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T HAS BEEN pointed out recently by Dr. Grace Grace L. Meigs, of the Federal Children's Bureau, that many thousand women lose their lives each year in this country because of accidents incident to child-bearing. Many, far too many, of these deaths are due to sepsis.

Years ago when Oliver Wendell Holmes led his famous attack on sepsis there began an intensive campaign in hospitals to eliminate puerperal infection from from their wards, which has resulted in the almost complete removal of sepsis from the lists of cases in our best hospitals. All hospitals have cases. brought in to them but the firstclass hospital considers it a disgrace to have a case develop in its wards.

Yet the number of cases is high. This is chiefly because women are still being improperly handled during the obstetrical period in numbers of districts. The best physician cannot avoid sepsis if he has not at his command the proper equipment to safeguard his patient. It is a well-established fact that the home, of whatever type it be, does not offer the same opportunity as a well-equipped hospital.

Our Hospital Equipment The question then arises as to how we are equipped with hospitals. There are listed in this state more than 150 hospitals which care for women and children and which have some obstetrical cases

during the year. There are, of course, small ones of which we have no knowledge. Of the 150 listed, eight are in places of less than 5,000 population. One may see at a glance how many women in the rural population would, in this calculation, be left entirely without readily available hospital facilities.

One naturally thinks at once: Why do not more rural women go to the large city where there are splendid obstetrical facilities? There are several ways of explaining this; in the first place, many women who can afford such service do not want to go so far from home that their husbands and children cannot visit them often; second, there are many homes where, even during the time the mother is in bed, she must oversee the household affairs because of the difficulty in securing domestic service; third, there are many women who cannot afford to go far from home or pay expensive rates; fourth, there are still a certain number of physicians and patients who are not yet ready to endorse hospital treatment as more efficient than that in any home.

Questionnaire Sent Out

In order to find out as a first step in this study how many women and little children were cared for by institutions in a year in Ohio, a questionnaire was sent by the director of the division of child hygiene of the State Department of

Health to 263 institutions. These comprise general hospitals, maternity hospitals and homes, county infirmaries (in all of which some women are delivered) and infant boarding homes and children's homes handling children under three years of age. Answers were received from all but fifty institutions. There were reported to have been handled in the three classes of institutions actually delivering women-general hospigeneral hospitals, maternity hospitals and infirmaries 19,201 women and children. This seems to be a large group but we must remember that Ohio registered 120,000 births in 1917.

The accompanying table shows the information gathered from the compilation of the individual questionnaires.

How Provide for Rural Woman?

The practical fact remains that the rural woman should have an available place to go if she has the money and the inclination. There are two ways of solving this difficulty. An ordinary dwelling house is capable of being made into a fairly efficient maternity hospital. Local physicians may be interested in such a proposition and may be induced to invest a small amount of capital, which, if the house is a success, may be recovered in a comparatively short time. Plumbing must be sanitary, water supply must be adequate, while a delivery room and a proper supervisor are essentials. The delivery room may be secured with time, plenty of enamel paint and a very inexpensive equipment. The supervisor is a very different matter. She should be a trained nurse and she should not have all of the work of the house to do as well as to officiate at deliveries. Just at the

present moment nurses are very hard to obtain. Indeed, they would always be so for rural places. Because of this, it is sometimes necessary to depend upon experienced nursing but even in this case a nurse could go to a large city and graduate from some maternity hospital from which she would obtain a certificate of special training. In some of the eastern states small experiments of this sort are being tried out and we hear that they are meeting with great success, that women are eager to avail themselves of the service of such an institution, and that the obstetrical record is a good one.

Community Obstetrical Center

Another possibility is to interest a group of people in the establishment of an obstetrical center as a part of a community program, taking perhaps a county or a section of a county as the unit upon which the burden of support should fall. It may be noted that there is in this scheme no suggestion as to what may be done to care for the very poor. This is not intended to care for this class especially. The cause of the down and out has been pushed to a great extent in the city until the two classes which claim nearly all of the medical attention are the down and out and the very rich. It is time that we planned systematically to care medically for the self-respecting people of moderate means who do not need or desire charity but who are entitled to good service if they pay a moderate sum for it.

The

establishment of county or divisional obstetrical centers would be a step towards accomplishing this. It would not be long, we believe, before rural women would avail themselves of the privilege of such service.

It Occurred in Ohio

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In Ohio, women at times have to care for themselves to an amazing degree. The writer met, a few weeks ago, in one of our rather thickly populated districts, woman, the mother of nine children, who was to give birth to a tenth child. She was going to her sister's and taking five children with her two pairs of twins and an older girl to care for them. She was leaving behind a husband and three boys, while another girl was being boarded out. She had attempted to stay at home but could not obtain either nurse or servant under the circumstances. She told of having stayed at home alone. when the last twins were born and of having sat up in bed and bathed both children herself the day after they were born. This was necessary because the only neighbor who

could come to her had to return home because of illness. Needless to say she had not been strong since the experience. Cases of this sort are all too common and this very woman expressed her indignation that there was no local hospital to which she could go and yet keep in touch with her family and home. This sounds like pioneer life in the West and yet it occurred right here in Ohio.

It would seem that at least a small experiment might be worked out in this state to demonstrate the value or otherwise of a co-operative scheme of this sort, which would offer to the woman of moderate means a safe place where she could go and, while not leaving her family quite behind her, yet secure the quiet and freedom from the nagging home details which she needs during the obstetrical period.

BUILD NEW SANATORIUM AND ENLARGE ANOTHER

Ohio is to have a new district tuberculosis hospital and one of the existing district hospitals is to be enlarged. Decisions to this effect. were reached by officials involved at meetings in April.

The new institution will be supported by Ottawa, Erie, Sandusky, and Lorain counties, with the possibility of Huron County joining later. Commissioners of these counties organized the district at a meeting in Elyria April 10.

De

tails of plans will be decided upon later. Huron County was represented at the meeting but reserved its decision on the question of joining in erecting the district.

A new building to be constructed at Springfield Lake Sanatorium will be financed by Summit County It will be deeded to the sanatorium trustees and will be used, under their control, for Summit County patients, with the proviso that when its full capacity is not needed by Summit County other patients may be admitted. This decision was reached at a meeting of the joint board of commissioners of the five counties in the district, held in Akron April 9. It followed a discussion of several months' duration regarding means of enlarging the hospital's facilities.

FOUND HOSPITALS FOR

TUBERCULOUS SOLDIERS Tuberculosis sanatoria for the treatment of diseased soldiers will be established by the army medical authorities at New Haven, Conn.; Prescott, Ariz.; Asheville, N. C., and Denver, Colo. They will cost. about a half-million dollars each.

SPRINGFIELD IS ACTIVE
IN EFFORTS TO KEEP
CITY'S CHILDREN WELL

Because the necessary information did not arrive until after last month's OHIO PUBLIC HEALTH JOURNAL had gone to press, mention of the Springfield health department's work in child hygiene had to be omitted from the compilation of reports on Ohio cities which are engaged in such activity. The following outline of what Springfield is doing is based upon material furnished by Dr. E. B. Starr, director of the municipal department of public health and sanitation:

Springfield's child hygiene bureau is under the supervision of Dr. C. G. Augustus, assistant director of the department, who is a full-time employee.

A dispensary service is maintained, open between 10 and II A. M. on Monday, Wednesday and Friday. Lithographed birth certificates are issued by the department and are accompanied, when sent out, by a leaflet entitled "How to Keep Your Baby Well." A letter bearing the signature of the city manager also goes with the certificate, urging the importance of keeping the certificate and calling attention to the service the city offers to mothers in helping to keep their babies well.

The newspapers of the city are furnished with weekly health articles, many of which deal with. questions of child hygiene. Plans are being considered for the purchase of an automobile for one of the department's nurses, who will devote practically all her time to home supervision of infants.

N the opposite page is shown in reduced size the registration card prepared by the Federal Children's Bureau for use in the weighing and measuring test of children, which is the opening feature of Children's Year, now under way.

The upper half of the card is retained by the child's parents as a record. It will be noted that space is provided for recording subsequent examinations. The reverse side of this upper half, which is not shown, bears a table giving average heights and weights, for boys and girls separately, at birth, at three months, at six months, at each month from the seventh to the forty-eighth inclusive, and thereafter at each year up to sixteen.

The lower half of the card is to be sent to the local committee, which will tabulate the statistics for the Division of Child Hygiene of the State Department of Health, and will then forward it to the Children's Bureau at Washington, where national statistics will be tabulated.

Local chairmen have received instructions to send in to Columbus statements of how many cards they need. Orders will be forwarded to Washington and

filled direct from there.

Counties which had been organized for work in the Children's Year campaign up to April 15 were as follows:

Ashland, Ashtabula, Athens, Brown, Butler, Champaign, Clinton, Coshocton, Crawford, Cuvahoga, Darke, Defiance, Erie, Fair

field, Fayette, Franklin, Gallia, Geauga, Greene, Guernsey, Hamilton, Harrison, Holmes, Huron, Jefferson, Lake, Lawrence, Licking, Lorain, Lucas, Marion, Medina, Meigs, Mercer, Miami, Monroe, Paulding, Pickaway, Portage, Preble, Richland, Sandusky, Seneca, Shelby, Stark, Summit, Tuscarawas, Van Wert, Washington, Williams, Wyandot.

President Wilson has voiced his approval of the nationwide "babysaving" campaign in the following letter to Secretary of Labor Wilson, of whose department the Children's Bureau is a branch:

THE WHITE HOUSE, WASHINGTON, MARCH 29, 1918. MY DEAR MR. SECRETARY: Next to the duty of doing everything possible for the soldiers at the front, there could be, it seems to me, no more patriotic duty than that of protecting the children, who constitute one-third of our population.

The success of the efforts made in England in behalf of the children is evidenced by the fact that the infant death rate in England. for the second year of the war was the lowest in her history. Attention is now being given to education and labor conditions for children by the legislatures of both France and England, showing that the conviction among the Allies is that the protection of childhood is essential to winning the war.

I am very glad that the same processes are being set afoot in this country, and I heartily approve the plan of the Children's