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... _. Nfld RT 97 N45 1949

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PROVINC~ OF N~WFOUNDLAND

DEPARTMENT OF ~EALT~ NURSING SERVICES

ANNUAL REPOR·T

OF TH~

Director of Departmental _ Nurses

FOR THE

YEAR ENDING DECEMBER 31st:. 1949

Dicks & Co. Limited

j.....___ __ ~----

PROVINCE OF NEWFOUNDLAND

DEPARTMENT OF HEALTH

NURSING S~RVIC~S

ANNUAL REPORT

OF TH~

Director of Departmental Nurses

FORTH~

Y~AR ~NDING D~C~MB~R 31st. 1949

Dicks & Co. Limited

5

llonourable J. R. Chalker,

}1 inister of Health,

Department of Health,

St. John's.

Dear Sir,

I ha.ve the honour to submit the Annual Report of the Nursing

Services for the year ending December 31st, 1949.

Respectfully submitted,

GERALDINE FITZ-GERALD, R.N.,

Assistant Director, (Field Supervisor) of Departmental Nurses.

St. John's, Newfoundland,

July 14th, 1950.

•

1949 R~PORT of the

Newfoundland Nursing Services

The year which ended D ·ecember 31st, 1949, saw a slow but steady improvement in Public Health Nursing Services in New­foundland. The shortage of nurses has been less acute than in previous years . Cottage Hospitals have been fully staffed at all times and several vacancies in Outport D,istricts have been filled.

Three additional nurses were employed by the Tuberculos·is :Dispensary in order that more home visiting of tuberculosis patients rnight be done in St. John's. These nurses have been transferred to the city staff of district nurses and a system of rotation of duties has been inaugurated. In this way, all nurses carry out a two month period of duty in School Visiting, Tuberculosis Visiting and General District Nursing.

Before going into districts, nurses are given a three to four rnonths course of lectures, demonstrations and supervised field 'Nork. The field work includes District Nursing, Tuberculosis Visit­ing, Clinic Work, School Visiting and two weeks with the Child \Velfare Association. In January, this Association took over the whole programme for pre-school toxoiding in the city of St. John's, thus relieving our district nurses of that part of their Immunization Programme.

Miss Cecilia Norris, R.N., becam·e Supervisor of the St. John's District Nurses in May of this year, competently filling a vacancy -vvhich had existed for several months. Prior to this appointn~ent, l\!Iiss Norris had been Nurse in Charge at the Blood Bank.

Just before the end of the year, Miss Daphne Pratt was ap­pointed to the new post of Director of Health Education for the Department of Health and will work in close contact with the Nursing Service.

In September, Miss Myrtle Cummings, R.N., Director of the Departmental Nursing Service, left for North Carolina where she is studying for her Degree in Public Health Nursing. During her absence, the duties of the Director are being carried out by the Field Supervisor.

Three other nurses are taking Public Health Nursing Courses, one at Halifax and two in Toronto.

In the Spring, Miss Margaret Nix, Director of Health Educa­tion for Manitoba, visited the Province as a men1ber of a Health Survey Team. She spent considerable time with the Nursing Service and as a result new ideas for implementing Health Teaching into the Nursing Programme were obtained.

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Later in the year Miss Elizabeth Smellie, R.N., C.B.E., R.R.C., LL.D., of Ottawa, was in St. John's for the Graduating Exercises of the General I--Iospital Training School and visited the Nursing Ser­vice during her stay. Miss Smellie, who for twenty-five years wa'=' associated with the Victorian Order of Nurses, for Canada, showed great inter~st in our Public Health Programme. Her helpful sugges­tions and encouragement were much appreciated by those whose privilege it was to meet her.

The great demand for curative measures in Cottage Hospitals '-.nd Outport Districts, leaves little time for other activities. How­ever, the general interest in Health Education and Preventive 1\1edicine has incr·eased and in a few areas the nurses have done out­standing work in these fields.

The Public Health Nursing Programme includes:­

1. 2. 3. 4. 5. 6. 7. 8. 9.

10. 11. 12.

Communicable Diseases Control. Tuberculosis Control. Morbidity Service. School and Pre-School Health. Venereal Disease Control. Maternity Service. Clinics. Blood Bank. Training and Supervision of Midwives. Staff Education. Health Education and Nutrition. Junior Red Cross.

The Nursing Services are distributed as follows:-

1. St. John's District Nursing. 2. Outport District Nursing.

(a) 24 Districts (b) 6 Nursing Stations.

3. 14 Cottage Hospitals.

ST. JOHN'S DISTRICT:

The St. John's District Nurses carry out a large and varied pro­gramme. Their work includes school visiting, tuberculosis visiting, organized clinic work and all types of bedside nursing care.

They are called upon to do any special duties that may arise, such as escorting patients to or from the Neurological Institute in l\Iontreal. If help is urgentlv needed in Cottage Hospital or Outport District, a nurse from the St. John's staff is sent to the area con­c~rned and ren1.ains until the situation is under control.

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A great part of the District Nurses' travelling is done on foot and by city buses, therefore considerable time is taken in making even a few visits. Thus it can be understood that the temporary absence of even one nurse, throws a heavy load on the remaining staff.

Communicable Disease Control

a. Diphtheria Cases (Observation) ...... ...... ...... ...... ...... .... .. ...... ...... .. .. .. ...... 68 Home Visits ...... ...... .. .. .. ...... ...... ...... ...... .... .. .. .. .. .. .... .. .... ...... 143

b. Scar 1 et Fever Cases ...... ...... ...... .. .. .. ...... .... .. ...... .. .. .. ...... .... .. ...... ...... ...... ...... ...... 14 Home Visits ...... ...... ...... ...... ...... ...... ...... .. .. .. ...... ...... ...... .... .. ...... 34

c. Scabies and Impetigo Cases...... .. .. .. .. .. .. ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... 86 Home Visits ...... ...... ...... ...... ...... ...... ...... .. .... ...... .... .. ...... ...... 234

d. Measles, Whooping Cough & Chicken Pox Cases .................... ........ .. .............................. ...... ...... ........................ 74 Home Visits ...... .. .. .. ... ... ...... ...... ...... ...... .. .. .. .... .. ...... ...... ...... ...... 172

Tuberculosis Control

Cases (including advanced, minimal, arrested, . . contacts & chronic) .... .. ...... .. .. .. .. .... .. .. .. .. .... .. .... .. .... ...... 1,262

Vtstts .... .. ...... .. .. .. .. .. .. ...... ...... ...... ...... .. .. .. ...... ...... ...... .. .. .. ...... ...... .. .... .. .. .. 3,419

~o~bidity Service

a. Medical Cases .......... .. .. .......... ............ .................. ................ .. Home Visits ...... .. .. ........ .................. ...... ........................ .... . .

b. Surgical Cases .................. .. ...................................... .. ...... ..... . Home Visits ........................ .. .......... .. .......... ...... ...... ................ ..

c. Chronic Cases ........................................... ............. ............... . Home V ·isits ..... .

d. Pediatric Cases Home Visits ..... .

Schoot/ & Pre--School Health

Children Examined

662 3,768

111 684

68 gjg 537

1,182

a. Rapid Class-room Inspection .......................................... 15,808 b. Physical Examination ...... ...... .... .. ...... ...... .. .... ...... ...... ...... 5,575

Defects Found

a. Dental ...... ...... ...... ... .. . ...... ...... ...... ... .. . ...... .. .... ...... ...... ...... ...... ...... 3,105 b. Vision ...... ...... ...... ...... ...... ...... ...... ... ... ..... .. .... ...... ...... .. .... ...... ...... 499

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c. Tonsils 000 0 0 0 0 00000 0000 0 0 000 000 0 00000 o o oooo ooooo o o oo ooo 000000 •••• •• ·o···· •• o •• o 000000 00000 0 oOOoOO 1,()81 Toxoid Given (Injections) 00 0000 oooooo oooo oo oooooo ooo ooo 000000 000 000 0 0 0 000 O Oo ooo 4,934 Patch Tests 0 0 0000 . ooooo 00000 ••• oooo 000000 oo ooo o oo o o o o o ooO O O ••• ooo 00000 0 000000 000 000 000 000 0 00000 7,210

Pre-School Toxoid. This work has been taken over by the Child Welfare Association.

M ate1rnity Service a. Pre-Natal Cases oooooo 000000 000000 00 0 000 000000 000000 000000 000000 OOooOO 0 0 0000 000000 00 0 000 208

I-Iome Visits 000000 O o Ooo o 000000 000000 000000 000 00 0 0000 00 000000 0000 0 0 00 0 0 00 000000 oOoooo 00 0 0 00 592 b. Patients confined at home 000000 000000 ·o·o·· •• 00 00 000000 Oooooo 000000 000000 14

Home Visits .. Oo o o ·· o•oo 0 0 0000 ••• ooo oooooo oooooo 000000 000000 oooooo 000000 ooo·· · 00000 0 000000 53 c. Post-Natal Cases 000000 oooooo 000000 oooooo 000000 Oo ·· ·· 000000 000000 ooooo o 000000 000000 96

Home Visits 000000 Oooo oo 00000 0 .00000 O o o oO O 000000 00 0000 ooo ooo oO oooo 00000 0 000 0 00 oooooo 000000 296 d. Interrupted Pregnancies 00000 0 0 000 00 000000 ooo oo o O O OooO ooo·o· 00 0000 000000 22

Hotne Visits o o o o oo 000000 000000 00000 0 o o ooo o 000 0 00 00 0000 000000 000000 000000 ooooo. 0 0 0 000 000 0 00 63

M isceil aneous

Night Calls o • •• o. 000000 O ••O•o 00000 0 000000 oooooo oooooo 00000 0 ooo o oo 00000 0 0000 00 1,65)9

Clinics (in which nurses assist)

Venereal Disease Control

a. Clinics o •• o •• • ••• o. 00000 0 ooooo . o ooooo 0000 00 00 0 00 0 000000 00 0 0 00 ooo •• o 0 00 000 o ooooo 000000

b. No. Patients Treated 000 0 00 oooooo 000000 000 0 00 00 0000 o ooooo 000000 00000 0 000000

c. Total Treatments Given 0000 00 00 000 0 000000 000000 0000 0 0 000 00 0 000000 000000 0 0 0000

d. Rechecks 000000 00 0000 00 00 0 0 00 0000 000 000 • • oooo oooooo 000000 00 00 00 .00000 00000 0 ····o· oooo •• 000000

e. Visits and Interviews oOO o OO 000000 00 0000 00000 0 000000 o ooo o o 000000 0 0 0000 00 0 0 00

Fo'O'd Handlers

224 251

1,893 177 481

Clinics ...... o oo o · o oo-ooo .o.oo. ooooo· 0 00000 00000 0 OoooOO .o.o oo 0 00 000 000 000 00 0 000 oOoooo ooo ooo 000000 Ooooo o 32 Visits and Interviews OOooOO • •• oo. ooo .oo oo···· oo •• oo o.o.oo ooo •• o o oo •• o o o-. o o 0 0000 0 000000 498

General Clinic a. Visits to Clinic b. Min or Operations o ••••••• o ••• 000000 000000 ooo··· ooo··· oooo·o •• o o oo ••••• o .o •• o. 000000

Ante-Natal

7,870 39

Visits to Clinic .......... o •••••• o oo···· oo···o 000000 o ••••• 0000 0 0 000000 000 000 o ••••• ·o···o •••••• 1,079

E. E. N. T.

Visits to Clinic .. o.o. · · o··· •••• oo •••••• ·· o·· · ••••• • •• o • • ••••••• o •• o •• o ••••• 00000 0 o ooooo o •• o •• 1,463

Ch1ld Welfare

Visits to Clinic .o •••••• o.o ••• o.oo 000000 oo • • oo •• •• • o ooo.oo • •• ooo oooo·o o.o •• o •• o •• o ••• o.o 000000 6,336

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OUTPORT DISTRICTS Nursing Stations Included

Great credit is due to the Outport District Nurses and a true pioneer spirit is necessary to meet the challenge that awaits them tn n1any isolated areas.

The Outport District Nurse must be prepared to administer to all types of disease and injury. She must be able to use her skill a n d knowledge to the highest degree and yet must realize immed iate ly if the services of a doctor are essential. She is often the only sour ce of Health Education and Preventive Medicine.

Her own physical and mental health, her interest in the health of others and her skill in leadership, will be the foundation of her success in her work.

For urgent hospital cases plane service is now available when other transportation is impossible or would mean too much · delay. lp this way the isolated district nurse is saved many anxious tnoments.

After three to four months' training in St. John's, the Outport District Nurses are sent to Cottage Hospitals for six weeks. Here, further instruction and practice is given in dental extr.actions, hos­pital and home deliveries, minor suturing and general clinic work. The doctors and the Cottage Hospitals have been most co-operative in this respect and their help is greatly appreciated.

Health teaching and preventive work is increasing in the Out­ports and many nurses have shown a very keen interest.

Communicable Disease Control

a. Diphtheria (Observation) Cases ...... .. .. ........ ...... ............ .. ...... .... ...... ... .. . ..... . 4

b. Scarlet Fever

Cases .. ... . .... .. ... ... ..... . ...... ... ... ...... .. .... .. ... . ...... ... ... ...... ...... .. .... ...... 25

c. Chicken Pox, Measles, Whooping Cough Cases ...... ... ... ...... ...... ...... ...... ... ... ...... ...... ...... ...... ...... ...... ...... ... ... 313 Total Visits .. .... ...... ...... ...... .... .. ... .. . ..... . ...... ...... ...... ...... ...... ...... 888

Tuberculosis Control

Cases ...... ...... .. .. .. ... ... .. .. .. .. .... ...... .. .... ... ... ...... .... .. ..... . ...... ...... ...... ...... 491 Vis its ...... ...... ...... ...... ...... ...... .... .. ...... ...... ...... ...... ..... . ...... ...... ...... ...... 3,425

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Morbidity Service Medical Cases ....... ... ................................................................... . Home Visits ................................................................ .............. ..... . Surgical Cases ...... .. ...................... ....................................... ........ . Home v.,..isits .................. ...... ........................................ ................... . Pediatric Cases ................................................................ ............. . Home Visits ... .... .. ..................... ..................................................... . Dermatological Cases (including

Impetigo & Scabies) ...... .............. .. ..................................... . Home v~i sits ............ ..................... ........... .. ... ........... .......... .. ....... .... . E. E. N. T. Cases .................. ....... .. ..... .. ..................................... . Home Visits ... ..................... ............. ........................................ .

Clinics

Total Patients Examined ........... . ........... .

Dental Extractions ... ... ... .......................... .

Scho•ol & Pre-School Health

Total Children Examined .............................. .. ..................... .

Toxoid Given (Injections) .......... ............... ............................ .

Maternity Se·rvice

a. Pre-Natal Cases .. ................ .. ............................................ .. Home Visits ............................................................................ ..

b. Post-Natal Cases ................................................................ .. Home Visits .............. .. ...................................... · ...................... .. Deliveries ............................................................................ ..

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4,910 10,374

1,182 2,802 2,406 5,171

674 1,339

579 1,149

10,710 2,268

6,274 4,914

551 1,238

317 748 449

COTTAGE HOSPITALS

Cottage Hospital nurses must carry the responsibility of hos­pital administration which includes trajning and supervising all domestic and wardaide staff and the replenishing of all medical and household supplies, not overlooking the first and foremost resp o n­sibility, that of providing adequate nursing care for all patients.

In each of eleven of the fourteen hos pitals there: are only two graduate nurses. The nurse in charge gives all general anaesthetics while. the staff nurse assists the doctor at all operations.

Until this year, in several of these hospitals, the nurses were doing all the X-Ray work. At present six technicians, trained in X-Ray and Laboratory work, have been appointed to Cottage Hos­pitals and it is hoped that further appointtnents will be made in the following year.

With so n'luch curative nursing to attend to, it is not surprising that Health Teaching and Preventive work have., in many instances, been left in the background. However, many phases of health are being taught during the daily adm.in'istration of hospital duties. The serving of well balanced meals, the daily hygienic care given to patients, the cleanliness of the hospital and its equipment, will often leave a lasting impression on those who are admitted for treatment.

As in previous years, the statistics for Outport District work and Cottage Hospital Clinic work are far from accurate. Many of the monthly reports were inadequate and often confusing and a few of the Cottage Hospitals sent no out-patient report.

An effort is being made to simplify these reports and to impress upon the Outport staff the importance of statistics.

Patients Admitted ...... ...... ...... ... ... ...... ...... .. .... ...... .. .... 8,203 Visits to Cl'inics ...... .... .. ...... ... ... ...... ... ... ... ... .. .... .. .... ...... 19,946 District Visits ...... ...... .. .... ... ... ...... .. .... ...... .. .... ...... ...... ...... ...... 6,151 Dental Extractions ...... .. .. .. ... ... ...... ...... ..... . ...... ...... .. .... ...... 5,929 Home Deliveries ...... .... .. ... ... ...... ...... ..... . .... .. ... .. . ...... .. .. .. .. .... ...... ...... 103 Toxoid Given (Injections) ...... ...... ...... ... ... ...... ...... ...... 3,828

TRAINING OF MIDWIVES FOR OUTPORTS

As in previous years, suitable candidates were brought into St. John's from the Outports for a two month course in Midwifery.

Their tra:ining is under ·the direction of the Grace Hospital, with supplementary instruction in Prenatal care and attendance at Prenatal Clinics at the Department of Health. Twelve midwives w·ere granted licences this year.

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BLOOD BANK

In 1949 the increase of work at the Blood Bank has been even grea.ter t han the previous year. The two nurses, who are now per­manently employed, have been kept very busy.

2,213 persons attended the Blood Bank during 1949; 634 of these were voluntary donors while the remainder were replacement donors.

Accepted donors ............ .. ... . ... ......... ...... ...... ........... .

Amount of blood received ............... .. .

Amount of plasma processed ...... ... .. .

2,141

824,400 c.c.s.

176,600 c.c.s.

STAFF ~DUCATION - H~ALTH ~DUCATION

1. Staff Education: The programme has b een planned on two levels:-

(a) For new staff nurses.

(b) For all staff nurses.

During last year there were thirty-five new nurses taken on the Nurs1ing Service staff, thirty-one of whom were replacements and four were new appointments.

These nurses spent some time at St. John's headquarters before going into Cottage Hospitals or Outport Districts. They were given an orientation period during which they were able to observe the physical set-up of the Nursing Service and were familiarized with the record system. They spent two weeks at the Child Welfare Association which conducts the only Well Baby Clinic in St. John's. Here, under the direction of the Superintendent, Mrs. McCoan, the nurses gained essential knowledge in this phase of Public Health "f\Tursing.

The new staff nurses, during their period of training, also a t tend e d any conference or discussions that were conducted for the permanent staff.

There "\.v ere five staff conferences with the heads of various divis•ions f o r the purpose of acquainting new nurses with these J)ep artnl nts a nd of clarifying the relationship that should e:xlist bet,v een the m and the Nursing Service.

There were seven lectures on Public Health Nursing; theory and activities.

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Three films on Tuberculosis, Immunization and Home Visiting N urs'ing were shown.

Five conferences between the D 1irector of the Nursing Servic e and her supervisors were held to dis-cuss various problems arisn~g out of nursing activi.ties.

A conference was held at Markland Cottage Hospital and was attended by the director, her assistants, the nutritional adviser, the Junior Red Cross organizer, the director of Staff Education, ·the hospital staff and district nurses in that area. Later a similar confer­ence was held at Come by Chance Cottage Hospital and included in this group was Miss Margaret Nix, Director of Health Educat'ion for Manitoba.

These conferences were found to be of value in discussing the p roblems common to all the nurses in a definite area.

2. Health Education:

The Health Education programme of the Department of Health during the year 1949 merely touched on s ome of the main features tha t should be stressed. With the appointment in December of a full t1.me Director of Health Education plans can now be more specif1i.c and a wider field of work covered.

During the year courses in Home Nursing and First Aid were given on request to the following groups:

Y. W. C. A. ...... ...... ...... .. .... ... ... ... ... ...... ...... ...... ... ... ... ... .. .... 8 lectures Glenbrook Girls' Home ...... .. .... ...... ...... .... .. .. ... . ... ... .. .... 6 " Girl Guides .... .. ...... ...... ...... .. .... ...... ...... ...... ...... ...... ...... ... ... 18 ,,.

Adult Education Field Workers ... ... .... . . Night Class ............... .. .

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At fourteen ante-natal clinics expectant mothers were met ri.n groups of five for discussion, mainly on diet in pregnancy. Twenty to thirty mothers participated at each clinic. Midwives in training who attended the ante-natal clinic were also met with for general discussion.

A course in Public Health Nursing was given to four classes of nurses in training at the Ge-neral Hospital and at the Grace Hos­pital; thirty-two lectures in all. A

There was one conference with the field workers of the Jubilee Guild to discuss the significance of Health Education in ·the1i1r work.

Six lectures and a film show were given at the Summer School for Teachers at the Memorial College in an effort to acquaint the t eachers with the school health programme and to help them realize their part in it.

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The Department of Health was invited to participate in a ses­sion of the Convention for the School Supervisors at the Department of Education. This co-operation on the part of the Education aut llor­ities was much appreciated, as valuable interchange of ideas can take place to the benefit of all concerned.

There was one radio talk given in conjunction with the nutrition programme of Kitchen Corner dealing with ante-natal care. Eight articles on food, with particular reference to diet in pregnancy, were published through the courtesy of the Evening Telegram. Notices concerning Imn~unization for Diphther'ia and Whooping Cough were inserted in boLh daily papers for three months, in an effort to make parents aware of the necessity for this protection and to have them bring their pre-school children into one of the Child Welfare Asso­ciation Clinics for this purpose.

Folders and blotters stress'ing the need for immunization were printed locally for general distribution. A supply of blotters dealing with nutrition was also made available.

There were t-\v-o exhibits of health literature. One at the Sum­rner School for Teachers, for the purpose of showing them what the Department of Health had to offer and to give them an idea of the pamphlets, etc~, that are likely to be of most use to them.

At the Newfoundland Enterprises Industrial and Trade Fair in September a booth was mainta!ined by the Department of Health for Health Educational purposes. This was set up with a view to giving the public an idea of the extent to which Newfoundland is covered hy medical and nursing services. The direct methods of improving the nutrition o.f children and expectant mothers were shown through exhibiting samples of cod liver oil, orange juice and chocolate milk powder which are distributed free to these special groups. One of the means used by Junior Red Cross to encourage better hygiene in the schools was sho·wn through display of the sanitary water . con­tainer that th is organization makes available.

Posters and literature, covering all phases of health, were dis­played and 9,864 pieces of literature were distributed as well as 3,450 blotters. Comment was mostly favourable on this display and i.t 'is felt that it served its purpose to some degre-e in helping to inform people generally of the importance of health in their live-s.

There was of course no way of evaluating even approximately the use to which the literature was put. However, discretion was used in its distr'ibution and efforts were made to interest people in subject rnatter that seemed likely to be of the most value to them.

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TI-l~ NUTRITION PROGRAMM~ AS IT IS RELATED TO THE NURSE

The nutrition programme of the Department of I-Iealth 1s pat­terned along two main lines:-

1. Nutrition education as a long term measure.

2. The adoption of direct measures to improve the diet, as an expedient measure.

(a) Fortification of margarine with vitamins A and D · and enrichm,ent of flour with nutrients lost during the pro­cess of milling flour.

(b) Provision of supplementary foods to vulnerable groups.

The nurse is in a strategic position to play an important part in any health progran1.me, nutritional or otherwise.

The Role of the Nurse in Nutritio·n Education:

Any nutrition teaching undertaken by the district nurse must p=•ach two groups of people:

1. Those seemingly in good health.

2. Those known to be below par physically.

A programme geared toward the first of the above groups would stem to be the more difficult to carry out. It is logical to expect those who are sick to be mindful of their health, but it is altogether another n1atter to convince the well person of the need to keep well.

The nurse who takes the lead in creating a nutrition conscious­ness on the part of both the sick and well must first and foremost have a thorough grasp of the relationship of food to nutrition and the widespread influence of nutrition on the welfare of the country. In other words she must be wholeheartedly convinced of the worth­whiteness of effort aimed at arousing a nutritlion consciousness.

Guiding families in the development of good food habits re­qeires a knowledge of nutritional principles, but equally essentia~ i~ the ability to make practical suggestions for the appNcation ot this knowledge. The most effective work in changing food habits is not done by formal nutrition teaching, but by making appropriate suggestions or asking pertinent questions at the "right" ttime. If a nurse, for instance, arrives at a home to find the vegetables much over-cooked, the undernourished child eating excess sweets or the ccd liver oil which was brought from school sitting on · the window

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ledge in the kitchen, unused, she has excellent demonstration ma­terial at hand.

A definite indication of progress over the past year has been the increase in correspondence received from nurses re nutritional rnatters. More nurses are seeking advice on local nutritional pro­blems. Such topics as- ways to prepare types of fish, instructions fc r homemakers on preserving food, the use of skim milk for families ""VV·ho keep cows, .the use of raw vegetables for salads, etc., are exam­ples of material requested by nurses. Such requests as these indicate that the nurse is aware of the local problems and realizes that her nutrition teaching must be adapted to meet the local need. In this connection, the nurse as well as any other nutrition teacher must not ignore the fact thellt nutrition teaching must fit in with existing con­ditions.

It is hoped that in the future more nurses will feel free to con­tact the Department about local nutr1ition proble·ms.

Educational MaterialS' on Nutrition:

The nurse as well as any other nutrition teacher welcomes educational materials-pamphlets, posters, etc.-which serve to aug­tnent her teaching and which she _can distribute to families. The educational material, however, like the teaching itself, must fit 'in with the local situation. At the present time there is little suitable material available from the Department of Health. It is hoped that effort will be made in the future toward the possibility of produc'ing n1aterial adapted to local needs.

There seems to be a need for acquiring leaders of our local pro­blems and in this connection, a nutrition bulletin from the Depart­nient of Health for distribution to nurses as well as other leaders, is being planned. It is proposed that this bullet'in which will deal with local problems and the ways and means of combatting these problems be published once a month or once every two months.

Role of the Nu·rse re Sche·mes for the Distribution of Supplementary Foods:

1. School Feeding Scheme.

Nurses are asked to play a part in encouraging more profitable use of the cocoa milk powder, and cod liver oil for schools. Mimeo­graphed n1aterial dealing with all phases of the school feeding scheme, have been placed in the hands of nurses for the purpose of acqua'inting them with the policy of the Department of Health re­garding their use in the schools. The nurse's position in the district offers great opportunity for the fostering of enthusiastic interest in this scheme on the part of school board members, teachers and parents.

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2. Supplementary Food for Expectant Mothers and Babies.

Concentrated orange juice for free distribution to expectant rnothers and babies is handled almost entirely by nurses in nursing districts and hospitals. The nurse is, therefore, the key person in the IJromotion of the scheme. In view of the peculiar situation in New­foundland where people in most areas of the country must depend on vegetables rather than on fruits as a source of Vitamin C, and vvhen vegetables are so grossly over-cooked, every effort should be tnade to effect as wide as possible use of this concentrated orange juice as a source of Vitamin C. It is felt that there is some misuse as well as abuse of the product. It can be pointed out again that this concentrated juice has a high vitamin C content and its use on the part of expectant mothers and babies should be encouraged to the full.

As in the case of the concentrated orange juice, the use of cod liver oil needs to be encouraged to a greater extent. It is available free of charge through Public Health channels to expectant and nursing mothers, babies and children. S'ince cod liver oil is distri­buted to schools, the child of school age would not need to be sup­plied through the nurse or the Cottage Hospital unless for some rt:.ason the school has not been allocated a supply.

The Cottage Hospital- A Focal Point for Nutrition Teaching:

The type of meals served in Cottage Hospitals should serve as a pattern to the families in the area it covers of the type of meals which offer most, nutritionally. Up to this t'ime, little help has been offered to hospitals along the line of food service. It is hoped that before long a definite phase of the Department's nutrition pro­g-ramme will be that of "Consultant Service for Hospitals." A n1onthly bulletin dealing with aspects of food service in institutions i cs proposed to be sent to hospitals.

It is logical to conclude by saying once again that the nurs~, ·whether she be the district nurse, or a nurse on the staff of a Cottage :Hospital can play a vital role in bringing about the promised era of better health in this country. In undertaking a complete health pro­gramme the nurse must be ever mindful of the influence of poor nutrition on the population as a whole and will, therefore, include nutrition teaching as part of her health programme.

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JUNIOR RED CROSS

During the year 1949 Junior Red Cross in Newfoundland com­rleted its 13th year as a ward of the Department of Health and an integral part of the Nursing Service. The aims of Junior Red Cross \.vhich are Health, Service, Good Citizenship and Internat,ional Friendship, continued to form the basis for all motivation and teaching fur Junior Red Cross branches. Junior Red Cross supple­tnents and n1akes health teaching more effective which was the original reason for its fonnation in this province. It also helps to awaken in children their responsibilities as citizens and provides p1·actical n1eans by vd-lich they may help others. It fosters better understanding of other people in other countries.

As the Junior Reel Cross year is based on the· school year, June 1949 found Junior Red Cross. with a total of 996 branches in New­foundland's 2,300 classrooms with a membership of 31,549.

By the end of D ·ecember 1949 730 branches with a total of 24,024 rnembers had re-enrolled for the year 1949-50.

Since the last report, Juniors have contributed $1,095.73 to the I-f anclicappecl and Crippled Children's Fund. Th'is Fund now totals $5,000.00. It is made up entirely of voluntary contributions by Juniors and is used to aid children whose conditions call for medical attention beyond the rneans of their parents. Through this fund a young boy ' vas sent to New York for plastic surgery on an extensive birthn1ark, and arrangements are being made to aid a little girl who -vvill need sin1ilar surgery to remedy a facial disfigurem·ent.

Juniors, as good citizens, have continued to contribute to all worthy institutions. They have united with school children all over Newfoundland in selling Double-Barred Crosses to aid the New­foundland Tuberculosis Association in their work of .stamping out this disease.

The Sanitary Water Container:

The project begun in 1948 of replacing the bucket and common drinking cnp in N ewfoundlancl schools that have no running water ce>ntinued \vith much success. August 1949 found 249 water contain­ers and cones and d 1ispensers in the schools and by the end of De­cetnber 42 more '\vaier containers were purchased. Paper cones totalled 98,370, n1any being bought to replace those used.

Among the changes resulting from N ewfoundlancl's becorning a Province of Canada was the transfer of the British Red Cross Society in N e'\vfound land to a Provincial Divis'ion Branch of the Canadian Red Cross Society. It has been decided that on Anril 1st, 1950, the Junior Red Cross in this country will sever its ties with the

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Department of Health and will in future be sponsored by the Senior Red Cross Society; thus conforming with existing programmes of this organization in other countries. This will not mean, ho,vever, that the work of Junior Red Cross will in any way change, but 'it is hoped that with the proposed appointment of a field worker, Junior Red Cross as it exists will expand and become a more effective agent for good in our Newfoundland schools.

Plans for the future include increased help for handicapped and crippled children 'and a Mobile Dental Clinic for the purpose of providing needed dental care to the youth throughout the Island.

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