Document 10VELw2D4DLnDo2g3mREBZx4K

UlJ7f THE WELFARE WORK OF THE METROPOLITAN LIFE INSUR ANCE COMPANY FOR ITS INDUSTRIAL POLICY HOLDERS LEE K. FRANKEL Third Vice-President REPORT FOR 1918 ft ft REPORT OF THE WELFARE DIVISION FOR .THE YEAR 1918 Notwithstanding the difficulties encountered in carrying on the work of the Welfare Division during the war year, 1918, at maximum efficiency, I am pleased to report that little difference is to be noted in the results accomplished as compared with the preceding years. In fact, along certain lines, it appears that the war acted as a stimulus rather than as a deterrent. I refer in particular to the work of our Superintendents and Agents in cooperating with the Welfare Division. Too much cannot be said regarding the services rendered by our field men in every phase of patriotic welfare activity. Although many of our Nurses left our service for war duty, special mention should be made of the work of those who remained with us. I shall refer to these more in extenso in a later part of the report. The unique machinery which the Company has at its dis posal through its Agency staff enabled us to develop our activi ties along lines which are practical and which we believe in the long run must bring results. INSTRUCTION OF THE POLICY-HOLDER AND THE MEMBERS OF HIS FAMILY IN MATTERS OF HEALTH. (a) Health Literature The great difficulty in the past year has been to secure paper for our Welfare literature. Owing to the restrictions put by the Government on the sale and use of paper, we found it at times practically impossible to secure necessary stock. For this reason we were unable to meet all the demands made upon us. Naturally, owing to this limitation, we were restricted in the publication of new pamphlets. Nevertheless, two new pamphlets have been issued during the year. The first of these, "The Metropolitan Cook Book," which was issued in the latter part of 1918, already has proven its usefulness and need. The demands for this booklet are in creasingly large. In its preparation, we had primarily in mind the question of food conservation and the use of foodstuff's which could be purchased at reasonable cost. We have received letters 1 from many policy-holders indicating their pleasure in receiving this booklet. We are advised that it fills a long-felt want in the homes of many of our Industrial policy-holders. If we can educate these in modem methods of nutrition and preparation of food, we shall have gone a long way in reducing the incidence of diseases due to bad diet and improper feeding. Another booklet which has recently been issued and which has received much favorable commendation was prepared by Miss Eleanor Bridgeland, Supervisor of the Nursing Service, and is entitled " Information for Expectant Mothers." Follow ing our usual plan, the booklet has a very attractive cover. The text is written in a simple style so that every one can readily understand it. We are placing this booklet in the hands of Nurses in the belief that the expectant mother can best be approached through the professional visitor. Requests for the pamphlet are coming in from many associations interested in infant and child welfare who have expressed themselves in no uncertain terms regarding the value of this booklet. Regarding our Welfare literature issued in previous years, the number of pamphlets distributed in 1918 was limited, as stated above, by our inability to obtain paper. Notwithstanding this, a total of 14,599,122 copies was distributed during the year, making a total of 187,824,532 copies printed and distrib uted by the Company to date. (b) Nursing Service . The statistics of the Nursing Service show that, whereas we made 1,316,319 visits in 1917, a total of 1,431,085 visits was made in the year 1918. Considering the conditions which sur rounded the Nursing Service, this result is exceedingly grati fying. In a number of smaller communities, we were compelled to discontinue service during the year owing to the inability to obtain properly trained Nurses. If it be recalled that approximately 30,000 Nurses volunteered for service with the Army and the American Red Cross, we feel that we were very fortunate in being able to continue our service to the extent which we did, and, as a matter of fact, actually improve upon the service of the preceding year. The results are gratifying not only because of the increased number of visits but because the studies which we have made of individual services show a higher character of work. Agents have become better ac quainted with the requirements of the Nursing Manual and are 2 UMiy-: 09 reporting fewer cases where nursing is not necessary . Coopera tion between the Nurses and Agents is more pronounced, which likewise has been reflected in the kind of service given. Improvement in the professional status of the Nursing Sendees mentioned in the report of 1917 continued during the year 1918, as is indicated by the following tablet* r Percentage or Services in Specified Grade For the Years 1915 to 1918. Month and Yaar Excellent December, 1915____ Deoember, 1916...... September, 1917___ Deoember, 1918...,. 5.2% 3.9% 3.9% 2.4% *Ne*r service*. Good 33.4% 57.9% 65.4% 68.5% Fur 50,5% 34,2% 27.6% 25.9% Poor 10.5% .9% 1% .0% UnelaaiSed* .4% 3.1% 3.0% 3.2% While the number of excellent services decreased 1.5 per cent., which was probably due to war conditions, the number of good services increased from 65.4 per cent, to 68.5 per cent. Similarly, the number of fair services decreased from 27.6 per cent, to 25.9 per cent., whereas the number of poor services was entirely eliminated. In view of the unusual conditions existing during the past year, it is gratifying to know that we have been t able to satisfactorily maintain our professional standards. There can be no doubt that this excellent result was obtained by the close supervision which our Field Supervisors give on their visits of inspection and to the better cooperation on the part of Nurses, Superintendents and Agents, Increase in the cost of living has been reflected in the Nursing Service. In 1917, the cost per visit was 51.7 cents; in 1918, 52.5 cents. There is every likelihood, however, that the cost in 1919 will be even higher. On the other hand, the average number of visits per patient was reduced from 5.4 to 4.9. This we believe was due to better supervision and, in particular, to better cooperation between Agents and Nurses, through which unnecessary visits were avoided. The total cost of the service for 1918 was $810,387.86 as compared with i $724,134.98 for 1917. Based on the entire number of Indus trial policies in force, this makes a cost of 4.6 cents per policy as compared with 4.8 cents per policy in 1917. This is the amount which is paid by every policy-holder in the Company for 3 a highly skilled service during illness, given by graduate Nurses, and, from the standpoint of cost, is extraordinary, particularly if it be remembered that every policy-holder who desires the service in cases of acute illness may receive it during the entire period of incapacity, if such incapacity requires bedside care. This report would not be complete without a word regarding the heroic service rendered by our Nurses during the recent in fluenza epidemic. When it became apparent that the epidemic would be widespread and reach practically every'part of the United States and Canada, instructions were sent to Superin tendents to put on additional Nurses in case emergency situa tions in their respective Districts required it. This offer was availed of in many communities so that service could be given to policy-holders. In many communities, unfortunately, it was impossible to obtain additional Nurses. From every part of the country, however, word has been received from Superin tendents and others indicating that Nurses were on duty frequently twelve to fourteen hours per day. Many of them broke down under the strain. Many of them became afflicted with the disease in caring for their patients. Probably no greater testimonial could be given to the nursing profession than the splendid work done by its members during the recent epidemic. The work of our Field Nursing Supervisors likewise requires special mention. When Boston, Mass., realized the enormity of the situation which confronted it, Miss Bridges, our Field Supervisor in New England, was asked to take charge. She undertook to organize the Nursing Service in that community. It is no exaggeration to say that she kept at work fourteen to sixteen hours daily. Miss Foote, our Southern Supervisor, visited many of the cantonments in the South and gave practical advice and suggestions in meeting the epidemic situation. Miss Johnson, another of our Supervisors, was drafted by the Red Cross and was engaged in similar work. What Mrs. La Malle did in the Middle West is best indicated by an editorial which appeared in The Public Health Nurse, from which I give the following abstract: "The Visiting Nurse Association had been operating with only one Nurse in the field. She was doing the very best she could, but was practically helpless to handle the calls, which were running from thirty to sixty a day. Mrs. La Malle re quested that she be given all the calls in one-half of the city. She started at one o'clock in a taxi-cab, working intensely until 4 late in. the night, making every call assigned to her before quitting. "In many of the cases which Mrs. La Malle visited, the entire family were stricken and helpless. Some of them had not had an outsider enter their homes for days. She made arrange ments in many cases where she visited for removal to the emergency hospital, thereby undoubtedly saving many lives. At the meeting of the Medical Society held the same night, Dr. Owen publicly praised the effective work and cooperation rendered him by Mrs. La Malle and further stated that with out her assistance the situation would be much more serious than it was." The report of the Nursing Service undoubtedly brings up the - question raised last year regarding the influence of the nursing and the distribution of the Welfare literature on the Company's mortality. In the report of last year, it was shown that there had been a decrease at all ages in the Company's mortality from the year 1911 to 1916. This decrease varied from nine-tenths of 1 per cent at ages 75 and over to 22.2 per cent, at age one. The same gratifying decrease continued during the year 1917, as shown in the table below: Industrial Experience, Metropolitan Life Insurance Company, 1911 and 1917. Death Rates per 1,000 Com pared by Age Period. AGE PERIOD All ages.................... .... 1 to 4......................................... 1.................................................. 2.................................................. 3.................................................. 4.................................................. 5 to 9............................ 10 to 14....................................... 15 to 19....................................... 20 to 24....................................... 25 to 34...................................... 35 to 44...................................... 45 to 54....................................... 55 to 64...................................... 65 to 74....................................... 75 and over...................... mr 11.6 10.5 20.4 13.5 7.7 5.6 3.4 2.6 4.8 6.6 8.4.. 12.4 19.6 35.8 76.4 142.6 Per cent increase in seven years. 1911 12.5 12.8 25.2 16.6 9.3 6.6 4.2 2.7 4.7 7.3 9.5 13.7 19.8 36.0 74.5 139.3 Per Cant. Decline 7.2 18.0 19.1 18.7 17.2 15.2 19.1 3.-7 2.1 9.6 11.6 9.5 1.0 .6 *2.8 2.4 5 During the year 1917, there was an average increase in mor tality over that prevailing in 1911 of 2.5 per cent, at ages 65 and over and of 2.1 per cent, at ages 15 to 19. Aside from these, all other ages show a decline in mortality during the sevenyear period. If we study the subject by causes of death and compare our mortality with that of the Registration Area, the same satis factory results are shown. This is brought out clearly in the following table: RATES PER 100,000 FOR PRINCIPAL CAUSES OF DEATH --1917 AND 1911 COMPARED. Metropolitan Life Insurance Company (Industrial De partment) and Registration Area of the United States. (White and Colored Lives Combined) CAUSES OF DEATH ALL.I.Co. dad. Dept.) Rate* per 100,000 1017 Mil FvCent. Badostfcm is 7 Ynn Registration Arm U. 8. A Rate* per 100,000 1917 1911 PerCent. Redaetion in 7 Yean All causes of death.......... 1,161.1 1,253.0 7.3 1,416.8 1,415.9 *.l Typhoid fever................ 12.1 Acute infectious diseases of | childhood (measles, scar letfever, whoopingcough, diphtheria)................. } J 46.3 Acute poliomyelitis......... i.e Influenza...................... 14.4 Tuberculosis of the lungs... 172.3 Cancer, all forms........... 70.9 Organic diseases of heart... 142.0 Acute and chronio bron chitis........................ 10.8 Pneumonia--all forms...... 121.1 Bright's disease.............. 95.7 Diseases relating to child birth......................... 18.2 External causes (accidents, suicides and homicides)... / 93.2\ U106.7/ 22.8 58.9 1.6 15.6 203.0 68.0 141.8 15.2 115.3 95.0 19.8 97.9 46.9 20.6 9.4 15.1 *4.3 *.l 29.0 *5.0 *.7 8.1 r 4\ mo; 13.4 44.9 1.6 17.2 128.7 81.6 153.1 16.4 149.3 99.1 16.6 108.1 21.0 49.0 1.8 15.7 138.0 74.3 140.9 19.5 133.7 87.5 16.0 107.4 36.2 8.4 11.1 *9.6 6.7 *9.8 *8.7 15.9 *11.7 *13.3 *3.8 *.7 *Per cent increase in seven years, tIncludes nr deaths for 1917. For example, the Company's reduction in death rate from typhoid fever in 7 years (1911 to 1917) was 46.9 per cent., whereas in the Registration Area for the same period, it was 36.2 per cent. The reduction in the rate for pulmonary tubercu- 6 /<f' / losis was 15.1 per cent, in the Industrial Department of the Company, as compared with only 6.7 per cent, in the Registra tion Area. The diseases mentioned in the table on page 6 are largely those which come within the purview of our Nursing Service, including the infectious diseases of childhood, pneu monia, and particularly diseases relating to childbirth. The table shows that there has been an increase of 4.3 per cent, in mortality from cancer in the Company's Industrial Department experience. At the same time, there was an increase of 9.8 per cent, in the Registration Area. Mortality from external causes increased 9 per cent. In this are included war deaths. If these latter are deducted, the Company's Industrial experience would show a decrease in the mortality from external causes. Since special attention is being paid to diseases relating to childbirth, and as special attention is being given to maternity nursing, the data in the table are especially interesting. The Company's mortality in 7 years declined 8.1 per cent., whereas the mortality in the Registration Area increased 3.8 per cent. Probably nothing better attests to the value of the Nursing Service, and in particular the care given to women before and during childbirth, than the data just submitted. Last year we began systematically to offer prenatal service to policy-holders. This service was materially extended during the year 1918. In order to make service available to more policy-holders, a former rule was rescinded under which policy-holders could obtain maternity service only if policies were one year in force. This rule was changed so that now policy-holders are entitled to the service after the policies are nine months in force. We are hopeful that the extension of the prenatal care in connection with our maternity service will in due course have an increasingly favorable effect upon the mor tality from diseases relating to childbirth. COOPERATION WITH HEALTH AUTHORITIES AND SOCIAL AGENCIES IN IMPROVING HEALTH CONDITIONS. (a) Clean-up and Fly Campaigns As in the past, we requested Superintendents to cooperate with local civic organizations in arranging for clean-up cam paigns. In order to make our clean-up literature more effective, we revised the clean-up circular, making it a colored poster. 7 1 Two varieties of this poster were printed, one for distribution in communities in which the Street Cleaning Department did not undertake the removal of refuse; the other poster outlines to citizens the methods of coopt nation to be followed in com munities in which removal of refuse was provided for. During the year 1918, our representatives cooperated in 152 cities and distributed over 620,000 clean-up leaflets. (b) Baby Week Campaigns Early in the year a circular letter was sent to all Superin tendents advising them of the plan of the Federal Children's Bureau for a " Children's Year." We enclosed in this letter two leaflets explanatory of the campaign which the Children's Bureau intended to carry out in connection with this special activity. Superintendents were urged to get in touch with local Baby Week Corftmittees and to cooperate with them in every possible way. As a result, Metropolitan representatives in 176 cities throughout the United States were very active in these campaigns. It is the irony of the situation that while this was supposed to be " Children's Year," the probability is that the mortality among infants was higher than during the preceding year and that it will continue to remain higher during the year 1919. This of course was due to the influenza epidemic. In some cities during certain weeks of the epidemic, the infant mortality was from two to five times as high as during the corresponding weeks of last year. This does not necessarily mean that infants died of influenza, but rather that they died owing to improper care and attention. In many instances, mothers of babies died or were taken to hospitals, with a resulting increase in the number of deaths among their infants. The special Baby Week circulars which the Company pre pared several years ago, as well as the other literature on child welfare, were distributed very generously in connection with Baby Week campaigns. Over 475,000 of these booklets and leaflets were given to various welfare organizations or distributed by our agents. (c) Patriotic literature While it had no particular bearing upon the health conditions in various communities, the Company felt it to be its duty during the year 1918, owing to conditions which prevailed, to 8 educate its policy-holders along patriotic lines by distributing to them a small booklet prepared by the National Committee on Patriotic Literature, containing the words and music of the more important patriotic songs of the United States. In addi tion to placing these booklets in the homes, thousands of copies were given to public school authorities for use in school work. Requests have come to us from many organizations engaged in the sale of Liberty Bonds and War Savings Stamps for copies of this booklet. In fact, requests have come to us from all types of organizations and societies including churches, Y. M. C. A.'s, etc. A total of 1,475,000 of these booklets has been distributed. - As heretofore, requests have come to us from public schools throughout the United States for copies of our literature to be used as text books in connection with the training of pupils in sanitation and personal hygiene. We have endeavored to meet these requests to the best of our ability. Our limitations in this respect, owing to lack of paper, have been indicated above. Nevertheless, during the year we furnished our pamphlets to schools in 126 communities in the United States and Canada. INDUSTRIAL SERVICE BUREAU. Two years ago, the Industrial Service Bureau was organized by the Welfare Division in the belief that it might help em ployers to work out the human problems of industry. It was our thought that the literature which had been collected by the Company, together with the Company's own experience in hand ling labor problems, might be of benefit to other employers of labor. In conducting the work among its own employees, the Company has necessarily made careful studies of similar work undertaken by other corporations. The Company's library on this subject is a fairly complete one. During the year, the Industrial Service Bureau issued the first of its publications entitled " Hiring and Firing." This book let seems to have struck a sympathetic chord. Requests have come in from hundreds of employment managers, students of employment problems, corporations and firms interested in the important problem of personnel. We have supplemented this booklet by correspondence with many employers regarding specific problems in their industries. The growth of the Group Insurance Department has demonstrated the need for the Industrial Service Bureau, and it 9 1 is hoped that during the coming year, this activity will be materially extended. At present we are planning to place a more intensive service at the disposal of employers insured in the Group Insurance Department and to give them, if necessary, the personal services of men who have had expert training in employment, managerial and welfare problems. THE FRAMINGHAM DEMONSTRATION. The Framingham Demonstration is now in its third year. Under the original offer of the Company to the National Tuber culosis Association, $100,000 was granted for an experiment to cover a three-year period. It is quite probable that the experi ment may have to be continued beyond this time. Results thus far obtained indicate very strongly that the experiment has been worth while and that, if it be continued a sufficiently long time, the hopes of the donors may be realized. The Special Committee having the Framingham Demonstra tion in charge has published a series of monographs which fully describe the methods and plans of the experiment, together with special monographs describing some of the special features of the work in Framingham, among these being the medical examination of citizens, diagnostic standards set up by the Committee, etc. The reader is referred to these monographs for a more elaborate statement of the work thus far done. It will suffice to say that apparently the infant death rate in Fram ingham has been reduced since the Demonstration was begun. Dining the decade 1906 to 1916, approximately 14 people of all ages died per thousand living; during the first year of the Demonstration, this number was reduced. The tuberculosis death rate for the decade 1906 to 1916 was 121 per 100,000. While the data thus far obtained must be taken with reserve, there are indications that the death rate from tuberculosis was reduced approximately 20 points per hundred thousand in 1917, and that a further decrease resulted in 1918. If these figures will be confirmed by a careful checking up of the data at hand, it would appear that, even in the short time in which the Experi ment and Demonstration have been under way, the results show that it has been worth while. SANITARY SURVEY OF NEW ORLEANS. In cooperation with the City Board of Health and with the approval of Hon. Martin Behrman, Mayor of New Orleans, the 10 J ij F1 i- i'5 l: . .- i- r. ; rt Company, early in June 1918, started an intensive study of the health and sanitary condition of the city of New Orleans. The expenses of the survey are to be shared equally by the City and the Company. The investigation is divided broadly into two parts--actual work in the field and the analysis of statistical data at the Home Office. The first inquiry was into the death rate, to determine whether it was normal or abnormal, and if abnormal, a de termination of the diseases or conditions producing the high rate, the effect of these diseases on the death rate and the meth ods in vogue for their control. A detailed study is being made of infant mortality and many of the more preventable communi cable diseases, as typhoid or tuberculosis. The sanitation of school buildings and the protection of school children from disease will be covered in the investigation. Especial attention is to be given to problems of municipal engineering--the public water supply, the disposal of excreta and garbage. The purity of the milk and other food supplies will be determined. The commercial and industrial life of the community is to be care fully studied, the hazards of industrial life, the sanitation of workrooms, adequacy of wages and the living conditions of the worker in the home. The relationship of poverty to disease will be considered and an investigation made of the methods of relief by public and private charities of the city. Finally, a careful scrutiny of the Health Department itself will be made, its methods, organization and distribution of its budget to provide' for all vital health problems. The survey is conducted, not in a spirit of criticism, but with a constructive viewpoint, and it is believed that valuable data will be obtained which will be of assistance in solving many public health problems, not alone for New Orleans, but other Southern communities. With this point in mind, a careful distinction has been made, throughout the survey, in the effect of the white and negro population on the community death rates. The main result hoped for as a result of the survey will be a reduction in the death rate of the future. New Orleans will benefit by having the way to a clean bill of health pointed out, a distinct attraction for a city contemplating the commercial expansion which New Orleans has in mind. The report is now in the final steps of its preparation. 11 rs: ALLOTMENTS AND ALLOWANCES FOR SOLDIERS' FAMILIES. Early in the year 1918, the Company sent a circular letter to all Superintendents calling their attention to the War Risk Insurance Law, and in particular to that section dealing with the question of allotments and allowances for soldiers' families. The Company's agents were advised that it would be part of their work during the year to become acquainted with policy holders in which some member of the family had enlisted or had been drafted and to explain to them the provisions of the law bearing on their cases. Through correspondence with Com missioner Nesbit of the War Risk Insurance Bureau, letters sent from this office regarding policy-holders were given special attention. As a result of this cooperation between agents and policy-holders, allotments and allowances were secured and expedited in hundreds of cases of families who, because of their ignorance of the law and of the method of procedure to obtain allotments and allowances, would probably not readily have obtained them. EXHIBITS. Owing to the epidemic of influenza which was at its height during the early fall, it was not possible for the Company to cooperate with local authorities in arranging for Welfare exhibits which are usually held at this time of the year. However, the Welfare exhibit was shown at 42 fairs. Many of these exhibits included an emergency hospital at which a Metropolitan Nurse was in attendance to give first aid to visitors. The value of these exhibits is best shown by the following abstract from a letter written by one of our Superintendents reporting on the exhibit held in his District: "In addition to our booth, we have had now for five or six years the official hospital on the grounds, which is known as the Metropolitan Life Insurance Company Emergency Hospital. It is the only hospital on the grounds, and I receive from time to time the thanks and appreciation of people who have received treatment. The exhibition authorities also appreciate very much what we do and depend upon us every year for this hospital, because if we did not have the hospital they would be compelled by law to supply one. Two trained nurses are in attendance every day from nine o'clock in the morning until midnight. During the exhibit, 54 people were treated at the hospital.'' 12 PICNICS Again, conditions incidental to the influenza epidemic pre vented the Company from holding picnics for policy-holders as extensively as heretofore. For this reason, only five such picnics were held during the year. Reports of these outings, however, are very gratifying, and it is the Company's intention to extend this phase of Welfare Work during the coming year. HEALTH AND HAPPINESS AND VETERAN LEAGUES Owing to the various war activities of the field staff, it was not possible for Agents to devote much time to the development of the Health and Happiness and Veteran Leagues. However, the membership of these leagues to date is 115,420 and 57,737 respectively. In Baltimore, one of our representatives has organized a particularly fine chapter of the Health and Happi ness League. The children of this chapter elect their own officers and conduct monthly meetings in a very businesslike fashion. The members of the League were continually engaged in the sale of War Savings Stamps and in other patriotic ac tivities. At times this chapter holds rather elaborate enter tainments which are conducted and financed entirely by the children themselves. Thirdf Vice-President. 13 n0 Year luued WELFARE PUBLICATION No. Dietr. Total Diatr. to in 19 IS Jan. 1,1919 1909 1910 1910 1910 1910 1912 1912 1912 1912 1U2 1012 1912 1912 1913 1013 1913 1913 1913 1913 1913 1913 1913 1013 1913 1013 1013 1913 1914 1914 1914 1914 1914 1914 1914 1QU 1914 1914 1914 1914 1914 1914 1914 1914 1914 1914 1914 1914 1914 1916 1916 1916 1915 1915 '915 115 .#*6 1916 1915 1915 1915 1915 1915 1915 1915 1915 1916 1915 1915 1915 1915 1915 1915 191$ 127,350 2.650 38,035 133,450 Teeth', Tonsils and Adenoids (Foreign)--r reach, Italian, The Child (Foreign)--French, Italian, PoHih andYtddUi Tli* RMlth nf tha Wnrkur--French...... ........................... Gonxumption Circular. (Diaoontinued in U. 3. during 1918) A Day in the Life of a Fly. (Dieeontinued in United Statee 258,300 70,97 59,275 119, J00 205,785 74,9(5 125,612 310,1 5 132,125 81.150 ' 87,225 178,125 162,306 19,455 5,500 1,200 88,475 84,710 678,400 All About Milk.................................................................. Measles.............................................................................. . niMiltfta.PMMtl .............................................. Health and HappineM League Hedge Folder (Canadian).. 327,415 209,425 69,325 125,950 99,375 31,035 92,349 13,160 9,925 78,474 19.190 225 154,685 12,440 Health Code........... ...................................................................................... Malaria........................................... ,,................................. The Light That Never Fail* (Diaeontinaad In 1915 aa a All About MBk-Fraoeh.................................................. Seven Ages of Women. (Discontinued in U. 8. in 1918)... 1,000 8,060 12,450 45,700 204,335 102,975 62,560 84,000 30,985 37,052 15,000 189,876 1411 20,872 33,712 63,725 29,026 1376 1,900 37376 500 6.706,335 484,855 6310,025 673,935 34,974,700 11,100 3329,729 894,050 636410 1386.460 6439,470 2.142.460 6,436,087 4,055466 1,312,925 1,061320 1433,439 1418389 2,097,730 229352 1368,410 1309,989 866365 606,626 414.000 4406460 700.000 1486440 1,971,890 796,100 6,380,445 1,146,775 182,760 1457,769 139,406 266349 5426419 128,126 13,825 7475 4,577,636 878,720 26,000 25,000 249,000 127400 400,000 400,000 286,000 28350 121,360 96,796 646300 876,335 1,040,115 402,935 392,960 4,184,675 175,708 192,262 201,100 1,465325 4323,161 4366,400 4,340497 4411372 4,430,750 4,379380 4308,950 4,304,175 1453,960 20,750 33,100 14 l Year Issued WELFARE PUBLICATION No. Distr. Total Diatr. to In 1918 Jan. 1,1919 1916 1916 1916 1916 1916 1910 1916 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1917 1918 1918 1918 1918 Special Campaign droolers.............................................. State Employment Bureau................................................. How to Live Long--French.............................................. Infantile Paraiyiia............................................................ Special Baby Week Circular............................................... Almanac (1917) ............................................................ . Circular re Health Offioer in Washington........................... Health Campaign Circular--French................................... War on Consumption--French.......................................... Baby Week Circular--French............................................ Tubereuloaia la Preventable--Engiah................................ Tubereuloaia b Preventable--French................................. Food Facta......................................................................... Food Fists--French.......................................................... Mankind's Moat Deadly Enemy........................................ Sanaa of Our Country........................................................ Soanet Fever--French....................................................... Pint Steps......................................................................... Almanac (1918)--Engiiah and Foreign Languages............. Toledo Health Code........................................................... Homing and Health Billa--Indiana.................................. Appropriation (or Tuberculosa--Now Hampshire.............. Appropriation for Tubereuloeia Study--Michigan.............. Homing and Health BQle--Michigan................................. Homing *c*t Health BiUt--QUnob................................. Appropriation (or Health Improvements--New Haven..... Sewer Bond Iaaue--Nashville, Tenn................................... Health Instraetions (or Erpectsnt Mothers. (Dietdbutian limited to Nurses)...................................................... Mankind's Moat Deadly Enemy--French.......... ............. Inluetua drcukrt............................................................. Cook Books........................................................................ Calendars (1919)................................................................ Total. 27,460 42,600 1,910 6,610 9,250 467,406000 221460 19,465 822,626 680,300 2460 167,700 2,000 6,375 2400,000 401,426 5,000400 1(499,122 66,000 370.000 49,676 712,500 170.000 6.685.000 18,000 2,086 20,460 10*26 188400 8460 964460 3(466 633*00 1,(76,300 8,026 544,660 (488*18 28.000 88400 21,900 76,100 75.000 199,900 19400 10.000 8400 6,376 2400.000 401,(26 6400,000 187,82(437 RECORD OF NURSING SERVICE, 1914-1918 1914 1916 1913 1917 1918 Cities and towns covered......... Number of patients under ears 1404 of Nurses.......................... 192,336 Number of visita mads........... 1,060488 Coat of Nurses' visits............... 8S2748L64 Cost per viat............................ .497 Number of visits par patient.. 6.5 Coet pee policy......................... .062 2,001 - 202,669 1,078463 3663,900.10 418 5.3 .060 1463 221466 1,189428 8812,936.72 .515 6.3 .064 2,130 242,760 1416419 8481,765.61 .517 5.4 .068 1,970 290482 1,431,085 8762,43846 .525 4.9 460 COST OF WELFARE DIVISION. (Excluding Nursing Service.) 1914 1915 1918 1917 1918 Publications and printing........ Expreai.................................... Exhibit*................................... Tuberculosis experiment, etc... Torsi Coot..................... 831,093.61 1147843 7,837.46 *74,229.48 $108458.07 11,328.95 7,941.41 8160,769.74 381,62949 16,066.82 7,160.60 3,434.79 8160,364.39 898*23.66 16,000.10 2,693.79 24400.60 3176,49043 358,407.98 10480.15 2,14443 3647836 8141444.12 15 4