It is a moral duty we owe to a helpless babe to give it a badge of citizenship. It is a duty we owe to ourselves as physicians, for great good has come to us through this means. The man who fails to report a birth violates the state law and subjects himself to a heavy fine. He does an injury to the helpless babe, and violates the confidence of a trusting family. And he cheats no one but himself, as the public is being rapidly educated to expect the fulfillment of this duty. The registration of the birth of a baby may save its property, its health, its liberty, and its life. I shall not tire you with a lot of statistics, as you will secure the statistics through the Ohio State Medical Journal and the OHIO PUBLIC HEALTH JOURNAL. It is our intention to supply the statistics to these publications at the earliest possible moment, and we believe that they will be more valuable to you if furnished promptly. Our bureau contains a mine of information. We invite you to make full use of it. It is always available, and we will gladly furnish it for the asking. I also extend to you an invitation to visit this bureau, as I feel that by a closer co-operation we will be mutually benefited. Since this paper was written the funds necessary to put in force the so-called "Mother's Certificate Plan" have been secured. This plan is now in use in New York, New Jersey, Virginia, Michigan and Wisconsin, and their registrars report excellent results. Briefly, the plan consists in sending to each mother a copy of the certificate of her child's birth, and also the inauguration of a campaign to educate the mother to the value of birth registration. The theory is that the mother who does not receive a certificate will apply for same either of the state bureau of the local registrar, and in that way the names of the physicians who are not making reports can be secured. This plan was put in operation beginning June 1st, 1917. and eventually we expect it to do birth registration a great deal of good. The response of the profession has been very encouraging. For January, February, March and April of 1915 32,330 births were registered. For January, February, March and April of 1916 35,674 births were registered. For January, February, March and April of 1917 37,791 births were registered. A part of this is of course due to a greater population, but much is due to a more complete report. MORTALITY OF MOTHERS IN CHILDBIRTH. The Metropolitan Life Insurance Company has compiled statistics on mortality of mothers in childbirth which show that among the two and three quarter-quarter million women of childbearing age, (between 15 and 44 years) who are policy holders in the Industrial department of that company, 1769 deaths occurred during the year 1916 from diseases and conditions incident to childbirth. This cor responds to a rate of 62.6 per hundred thousand white female policy holders, ages 15 to 44, or a decrease of 10.7 per cent. As compared with a rate of 70.1 per hundred thousand in 1911, this shows that progress is being made in the matter of reducing the frightful mortality rates from a cause that is preventable. Among colored women of the same ages the rate was 88.4 per hundred thousand in 1911 and was reduced to 70.4 per hundred thousand in 1916; a drop of 20.4 per cent. In other words the general conditions of mortality from the puerperal causes were practically the same among colored women in 1916 as among white women only six years earlier. Childbirth fever or puerperal septicemia was the most important of the particular diseases and conditions responsible for this maternal mortality. This single cause of death was responsible for 41 per cent of the total deaths from puerperal conditions. Albuminuria and convulsions associated with childbearing were responsible for 29 per cent and the accidents of labor 10 per cent. Accidents of pregnancy, chiefly abortions and miscarriages, caused 8 per cent of the total as did also puerperal hemorrhage. The consistent decline in mortality from these diseases and conditions among white and colored policyholders is in marked contrast to the practically stationary death rate from the diseases incident to childbirth in the population of the Registration Area of the United States, a fact pointed out in a bulletin on "Maternal Mortality" recently issued by the Federal Children's Bureau. In fact, the death rate among the company's policy holders is now lower from these puerperal conditions than among the female population in general, although the insured group is composed almost entirely of mothers of the industrial classes. The insurance company says this more favorable condition among the insured females is in large measure the result of the extensive care given by the visiting nursing service of the company to policyholders during pregnancy and after childbirth. In 1916, out of a total of 217,422 cases cared for, 4,212, or 19.4 per cent were concerned with maternity. Of these maternity cases, 30,189 were intensively nursed under the direction of a physician with an average of 7.7 visits per case. As a result of this very encouraging mortality showing the company has recently extended the privilege of the nursing service to female policyholders during the period of pregnancy, and two prenatal visits by nurses are allowed in addition to the eight nursing visits permitted after childbirth. TO WAGE WAR ON VENERAL DISEASES. Governor Stevens of California has appropriated $60,000 from the state war emergency fund for use in the campaign to control venereal diseases. State Health Officer Sawyer has requested county supervisors to provide in their annual budgets for hospital facilities for the care and isolation of persons, suffering from venereal diseases. THE PUBLIC HEALTH NURSE. The Public Health Nurse is a modern product. It is not strange that she is so, for the trained hospital nurse is only a late arrival. When Florence Nightingale went to alleviate the sufferings of the soldiers of the Crimea she had to endure the sneers of the skeptic and the rebuffs of the incredulous, for it was breaking new ground, and many well disposed people looked with suspicion on the project. It was difficult to get enough followers to make it worth while, but she had a vision and could see the possibilities for humanity in the work. With faith in herself and in the righteousness of her mission, she pressed on and lived to see all civilized people acknowledge her purity of heart and greatness of soul. It is a far cry however between the angel of '54 and the well equipped nurse of today. In those sixty odd intervening years our conception of disease has undergone a complete change. Histology and pathology have been re-written while bacteriology, the basis of modern medicine, has sprung into existence. The advent of anaesthesia coupled with asepsis has revolutionized surgery. The new public health based on our modern conception of infection has changed our methods of approach. Our knowledge of the specific causes of many of the Scourges have led to the adoption of national ways and means for their control. The application of such knowledge as we possess has done much in the past three quarters of a century to lengthen the span of human life to lessen disease and alleviate human suffering. It is not too much to say that the trained nurse has been an active factor in bringing about these beneficial results, but her work until very lately has largely been confined to institutions or to service more or less directly under their control. We are beginning to realize, however, that her sphere of usefulness is not circumscribed by narrow. conventional lines. That she is fitted by training as well as by nature to go into the highways and byways of life and to impart to those in need of such knowledge up-to-date information on matters pertaining to right living, the prevention of disease and the alleviation of human suffering. It is the layman's knowledge of disease prevention that has been the chief factor in reducing the death rate from preventable diseases. The scientist in his laboratory makes the discovery-the physician in the field tests its efficiency-the public become acquainted with it through press, lectures, clinics, dispensaries and other means of spreading information and apply it in the practical affairs of every day life. Intelligent citizenship is the great overruling force in the control of preventable maladies. In an age like the present where there is so much misinformation on matters pertaining to personal and community health it becomes imperative that the people be supplied with a systematic and well balanced quota of reliable health information. The community nurse is in a position to perform this service. more efficiently than any other agency that modern conditions have evolved. Being a paid official, the idea of charity is eliminated, and she is accorded a welcome entrance into many homes that otherwise would be closed against her. Her sympathetic nature gains her attentive hearing and home and living conditions are profitably discussed. Instruction is given in personal and community hygiene, the cause and prevention of disease, the relief of suffering, the responsibilities of motherhood, the care and feeding of infants and the hundred and one other odds and ends that are comprehended under the term "right living". When it comes to ministering to the unwell, communicating instruction to the home-makers, giving help to the needy. caring for the helpless or imparting kindly and wise counsel to those in need of such, the trained nurse has the advantages over any other known means or instrumentality. Wherever the experiment has been tried the results have exceeded the most sanguine hopes of those who have been responsible for it. In our State there was for a time some legal difficulty in the way of providing funds for the expense incurred but the last two sessions of the legislature have amended the laws so that now officials have ample legal authority for making necessary appropriations. This is a feature of our public health work that is bound to grow and there is no department of our public health service that will give greater returns for the money expended. — The Pennant, published by the North Dakota Anti-Tuberculosis Association. SANITATION AND HEALTH FROM THE FOOD STANDPOINT.* J. D. Mickle, in his address before the Dairy, Food and Drug Association at Atlantic City, on "Sanitation and Health from the Food Standpoint" calls attention as to how the word "sanitation" may be applied to the preservation and protection of health by the careful handling of food products. Sometimes in making application of the word its true definition is lost sight of, but it is used to express a degree of cleanliness or freedom from visible filth, and we may say that an object or place is quite sanitary when strictly speaking the reverse may be true. The word should have no broader meaning than to the food official upon whom has been placed the responsibility of passing judgment upon the food establishment, the suitability of food products and into whose hands has been given the power of law enforcement. Frequently such an official is severely criticised and ridiculed because of his convictions as to the meaning of the word "sanitation." Many times the criticism is justified, owing to the fact that the application of the word is based upon theoretical and impractical ideas and not on plain common sense, and a practical understanding of the significance of the word and its proper application. It is stated by certain medical experts that proper sanitary precautions would save 3.000,000 lives in Europe and America annually, and that more than half of this relates itself directly to the handling and care of foods. The importance of the proper preparation, care. sale and consumption of such products must therefore be given careful consideration. *Abstract from an address by J. D. Mickle, Oregon, printed in the American Food Journal for September. 1917. The great enemies of food preservation are bacteria, and it is essential that every precaution be taken in order to protect foods from such bacteria as will cause their decomposition. Foods are classified into carbohydrates, fats, minerals and proteids. The one of these which is most necessary to man and is absolutely indispensable is the proteids. The other foods are sometimes called "fuel foods," while the proteids are termed "building foods." Milk, eggs, meat, cheese and legumes are familiar sources of this product. Unfortunately these same proteids are the favorite food for bacteria. It is as essential to them as it is to man and they do not hesitate to make their attack on this the most vital point in our food supply. The only possible answer to this development of bacteria is cleanliness. Sanitary conditions everywhere is the one thing that saves the day. Food products kept under proper sanitary conditions do not deteriorate rapidly and not only do they furnish the consumer that for which he pays, but they also relieve the dealer from a great deal of responsibility and trouble. Any expense incurred by improving the sanitary conditions is usually more than returned in the saving from loss by delay, the saving of extra labor in the handling of tainted products and in the increased trade and confidence bestowed by satisfied customers. It pays to be scrupuously careful in food handling. CARD RATING SYSTEM FOR FOOD HANDLERS. In Portland, Ore., the board of health has adopted a system. of rating stores handling food products of any kind, with reference to the sanitary condition of such stores. A store whose sanitary condition, according to the inspection of the health board, averages 90 per cent or better is given and is required to display a card showing that its rating is "A". Shops averaging only 80 per cent are required to display a "B" card, and those rating under 80 per cent a "C". The card must be displayed so that every patron may see it, and the regulation is enforced by frequent inspections. As might be expected a noticeable improvement has been made in all shops, each merchant being anxious to get an "A" rating. An advertising point is made by the merchant of a good rating, and customers profit by improved sanitary conditions. DROPS IN BABY'S EYES. All good doctors great and wise Regardless of its rank or size We put the drops in baby's eyes. Just one thing more we beg to mention, Please give these babies prompt attention. -BY A PUBLIC HEALTH NURSE. |