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HERMANN M. Biggs, M. D., State Commissioner of Health,

Albany, N.Y..

DEAR SIR.— I have the honor to transmit herewith the Annual Report of the Division of Child Hygiene for the year 1917.

The exigencies following our entrance into the war during the past year have largely affected both the progress of the work in the Division and the activities for child welfare in the field. Early in the year the Director, Dr. Henry L. K. Shaw, received a commission as Major in the Medical Reserve Corps, U. S. A., and at once responded to his country's call.

The temporary vacancy thus created was filled by the appointment of Dr. Edward Clark of Buffalo as Acting Director of the Division.

The year 1916 has been recorded in the annals of public health of this State as the year of the great epidemic of infantile paralysis. This epidemic was sudden in its onset, so unexpected, and left so many crippled victims requiring careful and long continued after-care, that public efforts were somewhat diverted from the regular channels for child welfare to meet this new issue. Unusual efforts for child welfare along these lines had been put forth in all communities during 1916 and a reaction in 1917 was to be expected. Then came the entrance of the United States into the great world war, just at a time when it was hoped that efforts for child welfare throughout the State would be renewed along such lines as had been established prior to the appearance of the epideniic. This was not the case however, for matters pertaining to the preliminary preparations for effective war service organization absorbed the larger part of public attention, time and means, and for this reason the regular advancement of child welfare work was again inhibited for a time.

Although somewhat handicapped in 1917, the Division of Child Hygiene has endeavored to carry out the purposes for which it was created, and a careful study of the work accomplished by its field and office force during the past year will show that this has been of great benefit. The year 1918, however, bids fair to accomplish cren greater results than were attained in any year since the establishment of the Division of Child Hygiene in the State. This will be due to the special efforts to be made by all agencies having to do with child hygiene, to conserve the interests: of all children throughout the State.

Infant welfare campaign It has been the constant aim of the Division to utilize the best: means for reducing the infant mortality in the State through constructive educational work. As in former years, every effort was made to bring the matter of child life conservation prominently before the public. Through the media of the public press, addresses, lectures, practical demonstrations, baby health conferences, children's day sermons, exhibits and distribution of child welfare literature public interest was enlisted throughout the State. As a result new infant welfare centers were established and are now being maintained as a part of community health work. A comparison of the infant death rate in cities where infant welfare stations have been established and maintained

year after year, with the infant death rate of cities where such stations have not been established or have been abandoned for one reasoL or another after a year's trial, shows that in the former the infant mortality rate is constantly diminishing, while in the latter it is just as constantly increasing. Taken in connection with the fact that one-half of the deaths of infants is due to preventable causes, this would seem to demand that all communities of 10,000 or over te urged to attain a fifty per cent saving in infant lives: by the establishment of one or more infant welfare stations and the appointment and support of one or more visiting trained


Little Mothers Leagues were formed in many parts of the State for the practical education in health matters of young girls, upoz: whom devolves to a large extent the care of the infant and the children of pre-school age in the home, particularly after school hours and during the summer vacation. The “Little Mothers " League is a name given to classes consisting of girls twelve to

sixteen years of age, which have as their object the instruction of their members in all practical matters relating to the infant and ihe child of pre-school age. The instruction given these girls by a competent trained nurse is carried out in a practical way, by actual demonstration, by example and by free discussions. The girls put the knowledge thus gained into practical operation in their homes, and from everywhere come reports of the excellent service which these well-informed “Little Mothers" are rendering in their own homes under the supervision, at all times, of their parents.

County fairs As the time approached for the holding of the annual county fairs throughout the State the Commissioner determined upon a campaign to aid the Federal authorities in the conservation of food in the State. The county fair at once suggested itself as a means through which several hundred thousand citizens in the State and through them many more thousands could be reached and taught in a practical manner the relative value of the various foodstuffs and their relation to health. The Acting Director of this Division was therefore delegated to visit county fairs and combine this work with his talks on Child Hygiene. One hundred and forty-six addresses were given by him in thirty-four different cities and towns, at fairs, schools, clubs, boards of trade, etc. During September and October many county fairs were visited, a food exhibit installed, and large quantities of literature relating thereto distributed. This work was pronounced a great success by those in attendance at the fairs. The average zumber of persons addressed at the fairs at Hornell, Cortland, Gouverneur, Ogdensburg, Cape Vincent, Palmyra, Ithaca and the Rochester Exposition was 3,000. The usual subject of address was “Food and its Relation to Health "

Infant welfare nurses

The work of the infant welfare nurses of the Division has been planned and carried on with a view to a reduction of the infant mortality rate, wherever it has been found possible to do so. To this end a preliminary survey of the local health conditions was

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