Cincinnati, Ohio.-Extensive work toward caring for and educating expectant mothers is carried on by private organizations. Fall River, Mass.-The District Nursing Association does excellent work in caring for expectant mothers. Buffalo, N. Y.-The Visiting Nurse Association carries on prenatal work as part of the regular routine. Boston, Mass.-The Boston Board of Health has a prenatal and postnatal subdivision of its division of child hygiene. Systematic and extensive work is carried on by the committee on infant social service in the Women's Municipal League, by the pregnancy clinic of the Boston Lying-in Hospital, and by South End House, one of the social settlements. Inasmuch as this feature in the work of the prevention of infant mortality is comparatively new, the methods and instruction required under it are difficult of access. We here reproduce the prenatal bulletin of the city of Providence, R. I., issued in 1910, and also the circular of the Oregon State Board of Health, very recently issued, believing that these will be especially acceptable to health officers in the smaller cities. EFFECT OF HOUSING CONDITIONS ON INFANT MORTALITY. In organizing a baby-saving campaign the first and main point of attack is usually the milk supply. There seems to be general agreement that this emphasis is justified, but there are also warnings from health experts against classing milk as the sole factor which brings about the high death rate among babies. A large number of diseaseproducing conditions are covered by the term "bad housing conditions." In a broad sense the remedy lies in having better building regulations, more supervision of tenement construction, more serious. study of the congestion question in the large cities, and the field is so large that it is not possible to accomplish much in a quick campaign, beyond what good may result from giving the question publicity. But many of the accompanying evils, such as bad ventilation and lack of cleanliness, are being attacked through the influence of the visiting nurses, through instructions to "little mothers" and through educational printed matter, and doubtless the effort has an effect in lowering the death rate from "bad-air" diseases, such as pneumonia and bronchitis, which make up approximately 15 per cent of the total causes of infant mortality. 1 See Appendix, pp. 90 and 91. FIGHT AGAINST FLIES, GARBAGE ACCUMULATION, DUST, ETC. While it is quite generally agreed that the germ of cholera infantum originates with the cow excreta, and that dirty milk is the principal carrier of the infection, it is by no means admitted that it is the only carrier-the house fly, as a death distributor, is only recently receiving the attention it deserves. Flies carry the infection not only to exposed milk but directly to the baby's mouth or to the nipple of its bottle. To limit the breeding of flies is the essential thing, and this can be done most effectually by giving the health office of the city power to enforce the collection of garbage and regulation of the city dumps. Insistence upon screens for the baby's rooms and for the baby's bed is a part of the campaign against infant mortality. Not only the flies, but dust, as is now well known, is a carrier of enteritis germs and through this the breast-fed child no less than the bottle-fed is exposed to the dangers of this summer terror. When it is understood that this germ when developed can and does use dust particles as a vehicle upon which to ride from pastures to the dusty streets and thence into homes, however carefully guarded and protected its little ones may be, the importance of permitting the health department to have supervisory control over street sprinkling in poor residence districts during June, July, August, and September becomes very apparent. The need for this precaution will be more readily understood when it is realized that the infant death rate in the hot weeks almost invariably falls for a few days after a general dust-settling rain. STABLES AND STABLE FLIES. Upon the opening of summer a thorough listing of all horse stables and livery barns, whether public or private, is made by cities like Seattle and Indianapolis, and complete measures for the control of the fly-breeding places instituted. Whether or not the stable fly is the only carrier of infantile paralysis it is certainly one, probably the principal carrier. Certain cities have issued circulars with magnified cuts of the stable fly to show the distinction between that and the common house fly. This distinction is not generally known and is not readily ascertainable by the eye. In fair weather the stable fly rarely enters the house; just before a rain or a storm it does enter the house and the common saying that "just before a storm the flies bite" is indicative of this. The house fly does not "bite "; it is always the stable fly that bites and it is its bite which is so often fatal to small children. Below is the form of stable score card used in Seattle, Wash., in its inspection service to eradicate the breeding places of flies and control stable flies: DEPARTMENT OF HEALTH AND SANITATION, CITY OF SEATTLE. If poorly constructed... If dilapidated.. Floors, cement with proper gutters and catch basin, and sewer or cesspool connection.... Cement, badly laid. Cement, broken... Wood, tightly laid, as per ordinance. Wood, open cracks.. Manure box, strictly fly proof, with vent. Surroundings, perfectly clean.. If there is water on lot.. If there is manure scattered about.. If premises are disorderly... If any manure be on premises, exposed to flies, score will be limited to 49. Filthy catch basins, deduct 5 from total. FRESH-AIR CAMPS AND HOSPITALS. Fresh-air camps have been operated during the summer months with good results in many cities. These are usually private philanthropies. Although prevention is the chief end and aim of all work in behalf of children, nevertheless there must be hospital accommodations for those cases of illness which can not be properly cared for at home. As a city grows a hospital of some sort sooner or later becomes a necessity. However small such a hospital, it may contain from the first beds for children. As an example of what is possible on a large scale, Cleveland, Ohio, has a finely equipped Babies' Hospital, devoted entirely to the care of infants and young children. In almost any hospital it is possible to turn over to the exclusive use of children some of the beds and facilities, so that in case of emergency there will be some place where sick children may be taken care of. EDUCATIONAL WORK THROUGH THE DISTRIBUTION OF CIRCULARS, PAMPHLETS, ETC. The volume of printed instructions annually issued, as well as the character of the material, improves each year. State boards of health have issued exceedingly valuable pamphlets appealing alike to city authorities to bestir themselves and to parents to instruct themselves in the care of babies. These two audiences have not always been kept distinct, as much material directed at both is sometimes contained in the same pamphlets. The North Carolina State Board of Health issued in 1912, as Special Bulletin No. 10, a pamphlet on "The Baby," using most effectively a cartoon of a mother gazing into the empty cradle. A part of the legend is "In future men will stop locking the stable door after the horse is stolen. They will not be content with spending on a funeral the money that would have saved the child; they will not tolerate the thought that a poor mother must bear 10 children to raise 5." "Save the Baby" articles are prepared by a number of the State boards, and furnished to the papers throughout the State. In North Carolina these are included from time to time in the State Board of Health's "Daily Press Service" publications. In other States as Iowa, Idaho, etc., where the general scheme is adopted the articles are prepared only on special occasions. A bibliography of these State and city publications would be valuable and may form a part of this report next year, but can not be attempted now. Some cities, notably Chicago and Seattle, issue weekly or monthly bulletins which in addition to statistical matter contain much that is instructive as to the care of babies' food. The health officer of Washington, D. C., issues instructive pamphlets on such subjects as the care of milk, the fly menace, methods of destroying flies, etc. Lectures to mothers and moving-picture films, illustrative of the principles of baby hygiene, are also among the educational features which some cities have successfully adopted. Of prime importance are the folders addressed to mothers and dealing directly with the care and feeding of the child. These are mailed immediately upon receipt of notice of birth of a child, or are delivered by the nurse who calls as the result of such birth notification. Such folders are issued in all of the principal languages spoken in the locality, as, for instance: Bridgeport, Conn., prints in four languages; Providence, R. I., in five; the State Board of Health of Pennsylvania publishes such circulars of instructions in five or six languages, and furnishes these to the various cities of the State. Likewise the Department of Health of New York issues a pamphlet on "How to Save the Babies," which is distributed through the city health bureaus. Selected copies of these circulars in various languages will be found in the appendix. The importance of having these instructions in many languages will be apparent. It very often happens that the mother does not understand the language either of the visiting nurse or of the physician, and is hence thrown back, as soon as they leave the house, upon her own resources, or left to the mercy of advisory neighbors as ignorant as herself. It may frequently happen, also, that where health officers have no means or opportunity of doing anything more they can have such circulars distributed among mothers, or have the material printed in the local papers. Experience has shown that the editor, for instance, of the Italian paper is glad to print this material if the copy is furnished to him in Italian; the publisher of the Yiddish paper is entirely willing to publish it if it can be furnished to him in Yiddish, etc. It should be noted that these "Care of the Baby" and "Save the - Baby" circulars frequently contain some information as to the care of the mother immediately before the birth of the child. CONCLUSION. It is evident that no universal program for civic baby-saving work can be laid down, because each community must begin at the point which is practicable or most urgent as shown by local conditions, but the following summary is offered as universally applicable: (1) A continuous graphic statement of the births and deaths of babies, kept by means of different-colored pins to be placed day by day on a city ward map or, preferably, a block map showing each dwelling, is a simple means of keeping informed as to the points of danger.1 (2) Complete registration of births is necessary in order that the baby may be brought under observation as soon after birth as possible. (3) The appeal to mothers to nurse their babies can not be made too strong, since it is estimated that bottle-fed babies have only onetenth the chance to live that breast-fed babies have. (4) A clean milk supply is a fundamental need. The ideal is: Nothing short of clean milk for everybody. This calls for intelligent and effective inspection of farms, the means of transportation, and the shops where milk is sold. Milk stations for distributing clean milk to babies, maintained by private philanthropy, are a useful beginning. 1 See page 14. |