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Hebrew Sanitarium, Far Rockaway..

4 Mothers, 1; children, 3. Holiday Farm

2 Nyack, Fresh Air Sanitarium...

4 Amityville, through Association for Improving the Condition of the Poor....

1 Green's Farm, through Association for Improving the Condition of the Poor..

1 St. Eleanora's Home...

1

498 No. of tenement house complaints..

35 No. of cases reported to Department of Correction.. 1 No. of cases reported to Department of Charities... 3 No. of cases reported to Bureau of Licenses..

1 No. of cases—arrangements made for lessons at Music School Settlement

1 No. of cases to whom milk was furnished-40: Borden's

12 Straus New York Milk Committee.

5 New York Diet Kitchen ...

21

40 No. of quarts of milk furnished—979 at 8c. per qt... $78.32 Borden's

370 New York Diet Kitchen.

422 Straus

138 New York Milk Committee...

49

.979 No. of babies supplied with clothing.

8

18.93 No. of babies supplied with sugar and milk. 5

2.15 No. of babies supplied with prepared barley.. 3 .60 No. of babies supplied with nipples..

4 .40 No. of babies supplied with eggs...

1 .25 No. of babies supplied with Nestle's Food. 1

2.25 No. of babies supplied with bicarbonate..

1 .10 No. of babies supplied with cocoanut oil for enunctions

5 -1.90 No. of babies supplied with bottles...

.55 No. supplied with cot......

1 1.48 Amount expended for carfare (personal) by nurse..

21.70 Amount expended for carfare for patients to and from hospitals and dispensaries...

4.90 Amount expended for telephone outside office.....

.85

It is as yet too early to publish statistics showing the effect of the district field service upon the death rate, although the evidence as it accumulates is increasingly satisfactory. In the summer of 1907 the Association conducted a very large experiment financed by Mr. John D. Rockefeller, to determine this point. In the course of two and a half months, July 1st to September 14th, the district nurses attached to Junior Sea Breeze, our summer hospital camp and dispensary for sick babies, found 35,517 children under two years of age for whom they cared and whose mothers they instructed in infant and personal hygiene, with the result that there was a very considerable diminution of the death rate in the ward which they covered.

In this connection may I say a word about the importance of uniform records ? Without a perfect agreement among superintendents of hospitals and clinics as to items to be included in their records, and as to the method of entering them, etc., it will always remain impossible to keep a check upon the work, and therefore impossible to make it thoroughly effective. From the point of view of the intelligent social worker, work, the social and scientific values of which cannot be accurately charted, is as nearly useless as an exploration that brings back glowing and vague reports unaccompanied with diagrams, specimens and maps.

In addition to keeping very complete statistical tables, the Association requires the nurse to dictate a daily history which enables the superintendent to maintain constant control of the service. The following history not only shows the character of the diary, but also gives a fair idea of the quality of the field nurse's work.

CHARACTERISTIC HISTORY,

"July 15/08.- Mother came to the dispensary with her sick baby. The mother has been nursing baby and the doctor says that the child has not been getting enough nourishment. He said its feedings must be increased, and he also instructed me to take it to the surgical ward to have the glands on its neck lanced.

"July 16/08.—Called. Found family living in two small rooms on the ground floor, one of which was a shoemaker's shop. There are eight children, six of whom are living at home. The back living room is very dirty. To take care of the six children the father earns a weekly wage of $4. His brother offered him a free room, but because of the number of children the landlord would not permit them to use it. The mother is very sickly and nervous. Her milk is not sufficient for the baby. I ordered milk for baby and showed the mother how to prepare it for her six-months-old child. Told her to give two bottles a day in addition to nursing. She and her people are very grateful for my help.

"July 17/08.—Called to see if mother had prepared milk properly. Baby's neck is swollen much worse. Instructed mother to bring baby to the dispensary this afternoon.

"Same date.-Saw baby at dispensary. Doctor told the mother to alternate the breast feeding with a prescription of milk. Nurse showed mother how to make prescription.

"July 18/08.—Mother said that the milk which I had ordered had not come.

Gave her tickets to the diet kitchen. She was very much worried about her baby, as the glands on its neck were very badly swollen, and she was afraid to take it back to the dispensary on the 20th, when the doctor had ordered her to return. Wanted to know if she should take it back to-day. The baby had no fever, so I told her to wait until Monday. Having seen to it that she got her milk from the diet kitchen, I instructed her to feed her baby alternately from a bottle and at her breast. The baby is to have a feeding every three hours.

"July 20/08.—Mother brought baby back to the dispensary. Neck had been dressed in the surgical clinic. Baby is looking better. Mother says it is fine. She also says that the milk agrees with it.

"July 24/08.—Called at home. Baby is better. The house is still very dirty. Mother says she is hungry. I gave her milk tickets for herself and for the baby, and instructed her to drink milk. I also promised her that a relief visitor would come from the Association for Improving the Condition of the Poor.

"July 31/08.—Called. Found visiting cleaner from the Association. House was being cleaned and the washing done. Baby was sleeping in front of the house in its carriage. It seemed much better. Temperature 100°. Mother states, however, that its bowels had not been quite right. Gave instructions for the baby's care.

“Aug. 5/08.—Called. Found mother and baby both better. Mother says that the baby does not want anything to eat and she thinks it is sick. Examination shows that the baby is well, but that it has lost its appetite on account of the heat.

"Same date.-Mother brought baby to the dispensary. Doctor says the baby is getting along all right. Does not need any additional treatment, but mother is to continue former instructions.

"Aug. 8/08.—Called. Mother and baby are looking better. Baby is doing very well. House was in better condition than nurse had ever seen it before. Baby is now getting along upon its mother's milk. No extra food is required. I shall keep the family under observation until mother and baby are both perfectly well.”

In conclusion may I refer to the Caroline Rest Home for Convalescing Mothers, which has recently been presented to the Association by Mr. George H. F. Schrader? This admirable home, situated among the beautiful hills of Hartsdale, has been designed not only as a sanitarium for the mothers and babies who are being sent to it, but as a school where, under the most favorable conditions, mothers of the poor receive instruction in the duties of motherhood, in personal hygiene, the care of their children and the right conduct of their homes. Mr. Schrader is imbued with a deep faith in the curative power of education. Through the example of Caroline Rest, and the field nurses attached to it, he hopes that all hospitals and dispensaries will become centers not only of medical treatment, but of preventive education. With its ample accommodation for sixty persons -thirty mothers and their babies—the Convalescent Home will receive patients not only from philanthropic societies, but also from hospitals and dispensaries. Its bright wards, sun parlors, living and demonstration rooms complete the chain of our equipment for developing an adequate field service in connection with children's dispensaries, and we are trying to make it a potent factor in the co-ordination of the many excellent institutions that are directing their energies to the conservation of life through the scientific care of mothers and their little children.

260

CO-OPERATION IN DISPENSARY WORK AS EXEMPLIFIED BY THE ASSOCIATION OF TUBERCULOSIS CLINICS

OF NEW YORK CITY. *

JAMES Alex. MILLER, M.D.

President, The Association of Tuberculosis Clinics of the

City of New York. (By invitation.)

The dispensary problem has loomed large for some years among the difficulties and perplexities involved in the operation and administration of hospitals and other medical charities.

It has no less also been the concern of the sociologist, the philanthropist, the medical school, the private practitioner of medicine, and even of our legislators.

Approached from these various points of view, the problem has been analyzed little by little until it has found its expression in the common phrase, “The Abuse of Dispensaries," a designation now familiar enough to represent a fairly concrete idea. This so-called abuse consists in the attendance upon the dispensary of large numbers of those who are in no way suitable objects of medical charity.

The harmful effects of this practice have been variously demonstrated to be a tendency toward pauperization of the patients themselves, an injustice to many private physicians thus deprived of legitimate fees, the over-crowding of the dispensary resulting in hurried and faulty diagnosis and treatment with the consequent injustice to the patient and the professional demoralization of the physician, the long delay and insufficient attention paid to the proper dispensary patients, and the temptation to physicians to exploit the dispensary for their private advantage.

*Read by Dr. R. R. Ross, Buffalo, N. Y.

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