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plete with saddle and riding clothes to make the trip across ploughed fields and river to see the patient. One of the better midwives was attending her and was much perturbed over the delay. The patient was in a very serious condition-placenta praevia-eight-month pregnancy and bleeding profusely. As nothing could be done in the home of 2 rooms for 13 people the nurse had to plan means whereby the patient could be moved to the hospital in a hurry. She returned to the ranch and called the health department for someone to make hospital arrangements, to send morphine to a designated meeting place, where a schoolboy was sent on horseback to bring it to the nurse. Two men were instructed to attach springs and mattress to the only wagon available on which the patient had to be strapped and held on while negotiating the river crossing and the ploughed fields. In the meantime, the nurse returned to the ranch and was busy putting chains on her car and arranged for the men to follow along to help get the car over the worst part of the road. All were to meet at a certain gate on the road. The timing was excellent as they all met within seconds. The boy who went after the medicine had changed horses twice as he ran them all the way. It was was only a matter of minutes to give the morphine to the patient and place her in the car and get stared. However, wih

he assistance it took 272 hours to cover the ne 3 miles, during which time the patient was certainly not improving in spite of morphine being adminstered a second time. At 6:30 the nurse was exceedngly happy to be able to turn a live patient over to the hospital and doctors for further care. She was given plasma, two direct transfusions that night; the baby was delivered dead, but the patient recovered and was able to return home in 10 days.

CASE STORY NO. 14

Baby of a private in the Army was born prematurely at a small hospital in an outlying district of the city. Baby weighed 2 pounds at birth and was not doing well as floor nursing service was inadequate. There were no provisions for nursing care of premature infants in this hospital. This baby was not strong enough to be moved to a larger, better-equipped hospital. It was obvious 24-hour special nursing service was needed at once if the baby was to survive.

There was great difficulty in obtaining nurses for the baby in view of the nursing shortage and particularly as the hospital was so far from the cityHospital personnel refused to take the responsibility in securing nurses.

The EMIC staff spent considerable time and effort in calling numerous registries, other nursing and social agencies. After some time nurses were finally secured through a special agency. Baby soon began to improve under the care of special nurses. Nursing service was continued until the baby left the hospital, at which time the weight was 6 pounds, 10 ounces.

Patient was then referred to the Visiting Nurse Service prior to discharge from the hospital. Mother was taught how to care for a premature infant. Nurse visited regularly until the baby was well adjusted to the home situation and until the mother had secured a hand with her child.

This patient is now under medical and nursing supervision at a child health station and is doing very well.

CASE STORY NO. 15

The landlady of this patient called stating that her roomer, Mrs. L, was pregnant and was ill at present. She was weak, had heart trouble, and needed a doctor. The patient was under care at a city hospital.

The EMIC staff contacted the Visiting Nurse Association, one of whose staff nurses visited and found that the patient was physically unable to make the trip to a prenatal clinic at the city hospital, therefore, was not going regularly. A private obstetrician was engaged (selected through the Maternity Center Association) who made two visits to the home. Then medical supervision was continued in his office. It was found that the patient had an anemia for which she was given liver extract (this was paid for by EMIC).

The nurse visited regularly to give instruction in supervision and maternity hygiene. Patient needed special foods rich in iron and the nurse helped her with food planning and budgeting so that patient could have this.

Patient lived alone in this city. Her family was in Mississippi, to which she was anxious to return as soon as possible. The social worker in the EMIC office contacted the Red Cross who arranged for the patient's railroad fare. Mrs. L's

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health improved rapidly and she was able to make the trip back to Mississippi. There she continued her EMIC care. Arrangements were made for this medical care in Mississippi.

CASE STORY NO. 16 When I entered that shack of a house, crowded with children and flies, I shuddered to think another serviceman's child was to live here. I climbed up two flights of stairs and called for Mrs. Jones. A slight blond about 25 answered me. She was very polite, yet seemed a little awed that I was there to help her. Then suddenly "she cut loose" and gave me this story :

“Pate and I have been married 10 years. We have two fine children and the other one will come the first of the year. My little girl starts to school next week. The little boy is absolutely out of clothes for the winter. Pete's in the Navy, you know, and is in San Francisco ready to ship out. I am trying to make ends meet with $100 a month. Could you help me or tell me where I could get some help?"

I assured her that our city had facilities for helping her financially and told her of the medical care available under the emergency maternity and infant care bill. We went on then to discuss her physical condition which was very poor. Later on we worked out a plan with the Red Cross for some financial aid to equip the little girl for school. Mrs. Jones seemed a different person when relieved of the problems facing her, and she says it will mean a lot to her sailor husband to know his family will be cared for.

CASE STORY NO. 17

A 12-year-old child was brought to the attention of the school purse. This girl weighed 100 pounds and had to wear extra-size, dark, mature-looking clothes, making her very conspicuous. As a result of her appearance, she was teased by her classmates, who called her "Fatty." She was never invited to parties; teacher reported that she was too heavy and clumsy to participate in any of the activities of the group. She was absent from school very frequently.

Nurse visited the home and interviewed the child's mother, who did not seem too concerned about the child's appearance. Mother stated that both sides of the family were obese and that child came by it naturally. She also stated that child ate very little and the reason she did not care to go to school was because she felt out of place. The child preferred to read and pursue her studies by herself at home and the mother wondered if a visiting teacher could be assigned so that the child would not have to go to school and mix with the other children.

Arrangements were made to have the parent come to the school when the doctor was due. The doctor was able to convince the mother that the child had an endocrine disturbance and should be placed under very special care. Referral was made to an endocrine clinic for complete examination and treatment.

Within 6 months the girl lost 50 pounds; her whole appearance changed. She came to school willingly and became very much interested in her school and social activities. The nurse made up a special weight graph for her and had the girl report every Monday morning to weigh herself and chart her progress. It was thrilling to see the change in this youngster's appearance. All this could not have been accomplished without the nurse's keen observance and follow-up care of the child.

CASE STORY NO. 18

Mr. H was worried, distracted, unhappy-in fact, he was so upset that he just couldn't think things out by himself. Too many things had happened in such a short time.

First Mrs. H ran a temperature and lost weight after Robert was born. So an X-ray was ordered. The doctor said, "Far advanced tuberculosis-admit to Sunnyside at once.” But it was too late. Bobby was only 2 months old and his mother was dead. Then there was the danger that Dorcas, aged 21/2, and James, aged 5, might have been infected before their mother went to the sanitarium. In addition, Dorcas had cried and complained of severe pain in her left leg. And now, to cap the climax, Mr. H was being inducted into the Army-how could he leave his little family under the circumstances? How could he make a good soldier with all of these worries? He had been making a good salary, but with all of the expenses of sickness, most of the money was spent before he received it and he just couldn't be happy unless he knew the children were well cared for.

Mrs. B, of Sunnyside, told Mr. H she would ask the Public Health Nursing Association to help him. We assisted the father in making plans for Dorcas' medical care and she was admitted to Hospital, March 3, 1945. The other members of the family were gotten under care of TB clinic. Plans were made for children's care with relatives. James, the oldest child, had a positive reaction to his tuberculosis test. He was sent to live with maternal aunt at Hamilton, Ohio, and was referred to the TB Association at Hamilton. Robert, the infant, was being cared for by maternal uncle in Indiana. Dorcas' health has improved after 4 months in the hospital and has been furloughed in hip spica to the department of public welfare boarding home. A trust fund has been made for Dorcas at the department of public welfare from father's allowance.

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CASE STORY NO. 19

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This mother of five children, who was expecting the sixth, should know all about childbirth by this time, you would think. Well, she didn't.

Not because the family was poor. Many well-to-do women with as many children really knew less than this mother. Let's call her Mrs. Smith for the sake of anonymity.

Well, Mrs. Smith was going to have a baby-her sixth. She didn't know what a woman should know about the anatomy involved in child th, growth and development of the baby before birth, and things about her own health, such as care of the teeth, control of diet, frequency of eating, the need for milk, and things like that which have a lot to do with the kind of baby that is born,

But this time is was different. Through the Government's program of maternal care for the wives of servicemen, the Public Health Nursing Association, an agency supported by the community fund was called in.

Mrs. Smith's husband was in the Army-he was overseas. Mrs. Smith was just beginning to get acquainted with her visiting nurse when the telegram came. the one from the War Department.

"Killed in action,” it said.

Five fatherless children and a new baby on the way. A tough case, that visiting nurse will tell you. But they are accustomed to tough cases at Public Health Nursing Association. They are accustomed to them, but they don't let them fall into slots and become routine. And so, this case of Mrs. Smith's didn't become routine. It became so individualized that she poured her grief out in big shaking sobs on the shoulder of the visiting nurse. Then came the innermost, sacred little things that you just don't talk about, unless maybe you get one of those War Department telegrams. And the capable shoulder of the visiting nurse almost sagged beneath the burden. Do nurses cry? No, but they understand; this one did, and Mrs. Smith knew she had a friend when she thought she was all alone, someone who understood and she felt better. And gradually, as the time approached for her baby she became reconciled to the fact that her husband's death was a noble thing and the price great men willingly pay for the love of a country where little children may live in freedom.

Before Mrs. Smith went to the hospital she knew all about the care of her teeth, the milk, and the diet. When she returned home all of the supplies for the new baby were there.

The baby? The nurse described him as beautiful, which means of course, that he was normal and healthy, and who can tell, he may be President some day and issue a proclamation designating such and such a week as public-health nursing week.

CASE STORY NO. 20

I am 28 years old and have a lovely wife and two young sons. My job at the garage furnished us with enough for payments on our small home, food, and clothing. Life had been a rather pleasant thing when all of a sudden I found myself unable to bend down or walk very far without severe pain in my legs and back. Before long I went to the clinic in our city hospital and in a few weeks after a thorough examination as well as many tests the diagnosis was made.

"Stay in bed flat on your back for 6 weeks, then if the spine is in proper condition we can apply a plaster cast. Your wearing the cast for a year or so should restore your ability to be up and about but never as actively again as you once were:” The doctor's words struck with the force of thunder.

So many problems crowded my mind that I wondered how we could make ends meet. My wife whose courage is ever a comfort set about the tasks with a cheerfulness which made my condition seem less horrible than at first it appeared.

The boys could not understand their father being in bed all the time at 2 and 4 years of age, they seemed too young to do much but play, laugh, cry, and be into everything within reach. My wife worked hard but with the extra work and responsibility, tired easily and I in my discontent at being "a burden” was not in the best of spirits at the possibility of losing our home and all we had hoped for.

Soon my case was reported to the Public Health Nursing Association and a visiting nurse came to call. Her sympathetic consideration did much to inspire our confidence on that first visit. She saw and would offer suggestions to many of the problems we faced. There were suggestions for the diet, a tray set up for items needed at bath, and the Family Service Agency was contacted in regard to the needs in our home with the disappearance of the income. The community center a few blocks away offered an opportunity for the children to have supervised play, rest periods, and a lunch during the day.

As these things worked out it was time for the cast to be put on-that was an exciting day for with the cast on I could be up once more.

The cast has been on 6 months now and with the aid of an occupational therapist, who comes from the social service agencies, I have learned handicrafts to do and am able to sell them—in so doing I, at last, can begin to feel like a breadwinner once more.

This letter is to those of you who do not realize the value of the community fund and the new lease on life that can be had with the benefit of those serving to help those of us who for a time could not help ourselves.

EXHIBIT 30

NATIONAL ASSOCIATION OF COLORED GRADUATE NURSES, INC.,

New York 19, N. Y., June 19, 1946. Hon. CLAUDE PEPPER,

Senate Office Building, Washington, D. C. DEAR SENATOR PEPPER : Enclosed is a copy of the statement sent by me to the Committee on Labor of the House of Representatives, in relation to the Maternal and Child Health Act.

Since it is impossible for me to be in Washington on June 21 or 22, I would like to have this statement recorded. Very truly yours,

MABLE K. STAUPERS, Executive Secretary. Too long has America failed to give the same consideration to her human resources as is given to her economic resources. Billions of dollars have been spent to fight a war which threatened the security of our Nation. It is important, too, that our financial resources be used to fight for better health for the American people. The selective-service statistics indicate how urgently a war for good health is needed.

The further reduction of the morbidity and mortality rates among mothers and children is most important. It is also important that we give a greater degree of care to those children who through no fault of their own are born to parents whose economic status is limited, and who live in areas where health care is not provided.

The Children's Bureau of the Department of Labor has done an outstanding job with the limited resources which have been made available to them. However, this is not enough. More adequate provision should be made for the health and welfare of our mothers and babies.

The National Association of Colored Graduate Nurses believes that s. 1318 should be enacted into law, since the provisions of this bill would make these services possible.

EXHIBIT 31

NATIONAL LEAGUE OF NURSING EDUCATION,

New York 19, N. Y., June 19, 1946. Hon. CLAUDE PEPPER,

United States Senate, Washington, D. C. DEAR SENATOR PEPPER: Complying with the request contained in your telegram of June 18, I enclose two copies of the statement on H. R. 3922 or its equivalent which I submitted at the request of Representative Augustine B. Kelley before the Committee on Labor Subcommittee on Aid to the Physically Handicapped on June 6, 1946.

At the time of submitting this material, we left with the subcommittee 100 copies of the enclosed statement. Very sincerely yours,

RUTH SLEEPER, President.

STATEMENT OF Ruth SLEEPER, REGISTERED NURSE, PRESIDENT, NATIONAL LEAGUE

OF NURSING EDUCATION, ON H. R. 3922, OR ITS EQUIVALENT, BEFORE THE COMMITTEE ON LABOR SUBCOMMITTEE ON AID TO THE PHYSICALLY HANDICAPPED, JUNE 6, 1946

In principle the concerns of the National League of Nursing Education are those expressed in the proposed Maternal and Child Welfare Act-the promotion of health, the prevention of disease, and the proper care of all mothers during the maternity cycle and all children when ill. In actual functioning the National League of Nursing Education is a "nursing education for nursing service” association. Its major activities have included :

1. Development and promotion of standards for all types of nursing education,

2. Promotion of a consultation service on all phases of nursing education.

3. Studies related to nursing education and nursing service. The National League of Nursing Education has 8,950 members, with representation in 47 States, District of Columbia, Alaska, Hawaii, and Puerto Rico.

It is desired to make clear the specific interests of the organization I represent in the legislation proposed in the maternal and child-welfare bill. These interests are concerned with the technical and educational espects of the bill as they relate to the training of qualified nursing personnel and to the quality of nursing service given to mothers and children.

There are at present approximately 1,300 State-accredited professional schools of nursing in 47 States and the District of Columbia. Every professional nurse graduated from these schools will have had some kind of training in maternity nursing and nursing of children since such training is a requirement for admission to the State licensing examinations. But, unfortunately, in many Stateaccredited schools of nursing, both the maternity nursing experience and the experience in the care of children are too narrow in scope to prepare nurses to fulfill the nursing responsibilties contained in the bill under discussion. Specifically, in a large number of schools the training in maternity nursing is limited to the hospitalization period of mothers and does not include prenatal nursing or post partum nursing after the mother leaves the hospital, important health services in the maternity cycle. Evidence in support of this statement is the fact that only 48 percent, or 624, of the 1,300 schools report that their students receive out-patient experience, the field which largely provides prenatal and post partum experience."

The limitations of the training for the care of children are not unlike those of the training for maternity nursing. In too many undergraduate schools the nursing of children is narrowed to the hospitalization period. As indicated in the preceding paragraph, only 48 percent of the schools provide out-patient experience, and it is in the out-patient clinics where students have the opportunity to participate in well-baby and preschool clinics. Only two-fifths of the schools give their students training in acute communicable disease nursing, an important phase in the preparation for the care of children. The number of schools which provide experience in the nursing care of either premature infants or crippled children is not known. It is probable that the number is small for both services. A sound training in the nursing of children should provide for an understanding of their emotional, mental, and spiritual needs as well as the knowledge and skills required for their physical care during illness.

The reason for the inadequate professional undergraduate training in many schools of nursing is deep-rooted. Fundamentally, it is economic. There are relatively few schools of nursing controlled by educational institutions (less than 50). The remaining 1,250 are hospital-owned schools. As such, they provide service for the hospital, and in providing this service it is by no means always possible to prepare the student for the broad nursing functions which are implicit in the Maternal and Child Welfare Act.

1 Unpublished study, National League of Nursing Education, 1946. ? Unpublished study, National League of Nursing Education, 1946.

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