away from the curd. This removes much of the sugar and salts of the milk. The curd is then broken up by passing several times through a fine strainer and mixed with a pint of water and a pint of lacto-bacillary milk. This food is fed uncooked and is one of the best foods used in this condition.

In the care of babies always know the character and the formula of the food you are using whether breast or modified milk. Never increase the food if the baby is gaining unless it seems very hungry. In very hot weather reduce somewhat the amount of food.

PLANS OF THE DIVISION OF CHILD HYGIENE
HENRY L. K. SHAW, M.D.

Director, Division of Child Hygiene

The Child Welfare Exhibit has been in constant use since the beginning of the year and until recently was shown almost exclusively in the northern tier of counties. Canton, Malone, Saranac Lake, Plattsburg, Ogdensburg, Norwood, Watertown, Rome and Carthage were visited and as a result six new infant welfare stations are in process of organization. In several places, where it did not seem feasible at present to maintain such a station it was decided to employ the services of a public health nurse to carry on this work. A number of the cities and larger villages, where no infant welfare work is in operation, have made requests for an exhibit to be shown and it is planned to visit as many of these localities during the summer months as can be arranged. It has been found that the demonstrations and talks make an especially strong appeal to the people living in the smaller villages which, because of their very remoteness, are often deprived of such advantages.

The necessity for more thorough and systematic efforts along the lines. of prenatal care and instruction is patent. Even a modicum of instruction given to an expectant mother as to her diet, clothing, etc., and a careful observance of the rules laid down, will go far towards lessening infant mortality which in the first month of life contributes, from the so-called congenital diseases, about 40 per cent of the deaths occurring in the first year. This figure has as yet shown no material reduction in spite of the fact that the general mortality in the first year has been greatly reduced, and a careful study of the problem indicates that it can only be affected by the education of the mother before her baby is born. This work with the expectant mother, wherever in operation, has been rewarded by a striking decrease in the mortality of the babies whose mothers had received this special care and instruction, and it can not be too strongly urged as a leading activity to include in the regular duties

of visiting nurses and nursing associations. The infant welfare nurse pays especial attention to this feature of her work and it assumes a prominent place in every exhibit curriculum.

In connection with our Child Welfare Campaign for the summer months, which has as its prime motive the bringing of correct information to the mother and those who have the welfare of children at heart, it is hoped to impart such instruction as will tend to reduce the very high mortality of the first two years of life which is induced by a variety of respiratory diseases. An effort will be made wherever an exhibit is held to emphasize the necessity for the proper use of fresh air, attention to slight colds and bronchial affections, and the provision of suitable clothing for the different seasons.

Not only have the exhibits become admittedly potent factors in the reduction of infant mortality but various other agencies are being constantly enlisted. An inquiry is now in process to obtain data as to the nature of the work being performed by the various day nurseries in the State outside of New York City. The high ideals and concepts of the home should be maintained as far as possible by these organizations and it is the purpose of the Division of Child Hygiene to secure their cooperation in order that the principles of child welfare may be fully outlined and carried into effect by those who are earnestly laboring to provide proper training not only for the babies but for the mothers as well. Only too frequently has it been demonstrated that the latter are untaught in the smallest essentials of correct infant care, but they are usually found willing to learn and respond readily to suggestions affecting the welfare. of their children. These institutions which are, for a few hours at least, the homes of very many babies, can not be too thoroughly imbued with the importance of their work; not only is there a vast opportunity presented to instill correct habits in the young child that will ensure its health and happiness in later years, but many problems dealing with infant mortality find a happy solution in the care and training given at the day nurseries.

It has been definitely ascertained that children who are forced to become bread-winners do not now receive a thorough physical examination to determine their fitness for such employment. Moreover, the examinations required by law afford no satisfactory information as to whether physiological standards are being maintained for these growing toilers, nor as to the effects of such occupations and confinement on the health of the child. Great possibilities for remedying these evils lie in a study of the child labor question, and cooperation with agencies dealing with this problem are planned as an additional feature of our life-saving campaign.

WASH YOUR HANDS

HELEN JOHNSTON

Department of Health Education, George Peabody College for Teachers, Nashville, Tenn.

E. L., a student at the university of Wisconsin, was employed in a boarding-house to scrape, wipe and stack dishes. When the university opened on the first of October, 1908, he was not well, and, as his condition did not improve, he consulted an oculist with regard to frequent headaches. Relief was not obtained; and on the thirtieth of October he returned to his home where he died within two weeks of typhoid fever. During the last week in October a number of persons in the boardinghouse at which E. L. was employed, became ill; and in less than a month forty-one cases of typhoid occurred among those boarding or working there. After a most careful study of the epidemic and of all its possible causes, the State Hygienic Laboratory placed the blame for the outbreak upon E. L. During all those wretched days he had been harboring typhoid bacilli, which were expelled from his body at each visit to the toilet. His fingers, moistened with urine or soiled with excreta, became infected with germs which were transferred to the dishes and thence to the food. Ledingham and Arkwright, in "The Carrier Problem in Infectious Diseases" relate the following interesting history of a urinary carrier. Twenty-four cases of typhoid occurred among soldiers of various regiments stationed near Kilworth, Ireland, in 1909. The twenty-four men had drunk milk from the dairy of Farmer O'Neal. Upon examination of the members of O'Neal's household, it was found that a dairy-maid. was expelling typhoid bacilli in her urine. In 1903 she had been ill with typhoid fever. Six months after her attack she had returned to her duties at the farm, and in a little while O'Neal and his child developed typhoid. In 1906 she entered the employ of another farmer. During her residence at this place her employer's wife and three children and a hired man's wife and child fell ill with typhoid. In November, 1908, she returned to O'Neal's. In December a carpenter, who drank milk from O'Neal's, and two of O'Neal's sisters came down with typhoid fever. In February a visitor at the farm developed the disease; and in the same month the post office clerk who bought milk from O'Neal suffered an attack. His case was followed by that of the twenty-four soldiers. In six years the unclean hands of this dairy-maid had been responsible for the illness of forty persons.

The "Acme", a lumber steamship plying between ports along the California coast, became known as the "fever-ship ". During a period of three and one-half years twenty-six sailors had succumbed to typhoid.

An investigation of the cases aboard the "Acme" was undertaken by Dr. W. A. Sawyer, Director of the State Hygienic Laboratory at the University of California, upon the request of the State Board of Health. It involved not only the usual sanitary surveys and laboratory tests of blood, urine and feces, but a study of the records of the United States Marine Hospitals at San Francisco and Los Angeles, the names and dates of the back pay-rolls of ship owners and interviews with four of the early patients.

The conclusion was that the twenty-six cases of typhoid on the steamer "Acme", and one earlier case on the "Artic" had been caused by a carrier H, who had been ill with typhoid four months before the infection of his first victim. H. had nothing to do with the preparation or handling of food. It was the opinion, however, that water in a cask, into which the crew was in the habit of dipping a drinking cup, had been contaminated by his hands.

On March 17, 1914, a church dinner was served in Hanford, California. Three days later there began the development of a typhoid epidemic, in which ninety-three persons suffered. Dr. W. A. Sawyer went to Hanford. After a tireless, far-reaching investigation the details of which are of compelling interest, Dr. Sawyer stated the source of the infection to be a carrier, Mrs. X.

Her contribution to the dinner was a pan of Spanish spaghetti which, in the course of preparation had become infected from her hands. That the baking of the food had not freed it from infection was proved by an experiment made in the State Hygienic Laboratory. Spaghetti prepared as Mrs. X. had prepared hers, was inoculated with typhoid germs and baked "until the surface was dark brown; the points sticking up. from it, charred; the liquid around the margin, boiling vigorously; and the whole dish sizzling." When the temperature of the mass was taken it was found that while the thermometer registered 181 degrees F. at the surface, it registered only 82.4 degrees F. in the interior. Spaghetti taken from the surface was free from germs; but that taken two and one-half inches below the surface near the center showed typhoid germs in abundance.

Mrs. X. herself had never had typhoid fever. Thirty-five years before, however, she had nursed her daughter through an attack, and "she may have received her infection then," for it was proved by laboratory methods that she was a carrier and that her "infection and immunization" had not been of recent date. Investigation revealed the fact that in previous years four persons who at different times had boarded at the home of Mrs. X. had become ill with typhoid fever. Thus the number of her victims reached the known total of ninety-seven.