"WHERE BABIES

NEVER DIE." The vital importance of child welfare work the world over is given daily new emphasis by the events of war. Never before have the nations so well understood the value of sound physical manhood and womanhood for the upbuilding of those common ideals for which civilization stands.

Cleveland entertains today and tomorrow in the person of Dr. F. Truby King of New Zealand one who has earned for that island dominion the title of "the country where babies never die." The doc

tor is now on his way to England to inaugurate in the home land methods of welfare work that have proved so efficacious in New Zealand. At Washington he will confer with federal authorities in reference to work of the same kind in the United States.

Child welfare work in this city has already been given a great impetus through the activity of the Cleveland health department and the bureau of child hygiene. A particular effort is now under way to promote still further the movement to curtail the death rate among infants and to save for the

state a large percentage of the human resources now needlessly sacrificed. The visit of Dr. King should prove of great assistance in giving the local welfare workers new encouragement and in awakening the consciousness of the community to the magnitude of the task in hand.

By painstaking organization, by insisting upon the importance of prenatal care and of birth registration, by making every mother of the land virtually an active partner in the work of saving New Zealand's babies, Dr. King reduced infant mortality to an astonishingly low figure. The encouraging fact about it is that much the same accomplishment is possible for the United States and for any other country willing to buckle to the task as New Zealand did.-Cleveland Plain Dealer.

PIGS IS PIGS

Much has been said of late regarding the re-establishing of pigs within the limits of some of our cities. To any thinking person, a proposition of this kind should certainly be turned down by those who have the power to keep intact the present regulations.

Many arguments have been advanced favoring the return of the pig. Without being in the least unpatriotic, we wish to state that the argument of cleanliness, which can not be maintained with pigs, in connection with good health overshadows all points in favor of the pig return.

While dirty pigpens are not directly the cause of any disease affecting mankind, nevertheless as a breeder of flies and as an incentive for the pig owner to disregard all other rules of cleanliness, it cer

tainly is a splendid opportunity for conditions such as existed twenty or more years ago to return and bring with them the high death rates that have but recently been lowered.

As for ourselves, if pigs should ever be allowed to return to the city limits, we are going to buy a five-acre tract of land on the highest surrounding mountain and reside there. Aside from that, we would request and make every effort to obtain sufficient funds to employ enough inspectors (one for each block) to supervise the dirtiness of the pigpens.

A pigless community has been the aim for a long time. They should not be allowed to return with a mere stroke of the pen.Cumberland (Md.) Health Bulletin.

PUBLIC HEALTH

SERVICE CONSIDERS

MALNUTRITION Following studies of the causes of draft rejections, which are interpreted to mean that malnutrition in childhood was an important underlying cause, the United States Public Health Service, it is officially announced, is considering a national program of co-operation with state, county and municipal health authorities for the purpose of safeguarding the health of school children.

Steps to see that every school child is provided with a warm, properly balanced meal at noon are advocated. The rising cost of living and the lack of general knowledge of healthful substitutes for valuable articles of food, it is declared, make attention to this factor especially important at the present time,

W

HILE the work to be done for child welfare is unlimited, and while parts of the state are still to be reached, yet a very substantial beginning has already been made in Ohio.

The war has materially interfered with the development of the public health nursing service and even taken nurses from centers well established for which successors cannot be found to fill the vacancies. Still there are more than 400 of these trained workers who have the entrée to the homes and schools of the state, and are accomplishing a great deal toward the welfare of children.

We are constantly hearing from nurses in the state and it may be of interest to quote from four typical letters and reports which came to the office during the past week:

Training Schoolgirls "Seven classes in practical home nursing lessons were begun during the past month. About 150 eighth grade girls wanted to join the class, and we finally, by drawing lots, started with fifty. The Care and Feeding of Infants will follow these lessons for those who have successfully completed the home nursing work. My 'Chase doll' is an attraction. She is being dressed in garments made by hand by the

class of freshmen girls who begged for the lessons."

A county nurse writes: "Just now I am thinking out the prenatal and infant care problem. I want to have a column each week

in every paper in the county, if possible, and in this column to tell mothers that I am ready to help by sending literature or by going to them. I am trying to think of some way of having a steady supply of material for my papers and to get it in them all."

Defects Corrected

Another nurse reporting 1,050 school children examined in 1917 found 808 needing attention of some kind. She says: "The best part of the autumn's examining was the large number of children. whose card showed a defect noted. the year before, but examination. proved it corrected by proper medical, surgical, or dental treatment."

Medical inspection came before school nursing, but it amounted to little until the systematic "followup" work was undertaken. To find a defect means little if the parents are not persuaded to have it corrected if the child is not taken to the proper place to receive medical care and treatment - if the educational work in the homes is omitted.

Another nurse writes: "We shall soon be sending the 'Little Mothers' League' certificates for Dr. Freeman to sign. Some of my girls have written splendid essays on 'Baby Care or How to Keep the Baby Well.' We have helped to organize three parent-teacher associations this winter and while they are yet in infancy we hope that they will live and grow rapidly."

Little Mothers' Leagues

In many places where there are public health nursing centers, "Little Mothers' Leagues" are being established and the children are being taught how to care for a baby. The children are delighted to join these classes; and their new found knowledge is not limited to the children themselves, for it is taken back to the home and the parents. No one could estimate the value of teaching eighth grade and high school girls, who so often care for little brothers and sisters, the proper feeding of infants and simple rules of hygiene and health. Later when these children are real mothers they will not altogether forget the instructions received, and can take up their responsibilities with more intelligence than that which their parents possessed.

A successful public health nurse reaches so many different groups of people in her work that her opportunities for helpfulness are very great. She comes in touch with women's clubs and other private organizations, with boards of health and boards of education, with life insurance companies and social agencies, with city and county officials and chambers of commerce, with ministers, physicians and teachers. But best and most useful of all the nurse's opportunities

is her welcome in the homes of the people. She gains this welcome through her services in time of sickness, through her interest in and care of the children of the family.

Work in the Home Counts

"A pure milk supply alone is ineffective; the milk station (in itself little more than a bait to attract the mothers) and its conferences and clinics are insufficient. It is the home modification of milk, according to an individual formula, that counts. It is the home visit that gives the nurse an opportunity to teach the mother practically and thoroughly the entire infant regimen and care and, at the same time, the hygiene of home and family and particularly the hygiene of pregnancy."

Ohio's law in regard to the prevention of blindness caused by inflammation of the eyes of the newborn is closely patterned after the model law drafted by the American Medical Association and is said to be "one of the most advanced measures ever enacted in the United States for the prevention of blindness." According to this act, every case of inflammation of the eyes of the newborn must be reported immediately to the local health officer. If the case should come under the observation of a nurse, she too is responsible by law for the reporting of the condition. If the afflicted baby should be in a family where a private nurse cannot be employed, the health officer is instructed to call upon the public health nurse if he needs help for the treatment of the baby's eyes. If the little patient should be in a locality where there is no nursing service, by telephoning or telegraphing to the State Department of Health, a nurse can be obtained

to care for the baby's eyes and to teach the family the danger of the inflammation.

Community's Responsibility

If each community is to save its own babies and this seems a reasonable program, then the responsibility of providing the means of child welfare work goes back to each local community. A state or

national department can arrange the program and stand ready to give advice to those who want it, but it cannot take the responsibility which belongs elsewhere. One important part of a program of child saving is supplying and employing public health nurses, for in the last analysis they are the workers who most easily and naturally reach the parents and the children.

Organization implies a dynamic relationship of parts. In a biological sense it means a co-ordination of organs to perform a distinct service for the good of the whole. The environment in which the organization is to perform its functions will naturally determine its structure. A very simple organization for child welfare may well, meet the needs in a small homogeneous community. In a large city the hostile factors in the environment become more and more complex and call for other organs to cope with the situation.

If space permitted it would be interesting and profitable to trace the various steps in the development of modern infant welfare work in our great cities. With our present organization the campaign against infant mortality has settled down to a steady push along the whole line rather than in brilliant raids against "impure milk", poor housing, flies,

etc. We have come to realize that the factors entering into the infant welfare problem are not so simple as at first conceived.

Dr. Newman was perfectly correct when he said that the infant mortality in a community was the most sensitive index we possess of the social and economic conditions of that community. While milk stations and consultations for mothers rendered distinct service in educating the community to higher standards of milk for babies, it was early seen that without intelligent feeding directions of a competent physician and follow-up by nurses in the homes, much of the force in our infant work would have been lost.

It was perfectly natural that the simplest factors in the infant mortality problem should first be met. and largely solved. and largely solved. We are now face to face with complex social and economic factors which, under