1, 1917, one of the regular staff of the State supervising nurses was again assigned to the after-care clinical staff as executive nurse, having acted in this capacity since the inception of the clinics in the fall of 1916. This nurse remained with the clinics until she was called into military duty on February 1.

One of the after-care supervising nurses was taken from her district to act as chief examiner at the clinics, assisting the orthopedic surgeon. During her absence from her district her territory was covered by the nurse in charge of the adjoining district. Many of the patients (277) having serious deformities as a result of the effects of the disease, either during the 1916 or previous epidemics, required operative treatment. For these cases the nurses secured admission in either the State Hospital for Crippled and Deformed Children at West Haverstraw, or in the Hospital for Ruptured and Crippled at New York city, where they were operated on by the attending surgeons, after which their care was again supervised by the after-care nurses.

The gratifying results of this intensive system of follow-up by the supervising nurses in the after-care work is detailed in the report of Dr. L. W. Hubbard, the orthopedic surgeon, in charge of the work.

On April 1, in addition to the supervision of the nurses. engaged in the "after-care" work, I was assigned as Acting Director of the Division of Public Health Nursing of the Department, thus taking over the direction of the work of the six state supervising nurses who have been engaged in public health nursing since the organization of the Division. The activities of these state supervising nurses are best shown by the following table:

Mills

Whitestown

Grand Island.

Watervliet.

Medina

Liverpool

Schenectady

Cuba

The activities consist of:

1. Prevention and control of tuberculosis.

In the prosecution of this work, tuberculosis surveys have been made in five counties during the year, to discover the number of cases of the disease and to learn what provision existed for their care. Due to the enactment of legislation making it manatory for each county having a county tuberculosis hospital to employ a county nurse, five counties in which hospitals have been opened during the past year have recently employed county nurses and their work in their respective counties had to be organized. In each county employing such county tuberculosis nurse, a state supervising nurse, trained in the field work of finding tuberculous cases and well acquainted with the procedure of securing proper diagnoses, the admission of patients to sanatoria, or home treatment of the same, has been sent to accompany the county nurse in her district and to acquaint her with the procedures necessary to secure such medical aid or material relief as was found necessary through existing municipal officers or social welfare agencies. A standard system of reports to be used by county tuberculosis nurses in rendering reports to the board of managers of county tuberculosis hospitals has also been devised. Thus the work of each county tuberculosis nurse has been standardized and her activities supervised by this Division.

2. Prevention of infant mortality.

The duties of the nurse assigned to this work consists of assisting local communities in inauguration of campaigns by means of surveys of local conditions, child welfare and milk exhibits, talks, demonstrations and distribution of literature on the subject of infant care. In cooperation with the Department of Education the nurse assigned to this work has endeavored to secure the formation of "health leagues" in the various schools throughout the State.

3. The supervision of midwives.

During the past year the supervision of midwives has been placed under the jurisdiction of the Division of Vital Statistics of the Department, and a state supervising nurse, having received special instruction in the supervision of midwives, has been assigned to the work. This nurse has obtained the licensing of

approximately 500 midwives practicing in the State, has secured the prosecution of women practicing without the necessary qualifications in three instances. She has also held classes for the instruction of midwives in the larger centers of the State in an effort to make these midwives efficient attendants on normal cases of childbirth, to reduce infant mortality and to improve birth registration. The supervision of midwives under the direction of the Vital Statistics Division, with the assistance of a full-time nurse, places the work upon a basis far more satisfactory than ever before.

4. Investigation of birth registration.

In selected communities where the records filed in the State Department show high infant mortality rates, investigations are conducted by the supervising nurses to learn if all the births occurring in such municipalities have been properly recorded. In many instances, by a house to house investigation many children are found whose births have never been recorded. On further investigation an unlicensed midwife is found practicing in the community, or one or more physicians are discovered violating the Vital Statistics Law requiring the prompt registration of a birth within five days of its occurrence. In this investigation the nurses have been assisted by access to baptismal records in the churches. Birth registration has been investigated during the past year in twenty-one different municipalities in the State, and in one county (Dutchess) an investigation was made to ascertain the development of obstetrical work in a typical rural community. This investigation brought out the need of better supervision of the mothers by the nurses in rural communities before, during, and after confinement.

5. Health surveys.

These surveys were made to determine the nature and amount of illness present in any given community and to learn what proportion of such illness was preventable. Such surveys were made in thirteen different municipalities in the State. Following these surveys measures were undertaken by the Department to bring the facts in each instance before the communities investigated and to formulate a plan whereby the toll from preventable illness might be lessened. In two of the largest second-class and in