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care, midwives, ante-natal, hospital, infant, births and supervision

BIRTH Ante-natal care involves, as we have seen, clinics and home visiting. It involves also hospital ac commodation for complicated cases of pregnancy, and advance supervision of preparations for con finement, whether under the care of physicians or midwives. The training of midwives and official recognition of their calling seem to be a present necessity, if not a permanent policy. Ante-natal care incidentally gives an opportunity for personal contact between capable nurses and midwives which should help to increase the efficiency and raise the standards of the practice of midwifery. Related to this is the diminution which may be expected in the number of cases of ophthalmia neo natorum by instructing mothers to insist that the effective silver drops shall be applied to the eyes immediately after birth; for while it is a reproach to our sanitary standards that this precaution should be necessary, nevertheless it is necessary, and will be necessary until the infectious disease which is responsible for a large part of congenital blindness has become as rare as small-pox, instead of being, as at present, more prevalent than measles. Mainly, however, and inclusive of all the other anticipated results of ante-natal instruction and supervision, is the production of healthier and stronger children and a reduction of the general infant mortality and morbidity.

At the time of birth the minimum requirement is skilled and prompt attendance in normal confine ment at home, and prompt and adequate hospital care when there are conditions involving special danger to mother or child, unless the home condi tions are exceptionally favorable for constant medi cal and nursing oversight.

Even for the normal labor of mothers in corn

3 fortable economic circumstances the use of the ma ternity hospital grows apace, for the reason given by Sir Thomas More some centuries ago as to why hospitals were used in his Utopia, simply that they were more comfortable places in which to be sick.

The registration of every birth is an essential feature of our social program, but one which we have been exceedingly remiss in recognizing. For

lack of an accurate record of births we can only guess about such vital questions as the natural increase of population and the rate of infant mor tality in most of our cities and states and in the United States as a whole. Child-labor laws, and other legislation involving proof of age or nativity, are creating and increasing popular appreciation of the usefulness of this piece of red tape, as it has probably been regarded by the average native American. In many cities documentary evidence of age is required both to get into school and to get out, if release is desired as early as possible. Birth certificates are frequently needed to establish a right to inheritance or to American citizenship. Of even greater importance to the individual, how ever, though he may not so readily see it, is the basis an accurate registration of births gives to the sanitarian for studying the fluctuations of infant mortality, that "sensitive index . . . of social welfare and of sanitary administration,"* and the starting-point it furnishes for the operation of a Newsholme.

systematic supervision of babies. The Census Bureau is working away at this problem, as it is at the registration of deaths. It must be solved chiefly, however, by the local boards of health. There is no reason why every city in the country should not have, within half a dozen years, if it wants it, a record of births that is practically com plete. Recent tests in New York indicate that ninety-eight or ninety-nine per cent are now prop erly reported in that city, and if that is possible in New York, with its unparalleled difficulties of varieties in custom and language, it is possible any where in the country. By acknowledgment of the receipt of certificates, by mailing copies to the parents, by occasional checking-up canvasses of selected blocks and enforcement of penalties against persons found to have been neglectful, an intelli gent and resourceful Board of Health can success fully establish the cooperation of physicians, midwives, and parents.