 1, at the State fair. Exhibit material was lent twenty
times.
Breast feeding was promoted by distribution of literature on the subject.
It is estimated that at least 9 0 per cent of the children born in the State
are breast fed.
Infants born in the State during the year— 42,737; infants under 1 year
of age reached by the work of the bureau— 25,000; preschool children
reached— 2,573 (exclusive of those reached by literature distributed) ;
expectant mothers reached— 2,500.
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 in which maternity and infancy work
was done.during the year— 46.
Since the beginning of the State’s cooperation under the maternity and
infancy act nine counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the bureau’s work much maternity and infancy work was
done by industrial nurses and county nurses not paid from maternity and
infancy funds. At the suggestion of the district maternity and infancy
nurse a mothers’ club in one town organized a toxin-antitoxin clinic, at
which almost the entire preschool population was immunized. Three per
manent health centers organized by a maternity and infancy nurse in
another town were being equipped by local organizations.
The following organizations cooperated in the bureau’s work: State federa
tion of women’s clubs, American Legion, Council of Farm Women, and
the parent-teacher association. Among the children examined at confer
ences reported in the foregoing paragraphs 628 were examined in the
“ Get ready for school” drive sponsored by the National Congress of
Parents and Teachers.
The outstanding feature of the year’s work was the institutes conducted for
midwives in the summer months.
TYPES OF WORK AND SOME RESULTS
The bureau of child hygiene and public-health nursing was established in the
State board of health in 1919. The governor accepted the provisions of the
maternity and infancy act on December 31, 1921. This was followed by
legislative acceptance approved by the governor on March 11, 1922.
A nurse has had immediate charge of the work of the bureau, assisted by
a central staff of nurses, and physicians have been paid for part-time services.
A county nurse paid from maternity and infancy funds has been detailed for
full-time maternity and infancy work for the past few years. A physician
gave volunteer service at a prenatal center.
Cooperation has been maintained with the American Legion, women’s
organizations, and the parent-teacher association.
The program of work has included child-health conferences, prenatal con
ferences, classes in infant and child care for girls, classes for mothers, and
visits to the homes of mothers and babies by public-health nurses.
9 South Carolina was adm itted to the United States birth-registration area in October,

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PBINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 19 2 8

131

A major feature was the instruction and supervision of negro midwives.
'Its effect is indicated by the fact that the midwives’ bags now are clean and
properly equipped, also by their new pride in their work and their conscientious
reporting of births. Through the development of the prenatal center for
negroes established in 1926, an institute for negro midwives was developed,
instruction being given at actual deliveries by a physician. This work marks
a departure in the instruction of negro midwives and offers suggestions for
improvement in the training of this large and unskilled but still necessary
group.
The State has been both in and out of the United States birth-registration
area during the period of cooperation under the maternity and infancy act,
having been dropped from the area in 1925. A continuous campaign for
readmission has been conducted, and in this the bureau has given cooperation
and assistance.
As the State was not readmitted to the birth-registration area until after
the close of the fiscal year 1928 no statement as to mortality rates can be
made.

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SOUTH DAKOTA
STAFF AND ACTIVITIES IN 1928
Administrative agency:
State board of health, division of child hygiene, Waubay.
Funds expended: Total, $7,325.18 (all Federal).
Staff:
Director (nurse). Two physicians, 4 nurses, 1 lecturer (part time), and
1 secretary were employed for short periods. Two county nurses were
paid in part from maternity and infancy funds.
Activities:
Combined prenatal and child-health conferences conducted by physicians—•
49; expectant mothers registered and examined— 18; infants and pre
school children registered and examined— 1,476.
Defects found in children examined at conferences— 4,775; children having
defects— 1,391.
Lessons in care of infants and preschool children were given to 194 girls
in 2 high schools and 1 normal school.
Classes for mothers— 2 organized; mothers enrolled (plus those carried
over from previous year) and completing course— 257; lessons in
course— 7.
Maternity homes inspected— 54; inspections made— 63.
Group demonstrations— 33, of layette, preparation of room for confinement,
preparation and sterilization of obstetrical supplies, explanation of
anatomical charts, and foods and other things needed by growing children.
Surveys— 2 : (1) Of all maternity homes and maternity departments of
hospitals in the State. (2) Of the extent of infantile paralysis In the
State.
Campaign— 1, for observance of May Day as Child Health Day. Circular
letters asking for local cooperation were sent out, and assistance was
given in planning local programs and health conferences. Many children
were given physical examinations at the conferences organized. The
extension department of the State college of agriculture made plans to
indicate a day in its yearly program for such observance of May Day.
Talks and lectures— 16.
Literature prepared— Mother’s Book (new edition).
Literature distributed— 23,638 pieces.
New names registered for prenatal letters— 634; prenatal letters dis
tributed— 722 sets. Letters were sent to all the physicians in the State
advising them that the division had prenatal letters and literature for
distribution and inclosing'cards for use in requesting copies of the pre
natal letters for their patients. Many physicians took advantage of
this service.
Nutrition work was done through the distribution of diet slips entitled
“ Food Suitable for the Growing Child.”
Exhibit conducted— 1, at the State fair, of posters, motion pictures, layette,
and room for the baby. Exhibit material was lent eleven times.
Statistical studies made— births, by attendants at birth; stillbirths, deaths
of infants under 1 month of age, and deaths under 5 years, by causes;
deaths of mothers from causes associated with childbirth.
Breast feeding was stressed in literature distributed, talks given, and
instruction given to individual mothers at conferences.
Infants born in the State during the year— 13,902 reported; infants under
1 year of age reached by the work of the division— 9,114; preschool
children reached— 1,287; expectant mothers reached— 705.
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— 64 organized, 5 unorganized (largely of Indian popu
lation under Government care) ; counties in which maternity and infancy
132

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PRINCIPAL. ACTIVITIES OP INDIVIDUAL STATES, 192 8

133

Activities— Continued.
work was done during the year— 54 organized, 1 unorganized; counties
in which maternity and infancy work has been done since the acceptance
of the maternity and infancy act— 64 organized, 1 unorganized.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the division’s work health conferences for preschool children
were conducted in 6 towns, with an attendance of 532, and 2 county nurses
not paid from maternity and infancy funds conducted mothers’ classes.
The division gave supervisory assistance to local organizations, assisted
them in securing personnel, and supplied literature for distribution.
From reports from child-health conferences it is estimated that 66 per
cent of the babies are breast fed.
The following organizations cooperated in the division’s work: State col
lege of agriculture (extension service), State medical association, State
tuberculosis association, State league of women voters, State federation
of women’s clubs, State graduate nurses’ association, American Legion
and its auxiliary, and the parent-teacher association. They assisted with
health conferences, mothers’ classes, and the campaign for the observance
of May Day as Child Health Day.
TYPES OF WORK AND SOME RESULTS
The division of child hygiene was established in the State board of health
in 1921. The governor accepted the provisions of the maternity and infancy act
on February 10, 1922. This was followed by legislative acceptance approved
by the governor on March 2, 1923.
A medical director was in charge during the earlier years; later a publichealth nurse directed the work. Staff nurses have been employed, and nurses
paid in part from maternity and infancy funds have been detailed to counties.
The division has had the benefit of cooperation from the State college of
agriculture, the State medical, tuberculosis, public-health, and graduate nurses’
associations, the American Red Cross, the American Legion and its auxiliary,
women’s organizations, and the parent-teacher association.
Child-health conferences and combined prenatal and child-health conferences
conducted by physicians have been a prominent feature of the program. Classes
for mothers in infant and prenatal care also have been included.
The inspection of maternity homes and hospitals accepting maternity cases
has been a duty of the division for several years through legislation assigning
the responsibility for licensing and inspection to the State board of health.
Since 1924 maternity and infancy funds have been used for the free distribu
tion of ampules of nitrate of silver for use in the eyes of the newborn. Returns
from birth certificates indicate that this prophylactic is generally used.
T hrough th e sen d in g o f lite ra tu re on in fa n t care to th e p aren ts o f bab ies w h o se
b irth s are registered in stru ction in th e care and h y g ien e o f th e baby i s m ade
a v a ila b le to p ractically all p aren ts w ho can read.
During 1928 two counties assumed the financial responsibility for the ma
ternity and infancy nurses detailed to them.
.
.
The educational work and general program established were continued during
the year ended June 30, 1928, though there was a curtailment 6f funds in 1927.
The effect of the program is shown by the increase in requests by women for
literature relating to prenatal, infant, and child care. It is shown also by the
statements of many physicians that fewer women now wait until they are in
labor to send for medical assistance; this the physicians attribute to the educa
tional program in prenatal care.
_
The State is not in the birth and death registration areas. Legislation is
necessary to meet the requirements of the United States Bureau of the Census
for admission. Maternal and infant mortality rates based on figures from the
Bureau of the Census consequently are not available.

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TENNESSEE
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public health, division of child hygiene and publichealth nursing, Nashville.
Funds expended: Federal, $21,523.18; State, $19,021.72; total, $40,544.90.
Director (physician, part time), 1 physician (11 months), 3 nurses (2 part
year, part time), 1 supervisor of midwives, 1 accountant, 1 stenographer
(part time). Twenty-nine county nurses in 18 counties were paid in part
from maternity and infancy funds.
Activities:
Combined prenatal and child-health conferences conducted by physicians__
9 ; expectant mothers registered and examined— 16; infants and preschool
children registered and examined— 29; visits to conferences by expectant
mothers— 18; visits by children— 68.
Child-health conferences conducted by physicians— 107; infants and pre
school children registered— 3,893; number examined— 3,256.
Defects found in children examined at conferences— 4,553; children having
defects— 2,141. Parents had defects corrected in 186 of the children
(report incomplete).
Prenatal conferences conducted by physicians— 12; expectant mothers
registered and examined— 57.
Conferences conducted by nurses, no physician present— 65; children in
spected— 2,146; mothers instructed in prenatal care— 879.
New permanent combined prenatal and child-health centers—2 established
as a result of the maternity and infancy work. They are supported by
the county health unit, colored women’s federated clubs, midwives’ clubs,
and volunteer workers.
New permanent child-health center— 1 established as a result of the maternity and infancy work. It is supported by State and county funds.
Classes for girls in care of infants and preschool children— 2 organized;
girls enrolled and completing course— 31; lessons in course— 13.
Classes for mothers— 4 organized; mothers enrolled plus those carried over
from previous year— 121; lessons in course— 6.
Classes for midwives— 14 organized; midwives enrolled plus those carried
over from previous year— 753; lessons in course— 6. Most of these mid
wives were enrolled in the classes conducted by the State supervisor
of midwives, which had not been completed at the close of the year under
review. In classes conducted by county nurses, who had only a limited
territory to cover, 28 midwives completed the course.
Home visits by nurses— 4,405 (prenatal cases seen, 851; postnatal cases,
1,008; infants, 1,446; preschool children, 2,108).
Maternity home inspected— 1 ; inspection made— 1.
Infant home inspected— 1 ; inspection made— 1.
Group demonstrations—33, of vision test for preschool children, equipment
for midwives, maternity supplies and layette, the use of silver-nitrate
solution in the eyes of the newborn, and other phases of maternal and
infant care.
Surveys— 2 : (1) Of midwives, in 24 counties. (2) Of the prevalence of
goiter, in 36 counties. As a result of the goiter survey a state-wide sur
vey of the prevalence of goiter was made by the United States Public
Health Service.
Campaigns— 3 : (1) For the observance of May Day as Child Health Day
(2) For checking the registration of births of children examined at
child-health conferences in 21 counties. (3) For the organization of
combined child-hygiene conferences and tuberculosis clinics for children
in 15 counties,

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 192 8

135

Activities— Continued.
Talks and lectures— 546, to audiences totaling 14,202 persons.
^
Literature distributed— 50,351 pieces.
New names registered for prenatal letters— 416; prenatal letters distributed— 416 sets.
Graduate courses in obstetrics and pediatrics were conducted at the health
officers’ conference held in cooperation with Vanderbilt University.
Nutrition work was done through individual instruction of mothers.
Exhibits conducted— 19, including posters, motion pictures, and models,
at fairs and at various meetings. Exhibit material was lent twentyfive times.
Statistical study made— maternal and infant mortality, 1916-1926, inclusive.
Breast feeding was emphasized through the distribution of 21,450 pamphlets
on the subject and through instruction given to mothers at conferences
and in home visits.
Infants born in the State during the year— 54,057 ; infants under 1 year
of age reached by the work of the division— 1,535; preschool children
reached— 2,969 ; expectant mothers reached— 969.
Counties in the State—95; counties in which maternity and infancy work
was done during the year— 64 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 95.
The following organizations cooperated in the division’s work: State
department of education, State medical association, State conference of
social work, State federation of women’s clubs, and the parent-teacher
association. Among the children examined at conferences reported in
the foregoing paragraphs, 121 were examined in the “ Get ready for
school” drive sponsored by the National Congress of Parents and
Teachers.
TYPES OP W ORK AND SOME RESULTS

}

The division of child hygiene and public-health nursing was established in
the State department of public health in 1922. The governor accepted the pro
visions of the maternity and infancy act on April 13, 1922. This was followed
by legislative acceptance approved by the governor on March 24, 1923.
Physicians have directed the work of the division during most of the period
of cooperation, and additional physicians have served on the staff, also publichealth nurses. Changes in State administration have brought about some
changes in the staff and in the program of work. Nurses have been detailed to
counties and paid from maternity and infancy funds in proportion to the amount
of time spent on maternity and infancy work.
The division has had the advantage of cooperation from the State department
of education and from state-wide professional and lay organizations (medical
association, conference of social work, federation of women’s clubs, and parentteacher association).
The State staff nurses have given advisory and supervisory services to the
county public-health nurses. In addition to the usual nursing program con
ducted by the nurses detailed to counties, itinerant child-health conferences
were conducted by a physician. The negro woman physician on the staff in
structed and supervised the negro midwives and held child-health conferences
for the negroes. She also conducted a campaign among the people of her own
race for better registration of births and deaths.
Maternity and infancy funds have been used since 1026 for the free distri
bution of ampules of nitrate of silver.
The campaign for admission to the United States birth-registration area, in
which the division assisted, resulted in the State’s admission to the area in
1927. As the State was not admitted to the area until 1927, figures from the
United States Bureau of the Census are available for that year only. The
infant mortality rate for the State as a whole was 71 deaths in every 1,000
live births. In urban areas the rate was 86; in rural areas it was 67. The
maternal mortality rate for the State as a whole was 71 per 10,000 live births.
In urban areas the rate was 120.3; in rural areas it was 56.2.

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TEXAS
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, bureau of child hygiene, Austin.
Funds expended: Federal, $33,413.28; State, $34,609.64; total, $68,022.92.
Staff:
Director (physician), 4 nurses (1 part year), 1 inspector of maternity and
infant homes, 1 secretary, 4 stenographers, 1 mail clerk (half time).
Twenty-seven county nurses were paid for half-time maternity and in
fancy work (8 part year).
Volunteer assistants— 491 physicians and dentists, 51 nurses.
Activities:
Child-health conferences conducted by physicians— 383; infants and pre
school children registered— 5,057 ; number examined— 4,994; visits to con
ferences— 6,428.
Defects found in children examined at conferences— 6,462; children having
defects— 3,852. Parents had defects corrected in 443 of the children.
Prenatal conferences conducted by physicians— 22; expectant mothers regis
tered— 62; number examined— 144 (at conferences, 7 ; in their homes,
137) ; visits to conferences— 113.
Conferences conducted by nurses, no physician present— 536; children in
spected— 3,521; mothers instructed in prenatal care— 87; visits to con
ferences by children— 7,738; visits by mothers— 1,057. In addition 2,305
children were inspected individually in the nurses’ offices, and 295 mothers
were similarly instructed in prenatal care.
Parents had 794 defects corrected in the children inspected by nurses.
Dental conferences— 65; expectant mothers receiving dental examination-^,
73; preschool children receiving dental examination— 2,172.
New permanent child-health centers— 20 established as a result of the ma
ternity and infancy work. They are supported by county funds and
maternity and infancy funds.
Classes for girls in care of infants and preschool children— 104 organized;
girls enrolled— 2,342; number completing course— 1,301; lessons in course—

12.

Classes for mothers— 53 organized; mothers enrolled— 932; number com
pleting course—267; lessons in course— 12.
Classes for midwives— 15 organized; midwives enrolled plus those carried
over from previous year— 918; number completing course— 65; lessons
in course— 10.
Home visits by nurses— 13,582 (prenatal cases seen, 1,336; obstetrical cases,
260; postnatal cases, 722 ; infants, 3,072; preschool children, 5,146).
Maternity homes inspected— 45; inspections made— 75.
Infant homes inspected— 199; inspections made— 227.
Group demonstrations— 1,492, on various phases of maternal and child care,
to groups of mothers, midwives, teachers, and children.
Campaigns— 6 : (1) For promotion of birth registration, state-wide. (2)
For observance of May Day as Child Health Day, in 9 counties. (3)
For examination of preschool children and correction of their defects
before the children should enter school, in 28 counties. (4) For vaccina
tion against smallpox, immunization against diphtheria, and inoculation
against typhoid fever, in 8 counties. (5) For improvement in sanitation,
important in reducing infant mortality, in 5 counties. (6) For enumera
tion of midwives, in 17 counties.
Talks and lectures— 424.
Literature prepared— outline of study courses on care of the expectant
mother.
136

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PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 192 8

137

Activities— Continued.
Literature distributed— 66,536 pieces.
Nutrition classes— 11, conducted by county nurses; enrollment— 197 pre
school children.
Exhibits conducted— 28; additional exhibits were conducted by the county
nurses. Exhibit material prepared— 4 sets of charts showing the types
of literature distributed by the State department of health. Exhibit
material was lent sixty-five times.
Breast feeding was emphasized in health clubs taught by the county nurses.
Infants born in the State during the year— 92,170 reported; infants under
1 year of age reached by the work of the bureau— 43,220; preschool
children reached— 20,494; expectant mothers reached— 7,381.
The bureau sends letters to parents of all infants whose births are reg
istered in the State bureau of vital statistics, advising them that litera
ture on child care may be had upon request.
Counties in the State— 254; counties in which maternity and infancy work
was done during the year— 60; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 115.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The bureau organized a State health council, outlined the organization of
county health councils for organizations interested in health work, and
distributed outlines for study courses to these groups.
The following organizations cooperated in the bureau’s work: State medical
association and auxiliary, State league of women voters, State dental
association, American Legion and auxiliary, Women’s Legislative Council,
and parent-teacher associations. The State dental association made a
survey that included preschool children. The auxiliary of the State
medical association organized child-health councils and parent teacher
association study circles. Other assistance was given in conducting the
birth-registration campaign and in securing the cooperation of county
public-health nurses. Among the children examined at child-health con
ferences reported in the foregoing paragraphs, 1,231 were examined in the
“ Get ready for school ” campaign sponsored by the National Congress of
Parents and Teachers.
Among the outstanding features of the year’s work were the results accom
plished in the campaign conducted in cooperation with the parent-teacher
associations.
TYPES OF W ORK AND SOME RESULTS

The bureau of child hygiene was established in the State department of
health in 1919. The governor accepted the provisions of the maternity and
infancy act on February 20, 1922. This was followed by legislative acceptance
approved by the governor on February 24, 1923.
A medical director has been in charge of the work of the bureau. Maternal
and infant welfare has been promoted through the activities of a number of
county nurses who are paid in part from maternity and infancy funds, and
a relatively small central staff of nurses. Two negro itinerant nurses who work
with the negro midwives and with other persons among their own race are on
the State staff.
Both county and State workers had the benefit of cooperation from the
State medical' society and its auxiliary and the State dental association, the
American Legion and its auxiliary, women’s organizations, parent-teacher
associations, and home demonstration agents.
Notable features of the work have been the establishment of many new
permanent child-health centers, increase in the dissemination of information
on prenatal care through the distribution of the pamphlet prepared on that
subject, state-wide campaigns for the promotion of birth and death registration
and for improvement in the milk supply and in sanitation, the great increase
in 1928 in the number of counties in which maternity and infancy work was
done, the “ Get ready for school ” campaign, and the assumption by two
counties of the financial responsibility for maternity and infancy work begun
with maternity and infancy funds.
48278°— 29------10

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138

THE

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

In 1921 the State legislature passed a law requiring the use of nitrate of
silver in the eyes of the newborn. Since the State has cooperated under
the maternity and infancy act 3,697 midwives have received instruction which1
'
has included directions for the use of nitrate of silver as well as information
concerning the importance of birth registration.
As the State is not in the United States birth-registration area no state
ment as to maternal and infant mortality rates can be made.

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UTAH
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State board of health, bureau of child hygiene, Salt Lake City.
Funds expended: Federal, $13,000; State, $1,080.59 (for first half of fiscal
year only); total, $14,080.59.
Staff:
Director (physician), 1 nurse, 1 dentist, 1 vital-statistics clerk, 1 stenog
rapher. Four physicians were employed as needed to conduct confer
ences. Four county nurses and one county health officer were paid in
part from maternity and infancy funds.
Volunteer assistants— approximately 1,000 physicians, nurses, dentists, and
lay persons.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
526; expectant mothers registered— 180; infants and preschool children
registered— 10,927; children examined— 10,900; visits to conferences by
expectant mothers— 184; visits by infants and preschool children— 13,633.
Defects found in children examined at conferences— 18,799; children having
defects— 8,923. Parents had defects corrected in 2,056 of the children.
Dental conferences— 125; expectant mothers receiving dental examina
tion— 29; preschool children receiving dental examination— 2,885. In
addition 116 children were given dental examination outside conferences.
New permanent combined prenatal and child-health centers— 33 established
as a result of the maternity and infancy work. They are supported by
local funds.
• Classes for mothers— 3 organized; mothers enrolled plus those carried over
from previous year— 192; number completing course— 158.
Home visits by nurses— 1,900 (prenatal cases seen, 165; obstetrical cases,
11; postnatal cases, 21; infants, 493; preschool children, 1,039).
Maternity homes inspected— 5 ; inspections made—0.
Group demonstrations— 122, of various phases of maternal and child care.
Campaigns— 3 : (1) For examination of preschool children and correction
of their defects before they should enter school. (2) For observance
of May Day as Child Health Day. (3) For immunization against
diphtheria and vaccination against smallpox. Assistance was given in
this campaign, which was conducted by the State board of health.
Talks and lectures—297.
Literature prepared— Infantile Paralysis, Epidemic Cerebrospinal Menin
gitis.
Literature distributed— 25,000 pieces.
New names registered for prenatal letters— 665; prenatal letters distrib
uted— 429 sets.
Nutrition work was done through instruction given to groups of mothers at
many of the child-health conferences and to individual mothers of
children having nutritional defects.
Exhibit conducted— 1, at the State fair, including films, posters, patterns
for layette and baby clothes, with demonstrations of feeding methods,
dental care, and immunization against diphtheria. Exhibit material
prepared— posters, clothing for mother and baby. Exhibit material was
lent twelve times.
Breast feeding was promoted by instruction given to mothers at conferences
and by. literature distributed.
Infants born in the State during the year— approximately 13,500; infants
and preschool children reached by the work of the bureau— approxi
mately 25,000; expectant mothers reached— 1,010.
139

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140

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
:
. „ •^
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— 29 ; counties in which maternity and infancy work
was done during the year—25 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
Since the beginning of the State’s cooperation under the maternity and
infancy act one county has assumed the resposibility for maternity and
infancy work begun with maternity and infancy funds.
As a result of the bureau’s work a number of communities in 11 counties
conducted 144 child-health conferences without assistance from the State
staff; 1,857 infants and preschool children were given physical exami
nation ; the total number of examinations made was 2,942, and the num
ber of corrections of physical defects reported was 234.
The bureau rendered supervisory assistance to local organizations con
ducting maternity and infancy work.
Prominent church relief societies and the parent-teacher association coop
erated in the bureau’s work. They assisted at health centers and at
dental conferences, lent maternity bundles, and helped to secure thé names
of expectant mothers.
The outstanding achievement of the year was the number of corrections
reported of physical defects found in children examined at health conferences.
TYPES OF W ORK AND SOME RESULTS

The bureau of child hygiene was established in the State^ board of health in
1922 The governor accepted the provisions of the maternity and infancy act
on January 23, 1922. This was followed by legislative acceptance approved by
the governor on February 28, 1923.
. \+ .
' rJt .
n
A medical director has had charge of the work, assisted in the field by a
nurse and a dentist. Maternity and infancy funds have been used to assist
in maintaining county health units, in which both county health officers and
county nurses have promoted maternal and infant welfare. Valuable coopera
tion has been given by the parent-teacher association, church relief societies, and
a farm organization.
, .
^
*
Numerous child-health conferences have been conducted in the full-time county^
health units and by the director of the bureau. Many permanent combined
prenatal and child-health centers have been established, at which return and
regular conferences were held. A large number of dental conferences also
have been held in the last two years.
moo + iqov
Infant mortality rates show a downward trend from 1922 to 1927. The
lowest infant mortality rate ever recorded in the State was reached in 1927,
when 54 infants under 1 year of age died in every 1,000 born alive. In 1922
(the year in which cooperation with the Federal Government was^ begun) the
rate was 69; that is, 15 more babies died in every 1,000 born alive in 1922 than
Maternal mortality rates showed a downward trend from 1922 to 1926,
inclusive, but 1927 was marked by a rise in this rate.

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VERMONT
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of public health, Burlington.
Funds expended: Total, $5,000 (all Federal).
Staff:
Director (physician, State health officer serving), 1 nurse, 1 stenographer.
Activities:
Child-health conferences conducted by physicians— 22; infants and preschool
children registered and examined— 638; visits to conferences— 649.
Defects found in children examined at conferences— 957; children having
defects— 455.
Classes for girls in care of infants and preschool children— 5 organized;
girls enrolled and completing course— 55; lessons in course— 5.
Talks and lectures— 36. Many of these were illustrated by slides.
Literature distributed— 7,692 pieces.
Breast feeding was stressed in the literature distributed and in all talks on
infant care.
Infants born in the State during the year— 7,312; infants under 1 year of
age reached by the work of the department— 98 at conferences, 7,073 by
birth certificates; preschool children reached— 589.
The department sends literature on infant hygiene to parents of infants
whose births are registered in the State bureau of vital statistics when
the parents request it from the list of available literature sent to them.
Counties in the State— 14; counties in which maternity and infancy work
was done during the year— 13.
The following organizations cooperated in the department’s maternity and
infancy work: Federated women’s clubs, parent-teacher associations,
mothers’ clubs, and home-bureau groups. They assisted at conferences
and lectures and helped to bring the maternity and infancy work to the
attention of the public.
TYPES OF WORK AND SOME RESULTS

The governor accepted the provisions of the maternity and infancy act on
January 24, 1922, but the Federal allotment of $5,000 was returned to the
Federal Treasury. Three years later the State again accepted the provisions
of the act, through legislative enactment approved by the governor on February
20,1925. Official action has not been taken to create a child-hygiene division or
bureau in the State department of health.
The maternity and infancy funds available in the State are administered
directly by the State health officer, who directs the maternity and infancy work
with a staff consisting of a nurse and a stenographer.
The program has not been continuous. In the first full year of the State’s
cooperation under the act a nurse conducted a demonstration in a limited number
of rural communities. This was followed by a state-wide educational program
and an increasing number of child-health conferences. The sending of a birthregistration certificate, together with a letter offering literature and advice, to
the parents of every infant whose birth was registered was one phase of the
educational program. The year 1928 was marked by an expanding program in
maternal and child hygiene.
Cooperation has been maintained with women’s organizations, the parentteacher association, and home-bureau groups. The home-bureau groups fre
quently arranged for the child-health conferences and lent their officers to
sponsor them.
Usually the effects of a health program are cumulative and are not at once
apparent, and Vermont is no exception to this rule.
There has been a slight decline in infant mortality during the State’s brief
period of cooperation. The infant mortality rate in 1925 was 72 (deaths of
infants under 1 year of age per 1,000 live births) ; in 1927 the rate was 70.
The maternal mortality rate has not declined during the period 1925 to 1927.
In 1925 it was 67.9 (deaths of. mothers from puerperal causes per 10,000 live
births), and in 1927 it was 72.6.

141

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VIRGINIA
STAFF AND ACTIVITIES IN 1928

Administrative agency:
State department of health, bureau of child health, Richmond.
Funds expended: Federal, $25,574; State, $20,574; total, $46,148.
Staff:
Director (physician), 1 physician, 3 dentists (part year), 3 nurses (1 part
year), 1 midwife supervisor (nurse), 1 supervisor of mothers’ corre
spondence course (nurse), 4 stenographers, 3 clerks. Temporary assist
ants were employed as needed. Fifty county nurses and ten city nurses
were paid in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 146; infants and pre
school children registered and examined— 2,979. Many local physicians
cooperated by making examinations at these conferences. As it was not
possible to examine all school entrants at the conferences conducted by
the bureau an endeavor had been made in 1926 to interest parents in
taking their children to a private physician for a physical examination
before the child should enter school. The cooperation of superintendents
of schools, physicians, and parents had been enlisted and the experiment
tried on a small scale. The same plan was followed in four counties
and one city in the summer of 1927, with the result that about one-third
of the school entrants in three counties, more than nine-tenths in another
county, and approximately one-half of the school entrants in the city
were examined.
Defects found in children examined at conferences— 5,207; children having
defects— 2,500. Emphasis was placed on the examination of children who
would enter school for the first time in the coming fall, so the majority
of the children examined were 5 and 6 years of age. The dentists made
dental examination of 1,443 children at these conferences.
Conferences conducted by nurses, no physician present— 342; children
inspected— 4,167; mothers instructed in prenatal care— 1,609; visits to
conferences by children— 4,305.
New permanent child-health - centers— 13 established as a result of the
maternity and infancy work. They are supported by maternity and
infancy funds and by local organizations.
Classes for girls in care of infants and preschool children— 42 organized;
girls enrolled— 1,447; number completing course— 94; lessons in course—^
10 to 32.
Classes for mothers 23 organized; mothers enrolled— 478; lessons in
course— 10 to 32.
Classes for midwives— 40 organized, in 20 counties; midwives enrolled—
254; lessons in course— 8. The midwife supervisor conducted classes in
8 counties and assisted nurses in conducting classes in 12 additional
counties.
Home visits by nurses— 118,576 (prenatal cases seen, 1,444; postnatal cases,
1,337; infants, 4,137; preschool children, 8,328).
Maternity homes inspected— 4; inspections made— 4.
Community demonstration— 1, of a maternity and infancy public health
nursing program, in 3 counties.
Survey— 1, state-wide, of hospital facilities available for maternity care.
The bureau is cooperating in a study of maternal mortality being conducted in the State by the United States Children’s Bureau with the
indorsement of the State medical society.
Talks and lectures— 131.
Literature prepared— Feeding the Infant, The Baby (revised).
Literature distributed— 228,836 pieces.
142

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 19 2 8

143

Activities— Continued.
A correspondence course for mothers was conducted, for which 1,812
women enrolled during the year (plus 823 carried over from previous
year) ; lessons in course— 12, divided into two sections, for either of
which women may register if they do not wish to take the whole course;
number of women completing 12 lessons— 435; many others completed
one of the 6-lesson sections.
Two institutes for “ doctors’ helpers ” were conducted, one at the Uni
versity of Virginia (for white women), one at the Virginia Normal
and Industrial Institute (for colored women). The daily 5-hour ses
sions were divided into periods of two hours for maternity and infant
care, two hours for demonstrations in home nursing, and one hour for
personal hygiene. Physicians from the University of Virginia Medical
School and local physicians in Petersburg cooperated by giving lectures.
Attendance— 55 (15 white women, 40 colored women).
The bureau cooperated in parents’ institutes held in six communities
under local auspices.
Statistical study made— infant mortality, 1917-1922, as compared with that
of 1922-1927, in 23 counties.
Breast feeding was emphasized through instruction given to mothers by
the nurses, through a paper on the subject presented to the State
medical society, and through use of a breast-feeding slogan on the
bureau’s stationery.
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— 109; counties in which maternity and infancy
work was done during the year— 54; counties in which maternity and
infancy work has been done since the acceptance of the maternity and
infancy act— 97.
Since the beginning of the State’s cooperation under the maternity and
infancy act one county has assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The following organizations cooperated in the bureau’s work: State league
of women voters, advisory committee of the State medical society, Vir
ginia Polytechnic Institute (home-economics extension service), Coop
erative Education Association, and the American Red Cross.
An outstanding feature of the year’s program was the furtherance of the
work made possible through the cooperation of local physicians and of the
advisory committee of the State medical society.

TYPES OF WORK AND SOME RESULTS
The bureau of child health was established in the State department of health
in 1918. The State accepted the provisions of the maternity and infancy act
through legislative enactment approved by the governor on February 27, 1922.
The same medical director has been in charge of the work during the entire
period of cooperation with the Federal Government. A small central staff con
sisting of an additional physician and three nurses has conducted the general
field work the past few years.
Maternity and infancy funds have been granted to counties and communities
to assist with the salary and expenses of public-health nurses who have given
part of their services to maternity and infancy work. Forty to 50 nurses have
been thus employed in counties and 10 in cities in 1927 and 1928.
The bureau has had the advantage of cooperation by the State medical society,
the Virginia Polytechnic Institute, and the Cooperative Education Association
(through its division superintendents), the American Red Cross, and the State
league of women voters.
Because 60 public-health nurses were contributing some services to the ma
ternity and infancy work during 1928 their visits to homes of mothers and in
fants were especially prominent in the maternity and infancy program of the
State. Instruction to special groups, mothers’ correspondence courses, classes
for midwives, and institutes for “ doctors’ helpers ” disseminated further infor
mation on maternal and child care.
Literature on infant care, including that sent to parents of all infants whose
births were registered, has reached an increasing number of persons within the
past few years.

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1 44

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The study of maternal mortality sponsored by the State medical society*
which is being made in the State by the United States Children’s Bureau with
the cooperation of the State bureau of child health, is expected to furnish
valuable information.
The infant mortality rate has fluctuated during the period 1922 (the first
year of the State’s cooperation under the act) to 1927, the rate in 1927 (75
per 1,000 live births) being slightly lower than that in 1922 (77).
The maternal death rate shows a material decrease, the 1927 rate being the
lowest since Virginia was admitted to the United States birth-registration area.
The rates for both white and colored mothers were lower in 1927 than in 1922.
The rates for both urban and rural areas were also lower in 1927 than in
1922 ( 6.9 per cent lower for urban areas and 19.1 per cent lower for rural
areas), as is shown by the following figures:

Maternal mortality rates ( deaths of mothers from puerperal causes per 10,000
live Mrths)
State_______
W h ite Colored.
U rbanRural

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1922
71.8
58.3
101.7
111.9
61.2

1927
61.5
47.9
93.6
104.2
49.5

W A S H IN G T O N

STAFF AND ACTIVITIES IN 1928
Administrative agency:
State department of health, division of public-health nursing and child
hygiene, SG&ttlG*
Funds expended: Total, $5,000 (all Federal).
Staff:
Director (nurse, not paid from maternity and infancy funds), 1 stenog
rapher, 1 clerk (part time). Twelve physicians were employed as needed
to conduct conferences. One county nurse was paid from maternity and
infancy funds (half year).
Activities:
Child-health conferences conducted by physicians— 74; infants and pre
school children registered and examined— 3,152. Local dentists made
dental examinations at these conferences.
Defects found in children examined at conferences— 4,788; children having
defects— 1,079. Parents had approximately two-thirds of the defects
corrected.
New permanent child-health centers— 9 established as a result of the
maternity and infancy work. They are supported by local organizations.
Group demonstrations— at about a third of the child-health conferences,
of layettes, proper foods, preparation of formulas, and the giving of
sun baths.
The division is cooperating in a study of maternal mortality being con
ducted in the State by the United States Children’s Bureau with the
indorsement of the State medical society.
Campaigns—2 : (1) For prevention of diphtheria, in 3 counties. Plans
have been formulated for a state-wide campaign for prevention of
diphtheria. (2) For vaccination against smallpox, state-wide.
A state-wide May Day program was sponsored by the division, features of
which were health demonstrations, lectures, child-health conferences,
window displays, and radio talks.
Talks and lectures— 90. Some of these were given by pediatricians before
county medical societies to emphasize the value of periodic health exami
nations of children and were intended to stimulate local communities to
conduct child-health conferences at regular intervals.
Literature distributed— 18,114 pieces.
A 15-lesson correspondence course for mothers was conducted through the
extension bureau of the State university; mothers registered (including
48 carried over from previous year)— 126.
Nutrition work was done through instruction to individual mothers at
conferences. The extension service of the State agricultural college co
operated in the nutrition work, specialists conducting a number of nutri
tion classes for mothers of preschool children.
Exhibits conducted— approximately 55, on nutrition, sanitation, and hy
giene, at fairs and child-health conferences. The motion-picture film
Sun Babies was shown twenty-eight times. Exhibit material was lent
fourteen times.
Breast feeding was stressed in all conferences and lectures. Information
in regard to feeding was secured for 1,507 of the infants examined at the
conferences: 44 per cent were breast fed, 33 per cent partly breast fed,
and 24 per cent artificially fed.
Infants bom in the State during the year— 23,343; infants under 1 year of
age reached by the work of the division— 1,106 (exclusive of those reached
by literature distributed) ; preschool children reached— 2,046 (exclusive
of those reached by literature distributed).
145

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146

the

w elfare and

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

Activities— Continued.
Counties in the^ State— 39; counties in which maternity and infancy work;
was done during the year— 25; counties in which maternity and infancy
work has been done since acceptance of the maternity and infancy act—33T
Since the beginning of the State’s cooperation under the maternity and
infancy act five counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the division’s work three weight and measurement clinics
conducted by lay groups supervised by nurses were established, classes in
infant feeding were begun in connection with weight and measurement
clinics in several counties, courses of lectures for mothers were given in
three cities, and classes for mothers were conducted in two rural com
munities.
The following organizations cooperated in the division’s work: State agri
cultural college, State medical association, American Red Cross, State
federation of women’s clubs, parent-teacher associations, and preschool
circles. Their cooperation consisted largely of sponsoring child-health
conferences or assisting with them.
Among the outstanding features of the year’s work were the campaigns for
prevention of diphtheria and smallpox, the initiation of a study of maternal
mortality in cooperation with the United States Children’s Bureau, and lectures
by pediatricians before county medical societies.

TYPES OF WORK AND SOME RESULTS
The division of public-health nursing and child hygiene was established
in the State department of health in 1920. The State accepted the provisions
of the maternity and infancy act through legislative enactment approved by the
governor on March 16, 1923.
During the first few years of cooperation with the Federal Government a
physician directed the work of the division. Later a nurse served as director.
Prominent pediatricians have been employed on a part-time basis to conduct
child-health conferences and to lecture to county medical societies on maternal
and infant hygiene. Nurses paid from maternity and infancy funds have
been detailed to counties in a generalized nursing service. This has resulted
in the assumption by five counties of the maintenance of this type of nursing
service.
The division has had the benefit of cooperation from the State university
and the State agricultural college, the American Red Cross, the State medical
association, women’s organizations, and parent-teacher associations.
The major feature of the child-hygiene program has been the development
of interest in infant and child care through child-health conferences and
through visits to mothers, infants, and preschool children by the public-health
nurses.
The effect of the program is reflected in the decline of the infant mortality
rates. The rate for 1927 was the lowest the State has had since it entered
the birth-registration area (in 1917). In 1922, the year before cooperation under
the maternity and infancy act, 62 babies under 1 year of age died in every
1,000 born alive, whereas in 1927 the rate was 50, a saving of 12 babies in
every 1,000 bom alive in 1927 compared with 1922.
The maternal mortality rate has fluctuated from year to year. In 1922
the rate was 78.8 (puerperal deaths per 10,000 live births), whereas in 1927
the rate was 66.5. The lowest rate (60.2) was that of 1925. In no year
since the State’s cooperation under the maternity and infancy act has the
death rate from puerperal causes been so high as it was in 1922. Information
furnishing a basis for further effort toward reduction of maternal mortality
will no doubt be forthcoming from the study of maternal mortality now in
progress in the State.

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W E S T V IR G IN IA

STAFF AND ACTIVITIES IN 1928
Administrative agency:
State department of health, division of child hygiene and public-health nurs
ing, Charleston.
Funds expended: Federal, $18,414.42; State, $14,871.74; total, $33,286.16.
Staff:
Director (nurse, part time), 1 nurse, 1 vital-statistics field worker, 1 vitalstatistics clerk, 1 auditor (2 months, part time), 1 stenographer, 1 clerk.
Twenty-two county nurses in 16 counties were paid in full or in part from
maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 454; infants and pre
school children registered and examined— 3,557; visits to conferences—
5,5ia
New permanent child-health centers—21 established as a result of the
maternity and infancy work. They are supported by Federal, State, and
county funds.
Classes for girls in care of infants and preschool children— 83 organized;
girls enrolled— 1,212; number completing course—351 (report incomplete) ;
lessons in course— 12 to 16.
Classes for mothers— 53 organized; mothers enrolled plus those carried over
from previous year— 1,507; number completing course— more than 335
(report incomplete) ; lessons in course— 4 to 12.
Home visits by nurses— 12,814 (prenatal cases seen, 1,428; obstetrical cases,
72; postnatal cases, 1,399; infants and preschool children, 6,308).
Group demonstrations— 320, of various phases of maternal and infant care.
Surveys— 2 : (1) Cost of medical care. (2) Community health conditions
affecting children.
Campaigns— 5 : (1) For clean milk supply. (2) For examination of pre
school children and correction of their defects before the children should
enter school. (3) For observance of May Day as Child Health Day.
(4) For immunization against diphtheria and scarlet fever, inoculation
against typhoid fever, and vaccination against smallpox. (5) For early
diagnosis of tuberculosis.
Talks and lectures— 696.
Literature prepared— prenatal letters, form for community-health survey,
outline for organization of child-health conferences, outline for organiza
tion of nutrition work, score sheet for nutrition program.
Literature distributed— 74,583 pieces.
New names registered for prenatal letters— 1,677; prenatal letters dis
tributed— 1,285 sets.
A correspondence course for mothers was conducted, for which 6,344 women
were enrolled (plus 7,206 carried over from previous year). The course
consisted of letters and literature concerning the prenatal and preschool
periods sent at intervals; it differed from the usual correspondence course
in that answers to questions were not sent in by the mothers. When
expectant mothers register for the course they are sent first a series of
five prenatal letters a week apart. Many of the full-time county health
officers send letters to parents of newborn infants upon receipt of birth
certificates, offering to enroll the mothers for this course.
Nutrition work was done through nutrition classes and individual work
with mothers, through the motherhood correspondence course, and in
home visits. Plans have been made to launch a state-wide nutrition
program in cooperation with other State agencies.
Exhibits conducted— 2. The division was also represented in 5 exhibit
conducted by the bureau of public-health education of the State departs
ment of health. Exhibit material was lent 8 times.
147

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148

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Statistical studies made— maternal and preschool-child deaths, by counties;
public health nursing activities; women enrolled for motherhood corre^
spondence course, by counties.
Breast feeding was emphasized in talks and lectures given and in literature
distributed.
Infants born in the State during the year— approximately 45,000; infants
and preschool children reached by the work of the division— approxi
mately 16,000; expectant mothers reached— approximately 3,100.
Counties in the State— 55; counties in which maternity and infancy work
was done during the year— 39; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 50.
Since the beginning of the State’s cooperation under the maternity and
infancy act one city has assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.
As a result of the division’s work farm women’s clubs organized and con
ducted child-health conferences throughout eight counties. Local physi
cians made the examinations, and a nurse from the division’s staff
assisted at the conferences.
The division rendered advisory and supervisory assistance to local organi
zations upon request
The following organizations cooperated in the division’s work: State
department of education, State university (extension division), State
tuberculosis association, State league of women voters, farm women’s
clubs, and the parent-teacher association.

TYPES OF WORK AND SOME RESULTS
The division of child hygiene and public-health nursing was established in
the State department of health in 1919. The governor accepted the provisions
of the maternity and infancy act on February 6, 1922. This was followed by
legislative acceptance approved by the governor on April 13, 1923.
The same nurse has' directed the work of the division during the entire period
of cooperation, with the assistance of one or more nurses and clerical workers.
An increasing number of public-health nurses (22 in 1928) have been detailed
to counties and paid from maternity and infancy funds in proportion to the
amount of time given to maternity and infancy work.
Cooperation has been maintained with other branches of the State government
(the department of education and the State university), with the State' tuber
culosis association, women’s organizations, and the parent-teacher association.
Emphasis was placed on child-health conferences, classes for mothers in
infant and maternal care, classes for girls in infant care, motherhood corre
spondence courses, establishment of centers, and extension of work through the
development of county health departments and placing of county nurses.
Nitrate of silver for use in the prevention of ophthalmia neonatorum has been
distributed free by the use of maternity and infancy funds since 1926.
The division has assisted in campaign work for the State’s admission to the
United States birth and death registration areas, which was accomplished in
1925. The infant mortality rate was 80 in 1925 and 72 in 1927; that is, 8 fewer
babies died in every 1,000 born alive in 1927 than in 1925. The maternal mor
tality rate (puerperal deaths per 10,000 live births) for the State as a whole
was 61.5 in 1927 as compared with 63.3 in 1925. The rate in rural areas was
50.8 in 1925 and 46.8 in 1927; in urban areas the rate was 117.7 in 1925 and
130.3 in 1927.

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W IS C O N S IN

STAFF AND ACTIVITIES IN 1928
Administrative agency:
State board of health, bureau of child welfare and public-health nursing,
Madison.
Funds expended: Federal, $29,303.55; State, $22,751.62; total, $52,055.17.
Staff;
Director (physician), 4 physicians (1 part year), 4 nurses, 1 organizer
of infant-hygiene courses (part year), 1 demonstrator of infant-hygiene
classes, 1 publicity editor (part year), 1 vital-statistics field worker,
2 vital-statistics clerks (part year), 1 bookkeeper and filing clerk, 1 silvernitrate clerk (part year), 1 general clerk, 2 stenographers. One county
nurse was paid in part from maternity and infancy funds.
Volunteer assistants— 28 physicians, 171 nurses, 162 lay persons.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
434; expectant mothers registered and examined— 272; infants and pre
school children registered and examined— 6,824; visits to conferences by
expectant mothers— 303; visits by infants and preschool children— 11,437.
Defects found in children examined at conferences— 8,123; children having
defects— 6,065. Parents had defects corrected in approximately one-third
of the children.
New permanent combined prenatal and child-health centers— 20 established
as a result of the bureau’s maternity and infancy work. They are sup
ported by local, State, and maternity and infancy funds. Six of these
centers were the outgrowth of demonstration child-health conferences
conducted periodically by the bureau.
The promotion of infant-hygiene courses in the schools of the State has
been continued. Two workers gave full time to this activity (one for
half the year only). Demonstration courses were given in selected
schools, and wherever the teacher approved boys as well as girls were
included in the classes. Demonstration classes were given also before
rural mothers’ clubs, and the clubs in turn sponsored the introduction of
the course in the schools in their respective communities. The course is
given in many of the schools of the State, and as in former years the
State board of health issued certificates to pupils completing the course.
During the year 4,901 pupils completed the course in schools that re
ported to the State board of health. Certificates are not issued to stu
dents above high-school grades.
Home visits by nurses— 1,110 (prenatal cases seen, 48; postnatal cases, 53;
infants, 464; preschool children, 1,264).
Community demonstration— 1, of prenatal care and care of the preschool
child in a public health nursing program, covering 1 county.
Group demonstrations— 295, to students, teachers, women’s clubs, and other
groups, on various phases of infant and preschool-child care.
Surveys— 2 : (1) Of birth registration, state-wide. From November, 1927,
a field worker covered the State, county by county. Local registrars,
clergymen, and newspaper editors were interviewed, and the importance
of birth registration was stressed. (2) Of maternal mortality.
In
September, 1927, the State medical society passed a resolution indorsing
a proposed intensive study of maternal deaths. One physician was
detailed to give full time to this work, which was begun late in Feb
ruary, 1928. By the close of the fiscal year 172 deaths had been studied.
Talks and lectures— 143.
Literature prepared-pamphlets on goiter (revised), diet charts, prenatal
letters.
Literature distributed— 413,191 pieces.
149

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150

the welfare and hygiene of maternity and infancy

Activities— Continued.
New names registered for prenatal letters— 2,390 ; prenatal letters dis
tributed— 3,168 sets.
Exhibits conducted— 6, consisting of layettes, literature, and posters at thé
State fair and five county fairs. Exhibit material prepared— spot maps,
graphs.
Breast feeding was stressed in individual instruction to mothers at health
centers, in lectures, and in the literature that was sent to parents with
each birth-registration card. About 90 per cent of the children who
attended the health centers were breast fed.
Infants under 1 year of age reached by the work of the bureau— 62,630;
preschool children reached— 5,343; expectant mothers reached— 3,488.
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— 71; counties in which maternity and infancy work
was done during the year— 66; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 71.
Since the beginning of the State’s cooperation under the maternity and
infancy act 22 counties and communities have assumed the responsibility
for maternity and infancy work begun with maternity and infancy funds.
As a result of the bureau’s work many permanent child-health centers were
established by local agencies, and county-wide campaigns for the pre
vention of goiter and diphtheria were begun in a number of counties.
The following organizations cooperated in the bureau’s work: State fed
eration of women’s clubs, State federation of colored women’s clubs, State
league of women voters, the American Red Cross, and the parent-teacher
association. These organizations helped to finance permanent health
centers and referred names of mothers to the bureau for prenatal
instruction.
Among the outstanding achievements of the year were the securing of con
tinued local support for health centers already established and the arrangement
with local communities to assume responsibility for other centers which had
previously been operated by the bureau.

TYPES OF WORK AND SOME RESULTS
The bureau of child welfare and public-health nursing was established in the
State board of health in 1919. The governor accepted the provisions of the
maternity and infancy act on December 22, 1921. This was followed by legisla
tive acceptance approved by the governor on May 18, 1923.
The program of maternal and infant welfare is conducted by a State staff
of physicians, nurses, and other workers. Cooperation has been given by local
lay groups and by various state-wide organizations of women (both white and
colored), the American Red Cross, and the parent-teacher association. Coopera
tion between the State departments of health dnd of public instruction has
made possible the introduction of courses of infant hygiene in the curriculum
of the public schools. One or two organizers or instructors from the staff of
the bureau of child welfare and public-health nursing have been detailed to
organize the classes in the schools and to give instruction in infant care to
teachers who conduct the course. A special effort has been made to include the
work in both graded and rural schools.
Early in the history of the State administration of maternity and infancy
funds a “ child-welfare special,” or health truck, was placed in the field to carry
a physician and nurse who would examine children and disseminate information
on child and maternal care in the rural districts. The special was retired from
service in October, 1927. This itinerant service, together with the organizing
and conducting of demonstration centers by the State staff, has resulted in the
establishment of many permanent child-health and prenatal centers, some of
which are now supported by local funds. The number of permanent centers
organized has increased each year; 20 were formed in 1928. Cooperation of
local women’s groups has made their financing possible.
In October, 1927, a study of maternal deaths, indorsed by the State medical
society, was begun in the State. The United States Children’s Bureau will
cooperate in tabulating, analyzing, and publishing the data collected.
The State began free distribution of nitrate of silver for the prevention of
ophthalmia neonatorum in 1911, and maternity and infancy funds have been

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151

used to assist in the distribution of this prophylactic since 1923. A survey made
before this date showed ophthalmia neonatorum to be the cause of blindness of
”25 per cent of the total number of children in the schools for the blind. No
survey has been made since, but reports indicate that the number of such cases
has decreased at least 75 per cent.
The infant mortality rate in 1917 (the year in which the State was admitted
to the United States birth-registration area) was 78 infants under 1 year of
age dying in every 1,000 born alive. The infant mortality rate in 1927 was

Distribution

prenatal and child-health
W isconsin, 1927—28

centers,

cou n ties;

59, the lowest since the State entered the birth-registration area. During the
period of operation of the maternity and infancy act the rates have been as
follows: 1922, 71; 1923, 70; 1924, 65; 1925, 67; 1926, 69; 1927, 59. Twelve
more babies survived to 1 year of age in every 1,000 born alive in the State in
1927 than in 1922, the first year of operation of the maternity and infancy act.
Maternal mortality rates were lower in 1927 than in 1922. For every 10,000
live births in 1922 the number of mothers who died was 56; in 1927 the number
of those who died was 53.

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WYOMING
STAFF AND

A C T IV IT IE S IN

1928

Administrative agency:
State department of public health, division of maternal and infant welfare,
Cheyenne.
Funds expended: Federal, $5,057.12; State, $5,000; total, $10,057.12.
Staff:
Director (State health officer serving), 1 vital-statistics clerk, 1 clerk
(part year). Five county nurses were paid from maternity and infancy
funds (part year).
Volunteer assistants— 49 physicians, 15 dentists, 15 nurses, 66 lay persons.
Activities i
Child-health conferences conducted by physicians— 54; infants and pre
school children registered and examined— 1,252.
Defects found in children examined at conferences— 631.
Conferences conducted by nurses, no physician present— 7 ; mothers attend
ing— 67.
Classes for girls in care of infants and preschool children— 10 organized
by a nurse lent to the division by the United States Children’s Bureau;
girls enrolled— 147; number completing course— 106; lessons in course— 6.
Classes for mothers— 12 organized by a nurse lent to the division by the
United States Children’s Bureau; mothers enrolled— 463; number com
pleting course— 338; lessons in course—6.
Home visits by nurses— 3,373 (to prenatal cases, 401; obstetrical cases, 19;
postnatal cases, 258; infants, 908; preschool children, 1,208; and follow
up visits to other agencies— 579).
Group demonstrations— 22, of various phases of maternal and infant care.
The State health officer made a special effort to impress upon all persons
with whom he came in contact at various health conferences over the
State the urgency of immunization against diphtheria, inoculation against
typhoid fever, and vaccination against smallpox.
Talks and lectures— 150.
Literature prepared— several articles on immunization. These were dis
tributed at conferences and by the nurses.
Literature distributed— approximately 10,900 pieces.
Nutrition work was done through talks and the distribution of literature.
Breast feeding was stressed in instruction given at conferences and in
home visits.
Infants born in the State during the year— 4,456; infants under 1 year of
age reached by the work of the division (exclusive of those reached by
literature distributed)— 908; preschool children reached— 1,208; expec
tant mothers reached— approximately 400.
The nurses working in rural areas checked the registration of births of the
infants with whom they came in contact and had births registered and
certificates issued for those not registered; they were appointed deputy
registrars for this purpose.
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— 23; counties in which maternity and infancy work
was done during the year— 22; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 23.
1
The parent-teacher association and other organizations (not reported by
name) cooperated in the division’s work.
Among the outstanding features of the year’s work were the stressing of the
importance of hygiene work for rural children and of the need for immunization
against diphtheria, inoculation against typhoid fever, and vaccination against
smallpox.
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T Y P E S O F W O R K A N D SO M E R E SU LT S

f The division of maternal and infant welfare was established in the State
department of health in 1922. The governor accepted the provisions of the
maternity and infancy act on January 16, 1922. This was followed by legisla
tive acceptance approved by the governor on February 20, 1923.
Changes in the State administration, and resulting changes in the personnel
of the State department of health have interrupted the continuity of the mater
nity and infancy program.
Early in 1927 plans were made to cover the State with a nursing service by
assigning several counties to each of the nurses, with the exception of one
county which had a full-time county unit and to which a nurse paid by ma
ternity and infancy funds had been detailed. Five nurses paid from ma
ternity and infancy funds were assigned to the field work, and a nurse lent by
the United States Children’s Bureau assisted. The program of work for the
nurses included visits in the homes of infants, preschool children, and expectant
mothers, arranging for child-health conferences, improving birth registration,
giving instruction to classes or groups of girls in infant and child care and to
groups of women in infant and prenatal care, and disseminating information
on the importance of immunization against diphtheria, vaccination against
smallpox, and inoculation against typhoid fever. The five nurses have continued
this program in 1928, under the direction of the State health officer.
The division has had the benefit of cooperation from the parent-teacher asso
ciation, women’s clubs, and several other organizations, and of volunteer assist
ance from a number of professional and lay workers.
The sending of literature on infant care from the division of maternal and
infant welfare to parents of all children whose births are registered was con
tinued during 1928.
In 1922, the first year of the State’s cooperation under the maternity and
infancy act, 79 babies in every 1,000 born alive died in their first year of life:
in 1927, 69 died in their first year.
48278°— 29------11

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FEDERAL ADMINISTRATION
FED ER AL STAFF

The maternity and infant-hygiene division of the United States
Children’s Bureau, one of its major divisions, was created in 1922
to assist in the administration of the maternity and infancy act. The
bureau has kept in touch with the work of the States through reports
from the States, staff visits to the States, and the annual conference
o f directors of the State bureaus and divisions in charge of the local
administration of the act. Reports from the States included budgets
and plans submitted for approval to the Federal Board of Maternity
and Infant Hygiene, an annual report on activities, and semiannual
financial reports. Copies of monthly or other reports made by the
directors to their respective State health officers also are received
from many States.
During the year under review 10 persons (4 physicians, 2 publichealth nurses, an auditor, and 3 clerical workers) were regularly
employed full time in the maternity and infant-hygiene division.
Seven additional physicians were employed as the maternal-mor
tality study was begun in successive States. (See p. 157).
The physicians on the staff included: (1) The director, who was
the executive officer of the division and who gave consulting service
to State directors in the field; (2) an associate physician, whose
duties included research, consultant service, answering of special
correspondence, and preparation of literature and a newsi-letter;
(3) a physician in special charge o f details of the maternal-mortality-^jL
study being conducted by the bureau; and (4) a negro physician, ^
who gave instruction to negro midwives in regard to midwifery pro
cedure and the reporting of births. Two part-time consultants in
child hygiene and a part-time consultant in obstetrics were also on
the bureau’s staff. The public-health nurses advised and assisted in
State programs and in campaigns for the promotion of birth regis
tration and did other special pieces of field work as requested by the
States. The auditor has audited the accounts of cooperating State
agencies. The regular office staff consisted of a secretary and two
stenographers.
CONFERENCE OF STATE DIRECTORS

The fifth annual conference of directors of State bureau^ and
divisions administering the Federal maternity and infancy act was
held at the Children’s Bureau in Washington, April 2 to 6, 1928.
Representatives attended from 43 cooperating States and the Terri
tory of Hawaii. State health officers were present from five States—
Arkansas, Michigan, Oregon, Utah, and Wyoming. In addition to
the 35 directors a number of associate directors, supervising nurses,
and other members of the State bureaus and divisions were present.
Representatives from the three noncooperating States also attended
the conference, likewise a number of representatives from private
154

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organizations for^the furtherance of child welfare or hygiene or re
f l a t e d purposes. The total number of persons present was 82, not
^including field workers of the maternity and infant-hygiene division
wno returned to Washington for the conference and other members
or the Children’s Bureau staff. This annual conference has been
extremely valuable in developing a better understanding o f maternal
and infant hygiene, methods of cooperating with local communities,
and. methods of interesting parents in better care for their children,
also in solving problems of office administration.
The first three days of the conference were devoted to discussion
of the following general subjects: Care during delivery and confine
ment, reduction of the maternal and infant mortality rates in rural
areas of certain States, reports on phases o f maternity care in ‘two
foreign countries, causes and prevention of neonatal mortality, prog
ress of the study of maternal mortality, and general administrative
problems. Members of the Children’s Bureau’s consulting commit
tees on pediatrics and on obstetrics and other prominent physicians
leaders in public health, health officers, and nurses took part in the’
program and discussions. The papers, some of which have been
printed in professional journals, form part of the conference pro
ceedings to be published by the Children’s Bureau. A limited num
ber of copies will be available for distribution, also reprints of
several of the papers read.
The fourth day of the conference was spent in Philadelphia visit
ing the Children’s Hospital at the invitation of Dr. Howard Childs
Carpenter, the representative of the American Child Health Asso
ciation on the bureau’s consulting pediatric committee. The formal
part of the program consisted of a lecture and demonstration on
prevention of children’s diseases and inspection of the well baby
by Doctor Carpenter; a lecture and demonstration on the mental
examination of an infant, by Mrs. Dorothy K . Hallowell, psycholo
gist of the Philadelphia Children’s A id Society | and a lecture illus
trated with lantern slides on supervision of the health of dependent
children, by Mr. J. Prentice Murphy, executive secretary o f the
Philadelphia Children’s Bureau.
The fifth day of the conference was devoted to a round-table dis
cussion in Washington of field and statistical problems connected
with the maternal-mortality study. This was participated in by 15
representatives of States and by members of the Children’s Bureau
staff who are conducting this study in several States.
PROMOTION OF BIRTH REGISTRATION

The Children’s Bureau has continued cooperation with the National
Committee to A id Completion of the Registration Area before 1930
by assisting in the promotion of birth registration in States having
registration campaigns within the year under review. The director
of the maternity and infant-hygiene division is a member of the
committee, and at the request of the United States Bureau of the
Census and of the respective State departments of health the Chil
dren’s Bureau detailed members of its staff to several States for
varying periods. One staff physician assisted in promoting the reg
istration of births attended by negro midwives in Georgia and Texas.

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156

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The consulting public-health nurse gave assistance in Oklahoma and
later in Texas during nearly half the year under review. A membem
of the statistical division of the Children’s Bureau was lent to Col-J
orado, Oklahoma, and Texas for field work in connection with cam
paigns for improvement of birth registration in those States.
SPECIAL ASSISTAN CE TO STATES

Special consulting service from members of the Children’s Bureau
staff is frequently requested by State bureaus and divisions of child
hygiene or welfare. During the year under review a total of 41
visits were made to States by physicians and nurses from the ma
ternity and infant-hygiene division to advise with members o f the
State staffs regarding the maternity and infancy program or the
maternal-mortality study. The director of the maternity and infanthygiene division spent short periods in Colorado, Idaho, Kansas,
Maine, Michigan,, Montana, Nebraska, Nevada, New! Hampshire,
Oregon, Rhode Island, Utah, Washington, W est Virginia, and
Wyom ing, conferring with State administrators and reviewing types
of work in these States. Special trips in the interest of maternity
and infancy work were made to Illinois, Maryland, New York, Ohio,
Tennessee, and W est Virginia. The physician in charge o f the
details of the field work of the maternal-mortality study gave con
sulting service in Alabama, California, Kentucky, Michigan, Minne
sota, Nebraska, Oregon, Virginia, Washington, and Wisconsin.
Eight physicians employed for varying periods in the maternalmortality study were lent to Alabama, Kentucky, Maryland, Ne
braska, Oregon, Rhode Island, Virginia, and Washington.
Assistance from the Children’s Bureau is frequently sought by
individual States for special pieces of work undertaken or under
consideration, and several members of the maternity and infanthygiene division or other divisions of the bureau have been detailed
to give service during the past year. One of the consultants in
child hygiene assisted in conducting demonstration child-health con
ferences for a short period in Nevada. Later he conducted demon
stration child-health conferences before groups of physicians and
local medical societies at 25 points in the State, with an enrollment
of 867 physicians; 480 physicians and 80 other visitors were in at
tendance. Another consultant lectured and assisted at a publichealth conference in W est Virginia. The consultant in obstetrics
conducted a course in obstetrics in Oklahoma for physicians during1
an entire month. The number of physicians enrolled was 352, the
total attendance of physicians was 545, and 131 nurses (and a few
other visitors) came for the lectures. The midwife instructor (a
negro woman physician) conducted courses of instruction for negro
midwives in Georgia and Texas, aided promotion of birth registra
tion in those States, and assisted at the Tuskegee health institute.
A staff nurse taught classes for mothers in South Dakota and con
ducted a demonstration maternity and infancy nursing service (cov
ering several counties) in Wyoming. The consulting public-health
nurse gave consulting nursing service in Kansas, North Carolina,
North Dakota, South Carolina, Texas, and Vermont and assisted
with the birth-registration campaigns in Oklahoma and Texas. A

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statistician from the Children’s Bureau gave assistance in analysis
o± maternal and infant mortality figures in Kentucky, North Caro
lin a , and Virginia, and another member of the statistical division’s
stair assisted m promoting birth registration in Colorado, Oklahoma
and lexas.
’
Frequent assistance has been received from the bureau’s two con
sulting committees—-the pediatric committee and the obstetrical committee— whose members have given generously of their time and
thought to various questions of importance arising in connection
with investigations undertaken by the bureau (as the maternalmortality study) publications planned or in preparation, and prob
lems laid before the bureau by individual States.
RESEARCH A N D PUBLICATIONS
S T U D Y O F M A T E R N A L M O R T A L IT Y

The study of maternal mortality (for which a plan of work
schedules, and instructions were made in 1926 by the consulting
obstetrical committee of the Children’s Bureau at the request of the
bureau, following discussion of the project at the 1926 conference
o± directors of State bureaus and divisions of child hygiene) was
under way m 12 States during the year under review ? Alabama,
Kentucky, Maryland, Michigan, Minnesota, Nebraska, New Hamnslnre’ Oregon, Rhode Island, Virginia, Washington, and Wisconsin
I Ians for beginning the study after the close of the fiscal year 1928
WT ^ di0]?.ted m three ^ ^ i o n a l States: California, North Dakota
Oklahoma.- In each of these States the work was undertaken
the request of the State board of health and with the indorsement
of the State medical society or association. Facts in the birth and
fcdeath certificates filed in the State bureaus of vital statistics afford
*the preliminary data, and the State bureaus are giving generous
cooperation in work involved in this phase of the study! Further
information is obtained by medical investigators who are inter
viewing the physician, midwife, or other attendant at birth for
every woman who has died in childbirth within the two years selected
for the period of the study—January, 1927, to January, 1929. The
hospital record is also secured for any of these women having hos
pital care. In three States the physicians conducting the study are
members of the staffs of the State bureau or division or child hygiene •
members of the Children’s Bureau staff have been assigned to tta
work in the remaining nine States.1 Information concerning ap
proximately 7,000 deaths will have been obtained when this,investi
gation is completed. The data will be compiled, analyzed, and pub
lished by the Children’s Bureau.
F
S T U D Y O F N E O N A T A L M O R T A L IT Y

A n investigation to obtain certain basic facts in regard to neonatal
deaths is being made for the Children’s Bureau. Preliminary study
to determine methods and schedules was begun in January, 1928 in
cooperation with the pediatric, obstetrical, and pathological departII In California, North Dakota, and Oklahoma physicians from the staffs o f the ehiiri
hygiene divisions will do the medical interviewing.
sta s 01 tae cm id"

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158

THE

w elfare and

h y g ie n e

of m a t e r n it y a n d in f a n c y

ments of the school of medicine of Yale University. A t the close of
the year under review 100 newborn infants had been examined cm
the first day of life and reexamined on approximately the thirdyi
tenth, fourteenth, and forty-second days. Complete pathological
study was made of 8 infants who died within their first 42 days of
life. Reexamination at 1 year of age will be made. To facilitate*
statistical analysis the details of the examinations, together with
family, prenatal, natal, and postnatal histories, are being recorded
on carefully planned schedules. Effort has been made to include
all data that may possibly throw light on any of the obscure illnesses
of this period.
S T U D Y O F R IC K E T S

The material collected in a three-year demonstration of community
control of rickets at New Haven, Conn., conducted by the Children’s
Bureau in cooperation with the pediatric department of Yale Uni
versity School of Medicine and the New Haven Department of
Health has been in process of analysis during the year ended June
30,1928. Careful study is being made of the significance of the mild
est forms of rickets as well as of the more severe and obvious forms
in relation to the growth, nutrition, diet, and general health and
development of the child. Cod-liver oil and sunlight are being
studied in relation to the prevention and control of rickets, and case
studies of certain groups of children are being made.
This study has furnished a larger number of rontgenograms show
ing the centers of ossification in the wrists of children under 5 years
of age than have been available for study, and the-rontgenograms
afford a valuable source for determining more exactly the beginning
of the growth of the bone. Therefore in connection with the general
analysis the number of ossification centers in the wrist has been
studied in relation to age, sex, race (negro or white) height, weight^
and rickets.
.
.
Statistical analysis is being made o f the material obtained in a
study o f rickets in Porto Rico in January and February, 1927. The
tabulation of the material of the clinical and Röntgen examinations
and the interviews with the mothers o f the 584 children under 3 years
of age who were examined is practically completed. A s children
born in a tropical country and known to live much of the time out of
doors and in houses whose windows are unglazed probably receive
antirachitic treatment in a natural manner and have as normal bone
growth as it would be possible to find, the rontgenograms should
establish- a* standard of normality valuable in the further interpreta
tion of those made in New Haven. The rontgenogram diagnosis for
509 of the children was normal. Marked active rickets was apparent
for 1 o f the 584 (about half of whom were under 1 year of age).
Evidence of very slight rickets definitely under control appeared for
three children, and evidence o f moderate healed rickets for a fifth child
(who until three months before the examination had lived in New
York C ity).
For 70 the rontgenogram diagnosis was doubtful.
The nutrition of the children was on the whole only fair. The diets
of their mothers, as indicated by that on the day before the interview,
were found to be generally poor; only 10 per cent were rated as

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FEDERAL ADMINISTRATION"

159

good, 40 per cent as fair, and 50 per cent as poor or very poor. The
inadequacy of the diets of both mothers and children is of interest in
view of the almost negligible amount of rickets found among these
Porto Rican children. Analysis of the children’s growth in relation
to diet, rickets, and sunlight is being made and will be included in
the report.
S T IL L B IR T H S A N D N E O N A T A L M O R T A L IT Y IN M IN N E A P O L IS

Tabulation of the findings of approximately 1,000 stillbirths and
neonatal deaths in Minneapolis, Minn., is being made by the Chil
dren’s Bureau in cooperation with the University of Minnesota. The
material includes gross and microscopic findings of the autopsies of
stillborn infants and of infants who died within the first two weeks
o f life. The history o f the mothers’ previous pregnancies is part o f
the record, as well as the history of the pregnancies resulting in the
children that came to autopsy and the details of labor and puerperium. The prenatal care received will be studied in relation to
the autopsy findings.
R E L A T IO N O F P O S T U R E T O P H Y S IC A L F IT N E S S

The report of the 2-year study o f the results of posture training in
a group o f children 5 to 18 years of age made in elementary schools
of Chelsea, Mass., has been completed and will be published as one of
the bureau’s bulletins. These children did not differ from other
children in the school except that they were given special training in
posture in addition to the regular physical-education exercises in the
curriculum. Changes observed in the physical characteristics of the
children who received posture training are compared with those found
among children of similar nationality and age distribution in other
Tooms of the same grade of the school who received no special training.
CARE

O F T H E P R E S C H O O L C H IL D — L E S S O N M A T E R IA L

A series of outline lessons on the care of the preschool child for
the use o f self-directed study clubs, some of which were prepared
by the maternity and infant-hygiene division of the bureau and dis
tributed in mimeographed form in the previous year; were issued in
convenient printed form during the year under review. In addition
to the list of references the set contains nine lesson leaflets on the
following subjects: Health examination, physical defects, teeth, nu
trition, food likes and dislikes, posture, need of sunshine and open
air, behavior, and protection against communicable diseases.
N E W S -L E T T E R

Several news-letters were prepared in mimeographed form and sent
at intervals to the State bureaus and divisions of child hygiene or
welfare. Included in these news-letters were abstracts of reports
o f scientific work in fields germane to maternity and infancy work,
brief reviews of new publications, items of interest reported by State
bureaus and divisions and by the Federal division of maternity and
infant hygiene, and news from foreign fields of related work.

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160

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
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
free to persons requesting single copies, and limited numbers are sent
to the States for free distribution. During the year under review
a total of 1,262,431 popular publications were distributed to mothers.
Monthly allotments of Prenatal Care, Infant Care, and Child Care
are supplied to State bureaus and divisions of child hygiene or wel
fare, also to a few county and city boards of health. Many States
buy additional copies from the Government Printing Office. From
the dates of their publication more than 8,000,000 of these three bulle
tins and of Child Management— the next most popular bulletin—
have been distributed. The bureau’s distribution of these bulletins
and others of the more widely used publications during the year
ended June 30, 1928, was as follows:
Bulletins.— Prenatal Care, 159,797; Infant Care, 419,950; Child
Care, 144,519; Child Management, 48,473.2
Folders.— Minimum Standards of Prenatal Care, 46,302; W h y
Drink Milk? 34,238; W hat Builds Babies? 59,459; Sunlight for
Babies, 94,882; Breast Feeding, 56,711; Keeping the W ell Baby W ell,
84,775.
Dodgers.— Books and Pamphlets on Child Care, 9,150; Is Your
Child’s Birth Recorded ? 12,446 ; Feeding the Child, 19,452 ; W hat Do
Growing Children Need? 26,381.
Small charts.— Baby’s Daily Time Cards, 26,818 sets.
M O T IO N P IC T U R E S A N D

E X H IB IT M A T E R IA L

The Children’s Bureau has posters, motion pictures, film strips
for use in automatic and hand projectors, and other exhibit m a te r ia l»
that may be borrowed. (See p. 179.) During the year 355 ship
ments of exhibits were sent on request to international, National,
State, and local agencies, including the American Medical Associa
tion and other medical societies, public-health services, boards of
health, child-welfare societies, fraternal societies, educational insti
tutions, Young Women’s and Young Men’s Christian Associations,
the American Red Cross, Boy Scout Troops, Camp Fire Girls,
women’s clubs, parent-teacher associations, social-service organiza
tions, and State and county fairs.
A t the request o f the American Medical Association the bureau
cooperated with the association in the preparation of a set of 10
colored posters dealing with such subjects as prenatal care, birth reg
istration, breast feeding, care of the baby, and diet. The posters
will be distributed by both organizations. Several other new sets
of posters were added to the bureau’s collection, and permission
to reproduce several of the bureau’s posters was granted to a number
of State tuberculosis associations and educational institutions.
3 The wide distribution o f Infant Care was made possible through a special appropriation
fo r the purpose. The com paratively limited distribution o f Child Management was due
to its being out o f print a part o f the year. The orders for sale o f these four bulletins
by the Government Printing Office in the fiscal year ended June 30, 1928, were as follow s :
Prenatal Care, 55 ,000 ; Infant Care, 130,000; Child Care, 33,500; Child Management,
78,700.

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FEDERAL ADMINISTRATION

161

The bureau produced during the year a new 1-reel motion picture,
The Best-Fed Baby, to illustrate the advantages o f breast feeding
over artificial feeding. In preparing the scenario and producing
the film the bureau had the cooperation of the New York State Board
of Health through the director of its division of maternity, infancy,
and child hygiene and the assistance of one o f its consultants who
is a well-known pediatrist. Advice was given also by a pediatrist
from Oregon who is an authority on breast feeding. Before being
released the film was reviewed at the 1928 conference of State di
rectors of maternity and infancy work. The bureau also produced
a new film strip entitled “ The Preschool Days of Betty Jones,”
which shows the essentials of care for the preschool child.

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APPENDIXES
APPENDIX A.— TEXT OF THE ACT FOR THE PROMOTION OF THE
W ELFARE AN D HYGIENE OF M ATERN ITY AND IN FANCY AND
OF SUPPLEM ENTARY LEGISLATION
[S. 1039— Sheppard-Towner A ct; Public 97— 67th Congress; 42 Stat. 224]
An A ct For the prom otion o f the welfare and hygiene o f maternity and infancy, and for
other purposes

B e it enacted 6y the Senate and House of Representatives of the United States
of America in Congress assembled, That there is hereby authorized to be appro
priated 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.
S ec . 2. For the purpose of carrying out the provisions of this Act, there is
authorized to be appropriated, out of any moneys in the Treasury not otherwise
appropriated, for the current fiscal year $480,000, to be equally apportioned
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 man
ner hereinafter provided : Provided, That there is hereby authorized to be appro
priated 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 pro
portion which their population bears to the total population of the States of the
United States, according to the last preceding United States census : And pro
vided further, That no payment out of the additional appropriation 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 expenditures in
that State until the close of the succeeding fiscal year.
S eo . 3. There is hereby created a Board of Maternity and Infant Hygiene,
which shall consist of the Chief of the Children’s Bureau, the Surgeon General
of the United States Public Health Service, and the United States 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.
Sec. 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 division
in its State agency of health, the said State agency of health shall administer
the provisions of this Act through such divisions. If the legislature of any State
has not made provision for accepting the provisions of this Act the 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

163

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164

th e

w elfare

and

h y g ie n e

m a t e r n it y

and

in f a n c y

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.
S e c . 6. Out of the amounts authorized under section 5 of this act the Chil
dren’s Bureau is authorized to employ such assistants, clerks, and other per
sons in the District of Columbia and elsewhere, to be taken from the eligible
lists of the Civil Service Commission, and to purchase such supplies, material,
equipment, office fixtures, and apparatus, and to incur such travel and other
expenses as it may deem necessary for carrying out the purposes of this act.
S e c . 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. If these plans shall
be in conformity with the provisions of this act and reasonably appropriate
and adequate to carry out its purposes they shall be approved by the board and
due notice of such approval shall be sent to the State agency by the chief of
the Children’s Bureau.
Sec. 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.
Sec. 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; (3) the
amount, if any, that has been appropriated by the legislature of the State for
the maintenance of the services and facilities of this act, as provided in sec
tion 2 hereof ; and (4) the amount to which the State is entitled under the pro
visions of this act. Such certificate, when in conformity with the provisions
hereof, shall, until revoked as provided in section 12 hereof, be sufficient
authority to the Secretary of the Treasury to make payment to the State in
accordance therewith.
Seo. 11. Each State agency cooperating with the Children’s Bureau under
this act shall make such reports concerning its operations and expenditures
as shall be prescribed or requested by the bureau. The Children’s Bureau
may, with the approval of the board, and shall, upon request of a majority of
the board, withhold any further certificate provided for in section 10 hereof

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165

APPENDIXES

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 shall give notice in writing to the authority designated to represent
the State, stating specifically wherein said State has failed to comply with
the provisions of this act.
S e c . 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.
S e c . 13. The Children’s Bureau shall perform the duties assigned to it by
this act under the supervision of the Secretary of Labor, and he shall include
in his annual report to Congress a full account of the administration of this
act and expenditures of the moneys herein authorized.
Sec. 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]
An A ct T o extend the provisions o f certain laws to the T erritory o f Hawaii.
*

Sec. 3. The Territory of Hawaii shall be entitled to share in the benefits of
the act entitled “Am act for the promotion of the welfare and hygiene of mater
nity and infancy, and for other purposes,” approved November 23, 1921, and
any 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 Act To authorize fo r the fiscal years ending June 30, 1928, and June 30, 1929, appro
priations fo r carrying out the provisions o f the A ct entitled “ An A ct fo r the prom otion
o f the w elfare and hygiene o f maternity and infancy, and fo r other purposes,” approved
November 23, 1921, and fo r other purposes.

B e it enacted by the Senate and House o f 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 sec
tion and inserting in lieu thereof the words “ for the period of seven years.”
Sec. 2. That said act entitled “An act for the promotion of the welfare and
hygiene of 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.

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APPEN DIX B.— ADM INISTRATIVE AGENCIES AND OFFICERS
State administrative agencies and names of the executive officers for the admin
istration of the act for the promotion of the welfare and hygiene of maternity
and infancy (as of June SO, 1928)
State (and Territory)

Administrative agency and department

Bureau of child hygiene and public-health nursing,
State board of health (Montgomery).
Arizona......... - .......... Child-hygiene division, State board of health
(Phoenix).
Arkansas__________ Bureau of child hygiene, State board of health (Little
Rock).
California..-........... Bureau of child hygiene, State department of health
(San Francisco).
Colorado____ ____ _ Child-welfare bureau, State department of public
instruction (Denver).
Connecticut8______ Bureau of child hygiene, State department of health
(Hartford).
Delaware__________ Division of child hygiene, State board of health
(Dover).
Florida..................... Bureau of child hygiene and public-health nursing,
State board of health (Jacksonville).
Division of child hygiene, State board of health
Georgia...............
(Atlanta).
Hawaii____________ Division of maternity and infancy, Territorial board
of health (Honolulu).
Idaho....................... Bureau of child hygiene, State department of public
welfare (Boise).
Illinois 8___________ Division of child hygiene and public-health nursing.
State department of public health (Springfield).
Indiana.............. ...... Division of infant and child hygiene, State board of
health (Indianapolis).
Iowa...................... . Division of maternity and infant hygiene, State
University of Iowa, State board of education (Iowa
City).
Kansas.................... Division of child hygiene, State board of health
(Topeka).
Kentucky................ Bureau of maternal and child health, State board of
health (Louisville).
Louisiana.............. . Bureau of child hygiene, State department of health
(New Orleans).
Maine.............. ........ Division of public-health nursing and child hygiene,
State department of health (Augusta).
Maryland-------------- Bureau of child hygiene, State department of health
(Baltimore).
Massachusetts 8 ___ Division of hygiene, State department of public
health (Boston).
Michigan......... ........ Bureau of child hygiene and public-health nursing,
State department of health (Lansing).
Minnesota........... ... Division of child hygiene, State department of health
(Minneapolis).
Mississippi________ Bureau of child hygiene and public-health nursing,
State board of health (Jackson).
Missouri__________ Division of child hygiene, State board of health (Jef
ferson City).
Montana.................. Child-welfare division, State board of health (Hel
ena).
Nebraska__ _______ Division of child hygiene, bureau of health, State de
partment of public welfare (Lincoln).
Nevada___________ Child-welfare division, State board of health (Reno).
New Hampshire___ Division of maternity, infancy, and child hygiene,
State board of health (Concord).
New Jersey.............. Bureau of child hygiene, State department of health
(Trenton).
New Mexico_______ Division of child hygiene and public-health nursing,
bureau of public health, State department of pub
lic welfare (Santa Fe).
New York_________ Division of maternity, infancy, and child hygiene,
State department of health (Albany).
North Carolina____ Bureau of maternity and infancy, State board of
health (Raleigh).

Alabama............ ......

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Director
Jessie L. Marriner, R. N.
Mrs. Charles R. Howe.
Dr. C. W. Garrison. 1
Dr. Ellen S. Stadtmuller.
Mrs. Estelle N. Mathews. 8
Dr. A. Elizabeth Ingraham.
Dr. Clealand A. Sargent.
Mrs. Laurie Jean Reid, R. N.
Dr. Joe P. Bowdoin.
Mabel V. Smyth, R. N.
Dr. Emily F. Bolcom.
Dr. Grace S. Wightman.
Dr. Ada E. Schweitzer.
Edward H. Lauer, Ph. D.
Dr. J. C. Montgomery.
Dr. Annie S. Veech.
Agnes Morris.
Edith L. Soule, R. N.
Dr. J. H. Mason Knox, jr. 4
Dr. Merrill E. Champion.
Dr. Lillian R. Smith.
Dr. E. C. Hartley.
Dr. F. J. Underwood.1
Dr. Irl Brown Krause.
Dr. Hazel Dell Bonness.
Louise M . Murphy, R. N.
Mrs. S. H. Wheeler.8
Mrs. Mary D. Davis, R. N.
Dr. Julius Levy.5
Dorothy R. Anderson, R. N .4
Dr. Elizabeth M. Gardiner.
Dr. George Collins.

167

APPENDIXES

State administrative agencies and names of the executive officers for the admin
istration of the act for the promotion of the welfare and hygiene of maternity
and infancy (as of June 30, 1928) — Continued
State (and Territory)

Administrative agency and department

North Dakota_____

Division of child hygiene and public-health nursing,
State department of public health (Bismarck).
Division of child hygiene, State department of health
(Columbus).
Bureau of maternity and infancy, State department
of public health (Oklahoma City).
Bureau of child hygiene, State board of health (Port
land).
Preschool division, bureau of child health, State de
partment of health (Harrisburg).
Division of child welfare, State board of health
(Providence).
Bureau of child hygiene and public-health nursing,
State board of health (Columbia).
Division of child hygiene, State board of health
(Waubay).
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 City).
State department of public health (Burlington).......
Bureau of child health, State board of health (Rich
mond).
Division of public-health nursing and child hygiene,
State department of health (Seattle).
Division of child hygiene and public-health nursing,
State department of health (Charleston).
Bureau of child welfare and public-health nursing,
State board of health (Madison).
Division of maternal and infant welfare, State de
partment of public health (Cheyenne).

Ohio______________
Oklahoma_________
Oregon......................
Pennsylvania--------Rhode Island______
South Carolina____
South Dakota--------Tennessee—________
Texas_______- _____
Utah.........................
Vermont__________
Virginia.......... - ........
Washington_______
West Virginia______
Wisconsin_________
Wyoming.................

1 State health officer serving.
1 Executive secretary.
3 State not cooperating.
4 Chief.
8 Consultant.
8 Acting chief

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Director
Dr. Maysil M . Williams.
Dr. J. A. Frank.8
Dr. Lucile S. Blachly.
Dr. Frederick D. Strieker.1
Dr. Mary Riggs Noble.4
Dr. Marion A. Gleason.
Ada Taylor Graham, R. N.
Florence E. Walker, R. N.
Dr. W. J. Breeding.
Dr. H. N. Barnett.
Dr. H. Y. Richards.
Dr. Charles F. Dalton.1
Dr. Mary E. Brydon.
Mrs. • Mary Louise Allen,
R. N .4
Mrs. Jean T. Dillon, R. N.
Dr. Cora S. Allen.
Dr. W. H. Hassed.1

APPEN DIX C.— M ATERN AL AN D IN FA N T M ORTALITY RATES
T

a b l e

I .— M a te r n a l m o r ta lity r a te s , b y S ta te s , in u r b a n a n d r u r a l d is tr ic ts o f th e
U n ited S ta te s b ir th -r e g is tr a tio n a r e a ; 1 9 1 5 -1 9 2 7 1
Deaths of mothers from puerperal causes per 10,000 live births
State
1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

Area.......................... 60.8
U rban............ . 64.1
Rural__________ 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

68.2
77.1
59.4

66.4
73.2
59.5

66.5
73.8
58.7

65.6
73.5
57.6

64.7
73.5
55.5

65.6
73.9
56.7

Alabama_____ _____
Urban_________
Rural................

1927
64.7
74.8
55.3
79.6
110.2
73.2

Arizona. ............ ......
Urban........ ........
Rural__________

102.5
107.6
100.6

Arkansas. .1________
Urban_________
Rural_________ 1

89.0
125.2
74.9
89. 7
134.5
85.9

California__________
Urban.......... .
Rural..................

79.8
88.1
68.7

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

57.6
61.3
52.2

62.2
68.8
41.6

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

55.3
57.2
45.4

63.2
101,5
20.8

65.8
60.5
71.7

83.7
90.0
77.1

76.9 77.0 92.9
82.6 102.3 109.4
70.8 51.5 76.3

58.6
85.2
32 6

F lorida..................
Urban........... .
Rural........ .........

121.4 121.4 106.9
108.8 130.9 101.4
126.2 117.2 109.7

109.9
97.8
115.2

Idaho........... .............
Urban....... .........
Rural............ .

56.9
75.1
54.5

60.0
62.9
59.6

Connecticut_______ 56.1
Urban................. 63.0
Rural__ _______ 36.0

48.9
51.1
42.1

51.0
55.2
36.9

74.9
73.5
79.5

Delaware............ ......
Urban_________
Rural__________

Illinois____________
Urban.................
Rural__________
Indiana........ .......... .
Urban.................
Rural..................

72.5 103.9 84. 2 87.5
87.1 124.3 102.5 104.8
64.1 91.9 73.0 75.2

68.6
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

55.6
63. 5
40 1

66.0
84. Í
53.2

64.9
77.4
55.2

58.1
66.0
51 5

60 5
8Ó.2
48 9

64 8
81.1
50 8

81.1

59.8
79.1
52.2

55 9
81. 3
45. 3

60 4
87. 8
48.8

58 9
89 1
46 O

54.4

Iowa..................... .
Urban_________
Rural__________
Kansas......................
Urban................
Rural__________ .........

......

Kentucky____ _____
Urban_________
Rural.................

75.9 114.3 82. 5 84.3
92.0 151. 7 107. 5 101.9
72.4 105.8 76.4 78.6

64.3 75.9 68 4
8k 1 107.7 104.8
57.6 64.8 55.0

62 7
82 6
54! 9

65 4
83 2
58.4

69 7
93 1
60.7

60.1 80.0
98.4 119.0
54.6 74.3

62.7
93.4
57.5

60 7
96 6
54.3

61 8
88 4
56.5

59 5

58 4
74 8
54! 6

63.2
91.8
59.0

64.4
93.9
59.4

59 6
80 4
55.5

54! 5

Louisiana_____ ____
Urban...............
Rural..................
Maine....................... 67.9
Urban_________ 82.4
Rural— ....... ...... 63.2

123. 2
77.1

67.3 85.7 85.8 84.8 74.0 75.8
94.0 97.4 91.7 103.6 100.9 102.4
58.7 81.8 83.8 77.2 62.9 64.4
Source: United States Bureau of the Census.

168

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

78.0
81.1
76.9

87.0 82.3 72.2 66.9
97.8 125.6 102.5 106.6
82.1 63.2 58.8 49.7

79.5
123.5
60.0

APPENDIXES
T

a b le

169

I .— Maternal mortality rates, by States, in urban and rural districts of the
United States birth-registration area; 1915-1927— Continued
Deaths of mothers from puerperal causes per 10,000 live births
1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

Maryland_________
63.9
Urban_________
75. 7
Kural__________ ......... 52.9

68.0
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

57.8

57.5

37.0

42! 4

36.5

59.8 65.0
63. 7 70.4
41.8 40.2

92.2
96.0
74.5

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

44! 9

47! 4

35! 2

66.8
72.9
61.8

68.2
72.8
64.0

74.2
76.3
72.3

85.9
96.6
75. 5

77.2
83.2
71.0

93.2
97. 7
87.5

68.5
71.1
65 5

68.5
73. 0
63. 2

70.3
82 2
54 5

65.3
72 8
55 2

63.7
71 7

67.2

68.0

51.9
54.3
Rural__________ 50.8

54.6
62.2
51.0

55.7
59. 7
53.7

78.2
87.6
73.9

67.4 78 5
64.4 90.2
68.8 ' 72.2

57 2 49 5
80 8 54. 1
44.2 46.8

60 2
77 2
49.8

49 7
57 7
44.6

59 7
48.4

57.2
59.6
Rural__________ 46.8
Michigan__________

Mississippi________
Urban_________
Rural__________

1926

1927

45! 5

45! 2

95.3 83. 2 88.1 95.1 98. 3 78 7
179.8 202.1 161.9 149.4 163 1 129 7
88.3 72.7 81.6 89.6 92.1 73.6

86 7
158 1

Missouri___________
Urban_________
Rural_____ ____

67.4
80 8
57.9

Montana__________
Urban_________
Rural.. _______

75.5
85. 2
71.9

65.6
94.5
55.5

81.1 80 2
79.6 113.9
81. 6 68 5

66 3
102 6
53 7

58.0 57.9
89.9 101.1
49.1 44.4

63. 2
89 5
54. 6

57.1
89 2 104 8
46 7 54 2

48 8

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

64.8
58.8
71.3

58.5
68.3
34.7

64.1
70.9
48.3

57. 0
64. 5
39. 5

62.3
73.1
37.3

64 3
74 9
39 8

57 fi
64 9
41 1

70 7
44 3

62.7
65.1
52.7

60.2
62.2
51.7

57.3
59.0
50.2

58.6
62.0
43.5

59.6
62.9
45.1

56.5
59.1
44.9

60.6
63.1
49.6

North Carolina_____
82.4 107.9 92.6 100.0 73.5 79.5 79.6 77.5 86.6
Urban_________
117.6 186.7 167. 6 168.0 119.8 128. 5 114 1 124 2 131 5
Rural...... ........... - ....... ......... 80.2 103.0 87.5 91.7 67.8 73.1 74.6 70.0 78.9

88.3

65.6

7e! 8

57! 2

North Dakota______
Urban_________
Rural. _______

79.1
85.9
76.9

Nebraska__________
Urban_________
Rural. _______
New Hampshire____ 61.0
Urban_________ 69.3
Rural______
53.0

71.5 65.8
101.4 105.4
63.1 54.6
72.4
75.9
69.1

70.0
67.5
72.7

77.8
74.5
81.5

79.7
87.2
71.6

71.4
76.4
66.1

New Jersey..............
Urban_________
Rural- ________
New York_________ 58.6
Urban_________ 58.8
Rural ________ 57.9

54.3
54.1
54.8

Ohio. ____________
Urban______
Rural_______ _

57.4
56.0
63.9

79.7
79.1
82.6

71.3 96.8
80.9 104.5
59.4 87.3

Oregon................... .
Urban_________
Rural. - ....... .

62.4
63.9
55.9

68.7
68.2
71.0

56.9
99.9
51.5

61.5
62.0
61.4

42.9
69.8
39.4

51. 0
105. 0
43 0

81 6
47 1

80 7

75 9
40 6

72 3

79. 5
91.3
63.0

72. 2
84.9
55. 3

66 2
78 0
50. 7

71 5
83. 7 76 2
54 1 46 7

101.2 94.4
123.9 82.4
87.2 102.8

74.3
73.1
75.2

82 8
91.6
76.8

68 7
79. 2
61. 9

64 9
72.8
59. 6

7Ì. 7

72 7

59 0
66 2
54 0

75 0
55 7

73.8
83.3
62.0

Pennsylvania______ 64.3
Urban_________ 74.1
Rural__________ 55.2

70.1
82.4
58.6

64.9 104.6
75.4 111.1
54.6 98.3

68.2
81.9
54.6

77.6
88.9
65.5

68.3
84.4
52.2

62.2
75.8
48.7

65.9' 63.3
82.0 82.1
49.6 44.2

64.2
81.8
46.5

63.7
80.4
46.7

64.0
83.3
44.4

Rhode Island—. ....... 66.2
Urban_________ 72.8
Rural— - ........... 36.0

58.1
63.2
36.1

63.5 98.1
69.7 .04.1
35.7 69.8

(2)

71.0
76.3
39.0

55.2
57.8
41. 2

63.0 63.4
70.4 66. 9
19.1 : 42.3

52.1
58.3
14.6

59.6
62.0
43.9

64.1
71.1
21.0

Urban_________
R u ral................
Tennessee.... .............
Urban_________
Rural____ _____

111.6 122.0 98.1 106 8 97 1 107 8
170.3 163.0 177. 7 141.4 140.3 177.9
106.4 117. 3 88.4 102.4 91.8 99.5
1

8 Dropped from the United States birth-registration area.

48278°— 29------12

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

(2)

71. 0
120.3
56.2

170

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

I.— Maternal mortality rates, by States, in urban and rural districts of the
United States birth-registration area; 1915-1927— Continued

a b le

Deaths of mothers from puerperal causes per 10,000 live births
State
1920

1921

1922

1923

1924

1925

1926

1927

59.4 86.3 83.6 79.1
67.8 106.4 114.2 112.7
Urban................
Rural________ -v ......... ......... 56.1 78.0 69.9 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

75.4
100.0
61.2

73.1
97.6
68.7

74.5 69.6
84.5 133.9
72.6 57.0

81.0 67.9
90.4 137.9
78.9 53.2

67.2
65.1
67.6

72.6
133.0
59.2

70.1 79.8
95.2 122.8
63.2 67.3

61.5
104.2
49.5

1915

Vermont____ ______ 61.2
U rban............... 51.9
Rural.................. 62.8
Virginia....... .............
Urban................
Rural__________

1916

78.5
72.2
79.7

Wisconsin_________
Urban....... .........
Rural__________

...... ......

District of Columbia. 69.7 101.4

63.6
51.3
65.8

1918

79.9
50.7
85.4

81.8 107.0
130.3 161.1
70.9 94.5

......

Washington.... .........
Rural__________

1917

1919

79.6
83.2
79.0

82.6 86.5 70.0 71.8
92.1 133.0 113.3 111.9
80.0 73.8 58.7 61.2

73.7 98.5 86.0
86.2 103.6 100.6
63.4 93.8 71.7

57.3
58.1
56.9

85.5

59.6
68.8
54.4

90.7

70.2
82.7
67.7

48.0
62.1
39.8

85.6

92.0
99.0
84.6

67.3
82.3
57.8

77.7
86.7
69.0

58.1
73.9
48.2

88.4 101.3

78.8
84.4
73.3

74.4 65.2
99.5 100.4
67.4 55.5
66.5
70.2
62.7

70.9
85.9
55.1

60.2
69.3
50.1

75.0
89.2
59.7

66.5
68.1
64.7

63.3 70.6
117.7 129.5
50.8 57.4

61.5
130.3
46.8

59.6
71.1
50.3

52.8
56.2
50.0

71.3 72.7 97.6 95.2 93.4
110.6 113.5 126.2 139.3 58.5
62.0 61.6 89.9 83.6 101.9

87.2
125.0
79.0

55.8
66.8
48.9

58.1
69.5
50.3

60.5
66.9
55.8

70.5 101.0 121.8

52.3
63.0
44.1

86.7

77.4

86.3

I I ;—Maternal mortality rates, by color, in the United States birth-regis
tration area and in States having 2,000 or mere colored births annually;
1915-19271

a ble

Deaths of mothers from puerperal causes per 10,000 live births
state
1915

White_____ ____

1916 -1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

60.8 62.2 66.2 91.6 73.7 79.9 68.2 66.4 66.5 65.6 64.7 65.6
60.1 60.8 63.2 88.9 69.6 76.0 64.4 62.8 62.6 60.7 60.3 61.9
105.6 117.9 117.7 139.3 124.4 128.1 107.7 106.8 109.5 117.9 116.2 107.1

1927
64.7
59.4
113.3

White

79.6
62.5
111.6

White

89.7
72.5
151.0
79.8
82.4
56.7

76.9
78.2
65.0

68.3
70.7
45.1

56.4
56.4
56.1

57.6
56.3
76.7

121.4 121.4 106.9
90.0 102.2 90.4
186.9 163.4 148.5

109.9
89.8
156.7

63.2 64.1 61.6 58.3 65.0
61.8 61.6 59.5 56.4 63.2
111.6 137.5 108.8 100.3 104.9

55.6
53.0
110.2

58.1 60.5 64.8
56.8 58.4 62.4
96.2 121.2 134.5

65.7
64.0
111.0

71.9
72.8
63.1

67.5
68.8
53.6

White

White
_ .
Colored..... .........

' (2)

(*>

(2)

(*)

(?)

(2)

59.2
56.7
88.5

1 Source: United States Bureau of the Census.
2 Not shown for years in which the number of colored births was less than 2,000,

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

60.1
59.6
65.8

171

APPENDIXES
T

II .— Maternal mortality rates, by color, in the United States birth-registration area and in States having 2,000 or more colored births annually;
1915-1927— Continued

a b le

Deaths of mothers from puerperal causes per 10,000 live births
¡state
1915

White_________
Colored___ ____

1916

...... ......

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

60.1 80.0 63.2 64.4 62.7 60. 7 59.6 61.8 59.5 58.4
56.4 75.0 58.5 59.7 56.7 53.9 54.2 57.0 53.6 54.9
108.2 153.8 125.0 130.4 147.7 185.0 153.5 130.7 138.0 106.2

63.9
Maryland.................
56.0
W hite............... Colored________ ......... 98.0

White

_____

White

_______

White

___

49-4
45.3
108.6
90 9
69 8
125.8

White ................

Michigan__________
White
___

1927

68.0 95.3 83.6 75.7
61.0 85.8 76.1 65.9
97.8 138.1 115.0 118.3
0

(2)

66.5
59.5
96.1

59. 4
5a5
84.3

(2)

60.0 65.5
54.3 56.6
83.0 101.5

58.2
50.5
89.0

57.8
47.4
98.3

57.5
53.9
71.9

70.3 65.3 63.7 67.2
69.1 63.8 61.9 65.9
122.3 116.2 126.9 110.4

68.0
66J
123^4

95.3 83. 2 88.1 95.1 98.3
71.4 64. 8 65.5 65.1 66.6
120.3 100. 5 109.5 125.5 128.7

78. 7
65.2
91.6

86.7
61-1
111^4
67-4
63-6
130-7

58.5 64.1
55.6 61.6
124.8 119. 3

57 6
55. 8
84.0

62 6
59.3
109 6

58.6 59.6 56.5
57.5 58.1 54.3
93.1 101.6 116.9

60.6
58.0
125.5

79.5 79.6 77.5 86.6 88.3
70. 5 67. 3 65. 5 68.0 71.4
99. 4 107.0 ias. 8 127.9 125. 7

65.6
50. 8
98 9

71.3 96.8 73.8 79.5 7a 2 66. 2 71.5 64.1 67.6 67.1
69.8 95.7 7a 1 78.2 70. 6 63. 8 68.0 62. 2 64. 5 64 4
White
______
C olored............. ......... ......... 136.0 138.2 126.4 120.3 116.0 132.9 158.2 101.8 129.6 115.8

61 9
59. 6
104.0

New York-------------- 58.6
White..... ..........- 58.1
Colored...... ........ 97.2

54.3 57.4 79.7 62.4 68.7 62.7
53.6 56.5 79.1 60.9 67.1 60.9
96.3 118.3 114.0 140.7 142.1 139.4
sa 4 107.9 9a 6 100.0 7 i 5
68.1 94.0 82.0 86.2 61. 0
114.8 139.0 117.6 132.2 101. 8

North Carolina-------

Pennsylvania---------- 64.3
W hite.— ........... 63.3

70.1
69.1

64.9 104.6
63.6 102.9

68.2 77.6 68.3
65.5

76.0

67.4

112.2 118.7 118.6 174.7 157.9 130.6 97.7

60.2
59.3
97.2

57.0 6a 3
55.0 59. 2
96.6 117.1
57.3
56.5
85.2

62.2 65.9 63.3
61.2 64.6 61.0
94.0 100.9 114.7

111.6 122.0 98.1 106.8 97.1 107.8

78.1 89.9 77.9 85.5 74.1 75.9
144.2 154.0 118.1 128.0 121.8 140.8

White....... ..........

64.3
62.7
90.9

64.2 63.7
62.7 61.5
97.9 109 2
0

64.0
61.6
111 6
0

71.0
58.7
134.8

White_________
Colored________
64.4 96.0 66.0 75.4 56.9 58.3 59. 7 50.1 52.6 71.2
120.6 131.8 118.7 110.9 99.4 101.7 107.8 99.6 109.7 99.6

79. 8

61 5
47 9
93.6

63.3 70.6
59.6 66.1
125.3 139.9

61. 5
58.9
103.8

District of Columbia. 69.7 101.4 85.5 90.7 85.6 88.4 101.3 70.5 101.0 121.8 86.7 77.4
White_________ 56.1 76.3 59.0 78.1 67.8 66.5 98.6 56.1 89.3 91.7 60.8 64.4
Colored............... 99.4 157.5 147.7 126.1 131.6 143.8 107.7 105.7 129.5 189.6 143.3 104.9

130.6

81.8 107.0

82.6

86.5

70.0

71.8

74.4

65.2

White.................

8 Not shown for years in which the number of colored births was less than 2,000.
8 Dropped from the birth-registration area.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

70.1

86.3

66.0

172
T

able

th e

]

w elfare

and

h y g ie n e

m a t e r n it y

and

in f a n c y

III .—Infant mortality rates, by States, in urban and rural districts of
the United States birth-registration area; 1915-19271
Deaths of infants under 1 year of age per 1,000 live births
State

Area..... .....................
Urban..... ...........
Rural........ ..........

1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

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

73
74
72

1927
65
65
64
64
77
62

121
111
125

130
115
136
61
82
59

Connecticut..........
Urban_________
Rural........ ..........

107
103
119

101
101
101

94
93
96

86
100
78

Rural............- --

107
106
112

87
104
77

70
64
79

74
68
83

66
60
75

71
64
81

73
66
83

67
62
74

69
62
79

63
56
72

62
57
70

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

71
71
71

82
88
80

74
87
68

75
85
70

67
69
67

63
59
63

50
53
50

79
88
7t

82
96
72

71
79
66

59
66

76
81
68

82
85
77

71
75
65

73
74
70

69
68
72

64
64,
66^

67
76
61

71
78
65

65
73
59

68
75
62

72
78
68

59
63
55

55
66
50

56
70
50

59
72
53

55
67
50

77
98
73

80
106
73

70
88
65

73
92
67

63
73
59

65
79
60

63
78
57

59
70
54

62
72
58

65
76
61

55
62
53

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

61
71
59
77
*89
73

Maine.____________
Urban_________
Rural__________

Massachusetts_____
Urban_________
Rural........ .........

105
109
104

101
103
92

108
128
102

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

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

81
81
81

100
103
87

98
99
91

113
115
104

88
90
82

91
92
83

7676
77

81
82
76

78
78
75

68
68
66

73
73
74

73
73
72

65
65
64

90
97
82

92
100
82

79
81
76

75
81
67

80
85
74 1

72
75
68

75
79
71

77
82
70

68
70
64

89
88
97
97
81
80
i Source: United States Bureau of the Census.

Michigan..... ...........
Urban....... ..........
Rural____ _____

86
96
78

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

96
106
87

173

APPENDIXES
T a b l e ILL—Infant

mortality rates, by States, in urban and rural districts of
the United States birth-registration area; 1915-1921— Continued
Deaths of infants under 1 year of age per 1,000 live births

Minnesota_________
Urban_________
Rural__________

1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

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

58
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

Missouri___________
Urban_________
Rural_________

New Hampshire.......
Urban_________
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

55
68
51

58
69
54

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

New Jersey________
U rban...............
New Y ork ............ .
Rural__________

99
..102
89

94
97
83

Urban_________

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

North Dakota______
Urban.................
Rural__________
92
103
79

94
100
87

Oregon_____ _____ _
Urban_________
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

52
39
62

97
99
95

88
86
89

88
89
87

90
87
94

79
80
77

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

Rhode Island______
Urban_________
Rural _______

120
118
129

111
116
93

108
109
101

126
127
118

(2)

113
139
111

116
150
112

96
127
92

93
105
91

96
117
94

102
121
99

South Carolina_____
Urban.............
Rural__________

Ca)

<*>

(?)

Tennessee_________
Urban..............
Rural__________
Utah. ......................
Urban.................
Rural.................
Vermont.... ........ ......
Urban_________
Rural...... ........ .

85
116
80

93
128
86

Virginia___________
Urban________ _
Rural.................

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

75
70
78

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

72
72
72

98
129
91

103
145
93

91
106
87

84
107
77

79
95
74

77
94
72

84
98
80

78
93
73

81
97
76

84
103
78

1 Dropped from the United States birth-registration area.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

174

the

w elfare and

h y g ie n e

of m a t e r n it y a n d

in f a n c y

Infant mortality rates, by States, in urban and rural districts of
the United States birth-registration area? 1915-1927— Continued

T a b l e III. —

Deaths of infants under 1 year of age per 1,000 live births
State
1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

69
62
75

69
67
71

63
59
67

66
64
69

55
55
56

62
58
65

67
51
62

56
52
61

56
50
64

56
54
59

50
47
53

80
93
77

82
93
79

72
84
69

Washington________
Urban_________
Rural__________
West Virginia...........
Urban_________
Rural__________
W isconsin...............
Urban_________
Rural__________

78
92
69

79
99
67

80
94
71

77
90
68

72
79
68

W yom ing......... ......
Urban...............
Rural__________
District of Columbia ...111

106

112

1927

71
78
67

70
77
65

65
67
63

67
71
64

69
74
65

59
61
58

79
104
73

80
102
73

64
73
62

6451
67

76
78
75

69
64
70

IV.— Infant mortality rates, by color, in the United States birth-registra
tion area and in States having 2,000 or more colored births annually: 191519271

a b le

Deaths of infants under 1 year of age per 1,000 live births
State

White.................

1915

1916

1917

1918

1919

1920

1921

1922

1923

1924

1925

1926

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

1927
65
61
100

Alabama......... . . .
W hite...........
Colored...........

64
55
82

Arkansas__________
White_________
Colored________

61
56
77

California...... ...........
White______. . .
Colored___ ____

70
70
73

74
74
77

66
66
69

71
71
77

73
73
72

Florida......................
W hite................
Colored___ ____
Illinois.......................
White....... ........
Colored........ ......

67
67
70

69
69
65

63
63
65

62
62
69

82
70
107

74
60
105

75
62
107

67
56
93

76
75
125

82
79
157

71
68
141

73
70
122

69
68
109

64
62
105

Indiana..................
White_________
Colored............. .

65
63
140

68
66
119

72
70
145

59
57
96

Kentucky____ ____
White..-._______
Colored________

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

61
58
109

Louisiana__________
White_______
Colored......... .

77
58
109

Maryland.................
White.................
Colored________
Michigan__________
White_____ ____
Colored............. .

121
101
209

120
101
201

140
124
215

105
92
160

104
90
164

94
81
147

95
80
155

86
76
128

90
76
146

87
74
137

(2\

80
79
147

72
71
126

75
73
149

124 1

102

1 Source: United States Bureau of the Census.
1 Not shown for years in which the number of colored births was less than 2,000.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

81
68
134

175

APPENDIXES
T

v ^

IV .—Infant mortality rates, by color, m the United States birth-registra
tion area and in States having 2,000 or more colored births annually; 1915—
1927— Continued

a ble

Deaths of infants under 1 year of age per 1,000 live births
State
1915

1916

1917

1918

1919

1920

W hite.................

1921

1922

1923

1924

1925

1926

68
53
85

68
56
79

68
53
82

71
55
88

68
53
83

70
59
81

1927
67
55
78
60
57
112

White'.................
New York_________
White_________
Colored........ ......

79
76
129

72
69
124

70
67
125

69
65
125

70
67
122

61
58
113

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

59
57
109

North Carolina_____
White...............

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

79
66
109

Ohio..........................
White_________
Colored—............

92
91
158

94
92
178

90
88
157

83
81
153

75
73
122

72
70
111

75
72
139

67
64
113

70
67
127

76
73
128

62
60
103

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

69
67
112

113
76
149

116
83
148

96
69
123

93
67
119

96
70
125

102
77
127

(8)

Pennsylvania______
White_________
Colored......... .

99
98
191

110
108
184

94
93
169

74
71
139

114
113
180

South C arolina.___
White....... ..........
Colored..............
Tennessee............. .
White_________
Colored...............

71
64.
107

Virginia______ _____
White.................
Colored________

98
80
137

103
86
141

91
78
120

84
72
110

79
68
103

77
65
102

84
71
115

78
66
104

West Virginia______
W h ite ...............
C olored..______
District of Columbia.
W h ite ..............
Colored...............

(8)

111
83
173

106
83
158

97
71
160

112
85
188

85
67
132

91
72
139

83
68
122

85
64
134

92
71
143

76
62
108

81
67
111

84
72
111

75
62
106

80
78
110

82
79
124

72
70
101

87
67
132

85
67
123

68
49
109

« Dropped from the United States birth-registration area.
T

V .—Infant mortality rates ( deaths of infants under 1 year of age per
1,000 live births) from specified causes in the expanding birth-registration
area; 1915-1927

a b l e

Cause of death
Syphilis.............
Convulsions................................ .
Bronchitis 1.....................................
Bronchopneumonia............. .........
Pneumonia................................ .
Diseases of the stomach.................
Diarrhea and enteritis...................
Congenital malformations__ ____
Congenital debility........
Premature birth.......
Injury at birth............
Other diseases of early infancy___

1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927
1.2
1.6
2.6
9.9
4.2
1.5
23.2
6.4
11.8
18.5
4.2

1.4 1.2 1.0 0.9 0.9 0.9 0.8 0.8 0.7 0.7 0.6
1.3 1.1 1.2 1.0 1.0 0.9 0.8 0.7 0.7 0.7 0.6
2.5 2.2 2.1 1.8 1.7 1.0 1.2 1.1 0.9 0.8 0.8
9.5 8.3 9.0 7.8 7.9 6.2 7.8 7.8 7.0 6.9 8.0
3.9 4.2 4.9 3.2 3.2 2.4 3.0 2.9 2.8 2.6 2.9
1.4 1.2 1.4 1.4 1.2 1.0 0.8 0.8 0.7 0.6 0.5
24.0 20.0 19.0 15.7 14.9 13.5 11.7 11.5 9.2 11.2 9.7
6.8 6.3 6.5 6.3 6.2 6.1 6.3 6.3 6.1 6.2 6.2
10.2 8.8 9.3 8.2 7.7 4.4 3.9 4.0 3.5 3.5 3.3
19.3 19.1 20.2 19.2 19.4 17.9 18.1 17.8 17.7 17.2 17.7
4.2 3.8 3.3 3.4 3.7 4.2 4.5 4.6 4 8 4.9 4.9
(') (>) 0) 0) (9 0) 2.7 2.5 2.6 2.5 2.4 2.2

Source: U. S. Bureau of the Census.
1 Included with congenital debility.

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

0.7
0.5

0.6

5.8
2.3
0.5
7.8
5.6

2.8

16.8
4.8

2.0

176

the

w elfare and

T a b l e Y I . — Maternal

of m a t e r n it y and’ in f a n c y

h y g ie n e

mortality rates for the United States and certain foreign
countries 1
Deaths of mothers from puerperal causes per 10,000 live births

Country

1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927

Australia__________________ ____
Belgium____ ____ ___ ____ ______
Canada2_ __________________
Chile............................................
Czechoslovakia___________
Denmark_______ ____________
England and Wales*. _______
Finland __________________
Germany_________ ________
H u ngary.............. .....................
Irish Free State___________
Italy.........................................
Japan______________ ____
The Netherlands 8. _______
New Zealand_________
Northern Ireland_______ _
Norway........... ..............
Salvador.. __________
Scotland.....................
Spain________________
Sweden..... .................
Switzerland- _______
U. S. birth-registration area 4 .
Uruguay________ _________

47
72

47
57
51
79

42
34
40

41
36
45

39
38
45

38
44
49

44
40
51

24
43
36
49
32

20
39
33
49
29

22
36
25
47

27
35
26
59

30
35
25
60

37
38
30
52

29
33
34
51

28
35
24

26
36
23
51

22
57
64
51
27
55
68
33

50
60

61
52
29

57
52
27

59
51
25

70
64
26

62
53
32

62
50
27

61
22

62
29

66
32

92
30

74
23

80
34

45
53
55
80
20
38
30
50
30
57
25
33
25
51
47
25
46
66
49
25
51
66
27

51
56
54
74
33
26
38
31
52
28
48
27
34
23
51
49
28
50
64
46
23
46
67
27

55
58
60
61
31
23
37
35
53
31
48
32
31
24
50
45
29
57
58
44
48
66
25

56
50
56
61
33
24
41
29
50
29
47
28
30
26
47
44
27
50
62

65
25

53
57
58
41

49
32
49
27
29
42
56

55
64

62
64

66
30

1 Figures from official sources.
2 Exclusive of Quebec from 1921 to 1925.
8 Omitting from calculation of rates prior to 1924 the live-born infants who died before registration of
birth (within 3 days of birth).
4 The United States birth-registration area has expanded during this period from 10 States in 1915 to
41 States in 1927.
T a b l e V II .—Infant

mortality rates for the United States and certain foreign
countries 1
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 1926 1927
Australia.........................................
Austria________ _______ _______ _
Belgium.________ _____________
Bulgaria__________ ______ ______
Canada 8................................... .
Chile.____________ _______ _____
Czechoslovakia___________ _____
Denmark______________________
Egypt....... ..................... ................
England and Wales................ ......
Finland___________ _______ ____
France 8.... ......................................
Germany__________ _____ ______
Guatemala____ ______ ____ _____
H u ngary...___________ ________
Irish Free State. .......................
Italy __________ _______________
Japan________ _____ _______ ____
Lithuania..................................
Latvia.......... ...............................
The Netherlands...........................
New Zealand_______________ _
Northern Ireland................. .
Norway........................................
Salvador___________________ .
Scotland.. ________ ________
Spain____________________
Sweden______ _____ _____ _
.
Switzerland- ____________ .
U. S. birth-registration area.. . . .
Uruguay ___________ _________

68
218

70
192

56
186

254

241

269

59
193

255

69
156
109
110

69
157
110
146

306

263

66
154
122
158
88
278

53
156
114
155
87
240
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

42
77
55
124
101
145
62
70
76
94

44
76
50
118
79
148
56
61
77
104

100

110
110
142
168

91
110
122
149

96
118
123
155

97
115
138
154

89
135
119
121

80
97
99
131

264

219

215

217

158

193

77
133
83
95
115
134
76
193

147
160

147
170

139
173

192
189

129
170

127
166

129
168

126
152
76
90
100
111

97
147
70
78
101
124

107
155
65
79
94
107

100
183
65
88
101
110

102
156
70
82
87
101

92
165
63
84
86
117

54
141
90
147
64
74
76
107

57
127
95
150
79
266
148
84
150
75
107
85
109
81
193
72
126
156
170
101
61
40
85
50
150
98
14ft
60
62
71
108

53
119
100
79
258
146
80
155
75
85
89
105
99
168
68
119
142
179
107
58
40
86
46
139
91
55
58
72
115

54
104
102
251
154
84
146
70

102
102
167
74

137
146
88
61
40
85

57
73
93

57
65

1 Figures from official sources.
2 Exclusive of Quebec from 1921 to 1925.
8 Omitting from calculation the deaths of infants occurring before registration (within 3 days of birth).

https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

APPENDIX D.— PUBLICATIONS AND EXHIBITS OF THE CHILDREN’S
BUREAU BEARING UPON M ATERN AL, IN FAN T, A N D CHILD W E L
F A R E A N D HYGIENE
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.
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, 1927. No. 186. 150 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
Yan 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.
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. 181. 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.
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.
177

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w elfare and

h y g ie n e

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Infant Care (revised). No. 8. 118 pp.
Child Care— The Preschool Age, by Mrs. Max West. No. 30. 82 pp.
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.)
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 Age; 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. 171. 74 pp.
A Tabular Summary of State Laws Relating to Public Aid to Children in Their
Own Homes in Effect January 1, 1929, and the text of the laws of certain
States. Third 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.
List of Psychiatric Clinics for Children in the United States. No. 191. 28 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.) 8 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.)
Transverse Lines in X-Ray Plates of the Long Bones of Children, by Martha
M. Eliot, M. D., Susan P. Souther, M. D., and E. A.-Park, M. D. (Reprinted
from Bulletin of the Johns Hopkins Hospital, vol. 41, no. 6 (December, 1927),
pp. 364—388.)

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Lesson Material on Care of the Preschool Child:
No. 1. Your Child’s Health Examination.
No. 2. Your Child’s Physical Defects.
No. 3. Your Child’s Teeth.
No. 4. Your Child’s Nutrition.
No. 5. Your Child’s Food Likes and Dislikes.
No. 6. Your Child’s Posture.
No. 7. Your Child’s Need of Sunshine and Open Air.
No. 8. Your Child’s Behavior.
No. 9. Protecting Youd Child against Communicable Diseases.
References on Prenatal, Infant, and Child Care, and Child Management.
The Children’s Bureau; what it is, what it has done, and what it is doing for
the children of the United States.
List of Publications, January 2, 1929.
List of Exhibits.

FOLDERS
Minimum Standards of Prenatal Care. No. 1.
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.
Out of Babyhood into Chidhood. No. 10.
Why Sleep? No. 11.

DODGERS
Books and Pamphlets on Child Care (revised). No. 1.
Is Your Child’s Birth Recorded? (revised). No. 3.

SMALL CHARTS
Baby’s Daily Time Cards (a series of six cards, 5 by 8 inches, a different color
for each age period up to 2 years). Chart No. 14.

EXHIBIT MATERIAL1
Infant Welfare (10 posters in colors, 22 by 28 inches).
The Health of the 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 six, 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. Made in 1923.)
Our Children. (Two-reel film, showing time 35 minutes. Titles in English or
Spanish. Made in 1917.)
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 Lead to Mothers and Babies. (Film strip illustrating the work
done under the maternity and infancy act.)
The Healthy Baby. (Film strip showing the care of the baby to 2 years of age.)
Rickets. (Film strip showing the effects of the disease and how it is prevented
and cured.)
1 A descriptive list o f Children’ s Bureau exhibits containing a statement o f the condi
tions and procedure o f loan and purchase can be had on application to the bureau.

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

The Preschool Days of Betty Jones. (Film strip showing the care of the pre
school child.)
Teaching the Old Midwife New Tricks. (Film strip showing the method of
instruction used in classes for midwives.)
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).
Citv Playground for Children (model; weight, 109 pounds).
Sun Baths for Babies (model; weight, 95 pounds).

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