DR. PHILIP VAN INGEN'S PAPER 359 



of the home country. One can walk for many blocks 

 in certain sections of the city and not see one word 

 of English displayed in the windows, or hear one 

 spoken, except by the children of school age. Over 

 one-half of the confinements among the poorer parts 

 of the city are attended by midwives. Our situation 

 in regard to the midwife is not so fortunate as that 

 here in England. Supervision is poor, owing to the 

 enormous amount of work which the Division of 

 Child Hygiene of the Health Department has been 

 obliged to assume without sufficient funds for carrying 

 it on. Instruction has only just been begun, and that in 

 the face of strong, and, I think, misguided opposition. 



Such are the conditions under which we have 

 worked, and we have chosen the districts where they 

 are at their very worst, our object being to see what 

 can be accomplished under existing conditions. The 

 conditions are in urgent need of correction, but years 

 must elapse before that can be accomplished, if it 

 ever can, and meanwhile the babies are dying. 



The work is carried on by eight trained nurses, 

 under the supervision of a directing nurse and a field 

 physician. Two volunteer medical directors have 

 general direction of the work, and a medical council 

 stands ready to advise as to methods and special 

 matters which come up. The nurses were chosen 

 with the greatest care, for patience, tact, and devo- 

 tion are unusually necessary in this work. They 

 were given a thorough preliminary course of instruc- 

 tion in the hygiene of pregnancy, the causes of the 

 mortality during the first month of life, and the great 

 importance of maternal nursing. They were obliged 

 to thoroughly acquaint themselves with the existing 

 facilities for relief in all kinds of emergencies. Then 

 they were sent into their districts. They come in 

 touch with expectant mothers by house to house visit- 

 ing, and by co-operation with the municipal milk 

 stations (which are really baby welfare centres), relief 



