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U. S. D EPARTM EN T O F LA B O R CHILDREN’S BUREAU JULIA C. LATHROP. Chief INFANT MORTALITY RESULTS OF A FIELD STUDY IN JOHNSTOWN, PA., BASED ON BIRTHS IN ONE CALENDAR YEAR EMMA DUKE I N F A N T M O R T A L I T Y S E R IE S N o . 3 Bureau Publication N o . 9 W ASHINGTON GOVERNMENT PRINTING OFFICE 1915 ifca-1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis ADDITIONAL COPIES OF THIS PUBLICATION MAY BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 20 CENTS PER COPY V 3 C?^ *"f ft * CONTENTS. Page. Letter of transmittal................................................................. ...................................... 5-9 Introduction........................................................................... 11-14 Relation of infant mortality to environment............................................................. 14-26 Neighborhood incidence...... ................................ 14-20 Sanitary conditions—sewerage, pavements, and garbage collection s........... 20, 21 Housing.......................................................................................................... 21-26 Nationality...................................................................................................... 27-31 General nativity..................................................................... 27,28 Serbo-Croatian.................................................................................. ..................... '. 28, 29 Italian......................................................................................................................... 29, 30 Slovak, Polish, e tc ................................................................................................... 30 Other nationalities............ ........... .......................................................................... 30, 31 Stillbirths........................................................................................................................... 31 Attendant at birth ............................. 32-34 Mothers................................................................................................................. 34-36 Literacy...................................................................................................................... 34 A bility to speak English.............................................................................. 34 Years in the United States..................................................................................... 35 Age......................................................................................... 35,36 Baby’ s age at death and cause (disease) of death................ 36-38 Feeding................................................ 38-42 Sex........................................................................ ....... ......................................................42,43 Mother’s household duties; cessationand resumption o f.......................................... 43-45 Economic factors.............................................................................................................. 45-49 Earnings of father...................................... .............................................................45-47 Gainful work of mother........................................................................................... 47-49 Illegitim acy........................................ 49 Reproductive histories.................................................................................................... 50-53 G E N E R A L TABLES. Table I.— Distribution of births according to nationality of mother, b y section of city and ward............................................................................................................ Table II.— Distribution of births, live births, stillbirths, and deaths in first year, according to nativity of mother, b y section of city and ward.................... Table I I I .— Distribution of births to native and foreign married mothers and number and per cent of births in each group to those gainfully employed, b y section of city .......................................................................................................... Table IV .— Distribution of births to married mothers, according to attendant at birth and to nativity of mother,b y section of city and ward.......................... Table V .— Distribution of live births and of deaths during first year, according to number of persons and number of rooms per family .......................................... Table V I.—Distribution of births, live births, stillbirths, and of deaths during first year, according to nationality (detailed) of mother....................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 57 58 59 60 61 62 CONTENTS. 4 Page. Table V II.—Distribution of births, live births, stillbirths, and of deaths during first year, according to attendant at ba by’s birth and nationality of m other.. 63 Table V III .—Distribution of deaths of infants at specified age, according to cause of death of infant and nativity of mother..................................................... 64 Table I X .— Distribution of babies alive at beginning of each month from first to ninth, according to type of feeding during each month; number continu ing such diet until following month; number changing to other specified type of feeding; number of deaths in each group in first year and also deaths at beginning of next month........................................................................................ 65, 66 Table X .— Distribution of births to married wage-earning mothers, according to husband’s annual earnings and nativity and earnings of mother........ ......... 67 Table X I .—Distribution of results of reportable pregnancies (live births and stillbirths) and miscarriages, according to number per mother and nativity of mother.............................................................................................................- ......... 68, 69 Table X I I .—Distribution of results of reportable pregnancies (live births and stillbirths) and miscarriages, according to number per mother and age of mother at each pregnancy................................................. - ...................................... 70, 71 Table X I I I .— Distribution of results of reportable pregnancies (live births and stillbirths) and miscarriages, according to number per mother and husband’s 72-75 earnings................... Table X IV .— Distribution according to number of pregnancies and age groups of married mothers classified b y nativity............................................................. 76 Table X V .— Distribution of married mothers by losses sustained, according to nativity of mother and number of possible losses................................................. 77 A PPE N D IXE S. Appendix I.— Statements of m others........................................................................ 81-85 Appendix II.— Detailed description of method used for computing infant mortality rate for this report and comparison with conventional m ethod----- 86-88 Appendix I I I .—The milk supply............................. 89-93 ILLU STRATION S. Plates A to R https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Follow page 93 LETTER OF TRANSMITTAL. U. S. D epartm ent of L abor, C h il d r e n ’ s B u r e a u , Washington, August 24, 1914S i r : I transmit herewith a statement of the first study in the field inquiry contemplated by the Children’s Bureau into the sub ject of infant mortality in the United States. This study was made in Johnstown, Pa., during the first year of the bureau’s existence, and is submitted as the first item in a proposed series of studies into infant mortality to be made in a number of typical communities throughout the country. The city of Johnstown was selected because of its interest as a type of town in which there are no large factories employing women and because its size and its good birth registration permitted a study by the staff which the bureau could at first assign to this work. The subject of infant mortality was chosen, first, because of its obvious importance as recognized by the fact that it is the first subject mentioned in the law creating the bureau; second, because of its fundamental value to further work of the bureau; and third, because it was practicable to make a single study, complete in itself, which would yet form part of an integral whole as it became possible to extend the field inquiry. The restricted and tentative character of this first study is recognized. Its results will be constantly compared and collated with those of following similar studies in other communities. Doubt less the method of the general field inquiry may be modified from time to time, but the essential basal material of the schedules will be comparable throughout. Infant mortality is a subject of profound social importance. The modern view has ceased to’ be fatalistic; infant mortality is now regarded as a preventable waste, injurious to survivors as well as destructive to infants, and cruelly increasing the burden of rearing a family. Sir Arthur Newsholme, the great English authority, has said,. “ Infant mortality is the most sensitive index we possess of social welfare and of sanitary administration, especially under urban conditions.” Nationally, the United States has as yet no means of measuring the extent and significance of its infant mortality. If it were practicable, it would be illuminating to visit each one of the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 5 6 LE TTE R OF T R A N S M IT T A L . 2,500,000 children who, it is estimated, are born in this country yearly, and to take note of the varying social and economic condi tions under which some 300,000 of them die and the others survive. As this is manifestly impossible, the nearest approach is to consider certain communities typical of the whole, and it is believed that in the course of a few years’ study such data can be presented as will give the United States a fairly adequate measure of the conditions under which American-born infants survive or perish, and of the possibilities of modifying those conditions by local action. Brilliant work for infant welfare has been done in many localities, notably by the public-health authorities and volunteer organizations of the larger cities, and incidental thereto much information regard ing infant mortality has been gathered; but in the greater part of the country, especially in the smaller cities and rural communities, it is as yet hardly recognized that the problems which confront the crowded quarters of the great cities may also exist in less congested areas. In accordance with the plans for a general inquiry into infant mortality, Mr. Ethelbert Stewart, the first statistical expert of the Children’s Bureau, directed the preparation of the schedule and the field work at Johnstown. This study considers all the babies born in Johnstown within a single calendar year. Since the work was begun in January, 1913, it was necessary to select the year 1911 as the latest in which all babies born could have attained a full year of life. Mr. Stewart preceded the agents by a visit to Johnstown in which he explained the purposes of the inquiry, and the courtesy with which the agents were received by the general public—the press, the clergy, civic and volunteer organizations, and especially by the mothers themselves—was a valuable factor in making the inquiry successful. Above all, the bureau wishes to express its obligation to the mothers of Johnstown, without whose generous understanding and help the inquiry could not have been conducted. Their good will is evidenced by the fact that, out of 1,553 mothers visited, only two refused information. The readiness with which the information was given undoubtedly depended upon the appeal to the mothers to cooperate with the Government in the effort to learn how to save babies’ lives and to the fact that the agents could show that the information given was not to be used in any personal way. The schedules were taken by Miss Emma Duke, Miss Sophia Vogt, and Miss Emily Miladofsky, special agents of the bureau, while the preliminary work of transferring to the schedules the information contained on the State records of birth was done by Mr. A. V. Par- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis LE TTE R OF T R A N S M IT T A L . 7 sons, special agent of the bureau, who also took the photographs reproduced. Just as the work of filling out the schedules was being completed in Johnstown, Mr. Stewart was transferred to the Bureau of Labor Statistics, and his loss, together with other bureau exigencies, delayed the completion of the report. Miss Emma Duke has written the text and she has had the assistance of Miss Sophia Yogt and Miss Ella A. Merritt in making the tabulations. Mr. Lewis Meriam, Assistant Chief of the Children’s Bureau, was interested in the inquiry from the start, and on Mr. Stewart’s transfer was placed in charge of the statistics. The bureau wishes to acknowledge its indebtedness to all those who have aided in the preparation of this study by preliminary advice and by criticism of the schedule or manuscript. The method of the inquiry is in one respect unique, so far as we are aware. Instead of taking as its point of departure the death records of children who have not survived their first year, the birth records are first secured for all children born within a certain calendar year, and each child is then traced through the first 12 months of life, or as much of that period as he survives, in order to obtain information as to the conditions which surround all the children of the town born during the given year. It is evident that this inquiry can be carried on effectively only in communities which have birth registration, and its extension to include typical units throughout the country must depend largely upon the further extension of birth registration. The law creating the bureau provided for no medical officer upon the staff, and the inquiry was necessarily restricted to a consideration of family, social, industrial, and civic factors. The original material of the schedule was secured through personal interviews between individual mothers and the women agents. As the text shows, cer tain facts regarding the civic surroundings of the families were secured in addition to the interviews, but the chief value of the inquiry lies in the information afforded by the mothers. It is plain, however, that a study thus limited must omit certain important con siderations. It is not fair nor practicable to enter a home and ask questions regarding conditions which, if they exist, are considered personally humiliating. Hence it was necessary to omit questions bearing on matters of personal character or behavior, and therefore to omit all consideration of two recognized factors in infant mor tality— alcoholism and venereal disease. It is anticipated that the bureau will be in a position later to consider these and other factors, notably those connected with the employment of mothers and with industrial diseases, by methods independent of family inquiry. The emphasis of the inquiry, as shown throughout the text, was upon certain of the more obvious economic, social, and civic factors which have surrounded the lives of the children of Johnstown born https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 L E TTE R OF T R A N S M IT T A L . within the given year. Civic action can remedy defective sewerage and scavenger systems and dirty unpaved streets which are instru mental in creating conditions that endanger the lives of infants. The extension of city water to all houses; improved methods for sewage disposal, garbage collections, and general scavenging; the paving of streets and inhabited alleys; the widening of alleys; the improved grading of streets and alleys; the relief of house and lot congestion; the abolition of wells and yard privies; sewer connec tion for all houses; the abatement of the smoke nuisance— all of these are needed improvements for the infant health and the general health of Johnstown. But the public’s responsibility does not end merely in remedying such conditions as those just noted. There is a growing tendency on the part of municipalities to accept responsibility for furnishing information and instruction to its citizens. Some cities have reduced their infant mortality rate by having expectant mothers instructed in prenatal care; others by sending instructive visiting nurses, imme diately after the birth of a child, into homes that need them. Other means which have been found effective in reducing excessive infant mortality rates are baby welfare stations, consultation stations for expectant and nursing mothers, and the distribution of sound litera ture on prenatal care, the care and feeding of infants, the care of milk, and other hygienic matters. The importance of a pure milk supply in reducing infant mortality has been repeatedly demonstrated. The direct effects of impure milk on the health of Johnstown babies could not be ascertained in this investigation, but the careless handling of milk was obvious, and at the request of the Johnstown Board of Health and the local health officer the Children’s Bureau secured the cooperation of the Bureau of Animal Industry of the Department of Agriculture in making a comprehensive investigation of the milk supply in Johnstown. The findings of the experts, L. B. Cook, C. E. Clement, and B. J. Davis, printed in full on pages 89 to 93 of this report (Appendix III), justify the citizens’ campaign for clean milk now under way in Johnstown. In many directions public spirit is active in Johnstown. The city is awakening to its needs and to its responsibilities as well. It sup ports a strong civic club and other associations which are studying ways and means to proceed. Its newspapers are virile and pro gressive and plans are being made to remedy insanitary conditions. Through private effort a visiting nurse has been secured to instruct mothers in the care of their homes and their children. The Johnstown report shows a coincidence of underpaid fathers, overworked and ignorant mothers, and those hazards to the life of the offspring which individual parents can not avoid or control https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis L E TTE R OF T R A N S M IT T A L . 9 because they must be remedied by community action. All this points toward the imperative need of ascertaining a standard of life for the American family, a standard which must rest upon such betterment of conditions of work and pay as will permit parents to safeguard infants within the household. Toward the slow working out of the essentials of such a standard it is hoped that the bureau’s continued studies into infant mortality may contribute. While the bureau has not yet determined upon all the units of the inquiry, it is the purpose at present to study localities outside those great urban areas whose spectacular needs have secured costly and effective work by municipal and volunteer organizations. Such work should be equally valuable and, on the whole, equally applicable in smaller towns and even in rural communities. That similar prob lems and needs exist also in our less congested areas is proved by the 1913 report of the New York State Health Commission, which has made plain the unfavorable health showing of the State as a whole as compared with that of the city of New York. This report and the studies upon which it is based have furnished the impetus for new legislation which extends throughout the State certain measures for improving the health of children which have already proved effective in the largest city of the State. In various parts of the world the history of intelligent efforts to surround babies with healthful con ditions shows a progressively lessening infant mortality rate and leads to the belief that the problems of infant mortality can be solved. Sir Arthur Newsholme, who has already been quoted above, says in the Forty-Second Annual Report of the Local Government Board (1912-13), “ It is obvious that the complex problems involved (ex cessive infant and child mortality) can not be effectively stated in a single report, and that investigation is called for in nearly every center of excessive mortality.” It is therefore desired to pursue this inquiry in various typical communities throughout the country so that the facts may secure popular attention. Clearly the law creating the Children’s Bureau, framed by experts in child welfare, embodies the conviction that if the Government can “ investigate and report” upon infant mortality, the conscience and power of local communities can be depended upon for necessary action. Respectfully submitted. J u l i a C. L a t h r o p , Chief. Hon. W i l l i a m B. W i l s o n , Secretary o f Labor. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY : JOHNSTOWN, PA. INTRODUCTION. The term infant mortality, used technically, applies to deaths of habies under 1 year of age. An infant mortality rate is a statement o f 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 oc curred during the calendar year 1912.1 Infant mortality can be accurately measured in no other way than b y means of a system of completely registering all births as well as all deaths. In 1911 the United States Bureau of the 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 can not be computed owing to this generally incom plete registration. In the 1911 census report on mortality statistics,2 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: i For more detailed description of method see Appendix II, pp. 86 to 88. a Bulletin 112, Bureau of the Census, p. 23. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 11 12 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. D eaths of q u e n n ia l Y ears Ch il d r e n P e r io d s 1909 and 1 Y e a r of A ge 1901 t o 1910, a n d under from per also 1,000 for L iv e the B ir t h s , b y Q u in Sin g l e Ca l e n d a r . 1910.1 COUNTRY. Chile................................................... Russia (European).................................... Austria.............................................. Hungary.............................. Prussia................................ Jamaica.......................................... Spain................................... Ceylon................................................. Italy.......................................... Japan................................... Servia........................... Belgium....................................... Bulgaria.............................................. France.......................................... England and Wales................................. The Netherlands................................. Switzerland................................................... Finland................................................... Scotland................................................ Denmark.................................. Province of Ontario...................... Ireland.......................................................... Australian Commonwealth.................... Sweden....................................................... Norway.................................... New Zealand........................................... 1901 to 1906 to 1905 1910 306 (8) 215 212 190 174 173 171 168 154 149 148 148 139 138 136 134 131 120 119 * 114 98 97 91 81 75 1909 1910 315 315 313 204 168 191 212 164 174 194 157 m 189 202 155 166 176- 137 117 114 117 127 94 78 70 120 109 99 115 111 108 98 131 92 72 72 72 62 105 108 118 123 95 75 68 1 From the Seventy-third Annual Report of the Registrar General of Births, Deaths, and Marriages in. England and Wales (1910). London, 1912. 2 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 moth ers, physicians, nurses, and others experienced in the care of chil dren, and also of trained investigators and statisticians, in the prep aration of a schedule which was submitted to them for criticism. With its limited force and funds it was not possible for the Chil dren’s Bureau to extend its inquiries throughout the entire United States. It was therefore decided to make intensive studies of babies bom 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 con ditions typical of other communities. Moreover, the State commis sioner of health and the State registrar of vital statistics were both https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. 13 working zealously to enforce birth-registration laws; both were ac tively interested in reducing infant mortality, and they welcomed a study of the subject in their State. In Johnstown the mayor, the pres ident 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 cal endar 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 essen tial 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 bom 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 begin ning the work, however, agents of this bureau were told that the Ser vian 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 them selves, and that therefore their babies usually escaped registration. The omission of these babies meant the exclusion of a number of moth ers 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 Servian 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 Servian quarter to inquire con cerning births in 1911. A number of unregistered babies of Servian 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. 14 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 com pleted 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. Still Live Total NATIONALITY OP MOTHER. births. births. births. Total.................... 380 Physi cian. Mid wife. 30 227 153 158 189 33 47 76 151 58 95 122 36 5 184 7 26 12 35» 27 10 1 6 26 3 3 16 3 4 2 6 2 15 4 4 2 3 3 5 37 7 1 5 36 4 2 73 50 19 89 15 Native......................... Foreign....................... 134 246 118 232 Slovak, Polish, etc.............. 43 13 1 8 41 7 7 41 11 1 8 39 6 7 2 2 123 116 7 Austrian (not otherwise specified)............................ Fe male. Certifi cate showing: deaths Un during known. first year. 350 16 14 Italian.................................... Syrian and Greek................ Male. ATTENDANT AT BIRTH. 2 1 3 5 i 2 2 4 1 RELATION OF INFANT MORTALITY TO ENVIRONMENT. NEIGHBORHOOD INCIDENCE. The rate of in fant, mortality is regarded as a most reliable test of the sanitary condi tion of a district. (Sir Arthur Newsholme, Elements of Vital Statistics, p. 120. Lon don, 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , P A . 15 about 4 miles. The city is composed of 21 wards and is an aggrega tion 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. T a b l e X . 'D i s t r i b u t io n o p P o p u l a t i o n , L i v e B i r t h s , a n d D e a t h s D u r i n g F i r s t Y e a r , a n d I n f a n t M o r t a l it y R a t e A c c o r d in g t o S e c t io n o f J o h n s t o w n , f o r A l l C h il d r e n I n c l u d e d i n t h is I n v e s t i g a t i o n . SECTION OF CITY AND WARD. Popu lation, 1910.1 The whole city................................. 55,482 Down-town section (wards 1. 2,3, 4) .. Kernville (wards 5, 6)................ ' . Hornerstown (ward 7 ).............. Roxbury (ward 8 )......................... Conemaugh Borough (wards 9, 1 0 ).................... Woodvale (ward 11)....................... '___ Prospect (ward 12).................; ..................... Peelorville (ward 13)................................. Minersville (ward 14)...................................... Cambria City (wards 15, 16)................................. Moxham (ward 17).............................................. Morrellvilie (wards 18,19, 20)................ Coopersdale (ward 21).......................................... 5,944 6,070 2’ 862 5,282 1,893 1,443 2,403 8,706 5,735 5,757 966 Deaths during Total first year Infant live-bom mortality babies. of babies rate. born in 1911. 80 104 10Ö 85 136 107 55 18 72 310 157 194 16 156.0 117.6 (2) 16 8 89.2 82.5 (2) 1 Federal census of 1910. * 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 modem health officer recognizes this and generally has in his office a wall map upon which are indi cated 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 next table shows the compar ative frequency of infant deaths in each of the several sections of Johnstown as well as the rate of infant mortality, total population, proportion of foreign population, proportion of foreign mothers, and total births in the year 1911 in each. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16 INFANT M ORTALITY: JOHNSTOW N, PA. T able 2 . — R elative R ank op S ections op J ohnstown , A ccording to I npant Mortality R ate por all Childern I ncluded in T his I nvestigation , T otal P opulation , T otal F oreign B orn , P ercentage op F oreign B orn in T otal P opulation , N umber of B abies B orn A live in 1911, P roportion op F oreign B orn M others , and N umber op I nfant D eaths . BANK OF THE SEVERAL SECTIONS OF THE CITY ACCORDING TO— SECTION OF CITY AND WARD. Babies included in investiga * Per tion. Total cent of Infant Total foreignborn foreignmortal popu Propor bom ity rate. lation.1 popu Number tion of Number lation.1 popu live born. foreign of infant lation.1 mothers. deaths. 1 2 •3 4 5 6 7 8 9 10 11 (2) (2) 8 2 1 6 2 2 11 1 8 5 7 7 10 4 3 2 11 11 1 5 1 10 6 9 5 4 12 5 3 4 13 8 9 10 12 4 8 3 3 6 7 9 5 12 11 7 6 7 9 13 13 13 10 12 2 2 1 11 3 4 12 1 3 9 4 8 6 5 7 6 13 9 11 12 10 13 8 10 1 According to Federal census of 1910. 2 Total live births less than 50; base therefore considered too small to use in computing an infant mor tality rate. 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 favor able ward. This is where the poorest, most lowly persons of the community five—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 fine of the Pennsylvania Rail road. To the north of the tracks rises a steep hill, toward the top of which is Woodvale Avenue, the principal street north of the rail road. (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 some times only the sinks are connected with the sewer and the yard privy is retained. On the streets above Woodvale Avenue dwellings are more scat tered 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 W ood vale. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. 17 The streets near the bottom of the hill, as Plum Street, for exam pie, 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 W ood vale 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 offen sive 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. I t 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 resi dential 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 pop ulation and house congestion are greater here than elsewhere in the city. 61112°— 15------2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 I N F A N T M O R T A L IT Y : J O H N S T O W N , P A . 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 num ber 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 com paratively 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 downtown 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 sec tion has not the unwholesome atmosphere that characterizes Woodvale and to a lesser extent Prospect, Cambria City, and Minersville. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. 19 The infant mortality rate of 117.6 per thousand in Roxbury is the same as that of Conemaugh Borough. For reasons not plainly appar ent the rate here is higher than in Moxham, Morrellville, Kernville, or the down-town section, although it appears to be as favorably con ditioned as these sections are from a social, economic, and sanitary standpoint. Here, as in all these sections, however, are many con ditions 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 moi:e 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 20 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. the base number is small for such a computation. Coopersdale, how ever, 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 Pros pect. A number of company houses are located here in which sani tary conditions are f airly 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 sewage 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 un covered 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , P A . 21 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 re quired 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 Penn sylvania has a law (act of Apr. 20, 1905) which provides for the pun ishment 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. four rooms each are common, and they are known locally as threefamily, 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 apart ments, 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 com pared 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 com fortable 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 23 I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. T able B . — D i s t r i b u t io n o p L i v e B ir t h s a n d o p D e a t h s D u r i n g F i r s t Y I n f a n t M o r t a l it y R a t e , A c c o r d in g t o H o u s i n g C o n d i t i o n s . ear, and • 1 i HOUSING CONDITIONS. DEATHS DURING FIRST YEAR. Live births. Infant Number. mortality rate. 1,463 196 134.0 808 336 319 99 47 50 122.5 139.9 156.7 496 965 2 36 159 1 72.6 164.8 (*) 1,173 288 2 138 57 1 117.6 197.9 0) 1,333 128 2 176 19 1 132.0 148.4 0) 801 632 28 2 80 107 8 1 99.9 169.3 739 722 2 80 115 1 P> (x) 108.3 159.3 0) 1 Total live births less than 50; base therefore considered too small to use in computing an infant mor tality rate. The following summary may be of interest in indicating some rela tion between infant mortality and cleanhness or uncleanliness com bined with dryness or dampness of homes : T 4 . — D i s t r i b u t io n o p L i v e B ir t h s a n d o p D e a t h s D u r i n g F i r s t Y e a r * a n d I n f a n t M o r t a l it y R a t e , A c c o r d in g t o C l e a n l i n e s s a n d D r y n e s s o p H o m e . able DEATHS DURING FIRST YEAR. TYPE OF HOME. •Clean: Moderately clean: j_/x y ...•••••••• * Dirty: https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live births. Infant Number. mortality rate. 1,463 196 134.0 943 354 166 107 58 31 113.5 163.8 186.7 807 656 99 97 122.7 147.9 581 362 61 46 105.0 127.1 158 196 27 31 170.9 158.2 68 98 11 20 161.8 204.1 24 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. 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-bom 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: T a b l e 5 . — N u m b e r o p B a b ie s L i v i n g i n H o m e s op E a c h Sp e c if ie d Siz e A v e r a g e N u m b e r o f P e r s o n s P e r R o o m i n H o m e s o p E a c h Si z e . ’ SIZE OF HOME. Live-bom babies. All homes................ 1,463 1 room............................... 2 rooms.............................. 3 rooms.............................. 4 rooms.............................. 5 rooms.............................. 6 rooms.............................. 7 rooms.............................. 33 165 147 526 222 233 38 Persons per room. SIZE OF HOME. Live-bom babies. 43 4.42 2.27 1.83 1.58 1.22 1.07 .96 Not reported................. 22 and- Persons per room. 0.88 .93 .88.64 .75 .69.43- In homes of one, two, three, or four rooms or where the number o f occupants ranged from 4.42 to 1.58 persons per room the infant mor tality 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. 25 T a b l e 6 . — D is t r ib u t io n o p B ir t h s a n d o p D e a t h s D u r in g F ir s t Y e a r A m o n g B a b ie s Su r v iv in g a t L e a s t 1 M o n t h , a n d I n p a n t M o r t a l it y R a t e , A c c o r d in g t o C e r t a i n C o n d i t i o n s i n B a b y ’ s S l e e p i n g R o o m . BABIES WHO LIVED AT LEAST 1 MONTH. Deaths during first year. CONDITIONS IN BABY’ S SLEEPING BOOM. Total. Number. 1,389 122 600 725 57 7 40 71 575 810 4 32 88 2 Number of others sleeping in same room with baby: 3 t o 5 ............................ ............................................................. ................................. Rate per 1,000 of those who lived 1 month8 7 .8 66.7 97.9 122.8 7 4 0) Baby sleeping alone in separate bed: N o..................................................................................................................... 5 5 .7 108.6 <») 1 Total number of babies less than 50; base therefore considered too small to use in computing rate. 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 26 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. that at night the windows were ‘ 1always shut tight.” The babies subjected to differences of ventilation show corresponding variations in infant mortality rates. ■Ta b l e 7 . — D i s t r i b u t io n o f B ir t h s a n d o f D e a t h s D u r i n g F i r s t Y e a r , a n d I n f a n t M o r t a l it y R a t e a m o n g B a b i e s S u r v i v i n g a t L e a s t 1 M o n t h , A c c o r d in g to V e n t il a t io n of B a b y ’ s R o o m . BABIES WHO LIVED AT LEAST 1 MONTH. Died during first year. VENTILATION OP B AB Y’ S BOOM. Total. Number. Total. ■Good............. Fair............... Poor.............. Not reported i Rate per 1,000 of those who lived 1 month. 1,389 122 87.8 604 392 390 3 17 36 66 3 28.1 91.8 169.2 (‘ ) Total number of babies less than 50; base therefore considered too small to use in computing rate. 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 venti lation 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 con stantly 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. 27 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 o f 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 news papers about misdemeanors committed in foreign sections. The report of the Immigration Commission1 comments “ on the attitude o f the police department toward foreigners * * * with regard to Sunday desecration,” and states that “ the Croatians are accus tomed to spend Sunday in singing, drinking, and noisy demonstra tions. The police have been instructed to show no leniency on ac count 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 im morality among foreigners.” “ Sabbath desecration” is the crime foreigners are most frequently charged with. 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 through out a period of 24 hours instead of for the usual 10 or 14 hour period and another group had 24 hours off duty. Some departm ents^ the steel mills, however, shut down on Sundays, and in some de partments for certain occupations an eight-hour day prevails, but these more favorable conditions do not prevail among thè majority o f 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 i United States Immigration Commission Reports, Volume V in , “ 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 practi cally the same. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 28 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. of arrest for “ crimes that make them a nuisance to the native popu lation” 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 establish ments 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 Sab bath day, commonly called Sunday, after 12 o’clock m.” The ordi nance 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-Croatian1 where, as shown in the next table, infant deaths numbered 263.9 per 1,000 live births. T a b l e 8 . — D i s t r i b u t io n o p B i r t h s , L i v e B i r t h s , Y e a r , a n d I n f a n t M o r t a l it y R a t e , A c c o r d in g D e a t h s D u r in g F ir s t N a t io n a l it y op M o t h e r . and to DEATHS DURING FIRST YEAR. NATIONALITY OF MOTHER. Total births. Total live births. Number. All nationalities............................................................ Slovak, Polish, etc......................................................................... Italian.................................................................................. ............ Infant mortality rate. 1,551 1,463 196 134.0 860 691 815 648 85 104.3 171.3 394 76 75 53 38 33 367 72 71 47 38 31 12 10 12 10 111 65 19 13 6 4 4 177.1 263.9 183.1 (l) St (l) 1 Total live births less than 60; base therefore considered too small to use in computing an infant mor tality rate. 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. 1 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.” https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N F A N T M O R T A L IT Y * J O H N S T O W N , PA. 29 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 wash ing and ironing, and buys and prepares the food for all the lodgers. Usually she gets everything on credit and the lodgers pay their respec tive 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 mor tality 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 8. 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; https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 30 IN F A N T M O R T A L IT Y : J O H N S T O W N , PA. steamship agents; bricklayers, skilled and semiskilled trades. carpenters, or workers at other 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 rep resented in the investigation excepting the Serbo-Croatian. The babies of Slovak 1 mothers were found to be most numerous, there being 276 of them. There were 108 babies of Polish,2 2 of Bohe mian,3 and 7 of Ruthenian4 mothers. In addition, one baby of a Scandinavian (Danish) mother was -included, not because Scandina vians 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.” The rate for this group is lower than that for either the SerboCroatians or the Italians, hut 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, hut on the whole they have been in Johnstown longer, are more pros perous, 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 pos sessed of more comforts than those of the Serbo-Croatians and Italians. OTHER NATIONALITIES. The British5infant 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 1 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. 2 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. 3 xhe 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. 4 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. 6 English, Irish, Scotch, and Welsh included in the term British. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 31 I N F A N T M O R T A L IT Y : J O H N S T O W N , PA. to hear a man, one who could hardly speak English, say, "W e are notforeigners; we are Germans.” The British and Germans occupy the same relative position economically that they occupy in tho infant mortality scale with relation to other races. In the Magyar 1 group, of 38 babies born alive 4 died in their first year, making an infant mortality rate of 105.3, which is almost a» 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 investigationThey 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 nation ality is not as significant as the difference in rate between native and foreign mothers. Although a special study of the causes of still births 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 o f some interest, and therefore shown in the next table. T able 9 .— D istribution of B irths and of Stillbirths , and R ate of Stillbirth ® per 1,000 B irths , A ccording to N ationality of M other . STILLE IRTHS. NATIONALITY OF MOTHER. Total births. Number. All nationalities...................................................................................... Rate per 1,000 births. 1,551 88 56 . 7 860 45 43 52. 3 6 2 .2 ' 691 394 76 75 53 27 4 4 6 2 60. & 38 33 12 68.5 52.6 5 3 .3 1 1 3 .2 10 i The race of Finno-Tatar origin that invaded Hungary about the ninth century and is now dominant there; commonly called Hungarians. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 32 IN F A N T M O R T A L IT Y : J O H N S T O W N , P A. ATTENDANT AT BIRTH. The native mother usually had a physician at childbirth; the foreign-born, a midwife. The more prosperous of the foreign moth ers, however, departed from their traditions or customs and had physicians, while the American-born mothers, when very poor, re sorted to midwives. The midwives usually charged $5, and some times 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. T able 10 . — N u m b e r and P e r C e n t o f B ir t h s A c c o r d in g a n d N a t iv it y o f M o t h e r . to A ttendant at B ir t h M OTH ER ATTEN DED B Y — A L L B IR T H S . Physician. N A T IV IT Y OF M OTHER. Num ber. Per cent. Num ber. Per cent. Midwife. Num ber. Per cent. Neighbor, rela tive, or friend. No one. Num ber. Per cent. Num ber. Per cent. All.................... 1.551 100.0 928 59.8 588 37.9 14 0.9 21 1.4 Native mothers........ Foreign mothers___ 860 691 100.0 100.0 774 154 90.0 22.3 84 504 9.8 72.9 2 12 0.2 1.7 21 3.0 Two-thirds of those having no attendant were Serbo-Croatians. I t was a Polish woman, however, who gave the following account o f the birth of her last child: A t 5 o ’clock Monday evening went to sister’ s to return washboard, having just finished day’s washing. Baby b om while there; sister too young to assist in any w ay; woman not accustomed to midwife anyway, so she cut cord herself; washed b a by at sister’ s house; walked home, cooked supper for boarders, and was in bed b y 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 b a by ’s birth, b u t 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 phy sicians than for those delivered by midwives or for those at whose birth no properly qualified attendant was present. This is not neces sarily an indication of the quality of the care at birth, although in some cases the inefficiency of the midwife may have directly or indi rectly caused deaths, just as in some instances a physician’s ineffi ciency 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY: JO H N STO W N , PA. 33 T able 1 1 .— D istribution of B irths and of D eaths D uring F irst Y e a r , and I nfant M ortality R ate , A ccording to A ttendant at B irth and N ativity of M other . DEATHS DURING FIRST YEAR. Total live births. ATTENDANT AT BERTH AND NATIVITY OF MOTHER. Infant Number. mortality rate. 1,463 196 134.0 866 87 100.5 730 136 68 93.2 139.7 562 101 179.7 83 479 15 86 180.7 179.5 35 8 C1) 2 33 2 6 0) (i) 19 1 Total live births less than 50; base therefore considered too small to use in computing an 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 this 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, as shown in the next tabulation: T able 1 2 .— D istribution A ccording to A ttendant of at B irths and of D eaths D uring F irst Y e a r , B irth , for B abies of Serbo -C roatian M others . ATTENDANT AT BIRTH. ALL BIRTHS TO SERBO-CROATIAN MOTHERS. Live births. Deaths during first year. Number. Per cent. 76 100.0 72 19 31 22 9 14 40.8 28.9 11.8 18.4 28 21 9 14 2 12 2 3 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 6 1 1 1 2 ° — 1 5 ------- 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: J O H N STO W N , PA. 34 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. LIT E R A C Y .1 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. 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. T able 1 3 .— D istribution of B irths and of D eaths D uring F irst Y e a r , I nfant M ortality R a te , and N umber and P er Cent of Stillbirths , A ccording to L iteracy of F oreign M others . STILLBIRTHS. LITERACY OF FOREIGN MOTHERS. Total births. Live births. DEATHS DURING FIRST YEAR. Infant Number. Per cent. Number. mortality rate. Foreign mothers...... ............................ 691 648 43 6.2 I ll 171.3 Literate.............................................................. Illiterate............... J........................................... 445 246 419 229 26 5.8 6.9 62 49 148.0 214.0 17 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. T able 1 4 .—D istribution of B irths and of D eaths D uring F irst Y e a r , I nfant M ortality R a t e , and N umber and P er Cent of Stillbirths , A ccording to A bility of F oreign M other to Speak E nglish . STILLBIRTHS. ABILITY TO SPEAK ENGLISH. Total births. Live births. DEATHS DURING f ir s t y e a r : Infant Number. Per cent. Number. mortality rate. Foreign mothers.................................... 691 648 43 6.2 Ill 171.3 Speak English.................................................. Can not speak English................................... 263 428 247 401 16 27 6.1 6.3 36 75 145.7 187.0 ‘ B y literacy is meant ability to read and write in any language and not simply in English. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N , PA. 35 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 coun try for different periods of time. T able 1 5 .— D istribution op B irths and op D eaths D uring F irst Y ear and I nfant M ortality R a te , A ccording to L ength of R esidence op F oreign M other in the U nited States . DEATHS DURING FIRST YEAR. Total live births. YEARS IN THE UNITED STATES. Foreign mothers........................ . 5 years or less.............................. Over 5 years................................... Infant Number. mortality rate. 648 Ill 171.3 168 480 36 75 214.3 156.3 The high infant mortality rate for the children of newer immi grants, 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. T able 1 6 .— D istribution op B irths and op D eaths D uring F irst Y ear I nfant M ortality R ate , and N umber and P er Cent op Stillbirths , A ccording to A ge op Mother . STILLBIRTHS. AGE OF MOTHER. Total births. Live births. Number. All mothers.................. ..................... Under 20..................................................... 20 to 24...................................................... 25 to 29......................................................... 30 to 39..................... .......... .............................. 40 and over............................................ Infant Per cent of total. Number. mortality rate. 1,551 1,463 88 5.7 105 476 410 480 83 95 454 391 449 74 10 22 9.5 4.6 4.6 6.5 7.5 19 31 6 D E A TH S. 196 ÎT 55 56 61 11 134.0 136.8 1 2 1 .1 143.2 135.9 148.6 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: J O H N STO W N , PA. 36 also Table X II on page 70, based upon the entire reproductive 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 liv e one week than an old man of 90, and less chance to liv e a year than one of 80.— B ergeron . 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. T able 1 7 .— N umber and P e r C e n t D i s t r i b u t io n at D eath . op D eaths op B a b ie s , by A ge DEATHS OF BABIES OF ALL MOTHERS. AGE AT DEATH. Number. Per cent distri bution. Total deaths in first year. 196 100.0 First quarter........................... First month.............................. 108 74 55.1 37.8 45 23.0 30 4 11 15.3 2.0 5.6 Second week. Third week.. Fourth week. 14 7 8 7.1 3.6 4.1 Second month. Third month.. 18 16 9.2 8.2 Seçond quarter. Third quarter.. Fourth quarter. 42 31 15 21.4 15.8 7.7 First week.............. .......... — Less than 1 day and 1 day........ 2 days................ .................... 3 to 6 days...................... .............. 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 37 IN FAN T M O RTALITY: J O H N STO W N , PA. 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 diarrhea and enteritis, 50 to respira tory diseases, and 44 to some other or to some ill-defined cause. T able 1 8 .— D istribution of D eaths D uring F irst Y ear and I nfant M ortality R ate , A ccording to Cause of D eath and Nativity of M other . D E A TH S D U R IN G FIRST Y E A R OF B A B IE S OF- Native mothers. All mothers. Foreign mothers. C A USE O F D E A T H . , Infant Infant Infant Number. mortality Number. mortality Number. mortality rate. rate. rate. 196 52 50 24 19 7 44 134.0 85 104.3 Ill 171.3 35.5 34.2 16.4 12.9 4.8 30.1 17 19 11 5 6 27 20.9 23.3 13.5 6.1 7.4 33.1 35 31 13 14 1 17 54.0 47.8 20.1 21.6 1.5 26.2 The latest census report on mortality statistics characterizes diar rhea 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. H o lt1 says that one of the most striking facts about diarrheal dis eases 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. T able 1 9 .— D istribution of Deaths , A ccording to Cause of D eath and Q uarter of Calendar Y ear in which D eath O ccurred . Q U A R T E R OF C A L E N D A R Y E A R IN W H ICH D E A T H O CC U R R E D . C A USE O F D E A T H . All deaths. First. All cau ses...___ *.............. ....... Diarrhea and enteritis......................... Respiratory diseases............................ Premature births................................. Congenital debility or malformation. Injuries at birth................................... Other causes or not reported............. 196 54 52 50 24 19 7 44 3 24 7 5 5 10 The Diseases of Infancy and Childhood, by L. Emmett Holt. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Second. Third. 29 74 p. 345. Fourth. 39 12 11 3 4 1 8 New York, 1912. 38 IN FAN T M O RTALITY: JO H N STO W N , PA. 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 Lindemann1 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 dis tinctly harmful effect of hot weather on the infant is increased when the housing conditions are bad; in overcrowded homes with bad ven tilation 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 feed ing, many infants are able to pass through extremely hot weather without diarrheal disturbances. 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. McCleary2 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, how ever, 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. 1 Liefmann, H ., and Lindemann, H ., Die Lokalization der Säuglingsterbliehkeit und ihre Beziehungen zur Wohnungsfrage. Med. Klinik 1912, pp. 8, 1074. 2 Infantile Mortality and Infants’ Milk Depots. London. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N , PA. 39 Breast feeding is far more general, comparatively, among the poorer mothers than among the well to do, as shown by the following sum mary 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. T able 2 0 .— D istribution op B abies A live at 3, 6, and 9 M onths op A ge T ype op F eeding at E ach op Said A ges , A ccording to A nnual E arnings F ather and N ativity of M other . by of B A B IE S LIV IN G A T AG E OF— 6 months. 3 months. ANNUAL E A R N IN G S OF F A T H E R A N D N A T IV IT Y OF M O T H E R . 9 months. Completely weaned from breast. Completely weaned from breast. Total. Total. Total. Number. . Number. Per cent. Completely weaned from breast. Number. Per cent. Per cent. 193 14.2 1,313 250 19.0 1,282 353 27.5 . 22 48 114 9 6.5 13.4 18.1 33.3 322 351 616 24 32 63 146 9 9.9 17.9 23.7 37.5 309 342 608 23 57 85 201 10 18.4 24.9 33.1 43.3 765 155 20.3 747 195 26.1 735 251 34.1 69 180 491 25 10 36. 100 9 14.5 20.0 20.4 36.0 66 177 482 22 13 46 127 9 19.7 26.0 26.3 40.9 65 173 476 21 18 55 168 10 27.7 31.8 35.3 47.6 Mother foreign.............. 590 38 6.4 566 55 9.7 547 102 18.6 Under $624............................... $625 to $899............................... $900 and over1......................... Not reported 2............... 272 178 • 138 2 12 12 14 4.4 6.7 10.1 256 174 134 2 19 17 19 7.4 9.8 14.2 244 169 132 2 39 30 33 16.0 17.8 25.0 Total....................... 1,355 Under $624........................ $625 to $899........................ $900 and over1.................. Not reported 2.................. 341 358 629 27 Mother native............. Under $624.............................. $625 to $899......... $900 and over1....................... Not reported2.......................... ' 1 Includes those reported as earning “ ample.” “ Ample,” as used in this report has a somewhat techni cal 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.” 2 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 precedhig 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. Some additional details concerning the type of feeding of babies of native and foreign mothers are given in the next table. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis in f a n t 40 M o r t a l it y : jöh n sto w n , pa. T able 2 1 .— N umber and P er Cent op B abies A ged 3, 6, and 9 M onths W ho R eceived Specified T ype op F eeding , A ccording to N ativity op M other . AGE OF BABY. TYPE OF FEEDING AND NATIVITY OF MOTHER. 9 months. 6 months. 3 months. Number. Per cent. Number. Per cent. Number. Per cent. All babies........................................ 1,355 100.0 1,313 100.0 1,282 100.0 . Exclusively breast fed............................ Partly breast fed...................................... Exclusively artificially fed..................... 987 175 193 72.8 12.9 14.2 616 447 250 46.9 34.0 19.0 220 709 353 17.2 55.3 27.5 Native mothers’ babies....................... 765 100.0 747 100.0 735 100.0 Exclusively breast fed.................................... Partly breast fed........... ................................. Exclusively artificially fed............................ 512 98 155 66.9 - 12.8 20.3 307 245 195 41.1 32.8 26.1 87 397 251 11.8 54.0 34.1 Foreign mothers’ babies..................... 590 100.0 566 100.0 547 100.0 Exclusively breast fed....... ............................ Partly breast fed.............................................. Exclusively artificially fed............................ 475 77 38 80.5 13.1 6.4 309 202 55 54.6 35.7 9.7 133 312 102 24.3 57.0 18.6 The following table shows that artificially fed babies die at a much more rapid rate than breast-fed babies. In the very earliest months exclusive breast feeding seems to be the only safe method. After four months the danger of giving some other food in addition to the breast milk does not seem to be so great. T able 2 2 .— D istribution op B abies A live at E nd op E ach M onth , F rom S ec ond to T enth , I nclusive , A ccording to T ype op F eeding D uring E ach M onth Specified , N umber op D eaths D uring F irst Y eah , and R ate per 1,000 A live in E ach G roup . LIVE-BORN BABIES. Deaths during first year. TYPE OF FEEDING AT TIME SPECIFIED. Number alive at specified Rate per time. Number. 1,000 alive at specified time. Second month...................... 1,389 122 87.8 Breast exclusively.......................... Mixed (i. e., breast and other). . . Artificial (i. e., no breast m ilk).. 1,181 77 131 85 31 6 72.0 77.9 236.6 Third m onth.. 1,371 104 75.9 Breast exclusively... Mixed......................... Artificial..................... 1,112 98 161 60 9 35 54.0 91.8 217.4 Fourth month 1,355 88 64.9 Breast exclusively.. . Mixed......................... Artificial..................... 987 175 193 46 10 32 46.6 57.1 165.8 Fifth month.. 1,337 70 52.4 Breast exclusively... Mixed......................... Artificial.................... 871 253 213 33 10 27 37.9 39.5 126.8 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY! JO H N STO W N , PA. T able 2 2 . — D i s t r i b u t io n ond to 41 of B a b ie s A l iv e a t E n d of E a c h M o n t h , F ro m S ec T e n t h , I n c l u s i v e , e t c .— Continued. LIVE BORN BABIES. Deaths during first year. Number alive at Rate per specified time. Number. 1,000 alive at specified time. TYPE OF FEEDING AT TIME SPECIFIED. Sixth month 1,318 51 38.7 Breast exclusively Mixed.................... Artificial............... 780 310 228 20 10 21 25.6 32.3 92.1 Seventh month 1,313 46 35.0 Breast exclusively___ Mixed........................... Artificial..................... 616 447 250 18 10 18 29.2 22.4 72.0 Eighth month. 1,305 38 Breast exclusively.., Mixed......................... Artificial................... . 502 541 262 13 11 14 Ninth month. 1,291 24 18.6 Breast exclusively., Mixed...................... . Artificial.................. 395 611 285 7 10 7 17.7 16.4 24.6 1,282 15 11.7 220 709 353 3 8 4 13.6 11.3 11.3 Tenth month Breast exclusively.. Mixed...................... . Artificial................... 25.9 20.3 53.4 The next table differentiates between babies of native and foreign mothers, giving the statistics by three-month periods instead of by single months. T able 2 3 .— D istribution of B abies A live at the E nd of 3, 6, and 9 M onths, R espectively , A ccording to T ype of F eed ing , N umber of D eaths D uring F irst Y e a r , and R ate per 1,000 A live in E ach G roup , b y N ativity of M other . BREAST FED EXCLU SIVELY. AGE OP BABY AND NATIVITY OF MOTHER. Babies alive at age indi cated. MIXED f o o d : BREAST AND OTHER. Deaths in first year. Deaths in first year. Rate per 1,000 alive at specified age. Total. Num ber. Total. ARTIFICIAL FOOD: NO BREAST MILK. Deaths in first year. Rate per 1,000 alive at specified age. Total. Num ber. Num ber. Rate per 1,000 alive at specified age. ALL 3 months___ 6 inonths___ 9 months___ 1,355 1,313 1,282 987 616 220 46 18 3 46.6 29.2 13.6 175 447 709 10 10 8 57.1 22.4 11.3 193 250 353 32 18 4 165.8 72.0 11.3 765 747 735 512 307 87 12 2 1 23.4 6.5 11.5 98 245 397 2 1 1 20.4 4.1 2.5 155 195 251 21 14 3 135.5 71.8 12.0 590 566 547 475 309 133 34 16 2 71.6 ' 51.8 15.'0 77 202 312 8 9 7 103.9 44.6 22.4 38 55 102 11 4 289.5 72.7 9.8 NATIVE. 3 months___ 6 months___ 9 months___ FOREIGN. 3 months___ 6 months___ 9 months___ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 42 IN FAN T M O RTALITY: JO H N STO W N , PA. These statistics show that the manner of feeding is one of the most important considerations in the life and health of a baby. But a comparison of the number of deaths among babies whose fathers earn specified sums (Table 31) shows that the influence of poverty reaches even the breast-fed baby. When the fathers’ earnings are small a larger proportion of babies die despite breast feeding. SEX. The Johnstown investigation comprehended 1,551 births in the year 1911, male births numbering 813 and female 738, the proportion being as 1,101.6 male to 1,000 female births; or, stated inversely, 907.7 female to 1,000 male births. Newsholme1 says that “ male infants always suffer from a higher infant mortality rate than female infants,” and in Johnstown we find this true for the group as a whole, the rates being as shown in the next table: T a b l e 24.—D i s t r i b u t io n o f L i v e B ir t h s a n d S t il l b ir t h s a n d D u r i n g F i r s t Y e a r , a n d I n f a n t M o r t a l it y R a t e , A c c o r d in g Bab y. STILLBIRTHS. SEX OF BABY. All births. Live births. Total. Total babies.................... Male................................... Female................................ ' Rate per 1,000 births. of to D eaths Se x of DEATHS IN FIRST YEAR. Total. Infant mortality rate. 1,551 1,463 88 56.7 196 134.0 813 738 761 702 52 36 64.0 48.8 105 91 138.0 129.6 Among foreign mothers male births were considerably in excess of female births; among native mothers the reverse was true. The more favorable mortality rate for female infants does not prevail among the children of foreign mothers, as can be seen in the next table, which shows an infant mortality rate of 177.5 for girls as compared with one of 166.2 for-boys. 1 Thirty-ninth Annual Report of the Local Government Board. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis London 1910. IN FAN T M O RTALITY: JO H N STO W N , PA. 43 T able 2 5 .— D istribution of A ll B irths , L ive B irths , and Stillbirths D eaths D uring F irst Y e a r , and I nfant M ortality R ate , A ccording of B aby and N ativity of M other . STILLBIRTH S. S E X O F B A B Y A N D N A T IV IT Y OF M O T H E R . , All births. Live births. Total. Rate per 1,000 births. and of to Sex D E A T H S D U R IN G F IR ST Y E A R . Total. Infant mortality rate. B A B IE S OF N A T IV E M O TH ERS. Total number................................................ Male: Female: 860 815 45 52.3 85 104.3 433 50.3 406 49.8 27 60.0 62.4 46 54.1 113.3 427 49.7 409 50.2 18 40.0 42.2 39 45.9 95.4 691 648 43 62.2 111 171.3 380 55.0 355 54.8 25 58.1 65.8 59 53.2 166.2 311 45.0 293 45.2 18 41.9 57.9 52 46.8 177.5 B A B IE S OF F O R E IG N M O TH E R S . Male: Number............................................................. Female: Number............................................................. , 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: T able 2 6 . — D i s t r i b u t io n q u is h m e n t of of Part of of H B ir t h s A o useh old c c o r d in g t o T im e o f t h e M o t h e r ’ s R e l i n D u t ie s B e f o r e C o n f in e m e n t , b y N a t iv it y M other. TIM E O F R E L IN Q U IS H M E N T O F P A R T OF H O U SEH O LD D U TIES B E F O R E CON FIN E M E N T. No household duties relinquished to day of confinement............................... Part of duties relinquished: Less than 7 days before confinement............................................................ 7 to 13 days before confinement.................................................................... 2 weeks to 1 month before confinement....................................................... 1 month or more before confinement............. '........... .................................. All births. To native To foreign mothers. mothers. 1,551 860 691 1,350 695 655 3 7 16 174 1 1 5 12 146 1 2 2 4 28 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. T able 2 7 .—D istribution of B irths and of D eaths D uring F irst Y ear , and I nfant M ortality R ate , A ccording to T ime of R elinquishment of P art of H ousehold D uties of Mother B efore Confinement . TIM E O F R E L IN Q U IS H M E N T OF P A R T O F H O U SEH O LD D U TIES B E F O R E CON FIN E M E N T. All mothers........................... No cessation or less than 1 month I month or more.............................. No housework............................... . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis All births. Live births. Infant Deaths during mortal first year. ity rate. 1,551 1,463 196 134.0 1,376 174 1 1,302 160 1 178 18 136.7 112.5 IN FAN T M O RTALITY: JO H N STO W N , PA. 44 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, par ticularly 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. T able 2 8 .— D istribution of L ive B irths and of D eaths D uring F irst Y e a r , and I nfant M ortality R ate , A ccording to T ime of M other R esuming P art of H ousehold D uties A fter Confinement , b y N ativity of M other . DEATHS DURING FIRST Y E AR. LIVE BERTHS TO— TIME OP RESUMING PART OF HOUSEHOLD DUTIES AFTER CONFINEMENT. All Foreign Native mothers. mothers. mothers. Total. Infant mortality rate. Total........................................................................... 1,463 815 648 196 134.0 8 days or less................................. ..................................... 9 to 13 days.......................................................................... 14 days or more................................................................... Mother died or not reported............................................ 467 560 427 9 44 446 318 7 423 114 109 2 79 70 41 6 169.2 125.0 96.0 P) 1 Total Humber 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 nutri tion. 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N , PA. 45 T a b l e 2 9 . — D is t r ib u t io n op L iv e B ir t h s a n d op D e a t h s D u r in g F ir s t Y e a r , a n d I n p a n t M o r t a l it y R a t e , A c c o r d in g t o T i m e o p M o t h e r R e s u m i n g a l l H o u s e h o l d D u t ie s A fte r C o n f in e m e n t , b y N a t iv it y op M o t h e r . D E A TH S D U R IN G FIRST YJ£a R . L IV E B IR TH S TO — T IM E OF R E S U M IN G ALL H O USEHOLD D U TIES A FTE R C O N FIN E M E N T. Foreign Native AH mothers. mothers. mothers. Total. Infant mortality rate. Total.....................................................- ................... 1,463 815 648 196 134.0 8 days or less................................. ...................................... 9 to 13 days................................................. - ....................... 14 days or more.. . : ............................- - - - ......................... Mother died or not reported............. .............. - .......... 219 182 1,053 9 13 132 663 7 206 50 390 2 37 30 123 6 168.9 164.8 116.8 (*) 1 Total live births less than 50; base therefore considered too small to use in computing an infant mor tality rate. The infant mortality rates for all mothers in the group just re ferred 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.” 1 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. i “ 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 5521.” https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N . PA. 46 3 0 . — D i s t r i b u t io n o p L i v e B ir t h s a n d o p D e a t h s D u r i n g F i r s t Y I n p a n t M o r t a l it y R a t e , A c c o r d in g t o A n n u a l E a r n i n g s o p F a t h e r N a t i v i t y o p M o t h e r , f o r L e g it im a t e L i v e - B o r n B a b i e s . T able ear, and and ANN UAL E A R N IN G S OF FA T H E R Total............................... ACCORDING TO N A T IV IT Y OF W IF E . Total live birtbs. Deaths Infant during mortality first year. rate. 1,431 187 130.7 Under $625................................ 384 82 213.5 Under $521.......................... $521 to $624..................... 219 165 56 26 255.7 157.6 $625 to $899............................... 385 47 122.1 $625 to $779............. - ......... $780 to $899......................... 224 161 24 23 107.1 142.9 $900 or more..... ........................ 186 18 96.8 $900 to $1,199....................... $1,200 or more.................... 138 48 14 4 101.4 83.3 Ample1 .............................. ...... 476 40 84.0 Husbands with native wives - 785 76 96.8 Under $625..........................-............ 80 16 200.0 Under $521................................ $521 to $624............................... 32 48 9 7 (2) 145.8 $625 to $899....................: ................ 193 20 103.6 86 107 6 14 69.8 130.8 $625 to $779............................... $780 to $899............................... . $900 or more................................. 129 10 77.5 $900 to $1,199........................ $1,200 or more............ .............. 92 37 7 3 76.1 1 (2) Ample1 ............................................ 383 30 78.3 Husbands with foreign wives 646 111 171.8 Under $625.........................*............ 304 66 217.1 187 117 47 19 251.3 162.4 Under $521................................. $521 to $624............................... $625 to $899..................................... 192 27 140.6 $625 to $779................................. $780 to $899................................. 138 54 18 9 130.4 166.7 $900 or more.................: .................. 57 8 140.6 $900 to $1,199.............................. $1,200 or more............................ 46 11 7 1 152.2 (2) Ample1............................................ 93 10 107.5- 1 See note on page 45. 2Total live births less than 50; base therefore considered too small to use in computing an infant mortality rate. 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, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 47 IN FAN T M O RTALITY: JO H N STO W N , PA. 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 liveborn babies as in the foregoing table. T able 3 1 .— N umber and th e P e r C e n t o p M o t h e r s b y N a t i v i t y , A c c o r d in g A n n u a l E a r n in g s op H u s b a n d . ALL MOTHERS. NATIVE MOTHERS. to FOREIGN MOTHERS. ANNUAL EARNING OF HUSBAND. Number. Per cent. Number. Per cent. Number. Total...................................................... Under $521............................................. $521 to $624........................... $625 to $779 ........................................... $780 to $899.................................................. $900 to $1,199..................................... $ 1 ,2 0 0 and over............................................ Ample1....................................................... 1,491 1 0 0 .0 816 1 0 0 .0 233 174 229 166 146 50 493 15.6 11.7 15.4 36 50 4.4 1 1 .1 108 98 39 399 9.8 3.4 33.1 86 6 .1 10.5 13.2 1 2 .0 4.8 48.9 675 197 I 124’ 143 58 48 Per cent. 1 0 0 .0 29.2 18.4 2 1 .2 8 .6 7.1 11 1 .6 « 13.9 1 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 indus trial 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 1‘ 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 hus bands. Usually they kept lodgers. This was done by the foreign mothers principally, exactly one-third of whom had lodgers, as com pared 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 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY: JO H N STO W N , PA. 48 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 percent age 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. T able 3 2 .—N umber and P er Cent of H usbands with W age -E arning W iv e s , b y N ativity of W ife and A nnual E arnings of H u sband . HUSBANDS HAVING NATIVE WIVES. TOTAL HUSBANDS. Husbands with wage-earning wives. Husbands with wage-earning wives. ANNUAL EARNINGS OF HUSBAND. Number. A HUSBANDS HAVING FOREIGN WIVES. Number. Number. Num ber. Num ber. Per cent. Husbands with wage-earning wives. Per cent. Num ber. Per cent. Total.................... 1,491 278 18.6 816 26 3.2 675 252 37.3 Under «521..................... «521 to «624.................... #625 to #779..................... #780 to $899.................... $900 to $1,199................. 233 174 229 166 146 50 493 111 57 51 25 13 47.6 32.8 22.3 15.1 8.9 2.0 4.1 36 50 86 108 98 39 399 9 3 4 6 1 25.0 6.0 4.7 5.6 3 .8 197 124 143 58 48 11 94 102 54 47 19 12 1 17 51.8 43.5 32.9 32.8 25.0 9.1 18.1 “ Am ple"1...................... 1 20 1.0 1See 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 nonwageearning mothers. Wage-earning mothers and low-wage fathers https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY: J O H N STO W N , PA. 49 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. T able 3 3 .— D istribution op L ive B irths and op D eaths D uring F irst Y e a r , and I nfant M ortality R ate for B abies op W age - earning and N onwage earning M others , A ccording to A nnual E arnings op F ath er . MOTHER NOT A WAGE EARNER. MOTHER A "WAGE EARNER« ANNUAL EARNINGS OF FATHER. Live births. Number of deaths in first year. Live births. INFANT MORTAL ITY RATE. Number . Mother of deaths a wage in first earner. year. Mother not a wage earner. Total........................................................ 266 50 1,165 137 188.0 117.6 Under $521........................................................ $521 to $624........................................................ $625 to $779........................................................ $780 or over, or “ ample ’ ’ 1............................ 105 53 48 60 26 8 6 10 114 112 176 763 30 18 18 71 247.6 150.9 127.1 166.7 263.2 160.7 102.3 93.1 1 See note on page 45. ILLEGITIMACY. Of the 1,551 births 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 con cerning 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 bom in wedlock. T able 3 4 .— D istribution op B irths and op D eaths D uring F irst Y e a r , I nfant M ortality R ate , A ccording to L egitimacy . and DEATHS DURING FIRST YE AR. LEGITIMACY. Illegitimate..................................................................................... Legitimate............................................................................................. Total births. 34 1,517 Live births. 32 1,431 Infant Number. mortality rates. 9 187 281.3 130.7 Thirty-two, or 3.7 per cent, of the 860 native mothers, as com pared with 2, or 0.3 per cent, of the 691 foreign mothers visited, had illegitimate children in 1911, 61112°— 15------ i https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N , PA. 50 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 mis carriages 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 aggre- \ gate 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 num bered 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 1 pregnancies. 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. T able 3 5 .— D istribution of M others , of L ive B irths , and of D eaths D uring F irst Y e a r ,.and I nfant M ortality R ate for B abies of N ative and F oreign Married M others , A ccording to the N umber of R eportable P regnancies . NUMBER OF BABIES. Number REPORTABLE PREGNANCIES FOR MARRIED of married MOTHERS. mothers. Bom alive. Total........................................................ 1,491 5,363 1 .................................................................. 2 ............................................................ 3 ..................................................................... 4 ............................................................ 5 .......................................................... 6 ........................................................... 7 .................... ....................................... 8. ................................................................ 9 ........... ........................................... 10 or more......................................................... 339 283 214 186 147 94 83 54 33 58 322 544 626 723 704 546 555 426 283 -634 INFANT MORTALITY RATE AMONG BABIES OF— Foreign Native All Died in first year. mothers. mothers. mothers. 804 149.9 113.1 184.6 35~ 59 92 78 103 88 78 95 41 135 108.7 108.5 147.0 107.9 146.3 161.2 140.5 223.0 144.9 212.9 75.9 76.5 118.0 99.4 86.1 157.4 100.0 157.6 128. 4 164.5 183.7 156.7 177.6 116.3 191.5 163.6 173.8 272.7 155.2 257.6 The statistics, based upon the results of all her reportable pregnan cies, show a generally higher infant mortality rate where the mother has had many pregnancies, but there is not always an increase from i “ 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY: JO H N STO W N , PA. 51 one pregnancy to the next. This is more clearly shown when the pregnancies are grouped as in the next table,. T able 3 6 .— I nfant M ortality R ate for all Children B orne b y Married M others , A ccording to Specified N umber of R eportable P regnancies . REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. Total Infant mortality rate, 149.9 land 2 .. 3 and 4 .. 5 and 6 .. 7 and 8 .., 9 or more 108.5 126.0 152.8 176.4 191.9 This tendency is shown in still another form of summary: Combi nations 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. T able 3 7 .— I nfant M ortality R ate for A ll Children B orne b y Married Mothers , A ccording to Specified N umber of R eportable P regnancies , b y G roups . REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. Infant mortality rate. GROUP 1. REPORTABLE PREGNANCIES FOR MARRIED MOTHERS. Infant mortality rate. GROUP 2. 108.5 124.7 119.2 171.5 178.8 183.9 This influence of the size of the family upon the infant mortality rate is shown in the computations giving the relative infant mor tality 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. T able 3 8 .— I nfant M ortality R ate for A ll Children B orne by Married M others , A ccording to the O rder in which the Child was B orn . order o f b ir t h . Infant mortality rate. 143.6 131.2 First and second bom children___ 138.3 ORDER OF BIRTH. Seventh-born child................................ Eighth-born child........................ i ............ Seventh and eighth born children. 144.2 142.0 Third and fourth born children___ 143.2 178.1 175.5 Fifth and sixth born children....... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 177.0 Infant mortality rate. 192.1 165.4 181.5 128.2 252.3 Ninth and later born children___ 201.1 IN F A N T M O RTALITY: JO H N STO W N , PA. 52 The next table gives a further elaboration of the same data; that is, it shows the infant mortality rate where such rates are lowest and highest, respectively, according to the age of the mother at the child’s birth and the order in which the child was born. Attention is again directed to the fact that the statistics presented in this section on “ Reproductive histories” are based upon the total number of reportable pregnancies; that is, in addition to the pregnancies resulting in births in 1911, all prior pregnancies of the women considered in the investigation have been included. T able 3 9 .—'Lowest and H ighest I nfant M ortality R ates , A ccording to A ge of M other at B irth of Child and the O rder in which Child w as B orn . INFANT MORTALITY RATES, ACCORDING TO MOTHER’ S AGE. ORDER Lowest mortality. o f b ir t h . Highest mortality. Mother’s Mortality Mother’s Mortality age. rate. age. rate. Second child...................... .................................................................... Fourth child....................................................................................... 20-24 140.0 Under 17 367.3 25-29 25-29 30-39 30-39 30-39 30-39 92.1 100.3 106.4 122.4 105.8 164.8 190.4 178.6 160.8 155.0 236.6 171.4 17-19 17-19 25-29 20-24 25-29 25-29 The differences in size of family for native and foreign mothers of different ages are indicated in the next table. The total and average number of live-born children, not reportable pregnancies, are given. T able 4 0 .— T otal and A verage N umber of L iv e -B orn Children B orne b y Married Mothers H avin g E ither a L ive B irth or a Stillbirth in 1911, Classified b y N ativity and A ge of Mother . ALL MARRIED MOTHERS. AGE OF MOTHER AT BIRTH OF CHILD IN 1911. NATIVE MARRIED MOTHERS. FOREIGN MARRIED MOTHERS. Live-bom chil dren. Total. Live-bom chil dren. Total. Number. Average. Live-born chil dren. Total. Number. Average. Number. Average. All ages___ 1,465 5,363 3.7 801 2,600 3.2 664 2,763 4.2 Under 20years.. 20 to 24 years___ 25 to 29 years___ 30 to 39 years___ 40 years and over. 81 456 389 459 80 96 908 1,261 2,480 618 1.2 2.0 3.2 5.4 7.7 62 258 196 240 45 70 483 536 1,188 323 1.1 1.9 2.7 5.0 7.2 19 198 193 219 35 26 425 725 1,292 295 1.4 2.1 3.8 5.9 8.4 The next table shows all losses of pregnancy sustained by 628 mothers and the rate of loss per 1,000 births for mothers having different numbers of births or reportable pregnancies. For all mothers it was 188.4. “ Loss,” as here used, means the sum of infant deaths (or deaths in first year) and stillbirths, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FAN T M O RTALITY: JO H N STO W N , PA. 53 T able 4 1 , —A ggregate N umber op B irths , L osses , and R ate op L oss B irths , A ccording to N umber op B irths per M other . NUMBER OF BIRTHS PER MOTHER. per Aggregate Aggregate number number of births. oflossesl 1,000 Rate of loss per 1,000 births. 5,617 1,058 188.4 335 554 648 748 740 576 574 432 324 686 53 87 113 109 133 119 104 102 65 173 158.6 157.0 174.4 145.7 179.7 206.6 181.2 236.1 200.6 252.2 ' The influence of the economic factor on infant mortality among the babies born prior to 1911 can not be determined with exact ness, as no inquiry was made concerning earnings of the father when the other children were born. But it is believed that his earnings during the year following the birth of the 1911 baby can be re garded as an index of the economic standing of the family for some time past. In individual cases, of course, revolutionary changes in the family’s income may have occurred, but for the great mass of people in the group considered it is not likely that within such a short space of time as that covered by the child-bearing period of the women considered— most of whom had not had numerous preg nancies:—marked changes had taken place. If these known earn ings are accepted as an index, the following variations are found to occur in the infant mortality rate for all the babies of whom a record was secured: T able 4 2 .— I nfant M ortality R ate por all Children op Married M others I ncluded in this I nvestigation , D istributed A ccording to the F ather ’ s E arnings . FATHER’ S a n n u a l e a r n in g s . Infant mortal ity rate. 197.3 193.1 163.1 f a t h e r ’ s a n n u a l e a r n in g s . $780 to $899..................................... ............. $900 to $1,199................................................. $1,200 and over............................................. Infant mortal ity rate. 168.4 142.3 102.2 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. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis GENERAL TABLES. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis GENERAL TABLES, B ir t h s A c c o r d in g t o N a t i o n a l i t y S e c t io n o f C i t y a n d W a r d . op M other, by Births to native mothers. op Births to all moth ers.1 T a b l e I . — D i s t r i b u t io n All sections............................. 1,551 860 691 87 69 18 42 20 li 14 36 14 6 13 6 6 5 1 2 106 100 6 1 34 72 33 67 1 5 1 - 118 90 107 83 11 7 5 4 142 78 64 18 41 3 24 17 1 2 6 6 1 4 52 14 3 1 3 204 59 5 21 4 4 2 22 1 4 6 2 15 4 2 2 1 • 4 4 4 2 1 11 5 3 1 Ward ft Cambria C ity .................................. W a r d IS W a r d 16 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 75 67 48 30 27 37 1 17 Ì13 57 20 77 25 33 18 18 88 24 2 59 49 330 31 299 11 7 24 98 201 • 65 139 169 133 36 21 204 135 69 42 89 55 60 44 45 46 45 10 14 30 4 8 38 30 8 4 6 6 Hebrew. Syrians a n d Greeks. 53 33 12 10 2 3 .7 4 2 2 3 1 4 2 2 1 2 2 1 3 2 1 38 1 1 2 1 1 3 37 V British. 75 17 105 225 Magyars. 76 Germans. Croatians, Ser vians, etc. 394 Italians. Slovaks,Boles, etc. Total. SECTION OF CITY AND W ARD. BIRTHS TO FOREIGN MOTHERS. 1 1 1 2 2 2 2 3 1 2 2 1 2 7 1 1 1 1 1 1 Includes both legitimate and illegitimate births. 57 INFANT. MORTALITY : JO H N STO W N , PA, 58 T a b l e I I . — D i s t r i b u t io n o f B i r t h s , L i v e B i r t h s , S t i l l b i r t h s , a n d D e a t h s i n F i r s t Y e a r , A c c o r d in g t o N a t i v i t y o f M o t h e r , b y S e c t io n o f C i t y a n d W ard. Live births. 45 85 691 648 43 4 69 63 6 4 18 17 1 Ward 1............................ 42 40 17 2 2 1 36 14 34 2 1 6 6 6 3 6 5 20 11 Kernville................................ 14 13 1 1 106 104 2 10 1 13 12 2 2 1 1 6 100 98 2 Ward 5 ................................... Ward 6 . ........................... 34 72 34 70 2 Hornerstown—Ward 7 .......... Roxbury—Ward 8 ................... 118 90 109 85 9 5 10 Conemaugh Borough........... 142 136 6 ■ 16 Ward 9 ................................... Ward 1 0 ................................. 75 67 72 64 3 3 10 6 Woodvale—Ward 1 1 .............. 113 57 6 2 2 29 12 3 3 33 67 33 65 17 107 83 100 Stillbirths. All births. Deaths in first year. 815 7 Stillbirths. Live births. 860 80 All sections................. 1,551 1,463 Stillbirths. 196 87 - Live births. 88 Down town........................... SECTION OF CITY AND W ARD. All births. All births. Deaths in first year. FOREIGN MOTHERS .1 NATIVE MOTHERS.1 Deaths in first year. ALL MOTHERS.1 1 I ll 5 5 5 1 1 1 5 6 6 1 2 1 1 1 5 X 2 3 5 16 11 9 79 7 4 8 7 6 2 1 1 2 78 75 3 6 64 61 3 10 48 30 46 29 2 1 3 3 27 37 26 35 1 2 7 3 24 33 16 17 1 6 8 1 88 83 5 24 22 2 2 23 3 2 1 Minersville—Ward 1 4 ............ 77 107 55 18 72 - 5 9 25 33 18 18 3 59 55 4 6 Cambria C ity ....................... 330 310 20 55 31 29 2 4 299 281 18 51 Ward 1 5 .......................... — Ward 1 6 ................................. 105 225 98 7 13 20 98 23. 1 1 1 35 7 24 6 212 3 201 92 189 6 12 19 32 Moxham—Ward 1 7 ................. 169 157 12 14 133 124 9 10 36 33 3 4 Morrellville............................ 204 194 10 16 135 129 6 10 69 65 4 6 Ward 1 8 ................................. Ward 1 9 ........................ Ward 2 0 ................. . 89 55 60 85 52 57 4 3 3 8 44 45 46 43 42 44 1 42 3 3 10 10 2 4 3 3 45 5 3 14 13 38 36 2 8 30 28 2 4 8 8 20 Coopersdale—Ward 21 ' : . . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 11 1 • 1 Includes both married and unmarried mothers. 2 4 2 1 4- IN F A N T M O RTALITY: JO H N STO W N , PA. T able 59 I I I .— D i s t r i b u t io n o f B ir t h s t o N a t i v e a n d F o r e i g n M a r r i e d M o t h e r s a n d P e r C e n t o f B ir t h s i n E a c h 'G r o u p t o T h o s e G a i n f u l l y E m p l o y e d , b y S e c t io n o f C i t y . and N umber B IR T H S TO M A R R IE D M O T H E R S . SECTIO N O F C ITY. Per cent.1 1,517 281 18.5 86 104 4 3 4.7 2.9 .9 112 Conemaugh Borough.............. 85 143 110 Morrellville........................... .. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 52 19 75 329 167 197 38 Total. Total. Num ber. 1 1 40 50 6 1 .2 28.0 45.5 11.5 1 121 30.7 36.8 18 1 0 .8 11 5.6 23 2 Gainfully em ployed. Gainfully em ployed. Gainfully em ployed. Total. All sections.................... Foreign. Native. All. Num ber. Num ber. Per cent.1 828 26 3.1 689 255 68 98 2 3 2.9 3.1 18 6 2 101 78 78 23 28 17 17 31 131 128 30 1 1 4 2 2 1 1 1 2 6 1 Not shown when base is less than 50. 1 .0 11 1.3 5.1 . 7 65 87 24 Per cent.1 37.0 36 48 4 55.4 55.2 22 120 37.9 40.3 16 5 7.2 2 1.5 4.7 58 298 36 69 8 2 60 IN FAN T MORTALITY : JO H N STO W N , PA, T a b l e I V . — D i s t r i b u t io n o f B i r t h s to M a r r i e d M o t h e r s A c c o r d in g to A t t e n d a n t a t B i r t h a n d t o N a t i v i t y o f M o t h e r , b y S e c t io n o f C i t y a n d W ard. A TTE N D A N T AT B IR T H . All married mothers. 2 Ward 1 ............................ Ward 2 ................................... Ward 3 ................................... Ward 4 ............................ 42 41 19 1 1 2 2 36 14 5 13 36 14 5 14 8 12 11 2 1 1 Kemville................................ 104 94 10 98 91 7 6 3 Ward 5 ................................... Ward 6 ................. ................. 34 70 32 62 2 8 33 65 32 59 1 6 5 3 Homerstown—Ward 7........ Roxbury—Ward 8 ................... 112' 93 78 18 7 1 101 89 73 11 il 4 5 Conemaugh Borough........... 143 72 70 1 78 66 11 Ward 9 ................................... Ward 1 0 ............................ 75 47 25 28 42 44 1 48 30 22 4 7 71 7 4 47 4 23 28 17 17 18 23 13 13 5 4 4 20 10 85 68 78 2 Midwife. 689 134 522 18 14 6 6 5 5 3 5 1 1 7 5 3 1 7 2 1 65 6 59 3 3 24 1 27 38 87 24 14 110 52 19 75 32 31 15 24 Cambria City......................... 329 53 255 21 31 26 Ward 1 5 ................................ Ward 16................................ 105 224 11 88 6 4 42 167 15 7 24 22 2 200 Moxham—Ward 1 7 ................. 167 140 26 1 131 123 8 20 17 18 Morrellville............................ 197 133 64 128 113 15 69 20 49 Ward 1 8 ................................ Ward 1 9 ................................ Ward 2 0 ................................ 87 55 55 46 48 39 41 7 16 42 45 41 36 42 35 6 45 10 10 6 35 3 6 14 4 4 19 Coopersdale—Ward 2 1 ______ 38 32 6 30 29 1 8 3 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 33 1 1 Woodvale—Ward 1 1 .............. Prospect—Ward 12................. Peelorville—Ward 13.............. Minersville—Ward 1 4 ............ 21 Other or none. 66 Midwife. 83 68 35 Physician. 743 6 All births. Physician. 828 80 Other or none. All births. 605 86 All sections................. 1,517 Other or none. 877 Down town........................... All births. Midwife. Native married mothers. Foreign married mothers. Physician. SECTION OF CITY AND W ARD. 2 8 2 58 U 5 298 27 3 Qft 16 250 20 21 61 IN FA N T M O RTALITY: JO H N STO W N , PA, 165 29 147 24 526 79 222 20 233 20 fBirths... 24 19 3 1 7 5 4 4 6 6 2 1 (Births... 275 31 14 46 5 35 4 96 12 29 2 37 3 4 3 6 2 1 fBirths... 234 30 7 1 44 12 20 5 83 9 40 2 23 4 5 2 2 1 4 fBirths... 229 22 27 1 24 6 88 9 31 1 43 4 4 5 1 1 1 5 fBirths... 182 18 2 21 4 17 56 8 37 2 34 3 5 7 1 2 fBirths... 164 15 2 10 1 20 2 50 6 32 1 30 3 9 1 6 3 1 1 fBirths... 107 17 2 5 14 2 37 6 16 3 18 1 4 2 6 1 2 1 3 1 fBirths... 79 8 . 2 1 2 6 27 2 13 2 13 1 6 2 4 2 4 fBirths... 58 15 1 1 2 1 26 11 7 2 15 1 1 1 3 2 .......... A 4 ................... -- 6 ........................... 6.................... ........... Unknown number of rooms. 6 rooms. 33 3 38 6 9 rooms. 5 rooms. 1,463 196 8 rooms. 4 rooms. mirths... [Deaths.. 7 rooms. 3 rooms. 3......... - 2 rooms. 2.................... 10 rooms and over. f a m il y N U M B E R O F B A B IE S "WHO W E R E B O R N A L IV E A N D N U M B E R OF SUCH B A B IE S W H O D IE D D U R IN G FIRST Y E A R IN H O M E S H A V IN G — 1 room. person s pe r (N O T IN C L U D IN G B A B Y ). All live-bom ba bies. T a b l e V . — D i s t r i b u t io n o f L i v e B ir t h s a n d o f D e a t h s D u r i n g F i r s t Y e a r , A c c o r d in g t o N u m b e r o f P e r s o n s a n d N u m b e r o f R o o m s p e r F a m i l y . 43 6 36 4 1 1 1 16 1 3 1 10 1 3 12.................... 21 5 1 1 10 2 2 i 6 1 1 1 13------------ - 20 4 1 13 3 4 1 14.................... 8 2 1 5 1 2 1 15.................... 6 1 3 2 16.................... 4 2 4 2 3 1 1 1 1 1 18.................... 5 1 1 2 2 20.................... 3 1 1 22................. 1 1 19.................... 23....... ............ Not reported. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 1 1 i ......... 1' 1 1 22 3 7 1 1 . 1 1 1 1 1 1 1 1 1 12 2 2 2 11.................... 17.................... 22 4 1 1 1 62 T IN FAN T M O RTALITY: JO H N STO W N , PA, V I . — D i s t r i b u t io n o f B i r t h s , L i v e B i r t h s , S t i l l b i r t h s , D u r i n g F i r s t Y e a r , A c c o r d in g t o N a t i o n a l i t y ( D e t a i l e d ) able N A T IO N A L IT Y OF M O T H E R . Welsh............................................................................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis All births. Live births. and of of D e a th s M o t h e r .' Still births. Deaths during first year. 1,551 1,463 88 860 815 45 85 691 648 43 111 394 367 27 65 276 108 2 7 1 258 100 2 6 1 18 8 48 14 1 3 196 76 72 4 19 34 39 3 32 37 3 2 2 8 10 1 75 53 38 33 12 13 4 4 71 47 38 31 12 13 3 3 4 6 13 6 4 4 2 2 12 12 10 2 10 2 10 10 2 i 1 IN F A N T M O RTALITY: JO H N STO W N , PA, 63 T a b l e V I I . — D i s t r i b u t io n o f B i r t h s , L i v e B i r t h s , S t il l b i r t h s , a n d o f D e a t h s D u r i n g F i r s t Y e a r , A c c o r d in g t o A t t e n d a n t a t B a b y ’ s B i r t h a n d N a t i o n a l it y of M o t h e r . A T T E N D A N T A T B A B Y ’ S B IR T H A N D N A T IO N A L IT Y OF M O T H E R . All mothers...................................... Physician............................... Midwife...................................... Other.............................................. None....................................... Native mothers....................................... Physician................................................. Midwife.......................................... Other..................................................... Foreign mothers......................................... All births. Live births. 1,551 1,463 928 * 588 14 21 866 562 14 21 860 815 774 84 2 730 83 2 Still births. Deaths in first year. 62 85 i 691 Physician.............................................. Midwife..................................................... Other..................................................... None...................................................... 154 504 12 21 Slovak, Polish, etc........... ............................... .. . 394 Physician......................................................... ; Midwife........................................................ Other......................................................... None............................................................. 45 340 12 21 1 7 Croatian, Servian, etc....................................... 76 Physician.................................................... Midwife........................................................ Other....................................................... None........................................................... 31 22 14 _ 9 14 2 Italian.............................................................. Physician.......................................... . Midwife....................................................... X 71 German........................................................ Physician......................................................... Midwife................................................. Magyar....................................................................... Physician.......................................... Midwife....................................... •........... 6 27 26 38 38 7 31 31 British............. ..................................... Physician.............................................. Midwife.............................................. Other............................................ Syrian and Greek............................... Physician................................................. Midwife.............................................. Hebrew..................................................... Physician. Midwife... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 12 i 12 3 9 10 10 8 8 2 2 64 INFANT, MORTALITY : JO H N STO W N . PA, Table V I I I .— in g to D i s t r i b u t i o n o f D e a t h s o f I n f a n t s a t S p e c if ie d A g e , A c c o r d Ca u s e o f D e a t h of I n f a n t a n d N a t iv it y of M o t h e r . AG E AT DEATH. ai L ess 08 th an w eek . 1 1 w eek b u t less th a n 1 m on th . 1 m on th b u t less th a n 1 year. o u < m’ 9 & ¡g P P © CO A © a © © eh 13 o >> 03 P !>» U CO P A * ft <N CO o H £ rH © © • CO CO 9 A 43 CO I .a 4-3 CO c3 rP CO d-3 4 CO 43 43 P ,© P rO P A 4 -a ,P P P »43 P a CO a co a> P © © P rO .d-3 4 P O A o a a <N Eh ,h O 9 © p A co M CO 43 CO 13 . © A <N >> cS CO a c3 A 43 CO b u t less th an m on th . c3 C A U SE OF D E A T H OF IN F A N T A N D N A T IV IT Y O F M O T H E R ? >> p- © > o C9 a All causes.......................... 196 45 30 4 11 29 14 7' 8 122 18 16 42 31 15 Native mothers........................... Foreign mothers......................... 85 111 25 20 18 3 1 4 7 9 20 2 12 1 6 6 2 51 71 9 9 7 9 18 24 12 19 5 10 5 3 2 46 5 4 17 15 5 3 2 i 2 16 30 3 5 12 5 10 2 3 12 Diarrhea and enteritis........... 52 1 1 Native mothers................................. Foreign mothers................................. 17 35 1 1 5 Respiratory diseases............... 50 Native mothers.................................. Foreign mothers................................. 19 31 Premature births.................... 24 21 19 Native mothers.................................. Foreign mothers................................ 11 11 11 13 10 8 Congenital debility or mal formation ............................. 19 10 7 Native mothers.................................. Foreign mothers........... ..................... 5 14 4 3 6 Injuries at birth...................... 7 7 Native mothers.................................. Foreign mothers................................. 6 G 1 1 Other or not reported............ 44 Native mothers.................................. Foreign mothers............................... . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 27 17 3 3 3 47 7 4 15 13 8 19 28 2 5 2 2 8 7 5 8 2 6 3 i 2 3 i 2 3 3 2 3 3 2 3 3 1 2 6 2 1 4 1 1 1 3 2 2 3 2 1 1 6 1 1 3 3 1 1 3 1 1 5 2 3 4 12 6 1 5 26 5 6 10 3 2 1 3 8 4 2 1 5 16 10 4 4 2 5 2 1 1 4 1 1 T a b l e IX.— D i s t r i b u t io n 1 o f B a b i e s A l i v e a t B e g i n n i n g o f E a c h M o n t h f r o m F i r s t t o N i n t h , A c c o r d in g t o T y p e o f F e e d i n g D u r i n g E a c h M o n t h ; N u m b e r C o n t i n u i n g S u c h D i e t U n t i l F o l l o w in g M o n t h ; N u m b e r C h a n g i n g t o O t h e r S p e c i f i e d T y p e o f F e e d i n g ; N u m b e r o f D e a t h s in E a c h G r o u p in F ir s t Y e a r a n d a l s o D e a t h s a t B e g in n in g o f N e x t M o n t h . 61112 A L IV E A T B E G IN N IN G OF SPECIFIED M O N T H . O N S A M E D IE T A T B E G IN N IN G OF NEXT M ONTH. CHANGED TO M IX E D DIET A T B E G IN N IN G OF N E X T M O N T H . C H A N G E D TO A R TIFICIAL D IE T A T B E G IN N IN G OF N E X T M ONTH . C H A N G E D TO B R E A S T E X C L U S IV E L Y A T B E G IN N IN G OF NEXT M ONTH. Total. Lived first year. First month...................... . 1,463 1,267 Breast exclusively..................... . Mixed..................... , ..................... Artificial exclusively.................. No feeding, infant died at once 1,333 43 55 32 1,193 36 38 Died in first year. 140 7 17 32 Total. 1,180 34 53 Lived first year. Died in first year. 1,164 103 Second month...... ............. 1,389 1,267 1,306 1,213 1,181 . 77 131 1,096 71 1,111 1,051 68 94 74 121 Third month.................... . 1,371 1,267 Breast exclusively...................... Mixed............................................ Artificial exclusively.................. 1,112 98 161 1,052 89 126 92 150 Fourth month................. . 1,355 1,267 1,211 1,148 Breast exclusively..................... Mixed...........................; .............. . Artificial exclusively............. . 987 175 193 941 165 161 166 177 835 159 . 154 Fifth month..................... . 1,337 1,267. 1,203 1,159 871 253 213 838 243 186 780 227 196 760 220 179 Breast exclusively.. . Mixed......................... . Artificial exclusively. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 104 Lived first year. Died in first , year. Total. 39 78 84 36 1,095 32 37 Breast exclusively..................... . Mixed.......................................... . Artificial exclusively.................. 100 Total. 1,145 24 83 940 84 121 87 Lived first year. Died in first, Total. year. Lived first year. Died in first year. Dead at beginning oi next month. IN F A N T M O RTALITY: JOH N STO W N T Y P E O F FEEDING-. 32 05 cn T IX.— D i s t r i b u t i o n o p B a b i e s A l i v e a t B e g i n n i n g o f E a c h M o n t h p r o m F i r s t t o N i n t h , A c c o r d in g t o T y p e o p F e e d i n g D u r i n g E a c h M o n t h ; N u m b e r C o n t i n u i n g S u c h D i e t U n t i l F o l l o w i n g M o n t h ; N u m b e r C h a n g i n g t o O t h e r S p e c if ie d T y p e o p F e e d i n g ; N u m b e r o p D e a t h s i n E a c h G r o u p i n F i r s t Y e a r a n d a l s o D e a t h s a t B e g i n n i n g o p N e x t M o n t h — Continued. able A L IV E A T B E G IN N IN G OF SPECIFIED M O N TH . O N S A M E D IE T A T B E NEXT G IN N IN G OF M O N TH . CHANGED TO M IX E D D IE T A T B E G IN N IN G OF N E X T M O N T H . C H A N G E D TO ARTIFICIAL D IE T A T B E G IN N IN G OF N E X T M ONTH. C H A N G E D TO B fiE A S T E X C L U S IV E L Y A T B E G IN N IN G OF NEXT M O N TH . Sixth month...................................... Total. Lived first year. Died in first year. Total. Lived first year. Died in first year. Total. Lived first year. Died in first year. Total. Lived first year. Died in first year. Total. Lived first year. Died in first year. Dead at beginning of next month. 1,318 1,267 51 1,108 1,064 44 160 158 2 45 45 Breast exclusively......................................... Mixed....................................... Artificial exclusively........................ 780 310 228 760 300 207 20 10 21 616 287 205 598 279 187 18 148 147 1 15 15 8 12 11 1 10 20 10 20 Seventh month................................... 1,313 1,267 46 1,166 1,130 36 112 110 2 27 27 616 447 250 598 437 232 18 502 429 235 489 420 98 14 96 14 13 3 13 3 3 221 13 9 14 2 18 11 11 4 1,305 1,267 38 1,141 1,119 22 95 94 i 55 54 502 541 262 489 530 248 13 388 507 224 7 90 4 1 11 11 9 91 4 14 395 516 230 19 25 Ninth month....................................... .1,291 1,267 24 1,003 989 14 158 158 Breast exclusively......................................... Mixed........................................... Artificial exclusively..................................... 395 611 285 388 601 278 7 220 551 232 217 543 229 3 10 140 18 3 140 18 Breast exclusively..................................... Mixed.................................................. Artificial exclusively............................... Eighth month..................................... Breast exclusively.......................... ........... Mixed....................................... Artificial exclusively................................. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 11 7 18 6 8 5 3 1 14 19 24 1 7 121 120 1. 32 40 49 31 40 49 1 IN FAN T M O RTALITY: JO H N STO W N , PA, T Y P E OF F E E D IN G . os IN F A N T MORTALITY JO H N STO W N - PA, 67 T a b l e X . — D i s t r i b u t io n o p B ir t h s t o M a r r i e d W a g e - e a r n i n g M o t h e r s , A c c o r d in g t o H u s b a n d ’ s A n n u a l E a r n i n g s a n d N a t i v i t y a n d E a r n i n g s o p M other. B IR TH S TO M A R R IE D W A G E -E A R N IN G M O T H E R W IT H B A N D E A R N IN G A N N U A L L Y — N A T IV IT Y A N D A N N U A L E A R N IN G S OF M A R R IE D M O T H E R . Total births. Under $521. $521 to $624. $625 to $779. $780 to $899. $900 to $1,199. All wage-earning mothers.. 281 112 57 51 25 14 Under $53..-...................................... $53 to $103......................................... $104 to $207........................................ $208 to $311........................................ $312 and over.................................... Not reported................................... 20 6 5 23 46 23 14 16 16 8 12 8 4 7 3 4 7 1 57 89 60 46 9 1 11 4 12 19 3 i i 2 1 6 1 3 1 9 3 6 5 5 4 3 3 2 2 1 1 1 1 2 2 Foreign wage-earning mothers.. 255 54 47 19 Under $53....... .................... ................... $53 to $103................................................. $104 tò $207............................................... $208 to $311............................................. $312 and over.......................................... Not reported.......................................... 14 52 84 56 43 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 21 2 26 1 1 2 3 103 4 1 2 21 11 20 15 16 9 17 7 45 4 13 8 12 8 3 5 6 1 i 7 7 Native wage-earning mothers... 1 $1 ,2 0 0 and Ample.1 over. 2 2 Under $53................................................. $53 to $103................................................. $104 to $207............................................... $208 to $311............................................... $312 and over................................ .......... Not reported.......................................... 3 3 3 3 H US See note on page 45, 2 13 i 18 3 3 3 3 2 2 i 1 2 1 7 4 T able XI.— D is t r ib u t io n op R esults op R e p o r t a b l e P r e g n a n c ie s ( L i v e B ir t h s a n d St il l b ir t h s ) N u m b e r p e r M o t h e r a n d N a t iv it y op M o t h e r . and M i s c a r r i a g e s , A c c o r d in g to M IS C A R R IA G E S I N A D D IT IO N TO R E P O R T A B L E P R E G N A N C IE S . R E P O R T A B L E P R E G N A N C IE S A N D R E S U L T S T H E R E O F . Live births. All married mothers.. Total Total preg births. nancies. Excess due to plural births. Stillbirths. Number of mothers reporting miscarnages. Deaths in first year. Number of mothers. Num ber. Number of mothers having live births. Num ber. Num Number ber of of Infant mothers mortality still births. having rate. babies die. N umber of mothers having still births. Number of miscar Per cent riages re ported. of all births. Total mothers. Per cent of all mothers. 5,654 5,617 63 1,491 5,363 1,465 804 509 149.9 254 194 4.5 191 130 8.7 343 576 650 752 740 568 586 437 299 4 318 279 214 186 147 93 83 54 33 58 6 .1 8 8 32 24 29 36 28 23 23 27 15 13 14 16 18 18 14 14 15 9 ,45 5.6 3.7 3.9 4.9 3.9 5.3 2.5 5.4 4.8 23 26 20 108.7 108.5 147.0 107.9 146.3 161.2 140.5 223.0 144.9 21 78 95 41 135 34 54 75 64 67 60 48 42 666 322 544 626 723 704 546 555 426 283 634 35 59 92 78 103 2 12 339 283 214 186 147 94 83 54 33 58 21 3................................................. 4................................................. 5................................................. 6 ................................................. 7................................................. 8 ................................................. 9............................................... 1 0 or more............................... 339 566 642 744 735 564 581 432 297 654 8 10 2.4 5.7 8.4 9.7 9.5 14.9 18.1 16.7 (i) 17.2 Native................................. 2,717 2,744 27 816 2,600 801 294 1 .......... ........................................ .. 2 .......................................................................... 3 .......................................................................... 234 346 333 376 325 236 351 338 377 326 2 234 173 222 222 222 266 184 117 314 267 187 118 322 224 327 322 362 302 216 250 184 109 304 17 25 38 36 26 34 25 29 14 50 1 ................................................ 2 ................................................ 4 ........................................................ 5 .......................................................................... 6 ........................................................ 7........................................................ 8 ........................................................ 9 .......................................................................... 1 0 or more ..................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 8 8 5 4 5 5 5 5 1 1 1 3 1 8 111 94 65 37 38 23 13 28 170 111 94 65 37 38 >23 13 28 88 22 31 11 21 31 13 22 7 22 20 2 1 2 .9 16 32 17 206 113.1 144 115 5.2 136 92 11.3 17 23 31 31 75.9 76.5 118.0 99.4 12 5.1 7 18 8 6 .1 10 10 15.4 6 18 17 7 19 1 0 0 .0 157.6 128.4 164.5 17 3 9 18 4.7 4.0 7.4 • 2J7 6.4 3.0 7.5 13.5 157. 4 16 13 19 5 ii 7 13 15 21 22 24 16 15 24 12 21 2 6 10 1 .6 8 7.6 5.6 4 11 6 .8 21 13 13 17 25 10 13 5 3 7 10. 6 m m l 1) (*) IN FAN T M O RTALITY: JO H N STO W N , PA. NUMBER o p r e p o r t a b l e p r e g n a n c ie s PER M OTHER AND N A T IV IT Y O F M O T H E R . 05 00 Foreign............. ................. 2,837 105 220 or more....................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 107 225 312 375 414 346 • 319 250 181 344 36 675 2 105 5 3 7 4 4 4 110 2 1 4 103 92 82 57 45 31 20 30 2,763 98 217 304 361 402 330 305 242 174 330 664 96 109 103 92 82 56 45 31 20 30 510 18 34 54 42 77 54 53 66 27 85 303 17 31 44 33 46 38 30 25 13 26 iNot shown when base is less than 50. 184.6 183.7 156.7 177.6 116.3 191.5 163.6 173.8 272.7 155.2 257.6 110 9 8 8 14 12 16 14 8 7 14 79 3 .8 ' 9 7 7 8.4 3. 6 8 12 8 11 5 5 7 < 2 .6 3.7 2.9 4. 6 4.4 3. 2 3.9 4.1 55 38 5.6 1 1 1 .0 5 5 7 6 2 7 9 4 (*) lit 0 ) 0 ) IN FA N T M O RTALITY: JO H N STO W N , PA. 10 309 368 410 342 315 248 180 340 2,873 O CO T able XII.— 'D i s t r i b u t i o n op R esults to op N umber R e p o r t a b l e P r e g n a n c i e s ( L i v e B ir t h s a n d S t i l l b i r t h s ) p e r M o t h e r a n d A g e op M o t h e r a t E a c h P r e g n a n c y . R E P O R T A B L E P R E G N A N C IE S . N U M B E R OF R E P O R T A B L E P R E G N A N C IE S A N D A G E OF M O T H E R A T B IR T H OF B A B Y B O R N IN 1911. L IV E B IR TH S. B A B IE S D Y IN G IN FIRST Y E A R . and M i s c a r r i a g e s , A c c o r d in g STILLBIRTHS. M ISC A R R IA G E S . Resulting births. Total. Mothers reporting. Number of mothers. Num ber. Number of mothers. Num ber. Number of mothers. Infant mortal ity rate. Num ber. Number of mothers. Per cent Num of all ber re births. ported. Number. Per cent of all mothers. 191 130 8.7 All married mothers___ 5,554 5,617 63 1,491 5,363 1,465 804 509 149.9 254 194 4.5 Under 20 years.......................... 20 to 24 years.............................. 25 to 29 years.............................. 30 to 39 years.............................. 40 years and over..................... Average age: 28 years. 107 933 1,316 2,570 628 108 946 1,329 2,595 639 1 96 908 1,261 2,480 618 81 456 389 459 80 12 11 12 1 1 .1 140 185 382 85 115 132 207 44 125.0 154.2 146.7 154.0 137.5 12 38 4.0 5.1 4.4 3.3 19 46 95 31 3.9 66 21 29 55 84 14 18 27 11 89 461 395 466 80 19 14.2 23.8 6 .1 8 8 2.4 13 13 25 68 115 reportable pregnancy........ 339 343 4 339 322 318 35 34 108.7 21 21 Under 20 years.................................. 20 to 24 years..................................... 25to29yeafs..................................... 30 to 39 years..................................... Average age: 23 years. 74 178 57 30 75 179j 58 31 1 1 1 1 74 178 57 30 67 176 54 25 66 8 8 18 4 5 119.4 102.3 74.1 (2) 8 175 53 24 7 18 4 5 3 4 3 4 6 10 283 544 279 59 54 108.5 12 21 12 156 74 39 154 73 38 3 37 9 5 (2) 139.1 63.8 65.8 2 302 141 76 4 3 42 9 5 214 626 214 92 75 3 77 95 36 3 8 3 77 95 36 3 1 1 40 41 31 33 8 2 8 2 1 reportable pregnancies___ 566 576 Under 20 years.................................. 20 to 24 years..................................... 25 to 29 years................................... . 30 to 39 years..................................... 40 years and over........................ . Average age: 25 years. 24 312 148 78 4 24 317 151 80 4 3 reportable pregnancies___ 642 650 Under 20 years.................................. 20 to 24 years..................................... 25 to 29 years.................................... 30 to 39 years...........*......................... 40 years and over............................. Average age: 26 years. 9 231 285 108 9 9 234 288 3 3 110 2 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 9 5 3 2 8 1 227 277 105 9 3 3 3 3 6 10.7 1.7 6.9 (2) 2 2 32 28 5.6 23 16 3 15 (2) 4.7 4 3 13 9 3 147.0 24 (2) 176.2 148.0 76.2 (2) 1 7 11 6 11 5 5 10 6 6 6 .6 5 5.0 12 3 7 23 3.7 26 18 1 (2) 3.0 3.8 4.5 7 14 4 6 1 1 2 7 4 6 .8 1.7 5.3 (2) 5.7 3.8 4.1 (2) 8.4 7.8 7.4 (2) (2) IN FAN T M O RTALITY: JO H N STO W N , PA. Num Excess ber. over preg nancies.1 “3 ® 4 reportable pregnancies. . . . 30 to 39 years..................................... 40 years and over............................. Average age: 29 years. 5 reportable pregnancies----- 744 752 8 160 301 255 36 4 735 740 5 50 280 375 30 50 283 377 30 ' 564 568 6 6 1 3 21 3.9 22 18 12 11 6 ~6 10 7.5 3 3 3 3 20 14 723 186 78 64 107.9 39 75 63 9 148 290 249 39 75 63 28 21 26 21 23 17 3 189.2 89.7 84.3 (2) 147 704 147 103 67 146.3 36 31 4.9 10 10 183.7 191.7 1 1 17 16 15 14 2 .0 6 .0 6 9 51 40 3 7 31 27 6 49 266 361 28 94 546 93 88 60 161.2 22 13 3.9 23 14 1 21 6 4.5 4.1 1.5 6 3 15 13 56 75 3 2 56 75 2 . 1 1 0 .8 (S ) ' 2 9.7 (2) 8 .0 9.5 (2) 9.5 7.1 10.7 (2) 4.2 (2) Average age: 30 years. 6 reportable pregnancies----- 4 14.9 1 2 1 60 1271 347 60 17 36 (s) 181.1 155.6 66 133 362 67 3 23 54 11 66 11 8 6 1 2 1 .2 1 1 11 1 581 586 5 83 555 83 78 48 140.5 31 22 5.3 27 15 255.6 119.4 113.6 9 18 4 5 15 1 0 .0 2 1 4.6 4.3 19 2 223.0 ii 7 2.5 15 .9 16.7 215.9 10 1 6 1 2.4 (2) 15 9 17.6 132 360 22 (2) (2) Average age: 33 years. 7 reportable pregnancies----- 98 * 392 91 99 395 92 14 56 13 90 377 88 14 56 13 23 45 1 10 13 28 7 432 437 5 54 426 54 95 42 2 51 3 87 1 3 18.1 (2) (2) 6 “ Averageage: 3 4 years. 8 reportable pregnancies----i 30 to 39 years..................................... 40 years and. over.............................. Average age: 35 years. 9 reportable pregnancies----- 16 408 16 413 8 8 297 299 207 90 208 91 654 666 12 360 294 364 302 4 40 (2 ) 1 403 7 2 33 283 33 41 20 144.9 16 11 5.4 13 8 1 1 23 195 23 13 3 6.3 3.3 4 10 164.1 1 0 2 .3 5 88 15 5 8 10 32 9 5 51 1 3 24.2 (2) (2) “ Average age: 37 years. 10 or more reportable preg nancies----- ---------------------- 8 8 58 634 58 135 45 212.9 32 17 4.8 14 10 33 25 342 292 33 25 85 50 26 19 248.5 171.2 22 10 11 6 6 .0 7 6 3.3 “ Average age: 39 years. 1 Excess of births over pregnancies due to plural births. Rate not computed because of small base. 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 Includes 21 having 10 pregnancies; 16 having 11; 11 having 12; 6 having 13; 3 having 14; 1 having 16. 17.2 (*) (2) IN F A N T M O RTALITY: JOH N STO W N 156 300 252 36 29 186 T a b l e X I I I . — D is t r ib u t io n op R esults op to R e p o r t a b l e P r e g n a n c i e s (L i v e B i r t h s a n d S t i l l b i r t h s ) N u m b e r per M o th er a n d H u s b a n d ’ s E a r n in g s . L IV E B IR T H S . R E P O R T A B L E P R E G N A N C IE S . Mothers reporting. Resulting births. Total. Number Infant Num Num mortality of mothers. ber. ber. rate.1 Num ber. Number of mothers. 63 1,491 5,363 1,465 804 149.9 509' 8 902 227 173 227 163 143 49 483 178 129 130 99 78 30 160 197.3 193.1 163.1 168.4 142.3 161.3 95.6 110 797 588 548 186 1,674 108.7 Excess Number. over preg nancies. 5,617 Husband earns: Under $521.............................. $521 to $ 6 2 4 ..,...................1.. $625 to $779............................... $780 to $899............................. $900 to $1,199.......................... $ 1 ,2 0 0 and over....................... Ample 2 .................................... 938 691 816 611 574 196 1,728 946 700 826 616 581 199 1,749 21 233 174 229 166 146 50 493 reportable pregnancy.. . 339 343 4 339 322 318 35 48 48 23 48 35 43 43 22 22 46 . 32 36 13 130 44 32 35 13 129 11 2 6 544 62 Husband earns: reportable pregnancies. . Husband earns: $625 to $ 7 7 9 ........................... $780 t.r> $R9Q Ample 2 ...................... ............ 1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 5 7 3 39 1 136 13 137 1 48 23 46 35 38 13 136 566 576 10 283 2 2 1 31 36 55 28 23 23 46 35 38 2 9 10 62 72 64 74 110 111 56 46 16 204 56 46 16 209 2 5 8 102 668 68 108 53 41 14 198 254 194 4.5 31 25 61 48 18 109 44 32 29 28 33 13 75 23 24 9 61 4.7 4.6 3.5 4.5 5.7 6.5 4.3 34 21 21 6 .1 75 88 11 2 5 3 4 3 4 1 Number Per cent Num ber re of all of Per cent mothers. births.1 ported. Number. of all mothers. 21 191 130 8.7 27 17 14 15 19 18 7.31 1 2 .0 22 21 30 25 8 .0 6 .6 11.4 12.3 8 6 58 41 8.3 8 8 2.4 1 2 1 2 5 1 2 1 2 3 3 3 3 1 8 61.5 8 7 7 5.1 5 5 279 59 108.5 54 32 28 5.6 23 16 5.7 31 36 55 28 23 7 99 11 8 176.4 177.6 157.4 169.8 11 6 2 6 2 6 8 .1 3 16 7 3 3 5 2.7 5.4 2 1 2 2 4.4 55.6 2 1 11 3 3 5 2 11 1 8 17 9 2 1 11 ( 3.1 4 4 1 5.3 9 4 1 6 5.9 M O RTALITY: JO H N STO W N , PA. Number of mothers. 5,554 1 M ISC A R R IA G E S . STILLBIRTH S. B A B IE S D Y IN G IN FIRST Y E A R . pregnancies.. A 11 reporta ble M i s c a r r i a g e s , A c c o r d in g IN F A N T SPECIFIED N U M B E R O F P R E G N A N C IE S F O R A L L M A R R IE D M OTH ERS A N D A N N U A L E A R N IN G S O F H U S B A N D . and 3 reportable pregnancies.. Husband earns: Under $621...... ...................... $521 to $624.............................. $625 to $779............................ $780 to $899.............................. $900 to $1,199........................... $1 ,2 0 0 and over....................... Ample2. . . ............. ................ 5 reportable pregnancies. Husband earns: Under $521............................ $521 to $624............................ $625 to $779........ .................... $780 to $899............................ $900 to $1,199......................... $1 ,2 0 0 and over................. Ample2. . . ............................ 6 reportable pregnancies. . Husband earns: Under $521.............................. $521 to $624.............................. $625 to $779.............................. $780 to $899...................... $900 to $1.199................... . $1 ,2 0 0 and over....................... Ample 2 .................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 650 8 214 626 214 114 115 104 84 87 58 7 195 1 2 38 34 28 29 19 110 101 84 87 57 6 192 38 34 28 29 19 1 2 T 2 3 64 188 64 744 752 8 186 723 186 104 104 89 137 97 58 41 226 26 101 86 26 1 1 1 2 1 2 34 24 14 56 129 95 55 39 218 147 704 147 26 18 26 18 102 88 136 96 56 40 224 i 735 740 5 130 90 131 91 1 1 22 34 24 14 10 82 83 55 22 10 56 210 212 2 42 125 85 99 106 60 26 203 564 568 4 94 546 93 132 60 114 48 72 132 60 115 48 74 12 127 22 10 124 59 21 10 19 110 19 8 12 2 21 48 70 8 12 2 21 100 110 100 110 66 30 65 30 12 126 20 22 1 13 6 1 2 1 ' 11 124 iNot shown when base is less than 50. 20 22 13 6 42 IN F A N T M O RTALITY: JO H N STO W N , PA. 4 reportable pregnancies. . Husband earns: Under $521............... »............ $521 to $624............................ $625 to $779.............................. $780 to $899.................... ......... $900 to $1,199........ ................. $1 ,2 0 0 and over....................... Ample 2 .................................... 642 T able XIII.— D i s t r i b u t i o n op R to reportable 7 reportable pregnancies. . p r e g n a n c ie s . $ 7 8 0 t o $890 $ 9 0 0 t o $1 1 9 9 8 reportable pregnancies. . B A B IE S D Y IN G IN FIR ST Y E A R - Number Num of ber. ■mothers. Number Infant Num mortality of ber. rate.1 mothers. Total. Excess Number. over preg nancies. . • 9 reportable pregnancies. . $780 t o $899 . * 9 0 0 t o $1 1 9 9 Amnles.................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis M ISC A R R IA G E S . STILLBIRTH S. Num ber. Number of mothers. Per cent Num ber re of all Per cent births.1 ported. Number. of all mothers. 581 586 5 83 555 83 78 140.5 48 31 22 5.3 27 15 91 56 98 35 84 92 56 101 35 84 1 13 g 14 5 88 51 97 32 79 13 8 14 13 15 16 147.7 294.1 164.9 4 5 4 3 5 4 4 3 4.3 8.9 4.0 2 1 2 2 6 .0 3 5 3 21 22 1 22 5 12 3 8 6 9 5 5 4 1 3 1 1 196 196 8 2 186 28 20 107.5 14 10 7 5.1 2 12 432 ' 437 5 54 426 54 95 223.0 42 11 7 2.5 15 9 120 120 15 31 2 1 1 12 5 6 12 5 6 12 10 3 4 2 2 2.5 4.1 2 1 4 5 3 3 2 3 22 11 11 6 265.0 234.0 5 88 98 41 49 24 16 89 1 2 11 117 94 41 46 24 16 15 96 • 40 48 24 16 88 2 11 11 125.0 2 6 1 1 1 .1 297 299 2 33 283 33 41 144.9 20 16 11 81 72 18 18 18 18 72 82 72 18 19 18 18 72 1 9 8 2 2 2 2 8 80 70 15 17 18 16 67 9 8 2 2 2 2 8 15 187.5 142.9 6 6 2 2 2 1 1 2 Husband earns: $521 to $624. . $625 to $779 . c c o r d in g ' Mothers reporting. Number of mothers. 12 3 Husband earns: $521 t o $024 $025 t o $779 $780 t o $899 $ 9 0 0 t o $1 19 9 M is c a r r ia g e s , A Resulting births. Husband earns: $521 t o $fi24 L IV E B IR T H S . and 3 1 6 7 8 8 .6 1 3 10 3 5 2 2 2 9 134.3 4 2 2 1 5 4 / / 1 2 1 7 5 i 3 1 1 1 1 5.4 13 8 2.4 3 3 2 1 1 6 2 2 .8 6.9 78.1 3 16.7 IN FAN T M O RTALITY: JO H N STO W N , PA. SPECIFIED N U M B E R OF P R E G N A N C IE S F O R A L L M A R R IE D M OTHERS A N D A N N U A L E A R N IN G S O F H U S B A N D , R e p o r t a b l e P r e g n a n c ie s (L i v e B ir t h s a n d S t il l b ir t h s ) N u m b e r p e r M o t h e r a n d H u s b a n d ’ s E a r n i n g s — Continued. e su l t s op 10 or more reportable pregnancies...................... Husband earns: Under $521.............................. $521 to $624............................. $625 to $779.............................. $780 to $899.............................. $900 to $1 199 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 666 56 32 70 78 114 24 280 58 33 71 80 114 24 286 1 12 58 634 58 2 1 1 2 5 ,3 5 3 7 52 32 70 76 10 2 110 22 10 2 25 272 25 6 • 6 Not shown when base is less than 50. 6 7 IN F A N T M O RTALITY: JO H N STO W N , PA. Ample 2 .............. ..................... 654 IN FAN T M O RTALITY: J O H N STO W N , PA, 76 T a b l e X I V . — D i s t r i b u t i o n A c c o r d in g t o N u m b e r G r o u p s o p M a r r ie d M o t h e r s Cl a s s if ie d ALL M OTH ERS. m o t h e r ’s a g e a n d able n um ber of report op by P r e g n a n c ie s N a t iv it y . N A T IV E M O T H E R S . and A ge F O R E IG N m o t h e r s . - P R E G N A N C IE S . Number. Per cent. Number. Per cent. Number. Per cent. Total pregnancies.......................... 1,491 1 0 0 .0 816 675 1 0 0 .0 1 ................................................................... 2 ........................................ .......................... 22.7 19.0 14.4 12.5 9.8 6.3 5.6 3.6 234 173 28.7 105 2 1 .2 110 3................................................................... 4................................................................... 5................................................................... 6 ................................................................... 7................................................................... 8 ................................................................... 9 ................................................................... 1 0 and over................................................. 339 283 214 186 147 94 83 54 33 58 111 103 92 82 57 45 31 15.6 16.3 15.3 13.6 3.9 94 65 37 38 23 13 28 13.6 11.5 Under 20 years, total pregnancies___ 89 1 0 0 .0 66 1 0 0 .0 1 .......................................................................... 2 ........................................................................... 74 55 3 10 1 83.3 15.2 1.5 19 3......................................... ............................... 83.1 13.5 3.4 2 2 82.6 8.7 8.7 20 to 24 years, total pregnancies....... 461 1 0 0 .0 261 1 0 0 .0 200 1 0 0 .0 1 ........................................................................... 2 ........................................................................... 178 156 77 39 38.6 33.8 16.7 8.5 64 70 35 25 10 1 2 .2 .2 6 32.0 35.0 17.5 12.5 3.0 1 43.7 33.0 16.1 5.4 1.5 0.4 25 to 29 years, total pregnancies....... 395 1 0 0 .0 199 1 0 0 .0 196 1 0 0 .0 1 . . ....................................................................... 2 .......................................................................... .57 74 95 75 56 45 46 40 40 17 7 4 2 2 .6 12 6 .1 23.1 28 55 35 39 15 14.3 28.1 17.9 19.9 7.7 5.1 2 14.5 18.7 24.1 19.0 14.2 5.6 3.5 .4 30 to 39 years, total pregnancies........ 466 1 0 0 .0 1 ........................................................................... 2 ........................................................................... 3......... ................................................................. 4........................................................................... 5 ........................................................................... 6 ........................................................................... 7........................................................................... 8 ........................................................................... 9 ........................................................................... 10 and over........................................................ 30 39 36 63 75 60 56 51 23 33 6.4 8.4 7.7 13.5 16.1 12.9 10.9 4.9 7.1 40 years and over, total pregnancies. 80 1 0 0 .0 2 ........................................................................... 2 3........................................................................... 4.......................................................................... 5........................................................................... 6 ........................................................................... 3........................................................................... 4........................................................................... 5........................................................................... 6 .......................................................................... 7...................... .................................................... 8 ........................................................................... 3.......................................................................... 4........................................................................... 5 .......................................................................... 6 .......................................................................... 7........................................................................... 8 .......................................................................... 9 ........................................................................... 1 0 and over........................................................ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 22 14 3 9 6 11 13 1 10 25 2 .2 1 2 .0 2.5 3.8 11.3 7.5 13.8, 16.3 1.3 12.5 31.3 U4r 86 42 14 4 1 0 0 .0 8 .0 4.5 4.7 2 .8 1 .6 3.4 2 0 .1 2 0 .1 8.5 3.6 20 30 23' 1 2 .1 8.4 6.7 4.6 3:0 4.4 1 0 0 .0 2 .0 10 2 245 1 0 0 .0 221 1 0 0 .0 20 8 .2 1 1 .8 1 0 .2 10 10 11 4.5 4.5 5.0 13.6 15.8 16.3 12.7 12.7 29 25 33 40 24 28 23 1 .0 8 13.5 16.3 9.8 11.4 9.4 3.3 15 6 .1 30 35 36 28 28 15 18 45 1 0 0 .0 35 1 0 0 .0 2 3 7 4 4.4 6.7 15.6 8.9 5 1 1 .1 2 2 6 5.7 5.7 17.1 6 13.3 7 2 0 .0 5 13 1 1 .1 5 28.9 12 1 6 .8 8 .1 2.9 14.3 34.3 IN F A N T M O RTALITY: JO H N STO W N , PA. T able XY.— D i s t r i b u t io n in g to N a t iv it y 77 M a r r ie d M o t h e r s b y L o s s e s S u s t a in e d , A cco r d M o t h e r a n d N u m b e r o p P o s s ib l e L o s s e s . op op D ISTR IB U TIO N O F M O T H E R S A CCO RD IN G TO N U M B E R OF LOSSES. N U M B E R OP B IR T H S O R POS S IB L E LO SSE S AND N A T IV IT Y O F M O T H E R . Number of mothers. 2 3 losses. 4 losses. 5 losses. 6 8 losses. losses. losses. 121 60 24 13 8 1 2 1 1 2 2 2 1 4 2 1 i 1 2 i 1 All mothers............. 1,491 399 birth................................ births............................... 3 births............................... 4 births............................... 5 births............................... J 6 births............................... / 7 births............................... 7 8 births............................... 9 births............................... 1 0 or more births.............. 335 277 216 187 148 96 82 54 36 60 53 67 73 55 48 44 Native mothers............. 1 2 22 18 9 8 10 10 15 5 4 13 i 7 816 199 59 19 5 6 1 b irth ..................................... 2 births...................................... 3 births...................................... 4 births...................................... 5 births....... ............................. 6 births...................................... 7 births...................................... 8 births...................................... 9 births...................................... 1 0 or more births..................... 232 170 29 36 35 33 19 19 15 29 4 6 5 4 7 Foreign mothers........... 675 200 62 b ir th ...,................................. births...................................... 3 births........... .-......................... 4 births...................................... 5 births...................................... 6 births...................................... 7 births...................................... 8 births...................................... 9 births...................................... 1 0 or more births..................... 103 107 105 89 83 58 45 33 24 31 38 1 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 98 65 38 37 21 21 31 10 8 22 29 25 12 10 5 4 . 10 14 13 19 13 19 111 10 or more losses. 1 loss. 4 8 11 8 10 10 5 7 1 6 10 3 4 7 1 8 3 3 3 1 1 1 1 4 5 41 19 7 1 1 2 2 3 3 5 7 7 7 7 6 8 3 5 7 7 9 6 11 2 1 2 2 7 2 2 4 2 1 2 9 2 i 2 2 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX I. STATEMENTS OF MOTHERS. The statements appended herewith are taken from the testimony of the mothers whose babies were included in the investigation. They, like photographs of random spots, illustrate instances where hard work and a limited income are coexistent with marked loss of infant life. They are offered not as medical or scientific testimony, but because of the natural interest in the mother’s viewpoint on these intimate matters. A closer contact with a few individual cases can not but serve to humanize and make more realistic a mass of figures on similar and related topics. Mother aged 34 years; 9 pregnancies in 17 years; 7 live born; 2 stillborn; no miscar riages reported; 3 deaths in first year, viz, aged 9 weeks, strangled on milk; aged 1 year, pneumonia; aged 6 months, pneumonia; 3 children living at time of agent’s visit. In poor health. Has had sunstroke. Worries. Torn at birth of one child. Has lacked medical attention. Father has miner’s consumption. Mother aged 36 years; 10 pregnancies in 12 years; 6 live bom ; 1 stillborn; 3 miscar riages reported; one death in first year, viz, 4 hours, hemorrhage; 5 children living at time of agent’s visit. Formerly toll keeper and had to lift heavy gate during earlier pregnancies. Housework since marriage excessive. Always has instrument deliv eries. Home fair. Father skilled mill hand. Mother aged 38 years; 12 pregnancies in 17 years; 11 live born; 1 miscarriage reported; 3 deaths the first year? viz, 3 weeks, prematurity; 3 months, pneumonia; 3 weeks, unknown; 7 children living at time of agent’s visit. During pregnancy resulting in premature birth, in a state of worry and excitement owing to frequent fights in neighborhood. During pregnancy resulting in miscarriage she overexerted self doing heavy laundry work, lifting boilers, etc. Home fair. Mother aged 35 years; 11 pregnancies in 15 years; 8 live born; 3 miscarriages reported; 3 deaths in first year, viz, aged 10 days, yellow jaundice; 10 days, cause unknown; 6 months, spinal meningitis; 4_ children alive at time of agent’s visit. Had to do excessive work during pregnancies, as sweeping, washing, lifting tubs, carrying water, etc. Mother aged 25 years; 7 pregnancies in 6 years; 3 live born; 4 stillborn; 2 deaths the first year, viz, aged 11 days, cause unknown; aged 2 days, cause unknown; 1 child alive at time of agent’s visit. Physician stated mother was overworked during preg nancies, therefore during pregnancy resulting in birth of healthy baby in 1911 she was extra careful of self. Fair home. Father skilled mill worker. Mother aged 34 years; 4 pregnancies in 5 years; all live born; 1 death the first year, ■viz, aged 11 months, spinal meningitis; 3 children alive at time of agent’ s visit. D oc tor stated period of gestation only 8£ months for each p r e g n a n c y A lw a y s mis erable during pregnancies. Can not eat. Feet and legs swell. Children fed and cared for intelligently. Home good. Mother aged 41 years; 12 pregnancies in 22 years; 12 live bom ; 1 death the first year, viz, aged 3 weeks, spasms; 11 children alive at time of agent’s visit. Baby of 1911 poorly developed and in poor health at 1 year of age. When 6 months old was given soup, milk, coffee, and crackers; at 9 months, sauerkraut, cabbage, pie, and every thing. Dirty house. Father machinist in mill. Mother aged 37 years; 12 pregnancies in 15 years; 8 live bom ; 4 miscarriages reported; 1 death the first year, viz, aged 1 month, cause unknown; 6 children alive 6 1 1 1 2 ° — 1 5 ------- 6 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 81 82 IN FAN T M O RTALITY: J O H N STO W N , PA. at time of agent’s visit. Hard worked and worried during pregnancies. Laundry and char work in addition to home duties, but manages to give babies only breast milk during first year. Mother aged 31 years; 10 pregnancies in 10 years- 8 live bom ; 2 stillborn; 4 deaths the first year, viz, aged 7 days, 2 days, 1 day, 12 hours, cause unknown; 4 children alive at time of agent’s visit. Doctor says not strong enough to bear babies to term or to have healthy children. Mother aged 32 years; 7 pregnancies in 11 years; 5 live born; 2 stillborn; one death the first year, viz, aged 2 months, mother says from nervous shock and fright from passing trains. Baby died a day or so after family moved to house along railroad track; 3 children alive at time of agent’s visit. Mother aged 27 years; 6 pregnancies in 10 years; 6 live bom ; 3 deaths the first year, viz, all aged few weeks, cause unknown; 3 children alive at time of agent’s visit. Babies who died all born before marriage, when mother was a servant and had to leave them to be artificially fed and poorly cared for when she went to work. Mother aged 30 years; 9 pregnancies in 14 years; 6 live bom ; 3 stillborn; nfc deaths the first year; 3 children alive at time of agent’s visit During one pregnancyv' resulting in stillbirth felt strain of struggle she made to separate fighting lodgers; dur ing another resulting in stillbirth she had fall on ice; and during the third her work had been excessive. Mother aged 41 years; 13 pregnancies in 22 years; 13 live bom ; 7 deaths the first year, viz, aged 1 year, 1 year, 2 days, 1 month, few minutes, 6 weeks, 8 weeks, causes unknown; 4 children alive at time of -agent’s visit. No member of family has ever attended school. They own a lot in a miserable unpaved alley, on which they have built houses 3 deep. They have a dirty cow shed there and sell m ilk in open receptacles. No sewer connection; yard privy; but they have city water. Save father’s earnings and live on milk sales. Never has a doctor or midwife at child birth—manages alone. Began to do her housework two days after birth of 1911 baby. Mother aged 26 years; 6 pregnancies in 5 years; 5 live bom ; 1 stillborn; 3 deaths m first year, viz, aged 15 minutes, one-half day, 3 days; 1 child alive at time of agent’s visit.^ The 1911 baby alive and in poor health at 1 year of age. Was given table food in addition to breast milk from 4 months of age. Mother aged 31 years; 6 pregnancies in 9 years; 6 live bom ; 2 deaths the first year viz, aged a few months, croup; a few months, bronchitis and pneumonia; two others at 14 months, each of bronchitis and pneumonia; 2 children alive at time of agent’s visit. Father has tuberculosis. Poor, insanitary home. Total income, $500 a year. Mother aged 33 years; 4 pregnancies in 8 years; 3 live bom - 1 miscarriage reported; 1 death the first year, viz, aged 4 months, pneumonia; 2 children alive at time of agent’s visit. Does excessive work in own home in addition to char work. The 1911 baby was only one to die in first year. Deserted b y husband early in that pregnancy. This pregnancy period was one of worry and mental and physical strain to support her family, and when baby was bom she had no milk and gave him condensed milk from birth. Mother aged 30 years; 11 pregnancies in 12 years; all live bom ; 5 deaths the first year, of which 2 were from pneumonia; 6 children alive at time of agent’s visit. Frail, hard worked, and worried over money matters. Kitchen is living room and a dark h o le in basement.” Ventilation of home bad; sleeping-room window al ways shut “ tight.” Baby bom in 1911 died of pneumonia at age of 9 months. Mother aged 34 years; 6 pregnancies in 10 years; 6 live bom ; 5 deaths in first y e a r causes thereof unknown. The 1911 baby was aged 2 months at death; 1 child alive at time of agent’s visit. Says she has never had enough to eat since marriage and that breast milk always leaves her two weeks after childbirth. Poor, dirty close house. Father a teamster who spends considerable portion of wages in arink. ’ Mother aged 20 years; 1 pregnancy, resulting in a live-bom child who died at the SLg©of 9 months of cholera infantum. Hor only child bom ovor one year after hus band s desertion; latter claims she is syphilitic. She comes from feeble-minded family whose history is matter of State record. Her grandfather acquitted of killing his son on account of mental condition. Her mother and sister and latter’s 18months-old baby all officially pronounced feeble-minded. Family of loose morals. The baby bom in 1911 weaned from breast at age of 4 months and died of cholera in fantum at age of 9 months. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O RTALITY: JO H N STO W N , PA. 83 Mother aged 30 years; 9 pregnancies in 11 years; 8 live births; 1 miscarriage re ported; 3 deaths in first year, viz, aged 3 months, pneumonia; aged 8 months, m a l a r i a l fever and rheumatism; and the baby bom in 1911 Weaned from breast when 6 weeks of age, died at age of 9£ months of gastroenteritis; 5 children alive at time of agent’s visit. During pregnancy resulting in miscarriage two months after conception, lived on second floor and had to carry heavy wash up and down from yard. Mother aged 27 years; 3 pregnancies in 3 years, all live births; 2 died in first year, viz, aged 15 days of cause unknown to mother, and other bom in 1911, of hereditary syphilis, according to death certificate. Poor, dirty home. Father a steel-mill la borer at $10 a week. One child alive at time of agent’s visit. Mother aged 35 years; 6 births in 12 years; 4 live births and 2 stillbirths. A ll live bom died in first year, viz, aged 6 weeks, bronchitis; aged 13 days, bronchitis; aged 2 days, weak from birth; aged 4 hours, inanition, the last being the 1911 baby. Had another child the following year and she and her husband were so anxious that at least one child should live that she consulted physician concerning its care. Upon his advice she gave up her 20 boarders immediately after child’s birth and devoted all her time to it.- Thinks she did not stop her hard work soon enough; says she has always worked too hard, keeping boarders in this country and cutting wood and carrying it and water on her back in the old country. Also says the carrying of water, coal, and cases of beer in this country is great strain on her. Father furious be cause all babies die; wore red necktie to funeral of last to show his disrespect for wife who can only produce children that die. A type of woman who would follow, and profit by, instruction in prenatal care. Mother aged 25 years; 3 pregnancies in 3 years; all live births; 2 died in first year, viz, aged 1 day, cause unknown; aged 11 months (bom in 1911), pneumonia; 1 child alive at time of agent’s visit. Father a steel-mill hand. Damp, badly ventilated home, outside toilet. Mother aged 27 years; 8 children; 1 before marriage and 7 in the 11-year period since marriage at the age of 16. A ll live births; 3 deaths under 1 year of age, viz, aged 8 months, unknown cause, “ stomach turned b la ck ” ; 3-months old, same statement as for 8; months old child; aged 11 months, ileocolitis. This last born in 1911, was breast fed only three months and then given condensed milk to supple ment breast-milk feeding. Four children alive at time of agent’s visit. Boarders. Fairly good home. Father a steel-mill hand. Mother aged 25 years; 2 pregnancies in 8 years; both live-bom children, of whom one died, aged 2 days, cause unknown. Mother says neither doctor nor midwife present at birth; that husband “ caught” baby at 3 a. m., and she was up and doing regular work at 6 a. m. One child alive at time of agent’s visit. Thirteen boarders. Family sleeps in kitchen, which is also used as dining and living room for boarders. Water supply in yard, and privy in yard used b y several families. Father works in coal mine. Mother aged 34 years; 8 pregnancies in 16 years; all live-bom children, all but 2 of whom died in first 2 weeks of life from unknown causes, except the last, whose death was certified as from ileocolitis; 2 children alive at time of agent’s visit. Never has doctor or midwife at childbirth. Very ignorant. Father a laborer in steel mill. Mother aged 28 years; 3 pregnancies in 3 years, resulting in 4 live births; 2 (twins) died in their first year, aged 1 month and 4 months, of inanition and malnutrition, respectively; they were never breast fed ; condensed milk from birth ; 2 children alive at time of agent’s visit. Six boarders. Poor, dirty home. City water in yard, also dry privy. Father a steel-mill hand. Mother aged 36 years; 12 pregnancies in 17 years; all live births; 3 died first year, viz, aged 9 days, born sickly with big head; 9 months, bowel trouble; 10 months, bowel trouble; 9 children alive at time of agent’s visit. Began to feed the 1911 baby, who died last, on raw cows’ milk from the age of 2 months because she went out to do laundry work and cleaning in the home of a physician and the baby had to be fed in her absence. Bought milk from neighboring cow shed. Combined housework for her large fam ily and outside work a great strain on mother. Dirty home. Father works in mine. Mother aged 31 years; 10 births in 14 years, 1 being stillbirth. Every live-born child of this woman died in 1 year or less, as follows: Age 4 months, cough; 3 months, cough; 1 year, unknown; 1 year, unknown (the last two Were insured for $26 each; https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 84 IN FAN T M O RTALITY l ; JO H N STO W N , PA. one baby died before company delivered policy); the others died at ages of 3 months, 4 months, 1 year, 3 months, and 10 weeks, respectively, of causes unknown to mother, who said all had ‘ ‘ sores on body. ’ ’ Certificate gives scrofula as cause of death of baby born in 1911. The first 2 children were born and died in Europe. Attending m id wife in Johnstown says father has syphilis. Both parents, however, claim to be healthy; father drinks, came to United States 2 years ahead of wife. Had worked in cigar factory from age of 13 until she came to United States. Her own mother had worked in same place 30 years. She never stays in bed over 3 days when a child is born. Father a car-shop rigger. Mother aged 25 years; only 1 pregnancy; mother married 2 years. Baby born alive with “ sores on b o d y ” ; died aged 4 months; she says “ wasted aw ay” ; certifi cate states ileocolitis. Weaned from breast when 3 weeks old because she had typhoid. Hard worker, bu t has dirty home and never opens a window. Water and privy in yard. Father a steel-mill hand. Mother aged 20 years. First and only pregnancy resulted in live-bom child who died, aged 6 months, of convulsions. Weaned from breast, aged 4 months, because her milk left her on accoun t of hard work. Baby on condensed milk till 5 months old, then given bread, cakes, apples, etc. Five boarders. Home neither clean nor well' ventilated. Father a steel-mill worker. Mother aged 22 years; only 1 pregnancy; a live-bom child that died in July, aged 7 months, of cholera infantum. Milk and crackers added to breast feeding at age of 5 months. Again pregnant when baby was 6 months old, but continued nursing baby until its death, 1 month later. Unclean 1-room home; yard hydrant and privy for use of this and other families. Father works in coal mine. Mother aged 38; 13 pregnancies in 17 years, 11 live births and 2 premature stillbirths. Only 2 children living at time of agent’s visit. The second to eighth, the eleventh, and the thirteenth children died of bowel trouble at ages ranging from 3 weeks to 4 months. Only cause of death she can give is that “ food did not agree with them. ’ ’ Believed in feeding babies and gave them everything anybody told her to give them; begins at 1 month to give them bread, potatoes, egg, crackers, etc. For last baby that died she got a goat and gave the baby its milk; goat got sick, but she persisted in g i v i n g the baby its milk until the goat went dry. Directed the feeding of her daughter’ s baby until its death at 3 months of age. On account of many children she has had, the neighbors consider her an authority on baby care. Slovenly home. Dry privy in yard. Father a stable hand. MOTHERS WHO HAD STILLBORN CHILDREN IN 1911. Mother aged 23 years; 2 live births and 1 stillbirth in 4 years. Stillbirth followed a fall down cellar steps while carrying coal when 6 months pregnant; 2 children alive at time of agent’s visit. Father works in coal mine. Mother aged 24 years; 3 pregnancies in 5 years, 2 live births and 1 stillbirth, which physician said was due to excessive work on sewing machine during pregnancy. Both live-bom children alive at time of agent’s visit. Father a steel-mill hand. Good home. Mother aged 30 years; no live births; 2 miscarriages and 1 stillbirth from August, 1910, to November, 1911; periods of gestation 5, 4, and 6 months, respectively. Cause of losses unknown. When 21 years old had operation for prolapsis. Always tired and weak during pregnancies. Father a steel-mill worker. Home good. Mother aged 39 years; 9 pregnancies in 19 years; 5 live births; 2 stillbirths; 2 miscar riages reported. Gives overwork and worry as cause of miscarriages and 1 stillbirth and a fall as cause in the other stillbirth; 4 children alive at time of agent’s visit. Father laborer in steel mill. Home good. Mother aged 27 years; 3 pregnancies in 8 years; 2 live births (in 1903 and 1905) and 1 stillbirth (in 1911); 2 children alive at time of agent’s visit. In 1908 had fall which caused internal misplacements; never had treatment for same; during 1911 pregnancy had convulsions from uremic poisoning. She has kidney trouble. Fair living conditions. Father a mill hand. Mother aged 30 years; 2 pregnancies in 2 years; no live births. First a miscarriage after 4$ months’ gestation, said to be due to fall; second, after 7 months’ gestation, attrib uted to indigestion. Father a machinist in steel mill. Home clean. Dry privy and well are in yard. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis in f a n t M o r t a l i t y : .t o h n s t o w N , pa. 85 Mother aged 37 years; 10 pregnancies in 16 years; first, seventh, eighth, and ninth children were live bom ; the others stillborn. All the live born died, as follows: Age 3 months, scarlet fever; 2 months, scarlet fever; 6 months, “ boils on stomach” ; 6 weeks, cause unknown. Has no idea of causes of stillbirths; very ignorant. Keeps boarders. Father a laborer in steel mill. Mother aged 31 years; 5 pregnancies in 8 years; 4 live bom ; 1 (the last) premature stillborn from an unknown cause. All the live-bom children died under 6 months of age, viz, 6 months old, summer complaint; 2 months, summer complaint; 2 weeks, unknown cause, but was half black and had sores on stomach; 1 day old, cause unknown. Keeps boarders. Home bad. Father a laborer in steel mill. Mother aged 28 years; 5 pregnancies in 3 years; 4 live births, the last a stillbirth; all live bom died of unknown causes at ages of 10 months, 3 weeks, 2 weeks, and 2 weeks, respectively. First baby bottle fed from birth; could not nurse him on account of having ‘ ‘neck full of boils. ’ ’ Has had hospital treatment for womb trouble. Father a steel-mill worker. Insanitary home. ./Mother aged 23 years; 4 pregnancies in 3 years; 1 live birth and 3 stillbirths. The liv e-b om baby, who died at age of 3 months of unknown cause, had “ scabs on face.” She is a charwoman, who thinks that “ possibly” she works too hard. While preg nant always has fear babies will be born dead. Does not feel good after big day’s work done during pregnancy. Father a steel-mill hand. Poor home conditions. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX II. DETAILED DESCRIPTION OF METHOD USED FOR COMPUTING INFANT MORTALITY RATE FOR THIS REPORT, AND COMPARISON WITH CON VENTIONAL METHOD. In this study the infant mortality rate is obtained by comparing the number of babies born alive in Johnstown in 1911 with the num ber of those same babies who died before they were a year old, omit-v ting, as was necessary in a detailed study where approximations were not allowed, those babies whose parents could not be located by the bureau’s agents. This method gives an exact and absolute infant mortality rate of 134 per thousand for this limited group of babies. Obviously, this method can not practically be used to obtain the infant mortality rate for large groups of population, year by year. Where there is a constant flow of population, cities, States, or com munities can not trace the place of birth of infants dying within their respective areas or follow each child born within their boundaries if it moves away. It is impossible to know the life history of each child born in the area considered in a given year and to determine, as has been done for this intensive study of a small and definite group, how many babies per 1,000 live born in a given area actually do die under 1 year of age. The established method of obtaining an infant mortality rate is to compare the live births in a given area during a single calendar year wdth the infant deaths (that is, deaths of babies under 1 year of age) occurring during that same year. Of course, the babies dying in that year are not all born in tne same year nor in that same area, and of »those born in the given calendar year not all who die under 12 months of age die in the calendar year of their birth. But this is the only feasible method as yet discovered for approximating an infant mortality rate for large areas, and it is sufficiently accurate for practical and comparative purposes; that is, for approximating the relative rank of different cities, States, and countries with respect to infant mortality. The infant mortality rates of the various States and also of cities of at least 50,000 population within the régistration area 1 of the United States for the year 1910 are shown in the following table, taken from a bulletin of the Federal Census Bureau.2 All the rates in this table are computed by the established method. 1 The Bureau of the Census designates as the registration area the area comprising States in which the registration laws are of suitable character and sufficiently well enforced to insure at least approximately complete (i. e., at least 90 per cent) returns of births and deaths. In addition to such States it includes certain cities in nonregistration States in which the returns are made with equal effectiveness under local * Bulletin 109, Mortality Statistics: 1910. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Government Printing Office, Washington, 1912. IN FAN T M ORTALITY: JOHNSTOW N, PA. 87 P o p u l a t io n , R e g is t e r e d B ir t h s , D e a t h s of I n f a n t s u n d e r 1 Y e a r o f A g e , a n d I n f a n t M o r t a l it y R a t e s f o r R e g i s t r a t i o n St a t e s a n d R e g is t r a t io n C i t i e s h a y i n g a P o p u l a t i o n o f a t L e a s t 50,000 i n 1910. Popula tion in 1910. DEATHS 2 OF INFANTS UNDER 1 YEAR CF AGE. Births. 1 Number. Per 1,000 births.8 R E G IST R A T IO N STATES. Connecticut............................... ................... . ................................ Maine............................................................................................... Massachusetts.............................................. . . » ............................ . Michigan..... ...................................................................................... New Hampshire........................................................................... . Pennsylvania.................................................................................. -Rhode Island........................................................ '....................... Vermont........................................ .................................................. 1,114,756 742,371 3,366,416 2,810,173 430,572 7,665,111 542,610 355,956 27,291 15,578 86,765 63,566 9,385 202,631 4 6 ,595 7,343 Connecticut: Bridgeport............................................................................... Hartford.................................................................................... New Haven........................... ; ......................................... ....... Waterbury...................................................................... .......... 102,054 68,915 133,605 73,141 Washington, D. C.......................................................................... Portland, Me................................................................................... . 331,069 58,571 • Massachusetts: Boston................................................................................... . Brockton.................................................................................. Cambridge................................................................................ Fall River................................................................................. Holyoke............................................................................... Lawrence................................................................ ................. Lowell......................................................................... ........... . Lynn......................................................................................... New Bedford............................................................................ Somerville,............................................................................... Springfield............................................................................... Worcester.................................................................................. 3,476 2,108 11,377 7,912 1,373 28,377 791 127 135 131 124 146 140 4 168 168 2,976 2,411 3,772 2,150 367 286 406 320 123 119 108 149 7,016 1,163 1,068 167 152 144 670,585 56,878 104,839 119,295 57,730 85,892 106,294 89,336 96,652 77,236 88,926 145,986 17,760 1,359 2,462 4,591 1,702 3,165 2,630 2,218 3,873 1,728 2,438 3,918 2,246 134 293 854 362 529 607 216 685 174 302 536 126 99 119 186 213 167 231 97 177 Michigan: Detroit....................................................................................... Grand Rapids......................................................................... Saginaw...... ................................... ......................................... 465,766 112,571 50,510 11,960 2,693 897 2,138 329 130 179 Manchester, N . H ........................................................................... 70,063 1,939 375 193 New York, N . Y ........................................................................... Bronx Borough...... ................................ ............................... . Brooklyn Borough................................................................. Manhattan Borough......................................................... ...... Queens Borough...................................................................... Richmond Borough................................................................ 4,766,883 430,980 1,634,351 2,331,542 284,041 85,969 129,316 10,926 43,128 6,1'59 11,047 5,063 8,900 865 284 125 96 117 135 Pennsylvania: Allentown................................................................................. Altoona...................................................................................... Erie........................................................................................... Harrisburg............................................................................... . Johnstown.................. ............................................................. Philadelphia............................................................................. Pittsburgh................................................................................ Reading......................................................... .......................... Scranton.................................................................................... Wilkes-Barre............................................................................ 51,913 52,127 66,525 64,186 55,482 1,549,008 533,905 96,071 129,867 67,105 1,406 1,392 1,713 1,308 1,628 38,666 15,059 2,370 3,512 1,840 202 144 119 115 129 165 138 150 142 148 146 4 1 ,1 1 1 R E G IST R A T IO N CITIES OF 50,000 PO PU LATIO N O R O V E R IN 1910. Rhode Island: Pawtucket............................................................................... Providence..................... ......................................................... 1 2 8 8 5 51,622 224,326 6 6 ,1 1 2 7,095 2,055 124 137 122 145 122 138 166 197 169 268 5,334 2,259 336 520 269 (*) (6) Provisional figures; exclusive of stillbirths. Exclusive of stillbirths. Based on provisional figures for births. The figures for Rhode Island are exclusive of Providence and Pawtucket. Returns of births not received from State board in time for inclusion. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 101 191 827 (6) (*) 88 INFANT M ORTALITY: JOHNSTOW N, PA. It will be seen by this table that Johnstown is among the 10 cities of more than 50,000 population which had an infant mortality rate for 1910 in excess of 150 per 1,000 births. These 10 cities and their respective rates are as follows: Lowell, Mass., 231; Holyoke, Mass., 213; Manchester, N. H., 193; Fall River, Mass., 186; Detroit, Mich., 179; New Bedford, Mass., 177; Lawrence, Mass., 167; Johnstown, Pa., 165; Washington, D. C., 152; and Pittsburgh, Pa., 150. It should be borne in mind that the absolute infant mortality rate of 134, computed for the group of babies included in this investi gation, that is, for those born in Johnstown in 1911, can not be com pared wifi1 any of the approximate rates in the foregoing table, since the basis of computation is entirely different. But the method used in this report seemed to be the only practicable one for our purpose, namely, to measure the infant mortality rate in different districts m the city where the babies are subjected to varying conditions. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX III. THE MILK SUPPLY. [A study by the Dairy Division, United States Department of Agriculture, May 23 to June 16,1913. ■ Conducted by L. B. Cook, C. E. Clement, and B. J. Davis.] Between the dates of May 23 and June 16, 1913, the Dairy Divi sion, United States Department of Agriculture, made a study and survey of the milk supply of Johnstown, Pa. This study consisted of a chemical and bacteriological examination of samples and an inspection of the sources of supply. The Government score card was used for all inspection work. This work showed that about 4,000 gallons of milk were consumed daily in the city, or an average of a little over one-half pint per capita. About two-thirds of this milk is shipped over the Baltimore & Ohio and the Pennsylvania Railroads, but by far the most over the Baltimore & Ohio. The sources of the milk supply may easily be divided into city cow dairies, farmer milk dealers, dairy farms, city milk plants, and stores. Each of these will be discussed separately. CITY COW DAIRIES. About 150 cows are kept within the city limits. Most of these dairies are owned by foreigners and consist of two or three cows. The city dairies produced about 150 to 200 gallons of the city ’s milk supply. These dairies are very filthy and the sani tary conditions bad. The health of the cows is somewhat questionable, because the majority are stabled in small stables throughout the year. These stables are so small and the cows so crowded in that in some stables they have to take turns in lying down. The stables frequently have no means of ventilation or lighting except one or two small openings in the sides of the building. Most of the stables were located near contaminating surroundings, such as manure piles and outside closets. The food for the cows in many of these dairies was fermented and in a bad condi tion, due to its being a wet mixture which was prepared far in advance of feeding. The utensils were very poor in construction, most of them having open seams and in a condition impossible to clean properly. The pails were of the common cheap open type. In nearly all cases city water was used for all purposes. The cows were not in as bad a condition as they might have been with regard to cleanliness, although very little bedding was used, but the manure as a rule was not left standing in the stable, which accounts partly for the condition of the cows. The uncleanliness of the stable was marked, and usually no credit was given under this heading. Very few whitewashed stables were found, while cobwebs, dirt, and dust abounded nearly everywhere. The manure was removed to a box or pile near the stable. Some of these boxes were covered, but many were not. These city dairies had no milk houses. As soon as the milk was milked it was taken to the house, strained, and delivered to the customers, who were usually the neighbors. The milk utensils were often found dirty and being used for many other purposes. It is very doubtful if many of these milk pails are ever thoroughly scalded. After being washed they were kept almost any place, but were seldom put in a good place free from contaminating surroundings. The milking was usually done b y the women, who wore very dirty clothes and often milked with wet and filthy hands.' No pretense was made to clean the cows or use a damp cloth. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 89 90 INFANT M ORTALITY: JOHNSTOW N, PA. The milk was not cooled, but sold while warm at 8 cents per quart. Most of the consumers who bought this milk had no ice or refrigerators, therefore i t remained warm for some time or until consumed. Sometimes the milk was placed in earthen jars and set on the cellar bottom, but as a rule no effort was made at cooling. The milk was sold twice a day. . . . . . _ The average score for the 48 city dairies visited was 26.34 points. The highest was 43.50 and the lowest 16.75— 12 scored below 20, 23 between 20 and 30, and 12 in the thirties, with 1 above 40. PARMER MILK DEALERS. B y farmer milk dealers is meant those farmers who retail their own m ilk and pos sibly bu y a little from other farms. There are about 26 such dealers in the city and they handle about 1,000 gallons of the city ’s m ilk supply. Some of these dairies were the source of the city ’s best milk. The average score of these dairies was 39.43. Most of this m ilk is hauled from 3 to 5 miles to the city, then peddled upon the street. These dealers bottle very little milk, and most of it is drawn from a faucet. They use covered wagons and some peddle garden truck— like flowers, onions, etc.— on the same wagon. ,, . , , . , , . . ■£ The cows, as a rule, seemed to be in good health, but very few had ever been tuber culin tested. The bams were of the sort typical of that section of the country, with a stone wall on one side and an overhanging shed on the other, which meant that the stables were dark, as light could only enter at the ends. The basement was used for all the farm animals, as horses, pigs, cows, chickens, etc., and the cow stable was not separated from the rest. The general construction was only fair. A few cement floors, tightw alls, ceilings, etc., were found. The ventilation was poor and conditions as to the cleanliness oi the stable very bad. In many of the stables at this time of the year the manure was not removed daily and oftentimes it was piled near the stable. In general the cows could be well rated as to cleanliness, as they were outdoors both day and night. A t some of these farms milk houses were found, but many used the cellar of the house for handling and cooling the milk. These m ilk rooms were often used for the storage of other things and were not as clean as they should be. Some strained the milk at the stable, but many removed it to the m ilk room for straining. Many of the utensils were of poor construction and were not thoroughly washed. The m ilk dealers usually scalded the pails and had a place to keep them after being washed. No covered pails or special milking suits were found and only one milk cooler Most of the milkers m ilk with a dry hand, but do not clean the cows or use a damp cloth. Most of these farms had excellent water facilities, having running water at a temperature of from 50° to 55° F. This was used for washing utensils and cooling the milk. ; , , ., , . The cooling was done b y setting the 5-gallon cans in a trough of running water, but oftentimes the milk was not stirred, therefore the cooling was delayed; Some of these dairymen used ice on the farms and on the wagons. The lowest score of these farmer m ilk dealers was 22.40 and the highest was 53.50. There were 4 farms scoring in the twenties, 8 in the thirties, 13 in the forties, and 1 above 50. . DAIRY FARMS. Under this heading is meant the farms that ship or draw milk to the dealers. Some of these farms sold cream in the summer and m ilk in the winter. Two hundred and twenty-one of such farms were visited and their average score was 36.06, which was a little lower than the farmer dealer. Some of these farms were fairly good, but most of them were poor in their facilities and methods of handling milk. In gen eral these farms were like the farm dealers, but many were much worse. Very few had’ any milk houses, but handled the milk in the cellar or set the cans in some trough of running water. These farmers oftentimes had to carry their m ilk several miles over very bad roads to the railroad station where it was shipped to Johnstown. Very few covered pails or m ilk coolers were being used. The lowest score for these farms was 22.50, while the highest was 70.6. Of these farms 52.9 per cent scored between 30 and 40. _ T ransportation .—Most of this m ilk was shipped over the Baltimore & Ohio Rail road from points between Somerset, Pa., and Johnstown. The m ilk was placed on the uncovered platform at the receiving station, then placed in baggage cars for trans portation. No refrigerator cars were used. The total railroad haul on this line is about 40 miles. When the m ilk reaches Johnstown it is at a temperature of about 65° F., depending on the outside temperature. It is then unloaded onto an uncov ered platform, and if the dealer does not take it away at once it is left in the sun to https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT Mortality : joh Nst6WN, Fa . 91 get still warmer. One day after taking temperatures on arrival of the train,- the in spectors returned in one and one-half hours and found about one-half of the milk still in the sun and the temperature of the m ilk was then about 15° warmer, or at a tem perature of about 85° to 90° F. Some of the m ilk shipped over the Pennsylvania Railroad comes a longer distance, but no refrigerator cars are used for the Johnstown supply and about the same con ditions exist. CITY MILE PLANTS. There are about 15 city m ilk dealers. These dealers have their milk shipped in or hauled on wagons. The two large dealers in Johnstown handle about one-half of the city ’s m ilk supply. The small dealers have no milk plant, as they take the m ilk as delivered from the farm and peddle it direct. Most of them have a refrigerator for storage of any milk left over. They bottle very little, and a few use ice. The two large milk companies pasteurize and bottle all of their retail trade. One of these dairies has four creameries outside of Johnstown from which it draws some of its /u p p ly when needed. These plants are located at Indiana, Martinsburg, Woodbury, and New Enterprise, Pa. These plants do a considerable cream and ice cream busi ness; some of them also pasteurize the milk before it is shipped to Johnstown, where it may be repasteurized and is bottled. The sanitary conditions in these plants were found to be poor and no ice was used on the wagons. Apparently, from the bacterial results, the pasteurizing did very little, if any, good. The flash method was used at a temperature of about 165° F., and after pasteurizing the milk was exposed to much contamination. The average score of all of these plants was 39.37. Some of the plants received a higher score than they really deserved, because they had no real plant but only a refrigerator and a place to wash the utensils, the milk not being brought to the plant. The milk cans as returned to the farmer were in a very bad condition, as these plants do not properly wash them. Some of them rinse the cans, while others do not even do that; consequently when the farmer receives the cans they have sour milk in them and very bad odors. W ith a farmer’s lim ited means at hand it is nearly impos sible to get these cans in proper condition to again ship sweet milk in them. One creamery at Friedens, Pa., ships about 100 gallons of milk direct to some of the small city dealers and stores. STORES HANDLING MILK. A great many of the stores sell milk. Some of these buy bottled milk, while others buy direct from the farmer and sell dipped or faucet milk. Most of this milk is sold as an accommodation to customers. Many of these stores have ice boxes or refrig erators to keep the milk cold. However, some of the stores have no facilities for keep ing the milk at a low temperature and the cans or bottles are allowed to sit on the floor until all the m ilk is sold. These stores do not wash the cans or bottles. Much of this store milk is open to considerable contamination from dust, dirt, and flies. The average score of the stores handling bulk milk was 46.11. The highest was 72.75, and the lowest 12.30. BACTERIOLOGICAL AND CHEMICAL RESULTS. Samples for this work were taken at as many sources as possible. The samples taken at the city cow dairies gave a low bacteria count, due to the sample being taken imme diately after milking. In all, 163 samples of milk were examined, 115 being from producers and 48 from dealers. The maximum bacteria count was 319 million per cubic centimeter, and the minimum count was 3,650 bacteria per cubic centimeter. This sample was taken from one of the city cow dairies and it was fresh milk direct from the cow. The average count of all samples was 1,699,587 bacteria per cubic centimeter. Two samples were sour when taken at the railroad station. 7 samples, or 4.2 per cent, were under 50,000 bacteria per cubic centimeter. 6 samples, or 3.6 per cent, were between 50,000 and 100,000 bacteria per cubic centi meter. 31 samples, or 19 per cent, were between 100,000 and 500,000 bacteria per cubic centi meter. 22 samples, or 13.5 per cent, were between 500,000 and 1,000,000 bacteria per cu b ic centimeter. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 92 IK FAK T M ORTALITY: JOHNSTOW N, PA. 45 samples, or 27.6 per cent, were between 1,000,000 and 10,000,000 bacteria per cubic centimeter. 44 samples, or 27 per cent, were between 10,000,000 and 50,000,000 bacteria per cubic centimeter. 8 samples, or 4.9 per cent, were over 50,000,000 bacteria per cubic centimeter. This table shows that 59.5 per cent of the samples contained over 1,000,000 bacteria per cubic centimeter. The fat was only determined on 161 samples, and the average per cent was found to be 3.58. The minimum per cent was 1.2 and the mavimirm 5. 14 samples, or 8.7 per cent, contained below 3 per cent fat. 108 samples, or 66.1 per cent, contained between 3 and 4 per cent fat. 39 samples, or 25.1 per cent, contained 4 per cent fat or above. The total solids was determined on 93 samples with an average of 11.68. GENERAL SUMMARY. The bacterial results and the inspection work show that the milk sold in JohnstovVn, Pa., is very poor. The scores are low and most of the milk has a bacteria count in the millions. This is easily explained b y the fact that the city does no milk in spection work, therefore the general methods and ideas in use do not tend for clean milk. The general idea is that if milk is not sour it must be all right; then where the milk is pasteurized no particular pains are taken with its care. Our results show that pasteurizing did very little if any good. On the farms and in the city no par ticular methods or care are used to keep the bacteria count low. . 1. There are 48 dairies in the city with an average score of only 26.84 out of a pos sible 100. On the whole, the, city dairies were vile from a sanitary standpoint. While the bacteria counts taken on this milk were fairly low it must be remembered that milk produced at these places is delivered warm to the consumer; this milk is sold in the poorer sections, where there is usually no way to keep it cold until it is tlsed, so that before it is finally consumed the bacteria count is probably extremely high. 2. The dairymen who operated farms and sold the milk from their own farms were in average condition for uninspected dairies. Their average score was 39.43 out of a possible 100. 3. Transportation facilities are very crude and there is an entire lack of care in handling the milk from the farm to the city. 4. The facilities for handling the milk in the city are very poor; many dealers have ho equipment or means of refrigerating the milk or handling it properly. The average score of the city dairies was 39.37 out of a possible 100. There were only two plants inspected which were in fairly presentable condition. Pasteurization as carried on at the present time in Johnstown is a farce. This is shown b y the fact that 52 farmers shipping milk to one of the dairies averaged 1,419,961 bacteria per cubic centimeter when the milk arrived at Johnstown, while samples taken from the milk supply handled b y this dairy showed an average count of 18,337,500 bacteria per cubic centimeter, indicating that the milk was much worse after it had been pasteurized” than it was before. Another large dairy did a little better, but the results obtained there showed a very incomplete pasteurizing process. Twenty-eight dairymen supplying milk to the latter dairy averaged 30,410,071 bacteria per cubic centimeter when the milk arrived at Johnstown, while the finished product as put out b y the dairy averaged 3,150,083-bacteria per cubic centimeter. 5. A large amount of dipped milk is sold both from the wagons and from stores in Johnstown at the present time. Such a practice is at best insanitary, but carried on as it is in Johnstown it is a positive menace. 6. Bacteria counts showed that the milk averaged 1,699,587 and that 59.5 per cent of the samples showed over a million bacteria per cubic centimeter. 7. Aside from the bacteriological condition of the milk it was found to be in many cases lacking in the required food elements. Of 44 samples taken from milk dealers 29.5 per cent were found to be below the State standard for butter fat, while of 118 samples taken from producers, 22.9 per cent were found to be below the State standard for butter fat. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 93 IN F A N T M O RTALITY: JO H N STO W N , PA. R esults op th e I n s p e c t io n W D one ork City cow dairies. Score. 0to 10 . ................................................................ 10to 20....................................................................... ......... 20 to 30 .................... ........................ ......................... 20 to 4 0 12 12 1 23 ......................................................................................... 40 to 50...................... .......................................... ................ 50 to 60..............................................- .................................. 60 to 7 0 ¿0to 9 0 90 to 100 in Jo h n s t o w n , P a . Farm milk dealers. Dairy farms. City milk plants. 1 4 8 13 1 ........................................................................... 43 117 55 3 4 4 2 1 2 Stores. 2 1 4 1 ........................................................................... ................................................................. Total1......................................................................... 48 26 Average score....................................................................... 26.34 39.43 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 11 221 36.06 39.37 i In all, 314. o \ 8 46.11 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Infant Mortality: Johnstown, Pa., 1913. PLATE A OPEN D ITC H ALONG W OODVALE AVENUE, W H IC H HOUSE DRAINAGE. RECEIVES ALL K IN D S OF This ditch Is cleaned out by heavy rains, but within a few days becomes offensive again. important street in Woodvale is unpaved and without sidewalks. PLATE B This Infant Mortality: Johnstown, Pa., 1913. V IE W OF AN OPEN D ITC H ON PLUM STREET, W H IC H AGE OF ALL K IN D S. RECEIVES HOUSE D R A IN This waste flows along for a distance of about an eighth of a mile before emptying intothe sewer. Ducks and geese are frequently seen in the ditch. Children wade here. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Infant Mortality: Johnstown, Pa., 1913. PLATE C AN O TH ER V IE W OF PLUM STREET. Open sewer ditch, a convenient dumping place for empty beer kegs, etc. Infant Mortality: Johnstown, Pa., 1913. PLATE D https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis SIX TH STREET, OFF MAPLE AVENUE. One type of tenement. Littered street. PLATE E Infant Mortality: Johnstown, Pa., 1913. AN OPEN D ITC H ALONG NEW STREET, PROSPECT. Private pipes into this ditch are numerous. Here the waste flows along until it enters a sewer at the right of the fence near the center of the background. PLATE F Infant Mortality: Johnstown, Pa., 1913. LOWER PART OF BRADLEY ALLEY, W H IC H RUNS A LM OST T H E E N TIR E LENGTH OF CAMBRIA CITY. Main orfront entrancesto abuttinghousesshown. 19 feet 10 inches. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Unpaved. Width, PLATE G Infant Mortality: -Johnstown, Pa., 1913. UPPER END OF BRADLEY ALLEY, CAM BRIA C ITY. (See preceding picture.) PLATE H Infant Mortality: Johnstown, Pa., 1913. A FRONT YARD ON CONNELLY AVENUE, M INER SVILLE. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PLATE I Infant Mortality: Johnstown, Pa., 1913. A VIE W OF KELLEY ALLEY OR GARVEY PLACE IN M IN E R S V IL LE . Houses to the left of the'picture are of flimsy construction. flows into the street. PLATE J Drainage from the large house Infant Mortality: Johnstown, Pa., 1913. ONE OF SEVERAL LITTL E ALLEYS OF CONEM A U G H BOROUGH LEADING DOW N T H E H IL L FROM HUBER STREET. Waste water from the houses not absorbed by the soil trickles down the depression noted in the center. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PLATE K Infant Mortality: Johnstown, Pa., 1913. H O R R IC K STREET, CO N EM A U G H BOROUGH, NEAR C ITY L IM IT S ; BOARDED W ALK OVER A NATURAL BROOK. LOOSELY The brook has a considerable fall and carries off with fair rapidity the house sewage it receives. PLATE L Infant Mortality: Johnstown, Pa., 1913. AN ASH AND RUBBISH HEAP BELOW PEELORVILLE, LO O K IN G UP FROM T H E PENNSYLVANIA DEPOT. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Company houses shown in the picture. PLATE M T H E CO N EM A U G H Infant Mortality: Johnstown, Pa., 1913. RIVER, TAK EN FROM W ALN U T STREET B RIDGE T H E PEN NSYLVANIA RAILROAD DEPOT. NEAR Because of the low stage of water usual in the warm months, sewage is exposed on the stones and rocks. PLATE N Infant Mortality: Johnstown, Pa., 1913. V IE W OF STONY CREEK, LO O K IN G WEST, TAK EN FROM FR A N K LIN STREET BRIDGE. Discharge of sewage through some of the outlets In the wall trickles down the wall for a distance of perhaps 6 feet before reaching the water. At low stage of the river the deposits on the stones below become very offensive. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PLATE O Infant Mortality: Johnstown, Pa., 1913. T H E C O N EM A U G H RIVER. View from foot of bridge at end of Johns Street, just above the point where the Conemaugh and Stony Creek meet. The sewer drainage settles in the ditch alongside the retaining wall for perhaps 150 feet before reaching the sluggish current of the river itself. When the ditch becomes clogged it is dugout, and the contents thrown on the dry bed between the ditch and the river must remain there until washed into the middle of the stream by high water. PLATE P Infant Mortality: Johnstown, Pa., 1913. A CLOSER V IE W OF T H E D ISCHARGE FROM A SEWER O U TLET SET IN T H E R E TA IN IN G W ALL ALONG STONY CREEK. Taken at extreme east end of the Haynes Street footbridge, where odors from the stream are especially offensive. Note that the sewage does not enter the water directly but in a way liable to promote nuisance. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PLATE Q T E N -F A M IL Y Infant Mortality: Johnstown, Pa., 1913. T E N E M E N T , PLUM STREET, W OODVALE. O P PO SITE FRONT DOORS. PLATE R OUTDOOR TO ILE TS Infant Mortality: Johnstown, Pa., 1913. A CLOSER V IE W OF T H E SAME PLUM STREET, W OODVALE, TE N E M E N T S AND TO ILE TS . The steep hill toward the back leads to Woodvale Avenue. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis