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Congratulations to Maryland, Virginia and Kentucky, the latest states to be admitted to the Registration Area for Births by the Director of the Census, Sam L. Rogers.

The Registration Area for Births was established in 1915 and was then composed of ten states and the District of Columbia, representing 10 per cent of the territorial extent of the United States, but containing 31 per cent of the country's population. For this area the Bureau of the Census has recently issued its first annual report, entitled "Birth Statistics." As the area grows the annual reports will deal with the births in a constantly increasing portion of the country and will, therefore, become of constantly increasing interest and value.

The outlook for a very rapid growth of this Registration Area for Births is so good that a word of cheer to the states outside should be given. The need of complete birth registration is recognized now as never before. The age of the soldier must be known, and so a new argument for birth registration comes to the United States. Since war was declared tests of the completeness of birth registration have been made by special agents of the Census Bureau in Virginia and Kentucky, and both these states secured a rating of over 90 per cent. which represents the degree of completeness required for admission. to the area.

Similar tests are now being made in Indiana and New Jersey, and before the year is over will be conducted in North Carolina, Ohio, Utah, and Wisconsin. Several other states are nearly ready to seek admission, and it is by no means a wild prediction that the Birth Registration Area within the next two years will be more than trebled in size and will contain over two-thirds of the population of the United States.

One physician recently became so thoroughly aroused to the desirability of recording births that he reported to the local registrar 450 births which had occurred in his practice since 1900.

Parents and physicians everywhere are awakening to the importance of this matter and the fashion now is to register baby's birth.

DEATH CLAIMS ONE OUT OF EVERY TEN BABIES BORN IN 1916, SAYS REPORT.

One baby out of every ten born dies before it is one year of age in the cities of the United States with a population of 25,000 and over, according to statistics just issued by the New York Milk Committee, based upon infant mortality statistics received from 150 cities. for 1916. "These cities represent one-fourth of the population of the United States and they report 670,000 living births and 68,500 deaths under one year of age for the year 1916, making an infant mortality rate of 100 baby deaths for each 1,000 births reported," says J. H. Larson, secretary of the Committee.

The death rate among babies in the larger American cities has been reduced 11 percent since 1910, according to the New York Milk Committee survey. This reduction has been made among cities of 100,000 population and over. The smaller cities have not done so well. The reduction in cities between 50,000 and 100,000 population is only 2 percent, while those under 50,000 show an increase of 5 percent. The general reduction is 9 percent.

Among the largest Ohio cities, Columbus, Ohio, has the lowest infant mortality rate-89.6 per 1,000 births reported, Cleveland 107.0, Cincinnati 97.3, Toledo 111.5, Dayton 98.4, Akron 90.2 and Canton 109.1. Among smaller Ohio cities Lorain has the high rate of 181.1. Zanesville is next with 124.5, while Lima is low with a rate of 78.7, and Springfield 80.4.

The lowest infant death rate in the country in 1916 among the cities of 100,000 and over was in Portland, Oregon, with a record of only 55 baby deaths per 1,000 births. Fall River, Mass., is the highest with a rate of 163.

The 68,500 deaths of babies under one year of age in 1916 show a decrease of 6,536 infant deaths when compared with an average of 75,075 for the five year period 1906-1910.

Infant mortality is said to be the most sensitive index of social welfare. In war time it may well serve as a guide for cities and local communities in child welfare activities. After three years of war Great Britain and Germany are planning national movements for maternity, infant and child conservation, hoping in this way within a few years to replace the man power lost in the war.

"The marked decreased in infant deaths did not begin until 1910 when organized infant welfare work became general," says the New York Milk Committee.

"Assuming that the statistics for the 150 cities included in the New York Committee survey may represent statistics for the entire population of this country, then we would have approximately 2,750,000 births and 275,000 deaths in one year annually," says Secretary Larson of the Committee.

"Besides this it is known that there occurs annually about onehalf as many still births as deaths, under one year. Through general education, the baby milk station movement, and other efforts along

kindred lines, baby deaths have been reduced 9 percent since 1910. It is recognized that through maternity care still births can be reduced 22 percent and deaths through the first month after birth can be reduced 28 percent. Nearly half the deaths under one year are of babies less than one month old. This country is following the example of Germany and Great Britain and is now beginning to think of a national maternity care program. When this movement gets under way it should save at least 75,000 mother and baby lives annually."

OHIO CONTRIBUTES HEALTH EXPERTS.

The national service is taking from Ohio some of its most skilled surgeons, physicians and public health experts.

On September 4, Dr. Frank G. Boudreau, Director of the Division of Communicable Diseases, State Department of Health, left the service of the state under orders from the War Department to report to the Army Medical School at Washington, D. C., preparatory to entering upon active war service. Dr. Boudreau had previously been commissioned first lieutenant in the medical section, U. S. Officers' Reserve. Dr. Boudreau is the second division head of the state health department to enter the national service. Dr. J. R. McDowell, director of the Division of Public Health Education and Tuberculosis, after three months' training at Fort Benjamin Harrison, is now in active service at Camp Sherman, near Chillicothe, with the rank of captain. J. S. McCune, chemist in the Division of Laboratories, is also on a leave of absence from the state service to take training in the officers' training camp at Fort Benjamin Harrison.

"THE SCHOOL NURSE."

A new book, "The School Nurse," by Lina Rogers Struthers, R. N., has just been published by G. P. Putnam's Sons, New York. It is a companion to Ellen LaMotte's "The Tuberculosis Nurse," and covers the entire field of school nursing work. It is well illustrated and contains a complete set of charts, record and report blanks for the use of the school nurse. The price of the book is $1.75.

Mrs. Struthers was the pioneer school nurse in this country. She inaugurated the work in New York City in 1902 and served as superintendent of school nurses there from 1902-1908. Later she served in the same capacity in Toronto, Canada, from 1910 to 1913.

The volume is a welcome addition to the rapidly growing literature in the public health nursing field. Health officers, school teachers, physicians and especially public health nurses will find the work interesting and practically helpful.-Robert G. Paterson.

THE OHIO SCHOOL CHILD IN 1917.

FRANCES M. HOLLINGSHEAD, A. M., M. D.

Division of Child Hygiene, State Department of Health.

With the reopening of the public schools one wonders what will be done during the next twelve months to increase the health and resistance of Ohio's school children. Physical supervision of school children is often thought to have been universally established in this state, but as a matter of fact such supervision, in its simplest forms, has not yet been undertaken by even one-half of the incorporated communities of the state.

We find that the number of children enrolled in the city schools in Ohio in 1916 was smaller than that of those enrolled in the schools of the smaller places. In the city schools there were 455.553. In rural and village schools there were 493,836. Ohio is like most of the other states studied in respect to this. On the other hand the burden of physical defect is greater among rural school children than among those in the city schools. Herein we find the chief justification for the immense expenditure of money and effort which has been incurred by the great city. That the city child, despite his home being many times overcrowded, often living below the norm as regards food and air, without sunshine or playground in his life, may be a healthier child than the one in the country with fresh air, sunshine, a one-family home, and plenty of food, is surely a subject which warrants sober thought. This is the great result which we believe to have been brought about by the last twenty years' effort in the realm of physical supervision of children.

Granted that physical supervision has really improved the physical status of children, is it not fair to say that such care should be made as rapidly as possible as much a part of the school curriculum as reading or writing? It will be of little profit to the child to be taught various things if he be physically unfit to stand up to the requirements which modern life with all of its dangers from disease, overstrain and competition, shall make upon him. Nor is there any doubt that in the very first years of the child's life are laid the foundations for this resistance. A question which is often raised of late is why are children not put into proper condition before they enter school? Here is the crux of the whole situation. All of the so-called school defects should be eliminated before the children reach six years of age, with the exception of a small proportion of the eye cases. This will undoubtedly be the ultimate solution of the problem but in the meantime we must care to the best of our ability for the children already in the system.

A partial study was made, under the Division of Child Hygiene of the State Department of Health, during the past winter of children in two of the counties of the state. In Erie County some thousand children were studied as regards heads and necks, that is, eyes, ears, nose, throat and glands were gone over carefully. In Union

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