THE REPORT OF THE PHILADELPHIA BABY SAVINC; SHOW 1912 o o s u < o THE REPORT OF THE PHILADELPHIA BAB\^ SA\ ING SHOW AM) THE PR()CEEDIX(;S OF THE CONFERENCE OX INFANT HV(;iENE Kditki) hv THE PrBLICATlON (OMMITTKK IlhXsitidvcV PCBLISHED liY THE EXECUTIVE ("OMMITTEE 1 9 1 ;5 ^^ Win. F. Fell Company Printers Philadi'l phia Foreivord 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. z o OS D o 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"« 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. 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 *- t; c "^ 3 .^ g-r- Bt$ S c5 ■r.-S,^. s-i^ t^r 7^ =.■!'' ts-S-i ^ CO c3 a erf t;co i5 -'-" ^^ Si^- -^ ^ CI rj 3^ sx "3 — f^ = ^ !„ >; P^ c -S E £ •t;^ ,. (=.■=- S E «y-> — <€ 1 : 1 — ; t v) J S v> -5 " 3<:t— a. ^-' ^-D « ■■ fwoo s IIIIIIIIIIUlillilii 22 DIRECTORY AM) CATJ f.ncri' of EXHIBITS 23 carefully <;iiMr(l('|>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 coniinnted 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") 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 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 eolleetef 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, naileercu- 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' 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^ |«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;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 ;uiools 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-. 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 undouU ^ edly the want cf proper m^enial cait. |Bv iKiraii! in tie artificial or hand lhdil« if inlanis 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-ciys 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 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<'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. (' 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. ( )ne fly can cari'y and may dci)o-it in our fi)oria. 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 collecletort(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 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(icFED 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 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 '/. 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 " 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 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 ilcl 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) ATIlilidiiess 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 - 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//^-//'// / 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. 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 ( . 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 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 of thc^e d incases who were employed in the handlinji of milk. ' .'?. The diphtheria l)a• 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.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)arer 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 unv 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 \(>riii;il and I'ivc Aluioniial St()()l>. tlio Lai tcr t lie IU--11II iil' Iiri|iio|)cr Fcodiiif^. Weight curve sliowiiiL; loss I'roiii siiiiinier (liairlil<' showini; relation of weiulit to ^■itality. (\)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 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!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 niethol' 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 iiool 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 uuei;. iS,-c- I'l.-ilr WW I.) ( tn t\Mi ^licjvcs on the left-hand screen were |:laced thirleen jars ct 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
  • |ilay llic xarioiis t'oi nisi nil- siiitalilc to iiitaiicy and early cliildliood and to show siiii|ily aiiele(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 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 " 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 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 ( 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; tii 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 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('\/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 when nothing Iml caimcd or oxcrheatccl foods are eaten for a long time. The i)rolongchown 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 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; ly 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 " 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\\(> 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 |ihien 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 le n])on which was ])laced a tra.v containing baby dust- ing-l)OWy 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 ' and iiii;lil . " " Keej) the hahy warm hy the use of sufficient liody- and lie; 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 laii>- 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 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\(; Rooms H one. Sif^n: " Tni^ |{read. a can of tomatoes, a can of ])eas, an open, ])arliall.\ emptiec! milk-hottle. and an oil-lamp. Over the various articles and the tahle were scattered many artificial flies. .\ manikin doll, repre- sentinu' .-i child, seated at the lahle, was pn'snm.ahlx- eni;at;cd in ealinu' tomatoes, which were --nK'ared over his cheeks. .M)o\c the child wa^ [)la<-ed a siun readinj;': "Keep ( 'hildreu Clean." Another manikin, representing; a liah.v, was pl.iced in a jjo-cart. The hahy held a dirty, ordinary hottle containinuciirdled milk. .\ si^n allached lo the jfo- cart read; ""'Ihis Mahy is Too ^ ount; For a (io-('art.' There was a chair upotl which was placev another small child i r<'present<'il 1)>- a manikin doll', 'i'his chair eonlained I he sii;n, "" I'ets Carry Disea.se." (lose liy I he lalile was placed a !iarl>at;e can lilleil with izarliauc I pon this was |ilaced a sii^n. ■'keep the Slop (an ('oxercil. Close l)y were two si^iis readiiii^; " Keeji llic l-'lic- Out" and ""Keep the \Viiid()Ws Open hut Closely Screened." In a corner of the room was |)lacc(i a cookiiii; raniie, and upon it were some old l)ots and jians. In another corner of the room were se\cral soiled diajn-rs, and oil a clothesline stretched across the room were huiii;- two diapers. On this line was linn<; also a legend reading: ■"When the Bahy's Diaper is Soiled, Change and Wash it at Once." There were three other signs in the hooth, which read: (\) "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 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 <'xsi\<' 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,-ichclioto- 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 . 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 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 any 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 Tas- de- Cai-a * IIVlLUS ( mi& ;Tas nt CoHSULTATlOM AG. NoUT!Kl5SoH5.Hl 1^13 04 ■■ AvEC. 1. •• •« w^ »<- 2 I z ^ i 1} ^ < < r cr 1 i \n >• Ul J < P r > -J i5 t J u I < i 3 j Z 1: 1/1 Ul h T |i- 4C ni 3S I JO 1 zfJ 2M illi B^ ■ a-f a ^^ 1 pB| u ^ Ul ■^ 1 1 114 I ^ i B^ B-7.4M 9 «7 % tt 1 K 1 i^ ^^1 ■ 1 m 1 IO.S- ttrri B^^ ^ ^■.s^^l ii-^l 1 " m 1 ■ ^ '" ■^ ■^ ^ ^ ■ ^ ■ ^fl 1 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 SE-N5 IOC IS r^OI\TAU\-TE. "joTM-e-TiE. O X. 1 /\« rrtttr M n. 1^0 + Ztjznr no lO-a ■■P ^^_ ^k ^p 47 7.5 a. m 1 !■ i 1 m^ 1 FiK. 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 ThC ntPuc-ioN IH »Mr^MT noitTAUiTY 1 H YoM K cr? ^. Ne w \or^K ATTe^ THE ts.TATli-t*,MMe«T OF I^H_»sod I8"3S ia9 6 (83 V >S3i. j ^^ «, ^^ ^eo ia'9 ^^ '^■^ 2 » c^^^^^SnS^ z3-y zr7 1 ■ /i^ 30 1/5- '•°^R iiii^^^— \% ^^^^^KM^Bm^^Bwwvi 75- 7X w^ '"^^■^^^^^■ll_ 3^^ ^^^^^s^$^^^Ss^^^:^^^i^^^^^i^^BMc^^^i^ N^NN ■^m^ w^n; MsNN HH 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 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'tiovbtrt>/)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 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