will be more in line with the general work the Department of Commerce and Labor is undertaking." Of the three bureaus whose functions were then considered most closely related to the work of the proposed Children's Bureau, two (the Bureau of Labor and the Bureau of the Census) were in the Department of Commerce and Labor. The third, the Bureau of Education, was then in the Department of Interior. In an article on the Children's Bureau in its niche, published in The Survey, January 24, 1920, Florence Kelley, who with Lillian Wald, founder of Henry Street Settlement, originated the idea of the Children's Bureau said: "Had the bureau in its inception been limited by the outlook either of a department of health or of a department of education-assuming that both of those departments were led by the wisest and most generous of statesmen-there would of necessity have been lost much of the very fine work of the division. Its activities have traversed many fields and in particular they have thrown great light on the so-called borderland of science, the undefined region which has belonged assuredly to none. Under its present direction in the Department of Labor, the department which par excellence is concerned with broad considerations of human well-being, the Bureau has had the untrammeled right freely to serve the Nation. "One of the needs most keenly felt by those who agitated for the establishment of a Federal Children's Bureau was that of a center of information regarding all the children of the country and regarding the social and economic conditions affecting their welfare. For this reason, the Department of Labor was fittingly selected as the proper place for the Bureau, and under its aegis the Bureau began its many-sided work on the complex problem of child welfare. EARLY PROGRAM OF THE CHILDREN'S BUREAU A woman, Lillian D. Wald, pioneer in public-health nursing and founder of Henry Street Settlement, New York, had first suggested the need for a Federal children's bureau and had worked with Mrs. Florence Kelley, another great pioneer in behalf of children, in securing the establishment of the Bureau. A woman was chosen as first Chief of the Children's Bureau, Julia C. Lathrop, who had been associated with Jane Addams of Hull House throughout its history and had established a national reputation as a member of the State Board of Charities of Illinois and as promoter of such important social reforms as the juvenilecourt movement. The Children's Bureau was at first in the Department of Commerce and Labor, but in 1913, when the Department of Labor was established, it was transferred to that Department. The first appropriation was $25,640 and the staff consisted of 15 persons, of whom all except the Chief and her private secretary were appointed under Federal civil service. In her first annual report for the fiscal year 1913 Miss Lathrop defined "the final purpose of the Bureau" as being "to serve all children, to try to work out the standards of care and protection which shall give to every child his fair chance in the world." In her second annual report Miss Lathrop called attention to the close cooperation that had been developed with the United States Bureau of the Census and stated: "Other bureaus of the Government which have to do with children have also wide powers ascribed to them by law. Apparently the best method of securing the highest possible degree of effectiveness is by the joint action of various bureaus having common interest in the investigation of a particular subject." During the 9 years in which Julia C. Lathrop was Chief of the Children's Bureau, from 1912 to 1921, the Bureau's work was established upon a firm foundation of scientific research and dissemination of information to the people of the country. These services were carried on and expanded under the administration of Grace Abbott, from 1921 to 1934, and of Katharine F. Lenroot from 1934 on. The early studies of infant mortality, which placed major emphasis on income, housing, employment of the mother, and other factors affecting the infant death rate, were made under the direction of staff which included physicians, social workers, and statisticians. These inquiries concerning infant mortality and studies of maternal mortality and maternal and infant care in rural areas, led to the plan for Federal and State cooperation in promoting maternal and infant welfare which was later embodied in the Sheppard-Towner Act of November 23, 1921. Under this act, which was in operation from 1922 until 1929, 45 States and the Territory of Hawaii were assisted in the development of State and local services for mothers and babies. Evidence gathered by the Children's Bureau of conditions under which children were employed led to the passage of the first and second Federal Child-Labor Laws, both of which, after short periods in operation, were declared unconstitutional, and to the submission in 1924 of an amendment to the Constitution which would have given Congress the power to enact child-labor legislation, but which was ratified by only 28 of the 36 States necessary for its adoption. Greatly improved standards of State legislation and administration of child labor laws were achieved. Studies of juvenile courts, mothers' aid, illegitimacy, other aspects of dependency and delinquency and mentally deficient children contributed to the development of standards and improved methods of dealing with these problems. It is of interest to review in some detail the mothers' aid movement in relation to the Children's Bureau. The White House Conference on the Care of Dependent Children, called by President Roosevelt in 1909, passed a resolution stating that, "Home life is the highest and finest product of civilization. It is the great molding force of mind and of character. Children should not be deprived of it except for urgent and compelling reasons." It was 2 years, however, before the first State-wide mothers' pension law was passed, in Illinois. At that time the theory was widespread that public relief would never be well administered, that there would be political interference, that it would increase pauperism and that private charities could and should handle relief. This controversy reached its height at the National Conference of Charities and Correction which met in Cleveland in 1912. It was eventually silenced by the success and popularity of mothers' aid. Miss Lathrop believed that public agencies could and must function effectively if social needs were to be met. She said, "Are we not taking all this in too elderly a fashion? We act as though we were in the afternoon of time, and our methods of progress almost finished, when in fact, we are in the gray dawn of time as to our expression of public responsibility for the care of the young of the state. We are frightened in that gray dawn by the spooks and bogies of the old English poor law By 1914, 21 States had passed some kind of mothers' aid laws, the forerunner of the aid-to-dependent-children provisions of the Social Security Act. The Children's Bureau undertook to compile these laws in that year. Until the passage of the Social Security Act in 1935 the Bureau engaged in active promotion of mothers' aid legislation and good standards of administration. From the first the Bureau recognized the importance of making the results of scientific research and practical experience available to the people of the country in simple, nontechnical language. Popular bulletins on infant care, prenatal care, and child care and guidance were widely distributed, and the Bureau has carried on from the beginning a large correspondence with individual mothers. In the preparation of the first edition of Parenatal Care the Bureau consulted with a large number of well-known physicians and received special help from Dr. J. Morris Slemons. In the preparation of the first edition of Infant Care in 1914 the Children's Bureau sought the assistance of Dr. L. Emmett Holt and Dr. Samuel McC. Hamill who gave helpful suggestions especially with respect to the sections on infant feeding. Since 1919 the Children's Bureau has had the active assistance of a committee of pediatricians: Dr. Richard M. Smith of Boston representing American Pediatric Society, Dr. Julius H. Hess of Illinois representing the Section on Diseases of Children of the American Medical Association, Dr. Howard Childs Carpenter of Philadelphia representing the American Child Hygiene Association, later the American Child Health Association, until that organization went out of existence. In 1933, at the request of the Children's Bureau, the American Academy of Pediatrics designated Dr. Samuel McC. Hamill as member of this committee. In 1936 Dr. Hamill was replaced by Dr. J. H. Mason Knox of Baltimore. The Children's Bureau has also had the assistance of a committee of obstetricians to review popular bulletins on maternity care, including Dr. Fred L. Adair, Dr. Robert L. DeNormandie, and Dr. James R. McCord. All popular bulletins on infant, child, or maternal care have been approved by these committees before publication. Cooperation with national women's organizations in popularizing the knowledge gained through research and field study and stimulating community efforts for child welfare took the form of birth-registration, baby-week, and children's year campaigns, followed by the second White House conference, the 1919 Con ference on Standards of Child Welfare, covering the economic, health, social service, and employment problems of children. Throughout these early activities the work was carried on by means of a coordinated approach to the wide range of health, employment, and social problems of children, in which the professional services of physicians, nurses, social workers, economists, and statisticians were utilized. Studie of infant mortality, for example, were planned from both the economic and the medical approach; in studies of child labor the professional experience of physicians, industrial and economic investigators, and social workers was utilized. Studies of child dependency, delinquency, and mental deficiency took into consideration the health, social and industrial aspects of these problems. From the beginning the Children's Bureau was closely associated with the American Association for the Study and Prevention of Infant Mortality. In 1912, the Chief of the Children's Bureau was made a member of the board of directors of this association. In an address to the American Association for Study and Prevention of Infant Mortality, made October 2, 1912, Miss Lathrop said: "Some people have been afraid that this Bureau would be some distant automatic sort of machine which would dull local activity and interest in children, and which would over-ride the dignity and the rights of parents. This Bureau will be nothing of the kind; it never can be so long as it proceeds in that spirit which recognizes as the most important and precious thing in the world, parental affection and care for a child."1 In her last annual report, for the fiscal year 1921, Miss Lathrop said: "The great contribution which the establishment of the Children's Bureau made to child-welfare theory and practice was that a unified social, economic, and industrial approach to all problems in this field was, for the first time, made possible. Previous to that time there had been a constant growth of interest in the protection and welfare of childhood, and public and private organizations had been expanding and multiplying. But no agency, State or private, had as yet developed a program embracing all the interests of childhood." In the section on the Children's Bureau included in the Twentieth Annual Report of the Secretary of Labor, for the fiscal year 1932, 20 years after the Children's Bureau had been established, Grace Abbott, second Chief, said: "The Children's Bureau was made an instrument of national leadership and national service by its first chief, Julia C. Lathrop, who directed its activities from 1912 to 1921, and who cherished the Bureau as her fondest interest until her death on April 15 of this year. In the spirit of Miss Lathrop's efforts to conserve the Nation's childhood during the war years, the Children's Bureau has endeavored in a variety of ways, within the limits of its resources, to serve those who are striving to protect children from the still more devastating effects of unemployment. Without additional appropriations the Bureau has reorganized its work so as to give chief emphasis to the problems of children affected directly by unemployment. At the same time, it has continued its scientific studies in the fields of child health, child labor, recreation, dependency, and delinquency, and the preparation and distribution of popular and scientific bulletins. These activities furnish a continuing basis for maintaining the ground won and for advancing, when possible, in the effort to assure fuller opportunity and greater protection to the children of America." In the same report Miss Abbott said: "We must go forward with the whole program for children: 'Protective foods' may be the first requirement, but schools, playgrounds, agencies for preventing delinquency, organizations caring for dependent children in their own homes and outside when necessary, must also be maintained, and, in many instances, their resources must be expanded to meet unprecedented needs.” PROMOTING THE HEALTH OF MOTHERS AND CHILDREN Education of parents in infant and child care Almost as soon as the Children's Bureau was established, work was begun on preparation of a series of pamphlets dealing with the home care of young children. No such bulletins had been issued previously by Government agencies. Infant Care has exceeded any other Government publication in sustained popularity. It owes much of its popularity to physicians in private practice, who distribute 1 American Association for Study and Prevention of Infant Mortality, transactions of the third annual meeting, Cleveland, Ohio, 1912, p. 50. Franklin Printing Co., Baltimore, 1913. it to the mothers of infants under their care, and to State, county, and municipal health departments, who use it in their programs of health education. Many other means of reaching parents are used; the Bureau was one of the first Government agencies to carry on a weekly radio program, which was on the air without interruption for many years. Annual celebrations of May DayChild Health Day, under Presidential proclamation, serve to stimulate general interest in various phases of child health. Technical and scientific studies During its early years the Children's Bureau traced the lives of approximately 23,000 infants, whose mothers freely cooperated in the studies, from birth to their first birthday, if they lived that long, or to their death, if they died under 1 year of age, and studied the various factors which might be held responsible for their death. The published reports of these studies made available for the first time a body of scientific data on the causes of infant mortality. The investigation of infant mortality indicated that a large proportion of infant deaths are the result of conditions existing before birth and also that the sickness or death of the mother after the baby's birth lessens the child's chance for life and health. The Bureau, therefore, began the collection and interpretation of statistics of maternal mortality, including a careful study of every maternal death in 13 States occurring over a 2-year period, and in 2 States over a 1-year period, about 7,500 deaths in all. The recommendations drafted by the Bureau's advisory committee on obstetrics, based on the finding of these studies, provided for leadership and the setting of standards for maternal care by the medical profession, and for strengthening the education of the general public in regard to the need for and meaning of adequate maternal care. So impressed were local medical societies by these studies that academies of medicine in New York, Philadelphia, and other cities undertook continuing studies of every maternal death, to try to determine whether it might have been prevented, using schedules similar to those developed by the Children's Bureau. These studies are continuing to the present day, and effecting great improvement in obstetric care. Other important undertakings include studies and demonstrations of methods of prevention of rickets in infants, studies of infant mortality and maternal care in certain cities, and studies of neonatal mortality and morbidity, prematurity, and stillbirths. Methods of hospital care of premature and other newborn infants, policies adopted by industry with reference to conditions of work and provisions for maternity care for women employees who are pregnant, and studies of health problems involved in day-care programs for children whose mothers are employed, all have been the subject of first-hand inquiry by the Children's Bureau. Development of standards of care Standards of prenatal care, infant feeding, and child-health supervision, developed by the Children's Bureau in consultation with national authorities in these fields, are embodied in its bulletins for parents and in bulletins and articles for the use of physicians, nurses, hospital administrators, and administrators of health services. Extension of public-health-nursing services, child-health conferences, and health supervision of infants by physicians in their private offices have furnished increasing opportunity for standards to be translated into practice by mothers under professional guidance. Recommendations concerning standards for maternal and child-health services have been developed by the White House Conferences held every 10 years, special conferences, and the work of advisory committees to the Children's Bureau. Administration of grant-in-aid to the States for maternel and child-health services and services to crippled children A plan for public protection of maternity and infancy with Federal aid, presented by Miss Lathrop in her fifth annual report, was based upon the principle of extension of local maternal and child-health services through the leadership and assistance of State health agencies receiving grants of funds from the Federal Government. Thus precedents developed extensively in the improvement of agriculture through Federal aid were applied to promotion of the wellbeing of children, just as the fact-finding functions outlined in the act of 1912 creating the Children's Bureau had been suggested by similar work in the Department of Agriculture. In her fifth annual report in 1917, Miss Lathrop recommended that a maternity and infant-welfare program should include publichealth nurses available for instruction and service; instruction through schools, universities, and extension teaching in hygiene for mothers and children; conference centers affording convenient opportunity to secure medical examination of well children and expert advice as to their best development; adequate confinement care; and hospital facilities made available and accessible for mothers and children. This proposal led to the long struggle for a Federal maternal and child-health program, which resulted first in the passage in November 1921 of the Sheppard-Towner Act, providing grants by the Children's Bureau to State agencies for the protection and welfare of maternity and infancy, an act which was in effect from 1921 to 1929, and later in the maternal and child-health provisions of title V of the Social Security Act of 1935, as amended in 1939. When the Children's Bureau started its work, no State had in its health department a child-hygiene division or bureau. Stimulated by the Children's Year campaign undertaken under the leadership of the Children's Bureau in 1918, and by the discussions of Federal aid to the States in the course of passage of the Maternity and Infancy Act of 1921, 46 States had organized such divisions by the end of 1922. Public-health-nursing services, prenatal and child-health conferences, supervision of midwives, and public education in maternal and infant care expanded rapidly from 1922 to 1929, while the Maternity and Infancy Act was in operation, and laid the foundation for the much greater expansion of maternal and child-health services under the Social Security Act of 1935, whose provisions for maternal and child-health services were based upon facts assembled by the Children's Bureau and proposals developed through the Bureau's initiative. Federal administration of maternal and child-health services under title V, part 1, of the Social Security Act is vested in the Children's Bureau. Allotments to the State health departments are made by the Secretary of Labor on the basis of the ratio of live births in the State to the total live births in the United States, plus a uniform grant to all States. An additional allotment is based on the need of the State for financial assistance in carrying out its State plan. Approval of State plans by the Chief of the Children's Bureau is based upon the requirements of the act-financial participation by the official State health agency; administration of plan by State health agency; such methods of administration as are necessary for proper and efficient operation of the plan; submission of required reports to the Secretary of Labor; extension and improvement of local maternal and child-health services; cooperation with medical, nursing, and welfare groups and organizations; and provision of demonstration services in needy areas and among groups in special need. The program, for which an annual Federal appropriation of $5,820,000 for grants to States is now authorized, is in its ninth year. It is in operation in the 48 States, the District of Columbia, Hawaii, Alaska, and Puerto Rico. Under its stimulation much progress has been made in strengthening and improving the administrative facilities of the State health departments for carrying on programs of maternal and child health and in developing local services for mothers and children under local health departments. Among these local services administered or supervised by State health agencies for the calendar year 1943 were the following (figures in round numbers): Prenatal medical care, 146,000 women. Prenatal nursing care, 265,000 women. Home-delivery nursing care, 13,000 mothers. Medical supervision in child-health conferences, 451,000 infants and preschool children. Public-health-nursing service, 1,093.000 infants and preschool children. Public-health-nursing service (home and school service), 1,974,000 school children. Smallpox immunization, 1,695,000 children Diphtheria immunization, 1,227,000 children, of whom 43 percent were under 5 years of age Growing out of experience in the maternal and child-health program under the Social Security Act, and with special appropriations by Congress, the Children's Bureau administers grants to State health agencies, amounting for the fiscal year 1945 to $42,800,000, for free medical, nursing, and hospital carethe medical care by physicians of the wife's own choosing-to the wives and infants of the men in the four lowest pay grades of the armed services, and of Army and Navy aviation cadets. During the fiscal year 1945 it is expected that from one-sixth to one-fifth of all the births in the United States will be cared for under this program. Although it has been in operation only since March 1943 it is an important factor in maintaining under wartime conditions, the gains |