Infant Hygiene Research Articles

Motherhood, medicine and magazines in interwar Vienna: the case of Die Mutter (The Mother, 1924–1926)

In an era long before ‘Doctor Google’, the question of how people accessed information about their bodies and their health is significant. This article investigates how medical knowledge about motherhood...

Milk and hygiene in Eastern France: the ‘goutte de lait’ at Besançon and the ‘œuvre du bon lait’ at Bar-le-Duc (late nineteenth to early twentieth centuries)

Abstract— Food security held a central place in the hygienist project to improve the quality of milk. While it may be difficult to grasp the question of milk and dairy products globally in hygienist discourse, this article proposes a focused study of two specific ‘œuvres de la goutte de lait’ (‘drop of milk’—the name given to specific social projects for milk quality) at Besançon and Bar-le-Duc in Eastern France. The ‘œuvre de la goutte de lait’ was an institution that sought to supply healthy milk to mothers who were unable to suckle their babies. This preoccupation with infant hygiene was allied to the development of pediatrics and childcare. Milk as a foodstuff was at the heart of the hygienist project of the turn of the twentieth century: on the one hand, it could carry tuberculosis, and was thus suspect; on the other, it provided an alternative to the problems of maternal breastfeeding. These projects helped contribute more broadly to the development of a municipal hygienics that was an essential characteristic of the emerging modern state in France.

MATERNAL HEALTH BELIEFS AND PRACTICES IN INFANT HEALTH CARE

Reducing the infant and maternal mortality and morbidity rates of the country through education is of primordial concern. Using the descriptive survey method, this study aimed to determine the health beliefs and practices of mothers on infant feeding, hygiene and care of sick infant; determine conformance to Essential Newborn Care protocols; and identify implications of health beliefs and practices on the health of infant. Data were gathered through questionnaire-checklist from sixty-eight (68) women with children 0-1 year old residing in Arandurugan Village Guinobatan, Albay. The beliefs and practices of mothers were varied. The mothers were found to strongly believe in breastfeeding while some believed in herbolarios, using of guava/santol leaves in bathing after an illness, breastfeeding while hungry as cause of ill health, applying chewed leaves/saliva on the baby’s abdomen as treatment for colic, and wearing amulet or religious articles to ward off evil spirits. Additionally, the mothers always practiced breastfeeding and often practiced applying alcohol on the umbilical cord, bathing with warm water while covering the umbilical cord with dressing, and frequently practiced applying baby oil on scalp/body, cutting hair only when child reaches one year old, and keeping windows/ doors closed while bathing. In caring for sick infants, mothers consulted doctor or midwife, and sometimes gave medications not prescribed by doctors. The mothers’ belief and practices particularly on infant feeding is in conformance with the Essential Newborn Care (ENC) protocol utilizing the BEmONC approach. However, there is a strong need to educate the mothers particularly on hygiene and care of sick infant.

The Safe Start trial to assess the effect of an infant hygiene intervention on enteric infections and diarrhoea in low-income informal neighbourhoods of Kisumu, Kenya: a study protocol for a cluster randomized controlled trial

BackgroundSymptomatic and asymptomatic enteric infections in early childhood are associated with negative effects on childhood growth and development, especially in low and middle-income countries, and food may be an important transmission route. Although basic food hygiene practices might reduce exposure to faecal pathogens and resulting infections, there have been few rigorous interventions studies to assess this, and no studies in low income urban settings where risks are plausibly very high. The aim of this study is to evaluate the impact of a novel infant food hygiene intervention on infant enteric infections and diarrhoea in peri-urban settlements of Kisumu, Kenya.MethodsThis is a cluster randomized control trial with 50 clusters, representing the catchment areas of Community Health Volunteers (CHVs), randomly assigned to intervention or control, and a total of 750 infants recruited on a rolling basis at 22 weeks of age and then followed for 15 weeks. The intervention targeted four key caregiver behaviours related to food hygiene: 1) hand washing with soap before infant food preparation and feeding; 2) bringing all infant food to the boil before feeding, including when reheating or reserving; 3) storing all infant food in sealed containers; and, 4) using only specific utensils for infant feeding which are kept separate and clean.ResultsThe primary outcome of interest is the prevalence of one or more of 23 pre-specified enteric infections, determined using quantitative real-time polymerase chain reaction for enteric pathogen gene targets. In addition, infant food samples were collected at 33 weeks, and faecal indicator bacteria (Enterococcus) isolated and enumerated to assess the impact of the intervention on infant food contamination.ConclusionTo our knowledge this is the first randomized controlled trial to assess the effect of an infant food hygiene intervention on enteric infections in a high burden, low income urban setting. Our trial responds to growing evidence that food may be a key pathway for early childhood enteric infection and disease and that basic food hygiene behaviours may be able to mitigate these risks. The Safe Start trial seeks to provide new evidence as to whether a locally appropriate infant food hygiene intervention delivered through the local health extension system can improve the health of young children.Trial registrationThe trial was registered at clinicaltrial.gov on March 16th 2018 before enrolment of any participants (https://clinicaltrials.gov/ct2/show/NCT03468114).

CUSTO DE PRODUTOS INFANTO-JUVENIS PARA HIGIENIZAÇÃO BUCAL EM SALVADOR (BA)

O novo paradigma de saúde adotado pela Odontologia nas últimas décadas vem priorizando a prevenção de doenças bucais. A desorganização mecânica do biofilme dentário é o padrão ouro para o estabelecimento e manutenção de um ambiente bucal saudável. Baseado nos dados recentes sobre a redução da cárie dentária no público infanto-juvenil, o presente estudo tem como objetivo estimar e analisar o custo financeiro mensal necessário para a realização da higienização bucal diária de crianças e jovens na cidade de Salvador (BA). Estudo prospectivo, transversal e de abordagem quantitativa. Em maio e junho de 2014, por meio de um formulário, foram coletadas informações básicas sobre todos os produtos infantis (escova dental, dentifrício, fio/fita dental e antisséptico bucal) encontrados em 16 supermercados de Salvador, totalizando 261 produtos. O custo médio mensal em relação à escova dental foi R$1,78, para fio/fita dental foi R$6,30, para dentifrício foi R$4,32 e para o antisséptico bucal foi R$36,00. Quando associados, escova dental, dentifrício e fio/fita dental totalizaram um gasto médio mensal de R$12,40 - valor correspondente a 1,71% do salário mínimo nacional vigente no momento da coleta de dados. Quando acrescido o antisséptico bucal aos outros três produtos, o valor mensal ascendeu para R$48,40 (6,68% do salário mínimo vigente). Os produtos de higiene infanto-juvenis apresentam custos superiores aos produtos para adultos relatados na literatura. A utilização dos quatro produtos investigados impõe um peso significativo sobre a renda familiar, principalmente devido ao antisséptico bucal. É importante que os cirurgiões dentistas personalizem suas indicações de produtos considerando as necessidades de cada paciente e também suas condições financeiras.

Elimination Communication: Diaper-Free in America.

* Abbreviations: EC — : elimination communication MRSA — : methicillin-resistant Staphylococcus aureus When we were planning to have our third child, we made a conscious decision to not use disposable diapers. We felt sheepish that we had already contributed 2 children’s worth of diapers to our nation’s landfills. Unfortunately, washing and drying cloth diapers could triple the amount of work for us. Further, exchanging disposable diapers for energy- and water-consuming laundering was not an environmentally guilt-free option. How did we as humans take care of children before disposable diapers? Researching this question, we soon learned about elimination communication (EC). EC, also known as natural infant hygiene, is the practice of using the infant’s natural timing and cues to recognize when they need to defecate or urinate. By identifying these cues, caregivers can coordinate elimination in the toilet rather than in a diaper. Contrary to the notion that infants relieve themselves randomly and constantly throughout the day, infants naturally eliminate at predictable times, such as on waking or after feeding. Caregivers can incorporate audio cues (soft whistle or hum) to associate with the act of eliminating. With practice, many children learn to eliminate when they are in proper position and hear the cue. EC is not a new concept. Humans have been doing this for millennia and still do in most resource-limited regions. As little as 3 to 4 generations ago, most Americans did as well. So, why has the pendulum in mainstream American culture swung so far away from EC? The disposable diaper was first patented in 1955.1 In 1962, pediatric developmental specialist Dr T. Berry Brazelton published … Address correspondence to Jeffrey M. Bender, MD, Department of Pediatrics, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS 51, Los Angeles, CA 90027. E-mail: jbender{at}chla.usc.edu

Hybrid activist collectives: reframing mothers’ environmental and caring labour

Purpose The purpose of this paper is to use a case study of an online parenting forum to theorise how mothers’ everyday environmental and caring labour is a form of environmental and social activism in the home, that while not organised as such, is still collectivised in a “hybrid activist collective”. Design/methodology/approach Using ethnographic data and content analysis from an online parenting forum for the nappy-free infant hygiene practice known as “elimination communication”, the author compares the matters of key concern arising for this group of mothers with economic activist concerns as identified by Gibson-Graham et al. (2013) in their community economies work. Findings The paper finds a high degree of resonance between the key concerns of the elimination communication forum members with the key concerns of community economies. Furthermore, the author identifies the components of what might comprise a “hybrid activist collective” of mothers and others undertaking direct action for environmental and social change. Social implications Mothers and others acting for social and environmental change through domestic practices should be recognised for their important environmental and caring labour. Originality/value The paper proposes the “hybrid activist collective” as a way of understanding the human and non-human elements that gather together to act for environmental and social change in a collectivised, but not formally organised manner.

In the Garden of Puériculture: Cultivating the Ideal French Infant in Real and Imagined Landscapes of Care (1895–1935)

This essay examines the architectural, visual, and imagined therapeutic landscapes of puericulture, a science of infant rearing developed by French obstetrician Adolphe Pinard in 1895 amid fears of depopulation, infant mortality, and racial degeneration in France. Puericulture, a French neologism establishing a rough linguistic equivalence between agricultural cultivation of the land and the scientific cultivation of human nurslings was, by the early twentieth century, widely diffused across France, parts of Western Europe, and South America. Comprised primarily of an uncontroversial program of prenatal and well-baby care, it had two principal domains of action. One was spatial, as the examination and rehabilitation of bodies of infants and childbearing women required the development of an architectural infrastructure of prenatal clinics, sterilized milk depots, centers for infant hygiene, creches, and well-baby consults. One was educative, as pedagogical tracts instructed women on breastfeeding, proper methods of infant care, and other hygienic matters. It also, however, in its focus on human fecundity, and matters of “soil and seed” fueled eugenic and pronatalist fantasies that engaged not only with the rational clinic, but with broader imaginative geographies of colonial empires, docile female bodies, and aseptic factories for French babies.

Older adults with kidney disease-epidemiology and clinicopathologic correlations: a remarkable single-center survey.

The occupants of our globe, on average, are steadily growing older consequent to lower birth rates and longer life expectancy. While the actual tempo of this global aging process varies from region to region, due to the impact of epidemics of disease (e.g. AIDS), reduced infant mortality, hygiene, malnutrition and violence, there is little doubt that the aging of society as a whole will have profound effects on healthcare systems and clinical practice. The discipline of nephrology is not exempt from these events, indeed it has already been and is continuing to be impacted by the aging of society, particularly in income-rich countries. The prevalence of acute and chronic kidney diseases is expected to increase significantly in the next few decades, largely in the older adult population. The specific causes or nature of these diseases are quite heterogeneous and often difficult to categorize on clinical grounds alone. Renal biopsy has been and continues to be a powerful tool to add precision to diagnosis. Many surveys of renal pathology, as it exists in a given population and how it changes over time, have been published, mostly collected in regional renal biopsy registries, but relatively few have focused mainly on the older and elder adult, conventionally defined as having attained the age of 65 years or more [1–3]. The survey by Jin et al. [4] from Jinling Hospital and the Nanjing University School of Medicine in Nanjing, China, published in this issue of Nephrology Dialysis Transplantation is a good example of this kind of morphological/epidemiological investigation. Remarkably, over 29 000 renal biopsies were performed in adults (age 18–81 years) at a single center over a 10-year period, of which ∼850 (2.9%) were performed in older or elder adults. These older subjects had a variety of clinical presentations and indications for performance of renal biopsy, but the actual rate of renal biopsy performance is not precisely known, but a rate of ∼2900 renal biopsies per year would be high by any standard. Undoubtedly, selection pressures such as the referral nature of and the cachement areas sub-served by the center play large roles in the epidemiological observations reported. Not surprisingly, proteinuria (including nephrotic syndrome; NS) with or without hematuria or acute kidney injury (AKI) was commonly the reason for performance of renal biopsy—observed in almost two-thirds of the subjects. Glomerular or vasculitic diseases predominated— slightly over 70% of all biopsies showed lesion of membranous nephropathy (MN), IgA nephropathy (IgA N), minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), small vessel vasculitis (SVV), diabetic nephropathy (DN) or amyloidosis (AM). DN is likely under-represented (at 9.75%) in this series, compared with its actual prevalence in the population as a whole—even though in this series renal biopsies were performed in diabetic subjects with renal involvement and without biopsy ‘contraindications’. It is not clear if the extent of ‘atypical’ characteristics at presentation influenced the decision to perform renal biopsy in diabetic subjects. Among elderly subjects presenting with NS, four lesions (MN, AM, MCD and IgA N) accounted for 80% of those observed. The distribution of these lesions in the elderly is strikingly different from that observed in the ‘control’ younger population. It is also noteworthy that the most common lesion in the very old (>75 years) was MN. Of great interest is the low prevalence of lesions of FSGS in both the young and old subjects alike (5.8 and 4.7%, respectively). Among older patients presenting with NS (with or without AKI) on only 28/851 (3.3%) demonstrated FSGS on renal biopsy. The frequency of FSGS in this and other studies in Asians is much different that seen in non-Asian populations, especially in subjects of African ancestry [5]. This difference is likely explained on a genetic basis (lack of APOL1 risk alleles in Asians), but environmental influences cannot be excluded [6]. The relative rarity of ‘primary’ or ‘idiopathic’membrano-proliferative glomerulonephritis (MPGN) in the elderly is notable (only 7 in 851 cases; 0.82%). These data support the contemporary view that IN F O C U S

Elimination communication as colic therapy

Colic is generally defined as excessive crying in early infancy and can have negative consequences on the infant as well as on the infant’s family life. Excessive crying can result in escalating parental stress levels, abusive caregiver response, increased risk of shaken baby syndrome and parental postpartum depression. In addition to excessive crying, symptoms and descriptors of infant colic include inconsolable crying, screaming, legs drawn up against the abdomen, furrowing of eyebrows, distended abdomen, arched back, passing gas, post-feeding crying and difficulty defecating. There are few well-designed, reproducible, randomized, large-scale studies which demonstrate efficacy of any therapeutic method for colic. An unexplored etiology is that colic is functionally related to a decrease in stooling frequency. Gut distention may periodically result in intensifying discomfort for the infant and in concomitant inconsolable crying. Elimination communication (EC; also known as Natural Infant Hygiene and sometimes referred to as infant potty training, baby-led potty training or assisted infant toilet training) involves the use of cues by which the infant signals to the caregiver that the infant needs to micturate or defecate. Such cues can include types of crying, squirming, straining, wriggling, grimacing, fussing, vocalizing, intent look at caregiver, red face, passing gas and grunting, many of which are the same initial symptoms related to the onset of colicky infant states. A caregiver’s attentive and nurturant response to an infant’s cues involve uncovering the infant’s intergluteal cleft and cradling the infant gently and non-coercively in a supported, secure squatting position. This position will increase the infant’s anorectal angle thus facilitating complete defecation. It is hypothesized that effective and timely elimination will cause increased physical comfort for the infant; colic symptoms will concomitantly decrease.

Germans into Jews: Remaking the Jewish Social Body in the Weimar Republic (review)

Germans into Jews: Remaking the Jewish Social Body in the Weimar Republic, by Sharon Gillerman. Stanford Studies in Jewish History and Culture. Stanford, CA: Stanford University Press, 2009. 238 pp. $50.00. It was once difficult for historians to escape the shadow of Auschwitz and write a narrative of Jews that did not focus on antisemitism and assimilation. The postwar Zionist assumption was that Jews gave up being Jewish in order to become German, with catastrophic results. Since the 1980s, however, historians have stressed how assimilating involved not discardingjewish life but rather transforming and reaffirming it. This slim book on German-Jewish welfare during the Weimar continues with that revisionist approach. It shows how after 1918 Jews created a vast and extensive network of public assistance organizations. These associations were tightly integrated - ideologically, structurally, and even financially - into the sprawling Weimar welfare state that touched the lives of all Germans. The integration, the author Sharon Gillerman argues, was due to the agreement of Jewish welfare workers with their Christian and secular counterparts that Germany could heal the wounds from the lost war and the economic crises only by invigorating the social body (Volkskorper) - that is, by promoting the health, fertility, productivity, and morality of the population as a whole. Against those who think that being Jewish and being were at odds, Gillerman details how Jewish welfare organizations consciously aimed to redeem and restore the nation. But Jewish welfare also revitalized Jewish communal life. The welfare organizations intervened in the lives of the tens of thousands of needy and wayward Jews, and fostered a Jewish identity by collecting membership dues from close to half of the adult Jews in Germany. Furthermore, because so much Jewish ritual happened in families, welfare organizations that socially supported parents and children had an especially important role in maintaining Jewish life. They accordingly complemented and even rivaled religious institutions in invigotating Judaism. In fact, according to Gillerman, the Central Welfare Agency of Jews, which coordinated the semi-autonomous associations, was German Jewry's most important organization during the Weimar Republic (p. 82). Population policy was of particular concern because the number of Jews had halved over the previous half century in proportion to the general population, a result of the tendency of middle-class Jews to marry late and have few children. According to the workers, the Jewish social body was literally shrinking. The remedy was to intervene more vigorously with welfare: giving better care for orphans; providing early marriage funds; offering medical assistance, especially pre- and postnatal care; encouraging breast feeding and healthy infant hygiene; promoting physical culture; redressing youth delinquency; aiding crippled veterans; retraining the unemployed and finding them jobs; and setting up marriage bureaus to help poor youngjewish women find Jewish husbands (Jewish men often preferred large dowries, even if that meant marrying a gentile). The workers, most of whom were female, also proposed that the new woman - the modern, independent, and sexually loose urbanite allegedly prominent among Jews - should be replaced by the new Jewish mother, who was politically liberated but also committed to aiding the Jewish community and nurturing the Jewish social body. …

Constructing the pediatric nurse: eugenics and the gendering of infant hygiene in early twentieth century Berlin.

This article explores the connections between infant mortality, eugenic thinking, and the professional development of pediatricians and pediatric nurses in the early twentieth century. It argues that the goal of the physicians affiliated with Germany's National Hospital to Combat Infant Mortality was to create and disseminate a centrally-controlled message about infant hygiene, and to transform infant care into a medically-managed event. The deeply gendered ways in which both the hygienic program, and the medical division of labor were constructed, had the ambiguous result of expanding training opportunities for pediatric nurses, while at the same time, severely limiting their professional autonomy.

Pediatric Advocacy: Yesterday, Today, and Tomorrow

The reason that advocacy is so much embedded in the work of pediatrics is that children have little political voice of their own and rely on the proxy voice of others including pediatricians to speak out on their behalf. This voice is so important because of the overrepresentation of our children among the poor and underserved. It should be stated that the “shared voice” of pediatrics has been heard throughout our history—speaking on behalf of all children. As we proceed into the next millennium, it is proper to reflect on pediatrics’ past, our present, and future so that, as a profession, advocacy will continue to play a key role. At the turn of the century, there were about a half dozen practitioners devoted to the care of children. Today, the membership of the American Academy of Pediatrics (AAP) is >57 000 physicians. The role of advocacy in pediatrics dates back to the end of the 19th century when an epiphany within medicine crystallized the necessity that children deserved a cadre of professionals dedicated to their care. In addition, it was evident even then that an emphasis on advocacy and the protection of children would comprise a core aspect of the profession. In the United States, Dr Abraham Jacobi is considered the “Father of Pediatrics.” In 1859, he published his seminal text titled: Midwifery and Diseases of Women and Children. In addition, he was the first professor of pediatrics in America at New York Medical College, and in 1860 established the first free pediatric clinic in America.1 Dr Jacobi was one of the pediatric pioneers who understood the link between the environmental milieu children found themselves and the incidence of disease. His efforts characterized the beneficence of our profession. The emergence of the Industrial Revolution in the 19th century led … Reprint requests to (C.N.O.) Department of Pediatrics University of Minnesota Medical School Maternal and Child Health Division of Epidemiology School of Public Health West Bank Office Building, 1300 Second St South—Ste 300, Minneapolis, MN 55455. E-mail: oberg001{at}umn.edu

Un discurso sanitario para un proyecto político. La educación sanitaria en los medios comunicación de masas durante el primer franquismo

Making used of the radio conferences organized by «Jefatura Provincial de Sanidad» of Málaga during 1939 and 1940 on maternal and infant hygiene, which were published, in this study we analyse the relationship between politics and health education. The article show how the popularization of medicine was a resource used by national-syndicalism more than sanitary information for the population during early years of Francoism.

Infant mortality and concepts of hygiene. Strategies and consequences in the Kaiserreich and the Weimar Republic: the example of Berlin

The fight against infant mortality followed the guidelines of “hygiene” and their modifications into social, racial, and national hygiene. In Berlin, the campaign to promote infant hygiene began in 1904, when the municipal authorities started to create infant care centers tentatively under the auspices of a charitable association. During and after the First World War, the authorities expanded this campaign to reflect a growing commitment to the principles of social and racial hygiene, which aimed both to improve social conditions that worked against the health of children and to strengthen the constitution of the race. While racial hygienists feared that social measures for the weak would promote degeneration by encouraging their survival, social hygienists argued that it was impossible to distinguish between “fit” and “unfit” in early childhood, and eugenics became increasingly important. Social hygiene as a means of prevention was reduced to a “systematical registration” of the more or less fit individuals. This development and the eugenic background of infant care created a link to the concept of selection in Nazi Germany.

Reported infant feeding, oral hygiene and dental attendance patterns in children aged 5 years and under referred for extraction of teeth under general anaesthesia.

This study was designed to examine reported infant feeding, oral hygiene, and dental attendance practices in children who had established dental disease before attaining school age. Data were collected by structured interview from the mothers of 150 children aged 5 years and under who were referred to a hospital Paediatric Dentistry Unit for the extraction of teeth under general anaesthesia. Few children in this study had been exclusively breast-fed, and, although unconfirmed by data derived from matched caries-free controls, the development of dental caries would appear to be related to prolonged bottle-feeding, including the use of a night-time bottle until just before weaning, the early introduction and regular consumption of larger than average amounts of confectionery, coupled with reportedly regular but unsupervised toothbrushing. Although decay was already established in over a third of children before they visited a dentist for the first time, little evidence of restorative care was found. It would appear that the primary care services fail this youngest age-group.

ABC of Breast Diseases: Breast Infection

Breast infection is now much less common than it used to be. It is seen occasionally in neonates, but it most commonly affects women aged between 18 and 50; in this age group it can be divided into lactational and non-lactational infection. The infection can affect the skin overlying the breast, when it can be a primary event, or it may occur secondary to a lesion in the skin such as a sebaceous cyst or to an underlying condition such as hidradenitis suppurativa. View this table: Organisms responsible for breast infection View this table: Antibiotics most appropriate for treating breast infections* A breast abscess in right hand breast. There are four guiding principles in treating breast infection All abscesses in the breast can be managed by repeated aspiration or incision and drainage. Few breast abscesses require drainage under general anaesthesia except those in children, and placement of a drain after incision and drainage is unnecessary. Neonatal breast infection is most common in the first few weeks of life when the breast bud is enlarged. Although Staphylococcus aureus is the usual organism, Escherichia coli is occasionally the pathogen. If an abscess develops the incision to drain the pus should be placed as peripheral as possible to avoid damaging the breast bud. Neonatal breast abscess. Better maternal and infant hygiene and early treatment with antibiotics have considerably reduced the incidence of abscess formation during lactation. Infection is most frequently seen within the first …

The Role of the YWCA in the Development of the Chinese Women's Movement, 1890-1927

Nineteenth-century socioeconomic turmoil transformed women's position and spurred women's movements in the West and later in China. Founded to deal with women's new problems, the YWCA, quasi-religious in character, was carried from Britain and America to China in 1890. Attracting both Christians and non-Christians, the China YWCA became prominent in the effort at urban social reform. It initiated projects promoting women's welfare in such areas as adult literacy classes, vocational training, physical education, and overseas scholarships for female students and infant hygiene and nutrition. As the view that women essentially differed from men gave way before egalitarian ideologies, the YWCA's prestige among educated Chinese declined between 1919 and 1927. In its heyday, however, the YWCA not only awakened many Chinese to women's issues, but also provided women with the leadership skills that fueled the more politicized women's organizations of the late 1920s.

BIRTH CONTROL AS VIEWED IN 1923 BY A HIGHLY RESPECTED AMERICAN PEDIATRICIAN

Dr. Richard Arthur Bolt (1880-1959) was both a greatly respected American pediatrician and an acknowledged leader in the development of maternal and infant hygiene programs. His chapter entitled "The Mortalities of Infancy" in Isaac Abt's (1867-1955) encyclopedic, nine-volume treatise on pediatrics, published between 1923 and 1926, contains this negative view of birth control.1 This terrific loss of life in utero or shortly after birth constitutes a serious problem from a biological as well as a social standpoint. Of recent years there has been an alarming increase in the frequency and actual number of induced abortions. This has gone hand in hand with the insidious propaganda for so-called "birth control" or "voluntary parenthood"—a movement which has gained momentum in France, Holland and New Zealand, and has gradually spread to England and the United States. While the birth control enthusiasts would indignantly disclaim any connection between the "contraceptive methods" of "voluntary parenthood" and induced abortions, it is very evident that the more "moral technique" of contraception must often break down and relief from the "accidents" which follow be frequently sought in induced abortion. Thus far contraceptive methods have been practiced largely by the elite and better educated classes. Those most able to bear children and meet their support have been the very ones to shirk the responsibility, while those for whom birth control is claimed to be a great boon still proceed to build up large families. It has been estimated that at least four children to a family are necessary to keep up the stock.

A COMMUNITY HEALTH CHALLENGE--NORTHEAST BRAZIL.

A Community Health Challenge—Northeast Brazil George M. LeibyM.D.F.A.P.H.A., and Fernando FigueiraM.D.F.A.A.P. CopyRightDr. Leiby while special assistant to the Surgeon General, USAF, served as consultant to the U. S. Agency for International Development to establish with Brazilian counterparts this Northeast Brazil Health Development Program. He later served as chief public health adviser, USAID, to implement this Binational Community Development Program. Dr. Figueira is professor and chairman, Department of Pediatrics and Infant Hygiene, Medical School, University of Recife, and chairman, Seção 1 (Norte), Distrito XI da American Academy of Pediatrics, Recife, Pernambuco, Brazil. https://doi.org/10.2105/AJPH.54.8.1207 Published Online: August 29, 2011