August 16, 1958


Author Affiliations

Apto. Post. 39 Tacámbaro, Michoacan, Mexico.

JAMA. 1958;167(16):2029-2030. doi:10.1001/jama.1958.02990330125020

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To the Editor:—  A paper on infant mortality by Verhoestraete and Puffer appeared in The Journal (167:950-959 [June 21] 1953). Some six years of work for the World Health Organization and the United Nations Children's Fund in rural China and northeastern Brazil gradually forced upon me a conviction that in so-called underdeveloped countries (i. e., countries with few machines and little money but many people), the quickest, simplest, and easiest approach to reduction of sickness and death at childbirth is by training rural midwives. One teaches them simply and practically to do a few things—the main ones being to (1) recognize easily perceptible anomalies of pregnancy early and, if possible, send women with such anomalies to a doctor before labor begins; (2) scrub their own hands with soap and hot, boiled, running water, poured from a tin can or kettle; (3) under no circumstances insert their fingers into the

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