EDUCATIONAL WORK THROUGH THE DISTRIBUTION OF CIRCULARS, PAMPHLETS, ETC.

The volume of printed instructions annually issued, as well as the character of the material, improves each year. State boards of health have issued exceedingly valuable pamphlets appealing alike to city authorities to bestir themselves and to parents to instruct themselves in the care of babies. These two audiences have not always been kept distinct, as much material directed at both is sometimes contained in the same pamphlets.

The North Carolina State Board of Health issued in 1912, as Special Bulletin No. 10, a pamphlet on "The Baby," using most effectively a cartoon of a mother gazing into the empty cradle. A part of the legend is "In future men will stop locking the stable door after the horse is stolen. They will not be content with spending on a funeral the money that would have saved the child; they will not tolerate the thought that a poor mother must bear 10 children to raise 5." "Save the Baby" articles are prepared by a number of the State boards, and furnished to the papers throughout the State. In North Carolina these are included from time to time in the State Board of Health's "Daily Press Service" publications. In other States as Iowa, Idaho, etc., where the general scheme is adopted the articles are prepared only on special occasions. A bibliography of these State and city publications would be valuable and may form a part of this report next year, but can not be attempted now.

Some cities, notably Chicago and Seattle, issue weekly or monthly bulletins which in addition to statistical matter contain much that is instructive as to the care of babies' food.

The health officer of Washington, D. C., issues instructive pamphlets on such subjects as the care of milk, the fly menace, methods of destroying flies, etc.

Lectures to mothers and moving-picture films, illustrative of the principles of baby hygiene, are also among the educational features which some cities have successfully adopted.

Of prime importance are the folders addressed to mothers and dealing directly with the care and feeding of the child. These are mailed immediately upon receipt of notice of birth of a child, or are delivered by the nurse who calls as the result of such birth notification. Such folders are issued in all of the principal languages spoken in the locality, as, for instance: Bridgeport, Conn., prints in four languages; Providence, R. I., in five; the State Board of Health of Pennsylvania publishes such circulars of instructions in five or six languages, and furnishes these to the various cities of the State.

Likewise the Department of Health of New York issues a pamphlet on "How to Save the Babies," which is distributed through the city health bureaus. Selected copies of these circulars in various languages will be found in the appendix. The importance of having these instructions in many languages will be apparent. It very often happens that the mother does not understand the language either of the visiting nurse or of the physician, and is hence thrown back, as soon as they leave the house, upon her own resources, or left to the mercy of advisory neighbors as ignorant as herself. It may frequently happen, also, that where health officers have no means or opportunity of doing anything more they can have such circulars distributed among mothers, or have the material printed in the local papers. Experience has shown that the editor, for instance, of the Italian paper is glad to print this material if the copy is furnished to him in Italian; the publisher of the Yiddish paper is entirely willing to publish it if it can be furnished to him in Yiddish, etc. It should be noted that these "Care of the Baby" and "Save the Baby" circulars frequently contain some information as to the care of the mother immediately before the birth of the child.

CONCLUSION.

It is evident that no universal program for civic baby-saving work can be laid down, because each community must begin at the point which is practicable or most urgent as shown by local conditions, but the following summary is offered as universally applicable:

(1) A continuous graphic statement of the births and deaths of babies, kept by means of different-colored pins to be placed day by day on a city ward map or, preferably, a block map showing each dwelling, is a simple means of keeping informed as to the points of danger.1

(2) Complete registration of births is necessary in order that the baby may be brought under observation as soon after birth as possible.

(3) The appeal to mothers to nurse their babies can not be made. too strong, since it is estimated that bottle-fed babies have only onetenth the chance to live that breast-fed babies have.

(4) A clean milk supply is a fundamental need. The ideal is: Nothing short of clean milk for everybody. This calls for intelligent and effective inspection of farms, the means of transportation, and the shops where milk is sold.

Milk stations for distributing clean milk to babies, maintained by private philanthropy, are a useful beginning.

1 See page 14.

(5) The organization of "Little Mother Leagues" or similar classes in the public schools, through which girls from 12 to 14 years of age are taught all practical methods of home making, including baby hygiene and feeding, ranks as important work in the prevention of infant mortality in this and in the next generation.

(6) All efforts for civic cleanliness serve the babies no less than the rest of the population.

In conclusion, as summing up the significance of the work described in this publication it seems fitting to recall the statement of a great sanitary authority that the infant death rate is the truest index of the welfare of any community.

APPENDIX.

HOW TO SAVE THE BABIES-IT IS NOT THE BABIES BORN BUT THE BABIES SAVED THAT COUNT.

[Suggestions to Mothers from the New York State Department of Health, Eugene H. Porter, A. M., M. D., commissioner. Written by H. L. K. Shaw, M. D., consulting pediatrician, and issued by the division of publicity and education of the State department of health, Albany.]

SAVE THE BABIES.

This booklet is prepared and placed at the free disposal of the mothers of the State of New York to assist them in the care of themselves during pregnancy and in the care of the baby after it is born. Copies can be obtained through the local health officer or the registrar or direct from the State Department of Health, Albany, N. Y.

At present it is published only in English; as the need is demonstrated it will be issued in other languages. It is by no means intended to take the place of the physician, whose advice should be frequently sought and followed.

It is the desire of the commissioner of health that a copy of these suggestions be placed in the hands of every expectant mother, or that it reach her as soon as possible after the birth of her child. The local registrar or health officer will cooperate in seeing that this wish is fulfilled.

HOW TO SAVE THE BABIES.

Do you know that out of every five deaths in New York State one is that of a baby less than a year old? A large percentage of these are due to causes which could and should be prevented.

An epidemic of smallpox gives rise to startling headlines in the newspapers and the entire community is aroused and alarmed. Public opinion demands prompt and vigorous action on the part of the health officers. Yet the number of deaths in this disease is exceedingly small in comparison with the number of preventable deaths among infants.

The New York State Department of Health is endeavoring to 66 save the baby" and enlists your support.

A large number of deaths among infants indicates the existence of insanitary conditions or of ignorance that will affect not alone the little children but the entire community.

The most important factor in the solution of this problem is the mother. She is the natural caretaker of her baby. A lower death

rate among the babies can only be accomplished through intelligent motherhood, maternal nursing, cleanliness and fresh air, and pure and properly prepared milk for the babies who have to be artificially fed.

The following suggestions are made in order that the mother can intelligently prepare and care for her baby.

BEFORE THE BABY COMES.

Health of mother.-A poorly fed or sickly mother can not give birth to a vigorous, healthy infant and successfully nurse it. Such a mother rarely carries her baby for the full 280 days. A woman who has had repeated miscarriages or whose labors have come on before time should, early in pregnancy, consult her physician in order that the underlying cause can be cured or alleviated. During pregnancy, and especially in the latter months, the expectant mother must have abundant rest and spare herself as much as possible. An extra amount of sleep is required by the pregnant woman, and a daytime rest for an hour or two is desirable. Select and consult your physician early in pregnancy. Keep yourself in good health. Hard household labor or factory work during the latter months of pregnancy tend to bring about miscarriages or the birth of puny and undersized children.

Exercise.--Exercise in the open air in the form of walks should be taken throughout the entire course of pregnancy. Violent exercise in any form should be prohibited, and unnecessary stair climbing must be avoided in the latter months. The sewing machine must not be used toward the end of pregnancy.

When labor is threatened before the proper time the mother should go at once to bed and remain perfectly quiet until the danger is well passed.

Care of nipples.-Small, flattened, or depressed nipples should be drawn out with the forefinger and thumb and held for five minutes night and morning during the two months preceding labor. The nipples should be carefully anointed each night with white vaseline and washed each morning with castile soap and warm water. This will soften and remove the milk which is secreted in the latter part of pregnancy, and which if not removed would form hard crusts and ulcerate the soft tissue beneath. Proper attention to the care of the nipples during pregnancy will make the act of nursing one of pleasure and satisfaction instead of one of pain and discomfort.

Diet. The diet should be carefully regulated. A full, wholesome, and liberal diet is essential. This depends on the woman's tastes and habits, as food which agrees with one will not agree with another. Highly seasoned or very rich food should be avoided as well as fatty foods and coarse vegetables.

The following dietary is recommended during pregnancy and nursing:

Soup.-Any kind.

Fish.-Fresh fish of any kind, boiled or broiled. Raw oysters and raw clams.

Meats.-Chicken, beef, ham or bacon, veal, lamb, tender lean mutton. Red meat should be allowed in moderation and only once a day.