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U. S. DEPARTMENT OF LABOR CHILDREN’S BUREAU JULIA G. LATHROP. Chief INFANT MORTALITY RESULTS OF A FIELD STUDY IN WATERBURY, CONN. BASED ON BIRTHS IN ONE YEAR By ESTELLE B. HUNTER si INFANT MORTALITY SERIES No. 7 Bureau Publication No. 29 WASHINGTON GOVERNMENT PRINTING OFFICE 1918 6» 2 . 7 https://fraser.stlouisfed.org Sb$ Federal Reserve Bank of St. Louis ADDITION AL COPIES ®F THIS PUBLICATION M A T BE PROCURED PROM THE SUPERINTENDENT OP DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D . C. AT 20 CENTS PER COPY https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis cP to LLSlC % a -3 CONTENTS. Page. Letter of transmittal.................................................... ............................................ 9 Foreword......................... '.......................................................................................... 11 Introduction.. fi..................................... .................................................. .......... 15-23 Infant mortality rate. . ...................... ....................................... . . . . . . ....... . 15 16 Object and general plan of infant mortality investigations........................... Selection of Waterbury...................................................................................... 17 18 History............................... Method of inquiry.................................................. 20 Analysis of material....................................................................................... .......... 23-90 Material considered........... ........................ .......................................... . . . ...... 23 Ward distribution.................................. 23 Medical cause of death............................. 26-34 All causes......................................... ; .................................. ................. . 26 Gastric and intestinal diseases...................................................... . . . ...... 28-33 H eat.................................................................................... .............. 29 Improper feeding___ . . . . . . .......... 30 Poverty...................... 30 Ignorance..........11. 1: 1. 1. . . . . . . . .. .. . . ..................... 32 Causes of death peculiar to early i n f a n c y ..................................... 33 Principal respiratory diseases.......................................... ...................... 34 Age at death..... ....................... ........................ ..... ........................................... 35 Month of birth............................... 36 Age of mother and order of birth....................................... ............................. 37 Plural births............................................................... 39 Sex...................................................................... ........... , .................................. 40 Stillbirths.................................................... ......................................... . . . . 41 Maternity care............................................. ...................................................43-48 Employment of mother during pregnancy............................................... 43-44 Housework............................................................................................ 43 Factory work........................... 44 Attendant at birth........................................................................ ...........J. 44 Nursing care during confinement period.................................................. 48 Maternal mortality........ ............................................................* ...................... 49-51 Maternal mortality from conditions connected with pregnancy and childbirth................................. 50 Feeding.................................... 51-58 Breast versus artificial feeding.................................................................. 52 Mixed feeding......................................................... 54 Artificial feeding......................................................................................... 54-57 Relation of income to feeding............................................................. 55 Condensed m ilk ........ .’ ......................,................................................ 57 Causes for weaning..................................... ............................................... 57 Period intervening between pregnancies........................... 58 Economic and industrial factors............................................ 59-69 Occupation of father.......................................................... l.S :.................. 59 Father’s earnings............................. 60 Infant mortality rate by father’s earnings.............................................. 62 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 4 CONTENTS. Analysis of material—Continued. Economic and industrial factors—Continued. Page. Supplementary earnings......... ................................................................... 64 Employment of mother during year preceding birth of b aby............... 65 Employment of mother during year following birth of baby................. 66 . Relation between low earnings of father and employment of mother.. 66 Lodgers as a source of income......................................................... .......... 67 Size of family and total earnings of fam ily............................................. 68 Nationality........................................................................................................... 69-77 Infant mortality rate by nationality........................ ................................ 69 Size of family............................... . . . . ................ ..................... . ................ 70 Non-English speaking nationalities................ . ........................................ 71-73 Lithuanians.................................................................. 71 Italians................................ ..........* .. ; ........................... . 72 Years in United States and ability to speak English....................... . 73 Literacy.............. I ..................................................................... ................. 74 Ignorance and superstition......................................................................... 76 Housing.......................................... ......................................................... .'.........77-90 General housing analysis................ 78 Intensive housing study................................................................................81-90 Composition of districts.................................................. 82-90 Lot congestion........ .................................. 83 Number of apartments in building........ ................................ .. 83 Number of rooms in dwelling......................... 84 84 Rentals............................................................................ . ........... Number of persons and rooms in apartment.............................. 84 Overcrowding of sleeping rooms....................... 85 Ventilation..................................................................................... 87 Household sanitation....................... 88 Housing evils in other sections of c ity ............. ................. ........ ............ 90 Civic factors....................................................... 90-98 Infant-welfare work....................................... 90-91 Visiting nurses association.......... ........... ............. ................................, 91 Free m ilk................................... ...................................................... 91 I c e ....................................................... .............. , _____ _______*___ 91 Little Mothers’ League............... ...................................... ! ....................... 91 County health officer........................................ 91 City health department............... 92-95 Milk supply.........................^........................... ............... ........................ 92 Garbage collection and disposal........ ........ ................. ............................ 94 ' Ashes and rubbish disposal................................................................... .. 94 Factory waste and sewage disposal........ .......... ................ . . . .......... ....... 95 Water supply.............................................. ............... .......... 1 . . . . . . . .......... ; 96 Street paving.................................. . . . . . .......... ................................ ............ 97 Summary and conclusions..-...................... ...................... . . . ............................... 98-101 Registration of births......................................... 98 Infant mortality rate................................ ................................................ 98 Nationality............................ 98 Medical cause of death............................. 99 Stillbirths....................... ..... 1 ___ I ...................................................... 99 Attendant at birth....................................................................................... 99 Feeding....... ................................. 99 Income........ ............. ......................... ..... . . ! . . . . . .......... ...................... 99 Conclusion.-................................................................................... 100 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis CONTENTS. 5 Appendix A: Infant-welfare work, 1914-1916................................ . ...................................... 103 Appendix B : Selected districts in intensive housing study............. . ....................... . 105-112 District I ................................................................................... 105 District I I ................... 106 107 District I I I ..................................... District IV .......... ............................................ ............................ ............** 108 District V ............................................................................ HI • District V I .................................................................................................... HI MAPS. Map showing distribution of live births and infant deaths included in study, according to place of residence.................................................................. facing p. 23 Map showing water supply and sewage disposal system............................ facing p. 97 CHARTS. Chart I. Per cent distribution of unregistered live births, according to nation ality of mother...................................................................................................... Chart II. Per cent distribution of births, according to ward of residence and nationality of mother............................................................................................ Chart III. Per cent of infant deaths due to specified causes, according to nativity of mother............................................................... .................................. Chart IV. Deaths from specified causes by calendar month of death.................. Chart Va. Per cent artificially fed of infants surviving at age specified, according to nationality of mother.................. ........................... ; ........................................ Chart Vb. Per cent of infant deaths caused by gastric and intestinal diseases, according to nationality of mother............ ....................................................... Chart VI. Deaths in specified month of age............. ........ ..................... .............. Chart V II. Per cent dying subsequently in first year of life of infants surviving at beginning of specified month of age, by type of feeding............................... Chart V III. Per cent of births to mothers of specified nativity occurring in families where the father earned less than specified amount............................ Chart IX . Infant mortality rates in Johnstown, Pa., New Bedford, Mass., Manchester, N; H., and Waterbury, Conn., by earnings of father................... 21 25 27 29 31 31 35 52 61 63 GENERAL TABLES. Table 1. All known issues during selected year, infant deaths, infant mortality rate, and per cent of stillbirths and miscarriages, according to nationality of mother and registration status of birth.................... ................................... Table 2. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to nationality of mother............................... Table 3. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, by ward of residence....................................................... Table 4. Births during selected year, according to nationality of mother and nativity of father........................................................................ ......................... Table 5. Number and per cent distribution of deaths among infants born in Waterbury during selected year and of infant deaths in the registration area in 1914, by cause of death...................J................................................. .............. Table 6. Number and per cent distribution of deaths among infants bom during selected year to mothers of specified nativity, and infant mortality rates, by cause of death........................................................... ...................... ..................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 114 115 115 116 117 118 & CONTENTS. Page. Table T. Deaths among infants bom during selected year occurring in specified calendar month, by cause of death............................... ., ............................... Table 8. Deaths among infants bom during selected year occurring in specified month of life, by cause of death........................... . ............ ......................... . . . Table 9. Births from all pregnancies, infant deaths, infant mortality rate, and per cent of stillbirths, according to order of pregnancy and age of mother___ Table 10. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to age of mother at birth of child and n a tiv ity ,. . . . . . -----. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Table 11. Mothers reporting specified number of stillbirths, all pregnancies^ by number of births and nativity.................................. ..................................... Table 12. Mothers reporting specified number of miscarriages, all pregnancies, by number of pregnancies and nativity......................... . . . . . . ............. .............. Table 13. Births during selected year to mothers of specified nativity, according to usual help in household....... ........................ ................. ........................ . Table 14. Births during selected year to mothers gainfully employed in speci fied way during year before birth of infant, according to length of interval between mother’s ceasing work and confinement, and nationality of mother.. Table 15. A ll known issues during selected year to mothers of specified nation ality, according to kind of attendant at birth, registration status, and inclusion in or exclusion from detailed analysis......................... ...................................... Table 16. All known issues during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to kind of attendant at birth, regis tration status, and inclusion in or exclusion from detailed analysis................. Table 17. Births during selected year to mothers of specified nativity, accord in g to kind and duration of help at confinement................................................ Table 18. Live births during selected year to all mothers and to mothers who died within one year after birth of infant and infant deaths, according to nativity of mother and interval between confinement and death of mother.. Table 19. Infants born during selected year to mothers of specified nativity and surviving at beginning of the month, number and per cent of infants dying subsequently in first year, and infant deaths in specified month of life,. according to month of life and type of feeding in the month............. .............. Table 20. Number and per cent distribution of infants born during selected year and surviving at end of specified month, by type of feeding during month specified, according to nationality of mother................................................. .. Table 21. Infants born during selected year and surviving at end of 3, 6, and 9 months whose fathers earned specified amount, and number and per cent of subsequent infant deaths during first* year, according to type of feeding throughout specified period and nativity of mother......................................... Table 22. Infants bom during selected year and surviving at end of 3, 6, and 9 months of age whose fathers earned specified amount, and number and per cent artificially fed, according to nationality of m other................................... Table 23. Infants born during selected year and weaned under 1 year of age. by age and reasons for weaning.................................................................. -.____ Table 24. Births during selected year in each father’s earnings group, according to occupation of father.............. ................... ........ . .............. ..........................'. Table 25. Number and per cent distribution of births during selected year to mothers of specified nativity, according to earnings of father.......................... Table 26. Births during selected year in families of specified number of persons and average number of persons per family, according to earnings of father and nativity of mother...... ....................................... ............................................ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 118 119 119 122 123 124 125 125 127 128 129 130 131 132 134 136 138 138 139 140 CONTENTS. T Page. Table 27. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to earnings of father and nativity of mother.. 141 Table 28. Number and per cent distribution of births during selected year in each father’s earnings group, according to source of family income___ . . . . . . 142 Table 29. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to nationality of mother and her employ ment at home or away from home during year before birth of infant............. 143 Table 30. Live births during selected year, infant deaths, and infant mortality rate, according to working status of mother during year following birth of infant and infant’s age when mother resumed gainful work away from home.. 144 Table 31. Live births during selected year, infant deaths, and infant mortality rate, according to occupation of mother during year following birth of infant.. 144 Table 32. Births during selected year in households of specified number of members, according to number of lodgers in family and nationality of mother.. 145 Table 33. Births during selected year-in families of specified number of persons, according to total family earnings and nationality of mother........................... 147 Table 34. Mothers reporting specified number of births resulting from all preg nancies, by nationality of mother.............................................................. ........... 148 Table 35. Births during selected year to foreign-born mothers resident in United States specified number of years, according to nationality of mother............. 14ft Table 36. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to number of tenements in dwelling........... 149 Table 37. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to average number of persons per room___ ' 149 Table 38. Births during selected year in dwellings of specified number of rooms, according to number of persons to dwelling and nativity of mother.________ 150 Table 39. Births during selected year in each ward of residence, according to sanitary condition of dwelling.............................. 1............................................ . 151 Table 40. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to tenure and rental of home and nativity of m other.................................................................................... .............................. 152 Table 41. Buildings in selected districts, by number of apartments in building.. 153 Table 42. Apartments in selected districts, by number of rooms in apartment.. 153 Table 43. Households in selected districts, according to nationality and color of head of household........................................................................................... - 154 Table 44. Persons in selected districts, according to family status...................... 154 Table 45. Total monthly minimum and maximum rental and average per room and per apartment, by number of rooms in apartment—selected districts... 154 Table 46. Measured sleeping rooms in selected districts occupied by specified numbers of children or adults, according to actual cubic contents and fulfill ment of legal minimum requirements.................................................................. 155 Table 47. Persons and toilets in selected districts, according to specified num ber of persons per toilet and type and location of toilet.................................... 157 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis LETTER OF TRANSMITTAL. U. S. D epartm ent Ch of L abor il d r e n ’s B , ureau , Washington, December 5, 1917. Sir : Herewith I transmit a study of infant mortality in the city of Waterbury, Conn., being the fourth item in a series of studies of the same subject which the Children’s Bureau is conducting. Miss Estelle B. Hunter was director of the field work and has written the report. Special acknowledgment is made of the services of the special agents who secured the schedules in the field, Misses Eunice Crane, Marie Hourwich, Viola Paradise, Ethel Springer, Ruth True, and Helen Wilson. Miss Wilson made the special study of Waterbury housing. Miss Rena Rosenberg examined schedules in the field and assisted in the preparation of the report. Miss Emma Duke, head of the statistical division of the Children’s Bureau, had general supervision of the preparation of the statistical material The Children’s Bureau acknowledges with much appreciation the cooperation of municipal authorities, of volunteer associations, and of the press in Waterbury. XT TXT T> TTT JuL1A C. L a t h r o p , Chief. Hon. W. B. W ilson, Secretary o f Labor. 9 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis FOREWORD. Although the period covered by this inquiry, June 1, 1913, to May 31, 1915, included the first nine months of the first year of the war, the conditions portrayed in this report are in the main prewar conditions. The extensive changes in industry which have been . brought about in Waterbury by the war were just commencing to make themselves felt at the close of the inquiry. The population of Waterbury, which in 1914 was estimated by the United States Bureau of the Census at 82,517, has been greatly increased during the past three years by the addition of large numbers of negroes from the South and foreign born of many nation alities from other communities who have been attracted by the high wages paid in the munition factories. But coexistent with high wages these newcomers have found an even higher cost of living. Furthermore, the city was unprepared for this sudden increase in population, and even ability to pay for comfortable surroundings has not insured ability to secure them. The problem of housing these newcomers is beginning to receive attention, but accommodations for housing the rapidly increasing population of the city are still inadequate. In February, 1916, a group of Waterbury citizens petitioned the mayor to appoint a hous ing committee to investigate and report upon conditions. As a result the mayor appointed a committee of six leading citizens, who secured the services of an expert in city planfling. Under his direction the city was surveyed and a report with recommendations was presented to the public through the newspapers. Acting upon the information in this report two large manufac turing plants have been erecting a number of houses of desirable types, but many of these will not be available before 1918. Although a step in the right direction, they can not begin to meet the imme diate demand for housing accommodations. It is obviously impracticable to attempt to enforce laws pertaining to overcrowding when eviction from one center of congestion would merely increase congestion in another center. Certain conditions, however, could be corrected, such as disrepair of buildings, inadequate or faulty plumbing and toilet facilities, infrequent and irregular col lection of garbage, insufficient or impure milk and food supply. These must be adequately supervised and controlled by the city if the health of the community is to be maintained« It should be ll https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 FOREWORD. recognized that the intensive room congestion as it exists in Waterbury to-day greatly increases the susceptibility of the population to disease. Such health measures as can be taken should therefore he most vigorously enforced. The health department should be re sponsible for all of this work. But Waterbury, which in 1914 appro priated hut 17.7 cents per capita population for its health work, about one-third the recognized minimum, appropriated even less per capita in 1917. It still expects its health department to do efficient work with the staff and equipment which were inadequate in 1914, namely, a part-time health officer, one milk and food inspector, one tenement-house inspector, and one supervisor of garbage collection.* Employment of married women has greatly increased in Water bury since the beginning of the war, one large munition plant alone employing several thousand women, nearly one-half of whom are married. The employment of mothers brings with it problems of infant and child care, in a proper solution of which the city, as well as the mother, is vitally interested. However, a large measure of the responsibility for the welfare of the children of working mothers rests upon the State or municipality which permits the mother to pursue gainful occupations outside the home. As a basis for intelligent action information on the following points should be secured: (1) What care does the child of the working mother receive ? (2) If the child is cared for in a day nursery, what supervision does the nursery receive and by whom is it given ? (3) If the child is cared for at home, is some older child required to care for the baby when he should be in school ? (4) If the mother works at night, is she able to give the child the proper care during the day ? The results of such an inquiry undoubtedly would lead the com munity to consider whether it would not prove better, and in the end cheaper, to make provision that would enable the mother to remain at home with her children. Twenty-five States have passed mothers’ pension laws providing pensions which permit the mother to remain at home with her children, free from financial worry, until the children themselves reach an age when they can become wage earners. One private organization is attempting to reduce infant mortality in Waterbury by maintaining an infant-welfare station in that section of the city where infant mortality from preventable causes was highest at the time of the investigation. But the 1916 report for this organ ization indicates that of the Lithuanians, who, more than any other group, appear to need wise direction in the care of their infants, few have availed themselves of its services. In brief, many of the conditions set forth in this report as existing in 1915 have grown steadily worse. Furthermore, other factors, such as the addition of new racial elements to the population and https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis FOREWORD. 13 the increased employment of mothers, have contributed to the causes of ill health and high mortality for both adults and children. Such a situation, deplorable at any time, is particularly disastrous when a country is engaged in war. England, Germany, and France are at tempting to retrieve the mistakes made at the beginning of the war through their failure to realize that an adequate preparedness pro gram includes increasing and strengthening all public-health meas ures. Under existing circumstances Waterbury’s population, even with greatly increased wages, can not purchase healthful living con ditions; until they can be purchased, the city can not expect to conserve the health of the community nor to lower materially its infant mortality rate. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY, WATERBURY, CONN. g INTRODUCTION. The inquiries of the Federal Children's Bureau into the causes of infant mortality mark the beginning of an attempt on the part of the United States Government to obtain an accurate measure of the relative importance of various factors in the great waste of infant life in this country. Obviously this attempt must rest upon an accu rate knowledge of the number and location of births. Owing to the incomplete registration of births and deaths in many sections of the country it is impossible at the present time to compute an exact infant mortality rate for the United States as a whole. We are still guessing at our birth and death rates in spite of the fact that we have long known that uniform methods of keeping our vital statistics are essential to intelligent government. INFANT MORTALITY RATE. Infant mortality is a technical term referring to deaths of infants under 1 year of age. An infant mortality rate is the number of such deaths per thousand live births.1 The usual method of computing an infant mortality rate for a certain area is to divide the number of deaths of infants under 1 year of age occurring in a given calendar year b y the number of live births in the same year. Obviously the number of deaths thus secured includes not only deaths of infants born in the same calendar year, but also deaths of some infants born in the preceding year and of some bom in a different area. In other words, the two numbers do not refer strictly to the same group of in fants. To avoid this-inaccuracy the infant mortality rate in this study is based on the number of babies born alive in a certain area within a given 12 months and the number of deaths under 1 year in this same group, thus excluding the deaths of any infants not born in the specified area and period. That birth registration in the United States is not only universally imperfect, but that it is much more imperfect than death registration, is generally recognized. Hence rates computed b y the usual method involve what Phelps has called the great American infant mortality * In some countries the infant mortality rate lias been computed on the basis of an births, including stillbirths; but thiB practice is not general in the United States, nor has it been followed in any work: of the Children’s Bureau. 15 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16 IN F A N T MORTALITY. fallacy, which arises from dividing the practically complete number of deaths b y the incomplete number of births, thereby obtaining too high a death rate. In 1911 the United States Bureau of the Census1 estimated that in 23 States and the District of Columbia, containing more than onehalf of the population of the United States, at least 90 per cent of the total deaths were registered. Within this part of the deathregistration area the infant mortality rate was computed as 124 per thousand live births.2 A later report of the Census Bureau shows for 1915 a rate of 100 in the birth-registration area, a much smaller section of the country, consisting of the New England States, New York, Pennsylvania, Michigan, Minnesota, and the District of Colum bia and containing about one-third of the population. In these States the rate varies from 70 to 120, as shown below, while the rates for cities of 25,000 population or over in 1910 in the same area range from 54 in Brookline and Malden, Mass., to 196 in Shenandoah, Pa. Infant mor tality rate in calendar year 1915.“ State. 107 105 101 86 70 a State. New Hampshire.................................... New Y o r k ............................................. Pennsylvania......................................... Infant mor tality rate in calendar year 1915.® 110 99 110 120 • 85 U. S. Bureau of the Census, Birth Statistics, 1915, p. 10. Although the rate, 100, for the birth registration area of the United States compares favorably with that for Hungary, which was 212 in 1909 and 194 in 1910, it appears unnecessarily high when we consider that New Zealand kept its rate for the entire country down to 62 and 68 for the same years and has since further reduced it to 51. Reduction of infant mortality in the United States has not kept pace with scientific research, which' is constantly adding to the list of preventable diseases. The immediate task of every community should be to prevent infant deaths from such diseases. Medical authorities claim that application of the knowledge at present avail able would save at least one-half of the infant lives now needlessly sacrificed. OBJECT AND GENERAL PLAN OF INFANT MORTALITY INVESTIGATIONS. The main object of this inquiry was to determine not alone the relative frequency of deaths among infants under 1 year of age under different economic, social, and civic conditions, but also the * U. S. Bureau of the Census, Mortality Statistics, 1911, p. 10. *Ibid., p. 25. * Statistics of the Dominion of New Zealand, 1909,1910, and 1915. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 17 importance of the various economic, social, and civic factors in determining an infant mortality rate. With its limited force and funds the Children’s Bureau could not extend its inquiries throughout the entire United States. It there fore decided to make intensive studies in each of a number of typical areas throughout the country, the results eventually to be combined and related. The choice of the first areas was necessarily restricted to places of such size as cou ld. be covered thoroughly within a rea sonable time b y the few agents available for the work; and in order to obtain a complete record of the births and1 deaths in a selected community without the necessity of making a house-to-house can vass, communities within the birth-registration area with popula tions of 50,000 to 100,000 in 1910 were selected. All the cities chosen were manufacturing centers, each with a large foreign element. The initial study was made in Johnstown, Pa., a steel-manufacturing city, where none of the large factories employed women. This was followed b y studies in Manchester, N. H., a cotton-manufacturing town with a high percentage of women at work outside their homes; Brockton, Mass., a shoe-manufacturing center with a high wage level; Saginaw, Mich., a town of varied indus tries; and New Bedford, Mass., a seaboard textile town. A similar study was made by the city of Montclair, N. J., using schedules fur nished by the Children’s Bureau, which later tabulated and published the results. SELECTION OF WATERBURY. Waterbury, Conn., was the seventh city selected as a unit in this national study of the causes of infant mortality. Factors which determined this choice were its location within the birth-registration area, a large foreign group constituting over one-third of the city’s entire population, and a population of sufficient size1 to offer a base large enough to permit accurate deductions from the tabulation of facts secured from the investigation. Moreover, in contrast to some of the other places selected, it had but a small proportion of married women engaged in work outside their homes, and its chief industry, brass manufacturing, had not been represented in the cities previously studied. The infant mortality rate in Waterbury since 1910 has fluctuated between 134 in 1911 and 174.1 in 1913, with an average of 146.5 for the five-year period. . 1U. S. Bureau of the Census Bulletin 133, estimated population 1914, 82,517. 14458°— 18------2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 T able I IN F A N T MORTALITY. —Live births, infant deaths, and infant mortality ratesfor five years, 1910-1914 Live births. Year. 2,150 2,164 2,210 2,171 2,241 a Infant deaths. 320 290 303 378 311 Infant mortality rate. 148.8 134.0 137.1 174.1 138.8 Connecticut Vital Statistics, 1910, 1911, 1912, 1913,1914. The latest census figures show it to have been 143 in the calendar year 1915/ while that for the entire birth-registration area of the United States for the same year was 100. Waterbury’s rate was not only higher than the average for the entire birth-registration area in that year, but was higher than the rate in any other town or city in Connecticut and higher than the rate in all but 26 of the 250 cities reported in the birth-registration area. HISTORY. Waterbury was settled in 1677. Sometime later a committee of the colonial government estimated that the territory including what is now Waterbury, Watertown, Plymouth, parts of Middlebury, Oxford, and Prospect “ might comfortably support 30 fam ilies/’ an. estimate obviously based on the assumption that in spite of the hilly and rocky character of the district it was to be an agricultural community. In 1910 Waterbury alone had within its boundaries 14,556 families.2 It was organized as a borough in 1825 and char tered as a city in 1853. In 1910 it was the fourth largest city in Connecticut, having, according to the Federal census of that year, a total population of 73,141. Of this number 24.9 per cent were native white of native parents, 39.1 per cent native white of foreign or mixed parents, 34.9 per cent foreign-born white, and only 1.1 per cent colored. Waterbury is the largest brass and copper manufacturing city in the United States. In 1909 it ranked,third in the State in the total value of manufactured products. Since becoming a manufacturing center and especially since 1850 the growth of Waterbury has been remarkable, the population increasing from 5,137 in 1850 to 73,141 in 1910. This increase in population was due in great ,part to the large influx of immigrants drawn by the demand for workers in the fac tories. The order of their coming corresponds closely to the order in which the various nationalities have been added to the United l U. S. Bureau of the Census, Birth Statistics, 1915, p. 10. *U. S. Census 1910, Population, Vol. II, p. 257. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, OONÌT. 19 States as a whole— the English and Irish, followed by the German and French, and later by the Italian, Austro-Hungarian, and Russian. In 1910 there were 25,498 foreign-bom white in Waterbury, repre senting at least 23 countries; the most important groups, numeri cally, are shown in the following statement, which for purposes of comparison includes the figures for 1900: Country of birth. 1910 a 1900 & Country of birth. 1910« Germany......................................... 422 1,901 401 1,175 228 1,433 113 1,777 489 938 149 1,195 Ireland............................................ Italy................................................ Russia............................................. Scotland.......................................... Sweden............................................ Other foreign countries................. 5,838 6,567 5,600 525 624 784 1900 & 5,866 2,007 1,265 386 397 782 a U. S. Census 1910, Population, V oi. II, p. 256. 6 U. S. Census 1900, Population, Voi. I, Part 1, pp. 800-803. The greatest recent immigrant growth has been in the Italian and Russian groups. The Italians first appeared in Waterbury about 1870; in 1900 they numbered 2,007 and increased to 6,567 in the next 10 years. They now form the largest foreign group in the city, outnumbering even the Irish, who in 1900 equaled more than twice the population of any other foreign group. The latter have remained practically stationary in number since 1900 and are now the second foreign group in size. The third most important foreign group is the Russian, which includes Lithuanians, Russian Poles, and Russian Jews, by far the greatest number being Lithuanians, the first of whom came to Waterbury in 1890. The city is divided into five wards, each of which radiates from the center and includes business, residential, and rural sections. The Naugatuck River runs south through the city a little to the west of the center, separating practically all of ward 3 and half of ward 4 from the other wards. The flat land, which forms the Nauga tuck Valley, was the natural selection for the location of the homes of the workers in the manufacturing plants located along the stream. An increasing number of shops and factories and their attendant industries necessitated the growth of the business section of the city, thereby decreasing the amount and increasing the value of valley land available for home sites. In time this pressure of land values began to force the population up the surrounding hills where the problem of congestion is as yet unknown, although inadequate water* supply, sewage disposal, and transportation are serious obsta cles to proper living. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 20 IN F A N T MORTALITY. METHOD OF INQUIRY. In accordance with the plan determined upon by the Children’s Bureau for all infant mortality inquiries, the primary basis of selection was to be registered births, but the fact that there were comparatively few infants of Lithuanian mothers registered made it seem advisable to make a house-to-house canvass as a check on the completeness of birth registration in Waterbury. This canvass, supplemented by comparison with baptismal records, death certifi cates, and records of social agencies, disclosed 329 1 unrecorded live births, representing 12.8 per cent of all live births in the city for the 12 months under consideration. Of these unrecorded live births, 222 were of children of foreign-born mothers, 171, over one-half, occurring to Lithuanian mothers. Although constituting but 18.1 per cent of all births to foreign-born mothers, and 12.2 per cent of the births to all mothers considered in the detailed study, the Lithuanians had the highest infant mortality rate of -any nationality.2 Waterbury was officially unaware of the existence of at least 12.8 per cent of its accessions by birth, unless death and need for a burial permit secured registration of the fact that these infants had been for a time part of a community which cared too little for their wel fare even to register their arrival. Fifty-two, or 15.8 per cent, of the 329 live-bom babies whose births were unregistered were recorded only in the death records of Waterbury. Thirty of these 52 deaths were of Lithuanian babies, the group having the highest infant mortality rate from all causes, and more important still, the largest proportion from preventable causes. The per cent distribution of unregistered five births according to nationality of mother is shown in Chart I. Of the 329 cases not registered, failure to report was attributable in 11 or 3.3 per cent to hospitals, in 38 or 11.6 per cent to private physicians, and in 156 or 47.4 per cent to midwives. In the remain ing 124, representing 37.7 per cent of the unregistered births, either there was no recognized attendant or information regarding the attendant was not secured. Often the unlicensed midwives had physicians sign as the attendant at birth, and of the births found to be attended b y midwives who had no supervision of any kind a large proportion were not registered at all. Some midwives were regu larly failing to report their cases, only a very small number of births attended b y them being recorded. The initial fault lies in the failure to enforce the State law of Con necticut for the registration of births and deaths. The law 3 pro1 General Table 1. * General Table 2. 3 A Manual of Statutes of Connecticut relating to the Public Health and Safety, 1902, secs. 1861, 1870,4714, 4715. and 4719. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBUKY, CONN. 21 vides (1) that all persons acting as paid attendants at the birth of a child must be regularly licensed practitioners; (2) that the fact of the birth must be reported in writing to the local registrar not later than the first week of the month succeeding the birth; and (3) ap propriate' penalties for failure to observe the above provisions of the law. The law is weak in that it permits a perilously long period to elapse between the date of birth and the date of registration, and it makes C H AR T I.— PER C E N T D IS TR IB U TIO N OF U N R E G IS TER E D L IV E B IR TH S, ACCORDING TO N A T IO N A L IT Y OF M OTHER. scant provision for enforcement. That the law has not proved effective, in at least some sections of the State, is shown by the fact that in 1912 the county health officer of New Haven County in his report to the State board of health stated:1 Investigations made in the city of Waterbury during the past summer showed that more than 50 per cent of the births occurring among the families of some of the foreign population were never returned to the registrars of vital statistics. This must be over come in some way, as it destroys the accuracy of all of the vital statistics of the State. 1 Report of State Board of Health, 1911-12, p. 84. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 IN F A N T MORTALITY. As shown by the Children’s Bureau canvass, the registration is still incomplete. If it is to be made satisfactory, prompt registration of births should be one of the recognized duties of physicians, midwives, or other persons called upon to fill the position of attendant at birth. Immediate and persistent prosecution for failure to report the births would prove a most effective method of improving birth registration and would serve also to eliminate from practice those who at present are practicing without licenses. The preliminary work of the Waterbury investigation was begun in April, 1914. This consisted of copying the names, addresses, and other information contained in the birth certificates on file at the city hall for all babies born during the period commencing June 1, 1913, and ending May 31, 1914. These 12 months were selected because they constituted the most recent 12-month period which would per mit all the babies to have lived at least one year before being visited. In addition to transcribing the city records to the uniform schedules upon which the facts gathered in the course of the inquiry were to be entered, a schedule was filled out for every unregistered baby for whom was found a baptismal record or a record with some social agency or institution. Information from the death certificates on file was copied on the schedules already made out from the birth certificates for all babies whose birthplace was given as Waterbury, Conn.; for 52 no birth certificates were found. Schedules were therefore filled out from the death certificates as they had been from baptismal records and the records of social agencies. These schedules were assigned to the agents, who called not only at the addresses secured as indicated but at every house in the city to make inquiries concerning all births and infant deaths which had occurred during the selected period. The information called for by the schedule was secured through personal interviews of individual mothers by the woman agents. The study was absolutely democratic; the mother of every baby born in the year selected, whether rich or poor, native or foreign born, was sought. As the text shows, certain facts regarding the civic surround ings of the families were secured in addition to the data from inter views, but. the chief value of the inquiry lies in the information afforded by the mothers. While the preliminary clerical work was in progress the people of Waterbury were being made familiar with the purpose and plan of the investigation. The unfailing cooperation so generously given through out the inquiry by the entire city of Waterbury, through its public officials, institutions, private organizations, press, clergy, and various other representatives, is responsible in large measure for the success of the inquiry. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 23 In every section of the city the agents of the Federal Children's Bu reau found evidences of the intelligent manner in which Waterbury had prepared the mothers for the visits of the Government agents. As the Children's Bureau has no power to compel answers, all informa tion secured must be given willingly. It is therefore a great tribute to the constructive interest of Waterbury mothers that of the 2,197 mothers visited not one refused the information upon which the re port is based. ANALYSIS OF MATERIAL. MATERIAL CONSIDERED. This investigation considers all live-born and all stillborn infants of 7 or more months’ gestation, registered and unregistered, bom in the city during the 12 months selected (June 1, 1913, to May 31, 1914) whose families lived in the city with the baby for at least 9 months of the baby’s first year and for whom accurate records could be obtained.1 WARD DISTRIBUTION. The distribution of the 2,144 live-born infants and the deaths of 263 of the group who died before reaching 1 year of age is shown on the map facing this pagé. A large number of infant deaths in a certain section does not necessarily indicate a high infant mortality rate for that section- Therefore the insert map showing the rates by wards must be considered in connection with the spot map in order not to give undue weight to numerous infant deaths in densely populated areas. To consider the infant mortality rate for the city as a whole obscures the fact that the rates for certain sections within the city may be much higher or much lower than the rate for the entire city. It might be expected that in a city like Waterbury, where the wards radiate from the center of the city, ward rates would be similar on account of the inclusion of a sample of every variety of neighborhood within the boundaries of each ward, from the congested section near the heart of the city to the rural areas at the edge. But rates varying from 150.1 in the fourth ward to 70.6 in the second ward are shown in Table II which presents the distribution of births and infant deaths together with the infant mortality rate for each of the wards. ---------------:--------------------------------------— _________________ _____________________ ■ _________________ I 1Four hundred and fifty-seven births were excludedfrom the detailed study for the following reasons: Two hundred and sixty-three mothers moved from AVaterbury before the^nd of the baby’s first year or spent the greater part of the year outside of the city: 49 mothers (termed “ nonresidents” ) came to Waterbury to avail themselves of its hospital service and returned to their homes outside the city shortly after confinement; in 3 cases the information regarding the baby was given by some person other than the mother and there seemed reason to doubt its authenticity ; 12 schedules for infants of unmarried mothers were excluded on the ground that there was no family group; 12 schedules for miscarriages were excluded, as the study is con fined to live births and stillbirths that have resulted from at least 7 months’ gestation, and 118 could not be located. These 118 births constituted only 4.4 per cent of the 2,654 names secured, although in many in stances the visits to the homes were not made until 2 years after the birth of the child concerning whom the information was sought. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 24 IN FA N T1 MORTALITY. T a b l e I l.a —Live births during selected year, infant deaths, and infant mortality rate, by ward of residence. Total live births. Ward of residence. Ward: 1 .................................................................................................. 2 ........................... ...................................... ................. . . . . . . . . . 3 .................................................................................................. 4.......................................................................................................... 5 ........................................................................................................ Infant mortality rate. Infant deaths. 2,144 263 122.7 451 326 482 573 312 63 23 51 86 40 139.7 70.6 105.8 150.1 128.2 a General Table 3. A partial explanation of the varying rates is indicated by Chart II, which brings out the fact that in all wards but the second the births to foreign-bom mothers greatly outnumbered those to the native mothers. Of the foreign-bom mothers the bulk of the Italians were found in wards 4, 3, and 1, given in order of importance; the Lithu anians in wards 3 and 4, and the Irish in wards 5 and 4. T a b l e I I I . —Births during selected year in each ward of residence according to nationality of mother. Ward of residence. All wards. 4 11 573 12 312 11 147 179 7 3 160 322 1 10 136 437 1 11 99 213 2 9 628 260 195 89 60 57 56 40 54 23 7 5 2 1 1 121 6 31 36 39 18 7 11 19 5 77 5 19 20 15 17 6 9 11 2 1 129 145 15 2 4 10 2 5 10 6 3 203 98 62 20 1 10 28 8 7 8 3 98 6 68 11 1 2 13 7 7 2 Italian............................................ English, Scotch, and Welsh!)....... 1 1 1 cd H S 10’ 482 1 Stillbirths. 326 2 7 3 Live births. 9 163 288 -4-S Ja s +2 CG Live births. 451 13 40 •Live births. 53 Stillbirths. All mothers. . .......... ............... 2,144 705 Native mothers................................... Foreign-born mothers.......................... 1,439 Live births. Live births. 5 Stillbirths. I 3 Live births. 2 Stillbirths. 1 Nationality of mother. 5 1 1 a Including 65 Polish, 20 Russian, 2 Slovak, 2 Bohemian, 1 Serbo-Croatian, and 1 Ruthenian. b Including 18 English, 21 Scotch, and 1 Welsh. c Including 29 Scandinavian, 7 English Canadian, 6 French, 5 Magyar, 3 Syrian, 2 Greek, 1 Dutch, 1 Spanish, and 1 West Indian Black. ' Throughout this report, with the exception of the special housing section, the nationality of the mother rather than that of the father has been shown, because it is believed that in those cases in which the parents are of different nationalities the customs and traditions of the mother determine the character of the care given the infant. This procedure affects only 12.9 per cent of the total 2,197 cases, as for 1,911, or 87 per cent, the nationality of the parents was the same.1 1 General Table 4. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WAT E B B UE Y , CONN. 25 C H A R T II.— PER C E N T D IS TR IB U TIO N OF B IR TH S, ACCORDINO T O W AR D O F RESIDENCE AND N A T IO N A L IT Y O F M O TH ER. Per cent. 0 1 2 3 4 5 6 7 Ward 1 mam Ward 2 Ward 3 m m m m m Ward 4 '/////MM Native. Ward 5 Italian. Lithuanian Allother. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 9 10 26 IN F A N T M O R T A L IT Y . MEDICAL CAUSE OF DEATH. The medical cause of death is the immediate cause only. Cor rectly speaking, it is not only a cause but also a result the result of improper economic and social conditions. The discussion of any one of the group of diseases shown in Chart I I I necessitates the consid eration of factors responsible for the creation of the disease. Congeni tal debility suggests improper care or illness of the mother during the period of gestation j diseases of nutrition and gastric and intesti nal diseases point to improper care <of the infant, particularly in the matter of feeding, although hot weather or infection and a defective digestive tract may also be responsible. These causes in turn may be affected by such factors as insufficient income, improper hous ing conditions, employment of the mother, or ignorance or indif ference on the part of the caretaker of the infant. In considering the tables presented in this report the reader must constantly bear in mind that, though the infant mortality rate may be shown to vary with variations in some one factor, the inference that the factor is a direct or sole cause is not always warranted; the nature of the facts and the interrelation of the various factors considered may prohibit the inference of too close a relationship. All causes.1— The most important causes of infant deaths in Waterbury are the group of gastric and intestinal diseases, which caused over one-third of all infant deaths. Second in importance are the deaths from premature birth, congenital debility, injuries at «birth, etc., included under the group heading “ Earty infancy.’ ’ Almost one-third of the deaths were due to this cause. Third in order are respiratory diseases, causing 14.8 per cent of all infant deaths. i Principal causes of death for infants under 1 year according to classification by United States Bureau of the Census for deaths during this period. (Mortality Statistics, 1914, p. 660.) The term “ gastric and intestinal diseases,” as used in the tables and discussion, includes only the diseases of this type which are most important among infants, i. e., diseases of the stomach, diarrhea, and enteritis. It does not include all' ‘diseases of the digestive system’ ' as classified under this heading according to the detailed International List of Causes of Death, Respiratory diseases, similarly, includes only those of the respiratory diseases which are most important among infants, i. e., acute bronchitis, broncho-pneumonia, and pneumonia. It does not Include all “ diseases of the respiratory system” as classified under this heading according to the detailed International List. Epidemic diseases includes only those of this group which are most important among infants. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 27 WATERBURY, CONN. C H A R T 111.— PER C E N T O F IN F A N T D EATH S DUE TO SP EC IFIE D CAUSES, ACCORDING TO N A T IV IT Y O F M OTHER. Per cent. 0 10 20 30 40 Gastric and intestinal. Early infancy. Respira tory. Epidemic. The proportion of deaths from each group of causes in Waterbury during the selected year as compared with that in the registration area in 1914 is shown in Table IV. Waterbury’s per cent distribu tion of deaths was lower than that for the registration area in every group of diseases except that from gastric and intestinal diseases, for which group it had a percentage 9.2 higher than that for the regis tration area. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 28 IN F A N T M O R T A L IT Y . T a b l e IV .a—Per cent distribution of deaths among infants born in Waterbury during selected year and of infant deaths in the registration area in 1914, by cause of death. Waterbury. Registration area. Cause of death. a 100.0 100.0 33.5 14.8 3.8 31.6 6.8 .4 1.5 7.6 24.3 15.5 6.2 33.9 8.2 1.2 1.9 8.7 General Table 5. Gastric and intestinal diseases.— Gastric and intestinal diseases, the group causing the greatest number of infant deaths in Water bury, are largely preventable, yet they were responsible for 88 or one-third of all infant deaths in Waterbury, a proportion greatly in excess of that for the registration area. Diseases of the intestinal tract can in most cases be traced to some combination of summer heat, unhygienic surroundings, and improper care such as unsuitable feeding or neglect. These in turn may be conditions fostered by ignorance and poverty. It follows that a program for the preven tion of gastric and intestinal diseases must include provision of adequate incomes for proper family life and education of the mother which will insure intelligent care for the infant. Although births to Lithuanian mothers constituted only 12.2 per cent of all births, the infants of this group contributed 20.5 per cent of all infant deaths and 30.7 per cent of infant deaths from gastric and intestinal diseases. More significant still, one-half of all the Lithuanian infant deaths resulted from these diseases. V .— Total deaths among infants born in selected year and number and per cent of deathsfrom gastric and intestinal diseases, according to nationality of mother. T able Nationality of mother. Infant deaths. Deaths from gastric and intestinal diseases. Number. Native mothers........................................................................................ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Per cent. 263 88 33.5 69 194 18 70 26.1 36.1 69 54 36 35 21 27 12 10 30.4 50.0 33. 3 28.6 29 WATERBTTRY, C O N N . . Heat.— The most striking fact about deaths from gastric and intes tinal diseases is the marked increase in number during the summer months. The small number of deaths from this cause during the winter months, the rapid increase throughout the summer, culminat ing in September, and the sudden drop in October, are shown in Chart IV. C H A R T IV .— D EATH S FROM S P EC IFIED CAUSES B Y CALEN DAR M ONTH O F D E A TH . Jan. Feb. Mar. Apr. May June ' July Aug. Gastric and intestinal disease s — — — -r——— — Respiratory diseases -- ----- ------------------Diseases of early in fan cy-------------------------------------- Sept. Oct. Nov. Dec. The sudden increase in September is no doubt due in part to the cumulative effect of the summer heat, which jn 1913 was sustained for a long period, as shown in the following tabular statement. The effects of heat are increased by poor ventilation and improper sur roundings within the home, making the infant an easy prey to all diseases which affect the intestinal tract. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 30 Temperature and precipitationfor Waterbury, Conn., during the period of the investigation. [Furnished by the Weather Bureau, U. S. Department of Agriculture.] Temperature. Temperature. Precipi tation. Precipi tation. 1913. July..................... November.......... December........... Mean. Maxi mum. Mini mum. °F . °F . °F . 67 73 71 62 57 44 35 92 97 96 88 80 70 57 38 45 44 33 30 24 11 Mean. In ch es. 3.31 1.36 2.93 3.37 8.83 2.92 2.84 1914. January.............. February............ °F . 28 22 35 46 Maxi mum. •F. 55 53 72 83 94 Mini mum. •F. -1 0 -1 1 12 21 31 In ch es. 3.87 3.10 6.09 3.87 2.81 Improper feeding.—An important cause-of gastric and intestinal diseases is improper feeding. A comparison by nationality of the percentage of artificially-fed infants at the end of the first 3 months, 6 months, and 9 months of life with the per cent of infant deaths from gastric and intestinal diseases for the same nationalities, shows that among infants of foreign-born mothers the percentage of deaths increases with the proportion of infants artificially fed. Poverty.— That the native mothers constitute the only group with the coincidence of a high percentage of artificial feeding and a low percentage of infant deaths from gastric and intestinal diseases is shown graphically in Charts Va and Vb. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 31 WATERBURY, CONN. C H AR T V A .— PER C E N T O F A R T IF IC IA L L Y -F E D IN FA N TS SUR V IV IN G A T AG E SP EC IFIED , ACCORDING T O N A T IO N A L IT Y O F M O TH ER. Per cent. 0 10 15 20 25 ___________________________________________________________________________________________ j.r .....i........................ 30 35 40 45 50 1 1 | | |1 3 mos. 5 i 1 _____________ 6 mos. / / / / / / / / / / / / / / / / C H A R T VC. — PER C E N T OF IN F A N T D EA TH S CAUSED B Y G ASTRIC AND DISEASES, ACCORDING T O N A T IO N A L IT Y O F M OTHER. Per cent. ////////////✓ ////////// Irish. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis vm m m IN TE S TIN A L 32 IN F A N T M O B T A L IT Y . Safety in the use of artificial feeding is greatly increased by proper and intelligent care. Such care depends not only upon the intelli gence of the mother, but also upon her financial ability to provide proper food and competent medical supervision. The influence of income on the survival of artificially-fed infants is discussed in the section on feeding.1 Consideration of the foreign-born groups shows most strikingly that increased income alone will not assure safety to the artificially fed infants. The highest percentage of deaths from gastric- and intestinal dis eases among all artificially-fed infants was found among the Lithu anians, the group with the lowest earnings; the second highest per centage of infant deaths from these causes occurred among the Irish, although their incomes from fathers' earnings were exceeded only by those of the native families. In the native groups there existed a coincidence of high incomes, extensive artificial feeding during the early part of the infants’ first year, and a low percentage of deaths from gastric and intestinal diseases. It should also be taken into consideration here that the native mothers had much smaller families than did the foreign born, so that even the native families in the lowest income group enjoyed a better standard of living than the foreign-born families in the same group. Ignorance.— A primary cause to which but slight recognition has been given is the fatalistic acceptance of the deaths of their children by a large number of the foreign-born mothers. Many of the Lithuanian mothers of Waterbury exhibited a striking lack of knowledge of the causes from which their babies died and seemed surprised that any one should think it possible to prevent the deaths of those ordained to die in infancy. Even those mothers who knew the causes were ignorant of the fact that many of these deaths were preventable. One Lithuanian mother lost 5 of her 11 children before they had lived 10 months and 4 had died of “ stomach trouble.” The death certificate for the last baby showed “ acute colitis’*’ as the cause of death. The mother’s custom was to give the newborn baby the bottle at his first feeding, but she did not associate this with the “ stomach trouble” so common to her children. A Lithuanian mother who had lost 5 of her 8 children in early infancy knew that 2 died as the result of diarrhea and another from an unknown cause; 2 she stated “ were always weak. ” The death certificate for one of these stated 11malnu trition— improperly modified milk.” This mother, too, fed her babies artificially from the first. Another Lithuanian mother stated that 4 of her 9 children died before reaching 6 months of age, 3 of them from diarrhea, and the last from a severe cold. But the death 1 See p. 55. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 33 certificate for the last baby showed “ bronchitis and malnutrition.” An Italian mother who had had 14 pregnancies, stated that 2 were miscarriages, 1 died as the result of bronchitis, 3 from unknown causes, and 5 because they had been “ bewitched.” The death cer tificate for the last baby who had been “ bewitched” showed the cause of death to be “ acute gastroenteritis.” The other foreign-born groups and the native mothers also showed need for education in matters of child hygiene, particularly in regard to diseases of the intestinal tract, which are so largely preventable. Causes of death peculiar to early infancy.1— Diseases of early infancy are second in importance among the causes of infant mor tality in Waterbury and are responsible for a higher percentage of the deaths among infants of native mothers (33.3) than among those of foreign-born mothers (30.9). The Report of the Medical Officer of Great Britain’s Local Gov ernment Board records: Of the total deaths of infants in the first year after birth, about one-fifth occur in the first week after birth, one-third in the first month after birth, and over onehalf in the first three months after birth. Nearly all the deaths in the first week and most of the deaths in the first month of life are attributable to antenatal and natal conditions.2 In Waterbury 31.6 per cent of all infant deaths were due to condi tions existing before the birth of the child or of injury and accident at birth; of those that died under 2 weeks, 72.7 per cent died from these causes. How many of these deaths in early infancy might have been pre vented can not be estimated, but experiments in this direction have proved conclusively that adequate prenatal care will prevent a large proportion. Such care involves education of the prospective mother in proper care of herself during pregnancy, supervision of the patient throughout pregnancy by a skilled obstetrician, together with proper nursing care and adequate obstetrical service at the time of confinement. Such care is beyond the means of many Waterbury women. Poverty necessitates ecoiiomy in the amount and variety of food, often makes it impossible for the prospective mother to discon tinue work until labor pains actually commence, prohibits any medical attention which she feels is not absolutely necessary, and cuts her off in every conceivable way from the care which she should have if she is to bear healthy, live-born children with the least danger and discomfort to herself. The establishment of free or moderately priced adequate prenatal and confinement service for those women who otherwise could have 1 The term “ causes of death peculiar to early infancy” as used in the tables and discussion includes those deaths due to premature birth, congenital debility, and injuries at birth. •Report Medical Officer, Great Britain’s Local Government Board, 1913-14, p . X X X IIT . 14458°— 18----- 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 34 no supervision during pregnancy would save many infant lives to the community and would reduce materially the enormous amount of unnecessary suffering which at present causes many women to face approaching motherhood with dread and despair. Principal respiratory diseases.— Respiratory diseases were respon sible for 14.8 per cent of the 263 infant deaths considered in this report, ranking third in importance as a cause of infant mortality.1 This proportion does not differ greatly from the corresponding figure (15.5) for the entire registration area for 1914. In Waterbury the percentage of deaths from this cause among infants of native mothers was practically the same as that among infants of foreign-born mothers, being 14.5 per cent for the former and 14.9 per cent for the latter. The months January to May, inclusive, registered the greatest number of deaths from respiratory diseases, as shown by Chart IV .3 In general, deaths from these diseases have been found to be most common in late winter and in the spring; the seasonal incidence is due, it is generally agreed, to increased danger from infection'caused by inadequate house ventilation during the colder months. Results of recent experiments indicate that here, too, the educa tion of the mother is the foundation upon which to build. She must be taught that breast milk and fresh air in adequate amounts afford protection against these diseases; that they are infectious and the baby must therefore be kept away from persons suffering with colds, and that respiratory infections in the infant must receive early treat ment under the direction of a competent physician. But preventive work is still in the experimental stages and so far but slight progress has been made. ^ e e Chart III, p .''27. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis * See Chart IV , p. 29. WATERBURY, CONF. 35 AGE AT DEATH. The first few days and weeks of life are by far the most hazardous, due in large measure to prenatal conditions. Prenatal conditions largely influence the health of the infant after birth, and the nine months of gestation should be recognized as months of preparation for the difficult adjustment which the infant must make during the first few weeks of life. Proper attention to the importance of this period would prevent not only many of the early deaths but much of Number C H A R T VI — D EA TH S IN S P EC IFIED M O NTH O F AGE. the illness of childhood and consequent handicaps throughoutlif e. The hazards of these first months of life are clearly shown in Chart V I ; 881 of the 263, a little over one-third of the total infant deaths for the 12 months under consideration, occurred before the end of the second week of life; 107 or 40.7 per cent during the first month; 135 or 51.3 per cent in the first two months; and 153 or 58.2 per cent, well over one-half, took place before the end of the third month of life. 1 General Table 8. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 36 The corresponding figures for the entire registration area of the United States during the year 1914, as shown in Table VI, were 45.5 per cent under one month, 54.7 per cent under two months and 62.3 per cent under three months of age. The fact that the percentage of deaths from diseases of early infancy is lower for Waterbury is probably due to the high percentage of deaths from gastric and intestinal diseases, the greater number of which occurred after the third month of the child’s first year. V I.—Per cent distribution of deaths among infants born in Waterbury during selected year and infant deaths in the registration area in 1914, by age at death. T able Age at death. Registra Waterbury. tion area, a All ages................................ 100.0 100.0 Under 1 month................. ........ Less than 1 day....... ............... 1 day but less than 2............... 2 days but less than 3.............. 3 days but less than 7. ............ 1 week but less than 2............. 2 weeks but less than 1 month. 1 month but less than 2................. 2 months but less than 3............... 3 months but less than 6................ 6 months but less than 9............... 9 months but less than 12.............. 40.7 14.4 4.2 3.8 6.5 4.6 7.2 10.6 6.8 19.5 12.5 9.9 45.5 14.6 5.1 3.7 7.3 6.5 8.4 9.2 7.6 16.7 11.9 9.2 o Derived from U. S. Bureau of the Census Mortality Statistics, 1914, p. 660. The proportion of deaths during the early months of life is greater for infants of native mothers than for those of foreign-bom mothers as shown in the following summary: Per cent distribution of all infant deaths. Age at death. Native mothers. 44.9 13.1 8.7 Foreignborn mothers. 39.2 9.8 6.2 This result is to be expected, as 55.6 per cent of the deaths occur ring during the first two months of life are due to the group of diseases “ causes peculiar to early infancy,” the most important group of causes of death for infants of native mothers. MONTH OF BIRTH. The relation of the month of birth to the age at death and the per cent of infant deaths by month of birth are presented in Tables V II and V III. The mortality rate was lowest for infants bom in Octo ber (95) and highest for those born in April (158.8). A study of the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 37 distribution of infant deaths as shown in Table V III seems to indicate that deaths under 1 month are most frequent among infants bom during the winter months, and in the second to the fifth months of life the greater number of deaths occur among babies born in the late spring and in the summer. Table V II.—Live births during selected year and number and per cent of infant deaths, by month of birth. Infant deaths. Month of birth. Live births. Number. T hevear................................................ __ _ Jane. 1913................... July, 1913.................................................... August, 1913.............................................. September, 1913.............................................. October, 1913.............................................. November. 1913........................................... December, 1913............................................................. January, 1914.......................................................... February, 1914................................................................. .. March, 1914..................................................................... April, 1914................. ............................................. May, 1914............................................................................ T able 2,144 168 151 198 160 179 190 184 188 174 198 170 184 Per cent. 263 20 11.1 21 V III.—Live births during selected year and infant deaths occurring in specified month of life, by month of birth. AGE OF MOTHER AND ORDER OF BIRTH. The infant mortality rate, according to age of mother and order of issue based on all births reported in the maternal histories, is shown in Tables IX , X , and X I. The death rates for babies of extremely young mothers and for mothers aged 40 and over are very high, being 177.6 for the former and 160.3 for the latter. There is a material decrease in the rate for infants of mothers between the ages of 20 to 24 and 25 to 29; the rate rises again for babies born to mothers of the later age groups. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 38 IN F A N T M O R T A L IT Y . T a b l e I X .«— L iv e births resu ltin g fr o m a ll pregnancies, in fa n t deaths, and in fa n t m orta lity rate, according to age o f m other. Live births. Age of mother. a General Table 9. Infant deaths. Infant mortality rate.& 7,507 987 131.5 518 2,368 2,451 1,418 613 131 8 92 300 297 184 87 21 6 177.6 126.7 121.2 129.8 141.9 160.3 6 Not shown where base is less than 100. Consideration of the births to the same mothers during the selected year only 1 brings out the fact that the rates for all age groups show a similar trend except those for mothers under 20, for which the figures are too small for use in computing a rate. For the births to mothers in the single year of investigation there is a somewhat greater decline in the rate among mothers between 20 and 24, while the death rate of 192.3 for children of mothers 40 and over is even higher than that for mothers of the same age in the group showing all pregnancies. T a b l e X . — T otal births resu ltin g fr o m a ll pregnancies and per cent o f births o f specified nu m bers in order o f birth , according to age o f m other at birth o f in fa n t. Per cent of births order. Total births. Age of mother. a # Sixth and later. Ninth and later. 2,458 2,526 1,466 641 133 0.8 10.0 37.8 64.0 83.5 0.6 6.7 27.0 54.9 oi specified Eleventh and later. (a) 0.8 9.0 32.3 Less than one-tenth, of 1 per cent. The variation in the infant mortality rate according to order of pregnancy is brought out in Table X I. The rate for first-bom children is 121.9; for second-bom, 112.5; and it increases, with slight irregularities, for later-bom children with the number of pregnancy to 197. 2 for ninth-born children, the latest for which the figures are large enough to compute a significant rate. It is difficult to estimate how much the higher death rate for infants bom to women of 40 and over is due to uterine exhaustion from bearing many children and how much it is due solely to age develop ment. Of all children bom to women of this age group, 32.3 per i General Table 10. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBTJRY, CONN". 39 cent are issues of an eleventh or later pregnancy, 54.9 per cent of a ninth or later pregnancy, and 83.5 per cent of a sixth or later preg nancy. For younger age groups the per cent of children who are issues of a sixth or later pregnancy is smaller and decreases rapidly as the age decreases, being 64 per cent for mothers between 35 and 39 years of age, 37.8 per cent for mothers between 30 and 34, and only 10 per cent for mothers between 25 and 29. The infant mortality rate for infants of mothers under 20 is very high (177.6) in spite of the fact that nearly 95.4 of the infants con sidered are first and second bom , for which the rate averages 117.8 (mothers of all ages). Not quite one-seventh of all first and second births were to these extremely young mothers. It is evident, there fore, that the age of the mother or some factor connoted by age here exercises an unfavorable influence on infant mortality independent of order of birth. The influence of age alone may be shown by a study of infant mortality rates for first births alone. The rate decreases from 167.5 for infants of mothers under 20, and 117 for ages 20 to 24, to a minimum of 83 for ages 25 to 29, and rises to 161.3 for infants of mothers 30 years old and over. T a b l e X l.a — L iv e births resu ltin g fr o m a ll pregnancies, in fa n t deaths, and in fa n t m ortal ity rates, according to order o f pregnancy. Live births. Order of pregnancy. Infant deaths. Infant mortality rate.& A ll pregnancies......................................... 7,507 987 131.5 Pregnancies: First.......................... i ................. Second............................................ Third......................................... Fourth................. ................ Fifth............................................... Sixth....................................... Seventh.............................................. Eighth........................................................... Ninth.................................. Tenth....................................... Eleventh and later.............. 1,994 1,547 1,171 870 625 426 316 211 142 93 112 243 174 151 109 98 72 46 33 28 14 19 121.9 112.5 128.9 125.3 156.8 169.0 145.6 156.4 197.2 -------------------a General Table 9. 169,6 6 Not shown where base is less than 100. PLURAL BIRTHS. Of the total pregnancies resulting in plural births 81 were livebom twins, 5 stillborn twins, 8 twin miscarriages, 4 one live-bom and one stillborn twin, and one a miscarriage and a live-bom baby. The total number of issues for all pregnancies was 8,339/ making the rate for plural births 11.9 per 1,000 issues. This is higher than the corresponding rate for Manchester, which was 10.8. Seventy deaths occurred among infants who were the result of plural births, giving the exceedingly high death rate of 419.2; in Manchester the rate was 500. 1This includes 567 miscarriages not included elsewhere in this report. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis . 40 IN F A N T M O R T A L IT Y . T able X I I .—Plural births resulting from all pregnancies, infant deaths, and stillbirths, according to age of mother. Totalbirths. Age of mother. A ll mothers. a Under 20 years__ 20 to 24 years........ 25 to 29 years........ 30 to 34 years........ 35 to 39 years........ 40 years and over. Live births. Infant deaths. Stillbirths. 181 167 70 14 -12 43 54 52 16 4 12 39 50 46 16 4 6 15 20 22 5 2 4 4 6 a The result of 99 pregnancies, of which 81 resulted in live-bom twins, 5 resulted in stillborn twins, 8 resulted in miscarriage twins, 4 resulted in stillborn and live-bom twins (4 each), 1 resulted in a miscarriage and a 1ive birth; 5 mothers had 2 sets of twins. SEX. In conformity with general experience, the infant mortality rate among the male infants was higher than among the female as shown in Table X III. T able X I I I .—Births during selected year, infant deaths, and infant mortality rate, according to sex of infant and nativity of mother. Sex of infant and nativity of mother. Total births. Live births. Infant deaths. Infant mortality rate. A ll mothers............................................................... 2,197 2,144 263 122.7 Female................................................................................ 1,115 1,082 1,089 1,055 150 113. 137.7 107.1 Native mothers........................................................ 718 705 69 97.9 Female................................................................................ 373 345 365 340 41 28 112.3 82.4 Foreign-bom mothers.............................................. 1,479 1,439 194 134.8 Female.............. ................................................................. 742 737 724 715 109 85 150.6 118.9 The rate for female infants of native mothers was but 82.4, while the rate for their male infants was 112.3. But even this compara tively high rate for the male infants was lower than the rate of 118.9 for the female infants of foreign-born mothers; the rate for male infants of this group was 150.6. The proportion of male births to total births is slightly greater for native mothers than for foreign-bom mothers; consequently the average for the native mothers is slightly weighted by the excess proportion of male births with higher mortality, while the average for foreign-born mothers is slightly lessened by the relatively low proportion of male births; the true difference between the mortality rates for infants of native and'foreign-born mothers is s lig h tly greater than that shown by the difference between the averages for both sexes and is shown by the differences between the rates for each sex separately. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W A T E R B U R Y , CO N N . 41 STILLBIRTHS. It is now recognized that much of the tremendous loss of life before and at birth can be prevented. An analysis of the fetal loss of life in a community has, therefore, a logical place in every study of infant mortality. Such an analysis, however, can not be made for Waterbury because the State law of Connecticut makes no definite requirements relative to the registration of miscarriages or stillbirths, the general term “ births” being used, but not defined in the law. The total number of stillbirths and miscarriages known to have occurred in Waterbury during the period under discussion was 86,1 but complete histories were secured for only 53 stillbirths. Even though we accept the former figure, it is obviously much too low, as registration of stillbirths is much more difficult to secure than that of live births, and even a house-to-house canvass may not se cure a complete record of stillbirths. Therefore, as the city failed to register over 12 per cent of its live births, and as its laws do not emphasize the necessity for registering stillbirths, a large percentage of the latter probably were not recorded. Although the figures for stillbirths are admittedly too small and incomplete to permit of detailed analysis, nevertheless they may he taken as an indication of conditions. The distribution of these 53 stillbirths by nationality of mother is shown in Table X IV . T a b l e X I V .o — B irth s during selected year and nu m ber and-per cent o f stillb irth s, according to n a tio n a lity o f m other. Stillbirths. Total births. Nationality of mother. Number. Per cent. All mothers.............................. 2,197 53 2.4 Native mothers........................... Foreign-born mothers................................. 718 1,479 13 40 1.8 2.7 651 267 200 361 23 7 5» 5 3.5 2.6 2.5 1.4 Italian............................................... Lithuanian....................................... Irish............................................... All other............................................ a General Table 2. An analysis of the small group for which records were secured shows that the per cent of stillbirths was lowest for native mothers and highest for Italian mothers. In case of births to native mothers, a low proportion of stillbirths was associated with a low infant mortality rate; but for births to Italian mothers a comparatively low mortality rate is accompanied by a high proportion of stillbirths. As stillbirths result largely from the same prenatal conditions which 1 General Table 1. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T 42 M O R T A L IT Y . cause a large number of the infant deaths in the first few weeks of life, it naturally follows that for any group a low infant mortality raté should not be considered a satisfactory goal unless accompanied by a low stillbirth rate. That the stillbirth figures for the selected period are much too small is clearly indicated in Table X V , which gives the stillbirth rate for all pregnancies of the same mothers. The rate is higher for every nationality except the Irish, for whom it is six-tenths o f 1 per cent lower than that based on the smaller figures. T a b l e X V .— T ota l births resu ltin g fr o m a ll pregnancies and n u m ber and per cent o f stillb irth s, according to n a tio n a lity o f m other. Stillbirths. Nationality of mother. Total births. Number. 7,772 265 • 2,027 5,745 53 212 2,689 961 823 1,272 139 26 16 31 Per cent. 3.4 ^ T ë 3.7 5.2 2.7 1.9 2.4 But here, as in the figures for the selected year, the Italians show the highest stillbirth rate, a rate almost twice that of the Lithuanians. The importance of order of birth, employment of mother, family income, and other factors discussed in connection with infant mor tality can not be gauged b y the 53 stillbirths for which such data were secured, and a study of stillbirths alone ehminates from con sideration a large number of prenatal deaths which are equally significant. Combining all stillbirths and miscarriages reported by the 2,155 mothers visited gives a total of 832 prenatal losses, as shown in Table X V I. The total number of issues to these mothers was 8,339, giving a prenatal mortality rate of 99.8. At present little attention is paid b y some physicians, or even by many mothers themselves, to the losses which occur during the early months of fetal existence. One mother who was interviewed was much amused b y the attempt to include all miscarriages in her maternal history, because, as she expressed it “ they didn’ t amount to anything under three months.” Although it may never be prac ticable to insist that every pregnancy be recorded, it must be real ized that until registration of all recognized pregnancies is made com pulsory a vast opportunity for the study of measures for preventing prenatal deaths and deaths which occur in early infancy is lost. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 4$ WATERBUBY, CONN. T able X V I.—Stillbirths and miscarriages, and mothers reporting specified number of issues of specified hind. Number of issues of specified kind. Total issues. Kind of issue. Stillbirths <*...................... Miscarriages 6........................... 265 567 aGeneral Table 11. All mothers. 184 363 1 137 235 2 3 4 31 77 10 34 3 12 5 6 4 8 9 1 1 2 6 General Table 12. Medical causes of stillbirths must be diagnosed in hospitals, where the proper equipment for diagnosis is available. Certain of these causes are extremely important, as emphasized by Dr. J. Whitridge Williams in a study of the limitations and possibilities of prenatal care. He says: * * * it has long been known that this disease (syphilis) plays an important part in the causation of fetal deaths and should always be borne in mind when successive pregnancies end in the birth of dead children * * *.1 The importance of these medical causes of stillbirths has not been overlooked, but they can not be studied in this type of investigation, which aims to discover the social causes which must be considered in connection with the immediate medical cause if a real solution of the problem is to be found. MATERNITY CARE. Employment of mother during pregnancy.— Important as medical supervision during pregnancy is, the need for sufficient household help and early cessation from steady employment should be emphasized in the program of adequate prenatal and confinement care. Housework.— Of the 2,197 births studied, 1,7402 or 79.2 per cent were to mothers accustomed to doing their household work, including cooking, cleaning, and washing and ironing without any paid as sistance; 371 or 16.9 per cent were to mothers having some help, usually a woman to clean once a week or to do the washing; only 71 or 3.2 per cent were to mothers keeping a servant. • Of the 716 3 births to mothers whQ were gainfully employed during the year before the infant's birth, 558 or 77.9 per cent were to mothers who worked in the home, 519 to those keeping lodgers, and 39 to mothers engaged in some other form of home work. Five hundred and ten births were to mothers who worked up to within two weeks of confinement, most of them continuing up to the day and often to the hour of confinement. ) 1 Williams, J. Whitridge. p. 35. 2 General Table 13. 2 GeneralTable 14. American Association for Study and Prevention of Infant Mortality, 1914, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 44 Factory work.— Connecticut is one of the four States possessing a law prohibiting factory work for women during the last months of pregnancy.1 Of the 95 women who worked in the metal factories, 66 ceased work at least three months before confinement, 15 more stopped before the last month of pregnancy, and only 2 worked up to within two weeks of the baby’s birth. Attendant at birth.— A large foreign population would naturally presuppose the general employment of midwives for confinement services. It is therefore surprising to find that almost half of the foreign-bom and more than nine-tenths of the native mothers were attended at the time of confinement by physicians only. T ab le X Y II.—Number and per cent distribution of births during selected year to mothers of specified nativity, according to hind of attendant at birth. Total mothers. Kind of attendant at birth. Number of births. Percent distribu tion. Native mothers. Number of births. Per cent distribu tion. Foreign-bom mothers. Number of births. Per cent distribu tion. All classes.................................. 2,197 100.0 718 100.0 1,479 100.0 Physician and midwife...................... Physician............................................ Midwife.................................. ............. Other.......... ........................................ 54 1,405 669 57 11 1 2.5 63.9 30.5 2.6 .4 (<*) 1 686 27 4 .1 95.5 3.8 .6 53 719 642 53 11 1 3.6 48.6 43.4 3.6 .7 a (o) Less than one-tenth of 1 per cent. In addition one-tenth of 1 per cent of the native and 3.6 per cent of the foreign-bom mothers were, attended b y both a physician and a midwife. These were usually cases attended b y midwives in which some complication developed at the time of labor, making it necessary for the midwife to call in a physician to take charge of the case. Of the 2,197 births included in the detailed analysis which occurred in Waterbury during the selected period, 209 2 cases were attended by physicians in hospitals, 1,250 by private physicians, 669 b y mid wives, and 69 had either some attendant other than those specified or no attendant, or there was no report upon the case. Of the 669 cases attended by midwives over one-third had no attendants other than midwives whose names do not appear in the State’s published direc tory of licensed practitioners. One unlicensed midwife attended about 90 confinements during the 12 months under consideration, her work being supervised by her daughter (a registered midwife) and by 1 It shall be unlawful for the owner, proprietoi, manager, foreman, or other person in authority, of any factory, mercantile establishment, mill, or workshop knowingly to employ a woman or permit a woman to be employed therein within four weeks previous to confinement or four weeks after she has given birth to a child. Any person who shall violate any provision of this act shall be fined not more than $25, or imprisoned not more than 30 days, or b o th —Acts of 1913, ch. 112, secs. 1 and 2. 2 General Table 16. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 45 W ATERBTJRY, C O N N . a physician. Over one-fifth of the cases attended by midwives, how ever, received no supervision of any kind. Midwives attended 3.8 per cent of the births to native mothers, the majority of whom were native born of foreign parents who at the time of confinement were probably influenced b y the Old World customs of their mothers. Six hundred and forty-two or 43.4 per cent of the births to foreign-born women were also attended b y mid wives. This included 447 or 68.7 per cent of the births to Italian mothers, 144 or 53.9 per cent of those to the Lithuanians, and 2 or 1 per cent of the births to Irish mothers. T able X V I I I a.—Births during selected year to mothers of specified nationality, according to hind of attendant at birth. Births to foreign-bom mothers. Kind of attendant at birth. Total births. Births to native mothers. Total. Italian. Lithu anian. Irish. All other. All classes.................................... 2,197 718 1,479 651 267 200 361 Physician............................................... Midwife................................................. Other, -none, or not reported............... 1,459 669 69 687 27 4 772 642 65 171 447 33 107 144 16 192 2 6 302 49 10 a General Table 15. The large number of confinements attended b y midwives, usually without any supervision or control, made it seem advisable to obtain some data regarding the nature of the care given by mid wives in Waterbury. This information was secured b y a supple mentary schedule. Many of the mothers refused the informa tion, fearing it would lead to prosecution of the midwife, who, in many cases, was practicing without a license. A little less than one-third gave the required information. These cases were repre sentative, however, of the groups employing midwives, the larger number being Italian and Lithuanian. In the majority of cases the mother and midwife were of the same nationality, although one of the best midwives employed b y the Italian mothers was unable to speak or understand Italian and all conversation had to be conducted in the sign language. The Italians in particular associate a strong sense of shame with permitting a man to attend a woman in con finement. Many of the Italian mothers interviewed spoke of this, adding that in Italy no woman would have a man physician, except in cases in which complications developed. The Lithuanian women generally made no comment except to the effect that midwives were as a rule just as good as doctors, did more, and charged less. The extensive service at less cost than the limited services of a physician also impressed the Italian mothers, one of whom exclaimed : / ‘ Doctor no good; come one time, good-a-bye; that all. Midwife come eight days, wash bambino, wash mamma. Don't gotta have https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 46 INFANT MORTALITY. nurse. All right.” The usual fee for the midwives for eight daily visits following confinement was $8, while the physician s fee for similar service ranged from $15 to $25. But the midwives per formed a multitude of services not rendered b y the physician and extended their care over weeks, if necessary, without any extra charge, in some cases even making a reduction j f the family was unable to pay the usual amount. Frequently the midwife remained in the home, taking the mother’s place until she was able to resume her duties. The performance of such intimate offices naturally serve to strengthen the midwife’s hold on the family, as they realize that no such services could be expected from the physician. The quality of the confinement care received little consideration, childbirth being regarded more an incident than an event by the majority of mothers interviewed. They frequently waited until the first stage of labor had begun before sending for the attendant. Some member of the family or a neighbor thereupon rushed for the nearest midwife, and, if she happened to be out, anyone suggested by the first person encountered was engaged. In many cases the mother knew only the Christian name of her attendant and one mother who was typical of many said: “ I forget her name, I forget her house, I forget all but what she charge.” One reason for the confidence foreign-born women repose in mid wives is probably due to their assumption that a midwife in the United States is entitled to the same standing she would enjoy in Europe. There, midwives are usually graduates of schools of mid wifery and in most countries the Government supervises all mid wives who are licensed to practice. The Connecticut law provides that a midwife practicing in that State shall pass an examination given by the State board of examiners of midwives and receive from it a license to practice. As insufficient steps are taken to enforce the law, it is widely disregarded. It was evi dently framed to apply primarily to medical practitioners and the clauses pertaining to midwives were inserted without appropriate changes being made throughout the law. No person may practice medicine, surgery, or midwifery without obtaining a certificate of registration from the State board of health.1 1 R e q u i r e m e n t s f o r o b t a i n i n g c e r t if i c a t e o f r e g i s t r a t i o n .— H o person shall obtain a certificate of registration as in section 4714 required until he has passed a satisfactory examination before one of the examining com mittees appointed for the purpose b y the State board of health, nor until he has filed with said board dupli cate certificates signed b y a majority of said examining committee, stating that they have found him quali fied to practice either medicine, surgery, or midwifery, nor until he has filed with said board duplicate statements subscribed and sworn to b y him upon blanks furnished by said board, giving bis name, age, place of birth, and present residence, stating of what medical college he is a graduate, and the date of such graduation, together with such other information as shall be required by said blanks. No person shall be eligible to said examination until he presents to the committee, by whom he is to be examined, satis factory evidence that he has received a diploma from some legally incorporated medical college. Any person passing such examination and filing said certificates and statements shall receive from said State board of health, upon payment of two dollars, a certificate of registration, which shall state that the person named has been found qualified so to practice.—A Manual of Statutes of Connecticut relating to the Pub lic Health and Safety, 1902, see. 4715. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 47 If an applicant for the practice of midwifery is accepted for exam ination she pays $10 instead of the $15 exacted for those desiring to practice medicine or surgery. She is not required to have a knowledge of English, but an opportunity for deception is offered by that section of the law providing that if an applicant does not understand or speak English the examination can be conducted through an interpreter of the language which the applicant under stands. Penalties are provided for violation of the act. Many mothers interviewed knew that the midwives they em ployed were not licensed, but they were unable to understand the reason, especially in cases where their services had been more satisfactqry than those of the licensed midwives. Only one midwife was found who gave any prenatal care which could compare with that given by a clinic or a well-trained obstetri cal nurse. She made frequent urinalyses and always referred the case to a physician whenever traces of albumen made their appear ance. She instructed the mothers in regard to the proper diet, care of the breasts, exercise, necessary preparation for confinement, and the outfit for the baby. During the confinement period she took the mother’s temperature daily; the general testimony was to the effect that she was very clean, using disinfectants and exercising great care in all that she did. Her charges varied from $5 to $18, according to the financial standing of her patients, but so far as could be learned the same skilled attention was given to all. At the other extreme were found several midwives who were ignorant and careless, and the incidents related by many of the mothers showed complete ignorance on the part of the midwife of the dangers of infection. One mother reported that as a result of improper care at confinement she became bloated and suffered great pain. She notified the midwife, who gave her no attention except to send an old woman to examine her. The patient continued to grow worse and finally called in a physician, who said he would do noth ing for her without examining her. As she would not permit that, he was obliged to retire from the case. When visited over two years after the confinement the woman was still an invalid. Extremes in confinement care were also found in cases attended by physicians, due, no doubt, to the popular belief, prevalent in all sections of our country, that confinement cases do not require the services of specialists. Dr. J. Whitridge Williams,1 in summing up needed reforms in obstetrical education, emphasized the need of “ education of the laity that poorly trained doctors are dangerous, that most of the ill» of women result from poor obstetrics, and that poor women in fairly ‘ Williams, J. Whitridge. American Association for Study and Prevention of Infant Mortality, 1911, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 48 INFANT MORTALITY. well conducted free hospitals usually receive better care than the well-to-do women in their own homes.” He also urges the extension of free obstetrical services such as hospitals and out-patient service for the poor and proper semifree hospital accommodation for those in moderate circumstances, with qualified obstetrical attendant nurses. All of these reforms in obstet rical knowledge and equipment need development in Waterbury if each year over 2,000 of its mothers are "to receive proper care during pregnancy and at the time of confinement. Nursing care during confinement period.— The care of the mother during the two weeks following the birth of the baby is extremely important, as the future health of the mother frequently depends ujion her care during this period. Native mothers in general received much better nursing care than the foreign born, slightly more than 20 per cent having hospital care and, in addition to these, over 15 per cent were attended by trained nurses; of the foreign-born mothers only 4 per cent had hospital care and 5 per cent were attended in the home by trained nurses. The mothers of. 377 babies or 52.5 per cent of the native group and of 930-or 62.9 per cent of the foreignborn group confined at home had some household help other than the family during the confinement period; but 76 or 10.6 per cent of the former and 407 or 27.5 per cent of the latter were obliged to rely solely upon neighbors or members of the family. It is this group which is so apt to prefer the midwife to the physician, since the former renders the services of the physician, nurse, and servant at far lower cost. Many of these families were unable to pay for services of any kind, and frequently there was no one except neighbors to do the house work unless it was left for the father of the baby when he returned from work. Under such conditions mothers with other small children could not remain in bed as long as they should. One Italian mother found it impossible to remain in bed more than four or five days when her last baby, the ninth child, was born, because in addition to caring for the seven children at home, all under 14 years of age, it was necessary for her to do the cooking and laundry work for several lodgers. Since the father of the family earned less than $500 a year it was impossible to hire household assistance, and the only help given the mother was by neighbors and the baby’s father. So long as those families in the lowest wage group do not receive sufficient income to insure at least the necessities of life, plans for adequate free prenatal and confinement care should include sufficient household help to permit the mother to remain in bed as long as advised by her physician. * https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. 49 MATERNAL MORTALITY. The importance of maternal care, especially during the first few months of fife, is in itself sufficient reason for including a study of maternal mortality in a report on the prevention of infant mortality. The death of the mother at any time during the infancy of the child is prejudicial to its welfare, as the death of the mother removes the child’s natural caretaker and another must be substituted. Each change in caretaker is accompanied by changes in standards and methods which can not be otherwise than disturbing to the health of the infant. Eighteen of the mothers considered in this report died during the 12 months following childbirth.1. Two of the births to these 18 mothers were stillbirths. Among the 16 five-born babies, instead of the two deaths that would normally have occurred at the average rate for the city (122.7), there were actually six deaths before the end of the first year of fife, a rate three times the normal. In the majority of the cases where the mother died during the early infancy of the child the responsibility for the infant’s care was naturally transferred to the father. Unable to care for the child himself, he was forced to hire an outsider to come into the home or to place the child in an institution, unless older children or relatives came to his assistance. An excellent example of the dilemma faced by a father responsible for the care of a motherless infant is found in a family in which the mother died when the baby was 2 months old and the other three little girls were all under 8 years of age. The father, not knowing how to care for the baby, took her to the hospital, not because she was ill but because he did not know what else to do with her. Two weeks later he removed her from the hos pital to the home of his sister, who was able to care for her but two weeks, when the baby was returned to the hospital where she re mained for almost a month. The father then took the baby to his home in charge of a housekeeper; but, not liking the care given her, took her to a friend, who kept her five days, when she died of “ bron chitis and exhaustion.” This child was perfectly well and strong at the time of the mother’s death, but died less than two months later in spite of the father’s earnest effort to provide the best possible care. J 1 The following enumeration gives the death-certificate causes of death and the period elapsing between the day of confinement and the day of death: (1) Puerperal sepsis and cerebral embolism, 7 days; (2) acute nephritis and acute uremic poisoning, less than 1 day; (3) puerperal infection, 7 days; (4) puerperal sepsis, 14 days; (5) puerperal nephritis and general septicemia, 9 days; (6) kidney of pregnancy and uremic convulsions, 1 day; (7) acute parenchymatous nephritis and uremia supervening; 7 days; (8) hemorrhage and pregnancy, less than 1 day; (9) nephritis, pulmonary edema, and exhaustion, 1 day; (10) post partum hemorrhage, acute nephritis, and pregnancy, 9 days; (11) pneumonia and grippe, 8 months; (12) chronic endocarditis and pregnancy, labor, and acute dilatation of heart, less than 1 day; (13) pulmonary tuberculosis and exhaustion, 3 months and 1 day; (14) pulmonary tuberculosis and exhaustion, IS weeks; (15) lobar pneumonia, 9 days; (16) erysipelas (facial) and interstitial nephritis, 5 months; (17) mitral regurgitation and nephritis, 10 months and 18 days; (18) pulmonary tuberculosis and exhaustion, 7 months. 14458°—1?----- 4 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 50 IN F A N T M O R T A L IT Y . In the 12 instances of maternal mortality following closely on childbirth the problem of the infant’s care was solved as follows] In 4 cases relatives took the baby, 1 was adopted, 1 was boarded in a private family, 1 was placed in an institution, and 5 spent the greater part of their first year of life in hospitals. Maternal mortality from conditions connected with pregnancy and childbirth.—That the subject of maternal mortality from con ditions connected with pregnancy and childbirth has received so little attention heretofore is due to the fact that the relatively small number of deaths of mothers from childbirth has been lost sight of in the large number of normal deliveries. Consideration of the actual figures gives the matter more importance. It is estimated that in the year 1913 there were in the United States 15,376 deaths 1 due to childbirth, and of these 6,977 were due to complications of childbed fever, or puerperal sepsis, a disease which is largely preventable. The best practical method for comparative purposes is to compute the maternal mortality rate on the number of maternal deaths per thousand live births. This ra te2for the provisional birth-registration area for the year 1910 was 6.5 for all deaths from all diseases con nected with pregnancy and confinement, of which 2.9 was from puerperal septicemia and 3.6 for deaths from all other diseases of pregnancy and confinement. For every 154 babies born alive one mother lost her life. In Waterbury, during the period considered in this study, 10 mothers died from causes resulting directly from confinement; 4 of these deaths were caused by puerperal septicemia. The number of maternal deaths per 1,000 live births from all diseases of pregnancy and confinement was 4.7; from puerperal septicemia, 1.9; and from all other diseases of pregnancy and confinement, 2.8. One mother lost her fife for every 214 babies born alive in Waterbury. In addition to the mothers included above, one died the day following confinement and one died in less than two weeks. Comparative figures for maternal mortality for Connecticut, Water bury, and the provisional birth-registration area for 1910 are given in Table X I X . Waterbury had a rate of 5.1 for deaths from diseases of pregnancy and confinement, or 0.3 less than the rate for the State and 1.4 less than that for the birth-registration area; and for deaths from puerperal septicemia it had a rate less than that for the other cities shown and 0.5 less than the rate for the State. 1U. S. Children's Bureau publication No. 19, Maternal Mortality, p. 14. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis * Table X IX , p. 51. 51 WATERBTJRY, OONN. X I X .'—Population estimated as of July 1, 1910, live births, deaths, and death rates per 100,000 population and per 1,000 live birthsfrom diseases of pregnancy and con finementfor the provisional birth-registration area, the State of Connecticut, and speci fied cities, 1910:a T able Deaths from diseases or pregnancy and confinement. State and city. Population Live .Tuly 1,1910 births (estimated). 1910. Puerperal septi cemia. Total. Rate Rate per per Num 100,000 1,000 Num ber. popu live ber. lation. births Rate per 100,000 popu lation. All other. Rate per 1,000 Num live ber. births Rate per 100,000 popu lation. Rate per 1,000 live births 9.2 7.4 8.8 6.7 9.5 3.6 3.0 3.0 2.4 3.3 —I--------------Provisional birthregistation area 22,222,404 562,390 3,652 Connecticut............. 1,119,109 27,291 148 Bridgeport........... . 102,709 2,976 15 New Haven............. 134,145 3,772 19 WaterbUryfc............ 73 605 2,150 11 16.4 13.2 14.6 14.2 14.9 6.5 1,612 5.4 65 6 5.0 5.0 10 5.1 4 7.3 5.8 5.8 7.5 5.4 2.9 2,040 2.4 83 2.0 9 9 2.7 1.9 7 o U. S. Children’s Bureau publication No. 19, Maternal Mortality, p. 52. The birth-registration area is as established by United States Bureau of the Census. See Mortality Statistics, 1911. b Connecticut Vital Statistics, 1910, pp. 12, 55. FEEDING. Improper feeding of infants, especially during the first nine months of life, is one of the most important causes of infant mortality. The mother who through ignorance, carelessness, or necessity too soon substitutes artificial food for breast milk opens the way for diseases, especially those of the intestinal tract, as was discussed in the section of this report on gastric and intestinal diseases. Of the 2,197 births included in this report, 2,144 were live born, but of this number 63 did not survive long enough to be fed and for 2 the information secured was incomplete; hence the tables relating to feeding are based upon the remaining 2,079.1 Methods of feeding are divided into (a) breast feeding; (6) artifi cial feeding, i. e., any feeding from which breast milk has been excluded; and (c) mixed feeding, a combination of breast with some other form of feeding. Owing to the fact that most babies receive more than one kind of feeding during the first nine months, it is necessary in considering either group to classify according to the type of feeding given during the greater part of a specified month. Of the 2,079 infants who lived long enough to be fed, 226 or 10.9 per cent were artificially fed during the first month of life, thereby being robbed of the protection afforded b y maternal nursing. It is significant that 58, or more than one-fourth of these infants who were artificially fed from birth, died before the end of their first year, the mortality rate for this group being 256.6, more than twice that for Waterbury as a whole. 1 General Table 19. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 52 IN F A N T M O R T A L IT Y . Many of these deaths doubtless resulted from conditions which existed before the birth of the child, and exclusive breast feeding might have been powerless to prevent them. But to rob the already handicapped child of his mother’s milk is to remove his most powerful aid in the fight for life, and every effort should be made to secure maternal nursing at least during the early days of fife. This is strikingly portrayed in Chart VII, which shows the per cent of both artificially and breast fed babies alive at the beginning C H A R T V II.— PER C E N T DYING S U B S E Q U E N TLY IN FIRST Y E A R O F L IF E O F IN FA N TS SUR V IV IN G A T B E G IN N IN G O F S P EC IFIED M ONTH OF A G E , BY T Y P E O F FE E D IN G . Per cent. of specified months who died before the end of the year. It brings out the fact that a baby breast fed the first month has a slightly greater chance of living until the end of the year than the baby who has survived to the sixth month of life and is artificially fed at that time. Breast versus artificial feeding.—A comparison of the percentage of deaths through the year for breast-fed and artificially-fed infants according to the type of feeding for any single month will reveal the great advantage the breast-fed baby has over the one who is artifi- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBTJEY, C O N N . 53 cially fed. Feeding for only nine months of the child’s first year has been considered, as after that period breast milk is not, in most cases, essential to his diet. As he approached the . time when he could he safely weaned the difference between the death rates for the two groups became less marked. The artificially-fed child had from three to four times as great a mortality as the breast-fed baby at every age through the sixth month of life, as is clearly demonstrated in Table X X . But each succeeding month shows a marked decline in the difference until the ninth month, when the breast-fed group has an advantage of only 1.2 per cent. Whereas the per cent of deaths for breast-fed babies was only slightly higher for babies of foreign-bora mothers in the first six months of life, the differences in the per cent of deaths for arti ficially-fed infants was marked, being about twice as high for the foreign bora during the first three months and over three times as great for the second three months. Such wide differences indicate that there is great need of education among the foreign-bora mothers, especially in regard to proper methods of artificially feed ing their infants. T a b l e X X .a — Number_ o f in fa n ts d yin g before en d o f fir st year o f life p er 1 0 0 in fa n ts su rvivin g at the begin in g o f specified m on th and fe d in specified w a y, according to n a tiv ity o f m other. Month of life and type of feeding. First month: Second month: Third month: Fourth month: Fifth month: Sixth month: Mixed..... ...........' ....................................................................... Seventh month: Eighth month: Ninth month: a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis General Table 19. Total mothers. Native mothers. Foreignbom mothers. 7.4 15.4 25.7 5.7 12.5 16.3 8.3 16.7 32.1 5.4 10.5 18.4 3.6 8.3 12.1 6.2 11.9 23.3 4.2 8.7 13.8 3.1 4.7 12.4 18.2 3.1 6.4 12.3 2.7 5.8 3.2 8.7 17.4 2.5 4.8 10.1 1.9 3.0 4.1 2.8 5.5 14.6 2.2 3.0 8.1 1.3 3.3 3.3 2.6 2.9 11.8 2.1 1.7 5.6 .8 2.3 2.7 2.6 1.5 7.9 2.0 l.v2 4.8 .9 1.8 2.2 2.5 1.0 6.7 2.1 .7 3.3 1.2 .5 1.4 2.5 .8 4.8 8.5 54 IN F A N T M O R T A LITY . Mixed feeding.— The above comparisons have not considered mixed feeding, which is not so desirable during the earliest months of the infant’s life as exclusive breast feeding but is much better than artificial feeding. Even partial breast feeding somewhat safeguards the infant’s digestion and to some extent insures him against early death. Any attempt to discuss the groups “ m ixed” and “ artificially fed ” must take into consideration the fact that they included infants receiving every grade of care, from the child whose parents were able to secure for it highly specialized supervision of a medical adviser to the baby who received the scant attention of the untrained and over worked mother who must provide for a large family with an inadequate income. Through the fifth month 1 the deaths among the babies who had mixed feeding were relatively twice as numerous as among those wholly breast fed, although from one-third to one-half less than for those entirely artificially fed. In other-words, where the artificiallyfed baby had three chances of dying, the one on mixed feeding had but two, and the one breast fed had only one chance of dying before the end of the first year. Artificial feeding.— It is commonly stated that native mothers are much more apt to discontinue nursing their children during the early months of life than are foreign-born mothers. Although a compari son of the native and foreign born only would support this theory, a division of the foreign born into component nationality groups shows that throughout the first nine months the per cent of artificial feeding is greater for the infants of Lithuanian mothers than for the infants of native mothers. Table X X I .«—Per cent artificiallyfed of infants surviving at end oj specified month of life, according to nationality of mother. First month. Nationality of mother. N ative mothers............................................................................... Foroign-bom mothers...................................................................... Italian........................................................................................ Lithuanian............................................................. . - .............. Other........................................................................................ a 13.2 9.0 4.5 16.4 9.9 10.9 Third month. 26.0 15.8 8.6 29.7 15.2 19.1 Sixth month. 30.6 22.9 15.3 39.5 21.6 26.1 Ninth month. 44.1 29.4 20.8 49.3 29.5 31.4 General Table 20. If for any month the nationalities be arranged m decreasing order according to the percentage of infants receiving no breast milk, the enumeration will be (1) Lithuanian, (2) native, (3) Irish, (4) Italian. A list of nationalities similarly arranged according to infant mortality rates for the selected period results in the following order: (1) Lithuanian, (2) Irish, (3) Italian, (4) native.2 With the exception i Table X X , p. 53. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis * General Table 2. 55 W ATERBURY, CONN. of the native the relative positions for the specified groups is iden tical, indicating a direct relation between the infant mortality rate for a nationality and its group method of infant feeding. Relation o f income to feeding.— The predominance of the native in the highest income group suggests that adequate income may have played some part in insuring safety in artificial feeding. This fact seems to be indicated by the figures in Table X X I I , which show that as the income irom father's earnings increased the per cent of infant deaths decreased for each kind of feeding. But it also shows that the per cent of deaths for artificially-fed infants was much higher than for breast-fed infants in every income group. Breast feeding is a safeguard to the infant of the poor mother, who may be able to provide good and sufficient breast milk when she would not be able to afford the proper ingredients for artificial food. X X I I .—Infants born during selected year surviving at end of 8 and 6 months of life whosefathers earned specified amount, and number and per cent of subsequent infant deaths, according to type offeeding throughout specified period. Table Earnings of father. v> Infant Type of feeding and pe sur viv riod of life. ors.« First 3 months.................. Breast exclusively. . . . Mixed........................... Artificial exclusively.. More than 1 type........ First 6 months. . . ' ......... Breast exclusively___ Mixed.......................... Artificial exclusively.. More than 1 type........ 1,989 1,467 36 190 296 1,938 1,070 27 177 664 Subse quent infant deaths. Under 8650. 8650 to 81,049. 31,050 and over. Subse Subse Subse quent quent quent In In In infant infant infant fant fant fant deaths. deaths. deaths. sur Sur sur viv viv viv ors. ors. Num Per Num Per Num Per ors. Num Per ber. cent. ber. cent. ber. cent. ber. cent. 110 65 1 26 28 69 21 . 1 13 24 5.5 3.7 2.8 13.7 9.5 3.0 2.0 3. 7 7.3 3.6 973 746 16 78 133 940 523 12 71 334 71 7.3 37 5.0 1 6.3 14 17.9 19 14.3 38 4.0 11 2.1 1 8.3 7 9.9 19 5.7 666 476 10 66 114 653 364 7 63 219 31 14 4.7 2.9 9 8 18 8 13.6 70 2.8 2.2 6 4 9.5 1.8 305 217 10 38 40 306 162 g 35 95 6 2 2.0 .9 3 1 1 7.9 1 1.1 .3 ° Including those for whom there were no earnings and those not reported. Of the babies artificially fed at the end of the third month of life 28.1 per cent of the native were in the group whose fathers earned $1,050 and over during the year following the birth of the baby as compared with 7.4 per cent of the Irish and 4 per cent of the Italians; there were no Lithuanians in this income group. (See Table X X I I I , p. 56.) The corresponding figures for the babies living at the end of the sixth month show little variation, being 30.8 per cent of the native, 8.3 per cent of the Irish, 4.5 per cent of the Ital ians, and 1.2 per cent of the Lithuanians. O f the Lithuanian infants artificially fed at the end of the third month 85.5 per cent had fathers who earned less than $650 during the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 56 IN F A N T M O R T A L IT Y . year following the birth of the baby, 72 per cent of the Italians and 44.4 per cent of the Irish also falling in this income group. The feeding methods of the various nationalities were not materially affected by increased incomes.1 Very few of the Italians substituted artificial for breast feeding in*any income group; a large proportion of the native and Lithuanians but not so many of the infants of Irish mothers were artificially fed regardless of the fathers' earnings. X X I I I .— Number and per cent in eachfather's earnings group of infants sur viving and artificially fed at end of specified period of life, according to nationality of mother. T able Earnings of father. Specified period and nationality mother. 3 months: 6 months: 9 months: a Total artifi of cially fed in fants.« Under $650. Num ber. Per cent. 171 50 69 27 38 . 36 59 12 22.2 72.0 85.5 44.4 237 88 . 86 36 53 63 70 17 22.4 71.6 81.4 47.2 282 118 104 48 57 86 85 20 20.2 72.9 81.7 41.7 $650 to $1,049. Num ber. Per cent. $1,050 and over. Num ber. Per cent. 28.1 4.0 48.0 16.0 11.6 40.7 48 2 2 7.4 106 17 13 14 44.7 19.3 15.1 38.9 73 4 1 3 30.8 4.5 1.2 8.3 123 23 12 20 43.6 19.5 11.5 41.7 95 5 2 6 33.7 4.2 1.9 12.5 82 8 , 8 11 Including those for whom there were no earnings and those not reported. One of the serious handicaps imposed by poverty is the inability to procure the essentials for successful artificial or mixed feeding, viz, (1) pure milk, (2) equipment for preparing and keeping modified milk, (3) supervision by a physician with special training in methods of infant feeding, and (4) instruction in preparing and using the for mulas prescribed by the physicians. At the time this investigation was made the supply of safe milk available for the poorer sections of Waterbury was inadequate. Many of the mothers living on the hills on the outskirts of the city were un able to secure milk without going down into the city, as, during bad weather, the condition of the roads made it impossible for the dairies to deliver. In the congested districts it was the practice to purchase “ bulk” m ilk from small shops where, during the summer months cans were kept in the heat, open to dust and flies, and the milk was ladled out to customers in a measure covered with dirt and stale if not sour milk. 1 General Table 21. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 57 W ATEBBURY, CONK. . Condensed milk.—Many of the mothers interviewed were unable to afford good cows' milk and had substituted condensed milk for all or part of the artificial feeding. Of the 339 babies who received condensed milk, 101 or nearly onethird were so fed during the first month of life. In 6 cases this form of feeding was advised by physicians, but in general the condensed milk was used because pure cows’ milk was not easily obtainable and because condensed milk was cheaper and could be kept longer with out ice than cows’ milk. Infants fed on condensed milk are often fat but have, as a rule, feeble resistance when attacked by acute dis ease, especially of the intestinal tract. Of the 339 babies fed on con densed milk the mothers of 126 were native and of 213 foreign born; of the latter, 107 were Italian, 55 Lithuanian, and 19 Irish. Even though the figures were large enough to permit accurate de ductions in regard to the infant deaths among the infants fed on con densed milk, such a rate would not tell the entire story, as it would not measure the effects of condensed-milk feeding on the survivors. Holt tells us it is rare to see a child reared on condensed milk who does not show some evidence of rickets, and its prolonged use some times produces scurvy. It is permissible only as a temporary food and should never be used when good fresh cows’ milk can be obtained.1 Causes for weaning.— The reasons given by the mothers for weaning the 588 2babies who were deprived of maternal feeding at the age of 9 months or younger showed that the majority of them believed they were forced to wean their babies, 333 (over one-half) stating that the supply of breast mils; was inadequate or had stopped entirely. Breast feeding is much more universally possible than is generally believed, for scientific research proves that only a few mothers are physically unable to nurse their babies if proper attention is given to the breasts during pregnancy and if persistence and care are exer cised immediately following the birth of the baby. Visiting nurses in Waterbury stated that they found among the poorer classes of all nationalities many women whose milk dried before the normal period. Inquiries proved that very few women knew that this could have been prevented by proper diet and care, nor did they realize the impor tance of breast feeding; particularly was this true of the Lithuanian mothers. One physician who had a large practice among this par ticular group stated that the Lithuanian women bear beautiful, strong children but are so unwise in their methods of feeding that their babies are peculiarly susceptible to gastric and intestinal diseases. In every respect the Lithuanian mothers-particularly showed need of instruction in regard to prenatal, confinement, and postnatal care. But such care, however excellent, can not entirely neutralize > Holt. L. Emmett. Diseases oi Infancy and Childhood, 1916, p. 158. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 General Table 23. 58 IN F A N T M O R T A L IT Y . the effects of poverty; for poverty brings with it overwork, worry, and frequently insufficient food and clothing, and insanitary sur roundings. However, a great deal can be done and needs to be done in Waterbury, where the mothers of only 32 or 5.4 per cent of the babies who were weaned during the first nine months of life, acted upon the ad vice of physicians. Of the other babies weaned during this period, 65 had mothers who were ill and unable to nurse them, 72 had mothers who became pregnant and thought weaning advisable, and the mothers of 22 acted upon their own judgment for various slight reasons. A number of mothers stopped nursing when their babies became ill, thereby robbing them of one of their best defenses against disease; a few mothers admitted they disliked to nurse their babies or found that it inter fered with their pleasure; only 7 infants had mothers who were forced to make the change by the necessity of performing gainful work away from the baby. PERIOD INTERVENING BETWEEN PREGNANCIES. Pregnancy was given as the cause for weaning 721 or 12.2 per cent of the babies weaned at 9 months of age or younger. The native mothers did not become pregnant so soon after the last con finement as the foreign-born mothers, none of the former having be come pregnant before the last child was 6 months old while 26 of the foreign-bom mothers, 20 of whom were Italians, became pregnant before the sixth month of the last child. In several cases the later pregnancy commenced as early as the third month after the last confinement. One hundred and thirty-four or 6.1 per cent of the mothers of the 2,197 babies included in this study became pregnant within one year of the infant's birth, of which only 22 or 3.1 per cent were native mothers, although they constituted 32.7 per cent of the total number of mothers. i General Table 23. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 59 W ATERBURY, CONK. X X I Y .—Births during selected year and, number and per cent of births to mothers who became pregnant within one year afterbirth of infant*, according to length of interval between birth and next pregnancy and nationality of mother. Table Nationality of mother. Total births. Mothers pregnant within 1 year. Interval between birth and pregnancy. 5 3 4 6 Num Per 8 9 7 ber. cent. mos. mos. mos„ mos. mos. mos. mos. All mothers.......... 2,197 134 6.1 718 22 3.1 112 7.6 4 12 80 8 10 14 12.3 3.0 5.0 3.9 3 1 11 F oreig n -b o r n mothers........... 1,479 Italian.......... Other........... 651 267 200 361 4 12 1 10 10 mos. 11 mos. 12 mos. u 9 18 13 18 20 19 1 5 2 3 5 1 5 10 8 13 11 15 15 18 6 6 1 1 2 5 9 1 1 2 9 9 1 2 3 12 1 2 13 2 1 2 3 1 1 1 2 1 2 ECONOMIC AND INDUSTRIAL FACTORS. Occupation of father.— Waterbury’s chief industry in 1909, as shown by the 1910 census rep ort1 was the manufacture of brass and bronze products, 15 such establishments existing at that time employing 10,031 persons, of whom 9,603 were wage earners and 428 salaried employees. The majority of the fathers of the families considered in this report belonged to the group of wage earners in the brass manufac turing industries which are included in “ Manufacturing and mechani cal industries" shown in Table X X V . Table X X V .a—Births during selected year in eachfather's earnings group, according to employment offather. Earnings of father. Employment of father. All industries....................... Manufacturing and mechanical industries...................................... Trade..................... : ......................... Transportation................................ Public service.............; .................... Professional and semiprofessional pursuits................... ..................... Domestic and personal service....... Clerical occupations (all indus tries) .............................................. Agriculture and forestry................. No occupation.................................. Not reported..................................... Total births. Un $450 $550 $650 $850 $1,050 der to to to to to $450. $549. $649. $849. $1,049. $1,249. 2,197 492 316 286 416 308 135 192 52 1,499 236 132 43 418 21 21 7 242 27 25 2 206 22 19 9 276 48 29 1 193 44 18 5 82 10 12 14 70 51 8 4 12 13 52 118 1 14 13 4 12 4 33 6 21 7 4 30 17 4 72 15 18 12 3 4 3 10 2 20 3 18 2 6 10 2 3 4 2 2 1 2 2 18 a General Table 24. 1 U. S. Census 1910, Manufactures, Vol. IX , p. 154. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis earn $1,250 No ings and and not re over. ported. 1 IN F A N T M O R T A L IT Y . 6G Only 192, constituting 8.7 per, cent of the total 2,197 infants, had fathers who earned $1,250 and over during the year following the birth of the baby. The 25 factory operatives included in this income group were casters and other skilled laborers, receiving a very high rate of pay. More than one-third of the factory operatives were found to be earning less than $450 and 982 1 or 94.3 per cent of the factory operatives earned less than $1,050. Father’s earnings.— The earnings of the father for the year follow ing the birth of the baby for whom information has been secured have been considered in this report as the best procurable index of the economic status of the family. Additional income from such sources as mother’s earnings outside the home, from lodgers, children’s earn ings, or regular supplemental income from relatives indicates that the father’s earnings were insufficient to provide for the needs of the family without assistance, and the family with an income so supplemented therefore generally belongs in one of the lowest economic groups. Income from investments indicates that the family had more than sufficient for their daily needs and as a rule the father’s earnings would indicate one of the higher income groups as the one in which the family properly belonged. * Of the 2,197 2 infants considered in this report nearly one-fourth had fathers who earned less than $450, more than one-third less than $550, and over four-fifths less than $1,050. The cumulative chart (Chart V III) brings out the comparatively large proportion of foreign born in the lower income groups. i General Table 24. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis » General Table 25. W ATERBURY, CO NN. 61 C H A R T V I II .— PER C E N T O F B IR TH S TO MOTHERS OF S P EC IFIE D N A T IV IT Y OCCURRING IN FA M ILIES W H E R E T H E F A TH E R EA R N ED LESS TH A N S P EC IFIE D A M O U N T. Per cent. Under $1,250 Under $1,050 Under $850 Under $650 Under $450 Native............. I Foreign born .. The foreign-born group was much more poorly paid than the native group, 30.6 per cent earning under $450 for the year, compared with 5.6 per cent of the native. A t the other end of the scale 30.4 per cent of the babies of native mothers had fathers who earned $1,050 or over, while only 7.4 per cent of those in the foreign-born group had such large incomes. Of the infants of native mothers the group whose fathers earned $650 to $849 had the greatest number, while of the foreign-born the group earning under $450 contained more than any other. The Italians and Lithuanians occupied the lowest wage level and the native the highest, while the Irish and other foreign born occupied a position midway on the scale. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 62 IN F A N T M O R T A L IT Y . Even in the lowest income group the native families had an advan tage over the foreign-born group due to the smaller size of the family, an advantage maintained throughout every income group, the aver age approximating one less member for the native than for the foreignborn families.1 Infant mortality rate by father’ s earnings.— The repeated coinci dence of the marked and generally regular decline in the infant mortality rate with the increase of father’s earnings is strikingly brought out for the four cities charted in Chart IX . Although certain irregularities occur in each curve, these are doubtless due to the small basic figures of the higher income groups. i https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis General Table 2$. WATERBTJRY, CO NN 61 C H AR T IX .— IN F A N T M O R TA L ITY R A TES IN JO H N S TO W N , P A., N E W BEDFORD. MASS., MAN C H E S TE R , N. H ., A N D W A TE R B U R Y , C O N N ., B Y EAR N IN G S O F FA TH E R . V\faterbury M a n ch ester N ew Bedford iJohnsfown https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis —! — ..+. .4 .... t J_. t . % __ _ _ __ IN F A N T M O R T A L IT Y . 64 The infant mortality rate for Waterbury for babies whose fathers earned less than $450 during the year following the birth of the baby was 153; the rate very gradually decreased in the next two income groups, but it did not fall below 100 until the group $850 to $1,049 was reached. T a b l e X X V I .a— L iv e births during selected year, in fa n t deaths, and in fa n t m orta lity rate, according to earnings o f fa th er. Live births. Earnings of father. General Table 27. Infant mortality rate. 6 2,144 263 122.7 477 73 45 40 48 26 12 13 4 2 153.0 148.0 142.9 117.9 85.8 89.6 68.4 304 280 407 303 134 190 20 29 a Infant deaths. 6 Not shown where base is less than 100. A consideration of rates which include also the earlier bom chil dren in each earnings group shows the same relation between the infant mortality rate and income, i. e., that the infant mortality rate decreased as the father’s earnings increased. The rate was 158.7 in the group earning under $550, decreasing steadily until for the group earning $1,050 to $1,249 the rate was only 96.6; it increased slightly for the highest income group, but the difference is negli gible. T able XXVII.*—L iv e births resu ltin g fr o m a ll pregnancies, in fa n t deaths, and in fa n t m orta lity rate, according to earnings o f fa th er. Live births. Earnings of father. All classes................................................................................... - * Infant deaths. Infant mortality rate. 7,507 987 131.5 2,949 969 1,404 955 435 ' 575 100 120 468 125 163 96 42 57 24 12 158.7 129.0 116.3 100.5 96.6 99.1 240.0 100.0 ---------------------------. Supplementary earnings.— Of the 2,197 babies considered in this report, 1,2491 or 56.9 per cent were bom into families in which the father’s earnings supplied the only Sburce of income for the family 1 General Table 28. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 65. WATERBTJRY, COISHST. during the year following the baby’s birth. In 32.3 per cent of the famihes other wage earners added to the family income, and in 10.7 per cent the father’ s earnings were supplemented by other income. Practically all of this supplementary income from earnings of mem bers of the family other than the father was found in famihes where the father earned less than $1,050. Only 28 or 3.9 per cent of the births occurring in families where the father’s earnings were supple mented by earnings of other members of the family were found in the two highest income groups. Employment of mother during year preceding birth of baby.— An interesting fact is shown by comparing General Tables 29 and 30. Although the per cent of live-bom infants whose mothers were employed the year before confinement was 32.4, only 1.3 per cent higher than the number who worked during the year following the birth of the baby, the mothers of 153 or 7.1 per cent were employed away from home, as compared with 73 or 3.4 per cent during the year following the baby’s birth; The coincidence of a low infant mortality rate with nonemploy ment of mothers and the much lower rate for infants whose mothers worked at home than for those whose mothers were employed away from home during the year preceding the baby’s birth, is brought out in Table X X V III. X X V I I I .® —Births during selected year, infant deaths, and infant mortality rate, according to employment of mother during year before birth of infant and nativity of mother. T able Employment of mother during year before birth of infant and nativity of mother. Tota births. Live births. Infant deaths. Infant mortality rate, b All mothers............................... 2,197 2,144 263 122.7 *Not gainfully employed................... Gainiully employed........................... At home.................................. Away from home............. ........... Not reported.................................. 1,480 716 558 158 1 1,448 695 542 153 1 160 103 71 32 110.5 148.2 131.0 209.2 Native mothers................... ........ Not gainfully employed........... Gainfully employed.............. At home........................... Away from home.................. Not reported................... Foreign-bom mothers............ Not gainfully employed.......... Gainfully employed.............. At home............................. Away from home...................... a General Table 29. 14458°—18----- 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis b 718 705 69 97.9 594 123 71 52 1 583 121 70 51 1 54 15 7 8 92.6 124.0 1,479 1,439 194 134.8 886 593 487 106 865 574 472 102 106 88 64 24 122.5 153.3 135.6 235.3 Not shown where base is less than 100. 66 IN F A N T MORTALITY. Employment of mother during year following birth of baby.— In a city whose industries employ a large number of women it will follow naturally that many are married women with families of small chil dren. Mothers who are obliged to go to work must perforce substi tute artificial feeding for nursing and intrust to others the care of their infants. The result is a high infant mortality rate for infants of working mothers. In Manchester, N. H., this rate was 312.9. In Waterbury the number of infants whose mothers were employed away from home during the year following the baby’s birth was too small to be a factor in the infant mortality rate for the city; therefore the large percentage of infants artificially fed at an early age and the high infant mortality rate can not be attributed to employment of mothers outside the home. Of the 2,144 live-born infants considered in this report only 73 *, or 3.4 per cent had mothers who were employed away from home at any time during the year following childbirth; and of the 73, 23 had mothers who did not commence work until after the infant’s death and 22 had mothers whose work was not resumed until their babies were 6 months old, leaving only 28 or 1.3 per cent of the very young infants whose lives were endangered through the absence of their mothers on account of work. Relation between low earnings of father and employment of mother.— The effect of low earnings of the father on the mother’s employment is shown in Table X X I X , the number of mothers gain fully employed varying inversely with the amount of the fathers’ earn ings for the three lowest income groups. X X I X .—Births during selected year and number and per cent of births to mothers gainfully employed during year following birth of infant, according to nativity of mother and earnings of father. T able All mothers. Total births. Under $450.............................. $450 to $549.............................. $550 to $649.............................. $650 to $849............................. $850 to $1,049.......................... $1,050 to $1,249........................ $1,250 and over....................... No earnings............................. Not reported.................... .... 2,197 492 316 286 416 308 135 192 22 30 Gainfully employed. Births. Num ber. 682 262 124 90 97 45 16 19 17 12 Num ber. Per cent. 31.0 718 53.3 39.2 31.5 23.3 14.6 11.9 9.9 77.3 40.0 40 46 65 179 157 81 137 6 7 1 General Table 30. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Foreign-bom mothers. Gainfully employed. Gainfully employed. Earnings of father. All classes..................... Native mothers. I ll 20 11 13 29 14 5 12 6 1 Num ber. Per cent. Per cent. 15.5 1,479 571 38.6 50.0 23.9 20.0 16.2 8.9 6.2 8.8 100.0 14.3 452 270 221 237 151 54 55 16 23 242 113 77 68 • 31 11 7 11 11 53.5 41.9 34.8 28.7 20.5 20.4 12.7 68.8 47.8 W A T E R B U R Y , CO N N . 67 The figures shown in this table seem to indicate that economic pres sure forced the few mothers in Waterbury who did work to take this method of adding to the family income. But only 682 or 31 per cent of all babies had mothers who were gainfully employed during the year following the birth of the baby, which is much lower than the corresponding rate for Manchester, N. H.— 43.9 per cent. Only 15 of these mothers earned $550 and over, 61.3 per cent, almost two-thirds earning less than $150 during the entire year. Low as these figures are, they are too high to measure accurately the actual financial assistance rendered by the mother. X X X .—Number and per cent distribution of births during selected year to gainfully employed rnothers of specified nativity, according to earnings of mother during year following birth of infant. T able All mothers. Foreign-bom mothers. Native mothers. Earnings of mother. Total births. Per cent distribu tion. Births. Per cent distribu tion. Births. Per cent distribu tion. All classes.................................. 682 100.0 I ll 100.0 571 100.0 Under $150........................................... «150 to $249.......................................... $250 to $349..»...................................... $350 to $549.......................................... $550 and over....................................... No earnings«»................................... Not reported.................................. 418 127 62 24 15 2 34 61.3 . 18.6 9.1 3.5 2.2 .3 5.0 50 22 18 7 4 45.1 19.8 16.2 6.3 3.6 368 105 f 44 17 11 64.4 18.4 7.7 3.0 1.9 10 9.0 24 4Ì2 ° “ No earnings” means failure to pay on the part of the lodger. Lodgers as a source of income.— Five hundred and forty-four1 liveborn infants, constituting 81.7 per cent of the infants whose mothers were gainfully employed during" the year following the birth of the in fant, had mothers who kept lodgers during this period. These lodg ers contributed varying amounts to" the family income. A lodger might rent a room from the family solely for his own use, or he might have it with a member of the family or with a fellow lodger; his rental might or might not include the care of the room, his personal laundry work, and mending; he might be a regular attendant at meals with no responsibility for providing the food for them or he might purchase his own food and pay for its preparation. With so many variations o f the term “ lodger” it was obviously impossible to do more than tabulate the gross receipts from lodgers as “ mother’s earnings.” In some cases this amount was an underestimate, as in the case where the lodger provided his own food, which frequently served to elaborate the family menu; but in the majority of cases it was much too high, as few mothers were found who were willing to admit that keeping hoarders was a lucrative occupation. In many cases meals were served simply as an added attraction to the rooms to be rented. 1 General Table 31. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y . 68 Nearly one-fourth of the 2,197 infants had mothers who kept lodgers during the year following the baby’s birth. This form of add«s«^ ing to the family income was confined almost entirely to the foreign^ born, only 7.9 per cent of the natives having lodgers while 66.3 per cent of the Lithuanians and 30 per cent of the Italians kept them. In a number of families six or more lodgers were kept at a time, but in the majority of the cases the number did not exceed two. Sixteen per cent of the Irish had lodgers, but seldom more than one at a time. X X X I.'a— Births during selected year, number and per cent of births to mothers leeping lodgers, and number of births to mothers leeping specified number of lodgers, according to nationality of mother. T able Mothers keep ing lodgers. Nationality of mother. Total births. All mothers......................... 62,197 - . Other foreign bom ........................ a General Table 32. 718 651 267 200 361 Num Per ber. cent. 535 57~ 195 177 32 74 Number of lodgers. 10 1 2 3 4 5 6 7 8 |9 24.4 178 164 79 65 23 17 4 ■2 j 1 2 7.9 30.0 66.3 16.0 20.5 44 54 30 20 30 10 59 65 7 23 1 40 27 2 9 ii 3 1 2 .... 1 9 1 5 10 3 1 1 20 35 2 7 .... i 1 &Including 3 for whom there was no report. Size of family and total earnings of family.—Although, the total earnings of the family during the year following the baby’s birth 1 in cluded the mother’s earnings from lodgers, which was not net income, nevertheless it gives a rough measure of the amount which was available for the support of the family. Not only did certain nationalities tend to have larger families, but the same nationality groups had smaller incomes with which to provide for a greater number^ as shown in Table X X X I I ; 52.1 per cent of the Italians were in the income group under $550, and of this number 37.2 per cent had 5 or more members in the family; 43.4 per cent of the Lithuanians were in the same income group, with 32.8 per cent having 5 or more members in the family; only 22.5 per cent of the Irish were in the lowest income group, but of this number 44.4 per cent had 5 or more in the family; 9.6 per cent of the natives were in this group, and of these only 13 per cent had 5 or more members in the family. In brief, about one-ljalf of the Lithuanians and Italians, one-fourth of the Irish, and no£ quite onetenth of the native were in the lowest income group, but even within this group there are degrees of poverty, determined b y the extent to which the income must be spread out over the necessities for a varying number of people. i General Table 33. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W A T E R B U B Y , CONN". 69 X X X I I .*—Births during selected year, number and per cent of births in families with total earnings less than $550, and number and per cent of such births occurring in families with 5 or more members, according to nationality of mother. T able Births in families with less than $550 total earnings— Total births. Nationality of mother. With 5or more mem bers in family. Number. Per cent. Number. Per cent. All mothers................ Native mothers.............. Foreign-bom mothers...................... Italian............................. Lithuanian..........................:. Irish........................ Other......................... ‘ 2,197 639 29.1 211 33.0 718 1,479 69 570 9.6 38.5 9 202 13.0 35.4 651 267 200 361 339 116 45 70 52.1 43.4 22.5 19.4 126 38 20 18 37.2 32.8 44.4 25.7 It therefore follows that although about the same proportion of Lithuanians and Italians fell in the lowest income group, the Italians as a group suffered greater economic pressure due to the larger per centage of families having five or more members. NATIONALITY. The 1,479 infants of foreign-born mothers included in this study represented 24 nationalities, of which the most important numer ically were the Italian, Lithuanian, and Irish, as shown in the fol lowing tabular statement: Nationality of mother. Italian............................... Lithuanian......................... Irish.................................. S lav ic«................. ....... Jewish............................... l Number of births. Nationality of mother. 651 267 200 91 61 Including 18 E n g f s h ^ c o l c h ; L S<n w h ! ® 0^ ™ Number of births. 58 56 40 ’ 1 Serb°-Croatian- and 1 A th enian. is h ,^ d T w e s t Indian^lack ’ 7 Englisli Canadian>6 French, 5 Magyar, 3 Syrian, 2 Greek, 1 Dutch,1 Span- In every community having a large number of recent immigrants it is common experience that the latest arrivals must accept what their predQcessors have discarded. This is true of the houses in which they live, the work they do, and the wages they receive. Infant mortality rate by nationality.— The fact that the infant mortality rate for the infants of foreign-born mothers was 134.81 and for those of native mothers 97.9 indicates that Waterbury had failed to insure equal opportunities for infant health for all the nationalities within its boundaries. The high rate for the infants 1 General Table 2. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y . 70 of foreign-born mothers was due largely to the rate for the Lithu anians (207.7) and the Irish (184.6); the Italians, who form the bulk of the foreign-bom population, having the comparatively low rate of 109.9. As no other single nationality is represented b y as many as 100 births, the rates for these nationalities are not significant and hence are not shown in detail. For the 356 cases which constitute all other foreign bom the rate is 98.3, practically the same as that for the infants of native mothers. Table ’X.'X.'KlIl.a^Live births during selected year, infant deaths, and infant mortality rate, according to nationality of mother. Nationality of mother. Native mothers........................................................................................ Lithuanian........................................................................................ a Live births. Infant deaths. Infant mortality rate. 2,144 263 122.7 705 1,439 69 194 97.9 134.8 628 260 195 356 69 54 36 35 109.9 207.7 184.6 98.3 General Table 2. When all pregnancies are considered the infant mortality rates for each nationality group, except the Irish, show an increase over the rate for the selected year, but the relative order of the different groups varies. The Lithuanians still stand out with the highest rate, but the rate for the Italians is slightly higher than that for the Irish, the reverse of conditions for the selected year. The varia tions between the rates for all pregnancies and those for the-selected year are shown in Table X X X IV . T able X X X I V .'—Infant mortality rates for all issues andfor the selected year, according to nationality of mother. Nationality of mother. Foreign-bom mothers................................................................................................. All issues. Selected year. 131.5 122.7 107.9 139.9 97.9 134.8 127.8 222.5 125.2 112.0 109.9 207.7 184.6 98.3 Size of family.— The total number of pregnancies according to nationality of mother is interesting as an indication of the tendency of certain nationalities to have large families. Of the native mothers 82.2 per cent reported no more than four births; 70.3 per cent of the Lithuanians, 64 per cent of the Irish, and https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBTTRY, CO N N . 71 60.6 per cent of the Italians were in the group having no more than four births. Considering the mothers having nine or more births, Table X X X V shows that only 3.3 per cent of the native mothers fell in this group, while 7.9 per cent of the Italians, 7.1 per cent of the Irish, and 6.1 per cent of the Lithuanians had nine or more births. T able X X X V . — 'Number and per cent of mothers reporting specified number of births resulting from all pregnancies, by nationality. 1 to 4 births to mother. Nationality of mother. 9 or more births to mother All mothers Number. Per cent. Number. Per-cent. All mothers.......................................... 2,155 1,522 70.6 119 5.5 Native mothers.............................................. Foreign-born mothers................................... 704 1,451 579 943 82.2 65.0 23 96 3.3 6.6 Italian...................................................... Lithuanian............................................. Irish......................................................... Other....................................................... 634 263 197 357 384 185 126 248 60.6 70.3 64.0 69.5 50 16 14 16 7.9 €.1 7.1 4.5 Non-English speaking nationalities.— It is true, of course, that a tendency exists among foreign non-English speaking groups to form communities of their own, wherein they retain their native customs and language. This militates against acquiring a knowledge of the customs and language of the United States and makes the assimila tion of these groups slow and difficult. But the city whose industries have invited the immigrant is responsible for his welfare, and the realization of this fact should come first to those members of the com munity who have longest resided in it. Upon them rests the respon sibility for farsighted preventive work which will make the immi grant an asset to the community instead of a menace. The two most important non-English speaking groups in Waterbury were the Italians and the Lithuanians. Lithuanians.— A large majority of the Lithuanians lived in the southwestern section of the city known as Brooklyn, along the Nau gatuck River, in wards 3 and 4, where they continue their own cus toms. Although not given to associating with other nationalities they are sociably inclined among themselves, and those who know them find them intelligent, full of fancy and poetry, with a deeprooted family affection. But toward those with whom they are unacquainted they display a disposition to taciturnity, which gives rise to the popular idea that the Lithuanians are a stolid, indifferent race, little given to demonstration of any sort. Few of the Lithu anians who settle in the cities of the United States are familiar with city life. Lithuania is primarily an agricultural country where the outdoor farm work is shared by men and women alike. One mother https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 72 IN F A N T M O R T A L IT Y . visited said that from the time she was 7 years old until she was 14 she worked as a shepherdess. Then, being strong enough to do a man’s work, she worked in the fields planting and harvesting the crops. She was a short, sturdy woman, with rusty yellow hair, a stout, but powerful figure, and, like many of the Town Plot Lithu anian women, wore no shoes or stockings in the house. Italians.— Some Italians were to be found in every ward in the city,1 and those living in the congested sections suffered from all the housing evils described in the special housing section of this report. But their native desire to own a piece of land led many out of the crowded valley to the hilltops, where improvements were nonexistent and land was cheap. Here they could create a mode of life com parable in many ways to that to which they were accustomed in Italy. One colony was found on the outskirts of eastern Waterbury, near Reidville, and another in the northern section of the city, on Chestnut Hill, in the vicinity of Lakewood. The male members of these groups were forced to arise before 5 o ’clock in order to reach the factories in which they worked, and they did not return home until 7 o ’clock in the evening. In wet or winter weather the roads leading from these sections to the car lines were almost impassable, but in spite of these difficulties they pre ferred their hilltop homes to the congestion of the city. One mother in the Lakewood colony led the agent to the crest of the hill which overlooks the city. She pointed to the blue pool of a disused reservoir in the immediate foreground, the fringe of forest about the edge of the city, and then to the crowded section of the city. The interpreter’s literal translation of her words was singu larly forceful: “ There, dirt and much people; here, beauty and room and garden.” These gardens, which were cared for on week days entirely by the women, might well serve as models of intensive culti vation. Each house, whether it was a shack or a modern house, had its own plat of ground, usually defined by a stone fence or a wellkept hedge. Each garden had at least a few grapevines and there were several large vineyards located on the hillside in true Italian style. Practically all the garden produce was consumed by the families themselves. One mother stated that all the food for the family except flour and macaroni was obtained from chickens and the garden. In the Reidville colony the Italian love of the picturesque found expression in the tinting of the cement of which many of their houses were made. These rural colonies did not enjoy the modern sanitary conven iences provided for their countrymen who lived in the center of the city, but they had an abundance of fresh air and room and in the 1 See Table III, p. 24. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBUEY, COETET. 73 summer no doubt they had advantages over the city dwellers. But in the winter the room overcrowding was as great as tenement overcrowding in the city, fresh air as vigorously excluded, and the lack of water-supply and sewage-disposal facilities— serious depriva tions at all seasons— created conditions as unfavorable to health as those surrounding the tenement dweller. Years in United States and ability to speak English.— The extent to which the foreign-born residents of a community can speak English indicates, in a measure, the success of that community in assimilating its foreign-born population. Of the non-English speaking foreign-born groups in Waterbury the Italians, who came with the last wave of immigration, show a per centage of 17.5 1 in the United States less than three years, while 39.8 per cent of their number had been here nine years or more. The most recent arrivals are the Lithuanians, 12.7 per cent having been in this country less than three years and but 32.2 per cent nine years or more. As the non-English speaking immigrants tend to settle in colonies, length of residence in the United States does not necessarily indicate that they have to any appreciable degree given up the language and customs of their fatherland. If the children do not attend the public schools, it is possible for native Americans of foreign-born parentage to grow to maturity and even become parents them selves without a speaking knowledge of'English. Three such moth ers were found in Waterbury. More than three-fourths of the Italian mothers and nine-tenths of the Lithuanian mothers were unable to speak English. Thus they were isolated, except for such information in regard to teAmerican ways” as was absorbed from the father or the children. Of the English-speaking foreign born the largest group was the Irish, who came to Waterbury with the earliest immigration. There have been but few recent additions to their number, approximately 1. per cent of the Irish mothers visited having been in the United States less than three years and more than four-fifths, nine years or longer. The infant mortality rate for the infants of foreign-born mothers, as shown in Table X X X V I , was 134.8. For the infants of those foreign-born but English-speaking nationalities, such as the English, Irish, etc., the rate was 181.8 as compared with 125.3 for the nonEnglish speaking nationalities. The comparatively low rate for non-English speaking nationalities is largely due to the preponder ance of Italians, for whom the infant mortality rate was only 109.9. Considering the infant mortality rate for non-English speaking nationalities according to their ability to speak English, Table 1 General Table 35. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 74 IN F A N T MORTALITY. X X X V I shows a much higher rate for the group unable to speak English. But this does not hold true for the Italians, the rate for those able to speak English being 122.6, while it is only 105.7 for those unable to speak English, a difference which may not be particularly sig nificant owing to the small number of cases upon which these rates are based. It is, however, a matter of common observation that Italian mothers who do not speak English are successful in caring for their children according to Italian customs, of which the most important is giving the baby breast milk the greater part of his first year of life. X X X V I .—Live births to foreign-bom mothers during selected year, infant deaths, and infant mortality rate, according to nationality of mother and her ability to speak English. T able Nationality of mother and ability to speak English. Livebirths. Infant deaths. Infant mortality rate.«» . All foreign-bom mothers.............................................................. 1,439 194 134.8 English-speaking nationalities............................................................... Non-English speakingnationalilies..-................................................... 242 1,197 44 150 181.8 125.3 Able to speak English. . . . '............................................................... Unableto speak English b .................... ........................................... 370 827 37 113 100.0 136.6 Italian mothers.................................................................... 628 69 109.9 Able to speak English............................................................... Unable to speak English........................................................... 155 473 19 50 122.6 105.7 Lithuanian mothers...................................................... 260 54 207,7 Able to speak English................... ........................................... Unable to speak English........................................................... 19 241 5 49 203.3 Other foreign-bom mothers............................................... 309 27 87.4 Able to speak English............................................................... Unable to speak E nglish.......... ............................................... 196 113 13 14 66.3 123.9 a Not shown where base is less than 100. b In addition, 3 native mothers were unable to speak English. Literacy.— Inability to read and write or to speak English greatly increases the isolation of a mother and thereby lessens her op portunity to profit by the constantly increasing knowledge in matters of health and better living. A large number of the foreignborn mothers in Waterbury were unable to read or write in any language, thus prohibiting any communication with them except through the oral use of their own language. The number and per cent of illiterates found among the mothers of the 2,197 infants included in this inquiry is given in Table X X X V II. These figures represent a minimum of illiteracy as all claims to literacy were accepted and no tests of any kind were given. There were only four cases of illiteracy among the native mothers. A study of the individual nationality groups included under “ foreign born” shows that births to Italians and Lithuanians comprised 88.4 per cent of the births to foreign-born illiterate mothers. The per cent of illiteracy was much higher for the Lithuanians than for the Italians. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBTJRY, CONST. T able 75 X X X Y I I . —Births during selected year and number and per cent to illiterate mothers, according to nationality of mother. Nationality of mother. Total births. Births to illiterate mothers. Number. Per cent. ' All mothers.................................................................................... 2,197 588 26.8 Native mothers........................................................................................ Foreign-bom mothers............................ ................................................ 718 1,479 4 584 .6 39.5 Italian................................................................................................ Lithuanian........................................................................................ Irish................................................................................................... Other................................................................................................. 651 267 200 361 '349 167 1 67 53.6 62.5 .5 18.6 For both of these nationality groups the infant mortality rate was much lower for the infants of illiterate mothers than for those of literate mothers, as shown in Table X X X V III . This would indi cate that ability to read and write in itself will not necessarily pre vent infant mortality, nor is illiteracy, undesirable as it is, sufficient to cause a high infant Mortality rate if the mother provides breast milk and intelligent care for the infant. The illiterate mother may be gifted with good judgment or she may have learned through example the proper methods of caring for herself and her baby. But many of the rapidly increasing avenues of public information regarding the most approved methods of infant care are closed to the illiterate mother unless she is given individual instruction either within her home or at an infant welfare station. X X X V III.—Live, births during selected year to foreign-bom mothers, infant deaths, and infant mortality rate, according to literacy and nationality of mother. Table Literacy of mother.« Live births. Infant deaths. c 2,144 263 122.7 1,439 194 134.8 872 126 68 144.5 120.4 2 628 Illiterate.....................................................■_..................................... Lithuanian............................................................................. . Illiterate............................................................................................ All other..................................................................................... 69 109.9 291 335 2 260 34 35 116.8 104.5 54 207.7 96 164 195 25 29 36 176.8 184.6 194 1 356 36 185.6 35 98.3 291 65 31 4 W6.5 Persons who can read and write in any language are reported literate. 6 Not shown where base is less than 100. c Including 4 births to illiterate native mothers. a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Infant mortality rate.ô 76 IN F A N T M O R T A L IT Y . Ignorance and superstition.— Ignorance in matters of infant hygiene is not confined to any one group of mothers, nor is all igno rance of the same variety. The inexperienced young mother may lack knowledge of the proper methods of caring for her child; but if she is intelligent and financially able to procure competent medical guidance, her ignorance is not so apt to prove injurious to the child. Interviews with the mothers of the 651 babies in the Italian group and the 267 in the Lithuanian group brought out strikingly for each group the,prominent part ignorance and superstition played in the care given the newly arrived infants of these foreign-born mothers. Comparatively little superstition was found among the Lithuanian mothers, but, as was pointed out in the section on causes of death, the majority of them accepted the deaths of their children with fatalistic fortitude. One Lithuanian mother of 9 children had lost 6 of them, all but 1 of the 6 dying before reaching the first birth day. She had no idea what caused the death of any except the 3year-old girl who had been quarantined with measles at the time of her death. Another Lithuanian mother who had borne 9 children had lost 5, none of them reaching the eighth month of life, but she could give no information as to the cause of any of the deaths; the death certificate for the last child stated the cause of death as “ ma rasmus and exhaustion.” The same ignorance of the causes of infant deaths was displayed by a Lithuanian mother who had lost 1Ô of the 13 live children she bore. Their ages at the time of death ranged from 5 weeks to 1 year and not one was premature. The inquiry also brought to light the fact that many weird super stitions of Italian origin were flourishing with Old-World vigor in the very heart of Waterbury. “ Charms” to ward off the glances from “ the evil eye” and “ charm breakers” for those who had been “ bewitched” were, in the opinion of many Italian mothers, important factors in the reduction of infant mortality. That there was suffi cient popular opinion to this effect to make “ charm breaking” profit able was evidenced by two Italian women who supported themselves entirely by this peculiar occupation. One mother described, with great emotion, their hbme in Italy,'on the outskirts of Naples. The father left them to go to the United States and three years later sent for his wife and children. Then she said : “ Food and beauty— they are not so plentiful in this country ; but there are not so many witches, and that is better.” When ques tioned about witches she said that both of her children who died in infancy were perfectly “ well, happy, and beautiful” until “ suddenly they grew thin to skin and bones and died within two weeks.” No doctor could discover the cause. Finally one of the family remem bered that the mother had changed midwives, and immediately they https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBITRY, C O N N . 77 knew that the midwife who had been supplanted was the witch who caused the death of the babies. An 18-year-old neighbor «of this Italian mother came in at this point in the story. She was born in the United States and had been educated in the public schools, but she still held firmly to the tradi tions of her people. When asked if she believed in witches she said: Yes, indeed. Of course, to be a witch a girl baby must be born at midnight at Christmas. A boy baby born at that time always has some mark of an animal, such as claws or a patch of fur somewhere on his body. He is never quite right and has not a witch’s powers.” It was the same girl who told of the two women who sold love potions and charms to ward off the evil eye, and also treated the babies who had been bewitched. Another Italian mother who had had nine pregnancies had a mis carriage, followed by a stillbirth and another miscarriage; and the last baby died at the age of 15 days. When questioned as to the cause, she simply stated that the last baby had been bewitched. The death certificate showed “ capillary bronchitis.” It requires a great deal of patient work to substitute for such deeprooted superstition a knowledge of and belief in the modern methods of infant care. It is not a task for any one person or group of persons, but it needs the combined forces of the city health department, the local nursing organizations, social workers in all branches, the churches, and the parents themselves. HOUSING. The importance of housing, water supply, sewage disposal, garbage collection, and care of the public thoroughfares as factors in a city’s health program has long been recognized and often discussed. But as yet no method has been devised whereby the effect of each sani tary defect can be measured and expressed in a mortality rate for any given district. Although in general unfavorable conditions are apt to concentrate in definite areas, frequently one district represents the worst phase of only one condition. The infant mortality rate for that district will indicate in a measure the degree to which the good factors predominated, although the difficulty of measuring the importance of sanitary factors is increased by their interrelation with other conditions which affect infant mortality. For example, it is common experience to find that housing evils exist in sections occupied, through economic necessity, by the poorest paid group, who because of poverty, ignorance, indifference, or lack of opportunity are unable to maintain a standard of living con ducive to good health and proper development. The proper care of infants involves a great deal besides the mere prevention of death. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 78 IN F A N T M O R T A L IT Y . They must be kept in good health and surrounded with such family life as will be conducive to their normal development. These results can not be secured in -dwellings where housing evils exist. Sufficient, room, conveniences which minimize the mother’s household labors, well-constructed buildings which insure freedom from dampness and drafts, adequate toilets, provision for the admis sion of sufficient sunshine— all of thèse react to the welfare of both the infant and the mother, upon whom the infant depends for care. Logically, therefore, housing has a place in the program for the reduction of infant mortality. There is a certain minimum of sani tary safety and convenience which the municipality owes to all of its members, particularly to its youngest, who need every possi ble advantage in early infancy if they are to develop into physi cally and mentally valuable citizens. It is a generally accepted prin ciple that every city should require owners of houses or tenements so to build or remodel all places of habitation that the tenants can secure sufficient light, warmth, air, and privacy; that the law should provide that such sanitary conveniences as are now considered neces sities for urban dwellings be installed, namely, running water, indoor toilets, bathtubs, and sewer connections; that all these, once installed, be kept in order; and that a sufficient number of inspectors be pro vided to enforce these provisions. The city, however, has but laid the foundations for housing reform when it has complied with these accepted requirements of legislation. It is also a recognized duty of the city to provide educational facilities in regard to all matters of hygienic living, as the provisions for adequate housing accommo dations can easily be nullified through the ignorance of tenants. Waterbury has a tenement-house act which is designed to cover the needs of the city, but its provisions apply solely to tenements erected since its passage, whereas old buildings are those most apt to be insanitary and in disrepair. The city had .only one tenement-house inspector and one sanitary inspector to enforce the provisions of the law, which in 1910 regulated 7,715 dwellings occupied by 73,141 persons. Both dwellings and occupants have greatly increased in number, but Waterbury has made no provisions for a corresponding increase in the staff of in spectors upon whom rests the responsibility for enforcing the housing laws. General housing analysis.— In considering the housing problem in Waterbury two methods have been adopted: First, a general housing analysis of the facts secured for the homes in which the 2,144 1 liveborn babies scheduled resided during the greater part of the year after birth; second, an intensive housing study of six scattered disi For the 53 stillborn babies the home visited was the one in which the mother spent the greater part of pregnancy. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBTJKY, CONN. 79 tricts selected solely on the basis of the bad "housing existing within them. The 3-tenement dwelling was the prevalent type of home in which the infants considered in this report spent the greater part of their first year, or so long as they survived. The 2-tenement dwelling came next in popularity, followed in decreasing order by the 6, 1 ,4 , 8, 12, and 5-tenement dwellings.1 The infant mortality rate in creased steadily according to the number of tenements in the dwell ing from 88 in the 1-tenement dwelling to 174.4 for the 4-tenement dwelling, and dropped to 157.5 for dwellings of 5 tenements and over. The location of the building on the lot is considered in Table X X X I X , which shows the infant mortality rate for infants living in alley or rear houses to have been 172, while for those living in houses wdth street frontage it was 120.6. T able X X X I X .—Live births during selected year, infant deaths, and infant mortality rate, according to location of dwelling. Location of dwelling. Live births. Infant deaths. Infant mortality rate. 2,144 263 122.7 2,048 93 3 247 16 120.6 172.0 Overcrowding within the dwelling, its sanitary condition, and con dition of repair have a close relationship to the health of the tenants, of whom the babies are the most susceptible to surroundings. A rough measure of overcrowding is shown b y the average number of persons to a room,2 but the fact of room overcrowding depends upon the actual use of rooms b y the individual family. N.ewsholme takes as a standard that a house is overcrowded when the number of occupants exceeds double the number of rooms in the house. According to this measure the congestion in 4-room apartments 3 was greater than in any other, in some cases in both native and foreign-born groups as many as 11 persons living in 4 rooms. Room congestion was much more common among the foreign bom than among the native, 6.2 per cent of the former and 1.3 per cent of the latter living in dwellings where the occupants exceed twice the num ber of rooms. Certain sanitary factors, such as kind and location of toilet, water supply, cleanliness, and ventilation, are of interest in studying hous ing conditions, but the data on such items as cleanliness, ventilation, 1 General Table 36. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 General Table 37. 3 General Table 38. 80 EN FAN T M O R T A L IT Y . and condition of toilets, when dependent upon the judgment of sev eral investigators, are not reliable measures. ^ The kind and location of toilets and the source of the water supply; is shown by wards.1 Privies are admittedly undesirable, but it would be u n fa ir to rate ward 2, in which 14.9 per cent of the toilet accom modations were yard privies, as inferior to ward 1 with only 5.4 per cent privies, unless the indoor toilets of the latter were known to be cleaner, in better repair, and used by fewer persons. Table X L .—Number and -per cent of dwellings in each ward having specified hind of toilet facilities and water supply. Ward 1. Item. Num ber. 25 55 19 Privy a ....................................... Toilet not in dwelling.............. Water supply other than city .. a Ward 2. Per Num Per cent. cent. ber. 5.4 12.0 4.1 50 78 47 14.9 23.2 14.0 Ward 3. Ward 4. Num Per Num Per ber. ber. cent. cent. 57 118 48 11.6 23.9 9.7 58 227 19 9.9 38.8 3.2 Ward 5. Num Per ber. cent. 43 141 27 13.3 43.7 8.4 Including 1 case no toilet, third ward. The neighborhood, type of house, amount of overcrowding— all are in large part determined b y the ability of the family to own their home or by the amount of rent they are able to pay. Of the infantsof native mothers 11 per cent, and of those of foreign-born mothers 9.6 per cent belonged in families owning their own homes.2 Owning the home indicates an economic status well above the poverty line, and it is significant that the infant mortality rate for the babies of both native and foreign-bom mothers who owned their own homes was much lower than for those of the group who rented their homes. For the latter group the infant mortality rate decreased as the rental increased for both native and foreign born. The foreign born paid much lower rentals than the native, an excellent indication that in general the accommodations they secured were much less desirable. However, rentals do not necessarily repre sent actual value received in accommodations, as land values and the desirability of the neighborhood are important factors to be consid ered in a study of rentals. Of the total number of infants whose families were considered, 9.1 per cent were members of complex households. These included young married couples living with the parents of either husband or wife, or vice versa; married couples who were related keeping house together in order to share expenses; and others who for various reasons desired to maintain cooperative establishments. In general the complex families paid higher rentals than the simple families, necessitated in part by the increase in the number of people living in the house and 1 Général Table 39. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 General Table 40. W ATERBURY, CONN. 81 made possible by the combined resources of two or more family groups. A study of simple households brings out the fact that $10 to $15 represented the prevailing rentals for both native and foreign-bom families, but of those renting homes there were 57.5 per cent of the families of infants of foreign-bom mothers and 38.5 per cent of those of native mothers who paid this rental. Slightly more than onethird of the native families paid $15 to $20 per month rent, while only one-tenth of the foreign-born families were in this group. In this connection it should be remembered that the same rental paid by native and foreign-bom families does not mean comparable standards of living, for, as shown in the section on family income, the native family is smaller than the foreign bom. A rental which will provide a comfortable home for a family of three will secure for a large family only accommodations which necessitate overcrowding and attendant evils. In brief, the findings are that a high infant mortality rate was coex istent with living in houses on the rear of the lot or facing the alley, with overcrowding within the apartment, and with low rentals. But even these facts do not furnish a picture of the actual conditions existing in those sections of Waterbury where its worst housing evils were to be found. Intensive housing study.—Certain housing itemjs, such as lot, dwelling, and room congestion, repair and ventilation of toilets, ventilation of dwellings, and other matters of household sanitation must be observed by the investigator if the facts secured are to be reliable. Since the intensive housing study was designed to supple ment the general study by supplying information on these items, it was obviously necessary to shift to a more direct method than that used in the general inquiry. The latter was based on information supplied by the mother regarding the house in which the infant spent the greater part of his first year, while in the former information was secured from personal observation by the agent at the time of her visit. Six districts in which the housing accommodations were especially unfavorable to hygienic living were selected after consulting the rep resentatives of various social agencies, who were familiar with the entire city. These districts, rather widely distributed geographically,1 were representative, uot of Waterbury’s housing as a whole, but of those sections of the city which constituted its housing problem. 1 District I consists of French, Anne, and Gilbert Streets, located in ward 3, in the angle formed by Willow and West Main Streets; District II, Railroad Hill, runs through the center of'the southern half of ward 4; District III, including Brown Street and North Elm Street between Water and Cherry Streets, in ward 1, lies in the angle formed by North and East Main Streets; District IV is a portion of Bank Street forming the boundary line between wards 3 and 4; District V adjoins the northern part of the Bank Street district, extending between Bank, South Main, and Grand Streets and includes Canal, Chatfleld, two short alleyways known as Rear South Main, and that portion of Meadow Street lying between Bank and South Main Streets; District V I, Rushton Place, is entered from South Main Street by an alleyway, just south of Meadow Street. For a description of these districts see Appendix B. Digitized for 14458°— FRASER18------ 6 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 82 IN F A N T M O R T A L IT Y . Within these selected districts only 141 (Table X L I) of the 2,144 live-bom infants included in the infant mortality study spent the greater part of their first year of life; of these, 14 died before attain ing the age of 1 year. These numbers are too small to afford a basis for significant conclusions; therefore no attempt has been made to measure the effect of the special housing evils in these districts upon the infant mortality rate. Composition of districts.— These districts included a total of 2111 buildings containing 8112 apartments (68 of which were vacant at the time of the investigation), in which were housed 5,0433 persons. In these districts every apartment was visited, every toilet and bedroom inspected, and all bedrooms which obviously were not sufficiently large to meet the legal minimum requirement were measured. A special housing card was filled out with information regarding each apart ment, house, and premises, by an agent with special training as a housing investigator, thereby insuring technical treatment of the subject and but one standard of judgment. The districts were selected solely with reference to housing; they included 12 nation alities,4native white, native black, Italian, Lithuanian, Irish, Jewish, Polish, French Canadian, Russian, German, English, and Swedish.5 The 742 households reported were divided as follows: Twentyseven.or 3.6 per cent native white, 6 or eight-tenths of 1 per cent native black„ 408 or 55 per cent Italian, 165 or 22.2 per cent Lithu anian, 50 or 6.7 per cent Irish, 35 or 4.7 per cent Jewish, 26 or 3.5 per cent Polish, and 25 or 3 .4 'per cent other foreign born. In 141 of these households a birth had occurred during the period under consideration. In three of the districts there were no deaths of the infants included in this study; and the infant mortality rate, based on the total births and infant deaths for the six districts combined, was only 99.3. T able L X I .—Live births vend infant deaths in selected districts', by district. Selected district. Live births. 141 District! 7 15 13 61 42 3 Infant deaths. 14 1 6 7 i General Table 41. 1 Genera ITabSe 42. » General Table 44. _ , .. * In discussing tbe nationality of households in the special districts -referred to on pages 81 to 90 and in Appendix B, the nationality of the head of the household is shown. &General Table 43. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W A T E R B U R Y , C O N S'. 83 This low rate is explained in part by the large proportion of births occurring in these special housing districts to the two nationality groups having low infant mortality rates, 95 Italian and .10 native, making a total of 105 or 74.5 per cent o f all births in these districts. The Lithuanians also show a low rate, but undoubtedly this is due to the small number included, as consideration of all Lithuanians in the city gives the high rate of 207.7. T able L X II. — Live births and infant deaths in selected districts, according to nationality of mother. Nationality of mother. All births................................................ Native............................ ......... Foreign born.................................... . Italian.......................................... Lithuanian............................... ...... . Irish................................... Other................................................ Live births. Survivals. Infant deaths. 141 127 14 10 131 9 118 1 13 95 26 1 9 85 23 1 9 10 3 The wage earners of these districts as a whole, as might be expected, were employed in occupations demanding little skill and consequently offering low wages. Three hundred and twenty-three were em ployed in the brass factories in occupations ranging from caster to yard laborer; 60 in iron foundries and other iron manufactories; 104 in retail trade as peddlers, small grocers, butchers, etc.; 49 in the building trades in various occupations from carpenter to mason’s helper; and 29 as teamsters or truck drivers. There Were 56 mis cellaneous laborers, and other occupations included teachers, doctors, j anitors, street car conductors, and washerwomen. Lot congestion.— It was found to be impracticable to compute the percentage of area covered on each lot due to the difficulty of measur ing lots of irregular shape, the large number of yards used in common by the occupants of several buildings, and the indefinite lot line. Of the premises of the 211 buildings visited, 15 lots or 7.9 per cent were found to be entirely covered, and 83 or 43.9 per cent nearly covered or had only a few square feet of open space. Number o f apartments in building.— Of the 211 buildings visited, 105 1 or 49.8 per cent were 1 or 2 family houses. These houses contained only 21.2 per cent of all the apartments visited. Four hundred and nineteen or 51.7 per cent of the apart ments were in houses containing 6 or more families, 287 or 35.4 per cent in houses of 8 or more families, 189 or 23.3 per cent in houses of 12 or more families, and 87 or 10.7 per cent were in houses accom modating 16 or more families. 1 General Table 41. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 84 Number o f rooms in dwelling.— One hundred and eighty-four 1 or 24.8 per cent of all the apartments, exclusive of those that were vacant, contained 3 rooms or less; 276 apartments or 37.1 per cent, 4 rooms; 164 or 22.1 per cent, 5 rooms; while 118 or 15.9 per cent had 6 or more rooms. Rentals.— In the districts canvassed there was a wide range of rentals for apartments varying from $32 to $8 a month for two-room apartments, from $4 to $14 for three-room apartments, from $6 to $16 for four-room apartments, from $7 to $20 for five-room apartments, and from $8 to $32 for six-room apartments, but the average rental per room remained almost stationary, ranging from $2.62 in sixroom apartments to $3.01 in three-room apartments, while two-room and five-room apartments averaged $2.85 and $2.70 per room, re spectively, and four-room apartments $2.76 per room. The average monthly rental of apartments thus increased proportionately from $5.70 for a two-room apartment to $15.72 for a six-room apartment. Even within the limited areas described, however, the poorer families were being forced, by the increased rental per room, into the smaller apartments, as has already been shown. Number o f persons and rooms in apartment.— To measure the degree of congestion it is necessary to know not only the size of the apartment but also the number of occupants and whether they are adults or children. The number of persons in the household together with the number of rooms in the apartment is shown in Table X L III T able X L I I I .—Apartments in selected districts with specified number of persons in household, according to number of rooms in apartment. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W A T E R B U R Y , CO N N . 85 To the right of the broken line are shown the number of family groups with two or more persons to a room. There were 240 such families, amounting to 32.3 per cent of the total number reported and including 2,201 persons, of 43.6 per cent, of the total population of these special districts. The high degree of crowding in apart ments having two or more persons to a room is exemplified b y a fam ily of six living in three rooms. Under such circumstances part of the family must sleep in the kitchen-living room or all six must crowd into the two bedrooms. There were eight instances of families of eight living in three rooms, all eight persons having to sleep in two bedrooms unless the kitchen was used for sleeping purposes. There was one instance of 11 persons living in three rooms. Under these circumstances, even if three persons sleep in the kitchen— which is also dining room and living room—four persons must sleep in each of the two bedrooms. A number of extreme cases may be cited for four-room apartments as follows: Six households with 12 members, four with 13, two with 14, and one with 16, the last showing the extreme congestion of 4 persons sleeping in the kitchen and 4 in each bedroom, or if the kitchen was not used for sleeping pur poses, 5 persons in each of two bedrooms and 6 in the other. In addition to the 2,201 persons living in congestion amounting to two or more persons to a room, 183 families, including 1,350 persons, lived in homes congested at a rate of one and one-half but less than two persons to a room, which necessitated using the kitchen for sleeping purposes or two or three persons sleeping in each badroom. Com bining the two groups described we find that 3,551 persons, or 70.4 per cent of the total population of all the districts canvassed were living under conditions of overcrowding at a rate of from one and one-half to four persons per room. Overcrowding o f sleeping rooms.—The legal minimum requirement for sleeping rooms in Waterbury is 500 cubic feet of space for each adult and 300 cubic feet for each child under 12 years.1 That it is not too high can best be realized by computing the size of a room con taining 500 cubic feet of space, in which the legal requirement for height is 8 feet 6 inches. In such a room the floor dimensions are approximately 8 feet by 7 feet 4 inches, a little more than the length of a cot each way. For a child, a room no larger than a fair-sized pantry would meet the legal requirement— one that is 8 feet 6 inches high, with floor dimensions 6 feet by 5 feet 8 inches. Low as this legal requirement is, 3,0532 persons, or 60.5 per cent of the total population of these selected districts, slept in rooms which did not meet it. In addition 324 persons, over 6.4 per cent, slept in rooms which had less than one-half the legal minimum. There were many extreme instances in which the cubic space fell far below that required iConnecticut Public Acts, 19U, ch. 220, sec. 7. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 General Table 46. 86 INFANT MORTALITY. by law, such as that of 2 adults and 3 children, and that of 3 adults and 2 children, for whom the legal requirement was 1,900 and 2,100 cubic feet, respectively, sleeping in rooms containing between 500 and 600 cubic feet of air space, less than one-third the legal minimum; another, where 2 adults and 5 children, for whom the legal requirement was 2,500 cubic feet, slept in a room containing between 800 and 900 cubic feet of air space; and again, 3 adults and 5 children in a space con taining between 1,100 and 1,200 cubic feet where the requirement was 3,000 cubic feet. There was considerable variation in bedroom congestion in the six selected districts as shown in Table X L IV and Table X L V , which present, by districts, the total number of bedrooms and the total population of the districts, giving the number of rooms meeting the legal requirements and the number falling below them. Nine hundred and eighty-eight persons, or 77.9 per cent of the population of District Y, slept in rooms containing less than the legal requirements for cubic air space. District V I followed with 73.6 per cent, District II with 66.3 per cent, District I with 60.4 per cent, while Districts IV and III had, respectively, 52.4 per cent and 41.3 per cent of illegal bedroom congestion. T able X L IV . — Bedrooms in selected districts, according to fulfillment of legal minimum requirements of cubic capacity. Size of bedrooms. District. All se lected dis tricts. I II III 1.967 131 309 1,007 943 17 66 65 146 163 IV V VI 267 782 432 46 193 74 445 320 17 137 295 20 28 X L V . — -Number and per cent distribution for selected districts of adults and children occupying bedrooms meeting and not meeting the legal minimum requirements of cubic capacity. T able ' District. All selected districts. . I Size of bedroom. Per Per cent cent disdis All All Chil tribu- per Chil tribu per Adults. dren. Adults.. dren. tiontion sons. sons. of all of all per per-, sons. sons. All bedrooms..................... — . — . . . . . . . o5,043 Legal....................................................................... 1.917 Illegal...................................................................... 3,053 . a b 3,498 1,472 100.0 6 351 249 90 100.0 1,451 466 2,047 1,006 95 154 32 58 36.2 60.4 38.0 60.5 Including 73 persons for whom there was no report. Including 12 persons for whom there was no report. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis .127 212 W ATEEBUBY, CONN. 87 X LV . — Number and per cent distribution for selected districts of adults and children occupying bedrooms meeting and not meeting the legal minimum requirements of cubic capacity—Continued. T able District. II III Per Per cent cent dis dis All All Chil Chil tribu per per Adults. dren. Adults. dren. tribu tion tion sons. of all sons. of all per per sons. sons. Size of bedroom All bedrooms.................................................. 765 516 249 100.0 632 423 209 100.0 Legal............. ............................................................ Illegal........................................................................ 258 507 192 324 66 183 33.7 66.3 371 261 270 . 101 153 108 58.7 41.3 District. V IV Size of bedroom. V I, Per Per Per cent cent cent dis dis dis All All All Chil tribu per Chil tribu Chil tribu per per Adults. dren. tion sons. Adults. dren. tion sons- Adults. dren. tion sons. of all of all of all per per per sons. sons. sons. All bedrooms. al.917 1,338 Legal......................... 852 Illégal........................ 1,004 673 665 a 518 100.0 1,268 908 360 100.0 44.4 52.4 200 708 80 280 179 339 280 988 22.1 77.9 no 64 46 100.0 29 81 21 43 8 38 26.4 73.6 Including 01 persons for whom there was no report. Ventilation.—The size of the room, important as it is, forms an index, more arbitrary than exact, to the adequacy of air in that room. The possibility of proper ventilation is equally important, though more difficult to measure with precision. The law requires window space in each bedroom equal to at least one-eighth of the floor area. Measurements were not taken to show in how many cases this requirement was met, but in most instances inadequate ventilation was not so much the result of inadequate window space as of too restricted an area upon which the window opened. A window opening upon a narrow passage, court, or lot line, or upon a small shaft can not give proper ventilation, no matter how large it may be. Bedrooms opening upon the street have, on the whole, the best opportunity for admitting light and air. There were 705 such bedrooms, or 35.8 per cent of the total number. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 88 INFANT MORTALITY. T able X L V I .—Bedrooms in selected districts, according to character of outlook, Character of outlook. A ll bedrooms............................................................... District. Total bed rooms-. I 1,967 131 46~ 20 15 13 104 555 60 1 427 705 21 II ni IV V 309 267 782 432 3 37 16 14 9 84 212 29 9 4 1 1 20 138 24 95 281 5 51 180 4 54 3 52 4 22 48 4 145 101 7 99 1 68 95 1 VI 46 .................... .................... 46 ---------- — Four hundred and twenty-seven or 21.7 per cent of the bedrooms had an outlook upon yards which, though varying in size, probably give .the next best opportunity for adequate ventilation. Sixty bed rooms had windows opening upon porches which partially shut out light and air from the rooms. Five hundred and fifty-five bedrooms opened upon passages which, while varying from 6 inches to 6 feet in width, generally did not afford adequate light and ventilation. To a still greater extent did this apply to courts upon which 104 bedrooms opened, and to lot lines (passages 6 inches or less running along the lot line) upon which 13 bedrooms opened. The disad vantages of a bedroom opening upon a shaft of any size are obvious; sometimes the odor of stale air, accumulated rubbish, and dirt is so foul that the window can not be opened at all. Fifteen bedrooms were found having no other openings than those upon a shaft; 20 had no windows other than those opening into another bedroom, kitchen, or hall; 46 contained no windows whatever. In all, 66 bedrooms had no opening upon the outside air, and a total of 707, or 35.9 per cent of all bedrooms, had no better outlook than passage, court, lot line, shaft, or inside room, all of which may be considered inadequate. Household sanitation.— Serious as the problem of overcrowding is, it is no more serious than the problem connected with house hold sanitation. Toilets, their number, location, and condition, are the most im portant of sanitary conveniences. This special housing study in cludes 6201 toilets serving 5,043 persons. Five hundred and eleven, a large majority of the toilets, were each used by one family only, 82 by two families, 11 b y three families, 15 b y four families, and 1 b y six families. The number of persons using a single toilet was often very large; 117 toilets each accommodated from 10 to 14 persons, 28 toilets were used by 15 to 19 persons, 10 b y 20 to 24 persons, and JGeneral Table 47. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBTJRY, CONN. 89 8 b y 25 or more persons. In the group used b y 25 or more persons one toilet was used by 32 and one by 33 persons. Combining these groups, we find 2,236 persons, 44.3 per cent of the total population, using toilets which must accommodate 10 or more persons. In 390 instances toilets were located within the apartment; 125, about one-fifth of the total number, in the hall, 30 in the basement or cellar, 18 on the porch, and 12 (exclusive of privies) in the yard. The 45 dry yard privies constituted 7.3 per cent of the total number of toilets, the 476 persons using them equaling 9.4 per cent of the total population of these districts, an average o f 10.58 persons per privy. Hall and porch toilets show an average of 10.22 and 10.78 persons, respectively, per toilet, while yard water-closets show an average of 12.25 persons. Apartment and basement or cellar toilets with averages of 7 and 7.27, respectively, show the lowest average number of persons per toilet. Not only were the hall, porch, and yard toilets commonly used by a larger number of persons than the apartment or even the basement toilets, but they were usually unlocked and so open to more promis cuous use. They were also apt to be used by more than one house hold, thus dividing responsibility and with it the chances of cleanliness. Only 204, 35.5 per cent, of tne water-closets reported were in good condition. In 71 instances filth was found in the compartment or on the bowl or seat, a serious condition, since disease germs (such as those of typhoid fever and gastric and intestinal diseases) may be spread by the flies which find a breeding place here. In 269, almost one-half of all the water-closets reported, the bowl or fixture was found corroded or discolored and the enamel facing broken off, making a rough surface impossible to keep clean and often caked with a black, slimy deposit. Very few of the water-closets visited were free from odor, but this was not especially noted except in 160 cases, where it was so bad as to pervade the apartment and often the entire hall way or house. The uncleanliness of the toilet was frequently caused b y its poor repair as well as its use b y too many persons. Twenty water-closets did not flush at all at the time of inspection, while 174 did not flush adequately; 249 were found leaking sufficiently to keep the floor wet; and in 77 the seat was either broken or entirely gone. In some instances it had been patched with pieces of tin with rough, rusty edges, or with pieces of leather or unfinished splintering wood fastened with nails sometimes having large rusted heads. Such a condition not only causes discomfort, but may cause serious infection. Only 199, a little more than one-third, Were found in good repair. Closely allied with the condition of the water-closets are the means of lighting and ventilation. One hundred and ninety-two water https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 90 INFANT MORTALITY. closets, 33.4 per cent of the total number, were found to he light; 207 or 36 per cent were designated as gloomy, and 154 or 26.8 per cent were reported as dark. Equally important is the possibility of ventilating the toilet and renewing the air which is being constantly vitiated by. unclean, broken fixtures. One hundred and five water-closet compartments had no windows whatever, and 48 had windows which did not open either because fixed in the frame and never made movable, or because nailed tight b y the landlord, as was found in several instances. In a few cases thè compartments without windows were fitted with small ventilating flues, but they seemed to be of no practical value, and the two groups described, 26.6 per cent of the water-closets, were for all practical purposes without any ventilation. Add to these 198 compartments fitted with windows which opened but were inadequate because opening upon small shafts or narrow pas sages, and the result is a total of 351 water-closets, 61 per cent of the total number, which were inadequately ventilated. Housing evils in other sections of city.— All the conditions de scribed— the dark insanitary toilets, the crowded ill-ventilated bed rooms, the small congested apartments, the damp cellars, and the yards made foul by uncollected garbage, drainage from sinks or yard privies— all these were found not only in the districts canvassed but in other sections of which those districts were typical. The large tenement type, for example, was found also along portions of South Main, East Main, and Baldwin Streets. On Spring, Brook, School, Scovili, Phoenix, Jefferson, and Union Streets were found types similar to those described in Districts III and V. Parts of South Leonard Street, South Riverside Street, Lafayette Street, and espe cially River Street had a type of house similar to that in the worst portions of Railroad Hill, and on a part of River Street were found, corresponding conditions of yard privies. CIVIC FACTORS. INFANT-WELFARE WORK.1 In many of our large cities high infant death rates caused largely by unwise feeding of the infants have been lowered through the establishment of infant-welfare stations where well infants are kept in good health through supervision of their feeding, formulas being prescribed by a physician after examination of the infants. The infant-welfare nurse visits the home and instructs the mother in the proper method of preparing the formula and in other matters of hygiene relative to the infant’s health. Frequent visits to note the child’s condition result in warding off, through early detection and 1See Appendix A for report on development of infant-welfare work since the close of the investigation. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 91 treatment of seemingly slight symptoms, many illnesses which might otherwise prove severe. Visiting nurses association.— At the time this investigation was made there were no infant-welfare stations in Waterbury and the only agency which avowedly did any work for either sick or well babies was the visiting nurses association. Two visiting nurses were assigned exclusively to the work for infants. They received their cases from physicians and social agencies and from personal applica tions on the part of families. These two nurses did not care for confinement or contagious cases. The greater part of the work was done for sick children, although a little instruction was gfren for any well children whose mothers wished advice in regard to weaning, Obviously two nurses can not adequately care for even the sick babies in a community of almost 83,000. It naturally follows that preventive work with this inadequate number of nurses, if done at all, will be more or less haphazard, for n o .constructive plan can be made and carried out without an adequately supported staff of sufficient size. Free millc.— At the time of this investigation no milk stations existed in Waterbury, but the visiting nurses association received annually from the city $400 for the purchase of milk to be dis tributed free to any person recommended by the. association. Some of this milk was given to mothers for the babies, but the greater part was given to invalids. Ice.—This association also distributed ice boxes and ice tickets during the summer. The work was necessarily very limited owing to lack of funds. It was, however, felt by the nurses to be a very important factor in the health of artificially-fed babies, as without ice the mothers could not keep cows’ milk in condition fit for use. Little Mothers’ League.— The Waterbury Girls’ Club organized a Little Mothers’ League, consisting of 78 little girls, who met at Leavenworth Hall three times a week for 30 weeks to receive instruc tion from a visiting nurse in the proper methods of caring for babies. Many of these children were daughters of non-English speaking par ents, so that the children themselves became instructors of their mothers in the American methods of raising babies. COUNTY HEALTH OFFICER. The county health officer’s duties include the supervision of local health officers, authority in case of local epidemics, responsibility for rural conditions, and enforcement of the law relating to vital statistics. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 92 CITY HEALTH DEPARTMENT. The Waterbury department of public health consists of a board of five commissioners, a clerk, 1 health officer, 1 sanitary inspector, 1 tenement house inspector, 1 milk and food inspector, 1 supervisor of garbage, 2 medical inspectors of schools, 1 bacteriologist, and 2 school nurses. These are all full-time positions with the exception of the health officer, who is expected to plan and supervise the work of his entire department by devoting to it only a few hours a day and he receives therefor the exceedingly small compensation of $1,200 per annum. In his report for the year 1914 the health officer states: T h is departm ent had at its disposal, for th e year 1914, £29,864.75. O f this am ount $14,188 was allow ed for c o lle ctio n and disposal of garbage, lea vin g for actu al health work $15,676.75, or a p p rox im a tely 17.7 cen ts per ca p ita . How inadequate this amount is, is brought out in “ A Survey of the Activities of Municipal Health Departments in the United States,” 1 which says: Far too m any o f our c it y health departm ents undertake far too little in proportion to th eir opportu nities; on th e other hand, all too few re ce iv e an anyw here near ade quate appropriation. U nder th e circu m stan ces on e m ay reem phasize th e suggestion that there should b e a m in im u m yearly per ca p ita figure for a m odern departm ent— a k in d o f m in im u m wage. T h e suggestion is n ot new — h avin g been m ade b y Park in 1911, the figure set b y h im ranging from 50 cents to $1 a ccord in g to the size o f th e c ity , and b y th e com m ittee on a c tiv itie s o f m u n icip a l health departm ents o f th e A m erican P u b lic H ealth A ssociation , its figure b ein g 50 cents. C ertain ly 50 cen ts for real preven tive measures w ould b e an en tirely reasonable figure, and in all p ro b a b ility the tim e is n ot far distant w hen our c it ie s wi,ll allow th eir health departm ents a dollar a head— an am ount still m oderate w hen com pared w ith th at sp en t for p o lic e or fire p rotection . In his report the health officer calls attention to the fact that— F ailure to m ake appropriations for th e establishm ent o f m ilk stations has curtailed th is dep a rtm en t’s in flu en ce in it s fight against in fa n t m orta lity. A lis t of births occu rrin g du rin g th e sum m er m onths has been com p iled b y th e departm ent, and literature in stru ctin g m others as to th e proper care of ch ild ren has b een distribu ted . This was the first effort of the kind on the part of the health de partment, which heretofore, through lack of funds and an insufficient corps of workers, had never been able to do any educational preven tive work to reduce infant mortality. Milk supply.— In the year 1914 Waterbury did not require pas teurization nor the bottling of any of the milk sold within the city, two things which vastly increased the responsibilities and duties of the one inspector, who could not adequately supervise the milk supply for a city with a population of almost 83,000. His duties also included the supervision of all dairies, vehicles, milk cans, stores where milk was dispensed, and the collection of samples for analysis. 1Schneider, Franz, jr., pp. 21, 22. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN-. 93 In the same year an ordinance was passed requiring retail dealers to cleanse all milk cans before returning them to the dairies. Recording to the report of the health officer the result was a marked decrease of the bacteriological count in samples of milk obtained in certain districts. The milk and food inspector stated that at lea,st four times each year he visited every farm which supplied milk to the city of Waterbury. His inspections, so far as possible, were made at the m i l k i n g hour to enable him to inspect the conditions under which the m i l k i n g was done. An ordinance requires that “ immediately after each cow is milked the milk shall be strained through a fine wire gauze and a layer of absorbent cotton protected on either side by a piece of cheesecloth.” But nowhere in the ordinance is it stipulated that these articles for straining shall be sterilized, and when questioned on this point the inspector said that he sometimes found them quite dirty. The State of Connecticut forbids the use of milk containing more than 1,000,000 bacteria per cubic centimeter. In commenting upon this, State Bacteriologist Prof. Henry W. Conn, in his 1912 report, said: W h ile it is thus recogn ized th at ba cteriologica l analysis is o f extrem e va lu e in deter m in in g th e q u a lity o f m ilk , i t is d ifficu lt or im p ossib le to set an y bacteriological standard th a t shall b e o f equal v a lu e in large and sm all com m u n ities. T h e m ilk d istribu ted in large c itie s is on th e average older, sin ce it has a m u ch longer trans portation than th at d elivered in th e sm aller ones, and th is in e v ita b ly produces the higher cou n t * * *. If, therefore, a ba cteriologica l standard is to b e required, it m ust b e graded a ccordin g to con dition s. F or exam ple, th e last legislature in this State ad opted th e standard of 1,000,000 b a cteria per c u b ic centim eter. T h is standard m ay b e reached w ith the v e ry greatest ease in a ll of th e tow ns in th e State, and b eyon d question, in th e ordinary sm all com m u n ities, m u ch m ilk w h ich passes this standard m ay have been produced under careless con dition s, h ave been carelessly handled, or m ay b e too old for proper sale. H en ce this standard o f 1,000,000 b a cteria is no in ce n tiv e w hatsoever to dairym en furn ish in g sm all towns to increased carefulness in the handling o f th e m ilk , because i t can b e reached w ith ou t an y sp ecia l care; and em phasis upon such a standard w ou ld decrease, rather th an increase, th e atten tion w hich is given b y the dairym en and th e m ilk producer to furn ish in g satisfactory products. * * * D airym en in C on n ecticu t * * * h ave no d ifficu lty w hatsoever in p rodu cin g m ilk w ith a bacterial content far superior to th at of th e standard set b y law, and in our com m u n ities m ilk w ith bacteria a b ove th issta n dard sh ou ld b e u nh esitatin gly con d em n ed .1 The city of Waterbury recognized the need for more stringent legislation and accordingly passed a law that no person should bring or send to Waterbury any milk containing over 300,000 bacteria per cubic centimeter. Even this standard is not difficult to attain. Dr. Grulee says: A co u n t o f over 100,000 ba cteria per c u b ic centim eter is certa in ly n o t fit for use in nourishing th e in fa n t, b u t a cou n t of 10,000 or b elow is desirable.2 1 Connecticut State Board of Health, 1911-12, pp. 153, 154. 2 Grulee, Clifford G. Infant Feeding, 1914, p. 121. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 94 The bacteriological count is made in the city bacterologieal depart ment, where disease cultures are also examined; for the year 1914 the bacteriologist examined 1,098 samples of milk for their bacterial c o n t e n t , only 6 of which were found to contain bacteria in excess of the legal maximum. Two days a week the inspector devoted to inspecting the 350 licensed shop venders of milk. The limited amount of time and the fact that he had no assistance made it impossible for him to inspect them as frequently as desirable. When a shop is under suspicion of selling low-grade milk and has been reported to the inspector, samples of the milk are tested first from the shop, then from the milk depot- from which the .milk is distributed, and if necessary are traced back to the farm and to the cows. Waterbury milk is tested in three ways: (1) B y the bacterial count, (2) by straining through fine gauze for dirt, and (3) b y qualita tive analysis, i. e., to determine the per cent of fat, water, and milk solids. For the year 1914 the inspector reported the inspection of 550 dairies, 626 stores, and 249 vehicles. In addition, 1,309 samples of milk were examined for dirt and solid contents. Of these, 28 were found below standard. Garbage collection and disposal.— An important phase of house hold sanitation is the regular and frequent collection of garbage. Waterbury had, at the time of this investigation, a city ordi nance which provided that garbage, ashes, and rubbish should be kept separate; but the superintendent of garbage disposal stated that the city collected the garbage even when mixed with ashes or rubbish to avoid discussion with the tenants. These collections, the ordinance provided, were to be made twice a week from November 1 to May 1 and three times a week the remainder of the year. There was no systematized method of garbage disposal. On days when collections were made the farmers drove in toward Waterbury until they met the garbage wagons. The garbage was then transferred to the farm wagons and hauled to the farms, where it served as food for hogs or as fertilizer. In 1914 the health officer reported1 that as there were 311 collection days during the year, the annual amount removed was about 12,440 tons. Of this amount one-half was col lected b y the city teams and the remainder by private collectors. Ashes and rubbish disposal.—Ashes and rubbish were not collected by the city, but the owner of the house, or in some cases the tenant, was responsible for their removal. As this involved expense and trouble, carelessness naturally resulted. About 50 firms and drivers i Annual Report of the Health Officer oi the City of Waterbury, 1914. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 95 were licensed to collect ashes and rubbish, which they must remove from the city, use for filling in their own land, or dump at points (new streets whieh were being graded or filled in) designated by the super intendent o f streets. The street sweepings and manhole, and sewer cleaning wastes were also used with ashes for street grading, except in winter, when they were taken to Brookside, the city poor farm, to be used as fertilizer.1 In the districts in whieh the intensive housing study was made families reported and evidence proved that collections were made very much less frequently than was officially planned. Health laws, moreover, required a covered receptacle of prescribed sanitary type, but this requirement was generally evaded in the special districts canvassed, the garbage frequently being piled in the yard. On Rail road Hill the city apparently made few garbage collections, and the families not feeding the garbage to chickens simply “ pitched it down the b a n k /’ Along North Leonard Street obnoxious conditions were found to exist, particularly on the rear lots where garbage and piles of tin cans had accumulated for many weeks, and no steps had been taken by the landlords, tenants, or city to remove them or to make provision for proper containers. Such conditions of accumulated filth result in breeding large swarms of flies, which may become carriers of disease germs. Along the east side of North Riverside Street the back yards border on the Naugatuck River, which suffers, as do most Connec ticut streams, from uncontrolled sewage and waste pollution. Factory waste and sewage disposal.— Factories commonly disposed of their waste by emptying it into the streams, in direct violation of the city ordinance. Both chemicals and oils in factory waste are objectionable and in many places discolor the streams and render them foul smelling. A t low water decomposing sludge and other deposits could be seen all along the banks of the river. Including the private sewers, many of which were most insanitary as a result of their insufficient size, the city had only 55.9 miles of sewers, leaving 71.7 per cent of the 198 miles of streets without provision for sewage disposal.2 This is largely due to the excessive expense of installing any underground service in Waterbury. The city is built upon a rock foundation and all laying of pipes necessitates extensive blasting, which is both a slow and expensive process. The disposal of waste from dry privies and cesspools was not cared for by the city, nor was its disposal by private property holders supervised. 1 T iis practice has been discontinued. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 See map facing p. 97. 96 INFANT MORTALITY. WATER SUPPLY. The city of Waterbury is supplied with water from two large reservoirs 12 miles northwest of the city and two smaller subsidiary reservoirs on the southeast boundary of the city. The latter form a separate system known as the high service and are partly sup plied by pumping from the low service. The combined capacity of all reservoirs is 2,950,000,000 gallons. The city owns all of the land immediately adjoining the water sheds for all reservoirs. No one lives upon the city’s land except the caretakers, for whose dwelling a special sewer and drainage system was installed in order to protect the water supply. The entire watershed for all reservoirs embraces about 30 square miles, of which the city owns about 3. The dam at Morris Reservoir contains an elaborate system for aerating the water as it is drawn into the Wigwam basin. The report of the city engineer says: For th is purpose four aerating slu ices w ere b u ilt in th e m asonry of th e w eir wall and con n e cte d w ith th e gate cham bers of th e service-gate house. T h ey are at eleva tions corresponding to elevations o f in le t gates w h ich ad m it water from th e reservoir to the gate cham bers and p erm it o f g iv in g th e water a m axim u m exposure to th e air in passing from one lake to the oth er.1 There is no filtration system, but the water is stored for various periods of time. Rosenau says: V ery few parasites pathogenic for m a n m u ltip ly in water under natural condition s. In tim e th e y all d ie out. H en ce a stored water is reasonably safe. In ad d ition , the organic m atter undergoes d ecay and returns to its sim p le m ineral constituen ts. H en ce a stored water w ill in tim e free its e lf n ot on ly of harm ful parasites b u t also of m ost of its organic p o llu tio n .2 The water supplied* to Waterbury during seven or eight months of the year has been held in storage for a period of from one to several months. But during the late winter and early spring the melting snow greatly increases the contents of the reservoirs, frequently caus ing them to overflow. During such periods it is possible for water which has been in storage only a few days to become part of the city’s water supply.3 Examination of the water supply is made by the State, the samples being collected and supplied by the city water department. From June, 1913, to May 31, 1914, the East Mountain system supply of Waterbury received 12 examinations, the Wigwam Reservoir supply 8, and the Prospect Reservoir 5 examinations. No colon bacilli were found at any examination, and the number of bacteria per cubic centimeter for the entire 25 examinations was under 100 at 13 1 Municipal Register, 1913, Waterbury, Conn., City Engineer’s Report, p. 28. i Rosenau, Milton J. Preventive Medicine and Hygiene, 1917, pp. 881, 882. 8 Since this investigation the city has installed apparatus for treating the water with liquid chlorine during the overflow period, thereby insuring a safe water supply. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis c/A*/r ctrv 14458°—18 (To face page 97.) https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. 97 examinations. In October, 1913, the reading of the East Mountain system was 2,370 bacteria per cubic centimeter, and it was 3,500 in the same month for Wigwam Reservoir and only 480 for Prospect Reservoir. The typhoid-fever record of a city is generally accepted as some indication of the purity of the water supply. In his annual report for 1914 the health officer of Waterbury says: T h e c it y is to b e congratulated u pon th e few cases o f ty p h o id fever occurring during 1914. T here w ere b u t 32 cases reported du ring th e year, as com pared w ith 105 o f the year previous. There was b u t 1 death from th e disease. In no instant [instance] co u ld an y e v id e n ce b e ob ta in ed th at w ou ld lead to th e b e lie f that local con d ition s caused th e disease. A pure water su p p ly and an absen ce of unsanitary places is respon sib le for our freedom from ty p h o id fever. At the time of this inquiry there were 91.78 miles of main water pipe 4 to 36 inches in diameter, with branch pipes running parallel to this on streets where houses were supplied with city water. The main and branch pipes were connected with gates, the houses being supplied from the branch pipes. There were a few private mains, but 106.22 miles or 53.6 per cent of the street length of the city were not supplied with city water. Some thickly populated areas were obliged to depend entirely upon wells for their water supply. These were largely dug wells, with inadequate protection against surface drainage, and were frequently placed in dangerous proximity to stables and privy vaults. Every apartment in the districts specially studied for housing con ditions was supplied with running water. In those parts of the city that were supplied with city water only one house was reported that did not have running water piped into it. In this, a two-story cot tage, the only faucet was in the musty and ill-smelling cellar, with a ceiling so low that it was impossible to stand erect. The occupant of the cottage, the mother of one of the babies scheduled in the infant mortality investigation, reported that the cellar was always flooded in winter. There was a sink without a faucet in her pantry, but as it was not connected with any drain pipe she threw the waste water into the yard. The map showing the distribution of the city water supply brings out clearly the need for extended service, particularly in outlying districts. STREET PAVING. The Waterbury housewife suffered from the condition of the streets, which were a source of mud in wet weather and dust and dirt in dry weather. Of the 198 miles of streets, 180.7 or 91.3 per cent had no paving, 10.5 miles or 5.3 per cent were paved with what is termed “ permanent paving/’ and 6.7 miles or 3.4 per cent with macadam. The street cleaning wa3 done by a corps of men 14458°—18-----7 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y . 98 in white uniforms and the small section of the city possessing paved streets was kept in good condition. The greater part of the city, however, in spite of oiling or sprinkling, suffered from ill-kept roads. In those sections lying on the steep hillsides, snow in winter, elaylike mud in wet weather, and deep ruts partly filled with rocks in dry weather discouraged the residents from unnecessary travel. In some instances the situation works a real hardship, as was illustrated by the cases of families unable to ohain fresh milk for the children be cause of the impassable condition of the hillside roads during the greater portion of the year. SUMMARY AND CONCLUSIONS. The causes of infant mortality are numerous and infinitely com plex, and effort directed along only one or two lines of improvement will not reduce the infant death rate to the minimum attainable. This investigation adds to the evidence that infant deaths are more frequent among the families with insufficient incomes and the accompanying evils, such as insanitary surroundings, improper housing, unsuitable and insufficient food and clothing, lack of proper medical attention, and the necessity of adding to the family income through the employment of the mother. Registration of births.— All cities, particularly those within the registration area, should find their starting place for the reduction of infant mortality in the records of their vital statistics, but this Was not possible in Waterbury. For the period under consideration 331 or 12.5 per cent of all births were found not to be registered. Over one-half of all these unregistered births were of the infants of Lithu anian mothers, the group having the highest infant mortality rate, 207.7. Infant mortality rate.— Of the 2,144 live-born infants upon which this study is based 263 died, giving an infant mortality rate of 122.7. Division of the city into wards shows ward 4 with the highest rate (150.1) and ward 2 with the lowest rate (70.6). These rates, however, are not so significant as those for the various nationality groups. Nationality.— The rate for the component nationality groups was 207.7 for the Lithuanians, 184.6 for the Irish, 109.9 for the Italians, and 97.9 for the native. The high rate for the foreign born suggests that some of the groups of the foreign born did not enjoy equal advantages with the native families. A little less than one-third of the births included in this report were those to native mothers, while slightly more than two-thirds were to the foreign-born group; of the latter the chief groups were the Italian with 651 births, the Lithuanian with 267, and the Irish with 200. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. 99 Medical cause of death.— Gastric and intestinal diseases caused over one-third of all the infant deaths considered. The per cent of deaths from this group of causes is exceedingly high, being 9.2 per cent higher than that for the registration area in 1914. Gastric and intestinal diseases caused one-half the deaths of Lithu anian babies, one-third of those among the Irish, approximately the same proportion among the Italian, and slightly more than one-fourth of the deaths among the other foreign born and among the native. Diseases peculiar to early infancy caused about one-third of the infant deaths, but the per cent of deaths from this group of causes and that from respiratory and epidemic diseases were lower than the corre sponding proportions for the birth-registration area. Stillbirths.— Incomplete registration of stillbirths made analysis of stillbirths for the year under consideration impracticable. But study of all stillbirths resulting from all pregnancies of all mothers inter viewed brought out the fact that the stillbirth rate was highest for the Italians and lowest for the Irish; the rate for the Lithuanians was only about one-half that of the Italians. Attendant at birth.— Physicians attended 95.7 per cent of the births to native mothers and but 52.2 per cent of those to foreignborn mothers. The foreign-born group had 43.4 per cent attended by midwives, but only 3.8 per cent of the native births were so attended. No supervision by public or private authorities was exercised over midwives except that a registered license to practice was required; yet one-third of the births in this study attended by midwives only, were attended by unlicensed practitioners. Feeding.— A large percentage of artificially fed babies was accom panied by a high mortality rate for infants of foreign-born mothers, but the native group maintained a low infant mortality rate in spite of a high percentage of artificial feeding. Although the native group, in accordance with general findings, substituted artificial for maternal feeding earlier than the foreign born, consideration of the nationalities composing the latter group showed the Lithuanians with the highest percentage of early arti ficial feeding. Income.— Waterbury has contributed to the rapidly accumulating evidence which establishes the coincidence of poverty and a high infant mortality rate. For the families in which the fathers earned less than $450 during the year following the birth of the baby, 153 out of every 1,000 babies born alive died before reaching their first birthday. Although the rate decreased as the father’s earnings increased, it did not drop below 100 until these earnings exceeded $850. Nearly one-third (30.6 per cent) of the fathers of infants having foreign-born mothers earned less than $450 during the year under https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 100 IN F A N T M O R T A L IT Y . i; consideration and only 7.4 per cent of them earned $1,050 or more. On the other hand in the native group there were only 5.6 per cent earning less than $450, while 30.4 per cent of them earned $1, 050 or more. In connection with these figures a consideration of the fact that the native families were 'much smaller than the foreign horn brings into prominence the tremendous financial disadvantage under which the foreign-born population lives and labors. Conclusion.— Waterbury’s infant mortality rate of 122.7 is largely the result of deaths from preventable causes; practically all the deaths from gastric and intestinal diseases, a large proportion of the deaths peculiar to early infancy, and many of the deaths from respiratory and epidemic diseases can be prevented. The work of prevention should begin with complete birth registra tion, which involves securing the passage and enforcement of a law requiring more immediate registration of births. In addition a system must be evolved to provide suitable obstetrical care for every mother. Stillbirths and the large number of deaths in the early weeks of life suggest the need for complete prenatal care, involving obstetrical clinics where frequent examinations of the mothers are made during pregnancy, nurses to make prenatal visits, and, equally important, thorough education of the prospective mother in the proper care of herself during pregnancy and at the time of confinement. For those who are unable to pay for proper medical and nursing supervision equally skilled service must be provided at reduced rates or given free. Gastric and intestinal diseases are largely a matter of improper care, primarily in respect to feeding. Obviously, education of the mother is the most effective weapon against a high infant death rate from this group of diseases. Infant-welfare stations where well babies are kept well by means of periodical visits to the station for examination; instruction of the mother by a physician who is a specialist in infant care; public-health nurses who visit the homes to show the mother how to care for the infants, teach home modifica tion of milk, and in other ways direct the mothers how to carry out the physician’s orders— these are the important factors in a program for postnatal or “ well baby” care. For the sick babies of the families unable to afford private medical care there must be dispensaries or clinics presided over b y specialists in the various infants’ diseases. Visits to these clinics should be supplemented by the home-nursing visits, in order to insure execu tion of the physician’s orders. Many difficulties attend the carrying on of such work even after the plans have been perfected and the machinery for executing them https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. 101 has been set in motion. For instance, the Lithuanians and Italians have adhered largely to their native language and customs, 75 per cent of the Italian mothers and 92 per cent of the Lithuanian being unable to speak English. Furthermore, 39 per cent of the foreignborn mothers were illiterate, 53 per cent of the Italians and 62 per cent of the Lithuanians being unable to read or write in any language. Their illiteracy and inability to speak English are great barriers to their instruction in matters of hygiene. Obviously, a great deal of personal work will be necessary if these mothers, who contribute the largest number of children to Waterbury and also the greatest number of prenatal and infant deaths, are to learn how to bear and rear normal children with the minimum of discomfort and injury to themselves. Low earnings of the fathers were accompanied in Waterbury by a high infant mortality rate. Low earnings also had a close relation ship with many of the factors which unite in causing undesirable living conditions. Poverty forces the family to live in the least desirable sections of the city, where lot congestion and room over crowding are most frequent, and where the disrepair of the buildings is a constant menace to the health of the entire family. Waterbury had within its borders several definite plague spots, where almost every type of housing evil could be found, such as dilapidated onefamily frame dwellings, ramshackle tenements in which overcrowd ing existed to a serious extent, alley houses, generally insanitary yards, with infrequent garbage and refuse collections. The problem of room congestion was complicated by the custom of keeping lodgers, nearly one-fourth of the mothers interviewed adding to the family income in this way. A t the time of the inquiry certain conditions generally associated with a high infant mortality rate did not exist in Waterbury, e. g., extensive employment of mothers outside the home, a large negro population, "and a high per cent of illegitimacy. Infant deaths in Waterbury are largely preventable, a fact which should encourage an immediate campaign to reduce the infant mortality rate to a minimum. Such a campaign should recognize two important principles of health work: (1) Specific preventive measures, such as the establishment of infant-welfare stations, will lessen and prevent infant illness as well as infant deaths; (2) general preventive measures such as those under the jurisdiction of the local health department will lessen and prevent sickness and deaths among all classes of the population. Public opinion must be edu cated to demand from all members of the community the cooperative action necessary for the eradication of the conditions which are responsible for the deaths of its youngest members. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX A. INFANT-WELFARE WORK, 1914-1916. - Since the close of the inquiry upon which this report is based the visiting nurses association has increased its work for infants, as shown in the following extracts from the reports of that organiza tion for 1915 and 1916: In Septem ber [1914] i t was d e cid e d to d iv id e the c it y in to seven districts and let each nurse care for all the sick , adults or infants, in her d istrict and as far as possible v isit e v e ry b a b y b o m in it. T h e nam es and addresses of these ba bies are obtain ed from th e birth-registration list at the c ity c le rk ’s office. T h e m others are v isited and advised, and in m any cases are g iv en th e e x ce lle n t pa m ph let, T h e B a b y , furnished b y th e M etropolitan L ife Insurance Co., prin ted in E nglish, Italian, F ren ch , G erm an, Polish, and Y id d is h . T o m ake this w ork am ong b a b ie s m ore effectiv e, m ilk stations in the m ore den sely p op u la ted parts of the c ity are n eed ed . T h e fu n ction of these stations is: T o advise m others in regard to the care and feedin g of infants. T o encourage breast feeding. W here artificial feedin g is necessary, to su p p ly m ilk of good q u a lity, at perhaps a low ered cost to persons u na ble to p a y fu ll m arket value. B y edu ca tion in the p reven tive measures of ch ild h ygien e to p reven t th e diseases o f in fa n cy and ch ild h ood caused and in flu en ced b y errors in diet. T o serve as centers for all w ork relative to the w elfare of infants. Closely follow in g along this lin e of postnatal w ork com es the n eed of prenatal w ork, w h ich is th e care and in stru ction of ex p ecta n t mothers. During the year 1916, 1,999 babies received care. In all, 6,994 visits were paid these babies. The most impoitant preventive work accomplished during this year was the opening of a baby-welfare station in June, 1916, in the heart of the Lithuanian section. Six physicians volunteered their services, so that there was a doctor at the station daily during the summer months. Later it was found necessary to have the doctors present on only two days each week. Every baby brought to the station is weighed and given a thorough physical examination. The mother is instructed in proper feeding of the baby and if such feeding is artificial she buys pasteurized milk on sale at the station. In regard to the work of this station the superintendent says in her report: I t is d e c id e d ly u p h ill w ork, as m a ny superstitions and custom s of th e old cou n try h a v e to b e overcom e b y persuasion and persistence, and it requires endless op tim ism 103 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 104 IN F A N T M O R T A L IT Y . o n the part of the nurse. O u t of 282 babies brought to the station w e h ad 27 deaths, b u t m ost of these deaths occu rred am ong babies brought to us in A d y in g con d ition . I n con n e ctio n w ith th is w ork w e are starting L ittle M others Leagues— classes w here you n g girls, w h o often h a v e th e care of th eir youn ger brothers and sisters, are taught the care o f babies, personal h ygien e, and A m erica n standards o f liv in g, T h ey, understanding E nglish, take th e in form ation h om e to th eir parents, w ho are not always able to grasp w hat is taught th em b y th e nurse on th e s u b je ct of their babies. W e also h op e so to rouse th e interest of these w om en that w e can form m others’ classes. T h e urgent n eed of m ore stations throughout th e c it y can n ot b e too strongly stated. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX B. SELECTED DISTRICTS IN INTENSIVE HOUSING STUDY. District I.— Each district was so far as possible a unit in type of housing. District I was perhaps the most homogeneous. It consisted of French, Anne, and Gilbert Streets, which cross each other, forming a small, swastika-like knot wherein existed a type of housing distinct from that of the prosperous neighborhood by which it was surrounded. In this district the houses were small, old, dilapidated, and uni formly of frame construction. Of the 24 houses, 15 were two, and 9 were three stories high. Fourteen of the 24 were one or two family cottages and only two contained as many as six apartments. With the exception of three one-family cottages occupied by their owners, who kept them in fair condition, and one newer two-family cottage, all the houses, at the time the investigation was made, were in poor repair and several of them were in a state of utter dilapi dation, some sagging as much as 6 inches along an entire side. In several instances both inside and outside stairways were so broken and worn as to be dangerous. The plaster on walls and ceilings was almost uniformly broken and dirty; floors were warped and sagging; the partition walls, ceilings, and floors were so thin and worn that in a number of cases water poured through the ceiling of the first floor apartment when the floor above was scrubbed, and in several cases the roofs leaked copiously in rainy weather. In a very large number of cases the plumbing was seriously out of order, as the following instances illustrate: Eight toilets in the district did not flush at all when seen; one, the family reported, had not flushed for two months; in one house on Gilbert Street the toilet in the second-floor apartment leaked through the floor into the sink located just below; in another house on the same street the water leaked through from the second-floor sink to the sink below, and in this house, as in a number of others, the family upstairs was unable to get water when the family downstairs was using it— sometimes “ not enough to get the meals” and often not enough to flush the toilet. In one house water from the sewer had backed up in the tubs to the depth of 3 or 4 inches The dilapidation, of the houses made them a prey not only to damp ness resulting from faulty plumbing but also te dampness from out side, due to their position on the hill. Along French and Gilbert 105 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1G6 IN F A N T M O R T A L IT Y . Streets the land slopes up gradually from West Main to the bend where French Street turns at right angles to itself and runs into Gilbert Street. Here, along the north side of French Street, the land rises abruptly in a hill against which the houses on this side of the street are built. Garbage and rubbish rolled down the side of the hill, collecting in a heap which partly buried the first-story windows. Water drained down the hill into the cellars and firstfloor apartments, resulting in dampness throughout the house; in the cellars the dirt floors were damp even in the driest weather. The streets reflected the disrepair o f the houses. They were as narrow as alleys and along French Street and part of Gilbert and Anne there were no sidewalks, while the roadway was peppered with numerous holes which were transformed into pools in wet weather. In dry weather a thick deposit of dirt blew down the hill, carrying with it the rubbish which was so conspicuous in this entire section. The district was largely Italian, having 32 Italian households, 3 native white, 4 native black, 7 Irish, 2 English, and 1 German family.* District II.— In District II (Railroad Hill) the Lithuanians, Italians, and Irish predominated, the Lithuanians with 46 families forming 36.5 per cent of the total households, the Italians and Irish with 36 and 33 families, respectively, contributing 28.6 and 26.2 per cent. In addition to these there were 7 native white, 2 German, and 2 Polish families. The Irish were the earliest inhabitants of the neighbor hood and had drifted to the lower or south end of the hill, where they lived in one and two family cottages generally owned by the occu pants and kept in much better condition than most of the houses farther north which were rented to Italians and Lithuanians. The houses were of much the same character as those in District I —frame, small, old, and in poor repair. Fifty-one out of the total 56 were one or two stories high, and 38 or 67.9 per cent contained one or two apartments, while only two had as many as six apartments. Aside from 11 cottages owned by Irish families as already described, the houses were in as poor repair as those in District I, with broken stairways and plaster, leaking roofs, and faulty plumbing. In one cottagb where a widow with four children lived rent free because the landlord “ would only have to pull the place down*’ if she moved out, every step in the stairway was broken. Roofs, floors, and ceilings were mildewed and sagging,, threatening instant collapse. In another dilapidated two-room hut the door was entirely gone and a eurtain screen had been put up as a makeshift. Railroad Hill is a long, narrow, slightly winding ridge running north and south between the Naugatuck River on the east and the New York, New Haven & Hartford Railroad tracks on the lower land to the west. The city sewer is laid along the hill for about 1 General Table 43. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. 107 one-quarter of its length from the north, and beyond that is carried along the Naugatuck Valley beside the hill. The sinks and waterclosets in most of the houses at the northern end of the hill drained into this city sewer; but the greater number on the hill were not connected with the sewer, and the waste pipes from the sinks poured the soapy, greasy water into the yard. Here it was sometimes dispersed over the surface, sinking into the ground and making the entire yard damp and muddy, and sometimes was carried in a stream down the hill into the garden or to the swampy land by the river. This situation was the more serious since there were in this district six basement dwellings, one-half of the number found in all the districts canvassed. It was particularly objectionable in such cases as that of the small hut without a door, already described. This was on lower land than the large tenement next door, the drainage from which poured down into the lower yard, making it impossible at times for the occupants of the small cottage to reach their toilet in the yard without wading in sewage to their ankles. The worst feature of the lack of sewer connections is the yard dry privies. During the summer months these privies became especially offensive, the stench often being strong enough to reach a person walking along the street. Only 2 of the privies were in what could be termed fair condition, moderately clean and with comparatively little odor; 6 were filthy and 17 others were in need of immediate cleaning. In 13 instances the compartments had broken through behind and the contents were overflowing down the hillsides. In one particularly offensive case, where 6 families includ ing 32 persons used the same privy vault, the overflow had formed an open pool, which served as both breeding and feeding place for countless flies which covered its surface. One privy was so bad that two families had moved away one after the other and the family which remained used the bushes rather than go near the toilet. On the west side of the hill these toilets drained into the vegetable gardens of the Italian families and on the east side into the river, which is very shallow at this point and used by the children for wading in summer. The hill at its southern end is somewhat farther from the stream, and into the intervening swampy land privies and waste pipes drained. The water stood here in stagnant, evil-smelling pools. An attempt to find out how often the privies were emptied or cleaned was fruitless, as only two families could remember a time when they were emptied. To add to the discomfort the compart ments were generally out of repair and two of the seats were so broken as to prohibit their use. District III.— Like District I, District III showed a similar small, old, dilapidated cottage type of house. District III, including Brown Street and North Elm Street between Water and Cherry, while still https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 108 IN F A N T M O R T A L IT Y . having a fair proportion of houses of this type, is being gradually invaded by the larger brick tenement. In thi^ district 17 out of 31 houses were two stories high, 2 were four stories, and 1 five. Seventeen houses were one or two family cottages while 2 contained five apart ments, 4 contained six, 1 eight, 1 twelve, and 1 thirteen. Italians and Jews predominated in this district, forming 33.6 per cent and 29.9 per cent, respectively, of the total 107 households. Polish followed with 17 families, and native white with 10, while Russian, Lithuanian, German, and Irish totaled 12 families. Six of the houses in this district were found to he in good or fair condition, others being in various degrees of disrepair. Here were the same dirty, broken plaster, warped floors, splintered woodwork, and steep, narrow, broken stairways as in Districts I and II, and in some instances the entrance steps were entirely destroyed. Thirteen houses were noted as particularly damp; in one of these the mother reported that water from the street drained into the cellar where the toilet was located, making it impossible to keep it in a sanitary condition. In one building the tenants reported three cases of tuberculosis, one of pneumonia, and one of bronchial asthma, and an 8-months-old baby in one family was in the hospital with pneumonia at the time the house was visited. In an apartment on the third floor was a 9-year-old boy with incipient tuberculosis and a 17-year-old girl said to be dying of bronchial asthma. In an adjoining apartment on the same floor a baby had recently died from tuberculosis; the husband of the b a b y’s older sister, living in the same apartment of three rooms, was in an advanced stage of tuberculosis and he and his wife slept in one of the small bedrooms. The remainder of the baby’s family, father, mother, and two children, fearing infection, were crowded into the remaining bedroom, containing only 880 cubic feet of air space, although the legal minimum requirement for the four persons was 1,600 cubic feet. This building was new, being only three or four years old, of brick, and in fair repair. It was five stories high, contained 13 families, and seemed fairly well planned as to light and ventilation. The toilet of every apartment in the building opened upon the same shaft, making every family afraid to open the window in the toilet for “ fear” of contagion from the next apartment. District IV.— While the large tenement type of dwelling was present in only three cases in District III it was the rule in District IV, which included Bank Street, beginning just south of the lodging-house, staghotel, and business-house belt, reaching half a block south of Grand Street, south the length of Bank Street, across the river to Washing ton Avenue. Below this the character of the houses changed from the large brick tenement to smaller frame houses in fairly good con https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W A T E R B U R Y , OO N N . 109 dition, with the exception of two large brick buildings on the corner of Bank and Porter Streets, a block farther souths which were in cluded in the study because they were in accordance with the Bank Street type. District IV was the largest district canvassed, having a popula tion of 1,9171 persons of whom 773 or 40.3 per cent were adult mem bers of the families, 592 or 30.9 per cent adult lodgers, 522 or 27.2 per cent children under 12, and 30 for whom no information was secured, proportions corresponding closely to those of the total population of the six districts combined. Italians and Lithuanians predominated in District IV, the Italians having 148 or 52.5 per cent of the total number of households and the Lithuanians, who concentrated in a colony south of the river, having 115 or 40.8 per cent. All other nationalities, native white, Irish, French Canadian, Jewish, English, and Swedish combined, totaled 18 families or 6.4 per cent of the entire number. Bank Street is essentially a business street. It is lined with brick buildings containing dwellings above the stores. Twenty-one of the houses included in this district were two stories, 21 three stories, and 20 were four stories in height. Twenty-one houses contained one or two apartments, 25 had five or more, and 9 had ten or more, 1 having seventeen apartments and 1 eighteen. The special hous ing defect of this district was the large proportion of gloomy and poorly ventilated rooms. This condition inevitably accompanies this prevalence of large block tenements built with a very narrow passage between buildings or none at all. The defect is purely structural and is to be found irrespective of the state of repair. Indeed, on Bank Street a number of tenement houses maintained in fair condi tion contained bedrooms having no windows whatsoever or windows opening only into other rooms or hallways. When combined with bad sanitation and dilapidation this type of building introduces the worst possible housing conditions. Many such buildings were found in the small section of Bank Street known as Wards Flats, just north of the river and just south of the Bank Street factory belt. Here were four buildings, one of 8 tene ments, one of 14, and one of 17, and one a rear 5-family house. In these four buildings lived 230 people. The buildings were very old and dilapidated, with dank, clammy, filthy walls, dark, narrow halls and stairways, and broken woodwork. Plaster was breaking off the walls and ceilings in great pieces. The head of one household said that the pipes had been so rusted and corroded that no water would run, and he had finally secured new pipes at his own expense. The waste pipes from the 17-family tenement drained into the river I General Table 44. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis ilo IN F A N T M O R T A L IT Y . which flows along its side. A number of the toilets were in the last stages of disrepair. One closet was leaking so badly that water stood from two to three inches deep on the floor and one could not enter the compartment. One toilet, used by 2 families including 14 persons, had not flushed for four days and was mil of refuse. An other, badly corroded, flushing inadequately, leaking all over the floor, and fitted with an old broken board for a seat, was built under the stairway, where it was impossible to stand upright. Another ill-smelling toilet with seat and floor broken had been patched by the tenant. The bowl was corroded and it had no chain or any flushing apparatus left, but was the only accommodation for 2 families, including 20 persons. In one apartment a toilet, corroded and flushing inadequately, was not even placed in a separate com partment, but was located in the hallway, shut off from the rest of the apartment by only a curtain stretched in front of it. In the four buildings just described 15 bedrooms had no windows at all or windows opening only into other inadequately ventilated rooms, while 11 had small dark glass windows opening on a covered shaft closed to the outside air. Another flagrant example of uncontrolled housing, diverging from the Bank Street tenement type but compatible with the character of the neighborhood as a business center, was the old frame hotel on the corner of Bank and Meadow Streets, converted into a tenement house.1 This was visited a number of times through a period of five months. At the time of the first visit only 3 families lived here; later it was occupied by 6 families, but at no time was the house fully occupied. The occupied apartments were unfit for habitation. They had sag ging ceilings, broken, filthy plaster and woodwork, and were fitted with thin partitions and faulty, makeshift plumbing. It was, how ever, the condition of the unoccupied apartments and of the toilets which constituted the greatest menace to health. Only two toilets were found which flushed at all and they did not flush adequately. A t the end of each of the two wings on the second floor were toilets not flushing and choked to the top of the bowl. These and the unoc cupied rooms were unlocked and open to the promiscuous use of any tramp or passer-by. As a result the floors of the rooms were vile with refuse of months’ accumulation. Before the end of the investigation much of the filth had been cleaned out of these rooms and many of the doors painted and fastened, but at no time during the 5 months of the investigation in the city were the toilets described either properly cleaned or put in repair. One of the babies scheduled in the infant mortality investigation lived in this house and, because his mother went out to work, was left all day to play about in these unoccupied rooms in the care of two 1 This building has since been razed. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATEBBU RY, CONN. Ill little girls, 8 and 5 years of age. Not only the menace to health of this insanitary condition should be emphasized, but the social danger of giving any vagrant free access to those empty rooms where little girls played unprotected, should be recognized. District V.— District V, which adjoins the northern part of the Bank Street district, extended between Bank, South Main, and Grand Streets and included Canal, Chatfield, two short alleyways known as Rear South Main, and the portion of Meadow Street lying between Bank and South Main. Italians, with 156 families, constituted 97.5 per cent of the total number. There were but 4 other families, 1 Irish, 1 Jewish, and 2 native black. This district was second in size, with a population of 1,268 persons. Of these, 484 or 38.2 per cent were adult lodgers and 357 or 28.2 per cent children under 12 years of age. In this district, containing both the small frame cottage and the larger brick tenement typical of the greater part of Bank Street, were found the bad features common to both types of buildings. The large brick tenement on Bank Street, especially in the more pros perous portion of the Lithuanian colony south of the river, was some times in good repair. In District V it was uniformly old and in very bad repair. In this district also one building was reported which contained 19 apartments and was a modified dumb-bell type. In this four-story building there were 6 apartments on each floor except the first, which had 2 apartments behind the store; and the second, where 2 apartments had been combined to make 1 large apartment for the owner. There were 2 bedrooms on each floor which had no windows whatsoever, but which ventilated over a partition into another bedroom which in turn opened upon a narrow lot line court. Four hall toilets on each floor opened on narrow inadequate shafts and were very offensive. District VI.— Close to District V is Rushton Place, designated District VI, which is very small but contained several interesting features. Here were 7 Polish families, 7 French Canadian, 4 native white, and 1 Irish. Rushton Place is entered from South Main Street by an alleyway just south of Meadow Street. In the center of the place was a large oblong plot of vacant land circled by a narrow dirt road. At one end was a 2-family frame cottage, at the other an 8-family tenement, also frame and almost empty. Facing on the plot along the south side was a long, low, frame, 16-family tenement. The houses were built by the same man, on the same plan, and were old and in very bad repair. The 2-family cottage was in better condition than the other houses and had two toilets inside the house. The 8-family house had two yard closets at each end of the building, one not flushing at all and the other in poor condition. For the 16-family house were four yard closets in a shed with four compartments. These were used https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 112 IN F A N T M O R T A L IT Y . promiscuously by all the occupants of the building amounting, at the time of inspection, when two apartments were empty, to over 100 persons. The toilets were foul. One of the closets did not flush at all and the accumulated filth had overflowed upon the floor. Flush ing in the other three closets was insufficient to carry away the con tents of the bowls and all were leaking so that none of the compart ments could be entered without wetting the feet. These closets in this filthy condition were located just behind the building and only a few feet from the doorsteps where the children played and the family gathered on summer evenings. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IÜTFANT M O RTALITY , 114 GENERAL TABLES. T a b l e 1.—All known issuesa during selected year, infant deaths, infant mortality rate, and per cent of stillbirths and miscarriages, according to nationality of mother and regis tration status of birth. Stillbirths and miscarriages, c Live Infant Registration status of birth and nationality of Total issues. births. deaths. mother. Infant mortality rate.6 Per Num cent of ber. ,ttotal issues. 6 Registered and unregistered. 2,654 2,568 311 121.1 86 3.2 Nativity of mother not reported... Native mothers............................. . Foreign-born mothers.................... 92 882 1,680 90 855 1,623 3 84 224 98.2 138.0 2 27 57 3.1 3.4 723 282 216 411 48 697 273 209 399 78 56 38 47 5 111.9 205.1 181.8 117.8 26 9 7 12 3 3.6 3.2 3.2 2.9 2,323 2,239 259 115.7 84 3.6 6 860 1,457 4 834 1,401 79 180 94.7 128.5 2 26 56 3.0 3.8* 700 111 210 393 43 675 102 203 381 40 71 26 37 46 105.2 254.9 182.3 120.7 25 9 7 12 3 3.6 8.1 3.3 3.1 331 329 52 158.1 2 .6 86 21 222 3 198.2 1 1 .4 Italian......... Lithuanian... Irish............ . Allother___ Not reported Registered Nativity of mother not reported. Native mothers........................... Foreign-born mothers................. Italian......... Lithuanian.. Irish............ Allother___ Not reported Unregistered............................................. .Nativity of mother not reported....................... Native mothers................................................... Foreign-born mothers......................................... Italian.......... Lithuanian.. Irish............ All other___ Not reported 86 22 223 23 171 6 18 5 22 171 6 18 5 44 7 30 1 1 5 1 175.4 1 120 additional records were secured of infants said to have been bom in Waterbury during the selected year. 69 of the 120 proved to be of infants not born during the year and 51 of infants bom outside of Water bury. . 6 Not shown where base is less than 100. c Retailed study confined to live births and to stillbirths that had resulted from 7 or more months’ gestation. a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY, CONN. H 5 T a b l e 2 .—Births' during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to nationality of mother. Stilll)irths. Nationality of mother. All mothers........................ Native mothers___ Foreign-born mothers............. Ita lia n ....................... . Lithuanian............................. Irish.................................. Slavic b ..................; ___ Jewish.......................... German............................... French Canadian........................ English, Scotch, and Welsh c.......... All other d ......................... Total Live Infant births. births. deaths. Infant mortality rate.» Num ber. Per cent of total births.® 2,197 2,144 263 122.7 53 2.4 718 1,479 705 1,439 69 194 97.9 134.8 IS 40 18 2.7 651 267 200 91 61 58 56 40 55 628 260 195 89 60 57 56 40 54 69 54 36 11 3 5 3 8 5 109.9 207.7 184.6 23 7 5 3.5 2. 6 2.5 i i Not shown where base is.less than 100. Including 65 Polish, 20 Russian, 2 Slovak, 2 Bohemian, 1 Serbo-Croatian, and 1 Ruthenian e Including 18 English, 21 Scotch, and 1 Welsh. d Including 29 Scandinavian, 7 English Canadian, 6 French, 5 Magyar, 3 Syrian, 2 Greek 1 Dutch 1 Spanish, and 1 West Indian Black. ’ ’ a b T a b l e 3 .—Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, by ward of residence. Stillbirths. Ward of residence. The city .............................. Ward: 1.................................. 3............................................. 5 ................................................. .......................... 5 .................................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live Infant Total births. births. deaths. Infant mortality rate. Num ber. Per cent of total births. 2,197 2,144 263 122.7 53 2/4 460 336 493 585 323 451 326 482 573 312 63 23 51 86 40 139.7 70.6 105.8 150.1 128.2 9 10 11 12 11 2.0 3.0 2.2 2.1 3.4 116 I N F A N T M O R T A LIT Y . T a b l e 4.—Births during selected year, according to nationality of mother and nativity of father. Nationality of mother and nativity of father. All mothers............................. Births dur ing selected year. 2,197 Mother’s nationality same as father’s 1,911 Both native..................................................... Both ofsameforeign nationality................... Mother’s nationality different from father’s ....... 556 1,355 284 One parent native, other foreign................... 254 Mother native, father foreign..................... Mother foreign, father native..................... 160 94 Mother’s nationality: Irish............................................. English, Scotch, and W elsh___ French Canadian........................ German....................................... Jewish.......................................... Italian......................................... Lithuanian.................................. A llother...................................... Parents of different foreign nationalities Mother’s nationality: English, Scotch, and W elsh............. German....................................... . Irish.............................................— French Canadian.............................. A lloth er............................................ Mother native,father’s nationality not reported https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 31 16 & 12 2 1 1 15 30 8 7 7 1 7 2 WATERBURY, GÖNN 1 1 .7 T a b l e 5 . —Number and per cent distribution of deaths, among infants born in Waterbury during selectedyear and of infant deaths in the registration area in 1914, by cause of death. Infant deaths in— Abridged In ternational List No.» Detailed Interna tional List No.a Waterbury. Cause of death. & Per Num- cent ber. distribution. A ll causes, 24 25 102,103...................... 104............................. 20 . Part of 23___ 22 Part of 3 3 .... 89............................... 91....... ...................... 92............................... 150.......... .................. Part of 33___ 151(1)........................ Part of 33___ }l51(2), 152(2), 153.... Part of 37___ Part of 37___ 152(1)........................ 5 6 7 8 . 9 Part of 12___ Part of 12___ Part of 37___ 13 14.. 15................... Part of 37___ 35... 38... 6................................ 7................................ 8................................ 9 . . ............................. 10.............................. 14.............................. 18........................... ... 24.............................. 28, 29......................... 30.............................. 31,32,33, 34, 35........ 37 I............ 155 to 186.................. 187,188, 189.............. 61............................... 17 . Part of 37___ 71..........................! . . 19................... 79.............................. Gastric and intestinal diseases c . Diseases of the stomach....... Diarrhea and enteritis.......... Respiratory diseases d ................ Acute bronchitis................... B roncho-pneumonia............. Pneumonia............................ Malformations.............................. Early infancy............................... Premature birth................... Congenital debility ............ Injuries at birth.................... Epidemic diseases « .................... Measles.................................. Scarlet fever.......................... Whooping cough................ Diphtheria and croup.......... Influenza................................ Dysentery.............................. Erysipelas.............................. Tetanus.................................. Tuberculosis of the lungs__ Tuberculous meningitis....... Other forms of tuberculosis.. Syphilis.................................. External causes........................... Diseases ill defined or unknown. A ll other causes........................... Meningitis.............................. Convulsions........................... Organic diseases of the heart Other...................................... Registration area. Number. Per cent distribution. 263 100.0 155,075 100.0 • 88 4 84 39 8 23 8 10 83 34 36 13 18 1 33. 5 1.5 31.9 14.8 3.0 8.7 3.0 3.8 31.6 12.9 13.7 4.9 6.8 .4 4 1 2 1.5 .4 .8 2 .8 1 4 .4 1.5 3 1 4 20 3 5 i.i .4 1.5 7.6 1.1 1.9 12 4.6 37,736 2,556 35,180 24,036 3,458 13,653“ 6,925 9,663 52,535 28,270 18,549 5,716 12,714 1,041 204 3,899 977 481 573 740 368 883 1,118 448 1,982 1,926 2,964 13,501 1,659 2,950 596 8,296 24.3 1.6 22.7 15.5 2.2 8.8 4.5 6.2 33.9 18.2 12.0 3.7 8.2 .7 .1 2.5 .6 .3 .4 .5 .2 .6 .7 .3 1.3 1.2 1.9 8.7 1.1 1.9 .4 5.3 a The numbers indicate the classification in the abridged and the detailed lists, respectively, of the Manual of the International List of Causes of Death. b The causes of death included in this list are those used b y the United States Bureau of the Census (see Mortality Statistics, 1914, p. 660) in classifying the deaths of infants under 1 year. They are those causes of death or groups of causes which are most important at this age. The numbers of the detailed and abridged International Lists will facilitate their identification. In order to make discussion of the figures easier, these causes of death have been grouped in 8 main groups. » The term ‘ ‘ gastric and intestinal diseases ” as used in the tables and discussion includes, as above shown, only the diseases of this type which are most important among infants, i. e., diseases of the stomach, diar rhea, and enteritis. It does not include all “ diseases of the digestive system ” as classified under this head ing according to the detailed International List. ¿ “ Respiratory diseases” as used in the tables and discussion similarly includes only those of the respir atory diseases which are most important among infants, i. e., acute bronchitis, broncho-pneumonia, and pneumonia. It does not include all “ diseases of the respiratory system” as classified under this heading according to the detailed International List. e “ Epidemic diseases” as used in the tables and discussion includes only those of this group which are most important amonginf ants. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 118 INFANT MORTALITY. T a b l e 6.— Number and per cent distribution of deaths among infants born during selected year to mothers of specified nativity, and infant mortality rates, by cause of death. Deaths among infants bom during selected year to— All mothers. Native mothers. Foreign-born mothers. Cause of death. Infant Per Infant Per Infant Per Num mor cent Num mor cent Num mor cent ber. tality distri ber. tality distri ber. tality distri rate. bution. rate. bution. rate. bution. A ll causes............................ 263 122. T 100.0 69 97.9 100.0 194 134.8 100.0 Gastric and Intestinal diseases....... Respiratory diseases............ Malformations........................ Early infancy............................ 88 39 10 83 41.0 18.2 4.7 38.7 33.5 14.8 3.8 31.6 18 10 4 23 14.2 5.7 32.6 26.1 14.5 5.8 33.3 70 29 6 60 48. 6 20. 2 4. 2 41.7 1 14.9 31 30.9 Premature birth................... Congenital debility................... Injuries at birth........................ 34 36 13 16.9 16.8 6.1 12.9 13.7 4.9 11 7 5 15.6 9.9 7.1 15.9' 10.1 7.2 23 29 8! 16. 0 20. 2 5.6 il a 14.9 4.J 18 1 4 20 8.4 .A 1.9 9.3 6.8 .4 1.5 7.6 7 9.9 10.1 11 7.6 R7 1 6 1.4 8.5 1.4 8.7 3 14 2* 1 9.7 1’ S 7.2 Epidemic diseases................... External causos............. Diseases ill defined or unknown... A ll other causes.......... T a b l e 7 .—Deaths among infants bom during selected year occurring in specified calendar month, by cause of death. Deaths among infants born during selected year. Epidemic diseases................ External causes.................... Diseases ill defined or unknown.......... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 1 4 20 - 1 1 1 1 5 3 18 i 8 2 3 26 2 1 14 1 1 2 2 1 1 i 7 7 10' — 7 3 2 1 1 — December. 12 1 1 4 2 6 •*** 1 1 5 i3 28 1 4 5 3 2 25 . . 1 1 October. 6 September. 34 36 13 1 9 1 2 1 8 15 3 1 5 -----16 August. Premature birth.......................... Congenital debility........................ Injuries at birth................................. 6 i 8 15 July. 1 8 May. 39 10 83 44 June. Gastric and intestinal diseases................ Respiratory diseases............ Malformations............... ïiârly infancy................ March. 24 April. January. 263 February. Total. All causes.............................. November. 1 Occurring in specified calendar month. Cause of death. — 2 4 2 — ... 1 1 4 WATERBURY, CONN, 119 T a b l e 8.—-Deaths among infants born during selected year occurring in specified month of life, by cause of death. Deaths in specified month of life. 107 gg 1 Under 2 weeks. 28 88 39 10 83 14 7 6 69 8 2 6 64 5 6 34 36 13 34 23 12 34 18 12 5 5 1 2 1 1 2 18 1 4 20 3 1 1 1 2 3 2 1 2 2 7 6 1 2 2 1 1 Congenital debility..................... Epidemic diseases............................ Diseases ill defined or unknown___ All other causes................................. fc3 O •Ö ood © S3 3 18 11 4 10 1 1 2 m À +» d © À H 3 o À > Ci 3 I 3 3 Eleventh. 263 Total deaths. All causes..................... Gastric and intestinal diseases___ __ Respiratory diseases.......................... ; II ; m os || to Cause of death. 1 2 weeks but un| der i month. First. À -*■3 d Ci 3 œ fe E 33 16 16 19 7 13 13 13 4 9 9 4 8 3 3 2 5 5 8 3 3 1 1 7 3 2 2 1 1 8 5 1 2 1 a 1 1 2 U l £ 1 1 1 2 1 &H 1 1 1 1 2 3 T a b l e 9.—Births from all pregnancies, infant deaths, infant mortality rate, and per cent of stillbirths, according to order of pregnancy and age of mother. Stillbirths. Order of pregnancy and age of mother, Infant Total. Live births. births. deaths. Infant mortality rate.® Num ber. Per cent of total births .a All pregnancies, all ages__ 7,772 7,507 987 131.5 265 3:4 Under 20....... ............................... 20 to 24....................................... | 25 to 29.......................................... 30 to 34.......................................... 35 to 39........... ............................ . 40 and over................................... Not reported................................ 539 2,458 2,526 1,466 641 133 9 518 2,368 2,451 1,418 613 131 8 92 300 297 184 87 21 6 177.6 126.7 121.2 129.8 141.9 160.3 21 90 75 48 28 2 1 3.9 3.7 3.0 3.3 4.4 1.5 First pregnancy, all ages.. 2,073 1,994 243 121.9 79 3.8 Und;er 20....................................... 20 to 24.......................................... 25 to 29.......................................... 30 to 34........................................... 35 to 39.......................................... 40 and over................................... Not reported................................ 403 1,084 459 106 18 1 2 388 1,034 446 105 18 1 2 65 121 37 16 3 1 167.5 117.0 83.0 152.4 15 50 13 1 3.7 4.6 2.8 .9 Second pregnancy, all ages 1,595 1,547 174 112.5 48 3.0 Under 20....................................... 20 to 24.......................................... 25 to 29.......................................... 30 to 34.......................................... 35 to 3 9 . . ..................................... 40 and over................................... Notreported........................ v . . . 112 736 549 157 37 2 2 106 718 531 152 37 2 1 20 83 53 16 1 188.7 115.6 99.8 105.3 6 18 18 5 5.4 2.4 3.3 3.2 c Not shown where base is less than 100. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 1 120 IN F A N T M O RTALITY . T a b l e 9.— Births from all pregnancies* infant deaths, infant mortality rate, and per cent of stillbirths, according to order of pregnancy and age of mother—Continued. Stillbirths. Order of pregnancy and age of mother. Infant Live Infant mortalityTotal births. births. deaths. rate. a Num ber. Per cent of total nrths.Œ 128.9 44 3.6 149.2 113.8 100.0 15 16 11 2 3.8 2.9 5.8 Third pregnancy, all ages........ 1,215 1,171 151 Under 20.............................................. 20 to 24........... ..................................... 25 to 29................................................ 30 to 34................................................. 35 to 3 9 :.............................................. 40 and over.......................................... Not reported....................................... 23 397 552 191 45 6 1 23 382 536 180 43 6 1 7 57 61 18 5 2 1 893 870 109 125.3 23 2.6 Under 20.............................................. 20 to 24................................................ 25 to 29........................................... 30 to 34................................................ 35 to 3 9 ............................................... 40 and over......................................... Not reported....................................... 1 173 418 232 63 5 1 1 170 407 227 59 5 1 27 49 22 10 158.8 120.4 96.9 3 11 , 5 4 1.7 2.6 2.2 Fifth pregnancy, all ages........ 646 625 98 156.8 21 3.3 20 to 24.............................................. 25 to 29................................................ 30t o 3 4 ...................... - ..................... 35 to 39.........................- .................... 40 and over......................................... Not reported..................................... 48 295 226 68 g 1 44 288 219 65 8 1 9 41 37 8 2 1 142.4 168.9 4 7 7 3 2.4 3.1 Fourth pregnancy, all ages — 1 Sixth pregnancy, all ages....... 443 426 72 169.0 17 3.8 20 to 24............................................... 25 to 29............................................... 30 to 34............................................... 35 to 39.....................................■'......... 40 and over........................................ Not reported.......... .............. - .......... 17 147 199 73 è 1 17 141 192 70 5 1 2 30 24 15 212.8 125.0 6 7 3 1 4.1 3.5 Seventh pregnancy, all ages -. 331 316 46 145.6 15 4.5 20 to 24................................... - ......... 25 to 29............................................... 30 to 34............................................... 35 to 39............................................... 40 and over........................................ Not reported..................................... 2 69 156 90 13 1 2 66 150 84 13 1 1 14 24 4 2 1 160.0 3 6 6 3.8 218 211 33 156.4 7 3.2 i 23 lo i 74 19 1 22 98 72 18 6 13 10 4 1 3 2 1 3.0 147 142 28 5 3.4 7 60 66 14 7 58 63 14 4 10 11 •3 2 3 Eighth pregnancy, all ages. . . 20 to 24............................................... 25 to 29...................................... ........ 30 to 34............................................... 35 to 39............................................... 40 and over........................................ Ninth pregnancy, all ages — 25 to 29............................................... 30 to 34............................................... 35 to 39............................................... 40 and over........................................ .: 1 197.2 97 93 14 4 25 to 29....................... ...................... 30 to 34............................................... 35 to 39.............................................. 40 and over..................... ................. 6 26 49 16 6 25 46 16 2 2 8 2 1 3 Eleventh pregnancy, all ages. 49 47 4 2 1 1 25 to 29............................................ 1 8 8 30 to 34............................................. 3 28 26 35 to 39............................................. 12 12 40 and over...................................... a Not shown where base is less than 100. 2 Tenth pregnancy, all ages — https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis im W A T E R B T J R Y , C O tfN , T a b l e 9. —Births from all pregnancies, infant deaths, infant mortality rate, and per cent of stillbirths, according to order of pregnancy and age of mother—'Continued. Stillbirths. Order of pregnancy and age of mother. Total Live Infant births. births. deaths. Infant mortality rate. a Num ber. Twelfth pregnancy, all ages___ 30 to 34.................................................. 35 to 39.................................................. 40 and over........................................... Thirteenth pregnancy, all ages. 30 to 34.................................................. 35 to 39.................1............................... 40 and over........................................... Fourteenth pregnancy, all ages. 30 to 34.................................................. 35 to 39.................................................. 40 and over........................................... Fifteenth pregnancy, all ages... 35 to 39................................................. 40 and over........................................... Sixteenth pregnancy, all ages. . 35 to 39.................................................. 40 and over........................................... Seventeenth pregnancy, all ages 85to>39.................................................. Eighteenth pregnancy, all ages. 40 and over........................................... . Nineteenth pregnancy, all ages.. 40 and over............................................ “ Not shown where base is less than 100. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Per cent of total births.“ 122 IN F A N T M O R T A L IT Y . T a b l e 10.—Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to age of mother at birth of child and nativity. Stillb irths. Age of mother at birth of child and nativity. Infant Live Total births. births. deaths. Infant mortality rate.« Num ber. Per cent of total births.o 2,197 2,144 263 122.7 53 2.4 96 546 658 479 312 105 1 95 534 643 463 304 104 1 12 53 78 -56 44 20 99.3 121.3 121.0 144.7 192.3 1 12 15 16 8 1 2.2 2.3 3.3 2.6 1.0 718 705 69 97.9 13 1.8 53 201 208 132 95 29 53 199 203 131 91 28 6 13 27 13 6 4 65.3 133. 0 99.2 2 5 1 4 1 1.0 2.4 .8 Foreign-born mothers..................................... 1,479 1,439 194 134.8 40 2.7 20 to 24........................................................................ 25 to 29....................................................................... 30 to 34........................................................................ 35 to 39................................- ...................................... 43 345 450 347 217 42 335 440 332 213 76 1 6 40 51 43 38 16 119.4 115.9 129.5 178.4 1 10 10 15 4 2.9 2.2 4.3 1.8 All mothers...................................................... 20 to 24................................... .................................... 25 to 29........................................................................ 30 to 34........................................................................ 40 and over................................................................. Native mothers............................... . ............... 20 to 24........................................................................ 30 to 34 ...................................................................... 1 a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where hase is less than 100 " W A T E R .B U R Y , C O N N . 123 T a b l e 11. —Mothers reporting specified number of stillbirths, all pregnancies, by number of births and nativity.a Number of mothers. Births to mother and nativity of mother. Reporting specified number of stillbirths. Total. None. All mothers....... ....... Births: 1.................................... 2................................... 3 .................. 4 5 6 428 335 270 206 132 ............ ...... ........... ...... 7 .................. 8 ................. 9.................................... 10.................................... 11.................................... 12.................................... 1 3 ................................. 14............................... 16.................................... 18................................... 100 76 47 38 14 14 3 1 1 1 ■ Native mothers. . . . . . Births: 1.................................... 2.................................... 3 ....................... ........... 4................................... 5 . : ................................ 6.................................... 7 .................. 8 .................. 9.................................... 10.................................... 11.................................... 12............................. 6 ...... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 137 31 10 3 480 413 309 234 181 113 85 59 41 32 10 10 9 11 23 24 19 15 9 13 3 6 2 2 4 2 10 5 2 3 2 1 1 2 1 1' 2 2 1 1 1 1 3 2 3 8 1 •3 2 5 175 108 54 35 27 13 13 11 7 1 9 1 1 1 1 1 1 109 266 249 223 205 168 101 85 58 36 30 260 238 201 180 146 86 72 46 30 25 9 6 9 20 16 18 12 7 8 3 5 2 2 1 1 Excluding miscarriages. 7 2 1 2 2 1 2 1 1 1 1,305 8 2 2 1 1,451 1 1 1 1 1 6 1 220 3 4 2 223 179 12 12 a 1,971 28 8 2 2 7 .................. 8 .................. 9.................................... 10................................ 11.......................... 12.................................... 13 .................... 14 .................. 16............................. 18.................................... 3 666 65 38 31 15 18 11 Foreign-born mothers 2 701 112 Births: 1.................................... 2............................... 3 .................. 4 .................. 5 .................. 1 1 24 9 1 2 1 8 3 2 3 2 1 1 1 1 1 2 2 1 1 1 1 1 2 1 1 1 124 IN F A N T M O R T A L IT Y . T able 12.— Mothers reporting specified number of miscarriages, all/pregnancies, by number' of 'pregnancies and nativity. Number of mothers. Reporting specified number of miscarriages. Pregnancieso to mother and nativity of mother. Total. None. All mothers..................................................... Pregnancies: 1ft ............................................ Pregnancies: Foreign-horn mothers................. .................. Pregnancies: 1,792 466 410 331 256 207 126 ■ 119 78 57 50 25 15 5 3 3 2 1 1 466 381 288 208 162 88 74 54 28 26 7 8 ................................................... 8 .......................................... 10 11 ................................ .......................... ................................................. ....................................... 4 235 77 34 12 4 29 40 39 32 24 21 11 10 13 10 3 2 1 3 8 10 11 16 7 10 6 3 1 1 1 ' 1 3 3 8 3 5 2 3 2 3 4 2 1 1 1 1 3 3 6 2 4 1 2 2 1 1 2 12 19 12 11 2 5 2 4 2 2 2 1,190 162 225 192 161 132 66 64 40 21 21 7 6 17 21 27 21 22 16 9 6 11 8 1 2 1 213 168 118 66 43 28 17 19 16 8 3 4 1 213 1,451 96 47 30 22 10 14 7 5 5 1 1 _____ 2 1 1 22 a-Including miscarriages. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 73 602 190 164 98 102 59 41 42 22 11 4 3 3 2 1 1 2 1 1 704 253 242 fi ‘ 14 2,155 8 1 4 2 1 1 1 1 1 2 55 30 10 3 2 8 7 15 5 8 5 2 1 1 1 3 3 7 2 4 2 3 2 3 2 2 1 1 1 1 1 1 !......... 1 1 3 1 1 1 1 1 « W ATERBTJRY, CO N N . 125 T a b l e 13 .—Births during selected year to mothers of specified nativity, according to usual help in household. Births during selected year to— Usual help in household. All mothers. Total................................................ No hired help................................. Laundress or other partial help..................... Servant kept............................ Mother boards........................................... Not reported...................................... Native mothers. Foreignbom mothers. 2,197 718 1,479 1,740 371 71 9 6 456 201 55 3 3 1,284 170 16 6 3 T a b l e 14.—Births during selected year to mothers gainfully employed in specified way during year before birth of infant, according to length of interval between mother's ceasing work and confinement, and nationality of mother. Births during selected year. To mothers gainfully employed during year preceding birth of infant. v. Interval between mother’s ceasing work and confinement, and nationality of mother. At home. Total All mothers.............................. Away from home. Total In factories. In cleri As Keeping Other cal home sales All lodgers. work. occu other. All women. Metal. other. p a tions. 2,197 716 519 39 95 15 7 5 36 Gainfully employed................ 716 Interval: Under 2 weeks............................ 522 2 weeks, under 1 month............. 11 1 month, under 3........................ 37 3 months, under 9 ....................... 118 9 months or more........................ 24 Not reported............................... 4 Not gainfully employed.......................... 1,480 716 519 39 95 15 7 ~ 5~ 36 522 11 37 118 24 4 485 9 6 15 1 3 25 2 3 3 5 i 5 2 17 66 12 10 0 Native mothers.......... .................... 718 123 58 13 30 3 7 i ii Gainfully employed................... Interval: Under 2 weeks............................. 2 weeks, under 1 month............. 1 month, under 3 ........................ 3 months, under 9....................... 9 months or more..................... Not reported............................ Not gainfully employed............. 123 123 68 13 30 3 7 i a 56 2 13 40 11 1 594 56 2 13 40 11 1 47 2 2 5 1 1 7 2 i 3 20 5 2 1 5 1 x Foreign-born mothers.................... 1,479 593 461 26 65 12 i <1 25 593 593 461 26 65 12 4 | 25 466 9 24 78 13 3 886 466 9 24 78 13 3 438 7 4 10 18 2 1 2 2 10 46 7 3 8 1 i 11 Gainfully employed....................... Interval: Under 2 weeks............................. 2 weeks, under 1 month............. 1 month, under 3 ........................ 3 months, under 9....................... 9 months or more........................ Not reported............................... Not gainfully employed........................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 1 1 i 1 1 i 1 U N 126 IN F A N T M O BTALITY . Ik.—Births during selected year to mothers gainfully employed in specified way during year before birth of infant, according to length of interval between mother’s ceasing work and confinement, and nationality of mother—Continued. T able Births during selected year. To mothers gainfully employed during year preceding birth of infant. Interval between mother’ s ceasing_worb: and confinement, and nationality of mother. Total. Total. Italian mothers............ ............ Interval: 2 \V66kbj imdwi 1 Diyiitli.. . . • . . . Lithuanian mothers.............. . Interval: Irish mothers.................................. - 1 A Interval: 200 15 21 4 1 2 243 243 200 15 21 4 1 2 199 5 6 25 6 2 408 199 5 6 25 6 2 188 10 1 1 2 1 1 267 194 154 5 25 8 2 8 2 2 5 1 2 4 2 5 1 3 13 5 1 3 2 ... 194 194 154 5 25 157 7 27 3 73 157 7 27 3 152 1 1 4 i 4 19 200 51 36 6 9 6 9 5 1 2 3 1 51 51 36 34 34 2 2 10 2 1 31 2 105 71 2 10 2 1 149 361 105 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis In factories. In cleriAs cal All Keeping Other sales occu lodgers. home women. other. work. Metal. All pa other. tions. 243 651 2 Interval: Away from home. A t home. 76 2 0 16 2 256 105 2 9 16 2 1 1 3 2 1 6 13 3 71 6 13 3 67 1 1 2 4 1 1 1 2 3 9 12 2 4 1 - 1 4 2 W A T E R B U R Y , CONN, 127 T a b l e 1 5.-~Ali known issues during selected year to mothers of specified nationality, according to hind of attendant at birth, registration status, and inclusion in or exclusion from detailed analysis. Issues during selected year to— Kind o attendant, registration status, and inclusion of birth in or exclu sion from detailed analysis. Foreign-born mothers. Mothers with All Native nativ moth moth Not ity not ers. ers. Total. Italian. Lithu All re re anian. Irish. other. port ported. ed. All births........................... .•.......... 2,654 882 1,680 723 282 216 411 48 92 Physician (at hospital)................... •___ 309 Physician (not at hospital) «................. 1,452 724 Other, none, or not reported................ 169 221 625 30 6 « 85 822 694 79 12 184 490 37 4 113 146 19 30 178 2 6 35 310 4 37 3 5 11 6 84 Registered............................... 2,323 860 1,457 700 111 210 393 43 6 Physician (at hospital).................... 297 Physician (not at hospital)............. 1,413 568 Other, none, or not reported........... 45 212 614 28 6 82 796 540 39 10 177 480 33 4 100 6 i 30 177 2 34 305 V 4 37 3 3 3 1 Unregistered........... ............... 331 22 223 23 171 6 18 5- Physician (at hospital)................... Physician (not at"hospital)............. Midwife............................................. 12 39 156 124 9 11 2 3 26 154 40 2 7 10 4 1 13 140 18 5 1 5 4 8 Births included in detailed analysis............................... 2,197 718 1,479 267 200 361 Physician (at hospital)........................ 209 Physician (not at "hospital)................... 1,250 Midwife..................... ' ............................ '669 Other, none, or not reported............ .. 69 153 534 27 4 56 716 642 65 9 162 447 33 3 104 144 16 23 169 2 6 21 281 ■40 10 1,970- 703 1,267 628 102 194 343 Physieian (at hospital)................... 203 Physician (not at "hospital)............. 1,214 Midwife..................... *..................... ■ 516 Other, nono, or not reported........... 37 150 523 26 4 53 691 490 33 7 155 437 29 3 92 6 i 23 168 2 i 20 276 45 2 Registered.............................. 85 2 84 Unregistered......................... 227 15 '212 23 165 6 18 Physieian fat hospital).................... Physician (not at hospital)............. Midwife............................................. Other, none, or not reported........... 6 36 153 32 3 11 1 3 25 152 32 2 7 10 4 12 138 15 1 g 1 5 4 8 Births excluded fr o m de tailed analysis..................... . 457 164 201 72 15 16 50 48 92 Physician (at hospital)......................... Physician (not at hospital)................... Midwife................................................... Other, none, or not reported................. 100 202 55 100 68 91 3 2 29 106" 52 14 3 22 43 4 1 9 2 3 7 9 14 29 4 37 3 5 Registered............................... 353 157 190 72 9 16 ' 50 43 6 Physician (at hospital)................... Physician (not at hospital)............. Midwife............................................. Other, none, or not reported.......... 94 199 52 8 62 91 2 2 29 105 50 6 3 22 43 4 1 8 7 9 14 29 4 37 3 3 Unregistered.......................... 104 7 11 Physician (at hospital)....... ........... Physician (not at hospital)............. Midwife..................... ' ..................... Other, none, or not reported........... 6 3 3 92 6 1 1 2 8 ............ If ' '• 1 1 84 1 6 5 i 2 3 5 83 2 84 ° Including 55 cases attended by both physician and midwife; 2 mothers were native, 27 Italian, 23 Lithu anian, and 3 of other foreign nationality. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 128 IN F A N T M O RTALITY . T a b l e 16 .—All "known issues during selected year, infant deaths, infant mortality rate, s and per cent of stillbirths, according to kind of attendant at birth, registration status, and ' jp ' inclusion in or exclusionfrom detailed analysis. Stillbirths and miscarriages. Kind of attendant, registration status, and inclu sion of birth in or exclusion from detailed analysis. Live Infant Total issues. births. deaths. Infant mortality rate.“ Num ber. Per cent of total issues.“ All births................................................... 2,654 2,568 311 121.1 86 3.2 Physician (at hospital)...................................... Physician (not at nospital) *>.............................. Midwife................................................................ Other, none, or not reported.............................. 309 1,452 724 169 295 1,388 716 169 '43 171 81 16 145.8 123.2 113.1 94.7 14 64 8 4.5 4.4 1.1 Registered......................................... . 2,323 2,239 259 115.7 84 3.6 133.8 121.5 94.6 13 63 8 4.4 4.5 1.4 158.1 2 .6 Physician (at hospital)................................ Physician (not at nospital).......................... Midwife.......................................................... Other, none, or not reported................... 297 1,413 568 45 284 1,350 560 45 38 164 53 4 Unregistered....................................... 331 329 52 Physician (at hospital)..... .......................... Physician (not at hospital).......................... Midwife.......................................................... Other, none, or not reported....................... 12 39 156 124 11 38 156 124 5 7 28 12 179.5 96.8 Births included in detailed analysis. 2,197 2,144 263 122.7 53 2.4 164.3 122.7 113.3 2 44 7 1.0 3.5 1.0 Physician (at hospital)....................................... Physician (not at nospital)......................... . Midwife................................................. ............. Other, none, or not reported.............................. 209 1,250 669 69 207 1,2Q6 662 69 34 148 75 6 1 1 Registered.......................................... 1,970 1,918 222 115.7 52 2.6 Physician (at hospital)................................ Physician (not at hospital).......................... Midwife.......................................................... Other, none, or not reported....................... 203 L 214 516 37 201 1,171 509 37 31 142 47 2 154.2 121.3 92.3 2 43 7 1.0 3.5 1.4 Unregistered....................................... 227 226 41 181.4 1 .4 Physician (at hospital)................................ Physician (not at hospital)......................... Midwife,........................................................ Other, none, or not reported....................... 6 36 ÎJ58 32 6 35 153 32 3 6 28 4 183.0 113.2 33 7.2 126.4 12 20 1 12.0 9.9 1 457 424 48 Physician (at hospital).................................... Physician (not at hospital)............................. Midwife............................................................. Other, none, or not reported.......................... 100 202 55 100 88 182 54 100 9 23 6 10 Registered....................................... 353 321 37 115.3 32 9.1 Physician (at hospital)............................. Physician (not at hospital)...................... Midwife...................................................... Other, none, or not reported.................... 94 199 52 8 83 179 51 8 7 22 6 2 122.9 11 20 1 10.1 104 103 11 106.8 1 1.0 6 3 3 92 5 3 3 92 2 1 Births excluded from detailed analysis. . Unregistered............................. . Physician (at hospital)............ - ............... Physician (not at nospital)...................... Midwife...................................................... Other, none, or not reported.................... 8 100.0 1 .... 1 a Not shown where base is less than 100. &Including 55 cases attended by both physician and midwife—45 live births, 17 infant deaths, and 10 stillbirths. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 129 T a b l e 17.—Births during selected year to mothers of specified nativity, according to hind and duration of help at confinement. Births during selected year to— Kind and duration of help at confinement. All mothers. Native mothers. Foreignborn mothers. Total......................... ..................................................................... 2,197 718 1 479 None, or members of household............................................................ Trained nurse................................................................................ 483 195 76 113 407 Less than 1 week.............................................................................. 1 week but less than 2 ...................................................................... 2 weeks but less than 1 m onth........................................................ 1 month or more............................................................................... 18 59 97 21 ii 29 56 17 7 30 41 4 209 150 59 4 71 125 5 4 3 53 89 4 1 i 18 36 1 3 1,307 377 930 71 408 527 299 2 9 84 203 81 62 324 324 218 2 3 2 i Less than 1 week.............................................................................. 1 week but less than 2 ..................................................................... 2 weeks but less than 1 month........................................................ 1 month or more............................................................................... Not reported................................ .................................................... Less than 1 week................................................................ •............ 1 week but less than 2 .............. ....................................................... 2 weeks but less than 1 month........................................................ 1 month or more............................................................................... 14458°— 18-------9 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y . 130 T a b l e 18.—Live birthsduring »electedyear to all mothers and to mothers who died within one year after birth of infant and infant deaths, according to nativity of mother andr interval between confinement and death of mother. Nativity of mother and interval between confinement and death of mother. Live births. 2,144 Number oi months after confinement: 3 months but less than 4 .............................................................................. Number of months after confinement: Number of ¡months after confinement: https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Infant deaths. 283 1-6 7 10 2 1 1 1 1 6 1 705 69 8 2 4 1 1 1 1 2 1,439 194 8 5 6 1 1 4 i m i WATEEBCEF, <S0JfíK, T able W.-^-Infants born during selected year to mothers of¡specified nativity and surviving at beginning of flue month, mmnber ami per cent of ¿nfmte dying subsequently in first year, and infant deaths in specified month of life, according ;to month <sf Ufe and type offeeding in the month. All mothers. Subsequent infant deaths in— specified rttdiith. 704 09 9.8 31 1,438 194 13.5 78 134 7.4 8 15.4 58 25.7 63 27 2 IS .63 577 16 92 19 33 2 15 19 5.7 12.5 16.3 8 3 19 1,224 36 134 44 101 6 43 44 8.3 16. 7 32.1 1 32 Second month................... 2,035 156 28 673 38 5.6 9 1,362 118 .8.7 Breast exclusively_____________ 1,624 Mixed_________ ___ __ __ _____ 95 Artificial exclusively................... 6 316 88 10 58 3.6 8.3 : 12.1 j 4 2 ' 1,127 j 59 j b 176 i 70 7 541 •6.4 j 18 « 6 4 ; 29 i 4.4 6 1,343 1 99 4.2 8.7 13.« First month_____________ ¡2,1*12 Breast exclusively.................... . . 1,801 Mixed............................................ 52 Artificial exclusively__________ -226 Not fed, -died at ¡once_______ ___ S3 TUrd month____________ 2,007 263 b 128 Breast exclusively....................... cl, 479| «62 Mixed____________________ __ _ ^138 d 2 Artificialexciusdvely__________ 390 54 Fourth month.............. . 1,989 Breast exclusively____________ cl, 336 Mixed........ .................................. 188 | Artificial exclusively................... 465 j 110 -12.3 107 7.7 5 •First year. > F 5> la .3 3 g a 3 % 5.4 ID 497: 18 s 10. 5' 36 ; 3 18.4 •i>13 140 17 5. S' c6 c, 3 é m 1 3 44.7 14 4.1 176! 15 ¡ 3.1 1 c l,032 8.5| 5 658 ! 23* 3.5': .5 1,331 j 214 i 41 ' 3.1 c.S 12 6.4 : 8 57 12.3 8 401 111 2.7 -5.0 ; 207 : i s ; 5.8 3 ¡ 94 4.8 16 653 : 18 3 Breast exclusively______ ______ 1,217 ! 31 Mixed........................................... 249 | 12 Artificial exclusively___________ «507j C'51 2.5 4.8 10.1 4 Fifth month_____ ____ ... 1,973 i ■c 2 clO 2.8 ; 2 cg35] 138 j 258¡ 1,320 366 7 1 1.91 1 67 2 3.0 : 220 ; 9 ; 4.1 2 851 ¡ 182 ; £'287; First year. 4. 7 871 S .5¡ 76 ; 5.8 : 13 4.0 3 1,3071 63 758243 j 306 ; 20 7 36 Eighth month______ __ Breast exclusively................ M ixed.................................... Artificial exclusively.- _______ 1,938 i 59; 3.0 7 ; 647 875 ; 4.7.5 i 588 : 18 8 33 2.1 : 1.7 5.6 2 258 | 2! 1 131 . 3 j 4 258 7i. 1,931 1 52 2.7 732 573 ; «2 6 : 15 730 2.0 1.2 2 4 .8 8 39 2.0 13 642 7 1.1 3 12 ■5 2.1 .7 3.3 5 172 1 187 c 7 ¡283 2 1 4 1.2 .5 1.4 2 Ninth month...................... 1,01« ¡ Breast exclusively....................... M ixed................. ........ ........... . Artificial exclusively__________ 580 677 «661 c22 33 3 646 12 11! 1.9 : 1 1,291! .8 2.3 2.7 11 1.7 ; 4 ; 1,285: 212 2; .0 : 165 * 3 1/8 2 * 269 } ■6 | 2.2 2. 1 617 S 344 330 : 520 j 408 a 357; j 1,276: 408 490 c¡378 4 11 24 Í 2. 8 i ¡3 10 2 £42 14.6 ; cS 2.2 3 .319 . 4 . 1.8 3.0 3 .91 3 ¡ 3. 3 * 8. 1 1 13 240 } ¡8 ; 3.3 * 3 Seventh month.............. 12 eg c3G 3.2 12 i «. 7 -3 45 i 7 .4 ; 5 78 Breast exclusively______ ______ Mixed................................... Artificial exclusively................... 7.4 18.2 24 10 44 2.3 19 6. 2 & 2 11. 9 23.3 »11 39 Sixth m onth...................... 1,957j 15* m 44 £48 Breast exclusively_____________ 1, 077! ¡334 Artificial exclusively....... ............ 546 i 19 650 Pér céfit. 8 u Number. First year. Pet cent. H -p •-f-3 rfl too .s 3 S Specified month. Per cent. e . i Subseqent infant deaths in— . Infant survivors.« s w V Foreign-horn mothers. Subsequent infant deaths in— Specified mohth. J© Month of life and type of feeding. Native .mothers. 4 .8 1 m 2. 6 : 3 2. 9 3 11.8 10 47 ¡3.6 •6 16 5 26 !2.6 1. 5 7.9 2 1 41 3.2 9 13 4 24 2. 5 1.0 6.7 2 1 32 2.5 10 10 2.5 .. 8 4.8 _2 4 cl8 3 6 t c-6 ° I?xeluding 2infants.far whomfeeding was net reported—1 with native mother and 1 with foreign-born mother. , & i>Including 2infants who died ait beginning of month who ¡were.fedin specified wayin preceding month. eIncluding 1 infant who 'died at beginning’of month who wnsied in specified way in preceding month. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis month specified, according to nationality of mother. 132 T a b l e 20 — Number and per cent distribution of infants born during selected year and surviving at end of specified month, by type offeeding during Infants a bom during selected year and surviving at end of— First month. Second month. Third month. Fourth month. Type of feeding and na tionality of mother. Num ber. Native mothers....... For6ign-bom moth ers ......................... 2,035" 100.0 2,007 Per Num cent ber. distri bution. 100.0 1,989 Per Num cent ber. distri bution. 100.0 1,973 Per Per Num Num tent cent ber. distri ber. distri bution. bution. 100.0 100.0 664 100.0 658 569 15 89 84.6 2.2 13.2 493 33 138 74.3 5.0 20.8 446 41 171 1,362 100.0 1,343 100.0 1,331 647 319 91 237 100.0 1,291 1,307 1,320 673 56.2 10.3 33.5 100.0 100.0 74.1 6.8 19.2 100.0 650 365 67 218 399 50 204 1,473 135 381 100.0 55.4 17.1 27.5 61.1 7.7 31.2 653 67.8 6.2 26.0 80.4 4.5 15.1 1,938 Seventh month. Eighth month. Per Num cent ber. distri bution. 1,074 331 533 100.0 100.0 1,614 90 303 100.0 62.0 12.6 25.4 67.5 9.4 23.2 87.2 2.5 10.4 1,957 1,213 247 497 1,331 185 457 1,774 50 211 Sixth month. 1,931 Per Num cent distri ber. bution. Per cent distri bution. 100.0 1,905 100.0 730 570 618 38.1 29. 7 32.2 575 676 654 30.2 35.5 34.3 Per Num cent ber. distri bution. 100.0 Ninth month. 1,918 873 474 584 45.2 24.6 30.2 100.0 646 100.0 642 100.0 639 100.0 49.3 14.1 36.6 258 131 257 39.9 20.3 39.8 212 163 267 33.0 25.4 41.6 170 187 282 26.6 29.3 44.1 100.0 1,285 100.0 1,276 100.0 1,266 100.0 615 343 327 47.9 26.7 25.5 518 407 351 40.6 31.9 27.5 405 489 372 32.0 38.6 29.4 574 100.0 571 100.0 567 100.0 305 171 98 53.1 29.8 17.1 255 209 107 44.7 36,6 18.7 209 240 118 36.9 42.3 20.8 58.5 18.6. 22.9 Artificial exclusively......... 1,205 35 122 88.5 2.6 9.0 1,121 57 165 83.5 4.2 12.3 1,027 94 210 77.2 7.1 15.8 932 135 253 70.6 10.2 19.2 848 180 279 64.9 13.8 21.4 755 240 296 Italian mothers. 596 100.0 592 100.0 '585 100.0 582 100.0 580 100.0 577 Breast exclusively...... Artificial exclusively.. 551 18 27 92.5 3.0 4.5 526 26 40 88.9 4.4 6.8 493 42 50 84.3 . 7.2 8.6 453 61 68 77.8 10.5 11.7 416 84 80 71.7 14.5 13.8 366 123 88 L ith u a n ia n mothers.......... 244 100.0 235 100.0 232 100.0 228 100.0 223 100.0 218 100.0 216 100.0 214 100.0 211 100.0 97 35 86 44.5 16.1 39.5 72 48 96 33.3 22.2 44.4 59 51 104 27.6 23.8 48.6 46 61 104 21.8 28.9 49.3 Breast exclusively...... Artificial exclusively.. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 197 7 40 80.7 2.9 16.4 177 6 52 75.3 2.6 22.1 151 12 69 65.1 5.2 29.7 127 25 76 55.7 11.0 33.3 109 33 81 48.9 14.8 36.3 100.0 63.4 21.3 15.3 ‘ INFANT MORTALITY. All mothers.............. Per Num cent ber. distri bution. Fifth month. Irish mothers. . . 182 100.0 180 100.0 178 100.0 175 100.0 170 100.0 •167 100.0 167 100.0 166 100.0 163 100.0 Breast exclusively...... Mixed........................... Artificial exclusively.. 161 3 18 88.5 1.7 9.9 151 6 23 83.9 3.3 12.8 140 11 27 78.7 6.2 15.2 132 13 30 75.4 7.4 17.1 120 17 33 70.6 10.0 19.4 109 22 36 65.3 13.2 21.6 92 34 41 55.1 20.4 24.6 80 41 45 48.2 24.7 27.1 61 54 48 37.4 33.1 29.5 Other foreignbom mothers.. 340 100.0 336 100.0 336 100.0 335 100.0 334 100.0 329 100.0 328 100.0 . 325 100.0 325 100.0 Breast exclusively...... Mixed............•.............. Artificial exclusively.. 296 7 37 87.1 2.1 10.9 267 19 50 79.5 5.7 14.9 243 29 64 72.3 8.6 19.1 220 36 79 65.7 10.8 23.6 203 46 85 60.8 13.8 25.5 183 60 86 55.6 18.2 26.1 146 90 92 44.5 27.4 28.1 124 106 95 38.2 32.6 29.2 89 134 102 27.4 41.2 31.4 “ Excluding 2 infants for whom feeding was not reported—1 with native mother and 1 with foreign-born mother. WATERBURY, CONN. 133 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis born during selected year and surviving at end of 8, 6, and 9 months whose fathers earned specified amount, and number and per cent of subsequent infant deaths duringfirst year, according to type offeeding throughout specified period and nativity of mother. JL34 T able 21.—Infants Earnings of father. Type of feeding throughout specified period and nativity of mother. Under $450. $450 to $549 $550 to $649 $650 to $849 $850 to $1,049 Subse quent infant deaths. Subse quent infant deaths. Subse quent infant deaths. Subse quent infant deaths. Subse quent infant deaths. CO o m 3 ¡3 to Ö © © to © 9ri a CO to d kd -H o o C O to o •p to 3 W d «a dH H ■p to .§ to © d © A © d a to »a i ©' d k-H ¡25 Pd •p to B CO d «a pH H > > V to © o$-4 »4 © rQ a d fc •4-2 d © © to © PH ’s § ¡3 P © © © Ph 19 9 6.8 4.2 258 192 5 5 10 2 25.0 11.9 3.7 1.3 4 21.1 4.3 24 35 249 132 3 22 92 244 70 to © to © A S 3 ¡25 to d © © © Ph. Subse quent * infant deaths. $ o2 > ’> > > to d -4-3 d «a d $1,050 to $1,249 to rÛ a d 5 +2 S © 1© to Ph §CO -4-3 d c3 *d t© o a il s ¡Zi to d © © to © Ph $1,250 and over. C toO O l> V to d +» d «a d No Not re earn ported. ings. Subse quent infant deaths. ¡25 to d © © to © Ph to c3 © to .3 > Vto to d d CO to 1 d © rQ d •a k-H CQ O a A d to O *a g .3 to to d © d to a* d © rO «a d d m M CO to © rO to 03 'S d m ALL MOTHERS. First 3 months............................. Mixed............... ..................... Artificial exclusively............ Mixed.................I .............. . . first § months.......’.7___-__ Breast exclusively.. . . . __ ,, M ixed.., __ 4 ......... 1,989 110 1 467 1 36 190 26 296 28 1 938 59 1.070 21 1 7 27 177 13 664 24 1,905 26 7 21 7 170 l, I4ä 12 5.5 3.7 2.8 13.7 9.5 3.0 2.0 3.7 7,3 3.6 1.4 1.2 4.1 Li 437 34 7.8 341 21 6.2 6 34 5 14.7 8 14.3 56 422 19 4.5 7 3.0 236 6 1 3,8 30 130 11 7.3 7 1.7 410 132 2 1,5 5 28 5 245 2.0 278 213 3 20 42 269 6.1 9.1 39 27 3 19 92 26? 86 3 19 159 4 8 2 3.0 2.3 2 4 21.1 2 1.3 2 2 5.1 7,4 21 151 18 7.0 7 3.6 1 14.3 4 16.7 6 17.1 9 3.6 2 1.5 1 33.3 2 9,1 4 4.3 4 1.6 1 1.4 1 2 4.8 1.3 2 3.3 375 17 g 268 6 40 5 3 61 370 12 6 207 5 4 39 2 119 5 863 111 2 5 36 ' T 2 211 291 14 4.8 5 208 2.4 4 26 4 15.4 12.5 53 5 9.4 4.9 6 2.1 3.2 283 2 2.9 157 1.3 2 24 10V8 2 8,3 1.? 1ÖÖ 2 2.0 .? 2 1.4 2?9 1.8 81 1 1 4.3 23 2.8 Ï ,9 174 ,6 4.5 3.4 178 130 10 19 19 177 98 8 18 53 177 49 5 1 0.6 17 io l ï 28 18 ï ï 1 5.3 2 5 17 6 l l 6 4 28 15 ï ï 2 2.6 1 1.9 127 1 1 7.7 13 127 87. 5 2 19 21 123 64 2 10.5 1 4.8 1 .8 17 42 122 35 1 3.9 2.3 2.4 18 105 17 70 2 9 16 3 6 7 27 5 2 11 6 16 NATIVE MOTHERS, First 3 months., ..... ................. Mixed................7...... ......... Artificial exclusively.'. . More than one ty p e ............. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 658 445 12 83 118 23 12 6 5 3.5 2; 7 7,2 4.2 33 22 4 7 2 2 3 9 60 41 1 6 12 1 1 16, t 8,3 161 108 2 22 29 5 4 3.1 3.7 1 4.5 148 98 1 18 31 7 1 3 4.7 1.0 16.7 9 10.0 78 11 13 88 8 18 .8 5 3 1 7 1 4 2 -4. 2 1 i ï ï ESTFANT M <ffiTALlTXr. Total infant survivors, a Subse quent infant deaths. First 6 months...................... . Breast exclusively........... Mixed,. #».* «lm..tv*__ Artificial exclusively4i... More than one type m « » First 9 mònthSa.................... Breast exclusively **»*__ Mixed. Artificial exclusively.. . . Mote thaa one ty p e .. . . . 37 . . . . 20 60 26 2 3.3 ii.8 3.1 3 14 37 13 6 28 59 16 1 1 1 4,8 3 21 6 37 1 1 4Ó4 32 319 19 6 30 5 49 8 389 17 224 7 6 26 1 133 9 3*8 6 o 125 5 24 224 4 7.9 6.0 12 4 1.9 1.3 33 12 2 6.1 3 3 4 3.8 2.1 .0 4 17 32 7 2 1 2 2 2.5 .5 4 21 87 43 1 20 23 47 17 1 10 19 22 7 6.5 4.2 4.2 18,7 12.9 3.6 2.3 5.6 10.3 4.5 1.7 1.7 8 10 5.5 1.3 7 4 2.5 1.3 2 1 1.4 i. 3 76 39 5 1 16.7 3.6 1.7 1 4.5 2 3.5 2 1.3 1 6.3 11 26 76 20 4 4 ... 16.7 1 1 4.5 1,1 11 45 .„ .r i 4 Si 4 16 8.1 7 4.6 1 16.7 3 16.7 5 21.7 7 3.7 2 1.9 1 33.3 1 6.3 4.7 3 1.6 3 1 1.9 12 5 5.6 3.1 7 4 3.0 49 33 3 6.1 1 3,0 4 3 8 5 2,2 9.4 3.8 3.9 1 2 4 1 12.5 9.1 2.9 1.2 8 8 47 25 2 25.0 3 17.0 1 2 2 12.5 4.1 1.4 6 16 46 15 . 1 1 12.8 1.2 6 25 4 1 13 1 1 1 1 2 6 1 FOREIGN-BORN MOTHERS. First 3 months..................... Breast exclusively.. . . . . . M ixed... . . . . . . . . . . . . . . . . Artificial exclusively.. . . More than one type. . . . . First fl m o u th s,.... . . . . . ___ B reast exclusively.. . . . . . M ix e d ,.» ..... . . . . . . . . . . . Artificial exclusively.. . . More than one type. * .,. First 9 months...................... Breast exclu sively....... Mixed.......... ................. Artificial exclusively » ... More than one type»*».» a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16,7 16.3 4,4 3.1 3.8 6,8 1.6 1.0 1.8 239 180 3 17 33 232 13? 3 16 78 230 73 3 16 138 17 7 7.1 3:8 5 5 10 2 29.4 15.2 4.3 1.5 4 4 8 2 25.0 5.1 3.5 2.7 4 2 25.0 1.4 198 151 6 18 23 189 106 3 16 64 185 54 2 15 114 2 1.8 3 2 1.53.0 1 .8 4.9 12 7 ... 21 14 1 2.1 ‘Y 3 12 5 5 2 21 11 . . . i 6.3 "Y 5 12 3 Y 5 21 4 ~2 7 "Y 12 Excluding 2 infants for whom feeding was not reported—1 with native mother and 1 with foreign-bom mother. ..... ., . per cent artificiallyfed, according to nationality of mother. 136 T a b l e 22. —Infants born during selected year and surviving at end of 3, 8, and 9 months of age whose fathers earned specified amount, and number and Infants bom during selected year— Whose fathers earned specified amount. Infants living and artificially fed at specified ages and nationality of mother. Total.« Under $450. $450 to $549 $550 to $649 $650 to $849 $850 to $1,049 $1,050 to $1,249 $1,250 and over. No earn ings. Not re ported. ALL MOTHERS. 278 43 437 72 16.5 422 102 24.2 410 126 30.7 15.5 21.9 269 59 267 72 27.0 258 49 19.0 26.5 32.8 375 80 21.3 249 66 244 80 291 59 20.3 370 110 29.7 29.0 363 128 35.3 36.2 283 82 279 101 28.3 37.4 127 36 123 46 122 50 41.0 178 30 16.9 177 52 29.4 42.4 28 8 17 4 23.5 28.6 17 6 35.3 177 75 27 14 16 8 50.0 28 10 35.7 51.9 NATIVE MOTHERS. Infants living at end of 3 months............................. Number artificially fed....................................... Per cent artificially fed....................................... Infants living at end of 6 months............................. Number artificially fed..................................... . Per cent artificially fed....................................... Infants living at end of 9 months............................. Number artificially fed....................................... Per cent artificially fed....................................... 658 171 26.0 36.6 44.1 647 237 33 11 33.3 639 282 33 15 32 16 50.0 25.6 39 10 37 12 32.4 43.3 37 12 60 26 59 29 49.2 32.4 161 41 60 17 28.3 25.5 35.6 41.1 160 57 158 65 148 41 27.7 34.3 143 49 141 58 41.1 78 22 ,28.2 36.8 127 26 20.5 76 28 35.7 76 32 42.1 126 45 126 63 50.0 7 3 5 42.9 5 2 40.0 75.0 7 3 42.9 4 3 6 4 66.7 FOREIGN-BORN MOTHERS. Infants living at end of 3 months.......« ....... . Number artificially fed................................... Per cent artificially fed....................................... Infants living at end of 6 months............................. Number artificially fed........... .»........................ Per cent artificially fed...................................... Infants living at end of 9 months............................. Number artificially fed....................................... Per cent artificially fed.......... , .......................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 15.8 404 61 1,331 210 1,291 296 22.9 1,266 372 29.4 15.1 22.4 29.1 389 87 378 110 13.8 239 33 232 47 20.3 • 16.2 189 '* 40 21.2 230 60 26.1 198 32 27.6 185 51 214 39 18.2 25.2 210 53 205 63 30.7 49 14 143 18 12.6 23.6 31.2 28.6' 140 33 138 43 38.3 39.1 12 4 51 4 7.8 47 18 33.3 51 7 13.7 46 18 . 33.3 51 12 23.5 41.7 12 4 12 5 21 5 23.8 21 7 33.3 21 10 47.6 INFANT MORTALITY. 1,989 Infants living at end of 3 months............................ 381 Number artificially fed. *................................... 19.2 Per cent artificially fed...................................... « ... | 19.2 1,938 Infants living at end of 6 months............................. 533 Number artificially fed....................................... 27.5 Per cent artificially fed....................................... 1,905 Infants living at end of 9 months............................. 654 Number artificially fed....................................... Per cent artificially fed....................................... 34.3 / I ta lia n m o th ers. Infants living at end of 3 months............ Number artificially fed................. Per cent artificially fed...................... Infants living at end of 6 months............ Number artificially fed...................... Per cent artificially fed...................... Infants living at end of 9 months............ Number artificially fed...................... Per cent artificially fed...................... 585 50 8.6 15.3 9.2 577 88 16.0 567 118 20.8 23.3 229 21 225 36 219 51 93 7 128 8 6.3 10.2 127 13 126, 17 13.5 7.5 91 14 15.4 20.2 9.5 63 6 62 10 16.1 89 18 36 2 5.6 19.4 61 13 21.3 27.8 36 7 36 10 14 1 8 1 12.5 25.0 8 2 8 2 25.0 7.1 14.3 14 2 14 9 21.4 8 2 25.0 8 2 25.0 6 2 33.3 6 2 33.3 8 2 25.0 6 2 33.3 L ith u a n ia n m o th ers. 232 69 29.7 39.5 218 86 211 104 49.3 56 16 97 28 28.9 28.6 92 34 37.0 88 39 44.3 32 15 46.9 29 15 51 21 41.2 51.7 50 29 58,0 23 5 21.7 29 17 58.6 39.1 40.9 23 9 22 9 2 1 10 4 40.0 50.0 9 3 33.3 4 2 11 3 27.3 4 4 1 2 1 25.0 50.0 2 1 50.0 50.0 5 1 20.0 2 1 2 2 100.0 5 1 20.0 5 3 60.0 Ir is h m o th ers. Infants living at end of 3 months............ Number artificially fed...................... Per cent artificially fed...................... Infants living at end of 6 months............ Number artificially fed..... ................ Per cent artificially fed...................... Infants living at end of 9 months............ Number artificially fed................... Per cent artificially fed...................... IS. 2 21 6 178 27 167 36 28 6 21. 4 23 8 34 8 163 48 47.8 29.5 10.3 24.0 11.5 25 6 46 8 17.4 26 3 25 6 24.0 23 11 29 3 25 3 12.0 20.5 25 3 12.0 44 9 42 12 28.6 9 2 31 3 3 2 7 66.7 22.2 9.7 9 3 30 5 16.7 29 8 27.6 66.7 7 2 9 4 44.4 3 2 7 33.3 28.6 3 2 W ATERBTJRY, C O X Y . Infants living at end of 3 months............ Number artificially fed...................... Per cent artificially fed...................... Infants living at end of 6 months............ Number artificially fed...................... Per cent artificially fed...................... Infants living at end of 9 months............ Number artificially fed...................... Per cent artificially fed...................... 66.7 O th er fo r e ig n -b o r n m o th ers. Infants living at end of 3 months............ Number artificially fed...................... Per cent artificially fed...................... Infants living at end of 6 months............ Number artificially fed..................... Per cent artificially fed...................... Infants living at end of 9 months............ Number artificially fed...................... Per cent artificially fed...................... a 336 64 19.1 329 86 26.1 50 6 12.0 18.4 325 102 31.4 18.8 20.0 49 9 48 9 44 7 30 6 24.1 29 7 29 8 27.6 15.9 ' 18.6 31.0 43 8 42 13 24.4 30.9 82 20 81 25 80 29 36.3 65 10 15.4 26.6 34.4 64 17 30 11 36.7 28 12 42.9 64 22 11.5 19.2 27 11 40.7 2 1 26 3 26 5 26 6 23.1 50.0 50.0 50.0 7 2 1 7 2 28.6 2 1 7 3 42.9 Excluding 2 infants for whom feeding was not reported—1 with native mother and 1 with foreign-bom mother. Co https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 138 IN F A N T M O R T A L IT Y . T a b l e 2 3 .— In fa n ts b o m d u r in g s e le c te d yea r a n d rea son s f o r an d w ea n ed w a d er 1 yea r o f a ge, b y age w e a n in g . Ago in months at time of weaning. Reason for weaning. 10 ! All reasons_______ . . . ___________ Mother pregnant...................................... Illness of ¡mother............. .................. Infection or other abnormal condition breast................................................... Poor, insufficient, or mo milk .............. — Mother died......... ................ .................. . Mother w-ent to work.............................. Mother’ s judgment................. .......... Doctor’s advice_______ ________ ______ Infant would not nurse........................... Infant’s illness----- ------ --------- ------ ..... Infant taken from mother...... ................ All other«................................................. Not reported.................................... — 740 63 ■89 122 3 5 79 17 365 2 9 58 5 3 3 18 2 4 4 3 ‘ *3* 7 2 5 2 1'8 1 1 24 1 1 *T 19 1 " i* 56 ' 43 43 52 60 40 17 4 4 58 5 74 ' 42 49 15 2 4 1 2 3 5 a Including 1 weaned at visiting nurse’s direction, 1 on account of mother earing for sick child, and 1 mother unable to nurse for reasons not stated. T able 2 4 .— B ir t h s d u r in g s e le c te d yea r in ea ch o c c u p a tio n fa th e r 's ea r n in g s g r o u p , a c c o r d in g to o f fa th e r . Earnings of father. Total births. Under $450 to $450. $549 Occupation ©f father. All occupations......... 2,197 1 Manufacturing and mechanieal industries______ 1,®9 14 I 1 linotypers, and Factory operatives a ...................... O+ihftr Laborers, helpers, and apprenMachinists, millwrights, and Manufacturers,'proprietors, manShoemakers and cobblers (not in Skilled mechanics, building trades Others in manufacturing and T ra d e...--------------. . -------Bankers, brokers, real estate and Retail and wholesale dealers (proprietors, officials,and managers Salesmen and commercial trav- 416 492j 316 286 418 242 206 j 276 ' 1. 4 2 1 22 Compositors, $550 $650 $850 $1,050 $1,250! No Not re to and -earn ported. to* to to $649 j $849 $1,049| $1,249 over. ings. 160 153 2 ! 205 201 1 3 7 1 7’ 188 183 1 4 35 23 7 2 3 110 3 2 8 16 l,'04i 1,013 2 26 353, 351; 1; 1 1 6 22 30 82 '70 1 11 2 2 6 2: 5■ 76 68 2 1 28 . 27 2 2 25 . 24 8 1 1 1 1 1 1 5 5 5 22 2 32 20 1 3 1 1 3 4 4 9 2 1 33 1 17 129 24 29 4 4 2 18 5 4 3 24 4 7 1 2 IS 4 1 ' 6 192 ; 1 26 u 193 ; 135 22 7 2 .7 20 5 6 308 5 236 21 27 22 48 44 10 51 21 .50 15 8 4 6 6 10 6 6 2 22 1 2 7 3 01 5 13 5 14 15 4 25 2 1 16 1 2 u 1 ......... 2 8 1 10 1 5 2 4 41 ___ ___ 7 4 2 1 3 IS Others in trade— ........................ a Excluding persons engaged in work in the factory which as not peculiar to the industry, as clerks, machinists, boilermakers, ete. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis W ATERBURY , CONE. 139 T a b l e 24.—Birtks during selected year in each father's earnings group, according to occupation offather—Contiaued. Earnings o f father. Occupation of father. Total births. Under $450 to $450. $549 Transportation.................... Chauffeurs, teamsters, expressm e n . . . . . . . . ................... ...... . . . Conductors, motormen,and trainm en ....... ........................ ...........: Express, post, telegraph, and telephone employees.......... ............ Laborers................. ..................... Proprietors, officials, and managers........................................... Others in transportation_______ _ Public service____________ Firemen and policemen........... ..... Laborers_____ _______ _____ ____ Officials and inspectors............ ..... Others in public service. . . . . . . . . . Professional and semiproSessional pursuits............. Domestic and personal s e r v ice ,,........ ................. $550 to $649 $650 $850 $1,050 $1,250 No to to to and earn Not re $849 $1,049 $1,249 over. ings. ported. 132 21 25 19 29 18 12 8 1 49 10 9 10 14 4 1 27 2 1 2 $ 7 5 8 26 12 1 4 1 2 1 8 4 5 17 1 3 2 ■4 43 7 2 9 1 18 19 1 6 1 1 2 9 1 ___ 3 4 5 14 4 3 12 2 1 1 2 52 1 4 4 6 7 30 14 12 33 21 4 17- 24 15 2 4 5 $ 5 8 2 1 6 2 1 8 2 1 9 3 2 12 1« 1 3 1 6 1 72 15 3 4 3 10 i 2: 20 3 18 2 Farmers or farm workers......... . Lumbermen and woodchoppers.. 14 1 3 1 2 3 2 No occupation..................... Not reported................... . 18 12 3 2 2 i Clerical occupations (all industries)_____________ 1 Agriculture and forestry___ 57 13 ; i 5 4 1 1 3 1 3 4 6 . ! 4 1 ' 2 118 Barbers.._____ ____ _____ ______ Janitors and elevator operators... Saloon keepers and bartenders. . . Servants........................................ Others in domestic and personal s e r v ice ..................................... ......... 2 10 2 2 2 2 2 ‘ ■ 18 i . X' . J T a b l e 25.-—Number and per cent distribution of births during selected year to mothers of specified nativity, according to earnings offather. Births during selected year to— Earnings of father. All mothers. Number. Per cent distribu tion. Native mothers. Number. Per cent distribu tion. Foreign-born mothers. Number. Per cent distribu tion. All classes.............................. .. 2,197 100.0 718 100.0 1,479 100.0 Under $450........................... $450 to $549.......................................... $550 to $649...................................... $650 to $849.......................................... $850 to $1,049....................................... $1,050 to $1,249.................................... $1,250 and over.................................... No earnings....................................... Not reported....................................... 492 316 286 416 308 135 192 22 30 22.4 14.4 13.1 18.9 14.0 6.1 8.7 1.0 1.4 40 46 65 179 157 81 137 6 7 5.6 6.4 9.1 24.8 21.9 11.3 19.1 .8 1.0 452 270 221 237 151 54 55 16 23 30.6 18.3 14.9 16.0 10.2 3.7 3.7 1.1 1.6 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A LITY , 140 T a b l e 26.—Births during selected year in families of specified number of persons and average number of persons per family, according to earnings of father ana nativity of mother. Births during selected year in— Average num Earnings o f father ber of and n a t iv it y o f mother. per family. tal. All mothers... 4.0 2,197 4.0 4.1 4.0 4.0 3.8 3.9 3.7 3.7 4.9 Under $450....... $450 to $549___ $550 to $649___ $650 to $849___ $850 to $1,049... $1,050 to $1,249. $1,250 and over. No earnings___ Not reported... Native mothers Under $450....... $450 to $549___ $550 to $649___ $650 to $849___ $850 to $1,049... $1,050 to $1,249. $1,250 and over. No earnings___ Not reported... F oreign-born mothers....... 3.5 718 3.4 3.4 3.4 3.8 3.4 3.4 3.4 2.3 3.7 40 46 65 179 157 81 137 6 7 4.2 1,479 4.1 4.2 4.2 4.1 4.4 i 4.6 4.5 4.3 5.3 Under $450....... $450 to $549___ $550 to $649___ $650 to $849___ $850 to $1,049... $1,050 to $1,249. $1,250 and over. No earnings___ Not reported... a b 492 316 286 416 308 135 192 22 30 452 270 221 237 151 54 55 16 23 Families of specified number a of persons. i 2 4 8 9 10 527 355 291 170 120 69 38 19 43 24 23 39 18 8 9 3 3 28 22 15 21 16 12 3 1 2 12 10 13 11 7 3 9 4 6 6 7 9 3 2 4 1 24 18 10 1 2 2 4 2 2 4 2 4 2 2 3 5 6 7 5 582 i 3 1 108 85 69 107 107 42 53 6 5 117 72 68 107 67 34 55 4 3 6 77 48 39 51 32 14 22 4 4 256 202 107 52 31 2 4 6 16 7 6 10 2 2 2 12 5 1 6 1 i 9 8 4 2 325 248 239 139 96 3 i 2 2 i 1 15 17 25 51 69 32 42 3 21 326 14 13 19 51 36 25 41 3 93 44 51 65 45 18 33 3 6 7 29 25 9 28 1 93 103 90 75 41 68 59 38 44 22 44 49 44 33 21 56 56 36 35 27 38 31 20 25 13 8 10 9 9 7 3 5 12 11. 14 3 4 4 2 3 3 6 3 Not re 14 ported.6 1 51 28 28 11 22 8 14 11 12 7 8 5 1 8 1 5 1 2 3 4 6 4 3 7 1 2 1 Excluding infant born during selected year. Including 1 mother, a servant, not living as a member of family. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 1 1 V .'S 'i WATERBTTRY, C O N K Table 141 27.—Births during selected year, infant deaths, infant 'mortality rate, and per cent of stillbirths, according to earnings offather and nativity of mother. Stillb irths. Earnings of father and nativity of mother. Infant Total Live births. births. deaths. Infant mortality rate, a Num ber. Per cent of total births.» All m others......................................... ........... 2,197 2,144 263 122.7 53 2.4 Under $450.............................................................. .. $450 to $549.................................................................. $550 to $649............................................... ................. $650 to $849................................................................. $850 to $1,049............................................................... $1,050 to $1,249............................................................ $1,250 and over........................................................... 477 304 280 407 303 134 190 20 29 73 45 40 48 26 12 13 4 2 153.0 148.0 142.9 117.9 85.8 89.6 68.4 15 12 6 9 5 1 2 2 1 3.0 3.8 2.1 2.2 1.6 .7 1.0 Not reported................... ........................................... 492 316 286 416 308 135 192 22 30 Native mothers............................................... 718 705 69 97.9 13 1.8 40 46 179 157 81 137 6 7 40 45 64 176 152 80 135 6 7 9 8 6' 19 11 4 9 2 1 108.0 72.4 1.7 3.2 66.7 1 1 3 5 1 2 Foreign-born mothers..................................... 1,479 1,439 194 134.8 40 2.7 Under $450.................................................................. $450 to $549...................................... ........................... $550 to $649................................................................. $650 to $849................................................................. $850 to $1,049............................................................... $1,050 to $1,249............................................................ 452 270 221 237 151 54 55 16 23 437 259 216 231 151 54 55 14 22 64 37 34 29 15 8 4 2 1 146.5 142.9 157.4 125.5 99.3 15 11 5 6 3.3 4.1 2.3 2.5 $450 to $549........... $550 to $649...... ................. ........................... ........... $650 to $849................................................................. $850 to $1,049............................................................... $1,050 to $1,249............................................................ $1,250 and 6ver........................................................... a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where base is less than 100. 2 1 1.5 142 IN F A N T M O E T i U I T . T a b l e -28.'— N u m ber and p er cent d istrib u tion -of births during selected pear in each fa th er’s earn in gs g r o u p , according to source o f fa m ily in com e. Earnings of father. Ù . © a, "A ' No earn ings. Pet cent dis tribution. | Number. Per.cedt dis tribution. Per eedt dis tribution. 1 Number. $1,250 $1,0* 1® 1 -andover. $1,249 Per cedt distfibution. B 43 iz; | Number. CD. ,Q Pet cedt distfibution. Pet cent distribution. s . ! % $650 to $849 w ® Number. ©? Pet .cent dis tribution. Pèr cent dis tribution. Number. Source tsf family Income. $550 ito . Under $550. , S a l Total births. Not re port ed. "3 p O *4 c'-S © ¡3 £ ©■** 1 . 1 j AM sources----------- 2,197 1-80.0 808 1®. 0 286 100.0 446 1®. 0308 1®.0 135100.0 192 m e 22100.© 39 109.0 Derived from earnings Pather only wage-Other wage-earners, total earnings........ 1 ,9 * 89.2 762 84.3 259 90.6 379 01.1 267 86.7 116 85.9 •133 69.8 17 77.3 2o S3.8 15 50.0 1 249 56.9 362 44.8 189 59.1 270 64.9 212 68.8 99 73.3 122 63.6 709 ■32.’3 400 49.5 90 51.5 109 26.2 55 17.9 17 12.6 11 10.9 226 27.9 4.9 11.6 14 4.9 $Um7 IU • 138 6.4 49 ■6.1 55 19.3 13 4.5 $850 to $1,040..... 1.0 4 1.4 vii. $1,050 to «1,249.. 1.4 3$ 3 $1,250 and ov er.. ■25 1.1 12 1.5 Not reported...... Earnings supplemented by other income_____ 235 10.7 46 2 m 5.7 27 14 «3.7 34 ¿ .’2 45 10.7 11 14 3.4 27 14 3.4 17 o .5 3.6 8.8 5.5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 0 5.9 6.7 11 5.7 1 4.5 2 1 3.3 9.1 9 30.0 9.4 37 •8.9 41 13.3 19 14.1 59 30.7 3 13.6 3 10.0. 2 9.1 i S~7 1 a 5.7 17 77.3 10 33.3 Less than one-tenth of I per cent, 143 WATEEBUSr, -0030T. T a b l e 2$.—Births during selected year, infant deaths, infant mortality rate, and per ' mat of stillbirths, according to nationality of mother and her employment at home or away from home during year before birth of infant Stillbirths. Live Infant Total births. births. deaths. Employment oi mother during year before birth xAinfant and nationality o f mother. All mothers. Not gainfully em ployed-. Gainfully employed_____ At home..................... Away from ho me----Not reported-............... - . Native mothers. — Foreign-born mothers. Not gainfully employed. Gainfully employed....... At home................... Away from home__ Italian mothers. Lithuanian mothers. Not gainfully employed. Gainfully employed-----At hiome..............— Away from home__ Irish mothers. Gainfully employed— At home................ Away from home.. Other foreign-born mothers-------.. Not gainfully employed. Gainfully employed....... A t home................... Away from home___ a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis of total birtha.® 263 122.7 • 53 2.4 1,180 716 160 103 71 : 32 1M.S i 148.2 j 131.0 . 209.2 32 21 : IS i 5: •2.2 2.9 2.9 3.2 1,448 695. 542 153 1 718 .705 69 97. 9 ! 13 \ 1.8 594 123 21 Ug 1 583 121, 70 < 54 15 7 92.6 : 124.6 11 2 1 1 1.9 1.6 8 1 1,473 1,439 194 134. 8! 40 2.7 886 593 487 106 866 574 472 102 106 88 64 24 122.5 153.3 : 135.6 235.3 21 19 ! 15 4 2.4 3.2 3.1 3.8 «51 : «28- 69 : 109.9 \ 23 3.5 113.4 103.9 98.5 11 12 12 2.7 4.9 5.6’ 28 28 45 24 20 4 267 260 54 207.7 7 2.6 73 194 159 35 72 188 156 32 16 202.1 38 192.3 30 8 — - ............ 1 6 3 3 3.1 1.9 200 195 36 184.6 5 2.5 4 1 2.7 408 243 215 N ot gainfully employed..................................... Gainfully employed-----------------------------------At home....... .............................................. Away from heme...................-.................... Per cent 2,197 . 2,144 558 158 x Not gainfully employed. Gainfully employed-----At home___________ Away from home__ Not reported................... Infant mortality . Num rate.« ber. 397 231 203 149 51 145 50 33 36 14 .25 11 § 5 17:2.4 361 356 35 98.3 5 1.4 .256 251 20 15 39.7 142.9 5 2.0 28 28 1 Not shown where baae Is less than 100. 7 1 IN F A N T M O R T A LITY . 144 T a b l e 30.—Live births during selected year,*infant deaths, and infant mortality rate, according to working status of mother during year following birth of infant and infant's age when mother resumed gainful work away from home. Working status of mother during year following birth of infant. Live births. Survived one year. Infant deaths. Infant mortality rate.» All mothers......................................................................... 2,144 1,881 263 122.7 No gainful work........................................................................... Gainful work................ ............................................................... 1.478 666 1,313 568 165 98 111.6 147.1 Resumed after infant’s death............................................... Resumed during infant’s life................................................ Time of resumption not reported......................................... Work in home*................ .*................... ................................ Resumed after infant’s death......................................... Resumed during infant’s life......................................... Time of resumption not reported.. . ; ........................... Work out of homeT..................*....................... ..................... Resumed after infant’s death......................................... Resumed during infant’s life......................................... Infant’s age“at time of resumption: Less than 1 month................. .......................... 1 month but less than 2.................................... 2 months but less than 3 .................................. 3 months but less than 4 .................................. 4 months but less than 5 .................................. 5 months but less than 0................................ 6 months or older............................................... 42 623 1 593 19 573 1 73 23 50 a 568 521 521 47 47 3 42 55 1 72 19 52 1 26 23 3 7 5 5 22 90.8 1 2 2 6 6 2 6 88.3 121.4 1 5 4 22 1 Not shown where hase is less than 100. T a b l e 31.—-Live births during selected year, infant deaths, and infant mortality rate, according to occupation of mother during yearfollowing birth of infant. Occupation of mother during year following birth of infant. Live births. Infant deaths. Infant mortality rate.« All mothers.................................................................................. . 2,144 263 122.7 Not gainfully employed.................................................. ....................... Gainfully employed........: ...................................................................... 1,478 666 165 98 111.6 147.1 593 544 1 48 73 7 3 14 40 5 35 9 72 64 121 4. Keeping lodgers......................................................................... Home work Irom factory..................................................... .... Other home work....... ............................................................... Away from home.............................................................................. Servants...................................... .............................................. Laundry operatives................................................................... Others in domestic and personal service................................. Factory operatives........"........................................................... Textile.............................................................................. Metal................................................................................. Other occupations.................................................................... a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where base is less than 100. 8 26 2 1 5 15 3 12 3 ILL 6 145 W ATEBBURY, CONN. Table 32.—*Births during selected year in households of specified number of members, according to number of lodgers in family and nationality of mother. » Births during selected year. Number oi lodgers in family and nationality of mother. In households of specified number of members. To tal. 2 3 4 5 6 7 All mothers...................... 2,197 280 362 37? 342 281 .208 No lodgers kept......................... 1,659 Lodgers kept........................ ... 535 I lodger................................ 178 2 lodgers.............................. 164 3 lodgers.............................. ¡9 4 lodgers.............................. 65 5 lodgers.............................. 23 6 lodgers.............................. 17 7 lodgers.............................. 4 8 lodgers.............................. 2 9 lodgers.............................. 1 10 lodgers............................. 2 Not reported.............................. 3 280 324 38 38 292 80 47 33 “>54 88 35 37 16 186 95 29 32 21 13 119 89 10 36 13 20 10 r 9 140 86 54 10 10 14 10 3 7 12 and Not re over. ported. 10 11 107 50 26 23 6 63 44 2 9 8 15 4 5 1 26 24 5 6 5 2 4 2 ii 15 2 1 1 5 1 i 2 1 1 15 8 3 i 1 2 1 1 *” 2 Native mothers............... -18 152 165 144 91 55 34 31 26 7 5 4 4 No lodgers kept___ '.................. Lodgers kept............................. 1 lodger................................ 2 lodgers.............................. 3 lodgers.............................. 4 lodgers.............................. 6 lodgers.............................. Not reported.............................. 660 57 44 10 1 1 1 1 152 155 10 10 124 20 18 2 80 11 7 4 48 7 4 3 32 2 2 28 3 2 22 4 1 1 1 7 5 4 3 Foreign-bom m others... 1,479 1 1 128 197 228 251 226 174 109 81 43 21 19 No lodgers kept......................... Lodgers kept............................. I lodger................................ 2 lodgers.............................. 3 lodgers.............................. 4 lodgers.............................. 5 lodgers.............................. 8 lodgers.............................. 7 lodgers.............................. 8 lodgers.............................. 9 lodgers.............................. 10 lodgers............................. Not reported............................. 999 478 134 154 78 64 23 16 4 2 1 2 2 128 169 28 28 168 60 29 31 174 77 28 33 16 138 88 25 29 21 13 87 87 8 36 13 20 10 58 51 8 10 14 9 3 7 41 40 1 8 7 15 4 4 1 19 ?4 5 6 5 2 4 ? 6 15 2 1 1 6 1 1 ? 1 1 H 8 Italian mothers......... 651 49 76 92 104 104 80 52 42 28 11 12 No lodgers kept.................. Lodgers kept...................... 1 lodger......................... 2 lodgers........................ 3 lodgers....................... 4 lodgers........................ 5 lodgers........ ............... 6 lodgers........................ 7 lodgers....................... 8 lodgers........................ 10 lodgers...................... Not reported.................... 455 195 54 59 40 20 11 5 3 2 1 1 49 69 7 7 78 14 5 9 76 28 13 10 6 64 40 13 14 8 5 44 36 4 17 7 4 4 28 24 5 2 10 3 2 2- 24 18 1 3 5 5 2 1 1 13 15 4 3 4 1 2 1 3 8 ? 1 1 2 7 5 Lithuanian mothers. 267 13 No lodgers kept.................. 1 lodger......................... 2 lodgers........................ 3 lodgers....................... 4 lodgers....................... 5 lodgers........................ 6 lodgers....................... 7 lodgers........................ 14458°—18----- 10 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis a ■ "" 1 i 2 1 1 2 1 1 21 39 47 43 46 26 18 6 90 13 14 7 177 30 7 65 27 35 9 10 1 ....... 1........ 11 28 13 15 18 29 5 15 9 13 30 4 9 9 8 8 38 6 20 i 6 3 4 i 5 4 14 1 5 3 i 8 i ... 16 5 11 6 2 i 2 1 i • 1 1 1 1 i 5 3 5 2 1 3 1 1 2 1 i IN F A N T M O R T A L IT Y . 146 T a b l e 32.—Births during selected year in households of specified numbers of'members, according to number of lodgers in family and nationality of mother—Continued. Births during selected year» Number of lodgers in family and nationality of mother. In households of specified number of members. To tal. 4 5 6 40 33 45 25 19 13 6 34 6 6 27 6 4 2 38 7 21 4 3 i 14 5 2 i 12 1 6 2 3 200 13 No lodgers kept.................. 168 Lodgers kept....................... 32 1 lodger...........................! 20 2 lodgers......................... i 7 3 lodgers....................... 2 4 lodgers....................... 2 10 lodgers.............................. 1 13 Foreign-bom mothersContinued. Irish mothers......... Other foreign-born mothers................... I 361 No lodgers kept. Lodgers kept___ 1 lodger....... 2 lodgers___ 3 lodgers___ 4 lodgers___ 5 lodgers___ 6 lodgers___ 9 lodgers___ Not reported---- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 286 74 30 23 9 7 3 1 1 1 2 8 ^7 9 12 and Not re over. ported. 10 11 1 1 4 1 2 2 i 1 1 1 2 1 53 60 64 55 54 29 18 15 8 4 53 52 8 8 52 12 7 5 42 13 5 6 2 40 14 5 5 4 21 8 2 2 1 3 12 6 2 i i 2 7 8 5 3 1 2 2 2 2 1 2 2 1 1 ........ 1 1 1 i ■• W A T E R B U R Y , GÖ N N . Table 147 33.—Births during selected year infamilies of specified number of persons, according to total family earnings and nationality of mother. Births during selected year in- Total family earnings and nationality of mother. Families of specified number a of persons. ilies. A ll mothers................................. 1 2 I 3 4 5 6 7 8 9 or Not remore ported.6 2,197 5 582 I 527 355 291 170 120 69 68 Under $550............................................. $550 to $649............................................ $650 to $849........................................... $850 to $1,049........................................ $1,050 to $1,249.................................... $1,250 and over......... ............................. No earnings and not reported............... 639 301 446 331 182 247 51 3 i 1 153 70 127 109 54 59 10 153 73 106 83 44 60 8 115 53 65 50 23 41 8 95 50 60 34 20 25 7 58 22 37 22 9 17 5 37 13 27 17 14 9 3 15 12 11 5 7 14 5 6 8 10 11 11 18 4 Native mothers............................. 718 3 256 202 107 52 31 24 18 18 7 Under $550.............................................. $550 to $649.............................................. $650 to $849.......................................... -, $850 to-$l,049.............. ............................ $1,050 to $1,249........................................ $1,250 and over................................... Not reported...................................... 69 58 164 156 99 160 12 2 ' 28 21 54 68 36 i 44 5 21 18 47 39 29 44 4 7 7 25 27 10 31 5 •7 13 7 8 11 1 2 2 12 4 1 10 1 2 8 1 7 2 4 » 5 5 6 1 1 1 2 2 6 2 Foreign-horn mothers............. 1 10 4 3 3 2 3 1,479 2 326 325 248 239 139 96 51 50 3 570 243 282 175 83 87 39 1 132 55 59 44 15 16 4 108 46 40 23 13 10 8 90 43 47 27 12 14 6 56 20 25 18 8 7 5 37 13 19 10 10 4 3 14 10 10 3 2 8 4 5 7 8 9 5 13 3 2 Î 125 49 73 41 18 15 5 Italian mothers...................... 651 1 128 127 114 109 67 47 26 29 3 Under $550................' ..................... $550 to $649....................................... $650 to $849....................................... $850 to $1,049.................................... $1,050 to $1,249.................... v........... $1,250 and over................................. No earnings and not reported......... 339 112 102 ,47 16 20 15 1 70 21 21 8 5 1 2 74 23 14 10 2 4 66 18 17 6 2 1 4 53 19 19 9 1 4 4 36 9 10 6 2 2 2 22 9 9 3 1 2 1 11 7 5 1 4 6 6 4 3 6 i Lithuanian mothers.............. 267 80 65 42 47 12 14 4 3 Under $550....................................... $550 to $649...................................... $650 to $849...................................... $850 to $1,049.................................... $1,050 to-$l,249.................................. $1,250 and over................................. Not reported................................... 116 54 46 21 10 12 8 27 17 23 7 1 4 1 33 11 11 5 2 1 2 18 12 4 4 2 1 1 23 9 5 4 2 2 2 7 3 6 2 2 1 2 1 1 Under $550.............................................. $550 to $649.............................................. $650 to $849.............................................. ^-4850 to $1,049............................... .*........ $1,050 to $1,249........................................ i $1,250 and over.................................. . No earnings and not reported............... 2 2 1 1 1 2 1 Irish mothers.......................... 200 21 50 34 39 23 13 11 Under $550.................................. ;. $550 to $649....................................... $650 to $849...................................... $850 to $1,049.................................... $1,050 to $1,249.................................. $1,250 and over................................. Not reported.................................... 45 30 49 39 18 16 3 3 2 5 8 1 2 10 6 14 13 4 3 12 8 6 4 1 2 1 6 8 12 5 4 4 7 2 6 5 5 1 3 2 2 2 2 3 1 Other foreign-born mothers.. 361 1 97 83 58 44 37 Under $550....................................... $550 to $649....................................... $650 to $849....................................... $850 to $1,049................................... $1,050 to $1,249........ ........................ $1,250 and over................................. No earnings and not reported......... 70 47 85 68 39 39 13 i 25 15 9 15 24 20 18 16 11 7 8 1 8 2 2 12 8 13 9 8 6 2 8 7 11 9 5 4 6 6 9 9 1 3 3 1 2 1 3 1 3 1 22 10 9 4 1 5 4 5 2 1 1 2 1 2 4 1 2 “ Excluding infant born during selected year. fr Including 1 mother, a servant, not living as a member of family. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 9 4 2 1 ........ 2 IN F A N T MORTALITY. 148 T a b l e 34.— Mothers reporting specified number of births resulting from all pregnancies, by nationality of mother. Number of mothers. Reporting specified number of births, all pregnancies.« Nationality of mother. roxai. 7 8 I 9 10 11 12 13 14 16 All mothers............. 2,155 489 428 335 270 206 132 100 76 1 47 38 14 14 3 1 1 1 18 58 8 30 2 12 2 12 3 1 1 1 41 34 20 16 7 4 5 13 14 7 8 3 1 4 2 1 1 1 i___ 5 .... 1 3 3 |___ 4 6 2 1 6 2 1 1 1 2 2 1 1 Foreign-born mothers...... Lithuanian................. 2 4 3 5 6 704 223 179 112 65 38 31 1,451 266 249 223 205 168 101 634 101 263 67 197 19 91 21 59 11 9 57 9 55 English, Scotch, and 40 15 14 88 106 49 32 39 31 17 13 10 16 8 22 9 5 5 10 7 5 15 85 89 37 37 17 6 6 4 75 26 24 12 10 2 8 50 16 12 3 4 2 7 3 6 6 5 1 6 2 2 11 36 4 2 1 2 1 i 18 1 } ifH «Excluding miscarriages. b Including 65 Polish, 20 Russian, 2 Slovak, 2 Bohemian, 1 Serbo-Croatian, and 1 Ruthenian. c Including 18 English, 21 Scotch, and 1 Welsh. ¿Including 24 Swedish, 7 English Canadian, 6 French, 5 Magyar, 3 Danish, 3 Syrian, 2 Greek, 2 Norwe gian, 1 Dutch, 1 Spanish, and 1 West Indian Black. T a b l e 35 .—Births during selected year to foreign-born mothers resident in United States specified number of years, according to nationality of mother. Births during selected year to foreign-born mothers. Resident in United States specified number of years. Nationality of mother. Total. Under 3. 3 to 5 6 to 8 and Not re 9 to 11 12 to 14 15 over. ported. All foreign-born mothers........... 1,479 195 | 272 303 245 166 288 fo Italian................................................... Lithuanian........................................... Irish...................................................... 651 267 200 . 91 61 58 56 40 55 114 I 34 2 21 8 4, 137 75 12 16 12 1.0 3 2 5 137 . 70 22 26 15 11 4 9 9 108 47 37 17 8 6 6 5 11 65 20 43 5 4 8 8 1 12 86 19 82 6 14 ' 18 35 4 2 2 13 1 German................................................. Allotber c ...... .................................... Including 6 Including c Including Spanish, and a 8 I 4 1 65 Polish, 20 Russian, 2 Slovak, 2 Bohemian, 1 Serbo-Croatian, and 1 Ruthenian. 18 English, 21 Scotch, and 1 Welsh. 29 Scandinavian, 7 English Canadian, 6 French, 5 Magyar, 3 Syrian, 2 Greek, 1 Dutch, 1 1 West Indian Black. “S. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis WATERBURY, CONN. 149 T a b l e 36.'—Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to number of tenements in dwelling. Stillbirths. Total Live Infant births. births. deaths. Tenements in dwelling. All dwellings. Infant mortality rate.® Number. Per cent of total births.« 2,197 2,144 263 122.7 53 2.4 220 478 667 176 64 303 27 73 35 10 . 8 75 7 9 7 15 2 14 1 1 5 216 466 650 172 63 296 27 73 33 9 8 70 7 9 7 15 2 14 1 1 5 19 47 67 30 11 44 4 10 6 1 1 11 3 1 4 3 88.0 100.9 103.1 174.4 4 12 17 4 1 7 1.8 2.5 2.5 2.3 Tenements in dwelling: 2 3 ........... 4 ..... 6............. 7 .. 9 .. . 10 . 11............ 12............ 8 13 14 15 16 17 18 20 ! .. .. .. .. .. .. ............. 26................... Not reported. 148.6 2.3 2 1 5 - 1 ■ a Not shown where base is less than 100. T a b l e 37 .—-Birth during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to average number of persons per room. Stillbirths. Persons a per room. Infant Total Live Infant births. births. deaths. mortality rate. 6 Total................... ........... 2,197 2,144 Less than 1......................... 1 but less than 2.....,................. 2 but less than 3.................. 3 but less than 4...................... Not reported................. 827 1,150 206 3 11 812 1,118 201 3 10 a Excluding infant born during selected year. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 101.0 1 1 129.4 Num ber. Per cent of total births.& 53 2.4 15 32 5 1.8 2.8 2.4 6 Not shown where base is less than 100. 150 IN F A N T MORTALITY. T a b l e 38.— Births during selected year in dwellings of specified number of rooms, according to number of persons to dwelling and nativity of mother. Births during selected year. In dwellings of specified number of rooms. Persons a to dwelling and nativity of mother Total. | All mothers........................ 2,197 Persons to dwelling: 4.............................................. 5.............................................. 362 372 342 281 208 140 107 3 4 5 6 7 8 9 10 11 25 298 796 681 236 64 48 21 11 2 11 49 63 69 63 27 18 8 1 95 97 136 106 117 120 130 91 87 119 66 85 38 55 47 '32 16 12 8 10 1 6 1 2 1 26 5 30 11 5 9 39 25 9 11 6 29 12 3 7 25 4 3 27 14 51 4 6 3 11 1 1 5 4 2 5 1 3 4 3 2 1 4 1 1 2 3 2 1 2 1 4 36 164 290 125 39 28 15 8 1 4 4 14 7 8 4 2 47 48 27 15 12 3 4 5 1 2 70 64 37 18 14 7 12 3 21 23 29 13 12 10 12 3 1 9 7 6 5 4 4 3 4 5 7 5 2 2 1 3 3 3 1 1 4 1 1 1 1 1 2 1 1 5 3 1 26 6 Native mothers.................. 718 Persons to dwelling: 6.............................................. 165 144 91 55 34 " i 26 7 5 4 Foreign-born mothers....... 1,479 2 i 1 2 8 1 1 1 1 1 1 1 1 3 2 i 5 3 1 .........../ 1 1 2 2 3 1 21 262 632 391 111 25 20 3 6 1 3 1 1 5 1 1 1 1 j Persons to dwelling: 7 4............................................ 12 or more............................ 197 228 251 226 174 109 81 43 21 £r\. 19 2 5 3 1 I 1 1 1• 1 35 56 88 90 61 59 115 25 107 82 18 7 51 1 f 27 1 11 8 1 2 31 36 56 54 69 52 31 35 13 8 6 1 2 7 2 10 12 3 ■4 1 17 ■ 7 1 3 15 15 _ 1 4 2 ii 5 ii 3 i 1 3 2 2 5 \ a Excluding infant born during selected year. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not re 12 1 16 ported. 2 i 1 2 i 1 __ 1 2 1 1 2 .... 1 1 W ATERBURY, CONN. 'T a b l e 39, 151 •Births during selected year in each ward of residence, according to sanitary condition of dwelling. Ward of residence. Sanitary condition of dwelling. Total. births. 1 Total dwellings a ...................... Water supply: . City................................................................... Spring............................ Well or cistern................... Not reported................. Type of toilet: Water-closet.................. Privy........................... No toilet........................... Not reported.......................... Location of toilet: In dwelling.................. Not in dwelling............... No toilet......................... Not reported...................... Sewer connection: f Sink connected............... Sink not connected.............. Not reported............................. Toilet connected..................... Toilet not connected........... Not reported...................... 3 2 4 5 2 1Q7 ’ 37 123 5 1 2 23 1 2 1 1 574 *619 1 3 1 1,884 309 4 1,854 338 406 52 404 54 i 62 i . '^ B r ,^f1S ^ i^ eans^ i j Ce w hlchfamily lived during greater part of year following birth of infant, or, in case of stillborn child, where mother spent the greater part of her pregnancy period. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M O R T A L IT Y . 152 Table Ad.—Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to tenure and rental of home and nativity of mother. Stillbirths. Tenure and rental of home and nativity of mother. Infant mortality rate.a Num ber. 263 122.7 53 24 91.6 100.9 2,144 2,197 All mothers. Home owned........................................ . B y infant’s family................................. B y other family in infant’s household. Home not owned.......................................... Monthly rental: Under $ 5 ...,................................... $5 but less than $10......................... $10 but less than $15....................... $15 but less than $20....................... $20 but less than $25— . . . . . . . 1... $25 but less than $35....................... $35 but less than $50............... , — $50 or over....................................... Free............. .................................. Not reported................, ................ Boarding...................................................... . Not reported........................... ........... ......... Native mothers. Home owned................................................. B y infant’s family................................. B y other family in infant’s household. Home not owned............. ................- ......... Monthly rental: $5 but less than $10......................... $10 but less than $15....................... $15 but less than $20....................... $20 but less than $25....................... $25 but less than $35...................... . $35 but less than $50....................... $50 or over.................................... . Free................................................ Not reported.................................. Not reported................................................ Foreign-bom mothers. Home owned................................................. By infant’s family................................. B y other family in infant’s household. Home not owned.......................................... Monthly rental: Under $5.......................................... $5 but less than $10......................... $10 but less than $15.................» ... $15 but less than $20.................... $20 but less than $25....................... $25 but less than $35....................... $35 but less than $50....................... Free................................................. Not reported................................... Boarding....................................................... a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live Infant Total births. births. deaths. 265 221 44 ,924 262 218 44 1,875 2 440 972 359 58 45 14 2 428 947 348 58 44 14 1 2 31 6 22 2 2.5 237 75 115 34 5 175.2 121.4 97.7 1 2 2 705 97. < 108 79 29 608 107 78 29 596 74.8 1 202 .9 2.0 * 105.3 94.1 1.3 3.3 134. i 2.7 103.2 114.3 1.3 1.4 35 36 10 1 1 16 2 2 1,439 157 142 15 1,316 155 140 15 1,279 2 2 372 741 150 23 • 8 4 361 719 146 23 15 15 6 13 102.3 67 228 1,479 1 3.1 31 5 2 1 16 2.6 2 718 231 209 35 37 10 2.7 194 176 8 4 1 Not shown where base is less than 100. 137.6 182.8 126.6 102.7 37 2.8 3.0 3.0 2.7 W A T E R B U R Y , CONN, 153 T a b l e 41.—Buildings in selected districts, by number of apartments in building. Buildings in— Apartments in building. District. All districts. I All classes 211 II III IV V VI 24 56 31 62 35 .3 5 9 7 1 12 26 9 5 2 2 8 9 2 3 2 4 3 8 13 9 7 7 6 12 5 9 2 4 1 Apartments: 1............ 2............ 3 . 4 . 5 . 6 . 2 8 or over___ a 8 7 2 a Including one building in which three apartments were used as one. In other tables this has been entered as a single household. T a b l e 42. —Apartments in selected districts, by number of rooms in apartment. Apartments in— Booms in apartment. District. All districts. All classes....... 811 Booms in apartment: 1.................. 2 .................. 3 ... 4 ......... 5 ............................................................ 6 ...... 7.................. 8 . ........................... 9 or over.............. Not reported............. Vacant....... .............. 60 II III IV 133 111 304 1 1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 177 30 153 27# 164 69 28 14 7 68 a VI Three apartments combined and used as one. 17 26 154 IN F A N T MORTALITY. T a b l e 43.— Households in selected districts, according to nationality and color of head of household. Households in— Distriet. Nationality and color of head of household. All districts. A ll nationalities........................................................ N a tiv e ............................................................................... - ....................................... Foreign-horn....................................................................... 3 I II 49 126 III IV V 107 282 160 19 7 T nT ~~ 3 2 4 3 4 7 10 709 42 119 97 278 158 408 165 50 26 35 25 32 36 46 33 2 36 4 1 17 32 7 148 115 7 156 2 6 1 743 33~ 27 6 7 3 2 3 4 2 15 1 1 7 7 1 1 a VI Including 11 French Canadian, 5 Russian, 5 German, 3 English, and 1 Swedish. T a b l e 44.—Persons in selected districts, according to family status. Persons in— District. -Family status. All districts. A ll classes.................................................................. III IV V VI I II 5,043 351 765 632 1,917 1,268 110 2,060 1,478 1,475 30 128 133 90 388 126 251 294 128 210 427 484 357 50 15 45 773 592 522 30 T a b l e 45.— Total monthly minimum and maximum rental and average 'per room and per apartment, by number of rooms in apartment—selected districts £ Monthly rental. Rooms per apartment. Number of apart ments. Average per— Minimum. Maximum. Room. 1 24 141 259 149 59 17 10 3 1 $4.00 3.00 4.00 6.00 7.00 8.00 10.00 10.00 14.00 6 26.00 $4.00 8.00 14.00 16.00 20.00 32.00 17.00 20.00 18.00 6 26.00 $4.00 2.85 3.01 2.76 2.70 2.62 1.85 1.88 1.80 Apartment. $4.00 5.70 9.05 11.05 13.50 15.72 12.97 15.00 16.16 ..............j.'. v- Excluding 3 cases of free rent, 54 of owned property, and 90 for which there was no report. 6 Combined rental for 3 apartments used as one. a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis T a b l e 46.— Measured sleeping rooms in selected districts occupied "by specified numbers of children or adults, according to actual cubic contents and fulfillment of legal minimufn requirements.a S le e p in g r o o m s o c c u p i e d T ota l m e a s u red s le e p in g room s. C u b ic c o n t e n t s o f r o o m . rH d d l 3o 3 d 3 2 03 c* • C4 dd d 3 93 o i 3© rH CO +> © -d d © 033 3© CO d 3 d 03 N © c* d Lg 4-» © |NJ / by — >3 3 d d d <N d3© 1 ,300 1 ,4 0 0 a© 03 CO -d 4-> © is '3 ’S 3a Is CO ■; |>d CO i| 3 i «1 C* 1 i © »o rH to s | i 1 03 *2 H © L e g a lly r e q u ir e d c u b i c c o n 300 t e n t s ..................................f e e t . . 1 ,2 1 0 600 800 1 ,000 1 ,1 0 0 1 ,200 31 318 49 7 2 6 1 25 9 14 81 15 10 65 8 lp i 51 4 2 49 5 6 4 2 28 8 2 2 2 14 1 si 46 23 61 1 j j ___ 8 1 16 2 2 3 13 2 12 2 V 1 1 8 900 10 199 29 1 ,500 103 1 ,5 0 0 1 ,6 0 0 1 ,7 0 0 1 ,800 1 ,900 2 ,0 0 0 2 ,0 0 0 8 129 4 18 50 1 69 3 14 1 1 2 1 9 3 5 11 4 C u b ic f e e t : 1 23 300 t o 4 9 9 . . . 600 t o 5 9 9 ................................ 600 t o 7 9 9 ................................ 800 t o 8 9 9 . . . 900 t o 9 9 9 ................................ 50 232 4 161 2 1,000 t o 1,099......................... 155 164 to l ’ l99................... M 00 1,200 t o 1,299.................. 1,300 t o 1,399......... 1,400 to 158 2 2 2 84 1 1 66 1,499......................... 1,500 t o 1 ,5 9 9 .. 1,«nn t o 1,699 44 30 20 1,700 t o 1,799 7 1,800 t o 1,899 - 5 1,900 to 1,999 . 2 000 t o 2,099 2 200 t.n 2 299 2 600 t o 2,699 . 4 2 6 1 1 2 • 1 1 1 2 2 1 1 1 4 1 1 36 5 9 24 2 35 32 3 15 11 3 17 23 1 29 14 4 16 1 3 § 4 9 8 27 12 9 i 10 5 2 2 9 12 3 1 3 3 1 1 “ 2 1 2 6 7 1 16 3 6 9 7 2 4 10 8 3 3 3 8 1 1 T 1 5 3 2 i 1 1 1 l 2 4 l 1 4 1 W ATERBURY, CONN. — A l l c la s s e s ........................ . 500 1 2 % 1 a Rooms to left of black line in distribution table fulfill legal minimum requirements of cubic contents for occupants specified. 155 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis fulfillment of legal minimum requirementsa—Continued. 156 T a b l e 46.— Measured sleeping rooms in selected districts occupied by specified numbers of children or adults, according to actual cubic contents and 2,500 2,600 2,700 2,800 2,800 3,000 .3,000 3,500 1 11 1 2 1 1 6 1 1 7 adults. 2,500 1 6 adults. 2,400 6 3 adults, 4 children. 2,300 9 5 adults. 2,200 13 o3® ....... 1 1 3 3 2 1 1 1 1 2 2 1 2 1 1 1 1 1 1 4 2 2 1 1 1 1 2' 1 1 1 2 1 1 1 1 1 1 1 I— r -7 ““ ---------- 1---------- o Rooms to left of black line in distribution table fulfill legal minimum requirements of cubic contents for occupants specified. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 adults, 5 children. 2 adults, 6 children.' 4 adults, 2 children. 2 adults, 5 children. 3 adults, 3 children. 2,100 •+2»t3 IN F A N T M O RTALITY , Cubic feet : Less than 0................................... 300 to 499. 500 to 599. 600 to 799. 800 to 899. 900 to 999. 1.000 to 1,099. 1,100 to 1,199. 1.200 to 1,299.. 1,300 to 1,399. 1,400 to 1,499.. 1,500 to 1,599.. 1.600 to 1,699. 1,700 to 1,799. 1,800 to 1,899. 1,900 to 1,999.| 2.000 to 2,099.. 2.200 to 2,299. 2.600 to 2,699. 2 adults, 4 children. cubic contents................................................. feet.. All classes. 3 adults, 2 children. Cubic contents of room. 4 adults, 1 child. 1 Sleeping rooms occupied by- 1 157 WATERBTJRY, C O N N . T able jj 47.—Persons and toilets in selected districts, according to spedfied number of persons per toilet and type and location of toilet. Number of persons per toilet. Total. Type and locar tion of toilet. Less than 5. 5 to 9 10 to 14 / 15 to 19 20 to 24 25 and more. Not re ported. Toi Per Toi Per Toi Per Toi Per Toi Per Toi Per Toi Per T oi Per lets. sons. lets. sons. lets. sons. lets. sons. lets. sons. lets. sons. lets. sons. lets. sons. A lltoilets.. Water-closets...... Location: In ball.......... On porch...... 620 5,043 97 304 355 2,496 476 575 4,567 7 90 23 281 16 115 339 2,381 390 2,730 125 1,278 30 218 18 194 12 147 71 231 28 254 1,771 57 55 399h 38 19 126 4 7 52 7 4 33 11 12 1 2 2 8 117 1,350 11 133 106 1,217 o https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 634 447 4S 87 28 454 8 20 6 9 2 130 324 3 94 146 31 53 10 2 8 8 216 43 173 173 8 1 5 7 32 184 5 7 3 83 2 1 2 4 101 2 5 7 216 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis
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