from 50 cents an hour to $2 a clinic when dentists used their own materials.

NURSING SERVICES

The 52 State plans included a total of 331 nurses on the State health-department staffs, paid in whole or in part from MCH funds; 26 of these were directors and 6 were assistant directors; 82 were supervisory or advisory nurses. Eighty-six were consultants, including 20 consultants in maternal and child health, 6 in obstetric nursing, 2 in pediatric nursing, 24 in hospital nursing practice, 32 in public-health nursing, 1 in school health, and 1 in oral hygiene. Twenty-three were nurse-midwives, and 108 were public-health nurses not otherwise designated.

Nursing units were reported as being separate divisions responsible directly to the State health officer in 35 States. In the remaining 17 States, the nursing service was part of local health service in 12, in the division of preventive medicine in 2, under maternal and child health in 1, in the division of epidemiology in 1, and in the division of rural sanitation in 1.

Fees to graduate nurses were reported in the plans of 13 States. The rates of payment to graduate nurses for home. delivery nursing service have been stated previously under "Home delivery nursing service." For postpartum care the fees ranged from $1 to $1.25 a visit, and for service at clinics, from 75 cents to $3 an hour and from $5 to $7 a clinic.

Thirty States provided postgraduate I staff education for a total of 61 State public-health nurses and 87 local publichealth nurses for periods varying from 2 weeks to 12 years. Special training in obstetric and pediatric nursing, ranging in duration from 3 weeks to 2 semesters, was provided by 13 States for a total of 103 hospital nurses.

The major MCH contribution to nursing service is of course in local areas, where several thousand publichealth nurses are paid wholly or partly from MCH funds.

NUTRITION

Forty-two State plans made provision for a total of 99 nutritionists on their staffs, including 9 designated as directors, 41 as consultants, and 49 as nutritionists. Another State employed

a physician as director of nutrition service.

In the plans of 33 States the nutrition unit appeared in the division of maternal and child health and in 4 additional States the nutrition personnel were listed with maternal and child-health personnel. Nutrition service was in separate units responsible to the State health officer in 5 States; under local health administration in 3 States; under health education in 2 States, and under the division of preventive medicine in 1. The plans of 4 States did not give this information.

Postgraduate education was planned by 8 States for 10 nutritionists each, for periods of from 6 weeks to 1 academic year.

MENTAL HYGIENE

The plans of 14 States described mental-hygiene services in operation. In 4 of these maternal and child-health division alone conducted these services; in 3, separate mental-hygiene units within the State health departments conducted them; and in 7, mentalhygiene services were carried on by other State agencies and unofficial groups, under the supervision of the State health department. These included State psychopathic hospitals, State departments of mental health, a State board of mental hygiene, a State mental hygiene society, and a State medical college.

The MCH plans and organization charts of 11 States indicated separate units, sections, or departments of mental hygiene, 5 within the State health department, 1 in the department of public welfare; 5 were separate State depart

ments.

Among the medical personnel previously enumerated are 6 physicians, who served in the mental-hygiene programs of 5 States, 2 as directors of mental hygiene and 4 as consultants. Four States included 5 psychologists and 3 psychiatric social workers in their programs.

New mental-hygiene services were proposed by 10 States, in 1 of which they were to be provided entirely by the maternal and child-health division, in 3 by the maternal and child-health division in cooperation with other official agencies; and in 6 by agencies other

than the division of maternal and child health.

In the other State plans no mentalhygiene services were described, either in operation or proposed. In 2 of these, however, a division of mental health had recently been created within the State department of health but was not yet in operation. In 1 State a section of mental hygiene was being created within the State board of health, and in a fourth State, departments of health and welfare and community groups were preparing a plan for such services, to be submitted soon to the State health department.

MEDICAL SOCIAL SERVICE

More medical-social workers were being brought into the maternal and childhealth service. Twenty-three States listed a total of 37 medical-social workers: 34 full-time workers and 3 others who divided their time between maternal and child health and crippled children's services. Of these positions, 13 were vacant at the time the plans were submitted, 12 full-time and 1 parttime. While these workers were concerned primarily with the emergency maternity and infant care program, they gave service also to the regular MCH program, and it is hoped that (Continued on page 14)

S

INCE THE END of the Second

World War in 1945, the rehabilitation of the shattered health of mothers and children in France has been a major concern for that country's Government. Although the particular needs of these population groups were recognized in France many years before the war, the facilities for safeguarding their health were admittedly insufficient in quantity and lacking in proper organization. In 1945 the Government made plans for reconstruction on a national scale of the resources for maternal and child health work, and it later placed on the newly organized Ministry of Public Health and Population the duty of transforming these plans into reality.

As a guide for carrying out this assignment an extensive body of legislation has set forth the principles and methods of a Nation-wide system of health services for mothers and children. This system, laying stress on the prevention of disease, is being gradually organized by utilizing the already existing facilities, with necessary modifications, and by developing new agencies where none exist. In this work the Ministry is aided by the social-insurance organizations, which, in France, as in other countries with well-organized social insurance, consider it financially advantageous to themselves to install facilities for preventive treatment with the aim of reducing ill health.

The organization of health work for mothers and for children under 6 years of age on a national scale was begun by the Government through a decree of November 2, 1945, and continued. through regulations at various times in the next 2 years. This decree calls for division of the departments (administrative sections of the French territory) into districts. Each district must have 1 prenatal clinic for every 20,000 inhabitants and 1 child-health clinic for children under 2 years of age for every 8,000

inhabitants; also facilities for the diagnosis of tuberculosis and for the treatment of venereal disease, and a laboratory with the necessary equipment.

Protection of mothers

At the prenatal clinics a free examination is given to expectant mothers three times during pregnancy, and another within a month after confinement. The first examination, to be given before the end of the third month of pregnancy, is aimed at the detection of syphilis, tuberculosis, nephritis, heart disease, and diabetes. An X-ray examination of the lungs and a blood test for syphilis are required in every case. In the second and third examinations, given in the sixth and eighth months of pregnancy respectively, the urine is tested for albumin. Within a month after the birth of the child, the mother is required again to present herself at the clinic; this time she is given a general clinical examination, a pelvic examination, and whenever possible an X-ray of the chest.

A father must also be examined whenever this is considered necessary in view of the mother's state of health.

Treatment is available free of charge to persons covered by social insurance, who constitute an increasingly large majority of the French people.

An important element in the protection of maternal health is the maternity benefit introduced in France several years before the Second World War. Since the end of the war France has been going along with other countries, notably England, Sweden, and Soviet Russia, in expanding the maternity benefits. This was done in France under a law of August 22, 1946, so that at present the following kinds of benefits are available there:

1. Childbirth benefits, payable under specified conditions in two installments, specified conditions in two installments, after the birth of a child;

2. Family allowances for the second and each subsequent child, payable

from the child's birth (or under cer tain conditions, from before the birth until the end of the compulsory school attendance period, and longer in som cases;

3. "Single wage" benefits for couple whose income consists of the wages o husband or wife only.

4. Prenatal benefits. The family al lowances and the single-wage benefits may begin before the birth of the child They are then called prenatal benefit and are paid from the day the preg nancy is reported to specified author ties. If the report is made during the first 3 months of pregnancy, the prenatal benefits are paid for the whole : months. The purpose of this is to encourage the mother to place herself un der medical observation early in preg

nancy.

According to a decree of March 6 1947, the childbirth benefits may not be combined with the maternity benefits paid under the social-insurance law, and therefore the former are paid only to women who are not covered by social insurance. They are paid from the national treasury. The other kinds of benefits are limited to persons who are covered by social insurance, with the Government assuming a part of the cost. Also, the employed mothers of France benefit by the childbirth convention of the International Labor Organization, which is in effect in many countries of the world (it is not in effect in the United States). Under this convention French women are prohibited from working for a specified time near the childbirth period and, as a compensa! tion for the loss of pay, they receive a! part of their wages. This is paid by the social-insurance organizations to their members; smaller amounts are paid by the treasury to women not covered by social insurance. Nursing benefits are also provided by law.

If a woman fails to present herself for the required prenatal and postnatal examinations and to follow the instructions issued to her on the care of her own health and that of the child, she loses her right to the prenatal and childbirth benefits and to the premiums which are paid for regular attendance at a prenatal clinic. This, however, does not apply to the nursing benefits, which are canceled only in case the woman fails to take proper care of herself and

:

the child as she is directed to by the social workers on the staffs of the prenatal and child-health clinics, who visit the mothers in their homes.

Protection of young child's health

An important factor in the safeguarding of child life is the child-health clinic, where the health and growth of the children are watched and the mothers are instructed in their care. Such clinics existed in France before the war, but at present efforts are being made to increase their number and to expand their work. Children less than 1 year of age are brought to the clinic for examinations at specified intervals. Regular attendance is rewarded by prizes in cash and in goods.

For every child brought for the first time to the clinic a health card is issued. This card must be preserved by the parents and presented at every subsequent medical examination of the child from infancy to the end of the schoolattendance period. The results of the examination and the prescribed treatment must be noted on the card, according to regulations issued in December 1946.

A social worker who finds that the benefits paid to the mother are not used for the good of the child or that a child lacks proper care must report this to the departmental director of public health. If a child seems ill, the worker advises the family to call a physician, and if her advice remains unheeded she refers the case to a physician engaged in child-health services.

For the greater effectiveness of the health work, pediatricians are to be appointed to act as technical advisers in maternal and child health to the departmental director of public health. In addition, these pediatricians may be entrusted with technical control over public agencies and private organizations engaged in maternal and childhealth work. According to a decree of May 22, 1946, each pediatrician acting in such capacity must have a definite territory assigned to him; one or more associates may be appointed for him.

Annual reports on the administration of the health services for mothers and for children less than 6 years of age in each department must be presented by the prefect to the Minister of Public Health and Population. The cost of

administering the services is shared by the National Government, the departments, and the communes (the smallest administrative divisions of French territory).

As an attempt to coordinate the health work for children under 6 years of age a Supreme Council of Child Welfare has been organized in the Ministry of Public Health and Population under a decree of January 8, 1947. The membership of the council includes several public-health officials, two pediatricians, and one social worker. The council studies all questions referred to it by the Ministry and serves as a liaison among the Government agencies of France that are engaged in child-welfare work.

Protection of school children's health

School children's health has been claiming public attention for many years; and school medical services have been gradually introduced in a number of cities by the municipal governments. These efforts, however, have been inadequate in organization, and have been able to take care of only a small part of the school children. Therefore the Government has undertaken, as a part of its postwar rehabilitation, to organize a Nation-wide system of health services for all school children during the entire school-attendance period.

The foundation for this work was laid down in the decree of October 18, 1945, concerning the protection of school children's health; this decree was followed a year later by regulations translating it into action.

These regulations, issued in November 1946, stress prevention of communicable diseases, particularly tuberculosis, in view of the children's undernourished condition. They require that all children between the ages of 5 and 6 years shall be vaccinated and that they shall receive a physical examination, including examination of the mouth and teeth. This plan is followed in order to allow enough time for the correction of defects before the child enters school.

Parents failing to present their children for such an examination are subject to a fine or imprisonment. Conditions requiring treatment are reported to the parents.

The results of each examination are noted on an individual health card,

which is issued to each child and is kept by the school authorities while the child is attending school. After that it is turned over to the parents. Children examined regularly

During the years of school attendance periodic examinations must be given to all school children. These examinations, like those given the child entering school, are free; but examinations by specialists and the laboratory tests are free only to children who are covered by social insurance; others must pay according to a fixed schedule.

The examinations are given by fulltime or part-time school physicians. In each department these physicians are under the supervision of a chief school (Continued on page 14)

"The chief victims in the families

N A COUNTY in the Southwest-a

I

rural county of 5,380 square miles

a child-welfare worker was talking about her work.

"Much can be done." she said, "for this county's children. But not for the children in the cotton camps. Those families are shrugged off by the county, by the folks as well as the officials. Even the State finds the job of helping them too big. These migrants are the American untouchables! Yet these families-children included-pick the crop; without them the growers would be sunk."

"What can be done for these children?" Her thoughtful eyes seemed to look for an answer beyond her own county to the continental expanse of 48 units woven into one great people: Surely that people is equal to caring for the children who follow the million miles of criss-crossing highways, back and forth across State lines-spending their babyhood in trucks, in shacks, on the edges of fields; spending their childhood working with their parents on the crops that mature somewhere every month of the year. Following rich harvests, they lose the advantages that are supposed to accrue to American children from the Nation's agricultural and industrial wealth.

What can be done for these children who move from crop to crop?

The Federal Interagency Committee on Migrant Labor offers an answer. In a report, "Migrant Labor; a Human Problem," published by the Retraining and Reemployment Administration of the United States Department of Labor, that committee restates, in national terms, what that local child-welfare worker said about the children in the cotton camps of her county:

"A sizable segment of our population," it says, "through community and State neglect, has been robbed of so many normal American and human rights that it is almost unbelievable. Child labor, substandard living, and a

padlock against education have destroyed the rights of children and drastically disturbed the integrity of family life among migrant workers. Estimates ranging from one to five million individuals comprise America's forgotten people of 1947, agricultural and industrial migrants. This equals the population of from 4 to 12 of our 48 States. Unorganized, . . ineligible for educational, health, or welfare benefits, . . . migrants migrants frequently find maintenance of even a minimum standard of living an impossibility."

The seriousness of the situation was recognized by the Twelfth National Conference on Labor Legislation, which was held in Washington late in 1945, representing 42 States, the District of Columbia, and Puerto Rico. This conference recommended organization of a Federal committee made up of the agencies having responsibilities toward migrant workers (these agencies are the Department of Labor, the Department of Agriculture, the Federal Security Agency, the National Housing Authority, and the Railroad Retirement Board). This committee, the conference decided, should study and report on working and living conditions and should work out a program to set standards for migrants equal to those set for other workers.

The committee was established in May 1946 under the authority of the War Mobilization and Reconversion Act of 1944. Now it has issued its re

port, describing actual conditions, and making recommendations in three parts: (1) Community and employer acceptance of their obligations toward migrant workers brought in for agricultural and industrial labor; (2) improved practices in recruiting, transporting, and placing migrant workers and in providing them with better housing, health, education, and welfare services; and (3) legislation, Federal, State, and local, to improve the working and living conditions of migrants.

"... are the children." Of the "background discussions," which r rate the difficulties and the remedies: them, the focus for readers of The Ch is "Child Labor and Education."

The report shows that much of t agricultural work these children do as undesirable for them as the work t children did in factories until legis tion forbade or regulated it. It sho the meagerness of current legislat protection, Federal and State, for the extremely young workers.

Frequent change from place to pla makes these children feel uprooted a: unwanted. Left to themselves day aft day they may develop serious physic and mental difficulties. The committ recommends tax-supported day-ca centers, with local people, employer and workers joining to plan and to p thought and effort into making the work.

Specific about the education of m grant children, the report declares th: not only do these children have a rig to the services of schools in whateve

community and State they reside in fo short times, but the schools have a dut to plan services especially for thes children, even though the services cos many dollars.

For example, a thorough servic might mean the employment of an ext supply or reserve of teachers or tuto: by State, county, or city school system Part of their duties would be to locat migrant children, to help them get int school, and to organize classroo groups when and where they wer needed. These teachers would be edu cated to understand the hardships these children had suffered arising from their changing home life, their irregula schooling, undernourishment, and the fears and hostilities created by their be ing discriminated against in many of their temporary homes. Courses and school equipment for older pupils are also suggested.

If we Americans sincerely want to prevent a caste system from growing up based on a gross difference in education. and the other necessities of childhood. the problems of the migrant family are the problems of us all.

Hilary Campbell

California Youth Committee Studies Transient Youth

California is acutely aware of the roblem of transient, migrant young eople. During the war an increasing umber of young workers flocked to the oast for war work, and the movement as continued and appears to be growng since the close of the war. Some are eterans who remember with pleasure heir days here; others have followed heir friends who are at work or in school.

Nonresident minors who get into dificulty are often passed on to the next ommunity by officials too overburdened o handle the problems, and many hunAreds are returned to their home communities in other States. San Diego, with the aid of State War Council funds, experimented in establishing a facility where these young transients could be held pending their acceptance by their own communities, whether within the State or without. The report concluded that communities, with the aid of State or Federal funds, could go a long way toward eliminating one of the most serious problems facing our Nation. It was concluded, also, that the transient problem is not only a local but also a State and Federal responsibility, requiring an intelligent and cooperative method of handling.

As the basis for a program for dealing with the young migrants, the California Youth Committee, appointed by the Governor in 1945, has received a grant of money from the Rosenberg Foundation of San Francisco to study the extent of the problem.

The plan of the study is to conduct surveys simultaneously in 14 cities on main routes into the State or in areas where present reports indicate that such youth are congregating. These are Los Angeles, San Diego, San Bernardino, Long Beach, Riverside, El Centro, Bakersfield, Fresno, Stockton, Sacramento, Redding, Salinas, Oakland, San Francisco. Information will be obtained regarding migrant or transient youth as they make contact with private and public youth-serving agencies. By repeating the census several times during the next 6 months, it is hoped that a picture of the problem can be secured, which will give the Governor and the California Youth Committee information and suggestions regarding plans for the adequate care of these young

newcomers.

Mary Bishop Perry, regional consultant, Child Labor and Youth Employ

ment Branch, Division of Labor Standards, United States Department of Labor, is on leave of absence to head the survey. Dr. Robert A. McKibben, chairman of the California Youth Committee, and Mrs. Paul Eliel, chairman of the executive committee of the Committee for the Study of Transient Youth, are working closely with the developing plans. State and local agencies dealing with youth will cooperate in the study. Mary Bishop Perry

Kansas Council for Children

Active

A Kansas Juvenile Code Commission of five members has been authorized by the legislature to study the laws of the State relating to children and to report their findings and recommendations, in the form of drafts of bills, to the Governor and the legislature by January 1949. The authorization specifies that this study and compilation of facts shall include "dependent, neglected, delinquent, emotionally and mentally disturbed children, and problems related to children in this State." The commission is also to "investigate the causes, prevention, and cure of juvenile delinquency." The sum of $12,500 was appropriated for the 2 years' work of this commission.

The Kansas Council for Children was active in the support of this and other legislation affecting children. Improvement of marital laws, the requirement that bread be enriched, and various desirable hospital and medical measures were passed. The vigilance of the council helped prevent the passage of two measures that would have separated certain work for children from the childserving agencies. The first of these was a bill to shift the children's institutions to the State Board of Administration. The second, which perhaps would have been even more damaging, was a proposal that juvenile homicide cases be placed under the jurisdiction of the District Court.

Among other work of the Kansas Council for Children this spring was cooperation with State public and private groups in planning and executing a conference on exceptional children, to which were invited an administrator and a classroom teacher from each and a classroom teacher from each school system in the State, workers in social and health services, and the faculty of the teacher-training institutions.

Colorado Improves Services

for Children

The Colorado Legislature in April 1947 passed a bill creating a children's code commission of five members to make a careful survey of child welfare and to report to the Governor and the general assembly by November 15, 1948. This is another step in the steady march of legislation and development of services in behalf of the children of the State.

Colorado has persistently improved its provision for services for children. After the Colorado White House Conference of 1932, the State Department of Public Welfare, with a child-welfare division, was established. As a result of State and Federal cooperation made possible by the Social Security Act of 1935, marked improvement in certain provisions for general welfare and for the health of children took place.

Ten years later, the 1942 Colorado White House Conference on Children in a Democracy adopted a report of a survey of conditions and services affecting children, which was made by 10 committees, including over 300 qualified lay and professional leaders. These studies revealed many "serious gaps in the program of the State for the protection and education of its children," such as insufficient health agencies, recreational facilities, and libraries accessible to rural youth; insufficient laws regarding supervision of the care of children in foster homes and of child adoption and placing; inadequate educational programs in the State homes for defective children and in the State reformatory, and inadequate regulation of employment of minors.

Soon after the war, interested citizens raised approximately $800 to aid the University of Colorado in a study of children's laws. The creation in 1947 of a children's code commission by act of the legislature is the next step in this ever-advancing program. The code commission is instructed to study the needs of children in matters which can be controlled or improved by legislative enactment and to consider also the existing laws, together with such "changes in the laws and additions to them as may be needed to embody the

best experience on those subjects both

in relation to ameliorating the conditions of children and preventing con.ditions which adversely affect the welfare of children." A sum of $7,000 has been appropriated for the expenses of this code commission.

Stella Scurlock

13