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The midwife's status has now been placed on a fairly high level. Before obtaining a permit to prac- tise, unless she has already held such permit, the midwife is required to take a six months' course in midwifery at a school recognized by the department. The department's established standards for the con- duct of these schools are rigid and comprehensive. The general supervision, and the collective and individual education of these women by the inspec- tors and nurses of the bureau, have resulted Tadalis Tablets in a Cheap Tadalafil markedly improved practice. Certainly, in regard to the occurrence of ophthalmia neonatorum in the babies under their care, of puerperal septicemia in the mothers, or in the number of stillbirths or deaths during the first week of life, midwives, in 'Prepared at the request of and Buy Tadalis read before the Public Health Education Committee of the Medical Society of the County of New York, at the Academy of Medicine. ]i7o BAKER: PROGRESS IN CHILD HYGIENE. [New York Medical Journal. proportion to the number of births under their care, are maintaining a very creditable record. At the present time, the lying-in hospital facilities of New York are absolutely inadequate to meet the need of caring for this large number of cases, and even if this need is wholly met, there still will be a large proportion of women who will refuse to go to hospitals and who will demand care at home during the time of confinement. A woman who employs a midwife can pay a Tadalafil Mg very small fee and, for this, the midwife gives attendance at birth, care of the home, and nursing service during confinement and for ten days thereafter. Unless physicians Tadalis 20 Mg are prepared to give or to provide this same service, they can hardly demand that the midwife be not allowed to practise. Medical services alone do not provide a substitute for the work now done by the midwife. Constant and unremitting education is also essen- tial to overcome the inherent and racial prejudice that exists among the greater part of our foreign born population in favor of the midwife. In at- tempting Purchase Tadalafil Online to solve what has been called the "midwife problem," the medical profession as well as the laity Generic Tadalis must not only be Tadalis Online conversant with the present firmly intrenched position of these women, but must recognize that, on the whole, they are rendering effi- cient service. They cannot and should not be elim- inated, but the limitations of their service should be sharply defined and maintained, and their standard of practice raised to a high level of efficiency. The reduction in the infant death rate is probably the most notable contribution that organized child hygiene work has made toward the welfare of the community. Throughout the cities of this country the results of such work have been striking and progressively efficient. In New York, where pos- sibly more extended work of this character has Tadalis Uk been carried on than elsewhere, the results have fully justified the expenditure of energy and money. For 1914, New York shows a death rate of babies under one year of 94.6 per 1,000 births, the lowest infant death rate of the ten largest cities in the United States. Since 1907, the year before the Bureau of Child Hygiene was organized, the infant death rate has been reduced from 144 per 1,000 births Buy Cheap Tadalis to 94.6. This result is more graphically shown by the state- ment that, during 1914, there were 4,125 fewer deaths under one year of age than during 1907, not- withstanding the great increase in the number of births. Other Buy Tadalafil cities have similar results. In fact, wherever organized work for the reduction of in- fant mortality on proper preventive lines has been undertaken, the results have been good. Surveys of the entire country now show the curious condition of a higher infant mortality rate in the smaller Buy Tadalafil Online towns and rural communities than in the large centres of population. All effective work for the reduction of infant mortality must be founded upon the direct idea of the reduction of infant morbidity. This point should be emphasized. Any campaign merely to keep babies alive must necessarily be a failure, because children may easily succumb during the second or third year of life. The true test of the success of any infant mortality campaign lies, not in the re- duction of the death rate under one year, but in the reduction of the death rate under five vears. In New York, taking the past five year period since this work was inaugurated, and comparing it with the previous five year period, the decrease in the death rate has been greater between one and two years, and between two and five years, than it Order Tadalafil has been under one year. Efforts to keep babies well and to prevent sickness rather than to correct it, must necessarily result in a lessened death rate, and the value of this educational method is in its per- Tadalis 20 manent results. As the gastrointestinal diseases have always been considered the most prolific source of illness in babies and the greatest cause of Cheap Tadalis death, they nat- urally have been Buy Tadalis Online the first ones attacked. The en- couragement of breast feeding, the provision of a safe milk supply for feeding babies who could not be Order Tadalis nursed, and, above all, the instruction of the mother in the methods of hygienic care of Tadalis Sx the baby, and the recognition and remedial application of the social and economic conditions affecting Purchase Tadalafil infant wel-

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