For the purposes of my paper, I will consider the "needy child" as the child of destitute, diseased or vicious parents or without parents. He is one of a large family often with no one competent or willing to care for him. Such a child may become the legitimate concern of health officials, when he endangers the public health by reason of being diseased himself or liable to contract contagion from his environment.

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The children are the state's best asset. Fortunately, the greatest achievements of modern preventive medicine have been in safe‐guarding young life. All of the infectious diseases find childhood their most fertile field. The steadily dwindling death rates from all the infections mean a larger percentage of children coming to adult life. Not only are Health Boards bound to protect children from the preventable infections, but they are everywhere seeking to improve those conditions that make for clean and vigorous man and womanhood. To this end, they do much missionary work; they cordially cooperate with organizations of this character. They everywhere do much educational work in general sanitation and in regard to the nature and prevention of specific diseases, like tuberculosis and venereal diseases. But it must never be forgotten that in their official actions, Health Boards are bound to conform to legal restrictions.

Childhood and Child Hygiene have received and are still receiving much attention from Boards of Health. The educational campaign involves the home and the school. The Health Board, in cooperation with the social worker, the church and the educational department of the state, are interested in the growing human animal. But Health Boards are especially interested in that animal as such, i. e., in his body. His moral and intellectual nature belongs particularly to other departments. "The needy child" is entitled to a very large share of the interest that attaches to these several departments.

The problem of the needy child in the city has been much more carefully worked out than the same problem in the country. Organizations of various kinds, hygienic, sociological and religious, and public institutions have devoted themselves to the practical solution of the child‐hygiene problem as seen in the slums and crowded tenements. It has been too largely taken for granted that the country child must grow up clean and healthy in mind and body by virtue of his surroundings. The atmosphere and living conditions of farm and village to most people are synonymous with physical strength and purity.

It is undoubtedly true that crowds breed pestilence. It is likewise true that pestilence is not peculiar to the crowded city. Rural Vermont has her slums as well as the city. Proportionate to her population, these are as serious a problem here as in the metropolis. A visit to homes in some of the remote districts of our mountain towns will, I am sorry to say, reveal conditions as demoralizing to soul and body as exist in congested districts of great cities.

Speaking then from the viewpoint of the health official, let me call your attention to some of those phases of the needy child problem that have to do with his physical health and the physical well being of the community. In doing this, you will pardon me if I speak very plainly of conditions that are too often unknown or ignored by the public. Perhaps the most common situation that confronts the health official in this connection is the contagious disease, the case of diphtheria, scarlet fever, typhoid fever, smallpox or infantile paralysis in the small two or three room house with several other children besides father and mother. The bread winners may be both the father and mother and perhaps one or two of the older children.

The quarantine, if the case is one of these acute quarantinable diseases, may shut up in these narrow limits one or all of the bread winners and the well children of the family. Of course the situation thus created is a serious one as far as the family itself is concerned and is apt to be expensive to the town. Worse than that, the disease is pretty sure to involve the rest of the family, inasmuch as case‐isolation, under these circumstances, is practically impossible. Proper care and nursing of the sick is also impossible.

The proper care of the acute contagious diseases, under such conditions as these, is a very serious question and one that is of exceedingly common occurrence. It is not confined to villages and cities, but occurs in isolated hamlets and far from neighbors.

There is only one satisfactory way of handling such a situation and that is to be able to remove the case to a proper isolation hospital. A proper isolation hospital is comparatively unknown, I am sorry to say, in Vermont. There are less than half a dozen towns in the state having any kind of hospital for taking care of such cases and such as there are are seldom fit for this use. Section 5439 of the General Statutes gives towns authority "to combine to build, equip and maintain isolation hospitals." So far as I am aware, no towns in the state have thus far taken advantage if this act.

The need of isolation hospitals in rural communities in New England is very palpable and urgent. Indeed it is comparatively rare to find a city or large village with such facilities.There have been at various times, as the necessity arose, houses in the outskirts of towns and cities pressed into use as "pest‐houses," usually under the lash of threatened panic from smallpox. Comfortless, desolate; unattractive, lacking the first requisites of a hospital, no one can blame children or their fathers and mothers from objecting to being transferred to such places.A comfortable isolation hospital in any community would relieve a very trying situation in cases of diphtheria, scarlet fever, smallpox, infantile paralysis and various other diseases, as far as the quarantine is concerned, and would serve the best interests of the patients themselves, inasmuch as it would offer them the best possible chance of recovery without permanent impairment of any part of the body. Furthermore, it is not only a relief to the family; in that they are relieved of a burdensome quarantine, but it furnishes the best possible protection for the community. In times of epidemic, such an institution substitutes one focus of infection for many.

An isolation hospital should be a hospital and not a "pesthouse." It should be arranged in accordance with hospital architecture, be properly equipped and have proper and real nurses. There is probably no other detail of our equipment for handling diseases, not only among the needy children, but among the well‐to‐do as well, that would prove as good paying an investment for our Vermont towns. The problem of handling the acute infections among needy children, whether in the city or the country, can only be successfully solved in this manner.

There are certain other points at which the health official comes in contact with the needy child. We have constantly with us the tuberculosis problem. We have not begun as yet to solve that problem in our state. Let me quote from a recent communication, which has come to the State Board of. Health on this subject of tuberculosis. The following is from a school superintendent. He says:

"There is a negro family living there by the name of _____ that has been afflicted with tuberculosis. The mother is reported to be in the advanced stages of the disease. Two children have died of it during the last year, and two others have been patients in the Sanatorium at Pittsford.

The father insists upon having these two, who have been in the sanatorium, as well as two other children in the family, attend school.

I believe that the family are a real menace to the health of the other members of the school."

A personal appeal from another source tells of a family of six children, the oldest fourteen, and father and mother, who live in a four‐room house. The father gets $9.00 a week, when able to work, which is not continuously, as he is not strong or well.

The mother has tuberculosis but goes out doing day's work as she is able. The two oldest children have suspicious coughs and all the children are in the public schools.

These are sample communications. They might be multiplied.

We have not made any provision, as a state, for the care of advanced cases of tuberculosis, or for the children of tuberculous parents. It is not necessary for me to emphasize the danger to children of living in close environment with open cases of this disease. It is pretty generally known that 90% of all children, who live to the age of fifteen years, become infected. A large proportion of these of course never develop the disease. A small proportion do, sometimes early, more often, later, in life. These latter are quite apt to be the children with the hereditary predisposition. Most of our large cities and many small ones have recognized the seriousness of this problem of the tubercular child and have made provision for his education in so‐called open air schools.The situations described above are not uncommon in our Vermont towns. We have neither a sanatorium for advanced cases nor an open air school for children, who are predisposed. Both of these shortcomings on the part of our state should receive legislative attention. The need of provision for advanced cases may be really characterized as a crying need. Complaints of poor tuberculous families, with advanced cases in close association with small children, are constantly developing in all sections of the state. They are quite apt to spend their last days in the poorhouse, where they are brought into contact with other unfortunates, who become easy victims of contact infection. The advanced cases should be provided with proper sanatorium care and the weaklings among the children should be given an opportunity to get health and education together in the open air school.

Health inspection of the public schools, in cases of children showing the chain of symptoms, characteristic of the tubercularly inclined, may be of great assistance in detecting this condition. Such inspection contains great possibilities for the needy child. It may ensure early detection of tubercular tendencies and their removal. It may also safeguard the child against other chronic infections as well as the acute contagious diseases.

Health inspection in the schools may be made of the highest importance to the individual and to the community. It is an axiom that the early detection of any of the infectious diseases makes it possible to limit the spread of the disease and gives the individual the best opportunity for recovering. Health inspection in the schools should not be confined to a handful of the larger towns; its benefits should reach into every part of the state.

To this end, Inspection Districts of convenient size might properly be adopted as units for health inspection.

A qualified medical man employed in each of these districts would ensure early detection of chronic disease or weakness as well as the acute infections. His advice should be given effect and made of practical value to the child, by the "follow‐up" nurse.

This combination, a competent school physician and a trained school nurse, would go far towards solving the needy child problem, from the health official's viewpoint. Both are essential. The physician alone is competent to decide questions of diagnosis and to direct methods of treatment. The school nurse, under his guidance, can supervise and carry out his directions. Further, she can often do real missionary service in these cases. Health inspection of the public schools is really the best friend of the needy child, as well as of its father and mother. Wherever this plan has been tried statistics prove overwhelmingly the advantage to this class of the community and to the community as a whole.

Not only does the school nurse see that the needy child has the proper medical or surgical care, but she is apt to be in touch with organizations of various kinds for the relief of such families and through her agency food and clothing may also be provided, when necessary. She detects bad housing conditions, as well as unsanitary, and in a tactful way, she may frequently shield the child from the effects of neglect or abuse at home.

The Vermont State Conference of Charities and Correction, I believe, can solve the needy child problem in Vermont in no more satisfactory way than by urging health inspection in all our schools.

In discussing the needy child from the Board of Health standpoint, I venture to call your attention to a still darker phase of the subject, viz., the liability of these children, as well as all children, to contract venereal disease. Let me quote again from communications that come to the State Board of Health. This is from a health officer:

"A short time ago a complaint came to me that there was a family in our town that had sores on them that did not heal. I investigated the matter and found three children with their feet and legs covered with nasty sores. The mother said they got the trouble from their cousins. I went there and found the same thing. I called Dr._____of ______ and he visited both families. The mother of one of the children had a suspicious sore on her nose and the father had several ulcers on one hand."

The following is from a wife and mother. Much of this letter is unfit for recital. All of it shows a grade of depravity rarely found.

"I write in the interests of public and private health and the general well being of every one. My husband _____ of ______ has been suffering from syphilis for more than nine months, and up to August 1st he had delusively told me that physicians' diagnosis was ‘canker' and that it was not infectious….. that he had raw throat, mouth and lips…… We have two small children, boy and girl…… He drinks out of roadside cups; bites off plugs of tobacco from his fellow workmen, smokes their pipes ‘to pepper them,' as he calls it. He gets more or less of this mattery saliva on anything he gets near his mouth. I am his wife and I know what I am talking about…… He is going to pick apples to sell for cider at the cider mill. At home (his mother) who, I also think, has the same malady, they make butter for sale; also pare and dry apples for the market. Two children and two adults drink from a common dipper as well as eat up apples and other foods that my husband has partly eaten. (His mouth and tongue are so sore that he can't eat much). These children, if they get this malady, will be apt to transmit it to the other children in school," etc.This graphic description of what has sometimes been called the black plague reveals a situation that I feel sure is rather unusual, but one that is occasionally seen in rural Vermont.

Finally, here is a letter from a physician and health officer, who gives unquotable details and asks for advice as to what to do in the case of a girl coming from a neighboring town to a school in his town. Her parents, brothers and sisters have gonorrhea and she is undoubtedly infected.

These diseases, especially gonorrhea, are found in Vermont schools every year, and occasionally it has been necessary to close a school, because of its occurrence among the pupils.

The Legislature of 1915 enacted a law entitled: "An Act for the Prevention of Venereal Diseases." Section 4 of that Act provided that the State Board of Health "shall make and enforce such rules and regulations for the quarantining and treatment of cases of gonorrhea and syphilis reported to it as may be deemed necessary for the protection of the public."

I think you can all appreciate the practical difficulty of enforcing any regulations for the quarantining of these cases or for their proper treatment, without some institution in the state to which such cases may be taken.

An Act of the previous Legislature required the Board to provide at the expense of the state, for purposes of diagnosis, facilities for the free examination of persons suspected of having either of these diseases.

During the past year (1916) of a great number of bacteriological examinations made for the purpose of diagnosing these two diseases, 758 were positive. This will give you an inadequate idea of the prevalence of these diseases in our state. Childhood is not exempt from either and particularly needy childhood. Of the total number found in the state, 20 cases of syphilis and 92 cases of gonorrhea were under twenty years. There is good reason for thinking that all these figures, representing only cases applying for treatment, are far short of the truth.

The practical care and prevention of these diseases is perhaps the most baffling question of preventive medicine at the present time.

The Act of 1915 evidently contemplated that treatment should in some way be provided for these cases. Such treatment should undoubtedly be made available for them. The laws will have to be made more specific, however, as to ways and means, before much can be accomplished. Meantime education promises the best results. The public generally must be taught all about these diseases, as they have been about tuberculosis.

This education must reach the grown‐ups. Segregation and hospital care, desirable theoretically, are yet impracticable.

In spite of the rather black picture I have drawn of the "needy child" in our state, from the Board of Health standpoint, the outlook for childhood as a whole in Vermont was never so good as today. More children are surviving the oldtime perils of youth, to reach adult life, than ever before. The needy children share these benefits.

The suggestions which I would urge on this organization, for still further safe‐guarding childhood may be summarized as follows:

Our Vermont towns should provide Isolation Hospitals, which are real hospitals, individually or collectively.

We should provide Sanatorium care for advanced cases of tuberculosis.

The schools may be made a chief factor in saving the needy child, physically; first, by providing outdoor schools for the tuberculous or those predisposed to that disease, and second by making health inspection universal.

Finally, an educational campaign, in regard to the nature and prevention of venereal diseases, should be carried on— similar to the campaign now being waged against tuberculosis.

This Charities and Correction organization does well to bring this problem of the needy child into prominence. The State Board of Health will cooperate with you in your work, as far as the law allows.