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L 5.20:47


A P R IL 6


A P R IL 6

T he Public Health Nurse
H o w She Helps to K eep the Babies W ell



C H IL D R E N ’S Y E A R L E A F L E T N O . 6
Bureau Publication No. 47


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

A P R IL 6


A P R IL 6

After the Weighing, What Next?
The Children’s Bureau has asked us to make the year of April,
1918, to April, 1919, Children’s Year, and, as a first step, to under­
take the weighing and measuring of all of Uncle Sam’s babies who
are under 6 years o f age. I f your community is like most American
cities and towns, it has gone into this movement with all its might,
realizing how much the health o f the babies means to their fathers
and brothers who are fighting in France now, and how much it will
count for the strength of our country in the future.
A great many babies have probably been weighed and measured
in your town this summer. Some of them, a good many, have been
found to be healthy and vigorous; some have been found to be under­
developed and ailing. These statistics are interesting and valuable,
but are they all the weighing and measuring campaign was for?
Its main end, I take it, was not to gather statistics, but to save the
lives of some of these babies who would otherwise die of preventable
disease. The Children’s Bureau believes that 100,000 o f these lives
can be saved during this year, if we set ourselves resolutely to the
task. We want to know where the sick babies are in order that we
may make them well; and we want to know where the well babies
are, too, in order that we may keep them well.
Why the Babies Die.
I f the lives o f 100,000 babies can be saved by something that we
can do or leave undone this year, it must be that what some of us
have done or left undone has caused the death o f 100,000 babies each
year in the past. Those babies did not die of their own accord.
They were killed—killed by feeding them with dirty, uncooked cow’s
milk or some other improper food, killed by weakening them with
heavy clothing and then exposing them to a sudden draft, killed by
letting some one who was coming down with | a cold ” fondle them
78112°— 18
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and pass on to them the deadly germs of some disease. They were
most of them, these 100,000 killed by their mothers or their grand­
mothers or their sisters, who loved them very much but did not know
how babies ought to be cared for.
The proportion o f young babies that will die depends almost wholly
on the amount their mothers know about infant care. In Russia 1
baby in every 4 dies before completing the first year of life. The
Russian mothers love their babies, but the “ mother instinct ” does
not teach them to feed them only on mother’s milk or clean, pas­
teurized cow’s milk, and so they give those babies other foods and
the babies are killed by summer diarrhea. In the United States
about 1 baby in 8 dies before reaching its first birthday. That is
better than the Russian record; but in New Zealand only 1 baby
out of 20 dies in the first year o f life. The New Zealand mothers
are no more devoted than ours. They are no more highly educated
nor any wiser in most matters, but they have learned more about
infant care.
The great object of this whole campaign of Children’s Year is to
teach American mothers how they, too, may keep their babies well.
The Infant Welfare Station.
The locaL institution about which this campaign centers, the Little
Red Schoolhouse of the Baby-Saving Movement, is the infant wel­
fare station. This is a place where the mothers may bring their
babies—and where every one of them should be urged to bring her
baby, at least once a week—for examination and advice.
Here the physician in charge will examine the child each week,
see if he is growing normally, and detect any sign of the beginning
of an unhealthy condition in the very first stage, when cure is easy.
Here the mother is told how to feed and clothe and care for the baby;
is given, in short, all the advice she needs to keep the baby well.
It is the establishment of stations of this kind, and the education of
the mothers who have come to them, which have proved everywhere
the most powerful weapons in defending the infant against prevent­
able disease. The establishment of such stations in New York City
led to a reduction o f two-thirds in the infant death rate, with a sav­
ing of 4,125 infant lives. Everywhere the story has been the same,
hence we may say with complete confidence that any community can
reduce its infant mortality rate and save a definite proportion of the
infant lives now sacrificed to ignorance by the establishment of an
infant welfare station.
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The Public-Health Nurse and the Child-Welfare Campaign.
At the right hand o f the physician in the infant welfare station
stands the public-health nurse. It is she who first interviews the
mother, who does the weighing, and prepares the baby for examina­
tion. It is she who keeps the records, and it is she who shows the
mother just how the physician’s directions should be carried out, how
the baby should be dressed and bathed, and how cow’s milk should be
so prepared and pasteurized as to make it safe if breast feeding is
Above all, it is the public-health nurse who follows the case into
the home and there on the spot, with the utensils and the conditions
which the mother has at her disposal, she teaches the principles of the
care o f the baby in the most effective way. She is the final link in the
chain that connects the scientific investigator in his laboratory with
the children he is working to save. She is the messenger who brings
the last word of science to the place where it must really be applied
if our knowledge is to be effective.
What the Public-Health Nurse Does for the Older Children and
for Adults.
The educational work of the inf ant-welfare station is but one aspect
o f the work o f the public-health nurse. When the infant grows up
and enters school, his physical health is still a matter o f grave con­
cern. Defects o f eyesight and hearing, decay of the teeth, tonsil and
adenoid growths may develop and cause diseases, easily checked in
time, but serious if permitted to run their course. It is the school
physician who finds these defects; but once more it is the publichealth nurse who follows the child into the home and sees that the
needed hygienic care or medical treatment are actually secured.
When cases o f communicable disease develop in the community, it
is the public-health nurse who goes into the home and sees that the
necessary precautions are taken to prevent the spread of infection
from one to another. In tuberculosis, abofe all, she not only teaches
the patient how to protect others from his infected discharges but
how so to conduct his own life that his vital resources may be built
up for a successful struggle against the internal enemy.
The nurse is the central figure in the modern public-health cam­
paign. The major object o f that campaign is the training o f the
individual in the laws of personal hygiene and public sanitation, and
it is the nurse who brings those laws in effective form to the factory'
and to the tenement dwelling where they must be applied.
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Does Your Community Need More Public-Health Nurses?
Is your city or town or country village doing its' part in the pro­
tection of its citizens by placing at their disposal the beneficent serv­
ices of the public-health nurse?
Experience in other communities will make it easy to answer this
question. It has been found that for every 5,000 to 10,000 persons in
a city or county there should be one general visiting nurse who can
do most of the general public-health work as well, while for every
1.000 to 3,000 children in the schools in congested districts there
should be a school nurse as well. Whether the infant welfare and
tuberculosis nursing and school nursing shall be carried out by the
visiting nurses or by separate staffs under the board of health or the
board of education depends largely upon local conditions; but some­
where there should be provided nursing service equivalent to that
specified above, the full time of one nurse for every 5,000 to 10,000
people and the full time o f one additional nurse for every 1,000 to
3.000 children in the schools.
I f your community is not provided with such public-health nursing.
service you may be sure that its citizens are suffering from illness
that could and should be avoided and that its babies and grown
persons are dying from preventable disease.
How to Secure Public-Health Nurses.
The first step in the organization of adequate public-health nursing
service is to form a strong local committee representing the local
health department, the medical profession, the women’s clubs, the
clergy, the press, and the organizations devoted to commercial and
civic betterment. The local situation should be studied to see what
facilities are already provided and where new public-health nurses
can best be employed, by the health department, by the visiting nurse
association, or by some other private organization. Next, funds
must be obtained sufficient to pay a salary o f at least $1,200 for each
nurse, with adequate allowance for expenses. Theoretically, These
funds should be provided from the public purse, for health work of
this kind is clearly a community responsibility. In many instances,
however, it may more easily be begun on private initiative, for the
education of budget-making bodies is often a slow process; and the
babies can not wait.
After all preparations are made, the task of obtaining a properly
qualified public-health nurse will be by no means an easy one. Work
of this character requires special training and experience, in addi­
tion to the ordinary education of the graduate registered nurse, and
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'W '

the demands of the war have made serious inroads upon the group
o f qualified women, already far too small to meet essential publichealth needs.
The National Organization for Public-Health Nursing, 156 Fifth
Avenue, New York City, will do all that is possible to aid local com­
munities in securing public-health nurses and in planning for the
development o f the service. A committee of this organization, in a
recent letter to the Woman’s Committee o f the Council of National
Defense, has recently made the admirable suggestion that where a
qualified public-health nurse can not be found a graduate nurse
should be selected and sent for training, to one o f the schools which
offer four or eight months’ courses in public-health nursing. Such
courses are given in New York, Boston, Philadelphia, Chicago,
Cleveland, New Haven, and many other places, and the National
Organization for Public-Health Nursing will furnish detailed in­
formation in regard to them. Miss Jane A. Delano, director o f the
department o f nursing of the American Red Cross, has suggested
that the services of those women who have taken Red Cross courses
of instruction may often be profitably utilized as home health volun­
teers in the public-health campaign but only and always under the
direction o f a qualified public-health nurse.
a War Service.
The present wor
is a conflict not only between armies
but between nati
, not primarily from military
weakness, b u t.
and economic structure, founded
on poverty and
under the strain. The allies
will win, not merely
of their soldiers, but even
more through the soli
pies, based on democracy
and justice fqr the average
th and efficiency, and the
enthusiasm that springs from
on the part of
the munition worker, the food p
pbuilder, and the
railroad employee—these are the sine
; and, therefore,
every step taken to maintain, such vital
a vital factor in the
winning o f it.

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