Public Health Is Purchasable. Twenty-five Thousand Lives Can Be Saved In New York State Within The Next Five Years HERMANN M. BIGGS, M.D. PUBLIC HEALTH NURSING NUMBER WHAT USE CAN I MAKE OF VITAL STATISTICS IN PUBLIC HEALTH NURSING PUBLIC HEALTH NURSING AND TUBERCULOSIS THE PUBLIC HEALTH NURSE AND THE PROMOTION OF CHILD HYGIENE Monthly Bulletin New York State Department of Health MATTHIAS NICOLL, Jr., M.D., Editor Public Health Nursing and Tuberculosis, Otto R. Eichel, M.D................... The Public Health Nurse and the Promotion of Child Hygiene, Henry L. K. The Management of an Outbreak of Typhoid Fever, F. M. Meader, M.D.... The Public Health Nurse and the Well, Theodore Horton, C.E..... Are Rural Health Districts in Need of a Health Centre, C. Josephine Durkee.. JUNE, 1916 PUBLIC HEALTH NURSING A new impetus was given to public health nursing in New York State by the enactment of general amendments to the Public Health Law and to the Education Law during the 1913 session of the Legislature. The amendment to the Education Law authorized local boards of education to employ school nurses to assist in controlling communicable disease in schools and to take part in the physical examination of school children and the amendment to the Public Health Law authorized local boards of health to employ public health nurses whose qualifications shall be determined by the Public Health Council of the State and who shall work under the direction of the local health officer. These two laws made the first official recognition of public health nursing in New York State. Since the enactment of these two laws the number of nurses employed by local boards of education and local boards of health has steadily increased until now there are 81 communities outside of New York City that have public health nurses employed either in school inspection work or in public health work, under the direction of the local health officer, or employed in both capacities. Constant demands are being made upon the Department of Health of the State for assistance in securing nurses who can interpret vital statistics, who can study the causes of infant mortality and render aid in removing these causes, who can supervise midwives, who can assist in the detection of cases of tuberculosis and other communicable diseases, who are familiar with the various methods of securing admission of tuberculous patients to suitable hospitals and sanatoria, and who can not only be of assistance in ascertaining physical defects in school children but who also have the ability to assist in having these defects remedied. The State Department of Health realizes the importance of this nursing work and desires to render assistance with the limited forces at its command to all public health nurses throughout the State, hoping that through its supervising nurses and sanitary supervisors it may steadily increase the value of public health nursing. WHAT USE CAN I MAKE OF VITAL STATISTICS IN PUBLIC HEALTH NURSING CRESSY L. WILBUR, M.D. Director, Division of Vital Statistics In her important work for the saving of lives, the public health nurse desires to avail herself of every possible scrap of assistance, no matter how unpromising may be its source. Hence the appeal to "vital statistics." How can vital statistics be of service? In general, in two ways: (1) as statistical data for measuring and comparing the actual conditions of mortality, with a view to obtaining definite evidence of their amelioration as a result of public health work, and (2) as official records, furnishing a basis for intensive study of individual cases. In the beginning it must be understood that statistics relate properly to masses, that is to say, considerable numbers of events. A few observations can not afford real statistical evidence pro or con. A practical test is to observe whether one or two, or perhaps a very few, additional cases would markedly change the indications, as for example the rate of infant mortality. If so, the data are too few for definitive rates. Hence monthly rates, especially for small places, should be used only as "straws" to show which way the wind of fatal illness was blowing for the moment. Refer also to the issue of the OFFICIAL BULLETIN containing the last annual rate, based upon a full year's returns. Even this, for small places, must be checked by examination of the rates for several previous years in order to know whether infant mortality, for example, was persistently high or low, or varied widely from perhaps accidental causes. What is "infant mortality"? How computed? How computed? In Niagara Falls there were, for example, 1,358 children born alive during the year 1915 and also, during that year, 166 deaths of infants under 1 year of age. (Both births and deaths exclude stillborn children, of which there were 68 reported. What were the causes of these stillbirths and how many might have been born alive through proper prenatal care?) Divide the number of deaths of infants under 1 year by the number of children born alive and we have: 0.122. It is convenient and conventional to express this ratio as a whole number based upon 1,000 births, hence the numerator of the fraction may be multiplied by 1,000 before division or the quotient be multiplied (by omitting the decimal point) so that the rate, as ordinarily expressed, is 122 per 1,000. 166 In April, 1916, there were in the same city 119 living births and 16 deaths of infants under 1 year. The monthly rate computed in the same manner as above, is 134. This would apparently show somewhat more unfavorable conditions for the month with respect to infant mortality, but note the small number of cases involved in the monthly rate. With only two fewer deaths, the ratio would have been 118, or less than the average for the preceding year. Examination of the actual returns, with special reference to the causes of death as reported by the attending physicians, may show that there were few or no deaths due to communicable or preventable diseases -nothing suggesting preventive sanitary action. Hence the lesson not to place undue stress upon minute and accidental fluctuations of the infant mortality rates, although watching them closely and, above all, studying the causes of the deaths of infants and young children as revealed by the original certificates or the exact copies which are kept on file in the office of each local registrar of vital statistics. The value of the statistics for a given community also depends upon whether all the births and deaths are registered as required by law. There are more likely to be omissions of births than of deaths, hence in your work among young children it is well to note their names, dates and places of birth and ascertain, by examination of the local register, whether they have been duly recorded. Allowance should also be made. for births and deaths in maternity hospitals not properly chargeable to the population of your district, as well as for deaths of children belonging to the district in hospitals located outside. It is a part of the public health nurse's duty to consult the birth and death registers, to inspect all births unattended or attended only by midwives, and also, under certain circumstances, births attended by physicians. With knowledge of the personal and family conditions, the question may be asked in each case: Was this death preventable? And if so, what could I do, in a similar instance, to avert it? Ask the aid of the Health Officer in studying the records. Also refer to the Physicians' Pocket Reference to the International List of Causes of Death, with its suggestions as to vague and indefinite causes. Diarrheal diseases are especially important in the first and second years of life. Congenital debility"- malnutrition, marasmus, etc., under this head — and premature birth taken together cause even more deaths in the first year; what better prenatal care can be provided? Pneumonia and bronchopneumonia also cause many deaths, some of which are due to antecedent infectious diseases. Go behind the returns, whenever necessary, endeavoring to get at the true causes and conditions of infant and child mortality. |