WM. H. WELCH, M. D. 91 



An interesting question is raised as to what shall be the 

 relation of such municipal official work to that of private 

 initiative and private organization. I do not think it is pos- 

 sible to draw a very sharp line here. Very often work 

 which is begun by private initiative can then be taken over 

 more successfully by the municipal or State boards of health 

 than if they were called upon to initiate the work. I mean 

 that it is, at least so far as our experience here in Baltimore 

 and Maryland goes, often the case that work which is under- 

 taken by some private organization or some public organiza- 

 tion, which, however, is not connected with the Government, 

 and which is carried on to a certain point, can then be taken 

 over by the Health Board to a great advantage. A very good 

 illustration of that is our experience with tuberculosis work. 

 It became perfectly evident that our State Association for the 

 prevention of tuberculosis was doing work which, properly 

 speaking, did belong to the community or to the government. 

 We felt that we should have stood very little chance of get- 

 ting an adequate appropriation from our City Council if we 

 went there without any demonstration as to what could be ac- 

 complished by this system, so we employed a certain number 

 of tuberculosis nurses and it became apparent that we were 

 doing an immense amount of service to the community. With 

 that as an argument we appeared before the Mayor and City 

 Council and we had no difficulty in persuading them to make the 

 requisite appropriation for carrying on the work. And I imagine 

 that is only one example of many that might be cited and possibly 

 it may serve as a guide in this work of prevention of infant 

 mortality. 



It is evident from the programme that one topic, that of mid- 

 wifery, was not included on the official programme. It is largely 

 in consequence of the omission of that and the recognition of 

 its great importance that I think this meeting should not go 

 by without at least some discussion of this very important 

 question, and I would like to emphasize its importance in all 

 that relates to the care and preservation of the health of infants. 

 We encountered it here in our efforts to do something in the 

 cause of the prevention of blindness. It requires, I think, no 

 special argument to appreciate the importance of this subject in 

 this campaign for the prevention of infant mortality, although the 

 question is one to which we have rather shut our eyes in the past. 

 It is, of course, a department of the practice of medicine, but 

 one might say an outlawed department of the practice of medi- 

 cine in this country, and the same is true to a great extent 

 in Great Britain. Physicians have here ignored the practice 



