Maternity Hospitals as a Rural Need

By Frances M. Hollingshead, M. D., Director, Division of Child

Hygiene, State Department of Health

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T HAS BEEN pointed out re- during the year.

There are, of cently by Dr. Grace L. course, small ones of which we

Meigs, of the Federal Chil- have no knowledge. Of the 150 dren's Bureau, that many thousand listed, eight are in places of less women lose their lives each year in than 5,000 population. One may see this country because of accidents at a glance how many women in incident to child-bearing. Many, the rural population would, in this far too many, of these deaths are calculation, be left entirely withdue to sepsis.

out readily available hospital faciliYears ago when Oliver Wendell ties. Holmes led his famous attack on One naturally thinks at once: sepsis there began an intensive Why do not more rural women campaign in hospitals to eliminate go to the large city where there are puerperal infection from

from their splendid obstetrical facilities? wards, which has resulted in the There are several ways of explainalmost complete removal of sepsis ing this; in the first place, many from the lists of cases in our best women who can afford such servhospitals. All hospitals have cases ice do not want to go so far from brought in to them but the first- home that their husbands and chilclass hospital considers it a dis- dren cannot visit them often; secgrace to have a case develop in its ond, there are many homes where, wards.

even during the time the mother Yet the number of cases is high. is in bed, she must oversee the This is chiefly because women are household affairs because of the still being improperly handled dur- difficulty in securing domestic serying the obstetrical period in num- ice; third, there are many women bers of districts. The best physi- who cannot afford to go far from cian cannot avoid sepsis if he has home

pay expensive rates; not at his command the proper fourth, there are still a certain equipment to safeguard his patient. number of physicians and patients It is a well-established fact that the who are not yet ready to endorse home, of whatever type it be, does hospital treatment as more efficient not offer the same opportunity as than that in any home. a well-equipped hospital.

Questionnaire Sent Out
Our Hospital Equipment

In order to find out as a first The question then arises as to step in this study how many women how we are equipped with hos- and little children were cared for pitals. There are listed in this by institutions in a year in Ohio, a state more than 150 hospitals which questionnaire was sent by the dicare for women and children and rector of the division of child hywhich have some obstetrical cases giene of the State Department of


Health to 263 institutions. These present moment nurses are very comprise general hospitals, ma- hard to obtain. Indeed, they would ternity hospitals and homes, county always be so for rural places. Beinfirmaries (in all of which some cause of this, it is sometimes neceswomen are delivered) and infant sary to depend upon experienced boarding homes and children's nursing but even in this case a homes handling children under nurse could go to a large city and three years of age. Answers were graduate from some maternity hosreceived from all but fifty institu- pital from which she would obtain tions. There were reported to a certificate of special training. In have been handled in the three some of the eastern states small exclasses of institutions actually de- periments of this sort are being livering women - general hospi- tried out and we hear that they tals, maternity hospitals and in- are meeting with great success, firmaries - 19,201 women and that women

are eager to avail children. This seems to be a large themselves of the service of such group but we must remember that an institution, and that the obOhio registered 120,000 births in stetrical record is a good one. 1917. The accompanying table shows

Community Obstetrical Center the information gathered from the Another possibility is to interest compilation of the individual ques- a group of people in the establishtionnaires.

ment of an obstetrical center as a part of a community program, tak

a How Provide for Rural Woman?

ing perhaps a county or a section The practical fact remains that of a county as the unit upon which the rural woman should have an the burden of support should fall. available place to go if she has the It may be noted that there is in money and the inclination. There this scheme no suggestion as to are two ways of solving this diffi- what may be done to care for the culty. An ordinary dwelling house very poor. This is not intended to is capable of being made into a care for this class especially. The fairly efficient maternity hospital. cause of the down and out has been Local physicians may be interested pushed to a great extent in the in such a proposition and may be city until the two classes which induced to invest a small amount claim nearly all of the medical atof capital, which, if the house is a tention are the down and out and success, may be recovered in a com- the very rich. It is time that we paratively short time. Plumbing planned systematically to care must be sanitary, water supply medically for the self-respecting must be adequate, while a delivery people of moderate means who do

a room and a proper supervisor are not need or desire charity but who essentials. The delivery room may are entitled to good service if they be secured with time, plenty of pay a moderate sum for it. The enamel paint and a very inexpen- establishment of county or divisive equipment. The supervisor is sional obstetrical centers would be a very different matter. She a step towards accomplishing this. should be a trained nurse and she It would not be long, we believe, should not have all of the work of before rural women would avail the house to do as well as to offi- themselves of the privilege of such ciate at deliveries. Just at the service.


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It Occurred in Ohio

could come to her had to return In Ohio, women at times have home because of illness. Needto care for themselves to an amaz- less to say she had not been strong ing degree. The writer met, a few since the experience. Cases of weeks ago, in one of our rather

this sort are all too common and thickly populated districts, this very woman expressed her inwoman, the mother of nine chil- dignation that there was no local dren, who was to give birth to a hospital to which she could go and tenth child. She was going to her yet keep in touch with her family sister's and taking five children

and home. This sounds like piowith her — two pairs of twins and neer life in the West and yet it ocan older girl to care for them. curred right here in Ohio. She was leaving behind a husband It would seem that at least a and three boys, while another girl small experiment might be worked was being boarded out. She had at- out in this state to demonstrate the tempted to stay at home but could value or otherwise of a co-operanot obtain either nurse or servant tive scheme of this sort, which under the circumstances. She told would offer to the woman of modof having stayed at home alone

erate means a safe place where she when the last twins were born and could go and, while not leaving her of having sat up in bed and bathed family quite behind her, yet secure both children herself the day after the quiet and freedom from the they were born. This was neces- nagging home details which she sary because the only neighbor who needs during the obstetrical period.

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CITY'S CHILDREN WELL Ohio is to have a new district tuberculosis hospital and one of the

Because the necessary informaexisting district hospitals is to be

tion did not arrive until after last enlarged. Decisions to this effect month's OHIO Public HEALTH were reached by officials involved JOURNAL had gone to press, menat meetings in April.

tion of the Springfield health deThe new institution will be sup- partment's work in child hygiene ported by Ottawa, Erie, Sandusky, had to be omitted from the comand Lorain counties, with the pos- pilation of reports on Ohio cities sibility of Huron County joining which are engaged in such activity. later. Commissioners of these The following outline of what counties organized the district at a Springfield is doing is based upon meeting in Elyria April 10. De

material furnished by Dr. E. B. tails of plans will be decided upon Starr, director of the municipal delater. Huron County was repre-partment of public health and sanisented at the meeting but reserved tation: its decision on the question of joining in erecting the district.

Springfield's child hygiene

bureau is under the supervision of A new building to be constructed at Springfield Lake Sanatorium will

Dr. C. G. Augustus, assistant dibe financed by Summit County

rector of the department, who is

a full-time employee. It will be deeded to the sanatorium trustees and will be used, under A dispensary service is maintheir control, for Summit County tained, open between 10 and 11 patients, with the proviso that A. M. on Monday, Wednesday and when its full capacity is not needed Friday. Lithographed birth cerby Summit County other patients tificates are issued by the departmay be admitted. This decision ment and are accompanied, when was reached at a meeting of the sent out, by a leaflet entitled "How joint board of commissioners of to Keep Your Baby Well.” A letthe five counties in the district, held ter bearing the signature of the in Akron April 9. It followed a .

city manager also goes with the discussion of several months' dura- certificate, urging the importance tion regarding means of enlarging of keeping the certificate and callthe hospital's facilities.

ing attention to the service the city offers to mothers in helping to

keep their babies well. FOUND HOSPITALS FOR

The newspapers of the city are TUBERCULOUS SOLDIERS

furnished with weekly health Tuberculosis sanatoria for the articles, many of which deal with treatment of diseased soldiers will questions of child hygiene. Plans be established by the army medical are being considered for the purauthorities at New Haven, Conn.; chase of an automobile for one of Prescott, Ariz.; Asheville, N. C., the department's nurses, who will and Deriver, Colo. They will cost devote' practically all her time to about a half-million dollars each. home supervision of infants.

Notes on Child Conservation Campaign

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under way.

N the opposite page is shown field, Fayette, Franklin, Gallia, in reduced size the registra- Geauga, Greene, Guernsey, Hamil

tion card prepared by the ton, Harrison, Holmes, Huron, Federal Children's Bureau for use Jefferson, Lake, Lawrence, Lickin the weighing and measuring test ing, Lorain, Lucas, Marion, Meof children, which is the opening dina, Meigs, Mercer, Miami, Monfeature of Children's Year, now roe, Paulding, Pickaway, Portage,

Preble, Richland, Sandusky, SenThe upper half of the card is eca, Shelby, Stark, Summit, Tusretained by the child's parents as carawas, Van Wert, Washington, a record. It will be noted that Williams, Wyandot. space is provided for recording subsequent examinations. The re- President Wilson has voiced his verse side of this upper half, approval of the nationwide "baby

“ which is not shown, bears a table saving" campaign in the following giving average heights and weights, letter to Secretary of Labor Wilfor boys and girls separately, at son, of whose department the birth, at three months, at six Children's Bureau is a branch: months, at each month from the

The White House, seventh to the forty-eighth inclusive, and thereafter at each year

WASHINGTON, MARCH 29, 1918. up to sixteen.

MY DEAR MR. SECRETARY: Next The lower half of the card is to the duty of doing everything to be sent to the local committee, possible for the soldiers at the which will tabulate the statistics front, there could be, it seems to for the Division of Child Hygiene me, no more patriotic duty than of the State Department of Health, that of protecting the children, and will then forward it to the who constitute one-third of our Children's Bureau at Washington, population. where national statistics will be The success of the efforts made tabulated.

in England in behalf of the chilLocal chairmen have received dren is evidenced by the fact that instructions to send in to Colum- the infant death rate in England bus statements of how many for the second year of the war was cards they need. Orders will be the lowest in her history. Attenforwarded to Washington and tion is now being given to educafilled direct from there.

tion and labor conditions for chil

dren by the legislatures of both Counties which had been organ- France and England, showing that ized for work in the Children's the conviction among the Allies is Year campaign up to April 15 that the protection of childhood is were as follows:

essential to winning the war. Ashland, Ashtabula, Athens, I am very glad that the same Brown, Butler, Champaign, Clin- processes are being set a foot in ton, Coshocton, Crawford, Cuva- this country, and I heartily aphoga, Darke, Defiance, Erie, Fair- prove the plan of the Children's

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