Chapter IV: Infant Mortality (2)

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.

The 1,491 married mothers of babies born in 1911 had had an aggregate of 5,554 pregnancies, resulting in 5,617 births, the excess of 63 births over pregnancies being due to plural births. Eight hundred and four of these children died under 1 year of age, making an infant mortality rate of 149.9 for all their babies, as compared with the rate of 134 for those born in 1911. The stillbirths of these women numbered 194, or 4.5 per cent. of the total number of births; miscarriages reported numbered 191, but these were not added to the total reportable[36] pregnancies.

Footnote 36:

“Reportable” pregnancies are those terminating either in the birth of
a live child or of a dead child when the period of gestation exceeds
28 weeks; that is, when its registration or report is required by law.

Details as to the infant mortality rates for all babies born to native and foreign mothers included in this study, not only in the year 1911 but at any other time, are presented in the next table, which classifies the babies according to the total number of reportable pregnancies that their mothers had had, to and including the pregnancy resulting in the 1911 birth.

TABLE 35.—DISTRIBUTION OF MOTHERS, OF LIVE BIRTHS, AND OF DEATHS DURING FIRST YEAR, AND INFANT MORTALITY RATE FOR BABIES OF NATIVE AND FOREIGN MARRIED MOTHERS, ACCORDING TO THE NUMBER OF REPORTABLE PREGNANCIES.

═════════════════╤════════╤═════════════════╤══════════════════════════ REPORTABLE │ Number │ │ PREGNANCIES FOR │ of │NUMBER OF BABIES.│ INFANT MORTALITY RATE MARRIED MOTHERS. │married │ │ AMONG BABIES OF— │mothers.│ │ ─────────────────┼────────┼────────┬────────┼────────┬────────┬──────── │ │ Born │Died in │ All │ Native │Foreign │ │ alive. │ first │mothers.│mothers.│mothers. │ │ │ year. │ │ │ ─────────────────┼────────┼────────┼────────┼────────┼────────┼──────── Total │ 1,491│ 5,363│ 804│ 149.9│ 113.1│ 184.6 ═════════════════╪════════╪════════╪════════╪════════╪════════╪════════ 1 │ 339│ 322│ 35│ 108.7│ 75.9│ 183.7 2 │ 283│ 544│ 59│ 108.5│ 76.5│ 156.7 3 │ 214│ 626│ 92│ 147.0│ 118.0│ 177.6 4 │ 186│ 723│ 78│ 107.9│ 99.4│ 116.3 5 │ 147│ 704│ 103│ 146.3│ 86.1│ 191.5 6 │ 94│ 546│ 88│ 161.2│ 157.4│ 163.6 7 │ 83│ 555│ 78│ 140.5│ 100.0│ 173.8 8 │ 54│ 426│ 95│ 223.0│ 157.6│ 272.7 9 │ 33│ 283│ 41│ 144.9│ 128.4│ 155.2 10 or more │ 58│ 634│ 135│ 212.9│ 164.5│ 257.6 ─────────────────┴────────┴────────┴────────┴────────┴────────┴────────

The statistics, based upon 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. This is more clearly shown when the pregnancies are grouped as in the next table.

TABLE 36.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED
MOTHERS, ACCORDING TO SPECIFIED NUMBER OF REPORTABLE PREGNANCIES.

════════════════════════════════════════════════╤══════════════════════ REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. │Infant mortality rate. ────────────────────────────────────────────────┼────────────────────── Total │ 149.9 ════════════════════════════════════════════════╪══════════════════════ 1 and 2 │ 108.5 3 and 4 │ 126.0 5 and 6 │ 152.8 7 and 8 │ 176.4 9 or more │ 191.9 ────────────────────────────────────────────────┴──────────────────────

This tendency is shown in still another form of summary: Combinations of four or less pregnancies are, for convenience, considered as group 1, while the combinations of over four are designated group 2. The differences in rates in the two groups are notable. The infant mortality rate is much lower for the first than for the second group.

TABLE 37.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED
MOTHERS, ACCORDING TO SPECIFIED NUMBER OF REPORTABLE PREGNANCIES, BY
GROUPS

════════════════════════════════════════════════╤══════════════════════ REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. │Infant mortality rate. ────────────────────────────────────────────────┼────────────────────── │ GROUP 1. │ │ 2 or less │ 108.5 3 or less │ 124.7 4 or less │ 119.2 │ GROUP 2. │ │ Over 4 │ 171.5 Over 5 │ 178.8 Over 6 │ 183.9 ────────────────────────────────────────────────┴──────────────────────

This influence of the size of the family upon the infant mortality rate is shown in the computations giving the relative infant mortality rate for the different children borne by married mothers. The rate is most favorable for the second-born child, being 131.2. Among first born it is 143.6; for tenth or later born children 252.3.

TABLE 38.—INFANT MORTALITY RATE FOR ALL CHILDREN BORNE BY MARRIED
MOTHERS, ACCORDING TO THE ORDER IN WHICH THE CHILD WAS BORN