The same county borough had the lowest rate among the metro politan boroughs in 1914. In the counties of Lancashire and York shire it is the practice for a considerable proportion of married women to be employed in the textile mills, and it is difficult to resist the conclusion that the nature of their employment, to gether with the strain of managing the household and bearing large families, is in no small degree responsible for the unenviable posi tion which the towns occupy and have occupied for so many years. The puerperal death-rate in Wales has always been higher than that in England, and, until recently, than in Scotland. That is probably due, not so much to any special cause peculiar to Wales, as to the fact that, broadly speaking, the whole country is either extremely rural or highly industrial. The services available in most rural areas leaving much to be desired, and the exceedingly hard life associated with the mining industry, must be factors contributing to the high maternal mortality rates disclosed.
An enlightened public opinion would encourage and, where necessary, compel the local authorities to provide the services considered by the experts to be essential. The medical profession has the knowledge ; administrators, local and national, are capable of creating the administrative machinery ; there is no lack of voluntary helpers; the provision of the necessary finance and the co-operation of mothers are the factors depending upon education.
It may be said, in summing up this vitally important subject, that there are few departments of human life in which greater and more beneficent progress has been made in recent years, as compared with the ignorant and haphazard practice of the past.
International Year Book of Child Care and Protection, compiled by E. Fuller (1925) ; Oeuvre Nationale de l'en
fance—Rapport annuel (Brussels, 1923) ; Inter. Record of Child Wel fare Work, No. (Brussels, continued as Bulletin inter national de la protection de l'enfance (No. 22) (Brussels, 1924) ; Co-operation et prevoyance sociale en Tchecoslovaquie, ed. A. Klimt (Prague) ; The Declaration of Geneva (in 36 languages) (London) ; J. M. Campbell, M.D., Reports on Public Health and Medical Sub jects, No. 5: Maternal Mortality; No. 48: The Protection of Mother hood, Ministry of Health (H.M. Stationery Office, 1924) ; Report of the Proceedings of the Third English-speaking Conference on Infant Welfare (1924) ; Annual Report of the Infant Welfare Societies of Chicago (Chicago). (M. Box.) In the United States public health work essentially educa tional in character did not begin until the present century. The great increase in scientific information as to the pathology of disease, together with the development of a public-nursing tech nique, made possible a preventive programme. Before 1900 pub lic health activities were largely confined to the control of con tagious disease and sanitation. Thus, while the first school inspec tion was begun in Boston in 1894, the first health teaching in con nection with the schools was undertaken through the co-operation of the Henry Street Nursing Service in New York in 1902 ; and the present type of school health programme which seeks to in terest the child in the formation of good health habits began to be included in school curricula only about 1918.
The establishment of the first bureau of child hygiene, in New York city in August, 1908, began a new era in the child health program. In 1910 New York and Louisiana organized divisions of child hygiene in their State departments of health. The U.S. children's bureau created by act of Congress in the spring of 1912 was directed to "investigate and report upon . . . all matters pertaining to the welfare of children and child life among all classes of our people . . . and especially . . . the questions of infant mortality, the birthrate . . . and diseases of children," and under the leadership of Julia C. Lathrop began at once a se ries of studies of infant mortality, the publication of popular bulletins and co-operation in demonstrations of child health ex aminations, "baby weeks," etc. By 1920 child hygiene divisions had been established in most of the larger cities and towns and in the departments of health in 28 States. In 1921 the U.S. Mater nity and Infancy Act, popularly known as the Sheppard-Towner Act, was passed.