INFANT MORTALITY
_In the preceding pages it was stated that a high birth-rate is always
accompanied by a high infant mortality. The material presented in this
chapter demonstrates the fact that ignorance of methods to prevent
conception forces the wives of ill-paid wage-workers to bear an excess
of unwanted children. Figures are adduced to show an appalling death
rate of infants under five years of age and the economic distress of the
survivors in families unwanted and too large._
_MEDICAL GYNECOLOGY. Howard A. Kelly, A.B., M.D., LLD., Professor of
Gynecological Surgery in Johns Hopkins University, and
Gynecologist to the Johns Hopkins Hospital, etc. D. Appleton Co.
New York and London, 1912._
As long as a community can rest content in the belief that a large
infant mortality is the natural method of reducing the race of the
unfit, the doctrine of _laissez-faire_ can be accepted with
complaisance. If, however, it seems probable that the influence of
environment must be reckoned as a greater cause of infant mortality and
of physical unfitness than the influence of heredity, it may be wiser
for society, as it certainly will be easier, to preserve the lives and
health of the children born, than to stimulate an increase in a birth
rate now diminishing. As it is an open question whether the race as a
whole suffers mental and physical deterioration from a diminished rate
of production among the superior stocks, it is unquestionably a matter
of public policy, as well as of common humanity, that conditions of
living in communities should be made favorable to the preservation of
the life and health of all infants and children. P. 41.
_EUGENICS AND RACIAL POISONS. Prince A. Morrow, M.D. Pamphlet
published by the Society of Sanitary and Moral Prophylaxis, N. Y.,
1912._
Observation shows that the class known as degenerates is increasing much
more rapidly than the general population and that their average duration
of life has been lengthened. Diseases may be cured, but degeneracy,
which is usually due to some inherited defect in the physical, mental or
moral nature of the individual, is rarely amenable to curative
treatment. It is only through applied eugenics that the vast volume of
disease and degeneracy which flows through the channels of heredity can
be prevented. Obviously this can be accomplished only through education
and legislative restriction upon the procreation of the unfit.
In the making of the child, the mother not only contributes one half of
the ancestral qualities which enter into its constitution, but furnishes
all the nutrition and energy which serve to support its life. From this
point of view the mother is the supreme parent of the child, she is the
source of its life and from her blood is drawn the material which
contributes to its growth and development. The welfare of the mother is
the welfare of the child. We have thus come to recognize the dominant
influence of the mother’s relation to the health, as well as the life of
the race. A high standard of physical motherhood is the most favorable
asset of a nation. Havelock Ellis, in his recent work, on the Psychology
of Sex, says, “Nations have begun to recognize the desirability of
education, but they have scarcely yet come to recognize that the
nationalization of health is even more important than the
nationalization of education. If it were necessary to choose between the
task of getting children educated and the task of getting them well born
and healthy, it would be better to abandon education. There have been
many great people who never dreamed of national systems of education;
there has been no great people without the art of producing healthy and
vigorous children.”
Newman, the distinguished author of the work on “Infant Mortality”
declares that the problem of infant mortality is not one of sanitation
alone, or housing, or indeed of poverty as such, it is mainly a question
of motherhood.
It is not probable that the scientific methods which have been
successfully applied to plants and the selective breeding of animals
will ever replace the haphazard methods of human reproduction.
There is no fact better established than that a man can transmit only
that which he is. If his system is weakened by excess or tainted with
disease he can beget only physical weakness, or beings tainted with
disease. The syphilitic, the consumptive, the epileptic, the alcoholic,
should not produce his kind.
_NEO-MALTHUSIANISM AND RACE HYGIENE IN “PROBLEMS IN EUGENICS.” Vol. 2.
London, 1913. Dr. Alfred Ploetz, President of the Int. Soc. for
Race Hygiene._
Arthur Geissler concluded from a study of about 26,000 births of
unselected marriages among miners that the mortality of children was
least in the four first-born, and then increased to a very high rate.
Following are Geissler’s figures, (marriages with only one or two
children are omitted).
Deaths during first year
1st born children 23%
2nd born children 20%
3rd born children 21%
4th born children 23%
5th born children 26%
6th born children 29%
7th born children 31%
8th born children 33%
9th born children 36%
10th born children 41%
11th born children 51%
12th born children 60%
_INFANT MORTALITY. Results of a Field Study in Johnstown, Pa., based
on Births in one calendar year. By Emma Duke, Infant Mortality
Series, No. 3. Bureau Publication No. 9. U. S. Department of
Labor, Children’s Bureau._
The pamphlet embodies the result of a field study in Johnstown, Pa.,
based on one calendar year. The inspection was made in 1913, of the 1911
babies, so that even the last born baby included had reached its first
birthday—or rather had had a chance to reach its first birthday; many of
them were dead long before that day. Every mother of a 1911 baby was
visited. She was questioned about the health of that child and all her
other children. The report takes up the familiar factors—neighborhood
environment, sanitary conditions, sewage, housing, nativity, attendance
at birth, feeding, age of mother, and like matters. Full information is
given on these points. Then the report considers infant mortality from a
novel viewpoint—the relation of the death rate to the size of the
family. The Johnstown statistics include families varying in number from
one child to ten and over, and varying in health from none living to all
living. The result of the study of infant mortality in relation to the
size of the family is thus stated: “The statistics, based on the results
of all her reportable pregnancies, show a generally higher infant
mortality rate where the mother has had many pregnancies, but there is
not always an increase from one pregnancy to the next.” The following
table shows this tendency. It is based on the reproductive histories of
1,491 married mothers who had 5,617 births. Miscarriages are not
included.
Infant Mortality Rate for all Children borne
by Married Mothers: Table 36
Number of Pregnancies. Infant Mortality Rate.
1 and 2 108.5 per 1,000
3 and 4 126.0 per 1,000
5 and 6 152.8 per 1,000
7 and 8 176.4 per 1,000
9 or more 191.9 per 1,000
Average 149.9 per 1,000
In contemplating these figures we think immediately of wage-earning
mothers away from home, ignorant feeding, and lack of care. These are
powerful factors in raising the death rate.
Of all the 1911 babies who died before they were a year old, 37% died in
the first month of life. So much pain and misery and then no baby after
all. All the skill in the world could not have saved those babies who
lived only long enough to die.
The infant mortality rate for the babies whose fathers earn under $521
is almost twice as great as for those born into families in the most
prosperous group. These figures strengthen the conclusion reached in the
study of the babies born in 1911, namely that the economic factor is of
far-reaching importance in determining the baby’s chance of life.
One of the tables showing the influence of the economic factor, is
calculated on the basis of 1,434 live-born babies with fathers. 187 of
these babies succumbed during the first year, giving a general mortality
rate of 130.7 per 1,000. In these families a very few of the mothers
worked outside the homes.
Father’s earnings Live-births Deaths 1st year Infant mortality rate
Under $625 384 82 213.5
$625 to $899 385 47 122.1
$900 or more 186 18 96.8
Ample 476 40 84.0
Expressed in words, this table asserts that when the family income is
under $625 a year, the children born alive die before the first birthday
at the rate of 213.5 to the 1,000. In striking contrast when the income
is $900 or more, they die only 96.8 to the 1,000. “Ample” was the
expression used when the investigator could not obtain exact information
as to the amount, but saw no evidence of actual poverty. The same ratio
held good when it was calculated for the native-born mothers alone and
when it was calculated for the foreign-born mothers alone. Even where
mothers are American-born women, staying at home to look after their
children, the amount of money to be spent on the child strongly
influences its chance of life and death.
According to this table the superiority which children in indigent
households show over children in well-to-do households is preeminent
skill in dying. When father earns $12 a week the children die at the
rate of 213 per 1,000; but when father earns $18 a week, only 96
children per 1,000 pass away the first year of their lives. The lower
the father’s wages, the higher the babies’ death rate. Many a death
certificate should read, “Died of poverty.”
The following table is compiled from the 5,617 children borne by 1,491
married mothers, in Johnstown, Pa.
Order of Birth Deaths per 1,000
1st and 2nd born children 138.3
3rd and 4th born children 143.2
5th and 6th born children 177.0
7th and 8th born children 181.5
9th and later born children 201.1
Apparently the size of the family has much to do with the child’s chance
of living, and apparently the earlier in the succession the child is
born, the better chance of life it possesses. Death warrants await the
coming of the youngest born.
Table 42.—Infant mortality rate for all
children of married mothers included in this
investigation, distributed according to the
father’s earnings.
Father’s annual earnings Infant mortality rate
Under $521 197.3
$521 to $624 193.1
$625 to $779 163.1
$780 to $899 168.4
$900 to $1,199 142.3
$1,200 to $1,200 and over 102.2
U. S. DEPARTMENT OF LABOR CHILDREN’S BUREAU
Julia C. Lathrop, Chief
INFANT MORTALITY
RESULTS OF A FIELD STUDY IN JOHNSTOWN, PA., BASED ON
BIRTHS IN ONE CALENDAR YEAR
BY EMMA DUKE
1915
(_Certain tables omitted_)
INFANT MORTALITY: JOHNSTOWN, PA.
_INTRODUCTION_
The term infant mortality, used technically, applies to deaths of babies
under 1 year of age. An infant mortality rate is a statement of the
number of deaths of such infants in a given year per 1,000 births in the
same year. Some countries include stillbirths in making the
computations, but this method is not generally followed in this country
nor has it been followed in this report.
Ordinary procedure is to compare the live births in a single calendar
year with the deaths of babies under 12 months of age occurring in that
same year, even though those who died may not have been born within the
calendar year of their death. The infant mortality rates in this report,
however, have not been computed on the usual basis, but for the purpose
of securing greater accuracy in measuring the incidence of death this
bureau has considered, in making the computation, only so many of the
babies born in the year 1911 as could be located by its agents, and has
compared with this number the number of deaths within this group of
babies who died within one year of birth, even though some of these
deaths may have occurred during the calendar year 1912.
Infant mortality can be accurately measured in no other way than by
means of a system of completely registering all births as well as all
deaths. In 1911 the United States Bureau of Census regarded the
registration of deaths as being “fairly complete (at least 90 per cent.
of the total)” in 23 States, but the same degree of completeness in the
registration of births was found only in the New England States,
Pennsylvania, and Michigan, and in New York City and Washington, D.C. An
exact infant mortality rate for the United States as a whole cannot be
computed owing to this generally incomplete registration. In the 1911
census report on mortality statistics, however, the infant mortality
rate is estimated at 124 per 1,000 live births. How this estimated rate
compared with the computed rates for other countries is shown in the
following summary:
DEATHS OF CHILDREN UNDER 1 YEAR OF AGE PER 1,000 LIVE BIRTHS, BY
QUINQUENNIAL PERIODS FROM 1901 TO 1910, AND ALSO FOR THE SINGLE
CALENDAR YEARS 1909 TO 1910.[10]
═══════════════════════╤═══════════╤═══════════╤═══════════╤═══════════
COUNTRY. │ 1901 to │ 1906 to │ 1909 │ 1910
│ 1905 │ 1910 │ │
───────────────────────┼───────────┼───────────┼───────────┼───────────
Chile │ 306│ 315│ 315│ 313
Russia (European) │ ([11]) │ │ │
Austria │ 215│ │ │
Hungary │ 212│ 204│ 212│ 194
Prussia │ 190│ 168│ 164│ 157
Jamaica │ 174│ 191│ 174│ 188
Spain │ 173│ │ │
Ceylon │ 171│ 189│ 202│ 176
Italy │ 168│ │ 155│
Japan │ 154│ │ 166│
Servia │ 149│ │ │
Belgium │ 148│ │ 137│
Bulgaria │ 148│ │ │
France │ 139│ │ 120│
England and Wales │ 138│ 117│ 109│ 105
The Netherlands │ 136│ 114│ 99│ 108
Switzerland │ 134│ │ 115│
Finland │ 131│ 117│ 111│ 118
Scotland │ 120│ │ 108│
Denmark │ 119│ │ 98│
Province of Ontario │ 114│ 127│ 131│ 123
Ireland │ 98│ 94│ 92│ 96
Australian Commonwealth│ 97│ 78│ 72│ 75
Sweden │ 91│ │ 72│
Norway │ 81│ │ 72│
New Zealand │ 75│ 70│ 62│ 68
───────────────────────┴───────────┴───────────┴───────────┴───────────
Footnote 10:
From the Seventy-third Annual Report of the Registrar General of
Births, Deaths, and Marriages in England and Wales (1910). London,
1912.
Footnote 11:
Available only for the period from 1896 to 1900, when it was 261.
When it had been decided by the Children’s Bureau to make infant
mortality the subject of its first field study and to include all babies
born in a given calendar year, regardless of whether they lived or died
during their first year, advice and cooperation were enlisted of
mothers, physicians, nurses, and others experienced in the care of
children, and also of trained investigators and statisticians, in the
preparation of a schedule which was submitted to them for criticism.
With its limited force and funds it was not possible for the Children’s
Bureau to extend its inquiries throughout the entire United States. It
was therefore decided to make intensive studies of babies born in a
single calendar year in each of a number of typical areas throughout the
country that offered contrasts in climate and in economic and social
conditions, the results to be eventually combined and correlated. It was
necessary to restrict the choice of the first area to a place of such
size as could be covered thoroughly within a reasonable time by the few
agents available for the work.
Johnstown, Pa., was the first place selected. It is in a State where
birth registration prevails, and hence a record of practically all
babies could be secured; it is of such size that the work could be done
by a small force within a reasonable period, and it seemed to present
conditions that could with interest be contrasted with conditions
typical of other communities. Moreover, the State commissioner of health
and the State registrar of vital statistics were both working zealously
to enforce birth-registration laws; both were actively interested in
reducing infant mortality, and they welcomed a study of the subject in
their State. In Johnstown the mayor, the president of the board of
health, the health officer, and other local officials all showed the
same spirit of hearty cooperation and interest.
Inasmuch as the study was confined to babies born in a single calendar
year and work was begun in January, 1913, the latest year in which the
babies could have been born and still have attained at least one full
year of life was 1911.
Work was begun on January 15, 1913, with the transcription from the
original records at Harrisburg of the names and other essential facts
entered on the birth certificates of babies born in 1911, and, if the
baby had died during its first year of life, items on the death
certificate were also copied.
In the meantime the people of Johnstown through the press, and through
the clergy in the foreign sections, had been informed of the purpose and
plan of the investigation. Without the friendly spirit thus aroused and
the interest manifested by the Civic Club and other organizations the
work could not have been brought to a successful issue. The
investigation was absolutely democratic; every mother of a baby born in
1911, rich or poor, native or foreign, was sought, and it is interesting
to note refusals were met with in but two cases.
The original plan was to limit the investigation to those babies born in
the calendar year selected whose births had been registered, the purpose
being to secure facts concerning a definite group and not to measure the
completeness of birth registration. Shortly after beginning the work,
however, agents of this bureau were told that the Serbian women in
Johnstown seldom had either a midwife or a physician at childbirth; that
they called in a neighbor or depended upon their husbands for help at
such times, or that they managed alone for themselves, and that
therefore their babies usually escaped registration. The omission of
these babies meant the exclusion of a number of mothers in a group that
was too important racially to be omitted from an investigation embracing
all races and classes. Accordingly a list of babies christened in the
Serbian Church and born in the year 1911 was secured and an attempt made
to locate them. In addition an agent called at each house in the
principal Serbian quarter to inquire concerning births in 1911. A number
of unregistered babies of Serbian mothers were thus found and included
in the investigation.
The agents were sometimes approached by mothers of babies born in 1911
who resented being omitted from the investigation simply for the reason
that their babies’ births had not been registered. The agents were
therefore instructed to interview mothers thus accidentally encountered
and to include their babies in the investigation. But no additional
baptismal records were copied nor was a house-to-house canvass made of
the city; in fact, no further means were resorted to to locate
unregistered babies for the purpose of including them in the
investigation.
There were 1,763 certificates copied at Harrisburg, and 1,383 of the
babies named in them were reached by the agents. In addition, 168 babies
for whom there were no birth certificates, but who were located in the
ways just noted, were included, making a total of 1,551 completed
schedules secured.
Of the 380 not included in the investigation there were 149 who could
not be located at all; 220 others had moved out of reach—that is, into
another city or State; 6 of the mothers had died; 3 could not be found
at home after several calls, and 2 refused to be interviewed.
From the following summary of data recorded on the certificates of the
380 unlocated babies just referred to it appears that the infant
mortality rate (134.3) among them is almost the same as that (134) shown
in Table 1 for babies included in the investigation. In reality,
however, it is perhaps a little higher, as some of these babies no doubt
died outside of Johnstown and their deaths were recorded elsewhere.
════════════╤═══════╤═══════╤═════════════╤═════════════
│ │ │ │SEX OF BABY.
├───────┼───────┼─────────────┼─────┬───────
│ │ │ │ │
NATIONALITY │ Total │ Live │ │ │
OF MOTHER. │births.│births.│Still-births.│Male.│Female.
│ │ │ │ │
│ │ │ │ │
────────────┼───────┼───────┼─────────────┼─────┼───────
Total │ 380│ 350│ 30│ 227│ 153
════════════╪═══════╪═══════╪═════════════╪═════╪═══════
Native │ 134│ 118│ 16│ 76│ 58
Foreign │ 246│ 232│ 14│ 151│ 95
────────────┼───────┼───────┼─────────────┼─────┼───────
Slovak, │ │ │ │ │
Polish, │ 43│ 41│ 2│ 27│ 16
etc │ │ │ │ │
Croatian and│ 13│ 11│ 2│ 10│ 3
Servian │ │ │ │ │
Magyar │ 1│ 1│ │ 1│
German │ 8│ 8│ │ 6│ 2
Italian │ 41│ 39│ 2│ 26│ 15
Syrian and │ 7│ 6│ 1│ 3│ 4
Greek │ │ │ │ │
British │ 7│ 7│ │ 3│ 4
Austrian │ │ │ │ │
(not │ 123│ 116│ 7│ 73│ 50
otherwise │ │ │ │ │
specified)│ │ │ │ │
Not reported│ 3│ 3│ │ 2│ 1
────────────┴───────┴───────┴─────────────┴─────┴───────
════════════╤════════════════════════════╤═══════════
│ ATTENDANT AT BIRTH. │
────────────┼──────────┬────────┬────────┼───────────
│ │ │ │Certificate
NATIONALITY │ │ │ │ showing
OF MOTHER. │Physician.│Midwife.│Unknown.│ deaths
│ │ │ │ during
│ │ │ │first year.
────────────┼──────────┼────────┼────────┼───────────
Total │ 158│ 180│ 33│ 47
════════════╪══════════╪════════╪════════╪═══════════
Native │ 122│ 5│ 7│ 12
Foreign │ 36│ 184│ 26│ 35
────────────┼──────────┼────────┼────────┼───────────
Slovak, │ │ │ │
Polish, │ 4│ 37│ 2│ 3
etc │ │ │ │
Croatian and│ │ 7│ 6│ 5
Servian │ │ │ │
Magyar │ │ 1│ │
German │ 2│ 5│ 1│ 2
Italian │ 3│ 36│ 2│ 4
Syrian and │ 3│ 4│ │ 1
Greek │ │ │ │
British │ 5│ 2│ │
Austrian │ │ │ │
(not │ 19│ 89│ 15│ 20
otherwise │ │ │ │
specified)│ │ │ │
Not reported│ │ 3│ │
────────────┴──────────┴────────┴────────┴───────────
RELATION OF INFANT MORTALITY TO ENVIRONMENT NEIGHBORHOOD INCIDENCE
The rate of infant mortality is regarded as a most reliable test of the
sanitary condition of a district. (Sir Arthur Newsholme, Elements of
Vital Statistics, p. 120. London, 1899.)
Johnstown is a hilly, somewhat Y-shaped area of about 5 square miles
which spreads itself out into long, narrow, irregularly shaped strips,
detached by rivers and runs and steep hills. In some places it is not
over a quarter of a mile wide, but its extreme length is about 4 miles.
The city is composed of 21 wards and is an aggregation of what were
formerly separate unrelated boroughs or towns. The names of these
different sections, together with the numerical designations of the
wards included in or comprising them, are shown in the following table.
This table gives for each section not only the total population
according to the Federal census of 1910, but also the number of
live-born babies included in the investigation and the number and
proportion of deaths among such babies during their first year.
TABLE 1.—DISTRIBUTION OF POPULATION, LIVE BIRTHS AND DEATHS DURING
FIRST YEAR, AND INFANT MORTALITY RATE ACCORDING TO SECTION OF
JOHNSTOWN, FOR ALL CHILDREN INCLUDED IN THIS INVESTIGATION.
════════════════════════════════╤═══════════╤═════════╤══════╤═════════
│ │ │Deaths│
│ │ │during│
│ │ │first │
│Population,│ Total │ year │ Infant
SECTION OF CITY AND WARD. │ 1910.[12] │live-born│ of │mortality
│ │ babies. │babies│ rate.
│ │ │ born │
│ │ │ in │
│ │ │ 1911 │
────────────────────────────────┼───────────┼─────────┼──────┼─────────
The whole city │ 55,482│ 1,463│ 196│ 134.6
════════════════════════════════╪═══════════╪═════════╪══════╪═════════
Down-town section (wards 1, 2, │ 5,944│ 80│ 4│ 52.0
3, 4) │ │ │ │
Kernville (wards 5, 6) │ 6,070│ 104│ 6│ 57.7
Homerstown (ward 7) │ 4,476│ 109│ 17│ 156.0
Roxbury (ward 8) │ 2,862│ 85│ 19│ 117.6
Conemaugh Borough (wards 9, 10) │ 5,282│ 136│ 16│ 117.6
Woodvale (ward 11) │ 3,945│ 107│ 20│ 271.0
Prospect (ward 12) │ 1,893│ 55│ 11│ 200.9
Peelorville (ward 13) │ 1,443│ 13│ 4│ ([13])
Minersville (ward 14) │ 2,403│ 72│ 9│ 125.0
Cambria City (wards 15, 16) │ 8,706│ 310│ 55│ 177.4
Moxham (ward 17) │ 5,735│ 157│ 14│ 39.2
Morrellville (wards 18, 19, 20) │ 5,757│ 194│ 15│ 32.5
Coopersdale (ward 21) │ 968│ 36│ 8│ ([13])
────────────────────────────────┴───────────┴─────────┴──────┴─────────
Footnote 12:
Federal census of 1910.
Footnote 13:
Total live births less than 50; base therefore considered too small to
use in computing an infant mortality rate.
To learn where the babies die is perhaps the first step in solving the
infant mortality problem. The modern health officer recognizes this and
generally has in his office a wall map upon which are indicated
sections, wards, city blocks, and sometimes even houses. As infant
deaths are reported, pins are stuck in the map in the proper places, a
density of pins on any part of the map indicating, of course, where
deaths are most numerous, although the percentage of infant deaths may
not be the highest.
The highest infant mortality rate, 271, is found in the eleventh ward,
known as Woodvale, although this is neither the most populous ward nor
the one having the largest number of births. The infant mortality rate
here, however, is double the rate for the city as a whole and more than
five times as great as it is for the most favorable ward.
This is where the poorest, most lowly persons of the community
live—families of men employed to do the unskilled work in the steel
mills and the mines. They are for the most part foreigners, 78 per cent.
of the mothers interviewed in this ward being foreign born.
Through Woodvale runs the main line of the Pennsylvania Railroad. To the
north of the tracks rises a steep hill, toward the top of which is
Woodvale Avenue, the principal street north of the railroad. (See plate
A.) Sewer connection is possible for the houses along this avenue, as a
sewer main has recently been installed, but the people have not in all
cases gone to the expense of having the connection made, and in other
cases where they have done so sometimes only the sinks are connected
with the sewer and the yard privy is retained.
On the streets above Woodvale Avenue dwellings are more scattered and
the appearance is more rural. A few of the families still have to depend
upon more or less distant springs for their water, although city water
is quite generally available throughout Woodvale.
The streets near the bottom of the hill, as Plum Street, for example,
are so much below the level of the sewer mains that they can not be
properly drained into the sewer. Private drain pipes from houses are
buried a few feet below the surface and protrude from the sides of the
hills, dripping with house drainage which flows slowly into ditches and
forms slimy pools. (See Plates B and C.)
None of the streets on the north side of the railroad track are paved;
sidewalks and gutters are lacking. In cold weather the streets are icy
and slippery and even dangerous on account of the grade. In warm weather
they are frequently slippery and slimy with mud.
Maple Avenue is the principal street of that part of Woodvale lying to
the south of the railroad tracks, and it is the only properly paved and
graded street in Woodvale. The streets on this side of the tracks,
however, are not in as bad a condition as those to the north, nor are
the drainage and general sewerage conditions as offensive as north of
the tracks, but many of the streets are nevertheless muddy and filthy.
(See Plate D.)
Prospect ranks next to Woodvale in infant mortality, having a rate of
200. This section, lying along a steep hill and above one of the big
plants of the steel company, has not a single properly graded, drained,
and paved street. The sewers are of the open-ditch type, and the natural
slope of the land toward the river is depended upon for carrying off the
surface water that does not seep into the soil. The closets are
generally in the yard and are either dry privies or they are situated
over cesspools. Some of the people who live on the lower part of the
slope have wells sunk directly in the course of the drainage from above.
(See Plate E.)
Cambria City, which is composed of the two most populous wards of
Johnstown, has the third highest infant mortality rate, 177.4. It has a
large foreign element, as is evidenced by the fact that 90.6 per cent.
of the mothers interviewed were foreign born. It is situated along the
river, between the hills of Minersville and Morrellville, and somewhat
to the north of Prospect. The sewage from other residential sections and
from the steel mills above them empties into the river at this point. In
warm, dry seasons the river is low, flows slowly, and forms
foul-smelling pools.
Sewer connection is possible for most of the houses in Cambria City,
although all are not connected. Some, on the streets bordering the
river, have private drain pipes that empty out into the stream. Others
have their kitchen sinks connected with the sewer but still retain yard
privies, which, of course, are not sewer connected.
There is considerable crowding of houses on lots, rear houses being
commonly built on lots intended for but one house. Density of population
and house congestion are greater here than elsewhere in the city.
The streets of Cambria City are somewhat better graded and more
generally paved than those of Woodvale, but muddy streets and unpaved
sidewalks nevertheless exist here. Broad Street, however, which is the
business thoroughfare and runs through the center of the section, is the
widest and best constructed street in Johnstown. Bradley Alley, on the
other hand, running the length of Cambria City and parallel to Broad
Street, is the most conspicuous example in the city of a narrow lane or
alley used as a residence street. A number of small dwellings, generally
housing more than one family, have their frontage on this alley, which
is 19 feet 10 inches in width and without sidewalks. It is unpaved and
in bad condition, generally being either muddy or dusty and littered
with bottles, cans, and other trash. (See Plates F. and G.)
Homerstown has an infant mortality rate of 156, ranking fourth among the
several sections of Johnstown in this respect. It has a fairly
prosperous and somewhat suburban appearance, but its comparatively high
infant mortality rate can perhaps be partly accounted for by the bad
street conditions and the fact that refuse of all sorts is dumped into
the shallow river at this point.
Minersville is a district where a high rate would be expected from
prevailing conditions. The rate is 125, or less than the average for the
city but more than double that for the most favorable sections. This
ward is built on a hill and so located that the rising clouds of
grit-laden smoke from the steel mills envelop it much of the time. Only
one street in this section is well paved, and this is seldom clean.
Houses on some of the streets near the top of the hill are not sewer
connected, and streams of waste water trickle down the hill and give
rise to unpleasant odors. (See Plates H and I.)
Conemaugh Borough, with an infant mortality rate of 117.6, ranks sixth
in this respect among the sections into which Johnstown has been
divided. It comprises wards 9 and 10 and begins at the edge of the
down-town section and spreads upward over the hills to the southwest.
Some of the houses on streets near the top of the hill are not sewer
connected, and streams of water constantly trickle down the numerous
alleys and streets that descend the hill. (See Plate J.) This section
makes a very unfavorable first impression because of the open drainage
and of the many dirty, badly paved streets. (See Plate K.) Unlike some
of the other wards, it has a rather evenly distributed population and is
without the vast uninhabited areas and acutely congested spots found in
some other sections. On the whole there is little crowding on the lots
and there are many good-sized yards. One-third of the population is
foreign born. Of these the Italians are the most numerous. Despite
certain ugly spots this section has not the unwholesome atmosphere that
characterizes Woodvale and to a lesser extent Prospect, Cambria City,
and Minersville.
The infant mortality rate of 117.6 per thousand in Roxbury is the same
as that of Conemaugh Borough. For reasons not plainly apparent the rate
here is higher than in Moxham, Morrellville, Kernville, or the down-town
section, although it appears to be as favorably conditioned as these
sections are from a social, economic, and sanitary standpoint. Here, as
in all these sections, however, are many conditions not conducive to
health. For example, parts of Franklin Street are in bad repair. The
roadway is full of ruts and holes; the street, which is seldom
sprinkled, is dusty in dry weather and muddy in wet weather, and in
front of good houses along one section of this street runs an open ditch
that receives house drainage.
Moxham has the eighth highest infant mortality rate, it being 89.2.
Conditions here are generally rather favorable, although there is some
complaint that at “high water” the sewage received by one of the runs in
this section backs into some of the houses and then the sinks and
water-closets overflow. Some of the homes here, near the city limits,
are not supplied with city water but are still dependent upon wells and
springs.
One of the three wards constituting Morrellville (ward 18) has a rural
appearance; there is little house crowding on lots, big yards are
common, and the streets are not paved. It is, however, marred by an
offensive open-ditch sewer. Ward 19 of Morrellville has a more finished,
less rural appearance. One of its objectionable features is that house
drainage and the bloody waste of slaughterhouses are emptied into a
shallow stream that flows through it. Ward 20 adjoins ward 19, and
although it spreads out into a suburb it appears for the most part to be
a comfortable and busy little village. Strayer’s Run winds about here
and receives sewage. The fact that it is without a guardrail in some
places and that the railing is inadequate in others makes it a source of
danger, and according to common report such accidents as children
falling into the stream have occurred. The infant mortality rate for
Morrellville is 82.5.
Kernville, a section with a considerable proportion of prosperous
people, has a very favorable infant mortality rate, it being 57.7. Parts
of this section, however, are on a hill stretching upward from Stony
Creek, which is both unsightly and offensive in warm weather and when
the water is low.
The down-town section, i.e., wards 1, 2, 3, and 4, where are to be found
many of the best conditioned houses, the homes of many of the well-to-do
people, has the lowest infant mortality rate in the city, it being but
50.
No infant mortality rate is presented in the tables for Coopersdale or
for Peelorville. In the first-named section only 36 live-born infants
were considered, and 8 of them died in their first year. But this high
rate need not be considered as especially significant, as the base
number is small for such a computation. Coopersdale, however, is a
suburban-appearing community in which one would expect the infant
mortality rate to be low.
Peelorville is that part of the thirteenth ward which adjoins Prospect.
A number of company houses are located here in which sanitary conditions
are fairly good. The ward seems to have good drainage and no sewage
nuisances. It is a community of wage earners and not of prosperous
homes. Only 18 babies are included in the report for this district, one
of whom died. With such a small base the infant mortality rate is not
significant. (See Plate L.)
SANITARY CONDITIONS—SEWERAGE, PAVEMENTS, GARBAGE COLLECTIONS
The general inadequacy of the sewerage system which has been indicated
for the city as a whole is due in part to the fact that the city is
largely an aggregation of sections, formerly independent of Johnstown
itself, which have been annexed at different periods. Some of these
boroughs had sewer systems more or less developed when they were taken
into Johnstown; others had none. Not only the sewerage of Johnstown but
that of outlying boroughs pollutes the two shallow rivers, the Conemaugh
and the Stony Creek, that flow through Johnstown. These are burdened
with more waste than they can properly carry away, and the deposits
which are left on the rocks in various sections of both rivers create
nuisances that are the subject of much complaint, especially during the
warm summer months. (See Plates M, N, O, and P.) At various times
agitation has been started to improve the rivers which, as they flow
through Johnstown, are, at the low-water stage, little better than
swamps of reeking slime from the waste matter emptied into them from the
hundreds of sewers along their banks. The pipes through which waste
matter is emptied into the streams go only to the river edge, leaving
their mouths uncovered and making the river beds at times pools of
slowly flowing filth. These unsightly, malodorous conditions could be
remedied if pipes were extended out into the middle of the streams,
where the water is deeper.
With the exception of sprinkling a few wagon loads of lime along the
banks of the streams each year, the city has done nothing to abate the
nuisances arising from the use of these rivers as sewers or to restrain
the coal and steel companies from allowing the drainage from mines and
mills to enter the streams.
The engineer’s records show that Johnstown had in 1911 a total of 41.1
miles of sewers and 36 sewer outlets, and 82 miles of streets, 52.7
miles being paved. The alleys in Johnstown are generally inhabited. They
are narrow and without sidewalks. Their length is 52.88 miles and 47.35
miles are unpaved. The combined length of streets and alleys is 134.88
miles. A comparison of this combined length of streets and alleys with
the 41.1 miles of sewers having 36 outlets shows the inadequacy of the
sewer system.
Not only is there an absence of paving, but the roadways are in very bad
condition. A protest by “A Citizen” in the _Democrat_ of June 26, 1913,
says that there are nine months in the year when it would be impossible
for the proposed fire-department automobile engines to attend a fire in
the seventh, eighth, eleventh, seventeenth, eighteenth, nineteenth,
twentieth, and twenty-first wards owing to the condition of the streets.
The scavenger system is also very defective. Citizens are required to
pay for the removal of their ashes, trash, and garbage. Garbage
collections are not made by the municipality, but by private
contractors, and any sort of receptacle, covered or uncovered, can or
box, is pressed into service by householders. It is by no means uncommon
to find streets and alleys littered with ashes, garbage, bottles, tin
cans, beer cases, and small kegs. Dirty streets are by no means
exceptional in Johnstown, even though the State of Pennsylvania has a
law (act of Apr. 20, 1905) which provides for the punishment of any
person who litters paved streets. It reads, in part, as follows (sec. 7
of Pamphlet Laws, 227):
“From and after the passage of this act, it shall be unlawful, and is
hereby forbidden, for any person or persons to throw waste paper,
sweepings, ashes, household waste, nails, or rubbish of any kind into
any street in any city, borough, or township in this Commonwealth, or to
interfere with, scatter, or disturb the contents of any receptacle or
receptacles containing ashes, garbage, household waste, or rubbish which
shall be placed upon any of said paved streets or sidewalks for the
collection of the contents thereof.
“Any person or persons who shall violate any of the provisions of this
act shall, upon conviction thereof before any magistrate, be sentenced
to pay the cost of prosecution and to forfeit and pay a fine not
exceeding $10 for each offense, and in default of the payment thereof
shall be committed and imprisoned in the county jail of the proper
county for a period not exceeding ten days.”
In a report on infant mortality to the registrar general of Ontario,
1910, Dr. Helen MacMurchy says: “Improve the water supply, the sewerage
system, and the system of disposing of refuse; introduce better
pavements, such as asphalt, and at once there is a decline in infantile
mortality.” All these are sanitary features in need of great improvement
in Johnstown, and unquestionably a lowered infant mortality rate would
reward any efforts for their betterment.
HOUSING
In Johnstown the so-called “double” house predominates, usually frame.
The double house is in reality two semidetached houses built upon a
single lot. Rows of three or more houses of two, three, or four rooms
each are common, and they are known locally as three-family, or
six-family houses, as the case may be. Sometimes these are “rear
houses,” that is, they are built behind other houses that face the
street, on the same lots and in fact are approached by way of a narrow
alley running alongside the house that has its frontage directly on the
street. For this type of house water-closets or privies are often in
rows in the yard or court that is used in common by all families. (See
Plates Q and R.) In some places they are too few in number to permit
each family to have the exclusive use of one.
Johnstown has three or four comparatively high-grade apartment houses,
and in several office buildings rooms are rented to families for
housekeeping. These are generally taken by native families.
In one of these office buildings the two lower floors are used for
business purposes and the two upper floors are given over entirely to
tenement purposes. From 40 to 50 families live here, many of whom have
but one room. To serve the 20 or 25 families on each floor there is one
bath and toilet room for men and another for women. Adjoining the toilet
rooms is a small room containing garbage cans and trash receptacles for
the use of the tenants.
The sanitary conditions in some of the best tenements or apartments,
however, are not up to the standards of other cities, and in those
occupied by the poorer people conditions are much worse than are usually
permitted to exist in cities having large tenement houses in great
numbers, where a tenement-house problem is recognized as such and active
efforts are made by the municipality to improve conditions.
An absolute measure of the importance of each single housing defect in a
high mortality rate can not be secured from this study. But it is not
without interest to note that in homes where water is piped into the
house the infant mortality rate was 117.6 per thousand, as compared with
a rate of 197.9 in homes where the water had to be carried in from
outdoors. Or that in the homes of 496 live-born babies where bathtubs
were found the infant mortality rate was 72.6, while it was more than
double, or 164.8, where there were no bathtubs. Desirable as a bathtub
and bodily cleanliness may be, this does not prove that the lives of the
babies were saved by the presence of the tub or the assumed cleanliness
of the persons having them. In a city of Johnstown’s low housing
standards, the tub is an index of a good home, a suitable house from a
sanitary standpoint, a fairly comfortable income, and all the favorable
conditions that go with such an income.
The same trend of a high infant mortality rate in connection with other
housing defects is noted in the next table.
TABLE 3.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY RATE, ACCORDING TO HOUSING CONDITIONS.
Deaths during First Year
HOUSING CONDITIONS Live births Number Infant mortality rate
Total 1,463 196 134.0
Dry homes 808 99 122.5
Moderately dry homes 336 47 139.9
Damp homes 319 50 156.7
Bath 496 36 72.6
No bath 965 159 164.8
Not reported 2 1 ([14])
Water supply in house 1,173 138 117.6
Water supply outside 288 57 197.9
Not reported 2 1 ([14])
City water available 1,333 176 132.0
City water not available 128 19 148.4
Not reported 2 1 ([14])
Yard clean 801 80 99.9
Yard not clean 632 107 169.3
No yard 28 8 ([14])
Not reported 2 1 ([14])
Water-closet 739 80 108.3
Yard privy 722 115 159.3
Not reported 2 1 ([14])
Footnote 14:
Total live births less than 50; base therefore considered too small to
use in computing an infant mortality rate.
The following summary may be of interest in indicating some relation
between infant mortality and cleanliness or uncleanliness combined with
dryness or dampness of homes:
TABLE 4.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY, ACCORDING TO CLEANLINESS AND DRYNESS OF HOME.
Deaths during First Year
TYPE OF HOME Live births Number Infant mortality
rate
All types 1,463 196 134.0
Clean 943 107 113.5
Moderately clean 354 58 163.8
Dirty 166 31 186.7
Dry 807 99 122.7
Damp 656 97 147.9
Clean:
Dry 581 61 105.0
Damp 362 46 127.1
Moderately clean:
Dry 158 27 170.9
Damp 196 31 158.2
Dirty:
Dry 68 11 161.8
Damp 98 20 204.1
Dirt is doubtless unhealthful, but the amount of ill health or the
number of infant deaths caused by a home being dirty can hardly be
measured, when, as is usually the case, the dirt is accompanied by so
many other bad conditions arising from poverty. For example, a home in
close proximity to railroad tracks or mills whose stacks send forth
clouds of soot, smoke, and ashes is generally the poorly built home of
those who have neither time nor means to secure and retain cleanliness
under such difficulties.
Overcrowding in homes is another factor the relative importance of which
can not be exactly determined, because of its close connection with
other ills. But the degree of overcrowding is greatest in the small
cheaper houses, those of one, two, three, or four rooms. The average
number of persons per room in the homes of all live-born babies for whom
the data were secured was found to be 1.38. Homes of four rooms were
more numerous than those of any other size and they housed an average of
1.58 persons per room. The number of babies in homes of various sizes
with the number of persons per room for homes of each size was as
follows:
TABLE 5.—NUMBER OF BABIES LIVING IN HOMES OF
EACH SPECIFIED SIZE, AND AVERAGE NUMBER OF
PERSONS PER ROOM IN HOMES OF EACH SIZE.
Size of home Live-born babies Persons per room
All homes 1,463
1 room 33 4.42
2 rooms 165 2.27
3 rooms 147 1.83
4 rooms 526 1.58
5 rooms 222 1.22
6 rooms 233 1.07
7 rooms 38 .96
8 rooms 43 0.83
9 rooms 22 .93
10 rooms 4 .88
11 rooms 4 .64
12 rooms 1 .75
13 rooms 1 .69
14 rooms 2 .43
Not reported 22
In homes of one, two, three, or four rooms or where the number of
occupants ranged from 4.42 to 1.58 persons per room the infant mortality
rate was 155, as compared with a rate of but 101.8 in larger homes,
where the number ranged from 1.22 to 0.43 persons per room.
The 1910 census returns show that the greatest overcrowding was in ward
15, where the average number of persons per dwelling was 9.9. Wards 16,
11, and 14 came next with rates of 8.3, 7.7, and 7.2 respectively. The
infant mortality rate for these four wards is 190.2, which is over
one-third more than the rate for the whole city.
The mortality rate among infants who slept in a room with no other
person than their parents was much lower than among those who slept in a
room with more than two persons. The babies that slept in separate beds
also had a much lower infant mortality rate than those who did not sleep
alone, as shown in the next table. (Table omitted.)
In presenting statistics on sleeping and ventilation, only the babies
who lived at least one month have been considered, for the reason that
so many deaths during the first month of life were due to prenatal
causes.
The incidence shown in the foregoing table is significant, even though
it can by no means be deduced therefrom that the health of a large
proportion of babies was so impaired by sleeping with older and more or
less unhealthy persons that death resulted. But irregular night feeding
and overfeeding are undoubtedly harmful, and the mother is tempted to
subject the baby to this when it sleeps with her and disturbs her rest.
Of the 1,389 babies who lived at least one month, 600, or 43.2 per
cent., lived in homes where the baby slept in a room with not more than
two other persons. The fact that the baby slept in a room with no more
persons than its parents generally argues that the family’s means
permitted them to have one or more additional rooms for other members of
the family, but in other cases, of course, merely that there were no
other persons in the family.
Almost every home visited had means for good ventilation of the baby’s
room at night, yet but 604, or 43.5 per cent., of the 1,389 babies who
lived at least a month slept at night in well-ventilated rooms—that is,
in rooms where, according to the mother’s statement, a window was open
all night. Some mothers opened windows when the weather was neither cold
nor damp; or opened them in a hall or room adjoining that where the baby
slept; others emphatically stated that at night the windows were “always
shut tight.” The babies subjected to differences of ventilation show
corresponding variations in infant mortality rates.
A high death rate in badly ventilated homes can not be charged wholly to
bad air. The mother who did not, or could not, provide proper
ventilation was generally the mother without the means or the knowledge
necessary to enable her to care for her baby properly in other respects,
and yet the marked differences suggest that ventilation is itself a very
important ally of the baby in its first year of struggle for existence.
In many rooms that were poorly ventilated, windows were not opened for
the reason that the room was not properly heated and the houses
themselves were flimsy and drafty. The problem in such houses is to keep
warm. If the windows were frequently or constantly opened, the houses
would be too cold to live in. In some localities the outside air is so
laden with soot, ashes, dirt, and smoke that every effort is made to
keep it out of the house.
The foreigners, who generally have the most miserable homes, are not
dirty people who select bad living conditions through innate poor
judgment, low standards, and lack of taste. The squalid homes which
housed the natives and later the Germans and the Irish until the present
type of immigrants came to do the more poorly paid work were the only
homes available within the purchasing power of their low wages. The new
immigrants demanded practically nothing and the owners did practically
nothing in the matter of improving these homes, which naturally became
more and more squalid as time went on. An excessive infant mortality
rate and insanitary homes in unhealthful sections were found to be
coexistent.
NATIONALITY
GENERAL NATIVITY
The investigation embraced 860 babies of native mothers (of whom 6 were
negroes) and 691 babies of foreign mothers, making a total of 1,551. The
infant mortality rate for the entire group was 134 per 1,000 live
births; for the babies of native mothers 104.3, and for those of foreign
mothers 171.3. The stillbirth rate for native mothers having children in
1911 was less than that for foreign mothers, being 52.3, as compared
with 62.2 per 1,000 total births.
The line between the natives and foreigners is very sharply drawn in
Johnstown. The native population as a rule knows scarcely anything about
the foreigners, except what appears in the newspapers about misdemeanors
committed in foreign sections. The report of the Immigration
Commission[15] comments “on the attitude of the police department toward
foreigners ... with regard to Sunday desecration,” and states that “the
Croatians are accustomed to spend Sunday in singing, drinking, and noisy
demonstrations. The police have been instructed to show no leniency on
account of ignorance of the municipal regulations, and, without any
attempt at explaining the laws, they arrest the offenders in large
numbers.” Again, it states: “They are arrested more often for crimes
that make them a nuisance to the native population than for mere
infractions of the law.... Few arrests are made for immorality among
foreigners.” “Sabbath desecration” is the crime foreigners are most
frequently charged with.
Footnote 15:
United States Immigration Commission Reports, Volume VIII.,
“Immigrants in Industries: Part 2, Iron and Steel Manufacturing in the
East,” p. 387. Reference is to Johnstown and is a very true picture of
various immigrant institutions and of the comparative progress and
assimilation of different races there. Although the immigration report
was made five years before our investigation, conditions remain
practically the same.
Foreigners are employed largely in the less skilled occupations of the
steel mills, which operate 24 hours a day, seven days a week. At the
time the investigation was made some of the men in the steel mills
worked for a period of two weeks on a night shift of 14 hours, then two
weeks on a day shift of 10 hours, and back again to the night shift of
14 hours for another two weeks, and so on. When shifts were changed, one
group of men was required to work throughout a period of 24 hours
instead of for the usual 10 or 14 hour period and another group had 24
hours off duty. Some departments of the steel mills, however, shut down
on Sundays, and in some departments for certain occupations an
eight-hour day prevails, but these more favorable conditions do not
prevail among the majority of the unskilled foreign workers whose homes
were visited.
The foreigners who work on a 24-hour shift in a mill on one Sunday
frequently “desecrate” their alternate free Sabbath by “singing,
drinking, and noisy demonstrations,” in spite of the known danger of
arrest for “crimes that make them a nuisance to the native population”
or for “Sabbath desecration,” laws concerning which are strictly
enforced in Johnstown; for example, children are not permitted to play
in public playgrounds on Sunday and mercantile establishments are
required to be closed on that day. Also, it is “unlawful for any person
or persons to deliver ice cream, or to sell or deliver milk from wagon
or by person carrying same, within the city on the Sabbath day, commonly
called Sunday, after 12 o’clock m.” The ordinance from which the
foregoing sentence was quoted became a law on January 25, 1914.
SERBO-CROATIAN
The foreign group having the highest infant mortality rate is the
Serbo-Croatian[16] where infant deaths numbered 263.9 per 1,000 live
births.
Footnote 16:
A distinct and homogenous race, from a linguistic point of view, among
Slavic peoples. They are divided into the groups “Croatian” and
“Servian,” on political and religious grounds, the former being Roman
Catholics and the latter Greek Orthodox. Their spoken language is the
same but they can not read each other’s publications, for the
Croatians use the Roman alphabet, or sometimes the strange old Slavic
letters, while the Servians use the Russian characters fostered by the
Greek Church.
Three Krainers have also, for convenience, been included in this
group. Krainers are Slovenians from the Austro-Hungarian Province of
Carniola and are designated “close cousins of the Croatians but with a
different though nearly related language” by Emily Greene Balch in her
book entitled “Our Slavic Fellow Citizens.”
The men of the Serbo-Croatian group are fine looking and powerful and
are employed in the heavy unskilled work of the steel mills and the
mines. They greatly outnumber the women of their race in Johnstown, and
a man with a wife frequently becomes a “boarding boss”; that is, he
fills his rooms with beds and rents out sleeping space to his fellow
countrymen at from $2.50 to $3 a month each. The same bed and bedding is
sometimes in service both night and day to accommodate men on the night
and the day shifts of the steel mills.
The wife, without extra charge, makes up the beds, does the washing and
ironing, and buys and prepares the food for all the lodgers. Usually she
gets everything on credit and the lodgers pay their respective shares
biweekly. These conditions exist to some extent among other foreigners,
but are not as prevalent among other nationalities in Johnstown as among
the Serbo-Croatians.
In a workingman’s family, it is sometimes said, the woman’s work-day is
two hours longer than the man’s. But if this statement is correct in
general, the augmentation stated is insufficient in these abnormal homes
where the women are required to have many meals and dinner buckets ready
at irregular hours to accommodate men working on different shifts.
The Serbo-Croatian women who, more than any of the others, do all this
work are big, handsome, and graceful, proud and reckless of their
strength. During the progress of the investigation, in the winter
months, they were frequently seen walking about the yards and courts, in
bare feet, on the snow and ice-covered ground, hanging up clothes or
carrying water into the house from a yard hydrant.
Whether it harmed them to expend their force and vigor as they did could
not be determined in individual cases, but their babies are the ones who
died off with the greatest rapidity, their infant mortality rate being
263.9, as compared with the rates of 171.3 for all the foreign; 104.3
for the natives; and 134 for the entire group as shown in Table 18.
Excluding babies of Serbo-Croatian mothers, the infant mortality rate
for babies of foreign mothers is but 159.7.
ITALIAN
The Italian mothers visited in Johnstown bore 75 children in 1911, 4
being stillborn. The infant mortality rate among the live born was
183.1, the highest of any racial group excepting the Serbo-Croatian,
where it was 263.9.
The Italians have been in Johnstown somewhat longer than the
Serbo-Croatians and they seem to have a little firmer grip on the
community life there. Their homes are a shade better, a trifle cleaner,
and somewhat less crowded than those of the Serbo-Croatians, although
their hygienic standards seem little if any higher and they rank no
better in literacy. The women do not perform the arduous duties that are
the lot of so many of the Serbo-Croatian women; they have not the robust
physique of the latter and the men are not found in those branches of
the steel industry which require the extraordinary strength possessed by
the Serbo-Croatians. The occupations of the Italian fathers were found
to be more diversified than those of the Serbo-Croatians, some being
fruit, grocery, or cheese merchants; steamship agents; bricklayers,
carpenters, or workers at other skilled and semiskilled trades.
SLOVAK, POLISH, ETC.
The infant mortality rate in the group designated “Slovak, Polish, etc.”
is 177.1. In this group are included all the Slavic races represented in
the investigation excepting the Serbo-Croatian. The babies of Slovak[17]
mothers were found to be most numerous, there being 276 of them. There
were 108 babies of Polish,[18] 2 of Bohemian,[19] and 7 of Ruthenian[20]
mothers. In addition, one baby of a Scandinavian (Danish) mother was
included, not because Scandinavians bear the least racial resemblance to
the Slavic races, but because the few Scandinavians in Johnstown
happened to be on about the same economic footing as the “Slovak,
Polish, etc.”
Footnote 17:
Slovaks occupy practically all except the Ruthenian territory of
northern Hungary; also found in great numbers in southeast Moravia.
They are the Moravians conquered by Hungary. In physical type no
dividing line can be drawn between Slovaks and Moravians. It is often
claimed that Slovak is a Bohemian dialect.
Footnote 18:
The west Slavic race native to the former Kingdom of Poland. For the
most part they adhere to the Roman rather than the Greek Orthodox
Catholic Church.
Footnote 19:
The westernmost division or dialect of the Czech and the principal
people or language of Bohemia. Czech is the westernmost race or
linguistic division of the Slavic (except Wendish, in Germany), the
race or people residing mainly in Bohemia and Moravia.
Footnote 20:
Also known as Little Russians; live principally in southern Russia;
also share Galicia with the Poles but greatly surpassed by Poles in
number. In language and physical type resemble Slovaks. Generally
Greek Orthodox, but a few are Greek Catholics of the Roman Catholic
Church, whose priests marry, and are separated from other Roman
Catholics by marked religious differences.
The rate for this group is lower than that for either the
Serbo-Croatians or the Italians, but it is nevertheless very high and
one exceeded by only a few European countries, as shown by the table on
page 12.
Some of the “Slovaks, Poles, etc.,” live in the same squalid sections as
the Serbo-Croatians, and in the same type of inferior houses, but on the
whole they have been in Johnstown longer, are more prosperous, and are
therefore beginning to move from Cambria City and Woodvale, where
formerly practically all lived, into more desirable sections. Those who
have been in this country longest and intend to stay here are buying
homes with large yards in the less crowded sections and are raising
vegetables and flowers. Others, however, still remain in poor
neighborhoods and sometimes buy houses there for from $300 to $600 each,
built close together on rented ground.
Lodgers are by no means uncommon among the people in this group, but
usually their homes are cleaner, less crowded, and possessed of more
comforts than those of the Serbo-Croatians and Italians.
OTHER NATIONALITIES
The British[21] infant mortality rate in Johnstown is 129 and the German
127.7. The British and Germans in Johnstown are more prosperous than the
Slavic, Magyar, Jewish, Italian, Syrian, and Greek peoples, and regard
the others as “foreigners.” It was strange to hear a man, one who could
speak English, say, “We are not foreigners; we are Germans.” The British
and Germans occupy the same relative position economically that they
occupy in the infant mortality scale with relation to other races.
Footnote 21:
English, Irish, Scotch, and Welsh included in the term British.
In the Magyar group, of 38 babies born alive 4 died in their first year,
making an infant mortality rate of 105.3, which is almost as low as that
for babies of native mothers. The Magyars are little if any better off
than the other “foreigners” among whom they live, but they possess
somewhat higher standards of living. They live in poor neighborhoods and
have inferior houses, but their homes are cleaner and they themselves
somewhat more alert, personally cleaner, and less illiterate than the
other foreigners.
There were but 10 babies of Hebrew mothers and 12 of Syrian and Greek
mothers; among these there were no deaths. These groups are too small
numerically to be significant in a comparative race study of infant
mortality.
STILLBIRTHS
In all there were but 88 stillbirths included in the investigation. They
were more numerous proportionately among the Germans than among the
mothers of any of the other nationalities. No single nationality group,
however, has a very large representation, and hence a comparison of the
rate for one with that for another nationality is not as significant as
the difference in rate between native and foreign mothers. Although a
special study of the causes of stillbirths was not made in connection
with a study of deaths of infants during their first year of life,
nevertheless the incidence of these births among the different
nationality groups is believed to be of some interest, and therefore
shown in the next table. (Omitted.)
ATTENDANT AT BIRTH
The native mother usually had a physician at childbirth; the
foreign-born, a midwife. The more prosperous of the foreign mothers,
however, departed from their traditions or customs and had physicians,
while the American-born mothers, when very poor, resorted to midwives.
The midwives usually charged $5, and sometimes only $3; they waited for
payment or accepted it in installments, and they performed many little
household services that no physician would think of rendering.
Two-thirds of those having no attendant were Serbo-Croatians. It was a
Polish woman, however, who gave the following account of the birth of
her last child:
At 5 o’clock Monday evening went to sister’s to return washboard, having
just finished day’s washing. Baby born while there; sister too young to
assist in any way; woman not accustomed to midwife anyway, so she cut
cord herself; washed baby at sister’s house; walked home, cooked supper
for boarders, and was in bed by 8 o’clock. Got up and ironed next day
and day following; it tired her, so she then stayed in bed two days. She
milked cows and sold milk day after baby’s birth, but being tired hired
some one to do it later in week.
This woman keeps cows, chickens, and lodgers; also earns money doing
laundry and char work. Husband deserts her at times; he makes $1.70 a
day. A 15-year-old son makes $1.10 a day in coal mine. Mother thin and
wiry; looks tired and worn. Frequent fights in home.
The infant mortality rate was lower for babies delivered by physicians
than for those delivered by midwives or for those at whose birth no
properly qualified attendant was present. This is not necessarily an
indication of the quality of the care at birth, although in some cases
the inefficiency of the midwife may have directly or indirectly caused
deaths, just as in some instances a physician’s inefficiency may have
caused them. The midwife, however, is resorted to by the poor, and in
their homes are found other conditions that create a high infant
mortality rate.
Frequently the Serbo-Croatian women dispense altogether with any
assistance at childbirth; sometimes not even the husband or a neighbor
assists. Over 30 per cent. of the births among the women of that race
took place without a qualified attendant. More than one-half of those
delivered by midwives, less than one-fifteenth of those delivered by
physicians, and about one-fifth of those delivered without a qualified
attendant had babies who died in their first year of life.
Fifteen of the 19 Serbo-Croatian women whose babies died under 1 year of
age kept lodgers.
In Johnstown the midwife is resorted to principally by the poor. Recent
laws that the State is now trying to enforce require that the standard
for the practice of midwifery be raised. If this can be done midwives
might become definitely helpful persons in the community. One or two of
the intelligent graduate midwives in Johnstown have been an educational
force among the foreign mothers for some years past. On the other hand
there were others who were so dirty and so ignorant that they were a
menace to the public health.
MOTHERS
LITERACY[22]
There are differences in the infant mortality rate between the babies of
literate and the babies of illiterate mothers; between those with
mothers who can speak English and those with mothers who can not; and
between babies of the mothers who have been in this country for a
considerable period and those of the newer arrivals. Comparisons of this
nature are confined to the foreign mothers, as only three cases of
illiteracy were found among native mothers, and the other comparisons
would not, of course, be applicable in any case to native mothers.
Footnote 22:
By literacy is meant ability to read and write in any language and not
simply in English.
The next table shows that the infant mortality rate among the children
of illiterate foreign mothers was 214, or 66 per thousand greater than
the rate among literate foreign mothers.
TABLE 13.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR,
INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS,
ACCORDING TO LITERACY OF FOREIGN MOTHERS.
═══════════════════════╤═══════╤═══════╤═════════════╤═════════════════
LITERACY OF FOREIGN │ Total │ Live │STILLBIRTHS. │ DEATHS DURING
MOTHERS. │births.│births.│ │ FIRST YEAR.
───────────────────────┼───────┼───────┼───────┬─────┼───────┬─────────
│ │ │ │ Per │ │ Infant
│ │ │Number.│cent.│Number.│mortality
│ │ │ │ │ │ rate.
───────────────────────┼───────┼───────┼───────┼─────┼───────┼─────────
Foreign mothers │ 691│ 648│ 43│ 6.2│ 111│ 171.3
═══════════════════════╪═══════╪═══════╪═══════╪═════╪═══════╪═════════
Literate │ 445│ 419│ 26│ 5.8│ 62│ 148.0
Illiterate │ 246│ 229│ 17│ 6.9│ 49│ 214.0
───────────────────────┴───────┴───────┴───────┴─────┴───────┴─────────
ABILITY TO SPEAK ENGLISH
The next table shows that babies whose mothers can not speak English
were characterized by a more unfavorable infant mortality rate than
other babies.
TABLE 14.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR,
INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS,
ACCORDING TO ABILITY OF FOREIGN MOTHER TO SPEAK ENGLISH.
═══════════════════════╤═══════╤═══════╤═════════════╤═════════════════
ABILITY TO SPEAK │ Total │ Live │STILLBIRTHS. │ DEATHS DURING
ENGLISH. │births.│births.│ │ FIRST YEAR.
───────────────────────┼───────┼───────┼───────┬─────┼───────┬─────────
│ │ │ │ Per │ │ Infant
│ │ │Number.│cent.│Number.│mortality
│ │ │ │ │ │ rate.
───────────────────────┼───────┼───────┼───────┼─────┼───────┼─────────
Foreign mothers │ 691│ 648│ 43│ 6.2│ 111│ 171.3
═══════════════════════╪═══════╪═══════╪═══════╪═════╪═══════╪═════════
Speak English │ 263│ 247│ 16│ 6.1│ 36│ 145.7
Can not speak English │ 428│ 401│ 27│ 6.3│ 75│ 187.0
───────────────────────┴───────┴───────┴───────┴─────┴───────┴─────────
YEARS IN THE UNITED STATES
In addition to a consideration of the babies according to their mothers’
ability to speak English, it is of interest to note the infant mortality
rates among babies whose mothers have been in this country for different
periods of time.
The high infant mortality rate for the children of newer immigrants,
illiterates, and those who can not speak English is perhaps affected by
the fact that they are at the same time generally of the poorest
families and are housed in the most insanitary and unhealthful part of
the city.
AGE
The age of the mother is frequently believed to be a factor in the
health of the child. The highest infant mortality rate was found to be
that for the group of babies with mothers over 40 years of age, and the
lowest for babies of mothers from 20 to 24 years of age.
TABLE 16.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR,
INFANT MORTALITY RATE, AND NUMBER AND PER CENT OF STILLBIRTHS,
ACCORDING TO AGE OF MOTHER.
════════════════╤════════╤════════╤═════════════════╤══════════════════
AGE OF MOTHER. │ Total │ Live │ STILLBIRTHS. │ DEATHS DURING
│births. │births. │ │ FIRST YEAR.
────────────────┼────────┼────────┼────────┬────────┼────────┬─────────
│ │ │ │ Per │ │ Infant
│ │ │Number. │ cent. │Number. │mortality
│ │ │ │ │ │ rate.
────────────────┼────────┼────────┼────────┼────────┼────────┼─────────
All mothers │ 1,551│ 1,463│ 88│ 5.7│ 196│ 134.0
════════════════╪════════╪════════╪════════╪════════╪════════╪═════════
Under 20 │ 105│ 95│ 10│ 9.5│ 13│ 136.8
20 to 24 │ 476│ 454│ 22│ 4.6│ 55│ 121.1
25 to 29 │ 410│ 391│ 19│ 4.6│ 56│ 143.2
30 to 39 │ 480│ 449│ 31│ 6.5│ 61│ 135.9
40 and over │ 80│ 74│ 6│ 7.5│ 11│ 148.6
────────────────┴────────┴────────┴────────┴────────┴────────┴─────────
The youngest mothers have a higher stillbirth rate than other mothers,
and the oldest group of mothers has the next highest rate. In this
connection not only the foregoing table is of interest, but also Table
XII, based upon the entire reproduction histories of the mothers
included in this study. As all the children borne by these mothers are
included, the base numbers in the latter table are larger and the
figures therefore somewhat more significant.
BABY’S AGE AT DEATH AND CAUSE (DISEASE) OF DEATH
_A baby who comes into the world has less chance to live one week than
an old man of 90, and less chance to live a year than one of
80.—Bergeron._
The most dangerous time of life is early infancy; even old age seldom
has greater risk. Death strikes most often in infancy. The Johnstown
babies died during their first year of life at the rate of 134 per 1,000
born alive, and they paid their heaviest toll in their very earliest
days. If the total of 196 deaths had been distributed evenly throughout
the 12 months, 8.3 per cent. of the babies would have died each month
and 25 per cent. during each quarter. But instead of that 37.8 per cent.
died in the first month; 9.2 per cent. in the second, and 8.2 per cent.
in the third, or over 55 per cent. in the first quarter.
TABLE 17.—NUMBER AND PER CENT DISTRIBUTION OF DEATHS OF BABIES, BY AGE
AT DEATH.
═══════════════════════════════════╤═══════════════════════════════════
AGE AT DEATH. │ DEATHS OF BABIES OF ALL MOTHERS.
───────────────────────────────────┼─────────────────┬─────────────────
│ Number. │ Per cent.
│ │ distribution.
───────────────────────────────────┼─────────────────┼─────────────────
Total deaths in first year │ 196│ 100.0
═══════════════════════════════════╪═════════════════╪═════════════════
First quarter │ 108│ 55.1
First month │ 74│ 37.8
═══════════════════════════════════╪═════════════════╪═════════════════
First week │ 45│ 23.0
───────────────────────────────────┼─────────────────┼─────────────────
Less than 1 day and 1 day │ 30│ 15.3
2 days │ 4│ 2.0
3 to 6 days │ 11│ 5.6
│ │
Second week │ 14│ 7.1
Third week │ 7│ 3.6
Fourth week │ 8│ 4.1
│ │
Second month │ 18│ 9.2
Third month │ 16│ 8.2
│ │
Second quarter │ 42│ 21.4
Third quarter │ 31│ 15.8
Fourth quarter │ 15│ 7.7
───────────────────────────────────┴─────────────────┴─────────────────
The large number of deaths in the first few hours or days of life
indicates that many babies are born with some handicap and that in many
instances the mother has been subjected to some condition which resulted
in the birth of a child incapable of withstanding the ordinary strain of
life. Of the 45 babies who died in Johnstown less than a week after
birth, 38 died of prematurity, congenital debility or malformations, or
injuries received at birth. In one other case the cause of death was
given as “bowel trouble” and in six other cases it was not clearly
defined. In addition to the 45 babies just referred to as having died in
their first week, 12 died later either from prematurity or from
congenital defects.
Of the deaths from causes arising after birth, 52 were attributed by the
attending physicians to diarrhoea and enteritis, 50 to respiratory
diseases; and 44 to some other or to some ill-defined cause.
TABLE 18.—DISTRIBUTION OF DEATHS DURING FIRST YEAR AND INFANT MORTALITY
RATE, ACCORDING TO CAUSE OF DEATH AND NATIVITY OF MOTHER.
═════════════════╤═════════════════════════════════════════════════════
CAUSE OF DEATH. │ DEATHS DURING FIRST YEAR OF BABIES OF—
─────────────────┼─────────────────┬─────────────────┬─────────────────
│ All mothers. │ Native mothers. │Foreign mothers.
─────────────────┼───────┬─────────┼───────┬─────────┼───────┬─────────
│ │ Infant │ │ Infant │ │ Infant
│Number.│mortality│Number.│mortality│Number.│mortality
│ │ rate. │ │ rate. │ │ rate.
─────────────────┼───────┼─────────┼───────┼─────────┼───────┼─────────
All causes │ 196│ 134.0│ 85│ 104.3│ 111│ 171.3
═════════════════╪═══════╪═════════╪═══════╪═════════╪═══════╪═════════
Diarrhea and │ 52│ 35.5│ 17│ 20.9│ 35│ 54.0
enteritis │ │ │ │ │ │
Respiratory │ 50│ 34.2│ 19│ 23.3│ 31│ 47.8
diseases │ │ │ │ │ │
Premature births │ 24│ 16.4│ 11│ 13.5│ 13│ 20.1
Congenital │ │ │ │ │ │
debility or │ 19│ 12.9│ 5│ 6.1│ 14│ 21.6
malformation │ │ │ │ │ │
Injuries at birth│ 7│ 4.8│ 6│ 7.4│ 1│ 1.5
Other causes or │ 44│ 30.1│ 27│ 33.1│ 17│ 26.2
not reported │ │ │ │ │ │
─────────────────┴───────┴─────────┴───────┴─────────┴───────┴─────────
The latest census report on mortality statistics characterizes diarrhoea
and enteritis as the “most important preventable cause of infant
mortality” in the United States, and numerically at least it proves to
be the most important cause of infant death in Johnstown.
Holt[23] says that one of the most striking facts about diarrheal
diseases in infants is their prevalence during the summer season. In
Johnstown the infant diarrheal deaths were least prevalent in the first
quarter of the year, next in the second, next prevalent in the fourth,
and most prevalent in the third or summer quarter.
Footnote 23:
The Diseases of Infancy and Childhood, by L. Emmett Holt. p. 345. New
York, 1912.
TABLE 19.—DISTRIBUTION OF DEATHS, ACCORDING TO CAUSE OF DEATH AND
QUARTER OF CALENDAR YEAR IN WHICH DEATH OCCURRED.
═══════════════════════════════╤═══════╤═══════════════════════════════
CAUSE OF DEATH. │ All │ QUARTER OF CALENDAR YEAR IN
│deaths.│ WHICH DEATH OCCURRED.
───────────────────────────────┼───────┼───────┬───────┬───────┬───────
│ │First. │Second.│Third. │Fourth.
───────────────────────────────┼───────┼───────┼───────┼───────┼───────
All causes │ 196│ 54│ 29│ 74│ 39
═══════════════════════════════╪═══════╪═══════╪═══════╪═══════╪═══════
Diarrhea and enteritis │ 52│ 3│ 5│ 32│ 12
Respiratory diseases │ 50│ 24│ 8│ 7│ 11
Premature births │ 24│ 7│ 5│ 9│ 3
Congenital debility or │ 19│ 5│ 2│ 8│ 4
malformation │ │ │ │ │
Injuries at birth │ 7│ 5│ 1│ │ 1
Other causes or not reported │ 44│ 10│ 8│ 18│ 8
───────────────────────────────┴───────┴───────┴───────┴───────┴───────
Our figures are too small to admit of broad generalizations or a very
full discussion of infant deaths according to the period of the year.
This excess of infant deaths from diarrhea in the summer months has been
established by statistics in many countries, and the cause of such an
excess has been the subject of much discussion, but as yet there is no
general agreement. Liefmann and Lindemann[24] conclude, however, that in
this field of controversy there are certain facts which are at present
well established, these being the dependence of the high summer
mortality on methods of feeding, on hot weather, and on the living and
social condition of the parents. The last factor mentioned by these
authors, including as it does housing conditions, economic status, and
degree of intelligence, is becoming more and more the subject of study
and investigation. It has been shown that the distinctly harmful effect
of hot weather on the infant is increased when the housing conditions
are bad; in overcrowded homes with bad ventilation the indoor
temperature may be many degrees higher than the outdoor temperature. The
ignorance and carelessness of mothers has also been shown to increase
the bad effect of hot weather. With hygienic care, including cool baths,
much fresh air, and careful feeding, many infants are able to pass
through extremely hot weather without diarrheal disturbances.
Footnote 24:
Liefmann, H., and Lindemann, H., Die Lokalization der
Sauglingsterblichkeit und ihre Beziehungen zur Wohnungsfrage. Med.
Klinik 1912, pp. 8, 1074.
Respiratory diseases were reported as a cause of death with almost as
great frequency as diarrheal diseases. As shown by Table 19, these
deaths occurred principally in the colder months of the first and fourth
quarters of the calendar year.
FEEDING
Food is recognized as of such importance in relation to infant mortality
that studies of this subject frequently resolve themselves into studies
of feeding only. Invariably these demonstrate the truth of the statement
of Dr. G. F. McCleary[25] that “in human milk we have a unique and
wonderful food for which the ingenuity of man may toil in vain to find a
satisfactory substitute.” Many mothers, however, still fail to
appreciate the risk their young babies face in being given any except
the natural infant food, and consequently babies are in large numbers
wholly or partly weaned from the breast in the earliest months of their
lives.
Footnote 25:
Infantile Mortality and Infants’ Milk Depots. London.
Breast feeding is far more general, comparatively, among the poorer
mothers than among the well to do, as shown by the following summary
which gives the number and per cent. of babies of mothers with husbands
earning varying incomes, who had been completely weaned from the breast
when they were 3, 6, or 9 months of age, respectively. For each of the
periods indicated the percentage completely weaned from the breast is
much greater in the groups where earnings are highest.
TABLE 20.—DISTRIBUTION OF BABIES ALIVE AT 3, 6, AND 9 MONTHS OF AGE BY
TYPE OF FEEDING AT EACH OF SAID AGES, ACCORDING TO ANNUAL EARNINGS OF
FATHER AND NATIVITY OF MOTHER.
══════════════╤═════════════════════════════════════════
ANNUAL │
EARNINGS OF │
FATHER AND │ BABIES LIVING AT AGE OF—
NATIVITY OF │
MOTHER. │
──────────────┼────────────────────┬────────────────────
│ 3 months. │ 6 months.
──────────────┼──────┬─────────────┼──────┬─────────────
│ │ Completely │ │ Completely
│Total.│ weaned from │Total.│ weaned from
│ │ breast. │ │ breast.
──────────────┼──────┼───────┬─────┼──────┼───────┬─────
│ │Number.│ Per │ │Number.│ Per
│ │ │cent.│ │ │cent.
──────────────┼──────┼───────┼─────┼──────┼───────┼─────
Total │ 1,355│ 193│ 14.2│ 1,313│ 250│ 19.0
══════════════╪══════╪═══════╪═════╪══════╪═══════╪═════
Under $624 │ 341│ 22│ 6.5│ 322│ 32│ 9.9
$625 to $899│ 358│ 48│ 13.4│ 351│ 63│ 17.9
$900 and │ 629│ 114│ 18.1│ 616│ 146│ 23.7
over[26] │ │ │ │ │ │
Not │ 27│ 9│ 33.3│ 24│ 9│ 37.5
reported[27]│ │ │ │ │ │
│ │ │ │ │ │
Mother │ 765│ 155│ 20.3│ 747│ 195│ 26.1
native │ │ │ │ │ │
──────────────┼──────┼───────┼─────┼──────┼───────┼─────
Under $624 │ 69│ 10│ 14.5│ 66│ 13│ 19.7
$625 to $899 │ 180│ 36│ 20.0│ 177│ 46│ 26.0
$900 and │ 491│ 100│ 20.4│ 482│ 127│ 26.3
over[26] │ │ │ │ │ │
Not │ 25│ 9│ 36.0│ 22│ 9│ 40.9
reported[27]│ │ │ │ │ │
│ │ │ │ │ │
Mother │ 590│ 38│ 6.4│ 566│ 55│ 9.7
foreign │ │ │ │ │ │
──────────────┼──────┼───────┼─────┼──────┼───────┼─────
Under $624 │ 272│ 12│ 4.4│ 256│ 19│ 7.4
$625 to $899 │ 178│ 12│ 6.7│ 174│ 17│ 9.8
$900 and │ 138│ 14│ 10.1│ 134│ 19│ 14.2
over[26] │ │ │ │ │ │
Not │ 2│ │ │ 2│ │
reported[27]│ │ │ │ │ │
──────────────┴──────┴───────┴─────┴──────┴───────┴─────
══════════════╤════════════════════
ANNUAL │
EARNINGS OF │
FATHER AND │BABIES LIVING AT AGE OF—
NATIVITY OF │
MOTHER. │
──────────────┼────────────────────
│ 9 months.
──────────────┼──────┬─────────────
│ │ Completely
│Total.│ weaned from
│ │ breast.
──────────────┼──────┼───────┬─────
│ │Number.│ Per
│ │ │cent.
──────────────┼──────┼───────┼─────
Total │ 1,282│ 358│ 27.5
══════════════╪══════╪═══════╪═════
Under $624 │ 309│ 57│ 18.4
$625 to $899│ 342│ 85│ 24.9
$900 and │ 608│ 201│ 33.1
over[26] │ │ │
Not │ 23│ 10│ 43.3
reported[27]│ │ │
│ │ │
Mother │ 735│ 251│ 34.1
native │ │ │
──────────────┼──────┼───────┼─────
Under $624 │ 65│ 18│ 27.7
$625 to $899 │ 173│ 55│ 31.8
$900 and │ 476│ 168│ 35.3
over[26] │ │ │
Not │ 21│ 10│ 47.6
reported[27]│ │ │
│ │ │
Mother │ 547│ 102│ 18.6
foreign │ │ │
──────────────┼──────┼───────┼─────
Under $624 │ 244│ 39│ 16.0
$625 to $899 │ 169│ 30│ 17.8
$900 and │ 132│ 33│ 25.0
over[26] │ │ │
Not │ 2│ │
reported[27]│ │ │
──────────────┴──────┴───────┴─────
Footnote 26:
Includes those reported as earning “ample.” “Ample,” as used in this
report has a somewhat technical meaning; when information concerning
the father’s earnings was not available and the family showed no
evidences of poverty, the word “ample” was used. When, however, the
family was clearly in a state of abject poverty, it was included in
the group “Under $521.”
Footnote 27:
Unmarried mothers’ babies also included.
Breast feeding, wholly or in part, is continued for a longer period by
foreign than by native mothers, as indicated in the preceding table,
showing that 20.3, 26.1, and 34.1 per cent. of the native mothers’
babies as compared with 6.4, 9.7, and 18.6 per cent. of the foreign
mothers’ babies had been weaned from the breast at the age of 3, 6, and
9 months, respectively.
TABLE 25.—DISTRIBUTION OF ALL BIRTHS, LIVE BIRTHS, AND STILLBIRTHS AND
OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE, ACCORDING TO
SEX OF BABY AND NATIVITY OF MOTHER.
═══════════════════════╤═══════╤═══════╤══════════════╤════════════════
SEX OF BABY AND │ All │ Live │ STILLBIRTHS.│ DEATHS DURING
NATIVITY OF MOTHER. │births.│births.│ │ FIRST YEAR.
───────────────────────┼───────┼───────┼──────┬───────┼──────┬─────────
│ │ │ │ Rate │ │ Infant
│ │ │Total.│ per │Total.│mortality
│ │ │ │ 1,000 │ │ rate.
│ │ │ │births.│ │
───────────────────────┼───────┼───────┼──────┼───────┼──────┼─────────
BABIES OF NATIVE │ │ │ │ │ │
MOTHERS. │ │ │ │ │ │
│ │ │ │ │ │
Total number │ 860│ 815│ 45│ 52.3│ 85│ 104.3
═══════════════════════╪═══════╪═══════╪══════╪═══════╪══════╪═════════
Male: │ │ │ │ │ │
Number │ 433│ 406│ 27│ 62.4│ 46│ 113.3
Per cent. │ 50.3│ 49.8│ 60.0│ │ 54.1│
Female: │ │ │ │ │ │
Number │ 427│ 409│ 18│ 42.2│ 39│ 95.4
Per cent. │ 49.7│ 50.2│ 40.0│ │ 45.9│
│ │ │ │ │ │
BABIES OF FOREIGN │ │ │ │ │ │
MOTHERS. │ │ │ │ │ │
│ │ │ │ │ │
Total number │ 691│ 648│ 43│ 62.2│ 111│ 171.3
═══════════════════════╪═══════╪═══════╪══════╪═══════╪══════╪═════════
Male: │ │ │ │ │ │
Number │ 380│ 355│ 25│ 65.8│ 59│ 166.2
Per cent. │ 55.0│ 54.8│ 58.1│ │ 53.2│
Female: │ │ │ │ │ │
Number │ 311│ 293│ 18│ 57.9│ 52│ 177.5
Per cent. │ 45.0│ 45.2│ 41.9│ │ 46.8│
───────────────────────┴───────┴───────┴──────┴───────┴──────┴─────────
MOTHER’S HOUSEHOLD DUTIES, CESSATION AND RESUMPTION OF
The extent to which the native and foreign mothers in Johnstown
relinquished a part of their household duties as the time for their
confinement approached is shown below:
TABLE 26.—DISTRIBUTION OF BIRTHS ACCORDING TO TIME OF THE MOTHER’S
RELINQUISHMENT OF PART OF HOUSEHOLD DUTIES BEFORE CONFINEMENT, BY
NATIVITY OF MOTHER.
════════════════════════════════════════════╤════════╤════════╤════════
TIME OF RELINQUISHMENT OF PART OF HOUSEHOLD │ All │ To │ To
DUTIES BEFORE CONFINEMENT. │births. │ native │foreign
│ │mothers.│mothers.
────────────────────────────────────────────┼────────┼────────┼────────
All mothers │ 1,551│ 860│ 691
════════════════════════════════════════════╪════════╪════════╪════════
No household duties relinquished to day of │ 1,350│ 695│ 655
confinement │ │ │
Part of duties relinquished: │ │ │
Less than 7 days before confinement │ 3│ 1│ 2
7 to 13 days before confinement │ 7│ 5│ 2
2 weeks to 1 month before confinement │ 16│ 12│ 4
1 month or more before confinement │ 174│ 146│ 28
Had no household duties │ 1│ 1│
────────────────────────────────────────────┴────────┴────────┴────────
Among the 174 babies of mothers who relinquished part of their household
duties a month before confinement, the infant mortality rate was 112.5,
as compared with 136.7 for those of other mothers.
TABLE 27.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND
INFANT MORTALITY RATE, ACCORDING TO TIME OF RELINQUISHMENT OF PART OF
HOUSEHOLD DUTIES OF MOTHER BEFORE CONFINEMENT.
══════════════════════════════════╤════════╤════════╤════════╤═════════
TIME OF RELINQUISHMENT OF PART OF │ │ │ Deaths │ Infant
HOUSEHOLD DUTIES BEFORE │ All │ Live │ during │mortality
CONFINEMENT. │births. │births. │ first │ rate.
│ │ │ year. │
──────────────────────────────────┼────────┼────────┼────────┼─────────
All mothers │ 1,551│ 1,463│ 196│ 134.0
══════════════════════════════════╪════════╪════════╪════════╪═════════
No cessation or less than 1 month │ 1,376│ 1,302│ 178│ 136.7
1 month or more │ 171│ 160│ 18│ 112.5
No housework │ 1│ 1│ │
──────────────────────────────────┴────────┴────────┴────────┴─────────
To what extent the relinquishment of household duties at a given time
directly affected the health of the child can not be definitely shown. A
relation may exist, but on the other hand the difference in the
mortality rate may be due to the fact that the mothers could afford to
give consideration to their condition and escape some of their heaviest
tasks as their pregnancy approached its end, and were members of
families who were thoughtful of them and relieved them of these tasks or
employed extra household assistance at such times.
Another indication of intelligence and of comfortable surroundings is
the care given a mother in the early days of her baby’s life,
particularly if she is a nursing mother. The duration of her rest period
before the resumption of part of her household duties is one measure of
this. The foreign mothers, with less education, more numerous and
arduous tasks, less opportunity for leisure, and smaller incomes, begin
to resume their housework sooner than the native mothers with young
babies.
TABLE 28.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING PART OF
HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER.
═══════════════════════════╤══════════════════════════╤════════════════
TIME OF RESUMING PART OF │ │ DEATHS DURING
HOUSEHOLD DUTIES AFTER │ LIVE BIRTHS TO— │ FIRST YEAR.
CONFINEMENT. │ │
───────────────────────────┼────────┬────────┬────────┼──────┬─────────
│ All │ Native │Foreign │ │ Infant
│mothers.│mothers.│mothers.│Total.│mortality
│ │ │ │ │ rate.
───────────────────────────┼────────┼────────┼────────┼──────┼─────────
Total │ 1,463│ 815│ 648│ 196│ 134.0
═══════════════════════════╪════════╪════════╪════════╪══════╪═════════
8 days or less │ 467│ 44│ 423│ 79│ 169.2
9 to 13 days │ 560│ 446│ 114│ 70│ 125.0
14 days or more │ 427│ 318│ 109│ 41│ 96.0
Mother died or not reported│ 9│ 7│ 2│ 6│ ([28])
───────────────────────────┴────────┴────────┴────────┴──────┴─────────
Footnote 28:
Total number of live births less than 50; base therefore considered
too small to use in computing an infant mortality rate.
The fact that a mother takes up her housework in the early days of her
baby’s life does not necessarily increase the danger of its death. In
some cases, however, mothers stated that the quantity of their breast
milk was noticeably impaired when they got up and resumed their work too
soon. Naturally this would affect the baby’s nutrition. In other cases a
mother’s cares and duties may be so absorbing that she can not give the
baby full attention. Whatever the exact explanation, attention should be
called to the greater frequency of infant deaths when the mother resumed
household duties very soon after childbirth.
A statement of the time of the mother’s resumption of household duties
in full, like that giving the time of resumption in part, shows that the
native mothers have the longer period of rest.
TABLE 29.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY RATE, ACCORDING TO TIME OF MOTHER RESUMING ALL
HOUSEHOLD DUTIES AFTER CONFINEMENT, BY NATIVITY OF MOTHER.
═══════════════════════════╤══════════════════════════╤════════════════
TIME OF RESUMING ALL │ │ DEATHS DURING
HOUSEHOLD DUTIES AFTER │ LIVE BIRTHS TO— │ FIRST YEAR.
CONFINEMENT. │ │
───────────────────────────┼────────┬────────┬────────┼──────┬─────────
│ All │ Native │Foreign │ │ Infant
│mothers.│mothers.│mothers.│Total.│mortality
│ │ │ │ │ rate.
───────────────────────────┼────────┼────────┼────────┼──────┼─────────
Total │ 1,463│ 815│ 648│ 196│ 134.0
═══════════════════════════╪════════╪════════╪════════╪══════╪═════════
8 days or less │ 219│ 13│ 206│ 37│ 168.9
9 to 13 days │ 182│ 132│ 50│ 30│ 164.8
14 days or more │ 1,053│ 663│ 390│ 123│ 116.8
Mother died or not reported│ 9│ 7│ 2│ 6│ ([29])
───────────────────────────┴────────┴────────┴────────┴──────┴─────────
Footnote 29:
Total live births less than 50; base therefore considered too small to
use in computing an infant mortality rate.
The infant mortality rates for all mothers in the group just referred
to, according to the time of resuming housework in full after
childbirth, show fewer infant deaths proportionately when the mother has
had a longer rest; that is, a rest of two weeks or more.
ECONOMIC FACTORS
EARNINGS OF FATHER
A grouping of babies according to the income of the father shows the
greatest incidence of infant deaths where wages are lowest, and the
smallest incidence where they are highest, indicating clearly the
relation between low wages and ill health and infant deaths.
For all live babies born in wedlock the infant mortality rate is 130.7.
It rises to 255.7 when the father earns less than $521 a year or less
than $10 a week, and falls to 84 when he earns $1,200 or more or if his
earnings are “ample.”[30] The variation in the infant mortality rate
from one earnings group to another is not perfectly regular and
consistent, but if any two or more consecutive groups are combined an
invariable lowering of the infant mortality rate from one such combined
group to that next higher results.
Footnote 30:
“Ample” as used in this report has a somewhat arbitrary meaning. When
information concerning the father’s earnings was not available and the
family showed no evidences of actual poverty, the word “ample” was
used. If no information concerning earnings was available when, on the
other hand, the family was clearly in a state of abject poverty, then
the income was tabulated as “Under $521.”
TABLE 30.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY RATE, ACCORDING TO ANNUAL EARNINGS OF FATHER AND
NATIVITY OF MOTHER, FOR LEGITIMATE LIVE-BORN BABIES.
═════════════════════════════════════════╤═════════╤═════════╤═════════
│ Total │ Deaths │ Infant
ANNUAL EARNINGS OF FATHER ACCORDING TO │ live │ during │mortality
NATIVITY OF WIFE. │ births. │ first │ rate.
│ │ year. │
─────────────────────────────────────────┼─────────┼─────────┼─────────
Total │ 1,431│ 187│ 130.7
═════════════════════════════════════════╪═════════╪═════════╪═════════
Under $625 │ 384│ 82│ 213.5
─────────────────────────────────────────┼─────────┼─────────┼─────────
Under $521 │ 219│ 56│ 255.7
$521 to $624 │ 165│ 26│ 157.6
│ │ │
$625 to $899 │ 385│ 47│ 122.1
─────────────────────────────────────────┼─────────┼─────────┼─────────
$625 to $779 │ 224│ 24│ 107.1
$780 to $899 │ 161│ 23│ 142.9
│ │ │
$900 or more │ 186│ 18│ 96.8
─────────────────────────────────────────┼─────────┼─────────┼─────────
$900 to $1,199 │ 138│ 14│ 101.4
$1,200 or more │ 48│ 4│ 83.3
│ │ │
Ample[1] │ 476│ 40│ 84.0
│ │ │
Husbands with native wives │ 785│ 76│ 96.8
═════════════════════════════════════════╪═════════╪═════════╪═════════
Under $625 │ 80│ 16│ 200.0
─────────────────────────────────────────┼─────────┼─────────┼─────────
Under $521 │ 32│ 9│ ([31])
$521 to $624 │ 48│ 7│ 145.8
│ │ │
$625 to $899 │ 193│ 20│ 103.6
─────────────────────────────────────────┼─────────┼─────────┼─────────
$625 to $779 │ 86│ 6│ 69.8
$780 to $899 │ 107│ 14│ 130.8
│ │ │
$900 or more │ 129│ 10│ 77.5
─────────────────────────────────────────┼─────────┼─────────┼─────────
$900 to $1,199 │ 92│ 7│ 76.1
$1,200 of more │ 37│ 3│ ([31])
│ │ │
Ample[1] │ 383│ 30│ 78.3
│ │ │
Husbands with foreign wives │ 646│ 111│ 171.8
═════════════════════════════════════════╪═════════╪═════════╪═════════
Under $625 │ 304│ 66│ 217.1
─────────────────────────────────────────┼─────────┼─────────┼─────────
Under $521 │ 187│ 47│ 251.3
$521 to $624 │ 117│ 19│ 162.4
│ │ │
$625 to $899 │ 192│ 27│ 140.6
─────────────────────────────────────────┼─────────┼─────────┼─────────
$625 to $779 │ 138│ 18│ 130.4
$780 to $899 │ 54│ 9│ 166.7
│ │ │
$900 or more │ 57│ 8│ 140.6
─────────────────────────────────────────┼─────────┼─────────┼─────────
$900 to $1,199 │ 46│ 7│ 152.2
$1,200 or more │ 11│ 1│ ([31])
│ │ │
Ample[32] │ 93│ 10│ 107.5
─────────────────────────────────────────┴─────────┴─────────┴─────────
Footnote 31:
Total live births less than 50; base therefore considered too small to
use in computing an infant mortality rate.
Footnote 32:
See note on page 45.
In considering the babies of native and of foreign mothers separately in
the foregoing table, similar variations in mortality rates according to
earnings of father are found, although the foreign infant death rate is
higher in each group. The foreign are less numerous both actually and
relatively in the higher wage groups.
The foreigners of a given wage group almost always live in a poorer
neighborhood than the natives earning the same amount. The foreigners go
where they find their own countrymen, most of whom are poor, and hence
even those who earn a fair wage find themselves, until they become
Americanized, surrounded by poor conditions and an ignorant class of
people.
It is of interest to note what per cent. of the native and what per
cent. of the foreign are in the several earnings groups. The next table
shows this for all married mothers and not simply for those of live-born
babies as in the foregoing table.
TABLE 31.—NUMBER AND PER CENT OF MOTHERS BY NATIVITY, ACCORDING TO THE
ANNUAL EARNINGS OF HUSBAND.
═════════════════╤═════════════════╤═════════════════╤═════════════════
ANNUAL EARNING OF│ ALL MOTHERS. │ NATIVE MOTHERS. │FOREIGN MOTHERS.
HUSBAND. │ │ │
─────────────────┼────────┬────────┼────────┬────────┼────────┬────────
│Number. │ Per │Number. │ Per │Number. │ Per
│ │ cent. │ │ cent. │ │ cent.
─────────────────┼────────┼────────┼────────┼────────┼────────┼────────
Total │ 1,491│ 100.0│ 816│ 100.0│ 675│ 100.0
═════════════════╪════════╪════════╪════════╪════════╪════════╪════════
Under $521 │ 233│ 15.6│ 36│ 4.4│ 197│ 29.2
$521 to $624 │ 174│ 11.7│ 50│ 6.1│ 124│ 18.4
$625 to $779 │ 229│ 15.4│ 86│ 10.5│ 143│ 21.2
$780 to $899 │ 166│ 11.1│ 108│ 13.2│ 58│ 8.6
$900 to $1,199 │ 146│ 9.8│ 98│ 12.0│ 48│ 7.1
$1,200 and over │ 50│ 3.4│ 39│ 4.8│ 11│ 1.6
Ample[33] │ 493│ 33.1│ 399│ 48.9│ 94│ 13.9
─────────────────┴────────┴────────┴────────┴────────┴────────┴────────
Footnote 33:
See note on page 45.
The 1,491 married mothers included in the foregoing table bore 1,517
babies in 1911, the excess being due to plural births. The 33 unmarried
mothers and their 34 babies (one mother had twins), although included in
some of the general tables, are not included in those relative to the
earnings of the husband.
GAINFUL WORK OF MOTHER
In localities where large numbers of women are engaged in industrial
work, comparisons are frequently made of the death rates among their
babies with those of the babies of mothers not so engaged. In Johnstown,
however, industrial occupations are not open to women, and but 3.1 per
cent. of the mothers visited went outside their homes to earn money. All
mothers who gained money by keeping lodgers or in any other way are, for
convenience, designated “wage-earning” mothers, even though their
earnings were not in the form of a definite wage at stated periods.
Although not industrially engaged, nearly one-fifth of the mothers did
resort to some means of supplementing the earnings of their husbands.
Usually they kept lodgers. This was done by the foreign mothers
principally, exactly one-third of whom had lodgers, as compared with
less than 1 per cent. of the native women. Usually work done outside the
home consisted either of char work or of assisting husbands in their
stores. Generally these stores were in the same building with the home.
When a mother of a young baby does not give her full time to her duties
within the home but resorts to means of earning money, it generally
indicates poverty. This is true to a greater degree in Johnstown than in
places which have many inducements for women to work. In Johnstown, with
its excess of males, especially in the foreign population, the woman’s
services are particularly needed to make the home.
In the group where the husband earns $10 a week or less—that is, under
$521 a year—many of the women are wage earners. In each group showing
better earnings for the husband the number and percentage of
wage-earning wives decline. Such a tabulation as the following almost
automatically fixes the minimum wage on which a man, wife, and a child
or two can live with any degree of comfort in Johnstown at about $780 a
year. When the husband’s wage is less than $780 a year, it is shown that
the wives, in considerable number, must be wage earners. As shown in the
next table, in nearly half of the families where the husband earns $10 a
week or less (less than $521 a year), the wife resorted to some means of
earning money; when he earned as much as $900 a year, only 8.9 per cent.
of the wives worked, and in the small group where the man earns as much
as $1,200 a year, only 1 in 50.
TABLE 32.—NUMBER AND PER CENT OF HUSBANDS WITH WAGE-EARNING WIVES, BY
NATIVITY OF WIFE AND ANNUAL EARNINGS OF HUSBAND.
═══════════════╤══════════════════════════╤══════════════════════════
│ TOTAL HUSBANDS. │ HUSBANDS HAVING NATIVE
│ │ WIVES.
───────────────┼────────┬─────────────────┼────────┬─────────────────
ANNUAL EARNINGS│ │ Husbands with │ │ Husbands with
OF HUSBAND. │Number. │ wage-earning │Number. │ wage-earning
│ │ wives. │ │ wives.
───────────────┼────────┼────────┬────────┼────────┼────────┬────────
│ │Number. │ Per │ │Number. │ Per
│ │ │ cent. │ │ │ cent.
───────────────┼────────┼────────┼────────┼────────┼────────┼────────
Total │ 1,491│ 278│ 18.6│ 816│ 26│ 3.2
═══════════════╪════════╪════════╪════════╪════════╪════════╪════════
Under $521 │ 233│ 111│ 47.6│ 36│ 9│ 25.0
$521 to $624 │ 174│ 57│ 32.8│ 50│ 3│ 6.0
$625 to $779 │ 229│ 51│ 22.3│ 86│ 4│ 4.7
$780 to $899 │ 166│ 25│ 15.1│ 108│ 6│ 5.6
$900 to $1,199 │ 146│ 13│ 8.9│ 98│ 1│ 1.0
$1,200 and over│ 50│ 1│ 2.0│ 39│ │
“Ample”[34] │ 493│ 20│ 4.1│ 399│ 3│ .8
───────────────┴────────┴────────┴────────┴────────┴────────┴────────
═══════════════╤══════════════════════════
│ HUSBANDS HAVING FOREIGN
│ WIVES.
───────────────┼────────┬─────────────────
ANNUAL EARNINGS│ │ Husbands with
OF HUSBAND. │Number. │ wage-earning
│ │ wives.
───────────────┼────────┼────────┬────────
│ │Number. │ Per
│ │ │ cent.
───────────────┼────────┼────────┼────────
Total │ 675│ 252│ 37.3
═══════════════╪════════╪════════╪════════
Under $521 │ 197│ 102│ 51.8
$521 to $624 │ 124│ 54│ 43.5
$625 to $779 │ 143│ 47│ 32.9
$780 to $899 │ 58│ 19│ 32.8
$900 to $1,199 │ 48│ 12│ 25.0
$1,200 and over│ 11│ 1│ 9.1
“Ample”[34] │ 94│ 17│ 18.1
───────────────┴────────┴────────┴────────
Footnote 34:
See note on page 45.
It is impossible to judge from statistics alone whether or not the work
done by an individual woman, either her own housework or work for money,
is so excessive as to affect her during pregnancy or while nursing to
the extent of reacting on the health of the baby; but the fact is that
the infant mortality rate is higher among the babies of wage-earning
mothers than among others, being 188 as compared with a rate of 117.6
among the babies of nonwage-earning mothers. Wage-earning mothers and
low-wage fathers are in practically the same groups, and it is difficult
to secure an exact measurement of the comparative weight of the two
factors in the production of a high infant mortality rate.
TABLE 33.—DISTRIBUTION OF LIVE BIRTHS AND OF DEATHS DURING FIRST YEAR,
AND INFANT MORTALITY RATE FOR BABIES OF WAGE-EARNING AND
NONWAGE-EARNING MOTHERS, ACCORDING TO ANNUAL EARNINGS OF FATHER.
═════════════════╤═════════════════╤═════════════════╤═════════════════
ANNUAL EARNINGS │ MOTHER A WAGE │MOTHER NOT A WAGE│INFANT MORTALITY
OF FATHER. │ EARNER. │ EARNER. │ RATE.
─────────────────┼────────┬────────┼────────┬────────┼────────┬────────
│ │ Number │ │ Number │ │ Mother
│ Live │ of │ Live │ of │Mother a│ not a
│births. │ deaths │births. │ deaths │ wage │ wage
│ │in first│ │in first│earner. │earner.
│ │ year. │ │ year. │ │
─────────────────┼────────┼────────┼────────┼────────┼────────┼────────
Total │ 266│ 50│ 1,165│ 137│ 188.0│ 117.6
═════════════════╪════════╪════════╪════════╪════════╪════════╪════════
Under $521 │ 105│ 26│ 114│ 30│ 247.6│ 263.2
$521 to $624 │ 53│ 8│ 112│ 18│ 150.9│ 160.7
$625 to $779 │ 48│ 6│ 176│ 18│ 127.1│ 102.3
$780 or over, or │ 60│ 10│ 763│ 71│ 166.7│ 93.1
“ample”[35] │ │ │ │ │ │
─────────────────┴────────┴────────┴────────┴────────┴────────┴────────
Footnote 35:
See note on page 45.
ILLEGITIMACY
Of the 1,551 birth included in this investigation 34, or 2.2 per cent.,
occurred out of wedlock. Nine of the 32 illegitimate babies who were
born alive died during their first year. It is recognized that these
figures are a very small base from which to draw conclusions concerning
the effect of illegitimacy on the infant mortality rate. It is of
interest, nevertheless, to note that the findings for this small group
are similar to those of countries which compute an infant mortality rate
for legitimate and illegitimate children separately, that is, a rate for
illegitimates more than twice as high as for children born in wedlock.
TABLE 34.—DISTRIBUTION OF BIRTHS AND OF DEATHS DURING FIRST YEAR, AND
INFANT MORTALITY RATE, ACCORDING TO LEGITIMACY.
════════════════════════╤═════════╤═════════╤══════════════════════════
LEGITIMACY. │ Total │ Live │DEATHS DURING FIRST YEAR.
│ births. │ births. │
────────────────────────┼─────────┼─────────┼─────────┬────────────────
│ │ │ Number. │Infant mortality
│ │ │ │ rates.
────────────────────────┼─────────┼─────────┼─────────┼────────────────
Illegitimate │ 34│ 32│ 9│ 281.3
Legitimate │ 1,517│ 1,431│ 187│ 130.7
────────────────────────┴─────────┴─────────┴─────────┴────────────────
Thirty-two, or 3.7 per cent., of the 860 native mothers, as compared
with 2, or 0.3 per cent., of the 691 foreign mothers visited, had
illegitimate children in 1911.
REPRODUCTIVE HISTORIES
In addition to the data relating exclusively to babies born in 1911, a
statement was secured from each mother as to the number and duration of
each of her pregnancies and the result thereof; that is, the number of
children she had borne, alive or dead, the number of miscarriages she
had had, and the age at death of each live-born child who had died.
Although this information was secured for all mothers, tabulations are
presented of the data furnished by married mothers only. Comparatively
few single mothers reported more than one child, and information from
them on this point is not believed to be as reliable as that from
married mothers.