our present social organization, are extremely difficult to meet. The first thing for any community contemplating the organization of child welfare work to do is to line up its local problems and face them squarely with well tested methods. The experience of other communities should be carefully studied. The infant welfare problems of small communities, or rural districts, must largely be solved by a co-operation on the part of interested individuals and existing private philanthropies. The public officials, too often apathetic, may be awakened slowly if they are "shown". In a large city like Cleveland the organization of a Bureau of Child Hygiene must be planned upon broad lines. Such an organization will not be an overnight growth. Many of the parts which are now so well integrated were adjusted only after much experiment and painstaking endeavor on the part of philanthropic individuals or societies. It is often the history of infant welfare work that three or four organizations carrying on cognate lines of work for children gradually converge until their functions blend and a new organization becomes inevitable. This has been the case in Cleveland, where the pioneer efforts of the Milk Fund Association, the Visiting Nurse Association and the Infants' Clinic resulted in the organization of the Babies' Dispensary and Hospital. A decade of education along child welfare lines in Cleveland has convinced the community that the municipality is largely responsible for the welfare of its children, and that the city should carry on definite work along preventive lines for its babies and older children. To carry out the most effective work in large centers it is essential that the work be centralized in a Bureau or Division of Child Hygiene under the Division or Board of Health. The administrative head should be a chief on full time who is directly responsible to the commissioner of health. It is desirable that the chief of the bureau be in close touch with the health educational work of the community, and active in the instruction of physicians and nurses along child welfare lines. The further a Bureau of Child Hygiene can be removed from any political influences the better for the community. It would be ideal to have every member of the bureau working under efficient civil service. In order to keep in touch with the daily work in the infant welfare centers throughout the city it is advisable to have an assistant chief who could devote a large share of his time to visiting the centers. The backbone of any infant welfare organization will be well trained physicians and nurses with a "vision" as well as a "feeling" for social service. The importance of training physicians in modern methods of infant feeding and child hygiene cannot be over-estimated. The public health nurses should be on full time and, whether doing "generalized" or "specialized" nursing in the districts, should be kept in touch with advances in the work by courses of lectures. With a good corps of nurses and physicians, and an adequate office force to keep up the records, the following organization of departments under the Bureau of Child Hygiene should meet the needs of a modern city: 1. Infant Welfare Centers as integral parts of the health centers in each health district, to be equipped as prophylactic babies' THE OHIO PUBLIC HEALTH JOURNAL. dispensaries for weighing babies, keeping careful records, examination by physicians, directions as to feeding and general hygiene of infancy. Public health nurses in attendance who follow the babies in their homes. Milk prescribed from the centers. These centers could also be used as diagnostic clinics. All ill babies to be referred to private physicians or suitable hospitals and dispensaries for treatment 2. A Department for the Inspection and Supervision of Midwives. One nurse should be placed in charge of this important work. All problems coming up in regard to illegal practice should be taken up with the chief of the bureau or commissioner of health. 3. Department for the Preven tion of Infant Blindness. Special nurses should be delegated to this work. The number of nurses will depend upon the size of the community and the character of the physicians and midwives in it. 4. Department of Boarding Homes for Babies. At the present time this department is a necessity in every large cosmopolitan city. One or more nurses should be assigned to make investigations of boarding homes and keep in very close touch with them. Co-operation with the Humane Society, or other agencies receiving young children, is essential. It be wise, as may we have thought in Cleveland, to combine the work of (2), (3) and (4) into one Department of Eye, Midwifery and Boarding Homes for Babies. 5. Some department or individual who can check up on the Milk Supply going to the babies in the infant welfare centers. Medical Inspection and examination of all school children. In Cleveland the medical inspection through the board of education. in the public schools is carried out The public health nurses under the Division of Health, however, inspect the children in seventeen parochial schools. 7. Sanitary and hygienic supervision of institutions taking deof day nurseries. While this is not pendent or delinquent children, or carried out in Cleveland to any great extent at present, it is felt that this phase of the work should be developed. 8. A Department of Maternity Welfare or Prenatal Care for the examination and instruction of mothers, or expectant mothers, is absolutely necessary if we are going to make any impression upon ing the first days of life. the appalling number of deaths durCleveland is just beginning this important piece of work. In all of our organization it should never be lost sight of that simply one of a number of bureaus. the Bureau of Child Hygiene is operating under the Division of munity. Health for the welfare of the comThe Bureau of Child with all the other bureaus. Hygiene must constantly co-operate Its quently be discussed with the other aims and problems should frebureau heads. It is furthermore necessary never to get out of touch with private philanthropies and other organizations doing similar work for children of the community. The closest possible co-operation should be cultivated with babies' dispensaries, mothers' clubs, Federation of Women's Clubs, the public schools, munity which needs and demands. etc., etc. After all it is the comthe sort of work the bureau is attempting to do, and the community should accordingly be educated to back up this work. Child Hygiene Activities of Municipal Health Departments of Ohio What is being accomplished by Ohio cities which have organized work in child hygiene under bureaus within their municipal health departments is outlined in the series of accounts for separate cities presented herewith. The information contained in these sketches was furnished by health officials of the cities in question in response to requests from the State Department of Health. Dr. Richard A. Bolt's article on "The Organization of a Municipal Bureau of Child Hygiene," contained in this issue, while it deals with such organization in general, yet touches in some detail upon Cleveland's activities. For other cities the accounts follow: A REVIEW OF CHILD HYGIENE DURING THE PAST TWO YEARS IN CINCINNATI Abstract of a Report by W. H. Peters, M. D., Chief Medical Inspector, Cincinnati Department of Health INFANT WELFARE Nine infant welfare centers were operated by the health department during the summer under the supervision of the school nurses. Clinics and mothers' conferences were conducted at the centers by the district physicians. In thousands of home visits the nurses taught mothers how to care for their babies, how to prepare and modify milk and how to bring about the best possible home environment. The conferences with the district physicians resulted in surgical correction of many physical defects. Milk distribution was conducted from the nine centers. BABY WEEK In Cincinnati's observance of the nation-wide Baby Week, numerous medical, civic and welfare organizations co-operated with the health department. Features of the week's program included special window displays by department motion stores, showing of approved child- CHILDREN OF PRE-SCHOOL AGE The child welfare bureau, directed by Dr. Wade MacMillan, has charge of this work. Its staff comprises a surgeon experienced in orthopedics and the surgery of childhood, a physician experienced in childhood diseases, an eye, ear, nose and throat specialist; a nurse from the department of health and two volunteer social workers. Weekly meetings are held in school THE OHIO PUBLIC HEALTH JOURNAL. buildings, to which mothers of the neighborhood are urged to bring their children of pre-school age. Examinations are made in the presence of the mother, diseases and defects are explained in simple terms and medical attention by a private physician or a clinic is advised. Cases are followed up to see if this advice is heeded. SCHOOL HYGIENE Health promotion among school children and teachers is a function of the health department co-operating with the board of education. A medical bureau exists in 118 public and parochial schools and is supplemented with nursing service in sixty-eight. Sanitary inspections of schools are made twice a year by all physicians and from time to time by the division of sanitary inspection. Passing of a physical examination has been made a prerequisite for the granting of a teacher's certificate by the Cincinnati school examiners. VACCINATION Vaccination of school children. is compulsory. There was little objection to this regulation. EXAMINATION OF SCHOOL CHILDREN Medical examination is made of every child who returns to school after an absence of four consecutive days. From September 15 to December 20, 1917, forty-three diphtheria cases were disclosed in examination of 400 throat cultures from such absentees. Scarlet fever is also detected in such examinations. Physicians examine all children referred to them by principals, teachers or nurses, and make routine examination of all children in the second grade, in order to detect physical defects. Nurses make classroom inspections Figures show better results from for the detection of pediculosis. examinations in schools which have nursing service than in those which have no nurses. an increase from year to year in They also show the number of cases referred by teachers to physicians. RETARDATION STUDY. Medical examination and study of 2,434 of the 4,738 children who were not promoted in June, 1915, gave valuable data. At a cost of $30 per pupil per year, the cost to the community, if ratios in this group applied to all failures, was $275,000 for this one year's failures. Of the children examined, 1,236 had marked physical defects, and 220 were tentatively classed as mentally deficient. Poverty and bad home conditions were also an important cause of retardation. Recommendations include: Establishment of a hospital school for children with chorea, epilepsy and tuberculosis of the bones and joints; opportunity classes for slow and backward children; compulsory attendance during the first two years; prompt reference of backward children to the school physician before failure occurs. CONSERVATION OF VISION Three special classes have been established for "partially blind" and a fourth is to be organized. and "partially sighted" children The object is to teach these children as seeing children and rescue them from lives of blindness and dependency. Physical examination was made of all children in the schools for the blind and conservation of vision classes. The board of education has employed a visiting oculist. Statistics on children in the conservation of vision classes show that the aver age retardation was reduced from three years in 1915 to 1.6 years in 1917 and that the proportion of children not retarded was increased from nine percent in 1915 to thirtytwo percent in 1917. OPEN-AIR SCHOOLS Four open-air schools were attended by 114 children, who were admitted after physical examination by district physicians. In cooperation with the board of education, the health department selects the children most in need of openair treatment. Active cases of tuberculosis are not accepted. A fifth school was opened in September, 1917. A school for tuberculous children is situated on the grounds of the municipal tuberculosis sanatorium, with accommodations for fifty resident pupils. LITTLE MOTHERS' LEAGUES During the past two years 2,400 girls in thirty-one schools have been enrolled in these leagues. The weekly meetings are usually restricted to girls in the seventh and eighth grades. The work covered is similar to that usually done by these leagues. HEALTH CERTIFICATES District physicians, in accordance with state laws, examined 3,990 children who applied for work certificates. Recommendation is made. that funds be provided to put this work under one physician in a central office. CO-OPERATION Co-operation between the school officials and teachers and the health authorities has always been complete. THE STAFF COST The staff consisted of fifteen district physicians, fourteen school nurses, eight dentists, five dental clinic assistants and the chief medical inspector. With the exception of four district physicians and the dentists (who work on half-day shifts), all are full-time employees. The estimated expenditure for school hygiene was approximately $25,500 per annum. CHILD WELFARE WORK IN DAYTON Commissioner of Health By DR. A. O. PETERS, This work was begun about twelve years ago by an organization known as the "Flower and Fruit Mission." This organization has since become known as the T Nurses' Association. The arted with the organfree clinic and milk station. At the same time a visiting nurse was employed to work in this field. In 1914 the Visiting Nurses' Association allied itself with the Division of Health and the Tuberculosis Society. As now organized all our nursing activities of these three organ |