tion of a field service which I hope will one day be attached to every children's hospital and dispensary and more particularly to every maternity hospital, where it is so greatly needed. The report of one of the largest maternity hospitals in New York shows that no attention is paid to the mother until labor, that the average residence in the hospital is 14 days, that no instruction is given the mother except in complicated cases, and that no one follows her into the home. Is it surprising that while the reports of 12 leading maternity hospitals shows mortality rate of from 8% to 4%, 17,437, or 15% of the total born in Greater New York in 1907 died before reaching one year of age, 4,000 died of immaturity before reaching one month of age, and over 7,000 were born dead. A grave responsibility will rest upon maternity hospitals until they have provided a field service not only adequate to the task of following discharged mothers into their homes, but adequate also to caring for and educating mothers in their homes well in advance of confinement. It is to co-operate with them to this end that the Caroline Rest nurses are maintained. By way of a further contribution to the reduction of infant mortality through education and prevention, the Association last spring opened seven milk depots,—which are children's dispensaries in a very proper sense,—and made them centers not for the promotion of artificial feeding, but of breast feeding and the improvement of living conditions in the home. A full report of the summer's work of these seven depots is about to be issued, and I shall therefore only touch upon it here. The central fact concerning them is this, that no mother who comes to them can get milk 1. Without securing a statement from a physician that she is physically unable to feed her baby at the breast. If factory work is interfering with breast feeding, she is referred to the relief department of the Association. 2. Without pledging herself to bring the baby to the depot at regular intervals to be weighed and examined by the attending physician. A nurse is attached to each depot to assist the attending physician and to follow the babies into the homes. Moreover, both at the depots and in their neighborhoods, classes have been organized for the instruction of mothers in personal hygiene, in the care of their babies and their homes, and in the importance of breast feeding. The thirty-six physicians who have given their services to this work during the past summer have now organized themselves into a permanent association of physicians of the New York City Milk Depots, of which Dr. Godfred R. Pisek, Chairman of the Pedriatric Section of the Academy of Medicine, is president. The association has adopted the following program: The reduction of infant mortality by the encouragement of breast feeding and the education of mothers in infant hygiene. a. b. The gathering of information which will make a more intelligent and effective campaign against infant mortality possible. C. The working out of the principles of infant feeding and a system of hygienic instruction to the mothers. capable of general instruction and development. d. The bringing out of a spirit of co-operation and mutual assistance on the part of physicians, milk dealers, and all persons interested in social, physical and moral progress. For the organization of this association, as well as for the conduct of the depots and consultations, Mr. Wilbur C. Phillips, the able and devoted secretary of the New York Milk Committee (of the Association for Improving the Condition of the Poor) has been largely responsible. It was also at Mr. Phillips' instance that the New York Department of Health last June called a conference on the summer care of babies, which is now permanently organized for the all-yearround care of infants, and through which 50 hospitals, churches, settlements and other social organizations are co-operating with the Department of Health and its steadily increasing corps of district nurses. A report just issued by the Department attributes to this conference a marked decrease in the infant death rate during the summer months as compared with last year. I now come to the concluding steps in the development of the Association's plan for the extension of field work in connection with children's dispensaries. Last spring Dr. F. S. Meara, who looks after the babies in the wards and the children's dispensary of Bellevue Hospital, was deplor ing his inability to control the development of cases whose illness was due to improper home conditions. Because of an adequate field service, it was not only impossible to prevent the repeated recurrence of diseases once cured-this was especially true of feeding cases-but there was no way of determining what became of the convalescent patients discharged from the wards. As you know, public hospital wards are often very crowded and the doctor cannot always keep a patient there as long as he might wish. We felt that both from the points of view of administrative cost and medical efficiency, it would pay to attach a field nurse to the children's dispensary at Bellevue who would assist the physician in charge, visit the babies in the ward, and follow all babies and children into their homes not ony to continue treatment, but also to correct unfavorable home conditions and promote better habits of living. Miss Franklin, one of our Caroline nurses, was assigned to this service. After two months I had the satisfaction of presenting a most satisfactory report to Dr. John Winters Brannan, President of the Board of Trustees of Bellevue and Allied Hospitals, with the result that Bellevue has since added a district field nurse to the staff of its children's department. In addition to this result, the Association has since that time, at the request of Dr. Northrup, organized a district field service in connection with the University-Bellevue Children's Clinic, and has under consideration an application from Dr. J. Dodge Peters, of Roosevelt Hospital, for a nurse to organize a field service in connection with the children's clinic there. It was under Dr. Peters that Miss Franklin did much of her work at Bellevue this summer, and his letter requesting that she be transferred to Roosevelt says: "In my feeding cases particularly, Miss Franklin has been of very great assistance because she could visit the patients' homes and could directly see to it that my instructions were properly carried out. This has led to a much better series of favorable results than were formerly obtained. Through her visiting she has discovered and referred to the Clinic new cases which parents in our district would not have brought to the dispensary on their own initiative, and which we have been able to cure or aid materially. She has also been of great assistance in educating mothers to a better idea of our work." Miss Franklin continued at Bellevue during four months, May 1st to September 1st. Her report shows how essential it is that a field nurse should be thoroughly well informed about all the social resources of the city, and that she should be well trained in the social as well as the medical point-of-view. I present the entire report because I can think of no better way to show the range of the field nurse's opportunity for service. You will observe that while a total of 150 cases were discharged from the hospital wards and treated at the dispensary, the nurse discovered 498 persons who needed convalescent fresh-air treatment in the country. Moreover, it is worth noting how her knowledge of other institutions than the one in which she was serving not only contributed to her efficiency, but also made her an important influence in the co-ordination of hospitals and dispensaries which usually act as isolated units. REPORT OF A. I. C. P NURSE FURNISHED TO CHILDREN'S CLINIC AND WARD, BELLEVUE HOSPITAL, MAY New York University & Bellevue Clinic.. Roosevelt ... Ruptured and Crippled Hospital.. No. of cases placed in hospitals—32: Bellevue Gouverneur Junior Sea Breeze. Manhattan Eye, Ear & Throat.. 4 ..... 1 1 1 New York Infant Asylum (Maternity Dept.).. Seaside St. Luke's No. of cases reported to Department of Health—18: Chickenpox Call for physician Measles Tuberculosis 11 1 11 3 1 4 1 3112 No. of relief cases referred-29: Association for Improving the Condition of the Poor United Hebrew Charities. Free Synagogue No. of cases referred for fresh air outings-498: See Breeze Stay Party.. Mothers, 52; children, 146. Sea Breeze Day Party.... Mothers, 41; children, 97. American and Journal Outings. Mothers, 6; children, 9. Edgewater Creche ... Mothers, 11, children, 20. Floating Hospital 74 Mothers, 23; children, 50. Health Home, Children's Aid Society........ Mothers, 11; children, 19. 73 30 |