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In recent years nursing personnel associated with a County Health Department have become involved in efforts to assess the effectiveness of their services, with particular emphasis on determining the benefits to the populations they serve. The present study was developed in response to questions concerning whether the skills of professional nurses were being utilized to best advantage within the school system. It was decided that identification of children with a past record of high absence would be a reasonable way of defining a group of children with a high risk of future episodes of illness and possibly a high prevalence of basic health problems. Since it was anticipated that children so defined could benefit from nursing service, it was concluded that high absence children constituted an appropriate risk group to which nursing services could be profitably directed. This group was therefore selected for the pilot program. The major objectives of the study were to consider the utility of directing nursing services to a defined risk group and to document the results of the experience in terms of patient outcomes, specifically, change in absence experience. The basic working hypothesis was that focused nursing attention would be positively associated with a reduction in days absent. From the perspective of the service agency some of the concomitant benefits from the study are: the methodology, using absence as an indicator, suggests a practical approach to identification of a high risk population; the school health program can be planned to further explore emphasis on prevention through selected priorities rather than continuing to be crisis oriented; and efforts can be directed toward development of improved documentation of nursing intervention not only to provide an improved data base for evaluation but also to meet the current demand for accountability. In addition to providing a meaningful experience in program evaluation for nursing staff within the health department, participation in the study promoted more effective communication between the school system and the health department which share joint responsibility for the school health program.

Health teaching in schools where the interest of the pupils was directed towards their own health conditions resulted in large health gains to them. Control classes lacking this incentive gained much less. The author suggests uniform health programs in schools as a part of the government machinery.

practitioner's point of view, and the meaning of the humanities in the education of the professional nurse are included in this section. A third section includes essays on the next 50 years. The last essay is written by a recent graduate of the university program. The three essays in this section are stimulating and thought-provoking in pointing out new directionssocial change with new values, changes in the way we live, and more humanistic work with people. "Identity and destiny" appear as guidelines for development in the new era. The book brings together a variety of opinions and will be a useful reference in any library and for a variety of health professions. Parallel developments and philosophies will be of interest to readers in the United States. KATHRYN A. ROBESON

Sara Jospehine Baker, MD, DrPH, was the first director of New York’s Bureau of Child Hygiene and an instrumental force in child and maternal health in the United States. A lesbian and a feminist, Baker was also a suffragist and a member of the Heterodoxy Club, a radical discussion group made up of more than 100 women, where she was known as “Dr Joe.”1 To succeed in the male-dominated world of public health administration, she minimized her femininity by wearing masculine-tailored suits and joked that colleagues sometimes forgot that she was a woman. Whether her sex was accounted for or set aside, it is doubtless that Baker faced gender discrimination and the same obstacles to a high-profile career that confronted women physicians throughout the medical profession in the early 20th century.2 In contrast to many of her colleagues’ emphasis on laboratory-based public health, Baker focused on preventive health measures and the social context of disease. Her work with poor mothers and children in the immigrant communities of New York City had a dramatic impact on maternal and child mortality rates and became a model for cities across the country as well as the United States Children’s Bureau, established in 1912. Sara Josephine Baker was born in 1873 in Poughkeepsie, New York, to Daniel Mosher Baker, a lawyer, and Jenny Harwood Brown. In her autobiography, Fighting for Life,3 Baker recalled a happy childhood and a good and supportive relationship with both her parents. Her mother was one of the first graduates of Vassar College, and Baker was raised with the expectation that she would also attend the college, but her plans changed when her father and brother died suddenly. Newly responsible for the family’s finances, she gave up her scholarship and applied to medical school instead. In 1894, Baker enrolled at the Woman’s Medical College of the New York Infirmary, originally founded by pioneering physician Elizabeth Blackwell and her sister Emily Blackwell. While associating with the first generation of women to attend medical school, Baker was introduced to some powerful female role models, including faculty member Mary Putnam Jacobi. After graduating in 1898, Baker negotiated a year’s intern-ship at the New England Hospital for Women and Children in Boston, where she worked at an outpatient clinic serving some of the city’s poorest residents. She developed a keen interest in the connection between poverty and ill health, which led her to a commitment to social medicine that would shape the rest of her career. Baker opened a private practice in New York in 1899 with a friend she had met during her internship, but the 2 women struggled to make just $185 in the first year. To help cover costs, they also worked as medical examiners for the New York Life Insurance Company, paving the way for women physicians to work in the insurance industry. Baker also worked part time as a medical inspector for the city, where she met key health administration officials. In 1907, Dr Baker was appointed assistant commissioner of health, and managed smallpox vaccination programs and sanitation issues, as well as the notorious case of “Typhoid Mary,” the cook who had unknowingly spread typhoid in the city while working in several New York households.4 In 1908, Baker was appointed director of the city’s new Bureau of Child Hygiene, the first such bureau in the United States. Building on her previous work on disease prevention and education, she developed programs on basic hygiene for immigrants living in slum neighborhoods and the Little Mothers Leagues, which trained young girls who were responsible for the care of their siblings (while their parents went out to work) on the basics of infant care. Alongside baby health stations that distributed milk and midwife training and regulation, she created policies that had an enormous impact on maternal and infant mortality. Thirty-five states implemented versions of her school health program. By the time Baker retired in 1923, New York City had the lowest infant mortality rate of any major American city.5(p33) Baker founded the American Child Hygiene Association in 1909 and served as president of the organization in 1917. That same year, she became the first woman to earn a doctorate in public health from the New York University and Bellevue Hospital Medical College (later the New York University School of Medicine). From 1922 to 1924, she served as a member of the Health Committee of the League of Nations and as a consultant on child hygiene to The New York State Department of Health, the US Department of Labor, and the US Public Health Services. Dr Baker wrote 50 journal articles and more than 200 pieces for the popular press about issues in preventive medicine, as well as five books: Healthy Babies (1920),6 Healthy Mothers (1920),7 Healthy Children (1920),8 The Growing Child (1923),9 and Child Hygiene (1925) (extracted here). She retired to New Jersey with her life partner, novelist Ida Wylie, and another woman physician, Louise Pearce, in the mid-1930s, where they shared a house until Baker’s death in 1945.

year was $1.22 per capita of which 23 cents was for contagious disease work, and 18 cents for medical inspection of schools. The school health program has been reorganized during the year to provide for the following main features: 1. The installation of permanent records of the physical examinations made by the physicians. 2. Provision for the use of physicians, nurses and teachers, for the prompt exclusion and return to school on recovery of pupils suffering from either minor or major contagion. 3. A follow-up service on pupils suffering from physical defects in the Continuation School through the co6peration of the Continuation School teachers and nurses. 4. Supervision of the staff in a form designed to be helpful and to improve standards through the development of the best techniques and procedures found useful in modern school health supervision practice.