Appendix-Continued. How to Take Care of Babies (published in French by the Providence, R. I., Summer Care of Babies (circular issued by the Bridgeport, Conn., Depart- 91 LETTER OF TRANSMITTAL. U. S. DEPARTMENT OF LABOR, CHILDREN'S BUREAU, Washington, D. C., June 16, 1913. SIR: As a preliminary to more careful study of the work now carried on in various cities for the prevention of infant mortality, the following letter was sent to the mayors of the 109 cities of the United States having a population of 50,000 or more each: DEAR SIR: We are much interested in ascertaining the prospects of babysaving campaigns for the summer of 1913 in the principal cities of the country. May we ask you to give us information as to the organization of your department of health as especially related to the care of infants in summer? We should like especially to have any recent reports that you have made as to this service, and to know whether there is to be any enlargement of the service over last year; also what special features of your system you would recommend for general adoption. In making this inquiry it was only anticipated that it would secure needed information for the office of this Bureau. The replies have shown that work of the utmost significance is going on in certain cities, while little or nothing is being done in others. In various instances city officials have shown much interest in such work and have made inquiries as to the best methods of initiating it. In view of the interest shown and of the practical value of many of the replies received, the Bureau has summed up the information contained in them in the following statement as to the summer care of babies in certain American cities. The effort has been not to present in any respect an exhaustive report, but to show what is being done in various localities and the ways to go about such work. The appendix contains examples of circulars in various languages available for reproduction. It is intended to follow this preliminary statement by fuller bulletins, issued from time to time, showing the most advanced methods employed by various communities to safeguard the health of children, with especial reference to the growing work of rural health officers and rural nursing. Special acknowledgment is made of the services of Mr. Ethelbert Stewart, statistical expert of this Bureau, in the preparation of the present pamphlet. Very respectfully, JULIA C. LATHROP, Chief. Secretary of Labor. Hon. WILLIAM B. WILSON, BABY-SAVING CAMPAIGNS. SCOPE OF THE BULLETIN. What the American cities are doing and can do toward preventing infant mortality and the too common high death rate of children under 5 years of age is to be the subject of an annual bulletin by the Children's Bureau. The present issue does not claim to be complete either as to the cities which are giving attention to such work or to the scope of their activities; it is merely a preliminary outline, introductory of 'what the Bureau hopes to accomplish in the way of acquainting cities with one another, when all cities have come habitually to report all such activities or lack of them to this Bureau. Summer campaigns for babies' lives have been waged with such marvelously good effect in some cities, both in this and foreign countries, that it seems important to enlist the energies of as many cities in this work as possible. To this end it is most important that each city should know, in somewhat of detail, just what the other cities are doing. Information which represents a large expenditure of labor and which is invaluable as demonstrating comparative methods in different cities is tied up in reports of local health officials which have little or no circulation. To present, for the information and perhaps encouragement of all, the results of investigation as to the little or much that is being done by the various cities, whether directly or through municipal activity in conjunction or cooperation with private philanthropies, will be the purpose of this annual bulletin on summer campaigns for babies to be issued hereafter by this Bureau. CITY HEALTH OFFICIALS' WORK IN REDUCING DEATH RATE. The Special Public Health Commission of the State of New York, which was appointed by Gov. William Sulzer to collect facts, receive suggestions, and make recommendations as to changes in the public health laws and their administration, in its report to the governor, under date of February 19, 1913, makes clear the influence of city health officers in reducing the general death rate of cities within the last 10 years. It shows the mortality rate per 100,000 in cities of the State, including villages of over 8,000 inhabitants, and the corresponding rate in rural districts and villages of fewer than 8,000 inhabitants. "It will be noted," says the report in discussing a chart in which the conditions are graphically shown, " that the urban death rate, beginning at 1,771 in 1902, falls to 1,466 in 1912. The rural and village death rate, beginning at 1,404 in 1902, has slowly risen, beginning to exceed the urban death rate in 1909, and since that date the divergence between the two in favor of the urban death rate has steadily increased." While, as Prof. Walter F. Willcox, of Cornell University, states, the somewhat more "complete registration of rural deaths in later years and the preponderance of population of the middle ages in cities, owing to immigration" may account for some of the sharpness of the contrast, nevertheless these considerations leave practically unaffected the general fact indicated by the figures, that the urban death rate is falling more rapidly than the rural and village death rate. That the attention given to such matters by local health officers, by private charitable societies, and by both in cooperation, has reduced the general death rate of cities below that of rural districts and villages is certainly a tribute to such efforts. It indicates clearly what can be done even with faulty organization and meager cooperation and emphasizes the importance of more extended and better organized means and method. Discussing the reduction of death rates, the report referred to, after detailing the work against tuberculosis, says:1 Next largest in the groups of deaths which are to a large extent preventable by known and practical methods, is infant mortality. The number of deaths from diarrhea and enteritis among those under 2 years of age in 1912 was 7,024. Measures are being taken in a number of cities for reducing infant mortality. The first step in a comprehensive plan for the State as a whole is an adequate birth registration law, efficiently and uniformly enforced throughout the State. The enactment of such a law and the initial steps in its enforcement rest upon the State. With knowledge of the number of infants born and the localities and the causes of deaths, each village and city of considerable size should, when necessary, secure through its health department (a) the instruction of mothers during the prenatal period, (b) competent attendance at childbirth, (c) the encouragement of breast feeding, (d) medical supervision of the child at stated intervals, whether breast or bottle fed, and (e) pure, clean milk for infants for whom maternal nursing is impossible. Each city with a population in excess of 10,000 and having an industrial population should have one infant-welfare station and larger cities with an industrial population should have one such station for approximately each 20,000 inhabitants. There is no doubt that through effective action by the State in securing birth registration and in encouraging localities to undertake and effectively to prosecute such infant-welfare work, the number of deaths of children under 2 years could be enormously reduced in the immediate future. 1 Gov. Sulzer's Message on Public Health with Report of Special Health Commission, transmitted to the legislature Feb. 19, 1913. |