Helen M. Wallace

The Inadequacy of Routine Reporting of Fetal Deaths : As Evidenced by a Comparison of Such Reporting with Maternity Cases Paid for under the Emergency Maternity and Infant Care (EMIC) Program

PUBLIC health workers for many years have been greatly concerned with the reduction of infant mortality. Important as such reductions are, it is becoming increasingly clear that the saving of lives lost after birth is only part of the problem of preventing loss of life in this period. Thousands of prospective lives are lost each year through deaths of viable infants born at or near termination of pregnancy, representing a tremendous wastage of pregnancy. For example, in 1947 the number of infant deaths (i.e., deaths within the first year of life) reported in New York City was 4,517, while the number of fetal deaths reported was 14,077. Bringing a larger number of these fetuses to a later stage of pregnancy enhances the chances for a live birth. More and more, then, it becomes important to focus on the problem of fetal deaths. Before attacking the problem, one has to know the extent of it. Many attempts have been made in different countries and within the United States to obtain

The opinions of private physicians of a medical care program; experience in the emergency maternity and infant care program in New York City.

Abstract The opinions of all physicians (a total of 5,575) who themselves cared for EMIC patients in New York City during World War II were solicited through a questionnaire with specific questions to which “yes” or “no” or “no opinion” answers could be given. About 50 per cent of physicians responded and this group of respondents was found to be representative of the entire group who cared for patients. Data were secured through three separate mailings and one telephone inquiry to a random sample. The similarity of the data so collected and the unusually large number of returns make it sound to conclude that this study reflects reasonably accurately the opinions of all the physicians in the community who cared for EMIC patients. About 90 per cent thought the program reached its objective of raising morale. Slightly fewer, but still more than three-fourths of the total, were satisfied with the procedures of application and authorization and with the general administration of the program. More than 90 per cent were satisfied with the method of payment directly to the physician and only a very small number, fewer than 1 per cent, would have preferred a cash payment to the patient. More than 90 per cent of the physicians thought that the functioning of the plan had not interfered with the patient-physician relationship. Of the small number who thought the plan had produced a change, almost one-fifth thought it made the relationship better rather than worse. Pediatricians seemed more likely to think it better. Availability of consultation services was generally appreciated but there was not as much positive expression of approval for special nursing service as for medical consultation by specialists and services of visiting nurses. The greatest dissatisfaction was in the amount of the fee paid, particularly the obstetric fee. In general, more participation, i.e., caring for a greater number of cases, was associated with a more favorable opinion of EMIC. This analysis is thought to be unique in that it is apparently the only one recorded so far in which the opinions of physicians who actually cared for EMIC patients in a community have been secured and analyzed. It is suggested that similar studies of the opinions of the physicians participating in and the patients receiving care from the many medical care programs now being tried out in this country be made.

Children with muscular dystrophy

Summary A study of 185 children and youthreported with muscular dystrophy to the New York City register revealed that 130 could be located. Of the 130 located children, 113 had muscular dystrophy, of whom 100 were still alive. The study of the 100 surviving children with muscular dystrophy revealed that as a group there is considerable need for improvement of medical and health, social, educational, and recreational services.

Methods of securing uniformity in hospital statistics on premature infants in New York City.

Summary This paper describes a study undertaken in New York City to ascertain the completeness and accuracy of previous methods in keeping hospital statistics on the survival rates of prematurely born infants, and describes the current plan established so that each hospital in the community may be assured that its statistics will be complete, accurate, and consistent, and so that some comparability between premature centers may be possible.

What the hospital nursing consultant does.

THE New York City Department of Health has had a nursing consultant in the program of care for mothers and newborn infants for the past 3 years. In 1944, it was found that the neonatal mortality rate in New York City had increased, and that this increase was mostly due to deaths from diarrhea of the newborn. This was a wartime period when there was an acute shortage of hospital nurses resulting in a general breakdown in the quality of nursing service in hospitals. The birth rate at this time was on a trend upward. To help meet the problem, a public health nursing consultant was added to the staff to help hospital personnel improve and streamline nursing technics, in an effort to prevent infection and cross-infection in the maternity and newborn infant services. A preliminary survey of 70 hospitals in New York City was made by the public health nursing consultant in the latter part of 1944 and the early part of 1945; a subsequent survey was made later in 1945 as a follow-up of the earlier one. Some of the findings have been described in our article on Modernizing Practices in Maternity Hospitals and Newborn Baby Services, which appeared in the July 1946 issue of Public Health Nursing. As pointed out in this report, the results of these two surveys showed that the nursing consultant was able to interpret-to hospital nurses the need for improving basic

Congenital heart disease in a medical rehabilitation program.

Summary A study of the first 129 childrenwith congenital heart disease cared for in the New York City medical rehabilitation program reveals the following facts: 1. This group of 129 children represents 41 per cent of the children with congenital heart disease cared for by the participating hospitals during the period studied. 2. Most of the children were in theinfant, preschool, and early schoolage groups. 3. Three of the nine participating hospitals cared for 76 per cent of the children in the program. 4. Forty-seven per cent of the childrenreceived a diagnostic work-up only, and 53 per cent received a diagnostic work-up and surgery. 5. At each step of the way in themanagement of children with congenital heart disease, a considerable number of children had a change in diagnosis. 6. Of the children having surgery, 23 per cent were cured and 48 per cent were improved. Seventeen per cent of the children died during or after surgery. 7. The average cost per child was

The Hospitalization of Cases of Communicable Diseases

218.31. 8. The average length of hospitalstay was 31.9 days, of which 16.7 days were covered by the program. The implications of these findings for improvement in the administration of the program and in the care of handicapped children are discussed.

Maternal and child health practices : problems, resources, and methods of delivery

THE American Public Health Association, from its earliest beginning, has been active in dealing with the many problems of communicable diseases. American, as well as international literature is ripe with the work of its members in this field. The fields of bacteriology, epidemiology, statistics, legislation, treatment, prevention and control of infectious agents in our environment have been the areas where the Association has been most active. Recognizing the need to reconsider current scientific information, the Committee on Research and Standards in 1948 began a study of the present practices in the hospitalization of communicable diseases. Alfred L. Burgdorf, M.D., M.P.H., a member of the Committee, was appointed Referee. His report was made at the Annual Meeting of the Association in Boston on November 10, 1948, under the title, Hospitalization of Cases of Communicable Diseases, Together with Certain Considerations of the Isolation Techniques and Nursing Procedures Used (A.J.P.H. 39, 10:1289-1294 (Oct.), 1949). The report recommended formation of a committee of representatives of national professional societies to consider simplifying the physical requirements for isolation units so that they can beconme an integral part of the general hospital, and to outline in simple terms the basic requirements for isolation techniques that will be in keeping with the present knowledge of infectious disease. On April 20, 1951, a Conference Committee on Hospitalization of Communicable Diseases, called by the Committee on Research and Standards of the American Public Health Association and financed by the National Foundation for Infantile Paralysis, met in New York City. Representatives of the following organizations participated in the Conference: