The efficient work done by the school nurses in New York City, and
elsewhere, though sadly restricted in its scope, suggests far wider
possibilities. If nurses were appointed in far greater numbers, at least
one to each large school, their functions might be enlarged. If, as has
been suggested, they were to receive special social training, possibly
at the expense of part of their present medical training, they might
attend to the needs of those below school age as well as of those
enrolled at school. Above all, they might be made a potent means of
educating the mothers. It has been found that visiting nurses attached
to the schools receive cordial welcome as a rule, are not viewed with
suspicion as other officials or philanthropic visitors are, and have a
correspondingly greater influence. The weak point in such a proposal
lies in the fact that the school nurse would not, if her work was based
upon the school registration, reach those families not represented in
the schools. Thus the most important cases of all, educationally, young
mothers with their first babies, would not be reached.
Elsewhere I have referred to the efforts made in some cities to educate
mothers by the distribution of leaflets and pamphlets upon the subject
of infant feeding and general care. Some of these leaflets and pamphlets
which I have seen are models of concise lucidity, and their wide
distribution among mothers intelligent enough to profit by them would be
of great value. One of the first difficulties presented when this plan
is attempted upon a large scale is the efficient distribution of the
literature. To accomplish anything at all, the literature must be
printed in the various languages represented in the city’s industrial
population, and it is no easy matter to see that each mother gets
literature in her own language. Quite recently, I heard of a tenement in
which there were families representing no less than fourteen
nationalities, and in which lived Mrs. O’Hara, a German, speaking little
English! Added to this difficulty is the expense of distribution. If
sent by mail,—and in large cities no other method seems possible,—the
cost is enormous. To send a single circular to the registered voters of
New York City, for instance, requires an expenditure of upwards of
$60,000 for postage alone.[168] There would seem to be no good reason
why the Federal Government should not authorize the Health Boards to
send all such educational matter through the mails free of cost. Why
should the Health Department of a city not have the privilege of a local
frank? Nothing could well be more foolish than the system under which
the city, while performing a national service, must pay the national
post-office for doing its share of the work.
Many of the mothers, especially of our immigrant population, are quite
unable to read, and literature is wasted upon them. It will be seen,
therefore, that the propaganda of health by literature is subject to
several important restrictions. While admirably adapted to simple,
homogeneous communities in which there is a small percentage of
illiteracy, it fails to meet the needs of our great cosmopolitan cities.
If it were possible to have all births reported at once to the Health
Department by telephone, in order that each case might be visited by
special maternity nurses, it would be comparatively easy to give
special, personal attention to those cases in which literature would be
worthless. This plan has been adopted in Australia with conspicuous
success. The State Children’s Department appoints women inspectors to
visit the children of the poor. These nurse inspectors have to report,
not only upon the condition of the homes, but of the children. The
mothers are furnished with printed instructions as to the kind of food
to be given, the proper quantities, methods of preparation, and times of
feeding. If the child does not thrive satisfactorily, the nurse
inspector calls in one of the physicians of the department. If milk
cannot be properly assimilated, something else is tried. In short, all
that skill and care can do to protect the lives of the infants is done,
with the result that the infantile death-rate has been reduced from 15
per cent to 8 per cent.[169]
[Illustration:
A MAKESHIFT: HAMMOCKS SWUNG BETWEEN THE COTS IN AN OVERCROWDED DAY
NURSERY
]