THE REPORT OF THE 
 PHILADELPHIA BABY 
 SAVINC; SHOW 1912 
 
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 REPORT OF THE PHILADELPHIA 
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 Knowledge is waste, unless knowledge saves. Humanitj' is the measure of 
 scientific discovery. Unless the many learn, the few teach in vain. 
 
 The Philadelpiiia Baby Saving Show lived all tliis. It sought to bring the 
 newest fact in medicine near the newest baby. It brought science to worship the 
 babe in arms, and most of all the babe for whom "there was no room in the inn," the 
 inn of all the world in which the best rooms are taken by the old and advantaged, 
 which are the past, and the babe, which is the future, is brought forth to pay the 
 heavy tax of death, laid by a decree greater than Caesar's, through which all the 
 world is indeed at last taxed, but the babe first and most of all. 
 
 Not all babies. Even this tax of death laid on babies can be commuted by 
 care and knowledge. The death of the old is inevitable and in the course of nature. 
 The death of babies is social murder and in the course and carelessness of man. 
 Educate the mother, and the baby will have life more abundantly. Given perfect 
 conditions, or at least as perfect as our known knowledge now permits, and not one 
 baby in an hundred would die, as a baby. Years later, age would end. Now, 
 babyhood slays. Leave conditions as they are and twenty or twenty-five out of an 
 hundred babies die. 
 
 The fight for babies is in most cities the fight for a quarter of tho.sc born. 
 No one can win this fight but the mother. Add to her love, knowledge, and to her 
 knowledge, instruction, and to instruction, practice, and a place in a mother's 
 arms would be the safest of all refuges. Today society slays one in four babies 
 in their mothers' arms. It is the most unsafe refuge known. No other part of 
 society dies as much as babies. 
 
 The Baby Saving Show in Philadelphia was an effort, both beautiful and blest, 
 to make a place in a mother's arms as safe as it looks — to make it the home of life 
 as well as of love, and not, as it is now, the haunt and harvest of death. It was 
 pathetic to discover that the mothers already knew this. They knew no statistics. 
 They only knew babies and little white coffins. Try to think what it mean.s — if 
 you can bear the poignant pang of this discovery — to find out through this show 
 that mothers by the ten thousand knew that their babies need not die, knew that 
 somewhere there were men who knew what would save their babies, and yet knew 
 no place where they could get this precious knowledge, this buckler and shield 
 against the darts of death, aimed at the babies in their arms. 
 
 The instant the Philadelphia Baby Saving Show was opened it filled with 
 
 mothers. Every day it filled over and over again. They came by companies, by 
 
 regiments, by brigades, and by divisions. No Philadelphia procession ever equaled 
 
 the numbers in these throngs seeking knowledge how to keep their babies alive. 
 
 i 3 
 
 281760 
 
4 FOREWORD 
 
 It was given them. It was flung out in print. It was made plain in placards. 
 Models made it still plainer. Safety was acted. Hundreds of young women, 
 trained in this wondrous tale, told it in booth and alcove. The future mother, 
 patiently waiting until she met her chance of one death in twenty in childbirth, 
 came to hear lectures that she might save the child below her heart from one 
 death in five births that lay in wait for it. Girls came with their dolls to learn how 
 they could care later for their babies. Women about to be married came and 
 learned the perils disease sows and sets in the path of careless love. Men learned 
 how they slay mother and child in an ignorance deadlier than Herod's. 
 
 IF ONE BABY SAVING SHOW DID THIS IN ONE CITY, AS IS HERE SET 
 DOWN, WHY NOT HAVE A BABY SAVING SHOW IN EVERY CITY, EVERY 
 YEAR ? 
 
 Talcott Williams. 
 
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Table of Contents 
 
 PAOB 
 
 Foreword 3 
 
 List of lLLr3TR.\TioNS 7 
 
 Introduction 9 
 
 draectory and catalogue of exhibits, charts, diagrams, signs, and illustrations 19 
 
 Bureau of the Census, U. S. Department of Commerce and Labor 21 
 
 The Pennsylvania State Department of Health 25 
 
 Hereditary S^-pliilis 30 
 
 Heredity and Eugenics 34 
 
 Housing and Environment 39 
 
 Exhibit of the Housing Commission, Philadelphia 53 
 
 The Visiting Nurse Society, Philadelphia 61 
 
 Conditions Relating to Maternal Environment During Pregnancy 71 
 
 Care of the New Born 75 
 
 Committee for Prevention. — X. Y. Association for the I$lind 78 
 
 A Model Diet Kitchen 82 
 
 Department of Public Health and Charities, Bureau of Health, Philadelphia 83 
 
 Division of Bacteriology, Laboratorj' of Hygiene 83 
 
 Communicable Diseases 83 
 
 The Philadelphia Hospital for Contagious Diseases 89 
 
 Division of Vital Statistics, Bureau of Health. Philadelphia 91 
 
 Division of Child Hygiene, Bureau of Health, Philadelphia 92 
 
 U. S. Public Health and Marine Hospital Service 94 
 
 Health Department of the District of Columbia 95 
 
 Diseases Other than Communicable 95 
 
 U. S. Department of Agriculture, Bureau of Chemistry 103 
 
 Philadelphia Pediatric Society's Milk Commission 105 
 
 The Pennsylvania State Livestock Sanitary Board 107 
 
 The Care of Milk in the Home 107 
 
 Infant Feeding IH 
 
 Utensils Used in Infant Feeding Ill 
 
 Foods and Food Values 113 
 
 Arti6cial Feeding 122 
 
 Breast Feeding 129 
 
 Rules for the Nursing Mother 133 
 
 Care of the Baby 137 
 
 Bad Booth 145 
 
 Patent Medicines and Soothing Syrups 147 
 
 Patent Foods 149 
 
 Hospitals and Institutions 154 
 
 Lectures and Speakers at the Baby Sa\7ng Show 154 
 
 Lectures and Speakers at the Subsidiary Shows 161 
 
 Down-town Subsidiary Show 161 
 
 Kensington Subsidiary Show 162 
 
 Germantown Subsidiary Show 162 
 
 Manayunk Subsidiary Show 163 
 
 5 
 
6 TABLE OF CONTENTS 
 
 PAGE 
 
 Committees and Organization 167 
 
 Financial Statement 173 
 
 Guarantors 174 
 
 Contributors 175 
 
 Proceedings of the Conference on Infant Hygiene 179 
 
 First Session 179 
 
 Introductory Address of Mr. Homer Folks 180 
 
 Municipal Child Bureaus, by S. Josephine Baker, M.D 182 
 
 Discussion 188 
 
 Infant Milk Depots, by Rowland Godfrey Freeman, M.D 191 
 
 Discussion 201 
 
 A Consideration of the Social Service Work of the Department of Diseases of Children 
 
 in the Massachusetts General Hospital, by Dr. Fritz B. Talbot 204 
 
 Discussion 208 
 
 Second Session 213 
 
 The Regulation of Midwifery, by Dr. James L. Huntington 213 
 
 Discussion 219 
 
 The Control of Marriages of the Unfit, by Henry H. Goddard, Ph.D 221 
 
 Discussion 223 
 
 The Effect of Housing Upon Infant Mortality, by Prof. C.-E. A. Winslow 228 
 
 Discussion 231 
 
 Third Session 234 
 
 Institutional Care of Infants, by Hastings H. Hart, LL.D 235 
 
 The Henry Street Settlement's Contribution Toward the Conservation of Infant Health 
 
 and Life, by Elizabeth E. Farrell 241 
 
 Prenatal Care of Infants, by Mrs. William Lowell Putnam 245 
 
 Discussion 249 
 
 Education for Better Parenthood, by Dr. Helen C. Putnam 251 
 
 Discussion 257 
 
 The Value of Recreation in Relation to Infant Mortality, by Mrs. Luther H. Gulick . . 258 
 
 Discussion 263 
 
 Index 265 
 
List of Illustrations 
 
 PLATE PAQB 
 
 I. SUiirway Approaching the Main Exhibit Hall Frontispiece 
 
 II. The (\>aches of Our Patrons Facing 4 
 
 III. The Kest Room for Mothers and Babies " 8 
 
 IV. Main Exhibition Hall (looking west) " 12 
 
 V. Main Exhibition Hall (looking east) " 16 
 
 VI. Directory of Main Hall and Exhibit Spaces in Wstibule, Foyer, and Corridors 20 
 
 \TI. Vestibule South — Charts from tlie Exhibit of Tlie Bureau of Census, U. S. Dept. of 
 Comracrec and Labor. Showing the Proportion of Deaths of Infants under One Year 
 
 and Children Under Five Years of Age to ToUiI Deaths at all Ages 22 
 
 VIII. Vestibule North — Pennsylvania State Department of Health 26 
 
 IX. Section A. O. Hereditary Syphilis. The Sy[)hilis Germ and Characteristic Lesions. ... 32 
 
 X. Section A, No. i. Portion of Exhibit on Heredity an<l Eugenics . 38 
 
 XI. Charts Showing the Rosult.s of Hou.'ic Infection with Tuberculosis and the Effects of 
 
 Overcrowding as a Cause of Infant Mortality 40 
 
 XII. Charts and Photographs Relating to Housing and Environment 48 
 
 XIII. Charts and Photographs Relating to Housing and Environment 50 
 
 XIV. Section A, No. 4. Housing and Environment 62 
 
 XV. Section A, No. 6. Housing and Environment. Exhibit of Housing Commission of 
 
 Philadelphia 54 
 
 XVI. Photographs and Charts, Housing Commission of Philadelphia 66 
 
 XVII. Photographs and Charts, Housing Commission of Philadelphia 68 
 
 XVIII. Section .\, No. 8. Visiting Nurse Society of Philadelphia 60 
 
 XIX. Photographs and Charts, Visiting Nurse Society of Philadelphia 62 
 
 XX. Photographs and Charts, Visiting Nurse Society of Philadelphia 64 
 
 XXI. Little Mothers Receiving Instruction 66 
 
 XXII A. Section A, No. 5. Bad Room — Actual reproduction of insanitary conditions found in a 
 
 room opening into a blind alley in Philadelphia 68 
 
 XXII B (xxiii). Section A, No. 7. Improved Room — Showing how the Bad Room was im- 
 proved at small amount of expense 69 
 
 XXIV. Section A, No 12. E.xhibit of Charts Relating to Prenatal Environment 70 
 
 XXV. Section A, No. 10. Charts and Photographs Relating to the Care of the New Bom .... 74 
 XXVI. Section A, No. 1 1 . Charts and Photographs, Committee for Prevention, N. Y. Asso- 
 ciation for the Blind 80 
 
 XXVII. Section B, No. 13. Division of Bacteriologj-, Laboratory of Hygiene. Bureau of 
 
 Health, Philadelphia 84 
 
 XXVIII. Section B, No. 14. Communicable Diseases, Bureau of Health, Department of Pub- 
 lic Health and Charities, Philadelphia 88 
 
 XXIX. Section B, No. 16. Division of Vital Statistics, Bureau of Health, Department of 
 
 Public Health and Charities, Philadelphia 90 
 
 XXX. Section C, No. ^1. Diseases Other Than Communicable 96 
 
 XXXI. Section C, No. 22. U. S. Department of Agriculture, Bureau of Chemistry 100 
 
 XXXII. V. S. Department of Agriculture, Bureau of Chemistry, Chart Showing Composition 
 
 of Foods for Infants 101 
 
 7 
 
8 LIST OF ILLUSTRATIONS 
 
 PLATB PAGE 
 
 XXXIII. U. S. Department of Agriculture, Bureau of Chemistry. Chart Showing Milk Basis of 
 Infant Foods 102 
 
 XXXIV. Section C, No. 23. Philadelphia Pediatric Society's Milk Commission 104 
 
 XXXV. Section C, No. 24. Production and Handling of Milk 106 
 
 XXXVI. Section D, No. 26. Division of Infant Feeding. Utensils Used in Preparation of Foods 
 
 for Infant Feeding 110 
 
 XXXVII. Section D, No. 28. Chief Foodstuffs in Amounts Needed at Different Ages 114 
 
 XXXVIII. Section D, No. 28. Nutritive Value of Foods 116 
 
 XXXIX. Section D, No. 28. Composition of Food Materials 118 
 
 XL. Section D, No. 28. Forms in Which Milk May Be Given 120 
 
 XLI. Section D. No. 32. A Plain Clean Kitchen 126 
 
 XLII. Section D, Nos. 34 and 36. Breast Feeding 128 
 
 XLIII. Section D, Nos. 34 and 36. Reproduction from a Colored Lithograph made from 
 
 an Original Water-Color Painting: " Mother and Nursing Child "; by Eleanore .\bbott 132 
 
 XLIV. Section D, No. 27. Care of the Baby— Clothing 136 
 
 XLV. Section D, No. 29. Care of the Baby— Bathing, Weighing, etc. . 138 
 
 XLVI. Section D, No. 33. Care of the Baby 140 
 
 XLVII. Section D, No. 3.5. Care of the Baby. Committee on Childhood Health Exhibit of 
 
 Boston 142 
 
 XLVIII. Section D, No. 37. Committee on Childhood Health Exhibit of Boston 144 
 
 XLIX. Foyer — " Bad Booth" — Patent Medicines and "Soothing SjTups" 146 
 
 L. Foyer— "Bad Booth "—"AH Things Bad for Babies" 148 
 
 LI. Foyer — Mechanical Device Indicating the Frequency of Deaths of Infants 150 
 
Introduction * 
 
 There is no age period in which the number of deaths is greater than during the 
 first year of Hfe, and none in which the number of preventable deaths is so great. 
 It is also true that this high mortality is chiefly amongst those who are most ignor- 
 ant. It is very manifest, therefore, that if nmch impression is to be made upon the 
 mortality, as well as the morbidity, of this first year of life, some means must be 
 adopted by which this class of pcojjle can be taught to understand the danger of their 
 environment and of their present methods of living, as well as to appreciate the value 
 of the preventive mea.sures which intelligent health officers are endeavoring to en- 
 force. 
 
 How is such education to be administered? Ignorance of and indifference 
 toward health measures are as old as man. To overcome this long-standing 
 ignorance and prejudice in the shortest possible time is no sinecure. Large and 
 widely different groups of people must be taught, and the lessons must be presented 
 in such form as to interest and appeal to the intelligence of them all. The ignorant 
 foreigner, who may not even understand the English language or be able to read his 
 own, must be enlightened. The children of the foreign born, who learn English 
 and adopt the American ideas more quickly than their parents, must be used not 
 only as interpreters, but also as teachers. They must be taught that they may teach. 
 This is also true of the children of the native born, for in many of the families of 
 the poor the older children are the acting mothers, the ones upon whom falls the 
 responsibility of caring for the babies of the household. 
 
 Education must not be limited to the mothers and sisters of the family, how- 
 ever. The fathers must be made to understand what is needed for the safeguarding 
 of their babies' lives. This phase of educational work has been entirely neglected 
 or left to be imparted at second hand by wives and children. Without this knowl- 
 edge, the co-operation of the head of the household, which is absolutely essential, 
 will be lost, and much of the effort expended in teaching the wives and children will 
 go for naught. 
 
 Education must extend also to the more enlightened element of the community. 
 While it is true that relatively few of the infant deaths occur among this latter class, 
 it must be remembered that even here there is a very unnecessary waste. This must 
 be prevented, and at the same time the educated classes must be made to realize 
 the enormity of the infant death-rate among the poor, the conditions which cause it, 
 and the possibility of its control; yes, even more: they must be made to earnestly 
 co-operate in the struggle to end this unnecessary slaughter of the innocents. 
 
 * The substance of this introduction was included in a report of the Philadelphia Baby Saving 
 Show to Section III of the International Congre-ss on Hygiene and Demography, Washington, D.C. 
 
 9 
 
10 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 The ignorance of many of the educated, if one may use a paradox, and their 
 attitude toward the problem of baby saving, are incomprehensible. Whilst making 
 personal appeals for funds to finance this Baby Saving Show, a gentleman of unusual 
 culture seriously argued with a member of the committee that the present-day city 
 must be looked upon as a place for children to die in— as little better than a morgue. 
 This is only one of several equally remarkable view-points that were encountered. 
 The minds of such men must be cleared. They must be brought face to face with 
 the living problems ; they must see things as they are, so that they may understand 
 why they should not be. 
 
 What are we doing to educate these widely divergent groups of people? How, 
 for instance, are we telling the educated and comfortably situated in life how the 
 other half lives, of the morbidity and mortality of their children, of the causes that 
 produce these results, and the possibility of their prevention? Occasional items 
 appear in the public press, occasional articles are published in weekly or monthly 
 magazines, occasional lectures are delivered, and occasionally health boards issue 
 health pamphlets. Doubtless these documents are read by some, remembered for 
 a time, and then forgotten. It is questionable whether the newspaper and magazine 
 articles so much as counteract the baneful influences of the beautifully illustrated 
 and richly promising patent food and drug advertisements which many of these 
 publications contain. Only a small minority can be reached through these avenues. 
 
 Federal, State, and municipal governments are studying the problem of baby 
 saving; charitable institutions and organizations are adding their efforts; and great 
 international congresses are being held in the interest of the babies. The educated 
 public knows that something is going on, perhaps that the lives of babies are under 
 consideration, but they do not get from such activities an intimate knowledge of the 
 facts which they must have before we can hope to secure their active co-operation in 
 working out this great problem of baby saving. 
 
 For the other class — the ignorant poor — much more direct work is being 
 done. Printed instructions upon the care of the baby and on general matters of 
 hygiene, easy of comprehension, and in the necessary languages, are being distri- 
 buted. What is of more imi)ortance, municipalities are establishing departments 
 of Child Hygiene which have their milk stations and various other educational 
 centers, and their corps of social workers and visiting nurses who carry the desired 
 knowledge directly into the home. Social organizations are establishing educational 
 settlements in the densely populated and poverty-stricken districts of our cities, 
 and conducting many other activities, the purpose of which is to establish right 
 methods of living. 
 
 Relatively recently, educational exhibits have come into vogue and our limited 
 experience of them has clearly shown that they must be reckoned among, if not 
 considered the most efficient, means at our disposal for the dissemination of knowl- 
 edge and the stimulation of public opinion. That most wonderful Health Exhibi- 
 tion in Dresden last year, and the very remarkable international tuberculosis 
 exhibition held in Washington a few years ago, carried knowledge of the causes, 
 ravages, and methods of prevention of the Great White Plague and all other pre- 
 
INTRODUCTION 11 
 
 ventable diseases to hundreds and thousands of individuals who would not have 
 obtained such information in years through the avenues previously described. 
 
 Such exhibitions convey knowledge through the medium of both the eye and the 
 ear, and as Professor Adami has well said, "It is a principle absolutely established 
 in teaching that facts when reaching the brain through the one channel of either 
 hearing or seeing a written page, do not impress the mind or become fixed therein 
 with the same sureness as when both ear and eye are employed. The graphic 
 representation of a condition is very much more impressive than any amount of 
 reading or study of columns of figures." 
 
 It was because of our belief in this method of impressing the minds of communi- 
 ties that we organized a Bal)y Saving Show in Philadelphia. 
 
 ORG.\NIZATION AND AtSPICES UNDER WHICH THE SHOW WAS HELD 
 
 Recently there has been organized in Philadelphia a Committee having the 
 following clearly defined purpose: 
 
 "The purpose of the Committee shall be to make itupiiry concerning condi- 
 tions affecting the hygiene of infants and children, and make the results of 
 such inquiry available to official and pri\at(' agencies concerned; and to 
 co-operate with the Department of Pul)lic Ileallli and Charities, the Board of 
 Education, and other organizations — public and private — in the promotion 
 of a comprehensive and constructive program of child hygiene, based upon 
 adequate information and consideration of community needs." 
 
 This organization is called The Child Hygiene Committee of Philadelphia. 
 The idea of a Baby Saving Show originated with Dr. William Dufheld Robin- 
 son, a member of this Committee, and was presented to the Committee for 
 its consideration at one of its earliest meetings. The suggestion was ap- 
 proved by the Committee, which determined to make the conduct of The 
 Baby Saving Show the first activity of the new organization. Realizing the 
 importance of securing the co-operation of other organizations engaged in infant 
 welfare work, the Child Hygiene Committee appointed a sub-committee which 
 was authorized to select an Executive Committee for the conduct of the Baby 
 Saving Show, the personnel of which should represent the various organizations 
 actively interested in the conservation of infant life. Such a committee was formu- 
 lated, and the Show was held under the auspices of The Child Hygiene Committee, 
 The Department of Public Health and Charities, and many other co-operating 
 agencies. 
 
 Organization. — The work of organizing the Show was begun about three months 
 before the date of its opening. The plan of organization is published in another 
 portion of this report. As it will show, about 150 men and women were actively 
 engaged in the work of preparation, and they were compelled to work unremittingly 
 during the entire period. 
 
 Publicity. — From the time the Show was decided upon, the press of Philadel- 
 phia manifested an interest. Occasional notices appeared during the first few 
 weeks. On the 22d of April a press agent was appointed who supplied material 
 
12 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 to the newspapers two or three times each week, which was very fully published by 
 nearly all of them. During the continuance of the Show the papers published long 
 illustrated articles each day, some of them continuing this practice during the course 
 of the subsidiary shows. 
 
 The press, next to the comments of those who visited the Show during the first 
 days, was probably the most potent factor in bringing the Show to the attention 
 of the public. Other measures, such as bill posters, street banners, window placards, 
 and tickets to be given in exchange for the booklet on the care of the baby, were 
 distributed widely throughout the city. 
 
 Selection of the Time of Holding the Show. — The month of May was chosen as the 
 most appropriate date for the holding of the Show, as it immediately preceded the 
 period of the year in which the preventable infant deaths are most common. 
 
 Selection of Exhibition Hall. — The Show was formally opened on the 18th of May 
 in Horticultural Hall, the largest and most attractive centrally located exhibition 
 hall in the city of Philadelphia. The Committee felt that there was much educa- 
 tional value in a setting that would provide adequate light, space, ventilation, and 
 cleanliness, and make possible simplicity and beauty of arrangement of exhibits. 
 
 Duration of Show. — It was determined to hold the Show for a period of nine days 
 in the central portion of the city and, later, for periods of four days in each of 
 four of the thickly populated portions of the city. The subsidiary shows were 
 given for the benefit of those who could afford neither the time nor the money 
 necessary to go to the central portion of the city. 
 
 Subsidiary Shows. — The total attendance at the four subsidiary shows was 
 39,831 for sixteen days, as against a total attendance of 67,507 for eight days in 
 Horticultural Hall; 21,745 of the former number came to the first of the four 
 shows. This show was more satisfactorily attended than the others, because it 
 was held in the crowded Jewish section, and in a hall which was centrally located 
 and commonly used as an entertainment hall by the people of the community. 
 
 There were certain difficulties connected with the conduct of the subsidiary 
 shows which naturally limited their popularity. The exhibits could not be moved 
 in their entirety; they had to be quickly transported and quickly put into place; 
 the exhibition rooms were inadequate; the arrangement of the exhibits was less 
 attractive and less effective; the conduct of the exhibit was more difficult, and ade- 
 quate demonstration was lacking. Judging from the size and character of the 
 attendance upon the main show, it is probable that a larger group of people could 
 have been reached and more good accomplished had the Show been continued for 
 another week in the central location. 
 
 Cost of the Shoiv. — The total amount of money expended in the preparation, the 
 conduct, the taking down and transporting of the exhibit to the various subsidiary 
 show buildings, its final rehabilitation and storage, and the publication of the pres- 
 ent report, amounts to $14,704.34. The Committee feels privileged to congratu- 
 late itself upon this rather remarkable showing. 
 
 Method of Financing the Show. — Practically this entire sum was underwritten 
 by a group of public-spirited private citizens, who guaranteed amounts varying 
 

LXTRODUCTIOX 13 
 
 from $100 to $200, before any public appeal for funds was made. An appropriation 
 of $5,000 by the city government, together with the general subscriptions, enabled 
 the Committee to return to the guarantors about forty per cent, of their guarantees. 
 
 Color Scheme for Charts, Photographs, and Backgrounds. — Before the preparation 
 of the Exhibit was begun, it was decided to use a uniform color scheme for the back- 
 grounds and mountings of the charts and photographs, as well as a uniform method 
 of lettering which would be attractive, and at the same time restful to the eye. 
 The backgrounds were of a light sage green, and the charts an ivy green, and the 
 lettering, which was in white, and in the De Vinne type, of uniform size and large 
 enough to be read easily from a distance. 
 
 The Legends. — Realizing the discouraging effect of long legends and overful 
 descriptions, we insisted upon short legends, clearly, concisely, and directly expressed, 
 and the presentation of a small number of salient points expressed in the most 
 emphatic way, rather than risk fatiguing the visiting public by setting fortii in 
 charts everything knowni of the various activities employed in baby saving. Intri- 
 cate statistical charts were also eliminated as a feature of the Show. For the 
 benefit of those who desired to study them there were exhibited a few admirably 
 prepared statistical charts secured from the United States Bureau of the Census, 
 The Department of Health of the State of Pennsylvania, and The Department of 
 Vital Statistics of the Department of Public Health and Charities of Philadelphia, 
 practically all of which were graphically arranged. 
 
 Object Teaching. — Realizing, also, that concrete object lessons represent the 
 most effective means of fixing facts in the minds of people, much of the exhibit was 
 illustrated by means of objects, some of the booths containing practically no legends. 
 
 Plan of Exhibition Building. — The Exhibition Hall was divided as follows: On 
 the first floor was the entrance hall to the main stairway, on either side of which 
 there was admirable space for exhibition purposes, and in the rear of the building 
 there was a large audience room, which was used for lectures and demonstrations. 
 On the second floor there was in the front of the building a large foyer, and leading 
 from this on either side of the stairway were wide corridors, with more than 200 
 linear feet of wall space, and back of these the main hall of the building. 
 
 Placing and Correlation of E.rhibiis. — In the entrance hall to the right of the 
 stairway was placed the admirable exhibit of the Department of Health of the State 
 of Pennsylvania, and to the left the statistical exhibit of the Bureau of the Census. 
 The corridors of the second floor accommodated the loan exhibits of the various 
 charitable organizations of Philadelphia and other cities. In the main hall of the 
 second floor was placed the main exhibition, which was created by the Committee 
 having the Show in charge. It was in this main hall that the relationship of the 
 exhibits to each other and the order of their sequence were given consideration. 
 Those entering the hall were required to follow a one-way arrow. It was the orig- 
 inal plan of the Committee that the exhibits should be arranged in the following 
 sequence: First, heredity and eugenics; second, housing and environment; third, 
 the care of the mother during pregnancy and the lying-in; fourth, the care of the 
 new-born; fifth, breast feeding; sixth, the relative value of milk and the proprie- 
 
14 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 tary foods; seventh, the production and handling of milk and the care of milk in 
 the home; eighth, the substitute feeding of infants; and ninth, the care of the baby, 
 its clothing, bathing, exercise, hours of sleep, etc. 
 
 Owing to the fact that it was necessary to introduce a water-supply into the 
 exhibit on artificial feeding, it became necessary for the Committee to change this 
 plan to some extent, but in order that the sequence might be disturbed as little as 
 possible, the booths relating to the first four subjects above referred to were placed 
 in the southern division of the hall, and those relating to breast feeding, the sub- 
 stitute feeding of infants, the care of the baby, etc., in the northern section. The 
 middle portion was devoted largely to exhibits relating to communicable and non- 
 communicable diseases, together with booths relating to the relative value of milk 
 and the proprietary foods, the production and handling of milk and the care of 
 milk in the home, the last three immediately preceding the substitute feeding of 
 infants. 
 
 Each visitor to the Show had impressed upon him first of all the prenatal 
 influences which afi'ect the morbidity and mortality of infant life, influences concern- 
 ing which the majority knew nothing. The lessons in this department were so 
 directly taught, and the relationship of cause to efl'ect so clearly defined, that no 
 one of ordinary intelligence could possibly fail to read them. 
 
 The last booths visited before leaving the hall related to the subject of postnatal 
 influences, of many of which the visitor had heard, but concerning which he was 
 here to learn more. 
 
 Separation of the Exhibits of Proper and Improper Methods. — There was one 
 feature in the general arrangement which jiroved of great value, and that was the 
 separation of the exhibits of incorrect and detrimental methods and equipment 
 from those which were correct and helpfid. Experience in other exhibitions had 
 shown that where the good and the bad were placed side by side, the illiterate 
 classes had sometimes carried away and jiut into practice incorrect methods, 
 assuming that anything which had been observed in the exhibition was worthy of 
 imitation. The only studies in contrasts which were approved were those between 
 good and bad dairy barns, illustrated by models representing the exhibit of the 
 Pennsylvania State Livestock Sanitary Board, the right and wrong way of caring 
 for milk in the home, and a good and bad living room. These latter were reproduc- 
 tions of a dirty, dila])idated room, which was transformed into a clean, attractive 
 room by the expenditure of $2.87, plus a little muscular effort on the part of the 
 occupants, and a stirring-up, by the visiting nurse, of the landlord and city authori- 
 ties to the point of carrying out the sanitary measures which they were legally 
 bound to effect. 
 
 Booth Containing Things Bad for Babies. — The undesirable things were shown 
 in the foyer, which was in the front of the building and separated from the main 
 hall by the corridors, and over the entrance of which hung the legend, "Things 
 Which are Bad for the Baby." This arrangement, aside from preventing confusion, 
 enabled the Committee to broaden the scope of this pha.se of the exhibition. In 
 this booth were shown rooms with defective ventilation, untidy, ill-furnished, and 
 
INTRODUCTION 15 
 
 overcrowded; baby pacifiers; improper feeding bottles and nipples; injurious 
 secret nostrums and patent medicines; incorrect methods of bathing, holding, and 
 feeding babies, the bad effects of strong lights upon the eyes, etc. 
 
 Section on Breast Feeding. — Especial effort was made to lay stress upon the 
 importance of breast feeding. The booth devoted to this subject was one of the 
 most artistically and attractively arranged in the entire exhibit. It contained, 
 among other things, some admirable photographs illustrating the proper method 
 of holding the baby during nursing, an advergraph, an electrically operated instru- 
 ment that displayed successively a series of valuable legends relating to breast 
 feeding, and an exquisite original water-color painting of a mother nursing her baby. 
 An admirable reproduction of this painting, on the reverse side of which were 
 printed proper instructions for breast feeding, was freely distributed from this 
 booth by an attractive, intelligent nurse in uniform. 
 
 Section on Hereditary Syphilis. — Another most successful section was the one 
 relating to hereditary syphilis. This was the first exhibit approached upon entering 
 the main hall. The first charts defined in delicately framed but unmistakable 
 language the most common method of conveying syphilis. Beside this was a chart 
 defining the Was.sermann reaction in simi)le language, and, for the purpose of attract- 
 ing the eye, in the center of this chart was placed a series of tubes illustrating the 
 reaction. Beside this were charts pointing out the length of duration of syphilis, 
 especially of inadequately treated syphilis, the certainty of its transmission to the 
 offspring, and the importance of the blood test for those who had had syphilis, 
 especiall.y those who contemplated matrimony. The balance of the exhiljit con- 
 sisted of colored drawings of the lesions of congenital syphilis, each drawing bearing 
 a descriptive legend. 
 
 A bolilly illustrated public exhibit of syphilis was entirely new to the city of 
 Philadeli)hia, and its effect upon the public mind was observed with very great 
 interest by the Committee. It was previously planned that this exhibit should be 
 very carefully, and at the same time clearly, demonstrated, and that no misinter- 
 pretation of its purpose should be imparted to the mind of any of the j'outhful 
 visitors to the exhibit. There was no part of the Show that was studied more 
 thoughtfully, and api^arently none that made a deeper impression. 
 
 As an illustration of this, the following circumstance is of interest: A young 
 man was observed to approach the exhibit and carefully study it in every detail. 
 He was apparently much impressed and agitated by its teachings. He immediately 
 sought out a member of the Committee, to whom he confessed that he had had 
 syphilis, that he had been married within a year, and that his wife was pregnant, 
 and he desired to know if there was anything which he could do to protect his 
 prospective offspring from the possibility of congenital syphilis. It is reasonable 
 to assume that this lesson, which was probably learned too late by this young man, 
 was impressed upon the minds of many of the thousands of young people who had 
 the opportunity of studying it . Many illustrations of this character could be related 
 in regard to every one of the exhibits. 
 
 Demonstrators. — Experience in other exhibitions held in Philadelphia had 
 
16 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 impressed upon the Committee of the Baby Saving Show the importance of having 
 enough demonstrators to explain the exhibits to every one that entered the exhibi- 
 tion building, consequently permanent demonstrators were placed in practically 
 every booth. These demonstrators were thoroughly conversant with the lessons 
 the Committee desired to have imparted. In addition to these special demonstra- 
 tors, there was an adequate group of carefully selected demonstrating guides, com- 
 posed of young physicians and advanced medical students who were conversant 
 with the general purposes of the exhibitions, and who piloted individuals or groups 
 of individuals throughout the entire exhibit. Besides these demonstrators, there 
 were always present in the building a number of members of the Committee who 
 not only volunteered their services as demonstrators, but to whom any one desiring 
 special information was referred. 
 
 There has probably been no exhibition in America in which the demonstration 
 of the exhibits was more satisfactorily conducted, and none, therefore, we believe, 
 in which the lessons intended to be taught were more clearly imparted. 
 
 Aids. — In addition to these formal demonstrators, the Committee on Patron- 
 esses and Aids, besides stimulating wide-spread interest through its long list of patron- 
 esses, provided a corps of aids. A number of these aids were constantly on duty 
 from the opening to the closing hours of the Show. Two of them were stationed at 
 the entrance to the building to receive those who attended the Show, to direct 
 them as to the course to follow, to pilot mothers, who came with babes in arms to 
 the rest room, and to impart a spirit of welcome to all. Other aids were located 
 at definite points throughout the building to give information and distribute the 
 literature that was authorized by the Committee. 
 
 Bureau of Information. — A Bureau of Information was located just within the 
 main entrance to the building. This Bureau was in charge of a recent graduate of 
 The Woman's Medical College. It was her duty to supply guides to direct any one 
 interested in any special feature of the exhibition to that part of the building in 
 which such feature was placed, to supply special demonstrators when so requested, 
 to receive requests for Hterature and pamphlets, and to direct those needing medical 
 advice to their physicians, or, in the event of their being unable to pay a physician, 
 to some one of the various maternity and children's hospitals. 
 
 Number and Personnel of the Visitors. — In the nine days in which the Show was 
 given in Horticultural Hall it was visited by 67,507 persons. Children of twelve 
 years and younger were not admitted unless accompanied by their parents or 
 guardians, and no children or youths were permitted to wander through the exhibit 
 unattended. The personnel of the visitors, however, included a very large group 
 of little mothers, whose attention was especially centered upon the portions of the 
 exhibit which bore most directly upon the care of the baby. Of the total number 
 of visitors, the majority was unquestionably made up of prospective mothers and 
 mothers with infants. One of the demonstrators in a booth devoted to the clothing 
 of the baby was consulted by more than a thousand pregnant women, and during 
 a single hour on one day 200 women with babies in their arms entered the hall. 
 On this particular day there were admitted 1200 mothers with babes in arms. The 
 
IXTRODUCTION 17 
 
 number of fathers who came to get information for mothers who could not come was 
 striking. Many of them came with pencil and pajter to make notes of the things 
 they wished to remember. 
 
 An interesting feature was the large attendance of the well-to-do and rich, and 
 it was very gratifying to see many of these return a second and third time, selecting 
 hours during which the attendance was smallest in order that they might study the 
 exhibits thoroughly. The attraction of this class of individuals was one of the most 
 important devcloiiments of the Show, in that in the sections bearing upon heredity, 
 eugenics, and housing conditions, many of them gained their first knowledge of the 
 dangers which surround the offspring of the poor and ignorant inhabitants of our 
 cities — a very important lesson for them to have learned, since the supjiort of this 
 element of the public is very essential to the carrying out of public health measures. 
 
 The Show was very largely attended and carefully studied by active social 
 workers and philanthropists, not oidy from Philadelphia, but also from other cities, 
 thus extending its educational value beyond the confines of a single city. 
 
 Lectures. — Supplemental to the exhibition and with a view to broadening the 
 scope of the educational work, four short lectures were delivered in the lecture hall 
 on the first floor of the building each daj' — two in the afternoon and two in the even- 
 ing. All of these lectures related directly or indirectly to the subject of baby .saving, 
 and they were delivered by men and women from various parts of the country who 
 were especially conversant with the topics assigned them. Immediately before and 
 immediately after each series of lectures, and again at midday, several educational 
 moving ])ictures* were shown. In no way was the desire of the public to learn 
 better illustrated than in the attendance upon these lectures and demonstrations. 
 The room, which had a seating capacity of nearly 300, was overtaxed at practically 
 every session, and the audiences were always attentive and alert. 
 
 The lectures and demonstrations were continued during the course of the 
 subsidiary shows and were marked by the same characteristics. 
 
 During the week of the main exhibit, and with a view to attracting social 
 workers and all others intelligently interested in the jiroblem of baby saving, there 
 was held a Conference on Infant Hygiene, the contributions to which were almost 
 exclusively made by especially chosen individuals from other cities. The transac- 
 tions of this Conference, which form a part of this report, illustrate its scope and 
 value. 
 
 There are three additional points to be referred to in closing; they are — the 
 babies' rest-room, the character of the literature distributed, and the absence of 
 a commercial exhibit. 
 
 Realizing that many babies would be brought to the Show, the Committee 
 considered it necessary to make some provision for their care. For this purpose 
 a room in the rear of the first floor, adjacent to a toilet, was equipped with cribs and 
 all other necessary materials. The room was presided over by two trained nurses 
 and a resident physician. Sanitary diapers were provided, and absolute cleanliness 
 was insisted upon. Both by example and by word of mouth mothers were taught 
 
 * See Program. 
 
18 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 the value of care and cleanliness. Unfortunately, the capacity of the room was 
 overtaxed, but many valuable lessons were taught there, and, incidentally, the 
 Committee learned the importance of adequately providing for the care of babies 
 during exhibits of this character. 
 
 As to the literature, but two official documents were distributed : one the col- 
 ored drawing already referred to, and the other a booklet entitled "The Care of the 
 Baby." This latter was a very carefully and attractively prepared document 
 which contained all the information a mother would need for the proper safeguarding 
 of the baby, expressed in simple, direct language. The distribution of many tracts 
 and pamphlets was proscribed because experience in other exhibitions had con- 
 vinced the Committee that the essential lessons were often lost in a multiplicity 
 of documents. 
 
 No one who has not experienced it can appreciate the relief that comes from the 
 absence of a commercial exhibit. Commercial exhibits bring a revenue, but nothing 
 else of value, and the revenues from rented space are offset a thousandfold by the 
 noise and clatter, the barking of wares, the misleading statements, and the clouding 
 of the mind of those who come to learn. Professional exhibitors are versed in the 
 art of demonstrating. They know how to touch the sympathetic chord, and are 
 proficient in the art of promising more than they can give. They lure the crowd and 
 center the attention upon what they have, and the real exhibition, which is of some 
 value, gets no show. We recommend to all those who contemplate the formulation 
 of exhibits the elimination of the commercial exhibitor. 
 
 It is a very difficult matter to measure the effect of exhibitions. It is reason- 
 able to assume that a fair percentage of those who come to learn will carry some 
 lessons away with them, and that in many instances they will either directly or 
 indirectly impart them to others. In the light of these probabilities, it would seem 
 that the influence for good should be far reaching. 
 
 It is too soon to know the effect of this Baby Saving Show, but a study of the 
 infant mortality of the city for a comparison with that of other cities and an inquiry 
 amongst physicians, social workers, and visiting nurses, will probably justify the 
 hope of the Committee that it has accomplished much for the saving of babies in the 
 city of Philadelphia. 
 
 In an exliibilion, such as is herein described, the amount of labor involved in its preparation, and 
 the results accomplished by it, depend to a very great degree upon the character of co-operation extended 
 to its organizers. The Executive Committee of the Philadelphia Baby Saving Show were especially 
 fortunate in this respect. No aid was asked that was not willingly and enthusiastically given, not 
 alone by the state and city, and the many local organizations interested in the problem of baby saving, 
 but also by the Federal Departments and other institutions outside of Pennsylvania. The Committee 
 is especially obligated to The Bureau of Chemistry of the United States Department of Agriculture, The 
 Bureau of the Census of the United States Department of Commerce and Labor, The United States 
 Public Health and Marine Hospital Service, The Russell Sage Foundation, The Committee on Childhood 
 Health Exhibit of Boston, and the Health Department of the District of Columbia. 
 
Directory and Catalogue of Exhibits, Charts, 
 Diagrams, Signs, and Ilhistrations 
 
 This calalnmie contains a copy of every cliart and (lie descriptive lejicnd wliich 
 ai)peared on each of tlie |)hoto,<;ra|)hs and drawings shown in the etitire exliiliition. 
 
 Many of the iiootiis and indivichnd cliarts are ilhistrated. 
 
 The purpose of the Coniniiltee in puliHshinj; tlie catalogue in tliis form is to 
 illustrate the scope of the Show, and to make available to those wishing to formulate 
 similar exhiliitions the vast aniouid of material used in the Piiiladelphia Bahy 
 Saving Show. 
 
 Reatlers are advised to study the Directory [I'late \ I] carefully in order to 
 understand the divisions of the exhiltit which are referred to throughout the text. 
 
Directory 
 
 First Floor. 
 
 voniK/ie Department (fCmroem.mi Lalwr 
 SOUTH Bureau of Census. 
 
 vEsnwLe Pcnnsyifvaiiia State Department 
 •">"« of Health. 
 
 naxoFTOMtp} --InformatiMi Bureau. Ledure Hall. 
 wstiwif-soimij Rest Room fiir Mothers »nd Mxes. ToUet Kooms. 
 
 Corridor 
 
 Section E. 
 
 Chfldreiis Aid Society 
 Philadelphia. 
 
 Philaifelphia AssKiatieD 
 of Day NurseriM. 
 
 The Babies Hospital 
 of Fhiladelphia. J 
 
 Philadtlphia Modi' '' 
 mk SxkW. .:. 
 
 mam 
 
 TtThoirasWilsoSmilari™ »' 
 BjHimoK.Md. E" 
 
 St. (fcrfatrfs llms()i,l..%ib 3(i„' 
 Allany. N.Y. 
 
 Childim Hospital 
 
 d Philadelphia. acmes 
 
 JtffamHaleniJyUispital HtMum 
 
 MOOa OCT KITCHW 
 
 Fcyer 
 
 Section F. 
 BadBooth 
 
 All things bad 
 for the Babj*: 
 
 Galfeiy^ftjcr 
 
 EjffiodwB Offices. 
 Ladies Aid Cnnm 
 
 Pl.\te VI 
 DIRECTORY OF M.\IN HALL AND EXHIBIT SPACES IN VESTIBULE, FOYER AND CORRIDORS 
 
 20 
 
Bureau of the Census 
 
 Dkpartmext of Commerce and Lahoh 
 
 lA'cstihiilr Sciiitli. '2 H(ic>tli-.| 
 This section coiitaiMrd --tatiNtiral iliaj:raiiis rcialiii^ ti> ilratlis ol' infants. 
 
 TIio followinii cx|)lanatorv descriptions ()i(I not appear on the diatrranis, hut 
 Wfvr furnislie<l hy the IJurean al llie re(iU(-st of lli<' Coinniit tee. 
 
 ])l-\(ai.\M NO. 1. — Map Sliiiwini; I'rescnl and I'rospeef ive Registration States 
 for DeatIis.--Re!.;istration cities in non-reuist ration States. Map sliowiiii; provi- 
 sional hirtli rei;istration area. Not a sinjile State, not own a siiiijle city, in the 
 entire United States ])ossossos complete registration of l)irtii>. Md^lon ( lainis to 
 have about theliest — only !)(i jjcr cent. Tlic most utterly worthU'ss registration of 
 births among all the great cities of tlie enlirc civilized world may be claimed by 
 the cities of Baltimore. Chicago, and .New Orleans, 
 
 Dl.vciHAM NO. .'5. — Decrease of Infantile ^b)rtality. — Infantile mortality is 
 the ratio of deaths of infants nn<ler I year of age ])er 1,000 living births; foreign 
 countries by five-year ])eriods ( 1S<S()-1S!)(), l!)01~190o). No rates of infantile mor- 
 tality are available in the liiited States because (1) there is no general registration of 
 deaths; (i) even for areas with registration of (leaths the registration of births is 
 incomplete. 
 
 DiAURA.M No. 4.- Decrease of Infantile Mortality in Cities. — Infantile mortal- 
 ity is the ratio of deaths of infants under 1 year of age per 1,000 living births. 
 Foreign cities by .same five-year i)eriods as for foreign countries. Rates of infantile 
 mortality can not be given for American cities on account of their defective regis- 
 tration of births. 
 
 Diagram No. 5. — The Course of Infantile Mortality. — A century of the history 
 of infantile mortality, showing all the data availalile for various countries as com- 
 piled by the French government. The foreign countries are the same as in Diagrams 
 Nos. 3 and -1, the century being by five-year periods from ISOl to 1!)10 for deaths 
 of infants under 1 year of age (stillbirths excluded) i)er 1,000 living births. [From 
 Statistique Generale de la France.] 
 
 The era of modern sanitary civilization may be marked by the dates upon 
 which various countries began to record infant mortality. Some countries — China, 
 Turkey, and the United States — even yet possess no records of infant mortality. 
 
 DiACiRAM No. (3. — Watch the Birth Rate Decrease! There are Fewer Deaths 
 of Children Because Fewer Children are Born. — This leads, temporarily, to a lower 
 general death rate; later, to a higher rate because of fewer young persons at the 
 most healthy ages. Moral: If fewer babies are born their lives should be more 
 

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DIRECTORY AM) CATJ f.ncri' of EXHIBITS 23 
 
 carefully <;iiMr(l('<l. \ninl)iT nf liiiili-- \n-v 1,0(10 liviiiu |i(>|>nlat ion i>l illhirllis 
 excliidod), and ])er cent decrease tor t'nreii;ii lonntries l>y five-year periods. No 
 hirtli rates are piven in tlie tal>ies of International Statistics for the Inited States. 
 Why'-' Are not the 1)irth-- of ,\nierican l)al)ies worthy of reirislration? .\re the 
 births of your cliildren ])r()|)crly rcfiistcrcd? Why not'' 
 
 l)l ACRAM No. 7. — Decrease of the Mirth I{ate in Cities.- Much of I lie re(hictioii 
 in t he nniniicr of Deaths of Infants in cities, as for conn tries as a \\ hole, is dne to the 
 tliminished birth rate. Hence the necessity for i;reater savint; of (he little infant 
 life we are coniin<j to have. " \u infant sa\ed is worth two infants born?" I'er- 
 haps. \ot even one .Vnieric,-in city uilli .-i birlii r.itc worthy of inclusion in tiie 
 International Statistics? Not one sinf,'le ouel and the accurate registration of 
 births is the absohit<'ly necessary basis of correct data of infant niorlalily. 
 
 Di\(;n\\i Xo.S. Decrease of (Iciicral Death l{ate. — The "cruch'"" or "i:<'neral" 
 death rate has decreased in most countries havintr accurate ret;islralion during; 
 recent years, '{"his decrease is associat<'il with tlu- reduction in infantile mortality. 
 Foreign conntri<'s as in |ireccdint: diatrrams. TJie ■'cmde'" or oi'dinary death rale 
 (the term does not mean the imjierfcct or carelessly com]>nted death rate, but is 
 used in contradistinction to a d<\itli rate "corrected" for afie, sex. or other distri- 
 bnl ion of populat ion i is I lie first ready means of comjiarison for conditions alfectiiif; 
 mortality. Human life, on the whole, is becomini; safer all o\-er the ci\ili/,ed world; 
 and for infants as well as for all aj;es. 
 
 DiACHWi No. 0. — Decrease of (ieneral Death Rate in Cities.- The citie.s 
 of the world share in the general reduction of the death rate, and some, in recent 
 years, have shown heretofore unexampled low rates. We have reached an era of 
 low mortality; arc the babies get t ing I heir share? Foreign count rics as in preceding 
 diagrams and number of deaths per 1,000 li\ing population ^ stillbirths excluded) 
 by five-year i)erio(ls, with per cent decrease. 
 
 DiAiiiiwi Xo. 10. — Proportion of l")<atlis of Infants One Year and Children 
 Under Five Years of .\ge to Total Deaths at All Ages. Registration States: 1!)()!). 
 — The jier cent under 1 year and under ,) years is shown for the Registration .\rea 
 and Registration Slates, with the i)roportioTi of deaths out of every 100 deaths at 
 all ages, as taken from bulletin of Mortality Statistics. 190!). This is a very un- 
 sati.sfactory comparison, but no reliable data of infantile mortality are available 
 becau.se of the lack of accurate registration of births. 
 
 Di.\(ii{.\M No. 11. — ProjMirtion of Deaths of Infants Under One Year and 
 Children Under Five Years of .\ge to Total Deaths at All Ages, Registration Cities: 
 IDOi). — The same data are shown for Registration ( 'ities, 1909, as in Diagram No. 10 
 for States. (See Plate No. YII. I 
 
 Di.vGR.\M No. l'-2. — Probability of Dying in Kacli ^'earof .Vge per 1,000 Enter- 
 ing Upon that Age. Rate of mortality (qx ) by age in completed years from birth 
 to 100 years, for Germany (1891-1900), England and Wales (1891-1900), France 
 (1898-190;')), Ma.ssachusetts (189;5-189T), Registration States, Native White (males 
 only, 1900), Italy (1 899-1 ilO'i), and Sweden (1891-1900), for males and females 
 separately. Infant mortality. Note how the death curve resembles an ordinary 
 
24 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 fishhook (\/)- The chief point of this diagram, for the purposes of tliis meeting, 
 is the barb. Prevention of diarrheal diseases alone would cut down the rate of 
 infantile mortality by one-fourth. It is the object of those interested in the 
 study and jjrevention of infant mortality to cut off the bar!) of this hook of death. 
 High infant mortality means weakened childhood, impaired youth and middle 
 life, and ])rematurely feeble old age. The })oint of the barb permits the entrance of 
 poison for tlie whole of life. The chances of living ought to be greater at birth, 
 not less, as at present, than at other periods of life until extreme old age. 
 
 Dl\gr.\m No. 21. — The Twenty Most Imiiortant Causes of Death at Each 
 Year of Age Under 5, and for the Five- Year Period 5 to 9, Registration Area of the 
 United States: 1909. — Single years of age from 1 to 4, five-year period 5 to 9, with 
 per cent of all known causes at each age, are shown. The surfaces of the Circles 
 are Proportional to the Total Number of Deaths at Each Age. 
 
 DiAGR.\M No. 22. — The Twenty Most Important Causes of Death at Each 
 Decade of Human Life According to the Returns for the Registration Area of the 
 United States: 1909. — Per cent of all known causes at each age period. Ten-year 
 age periods are shown from under 10 years to 90 years and over. The Surfaces of 
 the Circles are Proportional to the Total Number of Deaths from Known Causes at 
 Each Age Period. 
 
 Di.^GRAM No. 25. — Most Important Causes of Infant Mortality.— Actual 
 deaths in the registration area of the United States, 1909, from all cau.ses of death 
 responsible for as much as 1 death in 100 at either the First (0-) or Second (1-) 
 years of life. Causes of death by age and number of deaths from 10,000 to 30,000 
 are shown. The names of all preventalile causes of infant mortality (wholly or in 
 large j)art) are in red. Detailed data and percentages in Census Bulletin on Mortal- 
 ity Statistics, 1909. 
 
 Di.\GR.\M No. 26. — The Greatest Foe of Infant Life is Diarrhea and Enteritis. 
 — Over two-thirds of the deaths from this disease are those of babies under 1 year. 
 The number of deaths during five years by calendar months for the registration area 
 of the United States, 1900-1904, is shown. Diarrhea and enteritis (which term 
 includes cholera infantum, gastroenteritis, milk infection, intestinal toxemia, etc.) 
 is a seasonal disease. That is to say, hot weather ]3ermits rajjid ])utrefactive 
 changes in uncooled and filth-infected food, more especially the baby's milk. 
 Breast-fed children largely escape. (See Plate \TI.) 
 
 Diagram No. 27. — The Keystone of the Arch of Public Health is the Saving 
 of Infant Lives. The Keystone in the Saving of Infant Lives is the Complete 
 Resistration of Births. The Keystone in tlie Development of Effective and 
 Thorough liirtli Registration in the United States is the Commonwealth of 
 Pennsylvania. 
 
 The Committee on Birth Registration of the American Association for the 
 Study and Prevention of Infant Mortality reported, in 1910, that "The only state 
 in the Union in which, now or at any former time, a determined effort has been made 
 to tlioroughly enforce the registration of births, as the law provides and with 
 
DTRKCTOny AXn CATAL0(,VK of KXHlBfTS 2.> 
 
 prosecution and enforcement of the |)en;ilty of the hiw in (ielinquent cases, is the 
 Commonwealth of Pennsylvania." 
 
 The effective work of the Bureau of \\\:\\ Statistics of the State Department 
 of Health of Pennsylvania is the keystone of our h<)p(- for conii)lete national regis- 
 tration of vital statistics and national life-savin<; of infants based on sound statistics 
 of infant mortality. 
 
 The Pcnnsi/lvania State Departmefit of Health 
 
 Vestiljulf, X.jrtli Siile, 3 lioiitlis. (I'lalc \ III is a R-pn.cluctiuii i.f tlic ('ciilr.il Ho.itli.) 
 
 Charts. 
 
 The minuti' analysis of ilcatlis of iiilauts Ky days, weeks, and iiKinlhs for 
 the i)rincipal lauscs of <lealh, lorcilily iiiustralcs tiie (hnition which 
 prenatal as well as |)ostnata! pre\-eiitivc measures nuist lake in order to he 
 most effective. 
 
 1. Cluirl sliuwiuf; llie currclatinn of \ ital faits in llii' sliidy cif infant iiiciitality. 
 
 The ('iirrdiiliiiii of Vila] Vartx is ahsolutcly 
 
 necessary to a Ihorouph under- 
 
 standiui; of ail human ])r()l)lems. P^very 
 
 iteiu of information on certifi- 
 
 cates of hirtlis. deaths, marriai^'cs, reports 
 
 of comnnuiicable diseases has 
 
 its special simiificance. Note how frecpu 
 
 •ntly the aue and cause ot death 
 
 ai)i)ear as failors in mortality tallies and 
 
 the aiic ot the mollicr in birth 
 
 tables. 
 
 
 2. Table .sliowing the analysis of deatlis of infants from principal c-aii.scs hy Hays 
 for tlie first week. Ijv weeks for the first month, an<l liy months for the first two 
 years of life. 
 
 3. Graphic chart showing the relative freqnency of deaths in the first year of 
 life and in i;nnii)s of popnlation at each succeeding five-year age period. (See 
 Plate VIII.l 
 
 4. Graphic- chart shr>wing the mortality curve from infancy to old age. 
 
 5. Chart showing ilivision of infant mortality into five principal groups. 
 
 The average niunber of rhildrcn lincludin"- ju-evious births) born to al 
 mothers was ;?.o; to native mother.s, 3.3; and to foreign mothers, 3.8. 
 
 6. Chart showing the nundicr of <'hildren per mother according to nativity. 
 
z 
 
 2 
 
 < 
 
 Z 
 
 z 
 
 H 
 O 
 
 z 
 
 w 
 > 
 
 36 
 
DIRECTORY AM) ( ATALOGUE OF EXHIBITS 
 
 The averaf;o nunihcr of lixiiiu cliiMrcn to cacli inotticr Miii-ludiiii: iircsciit 
 l)irth.s) was 'i.'.); to iiati\c iiiotlicrs, '2.S, and to lorciiTii inotlicrs. .'i.l. 
 
 Tho average age of all iiiotlicrs is -iS.;! years; of native mothers. '2S years, 
 and of foreign mothers, '•2!S.)S years. 
 
 7. ( "iiart sliowing age of mother acctiniiiig tt) iiati\ ily. 
 
 Rnral infant mortality rates are largely influenced l>y tlu> large foreign 
 j)oi)ulation in industrial settlements outside of cities. The uriian hirtii- 
 rate is ^.S.'-i and th<' rin-al rate. ;!0.7. 
 
 S. Cliart siu)\\in<; jirctjiortiiui iM-lwern rural and nrliaii inortality. 
 
 \'ital statistics are eolleete<l in I'ennsvK ,-iMia through the medium of 
 1.1(17 local registrars. Kadi spot on the map indicates the locat ion of t liese 
 officials. 
 
 iMap i>f I'ciiiis\ hania iruiicaling location of registrars.) 
 
 Infant mortality should include the |)n'natal morlalily occurring lielwecn 
 the fourth mouth of |)regnancv and liirtli. which amounts to !>,.>.S7 deaths 
 per year. These are recorded as .stillhirths and do not appear in mortality 
 tables. 
 
 The prom])t and com])lete registration of e\-cry hirth is a legal and sanitary 
 neeessit\'. advantageous alike to the child and to the state. 
 
 A nation without ahundant and healthy children is hut a few generations 
 removed from degeneracy. 
 
 \'ital statistics flash the wireless messages of death from lips that have 
 never learned to sjjeak. 
 
 The female mackerel lays ,50,(100 eggs. .Esop tells of the fox taunting the 
 lion with the .smallness of his family, to which he replied: "Yes — hut then 
 every child is a lion." Are our children to he in the mackerel or the lion 
 class? 
 
 The S. (). S. call of helpless infancy should not lie unanswered by twentieth 
 century civilization. 
 
 Two luuulred men in Pcnn.sylvania toil each day in digging graves for 
 people who die untimely deaths from preventable causes. One-half of 
 these graves are for babies. 
 
28 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 Infancy and old age are comrades in deatli. The man of 84 stands a 
 somewhat better chance of living one week than does the baby at birtli. 
 
 A Government's interest in human life should begin before conception 
 and end onlj' in the grave. 
 
 The yearly failure of one business enterprise in every ten would mean a 
 perpetual financial i>anic. The yearly loss of one baby in every seven 
 creates simply a mild alarm. 
 
 The rejiroduction of all species is a normal natural process. In the 
 human family it is more or less a matter of accident. 
 
 A baby has the right to be well liorn. Its clioice of parents is not its own. 
 
 If babies' bottles were blown in the shape of cothns they might hint at 
 possible tragedies. 
 
 The wordless sobs of suffering babyhooil sliould outshine the eloquence of 
 all ages and all languages. 
 
 Infant mortality is the "yard-stick" which measures the height of social 
 welfare and the breadth of human efficiency. 
 
 Prematurity or immaturity very often means overworking, overheating, 
 and underfeeding and too often a want of understanding. 
 
 Each and every child should be a ward of the state and nation. It sjiould 
 not have to be an orphan to become such. A.sylunis and foundlings' 
 homes make comparatively poor step-mothers. 
 
 Contagious diseases play a comparatively small i)art in infant mortality. 
 
 The baby as a business proposition: 
 
 You can insure the life of a healthy baby only after it has lived one month 
 and only for a maximum of twenty-five dollars. You can insure the unborn 
 progeny of animals for thousands of dollars. Is this a reflection on the 
 human babv, its mother, or on our own intelligence? 
 
DIRECTORY AM) CATALOCVK OF EXHIBITS 29 
 
 I'hci|uf,'rai)lis. 
 Tnherciiloiis fliildron (in tlicir way to tlic State Sotitli ^lomitaiii. 
 
 Saiiatdrimn at Mont Alto, wlirrc cliilclrcn nf all a^'os arc fared for. 
 
 Incipient anil A(i\ancc(i Inlicrciilosis. 
 
 Penna. State Sonth Mountain Saiiatoriiini. Mont Alto. 
 
 IJahy's hatli-aii event in tlic family 1 
 
 Practical ])reveiitlve work anions: the lialiio hy State 'i'Mlierctiiosi.s 
 Dispensary Nisiting Nur.ses. 
 
 Ilealtli. 
 
 Mont .Vllo Sanatorium. 
 
 Hos|)ital for Infants and ( liildrcn. Capacity. Kill lieds. 
 
 .V fightint; chance for a luKcrcnlous mother and two haliie-; M(Mnporary 
 open-air slee])in^'-room on a roof costini; .l^'iT. .)()!. 
 
 I'lie closed window opens tlii' door to the undertaker. 
 
 Two-fool hed-rooni window, naile<i shut — eit;ht sleejiers — three tui>ercu- 
 lous ciiildren. aijes one, two, and five. 
 
 (Ai'lual c.iiiiiiliim.) 
 
 Fresh .Vir — Health: .\ hcd-rooni .it the Statt' Sanatorium, Mont .\lto. 
 
 Instruction liy the vi>itiiiji nurse in the jirojier ))re|)aralion of food, a most 
 important feature in ])reventiiig infant mortality. 
 
 \ danyeroiis custom. How diseases often siipjiosed to he hereditary are 
 transmitted. 
 
 Every city in Pennsylvania has some sections like this. Bad housing, 
 foul air, liiuh infant mortality. 
 
 Polluted streams are res]lon^illle for more typhoiil fever than all other 
 sources coinhiiuHl. 
 
 The free distribution of antitoxins to the indigent forms an ini[iortant 
 feature in the prevention of infant mortality. 
 (Samples of antitoxin. ) 
 
30 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 Her editor 1/ Syphilis 
 
 Hereditary syphilis is a child destroyer 
 
 This l)ooth contained 9 charts which are self-cx| lanatory. 
 
 Section A. O. 
 
 Chart 1.— Iniiicating the way in which syphihs is transmitted. 
 Children inherit syphilis usually from the father. Syphilis in the adult is 
 curable. An adiiit ha\ing syphilis should never marry until cured. 
 
 A man having uncured .syi)hilis will give the disease to his wife. Syphilis 
 in either parent is a very common cause of abortions, miscarriages and 
 stilll)irths. 
 
 Beware of tlie advertisements or advice of those wlio promise quick cures. 
 Syphilis shoidd be treated for at least five years. 
 
 The one big cause of the spread of syphilis is immorality between men and 
 women. Therefore the stn-e means to stamp out sy|)hilis is for men and 
 women to be moral in the sex relations. Protect your future children 
 against syphilis by yourself leading a virtuous life. 
 
 If you have ever had syi)hilis, be examined by a ])hysician and have your 
 blood tested before being married and becoming a parent. 
 
 Chart 2.— The blood-test for syphilis. 
 Tubes 1. 2, and 3 contain the blood from three different persons. Tubes 
 la, 2a, and 3a contain blood from the same three patients to which have 
 been added the reagents for the blood-test for syphilis. 
 
 Tube 1 is from a man who does not have syphilis as jjroved by absence of 
 any change in tiie la tube. 
 
 Tulie ^ is from a man wlio contracted syphilis 1 fi years ago. He has shown 
 no signs of the disease for 13 years. He thought lie was cured and married 
 six years ago. He has a son five years old who developed hereditary 
 syphilis of the eye and skin. The father then had his own blood tested, 
 and the tube 'ia shows he still has the disease himself. He had not had 
 enough treatment to ciu-c his syphilis Ijcfore being married. 
 
 A })lood-test in a case like this woidd have shown the need for more treat- 
 ment before marriage and saved the child from hereditary syphilis. In 
 tube 3 is the blood from the five-year-old son of the tube i man. The 
 change in tube 3a proves the child lias syphilis. 
 
 Chart 3. — Syphilis both in adults and in chiUlren is a common disease in all parts 
 
 of the world. 
 
 Syphilis may be contracted innocently. One of the commonest innocent 
 causes of syphilis is kissing an adult or baby having the disease. A baby 
 may contract the disease from a wet-nurse wlio has syphilis. 
 
DIRECTOR)' I.V/) (ATA WOVE OE EXHIBITS 31 
 
 (hart 4 — I'Sci" Plate IX.) Tlir syi)liilis i;,Tm. 
 
 PhotoKrapli^ of liviiit; syphilis Ji, A. I?. (', I>. iS. E. the gt'rii! is niimnificd lOnn times, 
 P"|" ;iuil in !•" ^S; (.. k")()(l times. 
 
 Diagram. Sypliilis germs frum 'y\^\s (•()rk-s<Te\v-slia|ie(l i;cnn is tli<- cause of sypli- 
 ""•■''^'"- ills. It invades every tisMie of tlie iiody. It is nsn- 
 
 aily conveyed to tiie patient liy direct contact willi 
 Diagram. Syphilis germs in .^ sypl,i|itic .sore. It is most often con\c\-ed dnring 
 lif'sv'.hiiis'"'"'"'"™ ''"''' ''""' ill.'t:itiniate sex relations. It is fre.,nently_ due to 
 '''^'"'"'' monlli-to-nioutli kissinj;-. The ycrni is sometimes car- 
 
 ried to an innocent jjcrson on towels, razors, drinkiiii; 
 Diagram. Syplnlis germs m ^^.,^j^.,^ ,^,^^.^, j^^.^.^^ ^^^^.^i ,,^. ^,,„,^. ,,„^, haxuvj, 
 
 spleen of lieaii bahy, , ' ,. 
 
 the disease. 
 
 S\i)liilis in a contat:ioiis form alwavs remains Inrk- 
 Diagram. Syplnhs germs ,n .^•_^. .^^ |,^^, ,^^^^,^. |.^^_. ^.^,,^^._^ ._,.,^,,. .,|, ;.i^j,,,^, ^j^,,,^ ^f j^ 
 
 lia\e liccn rem<i\fd li.\' medical trt-atnient. Tests of 
 ... c I 1- tlie Mood will re\eal its i)rosence when it cannot lie 
 
 Diagram. Svphihs germs in ' 
 
 bloiiil-ve.ssels. detected liy aii>' otliei' means. 
 
 The four charts wliich follow illustrate jiiclorially some of the lesions of 
 Hereditary Sy|)hilis. 
 
 Cliarl ,").- (See I'lale IX. I 
 rhol,.gi:.pli. Hereditary Syphilis of the skin of a haliy's leg. 
 
 Svpliilis in a woman who contracted the disease on the 
 thnmh from handliiii: a l>aliy with hereililary .syphilis. 
 The sore on the thnmh (a chancrel was the first evi- 
 Photograph. dence of the .lisiasc and six weeks later sjKjts like 
 
 those on the forearm hroke out on the skin over the 
 whole liody. 
 
 .V syphilis sore on the ujiper liji in a i:irl of l.> years. 
 Photograph. who caught the disea.se by kissing a hahy who had 
 
 hereditary sy])hilis. 
 
 „, . , Ilcreditarv Sviihilis of the skin of a haliy's leg. Babies 
 
 rhotograpli. . ', ,. i-ii r i i j- 
 
 havmg such a. severe form ot thedisease nearly alwaysdie. 
 
 Cliart (1.— (See Plate IX.) 
 
 Photograph. Hereditary Syjihilis of the tongue in a seven year old boy. 
 
 Hereditary Syphilis which has caused destruction of 
 Photograph. jJ^P py^^ „ost._ ^^1 f^ee. 
 
 „, , , Hereditary Svi)hilis causing blindness in a 15 year old 
 
 rhotograpli. . . i c^ 
 
 boy. 
 
 Hereditary Syjihilis showing the effect of the disease 
 
 on the jiernianent teeth of an eleven year old boy. 
 
 Photograph. rpj^;^ jjatient also has an outbreak of syphilis in both 
 
 eves and in a bone of the leg. 
 
The ^hilis Germ 
 
 r flA,B.CJiaE,-nil!OBIiH 
 
 BMAamnED noo tihe& 
 .AirpwF.aa4Si»TniB 
 
 This CDritsatw shaped ^mn 
 is the ouse cf 9^hitis. II iixvwks 
 
 lent fly direct a>nlact with 
 a*s^iUtic sore. It is most 
 often oonveyed during ill- 
 
 13 ftcquenlly due to mouih- 
 to-nouth kisan^ The^mnis 
 aometimes carried to an inn- 
 oomtperBOQ on toweUrazom 
 diiokin^ oj^ etc wtuch haw 
 been undlgr some one Invinrf 
 
 Miife ina cmita^iDiis ibmi 
 ■Invs RuiiB brlMV the body 
 fer mn afler all visible -si^ 
 <f t Im ban RinoKd briK^aa 
 tiatnait'MsarflieHoodmU 
 meal la nesenoe when it cnuKt 
 
 Heredilaiy Chilis 
 
 of the ton^ in a smrnynr 
 old boy. ' 
 
 Hereditary Syphilis 
 
 wtiicii has c&i:3cd distrudion 
 of the eyes, nose and face. 
 
 Hereditaiy Syphilis 
 
 cauain^ blindness in a 15 year 
 old bqt 
 
 Hereditaiy Syphilis 
 
 Showing the effect of Uw disenseon 
 the permanent teeth of an clewn 
 
 Heredilary Syphilis 
 
 orUKskinofatals^k^ 
 
 atatgr with hen«tanr ^rphllia. ! 
 The mai the thnbla dinar) ; 
 MaUcilntoiiieKcorthediaeaK ' 
 ari six weks Wer >|«ils Hbe law 
 an the bnami broke oat on the ; 
 •kin OKT the whole bod$c 
 
 lijsoieoolheuiiwt 
 Har6>t«n,»hcai01- 
 Ir Uaaii^ a fcdv who ; 
 tad htraUfany wphilB. 
 
 Btmlilaiy MiiUa of (he akin 
 afahaivkk* Aabieshavii^ 
 ~" - ame fena ar be «*e«e 
 
 Hereditary 3yphilis 
 
 of both kn«s in a boy 
 He also has syphilis of 
 the eyes. 
 
 Hereditary ^hilis- 
 
 ftrtial Blindness and. 
 skin eruption. 
 
 Syphilis in an adull con- 
 tracted innocently from bein^ 
 tatlooed by a man who hnd 
 syrhili&'Ihc syphilis imns from 
 the 9p(iillK!5 mouth wrrc 
 carried on the laUoo- needle 
 into the pnlientis skin. 
 
 Pl.\te IX Section A. O. 
 
 HEREDITARY SYPHILIS. THE SYPHILIS GERM AND CHARACTERISTIC LESIONS 
 
 .■52 
 
DIRECTORY AM) CATAUHiVE OF EXHIBITS \V^ 
 
 Chart ?.— iSfi- Plate IX.) 
 
 Hfro(lit;irv Svi)liilis of hotli knees in a how He also 
 P loliiL'rap 1. ■ ^. 1 •'■• "r .1 I' 
 
 '^ ' lias Syphilis of tlie Kyes. 
 
 Ph(.tc>'rii)li Ilernlilary Syjiliilis. I'arlial Blindness and skin erup- 
 
 tion. 
 
 Syphilis in an adult eonlraeted iiuioeeni !>■ fi'oni heing 
 pi^^,^ ,i.. Ii tattooed hy a man who had syphilis. The syphilis 
 
 irernis from the .syi)hilitie"s mouth were carried on the 
 tat too-neeille into the patient's skill. 
 
 Cliarl S. 
 
 Permanent deformity of the nose due to destrnetion 
 '" "*-''''!"■ ,,f il,,. |„,nes in the nose liy Hereditary Syphilis. 
 
 I'erniani'nl scars of the iaee following sores due to 
 ' Jlerechtarx' ^yphihs. 
 
 I'hotdgrapli. 
 
 Heredilar\' Syphilis in a yount; nirl. The disease has 
 dcstroyc(l one e\('. (he nose, and pari of Ihc lip. 
 
 Hereditary Svphilis of the finuers. .\ <()nnnon form 
 ^ ' oi tlie disca.sc. 
 
 An .r-ray [)ieture of the forearm of a .")-year-old 
 Pliiilograpli. child. The hones show the etfecl of Hereditary 
 
 Syphilis. 
 
 The arm hone from a hoy 18 years of ajje who died 
 PIiutdKrapli. of Hereditary Syphilis. The disease also affected other 
 
 bones, joints, and internal organs. 
 
 Cliart I).— OtliiToffcTts of lii-rrdilary ^y|>llilis. 
 
 Hertnlitary Syphilis is a crippliuu and life-destroying blood di.sease iidier- 
 ited from one or both parents. 
 
 The more dangerous forms, which camiot be well shown in pictures, may 
 affect the brain, liuigs, liver, heart, blooil-vessels, sjHnal cord, nerves, and 
 other \ital parts. 
 
 Hereditary Syphilis eau.ses many babies to be born dead. Very often thi.s 
 disease does not show any visible signs luitil the liaby is from two to six 
 weeks oM. 
 
 Of the babies born alive with hereditary syjihilis, many die in spite of the 
 most carcfid treatment. Hereditary syi)inlis renders children easy jjrey 
 for other diseases which often result in death. Once gotten under control, 
 the disease can be cured by medicine given for years under a j)hysician's 
 direction. 
 
34 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Heredity and Eugenics 
 
 This booth contained the following legends and graphic charts: 
 
 Section A. Booth No. 1. 
 
 Alcoholism can scarcely lie placed in its proper relation to other causes of 
 excessive Infant Mortality imless it is regarded as a part of a vicious circle, 
 of which Ignorance, Carelessness, and Poverty form important parts. 
 
 INFLUENCE OF ALCOHOL ON INFANT MORTALITY 
 Table Showing the Progressive Death Rate in Alcoholic Families 
 
 Dead and 
 
 Dead and Dead-bnrn. Dead-Born 
 
 Cases Dead-born Pereeniayc Percentage 
 
 First Ijorn 80 27 33.7 (i.2 
 
 Second born 80 40 50.0 11.-2 
 
 Tliird Ijorn 80 4'2 52.0 7.6 
 
 Fourth and fifth born Ill 73 65.7 10.8 
 
 Sixth to tenth born 93 67 72.0 17.2 
 
 Influence of Alcohol on Infant Mortality 
 
 Xo. of Chil- Percentage 
 
 Xn. nf Xo. of dren Dead in of Dead 
 
 Mothers Children i? Years Children 
 
 Driinlvon mothers 21 125 69 55.2 
 
 Sobermothers 28 138 33 23.9 
 
 The Mating of the Unfit 
 
 The Law — The Cost 
 
 No Escape From These Laws 
 
 One parent neurotic, insane, ei)ile])tic, feeble-minded, imbecile, will 
 
 produce some children likewise afflicted. 
 
 Both parents liaving such diseases, all the children must suffer in the 
 
 same manner. 
 
 The children of alcoholic parents are often feeble-minded or degenerate. 
 
 Syphilis, a race poison, is transmissible in the blood, even to the second 
 generation. 
 
DIRECTORY AM) CATALOGUE OF EXHIRITS So 
 
 The standard of home life must !)(• raised. Fatherhood and motherhood 
 must he entered upon with (hie reco^nilidii of the moral duties and 
 responsil)ihties entailed. 
 
 Effect of Povkkty .\ni) I.nsiff 
 
 iciK.NT Food 
 
 
 Of 357 infants dead from all causes, :, per ecnl 
 
 (if the mothers 
 
 lived in a 
 
 pernieious social environment, and in addition 
 
 here were niark( 
 
 (1 poverty 
 
 and insulheiency of food. 
 
 
 
 Of 111 infants dying from immaturity, 10 per 
 
 ■cut . of the iiKil 
 
 hers were 
 
 in extreme povert.v and insiiflicicncy. 
 
 
 
 Effect of III Ukaltii ok ^Iotiikh on Infant Mohtalitv 
 
 Of 3o7 infants dead of all eaiises, ;>!) per cent, of the mothers had a history 
 of ill health duriiii;- and before prefiiianey. 
 
 Of 111 infants d,\ini;' from iiiimal iirit.v. .">.") per cent, of the nK)thers were 
 physically unfit. 
 
 The be 
 
 st test 
 
 of a civi 
 
 ligation, a 
 
 culture. 
 
 or 
 
 an 
 
 inst 
 
 itution, 
 
 is 
 
 whether it 
 
 eontril)uted to 
 
 I)roduce 
 
 good child 
 
 ren, well 
 
 en 
 
 lowed, 
 
 and to 
 
 ad\ 
 
 ance them 
 
 to their 
 
 fullest 
 
 possible 
 
 maturity. - 
 
 -Hall. 
 
 
 
 
 
 
 
 "Much mone,v is spent on special schools, special institutions, asylums, 
 homes, and special hospitals; every device is resorted to to cure what we 
 ought to have tried to prevent years ago." 
 
 We have the census figures showing infants killed b.v preventable diseases. 
 
 How can we obtain the long list of the babies iruunded for life by prevent- 
 able diseases.^ 
 
36 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOJJ' 
 
 Eugenics Means a Better Crop of Boys and Girls 
 The function of Eugenics is to produce a race healthy, well formed, and 
 vigorous by keeping the springs of heredity pure and undefiled, and 
 improving the inborn qualities of the offspring. — Morroxc. 
 
 We Study Agriculture and Household Arts to find out 
 
 How to raise better crops of wheat, 
 How to improve the breed of cattle, 
 How to hake better bread. 
 How to produce material wealth. 
 
 We should also study Eugenics in order to know — 
 How to endow childhood with its Birthrights of wholesome instincts and 
 vigorous life. 
 
 How to prevent conditions that now l)light and handicap thousands of 
 children before birth and throughout life. 
 How to improve the race-stock. 
 How to produce Human Wealth. 
 
 The child l)orn maimed and Ijlightcd is cheated of its birthright, being 
 robticd of i)ower for normal growth and development, and made to bear a 
 terrible burden of unhappiness. 
 
 There is no case on record in which two imbecile parents ha^•e produced 
 a normal child. 
 
 Illustrative Diagram 
 
 If half the money exj^ended now- had been spent on the Mother, the Child, 
 and the Home, over ^20, 10, or even 5 years ago— our special schools would 
 not be so urgently needed. 
 
 Registration of Births 
 
 Have you made personal incjuiry as to whether your birth and your chil- 
 dren's births have been properly registered? 
 
nrniy roRV i.v/) ( Ar.ir.oari-: or exhibits 37 
 
 Aloiiu willi ^ypliili- niil-l 1)C |il:i( rd al(i)lH>li>iil us ;i mtIdUs cmusc of liilaiit 
 Mortalitv . I'arciital iicf;lcct is a coiiimoii rcsiill nf alcdliolii- liahits, and 
 lliis iiii|)lic.s a liigli rato of mortality among rliihlrcn atiVctcd t>y sucji 
 neglect. 
 
 ("orxT Tin; Cost in rin. I'mtki) Sr\TKs 
 
 liViiiiliirss. 
 
 In ililani-. under out' year 7,:i('(!) 
 
 Cost of Institutions for all Mind $1, .>().•>, S(l() 
 
 Deofnrs.s and Diniihiicss. 
 
 Individuals who are deaf or diinil> or Kolli . S!),-2S7 
 
 Cost of schools for deaf and dnnil) .S:>..'i.JO. ()()() 
 
 Fcehlr-iiii)i(l('(l>ir.f.'< mid I mliccililji. 
 
 Feelile-minded in instilnlions IS. 1-7(1 
 
 Cost of their .'are .'i54,.'{S !.:!<) 1 
 
 Estimated not in institutions 'JSS.dOd 
 
 All a nieuace to the race and nation through conduct, crime, and ])roi)aga- 
 tion of their kind. 
 
 Some States now i)roliil)il the marriage of insane, epileptic, feehle-minded, 
 alcoholic, syphilitic, and criminal persons. 
 
 If we neglect the moral aspect of the res])onsiliilities of parentage, and 
 especially motherhood, we must i)ay the penalty of racial decay. 
 
 The architect may achieve a heautiful house, a convenient dwelling, or a 
 money-making skyscrajier, but unless he has first in each case achieved a 
 building healthful for its occupants he has failed in what should be his 
 highest aim. 
 
DIRECTORY AXD (AT.lLOarK OF EXHIBITS .'5!) 
 
 The conditions tiiat kill one out of five babies also maim tiie other four. 
 
 Section A. BiHitli Xo. i. iSiv VUU- X.) 
 
 Infant Afortality In Relation to Feedini; and Poverty. 
 
 Cir;ipliic ( hart. 
 
 Breast Fed Babies have a far better chance of liviiiir lliaii IIiom' fed by 
 hand, wlietlier in very jiuor families (ir in tlinse a lit lie iiellcr utl'. 
 
 Infant mortality rates per 10, 000 births ainoni; ille<iitiniate and legiti- 
 mate children in l,ondi)n and certain rural counties in 1!)0'J. 
 (iraj)iiir < "liart 
 
 Causes of Infant Mortality. 
 
 (iraphic Cliart. 
 
 Classifieation of the causes of 44,'-2'2() deaths under one year of aj^'e in New 
 York, Philadelphia, Boston, and ('liica>;o, 190!). 
 
 r.rai)liic Il.n-,iit.v Cliarl of KTiuna \V. ISnm I'.l.niary II. |SS<). 
 Ennna W. came to life in an almshouse, stamped with illegitimacy and 
 feeble-Tiiindedness. Her family's record reads: mother, two l>rotliers, 
 and a sislt>r feeble-minded; mother's father feebl(>-minded and mother's 
 mother tuiierculons. When a .second child was expected the mother was 
 induced by well-meaniui; i)eople to nuirry the father, who was a drunken 
 epilei)tic. Two children were born. Still lat(>r the same well-meaninj; 
 people aided her to oet a di\"orcc in order to marry the father of another 
 child about to be born. Since then foiu' more lia\'e been born. .\11 of 
 these children are feeble-minded. The entire family with the e.\cei)tiou 
 of the oldest child is at large. 
 
 Housing' and Environment 
 
 The two booths relating to Housing and Environment contained the following 
 charts and ])hotographs. The purpose of the charts was to emphasize the condi- 
 tions which connnonly endanger the lives of infants and children, and to place the 
 resi)onsibility for their correction. The photographs, each of which bears an ex- 
 planatory legend, represent actual conditions in Philadelphia — conditions which 
 are a menace to the health of her infants and children, and which nuist be corrected 
 
House E. 
 House F. 
 
 - 1309 
 
 « "- - '91* 
 Sister - 1911 
 
 BnAher — 1908 
 
 — 1910 
 
 Sister — 191 1 
 
 EEcJwvated oaeye 
 No recond. 
 
 Scfused bjr father 
 
 ' 
 
 Mother - 19U. Son - •• ■» - 
 Kilher -1312 sc *SjB,(s.,ii4 
 
 Plate XI 
 
 CHARTS SHOWING THE RESULTS OF HOUSE INFECTION WITH TUBERCULOSIS AND THE EFFECT 
 OF OVERCROWDING AS A CAUSE OF INFANT MORTALITY 
 
 40 
 
DinECTORY AXD CATALOGl'F. OF EXHIBITS 41 
 
 by co-o])er;iti()ii Ijetwecu the health autlioritii-s of tlie city of I'liiladelphia and 
 her citizens. 
 
 Section A. Booths \os. ;i and 4. (Spc Phitrs XII. XIII, iiikI XIV.) 
 
 Cliarls. 
 
 Cities having the most efficient service for tlic removal of waste, show the 
 lowest Infant Mortalitv from Diarrlid'al diseases. 
 
 Diarrh(ra is most jjrevalent when' the systems of removal of sewage and 
 house refuse are least satisfactorv. — .Xnr.shdliiic. 
 
 Evidence stronjily jjoints to the fact that in many cases infantile diarrlura 
 is due to surface accniiHilations of ofi'ensi\e maleriai in I lie \icinity of 
 houses, open garl)age-cans, garijafie duni])s, oriranic refu-~c in hack yards, 
 alleyways, streets, "utters, and open pri\y wells. 
 
 The resjionsibility for a large portion of the total infant mortality and 
 of the total mortality from infantile diarrluea must he home hy sanitary 
 authorities. 
 
 Cities with a high tcmj)crature duriTig the summer months, and a deficient 
 rainfall, sln>w a high death-rate from Diarrhn-al Diseases in Infants. 
 
 It is not so much a f|Ucstion of making new or more adequate sanitary 
 laws, health ordinances or police regulations to ])rotect the health and life 
 of children: as, the ap])licati()n and strict enforcement of existing laws, 
 ortlinanees and ])olice regulations and the earnest co-ojieration of the 
 jjcople assisting the authorities by obeying them. 
 
42 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 "Wlierever tlic health of the citizens is concerned. . . all governments 
 that are not chimerical make haste to interfere." — Carhjle. 
 
 No strict line can be drawn between miiniciiial and jjarental responsi- 
 bility for uncleanliness which makes for loss of infant life. 
 
 Domestic cleanliness has not a fair chance so long as the continuance of 
 privies, surface drainage, dirty streets and other insanitary conditions 
 are permitted to exist. 
 
 Infant mortality is only a statistical expression of the bad conditions 
 Ijy which Infant Life is surrounded. 
 
 The little babies who die are dead and gone, l)nt the conditions that 
 have caused their deaths remain, and will tend to make thousands of other 
 children grow u|) infirm or defective and deficient in some of the physical 
 needs of a full life. 
 
 The main reasons for the persistence of a high infantile mortality arc 
 undoubtedly tiie want of ])ropcr maternal care, the increase in the artifi- 
 cial or hand feeding of infants of suckling age and insanitary environ- 
 ment. 
 
 Efficient and active house to house sanitary inspection, and repeated 
 re-inspection, are important factors in reducing Infant Mortality. 
 
 Children are the truest indices of the sanitary condition of a crowded 
 neighborhood. 
 
DIRECTORY AM) CATAUXiVK OF EXHIBITS 43 
 
 No amount of effort will eradicate tuberculosis and other infectious diseases, 
 nor prevent physical and moral degeneration among city and town dwellers, 
 unless the lioiising ((uestioii is attended to first and foremost. 
 
 Polluted soil often gains access into homes as a line dust and jxiisons 
 food. 
 
 Alcoholic liahits ohviously lend to I'dxcrty. and to a direct lowering in 
 the Standard of Life; especially in relation to food ami Imusing. 
 
 Conditions dlk to IxtLEAN Habits wiih ii may Kndanckk th?: 
 
 Life of a Child 
 
 1. Filthy homes due to laziness. 
 
 2. Personal uncieanliness. 
 
 3. Dirty cellars, hack yards .ind alleyways. 
 
 4. Rnhhish and garbage in alley, hack yard and gutter. 
 
 5. I'ncovered garbage-can. 
 
 6. Soiled privy or water-closet seats and floors. 
 
 7. Uneoverccl privy .seats. 
 
 8. Keeping of nudean domestic pets (dogs and cats). 
 
 9. Soiled clothing and hcdding. 
 
 10. Unwashed dishes and partially eaten food lying ahout exposed to 
 flies. 
 
 1 1. Improper care of food. 
 
 \-i. I'sing of drinking-cuiis. glasses, and eating utensils that have not 
 ])een washed and scalded since their use l)y others. 
 
 l.'i. Handling of towels, handkerchiefs, and napkins used by some one else. 
 
 14. Tasting of food before gi^■ing to the baby. 
 
 15. Unscreened windows and baby crib (keep out flies). 
 
 16. Spitting on the floor. 
 
44 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Prevention of Infectious Diseases rests on a knowledge of their causes, 
 their mode of spreading, and the more accurate and complete this knowl- 
 edge, the more effective becomes our Prevention. 
 
 Conditions due to Bad Housinc; which may Endanger the Life of 
 
 A Child 
 
 1. Indifferent owner or landlord of premises. 
 
 2. Insufficient jiure water supply. 
 
 3. Bad i)lunil)ing and firoken drainage pi])es, surface drainage. 
 
 4. Lack of sunlight, rcntilaiion, and J re sh air. 
 
 5. Overcrowding of Ijed-rooms and sleeping rooms. 
 
 6. Badly constructed buildings, unlighted and unventilated halls and 
 stairways. 
 
 7. Inadequate fire-escapes. 
 
 8. Damp and undrained cellars. 
 
 9. Surface drainage in alleyways to street gutters. 
 
 10. Location of homes near open manure ])its, cow stables, slaughter-houses, 
 pig-pens, dump heaps, swam]js, open privies, street curb and sidewalk 
 markets, unscreened meat, vegetable, and fruit market stands. 
 
 11. Unscreened windows and doors of homes. 
 
 12. Insanitary condition of streets and neighborhoods. 
 
 13. Broken brick pavements on sidewalks and in alleyways. 
 
DIRECroRY A.\D CATALOGUE OF EXHIBITS 
 
 Conditions Due to TuofcHTLEssxEss 
 WHICH MAY Endanger the Life of a Child 
 
 1. Taking children into homes or places where there is sickness. 
 
 2. Attending funerals of tiiose who have died from any doul)tful or con- 
 tagious disease. 
 
 .'?. Sending children who are slightly ill to school, Sunday-school, kinder- 
 garten, dancing classes, parties, or allowing Iheni to l)lay or mingle with 
 other children. 
 
 ■1. Taking children into crowded places, overcrowded si reel -cars, moving 
 picture shows, curl) or street markets, on tiresome journeys, excursions, 
 or kee|)ing children \l\^ laic. 
 
 5. I'ermitting children lo play in ash heaps. duni|)ing gi-ounds. dirt,v 
 hack .yards or alleys in the \icinily of maiuire-pils, slatighter-houses, 
 piggeries, or wherc\-er there is filth or unhygienic surroundings. 
 
 fi. (iiving the haliy I'oikI Ihal lias li<>cn previously tasted hy others. 
 
 7. Exposing the hahy's eves lo I he direct ra\s of |hc sun. 
 
 8. (iiving children candy, hokey-pokey, ice-cream, heer, hananas, lea, 
 eotfee, cakes, or other iiii|)ropcr foods for infants ;ui<l children. 
 
 9. The use of feather dnslers oi IJic cnsluni of dry sweeping, and .--weeping 
 or dusting when Ihe \)n\\\ is in I he room. 
 
 Insect Carriers of Disease which may Endanger 
 
 the 
 
 Life of 
 
 
 
 A C 
 
 hii.d 
 
 
 
 
 
 Flics. 
 
 Mos(|uitoes, 1 
 
 edhugs, Fleas, 
 
 Ti.ks 
 
 
 
 Flies — Summer 
 
 Diari 
 
 lupa. Anthrax 
 
 , Cholera, Dy.sentery 
 
 , Sore Mouth, 
 
 Plague, Sore Eyes, 
 
 Trachoma, Tu 
 
 lerculosis, Ty 
 
 ihoid F 
 
 L'ver. 
 
 and other 
 
 disea.ses. 
 
 
 
 
 
 
 
 Mosquitoes — M 
 
 alaria 
 
 , bellow Fever 
 
 
 
 
 
 Infected An 
 
 IMALs 
 
 WHK H MAY 
 
 Kndanger the Life 
 
 of a 
 
 Child 
 
 Domestic Pets- 
 
 -Cat 
 
 - and Dogs - 
 
 Rats, Mice, 
 
 Horses 
 
 Pig 
 
 S Cattle, 
 
 Sheep. 
 
 
 
 
 
 
 
 Cats and Dog? 
 
 — Ra 
 
 lies, Diiihtheria, and other 
 
 Contagious 
 
 Diseases, 
 
 Skin Diseases and Worms. 
 
 
 
 
 
 Rats and Mice- 
 
 -Plague, Worms. 
 
 
 
 
 
 Pig.s — Trichinos 
 
 is. 
 
 
 
 
 
 
 Cattle. Sheep- 
 
 Ant hi 
 
 ax. Tuberculosis, and other d 
 
 isea.ses. 
 
 
 
46 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 Breeding and Feeding Places of Insects 
 
 Flies — Horse manure, cow stables, manure storage piles, stables, piggeries, 
 pig manure piles, pure loft dumping grounds, i)rivies, decayed food, fish, 
 meat, offal from slaughter houses, garbage, dirty alleys; fruits, vegetable 
 market stands; organic refuse found at street and curb markets. Un- 
 screened candy and cake shops. 
 
 Mosquitoes — Swamps, dirty ditches, water-tanks, water in vacant lots, 
 open water traps, damp cellars, unused sinks, ]>ools of stagnant water, 
 surface drainage in allej-s, unused buckets, cans, and otlier recejitacles 
 containing water. 
 
 Bedbugs, Fleas — In houses and homes that are dirty, unclean, badly ven- 
 tilated, and domestic pets (cats and dogsj when kept in a filthy condition. 
 
 Flies Carriers of Disease 
 
 It has been positively proven that flies are frequent carriers of disease. 
 They may carry germs in one of two ways: infected material on the head 
 and legs may be deijosited on the food, or the germs may be swallowed by 
 the fly and deposited later. 
 
 Flies Breed in Filth 
 
 AH the strenuous efforts suggested to destroy or catch flies amount to 
 almost nothing as comi)ared to the residts obtained from an active and 
 well-planned sanitary campaign directed against their breeding places. 
 
 Photographs. 
 
 1. 2. 
 
 Female House Fly resting on Male House Fly resting on glass, 
 
 glass, seen from above. seen from below. 
 
 Showing the six muscular legs, at the end of each of which are two claws, 
 and two sticky jiails. to which germs and filth adhere and by which they 
 are carried from j)lace to ))lace. 
 
 The best way to destroy the flj' is 
 
 to 
 
 REMOVE THE FILTH 
 
 Alleyway between Snyder Ave. and Jackson St. One row of houses 
 underdrained. 
 
 The op]iosite row has no sewer connection, no sewer in street to connect 
 with. 
 
 Broken ])avcnient, garbage, and refuse carelessly thrown aliout. 
 Flies and mosciuitoes abundant. Odors of decayed garbage and filth per- 
 meate the atmosphere. 
 
DIRFATORY AXP CATALoarK OF FXIURFFS 47 
 
 Italian Court. Entraiic(> throtiiili surfa(0-(lraiiic<l alleyway. 
 I'rivy vaults in insanitary condition. 
 
 Surface Drainage and Open Pri\y X'ault. Child playini; in alleyway. 
 
 Filthy Privy \'ault. Mroken i)riek pavement, scattered jiarliaiie and 
 refuse, flies swarming in vast numhers. Kitchen ten feet away. 
 
 Dark allcyua>-. Home of four families. No sunliahl ami Init little fresh 
 air. Hrokcn hrick pa\ciricnl. 
 
 The privy vault, the sm-face drained alleyway, and the earhage huckel, 
 are in the majority of eases near neiuhhors to the " I?aek Kitchen." 
 Filth— Flies. Kitchen. l'\)od, Disease. 
 
 Backyard of rcsidi'ucc in South Philadelphia. Showing overflow from 
 privy well, stagnant ilihli \\;ilcr. refuse, and garliage. Pulilic school 
 liuilding in hackgrouiid. 
 
 Surface drainage. 
 
 Siu'facc di'.'iinage water and till h |-unning through alli'y lo street . Prokeil 
 l)i-ick pavement ; refuse and fill h in gull<'r. street, and <in sidcw alk. 
 
 \\ here some of the hokey-pokey carts are housed. Surface drainage. 
 
 Municipal Dust. 
 
 Dry Sweeping of I'ulilic Streets. 
 
 Showing open manure cart standing in the sun for a j)erioil of two hours. 
 .Manure uncovered and flies swarming in vast nnmhers ahout the cart and 
 its contents. (Pith and Pine Sts.. I'hiladel])hia. P2.;!0P. ^L) 
 
 Showing |)ile of manure on street sidewalk. 
 
 Booth sliowing o])en unscreened manure pit. 
 
 Herd of slice]) lieing <lri\en o\"er the sidewalk in one of the ])rincipal resi- 
 dential sections I Locust and l.jthSts.).Philadel|)hia,at lO.V.^P The side- 
 walk was littered with niamu'e and dirt; ])edestrians tracked this material. 
 It was necessary for the occu[)ants of ]n-emi.ses to remove the tilth and 
 clean the sidewalks. (May 1.'), P)1^2.) 
 
 Cooked, smoked and raw meats for sale on street curl). Exposed to flies 
 and street dust. Better grades of meat under glass. 
 
 Cleaning!; fish on street curb. Scales, entrails, and piece.s of fish have been 
 thrown into the gutter. Street littered with filth and refuse. (The dark 
 sjiot in the street on the lower left-hand corner is the material thrown 
 away hy the fish cleaner.) Public school on op])osite corner. 
 
 Poultry. Meat, Sausages and Pickled Meat. Exjiosed to the street dust 
 and sun — and sold at a curl) market. 
 
■QKes hawQft (hemost rfRaent 
 service fcr the removal of waste, 
 show the lowest Inlanl " 
 from Diarrtweal diseases." I 
 
 and rffW wfcnmwrt of ocislH^ bwk enfr 
 nananoes and polkf reflations aiid Hie 
 exnest cooperation pf Itr pet^ assidiog 
 fitt authorBies b^ obevinf; (hem. 
 
 Undean Hal 
 pndanserthei 
 
 . FilHo' homes du? lo laiinoss. 
 i ftraoial uticteanliness. 
 J Dirfy cellars, hack^^nis _i ^e/v^ 
 4. RuUisli 1 ^Hngc in aUrK. bxkyinl 
 and gulter. 
 
 5 UiKnered jjHMjE<an. 
 
 6 SoiM pnyy x waler<lo3el xab and 
 fhm 
 
 Z l/miwwi pwy seats 
 
 i bedding. 
 
 lecpimlkpnes. 
 p^ caie of ibod. 
 
 l2.U!irSi)fdni*inJaip5.Jlas!M.-o*8 
 
 ulBMls. thai ha* irt b»n washed and . 
 
 ^xalded siiratliariwiycllKra. % 
 
 llandlinj rf towsfe handkart**! wdji 
 ^tB|]bns. used bf sowooe ^ 
 .Ta5lin8offaxlb*n!8iv(i«ki 
 
 is. Ulscmroi windBO and hl^ 
 (keep out (teJ | 
 
 active hoose to barsB 
 
 on.aiid [Tjiealod 
 I "H-iiBiiedion. are important factors j 
 ; in reducing. Iij&iil Mortalil)'.' 
 
 Tiie main nasuiK SrUe [n3i*m 
 
 ; cT a high irfanlilc xiamx an> undouU 
 ^ edly the want cf proper m^enial cait. 
 |Bv iKiraii! in tie artificial or hand 
 lhdil« if inlanis <f sodding ^ and 
 
 Plate XII 
 
 CHARTS AND PHOTOGRAPHS RELATING TO HOUSING AND ENVIRONMENT 
 
 48 
 
DIRKCTORY AM) ( ATAUK.UE OF EXHIBITS 49 
 
 Filtli and market rofuse and lien scavenger. 
 
 Manure, garhaye and refuse and trimmings from fisli and meat niarlvels 
 
 pile(l in street. Flies in threat numl)ers. 
 
 Tiie same street six hours alter the Maiket Carts ha\-e l(^ft. 
 
 Chicken butcher shop on sidewalk. Next door to a <lry-j;o()ds store. 
 
 Filth and refuse thrown into a street in Soulii ]'liila(lel|ihia. 
 
 Curl) market . \'ei;etal)les. Fruits, 15iea<l, Cakes, and Dry-u'oods. 
 
 Live eliieken market. Chicken crates piled in gutter and on .--idewalk. 
 
 Vegetable and fruil slreel-cu?-b markcl. T'hiladelphia. 
 
 The curb-slonc food cart. I'"ood exposed to street du^t and Hies. 
 
 Chicken market. ( hickcns killed on sidewalk — blood, jjieces of meat, 
 fat, and refuse scatterccl over the ])avement. 
 
 During her marketing, a careless parent lea\c-. a baby on edge ot slrcet- 
 curb next to a basket full of garbage and a dirty gutter swarming with tlies. 
 
 Cakes, fruits and candies which lui\'e been exposed to tlies and street dust 
 and which are sold to children. 
 
 A puni]). 
 
 The water-su])])ly for the majority of houses in two blocks of ^\()odeii 
 
 dwellings. 
 
 The new houses recently constructed seen in background. 
 
 A conilensed milk can as a common drinking-cup. 
 
 A Common Drinking Cup. A dangerous and dirty custom. It ma.v be 
 found in many houses, yards, school Iniildings, ])laygrounds, ])ublic parks, 
 and other i)laees. Every person, especially the babj', should have his own 
 drinking cup or glass. It should be washed frequently. 
 
 Garbage hand cart swarming with flies. 
 
 City Dumping Ground. 
 
 Boy working over the deposits. 
 
 Public school in Ijackgroiuid. 
 
 0])en lot near a public .school where rags, collected from dumps, ash-cans, 
 houses, etc., are spread out to dry. 
 
I'lxwnlion of Infedinis Diseases 
 resis on a kiKMbljSe dWv mode 
 cf sprealinj and llic more aoeurate 
 and cnnpli'le Ihis knwled^ He ntn 
 (flcctiw baomej air ft " " 
 
 Breeding aiid Feeding r 
 
 of Inseds. j 
 
 Horse manure, cow stables ', 
 TOnureslorags piles, stables | 
 'piggeries, pij manun- pilexdunp- ' 
 ing Smindi privies. dfcajwJ food ; 
 lisli.nimt.o(lal frem sJauShlcr 
 houses, garba^ dirtv alWs: fruil 
 W8*bte, marW slai«k organic 
 refiisc found at stiH* md curt mar- 
 f^sJkiOTOsd <»dy-r alsilop 
 
 bes-Snampsdirb'dilctiEs.iraler 
 '-Its. wafer in vacant lots, open 
 la- traps, damp cellars, umseif 
 ks. poet rf stagnant wafer. 
 (acs drainage in aSqys.un- ' 
 d budo^s. cans, and otiier 
 ' ' containing water. 
 
 I bugs. Heas-ln houses »i Junes Ud 
 I dirty uncieaii. badjv wntilalaj 
 I wlw ifcnieslic p* Idj J d*) 
 MinafilthyanttiDn. 
 
 reedinFillh. 
 
 I Hw simiuQiis efforts suggested 
 ■"-^orcateh fties. amount to 
 '"^ as coropatwj to the 
 _ i ftwn an adiw and 
 sanitary campaign diiw- 
 .^ Uh* breedm^ piaoes.' 
 
 Plate XIII 
 
 CHARTS .\ND PHOTOGR.\PHS RELATING TO HOUSING AND ENN'IRONMENT 
 
 50 
 
Diiu'j Tony AM) ( ATAi.oi.n: of i:\nfiiiTs ,->i 
 
 ("ow.s rccdint; nil ;i ( 'il y I linii]) 11 c:!)). 
 
 Sick ciiw in liitli\- (■(Hidil ion. I'ii; and cow iii;iiiii|-c sIciiimI in I lie saiiie 
 yard. I'lililii' scIkkiI acioss tiic sircrl. 
 
 Shiu.niitcr-lioiix- li)catcd dii-c<liy ncxi lo " W a^ilinL;l<lll S<-ii()(ii." I'liila. 
 I'igs, cattle and slu'C|) slaiii;lit('i-c(l licrc. I iiNcrcciicd windows of slaiiuii- 
 terinj; room. Sheep confined in jk-ii on Ironl sidewalk. 
 
 l'ii;-sties in clo^c |iro\iniily to a I'nlilic ScIhkiI. 
 
 l'i(;(ii:uiKs 
 
 Sliowint; liin'^cries. swanii) ami dMiniiini; yroiind for tnaiinre and rel'iiso. 
 It i.s estimated lliat there are ','(), KM) pi-s in IMiihidelpiiia lieiow Hitiier St. 
 and l)<"t\veeii llie Delaware and Scliuylkili l{i\ers. IJreediiig firoiind t't)r 
 flies and mos(|niloe-.. iMa.w H)l'-2.) 
 
 .'is ]>iys wiM'c coiifin<'d on llie-.e piemiscs. 
 
 Ojieii aarhaye cart -doi;s, chickens, uoats, jii",' iiiaiiure ])ilo — ojien 
 
 jirivv vault, no niiiiiiiiii water- public school huildint; in the liaekfiround. 
 
 (Phi'ladelphia.) 
 
 Piggeries within cil\ limits, Philadelphia. 
 Swine. Swill. Swamp. I'"illli— Flies! 
 
 Baek-yard I'ig-peti. 
 Near Taggert School. 
 
 Showing insanitary' conditions. 
 
 Showing insanilary conditions. 
 
 Insanitary t'omlitioii witliin a home. 
 
 Insanitary .\ttic Room. 
 
 Flashlight of room without outside ventilation. Small window and door 
 open into inner room and hallway. Cooking an<l sleejiing same room. 
 Insanitary conditions prevail. No sunlight or fresh air. 
 
 (ir;i]»liic ( liart 
 
 Com])arisoii of Exiientlitures for Ini]iortant Munici|)al Activities in Three 
 Leadint; American Cities. 
 
52 
 
DllilJTORY AM) < ATAJJIOL]-: i)l- KXlIllilTS 
 
 Exhibit of the H<)usin,ir Commission, FhHadclphia 
 
 |Srr l'lal.'> XV. XVI, X\ II] 
 
 HKAI.'lin IIOMKS M AKK IIK Al.TII Y I'KOI'I.K 
 
 Socti..Ti A. I!.... Ill No i; 
 
 This I mull I i()iil:iiii('<l iii(>(l<'l- illiistratini; ;i ilclcctivc cily l)l()ck and a proposed 
 reconstnul idii. and •.nine additional cliarls and |)li(>t()^'rai)lis rolatini; to housiuf^ 
 and cnx ironiiicnl . 
 
 M..ilcK Illu-li;iliii!,' Coiijirstnl :niil Rrroiistniclcd Blocks. 
 
 (1) IMiiladclphia Honsin^' ( 'onnnission I?lock Roconstrnclion. 
 
 'I\v])('s ol' Mock-. I'oi- coiitjcslcd iircas. 
 
 TIk'sc models show a eoniicsled city hloek as now hilill up and as il slionld 
 lie rebuilt. 
 
 ('<inipare the old with t he new plan. 
 
 Is il worth sKIO.doo lo the cjly to take thi' neeessary ste|)s to hrinu al)out 
 this eliaiifie? 
 
 (2) Congested Block Data: 
 
 .\rfji of hunt occupied hy imitdin^s 6'2,0()0 s(j. ft. 
 
 Dt'iLsity of populaliim per iicrc lill 
 
 N'unilicr of lionscs I.V> 
 
 Nurn!>cr of oiitl>iiitdiii^.s Hid 
 
 XuniluT 4if st(ir('-s 51 
 
 XiiiiiliiT of rear liouscs 65 
 
 Xuiuljcr of lioiLscs in l)ad repair 63 
 
 Xmnher of woixien houses 18 
 
 Xumlier of privy vaults 18 
 
 Xuniljer of privy houses al)ove vaults il 
 
 Xuniber of liydrauts 81 
 
 Xumtjer of people using tliese liydrants 1i\ 
 
 Death rate per 1000 people for the ward of wliicli this Ijlock is a part . . \^.'M 
 
 What Chance Have the Babies in such an Environ.ment? 
 
 (3) Reconstructed Block Data: 
 
 .\rea of land occupied liy Iiuitdings 4!),000 sq. ft. 
 
 Density of jjopidation per acre ^.5.'t 
 
 Xumber of houses 04 
 
 \uml5er of apartments 148 
 
 Number of stores 54 
 
 This reconstruction can be done by giving the city power to condemn 
 insanitary areas, purchase the property, remove the buildings, replot the 
 ground, and .sell the same to the highest bidder. 
 
54 
 
DIRECTORY AM) ( ATAJJUd'E OF KXIIIBITS 
 
 Charts 
 
 'J'hc liDiisc and the hody arc cadi licallli units, and tlic ^tnily of llic lionsc 
 lieallhy sliould lie as inijiortant to I lie arcliifecl as Personal llytriene is to 
 the pliysieian. The Body Healthy is the Foundation of all I'utilie Health 
 work. 
 
 It is a wise coiunnnilly wliieli places liraltji al)o\"e all eoiiunnnity ]ios- 
 .sessions. 
 
 Kii.i. TiiK Flies 
 Why? 
 
 Because — 
 
 1. l*'lics hrccd in manure and other lilt h. 
 
 "i. Flies walk an<l feed on excreta and sputa from people ill with typhoid 
 fever, tuherculosis. diarrh(eal affections, and many other diseases. 
 
 ;>. ( )ne fly can cari'y and may dci)o-it in our fi)o<l (i. ()()((. 000 l)act(>ria. 
 
 4. A fly is an enemy to health the health of our childi'cn. and the health 
 of our comunniity I 
 
 A lly camiot d<'\clop fi-om the c^l; in less than S days; therefore, if we 
 clean iii) everythini; thorouiihly every week, and keep all uiamu-e screened, 
 there need Ix' no flies. 
 
 Waste Disi)osal. 
 .V clean eitv is a healthv citv. 
 
 The city makes no original sanitary inspection. Hence the following 
 nuisances are only corrected when a citizen files a complaint. 
 
 I'liutuKraplis 
 
 Insanitary conditions. 
 
 One of many insanitary vacant lots. 
 
 Two-family house. 
 
 One has five children and the jiarents sleepini; in one room. 
 
 Privy vault adjoining, full and leaking. 
 
Waste Disposal. 
 
 A dean city is a heaHhy citjr. 
 
 Two- Family Roij» 
 
 tS dllMmt ami Uviuiwtf iW;u^ ineor mm. 
 Phyy vsoll »f>mij Ml ini Walai^. 
 
 Plate XVI 
 
 PHOTOGRAPHS AXD CHARTS. 
 
 HOUSING COMMISSION OF PHILADELPHIA 
 56 
 
niRKCTOUY AM) < ATAIJU.l'K OF EMU HITS 
 
 Sidowulk made filthy by flow i'rom alley. 
 
 (iarl)aiie and waste washed down, tlestroyiiit; ])a\(Miien( and Mockini; 
 
 gutters. 
 
 Dwellini; Teii.-inl rclii^cs to iiiov'e; no lied; windows hlockcd liy ])a|:er. 
 
 House di-;iin iii|ie carrNiii;; water-closet liltii. Defective test caj). Over- 
 flow to I lie cellar-kitchen lloor. 
 
 Dol; uiauurc collecle<l in I he couulrx and >tort(l in the eil\'. II >uch 
 houses in one ci)ni;cs|c(l Klock. 
 
 Cellar conJainint: •' lee! of water. -."> lion-~e^ in one row with w ater in t hi' 
 cellars. llun<lrc(U of sudi in the cit\'. 
 
 Cellar licd-rooni. Size .") teel S inches wide. 1 \ feet loni;, (i fei't (> inches 
 hi-ili. \\ indow ' ■> foot si.\. .'} men sleep here. 
 
 Sumniei' conditions. ()id\' one row of houses underdrained. Flies and 
 liios(|uitoes. SnielU unhearahle. Tenants keep their windows closed. 
 
 .\lley in new areas. <) parl\' pri\ ies. 7 full. .'! overflow ini;-. Decayecl 
 \'(>iielai)les. 
 
 Household waste ciu|)licd into the street. 
 
 .\llev fille(| with ii-<-; coiitainiut;' refuse and iiarhage. 
 
 Cellar Dwellinj; - Liviui;' room. No law to prohiliit its u^c. In many 
 .such rooms families eat, live, cook, and sleep. 
 
 Cellar Dwelling; — Rear room. Xo frc^h air; noliuht: no window. 
 
 Street made filthy hy surface drainage. 
 
 Old section of the city. Household wa-te in tilltfers. 
 
 Dead End .Vlley. 
 
 With a one-room occu])ietl house al)o\e .'? defective hopper closets. 
 
 Narrow street entrance — surface drainaye — S families, many hoarders, 
 small overcrowded rooni.s. 
 
 Dead End Street. 
 
 Horizontal tenements: surface drainat;e; insanitary surroundings. 
 
 Dead End .Vlley. 
 
 ■5 houses — two unsafe. Privy lieneath house. 
 
 i compartments, vault io feet dee]). 
 
use*-: :<,:eii..*^i'.'^ 
 
 i! 1. Flies breed in manure 
 ^; Z Flies walk and feed on t 
 jwn people iH with l|/phoid fever tv_ _ 
 
 ^^^al affedions, and many other du« 
 3. One flv can carry and may deposit 
 
 i-— «v» bacteria. 
 
 ■ is an enemy to heattli.-tlie ' 
 I bealtti of our coramunify! : 
 
 fly cannot develop mm the egg 
 ^—^ lefcre. if we dean up every. 
 sk. and keep all manure scree 
 be no flies. — ' 
 
 si 
 
 Pl..\TE X\II 
 
 PHDTIIGR.APHS .A.\D CH.^RTS. HOUSING COMMISSION OF PHIL.ADELPHI.A 
 
 58 
 
DIRKCTOUY AM) ( WIW UHiFf-: OF FXIfflirTS 59 
 
 Eiiclosod Rear < 'omt. 
 
 8 houses with 4 cellars lull of water. 
 
 Block Chasm. 
 
 These shc(l.s lilock IIh- kilchcii windows. 
 
 J'cn rear lioiiscs, n.irrow alley. 
 
 Surface (Iraiuat^c KiO feel, 1 lixdi-.inl . I pri\y, 71) pcopli- and many 
 
 hoarders. 
 
 Civic T s;liness. 
 
 !) narrow alleys rnn in from lhi> street to .t'> houses. 
 
 Two and one-half acres of roofs. 
 
 With an occasional chasm. T nany linildiiii;s on the land; no Mock 
 
 N'cntilal ion. 
 
 One reason for i).(l(IO prcv cntaMc deallis ammallx occnrrini; in i'liiladi'l- 
 
 phia. 
 
 •K). 0(1(1 propciiics not nmlcrdraincd. iinriilicd> of city sli-ecl-. one Mock 
 
 lonji, solidly Imilt up, wit hunt -(■wcrs. 
 
 I'i- I'cns. 
 
 In a pop I dons area and near a pnMic school in Soiit h W est I 'hi la. 
 
 Filthy I'ifjficries. 
 
 Near two-story homes in IJiclimond. 
 
 Scraping the jiiii manure out upon the ground in the Slamijcrs Lane 
 distri<-t. 
 
 Stackint;' piu filth in li.ick >ards. 
 
 Hrecdinu flies. South side of Stampers Lane. 
 
 Back yards. .Vsh and refuse pile. 
 The \-ault is one of --ij, ()()() in the city. 
 
 LTjicovered uarbage wayon near puhlic school. 
 
 Few such wagons are water-tight, therefore they go ahout leaking >will 
 
 along the city streets. 
 
 Diagnim. 
 
 This diagram indicated the method ])ursued hy the Philadel])hia Housing 
 Commission in carrying out its investigations regarding conditions of 
 drainage. 
 
CO 
 
DiRFJ ninr axd ( .itakk.i'f. or KXffnurs ei 
 
 The Visitinff Nurse Societif, Philadelphia 
 
 Suction A. H..i.lh \n. S. [Sr,- riiirs \..~, Will, XIX, X.\, ;iri,l XMl 
 
 This hontli coulaiiicd clKirK and pli()l()j;Tai)lis wliicli illustrated the aiiiis and 
 work of llic Society. Tiie two rooms in adjoininii' hootlis illustrated wliat the 
 Society acconi])lislicd in ojie instance in couveiiinj; a dirty, insanitary room and 
 alley into une that was clean and sanitary. 
 
 The object of this Society is to give to the poor and to those of moderate 
 means the best home inn-siiif; jjossihle under the circnnistances. 
 
 f'liart.s 
 
 Concentrate on the mother. What the mothcT is the children are. 'I'he 
 stream is no ])urer than the som-cc. 
 
 Let us glorify motherhood hy every means in our jiower .... Let us 
 have good mothering; that is at the foundation of happy, lu'althy children. 
 — John liiinis. 
 
 \ woman rarely looks better — even the plainest woman- than when she 
 has a little child clinging to her — her Ijest ornament. 
 
 The ups and downs of health closely follow the ups and downs of the 
 windows. 
 
 Hygiene is the Science of Health, and to have healthy people we must 
 begin with the T5al>v. 
 
Plate XIX 
 
 PHOTOGRAPHS AXD CHARTS, X'ISITIXG NT'RSE SOCIETY OF PHILADELPHIA 
 
 02 
 
DIRECTORY ASP ( ATM.nc.l'E OF KXIIIIilTS 63 
 
 CaRK of THK Im'ANT in TIIK IIoMF. 
 
 Love and affection. 15c spariiif^' iif kissc-.. I5ut ticiitly cudcllc the l)al)y. 
 Do not starve the bahy'.s heart. 
 
 Conditions II ahmi i i. lo Hauieos 
 
 1. 15a(l lioii-iim'. 
 
 '2. (^iie-.! i(iiial>le iiuhlstrial nietliiHl-.. 
 
 .'!. IiiHoraiit or iiichtt'ercnl niollierhood. 
 
 \. Irre.s|)onsil)le I'at herliood. 
 
 .5. Disrefjard of tlu' essentials of personal or l)al)\' hygiene. 
 
 (i. Tnii)erfeet or inadt'cpiate su]ier\ ision of the milk snpply. 
 
 T. Kilher inadeipiale sanitary laws or a failure lo enforce tliein. 
 
 
 CoNDITniNS FWOUAHI.K TO HaIUKS 
 
 
 1. 
 
 Intellijient Motherh 1. 
 
 
 o 
 
 Sufhi-ient Sleep and Rest. 
 
 
 3. 
 
 Maternal Nursing. 
 
 
 4. 
 
 Daily liathini;. 
 
 
 .>. 
 
 Cleanliness and Fresh .Vir. 
 
 
 (i. 
 
 Pnre Modified Milk for Baliies who lia\e to he artitic 
 
 ally fell. 
 
 t . 
 
 Enforcement of Existing Health and Sanitary Laws 
 
 and Police Reg- 
 
 nl 
 
 ations. 
 
 
 Clothing 
 
 Soft, easy fitting, and sufiii'ient (hut not hurdensome! garments for the 
 baby should be arranged. Tight bands are undesirable; but a smooth 
 knit undershirt mav be needed in cold weather or for delicate infants. 
 
Plate XX 
 
 PHOTOGRAPHS AND CHARTS, VISITING NURSE SOCIETY OF PHILADELPHIA 
 
 64 
 
DIRKCTORY AM) ( ATMJX.l'E OF I.XIHIUTS 65 
 
 15 \ ihim: 
 
 Once or twice a (lay a niodcralcly warm liatli slioiild he ])r(i\i(ic<l lor t ho 
 l)al)y, with identic aiui carcl'iil cloaiisiiii; of all jiarls — eyes. cars, and cvcry- 
 wiicrc. Kcc]) lh<' l)a!)y clean ami sweel, and "chanucil" as ot'lcii as lu'cd 
 arises. 
 
 Twenty-two lionrs of sleep ont of each twenly-fonr is I he rnle for the 
 first month, with abundant rest and freedom from exeitemenl all through 
 infancy. 
 
 A wakeful and pcexisli child is a sick child. 
 
 FnKSH All! 
 
 The hahy's room should lie llie hest xcutilalcd in the lionsc. and kept free 
 from dust, smoke, fumes, and i,'ases. Bahy's outiniis should he anijilc. with 
 avoidance of sudden chauL'cs and glaring sunshine in its eyes. 
 
 Flies are the danger signals of the presence of filth 
 
 Fingers 
 
 Filth '('^,l-Vv,T 
 
 PlIOTOGRAl'lIS KkLATINC TO BoTTLf>FED BaBIES 
 
 Bottle-fed l)al)ies. Visiting nurse instructing mother as to the dangers 
 of the ])acifiers and the had efi'ects which result from unclean methods of 
 prei)aring food for the babies. 
 
 A Bottle-fed Baby. 
 
 Bottle-fed Baby. 
 
 Numerous patent foods tried and failed. 
 
z 
 
 o 
 
 H 
 U 
 D 
 0! 
 
 z 
 
 u 
 w 
 
 c« 
 W 
 
 H 
 
 O 
 
 w 
 J 
 
 H 
 H 
 
 06 
 
niniJ TORY AM) ( ATM.lU.l'K OF KMIIIilTS 67 
 
 Same I5aliy six moiilli-- Iat(>r al'Icr iiiatcnial tVcdiiii; liail l)c<-ii socurod. 
 
 Twins— I?iil tic-lcd. IJotli liail Niiiiiiiicr i()in|)laiiit. Miillicr anxious to 
 learii iio\\ lo Iced the ))ahics. I'"olio\\('d iii^l ructions — l)al)ios now liviuu'. 
 
 Photogkaimis Ki lati-nc; to thk ICuif ation <if I.iTxr.F, .Motiidhs and tiik IIomk 
 
 Visits ok tiii; Xiksi; 
 
 Littlo mot hers Ix'ini; taui;Iit liy tlic \'i-itiim N iii'sc haw to care lor I he liahy. 
 ^lothor at work duriiiLr thi" day. 
 
 Group of anxious little mothers. Matiiitii; the I?al)y l,ittle mothers 
 taking lessons in how to care for the Haliy. Oldest i;irl i 11 years) kept 
 home fioui school to help her mother duriui; coUNaiesceuce. 
 
 A mother w il li I « in^ \\ ho was eaycr and anxious to learn all she could for 
 lier hahies' welfare. 
 
 She carefully followed the instruction of the \'isitinu- Xursc in rei^ard to 
 cleanliness, cNithiui;. fresh air. slec]). and proper feedinu'. 
 
 Triplets of poor .Jewish parents heing cared for hy a \ isitinj; Nurse. 
 
 Severe ease of pneumonia found hy a \'isitini; \urse. 
 
 The child lo the left has an eczema of the face. 
 
 The house and room were dirly, insanilar\-. and Kadl.v \<Mililaled. 
 
 PiioTocHAPHs Hi.i.\ri\(; TO K\\ ih<inmi:nt 
 Surface drainauc from alleyways to street. 
 
 Surface Drainaye. 
 
 L ncoN'cred u'arliane re<-eptacles. 
 
 Court in Tenement. Little sunlinht enters rooms in rear. Morning out- 
 ing in tenemeni court. 
 
68 REPORT OF THE PHILADELPHIA BABY SA]'L\G SHOW 
 
 Section A. licidlli \u. 5. 
 
 Plate XXII A 
 
 BAD ROOM 
 
 m;i Tiox A. No. 5 
 
 Card. 
 
 (Actual rcproiliiction of in.sanitary conditions found in a room opcniufi; into a hiind alley in 
 Philadelphia.) 
 
 Dirty Roo.m and Alley. Due to lack of hoii.so-to-hou.se sanitary inspec- 
 tion. Surface drainage; open and full privy vault ; broken brick pavement. 
 Landlord indifferent or ihou<ihtlcss. Mother sick — family poor, they do not 
 know u-hii the house and alley ntust be kept clean, or how to improve the 
 bad conditions. 
 
 Time — summer. Mother sick, lying with infant in bed. Dirty quilt 
 instead of .sheets; dirty i)illow; flies over everything; unwa.shed dishes; 
 bread and milk exposed to flies. Emjjty milk bottle, unwashed, on the 
 table; smoky lam]) chinmey; litter under the stove; unwashed j)ans and 
 teapot on it. Child in the corner with street-cat in its arms. Dirty wall- 
 paper, window-i)anes missing and holes stuft'ed with hurla]) and paper. 
 No screens either at window or door. Hydrant in alleyway beside open 
 door; rubliish strewn over bricks; torn ])ictin-e ui)ou the wall. Boxes 
 and paper and oil-cloth and kindling wood imder bed, table, and stove. 
 Door scribbled full of names, sketches, etc. 
 
DIRl'J TORY AM) ( ATM.tx.li: OF EXIIIHITS 
 
 Si-<li<in A. H..olh No. 7. 
 
 (I!» 
 
 Pi.Ari-; XXII H 
 
 I-MI'Kl i\ l:l) Ki 
 
 .\. Xi, 
 
 <^'»I'<' IldW TIIK 15.\I) HdoM WVS I.MI>K()\KD 
 
 AMiat was ddiif liy llic r//// -Alley ilcamvl and iiiKlcrilrainccI : |)i'i\y\ault 
 cleaiU'd and rcmovi'd; water coMiiccliuns made; eeiiieiileil alley\\a.\'. 
 
 Tiy Uw Ldiidlonl- ])ut in water, water-closet : repaired and w hitcwaslied 
 wall; put in window |)anes, ])ainted door and window-sills. 
 
 By the I '/.<////((/ .V//r.s(' — Sent for doctor, ex])lained why hou.se and alley 
 should be kept clean, at little expense. \'isited mother and baby while ill. 
 
 By the HiLsharid — Bouiiht soap, broom, scrubbing-brush, wooden crate, 
 nails, white i)aint. whitewash, two old brushes, second-hand bucket with 
 lid, netting, screen door, clock, and a geranium. Cleaned, scrubbed, 
 painted, white-washed room, made crib, ice-box, and closet. Total co.st, 
 $■2.87. Little mother helped father, nursed mother, and attended babj-. 
 
 Result. Mother in bed; clean sheets and pillows. Baby in home-made 
 crib witli mosquito netting over it. Child on chair with doll instead of cat. 
 ^^ alls whitewashed. Winilow and door screened. Window open from top. 
 Clean lamp hung from wall. The stove polished. Pans ancl s])oons hung 
 in closet. Clean towel over table, with geranium on it. Rocking chair 
 by bed. Alleyway clean. Covered garbage-can. Broom hung against 
 door, neat calendar on wall. Alarm clock on closet on wall. Alley under- 
 drained. Alley wall whitewashed. No uneven bricks. Xo flies. Room 
 is clean. 
 
70 
 
DIRECTonV AM) ( ATAUXU'E OF I.Xlfin/TS 71 
 
 Conditions R elating- to Matrrna/ Environment 
 I)u rinff Prcixn a n c// 
 
 ScftioTl A. HiM.lll No. I-,'. |S,r I'lntr \o. XXIV.) 
 
 This ])<)()tli coiitaincil .1 l;iri;c iiumlxT of 0(liu"ilii)ii;il cliiirt^ and the ^aiiilarv 
 cr|iii])mi'nt iicccs^an' in a iiropcrly lunii-hccl (Iciivcry roDin. 
 
 nirlii is nol llic loiniiicMccnKMit of lil'i\ K\ci-y cliild horn is ali\(' for 
 several nioiitlis l)ef()re l)irlii: liicrffore. it is necessary to eonsidci lis weil- 
 bein<' licfore it is l)orn. 
 
 Nine nionlii- liefore Kirlii and tlie first vcar after are from a iiealtii stand- 
 point the most important . 
 
 (^ver 0.0110 lialiie- die aimnall\' in I'iiiladelpliia ihirinir tlie first year of life. 
 
 IlYfllKNK (IF I'hKCX ANCV 
 
 Work; Shonl.l lie huht. 
 
 Heavy hftina' shoidd lie avoided. 
 
 Slee|i at least H hours eaeh niijht. 
 
 The pregnant woman should rest, each month, at the time she would expect 
 
 the menstrual jjcriod if she were not pregnant. 
 
 ('lothing': The elothina' should he loose, especially aarters and corsets. 
 Corset if worn should he let out as the ahdomeu increases in size to the 
 extent of ijerfeet comfort. Don't lace tij;htly. 
 
 Bathing-: Cleanliness is essential. Sea bathing during the early months 
 is not wise. 
 
 Excretions: Urine: At least a quart of urine should he ])assed in •■24 hours. 
 The ilrinking of water freely will tend to keep the amount normal. Scanty 
 urine, headache, swelling of the feet, hands, or face are danger signals in 
 the pregnant woman. She should send for her doctor, adopt a milk diet, 
 and take two tahles]io<infnls of salts. 
 
72 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 No child can be born in good liealth if tlie parents suffer from: 
 
 1. Lack of food. -t. Worry. 
 
 2. Overwork. 5. Excitement. 
 
 3. Fatigue. 6. Poverty. 
 
 Thp: Effect of .\lcohol ox Infant Mortality 
 
 The alcohol habit increases the infant death rate l)y weakening the minds 
 and bodies of adults, thus making parents less ca])alile of bearing healthy 
 children and of caring for those that have been born. 
 
 Bad Habits in the Parents Which Affect the Life and Health of Infants 
 
 Use of alcoholic drinks, morphine, opium, cocaine. Tea or coffee, used 
 in excess bj^ the expectant or nursing mother is poisonous to her child. 
 
 Poor health of the mollier and conse<|Ucnt want of breast milk are the 
 main causes of infantile mortality; therefore, it is of the greatest importance 
 that the mother guard her health before the baby is born. 
 
 ^Menstrual cliart showing the relationshi]> of menstruation to jjregnancy. 
 
 Miscarriage, Prem.\ture and Still-births 
 
 Frequency 
 
 There were 30,07.) babies liorn in Philadelphia last vear. 
 " 2.131 still-births. 
 
 o.)0 |)remature births in which the l)aby dietl. 
 ai)proximately 10, GOO miscarriages. 
 
 In Philadelphia a baby is born alive every thirteen minutes, and a baby is 
 lost liefore birth every forty-one minutes. 
 
 C.-VUSES 
 
 Accidents: Any violence causing a displacement of the womb or lireak- 
 ing loose the delicate attachments between the baby and mother. 
 
 Diseases of the Mother: Inflammation of the womb, tubes, or ovaries; 
 Syphilis, Gonorrhea, Bright's Disease, Tuberculosis, and Ty])hoid Fever. 
 Syphilis is the cause of 42 per cent of the miscarriages in the latter month.s 
 of pregnancy. No healthy baby can be born to .syphilitic i^arents. It will 
 die either before birth, or soon after, or grow to be an invalid, or become 
 an innocent offender to society. 
 
 Any condition or disease that causes death of the child tends to cause a 
 miscarriage. Syphilis is again the most common. 
 
nilU'JTORY AM) I A'lWlJX.l'K OF IXIltltlTS 73 
 
 PRf;Vp:NTI()N OF MislAliUIAGKS 
 
 Don't (Id llio family wash during |)re<;iianfy. Il i- clifapcr lo jiay for the 
 wash than to he siek in hed for a week, (io to lied at onee if there is nnieh 
 liaekaehe or pain in the alxloinen. If hleedinj; is present, consult your 
 ])hysieian. Any <mc of these syniptoins may mean that a miscarriage is 
 threateneil. 
 
 KkI'I'.i r (IF M ISC AHHI \(;KS VMI AllllH IKIN (IN Im \\r MllUTM.FI'^ 
 
 Of 111 iiifantv (lead from innnat uril.v. S!l molhers SO per cent i had a 
 history of miscarriages, alioilion or |irematnre liirth. lre(|Mcnll>" due to 
 .syj)hilis. 
 
 IXDlCF.n ATiOHTKIN" 
 Moi-all\ it i- \\ roiig. 
 J'hy.sicall.v it i^ wrong. 
 
 Why doit ' 
 
 Don't ask yoni' doctor to perform an aliorl ion. 
 
 Don't altem|it it yonrsclf. 
 
 It is a crime e(_inal to the nnwder of your lialix' afler its liirl h. 
 
 (irai)Iiic f'liarl. 
 
 Showing Canses of Hlindness in their i'roporlioiiate rre([iiency. 
 Indicated liy parallel line-~ of ditferent length-. 
 
74 
 
DIRFJ TOI!)' AM) ( ATM.iX.rE IH' /.XfUlilTS 
 
 Care of the Art*:' /ior?i 
 
 Section A. H,H,lh No. 1(1. |S,-.- Plate XXV. 1 
 
 'llii^ Koiilli ((iiihiiiK'il ,-i iniinlHT ot (•(liicatioiial cliaii- and plinlduraplis, and 
 sonic <il I lu' CI I ui| mil -11 1 necessary In tlic care nt' I lie hali.w 
 
 Cli.irls 
 
 TlTK ("iOLI)E\ Rn.K 
 
 For Tin; 1,111. AM) ]Ii;\i.Tii of tiii; H.vby 
 "Feed with llic Mollicr"-- Milk. 
 'I'lic Mullicr's Milk i- llic Naliiral Foixl. 
 AM) Tin; HK.ST." 
 
 aviiy:^ 
 
 Out of 101) liiillle-lcd cliildren ."«(! die diiriiii; llicir lirsl year. 
 Oiil III' 10(1 lircasl-lcd cliildren mily ' die. 
 
 FyVcn llic l)i)llle-led lialiies whn >iir\i\e arc mil -ii ^Iriiiii; and licallli.N' as 
 
 l)reast-fed lialiics. 
 
 Hot tie- ted lialiies "catch "" diseases mure lilt en Ilia n I he lireasl-reil. 
 
 'lliere arc \i'ry few nintlu-is ulin caiinnl inir-c lln-ir lialne-,. |)i) nut lie 
 di.scoiira.ucd; ])iil the liali\' In llic hrcast soon al'ler liiiili; cdiilinuc this 
 at intcrv.ils until the milk comes. 
 It will rarely fail. 
 
 The milk cannot lie liikmI if the inothci docs not i^ct omid 1 1 and plciitv 
 
 of it. 
 
 F\)od for the nur.sing niotlicr should consist of milk, urucl, cocoa and 
 milk-toast for the fir.st three da,\s. 'riieii the \-ariety and amount .should 
 be gradually increased. 
 
 Take plenty of \ci;ct allies: liread and liiitler and milk. 
 
 Milk is the liest food for nnr-inu' mothers. 
 
 Meat once a day is usually eiioiiiih. 
 
 Avoid hii^hly scasoni.'d foods, sahuls, jiastry, strawherrio.s and tomatoe.s, 
 alcoliolic drinks. 
 
 Weak tea ami coffee mav lie taken oiici' a dav. 
 
76 REPORT OF THE PHILADELPHIA BABY SAi'IXG SHOW 
 
 First Aid for the Baby Born Before the Doctor Arrives 
 
 Resuscitation of the Baby. 
 
 The lialiy .should lireathe at once after birth. If there i.s no movement of 
 the c-he.st or if the face and Hjis become darker in color, it is a .sign that air 
 is not entering the lungs. One way to make the baby breathe is quickly 
 to cleanse its mouth and throat by means of a little cotton and your finger. 
 
 Tying the Cord. 
 
 Tie the cord immediately after the birth of the liaby. Tie it tightly about 
 
 two inches from the baby's abdomen with linen tape which has been 
 
 boiled. Cut the cord J^ inch above this with .scissors that have been 
 
 boiled. 
 
 Wr.\p the Baby in a Warm Blanket Immediately after Birth 
 
 With a medicine-dropper put one drop of a 1 per cent, solution of silver 
 nitrate in each eye. Flush out at once with l)oric acid solution or weak 
 salt solution. 
 
 Gently rub the baby with warm olive oil. 
 
 Wii)C off the excess oil with clean soft linen. 
 
 Bathe the baby at the end of an hour with warm water, Castile soap, and 
 
 a soft cloth. 
 
 Bathe the hatiy in a warm room on the lap. not in a basin. 
 
 Dust tiie cord thoroughly with l)oric acid jjowder and fold it between two 
 pieces of sterilized gauze. 
 
 Wrap a flannel binder five inches wide around the bal)y"s abdomen. 
 
 This binder keeps the cord dressing in ])lace and the baby's abdomen 
 
 warm . 
 
 Change the liinder every day. 
 
 One-third of the Deaths of Children Occur in the First ]Month 
 
 Care, cleanliness, proper breast feeding and attention to what your 
 Doctor (not your neighbor) says, will prevent this mortality. 
 
 Shield the Baby's Eyes fro.m Strong Lights 
 
 The baby should be kei^t in a dark corner of the room for the first week 
 or two; its eyes may be permanently injured by exposure to strong light. 
 Wash the eyes for the first week with boric acid solution. 
 
 Do Not Pick the Baby Up When It Cries 
 The baby should be disturbed for only three rea.sons: 
 
 1. To feed it. 
 
 2. To batlie it. 
 
 3. To change its diapers. 
 
DIRECTOllY AM) ( ATM.iK.li: (IF rXII/IUTS 
 Prevent CoNsrn' aihin in the IJahv 
 
 'I'lic h.-iln's howt'ls slioilld lir lilip\t'(l once or Iwicc ciicll <l;iy. 
 
 If iioivssary, give a rectal iiijeition of two ounces nt lii>ilc<l water under 
 
 tlie direction of a phy.siciaii. 
 
 XtHsiNc Tin; I? \HV 
 
 The motlier should he on Ikm- side. I lie cliiid siiould re>l on the lied and 
 the mother's arm. 
 
 Fkedim; Tin; Mvnv 
 
 The l?al)y should not lie gixen food for the first t\vei\c horn s after liirlh — 
 If very fretful ui\e a little warm water that has heen hoiled. 
 
 I'dr the fir-l two weeks mirse tiie iialiy at thi' mother's lirea--t e\-ery two 
 jiour'- for fifteen minute- at a time durinu I lie da\' and t u ic<' at niiilil . 
 
 Si.EEI'IMi .\( < ()\I\l(ll) ATI<i\s I (IK TMi; h\nv 
 
 The Ualiy slioulil not -lcc|i in the same Keel uilli the mother. 
 
 This is dangerou-- as many lialiie-- have lieeii smothered or made sick ill 
 
 this way. 
 
 .V liurean drawer oi- clotheshasket makes an exccllcnl lied for tlie lialiy. if 
 a reiiiilar crili i- not to he had. 
 
 If tile Haliy is l'oorl\' Nonri-hed or Premature: 
 
 Do not dress the haliy in tiiilit clolhiiiii hut wrap it in warm hiaiikets 
 and siirroiinil it with strong hollies filled with hot water, lightly corked, 
 
 an<l do not hat lie the liali\'. 
 
 Dre.s.s the Haliy in Loose Clothing. 
 (See K.xhiiiit of Clothing.) 
 
 If the Mother's Uri'asts Hecome Inflamed. Hard, or Caked ; 
 
 Make a|i|ilications of hot water and apply a hinder to support the hreasts. 
 Do not ruh or hruise the hreasts. Consult your Doctor Prompt l\'. 
 
 Cracked ni]i]iles may lead to an ali--ce-.s in the hreast, therefore, cleanse 
 the ni[)ples w itli a lioric acid solution hefore and afternursing. I'se a nip))le 
 shield when the niiijiles are (Tacked or sore. 
 
 If THE Bakv has a Fever or .\ Con.n Consilt a Do( tok \t Once 
 
 I'fl(itui;ni|ills 
 
 Proper position for the liahy while lieing dressed and changed. 
 
 Bathe one part of the liody at a tiiiii'. Keej) the parts not l)eing hathetl 
 well co\ereil. 
 
78 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Dressing the Baby. 
 
 Notice how loose the clothing of the baby is. 
 
 A Cheap Crib. 
 
 Baby Ward in a ^Maternity Ilosjjital. 
 
 Walls, floor and i'urniture can lie easily disinfected. No crevices for dirt or 
 
 ^ernis. 
 
 Afodel Bath-tubs used in a ^Maternity Hos])ital. 
 
 One tub in use while the other is being steamed. After every bath these 
 
 tubs are freed from germs by means of steam. 
 
 Baby Ward in a Maternity Hospital. 
 Abundance of sunlight and fresh air. 
 
 Committee for Prevention. — A^. V. Associatioti for the 
 
 Blind 
 
 Section .\. Booth Xo. H. 
 
 This booth contained seven charts bearing upon the causes and prevention 
 of blindness. 
 
 Chart 1. [See Phitc Xo. XXVI.l 
 
 
 "Mit Messer, (label. Feuer, Licht, 
 
 
 Spielen kleine Kinder nicht." 
 
 
 "Lest they rue a sightless day, 
 
 
 With knives and fires 
 
 
 They must not l)lay.'" 
 
 
 — German Folk Rhyme. 
 
 
 Articles 
 
 
 The playthings which have blinded many eyes 
 
 Scissors 
 
 Knives Buttonhooks Popguns 
 
 Pencils 
 
 Pens Sharp sticks Hatpins 
 
 Forks 
 
 Hairpins Matches Washing soda 
 
 Pepi)er 
 
 Stones Putty-blowers Tinswords 
 
 
 Bean-shooters Umbrellas 
 
 
 Why let the children jilay with such dangerous toys? 
 
luiu.i ToiiY AM) ( ir.u.ix.ri: of exiiiiuts td 
 
 Cliart i. [See Pliitc No. \\\ 1.] 
 
 Prc\('iiti()ii of Uliiidin'ss 
 
 'l"rM(li<iiii;i 
 (ir;iliul;it<'(l l\vi'liils 
 
 lMi..f,,!;n.,ili ,.f Cirl 
 
 Blind I'l'diii 'l'r;iili(iiiia 
 Ivirly treatment woiilil lime sinccl lier siirlil 
 
 Graiuilaled eyelids sometimes eail-'i' l>lilidiiess iiiiles-, treated pniiiipt iy. 
 TraeliDina is very eoiitaiiioiis. 
 
 1 siiiy ediiimnii towels one souree of ronlau'ion. 
 I{iiliiiinu eyes with dirty hands another souree. 
 Cleanliness and fresh air the hesl |(re\enti\-es. 
 
 Dont delay iroini; to a doctor. 
 
 Any diseharf^e from the eye should Ix' inxcstiu'aled : it may saxc you vears 
 of blindness or seriously \veak<'ne<l siuht. 
 
 CIkiiI Xc. 3. 
 
 J're\'ent ion of Ulindness 
 
 |{al)> - Sore l'",yes 
 (( )|ilil lialmia Neonatorum) 
 
 Directions for the use of I'rex'cn- 
 tive SolutioTi 
 
 Ptiiitdfirnpti i.f l.illlc- f.lri 
 
 Bottle 
 Dropiior 
 
 Victim of "Bahies" Sore Eyes" 
 AKout '25 |)er cent, of all blindness is due to "babies" sore eyes " 
 
 Dangerous. 
 Due to a germ. 
 Preventable 
 
 This disease is - 
 
 If taken in time Curable. 
 
 One drop of 1 ]>er cent. Nitrate of Silver Solution woidd have saved their 
 sight. 
 
 Two cents and two minutes of time may save 70 years of darkness. 
 
 In New York State any physician or midwife can olitaiu this solution free 
 of charge, from the local Board of Health. 
 
 If Baby's eyes are red and swollen — see the eye doctor at once. 
 
PREVENTION 
 OF BLINDNESS 
 
 Spulcn UrnnlViid. 1- ,,,,1,1 
 W illi kiuM s ami I iri ,- 
 
 \ 
 
 he pi33^t\in^^; 
 which have hhndcOTnaa>' eyes 
 
 ;>i i.^-oi ■- l\ni\cs InjIliinliiHiks p(ip^\^uii,s 
 
 pnu lU i>cns sli.irpsl.il L h.ilpms 
 
 t'ui I-,- hairpins m^Uii' s v.,ii.hm^:.\«].i 
 
 p. IT"- --l™--^ |,,II.H..»„. l,u,.«o,xl. 
 
 Why lei Ihc children plav 
 wilh such dangerous tovs" 
 
 
 (t: 
 
 PREVENTION 
 OF BLINDNESS 
 
 Irachoma 
 
 Gramilalcd Fac-IicIs. 
 
 Bhnd Itom Trachoma 
 
 i",ii/ii lrai///uvi/ nva/(/ /nii'i- fui'tif /ur.-:hi/i/ 
 
 bluitf/uss unless /rcu/a/ pf\yf//^-<//(/ 
 
 Trachoma is vcr\ conlaj;iou.s 
 
 ?/s///i/ corumpn lonr/s tvti st'u/i i ■ , ■/< t v/A/tui w 
 Rti/'d/uii aics ivi/Zi ifi/lji /it///ifsi///t'//jtv S(^i/ni' 
 C/t (//i/i/icss ,j//,/f/i s/i i/// /A' A >//'// / 1 /,/, I i :s 
 
 Donl dcla\' ^oin^ lo a liotlor 
 
 .Uini Jisi/h//i/<- T'O"/ //u a/cs s/ic>ii/(/ ir 
 i/nrs/iiiu/itiu/ //uu/ sart' iuyi i/cu/s o/ 
 M/nf//iss IV saio//s/t/ tir<iAt/;i;/ .-ui/// 
 
 Ctv/J//ti//ct- /.V />. rt-////tv/ 
 
 Plaie X.WI Charts from Section A, No. ii 
 
 COMMITTEE FOR PREVENTION. N. Y. ASSOCIATION FOR THE BLIND 
 
 80 
 
DIRECTOUY AM) ( ATM.oarK OF EXIIIIUTS 81 
 
 rliart 4. 
 
 Pkkvi:nti()\ of Mlixdxk-^s 
 
 About :'..). (IIIO pcii|)lc iKH'dlcssly hliiid in llu- rnilcd States. 
 
 l'lii.l..^nL|ih 
 
 A i^riiiip (if cliildrcn wliosc 
 
 sifillt was needlessly lost. 
 
 'J'lie causes of needl<'ss lilindiiess: 
 
 ( )|)lillialniia iieoiiatonuii. 
 
 'J'raeli,)nia. 
 
 'riil)ereulosis of eves. 
 
 Iiiflaiiiniations. 
 
 IndnsI rial accidents. 
 
 A\ ood alcoliol. 
 
 Fourth of .lulv. 
 
 Nejilect of minor injuries. 
 
 Constant strain. 
 
 70, 000 eyes wasted for want of lare. 
 
 Chart 7. 
 
 Prevention of IJlindnes.s 
 Legislation Needetl: 
 
 A law — to compel physicians and niidwives to re|)ort all cases of re<l and 
 .swollen eyes in the new-born to the local boards of health within \i hours 
 after discovery. 
 
 A law — re(|niriui; local healtli officers to see that all cases of ophthalmia 
 neonatorum receive adequate treatment. 
 
 A law — comi)elling physicians to .see that ca.ses of contagiou.s disease.s are 
 surrounded with pro|)hylactic safeguards against communication. 
 
 A law — reciuiring ade(iuate training of mitlwives and systematic registra- 
 tion aiul control. 
 
 A law — compelling manufacturers to install api)liances to prevent injuries 
 to eyes. 
 
 A law — prohibiting indiscriminate use of fireworks. 
 
 A law — requiring the proper lighting of all public buildings, jiarticularly 
 factories and schools. 
 
 A law — preventing the manufacture of wood alcohol. 
 
 A program which every good citizen will work to enact. 
 
REPORT OF THE PHILADELPHIA BABY SAIIXG SHOW 
 
 Chart 5. 
 
 Prevention of Blindness 
 70,000 Eyes Needlessly Lost 
 
 (irnpliic ( 'hart. 
 
 Neglect and Abuse, 21,000 ' Industrial Accidents, 12,000 
 
 Fourth of July. (iOO 
 Oplitlialmia of the New- 
 born, 3.5,000 
 
 A little care at birth would have saved about .So, 000 eyes. 
 
 Immediate treatment and projier care would have ;aved about 21,000 eyes. 
 Industrial precautions would have saved about 12,000 eyes. 
 A sane Fourth of .luly would have saved over (iOO eyes. 
 
 70,000 eyes sacrificed through carelessness and ignorance. 
 Cost in money to Society, about $12,000,000 every vear. 
 
 Chart 6. 
 
 
 Prevention of Blindness 
 
 
 The Fatal Towel 
 
 
 (Towel on roller) 
 
 
 The common carrier of eye disease. 
 
 
 It lurks in ofBce, factory, hotel, store, and school. 
 
 spreading disease from 
 
 eye to eye. 
 
 
 Xerer Use il 
 
 
 Section C. Booth Xo. "io. 
 
 MODEL DIET KITCHEN 
 
 Legends : 
 
 Demonstration of Milk Modification every Hour. 
 
 Clean Bottles. 
 Clean Cold Milk. 
 Clean Nipples. 
 Clean LItensils. 
 
 Meats shoidd be well cooked but not overdone. They may be roasted, 
 boiled, or stewed — never fried. 
 
 Cereals should be thoroughly cooked at least two hours, or allowed to 
 simmer all night. 
 
 Demonstration of diet for second year of Life at 12 and 8 p. ii. 
 
 He finir that all fruit is fresh, and if cooked, that it is thoroughlv cooked. 
 
DIHFJ TORY . I .\7> ( . I T. I LOGl'K OF EXIIUil TS 83 
 
 Department of Public Health a)id Charities 
 Bureau of Health, Philadelphia 
 
 l)l\ISI()\ OF Ba<T?:HIOI,OGY. LaBOHATOUV of Ih(.IFNK 
 
 < O.M M I M( ABLE DISEASES 
 
 |Sc,- Plat.- No. XXVIIl 
 Section n. li h \... K!. 
 
 This I til ciintaiiH'd the \;ii'iiiu> riilliirc-incili:! used in lalioratorics tor the 
 
 cultivatiiiii (if hacti'iia. sucli as lidatiii. potato, liccf hrotli, and milk. Siiooial 
 stress was laid upon llu' rapidity' with wiiicii ])ra(ticaily ;dl hactcria iiiiilti|)ly in 
 milk, till' inhihitiiif,' oH'cct that low tcmiifraturi's have upon such t,'id\vth. and 
 the xarious ways in which hactcria i;ct into milk. 
 
 Tliere were a mimher of colored j^rapliic eliarts ijlusf ratiiijr: 
 
 1. Tlie manner in wiiich tvilierenlons cases disseminate tuherculosis hy ex- 
 pectoratinji on the sidewalks and streets, the s|)ufa dryinj^ and lieiiig circu- 
 lated throuudi (he atmosphere in the form of dust; and the transmission 
 of tliese ori^anisms tlirouuh the mcdiinn of tlies resliM<r upon the s|)utum, 
 and. later, upon uncooked food articles, especially milk. 
 
 i. The throat of a patient with dii)htheria; lu-neath this were a numher of 
 milk-cans, and a Icucnd |)oinliiiii out how the milk could heeonie infected 
 from such a patient . i In demonstratinf; this, references were made to e|)i- 
 demics of dipiitlicria. tyi)hoid fever, scarlet fever, etc.. caused through the 
 medium of milk infected liy victims of mild typc> of thc^e d incases who were 
 employed in the handlinji of milk. ' 
 
 .'?. The diphtheria l)a<illus. and the various w.ivs in which this oruanism 
 can he transmitted to a hahy. 
 
 4. The conditions which lead to the transmission of the various contagious 
 diseases to the infant. 
 
 5. The dangers of the common drinking-cu]). 
 
 6. The various avenues through which high temiieratures lead to the de- 
 velojiment of enteritis in children. 
 
 7. The various ways in which a hahy may hecome infected witli tuhercu- 
 losis. 
 
 There was a series of plates illustrating: 
 
 1. The colonies of hacteria which developed from ^^oVtt "t a teaspoonful of 
 milk. 
 
 i. The dift'ereuce in the uumlter of colonies in good milk and in l)ad milk. 
 
 3. The number of colonies which grew from water ]ilaced u])on culture- 
 media (emphasizing the importance of hoiling water for babies). 
 
 4. The number of liacteria growing about cows' hairs, placed upon the 
 culture-media (em])hasizing the danger of having cows" hairs get into the 
 milk in the iirocess of milkint;). 
 
J 
 
 z 
 
 (x. 
 
 o 
 
 o 
 
 H 
 
 o 
 
 o 
 o 
 
 o 
 
 2 
 w 
 
 H 
 
 O 
 
 z 
 
 o 
 
 84 
 
DIRFATOUY AM) ( tT.t /.(Kill-: OF FMl/lllTS 85 
 
 .). 'I'lic iiiiinlicr of <ii'i;;misins llial urcw iipmi m plalc cNiioscd lor one lioiir 
 ill an ordinary room (imlicalinu liic (lani;<'rs oi' dn^l. and tiic iiniiortanco 
 of protcctini; nncookc<l foods from dn-l i. 
 
 (1. Tlic mnnliiT of colonic^ L;ro\v ii from -mcars made from a rommou 
 di'inkiiii;-cnp. 
 
 7. Tniicrcli' Wacilli i;iii\\ n fr'om a conunon drinisiiiu-rup. 
 
 S. The numlx'i' of colonics ^ row n fi'oni dirl \' hands i cm pi i a si /.in j; I lie neoes- 
 sily of elcanlmess of Ihe hands whiUl liandliny mieooked articles of food). 
 
 'I'licre was also a series of cnll nre I iilies show im;': 
 
 1 . ( olonies of I he I nherele hacilliis i llic cause of I nlicrelllosis). 
 
 '■2. Colonies of (he pneimiococeiis 'the cause of |iiicimioiiia I. 
 
 .'i. ( olonies of I he diphi heria liacilhis ■ I he cause of diplit lieria). 
 
 1-. < 'olonies of lh<' I \ plioid liacillus i Ihe cause of typhoid t'cxcr). 
 
 .). ('olonies of the diplilhena i;crni t;row n from milk exposed to a case of 
 dipht heria. 
 
 Addil ional cxhiliits were: 
 
 Two charts ilhistratiiiL; the transmission of diphtheria !)>• diplitlioria 
 carriers. 
 
 .V eliart illustrating the intluenec of antitoxins upon the incidence and 
 mortality of diphtheria in the city of I'hiladelphia, comparing' thi.s with 
 Ihe incidence anil morlalily of diphtheria licforc antitoxin was employed. 
 Siiecimeiis of antitoxin. 
 
 Two |)hoto<;raplis. one of a (piart hot tie of milk coM'red with Hies, and 
 another of a half's feediiii; hottle. with a nipple attached, also covored 
 with flies; and lofionds illiistratinu the danger of such carelessness. 
 There was also an additional and very ell'ective colored chart contrasting 
 the methods of ))revention of disease in infants with the conditions which 
 lead to the dcNclopment of disease. 
 
 Section B. Bck.iIi .No. U, |Si-c I'tati- Xo. XWII I.| 
 
 This booth contained the following charts ami photographs: 
 
 A large chart containing much detail and illustrating the possibilities in 
 numbers in house-flies. An exercise for the imagination. 
 
 
 
 Hou.se-flies are filthy 
 
 andD; 
 
 n 
 
 .icrous 
 
 to liiiman 1 
 
 fe 
 
 
 Born 
 
 in 
 
 filth. 
 
 
 
 
 
 
 
 
 
 Reared 
 
 in filth. 
 
 
 
 
 
 
 
 
 
 Thev 
 
 feed npoii 
 
 filth. 
 
 and carry 
 
 filth w 
 
 tl 
 
 then 
 
 , not only c 
 
 •aiising 
 
 annoy- 
 
 ance 
 
 .11 
 
 niarkin 
 
 g a trail of disease and < 
 
 le: 
 
 ith wl 
 
 erever they 
 
 go. 
 
 
 Remeni 
 
 ler — No 
 
 Dirt. 
 
 No Flies ! 
 
 
 
 
 
 
 
8G REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Investigations Have Proved that House 
 
 -flies are bred in — 
 
 1. 
 
 Ashes mixed with vegetable 
 waste. 
 
 
 12. 
 13. 
 
 Rotten cabbage stumps. 
 Rotten carrots and cucum- 
 
 2. 
 3. 
 
 Banana peelings. 
 Barlev malt. 
 
 
 14. 
 
 bers. 
 
 Rotten feathers. 
 
 4. 
 
 Carrion on the street. 
 
 
 15. 
 
 Rotten meat. 
 
 5. 
 
 Chicken manure. 
 
 
 16. 
 
 Rotten potato peelings. 
 
 6. 
 
 Cow manure. 
 
 
 17. 
 
 Rotten eggs, paper, and straw. 
 
 7. 
 
 Horse manure. 
 
 
 18. 
 
 Rotten watermelons and can- 
 
 8. 
 
 Human excrement. 
 
 
 
 taloupes. 
 
 9. 
 10. 
 11. 
 
 Piggery manure. 
 Kitchen sloj) and offal. 
 Rotten bread and cake. 
 
 
 1!). 
 20. 
 21. 
 
 Sawdust sweepings. 
 
 Spent hops. 
 
 Sweei)age from garbage piles. 
 
 In fact, we may safely say they a 
 
 ■e brec 
 
 in any solid fermenting or decom- 
 
 posing material. 
 
 REMEMBER- 
 
 -NO DIRT— NO FLIES 
 
 
 
 The Natural Enemies 
 
 of Flies 
 
 
 
 
 Toads. 
 Spiders. 
 Scorpions. 
 Centipedes. 
 
 
 Lizards. 
 Some parasites. 
 Some birds. 
 Some insects. 
 
 
 Frost 
 Diseases 
 
 pecul 
 
 iar 
 
 to flies. 
 
 All of which did Init little to reduce the 
 
 ])e. 
 
 it, and now 
 
 man 
 
 has declared 
 
 war ! 
 
 
 
 
 
 
 
 
 Remember — N 
 
 Dirt 
 
 , No Flies! 
 
 
 
 
 
 
 
 The Common House-fly 
 
 
 
 
 The Hou.se-fly may 
 
 be a carrier 
 
 of the 
 
 following d 
 
 seases to you : 
 
 
 
 Tyjihoid fever. 
 
 Cholera. 
 
 Dysentery. 
 
 Diarrhoea in Infants. 
 
 Tuberculosis. 
 
 Anthrax. 
 
 
 
 Yaws. 
 
 Ophthalmia. 
 
 Diphtheria. 
 
 Smallpox. 
 
 Plague. 
 
 Pneumonia. 
 
 
 
 
 Will yoi 
 
 take 
 
 my chance.' 
 
 
 
 
 If not — then help tc 
 
 exterminate 
 
 the house-fly. 
 
 
 
 
 No Dirt 
 
 
 
 
 
 No 
 
 Flies 
 
DIRKCTORY AM) ( ATM.iH.l'K OF I.XII/IIITS 87 
 
 Some Facts ( niiccriiiiit; tlu' Iloiist'-fly 
 
 Tlic li(iiisc-fly is a disease carrier. 
 
 'I'lio li()iise-fl\- (le\'el<)|is fnnii the euix to a t'lill-Lrrowii fly in fniiii ten tii four- 
 teen (lays. 
 
 A family of flics all liorn al one lime ma>' consist of l-,'() lirolliers ami 
 .sisters. See a followinii chart for the size the f.miily may assume in one 
 season if the fly catchers are not husy. 
 
 The housc-llv will lirced in almost any ferment uil; or (Iccompo^inir material 
 — ])referal)ly manure. 
 
 Frost kills flies. l>iit etiout;h tuck themselves a\\a\' in warm nooks and 
 corners to start tlu' seasoiTs crop. 
 
 
 
 What 
 
 to. 
 
 oal 
 
 KMll 
 
 he l'l\ 
 
 ( 
 
 uesi ion 
 
 
 
 
 
 
 1. .\l)olisi| 
 
 ilies i^row . 
 
 he 
 
 lii-ecdint; I 
 
 Iac( 
 
 'S. 
 
 ( See 
 
 charl 
 
 si 
 
 iowhil; I 
 
 he 
 
 11 
 
 iitii. 
 
 s in 
 
 u liich 
 
 '2. Scre<'nin. 
 
 mos(|uiloes 
 
 $IO.(»(l().()()(l 
 
 ■ d 
 ar( 
 ,-ir( 
 
 )ors and w iml 
 climinaled. 
 .innually spen 
 
 1\\ s 
 
 t in 
 
 is ;i 
 
 arefi 
 the 
 
 necessary exped 
 
 1 estimator slat 
 
 riited States foi 
 
 lei 
 es 
 
 S( 
 
 1 
 
 tl 
 
 re 
 
 ml 
 at 
 
 ■Us 
 
 1 Hi. 
 
 t]lol'< 
 
 ^ ,ind 
 than 
 
 :>. Traps ,-ii 
 
 '1 1 
 
 < >isons. 
 
 
 
 
 
 
 
 
 
 
 
 
 4. Kill thai 
 
 (l\ 
 
 (fl 
 
 V) 
 
 
 
 
 
 
 
 
 
 
 
 ,). lint liesi 
 
 of 
 
 dl remoNc 
 
 dl t 
 
 hin 
 
 _s ui 
 
 u liich 
 
 fl 
 
 <-s floin-i 
 
 sh 
 
 
 See 
 
 th,- 
 
 ist. 
 
 Renieml>er 
 
 N 
 
 . Dirt, No 
 
 Fli. 
 
 •si 
 
 
 
 
 
 
 
 
 
 
 Some more facts eoneerning the house-fly 
 
 I'lie house-fly carries disease ijerms on its legs, wings, the surface of its 
 body and in its alimentary canal. It feeds u])on infected material and thus 
 takes up hjicteria for transmission. 
 
 House-flies traxel naturally ahout one-fourth mile from the jjlacc where 
 thi'y were hied. AVinds will carry them further. By clinging to matter 
 in transit, they may he trans])ortcd still greater distances. 
 
 The a\erage summer house-fly li\es ahout three weeks. The last crop 
 in the fall is more hardy, and enough endure to start the next season's crop. 
 
88 
 
DIRECTORY AM) ( ATAJ.OaVK OF KXIfffUTS 89 
 
 Xniiilicrs :iii(l ('l.-i^x-^ i>t I5ai|cria on I'"lirs. 
 
 (til one Hy. C. (MM). (10(1 liaclrri;!. Arc ilir> a ntiisanco?' 'SVs. 
 
 Tlircc pliotofirajilis of liit;hl.\' mauiiifit'il liousc-Hics. 
 
 Four pliotourapli-i sliowinu tlic (Icvclopmcnt of tlie housc-fly. 
 
 Tuo plinl()i;ra|ilis sliouiiiii tlic (IcNcloimii'iil of the house-fly. 
 
 Two plinlonraph'- -.howini: llie delaiK of llie hoi|se-fly. 
 
 'I'liere was. in adclilion. a sheH' cNleiKiiiiii acro-s llii^ l)o(ilh, which coii- 
 taiiieil — 
 
 S] cciiiieiis of roaches, l>e(ll)iii;s, fleas and flies on plates nn<lcr lilass jars. 
 .\ jar <-ontainini; li\'e flies and liedlinus. 
 
 rictnres of lialiic^ fed on milk conlaininL; llie-. and of Kaliic-- fed mi milk 
 without flies. 
 
 Heneatli each was ]dacc(l an c\i)laiiatory card. 
 
 .Ma|) showiiifi distriliiilion of manure and rau jiiles in I'liiladclphia under 
 order for aliandonmcnt hy .lune 1st. li)l-. 
 
 M;ip -howiiiti (list rihiition of slailizhlcr lioii-cs in I'hiladclphi.i. 
 'IIIK I'lIILADEI.lMIlA IKXl'llAI. I'OK (ONTAC-IOIS DISKASKS 
 
 Section 1!, It,.,,lli X„. 1.-,. 
 
 'I'liis hoolli contained: 
 
 .V complete series of photographs of the -]i|ciididly cipiippcd I'liiladclphia 
 II()s|)ilal for Contafiioiis Diseases, illustraliui; the entire routine of hospital 
 treatment, from the iioint of scndint; out the amhnlancc from the hosjiital 
 iiji to the point of di>.ini-~'~al of the patient after recovery. 
 
 .V photofiraph of two infants in the small-pox ward of the Hospital, one on 
 either knee of a nurse, one lia\ inu small-pox. and the other, which had been 
 admitted with an infected mother. havin>;- a recent vaccination, and 
 illiistratini; the protection of vaccination auainst the disease, this infant 
 having been kept in the suiall-pox section of the hosjiital until iK molher 
 was remo\'ed, cured. 
 
 .\ number of iihotographs ilhisfrating the eriiiitive diseases of childhooil, 
 as follows: vaccination, measles, Ko])lik"s s|iots, the sore throat of scarlet 
 fe\er, the strawberry tongue of .scarlet fever, chicken-pox, nmnips, scarlet 
 fe\er. 
 
 .V colored picture of a tliroat with diphtheria membrane on the tonsils. 
 
 A chart illustrating the great fre(iueney of tuberculosis and scarlet fever 
 in the congested districts of the eit.v of Philadel])hia: and one illustrating 
 the more even distribution of cases of di])litheria. 
 
 A chart reading: "Schools become at times centers of infection. The 
 neeessit.v for school medical insjiection is shown h\ a scarlet fever epidemic 
 which was stop]:ed l).v finding carrier eases in schools and excluding them." 
 
90 
 
DIRECTORY AXn ( ATAlJH.Vi: ill' EXIIllilTS 91 
 
 A chart reading: "Diplithcria. A disease wiiicii can he r<)l)l)ed of ils 
 terror hy timely and ])r()|)er treatment. Formerly \'^ per eeul of eases 
 died. Now 10 ]ier cent of eases die. Tlie rate eau he made still lower. 
 How? Hy iisini;' antitoxin on the first da.\ of the disease." 
 (The records for the last three years.) 
 
 A chart reading; "Measles. Cases and deaths ilhisl ral iuii the dani^er of 
 measles. \\\\\ overlook il!'" 
 
 A eliart showini; : The milk sn]iply zones and the (piantities produced aixl 
 transported in March. IIMJ. 
 
 Divisiox OF Vital St.vtistics. Briii. At ok IIi.ai.tii. 1'iiii.ai)i;i.imii.\ 
 
 Section li. li.iiilh X... K;, 
 
 This hoolli contained, almo^l e\clnsi\-ely. i;raphic chart-, and maps illn^l rat ini; 
 the following; conditions: 
 
 1. ('li:irls. 
 
 Deaths under one year of age, litll. 'I'olal Ki.'iO. 
 
 Preventahle diseases, '■2()()!) — H.ti per cent. 
 
 Congenital defects and accidents, 147!) — .'?-2 per cent, 
 
 Non-])revcntahle diseases, 101,) — -i-l per cenl. 
 
 Violence, (iT l.j |)ereent. 
 
 Total deaths from all causes. -2(!.(M)-2. litll. 
 
 Non-])re\t'ntahle diseases. 1:5, S.).') — .Vi.^ per cent. 
 
 Preventahle diseases, !), KIT — .'i4.!) percent. 
 
 \'ioleiice. largely preventahle, 1,007 — 0.1 percent. 
 
 Congenital defects and accidents, largely ])reventahle, l,.}-2:i — .5.!S per cenl. 
 
 Rirtiis, Stillhirlhs. and Premature Births. 1!)(K' to 1011. 
 
 Vital Statistics hy Wards. 
 
 \A hite hlocks show ing mnnher of deaths each month. 
 
 '■\\lK'n Hahics Die"— Deaths under two years in Philadelphia, 1011. 
 
 Total death.s of children nnder five years of age. also maximum, mininnim 
 and mean temperature and rclali\'e humidity l>y weeks for the year 1010. 
 
 Total deaths of children nnder two years of age. also maxinnim. mininunn 
 and mean temperature and relative humidity hy weeks for the year 1010. 
 
 Total deaths |}er 1000 coni]iare(l with deaths under five years, under two 
 years and nnder one year for 1011. 
 
 Total death.s per 1000 of ])opulation comi)are<l with deaths under ti\e years, 
 under two years and nnder one year. 
 
 Deaths from A\hoo])ing Cough under two years of age. 
 
 Deaths from Scarlet Fever imd(>r two years of age. 
 
 Chart showing the numher of deaths from fifteen (1,5) selected diseases. 
 
92 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Relation of deaths of children nnder five years of ajje to total nioitaiity by 
 years. 
 
 Deaths from Diphtheria luider two years of age. 
 
 Deaths from Typhoid under two years of age. 
 
 Deaths from Measles under two years of age. 
 
 Diphtheria, 5 years. 
 
 Deaths under two years of age and rates jier 10(1. ()()() of ];o|itdation at 
 5-year intervals. 
 
 Deaths from Pneumonia under two years of age. 
 
 Deaths from Tuberculosis under two years of age. 
 
 Deaths from Diarrhoea and enteritis un<ler two years of age. 
 
 Hirths, deaths under two years of age from diarrlura and enteritis in 
 relation to density of po])ulation for the year li)0!). 
 
 Deaths of children imder one year of age from all causes shown in relation 
 to diet, temjjeratnre, and humidity by weeks in sunnner of 1!)10. 
 
 Black blocks showing the number of deaths from various di.sea.ses. 
 "How Babies Die" — Deaths under two years in Philadelphia, 1!)11. 
 
 Two Maps. 
 
 Epidemic of Typhoid Fever caused by Break in Water Main. 
 Population expo.sed, 10(5,000. 
 
 C'a.ses reported Dec. 8, 1911, to Feb. 9, 191-2 367 
 
 Deaths -27 
 
 Per Cent. Fatal 7.36 
 
 City of Philadel])hia. 
 
 Location of Ca.ses of Typhoid Fever after Break in Water Main. 
 
 Causes of death under two years of age during 1911. Total di-aths, 5769. 
 
 Section H. liunth Xo. 17. 
 
 DivLsiox OF Child Hygiene, Bure.\u of He.\lth. Philadelphia 
 
 This booth contained the following graphic charts and photographs: 
 
 Graphic Charts. 
 
 The value of 8 municipal visiting nurses. Work performetl from July 1, 
 1910, to December 31, 1910. 
 
DIIUUTOliY AM) ( ATM.Oi.li: (IF IXIIIIUTS 93 
 
 ^ ;iliif of S iiiinii(i|i.il \ i-itiim nurses. AX'ork iicrl'oiiiird Ky S \ isitirig iiiimi- 
 <-i|);il nurses \\orkini; in wards -,'. :!. 1- ,inil ."), IIH 1. 
 
 Wild wcinM not i-.itlirr 111' a liorsi'.' i Articl<'s.) 
 
 Huw is your lialiN' li-d/ iSliou iiiu diilcirnt inclliods.) 
 
 The Short Hontc 'i'lic Safe Way. 
 riic Daiiucr Zone. 
 
 Showing course of llie milk from llic --laMe lo eoiisiinicr. 
 Dealli has marked d/zroiil of vvrvy Jiii in I heir first \-ear of hi'e. ( 1 1 lust ra- 
 tion. J 
 
 l'lii)t(if;ni|)lis. 
 Race Street I'ier. 
 
 Work of .Municipal Xisilin^ Xurses. I)i\ islon of ( 'hild Hyiiieiie. 
 Hureau of Health. 
 
 Does it |:ay a cit\' lo speud money f<ir nurses and pier hospitals? 
 A few of I he many results. 
 
 Chestnut Street I'ii'r. 
 
 Kecreatiou I'iers ii.sed for (are of IJahies. 
 
 'I'ypical 1 nih'rfed h'amily. I'"lannel Swaddling; in Suninier. 
 
 Aiie 80 years. .Vi^v SU days. 
 
 They ha\'e the same chance of li\ inu one year. 
 
 Instruct ini; a Class of Mothers. 
 
 School (iirls Learniui; ('are of Haliy. 
 
 Cleanina Xursiui; lioltlcs. Washini; Hahy's Mouth. 
 
 To li\"e under an awninii on the roof is hetter than under a roof in the 
 basement. 
 
 ^^ hat Would a muuici|ral \ isitin^' nnrse mean for this famii\ !' 
 The answer. 
 
 A ]iicture no artist can ])aint. 
 
 The home is somewhat harren. hut the heart is (;oo(l and true. 
 
 It i.s cheaper and hetter for a city to dispense Health than Charity. 
 
 Poverty will al«a.^•s exist. 
 
 But disease need not he its eoniiianion. 
 
94 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Sanitary etlucation is better than sanitary legislation. 
 
 Are they worth saving? 
 
 A (livisif)n of "Child Hygiene" is the logical need to care for the children 
 of all nations who become our future citizens. 
 
 Graphic Illustration. 
 Ophthalmia of New-Born. 
 
 Ignorance 
 Caused by j Carelessness 
 [ Neglect 
 Leads lo blindne.ss. 
 
 Section I!. Booth No. 18. 
 
 U. S. Public Health and Marine Hospital Service 
 
 Tliis booth contained the exhibits of ihi' I'nited States Public Health and 
 Marine Hospital Serxice and of the Health Department of the District of Cohini- 
 l)ia. The exhibits in both divisions consisteil of charts and tables, and in the latter 
 there was. in addition, a collection of illustrative |)aniplilcts and leaflets. 
 
 To obtain the greatest benefits from ])reventive medicine, we must begin 
 the Prevention with the beginning of life. 
 
 Infants' Milk Depots in the United States, li»l(t. 
 Milk-borne Scarlet Fever Epidemics (to October, 1!)07). 
 Infant Mortality in the Philippines. 
 
 Table comparing the Bacterial Contamination of \'accine Virus Before and 
 Since the Enforcement of the Act of Congress ai)])roved July 1, 1902, im]jos- 
 ing upon the Public Health and Marine Hospital Service the Federal Con- 
 trol of Viruses, Serums, etc. 
 
 \ariali(iH in Methods of Testing Tetanus .Vntitoxin liefore tlie promidga- 
 tion of the Standard Unit originated by thi' Public Health and Marine 
 Hospital Service. 
 
 ^^ilk-l)()rne Typhoid Fever Ei)idemics (to October, 1907). 
 Milk-borne Diphtheria Epidemics (to October, 1907). 
 
DIRECTOliV AM) ( ATM.iX.lE OF KXIIIIilTS 95 
 
 Health Department of the District of Columbia 
 
 "Discoiitriil uilli dirty and iiiiliytricnic siirroiiiidiiiiis is nl'lriil iiiu's the 
 very !)(•-.( ins|)lraliiiii lor liririiritii: nli<iiil liic cniidiliiiiis llial make for 
 h<-ailli." 
 
 (fnii)lii<- < 'liarts. 
 
 Estimated ()frs])ring of one fonialc fly dmiiii: seasons — from A|iiii 10 to 
 Sei)teinl)er I(i- Total. K/-'?.'!, (IS t. -21 1.' 
 
 (iraphic ("hart slmuiiit:: 
 
 Birtli Hate i)er 1. ()()(). While. 
 
 Pereeiilafje of deatiis of Inl'anis iindei- 1 year to reported li\c Hirllis. 
 
 Birth Rate ])er 1. (too. Colored. 
 
 Percentage of deal lis of Infants under 1 year to re|)orled li\ c Mirliis. 
 
 Visiting Niirsi* W'lirl;. 
 
 Prevention of Infant Mortality. Samples of the educational pamphlets 
 and leaflets used for (list rihut ion t>v tiie X'isiting Niu'ses of tlie tlepartment. 
 
 Diseases Other Than Communicable 
 
 Section C. Hndlli Xo. 19. 
 
 I'his section consisted of tlire<> hooths eontainini; chiefly colored drawings of 
 the non-conununical)Ie diseases which result in deformities or lesions which can 
 readily lie recognizeil hy the average layman. In the main they referred to con- 
 ditions which are likely to he neglected hy mothers of the ignorant, or overlooked 
 hecau.se of the insidiou.snes.s of their on.set and their failure to i)ro(iuce acute mani- 
 festations. There were a few additional drawings illu.strating certain acute in- 
 fectious conditions, such as ophthalmia neonatorum, which demand immediate 
 medical attention. 
 
 Colored Drawings Illustrating: 
 
 Diseases of the Xervou.s System. 
 
 Paralysi.s of the nerve of the face from exposure to cold. 
 
 Infantile hrain-paralysis. 
 
 Tetany. 
 
 Inflammation of the nerves following Diphtheria and the use of .Vlcohol. 
 
 Palsy of hand anil arm. 
 
 Spinal Paralysis. 
 
■A 
 
 ■A 
 
 A 
 
 96 
 
niHFj Tony wn ( atm.iu.ii: or i:\iiiiiirs 97 
 
 Six Colori'd DiMwinys lllnstratiii^: 
 
 One \(>riii;il and I'ivc Aluioniial St()()l>. tlio Lai tcr t lie IU--11II iil' Iiri|iio|)cr 
 Fcodiiif^. 
 
 Weight curve sliowiiiL; loss I'roiii siiiiinier (liairli<i'a. 
 
 Jaw and Icelli sliowiiit; rllccl of t liiiinli-suckin;; or coiiit'orter. 
 
 Intestinal Worms: 
 
 A. Tapeworm — (a) derived from pork and heef; (h) derived froni'lisli; (c) 
 
 derived from do<;, cal and lice. 
 
 1$. riiread worm. 
 
 ('. lionnd worm. Iicaij andeij;iis. 
 
 Infantile Scnrvy. 
 
 Disease of the Kidney. 
 
 Dropsy. 
 
 Weiiiht cur\c showing effect of acute milk infection. 
 
 Section ('. He... Ill \... '20. 
 
 I'alile sliowiiii; averaue weights and heights (hoys and ^irls). 
 'rai>l<' showini; relation of weiulit to ^■itality. 
 (\)lore(l drawint; illnst rat int;' di.seases of the skin. 
 Photographs sliowint;- '■(■atchy .sores" and eczema. 
 
 Colored drawings illustrating adenoids, (a) Adenoid.s — nioutli-hrcathing 
 — narrow chest; (h) j)()sitioii of the adenoids; (c) adenoids — j)re.sent — re- 
 mo\ cd. (l'hotogra|)hs.) 
 
 O.Iciv.l Diawiiii;^. 
 
 Throat showing I'',nlarged Tonsils. 
 Chihl with Knlargecl (dauds of Neck. 
 Child with Mastoid Ahscess. 
 Child with Stifi' Xeck. 
 
 (.'..lured l)nnviiif;s Illuslnitiug: 
 
 Rickets. 
 
 Cjiild with l)ow-legs. 
 
 Child with curvature of the s])ine. 
 
 Chilli with all of the deformities of rickets. 
 
 Child with "\wi helly." 
 
 Colored Drawings Stiowing: 
 
 Conditions of the Mouth. 
 
 Sim])le inflammation of the mouth. 
 
 Thrush. 
 
 Inflammation of the mouth with ulcers. 
 
 Deep ulceration of the mouth. 
 
 Gangrenous stomatitis. 
 
 Showing eru])tion of first teeth — "First Dentition."" 
 
98 
 
 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Colored Drawings. 
 
 Normal sitting position. 
 
 Posterior spinal ciirvatnre from sittini; too soon. 
 
 Photographs. 
 
 Birthmarks. 
 
 Itch. 
 
 Shingles. 
 
 Ringworm of the skin. 
 
 Ringworm of the scalp. 
 
 Cold sores. 
 
 Section C. Booth No. ••21. (See Plate XXX.) 
 
 Chart. ' 
 
 Pneumonia frequently follows Bronchitis. 
 
 Measles. 
 
 Whooi)ing-cough. 
 
 (;ril>]M'. 
 
 Diphtheria. 
 
 Acute Diarrhoea. 
 
 Scarlet Fever. 
 
 Chickcn-])ox. 
 
 Ervsi|)elas. 
 
 Cciliiic'il Drawings. 
 
 Cretins. 
 
 A cretin lief ore treatment. 
 A cretin after treatment. 
 
 Two Photographs. 
 
 Cretins. 
 
 Colored Drawings. 
 
 Diseases of the eye. 
 Pink eye. 
 Trachoma. 
 Sore eye at birth. 
 
 Stye. ■ 
 
 Colored Drawing. 
 
 Child with marasmus. 
 
 Colored Drawing. 
 
 A hand showing clubbed fingers from congenital heart disease. 
 
DIIIFA TOUY AM) ( ATAIJXiri-: OF FXIUIUTS 
 
 99 
 
 (ol.nr.l I )ra\\ in^'s of ( 'liilcircri. 
 
 Illiisl raliiii^- llic lollowiiiff tiilxTciilmis lesions: 
 'l"iil)i'rcul()sis of till' dhow, 
 'riihcrciilous hip diseaso. 
 'riil)onnlosis of the knee. 
 Tiilierciilosis of tlie ankle-joint. 
 Earl\' liilKTciHosis of the spine. 
 'I'uhereulosis of the sjjiTial roluniii. 
 'rnherenloiis peritonitis, 
 'rnherctilons inflammation of the hiain. 
 
 ( (ill. nil Drawilifis. 
 
 ( hildrcn w ilh : 
 IJow-l.-s. 
 Conyenital dislocation of holh hips. 
 
 Two <'i)|cinMl Drawings. 
 Di.soases of the hoiie.s. 
 
 (inipliic Cliart. 
 
 Sliowing causes of death per 1,0(1(1 in lirsl \carof life, from: 
 Unknown diseases. 
 
 Diphtheria, \vhoopilii;-conL;h, measles, scarlet l'c\-er. 
 Tiihercidosis, pn<'nmonia, and oilier inllammatory respiratory dis- 
 eases. 
 
 Congenital weakness and dehility. 
 Other known diseases, 
 (iastro-iideslinal iliseases. 
 
 Coluri'ii l)niuini,'s llliistratin": 
 
 Hare-lip. 
 
 Cleft -palate. 
 
100 
 

 CO 
 
 
 
 101 
 
Q 
 O 
 O 
 
 H 
 
 < 
 
 'A 
 
 'J. 
 
 O 
 is 
 
 o 
 
 
 
 w 
 
 X 
 u 
 
 o 
 
 w 
 
 D 
 m 
 
 H 
 
 102 
 
DIRF.( TDHY AM) ( ATAlJX.ri: OF FMHIIITS 103 
 
 U. S. Department of A^TicuItu re 
 Hu red u of Chem istri/ 
 
 \>r,- I'l.ltr \.\\I| 
 Srrliini <'. I!n.,lli \,,. ■,'-,'. 
 
 Til is IxKil h roiil.iiiii'il I III' Idlliiw iiii; ell. -iris show iiij; : 
 
 The coiiipd^il inn ul' dilVrrcnt |)r(i|iri('l;iry i'ooiU lor tlircc-inoni lis-old liahy, 
 (•(imi)ar<'cl uilli inolhcr^' milk. 
 
 ('()iii])osilioii o! foods for infants. (^Sce I'latr XXXII. j 
 
 Infant foods, cereal hasis. 
 
 ("oinposil ion of fornndas for child tlircc inonlhs old. 
 
 i'rc|>arc(l Ky the addition of milk and water. 
 
 Infant foods, milk liasis. 
 
 Composition of foi-nndas for child three months old. 
 
 Prepared li.\' the addition of water onl.v. 
 
 Infant foods, cereal and milk hasis. 
 
 ('onil)ositioii of formulas for child tlii-ee monlliN old. 
 
 Prei)arecl li\- the addition of water- only. 
 
 Milk basis infant foods. 
 
 Composition of formnlas for child three mont h> old. 
 
 Prepared hy the addition of milk and water, i See l'lat<' XXXill.) 
 
 Cereal and milk liasis infant food-,. 
 
 Composition of formnlas for child three months old. 
 
 Prei)ared h.v the addition of milk and w ater. iSee Plate XXXIII.) 
 
 Miscellaneous infant loo,U. i See Plate XXXIII.) 
 
 'rhirt\'-tw(i liollles Nhowinn various infant foods. 
 
104 
 
niRECToRY iM) ( .iT.tijx.rr: or i.xninirs 105 
 
 Phihidclphid Fcdidtric Socicfi/'s Milk Commission 
 
 |S,T !'l:,lr XWUj 
 
 Si'clioii <'. Hiicili \... -J.-i. 
 
 'I'll!-- Koolli ((irilaincd llic follow iiii; cxhiliil-: 
 
 A iliaiir;iiiiiii;il ic clinrl illiisl pmI iiii; llic i;rcalcr clliciciicy of llic lioinc-iiiailc ice- 
 box ill k(<"|iiiifi milk as i-oinparcd w it li I lir ordinary types of refriyerator. liie ii|)]ier 
 lialf of this cliart I'onlaiiied an illii->t i-atioii of a <T()ss-sectioii of an ordinary refrig- 
 erator, showiiiu tlic four section- in which it would he po-.sili!c to keep milk. 
 
 The milk liefore lieinir i)lace(j in these \arions com|iartnients was found to 
 contain ',',S,'i.(t()() hacteria jier c.c. At tlie end of -l\ lioiirs the mimlier of liacteria 
 had iiicrca-e(l in these compartments as follows: Compartment 1— '■2,4!li).()0() per 
 e.c.; comparlmeiit '2- :5,(i-2().(l(l(> per c.c.: compartment .'5 ,'5(),.5'-2S.(l()() per e.<-.; 
 comiiartmeiit I- '■2()..'5;5!).()0() ))er c.c. 
 
 In the lower half of the chart there was shown a cross-section of an ordinary 
 chea]) home-made icc-lio\ of the kind on exhiliition heneath tlie chart, eontainiiii; 
 Imt one compart m<nt . The niimlx-r of bacteria per v.r. in the milk before beinj; 
 l)laced in this ice-box was '2<S:i, ()()(), and at the end of '2 t hours it had only increased 
 to ,'i;>!l,(l()() jier v.v. To preserve the milk in this condition for "24 liotirs it re(|iiiro(l 
 bnt ti\c cciils" worth of ice. This test was carried out at the Henry I'hipps Insti- 
 tute. .Ml specimens of milk were taken from the same sample, and all experiments 
 conducted on the same da\. the niaximiim olhcial Icmpcraliire for the da\' bcint; 
 73° F. 
 
 There were in addition a lari:i' number of photograph- illii-t rat iiii; the ccrtili<'d 
 milk plants and their nietho<ls of procedure, and chart- illii-tratint; the chemical 
 anti bacteriolo.uii-al n'sults of the examinations of certified milk in the \arions farms 
 covering' the period of a year, and ilhi-lralinu the methods employed b\' the Com- 
 mission to secure its results. 
 
 There was also a chart gixiiig lli<' rc-nll- of some iinest igatioiis of market milks 
 wliicli was show 11 for the sake of comparison. 
 
 There were two charts giving a coni])arison of tlie nuniber of cases of tubercu- 
 losis canse<l by the human type of the tubercle bacillus with those caused by drink- 
 ing milk from tiiln'rcnlou- cows. 
 
 In the center of the liooth was ])laced a i)yraniid of certifierl milk and cream, 
 bottles sealed and certified as recpiired by the Commission. On the front of the 
 stand bearing this inramid was a frame containing the seals used by the various 
 producers of certified milk, and at the side of the stand was shown a consumer's 
 receptacle for receiving bottled milk (I'. S. Department of Agriculture) and the 
 capping anfl sealing device used in bottling certified milk. 
 
 Philadelphia having recently had a Milk Show, in which all the avenues that 
 milk must follow from the cow to the consumer were fully demonstrated, the .subject 
 of milk was much less extensively gone into in this Show. ^Ye did. however, aim to 
 em|)hasize two features which we felt had a special bearing u\w\\ infant health, 
 namely, the source of supi'ly and the i)roper method of receiving and earing for milk 
 
100 
 
DiRFJTonv AM) ( .\TM.()(,ri: or i.xiuiurs 107 
 
 ill llic lioiiic. 'Ilic snlijccl iif |)i-ii(lii(i iciii ua~ lipiiclicil iipdii in the cxliil)!! ion i>l' 
 tlircc txpcs of (lain' harns wliicli wwr loaned liv 
 
 THK I'F.WS^LVAM A S'lAI'K I,l\ KSIOCK SAMTAin UOAHO 
 
 'I'licsc nioiicl- were placcil in alcove-, al Ihc ca^liTn rml ol llie linildini;. Tlu-y 
 \\ <'r(' : 
 
 1. A model ol' a liail lyiieof larin liarai ii-.ed For dan'V inn'poscs. ^ ard. 
 burn, and >lalile liltliy; poor lii;lil and \ cnl ila I ion ; \arions kind^ of 
 liveslock crowded toyclhcr. 
 
 2. A model of ;i iioo<l lype of farm l)arn ii^cd foi- dair,\' purposes. i'"air eon- 
 sfrnetion: clean stalile. yard, anri eal I le; i;ood liL;lil and xcntilal ion: ijood 
 slancliions; eows separateil from ollici' li\'e..|oek. 
 
 I). A model of an <'\cellent lype of modern daii-y liaiai, Sanilarx' con- 
 .struelion; clean slai)le and cows; ade(|nale li;^lil and \cnlilalion; no 
 other livestock. A saiiitar\' milk-can and a metal milkinu-slool weic on 
 exiiihilion heside this model. 
 
 No.s. 1 and 'i were models of the oi'dniary liank liarn Ihe liarn mo>l com- 
 monly fonnd in the State of IViiiisylvania. No. i showiiij;- a method hy 
 wliich this tyjie of liarn c;in he comcrtccl into a perfectly sat isfaclor.x' and 
 .sanitarx liarn. 
 
 The Care of Milk in the Home 
 Si-.-ii.Mi c. n.Miiii N,,. ■,>+. is.T rtair WW.) 
 
 This hooth relati'(l almost exchlsiveiy to the care of milk in the home. Tlie 
 ([nestion of |)roduction, howexcr. was tonched upon liv the exhiliition of scxcral 
 photoiiraplis illustratinii; the interior and exterior of d.iiry farms of the hetti-i' type. 
 and a grapliie diagram (Cliicago Hoard of Health), (Mititled, "The lonu and the 
 .short haul." which ])oiiited out tlie extcn^ixc treatment that milk reccixcs from (he 
 time it leaves the cow until it finally reaclx's the infant. This was coni|)are(l with 
 an infant receiving the milk direct from the cow. 
 
 On two shehe.s placed in the fi-oiil of this hooth was a xcry eti'ectix'c graphic 
 demonstration of the right and the wrong w a\' of caring for milk in Ihe home. Ihe 
 following .sets of legends being iilaced inun<'<|ialely back of the articles n>ed in 
 ilemonslralion; 
 
 On Itic uppL'r .slielf, illustrating tlie correct mcthdil: 
 
 "Take the milk from the milkman yourself, or ha\e a box like this for him 
 to put it in." ( Placed above Ihe pro] )er kind of box, containing bottles.) 
 
 "\Mu-n you receive the milk from the milkman, jiut it on ice at once." 
 (Placed above a home-made ice-box. cut in half, illustrating the eheaimess 
 of construction and the pro|ier |iositionfor the milk.) 
 
 "When you make the milk mixture for your baby, see that all your utensils 
 are clean." (Phiced abo\e two bottles of milk and the necessary uten.sil.s 
 in clean condition.) 
 
108 REPORT OF THE PHILADELPHIA BABY SAVLXG SHOW 
 
 "111 iiiaking uj) milk mixtures for your l>iil)y use hoiled water that has been 
 cooled. After you have used what milk you want, cap or cover the bottle, 
 and put it hack on the ice at once." (Placed aliove a refrigerator con- 
 taining the milk in bottles.) 
 
 "Wlien milk bottles are em]jty, wash tlicm with snap and water; rinse 
 them with cold water, and then scald them with boiling water." (Placed 
 above the utensils necessary for this jirocedure.) 
 
 "Place emjjty l)ottles in a clean box with a lid." (Placed above a clean 
 milk bottle receptacle.) 
 
 "A suitable mixture for an infant, prepared from milk taken care of in the 
 manner al)ove described, when examineil bacteriologically, was found to 
 contain lint &2iU) bacteria jier c.c." (This legend was placed above a 
 baby'.s bottle filled with milk.) 
 
 On the lower shelf, illustrating the incorrect method: 
 
 "Do not let it stand on your .steps in the sun." (Placed above two milk 
 bottles standing on a doorstep.) 
 
 " Do not leave it on the kitchen table. " (This was i)Iaced aliove some milk 
 bottles surrounded by \ari()us unwashed kitchen utensils.) 
 
 "Do not use dirty bottles, bowls, or glasses." (This was j)laced above a 
 group of dirty utensils difficult of cleansing.) 
 
 "Do not use un])oiled water to dilute the milk for the baby's bottle. It is 
 full of germs. " (Placed above a kettle standing beneath a sijigot, and be- 
 side some milk bottles.) 
 
 "Do not leave it on the table, where flies can get in it." (Placed above 
 some ])artially em])tied bottles with the caps off, the bottles being covered 
 with artificial flies.) 
 
 " Do not throw the emi)ty bottles down anywiiere. " ( Placed above several 
 bottles lying on their sides, amid such articles as an old liroom, a broken 
 box, and some scraj^s of dirty paper.) 
 
 "A mixture made from the same kind and (|uality of milk, and secureil at 
 the same time, and having the same bacteriological content as that used in 
 the up]5er row, but cared for in the careless manner indicated in this row, 
 was examined and found to contain '•27,100 Inuteria per c.c." 
 
 In addition to the foregoing, the following charts were hung on the walls of 
 this booth : 
 
 Milk not kei)t on ice is unsafe to use. 
 
 Make vourself an ice-box if vou lunen't one. 
 
DIHFJ TORY AM) ( ATM.tH.l'i: OF F.XIfllilTS 109 
 
 It is till' iliitx- 111' llic Munici|),ilil\- In -cr that vmi uct I'lirc, ('lean, Frc>li 
 .Milk. 
 
 It is I/our duty to see tliat it is kept I'lii-e, (lean, aiul Fresh. 
 
 Tell your inilkuiaii In deliver .\oiir milk lo you I'rrsoiuilbi. 
 ])() uol lei liiui leave il on \iiur door-slei). 
 
 Dnll 
 ]),„i 
 Don 
 Ihui 
 Dnii 
 
 Don 
 Don 
 Don 
 Don 
 Don 
 
 Don 
 
 MILK -DON rS" 
 
 / liu\' milk unless you are sure llial it is clean. 
 
 N'xpose milk or its container to the ^nn. 
 
 / put milk in a \essel that has not previously heen scalded. 
 
 / cook milk in vessels that are used for other |)urposes. 
 
 / keej) milk in the same eoniparlmeni of the refrii;erator with other 
 I'ataliles. Milk ahsorhs odors as well as germs. 
 
 / leave a milk liottle uue<ivered. 
 
 / leave the milk I ml lie unw ashed after use. A\'ash it at once. 
 
 / fail to rinse the hottle in cold water before scalding. 
 
 / rescue dying flies from the milk and then use the milk. 
 
 t accuse the milk dealer of serving sour milk until you have investi- 
 gated your home handling of it. 
 
 / forget that ice is the best preservative for milk. See that it is ahont 
 the milk container, instead of heinu eaten 1)V the children. 
 
nu 
 
DiRKcTony AM) ( ATM.iu.ri: or rxiiniirs in 
 
 Infant Feeding 
 
 The exliiliits (111 infant feediiii;- ()ccii|iieil six linoths: The first colltailieil all the 
 utensils wliicli imild |;ussilily lie needed in tiie |ire|iai'ati(in and care of tiie milk; 
 the second cdnlaincd a deincinst laticm cif ludd \aines; liic liiird was dcxnted to 
 artificial feeding; the fdurlji was fitted n|i a-' a |iiain Uitilien; and tlie fifth and 
 sixth w ei-c (lc\ ( ili'd liilirea^t IccdlUL;. 
 
 UTENSILS USED IX 1X1 ANT FEEDINC; 
 
 Scclioii I). H....I1, \,,. .,>i;. iS,-c- I'l.-ilr WW I.) 
 
 ( tn t\Mi ^licjvcs on the left-hand screen were |:laced thirleen jars c<intainili<; 
 li(iric acid. Iiarlcy tureen-., rice. Iiar](\\' llcini'. (latmeai, junket taliK't^, sdur milk 
 talilets. rrnncl. dc\trnn/mu fcrnicni. i^i'ainiLi led ~iiL;ai'. mall -.ni:ar. milk-sUfiar. 
 and ii(ira\. 
 
 ( )n t lie shcl\ cn (in t lie center sci-ecn. and (in a kir.ue sliclf extending ardimd t lie 
 frcint and sides (if the lidcilh. wci'c placed twd home-made ice-ihcsts, ;i hy^^ienic 
 refrificratiir. ,i tireless ciioker. a small liand elm in. a liot fie warmer, a ( liapin dipper. 
 a Freeman pasteurizer, graduate i^lasses. strainers, ddiililc liciilcrs. |iifchers, and 
 saucepans made of ajiatewarc. a numlier of small liowls, spodiis, a pair of scales, 
 and varidiis additional articles which niiuiit lie used in the pn'paralion of infant 
 foods. 
 
 On the center screen were liunu' foiu' charts lieariiii; drawiui^s df ntcn-,i|s, ;ind 
 the melhdd df usiui;- them in the preparatidii (if liarlev water. wIkiIc (ir tup milk 
 mixtures, wlicx', and artificially -din-ed milk. 
 
 'IIkm'c were alsd sluiwu utensils iiecess.ir\' fur the carrying' out df a cheap method 
 of lidiiic pasteurization, and alxivc il Imng t he fdlkiw iiig chart : 
 
 
 
 
 Mcih 
 
 (1(7 /or Home Pasteurization 
 Articles X ceded 
 
 
 
 One kettle 
 One kettle; 
 
 large 
 ilidiit t 
 
 enough 
 wice the 
 
 to hold eight bottles standing ujirig 
 size df the first, with a cover. 
 
 ht. 
 
 
 
 
 
 
 Method 
 
 
 
 Place bottl 
 with cold 
 boiling wat 
 from the fi 
 out liottle.s. 
 
 .'s eoni 
 water, 
 er, an 
 re, let 
 cool r< 
 
 aining the milk mixture in the small kettle. 
 
 Place this in the large covered kettle, 1 
 1 allow to simmer gently for eight minutes 
 stand for one-half hour (keeping covered), 
 ipidly, and jilace on ice. 
 
 Nearlv fill 
 
 lalf full of 
 
 Remove 
 
 Then take 
 
112 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Above the lionie-inade refrigerator was a gra|)liic cliart, in the center of wliich 
 was a (h-awing of a cross-section of a refriii'erator witii the ])rei)are(l Ijottles in the 
 position which tliey sliouhl occu])y. Aho\e this was written: 
 
 A IIOxME-MADE Refrigerator. Cost 35 Cents 
 
 Beneatli it apjjeared the following: 
 
 TO MAKE 
 
 Buy an enii)ty biscuit tin Qi 2 inclies hiuli x \i inches wide, at tlie grocery 
 store. 
 
 Buy a tin bucket 8^2 inches high x 7^ 2 iuches wide. 
 
 Buy a wooden l)ox 16 inclies square. 
 
 Fill the box as indicated. It will hold all feeding bottles necessary for 
 twenty-four hours. 
 
 The two following charts completed the exhibit in this booth: 
 
 PASTEURIZATION 
 
 By this method milk is heated to a temperature of from 140-14.5 degrees 
 Fahrenheit and kept at this temjjerature for 30 minutes. The milk is then 
 cooled ra])idly in running water and put on ice in the refrigerator. Milk 
 so ])rei)ared and kc]>t directly on ice will remain sweet and wholesome for 
 24 hours. 
 
 Certified milk does not need Pasteurization during the winter weather, 
 but all milk for young or sickly infants should be Pasteurized during the hot 
 weather of the summer months. 
 
 STERILIZATION 
 
 By this method milk is heated to a temperature of 212 degrees Fahrenheit, 
 either in a s|)ecial apparatus, such as the Arnold Sterilizer, or by bringing 
 it to the boiling jjoint in a kettle or saucepan. Neither method'is so good 
 as Pasteurization. 
 
 Dirty milk or half spoiled milk cannot be made pure by any method. 
 
DiUKcTony iM) ( ATM.oari: of kxiiihits iuj 
 
 Foods and Food Values 
 
 Section D. li-nth \... -JS. 
 
 This l)i>i>tli was arraiiiicd to <li>|ilay llic xarioiis t'oi nisi nil- siiitalilc to iiitaiicy 
 and early cliildliood and to show siiii|ily aii<l clearly theii- relali\'e calorie values. 
 The exhibit consisted essentially of i;i'adnat<-(l cylinders, hollies and jars containinii 
 colored fluids or foods, ])ro])erly lal>ele(l, and arraniied on shelves. 'I"he remaining; 
 s|)aees on the three screens allotted to this Section were occupied hy explanatory 
 charts, food charts, and appropriate decorations. There is no ueneral view, hut the 
 l)hites with the explanatory Iciicnds show the itnporlani features. 'I"he charts and 
 specimens will lie descrilied without reference to their jiosilion on the .screens. 
 
 I)i-,(.r;ilivc I'riilts. 
 
 ••Fiv<' O'clock 'I'ea" i.l. W. S.l; "Suoar I'luni Tree" :M. 1'. - - Manihini " ilella 
 Rohhia). 
 
 Cluirt.s <if Dcpnrlinciil of Auriiiilliin — ( 'onip isition of Kood MaliTiajs. 
 '"K^fi'^ :i'i<l Cheese""; "Hntlerand Other Kat-\ieldin;i Foods""; "Snuar and 
 Similar Foods"; "Roots and Succulent Veuetahles." i See Plate WW I II. ) On 
 another screen : " ( 'omposit ion. I'"nnct ions and I ses of l^'oods"; "Cereal drains"; 
 "Bread and Other Cereal Foods"; ".Milk and Milk Products."" 
 
 EN])I:inMlory Cliarts. 
 These enumerate the principal foodslnffs ari<l define their uses and indicate 
 the prin<iples ujion which the calorie method of valuing foods is based. 
 
 ClKirt 1. 
 
 PROTEIN :\rOST ESSFATT.VL FOODSTTTF 
 
 No Substitute can replace it for(.ROWTII and RF:P.\IR 
 
 1,.\CK of PROIFIN had- to 
 ANEMIA, POOI{ ( IR( I L.VTIOX, FL.V15I5Y MUSCLES 
 
 ST.VRCIIES and Sl'CARS (Carbolivdrate) 
 
 CHEAP. EASILY I)I(;f:STED— Sujiplv IIFLVT an.l MLSCl LAR 
 
 POWER 
 LACK OF SUGARS and STARCHES leads to 
 
 LOSS of WEICHT and STREXCTH. 
 
 AV.VTER 
 Nearlv !)() PER CENT of INFANTS" FOOD (HU.MAN MILK) 
 CHILD of one YEAR needs 
 
 HALF as much WATER as ADULT. 
 
 MINERAL SALTS, etc. 
 Found in FRUIT JUICES, GREEN VEGETABLES, UNROLLED 
 
 :milk 
 
 LACK of ])roper SALTS causes 
 ANEMIA, SCURVY, RICKETS 
 

 i- 
 y. 
 
 a 
 
 < 
 
 Q 
 a 
 Q 
 
 
 114 
 
DIRK( TORY AM) ( MAIJX.IF. or KMIIIillS 115 
 
 Chart i. (I{,•f,■I■^ to I'lalr WWII) 
 
 BABY need 
 
 s ill 
 
 I'HOI'OIMIOX 
 
 Id 
 
 iil- 
 
 \\ 
 
 ■i-hl 
 
 
 FOl'R timos as 
 
 iiiiii' 
 
 1 W A TEli : 
 
 ,. 1 
 
 li- 
 
 III! 
 
 llu-i 
 
 
 V\\\\ times 
 
 as 
 
 imch 
 
 VXV a> Im> 
 
 IlK 
 
 .11 
 
 cr 
 
 
 
 TWICE as 
 
 niK 
 
 li (1 
 
 HI) 1 prolciii 1 
 
 IS 
 
 his 
 
 mot 
 
 KT 
 
 EQUALLY 
 
 as iniicli 
 
 SrCAK 1st 
 
 an 
 
 Id 
 
 as 
 
 liis motluT 
 
 (Mother tis( 
 
 s St 
 
 anil 
 
 ami --imar. 1 
 
 ah 
 
 \' > 
 
 iiu; 
 
 ir oil 
 
 l.v) 
 
 ClKirt 3. 
 
 I'OOnS ate BIHXEI) in the W^\^\ as COAL iiii.icr a BOILER 
 MrMiim BO|)^ IIKAT and MLSC ri,Al{ TOWEH 
 
 jiisl a^ 
 COAL viekls Sl'EAM HEAT and I'OWEU 
 
 OIL makes a HOTTER liiv than ( O AL or \V( toj) 
 
 FAT yields (iREATEH IlKATaiNl i;M;K(iV than other KOOnSTlEES. 
 
 PROTEIN (Curd) and < ARKOll^ l)|{ A IE (sugar or stareiii 
 
 liavc same YALUE as HEAT l'R( )l )!( IlKS 
 
 The MEASURE of HEAT is llie CALORIE 
 
 ONE PART l.v WEICHT (I gram) of PROTEIN \\A<U t .alorics 
 
 " ■• FAT •• !) " 
 
 .. CARBOHYDRATE " 4 " 
 
 A baby re(iuires 40 to .JO calories for each ])Oiind of weight 
 
 One quart of Milk contains (roughly) 
 
 Curd (Protein) .'!.j grams x 4 = 140 calories 
 Fat 40 '• X = ;5(iO calories 
 
 Milk Sugar 4,'> " x 4 = 180 calories 
 
 (ISO calories 
 
 Graduated Bottles and Jars. 
 
 The purpose of the exhibit shown in Plate XXX\ II is exi)lained by the 
 legend: 
 
 Chief Foodstuffs in Amounts Needed at Different Ages: Baby 10 AVeeks 
 old. Weight 11 lbs. Child 13 mos., AVeight 2-2 Ibs^ Nursing Mother— 
 110 lbs. 
 
z 
 
 Q 
 
 Q 
 O 
 O 
 li 
 
 O 
 
 a 
 
 D 
 
 < 
 
 H 
 D 
 Z 
 
 116 
 
DIHFA TORY AM) ( ATMMi.lF. Ill' IXIIIIUTS 117 
 
 Fur tacilily in ((Hiiparisoii woiiilits that were siiiiplc niiilliplfs of 11 wore 
 takoii for the older liahy and iiiotlier. Water, colored red, represented 
 protein; colored yellow, fat; colored lilue, earlioliydrale; niicolored, 
 water, (iihic eeiitinieters re|)resenled i;ranis liy wciiilit. Mineral sails 
 were represented Ity connno!i salt. 
 
 The graduated eylindi'rs and liottles contained, in order: l'rot<-in I 1.5 
 grms.). Fat {'■2.5 grnis.). Milk Sugar ( l.)() grnis.). Water (7.50 e.ein.). Mineral 
 Salts; Protein (.'50 grnis.). Fat (40 grins.). Sugar and Starch (75 grins.), 
 W'ater (1000 e.eiu.). Mineral Salts; Protein (!)() grins.). Fat (4.5 grm.s.), 
 Sugar and Starches (400 grins.). Water (^2000 c.cni.). Mineral S.ilts. 
 
 These diets represented in ronn<l nuniliers oOO, SOO, and -2 K)0 calories 
 respectively. 
 
 Plate XXW'lll (lc|mt-. the central f<-alnrc of tli<- cxhihil. The hollies 
 and jars, in each in-^t.inci'. contained a ipiantit.v of the food indicated on 
 the label, jnst siillicient to yield a nniforni I-'dihI or Fuel Viihie — 100 
 Calories, 'ihc three graduated cylinders near the lower right-hand cor- 
 ner rejiresented, hy colored fluids, the exact ainouiils of J'rotein, Fat, 
 and ( 'arhohydrate r<'(piired to yield 100 Calories, /. r., 'i.j, 11, and •!.'> grams. 
 'J'he foods were grouped with reference to the Chief Foodstnlf contained, 
 as shown hv the following legends and shelf lists: 
 
 TopSlielf; 
 
 Food,s of Same Nutritive \ ahie in .\mounts Shown. Chosen because of 
 Richness in Sugars and Starches. Milk or caiie sugar, rice and other 
 cereals. 
 
 Bottles and jars containing in onlcr: 
 
 Baked Potato, Shredded Wheat Biscuit. Toast, Soda Cracker.s, Sponge 
 Cake, Milk Sugar, Cane Sugar. Malt Sugar, Rice, JJoiled Rice (same 
 amount). 
 
 Legend; 
 
 Foods of Same Nutritive \'alue in .\niounts Shown. Chiefly Valuable for 
 Salts Contaiueil. Fruits, end of First Year: Only those shown advised; 
 Green Vegetables, end of Second Year. 
 
 Bottles and jars containing in order: 
 
 Orange Juice, Stewed Prunes, Apple Sauce, Cooked Spinach, Carrots, 
 Asparagus. 
 
 Lower Shelf: 
 
 Legend: 
 
 Foods of Same Nutritive \ alue in .Vmounts Shown. Chosen because of 
 Richness in Proteins, such as albumin or white of egg, lean meat, curd of 
 milk, gluten of wheat flour. 
 
'it' 
 
 ,:-i 
 
 '■■•'im' 
 
 1 
 
 ll 
 
 I ||!i^ 
 
 'ii 
 
 
 
 
 
 
 3 
 
 1 
 
 
 
 1 
 
 It i* 
 
 
 
 j-ifl ^ 1 
 
 ^^Bst 
 
 ^' Ml 
 
 
 
 
 
 
 ^> 1 
 
 
 >.i»Jm< 
 
 
 {^^■^^^ 
 
 pvi 
 
 "^Si 
 
 su 
 
 le 
 
 NOaansms' 
 
 o 
 
 C 
 
 y. 
 
 y, 
 
 y. 
 
 118 
 
niHFj Tdiiv AM) I AiAiAK.ri: iir ixiiiinrs 119 
 
 Hollli's :iri(l jnrs icinl.iiiiinj; in Di-drr: 
 
 XfulVliatcl ( 'heosc, E^fi- (I:irf;o). Split Vv:\ Souj), V.ii'j. Wliilc Cow "- Milk. 
 Skimmed .Milk. Buttermilk, Iliilil.nl. Moiled, Wliile Me.it uf Chickeu, 
 Tenderloin of Steak, Pressed lleet .Iiiii-e. l•:^^ Water, Ueel' Hrotli. 
 
 I.,-Krr„l; 
 Foods oi' Same Xiilritisc \ aliie in AnionnI-- Shown. ( 'lio~-en lieraUM' ol 
 Richness in Fats, --nch as cream. >dlk ol' cl;l;. Iiacon. oli\c oil. 
 
 Hnlllrs :n)(l j ir^ cmil niiini; m urdi-r: 
 15aeon, Hutter, Olive Oil, ^'olk of Fjij^s. .\\erai;i- (ream, Toi) Milk. 
 
 The lower Jiart of I'late XXXIX showed the a|)plicat ion of the Caloric 
 Method of eompntation lo human milk and to a few common snhst it ulcs. 
 l)ill'ererice>- in the i-clati\c proportion- of the chief food-tulf- were also 
 emiiliasi/.ed. 
 
 On Ipprr Shelf: 
 
 Di.'t of Infant of id weeks. 
 
 Mother's Milk, -liowinn (|uantity of each fccdini;ari(l numljci- of fced- 
 inji's US)- total food \alne. (I.")(l calories. 
 
 l..-rM.l: 
 
 Modili<'d Toj) Milk. Same ('(iiii poxituni ;is Mothi-i-'-- .Milk-S.\MK 
 FOOD WVLIF, (!,M) Calorie-. 
 
 Three iiraduated cylinders eoulainiui; coloreil fluids and re|)resentini; the 
 weifjlit of I'rotein (red). Fat (yellow i and Sui^ar (hhu') in a day's snpid.v 
 of human milk. 
 
 On l,nw,-iSli,-ir: 
 
 l-r-,-n.l: 
 Incorrect Modifications for 10 weeks. 
 
 Food value, (lot) calories. CoiukMised milk, diluted 1 to Ki: Error — exces- 
 si\e ((uantity, excess of siij^ar, low fat; Correction — reduce ((uantity, add 
 ereani. Plain cow's milk, diluted i j: Error — larae f|uantity, lack of suijar. 
 excess of ])rotein: Correction — reduce quantity, ad<l suuar and cream. 
 
 Eifjht l)ottles containiui; condensed milk, 1 to Ki; amount shown in each 
 liottle (Vi ounces) yields SO calories- Total. CljO calories. 
 
 Three graduated cylinders showinu relative ])ro])ortions l)y w<'if:ht of ]:ro- 
 tein, fat, milk, and cane sugar in diluted condensed milk. 
 
 Three graduated cylinders showing relative jiroportions hy weight of 
 protein, fat, and milk sugai in diluted cow's milk. 
 
120 
 
DIRECTORY .I.V/> ( ATA/JX.rF. OF i:\fllllfTS 121 
 
 Eight holtic-^ coiitaiiiinfi' cow's milk ;iii(| wiitcr — (Minal pjiiis: ;mi(iiiiit 
 shown ill cjich Kotilf IS ozs.) yiolds SO calorics — Total, '!.">n calorics. 
 
 All cxliiliit showiiii; in concrete form the ilici of a Child of IS Mouths was 
 also included. It is not i>iiiiircd in the I'lalcs. 
 
 The exhibit shown in I'late XI, was prepared to ilhistrate a few- of the 
 iiian.v forms in which milk could !»> ottered to a child. The unit of coiii- 
 ])arison, as explained l),v the IciiiMid. was !.")() calorics i list <'ad of 1(111 calories. 
 
 Different l*\)inis In which Milk Ma.v I?e (iixcii. ivicli article shown has 
 the same food \alnc as one iihiss i 7 ' •_> ounces) of milk, or l.>() caloiies. 
 
 Upper Slu-lf: 
 
 Hottlcs conlaininu: Cream of (Green") Pea Soup. Cream of S|iiiiacli Sou]), 
 Cream of Lettuce Sou]). Cream of Onion Soup. Cream of .Vs])ara.uus Soup, 
 Cream of ( 'elerv Soiij). ( ream of ( 'orn Soup. ( ream of Potato Soup. ( ream 
 of Tomato Soup, Oyster Stew (straiiicd I, Cream. AMicv. Skimmed Milk, 
 Pnttcrniilk, WIhiI.- Slilk. 
 
 LowiT Stirtf: 
 
 Six hottles containina': Milk (Irucls— Parli'.w .\rrow root . Cornmcal, Oal- 
 Tucal; Milk Co< oa. and a Malted Food. 
 
 Nine jars conlainiiii;: Hread I'liddini;. Tapioca Piiddiiii;, Mlaniinanuc. IJice 
 Pudilinu. liicc and Macaroni in Milk. Soft Cu-lard. Milk Toast, .Innkct. 
 
 Another exliiliil, pot illuslratecl. was meant to show the \alne of the 
 caloric standard as a ijuidc to the economical choice of foods. .\ pint of 
 milk costiiiii' 4 cents was compared, on the basis of current prices, with 
 more expensive as well as with cli<'apcr foods. Meats, finits. yreen vege- 
 tables, etc.. are examples of the more <'xpensi\c foods: butler, potatoes, 
 ]iens. and cereals of the less costlw 
 
 Cost of Foods. Comparati\-c Food \'alues Obtained for Price of Pint of 
 Milk (4 cents). 
 
 Fifteen bottles graduated in ounces. Each ounce of colored fluid repre- 
 sented 100 calories. The height of the fluid in each bottle measured the 
 caloric value of the food in question from the point of view of C(JST. 
 
Ui REPORT OF THE PHILADELPHIA BABY SAVLXG SHOW 
 
 A rtificinl Feeding 
 
 Section U. Booth Xo. 30. 
 
 Every effort was made in this liootli lo |>oint out the things that are 
 essential to successful artificial feeding. In the demonstration of its con- 
 tents, however, the fact was emphasized that artificial feeding should 
 never be resorted to until every effort had been made to prove that the 
 infant coidd not be satisfactorily nourislied at tlie mother's breast. Thi.s 
 teaching was fiu'ther imi)ressed iiijon tlie visitors l)y the legends and demon- 
 strations wliich were given in the booth on breast feeding. 
 
 The booth contained the following charts and photogiaphs: 
 
 Catecliism 
 
 for ^lothers — if the baby must be bottle-led. 
 
 Question. 
 
 What is the best milk to use? 
 
 An.swer. 
 
 Certified milk — Each bottle has a sjiecial cap with a Certifi- 
 
 
 cate of the Philadelphia Pediatric Society. 
 
 Q. 
 
 What is Certified Milk? 
 
 A. 
 
 Milk produced with s|)ecial care so that it shall l>e absolutely 
 clean. 
 
 Q. 
 
 Why tloes it cost so nuich!-' 
 
 A. 
 
 Because of the extreme care and trouble which is taken to 
 
 
 uudsC it clean and wholesome. 
 
 Q. 
 
 Is it worth all it costs? 
 
 A. 
 
 Undoulitedly. Try to get it, if you can jiossibly afford it. 
 
 Q. 
 
 Why is it necessary to be so carefid of milk? 
 
 A. 
 
 Because it spoils so (|uickly if it is cx])osed to the air or if it is 
 
 
 not kept next to ice. 
 
 Q. 
 
 What is modified milk? 
 
 A. 
 
 Milk which is altered (modified) by adding water, sugar, etc. 
 
 Q. 
 
 When should you u.se modifiefl milk? 
 
 A. 
 
 W hen told to do so by yoiu- DcK-tor. 
 
 Q. 
 
 Why should milk be modified for infants? 
 
 A. 
 
 Cow's milk should always be diluted with water, because it is 
 
 
 too strong. The younger the child the larger the amount of 
 
 
 water to be added. 
 
 Q. 
 
 What is Pasteiu'ized milk? 
 
 A. 
 
 Milk that is heated just to the sinunering point for 30 minutes. 
 
 
 It spoils more easily than Certified ]\Iilk. 
 
 Q. 
 
 \Yhat shall we buy if we cannot afford Certified Milk? 
 
 A. 
 
 Buy milk delivered in bottles by a clean milkman. If there 
 
 
 is any dirt in the bottom of the bt)ttle, it is probably manure 
 
 
 and you had best change your milkman. 
 
nililA TOHY AM) ( ATAlJX.Ii: OF I.XUIIIITS 
 
 I--':i 
 
 A\ lien it i> iiiiii()----ililr In iiiirsc yciiir li;il)y or Iol'cI ;i wri -luirsc. I'm. Hahv 
 slidiild l)c led (III propcrlx' |iri'p:irfil I'it^Ii cou'-. milk. 
 
 MI'1M.I> \\l) liOl ri.KS 
 !?()lllcs should lie round, not ilat. >o ;is to he easily cloaiiscd. Nipples 
 siionld lie st|-ai?ilil, shaped like a loliii Ihimhle. so that they can lie turned 
 inside out and t liorouiihlx' cleansed. 
 
 .M'ter each Iccdini; the nipple and liiittle should lie washed, lir-t in cold, 
 then in hot, water and suds. Keep the nipple in a solution of lioric ,icid 
 (two teaspoon In Is to a cup ot' water I'reshly nun ie each day i. Stand the 
 hot tie upside do\\ n to drain. Have a sejiarate lioltle I'or each I'eedini;. hut 
 I he same nipple uniy lie used lor all the leecliuu- ol one (lay. 
 Look thidUi.;h each nipple hefore you huy it. ^ ou should liarcly ne alile 
 to see lii;iil throuah the hole in the ni])ple. It is easy to make a hole lari;er 
 with a reil-liot needle point, liut you cannot make it suialk'r. 
 
 It should take the lialiy Irom It) to 1.") minutes to empty the hot t le. 
 
 .\ iti:i;.'rnlii sliouiiii; llic ililVi'nMiii- in llii- r.iti- uf Itnw fiMtn ililfi-rriil nipplr^. 
 1 niliT cacti iif llii' I'dttiiwint; t<Kciicls was .-lU ittiistralii>ii of ,iii invcrli'ii linltlc. 
 
 a. ]',rii Sliiir Xi/ijilr h. Midiiini Sluir Xi i)iili. r. I'lixl Xi/iplr. 
 
 \\ licii Itir liolltc cif milk is I iiilcr llir same ciUKiiliiiiis, Mitl< fl<i«> from Ilic niiiplc in 
 
 liclcl ii|i>i(li' (liiwn, \'i inilic^. Iliirr wilt lie \! m- :> ilroiis lie- a .slciw tint (■(inliniKins slrcaiii. 
 
 aliuvi- tin- lalilc, line itrnp wilt I wccn (he nipple and tin- laljt<-. Too fiixl. 
 
 .strike' tin- lalitc jn»t as I lie ni'\l ./„,v^ rii/lit. 
 
 (iiic t<';i\ cs liic nipi>Ic. 
 '/■„» .-.I,,,,-. 
 
 DIRECTIONS Ui;(;.VRI)l.\(. MILK .\N1) US PHKl'.VK.V HON FOR 
 
 TIIK 15.VBV 
 
 a. Vou cannot he too clean, so do not lie afraid to try. The milk, and the 
 hottles it comes in, should he clean. If they are dirty, chaniie your milk- 
 man. The hottles should not lie left on the doorste]) for cats and (lo>;s to 
 lick. Take them in as soon as delivered or else pro\ide ;i hox with a cover 
 for them to -.land in. .\s soon as the milk is taken in place it on the ice. 
 li. When the least hit of dirt i^ets into milk, the o'erms from the dirt multiply 
 so rajiidly thai in a few hours the milk can he rendered unfit to i;i\-e the 
 hahy. Therefore scald or lioii everylhinf;' which comes into contact with 
 milk and never leave milk ex])osed to the air. 
 
 c. As soon as pos^ilile afti'r the milk is receixcil. prciiai'c the feediuL;^ for the 
 entire day. 
 
 d. Boil all uten-.ils. including the nipples and liottli--. for Kl or \') minutes 
 hefore i)re])ariui;' the uiilk mixtures for the ilay. 
 
 e. \Yasli your hands hefore preparing the lialiy"s food. 
 
 f. Wash the neck and top of the hottle before removiim the cap. 
 
 g. When the milk is jirepared. put the t'eedini>s into the nursiui; hottles; 
 cork the hottles. and place then on ice. I Illustration: Six feeding hottles, 
 containing milk. ]ilaced against a block of ii e.j 
 
124 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 A chart showing the proper number of feedings and the intervals between 
 them. 
 
 1st and in(\ Months — Every 2 hours — feedings in -2i hours. 
 
 3d, 4th, 5th .... " '" 3 •• 7 
 
 Gth, 7th, Sth .... " " 3 " {) " 
 
 9th, 10th, nth. l'2th . . " " 4 " 5 " 
 
 Begin feedings at 5 or fi A. M., and end at 10 or IIP. M. Night feedings 
 after 11 P. M. aie unnecessary. 
 
 DON'T OVERLOAD THE BABY'S STOMACH 
 
 Tiie following life-size pictures of stomachs at different ages .show how 
 small they are and how much they will hold without being overstretched. 
 
 The Actual Size of the Stomach 
 
 At liirth. 
 
 Two weeks. 
 
 Four months, 
 
 Six months. 
 
 Eiglit to ten months 
 
 One oiuiee. 
 
 Two ounces. 
 
 Four ttiuiees. 
 
 Six ounces. 
 
 Eight ounces. 
 
 BABIES MUST BE GIVEN AVATER TO DRINK 
 
 Most people who own dogs are careful to give them plenty of drinking 
 water, esjiecially during the hot weather. (Colored drawing of a dog.) 
 
 Amateur gardeners never fail to flood their thirsty flowers with a plentiful 
 supply of fresh, cool water. (Colored drawing of a pot of flowers.) 
 
 The yellow canary receives a fresh cupful of water every morning when 
 his feeding cup is filled with seed. (Colored drawing of a canary in a cage.) 
 
 MORAL ! 
 
 Don't forget the baby. Gi\'e clean boiled water in a clean bottle with a 
 clean nipple, two or three times a da.y in winter and between feedings 
 in summer. The water should be at room tem[)cratiu'e in winter and 
 slightly cool, not ice-cold, iu simimer. 
 
 FACTS WHICH THE MOTHER :\IUST NOTE SO AS TO REPORT TO THE 
 
 DOCTOR 
 
 1. Weight: Whether gain or loss. 
 
 2. Stools: Number and color — Always save one or more diapers for the 
 doctor to see. Keep them in a daily cleaned closed receptacle. 
 
 3. Sjntting up or regurgitation 
 
 4. \'omiting. How of ten. ^ How .soon after feeding? 
 
 What nature.^ 
 
 5. Gas or wind. From stomach? From bowel? 
 
 0. Colic. JNIild .severe 
 
 7. Does the baby take all of each bottle? How much does he leave? 
 
 8. Is the bal)y satisfied? 
 
 n. Slee]3. Day night 
 
 10. How manv hours out-of-doors? 
 
Dflil-J TdltV WD ( ATAlAUai: (IF EMU HITS \io 
 
 CAITIONS FOR MOTHERS AM) M RSES 
 
 ;i. Kiicli fo('<ling should occii])y from 1.5 to iJO niiiititcs iiud no loiiijcr. If 
 tlic l);iln' trios to go to slec]) heforc the l)ottI(' i-; ciiiply, keep liiiii ;i\v;ikc. 
 1). Don't keep what is left in the holtic Inr the next iVcdint;-. Throw il 
 iiway. 
 
 c. Milk NJionld !"' diluted aceordinix lo lln' auc heall li and >\/r of the 
 hahy. The doetor should decide how strong to make the food, not the 
 next-door neighhor. 
 
 (1. Feeding too nnich or loo often or the w rong things, are the chief causes 
 of vomiting and dianhea in infancy. 
 
 e. A'rvyr i)ut the- uip|)le in your mouth Ix't'ore gi\ing it to llie haliy. I.ike- 
 wis(>, iicrcr use a nipple that has fallen on the floor, without scalding it. 
 Serious illness is caused hy such carelessness. It is much easier to make 
 a l)al).v sick than it i-- to cure the siekness. 
 
 f. ^^ hen you warm an ice-cold hottleof milk just liefore feeding the hah.v, 
 do it gradually hy using lukewarm water first. Otherwise, you may do 
 tlii^. 1 llhistralion of a hroken Ixitlle.) 
 
 g. Test the temperature of the milk hefore gi\ing il to the liaKy. Ky let- 
 ting a few drops fall on the inside of the torearm. Olheiwi>c. nou may 
 burn your liahy's mouth. 
 
 h. Do not heat a liottle when you go lo Iicd and kec|i it under the pillow 
 until the l)ai)y wakes up. This is a certain way to make the hahx' sick, 
 i. ^^ hen you lak<' Ihc hahy out during liol wealher, lak(> a hottlc of 
 l)oilc<l water with you. Dou'l take a hottlc of milkl 
 
 ('olorcd (Imviiif; sliinviiis tin- swolli'ii Iri; i)f an infant snlfiTini; from srurri/. Tlic 
 rrsutt of improper fcrdini:. 
 
 Scurvy rcsull> when nothing Iml caimcd or oxcrheatccl foods are eaten 
 for a long time. The i)rolongc<i use of condensed milk or i)atent foods 
 made without fresh, nnluvitcd milk, ma.v. therefore, cause .scurvy. 
 
 .\ilililioiial tliiiii:-. >hown in fiiis Itootli wt-rf: 
 
 An .r-ray photograph of a hahy's trunk, illustrating the exact size and 
 position of the .-loniach. The legend underneath it read; "The dark 
 ohlong shadow -hows the exact size and i)osition of a hah.v'-. -.louiach." 
 
 Two plioto<;rapli> illii-lrating tlii' proper procnluic in fft-iling the l)aliy. 
 
 a. Hold the hahy in ,vour arms when you give it the bottle. Because 
 the baby is so unfortunate as to have no breast milk is no reason why it 
 should miss its mother's arms. 
 
 h. If it is imi)()ssible for the mother lo hold the babv, let the sister hold 
 the l)ottle. 
 
 Seven pliotojiraplis .sliowing tlie resnlts of gooil and l)a(l artifieial feeding. 
 
 a. A baby, age IS months. Weight. ^2.5 ])ounds — which is just the jirojjcr 
 weight for a child of this age. Shows good results ]50ssible from artificial 
 feeding. 
 
 b. A bab.v. aee '2 .vears. Weight. '21 pounds 10 ounces. Should weigh '27 
 pounds. NOTICE the distended al)domen from continual overfeeding. 
 This child shows signs of rickets. 
 
ni} 
 
Dllil'J TonV AM) (MM.Oi.l'i: OF F.XllllUTS }-27 
 
 c. A l);il>y, :ii;c 7 iiKintlis. \\cii;lil, II |Hiiincl> 14 miners, s|iiinl<l \vciL;li 1(1 
 
 ])()im(is S ounces. It looks fairly hcallliy hiil is never '■s.-itisticd" liciaiiso 
 
 it has heen ini|)r<)|)eily fed. 
 
 (1. A hahy, ai;'e ,'5' J nioiitlis. W eiiilil . 7 pnuncis IMonnres. Should wciisli 
 
 I'i pounds S ounces. It never receixcd hreast milk, hut was fed chielly 
 
 on proprietary foods. It has gained one pound in two \v<-eks on a pioper 
 
 milk mixture. 
 
 V. .V l)al),N', at;(' 7 months :> weeks. Wei^lil, 1 1 pounds (i ounces. Should 
 
 weifi'ii 17 jiounds. The piclure shows a lar^e helly and v\cak muscles and 
 
 poor imtrition. 
 
 f. .V ('liiuese hahy, aiiC .J monlhs. \\eiL;lil, Id pounds 1(1 ounces. \\ 
 
 liirlh .") pounds !• ounces. Shows lirm umscles |)l<>nl y of fa I norm.al de- 
 
 velopmenl. Stomaeii distended after a I'eediTii;. 
 
 t;. .\ liai>.v, ai;e !■' 2 inouths. Weight, 7 pounds 7 ounces. Should wei^h 
 
 \i pounds. Was iinj)roperl,\' fed until IS days hefore Ihe |iiclurc was 
 
 taken; uained l."> ounces in IS da.vs on a ]U'o(ier milk mixlnre. 
 
 Shelf coutaiiiinii; Weitxlit scales, proper- feeding; hollies, nijiplcs and 
 
 hruslies for eleaninsi Itotlles. 
 
 Card-hoard clock dial with movable iuuids for indicaliui,' Ihe hour of Ihe 
 
 next leedinu'. Thermometers for teslinij; Ihe tenipeialure of milk pi'e- 
 
 parc(| for fecdini;. 
 
 Sfclioiil). lidnlli N(i. :!'.2. ^S^■(■ IMalfXM.l 
 
 A I'l.MN K ITCH I.N 
 
 This lioolh n'pi-esenled a simi)ie kitchen such as could he inshdled in any 
 home. The lloor was covered with oil (lolli, and Ihe e(|uipnienl con- 
 sisted of: 
 
 1. .\ plain kitchen lalile in its i cuter. 
 
 i2. A smaller kitchen lahle in the rear upon which were placed some cook- 
 ing utensils. 
 
 3. A.'losel. 
 
 4. Two sheK'es. 
 
 5. A cheap ice-hox. 
 (). .V waste call. 
 
 7. A eliair. 
 
 8. A sink ihot and i-old water) and drain hoard. 
 !). A <;as stove. 
 
 1(1. ( 'ooking' utensils. 
 
 11. All necessary utensil.s for cleaning' and sterilizing hottles. 
 
 1^2. A fly -catcher. 
 
 13. Jars for sugar, cereals and other ingredients of milk mixtures. 
 
 A qualified registered nurse was in constant attendance in this hooth. 
 Every half-hour during the day she gave demonstrations in the care of 
 milk in the home, the ijreparation of milk mixtures, the ])asteurization 
 of milk, and the cleansing and preservation of bottles, nijjples and other 
 utensils. 
 
128 
 
ninij TORY AM) < ATM.iu.n: or i:\niiiiTs u<) 
 
 Breast Fccrliuff 
 
 |S,-,- I'hil.- Xl.lll 
 Section I). Bi.iillis N'ds. ;U ami :!(). 
 
 Much time anil can- were cxiw-nded in ('iidcavDriiii; l<i ma!<(' tlicsc hoollis 
 particularly allractixc, in order tr) coiiecMitrate the at tt'iitioii of all those 
 who visited the Show not only upon the artistie illustrations, hut also u])on 
 the inipoitant teachintis whieh were contained in the i)rinle(l charts. 
 Most of the educational leijends in these hooths were show n on an adver- 
 grajili. 
 
 These hoot lis were under the const a nl direction ol' an at tractive, intelli^'cul 
 antl interested trained nurse in uniform, who, in addition to answeiiui: any 
 (pieslious that were asked of her, distril)ulcd colored litlioi:rai)lis of an 
 orijiinal water-color i)aintinf;', entitled. " Mother and Nursini; Child." Iiy 
 Eleanore AhhotI (sec Plate XLIII), which painlini; was huui; in thcci'nier 
 of the main liootli. 
 
 In addition lo the water-color painting; referrccl to. Ihc hooth contained 
 two pictures liy (iari Melchers one entitled "Mother and (liild. ' and 
 the other, " Mother Nursing a IJalic '; a i)as rcliit. l>y Louis H. l)oUi,dierty, 
 entitled "IJIiss," which represented an infant at the breast; a ])hotourapli 
 of a mother nursiufj her hah.v, entitled, "'I'he 'I'rue ("ons(>rvalion of Infant 
 Life"; a photograph of a hahy on a pair of wciuhinji; scales, over which was 
 written the advice, "Weigh, vour hahy often." and underneath which was 
 the legend, " Hreast-fed; seven and a half months old; weighs 17' o pt)unds, 
 anil is al)le to sit uj) alone"; a i)hotogra|)h of a mother with a |)rotective 
 covering over the nose and mouth, and an infant at her breast, underneath 
 whieh was written the legend, "This is the wa,v to avoid giving .vour infant 
 your eokl"; a i)en and ink sketch of a bab.v and a ealf, the ealf looking at 
 the baby, and the calf being made to sa,v: "You are the fellow who has been 
 stealing m,v breakfast and supi)er. Where is vour own mother?" 
 
 The following legends and advice aj)peareil on the charts which were 
 hiuit; in these booths: 
 
 Take this child awa,v. and nur^c it for mc. and I will give thee th,v wages. 
 And the woman took the child and nursed it. And the child grew. 
 
 Exodus, Chap. J, 9th and 10th verses. 
 
 To the mother's nature has been assigned the continued duty. res|)onsibil- 
 ity, and sujireme jo,v of the jiersonal nourishment and care of her offspring, 
 and nothing can riglitl.v replace it. 
 
130 
 
 REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 You cannot raise a race of sturdy men and women on the bottle. If a 
 nation is to possess vigor, it must in-o\ide mothers in fact as well as ni 
 name — mothers wlio nourish their offspring at their breasts. 
 
 THE REL.\TIVE EXPENSE OF BREAST AND BOTTLE FEEDING 
 
 Breast Feeding. 
 
 Bottle Feeding. 
 
 Bottles 
 
 Nipples 
 
 Milk 
 
 Lime-water 
 
 Sugar of milk 
 
 Barlev 
 
 Ice 
 
 Bottle-l)riishes 
 
 Soda 
 
 Physician 
 
 Medicine 
 
 These are necessary to the health of the nursing mother: 
 
 Fresh Air ** 
 
 Projier Rest 
 
 Moderate exercise out-of-doors 
 
 Daily warm bath 
 
 Loose clothing 
 
 Clcaidiness of breasts and nijiples 
 
 A nursing mother should drink jdenty of water and eat three good meals a day. 
 Select from these: 
 
 Breakfast 
 
 Fruits 
 
 Cereals 
 
 Eggs 
 
 Bacon 
 
 Fish 
 
 Rolls 
 
 Toast 
 
 Potatoes 
 
 Cocoa 
 
 Coffee 
 
 Milk 
 
 Luncheon 
 
 Broth 
 
 Cold Meat 
 
 (^hops 
 
 Fish 
 
 Oysters 
 
 Potatoes 
 
 ]?read 
 
 Pudding 
 
 Jelly 
 
 Stewed fruit 
 
 Cocoa 
 
 Milk 
 
 Dinner 
 Sou]) 
 Chicken 
 Roast beef 
 Roast lamb 
 Beef-steak 
 Fish 
 
 Potatoes 
 Green vegetables 
 Pudding 
 Custard 
 Ice-cream 
 Milk 
 
 Breast milk may be changed so as to make it harmful to the l)aby by any 
 of the following: 
 
 Fits of temper 
 Unwillingness to nurse 
 Unhapijiness 
 
 Hurry 
 Worry 
 Irregularity in rest and habits 
 
DiHFJ Tonv .i.\i> ( ATMju.ri: or kxiiiiuts vm 
 
 AVhy tlic milk of sonic mothers is bad for the l-'al>y. 
 
 Uecaiise they — 
 
 Xurse the lialiy lonj/jer than 'SO minutes 
 
 whenever it cries. 
 
 irre<;uhirly. 
 Drink tea. 
 
 porter and licer. 
 Do nol (hink enough water. 
 
 Don"! nurse the hahy c\cry lime it cries. Irreguhir luirsing or nursinij 
 too often spoils llic mothers milk and the l)al)y"s sloniacli. 
 
 Nur--inu llic KaKy ,il iiii;lil may so exhaust the milk supply as to render il 
 insuflicicnt for the day leedinys. 
 
 (Iiarl --liowinL; feeding; hoins at <litfci'cnt periods diirilii; the lirst year: 
 
 First and Second Months: excry two hours, no iiiiiht feedings. (Illus- 
 trative Diagram. : 
 
 Thinl to Ninth .Mouths: cxcry three hours, no night feedings. (Ilhis- 
 tratix e Diagram.) 
 
 Xinih to Twelfth Months: e\-ery four liourN. no night feedings. (Ilhis- 
 trative Diagram.) 
 
 Tlie lialiy may cry heeause il i^ hiingr\', hut it is usu.illy liccause of: 
 
 Discomfort 
 
 Indigestion 
 
 Pain 
 
 Habit 
 
 Temper 
 
 Schedule of weight and length of Ijody according to age — covering the 
 hrst two years: 
 
 -If/p Weight Length 
 
 Birth 7^3 pounds H) inches 
 
 One month 8^4 
 
 Two nu)nths \0]/^ 
 
 Three " 1-2}| " i-lYi " 
 
 Four " 14 
 
 Five •• 141., 
 
 Six •' 15 ■• '26 
 
 Seven " Iti 
 
 Eight •• 17 
 
 Nine " 18 " 27i •> " 
 
 Ten " HI 
 
 Eleven " \J0 
 
 Twelve '• -21 " 30 
 
 Two years '28 " 333 2 " 
 
 10 
 
I'l.AIE XLllI 
 
 REPRODUCTION FROM A COLORED LITHOGRAPH MADE FROM AN ORIGINAL WATER- 
 COLOR PAINTING: "MOTHER AND NURSING CHILD"— ELEANORE ABBOTT 
 Tlie lithograph, with "Rules for the Nursing Mother" printed on the reverse side, was freely distributed to 
 
 women 
 (See Reverse Side) 
 
 ):!'2 
 
Baby Saving Sho^w 
 
 PHILADELPHIA, 1912 
 
 Rules for the Nursing Mother 
 
 F<>K two or three months hetore the bah}" is lioru the clothing should be worn loosely over the 
 breasts. The nipples slio\ild be waslied each day with clean water and (jently drawn out with 
 thumb and foretiiv^ier and smeared with cocoa butter, cold cream, or sweet oil. This may 
 pre\ent sor.e and depressed nip])Ies. 
 
 In oriler to nurse the baby successfully the mother should lead a lite free from worry and 
 excitement. She should eat three j;ood meals a day of nourisbin',; food. She sliould drink water 
 freeb", at least t\\'o (2) (piarts a day. The nursinix mother should not drink tea. cofTee, beer, or other 
 alcoholic drinks. The bowels nuist be open once a d.ay. The mother should have plenty of sunliuht 
 and fresh air, and have at least ei^ht lunirs sleei> at nii;ht. 
 
 The baby should be put to the breast every four hours after it is born until the milk comes 
 on the tliird day. Do not <:ive su^ar water, gruels, catnip tea, or canionnle tea durini; this period. 
 Gi\e the baby a little warm water from a teaspoon. 
 
 NURSE THE BABY REGULARLY 
 
 I-"or the first two months, nurse every 2 hours from ,^ or 6 .\. M. until 10 or 11 P. M. 
 
 From three to four months, nurse c\ery 2': hours " 
 
 From four to nine months, nurse e\'ery 5 hours " " " " " 
 
 From nine to twebe months, nurse every 4 hours. 
 
 Feedings between 11 P. M. and 5 A. M. are ininecessary. Ne\er nurse the baby sinij)ly 
 bec.iuse it cries. If the cryintj is due to indigestion, nursing will onl}' make the bab\'spain \\"orse. 
 
 Don't forget to i;i\e the breast-fed infant water to drink. 
 
 .After nursini;, wash off the nip|)les with boric acid water (one teaspoonful of boric acid to a 
 tsacupful of warm water) and then dry them carefully. Wash the nipples a^ain with clean water 
 before niirsint^. If the nipples become sore, use a nipple shield luitil you can see \"our doctfft. If 
 there is too much milk, [lut on a breast binder and if necessary xise a breast i>ump. 
 
 The best way to ba\"e good breast milk is to nurse the baby regularly by the clock, and drink 
 freel)' of water (t\\(> <iuarts of water a da\"). YelKjw cornmeal i^ruel will often increase the breast 
 milk (two tablespoonfuls of yellow cornmeal to the quart of water, boil in a covered vessel for 5 hours). 
 A quart of milk should be taken daily. Cocoa made with milk is very good. Do not wean the baby 
 on your own responsibility, or for slight causes. For instance, green stools are no indication to wean 
 the baby. Alwa\ s consult your doctor before taking the baby off the breast. 
 
 The babv should gain at least 4 ounces a week. 
 
 Even if the milk is scanty at first, and tlie baby does not seem to be gaining in weight rapidly, 
 attention t(j these rides w ill often bring about a good suppl}' of milk and enable the baby to be nursed 
 until it is safe to give it the bottle. 
 
 If the mother has not enough milk for all the feedings, two or three breast feedings a day 
 may save the baby's life. 
 
 See your Doctor : 
 
 If the nipples are sc)re or cracked. 
 
 If the milk is scanty. 
 
 If the breasts are caked. 
 
 If the baby does not gain in weight. 
 
 (Reverse side.) 
 
 133 
 
13J, REPORT OF THE PHILADELPHIA BABY SAVIXG SHOW 
 
 Section D. Booth No. 40. 
 
 Every huhy is entitled to its natural food, breast milk. 
 
 Any other food than breast milk is unnatural. 
 
 Many thousands of babies die every year of marasmus, because there 
 is no breast milk tor them. 
 
 Marasmus results from their inability to digest and assimilate cow's 
 milk. Therefore they starve even in the midst of plenty. 
 
 It is our duty to do everything in our power to secure breast milk for 
 babies. It is their birthright and, in many cases, their only chance for life. 
 
 Putting a baby on the bottle is a serious matter, never to be undertaken 
 lightly. 
 
 We should never consent to begin bottle feeding until we have exhausted 
 every means to secure breast milk. 
 
 The exhibition of the various rules and appliances for bottle feeding is 
 for the l)enefit of those unfortunate baliies who have been denied their 
 birthright, but whom we just do our best to save. 
 
 Projjhylaxis of Breasts. 
 
 Before Birth. 
 
 Gently wash the nip])les daily with a mixture of equal parts alcohol 
 and water. Anoint with cold cream. 
 
 After Birth. 
 
 Wash the nipples before and after nursing with a solution of boric 
 acid. 
 
 If the breasts are too full, use a breast pump, and, if necessary, a breast 
 binder. 
 
 If the nijijiles are sore or cracked, or if the breasts become caked, consult 
 your doctor. 
 
 Don't treat them with any old thing that your neighbor advises. 
 
 Cartoon: 
 
 The Perils of Babyhood. A baby seated in a basin floating on water 
 and surrounded by protruding rocks — the rocks indicating jjatent foods, 
 etc. 
 
 Only one in ten bottle-fed baliies is well developed and the bad results of 
 bottle-feeding sometimes last a lifetime. Poor develojiment of adults often 
 owes its origin to the fact that their mothei's could not or would not nurse 
 them. 
 
DiniJ roll)' AM) ( ATAUU.l'K OF KXIIIHITS 135 
 
 C'arefullv note these facts: 
 
 Every attempt to depart from I)reast-f(>e(lintf adds to llie mimlier of d<'allis 
 amoiit; hahies. 'Jlie hreast-fed l)al)y lias ten times as many eliaiices of li\ - 
 ing as a hottle-fed hahy. 
 
 Bottle-I'eil lial)ies are ten limes more lialile to Ljel diarrhea llian hreast- 
 fed l)al)ies. Only one l)reast-red l)ali\' wil h (harriiea will die. to 7(( hottle- 
 fed hahies with the same disease. 
 
 Tlie hest way to inerea'-e tlie How of hrea->t milk is to nni-^-e the hahy 
 regnlai'ly. 
 
 Very mneh can he ilone l)y proper food. pro|)er ii\ing and |>ro|)i'r care of 
 the hreasts. to help t he mother nnrse her hahy. 
 
 "(ii\<' ns iiood motherhood and jzood prenatal <-onditions, and I have no 
 des]>air for the fntnre of this or any other country."- John lUinix. 
 
 There \\<'re al>o show n in t lic-e hoot li< : 
 
 1. 'J'wo ])liials eontainiui; partly diirested mother's milk, side hy side with 
 
 two i)liials of partly digested cow's milk, shown for the purpose of 
 empha-'i/im; the ditfer<'lic<' in the size of the curcU. 
 
 2. Five life-size glass models of stomachs, re])resenting the size at l)irth, 
 
 at two weeks, at two months, at six months, at eight months; an 
 aceom|)anying legend em])hasized the small size of a l)al)y's stomach. 
 
 •S. .\ shelt holding seven hell-jars containing sanii)le meals (hreakfast, 
 diimer and sup|)eri for luirsing mothers; accompanied hy an ex])lana- 
 tory note relating to the jirojier kinds and amounts of t'oods. 
 
 4. A sam])le hreast-hinder. 
 
 J. \n advergraph. This was an electrically operated instrument that di — 
 ])laye(l successively seventeen educational legends relating to hrea>t 
 i'eetling. 
 
 A MODEL OF A HOOM FITTED (P FOR THE USE OF A BABY DURING 
 
 TIIK nor WEATHER 
 
 An attempt was madi' in this room to sliow how it is jiossihle to utilize 
 the average sleeping room in the smaller houses to the Ix'st advantage for an 
 infant during the summer months. The window-sashes of the room had 
 heen removed in order to admit as much air as ])ossihle, and the outer 
 ]iortion of the window-frame was covered with mos(iuito netting. An awn- 
 ing hung heforc the window, for the ijurpose of keeping out the rain and 
 protecting the infant against the direct rays of the sun. The floor of the 
 room was uncovered, and the room contained an infant's erih, u])on which 
 
136 
 
DIRECTORY AM) ( ATALiX.ll-: OF EMIIRI Is 137 
 
 AMIS |ihi<i'(l ;i lart^c dull (re])iTsoiiliiiu an iiifaiil wliidi was very lightly clad; 
 a lly-killcr; a chair; and a ci)\-ci'C(i jiail tor -nilcd dia|)cr-. 
 
 Hy means of placards, attention was directed to the iniportaTice of placini; 
 milk on ice immediately after it has l,oen delivered; of killitiir any Hies 
 w liicli niiiiht he in the room; and of rcniov iic the soiled diapers and plaeinu' 
 them in a covered vessel. 
 
 Care of the Hohii 
 
 The exhihits in the hoot lis relating; to the cai'e of the hahy, as w ill he s(>en from 
 a s|ud.\' of the |)liotot;raphie |>lat<'s. were larL;<'l.\ compos<'d of models. There wer<\ 
 li(i\\c\cr, a nnmlier <pf charts and photoi;raphs. A detailc<l description ol the 
 contents of IJic lionths follows: 
 
 Scilicml). lin.illi N..,J7. (Sro Plate- Xl.IV.) 
 
 In the center of this hooth were hnnt; fixe pholoyraplis ilhistralini; the proper 
 proeeclnre to follow in dressing a Itah.v. Innne(lialel.\- above them was liiuifi ;i 
 lei^'end readint;: 
 
 "How to dress th<' hahy." 
 
 On a shelf heneath the ])hoto.t:raphs were sc\<'n dolU, ilhisl rat inii the methods 
 of ap|)lyini; articles of elothini;' and the manner of dot hini; an infant on hot and cold 
 days. 
 
 ( )n the \arious walls of the hootlis were hnnt; pattci-ns and com|)lctc onlfits 
 of elothini; of ditferent (lualities, one of them heini; Tnade from adnlt clolhini;, in- 
 tended to illnslrate an economical method of ])rovidini;' an outfit for an infant. 
 
 Ilnm;' npon the wall, and placed npoii the shelf, weri' a nnmlicr of [ilain wooden 
 to.v.s, and above them \\\\\\\<, the legend: 
 
 "The l)aby cannot lick paint from these." 
 
 Section D. H.iolli Xo. '2!). (Six- Plate XLV. 1 
 
 This b<ioth contained the followinu articles needed in the bathini; of thi- baby: 
 
 .V small tin tub; a large dish-pan; a soap tlish containing (astili- soap; ;i 
 small clotlies-i'ac-k. npon which were hung the neees.sary towels and a sanitary w.ish- 
 clotli; a chair; a small tal>le n])on which was ])laced a tra.v containing baby dust- 
 ing-l)OW<ler, a small bottle of oli\e oil. a box of zinc ointment, some pledgets of 
 sterile cotton, and a bottle of boiled water. \\y the bath-tub there was a naked 
 doll, representing a baby ready for tlie bath. There was also a weighing scales, 
 upon which was placed a doll baby. .Vboxc the latter was hung a h-genil which 
 read : 
 
 "Have your baby weighed ex'ery month at the butcliers or grocers. The 
 babv should aain \i ounces each month." 
 
138 
 
DIRECTniiY WD (AT. [/.<)(, 11-: ()/■' i:.\ I/I HITS ]'M 
 
 Oil llic walls (if llic iiDotli was limit: a <liaii coiil ailiilii: lli<- lnllciw iiii; l<'i;( ii<l: 
 
 " IJahy's daily lialli. Madi liali\' slidiild li.-i\c ils own soap, wash-dolli. 
 and towel. .Vl'tcr each Kalli scald oiil the tiili and lioil llic towels and 
 
 w ash elolli." 
 
 In the renter of the lioolli uas ;i l;iroc eliart eoiilainini; two pliotograjjlis. side 
 l)y side -one of a eniiii: liali\ ainl the other of a -niilint; liahy. Beneath were the 
 leL'ends: 
 
 This luiliji Is Cross. Win/? 
 
 
 He i.s fed or taken ii|) \\liene\e 
 
 r h.- 
 
 crie.s. 
 
 
 He is fed loo mneli. 
 
 
 He gets iee-ereani or eaiidy. 
 
 
 He i.s dressed too warmly. 
 
 
 He needs a hath. 
 
 
 His liowels do not mo\ e right. 
 
 
 He is wet. 
 
 
 He is kepi np too late. 
 
 
 He sleeps in a hot room with \\ im 
 
 ows 
 
 shut. 
 
 
 He is earned, rocked or Komiccd. 
 
 
 He is taken to the "'inoNies." 
 
 
 He is given a comtorter or soot 
 
 ling 
 
 syrup. 
 
 
 Tins Hdhi/ Is lluppii. U'ln/'f' 
 lie is fed regularly. 
 lie i^ fed propi-rl\'. 
 He gels lioilcd ualer lo drink. 
 He IS dressed properly. 
 lie is hat Ik'iI e\cry day. 
 Hi-, houcls mo\(' e\('ry day. 
 1 le i~ ke[)l dry and clean. 
 lie has plenix' of sleep. 
 He has fresh air all t he time. 
 He is lei alon<'. 
 
 'J"iii;hk .\uk no I'"i.ii;s on 1Ii\i. 
 He gels no patent medicine. 
 
 There were, in addition, three |iliotograplis. one illiislraling the nielhod of 
 cleansing the eyes of a hahy. aii<i the other two illii^t rating the proper method of 
 bathing the baby. 
 
 Section P. T?nntli Xu. 31, 
 
 This booth contained a swinging bed made out of cord so woNeii as to allow 
 the air lo penetrate. This was covered with mosfpiito netting. JJeside it was an 
 ordinary clothes-basket, wiiieii was fitted up with a bhmket, comfort, and pillow, 
 and abo\e it was a sign reading: 
 
 ".Vnotlier jilace for the baby lo sleej). "' 
 
 There was also an iron crib for the use of tiic infant when it had outgrown the 
 former de\'ice, and pro\-iding more room for it to roll and kick. Al)ove thi.s was a 
 sign which read: 
 
 "To l)e strong and healthy the baby must kick its legs and move its arms 
 
 freely every day. To do this, place him on a bed in a warm room, with all 
 
 his clothing remo^•ed but the shirt and diaper." 
 
140 
 
DIRI'J TOHV .l\J) ( ATAlJn.i E OF i:.\I/llilTS Ul 
 
 I pipii tlic w.ills of tile lioiitli wcri' llic foHdwiiia' lea'ciids; 
 
 ■■'I'lif l)al>y iiHist not sleep in tlie .saiiu> lied witli liis iiiollier." 
 '■ l''or tile first six months tlio l)al)y slionld sleep eiiihteen lionrs each <lay. 
 I'l'oni the aije of six nionlhs In one \<'ar. he shonlil sleep fifteen hours each 
 
 day. 
 l"'roiii liieafjcof one year to Iwci years, lie slmnld sli-ep fourteen hours 
 
 each day." 
 
 IJeneath tills leijend was a irraphie eliart eontainini; a eirele wliieli was marked 
 oil' into \arioiis seymeiits in hlaek and white, the lilaek indieatini; the hours for 
 sleep and the white the hours for wakiui;, teedin;:, and lialhitii;. 
 
 Other lej^ciids on I he walls read: 
 
 "I'ul ,\<)nr liali,\' to lied at (i o'clock. Kee|) the windows in Ihe lied-room 
 
 ojieu all nii^ht . " 
 
 ■'If t he Kaliy's hands and feet are cold, iise liot-w ater hot t les." 
 
 "The liali.v III list lireathe fresh air da>' and iiii;lil . " 
 
 " Keej) the hahy warm hy the use of sufficient liody- and lie<l-clollies. The 
 hed-elolhes must not l)e damp, and the lied must he aired e\('ry day." 
 
 Two diapers were iiuni; on the wall of Ihe lioolli, one folded prolierly and the 
 oilier hani;in^ loos<>; lieiieath liieni appeared the followiii;.; leiicnds: 
 
 " Keep Ihe dirty diapt'rs in water in a co\-ered hiiekel until ready to wash. 
 
 Wash them as soon as possihle, and after wasliiuu, hoil them. Dry them 
 
 well. Keep them in a clean place." 
 
 "Alwiiys keep a clean diaper on the lialiy." 
 
 Special oiu])hasis was laid upon the (pialily of material from which dia|)crs 
 should he made, and the ])r()])er sort of dia|)er cloth was shown. IJeneath this was 
 tile leyend: 
 
 "Diap<'rs made from tln'se materials oiiLjht not to irritate the halix's skin, 
 because they are soft. They are also easily washed." 
 
 Seotic.n I). ll.K.lh Xo. ;{;!. ( S>v I'lalr Xl.VI. 
 
 This booth coutaineil a ereei)in<;' pen, jilaced on a platform ele\ate(l alio\e the 
 floor. Tiie liottoni of the i)en was coxered with waddin", upon which was plaeetl a 
 doll with a number of toys. Beside it was a baby carriage of projjer design and ;i 
 eonimode chair. 
 
 In the center of tlie liooth was a legend reading: 
 
 "IIow should tile baby be | ickcil iij) and held)' Place one hand under his 
 back, the other under his head and neck. Ahvavs supixirf his head and 
 
 back." 
 
 Beneath it was a chart reading: 
 
 "The baby must not sit upright b<'fore he is eight months old. Ilis back 
 is not strong enough. It might get crooked." 
 
U2 
 
DIRECTORY AM) ( ATALoi.l'i: OF KXlIiniTS u,'! 
 
 Adililicinal Ic^'ciiils read : 
 
 "I'laco the hahy oiit-of-doors tii ^Iccp caili day: lie need- t'rc-li air." 
 "A clean house, a elean floor, and a clean liaUy lielp to l<ee|) tlie l>aii>- well." 
 ■■ Keep the floor clean so that the l)al)y will not eat dirt." 
 " Do not spit (in I he floor." 
 
 I here were several photoiil'aphs and colored pictures of lial)ies ujion the walls 
 of I he III lot li. 
 
 COMMITTKK ()\ ( inM)II(!()l) IIKAI.TII KXIIIlUr OF KOSION 
 |l?()()ins Nos. ■:,:, .\M) :i7] 
 
 Swtiiml). H.Milh \.i. ;!.3. iSrc I'lal,- Xl.\ II.) 
 
 This liooth was devoted almost e\clusi\-ely toweariui; apparel for the lialiy 
 and eontaincil : 
 
 .V pattern ol a sh'c] ini; coat for the iialiv, cost ini; ten c<'nls; coat of i;ray 
 flannel lined with pink eiderdown made uj) fiom this pattern [this 
 coat eoNcred the hahy's arms, feet, and l)od.\-, and an attached hood for 
 its head, left onlv the face visihle. The ap|)ro\iniale cost was shown 
 to lie liul •'^f.lO]; shoes for children of different ajies the |)rice on each 
 pail-; driers for stockings and shirt — costini;- thirty-five and lifl.v cents, re- 
 speclivcly; an ordinarv elothes-haskel made uj) as a hahy's hed. with 
 nialtress co\-ered with ruhher sheet, hlankets. etc.. and a eheai) hammock 
 made of cainas. with a nios(|uilo neltinu co\-eiini;. which could he Ininij 
 an.\where. 
 
 Section I), iiiiiilli \... .iT. iSir I'lalr \I.\ III. 
 
 This hooth contained samples nf chililren's clutiilni;, rompci-s. dresses, 
 undershirts, complete outfits of clolhinn for lln' newhorn — of ".i grades — 
 and patterns antl cut mati'rials for the making of outflts. 'I'he price was 
 attached to each article of elotliing and to each complete outfit. 
 The outfits contained all n<'cessar\' articles and were forniul.ileil with a 
 view to securing the l)est value at the lowest ])ossihle jjrice. 
 
 There were also shown an Ice-hox. a Chai)in (iii)])er. liottles. nipples, a 
 funnel, a graduated glass. (Sign over ice-hox reading: Home-made I<-e- 
 box, cost 31 cents, and nine jihotographs illustrating the method of mak- 
 ing the ice-box.) 
 
 The Committee on Childhood Ile.illh Kxliihit jihu-es these sample .irl ides 
 on exhibition, in charge of a skilled demonstrator in a room in the 
 thickly iiopulatetl districts of Boston, wliere they can be inspected b.v 
 prospective mothers and where these mothers can secure coupons to one 
 of several of the large tlepartnient stores of Boston, from which they can 
 purchase these outfits comi)lete at the price (luoted by the Committee. 
 
H 
 c/j 
 
 O 
 
 o 
 
 J 
 
 
 u-t 
 
niHFJTOUY AM) ( ATMJX.f'K OF KXUllilTS U.l 
 
 Bad Booth 
 riii.\(.s riiAi Ai{K i!\i) i(»i{ iiii: \^\\^\ 
 
 'I'lii- lilli- liiiiiu i)\('r llic cntrnncc <it' llic t'oycr. Tlic lover \\;i> M'paratcil rrcnn 
 tlio main cxliiliitioii liall hy the corridors siirroimdiiiii liic stairway. For this 
 reason it was sele(t<'(l as the place in wliicli to show the thinus liial are hail for the 
 liaKy, so that there could l)e no jiossihle conl'n-ion in the minds of miillier- as to 
 what was uood and what was had. 
 
 'I'lie Icillduini; lliiniis were shown here; 
 
 IJad l.iviNc .\Ni) Si.i;i;i'i\(; Rooms 
 H one. Sif^n: " Tni^ |{<mi\i is Iniit to I,i\ k In. Wiiv'"" 
 
 The windows in this room were tightly ilosed. 'I'he lloor was co\ ered with a 
 dirty, frayed eari)et. 'I'he room eonlained some rickety, nnpainled, mutilated 
 chairs, a lalile on which were placed a piece of l>read. a can of tomatoes, a can of 
 ])eas, an open, ])arliall.\ emptiec! milk-hottle. and an oil-lamp. Over the various 
 articles and the tahle were scattered many artificial flies. .\ manikin doll, repre- 
 sentinu' .-i child, seated at the lahle, was pn'snm.ahlx- eni;at;cd in ealinu' tomatoes, 
 which were --nK'ared over his cheeks. .M)o\c the child wa^ [)la<-ed a siun readinj;': 
 "Keep ( 'hildreu Clean." 
 
 Another manikin, representing; a liah.v, was pl.iced in a jjo-cart. The hahy 
 held a dirty, ordinary hottle containinuciirdled milk. .\ si^n allached lo the jfo- 
 cart read; ""'Ihis Mahy is Too ^ ount; For a (io-('art.' 
 
 There was a chair upotl which was place<l a supposedly sick cat, and the cat 
 was heini; stroked l>v another small child i r<'present<'il 1)>- a manikin doll', 'i'his 
 chair eonlained I he sii;n, "" I'ets Carry Disea.se." 
 
 (lose liy I he lalile was placed a !iarl>at;e can lilleil with izarliauc I pon this 
 was |ilaced a sii^n. ■'keep the Slop (an ('oxercil. 
 
 Close l)y were two si^iis readiiii^; " Keeji llic l-'lic- Out" and ""Keep the 
 \Viiid()Ws Open hut Closely Screened." 
 
 In a corner of the room was |)lacc(i a cookiiii; raniie, and upon it were some old 
 l)ots and jians. 
 
 In another corner of the room were se\cral soiled diajn-rs, and oil a clothesline 
 stretched across the room were huiii;- two diapers. On this line was linn<; also a 
 legend reading: ■"When the Bahy's Diaper is Soiled, Change and Wash it at Once." 
 
 There were three other signs in the hooth, which read: (\) "I'ut Hahies to 
 Sleej) hy Seven O'Clock. They Do Not (Jet Enough Sleep If Kept I'p Late." ('•2) 
 "The Bahy Should Sleep in a Crih and Without a Pillow." (S) "A Bahy Needs 
 From l(i to 20 Hours of Sleep in Each 24, In a (jiiiet Room, In Ilis Own Crih, With 
 Plenty of Fresh .Vir and No Flies, and Placed I'lion a Soft Feather Mattress." 
 
 Room two. Sign: "This Room is Unfit to Sleep In." Why? 
 
 The floor of this room was also covered with a dirty carpet: the windows were 
 tightly shut, and a hreak in the window was filled with rags. A sign placed on the 
 window read; "Sleep With The Windows ()])en." 
 
 The room contained a wooden Ix-d, and in it were manikins representing a 
 mother and a sleejiing hahy. The hed was covered with a dirty comfort. Signs 
 
146 
 
niRFJTdHV AM) ( ATMJX.ri: OF F.MIIIU'IS U? 
 
 oil tlii-- lied rr:i(l: "'llii' I?ai),\' Shdiild Slfc|> in ;i (rili." and "Tlic l?c(| ( liillics 
 Should !)(• ^^'a^ll;^l)l(■ a?id \\aslicd." 
 
 A chair |)hicc<l near tiic hcd liad a dirty apron thrown oxer tlic hack of il. and 
 ii|)<)ii it was jihiced a hinip. There were two sij;tis on (his chair, otic readinii "Do 
 Not Allow das to ]{nrn in Hal).\"s Sleepiiia- Room"; and the other, "'Inrii out all 
 Light in tiie i{al)y's l?ed Hooiii." 
 
 On a table in the room was |)laced a hottle of milk lor use in the nit;ht. .ind 
 n|Mpn this was a sifin readiiia: "This Will I'rohahiy Soni- " 
 
 I'liere was a bureau in (he room on wliicii were scattereil a nnml)er of articles of 
 elotllinji. It was pointec! out that a bureau siiould l)e moxabie or clexated above 
 the floor to make it possible to clean beneath it . 
 
 Another chair containe(l lh<' garments of the mollicr and child loosely piled 
 upon it, and over this was a siiiii reading;: "Clothes Should be ( 'arefull> lluni; I p." 
 
 'I'here was a cuspidor on the floor, and oxer it a sii;n readiiiii, "This Should be 
 Made of Metal a.s it is Easier to Keep (lean. Il Should l?e Ke|)l Coxcreil." 
 
 There was also .a comnioile in the room, and oN'er it a sign which read. "II I sed 
 at all. il Shonlcl be Kept < dx crcd and Fre(|Uenl l>- and Thoroughly ( 'Icansccl." 
 
 The reni.aindcr of llic foxcr was dixided into four booths, as follows: 
 
 Patent Medicines and Soothin,sx S//rups 
 
 |S-o I'hitt- XI.IX.] 
 
 li.K.th 1. 
 
 In the central portion of this booth was a draxving of a hand of a skeleton hold- 
 ing in its clasp eight bottles of the anodynes in common use. On either side of it 
 were enlarged photograi)hi<- reproductions of the labels of: Fitler's Soothing Car- 
 minative, Hooper's Anodyne. Dr. I'"aliev"s Pepsin .\nodyne, and Mrs. Win>low"s 
 Soothing Syru]). 
 
 .\t one end oi the iiootli xvas a photograph of tixe bottles containing laudanum, 
 with labels recommending them a,s valuable in (piieting babies, and on the ojjposite 
 end was a photograph of seven bottles of alleged di()htheria cures and preventives. 
 On two shelves in the central portion of the booth there were ^2!) bottles containing 
 different anodynes and soothing syrups, and above them was written the legend: 
 "These all contain opium. They may make yiiur liaby sick." 
 
 Heneath the shelves there were three ])hotograi)hic illustrations of bottles con- 
 taining soothing syrui)s, representing a total of 4iS. 
 
 11 
 
14S 
 
DIRECTOR) AM) < AT. {/.()(. IF. OF FMIIHITS 149 
 
 Patent Foods 
 
 Booth i 
 
 Tliis lidolli ((iiitainccl a iniinlicr iil' [atcnt f U. It \va^ pdiiitnl (Hit lliat tlic 
 
 majority of micIi fooil> contain an <'x<c>si\<' anionnl of >tan-li and snt;ar. and tliat, 
 in order to hrini; the anionnts of these inL:re(lients down to tlie normal, it \\a> 
 necessary to reduce the protein and fat content to siicli a low |-oint as to render them 
 of little value as foods. There was shown a chart em|ihasi/,ini: th<- relative vahie 
 
 of ])alent f Is, mother's milk, and cow's milk. There were -.oiue pliotoirraphs 
 
 of rachitic ami iiiMrasmic infants who hail heen fed on >ome of the patent foods. 
 Uiiderneat h one of I he photojiraijlis re|)resentinf; a child u il h rickets was the legend ; 
 "A child fed on food other than hreast milk often {i'cts ricket-." 
 
 Tlii-oimhollt this hootll esjx'cial emphasis was laid on the importance ot a 
 .snfficient amount of fat and protein in all foods, and the danger of e\cessi\e starch 
 and snt;ar, and the fact that most i)ateiil f Is are delicient in the former ingre- 
 dients and contain an excess of the latter. 
 
 I'ertaining to the general |)rol>lem of feeding there was a sign which read: 
 
 '■'I'wo tlics in May. 
 .V million in .Inly. 
 .V sick l)al>.\' in .Inly. 
 Kill e\er>' fl.\'.'" 
 
 Heneath this was hung a home-made tly-killcr, .iiid .-it t,-ichc<l to il was the 
 ad\ ice: 
 
 "M.'dse one of thc^e for every room in the house'" 
 
 Booth 3. (See Plate L.) 
 
 This booth eontaineil on the right screen a sign reading: 
 "Tins IS Wh.vt II.vppens When the Baby Uses a Comfokteh" 
 
 Immediat<'ly heneath was an illustration of .-i Petri plate showing the ciiltnres 
 made from a hahy comforter, and helow a white craiie. sncli as is |)laced on doors 
 of houses to indicate an infant's death. 
 
 Next was a sign, "See What Happens to the IJahy." and liencath it, two i>lioto- 
 grai)hs of hahies heing given milk from a hottle through tnlies, and lielow was a 
 jihotograph of two crihs in a hos|)ital containing hahies. 
 
 Beneath wa,s a sign reading " Keej) the Nipples Clean. Dirty Nipjilcs Make 
 Pure Food I'ntit to Use." 
 
 Below was placed a nijiple with a tuhe and the legend: "Do Not I se This 
 Kind," and heside it an ordinary cone-shaped ni|)ple, with the legend: "T'se Thi.s 
 Kind." 
 
 Beside this was a hottle with a tuhe nipple attached, and imdi'rneath it was 
 written, "This Kind of Nipple Shoidd Not Be Used. See What IIa|)|ieiis." 
 
 Below was a photogra])h of a Petri plate containing colonies of haiteria, and 
 below this a i)hotograi)h showing the mother grieving over a sick child. 
 
 Next was a |)icture of a baby in bed; a hot-water bottle had bei'ii ])laced in lied 
 beside the baby, and being too hot, had caused a burn. Beneath was the legend: 
 "See How it Burned the Baby." 
 
 In the center <if this .screen was a sign reading "This May Injure the Baby," 
 and beneath it four jjhotographs: (DA baby sucking its thimib; (i) a mother 
 jogging the baby on her knee; i.S) a mother holding a baby at arm's length al)ove 
 her head; and (4) a baby with bright smdight shining in its e.ves. 
 
Plate LI 
 FOYER— MECHANICAL DEVICE INDICATING FREQUENCY OF DEATHS OF INFANTS 
 
 150 
 
DIRECTORY AM) CATMAUHE OF EXIIIIilTS 151 
 
 On n shelf ajj;aiii.st this center screen were placed lliree diiMy toys, a (|iiarl of 
 milk, a (piart of li(|niil lieef preparation, a (|Uart jar half fnll of whisky. aTi<l a (piart 
 hot tie containini; inijjnri' alcohol: sonic improper rectal syringes and a doll illustrat- 
 ing shoes which were laced too tiuht. Ahoxc these were I he following si^ns: 
 
 (1) "Dirty riaythiniis Carry Disease." 
 
 (i) "'I'his (^uart of Milk Costs Kiulit Cenls, Docs Not Contain Alcohol. Will 
 Nourish The Mahy ','4 Hours"; "ThisC^uart of l,i(piid Meef I'reiiaration Costs $1.70, 
 Does Not Contain As Much Xourishment As This .Milk, and (dniains Kiiough 
 Alcohol to Make I he Hahy Drunk." 
 
 (■'5) "This Whisky Contains the Same .\moiuil of .Mcohol as Ihc l,i(|uid Hecf 
 I'rei)aration." 
 
 (4) "This is the lTiii)urc .Mcohol Cotitained in the Hecf I'reparalion." 
 
 (5) "This Syriufic Will Hurt the IJahy; Nozzle 'I'oo Hard an<l 'I'oo l.oiij,'. 
 ((!) "This Lacing is Too Tight. If Will Hurl the Hal.y's Fool." 
 
 On the left screen were the followinj;: A photoitraph of a molher walkini; in 
 tiie .street, liftinji; the l)al)y from the street to the sidewalk hy one arm. The lefjcnd 
 beneath read: "If ^'ou Lift a Hahy in This Way. \\n\ May Hurt its .\rm."' 
 
 A i)hot()graph of a molher roekinu a l)ali>. The Icfjcnd henealh read: "Do 
 Not Kock the Hahy After Feeding: it Makes it'\omil." 
 
 A i>hologra|)li of a hahy eating a hanana. The legeml lienealh read: "The 
 Doctor Will he Called Tonight." 
 
 .\ photograph of a mot her kissing a lial)>'. The Icgc'ud lienealh read: "Do 
 Not. Kiss Ihc Uahy; il Spreads Di.sea.sc." 
 
 Photographs of two hahies wrapped in sw addling clol lies. The legend hencath 
 read: "IJahies Dressed in This Way Caniiol Kxercise." 
 
 One large sign in the booth read, "Do Not .Mlow Babies lo Walk Too Ivirly; 
 it Tends to Make Them Bow-I>cgged." 
 
 Bootli i. (S.-(- I'lato 1,1.) 
 
 Tllis booth contained a device which graphically indicali'd llic frccjucney of 
 infants' deaths. 
 
 It was in the form of a railroad <ros>ing guarded by a drop gate. A train wa.s 
 pa.ssing, and children. re])resented by niinule dolls, were ])layiiig about the tracks. 
 
 The train consisted of three cars: the first was painted red, and contained the 
 legend: "Diarrheal Diseases": the second, blue, and contained the legend, "The 
 Diseases of Farly Infancy "; and the third, yellow, and contained the legend, 
 "Lung Di.seases." 
 
 The drop gate, which was operated mechanically, fell and rose every ten .second.s. 
 Al)o\e this device was placed the following sign: 
 
 " .'?.'24.'!.0.)S Habies in the Civilized World Die During Their First ^'ear 
 of Life. One-(|uarter of all the dead who die in the registration area are 
 dead before they reach their second year. Of Every Five Babies Horn, 
 One Dies During The First Year. About one-half of this loss is })re- 
 ventable. What will you do about it? Out of 100 Bottle-fed Babies, 
 50 Die; Out of 100 Breast-fed Babies, 7 Die." 
 
 To its left was the following sign: 
 
 "What Can You Do About It? Nurse your baby. Don't feed baliy 
 just because it cries; feed baby at regular hours. Keep the baby clean and 
 dry. (live the baby plenty of water. Demand pure food for your.self as 
 well as for the babv. Trv the fresh air cure." 
 
152 REPORT OF THE PHILADELPHIA RARY SAVING SHOW 
 
 To its riglit was the following sign: 
 
 "What Can You Do About It? Screen the windows and doors and 
 baby's crib. Remove the filth. Clean uj) your back yard. Keep baby 
 awav from sick children. Read the liaby Saving Pamphlet on the "Care 
 of The Baby.' Obey Health Law." 
 
 ACROSTICS 
 
 Measles. 
 
 Easiest disease to catch. 
 
 Alarming in infants. 
 
 Scores too many deaths. 
 
 Loose cjuarantine s])reads it. 
 
 Expose no child to it. 
 
 Sane mothers ])rotect their children. 
 
 Scarlet Fever. 
 
 Contagious and costly. 
 
 Avoidable, unnecessary. 
 
 Ravages child life. 
 
 Leaves many cri|)i)lc(l. 
 
 Ends often fatally. 
 
 Thoughtfulness and Watihfulness may jjrevent it. 
 
 Flourishes in Winter. 
 
 Exiles the afflicted. 
 
 ^'an(|uislles hai)piness. 
 
 Entraps the careless. 
 
 Requires strict quarantine. 
 
 Diphtheria. 
 
 
 Lidifference 
 
 to it is fatal. 
 
 Prom])t trea 
 
 tment is necessary. 
 
 Hospitalizai 
 
 ion gives control. 
 
 Terminates 
 
 too many lives. 
 
 Hostile to c 
 
 lild life es|)ecially. 
 
 Entraps the 
 
 careless. 
 
 Re(|uires strict quarantine. 
 
 Is curable. 
 
 
 Antitoxin cures it. 
 
 (The first letter of eacti line was printcil in brilliant Red color.) 
 
niRFJToRY AX/) c.iTAf.oari: or kxiiiiuts 
 
 (.(KID IIKAI.III AI.IMIMiF.I' 
 
 
 
 A is for Air. wliidi ;ill of us nccij. 
 
 
 
 1$ is for Hrcatiiiiii; (iccp; kiii(if\' (mInc iici-d. 
 
 
 
 C is for Consiiniption, thai kilN yoiiiit; and 
 
 old 
 
 
 D is for Dirt, with its danucrs uiilold. 
 
 
 
 E is for Katiiis; food yood and pure. 
 
 
 
 F is for Fhes wi- slionld not cnihirc. 
 
 
 
 (i is for (iiviiiff hcaltli kno\vlcdi;c lo all. 
 
 
 
 II is for Health for llic j;rcat and th<- small 
 
 
 
 I is for Illness, for wliicli we are to hlanx-. 
 
 
 
 J is for Jenner. the niaii of ^reat fame. 
 
 
 
 K is for Kiiowledn'e, to make lis <;row stron 
 
 4er 
 
 
 L is for Learning;, that we may live loii<.'er. 
 
 
 
 M is for Mouth, for reeeixiny our food. 
 
 
 
 \ is for Xotini; the thiniis that are uood. 
 
 
 
 () is for Order in all that we do. 
 
 
 
 I' is for Pasteur, a scientist tru<'. 
 
 
 
 Q is for (Questions of health wf always ^lnii 
 
 Id ■• 
 
 isk. 
 
 K is for l{ii;ht Reading, a |>rolital)l<' task. 
 
 
 
 S is for Sunshine. th<' foe of disease. 
 
 
 
 T is for 'rem|)tatiou, to loll at our ease. 
 
 
 
 V is for I'nkiiiduess, itself a grax-e sin. 
 
 
 
 \' is for Wssels for drinkiiii;. clean as a pin 
 
 
 
 W is for Washing;-, to l>e health\ ,ind clean. 
 
 
 
 X is for X-ray, to find the unseen. 
 
 
 
 ^" is for ^'outh. the lusty and slrons,'. 
 
 
 
 / is for Zeal to live wisely and lon^. 
 
 
 
154 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Hospitals and Institutions 
 
 Photographs, Cliarts, Models, and Descriptive Signs were Exhibited l)j' 
 the following Hospitals and Institutions: 
 
 Children's Hospital of Philadelphia. 
 
 St. Margaret's House and Hospital, Albany. New York. 
 
 f^hildren's Homeopathic Hospital, Philadelphia. 
 
 ("hildrcn's Seashore House, Atlantic City. 
 
 Tiic Philadelphia Hnnie for Infants. 
 
 Penn.sylvania State Congress for Mothers. 
 
 Children's Aid Society, Philadelphia. 
 
 The Philadelphia A.ssociation of Day Nurseries. 
 
 Babies' Hospital of Philadelphia. 
 
 The Russell Sage Foundation. 
 
 The Speedwell Society. 
 
 St. ^'incent's Home. 
 
 Philadelphia ModiKed Milk Society. 
 
 Jefferson Maternity Hospital. 
 
 St. Christopher's Hos])ital. 
 
Lectures and Speakers 
 
 12 
 
LECTURES AND SPEAKERS AT THE BABY SAVING SHOW 
 
 Moving Picture Demonstration at 12.50 p. m. Each Day 
 
 Moving Picture Demonstration Immediately Preceding and Following Each Lecture 
 
 Saturday, Maij 18th, 3 P. M. 
 Presiding Officer: 
 
 Dr. S. McC. Hamill, Professor of Diseases of Children, Philadelphia Poly- 
 clinic. 
 
 Address of Welcome: 
 
 Mr. George D. Porter, Director of the Department of Public Safety of 
 Philadelphia. 
 
 1. The Infant Death R.vte in Philadelphia and What the Department of 
 
 Public Health and Charities is Doing for its Reduction: 
 
 Dr. Joseph S. Neff, Director of the Department of Public Health and 
 
 Charities of Philadelphia. 
 
 2. What is Being Done by the Phil.\nthropic Organizations of Phila- 
 
 delphia for the Protection of the Life and Health of Infants: 
 Mr. Edwin D. Solenberger, General Secretary of the Children's .\id Society 
 of Pennsylvania. 
 
 8 P. M. 
 
 Presiding Officer: 
 
 Dr. Joseph S. Neff, Director of the Department of Public Health and 
 Charities of Philadelphia. 
 
 1. The Importance of Breast-Feeding: 
 
 Dr. L. T. Royster, of Norfolk, Va., ^'ice-chairman of the Section on Diseases 
 of Children of the American Medical Association. 
 
 2. How to Continue Breast-Feeding Under Difficulties: 
 
 Dr. M. Howard Fussell, Professor of Apphed Therapeutics in the Medical 
 Department of the University of Pennsylvania. 
 
 Sunday, May 19th, 3 P. M. 
 
 Lectures in Italian 
 Presiding Officer: 
 
 Chevalier C. C. A. Baldi. 
 
 1. The Importance of Breast-Feeding and the Dangers of Artificial 
 
 Feeding: 
 
 Dr. Henry M. Fisher, of Philadelphia. 
 
 2. How to Care for the Infant During the Summer Months: 
 
 Dr. Ignazio Cortese, of Philadelphia. 
 
 157 
 
158 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Domenica 19 Maggio, alle 3 P. M. 
 
 SoTTO LA Presidenza: 
 
 del Sig. Cav. C. C. A. Baldi, 
 
 Dr. H. M. Fisher, dara un discorso sopra L' Importanza di Nutrire il 
 Bambino d'al seno ed anche sopra Pericoli del Nutrimento Artificiale 
 del Bambino. 
 
 II Dottore Ignazio Cortese di Philadelphia parlera della Cara del 
 Bambino durante la Stagione Calda. 
 
 8 P. M. 
 
 Lectures in Yiddish 
 Presiding Officer: 
 
 Mr. Joseph Gross, of Philadelphia. 
 
 Introductory Remarks: 
 
 Rabbi B. L. Levinthal, of Philadelphia. 
 
 1. The Importance of Breast-Feeding and the Dangers of Artificial 
 
 Feeding: 
 
 Dr. Bernard L. Kahn, Member of the Philadelphia Pediatric Society. 
 
 2. How TO Care for the Infant During the Summer Months: 
 
 Dr. Solomon Seilikovitch, Member of the Philadelphia Pediatric Society. 
 
 Monday, May 20th, 3 P. M. 
 
 Presiding Officer: 
 
 Dr. William M. AVelch, Chief Diagnostician to the Bureau of Health of 
 Philadelphia. 
 
 1. Vaccination and Its Influence Upon the Infant Death Rate: 
 
 Dr. Jay F. Schamberg, Professor of Diseases of the Skin, Philadelphia 
 Polyclinic. 
 
 2. Diphtheria — Its Cure and Prevention: 
 
 Dr. John A. Kolmer, Professor of Pathology, Philadelphia Polyclinic. 
 
 8 P.M. 
 
 Presiding Officer: 
 
 Mr. J. A. Vogelson, Chief of the Bureau of Health of Philadelphia. 
 
 1. The Advantages of Milk Over the Advertised Substitute Foods fob 
 
 Babies: 
 
 Dr. J. Claxton Gittings, Instructor in Children's Diseases, Medical Depart- 
 ment of the University of Pennsylvania. 
 
 2. Infant Mortality and the Milk Question: 
 
 Dr. D. J. Milton Miller, of Atlantic City, Member of the American Pedi- 
 atric Society. 
 
LECTURES AND SPEAKERS 159 
 
 Tuesday, May 21st, 3 P. M. 
 Presiding Officer: 
 
 Dr. Charles A. Fife, Instructor in Children's Diseases in the University 
 of Pennsylvania. 
 
 1. The Care of the Newborn Infant: 
 
 Dr. E. P. Davis, Professor of Obstetrics, Jefferson Medical College, Phila- 
 delphia. 
 
 2. What Should be Demanded of the Midwife: 
 
 Dr. George A. Ulrich, Assistant Professor of Obstetrics, Jefferson Medical 
 College, Philadelphia. 
 
 8 P. M. 
 
 Presiding Officer: 
 
 Mrs. R. Tait McKenzie, Chairman of the Public Health Committee of the 
 Civic Club of Philadeljjhia. 
 
 1. The Extermination of the Typhoid Fly fro.m a City (Lantern Slide 
 
 Demonstration) : 
 Dr. C. F. Hodge, Professor of Biology, Clark University, Worcester, Ma.ss. 
 
 2. The Importance of Fresh Air, Light and Cleanliness in the Home: 
 
 Dr. Henry I. Bowditch, of the Department of Diseases of Children, Har- 
 vard Medical School, Boston, Mass. 
 
 Wednesday, May 22d, 3 P. M. 
 
 Presiding Officer: 
 
 Dr. L. J. Hammond, President of the Philadelphia County Medical Society. 
 
 1. SuM>iER Diarrheas — Their Causes and Prevention: 
 
 Dr. J. W. Schereschewsky, of the U. S. Department of Public Health and 
 INIarine Hosj)ital Service, Washington, D. C. 
 
 2. The Influence of Measles and Whooping Cough Upon Infant Mor- 
 
 tality : 
 
 Dr. Royal S. Haynes, Instructor in Diseases of Children, Columbia Uni- 
 versity, New York. 
 
 8 P. M. 
 
 Presiding Officer: 
 
 Dr. C. J. Hatfield, Vice-chairman of the Executive Committee of the 
 Baby Saving Show. 
 
 1. What the Consumer Should Demand of the Milkman: 
 
 Dr. Henry L. Coit, Ex-President of the American Association of Medical 
 Milk Commissions, Newark, N. J. 
 
 2. The Care of Milk in The Home: 
 
 Dr. Howard Childs Carpenter, Instructor in Diseases of Children, Univer- 
 sity of Pennsylvania. 
 
160 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Thursday, May 23d, 3 P. M. 
 Presiding Officer: 
 
 Dr. J. Torrance Rugh, Orthopedic Surgeon to the Methodist Episcopal 
 Hospital of Philadelphia. 
 
 1. Recreation Piers and City Parks in Relation to Infant Mortality 
 
 (Lantern Slide Demonstration) : 
 
 Miss Ellen C. Babbitt. Special Agent of the Department of Child Helping 
 of the Russell Sage Foundation, New York. 
 
 2. Day Nurseries — Their Value and Limitations: 
 
 Miss Alice Biddle, of Philadelphia. 
 
 8 P. M. 
 Presiding Officer: 
 
 Dr. Henry D. Jump, Chairman of the Committee on Infant Mortality of 
 the Philadelphia County Medical Society. 
 
 1. Influence of III Health in Infancy Upon the Future Development 
 
 of the Child: 
 
 Dr. Henry D. Chapin, Professor of Diseases of Children in the New York 
 
 Post-Graduate Medical School. 
 
 2. Cause and Serious Results of Sore Eyes in the Newborn (Lantern 
 
 Slide Demonstration): 
 
 Dr. Thomas B. Holloway, Instructor in Diseases of the Eye, Medical De- 
 partment of the University of Pennsylvania. 
 
 Friday, May S^th, 3 P. M. 
 Presiding Officer: 
 
 Dr. Theodore LeBoutiUier, Professor of Diseases of Children, Women's 
 Medical College of Philadelphia. 
 
 1. How to Clothe the Baby: 
 
 Dr. John F. Sinclair, Visiting Physician to the Babies Hospital of Phila- 
 delphia. 
 
 2. General Care of the Baby: 
 
 Dr. Alfred Hand, Jr., Visiting Physician to the Children's Hospital of 
 Philadelphia. 
 
 8 P.M. 
 
 Presiding Officer: 
 
 Dr. Ward Brinton, Director of the Babies Hospital of Philadelphia. 
 
 1. What Life in the Home Should Be: 
 
 The Right Reverend Philip M. Rhinelander, Bishop of Pennsylvania. 
 
 2. Tuberculosis in Relation to Infant Life: 
 
 Dr. H. R. M. Landis, Clinical and Sociological Director of the Henry 
 Phipps Institute. 
 
LECTURES AXD SPEAKERS 161 
 
 Saturday, May 2oth, 3 P. M. 
 Presiding Officer: 
 
 Dr. William Duffield Robinson, of Philadelphia. 
 
 1. The Care of the Mother During Pregnancy and the Preparation for 
 
 Confinement : 
 
 Dr. William R. Nicholson, Professor of Diseases of Women, Philadelphia 
 
 Polyclinic. 
 
 2. The Care of the Mother During Her Lying In: 
 
 Dr. Richard C. Norris, Physician in charge of Preston Retreat. 
 
 8 P. M. 
 
 Presiding Officer; 
 
 Mr. Alexander M. Wilson, Assistant Director of the Department of Public 
 Health and Charities of Philadelphia. 
 
 1. The Value of a Baby's Life: 
 
 Dr. Edward J. Cattell, Chief of tiic Bureau of Contracts and Statistics 
 of the Office of The Mayor, Philadelphia. 
 
 2. Philadelphia's Need of \ Municipal Child Bureau: 
 
 Dr. Jesse D. Burks, Director of the Bureau of Munici[)al Research of Phila- 
 delphia. 
 
 Sunday, May 26th, 3 P. M. 
 Presiding Officer: 
 
 Dr. Elizabeth L. Peck. 
 
 1. What Women Can Do to .\id in the Reduction of Infant Mortality: 
 
 Dr. Eleanor C. Jones, Visiting Physician to the Children's Wards of the 
 Women's Hospital. 
 
 2. What Children Can Do to Aid in the Reduction of Infant Mortality: 
 
 Mrs. J. Scott Anderson, of the Home and School League of Philadelphia. 
 
 LECTURES AXD SPEAKERS AT THE SUBSIDIARY 
 
 SHOWS 
 
 DOWN-TOWN SUBSIDIARY SHOW 
 
 310 Catharine Street 
 Wednesday, May 29th: 
 
 Dr. Theodore Le Boutillier — The Clothing of the Baby and the Care of the 
 
 Baby. 
 
 Dr. Bernard T. Kahn — Care of the Milk and Breast-Feeding. 
 
 Thursday, May 30th, 8 p. m. : 
 
 Dr. Maxwell Herman — Care of the Infant During the Summer Months. 
 Dr. John Penza — Care of the Milk in the Home. 
 
162 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Friday, May 31st, 8 p.m.: 
 
 Dr. Ignazio Cortese — Care of the Infant During the Summer Months. 
 Saturday, June 1st, 8 p.m.: 
 
 Dr. Maurice Goldberg — Care and Modification of Milk. 
 
 THE KENSINGTON SUBSIDIARY SHOW 
 
 Howard and Cambria Streets 
 
 Thursday, June 6th, 8 p. m. : 
 
 Dr. Howard Childs Carpenter — The Selection and Care of Milk in the Home. 
 Dr. J. Clinton Foltz— FUes. 
 
 Friday, June 7th, 8 p. m. : 
 
 Dr. Charles A. Fife — How to Care for the Infant during the Summer 
 
 Months. 
 
 Dr. John F. Sinclair — How to Bathe and Clothe the Baby. 
 
 Saturday, June 8th, 3 p.m.: 
 
 Mr. Edwin D. Solenberger — Wet Nursing. 
 
 Saturday, June 8th, 8 p. m. : 
 
 Dr. Alfred Hand, Jr. — The General Care of the Baby. 
 Dr. Theodore Le Boutillier — The Advantage of Breast-Feeding over Arti- 
 ficial Feeding. 
 
 Sunday, June 9th, 3 p. m. : 
 
 Dr. D. M. Hoyt — The Prevention of Tuberculosis in Infancy. 
 
 Dr. Hanna Kindbom — What Women can do in the Reduction of Infant 
 
 Mortality. 
 
 Sunday, June 9th, 8 p.m.: 
 
 Dr. Charles H. Weber — How to Continue Breast-Feeding under Difficulties. 
 Dr. Charles N. Sturtevant — ^Advantages of Milk Over the Advertised 
 Proprietarj' Foods. 
 
 GERMANTO^^ SUBSIDIARY SHOW 
 
 5849 Germantown Avenue 
 Thursday, June 13th: 
 
 Dr. J. CHnton Foltz — Instruction and Demonstration to the Demonstrators. 
 Dr. Wm. R. Nicholson — Care of the Mother. 
 
 Friday, June 14th: 
 
 Dr. H. B. Wilmer — Eugenics and Heredity. 
 
 Dr. John J. Mullowney — Social Diseases. 
 
 Dr. W. B. Fetterman — Care of the Child and General Hygiene. 
 
 Saturday, June 15th: 
 
 Dr. Robert L. Pitfield— Modification of Milk. 
 Sunday, June 16th: 
 
 Dr. Robert Downs— The Care of Milk. 
 
 Dr. Josephus UUom — The Care of the Baby. 
 
 Theodore Le Boutillier — The Clothing and Care of the Baby. 
 
LECTURES AND SPEAKERS 163 
 
 MANAYLNK SUBSIDIARY SHOW 
 
 Main and Rector Streets 
 
 Thubsday, June 20th, 8 p. m. : 
 Subject — Breast- Feeding. 
 Speaker — Dr. M. Howard Fussell. 
 
 Friday, June 21st, 8 p.m.: 
 
 Subject — Care of the Baby. 
 
 Speaker — Dr. Theodore Le Boutillier. 
 
 Saturday, June 22d, 8 p. m. : 
 
 Subject — Milk Feeding. Subject — Diseases of the Eye. 
 Speaker— Dr. O. H. Petty. Speaker— Dr. T. B. HoUoway. 
 
 Sunday, June 23d, 3 p. m. : 
 
 Subject — Contagious Diseases. 
 Speaker — Dr. J. D. Lehman. 
 
 Sunday, June 2d, 8 p. m. : 
 
 Subject — Artificial Feeding. 
 Speaker — Dr. H. C. Carpenter. 
 
 DAILY ATTENDANCE AT THE MAIN EXHIBIT, HORTICULTUR.\L 
 
 HALL 
 
 The Hall was open from 10 a. m. to 10 p.m., except on Sundays, when it was open from 
 
 1 P.M. to 10 P.M. 
 
 Saturday, May 18, li)l'2 3,iia 
 
 Sunday, May 19th 1,!»08 
 
 Monday, May iOlh 3,965 
 
 Tuesday. May ilst +.344 
 
 Wednesday. May 2^(1 9.413 
 
 Thursday." May «3d U.iOi 
 
 Friday, Mav:e4th 11,175 
 
 Saturday. May 25tli 13,263 
 
 Sunday, May 26th 6.014 
 
 Total Attendance 67,507 
 
 Number of Infants Cared for in Mothers' Rest Room, Horticultural 
 
 Hall, May 18th to 26th 
 
 Saturday, May 18, 1912 22 
 
 Sunday, May 19th 30 
 
 Monday, May 20th . . 110 
 
 Tuesday, May 21st 150 
 
 Wednesday, May '2'2,1 210 
 
 Thursday, May 23d 350 
 
 Friday, May 2'4th 280 
 
 Saturday, May 25th 316 
 
 Sunday. May 26th 265 
 
 Totiil 1,733 
 
 Total Attendance at Subsidiary Shows 
 
 Down-town Subsidiary Show 22,345 
 
 Kensington Subsidiary Show 6,216 
 
 Germantown Subsidiary Show 4,823 
 
 Manayunk Subsidiary Show 6,902 
 
 Total Number of Visitors to Subsidiary Shows 40,286 
 
 Total Number of N'isitors at Horticultural Hall 67,507 
 
 Total Number of Visitors to both Main Exhibit and Subsidiary Shows 107,793 
 
Committees and Organization 
 
COMMITTEES AND ORGANIZATION 
 
 OFFICERS 
 
 Honorary Chairman, Hon. Rudolph Blankenbubg 
 Chairman, Dr. Joseph S. Neff 
 Treasurer, Me. Edwahd T. Stotesbuby 
 Secretary, Dr. Howahd Childs Carpenter 
 Executive Secretary, Mr. Kahl de Schwedjitz 
 
 EXECUTIVE COMMITTEE 
 
 Mrs. R. R. Porter Bradford Mr. James S. Hiatt 
 
 Dr. Jesse D. Burks Dr. Henry D. Jump 
 
 Dr. Howard Childs Carpenter Miss Margaret Lehmann 
 
 Dr. Charles A. Fife Dr. Jo.seph S. Xeff 
 
 Dr. Lawrence F. Fhck Dr. W illiain Duffield Robinson 
 
 Mrs. \V. W. Frazier Mr. Edwin D. Solenbcrgcr 
 
 Dr. C. Lincoln Furbush Mr. K. T. Stote.sliury 
 
 Dr. Samuel McClintook Ilamill Mrs. TaleoU Williams 
 
 Dr. Charles J. Hatfield Mr. Alexander M. Wilson 
 
 committp:e of fixanx e 
 
 Dr. Lawrence F. Flick, Chairman 
 
 Mr. Edward Ames Ballard Mr. F. O. Harris 
 
 Mr. Edward Bok Dr. Charles J. Hatfield 
 
 Mr. George Burnham, Jr. Mr. Alba B. Johnson 
 
 Mr. J. Carstairs Dr. Henry D. Jump 
 
 Mr. Samuel Castner, Jr. Mr. Louis C. Madeira 
 
 Mr. Fred T. Chandler Mr. J. \'aughan Merrick 
 
 Mr. C. H. Clark, Jr. Mr. Randal Morgan 
 
 Mr. E. W. Clark Mr. Arthur E. Xewbold 
 
 Mr. Francis R. Cope, Jr. Mr. Clement B. Xewbold 
 
 Mr. Cyrus H. K. Curtis Mr. S. Davis Page 
 
 Mr. James M. Dodge Mr. Harold Peirce 
 
 Mr. George W. Elkins Mr. P. M. Sharpless 
 
 Mr. W. W. Frazier Mr. Philip L. Spalding 
 
 Mr. Lincoln Godfrey Mr. E. T. Stotesbury 
 
 Mr. John Gribbel Mr. S. M. Vauclain 
 
 Dr. Samuel McClintock Hamill Mr. Stuart Wood 
 
 COMMITTEE OX GEXERAL ARRANGEMENTS 
 
 Dr. Henry D. Jump, Chairman 
 Mr. Charles L. Chute, Secretary 
 
 Dr. Howard Childs Carpenter Dr. Howard Kennedy Hill 
 
 Dr. Charles A. E. Codman Dr. Edward Z. Holt 
 
 Dr. J. Clinton Foltz Miss Mary Ingham 
 
 Dr. A. P. Francine Dr. Theodore Le Boutillier 
 
 Dr. C. Lincoln Furbush Dr. William Duffield Robinson 
 
 Dr. C. H. Gray Dr. John F. Roderer 
 
 Dr. Charles J. Hatfield Dr. John F. Sinclair 
 
 167 
 
168 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 COMMITTEE ON PROCURING EXHIBITS 
 
 Dr. Charles A. Fife, Chairman 
 
 Dr. Howard Kennedy Hill, Secretary 
 
 Mr. George \\'. Atherholt 
 
 Miss Ellen C. Babbitt 
 
 Dr. E. P. Barnard 
 
 Dr. J. P. Bethel 
 
 Dr. William N. Bradley 
 
 Mr. J. B. Byall 
 
 Dr. A. A. Cairns 
 
 Dr. J. B. Carnett 
 
 Dr. Howard Childs Carpenter 
 
 Dr. Paul B. Cassidy 
 
 Dr. W. S. Cornell 
 
 Dr. Morris Cornfeld 
 
 Dr. Frank A. Craig 
 
 Dr. Ale.x. Heron Davisson 
 
 Dr. Frank D. Dickson 
 
 Dr. C. B. Farr 
 
 Dr. Lawrence F. Flick 
 
 Dr. Frederick Fraley 
 
 Miss Hannah Fox 
 
 Dr. C. Lincoln Furbush 
 
 Dr. M. H. Fussell 
 
 Dr. J. C. Gittings 
 
 Dr. Samuel McClintock Hamill 
 
 Dr. Charles J. Hatfield 
 
 Dr. Bailey Herman 
 
 Dr. Barton Cooke Hirst 
 
 Dr. John Cooke Hirst 
 
 Dr. E. Z. Holt 
 
 Dr. Francis B. Jacobs 
 
 Dr. Charles F. Judson 
 
 Dr. Alexander Klein 
 
 Dr. Norman L. Knipe 
 
 Dr. Frank Crozer Knowles 
 
 Dr. Edward Bell Knnnbhaar 
 
 Dr. H. R. M. Landis 
 
 Mr. Porter R. Lee 
 Miss Margaret Lehmann 
 Dr. Theodore Le Boutillier 
 Dr. Bertha Lewis 
 Dr. C. J. Marshall 
 Dr. Robert S. McCombs 
 Mrs. R. Tait McKenzie 
 Miss Ella Michael 
 Dr. D. J. M. Miller 
 Dr. Charles M. Montgomery 
 Dr. Arthur Newlin 
 Mr. Bernard J. Newman 
 Dr. S. W. Newmayer 
 Dr. Percival Nicholson 
 Dr. Richard C. Norris 
 Dr. Maurice Ostheimer 
 Miss Helen L. Parrish 
 Miss Charlotte Perkins 
 Dr. Robert L. Pittfield 
 Dr. C. S. Raue 
 Dr. W. T. Rees 
 Miss Nellie M. Rennyson 
 Dr. Sidney J. Repplier 
 Dr. John F. Sinclair 
 Dr. Frances R. Sprague 
 Dr. A. H. Stewart 
 Dr. Alice W. Tallant 
 Dr. Marianna Taylor 
 Mr. John A. Vogleson 
 Mr. Roy .Smith Wallace 
 Dr. Jolm K. Walker 
 Dr. Joseph Walsh 
 Dr. C. H. Weber 
 Dr. T. C. Westcott 
 Dr. C. Y. White 
 Dr. S. S. Woody 
 
 COMMITTEE ON LECTURES AND DEMONSTRATIONS 
 Dr. Samuel McClintock Hamill, Chairman 
 
 Dr. Howard Childs Carpenter 
 Dr. Ward Brinton 
 Mr. William B. Buck 
 Dr. J. Claxton Gittings 
 Dr. Alfred Hand, Jr. 
 Dr. Charles J. Hatfield 
 
 Dr. H. R. M. Landis 
 Mrs. R. Tait McKenzie 
 Dr. Theodore Le Boutillier 
 Dr. Maurice Ostheimer 
 Dr. J. Torrence Rugh 
 
 COMMITTEE ON PUBLICITY 
 
 Dr. William DufEeld Robinson, Chairman 
 
 Dr. J. B. Carnett 
 Dr. C. H. Gray 
 Dr. L. J. Hammond 
 
 Dr. Isaac Leopold 
 
 Dr. Theodore Le Boutillier 
 
 Mr. W. T. Rawson 
 
COMMITTEES AND ORGANIZATION 
 
 169 
 
 COMMITTEE OX EDITATIOX 
 
 Mr. James S. Hiatt, Chairman 
 
 Dr. Jesse D. Burks 
 Mr. Edwin S. Solenberger 
 Miss Margaret H. Lehmann 
 Miss Helen M. Glenn 
 Mrs. Martha J. Magee 
 Mrs. L. M. Roberts 
 Mr. Richard \\'aterman 
 Dr. E. E. Graham 
 
 Dr. J. P. Crozer Griffith 
 
 Dr. Alfred Hand, Jr. 
 
 Dr. C. F. Judson 
 
 Dr. Walter S. Cornell 
 
 Dr. Howard Childs Carpenter 
 
 Dr. George \V. Flounders 
 
 Mrs. Edwin C. Grice 
 
 Mr. Joseph liartilurci 
 Mrs. R. R. P. Itradford 
 Mr. Jo.seph Di Silvestro 
 Rev. J. P. Duffy 
 Rev. H. L. Duliring 
 Mr. John T. Enilen 
 Mr. Thomas S. Evans 
 Mrs. W. W. Frazier 
 Rev. Carl E. Grammer 
 Mrs. Edwin C. Grice 
 
 COMMirrEE ox SOCIAL ORGAXI/.ATIOXS 
 Mr. Alexander M. Wilson, Chairman 
 Mr. J. Bruce Byall, Secretary 
 
 Mr. James J. Hickey 
 Mr. Porter R. Lee 
 Miss Margaret H. Lehmann 
 Rabbi H. L. Leventhal 
 Mrs. Louis C. Madeira 
 Miss Katherine Melley 
 Mi.ss Laura .\. I'latt 
 Miss Florence L. Sanville 
 Mr. Edwin B. Solenberger 
 Mr. Rov Smith Wallace 
 Mr. Charles T. W alker 
 
 COMMITTEE OX P.VTROXESSES AXD AIDES 
 
 Mr,s. Talcott Williani.s, Chairman 
 
 Miss Gertrude II. Leidy, Secretary 
 
 Mrs. Cyrus Adler Mrs. William M. Kerr 
 
 Mrs. Rudolph Hlankenburg Mrs. R. Tait McKenzie 
 
 Mrs. Jasper Y. Brinton Mrs. James P. MeXichol 
 
 Mrs. Edward P. Da\is Mrs. Joseph S. Xeff 
 
 Miss Henrietta B. Ely Mrs. George Wharton Pepper 
 
 Mrs. Chancellor C. English Mrs. Lewis S. Somers 
 
 Mrs. Edward B. Finck Mrs. Edward T. Stotesbury 
 
 Mrs. W. AV. P'razier Miss Frances A. Wister 
 
 Mrs. Edward C. Grice Mrs. Owen Wister 
 Mrs. William F. Jenks 
 
 COMMITTEE OX PUBLICATIOX 
 
 Dr. C. Lincoln Furbush, Chairman 
 
 Dr. Samuel McClintock Hamill Mr. Karl de Schweinitz 
 
 Miss Ellen C. Babbitt 
 
Financial Statement 
 
 13 
 
FINANCIAL STATEMENT 
 
 Expenditures 
 
 1. Salaries and honoraria (including lecturers, demonstrators, stenographers, 
 
 office-boys, engineers, attendants, etc.) $i,452.iil 
 
 2. Printing, stationery, rent of typewriters, telephone and telegraph, ofiBce 
 
 supplies, carfare, etc 2,116.71 
 
 3. Postage .561.90 
 
 4. Advertising 1,553.78 
 
 5. Rent and in.surance 1,267.75 
 
 6. Main exhibit (including preparation of building and installation of exhibits, 
 
 signs, decorations, burlap, electrical lighting, plumbing equipment, 
 special installation, heat, light and power, drawing.s, blue prints, charts, 
 stereopticon an<l lantern .slides, moving picture machine and films 3,452.16 
 
 7. Subsidiary Exhibits (including plumbing equipment, special installation. 
 
 heat, light and power, preparation of building and installation of ex- 
 hibits, signs, decorations) 607.93 
 
 8. Freight, expres.sage, and hauling 107.97 
 
 9. Movingexhjbit 257.50 
 
 10. Miscellaneous (including disbursements for chairs, ice, repairs, hardware, 
 
 materials, etc.) 606.37 
 
 11. Printing report 1,600.00 
 
 Total expenditures $14,704.34 
 
 Receipts 
 
 Subscriptions $ 2,379.2,S 
 
 Appropriation from Councils 5,000.00 
 
 $ 7,379.23 
 Balance due from guarantors $ 7,325.11 
 
 Through the kindness of Mr. J. T. BjTne, of the Bureau of Municipal Research, 
 who contributed his ser\'ices, tlie accounts have been duly audited and found correct. 
 
 173 
 
174 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 GUARANTORS 
 
 1. 
 
 2. 
 
 3. 
 
 4. 
 
 5. 
 
 6. 
 
 7. 
 
 8. 
 
 9. 
 10. 
 11. 
 12. 
 13. 
 14. 
 15. 
 16. 
 17. 
 18. 
 19. 
 20. 
 21. 
 22. 
 23. 
 24. 
 25. 
 26. 
 27. 
 28. 
 29. 
 30. 
 31. 
 32. 
 33. 
 
 A friend of the Show 
 
 34. 
 
 Mr. 
 
 Eli B. Hallowell 
 
 Dr. Thomas G. Ashton 
 
 35. 
 
 Mr. 
 
 J. G. Harris 
 
 Mr. Richard L. Austin 
 
 36. 
 
 Mr. 
 
 .\lfred C. Harrison 
 
 Mr. Francis W. Ayer 
 
 37. 
 
 Mr. 
 
 Franklin S. Horn 
 
 Mr. Ellis Ames Ballard 
 
 38. 
 
 Mr. 
 
 Samuel F. Houston 
 
 Mr. H. R. Baltz 
 
 39. 
 
 Mr. 
 
 Alba B. Johnson 
 
 Miss Harriet Blanchard 
 
 40. 
 
 Mr. 
 
 John D. Johnson 
 
 Mr. Edward Bok 
 
 41. 
 
 Mr. 
 
 Lawrence McCormick 
 
 Mrs. Edward Bok 
 
 42. 
 
 Mr. 
 
 George H. McFadden 
 
 The Henry Bower Chemical Mfg. Co. 
 
 43. 
 
 Mr. 
 
 J. Franklin McFadden 
 
 Mr. George Burnham, Jr. 
 
 44. 
 
 Mr. 
 
 William L. McLean 
 
 Mr. George Burnham, Sr. 
 
 45. 
 
 Mrs 
 
 1. James P. McNichol 
 
 Mr. W. Atlee Burpee 
 
 46. 
 
 Mr. 
 
 Louis C. Madeira 
 
 Mr. J. H. Carstairs 
 
 47. 
 
 Mr. 
 
 T. E. Mitten 
 
 Mr. E. B. Cassatt 
 
 48. 
 
 Mr. 
 
 Randal Morgan 
 
 Mr. Samuel Castner, Jr. 
 
 49. 
 
 Mr. 
 
 Harrison S. Morris 
 
 Mr. Fred T. Chandler 
 
 50. 
 
 Mrs 
 
 1. Harrison S. Morris 
 
 Mr. C. H. Clark, Jr. 
 
 51. 
 
 Mr. 
 
 Arthur E. Newbold 
 
 Mr. E. W. Clark 
 
 52. 
 
 Mr. 
 
 Clement B. Newbold 
 
 Mr. Herbert L. Clark 
 
 53. 
 
 Mr. 
 
 S. Davis Page 
 
 Mr. S. W. Colton, Jr. 
 
 54. 
 
 Mr. 
 
 Richard G. Park 
 
 Mr. Cyrus H. K. Curtis 
 
 55. 
 
 Mr. 
 
 Frank T. Patterson 
 
 Mr. James Mapes Dodge 
 
 56. 
 
 Mr. 
 
 Harold Peirce 
 
 Mr. Chas. J. Eisenlohr 
 
 57. 
 
 Mr. 
 
 Frank C. Roberts 
 
 Mr. 0. W. Eisenlohr 
 
 58. 
 
 Mrs 
 
 i. Pedro G. Salom 
 
 Mr. George W. Elkins 
 
 59. 
 
 Mr. 
 
 P. M. Sharpies 
 
 Mr. Theodore N. Ely 
 
 60. 
 
 Mr. 
 
 Philip L. Spalding 
 
 Mr. Samuel S. Fels 
 
 61. 
 
 Mr. 
 
 E. T. Stotesbury 
 
 Mr. W. W. Frazier 
 
 62. 
 
 Mr. 
 
 Rodman AVanamaker 
 
 Mr. Louis Gerstley 
 
 63. 
 
 Mr. 
 
 S. M. Vauclain 
 
 Mr. Lincoln Godfrey 
 
 64. 
 
 Mr. 
 
 Robert T. Whitmer 
 
 Mr. Wm. H. Greene 
 
 65. 
 
 Mr 
 
 . George Wood 
 
 Mr. John Gribbel 
 
 66. 
 
 Mr. 
 
 Stuart Wood 
 
FINANCIAL STATEMENT 
 
 175 
 
 CONTRIBUTORS 
 
 Abernethy, S. C. 
 
 Aertson, Annie D. 
 
 Allen, S. L., and Co. 
 
 Amalgamated Lace Operatives of America 
 
 Anders, Dr. J. M. 
 
 Asiiman, W. N. 
 
 Bacharach, Rebecca 
 
 Barney, Chas. D. 
 
 Barth, Minna 
 
 Bell, Mrs. \V. Graham, Washington, D. C. 
 
 Bishop, J. V. S. 
 
 Bisler, G. A. 
 
 Bisler, G. A., Inc. 
 
 Borsch. Henry I'aul 
 
 Boyd, .Aiirelia M. 
 
 Brylawski, Miss 
 
 Burnham, Mary A. 
 
 Caldwell, Florence F. 
 
 Carstairs, Mrs. James 
 
 Cartun, Jacob 
 
 Cash 
 
 Cash 
 
 Cash Contributions 
 
 Cash from sale of Drinking Cups 
 
 Clark, C. W. 
 
 Converse, John \V. 
 
 Cook, M. A. H. 
 
 Cox, J. L. 
 
 Craig, James 
 
 Croft & Allen 
 
 Cunningham, Mrs. E. 
 
 Davidson, \Vm. G., & Co., Inc. 
 
 Davis, Miss 
 
 Davis, A. B. 
 
 Davis, Henry L. 
 
 Da\-is, Miss Mary 
 
 DeArmond, Mrs. Geo. J. 
 
 DeCou, Sarah H. 
 
 Derrick, Mrs. Alice P. 
 
 Dickson, S. S. 
 
 Dilks, Mrs. Walter Howard 
 
 D'Invilliers. Charles E. 
 
 Doan, Chas. R. 
 
 Dobbins, Murrell 
 
 Eliel, ^Irs. Louis S. 
 
 Ely, Harriet B. 
 
 Eshner, Annette F. & Juliet F. 
 
 Evans, Eleanor T. 
 
 Evans, George B. 
 
 Farr, Mrs. Wm. W. 
 
 Farran, Wm. J. 
 
 Felton, H. B. 
 
 Ferguson, Margaret M. 
 
 Fuguet. Mrs. Stephen 
 
 Fitch, Jas. E. 
 
 Flagg. Mrs. Stanley G.. Jr. 
 
 Fliegelman, Esther K. 
 
 Flick, Dr. Lawrence F. 
 
 Fo.\% G. Percy 
 
 Friedberger, Mrs. H. 
 
 Funk, Miss M. L. 
 
 Gallali, Rudolph 
 
 Garrett, Mrs. .\lfred C. 
 
 Gibbons, Mrs. Wm. H. 
 
 Graff, Rev. W. 11. 
 
 Guckcr. F. T. 
 
 Hadlev, Mrs. A. P. 
 
 Hallahan. P. T. 
 
 Harbison, Thos. li. 
 
 Harding, Mrs. .Mice E. 
 
 Harris. .las. Rus.sell 
 
 Haughtim. Richard 
 
 Hay, James 
 
 Hcnkcnsiefaren. J., A. 
 
 Hesscnl)nich. Mrs. H. 
 
 Hohlfcld Mfg. Co. 
 
 Hollar, Mrs. Wm. H. 
 
 Horn, Katharine S. 
 
 Howe, M. W. F. 
 
 Huey. Malcolm S. 
 
 Huston, Martha Y. 
 
 Hutchinson, louden 
 
 Hut( liinson. Mrs. S. E. 
 
 Ingham, Wm. .\. 
 
 Jenkins, Chas. F. 
 
 Jenkins, Mrs. (Charles Francis 
 
 Jenk,s, Helen C. 
 
 J. K. 
 
 J. N. M. 
 
 Johnson, Eldridge R. 
 
 .Joly. Geo. F., Jr. 
 
 Jones, Henry 
 
 Jones, James Collins 
 
 Judson, Mrs. O. A. 
 
 Justice, Wm. W. 
 
 Kaighn, Robt. 
 
 Kendig, Mrs. Daniel 
 
 Keyser, Mrs. Jas. D. 
 
 Kingston. H. H. 
 
 Koch, Mrs. Andrew P. 
 
 Kohn. Mrs. David 
 
 Kollner, Josepliine 
 
 Lane, George 
 
 Lang, Sophie F. 
 
 Lea, Charles M. 
 
 LeBoutillier, Minnie C. 
 
 Leeds, Sara B. 
 
 Leider, Mrs. Gertrude 
 
 Levy, Max 
 
 Lewis, Mrs. .\nna B. 
 
 Lewis, Edwin H. 
 
 Lenis, John F. 
 
 Lewis, Mrs. John Frederick 
 
 Lewis. Samuel N. 
 
 L. H. L. 
 
 Lipman, Mrs. Bella 
 
 Loos, A. J. 
 
 Loucheim, Mrs. Joseph 
 
 Lucearlin. Mabel E. 
 
 Marsden, Julia Hebard 
 
 Masland, J. Wesley 
 
 McCauley, Mrs. S. A. 
 
176 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 McCreary, Geo. D., Jr. 
 
 McUhenny, John D. 
 
 McPherson, John B. 
 
 Meang, Clara 
 
 Merrick, J. Vaughan 
 
 MiUer, Clara H. 
 
 Mitchell, Mary Cadwallader 
 
 Moore, Mrs. J. C, Jr. 
 
 Morris, Eliza L. 
 
 Morris, Mrs. F. W. 
 
 Morris, Jane Rhoads 
 
 Netter, Hilda H. 
 
 New Century Club 
 
 Newlin, Sarah 
 
 Nicholson, Mrs. Wm. R. 
 
 Norris, Geo. W. 
 
 Oliver, The V., Co. 
 
 Payne, Helena A. 
 
 Pennock, Edward 
 
 Petersen, Otto J. 
 
 Petty, J. K. 
 
 Phila. Assn. of Day Nurseries 
 
 Phila. Quartz Co. 
 
 Potter, H. Annie 
 
 Powell Knitting Co. 
 
 Randolph, Mrs. 
 
 Read, Wm. F. 
 
 Reeves, Francis B., Jr. 
 
 Reist, Monroe 
 
 Remmey, Richard C, Sons Co. 
 
 Rhoads, C. J. 
 
 Richardson, Mrs. C. M. 
 
 Ritchie, Sarah 
 
 Rosengarten, Jos. G. 
 
 Rossmassler, Bertha 
 
 Rothwall, Jane 
 
 Ryan, Thos. J. 
 
 Say re, John C. 
 
 Scattergood, A. G. 
 
 Scattergood, Mrs. E. S. 
 
 Scattergood, J. Henry 
 
 Scattergood, Maria C. 
 
 Schloss, Milton J. 
 
 Schreiner, E. T., M.D. 
 
 Sheble, Mrs. Frank J. 
 
 Sheppard, Mrs. Margaret 
 
 Sharp, Eliz. W. 
 
 Sibley, Mrs. Edward A. 
 
 Sinnott, Mrs. Jos. F. 
 
 Sinnott, Mary E. 
 
 Smith, C. Morton 
 
 Smith, Haseltine 
 
 Smith, F. Conrad, M.D. 
 
 Smith, VV. Hinckle 
 
 Snellenburg, Samuel 
 
 Snyder, Ehrman S. 
 
 Somerville, Anna M. 
 
 Spawn, J. N. 
 
 Stafford, Miss B. E. 
 
 Steele, Wm., & Sons Co. 
 
 Stern, Mrs. Horace 
 
 Stern, Louis 
 
 Stewardson, Miss M. M. 
 
 Strawbridge, F. H. 
 
 Strawbridge, Wm. J. 
 
 Strawbridge & Clothier 
 
 Sundry Cash Contributions 
 
 Sundry Contributions 
 
 Taylor, Mrs. Henry P. 
 
 Thomas, Mrs. Geo. C. 
 
 Tindle, Rebecca Knox 
 
 Trexler, S. W. C. 
 
 Vauclain, A. C. 
 
 Viener, B. 
 
 Walsh, Jos. 
 
 West, Cornelius 
 
 Westerman, S. A. 
 
 Weston, Mrs. S. Burn 
 
 Whelan, Thos. J. 
 
 W'hitcomb, Mrs. Chas. Mortimer 
 
 White, S. S., Dental Mfg. Co. 
 
 Willcox, James M. 
 
 Williams, Ellis D. 
 
 Williamson, Anna J. 
 
 Wister, Mrs. Owen 
 
 Wohlschlagel, J. Fred 
 
 Wolf, Albert 
 
 Woodward, Miss Eva P. 
 
 Wright, T. Howard 
 
Proceedings of Conference on Infant 
 
 Hygiene 
 
Conference on Infant Hygiene, Held in the Reception 
 Room of the Mayor of Philadelphia, City Hall 
 
 First Session— Wednesday, May 22, 2.30 P. M. 
 
 Presiding Officer: 
 
 Mr. Homer Folks, Secrelarv of the State Cliarities Aid Association, of Xew 
 Yoriv. 
 
 1. Introductory Remarks: 
 
 Mr. Homer Folks. 
 
 2. Municipal Child Bureaus: 
 
 Dr. Josephine Baker, Direetor of Child Hypiene, Department of Health, 
 New York City. Discussion to he opened hy Dr. Jesse D. Burks, Director 
 of the Bureau of Municipal Research, of Philadelphia. 
 
 3. Infant Milk Depots: 
 
 Dr. Rowland G. Freeman, Adjunct Professor of Pediatries, University and 
 Bellevue Hospital Medical School, New York. Discussion to he opened by 
 Dr. William C. Woodward, Health Officer of the Health Department of the 
 District of Columbia. 
 
 4. Social Service Work in Relation to the Conservation of Child Life: 
 
 Dr. Fritz Talbot, of the Department of Diseases of Children, Medical 
 Department of Harvard University. Discussion to be opened by Miss 
 Helen M. Glenn, Head Worker of the Social Service Department of the 
 University Hospital of Philadelphia. 
 
 5. Home Pl.\cing, ^'ERsus the Institutional Care of Babies: 
 
 Dr. H. Hastings Hart, Director of the Department of Child Helping of The 
 Russell Sage Foundation, New York. Discus.sion to be opened by Dr. J. 
 W. Schereschewsky, Director of the Exhibition of the 15th International 
 Congress of Hygiene and Demography. 
 
 Dr. Samuel McClintock Hamill: We are very fortunate, indeed, in hav- 
 ing with us Mr. Homer Folks, Secretary of the State Charities Aid Association of 
 New York, who has very kindly consented to preside at the opening session of 
 this Conference. Mr. Folks' active interest in one phase of the work among 
 infants, and his general interest in every department of that work, is well known 
 to you all. These and his many other interests keep him so fully occupied that 
 I know he has sacrificed much to come here. It is, therefore, with sincere appre- 
 ciation, as well as pleasure, that I introduce Mr. Folks to this audience. 
 
 179 
 
180 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 ADDRESS OF MR. HOMER FOLKS 
 
 I could not resist the temptation to take some part in a Baby Saving Show 
 and a conference connected therewith. It must be a very small part, because 
 in the course of the afternoon we have eight stated speakers and any quantity 
 of discussion, so that it falls to me simply to open the subject as briefly as may be. 
 
 I was highly pleased to see that you gave yourselves the title which the New 
 York Evening Post has referred to as "undignified, but very happy" — Baby 
 Saving Show. All my experience indicates that there is a great difference between 
 infants and babies. We usually talk about infants and infant mortality. I 
 think you are very much wiser in talking about "babies" and in giving the babies 
 a show. The difference between infants and babies is the difference between 
 the academic and the vernacular, between the uninteresting and the interesting. 
 There are exceptional men who, perhaps, would risk their lives to save an infant, 
 but there is no man who would not instantly risk his life to save a baby. It seems 
 natural that some dignified infants should die, pity though it be! but the death 
 of a baby is always tragic and always enlists our sympathy to the utmost degree. 
 I was glad to be invited to a show, not an exposition nor an exhibition, nor any 
 other learned affair. People like to go to a show, but must be wheedled into 
 going to an exhibition. I was also glad that the babies were not to be conserved 
 or protected, but just merely saved — the good old short word. Everybody under- 
 stands what saving babies is. It would be rather difficult, I think, to interest 
 the city authorities in a large way to devote sums of money to the protection of 
 infants, but I am perfectly sure that the appeal for saving babies would be irre- 
 sistible, and that a municipal organization to save babies could always get ade- 
 quate support. 
 
 Having gotten into the vernacular in the baby saving show, I wish to point 
 out, in opening, only two aspects of the subject in which I hope you have stuck 
 to the vernacular and the simple straightforward, old-fashioned words. The 
 first point which has occurred to me in connection with meetings for the preven- 
 tion of infant mortality, and in connection with the work of most of the agencies 
 which we set on foot for the saving of infants' lives, is this: that possibly we are 
 still a little too dignified to say as much as we ought to say about nursing babies. 
 All my experience in the care of babies, — and I have had quite a little experience 
 in the care of foundlings and babies separated from their mothers, — all that has 
 led me to see that so far as food is concerned no artificial feeding whatever can 
 take the place of wet-nursing; and if the baby must be separated from its mother, 
 or has been separated, then its greatest chance of life is to be wet-nursed by some 
 other mother who has lost her own baby. I think there is real danger that in 
 our campaigns and discussions and meetings about milk stations, and so on, we 
 may convey to the public mind, quite unintentionally, the impression that by 
 getting a pure milk supply, or approximately so, we shall save the babies. Now, 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 181 
 
 I have no impression at all that that will be the case, and I am firmly convinced, and 
 I believe we all are, that the greatest single step forward that could be taken 
 would be to secure the largest degree of nursing of babies by their own mothers; 
 and, therefore, I hope that in this baby saving show and the meetings connected 
 with it we shall not fail to make clear to the general public, as I believe it is clear 
 to all of us, that in discussing pure milk and milk stations, and all those accessories, 
 we do not wish to lose sight for a moment of the paramount inii)ortance of the 
 nursing of children by their own mothers in all suitable cases. Of course, there 
 are exceptions. 
 
 The second suggestion which I wish to make is that some of us social workers 
 and our charitable agencies jiromote and i)crhai)s produce a substantial part of 
 the ])roblems of infant mortahty. It is hard enough to deal with those aspects 
 of the problem that are thrust upon us, with conditions that are beyond our im- 
 mediate control. It certainly would be a j)ity if we deliberately and l>y intent 
 voluntarily increased the prosjjccts of infant mortality. And yet, over in New 
 York, to a much less extent, I am glad to say, in Philadelphia, but to some extent 
 in all large cities, we do deliberately do things which greatly increase the certainty 
 that a large number of infants will lose their lives. The thing I have in mind 
 is the ready separation of the young baby from its mother. We do that par- 
 ticularly when the child hajipens to be born out of wedlock. I have forgotten 
 how many hundreds of children, but a great many hundreds of babies in New 
 York, — some two thousand every year, I think, — are taken from their mothers 
 voluntarily, and in the name of charity, for the sake very often of endeavoring 
 to protect the reputation of the mothers' parents. A long series of efforts in 
 the care of such children shows that when that is done, under the best of cir- 
 cumstances, thus far about 50 per cent, of these babies do not live to be two years 
 of age. So we do enormously increase the probability of fatality by separating 
 the young infant from its own mother. I have come to the conclusion that if 
 we persist in our mistaken charity on that scale and in that manner, we should 
 be brought up by the law, and just as it is an offense against the law to abandon 
 a child on the street or in the park or other place, it should be as much an offense, 
 except under exceptional circumstances, to abandon an infant to the care of a 
 so-called charitable organization. 
 
 These two aspects of the subject contribute, it seems to me, to an unrecog- 
 nized degree, to the magnitude of the infant mortality problem. If we, as social 
 workers and charitable agencies and lying-in hospitals, will but revise our methods 
 and adjust our work wiih what we know to be the facts, we shall very materially 
 reduce the problem presented to the health authorities and the voluntary charita- 
 ble agencies, to bring it within workable measure. 
 
 There is one bureau in the government of New York City (which has a very 
 elaborate and comphcated array of bureaus) in which everybody believes, which 
 everybody believes to be doing exceedingly valuable work: it is the Bureau of 
 Child Hygiene. If the great Health Department of New York City did nothing 
 else but carry on that Bureau its entire expense would be amply justified. It is 
 
182 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 a particular pleasure to introduce to you the very efficient Director of the Bureau 
 of Child Hygiene of New York City, Dr. S. Josephine Baker, who will speak on 
 the subject of "Municipal Child Bureaus." 
 
 MUNICIPAL CHILD BUREAUS* 
 BY S. JOSEPHINE BAKER, M.D. 
 
 Director of Child Hygiene, Department of Health, City of New York 
 
 Hoffman has stated, in his work on "The Sphere of the State," that "that 
 is not the best government which governs the least, but, on the contrary, that 
 which enters most deeply into the real needs and daily interests of its subjects," 
 and, further, "the ultimate responsibility for the child is with the State, and it 
 should spare no means to make the child as useful a member of the State as the 
 capabilities of the child and the given circumstances permit." 
 
 Over one hundred years ago the State, through its power of government, 
 recognized this responsibility by deciding that a citizen, to be useful, must be 
 literate, and for this purpose established its system of free public education. To- 
 day the State is recognizing that a citizen, to be useful, must be healthy, and in 
 acting upon this principle has ultimately come to the realization that preventive 
 health work among children offers a vast field of potential possibilities, not only 
 in the prolongation of life, with a decreased death-rate, but in the greater efficiency 
 of those who live, with correspondingly decreased poverty, delinquency and 
 dependency. Modern sanitary science seeks to counteract those conditions 
 which further the development of the so-called "preventable diseases." As 
 life, measured by the years of its normal duration, approaches and passes its 
 meridian, the preventable diseases decrease in the frequency of their occurrence. 
 Approximately one-fifth of all deaths at all ages occur during the first five years 
 of life. At least one-half of these are preventable. The deaths from infectious 
 diseases are mainly encountered between five and fifteen years of age, while tuber- 
 culosis, which causes more deaths than any other single disease, is mainly dependent 
 upon a lack of natural or acquired resistance, and it is probable that this latent 
 tendency has its inception during the period of childhood. The effort to eliminate 
 tuberculosis will be successful only in proportion to the recognition of this knowl- 
 edge, for public health work among children offers a solution of the tuberculosis 
 problem in the only way it will ever be solved, and that is by primarily preventive 
 measures. 
 
 The vast alien population of our cities, the congestion of population, economic 
 strain, and lack of adjustment in living conditions, are matters which must cause 
 us the greatest concern, for, whatever may be the effect upon the adult, it is certain 
 
 * This paper has been slightly modified, but in all essential points is the same as that read by 
 me before the Section on Public Health of the New York Medical Society, April 18, 1912. 
 
PROCEEDINGS OF COXFERENCE ON INFANT HYGIENE 183 
 
 that it in no way approaches the serious results that are found in the case of infants 
 and children, born in, and doomed to live among, surroundings which afford them 
 little or no opportunity for a normal, sane, or healthy life. 
 
 Cities in themselves are causing the very conditions which sanitarians and 
 social workers are now using their efforts to correct. If cities produce the factors 
 that mean excessive infant mortality and high disease incidence among children, 
 the cities must pay the cost of their own neglect, and as a measure of self-preser- 
 vation bend their energies towards the elimination of those features which have 
 caused this serious and wholly deplorable condition of affairs. The cost, measured 
 in dollars and cents alone, may seem great to the unobservant aiul to those un- 
 familiar with the existing status, but from the point of view of tiie ])reservation 
 of the State, in assuring good health to the next generation, it is infinitesimal and 
 unworthy of consideration. The children of our vast alien population are our 
 real American citizens in the making. Keen, intelligent, actively interested in 
 all features of their new life, they furnish a never-ending source of ins])iralion 
 to those of us who know them, and work through and among them. Not only 
 are they the vulnerable points of attack in educational j)ublic health work, but 
 they are physically the material itself ui)on which the force of [)ublic health work 
 must be expended. Their future value to themselves and to the nation depends 
 upon their knowledge of those laws which make for j)hysical and mental well- 
 being. Thus, while health work among adults nuist be largely restrictive and 
 corrective, and often disappointing in its results, public health work among and 
 for children can be made i)reventive in its highest meaning, and the results are 
 well worthy of all the time, money and energy expended in producing them. 
 
 In line with these principles the Department of Health of New York City 
 organized its Division of Child Hygiene in August, 1908. This division has a 
 force of 154 physicians, 265 trained nurses, 33 nurses' assistants, 30 clerks and 
 typists, and 23 cleaners, employed during the entire year, and an additional tem- 
 porary force of 56 trained nurses and 33 nurses' assistants employed from May 
 1st to November 1st, to meet the extra summer work in the infants' milk stations. 
 
 Its object is to supervise and control the health of children insofar as a 
 municipal health department may accomplish this purpose. Its functions include: 
 
 1. The supervision and control of midwives. 
 
 2. The instruction of mothers in the care of babies by — 
 
 (a) District visiting. 
 (6) Infants' milk stations. 
 (c) Mothers' conferences. 
 {d) Little mothers' leagues. 
 
 3. The supervision of foundling babies boarded in private homes. 
 
 4. The sanitary supervision and control of day nurseries and institutions 
 for dependent children. 
 
 5. The medical inspection and examination of school-children. 
 
 6. Vaccination of school-children. 
 
 7. The issuing of employment certificates to children of legal working age. 
 
184 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 A question which has never been decided, and which probably never will be, 
 is the actual money value of a human life. Court decisions, which might be taken 
 as a standard, show a fluctuation so wide that no standard can be deduced. The 
 basis has usually been placed upon the earning capacity, and as infants' and young 
 children's earning capacity is rated as nil, the money value of their life or an 
 estimate of their future productive capacity, based upon good health, is exceedingly 
 difficult to determine. It has, however, been stated many times, without dispute, 
 that the value of the life of an infant under one year of age is $100. With this 
 as a basis, it may be seen that 15,000 infant deaths in New York City last year 
 alone meant a money loss of $1,500,000. 
 
 In its efforts to reduce infant mortality the Department of Health of New 
 York City has made a strenuous and energetic campaign during 1!)11. While it 
 is not possible to estimate the exact number of lives saved which may be charged 
 with any degree of accuracy to the credit of any particular organization working 
 in this field, yet from the point of view of the city and its expenditures it may 
 readily be demonstrated that the actual cost of saving the baby's life is con- 
 siderably lower than the loss involved in allowing it to die. Some few years ago 
 the New York Milk Committee, after a series of investigations, stated that the 
 average cost of medical attendance and funeral services for each baby that died in 
 New York City was $50. During 1911 the death-rate among infants brought to the 
 milk stations conducted by the Department of Health was 2.4 per cent.; in the 
 district work of the department under the charge of the visiting nurses the death- 
 rate was 1.4 per cent. The cost of this service amounted to about two dollars a 
 month for the milk station baby, and about sixty cents a month for the baljy who 
 was cared for in its own home. The total reduction in infant mortality for the 
 year in actual numbers was 1183, or a saving in dollars and cents of $118,300. 
 Even though such a method of reasoning may be used to prove the point I wish 
 to make, yet it would seem unworthy of consideration when compared with the 
 humanitarian side of this life saving project. The saving in human anguish alone 
 cannot be computed, and the conservation of life means more to the state than the 
 conservation of any of its material resources can ever mean. 
 
 The exact financial value of the medical inspection and examination of the 
 children who are attending our public schools is impossible to estimate. It has 
 never been possible to determine with mathematical accuracy the exact number 
 of non-promotions due to physical defects, or the influence on promotion of the 
 medical correction of these defects. Many other factors must be considered, as 
 the mental equipment of the child, the character of its instruction, the idiosyn- 
 crasies of teachers and the variability of the methods governing promotions; but 
 that the physical condition of the child bears a very direct relation to its progress 
 in school is an accepted deduction that may safely be made as a result of the 
 knowledge we already have upon this subject. In fact, this statement is almost 
 superfluous, as it is a matter of common reasoning that a sick child is necessarily 
 not in a condition either to attend school regularly or to profit by the instruction 
 that is given to it. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 185 
 
 In New York City, since 1908, 727,750 children in the public schools have 
 received a complete physical examination. Of this number an average of 40 per 
 cent, were found to have one or more associated physical defects, such as defective 
 vision, adenoid growths, enlarged tonsils, defective nutrition, pulmonary or cardiac 
 disease, ortho))edic defects and tuberculous glands, with or witliout the most 
 common defect that we find, namely, defective teeth. Thirty-five per cent, 
 of the remainder of the children examined were found to have defective teeth as 
 the only physical defect. Such a condition certainly merits consideration, as it is 
 quite evident that these defects have been hitherto unrecognized and untreated, 
 and that it is the duty of the city, in order to protect itself, to use all reasonable 
 means to see that the children are given an oi)|)ortunity to be placed in normal 
 physical condition. In the schools alone the efforts of the Division of Child 
 Hygiene have resulted in an immense gain in school time for those children who 
 were afTected with contagious eye and skin diseases, the neccssarj* exclusions from 
 school attendance for these reasons being reduced from over 57,000 in 1903 to 
 slightly over 3,000 in 1911. Of the children who were found to have physical 
 defects other than the single defect of teeth, approximately 80 per cent, have been 
 placed under medical care. Our experience in New York also coinc'idcs with that 
 of all other communities where a similar system of supervision of the health of 
 school-children has been in operation. The general improvement in the health 
 and cleanliness of the child and the home hygienic conditions which have a distinct 
 bearing upon the health of children is manifest to any one who compares the status 
 of the city child today witli that obtaining a few years ago. 
 
 One objection which has been raised by the medical profession in regard to 
 this work should not pass unnoticed. It has been alleged that the a.ssumption, 
 by the city, of the responsibility for the health of .school-children has made serious 
 inroads upon the practice and income of private physicians. In order to ascertain 
 the exact conditions in relation to this matter I have had tabulated for the year 
 1911 the various sources from which children have received treatment. During 
 that year, of the G5,150 children treated, 37,986 (58 per cent.) were treated by 
 private physicians or dentists, while the remaining 27,164 (42 per cent.) were 
 under the care of hos]jitals and dispensaries. An absolute rule of the Department 
 of Health is that no child shall be referred to an institution for treatment until it 
 has been definitely ascertained by the medical inspector or nurse that the family 
 is unable to pay for the services of a private physician. When it is remembered 
 that the defects for which these children are treated are those for which no treat- 
 ment had hitherto been received, and except for their discovery by the department 
 would remain neglected, it may readily be seen that the department is turning 
 over each year to the physicians of the city thousands of cases that would not 
 have come to them under other circumstances. 
 
 During the three years that this work has been in operation there has been a 
 definite decrease in the percentage of the number of individual defects found each 
 year, with the exception of defective teeth. The incidence of defective vision 
 has decreased from 13 per cent, in 1909 to 10 per cent, in 1911; defective nasal 
 
186 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 breathing, which implies the presence of adenoid growths, has decreased from 18 
 per cent, in 1909 to 11 per cent, in 1911, while hypertrophied tonsils show a decrease 
 from 22 per cent, to 15 per cent, in the same space of time. 
 
 This work in the schools, with its control of the contagious disease situation, 
 with the elimination of the school as the main focus of infection, the physical 
 examination of each child as soon as it enters school, before it is allowed to graduate, 
 and as nearly as possible every two years in the interim, the instruction of the 
 parents in the character of defects found, and in the necessity for treatment, and 
 the follow-up work necessary to induce parents to provide treatment or to record 
 their absolute refusal to do so, was performed during 1911 at a per capita cost of 
 43 cents. During this same year the per capita cost of the year's schooling in the 
 public schools of New York city was $43.90. 
 
 From a comparison of these figures and facts it would seem that one had a 
 right to conclude that from either an economic or humanitarian point of view the 
 city is justified in its expenditure by assuring to its future citizens that good health 
 which means virile and useful man- and womanliood. 
 
 The State has a wider duty in this matter, however, than merely to consider 
 the health of the child in its relation to its school progress. The broad and vital 
 questions which concern the health of the next generation are demanding attention. 
 
 In child hygiene, as it is viewed by the New York City Department of Health, 
 is implied the health surroundings and conditions of the child's entire life, not 
 merely the child in relation to any one jjhase of its development, nor in relation 
 to any one phase of its life in or outside of the home, but the child itself, from birth 
 to puberty, in relation to all the circumstances, conditions and incidents which 
 bear upon its life history and welfare. The health of the child to its fifth year has 
 a most important bearing upon its health between the fifth and fourteenth years, 
 which is the school age, while its health during that jjeriod is of equal importance 
 in determining its future welfare. Even during its school life the greater part of 
 its time is spent in the home or under influences which are not within the juris- 
 diction of the school authorities. Systematic and continuous oversight during 
 the entire life-cycle of the child is essential if we are to gain a well-rounded child- 
 hood. 
 
 In line with this policy the division includes in its activities the control of 
 niidwives who, in New York City, report about 40 per cent, of the total number 
 of births. The supervision and licensing of these women, under the authority 
 of the city, since the organization of the Division of Child Hygiene, has resulted 
 in a marked improvement in their methods, and consequently in the health of the 
 women and children under their charge. For six years the department has re- 
 quired that a 1 per cent, solution of silver nitrate be used by midwives as a pro- 
 phylactic measure for the prevention of ophthalmia neonatorum. The midwives 
 are required to report every case of sore eyes occurring in their practice, and 
 ophthalmologists are sent in each instance to determine if true ophthalmia 
 neonatorum is present. 
 
 For many years the statement has been made by competent persons that 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 187 
 
 one-quarter of all persons in the asylums for the blind were there as a result of 
 blindness due to ophthalmia neonatorum. In order to ascertain the result of the 
 activity of the department in this regard, a searching inquiry was made during the 
 past year to determine the present status of these cases. Inquiry was made of 
 every institution for the blind in New York City and throughout the State as to 
 the number of children under observation under five years of age, born in New 
 York City, and blind from ophthalmia neonatorum. This age limit was taken 
 as covering the time that the department's efforts might reasonably have shown 
 results. Only six cases were reported under this heading from all of the institutions. 
 The Committee on the Prevention of Blindness of the New York Association 
 for the Blind stated that their records under this heading showed but five or six 
 children of five years or under l)lind from this diseasea — total of twelve cases in 
 the entire State. In this point alone, in decreased human suffering, increased 
 efficiency, and economic independence, the gain is so vast that it cannot be com- 
 pared with the insignificant amount of money expended to produce such results. 
 
 The facts in regard to puerperal septicemia are also worthy of comment. 
 Every death that occurs in New York City from this disease is investigated by 
 the department. If a midwife has been in attendance at any time, even for a 
 period of only a few minutes, the case is listed against her record, and is classified 
 as one in which a midwife was in attendance. Notwithstanding this attitude, 
 which does not in any way give the midwife the benefit of the doubt, it has been 
 found that while approximately 40 per cent, of the births were reported by mid- 
 wives, only 24 per cent, of the deaths from puerperal septicemia can be charged to 
 their account, while physicians, reporting api)roximately CO per cent, of the births, 
 were in attendance at the time of confinement in the case of 70 per cent, of the 
 women who died from puerperal septicemia. 
 
 I have taken a few isolated instances of the work of the division simply to 
 give an idea of some of the directions in which a distinct value can be demonstrated. 
 No attempt can be made, however, within the limits of this paper, to cover the 
 many features of the work which are daily resulting in impro\'ed health and physique 
 to the children of the city. The work is an expression of the new relation between 
 boards of health and the public. It is not paternalistic, but rather social, economic, 
 and humanitarian; it is a definite recognition of the value of educational forces as 
 the predominant feature in modern sanitary methods. Its ultimate object is 
 one that is so broadly humanitarian in its purposes, and so stands for all that is 
 idealistic and valuable in our national life, that we may well agree with Croly, 
 who gives expression to the spirit permeating this constructive and far-reaching 
 effort to help children when he says: "The only fruitful promise of which the life 
 of any individual or any nation can be possessed, is a promise determined by an 
 ideal." 
 
 Mr. Folks: I am sure you will understand now what I said about the esteem 
 in which the Department of Health is held by the people of the City of New York. 
 
 I believe that the Bureau of Municipal Research of New York was actively 
 instrumental in securing a definite organization as a separate Bureau of the Depart- 
 
 14 
 
188 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 ment of Health, of the Bureau of Child Hygiene. The discussion of the general 
 subject introduced by Dr. Baker will therefore be opened very appropriately by 
 Dr. Jesse D. Burks, the Director of the Bureau of Municipal Research in Phila- 
 delphia. It is desired that the discussion be limited to infant hygiene, not in the 
 narrowest sense of the term, but rather covering the age period suggested by Dr. 
 Baker. I have great pleasure in introducing Dr. Burks. 
 
 DISCUSSION ON DR. S. JOSEPHINE BAKER'S PAPER 
 
 Dr. Jesse D. Burks: Dr. Baker has emphasized the advantage and importance of preventive 
 •work as opposed to curative or palhative work; and, by way of illustration, has given us some extremely 
 pertinent facts regarding preventable conditions among cliildren, especially among infants. Assuming 
 the value of a baby's life to be $100, she has called our attention to certain interesting financial 
 considerations, which indicate that New 'Vork might eliminate an annual loss of .$1,500,000 by saving 
 1500 babies every year. 
 
 To my mind, while such an argument furnishes a more or less striking and picturesque social appeal, 
 it is clear that a good many families that have babies could figure out that it costs them a good deal 
 more to bring up a baby than it does to bury one. The economic argument doubtless has its value, but 
 I do not regard this as the most effective appeal for preventive work. We are all willing to admit that 
 we ought to save the babies whether it costs $50 or $200 to bury one; or whether it costs more or less 
 to save a baby than to bury it. Dr. Baker may have foimd, however, that the men who appropriate 
 money for public purposes are influenced by the economic argument. 
 
 Dr. Baker has explained the favorable effect upon school children of the medical supervision pro- 
 vided by the Bureau of Child Hygiene. If the evidence shows that the health of school-children is 
 materially bettered by the work of medical examiners, we have a very substantial reason for supporting 
 a bureau of child hygiene. It is obvious that, unless the 750,000 children in New York public schools, 
 and the 175,000 children in Philadelphia public schools, are in physical condition to get from the school 
 what we expect them to get, there is an economic and educational loss not only to the children, but to 
 the community which is supporting the school, as well as the Bureau of Child Hygiene. 
 
 Dr. Baker then came to what she regarded as the fundamental appeal; that is, the humanitarian 
 appeal, the broad social interest in human life as such, which lies at the very foundation of such work 
 as the Bureau of Child Hygiene is doing. She brought out the importance of a new relation between 
 the health authorities and the community. It is this new relationship which furnishes the key to the 
 meaning of health work in a community; that is really at the bottom of what we are trying to do in a 
 Bureau of Child Hygiene. 
 
 I want to emphasize just one point which was rather assumed than brought out definitely in what 
 Dr. Baker had to say. One of the stock arguments of the stand patter is that we must not do anything 
 to pauperize the people. It is regarded as eminently proper to build automobile roads and speedways 
 for the use of those who use automobiles and drive fast horses. It is all right to build sewers and other 
 public works which everybody must use. But when it comes to furnishing milk and ice and medical 
 service to the unfortunate and handicapped, we are constantly met with the suggestion that we must not 
 pauperize the people. 
 
 Now, we went through exactly such a stage in the history of pubUc education. Public schools 
 were inaugurated as pauper schools; and there were undoubtedly arguments against the establishment 
 of public schools on the ground that we must not pauperize the people; that people should pay for their 
 education, otherwise they would not deserve or appreciate it. This last argument, of course, ceases to 
 have force when tlirough public taxation, everybody gets a chance to pay for education. 
 
 Education advanced through the pauper school stage, and the time came when the schools were 
 not only public but were generally patronized. Later public education passed through even this second 
 stage and reached a tliird stage; and we now have compulsory education. Public schools were first 
 for paupers; then they became free and general; and now have become general and compulsory. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 189 
 
 In the public health movement, wliich is just as fundamental a matter in a community as etliica- 
 tion, we are now at the place where we were in education about one hundred years ago. We are talk- 
 ing about pauperizing the people. We are actually providing nurse service and medical ser%'ice in 
 most of our communities, largely with the idea of taking care of tlie neglected poor. In some communi- 
 ties, as in New York and Philadeli)hia, we have carried the public health program somewhat further; 
 but not generally. The course of development for bureaus of child hygiene will certainly lead us to 
 the next stage, which is free medical service and free nurse service for all children whose parents call for 
 it. Within the ne.xt one hundred years, possibly the next fifty years, we shall get to the point of fur- 
 nishing medical service and nurse service to all cliildren; making it not only entirely free, and free from 
 the taint of pauperism, but compulsory. It will be an absolute requirement of the community that 
 every child shall submit to proper inspection, examination, and treatment as furnished by a bureau of 
 child liygiene. We are already coming to this point, in the inspection of school-children for contagious 
 disease. Indeed, the time seems to be rapidly apiiroaching when a bureau of child hygiene will be 
 regarded as a fundamental institution just as important to the community as the public school. Five 
 definite divisions or branches of this service will be required: 
 
 First, there must be a division of medical service, strictly speaking, having to do with the ex- 
 amination, inspection, and treatment of children. We .shall probably find that the preliminary ex- 
 amination of pupils for defects and inspection for symptom.s of contagious disease can be done by nurses 
 just as well, if not better, and at much lower cost, than by physicians. New York is now finding this 
 the case. It has recently been estimated that, by employing nurses to do this work, most of which 
 is now done by physicians. New York can save at least $53,000 a year. 
 
 Second, there will be a division of sanitation, having to do with questions of school sanitation and 
 home sanitation. This, of course, is not necessarily a medical function, but is closely related to this 
 whole problem of child hygiene. 
 
 Third, there will be a division of hygiene regvilation of the children's daily activities in school and 
 at home — largely again to be carried on by intelligent visiting nurses. 
 
 Fourth, there will be a division of instruction which will not only have charge of the instruction 
 of school-children in sanitation and hygiene, but the instruction of mothers in homes by the visiting 
 nurses and supervising physicians. This will doubtless include the much-debated subject of sex hygiene 
 instruction. 
 
 Fifth, there will be a division of physical education which will supervise the physical training of 
 children at school and may include adequate supervision and physical training of children before they 
 come into schools and after they leave. 
 
 These tentative proposals are submitted in the hope that they will suggest the large importance 
 which public hygiene and sanitation is likely to assume in the very near future. 
 
 Mr. Folks: The discussion will now be opened for a few moments to the friends who care to 
 participate, and I will ask them kindly to state their names as they arise. Each speaker is limited to at 
 most five minutes. 
 
 Mrs. \Villhm Lowell Putnam, Boston, Mass.: I want to ask Dr. Baker whether the doctors 
 and nurses supervise the mid wives? 
 
 Ur. Baker; You are now opening a very large question, and in the time at my disposal I cannot 
 take care of it. The midwife is not a theory at all. She cannot be ignored. She is here, and is going 
 to exercise her functions whether we license her or not. After an experience of three years with midwives, 
 as we have them regulated in New Y'ork City, I do not believe in ignoring them or refusing to license 
 them. I think we shoidd carry them farther than we have by giving them an adequate preliminary educa- 
 tion in properly equipped schools. In the State of Massachusetts, if I am not mistaken, the law does not 
 recognize midwives, and yet there are 5000 or 6000 cases delivered by midwives each year in Boston 
 alone. In addition to this number of reported cases there is also probably a large number of cases 
 treated by them which are not reported, because they are under no supervision. The deaths from 
 puerperal septicemia which occur in our cities cannot be attributed solely nor in greater part to the 
 midwives, since the proportion of deaths from this cause among cases delivered by them is not so large 
 as is the proportion of deaths in the cases delivered by physicians. As I stated in my paper, it has been 
 
190 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 found that while approximately 40 per cent, of the births were reported by midwives in New York, only 
 24 per cent, of the deaths from puerperal septicemia can be charged to their account, while physicians 
 reporting 60 per cent, of the births were in attendance at the time of confinement in the case of 76 per 
 cent, of the women w ho died from this cause. 
 
 I believe that existing conditions demand that midwives receive more supervision and training 
 than they are getting now, but I do not believe that they are the menace to the public health that many 
 people think. I am convinced that the question of the employment of midwives is one that we must 
 meet in all of our large cities. It is a natural and legitimate desire on the part of the women of the poor 
 to want midwives to attend them, since the midwife gives them infinitely more for their money than 
 does the physician who treats the class of cases now cared for by the midwife. We have established 
 in New York the first municipal school for the training of midwives in the United States. It is under 
 the auspices of the Bellevue and Allied Hospitals, and directed by Dr. Brown, of the Bellevue Hospital. 
 I wish you could send all the midwives there for training. 
 
 Dr. W. S. Newmater, Philadelpliia: I should like to ask Dr. Baker how much money was ap- 
 propriated by the City of New York for the work of the Department of Child Hygiene in the years of 
 1911 and 1912.? 
 
 Dr. Baker: In 1911, approximately $390,000; in 191i, approximately $600,000. 
 
 Mr. Folks: That is not paternalism, yet it is frequently spoken of as paternalism. 
 
 Miss Perkins, Philadelphia: What are the duties of a visiting nurse in New York? 
 
 Dr. Baker: I suppose you mean with relation to infant mortality. The work is divided into 
 two sections — that of the milk station and that of the so-called district visiting. We have one nurse in 
 each milk station and we have 55 milk stations. The district nurses are those who do the school work 
 in winter. Each nurse visits 150 babies and she gets to them each at least once in ten days. She re- 
 ports to the central office every day the exact status of each baby visited, so that the central office is 
 in constant touch with the condition of the entire number of babies under supervision. During the 
 past year these nurses at their visits instructed mothers in the care of babies. We prefer to work only 
 with the well babies, turning the sick over to some other agency. Last year we had about 17,000 babies 
 under the care of the district nurses. 
 
 Mrs. Cooper, San Francisco: I should like to know by what method you get in touch with the 
 well babies in New York. 
 
 Dr. S. Josephine Baker: We have the birth registry and the records sent in by midwives just 
 as soon as they are received in the department. The names are copied off and given to the nurses, 
 who are instructed to visit them at the earliest opportunity, which is certain to be within ten days of 
 birth. We do not visit any babies except those whose births are reported by midwives, although should 
 a nurse in going through a tenement house find a baby in a family which is not able to maintain a doctor 
 except for the actual confinement, we look into these cases also. 
 
 Miss Perkins, Philadelphia: I would like to speak of the work of the district nurses of Phila- 
 delphia. Their work is probably along the same lines as that of the New York nurses. We, too, re- 
 ceive some early reports from the midwives, and such cases are visited within twenty-four hours of the 
 time at which the report is received. A general observation is made, necessary advice is given, and if 
 any such condition as ophthalmia neonatorum is discovered, it is, of course, reported at once to the 
 proper medical authorities. With our eight nurses last year we made 30,000 visits, entering more than 
 6000 homes. 
 
 Mr. Folks: It may have occurred to some that the work outUned for the school-children was 
 very advanced, and some conservative citizens have doubted whether it was wise and proper. I think 
 they would be reheved and encouraged if they would read of the work as it is carried on very much 
 along these same lines in Great Britain and Germany. You will find, if you do not yet happen to have 
 read it, an exceedingly interesting article in "The Psychological Clinic," published by the University 
 of Pennsylvania, in either February or March, describing that work fully, and telling of the medical 
 examination of school-children in certain foreign countries and the operations of various kinds. This 
 medical work is carried on in direct connection with the school authorities, and the work is carried to 
 
PROCEEDINGS OF COXFEREXCE OX IXFAXT IIYGIEXE 191 
 
 its logical conclusion. I think we are only at the beginning of the development of school hygiene work 
 in connection with our children. 
 
 Mrs. Wilu.^m Lowell Putnam: Have you no institution.s for childbirths in New York.' 
 
 Dr. B.vker: There are several lying-in hospitals, but no accurate study has ever been made of 
 the exact amount of service that they render to the public. A superficial study, which has been made, 
 shows clearly that they are not at all adequate to the needs of the situation. 
 
 Mrs. Putn.^m: Then the people select the midvvives instead of going to these institutions? 
 
 Dr. B.\ker: Yes, we cannot reach everybody with these institutions. Tliey do not have the 
 capacity; they would have to reach abovit 75,000 cases a year if we covered the whole population. 
 
 Mrs. Putn.\m: Then you select the midwivcs' cases for your visiting nur.scs because you think 
 they need the care more.' 
 
 Dr. Baker: Y'cs, certainly. Aside from this, it gives us the opportunity of keeping in touch 
 with the midwives. 
 
 Mr. Folks: I tliink, now, in order to listen to all the papers, if there is no 
 objection, we will proceed to the next .sul)ject, and recur to this if we have time 
 later on. The next paper is on "Infant Milk Depots," by Dr. Rowland G. Free- 
 man, member of the Advisory Board of the New York Milk Committee: 
 
 INFANT MILK DEPOTS* 
 BY ROWLAND GODFREY FREEMAN, M.D. 
 
 Adjunct Professor of Pediatrics, University and Bellevue Hospital iledical School, \ew York City 
 
 The terrible mortality of children under one year of age, who are for the most 
 part born into the world with jierfect organs and who die only becau.se they are 
 deprived of the essential conditions of good health in infancy, is evidently one 
 that can and .should be speedily eliminated, or, at least, materially reduced. 
 
 This mortality has been a matter of some concern for many years, and the 
 attention it has received and the study of means of lessening it has already resulted 
 in cutting it down about one-half, so that in our well-administered cities now, 
 instead of finding a loss of one child in every three during the first year, or a mortal- 
 ity of 30 per cent., such as existed in New York some years ago, the city lo.ses less 
 than one child in every six, or, to be more accurate, about fourteen in every hundred 
 born. 
 
 These figures, however, scarcely represent the terrible mortality among 
 artificially fed children among the tenements, for while 80 per cent, of our babies 
 in New York are breast-fed and show a very slight mortality, there is such an over- 
 whelming mortality among the 20 per cent, of artificially fed babies as to bring 
 the mortality of the whole up to 14 per cent. It is evident, therefore, that the 
 mortality in artificially fed babies, which is unknown, probably represents some- 
 
 *The cuts accompanying this article are loaned by courtesy of .\rchives of Pediatrics, in the Octo- 
 ber, 1912, issue of which this article was published. 
 
192 
 
 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 thing like 70 per cent. It would seem, then, that the reduction in such mortality 
 is not so much a matter of a change of environment, because breast-fed babies 
 do fairly well in a poor environment, as it is a matter of feeding. 
 
 It is a well-established fact, from our experience in institutions, that there 
 
 
 
 
 
 
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 Fig. 1. — In order to ascertain the efficiency of tbe establishment of milk depots, the mortality in the 
 towns ha\-ing milk depots in 1904 was compared with that of the same towns in the year 1898, and, 
 as seen in this chart, the mortality in all the eleven towns containing milk depots showed some 
 diminution. 
 
 are some babies, at least in some institutions, who cannot be brought up on any 
 artificial food. These children need breast milk, and if our institutions could 
 arrange to supply a moderate amount of breast milk to very young babies that 
 will not thrive on artificial food, their mortality would be greatly reduced. 
 
PROCEEDINGS OF CO\FERE^'CE OX LXFAXT IIVGIEXE 193 
 
 Under the best conditions the babies are very rare that cannot be successfully 
 fed on artificial food, and wet-nurses are seldom resorted to in private practice 
 by resourceful pediatricians. 
 
 In private practice, where few babies are breast-fed, and then only for the 
 
 Fig. i. — In order to be sure that this was not due to other conditions than the milk depots, the mortality 
 in the same year of these eleven towns was compared with eleven neighboring towns in w-hich no 
 milk depots were established, and it was found that in the last eleven towns there was an invariable 
 increase in mortality in VMi over 1898. 
 
 first three or six months, not one in 150 dies during the first year, as against the 
 infant mortahty of 21 in 150 in New York City. So that this enormous mortality 
 would seem theoretically to be largely controllable by supplying these babies in 
 
194 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 3 Cor^MoNt^ nn, 
 
 DH CoH-bULTATiOH 
 
 He. r^our^r^i^^oH^ 
 
 the tenements with proper food, and, as we shall see later, the result of doing this 
 has been remarkable. 
 
 Several different organizations have been used for the reduction of infant 
 mortality, and in France, where, on account of the low birth-rate, infant life is 
 
 more vital to the prosperity of 
 the country, and vigorous means 
 have been taken to lessen infant 
 mortality, the first organizations 
 of this sort were established. 
 
 The first milk depot was es- 
 tablished in Paris by Dr. Variot 
 in 1892, one year previous to the 
 establishment of the Straus milk 
 depots in New York. Other 
 institutions for the accomplish- 
 ment of the same purpose have 
 been organized in France, where 
 there are three types of such 
 institutions — the Mutualite Ma- 
 ternelle, intended to help the 
 mothers who are nursing their 
 babies, as well as to assist in the 
 intrauterine development of the 
 child and to assist the mother, if 
 necessary, during the first months 
 of the child's life while she is 
 nursing it; the Consultations de 
 Nourrissons, which are attached 
 to the obstetrical clinics and are 
 intended to encourage the moth- 
 ers to nurse their children, if 
 possible, and, where necessary, 
 to furnish a proper substitute for 
 breast milk; and the Gouttes de 
 Lait, which are simply milk dis- 
 pensaries where, while nursing is 
 encouraged, proper advice con- 
 cerning artificial feeding is given. 
 The benefit derived from all 
 these institutions has been so evident that their organization has spread rapidly, 
 and milk depots may now be found in most of the countries of the world — in 
 France, Spain, Russia, Sweden, Italy, Switzerland, Germany, England, as well as 
 in South America and Africa. New York city now has some 75 milk depots, 55 of 
 which are under the supervision of the Department of Health. 
 
 Fig. 
 
 3. — In Auxerre, in 1898, with no milk depots, 205 
 infants under one year of age of every 1000 born died; 
 in 1904, with some milk depots, 140 died; wliile in 
 1905, with a considerable increase in milk depots, only 
 60 died. The mortality at the same time in infants 
 fed at the milk depots was considerably less — only 13 
 per 1000 in 1904 and i7 per 1000 in 1905; while in 
 this chart these results are compared with other towns 
 having no milk depots, giving a mortality of 120, 157, 
 and 214 per 1000. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 195 
 
 The first milk depots were all, I believe, organized through private philan- 
 thropy, but in recent years municipalities have undertaken their organization. 
 In this country I have personally felt that this work was safer in the hands of 
 private philanthropy, but I believe that those now organized unflcr our New York 
 Health Department will, for the present at least, be free from political interference. 
 
 Now as to organization. The ideal milk dejjot, to my mind, is one equipped 
 with rooms for preparing the milk, pasteurizing it in the nursing bottles and 
 distributing it from depots very near the home of the mother at cost, or to the 
 destitute free. The ideal equipment for 
 accomphshing this would be a large plant 
 for preparing and pasteurizing the milk, 
 with a consulting-room and dispensing- 
 room attached and with refrigerator 
 wagons for transporting the milk. There 
 should also be a number of substations 
 for distribution and consultation, with 
 still more substations for distribution 
 only. Each of the consulting stations 
 should be provided with a physician, who 
 would spend certain hours there eacli 
 day, and a nurse, who would spend all 
 her time on the work in the depot and 
 the homes. 
 
 This scheme provides the most eco- 
 nomical method of preparing and dis- 
 tributing the milk. It provides consult- 
 ing rooms, where the mother may take 
 her baby once a week for weighing and 
 for ad\'ice, as well as nearer distributing 
 stations, where the milk may be obtained 
 on other week days without going as far 
 as the consulting station. 
 
 It was estimated that for New York 
 an endowment of $5,000,000 would be 
 necessary to establish and support such 
 
 plants in all boroughs, and although efforts were made to obtain this endowment, 
 no philanthropist could be found who was willing to furnish the capital. 
 
 The Straus milk depots endeavored, in a limited way, to carry out these ideas. 
 They have used certified milk which has been pasteurized in the nursing bottles 
 and which was distributed with a sterile nipple for each bottle. They have not 
 accomplished all that they might, because, in the first place, there are too few of 
 them, and not a sufficient equipment of doctors and nurses. 
 
 Although I believe the ideal equipment is what should be pro\-ided, I am 
 convinced that very efficient work can be done with less equipment, where the 
 
 
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 i. — In Sens the mortality before the es- 
 tablishment of milk depots, in 1898, was 
 IIG per 1000. This fell in 1904 to 80 and 
 in 1905 to -tT; while the mortality among 
 the children fed at the milk depots was ii 
 in 1904 and iG in 1905. 
 
196 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 funds are limited, when certified milk is distributed and clinics are held by phy- 
 sicians, and nurses are provided who are active in the milk depots and at the 
 homes. Thus the New York Diet Kitchen Association which, with a small income 
 from subscriptions and endowment, was doing a very limited work in dispensing 
 milk to babies and invahds, has recently rapidly expanded its work through a 
 policy of charging those who can afford to pay, so that during the past year, with 
 
 S"^ T'ok.- 3\jn- >^c.< 
 
 Fig. 5.— In Ville de Toucy, while before the 
 establishment of milk depots the mortality 
 of infants under one year was 197.3, it fell 
 in 1905 to 1'20 and in 190G to 50.5. 
 
 Fig. 6.— At St. Pol-sur-Mer, a mortality of 2S8 
 before the establishment of milk depots 
 was reduced to 151. 
 
 an income of some $82,000, $45,000 of which was contributed by the mothers 
 who bought the milk, they have been able to dispense more than a million quarts 
 of milk from nine stations, and their results have been wonderfully good. Con- 
 sultations with physicians are held, and trained nurses have been attached to some 
 of the depots and will soon be attached to all. The mortality in the cases treated 
 at these depots has been extremely small. Of 2421 babies under their care between 
 June and October last, four months, including the summer months, they report 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 197 
 
 
 only thirty deaths from all causes, a mortality of 1.2 per cent, for these hot summer 
 months. Their results, I lielievc, could not be very materially improved were the 
 milk dispensed pasteurized in nursinp bottles. 
 
 On the other hand, I still believe that where funds are available the scheme 
 that I first mention should be carried out. 
 
 As to the results of milk depots in lowering mortality, it has been found that 
 where they are generally estab- 
 lished so as to sujjply all the Viuceuv^ - s>.n-'(.""W-Hiw~t.t d> t. 
 babies that need their help a re- 
 duction of about 60 per cent, is 
 obtained. This has been repeat- 
 edly demonstrated in France, and 
 the accompanying charts show 
 similar results from different sorts 
 of milk charities both in France 
 and in this country. 
 
 Excellent illustrations of the 
 efficiency of infant milk depots 
 on mortality are the results of 
 the establishment of milk depots 
 in the villages in the Province 
 of Bouches-du-Rhonc in southern 
 France, as shown graphically in 
 charts by P. Budin.* 
 
 The general movement for 
 the establishment of milk depots 
 in this province was begun in 
 1903. In order to ascertain the 
 efficiency of this establishment of 
 milk depots, the mortality in the 
 towns having milk depots in 1904 
 was compared with that of the 
 same towns in the year 1898, 
 and, as seen in Fig. 1, the mor- 
 taUty in all the eleven towns 
 containing milk depots showed 
 some diminution. In order to 
 be sure that this was not due to 
 other conditions than the milk 
 
 depots, the mortality in the same years of these eleven towns was compared with 
 eleven neighboring towns in which no milk depots were established (Fig. 'i) and it 
 was found that in the last eleven towns there was an invariable increase in mor- 
 tality in 1904 over 1898. 
 
 *"La Mortalite Infantile dans les Bouches-du-Rhone," by Pierre Budin. L'Obstetricjue, July, 
 1907. 
 
 . 7. — In Villeneuve-sur-Yonne. a morUlity of 103 was 
 reduced to only 3-2, while the mortality there in milk- 
 depot-fed children was G6 in 190-1 and in 1903. 
 These figures are compared on this chart with those 
 of three other towns of the same district having no milk 
 depots, which show a motality in 1905 of 17G, 163 
 and 117. 
 
198 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 These figures encouraged the expansion of this work, so that in 1905 a very 
 much larger number of infants were fed, and with this a greatly diminished death- 
 rate was noted. 
 
 Thus, in Fig. 3, it will be seen that in Auxerre in 1898, with no milk depots, 
 205 infants under one year of age of every 1000 born died; in 1904, with some 
 milk depots, 120 died; while in 1905, with a considerable increase in milk depots, 
 only 60 died. The mortality at the same time in infants fed at the milk depots 
 
 
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 ww; 
 
 I^H 
 
 ^^^^^■■smv 
 
 ^H 
 
 s\\mi 
 
 Fig. 8.— Comparison of the death rate in Yonkers before and after the establishment of milk depots 
 with that of other neighboring cities of similar size without milk depots. 
 
 was considerably les.s— only 13 per 1000 in 1904 and 27 per 1000 in 1905; while 
 in this same chart these results are compared with other towns having no milk 
 depots, giving a mortality of 120, 157, and 214 per 1000. 
 
 Again, at Sens (Fig. 4) the mortality before the establishment of milk 
 depots in 1898 was 116 per 1000. This fell in 1904 to 80, and in 1905 to 47; while 
 the mortaUty among the children fed at the milk depots was 14 per 1000 in 1904 
 and 26 in 1908. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 
 
 199 
 
 MoI\TA.uiT1 m 
 New lORl^ City 
 
 Again, in Ville de Toucy (Fig. 5), while before the estahhshment of milk 
 depots the mortality of infants under one year was 197.3 per 1000, it fell in 1905 
 to 120, and in 1906 to 50.5. 
 
 At St. Pol-sur-Mer (Fig. 6) a mortality of 288 before the establishment 
 of milk depots was reduced to 151; while in Villencuvc- 
 sur-Yonne (Fig. 7) a mortality of 1C3 per 1000 was re- 
 duced to only 32, while the mortality there in milk-depot- 
 fed children was 66 in 1904 and none in 1905. These 
 figures are compared on the same chart with those of three 
 other towns of the same district having no milk depots, 
 which show a mortality in 1905 of 176, 163, and 117. 
 
 If we take the average of the reduction in mortality 
 in Auxerre, Sens, \ille de Toucy, St. Pol-sur-Mer and 
 Villeneuve-sur-Yonne, we find that the infant mortality 
 in these towns after the establishment of milk depots was 
 about 38 per cent, of what it was before, showing a 62 
 per cent, reduction in mortality. 
 
 In this country marked reduction in infant mortality 
 following the establishment of infant milk depots has been 
 noted by Getty* in Yonkers (Fig. 8), where milk depots 
 were established in 1895. P^or three years previous to the 
 establishment of milk depots the deaths of children under 
 five years of age averaged 162 per 1,000. In 1896 they 
 were reduced to 135, while the deaths for the three years 
 previous to the establishment of these depots from diar- 
 rhea had been 91, they were reduced in 1896 to 48. Dur- 
 ing the same period the mortality in three neighboring 
 towns of similar population showed usually an increase in 
 1896 over the period of 1892-95 for the class under five 
 years of age, and also from diarrhea. 
 
 In New Y'ork a diminution of mortality following the 
 establishment of milk depots also occurred, although there 
 were other factors that were active at that time, and this 
 reduction cannot be attributed entirely to milk depots. 
 The mortality of infants under one year, before the estab- 
 lishment of milk depots in 1891 (Fig. 9), was 244, while in 
 1902 it was reduced to 158, and in 1906 to 144. They 
 reached, however, only 3,500 out of a population of 
 205,000 infants under two years. 
 
 The best illustration of the benefit of milk depots 
 in New York City is the result of observations carried on by the Rockefeller Insti- 
 tute under the supervision of Drs. Park and Holt,t on the condition of children fed 
 
 * New York Medical Journal, No. 15, 18, pp. 484-489. 
 t Archives of Pediatrics, No. li, 1903, pp. 881-909. 
 
 Fig. 
 
 9. — In New York a 
 diminution of mortal- 
 ity following the estab- 
 lishment of milk depots 
 also occurred. The 
 mortality of infanta 
 under one year, before 
 the estal^lishment of 
 milk depots in 1891, 
 was 244, while in 1902 
 it was reduced to 158 
 and in 1906 to 144. 
 
200 
 
 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 !*^l\TALiTY Of* CHn.nKEHO«:,«f^veo 
 
 m^up\rie^ "NiVK:*.trEx.»-».iv 
 
 lNVCiTiGA,T'OH 
 
 IH MG.W ^oivK. C nif 
 
 
 Com DEW- 
 
 6Tont 
 
 Goopo 
 
 BoTTi«Jl 
 
 Milk 
 Det-oT 
 
 
 7oc»tL». 
 
 ItCwtt-tt 
 
 jacMiuB 
 
 H5 Chkj 
 
 
 1^ D 
 
 iSS\ 
 
 513 . 
 
 + n 
 
 . ^1 
 
 
 
 
 
 JW 
 
 
 
 
 
 
 
 
 11 
 
 le 
 
 n 
 
 Ihbhh 
 
 
 
 
 
 
 
 
 
 
 11 
 
 
 
 1 
 
 IX 
 
 
 
 II 
 II 
 
 1 
 
 ^^B^^HI "^ 
 
 
 
 7 
 
 
 
 
 
 ■- 
 
 ■rr 
 
 1 
 
 
 Fig. 10. — The best illustration of the 
 benefit of milk depots in New York 
 city was the result of observations 
 carried on by the Rockefeller Insti- 
 tute under the supervision of Drs. 
 Park and Holt on the condition of 
 children fed in the tenements on dif- 
 ferent sorts of food. The mortality 
 of 70 children ted on condensed milk 
 during the summer was 20 per cent.; 
 while of those fed on store milk it 
 was 19 per cent.; on good bottled 
 milk, 9 per cent.; while the infants 
 fed from milk depots showed a mor- 
 tality of only i.l per cent. 
 
 in the tenements on different sorts of food, as 
 seen in Fig. 10. The mortahty of seventy- 
 children fed on condensed milk during the 
 sunnner was 20 per cent.; while of those fed 
 on store milk it was 19 per cent.; on good 
 bottled milk, 9 per cent.; while the infants fed 
 from milk depots showed a mortality of only 
 2.7 per cent. 
 
 It is evident from the results indicated in 
 the foregoing figures that if milk depots could 
 be established in New York with a sufficient 
 number of distributing points, so that each 
 tenement-house mother could readily obtain 
 proper milk for her baby, a reduction in infant 
 mortality .similar to that shown in certain 
 towns in France should be accomplished; that 
 is, a reduction of about 60 per cent., so that 
 the 17,000 deaths under one year should be re- 
 duced by 10,500, or to 6500, while a consider- 
 able saving in the lives of children between one 
 and two years of age would also result, and 
 that while every small movement of this sort 
 will have an impression, no very evident fife- 
 saving can be brought about, or useful lesson 
 for other communities taught, unless such 
 depots are established on a large scale. 
 
 It is interesting to ascertain, if possible, 
 whether this decrease of 60 per cent, is owing 
 to the dispensing of a clean, healthful milk or 
 to the education of the mothers, which is a 
 part of the function of milk depots. We, for- 
 tunately, have had in New York an oppor- 
 tunity of ascertaining fairly accurately what 
 can be done by education alone, for the Asso- 
 ciation for Improving the Condition of the 
 Poor in our city has always held that the poor 
 shoidd be helped by teaching them to help 
 themselves and not by establishing plants to 
 help them, and their attitude was probably one 
 reason why it was impossible to obtain a large 
 bequest for the establishment of milk depots. 
 
 To show the effect of education alone, this 
 Society equipped one Assembly District in 
 New York with ample doctors and nurses, who 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 201 
 
 visited the homes, established cHnics at a central depot, and instructed the mothers 
 in the essentials for the preservation of health in their children and the details of 
 the preparation of the milk, allowing them, however, to purchase the milk at the 
 grocery. To what extent they directed the mothers to good milk supplies I do 
 not know, but from their results I imagine that not much was done in that w\iy. 
 An indication of the amount of work they did can be shown by the fact that they 
 visited more than 116,000 families, where they gave instruction in feeding, cook- 
 ing, clothing, fresh air, nursing and general care. 
 
 The mortality in this Assembly District, as compared with the rest of the 
 city, showed that while the total deaths from all causes in the entire city increased 
 4 per cent., in this Assembly District they diminished 11 per cent.; while the 
 deaths from diarrhea in the whole city increased 1 i)er cent., in this .Vssembly Dis- 
 trict they diminished 10 per cent.; and the total deaths from diarrhea under five 
 years, which in the whole city increased 3 per cent., in this Assembly District 
 diminished I'i per cent.; so that we get a diminution in mortality in this Assembly 
 District of about 15 per cent. Wc may, therefore, conclude that the educational 
 features of milk dejiots will not give us much more than a 15 per cent, reduc- 
 tion in infant mortality, but we have already seen that milk depots with edu- 
 cation produce a 60 per cent, reduction in mortality, so we are left to credit good 
 milk with about 45 per cent. 
 
 These figures, while not accurate, seem to me significant, and I believe the 
 claim of philanthropists, that education, not milk, is necessary, is false. The 
 poor need education, but they need clean, healthful milk much more. 
 
 Mk. Folks: The discussion of Dr. Freeman's paper will be opened by Dr. 
 William C. Woodward, Health Officer of the District of Columbia. 
 
 DISCUSSION ON DR. RO\M>.\ND G. FREEMAN'S PAPER 
 
 Dr. \Yillia.m C. Woodward: I am sure we have listened with a great deal of interest to what 
 has been said about the work of milk stations. Certainly no one will deny the importance of milk 
 stations, nor the wonderful good that they accomplish through the food which they distribute. As 
 has been pointed out, however, there are two factors to be considered in the work of milk stations, one 
 being the food, and the otlier, the instruction. I would not be understood as belittling the importance 
 of the food when I say that the instruction is both for present purposes and for the future, in my judg- 
 ment, the more important. The supplying of a good milk through the medium of milk stations is im- 
 portant for two main reasons; the first is that it insures the baby a clean safe food, and the second, that 
 it gives an educational agency access to the home. 
 
 I can hardly understand how the supplying of good milk alone could by any possibility have ef- 
 fected a reduction of CO per cent, or even of -15 per cent, in the mortality among children less than one 
 year of age. I say that because, so far as I know, although I must confess that I have not looked into 
 the figures recently, the mortality from diarrheal diseases among children of one year of age and under 
 has nowhere been reduced by anything like 00 per cent, or even -13 per cent. Possibly 25 per cent, to 
 30 per cent, would fairly represent the percentage reduction in the mortality from these diseases. If 
 the distribution of milk had totally arrested diarrheal diseases, we could not even then look for a re- 
 duction of anything like 45 per cent., while, as a matter of fact, we know that the milk depots reach 
 only a small proportion of the children in any community. 
 
 It may be said that milk depots exert an influence on the prevention of disease and death resulting 
 
202 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 from other causes than diarrheal diseases, and that, of course, may be true; and yet I think we must 
 admit that that is a rather remote influence, so far as the food itself is concerned. We can hardly say 
 that these depots, tlirough their milk, prevent pneumonia, bronchitis, diphtheria, scarlet fever, or other 
 contagious diseases in the first year of life. For that reason I think we must attribute the improvement 
 not so much to the milk as to the influence of the nurse who must accompany the milk. 
 
 There is another factor that possibly is not generally understood, with respect to this infant mor- 
 tality in the first year of life, and that is a factor which the milk station can influence but little. I 
 refer to the mortality on the first day of life. Certainly we camiot attribute to a milk station any in- 
 fluence over that mortality; and yet, speaking for my own city of Washington, we found, for instance, 
 in 1911, that out of 957 deaths that occurred in the first j'ear of life, 151 occurred on the first day, 130 
 occurred between one day and one week, and 114 between one week and one month. In other words, 
 41 per cent, of the mortality in the first year of life occurred in the first month, and about one-sixth 
 occurred on the first day. These, of course, are not exceptional figures, because in the previous year, 
 out of 1070 deaths, 150 occurred on the first day, and in the year preceding that, out of 1042 deaths, 140 
 occurred on the first day. So we must look somewhere beyond the milk for the prevention of infant 
 mortality. W'e must look to the education of the mother, and the education of the older sister, and 
 the providing for needs other than the mere need of proper food. 
 
 We must begin the education of the mother before the child arrives, so that we may arrest at least 
 some part of this mortality of the first day of life, and we must follow the child through the first day and 
 onward more closely than we have done or are doing now. 
 
 One thing with respect to midwives. It may be a little out of relation to the discussion of milk 
 stations, and yet from my point of view, attaching as I do so much importance to the educational work, 
 it is interesting to find that while we have diminished the percentage of births attended by midwives 
 from about 50 per cent, of the total number to 15 per cent., nevertheless this terrible mortality in the 
 first day of life and in the first week and first month has not diminished, but has actually risen. The 
 number of babies that die on the first day of life is greater now than it was five years ago, whether you 
 compute it on the basis of the total population, or whether you compute it on the basis of the births 
 registered. 
 
 And so we come to the second factor of the work of the milk station, and that is the educational 
 work. I have said that the milk station is valuable, both because it provides for the needs of the baby 
 by giving it the milk it must have, and, what is more important in the long run, because it provides 
 for the education of the mother and of the older sisters and brothers; so that as time goes on we will 
 have more intelligent preparation for motherhood, and we shall have a better provision for the infant 
 when it arrives. I agree most thoroughly in everything that has been said respecting the importance 
 of a proper diet; but I think, after all, that there is a probably greater amount of good resulting from 
 the education that goes with the diet. 
 
 Mr. Folks : The question of milk stations is now open for general discussion 
 for about fifteen minutes, and no speaker may occupy more than five minutes. 
 
 Dr. S. Josephine Baker: I agree with Dr. Woodward most thoroughly as to the educational 
 value of the milk station, and I hope this side of the work will receive still greater emphasis in the future 
 than it has hitherto. In fact, the only reason for furnishing milk at milk stations at the present time 
 is, so far as I know, because no municipality is able to supply its citizens with a steady supply of good 
 milk for infant feeding, and if I am not mistaken. Dr. Freeman advocates having suflicient depots around 
 the city, or having the milk stores so carefully regulated that the people may get pure milk at all times. 
 I should like to see the time arrive when a mother may obtain proper milk in any part of the city, and 
 then the milk station may be used wholly for educational purposes. 
 
 The point brought out by Dr. Woodward with regard to the question of deaths of babies in the 
 first days of life is exceedingly interesting. Practically the entire reduction in infant mortality in New 
 York City has taken place in dia rrheal diseases. Practically no reduction is noted in the large number of 
 cases of congenital disease, so called, from wliich the deaths occurred during the first few weeks of life. 
 
PROCEEDINGS OF COXFEREXCE OX IXFAXT UYGIEXE 203 
 
 They furnish about 35 per cent, of the total number of deaths, and they are just as high now as they 
 were twenty years ago. 
 
 There is no question whatsoever that if we are to reduce our infant mortality very much further, 
 we have got to concentrate our attention upon the so-called congenital cases, and, consequently, the milk 
 station must be more and more an educational center for the prenatal care of the mother. \Ve are try- 
 ing to develop that work, and it is exceedingly difficult, but I think we shall be able to carry it out to 
 some degree. 
 
 We are also educating the girls in the public schools. \Ve have had our "little mothers' " meet- 
 ings, and last year 20,000 school girls were taught the proper way to take care of babies. 
 
 Another point I want to bring out is that I have the greatest admiration for the work of the New 
 York Diet Kitchen Association. I have been associated with that for the last two years. We must 
 not, however, rely too much on the city for funds for work of this nature. For two years the Depart- 
 ment of Health has furnished to these eight stations the dix^tors and the nurses, and, of course, their 
 salaries have been paid entirely by the city, so that the educational side of the work at the eight stations 
 has been paid out of the city funds. The results are admirable, but it is not (juitc the proper proportion 
 of expenditure to credit them all to the private agency. 
 
 The medical attendance and inspection of the infant arc looked upon as so integral a part of the 
 work of our milk stations that in one instance last summer, when a mother persistently refused to bring 
 her child to the milk station, where it.s progress could be watched, and where she could be taught as to 
 its proper care, she was no longer allowed to receive milk for herself and for the baby. 
 
 Dr. W. S. Cornell: It seems to me that considerable money and effort could be saved in the 
 distribution of milk if that work could be taken over by drug-stores, all of which possess facilities for 
 caring for milk. The proper sort of milk would then be available in every neighborhood in the city. 
 In a very short time the druggist would learn to kni)W the amount of milk necessary to carry to meet 
 the daily demand of his particular locality, which would in.sure against waste. 
 
 I believe that the modification of milk is sometimes, I wont say overdone, but perhaps given 
 relatively too much attention, compared with some of the other important factors. If we used three 
 standard modifications, for instance, and devoted more time to the other factors involved in the problem, 
 we couM probably get better results in the long run than we do now. I believe that we could have this 
 milk certified by the proper authority, the Bureau of Health, for instance, tested by its experts, and then 
 placed in these drug stores, where it would be available for the private physicians of the neighborhood. 
 We talk much of the physicians in connection with this work, having in mind the dispensary physician, 
 who is usually a young man, connected with the teaching staff of some one of the medical colleges, and 
 through this connection, more or less trained in pediatrics. But we should not forget that two-thirds 
 of the children never see such a doctor. They are treated by physicians untrained in pediatrics, and 
 often not even American born, men who are out of touch with the whole situation. These men feel that 
 they are likely to lose their patients if they refer them to the milk stations, and consequently they do 
 not; and we can scarcely blame them for adopting measures which are likely to lose them their means 
 of livelihood. If we place good milk within reach of their patients, I believe they will take advantage of 
 the opportunity to use it. I think we should at least cooperate with them to this extent. 
 
 I think also that the druggists would be very glad to handle the milk, because such procedure 
 would be more or less of an advertisement for them. 
 
 Miss Perkins: I have been able to observe the work of the milk stations in Philadelphia for 
 the last two years, and have come to the conclusion that the distribution of milk alone does not solve 
 this feeding problem. What the mothers obtain from the milk station is an article already prepared for 
 them; if for any reason the time comes, and it does come very frequently, when these mothers have to 
 move out of the range of a milk station, they are at once deprived of its advantages, and utterly unfitted 
 to secure or supply a substitute. Therefore, I feel that the best way in which to help these mothers 
 is to teach them how to modify the milk in their homes, and to impress upon them the necessity of always 
 securing a good milk, advice concerning wliich point can always be obtained from the Department of 
 Health. This not only equips the mother against all emergencies, but, as has been said, opens the home 
 for a more satisfactory carrying out of our follow-up work. Neglect of this provision is one of the under- 
 lying reasons for the extensive use of condensed milk and other equally objectionable proprietary foods. 
 15 
 
204 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Mr. Folks: K the chair may talk for just a second, I would like to point out that the milk station 
 is only one of our agencies. After all, it is a development from the medical and nursing station, and is 
 only one of four or five directions in which we are rapidly advancing, for the benefit of the whole com- 
 munity, our medical and nursing service. In the course of the last year I have become very radical in 
 one thing, although very conservative in most things. It has become perfectly clear in my mind that in 
 the very near future the medical and nursing professions will be just as much servants of the public 
 and organized for the benefit of the entire community as is the teaching profession today. We are 
 headed directly and rapidly in that direction, and, in my judgment, the faster we go the better. 
 
 Dr. Freeman: I would like to ask Dr. Woodward if his conclusions were based on reliable statis- 
 tics, for otherwise I think they must have been largely hypothetic. We do not claim that a reduction 
 of 60 per cent, in the mortality was effected solely by the supplying of pure milk, and it was not so stated 
 in my paper. I do not belittle at all the educational value of the milk station, but I tried to emphasize 
 the other side of the problem — the value of good milk — because I think the social workers ought to know 
 and appreciate its value. 
 
 Mr. Folks: When we handle percentages we are very likely to get into trouble unless we state 
 whether it is a percentage of total mortality, or whether it relates to a particular case or district. 
 
 Dr. Woodward: I did not mean to say that a reduction of 60 per cent, did not occur, but that 
 a reduction of 60 per cent, had not occurred simply because of the distribution of food. I would esti- 
 mate that a certain part of that 60 per cent, was due to the education that goes along with the milk 
 distribution. 
 
 Mr. Folks: We ■nill jiroceed to the next topic, which i.s "Social Service 
 Work in Relation to The Conservation of Child Life." I have pleasure in present- 
 ing to you Dr. Fritz Talbot, of the Pediatric Department of the Harvard Medical 
 School. 
 
 A CONSIDERATION OF THE SOCIAL SERVICE WORK OF 
 
 THE DEPARTMENT OF DISEASES OF CHILDREN IN 
 
 THE MASSACHUSETTS GENERAL HOSPITAL 
 
 BY DR. FRITZ B. T.\LBOT 
 
 The seed of hospital social service work was planted seven years ago* by Dr. 
 Richard Cabot, in The Massachusetts General Hospital. The work has developed 
 and spread so rapidly that now there is hardly a physician in the out-patient 
 departments who is not consulting with and using the social workers. The work 
 in the past has not been entirely satisfactory because the results have not been 
 commensurate ■nith the energy expended. This is particularly true of the adult; 
 the tendency, therefore, has been to devote more and more time to children, who 
 can be educated. Education and preventive medicine are bringing results of greater 
 importance than those obtained in curative medicine, and the healthy child 
 makes a good foundation on which to build the healthy adult. The social workers 
 are, therefore, concentrating their energies more and more on work among babies 
 and children. In this way a few himdred dollars used in preventing disease gives 
 
 * Since presenting this paper the writer has learned that Dr. Chapin, of New York, has had a 
 Social Service department in his hospital for ten years. 
 
ScKtmt Of CrgAniiation 0} CKiUre«s NVtiical Cut-Pal.ent Dc^-artment 
 
 N\as5achusett S G-eneral Hospital 
 Showing Interrelation Of Me A i c a 1 and Social Worn. 
 
 cliiUren rtferrtil 
 ■to 
 
 
 Female SorgicdT-'**^ 
 
 Adenitis 
 
 ffflffiySffi^ 
 
 SntduAte As>iitai\t> 
 
 for tvcdf mertt 
 
 Volurvlecrs Social Service AiS'jtints Student Vbtvnteeri 
 Nurse for Eiucationil Worn SociaV Wc r Ke r 
 Clinic Nurse (Afternoons) 
 
 VaSmitn 
 
 w ith Panen ti 
 
 INVESTIWmON 
 OF SOURCE 
 OF inftniON 
 
 and 
 
 ioape ration v(\(| 
 OfhopeJn 
 
 INVESTIfftTlON 
 DP 
 
 ;NVlKQNAlfmA55l 
 
 ftT HDMi: 
 m StHDOL 
 
 ?MENrALITl' 
 
 "Rachitis 
 
 <DfrtH( 
 
 Hosfital 
 
 Conv4iestf it Hme 
 
 5TAN[E 
 10 5TUDY 
 CflUStS 
 
 AIM AIM A!M 
 
 INVE5TIMTI0IV TREVENTION EBUCilTION 
 
 Of CAUSES DFIEFDRMIH QF MOTHtKS 
 CUKE Cf ?/ffl£Nl]cuRE Df FATimtKEALTHV Bll3lt5 
 
 Te e <1 i ti i< 
 C.5sts 
 
 I nsf rutfi.'n O f 
 
 Motlu 
 
 Hyj?ien€ «»vi 
 leMMt<4'tiat,M 
 
 Cj^H»fir4 Cite 
 
 Coo^eratufn 
 MilK itatiini 
 
 OF IN 
 
 [HIIBHOOU 
 
 HcArtDiseases 
 i-vl Compli cat lOTu 
 
 DcJ Ca^e at no»Mc 
 I r o V i s i o rx 
 
 Cocpe^rahcn 
 
 >rrtVS(V^H..>ti 
 
 ,,mimimmmi^^ 
 
 YROLQN&EIl 
 5UPERVI510W 
 
 A IM 
 UHEOF PATIENT 
 
 IF PQSSlELf 
 SElFSUPPORTlKfr ML_, 
 AWB WOMEW IMSflfE 
 
 OF MAvmCA-p 
 
 H V^i c^"ne Tybcrctloii 
 
 
 an! Pa rent 5 
 
 anj TcAC Hers 
 
 DcTifal Care 
 
 VacA'tiov<s 
 
 PREVEMTIDH 
 OF DISEASE 
 
 and, 
 Co^fktAi ion 
 
 H f g I c nt 
 
 givft 
 
 ; (K.ljrtn in 
 
 w byrculat 
 
 Farniltfi 
 
 Cjoyeration 
 
 ■ lhT>btrt>/)ii 
 
 
 W.th him 
 Dealing w.tK 
 
 CK.Uren 
 wKo ceme 
 t.» Cbnic 
 
 Ke 
 
 Co-opt rati n$ ASerxcies 
 
 LARGE TvPE INDICATES woM PLANNtal;!;::!^;;:^ ^teuh^. 
 
 Underlines Itijicales VVark far tijllr T'*'''"'' '^'•'"» Diet K.Uht^. 
 
 ' jAntiTubertwl^is See. Vatjfton Hchiw 
 
 UnJertahen V:.n,jM<.^t Ho-.s Hospital* 
 
 p«nri1 f«>T.^*m(icrfCTtfe1t7 H)fh'!irc>\ 
 
 205 
 
206 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 a dividend of thousands of dollars representing chronic diseases of later life which 
 have been stopped at the onset or prevented. It is only necessary to walk around 
 the wards of anj' large general hospital to see the wrecks of humanity who might 
 have been strong, healthy persons had they come under the proper influences in 
 their youth. 
 
 It is a common experience in all medical out-patient clinics to find that careful 
 work on the part of the physician means an increase in the number of his patients. 
 The public appreciates such effort. As a result, the physician is not able to keep 
 pace with the demands put upon him. For example, the Children's Medical 
 Department of the Massachusetts General Hospital had an average of eight 
 patients a day two .years ago; last month it had an average of 22 cases a day, and 
 additional social service workers have, therefore, been necessary. This large in- 
 crease in attendance necessitated the appointment of the three assistants shown 
 on the chart. The best work in any clinic depends upon two factors, skilled advice 
 on the part of the j^hysician and confidence on the part of the patient. Neither 
 of these alone results in successful treatment. It is here that the social worker 
 is of the utmost value; the most important part in the whole scheme is that the 
 social worker shall be a member of and work in the clinic. Dr. Abner Post, of the 
 Boston Dispensary, says that he "wants these social workers to be so much a part 
 of the clinic that the patient will not know where the social work begins and the 
 medical ends." Our Children's Medical Department has been able to accomplish 
 this. We started with a single social worker who visited certain types of cases 
 in the home, supervised the treatment, and thus made it possible to treat many 
 children in the home and out-patient department who otherwise would have been 
 treated in the hospital ward. She is able to supply the connecting link between 
 the home and the clinic, i. e., the personal element which is typified in the family 
 practitioner. 
 
 The accompanying chart shows graphically what we are doing (small type) 
 and what we hope to do (large type). When a patient comes to the hospital, he 
 is sent to a special department. For instance, should he have rachitis he is sent 
 to the orthopedic department, if adenoids and enlarged tonsils, to the throat 
 department, and so on. The orthopedic department sends the child with rachitis 
 to the Children's Medical Department to have its diet and hygiene regulated, 
 and in like manner the throat department sends its patients to us for physical 
 examination. The clinic nurse, who takes the temperatures, weighs the children, 
 and does other work in the morning, is the same nurse that visits the children at 
 their homes in the afternoon; she is both a trained nurse and a social worker. 
 Other social workers are working under her direction. At present one is investigating 
 rickets, another heart disease, and a third, who is partly social worker and partlj'^ 
 a trained nurse, is to help in our preventive work among the babies during the 
 summer. 
 
 We also cooperate with other agencies, when possible, in order to increase 
 the efficiency of our work. We consult and use the school nurses, school physicians, 
 school teachers, visiting nurses, the Anti-Tuberculosis Societies, the Society for 
 
PROCEEDINGS OF COXFEREXCE OX IXFAXT HYGIEXE 207 
 
 the Prevention of Cruelty to Children, the convalescent homes, the associated 
 charities, the De[)artment of State for Minor Wards, the relief societies, the milk 
 stations, diet kitchens, vacation homes, hospitals, children's agencies, and so on; 
 in fact, we cooperate with anybody who is interested in the work we are doing. 
 
 The following cases are examples of the old way of treating patients and of 
 the new way when the social worker helps us: 
 
 Walter J., an Irish boy, twelve years of age, lives in the North Knd of Boston 
 in a very "unsanitary tenement." Both of his parents have a police record for 
 drunkenness. He came to the Out-Patient Department and was found to have a 
 "probable tuberculosis." Careful directions were given to his parents about 
 diet, fresh air, rest, and the regulation of his habits. He returned to the Out- 
 Patient Department six times in the course of four months, but continued to lo.se 
 weiglit and look more seriously ill. The treatment of this rase was, therefore, 
 unsuccessful. The family situation was lieing handled by the Juvenile Court 
 and the A.ssociated Charities. -Miss Beaton, our Social Service Worker, in co- 
 operation with both of these, then went to his home to show the parents how to do 
 what had ])reviously been ordered. A back porch and i)arlor were turned into 
 resting and sleeping rooms. The boy was put to bed out-of-doors, and for the 
 first time received correct treatment. The result was rcTUarkablc: he improved 
 rapidly in health and gained seven pounds in three months. 
 
 This case is a sample of 14 other cases with some form of tuI)crculosis which 
 have been helped by the home visits of the social worker. 
 
 Another important group of cases shown on the chart is heart disease and 
 its complications, in which are included chorea, or St. Vitus' dance, and that very 
 insidious disease, endocarditis. The following case is an example of what may 
 happen to a child when proper care is not instituted: 
 
 Samuel R., six years, entered the hospital eighteen months ago with "acute 
 rheumatic fever," which was apparently cured quickly by rest and drugs, but it 
 was discovered before he went home that a slight leak had developed at one of the 
 valves of his heart. Five months later he was brought back one night to the 
 accident room, in a very serious condition, with blue lips, coughing, and panting 
 for breath. The small leak had in the interval become a big leak, and he was 
 doomed to the life of a cardiac cripple. He remained in the hospital four weeks 
 this time, and went home "much relieved." Things went from bad to worse; 
 last month he entered the hosjjital for the fourth time, to die of heart trouble. 
 
 There is hardly any hospital in the country that can keep a child long enough 
 to cure acute endocarditis. We have attempted to remedy this in the following 
 way. When the patient is acutely sick, he is sent into the hospital wards; as soon 
 as he is well enough to go home he is sent there to bed, and visited by the social 
 worker, who supervises the case from then on. She visits the home and tells 
 what to do; she takes the boy's temperature, and she tries to get the other members 
 of the family interested enough to help the child get well. The greatest trouble 
 we have had is in keeping the children interested enough to stay in bed. In two 
 instances we were fortunate to have a student volunteer who was willing to visit 
 the children three times each week to amuse and instruct them. 
 
208 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 The children complain of being kept out of school and thus getting behind their 
 classes. We try to get some one to instruct them and stimulate their interest in 
 the'right kind of reading. One child was kept in bed six months, at the end of 
 which^time all symptoms and signs of the disease were absent. 
 
 Some of the home surroundings are such that it is impossible for the family 
 to' look after the patient properly; a convalescent home was started for tliis type 
 of children with heart disease, and they are able to remain in bed as long as is 
 necessary. We hope eventually to have somebody teach them a quiet trade 
 fitted to their condition. Tailoring would be satisfactory if the hygienic condi- 
 tions of the shops were good. The important thing to remember is that they 
 must have supervision long after they are apparently well. 
 
 A girl of ten years with endocarditis applied to the Children's Medical Depart- 
 ment for treatment on December 26, 1911. She was a pale, restless child, several 
 pounds under weight, with dark circles under her eyes, and the physical examination 
 showed a leak in the aortic and mitral valves. She was put to bed. The social 
 worker discovered the child often read sensational literature until 11 o'clock at 
 night. She told her she must stop if she wanted to get well, and started her interest 
 in wholesome reading and better living. After four months' care she was able 
 to return to school, having gained 13 pounds and 12 ounces in weight. 
 
 Katherine Varden, aged five years, was brought to the clinic by her mother. 
 Examination revealed the presence of gonorrheal vaginitis. The child's condition 
 was really pitiable. Her mother reported that the father and two men lodgers 
 had had gonorrhea. 
 
 A home visit was made that afternoon, and the nature of the disease explained. 
 The mother got rid of the lodgers at once and started to clean the house. The 
 father was interviewed, and advised to go to a medical clinic for treatment, which 
 he did the next day. The sanitary conditions were very bad, an earth-closet in 
 the rear of the house having a most offensive odor, and the cellar being partly 
 filled with ^water. 
 
 A letter was written to the Board of Health, and inside of two days they had 
 eliminated the offensive unsanitary conditions. 
 
 The mother continued to bring the patient to the clinic until the discharge 
 ceased. 
 
 This child was under observation from September 5, 1911, up to May 15, 
 1912, and has had no discharge since February 1, 1912. 
 
 The sample cases cited above serve only to illustrate the infinite possibilities 
 of the work and are picked at random from those coming to our clinic every day. 
 
 Mb. Folks: This is certainly a most interesting paper. The discussion 
 •will be opened by Miss Helen M. Glenn, Head Worker of the Social Service 
 Department of the University Hospital of Philadelphia. 
 
 DISCUSSION ON DR. FRITZ TALBOT'S PAPER 
 Miss Helen M. Glenn : It is hard to determine whether we can compute the value of a baby's 
 life in dollars and cents, but we certainly can compute the cost of a baby's sickness to a hospital in re- 
 lation to the emplojTnent of skilled medical treatment and nursing care. If our efforts will prevent 
 this economic waste, they are of value, but to save the social waste is of even greater importance. So it 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 209 
 
 has been that in the past ten years many hospitals in larger cities have opened social service departments 
 to supplement the medical work and to make permanent the results already attained through medical 
 care. 
 
 In addition to what Dr. Talbot has said I want to outline several other opportunities these de- 
 partments may grasp in relation to child hygiene. A hospital makes an excellent point of departure 
 for children's work, especially if the doctor includes social work as part of his clinical routine. If the 
 mother sees the social worker at the hosi)ital, her visits to the home become a natural extension of the 
 hospital treatment. This gives the social worker an opportunity to do preventive work not only for 
 the child, which has been in the hospital or attemling the dispensary, but for the other children in 
 the home who are liable to the same diseases. It seems hardly necessary to emphasize the fact that 
 most of the sickness in any children's medical ward is from preventable diseases, and if diseases are 
 preventable, they are apt to be recurrent. Practically every hospitjxl can show record after record of 
 children having come to the hospital again and again. One hospital had a child five months in the 
 ward. Two days after her discharge she was brought back fatally ill with a prevcnt^ible disease. Out 
 of G5 cases of disease studied last July in the Children's Medical Dispensary of the University Hos- 
 pital, at least CO cases were due to preventable di.seases. Twenty were cases of chronic indigestion, 7 
 of acute gastritis, etc. 
 
 In regard to follow-up work of the child who has been in the hospital, we find that in probably 
 50 per cent, of the eases at the University Hospit;il there is some <lefinite social condition that will 
 immensely afject the convalescent child. In the hospital he has had regular hours, regidar treatment, 
 regular meals, etc. If he goes back into an insanitary home, the result is almost sure to be disastrous 
 unless there is somebody there to extend and carry on the hospital treatment. Our effort is always to 
 visit the home immediately after, if possible immediately before, the child's discharge, in order that this 
 critical tran.saction period may be made as safe for the child as possible. 
 
 Dr. Talbot has pointed out that the social worker should be continually alert to neighborhood 
 conditions, as well as to those in the family she is visiting. In one case that we handled the social worker 
 was visiting a child with a bad eye condition, which required constant and regular treatment. She 
 found in the neighborhood a baby with deformed limbs and another with facial eruption and discharg- 
 ing ears. A timid child was blind in one eye and the other eye was in bad condition. This was on a 
 street shut off from the central part of the city. In such instances as this the social worker has an op- 
 portunity to carry on a health campaign for the entire neighborhood, as well as for the family in which 
 she is interested. 
 
 All of us who are doing hospital social service work recognize that it may be a temporary thing. 
 Whether we should act as a private organization or whether we should be attached to a larger mimicipal 
 movement for child hygiene is an open question. Certainly for the present the hospital social service 
 department is supplying a pressing need. 
 
 Mr. Folks: The subject of hospital social service, especially in relation to 
 children, is now open for discussion for a few minutes. 
 
 Dr. Huntington: The thing which has impressed me most about the work that Dr. Talbot is 
 doing, as I have seen it in Boston, is the follow-up work of their clinic nurses and the effective manner 
 in which they secure the cooperation of the various other agencies doing work among children. 
 
 Mrs. M.J. M.\gee, Head Social Worker of the Pennsylvania Hospital, Philadelphia: I was 
 especially interested in Dr. Talbot's remarks concerning the heart cases. This is one of the most 
 serious problems we have to deal with in our social service work at the Pennsylvania Hospital. We 
 are trying to have the families move the invalid member to the first floor of the house, but this seems 
 difficult to accomplish. I would like to ask Dr. Talbot how long he follows up the heart cases. 
 
 Dr. Talbot: That is a difficult question to answer. We have been following up some cases very 
 closely for the past seven months, and I think we have several cures; but we must continue them under 
 observation for at least a year before we can say definitely that they are cured. It is, indeed, a pathetic 
 sight to see the boys and girls of from three to sLx years of age that come into children's wards for heart 
 
210 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 conditions— the anxious expression, the blue lips, the panting for breath, mark them as intense sufferers, 
 and yet they are the best little sufferers in the world. It has seemed heretofore that the limitation of 
 our observation of these cases made it almost impossible to do anything for them. Our present scheme 
 promises much, and if, by any chance, we can cure 50 to 60 per cent, of them, I think we will have real 
 reason to be happy. What we consider a cure is the absence of temperature, a heart of normal size, 
 and a pulse of normal rate. That is as far as we are trying to go at present. I believe a few hundred 
 dollars applied to the early treatment of these cases will save thousands of dollars in then- treatment 
 in later life. I believe, furthermore, that a large proportion of the chronic cardiac cases in adult life 
 have their beginning in childhood and can to a great extent be prevented by what we are endeavoring 
 to do. 
 
 Dr. Woodward: Do you think there is any value in extending the work to those cases which are 
 absolutely helpless? 
 
 Dr. Talbot: Only a certain amount of work can be done, and we have a limited amount of 
 money to spend on it. It has seemed to us, therefore, that it would be better to take the cases which 
 had not already become too far advanced, as neglect of such cases might make them hopeless, whilst 
 proper care might result in their cure. 
 
 Mr. Folks: Dr. Hart not yet having arrived, I will ask Dr. Schereschewsky 
 if he is prepared to open a discussion of the subject of Home Placing versjis the 
 Institutional Care of Babies. 
 
 Dr. Schereschewsky: I am willing to do so, although I am ignorant of the contents of Dr. 
 Hart's paper. I possess only a very general knowledge of the subject. However, there are certam 
 facts one can mention which operate disadvanUgeously to the institutional care of infants in this country. 
 The mortality rate is extremely high in such institutions. This is possibly due to a variety of condi- 
 tions. We have very few model institutions for the care of infants. The majority of them are over- 
 crowded, but the most important cause of their high infant death-rate is a lack of wet-nurses. I abso- 
 lutely agree with Professor Schlossman's statement that to have an institution for the care of infanU 
 without an adequate number of wet-nurses is just as inconceivable as a hospital devoted to surgical 
 cases without an operating room. 
 
 In most institutions, also, the regulations governing the control of contagious diseases are inade- 
 quate. Such diseases as trachoma and gonorrheal ophthalmia sometimes gain remarkable headway, 
 and measles and whooping-cough invariably attack every child not having had these diseases previously, 
 before the institutional epidemic ends. 
 
 From conversation with Dr. Hart I know that he is an advocate of the home placing of infants. 
 This system, when intelligently supervised, has been productive of excellent results. In fact, the mor- 
 tality amongst infants thus cared for is very much lower than that which obtains in the best of our in- 
 stitutions. If it were impracticable to improve the institutional care of children, J would say by all means 
 increase the number of children placed in homes to the utmost degree. At present, however, institutions 
 are a necessity, and will be for years to come. Furthermore, it is not impracticable at all to improve 
 them, nor to care for infants satisfactorily in them. All that is necessary to accomplish this is to possess 
 properly constructed buildings and adequate executive, nursing and medical supervision, together with 
 a sufficient number of wet-nurses to insure breast-feeding, in part, at least, for every infant in the in- 
 stitution. To secure these wet-nurses is not as difficult as one might think. It is a common thing in 
 Germany to find a wet-nurse able to suckle two children besides her own, and cases are on record where 
 the milk secretion in certain very productive wet-nurses has been sufficient to provide for three per day 
 in addition to her own. If, therefore, a conscientious effort was made to provide wet-nurses, we would 
 be able, after a while, to do away with all artificial feeding, which has been the greatest menace to the 
 lives of infants in institutions. 
 
 Then, too, there has not been sufficient attention paid to the matter of construction of such in- 
 stitutions in relation to economy of space, convenience of arrangement, and sanitary efficiency— quite 
 
PROCEEDINGS OF COXFEREXCE OX INFANT HYGIENE 211 
 
 the contrary, in fact. These institutions are so ill adapted to their purpose that they practically con- 
 tribute to the rapid spread of the infectious diseases which may develop in them. 
 
 There is an almost universal tendency, also, to overtax the capacity of institutions, and this 
 crowding is one of the most potent factors in the high death-rate. It should be perfectly possible, by 
 the correction of these and other similar defect.s, to have a death-rale in such institutions that would 
 compare favorably with that which obtains in families. 
 
 The institutional care of infants has the ativantage of being the more economical, which makes 
 the dependent child less of a tax upon the community at large. The community is rightly taxable for 
 the proper care of its dependent children, but it is the duty of the slate to provide such care at the least 
 possible expense commensurate with good results. If we find that such results are possible through the 
 proper institutional care of infants, as I believe they may be, then it becomes necessary for the state 
 to provide such institutions. 
 
 Mh. Folks: Do you know how many in.stitutions there are which measure up to this ideal con- 
 dition which you speak of. Dr. Schcrcschewsky? 
 
 Dr. Schereschewskt: As I said, I disclaim great familiarity with this subject, but there are 
 some abroad. 
 
 Mr. Folks: Could you name any in England or (ierniany? 
 
 Dr. Screreschewsky: I cannot name any in Euglaud, though I think there arc several in Ger- 
 many, and the name of the Resident Zeugnis-IIeiin occurs to me. The jjrinciple is the s.anu- whether 
 you have a larger or a smaller institution. The institutional care of children does not call for any com- 
 plicated conditions. Of course, I am not speaking from actual figures, but on general principles. I 
 would say, however, that any institution which averages a per capita expenditure of $5 a week for the 
 care of its infants, including the cost of the original investment, is being run at entirely too great an 
 expense. 
 
 Mr. Folks: Of course, they are boarded out at very much less than that, and (juite successfully, 
 so that I am not quite sure that an analysis of the figures would show any substantial difference in the 
 cost of the two systems, and what dilfcrence there is might be found to be in favor of family placing. 
 
 Dr. Scuereschewsky: There is this di.sadvantage about the family placing of children, and that 
 is that you do not have the constant medical supervision that one has in institutions. On the other 
 hand, there are, of course, many possible compUcations in the institutional system which do not obtain 
 in the placing-out system. 
 
 Mrs. Cooper, San Francisco: I have had an opportunity to visit institutions for the care of 
 children in many countries of the world. In Moscow I visited an institution which cared for 1000 babies, 
 each with its own wet-nurse. In Russia the crime of abortion is practically unknown. At the same 
 time it is not consi<!ered specially disgraceful for a mother to have a child born out of wedlock. The 
 result is that there are a great many children given over to the care of the state. This has made neces- 
 sary the establishment of great foundling asylums, such as those in St. Petersburg an<l Moscow. All the 
 babies are wet-nursed, and they are kept in the asylums until they are sent out by order of the doctors 
 to "mothers" in the provinces, that is, to mothers who have lost their own babies, or are willing to take 
 another baby besides their own. The maintenance of these children is paid in part out of the treasury 
 of the state until the child is able to go to scJiool. In this way Russia has saved about 1,000,000 citizens 
 in a hundred years in these two asylums. 
 
 The difficulty in this country would be that of securing a sufficient number of wet-nurses. We 
 have an institution in San Francisco in which we care for babies without wet-nurses and succeed very 
 well. We have only about .'SO babies under our care, at a per capita cost of less than $10 a month. We 
 attribute our success to a sufficient amount of fresh air and proper medical care. I believe something may 
 be said against the boarding out of children, especially in regard to the lack of control. They are usually 
 under the direction of a paid inspector, who makes his visits about once a week. The foster mother 
 soon knows when to expect him. She often sees him coming and hastens to get things into attractive 
 shape for the inspection. In the interval we are not absolutely sure what happens to the baby. But 
 in a small institution, where j'ou have good nurses who have the care of the children night and day 
 and adequate medical attention, the baVjies certainly get the proper care. 
 
212 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Dr. Schereschewsky: I would like to ask what is your death-rate in that San Francisco institu- 
 tion? 
 
 Mrs. Cooper: The rate is very much smaller than for the city at large. I cannot state the exact 
 percentage. The institution is maintained for the care of babies whose mothers are obliged to work to 
 support themselves, and who, therefore, cannot nurse them in the home. \Ve take the baby at any time 
 from the time it is born. The mother pays $8 a month if she is able, and if not, we take care of the 
 child until she is able. The baby undergoes a medical examination, so that we may know whether it 
 is sufl'ering from anything that would infect the other babies. If it has no contagious or infectious 
 disease, we bring it in. We would not accept a baby that could not be kept with the other children. 
 
 Dr. Schereschewsky: But any institution which cares for foundlings or illegitimate children 
 must be prepared to accept them under all conditions, otherwise the institution is not performing its 
 economic function. 
 
 Miss Ellen C. Babbitt: I agree with Dr. Schereschewsky that these institutions should be so 
 organized as to accept all those that apply, and that there should be no separation of the child from 
 the mother. Such separations at the doors of these institutions mark the very beginning of infant 
 mortality. Foundling asylums have no right to exist. 
 
 Mrs. Cooper: What is the mother to do if she has not a dollar to her name and has a baby which 
 she must care for? 
 
 Miss Babbitt: The Charities Aid, in New York City, has been demonstrating very clearly what 
 the mother should do. Miss Mason, of that organization, is here, and I should much prefer to have 
 her explain the work. The Aid has made it its business to secure work for the mother where she can 
 keep her child with her. In other words, they are attempting to prevent the existence of such things as 
 foundlings. Mr. Folks is interested further in making inquiry as to what the social service in the hos- 
 pitals is doing along this line. They are going to the hospitals and to other institutions that send out 
 nurses, and making a study of the women who are \-isited by the nurses before it is necessary for the 
 mother to go to the hospital. In Baltimore they attempt to prevent the separation of the mother and 
 the child through the medium of a "next friend," who endeavors to enlist the interest of the various 
 charitable agencies in securing her a position to which she can take her child. 
 
 It is a common experience in New York for mothers to be retained in hospitals but ten days after 
 confinement. In many of these hospitals the baby has been weaned by that time. The baby is then 
 on the bottle, and the mother has no particular reason for wanting to keep it with her. Consequently 
 she goes to a foundling asylum, tells her story, and the baby is taken from her. 
 
 Miss Mason, of the State Charities Aid Society, New York City: Our work consists in helping 
 out the mother who does not know what to do with her bal)y. She is encouraged to keep it with her, and 
 is referred to some private place where she can stay until she is able to plan something for herself. 
 
Second Session — Wednesday, May 22, 8 P. M. 
 
 Presiding Officer: 
 
 Dr. Joseph S. Neff, Director of the Department of Public Health and 
 Charities of Philadelphia. 
 
 1. The Regulation of Midwifery: 
 
 Dr. James L. Huntington, of Boston. Discussion to he opened by Dr. 
 Mary Sherwood, Chairman of the Committee on Midwifery of the Ameri- 
 can Association For Study and Prevention of Infant Mortality. 
 
 2. The Control of M.vrriagf.s of the Unfit: 
 
 Dr. Henry H. Goddard, Director of Research, The Training School for 
 Backward and Feeble-minded Children, Vineland, X. J. Discussion to 
 be opened by Dr. Charles W. Burr, Professor of Mental Diseases in the 
 University of Pennsylvania. 
 
 3. The Effect of Housing Upon Infant Mortality: 
 
 C.-E. A. Winslow, Professor of Biology, College of the City of New York. 
 Di.scussion to be opened by Mr. Bernard J. Newman, Secretary of the Phila- 
 delphia Housing Commission. 
 
 DR. JOSEPH S. NEFF 
 
 Director of the Departmeat o( Public Healtli and Charities of Philadelphia, Presiding 
 
 Ladies and Gentlemen: I have sometimes been accused, as presiding officer, 
 of talking too much, and of delving into the problems that are about to be discussed. 
 The subject of the first paper of the evening tempts me so much that in self-de- 
 fense I shall hasten to the pleasurable privilege of presenting Dr. James L. Hunt- 
 ington, of Boston, who will speak on "The Regulation of Midwifery." 
 
 THE REGULATIOX OF MIDWIFERY 
 BY DR. JAMES L. HUNTINGTON 
 
 Your committee has asked me to speak on the Regulation of Midwifery. 
 
 Midwifery is defined in the Century Dictionary as "The practice of obstetrics; 
 the practice of assisting women in childbirth. " 
 
 So as to avoid any possible misunderstanding, I am using midwifery as sjTiony- 
 mous with obstetrics, and shall speak of the obstetric problems in our American 
 cities, where we have a large foreign population with which to contend. 
 
 il3 
 
214 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Now, if we look at the obstetrics as conducted in the foreign quarters of any 
 of our large cities we are at once brought face to face with two classes of practitioners 
 — the midwife, usually dirty and untrained, and her competitor or accomplice, 
 the doctor, usually ignorant and often unscrupulous. It is of these two classes of 
 practitioners I wish to speak. 
 
 But as we have used the word foreign in connection with those that employ 
 the midwife, let us for a few moments retrace the steps of the immigrant and see 
 the midwife at home. 
 
 In Europe, obstetrics has always been in the hands of midwives, and the 
 necessity for the trained midwife was recognized as soon as higher medical knowl- 
 edge was considered essential for the practice of medicine. Let us take Germany 
 as an example of a country with a well-established midwife system, realizing that 
 what is true of Germany is, with only slight variations, true of the whole of Europe. 
 
 In Germany the midwife is carefully trained by the Government in well-estab- 
 lished Kliniks, usually by universitj' professors. 
 
 Midwives are rigidly examined before they are allowed to practice. Their 
 exact duties and limitations are carefully outlined by law. Before starting in 
 practice the mid\\-ife must report to the medical inspector in charge of that locality, 
 and after he has passed upon her credentials, she will be allowed to go to work, 
 but she is constantly under his supervision, and should she neglect her duty, or 
 disobey his instructions, she is .subject to fine or imprisonment. Not only that, 
 but she must report at once any abnormal symptoms occurring in the condition of 
 any of her patients to a physician, and should he fail to respond to her summons, he 
 is subject to punishment. 
 
 In considering the Continental midwife and her work, we must remember 
 the high standing of European physicians. The standard of education required 
 before they are permitted to practice is so high that impostors and charlatans, and, 
 to a lesser degree, dishonorable physicians, are excluded. Thus it is that the mid- 
 wife, when she summons medical aid, must necessarily call upon a trained prac- 
 titioner. 
 
 Then we must also bear in mind that in European coimtries laws on the statute 
 books are enforced without the slightest regard for local popular sentiment, so that 
 it is next to impossible for the midwife to violate the law and practice outside of 
 her narrow limits without being punished. 
 
 But in spite of this complete system, Germany today is seriously in doubt 
 as to the worth of her midwife system. Many obstetricians feel that just as long 
 as the midwife is tolerated, just so long puerperal fever will reap its yearly harvest, 
 and each year thousands of mothers and new-born babies will yield up their lives 
 unnecessarily as a result of the flaws and fallacies in the midwife system. 
 
 In England we find an entirely different story. True, the midwife has always 
 flourished there, but the Government regulation is of very recent date. The mid- 
 wives were so numerous, and the trained midwives so very few, that earlj' in the 
 present century tremendous pressure was brought to bear on Parliament, and the 
 present midwife system was adopted, in spite of very vigorous medical opposition. 
 
PROCEEDINGS OF COXFEREXCE OX IXFAXT IIYGIEXE 215 
 
 In comparing the system with America, we must bear in mind that in England, 
 as on the continent, the standing of the medical profession is high and the standard 
 uniform. Quacks are not countenanced, and unscrupulous medical men are com- 
 paratively few. 
 
 The result of this new system in England has been very curious and interesting. 
 The obstetricians, of all the medical men alone, urged the passage of the Midwife 
 Bill because they saw the worst results of the old regime and they felt that any 
 change must be an improvement. The general practitioner fought the bill. Now 
 we see the tables turned; for the most part the general practitioners are in favor 
 of the changed conditions. The midwife works with the general i)ractitioncr and 
 saves him much wearisome and unprofitable work. The general community is 
 probably, at the present time, better off, because midwives were numerous and 
 very dirty, and now they are, comi)arativeIy speaking, clean. IJtit the obstet- 
 ricians are feeling considerable regret, for they find that England is satisfied with 
 the midwife instead of the physician, which must steadily make for a lower ob- 
 stetric standard. 
 
 One member of the ]\lidwives Board for 1!)I1, Sir George Fordham, states in no 
 uncertain terms that all the normal midwifery of the country should be in the hands 
 of the midwives, and the medical profession act merely as consultants in emer- 
 gencies. Deprived of the bulk of normal oi)stetrics of today, how can the English 
 physician of the future be prepared competently to care for the emergencies? The 
 lowering of the obstetric standard nuist ultimately react on the infant welfare of 
 the future. 
 
 As the situation we are facing in this country is not so much the midwife 
 question as the question of poor obstetrics in general, it is interesting to note the 
 recent figures of Chalmers, in Glasgow, where the physicians are good, and the 
 nurses and midwives without proper training or supervision. He found that 
 puerperal fever was occurring in the practice of midwives and nurses at twice the 
 rate which obtained in the practice of cjualified practitioners when they had charge 
 of the patient from the beginning. In this country, what little investigation has 
 been accomplished has usually proved that, in this regard, the midwives were no 
 worse than the doctors with whom they were in competition. This has been used 
 as an argument in favor of the midwives. Does it not, however, merely show the 
 frightful level to which obstetric jiractice in America has been allowed to sink? 
 
 Professor Williams, of Johns Hopkins, has recently proved that obstetrics 
 is shamefully neglected in most of our medical schools, and that even the large 
 niiijority of students in our best schools, at the time of graduation, are not 
 sufBciently trained properly to conduct a case of normal labor on their own re- 
 sponsibility. 
 
 As we look at the history of obstetrics in America we do not find any uniform 
 standard. The situation differed probably in each of the thirteen colonies, and 
 now we have a different story in each State of the Union. 
 
 Let us see what has been the history of midwifery in Massachusetts, and how 
 the problem has been treated down to the present time. 
 
216 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 That the midwife was the chief practitioner of obstetrics in Massachusetts 
 in Colonial times we judge from the following paragraph, written by a Boston 
 physician in IS'-ZO: "Among ourselves it is scarcely more than half a century since 
 females were almost the only accoucheurs. It was one of the first and happiest 
 fruits of improved medical education in America that they were excluded from 
 practice, and it was only by the united and persevering exertions of some of the 
 most distinguished individuals our profession has been able to boast that this was 
 effected. " So we see that until about 1770 midwives flourished in Massachusetts, 
 but that from then on they disappeared from practice, so that the mere proposal 
 of one coming to Boston to practice brings out a forceful pamphlet on the midwife 
 question. 
 
 When the midwife came to Boston, and how she flourished in other parts of 
 Massachusetts, it is not difficult to imagine. She came with her fellow country- 
 men from Austria, from Russia, and from Italy, and working among her o^\'n 
 people, she was not noticed until gradually her position became established and 
 she gained recognition in that the laws for registration of births recognized her 
 existence. However, when the Board of Registration in Medicine and laws govern- 
 ing the practice of medicine were passed in 1894, the midwife was not mentioned, 
 and by such omission the Supreme Court of INIassachusetts has decided that mid- 
 wives are excluded from the practice of their profession, and midwives have been 
 fined for violating the law. 
 
 But this does not mean that Massachusetts is free from midwives. Careful 
 search reveals them at work in every city where the foreigners form a large proportion 
 of the population. But because of the enforcement of the law, feeble as it has been, 
 the midwife is not conspicuous. How many midwives there are, and how active, 
 it is very hard to say; careful investigation has, however, revealed some 150 in 
 more or less active practice. And in five cities, where they are unchecked in their 
 activities, in 1909 they attended 2138 births, or an average of 15 per cent, of all 
 the births in those five cities. 
 
 In Boston, during the year 1911, not a single birth was reported to the city 
 registrar by a midwife. But this does not mean that Boston is free from midwives. 
 They exist, unfortunately, but they are closely connected with physicians who re- 
 port the births for the midwives. Perhaps to some this would seem an ideal 
 solution of the problem — the midwife conducting the normal case, the physician 
 assuming the responsibility and exercising a supervision over the midwife. This 
 might be ideal in foreign countries, but here in America the physician who will 
 work with the midwife is not usually of such high standing as to promise much for 
 the welfare of the patients. 
 
 In view of this, in the recent Prompt Birth Return Law which has just been 
 passed in INIassachusetts, there is a clause requiring the physician or midwife 
 signing the report to state whether or not he or she was actually present at the 
 birth. Thus we hope gradually to secure evidence which will make it possible 
 to prevent the midwives from continuing the practice. 
 
 But in such a matter as this legislation is powerless. The keynote is education. 
 
PROCEEDLXGS OF COXFEREXCE OX IX FA XT HYGIEXE 217 
 
 We must educate the general public to realize the necessity for good obstetrics, and 
 place the means of obtaining it at the disposal of all, and then, with or without 
 laws against the midwife, she will disappear from our cities. 
 
 As a factor in this campaign of education a well-conducted maternity dis- 
 pensary is of tremendous power. Let me describe the working units of such an 
 institution: 
 
 A few rooms in a congested portion of the tenement-house district. The 
 patients apply for treatment as .soon as they wish, but the earlier the better, pref- 
 erably as soon as pregnancy is suspected. As soon as the diagnosis is made the 
 patient is visited by a .social worker, who sees to it that the jjatient is worthy of 
 charity, or else that a nominal fee is promised. The patient returns for monthly 
 conferences, meanwhile being visited by a district nurse. Should an abnormality 
 or any deformity be discovered the j)atient will be delivered in a maternity iiospital, 
 but if all is normal, in her ovni home, by students of medicine in medical school 
 centers, under the supervision of competent instructors, or by younger physicians 
 where students are not obtainable. Such an institution advertises itself and edu- 
 cates a constantly increasing proportion of the mothers of the future. 
 
 We are gradually develoiting the details of such a system in Boston, where the 
 Out-i)atient Department of the Lying-iu Ilosjiital has for many years cared for 
 more than 10 per cent, of all the births in the city. To show that the foreign 
 population will come to such a hospital I have collected the following figures from 
 the records of the Pregnancy Clinic of the Boston Lying-in Hospital, an institution 
 following the lines of prenatal work begun by the Women's INIunicipal League. 
 
 Of the last 1000 cases that have ajjplied for treatment in our Pregnancy Clinic, 
 83 per cent, were foreign born, a large proportion of them speaking little or no 
 Enghsh. Of these 1000 cases, 51 per cent, were born in Russia and 13 per cent, 
 in Italy. 
 
 Another method of education has been recently started by the Division of 
 Child Hygiene, Boston Board of Health. To prevent the high infant mortality 
 in certain of the most congested portions of Boston the scheme was adopted last 
 fall of sending around nurses to make visits in the homes where infant deaths had 
 occurred from enteric disorders the previous year. Where these nurses found that 
 another child was expected, they tactfully began a campaign of education by ad- 
 vising competent hospital care, but where this was refused, even after continued 
 urging, they endeavored to keep the confidence of the family, in spite of what might 
 ensue, striving to give prenatal and postnatal care, so far as the patient would 
 permit. The work started with two nurses, but it has been so successful that six 
 nurses are now at work in greatly increased territory. 
 
 There is another method of education which might be afforded these ignorant 
 immigrants, and that is to place in their hands upon arrival in this country a state- 
 ment of the true facts as to midwives and doctors, explaining that these terms in 
 America are not necessarily equal to their known European value; also where to 
 apply for advice in case of illness. 
 
 Let us briefly see what has been done elsewhere in America. In New York 
 
218 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 City, where over 50,000 births are conducted by midwives each year, the problem 
 has seemed too stupendous to be met as in Massachusetts, and so the midwife 
 has been recognized, and a school established for her education, and laws have been 
 passed for her regulation and supervision. 
 
 In Pennsylvania, until 1909, there was no law controlling the midwives. But 
 in that year such a law was passed. Dr. Newmayer, having had charge of the 
 working of this law in Philadelphia, has come to the conclusion that the midwife 
 is not an economic necessity. He believes that by education she can be gradually 
 eliminated. Such a work of education with this end in view has been begun in 
 Pittsburgh in the last few weeks. Finding that some 5000 l^abies were born every 
 year in that city without medical attendance, the Pittsburgh Maternity Dispensary 
 was established to care for this portion of the population. It has an eiEcient corps 
 of physicians, nurses, and social workers. 
 
 To summarize the regulation of midwifery in America, we have, first of all, 
 to face these problems: Obstetric education in our medical schools, the midwife, 
 and the ignorance and prejudice of the immigrant population. Let us be prepared 
 to meet these problems with eyes open to the facts. Our medical schools are not 
 giving proper framing in obstetrics. The general public is not awakened to the 
 value of obstetrically trained physicians. The man or the woman who is to take 
 the responsibility of obstetric cases must be prepared to cope with each and every 
 emergency which may occur during the labor or the puerperium — must be, in 
 other words, an obstetrician thoroughly trained in general medicine to give the 
 best results — to give the attention we know to be necessarj'. Anything less than 
 this is a makeshift and a substitution, and must be so regarded in the clear light 
 of modern science. To train women to take care of normal cases only must be 
 fallacious, for who is to make the diagnosis and be sure that the case is normal? 
 
 Until we have a uniform standard of medical education we will be sure to find 
 the ignorant physicians summoned by the midwife in trouble — the better trained 
 doctors will not be called upon — the contrast would be too marked. 
 
 It hardly seems fair to punish the immigrant mother for her ignorance. It 
 hardly seems right to say that there shall be two standards of obstetrics — one for 
 the poor and ignorant, and another for the intelligent and well-to-do. 
 
 Let us frankly acknowledge our shortcomings and strive to educate the general 
 public to realize the importance, the vital importance, of obstetrics, and demand 
 that it shall be thoroughly taught to every medical student before he is allowed to 
 practice medicine. And to only such persons as have adequate training shall the 
 full responsibility of attending obstetric cases be intrusted. 
 
 Then let us teach our immigrants that in America we believe in equality — 
 as near as possible an equal chance for life, health, and happiness given to each 
 child at birth, a single standard of obstetrics for all. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 219 
 
 DISCUSSION ON DR. JAMES L. HUNTINGTON'S PAPER 
 
 Dr. Mary Sherwood, Baltimore, Md.: It seems incredible that at the present stage of our 
 scientific knowledge a problem of such magnitude as this problem of the midwife remains to be faced. 
 It is an instance of an evil which has been so long existent that we have come to regard it as almost 
 ineviUible. The world today is waking up to several such problems. A similar one is the problem of 
 the social evil, and there are many people who say, with reference to both of these serious evils, that 
 they have always been, and therefore always must be. 
 
 However, the most interesting thing in reference to the midwife problem of the present day is the 
 fact that it is being faced, and the paper which has been presented to you just now gives a very ad- 
 mirable survey of the questions that we have to consider in connection with it. In a few communities 
 we have learned the facts that warn us that there are abroad in these communities a body of women 
 absolutely untrained for the most part, the majority of them foreigners, ignorant of their proper duties, 
 who are taking the responsibility, and who are permitted to take the responsibility, of caring for mother 
 and child in confinement. They contribute to our statistics of infant mortality by reason of the fact 
 that they are inadequately equipped to deal with the serious emergencies that from time to time con- 
 front them. They are not alone, however, in this contribution, since a study of obstetric statistics in 
 our cities emphasizes the fact that there are also many improperly equipped physicians who help to 
 swell the mortality figures. 
 
 The solution of the midwife problem is important and inevitable. We must meet in some way the 
 never-ceasing call for help from women about to be confined. How are we going to meet it? Shall 
 we have one standard for one woman and another standartl for another? Can we differentiate cases 
 and say this is the normal class and can be cared for by midwives, and this class is abnormal and re- 
 quires more intelligent care than midwives can give? This is not the solution, for no human being can 
 tell when a case apparently normal will become pathologic and demand the utmost skill. We have 
 known, since the time of Oliver Wendell Holmes, the nature of puerperal disease, and for many years 
 the method of its prevention. The same is true of ophthalmia neonatorum and its prevention, and yet 
 we have never, up to the present, applied this knowledge in such a way as to insure its benefits to al 
 women in confinement or to the helpless new-born babe. 
 
 I realize that we are facing a complex problem. It is not merely a question of obstetrics in cities; 
 that might be comparatively easy of solution, but it is also a question of obstetrics in rural communities. 
 Take, for instance, such communities as those in the North Carolina mountains, where the Holman 
 Association is doing its admirable work. We get astonishing facts from that region. We are told of a 
 mother who has delivered herself in nine consecutive pregnancies. Miss Holman told me recently of a 
 man who runs a saw-mill in one of these districts who is sent for from all the country around because 
 he has acquired some skill in the care of women in confinement. Then we are told of husbands who have 
 had from one to four wives who have died one after another in childbirth because of neglect in the critical 
 hour of confinement. What are we going to do in these communities where they haven't even midwives? 
 These questions we cannot answer today. We must first make a more comprehensive and sys- 
 tematic study of the facts connected with the whole problem. With this evidence before us, some 
 solution must be forthcoming. Present conditions of obstetrics in the United States are intolerable. 
 I believe that the problem we are discussing is a woman's problem, and that we shall never have a solu- 
 tion of it until women in general learn of present practices and demand better conditions, especially a 
 higher obstetric standard for physicians. 
 
 We must offer to women in confinement a care which is commensurate with their needs and com- 
 mensurate with our scientific knowledge at the present day; anything less than this is a sin upon our 
 souls. "To him that knoweth to do good and doeth it not, to him it is sin. " 
 
 The intolerable conditions of midwifery practice were borne in upon me in a very practical way, 
 not long ago, in Baltimore, when we tried to get together a simple exhibit on midwifery. Among other 
 things we had, side by side, the outfit which the average midwife in Baltimore considers all that she 
 needs to take with her to a case of confinement, and the outfit of the obstetric specialist. There was 
 the old, dirty, ragged bag, with torn lining, and in it were several articles which I am not going to detail — 
 a half dozen in all. There was no attempt at sterilization — nothing for a case of emergency; simply a 
 16 
 
220 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 few things picked up from around the house, stuffed into the bag, and taken to the confinement case. 
 Side by side with this was the equipment which Dr. Williams, of the Hopkins Hospital, considered 
 necessary for the obstetric out-patient service of the hospital. Here were two large bags, filled with 
 most carefully prepared and sterilized instruments and appliances — an absolute contrast to the other. 
 That little exhibit taught a powerful lesson, and made me feel most keenly that whatever the solution 
 of our problem may be, it must be something that will lessen the gap between the absolutely inade- 
 quate and the absolutely essential. 
 
 Dr. Schereschewsky: I merely want to say a few things in regard to the condition of mid- 
 wifery as it exists in the United Stated today. This question in our country is entirely on a par with 
 the conditions which existed when Meigs exclaimed, some thirty years ago, "The man who tries to tell 
 me that puerperal fever is brought by no other agency than an act of God is telling a falsehood." The 
 reason why some people want to regulate the midwife and continue her existence is because they believe 
 that the foreign population demands the midwife. \\'hilc this is true, it is chiefly so because they have 
 been used to the midwife at home. Every immigrant that comes to the United States is prepared, 
 from the time of his arrival, to detach himself from all his previous conceptions. He is coming to a new 
 country, he knows he is going to be amongst a new people, and he is perfectly ready to adopt what- 
 ever seems to be the standard practice of our people. So that while in Europe the immigrant may have 
 been used to the midwife, if we have something better to offer him in this country he will readily accept it. 
 
 There is another thing to which I wish to call attention in connection with this subject, and that 
 is that the chief and most powerful means by which we are going to reduce infant mortality is the medical 
 supervision of the infants of the poor during the first year of life, and yet in proposing to regulate the 
 midwife we are proceeding to deprive these infants, at the most important moment of their existence, of 
 the very medical protection that we propose to give them at a later period of infancy. The reasonable 
 conclusion would seem to be, therefore, that we should furnish a uniform standard of obstetrics of the 
 highest grade, especially looking to a proper medical supervision at birth, as well as through the first 
 year of life. 
 
 Dr. Newmayer: In Philadelphia we have about 400 practicing midwives. Of these 400, there 
 are only about 225 that we can get hold of to examine and license. The other almost equal number 
 change their names and places of residence so frequently that it is impossible to keep track of them. My 
 experience with the midwives in Philadelphia, in examining them for licensing and supervision, makes 
 me positive that midwives are a useless institution, but I agree with Dr. Huntington that it is impossible 
 to abolish the practice by any law. 
 
 Previous to 1909 we had no law in the State of Pennsylvania which gave us any hold upon the 
 midwife. In that year a law was enacted which gave us supervision over these practitioners. In June 
 of last year, 1911, a new act of the legislature repealed the former law, and we lost our supervision and 
 licensing power. Through a mistake in the act the law became inoperative at the first of the present 
 year. However, the new medical board of licensure is endeavoring to formulate some method by which 
 they hope to again place the midwife under complete control of the health authorities, and possibly, by 
 strict requirements for licensing, enable us to eliminate a great many of the most worthless, and keep the 
 others under direct supervision. 
 
 Dr. Neff: The subject of the next paper is of deep interest. We have been 
 accustomed to speak of the preventable infant mortahty for a long time, thinking 
 that it reaches in the neighborhood of 50 per cent., and we have been passing as 
 non-preventable a large percentage of the balance, but the steady progress made in 
 the laws of eugenics and euthenics within a very short space of time will, I hope, 
 lead us to find that many which we now call non-preventable deaths will be pre- 
 ventable; and thus a large number of people will be saved for maturity. It gives 
 me pleasure to introduce the Director of Research in the Training School for Back- 
 ward and Feeble-minded Children of Vineland, N. J., Dr. Henry H. Goddard, who 
 will speak on the subject, "The Control of Marriages of the Unfit." 
 
PROCEEDINGS OF COXFEREXCE ON INFANT HYGIENE 221 
 
 THE CONTROL OF MARRIAGES OF THE UNFIT 
 BY HENRY H. GODDARD, Ph.D. 
 
 A complete discussion of this toi)ic would involve the three subtopics of "Who 
 are the Unfit.''" "Why should they not marry?" "How can we prevent their 
 marrying?" 
 
 Within the brief limits of this paper it will be possible merely to touch upon 
 these three points. There are those who would spend a great deal of time in dis- 
 cussing "Who shall decide as to who are the unfit, and can any one decide the 
 question?" We have, however, the highest authority for the statement that there 
 are persons concerning whom it may be said, "it were better for thcni had they 
 never been born." A less humane civilization said it was best that they should 
 not live, and they were accordingly allowetl to die — to go to the wall in the struggle 
 for existence. At present we live by a dilfercnt ethic and consider that every 
 human life is sacred and must be maintained by all the arts at our command. 
 Therefore the only answer that we can give when we look about us and see people 
 who are living in misery because they are incapable of living otherwise is, " it were 
 better if they had never been born, " but since they are born, we must care for them — 
 not only their childhood, but their life. 
 
 Who, then, are these people who ought never to have been born? They are 
 those who have inherited a degenerate physique or such low mentality that they 
 are incapable of living a non-dependent life in the civilization in which they are 
 placed. I do not consider the group that are supposed to have inherited a moral 
 nature that makes them unworthy of living, because I doubt whether there is such 
 a class. 
 
 I shall not take time to argue the question that those people who have in- 
 herited a constitution so physically weak or degenerate that they are throughout 
 their lives not only uncomfortable themselves, but also a menace to their fellows, 
 ought never to have been born, and that such a strain in the human stock should 
 be cut off as soon as possible. Who these people are, and what are the physical 
 weaknesses that are thus transmitted, I leave for the physicians to answer. 
 
 I am interested in that other group, those who have inlierited a mentality so 
 low that they are "incapable of adapting themselves to their environment" or of 
 "competing successfully with the rest in the struggle for existence." Often physi- 
 cally strong and robust, and with a certain cunning by which they are able partially 
 to make up for their lack of intelligence and their inabihty to earn an honest living, 
 this class of people constitutes the most dangerous element in our community. 
 They make up a large part of our problem of pauperism and crime. They make 
 our slums and help fill our houses of prostitution. They ought never to have 
 been born, but having been born, they ought never to become parents of more 
 people like themselves. 
 
222 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 A considerable percentage of the babies that we are now trying to keep alive are 
 the children of this type of indiridual. These babies ought never to have been born, 
 but having been born and being kept ahve by our charity and efforts, we should at 
 the same time see that they never become parents. There are those who maintain 
 that if these children are kept alive and given favorable environment, and if brought 
 up right, they become useful citizens; in other words, that the whole problem is 
 one of environment. This is one of those one-sided views which is always dangerous. 
 
 I hope the time may come when the laws of heredity will be so well understood 
 and the facts will be so iridely known that all will be able to see the bearing of these 
 laws upon our social problem. Today it seems very difficult to teach the lesson. 
 We know that heredity is everything in plants and animals, but we are inclined to 
 believe that environment is everything when it comes to man. But such is not 
 the case. This is being demonstrated every day. Indeed, we have already come 
 to the concept that there are strains of mentaUty in the human family that are 
 transmitted just as truly as any other characteristic. These different strains have 
 different degrees of mental capacity, and range all the way from the imbecile to the 
 genius, and it is no more possible to get a genius out of an imbecile strain than it is 
 to get a red-haired child from a line in which there is nothing but black hair. 
 
 Now, certain of these strains are of such low mental capacity that they never 
 can adapt themselves to the environment found in our modern civilization. There- 
 fore these people are bound, as already said, to be always a burden to themselves 
 and a menace to society. Therefore, it were better had they never been born, but 
 being born, it must be that they shall never become parents. The strain must 
 stop with them. 
 
 Let us see what all this means from a concrete illustration, taken from the 
 facts as far as we know them. There are in Philadelphia today 250,000 children 
 in the public schools. Of these, 2 per cent., or 5000, are feeble-minded. Of these, 
 again two-thirds are feeble-minded by heredity. That means that when they grow 
 up and marry they will transmit their feeble-mindedness to their children. 
 
 All these marriages would be unfit; all these marriages should be prevented. 
 
 We may now consider in the briefest way the question of how to regulate the 
 marriages of the unfit. I beUeve this needs to be done, just as we regulate other 
 matters in our social life, by rules or laws and by publicity. For those people who 
 have not sufficient intelhgence to act wisely for themselves society must act and 
 must say, "you shall not marry." Those people who are above this line and have 
 intelligence must be educated to know the fact, so they will regulate their own 
 acts in accordance with knowledge. 
 
 These are the two lines along which modern eugenics is working. As fast as 
 our heredity laws become discovered and understood they must be made the com- 
 mon knowledge of all people, for surely no man or woman would take for a partner 
 in hfe a woman or man whom he or she had every reason to expect would produce 
 children who would be mentally defective and incapable of living a normal life. 
 
 It is sometimes said that the tender passion will never thus regulate itself. It 
 is true that "love laughs at locksmiths," but love will not laugh at fate. That is 
 
PROCEEDIXGS OF COXFEREXCE 0\ INFANT HYGIENE 223 
 
 evidenced today by the thousands of young people who refrain from matrimony 
 not because poverty faces them, but because of inabihty to live in the lu.rurij that 
 they want. The same thing applies to the further step. Not only will the man or 
 woman refrain from taking a mate who will beget or bear defective children for 
 them, but the man or woman who has once become convinced that tlicy them- 
 selves carry within them the germs of defect or degeneracy will voluntarily refrain 
 from matrimony. 
 
 The one thing we need in all this is knowledge. We need to know the facts 
 and to know the conditions under which the facts apply. Man will gamble on 
 uncertainties, but no man will gamble against a sure thing. As long as the laws 
 of transmission are not thoroughly known, and any man may say. "possibly I am 
 an exception," so long will many of these marriages of the unfit take place. But 
 once let the matter be understood so that it can be declared with absolute certainty 
 that such and such consequences will follow, and men will not take the chances, 
 except, as said above, in those cases where they have not intellect enough to draw 
 the conclusion from the premises. In those cases, society nnist act for them and 
 say, "thou shaft not!" 
 
 In conclusion, may I hope that I have made it clear that this whole new move- 
 ment along the line of infant mortality, this baby saving, is fraught with tremendous 
 consequences to the race, and that unless we go beyond the baby saving, and save 
 the adults from the vices and evils to which their very incapacity makes tliem liable, 
 and save them from becoming parents, we will in the end be injuring the human 
 race, rather than helping it. In all cases of bad heredity we are saving these 
 babies to become thieves, paupers, and prostitutes, unless we do something more 
 than merely to keep them alive through their infancy and childhood. We must 
 take care of them through life. 
 
 I have confined myself to the topic that was assigned me, and have not gone 
 into that large and equally important question, so prominent among the lower 
 classes, where the limitation of marriage does not limit the production of offspring. 
 
 Dr. Neff: The discussion of this paper will be opened by Dr. Charles W. 
 Burr, Professor of Mental Diseases in the University of Pennsylvania. 
 
 DISCUSSION ON DR. GODD.\RD'S PAPER 
 
 Dr. Charles W. Burr, University of Pennsylvania, Philadelphia: The breadth of the subject 
 and the lateness of the hour make it necessary for me to present the discussion which I have prepared in 
 abstract; I must, therefore, ask you to pardon me if I appear somewhat dogmatic and dictatorial in 
 what I say. I have no time to prove by argument the statements that I am about to make. (The sub- 
 joined is the original discussion and not the abstract.) 
 
 The real question concerns not marriage, but procreation: Should the unfit, those whose offspring 
 are likely to become public charges on account of disease, the result of their parentage, or to be useless 
 in adding to the commonweal — to be imbeciles, insane, or criminals (the degenerate, in a large sense) — 
 be permitted to procreate (no injury is done the State by the mere fact of marriage, no matter how 
 unfit the persons may be, if there be no offspring), and if not, how can they be prevented from doing so? 
 I include criminals, because those who are criminal by heredity are surely diseased. This is not synony- 
 mous with saying that all criminals are insane, or that all crime is the result of disease. It should Lo 
 
224 REPORT OF THE PHILADELPHIA BABY SAl^NG SHOW 
 
 remembered too that the word criminal does not mean the same thing to the psychologist and the legis- 
 lator. Law judges a man by his acts; psychology classifies him according to his attitude toward the 
 world, his mental and moral point of view. Law is interested in him only in so far as he affects society; 
 psychology is equally interested in him, whether he influences society or not. A man in jail, and justly 
 so, may be less a criminal from the psychologic standpoint than another who never broke the law. 
 
 I shall not consider the question as to whether life is worth living to the degenerate, regarding 
 himself alone, whether, so far as his personal happiness is concerned, it would have been better or worse 
 had he never been born, but shall look at the matter only from the point of view of the welfare of the 
 commonwealth and the good of the race. 
 
 I trust there is no need for me to explain that degeneracy and immorality are not synonjTnous; 
 that virtuous people may possess latent qualities which may, by the molding influence of heredity, 
 have an evil effect upon the nature of their offspring. Though degeneracy, in the ultimate analysis, 
 is always the result of breaking natural law, or, more accurately, is the result of the automatic and in- 
 evitable enforcement of natural law, the transgression is not infrequently unwitting, innocent, and some- 
 times unavoidable. Very often the degenerate of certain types exercises great self-control in inhibiting 
 throughout life the sexual instinct through fear of the woe he might cause to future generations by 
 marriage. This is true of many epileptics and people in whose families there is a preponderant strain 
 of insanity. 
 
 That the degenerate should not beget children is accepted in theory by all students who have 
 studied the matter clinically, but, unfortunately, there is no unanimity of opinion as to whom we are 
 to classify as degenerates. My genius may be your degenerate. One school holds, for example, that 
 all criminals are the victims of environment, and that if the good people were not so vicious, if society 
 only tenderly cared for the criminal, there would be no need of jails, and some sociologic writers, whose 
 personal acquaintance with criminals is evidently nil, want to reverse all our notions about morality 
 and have us believe that the only bad people in the world are the good. Some investigators teach that 
 all criminals are predestined to be such from birth, and that we can diagnose them by their physical 
 abnormalities. For the purpose of this discussion I will dogmatically assume that the unfit are the 
 imbecile, the insane, the alcoholic and other drug habitues, the so-called moral insane, and certain 
 criminals, because these classes of the community can be controlled more or less, whereas if we attempt 
 too much and endeavor to prevent the marriage of every one suffering from any disease, that, on theo- 
 retic grounds, may cause abnormal offspring, it will be found that in trying to do the impossible we will 
 fail to accomplish anything. 
 
 Those who maintain that heredity is nothing and environment everything; that any child can 
 be made into a mentally healthy and morally straight person if brought up under proper influences, 
 are sentimentalists and base their opinion on emotion. All children of all degenerates are not degenerate, 
 but the percentage is much higher than in the remainder of the population. The parents, or one parent, 
 of all degenerates are not degenerate. Heredity is not the sole cause of degeneracy; indeed, so far is 
 this from the truth that the defective classes are being constantly recruited by the offspring of the healthy 
 so far as we can judge health, and let me add that this fact will greatly minimize any effort to improve 
 the race by mere fiat of legislation. Many factors — disease in utero and early childhood, trauma, and 
 environment in the vulgar sense — may have a potent evil influence. Pelvic deformity in a woman 
 mentally and morally healthy may render labor so difficult as to lead to injury to the brain of the child 
 of such a nature as not to produce death, but to cause imbecility and idiocy. Acute illness of the mother 
 during pregnancy may, on theoretic grounds, result disastrously to the brain development of the fetus 
 without there being any gross evidence of disease. Syphilis, which is not in any proper sense a heredi- 
 tary disease, but in which the parent simply acts as the carrier of the organism which causes syphilis, is 
 a frequent cause of imbecility, and though there are usually very manifest signs of physical disease in 
 the infant, sometimes the symptoms are purely mental. A surprisingly large number of children give 
 a positive reaction to the Wassermann and Noguchi tests. I have seen a few children who have improved 
 very much under specific treatment, when the only evidences of specific disease were the positive re- 
 action and their ability to bear large doses of antispecifics. The influence of less serious diseases than 
 syphilis attacking the mother during pregnancy is hard to prove, but we are justified in beheving they 
 may affect the child. This theory certainly explains some otherwise inexplicable cases. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 225 
 
 It is impossible, in this short time, to discuss the respective importance of heredity and environ- 
 ment on the character of the individual. Much depends upon the definition of environment. If used 
 to mean the general surroundings, the training and education, the mental and emotional conditions 
 under which the child lives, then environment influences largely the character and nature of the very 
 large number of children who by heredity are so soft as to be mere clay in the hands of the potter; but 
 we all see every day many children who go their own way entirely uninfluenced by their surroundings — 
 we see men of great talent and noble character, whose environment wa.s, during llie foriiiati\e stage of 
 life, very poor, and degenerates of all kinds who wire trained most carefully in the best surroundings. 
 If it be used to include the influence of disease and trauma, then many children whose heredity is normal 
 develop into defectives because of it. The best heredity cannot withstand a serious injury, cither 
 traumatic or from disease, to the brain in childhood. One would expect a large number of degenerates 
 from malnutrition in childhood, not from underfeeding but from disturbances of assimilation, yet many 
 marantic children grow into mentally and morally normal men and women. 
 
 A very important question is the fitness of syphilitics for marriage. Xo one should procreate 
 during the active period of syphilis in any of its stages. The more dilficult question to answer is, should 
 a person who having had syphilis, has shown no signs of it for some years, and who had undergone 
 proper treatment, procreate.' For practical purposes the answer should be based not only on the 
 possible injury to the otfspring, but on the possibility of future illness in the person himself, rendering 
 him unable to maint.iin a household. I know of no a<-curate statistics, i. <?., dealing with large enough 
 numbers, showing how much the danger to the offspring is increased. Correct figures in the matter 
 can not be gathered and opinions differ. I know of many healthy children bom under such conditions, 
 but the risk is surely great. 
 
 Though parental tuberculosis seems .slightly to increa.se the danger of insanity in the offspring, 
 this is offset by the fact — and it is a fact — that the children of the tuberculous are very often far aliove 
 the average in mental vigor. AVhether the well-known mental brightness (jf children with tul)er<ulou3 
 spine and hip disease is due to the fact that their di.sease makes them unable to play, and hence forces 
 them to mental development, or whether it is due to the disease itself, is much di.scusscd. I am in- 
 clined to think that the nuxlerate constant, or almost constant, fever present may act as a stimulant to 
 the brain, both by its effect in increasing the rapidity of the circulation and by its own irritant effect. 
 
 The most difficult degenerates to control are the so-called moral imbeciles, because it is almost 
 impossible to formulate a workable law concerning them. They are the people who with little or no 
 manifest mental weakness show no moral sense, seem deliberately to choose a life of vice and crime, and 
 are entirely uninfluenced by all efforts to reform them. Crime in the legal sense is often only an in- 
 cident in their careers: vice is habitual. Their offspring are frequently degenerate. .Another class 
 very hard to control are the drunkards and drug habitues in general. In recent years the "cocain 
 fiends" have become a very serious problem. 
 
 The danger of producing defective offspring is not the same in all types of degenerates. For- 
 tunately one class, the idiots, are always incapable of procreation, and certain of the insane lose both 
 sexual power and desire sooner or later. Among the defectives who are able to procreate, the low- 
 grade imbeciles almost never, if indeed ever, have normal children. The high-grade imbecile may have 
 normal children, but the chance is remote. It would be interesting to know if high-grade imbeciles 
 from accidental causes are as prone as hereditary imbeciles to graft a bad strain on a family. This 
 matter has never been thoroughly studied and is rather of academic than of practical importance. The 
 mere fact of insanity, without any qualification, in a parent does not necessarily lead to degeneracy in 
 the next generation. For example, because years after the birth of a child a parent develops senile 
 dementia, or has a stroke in consequence of wide-spread cerebral arterial disease, and on account of the 
 accompanying sensory aphasia, becomes demented, it does not mean that the child will necessarily 
 show any sign of degeneracy of any kind. On the other hand, an attack of apparently mild mental 
 disease before, even years before, the child's conception, increases the danger greatly. The actually 
 insane should under no circumstances procreate. In epilepsy also the danger is very great. Unfor- 
 tunately, there is a very large class of people who, though they largely increase the number of the de- 
 generates, cannot be controlled in any way. I mean the "queer" people, the people who have strange 
 
226 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 mental and moral traits, and who yet get through life without any breakdown serious enough to require 
 any medical attention. These and the hysterics make wretched parents. 
 
 Another matter to be remembered is that different types of degeneracy are by heredity inter- 
 changeable; the epileptic may have insane children, the insane, hysteric, the hysteric, epileptic. 
 
 Now as to the remedies. It has been proposed to compel medical examination of all candidates 
 for marriage. This leaves out of account the control of the illegitimate production of children, a matter 
 of great and increasing importance. The original idea was, I believe, to examine men to discover the 
 presence or absence of venereal disease; today the idea seems to be to make a complete examination as 
 to the physical and mental state of both men and women. Such thorough and complete examinations 
 could not be made in practical life, and laws requiring them would be but perfunctorily enforced. The 
 difficnlties in the way of enforcement, save in the case of people with marked visible disease, are insuper- 
 able. Persons who practice medicine according to the tenets of peculiar and exclusive schools would 
 sign certificates of health on slight evidence. So far as the insane are concerned, they can not even now, 
 if certified, marry, or, rather, if they do, the contract can be made void. Parenthetically, let me say 
 that a surprising number of youths suffering from adolescent insanity marry in the very early stage, no 
 one suspecting they are not in good mental health. Only an alienist, and not always he, would find any 
 illness in them. Not a few such cases come to every large asylum for the insane a few weeks or even a 
 few days after marriage. The marriages are often annulled, if not by law, still in fact, but too often 
 conception has already occurred. The most dangerous class of the insane, from the point of view of 
 liability to procreate, are those whom no law could include, the borderland cases, whom only alienists 
 recognize and whom, if ^iiey be paranoid, very often the general public regard as talented and brilliant — 
 the general public, in their intellectual innocence, often mistaking the phosphorescence of mental put- 
 rescence for the clear light of pure reason. Alcoholics should not procreate, but to prevent this by 
 marriage laws is impossible, except in the most severe cases, even assuming such a law would work at all. 
 For very obvious reasons drunken j^ouths and some not drunken, living in the country and small towns, 
 are much more likely to procreate indiscriminately than youths living in cities. The helot does not 
 conceive. 
 
 The most important, the most practical means at our command to reduce the number of degen- 
 erates is to take proper care of imbeciles. They should all be segregated for life in institutions, preferably 
 state farms. The patients should have no relation with the outside world. Education should be 
 manual and, as far as the imbecile can receive it, moral, not literary. To teach an imbecile to read 
 does not increase his happiness and does increase his ability for evil. The policy of sending an imbecile 
 to an institution, training him and drilling him, and then turning him loose when he reaches maturity, 
 always leads to harm. Many a one leads a happy life in an institution and submits to discipUne easily, 
 who will go bad as soon as he is free. As a matter of fact, there are several thousand at large in Pennsyl- 
 vania, and very many procreate. The state of Pennsylvania, indeed the whole world, has failed en- 
 tirely in its duty toward them. If they were all cared for it would tremendously raise the mental 
 and moral level of the state. It would be economically wise because it would decrease the number of 
 inmates of jails. Almshouses, county jails, and houses of correction always contain large numbers 
 of imbeciles who lead therein a parasitic life, and often permanently hurt the youths there by acci- 
 dent, whereas in properly managed institutions, they could be made largely self-supporting. 
 
 Life imprisonment of habitual criminals would be of great service. Whether they be mentally 
 defective or not, they are morally defective, and the State owes them nothing as they are parasites. 
 The idea that they can be made moral is an idealistic dream. An argument against parole of prisoners 
 is that the clever plausible hypocritical ones, those who are good actors, will be those who get parole, 
 and they will take advantage of freedom. Every prison warden knows that the pretty faced youth in 
 the jail is not infrequently a much worse criminal, no matter how trivial the crime he maj' be doing 
 time for, than the man with the face of a "plug ugly," but kind-hearted prison visitors and those in- 
 terested in the "uplift" of criminals, do not know it and will not believe it. There is a prettiness of 
 weakness which is almost always associated with viciousness. 
 
 The attitude of the open door to "the oppressed of all nations" has increased the number of de- 
 generates in this country. Some of the "oppressed" are vicious, some insane, many physically weak. 
 Great efforts have been made by sentimentalists to nullify what laws we have regarding the refusal of 
 
PROCEEDLXGS OF COXFEREXCE OX LXFAXT HYGIENE 227 
 
 admission of immigrants to this country on medical prounds. It would be far better for this country 
 if some healthy immigrants were excluded if thereby the unfit could be kept out. 
 
 The above matters, i. e., the segregation of in\beciles and criminals and the exclusion of degenerate 
 immigrants, can readily be controlled by law. Another proposition, namely, surgically to asexualize 
 certain persons, I do not belie\e would ever be carried out on a sufficiently large scale to have any ap- 
 preciable influence, though laws ordering it will probably in the next few years, during the wild hysteric 
 fury of social reform through whi<h we are passing, be put on the statute books of many states and then 
 be forgotten. In a few states laws concerning the matter arc already on the statute book.s. 
 
 The evil of alcoholism can best be copcfl with by indirect means. Prohibition, api>arcntly, has 
 not been a success; indeed, in some states it seems to have greatly increased the abuse of cocain, e. g., 
 among the negroes of the south. The gradually, but now rather rapidly, increasing number of employ- 
 ers of labor who will not give work to drinking men will greatly decrease the number of drinkers. Of 
 course the capitalists are not in any way acting from altruistic motives; such a thotight is tcxlay in- 
 conceivable, but as often happens, their selfishness is wiser than some emotional altruism. Fear of 
 losing a job will not influence those born to be inebriates, nor those who will not work anyhow, but it 
 will keep from drinking many a man who wants to work but who is susceptible to the influence of alcohol. 
 The last are worth saving, the others will sink no matter what efforts are made to keep them up. 
 
 Another way of att-icking the whole problem would be to create s\ich a feeling of disgust for all 
 degeneracy that the normal boy or girl woulil not be attractcfl by the degenerate, but this would mean 
 a complete overturn of our attitude toward life and would require many generations to have any effect. 
 It would mean going back to the Greek ideal — the worship of the beautiful, the strong, the sjine, and 
 contempt for the weak. The prevalent attitude of the writers who are supposed to mold public opinion 
 is the reverse of this. We are continually having pity and sympathy preached at us. We are even told 
 we should breed with an inferior race, the negro, in order to strengthen that race though the evils of such 
 breeding are manifest. White children are compelled to go to school with negroes, and races that play 
 at school will breed together later. \o race was ever made strong by pity, and it is better to make the 
 better best than the worst only bad. Finally, the training of citizens in knowledge of physiology, or 
 rather teaching them how to live, would in time exert a great influence for good. 
 
 The arguments in this matter of the control of procreation by the unfit are not all on one side. 
 There is one against trying to control procreation which, rightly or wrongly, appeals to me; namely, 
 that in trying to eliminate the degenerate we may also eliminate the genius and without him there would 
 be no civilization. Progress does not depend upon the mass of men but upon the few — the geniuses. 
 Strange as it may seem, these biologic sports arise out of queer surroundings and sometimes from strange 
 ancestry. It may be well worth the world's while to suffer from many degenerates if thereby we can 
 grow one genius. 
 
 It is said sometimes b\' those who oppose all attempts to control the unfit that since they are con- 
 stantly being recruited from those of healthy ancestry and good surroundings, it is useless to try to do 
 anything. The argument is scarcely a good one, because though we cannot do a great deal, we can do 
 something — not so much as the enthusiasts think, but yet something worth while. 
 
 Dr. H.\rt: I am convinced that the last speaker is correct in his belief that in addition to proper 
 laws for the restriction of marriage, the entire segregation of the imbecile is necessary. First of all, 
 however, there should be segregation of the feeble-minded girl from twelve years old and upward. Here- 
 tofore every State in the Union which has undertaken the care of the feeble-minded has begun wrong. 
 They have established training-schools with the thought that, by special forms of instruction, under the 
 guidance of specially equipped teachers, and by the application of extraordinary measures of one kind 
 and another, they could develop the latent faculties of these children and bring out the qualities in them 
 that would enable them to play their part in the activities of the world. That has been the universal 
 custom until within the last year, and the results have been uniformly disappointing. .\ few children 
 have gone out from these institutions in normal condition, but these are probably exclusively children 
 who were apparently feeble-minded, and whose mental disturbances were dependent upon some nutri- 
 tional or other physical defect. Unquestionably, the greater part of the children sent out from such 
 institutions have been returned after a while, or have become burdensome to their families or the com- 
 munities in which they dwell. It seems to me that experience has proved the ineffectiveness of this 
 
228 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 plan. These children cannot be made normal, and as they are a menace to public morals, especially the 
 feeble-minded girl, I believe they must become permanent wards of the State. The last Legislature 
 of the State of Virginia passed an act which, I believe, was inspired by me, and which provides for the 
 care of feeble-minded girls, and postpones provision for the other feeble-minded until the feeble-minded 
 girl has been properly taken care of. The State of North Carolina passed a bill two years ago for an 
 institution for feeble-minded, and having been appealed to for advice by the Board of Trustees of this 
 institution, I recommended that they 6rst provide for the feeble-minded girl. I am informed that this 
 policy is to be adopted in that State. 
 
 I believe every State should pass laws providing for the immediate care of the girls of twelve years 
 of age and upward, and not postpone legislation until such time as they can provide for the whole great 
 mass of their feeble-minded. I think this is perfectly practicable. As soon as possible, also, provision 
 must be made for the feeble-minded male imbecile, but they are much less of a public menace. It is a 
 well-known fact that while it is very uncommon for a normal woman to consort with a feeble-minded 
 man, it is, alas! altogether too common for a normal man to consort with a feeble-minded woman. 
 
 Dk. Godd.\ed: I would just emphasize one thing Dr. Hart has said. There are still many who 
 are of the opinion that these feeble-minded can be cured. I think there is unanimity of belief among 
 all those who have worked with the feeble-minded, that no feeble-minded person was ever cured. It 
 was a mistaken diagnosis to start with if a cure was effected. So, as Dr. Hart says, we have been on the 
 wrong side in our methods. Not only are they never cured, but among all our children two-thirds have 
 not improved in mentality one iota in two years. They have Improved in ability to do a lot of things 
 which required no mentality superior to that which they already possessed, but their mental powers 
 did not increase. 
 
 Dr. Neff: We are gratified this evening to know that we are to have a dis- 
 cussion of the effect of housing conditions upon infant niortahty, a subject which is 
 of special importance to us in Philadelphia, for although we are a city of homes, we 
 have full knowledge of the bad factors, and some knowledge of how those factors 
 work. I have great pleasure in presenting Dr. Winslow, Professor of Biology in the 
 College of the City of New York. 
 
 THE EFFECT OF HOUSING UPON INFANT MORTALITY 
 
 BY PROFESSOR C. E. A. WINSLOW 
 
 College of the City of New York 
 
 As you know, the factors of infant mortality can be conveniently divided into 
 those which are constitutional and those which are environmental. We have 
 just had a striking demonstration of the importance of constitutional factors. Of 
 the environmental factors, our attention has been focused for the most part on one, 
 to a degree that I believe is out of proportion to the actual facts. That, of course, 
 is the milk supply. In all discussions of infant mortality, in all exhibits and con- 
 ferences, milk is given first place among the environmental factors, and probably 
 it should have first place, but too often it has almost the sole place. Of course, 
 that is not true in daily practice. The pediatrist and the infant mortality nurse 
 have given attention to the particular problem that I am going to discuss with you. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 229 
 
 but in general discussions of the subject, milk is the only environmental factor 
 considered. 
 
 In connection with the problem of housing we have generally recognized among 
 the essential features, provision for light, air, cleanliness, moral decency, and fire 
 protection, and all have their bearing ujion infant mortality; but the thing we want 
 to focus our attention upon tonight is air conditioning and its effect upon the infant 
 death rate. In the last few years in this country, we have heard something about 
 this through tlie Germans, and we now know what is meant by air conditioning. 
 We have outgrown the old superstitions which have hung longer about litis par- 
 ticular branch of sanitary science than about any other. Ten years ago, perhaps, 
 most discussions on ventilation and air-su])i)Iy would have been called "The Air 
 We Breathe"; and the si)eakers would have pointed out the dangers of carbon 
 dioxide and the dangers from morbific matter, a subtle mysterious poison in the air 
 we breathe. Now we give less consideration to the air we breathe and more to the 
 air which surrounds our bodies. It is not tiie carbon dioxide, nor any chemical 
 poison in the air, l)ut it is the simple fact of temperature and humidity which is 
 harmful. It is one of tlie curious instances of the tendency of the human mind to 
 reach after the far-fetched and remote, that hygienists so long sought to find some 
 mysterious poison, and forget all about temperature and humidity. 
 
 We know, now, that most of the effects of bad air are to be ex])lained as the 
 result of heat and moisture and their unpleasant effects on the regulating mechan- 
 ism of the body. The difference between bad air and good air lies in their effects 
 on the vasomotor system. 
 
 The two great preventable causes of infant mortality, the respiratory diseases 
 and the diarrheal diseases, are both very directly affected by the housing factor. 
 In the publications of the Chicago Department of Health, cases of pneumonia are 
 referred to as "b.ad air" diseases. Some of you may, perhaps, remember Dr. 
 Evans' reference to the "double cross" in Chicago, showing the respiratory diseases 
 in winter and the diarrheal diseases in summer. Pneumonia and bronchitis, of 
 the first class, make up 15 to 20 per cent, of the total causes of mortality among 
 infants. We have no statistical evidence to show just how great the factor of bad 
 housing conditions is, but we do know that pneumonia and bronchitis affect babies 
 and grown jjcople who are brought up in overheated rooms. There is no doubt 
 about that general fact. Then, too, that other group of diseases, the largest of all 
 the preventable groups, the diarrheal diseases, making up from 30 to 40 per cent, 
 of the total infant death-rate, can be traced in large part to this same cause; and 
 that is a point that some of us have come to realize only within the last very few 
 years. 
 
 At first, the summer diarrhea of infants was supposed to be due to the direct 
 effect of heat, and then the pendulum swept the other way, and it was supposed 
 that dirty milk alone was the cause. It seemed a little curious, however, that milk 
 should be so very much dirtier in summer than in winter. I think Dr. Neff will 
 bear me out that even in winter the milk supply of our American cities has been 
 pretty dirty in the past. Dr. Park and Dr. Holt, in 1894, in New York, showed on 
 
230 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 a small basis that babies fed on breast-milk die faster in summer than the babies 
 fed on the worst grade of store milk do in winter, from infant diarrhea. So there 
 must be another factor at work. The German, Fluegge, suggested, in 1879, that 
 heat itself was a great cause of summer disease, and he was followed up by Meinert 
 in 1891, Reitschel, Liefman and Lindemann, and others who worked out monthly 
 and daily curves, and in the Rudolf Virchow House in Berlin this question has 
 been studied exhaustively. It has been shown that this is a question of temperature 
 and humidity, as well as of food-supply among the bottle-fed children. It was 
 only when the daily deaths in the most recent work of Liefmann and Lindemann 
 were set forth along with the temperature records that the close connection between 
 the two became so clearly apparent. 
 
 In the early summer the babies die from something very closely resembling 
 heat stroke, and there are sudden deaths, ceasing closely after a drop in the tem- 
 perature. They have some very remarkable statistics showing that children in 
 cellars did not have this early summer death-rate, though their milk was worse 
 than others. In the late summer the diarrheal symptoms are much more evident- 
 In cases of heat stroke in early summer milk is, of course, one important factor, 
 for children fed on pure milk are able to resist the heat. In the late summer, again, 
 diarrheas affect the children fed on bad milk, but it is principally the combination 
 of bad milk and high surrounding temperature working together that makes the 
 trouble in either case. 
 
 I do not want any less attention paid to the problem of the milk supply; but 
 I think too little weight has been attached to the other factors. We ought to have a 
 better study of the causes of the summer diarrheas, and of pneumonia, bronchitis, 
 and the respiratory diseases in winter. 
 
 Now, the connection with housing, of course, is obvious enough. Rietschel 
 and some other Germans have obtained some very striking data respecting the 
 excess of indoor temperature over outdoor temperature. When the outdoor 
 temperature reaches about 73°, the death-rate increases, and the indoor temperature 
 is, of course, worse. In one house in Berlin, two years ago, Rietschel showed that 
 outdoors the maximum temperature only twice passed 79°, but in the house the 
 maximum was never below 75°, and on only three days out of 38 days was it below 
 82°. Twelve times it was over 86°, and three times over 97°. Remember, this 
 was when the temperature outside was under 79°, except on two occasions. On 
 nine of these days the minimum inside was over 77°, and on four days it was above 
 82°. 
 
 Now, on this point we have done practically nothing in this country. Dr. 
 Schwartz in New York has prepared some daily diagrams, but we have done nothing 
 to study housing conditions or the temperature to which the child is exposed. It 
 seems to me that this work is of importance enough for us to turn our attention 
 to at this time. There are several things we can do about it practically. In the 
 first place we need strong regulations for the proper kind of housing, for better 
 tenement construction, and so on. In the second place much may be done by 
 attention to the clothing and bathing of the child. Finally, it may at times be 
 
PROCEEDIXGS OF CONFERENCE ON INFANT HYGIENE 231 
 
 possible to use artificially cooled rooms for therapeutic purposes. At Mt. Sinai 
 Hospital in New York they are planning to have a cool room this summer for the 
 treatment of infant cases. It is a very curious tiling tliat we should warm our air 
 in winter, and yet in summer we should take the hot air as a dispensation of Provi- 
 dence, for it is just as easy to cool the hot air as it is to warm the cold air, though not 
 perhaps just as cheap. Perhaps in the future we shall have a more reasonable 
 temperature in our houses, schools, and public buildings in winter, and that we 
 shall use the coal saved to cool them in summer. There is a certain banking-house 
 in New York which is kept cool in summer, and their one comj)laint is that they 
 never can get rid of anybody who once comes into that office. 
 
 However, I am not urging any specific measures so much as I am urging the 
 need for a study of this problem, and the necessity that it should have an important 
 place in our infant mortality program. I was made Chairman of the Committee 
 on Housing at the last meeting of the Association for the Prevention of Infant 
 Mortality, and I should like very much to get practical workers interested in trying 
 to get some data. I think we ought in America to be able to make a rather com- 
 prehensive study of the effect of various environmental factors on infant mortality. 
 We could specialize at first on diarrhea. It is claimed in England, for instance, 
 that some diarrheas are contagious, but we do not know anything about it. We 
 do know that feeding is of supreme importance. We know that temperature is 
 of great importance. Could we not make a careful study in some of our large 
 cities, or in all our large cities, of these various sanitary factors? Until we do, we 
 shall not know definitely just what effect housing and clothing really have. Only by 
 such a comprehensive study can we learn how to rightly place our emphasis in the 
 campaign for the prevention of preventable infant mortality. 
 
 Dh. Neff: The discussion of this very interesting paper will be opened by 
 the Secretary of the Philadelphia Housing Commission, Mr. Bernard J. Newman. 
 
 DISCUSSION ON PROFESSOR WINSLOWS PAPER 
 
 Bern.\rd J. Newm.\n: It is almost useless to try to add anything to the discussion of so illuminat- 
 ing a paper as this treatise on temperature, though I do take exception to the statement that the charac- 
 ter of the air has no perceptible influence upon the health of the child. We do know that when we go 
 into a house where the windows and the doors have been kept closed and where there have been from 
 four to six people sleeping, our lungs rebel, and we feel as if we want to gape, showing that our system 
 objects to the kind of air we are breathing. Then we also know that air is infected by environmental 
 conditions that are often a serious menace to the health of the infant. We know, for instance, that 
 wherever there is an unclean privy close to the windows of a home, the air is infected and the children 
 suffer. We also know, from reliable statistics, that with two people in the room the death-rate averaged 
 20 per 1000, while with 10 people in the room the death-rate climbed as high as 79 per 1000. Many of 
 us know, also, the figures gathered in Berlin, where out of ^700 children that died, 1700 were bom and 
 lived in one-room apartments, and about 947 lived in apartments of two rooms, illustrating the direct 
 connection between the atmosphere of the room laden with organic impurities and the health of the 
 child. 
 
 But there is another side that connects the humidity of the air with the health of the child. We 
 know that where there are rooms with damp walls, where the cellars are filled with water, especially in the 
 
232 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 summer, there is great humidity in the air of the house, and this humidity and the air not cooHng off 
 over night keep the temperature at fever heat and the child suffers. These are all demonstrated facts. 
 Some Philadelphia houses and courts were found to be from 1G° to 20° warmer than the surrounding 
 streets. 
 
 One aspect of the matter decidedly interesting and worthy of investigation is the influence of filth 
 upon the atmosphere. Out of 5000 odd children that died in Philadelphia in 1910, somewhere between 
 22 per cent, and 23 per cent, died of contagious or infectious diseases. We know that the danger from 
 these diseases comes through the germ, and that the carriers, whether air or insects or both, to the child, 
 are responsible for the diseases and the subsequent deaths. 
 
 For example, take again the case of the open privy vaults. From the vault it is the 8y that carries 
 the germ. Sometimes a heap of ashes in the yard covers the filth, and when the ashes are disturbed, 
 there is an opportunitj' for the germ to be carried through the dust to the child. AVe know of a certain 
 case where there was smallpox in a house, and after the disease died out, and the house was fumigated, 
 a disturbance of rubbish in the yard caused a renewal of the outbreak. 
 
 So we could go on giving instances of a close relationship between bad ventilation in the dwellings 
 and insanitation about them, and sickness and death to the children. We must bear in mind that not 
 counting the 20 per cent, or 30 per cent, of the children born, who suffer in consequence of prenatal 
 conditions, 70 per cent, suffer more or less in consequence of conditions that exist in and about the house. 
 Now, these conditions may not be the primary cause of death, but the disease itself is not the primary 
 cause. These conditions are part of the many causes that enter into and affect the health of infants, 
 and no matter how many hospitals we build, no matter how many physicians are practicing, no matter 
 how many nurses are going into the homes, unless we keep the homes and their surroundings clean, we 
 retain the germs that are causing us this problem of infant mortality. 
 
 When the French started to build the Panama Canal, they sent over many physicians and they 
 built hospitals, but as long as the French were there the hospitals were filled. W hen the United States 
 took up construction work on the Canal it sent down sanitary engineers who made drains and cleared 
 away the breeding-places for mosquitoes. Their hospital was never filled. Sanitary improvements 
 reduced the sickness and very quickly cut down the death-rate. 
 
 We may make a temporary fight against diseases that cause infant mortality, and seem to be 
 winning, but unless we clear away the contributing causes in insanitation within and about the homes 
 we are not going to enjoy the fruits of our apparent victory very long. 
 
 Dr. Woodward: I did not come prepared to speak on this particular subject, but it is cer- 
 tainly very interesting. There are two things which Professor Winslow has said which I wish to 
 emphasize: the first is the importance of investigating the causes of infant mortality, and the second, the 
 importance of not attributing so much weight to the influence of atmospheric conditions until we know 
 more about them. 
 
 So far as the investigation of the cause of infant mortality is concerned, up to the present time, 
 unfortunately, we have to base our conclusions very largely on the mortality figures alone, and not upon 
 the morbidity figures that are associated with them. With infant mortality, as with mortality at all 
 other age periods, so long as we are limited to the investigation of vital cases, we cannot make a thorough 
 study of the causes which generally terminate in death, and we are not going to get satisfactory' results. 
 We must remember that infant mortality is the result of a large number of diseases arising from many 
 different causes. It is unnecessary to enumerate them here, but we know their name is legion, that they 
 are both constitutional and environmental, and we are not likely to find all fatalities, nor any large pro- 
 portion of them, directly associated with any one factor. 
 
 We must not expect to find a panacea for infant mortality or infant morbidity. I have listened 
 with much interest to the suggestion that temperature changes and changes in the humidity of the 
 atmosphere play an important part in the causation of infant deaths. It is not clear to me that we have 
 any evidence yet upon which to base that conclusion. In the first place, so far as the infant is concerned, 
 we are dealing with a creature that up to the time of birth is surrounded by a liquid medium of a tem- 
 perature of practically 98° F. ; we have to reckon with the change that comes when this child gets out 
 into the atmospheric air, with a very much diminished water content. But whether it is reasonable to 
 say that a being which has been developed in an environment of 98° and an environment of absolute 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 233 
 
 saturation can stand this high huniiility and high temperature less well than older creatures who have 
 not been submitted to it, remains to be proved. 
 
 Then there is another factor that we will have to reckon with in undertaking to determine the 
 effect of temperature and humidity on mortality, and that is its relationship to breast-feeding. We 
 know that breast-fed infants do not die in anything like the proportion in hot weather that artificially 
 fed infants do, and if temperature and humidity are the chief factors, or even very important factors, 
 why should wc find such a very marked ditfercnce? The same thing is true with respect to the deaths of 
 infants in the country, for so far as the general temperature is concerned, the temperature in the country 
 is high and the humidity also is high at the .same times that they are high in the neighboring cities; and 
 yet wc know that even in the suburbs of a large city deaths are less numerous among infants in the hot 
 weather than they are in the city. 
 
 We must suspend judgment, I think. Wc must not attribute too much weight to the theory that 
 temperature and humidity play a very important part in the death-rate. Nevertheless, the extent of 
 their influence should be determined, while at the 3Jime time we study fully the influence of the various 
 other causes, constitutional and environmentjd, that lead to our undue infant death-rate. 
 
 Dr. Newmayer: This novel and interesting suggestion of Dr. Winslow's appeals to me suf- 
 ficiently to stimulate me to conduct a .series of experiments along this line in Philadelphia during the 
 coming summer. There is no doubt that temperature and humidity not only have their direct effect 
 upon the child, but also upon the food that i.s given to the child. I presume this is the reason why the 
 bottle-fed babies have a higher mortality than tho.se fed at the breast. One of the best things in our 
 summer campaign in IMiiladclphia is our recreation piers. .\t one of these piers wc cared for several 
 thousand children during the summer months, with a very low de.ith-Rite. I have attributed nmch 
 of this good result to the separation of these children from their environment in the very congested 
 tenement and slum districts, as well as to the instruction of the mothers and the good care given the 
 infants by the nurses. I suppose I should have added that the lower temperature and fresher air that 
 were given them for the greater part of the day and evening at the piers, had at least an equal effect upon 
 the lovvering of the mortality. At the same time they were given pure milk, and the mothers were taught 
 how to care for and prepare this milk properly in the home. I believe we should provide more piers, 
 or more places fitted up like piers, say in the pul)lic s<|uares, where we might send the children on the hot 
 days of summer, thus separating them from the hot, close and filthy quarters that they live in. 
 
 Mr. Winslow: 1 did not want to im])ly for a moment that I do not appreciate the imi)ortance 
 of sanitary inspection and the cleaning up of the nuisances concerning which Mr. Newman spoke. Of 
 course, the germs from the privy vaults, etc., cannot fly through the air, but must be carried by flies or 
 other insects, and anything that can be done to lessen the number of breeding and feeding grounds is 
 very important. One thing that should be commented upon in this connection is the danger of infection 
 from the babies' diapers. Very often in houses where they would be horrified at the thought of main- 
 taining anything insanitary, the diapers are allowed to stand about exposed in pails where flies can feed 
 upon and carry the infecting organisms which they harbor. 
 
 Just a word about the statistics of housing. Some of these have been very carefully collected, 
 but it is not often done. When you say that babies die faster in a one-room tenement than in two rooms, 
 we must remember that people live in one room because they are poor, and this very likely will be as- 
 sociated with poor food, poor intelligence, and other unfavorable conditions. Many of them have the 
 poor protoplasm that Dr. Goddard spoke of. There is a whole mass of protoplasmic and other con- 
 ditions to be studied. Furtliermore, do not let it be thought that I have minimized the importance of 
 good milk. There is no doubt whatever that infant diarrhea is caused in large measure by bad milk. 
 What I want to do is to make a study of all these factors, so that not one of them shall be considered 
 supreme. 
 
 Dr. H.wiill; I am sure you will all agree with me that this has been a very interesting and in- 
 structive evening, and I know you will gladly join with me when, on behalf of the Executive Committee 
 of the liaby Saving Show, I extend our thanks to those who have so ably participated in the discussion 
 of these important problems. 
 
Third Session— Thursdmj, May 23, 10 A. M. 
 
 Presiding Officer: 
 
 Mrs. Owen Wister, President of the Civic Club of Philadelphia. 
 
 1. What the Henry Street Settlement is Doing to Conserve the Life 
 
 OF Infants and Children: 
 
 Miss Elizabeth Farrell, Resident of the Henry Street Settlement, New- 
 York. 
 
 2. Prenatal Care: 
 
 Mrs. William Lowell Putnam, Chairman of the Committee on Infant 
 Social Service of the Women's Municipal League of Boston. Discussion 
 to be opened by Dr. Philip Van Ingen, Member of New York Milk Com- 
 mittee. 
 
 3. Educational W'ork for Mothers of Today and Mothers of the Future: 
 
 Dr. Helen C. Putnam, Director of the American Association for Study 
 and Prevention of Infant Mortality. Discussion to be opened by Mrs. 
 Edwin C. Grice, of Philadelphia. 
 
 4. The Value of Recreation in Relation to Infant Mortality: 
 
 Mrs. Luther H. Gulick, of New York City. Di.scussion to be opened by 
 Mr. Alexander M. Wilson, Assistant Director of the Department of Public 
 Health and Charities of Philadelphia. 
 
 Dr. S. McC. Hamill: It gives me a great pleasure, indeed, to turn over the 
 direction of the morning's conference to Mrs. Owen Wister, President of the Civic 
 Club of Philadelphia. 
 
 Mrs. Owen Wister: Philadelphia is grateful to the organizers of the Baby 
 Saving Show. We are fully aware of our indebtedness to the physicians of our 
 community who are doing so much to bring needed knowledge to the masses of our 
 great population. The Civic Club, which I have the honor to represent, is deeply 
 interested in this undertaking, and is most happy to be invited to participate in it. 
 
 In the very interesting session held in this room yesterday afternoon many 
 people were disappointed that they were unable to listen to Dr. Hastings H. Hart, 
 of New York, who could not make the address that was promised at that time. We 
 are very fortunate, indeed, in having Dr. Hart with us this morning, to open the 
 third session of this Conference. It is hardly necessary for me to introduce Dr. 
 Hart, Director of the Department of Child Study of the Russell Sage Foundation, 
 who is so well known not only in this city, but in all parts of the United States. 
 
 234 
 
PROCEEDINGS OF CONFERENCE ON INFANT IIYGIF.NK 235 
 
 CARE OF INFANTS 
 BY HASTINGS H. HART, LL.D. 
 
 Director, Department of Child-Helping, Russell Sage Foundation 
 
 I am asked to say something about the institutional care of infants and tlie 
 placing of infants in family homes. There is often a disposition to make a pro- 
 miscuous condemnation of institution care of children. I am free to admit that 
 my own prejudices are in favor of family home care of children. I believe pro- 
 foundly in the maxim that was laid do%\-n by what is known as the White House 
 Conference, in 1899, in Washington, which declared that "Home life is the highest 
 and 6nest product of civilization — children should not be deprived of it except for 
 compelling reasons. " 
 
 I have made a long study of institutions, and the Russell Sage Foundation, 
 during the past two years, has made a .special study of this question. I am con- 
 vinced that there is a field for a limited amount of institutional work for infants. I 
 know from my own observation that there are institutions which are taking care 
 of infants with at least a reasonable degree of safety and success. For example, 
 there is in the city of Omaha an institution known as the Child Saving Institute. 
 I think that the care of infants in that institution approximates a proper standard. 
 They have a small institution — accommodations at no time for probably more than 
 30 infants. They have an arrangement with one of the general hospitals whereby 
 a nurse, after two years of training in the hospital training-school, goes to the Child 
 Saving Institute for a three months' special course in the care of infants, so that 
 all the nurses coming to them have already had two years of actual class or school 
 work. Then they have about one nurse of this qualified character for everj' two 
 infants. They have a head nurse, who is a first-class woman and would stand well 
 in any hospital, for she is well trained in her science. 
 
 The handling of the milk and the care of the infants are pretty nearly ideal. 
 I have not the actual figures as to the death-rate there, but I think it is lower than 
 that of infants in the general population of the city of Omaha. There is one thing 
 about that place that I think should be considered more seriously, and that is 
 that the dormitories contain some 15 beds for infants. I do not think there should 
 be that many infants in one room. 
 
 You may consider also an institution like the Babies' Ho.spital of the city of 
 New York, under Dr. L. Emmett Holt. There also the infants are cared for under 
 pretty nearly ideal conditions, and if all institutions for infants had a standard as 
 high as this one, I do not think that any one would want to denounce them. The 
 Babies' Hospital in Newark, N. J., under Dr. Henry L. Coit, is another example of 
 a high-class institution for infants. The study and records of the individual child 
 from the medical standpoint are there carried far above that in any other place with 
 which I am acquainted. Dr. Coit has given an infinite amount of study to this 
 
236 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 matter and has produced results that cannot be surpassed. I do not think he has 
 estabhshed a standard method, because it is a little too elaborate for general use, 
 but I believe that he has marked out the Une which must be followed in a somewhat 
 modified form if we are to care for infants successfully m our large cities. 
 
 There are other institutions also that are doing good work in endeavoring to 
 maintain high standards. On the other hand, I think it has to be said, in all fair- 
 ness, that the progress made in the last two years in the reduction of infant mor- 
 tality has not been shared in adequately by the large institutions for uifants. It 
 seems to be the general belief that the institutions have not kept up with the work 
 of the health boards and the milk committees in the reduction of infant niortahty. 
 They cannot do it with their present equipment, with their present force of nurses 
 and other help, and with the other machinery which they have thus far applied. 
 
 There is another line of institutional care for infants that is to be considered, 
 and that is the institutions which receive mothers and infants together, requiring 
 the mother to nurse the child, and in some instances to divide her milk between her 
 own child and a foundling baby. There is a large number of institutions of this 
 type. The Chicago Foundlings' Home is a good illustration. They have handled 
 this problem for many years, and have had a rule that they would not receive a 
 baby if the mother was known unless the mother came with it. They were re- 
 quired after coming to divide their milk, and they were given the care of physicians 
 and nurses, the child supplementing mother's milk with cow's milk, and they have 
 had very satisfactory results. 
 
 There are 84 Florence Crittenden homes throughout the country, and al- 
 though there have been great differences in the quality of work they performed in 
 the different cities, many of them are standing firmly for the breast nursing of the 
 child and u.se every influence to have the mother nurse her child, at least until the 
 child is through the nursing period and has acquired the teeth necessary to permit 
 it to take different food. 
 
 There are also many institutions of the same kind maintained by Catholic 
 sisterhoods and by different corporations. In my judgment it is very imwise to 
 condemn the work of these institutions as long as they will adliere firmly to the 
 plan of the mother nursing her own child. Of course, there is also the whole 
 question of the future of the child and what disposition should be made of it, but 
 I am speaking at the present time only of the question of infant mortalitj' as af- 
 fected by the institutional care of the infant. 
 
 It is difficult to get a just view of the work of the institutions, because there 
 are no adequate statistics on the question. None of the statistics now available 
 as to this phase of infant mortaUty can be regarded as wholly reliable. The sta- 
 tistics published in New York cover infants up to two years. We have no infant 
 mortality statistics covering those under one year old. They are also compUcated 
 by the fact of the different ages at which the infants are received at these institu- 
 tions. 
 
 I visited an institution the other day which seemed ideal, but the minimum of 
 age at which these children were received was three months, and, of course, we do 
 
PROCEEDLXGS OF COXFEREXCE ON LXFAXT HYGIENE 237 
 
 not know what happened to those that didn't come in under the three months. 
 Naturally, the mortality rate in that institution was low. I wish we had better 
 statistics on these questions. The facts exist, and the figures are recorded in our 
 cities, but somehow we cannot get at them. 
 
 As to the matter of placing the child in the family home, that term means 
 different things in different parts of the countrj' and in different cities. In the 
 West and in Chicago, when they speak of placing a child in a home, they almost 
 always mean giving it out to what we call a free home, where the child is received 
 by the people, cared for at their own expense, made a member of the family, and, 
 in a large proportion of the cases, is taken for legal adoption. That is one propo- 
 sition. In this city and in Boston, and in Massachusetts generally, when they 
 speak of placing out an infant they usually mean placing the child in a family on 
 board, where the board is i)aid cither in whole or in part by the parents, or perhaps 
 by some private organization, or by the city or State. Now these different methods 
 of placing the child mean different things. 
 
 You will find again that it is extremely difficult to get reliable statistics on the 
 mortality question with reference to babies that are boarded out. It makes a dif- 
 ference whether the baby is boarded out immediately after birth or within two or 
 three days afterward, or not until the age of three or four months. In the last 
 case you have left out of account those that died in the mean time. 
 
 The placing of children in family homes may be done in any one of several 
 different ways. In Massachusetts they believe and advocate very strenuously 
 the idea that institutional care of infants is entirely uimecessary. In New York 
 they believe that it is necessary to have some place where the large number of 
 foundling infants and the large number of mothers with illegitimate children can 
 be received, sifted, and distributed to the proper points. The Bellevue Hospital 
 performs that function for a large part of New York. In Boston the children's 
 societies have arranged so that if a child is brought Ln at 4 o'clock in the afternoon, 
 the child is received, has a medical examination, and before 5 o'clock is sent out 
 to a family home. The board is paid by the society. The boarding-out method 
 has been practised extensively by the State Board of Charity of Massachusetts 
 since the year 1868. Prior to that time babies were sent to the State almshouse. 
 Babies are boarded out by the city of Boston, and, to a limited extent, by four 
 different societies in the city of Boston. The method has been practised also by 
 the State Charities Aid Association in the city of New York, and by the Children's 
 Aid Society in Philadelphia. 
 
 The rate paid for board is very moderate — too moderate. It used to be as 
 low as $2, with $2.50 as the maximum. Now the rate runs from $2.50 to $3.50, 
 and, in some cases, to $4 a week, for babies boarded out by these public and private 
 institutions. When you pay a woman $2.50 for the care of a baby and she has to 
 purchase her own milk , has to sit up at night with the child, and has to take all the 
 responsibihty and anxiety of the child, you may imagine that the compensation 
 is exceedingly meager. If she has a sick child which will keep her up at night, the 
 maximum of $3.50 a week would certainly not be called extravagant compensation. 
 
238 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 I think that the women who undertake this work of nursing children are to a 
 large extent actuated by altruistic motives, and the best institutions take that 
 motive into account. The increase in the family expense by the purchase and 
 care of milk is considerable. I do not think the payment for board ought to be 
 less than $3 a week, and those societies that are interested in that work ought to 
 get it up to that standard. 
 
 I am told by people who are engaged in this work- — and I have had some ex- 
 perience myself in Chicago — that it is not at all impossible to get reliable boarding- 
 houses for babies. The great question in the past has been the lack of sufficient 
 strictness in selection. Advertisements are inserted in the newspapers and appli- 
 cants come in because the organization is known to have money for the care of 
 babies, and in some instances babies are boarded out without opportunity for proper 
 inspection. The number of available homes can be greatly increased by a careful 
 search, wider advertising, and by making use of certain private agencies. 
 
 There is no question that homes ought to be selected with the utmost care. 
 When the home is brought to the attention of the agency, an experienced, capable, 
 discriminating agent should go out at once and make an examination of the home, 
 its environment, its sanitary conditions, its arrangements for ventilation and heat- 
 ing, the care of the family, and so on. You will want to know whether there is 
 any tuberculosis in the family or any other infectious disease, and you will want 
 to know what have been the reputation and standing of the people in the community 
 in order to get a proper selection. This is not obtained by any deductive method. 
 It must be obtained by an agent who has acquired by experience such discernment 
 as will enable her to discover the essential things in that home, by going into it 
 and making observations directly and personally instead of by going around to 
 neighbors. The investigation of homes can be overdone. We have several in- 
 stitutions in New York that place out children, and the selection of homes is done 
 in this way: first, the applicant comes to the organization. The latter sends its 
 agent, who goes into the home. If they find conditions satisfactory, notice is sent 
 at once to the health department. An inspector of the health department also 
 makes an inspection before the child is placed. The place is also open to the in- 
 spection of at least three agencies who will go through the same procedure, and 
 some caretakers have complained that they could not take proper care of the babies 
 because they had so many inspections. I think that one efficient inspector could 
 do better work than these five, ■n'ith less mconvenience to the foster mother. 
 
 Another line of investigation concerns the placing of children in family homes 
 for adoption. Many of our institutions make it a habit to keep these babies, if 
 they survive, until they are two to three years old, before placing them in a family 
 home. I have been entirely unable to understand the psychology of that method. 
 It is expensive. It is hard on the child, who keeps possession of quarters that 
 might be given up to another, and I could never miderstand if a child is to be placed 
 in a family home, why it should not go there as an infant. It is easier to find a 
 satisfactory home for an infant than for an older child. He is much more able to 
 adapt himseK to the ways of the home and become a permanent member of the 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 239 
 
 family and become assimilated by the family. There should be an early de- 
 termination of the question whether the child is to be placed in a home, and if so, 
 the earUer the better. It is far better for them to be in well-selected family homes. 
 You can place them in homes and still give them the same care and advantage of 
 medical attention which they would get in the institution. 
 
 There is a third method of caring for children by placing them in family homes 
 that is extensively practised in New York city and Philadelphia and other cities 
 to a limited extent. This is the method of boarding out children with wet-nurses 
 in their own homes. I have been astonished to find to what an extent this is 
 possible. The New York Foundling Hospital has in the neighborhood of 300 
 infants boarded out with wet-nurse mothers. These are usually women who have 
 had miscarriages. The method of finding these women in New York is usually 
 by personal acquaintance among the women. A large majority of these are Italian 
 mothers. In some cities these mothers have been found by watching the health 
 department records. In any city where you have a prompt report of births it s 
 possible to trace the cases of premature birth in this way, and where the child has 
 been lost at birth the mother is promptly hunted up and the effort made to induce 
 her to receive a child for wet-nursing. 
 
 It is not necessary to exercise the same degree of care in selectmg the homes 
 of these wet-nurses as in the cases of bottle-fed babies. As a matter of fact, it is 
 safe sometimes to put a child on the breast in a home where you would not trust 
 a bottle-fed baby. Of course, it is desirable that the conditions should be sanitary 
 and the woman cleanly, but if you have a healthy woman and a home that is reason- 
 ably sanitary, a child may be kept there sue or eight months on the breast with 
 comparatively little danger if there is proper medical and nursing supervision. It 
 has been demonstrated in New York and in Philadelphia that a very nmch larger 
 number of such nursing women can be found than is supposed. I have been sur- 
 prised that in some other cities the work has been abandoned because it was claimed 
 that the mothers could not be found. These nurses can be found by proper methods 
 of search. 
 
 The compensation paid is ridiculously small. In New York, for more than 
 thirty years, the standard pay has been $10 a month for a woman who receives a 
 child in her ovm home and gives it nursing at the breast. That compensation 
 is certainly inadequate and ought to be increased, and it is one of the obstacles 
 which prevents finding a sufficient number of mothers. The institutions that 
 have been doing this work have been reluctant to increase the compensation be- 
 cause they never have enough money to do all they would like to do. At the same 
 time they have been forced in a considerable number of cases to put babies on the 
 bottle that might have been put on the breast. When the child received is sick 
 and gives the mother special care, anxiety, and responsibility, it would seem entirely 
 reasonable to give them from $2 to $5 a month as extra compensation. 
 
 If you will read the reports of St. Vincent's Home, you will get an idea of what 
 has been accompUshed in Philadelphia. They began ten or eleven years ago on 
 
240 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 this nursing proposition. Prior to that time their mortahty rate had been extreme, 
 and their reports show that they immediately succeeded in reducing it. 
 
 When infants are boarded out, either with wet-nurses or on the bottle, it is 
 extremely important that there should be an adequate supervision. Many of 
 the agencies that have used these methods have been delinquent in this respect. 
 As I have indicated, where babies are bottle fed the homes should be selected with 
 special care as to the interior conditions and environment. The women in all 
 cases should be carefully instructed as to feeding and should receive instructions 
 from the nurse and physician, and should be visited by the nurse at frequent inter- 
 vals. 
 
 The most thorough work in this respect that I know is done at Morristown, 
 N. J., under the Speedwell Society, organized by Dr. Chapin, of New York. They 
 have an abundance of fresh air; the babies are visited at least as often as once in 
 two days, and every day if they need medical attention, and they are kept under 
 very close medical and nurse supervision. Most of the babies received there 
 suffer from marasmic conditions from which they would ine\'itably die under 
 ordinary conditions, and a very large proportion of them are saved. 
 
 It is absolutely essential that we should have an adequate visiting nurse service 
 and medical service at command. Many of the institutions require that a baby 
 reported sick should be brought to the institution. This sometimes means a 
 journey of five to ten miles in a wagon or car with the temperature perhaps 90° 
 in the shade or 20° below zero. Then it is found that the child requires medical 
 care, and it is taken from its mother's breast and placed in the hospital at the very 
 time it needs breast nursing. Medical ser\'ice should be available in the home. 
 The visiting nurse should be on call on the telephone and should have the power 
 to call the physician if necessary without the formality of sending the child to the 
 institution. I am convinced that a very large proportion of the work now done in 
 institutions could be much more profitably done outside of the institutions. There 
 is a large expense attached to keeping adequate nursing force. I think one nurse 
 for two babies is not too many. When you come to take into consideration the 
 housing and feeding of the nurses, their discipline and training, you run into a very 
 large amount of expense. I believe, therefore, it would be wise for every society 
 to study carefully the method of placing children in family homes. 
 
 Mrs. Wister: The formal discussion of the subject of Dr. Hart's paper was 
 made a part of the program of the first session of this Conference. We shall, 
 therefore, proceed with the regular program of the morning. 
 
 The next subject to be discussed is, "What the Henry Street Settlement is 
 Doing to Conserve the Life of Infants and Children." Modern society owes a 
 very great debt to the College Settlement. It has pointed out a new aspect of 
 human brotherhood which is taught by example more easily than by precept. A 
 city must live with an open mind. It must look about and learn and take the best 
 it can get from such observation. I, for one, have always been extremely glad that 
 the great neighboring and cosmopolitan city of New York lies within the radius 
 
PROCEEDINGS OF COXFERENCE ON INFANT HYGIENE 241 
 
 of our vision. There are many things that we have learned from New York, many 
 more that we are all glad to learn, and I know that we have an extremely warm 
 welcome this morning for Miss Elizabeth Farrell, Resident of the Henry Street 
 Settlement of New York city, whom it gives me great pleasure to present to you. 
 
 THE HENRY STREET SETTLEMENT'S CONTRIBUTION 
 
 TOWARD THE CONSERVATION OF INFANT 
 
 HEALTH AND LIFE 
 
 BY ELIZABETH E. FARRELL 
 
 For the sake of tiiosc who do not know the neighborhood in which the Henry 
 Street Settlement works, permit me to say that, while it is located and its main 
 field is in tlie lower East Side of New York, where the congestion is said to be as 
 great as in any other part of the globe, it is not limited to this locality. It reaches 
 all parts of the city through its various activities. There are numerous branch 
 bouses — one in the Bohemian colony: one in the colored section, etc. This sug- 
 gests the conception of its duty to the city, and is suggestive of the social problems 
 that the Settlement attempts to solve. 
 
 This ideal and the variety of problems presented necessitate well-organized 
 and highly specialized work. I shall deal only with that phase of the work which 
 affects infant and child life, and discuss first, as perhaps the most interesting feature, 
 the work of the milk station. It should be borne in mind that conditions here are 
 nearly ideal. A limited milk supply permits of approximately complete control 
 with regard to number of babies, their cure, etc. It is quite impossible, at present, 
 at least, for municipal milk stations to provide anything like the quality of milk 
 provided for babies by the Settlement milk station. The milk dispensed there is 
 furnished by a friend of babies, a man of large means, who makes available almost 
 the entire product of his dairy. Only the small amount of milk which is needed 
 for the use of his immediate family is kept out. The dairy is as sanitary and up- 
 to-date as science can make it. The herd is made up of the finest line of stock, and 
 the plant and its equipment are frequently inspected. A graduate of an agricul- 
 tural college is in charge. Everything is done to maintain the highest standard. 
 Another important, indeed almost unique, feature of the milk station is that the 
 milk dispensed each day represents the product of that morning's milking. Through 
 the generosity of an express company a wagon awaits the train and brings the milk 
 directly to the milk station, where it is bottled for distribution to the mothers whose 
 babies are under the care of the Settlement. The milk is not pasteurized. The 
 bacterial count is uniformly low. It has been as low as 600 to the cubic centimeter. 
 The highest grade milk sold in New York city contains 30,000 bacteria to the cubic 
 centimeter. The County Medical Society certifies this milk. There are two 
 
242 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 articles of faith which Miss Wald beheves essential in milk station work. First: 
 milk for babies should be modified only in accordance with their individual needs; 
 second, the education of the mother is fundamental. 
 
 In order that the milk may be properly modified it is required that the baby 
 be brought to see the clinic doctor, who examines him, weighs him, talks with the 
 mother, and then gives a formula for the modified milk. This formula is given 
 to the nurse. Does this not seem reasonable? We would not think of giving 
 the same amount of medicine to whole groups of children who come to a clinic, 
 and yet many of us think the same modification of milk is good for all children. 
 Our contention is that the milk must be modified to suit the individual, and that 
 point must never be lost sight of by the doctor or by the nurse. 
 
 The formula is taken by the nurse to the home. At her first visit she explains 
 the formula to the mother, does all the work of modification herself, thus making 
 the lesson practical and concrete. The nurse herself sterilizes the bottles and the 
 nipples that go on the bottles. She puts the required amount of barley and sugar 
 in the milk. This is done with the mother looking on and helping as required. 
 When the milk is prepared, it is bottled and put on ice. Enough milk is modified 
 to last until the visit of the nurse the following day. At this second visit the 
 mother modifies the milk under the supervision of the nurse. If she has not yet 
 learned the lesson, the nurse gives her further instruction. In this work the nurse 
 uses the utensils she finds in the home. She uses the family spoons, cups, and 
 basins, and does not take things into the house. Because of the nurse's visit the 
 mother has learned what is meant by modification, and how it is accomplished, 
 and the nurse has learned what utensils are lacking for the proper preparation of 
 the milk and what means the mother has for their sterilization. In addition, she 
 frequently finds conditions which oppress the family and which they alone, be- 
 cause of ignorance or prejudice, cannot remove. The mother brings the baby back 
 to the clinic once a week while she is getting Settlement milk. If she does not 
 return, the nurse looks her up. If she persists in not bringing the child for the 
 doctor's help, she is dropped from the milk station records. This, however, almost 
 never occurs. At each return visit the baby is weighed and examined by the physi- 
 cian. The mother becomes interested in the procedure, and is exceedingly anxious 
 to see a gain from week to week. Breast-feeding, of course, is encouraged to the 
 utmost. The babies are kept at the breast as long as they thrive. If the mother's 
 milk supply is insufficient, she is urged to continue the breast and is allowed to get 
 milk to drink in order that she may be better able to nurse the baby. If necessary, 
 the physician orders that the baby be given the bottle to supplement the breast- 
 feeding. Mothers finding that the baby gains on this mixed feeding sometimes 
 want to discontinue the breast. If they, by chance, do discontinue the breast 
 for a few days and find that the baby has not gained satisfactorily, they are easily 
 persuaded to return to the nursing. 
 
 In connection with the supply of good milk for the babies the Settlement 
 gymnasium is open to the mothers and babies during the hot weather. Hammocks 
 and cots are provided for the children ; there is a nurse in attendance, and mUk and 
 
PROCEEDIMGS OF COyPERENCE OX IXFAXT HYGIENE 243 
 
 baths are given. Mothers and babies often come in the morning and sit throughout 
 the day, where they are out of the heat and away from the congestion and noise 
 of the streets and of the tenement houses. This single privilege alone is a great 
 baby saver. For a limited number of worn-out mothers with sick babies the farm 
 offers a refuge for an indefinite period in summer. Here they are under medical 
 care and are given the best possible food, and have all the advantages of outdoor 
 life. In addition, the recreation piers, floating hospitals, fresh-air and convalescent 
 homes, and similar agencies, either pulilic or {)rivate, are used to their capacity. 
 By building up the health of these mothers the health of the babies is insured. Last 
 summer, during the hot spell, there were under Settlement care 200 babies. Of 
 this number, not one was lost. 
 
 In addition to the milk station work the Settlement looks after babies and 
 children in all conditions of ill health. Last year no less than 3000 cases of pneu- 
 monia were cared for. The percentage of cures, approximately 91 per cent., com- 
 pared with that of hospitals (pediatrists report 35 per cent, mortality from hos- 
 pitals) for similar work, is most commendable. In hospitals babies often suffer 
 from cross infection, and, in addition, little babies taken to the hospitals often i)ine 
 for their mothers and die, just as they do in the foundling a.sylums, from lack of 
 mothering. By keeping them in their homes and giving them the mother's care 
 and love they do get well. Again, the advantage of this method of handling sick 
 children is that the mother is taught the importance of individual and proper care 
 of her children. The education of the mother and of the family is carried on while 
 the sick child is being nursed back to health. The nurse who visits the home from 
 day to day teaches the mother how to give her sick child an alcohol bath, how to 
 put on a compress, etc. As the child improves under the fresh-air treatment the 
 mother learns the value of open windows and sunlight. The Settlement .seeks by 
 education to "modify" the mother and to make her influence felt in the family and 
 in the neighborhood in which she lives. To this end the Mothers' Club was or- 
 ganized. The mothers are women who are knowm through the milk station or 
 through the district nursing service. At its last meeting there were 150 mothers 
 present, a remarkable showing in busy New York, in crowded districts where 
 mothers are supposed to be ignorant and not intelligently interested in their own 
 or their children's welfare. Not only does the Settlement go to the mother, but 
 it brings the mother to the Settlement. 
 
 The Settlement has also in its district nursing service a staff for the investiga- 
 tion and care of cases of contagious diseases. If, for instance, one of the milk 
 station nurses hears of the existence of a case of contagious disease, the fact is 
 immediately reported to the Settlement, and a nurse from the contagion staff is 
 sent to the house at once. There is, too, a staff of nurses to look after confinement 
 cases alone. The recent campaigns for the regulation of midwifery, prevention of 
 blindness, the control of tuberculosis, the instruction in hygiene, as well as that 
 for playgrounds, found strong support and intelligent guidance in the Settlement. 
 
 This work for babies and children has grown into what is now the most im- 
 portant recent thing in public education, the establishment in the public-school 
 
244 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 system of a regular corps of school nurses. This movement, now so general, is 
 due entirely to the influence of the Henry Street Settlement. \Mien the Com- 
 pulsory School Attendance Law went into effect, it sent all the children into the 
 school; then followed the medical inspection of school-children, which has worked 
 for the common good by eliminating the physically unfit from the schools. Into 
 this field came the school nurse, and she has demonstrated that many children 
 whom medical inspectors were compelled to exclude from the schools can be kept 
 there without detriment to themselves or to the other children if proper treatment 
 is provided. This treatment the nurse gives. The educational value of this work 
 is again the dominant note. The school nurse, by going into the home, educates 
 the mother in personal hygiene, in the care of clothing, the cleansing of hands, 
 heads, teeth, and bodies of her children. This all contributes to the lessening of 
 contagion in the schools, which, of course, was the original purpose of medical in- 
 spection of school-children; at the same time it makes the mother more intelligent 
 on those problems which arise because of the crowded conditions of city life. 
 
 In a very general way this is the story of what the Settlement is doing to con- 
 serve the health and the life of infants and children. We can scarcely hope, at 
 this time, to furnish all children in a given municipality with the service now avail- 
 able for a few children under the care of the Settlement. It is the function of the 
 Settlement, as of all volunteer agencies, to experiment, to point the way, to present 
 an ideal of accomplishment that can be realized. This experiment demonstrates 
 that it is possible to solve the problem of infant mortality, and suggests that infant 
 mortality is but an index of social conditions; it points out that infant mortality 
 is in direct proportion to the ignorance of the mother and the economic status of 
 the family. The ideal it presents is one of method. Not the alleviation of in- 
 dividual cases, however great in number they may be, but the ideal to be realized 
 is the prevention of infant mortality by means of the education of the mother in 
 the home. 
 
 Mrs. Wister: We are fortunate in having heard the civic appeal in the 
 closing remarks of Miss Farrell, and I am sure that every one of you has been inter- 
 ested in the wonderful record of those 200 infants. The rest of the story of the 
 200 babies will also be very interesting, and I hope that we may get it some time 
 in the future. I also welcome very much the expression, "modifying the mother." 
 I think it a very illuminating phrase, and one very illuminating to the people 
 carrying on this work. No one has been appointed to open the discussion of Miss 
 Farrell's paper, but I am sure we would be glad to have a discussion of it. 
 
 Mrs. Putnam: I should like to know the ages of the 200 babies. 
 
 Miss Farrell: I am sorry that I did not bring these statistics along with me. The babies, how- 
 ever, were all very young, the youngest probably about seven weeks, and the oldest probably not more 
 than eleven months. 
 
 Mrs. Wister: Yesterday afternoon I think all of us must have been impressed 
 by the infant mortahty statistics presented at the Conference, which indicated the 
 large number of very young babies dying each year. We all knew, perhaps, that 
 
PROCEEDINGS OF COXFERENCE OX IXFAXT TIYGIEXE 245 
 
 the poor little babies die, but I imagine that many of us did not realize the large 
 proportion that die in the first day, week or month of life. In Boston a great work 
 has been carried on to mitigate and prevent this very early mortality. In the past 
 winter two very interesting addresses were given in Philadelphia by Miss Bowker, 
 President of the Women's Municipal League of Boston, and among other phases 
 of the work undertaken by that great League is the work for the prenatal care of 
 infants. It was new to many of us, and was listened to with the deepest interest. 
 Today we are to learn more of this same remarkable work from a member of the 
 same society, and a leader on the Committee for the Prenatal ("are of Infants. 
 We know it will be of the deepest interest to every one connected with this Baby 
 Saving Show to listen to a description of this work. I have great pleasure in intro- 
 ducing I\Irs. William Lowell Putnam, Chairman of the Committee on Infant Social 
 Service of the Women's Municipal League of Boston. 
 
 PRENATAL CARE OF INFANTS 
 BY INIKS. WILLIAM LOWELL PUTNAM 
 
 I once heard a lady inveigh against the telephone because she said it did away 
 ■with all forethought, and her idea of forethought was that we must today plan for 
 tomorrow's dinner. It is perhaps unnecessary to add that she had no children 
 unexpectedly to fill the house with guests — her life was not so ordered that she 
 could ajijireciate the blessed modern appliances wliich make us able to obey the 
 Scriptural injunction to let the morrow take thought for the tilings of itself. Fore- 
 thought cannot be done away ■nith; the ditfercnce between us and the earlier 
 generation is in the kind of forethought we use. We are saved from much drudgery 
 which was needful for them, and thereby are we made free to prepare for the future 
 in ways of which they did not dream. 
 
 What better kind of forethought can we use than that shown in preventive 
 medicine.' We are moving toward the greatest step, slowly, with hesitancy, and 
 against opposition, but the world is gaining the strength to take it — that step is 
 the prevention of the reproduction of unfitness. But even if we are not yet ready 
 to take this step, there is another, second only to it, which sounds the keynote of 
 prevention in the life of the individual, and that is prenatal care. It is of this 
 work, as carried on by a committee of the Women's Municipal League of Boston, 
 that I want to tell you something. 
 
 Three years ago last month we started an experiment with pregnant women, 
 to see what benefit, if any, would result from the careful watching of these patients 
 by a nurse under the orders of a physician. We did not want to take them from 
 their homes and put them into rest houses, for pregnancy is a normal function, and 
 pregnant women should be surrounded, in so far as it is possible, by normal sur- 
 
246 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Foundings — we wanted only to help them to make their homes as ideal as they 
 could be made, and all the influences which could affect their babies, both physical 
 and s])iritual, as nearly perfect as it was possible to make them. The character, 
 therefore, of the nurses doing this work is even more important than that of other 
 nurses, for a woman is peculiarly susceptible to influence when she is carrying a 
 child. Of this spiritual side of this work I want to speak again later, but first we 
 must take up the physical side, for without our bodies we can ill harbor souls. 
 
 Our patients are ordinary women surrounded by ordinary circumstances — 
 part of them belong to the self-respecting poor, but some are socially above and 
 some below this level. 
 
 Every patient is visited as a matter of routine at least once in ten days, and 
 we believe that, if possible, once a week would be better. If any untoward cir- 
 cumstances develop, the patient is visited as much oftener as is necessary. The 
 nurse advises the patient with regard to exercise, diet, and clothing; she recommends 
 fresh air, plenty of water, inside and outside, rest, recreation, and work of the right 
 kind, but she never advises anything (except with the doctor's orders) more drastic 
 than cascara for internal benefit, or the strapping of an aching back for external 
 relief. At every visit she takes the blood-pressure with a little Tycos machine 
 which she carries with her, and she also tests the urine as a matter of course, for 
 we are determined to see if it is not possible to forestall the development of eclampsia 
 through the thorough investigation of these two matters. The result of the care 
 has been very gratifying with regard to the reduction in the number of cases where 
 this disease has threatened. During our first year the percentage of cases which 
 showed symptoms of threatened eclampsia was 10.2 per cent., which is not far from 
 an average number. During the second year the percentage of these cases dropped 
 to 4.8 per cent., and this year it has been but 1.7 per cent. — this with a constantly 
 increasing number of pregnant women under our care. 
 
 With but one nurse we are able to keep from 80 to 100 names on our list all 
 the time, and though many of them move away and are thus taken out of our care, 
 we have carried safely to confinement 1111 women. No patient has died during 
 pregnancy in the whole three years. In the first year there were two miscarriages, 
 only one in the second, and none at all last year. The percentage of still births 
 in 1911 was 1.9 per cent., of premature births, 2.1 per cent. 
 
 Counting even the premature infants, the birth-weight of our babies is very 
 considerably above the average, and yet not suflBciently so to make it hard for the 
 mother. It varies from 8 to 15 ounces above the general average of 7 pounds, as 
 given by Dr. Whitridge Williams. This year it has reached the higher figure. 
 We feel that these 15 ounces must give the baby a little more to draw on during 
 that trying period of adjustment to the new surroundings confronting it at birth, 
 which, though we have all forgotten it, I fancy must be a difficult feat at best. 
 
 The cost of the work is only $2.50 to $3.00 per patient for the full time visited, 
 which has averaged between two and three months, although sometimes we have 
 them come to us as early in their pregnancy as possible. We encourage the women 
 to pay the expense of their care, or as much of it as they are able, for we believe 
 
PROCEEDINGS OF CONFEREXCE ON INFANT HYGIENE 247 
 
 that it promotes their own self-respect to do so, and that it is much better for the 
 work that it be made self-supporting as soon as possililc, for in this way its de- 
 velopment can be unlimited. It is well to try experiments with money raised 
 for the purpose, but when a work has proved itself of value, charitable support 
 for it should cease as soon as it can stand alone. 
 
 The patients are so grateful for the help given them. One woman, at the 
 nurse's first visit, gave her a pass-key that she might come in more easily, and the 
 second time she called her patient had a dollar ready for her. Though, of course, 
 like every one else, the nur.se meets with an occasional rebuff, .she is much more 
 often greeted with remarks like this: "Nur.se. it means so much to have yon come." 
 or, "Nurse, after your visit I feel so much better," and she finds her.sclf able to 
 allay many groundless fears. Some patients say: "Every one is .so ready to give 
 you advice when they see your condition, but I just .said to my husband, T will 
 wait and ask nurse when .she comes,'" and then it apiiears that the advice gi\en 
 by her neighbor was not to take a bath, but to drink beer to keep up her strength 
 and to promote the flow of milk, perhaps six months subsequently, or if not lliis, 
 then some equally sapient suggestion. Among the younger coui)les, particularly, 
 she hears: "My husband thinks this work is fine, iiaving a nurse call" — and the 
 husband often suggests to his wife questions to ask the nurse. Occa.sionally she 
 has made to her the amusing announcement that the husband has changed his diet 
 to that recommended to the wife, and thinks his health distinctly benefitted by the 
 change. One woman .sent ])artieulariy for the imrse to come to .see her baby be- 
 cause she said she felt as if our mirse had a part in him — with her first baby she 
 had had a very hard time, but with this one everything had gone all right. It is not 
 only among the women in their first pregnancy that the work is appreciated. One 
 patient whom we cared for while she was carrying her sixth baby wrote afterward 
 that slie had done everything our nurse had told her and had never had such an 
 easy time before, and that it was so pleasant to have some one take care of her. 
 
 What I mean by the possibilities of the spiritual side of prenatal care is best 
 shown by the story of Miss Strong's Httle prenatal Easter party. Miss Strong is 
 a member of our committee, and is herself a trained nurse resident at South End 
 House. She has a group of women among her neighbors to whom she gives the 
 best kind of prenatal care, because it fills the spiritual need as well as the ])hysical. 
 She has stamp savings books ornamented with charming baby heads, and pasted 
 all over the back with lambs and flowers, each little device chosen by the mother 
 as her heart longs for it. On Easter morning, at 7 o'clock. Miss Strong had her 
 Easter party. The breakfast table was set with dainty little yellow and white 
 blossoms, budding horse-chestnuts opened their little hands in a tall vase beside 
 them, little white chickens and bunnies gamboled over the table-cloth, and at each 
 place was one white crocus in a little pot, and a tiny white candle which to those 
 women typified the light of the little life to come forth. Everything was perfect 
 except Mrs. McCarthy, who had had something to drink stronger than her early 
 cup of tea. This caused Mrs. ISIcCarthj' to be full of the spirit so often shown, 
 alas ! in all ranks of life, which spirit she gave vent to in such remarks as that she 
 
248 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 wasn't "going to get caught this way again, " etc., remarks -mth which we are all too 
 familiar, and which were quickly marring the spirit of the httle Easter party. As 
 they sat down to breakfast Miss Strong, with disappointment gnawing at her 
 heart-strings, had an inspiration; she turned to Mrs. McCarthy and asked her 
 to say grace. Such a thing had never been asked before, and Mrs. McCarthy's 
 soul was melted within her. She could not say any grace, but neither could she 
 jeer with the thought of grace in her heart. The difficulty was arranged by Miss 
 Strong's suggesting that they should each say grace for themselves, and the spirit 
 of Easter brooded once more o^'er the 12 women there gathered. 
 
 With us the work is spreading most encouragingly. Within the year the 
 Boston Lying-in Hospital has established a prenatal clinic with a visiting nurse, 
 and since last summer our Board of Health has been sending out two nurses through- 
 out the city to care for mothers and babies as well as after birth. Boston is trying 
 to establish a standard for this work among all its workers, and for this object a 
 permanent committee was apiwinted at a meeting held last ]March, at which were 
 present representatives of all organizations giving prenatal care. We want not 
 only to estabhsh a standard, but to coordinate this work. It is hoped that through 
 the Instructive District Nursing Association this can be accomplished, and we are 
 now giving half of our nurse's time to helping the association to standardize this 
 work, and by their request are supervising all of their prenatal work. 
 
 One great benefit to be derived from prenatal care is the education of the 
 prospective mother not only in the proper way to care for her coming baby after 
 it arrives, but also at the time of its arrival. Prenatal care should do much to 
 undermine the prestige of the ignorant practitioner and the midwife, and to sub- 
 stitute for them proper medical obstetric care, the benefits of which to the present 
 and future generations would be untold. 
 
 We are looking forward to the time when prenatal care shall become as much 
 an accompaniment of pregnancy as is care at a child's birth. This care should be 
 given patients by a nurse working under a physician, for $5 or $6 a patient, for 
 the full term of pregnancy. Thus the best possible care would be assured to those 
 women who cannot afford doctors' visits except in case of illness, and even among 
 the rich it would be desirable. It is unnecessary and wasteful for a doctor to give 
 his time to visiting a patient who is perfectly well in order to see that this condition 
 of health continues, when this object can be accomi)lished equally well and at 
 greatly reduced cost through the employment of a trained nurse. In fact, this 
 is the only way that those of moderate means can have prenatal care. The bene- 
 fits of the arrangement would be threefold : First, it would insure better care to the 
 patient, as through the nurse's knowledge a doctor would be summoned in cases 
 where the patient herself is often too ignorant of the danger of her condition to 
 summon him; Second, it would increase the doctor's practice for the same reason; 
 third, it would support the nurse. The plan of having a nurse supplement the 
 doctor by keeping him in constant touch with all his patients, yet calhng him in 
 only when he is really needed, is the efficient and business-hke way of caring for 
 them, and one which must in time commend itself to the community. 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 249 
 
 Mrs. Wister: I know how deeply interested the members of this Conference 
 have been in hearing about this work. It should now be helpful to listen to a 
 further discussion of this subject, and I have [)loasiire in presenting Dr. Philip 
 Van Ingen, member of the New York Milk Committee. 
 
 Dh. Phiup Van I.vgen: I think Mrs. Putnam and her committee have done splendid work in 
 Boston. They have called the attention of the whole country to this subject, and so have done more 
 than merely care for the interests of the people in Boston, wonderful as that work has been. We in this 
 country are very proud of what has been accomplished, but this work has been <lone along somewhat 
 similar lines, varying in different European countries, since 1891. The Maternity Insurance in France 
 has been trying to improve the chances of mothers to go through their pregnancy nonnally and to give 
 the babies born a better chance through this method of instructing mothers and providing them w ith the 
 means to stop work so that they may fit themselves for what they are to go through. I think all of us 
 who have listened to the addresses this morning are struck with one thing, particularly with the remarks 
 of Dr. Hart in speaking about the babies who arc public charges. They have emphasized the home 
 and what must be done in the home. Miss FarrcU has spoken about instruction of expectant mothers 
 in the home. Formerly, when anything was to be done, the only idea was to build a hospitjd or a refuge 
 or whatever it might be called. Now it seems that the home element is coming in more and more, and 
 we are now giving instruction and getting at the root of the matter. We are trying to bring about a 
 situation where instruction will do away « ith the need of uuich of the action hitherto considered neces- 
 sary. 
 
 We have also heard of the surprising amount of mortality, and we have seen the proportion of 
 infant mortaUty in the first month of life. In New York so far this year 40 per cent, of the infant mor- 
 tality has been of children under one month of age. In Boston, for the months of January, February, 
 and March, it was 44 per cent. In England and Wales, in the year 1909, for the entire year, the Regis- 
 trar General reports 87 per cent. In one week in New York (U per cent, of the recorded mortality under 
 one year was under one month of age. 
 
 Last summer the New York Milk Committee attempted to assist the health department in carry- 
 ing on milk stations and in reducing infant mortality. There were maintained Si stations in the Borough 
 of Manhattan, and 57 stations were maintained altogether. We began to tabulate our results early in 
 September, m order that we might have something to set before the public. We found that among 3182 
 babies under the care of the Milk Committee at their milk stations, practically only 7 per cent, were under 
 the age of two months, and under the age of one month occurs 40 per cent, of all the infant mortality. 
 
 We know that practically all infant mortality in summer is due to two classes of diseases — diarrheal 
 diseases and general debility, so called. We do not take into consideration the fact that the statistics 
 as published do not include still-births. In New York city last year there were nearly 7000 still-births 
 reported. There were i;«,000 births in all, so that makes 5 per cent, of all pregnancies resulting in 
 still-births. If you compare that with the figures you know for the deaths under one month, you will 
 find 10 per cent, of all pregnancies resulting in deaths before the child is one month old. 
 
 Mrs. Putnam has told us what their committee has been doing in Boston in this work in trying to 
 prevent still-births and the mortality during this first month, by teachmg the mother how to care for 
 herself and to prepare herself to take care of her baby and to produce a better baby. In France they 
 have worked out statistics, and it has been found that an increase in the weight of the babies of from 
 G to 8 oimces takes place where the proper care is taken, when the mother keeps quiet and takes care of 
 herself, particularly in the last months of pregnancy. In New York we are trymg an experiment along 
 the same lines. We find that only -i per cent, of our babies come to milk stations under one month of 
 age. We started putting two nurses on this prenatal work, through the assistance of Dr. Hart of the 
 Sage Foundation, in providing the salaries, and we later had to add another nurse to this work; and 
 during about four months we came into contact with 800 expectant mothers, .\bout 300 of them removed 
 out of the district where we were working, so we actually mstructed 500 mothers, carrying them through 
 between two and a half and three months, and followed them through one month after the baby was 
 born. W'e have figures for these 500 mothers, and whereas in New York city 42 out of 1000 babies born 
 
250 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 die in the first month, among our babies the deaths were 16 per 1000. Among all New York babies, 5 
 per cent, died before or at birth. Among our babies, including early miscarriages and still-births, we 
 had 1.4 per cent., and of these babies 3 out of 7 died as the result of unexpected conditions at birth. 
 These results are among the poorest of the population. We are down in the neighborhood of the Henry 
 Street Settlement, where the population ranges from 4000 to 5000 souls to a block. We have now our 
 two nurses at work. During the first fifteen days of May we registered 174 new mothers. We are 
 planning to have si.x nurses in New York in order to take different classes and nationalities of our popula- 
 tion, so that we may carefully study the effects of this prenatal care. We do not expect to do anything 
 to help mothers, as Mrs. Putnam's Committee is doing in Boston. W'e do not intend to tread upon the 
 toes of the licensed practitioner or midwife. We expect to cooperate with the hospitals and the charit- 
 able organizations, and we will take a patient from anybody and give her the very best care we can. 
 We expect each year to be able to take care, with our nurses, of 1800 cases, for we think every nurse 
 should be able to serve ten cases a day. We are going to do all we can to prepare the mother for her 
 new responsibilities. 
 
 Dr. S. Josephine Baker: There was one point brought out which is very significant and im- 
 portant. It is the fact that this is a work done by lay women. I am exceedingly interested in it from 
 the standpoint of the lesson it gives with respect to the work of the midwife, for there is no doubt that 
 this has lessened her practice. I think, also, that I see in this a prophecy of the future — of the time 
 when women in clubs, the lay women, will everywhere realize that each woman is her sister's keeper, 
 and then we shall have many more organizations busy in this great work. 
 
 Dr. William Woodward: I think we can hardly speak too highly of the work undertaken in 
 Boston. I pointed out yesterday the fact that a very large percentage of the mortality occurring dur- 
 ing the first year of life occurs not merely during the first month, but actually during the first day, and 
 we must look to work such as has been described by Mrs. Putnam for the cure of that high mortality. 
 In connection with the investigation of infant mortality during the first day of life that we have recently 
 undertaken in the District of Columbia we have come across a very interesting parallelism between the 
 infant mortality during the first day of life and the cost of living. As far back as we could trace, 
 with any reasonable degree of accuracy, the mortality rate during the first day of life follows very 
 closely the corresponding line for the cost of living. These figures are extremely accurate for the past 
 five years, and whether the computation is made upon the basis of the number of deaths during the 
 first day of life in proportion to the total population, or upon the number of deaths during the first 
 day of life compared to the total number of registered births, the result is the same, and the curve 
 runs pretty nearly parallel, so that we must try to discover, if we can, what element there is in the 
 cost of living that produces this apparent effect. 
 
 There is another thing that I would like to call to your attention. I hold no brief for the midwife. 
 We have, I suppose, about as poor and as inefficient a set of midwives in the District of Columbia as 
 exists anywhere, and yet, notwithstanding the fact that the percentage of births attended by midwives 
 has diminished since about 1893 from 50 per cent, to 15 per cent., the mortality during the first day of 
 life has not diminished; so that it is not due to the midwife that we have this high mortality. Dr. 
 Baker pointed out a somewhat similar condition in New York yesterday when she stated that a larger 
 percentage of cases of ophthalmia neonatorum is reported from the practice of physicians than from the 
 practice of midwives. We must bear in mind not only what Dr. Huntington said concerning the need 
 of abolishing midwives, if they are to be abolished, but also the need for the provision of better obstetric 
 service from physicians and nurses, and the work that Mrs. Putnam's society has undertaken will cer- 
 tainly go a long way toward affording, at least in the homes of poor people, that measure of care which 
 will bring about as nearly ideal conditions as possible. 
 
 Mrs. Wister: Dr. Woodward's statement suggesting a probable relationship between the cost 
 of living and infant mortality is extremely interesting. We shall anxiously await the result of a further 
 investigation of this suggestive problem. 
 
 Is there any further discussion.'' 
 
 Mrs. Pctn.\m: \\ith reference to the number of visits to be expected from a nurse, our one nurse 
 averages ten visits per day. The fact that we have but one makes it necessary for her to cover the whole 
 city of Boston, including such outlying districts as Cambridge, and even Jamaica Plains. When she 
 
PROCEEDINGS OF COXFERENCE ON INFANT HYGIENE 251 
 
 happens to find her cases grouped, she can, of course, visit a much larger number. In one morning, for 
 instance, she saw 12 cases in which she tested the urine and determined the blood-pressure. She en- 
 deavors to see the prospective mothers at least once in ten days. 
 
 A Question: Have you kept any record of the infant mortality after birth? 
 
 Mrs. Putnam: No; it is not easy to follow them without considerable additional work, which 
 we have not felt it incumbent upon our society to do. I know that this mortality must be low, because 
 our percentage of still-births is only 1.9 per cent, as compared with the average of 5 per cent. We try 
 to get the figures, but it is very difficult. 
 
 Mrs. Wister: I am afraid on account of the lateness of tlie hour we must 
 leave this very interesting subject, which I am sure we are all sorry to do. There 
 are doubtless many question.s we would like to a.sk Mrs. Putnam. 
 
 I have much pleasure in introducing Dr. Helen C. Putnam, Director of the 
 American Association for the Study and Prevention of Infant Mortality, who will 
 discuss the very interesting and important theme, "Educational Work for Mothers 
 of Today and Mothers of the Future. " 
 
 EDUCATION FOR BETTER PARENTHOOD 
 BY DR. HELEN C. PUTNAM 
 
 Chairman of Section on Public School Prevention of Infant Mortality of the .\merican Association for 
 Study and Prevention of Infant Mortality 
 
 Mothers must be something more than housekeepers; fathers, something more 
 than money-getters. Fathers and mothers have the greatest mission in the world, 
 the greatest vocation; and we have been establishing schools for every kind of 
 occupation except for the greatest — home-making and parenthood. 
 
 Parents up to this century have almost entirely undertaken their duties with 
 knowledge incidentally acquired. They have picked it up, a little here and there, 
 much of it being what they learned in their childhood homes. This picked-up 
 information, according to the Bureau of the Census, proves as wasteful of life as 
 was the picked-up knowledge of nursing before the days of training-schools. 
 
 According to the estimate of one federal authority, we rank twenty-second 
 below the best of the 31 civiUzed countries in our mortality rates for infants; ac- 
 cording to another, our most favorable estimate is about one-third down the list. 
 Either is especially discreditable when it is recalled that we lead all nations in 
 national wealth by a very generous margin. We are, too, the only civilized country 
 that has to estimate its infant mortaUty rate, the only one failing to keep accurate 
 records of the birth of its citizens. 
 
 Two million babies born alive have died during their first year in the last ten 
 
 years, with possibly as many more at birth and during the three preceding months. 
 
 Another large number, estimated at one-seventh of all conceptions, died during the 
 
 earliest months of pregnancy. In this last group many were deliberately murdered — 
 
 18 
 
252 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 we have no means of knowing the number; many died of syphilis in parent or 
 grandparent. Both murder and syphilis are preventable if society educates 
 potential parents for their vocation of home-making. Other prenatal deaths were 
 due to causes largely preventable by intelligent management. 
 
 Of the 2,000,000 born alive, probably more than 500,000 would still be living 
 if they had been so fortunate as to have been born in any one of 11 other countries. 
 All this is an intolerable waste of motherhood, fatherhood, and infant life; of 
 national resources and wealth, if calculated on a money basis. We believe from 
 local experiences that fully one-half of our infant deaths can be prevented with 
 sensible use of elementary scientific methods. It is very interesting to note just 
 at this time that in every one of the countries with lowest rates of infant and child 
 mortaUty women have equal political power with men to control the living con- 
 ditions surrounding children, and that in no one of the countries with higher mor- 
 tality rates is this the case. Such statistics interpreted signify that where women 
 are clear thinking enough to discharge their responsibilities toward children, and 
 men right minded enough to share the world's work on equally advantageous 
 terms, child life is safer and humanity better. For it is literally true that the 
 infant mortality rate measures the intelligence, health, and right living of fathers 
 and mothers; the standards of sanitation and morals of communities and govern- 
 ments; the efficiency of physicians, nurses, health officers, and educators. Sta- 
 tistics from all 11 countries show that alcoholism and poverty, the social evil 
 and divorce, industrial training and general education, training in sanitation and 
 obstetrics, a few or several or all these important factors in infant mortality, are 
 better controlled and guided than in this country. It is certainly woman's business, 
 her motherhood demands it, to guard the well-being of children on every side, their 
 well-being that determines the future of the human race. 
 
 In all that I shall say on education for parenthood I wish to be understood as 
 meaning regular education, standardized and made a permanent institution by 
 government. It is true that unoiScial groups in various places are through their 
 private efforts rendering valuable service by calling general attention to the pos- 
 sibilities for developing a better parenthood by class instruction. That, however, 
 is not my topic. I am discussing the possibiUties for all the people in schools and 
 classes under public boards of education. 
 
 Of 5,000,000 children entering the public schools, more than 3,000,000 drop 
 out of primary grades; another 1,000,000 drop out of grammar grades. We have 
 at present roughly estimated 20,000,000 young people between sixteen and thirty 
 years of age with only undirected picked-up knowledge since that childhood's 
 instruction given in the years between infancy and adolescence. These are all 
 liable to become parents. Society, in self-defense, must teach them right living 
 when they are old enough to learn. These are the years when home-making 
 instincts are waking and strongest. They are, therefore, the strategic years for 
 making such instruction most profitable. 
 
 We have two stupendous problems : how to make better parents of the children 
 who remain in the schools, and of those young people who dropped out of elementary 
 
PROCEEDINGS OF COXFEREWE OX IXFAXT EYGIEXE 253 
 
 grades. What can we do for those who complete the grammar grades hut do not 
 go on to high school? As only a small fraction of elementary children enter high 
 school, how can we best help these potential fathers and mothers under fifteen 
 years of age? 
 
 We know that in the brain there are various areas controlling each some 
 special act or function. Child study shows that certain areas at certain ages develop 
 best, and one certain age is, therefore, the opportune time to present one certain 
 line of instruction. If given at some unphysiologic period, it not only may not 
 develop its best, but may crowd out ideas that should occupy attention then. 
 
 Is it wise for formal education in these elementary years to cultivate the arts 
 of parenthood? The chief arts are labor to support the family and the care of 
 babies. Or is it wise, instead, for formal education to use these years for estab- 
 lishing ideals of life and parenthood on sound bases, with general manual training 
 to make beginnings in executive and coordinating ability? 
 
 One can always make httle children eager over anything by tactful methods. 
 They are utterly plastic in older hands — to the limits of natural law which finally 
 avenges its own violation. One can make them enthusiastic over the care of 
 babies very easily; but is it best for the next generation that Uttle girls, instead of 
 freedom, open air, play, be taught in schools to lift, carry, tend, feed, manage 
 babies? Is it best for the baby to be cared for by an intelligent child or by an 
 intelligent mother? Is it wise for society to tolerate, or to encourage through its 
 educational system, the economic or any other conditions that se|)arate mothers 
 and babies by teaching little girls to do mothers' work? We hear much of child 
 labor in factories; but there is also a problem of it in homes. It is already recog- 
 nized in sweat-shops and in country homes. Do any sexual mistakes of early 
 adolescence come from too early cultivation of parental instincts before right 
 education has laid foundations of ideals? 
 
 A recent masterly study of vocational education in Europe includes among its 
 final recommendations one that vocational education should not be given under 
 fifteen years of age; that these earlier years are needed for founding general in- 
 telligence and ideals and tastes, and securing elementary coordination of hand and 
 brain centers. If this is right, and it claims to sum up all educational experience, 
 then the vocation of home-making in its most important art — care of babies — does 
 not belong in elementary schools. We are the only animal, some one says, who 
 works its young in the care of others. With us it is already proving a blight. 
 
 I submit that girls are entitled to their girlhood, if they are to become good 
 mothers in their turn, as are boys to their boyhood, in preparation for fatherhood ; 
 as are babies to their mothers and mothers to their babies. And I submit that it is 
 worth while, very worth while, to do as is done in some places, secure pensions or 
 insurance for mothers, enabling them to care for their babies in homes suitable for 
 making citizens, with visiting nurses and teaching chnics and continuation schools 
 to show them how. 
 
 What should be done in the primary and grammar grades to a far greater 
 extent than now is to estabUsh habits in hygiene and sanitation, knowledge of the 
 
254 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 natural laws of nutrition and reproduction in plant and animal kingdoms (including 
 man, of course), elementary manual skill, including sew-ing and cooking and clean- 
 ing; and equally important it is to establish the ideal of life as a trust from an 
 infinite host of mothers and fathers who have gone before, to be guarded and 
 bettered in one's turn, and passed along to children infinitely. 
 
 We can no longer allow education to cease at or before adolescence, which has 
 its special needs for knowledge that could not be given earlier. Humanitarian 
 interests have lagged behind financial in efforts to continue education for those 
 over fifteen years of age. Trade schools under varying names are much better 
 established than instruction in the interests of home-making. 
 
 There are two questions that at once present themselves in this immense task 
 of meeting adolescent and adult needs of a population equaling the present school 
 population. Where is the money to come from, and where the teachers? Already 
 the federal government, through its Department of Agriculture, is jjromoting 
 vocational education for the farm, including home economics, by appropriating 
 millions of dollars. There is also a movement on foot to assist States financially 
 in establishing continuation schools under State boards of education, these schools 
 to include instruction in home-making. To lessen mortality and morbidity rates 
 and to improve the quality of its citizens is at last being recognized as of not less 
 national importance than to increase wealth. With federal assistance and local 
 cooperation in various directions the money will be found. 
 
 The need of able teachers is much more difficult to meet. Continuation in- 
 struction is coming by rapid evolution, however, not by revolution, and the prep- 
 aration of teachers is already beginning in universities, colleges (including agricul- 
 tural), normal and special schools. The outline of one such course for university 
 women will give an idea of the trend of this preparation and the possible trends 
 in high school and in continuation work for women between sixteen and thirty 
 years of age. All such to be effective must be sufficiently elastic for a wide range 
 of age, intelligence, and social needs. 
 
 In this course the central thought of four years' instruction is "improving the 
 individual so that future generations may attain a higher level than those preceding 
 them" — a marked contrast to present educational aims merely recognizing the 
 individual's interests. The study of social relations of the home comes after two 
 and a half years in chemistry, physics, biology, bacteriology, physiology, and 
 household arts and management. The development of the infant before birth 
 is first discussed, and, as they have seen these beginnings many times in plant and 
 animal life in their biologic laboratory, it is a simple matter to adapt that knowledge 
 to human life. 
 
 The inheritance of acquired and inherent characteristics is discussed, and the 
 effects on germ plasm of alcoholism, syphilis, drug habits. They learn the fact that 
 drunkards, insane, feeble-minded, habitual criminals, and sexually depraved men 
 and women usually have children with defective nervous systems, and usually 
 breed their kind. They learn the real significance of good stock on the father's 
 side and on the mother's. Teachers with this knowledge can do much directly and 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 255 
 
 indirectly in mothers' and parents' clubs, and with children, to develop through the 
 country right ideas of marriage to replace the unwholesome ones now so common 
 among young people and among their parents, who should know and teach their 
 children better. 
 
 There is a far-reaching significance in their enumeration of syphilis and gono- 
 eoccus infection (not gonorrhea, one of its manifestations) among ordinary con- 
 tagious disease, and in their study of these statistics as well as the others in govern- 
 ment and scientific reports, and their relation to the home; for they are not less 
 than five times as prevalent as tuberculosis and all other contagions together, and 
 they injure wives and children to an extent not possible to estimate. They are the 
 cause of many deaths before birth (characteristic of syi)hilis); of the death, degen- 
 eracy, blindness of many infants in the first years of life; of many childless families 
 and one-child families (a peculiarity of gonococcus infection); of the invalidism, 
 surgical mutilation, and death of many wives; of much insanity, rheumatism, 
 heart disease, and other physical and mental incapacity; of much divorce, un- 
 happiness, crime; of cx])cnditures of large public and i)rivate funds and effort on 
 misfortunes that can and should be prevented. They have, through slow processes, 
 exterminated ancient nations and modern communities. If they increase through 
 the next quarter century at the rate of the last, it would seem as if this nation, too, 
 must decline. In my own professional exi)erience, as in that of other physicians, 
 the fate of married sister or friend has i)revented, is preventing, marriages. 
 
 The students see logically that control of these contagions must be the same 
 as control of smallpox, scarlet fever, and any other of the several that we have 
 almost eliminated — every case must be reported to the board of health. That this 
 so evident first step is not taken is due to the fact that boards of health, who are 
 charged with administration of health laws, do not enforce the law requiring this; 
 that in the majority of States these laws have still to be enacted; that the great 
 majority of physicians will not report these cases because they are almost always 
 connected with illegal sex relations of men which they wish concealed; and that 
 city governments, through their courts and police, permit these dangerous men to 
 pass freely about in the community and into the homes where prostitutes never go, 
 because of the established idea that men may lead irregular lives not permitted 
 women — the so-called double standard of morals. 
 
 Education for parenthood necessarily brings with it the insistence that govern- 
 ment shall protect parenthood from these contagions and their evils; and as govern- 
 ment does not do so, never has been known to do so, possibly never can do so, as 
 the great majority of men claim, women in various countries in increasing numbers, 
 and with the cooperation of many of the best men (but invariably fought by saloon, 
 gambling, and other vicious elements) are securing the political right to protect 
 their own and their children's lives according to their duty to the laws of God. 
 There is no doubt in the minds of keen students of social relations that political 
 dominance of sex is wholly an evil and to both sexes; that the only right dominance 
 is wisdom, of which education and experience are giving women full share with 
 men. Civil law made by men not based on biologic law which women are learning 
 
256 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 ends ill disaster. The wise intelligence of mothers, of professional women in the 
 ministry, in law, in medicine, in sociology, and in education; laboring women with 
 their sense of wronging their children when they go out from the home to earn their 
 food; and the other mothers who see their dearest, without legal protection or 
 redress, contaminated body and soul, out of the under world whose pollution reaches 
 all classes — these are concentrating on the demand and are winning it. It is an 
 indispensable step toward the establishment of right sex relations. 
 
 After this study of heredity comes study of physical and mental development 
 of child and adolescent; the influence of city life and country life on development, 
 with school statistics of the rates of growth of boys and of girls; the kind of educa- 
 tion adapted to the different kinds of children; infant mortahty, the effect on it 
 of women's work outside the home, and of different kinds of occupations of mothers 
 before the child is born; governmental and social efforts to reduce infant mortahty; 
 the pension system for mothers, paying a small sum enabling them to stay at home 
 and nurse their babies, thus saving citizens to the State as governments have 
 hitherto pensioned soldiers who destroy citizens; the effects of institutional care 
 of babies and children on death-rate and on development, the cause of reduced 
 birth-rates, and the duty of the educated in the preservation of the race; children 
 in industry, and its legislation; the housing problem ; child psychology; children's 
 ^^ces; education of the will; a study of nervous states and their hygiene. 
 
 Among the theses presented by these students for their degrees was one ex- 
 cellent study of infant mortality by wards in that city. Another thesis dealt with 
 contagious diseases in the home, including syphilis and gonococcus infection. 
 Another girl made a special study of housing conditions in her city; another, of 
 the milk supply. This practical education of teachers and future mothers is 
 growing throughout the country. 
 
 To make instruction in the care of children as effective as possible this and 
 other similar courses utilize neighboring hospitals, or day nurseries, or kindergartens 
 and other institutions. In connection with every normal school there is always a 
 practice school of children, and medical inspectors are growing into teachers of 
 teachers in many such. 
 
 Instead of a few score of women trained like this, we need many thousands. 
 We also need proper training for fatherhood in other directions than money-getting. 
 Wealth, or even a livelihood, is not more important than this, as education by its 
 sins of omission lets us infer. BiUions are spent annually, largely out of shallow 
 purses, in destroying the home; on alcoholic and other drug habits, prostitution and 
 gambling, evil-breeding reading and recreation, inefficient pohtieal institutions 
 and officials. We must no longer let the years of adolescence and young adult life 
 run to waste educationally in either boy or girl, as we have been doing for so many 
 millions, when they are the crux of the problem of better marriages and better 
 children. 
 
 Mrs. Wister: We have greatly enjoyed Dr. Putnam's address. The subject 
 of these continuation schools and home-making forces is of great interest to the 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 257 
 
 large number of Philadelphians associated with our various civic and educational 
 bodies. I hope that Dr. Putnam may be able to convert our Federal authorities 
 in Washington to the necessity of the cause she so ably represents as successfully 
 as she has converted us. I am sure we shall see the establishment of the kinds of 
 schools Dr. Putnam advocates. 
 
 We happen in this city to have attained great distinction in many parts of the 
 United States because of the work done by one woman in the Home and School 
 League and the After School Club. It is not necessary for me to introduce to you 
 Mrs. Edwin C. Grice. 
 
 DISCISSION ON DR. HELEN C. PUTNAM'S PAPER 
 
 Mrs. Edwin C. Grice: I fancy we had better not take the time for a discussion of all the points 
 brought out in Dr. Putnam's paper, because of the lateness of the hour, but there are two or three points 
 that I should like to refer to briefly. 
 
 One might think, after hearing this discussion, that everybody lived in a congested district in the 
 city, and that every baby was born into a poor home. It does seem to me that the time has come for 
 us to look after children wljo do not happen to have been born in these congested districts. Is it not a 
 mistake to over-emphasize one class? Is there not a woman in this room who knows a neglected baby 
 of the rich? I am sure you do. I think we must consider, to some extent, at least, the education of 
 this class of the community. 
 
 I would take exception to Dr. Putnam's belief that it is only during the period of adolescence that 
 we should impress upon our young people the function of parenthood. Have you never seen the baby 
 girl "mother" her doll? Have you never seen the baby boy do exactly the same thing? Now, I believe 
 that it is at this impressionable period of the child's life that one can lay the foundations of the education 
 that we need for the home. Certainly, we want to make use of that period, for, as a psychological fact, 
 as well as through personal experience, we know that the earliest impressions are the ones that are the 
 most firmly fixed in the mind, and that are the hardest to eradicate in later life. 
 
 The third point that I want to emphasize is that there seemed to be just a little too much of the 
 professional side in the paper presented. I will say to the professional folk, you are doing a splendid 
 work, and you are giving your hearts to that work, but you are such a small body when you consider 
 the great nation of homemaking people who do not know even the terms you use. So you must train 
 the teachers to a sense of the fitness of things, to the extent that they can talk to us uninitiated folk in 
 our own language, so that we will underst^ind. 
 
 Naturally, the public school authorities cannot take over all the things that the volunteer workers 
 want taken over. There is too much to be done at one time. Here in Philadelphia we have been trying 
 an experiment, and it has proved to be such a success that we are going to repeat and extend it next 
 winter. Near a certain school, we noticed conditions which needed improvement, so a house was taken 
 next to the school, and a homemaking center created. In this "home" our girls are trained in mother- 
 craft and home work. They go from the school to this house in classes, at the convenience of the princi- 
 pal. Their duties in the "home" are very much like those of their own homes. Of course, babies come 
 there, because home would not be anything without baby life in it. They do not come by hundreds, 
 as they do in New York, but they come to us by the dozens, and they are weighed, and their mothers 
 are talked to and helped, and other mothers are invited to witness the work. The girls of the school 
 handle the babies as little mothers should. This work has been so successful that next year, through the 
 kindness of a generous Philadelphian, who has given us some $4000, we are going to open another "home," 
 and make it the center of homekeeping. 
 
 This is a suggestion, that is all,rbut it seems to us, while you are waiting for the Federal Govern- 
 ment to give you the funds for the larger work, it might be wise to take up some such smaller phase of it, 
 where the opportunity exists. Here is certainly a place where public-spirited citizens can do a great 
 deal of good to the community. 
 
258 REPORT OF THE PHILADELPHIA RABY SAVING SHOW 
 
 Lastly, I do not know how many of you have read the American Magazine for this month, and 
 have seen the article by Miss Tarbell on the "Irresponsible Woman and the Friendless Child." Those 
 who have, whether they be social worker or professional guide, must feel that there is still an untouched 
 field of effort waiting some worker's hand. Some effort should be made to arouse the great mass of 
 irresponsible women and relate them for good, in a real way, to the friendless children in our midst. 
 Awaken these women to a sense of the needs of child life about them. Teach them that the spirit of 
 childhood, like some frail flower, requires most delicate handling. Arouse in them that sense of woman- 
 hood which spells most truly motherhood. This, to my mind, is almost the greatest home education 
 which can be accomplished today. 
 
 Mrs. Wister; How sorry we all are that we have not the time for more 
 inspiring words from Mrs. Griee, and how sorry I am that I cannot give our dis- 
 tinguished visitors a description of some of the important things she has done for 
 Philadelphia. 
 
 The next name on our program is familiar to every one interested in and in 
 sympathy with the great play movement. Every one who has felt the pervading 
 influence of that movement will recognize the name of Mrs. Gulick as standing out 
 most prominently in the movement that is known as the "Camp Fire Girls." It 
 was expected that the Boy Scouts movement would appeal to people because most 
 people are naturally interested in boys, but I think many of us were surprised at 
 the prompt response given to the corresponding movement among the girls. Not 
 more than two weeks ago, in Savannah, I heard the people saying that Savannah 
 welcomes the Scout, but is carried away with the Camp Fire movement, and I 
 think that is true of many other places in this country. It gives me much pleasure 
 to present to you Mrs. Luther H. GuUck. 
 
 THE VALUE OF RECREATION IN RELATION TO 
 INFANT MORTALITY 
 
 BY MRS. LUTHER H. GULICK 
 
 I did not expect to be introduced in this way, as the leader of the Camp Fire 
 movement, although naturally I expected to say a good deal about that movement 
 in my few remarks. My husband, last week, was asked to make an address in 
 Albany about medical inspection in schools. On his return, I asked him if he 
 talked about Camp Fire Girls? You can imagine his reply. As a matter of fact, 
 he makes it a point to say something on that subject no matter what may be the 
 particular theme assigned him, and so I suppose I will say something about the 
 Camp Fire Girls, even though our subject today is the value of recreation in 
 relation to infant mortality. 
 
 Several months ago Dr. Gulick received a letter from a principal of one of the 
 large New York schools asking him if there would be an opportunity for the girls 
 who are members of the Little Mothers' League to receive honor in the Camp Fire 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 259 
 
 Girls. Naturally, this letter delighted us. We went to see the principal and 
 heard from her at first hand the work of this particular league. It seemed to us 
 that in meeting this principal we were meeting a mother — one of these new motliers, 
 a universal mother, or, to use a better term, a community mother. The organiza- 
 tion of Camp Fire Girls is very glad to cooperate with such work. They are ar- 
 ranging to cooperate with the Fruit and Flower Guild and other similar organiza- 
 tions. 
 
 To hear Miss Knox tell about the work in her school was to me one of the most 
 hopeful signs of what future motherhood is to be. The pageant of enhghtened 
 and unenlightened days was a wonderful example of how children can be taught 
 necessarj' things in a beautiful way. This work has been brought about through 
 the efforts of Dr. S. Josei)hine Baker, of the New York Department of Health. The 
 argument made for the founding of this League was a sound one. The care of the 
 youngest children of the large families, often so wTctchedly poor, is left to the eldest 
 daughter, frequently not much out of infancy herself. To the ignorance of these 
 young girls has been attributed a large percentage of the infant mortality. To 
 quote from Dr. Baker: "If these girls, the little mothers of their small brothers 
 and sisters, are unwittingly one of the causes of infant mortality, why not make 
 them one of the factors in reducing it.'" Dr. Baker doubtless has told you some- 
 thing of the wonderfully good work these young girls are doing. 
 
 One thing that impressed me most in regard to the pageant of the little mothers 
 was a song which James Oppenheim wrote for the Little Mothers' League of School 
 15. As Dr. Baker did not give you that poem, I want to read it to you: This 
 is what the girls sang in that pageant: 
 
 LITTLE MOTHERS' LEAGUE SONG 
 Upon our faces shines a light 
 
 Our toiling mothers have not seen; 
 America's high torch of white 
 We bring to pierce their troubled night. 
 
 We little mothers of Fifteen, 
 
 Of dear Fifteen, of dear Fifteen. 
 And so our sisters and our brothers 
 Have each of them two loving mothers 
 
 To make them grow up sweet and clean. 
 
 And in our homes new glories start 
 
 And child and mother on us lean 
 Schools, that taught us this sweet art. 
 We lay our hearts upon your heart. 
 
 We little mothers of Fifteen, 
 
 O dear fifteen, O dear Fifteen. 
 Your radiant light, your loving power 
 Shall teach our spirits till we flower 
 
 In womanhood, superb, serene. 
 
 If we can get children to sing these ideas, we have gone a great deal farther 
 than in giving them merely the material facts in regard to the care of babies. 
 
260 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 I have here two compositions selected from a great many written by members 
 of the Little Mothers' League, which seem to me to illustrate this idea of just what 
 community mothering really is. These little girls are becoming real community 
 mothers. The first is by Lillian Newman, of the eighth grade, who says: 
 
 "The work of the Little Mothers' League has been a success throughout the 
 four or five years we have established it. We are being taught each week how to 
 care and feed babies. We meet on Monday afternoon at three o'clock. The 
 president calls the meeting to order, and we begin our daily task. Our director 
 is Mrs. Kaiser; she suggests that we should cut out clippings from newspapers 
 about anybody who is trying to help save babies' lives. On March 27, 1912, we 
 had a pageant describing what members of the Little Mothers' League do in trying 
 to save babies. Every four weeks we have a meeting in the assembly because' Dr. 
 Pick speaks to us about babies' care. He told us that a baby of two or three 
 months should have more water than milk, and babies about six or seven months 
 should have more milk than water. He also said that we should use a round bottle 
 to feed the baby, because if we use a square bottle, it is bad to clean the bottle 
 because of the corners. Dr. Pick told us that before giving the baby a nipple we 
 should wash it well. One of the members cut out a clipping from a newspaper 
 about Mr. Isadore Straus, who died. He left a large sum of money for the care 
 of babies. 
 
 "Our L. M. L. has been one of the oldest and largest in the city of New York. 
 Nathan Straus has helped many a baby in New York city, and we older girls are 
 trying to help save more babies than what Nathan Straus did. So far our club 
 has been a great success, and I hope it will be a greater success by the next year. " 
 
 Here is the other composition, written by MoUie Zelt, of the fifth grade: 
 
 "I think it is very kind of the Little Mothers' League to teach us how to save 
 the lives of babies. 
 
 "One day, while I was doing my lessons, our neighbor came in and told my 
 mother that her baby was sick. My mother asked her what ailed the baby. She 
 told my mother that it was always vomiting. I heard her and asked her what she 
 gave the baby to drink. She said she used bottled milk. I asked her from what 
 station she bought it, and she said she used grocery milk. I understood what ailed 
 the child at once. Then I asked her to show me the bottle. I went into the house 
 and saw it was a square bottle. I told her that a square bottle wasn't good for the 
 baby's health, because if she washed the bottle, the dirt would be left in the corners. 
 I asked her why she didn't use Straus's milk. She said she never heard of it. I 
 told her if she wanted her child to feel well, she had better use it. She asked where 
 it was to be gotten, and I told her it was in Seventh Street Park. She used the 
 milk a whole week, and at the end of the week found that the child was getting 
 better.^ She came into my house and thanked me for what I had done. She used 
 Straus's milk for all her children and recommends it to other people." — Mollie 
 Zelt. 
 
 The child today does not spend its entire time at its mother's knee. It is sent 
 out to kindergartens, to playgrounds, to be entertained and taught by trained 
 workers, by community mothers. One of the objects of the Little Mothers' League 
 is not alone to help save the little brothers and sisters of the home, but to acquire 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 261 
 
 knowledge and training for future motherhood, which is also being put to service 
 where needed in the comnumity. 
 
 The aim of the Camp Fire organization is to fill the gap between childhood 
 and womanhood, and the still greater and wider gap between girlhood and mother- 
 hood, with the beautiful, wholesome things of life, teaching girls not alone feminine 
 accomplishments, but human life tasks. Training them not so much for the home, 
 but for the community, which is the larger home, not so much for individual mother- 
 hood, but for the universal motherhood. 
 
 In locahties where the .schools are not taking up this work, and there are, I am 
 sorry to say, too few Little Mothers' Leagues, the Camp Fire Girls plan to have 
 mothers give the girls this instruction. The organization is endeavoring to restore 
 some of the teaching functions to mothers. A mother with modern methods in 
 the care of her children will be asked by the Guardian of the Fire (as the leader 
 of a Camj) Fire is called) to give instructions in the feeding or bathing of the infant, 
 or the importance of recording weights and heights of infants. All girls need this 
 instruction even though they may not have the care of their little brothers and 
 sisters. We do not make this point in the movement too sharply defined, for we 
 do not think it wise to — all we do is to give an honor to the girl who learns and 
 performs the various things we have outHned for her. 
 
 In joining the organization the girl has only to learn and repeat the Wood 
 Gatherer's Desire, but for the next rank that of Fire Maker. 
 
 Among the requirements a girl must know the chief causes of infant mortality 
 in summer, and tell how and to what extent it has been reduced in at least one 
 American community. This covers, of course, a knowledge of personal hygiene, 
 diet, proper clothing, ventilation, and the value of fresh air. 
 
 In the list of elective honors, required to win promotion, there are included the 
 following tests involving the care of the baity: 
 
 1. Know how to care for a baby's bed. 
 
 2. Know how milk should be prepared for a six-months'-old baby; know 
 what is good milk for a baby a year old, and how it can be tested. 
 
 3. Know how much a baby should gain in weight each week for the first six 
 weeks, in height for each month for the first year. 
 
 The relation of weight to disea.se and vitafity. 
 
 4. Know and describe three kinds of cries of a baby and the cause of each. 
 
 5. Care for a baby for an average of an hour a day for a month. 
 
 6. Make a practical set of playthings for a child three years old. 
 
 7. Make a set of baby-clothes. 
 
 Sleeping, feeding, health, amusement, and clothing; this covers the practical 
 and material needs of babyhood. But behind the.se direct tests in the actual care 
 of babies there are ones of greater importance, tests in eugenics, which will help to 
 show the girls the effects of heredity and environment. 
 
 By making practical tests in the value of pedigreed seeds and pedigreed animals, 
 as against the net results of the success with those not pedigreed, a tangible appU- 
 cation of this most important factor is developed. 
 
262 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 An honor is given for experiments with a garden planted with good seeds and 
 accounting the results, also for experiments showing the influence of cultivation 
 and environment on seeds not good. She plants a plot with seeds treated with 
 bacteria solution, and another not so treated, and watches results, which experi- 
 ment wins an honor and serves to point toward the value of cultivation and care 
 as to the ultimate effects on reproduction of life. The demonstrating in nature 
 of the value of some one factor of heredity or environment, or in some strain of 
 animals as to the effect of breeding to health, endurance, length of life, color, form, 
 or effect of altered habits, is only symbohc. Its object is an illustrative one. 
 
 The whole purpose of the Camp Fire Girls is one to build up an all-round 
 character. Our physical tests are of the habit-forming kind. We give no honors 
 for running certain distances in a given time, or for jumping certain heights, but 
 we do give honors to girls who keep well, and who do the things for bringing this 
 to pass. To be free from colds three consecutive months during the winter months; 
 not to miss school or business for two months; for walking 40 miles in ten con- 
 secutive days. A telephone girl in my husband's oflSce recently walked 47 miles 
 in ten consecutive days in order to win this particular honor. 
 
 In one of the slum settlements a group of Camp Fire Girls are having real 
 romantic pleasure in this walking test. They coimt the number of blocks they 
 have walked during each day and report the amount. They know, as they have 
 never known before, the number of blocks to a mile. These are working girls. 
 
 In introducing business honors into the organization the object is a double 
 one: To teach girls to acquire orderly minds for their present needs and to aid 
 the next generation to more readily grasp the details of whatever occupation into 
 which their environment may thrust them. Mr. Williams Hard, in his "Women 
 of Tomorrow," claims that a woman with a business career behind her is better 
 fitted to rear sons than the woman without this training. This is obvious. 
 
 By this same scale of measurement a woman with training for a love of out- 
 of-doors, who has found romance in daily life, and enjoyment in all the wholesome 
 activities and occupations of womanhood, is of necessity better equipped to fulfil 
 the functions of motherhood than the young girl brought up in an atmosphere of 
 artificialities. This, too, is obvious. 
 
 Our program is for all kinds of girls, those who work for their living as well as 
 those who do not, whom we sometimes falsely call the more favored ones. It is 
 the hope of this organization to bind all girls together in one great sisterhood; to 
 teach loyalty to each other, and by the costume and insignia of the organization 
 to help girls stand together and to be worthy of being a link in the chain of life. 
 
 Aside from direct tests and honors given, the program is planned to fill the 
 girl with wholesome ideas of a Ufe balanced to meet all requirements. 
 
 If the girls take as their watchword, "Work, Health and Love," and put into 
 practice the ideas represented by these words, there is a wonderful possibility of 
 changing, of beautifying, the whole character of the next generation. 
 
 Mrs. Wister: We have listened to this address with great interest. I only 
 
PROCEEDINGS OF CONFERENCE ON INFANT HYGIENE 263 
 
 wish it were earlier in the day, so that wc could hear a great deal more about this 
 important subject. 
 
 Those who have lived in Philadelphia any length of time, and can look back 
 fifteen or twenty years, or longer, are impressed with the wonderful change that 
 has taken place in the attitude of our government toward the problems of health 
 and charities. It is a wonderful and very sudden change. Our present Director, 
 Dr. Neff, has always taken an especial interest in baby saving and baby feeding. 
 It gives me great pleasure to introduce the Assistant Director of the Department 
 of Public Health and Charities, Mr. Alexander M. Wilson, who will discuss Mrs. 
 Gulick's paper. 
 
 Mr. WiiaoN: If there be any virtue in brevity, I will try to find it. I have been very much 
 interested in this matter of recreation and the prevention of infant mort-tlity, but I will confine myself 
 solely to the matter of play. I am sorry that Mrs. Gulick did not tell us more of the recreational side 
 the Camp Fire movement. I am immensely interested in the Hoy Scout movement, particularly in the 
 manner in which it takes the boy out-of-doors, and I should have liked to hear somethint; of the way the 
 girls have developed that part of their plans which has to do with the great outdoors. She has given 
 you the ethical and educational side of the Camp Fire movement. We have that side also in the Boy 
 Scout movement, but I confess to you that it does not appeal to me as much as just the wholesome side 
 of getting the boys out for a romp in the open air. I have gone into It with a great deal of enthusiasm 
 recently, and I must say that I derive considerable pleasure from it. I get from it the opportunity to 
 indulge in the same sports that I enjoyed back on the farm at home, and I would like to see girls doing 
 the same sort of things that our sisters did there. Its relation to infant mortality was certainly well 
 brought out by what Mrs. Gulick has said. 
 
 I believe one of the troubles with our people today is that they do not play enough. I hope I 
 shall never lose the play spirit. I like to skate now as much as I did when I first learned, and I love to 
 go swimming with my boy of eight, as I hope I will with my baby girl of a few months when she is a little 
 older. I believe this sort of thing makes us better fathers and better mothers. 
 
 I think there is another side of the relation of recreation to the prevention of infant mortality that 
 might well be touched upon in one word. I had hoped to be able to show a lantern-slide which Miss 
 Babbitt brought, and which she showed me. It represents a mother with a baby carriage at her side, 
 looking wistfully between the bars of a fence into a recreation center. The suggestion was that she was 
 shut out. There did not seem to be very much there for either her or her baby to do. 
 
 What shall we do for the adult who wants to play? Should we not take care of this desire when we 
 extend our playgrounds movement? .\ great many of the men and women cannot even get out to Fair- 
 mount Park to play. The playground shown in the picture was in Chicago, but it might have represented 
 almost any city. Yet they have done some good things in Chicago along this line, for I have seen in that 
 city some rest stations and recreation centers which had space for the baby carriages, and something for 
 the mothers to do, and some of the big playgrounds in Chicago have provided very admirably for the 
 mothers' need of recreation. 
 
 I would particularly like to see something done for the j'oung people of between sixteen and twenty 
 years of age. The girls have no incentive to take them away from dance halls and other improper 
 surroundings. Now, I think the dance, under proper condition, is wholesome. I enjoy it myself, and 
 would like to see the right opportunity for this and other amusements extended to our young women. 
 We should not be ashamed to speak of play or to engage in it, for we adults should set the example in 
 these matters. 
 
 Mrs. Wister: I feel that Mr. Wilson's advice is very timely, and we are 
 obliged to him for it. 
 
 In bringing the Conference to a close I wish, on behalf of the managers of the 
 
264 REPORT OF THE PHILADELPHIA BABY SAVING SHOW 
 
 Baby Saving Show, to extend our most sincere thanks to the speakers who have 
 been good enough to come here and address us. I am sure the officers are extremely 
 sorry they cannot be here personally to deliver this message, and I am very glad 
 I have the opportunity of doing it for them. It is a privilege to have listened to 
 these addresses and discussions, the influence of which goes far beyond the audiences 
 we have had in this room, for through the courtesy of the public press, the inspira- 
 tion and enlightenment which have come throughout the Conference have been 
 extended to many thousands of our people throughout the City and State, and I 
 know that they, too, would wish to express their gratitude for the opportunity which 
 has come to them. 
 
Index 
 
Index 
 
 Abortion, induced, 73 
 Acrostics, infectious disease, l.'ii 
 Address at opening of Conference on Infant Hy- 
 giene, by Mr. Homer Folks, 180 
 Agriculture, U. S. Department of, exhibit of, 103 
 Alcohol, influence of, on infant mortality, 34 
 Alphabet, good health, 153 
 Artificial feeding, \ii 
 
 cautions for mothers and nurses, 
 
 125 
 directions regarding milk and its 
 preparation for the baby, 123 
 facts which the mother must 
 note to report to the doctor, 
 125 
 nipples and bottles, 123 
 Attendance at main exhibit, 103 
 
 at subsidiary shows, 103 
 Auxerre, infant milk depots in, 194 
 
 B 
 
 Baby, care of the, 137 
 
 Saving Show, committees. See CommiUees 
 
 of the Baby Saving Shoic. 
 Saving Show, rules for the nursing mother, 
 
 133 
 things that are bad for the, 145 
 Bad booth, 145 
 
 things that are bad for the baby, 145 
 
 room and how improved, 08, 09 
 
 Baker, S. Josephine, discussion on paper by, 188 
 
 S. Josephine, on municipal child bureaus, 
 
 182 
 
 Blind, New York Association for. Committee for 
 
 Prevention, 78 
 Blindness, prevention of, 79, 81, 82 
 Booth, bad, 145 
 Boston, Committee on Childhood Health Exhibit 
 
 of, 143 
 Bottles and nipples, 123 
 Breast and bottle feeding, relative expense of, 130 
 
 feeding, 129 
 Bureau of Chemistry, U. S. Department of Agri- 
 culture, exhiljit of, 103 
 of Health, Philadelphia, Division of Bac- 
 teriology, Laboratory of Hygiene, 83 
 of Health, Philadelphia, Division of Vital 
 
 Statistics, 91 
 of Health, Philadelphia, exhibit of, 83 
 
 Care of the baby, 137 
 of infants, 235 
 19 
 
 Care of milk in the home, 107 
 
 of the new born. 75 
 Cautions for mothers and nurses, 125 
 Census, Bureau of the, U. S. Department of Com- 
 merce and Labor, 21 
 Childhood Health Exhibit of Boston, Committee 
 
 on, 143 
 Committee on Childhood Health Exhibit of Bos- 
 ton, 143 
 for Prevention — N. Y. Association for 
 the |{lind, 78 
 Committees of the Itaby Saving Show, 107 
 Conmiittee on Education, 109 
 Committee, Executive, Ui7 
 Counuittee on Finance, 107 
 Committee on General .Arrangements, 
 
 107 
 Committee on Lectures an<l Demon- 
 strations, 108 
 Committee on Patronesses and Aides, 
 
 109 
 Committee on Procuring Exhibits, 
 
 l(i8 
 Committee on I'ublication, 109 
 Committee on Publicity, 108 
 Committee on Social Organizations, 
 
 109 
 and organization, 107 
 Communicable diseases. Bureau of Health, Phila- 
 delphia. 83 
 diseases other than, 95 
 Conference on Infant Hygiene, 177 
 
 on Infant Hygiene, address of Mr. 
 
 Homer Folks at opening of, 180 
 on Infant Hygiene, institutional care of 
 
 infants, 235 
 on Infant Hygiene, consideration of 
 the social service work of the De- 
 partment of Diseases of Children in 
 the Massachusetts General Hospi- 
 tal, 204 
 on Infant Hygiene, control of mar- 
 riages of the unfit, 221 
 on Infant Hygiene, education for 
 
 better parenthood, 251 
 on Infant Hygiene, effect of housing 
 
 upon infant mortality, 228 
 on Infant Hygiene, first session, 179 
 on Infant Hygiene, Henry Street Set- 
 tlement's contribution toward the 
 conservation of infant health and 
 life, 241 
 on Infant Hygiene, infant milk depots, 
 
 191 
 on Infant Hygiene, municipal child 
 bureaus, 182 
 
 207 
 
268 
 
 INDEX 
 
 Conference on Infant Hygiene, prenatal care of 
 infants, 245 
 on Infant Hygiene, proceedings of, 179 
 on Infant Hygiene, regulation of mid- 
 wifery, 213 
 on Infant Hygiene, second session, 213 
 on Infant Hygiene, third session, 234 
 on Infant Hygiene, value of recreation 
 in relation to infant mortality, 258 
 Conservation of infant health and life, Henry 
 
 Street Settlement's contribution toward, 241 
 Consideration of the social service work of the 
 Department of Diseases of Children in the 
 Massachusetts General Hospital, 204 
 Contributors to the Baby Saving Show, list of, 175 
 Control of marriages of the unfit, 221 
 
 Daily attendance at the main exhibit. Horticul- 
 tural Hall, 1G3 
 Department of Health, Pennsylvania State, 25 
 
 of Public Health and Charities, Bur- 
 eau of Health, Philadelphia, 83 
 Diet kitchen, a model, 82 
 Directions regarding milk and its preparation for 
 
 the baby, 123 
 Directory and Catalogue of Exhibits, Charts, Dia- 
 grams, Signs, and Illustrations, 19 
 
 and Catalogue of Exhibits, Bureau of 
 the Census, U. S. Department of 
 Commerce and Labor, 21 
 
 and Catalogue of Exhibits, Bureau of 
 Health, Philadelphia, communicable 
 diseases, 83 
 
 and Catalogue of Exhibits, care of milk 
 in the home, 107 
 
 and Catalogue of Exhibits, care of the 
 new born, 75 
 
 and Catalogue of Exhibits, Committee 
 for Prevention — N. Y. Association 
 for the Blind, 78 
 
 and Catalogue of Exliibits, conditions 
 relating to maternal environment dur- 
 ing pregnancy, 71 
 
 and Catalogue of Exhibits, Department 
 of Public Health and Charities, Bur- 
 eau of Health, Philadelphia, 83 
 
 and Catalogue of Exhibits, diseases 
 other than communicable, 95 
 
 and Catalogue of Exhibits, exhibit of 
 the Housing Commission of Phila- 
 delphia, 53 
 
 and Catalogue of Exhibits, foods and 
 food values, 113 
 
 and Catalogue of Exhibits, Health De- 
 partment of the District of Columbia, 
 95 
 
 and Catalogue of Exhibits, hereditary 
 syphilis, 30 
 
 and Catalogue of Exhibits, heredity 
 and eugenics, 34 
 
 and Catalogue of Exhibits, housing and 
 environment, 39 
 
 and Catalogue of Exhibits, infant feed- 
 ing, 111 
 
 Directory and Catalogue of Exhibits, model diet 
 kitchen, a, 82 
 and Catalogue of Exhibits, Pennsyl- 
 vania State Department of Health, 
 25 
 and Catalogue of Exhibits, Philadelphia 
 Hospital for Contagious Diseases, 89 
 and Catalogue of Exhibits. Philadelphia 
 Pediatric Society's Milk Commission, 
 105 
 and Catalogue of Exhibits, IJ. S. De- 
 partment of Agriculture, Bureau of 
 Chemistry, 103 
 and Catalogue of Exhibits, U. S. Pub- 
 lic Health and Marine Hospital Ser- 
 vice, 94 
 and Catalogue of Exhibits, Visiting 
 Nurse Society, Philadelphia, 61 
 Diseases other than communicable, 95 
 District of Columbia, Health Department of, 
 
 exhibit of, 95 
 Division of Altai Statistics, Bureau of Health, 
 
 Philadelphia, exhibit of, 91 
 Down-town subsidiary shows, lectures and speak- 
 ers at, 161 
 
 E 
 
 Education, Committee on, 169 
 
 for better parenthood, 251 
 
 Effect of housing upon infant mortality, 228 
 
 Environment, housing and, 39 
 
 Eugenics, heredity and, 34 
 
 Executive Committee, 167 
 
 Exhibit of the Housing Commission, Philadelphia, 
 53 
 
 Exhibits, Charts, Diagrams, Signs, and Illustra- 
 tions, Directory and Catalogue of, 
 19. See Directory and Catalogue of 
 Exhibits. 
 Committee on Procuring, 168 
 
 Facts which the mother must note to report to 
 the doctor, 124 
 
 Farrell, Elizabeth E., on the Henry Street Settle- 
 ment's contribution toward the conservation 
 of infant health and life, 241 
 
 Feeding, artificial, 922 
 breast, 129 
 
 Finance, Committee on, 167 
 
 Financial statement, 173 
 
 First session of Conference on Infant Hygiene, 179 
 
 Fhes, 55 
 
 Folks, Mr. Homer, address at opening of Confer- 
 ence on Infant Hygiene, 180 
 
 Foods and food values, 113 
 patent, 149 
 
 Freeman, R. G., discussion on paper by, 201 
 on infant milk depots, 191 
 
 General Arrangements, Committee on, 167 
 Gennantown subsidiary show, lectures and speak- 
 ers at, 162 
 
INDEX 
 
 2G9 
 
 Goddard, Henry H., on control of marriages of the 
 unfit, ii\ 
 discussion on paper by, 2i3 
 Good health alphabet. 153 
 Guarantors of the Baby Saving Show, 174 
 GuUck, Mrs. Luther H., discussion on paper by, 
 263 
 Mrs. Luther H., on the value of recreation 
 in relation to infant mortality, 258 
 
 H 
 
 Hart, Hastings H., on institutional care of infants, 
 
 235 
 Health Department of the District of Columbia, 
 
 exhibit of, 95 
 Henry Street Settlement's contribution toward 
 
 the conservation of infant health and life, 241 
 Hereditary syphili.s, 30 
 Heredity and Eugenics, 34 
 
 and Eugenics, effect of ill health of 
 
 mother on infant mortality, 35 
 and Eugenics, effect of poverty and in- 
 suflScient food on infant mortality, 36 
 and Eugenics, mating of the unfit, .34 
 Horticultural Hall, daily attendance at main 
 exhibit. I(i3 
 infants cared for in rest room, 
 163 
 Hospitals and institutions, 154 
 Hot weather, room fitted up for baby's use during, 
 
 135 
 House-flies, 85-89 
 Housing and environment, 39 
 
 Commission, Philadelphia, exhibit of, 53 
 Huntington, James L., discussion on paper by, 219 
 James L., on the regulation of mid- 
 wifery, 213 
 Hygiene, Infant, proceedings of Conference on, 179 
 
 Induced abortion, 73 
 Infant feeding. 111 
 
 utensils used in, 111 
 
 Hygiene, Conference on, first session of, 179 
 
 Conference on, proceedings of, 179. 
 
 See Conference on Infant Hygiene. 
 
 Conference on, second session of, 213 
 
 Conference on, third session of, 234 
 
 milk depots, 191 
 
 in Auxerre, 194 
 in New York, 199, 200 
 in Pas-de-Calais, 192, 193 
 in Sens, 195 
 in St. Pol-sur-Mer, 196 
 in ViUe de Toucy, 196 
 in Villeneuve-sur-Yonne, 197 
 in Yonkers, 198 
 mortality, effect of housing upon, 228 
 
 the value of recreation in rela- 
 tion to, 258 
 Infants, care of, 235 
 
 cared for in rest room. Horticultural Hall, 
 
 163 
 prenatal care of, 245 
 
 Infectious disease acrostics, 152 
 Influence of alcohol on infant mortality, 34 
 Institutional care of infants, 235 
 Institutions, hospitals and, 154 
 
 Kensington subsidiary show, lectures and speakers 
 
 at, 162 
 Kitchen, a model, 82 
 a plain, 127 
 
 Lectures and Demonstrations, Committee on, 168 
 and siK-akers, 157 
 
 at the subsidiary .shows, 161 
 at Germantown subsidiary 
 
 .show, 162 
 at Kensington subsidiary 
 
 show, 102 
 at Manayunk subsidiary 
 
 show, 16.3 
 in Italian, 157 
 in Yiddish, 158 
 Little Mothers* League song, 259 
 
 M 
 
 dailv attend- 
 
 Main exhibit. Horticultural Ha 
 
 ance at, 163 
 Manayunk subsidiary show, lectures and speakers 
 
 at, 163 
 Marriages of the unfit, control of. 221 
 Massachusetts General Hospital, scheme of or- 
 ganization of Children's Medical 
 Out-patient Department, 205 
 General Hospital, social service 
 work of Department of Diseases 
 of Children, 204 
 Maternal environment during pregnancy, condi- 
 tions relating to, 71 
 Midwifery, regulation of, 213 
 Milk Corumission, Philadelphia Pediatric Society's 
 exhibit of, 105 
 directions regarding its preparation for the 
 
 baby, 123 
 in the home, care of, 107 
 Miscarriages, effect of, on infant mortality, 73 
 
 premature births and still-births, 72 
 prevention of, 73 
 Model diet kitchen, a, 82 
 Mothers and nurses, cautions for, 125 
 Municipal Child Bureaus, 182 
 
 N 
 Neff, Dr. Joseph S., 213 
 New born, care of, 75 
 
 New York Association for the BUnd, Committee 
 for Prevention, 78 
 infant milk depots in, 199, 200 
 Nipples and bottles, 123 
 
270 
 
 INDEX 
 
 O 
 
 Organization, committees and, 167 
 
 Parenthood, education for better, 251 
 Pas-de-Calais, infant milk depots in, 192, 193 
 Patent foods, 149 
 
 medicines and soothing syrups, 147 
 Patronesses and Aides, Committee on, 169 
 Pennsylvania State Department of Health, ex- 
 hibit of, 25 
 State Livestock Sanitary Board, 
 models of dairy barns from, 107 
 Philadelphia, Department of Public Health and 
 Charities, Bureau of Health, ex- 
 hibit of, 83 
 Hospital for Contagious Diseases, 
 
 exhibit of, 89 
 Housing Commission, exhibit of, 53 
 Pediatric Society's Mlk Commis- 
 sion, exhibit of, 105 
 Pregnancy, conditions relating to maternal en- 
 vironment during, 71 
 Premature births and still-births, miscarriages, 72 
 Prenatal care of infants, 245 
 Proceedings of Conference on Infant Hygiene, 177. 
 
 See ConSerence on Infant Hygiene. 
 Publication, Committee on, 169 
 Publicity, Committee on, 168 
 Putnam, Dr. Helen C, discussion on paper by, 257 
 Dr. Helen C., on education for better 
 
 parenthood, 251 
 Mrs. William Lowell, discussion on paper 
 
 by, 249 
 Mrs. William Lowell, on prenatal care of 
 infants, 245 
 
 R 
 
 Recreation, value of, in relation to infant mor- 
 tality, 258 
 Regulation of midwifery, 213 
 
 Relative expense of breast and bottle feeding, 130 
 Room for baby's use during hot weather, 135 
 Rules for the nursing mother, 133 
 
 Scheme of organization of Children's Medical Out- 
 patient Department, Massachusetts General 
 Hospital, 205 
 
 Second session of Conference on Infant Hygiene, 
 213 
 
 Sens, infant milk depots in, 196 
 
 Social Organizations, Committee on, 169 
 
 service work of the Department of Dis- 
 eases of Children, Massachusetts General 
 Hospital, 204 
 Soothing syrups, patent medicines and, 147 
 Speakers and lectures, 157 
 Statement, financial, 173 
 Stomach, actual size of, 124 
 St. Pol-sur-Mer, infant milk depots in, 196 
 Subsidiary shows, down-town, 161 
 
 Germantown, 162 
 
 Kensington, 162 
 
 lectures and speakers at, 161 
 
 Manayimk, 163 
 
 total attendance, 163 
 Syphilis, hereditary, 30 
 
 Talbot, Fritz B. 
 
 Fritz B. 
 
 a consideration of the social 
 service work of the Depart- 
 ment of Diseases of Children 
 in the Massachusetts General 
 Hospital, 204 
 discussion on paper by, ! 
 
 Third session of Conference on Infant Hygiene, 234 
 
 U 
 Unfit, control of marriages of the, 221 
 United States Department of Agriculture,^Bu- 
 reau of Chemistry, exhibit of, 
 103 
 Public Health and Marine Hos- 
 pital Service, exhibit of, 94 
 Utensils used in infant feeding. 111 
 
 Value of recreation in relation to infant mortality, 
 
 258 
 Values, foods and food, 113 
 Ville de Toucy, infant milk depots in, 196 
 Villeneuve-sur-Yonne, milk depots in, 197 
 Visiting Nurse Society, Philadelphia, exhibit of, 61 
 
 w 
 
 Wmslow, C. E. A., discussion on paper by, 231 
 C. E. A., on the effect of housing upon 
 infant mortality, 228 
 
 Yonkers, milk depots in, 198 
 
 5 I'U 
 
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