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UNITED STATES DEPARTMENT OF LABOR
W . N . D O A K , Secretary

C H IL D R E N ’ S B U R EAU
'‘1

G RACE 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, 1929

Bureau Publication No. 203

U N ITE D STATES
G OVERN M EN T PR IN T IN G OFFICE
WASHINGTON : 1931

For sale by the Superintendent of Documents, Washington, D . C.

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Price 23 cents

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CONTENTS

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Letter of transm ittal__________________________________ _______■________________
Introduction--------------------- --------------------------------------------- -----------------------------------Funds available and accepted by the States--------------------------------------- -------Summary of State activities during 1929------------------------------------------------------Personnel of the administrative staffs_____________ ____________ _________
Conferences_________________ _ _________-,-------------------------------------------------- - Permanent prenatal and child-health centers----------- ----------------------------Defects found at conferences-------------------------------------------- —
-------- - - County health departments and county nurses------------------------------------Hom e visits______________________________ _____________________ ___________
Local demonstrations of maternity and infancy programs------------------Inspection of maternity and infant homes---------------------------------- ----------M id wives________________________________________ ________________ 'È&--------Classes for women in infant and prenatal care----------------------------------->&-Classes for girls in infant and child care------ ---------------------------- ------------Instruction of special groups in maternal and infant care-------------------Training field nurses in maternity and infancy work---------------- -----------Instruction in prenatal care______________________________________________
Talks and lectures--------------------------------- ----------------------------------------------------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-----------Seven years’ work of the cooperating States under the maternity and
infancy a ct_______________________________________ ______________________
Activities undertaken------------------------------------------------------- --------------Development of organized State agencies for promoting the welfare
, of mothers and children____________________________________________ —
Organized bureaus in State departments of health-----------------------Permanent local agencies for educating parents in child and
maternal health____________________________________________________
The maternity and infancy program in the development of
county and other local health work--------------------------------------------The trend in infant m ortality----------- ---------- ----------------------- l.-----------------The trend in maternal m ortality------------------------------------- - - - - ----------------Public interest in the promotion of the welfare and hygiene of m aternity and infancy--------------------------------------------------------------------------------Continuation of maternity and infancy work----------------------------------------Principal activities of the individual States during 1929--------------------------------Alabam a______________________________________________________ ____________
Arizona_________________________________________ 1------------------ ------- ------------Arkansas________________________ ___________________________________________
California________________ _ _ —
+------------------------------- ------------- - — - - - Colorado— * _ _____ i —
-------------- - - - --------------------- ------------------- ----------Delaware___________________ — ----------- ------------------------------- ---------------------Florida__________ ,____________ — -------------------------- --------- ------------------- ------Georgia_____________________________________ _______________________________
H awaii____________________________ ______________ $---------------------------------------Idah o. _____________ _____________________________________ *--------- --------- — Indiana------------------ --------------- -------------------------------------------------------- ----------- -Iow a_________________________________________________________ *--------------------K ansas___________________ __________ ______________--------------- ------- --------- —
Kentucky_________________________ ______________________ _________________
Louisiana____________ _______________________________________________________
M aine______________________________________________________________________

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CONTENTS

Principal activities of the individual States during 1929— Continued.
Maryland_____ !_____________________ n____________________________________
Michigan________________________________________________________ | ________
Minnesota________________________________
Mississippi________________ * ______________________________________ i____ ___
Missouri__________________________________________
M ontana___________________________________
Nebraska__________________________________________________________________
N evada_____________________________________
New Hampshire______________
New Jersey._____________________________
New Mexico________________
New Y o rk ___________________________________________________
North Carolina________________
North D akota__________________________________________________ _ ________
Onio-------------------------------------------------------. . . ________________________________
Oklahoma____ ___________ . . . __________ ______ ____________ ________________
Oregon_______________________
Pennsylvania_____________________________________________
Rhode Island_____________________________________________________ _ _______
South Carolina____________________________________________
South D akota___________
Tennessee_____ _ _ ^
. ______________________ ___________________________
Texas__________________________________________________
U tah ---------------------------------------- ^_______ ___________________________________
Vermont _______________ i ____ _______ _ _ ________________ ________________ ______
Virginia----------------------------- --------------------------------------------__________ _ _______
Washington____________________________________________ _____,______________
W est Virginia_________________________ _______________l_____________ ______
Wisconsin____________________________ ___ !___________ ______ ¡1_________à____
W yom ing----------------------------------------------------------------------------------------------------Federal administration during 1929___________________________________
Federal s ta ff.___________________________________________________
Assistance to States_ ^_______________
Promotion of birth registration__________________________________________
Research and publications__________________ . . . _________ _______ ___ _____
The services of the Children’s Bureau under the maternity and infancy a ct.
The staff of the maternity and infant-hygiene division________________
Assistance to States__________________________________ ___________________ _ ,
Conferences of State directors____________________________ __________^___
Advisory committees______________________
Surveys and studies______________________________ j,_______________________
Preparation of material for distribution._______________________________
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. Infant and maternal mortality rates________________________________
D . Publications and exhibits of the Children’s Bureau bearing upon
maternal, infant, and child welfare and hygiene_________________

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IL L U S T R A T IO N S
States accepting the benefits of the act (m a p )_______________________________
Infant mortality rates in 1921 in the birth-registration States of 1 9 2 1 .___
Infant mortality rates in 1928 in the birth-registration States of 1921____
Maternal mortality rates in 1921 in the birth-registration States of 1921 _
Maternal mortality rates in 1928 in the birth-registration States of 1 9 21 .
Maternal mortality rates in 1921 in rural areas of the birth-registration
States of 1921___________ \______________________________________________
Maternal mortality rates in 1928 in rural areas of the birth-registration
States of 1921________________________________________________________________

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LETTER OF TRANSMITTAL

U nited States D epartment of L abor,
C hildren’ s B ureau,

Washington, December 15, 1980.
Sir : There is transmitted herewith the report of the administra
tion of the maternity and infancy act for the fiscal year ended June
30, 1929, prepared under the direction of Dr. Blanche M. Haines,
director of the maternity and infant-hygiene division of the bureau.
Respectfully submitted.
G race A bbott, Chief.
H on. W. N. D oak ,
Secretary of Labor.
v

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STATES ACCEPTING THE BENEFITS OF THE ACT FOR THE PROMOTION OF THE WELFARE AND
HYGIENE OF MATERNITY AND INFANCY, WITH DATES OF LEGISLATIVE ACCEPTANCE
[Diagonal lines indicate States not cooperating]

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

On June 30, 1929, Federal aid to the States under the maternity
and infancy act— sometimes called the Sheppard-Towner Act—
which was passed by the Sixty-seventh Congress and approved by
the President in November, 1921, came to an end. The appropriation
for the promotion of the welfare and hygiene of maternity and infancy
authorized by the act was $1,240,000 annually for a 5-year period,
which ended with the close of the fiscal year 1927. This period was
extended by a bill which passed Congress in January, 1927, authoriz
ing a similar appropriation for the fiscal years 1928 and . 1929 and
providing that the act should be of no force and effect after June 30,
1929.1
During the fiscal year 1929 all the States in the Union except Con
necticut, Illinois, and Massachusetts— also the Territory of Hawaii,
to which the benefits of the act were extended in 1924— cooperated
with the Federal Government in an effort to promote the hygiene of
maternity and infancy.
FUNDS AVAILABLE AND ACCEPTED BY THE STATES

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, 1928, has been reported.2 Table 1 shows the
amounts available and the total amounts accepted by the States
from the appropriations for the fiscal years 1922 to 1929. At the close
of the fiscal year ended June 30, 1929, unexpended or unobligated
Federal maternity and infancy funds reverted to the Treasury of the
United States.
1 For text of the acts of Congress in regard to the promotion of the welfare and hygiene of maternity and
infancy see Appendix A, p. 127.
7V ,
2 The Promotion of the Welfare and Hygiene of Maternity and Infancy. United States Children’s
Bureau Publications Nos. 137,146, 156, 178,186, and 194. Washington, 1924-1929.

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T a b l e 1.— Amounts available to States and Hawaii from Federal maternity and infancy funds and amounts accepted, 1922 to 1929 1

[Final statement]

Total.:
Alabama___
Arizona____
Arkansas___
California. . .
Colorado___
Connecticut.
Delaware__
Florida____
Georgia____
Hawaii.........
Idaho______
Illinois_____
Indiana____
Iowa_______
Kansas_____
Kentucky__
Louisiana.
Maine .
Maryland.
Massachusetts.
Michigan.
Minnesota.
Mississippi.
Missouri.
Montana_______
Nebraska_______
Nevada________
New Hampshire.
New Jersey_____
New Mexico____
New York______
North Carolina..
North Dakota__
Ohio____ _______
Oklahoma...........

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Amounts
accepted by
States from
1922 appro
priation

$477,600.00

$316,554.02 * $1,201,725.96

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

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
(e)
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

25,836.95
12,253. 71
21,817.51
33,112.01
16,337.20
19,311.48
11,504.01
16,531.72
29,530.55
4 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
34,741.11
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

Amounts accepted by States and Hawaii from—

1924 appro
priation

1925 appro
priation

1926 appro
priation

1927 appro
priation

1928 appro 1929 appro
priation
priation 3

$716,333.40

$877,122.04

$932,754.69

$948,313.59

$957,458.84

$957,470.29

$776,576.54

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

25,826.95
12,253.71
12,000.00
23,941.58
10,000.00

25,836.95
12,253. 71
21,817. 51
29,130.00
9,942. 55

25,836.95
1,263.25
14,182.49
30,229.18
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

11,504.01
16,531.72
22,815.93
5,000.00
7,450.17

25,000.00
26,213.60
17,650.00
26,298.64
7,521.00
5,000.00
19,277.00

24,867.71
23,364.41
5,000.00
26,298.64
5,000.00
14,999.48
19,277.00

34,741.11
26,099.65
22,076.58
24,186.81
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
23,585.57
23,679.48

33,670.35
23,721.46
22,076.58

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

19,164.58

19,277.00

25,000.00
26,213.60
16,616.79
26,298.64
19,400.70
14,926.52
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. Il
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
31,754.73
23,679.48

34,741.11
26,099.65
22,076.58
21,000.00
13,700.00
11,000.00
10,522.00
12,988.31
31,284.55
12,430.33
80,041.78
27,259.66
6,600.00
27,645.85
23,679.48

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

12,578.11
5,000.00
8,337.15
12,988.31
31,284.55
12,430.33
65,369.17
27,259.66
6,000.00
5,000.00
23,626.67

THE W E LFA R E AND H YG IE N E OF M A TER N ITY AN D IN FAN C Y

States and Territory cooperating

Maximum
amounts avail
able from 1923,
1924, 1925,1926,
1927, 1928, and 1923 appro
1929 appro
priation
priations

Maximum
amounts
available
from 1922
appropria
tion 2

■-* *

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
” 8,797.56"
6,436.07
5.000.
9,363.93
5.000.
(s)

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
00 25.767.55
41,450.52
00 13.030.89
12.376.90
25,574.00
19.149.55
19,871.74
27,751.62
11.311.12

8,000.00
68,810.20
"2i,"§55.”65
12,844.24
18,521.94
32,567.38
6,365.00

25,574.60

10,000.00

5.000. 00
27,750.44
5.000.

15,283.46
68,810.99
4,999.86
21,355.65
14,272.92
22,410.73
40,689.20
13.000.
2,775.33
25,574.00
10. 000. 00
10, 000.00
27,751.62
11, 000.00
00

15.283.46
68,810.99
14,076.28
21.355.47
13,451.18
25,767.55
40,447.84
0013.000.
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
0012,279.23
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.
25.767.00
41,450.52
12.500.00
5.000.
25.574.00

£>,000.00

19,571.74
27,751.62
7,500.00

3,418.20
68,810.99
5.000. 00
21,333.90
005.000. 00
24,708.78
32,655.34
4,243.19
003,497.12
25,574.00
5.000. 00
19,871.74
5.000.
5,500.00

1 Under the terms of the act, each State accepting received $5,000 outright; an additional $5,000 was available to each State if matched; the balance of the appropriation was dis
tributed among the States, if matched, on the basis of population. Amounts shown are the amounts actually accepted b y the States less refunds of unexpended balances returned
to the Federal Treasury.
2 Owing to the fact that only a few months of the 1922 fiscal year remained at the time the appropriation act for that year was passed, a full appropriation was not made.
2 The 1929 appropriations were available for one year only. Previous appropriations were available for 2-year periods under the provision that “ 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 ” (42 Stat.
224, sec. 2). As both the original act and the appropriations under it terminated June 30,1929 (44 Stat. 1024), the Comptroller General of the United States ruled that no funds appro
priated under the act could be expended after June 30,1929 (decision of Apr. 9,1928, MS. Comp. Gen. A-22370).
« The benefits of the act were extended to Hawaii on Mar. 10,1924. No appropriation therefore was available to that Territory in 1923 and 1924. The total amount available to
the States in each year from 1923 to 1929 was $1,190,000.
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 AVA ILAB LE AND ACCEPTED B Y THE STATES

Oregon_______
Pennsylvania..
Rhode Island..
South Carolina.
South Dakota..
Tennessee........
Texas________
Utah................
Vermont..........
Virginia______
Washington__
West Virginia..
Wisconsin____
Wyoming____

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SUMMARY OF STATE ACTIVITIES DURING 1929

General plans of work under the maternity and infancy act for the
year 1929, as submitted by the cooperating States for the approval of
the Federal Board of Maternity and Infant Hygiene,3 did not differ
essentially from the plans of former years.
The education of the public in regard to the hygiene of mothers and
young children was continued. Instruction was given to individual
parents by physicians and nurses at health conferences and by nurses
in visits to homes. Lectures, talks, and class work contributed to the
information of physicians, nurses, teachers, mothers, young girls, and
midwives. Literature relating to maternal and infant care prepared
by both State and Federal agencies was widely distributed.
Increasing stress was placed on measures directed toward the pre
vention of disease in children and of abnormal conditions at child
birth. Many campaigns were conducted for immunization against
diphtheria, vaccination against smallpox, and the wider distribution
of nitrate of silver for use in the prevention of ophthalmia neonatorum.
In several States surveys were made of maternal and infant mortality
and morbidity in order to arrive at a clearer understanding of their
causes.
Investigations, surveys, and studies of agencies caring for mothers
and babies— including infant homes, maternity homes and hospitals,
and day nurseries— were reported by some of the States. Work
with midwives occupied an important place in the plans of those in
which a large number of births are attended by midwives. Many
States gave much attention to stabilizing their maternity and infancy
programs and establishing the work on a permanent basis. This
included securing from State legislatures appropriations for maternity
and infancy work equal to the amounts previously received from both
Federal and State appropriations, also securing financial support for
local child-health centers, for county infant and maternal health
programs, and for community nursing services by interested local
agencies or groups.
P E R SO N N E L

OF T H E

A D M IN IS T R A T IV E

STAFFS

Plans of work and the size of the budget have determined from year
to year the number and type of personnel employed in the States to
conduct the work. Physicians, nurses, dentists or dental hygienists,
nutritionists, social workers, field workers, and clerical and other
assistants were on the staffs of the State bureaus and divisions of
child hygiene. Changes in plans or types of work required corre
sponding changes to be made in the staff personnel.
The administration of the maternity and infancy act was vested in
the State health agency4 in the Territory of Hawaii and in all the
3 The Board of Maternity and Infant Hygiene was composed of the Chief of the United States Children’s
Bureau, the Surgeon General of the United States Public Health Service, and the United States Commis
sioner of Education (42 Stat. 224, sec. 3; see p. 127).
4 In Nebraska and New Mexico the administrative agency was in the State bureau of public health, which
is a part of the State department of public welfare. In Idaho the administrative agency was in the State
department of public welfare (which replaces the previous State board of health).

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SUM M ARY OF STATE ACTIVITIES DURING 1929

cooperating States except two. In one of these (Colorado) the ad
ministration of the act was given by the legislature to the bureau of
child welfare already existing in the State department of public in
struction; in the other (Iowa) the administration was given by the
legislature to the State board of education, with the provision that
the State university should be in actual charge of the work done.
The faculty of the medical school of the university constituted the
medical advisory committee in this State.
During all or part of the year 1929 physicians were directors of the
divisions in immediate charge of the work in 31 States: Arkansas,
California, Delaware, Georgia, Idaho, Indiana, Kansas, Kentucky,
Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana,
New Jersey, New York, North Carolina, North Dakota, Ohio, Okla
homa, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, Utah,
Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. In
five of these States— Arkansas, Mississippi, Oregon, Vermont, and
Wyoming— the State health officer was in direct charge of the State
administration of the act. Field supervising nurses assisted in four
of these States— Arkansas, Mississippi, Oregon, and Vermont— and
county nurses assisted in the fifth (Wyoming). Nurses served as
directors in the Territory of Hawaii and in nine States: Alabama,
Florida, Maine, Nebraska, New Hampshire, New Mexico, South
Carolina, South Dakota, and Washington.
Including State directors paid from maternity and infancy funds
but not including the 41 physicians who were at the head of the State
departments of health charged with the administration of the act,
35 physicians were employed on full time during the entire year and
28 physicians were employed on full time for part of the year in the
maternity and infancy program. Part time was given during the en
tire year by 19 physicians and during part of the year by 8 other
physicians. A number of States employed additional physicians for
occasional service, and 1,614 physicians gave volunteer service in
17 States and Hawaii. Usually volunteer or occasional medical
service was given for conference or consultation centers. The phy
sicians regularly employed served as directors, conducted childhealth and prenatal conferences, instructed classes in infant and
prenatal care and classes for midwives, and conducted special work
in the prevention of diseases of mothers and of preschool children.
PubHc-health nurses were employed either at staff headquarters or
as county nurses in the Territory of Hawaii and 45 cooperating States,
181 on a full-time basis during the entire year, 85 on full time part of
the year, and 26 for part time during the year.
In a number of States nurses were detailed to counties and paid
from maternity and infancy funds in proportion to the time given to
maternity and infancy work. Forty gave full-time service for the
entire year, 37 gave full-time service during part of the year, 163
gave part-time service for the year, and 154 were detailed for part
time for part of the year. Pennsylvania paid from maternity and
infancy funds about 135 nurses on a basis of time spent in maternity
and infancy work during the year. Approximately 900 nurses were
paid in full or in part from maternity and infancy funds, and more
than 700 additional nurses gave volunteer service. Nurses served
not only as administrators of 10 of the divisions or bureaus of child
hygiene, but also as supervisors and advisors of county and field

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TH E W E LFA R E AND H YG IE N E OF M A TER N ITY AN D IN FAN C Y

nurses, and as instructors of groups of midwives and classes in infant
and prenatal care. They visited the homes of infants and preschool
children and expectant mothers, established and assisted at health
centers, organized conferences and assisted at them, inspected mater
nity and infant homes, conducted demonstrations and exhibits in the
interest of better care for babies and for expectant mothers, promoted
campaigns for breast feeding and for birth registration, made surveys,
assisted with immunization work, and organized many types of
activities.
A few States employed dentists or dental hygienists to do educa
tional work to improve the condition of the teeth among preschool
children and expectant mothers. Three were employed on full time
and one on part time during the year, and nine were employed on
full time for part of the year. Additional dentists were employed
occasionally. Volunteer service was given by more than 300 dentists.
Supervision and instruction of midwives were accomplished through
the services of special personnel on the State headquarters staffs and
also through the work of county nurses. Four States— New York,
Pennsylvania, Tennessee, and Virginia— employed six supervisors
and instructors of midwives; three of these were physicians and three
were nurses. Maryland employed a supervisor for part of the year,
and Mississippi had a part-time supervisor for the year. County or
community nurses supervised or instructed midwives in many other
States.
Four inspectors of maternity and infant homes were employed in
three States— three for the year and another on part time for part
of the year.
A total of 121 stenographers and clerks were employed for the year;
49 others were employed part of the year, 12 gave only part-time
service for the year, and 7 were employed part time for part of the
year. Two States— Nevada and South Dakota— had no stenogra
phers nor clerks on their maternity and infancy staffs. Sixty-two
additional workers were employed, including nutritionists, lecturers
and publicity workers, a statistician, motion-picture operators, and
chauffeurs for child-welfare trucks. Lay persons numbering 4,683
gave volunteer service at conferences and in other ways in 15 States
and Hawaii. To summarize— a total of 1,054 persons were regularly
paid from maternity and infancy funds, and the volunteer workers
reported by 20 States and Hawaii numbered 7,339,
C O NFER ENCES

During the year under review each of the 45 cooperating States and
the Territory of Hawaii demonstrated methods of reaching the indi
vidual child and his parents with information on child care and maternal
care by child-health and prenatal conferences.
Thirteen States— Delaware, Georgia, Kentucky, Minnesota, Ne
vada, New York, North Carolina, North Dakota, South Dakota,
Utah, Virginia, Wisconsin, and Wyoming—reported holding 6,198
combined prenatal and child-health conferences conducted by physi
cians; 3,810 expectant mothers were registered and 3,396 were ex
amined at such conferences and 12,461 visits were made to them.
The number of infants and preschool children registered at the con
ferences was 49,151, and the number examined w;as 48,681; 63,167

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SUMM ARY OF STATE ACTIVITIES D URIN G

1929

visits were made to the conferences by infants and preschool children.
North Carolina led in the number of this type of conference reported
(3,436) and New York was second (1,095). North Carolina also led
in the number of children reported examined (15,323) and Utah was
second (10,189). New York led in the number of expectant mothers
reported examined (2,330) and North Carolina was next (675).
Child-health conferences conducted by physicians were reported by
the Territory of Hawaii and 39 States: Alabama^ Arizona, Arkansas,
California, Colorado, Delaware, Florida, ^Georgia, Idaho, Indiana,
Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan,
Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hamp
shire,. New Jersey, New Mexico, New York, Ohio, Oklahoma, Oregon,
Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas,
Vermont, Virginia, Washington, West Virginia, and Wyoming. The
number of children reported registered in child-health conferences
conducted by the bureaus or divisions of child hygiene was 163,864
in 38 States; the number examined was 173,963 in these 38 States and
also in an additional State that did not report the number registered.
The number of visits of infants and preschool children to such con
ferences was 306,837. Pennsylvania led in the number of childhealth conferences held (5,322), also in the number of children exam
ined (16,706). Alabama was second in the number of conferences
held (1,402). Indiana was second in the number of children examined
at such conferences (13,172).
Prenatal conferences conducted by physicians were reported by 17
States: Alabama, Arkansas, California, Colorado, Delaware, Georgia,
Maryland, Michigan, Mississippi, New Jersey, New York, Oregon,
Pennsylvania, South Carolina, Tennessee, Texas, and \ irginia. The
number of conferences held was 2,352; 8,019 expectant mothers were
reported registered and 9,749 were examined; 1 State reported 1,897
expectant mothers examined but did not report the number registered.
A total of 22,199 visits were made to the conferences by expectant
mothers. Georgia led in the number of prenatal conferences reported
(504) and in the number of expectant mothers examined (2,232).
New York was second in the number of conferences (396). Alabama
was second in the number of women examined (1,897) and Mississippi
was third (1,202).
:
Nurses conducted a total of 10,124 conferences in the Territory ol
Hawaii and 27 States: Alabama, Arizona, Arkansas, California,
Colorado, Delaware,Florida, Georgia, Idaho, Iow~a,Kansas,Louisiana,
Maine, Maryland, Michigan, Missouri, Nevada, New Jersey, New
Mexico, New York, Ohio, Oregon, South Carolina, Tennessee, Texas,
Virginia, and Wyoming. One State did not report the number of
conferences held,"though it reported the number of children inspected
and of mothers instructed in prenatal care. The total number of
children inspected at conferences conducted by nurses was 59,350.
The number of mothers instructed in prenatal care was 6,629. Childrenmade 129,190 visits to such conferences, and mothers made 15,108
visits. Missouri led in the number of conferences reported (4,347)
and Delaware was second (832). Missouri led in the number of
children inspected (22,496) and Iowa in the number of mothers
instructed in prenatal care (3,708).
Dental conferences conducted by dentists were reported by_ 16
States: Arizona, California, Colorado, Kansas, Louisiana, Maine,

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TH E W E LFA R E AND H YG IEN E OF M A TERN ITY AND IN FAN CY

Maryland, Mississippi, Missouri, Oklahoma, Oregon, South Carolina,
Texas, Utah, Virginia, and West Virginia. The number of conferences
held was 1,134; 1,305 expectant mothers and 22,969 preschool children
were instructed or given dental examination. Mississippi reported
the largest number of such conferences (384), also the largest number
of expectant mothers (1,202) and of preschool children (8,876) in
structed or examined. The number of expectant mothers advised or
examined by dentists was 1,125 greater in 1929 than in the preceding
year.
At conferences of all these types a total of 21,079 expectant mothers
were examined by physicians or were advised or instructed by nurses
and dentists on some phase of prenatal care.5 Fewer inspections of
children by nurses were reported, and fewer expectant mothers were
advised in nurses’ conferences than in the preceding year; but 2,778
more children were reported examined by physicians than in the
preceding year.
Table 2 summarizes the conference work in the cooperating States
and the Territory of Hawaii during the year ended June 30, 1929.
8 This figure may involve some duplication, as some of the same persons may have attended conferences
of different types.

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T a b l e 2.— Conferences held and 'permanent centers established in the States and the Territory of Hawaii cooperating under the maternity and
infancy act during the year ended June SO, 1929
Conferences conducted by physicians

Conferences conducted by nurses

T o ta l........................

Ex
Num- pectber of ant
con moth
fer
ers
ences regis
tered

Prenatal

Persons re
Visits to
ceiving den
conferences
tal advice
Ex
by—
Num
Moth*
Num pect
Num ChilNum- Chil ers
Chil
ber of
ber of dren Num ber of ant Num ber of dren
dren
con Ex
in
con regis ber of con moth ber of confer in
regis Ex
fer pect
ers visits ences spect struct
visits fer
fer
tered pect Chil ences tered
Chil Moth ences ant Chil
ed
ed
ences regis
ant dren
dren
ers
tered
moth dren
moth
ers
ers Visits to
conferences
by—

6,198 3,810 49,151 12,461 63,167 16,933 163,864 306,837 2,352 8,019 22,199 10,124 59,350

241

157

Idaho................................ —
Indiana................................

Michigan.............................
Minnesota_______________

1,042
2,487
31
570

1929

States and Territory coop
erating

Child health

Conferences con New health centers
established 1
ducted by dentists

SUMMARY OF STATE ACTIVITIES DURING

Combined prenatal and child
health

1,402 3,998 10,585
491
28
451
261 A199 4,199
811 8,801 12,629
93 2,274 2,274
967 3,004
293
685
89 2,212 2,212
165 492 3,668 5,248
846 4,083 16,444
68 2,447 . 2,447
572 13,217 13,229
187 3,927 3,927
176 4,854 4,854
3 97fi a 276
132 2,692 3,133
184 1,458 2* 153
456 7,199 7,199
987
14
987
14
18
429 6,728 6,728
553 10,188 15,981
5,776
170 ft
38 1,163 1,163

223

(2)

2,323

66
418
35
196

66
1,411
35
374

504 2,232

5,568

5
154
7
52

32
162

69
162

147 1,202

1,594

12
60

375
27
26
115
12
832
269
297
414
30

307
651
2,436
306
2,485
4,749
2,402
1,947
988

107
4

33
41
57
30

1,889
143
498
100

4,347 22,496

Com
bined
pre Child Pre
natal health
natal
and
child
health

6,629 129,190 15,108 1,134 1,305 22,969
(2)

16
80

226
301
261
436
3,708
12

5,218
16
383
692 0
9,500
226
306
14,964
712
4,749
2,844
556
5,864
988 824
95

3,708
12
59

1,992
281
538
200

306
400

250 42,680
ft
(2)

405
0

18
65
250

756
1,383

1,202 8,876
476

0
ft
ft
Montana..............................
Nebraska........................... .
i New permanent health centers whose support has been assumed wholly or in part by the respective counties or communities in the majority of the States.
1 Not reported.

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T a b l e 2.— Conferences held and permanent centers established in the States and the Territory of Hawaii cooperating under the maternity and
infancy act during the year ended June SO, 1929— Continued

Conferences conducted by nurses
Combined prenatal and child
health

States and Territory coop
erating

Ex
Num pect
ber of ant
con moth
fer
ers
ences regis
tered

Visits to
conferences
Ex
by—
Chil Moth
Num Chil
Num pect
Chil
dren
ers
ber of dren Num ber of ant Num Num
ber
of
dren
in
con
ber of con moth ber of confer in
regis Ex
fer regis
fer
ers visits ences spect struct
tered pect Chil ences tered visits ences
Chil Moth
ed
ed
regis
ant
dren ers
tered
moth dren
ers
201

201

108 3,102

541

80 10,216

80 12,747

30
541
67

469

153 7,094
26 1,144

469

206 12,464
26 Í, 144

98
(2)
11
824

2,968 2,968
5^600 29,413
' 121
' 121
12,640
(2)

93
125

750

396

933 3,012

92 4,343 4,343
144 4,978 4,978
208 2,315 2,810
5,322 16'706 76' 153
226
728 3,682
119 2,944 2,944

209
300

928
364

8,464
6', 165

593
284

5,791
4’ 967

23
935
90
469

609
609
9,283 15,928
5^601 5' 601
6,042 M

1,683

Conferences con New health centers
established
ducted by dentists

Prenatal

Visits to
conferences
by—

1 095 2 471 2,978 10,204 3,378
436
675 15,323 1,474 20,586
61 7,226
246
61 7,226

Utah

Child health

3,074

1,203

562 2,717
2
61
806 (a)
4,609
(2)

180

1,203

Persons re
ceiving den
tal advice Com
Num
bined
pre Child Pre
ber of
con Ex
natal health’
natal
and
fer
child
ences pect
ant Chil
health
moth dren
ers

180

13,481
56
69
(2)
3,100 1,413
(2)
474 7,580 '663

185

1,654
1,556

537

12
7

80
14

360

276
494

749
4,530

150
14

3,591
6|198

349 •

822

3,657

174

7,745

(2)

69
14

309
31
0

22
1
6
41

496
3 1,523

296

116
24

60 2,969
38
687

829

11
4

492

2 Not reported.
2 A total of 7,681 visits to nurses’ conferences was reported; apparently this figure includes visits by other mothers in addition to the 174 instructed m prenatal care.

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9
17
2
1

1
1
1

231

1
1

2
12
1
11

5
14
9
3

THE W E LFA R E AND H YG IE N E OF M A TER N ITY AND IN FAN CY

Conferences conducted by physicians

SUM M ARY OF STATE ACTIVITIES DURING

1929

P E R M A N E N T P R E N AT AL A N D C H IL D -H E A L T H C EN TER S

The. establishment of permanent prenatal or child-health centers—
or combined prenatal and child-health centers— has been in many
instances a result of itinerant or occasional child-health conferences
held by the State in towns and rural districts. In some communi
ties the permanent center has developed as an expansion of the health
program in a county health department. Later the maintenance of
the center has been assumed as part of the community’s responsibil
ity for the hygiene and welfare of its mothers and babies.
Three types of local centers have been developed in the maternity
and infancy work in the States: Combined prenatal and childhealth centers at which mothers, infants, and preschool children are
examined and advice relating to their welfare is given; centers for
children only; and prenatal centers for expectant mothers only.
During the year under review 65 new permanent combined prenatal
and child-health centers were established in 10 States: Delaware,
Florida, Georgia, New York, North Carolina, South Carolina, Ten
nessee, Utah, Virginia, and Wisconsin. The largest number estab
lished in any one State was 22 (in New York). The next largest
was 13 (in Wisconsin). Child-health centers numbering 127 were
established in Hawaii and 19 States: Arkansas, California, Georgia,
Idaho, Kentucky, Missouri, Montana, New Hampshire, New Jersey,
New Mexico, New York, Oregon, Pennsylvania, Rhode Island,
South Carolina, Texas, Virginia, Washington, and West Virginia.
Pennsylvania led in the number of new child-health centers during
the year (17) and Virginia was second (14). The establishment of
19 new permanent prenatal centers was reported by 9 States: Cali
fornia, Georgia, Mississippi, New Hampshire, New Jersey, New York,
Pennsylvania, Rhode Island, and South Carolina. Georgia led with
6 new centers of this type, and Mississippi was second with 4.
Table 2 shows the number of new health centers established in the
cooperating States and the Territory of Hawaii during the year
ended June 30, 1929.
D EFEC TS F O U N D A T C O N FER EN C E S

It is not the purpose of the child-health conference to hold exam
inations or consultations for the obviously ill child or baby. Sick
children, if brought to the conferences, are referred to their family
physicians or other agencies for care and treatment. The object
of the child-health conference is to examine and supervise the sup
posedly well child and thus prevent the development of deviations
from the normal by teaching parents correct standards of care.
However, many defects are found in the babies and preschool
children brought to conferences. The attention of parents is directed
to the defects found in their children, and they are advised to consult
their family physicians in regard to methods of correction. The
correction of defects is increased through the work of nurses in follow
up visits and the check-ups made in regard to corrections and im
provement. Although the State, county, and community nursing
personnel has usually not been sufficient to help or persuade all the
parents to have all needed corrections made or to ascertain the number
that have been made, a number of States reported the approximate
9412°—31----- 2

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THE W E LFA R E AND H YG IEN E OF M A TER N ITY AND IN FAN CY

number of defects corrected during the year under review. For
example, Alabama reported 1,363 defects found in 1,218 children
and 553 corrections made. Utah reported 18,716 defects in 8,265
children and 2,659 corrections.
The reports from State bureaus or divisions of child hygiene that
classified defects by age groups showed a larger proportion of defects
in children as they approached the age at which they would enter
school. Kecognition of this condition has led to cooperation with
parents and schools in arranging conferences in the spring for the
examination of preschool children who would enter school in the
fall. Attempts were then made to have the defects found all corrected
during the summer so that the child might start to school free from
physical handicaps. This type of work was developed largely through
the “ summer round-up” of children promoted and sponsored by the
National Congress of Parents and Teachers in cooperation with the
State bureaus and divisions of child hygiene’ and local health agencies.
As this type of work increased, the number of children having defects
corrected increased.
C O U N T Y H E A L T H D E P A R T M E N T S A N D C O U N T Y N U R SES

In 29 States maternity and infancy funds were allotted to the
counties for payment in whole or in part of a part-time or full-time
maternal and infant nursing service within the counties.
The development of county health departments with full-time
health officers in charge created a demand for special assistance with
maternity and infancy programs in the counties having such depart
ments. Maternity and infancy nurses were also employed in counties
not having such departments. Frequently the nurse conducted a
demonstration in rural child-health work which aroused a demand on
the part of the community for a full-time health department.
The number of nurses paid in full or in part from maternity and
infancy funds for county work in these 29 States was 394.6
The number of counties in the 29 States receiving aid from mater
nity and infancy funds during the year under review and the number
of counties so aided that had county health departments were as
follows:
8 This figure does not include the 11 town and city nurses subsidized in Virginia nor the nurses in the
public health nursing division of the State department of health in Pennsylvania paid in part from mater
nity and infancy funds.

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SU M M ARY OF STATE ACTIVITIES DURING

Counties receiving
aid from mater
nity and infancy
funds during the
fiscal year ended
June 30,1929

Counties receiving
aid from mater
nity and infancy
funds during the
fiscal year ended
June 30, 1929
State

State

New Mexico_______________

1929

Total

Number
having
full-time
local health
officers on
Jan. 1,1929

361

208

New York_________________

31
34
14
20
i
8
1
18
3
13
13
11
16
4

31
23
4
14

Ohio_____________ _________
Oklahoma--------------------------Oregon______________ ______

7
1
8
2
13
10
3

Total

South Carolina........................
Tennessee__________________
Texas______________________
U tah....................... ........... - Virginia____________________
Washington________________
West Virginia.......................—
Wisconsin__________________
Wyoming---------------------------

Number
having
full-time
local health
officers on
Jan. 1,1929

1
22
6
4
6
12
1
23
26
3
244
2
16
1
17

1
20
3
4
6
1
21
3
3
13
1
11
1

1 Aid was to specific communities in counties;

2 Eleven cities and towns also received aid.

The total number of counties in the 45 cooperating States was 2,948.
The number of counties receiving assistance from maternity and
infancy funds in the employment of public-health nurses to devote
full or part time to maternity and infancy work was 361, and 208 of
these counties had full-time health departments.7
The States that led in the number of county nurses employed for
full-time or part-time maternity and infancy work were Alabama,
Arkansas, California, Georgia, Maryland, North Carolina, Tennessee,
Texas, and Virginia. In some of th<&e States the policy was followed
of establishing full-time county health departments, and nurses in
these departments whose salaries were paid in part by Federal and
State funds and in part by county funds carried on the local maternity
and infancy programs. In the others there were few or no full-time
county health departments, and nurses whose salaries also were paid
jointly from Federal, State, and local funds did maternity and infancy
work in the counties under the general supervision of the State depart
ment.
H O M E V IS IT S

An important feature of the work in 39 States and Hawaii was the
visits made by the nurses on the State staff and by the county nurses
to the homes to instruct the mothers in prenatal, infant, and child
care. The home visit is one of the most successful methods of reach
ing the expectant mother and impressing her with the value of medical
supervision during pregnancy. The home visit is also useful to discuss
corrections needed for children examined at conferences.
The total number of home visits reported was 674,083. One State
in which visits were made did not give a complete report on the num
ber of visits, and six States— Indiana, Kentucky, North Dakota,
7 The total number of counties having full-time health departments on January 1,1929, was 467. Public
Health Reports, vol. 44, No. 20 (M ay 17, 1929), p. 1202. U. S. Public Health Service, Washington, 1929.

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THE W E LFAR E AND H YG IEN E OF M A TER N ITY AND IN FAN C Y

South Dakota, Vermont, and Washington— made no report of the
number of visits. New Jersey reported 65,000 visits made by nurses,
the largest number reported by any State. Georgia was next with
60,336, Rhode Island with 59,619, New York with 51,052, and Virginia
with 50,858.
Table 3 shows the number of home visits made in the cooperating
States and the Territory of Hawaii during the year ended June 30,
1929.
T a b l e 3.— Number of visits made by nurses, number of community and group
demonstrations, and number of counties in which maternity and infancy work
was done, in the States and the Territory of Hawaii cooperating under the maternity
and infancy act, during the year ended June 30, 1929
Demonstrations

States and Territory cooperating

Visits by
nurses

674,083
47,651
11,546
11, 799
25,256
1,842
9i 641
13,876
60,336
16, 337
128

Number of counties—
In which maternity
and infancy work
has been done—

Com
munity

163

Group

10,094

88
872
307
250

1,151

280

6,364
2,296
5,030
47,223
59,619
9,114

Utah— ____________ ___________________

17,147
lOj 903
3,672

1 Not reported.

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244
268
51
1,845
18
1,025
75
382
19
168
225
21

74
261

3
13
16
1
7

50,858
14, 538
734
1,494

During
1929

Since the
beginning
of co
operation

2,953

2.170

2,717

67
14
75
58
63
3
67
161

31
10
75
57
38

33
14
75

67
125
4

141

2 1,-125

914
14,662
7,289
12,647
3; 585
8,291
7,180
5', 081
1,041
3,020
13,382
65,000
2,459
51,052
49; 671

In the
State

2
1

143
379
1,043
17
27
15

585
376
22

44
92
99
105
120
64
16
23
83
87
82
114
56
93
17
10
21
31
62
100
53

77
36
67
5
46
69
95
254
29
14
100
39
55
71
23

1 Incomplete report.

42
86
43
101
50
22
11
23
81
62
82
60
28
71
17
10
21

62
53
34
37
76
29
67
5
46
65
71
70
28
12
98
36
48
71
22

61
3
67
161
4
44

92
99
105
120
62
15
23
83
87
82
114
90
17
10
21
31
62
62
47
82
77
36
67
5
46
65
95
121

29
13
98
36
55
71
23

SUM M ARY OF STATE AC TIV ITIES D U RIN G

1929

LOCAL D E M O N S T R A T IO N S OF M A T E R N IT Y A N D IN F A N C Y P R O G R A M S

A total of 163 community demonstrations of maternity and in
fancy work were reported by 14 States: Arizona, California, Louis
iana, Michigan, New Jersey, New Mexico, New York, Oklahoma,
Pennsylvania, South Carolina, South Dakota, Texas, West-Virginia,
and Wisconsin. These varied from a full maternity or infant-wel
fare program conducted in a county or community during several
months or a year to a demonstration of some special phase of the
work during a short period to emphasize an important feature of ma
ternal or infant care. During the year under review New York con
ducted 13 community demonstrations consisting of extensive programs
in maternal or infant care and Arizona conducted 78 consisting of
some special feature or features.
Demonstrations of special technique in the care of mothers and
infants or demonstrations of other relevant matters of especial inter
est were given before groups of mothers, midwives, girls, _nurses,
and other special groups. Demonstrations by nutritionists in foods
and food values were included in this method of reaching the public
with information. Thirty States reported 10,094 demonstrations
conducted before groups.
Table 3 shows the number of community and group demonstrations
conducted in the cooperating States reporting this phase of work
during the year <$nded June 30, 1929.
IN S P E C T IO N OF M A T E R N IT Y AN D IN F A N T H O M E S

Child-hygiene bureaus or divisions in the departments of health
or public welfare in 12 States reported the inspection of such insti
tutions during the year under review. In these States— California,
Idaho, Kansas, Nebraska, New Hampshire, New Jersey, New York,
North Dakota, Ohio, South Dakota, Texas, and Utah— a total of
1,196 maternity homes or maternity hospitals were inspected. The
number of inspections made was 1,365. California inspected 250
homes (making 291 inspections) and 371 hospitals (making 414
inspections).
The inspection of boarding homes for infants or children was
reported by the bureaus or divisions of child hygiene of seven States:
Kansas, Nebraska, New Hampshire, New Jersey, New York, North
Dakota, and Texas. These States made 1,775 inspections of 1,007
infant homes. Of these inspections 516 were of 454 boarding homes
for children in New York State.
M ID W IV E S

The instruction of midwives continued to occupy a large place in
the programs of maternal and child welfare of States in which mid
wives attend a large number of births. During the year under
review the instruction of midwives in class groups was reported by
15 States: Alabama, Arkansas, Delaware, Florida, Georgia, Ken
tucky, Louisiana, Maryland, Michigan, New Mexico, North Carolina,
South Carolina, Tennessee, Texas, and Virginia. The number of
groups or classes organized was 1,553; 9,425 midwives were enrolled,
and 4,477 completed the course. The number of lessons in the courses
in the different States varied from 2 to 10. In a number of States
the class work for midwives was followed by the organization of

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THE W E L F A R E AN D H YG IE N E OF M ATERN ITY AN D IN FAN C Y

imdwives’ clubs. At the regular meetings of such clubs an inspec
tion was made of the midwives and their bags. Supervision and
instruction were given to midwives by State staff nurses or county
nurses. This plan of continuous supervision has been especially well
adapted to the Southern States that have numerous negro midwives.
The plan has given the State bureaus or divisions a better knowledge
of the individual midwives, and as a result of continuous and per
sistent effort on the part of State staffs and the county health de
partments the type of midwives as well as their technique has im
proved greatly in the past few years.
T a b l e 4. Classes conducted, for instruction in maternal, infant, and child hygiene
reported by 87 States and the Territory of Hawaii cooperating under the maternity
and infancy act during the year ended June 80, 1929
Classes for women
States and Terri
tory cooperating

Total________
Alabama. _________
Arizona___________
Arkansas_________
California_________
Colorado__________
Delaware_________
Florida___________
Georgia._____ _____
Hawaii___________
Idaho_____________
Indiana___________
Kentucky_________
Louisiana_________
Maine____________
Maryland_________
Michigan_________
Minnesota.___ ____
Mississippi________
Missouri______ . . . .
Montana............ .
Nebraska_______ ...
Nevada....................
New Hampshire___
New J ersey...^ .....
New Mexico_______
New York________
North Carolina____
Oklahoma________ |
Oregon_____ ______
South Carolina____
South Dakota____ ■_
Tennessee................
Texas_____________
Utah_____________
Vermont...... ...........
Virginia..________
West Virginia_____
Wisconsin________

Classes for girls

Classes for midwives

Girls
Classes Women Women Classes
com
Girls
com
organ
enrolled pleting organ enrolled pleting
ized
ized
course
course
1,101

18,211

10,851

8
143
56
5

111
2,039
603
53

603
53

650

592

18
58

188
2,398

2,398

1
7
32
7 162
25

25
120
433
2,539
418

«78
74
360
8 2,750
149

109
2
15
21
6
78
7
42
9
5
64
3
1
94
88

1,680
0
40
329
179

88
714
106
33
1,263
96
9
1,734
1,088

2,185

36,290

23,293

1,553

9,425

51
2
88
25
48
3

314
35

719

2 110
182
78
0
2,691
20

1,073

403
2

1,217
41
1,760
2 110
182
84
0
4,554
48

318
807
455

95
2,939
2,374

24
35
17
192

678
544
380
3,974

406
380
3,924

264

146

206
(7)

186
0

105

2,248
0
572
504
179

M id
Classes
Mid
wives
organ
com
wives
ized
enrolled pleting
course

80
556
106

_____
145
85
9
480

10
5
234
27
12
173
2

166
0
4,079
0
345
2,843
58

102
0
3,780
(“)
345
2, 800
50

7
20
28

102
304
835

102
257
734

26
98
1
27
53
466

345
2,285
18
1,145
1,029
5,264

315
1,072
18
1,145
595
(4)

•

95
117
82, 730

361

226

3
23

116
496

«142

106

492

1 571 permits issued; lessons were continuous.
\ 2 other classes were organized, but enrollment and number of lessons were not reported.
3 Conducted by a member of the Children’s Bureau staff.
* Not reported.
8 Includes some carried over from previous year.
6 Includes 53 carried over from previous years.
7 95 midwives enrolled in classes for women completed the course.
8 Includes 255 boys.
* 1,171 certificates given.

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1571

10Infant-hygiene classes are conducted in public schools.

4,477

SUM M ARY OF STATE ACTIVITIES DURING 1929

States with large numbers of white midwives have regulated, in
structed, and supervised them. The midwives have been organized
into county, district, or State groups and have been given special
instruction. Unquestionably the close supervision and the follow-up
of midwives’ cases in the States that have employed supervisors of
midwives have contributed in a large measure to a lowered mortality
of mothers attended by midwives.
M .
Table 4 shows the number of classes orgamzed for midwives, the
number of midwives enrolled, and the number completing the course
in the States reporting these items for the year ended June 30, 1929.
Special opportunities for advanced courses for midwives with
bddside training in hospitals is a recent development of maternity and
infancy work. A graduate course for licensed midwives was offered
by the Jersey City Hospital in 1928. Fourteen midwives m that
year took the course offered and 25 midwives completed the course
and received certificates in 1929.
CLASSES FO R W O M E N IN IN F A N T A N D PRE N ATAL CARE

The State bureaus or divisions of child hygiene conducted 1,101
classes in prenatal and infant care for women, or especially for mothers,
in 27 States: Arkansas, Arizona, California, Colorado, Georgia, Idaho,
Indiana, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri,
Montana, Nebraska, Nevada, New Hampshire, New York, Oregon,
South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont,
Virginia, and West Virginia; 18,211 women were enrolled and 10,851
completed the course. The number of lessons in the course in the
different States, usually about 8, varied from 3 to 30. Michigan
led in the number of classes organized (162), Arkansas was next
(143), and Missouri was third (109). Michigan reported the highest
enrollment (2,539), Indiana was second (2,398), and Missouri was
third (2,248).
. , ,
,,
Table 4 shows the number of classes organized lor women, tiie
number of women enrolled, and the number completing the course
in the States in which such classes were conducted during the year
ended June 30, 1929.
C LASSES FO R G IRLS IN IN F A N T A N D CH ILD CARE

Instruction in infant care and child care was given by members of
the State staffs to 2,185 groups of girls from 10 to 15 years of age m
Territory of Hawaii and 28 States: Alabama, Arizona, Arkansas,
California, Colorado, Delaware, Georgia, Louisiana, Maine, Mary
land, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada,
New Hampshire, New Jersey, New Mexico, Oklahoma, Oregon,
South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, and
West Virginia. Florida gave instruction to girls but did not report
the number of classes; the number of girls reported enrolled was
36,290 and 23,293 completed the course. West Virginia reported
the largest number of classes organized (466), Georgia was second
(403), and Nebraska was third (234 class groups). The highest
enrollment for the year was in West Virginia (5,264), Georgia was
second (4,554), and Nebraska was third (4,079). The number 01
lessons in the course, usually 10, varied from 5 to 30. As a result 01
maternity and infancy work, courses in infant and child care and hy
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THE W E LFAR E AND H YG IE N E OF M A TER N ITY AND IN FAN C Y

giene were taught in many schools in Wisconsin, and a number of
lessons in the subject were given in schools by the organizer of infanthygiene classes, a member of the staff of the St#te bureau of child
welfare and public-health nursing.
Table 4 shows the number of classes organized for girls, the number
of girls enrolled, and the number completing the course in the States
and Hawaii during the year under review.
IN ST R U C T IO N OF SPECIAL G R O U PS IN M A T E R N A L A N D IN F A N T CARE

Graduate courses in pediatrics were conducted for physicians with
the assistance of the State bureaus or divisions of child hygiene or
child welfare in Colorado, Missouri, and Tennessee. The Georgia
Division of Child Hygiene cooperated with the United States Chil
dren’s Bureau in providing a course in obstetrics for physicians in four
congressional districts on request of county medical societies. Talks
and lectures on special care of mothers or infants and special phases of
administration or technique were given to physicians and nurses on
request. Classes for teachers or for prospective teachers were con
ducted by the child-hygiene bureaus or divisions in Kansas, Minnesota,
New Jersey, and Wisconsin. Classes or series of lectures for nurses
were arranged in Minnesota, New Hampshire, and Oklahoma.
T R A IN IN G FIELD N U R SE S IN M A T E R N IT Y A N D IN F A N C Y W O R K

During the year under review 30 States reported using some method
for further training of field and county nurses in maternity and infancy
work after their entrance on duty. Only five States were able to
require that nurses be thoroughly trained in public-health work be
fore they were employed. Supervisory or advisory visits by a nurse
supervisor or director were most frequently reported as the means
used to improve the methods of organizing maternity and infancy
nursing services. Loan libraries were part of the plans in a few States.
State and regional conferences and institutes for nurses were held in
a number of States. Several bureaus or divisions of child hygiene
placed new nurses in the field under more experienced nurses for a
time before assigning them to permanent stations. Four States—
Alabama, Delaware, Missouri, and New York— arranged for the
further training of newly employed nurses at training centers or in
“ training counties.” In general, the last year of the cooperation of .
the States under the maternity and infancy act was marked by a
greater resourcefulness in finding methods to improve the type of
services rendered by maternity and infancy nurses within the States.
IN S T R U C T IO N IN PRE N ATAL CARE

The development of good programs in maternal welfare has been
slow, but more progress was made in 1929 than in previous years.
Difficulties were met and were overcome in the selection of methods
of informing the public, and particularly the expectant mother, of
the advisability of medical supervision early in pregnancy and reg
ularly during this period, and of emphasizing the benefit of such
supervision to the unborn child and during the first month of fife as
well as to the fife of the mother. No one method of disseminating this
information was utilized in all the States. Activities found widely
useful in the States were prenatal conferences, prenatal centers,

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SUM M ARY OF STATE ACTIVITIES DURING 1929

classes for expectant mothers and other women, and classes for
midwives in which they were instructed to have their prospective
cases receive prenatal care. Visits by nurses to expectant mothers
and county-wide demonstrations in prenatal and maternal care— as,
for example, in New York and Michigan— also were successful
methods of imparting instruction on this subject.
The distribution of prenatal letters was a method of reaching many
pregnant women. During the year under review 24 States— Arizona,
California, Colorado, Delaware, Idaho, Kansas, Kentucky, Louisiana,
Maine, Michigan, Minnesota, Missouri, Montana, Nebraska, New
Hampshire, North Carolina, Oklahoma, Oregon, South Dakota,
Tennessee, Utah, Washington, West Virginia, and Wisconsin— en
rolled 39,246 women to receive prenatal letters. Twenty-five States
distributed 50,140 sets of these letters; a set usually consisted of
nine letters, one sent for each month of pregnancy. North Carolina
led in the number of women enrolled (9,671) and Oklahoma was
second with an enrollment of 6,697.
Table 5 shows the number of new names enrolled for prenatal
letters in the States reporting this activity and the number of sets of
letters distributed in the year ended June 30, 1929.
Correspondence courses in prenatal care were conducted in Min
nesota, Virginia, Washington, and West Virginia. Literature on
prenatal care prepared by the United States Children's Bureau and
by a number of States also was distributed by the cooperating States.
T a b l e 5.— Educational work done through talks and lectures, 'prenatal letters, and
distribution of literature in the States and Territory of Hawaii cooperating under
the maternity and infancy act during the year ended, June 30, 1929
Talks and lectures
I lumber pven to-

States and Territory cooperating
Total

Total_____________ ______ _ 29, 748
1,662
71
Arkansas________________________ 3,105
' 208
195
118
Florida___________________ ____
343
653
9
Idaho___________________________
10
Indiana_________________________
374
155
87
Kansas______________ ________
809
159
182
81
Maryland_______________________
Michigan___ ____________________
314
Minnesota_____ __ ______________
93
15,000
Missouri I . . . . . . _________________
'431
60
Nebraska....................... ................ .
73
New Hampshire...............................
1 Not reported.

235

Physi Nurses Lay
cians
groups

363
0)

1
50
34
88
4
4
17
2
6
5
3
6

(!)

521
(!)

1
3
13
6
16

5
60
37
8
30
16
7
2
1
7
2

11,992

8
345
137
82
800
158
178
66
298
47
(l)
409
44
53

224

1
1
3
13
32
(Î)
14

Radio
audi
ences
116

(1)
65
2,995
' 137
105
106
305
606

2 5.149 individual letters distributed.

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Prenatal letters

39,246

50,140

6,063,120

695

(i)
698

1,511
'362
788

3,536
' 362
732

355

740
619
322
1,607

0
1,913
0
1,643

3,229
1,127

3,943
3; 154

830
579
911

1,284

904
579
911
250
1,284

(i)
71,598
109,309
18', 666
14,600
52,226
25', 824
42,654
4,003
23,968
94' 577
108,500
170,016
365'500
ZZ, 766
7l' 602
125,000
17l|2i3
25i; 202
50,000
290', 887
98,610
2831771
1,500
1931648

2
4
14
22
6
3
3
11
1
0

Pieces of
literature
New
distrib
Sets
names distrib
uted
en
uted
rolled

3 322 letters distributed.

THE W E LFA R E AND H YG IE N E OF M ATERN ITY AND IN FAN CY

T a b l e 5.— Educational work done through talks and lectures, prenatal letters, and
distribution of literature %n the States and Territory of Hawaii cooperating under
the maternity and infancy act during the year ended June 30, 1929-— Continued
Talks and lectures

Prenatal letters

blumber pven to-

States and Territory cooperating
Total

Physi
Lay
cians Nurses groups

New Jersey______ ________ _______
New Mexico____ ________ ________
New York_____________ ____ ____
North Carolina__________________
North Dakota__________ . . . . ____
Ohio_______________ ______ ______
Oklahoma__________ ____ _______
Oregon_______ ____ _____________
Pennsylvania____________ _______
Rhode Island___ _____ ___________
South Carolina__________________
South Dakota___________________
Tennessee_______________________
Texas___________________________
Utah_____________________ _____
Vermont_________ ____ ________
Virginia_____________________
Washington_____________________
West Virginia___________________
Wisconsin________________ _
Wyoming___________ __________

* 51

299

23
1,052
8 323
«248
7 74
28
293
26
1,655
« 137
8 137
39
187
126
448
137

2
6
1

5
9
8
22

0)
0
T 12

33
6
6
10
1
8
3
10

36
4
1
1
28
6
56

Radio
audi
ences
2

20
50
228
16
1,029
'295
200
(7)
28
245
26
1,622
«127
129
28
186
86
439
70

New
names
en
rolled

Pieces of
Sets literature
distrib distrib
uted
uted

350

2
8
26

9,671

6, 697
1,200

10,036
1,197

676
809

42
786
809

529

515

4
1

780 82,293
1 299

1 233

2,627

2,946

100,000

20,491
760,114
315,856
27,828
242,000
352,503
50.000
433,575
42,776
40,436
36,741
53,176
40,554
28,738
28,059
307,778
17,942
94,486
386,427
11.000

1 Not reported.
* Includes 1 to midwives.
8 Includes 19 to dentists.
« Incomplete report.
7 To lay groups chiefly.
8 Includes 1 to dentists.
8 Includes 2,000 sets mailed to physicians and public-health nurses in the State.

TALK S A N D LECTURES

Phases of maternal and infant care were presented in 42 States and
the Territory of Hawaii through a total of 29,748 talks or lectures.
Mississippi reported 15,000, the largest number of talks reported as
given in any one State. Arkansas was second, reporting 3,105.
Radio talks were given 116 times, Oregon leading with 26. A total
of 362 lectures or talks were given to physicians, 521 to nurses, and
11,992 to lay groups. A few talks or lectures were addressed to
groups of dentists and a few to groups of midwives. Only 3 of the
States cooperating— Nevada, North Carolina, and Wyoming— did not
report formal talks or lectures as a means of disseminating information.
Table 5 shows the total number of talks and lectures given in the
42 States and Hawaii and the number addressed to physicians,
nurses, lay groups, and radio audiences during the year ended June
30, 1929.
D IST R IB U T IO N OF LITERATU RE

Forty-four States and the Territory of Hawaii reported distributing
literature on the care of mothers and babies and preschool children.
This included both State and Federal publications. The total num
ber of publications distributed by the States was in excess of 6,000,000
pieces. Eighteen States reported distributing 100,000 or more pieces
of literature. New York reported more than 760,000 pieces distrib
uted and Pennsylvania more than 430,000,

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SUM M ARY OF STATE ACTIVITIES DURING

1929

Hawaii and 21 States— Arizona, Delaware, Kansas, Maryland,
Michigan, Mississippi, Missouri, Montana, Nebraska, New Hamp
shire, New Mexico, New York, North Carolina, North Dakota,
Pennsylvania, South Carolina, South Dakota, Utah, Virginia, Wis
consin, and Wyoming— reported sending 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. The Colorado Child-Welfare
Bureau sent literature to the parents of babies whose births were
listed in the newspapers. In Iowa the division of maternity and child
hygiene supplied literature to the State board of health, to be sent
to the parents of infants whose births were registered with that board.
New Jersey and Rhode Island distributed literature to the parents
of newborn babies at the time of the visit of the public-health nurses.
Thus 25 States and Hawaii sent information on the care of the baby
to approximately all the parents of babies bom in those States during
the year under review. Several other States sent letters to parents
of babies whose births were registered, offering to send such literature
on request.
The estimated number of live births in the entire United States
during the year under review was 2,365,624. The number of births
registered in Hawaii and those States that attempted to reach the
parents of newborn babies with information on the care of babies
was approximately 1,113,000. A conservative estimate of babies
reached through literature on their care sent to their parents during
the year leads to the conclusion that half of the babies bom in the
United States during that year had the benefit of such information,
as a result of State and Territorial cooperation with the Federal
Government.
Table 5 shows the number of pieces of literature distributed by the
cooperating States and the Territory of Hawaii during the year ended
June 30, 1929.
E X T E N S IO N OF T H E U N ITE D ST A T E S B IR T H A N D D E A T H R E G IST R A
T IO N AREAS

During the fiscal year ended June 30, 1929, the United States
Bureau of the Census announced the admission of three States to
the United States birth-registration area— Colorado, South Carolina,
and Nevada— and of one State— Nevada— to the death-registration
area. The admission of these States brought the total number of
States in each area to 45. The States not in either area at the close
of the year under review were New Mexico,8 South Dakota, and
Texas. The prospects are good for an early completion of the birth
and death registration areas by the inclusion of these States and the
Territory of Hawaii. The Territory of Hawaii, which is in the deathregistration area but not yet in the birth-registration area, has made
efforts to improve its registration of births. During the year under
review the child-hygiene agencies in New Mexico and Texas con
ducted campaigns to improve the registration of both births and
deaths. Legislation in South Dakota providing smaller registration
districts would assist that State in entering the area.
6New Mexico was admitted to the United States birth and death registration areas in November, 1929.

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THE W E LFA R E AND H YG IEN E OF M A TERN ITY AND IN FAN CY
SU R V E YS A N D C A M P A IG N S

A total of 34 surveys made during the year ended June 30, 1929,
were reported by 20 States: Alabama, Arkansas, California, Colorado,
Delaware, ^ Kansas, Louisiana, Maryland, Michigan, Minnesota,
Mississippi, New Hampshire, New Mexico, North Dakota, Oklahoma,
Oregon, South Dakota, Tennessee, West Virginia, and Wisconsin.
These surveys included the study of maternal mortality being made
in a number of States in cooperation with the United States Children’s
Bureau and also surveys of midwives, of conditions affecting pre
school children, of completeness of birth registration, of maternity
homes and hospitals, of public-health nursing, of goiter in children,
of the extent of breast feeding, and of conditions affecting Indian
women and babies on a reservation (made by a State division of
child hygiene in cooperation with the United States Office of Indian
Affairs).
A total of 191 campaigns were conducted by 32 States: Arkansas,
California, Colorado, Delaware, Georgia, Idaho, Indiana, Iowa,
Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mis
souri, New Hampshire, New Jersey, New Mexico, New York, North
Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South
Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, West
Virginia, and Wyoming. Twelve States conducted campaigns for
the examination of preschool children and the correction of their
defects before they should enter school in the fall. This type of
campaign included in some States immunization against diphtheria
and vaccination against smallpox as qualifications to enter school;
15 States reported independent campaigns for immunization against
diphtheria, and 1 State reported a campaign for vaccination against
smallpox. Eleven States reported campaigns for the observance of
M ay Day as Child Health Day. Five States reported campaigns for
the improvement of birth registration in order to enter the United
States registration area, or to improve registration in certain coun
ties. Two States conducted campaigns for promotion of breast
feeding. Campaigns for the securing of dental corrections, early
recognition of tuberculosis in children, and improvement of milk and
water supplies and of sanitation affecting the health of children
each were reported by one State. The types of campaigns indicate
a growing general interest in the welfare of infants and of preschool
children and an effort to institute or increase various activities to
improve their condition and their chances for life and health.
Although a number and variety of campaigns were reported, there
was in addition a considerable amount of informal campaign work, as,
for example, the instruction of expectant mothers and other mothers
in the importance of breast feeding at health conferences and through
the literature distributed.
M A T E R N A L -M O R T A L IT Y S T U D Y

During the year under review a state-wide study of all the deaths
of women ascribed to puerperal causes that had occurred in the
calendar years 1927 and 1928 was made in 15 States: Alabama, Cali
fornia, Kentucky, Maryland, Michigan, Minnesota, Nebraska, New
Hampshire, North Dakota, Oklahoma, Oregon, Rhode Island,

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SUMM ARY OF STATU ACTIVITIES DURING

1929

Virginia, Washington, and Wisconsin. In each State the study was
undertaken at the request of the State board of health and State
medical society and was made in cooperation with the United States
Children’s Bureau. (Two States— California and Oklahoma— con
fined the study to the maternal deaths that occurred during the
calendar year 1928 only.) In California, Michigan, Minnesota,
North Dakota, Oklahoma, and Wisconsin physicians from the staff
of the State bureau or division of child hygiene made the study.
The United States Children’s Bureau lent personnel to 9 States—
Alabama, Kentucky, Maryland, Nebraska, New Hampshire, Oregon,
Rhode Island, Virginia, and Washington— to assist in securing data
on the schedules. The tabulations will be made by the Children’s
Bureau. (See pp. 117, 123.)
E X P A N S IO N OF A C TIV ITIES

The 45 cooperating States and the Territory of Hawaii contain
2,953 counties or parishes. During the period of cooperation under
the maternity and infancy act maternity and infancy work has been
done in 2,717 of these counties. This total, as given in 1929, shows
an increase of 46 counties over the total counties reported reached
in 1928. The number of counties in which maternity and infancy
work was done during the year under review was 2,170. Thirteen
States— Arkansas, Delaware, Florida, Maryland, Mississippi, Nevada,
New Hampshire. New Jersey, New York, Pennsylvania, Rhode
Island, South Carolina, ana Wisconsin— reached every county
within their borders during the year under review. During the
period of cooperation under the maternity and infancy act some
form of maternity and infancy work was done in every county in 32
States: Arizona, Arkansas, California, Delaware, Florida, Georgia,
Idaho, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan,
Minnesota, Mississippi, Missouri, Montana, Nevada, New Hamp
shire, New Jersey, New Mexico, New York, Oklahoma, Oregon,
Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah,
West Virginia, Wisconsin, and Wyoming.
No work was undertaken in 235 counties in the cooperating States.
In 2 States having 34 and 38 counties not reached, the work was done
mainly through the county health departments, as it did not seem
feasible to conduct state-wide programs in these States by the method
followed where the health program is centralized in a State depart
ment. Many of the 164 counties not reached by maternity and
infancy work in the remaining 9 States are sparsely settled, moun
tainous, or unorganized, a few being Indian reservations in which the
United States Office of Indian Affairs has charge of the health work.
No maternity and infancy work was done in one county in the Terri
tory of Hawaii, which is a leper settlement, isolated from outside
contacts.
The geographical extent of the maternity and infancy work has
increased each year, and each year intensive work looking toward
permanent services has been carried out more successfully.
The number of counties in the cooperating States and Hawaii in
which work has been done under the maternity and infancy act
during the year under review and since the beginning of cooperation
with the Federal Government is shown in Table 3 (p. 14).

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THE W E LFAR E AND H YG IEN E OF M A TER N ITY AND IN FAN C Y

Thirty-eight States reported the number of expectant mothers
reached by some form of maternity and infancy work during the year,
the total number being 197,897. Forty-three States and Hawaii re
ported the number of infants and preschool children reached— 1,289,090. In a number of States the reports were incomplete, in many
instances not including the mothers and children reached through
distribution of literature.
Efforts were made by the States during the last year of operation
of the maternity and infancy act to secure State appropriations ade
quate to continue the maternity and infancy work after June 30,
1929, on the scale made possible by the provision of both Federal
and State funds. In addition, even greater efforts than in former
years were made to place county and community work to which
assistance had been given on a permanent basis by having local
agencies assume the responsibility for their support. Nineteen
States— California, Colorado, Florida, Kentucky, Louisiana, Michi
gan, Minnesota, Mississippi, New Mexico, New York, Ohio, Oregon,
South Carolina, South Dakota, Texas, Utah, Virginia, Washington,
and Wisconsin— reported that since the beginning of cooperation
under the act the responsibility for the work initiated or assisted by
the State bureaus or divisions of child hygiene had been assumed by
161 counties and 13 communities. In 1 State— Maryland— 7 counties
had assumed all the responsibility except for the service of physicians
from the State staff. In addition, 7 States— Georgia, Kansas, Mis
sissippi, New Mexico, New York, Ohio, and Pennsylvania— reported
that 36 counties and 54 communities were to assume the responsibil
ity after June 30, 1929.
O R G A N IZ A T IO N S C O O P E R A T IN G IN T H E M A T E R N IT Y A N D IN F A N C Y
WORK

State and local public and private organizations continued during
the year under review to support the State maternity and infancy
work and to give active cooperation. The cooperation has included
formal indorsement of activities and assistance in organizing local
work, in carrying on campaigns, surveys, and demonstrations, and in
conducting health conferences. Financial assistance has been given
in conducting local work in some States and in continuing it after
maternity and infancy funds were withdrawn.
Every State cooperating under the maternity and infancy act re
ported cooperation received from one or more state-wide organiza
tions. The cooperating organizations included other State depart
ments and bureaus, professional groups, women’s organizations, and
fraternal and service organizations. In addition, cooperation was
given by many local organizations and by individuals.
Forty-two States reported assistance from the State parent-teacher
association. Thirty reported cooperation from the State federation
of women’s clubs. The American Red Cross and the State league of
women voters each was reported as giving special assistance in 18
States. The State medical association and the extension division of
the State university or State college of agriculture each was reported
as assisting in 14 States. The State department of education or of
public instruction and the State tuberculosis association each was
reported as assisting in 13 States. Ten States reported cooperation

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SUM M ARY OF STATE ACTIVITIES D URING 1929

from the American Legion auxiliary. The State dental association
and the American Legion each was reported as assisting in 9 States.
Six States reported cooperation from the State public-health associa
tion and 1 from the State public-health and tuberculosis association.
The auxiliary of the State medical association and the Woman’s
Christian Temperance Union each was reported as cooperating in 5
States, the legislative council of women was reported as cooperating
in 4 States, the State farm bureau in 3 States, and the American
Association of University Women in 2 States.
Other organizations reported cooperating in one or two States
included the State board or department of welfare, the State board
of control, the State board of charities and corrections, the State
child-welfare department or bureau, the State commission for the
blind, the State psychopathic hospital, the committee on maternal
welfare of the State medical association, district and county medical
societies, the State society for crippled children, the State health
council, the State child-welfare association, the State mental-hygiene
association, the State conference of social work, the State nurses’
association, the State organization for public-health nursing, the
visiting-nurse association, the State association of university women,
the State grange, the State chamber of commerce, the Daughters of
the American Revolution, the Catholic Daughters of America, the '
Young M en’s Christian Association, the Young Women’s Christian
Association, the Girl Scouts, the Camp Fire Girls, the Cooperative
Education Association, the Child Study Association, the State Chari
ties Aid Association, the Home Bureau, the State Development
Board, the Council of Farm Women, the State federation of colored
women’s clubs, home-makers’ clubs, farm women’s clubs, schools,
colleges, church organizations, men’s service clubs, business clubs
and fraternal organizations, community clubs, civic clubs, homedemonstration agents, and the press.

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SEVEN YEARS’ WORK OF THE COOPERATING STATES
UNDER THE MATERNITY AND INFANCY ACT
A C TIV ITIES U N D E R T A K E N

Though the details of the work under the maternity and infancy
act have differed in the different States, the aim in all has been
fundamentally educational; and, because the large cities already
have hospitals, physicians, nurses, and health departments, the
work has been primarily for mothers and babies living in the smaller
cities and in rural areas. All the States have sought to teach the
public how better care of mothers and babies will save hves and
improve health and to stimulate such local and individual interest
in the program that the work, once initiated, will be carried on by
the local community itself.
The types of activities that the States have carried on were, m
* general, the following:
1. Instruction of the individual as to the care of the mother and
child through—
(а) Health conferences conducted by physicians and nurses
directly under State auspices.
(б) Permanent health centers offering the same kind of in
struction but conducted under local auspices and financed
at least in part by local funds.
(c) Visits to mothers in their homes by public-health nurses.
(d) Demonstrations in the home in infant and maternal care.
2. Instruction of groups through—
(a) Classes—
(1) In infant care for adolescent girls.
(2) In infant care and prenatal care for mothers.
(3) In infant care and prenatal care for teachers, to pre
pare them to include maternity and infancy instruc
tion in their class work.
(4) For midwives.
(b) Graduate courses for nurses in maternity and infancy work
through State or regional conferences or institutes.
(c) Graduate courses in pediatrics and obstetrics for physicians
(usually conducted in conjunction with State or county
medical societies).
(d) Lectures, motion pictures, slides, charts, and exhibits.
3. Instruction through distribution of literature prepared by the
State or Federal Government on maternal and infant care and
hygiene, child care and management, and other subjects.
It is not possible to give an exact numerical summary of the States’
activities of these various types for the seven years in which the act
was in operation. Only approximate results can be shown by figures
reported by the States, as the figures available fall short of actual
26

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SEVEN YEARS’ WORK OF THE COOPERATING STATES

accomplishments. A number of factors influencing the develop
ment and growth of the work in the States have contributed to the
uneven character of reports in the earlier years as compared with
those of later years. It was not until well into the year 1923 that
the States were in a position to accept the full benefits of the mater
nity and infancy act through their legislatures. Four States created
child-hygiene divisions or bureaus in 1921, the year of the passage
of the act, and 10 States established such agencies after its passage.
There was also an increase from year to year in the number of States
cooperating under its provisions. It was not until 1927 that the
last two States to cooperate accepted the benefits of the act. In
each State some time necessarily was consumed in organizing the
supervising bureau or division and in getting the field work under
way. To the director the most important thing was to get the
work started; a good system of record keeping was secondary and
came later. Each State initiated its own program of work, and it
was not until the first reports of the work were published and the
first conference of directors of State bureaus was held in 1923 that
more homogeneous State programs were inaugurated. It was not
until the close of the fiscal year 1924 that comparable figures from
the States were available to any extent, and data on a few points
were not obtained until 1925 and 1926.
The total number of health, conferences at which expectant mothers
and children were examined by physicians, as reported by the cooperat
ing States during the 7-year period, was 144,777. Additional con
ferences conducted by nurses and dentists in which general instruction
was given on maternal and child care brought the total number of
conferences conducted to 183,252. A total of 2,978 permanent cen
ters consisting of child-health, prenatal, and combined prenatal
and child-health centers were established. The number of classes
organized for instruction, including classes for girls in infant care,
classes for mothers in infant and maternal care, and classes for mid
wives, was 19,723 during the last five years of operation of the act.
Visits to homes in the interest of mothers and babies made by publichealth nurses during the last six years of the act reached a total of
3,131,996. Reports covering the last five years of the act showed
22,030,489 pieces of literature distributed. During the last four years
of the act 176,733 sets of prenatal letters were distributed. The State
reports for the last four years showed that more than 4,000,000 infants
and preschool children-and approximately 700,000 expectant mothers
were reached by some form of the maternity and infancy work.
It should be noted that a decrease in numbers in an activity during
a given year means a change in work rather than a diminution of the
work. For example, when a State conducts itinerant demonstration
conferences over the entire State it reports a much larger number of
conferences held and numbers of mothers and children reached than
when, after this general educational work is done, it assists in the
development of permanent locally supported centers. When the
responsibility for maintaining the centers has been assumed by the
local community, the work is no longer reported as a State activity.
On the other hand, an actual expansion of the work is indicated in
some activities, as the increase in the distribution of prenatal letters
in 1929 and the larger numbers of children and expectant mothers
reached by the maternity and infancy activities in that year.
9412°—31-----3

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Table 6 summarizes the activities under the maternity and infancy
act during the period 1924 to 1929, inclusive, as reported by the coop
erating States and the Territory of Hawaii.
T a b l e 6 . — Summary of activities under the maternity and infancy act during the

last six years of its operation, as reported by the cooperating States and Territory
of Hawaii, 1924-1929
Permanent centers
established

Conferences conducted
by physicians

Year

Total______________________
1924_____________________________
1925..____ _______________________
1926_________ — ____ _____ _______
1927______________________________
1928__________ ____ ______________
1929___________ — ........— ________

Com
bined
pre
natal
and
child
health

Child
health

Pre
natal

Confer
ences Dental
con
ducted confer
ences
by
nurses

17,292

107,345

20,140

34,384

4,091

15,547
18,154
15, 524
21,347
19,840
16,933

6,088
3,781
2,686
3,231
2,002
2,352

G)
G)

(!)
1,945
1,808
7,341
6,198

6,407
6,273
11, 580
10,124

330
652
1,124
851
1,134

Com
bined
pre
Child
natal health
and
child
health
373

G)
G)

135
70
103
65

Pre

natal

2,294

311

1,084
506
140
235
202
127

188
65
8
14
17
19

Classes conducted
Year

1924...........— .'______ ______ _______
1925........ ........................... ...... . .
1926....... ......................... ...................
1927........................... ..........................
1928........................... ..........................
1929________ _____________________

For
For mid
For girls women
wives
7,397

6,578

5,748

1,362
1,365
1,199
1,286
2,185

1,403
1, 560
1,196
1,318
1,101

412
1,446
684
1,653
1, 553

Sets of pre
Home visits natal
letters
made
distributed

3,131,996
149,000
299,100
587,673
721,159
700,981
674,083

176,733

G).
G)

* 44,655
46,217
35,721
50,140

Pieces of
literature
distributed

22,030,489

2,195,000
3,192,919
4,403,218
6,176,232
6,063,120

1Not reported.

Public knowledge of the health problems of the infant and the
child has increased, and those in immediate charge of children and
their mothers are better informed about infant and maternal hygiene.
The importance of adequate prenatal care is being gradually learned.
The advantages of breast feeding have been stressed so frequently by
infant-welfare workers that the slogan printed on the stationery of
the bureau of child health of Virginia, “ The best-fed baby is the
breast-fed baby,” has become an accepted standard for the State
staffs and infant-welfare workers in general. Simpler and more
scientific formulas for feeding the bottle-fed baby have contributed
to his health and chance of living. A greater demand has developed
for the supervision of infants by competent pediatricians and specialists
in infant feeding.
Standards of prenatal care have been formulated with great care
by a committee of leading obstetricians from various parts of the
country, organized for that purpose at the request of the United States
Children’s Bureau in 1924.9 These standards have reached other
• Standards of Prenatal Care; an outline for the use of physicians. U. S. Children’s Bureau Publication
No. 153. Washington, 1925,

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SEVEN YEARS’ WORK OF THE COOPERATING STATES

obstetricians, have been incorporated in obstetrical courses in medical
colleges, and are part of the general knowledge of maternal-welfare
workers. Their effect seems to be reflected in the lower mortality
rate from puerperal eclampsia and convulsions, although the maternal
mortality rates from certain other puerperal conditions not so easily
influenced by prenatal care have not declined. Expectant mothers
demand and are receiving a higher type of prenatal care. '
State programs for the prevention of diseases in children through
vaccination and immunization against diseases for which preventive
measures have been accepted and proved effective have been extended
through the assistance of the maternity and infancy staffs. A lower
incidence of such diseases has been shown in areas where intensive
preventive work has been done.
The menace of the untrained, ignorant, and unclean midwife has
been greatly lessened during the years between 1921 and 1929 through
progress in their registration, regulation, supervision, and instruction.
Many States have used maternity and infancy funds to assist in
the manufacture and distribution of ampules of nitrate of silver for
use in the eyes of the newborn infant (to prevent ophthalmia neona
torum). These States reported in the last years of operation of the
apt an increase in the number of requests for the ampules from physi
cians and midwives— especially the latter. In several States no case
of ophthalmia neonatorum was reported during the past year. That
fewer babies are blind from this cause seemed to be the conclusion of
other States in their reports submitted at the expiration of the mater
nity and infancy act.
The States and the United States Children’s Bureau have made
studies and surveys of factors contributing to the morbidity and
mortality of mothers and babies. The necessity of obtaining fuller
and more accurate figures and of collecting more uniform data showed
the importance of completing the birth and death registration areas in
the United States. In 1921 the District of Columbia and 27 States
were in the United States birth-registration area. By the close of the
fiscal year 1929, 45 States and the District of Columbia were in the
birth-registration area. In 1921 the United States death-registration
area contained 34 States, the District of Columbia, and the Territory
of Hawaii. In 1929 the death-registration area included 45 States,
the District of Columbia, and the Territory of Hawaii. Maternity
and infancy workers have given considerable assistance in State
campaigns for improved registration of births and deaths.
Greater attention to the health of the preschool child marked the
closing years of the maternity and infancy act. Prevention of com
municable diseases for which means of prevention ar§ known, periodic
examinations of preschool children, the “ summer round-up” of pre
school children who will enter school in the fall, and the correction during
the summer of defects found in these children in health conferences
in the spring or early summer have been developed in large measure
smce 1921 and have grown to larger proportions in 1929, with resulting
better health for children at the beginning of their school life.
The increase in the trained personnel employed in the promotion of
maternal and infant health in 1929 as compared with 1921 and the
improvement in standards and methods of work also reflect the prog
ress made during the operation of the maternity and infancy act.

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THE W E LFA R E AND H YG IEN E OF M A TER N ITY AND IN FAN CY

DEVELOPMENT OF ORGANIZED STATE AGENCIES FOR PROMOTING
THE WELFARE OF MOTHERS AND CHILDREN
ORGANIZED BUREAUS IN STATE DEPARTMENTS OF HEALTH

A number of States anticipated the passage of the maternity and
infancy act while it was pending in Congress and created maternity
and child-hygiene bureaus or divisions to administer the funds under
the act if they should become available. Thirty-three such State
agencies were in existence at the beginning of 1921. During 1921
and 1922, 14 more were created; and in 1925, after extension of the
benefits of the act to Hawaii, that Territory established a division
of maternity and infancy.

By June 30, 1929, maternity and child-hygiene bureaus or divi
sions had been created and were functioning in the Territory of
Hawaii and in all the States except Vermont, which did not establish
a separate division or bureau to administer the Federal funds but
has carried on the work under the immediate direction of the State
health officer. Not only were such new agencies created, but those
already existing were able to expand through the granting of Federal
funds to the States that accepted the provisions of the act. The
States that did not accept the Federal funds secured larger appro
priations for maternal and child hygiene from their legislatures and
were stimulated to greater activities.
PERMANENT LOCAL AGENCIES FOR EDUCATING PARENTS IN CHILD AND MATERNAL
HEALTH

The directors of State divisions and bureaus of maternity and
child hygiene had as an objective the development of permanent
local interest in the care of mothers and children and the assumption
of local responsibility for such care.
Even in the first years of operation of the act many directors
regarded the itinerant health conferences that they conducted for
the local communities as demonstrations which were to pave the
way for the establishment of similar facilities for child care on a
permanent basis and with local support. This policy resulted in
the establishment of 2,294 permanent child-health centers from 1924
to 1929, inclusive, also 311 permanent prenatal centers, and 373
permanent combined prenatal and child-health centers— some sup
ported from local funds, others so supported in part.
THE MATERNITY AND INFANCY PROGRAM IN THE DEVELOPMENT OF COUNTY AND
OTHER LOCAL HEALTH WORK

Nurses paid in full or in part from maternity and infancy funds
have been detailed to counties, communities, or cities, sometimes to
work with an established county health unit or other official health
agency, sometimes to conduct nursing demonstrations for the pur
pose o f developing public interest in a permanent local nursing or
health service. N ot infrequently a nurse working alone in a county
afforded a starting point for the development of a full-time county
health department.
The establishment and extension of local health work were pro
m oted b y the use of maternity and infancy funds to help pay for
local maternity and infancy work in proportion to the amount of
time spent by the nurses in such work. Since the beginning of the

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SEVEN YE AES’ WORK OF THE COOPERATING STATES

operation of the act 161 comities and 13 communities have assumed
entire responsibility for maternity and infancy work begun by the
use of maternity and infancy funds. Other counties and commu
nities have assumed partial responsibility for such work or were
ready to assume it at the expiration of the maternity and infancy
act.
T H E T R E N D IN IN F A N T M O R T A L IT Y

The value of maternity and inf ancy work is reflected in the decrease
hi infant and maternal death rates in 1928 as compared with those
in 1921.
Although the general death rate for all ages for the expanding
birth-registration area was slightly higher in 1928 than in 1921, the
infant mortality rate was lower, according to the figures reported by
the United States Bureau of the Census. (Table I, Appendix C,
p. 132.) In 1921 in this area, consisting of 27 States and the District
of Columbia, the general death rate was 11.7 per 1,000 population;
in 1928, in the area consisting of 44 States and the District of Colum
bia, it was 12, an increase of nearly 3 per cent. The infant mortality
rate (deaths of infants under 1 year of age per 1,000 live births) for
the expanding area was 76 in 1921 and 69 in 1928, a decrease of 9 per
cent. This decrease was obtained despite the fact that a number
of States admitted to the area since 1921 had high infant mortality
rates. The 1928 rate (67) for the States that have been in the
birth-registration area during the entire period 1921 to 1928 is 11
per cent lower than the 1921 rate (75) for this area.
If the same infant mortality rates had prevailed through the
seven years of operation of the maternity and infancy act as in 1921,
more than 60.000 babies who survived would have died in their first
year of life.
The mortality rate for white infants in 1921 was 72, as compared
with 64 in 1928; for colored infants it was 108 in 1921 and 106 in
1928. In urban areas the mortality rate for infants was 78 in 1921
and 69 in 1928; in rural areas it was 74 in 1921 and 68 in 1928.
The maps on page 32 show the infant m ortality rates for the States
in the United States birth-registration area in 1921 and for these
same States in 1928.
Infant mortality has shown a downward trend throughout the
period of the cooperation of the States under the maternity and in
fancy act. In only one year was the rate higher than in 1921; that
year was 1923, when the rate was 77, as compared with 76 in 1921.
Slight fluctuations have occurred from year to year.
A comparison of infant mortality b y causes for the States and the
District of Columbia in the birth-registration area of 1921 (exclusive
of South Carolina) shows that the rates from the important group
causes were lower in 1928 than in 1921, with the exception of the rate
from respiratory diseases, which was higher. The later months of
1928 were marked b y a serious influenza epidemic, with its attendant
respiratory complications. The increase in the infant m ortality rate
in the area of 1921 from 64 in 1927 to 67 in 1928 was undoubtedly
due to the increase in the deaths from respiratory diseases, the mortal
ity rate for the group being 25 per cent higher in 1928 (12.9) than in
1927 (10.3). (Table 7, p. 33.)

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THE W E LFA R E AND H YG IEN E OF M A TERN ITY AND IN FAN C Y

The rates from gastrointestinal diseases show a definite downward
trend from 1921 to 1928. In 1928 the rate from these causes (7.9)
was 47 per cent less than in 1921 (14.8). This group shows a greater

reduction than any other group of causes. Although the rates from
natal and prenatal causes, which have their origin largely in the mother
during pregnancy and confinement, do not show the definite downward

Source: u.a ©ureauofthe Censua

Infant mortality rates in 1928 in the birth-registration States of 1921 (deaths
of infants under 1 year of age per 1,000 live births)

trend shown by the rates from gastrointestinal diseases, ‘ these rates
have nevertheless decreased during the period. As Table 7 shows,
the rate from natal and prenatal causes for the 1921 area was 33.9 in

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SEVEN YEARS’ WORK OF THE COOPERATING STATES

1928 as compared with 36 in 1921. Reduction in infant mortality from
gastrointestinal diseases reflects the work done in disseminating infor
mation on the importance of breast feeding and the proper prepara
tion 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 also reflects the wider
knowledge of the care of the baby, the prenatal care the mother
receives, and a greater attention to care at time of childbirth.
T a b l e 7.— Infant mortality rates, by specified groups of causes, in the United States
birth-registration area as of 1921, exclusive of South Carolina; 19 21-1928 1
[Source: United States Bureau of the Census]
Deaths of infants under 1 year of age per 1,000
live births
Cause of death

All other causes 6________ ___________________

1921

1922

75.0

75.7

76.2

70.3

71.8

73.6

64.0

67.0

36.0 35.9
14.8- 12.6
10.3 13. 7
4.6
4. 0
0.9
1.0
___ 8.3
5.9
2.6

35.6
12.3
13.8
5.4
1. 0
5.8
2.5

35.0
10.0
11.9
4.4
1. 0
5.7
2.4

34.9
11.9
12. 2
3. 7
1.0
5. 9
2.3

34.9
10. 2
14.3
5. 0
1.1
5. 7
2.4

33.5
8.0
10.3
3.5
0.9
5. 3
2.3

33. 9
7.9
12. 9
3. 6
0.9
5. 4
2.4

1923

1924

1925

1926

1927

1928

1 Including California, Connecticut, Delaware, Indiana, Kansas, Kentucky, Maine, Maryland, Massa
chusetts, Michigan, Minnesota, Mississippi, Nebraska, New Hampshire, New Jersey, New York, North
Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Virginia, Washington, Wisconsin,
and the District of Columbia. These are the States that were in the birth-registration area every year from
1921 to 1928. South Carolina was dropped from the area in 1925 and reinstated in 1928. Rates are for the
period 1921-1928 because 1921 immediately preceded the enactment of the maternity and infancy act and the
1928 figures are the latest available.
2 Includes premature birth, congenital debility, injuries at birth, other diseases of early infancy, congenital
malformations, syphilis, tetanus.
3 Includes diseases of the stomach, diarrhea and enteritis, dysentery.
4 Includes 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.
6 Includes convulsions and other causes of death.

Infant mortality rates for the year 1927 are available for 29 foreign
countries and for the year 1928 for 13 foreign countries. In 1927
six countries (Australia, the Netherlands, New Zealand, Norway,
Santo Domingo, and Switzerland) had lower rates than the United
States birth-registration area. Five of the 13 countries whose rates
are available for 1928 (England and Wales, Irish Free State, the
Netherlands, New Zealand, and Switzerland) had lower rates than
the United States birth-registration area. New Zealand, which for
many years has had a lower infant mortality rate than any other
country, had in 1928 a rate of 36. The States in the United States
birth-registration area most nearly approaching this rate are Oregon
with a rate of 47, Washington with a rate of 48, Iowa and Nebraska
with rates of 53.
The infant mortality rate of 1928 was lower than that of 1921 in
the United States and in each of the 12 foreign countries for which
rates for both 1921 and 1928 are available. These countries are
Austria, Chile, England and Wales, Germany, Irish Free State,
Japan, the Netherlands, New Zealand, Northern Ireland, Scotland,
Switzerland, and Uruguay.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
T H E T R E N D IN M A TE R N A L M O R T A L IT Y

During the period of the operation of the maternity and infancy act
slight fluctuations in the maternal mortality rates have occurred from
year to year, according to the figures reported by the United States
Bureau of the Census, but no material decrease has been effected,
except for certain causes. (Table II, Appendix C, p. 135.) The
maternal mortality rate for the United States birth-registration area
of 1921, which consisted of 27 States and the District of Columbia,
was 68 deaths from causes associated with pregnancy and childbirth
per 10,000 live births as compared with 69 in 1928 in the area, which
consisted of 44 States and the District of Columbia. This increase
in the expanding area is due primarily to admission of States that
have large negro populations and high maternal mortality. It is
noteworthy that a decrease occurred in the area as of 1921, exclusive
of South Carolina, the 1921 rate being 67 and the 1928 rate 64.
Under the maternity and infancy act the contacts with expectant
mothers have usually been outside the large urban centers. The effect
of this work, therefore, should be reflected in lowered maternal mor
tality rates in the rural areas. The rural rate for the 27 States and
the District of Columbia in the registration area of 1921 was 59 per
10,000 live births. The rate in 1928 was 56 for the same area.
The maternal death rates for the 26 States and the District of
Columbia in the birth-registration area from 1921 through 1928
show a downward trend throughout the period. In 1928 the rate
from all puerperal causes was 64 per 10,000 live births as compared
with 67 in 1921. The rates from puerperal hemorrhage, puerperal
septicemia, and puerperal albuminuria and convulsions were lower
in 1928 than in 1921. (Table 8.) It may be reasonably concluded
that although the maternal mortality rates show no substantial
decreases during the period of the maternity and infancy act, the
lives of many mothers have been saved in rural areas as a result of
the educational programs in regard to the need of prenatal care.
The maps on pages 35 and 36 show the maternal mortality rates in
the States in the United States birth-registration area in 1921 and in
the rural areas of these States, also the rates in these same States in
1928.
T a b l e 8 . — Maternal mortality rates, by cause of death, in the United States birth-

registration area as of 1921, exclusive of South Carolina; 1921—1928 1
[Source: United States Bureau of the Census]
Deaths of mothers from causes associated with pregnancy and childbirth per 10,000 live births
Cause of death
1921

1922

1923

1924

1925

1926

1927

All causes............ ..............................- , ................ 67.3

65.4
6. 5
6.5
7.6
23.6
17.8
3.4

65.8
6.8
6.6
7.6
25.0
16.1
3.6

64.0
6.0
6.6
6.7
24.0
17.0
3.8

64.3
5.9
6.6
7.1
24.2
17.1
3.6

64.6
7.0
7.0
7.5
23.6
16.2
3.3

62.3
5.9
6.9
7.0
24.1
15.1
3.4

Puerperal hemorrhage-------------- --------- ------------------- 7.2
Other accidents of labor----------------------- ---------------- 6.7
Puerperal septicemia......... ...............—- ........- .............. 27.1
Puerperal albuminuria and convulsions------------------ 17.4
3.2
All other causes................... —— ........... ............ - - - - -

1928
64.2
6.9
7.0
7.8
23. 5
15.8
3.3

i Ineluding California, Connecticut, Delaware, Indiana, Kansas, Kentucky, Maine, Maryland, Massa
chusetts, Michigan, Minnesota, Mississippi, Nebraska, New Hampshire, New Jersey, New York, North
Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Virginia, Washington, Wisconsin,
and the District of Columbia. These are the States that were in the birth-registration area every year from
1921 to 1928. South Carolina was dropped from the area in 1925 and reinstated in 1928. Rates are for the
period 1921-1928 because 1921 immediately preceded the enactment of the maternity and infancy act and the
1928 figures are the latest available.

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SEVEN YEARS* W O R K OP TH E COOPERATING STATES

Comparison of maternal mortality rates of the United States birthregistration area with those of foreign countries gives the United
States a less favorable position than the comparison of infant mor-

Source: U .S.Bureauof t h e Census

Maternal mortality rates in 1921 in the birth-registration States of 1921 (deaths
of mothers from causes associated with pregnancy and childbirth per 10,000
live births)

tality rates. The maternal mortality rate for the United States in
1927 (65 per 10,000 live births) was higher than that of any of the
20 other countries for which rates are available; in 1928 the rate (69)

Source: u.S.Bureau o f t h e Census

Maternal mortality rates in 1928 in the birth-registration States of 1921 (deaths
of mothers from causes associated with pregnancy and childbirth per 10,000
live births)

exceeded all but one of the 9 other countries reporting figures at this
time. The country with a rate most nearly approximating that of the
United States was Scotland, which had a rate of 64 in 1927 and 70 in

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TH E W E LFA R E AN D H YG IE N E OF M A TER N ITY A N D IN FAN CY

1928. M ost of the other countries had rates considerably lower. The
country with the lowest rate was Uruguay (22 in 1927 and 24 in 1928).

Source: U.S. Sureau of th e Censúa

Maternal mortality rates in 1921 in rural areas of the birth-registration States
of 1921 (deaths of mothers from causes associated with pregnancy and child
birth per 10,000 live births)

Figures for both 1921 and 1927 are available for 18 foreign coun
tries. In 7 the rate for 1927 was higher than that for 1921; in 2 the
1927 rate was the same as the 1921 rate; and in the United States and

Scttjrce: u.s. Sureau of th e Census

Maternal mortality rates in 1928 in rural areas of the birth-registration States
of 1921 (deaths of mothers from causes associated with pregnancy and child
birth per 10,000 live births)

9 other countries the rate was lower. The foreign countries showing
1927 rates lower than those of 1921 were Chile, Czechoslovakia, Fin
land, Irish Free State, Japan, New Zealand, Northern Ireland,
Switzerland, and Uruguay.

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SEVEN Y E A R S ' W O R K OF THE COOPERATING STATES

In the expanding United States birth-registration area the 1928
maternal mortality rate was 69 as compared with 68 in 1921. The
rates of a constant area (such as that of the States in the Umted
States birth-registration area from 1921 to 1928) are, however,
more comparable with those of foreign countries, which are generally
constant in size, than the rate of the expanding United States birthregistration area. The rate for such an area composed of the States
in the United States birth-registration area during the entire period
from 1921 to 1928 shows a decrease from 67 in 1921 to 64 in 1928.
*The 1927 rate for this area was 62. The tendency toward higher
rates in 1928 is also apparent in foreign countries, as 6 of the 9 foreign
countries for which 1928 rates are available (England and Wales,
Irish Free State, the Netherlands, Northern Ireland, Scotland, and
Uruguay) had higher rates in 1928 than in 1927. The rates for Japan
and New Zealand were the same for both years, and that for Chile
was lower.
i
.
The phase o f the work dealing with the importance oi prenatal care
for both mother and child has been well begun. Good prenatal care
is a factor in preventing puerperal albuminuria and convulsions; and
the downward trend in the rate of deaths from this cause of maternal
mortality during the operation of the maternity and infancy act has
been noted. The number of women seeking such care is still relatively
small, and much more education of the public as to the importance of
early and regular medical supervision of the expectant mother is
needed. Encouraging features are the increased interest shown by
women in seeking and by physicians in giving^ such care and the
recognition of the services of the maternity and infancy nurse as the
most effective means of reaching expectant mothers.
PUBLIC

IN T E R E S T IN T H E P R O M O T IO N OF T H E W E LFAR E
H Y G IE N E OF M A T E R N IT Y AN D IN FAN C Y

AN D

Great interest on the part of the public was aroused in the welfare
and hygiene of maternity and infancy as a result of the passage of the
maternity and infancy act. The regular work of the State agencies
and the United States Children^ Bureau in the administration oi the
act has provided additional stimulation of this interest,^ which has
developed quite outside of the actual information disseminated con
cerning maternal and infant care. , Newspapers and magazines have
carried columns on the care of mothers and babies. The public has
been informed about the essentials of proper care for mothers and
babies by material from these unofficial sources, which, have been
based largely on official information. Editorials have been written,
both pro and con, on the Sheppard-Townér Act. In 1921 it was still
a moot question whether child hygiene and maternal hygiene were
necessary divisions in a good State public-health program and whether
they belonged in a disease-prevention program. Now, however, the
general public, as well as official State agencies, recognize the necessity
of including in public-health programs the prevention of morbidity
and mortality of mothers and babies.
.
Obstetrical procedures and the feeding and care of babies are topics
on medical-society programs much more frequently than before the
passage of the maternity and infancy act, and sections on infant and
child hygiene contribute to the growing interest of public-health pro
grams and meetings. The welfare of the child and the mother is a

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THE W E LFA R E AND H YG IEN E OF M A TE R N ITY AND IN FAN C Y

topic of increasing interest at conferences of public-health nurses and
social workers also. The active support of the great organizations of
lay groups that have sponsored the maternity and infancy act from its
inception continues and is not confined solely to women’s organiza
tions. Some loss of public interest may be expected, however, as a
result of the curtailment of the work through the lack of appropria
tion of Federal funds.
CONTINUATION OF MATERNITY AND INFANCY W ORK

W ill the States carry on this joint work unaided b y the Federal
Governm ent so that there will be no loss to the mothers and babies?
Can we expect the expansion of programs on the basis of the demon
strated successes of the last few years without Federal assistance?

Nation-wide interest in this problem of the health of mothers and
babies has been almost as important in promoting the work as the
money contribution, but funds are essential if gains that have been
made are to be conserved and extended. When the Federal maternity
and infancy act came to an end every effort was made by its supporters
to secure State appropriations equaling at least the combined Federal
and State funds that were expended in the fiscal year ended June 30,
1929. This effort for increased appropriations was made in order to
continue the work that was being done and also because in the event
of the enactment of a law continuing Federal cooperation the in
creased appropriation would make possible an expansion of activities
along the lines that experience had indicated were desirable.
A t the expiration o f the maternity and infancy act 16 States and
the Territory of Hawaii reported that their legislatures had appro
priated an amount equaling or exceeding the combined Federal and
State- funds available for the previous year. These States are: Dela
ware, Maine, M aryland, Michigan, Missouri, New Hampshire, New
Jersey, New M exico, New York, North Carolina, N orth Dakota,
Pennsylvania, South Dakota, Tennessee, Vermont, and Wisconsin.
In some of these the appropriation was made because the women of
the State requested it in such overwhelming numbers that refusal
seemed impossible. In Florida the support for the work comes from
a millage tax for the health department, and the State reported that
it expected the returns to enable it to expend an amount equal to the
State and Federal funds for maternity and infancy work of 1929.

In five States— California, Indiana, Minnesota, Montana, and
Texas— the legislatures had made appropriations that represented
large increases over those for the previous year but did not quite
equal the amount of combined State and Federal funds which the
States had under the maternity and infancy act. The legislatures of
seven States— Georgia, Kansas, Ohio, Oklahoma, Rhode Island,10
West Virginia, and Wyoming— had made appropriations that repre
sented increases over State appropriations for 1929 but were consid
erably less than the combined State and Federal funds for 1929. In
six States— Arkansas, Colorado, Iowa, Nebraska, Oregon, and South
Carolina— the appropriations made were the same or less than the
State appropriations for 1929, so that the work had to be greatly cur
tailed. In Arizona, where the legislature made an increased State
10 In Rhode Island the 1930 legislature appropriated an amount equaling the combined Federal and State
funds that the State had under the maternity and infancy act.

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SE VEN Y E A R S ’ W O R K OF TH E COOPERATING STATES

appropriation, and in Utah, where the appropriation was the same as
in the previous year, the State funds might be spent only if Federal
funds were available. In Idaho no State funds might be spent after
December 31, 1929, unless Federal funds should be available.
Two States— Nevada and Washington— made no appropriations for
carrying on the work. The legislatures of Alabama, Kentucky,
Louisiana, Mississippi, and Virginia did not meet in 1929.11
The threat of withdrawal clearly acted as a two-edged sword, stim
ulating some States to greater expenditures and influencing others to
reduce the work if the Federal Government withdrew. In a third of
the cooperating States the money appropriated was sufficient to con
tinue the present activities; in the others physicians and nurses had
to be dismissed and Cooperative arrangements with counties and local
communities curtailed when the Federal Government failed to con
tinue promoting the health of mothers and babies through some sharing
of the expense involved. Even the States securing an appropriation
equaling the combined State and Federal funds reported a drop in
the interest in the program since July 1, 1929. In other words, the
participation of the Federal Government contributed something else
as important as money.
11 In Alabama the State board of health allotted from its appropriation the sum of $74,173 for “ child
hygiene and public-health nursing” in 1929. In Kentucky and Virginia the 1930 legislatures made appro
priations equaling the combined Federal and State funds the States had under the maternity and infancy
act. In the interim the work in Kentucky has been carried on with funds raised by private subscription.
In Mississippi the 1930 legislature appropriated a sum equal to the State appropriation for the previous
biennium. In Louisiana the 1930 legislature made no appropriation for maternity and infancy work.

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PRINCIPAL ACTIVITIES OF THE INDIVIDUAL STATES
DURING 1929

A summary of the work done in the individual States as reported
to the Federal office in their annual reports covering the fiscal year
1929 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 the
1929 appropriation.1 They are instead the actual expenditures dur
ing the fiscal year ended June 30, 1929, including any unexpended
balances carried over from the previous year.
ALA B A M A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene and pub
lic-health nursing, Montgomery.
Funds expended: Federal, $25,836.95; State, $20,836.95; total, $46,673.90.
otaii.
Director (nurse), 3 nurses (part year), 2 vital-statistics clerks (part year), 1
bookkkeeper (part time, part year), 1 stenographer (part year). Thirtythree county nurses were paid in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 1,402; infants and pre
school children registered and examined— 3,998; visits to conferences—
10,585.
Defects found in children examined at conferences— 1,363; children having
defects— 1,218. Parents had defects corrected in 553 of the children.
Prenatal conferences conducted by physicians— 223; expectant mothers ex
amined— 1,897; visits to conferences— 2,323.
Conferences conducted by nurses, no physician present— 375; visits to con
ferences by mothers— 5,218.
Classes for girls in care of infants and preschool children— 51 o r g a n i z e d ;
girls enrolled— 1,217; number completing course— 314.
Classes for midwives— 14 organized; midwives enrolled— 719. Permits to
practice issued— 571.
Hom e visits by nurses— 47,651 (prenatal cases seen, 5,006; obstetrical cases,
27; postnatal cases, 3,744; infants, 26,450; preschool children, 10,095).
Surveys -2: (1) Of maternal mortality (continued from the previous year),
state-wide, 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 m part by the State and in part by the United States Children’s
Bureau.
(2) Of midwives, in 1 county.
Talks and lectures— 1,662.
Literature distributed— many pamphlets on maternal and child care.
Breast feeding was stressed in the instruction given to mothers, in talk« to
groups, and in visits at homes.
Counties in the State— 67; counties in which maternity and infancy work
was done during the year— 31; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
8iCX

oo»

The following organizations cooperated in the bureau’s work: State board of
education, State child-welfare department, Alabama Polytechnic Institute
(agricultural-extension service), committee on maternal welfare of the
State medical association, and the parent-teacher association.
1 See footnote 3, Table 1, p, 3,

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

INFANT AND MATERNAL MORTALITY RATES8

Alabama was not admitted to the United States birth-registration area until
1927. M ortality rates of earlier years therefore are not available for comparison
with those of 1928.
In 1928 the general death rate for the State (12.4) slightly exceeded that for
the birth-registration area (12). Owing largely to the high mortality among
colored infants and mothers, the infant and maternal mortality rates for the
State were considerably higher than those for the birth-registration area. _ The
infant mortality rate for the State was 75, in contrast to 69 for the birth-registra
tion area; the maternal mortality rate for the State was 94, in contrast to 69 for
the area. The rate for colored infants in the State was 94 and that for white
infants was 64; the rate for colored mothers was 128 and that for white mothers
was 76.
AR IZO N A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, child-hygiene division, Phoenix.
Funds expended: Federal, $13,136.02; State, $7,253.71; total, $20,389.73.
Staff:
Director, 11 nurses (7 part year), 1 stenographer (part year).
Activities:
Child-health conferences conducted by physicians— 28; infants and pre
school children registered afid examined— 451; visits to conferences— 491.
Defects found in children examined at conferences— 685; children having
defects— 347. Parents had defects corrected in 73 of the children.
Conferences conducted by nurses, no physician present— 27; infants and
preschool children inspected— 307; mothers instructed in prenatal care—
16; visits to conferences by children— 383.
Dental conferences— 2 ; preschool children receiving dental examination— 56.
Classes for girls in care of infants and preschool children— 2 organized; girls
enrolled— 41 ; number completing course— 35; lessons in course— 8.
Classes for mothers— 8 organized; mothers enrolled— 111; number completing
course— 105. The number of lessons in the courses varied for the different
classes.
H om e visits by nurses— 11,546 (prenatal cases seen, 365; obstetrical cases,
22 ; postnatal cases, 232; infants, 1,352; preschool children, 1,617).
Com m unity demonstrations— 78, of a maternity and infancy public-health
nursing 'program. The work included health conferences, home visits,
class instruction, and home demonstrations, one or more of these activities
being conducted in each of 78 communities.
Group demonstrations— 88, on preparing obstetrical supplies, preparing
bed for confinement, bathing patient in bed, bathing the baby, preparing
formulas and caring for bottles, making bandages and dressings.
Talks and lectures— 71.
Literature distributed— 71,598 pieces.
New names registered for prenatal letters— 695; prenatal letters distributed—
698 sets.
Nutrition work was done through individual instruction to mothers.
Breast feeding was stressed by the nurses in their interviews with mothers
and in the literature distributed. It was estimated that 80 per cent of
the infants in the State are breast fed at birth, 50 per cent at 3 months
of age and 30 per cent at 9 months.
Infants born in the State during the year— 9,165; infants under 1 year of
age reached by the work of the division— 8,156 (through conferences,
home visits, and literature mailed with birth-registration cards); pre
school children reached— 2,206 (through conferences and home visits);
expectant mothers reached— 1,283 (through conferences, home visits,
and prenatal letters).
The division sends literature on infant hygiene to parents of all infants whose
births are registered in the State bureau of vital statistics.
* The infant mortality rate discussed in this section and in similar sections of the reports of other States
is the number of deaths of infants under 1 year of age per 1,000 live births in the designated year. The
maternal mortality rate is the number of deaths of mothers from causes associated with pregnancy and
childbirth per 10,000 live births. For tables of these rates for the United States birth-registration area and
for the individual States that were in the area, also for their white and colored populations and for urban
and rural areas, see Appendix C, p. 132. The general death rate is the number of deaths of persons of all
ages per 1,000 population.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Counties in the State— 14; counties in which maternity and infancy work
was done during the year— 10; 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: American
Red Cross, State federation of women’s clubs, church relief societies, and
parent-teacher associations. They assisted with conferences, purchased
milk for children, and provided the means for correction of some physical
defects. Am ong the children examined at health conferences reported in
the foregoing paragraphs were 141 examined in the “ Get ready for school”
campaign sponsored by the National Congress of Parents and Teachers.
The outstanding feature of the year’s work was the number of home visits made
by the staff nurses.
INFANT AND MATERNAL MORTALITY RATES

n0^ admitted to the United States birth-registration area until
.7, ., M ortality rates of earlier years therefore are not available for comparison
with those of 1928.
-fo 1928 both the general death rate (13.6) and the infant mortality rate (142)
for the State were higher than those for the United States birth-registration area
(12 and 69). The general death rate, however, was only 1.6 points higher, while
tbo infant mortality rate was more than twice as high. This higher rate was due
chiefly to influenza and the accompanying respiratory diseases, which were
responsible for almost a fourth of the total infant deaths in 1928.
The maternal mortality rate for the State (77) was also higher than that for the
birth-registration area (69). In the State, as in the area, more maternal deaths
were due to puerperal septicemia than to any other cause.
ARKANSAS
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene, Little
Rock.
fu n d s expended: Federal, $26,246.14; State, $12, 755.21; total, $39,001.35.
Staff:
Director (State health officer serving), 2 nurses (1 part year), 2 field workers
(1 part year), 1 stenographer. Thirty-six county nurses were paid in part
from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 261; infants and pre
school children registered and examined— 4,199.
Defects found in children examined at conferences— 5,179; children having
defects; 2,7 ip . Parents were known to have had defects corrected in
451 of the children (report incomplete).
Prenatal conferences conducted by physicians— 5; expectant mothers regis
tered and examined— 66.
Conferences conducted by nurses, no physician present— 26; infants and pre
school children inspected— 651; mothers instructed in prenatal care— 80 ;
visits to conferences by children— 692.
N ew permanent child-health centers— 3 established as a result of the mater
nity and infancy work. They are supported by public and private funds.
Classes for girls in care of infants and preschool children— 8 8 organized;
girls enrolled— 1,760; lessons in course— average of 12.
Classes for mothers— 143 organized; mothers enrolled— 2,039. In addition
56 self-directed preschool child-study circles used the lesson outlines issued
by the United States Children’s Bureau.
Masses for midwives— 40 organized; class meetings— 420; midwives enrolled—
1,073. ^The midwives do not complete a specified series of lessons; the
course is gradually enlarged as they show capability for more advanced
instruction. There has been a decided improvement in the midwife
situation. The midwives are giving more attention to prenatal care, and
when possible they take their patients to classes to receive instruction
irom the nurses. Frequently the midwives in remote areas arrange with
.
hysician and nurse of the county health unit to conduct conferences
+? ';aPlr homes. Intensive work was done in 56 counties, and in addition
the bureau examined birth certificates for new midwife names in 75
counties and followed up these midwives by correspondence.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— C ontinued.
Hom e visits by nurses— 11,799 (to prenatal cases, 713; obstetrical cases, 24;
postnatal cases, 867; infants, 2,133; preschool children, 3,493; miscellane
ous, 4,569).
Group demonstrations— 872, on preparation of foods, maternity outfits, and
other phases of maternal and infant care.
Survey— 1, of birth registration, in 75 counties.
Campaign— 1, for the examination of preschool children and the correction
of their defects. This is a year-round activity. Thirty-seven counties
were well organized for this campaign, and most of the other counties did
some work. About 4,000 preschool children met the “ Arkansas Health
Standard” for preschool children, which requires that they show proof of
registration of birth, be of normal weight, have had physical defects cor
rected, practice health habits, and be immunized against diphtheria, small
pox, and typhoid fever.
Intensive work was done in 10 counties to have health conferences conducted
for preschool children and educational work done among midwives.
Talks and lectures— 3,105.
Literature distributed— 109,309 pieces.
Nutrition work was done through individual instruction to preschool children.
Exhibits conducted— 357. Exhibit material prepared— graphs, charts for
testing vision. Exhibit material was lent 46 times.
Breast feeding was stressed in the instruction given in classes for mothers and
classes for midwives, also in the general educational activities of the bureau.
Infants born in the State during the year— 38,179; infants and preschool
children reached by the work of the bureau— 57,725; expectant mothers
reached— 16,430.
Counties in the State— 75; counties in which maternity and infancy work
was done during the year— 75.
As a result of the bureau’s work 4 county child-health councils were organized.
The development of 3 permanent and 3 itinerant nursing services was
partly due to the efforts of the bureau.
The bureau gave advisory and supervisory service to local organizations
doing child-health work.
The following organizations cooperated in the bureau’s work: State board
of education, State university (extension service), State tuberculosis
association, State society for crippled children, State federation of women’s
clubs, women’s auxiliary of the State medical society, American Legion
and its auxiliary, W om an’s Christian Temperance Union, and the parentteacher association. They assisted in the campaign to have preschool
children examined and correction made of physical defects. In addition
to the children examined at health conferences reported in the foregoing
paragraphs, 1,069 children 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 compiling and
initiating of the Arkansas Health Standard.
INFANT AND MATERNAL MORTALITY RATES

Arkansas was not admitted to the United States birth-registration area until
1927. Mortality rates of earlier years therefore are not available for comparison
with those of 1928.
The general death rate for the State in 1928 (10.3) was lower than the rate for
the birth-registration area (12). The infant mortality rate also was lower than
that for the birth-registration area, as the following figures show:
Arkansas

Area

T o ta l_______

Urban
Rural __

76
66

69
68

W h it e ..
Colored

61
86

64
106

The maternal mortality rate for the State was slightly lower in 1928 (88)
than in 1927 (90), but it was higher than the corresponding rate for the birthregistration area, owing in part to the high mortality rate for colored mothers
(151) in contrast to that for white mothers (70). The maternal mortality rate
for urban areas of the State (129) was higher than for rural areas (84).
9412°— 31------4

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
C ALIFO RN IA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public health, bureau of child
hygiene, San Francisco.
Funds expended: Federal, $38,596.19; State, $28,034.66; total, $66,630.85.
Staff:
Director (physician), 5 physicians (3 part year, 1 part time), 2 nurses (1
part year), 1 dentist (2 months), 2 inspectors of maternity homes, 1 financial
clerk (part time), 1 mailing clerk, 3 stenographers (1 part time, 1 for two
months). Twenty-three county nurses in 14 counties were paid wholly
or in part from maternity and infancy funds.
Volunteer assistants— 75 physicians, 35 dentists, 100 nurses, 350 lay persons.
Activities:
Child-health conferences conducted by physicians— 811; infants and pre
school children registered and examined— 8,801; visits to conferences—
12,629.
Prenatal conferences conducted by physicians— 154; expectant mothers
registered and examined— 418; visits to conferences— 1,411.
Conferences conducted by nurses, no physician present— 115; infants and
preschool children inspected— 2,436; visits to conferences by children—
9,500.
Dental conferences— 74 ; preschool children receiving dental examination—
756.
New permanent child-health centers— 11 established as a result of the bureau’s
maternity and infancy work. They were supported by city, county,
and maternity and infancy funds.
New permanent prenatal center— 1 established as a result of the maternity
and infancy work. I t was supported by city, county, and maternity and
infancy funds.
Classes for girls in care of infants and preschool children— 5 organized; girls
enrolled and completing course— 110; lessons in course— 18. Two ad
ditional classes were organized in one county, but figures on enrollment
and other items were not reported.
Classes for mothers— 56 organized; mothers enrolled and completing course—
603; lessons in course— 18.
Home visits by nurses— 25,256 (prenatal cases seen, 652; obstetrical cases,
37 ; postnatal cases, 34 0; infants, 2,632; preschool children, 4,050).
Maternity homes inspected— 250; inspections made— 291. Maternity
hospitals inspected— 371; inspections made— 414.
Community demonstrations— 2, of a maternity and infancy public health
nursing program. As the result of the demonstration in 1 community, steps
were taken to secure a permanent public-health nurse.
Group demonstrations— 307, on breast feeding, care of infants, preparation
of food, method of examining preschool children, maternity outfit, pre
natal Care, and other phases of maternal, infant, and child care.
Survey— 1, of maternal mortality (continued from the previous year), in
cooperation with the United States Children’s Bureau and with the in
dorsement of the State medical association.
Campaigns— 5: (1) For examination of preschool children and correction of
their defects before the children should enter school, state-wide. (2)
For vaccination against smallpox, in 1 county.
(3, 4, 5) For vaccination
against smallpox and immunization against diphtheria, in 3 counties.
Talks and lectures— 208, to audiences totaling approximately 10,300 persons.
Literature prepared— Thum b and Finger Sucking, Directions for Giving
Sun Baths, Vaccination against Smallpox, Prevention, of Diphtheria, Some
Simple Facts about Scarlet Fever.
Literature distributed— 18,666 pieces.
New names registered for prenatal letters— 1,511; prenatal letters distrib
uted— 3,536 sets.
Lectures on the medical aspects of prenatal care, the prevention and control
of toxemias, and the care of sepsis were given before county medical socie
ties by an obstetrician employed for four months for this purpose.
Nutrition work was done through individual instruction to mothers.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1929

Activities— C ontinued.
Exhibits conducted— 22, at fairs and various meetings. Exhibit material
prepared— figures dressed to represent physicians and nurses, to show the
distribution of the bureau’s service throughout the State; train for which
the stations were named to show proper food and care for infants in suit
able sequence through the first year of life. Exhibit material was lent
30 times.
Article prepared— The Preschool Clinic.
Statistical study made— infant and maternal mortality in hospital and home
confinements (in progress).
Breast feeding was stressed in the work of the pediatricians and publichealth nurses and in the literature distributed to mothers.
Infants born in the State during the year— 72,882; infants under 1 year of
age reached by the work of the bureau (exclusive of those reached by
literature distributed)— 6,374; preschool children reached— more than
12,300; expectant mothe s reached— 4,606.
Counties in the State— 58 ; counties in which maternity and infancy work
was done during the year— 57; 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- 17 counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
The bureau gave advisory service to full-time health units that did not have
a nurse paid in full or in part from maternity and infancy funds, also to
a city health department.
The following organizations cooperated in the bureau’s work: State board
of education, State medical and tuberculosis associations, State league of
women voters, State federation of women’s clubs, American Red Cross,
American Association of University W om en, men’s service clubs, and the
parent-teacher association. The assistance given included furnishing part
of the equipment for health centers established by the bureau.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for California in 1928 (14.5) was 10 per cent higher than
in 1921 (13.2). The infant mortality rate in 1928 (62), however, was 6 per cent
lower than in 1921 (66). For urban areas of the State the infant mortality rate
was 55 in 1928, as compared with 60 in 1921; for rural areas the rate was 72 in
1928 as compared with 75 in 1921.
The maternal mortality rate in 1928 (61) was 10 per cent lower than in 1921
(68). The rate for urban areas of the State was 64 in 1928 and 78 in 1921; that
for rural areas was 57 in 1928 and 55 in 1921. The difference in the maternal
mortality rates for these two years is not statistically significant, but the general
trend throughout the period of cooperation under the maternity and infancy act
has been definitely downward.
The work of the State bureau of child hygiene in the inspection of maternity
hospitals, which are largely in urban areas, and improvements in the hospital
service seem to be reflected in the decline in both infant and maternal mortality
in these areas.
C O LO R A D O
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public instruction, child-welfare
bureau, Denver.
Funds expended: Federal, $14,942.55; State, $4,942.55; total, $19,885.10.
Staff:
Director, 3 physicians (part tim e), 3 nurses (1 part tim e), 1 stenographer, 2
clerks (1 part year). Additional physicians, nurses, and a clerk were em
ployed for short periods.
Volunteer assistants— 54 physicians, 27 dentists, 9 nurses, 557 lay persons.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities:
Child-health conferences conducted by physicians— 93 ; infants and pre
school children registered and examined— 2,274. The organization for
.the conferences was done by a representative from the extension division
of the State university. Each community was asked to furnish a group
of not less, than 20 women to assist the local physicians and visiting spe
cialists at the time of the conference. The staff of the conference unit
consisted of the director of the bureau, a pediatrician, a nurse, a clerk, and
representatives from the State board of health, the State psychopathic
hospital, and the State dental and tuberculosis associations. An obste
trician accompanied the unit to communities in which as many as 20
expectant mothers were registered for examination.
Defects found in children examined at conferences— 5,515; children having
defects— 2,166. Parents had defects corrected in 385 of the children.
Prenatal conferences conducted by physicians— 7 ; expectant mothers regis
tered and examined— 35.
Conferences conducted by nurses, no physician present— 12; children in
spected— 306; mothers instructed in prenatal care— 226.
Dental conferences— 52; preschool children receiving dental examination—
1,383.
Classes for girls in care of infants and preschool children— 48 organized; girls
enrolled and completing course— 182; lessons in course— 10 to 12.
Classes for mothers— 5 organized; mothers enrolled and completing course—
5 3 ; lessons in course— 3.
Hom e visits by nurses— 1,842 (prenatal cases seen, 161; infants, 542; pre
school children, 1,139).
Group demonstrations— 250, on making and sterilizing maternity pack,
making baby clothes, bathing and dressing the baby, and preparing arti
ficial food.
Survey— 1, of birth registration, in 14 counties.
Campaigns— 2, for more complete birth registration, in 2 counties.
Talks and lectures— 195.
Literature prepared— preschool health-record card and birth-registration
cards (revised).
Literature distributed— 14,600 pieces.
New names registered for prenatal letters— 362; prenatal letters distributed— ■
362 sets.
Graduate course for physicians— throughout the year the staff pediatrician
conducted a course in pediatrics at the Colorado General Hospital and
Medical School. The enrollment varied from 6 to 8.
Nutrition work was done through nutrition classes in conjunction with
classes for girls in four counties.
Exhibits conducted— 6, of posters, models, and literature. Exhibit material
prepared— posters, baby basket, tooth-brush exhibit for preschool children.
' Breast feeding was promoted by physicians at all health conferences, by all
field workers in their contacts with mothers, and by literature sent to
mothers of newborn infants.
Infants born in the State during the calendar year 1928— 19,065; infants
under 1 year of age reached by the work of the bureau during the fiscal
year ended June 30, 1929— 4,059; preschool children reached— 4,813;
expectant mothers reached— 3,523.
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— 38 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 61.
Since the beginning of the State’s cooperation under the maternity and
infancy act two counties and one community have assumed the responsi
bility for maternity and infancy work begun with maternity and infancy
funds.
As a result of the bureau’s work, classes in infant hygiene for young girls
were conducted by county nurses, and campaigns for the prevention of
contagious diseases and the correction of physical defects were conducted
under local auspices.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
The following organizations cooperated in the bureau’s work: State uni,
versity (extension division), psychopathic hospital, and agricultural col
lege; State medical, dental, and tuberculosis associations; State federation
of women’s clubs; W om an’s Christian Temperance Union; m en’s service
clubs; and the parent-teacher association. They assisted in organizing
and conducting health conferences, in promoting county nursing services,
and in conducting campaigns for the prevention of contagious diseases
and the correction of physical defects. Am ong the children examined at
health conferences reported in the foregoing paragraphs were 308 examined
in the “ Get ready for school” campaign sponsored by the National Con
gress of Parents and Teachers.
Am ong the outstanding features of the year’s work were the assistance given
to the State board of health in birth-registration work, which resulted in the
admission of the State to the United States birth-registration area, and the
arousing of interest of physicians and expectant mothers in better prenatal care.
INFANT AND MATERNAL MORTALITY RATES

Colorado was not admitted to the United States birth-registration area until
1928. M ortality rates of earlier years, therefore, are not available for comparison
with those of 1928. In 1928 the general death rate for the State (12.9) was
higher than that for the birth-registration area (12), and the infant mortality
rate (89) was considerably higher than that for the area (69).
The maternal mortality rate (96) was also higher than that for the area (69).
DELAW ARE
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child hygiene, Dover.
Funds expended: Federal, $15,708.02; State, $9,559.83; total, $25,267.85.
Staff:
Director (physician), 2 physicians (part tim e), 9 nurses, 1 vital-statistics
clerk and bookkeeper, 1 stenographer. Five physicians were employed as
needed to conduct conferences.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
56; expectant mothers registered and examined— 29; infants and preschool
children registered and examined— 241; visits to conferences by expectant
mothers— 89; visits by children— 685.
Child-health conferences conducted by physicians— 293; infants and pre
school children registered and examined— 967; visits to conferences— 3,004.
Defects found in children examined at conferences— 1,096; children having
defects— 943. Parents had defects corrected in 571 of the children.
Prenatal conferences conducted by physicians— 52; expectant mothers regis
tered and examined— 196; visits to conferences— 374.
Conferences conducted by nurses, no physician present— 832; infants and
preschool children inspected— 2,485; mothers instructed in prenatal care—
301; visits to conferences by children— 14,964; visits by mothers— 712.
New permanent combined prenatal and child-health centers— 4 established
as a result of the division’s maternity and infancy work. They are
supported by State and Federal funds.
Classes for girls in care of infants and preschool children— 3 organized; girls
enrolled— 84; number completing course— 78; lessons in course— 12.
Classes for midwives— 18, organized by a physician lent to the State by the
United States Children’s Bureau; midwives enrolled and completing
course— 95; lessons in course— 7. In addition, 162 midwives attended
classes held every three months by members of the division’s staff in four
districts in each county in the State.
Hom e visits by nurses— 9,641 (prenatal cases seen, 217; obstetrical cases, 91;
postnatal cases, 749; infants, 2,407; preschool children, 4,109).
Survey— 1, to ascertain the number and ages of preschool children in all the
towns in the State and conditions of sanitation affecting them (continued
from the previous year).
Campaign— 1, for immunization of preschool children against diphtheria.
Talks and lectures— 118.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Literature distributed— 52,226 pieces.
New names registered for prenatal letters— 788; prenatal letters distributed—
732 sets.
Exhibits conducted— 2, at fairs. Exhibit material prepared— graphs and
charts. Exhibit material was lent four times.
Articles prepared— Infant Feeding— Prenatal and Neonatal Care Essential;
The Value of Health W ork among Mothers and Babies; Infant and Mater
nal M ortality; and articles for the bimonthly bulletin of the State board
of health.
Statistical studies made— maternal mortality; infant mortality, white and
colored, by counties; decline in the birth rate.
Breast feeding was emphasized in various activities of the division. It was
estimated that only about 50 per cent of the infants in the States are
breast fed.
Infants born in the State during the year— 3,946; infants under 1 year of
age reached by the work of the division— 3,867; preschool children
reached— 8,972; expectant mothers reached— 987.
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— 3; counties in which maternity and infancy work was
done during the year— 3.
.“
. . .
The following organizations cooperated in the division’s work: State anti
tuberculosis society, State parent-teacher association, and the Wilmington
Visiting Nurse Association. The visiting-nurse association reports to the
division the names of expectant mothers, to whom the division sends pre
natal letters and other informative literature.
The outstanding feature of the year’s work was the increase in activities to
promote prenatal care.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Delaware in 1928 (13.1) was the same as in 1921;
the infant mortality rate in 1928„(78), however, was 20 per cent lower than in
1921 (98). The rate for urban areas was 93 in 1921 and 71 in 1928; that for rural
areas was 103 in 1921 and 86 in 1928. The effect of increasingly better super
vision and care of infants is reflected in these rates. If the 1921 rate had pre
vailed in the State in 1928, 20 more infants in every 1,000 born alive would have
died before reaching their first birthdav, a total saving of 84 infant lives. The
decrease in the infant mortality rates is especially noticeable in the rate from
gastrointestinal diseases, which was 47 per cent lower in 1928 (13.2) than in 1921
(24.9). The lowest rate from these diseases during the period 1921 to 1928 oc
curred in 1927 (11.3). The 1928 rate was slightly higher, but the difference
was not statistically significant.
The maternal mortality rate, although lower during the last two years of the
maternity and infancy act than in any previous year, showed consulerable
fluctuation during the period of operation of the act. The rate for the State¡in
1928 (56) was lower than in 1921 (63). The rate for urban areas m 1928 (70)
also was lower than in 1921 (102). In rural areas, however, the rate in 1928 (42)
was higher than in 1921 (21). As the actual number of births in the State is
small, very slight increases or decreases in the number of maternal deaths make
very noticeable changes in the maternal mortality rates in general, changes in
these rates must be regarded as fluctuations rather than as indexes of improvement
or retrogression in the situation.
FLO RID A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene and pub
lic-health nursing, Jacksonville.
.............. , , , mnn
Funds expended: Federal, $21,846.68; State, $11,531.72; total, $33,378.40.
Director (nurse, part time), 10 nurses (6 part year, 1 part tim e), 1 auditor
(part tim e), 1 stenographer (part tim e), 1 file clerk, 1 typist (part tim e).
Volunteer assistants— 119 physicians, 94 nurses, 296 lay persons.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities:
Child-health conferences conducted by physicians— 89; infants and preschool
children registered and examined— 2,212; number of children ha vine
defects— 1,586.
Conferences conducted by nurses, no physician present— 269; infants and
preschool children inspected— 4,749.
New permanent combined prenatal and child-health center— 1 established
as a result of the bureau’s maternity and infancy work. It is supported
by local funds.
Classes for girls in care of infants and preschool children were conducted in
five counties. The course covered 24 lecture hours.
Classes for mothers were conducted in varying numbers to cover the com
munities as they were visited by district nurses in each county. The talks
and demonstrations given were adapted to local needs.
Classes for midwives— 807 organized; midwives enrolled— 2,939; number
completing course— 117; lessons in course— 4.
W hen cooperation under the maternity and infancy act was begun (in 1922)
4,000 midwives (mostly colored) were known to be practicing in the State.
Through the work of the bureau about 3,000, who were physically unfit
or of such mentality that they were incapable of receiving instruction, have
ceased to practice. The only new midwives permitted to obtain licenses
are women who can read and write, as this simplifies the process of instruc
tion. Great improvement in the work of the midwives has been noted
during the period of cooperation.
Home visits by nurses— 13,876 (to prenatal cases, 597; postnatal cases, 177;
infants, 2,947; preschool children, 3,405). Other visits were made to inter
view mid wives, to investigate stillbirths and cases of communicable dis
eases, to secure registration of births, and to arrange for child-health con
ferences.
Group demonstrations were made in connection with the work with mid
wives and in classes for women and girls, and occasionally at meetings of
women’s clubs and at nurses’ institutes. Each nurse carried the follow
ing demonstration material: Doll, doll bed, mattress, and bedclothes
newspaper pads for bed, layette, nipples, bottles, boric acid, castile soap)
cotton, baby powder, olive oil, cod-liver oil, tomato juice, zwieback, dry
milk, piece of soap (for pin cushion), and posters.
Talks and lectures— 343.
Literature distributed— 25,824 pieces.
Nutrition work was done through group and individual instruction.
Exhibits were conducted at all meetings in routine district work.
Articles prepared— 8, on various subjects relating to child care.
Institutes on maternity and infancy work— 10, conducted for nurses.
Infants born in the State during the year— 27,309; infants and preschool
children reached by the work of the bureau— 26,119; expectant mothers
reached— 978.
•
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 in
fancy act 13 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 medical
and dental associations, State federation of women’s clubs, business, fra
ternal, and church organizations, the American Legion, and the parentteacher association. The assistance given included free examinations
made by physicians and dentists, financial support, and help in conducting
conferences, making home visits, and distributing literature.
Among the outstanding achievements of the year was the securing of a State
appropriation sufficient to carry on the entire maternity and infancy program
after the withdrawal of Federal aid at the close of the fiscal year under review.
INFANT AND MATERNAL MORTALITY RATES

Florida was ^not admitted to the United States birth-registration area until
1924.
M ortality rates of earlier years therefore are not available for comparison
with those of 1928.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The general death rate for the State in 1928 (13.4) was 4 per cent higher than
in 1924 (12.9). The infant mortality rate, however, has shown a decrease from
1924 to 1928. The rates for these two years were as follows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1924

White....................................... ............................................................... —

Percentage
of difference

1928

—18

88
80

65
68

—26
—15

70
107

55
95

-2 1
-1 1

The maternal mortality rate showed a downward trend during the period 1924
to 1928. The rates for these two years were as follows:
1924

1928

State________

121

101

Urban
Rural __

109
126

80
110

W h it e -.
Colored.

90
187

91
125

This difference in the maternal mortality rates for 1924 and 1928 is due pri
marily to the change in the rates for colored mothers, as the rate for white moth
ers remained practically stationary. The training and supervision of negro mid
wives by the State bureau of child hygiene no doubt aided in reducing the maternal
mortality among the colored mothers. The maternal mortality rate in both
urban and rural areas was lower in 1928 than in 1924,
G E O R G IA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child hygiene, Atlanta.
Funds expended: Federal, $42,482.32; State, $39,541.69; total, $82,024.01.
Staff:
Director (physician, part time), 1 physician, 5 nurses, 1 dentist, 1 laboratory
assistant, 2 stenographers (1 part*year), 1 typist. Twenty-two county
nurses were paid from maternity and infancy funds (1 half time, 6 part
year.)
Activities:
Combined prenatal and child-health conferences conducted by physicians—
37; expectant mothers registered and examined— 19; infants and preschool
children registered and examined— 157; visits to conferences by children—
165.
Child-health conferences conducted by physicians— 492; infants and pre
school children registered and examined— 3,668; visits to conferences—
5,248.
M any of the conferences were conducted on the division’s “ healthmobile,” which tours the State annually.
Defects found in children examined at conferences— 16,460; children having
defects— 3,378. Parents had defects corrected in 257 of the children.
Prenatal conferences conducted by physicians— 504; expectant mothers
registered and examined— 2,232; visits to conferences— 5,568.
Conferences conducted by nurses, no physicians present— 297; infants and
preschool children inspected— 2,402; mothers instructed in prenatal care—
261; visits to conferences by children— 2,844; visits by expectant mothers—
556.
New permanent combined prenatal and child-health centers— 6 established
as a result of the division’s maternity and infancy work. They are sup
ported by local public and private funds.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
.
, a.
New permanent child-health centers— 2 established as a result of the division’s maternity and infancy work. They are supported by local public
and private funds.
. .
New permanent prenatal centers— 6 established as a result of the division s
maternity and infancy work. They are supported by local public and
private funds.
Classes for girls in care of infants and preschool children— 403 organized;
girls enrolled— 4,554; number completing course— 2,691; lessons in
course— 10.
Classes for mothers— 42 organized; mothers enrolled— 650; number com
pleting course— 592. The number of lessons in the course varied for the
different groups.
Classes for midwives— 455 organized; midwives enrolled— 2,374; number
completing course— 2,730 (includes some who enrolled in the^ previous
year); lessons in course— 10. All midwives known to be practicing in the
State have been visited since the beginning of the State’s cooperation under
the maternity and infancy act.
Home visits by nurses— 60,336 (prenatal cases seen, 3,100; obstetrical cases,
531; postnatal cases, 1,752; infants, 4,257; preschool children, 6,451).
Group demonstrations— 1,151, on bathing and dressing the baby, preparing
bed for confinement, preparing clothes for mother and baby, caring for the
baby’s eyes and the cord, and disinfecting the hands, to groups of mothers
and midwives.
.
Campaigns— 46: (1) For the observance of M ay D ay as Child Health D ay.
(2, 3) For immunization of children against diphtheria (1 campaign con
ducted in the fall, 1 in the spring). (4-46) For the prevention of diph
theria, smallpox, typhoid fever, malaria, and hookworm disease, in 43
counties. Staff nurses assisted physicians in giving 2,034 immunizations
against smallpox, 4,315 against diphtheria, 2,246 against typhoid fever,
and 87 against whooping cough to preschool children.
Talks and lectures— 653.
Literature distributed— 42,654 pieces.
Graduate courses in obstetrics for physicians were conducted in four of the
congressional districts of the State by a physician employed by the United
States Children’s Bureau. (See p. 116.) The organization work for these
courses was done by the division and by the district and county medical
societies.
#
Nutrition work was done through the organization of 71 nutrition classes.
Exhibits conducted— 151, at county fairs and various local meetings. The
*‘ healthmobile,’ ’ which is equipped with motion-picture machines and
health films, exhibited the films in the evenings following health con
ferences.
Articles prepared— 14, on various child-hygiene topics, besides articles for
newspapers.
Breast feeding was promoted through the literature distributed, through
lectures given, and through articles prepared for newspapers.
Infants born in the State during the year— approximately 57,000; infants
under 1 year of age reached by the work of the division— 42,035; pre
school children reached— 15,643; expectant mothers reached-;—27,941.
Counties in the State:— 161; counties in which maternity and infancy work
was done during the year—-125; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 161.
A t the close of the fiscal year under review 19 counties were prepared to
assume the responsibility for maternity and infancy work begun with
maternity and infancy funds.
_
*
The following organizations cooperated in the division’s work: State medi
cal association, district and county medical societies, women’s clubs, cham
bers of commerce, fraternal and business clubs, and parent-teacher asso
ciations. They helped to organize local groups and distributed literature.
Among the outstanding features of the year’ s work were the graduate courses
in obstetrics arranged for by the division with the cooperation of the district
and county medical societies.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
INFANT AND MATERNAL MORTALITY RATES

i o S e° rfira T a^i n o t .admltted, to the United States birth-registration area until
i92 8. Mortality rates of earlier years, therefore, are not available for compari
son with those of 1928.
*
^ i+
n ,192i th^
ner^ death rate for the State (11.2) was 7 per cent lower than
that for the birth-registration area (12). The infant mortality rate (82) was 12
per cent higher than for the area (69). The high rate in the State was due largely
to the mortality among colored infants, for whom the rate was 104, as com^ d h 6 8 for white infants. These rates are practically the same as those
torthe birth-registration area for both colored infants (106) and white infants (64).
w
S t S S
{- °I t,he State in 1928 (107) was considerably
higher than that for the birth-registration area (69), and the rates for both white
colored mothers (144) were higher than the corresponding
rates for the birth-registration area (63 and 121).
^
°
H A W A II
STAFF AND ACTIVITIES IN 1929

Administrative agency:
m iancy, Honolulu.

Territorial board of health, division of maternity and
J

Staff*-6* expended: Federal, $12,730.19; Territorial, $6,725.96; total, $19,456.15.
Director (nurse), 18 nurses (14 part tim e), 1 stenographer.
Volunteer assist ants— 26 physicians j 20 lay persons.
Activities:
Child-health conferences conducted by physicians— 846; infants and pre16 444 ° hlldren reglstered and examined— 4,083; visits to conferences—
Conferences conducted by nurses, no physician present— 414; infants and
preschooi children inspected— 1,947; visits to conferences by children—
5,864.
New permanent child-health centers— 6 established as a result of the divi
sion s maternity and infancy work and cooperation received from plan
tations. Four are supported by the division of maternity and infancy,
two by the Territorial board of health and a plantation.
Classes for girls in care of infants and preschool children— 2 organized; girls
enrolled— 48; number completing course— 20; lessons in course, 10.
Home visits by nurses— 16,337 (prenatal cases seen, 256; infants, 1,502;
preschool children, 960).
> >
>
Talks and lectures— 9.
Literature prepared Infant Feeding; Baby Diet (in Japanese).
Literature distributed— 4,003 pieces.
Nutrition work was done through individual instruction given to mothers
at conferences and in home visits.
Exhibit material was lent twice.
Breast feeding was stressed in the instruction given to mothers at confer
ences and in home visits.
Infants born in the Territory during the year— 11,498; infants under 1 year
of age reached by the work of the division— 2,842; preschool children
reached— 3,190.
Tim 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 settle
ment.
Nurses from the division assisted local organizations in conducting childhealth conferences.
Two mission organizations cooperated in the division’s work, lending rooms
in which child-health conferences were conducted.
INFANT AND MATERNAL MORTALITY RATES

The Territory of Hawaii has not been admitted to the United States birthregistration area, although it has been in the death-registration area since 1917.
figures, therefore, are not available from the United States Bureau of the
Census for comparison of infant or maternal mortality rates.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Territorial figures indicate, however, that infant mortality has decreased since
the benefits of the maternity and infancy act were extended to the Territory of
Hawaii by the Sixty-eighth Congress in 1924 and accepted by the governor in
the same year. The division of maternity and infancy, established in 1925, the
year in which the Territorial legislature confirmed the governor’s acceptance of
the provisions of the act, has given assistance in the work to promote the regis
tration of births to the standard required for admission to the birth-registration
ID A H O
STAFF AND ACTIVITIES IN 1929

Administrative agency. State department of public welfare, bureau of child
hygiene, Boise.
Funds expended: Federal, $7,450.17j State, $2,496.78; total, $9,946.95.
Staff:
Director (physician, part year), 4 nurses (3 part year), 1 stenographer.
Two county nurses were paid in part from maternity and infancy funds.
Volunteer assistants— 28 physicians, 315 nurses and lay persons.
Activities:
Child-health conferences conducted by physicians— 68; infants and preschool
children registered and examined— 2,447.
Defects found in children examined at conferences— 1,466; children having
defects— 1,196.
,
Conferences conducted by nurses, no physician present— 30; infants and
preschool children inspected— 988; mothers instructed in prenatal care—
436; visits to conferences by mothers— 824.
New permanent child-health centers— 2 established as an indirect result of
the bureau’s maternity and infancy work. They are supported by
Federal and county funds and the Rockefeller Foundation.
Classes for mothers— 18 organized; mothers enrolled— 188; lessons in
course— 4. Classes were still in progress at the close of the year under
review.
Home visits by nurses— 128.
Campaign— 1, for examination of preschool children and correction of their
defects before the children should enter school.
Talks and lectures— 10.
Literature prepared— Mother’s Manual.
Literature distributed— 23,968 pieces.
New names registered for prenatal letters— 355; prenatal letters distrib
uted— 355 sets.
Nutrition work was done through instruction given to mothers at health
conferences and in the classes for mothers.
Exhibits conducted— 68, of layettes, posture posters, and proper food for
children. Exhibit material prepared— chart of maternal and infant deaths,
by counties.
Statistical study made— deaths of children to 7 years of age, by causes, for
the period 1922 to 1927.
Breast feeding was stressed in the instruction given to mothers at conferences
and in classes.
Infants born in the State during the year— 9,185; infants under 1 year
of age reached by the work of the bureau— 12,511; preschool children
reached— 13,904; expectant mothers reached— approximately 1,000.
The bureau sends a list of available literature on infant hygiene to parents
of all infants whose births are registered in the State bureau of vital
statistics.
Counties in the State— 44; counties in which maternity and infancy work
was done during the year— 42; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 44.
The work of the bureau has been one of the factors leading to the establish
ment of seven full-time and six part-time county nursing services. Super
visory assistance was given to some local activities for the promotion of
child health.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
The following organizations cooperated in the bureau’s work: State medical
society, American Red Cross, State federation of women’s clubs, Joint
Legislative Council of Women, a church relief society, and the parentteacher association. They gave advisory assistance and helped at health
conferences. Am ong the children examined at health conferences reported
in the foregoing paragraphs were 347 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 organization of two
new county health units and the organization of classes for mothers in rural com
munities.
INFANT AND MATERNAL MORTALITY RATES

Idaho was not admitted to the United States birth-registration area until 1926.
M ortality rates of earlier years, therefore, are not available for comparison with
those of 1928.
In 1928 the general death rate for the State (7.7) was low compared with that
for the birth-registration area (12), and the infant mortality rate for the State
(69) was lower than that for the area (69). The State rates for urban areas (53)
and for rural areas (60) were both lower than the corresponding rates for the
birth-registration area (69 and 68).
The maternal mortality rate for the State in 1928 (68) was slightly lower than
that for the birth-registration area (69). The rate for urban areas in the State
was 51 and that for rural areas was 70.
IN D IA N A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of infant and child
hygiene, Indianapolis.
Funds expended: Federal, $33,187.44; State, $27,585.74; total, $60,773.18.
Staff:
Director (physician), 6 physicians (3 part year), 5 nurses (3 part year),
1 vital-statistics clerk, 1 secretary, 3 stenographers, 1 exhibits director,
5 clerks (3 part year).
Activities:
Child-health conferences conducted by physicians— 572; infants and pre
school children registered— 13,217; number examined— 13,172; visits to
conferences— 13,229.
Defects found in children examined at conferences— 73,702; children having
defects— 12,578.
Classes for mothers— 58 organized; mothers enrolled and completing
course— 2,398; lessons in course— 5.
Group demonstrations— 141, on various phases of maternal, infant, and
child care.
Campaigns— 3 : (1) For observance of M ay D ay as Child Health D ay,
state-wide.
(2) For dental hygiene, in 6 counties.
(3) For immunization
against contagious diseases, in 6 counties.
The ninth annual Child Health W eek was conducted at the Winona Lake
Chautauqua. The program included the examination of infants and pre
school children, table exhibits, posters, books, and motion pictures. A
symposium on factors and agencies affecting child health was held on one
afternoon.
Talks and lectures— 374.
Discussions of the relation of the health of the beginner in school to the school
program were given by the director and other physicians on the staff at
many teachers’ institutes.
Literature prepared— To Mothers (folder, revised).
Literature distributed— 94,577 pieces.
Nutrition work was done through instruction given at classes for mothers
and individual instruction to the mothers attending health conferences.
Exhibits conducted— 44, at National, State, and local meetings. The ninth
annual exhibit was conducted at the State fair in cooperation with the
State board of agriculture. Improvements had been made in the babies’
buildings, in which this exhibit is held, and new furniture and apparatus

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
were added. The usual exhibits of posters, panels, charts, and motion
pictures were shown, and demonstrations were made by the nurses through
out each day and evening. Physical examinations and mental tests were
made of 1,257 infants and preschool children. The nursery and play
ground, where parents might leave their children while they visited the
fair, were maintained as in previous years. About 67,000 persons visited
the exhibit. Exhibit material prepared— sun-bath model, dental model,
correct clothing and shoes for children, posters, and maps. Exhibit
material was lent nine times.
Articles prepared— Conditions Affecting the Health of Young Children,
Radio-Ulnar Olisthy, Indiana Progress- in Child Hygiene, Is the Preschool
Arm y Physically Fit? Eyes Have They, Ready for School, Tuberculosis
in Infancy and Childhood, The Teeth— Their Growth and Care, Mental
Hygiene, Beautiful Feet, The Blue Ribbon Child, and other articles in the
monthly bulletin of the State board of health and other publications.
Statistical studies made (based chiefly on records of mothers and children
attending conferences)— physical defects, nutrition, relation of diseases of
childhood to ear and tonsil defects and of both to nutrition, mental devel
opment; prenatal care, breast feeding (a study of 6,764 children showed
70 per cent breast fed 3 months or longer).
Infants born in the State during the year— 58,804; infants under 1 year of
age reached directly by the work of the division— 6,690; preschool children
reached— 15,232. M any more were reached indirectly through the litera
ture distributed and through contacts with volunteer workers.
Counties in the State— 92; counties in which maternity and infancy work
was done during the year— 86; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 92.
The division gave advisory assistance to local agencies doing maternity and
infancy work.
The following organizations cooperated in the division’s work: Other divi
sions of the State board of health, State board of charities and corrections,
State board of education (home-economics and attendance departments),
. State university (extension service), State medical, dental, and tubercu
losis associations, State health council, American Red Cross, State childwelfare association, State chamber of commerce, State league of women
voters, State federation of women’s clubs, American Legion, Purdue Uni
versity (agricultural extension), Boy Scouts, Girl Scouts, Campfire Girls,
Young M en’s and Young W om en’s Christian Associations, the parentteacher association, other professional and fraternal organizations, schools,
and churches.
Among the outstanding features of the year’s work were the campaign for
observance of M ay D ay as Child Health D ay, the lectures given before teachers’
institutes, and the securing of a State appropriation sufficient to carry on the
bureau’s work after the expiration of the Federal maternity and infancy act,
June 30, 1929.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Indiana in 1928 (12.7) was 7 per cent higher than in
1921 (11.9). The infant mortality rate in 1928, however, was definitely lower
than in 1921, as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921

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1928

Percentage
of differ
ence

-1 1

79
66

67
69

-1 5
-1 1

TH E W E LFAR E AND H YG IE N E OF M A TERN ITY AND IN FAN CY

These rates would indicate that 8 of every 1,000 infants born alive in 1928
survived who would have died if the 1921 rate had prevailed, a total saving of
some 500 infant lives in the State.
The maternal death rate also was lower in 1928 than in 1921, and both urban
and rural rates were lower, as the following table shows:

Deaths of mothers from
causes associated with
pregnancy and childbirth
per 10,000 live births
Area
1921

1928

Percentage
of differ
ence

State................................ ..................................................................

—10

Urban___ ______________ ______________ _____________
Rural________ ________________ _________________

86
56

81
45

—6
-2 0

A constructive program of education of rural women in the essentials of infant
care and hygiene and the hygiene of pregnancy, an especial feature of the work
in the State, has covered the rural districts. Its results seem indicated by the
lower infant and maternal mortality rates.
IO W A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of education, division of maternity and
infant hygiene, Iowa City.
Funds expended: Federal, $39,191.07; State, $18,506.81; total, $57,697.88.
Staff:
Director (director of the extension service of the State university serving),
1 physician, 5 nurses (1 part year), 1 dentist (part year), 1 dental hy
gienist, 1 social worker, 1 child-welfare specialist, 1 assistant child-welfare
specialist, 1 vital-statistics clerk, 3 stenographers.
Activities:
Child-health conferences conducted by physicians— 187; infants and pre
school children registered and examined— 3,927.
Defects found in children examined at conferences— 4,524; children having
defects— 3,340. Reports made by the nurses who followed up the children
examined at conferences showed that 45 to 79 per cent of the children
having defects had the defects corrected.
Conferences conducted by nurses, no physician present— 107; mothers
instructed in prenatal care— 3,708.
Hom e visits by nurses— 280.
The division assisted in a campaign conducted in one county to have pre
school children examined and their defects corrected before the children
should enter school.
Talks and lectures— 155.
Literature distributed— 108,500 pieces.
Exhibits conducted— 110, at State and county fairs. Exhibit material was
lent 16 times.
In addition to following up individual children referred to her by the nurses
assisting at child-health conferences, the social worker assisted in organiz
ing and supervising county-wide social-welfare agencies on the “ Iowa
plan, ” public, and private sources of funds for welfare work being coor
dinated under county welfare leagues. Four new organizations of this
type were established during the year.
The two child-welfare specialists on the division’s staff organized and
supervised parent-education groups, of which there were 387 in the State
at the close of the year under review. Their work was done in cooperation
with the State university, agricultural college, and normal school in the
state-wide parent-education project which was sponsored by the State
parent-teacher association. Detailed programs and study material were
supplied to the groups mentioned. Package libraries on the care of the

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
preschool child were prepared and put into circulation. Through a
general conference at Iowa City and institutes at three other centers an
effort was made to train leaders for study groups of this character.
Dental-hygiene work was done in cooperation with the oral-hygiene com
mittee of the State dental society. An advisory board consisting of
representatives of the dental society and other health agencies was formed
to prepare a dental-hygiene program for local communities. Thirty
counties adopted the program, the dental work in the communities
being done by local dentists. Demonstration programs were conducted
in representative communities— a rural district, a small town, a consoli
dated-school district, and a city of 8,000 inhabitants. Two dentalhygiene institutes were conducted for nurses.
Information on the length of time the baby was breast fed was obtained
for 12,332 babies as follows: Almost 8 per cent were never breast fed, 37
per cent were weaned before the ninth month, 14 per cent were weaned
either the ninth or the tenth month, and 41 per cent were nursed longer
than 10 months.
Infants born in the State during the year— 42,231; infants under 1 year of
age reached by the work of the division (exclusive of those reached by
literature distributed)— 2,356; preschool children reached (exclusive of
those reached by literature distributed)— 1,571; expectant mothers
reached (exclusive of those reached by literature distributed)— 952.
The division furnishes literature on infant hygiene to the State board of
health to send 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— 43 ; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 99.
The following organizations cooperated in the division’s work: State dental
society, State farm bureau, and the parent-teacher association. Am ong
the children examined at health conferences reported in foregoing para
graphs were 650 examined in the “ Get ready for school” campaign
sponsored by the National Congress of Parents and Teachers.
INFANT AND MATERNAL MORTALITY RATES

Iowa was not admitted to the United States birth-registration area until 1924.
Mortality rates of earlier years therefore are not available for comparison with
those of 1928.
The general death rate for the State in 1928 (10.4) was 6 per cent higher than
the rate in 1924 (9.8) and 13 per cent lower than that for the United States birthregistration area in 1928 (12). The infant mortality rate in 1928 (53) was not
significantly lower than in 1924 (55) but was 23 per cent lower than that for the
birth-registration area in 1928 (69). Iowa’s rural infant mortality rate in 1928
(47) was lower than the rate for rural areas in any other State in the birthregistration area. The rate for urban areas was 67.
The maternal mortality rate for the State in 1928 (48) was lower than that for
the State in 1924 (60), and it also was lower than that for the birth-registration
area (69) and for any other State in the area in 1928. In both urban and rural
areas the maternal mortality rates were lower in 1928 (67 and 40) than in 1924
(79 and 52).
Some of the reduction in infant and maternal mortality in the rural areas may
reasonably be attributed to the special work done by the division of maternity
and infant hygiene with groups of organized farm women throughout the State.
K A N SA S
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child hygiene, Topeka.
Funds expended: Federal, $22,650; State, $12,650; total, $35,300.
Staff:
Director (physician, part time), 3 nurses (1 part tim e), 1 Vital-statistics
clerk, 1 stenographer, 2 clerks. Eight county nurses were paid in part
from maternity and infancy funds.
Volunteer assistants— 134 physicians, 28 dentists, 157 nurses, 649 lay persons.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities:
I Child-health conferences conducted by physicians— 176; infants and pre
school children registered and examined— 4,854. Defects found in children
examined at conferences— 5,389.
Conferences conducted by nurses, no physician present— 4 ; infants and preschool children inspected— 95; mothers instructed in prenatal care— 12.
Dental conferences— 41 ; preschool children receiving dental examination—
1,042.
Classes in maternal and infant hygiene were conducted in three State
teachers’ colleges and one vocational school to prepare students to teach
the subject to girls in the seventh and eighth grades. The average num
ber of class meetings was 8.
Classes for mothers— approximately 70 group conferences were conducted;
520 mothers also received instruction in infant and child care at the
nurses’ offices.
H om e visits by nurses— 1,125 (to prenatal cases, 380; infants and preschool
children, 745).
(Report incomplete.)
Maternity homes inspected— 7; inspections made— 11.
Infant homes inspected— 62 ; inspections made— 132.
Surveys— 2 : (1) Of birth registration, state-wide.
(2) Of health condi
tions among mothers and children on an Indian reservation (continued
from the previous year). As a result of this survey the United States
Office of Indian Affairs arranged to provide the reservation with a
nurse and a part-time physician.
Campaign— 1, to have preschool children qualify as “ nine-pointers” through
out the State. To qualify for this designation the children had to have
normal vision, hearing, teeth, throat, posture, and weight, and be vacci
nated against smallpox and immunized against tvphoid fever and
diphtheria.
Talks and lectures— 87.
Literature distributed— 170,016 pieces.
New names registered for prenatal letters— 740; prenatal letters distributed—
5,149.
Nutrition work was done through individual instruction given to mothers
at child-health conferences.
Exhibits conducted— 6.
Exhibit material prepared— motion-picture film
dealing with the observance of M ay D ay as Child Health D ay. Exhibit
material was lent 21 times.
Breast feeding was stressed in the instruction given to mothers at childhealth conferences.
Infants born in the State during the calendar year 1928— 33,860; infants
under 1 year of age reached by the work of the division during the fiscal
year under review (exclusive of those reached by literature distributed)—
10,004; preschool children reached— 15,481; expectant mothers reached—
lj279.
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— 101; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancv
act— 105.
Eight counties were prepared at the close of the fiscal year to assume the
responsibility for maternity and infancy work begun with maternity and
infancy funds.
The following organizations cooperated in the division’s work: State federa
tion of women’s clubs, State league of women voters, American Legion
auxiliary, and the parent-teacher association. Am ong the children exam
ined at health conferences reported in the foregoing paragraphs, approxi
mately 1,200 were examined in the “ Get ready for school” campaign
sponsored by the National Congress of Parents and Teachers.
An outstanding feature of the year’s work was the educational effect of the
child-health conferences, including also the instruction in prenatal care given to
mothers attending these conferences,

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

INFANT AND MATERNAL MORTALITY RATES

During the operation of the maternity and infancy act Kansas cooperated
twice with the Federal Government. The first period of cooperation was from
January, 1922, to September, 1923, under the governor s acceptance of the pro
v is i o n s ^ the act. (See sec. 4 of the act, Appendix A p. 127.)
Cooperation
ceased when the State legislature of 1923 did not provide for
legislature of 1927 accepted the provisions of the act, and a second period of
cooperation began in M ay, 1927, continuing to the expiration of the act, June
30 1929. During the first period of cooperation a child-hygiene program re
ceived impetus, which later was reduced by limitation of funds and was expanded
when Federal funds were again available.
The general death rate for the State was higher m 1928 (11.4) than m 1921
(10.2). The infant mortality rate was lower m 1928 (59), however, than in
1921 (63). Both urban and rural rates were lower in 1928, the urban rate being
73 in 1921 and 69 in 1928, the rural rate being 59 m l 9 2 1 and 55 in 1928.
The maternal mortality rates were higher in 1928 than m 1921. The (differ
ence is largely due to the increase in the number of deaths caused by
other
accidents of labor,” the rate from this cause being 3.1 in 19 -1 and 8.6 m 1928.
The 1921 rate from this cause, however, is lower than that of any succeeding
year. There has been considerable fluctuation in the rates from all causes, the
rate of 1924 being the lowest for urban areas and that of 1927 the lowest tor
rural areas.
KENTUCKY
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of maternal and child
F u S % » d e d : UFederal, 826,298.64; State, $21,298.64; total, $47,697.28.
Staffi>irector (physician), 2 physicians (1 part tim e), 5 numes (1 p ^ time,
1 part year), 1 nutritionist, 1 clinical instructor (part year), 2 clinical
assistants (1 part year), 1 milk inspector (part year), 1 educational instruc
tor (part year), 1 bookkeeper (part time), 2 stenographers (1 part year),
13 clerks (9 part year). One county nurse was paid in part from maternity
and infancy funds. Additional medical, nursing, and clerical assistants
were employed for short periods as needed.
ACtl Combined prenatal and child-health conferences conducted by physicians—
36; expectant mothers registered— 158; infants and preschool children
registered and examined— 982.
. .
1on . ,
.
*
Child-health conferences conducted by physicians— 120; infants and pre
school children registered and examined— 3,276.
,
. _
Defects found in children examined at conferences— 3,147; children having
defects— 2 387. The percentage of children with physical defects has
noticeably declined. Eighty per cent of the children examined at con
ferences during the previous fiscal year were found to have physical defects,
whereas only 56 per cent of those examined during the year under review
New permanent child-health centers— 9 established as a result of the bureau's
maternity and infancy work. They are supported by local and State funds
the United States Public Health Service, and the International Health
Division of the Rockefeller Foundation.
nnmnlo, „
Classes for midwives— 10 organized; midwives enrolled and completing
course— 70; all-day classes in course— 2. When the bureau began its
work, about 3,500 midwives were practicing m the State. The number has
been reduced to 2,474, and only 858 midwives deliver as many as 5 babies
The b u reau cooperated in a study
mortality
the previous year) made in the State by the United States Children s
Bureau with the indorsement of the State board of health and the State
C ^ f m i g n s ^ S ? (i) For immunization against diphtheria, state-wide. (2)
ToPhave children qualify as “ blue-ribbon” children by being free from
defects in eyes, ears, nose, throat, and posture and being of normal weight.
Nearly 25,000 infants and preschool children reached these standards,
9412°— 31-------5

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Talks and lectures— 809.
Literature distributed— 365,500 pieces.
New names registered for prenatal letters— 619; prenatal letters distrib
uted— 1,913 sets.
Nutrition work was done through lectures to physicians, women’s clubs,
men’s clubs, and groups of children, through the distribution of literature,
and through talks with individual mothers at child-health conferences.
The nutritionist gave advisory assistance to local nurses and to teachers
of home economics.
An intensive study of pellagra was made in one county, and clinics for mothers
and children were held in two towns and six mining camps where the disease
was prevalent. Those attending the clinics were given instruction as to
the diet requirements for curing as well as preventing the disease.
Exhibits conducted— 70, consisting of a nutrition exhibit, posters, and
literature. Exhibit material was lent-70 times.
Other bureaus and a division in the State board of health, some work of which
was financed from maternity and infancy funds, carried on the following
maternity and infancy activities: (1) The division of health education
emphasized the importance of examination of infants and preschool
children and correction of physical defects.
(2) The bureau of epidemi
ology made efforts to interest parents in having their children vaccinated
against smallpox and immunized against diphtheria, scarlet fever, and
typhoid fever. It investigated and controlled two severe epidemics of
scarlet fever and one outbreak of puerperal sepsis in a hospital.
(3) The
bureau of public-health nursing reported much maternal and infant hygiene
work done by county and other local nurses who were not paid from
maternity and infancy funds but whose maternal and child-health pro
grams were arranged and directed by the bureau of maternal and child
health. They assisted in organizing and conducting 222 child-health
conferences (exclusive of those conducted in Fayette and Jefferson Coun
ties) ; made 4,769 visits to infants and preschool children and 885 to expect
ant mothers, distributed literature supplied by the bureau, and assisted in
the campaign for “ blue-ribbon” children. Almost all the county nurses
were planning county-wide intensive child-health programs for the
summer. (4) The bureau of vital statistics reported that inspectors of
birth registration made more than 800 visits to local registrars, physicians,
and midwives in the effort to promote more complete registration of births.
(5) The bureau of sanitary engineering reported the inspection of milk
supplies, in 33 towns and of water supplies in 95 towns.
Infants under 1 year of age reached by the work of the bureau (exclusive
of those reached by literature distributed)— 2,152; preschool children
reached (exclusive of those reached by literature distributed)— 6,000;
expectant mothers reached (exclusive of those reached by literature
distributed) -—2,071.
Counties in the State— 120; counties in which maternity and infancy work
was done during the year— 50; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancv
act— 120.
Since the beginning of the State’s cooperation under the maternity and in
fancy act 16 counties have assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.
The bureau gave advisory assistance to full-time health units, county
nurses, industrial nurses in mining camps, and nurses in church settle
ments who were doing maternity and infancy work and also furnished
literature to them.
The following organizations cooperated in the bureau’s work: State medical
and dental associations, State federation of women’s clubs, and the
parent-teacher association. They published educative and informative
material in their journals, assisted with work in local committees, and
helped in the campaign to raise funds by private subscription* to con
tinue the bureau of maternal and child health after the expiration of the
State appropriation and the termination of the Federal maternity and
infancy act.
The outstanding feature of the year’s work was the campaign for “ blueribbon” standards of health among infants and preschool children.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF IN D IVID U AL STATES,

1929

INFANT AND MATERNAL MORTALITY RATES

The general death rate for Kentucky in 1928 (1 1.9 ) was 13 per cent higher
than in 1921 (10.5). The infant mortality rate also 'was higher in 1928 than
in 1921, as the following figures show:
1921

1928

State________

U rb a n ._
R u ral. _

72
60

77
68

W h i t e ..
Colored

58
110

66
118

The 1921 infant mortality rates were low; in only one year (1927) since the
State’s admission to the birth-registration area in 1917 were the rates as low as in
1921. The increase in 1928 was due primarily to deaths from respiratory diseases,
the rate from these causes in 1928 (11.8) being 87 per cent higher than in 1921
(6.3). Thé 1928 rates from influenza, bronchopneumonia, and pneumonia were
all more than 50 per cent higher than the corresponding rates in 1921. Of the
other principal causes of infant deaths the rate for the natal and prenatal group
was slightly higher in 1928 than in 1921, whereas the rates for gastrointestinal
and communicable diseases were lower. As in other Southern States, the rate
for the State is affected by the high rate for colored infants. The rate for white
infants in the State (66) was only slightly higher than that for white infants in the
birth-registration area (64), whereas the rate for colored infants in the State
(118) was 11 per cent higher than that in the birth-registration area (106).
The maternal mortality rate in 1928 was lower than the 1921 rate for the State
as a whole, for both white and colored mothers, and for both rural and urban
areas, as the following figures show:
1921

1928

State________

Urban .
Rural .

93
57

78
55

W h ite. .
Colored

57
148

55
125

The rate for the State was higher in 1928, however, than in 1927, when it was
49, the lowest in any year since Kentucky was admitted to the United States
birth-registration area.
LO U ISIAN A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of cliild hygiene,
New Orleans.
Funds expended: Federal, $12,521; State, $2,521; total, $15,042.
Straff:
Director, 2 physicians (1 part time, 1 part year), 5 nurses (4 part year), 1
dentist (part year), 2 stenographers (1 for 1 month), 1 accountant (part
time), 1 motion-picture operator. Additional physicians were employed
for conference work as needed.
Activities:
Child-health conferences conducted by physicians— 132; infants and pre
school children registered and examined— 2,692; visits to conferences—
3,133.
Defects found in children examined at conferences— 6,073; children having
defects— 2,574. Parents had defects corrected in 254 of the children.
Conferences conducted by nurses, no physician present— 33 ; infants and
preschool children inspected— 1,889; mothers instructed in prenatal care—
18; visits to conferences by children— 1,992; visits by mothers— 59.
Dental conferences— 2 3 ; preschool children receiving dental examination—
2,487.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Classes for girls in care of infants and preschool children— 24 organized;
girls enrolled— 678; lessons in course— 30. Because the field force was
limited these classes could not be completed before the end of the year
under review. In some parishes 3 the classes were continued by nurses
of the local health unit; in others they were continued by home demon
stration agents.
Class for mothers— 1 organized; mothers enrolled (plus those carried over
from the previous year) and completing course— 78; lessons in course— 3.
Classes for midwives— 26 organized; midwives enrolled (plus those carried
over from the previous year)— 878; number completing course— -146; les
sons in course— 6. In the parishes having parish health units the publichealth nurses took charge of the classes after they were organized, and about
200 additional midwives completed the course in those classes.
Home visits by nurses— 914 (prenatal cases seen, 128; postnatal cases, 2 ;
infants, 60; preschool children, 2 7 0 ); midwives visited— 454.
Community demonstrations— 5, of midwife educational work, in 5 parishes.
Group demonstrations— 244, on phases of infant and maternal care, to
groups of midwives, little mothers’ clubs, and other groups.
Survey— 1, of midwives, in 5 parishes.
Campaign— 1, for examination of preschool children and correction of their
defects before the children should enter school, state-wide.
Talks and lectures— 159.
Literature prepared— physical standards for children 1, 2, 4, and 6 years of
age (leaflets).
Literature distributed— 3 3 ,7 6 6 pieces.
New names registered for prenatal letters— 322; prenatal letters distributed—
Exhibits conducted— 5 ; 3 were at parish fairs, 1 was a permanent exhibit
in the International Trade Exposition building in New Orleans (continued
from 1927), and 1 was in the health car of the State department of health,
which toured the State.
Exhibit material prepared— posters. Exhibit
material was lent 29 times.
Breast feeding was stressed in the instruction given to midwives and to
mothers at conferences, also in the literature distributed and motion
pictures shown.
Infants born in the State during the year— 41,677; infants under 1 year
of age reached by the work of the bureau— 1,054; preschool children
reached— 9,604; expectant mothers reached— 2,183.
Literature on infant care is sent to mothers whose names are filled in on
birth-registration blanks as being mothers of first-born children.
Parishes in the State— 64 ; parishes in which maternity and infancy work
was done during the year-— 22; 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 31 parishes have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the bureau’s work many c1asses for girls in infant and child
c.are were begun or continued by parish health units, and a dental program
was inaugurated in the schools of one parish.
The following organizations cooperated in the bureau’s work: State tuber
culosis and public-health association, State federation of women’s clubs,
business and professional women’s clubs, New Orleans Needlework Guild,
community clubs, and parent-teacher associations. Am ong the children
examined at health conferences reported in the foregoing paragraphs were
142 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 interest in better
standards of midwifery aroused among midwives and the increasing demand for
dental work among preschool children and expectant mothers.
3 In Louisiana the parish is the civil division corresponding to the county in other States.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OP INDIVIDUAL STATES, 1929

INFANT AND MATERNAL MORTALITY RATES

Louisiana was not admitted to the United States birth-registration area until
1927. Mortality rates of earlier years therefore are not available for comparison
with those of 1928.
In both 1927 and 1928 the general death rate was higher for the State than
for the birth-registration area. The 1927 State rate (12.3) was 8 per cent higher
than that for the area (11.4), and the 1928 rate (12.8) was 7 per cent higher
than that for the area (12).
The infant mortality rate in both years was also higher than that of the birthregistration area. In 1927 the State rate was 77 as compared with 65 for the
area, and in 1928 it was 78 for the State as compared with 69 for the area. These
higher rates are due to the mortality rate for colored infants, the 1928 rate for
white infants being 64, whereas that for colored infants was 102. The rate for
urban areas in the State in 1928 was 83, and that for rural areas was 76.
The maternal mortality rate for the State in 1928, also the rates for urban and
rural areas and for white and colored mothers, were higher than those for the
birth-registration area, as the following figures show:
Louisiana

T o ta l_______

Area

. 114

Urban _.
R u r a l..

162
92

78
62

W h i t e ..
Colored

_ 90
. 154

63
121

M A IN E
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, division of public-health
nursing and child hygiene, Augusta.
Funds expended: Federal, $19,999.48; State, $10,000; total, $29,999.48.
Staff:
Director (nurse, not paid from maternity and infancy funds), 12 nurses
(5 part year), 1 nutritionist, 1 stenographer, 1 clerk.
Volunteer assistants— 14 physicians, 11 lay persons.
Activities:
Child-health conferences conducted by physicians— 184; infants and pre
school children registered and examined— 1,458; visits to conferences—
2,153.
Defects found in children examined at conferences— 1,740; children having
defects— 1,160. Parents had defects corrected in 207 of the children
(report incomplete).
Conferences conducted by nurses, no physicians present— 41; infants and
preschool children inspected— 143; visits to conferences by children— 281.
Dental conferences— 2; preschool children receiving dental examination— 31.
Classes for girls in care of infants and preschool children— 35 organized;
girls enrolled— 544; number completing course— 406; lessons in course—

12.

Classes for mothers— 7 organized; mothers enrolled (plus those carried
over from the previous year)— 216; number completing course— 74;
lessons in course— 6. Each lesson was complete in itself, and many
mothers attended only 1 or 2 lessons.
Home visits by nurses— 14,662 (prenatal cases seen, 570; obstetrical cases,
8; postnatal cases, 260; infants, 1,416; preschool children, 3,339).
Group demonstrations— 268, to classes and group meetings.
Campaign— 1, for observance of M ay D ay as Child Health D ay. Nearly
all State and local organizations gave some recognition to the day, and
special activities were reported by 133 towns.
Talks and lectures— 182 (3 by radio).
Literature prepared— Nutrition Helps (leaflet).
• Literature distributed— 71,602 pieces.
New names registered for prenatal letters— 1,607; prenatal letters dis
tributed— 1,643 sets.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Nutrition classes— 37 conducted; persons enrolled— 354; lessons m course—
5. Individual instruction was given to 575 children at conferences; 80
homes.were visited and instruction was given regarding the diet of 250
children; 17 talks on nutrition were given to groups of children; and 15
talks were given to the classes in infant care. .
Exhibits conducted— 135. Exhibit material prepared— models, posters,
charts, and maps. Exhibit material was lent 65 times.

Breast feeding was stressed in the instruction given to mothers at con
ferences and in home visits.
Infants born in the State during the year— 16,432; infants under 1 year of
age reached by the work of the division— 3,844; preschool children
reached— 9,133; expectant mothers reached— 2,213.
,,
.\
The division sends a list of literature on infant hygiene, copies of which
may be had on request, to parents of all infants whose births are registered
in the State bureau of vital statistics.
Counties in the State— 16; counties in which maternity and infancy work
was done during the year— 11; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 15.
, , j
As a result of the division’s work many local and county nurses ponducted
classes in infant care. A t the completion of the course the division
issued diplomas to girls receiving a grade of 70 or higher.
The Maine Public Health Association and the American Red Cross co
operated in the division’s work.

An outstanding achievement of the year’s work was the increase in general
public interest in the work of the division and the increased interest and par
ticipation on the part of professional workers in the field of maternal, infant,
and child hygiene.
INFANT AND MATERNAL MORTALITY RATES

Maine did not begin cooperation with the Federal Government under the
maternity and infancy act until 1927, although an increased appropriation for
child-hygiene work was granted by the State legislature in 1922. In both
1921 and 1928 the general death rate was higher for the State than for the birthregistration area (14 and 13.8 for the State as compared with 11.7 and 12 for the

arThe infant mortality rate was also higher in both 1921 and 1928 for the State
than for the birth-registration area (88 for the State in 1921 as compared with
76 for the area, and 73 for the State in 1928 as compared with 69 for the area).
The rate for urban areas of the State was slightly higher (4 per cent) in 1928 (82)
than in 1921 (79). The rate for rural areas was lower in 1928 (77) than m 1921
(92). The rate for 1928 was, however, the lowest recorded for the State since
the United States birth-registration area was established ih 1915.
The maternal death rate for the State was the same m 1921 and 1928 (74 ),
although there was considerable fluctuation during the period. The rate for
urban areas was also the same in 1921 and 1928 (101), and there was very little
difference in the rates for the rural areas (63 in 1921 and 62 in 1928).
M ARYLAND
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of child hygiene,
Funds expended: Federal, $25,706.27; State, $14,277; total, $39,983.27.
Director (physician), 1 midwife teacher (part year), 1 health-education
worker (part time), 2 stenographers, 2 clerks (1 part year). Forty-five
physicians and four dentists were employed as needed to conduct con
ferences. Twenty-one county nurses were paid in part from maternity
and infancy funds.
Volunteer assistants— 10 physicians, 2 dentists, 85 lay persons.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities:
Child-health conferences conducted by physicians— 456; infants and pre
school children registered and examined— 7,199.
Defects found in children examined at conferences— 9,648; children having
defects— 6,065. Parents had defects corrected in approximately 1,000 of
the children.
Prenatal conferences conducted by physicians— 12; expectant mothers reg
istered and examined— 32; visits to conferences— 69.
Conferences conducted by nurses, no physician present— 57; infants and
preschool children inspected— 498; mothers instructed in prenatal care—
65; visits to conferences by children— 538; visits by mothers— 306.
Dental conferences— 61; preschool children receiving dental examination—
570.
Plans were made for the establishment after the close of the fiscal year of a
new health center in addition to the 35 centers already operating in the
counties.
Classes for girls in care of infants and preschool children— 17 organized;
girls enrolled and completing course— 380; lessons in course— 10..
Classes for mothers— 32 organized; mothers enrolled and completing
course— 433; lessons in course— 8.
Classes for midwives— 18 organized; mid wives enrolled— 206; number com
pleting course— 186; lessons in course— 8. Quarterly letters on some
important phase of their work were sent to licensed midwives.
Home visits by nurses— 7,289 (prenatal cases seen, 1,307; postnatal cases,
651; infants, 3,772; preschool children, 3,149).
Group demonstrations— 51, at conferences and meetings. Films and slides
on child health were shown and proper clothing and food were exhibited.
Survey— 1, of preschool children who would enter school in the fall.
The bureau cooperated with the United States Children’s Bureau in a study
of maternal mortality (continued from the previous year) made in the State
with the indorsement of the State medical society.
The bureau cooperated in a state-wide campaign for the observance of M ay
D ay as Child Health D ay, one feature of which was the examination of
preschool children so as to obtain correction of their defects before the
children should enter school.
Talks and lectures— 81.
Literature prepared— Guarding the Baby, Diagnosis of Dysentery, W hy
Prenatal Care?
Literature distributed— approximately 125,000 pieces.
Nutrition work was done through several nutrition classes conducted by the
county nurses who were paid from maternity and infancy funds.
Exhibits conducted— 56, of posters, films, clothing for the baby, and dental
exhibits. Exhibit material was lent 40 times.
Articles prepared— Pneumonia in Young Children, Nature and Nurture in
Child Hygiene, Better Health for Mothers and Babies, Child Health in
Scandinavia.
Statistical studies made— physical condition of children examined a t , health
conferences according to age groups (infancy to 5 years of age and 5 to 7
years of age); infant mortality from certain causes in the counties of
Maryland before and after the State was admitted to the United States
birth-registration area, also in 1921 and 1927; infant mortality in the
counties of Maryland, by causes and age groups (in this study it was
ascertained that of the total 1,237 deaths of infants under 1 year of age
819 were of infants less than 1 month old); infant deaths, infant mor
tality rates, neonatal deaths, and stillbirths in the counties, by years
from 1924 to 1928; cases of ophthalmia neonatorum, by counties and in
Baltimore city, by years from 1919 to 1929; maternal mortality in the coun
ties for the first nine months of 1928, by causes and age groups; attendant
a t birth (white and colored separately) for births occurring in the State as a
whole, for the counties as compared to Baltimore city, and for each county
separately.
Breast feeding was stressed in the instruction given to mothers at con
ferences and in home visits and in films shown.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Infants born in the State during the year— 15,437 (exclusive of those born
in Baltimore city, in which the State bureau of child hygiene does no work
because the city has its own bureau of child hygiene); infants under 1
year of age reached by the work of the bureau— approximately 15,000;
preschool children reached— approximately 5,500; expectant mothers
reached— approximately 7,500.
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
have assumed the responsibility for maternity and infancy work begun
with maternity and infancy funds.
As a result of the bureau’s work, health conferences and dental and ortho
pedic clinics for preschool children have been conducted in a number of
counties.
The following organizations cooperated in the bureau’s work: State publichealth association, American Red Cross, State federation of women’s clubs,
State league of women voters, service clubs, and parent-teacher associa
tions. They assisted in arranging for and conducting health confer
ences, furnished transportation for children, and distributed a large num
ber of pamphlets on prenatal care to expectant mothers.
Among the outstanding features of the year’s work were the extension of the
examinations of preschool children and the resulting correction of their defects,
the classes for midwives, and the increased interest in prenatal care and ap
preciation of its importance.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Maryland in 1928 (13.4) was practically the same as
in 1921 (13.6). The infant mortality rate in 1928 (80), however, was much lower
than in 1921 (94). In 1921, 1 infant in every 11 born alive died before reaching
the first birthday; in 1928, 1 in every 13 died during the first year of life. T his
difference was particularly noticeable in the rural areas of the State, the rate in
1921 being 102, which meant that 1 infant in every 10 died under 1 year of age,
whereas in 1928, when the rate was 77, there was a loss of 1 in every 13.
The high rates for the State in 1921 and 1928 were due to a large extent to the
mortality among colored infants. In 1921 the rate for colored infants was 147
compared with 81 for white infants, and in 1928 it was 128 for colored infants
compared with 67 for white infants.
The 1928 infant mortality rate for the State and for white infants was the
lowest since the State’s admission to the birth-registration area in 1916. The
rate for colored infants was lower in 1928 than in any other year except 1924,
when it was the same. The rate for rural areas in 1928 (77) was the lowest re
corded; for urban areas the lowest rate (81) occurred in 1927, the 1928 rate being
1 point higher.
The maternal mortality rate was slightly lower in 1928 (65) than in 1921 (67).
The lowest rate since the State entered the United States birth-registration area
occurred in 1927 (58). The rate for rural areas was 11 per cent lower in 1928
(56) than in 1921 (63). The urban rate was 3 per cent higher in 1928 (72) than
in 1921 (70). The greatest differences in the maternal mortality rates for the
State were those from puerperal hemorrhage and puerperal albuminuria and
convulsions. The rate from puerperal hemorrhage was 16 per cent lower in
1928 (7.5) than in 1921 (8 .9); the rate from albuminuria and convulsions was 14
per cent lower in 1928 (16.7) than in 1921 (191 5).
M IC H IG A N
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of child hygiene and
public-health nursing, Lansing.
Funds expended: Federal, $38,395.86; State, $30,877.19; total, $69,273.05.
Staff:
Director (physician), 2 physicians, 10 nurses (1 part year), 2 vital-statistics
clerks, 2 stenographers, 1 clerk, 1 mail clerk (part time). Three county
nurses were paid from maternity and infancy funds (2 part year),

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities:
Child-health conferences conducted by physicians— 14; infants and preschool
children registered and examined— 987.
Defects found in children examined at conferences— 2,375; children having
defects— 950.
Prenatal conferences conducted by physicians— 60; expectant mothers
registered— 162.
Conferences conducted by nurses, no physician present— 30 ; infants and
preschool children inspected— 100; mothers instructed in prenatal care—
250; visits to conferences by children— 200; visits by mothers— 400.
Classes for girls in care of infants and preschool children— 192 organized;
girls enrolled— 3,974; number completing course— 3,924; lessons in
course— 10.
Self-directed study clubs— 70 meetings held, with a total attendance of
1,270 women. The purpose of these clubs was to help women to inform
themselves in the fundamentals of prenatal, infant, and child care. They
were organized by a staff nurse and conducted by leaders selected from
among the local groups. Literature for use in the course was furnished
by the bureau.
Classes for women— 162 organized; women enrolled (plus those carried over
from the previous year)— 2,759 (including 95 midwives) ; number com
pleting course— 2,750; lessons in course— 6 ; in rural districts the 6 lessons
were combined in three 2-hour classes.
Hom e visits by nurses— 12,647 (prenatal cases seen, 1,450; postnatal cases,
200; infants, 3,3 71; preschool children, 1,416).
Community demonstrations— 11, in 11 counties, of a prenatal-nursing
program. 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. During the year 1,450 women received
calls from the nurses in charge. A total of 4,499 such calls were made
(2,991 prenatal, 1,508 postnatal).
Group demonstrations— 1,845, of obstetrical kit, layette, abdominal binder,
baby’s bed, preparation of bottle feeding, preparation of patient and of
bed for home delivery, and inspection of preschool children.
Surveys— 3 : (1) Of midwives, in 30 counties. (2) Of hospitals, state-wide.
(3) Of maternal mortality (continued from the previous year), in coopera
tion with the United States Children’s Bureau and with the indorsement
of the State medical society. The causes of death for the 1,568 deaths
studied by the close of the year under review were as follows:
Number
of deaths

T otal_____________________________________________________

1 ,5 6 8

661
Puerperal septicemia___________________________________________
Puerperal albuminuria and convulsions------------------- _ _ _ --------336
Puerperal hemorrhage______________________
163
Accidents of pregnancy________________________________________
159
130
Accidents of la b o r ..__________________________________
Embolus, sudden death, etc------- ---------------------------------------------105
Causes following childbirth (not otherwise specified)-------------14
Campaigns— 2: (1) For promotion of breast feeding, in 13 counties. In 4
of the counties the campaign was still under way at the close of the year
under review. In the 9 completed counties calls were made on 1,688
mothers of young infants. The need of instruction in the importance of
breast feeding is indicated by the fact that 119 infants in the group sur
veyed had never been breast fed and 217 were breast fed less than 1 month.
(2) For immunization of preschool children against diphtheria, in 3
counties. The bureau cooperated in the campaign to have preschool
children examined and their defects corrected before the children should
enter school and in the campaign for the observance of M ay D ay as Child
Health D ay, the director serving as chairman of the State M ay D ay
committee.
Talks and lectures— 314, to audiences totaling 9,319 persons.
Literature distributed— 171,213 pieces.
New names registered for prenatal letters— 3,229; prenatal letters dis
tributed— 3,943 sets.

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Federal Reserve Bank of St. Louis

THÉ WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Nutrition work was done through the instruction given in the classes for
women and for girls.
Exhibits conducted— 13, at fairs and at various National, State, and local
meetings. Exhibit material prepared— charts, graphs, maps, posters,
and pictures. Exhibit material was lent 33 times.
Article prepared— report on the maternal-mortality study mentioned in a
. foregoing paragraph.
Breast feeding was promoted by the breast-feeding campaigns, the instruc
tion given in classes for mothers and girls, and the literature distributed.
Infants born in the State during the year— 97,462; infants under 1 year of
age reached by the work of the bureau— 125,000; preschool children
reached— 25,000; expectant mothers reached— 18,000.
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— 81 ; 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 four counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the bureau’s work, 79 classes for girls in infant hygiene, in
which 1,647 girls were enrolled, were organized by nurses not on the
bureau’s staff and 4,019 home visits were made by them. Local communi
ties conducted a number of health centers, to which 32,947 visits were
made by infants and preschool children and 2,181 visits were made by
expectant mothers.
The following organizations cooperated in the bureau’s work: State depart
ment of public instruction, State agricultural college (extension division),
American Red Cross, State league of women voters, State federation of
women’s clubs, State nurses’ association, women’s auxiliary of the State
medical society, Daughters of the American Revolution, American Asso
ciation of University W om en, W om an’s Christian Temperance Union,
Michigan Child Study Association, Legislative Council of Michigan
Women, State grange, American Legion auxiliary, women’s fraternal
organizations, and the parent-teacher association. Am ong the children
examined at health conferences reported in the foregoing paragraphs 500
were examined in the “ Get ready for school” campaign sponsored by the
National Congress of Parents and Teachers. They assisted in the cam
paign for the observance of M ay D ay as Child Health D ay and in the
campaign to secure an appropriation to carry on the bureau’s maternity
and infancy work after the expiration of the Federal maternity and
infancy act.
The outstanding achievement of the year was the securing of a State appro
priation equal to the combined State and Federal funds allotted to the bureau
under the Federal maternity and infancy act which expired June 30, 1929.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Michigan was 11.9 in 1928 and 11.6 in 1921. The
infant mortality rate for the State was considerably lower in 1928 than in 1921,
as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921
State______ _______ ________________
Urban.___________________
Rural._____________ _____

79
81
75

1928

Percentage
of difference

69
62

-1 7

These lower rates resulted in the saving of more than 900 infants in the State
who would have died during the first year of life if the 1921 rate had prevailed.
In urban areas more than 400 and in rural areas almost 600 survived their first

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

vear who would have died if the conditions existing m 1921 had prevailed. The
lower rate for the State in 1928 as compared with 1921 was due largely to the
fewer deaths from gastrointestinal diseases, whiph more than any other cause
are influenced by proper care of the baby. The mortality rate from these dis
eases in 1928 was 7.5, a reduction of more than 50 per cent from the rate in 1921
(15.1). Throughout the period 1921 to 1928 there was, with some fluctuation, a
decline in the infant mortality rate from these causes. The rate from natal and
prenatal causes was 11 per cent lower in 1928 than in 1921, the trend having
been downward during the period. Respiratory diseases, on the contrary,
caused an increasing number of infant deaths, the rate being 39 per cent higher
in 1928 (13.3) than in 1921 (9.6).
j ® * , ,.
'
, . „
The maternal mortality rate was lower in 1928 than in 1921, the decrease being
confined, however, to rural areas, as the following table shows:
Deaths of mothers from
causes associated with
pregnancy and childbirth
per 10,000 live births
Area
1921

69
71
65

State.........
Urban.
Rural.

1928

66
78
48

Percentage
of difference
-4
+10
-2 6

This would indicate that 17 fewer mothers in rural areas of the State died from
puerperal causes for every 10,000 live births in 1928 than died in 1921, in urban
areas 7 more died from such causes for every 10,000 live births.
The improvement in infant and maternal mortality in rural areas undoubtedly
W8»s due in large part to the attention attracted to the health of mothers
babies through the surveys made, the special, instruction given to groups, and
the prenatal nursing services instituted in a number of counties.
M IN N E S O T A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, division of child hygiene,
Minneapolis.
* ___
Funds expended: Federal, $37,435.43; State, $21,000; total, $58,435.43.
Staff:
. . . . . .
.
Director (physician, part time), 1 physician (part tim e), 10 nurses (1
for 2 months), 1 vital-statistics field agent, 2 vital-statistics clerks, 4
stenographers, 3 clerks (2 part time).
Activities:
\ J , ,
,
. .
,
Combined prenatal and child-health conference conducted by physicians— 1;
expectant mothers registered and examined— 8 ; infants and preschool
children registered and examined— 18.
Child-health conferences conducted by physicians— 14; infants and pre
school children registered and examined— 396.
Certificates were issued to 1,015 girls completing the work in classes in the
care of infants and preschool children, the course for which was prepared
by the division, the classes being taught by nurses and teachers not on the
division s staff.
Classes for mothers— 25 organized; mothers enrolled (plus those carried
over from the previous year)— 611; number completing course 149;
lessons in course— 8.
. . . .
Courses for teachers on methods of teaching classes for girls in infant and
child care were Conducted at a number of the State teachers’ colleges. Two
lectures on maternity and infancy work were given to each new group of
public-health nurses at the University of Minnesota and to senior hospital
nurses in St. Paul and Minneapolis. One lecture, with exhibit of the divi
sion’s material, was given to each class of students in the university
medical school.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Home visits by nurses— 3,585 (to prenatal cases, 82 ; obstetrical cases, 20;
postnatal cases, 87 ; infants, 494; preschool children, 448; other, 2,454).
Group demonstrations— 18, on prenatal care and infant clothing and feeding,
to classes of university students, dispensary nurses, and groups of women.
Surveys— 2: (1) Of maternal mortality (continued from the previous year),
in cooperation with the United States Children’s Bureau and with the
indorsement of the State medical society. (2) Of public-health nursing.
It was found that 33 infant-hygiene nurses \yere working in the State in
addition to those employed by the division.
Campaign— 1, for the observance of M ay D ay as Child Health D ay, state
wide.
Talks and lectures— 93.
*
♦
Literature prepared— W hat the Child-Hygiene Division Is and Does.
Literature distributed— 251,202 pieces.
New names registered for prenatal letters— 1,127; prenatal letters distrib
uted— 3,154 sets.
A correspondence course consisting of 15 lessons was conducted for mothers
as in previous years. During the year under review 660 women registered
for the course and 348 were on the roll from the previous year. The number
completing the course was 268.
Exhibits conducted— 6, at the State fair, meeting of the State medical
association, and other meetings. Exhibit material prepared— charts and
graphs showing statistics of maternal, infant, and public-health nursing
and of mortality rates. Exhibit material was lent 46 times.
Articles prepared— 5, on various subjects relating to the division’s work.
Breast feeding was stressed in the literature distributed.
Expectant mothers reached by the work of the division— 1,217.
Counties in the State— 87; 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 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.
Nearly all the public-health nurses in the State conducted classes in maternal
or infant hygiene during the year under review. They also referred all
prenatal casés coming to their attention to the division for prenatal letters
or literature.
As a result of the division’s work among the Indians the United States Office
of Indian Affairs agreed to duplicate the number of Indian nurses placed by
the State department of health and to have that department supervise
the work of all the Indian nurses.
The following organizations cooperated in the division’s work: State depart
ment of education, State board of control, State university (extension divi
sion) , American Red Cross, State league of women voters, State federation
of women’s clubs, American Legion auxiliary, and the parent-teacher
association.
Among the outstanding features of the year’s work was the closer contact
established with public-health nurses in the State through advisory visits, which
resulted in an increase in the distribution of literature and in the general work of
the division.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Minnesota was practically the same in 1928 (9.5)
as in 1921 (9.4). The State has not only à comparatively low general death
rate but also a comparatively low infant mortality rate. The infant mortality
rate was 8 per cent lower in 1928 (54) than in 1921 (59). The rate of 1928
represents 2,656 deaths of infants under 1 year of age in the State. If the rate
o f 1921 had prevailed in 1928 there would have been 2,921 infant deaths; in
other words, 265 infants survived their first year in 1928 who would have died
under conditions prevailing in 1921. The difference in the rates in urban and in
rural areas was approximately the same as for the State as a whole, the rate for
urban areas being 59 in 1921 and 55 in 1928 and that for rural areas-being 59 in
1921 and 53 in 1928.
The maternal mortality rate was the same in 1928 (57) as in 1921. ' The rate
for urban areas was slightly lower in 1928 (78) than in 1921 (81), and the rate
for rural areas also was lower (43 in 1928 and 44 in 1921)*

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

M ISSISSIP P I
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene and publichealth nursing, Jackson.
Funds expended: Federal, $44,153.16; State, $34,153.16; total, $78,306.32.
Staff:
J
%
Director (State health officer serving part time) 1 physician (part time),
6 nurses, 1 dental hygienist (part time), 1 nutritionist (part year), 1 supervisor of mid wives (part time), 1 vital-statistics field worker (part year),
1 vital-statistics clerk, 2 technicians (part time, 1 part year) , 1 accountant
(part time), 3 stenographers (2 part time), and 1 typist. Eighteen county
nurses in 13 counties were paid in part from maternity and infancy funds.
Activities:
,
. .
. ,
.
,
Child-health conferences conducted by physicians— 429; infants and pre
school children registered and examined— 6,728.
.
Defects found in children examined at conferences— 7,896; children having
defects— 4,465. Parents had defects corrected in 787 of the children.
Prenatal conferences conducted by physicians— 147; expectant mothers reg
istered and examined— 1,202; visits to conferences— 1,594.
Dental conferences— 384, conducted by dentists who gave their services;
expectant mothers receiving dental examination 1,202; preschool chil
dren receiving dental examination— 8,876.
,
New permanent prenatal centers— 4 established as a result of the bureau s
maternity and infancy work. They are supported by county funds.
Hygiene classes— 126 organized in schools; pupils enrolled— 3,900 (3,b45
girls, 255 boys); number completing course— 3,838; lessons in course— 12 to
24 (18 hours). Instruction in prenatal, infant, and child care was included
in the course.
....
.
,
The supervision and instruction of midwives was continued. A t the close or
the year under review 3,040 midwives were practicing in the State.
Hom e visits by nurses— 8,291 (prenatal cases seen, 1,049; obstetrical cases,
373; postnatal cases, 397; infants, 1,526; preschool children, 2,989).
Survey— 1, of midwives, state-wide.
Talks and lectures— 15,000, to audiences totaling 250,000 persons.Literature prepared— Babies Are Safest, That Eyes M ay See, Milk, Aims
and Activities, Infant and Preschool Records, H ow Teeth Grow, Prevent
Facial Deformities.
Literature distributed— approximately 50,000 pieces.
Nutrition work was included in the activities of all the nurses and was par
ticularly stressed by the oral-hygiene division of the State board of health,
whose supervisor was a dental hygienist paid in part from maternity and
infancy funds.
. . .
,
. „
„ x
Exhibits were on display in all county health department offices. Posters
were shown at meetings of midwives. Films on maternal and child
hygiene were shown by the motion-picture truck, which traveled m 24
Breast feeding was stressed in talks to mothers and in the literature disInfants born in the State during the calendar year 1928 -48,034; infants
under 1 year of age reached by the work of the bureau during the fiscal
year ended June 30, 1929— approximately 47,000.
.
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 in
fancy act 12 counties have assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds, and 1 ^was ready o
assume such responsibility at the close of the year under review.
As a result of the bureau’s work many health conferences were conducted by
local agencies.
. . . .
,
.
, ____ ___ t
The following organizations cooperated in the bureau s work: State league ot
women voters, State federation of women’s clubs, State development
board, parent-teacher associations, and civic clubs. Among the children
examined at health conferences reported in the foregoing paragraphs
were approximately 5,000 examined in the •Get ready for school cam
paign sponsored by the National Congress of Parents and Teachers.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Among the outstanding features of the year’s work were the hygiene classes, the
prenatal conferences, and the supervision of midwives.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Mississippi was 31 per cent higher in 1928 (14.5)
than in 1921 (11.1). The infant mortality rate was higher in 1928 (74) than in
1921 (68), but the difference (9 per cent) was not so great as in the case of the
general death rate. The rates for both white and colored infants in the State
were higher in 1928 than in 1921, but the difference was greater for white than for
colored infants. The rural rate was higher and the urban rate lower. The rates
were as follows:
1921
68

1928

U rb an..
R ural. _

W h ite. .
Colored

53
85

State_______

There was practically no difference in the maternal mortality rates in 1921 and
1928. In the urban areas the rate was 15 per cent lower, the greater part of the
reduction being due to the lower rates among white mothers, but in rural areas
the rate was lower among colored mothers only. The rates were as follows:
1921

1928

State------------------------------ -------------------------------------------------

W h i t e - - - - - - ___________________________________ —
Colored_____________________________________________

71
120

76
112

Urban______
W h it e ..
Colored
Rural_______
W h ite -.
Colored.

180
157
217

154
119
205

62
114

70
105

M IS SO U R I
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child* hygiene, Jeffer
son City.
Funds expended: Federal, $24,186.81; State, $19,186.81; total, $43,373.62.
Staff:
Director (physician), 1 physician, 5 nurses (3 part year, 1 part time), 1
stenographer, 1 clerk (part time). Additional physicians were employed
as needed. Fourteen county nurses were paid in full or in part from
maternity and infancy funds.
Volunteer assistants— 147 county and city health officers, 37 nurses, a num
ber of dentists, 80 lay persons.
Activities:
Child-health conferences conducted by physicians— 553; infants and pre
school children registered and examined— 10,188; visits to conferences—
.15,981.
Defects found in children examined at conferences— 12,868; children having
defects— 7,730. Parents had defects corrected in approximately 20 per
cent of the children.
Conferences conducted by nurses, no physician present— 4,347; infants and
preschool children inspected— 22,496; mothers instructed in prenatal
care— 250; visits to conferences by children— 42,680; visits by mothers—
405.
Dental .conferences— 41, conducted by dentists who volunteered their
services under the auspices of dental societies; preschool children receiving
dental examination— 476.
New permanent child-health centers— 7 established as a result of the division’s
maternity and infancy work. They are supported by State and county
funds.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
Classes for girls in care of infants and preschool children— 10 organized;
girls enrolled— 166; number completing course— 102; lessons in course— 12.
Classes for mothers— 109 organized; mothers enrolled (plus those carried
over from the previous year)— 2,502; number completing course— 1,680;
lessons in course— 8.
Home visits by nurses— 7,180 (prenatal cases seen, 612; obstetrical cases,
52 ; postnatal cases, 408; infants and preschool children, 5,370).
Group demonstrations— 1,025, on giving sun baths, dressing the baby,
preparing the baby’s food, and other phases of infant and child care, at
health conferences and the classes for mothers.
Campaigns— 2 : (1) To have preschool children qualify as “ six-pointers”
and “ nine-pointers.” To qualify as six-pointers the children had to be
free from defects in vision, hearing, throat, teeth, and posture and be of
normal weight. To qualify as nine-pointers the children also had to
have their births registered, be immunized against diphtheria, and be
vaccinated against smallpox. (2) To have children under 4 years of age
qualify as “ blue-ribbon babies.” This project was determined upon in
response to a demand from Missouri mothers for a plan of rating the
health of the younger preschool children. The division drew up a general
scheme, which was presented at a conference of representatives of 15
State organizations and unanimously adopted by them. The represen
tatives furnished the names of local chairmen of their respective organiza
tions throughout the State and prepared a mimeographed letter, which
was sent to these chairmen with other child-health material. In this way
1,600 local clubs were reached. About 75 clubs sponsored child-health
conferences conducted by local physicians, and the number of blueribbon babies in the State is slowly increasing. Plans were made to
conduct at the State fair a blue ribbon baby contest instead of the betterbabies contests of previous years, prizes to be awarded to children who
met the blue-ribbon requirements. These are as follows: Good nutrition,
normal dentition, normal nose and throat conditions, normal genitalia,
no remediable orthopedic defect, average mental development, proof that
birth has been registered, proof of immunization against diphtheria and
smallpox, practice of good health habits, daily sun baths when the weather
permits, and cod-liver oil during the rest of the year for any child showing
signs of rickets.
Talks and lectures— 431.
Literature prepared— Sunlight for Babies, Prevention of Babies’ Sore Eyes,
Rural Public-Health Nursing, Tonsils and Adenoids, Blue-Ribbon Babies,
Suggestions for the Correction of Underweight in Children, Lesson Plans
for Mothers’ Classes.
Literature distributed— 290,887 pieces.
f
'^
New names registered for prenatal letters— 830; prenatal letters distrib
uted— 904 sets.
In order to meet the demand for competent rural public-health nurses a
rural teaching center was established in connection with the Boone
County Health Department. The staff of the department consisted of a
physician and four nurses, one of whom was paid from maternity and
infancy funds. She served as chief nurse in the unit and directed the
work of the student nurses. Through arrangement with the Rockefeller
Foundation each received a daily stipend of $3 while in attendance at the
training center, provided she received no compensation from any other
agency during that period. The course consisted of practical field experi
ence and weekly lectures by members of the staff of the State division and
other State representatives on the various phases of a generalized nursing
program for rural districts. Each week the chief examined and discussed
with these nurses the records of individual experiences. Special emphasis
was placed on prenatal, infant, and preschool-child work. Seven nurses
had completed the full 2-m onth course by June 30, 1929, and five had
spent one to two weeks at the center. Each was pledged to accept a rural
position in public-health nursing in Missouri and to remain in that
position at least a year provided her services were satisfactory to the
county employing her. Arrangements were made with the University
of Missouri whereby nurses taking the full 2-month course receive six
hours of university credit.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Graduate course for physicians— 1, for rural health officers, on the care and
feeding of infants, conducted at the Washington University medical
school for one week. Two hours a day were spent in the pediatric clinics,
and a series of lectures on nutrition, immunization, habit training, and
common childhood infections was given by members of the pediatric
staff. Ten health officers took the course. Since their return to their
stations most of them have established permanent child-health centers.
Nutrition work was done through individual instruction gives by the nurses
in the course of their work.
Exhibits conducted— 64, consisting of maps, posters, graphs, mechanical
health man, and films shown in automatic motion-picture machine.
Exhibit material prepared— graphs, posters, and maps. Exhibit material
was lent 137 times.
Articles prepared— 29, on various phases of child hygiene, for the bulletin
of the State board of health.
Breast feeding was stressed in talks to women’s clubs and in demonstrations
of manual expression for nurses. It was estimated that about 60 per cent
of the infants in the State are breast fed.
Infants born in. the State during the year— 63,401; infants and preschool
children reached by the work of the division (exclusive of those reached
by literature distributed)— 38,054; expectant mothers reached (exclusive of
those reached by literature distributed)— 1,766.
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.
Counties in the State— 114; counties 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— 114.
As a result of the division’s work one new county health department and
one county nursing service have been organized.
The division gave supervisory assistance to public and private child-health
agencies throughout the State.
The following organizations cooperated in the division’s work: State agri
cultural college (extension service), State society for crippled children,
State conference of social workers, State federation of women’s clubs,
women’s auxiliary of the State medical society, American Legion, and
parent-teacher associations. Of the children examined at health con
ferences reported in the foregoing paragraphs approximately 20 per cent
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 blue ribbon baby
project to foster interest in improving the health of the younger preschool children
and the establishment of the teaching center for public-health nurses preparing
to serve rural districts.
INFANT AND MATERNAL MORTALITY RATES

Missouri was not admitted to the United States birth-registration area until
1927. Mortality rates of earlier years therefore are not available for com
parison with those of 1928.
The general death rate for the State in 1928 (12.8) was 7 per cent higher than
for the birth-registration area (12). The infant mortality rate for the State
(66), however, was 4 per cent lower than that for the birth-registration area (69).
The high infant mortality rate for the State was due to the high rate for colored
infants (123), the rate for white infants being lower for the State (62) than for
the birth-registration area (64). .The rates for both urban and rural areas of
the State were lower than those of the birth-registration area; the urban rate
was 68 for the State and 69 for the birth-registration area, and the rural rate was
64 for the State and 68 for the birth-registration area.
The maternal mortality rate in 1928 was influenced by the high rate for colored
mothers, although the rate for colored mothers in the State was lower than in
the birth-registration area, as the following figures show:

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929
Missouri

Area

T o t a l . ._____

U rb a n .
Rural __

.
.

84
59

78
62

W h i t e ..
Colored

. 68
. 106

63
121

MONTANA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, child-welfare division, Helena.
Funds expended: Federal, $17,305.33; State, $8,700; total, $26,005.33.
Staff:
Director (physician, part year), 4 nurses (part time, 2 part year), 1 vitalstatistics clerk, 1 bookkeeper (part tim e), 1 stenographer, 1 clerk (2
months). Eleven county nurses were paid in part from maternity and
infancy funds.
Activities:
Child-health conferences conducted by physicians— 170; visits to conferences
by infants and preschool children— 5,776.
New permanent child-health center— 1 established as a result of the divi
sion’s maternity and infancy work. It is supported by maternity and
infancy funds, county funds, and a private organization.
Classes for girls in care of infants and preschool children— 5 organized.
Classes for mothers— 2 organized.
Hom e visits by nurses— 5,081 (prenatal cases seen, 382; postnatal cases,
175; obstetrical cases, 3; infants, 1,850; preschool children, 2,671).
Group demonstrations— 75.
Talks and lectures— 60 (including 38 by a physician lent to the State by
the United States Children’s Bureau).
Literature prepared— Sunny Boys (leaflet).
Literature distributed— 98,610 pieces.
New names registered for prenatal letters— 579; prenatal letters distrib
uted— 579 sets.
Exhibits conducted— 30. Exhibit material was lent 11 times.
Infants born in the State during the year— 10,175; infants under 1 year of
age reached by the work of the division (exclusive of those reached by
literature distributed)— 3,552; preschool children reached (exclusive of
those reached by literature distributed)— 6,790; expectant mothers
reached (exclusive of those reached by literature distributed)— 1,192.
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— 28; counties in which maternity and infancy work
has been done since the acceptance of the maternity and infancy act—^56.
The following organizations cooperated in the division’s work: American
Red Cross, State tuberculosis association, State federation of women’s
clubs, the parent-teacher association, and civic clubs.
Among the outstanding features of the year’s work were the requests made to
the division for the establishment of new county nursing services.
INFANT AND MATERNAL MORTALITY RATES

Montana was not admitted to the United States birth-registration area until
1922. Comparison is made therefore between the infant and maternal mortality
rates of 1922 and 1928.
The general death rate for the State was 22 per cent higher in 1928 (10.5)
than in 1922 (8.6). The infant mortality rate, on the contrary, was 15 per cent
lower in 1928 (61) than in 1922 (70). The 1928 rate for the State was the lowest
since the State’s admission to the birth-registration area. Reduction in the
rates has occurred in both urban and rural areas, the rate for urban areas being
59 in 1928 and 78 in 1922, that for rural areas being 62 in 1928 and 68 in 1922.
9412°— 31------ 6

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The maternal mortality rate was also lower in 1928 (75) than in 1922 (79).
This difference was due entirely to the lower rate in rural areas, which was 64
in 1928 as compared with 77 in 1922, whereas the rate for urban areas was 105
in 1928 as compared with 86 in 1922. The public-health nurses employed by the
State child-welfare division have done exceptional work in reaching rural mothers
and infants in spite of mountain barriers and other unusual difficulties in trans
portation.
N EB RASK A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public welfare, bureau of health,
division of child hygiene, Lincoln.
Funds expended: Federal, $16,000; State, $6,000; total, $22,000.
Staff:
Director (nurse), 3 nurses (1 part year), 1 inspector of maternity and infant
homes (part time, part year), 1 vital-statistics clerk, 1 stenographer.
Volunteer assistants— approximately 60 physicians, 28 dentists, 12 nurses.
Activities:
Child-health conferences conducted by physicians— 38; infants and pre
school children registered and examined— 1,163.
Defects found in children examined at conferences— 2,829; children having
defects— 1,163.
Parents had defects corrected in approximately onethird of the children (report incomplete).
Classes for girls in care of infants and preschool children— 234 organized;
girls enrolled— 4,079; number completing course— 3,780; lessons in
course, 2 to 5, followed by a written review in most instances. These
classes were taught in 103 high schools by a nurse from the division’s staff.
Special efforts were made to have the senior girls take the course, but in
some small high schools all the girl pupils enrolled in the classes. Many
girls who plan to be teachers were in the classes, thus becoming prepared
to extend the work to their own schools later.
Classes for mothers— 15 organized; mothers enrolled— 572; number com
pleting course— 40; lessons in course— 4.
Home visits by nurses— 1,041 (prenatal cases seen, 73; infants, 427; pre
school children, 541).
Maternity homes inspected— 103; inspections made— 103.
Infant homes inspected— 18; inspections made— 18.
Group demonstrations— 382, on giving sun baths, bathing and dressing the
baby, and other phases of infant and child care, at classes and other group
meetings.
The division cooperated in a survey of maternal mortality (continued from
the previous year) made in the State by the United States Children’s
Bureau with the indorsement of the State medical society.
Talks and lectures— 73.
Literature distributed— 283,771 pieces.
New names registered for prenatal letters— 911; prenatal letters distributed—
911 sets.
A special lesson in prenatal care was given in connection with a course on
nutrition of the expectant mother conducted by the extension service
of the State college of agriculture in eight counties for groups of rural
club leaders who will teach similar lessons in their home clubs.
Nutrition work was done through individual instruction to mothers at classes
and in home visits.
Exhibit conducted— 1, at the State fair, of films, models, and posters on sun
baths. Exhibit material was lent once.
Breast feeding was stressed in the instruction given in classes for mothers
and girls and in the literature distributed.
Infants born in the State during the year— 27,160; infants and preschool
children reached by the work of the division— 30,239; expectant mothers
reached— 911.
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— 93; counties in which maternity and infancy work
was done during the year— 71; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 90.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
.
. The division gave* supervisory assistance to local organizations doing childhealth work.
|
, . .
The following organizations cooperated in the divisions work: State col
lege of agriculture (extension division), American Red Cross, State fed
eration of women’s clubs, American Legion and auxiliary, W om an’s
Christian Temperance Union, and the parent-teacher association. They
assisted with conferences, classes, and general health programs. Among
the children examined at health conferences reported in the foregoing
paragraphs were 179 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 classes in infant
hygiene that were organized in high schools and the lessons in prenatal care that
were given to leaders of rural clubs.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Nebraska was somewhat higher in 1928 (9.7) than
in 1921 (9.2). The infant mortality rate in 1928 (53), however, was definitely
lower than in 1921 (59), as was the rate in urban areas in 1928 (59), as com
pared with 74 in 1921. The rates in rural areas were not significantly different
(51 in 1928 and 54 in 1921). Iif 1928 in the State as a whole there were 1,481
deaths of infants under 1 year of age. If conditions affecting infant mortality
had been the same as in 1921 there would have been 1,654 such deaths; 173
infants survived who would have died under conditions existing in 1921.
The maternal mortality rates, although lower in 1928 than in 1921, showed
no significant differences. The rate for the State was 60 in 1928 and 66 in 1921;
that for urban areas was 90 in 1928 and 105 in 1921; that for rural areas was 51
in 1928 and 55 in 1921. The maternal mortality rate from puerperal albu
minuria and convulsions has shown a downward trend from 1921 to 1928, and
deaths from these causes are influenced by the care the mother receives during
pregnancy. The rate from these causes, although slightly higher in 1928 (12.8)
than in 1927 (11.8), was 34 per cent lower than the 1921 rate (19.3).
Public attention has been directed to the importance of prenatal care through
the State medical society, whose committee on maternal welfare (especially the
chairman) were greatly interested in the study of maternal mortality being made
in the State in cooperation with the United States Children’s Bureau and gave
valuable assistance in the study.
N EVAD A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, child-welfare division, Reno.
Funds expended: Federal, $10,725.27; State, $3,582.50; total, $14,307.77.
Staff:
„
Executive secretary. Five county nurses who worked in 16 counties were
paid in part from maternity and infancy funds.
Activities:
•
, .
Combined prenatal and child-health conferences conducted by physicians
32; expectant mothers registered— 16; infants and preschool children reg
istered and examined— -201.
Conferences conducted by nurses, no physician present— 93 ; infants and
preschool children inspected— 1,203; mothers instructed in prenatal.care
1 8 0 -

. ,,

Classes for girls in care of infants and preschool children— 27 organized; les
sons in course— 25.
Classes for mothers— 21 organized; mothers enrolled— 504; number com
pleting course— 329; lessons in course— 25.
Home visits by nurses— 3,020 (prenatal cases seen, 315; obstetrical cases,
17; postnatal cases, 9 ; infants, 973; preschool children, 1,706).
Group demonstrations— 19, on various phases of the care of infants and pre
school children.
Literature distributed— approximately 1,500 pieces.
Prenatal letters distributed— 250 sets.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Breast feeding was stressed in the instruction given to mothers. It was esti
mated that 50 per cent of the infants in the State are breast fed.
Infants under 1 year of age reached by the work of the division— 3,728; pre
school children reached— 2,263; expectant mothers reached— approxi
mately 700.
Counties in the State— 17; counties in which maternity and infancy work
was done during the year— 17.
The Nevada Public Health Association cooperated in the division’s work,
contributing part of the salary of each nurse employed by the division.
An outstanding achievement of the year’s work was the admission of the State
to the United States birth-registration area.
INFANT AND MATERNAL MORTALITY RATES

Nevada was not admitted to the United States birth-registration area until
1929. Figures, therefore, are not available from the United States Bureau of the
Census for comparison of infant or maternal mortality rates.
Since the beginning of the State’s cooperation under the maternity and in
fancy act the child-welfare division has assisted in the work to promote more
complete registration of births in the effort to reach the standard required for
admission to the area. The admission of Nevada to the United States birth and
death registration areas was announced by the United States Bureau of the
Census in April, 1929.
N E W H A M P S H IR E
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of maternity, infancy, and
child hygiene, Concord.
Funds expended: Federal, $13,504.86; State, $7,988.31; total, $21,493.17.
Staff:
Director (nurse, not paid from maternity and infancy funds), 6 nurses (1 part
year), 2 stenographers. Physicians were employed as needed to conduct
conferences.
Activities:
Child-health conferences conducted by physicians— 98; infants and preschool
children registered and examined— 2,968.
Defects found in children examined at conferences— 2,708; children having
defects— 1,806. Parents had defects corrected in 461 of the children.
The division held its first child-guidance clinic in connection with one of the
health conferences, a consultant on child guidance and behavior being
added to the usual conference staff.
New permanent child-health centers— 2 established as a result of the divi
sion’s maternity and infancy work. They are supported by local public
and private funds.
New permanent prenatal center— 1 established as a result of the division’s
maternity and infancy work. It is supported by private funds.
Classes for girls in care of infants and preschool children— 12 organized;
girls enrolled and completing course— 345; lessons in course— 6.
Classes for mothers— 6 organized; mothers enrolled and completing course—
179; lessons in course— 6.
Home visits by nurses— 13,382 (prenatal cases seen, 628; obstetrical cases, 4;
r postnatal cases, 535; infants, 1,974; preschool children, 5,476).
Maternity homes inspected— 12; inspections made— 12.
Infant homes inspected— 16; inspections made— 17.
Group demonstrations— -168, at conferences and classes, on child care,
posture correction, preparation of food, preparation of maternity packages,
and other phases of maternal, infant, and child care.
Surveys— 2 : (1) To ascertain the number of infants and preschool children
needing supervision, state-wide.
(2) Of the number of infants breast fed,
in 5 districts. It was found that 57 per cent of those listed were breast
fed at birth, 43 per cent at 1 month of age, 24 per cent at 3 months, and
only 15 per cent at 6 months.
The division cooperated in a study of maternal mortality made in the
State by the United States Children’s Bureau with the indorsement of
the State medical society.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
Campaigns— 2: (1) For immunization of children against diphtheria, in 13
towns; 2,088 children were immunized.
(2) For observance of M ay
D ay as Child Health D ay, state-wide.
Talks and lectures— 235.
Literature prepared— leaflets on breast feeding and prevention of diphtheria.
Literature distributed— 193,648 pieces.
New names registered for prenatal letters— 1,284; prenatal letters dis
tributed— 1,284 sets.
A 3-day institute for nurses was conducted. This included discussions of
various phases of maternity and child-hygiene work, demonstrations, and
motion pictures.
The division maintained a library that was open to all public-health nurses
in the State.
Nutrition work was done through individual instruction to mothers at con
ferences and in home visits. One period in all the classes for mothers and
for girls was devoted to instruction on nutrition.
Exhibits conducted— 202, at conferences, schools, parent-teacher institutes,
and other meetings. Exhibit material prepared— posters, layettes, sun
suits, maternity outfits, and other exhibits relating to maternal, infant,
and child care and hygiene. Exhibit material was lent 125 times.
Breast feeding was stressed in talks to public-health nurses, in a letter to
the county medical societies, in fliers in all mail sent from the division,
and in the articles prepared for the monthly bulletins of the State board
of health. It was estimated that 57 per cent of the infants in the State
are breast fed.
Infants born in the State during the year— 8,680; infants under 1 year of
age reached by the work of the division— 8,680; preschoolchildren
reached— 9,023; expectant mothers reached— 3,500,
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics and
follows this with other literature at regular intervals.
Counties in the State— 10; counties in which maternity and infancy work
was done during the year— 10.
The division gave advisory service to State and local organizations doing
child-health work.
The following organizations cooperated in the division^ work: State board
of education, State university (extension service), State league of women
voters, State farm bureau, State association of university women, State
tuberculosis association, American Red Cross, American Legion, and the
parent-teacher association. They gave assistance at conferences, classes,
and the institute for nurses.
Among the outstanding features of the year's work were the expansion of the
prenatal program and the initiation of child-guidance clinics.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for New Hampshire was practically the same in 1928
(14.1) as in 1921 (13.7). The infant mortality rates for the State and for both
urban and rural areas, however, have shown a downward trend from 1921 to
1928 and were markedly lower in 1928 than in 1921, as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921

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Federal Reserve Bank of St. Louis

1928

Percentage
of
difference

-2 1

95
78

74
64

-2 2
-1 8

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The new low rate obtained for the State in 1927 was maintained in 1928;
in rural areas the 1928 rate was the lowest recorded; the lowest rate in urban
areas was reached in 1927 (72), the 1928 rate being 2 points higher (74). If
the 1921 rate had obtained in 1928, 18 more infants would have died in every
1,000 born alive; in other words, instead of 602 deaths of infants under 1 year of
age there would have been 755. Although the rates from all causes have de
clined since 1921, the greatest decline has been in the rate from gastrointestinal
diseases. The rate from these causes in 1928 (5.2) was 67 per cent lower than
that in 1921 (15.6).
There was some fluctuation in the maternal mortality rates during the period
1921 to 1928, but on the whole there was no decline. The maternal mortality
for the State was 63 in 1928, and 62 in 1921. The rate in urban areas was 62 in
1928, and 63 in 1921; in rural areas it was 65 in 1928, and 62 in 1921.
N E W JERSEY
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of child hygiene,
Trenton.
Funds expended: Federal, $35,569.10; State, $26,284.55; total, $61,853.63.
Staff: The Federal and State maternity and infancy funds constituted slightly
less than half the bureau’s budget during the year. The following staff were
paid from maternity and infancy funds: 33 nurses (5 part year, 3 serving as
assistant supervisors, 14 as district supervisors, 16 as teachers of child hygiene),
1 publicity agent (part year), 6 clerks (4 part year).
Activities:
Infants and preschool children registered and examined at child-health
conferences conducted by physicians— 5,600; visits to conferences—
29,413.
Defects found in children examined at conferences— 3,966; children having
defects— 2,700. Parents had defects corrected in 1,572 of the children.
Prenatal conferences conducted by physicians— 125; expectant mothers
registered and examined— 750; visits to conferences— 3,074.
Conferences conducted by nurses, no physician present— 562; infants and
preschool children inspected— 2,717; visits to conferences by children—
13,481.
New permanent child-health centers— 12 established as a result of the
bureau’s maternity and infancy work. They are supported by State and
Federal funds.
New permanent prenatal center— 1 established as a result of the bureau’s
maternity and infancy work. It is supported by Federal and State funds.
Classes for girls in care of infants and preschool children— 173 organized;
girls enrolled— 2,843; number completing course— 2,800; lessons in
course— 10.
Courses in child hygiene were conducted in some of the normal schools.
Two schools in which these courses were formerly taught by staff nurses
arranged to conduct similar courses without further assistance from the
bureau of child hygiene.
A course of 12 lessons and demonstrations was given at the State reformatory
for women. The essentials of prenatal care and the care of the baby were
taught.
The instruction and supervision of midwives was continued as in previous
years. The 405 licensed midwives in the State attend approximately
18 per cent of the total births, in some communities as many as 64 per
cent. The midwives have at least 1,800 hours’ training in a 9 months’
period and are licensed by the State board of medical examiners. Their
licenses must be registered yearly. Supervision consists of home visits by
the county supervisors, monthly meetings of midwives’ county organiza
tions, follow-up of their prenatal, delivery, and postpartum work, and the
investigation of maternal deaths, infant deaths, and stillbirths occurring
in their practice. A State conference of midwives is held annually.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued..
.
■
.
,,
. ,
, .
f
A member of the bureau’s staff was assigned to assist in the instruction or
midwives in the special course for licensed midwives in one of the hospitals
in the State. The course was reorganized during the year under review
so that the time to be spent in the hospital by the midwives will be devoted
to instruction and to the following practical experience. Proper care
during pregnancy, labor and delivery, and the postpartum period,
physical examinations, urinalysis, pelvimetry, the taking of blood pressure,
palpation for position of the baby, detection of the fetal heartbeat,
aseptic preparation for delivery, rectal examination, and examination tor
laceration.
.
Home visits by nurses— approximately 65,000.
Maternity homes inspected— 12; inspections m ade— oo.
Infant homes inspected— 247; inspections made -741.
_
,
Community demonstrations— 3 (continued from the previous year), to show
the value of prenatal care.
, .
Group demonstrations— 225, on prenatal care and related subjects.
Campaign— 1, for immunization of preschool children against diphtheria.
Talks and lectures— 38.
.
Literature distributed— approximately 100,000 pieces.
Number of sets of prenatal letters, distributed 350.
.
.
The supervisor of nurses gave a series of four lectures on child-hygiene work
to groups of nurses.
, ,
,
Exhibits conducted— 4; exhibit material prepared— map and chart.
Scientific article prepared— Maternal and Infant Mortality.
Breast feeding was stressed in the instruction given to mothers. IV was
estimated that 80 per cent of the babies under the supervision of the State
nurses are breast fed during their first month of life.
.
Infants born in the State during the year— 70,004; infants under 1 year of
age reached by the work of' the bureau— 25,000; preschool children
reached— 12,000; expectant mothers reached— 6,000.
Counties in the State— 21; counties in which maternity and infancy work
was done during the year— 21.
.
. ,
,
. .
, .
The bureau gave advisory and supervisory assistance to approximately
100 child-hygiene nurses paid by local communities.
.
The following organizations cooperated in the bureau s work: American Red
Cross, State league of women voters, State federation of women s clubs,
State commission for the blind, State tuberculosis league, the parentteacher association, and a fraternal organization. They assisted m caring
for crippled, blind, and tuberculous children. Among the children
examined at health conferences reported in the foregoing paragraphs
were 3,005 examined in the “ Get ready for school campaign sponsored
by the National Congress of Parents and Teachers.
INFANT AND MATERNAL MORTALITY RATES

The general death rate in New Jersey was practically the same in 1928 (H -8)
as in 1921 (11.7). The infant mortality rate, however, was considerably lower
in 1928 than in 1921, as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921

State_____ U rbanRural...
W hite..
Colored

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Federal Reserve Bank of St. Louis

1928

Percentage
of differ
ence

-1 2

74
74

66
63

-11
-1 5

71
139

61
124

-1 4
-1 1

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

If the 1921 infant mortality rate had prevailed in 1928, 9 more infants in
every 1,000 born alive in the State would have died during the first year of life.
The change in conditions resulted in a total saving of 614 infant lives. The
change in the rate is due primarily to the rate from gastrointestinal diseases,
which was 54 per cent lower in 1928 (7.8) than in 1921 (17.1). Gastrointestinal
diseases caused 23 per cent of the total infant deaths in 1921 but only 12 per cent
in 1928.
The maternal mortality rate for the State was the same in 1928 (59) as in 1921,
the urban rate being slightly lower and the rural rate being higher, as the
following figures show:
State.
Urban.
Rural.
W h ite . _
Colored.

1921

1928

68
35

65
44

56
125

57
89

N E W M E X IC O
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public welfare, bureau of public
health) division of child hygiene and public-health nursing, Santa Fe.
Funds expended: Federal, $12,453.17; State, $8,494.08; total, $20,947.25.
Staff:
Director (nurse), 2 nurses (1 part year), 2 statistical clerks (1 part year),
1 bookkeeper (part tim e), 1 birth-registration clerk (part year), 1 stenog
rapher (part time), 1 clerk (part year). Six county nurses were paid in
part from maternity and infancy funds.
Volunteer assistants— 15 physicians, 2 dentists, 14 nurses, 120 lay persons.
Activities:
'W\
*
Child-health conferences conducted by physicians— 11; infants and pre
school children registered and examined— 121.
Defects found in children examined at conferences— 101; children having
defects— 74.
Conferences conducted by nurses, no physician present— 2; infants and pre
school children inspected— 61; visits to conferences by children— 69;
visits by mothers— 56.
New permanent child-health center— 1 established as a result of the division’s
maternity and infancy work. It is supported by local funds.
Classes for girls in care of infants and preschool children—-2 organized;
girls enrolled— 58; number completing course— 50; lessons in course— 8.
Class for midwives— 1 organized; midwives enrolled— 8; number of lessons
in course— 10. The course was not completed until after the close of the
fiscal year under review. M any midwives were instructed in their own
homes.
Home visits by nurses— 2,459 (prenatal cases seen, 320; obstetrical cases,
156; infants and preschool children, 2,068; midwives, 89).
Community demonstrations— 8, of a maternity and infancy public health
nursing program, in 8 counties.
Group demonstrations— 21, of various phases of prenatal, postnatal, and
infant care, at meetings with a total attendance of 424 persons.
Survey— 1, of midwives, in 17 counties.
Campaign— 1, state-wide, to increase the registration of births to the stand
ard required for admission into the United States birth-registration area.
Talks and lectures— 51, to audiences totaling 1,884 persons.
Literature distributed— 2 0 ,49i pieces.
Nutrition work was done through individual instruction to mothers.
Exhibits conducted— 2. Exhibit material was lent five times.
Statistical study made— causes of death, by age groups.
Breast feeding was stressed in instruction given to mothers.
Infants born in the State during the year— 11,265; infants under 1 year of
age and preschool children reached by the work of the division— 13,653;
expectant mothers reached— 907 (report incomplete).

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

A cti vities— C ontinue d.
The division sends literature on infant hygiene to parents of all infants
whose births are registered in the State bureau of vital statistics.
Counties in the State— 31; counties in which maternity and infancy work
was done during the year— 20; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 31.
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. Four ad
ditional counties assumed responsibility for such work at the close of the
year under review.
As a result of the division’s work three county nurses not paid from maternity
and infancy funds included maternity and infancy work in their programs,
and two school nurses conducted conferences for infants and preschool
children.
The division gave supervisory assistance to local nurses doing maternity
and infancy work.
The following organizations cooperated in the division’s work: State bureau
of child welfare, State public-health association, State federation of
women’s clubs.
An outstanding feature of the year’s work was the improved registration of
births and deaths resulting from the campaign conducted by the division.
INFANT AND MATERNAL MORTALITY RATES

New Mexico was not admitted to the United States birth-registration area
until 1929. Figures, therefore, are not available from the United States Bureau
of the Census for infant or maternal mortality rates.
The division of child hygiene and public-health nursing has conducted cam
paigns for more complete registration of births in an effort to attain the standard
required for admission to the United States birth-registration area. The ad
mission of New Mexico to the area was announced by the United States Bureau
of the Census in November, 1929.
N EW YORK
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, division of maternity, infancy,
and child hygiene, Albany.
Funds expended: Federal, $85,274.34; State, $85,468.13; total, $170,742.47.
Staff:
Director (physician, not paid from maternity and infancy funds), 11 physi
cians (5 part time, 4 part year), 33 nurses (6 part year), 1 dental hygienist,
1 nutritionist, 2 supervisors of midwives (nurses), 3 vital-statistics clerks
(2 part year), 1 bookkeeper, 1 advance agent (for health conferences), 3
stenographers, 5 clerks (3 part year), 1 motion-picture operator, 2 punching-machine operators (part year), 1 chauffeur. Three county nurses
were paid from maternity and infancy funds. Two hundred and twentyone physicians throughout the State were paid for occasional service.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
1,095; expectant mothers registered— 2,471; number examined— 2,330;
infants and preschool children registered and examined— 2,978; visits to
conferences by expectant mothers— 10,204; visits by children— 3,378.
Child-health conferences conducted by physicians— 824; infants and pre
school children examined— 11,293; visits to conferences— 12,640. Defects
found in children examined at conferences— 14,799; children having de
fects— 5,826.
Prenatal conferences conducted by physicians— 396; expectant mothers
registered and examined— 933; visits to conferences— 3,012; total number
of examinations made— 2,922.
Conferences conducted by nurses, no physician present— 491; visits to con
ferences by infants and preschool children— 3,100; visits by mothers— 1,413.
Preschool children receiving dental examination by the dental hygienist—
3,055,

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
New permanent combined prenatal and child-health centers— 22 established
as a result of the division’s maternity and infancy work. They are sup
ported by local funds.
New permanent child-health centers— 11 established as a result of the
division’s maternity and infancy work. They are supported by local
funds.
New permanent prenatal centers— 3 established as a result of the division’s
maternity and infancy work. They are supported by local funds.
Classes for mothers— 83 organized (78 by staff nurses, 5 by local nurses);
mothers completing the course and receiving certificates— 1,171. “ Fam
ily-health conferences” were conducted for 79 groups of 10 to 30 women,
to whom 6 to 8 lessons and demonstrations were given. The number of
women receiving certificates after having attended at least 4 out of 6 classes
and having passed a written examination was 1,142.
The inspection and supervision of midwives was continued as in previous
years. Monthly questionnaires were sent to the midwives for report of
their work. The reports showed that 290 midwives attended 5,126 de
liveries (exclusive of those in New York City) during the calendar year 1928.
Only 2 cases of puerperal septicemia among the mothers delivered by mid
wives were reported. A few reports had not been completed at the close
of the year.
Hom e visits by nurses— 51,052. The 28,271 visits classified as to type were
as follows: Visits to mothers, 8,415; to infants, 11,111; to preschool children,
8,745.
Maternity homes inspected— 108; inspections made— 119.
Boarding homes for infants and preschool children inspected— 454; inspec
tions made— 516.
Community demonstrations— 13 (some continued from the previous year),
of maternity and infancy public-health nursing, prenatal nursing, and
breast feeding; 3 were county-wide and 10 covered communities. Staff
nurses were assigned to the 10 communities to organize complete maternity
and infancy programs, to establish mother and child health centers,
mothers’ health clubs, classes for girls, conferences to be conducted by
nurses, and conferences to be conducted by physicians. In one community
a teaching center for the instruction of staff and community maternity and
infancy nurses was combined with the demonstration program.
Group demonstrations— many, at talks to nurses and to lay groups, at classes,
and in visits to maternity homes and midwives.
All the nurses on the division’s staff assisted in a state-wide campaign con
ducted by the State department of health to have preschool children
immunized against diphtheria.
Talks and lectures— 299.
Literature prepared— Baby Travel Kitchenette, Problem for Parents, nutri
tion literature (revised). A Handbook of Standard Methods in Maternity
and Infancy Work, which was completed and issued, provides ready refer
ence for those who are initiating or desirous of improving local childhygiene work. Copies were sent to all local nurses, teaching institutions,
directors of State child-hygiene divisions, and other interested persons.
The requests for copies were so numerous that they could not all be com
plied with. One university adopted the book as a reference for a course
in child hygiene.
Literature distributed— 760,114 pieces.
Graduate courses in maternity and infant hygiene to prepare nurses to teach
mothers’ health clubs were conducted in six communities, and 34 nurses
were granted certificates after an examination.
Nutrition work was done through group and individual instruction. Seventyone lectures were given to miscellaneous audiences, and 4 to 6 lectures
were given to 49 classes organized among home bureaus and other organiza
tions.
Exhibits conducted— many. Exhibit material prepared— layettes, posters,
panels, and “ messages” to be used in motion-picture theaters. Exhibit
material was lent 88 times.
Article prepared— Health Supervision of the Preschool Child in Small Towns
and Rural Areas.
Statistical study made— puerperal deaths (continued from the previous
year).

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued. ,
, I ,
x ..
,
Breast feeding was stressed in the programs of all demonstration nurses and
also was promoted by the special breast-feeding demonstration in one
community.
.
Infants born in the State during the year— 216,594; infants and preschool
children reached by the work of the division (exclusive of those reached
by literature distributed)— approximately 33,000; expectant mothers
reached (exclusive of those reached by literature distributed)— approxi
mately 12,500.
1 ''. * 5 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 7 counties have assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds, and 54 additional
communities assumed such responsibility before the close of the year
under review or at its close.
The staff nurses gave advisory and supervisory assistance to local nurses as
well as to the division’s nurses detailed to local communities for various
types of maternity and infancy work. They standardized teaching and
demonstration material, records, methods, and activities, conducted courses
for nurses, assisted in planning community programs, and helped to arrange
and initiate various maternity and infancy activities.
A s a result of the division’s work much maternity and infancy work was done
by local organizations and persons not paid from maternity and infancy
funds, including programs for the observance of M ay D ay as Child Health
D ay, health conferences, classes for mothers, demonstrations at county
fairs, and the furnishing of sterilized obstetrical packages, clinic gowns,
layettes, and other supplies for use at health conferences.
The following organizations cooperated in the division s work: State commission for the blind, State Charities Aid Association, State league of
women voters, State federation of women’s clubs, State farm bureau,
American Legion, Catholic Daughters of America, Home Bureau, several
fraternal organizations, and the parent-teacher association. The assist
ance given included prompt treatment and nursing care for babies with
sore eyes, help in organizing local work, provision and preparation of
rooms for health conferences, transportation of persons attending con
ferences, assistance at conferences, preparation of supplies when the
responsibility for conferences was assumed by local communities, and some
financial aid. Among the children examined at health conferences re
ported in the foregoing paragraphs were 240 examined m the C et ready
for school” campaign sponsored by the National Congress of Parents and
Teachers.
The outstanding feature of the year’s work was the securing of a State appro
priation sufficient to carry on the maternity and infancy program after the expira
tion of the Federal maternity and infancy act, June 30, 1929.
INFANT AND MATERNAL MORTALITY RATES

New York did not begin cooperation with the Federal Government under the
maternity and infancy act until 1923.
.
.
. 0 1S ,,
The general death rate for the State was 7 per cent higher m 1928 (13.1) than
in 1921 (12.3). The infant mortality rate, however, was definitely lower m i y /8
than in 1921, as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921

State______
Urban. .
Rural
W h ite Colored

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Federal Reserve Bank of St. Louis

1928

Percentage
of
difference

-1 3

76
74

66
62

-1 3
-1 6

74
138

63
123

-1 5
-1 1

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

This lower rate in the State meant saving 2,220 infant lives; that is, if the
1921 rate had prevailed in 1928, there would have; been 16,732 infant deaths in
stead of 14,512. In both urban and rural areas and among both white and colored
infants the rate was lower in 1928 than in 1921.
The infant mortality rate from gastrointestinal diseases showed a greater per
centage of decrease during the period 1921 to 1928 than the rate from any other
cause of death. The 1928 rate (7.2) was 53 per cent lower than the 1921 rate
(15.2). The rate for 1927 (6.4) was the lowest during the period. Deaths from
natal and prenatal causes, though not showing the same decreases as those from
gastrointestinal diseases, showed a downward trend, the rate being 9 per cent
lower in 1928 (34.3) than in 1921 (37.7). The rate from respiratory diseases,
though showing some fluctuation during this period, was higher in 1928 (13.3)
than in 1921 (11.1).
The maternal mortality rate was lower in 1928 than in 1921 in the State and in
urban and rural areas. The rates for white and colored mothers were also
lower in 1928 than in 1921, although there was considerable fluctuation during
the period among the rates for the colored group. The rates for the two years
were as follows:
1921

State_______

1928

U rb an..
„ Rural __

65
53

62
46

W h ite ..
Colored

61
139

57
102

The maternal mortality rate from puerperal albuminuria and convulsions has
shown a steadily downward trend from 1921 to 1928, being 22 per cent lower in
1928 (10.8) than in 1921 (13.8). The rate from puerperal septicemia, although
fluctuating during this period, also was lower in 1928 (21.2) than in 1921 (24.8).
N O R T H CARO LIN A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of maternity and infancy,
Raleigh.
Funds expended: Federal, $37,234.52; State, $29,288.16; total, $66,522.68.
Staff:
.
Director (physician), 5 nurses, 1 stenographer, 2 clerks (1 part year).
Twenty-two county nurses were paid in part from maternity and infancy
funds.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
3,436; expectant mothers registered and examined— 675; infants and pre
school children registered and examined— 15,323; visits to conferences by
expectant mothers— 1,474; visits by children— 20,586.
Defects found in children examined at conferences— 6,083; children having
defects— 4,613. Parents had defects corrected in 3,030 of the children.
Conferences conducted by nurses, no physician present— m any; infants and
preschool children inspected— 4,609; mothers instructed in prenatal care—
474; visits to conferences by children— 7,580; visits by mothers— 663.
New permanent combined prenatal and child-health center— 1 established
as a result of the bureau’s maternity and infancy work. It is supported
by State and county funds.
Classes for midwives— 7 organized; midwives enrolled— 212; number com
pleting course— 158; lessons in course— 6.
Home visits by nurses— 49,671 (prenatal cases seen, 3,378; obstetrical cases,
2,793; postnatal cases, 5,375; infants, 8,028; preschool children, 6,187).
Literature distributed— 315,856 pieces.
New names registered for prenatal letters— 9,671; prenatal letters distrib
uted— 9,671 sets.
Breast feeding was stressed in the instruction given to mothers at Confer

ences and in home visits, also in the literature on breast feeding and the
postnatal letters distributed.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities— Continued.
Infants born in the State during the calendar year 1928— 80,887; infants
under 1 year of age reached by the work of the bureau during the fiscal
year ended June 30, 1929— 46,726; preschool children reached— 38,913;
expectant mothers reached— 30,048.
The bureau sends a postnatal letter and card for use in requesting literature
on infant hygiene to parents of all infants whose births are registered in
the State bureau of vital statistics.
Counties in the State— 100; 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— 62.
The State boards of education and of welfare and the parent-teacher asso
ciation cooperated in the bureau’s work. They assisted with the childhealth conferences and with the educational work among the midwives.
Among the children examined at health conferences reported in the fore
going paragraphs were 7,053 examined in the “ Get ready for school”
campaign sponsored by the National Congress of Parents and Teachers.
The outstanding feature of the year’s work was the number of health confer
ences conducted in which infants and preschool children were given physical
examinations by physicians or were inspected by nurses.
INFANT AND MATERNAL MORTALITY_RATES

The general death rate for North Carolina was 9 per cent higher in 1928 (12.3)
than in 1921 (11.3). The infant mortality rate in 1928 also was higher (15 per
cent) than in 1921; in both urban and rural areas of the State and for both white
and colored infants the rates were higher. The infant mortality rates were as
follows:
1921

1928

State______________________________________________________

Urban_________________
Rural__________________________________________

97
72

110
81

W h it e -_____________________ : ________________________
Colored______________________________________________

66
95

75
109

The maternal mortality rates likewise were higher in 1928 than in 1921, with
the exception of the rate in rural areas, which was slightly lower, as the following
figures show:
1921

1928

State_______

U rbanRural. .

120
68

145
67

W h ite -.
Colored

61
102

67
105

NORTH DAKOTA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public health, division of child
hygiene and public-health nursing, Bismarck.
Funds expended: Federal, $11,500; State, $1,500; total, $13,000.
Staff:
Director (physician), 1 physician (part year), 1 nurse, 2 stenographers (1
part year).
Activities:
Combined prenatal and child-health conferences conducted by physicians—
246; expectant mothers registered and examined— 61; infants and pre
school children registered and examined— 7,226.
Defects found in children examined at conferences— 8,704; children having
defects— 5,631.
Maternity homes and hospitals inspected— 42; inspections made— 42.
Infant home inspected— 1; inspection made— 1.

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THE W E LFA R E AND H YG IE N E OF M ATERN ITY AND INFANCY

A cti vities— Continued.
Surveys— 4 : (1) Of maternal mortality, in cooperation with the United
States Children’s Bureau and with the indorsement of the State medical
society. (2) Of hospitals, state-wide.
(3) Of mid wives, state-wide. (4)
Of birth registration, in 4 counties.
Campaign— 1, in 4 counties, for more complete registration of births.
Talks and lectures— 23.
Literature distributed— 27,828 pieces.
Infants born in the State during the calendar year 1928— 14,185,; infants
under 1 year of age reached by the work of the division during the fiscal
year ended June 30, 1929— 1,479 (exclusive of those reached by literature
distributed); preschool children reached— 5,747 (exclusive of those reached
by literature distributed).
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 a
pamphlet on prenatal care were mailed also to all persons whose marriage
was recorded in the State bureau of vital statistics during the year.
Counties in the State— 53; counties in which maternity and infancy work
was done during the year— 34; counties in which maternity and infancy
work has been done since the acceptance of the maternitv and infancv
act— 4 7 . . . .
'
The following organizations cooperated in the division’s work: American
Red Cross, State federation of women’s clubs, State tuberculosis associa
tion, American Legion auxiliary, the parent-teacher association, and home
makers’ clubs. They assisted in organizing and in conducting confer
ences. Among the children examined at health conferences reported in
the foregoing paragraphs were 1,053 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 contacts made
with 5,240 mothers, the examination of 7,226 preschool children at conferences,
and the distribution of literature relating to maternal, infant, and child care and
hygiene.
INFANT AND MATERNAL MORTALITY RATES

North Dakota was not admitted to the United States birth-registration area
until 1924. Mortality rates of earlier years therefore are not available for com
parison with those of 1928.
The general death rate and the infant mortality rate in 1928 were lower for the
State (8.6 and 59, respectively) than for the birth-registration area (12 and 69).
The infant mortality rate for the State as a whole was also lower in 1928 (59)
than in 1924 (67), as were the rates for both urban and rural areas. The rate for
urban areas was 68 in 1924 and 50 in 1928; that for rural areas was 67 in 1924
and 61 in 1928. The State rate and the rural rate in 1928 were the lowest that
occurred during the period 1924 to 1928. The lowest urban rate of the period
(47) occurred in 1927.
The maternal mortality rate in 1928 was lower for the State (57) than for the
birth-registration area (69). The rate for the State was the same as in 1924.
For rural areas it was slightly higher in 1928 (58) than in 1924 (51), but for urban
areas it was lower in 1928 (54) than in 1924 (100). In connection with this very
large apparent decrease in the urban rate it must be remembered that as North
Dakota is largely rural, the number of births in urban areas is small, so that a
very small variation in the actual number of deaths m ay affect the rate materially.
O H IO
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, division of child hygiene,
Columbus.
Funds expended: Federal, $26,581.70; State, $18,585.57; total, $45,167.27.
Staff: Director (physician, director of another division of the State department of
health serving), 1 physician, 6 nurses (1 part time, 5 part year), 2 assistants
m health education, 1 lecturer, 1 statistician, 1 chief of publicity (part year,
part time), 1 financial clerk (part year, part time), 1 clerk. Six county nurses
were paid in part from»maternity and infancy funds.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

Activities:
Child-health conferences conducted by physicians— 92; infants and pre
school children registered and examined— 4,343. The examination
' of preschool children and correction of their defects before the children
enter school has developed into an integral part of the work of most local
health departments. The plan of the division is to stimulate the exam
ination of all preschool children by their own family physicians.
Defects found in children examined at conferences— 16,463; children having
defects— 4,240.
Conferences conducted by nurses, no physician present— 26 ; infants and
preschool children inspected— 185.
Home visits by nurses— 6,364 (prenatal cases seen, 291; infants, 1,757; pre
school children, 1,487).
Maternity homes and hospitals inspected— 183; inspections made— 183.
Group demonstrations— 2, of the method of conducting health conferences
for preschool children.
Talks and lectures— 1,052.
Literature distributed— 242,000 pieces.
Nutrition work was done through the instruction given to mothers at con
ferences and in home visits.
Exhibits conducted— 19, at the State and county fairs and at an industrial
exposition. Exhibit material prepared— films and posters. Exhibit
material was lent four times.
Breast feeding was stressed in the instruction given to mothers in home visits.
Infants born in the State during the.year— approximately 112,000.
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 such literature with the birth cer
tificates upon receipt of the birth notice.
Counties in the State— 88; counties in which maternity and infancy work was
done during the year— 37; counties in which maternity and infancy work
has been done since the acceptance of the maternity and infancy act— 82.
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.
Three additional counties were ready to assume such responsibility at
the close of the year under review.
The division rendered advisory and supervisory service to local organiza
tions doing child-health work.
The following organizations cooperated in the division’s work: American
Red Cross, State public-health association, State federation of women’s
clubs, business and fraternal clubs, and the parent-teacher association.
They gave financial assistance and stimulated interest in conferences for
preschool children. All the children examined at health conferences
reported in the foregoing paragraphs 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 was the active participa
tion of local boards of health in the child-hygiene program. According to annual
reports from local health departments 23 per cent of the nursing service in rural
communities and 51 per cent in cities was in connection with child hygiene
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Ohio was 4 per cent higher in 1928 (11.7) than in
1921 (11.3). The infant mortality rates, however, were considerably lower in
1928 than in 1921, as the following table shows:

Area

Deaths of infants under 1
year of age per 1,000 live
births
1921

State— ______________________________

White____________________________________________________________

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75
76
73
73
122

1928
66
70
61
64
113

Percentage
of difference
-1 2
-8
-1 6
-1 2
—7

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The lower State rate in 1928 means saving 1,078 infant lives; that is, if the 1921
rate had prevailed in 1928 there would have been 9,031 deaths of infants under 1
year of age instead of 7,953. The greatest difference in the infant mortality rates
was in the rate from gastrointestinal diseases, which was 54 per cent lower in
1928 (7) than in 1921 (15.2). The lowest rate from this group of diseases during
the period 1921 to 1928 occurred in 1927, when it was 6.6.
The maternal mortality rate for the State in 1928 was considerably lower than
in 1921, as the following figures show:
1921

1928

State_______

' 72

Urban
R u ra l..

85
55

77
45

W h i t e ..
Colored.

71
116

62
106

The lower State rate in 1928 means a saving of 8 mothers for every 10,000 live
births. If the 1921 rate had prevailed in 1928, the number of mothers dying
from puerperal causes would have been 869 instead of 772.
OKLAHOM A
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public health, bureau of maternity
and infancy, Oklahoma City.
Funds expended: Federal, $29,487.29; State, $18,679.48; total, $48,166.77.
Staff:
Director (physician, 10% months), acting director (nurse, 1% months),
2 physicians (part year), 5 nurses, 1 stenographer, 3 clerks. Four county
nurses were paid in part from maternity and infancy funds. Additional
professional and clerical assistants were employed as needed.
Volunteer assistants— 34 physicians, 6 dentists, 461 lay persons.
Activities:
Child-health conferences conducted by physicians— 144; infants and preschool children registered and examined— 4,978.
Defects found in children examined at conferences— 19,344; children having
defects— 4,587. Only 1,766 children were followed up to see if defects had
been corrected. Parents had had defects corrected in 289 of these children.
Dental conferences— 6; preschool children receiving dental examination—
496.
Classes for girls in care of infants and preschool children— 7 organized;
girls enrolled and completing course— 102; lessons in course— 17.
Classes for student nurses in care of mothers and children— 2 organized at
2 hospitals; nurses enrolled and completing course— 51; lessons in course—

20.

Home visits by nurses— 2,296 (prenatal cases seen, 153; obstetrical cases,
3; postnatal cases, 84; infants, 637; preschool children, 2,442).
Community demonstrations— 3, of saving babies from summer diarrhea
through a program of child-health conferences, preschool surveys, and
intensive follow-up work. The purpose was to reduce the high death
rate due to insanitary conditions and other causes in one county and to
show in another how best to use a county nurse as the sole health worker
in addition to the part-time county health officer. The demonstration
in one county continued 11 months, in each of the other counties 6 months.
Group demonstrations— 74, on the need for physical examination, hygiene
of pregnancy, preparation for home confinement, care of infants, oral
hygiene, and other phases of maternal, infant, and child care, to groups
of farm women, city clubs, and other groups, totaling 2,613 persons.
Surveys— 3: (1) Of maternal mortality, state-wide, in cooperation with the
United States Children’s Bureau and with the indorsement of the State
medical association.
(2) Of hospitals, in 76 counties.
(3) Of midwives,
in one county.
Campaigns— 2 : (1> For pure milk supply, in two counties.
(2) For pure water
supply, in two counties.
Talks and lectures— 323, to audiences totaling 18,214 persons.
Literature prepared— Outlines in Child Care (used in the Indian boarding
schools), report of the bureau’s work, 1924 to 1928,

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Federal Reserve Bank of St. Louis

PRINCIPAL AC TIVITIES OF IN D IVID U AL STATES, 19 29

Activities— Continued.
Literature distributed— 352,503 pieces.
New names registered for prenatal letters— 6,697; prenatal letters distrib
uted— 10,035 sets.
Nutrition work was done through the demonstrations made, the talks given
by members of the bureau’s staff, and the literature distributed.
Exhibits conducted— 82, at State and county fairs and at various meetings.
Exhibit material was lent 20 times.
Article prepared— Does It Pay to Neglect the Mothers?
Statistical studies made— age groups of life hazards under 6 years of age,
causes of death of 4,308 of the 5,116 children who died under 6 years of
age in 1927, children with physical defects who repeated their grade in
' school, comparative study of public-health funds, the 11 chief causes of
death in Oklahoma in 1927.
Breast feeding was stressed in the literature distributed, in talks given, and
in the demonstrations made. It was estimated that approximately 85
per cent of the infants in.the State are breast fed.
Infants born in the State during the year— 47,055; infants under 1 year of
age reached by the work of the bureau— 11,825; preschool children
reached— 9,217; expectant mothers reached— 9,798.
Counties in the State— 77; counties in which maternity and infancy work
was done during the year— 76; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 77.
The baby rodeo, a child-health conference organized at a large ranch in
Ponca City, was held during four days in M ay, 1929. Children of pre
school age were eligible for examination, the limit of enrollment being 400.
Specialists from Oklahoma and other States made the examinations and
held consultations. M any of the children who had also been present at
previous rodeos had improved markedly in physical condition. A larger
number of children were found to be without physical defects in 1929 than
in the previous years. A special clinic for crippled children was held
under the auspices of the Oklahoma Society for Crippled Children during
one of the four days.
A training course for nurses was held in connection with the conferences of
the baby rodeo. Senior students as well as graduate nurses were permitted
to make the rounds of the conference rooms, working under the super
vision of the nurse in charge of each department in order to learn the
method of history taking, weighing, and measuring, and to observe the
various types of examination. Forty-six nurses were present on one or
more days of the conferences.
The following organizations cooperated in the bureau’s work: State agri
cultural and mechanical college (rural-extension division), State league
of women voters, State federation of women’s clubs, and the parentteacher association. Am ong the children examined at health conferences
reported in the foregoing paragraphs were 553 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 maternal mortality
study, the child-health conferences in rural areas, and the work accomplished
in connection with the baby rodeo.
INFANT AND MATERNAL MORTALITY RATES

Oklahoma was not admitted to the United States birth-registration area until
1928. Mortality rates of earlier years, therefore, are not available for comparison.
The general death rate for the State in 1928 (8.6) was 28 per cent lower than
the rate for the birth-registration area (12), but the infant mortality rate (69) was
the same as that for the area. This high rate is due largely to the rate for colored
infants (131), the rate for white infants being 65. The colored group includes
Negroes and Indians. The rates for both races were high, that for Negro infants
being 127 and that for Indian infants being 140. The rate for urban areas of the
State was 78; for rural areas it was 67.
The maternal mortality rate for the State in 1928 (71) was higher than that
for the birth-registration area (69). This rate also was influenced by the rate
for colored mothers (194), the rate for white mothers being 64. For urban areasthe rate was 118; for rural areas it was 60.
9412°— 31----- 7

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
OREGON
STAFF AND ACTIVITIES IN 1929

Administrative agency; State board of health, bureau of child hygiene, Portland.
Funds expended: Federal, $13,915.12; State, $4,327.73; total, $18,242.85.
Director (State health officer serving), 1 physician (part year, part tune),
1 prenatal supervisor (nurse), 2 nurses (part year), 2 stenographers (part
year). Other clerical and stenographic assistants were employed as
needed. Fifteen county nurses in six counties were paid in part from
maternity and infancy funds.
Volunteer assistants— 55 physicians, 30 dentists, 5 nurses.
Activities:
, ;
,
. .
. .
,
,
Child-health conferences conducted by physicians— 208; infants and pre
school children registered— 2,315; number examined— 2,220; visits to
conferences— 2,810.
....
,
.
Defects found in children examined at conferences— 2,710; children having
defects— 1,478. Parents had defects corrected in 216 of the children.
Prenatal conferences conducted by physicians— 209; expectant mothers
registered and examined— 928; visits to conferences— 1,654.
Conferences conducted by nurses, no physician present— 21; infants and
preschool children inspected— 69.
.
Dental conferences— 4 1 ; expectant mothers receiving dental examination—
3 ; preschool children receiving dental examination— 1,523.
.
New permanent child-health centers— 9 established as a result of the bureau s
maternity and infancy work. They are supported by local funds.
Classes for girls in care of infants and preschool children— 20 organized;
girls enrolled— 304; number completing course 257; lessons in course10. A series of classes for boys in personal hygiene and care of infants
was held in one county.
„ ,
'
...
Classes for mothers— 7 organized; mothers enrolled— 88; number completing
course— 80; lessons in course— 12.
. . . .
,
Home visits by nurses— 5,030 (prenatal cases seen, 690; obstetrical cases,
146; postnatal cases, 421; infants and preschool children, 2,336).
Group demonstrations— 261, on various phases of maternal and infant care.
Surveys— 2: (1) Of tuberculosis among preschool children, in one county.
(2) Dental survey of preschool children, in two counties.
,
The bureau continued its cooperation with the United States Children s
Bureau in a study of maternal mortality. (See pp. 117, 123).
Campaigns— 3: (1) For immunization against diphtheria, in five- counties.
(2) For correction of dental defects, in two counties. (3) For observance
of M ay D ay as Child Health D ay, state-wide.
Talks and lectures— 248 (report incomplete).
Literature distributed— approximately 50,000 pieces.
,
New names registered forprenatal letters 1,200} prenatal letters distributed— 1,197 sets.
' .u
.
,,
,
Nutrition work was done through individual instruction to mothers at con
ferences and in home visits and through talks given to groups.
Exhibits conducted— 52. Exhibit material was lent 50 times. All the
nurses were supplied with exhibit material consisting of posters and
• clothing and other articles for the baby.
Articles prepared— several press releases on child hygiene.
Breast feeding was stressed in all talks, classes, and conferences and in the
literature distributed. It was estimated that 85 per cent of the infants
in the State are breast fed.
Infants under 1 year of age reached by the work of the bureau approxi
mately 10,000 (including those reached by letters accompanying notifica
tion of registration of birth) , preschool children reached approximately
2,500; expectant mothers reached— approximately 3,000.
,
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 in the care of young children.
Counties in the State— 36; 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— 36.
Since the beginning of the State’s cooperation under the maternity and in
fancy act one county has assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF IN D IVID U AL STATES, 19 29

Activities— Continued.
Arrangements were made whereby the special instruction in prenatal care
begun with maternity and infancy funds by the University of Oregon
medical school and the Portland Free Dispensary will be continued by the
university.
A s a result of the bureau’s work, interest in child hygiene has increased
throughout the State. M any health conferences, classes, demonstrations,
and campaigns were conducted under local auspices.
The bureau rendered advisory and supervisory service to local agencies doing
child-health work.
The following organizations cooperated in the bureau’s work: State depart
ment of education, State university and agricultural college (extension
services), American Red Cross, State medical, dental, and tuberculosis
associations, State organization for public-health nurses, State federation
of women’s clubs, and the parent-teacher association. Among the children
examined at health conferences reported in the foregoing paragraphs were
207 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 efforts to have local
organizations assume the responsibility for work begun with maternity and in
fancy funds.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Oregon was 12 per cent higher in 1928 (11.6) than in
1921 (10.4). The infant mortality rate, however, was 8 per cent lower in 1928
(47) than in 1921 (51). The 1928 rate was the lowest recorded for the State and
lower than that for any other State in the birth-registration area. Both urban
and rural areas had lower rates in 1928 than in 1921, the rate for urban areas
being 50 in 1921 and 44 in 1928, and the rate for rural areas being 52 in 1921 and
49 in 1928.
The maternal mortality rate for the State was lower in 1928 (61) than in 1921 (74),
as were the rates for urban and rural areas. In urban areas the rates were 63 in
1928 and 73 in 1921 and in rural areas 60 in 1928 and 75 in 1921.

PENNSYLVANIA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of child health, pre
school division, Harrisburg.
Funds expended: Federal, $80,404.80; State, $63,810.99; total, $144,215.79.
Staff:
Director (physician), 4 physicians (part year), 4 dental hygienists (part
year), 2 supervisors of midwives (physicians), 3 field workers, 14 vitalstatistics clerks, 3 stenographers (part year), 6 clerks (3 part year).
Three community nurses and approximately 135 nurses in the publichealth nursing division of the State department of health were paid in
part from maternity and infancy funds.
Volunteer assistants— many physicians, nurses, and lay persons.
Activities:
Child-health conferences conducted by physicians— 5,322 (5,198 at childhealth centers, 124 on the health cars); infants and preschool children
registered and examined— 16,706 (9,854 at health centers, 6,852 on the
health cars); visits to conferences— 76,153 (69,301 to health centers, 6,852
to the health cars).
Correction was secured for 14,230 defects found in children examined at
health centers.
Prenatal conferences conducted by physicians— 300; expectant mothers
registered and examined— 364; visits to conferences— 1,556.
The division gave advisory service and furnished literature and record blanks
to child-health centers and prenatal centers supported by other agencies,
at which physicians conducted 9,607 child-health conferences (examining
24,445 infants and preschool children) and 4,109 prenatal conferences (at
which 13,997 expectant mother!? were registered). Infants and preschool
children made 213,993 visits to these conferences, and expectant mothers
made 66,143 visits.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
,
.
New permanent child-health centers— 17 established as a result of the division’s maternity and infancy work. The nursing service of 2 of these cen
ters is supported by State funds, that of 15 by funds from other agencies.
New permanent prenatal center— 1 established.
Instruction and supervision of midwives in 10 counties in the coal region of
the State were continued as in previous years; 507 midwives who attended
5,989 deliveries in 1928 were under supervision; 10 maternal deaths
occurred among the women attended by them (a maternal mortality rate
of less than 2 per 1,000 deliveries). All deaths from causes associated
with childbirth reported for mothers whom a midwife had attended at any
time during the labor were counted as deaths in the midwife’s practice
even though a physician was called later and signed the death certificate.
Two institutes for midwives were held.
Hom e visits by nurses— 47,223 (prenatal cases seen, 944; postnatal cases,
10,255; infants, 9,343; preschool children, 5,357).
.
Community demonstrations— 13, of a maternity and infancy public health
nursing program.
.
Campaign— 1, for observance of M ay D ay as Child Health D ay, state-wide.
Members of the division’s staff helped plan and organize local celebrations,
emphasis being placed on health conferences for preschool children. A
total of 454 conferences were held; and 16,059 children were examined at
354 of these conferences.
Talks and lectures— 74.
i
Literature prepared (revisions)— Health-Center Technique, Baby Book, diet
cards.
Literature distributed— 433,575 pieces.
.
Exhibit conducted— 1, at a farm show, of the health car (a
motorized
health center” ). Educational films were shown 51 times.
Articles prepared— Infant Mortality in Pennsylvania; Health-Car W ork m
Pennsylvania; The Preschool Child; Before Birth.
»
Statistical studies made— findings in physical examinations made on the
health car; midwife work for 1928 and half of 1929; comparative statistics
in midwifery, July 1, 1922, to June 30, 1929; sepsis and maternal deaths
in the practice of midwives, 1923 to 1928, inclusive.
Infants born in the State during the calendar year 1928— 200,786; infants
under 1 year of age reached by the work of the division during the fiscal
year under review (exclusive of those reached by literature distributed)
23,005; preschool children reached (exclusive of those reached by litera
ture distributed)— 24,460; expectant mothers reached (exclusive of those
reached by literature distributed)— 1,308.
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— 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 seven communities have assumed the responsibility for
maternity and infancy work begun with maternity and infancy funds.
One county made arrangements to assume such responsibility at the close
of the year under review.
The following organizations cooperated in the division’s work: State depart
ments of public instruction and of public welfare, American Red Cross,
State league of women voters, State federation of women’s clubs, State
tuberculosis ■association, and the parent-teacher association. They
assisted with the M ay D ay campaign, provided opportunities for members
of the division’s staff to speak at conventions and institutes, conferred
with the director of the division concerning plans of work, and lent support
to the standards for maternity and infancy work set by the division.
Among the outstanding features of the year’s work were the results of a cam
paign for the observance of M ay D ay as Child Health D ay, the holding of success
ful institutes for midwives, the success of the health-car work, and the increase
in the distribution of the division’s -booklet, Manual for Expectant Mothers.
INFANT AND MATERNAl! MORTALITY RATES

The general death rate for Pennsylvania was 12.1 in the year 1928 and 12.4
in 1921. The infant mortality rate for the State was definitely lower in 1928
(72) than in 1921 (88). The lowest rate recorded in the State was 69 in 1927.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF IN D IVID U AL STATES,

1929

The rates for both urban and rural areas and for white and colored infants were
significantly lower in 1928 than in 1921, as the following table shows:
Deaths of infants under 1
year of age per 1,000 live
births
Area
1921
State________ _____________ _______ _•__________________
Urban_________ ______ ________ _______ ________________
Rural________ ___________ _____________________ ,.
White......................................................................
Colored__________________________ ___________________

1928

Percentage
of difference

—18

86
89

74
70

—14
—21

86
134

70
116

—19
-1 3

If the 1921 rate had prevailed in 1928, there would have been 16 more infant
deaths for every 1,000 live births; in other words, 3,201 infants survived in 1928
who would have died under conditions existing in 1921.
The infant mortality rate from gastrointestinal diseases has shown a definite
downward trend through the period 1921 to 1928. This rate was 56 per cent
lower in 1928 (9.4) than in 1921 (21.5). The rates from natal and prenatal
causes were also definitely downward, although the difference between the 1928
and the 1921 rate is not so great as in the case of gastrointestinal diseases. The
rate from natal and prenatal causes was 10 per cent lower in 1928 (34.7) than in
1921 (38.6).
The maternal mortality rate was also definitely lower in 1928 than in 1921,
this difference being especially notable in the rural areas of the State, as the fol
lowing table shows:

Area

Deaths of mothers from
causes associated with
pregnancy and childbirth
per 10,000 live births
1921

1928

Percentage
of difference

S tate.........

-1 0

Urban..
R u r a l-

84
52

79
43

-6
-1 7

White. .
Colored.

67
98

60
84

-1 0
-rl4

The 1928 maternal death rate was the lowest since the State has been in the
birth-registration area. For every 10,000 live births in 1928, 7 mothers survived
who would have died if the 1921 rate had prevailed— a total saving of 147
mothers. In the rural areas of the State 92 mothers survived who would have
died if 1921 conditions had prevailed.
The greatest difference in the maternal mortality rates was in the rate from
puerperal albuminuria and convulsions, which was 22 per cent lower in 1928
(13.5) than in 1921 (17.4). The rate from puerperal septicemia was also lower
in 1928 (23.7) than in 1921 (29.1) by 19 per cent, but it showed more fluctuation
during the period than the rate from puerperal albuminuria and convulsions.
The State child-hygiene program was well under way at the time of the passage
of the Federal maternity and infancy act, a bureau of child health having been
established in the State department of health in 1919. Federal funds made
expansion of the program possible; this has included assisting the development
of child-health centers, conducting itinerant child-health conferences, and giving
close supervision to midwives. The contribution of Federal funds for maternity
and infancy work to the nursing service which covers the State has been an im
portant feature of the program. The effects, of the program are clearly reflected
in the saving of lives of mothers and infants in the later years of the adminis
tration of the maternity and infancy act.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

RHODE ISLAND
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child welfare, Providence
Funds expended: Federal, $19,076.28; State, $9,076.28; total, $28,152.66.
Staff:
Director (physician), 9 nurses (3 part year), 1 field secretary, 1 stenographer.
Nurses from other organizations were paid on a part-time basis to make
home visits to infants and preschool children.
Volunteer assistants— 3 physicians, 1 nurse.
Activities:
Child-health conferences conducted by physicians— 226; infants and pre
school children registered— 728; number examined— 409; visits to con
ferences— 3,682.
Defects found in children examined at conferences— 816; children having
defects— 716. Parents had defects corrected in 381 of the children.
New permanent child-health centers— 2 established as a result of the divi
sion’s maternity and infancy work. They are supported by State funds
and local private funds.
New permanent prenatal center^— 1 established as a result of the division’s
maternity and infancy work. It is supported by local private funds.
There are only 55 midwives in the State, 31 of whom are in Providence
and are supervised by the city board of health. The field secretary made
88 visits to midwives in other parts of the State.
Home visits by nurses— 59,619 (53,281 by staff nurses, 6,338 by the nurses
of other organizations employed to make visits; prenatal cases seen,
1,222; infants, 7,522; preschool children, 14,575).
The division continued its cooperation with the United States Children’s
Bureau in a study of maternal mortality. (See pp. 117, 123).
Campaign— 1 (continued from the previous year), for immunization of
preschool children against diphtheria.
Talks and lectures— 28.
Literature prepared— B aby’s Record (booklet).
Literature distributed— 42,776 pieces.
Nutrition work was done through individual instruction given by the nurses
in home visits.
Exhibits conducted— 2, at the State fair and Better Homes Week. Exhibit
material prepared— model of playground, model of proper food for chil
dren. Exhibit material was lent 5 times.
Breast feeding was stressed in the instruction given to mothers at confer
ences and in home visits.
Infants born in the State during the year— 12,520; infants under 1 year
of age reached by the work of the division— 7,522; preschool children
reached— 18,363; expectant mothers reached— 7,289.
The division supplies literature on infant hygiene to all nursing organizations
in the State, to be distributed locally by their members.
Counties in the State— 5; counties in which maternity and infancy work
was done during the year— 5.
As a result of the division’s work one local community established a childhygiene program, receiving only advisory service, literature, and record
cards from the division.
The State board of education and the parent-teacher association cooperated
in the division’s work. They assisted in maintaining health centers and
in arranging programs for the observance of M ay D ay as Child Health D ay.
Among the outstanding features of the year’s work were the number of home
visits made and the number of preschool children immunized against diphtheria
as a result of the division’s immunization campaign.
INFANT AND MATERNAL MORTALITY RATES

Rhode Island began cooperation with the Federal Government under the
maternity and infancy act in 1925.
The general death rate for the State in 1928 (11.7) was 7 per cent lower than
in 1921 (12.6). The infant mortality rate was 28 per cent lower in 1928 (67) than
in 1921 (93). The rates for both urban and rural areas were lower also; the
rate for urban areas was 68 in 1928 and 94 in 1921, and that for rural areas was
64 in 1928 and 86 in 1921.

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PRINCIPAL ACTIVITIES OF IN D IVID U AL STATES,

1929

The maternal mortality rates were lower in 1928 than in 1921. The rate for
the State was 60 in 1928 and 71 in 1921; for urban areas it was 66 in 1928 and 76
in 1921; for rural areas it was 22 in 1928 and 39 in 1921.
As Rhode Island is predominantly urban, the small number of births in rural
areas m ust be taken into consideration in connection with the maternal mor
tality rates, as the rate may be changed materially by a small increase or
decrease in the actual number of maternal deaths.
The division of child welfare has been able to make regular supervision of the
infants in the State a marked feature of the State child-hygiene work. The
study of maternal mortality begun in 1927 attracted attention to the benefit
of prenatal care.

SOUTH CAROLINA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene and publichealth nursing, Columbia.
Funds expended: Federal, $39,988; State, $16,333.91; total, $56,321.91.
Staff:
■
.
,
Director (nurse), 3 physicians (part time, 2 part year), 12 nurses (7 part
year), 1 dentist (1 month), 1 vital-statistics clerk, 2 stenographers. One
county nurse was paid from maternity and infancy funds for 10 months.
Activities:
,
*
. .
,
Child-health conferences conducted by physicians— 119; infants and pre
school children registered and examined— 2,944.
Defects found in children examined at conferences— 3,672; children having
defects— 2,234.
Prenatal conferences conducted by physicians— 45 ; expectant mothers
registered and examined— 537.
Conferences conducted by nurses, no physician present 2; mothers in
structed in prenatal care— 14.
4
Dental conferences— 25; preschool children receiving dental examination—
New permanent combined prenatal and child-health center— 1 established
as a result of the bureau’s maternity and infancy work. It is supported by
private funds.
.
■
,
New permanent child-health center— 1 established as a result of the bureau s
maternity and infancy work. It is supported by private funds.
New permanent prenatal center— 1 established as a result of the bureau s
maternity and infancy work. It is supported by private funds.
Classes for girls in care, of infants and preschool children— 28 organized;
girls enrolled— 835; number completing course— 734; lessons in course—
13.
Classes for mothers— 42 organized; mothers enrolled (plus those carried over
from the previous year)— 744; number completing course— 556; lessons
in course— 18.
,
. ,
Classes for midwives— 25 organized; midwives enrolled (plus those carried
over from the previous year)— 469; number completing course— 226;
lessons in course— 10. The institute for midwives, which opened in June,
1928, was continued for two months in the fiscal year under review.
Seventy-five midwives completed the course and were given certificates.
Home visits by nurses— 9,114 (prenatal cases seen, 644; postnatal cases,
270; infants, 976; preschool children, 3,891).
4
Community demonstrations— 16, of a maternity and infancy public health
nursing program, in 16 counties.
.
Group demonstrations— 143, usually of method of bathing and dressing the
baby, to the classes for midwives, mothers, and girls and at other group
meetings.
.
A _
Campaigns— 2: (1) For complete registration of births. (2) For immuniza
tion against diphtheria. Both were state-wide.
Talks and lectures— 293.
Literature distributed— 40,436 pieces.
Prenatal letters distributed— 42 sets.
.
Nutrition work was done through the instruction given in the classes lor
mothers and girls.

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Federal Reserve Bank of St. Louis

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Exhibit conducted— 1, at the State fair, of posters and literature. Exhibit
material prepared— posters. Exhibit material was lent 12 times.
Articles prepared— a series of 8 releases on the prevention of diphtheria.
Infants born in the State during the year— 41,820; infants under 1 year
of age reached by the work of the bureau— 29,178; preschool children
reached (exclusive of those reached by literature distributed)— 9,3 46;
expectant mothers reached— 2,615.
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 26 counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
As a result of the bureau’s work county nurses and also nurses employed
by private organizations organized child-health and prenatal conferences,
toxin-antitoxin clinics, and classes for girls, mothers, and midwives.
The director gave advisory assistance to organizations doing child-health
work by serving on their child-health committees. Staff nurses assisted
on request in child-health projects undertaken by local communities.
The following organizations cooperated in the bureau’s work: State Federa
tion of women’s clubs, American Red Cross, State league of women voters,
Council of Farm W om en, and the parent-teacher association. They
assisted in the campaigns and health conferences and in giving publicity
to the bureau’s work.
The outstanding feature of the year’s work was the institute for midwives.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for South Carolina was 10 per cent higher in 1928 (13.1)
than in 1921 (11.9). The infant mortality rate, however, was practically the
same in 1928 as in 1921, though there were decreases in the rates for colored
infants and for infants in urban areas. The rates were as follows:
1921

1928

U rb an. _______________________________________________
Rural--------------

127
92

117
94

W h ite. _______________ ___________________ 1--------- ------Colored-----------------------------------------------------

State.

78
115 123

The maternal mortality rate in 1928 was higher than in 1921, although a
decrease was apparent.in the rate for urban areas, as the following figures show:
1921

State____ _________________________________ ----------------------------

Urban________________________________________________
Rural_______________________________________________

178

W h i t e ..
Colored.

78
118

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Federal Reserve Bank of St. Louis

1928

109
170
88 100

88
129

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

SOUTH DAKOTA
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, division of child hygiene, W aubay.
Funds expended: $7,674.82 (all Federal).

Staff:

Director (nurse), 1 physician (part time, part year), 2 nurses (1 for 1 month,
1 for 3 months).
Activities:
Combined prenatal and child-health conferences conducted by physicians—
90 ; expectant mothers registered and examined— 108; infants and pre
school children registered and examined— 3,102.
Defects found in children examined at conferences— 12,370; children having
defects— 2,863.
Classes for mothers— 9 organized; mothers enrolled and completing course—
106; lessons in course— 7.
Maternity homes inspected— 58; inspections made— 75.
Community demonstration— 1, of maternity work and health work for pre
school children, in one county.
. Survey— 1, of maternity homes and hospitals, state-wide.
Campaign— 1, for observance of M ay D ay as Child Health D ay, state-wide.
Talks and lectures— 26.
Literature distributed— 34,741 pieces.
<
New names registered for prenatal letters— 675; prenatal letters distributed
785 sets. '
,
Nutrition work was done through group and individual instruction and
through literature distributed (including approximately 3,500 copies of a
leaflet, Food for the Growing Child).
Exhibits conducted— 7, consisting of models or posters. Exhibit material
prepared— House of Health, and Food Basket. Exhibit material was lent
10 times.
.
Articles prepared— N o Diphtheria in 1930, M ay D ay, State Fair Boys and
Girls’ Club Clinic.
Statistical study made— births, by attendant at birth; stillbirths; deaths of
infants under 1 month and under 5 years of age, by causes; deaths of
mothers from causes associated with childbirth.
Breast feeding was stressed at conferences and in the literature distributed.
It was estimated that 71 per cent of the infants in the State are breast fed.
Infants born in the State during the year— 15,162; infants under 1 year
of age reached by the work of the division— 14,223; preschool children
reached, 2,377 (report incomplete); expectant mothers reached— 845.
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
population); counties in which maternity and infancy work was done
during the year— 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, local agencies have sponsored health
conferences and other child-health activities.
The division gave advisory and supervisory assistance to public-health
nurses and organizations doing child-health work.
The following organizations cooperated in the division’s work: State college
of agriculture (extension service), State medical and dental associations,
State nurses’ association, State federation of women’s clubs, State league
of women voters, State public-health association, American Legion
auxiliary, the parent-teacher association, colleges, and normal schools.
The assistance given included sponsoring health conferences and helping
with M ay D ay activities.
INFANT AND MATERNAL MORTALITY RATES

South Dakota has not been admitted to the United States birth-registration
area nor to the death-registration area. Figures, therefore, are not available from
the United States Bureau of the Census for comparison of infant or maternal
mortality rates.

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100

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

TENNESSEE
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public health, division of child hy
giene and public-health nursing, Nashville.
Funds expended: Federal, $44,958.09; State, $36,477.97; total, $81,436. 06.
Staff:
Director (physician, part time ), 5 physicians (4 part year), 7 nurses (1 part
time, 5 part year), 1 supervisor of midwives (physician), 3 statistical
clerks (2 months), 1 accountant, 1 stenographer. Forty-three county
nurses in 23 counties were paid in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 593; infants and pre
school children registered and examined-— 5,791.
Defects found in children examined at conferences— 4,310; children having
defects— 3,748. Parents were known to have had defects corrected in
339 of the children (report incomplete).
Prenatal conferences conducted by physicians— 12; expectant mothers
registered and examined— 80; visits to conferences— 360.
Conferences conducted by nurses, no physician present— 276; infants and
preschool children inspected— 749; mothers instructed in prenatal care—
150; visits to conferences by children— 3,591; visits by mothers— 309. ^
New permanent combined prenatal and child-health centers— 2 established
as a result of the division’s maternity and infancy work. They are
supported by local funds.
Classes for girls in care of infants and preschool children— 26 organized;
girls enrolled— 345; number completing course— 315; lessons in course— 10.
Classes for mothers— 5 organized; mothers enrolled (plus those carried over
from the previous year)— 145; lessons in course— 8. Classes were not
completed at the close of the year under review.
Classes for midwives— 3 organized; midwives enrolled (plus those carried over
from the previous year)— 602; number completing course— 142; lessons
in course— 8. In addition, local health departments had 158 midwives
under supervision and conducted 98 class meetings.
Home visits by nurses— 17,147 (prenatal cases seen, 1,252; obstetrical
case, 1; postnatal cases, 1,278; infants, 5,408; preschool children, 7,571).
Group demonstrations— 379, of physical examinations and various phases
of infant care.
Survey— 1, of mid wives, in 4 counties. Assistance was given in a survey
of sanitary conditions and in the relief work done by the State department
of public health following a flood in 12 counties.
Campaign— 1, for immunization of preschool children against diphtheria.
The staff of the division organized the work in 25 counties and immunized
5,892 children under 7 years of age in addition to the several thousand
other preschool children immunized by other divisions of the State depart
ment of health and by local health departments.
Talks and lectures— 1,655.
Literature prepared— Bed W etting; Intestinal Parasites.
Literature distributed— 53,176 pieces.
New names registered for prenatal letters— 809; prenatal letters distributed—
809 sets.
A graduate course in pediatrics for physicians was given as part of a course
for county health officers conducted in cooperation with Vanderbilt
Medical College.
Exhibits conducted— 90, at the State fair, State medical association meeting,
and local meetings. Exhibit material was lent 10 times.
Breast feeding was stressed in instruction given to individual mothers and in
the literature distributed.
Infants born in the State during the year— 48,456; infants and preschool
children reached by the work of the division (exclusive of those reached by
literature distributed)— 19,519; expectant mothers reached— 1,445.
Counties in the State— -95; counties in which maternity and infancy work
was done during the year— 71; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 95.
The division rendered advisory service to local organizations doing maternity
and infancy work.

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Federal Reserve Bank of St. Louis

PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES,

1929

101

Activities— Continued.
•
.
, ,,
.
The State medical society (through its liaison committee) and the parentteacher association cooperated in the division s work. The former indorsed the campaign for immunization of children against diphtheria,
and the latter assisted with child-health conferences. Among the children examined at health conferences reported in the foregoing paragraphs
were 285 examined in the “ Get ready for school’ campaign sponsored
by the National Congress of Parents and Teachers.
An outstanding feature of the year’s work was the campaign for the immuni
zation of preschool children against diphtheria.
INFANT AND MATERNAL MORTALITY RATES

Tennessee was not admitted to the United States birth-registration area
until 1927. Mortality rates of earlier years, therefore, are not available tor com^ T h e ^ e n e ra l death rate2for the State in 1928 (12 6) was slightly higher than that
for the birth-registration area (12). The infant mortality rate for 1928 (81)
was also higher than that for the area (69). The rate for the State was affected
by the high rate for colored infants (121), although the rate for white infants in the
State (73) was also higher than that for the birth-registration area (64). 1 he 1928
rates for urban and rural areas were 98 and 75 respectively.
The maternal mortality rate for the State in 1928 (89) was higher than that for
the birth-registration area (69). As in the^ase of infant mortality, the rate was
influenced by the high rate for colored mothers, which was 153, whereas the rate
for white mothers was 76. The rate for urban areas was 136, and that for rural
areas was 74.
TEXA S
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, bureau of child hygiene,
Funds expended:

Federal,

$41,425.83;

State,

$35,661.77;

total, $77,087.60.

^ D i r e c t o r (physician), 6 nurses (2 part year), 1 inspector of maternity and
infant homes, 1 secretary, 3 vital-statistics clerks (part year, 2 part time),
4 stenographers, 2 clerks (part time, 1 part year). Twenty-seven county
nurses were paid for half-time maternity and infancy work (10 part year).
Volunteer assistants— 732 physicians and dentists, 56 nurses, 390 lay
persons.
A °ti Child-health conferences conducted by physicians— 284; infants and pre
school children registered and examined— 4,967; visits to conferences
Defects'" found in children examined at conferences—-6,518; children having
defects— 3,543. Parents had defects corrected in 368 of the children.
Prenatal conferences conducted by physicians— 7 ; expectant mothers
registered— 14; number examined— 9 ; visits to conferences— 55. In addi
tion, 81 expectant mothers were examined outside the conferences.
Conferences conducted by nurses, no physician present— 494; infantsi and
preschool children inspected— 4,530; mothers instructed in prenatal
care— 14; visits to conferences by children—
5 visits .by mothers— 31.
In addition, 493 mothers made 548 visits and 1,718 infants and pre
school children made 3,357 visits to the nurses’ offices for inspection and
Dental^conferences— 116; expectant mothers receiving dental e x a m in a tio n 60; preschool children receiving dental examination— 2,yby*
,
,
New permanent child-health centers— 5 established as^a result of the bureau s
maternity and infancy work. They are supported by State and county
Classes8 for girls in care of infants and preschool children— 98 organized;
girls enrolled— 2,285; number completing course— 1,072, lessons in
Classes ^ r
mothers— 64 organized; mothers enrolled
completing course— 145} lessons in course 12.

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1,263;

numbep

102

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Classes for midwives 23 organized; midwives enrolled and completing
?°« 9r£e— 4? 6 ; lessons. in course— 10. In addition, the county nurses held
l,b66f conferences with individual midwives. Since the beginning of the
State s cooperation under the maternity and infancy act 4,620 midwives
have been given instruction concerning the use of prophylactic drops in
++
rf* e newborn and the importance of registration of births
attended,
iw o negro nurses have devoted much time to work with the
negro midwives. Assistance was given by a negro physician lent by the
United States Children’s Bureau.
J
Home visits by nurses— 10,903 (prenatal cases seen, 1,257; obstetrical
cases, 219; postnatal cases, 533; infants, 2,419; preschool children, 3,876).
Maternity homes inspected— 47; inspections made— 75.
Infant homes inspected— 209; inspections made— 350.
Community demonstrations 7, of a maternity and infancy public health
nursing program, in 7 counties.
Group demonstrations 1,043, on preparation of maternity clothing, supPr®8 j r confinement, and care at confinement; selection and preparation
ol food; clothing and feeding of infants; care of the teeth; teaching health
habits; testing vision; and other phases of maternal, infant, and child
care.
Campaigns -94, in 40 counties. These were of 8 types, including campaigns
lor promotion of birth registration, for the examination of preschool
children and^ correction of their defects before they should enter school,
tor vaccination, immunization, and inoculation against communicable
diseases; and for other objects related to maternity and infancy work,
talk s and lectures— 137 (report incomplete).
Literature distributed— 40,554 pieces.
Names registered for prenatal pamphlets— 6,297.
Some nutrition work was done through classes for preschool children con
ducted by the county nurses.
Exhibits conducted 71, including 13 at county fairs. Exhibit material
was lent several times.
Breast feeding was stressed by the county nurses in all their contacts with
mothers.
Infants born in the State during the year— 101,270; infants under 1 year of
age reached by the work of the bureau— 55,542; preschool children
reached— 31,778; expectant mothers reached— 10,355.
The bureau sends letters to the parents of all infants whose births are
registered in the State bureau of vital statistics informing them that
literature on the care of children m ay be had on request.
Counties in the State— 254; counties in which maternity and infancy work
was done during the year— 70; counties in which maternity and infancy
wo/ k has been done since the acceptance of the maternity and infancy
act— 121.
Since the beginning of the State’s cooperation under the maternity and
infancy act six counties have assumed the responsibility for maternity
and infancy work begun with maternity and infancy funds.
In response to requests from three counties the bureau supervised the materm ty and infancy work in those counties.
The following organizations Cooperated in the bureau’s work: State medical
association and auxiliary, State dental association, W om en’s Legislative
Council, State league of women voters, the American Legion and auxiliary,
and parent-teacher associations. Among the children examined at health
conferences reported in the foregoing paragraphs were 3,603 examined
m the
Get ready for school” campaign sponsored by the National
Congress of Parents and Teachers.
The outstanding feature of the year’s work was the examination of preschool
children in cooperation, with the National Congress of Parents and Teachers
and its local branches in the ‘ ‘ Get ready for school” campaign.
INFANT AND MATERNAL MORTALITY RATES

Texas has not been admitted to the United States birth-registration area nor
tt
. a^a2 1-r^ 1Btratl0? i?re®i Figures, therefore, are not available from the
united otates Bureau of the Census for comparison of infant or maternal mor
tality rates. The bureau of child hygiene has conducted campaigns for better
registration of births and deaths in an effort to attain the standard required
oy tne .bureau of the Census for admission to the birth-registration area*

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103

UTAH
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child hygiene, Salt
Lake City.
Funds expended: Federal, $16,743.19; State, $3,700.06; total, $20,443.25.
Staff:
Director (physician), 1 physician (part time), 2 nurses (1 part year), 1
dentist (part year), 1 vital-statistics clerk, 2 stenographers (1 part year).
Two physicians were employed as needed to conduct conferences. One
county nurse and three county health officers were paid in part from
maternity and infancy funds.
Volunteer assistants— 14 physicians, 16 dentists, 8 nurses, 841 lay persons.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
541; expectant mothers registered— 80; number examined— 7; infants and
preschool children registered— 10,216; number examined— 10,189; visits
to conferences by children— 12,747.
Defects found in children examined at conferences— 18,716; children having
defects— 8,265. Parents had defects corrected in 2,659 of the children.
Dental conferences— 24; expectant mothers receiving dental examination—
38 ; preschool children receiving dental examination— 796. In addition,
109 children received examinations outside the conferences.
New permanent combined prenatal and child-health centers— 8 established
as a result of the bureau’s maternity and infancy work. They are sup
ported by local funds.
Class for girls in care of infants and preschool children— 1 organized; girls
enrolled and completing course— 18; lessons in course— 30.
Classes for mothers— 3 organized; mothers enrolled (plus those carried over
from the previous year)— -120; number completing course— 85; lessons in
course— 12.
Home visits by nurses— 3,672 (prenatal cases seen, 155; obstetrical cases, 15;
postnatal cases, 55; infants, 1,162; preschoolchildren, 3,292).
Maternity home inspected— 1; inspections made— 2.
Group demonstrations— -17, on various phases of infant care, in addition to
demonstrations made at all health conferences.
Campaigns— 2 : (1) For state-wide promotion of physical examination of
preschool children and correction of their defects before they should enter
school.
(2) For observance of M ay D ay as Child Health D ay, state-wide.
Assistance was given in the campaign conducted by the State board of
health for immunization of preschool children against diphtheria and small
pox. In some localities campaigns for immunization against typhoid
fever were conducted.
Talks and lectures— 137.
Literature prepared— Save the Babies (revised), lessons for classes for
mothers.
Literature distributed— 28,738 pieces.
New names registered for prenatal letters— 529; prenatal letters distrib
uted— 515 sets.
Nutrition work was done through individual and group instruction to moth
ers at conferences.
Exhibit conducted— 1, at the State fair, of nursery equipment, dental
hygiene, and care of the baby. Exhibit material prepared— posters, infant
clothing, and nursery equipment. Exhibit material was lent four times.
Breast feeding was stressed in the instruction given to mothers at con
ferences and in the literature distributed.
Infants born in the State during the year— approximately 13,000; infants
under 1 year of age reached by the work of the bureau— approximately
13,000; preschool children reached— 10,216 (through conferences); ex
pectant mothers reached— 764.
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— -28; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act-— 29.

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104

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities— Continued.
Since the beginning of the State’s cooperation under the maternity and
infancy act 1 county has assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.
As a result of the bureau’s work a number, of communities in 5 counties
conducted 138 child-health conferences without assistance from the State
staff, at which 1,583 infants and preschool children were given physical
examinations.
Parent-teacher associations and prominent church relief societies cooperated
in the bureau’s work. They assisted at health centers, dental conferences,
and clinics for immunization against diphtheria, typhoid fever, and small
pox, furnished maternity bundles, and reported names of expectant
mothers.
Among the outstanding features of the year’s work was the special follow-up
work done by the nurses to obtain correction of physical defects found in children
examined at conferences.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Utah was 8 per cent lower in 1928 (9.6) than in
1921 (10.4). The infant mortality rate was considerably lower in 1928 than in
1921, as the following table shows:

Deaths of infants under 1
year of age per 1,000 live
births
Area
1921

Urban_____. _________ ___________________ ________________
Rural................................................... ............ ..............

192S

69
75

55
61

Percentage
of difference

—20
-1 9

If the 1921 infant mortality rate had prevailed in 1928, 14 more infants would
have died in every 1,000 born alive. This meant a total saving of 182 infant
lives. The rise in the infant mortality rate from 54 in 1927 to 59 in1928 was due
entirely to influenza and the accompanying respirátory diseases. The rate from
gastrointestinal diseases ñas shown a downward trend throughout the period
1921 to 1928. The rate for these causes of death was 46 per cent lower in 1928
(3) than in 1921 (5.6). The examination and reexamination of infants at per
manent health centers established through the efforts of the State bureau of child
hygiene, assisted by a strong church organization, was the means of carrying
maternity and infancy work into localities in which medical and nursing care pre
viously had been difficult of access or altogether lacking. The results of this
work are no doubt reflected in the general improvement in the mortality rates.
The maternal mortality rate also was lower in 1928 (49) than in 1921 (73). This
lower rate indicates a saving of 24 mothers for every 10,000 live births; that is,
if the 1921 rate had prevailed in 1928, there would have been 94 deaths from
puerperal causes instead of 63. The 1928 rates for urban areas (58) and for rural
areas (43) also were lower than the corresponding rates in 1921 (93 and 63).

VERMONT
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of public health, Burlington.
Funds expended: $8,497.12 (all Federal).
Staff:
Director (physician, State health officer serving), 3 physicians (1 m onth),
2 nurses (1 part year), 1 stenographer.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

105

ChUd-health conferences conducted by physicians— 23; infants and pre
school children registered and examined— 609.
>
.
Defects found in children examined at conferences— 1,280; children having
defects— 502.
,
, _„ ,
„„
. , .
Classes for girls in care of infants and preschool children— 27, organized in
26 high schools and 1 normal school; girls enrolled and completing course—
1,145; lessons in course— 5.
. .
Class for mothers— 1 organized, with 9 mothers attending the single session
held.
,
, .
,
,
r
Group demonstrations— 27, on various phases of child care, to groups of
high-school girls in connection with the class work in high schools and a
normal school.
, ,
'C
L . TT u l
.
Campaigns— 2 : (1) For observance, of M ay D ay as Child Health D ay,
state-wide.
(2) For examination of preschool'children and correction ol
their defects before the children should enter school, in 34 communities.
Talks and lectures— 39.
__
Air
i
Literature prepared— Motherhood, A Few Thoughts for Mothers, Manual
of Infant Hygiene, physical examination record card.
Literature distributed— 28,059 pieces.
.
Lectures on obstetrics, pediatrics, care of the eyes of the newborn, and vital
statistics were given to 10 county medical societies by specialists employed
for the purpose.
.
. .
,.
. ,
Breast feeding was stressed in talks and lectures given and m motion pictures
Infants born alive in the State during the year— 7,008; infants under 1 year
of age reached by the letters sent with birth certificates 7,008.
The department of public health sends to parents of all infants whose births
are registered in th.e bureau of vital statistics a letter offering to send
literature on infant care upon request.
•’
T
Counties in the State— 14; counties in which maternity and infancy work
was done during the year— 12; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
Tim following organizations cooperated in the department’s maternity and
infancy work: State board of education, State university (extension
service), State league of women voters, State federation of women s clubs,
women’s joint legislative committee, Visiting Nurses
Association,
community clubs, and the parent-teacher association.
Among the outstanding features of the yearns work were the lectures given on
obstetrics and pediatrics before 10 county medical associations and the classes in
infant care conducted in 26 high schools and a normal school.
INFANT AND MATERNAL MORTALITY RATES

Vermont began to cooperate with the Federal Government under the mater
nity and infancy act in 1925. The governor accepted the provisions of the act
in January, 1922, but the Federal allotment of $5,000 was returned to the
Federal Treasury.
(See Table 1, footnote 5 p. 3.)
The general death rate for the State was practically the same in 1928 (13.9)
as in 1921 (14 2). The infant mortality rate, on the other hand, was materially
lower in 1928 (65) than in 1921 (78). Both urban and rural rates were lower in
1928, that for urban areas being 61 in 1928 and 102 in 1921, and that for rural
areas being 66 in 1928 and 73 in 1921. The rates for the State as a whole and for
urban and rural areas were the lowest since 1915, the year of the establishment
of the birth-registration area by the United States Bureau of the Census. _
The maternal mortality rate for the State was lower in 1928 (58) than m 1921
(73). The rate for rural areas was also lower (47 in 1928, as compared with o9 m
1921), being in 1928 the lowest since the establishment of the birth-registration
area. For urban areas the 1928 rate (106) was higher than the 1921 rate (98).
In connection with these rates, however, the small number of births m the estate,
particularly in urban areas, must be taken into consideration, as a slight increase
or decrease in the number of maternal deaths materially increases or decreases the
* rate.

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106

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

VIRGINIA
STAFF AND:ACT1VITIES IN 1929

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 (part year), 4 nurses (1 part year), 1 super
visor of midwives, 1 vital-statistics clerk, 4 stenographers, 2 clerks. Addi
tional assistants were employed as needed. Forty-four county nurses and
11 city and town nurses were paid in part from maternity and infancy
funds.
Activities:
Combined prenatal and child-health conferences conducted by physicians—
30 ; expectant mothers registered and examined— 6 ; infants and preschool
children registered— 469; children examined— 229; visits to conferences by
expectant mothers— 12.
Child-health conferences conducted by physicians— 935; infants and pre
school children registered— 9,283; number examined— 8,761; visits to con
ferences— 15,928.
Defects found in children examined at conferences— 4,465; children having
defects— 2,452. Parents had defects corrected in 430 of the children.
The plan begun in 1926 to interest parents in taking their children of pre
school age to their own family physicians for examination before the chil
dren should enter school was extended this year to 19 counties and 2 cities;
local physicians conducted conferences in their own offices, the parents
who were able paying small fees. The number of children examined was
2,383. This plan was formally indorsed by the child-welfare committee
of the State medical society, which met in the office of the State department
of health in the spring to consider the request of the division superintend
ents of schools that the physicians of the State send them physically fit
children to teach, or at least children who could reach the minimum “ fivepoint standard” of being free from defects in nose, throat, mouth, ears,
and eyes, and being less than 10 per cent underweight.
Prenatal conferences conducted by physicians— 94; expectant mothers regis
tered and examined— 70; visits to conferences— 349.
Conferences conducted by nurses, no physician present— 822; infants and
preschool children inspected— 3,657; mothers instructed in prenatal care—
174; visits to conferences by children— 7,745; visits by mothers— 7,681 (in
cludes visits by the 174 mothers receiving instruction in prenatal care).
Dental conferences— 231; expectant mothers receiving dental examination—
2; preschool children receiving dental examination— 829.
New permanent combined prenatal and child-health centers— 7 established
as a result of the bureau's maternity and infancy work. They are supported
by county health departments and Red Cross chapters.
New permanent child-health centers— 14 established as a result of the bu
reau’s maternity and infancy work. They are supported by county health
units, school boards, and private organizations.
Classes for girls in care of infants and preschool children— 53 organizedgirls enrolled— 1,029; number completing course— 595; lessons in course—^
Classes for mothers— 94 organized; mothers enrolled (plus those carried over
from the previous year)— 1,844; number completing course— 480; lessons
in course— 5 to 30.
Classes for midwives— 106 organized; midwives enrolled (plus those carried
over from the previous year)— 601; number completing course— 36; les
sons in course— 8. The number of midwives known to be practicing in the
State has decreased considerably since the State began cooperation under
the maternity and infancy act in 1922. The confinements attended by
physicians have increased in number while those attended by midwives
have decreased. The midwives’ work is of a much higher standard than
when the State began cooperation under the maternity and infancy act.
Each year a larger number have attended the institutes for “ doctors’ *
helpers
conducted by the bureau, in which they receive 25 hours of
instruction.
visits by nurses 50,858 (prenatal cases seen, 2,206; obstetrical cases,
4 9 1 ; postnatal cases, 2,186; infants, 6,248; preschool children, 8,819).

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107

PRINCIPAL ACTIVITIES OF IN D IVID U AL STATES, 1929

Activities— Continued.
,
„
.
, . . ,
Group demonstrations— 15, on various phases of maternal and infant care. .
The bureau continued its cooperation with the United States Children s
Bureau in a study of maternal mortality.
(See pp. 117, 123.)
Talks and lectures— 187.
Literature distributed— 307,778 pieces.
A correspondence course for mothers was conducted, for which 1,314 women
enrolled during the year (plus 1,063 carried over from the previous year
and 24 reinstated); 551 women completed the course. A record was ob
tained of babies born to the student mothers before they took the course,
during it, or afterwards; and three or four times a year a health bulletin
was mailed to each baby.
, ,
...
Five institutes for “ doctors’ helpers” were conducted for white women at
the University of Virginia and elsewhere, with an attendance of 107, and
one such institute for colored women was conducted at a State normal and
industrial institute, with an attendance of 40. Daily 5-hour sessions were
devoted to lectures and demonstrations. These institutes, begun in 1925,
have become an increasingly useful part of the bureau’s work.
Nutrition work was done through individual and group instruction to
mothers. Several nurses organized food clubs with the assistance of homedemonstration agents, three nurses helped to organize and supervise
nutrition camps, and nearly all the nurses conducted food demonstrations.
Exhibits conducted— 38, including proper foods, home nursing, sanitation,
and malaria control.
., .
Breast feeding was stressed in instruction given to mothers and midwives
and in the literature distributed.
.
.
.
Infants born in the State during the year— 54,262; infants under 1 year of
age reached by the work of the bureau— 44,558.
.
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— 100; counties in which maternity and infancy work
was done during the year— 98; 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 in
fancy 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 tuber
culosis association, State medical society, Cooperative Education Association, and the parent-teacher association. They assisted with conferences
and helped to finance some local nurses. Among the children examined
at the health conferences reported in the foregoing paragraphs were 2,171
examined in the “ Get ready for school” campaign sponsored by the
National Congress of Parents and Teachers.
An outstanding feature of the year’s work was the interest and cooperation of
the State medical society in the bureau’s plan to have the preschool children of
the State made physically fit to enter school.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Virginia in 1928 (11.7) was lower than in 1921 (12.2).
The infant mortality rate for the State in 1928 was also lower than in 1921.
These rates were materially affected by the high mortality rate for colored in
fants, the rate for white infants in 1928 being the same as that for white infants
in the birth-registration area.
The rates for the two years were as follows:
1921

1928

95
74

91
72

68
W h i t e . - . - - ---------------------------- ------------------------------ - 68
Colored______________________________________________ 103

64
104

State.
Urban-------------------- --------- --------- ---------------------------Rural____ ______ — ---------------------------------------------

9412°— 31-

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108

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

The maternal mortality rate was higher in 1928 than in 1921, and this was the
case for both white and colored mothers, as the following figures show:
State-------------------- ----------- --------------------------------------------------

1921

1928

U rban_________ ___________________ ___________________ 113
59
Rural________________________________________________
W h ite_______________ ______ ________________________ —
Colored_________________________________________ _____

57
99

121
62
59
114

W A S H IN G T O N
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department of health, division of public-health
nursing and child hygiene, Seattle.
Funds expended: $10,000 (all Federal).
Staff:
Director (nurse, part time), one stenographer, one clerk. Fifteen physicians
were employed as needed to conduct conferences. Tw o county nurses
were paid (one in full, one in part) from maternity and infancy funds
(part year).
Activities:
Child-health conferences conducted by physicians— 90; infants and pre
school children registered and examined— 5,601. Local dentists made
dental examinations at almost all these conferences. Group demonstra
tions of preparation of foods and formulas and of sun baths were made
by local workers at about nine-tenths of the conferences.
Defects found in children examined at conferences— 5,767; children having
defects— 2,536. It was estimated on the basis of check-ups by nurses that
parents had defects corrected in three-fourths of the children.
New permanent child-health centers— 9 established as a result of the divi
sion’s maternity and infancy work. They are supported by local funds.
Conferences are conducted at these centers by local physicians and nurses.
The division cooperated in a study of maternal mortality (continued from the
previous year) being made in the State by the United States Children’s
Bureau with the indorsement of the State medical society.
Talks and lectures— 126.
Many of these were given by the pediatricians at
child-health conferences.
Literature distributed—-17,942 pieces.
New names registered for prenatal letters— 780; prenatal letters distributed—
2,293 sets. The prenatal-letter service was begun about the middle of
the year. Letters were sent to approximately 2,000 physicians in the
State explaining the service and requesting them to indicate on attached
blanks whether or not they were desirous of securing this assistance.
Those desiring the service were asked to send the names of their maternity
patients with approximate dates of confinement. Explanatory letters
were also sent to all public-health nurses asking their cooperation. The
response was gratifying, and the division received numerous letters of ap
preciation from expectant mothers who were benefited by this service.
A 15-lesson correspondence course for mothers was conducted through the
extension service of the State university; mothers registered (including
122 carried over from the previous year)— 168; number completing course
— 20. Arrangements were made to carry the courses to completion for
those still enrolled.
Nutrition work was done through instruction to individual mothers at con
ferences. The extension service of the State agricultural college cooper
ated in the nutrition work, specialists conducting a number of nutrition
classes for mothers of preschool children.
Exhibits were conducted at all child-health conferences.
A bimonthly bulletin containing articles on child hygiene was issued, and
a news-letteT was syndicated to rural papers throughout the State.

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109

Activities— Continued.
Breast feeding was emphasized at all conferences and in lectures. Informa
tion concerning breast feeding was secured for 3,327 of the children ex
amined at conferences. Of this number, 63 per cent were entirely breast
fed, 21 per cent were partly breast fed, and 16 per cent were artificially
fed.
Infants born in the State during the year— 22,962; infants under 1 year of
age reached by the work of the division (exclusive of those reached by
literature distributed)— 1,626; preschool children reached (exclusive of
those reached by literature distributed)— 3,975.
Counties in the State— 39; counties in which maternity and infancy work
was done during the year— 36; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 36.
Since the beginning of the State’s cooperation under the maternity and in
fancy act six counties have assumed the responsibility for maternity and
infancy work begun with maternity and infancy funds.
As a result of the division’s work, campaigns for vaccination against small
pox and for inoculation against diphtheria were conducted in a number of
counties, weekly lectures were given to mothers in two cities, and bi
monthly lectures were given in another city under local auspices.
The following organizations cooperated in the division’s work: State agri
cultural college and State university (extension services), State medical,
dental, and mental-hygiene associations, State federation of women’s
clubs, State conference of social workers, American Red Cross, men’s
service clubs, preschool child study circles, and the parent-teacher asso
ciation. Their cooperation consisted largely of sponsoring child-health
conferences or assisting with them and of furnishing speakers for talks
and lectures.
Among the outstanding features of the year’s work were the campaigns for
the prevention of diphtheria and smallpox conducted in a number of counties
as a result of the division’s work, the lectures given in connection with childhealth conferences, the introduction of the prenatal-letter service, and the com
pletion of the maternal-mortality survey undertaken the previous year in coopera
tion with the United States Children’s Bureau.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Washington was 11 per cent higher in 1928 (10.5)
than in 1921 (9.5). The infant mortality rate in 1928 (48), however, was 13
per cent lower than in 1921 (55). The rates for urban and rural areas were both
lower also, that for urban areas being 43 in 1928 and 55 in 1921, and that for
rural areas being 54 in 1928 and 56 in 1921. The difference between the 1921
and 1928 rates represents a saving of 159 infant lives in the State; that is, if the
1921 rate had obtained in 1928, there would have been 1,274 deaths of infants
under 1 year of age instead of 1,115. The rate for the State as a whole and for
urban areas was lower in 1928 than in any other year since the State was admitted
to the birth-registration area in 1917; the lowest rate for rural areas (53) was
reached in 1927. The work of leading pediatricians who were employed to assist
the division by work with individual infants throughout the State, especially
in infant-feeding cases, is in all probability reflected in the lower infant mor
tality rates in the later years of the operation of the maternity and infancy act.
The infant mortality rate from gastrointestinal diseases was 37 per cent lower
in 1928 (3.2) than in 1921 (5.1). The trend of the rates from this cause has been
definitely downward throughout this period, although there have been some
fluctuations. In 1921 the rate was 5.1 ; in 1922, 6.7 ; in 1923, 4.6 ; in 1924, 5.4.
Thereafter lower rates prevailed; the lowest, 2.9, was reached in 1927. The 1928
rate of 3.2 may be regarded as a minor variation. The rate from natal and pre
natal causes also showed a downward trend during the period, being 13 per cent
lower in 1928 (29) than in 1921 (33.4).
The maternal mortality rate for the State was slightly lower in 1928 (72)
than in 1921 (78). The rates for both urban and rural areas were lower, that
for urban areas being 84 in 1928 and 87 in 1921 and that for rural areas being
59 in 1928 and 69 in 1921,

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110

THE W E LFA R E AND H YG IEN E OF M A TER N ITY AND INFANCY

WEST VIRGINIA
STAFF AND ACTIVITIES IN 1929

Administrative agency: Statje department of health, division of child hygiene,
Charleston.
Funds expended: Federal, $31,565.97; State, $14,871.74; total, $46,437.71.
Staff:
Director (physician), 3 nurses (1 part time), 1 director of public-health
education (part year, part time), 1 auditor (part year, part time), 1 vitalstatistics clerk, 1 stenographer, 1 clerk. Nineteen county nurses were paid
in part from maternity and infancy funds.
Activities:
Child-health conferences conducted by physicians— 469; infants and pre
school children registered and examined—-6,042.
Dental conferences— 11; preschool children receiving dental examination—
492.
New permanent child-health centers— 3 established as a result of the divi
sion’s maternity and infancy work. They are supported by maternity
and infancy funds and county funds.
Classes for girls in care of infants and preschool children— 466 organized;
girls enrolled— 5,264; lessons in course— 12 to 16.
Classes for mothers— 88 organized; mothers enrolled— 1,088; lessons in
course— 4 to 12.
Home visits by nurses— 14,538 (visits to prenatal cases, 1,107; obstetrical
cases, 8 3 ; postnatal cases, 1,251; infants and preschool children, 7,679;
other, 4,418).
Community demonstrations— 2, of methods of controlling infectious diseases.
Group demonstrations— 583, on * various phases of maternal and infant
hygiene at conferences, classes, and other meetings.
Surveys— 2 (continued from the previous year): (1) Of the cost of medical
care. (2) Of community health conditions affecting children.
Campaigns— 7: (1) For observance of M ay D ay as Child Health D ay,
state-wide.
(2) For examination of preschool children and correction of
their defects before the children should enter school, state-wide. (3)
For early diagnosis of tuberculosis in young children, state-wide. (4) For
immunization of preschool children against diphtheria, state-wide. (5, 6,
7) Clean up, safe milk, and elimination of flies, important in reducing
infant mortality, in several counties.
Talks and lectures— 448.
Literature prepared— Teachers’ Manual of Health Education, report of
child-health conferences, prenatal letters (revised), outline of public
health nursing activities.
Literature distributed— 94,486 pieces.
New names registered for prenatal letters— 1,299; prenatal letters dis
tributed— 1,233 sets.
A correspondence course for mothers was conducted, for which 4,782 mothers
were enrolled (plus 11,264 carried over from the previous year); 1,651
mothers completed the course.
Nutrition work was done through instruction given to groups and to indi
viduals at conferences and at classes and through the instruction given
in the motherhood correspondence course.
Exhibits conducted— 97, including models, motion pictures, literature,
charts, posters, and maps. Exhibit material prepared— models, charts,
and posters. A film on obstetrics was purchased for educational work
among physicians and nurses. Exhibit material was lent 20 times.
Statistical studies made— mothers enrolled for correspondence course, by
counties; midwives licensed in the State, by counties; maternal and pre
school-child deaths, by counties.
Breast feeding was promoted through the instruction given to mothers at
conferences and classes and in the motherhood correspondence course
and through the showing of a film on breast feeding.
Infants born in the State during the year— approximately 43,000; infants
and preschool children reached by the work of the division— approxi
mately 23,350; expectant mothers reached— 2,406.
Counties in the State— 55; counties in which maternity and infancy work
was done during the year— 48; counties in which maternity and infancy
work has been done since the acceptance of the maternity and infancy
act— 55.

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PRINCIPAL ACTIVITIES OF INDIVIDUAL STATES, 1929

111

Activities— Continued.
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 many clinics for the immunization of chil
dren against diphtheria were conducted under local auspices, and prelimi
nary plans were completed for the formation of a child-health section of
the State public-health association, whereby the child-health work of all
public and private organizations m ay be coordinated and carried out
under the State division of child hygiene.
The following organizations cooperated in the division’s work: State de
partment of education, State university (extension division), State medi
cal association and auxiliary, State tuberculosis association, State league
of women voters, farm women’s clubs, W om an’s Christian Temperance
Union, and the parent-teacher association. They assisted in campaigns
and surveys, gave publicity to the division’s work, and furnished oppor
tunities for conducting classes for mothers and girls.
Among the outstanding features of the year’s work were the extension of the
division’s program for immunization of preschool children against diphtheria, an
increase of interest in child-health work on the part of the public, and greater
cooperation in the State program for maternity and infancy work on the part of
physicians.
INFANT AND MATERNAL MORTALITY RATES

W est Virginia was not admitted to the United States birth-registration area
until 1925. Mortality rates of earlier years therefore are not available for com
parison with those of 1928.
The general death rate for the State in 1928 (10.2) was 15 per cent lower than
that for the birth-registration area (12). The infant mortality rate (70) was
slightly higher than for the birth-registration area (69). The rate for the State
was, however, the lowest since its admission to the area in 1925. The rates were
as follows:
1925

1928

State_____________________ __________________________________

U rban_________________________________________________
Rural___________ k________ ____________________________

93
77

W h ite_________________________________________________
78
Colored________________________________________________ 110

69
95

The maternal mortality rate in 1928 (57) was lower than that of the birthregistration area in the same year (69) as well as lower than that of 1925 in
the State (63). The rates were as follows:
1925

1928

U rb a n ..
Rural __

118
51

122
43

W h it e ..
Colored

60
125

53
110

State_____

WISCONSIN
STAFF AND ACTIVITIES IN 1929

Administrative agency: State board of health, bureau of child welfare and publichealth nursing, Madison.
Funds expended: Federal, $31,040.04; State, $22,751.62; total, $53,791.66.
Staff:
Director (physician), 5 physicians (2 part year, 1 part time), 5 nurses (2 part
year), 1 organizer of infant-hygiene classes, 1 publicity editor (1 month),
1 vital-statistics field worker, 2 vital-statistics clerks (part year), 1 book
keeper (part year), 1 silver-nitrate clerk (part year), 1 general clerk,
1 stenographer, 1 typist. One county nurse was paid in part from ma
ternity and infancy funds. '
Volunteer assistants— 34 physicians (report incomplete), 178 nurses, 183 lay
persons.

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112

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

Activities:
Combined prenatal and child-health conferences conducted by physicians—
541; expectant mothers registered and examined— 153; infants and pre
school children registered and examined— 7,094; visits to conferences by
expectant mothers— 206; visits by children— 12,464.
Defects found in children examined at conferences— 12,083; children having
defects— 5,737. It was estimated that parents had defects corrected in
one-fourth to one-third of the children.
New permanent combined prenatal and child-health centers— 13 established
as a result of the bureau’s maternity and infancy work. They are sup
ported by local, State, and Federal funds.
The promotion of infant-hygiene courses in the schools of the State was
continued. The course given in the schools that prepare teachers was
extended to include with the infant-hygiene lectures a 1-hour lecture on
the care of the expectant mother. The organizer of infant-hygiene classes
gave the complete course in 26 county normal schools and 10 teacher
training departments in high schools. She also gave a lesson of at least
1 hour to 601 high-school girls, 1,530 grade-school girls, and 96 vocationalschool girls and an hour’s talk to 240 mothers and to 489 rural and State
teachers of graded schools in their fall institutes. A t one institute a 4-hour
course was given. Certificates for completion of the course were issued
to 4,241 girls taught by the organizer and by school teachers. Certificates
are not issiled to students above high-school grade.
Hom e visits by nurses— 734 (prenatal cases seen, 42 ; postnatal cases, 39 ;
infants, 364; preschool children, 610).
Community demonstration— 1, in one county (continued from the previous
year), of prenatal care and care of the preschool child in a public health
nursing program. The names of 178 expectant mothers were listed to
receive prenatal letters and the mothers were given instruction and advised
to place themselves under the care of a physician during pregnancy.
Inspection was made of 2,493 preschool children. The importance of
early development of good health habits and of the correction of physical
defects before the child should enter school was stressed.
Group demonstrations— 376, on various phases of maternal, infant, and pre
school-child care.
Surveys— 3 ; (1) Of the prevalence of goiter among children, in one township,
to compare with data assembled in such a survey made in 1927. (2) Of
birth registration, state-wide. (3) Of maternal mortality (continued
from the previous year), in cooperation with the United States Children’s
Bureau and with the indorsement of the State medical society.
Talks and lectures— 137, to audiences totaling 5,907 persons.
Literature prepared— pamphlets on toxin-antitoxin and care of the teeth,
diet cards (revised).
Literature distributed— 386,427 pieces.
New names registered for prenatal letters— 2,627; prenatal letters distrib
uted— 2,946 sets.
Exhibit conducted— 1, at the State fair (lasting a week), consisting of layette,
posters, and literature. Exhibit material prepared— charts, maps, and
posters. Exhibit material was lent 36 times.
Breast feeding was stressed in the instruction given to mothers at health
conferences and in home visits, also in lectures and in the literature dis
tributed. It was estimated that five-sevenths of the infants in the State
are breast fed.
Infants born in the State during the calendar year 1928— 57,398; infants
under 1 year of age reached by the work of the bureau during the fiscal
year ended June 30, 1929— 64,501; preschool children reached— 6,475;
expectant mothers reached— 3,141.
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— 71.
Since the beginning of the State’s cooperation under the maternity and
infancy act 14 counties and 12 communities have assumed part or all of
the responsibility for maternity and infancy work begun with maternity
and infancy funds.

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PRIN CIPAL ACTIVITIES OF IN D IVID U AL STATES,

113

1929

Activities— Continued. \
,
,
As a result of the bureau’s work the interest in prenatal, infant, and preschool
child care has increased throughout the State. Every effort has been
made to increase the amount of prenatal and preschool-child work done
by all public-health nurses in the State. As a result all the county nurses,
many city nurses, and a few school nurses now include work for preschool
children In their general programs.
*
.
The following organizations cooperated in the bureau’s work: American
Red Cross, State federation of women’s clubs, State federation of colored
women’s clubs, State league of women voters, American Legion and its
auxiliary, and the parent-teacher association. They promoted local interest
in the work and financed health centers.
Among the outstanding features of the year’s work were the establishment of
many new health centers and the distribution in rural communities of literature
relating to maternal, infant, and child care and hygiene.
INFANT AND MATERNAL MORTALITY RATES

The general death rate for Wisconsin was 5 per cent higher in 1928 (10.8) than
in 1921 (10.3). The infant mortality rate, however, was materially lower in 1928
than in 1921, as the following table shows:
Deaths of infants under
1 year of age per 1,000 live
births
Area
1921

1928

Percentage
of
difference

-1 5

79
68

64
60

-1 9
-1 2
*

Eleven of every 1,000 babies born alive in 1928 would have died if the 1921 rate
had prevailed. This means a saving of more than 600 infant lives. Except in
1925, when there was a slight increase, the infant mortality rate from gastroin
testinal diseases has gone steadily downward from 1921 to 1928. This rate was
55 per cent lower in 1928 (5.9) than in 1921 (13.2). The rates from natal and
prenatal causes have also had a downward trend, the 1928 rate (34.7) being 8 per
cent lower than the 1921 rate (37.9). The work of the “ child-health special”
providing return conferences in rural areas over a period of several years, com
bined with the regular conference work and supervision of infants at permanent
centers, appears to have raised the standard of infant care and particularly of
infant feeding throughout the State.
.
.
The maternal mortaility rate was the same in 1928 (58) as in 1921. The rate
for urban areas was 69 in 1928 and 74 in 1921, and that for rural areas was 49 in
1928 and 48 in 1921.
W Y O M IN G
STAFF AND ACTIVITIES IN 1929

Administrative agency: State department.of public health, division of maternal
and infant welfare, Cheyenne.
Funds expended: Federal, $13,000; State, $500; total, $13,500.
Staff:
.
„
Director (State health officer serving), 1 vital-statistics clerk, 1 stenographer
(37 days). Three county nurses were paid from maternity and infancy*
funds (two part year). Seven physicians and one dentist were employed
as needed to conduct conferences.
Volunteer assistants at conferences— 60 physicians, 28 dentists, 37 nurses,
322 lay persons.

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114

T H E W E LFA R E AN D H YG IE N E OF M A TER N ITY AN D INFANCY

Activities:
Combined prenatal and child-health conferences conducted by physicians—
57; expectant mothers registered— 26; infants and preschool children
registered— 1,144; children examined— 941.
Child-health conferences conducted by physicians— 67; infants and preschool
children registered— 1,683; number examined— 1,470.
Defects found in children examined at conferences— 4,127; children having
defects— 1,260.
Conferences conducted by nurses, no physician present— 4; infants and
preschool children inspected— 78.
Home visits by nurses— 1,494 (prenatal cases seen, 241; obstetrical cases,
2; postnatal cases, 129; infants, 462; preschool children, 824).
Group demonstrations— 22, on various phases of maternal and child care.
Campaign— 1, for immunization against communicable diseases, special
emphasis being placed on immunization against diphtheria. The State
health officer, assisted by a nurse, gave approximately 20,000 doses of
toxin-antitoxin from January 1 to June 20, 1929.
Literature prepared— articles on diphtheria and toxin-antitoxin.
Literature distributed— approximately 11,000 pieces.
Nutrition work was done through lectures and instruction to individual
mothers.
Breast feeding was stressed in talks at conferences and in the instruction
given during home visits.
Infants born in the State during the year— 4,460; infants and preschool
children reached by the work of the division (exclusive of those reached
by literature distributed)— 4,200; expectant mothers reached (exclusive of
those reached by literature distributed)— 267.
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.
The following organizations cooperated in the division’s work: The American
Legion auxiliary, parent-teacher associations, schools, women’s clubs,
and local clubs.
Among the outstanding features of the year’s work were the health conferences,
the communicable-disease work (particularly the immunizations against diph
theria) , and the distribution of literature relating to maternal, infant, and child
care and hygiene.
INFANT AND MATERNAL MORTALITY RATES

Wyom ing was admitted to the United States birth-registration area in 1922
and began cooperating with the Federal Government under the maternity and
infancy act in the same year. Comparison is made therefore between the mor
tality rates of 1922 and 1928.
The general death rate for the State was lower in 1928 (8.7) than in 1922
(9.3). The infant mortality rate also was lower in 1928 (68) than in 1922 (79).
This lower rate meant that 11 of every 1,000 infants born alive survived who
would have died if the 1921 rate had prevailed, a saving of 50 infant lives.
The urban and rural rates also were lower in 1928 than in 1922, but in examining
these rates consideration must be given to the small number of births in these
areas, particularly in the urban areas (approximately 1,000 annually), as a
slightly larger or smaller number of infant deaths would materially increase or
decrease the rates. The rate for the urban areas was 78 in 1928 and 104 in 1922;
that for rural areas was 66 in 1928 and 73 in 1922.
The maternal mortality rate for the State was lower in 1928 (65) than in 1922
(71); but, as in the case of infant mortality, the small number of births in the
State, particularly in the urban areas, must be taken into consideration. There
was no significant difference in these rates in the two years, that for urban areas,
being 39 in 1928 and 111 in 1922; for rural areas, 70 in 1928 and 62 in 1922.

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FEDERAL ADMINISTRATION DURING 1929
FED ERAL

STAFF

The United States Children’s Bureau, whose maternity and infanthygiene division was created in 1922 to assist in administering thematemity and infancy act, has kept in touch with State and local
work through plans and budgets submitted for approval to the
Federal Board of Maternity and Infant Hygiene 1 and through reports
from the States, staff visits to the States, and the conferences of
State directors of the local administration of the act. Reports from
the States included annual reports on activities and semiannual finan
cial reports. Copies of monthly or other reports made by the direc
tors of the State bureaus or divisions to their respective State health
officers were also received from many States.
During the year under review the regular staff of the maternity and
infant-hygiene division consisted of 2 physicians, 2 public-health
nurses (employed for only part of the year), an auditor, a secretary,
and 2 clerks. The physicians were the director and a negro woman
physician employed for special work in States having large negro
populations. A Spanish-speaking field worker assisted in special
work in New M exico. The auditor audited the accounts of the
States cooperating under the maternity and infancy act; the accounts
in Hawaii were audited b y another member of the staff who visited
the islands.

Eleven physicians were employed for work on the maternal-mor
tality study—'1 physician in charge of details who also did interview
ing, and 10 physicians (some of them on a part-time basis) who
interviewed physicians and attendants of the women who died.
Two part-time consultants in child hygiene, one part-time consultant
in obstetrics, and one nurse consultant were also on the staff.
A S SIS T A N C E

ST A TE S

Special consulting service from the staff of the Children’s Bureau is
frequently requested by State bureaus and divisions of child hygiene
or welfare. During the year under review 17 States and the Territory
of Hawaii were visited by physicians or nurses from the maternity and
infant-hygiene division. The director of the division spent short
periods conferring with State administrators and reviewing types of
work in progress in Alabama, Arizona, Arkansas, California, Colorado,
Delaware, Hawaii, Louisiana, Maine, Nebraska, New Mexico, Ohio,
Texas, Vermont, and Virginia. Special trips for consultations in
the interest of maternity and infancy work were made to Illinois,
Massachusetts, and New York. The physician in charge of the
details of field work in the maternal-mortality study gave consulting
service and interviewed physicians in Alabama, Kentucky, and
Virginia; and the other physicians employed in connection with the
JSee the maternity and infancy act, sec. 3 (Appendix A, p, 127),

115

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116

the welfare and hygiene of maternity and infancy -

study were detailed to the following States at the request of the State
health departments: Alabama, Kentucky, Maryland, Nebraska,
New Hampshire, Oregon, Rhode Island, Virginia, and Washington.

Assistance in special pieces of work undertaken or under considera
tion in the cooperating States is frequently requested, and the bureau
made details to 17 States in accordance with such requests in the
year under review. Through the cooperation of the medical school
of Emory University a lecture course in obstetrics for physicians was
given in each of four congressional districts in Georgia, arrangements
being made by the State division of child hygiene and the district and
county medical societies.
Lectures to professional and lay groups were given in Montana
during the latter part of the year by the bureau’s consultant in
child hygiene. The negro woman physician on the bureau’s staff
organized and taught classes in midwife procedure and promoted
the registration of births attended by these women in Delaware
and Texas and assisted with an institute for doctors’ helpers in
Virginia. One of the public-health nurses who was employed for
part of the year gave a demonstration in Wyoming of the work to
be done by a maternity and infancy nurse; the other assisted in
work to improve the registration of births in Texas. The nurse
consultant visited Alabama, Arkansas, and North Carolina; a stat
istician from the bureau visited Califorqia, Nebraska, North Dakota,
Michigan, Minnesota, Oklahoma, Oregon, Washington, and Wiscon
sin in connection with the study of maternal mortality; and other
members of the bureau staff assisted in promoting birth registration
in New Mexico and Texas.
The bureau’s obstetrical and pediatric advisory committees gave
valuable assistance during the year under review.2 The consulting
obstetrical committee met at the bureau to discuss a revised manu
script of the bureau’s bulletin Prenatal Care, prepared by the chairman
of the committee, problems arising in connection with the ma
ternal-mortality study, and a plan for a series of lectures on obstetrics
before medical groups in various States. The pediatric advisory
committee met to discuss the manuscript of a revision of the bu
reau’s bulletin Infant Care (issued in December, 1929), and the
preliminary draft of a new bulletin to supersede the bulletin Child
Care.
P R O M O T IO N

OF B IR TH

R E G IS T R A T IO N

As in previous years, the Children’s Bureau gave assistance in
the campaigns for state-wide registration of births in States not in
the United States birth-registration area. For this purpose a member
of the bureau’s statistical division and a nurse from the staff of the
2 The members of the pediatric advisory committee are: Dr. Howard Childs Carpenter, associate pro
fessor of pediatrics, University of Pennsylvania School of Medicine, representing the American Child
Health Association; Dr. Julius H. Hess, professor of pediatrics, University of Illinois College of Medicine,
representing the section of diseases of children of the American Medical Association; and Dr. Richard M .
Smith, assistant professor of child hygiene, Harvard University Medical School, representing the American
Pediatric Society. The members of the obstetrical advisory committee are: Dr. Robert L. De Normandie,
instructor in obstetrics, Harvard Medical School, chairman; Dr. Fred L. Adair, professor of obstetrics
and gynecology, University of Chicago; Dr. Rudolph W. Holmes, professor of obstetrics, Northwestern
University Medical School, Chicago; Dr. Ralph W. Lobenstine, chairman medical advisory board, Mater
nity Center Association, New York; Dr. Frank W. Lynch, professor of obstetrics and gynecology, LTniversity of California Medical School; Dr. James R. McCord, professor of obstetrics and gynecology, Emory
University School of Medicine, Atlanta; Dr. C. Jeff Miller, professor of gynecology, Tulane University of
Louisiana School of Medicine, New Orleans; Dr. Otto H. Schwarz, professor of obstetrics and gynecology,
Washington University School of Medicine, St. Louis; Dr. Alice N. Pickett, assistant professor of obstetrics,
University of Louisville School of Medicine, Louisville.

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FED ERAL AD M IN ISTRATIO N, 1929

117

maternity and infant-hygiene division were detailed to Texas, and
the Spanish-speaking field worker was detailed to New Mexico.
The work of the negro physician on the bureau’s staff to improve
the registration of births among the negro populations of Delaware
and Texas has been mentioned in the preceding section. The
bureau also helped to promote birth registration through the mem
bership of the director of the maternity and infant-hygiene division
on the committee to aid completion of the registration area before
1930, organized by the American Public Health Association.
R ESEAR C H

AND

PU B LIC ATIO N S

STUDY OF MATERNAL MORTALITY

The investigation of maternal mortality conducted by the childhygiene bureaus or divisions of 15 States in cooperation with the
United States Children’s Bureau, on the request of the State boards
of health and with the indorsement of the State medical societies
(see p. 22), was practically completed during the year under review.
The data will be compiled, analyzed, and published by the Children’s
Bureau. Preliminary reports of findings for the puerperal deaths
in 1927 were given to medical groups in Maryland and Nebraska,
and tabulations of certain points in the schedule concerning the
2,650 puerperal deaths that occurred in 12 of the 13 States covered
in 1927 were made for the use of the secretary of the American
Medical Association’s section on obstetrics, gynecology, and abdom
inal surgery (who is a member of the consulting obstetrical, committee
of the Children’s Bureau) at the meeting of that association in
Portland, Oreg., in July, 1929.
STUDY OF STILLBIRTHS AND NEONATAL DEATHS

The Children’s Bureau assisted in the tabulation and analysis of
a study of stillbirths and deaths of infants under 2 weeks of age bemg
made by the medical school of the University of Minnesota. Through
this study, information on the prenatal, natal, and neonatal history
of the children, their physical measurements, the autopsy findings, and
the pregnancy history, natal history, and postpartum history of the
mothers will be made available.
STUDY OF NEONATAL MORBIDITY AND MORTALITY

Examination of newborn infants in New Haven by the Children s
Bureau in cooperation with the Yale University School of Medicine
was continued, also the work of preparing for analysis the data
obtained. This study is mainly exploratory, its purpose being to
discover what the evidence shows as to the need for further intensive
studies.
STUDY OF RICKETS

Tabulation and statistical analysis of the material collected in
the study of rickets in New Haven and the study of the health of
infants and preschool children in Porto Rico were continued. As
the prevention or control of rickets was the main purpose of the inves
tigation, special attention was given to the earliest manifestations
of the disease, and special study was made of the incidence of rickets
(both clinical and Röntgen ray) in successive age periods for the

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118

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

group of children who were examined repeatedly. A special report
on carpal centers of ossification as one index of growth will be based
on Rontgen-ray examinations of the short bones of the wrist made
in New Haven and similar material from the Porto Rico study.
NEW HEIGHT AND WEIGHT TABLES

The weight, height, and age figures for 83,846 white boys and
81,653 white girls under 6 years of age examined during Childrens’
Year (1918) were reanalysed to show average weight for height for
boys and girls by smaller age intervals and to present the averages
for a larger proportion of the children of these ages. Average weight
for height for each month of age during the first year of life will be
shown, also for each three months during the second and third
years, and for each six months during the fourth, fifth, and sixth
years. The new figures have been used in the new edition of Infant
Care and will be included in a new bulletin prepared to replace Child
Care.
OTHER PUBLICATIONS

Two new folders, Out of Babyhood into Childhood and Why Sleep?
were issued during the year under review. A new folder on Your
Child’s Teeth was in preparation and has since been issued. The
bureau’s folders Keeping the Well Baby Well and Why Drink Milk?
were revised; also the dodger Is Your Child’s Birth Recorded?
The bureau’s bulletin Prenatal Care was revised and to a large
extent rewritten, and the revision was considered at a meeting of
the bureau’s obstetrical advisory committee. With the help of the
the bureau’s pediatric advisory committee, new bulletins were pre
pared to replace Infant Care and Child Care (Publications 8 and 30).
These were sent to press after the fiscal year under review.
A series of 12 lessons containing material on child management
was in preparation during the year under review.2
DISTRIBUTION OF PUBLICATIONS

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
more-than 800,000 copies of the popular bulletins Prenatal Care,
Infant Care, Child Care, and Child Management were distributed
by the bureau to mothers directly and through monthly allotments
to State bureaus and divisions of child hygiene or welfare and a number
o f county and city boards of health. Many States buy additional
copies from the Government Printing Office; during the year under
review nearly 400,000 copies were sold. By June 30, 1929, 9,637,432
o f these bulletins had been distributed since the dates of publication.
MOTION PICTURES AND EXHIBIT MATERIAL

Among the Children’s Bureau exhibit material that may be bor
rowed are posters and panels, motion-picture films, film strips for use
in automatic and hand projectors, lantern slides, and models. (See
p. 142.) During the year under review 367 shipments of exhibit
This has been issued as Publication No. 202, Are You Training Your Child to Be Happy?

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material, including 3,261 panels, 423 reels of films, 350 slides, 78 film
strips, 12 models, and 10 projectors were sent to National, State, and
local organizations in continental United States, Hawaii, and the
Philippine Islands to aid them in their efforts to bring child-welfare
problems to the attention of the public. These organizations include
the American Medical Association and other medical societies,
public-health agencies, child-welfare and other social-service organi
zations, fraternal orders, educational institutions, Young Men s and
Young Women’s Christian Associations, The American lied Cross,
Bov Scout Troops, Camp Fire Girls, women’s clubs, and State and
county fairs. In addition, the bureau lent posters, slides, and motionpicture films to child-welfare organizations m Argentina, Brazil,
Canada, Costa Rica, England, India, Japan, Paraguay, Turkey, and
other foreign countries.
U

RADIO PROGRAMS

An increased demand for cooperation in radio programs was received
by the Children’s Bureau during the year under review. A regular
series of Wednesday morning radio talks on child welfare was begun by
the chief of the bureau on M ay Day (Child Health Day), and material
was supplied to individuals and agencies for the preparation of radio
programs on child care.

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THE SERVICES OF THE CHILDREN’ S BUREAU UNDER THE
MATERNITY AND INFANCY ACT

A maternity and infant-hygiene division of the Children’s Bureau
was organized in 1922 to administer the maternity and infancy act.
The existing child-hygiene division of the bureau continued, its
research in the general field of child health but had no responsibility
for the administration of the act. To the maternity and infancy
division, after approval of the State plans and budgets submitted to
the Federal Board of Maternity and Infant Hygiene1 were intrusted
the details of the Federal administration of the act. Its work included
auditing annually the State accounts covering the Federal and matched
funds allotted to the States under the act, checking financial reports
and reports of work submitted by the States with their plans and budg
ets, compiling annual reports of the joint work of the State and the
Federal Governments in this field, establishing contacts with the
States through advisory visits made by the administrative and field
staffs of the division, and. conducting surveys designed to promote the
purposes of the act.
The visits to the States b y the director, the other physicians, and
the consulting nurse kept the bureau informed of the types, amount,
and character of the work in the States. T o the States these special
ists brought an outside point of view of the work they were doing and
accounts of what other States were finding helpful. Sometimes an
obvious need for special personnel was noted, and this resulted in the
lending of personnel from the Children’s Bureau for demonstration or
some other special work in the States. In addition to its administra
tive work the maternity and infant-hygiene division served as a
clearing house for inform ation on maternal and infant care for the
public— which included mothers, authors, scientists, social workers,
nurses, and other groups.

Through this division field studies relating to maternity and infancy
were directed. The child-hygiene division also conducted studies and
research relating to the infant and the child, and both divisions
assisted in the preparation of publications, films, and other educa
tional material relating to maternal and child welfare issued by the
bureau.
T H E STAFF OF T H E

M A T E R N IT Y A N D IN F A N T -H Y G IE N E D IV IS IO N

For the purposes of administration $50,000 was allotted annually to
the Children’s Bureau from the maternity and infancy fund for 1923
and 1924 and $50,354 from 1925 to 1929.2 The headquarters staff of
the maternity and infant-hygiene division and the number of other
persons regularly employed were kept at a minimum. This policy
left available sufficient funds for certain studies and demonstrations
and for the lending of specially trained personnel to do special field
work for short periods. The headquarters staff was a fairly constant
group consisting of the director (a physician), an assistant director
or a specialist in child hygiene (also a physician), the accountant,
1See maternity and infancy act, secs. 3 and 8 (Appendix A, pp. 127, 128).
2See the maternity and infancy act, sec. 5 (Appendix A, p. 128).

120

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who in addition to auditing the expenditures of maternity and
infancy funds in the States also acted as accountant at headquarters,
a secretary, and two clerks. The field staff changed in type and
number of workers and in the services rendered as occasion demanded
and as new types of work developed. In 1929 this staff included 12
physicians, 2 nurses, and 1 other worker.
A S SIS T A N C E T O STA TE S

From 1922 to 1929 the director of the maternity and infant hygiene
division visited each of the cooperating States and the Territory of
Hawaii. Many of the States received several of these advisory visits.
The consulting nurse made advisory visits to approximately all the
cooperating States, and the accountant made annual visits to the
States to audit accounts.
The passage of the maternity and infancy act produced an im
mediate demand for trained workers, which was in excess of the
supply. At the request of the States the consulting staff nurse of the
bureau arranged a course of instruction in maternal and child care
for nurses, which she gave before groups of nurses. Between Decem
ber 1, 1922, and June 30, 1923, such institutes for nurses were held
in 16 States.
Many States requested the services of physicians from the Children’s
Bureau to conduct demonstration child-health or prenatal confer
ences. Physicians were secured for such work and served for varying
periods in Kentucky, Montana, North Carolina, North Dakota,
Oregon, and South Carolina.
Racial groups presented needs for special workers for improvement
of midwives. The negro midwives of the South offered a special
problem in connection with the lowering of the death rate in the
Southern States. At the request of the State health officers of
Delaware, Georgia, Tennessee, Texas, and Virginia, the negro woman
physician on the staff of the maternity and infant-hygiene division
served as instructor of negro midwives and promoted birth registration
for five years. She also held conferences in connection with health
week at the hospital of the State normal and industrial institute at
Tuskegee, Ala. The Spanish-speaking public-health nurse on the
staff aided in instructing midwives in New Mexico. Demonstrations
of maternity and infancy work were conducted in several States at
their request. For several months one of the public-health nurses on
the Federal staff conducted a demonstration nursing program in
maternal and child care in four counties of Utah; following this she
gave a demonstration program in care of the preschool child in
Nebraska, then a demonstration of a public-health nursing program
in the interest of mothers and babies in Wyoming. Each of these
demonstrations awakened local interest and stimulated local activi
ties for improving maternal and child hygiene.
Considerable assistance was given to State campaigns for improve
ment of birth and death registration. Good vital statistics are the
foundation for good public-health programs. They furnish the
compass by which public-health work is guided. Without them any
public-health program is more or less uncertain. Realizing this, the
Children’s Bureau was eager to assist States that were conducting
campaigns to bring themselves into the United States birth and
death registration areas,

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

To 10 States the bureau gave special assistance in their campaigns
to secure more complete registration: Arkansas, Colorado, Georgia,
Idaho, Louisiana, Nevada, New Mexico, Oklahoma, South Carolina,
and Texas. The director of the maternity and infant-hygiene
division also served as a member of the National Committee to Aid
Completion of the Registration Area before 1930. Both the birth and
death registration areas are now complete for continental United
States with the exception of South Dakota and Texas.
The specialists in child hygiene and obstetrics who were on the
the staff as consultants (see p. 115) gave part-time services on request
in 11 States. One specialist in child hygiene gave educational talks in
California, Colorado, Louisiana, Michigan, and West Virginia; another
was lent to give courses in child hygiene to physicians in Montana,
Nevada, and Oklahoma. A specialist who was consultant in ob
stetrics conducted courses in obstetrics for physicians in Kentucky
and Oklahoma and gave some educational talks in Alabama. A
member of the obstetrical advisory committee conducted such courses
in Georgia and Florida. The bureau gave special statistical assistance
in the analysis of maternal and infant mortality data in Delaware,
Indiana, Kentucky, Maryland, Michigan, New Hampshire, New
Jersey, New York, North Carolina, Ohio,Pennsylvania, Rhode Island,
Virginia, and Wisconsin. An analysis of infant and maternal mor
bidity and mortality in Idaho was requested by the Idaho Depart
ment of Public Welfare, and a statistician from the bureau was
assigned to the State for the study. At the request of Tennessee a
statistician was assigned to that State to make a study of neonatal and
maternal mortality in relation to the attendant at birth, in six counties.
C O N FER EN C E S O F STA TE D IR E C TO R S

Five annual conferences of directors of State bureaus and divisions
administering the Federal maternity and infancy act were held in the
Children’s Bureau in Washington during the seven years of the opera
tion of the act. (No conference was held in 1922, the first year of
the operation of the act, and none in 1929, the last year of its opera
tion.) The attendance included not only the directors from practi
cally all the cooperating States, a number of associate directors, super
vising nurses, and other members of the child-hygiene or childwelfare bureaus and divisions but also State health officers from sev
eral of the States. Representatives from the three noncooperating
States also attended some of the conferences. The directors decided
upon the time for holding the conferences and the topics to be dis
cussed. The Children’s Bureau arranged for transportation and
details in relation to the program, including securing of speakers.
Representatives from private organizations whose direct or indirect
purpose is the furtherance of maternal or child welfare or hygiene,
as well as specialists in pediatrics, obstetrics, nutrition, and related
subjects, were among those who appeared on the conference programs.
These conferences made possible the exchange of experiences by the
State directors and proved of great practical value to them.

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A D V IS O R Y

123

C O M M IT T E E S

Tw o advisory committees, one of pediatricians and one of obstetri
cians, rendered valuable services to the bureau.3 The members of
these committees are distinguished in their special fields. The pedi
atric advisory committee consists of three members, one named by
each of the following organizations: The American Pediatric Society,
the pediatric section of the American M edical Association, and the
American Child Health Association. The director of the childhygiene division of the Children’s Bureau meets with this committee.
Standards for conducting child-health conferences were formulated by
the pediatric advisory committee, with the assistance of two univer
sity professors of pediatrics and a State director of maternity and
infancy work. All educational material on infant care and child
care issued by the bureau is submitted to this committee for approval
or revision.

The obstetrical advisory committee was organized at the request
of the 1924 conference of State directors of bureaus of child hygiene,
the suggestion being made that a committee be appointed to draw up
standards of prenatal care for the use of physicians at clinics and
also in private work. The Children’s Bureau accepted the sugges
tion, and the chief of the bureau requested an obstetrician who is
also a member of the faculty of the Harvard Medical School to form
such a committee. The members, who represent different geograph
ical sections of the country, include instructors in obstetrics from
several medical schools. The director of the maternity and infanthygiene division of the Children’s Bureau meets with this committee.
This committee formulated standards of prenatal care for physicians,
which were published by the Children’s Bureau in 1925 as one of its
bulletins and which have been adopted by several medical schools for
use in their courses of instruction. The committee continued to
serve the bureau in an advisory capacity, and its chairman also hae
rewritten the bureau’s bulletin Prenatal Care, which like all ths
bureau’s publications on this subject was approved by the committee
before it was issued. The scope and character of the maternalmortality study made by 15 States in cooperation with the bureau
were determined largely by this committee.
These two committees are not merely nominal; they render great
service to the bureau and to parents and State directors who look to
the bureau for material on the subject of adequate maternal, infant,
and child care.
SU R VE YS

AN D

STU D IE S

The Children’s Bureau cooperated in surveys and studies in a
number of States. Usually the cooperation included the assignment
of bureau personnel for the purpose of collecting data in the States,
the information obtained to be compiled, edited, and published later
by the bureau.
SURVEY OF MATERNITY HOMES

Soon after the passage of the maternity and infancy act a survey of
maternity homes was made in cooperation with the State of Pennsyl
vania. Both health and social aspects were investigated, a physician
3

For the membership of these advisory committees see footnote 2, p. 116.

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THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

aiid a social worker bein^ assigned from the bureau for the study
Later the investigation was extended to Minnesota, and still later
Montana requested a survey of maternity homes and a physician was
assigned to make the survey in that State.
STUDY OF STILLBIRTHS AND NEONATAL DEATHS

+LA TTU?Vest¥ atii I1AT-f stillbirtbs and neonatal deaths was begun at
the University of Minnesota in 1923 for the maternity and infanthygiene division of the Children’s Bureau. The study related to

in r b ^ i6? 0? 8? 16
1 non

f0 r r h ie

deaths t eiore’ during> and after birth and

Patbol°?y> and prevention, based on
about 1,000 stillbirths and deaths of mfants under 2 weeks of age.
lh e tabulations are m process of analysis by bureau statisticians.
STUDY OF NEONATAL MORBIDITY AND MORTALITY

In 1928 the child-hygiene division of the bureau began a study of
the causes of neonatal morbidity and mortality, in cooperation with
I**!6 f t e? W
° o1 of Medicine. Infants were examined on
the first, third, tenth, fourteenth, and forty-second days of life, and a
pathological study was made of any who died before the forty-second
f
mf?r? atl0.i11 Regarding 1,001 cases to be included in the
report of the study will follow certain general lines relating the natal
and neonatal history of the child to the prenatal and natal history of
the mother. Special analysis will be made of the history o f the pre
mature mfants ; and the history of those who were stillborn or who
led within the first month after birth will be given special attention
to determme so far as possible the cause of death. The findings in
these special studies and in the autopsies made will be considered in
connection with the information available for the whole group.
STUDY OF MATERNAL MORTALITY

A maternal-mortality study was discussed by the chairman of the
bureau s obstetrical advisory committee at the 1926 conference of
btate directors of matermty and infancy work, and such a study was
approved by the conference. A plan of work, schedules, and instructions covering details of the work were prepared with the assistance
ol the bureaus obstetrical advisory committee. Every maternal
death registered within the calendar years 1927 and 1928 was investi
gated m 13 States and every such death registered in 1928 in these
States and two additional States. These 15 States were the followmg: Alabama, California, Kentucky, Maryland, Michigan, Minnesota Nebraska New Hampshire, North Dakota, Oklahoma, Oregon,
Khode Island, Virginia, Washington, and Wisconsin.
lh e investigations made by the physicians included the selection of
data from birth and death certificates, and visits to attendants phy
sicians, midwives, or others who attended the woman who died * The
hospital record was obtained for all of these women who had had hos
pital care. The Children’s Bureau lent physicians to nine States to
make the investigations. _ Six States supplied physicians from thenown staffs to make the visits to attendants, only advisory and other
occasional service bemg rendered these six States by the bureau
I acts m the birth and death certificates filed in the State bureaus of
\ital statistics afforded the preliminary data. Further information
was obtained by the medical investigators in their interviews with the
physician, midwife, or other attendant at birth for every woman who

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SERVICES OF TH E CH ILD REN ’S B U R EAU U ND ER THE ACT

125

died in childbirth within the period of the study. The data from the
7,537 schedules obtained in the 15 States came to the Children’s
Bureau to be tabulated and analyzed.
In the 13 States in which all maternal deaths of 1927 (3,234) were
investigated 797 of these deaths were due to albuminuria and con
vulsions. Reports on the prenatal care received were obtained for
728 of these deaths. More than half the women (375) received no
prenatal care. Of the 355 who had some prenatal care, 192 had
wholly inadequate care. Sixty-four had fair care beginning some
what late in pregnancy, and 76 received care that was regarded as good
though below the requirements in the bulletin, Standards of Prenatal
Care, prepared by the obstetrical advisory committee of the Chil
dren’s Bureau and issued by the bureau. Only 20 mothers had the
grade of care “ excellent” recommended in this bulletin. In 3 cases
the care could not be graded.
It should be borne in mind that the statement of the amount and
land of prenatal care given relates only to a group of women who died
from albuminuria and convulsions; a survey of care given mothers
surviving childbirth might show a larger proportion of women
receiving proper prenatal care.
Of the 3,234 puerperal deaths in 1927 in 13 States, 1,278 (40 per
cent) were due to puerperal septicemia. One of the objects of the
study has been to determine the underlying causes of the deaths from
sepsis, which form a large proportion of the puerperal losses. It was
found that abortions preceded 45 per cent of the deaths from septi
cemia. Of a total of 570 abortions 309 were induced, 154 were
spontaneous, 19 were therapeutic, and for 88 the type was unknown.
Thus abortions known to be induced were responsible for about onefourth of the deaths from sepsis.
A study of 796 cases in the sepsis group for which prenatal care was
reported showed that nine-tenths of the women had had inadequate
care or no care.
STUDY OF RICKETS

Some of the work of the child-hygiene division of the bureau was of
direct value in promoting the purposes of the maternity and infancy
act— in particular a study of rickets made by that division in coop
eration with the Yale University School of Medicine and the New
Haven Department of Health. A district consisting of three wards
of New Haven was selected for the demonstration part of the study,
which covered approximately three years. During this period
clinical and X-ray examinations were made of the children receiving
treatment and of a control group. Social and economic data having
a bearing on the development of rickets in New Haven also were
collected. Tabulations were made showing the relation of the New
Haven rickets diagnoses in each 3-month period to the amount of codliver oil taken, the diet, the presence of tanning of the skin, the rate
of growth, and the deviation from average weight for height and age,
not only in the period under consideration but also in contiguous
periods.
A study of approximately 600 Porto Rican infants also was made to
furnish further standards for interpreting the New Haven findings.
The study covered, in addition to data on rickets, not only certain
aspects of health but also material on social and economic conditions
in the families of the children, diets, and such local conditions as were

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126

the welfare and hygiene of maternity and infancy

pertinent to the study. The health of the children as indicated by
morbidity and mortality statistics was considered, their growth, and
their general physical condition. The report of this study will include
a detailed discussion of the incidence of rickets, evidences of the
disease found in rontgenograms of the arm bones and at physical
examination, and the relation of these evidences to various other
factors.
In addition to the rickets studies in New Haven and Porto Rico
a study was made of rickets in children in the District of Columbia.
Both clinical and X-ray data were collected in this investigation, and
attention was given also to the nutrition of the children.
P R E P A R A TIO N

OF M A T E R IA L

FO R D IST R IB U T IO N

Although the States themselves prepare popular publications on
child care and maternal care for distribution to the public, most
of them also receive regular quotas of certain popular bulletins
on child and maternal care issued by the Children’s Bureau, which
they distribute to their public. Several new folders were prepared
during the period when the bureau and the States were conducting
this cooperative program and were widely distributed by State
directors.
A number of bureau publications have been prepared for the infor
mation of physicians and nurses conducting child-health work, for
scientists, and for research workers. Included in this group of
publications are Standards for Physicians Conducting Conferences at
Child-Health Centers, Standards of Prenatal Care— an outline for
the use of physicians, Prenatal Letters (prepared for the use of State
bureaus or divisions of child hygiene), References on the Physical
Growth and Development of the Normal Child, Posture Clinics,
Posture Exercises, Habit Clinics for the Child of Preschool Age, Milk—
the Indispensable Food for Children, and What Is Malnutrition?
In the grant of funds to the States the maternity and infancy act
assisted directly in the promotion of the welfare and hygiene of
maternity and infancy. The surveys and studies of the Children’s
Bureau, the lending of members of the Federal staff who are specialists
in child hygiene and obstetrics, the conferences of State directors,
the assistance given by national advisory committees of pediatricians
and obstetricians, and the popular bulletins published by the bureau
also played an important part in this joint undertaking of the State
and Federal Governments.

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APPENDIXES
APPENDIX A — TEXT OF THE ACT FOR THE PROMOTION OF THE
WELFARE AND HYGIENE OF MATERNITY AND INFANCY AND
OF SUPPLEMENTARY LEGISLATION
[S. 1039— Sheppard-Towner A c t; Public 97— 67th Congress; 42 Stat. 224J
An Act For the promotion of the welfare and hygiene of maternity and infancy, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States
of America in Congress assembled, That there is hereby authorized to be 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 e c . 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: A nd 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 e c . 3. There is hereby created a Board of Maternity and Infant Hygiene,
which shall consist of the Chief of the Children’s Bureau, the Surgeon General
of the United States Public Health Service, and the United States Commissioner
of Education, and which is hereafter designatedin this Act as the board. The
board shall elect its own chairman and perform the duties provided for in
this Act.
The Children’s Bureau of the Department of Labor shall be charged with the
administration of this Act, except as herein otherwise provided, and the Chief of
the Children’s Bureau shall be the executive officer. It shall be the duty of the
Children’s Bureau to make or cause to be made such studies, investigations, and
reports as will promote the efficient administration of this Act.
S e c . 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
A c t: 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 provisions for accepting the provisions of this Act the governor of
such State m ay in so far as he is authorized to do so by the laws of such State
accept the provisions of this Act and designate or create a State agency to
cooperate with the Children’s Bureau until six months after the adjournment of
the first regular session of the legislature in such State following the passage
of this Act.
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Sec . 5. So much, not to exceed 5 percentum, of the additional appropriations
authorized for any fiscal year under section 2 of this act, as the Children’s
Bureau m ay 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.
Sec . 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 persons
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, equip
ment, 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.
Sec . 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 estimated
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.
Sec . 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 carry
ing 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 objections 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. W ithin 60 days after any appropriation authorized by this act has
been made, and as often thereafter while such appropiiation remains unexpended
as changed conditions m ay 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 legisla
tive authority, accepted the provisions of this act and designated or authorized
the creation of an agency to cooperate with the Children’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 submitted 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 appro
priated by the legislature of the State for the maintenance of the services and
facilities of this act, as provided in section 2 hereof; and (4) the amount to
which the State is entitled under the provisions 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.
Sec . 11. Each State agency cooperating with the Children’s Bureau under
this act shall make such reports concerning its operations and expenditures
as shall be prescribed or requested by the bureau. The Children’s Bureau
may, with the approval of the board, and shall, upon request of a majority of
the board, withhold any further certificate provided for in section 10 hereof
whenever it shall be determined as to any State that the agency thereof has
not properly expended the money paid to it or the moneys herein required to
be appropriated by such State for the purposes and in accordance with the
provisions of this act. Such certificate m ay be withheld until such time or
upon such conditions as the Children’s Bureau, with the approval of the board,

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APPENDIXES

may determine; when so withheld the State agency m ay 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.
Sec . 12. N o 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 accordance
with the provisions of this act be used for the payment of any maternity or in
fancy pension, stipend, or gratuity.
Sec. 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 Act To extend the provisions of certain laws to the Territory of Hawaii
*

Sec . 3. The Territory of Hawaii shall be entitled to share in the benefits ot
the act entitled “ An act for the promotion of the welfare and hygiene of mater
nity and infancy, and for other purposes,” approved November 23, 1921, and
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]
An Act To authorize for the fiscal years ending June 30,1928, and June 30,1929, appropriations for carrying
out the provisions 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, and for other purposes

Be it enacted by the Senate and House of Representatives of the United States
of America in Congress assembled, That section 2 of the act entitled “ An act
for the promotion of the welfare and hygiene of maternity and infancy, and for
other purposes,” approved November 23, 1921, is amended by striking out the
words “ for the period of five years” wherever such words appear in such sec
tion and inserting in lieu thereof the words “ for the period of seven years.”
S e c . 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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Federal Reserve Bank of St. Louis

APPENDIX B.— ADMINISTRATIVE AGENCIES AND OFFICERS
State administrative agencies and names of the executive officers for the administration
of the act for the promotion of the welfare and hygiene of maternity and infancy (as
of June SO, 1929)
State (and Territory)

Administrative agency and department

Alabama__________

Bureau of child hygiene and public-health nursing,
State board of health (Montgomery).
Child-hygiene division, State board of health
(Phoenix).
Bureau of child hygiene, State board of health (Little
Rock).
Bureau of child hygiene, State department of health
(San Francisco).
Child-welfare bureau, State department of public
instruction (Denver).
Bureau of child hygiene, State department of health
(Hartford).
Division of child hygiene, State board of health
(Dover).
Bureau of child hygiene and public-health nursing,
State board of health (Jacksonville).
Division of child hygiene, State board of health
(Atlanta).
Division of maternity and infancy, Territorial board
of health (Honolulu).
Bureau of child hygiene, State department of public
welfare (Boise).
Division of child hygiene and public-health nursing,
State department of public health (Springfield).
Division of infant and child hygiene, State board of
health (Indianapolis).
Division of maternity and infant hygiene, State Uni
versity of Iowa, State board of education (Iowa
City). •
Division of child hygiene, State board of health
(Topeka).
Bureau of maternal and child health, State board of
health (Louisville).
Bureau of child hygiene, State department of health
(New Orleans).
Division of public-health nursing and child hygiene,
State department of health (Augusta).
Bureau of child hygiene, State department of health
(Baltimore).
Division of hygiene, State department of public
health (Boston).
Bureau of child hygiene and public-health nursing,
State department of health (Lansing).
Division of child hygiene, State department of health
(Minneapolis).
Bureau of child hygiene and public-health nursing,
State board of health (Jackson).
Division of child hygiene, State board of health (Jef
ferson City).
Child-welfare division, State board of health (Helena)
Division of child hygiene, bureau of health, State
department of public welfare (Lincoln).
Child-welfare division, State board of health (Reno).
Division of maternity, infancy, and child hygiene,
State board of health (Concord).
Bureau of child hygiene, State department ofhealth
(Trenton).
Division of child hygiene and public-health nursing,
bureau of public health, State department of public
welfare (Santa Fe).
Division of maternity, infancy, and child hygiene,
State department of health (Albany).
Bureau of maternity and infancy, State board of
health (Raleigh).

Arizona______ ____
Arkansas__________
California..- ...........
Colorado__________
Connecticut 4______
Delaware__________
Florida____________
Georgia___________
Hawaii___ ________
Id aho..___________
Illinois 4....................
Ind ian a...._______
Io w a ...___________
Kansas.....................
Kentucky_________
Louisiana_________
Maine_____ _______
Maryland.......... ......
Massachusetts 4____
Michigan_________
Minnesota___ _____
Mississippi...........
Missouri..... .............
Montana__________
Nebraska....... ..........
Nevada___________
New Hampshire___
New Jersey......... .
New Mexico_______
New Y ork....... ........
North Carolina____

1 State health officer serving.
2 Chief.
3 Executive secretary

130

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Federal Reserve Bank of St. Louis

Director
Jessie L. Marriner, R. N.
Mrs. Charles R. Howe.
Dr. C. W. Garrison.1
Dr. Ellen S. Stadtmuller.2
Mrs. Estelle N. Mathews.'»
Dr. A. Elizabeth Ingraham.
Dr. Clealand A. Sargent.
Mrs. Laurie Jean Reid, R . N.
Dr. Joe P. Bowdoin.
Mabel L. Smyth, R. N.
C. K. Macy .1
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.s
Dr. M. Luise Diez.
Dr. Lillian R. Smith.
Dr. E. C. Hartley.
Dr. F. J. Underwood.1
Dr. Irl Brown Krause.
Dr. Ma Belle True.
Louise M. Murphy, R. N.
Mrs. S. H. Wheeler.3
Mrs. M aryD. Davis, R. N.
Dr. Julius Levy .8
Edith Hodgson, R. N .2
Dr. Elizabeth M. Gardiner.
Dr. George Collins.

» State not cooperating.
* Consultant.

131

APPENDIXES

State administrative agencies and names of the executive officers for the administration
of the act for the 'promotion of the welfare and hygiene of maternity and infancy (as
of June SO, 1929)— Continued
State (and Territory)

Administrative agency and department

North Dakota.......... Division of child hygiene and public-health nursing,
State department of public health (Bismarck) .
Ohio______________ Division of child hygiene, State department of health
(Columbus).
Oklahoma_________ Bureau of maternity and infancy, State department
of public health (Oklahoma City).
Oregon____________ Bureau of child hygiene, State board of health (Port
land).
Pennsylvania........... Preschool division, bureau of child health, State de
partment of health (Harrisburg).
Rhode Island........... Division of child welfare, State board of health
(Providence).
South Carolina____ Bureau of child hygiene and public-health nursing,
State board of health (Columbia).
South Dakota........ Division of child hygiene, State board of health
(Waubay).
Tennessee................. Division of child hygiene and public-health nursing,
State department of public health (Nashville).
T exas... _________ Bureau of child hygiene, State department of health
(Austin).
Utah______________ Bureau of child hygiene, State board of health (Salt
Lake City).
Vermont.. . r
Virginia___________ Bureau of child health, State department of health
(Richmond).
Washington________ Division of public-health nursing and child hygiene,
State department of health (Seattle).
West Virginia______ Division of child hygiene, State department of health
(Charleston).
Wisconsin_________ Bureau of child welfare and public-health nursing,
State board of health (Madison).
W yom ing......... ...... Division of maternal and infant welfare, State de
partment of public health (Cheyenne).

1State health officer serving.

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

2Chief.

6Acting chief.

Director
Dr. Maysil M. Williams.
Dr. J. A. Frank.6
Golda B. Slief, R. N .7
Dr. Frederick D. Strieker.1
Dr. Mary Riggs Noble.2
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.n
Dr. R. H. Paden.
Dr. Cora S. Allen.
Dr. W. H. Hassed.1

7Acting director.

APPENDIX C — INFANT AND MATERNAL MORTALITY RATES
T a b l e I .— Infant mortality rates, in urban and rural areas, and by color in States

having 2,000 or more colored births annually; States in the United States birthregistration area, 19 15-1928
[Source: IT. S. Bureau of the Census]
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 1927 1928
Area....... .............. __
Urban______ _______
Rural____________
White_______
C olored.......... ..............

100

103
94
99
181

101

104
97
99
185

101

100
88

108
94
97
161

91
151

87
89
84
83
131

91
81
82
132

76
78
74
72
108

70
64
79
70
73

83
74
77

60
75

76
80
72
73
110

77
78
76
73
117

71
72
69
67
113

71
64
81
71
77

83
73
72

73
72
79

77
77
77

77
77
75

98
93
103

100
100
101

104
99

95
91

110

100

157

141

72
73
70
68
111

73
74
72
70

65
65
64
61

69
69

112

100

64
106

67
62
74
67
70

69
62
79
69
65

63
56
72
63
65

62
57
70
62
69

62
55
72
62
65

69
67
77

73
70

72
70
82

59
57

59
58
63

91
87
94

93
87
100

71
71
71

109

105

Alabama.................
Urban...................
Rural...................
White_______
Colored___________
Arizona.____ _____
Urban___________
Rural_________________
Arkansas..........._
Urban___________
Rural___________
White_________
Colored______

.......

California________________
Urban_____ ___________
Rural_________________
White________________
Colored_______________

Colorado_______
Urban__________
Rural____________ ____
Connecticut.........................
Urban_________
Rural.................

107
103
119

Delaware........—
Rural_________

101
101
101

94
93
96

107
106

86
86

112

92
93
88

78
71

Florida____ ____
Urban__________
Rural__________
White________
Colored____________
Georgia__________________
Urban_______________
Rural_____________
White________ . .
Colored—_ __ ___
Idaho__________________
Urban______________
Rural___________ __
Illinois_____ ____ ________
Urban__ ____ _________
Rural________________
White________________
Colored........................... |........

132

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Federal Reserve Bank of St. Louis

81
68

75
125

122

133

APPENDIXES

T a b l e I .— Infant mortality rates, in urban and rural areas, and by color in States

having 2,000 or more colored births annually; States in the United States birthregistration area, 1915—1928— Continued
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 1927 1928
86
100

78
(?)
0

87
104
77
0
0

79
88

74
0
0

82
96
72
(i)
0

71
79
66

(*)
0

67
76
61
0
(i)

71
78
0
0

65
73
59
63
140

119

70
145

59
63
55
57
96

56
70
50

59
72
53

55
67
50

53
67
47
59
69
55

Rural_________________1____

75
62
66

72
78
68

77
98
73

80
106
73

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
82
152

93
119
90
87
191

82
105
78
77
147

73
90
70
69
138

62
72
60
58

69
83
67
64
157

72
89
68

65
79
62
61
119

71
85
67
67
119

75
92
72
71
134

61
71
59
58
109

110

67
157

.......

Maine____________________ 105
Urban.... ....................
109
Rural_________________ 104
Maryland—_______________
Urban________________
Rural___________

108
128
102
121
120
122
101

Colored______

209

Massachusetts. ..
101
Urban______
103
Rural_________________ 92

103
87

Michigan___________ _____ 86
Urban , .......................... 96
R u ral...______________ 78
White________ ____ ___ 0
Colored_______________ 0

96
106
87
0
(0

Minnesota__________ _____
Urban _______________
R u ra l___ ______ ______

70
77
67

100

70
78
66

89
89

81
147

94
93
96
81
147

95
87
104
80
155

91
92
83

76
76
77

81
82
76

79
81
75
0
0
59
59
59

109
98

91
89
91

102
110

105
98
115
92
160

104
105
103
90
164

102

101
201

140
146
135
124
215

98
99
91

113
115
104

90
82

89
97
81
0
0

90
97
82
0
0

67
75
64

71
79
67

93
107
89

101

120

116
123

97
80

68
66

100

82
0)
0
66

71
64

Mississippi_______________
Urban__ ______
Rural_________________
White________________
Colored_______________

77
89
73
58
109
86

90
82

101

81
81
81

76
128

76
146

87
83
92
74
137

134

80
82
77
67
128

78
78
75

68
68
66

73
73
74

73
73
72

65
65
64

64
65
63

75
81
67
0
0

80
85
74
79
147

72
75

77
82
70
76
124

70
64

71
126

75
79
71
73
149

69
74
62

66
102

126

58
60
56

62
62
62

57
56
57

60
61
60

58
57
58

52
48
54

54
55
53

68
86

71
94
69
55

70
77
69
59
81

64
55
78

94
87

53
85

67
53
82

87
67
53
83

71
72
71

67
72
65

71
73
70

77
77
77

113
124

101

102

72
61
86
66
68

64
62
123

58
70

61
59
62

57
71
53

55
51

58
69
54

51
60
48

53
59
51

88
97
78

87
95
78

80
90
69

93
102

80
81
78

76
87
65

79
82
75

69
72
66

69
74
64

i Not shown for years in which the number of colored births was less than 2,000.

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Federal Reserve Bank of St. Louis

73
82

59
74
54

132

102

110

78
83
76
64

97
82

112

115
133
97

118

79
92

70
78

131
89

7»
77
68
66

60
63
57
57

110

Montana_____ ___________
Urban________________
R ural.......................... .

New Hampshire_____ _____
Urban________________
Rural________________

76
79
75

Missouri___________
Urban______ __________
Rural_________________
White________________
Colored_______________

Nebraska_____ _____ ______

63
67
59

59
68

134

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

T a b l e I . — Infant mortality rates, in urban and rural areas, and by color in States

having 2,000 or more colored births annually; States in the United States birthregistration area, 1915-1928— Continued

Deaths of infants under 1 year of age per 1,000 live births
1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928
New Jersey______________
Urban________________
Rural_________________
White____ _______
Colored___ ____ ______
New York...........................
99
Urban______________
102
Rural____________
89
White____ ____
98
Colored..................... . . . 191

94
97
83
93
169

North Carolina_
Urban_________
R u ral....................
W h ite.........
Colored_________

91
93
85
90
176

97
98
93
95
175

100

102
84
168 124
98
82
85
74
14Ó 109

159
96
85
133

84
85
77
82
151

74
74
74
71
139

79
79
77
76
129

72
71
74
69
124

70
70
69

75
76
74
74
138

77
78
72
76
124

72
71
76
71

69
70
67

68
68
66
66

121

114

85
113
81

80
96

113

86
88

78
85
159

101

106

94
100

87
92
178

90
94
85
88

157

83
89
74
31
153

76
73
122

86
110
81
75
109

105

107

109

72
49
74

69
72
69

113

127

128

103

Oklahoma_____
Urban ______
Rural_______
White_____
Colored__________

Rhode Island______
Urban________
Rural.....................

63
69
59

108
184

114
114
114
113
180

120

111

110
110
110

118
129

116
93

113
109
109
194

129
130
128
126
226

108
109

126 (?)
127
118

111

101

South Carolina________
Urban ________
R u r a l.._______
White_______
Colored__________

100

99
101

98
151

60
63
97
99
95
95
167
(2)

113
139

116
150

111

112

76
149

83
148

47
44
49

59
88
86

89
87

90
87
94

79
80
77
76
138

82
81
83
80
131

82
81
83
80
139

112

67
68
64

(2)

97
117
94
78
115

81
98
75
73
121

134

142

151

93
94

85
79

80
81

94
94
94

96
127
92
69
123

93
105
91
67
119

117
94
70
125

121

12)

70
67

107

U tah........................
Urban____ ____ ___
Rural.. ...............
85
116
80

93
128
86

Virginia.......... ...................
Urban____ ____ ____
Rural______________
White__________
Colored_______________
2 Dropped from birth-registration area.

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Federal Reserve Bank of St. Louis

99
77
127

•Tennessee. ___ ____
Urban_________
Rural_______ i ___
White____________
Colored___________

Vermont_________
Urban . . . ____
Rural___________

70
61
64
113
69
78
67
65
131

Oregon_____ ________
Urban. _ ______
Rural................. ......
Pennsylvania..
Urban _______
Rural__________
White..........
Colored_______

59
50
61
66

78
139

63
61
124
65
66
62
63
123

76
in

132

59
59
62
57
109

110
68

92
103
79
91
158

119

71
70
71

North Dakota__
Urban__ _
Rural......... .
Ohio________
Urban__________
Rural_______
White____
Colored. . . . . . .

71
74
69

71
69
72

85
108
81

93
119

85
121

96
117
92

102

73
98

76
92
73

98
129
91
80
137

103
145
93

91
106
87
78

84
107
77
72

79
95
74

77
94

84
98

110

103

102

115

141 1 120

59
55
61

72
74
70
70
116

70
78

104

111

72
72
72

111

70
65
71

106

65
61
66

76
91
72
64
104

135

APPENDIXES

T a b l e I .— Infant mortality rates, in urban and rural areas, and by color in States

having 2,000 or more colored births annually; States in the United States birthregistration area, 1915—1928— Continued
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 Ì927 1928;
69
62
75

Washington..^.___________

69
67
71

63
59
67

64
69

55
55
56

62
58
65

57
51
62

56
52
61

W h ite..
78
92
69

District of Columbia_______ 111
White.............................. 83
Colored_______________ 173

106
83
158

97
71
160

79
99
67

112

85
188

80
94
71

85
67
132

77
90

72
79

91
72
139

83
68
122

50
47
53

48.
4Ì
54‘

80
82
72
84
93
93
77 1 79' ; 69
78 ; 79 i 70
110 . 124 1M?1

70,
78
69:
69
95

56
50
64

56
54
59

71
78
67

70
77
65

65
67
63

677i:
64

69 ! 59
74 ; 61
58
65

6164
60,

79
104
73

80
102

64
73
62

64
51.
67

76
78
75

69
64
70

85
64
134

92
71
143

76
62
108

87. 1 85
67 67
132 123

49
109

78
6546
107

T a b l e I I .— Maternal mortality rates, in urban and rural areas, and by color in

States having 2,000 or more colored births annually; States in the. United States.
birth-registration area, 1915—1928
[Source: U. S. Bureau of the Census]
Deaths of mothers from causes associated with pregnancy and childbirth
per 10,000 live births
' ' ''
State
1915 1916 1917 1918 1919 1920 1921 1922 1923 1924. 1925 ,1926 1^27- 1928
Area........ ............................. 61
Urban............................ 64
Rural___________ _____ 55
60
White___ ____________
Colored_______________ 106

62
65
57
61
118

70
62
63
118

92
96
87
89
139

74
79
69
70
124

80
86

74
76
128

77
59
64
108

73
59
63
107

67
74
59
63
109

65
66
73
73 ■ 74
55- 57
58
61. 60
62
118: 116 107
66

65
75
55
59
113
80

112

89
125
75

7769,
80

90.
!135' ¿6
72
151

129’
84
70;
151

* 58
60 ’
65- 59 6Ï
53,, : 53
52
60 1 56' ! 58‘
77
56
66

61
64
57
60

73
i 62

White________________
Colored_______________
Arizona___________________
U rban ............................
Rural__________ ______

102
1Ó8
101

Arkansas_________________
Urban________________
Rural__ ______________
White.............................
Colored____ ___________
80
88

69
82
57

77
85
65
78
65

78
55
71
45

72
77
65
73
63

67
71.
63
69.
54

59
63
54
571
89

Colorado_________________
Urban____ ____ _______
Rural_________________
Connecticut_______ ____ _
Urban_______ _______ _
Rural............ ..................

121

94
153:
82.
76
128

110

California_________________
Urban____ _____ ______
Rural.. _______ _______
White___ ____________
Colored_______________

69,
78
62
63

68*

96
114
84
56
63
86

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

49
51
42

51
55
37

75
74
79

62
69
42

75
38

53
58
32

57
62
37

57
62
38

57
49
60, ■1 55
43
21

58
60
48

53,
56
37

136

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

T a b l e I I .— Maternal mortality rates, in urban and rural areas, and by color in

States having 2,000 or more colored births annually; States in the United States
birth-registration area, 1915-1928— Continued
Deaths of mothers from causes associated with pregnancy and childbirth
per 10,000 live births
State
1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928
63

102
21

61
72

84
90
77

77
83
71
121

109
126
90
187

White_________ _______

102

93
109
76

59
85
33

107

110

131
117

101

101
110

90
148

110

102

98
115
90
157

121

163

63
67
57
62

White_______ _________

112

White________________

73
87
64
(‘)

104
124
92
(i)

84
103
73
(1)

87
105
75
(i)

64
71
53
62
138

62
70
48
60
109
58

84
53

65
77
55

0
0

69
86

76
92
72

114
152
106

82
108
76

102

64
85
58

76
108
65

105
55

60
98
55
56
108

80
119
74
75
154

63
92
59
59
125

64
94
59
60
130

63
93
57
57
148

61
97
54
54
185

60
80
56
54
154

58
65
47
56
100

60
80
44
58

57
75

160
63
60

65
70
56
63
105

56
63
40
53

57
61
49
56

110

111

62
81
45
(i)

65
81
51
62
134

52
57
96

121

60
79
52

56
81
45

63
83
55
62
88

56
57
131

82
63

White________________

78
81
77

67
94
59

64
76
53
56
98

72
64
61
98

85
104
77

97
82

92
84

95
94
96
138

84
90
76
76
115

118

76
78
73
66

101

102

87
98
82

82
126
63

67
70
63
60
96

59
60
59
53
84

60
63
56
54
83

Massachusetts____________
Urban____ ________ __
Rural_________________

57
60
47

60
64
42

65
70
40

92
96
74

71
75
51

75
78
54

65
48

73
37

Michigan_________________
Urban________________
Rural_________________
White________________
Colored_______________

67
73
62
i1)
I1)

73
64
O

74
76
72
i1)

97
76

77
83
71

93
98
87

69
71
65

69
73
63

0
0

Minnesota________________
Urban___ ____________
Rural_________________

52
54
51

55
62
51

56
60
54

78
88

67
64
69

79
90
72

57
81
44

49
54
47

72
58
57
102

81
52
64
111

51
70

59
89
46

48
67
40

65
83
58

70
93
61

63
85
54

110

60
83
54
54
138

58
75
55
55
106

49
62
47
45
109

60
78
55
55
125

91
123
77
70
126

114
162
92
90
154
101

White________________
72

77
64

67
107
50

80
123
60

58
74
37
51
89

58
69
42
47
98

58
73
36
54
72

100

64
67
47

63
67
35

64
65
59

102

74
62
65
72
56
56

65
69
38

64
72
53
62
127

67
77
52

78
53

66
110

122

65
73
55
64
116

123

78
48
65
116

60
77
50

50
58
45

53
60
48

57
76
45

44
43
45

57
78
43

34
70
82
55
69

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

80
91
125
107
136
98
85
144

White________________

Maine______ _____________
Urban________________
Rural_________ _______

56
70
42

137

APPENDIXES
T a b l e II.

Maternal mortality rates, in urban and rural areas, and by color in
Mates having 2,000 or more colored births annually; States in the United States
birth-registration area, 1915-1928— Continued

State

Deaths of mothers from causes associated with pregnancy and childbirth
per 10,000 live births
1915 1916 1917 1918 1919 1920 1921 1922[ 1923 1924 1925 1926 1927 1928

Mississippi..
Urban...
Sural...
White...
Colored.
Missouri___
Urban..
R ural...
White...
Colored.
Montana..
Urban.
Rural..

75
85
72

Nebraska..
Urban.
Rural..
New Hampshire.
Urban______
R u ral..........

72 I 70
76- 67
69 I 73

105
55

101

62
63
62

74
63

80
114
69

87
158
79
61

94
154

111

112

67
81
58
64
131

70
84
59

63 [ 57
90 89
55 47

105
54

59
91
49

60
90
51

61
52
71

71
83
59

76
80
71

65
59
71

63
62
65

63
71
44
59

59
65
44
57

57 62
64
73
40
37
55
59
97 117

64
75
40
63
91

58
65
41
56
84

110

New York________________ 59
U rban ......___________
59
Rural_____________
I 53
58
White------- ------Colored_______________ 97

63
65
53
61
139

57
59
50
57
85

59
62
44
57
93

60
63
45
58
102

57
59
45
54
117

61
63
50
58
126

73
120

80
114
75
67
107

77
124
70

87
132
79

61
102

North DakotaUrban____
Rural_____
Ohio.
UrbanRural..
White.
Colored-------------------- 136

97
104
87
96
138

1Dropped from birth-registration area.

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

78
145
67
67
105

128

57
100
51

62
62
61

51
105
43

57
54
58

62
76
41
60
104

64
77
45
62
106

64
76
47
62
102

82
47
64
130

116

71
118
60
64
19

Oregon___
Urban.
Rural..

Rhode Island .
Urban___
Rural____

102

104

154

59
62
46
57

112
57
51
99

Oklahoma_______
Urban_______
Rural____
White_______
Colored______

Pennsylvania.
Urban___
Rural____
White____
C olored...

106
75
105
64

35
56
125

North CarolinaUrban_____
Rural_____
White_____
Colored.......

103
54

New Jersey.
Urban..
R ural...
White...
Colored.

61
63
60
65
75
55
64
119

103
175

61
79
43
60
84

82
50
65
101
63
70
19

63
52
67 58
42 I 15

138

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY

T a b l e II. — Maternal mortality rates, in urban and rural areas, and by color in

States having 2,000 or more colored births annually; States in the United States
birth-registration area, 1915—1928— Continued
Deaths of mothers from causes associated with pregnancy and childbirth
per 10,000 live births
State
1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928
112
170
106
78
144

122
163
117
90
154

98
178
88
78
118

107
141
102
85
128

97
140
92
74
122

108
178
100
76
141

|
White

61
52
63

79
72
80

White________________

White

79
113
62

73
93
63

55
66
50

50
73
38

45
59
37

52
77
38

49
70
37

75
100
61

49
58
43

64
51
66

80
51
85

80
83
79

70
83
68

73
98
69

74
85
73

70
134
57

81
90
79

68
138
53

67
65
68

73
133
59

58
106
47

82
130
71
64
121

107
161
95
96
132

83
92
80
66
119

86
133
74
75
111

70
113
59
57
99

72
112
61
58
102

74
99
67
60
108

100
56
50
100

70
95
63
53
110

80
123
67
71
100

62
104
50
48
94

75
121
62
59
114

74
86
63

99
104
94

86
101
72

92
99
85

78
87
69

79
84
73

67
70
63

71
86
55

60
69
50

75
89
60

66
68
65

72
84
59

63
118
51
60
125

71
129
57
66
140

62
130
47
59
104

57
122
43
53
110

86
59
148

* Dropped from birth-registration area,

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

89
135
74
76
153

84
114
70

48
62
40

58
74
48

67
82
58
1

101
76
158

71
120
56
59
135

86
106
78

57
60
58
69
57 ' 54

70
56
99

109
170
100
88
129

59
68
56

___________

White.........................—

91
78
126

86
68
132

88
66
144

101
99
108

56
67
49

58
70
50

60
67
56

52
63
44

60
71
50

53
56
50

58
69
49

71
111
62

73
114
62

98
126
90

95
139
84

93
59
102

87
125
79

65
39
70

71
56
106

101
89
130

122
92
190

87
61
143

77
64
105

86
66
131

85
72
114

139

APPENDIXES

T a b l e I I I . — Infant mortality rates for the United States and certain foreign coun

tries; 1915-1928
[Figures from official sources]
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 1928
68
218

70
192

56
186

59
193

202

203

206

267
146

Chile.................. ................... 254

241

269
109

255
101

100

Austria_________ ____ _____

69
156
109
224
110

69
157
110
195
146
100
263
106
178
90
137
80

66
154
122
198
158
88
278
65
173
77
133
83

53
156
114
175
155
87
240
97
85
140
77
105
99
130
82
92
198
69
126
166
91

England and Wales________ 110

306
101
142
92
128
89

110
Germany........... ................... 168

110
148

118
155

115
154

135
121

97
131

130
85
147
160

116
219
81
147
170

115
216
84
139
173

116
217
80
192
189

112
159
84
129
170

81
193
78
127
166
128

95
134
68
76
193
73
129
168
93

50
107
68

51
89
64

48
97
64

103
48
101
63
144

93
45
95
62
132

83
51
94
58
147

85
48
87
54
141

77
42
77
55
124

Scotland................. ...........
126 • 97
70
76
78
Switzerland....... ................... 90
U. S. birth-registration area2. 100 101
Uruguay__________________ 111 124

107
65
79
94
107

100
65
88
101
110

102
70
82
87
101

92
63
84
86
117

90
64
74
76
107

101
62
70
76
94

Irish Free State___________
Japan___________ . . _______

New Zealand________ _____
Northern Ireland__________

54
54
57
53
61
141 127 119 1123 U24 i 120
100 95 100 104
176 189 174 189 167
165 150 152 127
88
79
79 102 94
283 266 258 251 226 170
121 143 122 148
U47 1148 U46 1154 1157
84
83
84
83
80
143 150 155 146 152
75
75
70
70
69
65
103 100
96 102 115
92 107
85
86
97
132 109 105 102 97
189
92
98
79
81
99 104
89
184 193 168 167 185
74' 71
66
72
68
68
128 126 119 127 120
163 156 142 137 142
138
88 101 107
88
96
170 179 146 151
147
58
61
59 i 52
66
61
44
40
40
40
39
36
76
85
85
86
78
78
50
50
50
48
51
118 150 139 155 118
53
77
47
48
91
83
79
98
89
86
60
56
56
61
62
58
57
54
57
72
73
77
71
65
69
104 108 115
93 106
100

1 Provisional figures.
2 The United States birth-registration area expanded from 10 States in 1915 to 44 States in 1928.
T a b l e IV . — Maternal mortality rates for the United States and certain foreign

countries; . 1915—1928
[Figures from official sources]
Deaths of mothers from causes associated with pregnancy and childbirth
per 10,000 live births
1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928

Canada___________________
Chile______ _______ ____ _
Denmark...............................
England and W ales........... .
Estonia_____ _____________
Greece____________________
Hungary__________________
Irish Free State___________
Italy______________ _______
Japan................. ...................
Lithuania_______ ____ ____
The Netherlands__________
New Zealand______________
Northern Ireland__________
Norway_________ _________
Salvador____________ ____ _
Scotland.................................
Sweden______________ ____
Switzerland__________ ____
U. S. birth-registration area2.
Uruguay................................

47
72

50
60

88
37

53
22
36

45
53
55
80

30
72
30
57
25
33
25
51
47
25
46
66
25
51
66
27

75
40
24
43

42
57
27
35

40
49
30
35

52
48
37
38

29
47
29
33

32
49
28
35

33
73
29
50
26
36

33
51
46
34
62
32
57
74
23

24
65
69
26
57
62
27
56
80
34

23
51
52
22
57
64
27
55
-68
33

47
56
27

59
50
28

60
51
30

29
52
47
30

61
29

57
27
54
62
29

59
25
56
66
32

70
26
51
92
30

61
22

47
57
51
79
37
20
39

20
38

55
51
56
53
59
56
58
50
61
54
60
56
57
56
74
61
61
58
58
1 33 i 31 1 33 1 34 1 36
23
24
26
31
26
38
39
41
41
41
45
40
38
41
41
31
35
29
32 130
85
88
28
31
29
32
30
48
48
47
49
45
27
32
28
26
26
34
31
30
28
27
59
56
50
23
24
29
29
26
42
51
50
47
49
49
44
48
45
56
29
32
28
27
56
63
50
57
50
64
58
62
64
64
23
24
26
43
44
46
48
37
67
66
65
66
65
25
25
22
27
30

1 Provisional figures.
2 The United States birth-registration area expanded from 10 States in 1915 to 44 States in 1928,

9412°— 31-

-10

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

47
44

49
28
234
49
52
70
69
24

A P P E N D IX D .— P U B LIC A TIO N S A N D E X H IB IT S OF T H E C H IL D R E N ’S
BUREAU B E A R IN G U P O N M A T E R N A L , IN F A N T , A N D C H ILD W E L
FARE A N D H Y G IE N E
BULLETINS

The Promotion of the Welfare and Hygiene of Maternity and Infancy— Report
of the Administration of the Act of Congress of November 23, 1921, for the
period March 20, 1922, to June 30, 1923. N o. 137. 42 pp.
The Promotion of the Welfare and Hygiene of Maternity and Infancy— Report
of the Administration of the A ct of Congress of November 23, 1921, for fiscal
year ended June 30, 1924. N o. 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. N o. 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.
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, 1928. N o. 194. 180 pp.
(The reports of the 45 coop
erating States and the Territory of Hawaii are available as separate leaflets.)
The Seven Years of the M aternity and Infancy A ct; excerpts from Publication
N o. 203 (The Promotion of the Welfare and Hygiene of Maternity and In
fancy, fiscal year ended June 30, 1929). 22 pp.
i Proceedings of the Third Annual Conference of State Directors in Charge of
the Local Administration of the Maternity and Infancy A ct (act of Congress
of November 23, 1921), Held in Washington, D . C ., January 1 1 -1 3 , 1926.
N o. 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. D e
Normandie, M . D . Separate N o. 1. 20 pp.
The Nurse’s Part in a State Program of Prenatal Care, by Carolyn Conant
Van Blarcom, R. N . Separate N o. 2. 8 pp.
How to Make a Study of Maternal Mortality, by Robert L. D e Normandie,
M . D . Separate N o. 3. 11 pp.
A Demonstration of the Community Control of Rickets, by Martha M .
Eliot, M . D . Separate N o. 4. 5 pp.
,
The Practical Application of Mental Hygiene to the Welfare of the Child,
by D . A . Thom, M . D . Separate N o. 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 1 1 -1 3 , 1927.
N o. 181. 167 pp.
The Problem of Compulsory Notification of Puerperal Septicemia, by George
Clark Mosher, M . D . Separate N o. 1. 13 pp.
The County Health Organization in Relation to Maternity and Infancy
Work and Its Permanency, by John A . Ferrell, M . D . Separate N o. 2.
Evaluation of Maternity and Infancy W ork 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 N o. 6. 7 pp.
i Available only by purchase from the Superintendent of Documents, Government Printing Office,
Washington, D. C.

140

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Federal Reserve Bank of St. Louis

APPENDIXES

141

Papers delivered at the Fifth Annual Conference of State Directors in Charge of
the Local Administration of the Maternity and Infancy Act, 1928:
Prevention of Neonatal Mortality from the Obstetrician’s Point of View, by
Fred L. Adair, M . D .
Causes and Prevention of Neonatal Mortality, by Richard A. Bolt, M . D .
Midwifery in Denmark, by Dorothy Reed Mendenhall, M . D .
Rural Hospitals or Maternities of Canada, by Mrs. Jean T . Dillon, R. N .
Prenatal Care (revised 1930). N o. 4. 71 pp.
Infant Care (revised, 1929). N o. 8. 127 pp.
The Child from One to Six; his care and training. N o. 30. (In preparation; to
supersede Child Care.)
Child Management (revised), by D . A . Thom, M . D . No. 143. 47 pp.
Are You Training Your Child to Be Happy? Lesson material on child manage
ment. No. 202. 57 pp.
Standards of Prenatal Care; an outline for the use of physicians. No. 153.
4 pp. (Also sample form for pregnancy record.)
Breast Feeding. N o. 83. 13 pp.
Standards for Physicians Conducting Conferences at Child-Health Centers.
No. 154. 11 pp.
(Also sample forms for conference record.)
H ow to Conduct a Children’s Health Conference. N o. 23. 24 pp.
Children’s Health Centers. N o. 45. 7 pp.
Milk, the Indispensable Food for Children, by Dorothy Reed Mendenhall, M . D .
No. 163. 43 pp.
W hat Is Malnutrition? (revised), by Lydia J. Roberts. N o. 59. 19 pp.
Nutrition W ork for Preschool Children, by Agnes K . Hanna. No. 138. 25 pp.
Maternal M ortality; 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.
1 References on the Physical Growth and Development of the Normal Child. N o.
179. 353 pp.
Th e 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. N o. 90. 327 pp.
Causal Factors in Infant M ortality; 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. N o. 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 . N o. 164.
32 pp.
Posture Exercises; a handbook for schools and for teachers of physical education,
by Armin Klein, M . D ., and Leah C. Thomas. No. 165. 33 pp.
A Study of Maternity Homes in Minnesota and Pennsylvania. N o. 167. 92 pp.
Recreation for Blind Children, by Martha Travilla Speakman. N o. 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. N o. 62. 15 pp.
List of Psychiatric Clinics for Children in the United States. No. 191. 28 pp.
FOLDERS

Minimum Standards of Prenatal Care. N o. 1.
Backyard Playgrounds. No. 2.
W h y Drink Milk? N o. 3.
W h at Builds Babies? N o. 4.
Sunlight for Babies. N o. 5.
Breast Feeding. No. 8.
Keeping the W ell Baby Well. No. 9.
Out of Babyhood into Childhood. No. 10.
W h y Sleep? No. 11.
Your Child’s Teeth. No. 12.
1 Available only by purchase from the Superintendent of Documents, Government Printing Office,
Washington, D. C.

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Federal Reserve Bank of St. Louis

142

THE WELFARE AND HYGIENE OF MATERNITY AND INFANCY
LEAFLETS AN D D O D G E R S

Books and Pamphlets on Child Care (revised). No. 1.
Is Your Child’s Birth Recorded? (revised). No. 3.
Federal Aid for the Protection of Maternity and Infancy, by Grace Abbott.
8 pp.
The Federal Government in Relation to Maternity and Infancy, by Grace
Abbott.
10 pp.
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.
List of Exhibits.
SM ALL CH ARTS

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 (revised February, 1930).
E X H IB I T M A T E R I A L 2

Infant Welfare (10 posters in colors, 22 by 28 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.
W ell Born. (Two-reel film, showing time 30 minutes. Titles in English or
Spanish. Made in 1923.)
Posture.
(Two-reel film, showing time 20 minutes. Either reel m ay 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.)
The Preschool D ays 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 in
struction used in classes for midwives.)
The Care of the Baby (50 lantern slides).
Infant and Child Welfare (54 lantern slides).
City Playground for Children (model; weight, 109 pounds).

(

2A descriptive list of Children’s Bureau exhibits containing a statement of the conditions and procedure
of loan and purchase can be had on application to the bureau.

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Full text of 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, 1929, Bureau Publication No. 203

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