258 METHOD OF DETERMINING INFLUENCE OF PHILANTHROPY 



tions, but no comprehensive scoring plan has been adopted which 

 would include in its scope all conditions which influence the care, 

 the physical condition and the living- powers of the infant. 



The method herewith presented consists of a statistical score 

 card and is designed for the collection of facts to determine the 

 influence of environment, of management, of nourishment and 

 of morbidity upon the viability of the infant and by a graphic 

 chart to show the improvement in viability during a given time 

 through the activities of medical philanthropy and educational 

 work directed to the betterment of the conditions which influ- 

 ence the lives of infants. (See pages 261-264.) 



Such a plan should be flexible enough to be easily adapted to 

 any line of medical work with infants either in the hospital, 

 the clinic or institution and through which the children may be 

 followed to their homes and kept under observation for a con- 

 siderable period after the institutional treatment has been termi- 

 nated. 



On general principles, the larger the number of individuals 

 tabulated, and the wider the area from which statistics are 

 gathered, the more accurate the results in estimating the value 

 of factors in sickness or death. In this way the findings of 

 federal agencies may be more accurate than when smaller num- 

 bers within narrower limits are tabulated, but while such official 

 statistics are of great value in the determination of mortality, 

 they lack certain important features of accuracy which char- 

 acterize all data which depends for its collection upon the will- 

 ingness of the individual reporting to comply with the letter of 

 the law. 



It is also true that when investigations are voluntary, there 

 is usually more attention paid to detail and they may be extended 

 to include facts impossible to obtain through the compulsory 

 method directed by municipal and federal bureaus for gathering 

 vital statistics. 



In order to make satisfactory use of the method herewith 

 presented, it is best to carry the investigations beyond the hospi- 

 tal, clinic, or consultation. It will require the work of a phy- 

 sician to determine the physical condition of the child and to 

 write its medical history. It also requires the service of a vis- 

 iting nurse to see the case periodically in its home, to weigh it 

 and mark the weight chart, to make records of the environment, 

 the hygiene, the management and care; to instruct the mother 

 or care-taker, to note any subsequent or intercurrent illness and 

 to make records of progress in any or all of the conditions 

 involved. 



The scoring, which should be done once each month, requires 

 the physician's judgment to correctly estimate the value of the 



