of the work. Consultation centers were increased, maternal nursing was encouraged, and mothers and school girls were educated in the care of infants. The purpose of this organization was

During the entire war and in every part of the military government of Paris.to assure to every needy woman who is pregnant or who has a baby less than 3 years old, the social, medical, and legal protection to which she has a right in a civilized society. To see that no woman is forgotten and no child ignored.

In Paris the infant mortality rate dropped from 155 in 1914 to 139 in 1918.

The results of the work were satisfactory enough to justify the establishment of a permanent organization to do similar work after the war.

Prewar legislation in favor of mothers and young children consisted of a law on confinement rest, a provision for maternity insurance, for factory nursing rooms, and for regulating midwifery. A considerable amount of infant welfare work was done by private agencies but, with the war deprivation, these funds were so decreased as to cause a general arrest of this important work.

In 1918 a maternity insurance fund was raised, wet-nursing centers were brought under Government supervision and Government subsidies were made available for the protection of infancy. A leading pediatrician was invited to prepare a more adequate bill for the national protection of infants by Government assistance and its speedy passage was widely advocated.

Though relatively high the infant mortality rate of 143 was declining before the war. The Government regulated the practice of midwifery, forbade the employment of women four weeks after confinement, and aided infant welfare work by subsidies.

During 1915 all child welfare work was organized under a special department of the National Committee for Food Relief. Health centers increased from 70 to 700 and mothers' canteens (for feeding nursing mothers) from 2 to 473. As a result of the work of the committee a decrease in infant mortality rates is reported by Dr. William Palmer Lucas in Brussels, Antwerp, and Namur. A bill for a national children's bureau was passed in September, 1919. This bill provided that half of the expense of all approved child welfare work be met. by State funds.

One of the chief aims of this legislation is to make instruction and care available in isolated rural communities. The Children's Bureau has published maternity and infant welfare studies in rural areas in four States. The following is quoted from one of these reports:

More than three-fourths of the mothers had no prenatal care whatever.

Almost two-thirds of those remaining at home had to meet the ordeal of childbirth without competent medical care.

One in eight were delivered by their husbands.

Some were entirely alone.

Eight died, a rate of 20 per 1,000 live births.

Very few had after care by physicians.

Those who went away paid $150 to $700, including cost of trip.

This survey was made in 1917.

Infant mortality rates for certain foreign countries and the United States.

Maternal mortality rates per 1,000 births (rates for latest available years up to 1917).

a

Delaware, New Mexico, New Hampshire, Pennsylvania, South Dakota have passed laws accepting the provisions of t Sheppard-Towner bill. Illinois has introduced a similar law.

The Idaho Legislature has prepared a joint memorial to the Sena and House of Representatives of the United States approving t pending measure having for its purpose the protection of materni and infancy and respectfully recommending and requesting th said measure be enacted into law.

The following State boards of health have given evidence of activ interest in the Sheppard-Towner bill: Alabama, California, Kansa North Carolina, New Jersey, New York, Pennsylvania, Rhod Island, South Carolina, Washington, West Virginia, and Wisconsin.

WHAT PRENATAL CARE IN LIMITED AREAS HAS ACCOMPLISHED.

New York milk committee-Report of an experiment in prenatal care, 1912-1916, com pared with Manhattan, same period.

Boston dispensary-Death rate of infants under 1 month of age per 1,000 births.

Results of Maternity Center Association, New York City-Comparison with Manhattan,

same period.

From these and other similar figures it is estimated that about two-thirds of the maternal deaths could have been prevented by adequate provision for proper instruction and care of these mothers medically, economically, and socially, before, during, and after confinement.

In localities where facilities for proper care of the mother have been provided and her intelligent cooperation secured, it is estimated that at least one-half of the infant deaths could have been prevented.

Maternal mortality: The United States maternal mortality rate is highest of 17 countries. The 1919 rate is 7.4 deaths of mothers per 1,000 live births. In round numbers this represents about 17,800 deaths of mothers from childbirth. At a conservative estimate, about two-thirds of these deaths could have been prevented by adequate provision for proper instruction and care of the mother medically, economically and socially before, during and after confinement.

Infant mortality: The United States stands seventh in infant mortality rate. The 1919 rate if 67 per 1,000 live births during the first year of life. In round numbers this represents about 200,000 infants dying in the first 12 months of life. About 74,700 die in the first month of life from natal and prenatal causes. In localities where facilities for the proper care of the mother have been provided and her intelligent cooperation secured, it is estimated that at least half of these deaths could have been prevented.

Maternal and infant mortality in the States: Maternal mortality rates range from 4.8 in Wisconsin to 11.2 in South Carolina. Infant mortality rates range from 63 to Washington and Oregon to 113 in South Carolina. There is wide variation in rates in different districts of the same city.

There is great need of aid in isolated rural districts.

It is estimated that adequate prenatal care and instruction in the hygiene of maternity and infancy would prevent the deaths of twothirds of the mothers and one-half of the infants.

STATEMENT OF DR. ELLA OPPENHEIMER, REPRESENTING CHILDREN'S BUREAU.

Dr. OPPENHEIMER. I simply wanted to give one further medical point of view. I have been intensely interested in the subject of child health

The CHAIRMAN. You are a physician?

Dr. OPPENHEIMER. Yes; I am a physician and I have confined my work to this line. I am familiar with the work of the Children's Bureau because I have been doing part-time research work for them in children's hygiene work.

It seems to me, from a medical point of view that this bill offers a very satisfactory starting point, at least, for the problems of the protection of maternity and infancy in this country. Those of us who are physicians realize that the immediate concern is adequate medical and nursing care, but the availability of that medical and nursing care depends in large part on the educational and economical and social conditions. I certainly feel that this bill provides that such medical care be made available through its agents and these educators.

Those who work in the cities in the child-welfare centers know how difficult it would be to get along at the present time without the help and the cooperation of public health nurses and social workers. We are able to do a great deal more work through their help than we could possibly negotiate if we did not have it.

Senator STERLING. Is your work here in the city of Washington, Doctor?

Dr. OPPENHEIMER. Yes; I feel, too, that this measure providing in its administration for public health nurses in the various counties

in the country will really give the country doctor equipment with which to work he has never had before, and will make him a great deal more efficient and useful by providing with nurses and care a consultation center with which he can accomplish a great deal more than ever before.

STATEMENT OF IDA WARD, PHILADELPHIA.

Mrs. WARD. It seems to me that the case has been admirably put and sustained. The case of its practicability has been put and sustained very well indeed and has been stated here very well indeed, but I think that the case of expediency has not been well sustained. Now I go about a good deal; I talked with the expressman here at Washington that took my trunk. I talk with all the people whom I meet and I find that the people are sullen. In Pennsylvania they have passed a number of welfare measures and the people are indignant because they have been passed at the expense of increased taxation. I feel that they have come up and have been carried through at a very unfortunate time, and had they come up at a more fortunate time they would have received the enthusiastic support of everyone. There are a good many who feel that the only way to retrench is to retrench; that the only way to economize is to economize, and to my mind there is a great question of the advisability of appropriating money even for such a good purpose at the present time when people are burdened and sullen and restless and almost ruthless under the heavy burden of taxation that they are carrying. The CHAIRMAN. You are not opposed to the bill itself?

Mrs. WARD. Only for that reason. Something was said about England. Now, the middle class of England, which is a great organization, the middle class--the class between the organized corporations and the laboring class one of the things that they successfully carried through was the subsidizing of hospitals. I question at this particular juncture if they would be glad to have a measure of this kind put over them in England.

Senator MCKELLAR. But about 90 per cent of all we spend is spent for war. Don't you think that we had better economize by cutting out a little of that spent for war and have a little more to be used for these babies?

Mrs. WARD. If you would do it. In Pennsylvania we were quite willing that the mothers' pension bill should go through, if they would cut down the wicked extravagance. I do not know whether you read the paper by Gordon Smith, of Pittsburgh, who has counted up the cost of the carrying on of the Government in Pennsylvania. It shows that ten taxpayers support each officeholder. Now, since Secretary Mellon has told us that our finances are such that we have to practice rigid economy, and since Secretary Hoover has told us that we must not increase our bureaus, I should think we should give it some consideration. But you are going on and putting this in the Bureau of Labor with some committee on hygiene.

Senator MCKELLAR. Will you allow me to give you an incident on how we economize? Last year the members of the Committee on Military Affairs reported a bill that would have cost this Government for war this year more than a thousand millions of dollars at the lowest calculation. I made a fight for 30 days on that. We reduced