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U S . DEPARTMENT OF LABOR

CHILDREN'S BUREAU
JULIA C. LATHROP, Chief

INFANT MORTALITY
RESULTS OF A FIELD STUDY IN BROCKTON, MASS.
BASED ON BIRTHS IN ONE YEAR

By

MARY V, DEMPSEY

INFANT MORTALITY SERIES No. 8
Bureau Publication No. 37

WASHINGTON
GOVERNMENT PRINTING OFFICE
1919


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Z 9]
I;

CONTENTS.

Letter of transmittal...................................................
In tro d u ctio n ..........................................
Infant mortality rates.....................................................................................................
Description of city ...............................................- ..........................................................
History...............................................................................................
Industrial conditions................
Method of procedure............................................................................
Analysis of findings...................................................................................................................
Infant mortality rate........................................
Age at death.................................................... <......... .............. .........................................
Stillbirths.............................................................
Cause of death......................................................... .*................................................
Diseases peculiar to early infancy......................................................................
Gastric and intestinal diseases—
............................ .......................................
Respiratory diseases............................................................. . . .1 ..........................
Attendant at birth........................................................................... .........................1 . . .
S ex............. ............................................................ t ......... - ................................. ..............
Age of mother.................................................................................
Order of birth...........................................
Feeding............................................................................................. J. . . . . . . . . . . . . . . .
Feeding and mother’s nativity...................................
Feeding and father’s earnings.............................................................................
Feeding and mother’s working status................................................................
N ationality................................- .................................................... - .............. ............ ..
Infant mortality rates by nationality...............................................................
Foreign nationalities..............................................................................
Lithuanians and Poles....................................................................................
Italians......................................
British and Canadians (except French Canadians).......................... ..
Scandinavians........... ........................................
Other nationality groups............ .................. •..............................................
Literacy and ability to speak English.......................................................................
Economic factors;........................
Father’s earnings as an index of economic status.........................................
Distribution of economic groups.........................................................................
Occupation of father................................................................................................
Infant mortality rates according to father’s earnings. . . .............................
No-earnings group................
Conditions favorable to low m ortality rates....................................... ............
Supplementary sources of incom e.....................
Size of fam ily and father’s earnings...................................................................
Father’s earnings and employment of mother................................................
Mother’s earnings— ............
Em ploym ent of mother during year preceding birth of baby
.............
Interval between cessation of work and confinement..................................
Em ploym ent of mother during year following birth of baby......................
3


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CONTENTS.

Analysis of findings— Cpntinued.
Page_
Maternal histories........: ................. . ............................................................................... 39-4
Infant mortality rate..................... .......................................................................„
40
Miscarriages. . . . ........
40
N ativity of mother............... ................. ................ „>..............................................
40
Deaths in early in fan cy................ .............. ........................................................
41
Plural births................................... .................... .............. .................... ..................
44
Order of pregnancy.............................................................. ...................................
44
Age of mother.............................................................................................................
42
Infant mortality rates by number of births to mother........................... ....
42
Ward distributiom ____ 1.................................................
42
Housing......................... ............ ........*..................................................................... ..........
44
Social agencies............................................................................. ..............................................
4g
Civic factors..................................................................................................
54-55
M ilk supply..................................
54
Water supply..................................................... .'............ ..........................................
52
Sewerage system ................ ............ ................................... . . . ............ .......... ' . . .
52
Sewage disposal..................................................$....................................................
53
Surface drainage......................................... ............................. ...............................
54
Garbage collection and disposal....................................................
54
Cleanliness of streets.............................................I................... . ...........................
54
Street and sidewalk paving............. .........................................
55
55
Smoke nuisance............................ .....................1................................... ................
The liquor question in Brockton........... .............. ...............................................................
55
Conclusions....................
55-58
Infant mortality rate.............................
55
N ativity of mother................................................................................
56
Earnings of father..................................................................... . . „...................... ..
56
Employm ent of mother..................... .............. ................ .................. ..................
56
Age and cause of death............. ............................................................................
56
Municipal sanitation...............................................................................................
57
Appendix.....................
59-68
Method of procedure....... ..............................................|........................ .......................59-68
Scope of inquiry.............................................................
59
Infant mortality rate..............................................
60
Exclusions in Brockton...............................
64
Stillbirth rates..................
66
Stillbirths excluded
..................... ................ .....................*.............................
66
Illegitim acy.............................................................................'.................................
67
GENERAL TAB LES.
Table 1. Births during selected year, infant deaths, infant mortality rate, and
per cent of stillbirths, by month of birth.....................................................................
Table 2 . Number and per cent distribution of deaths among infants born in
Brockton during selected year and of infant deaths in the registration area
in 1913, by cause of death................................................. ........................................... ....
Table 3. Deaths of infants bom during selected year occurring in specified
month, by cause of death..................... ............................................................ ...............
Table 4. Deaths of infants born during selected year in each ward of residence,
by cause of death...................................................................... i..........................................
Table 5. Births during selected year in each ward of residence, according to
nationality of mother......................................................... .......................................... . .


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CONTENTS.

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Page.

Table 6. Infants bom 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, ac­
cording to month of life and type of feeding in the m onth.........................................
Table 7. Number and per cent distribution of births during selected year to
gainfully employed mothers of specified nativity, according to earnings of
mother during year following birth of infant..............................................................
Table 8. Births during selected year in each father’s earnings group, according

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to occupation of father.................................................. - ................................................ - Table 9. Number and per cent distribution of-births during selected year in
each father’s earnings group, according to source and amount of fam ily

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75

incom e............................................................................................................................ ..........
Table 10. Live births in fam ilies of specified number of persons, according to
earnings of father...................... . .......... - - - - * - - .................. - .......... - .......... - ................
Table 11. Live births during selected year in dwelling of specified number of
rooms, according to number of persons in dw elling.......................................... ..........
Table 12. Births from all pregnancies, infant deaths, infant mortality rate, and
per cent of stillbirths, according to order of pregnancy and age of mother........
Table 13. Births to mothers married specified number of years, stillbirths, and
infant deaths, by number of births to mother............................................ ................
Table 14. Mothers reporting specified number of miscarriages, by number of

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pregnancies to mother.........................................................................................................
Table 15. Mothers reporting specified number of stillbirths, by number of births

81

to mother................................................................................................................... - ............
Table 16. Mothers reporting specified number of infant deaths, by number of

°1

live births to mother....................... ................................................ ...................................


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LETTER OF TRANSMITTAL.
U . S. D

epartm ent of

L

abor,

C h il d r e n ’ s B

ureau

,

Washington, A pril 8, 1918.
S i r : Herewith I transmit a study of infant mortality in the city
of Brockton, Mass., for one year, which constitutes the fifth item in
the series of studies of this subject conducted by the bureau.
Brockton was selected as an example of an industrial city with an
infant mortality rate notably lower than the average rate for the regis­
tration area. It is a city of a single industry, the manufacture of
shoes; skilled operatives are employed at comparatively high wages,
and trade-union conditions prevail.
Acknowledgment should be made of the cooperation given by the
citizens of Brockton in securing information upon which this study
is based. City officials, the press, the pulpit, women’s organizations,
and the shoe workers’ unions aided in making the purpose and
method of the study thoroughly understood. The essential material
was secured by interviewing the mothers of the babies under con­
sideration, and the generous assistance of these mothers alone
made the study possible. No mother refused to give the desired
information.
The field work for this study was directed, and the report was
written, by Miss Mary V. Dempsey. Miss Emma Duke supervised
the tabulation of the statistics. Dr. Robert M. Woodbury wrote the
appendix on method of procedure.
Respectfully submitted.
J u l ia C . L a t h r o p ,

Chief.
Hon.

W .

B. W i l s o n ,
Secretary o f Labor.

7


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INFANT MORTALITY—BROCKTON, MASS.
INTRODUCTION.
Brockton, Mass., was chosen as a unit in the inquiry of the Chil­
dren’s Bureau into the social, economic, and civic factors underlying
infant mortality for three reasons:
First It is situated in a State with excellent birth registration, an
important consideration on account of the assistance afforded by the
birth records in finding the mothers to be interviewed.
Second. As a town devoted to a single industry, employing skilled
workers, and paying high wages, Brockton presents an interesting
phase of the infant mortality problem. The city is almost exclu­
sively given over to the manufacture of shoes and shoe findings.
Third. Brockton has had for some years comparatively low death
rates and low infant mortality rates. The general death rate, more­
over, has shown a steady decrease year by year ; each year, from 1910
to 1913, inclusive, the city can claim the distinction of having had
the lowest rate among the cities in Massachusetts of at least 50,000
population, and for the 10-year period from 1901 to 1910, inclusive, its
average annual death rate also was the lowest in this group of cities.1
INFANT MORTALITY RATES.

An interesting comparison is afforded by a study of the infant
mortality rates for the State of Massachusetts and the cities in the
State having a population of 50,000 or more in 1910, and the general
infant mortality rate of 124 for the death registration States m the
same year.3

The State
Boston..........
Brockton___
Cambridge...
Fall R iv er.. .
Holyoke........
Lawrence—
Lowell..........
L ynn............
New Bedford
Somerville. . .
Springfield...
Worcester.. .,

133

119

117

110

124
102
120
186
213
168
231
100
180
126
137

111

117
100
97
151
163
135
184
112
156
78
102
133

110

102

126
78
114
177
183
141
189
102
148
93
102

98
98
151
200
128
151
82
143
86

104
105

a Seventy-third Annual Report on Births, Marriages, and Deaths in Massachusetts for tne Year 1914,

pp.
D , juXJyJm
206, 207.
*i\j I • Boston,
JJU O llV il, 1915.
,
,,
~X7‘
.n il
6 Seventieth Annual Report on Births, Marriages, and Deaths in Massachusetts for the Year 1911, pp.
181,182. Boston, 1912.
1 Seventy-third Annual Report on Births, Marriages, and Deaths in Massachusetts for the Year 1914,
p. 201. Boston, 1915.
U. S. Bureau of the Census, Mortality Statistics 1911, pp. 10, 25. Washington, 1913.


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INFANT MORTALITY.

DESCRIPTION OF CITY.

Brockton, located 21 miles south of Boston, has an area of 21£
square miles, more than half of which is decidedly rural in character.
The city’s growth has been from north to south along Main Street,
which is the center of all business activities.
The merchants of Brockton do not suffer in commercial competition,
because of the city’s proximity to Boston, in contrast to many other
communities within the same radius of the larger city. The wealthy
owners of factories and high-salaried officials connected with the
shoe industry live in Brockton. Their beautiful homes scattered here
and there save the city from the monotonous appearance which so
often characterizes manufacturing cities.
HISTORY.

®*"oc^ton has an interesting history dating back to the time when
Miles Standish purchased the Bridgewaters from Massasoit in 1649.
Although settled in 1700 as part of the town of Bridgewater, not until
1821 did it become a separate town known as North Bridgewater.
In 1874 the name of Brockton was adopted and in 1881 the city was
mcorporated. The development of Brockton has kept pace with that
of the shoe industry in New England, the population having increased
from 13,608 in 1880 to 56,878 in 1910.
INDUSTRIAL CONDITIONS.

Brockton is the largest center in the United States for the manu­
facture of men’s high-grade shoes and “ also occupies [the] chief place
in Massachusetts in the production of shoe-factory tools and sup­
plies.” 1 Within the city limits are about 30 shoe factories and
several factories devoted to the making of shoe parts and shoe find­
ings. In addition, many factories of the same kind are situated in
adjacent towns. No other manufacturing is extensively done in
Brockton; those who do not work in the shoe factories are to a large
extent engaged in meeting the needs of those who do. It is pre­
eminently a, one-industry town, and that industry is carried on by
■highly specialized workers who make good wages and possess an
unusual degree of skill. The unskilled workman, or the man who has
learned his trade in the manufacture of cheap shoes, must market his
labor elsewhere. As a result, the Brockton shoe operatives are, for
the most part, a picked force representing the best of the shoe workers
of New England.
The industrial situation in the city can not perhaps be better sum­
marized than in the abstract of a report made by the British Board
of Trade:2
1 U. S. Bureau of Labor Statistics.
Women, p. 25. Washington, 1915.

The Boot and Shoe Industry in Massachusets as a Vocation for

2 Livi^ Conditions of the Wage-earning Population in Certain Cities of Massachusetts. Abstract of a
Report by the Labor Department of the British Board of Trade, pp. 262-263. Massachusetts Bureau of
statistics, Boston, 1911.


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BROCKTON, M ASS.

11

The boot and shoe trade in Brockton is highly organized, and practically all the
manufacturers recognize agreements with the m en’s unions. The trade-union stamp
system has been developed with considerable success. There is little doubt that the
manufacturers regard the stamp as an asset of some value for advertising purposes and
as a quid pro quo for their concession of union claim s. The agreement, known as the
“ union stamp agreement,” is entered into between the manufacturer and the Boot
and Shoe Workers’ Union, the international organization which forms a coordinating
body for the unions concerned with special branches of the trade. The principal
provisions of the agreement are that “ the union agrees to furnish its union stamp to
the employer free of charge, to make no additional price for the use of the stamp, to
make no discrimination between the employer and other firms, persons or corpora­
tions who may enter into an agreement with the union for the use of the union stamp,
and to make all reasonable effort to advertise the union stamp and to create a demand
for the union stamped products of the employer, in common with other employers
using the union stamp. ” On the other side the employer agrees to hire as boot and
shoe workers only members of the union. It is further agreed that the union w ill not
cause or sanction any strike, that the employer w ill not lock out his employees while
the agreement is in force, and that all questions of wages or conditions of labor which
can not be mutually agreed upon shall be submitted to the Massachusetts State
Board of Conciliation and Arbitration.

The progress of the city under this régime is evident on every hand.
One rarely hears of dissatisfaction with the “ union stamp agreement.”
Although the high scale of wages demanded by the unions is said to
keep away from the city the cheaper sort of contracts, it keeps away
also much of the cheaper labor and draws to the city only those work­
men who are at least fairly skilled. Labor men throughout the State
consider that labor conditions in Brockton were more satisfactory than
in any other Massachusetts city.
In no [shoe] factory in Brockton and in few situated in surrounding towns can a
nonunion man be employed * * *. Altogether about four-fifths of the women
in the Brockton district belong to unions * * *. In Brockton the higher wage,
good factory equipment, and permanence of business concerns are no doubt largely,
due to the intelligent and moderate management of the unions. The fact that the
unions have to deal with a superior class of manufacturers, who reside among and
respect their working force, must be given a large place in the accomplishment of
these results.1

Wages in the boot and shoe industry are generally conceded to be
high as compared with those in other manufacturing industries. The
British Board of Trade states,2 furthermore, that—
there appears to be no doubt that the average yearly earnings of the boot and shoe
operatives are higher in Brockton than in any other boot and shoe center in Massa­
chusetts. It is claim ed, indeed, that they are higher than in any other center in the
world.

Although these statements were made about four years prior to the
year considered in this study, conditions had not materially changed
up to the time of this inquiry.
\
1 U. S. Bureau of Labor Statistics. The Boot and Shoe Industry in Massachusetts as a Vocation
for Women, pp. 98,99. Washington, 1915.
2 Living Conditions of the Wage-earning Population in Certain Cities of Massachusetts. Abstract of a
Report by the Labor Department of the British Board of Trade, p. 264. Massachusetts Bureau of Statistics,
Boston, 1911.


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12

I N F A N T M O R T A L IT Y .

An interesting feature of Brockton is the High proportion of children
in high school. In 1912-13 there were 1,382 children in high school,
compared to an estimated child population 15 to 19 of 5,336/ or
nearly 26 per cent. This figure is in striking contrast with that of
Fall River, 8 per cent, and of New Bedford, not quite 7 per cent.
This result is probably due to the city’s high economic level,
which permits children to continue in school longer than would other­
wise be the case, but it shows also an appreciation of the value of
education.
•
In summary, high wages appear to have developed high standards
of living, a desire for better education, and a sense of civic responsi-.
bility; as a result, the city enjoys improved civic conditions which in
turn react favorably upon the health of its residents.
METHOD OF PROCEDURE.

This inquiry was designed to show the effect upon infant mortality
of various economic, social, and physical factors. Births in a selected
year were studied and the number of deaths under 1 year of age among
them was determined; in this way an infant mortality rate, or the
deaths under 1 year per 1,000 live births, was found for the city and
the various subgroups. The year selected was from November 1,1912,
to October 31, 1913. The work of copying the birth certificates on
schedules was begun in October, 1914; if a death certificate was recorded
for a child born in the selected year, the facts on this certificate were
also transferred to the schedule. The women agents of the bureau
then began interviewing mothers, from whom most of the data used
in this study were obtained. No mother was interviewed before her
baby’s first birthday. Every home was visited whether the mother
was rich or poor, native or foreign, provided the baby was born in
Brockton during the year selected and his birth was registered at the
city hall.
Although no attempt was made to find unregistered, births b y mak­
ing a house-to-house canvass, by examination of baptismal records,
or by other means, 28 such births were discovered. Twenty-four of
these were obtained from death certificates and four living unregis­
tered babies were found purely by accident. Inasmuch as the agents
probably did not find all births which were not registered, the bureau
deemed it advisable to base the detailed study upon registered births
alone.2
/
Copies were made of 1,585 birth certificates (exclusive of duplicates).
Three hundred and twenty-eight registered births and 10 registered
miscarriages were excluded from the detailed study, 247 of the births
being to mothers who had moved from the city or whose correct ad1 The ages 15 to 19 are chosen as the group given by the Federal census that offers the best basis for com­
parison. The figure 1,382 includes all children in high school, not merely those 15 to 19.
2 See Appendix, p. 62.


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13

B R O C K T O N , M ASS.

dresses could not be found.1 No baby was included whose mother
did not reside in Brockton the greater part of the first year after his
birth. Complete data were obtained for the remaining 1,247 births,
including 37 stillbirths.
ANALYSIS OF FINDINGS.
INFANT MORTALITY RATE.

Of the 1,247 registered births included in the detailed study of
infant mortality in Brbckton, 37, or 3 per cent, were stillbirths.
The deaths among the live-born infants numbered 117, giving an
infant mortality rate of 96.7.
AGE AT DEATH.

Nearly one-half the infant deaths occurred in the first month of
life and as many before the end of the first day as between the ages
of 6 and 12 months. Of the 117 infant deaths, one-third occurred
in the first week; and more than one-fifth took place before the
babies were 1 day old.
T a b l e I I .— Number and per cent distribution o f deaths among infants bom in Brockton

during selected year, by age at death.
Infant deaths.
Age at death.

Number.

Per cent
distribu­
tion.

117

100.0

67

48.7

24
2
4
9
3
15
9
10
17
12
12

20.5
1.7
3.4
7.7
2.6
12.8
7.7
8.5
14.5
10.3
10.3

A study of the proportion of deaths occurring at various ages
reveals interesting differences between Brockton and the other
cities studied by the Children’s Bureau. (Table III.)
T a b l e I I I .— Per-cent distribution o f deaths among infants born in specified cities during

selected periods, by age at death.____________________
Age at death.

All
cities.

Brock­
ton.

Johns­
town.

Manches­
ter.

Saginaw.

New
Bedford.

All ages...............................................

100.0

100.0

100.0

100.0

100.0

100.0

Less than 1 month........................... ...........

35.5

48.7

37.8

27.9

56.6

3075

11.8
2.9
2.2
5.8
5.0
7.8
9.3
7.8
20.7
16.2
10.5

20.5
1.7
3.4
7.7
2.6
12.8
7.7
8.5
14.5
10.3

14.3

6.6
2.3
3.1
5.8
3.9
6.2
9.3
9.3
22.1
19.0
12.4

8.4
12.0
2.4
8.4
9.6
15.7
10.8
3.6
12.0
7.2
9.6

12.2
2.7
1.2
4.5
4.5
5.3
9.5
7.1
23.4
18.7
11.0

10.3

1.0

2.0
5.6
7.1
7.7
9.2
8.2
21.4
15.8
7.7

i See Appendix, pp.64 to 67, for detailed reasons for exclusions.


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IN F A N T M O R T A L IT Y .

'Die percentage of deaths occurring in the first day of life was
strikingly high in Brockton; it waS nearly twice as large as tho
average for all cities studied.
A baby who dies at a very early age is one who has not had a
fair start in life. In other words, the baby is bom with a handicap
and dies before he has an opportunity to reap any benefit from
breast feeding, sanitary environment, and the ample income and
superior intelligence of his parents. In Brockton, therefore, the
importance of these factors was lessened by the fact that a large
proportion of the deaths occurred at a very early age.
STILLBIRTHS.

Thirty-seven stillbirths were included in the detailed analysis.
The per cent that stillbirths formed of all births in the various cities
studied is shown in Table IV. Brockton’s stillbirth rate compared
favorably with that for New Bedford and Saginaw and was consid­
erably lower than the rates for Johnstown and Manchester.
T a b l e I V — Per cent o f stillbirths during selected year to mothers o f specified nativity, for

specified cities.

Stillbirths per 100 births.
City.

All cities.................................
Brockton..... ...........................
Johnstown...........................
Manchester.........................
Saginaw.........................
New Bedford..............................

Foreignborn
mothers.

Tot^l
mothers.

Native
mothers.

3.8

3.8

3.9

3.0
4.5
4.8
3.3
2.8

2.0
4.0
4.6
3.7
3.2

3.9
5.1
4.9
2.4
2.7

Stillbirths to mothers of 30 years of age or over were proportion­
ately more than four times as numerous as those to mothers under
30. The proportion increased slightly but steadily with the number
in order o f birth. (See Table X II, p. 20.)
Foreign-born mothers had proportionately almost twice as many
stillbirths as native mothers; 12 o f the 37 stillbirths included in the
study were to native mothers and 25 to foreign-born mothers. Com­
pared with the other nationality groups, the Italian and British
mothers had a high percentage of stillbirths. The Swedish and
Jewish mothers had none. (See Table X V III, p. 24.)
The proportion of stillbirths was large among illiterate mothers,
as well as among mothers who were unable to speak English. (See
Tables X X and X X I, p. 29.) Also, mothers in the lower eco­
nomic classes had more stillbirths proportionately than did those
who were more fortunately situated. (See Table X X III, p. 32.)


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BROCKTON, M ASS.

CAUSE OF DEATH.

A careful study of the certified or immediate cause of death, affords
clews leading to the more remote social or economic conditions affect­
ing the prevalence or incidence of disease. The number and per
cent of deaths caused by each group of diseases are shown in Table V.
T able Y .

Number and per cent distribution o f deaths among infants born during selected
year, by cause o f death.

Infant deaths.
Cause of death.
Number.

Per cent
distribu­
tion.

All causes..............................

117

100.0

Gastric and intestinal diseases___
Respiratory diseases.............
Malformations..................
Early infancy......................

15
16
6
45

12.8
13.7
5.1
38.5

Premature birth................
Congenital debility...............
Injuries at birth....................

20
18
7

17.1
15.4
6.0

Epidemic diseases.................
Diseases ill defined or unknown.
All other causes........................

10
6
19

8.5
5.1
16.2

%

Diseases peculiar to early infancy.—Forty-five, or 39 per cent, of
the 117 deaths, were traceable to causes peculiar to early infancy j
of these, 32 died in the first two weeks. Diseases peculiar to early
infancy, then, constituted the chief cause of death among the Brock­
ton babies studied.
Of every 1,000 babies who were bom alive in Brockton during the
year chosen, 37 died of causes peculiar to early infancy. In propor­
tion to the total deaths, these causes were relatively of much greater
importance than in other cities studied, notably Manchester; but
the rate— which is the fairer comparison— was about average.
T a b l e V I.

Infant mortality ratesfo r specified cities, by cause o f death.

Cause of death.
All causes...........................
Gastric and intestinal diseases..........
Respiratory diseases..................
Malformations.............. .
Early infancy.........................
Premature birth............ .
Congenital debility....................
Injuries at birth.........................
Epidemic diseases...............
Diseases ill defined or unknown..
All other causes.........................


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All
cities.

Brock­
ton.

Johns­
town.

Man­
chester.

Saginaw.

New
Bedford.

127.0

96.7

134.0

165.0

84.6

130.3

37.8
22.8
5.3
35.5

12.4
13.2
5.0
37.2

32.8
26.7
3.4
39.6

63.3
26.2
9.0
39.6

8.2
10.2
4.1
37.7

48.3
27.8
4.6
29.0

12.9
19.2
3.3

16.5
14.9
5.8

14.4
20.5
4.8

14.7
24.3
.6

12.2
24.5
1.0

9.7
15.5
3.9

7.7*
5.0
12.9

8.3
5.0
15.7

11.6
7.5
12.3

3.2
7.0
16.6

5.1
4.1
15.3

8.9
2.7
8.9

16

I N F A N T M O R T A L IT Y .

A striking contrast between the comparative infant mortalityrates for five cities studied by the bureau is shown in Table VI. The
rate from gastric and intestinal diseases for Brockton is low com­
pared with the rates, for Johnstown and Manchester. The rate from
diseases of early infancy is about the same in all the cities studied.
Evidently, while great progress has been made in decreasing the
number of deaths from gastric and intestinal diseases, little has yet
been done to decrease the deaths in early infancy. The very high
percentage of deaths in the first week or month of life merely pre­
sents the same truth with a different emphasis. In Johnstown,
Manchester, and New Bedford the work of mothers before confine­
ment may have contributed to a high rate in those cities, but in
Brockton, where the work as described was much less arduous than
in other cities, this employment can not be considered a factor in
the infant mortality of 37 from diseases peculiar to early infancy.
Gastric and intestinal diseases.—Fifteen babies died during their
first year from gastric and intestinal diseases; this number repre­
sents 12.8 per cent of all infant deaths. In Manchester 38.4 per
cent of all deaths under 1 year were due to this cause and in New
Bedford 37.1 per cent. The proportion of deaths under 1 year from
this cause in Massachusetts cities having a population of at least
100,000 in 1910 is shown in Table VII.
T a b l e V I I . — P er cent o f deaths under 1 year i n 1 9 1 3 due to gastric and in testin a l dis*
eases in M assachusetts cities w ith a p
‘ o p u la tio n o f 1 0 0 ,0 0 0 and over in 1 9 1 0 .

City.

Per cent.o

The State.............................

28.3

Cambridge,...................................
Fall R iv e r.....................................

22.8
31.3
36.1
37.5
28.5

Worcester.......................................

a Derived from U. S. Census Bureau, Mortality Statistics 1913, pp. 582 and 601-603.

Although these percentages are available only for cities which are
much larger than Brockton, it is plainly evident that the. proportion
of deaths caused by gastric and intestinal diseases was unusually lowin Brockton. This difference is shown in a more striking way by
the infant mortality rates from these diseases in the cities studied.
(See Table VI, p. 15.) In Brockton 12 out of every 1,000 live-born
infants died from gastric and intestinal diseases, while in Johnstown
33, in Manchester 63, and in New Bedford 48 died from these causes.
Of the 15 deaths from gastric and intestinal diseases, 14 occurred
during August, September, and October. (See General Table 3.)
The mortality from these diseases is usually greatest in the late
summer months.


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BROCKTO N, M ASS.

17

Respiratory diseases.—Of all infant deaths, 16, or 13.7 per cent,
'Were caused by respiratory diseases. This proportion is somewhat
lower for Brockton than for the other cities studied, with the excep­
tion of Saginaw. Twelve of these deaths occurred during the winter
months. Five of the children who died from this cause had native
mothers and 11 had foreign-born mothers. Ventilation of homes,
which, if inadequate, might be a factor in deaths from these diseases,
was found to be good in 82 per cent of the homes of native mothers
and in 56.5 per cent of the homes of foreign-bom mothers.
Ten babies died from epidemic diseases, six from diseases ill defined
or unknown, and 19 from all other causes.
ATTENDANT AT BIRTH.

A circumstance which clearly indicates the progress of the foreignbom residents of Brockton is the fact that they have become accus­
tomed to engaging physicians as attendants at childbirth. Of the
births to foreign-bom mothers, 36 or 5.7 per cent were attended by
midwives; these mothers were all Lithuanians. These 36 births were
2.9 per cent of all births during the selected year. In Manchester
13.6 per cent and in New Bedford 30 per cent of the births to foreignbom'mothers were so attended. Three of the births to foreign-born
mothers in Brockton were attended by neighbors or relatives, 3 had
no attendant, and in 2 cases the attendant was not reported. All
the births to native mothers were attended by physicians.
Two mid wives made birth reports to the city clerk during 1913; an
investigation of the practice of midwifery made in 1909 showed that
3 midwives were at that time practicing in Brockton.1 The midwife
has a peculiar status under the Massachusetts law; the Massachu­
setts Commission on Immigration states that “ as she is not a medical
practitioner under the law she can not legally practice. And yet she
is required to register all the births she attends, and is paid a fee for
doing this.” 2
This curious inconsistency in the law may tend to discourage the
registration of births by midwives in some cities throughout the
State, but nothing has been found to indicate that Brockton is among
their number.
1 Huntington, J. L., M. D. “ Midwives in Massachusetts.” Boston Medical and Surgical Journal,
Vol. C LXVII, No. 16, pp. 642-548.
2 The Problem of Immigration in Massachusetts, Report of the Commission on Immigfation, p. 193.
Boston, 1914.

69484°— 18----- 2


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18

I N F A N T M O R T A L IT Y .

T a b l e V I I I .— Number and per cent distribution o f births during selected year to mothers

o f specified nativity, according to kind o f attendant at birth. »

Total mothers.
Kind of attendant at birth.

Native mothers.

Per cent
distribu­
tion.

Foreign-bom
mothers.

Births.

Per cent
distribu­
tion.

All classes...........................................

1,247

100.0

613

100.0

634

100.0

Physician......................................................

1,203
36
8

96.5
2.9
.6

613

100.0

590
36
8

93.1
5.7
1.3

Births.

Births.

Per cent
distribu­
tion.

Various secret and fraternal orders, foreign societies, unions, and
private clubs have customarily engaged physicians for their mem­
bers by the year. As a rule each member pays a stated sum to this
physician and is in return entitled to his services for a year without
further charge.
SEX.

The masculinity, or ratio of male births to female births which
occurred in Brockton during the selected year, was 1,058 to 1,000.
The infant mortality was higher among male children. This con­
formity to frequently observed phenomena is shown not only for the
births and for the infant mortality rate in the city as a whole but for
the children of native and of foreign-bom mothers as well. In spite
of the high infant mortality among the males, more male than female
children survived at the end of the first year.
T a b l e I X .— Births during selected year, infant deaths, infant mortality rate, and per cent

o f stillbirths, according to sex o f infant and nativity o f mother.
Stillbirths.
Sex of infant and nativity of mother.


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Total
births.

Live
births.

Infant
deaths.

Infant
mortality
Per cent
rate.
Number. of total
births.

1,247

1,210

117

96.7

37

3.0

641
606

623
587

70
47

112.4
80.1

18
19

2.8
3.1

613

601

61

101.5

12

2.0

307
306

301
300

37
24

122.9
80.0

6
6

2.0
2.0

634

609

56

92.0

25

3.9

334
300

322
287

33
23

102.5
80.1

12
13

3.6
4.3

19

BROCKTON, M ASS.

AGE OF MOTHER.

The influence of the age of the mother on infant mortality is shown
in Table X .
T a b l e X . — Births during selected year, infant deaths, infant mortality rate, and per cent

o f stillbirths, according to age o f mother at birth o f infant.
Stillbirths.
Total
births.

> Age of mother.

All mothers........................................
20 to 24..........................................................
25 to 29..........................................................
30 to 39..........................................................

1,247
58
346
352
422
66
3

Live
births.

Infant
deaths.

117

1,210
57
340
349
398
63
3

8
36
30
38
5

Infant
mortality
cent
rate.» Number. Per
of total
births.«
96.7

.

105.9
86.0
95.5

37

3.0

1
6
3
24
3

1.7
.9
5.7

»N ot shown where hase is less than 100.

In Brockton the infant mortality rate was highest among babies
whose mothers were less than 25 years of age.
The combined data for the five cities studied show that the infant
mortality rate was highest for babies whose mothers were under 20,
while children, of mothers 40 and over had the next highest rate.
Mothers between the ages of 25 and 29 lost proportionately the fewest
babies.
T a b l e X I . — Infant mortality rates fo r specified cities, according to age o f mother at birth

o f infant.
Infant mortality rates for «—
Age of mother.
All cities. Brockton.

127.0
20 to 24..........................................................
25 to 29..........................................................
30 to 39..........................................................

180.6
131.2
117.4
121.5
142.1

Johns­
town.

96.7
105.9
86.0
95.5

134.0
121.1
143.2
135.9

Manches­ Saginaw. New Bed­
ford.
ter.
165.0
181.2
153.3
146.6

84.6

130.3

105.4
73.8
70.5

259.3
128.3
114.0
129.8
142.9

a Not shown where base is less than 100.

ORDER OF BIRTH.

The first-born children, according to Table X II, had a slightly
greater chance of dying than the second or third-bom children; the
infant mortality rate increased for the fourth-bom children, as well
as for those who were fifth or later in order of birth. This is in gen­
eral accord with the findings of other infant mortality studies and
with a similar table concerning number of pregnancies in the mater­
nal history section of this study. (See Table X X X IV , p. 41.)


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20

I N F A N T M O K T A L IT Y .

T a b l e X I I .— Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to number in order o f birth.

Total
births.

Number in order of birth.

All m others...................................
First............................................................
Second.......................................................
Third...........................................................
Fourth....................................................
Fifth and later.............................................

Live
births.

Infant
deaths.

Stillb irths.

Infant
mortal­
ity.
rate.

Number.

Percent
of total
births.

1,247

1,210

117

96.7

37

3.0

416
262
185
124
' 260

408
256
178
119
249

38
23
16
12
28

93.1
89.8
89.9
100.8
112.4

8
6
7
5
11

1.9
2.3
3.8
4.0
4.2

FEEDING.

All medical authorities are agreed as to the superiority of breast
milk over any other kind of food for infants. Yet in spite of the
constant reiteration of this well-known fact many mothers resort to
various other foods for their babies.
Thirty-three of the 1,210 live-bom babies died before they were
fed, although a few of them lived for two or three days. Of the
1,177 babies who were fed 232, or 19.7 percent, were never breast fed.
The proportion of breast-fed babies decreased as the age increased,
since more and more of them were given some food in addition to
breast milk or else were exclusively artificially fed. Table X I I I
shows the percentage of infants surviving at the beginning of each
month of life that were exclusively breast fed in that month. This
percentage fell from 78.5 in the first month to 33.2 in the nipjbh.
A baby who is breast fed in a given month has almost invariably
enjoyed the same type of feeding since birth. On the other hand,
the baby who is artificially fed in the ninth month may never have
had any breast milk, but he is far more likely to have been nursed
for a long or short time before being weaned. In other words,
feeding is a changing process that does not readily lend itself to
tabular presentation. A table showing the type of feeding at different
periods of an infant’s life should be regarded as a series of snapshots
rather than as a moving picture of his feeding during his first year.
T a b l e X I I I .— Infants bom during selected year, and surviving at beginning o f specified

month a and number and per cent exclusively breastfed during specified month.

Month of life.

First......................................................................
Second................................... ................................
Third....................................... ..........................
Fourth..........................................................
Fifth..................................................................
Seventh............ ................................................
Eighth........................... I ..........................
Ninth.......................................................
« Excluding 33 who died not fed.


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Total
infant
survivors.

ol,177
1,153
1.144
1,134
1,122
1,117
1,114

Breast fed exclusively.
Number.
924
752
650
608
424

Per cent.

21

B R O C K T O N , M A SS.

T a b l e X I V .— Deaths in the month per 1,000 survivors at beginning o f month and monthly

death rates per 1,000 infants fed in specified way, by month o f life.a

Month of life.

First.......................................................................................................

Fifth.......................................................................................................

Tenth to twelfth (average)....................................................................

Deaths in Deaths in month per
1,000 infants—
month per
1,000 sur­
vivors at
beginning Breast fed. Artificially
of month.
fed.
6 20.4
7.8
8.7
5.3
5.3
4.5
2.7
3.6
4.5
3.6

17.3
4.9
4.0
1.6
2.1
2.4
2.7

30.0
16.3
19.8
14.3
11.4
10.9
2.1
6.0
9.7
5.2

a Derived from General Table 6.

&The rate is per 1,000 infants who lived to be fed. The rate per 1,000 live births is 47.1; 33 infants died
not fed.

The facts in this table can be summed up as follows: If the monthly
rates for all infants are applied to 1,000 live births, subtracting suc­
cessively the deaths in each month to find the survivors at the begin­
ning of the next month, the number of survivors at the end of the
year would be 903. The deaths in the year (97) divided by 1,000
births would correspond to rate (96.7) for the city. If applied to
1,000 infants who lived to be fed, the deaths in the year would
total 71.
The relative difference between breast feeding and artificial feeding
may be expressed most clearly by applying to the group of 1,000
infants who lived to be fed the rates for each kind of feeding suc­
cessively. If the group were breast fed throughout the year, there
would have been 960 survivors; if artificially fed, only 872 survivors.
In other words, the mortality rates would be 40 and 128, respectively.
The rate for the artificially-fed is three times the rats for breast-fed
infants. The difference may be stated in still another way. Among
the infants who had either artificial or mixed feeding, 55 deaths
actually occurred. If all these babies had been breast fed and the

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22

IN F A N T MORTALITY.

rate for the breast-fed group had applied to them, only 17 deaths,
instead of 55, would have occurred in this group.
Feeding and mother’ s nativity.—Artificial feeding was more commonly practiced by the native mothers than by the foreign-bom
mothers. In fact, three native mothers were feeding their babies
artificially at the end of three months to every two foreign-bom
mothers. A t the end of six months and nine months the ratio was
still the same. Since the mortality among the artificially-fed babies
was higher, the fact that a larger proportion of infants of native
mothers was artificially fed may explain in part the relatively high
death rate among the native. Comparison of monthly rates by kind
of feeding for native and foreign-bom groups indicates that the mor­
tality among breast fed is approximately the same for the foreignbom as for the native group, but among the artificially fed the mor­
tality is considerably lower for infants of native mothers than for
infants of foreign-born mothers. This difference is obscured in the
average rates for the groups by the relatively larger proportion.of
infants of native mothers that was artificially fed. Probably greater
care exercised by native mothers in selection of good quality milk,
preparation and modification of the milk in accordance with phy­
sicians’ formulae might account for much of the difference.
T a b l e X V .— Number and per cent distribution o f infants born during selected year and

surviving at end o f third, sixth, and ninth month, by type o f feeding during the month
specified, according to nativity o f mother.
Infants surviving at end of—

Type of feeding and nativity of mother.

Third month.

Number.

All mothers...................................
Breast exclusively....................................
Mixed................ I....................
Artificial exclusively.............................
Native mothers................................
Breast exclusively.................................
i
Mixed................ ' ...............................
Artificial exclusively........................... .
Foreign-bom mothers...........................
Breast exclusively..................................
Mixed................ ’ ............................
Artificial exclusively.............................

Sixth month.

Ninth month.

Per cent
Per cent
Per cent
distri­ Number. distri­ Number. distri­
bution.
bution.
bution.''

1,134

100.0

1,117

100.0

749
38
347

66.0
3.4
30.6

554
111
452

49.6
9.9
40.5

1,105
36$T
226
511

100.0
33.3
20.5
46.2

559

100.0

553

100.0

546

100.0

337
16
206

60.3
2.9
36.9

239
45
269

43.2
8.1
48.6

145
109
292

26.6
20.0
53.5

575

100.0

564

100.0

559

100.0

412
22
141

71.7
3.8
24.5

315
66
183

55.9
11.7
32.4

223
117
219

39.9
20.9
39.2

Feeding and father’ s earnings.—The most interesting fact shown
in Table X V I, giving the proportion artificially fed for each earnings
group, is the relatively small proportion of artificially fed among the
lowest group compared with the proportion in the highest group.
The differences, however, were not very great, but their significance

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23

B R O C K T O N , M ASS,

is greater than might at first appear to be the case because of the
fact that the death rate among the artificially fed was so much
higher.
T a b l e X V I .— In fa n ts b o m during selected year and su rvivin g at end o f thud , sixth ,
and n in th m on th s, and n um ber and per cent a rtificia lly fe d during specified m on th ,
according to earnings o f fa th er.

Infants surviving at end of—

Earnings of father.

Total.

Total.
Num­
ber.

Artificially fed.

Artificially fed.

Artificially fed.
Total.

Ninth month.

Sixth month.

Third month.

Num­
ber.

Per
cent.

Per
cent.

Num­
ber.

Per
cent.

All classes..'.................

1,134

347

30.6

1,117

452

40.5

1,105

511

46.2

Under $650.............................
$650 to $1,0|9..........................
$1,050 and over......................
No earnings and not reported

250
652
219
13

68
205
70
4

27.2
31.4
32.0
30.8

248
627
219
13

86
263
97
6

34.7
41.3
44.3
46.2

246
-628
218
13

100
296
108
7

40.7
47.1
49.5
53.8

Feeding and mother’s working status.—The employment of
mothers away from home probably bears a closer relation to the
method of feeding than does nativity, custom, or economic status
of the family. But in Brockton only 13 or 1.1 per cent of the 1,134
mothers whose babies survived to the age of three months, had begun
to work away from home prior to that time, and of these, 8 were feed­
ing their babies artificially. Even at the age of 9 months only 31
or 2.8 per cent of the 1,105 mothers whose babies had survived, had
begun to work away from home previous to this period, and of this
number, 23 gave their babies artificial food.
It is obvious that the number of mothers who went to work away
from home during the baby’s first year was so. small that little impor­
tance can be attached to conclusions based on this group.
T a b l e X V I I .— In fa n ts born d uring selected year su rvivin g at end o f specified p eriod and
num ber and per cent a rtificia lly fe d , according to w orking sta tu s o f m other.

Type of feeding at specified age.

Infants living at end of three months.
Number artificially fed .................
Per cent artificially fed a ..............
Infants living at end of six months. . .
Number artificially fe d .................
Percent artificially fed o ..............
Infants living at end of nine months .
Number artificially fed.................
Per cent artificially fed a.-............

Total in­
fant sur­
vivors.

1,134
347
30.6
40.5
46.2

1,117
452
1,105
511

Mother gain­
Mother gain­ fully employed,
fully employed but time of re­
Mother not before speci­
sumption not
gainfully
fied time.
reported.
employed
before
specified
Away
Away
time.
At
At
from
from
home. home. home. home.
158
47
29.7
167
922
69
365
41.3
175
894
83
403
47.4

958
291
30.4
39.6'
45.1

a Not shown where base is less than 100.


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24

I N F A N T M O R T A L IT Y .

NATIONALITY.

In 1910 slightly more than one-fourth (15,425) of the entire popu­
lation of Brockton and three-eighths of the population 20 years of
age and over were foreign-born white, yet more than one-half the
babies included in this study werfe the children of foreign-born
mothers.
Infant mortality rates by nationality.— The infant mortality rate
for the native group was 101.5 compared with 92.0 for children of
foreign-born mothers, an unusual condition in New England manu­
facturing towns. This difference in favor of the foreign born, how­
ever, was more than offset by the fact that among these mothers
stillbirths were twice as numerous as among native mothers.
T a b l e X V I I I .-—Births duringrselected year, infant deaths, infant mortality rate, and 'per

cent o f stillbirths, according to nationality o f mother.
Stillbirths.
Nationality of mother.

Total
births.

Live
births.

Infant
deaths.

Infant
mortal­
ity rate.“ Number Per cent
of total
births.“

All mothers........................................

1,247

1,210

117

96.7

37

3.0

Native mothers..................................... ......

613

601

61

101.5

Foreign-bom mothers.......... .......................

634

609

56

92.0

12
/
25

3.9

Lithuanian and Polish *>.......................
Italian....................................................
Irish.......................................................
Swedish and Norwegian *.....................
Jewish..... ..............................................
English, Scotch, and Welsh d...............
French Canadian...................................
Other Canadian.....................................
All other*..............................................

153
118
90
62
57
33
22
60
39

147
111
86
62
57
30
21
58
37

17
8
3
i
5
5
3
8
6

115.6
72. 1

6
7

3.9
5.9

4

2.0

3
1
2
2

a Not shown where base is less than 100.
, 6 Including 133 Lithuanian and 20 Polish.
' c Including 60 Swedish and 2 Norwegian.
d Including 24 English, 6 Scotch, ana 3 Welsh.
* Including 11 Syrian, 8 Greek, 4 Armenian, 4 German, 4 Russian, 2 Finnish, 2 French, 1 Portuguese, 1
Roumanian, 1 European Spanish, 1 American Spanish.

Foreign nationalities.— Of the 15,425 foreign-born white residents
of Brockton in 1910, 6,862 came from English-speaking countries.
The only other countries represented by more than 1,000 people
were Russia with 3,178 and Sweden with 2,608. The different
nationality groups have come to Brockton approximately in the
following order:
English-speaking people.
Swedes.
French Canadians.
Italians.
Poles.
Jews.
Albanians and Greeks.
Syrians and Armenians.

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B R O C K T O N , M A SS.

25

The tendency of foreigners to live in old and congested districts
where they can obtain the lowest possible rents was not so marked
in Brockton as in many other New England cities. The only foreign
colony of any size was that of the Lithuanians, who lived near the
outskirts of the city in the section known as Montello, where there
was no possibility of lot congestion, although considerable crowding
existed within the buildings themselves. The Lithuanians, together
with the Italians, Jews, and southeastern Europeans, comprised what
was known as the “ foreign element” of Brockton; the Swedes have
been in the city so long that they are practically assimilated, while
the English-speaking foreign bom become Americanized in a veiy
short time and consider the Lithuanians “ foreigners.”
About one-half the foreign-born inhabitants of Brockton in 1910
were born in northwestern European countries. This fact has been
offered as an explanation of the low infant mortality rate enjoyed
by the foreign born of that city. But comparatively few of these
northern Europeans were parents of children born in this decade;
they were, rather, grandparents whose descendants are classified
as children of native mothers. Approximately 30 per cent of the
foreign-born mothers considered in this study were northern Euro­
peans; while those born in southern and eastern Europe, being more
recent immigrants and therefore younger, comprised about 54 per
cent of the foreign-born mothers. This refutes, for the year selected
at least, the above explanation of the low infant mortality rate for
the foreign born.
Lithuanians and Poles.— In Montello the Lithuanians and Poles
live side by side, the former being far the more numerous, and for
this reason the average citizen calls them all “ Lithuanians.” For
convenience, they have been considered as one group in this study,
although it is recognized that the nationalities are quite distinct.
The Poles have in some cases intermarried with the Lithuanians,
and they seem generally to have adapted themselves to the customs
of the Lithuanians among whom they live.
The births to Lithuanian and Polish mothers were more numerous
than those of any other nationality group; the infant mortality rate
for their babies was the highest for any one racial group excepting
that for the British and for the Canadian groups. (See Table X W I I,
p. 24.)
In 1910 the Lithuanians and Poles formed a negligible element
of the population, but since that time they have come to Brockton
in ever-increasing numbers. They have a compact colony and,
with their churches, stores, and fraternal organizations, are socially
self-sufficient. Because of their numbers and close association
with one another they have had little necessity for learning English.
The men as a rule have a fair working knowledge of the language


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26

I N F A N T M O R T A L IT Y .

after being in this country several years, but most of the women
are limited to the phrase, “ No speak English.” Of the 153 babies ip
this group, 64 had mothers who were able to read and write in English
or in their own languages, while but 39 had mothers who could speak
English.
The Lithuanian colony in Montello had become at the time of
this inquiry perhaps the most congested as well as one of the most
untidy parts of the city. The health department found that the
number of infant deaths had been greatest there during the five
years prior to 1913; as a result, one of the milk stations1 was estab­
lished there.
This section is a recent development of the city, hence most of
the tenement blocks have been erected during the past decade and
are in good repair. These buildings, generally of the three- or sixfamily type, are decidedly above the average, in other cities for
homes of workingmen whose incomes range from $500 to $1,000 a
year. Although standards of cleanliness in this section were below
the general level for the city and the best use was not made of the
means of ventilation available, few fundamental housing defects
were prevalent in this foreign quarter. The homes of 32 of the 153
babies of Lithuanian" and Polish mothers were in a dirty condition
when visited, while in 69 more cases the homes were but moderately
clean. The most conspicuous object in the Lithuanian homes was
the stove, which wds brilliantly polished regardless of the general
condition with respect to cleanliness.
Italians.— The inquiry embraces 118 babies of Italian mothers
Who were scattered over the city. This group had no colony, but,
With the exception of wards 3 and 6, was quite evenly distributed
through the different wards.2 The incidence of death among the
Italian babies was small, 72 out of 1,000 having died in infancy, but
the stillbirth rate was relatively high.
The Italians generally lived in the oldest buildings in the city—
often a dilapidated one-family house rearranged for two or three
families, or in many cases a few rooms back of a small fruit or grocery
•store. They evidenced a decided tendency toward thrift, as indi­
cated by the great efforts made to own their homes. Among the
more ambitious Italians was one family in possession of a threetenement house. This family lived on the third floor and rented
the two lower floors, the mother explaining that they had only an
equity in the house, but were trying to pay for it. The Italians are
looked upon as older settlers than the Lithuanians and Poles; more
of them can speak English and many of the second generation have
been fairly well educated. Some of the large and prosperous stores
of the city are operated by children of Italian parents.
1 See p. 49.


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s General Table 5.

27

BROCKTON, M ASS.

The Italians are most ambitions for the future of their children.
They do not feel that “ what was .good enough for me is good enough
for my children.” One young Italian mother told of her plans for
the college education of her four scrupulously neat little children.
She had no doubt that this aim could be accomplished on her hus­
band’s earnings of $1,000 a year if they saved until the children were
old enough. An old man stated in broken English that all the
Italians in the city were glad that the United States Government
had come to Brockton to look out for the little babies; that an
Italian’s first duty was to care for his “ bambinos” in every way in
his power. It is true, however, that he did not know the best way
of caring for them, inasmuch as he “ always kept the windows shut
tight for fear his grandchildren might catch cold.” In nearly every
instance they seemed willing, even eager, to learn the best methods
of caring for their babies. An educational campaign on the care of
babies would undoubtedly be very effective among the Italian
mothers of Brockton.
British and Canadians (except French Canadians).— This group
embraces 33 babies of English, Scotch, and Welsh mothers and 60
of English and Scotch Canadian mothers. B y comparing the 90
Irish with the 93 in this group a curious result is obtained. But
three deaths occurred among the Irish, compared with 13 deaths
among the British and Canadian. This great difference is not sus­
ceptible of a ready explanation. Although, because of the small
numbers in each case, no particular significance can be attached to
this contrast in infant mortality rates, this tendency coincides with
the fact that the Irish infant mortality rate, in general, is lower than
the English.1
In this connection it is of interest to note the variations in type
of feeding among the Irish on the one hand and the combined group
of British and Canadian (except French Canadian) on the other..
T a b l e X I X .— Infants bom to mothers o f specified nativity and surviving at the end o f

the third, sixth, and ninth month o f life, and number and per cent fed in specified way
during the month specified.
British and Canadian (except French
Canadian) mothers.

Irish mothers.

Month of life.

Third........................
Sixth........................
Ninth.......................

Breast fed.
Infant
surviv­
Per
ors.
Num­
ber.
cent.
84
84
83

63
52
36

75.0
61.9
43.4

Artificially fed.
Num­
ber.
18
22
28

Per
cent.
21.4
26.2
33.7

Breast fed.
Infant
surviv­
Num­
Per
ors.
ber.
cent.
81
77
77

52
37
27

64.2
48.1
35.1

Artificially fed.
Num­
ber.
26
33
37

Per
cent.
32.1
42.9
48.1

1 In 1914 the infant mortality rate was 87 in Ireland and 105 in England and Wales. U. S. Bureau of the
Census, Birth Statistics, 1915, p. 18. Washington, 1917.


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I N F A N T M O R T A L IT Y .

The proportion of babies who received no food other than breast
milk was always greater among the. Irish; similarly, the proportion
of babies who were artificially fed was greater among the British and
Canadian group. This fact may suggest a partial explanation of the
difference in infant mortality rates.
Living standards of the British and Irish families differed but little
from American families having the same economic status. The
homes visited were for the most part clean and the mothers seemed
to be thrifty and ambitious.
Scandinavians.—The Scandinavian group studied is very small,
consisting of 60 births to Swedish and 2 to Norwegian mothers. Only
one death and no stillbirths occurred among their number.
The strength of the Swedish settlement in the section known as
Campello, in the southern part of the city, is not represented accu­
rately by these numbers, because so many of the families are Ameri­
cans of Swedish extraction. Brockton owes much to its Swedish
colony; they have established homes on a plane as high if not higher
than that of the average American; they earn good wages in the shoe
factories, and spend them wisely, obtaining apparently the best possi­
ble results therefrom; as a rule they own their homes and are thrifty,
public-spirited citizens.
Other nationality groups.— Most of the Jewish mothers who had
babies during the selected year lived, in the western end of the fifth
ward. All of their 57 babies were live-bom, five of them dying in the
first year, giving a mortality rate of 87.7.
Twenty-two infants of French Canadian mothers were included,
one of them being a stillborn child. Three of the 21 live-bom babies
died during their first year.
Thirty-nine babies were bom to mothers of various other nation­
alities ; these groups were too small to be of any statistical significance.
LITERACY AND ABILITY TO SPEAK ENGLISH.

A mother familiar with the requirements of infant care is, next to
a good endowment of physical health, a baby’s- greatest asset. It is
unfortunately impossible to measure maternal intelligence directly,
but an analysis of mortality according to literacy and ability of the
mother to speak English is presented. If the mother is able to read
and write in some language, or to speak and understand English,
invaluable sources of information on the care of the infant are open
to her that would otherwise be entirely closed.
The mortality was greater among babies of illiterate mothers in
Brockton than among those of literate mothers. Since all but three
of the infants whose mothers were illiterate had foreign-bom mothers,
it is somewhat fairer to confine the comparison to the foreign-bom
group only. The mortality rate was then 88.1 for the literate and
103.9 for the illiterate. The percentage of stillborn babies is about
twice as high among the illiterate as among the literate group.

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29

BROCKTON, M ASS.

T a b l e X X .— Births during selected year to all mothers arid to foreign-horn mothers,

infant deaths, infant mortality rate, and p
“ er cent o f stillbirths, according to literacy o f
mother.
Stillbirths.
Total
births.

Literacy of mother.®

Live
births.

Infant
deaths.

Infant
mortality
Per cent
rate.
Number. of total
births.

1,247

1,210

117

96.7

37

3.0

1,079
167
1

1,052
157
1

100
17

95.1
108.3

27
10

2.5
6.0

Foreign-bom mothers...........................

634

609

56

92.0

25

3.9

Illiterate.................................................
Not reported................................................

469
164
1

454
154
1

40
16

88.1
103.9

15
10

3.2
6.1

Literate.........................................................
Illiterate....................................................
Not reported.................................................

a Mothers who can read and write in any language were reported literate; all others illiterate.

\

Thirteen per cent, or 167, of the 1,247 births were to illiterate
mothers; of the 634 births to foreign-bom mothers, 164, or 26 per
cent, were to mothers who could not read and write. Only 3 births
were to native illiterate mothers.
The distribution of births to foreign-bom mothers according to the
ability to speak English is shown in Table X X I ; in addition, one
native American mother was unable to speak E n g lish ,
T a b l e X X I .— Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to mother's ability to speak English.
Stillbirths.
Ability of mother to speak English.

Total
births.

Live
births.

All mothers..................................

1,247

1,210

Able to speak English..........................
Unable to speak English ®....................

1,037
210

1,011
199

Infant
deaths.

117
97~
20

Infant
mortality
Per cent,
rate.
Number. of total
births.
96.7

37

3.0

95.9
100.5

26
11

2.5
5.2

Foreign-bom mothers....... _________ __

634

609

56

92.0

25

3.9

English-speaking nationalities *>............... :
Non-English speaking nationalities............

183
451

174
435

16
40

92.0
92.0

9
16

4.9
3.5

Able to speak English........ .................
Unable to speak English................... ..

' 242
209

237
198

21
19

88.6
96.0

5
11

2.1
5.3

“ Includes one native mother..
6 English, Irish, Scotch, Welsh," and Canadian (except French Canadian).

Of the 451 births to mothers of non-English speaking nationalities,
209-or 46.3 per cent were to mpthers who could not speak English.
These 209 births were 16.8 per cent of all births included in this study.
Raising the standard of literacy, then, may tend to reduce the infant
mortality rate. Not that an illiterate mother is incapable of caring for
her baby as she should; it is simply a question of being unable to
avail herself of all the advantages which the literate mother enjoys;
C


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I N F A N T M O R T A L IT Y .

for example, the leaflet on “ Care of the B aby” which is sent by the
board of health to every mother in the city immediately after he:
child’s birth has been reported. When one realizes that the law re­
quires every birth to be reported within 48 hours,1 and a notice of all
births to he sent daily by the clerk or registrar to the local board of
health, it is easy to appreciate the great amount of good that may
be accomplished by this pamphlet giving advice on the care of the
baby.
In the same way, the mother’s inability to speak or understand
English sometimes deters her from attending lectures which might
prove to be of untold advantage to her.
ECONOMIC FACTORS.

The family income plays a large part in determining a very young
child’s chance of life. A low income in an industrial city implies
poor home sanitation, congestion, lack of adequate medical care, a
restricted diet, and a mother who is overworked, either in the factory
or at home. And to the combination of these circumstances, if not
definitely to the separate factors, is to be ascribed the heavy mortality
of babies bom under such conditions.
Father’s earnings as an index of economic status.—The earnings
of the father constitute the best single index of the standard of living
of the family, though in some respects not altogether satisfactory.
In many cases mother’s earnings can not be secured accurately on
account of the difficulty of separating net from gross income. This is
particularly true regarding income received from lodgers, the principal
single source of mother’s earnings in Brockton. Mother’s earnings
are sometimes secured at a cost of neglect that is out of proportion
t.o the value of the added income. Income from other sources is so
fluctuating and uncertain in its nature as to impair to a great extent
the value of total family income as an index of the standard of living
in the family. In view of these facts, father’s earnings have been
used as the best available index of the family standard.
The annual earnings shown were the amounts actually earned by
the father during the year following the birth of the infant. On ac­
count of lack of employment or for other reasons the father may not
have worked steadily. If the father had been unemployed for a
period during the year, he was classed in the earnings group corre­
sponding to the amount he had earned. These amounts, therefore,
ape not yearly rates of wages, since the periods of unemployipent
are not included. Rough estimates for the average amount of un­
employment made by both employers and employees ranged from
one to four months. The pay roll of one of the larger factories
showed 46 weeks of fairly steady work during 1913, a figure repre1 Massachusetts Acts of 1912, chap. 280.


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31

B R O C K TO N , M ASS.

senting 11.5 per cent of unemployment, exclusive of slack time dur­
ing the 46 weeks of work. In some cases other reasons beside
unemployment shortened the period of actual work. In several
instances the father was sick for two or three months; in a few others
the father died or deserted during the baby’s first year; in these
cases he was classed in the earnings group corresponding to the
amount he had actually received.
Distribution of economic groups.— In Brockton only 12.5 per cent
of the babies bom during the selected year had fathers earning less than
$550, while the corresponding proportion in Manchester, Saginaw, and
New Bedford was 30.4, 17. 9, and 37.7 per cent, respectively. The
fathers of 954, or 76.5 per cent, earned $650 and over, compared with
48.8 percent in the same class in Manchester, 64.1 per cent in Sagi­
naw, and 44.7 per cent in New Bedford. In Brockton 43.3 per cent
earned $850 and over, while' 18.6 per cent earned $1,050 and over
during the year after the baby’s birth.
In the lowest earnings group the foreign born were nearly three
times as numerous as the native; the reverse was true in the highest
group.
,
Occupation of father.—Of the 1,247 births included in this study,
688 or 55.2 per cent had fathers who were employed in the making of
shoes, shoe parts, and shoe findings; of these 634 were classed as
operatives, i. e., they had occupations peculiar to the shoe industry;
and the fathers of the other 54 were employed by the shoe factories
in other capacities such as officials, managers, clerks, machinists,
electricians, firemen, etc. The distribution of births according to
the occupation of the father in the various industries of the city is
shown in detail in General Table 8.
T a b l e X X I I .— N u m ber and per cent d istrib u tion o f births d uring selected year to m others
o f specified n a tiv ity, according to earnings o f fath er.

All mothers.
Earnings of father.
Total
births.

Native mothers.

Per cent
distribu­
tion.

Births.

Per cent
distribu­
tion.

Foreign-bom
mothers.

Births.

Per cent
distribu­
tion.

All classes............................................

1,247

100.0

613

100.0

634

100.0

Less than $550..............................................
$550 to $649...................................................
$650to $849..............................................
$850 to $1.049.................................................
$1,050 to $1,249..............................................
$1,250 and over.............................................
No earnings and not reported....... .............

156
122
414
308
95
137
15

12.'5
9.8
33.2
24.7
7.6
11.0
1.2

40
51
181
160
69
103
9

6.5
8.3
29.5
26.1
11.3
16.8
1.5

116
71
233
148
26
34
6

18.3
11.2
36.8
23.3
4.1
5.4
.9

Infant mortality rates according to father’s earnings.—The infant
mortality rate was highest (132.2) for the earnings group $650 to
$849, and lowest for the group $1,050 and over (65.5). Contrary
to the findings for other cities, the mortality rates for the earnings

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32

I N F A N T M O R T A L IT Y .

T a b l e X X I I I .— Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to earnings o f father.
Stillbirths.
Total
births.

Earnings of father.

Infant
Infant x mortal­
Per cent,
deaths. ity
rate.® Number. of total
births.®

Live
births.

All classes...........................................

1,247

1,210

117

96.7

37

3.0

Less than $550..............................................
$550 to $649..................... .............................
$650 to $849...................................................
$850 to $1,049.................................................
$1,050 and over.............................................

156
122
414
308
232
6
9

149
116
401
301
229
5
9

10
10
53
25
15
1
3

67.1
86.2
132.2
83.1
65.5

7
6
13
7
3
1

4.5'
4.9
3.1
2.3
1.3

#

'

a Not shown where base is less than 100.

The general rate for Brockton, which is relatively low comparjpd to
the other cities presented in Table X X IV , may be attributed in part
to the high wages prevailing in this city. In Manchester, Saginaw,
and New Bedford the rates for babies of the lowest earnings group
were from 3 to 5 times as great as for those in the highest earnings
group; the infant mortality rates for all cities combined show a
regular decline as the earnings increase. In the group studied in
Brockton this tendency does not appear.
T a b l e X X I V .— Infant mortality rates for specified cities, according to earnings o f father.

Earnings of father.

Under $550..................................... ..............
$550 to $649....................................................
$650 to $849....................................................
$850 to $1,049.................................................

All cities.

Brockton.

Manches­
ter.

Saginaw.

New
Bedford.

125.4

96.7

165.0

84.6

130.3

167.0
127.7
123.3
101.4
53.4

67.1
86.2
132.2
83.1
65.5

204.2
174.5
162.6
125.0
63.2

142.0
103.4
105.7
44.6
26.5

168.7
115.8
98.4
134.7
59.8

The rate for the selected year for the lowest earnings group appears,
in comparison with previous years, to be exceptional. The mor­
tality rate for previous births to the mothers in the group under $550
would normally not vary much from the rate in the selected year,
for conditions in the main in these families would not be materially
different in preceding years. But the mortality among previous

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33

BROCKTON, MASS.

births to mothers in this group was actually 151.3 or over twice the
rate found for the selected year. The other rates, given in Table
X X V , are also somewhat higher than for the year studied; for these
groups the earnings in previous years may not have been as high as
during the selected year which determined the earnings class, and
consequently conditions surrounding the infants born in previous
years may not have been so favorable.
Table X X V .—

In fa n ts born p reviou s to selected year to m others included in stu d y, in fa n t
deaths, and in fa n t m ortality rate, according to earnings o f fa th er d u rin g selected year.

Earnings of father during selected year.

TTnder $KfS0. . .

......................................... ............................

Live
births.

Infant
deaths.

Infant
mortality
rate.®

6 2,404

6 274

114.0

357
247
831
531
400
25
13

54
25
101
50
42
1
1

151.3
101.2
121.5
94.2
105.0

o j\ot snown wnere case is less man xuu.
,
b The apparent discrepancy between the births and deaths shown in this table and the figures secured
by subtracting the live births in the selected year and the deaths among them from the births and deaths
reported by the mothers in the maternal history section is due to the omission from the latter of the record
for 6 mothers. See section on maternal histones, p. 39.

Another point that might be mentioned in part explanation of the
low rate in the lowest earnings group for the selected year, is the fact
that a few fathers who earned comparatively little during the year
were classed in this group because of the low actual earnings. Ac­
tually the family standard in some of these cases was considerably
higher than the earnings would indicate. If the father deserted dur­
ing the year, or died, or lived for part of the year on savings because
of illness or incapacity to work, the family was put into the group cor­
responding to the amount that the father actually earned. In this
group was also included one father who earned less than $200, but who
received enough from rents and other sources to place him in the
highest group on the basis of family income. In fact> in 16 cases
where the father earned less than $450 the earnings were low on
account o f unusual circumstances rather than inefficiency of the
father or chronic slack work or short time in industry.
These
unusual cases would occur principally in the lowest group.
The analysis by type of feeding, as given in Table X V I, p. 23 shows
that a somewhat smaller proportion of infants in the lowest earnings
groups were artificially fed than in the higher earnings groups. This
fact may account in part for the low rate in this group.
No-eamings group.—A few instances were found where the fathers
earned or contributed nothing to the support o f the family. In one
case the father was separated from his wife; another deserted before
69484°—18-----3

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34

INFANT MORTALITY.

the baby was born; the others did not work at all during the year
after the baby’s birth on account of illness or injury. These were
classed in a separate group because of the various sources from which
the famihes drew their incomes. The mother who separated from her
husband went to work to support herself and baby; her two older
children were cared for by relatives. The deserted mother was
obliged to send three of her children to the State Home and the grand­
mother supported her and the baby. The family of one man who
wa^ afflicted with tuberculosis lived on savings, which can not prop­
erly be classed as earnings or income. This family was also given
some relief by the city.
Conditions favorable to low mortality rate.—A classification of the
1,247 births according to a combination of favorable conditions is
shown in Table X X V I. Class I is a “ baby aristocracy,” to be a
member of which one must meet five prerequisites. iThese prereq­
uisites represent conditions generally supposed to be favorable.
Only those babies were put in Class I who met all the following
conditions:
1. The father must have earned $850 or more during the year after
the birth.
2. The mother must not have been gainfully employed either dur­
ing the year before or the year after the baby’s birth.
3. The attendant at birth must have been a physician.
4. Both parents must be literate.
5. Housing conditions must meet the following standard:
(а) Good means of ventilation must have been provided and
good use must have been made of these means.
(б) The house must have been clean at the time of the agent’s
visit.
(c) The family must have had exclusive use of a water closet
located within the home.
id) City water must have been available within the home.
(e) The home must have housed less than one person to a
room.
Of the 1,247 births during the selected year, 208 met all the pre­
requisites and of that number 205 were live-born.
T a b l e X X V I .— B irth s during selected year, in fa n t deaths, in fa n t m orta lity rate, and per
cent o f stillb irth s, according to specified class.

Stillbirths.
Class.

All classes...........................................
Class I .........................................................
Class I I .................................. ...............


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Total.

Live
births.

Infant
deaths.

Infant
mortality
Per cent
rate.
Number. of total
births.

1,247

1,210

117

96.7

37

3.0

208
1,039

205
1,005

15
112

73.2
111.4

3
34

1.4
3.3

BKOCKTOlSr, MASS.

35

The benefits of a fairly good income with its concomitants are more
clearly ^demonstrated in this table than in Table X X III. In other
words, 73 out of every 1,000 babies died if their fathers earned fair
amounts, if their mothers remained at home, if they had at least fair
care at birth, and lived in good homes; while among those babies who
failed to meet one or more of these requirements, 111 o f every 1,000
died.
Supplementary sources of income.—Of the 1,247 births included
in this study, the families of 856 or more than two-thirds of the whole
number subsisted on father’s earnings alone; 389 received in addition
to this amount earnings of mother or other income or both; two had
no income whatever. The mothers of 244 of these 389 babies were
gainfully employed; for the rest the father’s earnings were supple­
mented from other sources, usually children’s earnings, rents, and,
in rare instances, interest on money invested.
The percentage of families who lived on father’s wages alone varied
directly with the amount of earnings. When the father earned
less than $550 only 56 per cent of the families lived on these earnings
only; the proportion increased until, when the father earned $1,250
and over, four-fifths were found to be subsisting on father’^ wages
as a sole source of income. The distribution of births in families
having supplementary sources of income according to the amount of
father’s earnings is shown in General Table 9.
Size of family and father’s earnings.—In considering the effect of
income upon the infant mortality rate, the size of the family is of
prime importance. With a given income a large family is obviously
much less comfortable than a small family.
The number of persons in the family according to father’s earnings
is given in General Table 10. This number is exclusive of the sched­
uled baby. The lowest earnings group contained the largest pro­
portion of live births in families with six or more members (19.5
per cent); the proportion decreased to a minimum of 11.3 per cent
in the group $850 to $1,049; in the group where the father earned
$1,250 and over it increased slightly to 14.7 per cent. In case of
many of the relatively larger families, the father’s earnings were
often supplemented by the earnings of the mother or of the other
children.
Father’s earnings and employment of mother.—The proportion of
mothers gainfully employed the year after childbirth declines pro­
gressively as father’s earnings increase. One mother out of every
five worked for wages or kept lodgers; but when the father earned
less than $550 proportionately more than four times as many mothers
were employed as when the father received $1,050 and over. In
other words, the amount the father earned was a factor in determining
whether or not the mother should go to work.


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36

INFANT MOBTALITY.

T a b l e X X Y I I .— Births during setected year and number and per cent o f births to mothers

gainfully employed during year following birth o f infant, according to earnings o f
father.

Total
births.

Earnings of father.

Births to mothers
gainfully employed,
---------------- -------------Number.
Per cent.

All classes....... .............

1,247

244

19.6

Less than $550.........................
$550 to $649..............................
$650 to $849..............................
$850 to $1,049.........................
$1,050 and ov er..................
No earnings and not reported.

156

53
29

34.0
23.8
20.8
18.2
7.8
13.3

122

414
308
232
15

86

56
18

2

Even in the very lowest earnings group slightly more than one-third
of the births during the selected year were to mothers who worked
during the year following the birth of the baby; this proportion
gradually decreased to 7.8 per cent when the father earned $1,050 and
over. Of the 278 births to mothers whose husbands were paid less
than $650 during the year, 82 or 29.5 per cent were to mothers having
gainful occupations; 16.8 per cent were to mothers gainfully employed
when the father earned more than this amount. This latter per­
centage (16.8) is lower than the percentage of mothers gainfully
employed for all the earnings groups together. Less than oneseventh of the births were to mothers gainfully employed in the
families where the fathers earned $850 and over.
Mother’s earnings.—More than one-half the mothers gainfully
employed during the year following the baby’s birth earned less
than $150 during this period. This amount was low for two
reasons: The majority of these mothers kept one or two lodgers;
those who were industrially employed worked only part of the year.
In these circumstances one would not expect large earnings. In
only nine instances did the mothers earn $550 and over. The
percentage of births in the different mother’s earnings groups is
shown for native and foreign-born mothers;1 a relatively larger
proportion of the births to foreign-born working mothers was in
the lowest group.
Employment of mother during year preceding birth of baby.—
Employment of the mother during some part of the year before con­
finement is shown in Table X X V III. More mothers worked the
year before than the year after confinement, the ratio being 128 to 100.
Compared with mothers employed in the year after confinement fewer
mothers were gainfully employed at home, but nearly four times as
many were engaged in occupations which took them away from home.
1 General Table 7.


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37

BROCKTON, MASS.

The infant mortality rate for children of mothers who did housework
only— that is, were not gainfully employed— the year before con­
finement was 100.4, while the children of mothers who were gainfully
employed died at the rate of 85.5; the same tendency is shown for
native and foreign-bom as well as for all mothers. The mortality
rates were about equal in the groups where the mothers worked at
home (84.4) and away from home (86.7). Mothers who were gain­
fully employed the year before confinement and those who were not
had proportionately the same number of stillbirths.
T a b l e X X V I I I .— Births during selected year, infant deaths, infant mortality rate, and

per cent o f stillbirths, according to employment o f mother during year before birth o f
infant and nativity o f mother.
Stillbirths'.
Employment of mother during year before
birth of infant and nativity of mother.

Total
births.

Live
births.

Infant
.Infant mortality
deaths.
cent
rate.« Number. Per
of total
births.«

All mothers.............

1,247,

1,210

117

96.7

37

3.0

Not gainfully employed.......
Gainfully employed.............
A t home.........................
Away from home...........

934
313
161
152

906
304
154
150

91
26
13
13

100.4
85.5
84.4
86.7

28
9
7
2

3.0
2.9
4.3
1.3

Native mothers..........

613

601

61

101.5

* 12

2.0

Not gainfully employed----Gainfully employed............
A t home.......... .............
Away from home..........

475
138
47
91

466
135
45
90

48
13
5
8

103.0
96.3

9
3
2
1

1.9
2.2

Foreign-bom mothers

634

609

56

92.0

25

3.9

Not gainfully employed —
Gainfully employed............
At home........................
Away from home.........

459
175
114
61

440
169
109
60

43
13
8
5

97.7
76.9
73.4

19
6
5
1

4.1
3.4
4.4

a Not shown where base is less than 100.

In all cities except Brockton the lowest infant mortality rate is
shown for babies of those mothers who were not gainfully employed
the year before confinement; mothers doing gainful work at home
lost their babies at a somewhat greater rate. (See Table X X I X .)
The highest rate of all, however, is for the babies whose mothers
worked outside the home, usually in industrial occupations. In
Brockton, the babies of mothers who worked in any capacity during
the year before confinement appear to have the advantage over
babies whose mothers were not employed.
It must be remembered, however, that mothers not ‘ ‘ gainfully
employed” often do as hard physical labor at housework as that per­
formed b y the gainfully employed, whether at home or away from
home. N ot so much difference, therefore, actually exists between
these groups, as might be inferred from the comparison.


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38

IN T A N T MORTALITY.

T a b l e X X I X . — Infant mortality rates for specified cities, according to employment o f

mother during year before birth o f infant.

Employment of mother during year
before birth of infant.

All cities.

Brockton.

Man­
chester.

Saginaw.

New Bed­
ford.

125.4

96.7

165.0

84.6

130.3

105.5
15&4

100.4
85.5

133.9
199.2

78.3
132.7

108.8
154.5

121.5
179.1

84.4
86.7

149.8
227.5

121.8
167.8

'(<*)
(a)

a Not shown where base is less than 100.

Interval between cessation of work and confinement.—An analysis
of the 150 live-bom babies whose mothers worked outside the home
during the year before the baby’s birth shows that two-fifths worked
less than half the year. . The mothers who ceased this work six
months or more before the baby’s birth lost fewer babies propor­
tionately than did those who worked later.
T able X X X . — Live births to mothers gainfully employed away from home during year
before birth o f infant, infant deaths, and infant mortality rate, according to length of
interval between mother's ceasing work and confinement.

Interval between mother’s ceasing work and confinement.

Live
births.

Infant
deaths.

Infant
mortality
rate.

150

13

86.7

88
62

10
3

113.6
48.4

Employment of mother during year following birth of baby.—Two
hundred and thirty-seven live-born babies, or 19.6 per cent of the
entire number included in the study, had mothers who were gainfully
employed during some part of the year following the birth of the
baby; three-fourths of these had mothers who kept lodgers and
almost 60 per cent of this number had but one lodger. The mothers
of 42 live-bom babies were employed outside the home; 9 of these
had mothers who went to work after the baby died. Only 33, then,
had mothers who took up industrial occupations during the lifetime
of their babies and 2 of these babies died. The mothers of only 13
went out to work before their babies were 3 months old; hence, 99
per cent of the Brockton babies were cared for b y their mothers dur­
ing the most critical period of infancy. Obviously, the question of
mother’s employment during the year after the baby’s birth was of
slight importance in Brockton.


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39

BROCKTO N, M ASS.

T able X X X I .— Live births during selected year, infant deaths, am? infant mortality
rate, according to working status o f mother during year following birth o f infant.

Working status of mother during year following birth of infant.

Live
births.

Infant
mortality
rate.®

Infant
deaths.

96.7

All mothers.............................. 1.................................................

1,210

117

No gainful work.....................................................................................

973

91

93.5

237

26

109.7

Resumed during infant’s life..........................................................

14
223

14
12

Work at home............... ............................................. . - ................

195

15

Resumed during infant’s life............... ....................................

5
.190

5
10

42

11

9
33

9
2

Resumed during infant’s life....................................................

(¡0
76.9
(6)

(b)

a Not shown where base is less than 100.
6 A rate for this group is not computed, as it would not be comparable with the other rates shown. The
infants in this group are obviously at risk only for that part of the year after the commencement of the
employment of the mother.

The effect of a mother’s gainful employment upon her child’s
chance of survival does not readily lend itself to statistical measure­
ment. One may concede that an industrial occupation which takes
the mother away from her home and precludes the possibility of her
nursing her baby at regular intervals can not be considered as a
factor other than detrimental to the well-being of a young child.
The number of mothers pursuing such occupations in Brockton was
so very small that no conclusions may be drawn from the data here
presented.
MATERNAL HISTORIES.

The mothers visited in the course of this study gave information
not only as to the children bom between November 1, 1912, and
October 31, 1913, but also with reference to all former pregnancies.
Data derived from these maternal histories on infant mortality rates
by nationality and by age and order of birth are presented to sup­
plement and corroborate the findings of the study of the scheduled
infants. Though the information was derived from the mother’s
statement only, and therefore may not be so reliable or so complete
as when checked by official records, yet the larger number of births
considered makes it possible to base the conclusions on a larger body
of evidence.
Inasmuch as 10 mothers gave birth to twins, the 1,247 babies had
1,237 mothers. The records of six mothers were excluded from the
tabulation because their statements were considered incomplete.
Information, then, is presented for 1,231 mothers who had given birth
to an aggregate of 3,703 children, of whom 95 or 2.6 per cent were
stillborn. Of the 3,608 live bom , 389 died in their first year.


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40

INFANT MORTALITY.

Infant mortality rate.—The infant mortality rate for all children
of the mothers considered was 107.8, a rate somewhat higher than
that found among babies born in the year selected. This infant
mortality rate can not be considered an index typical of conditions
in Brockton, since many of the babies included in the maternal his­
tory study were bom before their parents moved to Brockton and
only a small proportion of all the babies born in the, city during a
period of years was included.
Miscarriages.—In addition to the live births and stillbirths men­
tioned above, these mothers had had 206 miscarriages; these data
are not used in other tabulations. The information in regard- to
miscarriages is presented for whatever interest it may have, although
it is considered to be more or less unreliable, because some mothers
were reluctant about giving this information and others forgot.
Foreign-born mothers reported 107 miscarriages and native mothers
99. Five women reported having had more than 3 miscarriages; of
these two foreign-born mothers had had 6 and 7, respectively, while
three native mothers reported 4, 5, and 6, respectively.
Nativity of mother.—The infant mortality rate for all babies of
foreign-bom mothers was slightly lower than that for all babies of
native mothers. The rate for babies born to foreign-bom mothers
during the selected year was likewise low, compared with that of the
native group. (See Table X V III, p. 24.)
T a b l e X X X I I .— Total mothers, and births from all 'pregnancies, infant deaths, infant

mortality rate, and per cent o f stillbirths, according to nationality o f mother.
Stillbirths.
Nationality of mother.

Total Total
Live Infant Infant
moth­ births.
births. deaths. mortal­
ers.
ity rate.® Num­
ber.

Per cent
of total
births.®

All mothers'......................................

1,231

3,703

3,608

389

107.8

95

2.6

Native mothers...........................................
Foreign-horn mothers......../ ........... ...........
Lithuanian and Polish b ......................
Italian...................................................
Irish.......................................................
Swedish and Norwegian c ....................
Jewish...................................................
English, Scotch, and Welsh d ..............
French Canadian..................................
Other Canadian................... ...............
All other e . ...........................................

605
626
150
114
90
62
56
33
22
60
39

1,699
2,004
429
435
303
180
157
122
91
174
113

1,661
1,947
418
415
296
180
154
118
90
165
111

182
207
62
46
23
9
13
14
10
17
13

109.6
106.3
148.3
110.8
77.7
50.0
84.4
118.6

38
57
11
20
7

2.2
2.8
2.6
4.6
2.3

3
4
1
9
2

1.9
3.3

103.0
117.1

5.2
1.8

® Not shown where base is less than 100.
b Including 133 Lithuanian and 20 Polish,
c Including 60 Swedish and 2 Norwegian.
d Including 24 English, 6 Scotch, and 3 Welsh.
« Including 11 Syrian, 8 Greek, 4 Armenian, 4 German, 4 Russian, 2 Finnish, 2 French, 1 Portuguese, 1
Roumanian, 1 European Spanish, 1 America^ Spanish.

Curiously enough, all the babies bom to Lithuanian and Polish,
Italian, Irish, and Swedish and Norwegian mothers included in the
study died at a much higher rate than did those bom in the selected
year. On the other hand, the incidence of death among all babies
born to mothers of the British and Canadian groups, other than

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41

BROCKTON*, MASS.

French Canadian, was much smaller than among those born in the
year chosen.
Deaths in early infancy.—The 1,231 mothers considered in the
maternal history study had lost 389 live-bom infants; of these 128,
or 32.9 per cent, died before they had attained the age of 2 weeks.
This'high percentage of early deaths among all babies indicates that
the still higher proportion of deaths (35.9 per cent) in the first two
weeks among babies bom in the selected year was not peculiar to
the year chosen.
Plural births.—The mortality among twins and triplets is much
greater than among single births. Although the number of plural
births to the 1,231 Brockton mothers is small, a comparison of the
infant mortality rates for both classes of births is of interest. Of the
3,608 live births to these mothers, 63 were plural births; of the latter,
31 died in infancy, giving an infant mortality rate of 492.1, in striking
contrast to the rate (101) for single births.
T a b l e X X X I I I .— Single and plural births resulting from all pregnancies, infant deaths,

infant mortality rate, and per cent o f stillbirths.
Stillbirths.
Total
births.

Single and plural births.

Live
births.

Infant
deaths.

Infant
mortality
Per cent
rate.
Number. of total
births.

All births............................................

3,703

3,608

389

107.8

95

2.6

Single births............ .............................
Plural births.................................................

3,639
64

3,545
63

358
31

101.0
492.1

94
1

2.6
1.6

Order of pregnancy.—An analysis of the 3,703 births according to
the order of pregnancy is shown in Table X X X I V . Although by no
means regular in its rise from one pregnancy to the next, the infant
mortality rates show a tendency to increase with the number of the
pregnancy. The general trend was not very different, however, from
that shown in Table X I I (see p. 20), basfcd on births in the selected
year.
T a b l e X X X I Y .— Births from all pregnancies, infant deaths, infant mortality rate, and

' per cent o f stillbirths, according to number in order a o f pregnancy.

Total
births.

- Order a of pregnancy.

All pregnancies............. ................. .
Pregnancies:
First......................................................
Fourth.............................. - ...................
Fifth.......................................................
Seventh..................................................
Eighth and over............ s.....................

Live
births.

Infant
deaths.

3,703

3,608

389

107.8

95

2.6

1,241
824
561
378
252
173
116
158

1,211
804
541
367
248
169
114
154

126
76
62
43
29
16
16
21

104.0
94.5
114.6
117.2
116.9
94.7
140.4
136.4

' 30
20
20
11
4
4
2
4

2.4
2.4
3.6
2.9
1.6
2.3
1.7
2.5

a Excluding miscarriages.


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Stillbirths.
Infant
Per cent
mortal­
ity rate. Number. of total
births.

42

IN F A N T MORTALITY.

Age of mother.—The analysis by age of mother of all births included
in the maternal history study is presented in Table X X X V . The
general tendency for the rate to decrease as the age of the mother
increased was the same as that shown in Table X for infants in the
selected year. The rate for infants of mothers under 20 was the
highest, 145. The percentage of stillbirths on the other hand was
highest for mothers 30 and over, a tendency also shown in rates for
the selected year.
T a b l e X X X V .— Births from all pregnancies, infant deaths, infant mortality rates, and

per cent o f stillbirths, according to age o f mother.
Stillbirths.
Total
births.

Age of mother.

Live
births.

Infant
deaths.

Infant
mortal­
ity rate.o

Number.

Per cent
oftotal
births.o

All mothers........................................

3,703

3,608

389

107.8

95

2.6

Under 20.......................................................
20 to 24..........................................................
25 to 29............. ............................................
30 to 34..........................................................
35 to 39..........................................................
40 and over...................................................
Not reported.................................................

268
1,206
1,135
677
332
79
6

262
1,181
1,114
658
312
76
5

38
133
109
72
30
6
1

145.0
112.6
97.8
109.4
96.2

6
25
21
19
20

2.2
2.1
1.9
2.8
6.0

1

o Not shown where base is less than 100.

Infant mortality rates by number of births to mother.—Infant
mortality rates according to the number of births to .the mother are
presented in Table X X X V I. The rate was much higher where the
mother had had many births than where she had had but few.
The rate for infants of mothers reporting 4 births or less was 89.7;
while the rate where the mother had 5 or more births was 128.3.
T a b l e X X X Y I .— Live births from all pregnancies, infant deaths, and infant mortality

rate, according to the number o f births to mother.

Births to mother.

Live
births.

Infant
deaths.

Infant mor­
tality rate.

Total.........................................................

3,608

389

107.8

1 to 4 births.............................................................. .
5 births and over..........................................

1,917
1,691

172
217

89.7
128.3

WARD DISTRIBUTION.

The wards of Brockton radiate from the central part of the city like
the spokes of a wheel; each ward has a congested region near the cen­
ter of the city generally given over to business, a residential district
in which the population is evenly distributed, and a large stretch of
farm land. In regard to housing and sanitation, each ward contained
examples of the best conditions, the worst conditions, and all inter­
mediate stages. Little or no homogeneity existed in the nationality


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43

BROCKTON, MASS.

or income of the residents of any one ward, ward boundaries being of
olitical significance only. The differences in mortality rates in the
various wards of the city are shown in Table X X X V II.
T a b l e X X X V I I — Births during selected year, infant deaths, infant mortality rate, and

per cent o f stillbirths, by ward o f residence.
Stillbirths.
Ward of residence.

Total
births.

Live
births.

Infant
deaths.

Infant
mortal­
ity
rate.

Number.

Per cent
of total
births.

The city .............................................

1,247

1,210

117

96.7

37

3.0

Ward:
1..............................................................
2..............................................................
3..............................................................
4..............................................................
5 ............................................................
6 .........................................................
7..............................................................

128
126
149
156
226
300
162

127
124
146
147
220
289
157

9
12
14
12
25
28
17

70.9
96.8
95.9
81.6
113.6
96.9
108.3

1
2
3
9
6
11
5

.,8
1.6
2.0
5.8
2.7
3.7
3.1

The first ward had an infant mortality rate of 70.9, the lowest in
any ward in the city. It also had the lowest stillbirth rate. Twothirds of this ward was a farming district dotted with old-fashioned,
unimproved cottages. This portion had no paved streets, no sewer­
age system; in fact, it possessed all the advantages and disadvan­
tages of a country district. The western part of the ward, farthest
from the center of the city, was largely given over to one-family
houses of the attractive semibungalow type, of frame or concrete
construction, with well-kept lawns and gardens. Houses, for two
or more families were marked exceptions. Most of the finest hornet
in Brockton were located on West Elm Street, which runs through
the center of this ward. Streets were well shaded and presented a
most attractive appearance.
Main Street with its crowded business district formed the extreme
eastern end of the first ward; Some of the worst housing conditions
to be found in Brockton were in this immediate vicinity. Four
babies were bom during the year selected in Alton Court, an un­
paved, insanitary alley inhabited b y Italians. One of these babies
died. Since the time, of this inquiry conditions in this alley have
been improved to some extent.
The other wards bore a close resemblance to the first; the second
was the only one having no rural area. >In no ward except the first,
however, was the one-family house the prevailing type. The section
known as Campello, comprising parts of the third and fourth wards,
was originally the home of the Swedes and is now inhabited by the
natives of Swedish descent. Throughout Campello the well-kept
homes and yards bore witness to the thrift of the Swedish people.
Most of these people were skilled shoe operatives who owned their
homes.


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44

INFANT MORTALITY.

The homes in this section presented, a striking contrast to those
found along the boundaries of the fourth and fifth wards in the
vicinity of the gas house, where the homes were not so well kept up
and boasted in many cases of a heterogeneous collection of outhouses
in a more or less advanced stage of decay. Chickens were kept in
many instances, and the henhouses did not always comply with the
regulations of the health department which required them to be
placed at least 25 feet away from a dwelling. Smoke and odors from
the gas house and near-by shoe factories made this region somewhat
unattractive. Paved streets and sidewalks were almost unknown
and dirty yards were characteristic. Even in cases where fairly
clean and up-to-date houses were found, many of the yards appeared
to be filled with the accumulated rubbish of years.
The western end of the fifth ward was the home of the Jews, Ital­
ians, Greeks, and Syrians. Here were found the oldest and dingiest
tenement houses of the city, and as the mothers and children were so
often out on the sidewalks sunning themselves, the streets had the
appearance of the typical foreign quarter of a large city. The yards
were small and full of rocks and rubbish, while green grass was almost
unknown in the neighborhood. The infant mortality rate for this
ward was the highest in the city, being 113.6.
The northern part of the sixth and seventh wards, known as Montello, differed from other parts of the city in that no such great dis­
parity of social and economic status existed among its residents.
The Lithuanians had a compact colony in Montello, which was dis­
tinctly different from the rest of the city.
The number of deaths in each ward, according to the certified
cause of death, is presented in General Table 4. The deaths were
few and more or less evenly distributed. The fifth and sixth wards
in which housing conditions were relatively poor showed the greatest
number of deaths from respiratory diseases.
H OU SING .

Brockton styles itself the “ city of workers and winners.” Judging
from the general appearance of the town, this phrase seemed decid­
edly appropriate. Although one or two congested alleys and a few
isolated cases of dilapidated dwellings were to be found, Brockton
had no acute housing problem. Nor had it, according to the British
Board of Trade report, “ to contend with any evil legacy in the shape
of large blocks of dwellings, built according to the loose standards of
bygone days, such as characterize other and larger cities.” 1 This
condition was no doubt partly due to the recent development of the
city, although the high standard of intelligence demanded of the
shoe operatives, together with the fairly high wages they received,
1Living conditions of the wage-earning population in certain cities of Massachusetts, p. 268. B oston, 1911.


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was a potent factor in maintaining this housing standard. The city
as few or no housing laws except for fire protection.
The dwellings of Brockton were almost invariably frame. Among
the well-to-do, a family generally had the exclusive use of an entire
house and often a lawn and gardens. Among the working people,
however— the shoe operatives and small tradesmen— although the
“ cottage” or one-family house was by no means uncommon, the
two-tenement, three-tenement, and even six-tenement “ blocks”
were far more numerous.
The distribution of the 1,247 births considered in the detailed
study according to the number of families in the building appears in
Table X X X V III.
T a b l e X X X V I I I .— Number and 'per cent distribution o f births during selected year,

according to number o f families in building.
Births during selected
year.
Families in building.
Number.

Families to building:

Per cent
distribu­
tion.

1,247

100.0

249
452
376
30
10
101
26
3

20.0
36.2
30.2
2.4
.8
8.1
2.1
.2

The older type was a two-story house with gabled roof and attic
which was originally intended for the use of a single family. In
some cases it was rented to two families who shared the attic as a
storeroom; in others the attic was occupied by a third family. This
sort of building was invariably attractive in appearance, inasmuch
as it lent itself to a variety of design. The casual observer would
have taken it for the home of a well-to-do business man rather than
a house for two or three families. On the other hand, one would
not for a moment have mistaken the new three-tenement houses;
they were built on square lines with three separate porches, both
front and rear. This was the most common type of residential
building being constructed at that time for the workers of Brockton,
and, in fact, throughout other New England manufacturing towns.
The general criticism of these buildings is that the fire hazard is
great.
The Lithuanians and Poles had until recently shown but little
tendency toward the acquisition of real estate. One reason for this
was that practically all the homes in their community were three- or

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INFANT MORTALITY.

six-family tenement houses which probably would have cost alto­
gether too much and could not have been paid for by even the mos
prosperous in many years. The prospect was too discouraging.
. The New American Association, an organization formed for the
purpose of Americanizing foreigners in Brockton, interested a real
estate firm in building seven one-family cottages in the Lithuanian
section, and they were all sold to families of this nationality before
the foundations were laid. After this encouragement the association
decided to make plans for the building of many homes of this type.
Under ordinary circumstances the moderately prosperous Lithuanian
would be able to pay for such a home in about 10 or 12 years.
Among most of the foreign-born families and many of the native
both living room and dining room had a particularly uninhabited
appearance, while the kitchen represented every phase of the family’s
activities. The rooms of each flat were compactly grouped about the
kitchen to facilitate heating. In the lower-priced tenements such an
arrangement was essential because of the fact that all the rooms were
heated from the kitchen range.
The distribution of births included in the detailed study according
to the amount of rent paid and the ownership of the home appears
in Table X X X I X .
T a b l e X X X I X .— Number and per cent distribution o f births during selected year,

according to tenure and rental o f home.
Births during selected
year.
Tenure and rental of home.
Number.

Monthly rental:
$10.00 to $12.49............................................... ...............................................
$12.50 to $14.99............ ..................................................................................
$15.00 to $17.49................. .............................................................................

Per cent
distribu­
tion.

1,247

100.0

224
1,023

18.0
82.0

142
307
172
204
136
9
20
33

11.4
24.6
13.8
16.4
10.9
.7
1.6
2.6

Eighteen per cent of the births occurred in families owning their
homes; 65.7 per cent in families paying $10 or more rent per month;
and 27.3 per cent in families paying $15 or more rent per month.
Since fairly good flats of four rooms could be obtained for $10 a
month and $15 paid for a flat with all modern conveniences, it is
apparent that the majority of Brockton’s babies born in the selected
year were comfortably housed.
Of the 1,210 live-born babies included in this study, 1,083 lived in
homes of more than three rooms and 677 in homes of more than four

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rooms. The number of persons living in dwellings having a specified
number of rooms is shown in detail in General Table 11. These data
are assembled in Table X L and infant mortality rates are given for
babies who lived under varying conditions as regards congestion.
T a b l e X L .— Live births during selected year, infant deaths, infant mortality rate, according

to average number o f persons per room.

Live
births.

Persons« per room.

1 but less than 2....................................................................................

a Excluding infant bom during selected year.

Infant
deaths.

Infant
mortality
rate.*»

1,210

117

96.7

705
472
32
1

61
52
4

86.5
110.2

6 Not shown where base is less than 100.

The greatest mortality occurred among babies who lived in the
most congested homes. Overcrowding is an evil so closely allied with
poverty, ignorance, and dirt that it is difficult to obtain an absolute
measure of its importance. Nevertheless it may be conceded that
the baby brought up in a. home in which the number of rooms is equal
to or greater than the number of persons has a decided advantage
over one living under conditions of greater congestion.
More than half the homes, or 59 per cent, were rated as “ clean,”
while but 12 per cent were reported “ dirty” ; city water was available
in all but 10 homes; and in only six instances did the mother have to
carry water in from outdoors. In short, the percentage of families
living under favorable conditions was large. Every home visited
had the advantage of some modern conveniences; and in 41 per cent
all the following conditions were reported: Clean rooms, good means
of ventilation, city water in the home, exclusive use of a toilet
located within the dwelling, and sewer-connected sink and toilet.
Throughout the thickly settled sections, tenements were generally
provided with toilets within the home, 81 per cent of the homes
visited being so equipped. In this connection it may be noted that
the 185 yard privies, as well as the houses lacking city water and
sewer connection, were found mostly in the rural area included within
the city limits.
Although means of ventilating the toilet were commonly provided,
one six-family house was found where the bathrooms were without
windows and had no light or ventilation except indirectly through the
kitchen. The tenants complained of the difficulty of keeping the
toilet clean and aired under such conditions. A serious housing
defect was found in a few instances in the Lithuanian quarter, where
the back door of a few apartments opened directly into the toilet,
which in turn served as a hall leading to the kitchen. The disad
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vantages of such an arrangement are obvious. Eight toilets were,
found on porches and 36 were located in cellars. The latter were
objectionable from two standpoints: First, because they were
invariably poorly ventilated and often damp; second, because the
families had to descend one, two, or even three flights of stairs in
order to reach them.
Fifty-nine of the families visited had to share the toilet with one
or more other families. Where such a division of responsibility
existed, the difficulty of keeping the toilet clean was greatly in­
creased, because, as one mother expressed it, ‘ ‘What is everybody’s
business, is nobody’s business.” This sentiment applied with
equal force to the halls and stairways of the six-family tenements,
which were usually found to be very dirty, although often the rooms
within might be immaculately clean.
Ample means for light and ventilation were found, as there was
no lot congestion in the city; there were many vacant lots, few rear
houses, and few, if any, basement tenements.
The typical Brockton lot was 60 by 120 feet. Inasmuch as the
usual three-tenement house had a frontage of about 25 feet and a
depth of about 40 feet, it can readily be seen that a very large pro­
portion of the lot remained uncovered. Fifty-two alley and rear
houses were found and conditions in and about these houses did not
come up to the general standard established throughout the city;
but in no case did the occupants suffer from lack of light and air
because of overcrowding on lots.
In general, for an industrial city, Brockton’s housing accommoda­
tions were exceptionally good. The dwellings were almost uni­
formly in good repair, sanitary and other conveniences might be
secured at a fairly low rental, and neither lot congestion nor conges­
tion within the tenement existed to any extent; in the homes visited,
not a single dark room was found. Where dirt and insanitary con­
ditions existed, they could usually be traced to the family rather
than to any lack of public sanitation facilities. The citizens have
aimed high in regard to housing, and they have largely succeeded in
maintaining a standard of comfortable homes for workingmen’s
families.
SOCIAL AGENCIES.
The board of health is the most active agency in Brockton in
reducing infant mortality. It is composed of three members, one an
executive officer giving full time to the work and the other two
physicians who work part time.
Each birth occurring within the city limits must be reported to
this board within 24 hours. Immediately after this notice has been
received, the health department sends the mother a pamphlet1‘issued
for the purpose of lowering the infant mortality, and to give infor
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mation as to the proper care of milk in the home.” This is printed in
both English and Lithuanian. The law requires all cases of ophthal­
mia neonatorum to be reported to the health department. Such
cases were visited by the tuberculosis nurse who was in the employ of
the department. Between May 19 and December 31, 1913, she made
207 calls to 16- babies who were referred to her by midwives and
doctors as ophthalmia neonatorum cases. The health department
also has charge of the milk inspection and chemical analysis of the
city water. The total expenditures of this department for the year
ended November 30, 1913, amounted to $40,821.47.
The Brockton Milk and Baby Hygiene Association was organized
in 1913 and supported during that year b y private contributions.
The health department made a spot map showing where all the
infant deaths in the city for the past five years had occurred, as well
as the deaths from digestive disturbances, and milk stations were
established at the two points in the city where the number of infant
deaths had been greatest during that period of time— the sixth ward
and the fifth ward. The following extract has been taken from the
association’s report:
Stations opened on E verett Street and Am es Street on June 11th, closing on Septem ­
ber 20th [1913].

True to the nam e, the aim has been to provide and distribute clean

m ilk, modified to suit the need, and to teach mothers the proper care of babies.

N inety

babies have been cared for, tw enty-eight conferences with physicians held and three
hundred and seventy-four calls made b y nurses in the homes.

Nearly all the babies

have im proved under our care and several lives of little ones saved.

W e have proven

that there is need for such service and that the city should continue the service in
some form.

This work was accomplished at an expenditure of $728.37.1

Of this amount only a small part was refunded by the mothers
in payment for milk. A trained nurse was in charge of the station
during the three months in summer when the work was in active
operation. Physicians were in charge of the clinics. So successful
was this work the first year that the city took charge of it the follow­
ing year (summer of 1914), and since that time a third station has
been established. The Lithuanians and Jews were the nationalities
profiting most by this work, as the two stations on Ames and Everett
Streets were located in the heart of their respective districts. Their
interest and cooperation were aroused by mass meetings and indorse­
ment by their more prominent clubs and organizations.
The Brockton Visiting Nurse Association was established in 1904.
Its four nurses cared for the sick who were unable to secure proper
care in their homes and who could hot get or did not need hospital
care. An insurance company also engaged them for the care of all
its cases. The care of tubercular patients took a large part of their
time. During 1913 they made 882 visits to patients. Owing to
1 Thirty-second Annual Report of the Department of Public Health, 1913, p. 26. Brockton, 1914.
69484°— 18------ 4


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INFANT MOBTALITY.

the inadequate force no prenatal work was done at that time
and little educational work could be accomplished in the families
beyond the directions necessary for the care of the patients. Since
the time of this inquiry, however, the number of nurses has been
doubled and they have been able to devote considerable time and
attention to preventive work, including instructions to prospective
mothers on prenatal care. The supervising nurse of the association
also acts in the capacity of public health nurse for the city; this
cooperation has brought about many beneficial results.
The Brockton day nursery was organized in May, 1909, in the
center of the Jewish and Syrian quarter. A philanthropic citizen
made this work possible by presenting the building and a sum of
money, the interest of which was to be expended in maintenance.
The purpose of the nursery was to provide a place where widowed
mothers who were compelled to work might leave their babies
during the day. As a rule no baby was admitted whose father was
living, unless he were ill or apparently unable to secure employment.
The nursery cared for very few children under 1 year of age. A
kindergarten was conducted in connection with the day nursery and
small children were admitted upon the payment of 10 cents a day.
In cases where the mothers were unable to pay the babies were
admitted free.
Mothers’ pensions were paid in part by the city. The State paid
one-third and the city paid the remaining two-thirds. Widows
were eligible for this pension, as well as 'wives whose husbands had
been away for over a year and who had taken out a warrant charging
their husbands with nonsupport. They might apply for it or be
recommended. The State had its own investigator, who conferred
with the overseer and her report was referred to the authorities
in charge and acted upon by them. No stipulated amount was
fixed by law, but a budget was arranged b y some one in the depart­
ment and the same rates were applied to almost every family. The
home conditions were inspected from time to time and the State had
the privilege of withdrawing the pension if it seemed unwise to
continue it. Two mothers of children born during the selected
year benefited by this law.
The public charities were under the control of the overseer of the
poor. Outdoor relief was given to the poor in their homes and
patients were supported in the almshouse and other institutions.
The main burden of supporting the poor fell on this department
although a great deal of relief was given b y churches and societies.
Twelve of the families included in this study were the recipients of
city relief.
Until the spring of 1915 Brockton had no charity organization
society. While the city had to deal with no acute poverty problem,

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51

such a society was nevertheless greatly needed to prevent the duplica­
tion of effort, which had existed up to that time. The central relief
association was beginning to meet this need by maintaining a confi­
dential exchange.
The income from the Snow fund, which was left to the city several
years ago, was expended under the direction of the mayor, but he
referred practically all cases to the overseer of the poor. This income
amounted annually to about $3,500 and had to be spent for excursions
and for Christmas dinners and presents. The school nurses made the
recommendations for the excursions and outings.
The public-school department was an active influence in the broad­
est sense. It maintained industrial classes, evening schools, special
classes for non-English speaking children, continuation classes for
boys and girls between 14 and 16, summer schools, playgrounds,
school gardens made by the pupils, a parent-teacher association,
dental clinic, three medical inspectors, and a school nurse.
The New American Association aimed to protect foreigners from
exploitation, to train them to become true American citizens, and to
enable them to be assimilated into the community with a minimum
of struggle and delay. Through its influence public evening schools
for immigrants had been maintained, as well as special schools
for adults, schools for prospective citizens, and an immigrant pro­
tective and advisory bureau. Once a year a reception is held to wel­
come the newly naturalized citizen. This association had been
directing a study of the community from the immigrant standpoint.
The secretary for the association has written “ The Shoe City Reader,”
a simple textbook for the use of foreigners who are employed in the
shoe industry and who wish to learn English.
CIVIC FACTORS.
Milk supply.—The bacteriological laboratory of the health depart­
ment was one of the most complete and best equipped in New Eng­
land and the bacteriologist was a recognized authority throughout
the State. Sanitary milk inspection was begun in 1906 with the pur­
pose of securing for the city “ a clean, fresh, and healthful milk supply,
as well as one that would not fall below the standards prescribed by
law.” 1
The maximum bacterial count permissible was 500,000 per cubic
centimeter; this standard remained unchanged from summer to
winter. The dairies were inspected periodically. When pus or
streptococci were found in milk from any dairy, the individual cows
were examined until the infected animals were found, and these ani­
mals were then immediately isolated.
1 Thirty-second Annual Report of the Department of Public Health, 1913, p. 39. Brockton, 1914.


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INFANT MORTALITY.

The health department published the names of the 14 dairymen,
who during 1913 had an average of 50,000 or less bacteria to the
cubic centimeter, as well as the names of the 15 dealers with the lowest
average bacterial counts during the eight years since milk inspection
had been in force. As only, four of these had had averages of less than
50,000 throughout the whole time, it was evident that conditions
were being improved every year. Householders and physicians
might consult these records at the office of the health department.
“ The constant inquiries for such information is evidence of the inter­
est taken by the thinking public in this work.” 1 Out of 638 mothers
who gave their children cows’ milk at some time during the first year,
185 or 29 per cent purchased it of the 14 dairymen whose milk aver­
aged 50,000 bacteria or less during 1913.
During the year 196 dairies were scored and, with 100 as a maxi­
mum, the average score was 53. Two per cent scored below 31;
and 11 per cent below 41; only 2 per cent scored above 81. In this
connection, the bacteriologist in his annual report for 1013 stated:
In the matter of scoring dairies we have found nothing to shake our faith in the
belief that what the Brockton m ilk consumers are primarily interested in is the actual
quality of m ilk th ey are receiving rather than its possible production in a dairy scoring
95 per cent.

Water supply.—Brockton obtained its water supply from Silver
Lake, the largest of a chain of lakes about 15 miles distant from the
city. The water was chemically analyzed by the bacteriologist once
a week and the results of this analysis were published as a monthly
average. He reported “ a general freedom from pollution from
animal sources,” 2 as well as an extremely low bacterial count with a
total absence of colon bacilli and streptococci. The water of 23 wells
and springs was chemically tested also during 1913. Only 10 fam­
ilies included in this study used other than city water. One death
occurred in Brockton during 1913 because of typhoid fever.
Sewerage system.—Brockton had 125.02 miles of accepted public
streets and 71.79 miles of sewers in 1913. Since the city limits in­
cluded a large area which was rural in character, the proportion o f
accepted streets in the city proper which had sewer mains was much
larger than at first appears. But the city engineer estimated that
'the city had from 75 to 100 miles of “ private ways” which were not
“ accepted streets.” A “ private w ay” was a street laid out by indi­
viduals and not yet accepted as such by the city council. The city
assumed no responsibility whatever for accidents which might occur
on these streets. Though efforts were constantly being made to have
the city take these “ private ways” under its jurisdiction, but little
headway had been made at the time of this inquiry.
1 Thirty-second Annual Report of the Department of Public Health, 1913, p. 47. Brockton, 1914.
2 Thirty-second Annual Report of the Department of Public Health, 1913, p. 36. Brockton, 1914,


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The “ private ways” had no connection with the city sewer and
were unable to obtain it until they had been accepted as streets. In
the report of the city engineer and the sewer commissioners these
“ private ways” were ignored. If they were taken into consideration,
but 30 or 40 per cent of the streets had sewers. The majority of
dwellings in the city proper, however, were sewer connected, although
the homes of 320 or 25.7 per cent of the babies included in this study
did not have sewer-connected toilets and the homes of 209 or 16.8
per cent had sinks not connected with the sewer main. Some of
these were practically rural homes; others in the more thickly settled
part of the city were located on streets on private ways which had no
sewers; and some had availed themselves of the exemption in the
ordinance quoted below from the rules and regulations of the board
of health.
S e c t io n 1. B u ild in g s to be connected w ith sew er .— E very building situated on a
public street, court, or passageway in this city, in w hich there is a public sewer, is
hereby required b y this board to be connected b y a good and sufficient particular
drain w ith such pu blic sewer.
S e c . 2. T h e board of health m ay exem pt from the provisions of the preceding
section any building or buildings w hich in their judgm ent ought to be exem pted, and
said exem ption m ay be either temporary or permanent, as said board m ay determine.

The city engineer’s report for 1913 showed that the work of con­
necting buildings with the city sewer was progressing rapidly, 339
connections having been made during 1913. He estimated, however,
that at the end of the year 1913 about 17 per cent of the property
abutting on city sewers was at that time still unconnected.
Sewage disposal.—The method of sewage disposal in Brockton
was that of intermittent sand filtration. According to Rosenau,
“ the efficiency of intermittent sand filtration is higher than that of
any other process.” 1 The system is described by Merriman as follows:
The method of purifying sewage b y filtration is founded on the same principles
as those

*

*

*

for the artificial filtration of water.

Sewage is a very impure

water, b u t not m uch more impure than the surface drainage of some pastures and
swamps; b y passing it through soil at a slow rate and supplying sufficient air to enable
the useful bacteria to work, the dead organic matter becomes com pletely changed
into harmless gases and mineral compounds, so that the resulting effluent is clear
and pure water.2

The disposal plant was constructed in 1893 and has been improved
in 1905, 1908, and 1912. The city had 37 acres of sand beds in
1913. The plant is located in the extreme southwestern section of
the city in the third ward where the sandy soil is well adapted to
the purpose, and where it is convenient to a small stream, into
1 Rosenau, Milton J. Preventive Medicine and Hygiene, p. 969. New York, 1917.
2Merriman, Mansfield. Elements of Sanitary Engineering, p. 204,


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INFANT MORTALITY.

which the effluent is discharged. In his report on municipal engi­
neering, Baker states that "am ong the best-known examples of
intermittent filtration in America are the works at * * * Brock­
ton, Massachusetts.” 1
Surface drainage.—Surface drainage was excellent, being entirely
separate from the sewerage system. The streets were, in the main,
well graded and the rainfall was carried off by 19.51 miles of surface
drains.
Garbage collection and disposal.—Garbage collection in Brockton
was under the supervision of the overseer of the poor. Garbage
must be “ placed in covered vessels, and no ashes or other refuse
matter shall be mingled therewith.” 2
Collections were made in the central portion of the city three times
a week, and in the more remote sections only once a week. The
city furnished teams and hired labor to haul the garbage a mile
and a half from the center of the city, where it was either dumped
on the poor farm to be used as fertilizer or fed to the pigs. Com­
plaints „were sometimes made because of the odor from the wagons
passing through the streets on the way to the poor farm.
The overseer of the poor stated that it was only a matter of time
when some other system of garbage disposal would have to be
adopted, but no steps had been taken in that direction at the time
of this study.
Ashes and noncombustible rubbish were drawn to the city dumps.
These dumps appeared to be unnecessarily numerous and were very
unsightly, but they were an indication of the rapid growth of the city
rather than a menace to health. In the rural districts of the city
were many shallow pools of stagnant water into which tin cans and
other rubbish had been thrown. Apparently no attention had been
paid to these breeding places for mosquitoes. As far as it was possible
to determine, the ordinance regarding collections of garbage and ashes
was very well enforced.
Cleanliness of streets.—The highway commissioner reported that
no complaints of dusty streets were received during the summer of
1913. The streets were sprinkled with hot asphalt and a coating of
sand. This treatment was supposed to keep them dustless the entire
season, but opinions casually expressed indicated that the method was
not altogether satisfactory. Undoubtedly much of the dust came'
from dirty sidewalks which were everywhere in evidence. In the
outlying districts, where few of the streets were improved, serious
annoyance was occasioned after a hard rain by the mixture of mud
and sticky oil. B y far the larger proportion of the streets in the
1 Baker, M. N. Municipal Engineering and Sanitation, p. 150.
2 Rules and Regulations of the Board of Health, p. 11.


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sparsely settled districts were, however, merely country roads. The
paved streets of the city proper were kept in fair condition.
Street and sidewalk paving.— Only 8.26 miles of streets were paved
while 31.32 miles were macadamized. This was exclusive of State
roads which passed through the city.
Brockton had 10.98 miles of concrete and asphalt sidewalks and
8.53 mil os of granolithic sidewalks, making 19.51 miles of sidewalks
in all, as compared with 125 miles of accepted streets. In addition,
the 75 or 100 miles of “ private ways” had no improvements at all
unless provided by the individual property owner.
Smoke nuisance.—The city had never adopted a definite policy in
regard to the smoke nuisance, although an ordinance on this sub­
ject was being considered for the future. The only noticeable an­
noyance from smoke was in the vicinity of the gas house; the odors
there were especially trying also. Most of the factories burned soft
coal, but the fact that these factories were located in somewhat
sparsely settled parts of the city and were themselves widely sepa­
rated eliminated the smoke nuisance to a large extent. One of the
largest shoe factories in the city had had its steam power plant taken
out and electricity installed in its place about the time of this inquiry,
and since then other factories have taken similar action. But it
was through chance rather than design that Brockton had no smoke
nuisance.
THE LIQUOR QUESTION IN BROCKTON.
Alcoholism is recognized as one of the important causes of infant
mortality. Hence, the no-license law of Brockton which has been
in effect every year since 1886, with the single exception of 1898,
was believed by many inhabitants of the city to be a factor in the
low infant mortality rate. •
While it is easy to show the effect of drink on infant mortality in
specific cases, it is difficult to state how many infant lives are saved
by prohibition of the sale of liquor. Any influence which tends to
make healthier parents, better homes, and more contented families
will tend to reduce the number,of infant deaths. In common with
most of the complex social and economic factors underlying the
causes of infant mortality, the effect of prohibition, although ad­
mittedly beneficial, can not be measured directly. In a city having
excellent sanitation facilities, a strong sense of civic pride, good
wages, and intelligent workers, the abolition of saloons might be con­
sidered either as cause or effect.
CONCLUSIONS.
Infant' mortality rate.—During the year selected for this study
Brockton had an infant mortality rate of 96.7, which is relatively low
compared with other manufacturing cities having similar climatic


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56

INFANT MORTALITY.

conditions. This low rate has been attributed to the high wages paid
by the dominant industry of the city, the intelligence of the workers,
the fact that very few mothers were gainfully employed away from
home, and the generally good municipal sanitation. But when the
infant mortality rates of other cities of similar size and the general
type of population are considered, the Brockton rate does not seem to
be commensurate with the advantages generally enjoyed throughout
the city.
Nativity of mother.—The mortality among babies of foreign-born
mothers was lower than among babies whose mothers were native
Americans. Few, if any, New England manufacturing cities have
shown similar results. To a certain extent this favorable condition
is due to the fact that most of the foreigners who come to Brockton
with their families are skilled workmen. Furthermore, they are not
obliged to live under extremely poor housing conditions, as in more
congested cities.
The shoe industry demands skilled workers— others do not come
to the city in great numbers; the high wages paid enable the workers
to live in fairly comfortable homes. Although the more recent immi­
grants have not yet reached the standards of living attained by the
Swedes, Irish, and British in the city, nevertheless Brockton has no
problem of vast numbers of foreigners of an extremely low eoonomic
status with a standard of living correspondingly low.
Earnings of father.—Earnings of father appear to have a much
less definite influence on infant mortality in Brockton than in the
other cities studied. To what extent this was due to the good condi­
tions which prevailed generally throughout the city, to what extent
to the absence of saloons, or to chance variation due to the small
numbers considered in this study, could not be determined.
Employment of mother.—The number of mothers who were gain­
fully employed in Brockton was so small that this employment can
not be considered a factor in the general infant mortality rate,
although it may have been a factor in the mortality of their infants.
Age and cause of death.—The proportion of deaths occurring in
the first day, week, and month of life was unusually high. Most of
these deaths were caused by the diseases of early infancy and those
classified as “ other causes.” Inasmuch as apparently no organized
effort had been made prior to 1915 to reduce the number of deaths
from prenatal causes, the city’s most crying need seems to be that of
an adequate force of nurses to do prenatal work, as well as a clinic
where mothers might obtain advice and medical care before the
births of their children. In order to secure the maximum amount
of benefit from such a clinic, an educational campaign would, first be
necessary for the purpose of convincing mothers of the value of pre-


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BROCKTON, M ASS.

57

natal care. Mothers should, also be aroused to the importance of
haying the best medical care obtainable at childbirth. Shortly
before the publication of this report the visiting nurses had begun to
extend their work into the field °f prenatal instruction and advice,
but they had not yet been able to secure enough nurses to reach the
mothers to any appreciable extent.
The deaths from gastric and intestinal diseases, on the other hand,
form a relatively small percentage. These deaths are most easily
preventable. Breast feeding, high standards of living, intelligent
care, and good milk are factors which tend to reduce the death rate
from these causes. Infant-welfare stations were beginning to play a
prominent part in lowering the number of diarrheal deaths. In
Brockton these stations had been so recently established at the time
of this study that they had had no opportunity to reach the maximum
of efficiency.
Municipal sanitation.—At the time of the study the city had passed
no laws with reference to housing except for the purpose of fire
protection. Housing conditions, however, were exceptionally good
throughout the city.' But, as Brockton grows, will it keep up this
high housing standard ? The experience of other cities has proved
that most industrial communities siiccumb sooner or later to the temp­
tation to overcrowd both homes and lots. If laws are passed to pro­
hibit these evils in the immediate future the city may cpntinue to
possess a fair name as far as housing is concerned. On the other
hand, at the present rate of development and with the commercial
spirit everywhere rampant in an industrial town,, Brockton can
scarcely expect to fare better than conspicuously bad examples in
her own State.
The city’s system of sewerage and sewage disposal was excellent.
The sewage disposal plant, although not an unusual type in modern
cities to-day, was installed in 1893— a time when such high-grade
sanitation facilities were practically unknown. Unfortunately, many
homes in the city still lacked sewer connections in 1913.
Brockton has a problem to contend with in the abolition of the
many “ private ways.” Since these streets were located within the
city limits, it was difficult to understand why they should not have
had the privilege of being sewer-connected and protected by the city,
even though paving and sidewalks were out of the question for some
years.
The code in regard to the handling of milk in Brockton was a good
one and the laws were stringently enforced. The official bacterial
standard of 500,000 per cubic centimeter was very low, but the bacte­
riologist, b y appealing to the public to buy milk of those dairymen
whose milk averaged less than 50,000 bacteria has unofficially suc­
ceeded in raising the standard.


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58

INFANT MORTALITY.

With all the advantages existing in Brockton the infant mortality
rate should have been lower than it really was. One must remember,
however, that the city has developed very rapidly, having been
incorporated only 32 years at the time of this inquiry. During that
time remarkable progress has been made along the lines of sanitation
and civic betterment, and improvements along every line of city
activity were being pushed with much energy.


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APPENDIX.

M ETH O D OF PROCEDURE.

Scope of inquiry.—In the law creating the Children’s Bureau,
passed by the Sixty-second Congress, infant mortality was specified
first in the fist of subjects to be investigated. The mortality among
infants under 1 year is higher than mortality at any other period of
life except old age. The report of the Census Bureau on Mortality
Statistics showed that in 1911 for every thousand live births regis­
tered in the death registration States there were 124 infant deaths
under 1 year of age. In the birth registration area, including the
New England States, New York, Pennsylvania, Michigan, Minne­
sota, ana the District of Columbia, in 1915, for every thousand live
births registered there were 100 infant deaths. In these States the
rate of infant mortality varied from 70 to 120 for the States as a
whole, while for cities of 25,000 population or over (in 1910) in these
States the range of the rates is much greater—from 54 in Brookline
and Malden, Mass., to 196 in Shenandoah, Pa.
T a b l e I .— Infant mortality rates for States in the birth registration area: 1915.a

State.

Infant
mortality
rate.
107
105
101
86
70
110
99
110
120
85

a U. S. Bureau of the Census, Birth Statistics, 1915, p. 10. Washington, 1917.

It is evident from these figures that conditions in some States
and in some cities are much more favorable than in others. On the
causes of low or high mortality the figures of the Census Bureau
throw little light. If inquiries were made in restricted areas and
information on the physical, social, economic, and civic conditions
were secured for all births and all infant deaths under 1 year it would
be possible to determine the underlying causes that favored a low
mortality or produced a high rate.
With this object in view the Children’s Bureau selected a number
of cities that offered contrasts in economic, industrial, and social
conditions in which to make intensive studies of the conditions of
infant life and infant mortality. The choice of the first cities to be
studied was limited for practical reasons to cities with acceptable
birth registration, on account of the facilities afforded b y these
59


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INFANT MORTALITY.

records for learning where the mothers to be interviewed lived. It
was further necessary to' choose cities of such size that they could
be covered thoroughly within a reasonable time by the few agents
available for the work. Certain characteristics of the cities chosen
are summarized in Table II.' All were manufacturing cities, the
populations ranging, in 1910, from 50,000 to 100,000. All had a
large foreign element. In addition, judging by the provisional
figures available when the choice was determined upon, every city
with the exception of Brockton had a high infant mortality rate.
T a b l e I I .— Population in 1910, infant mortality rates 1910 and 1915, percentage o f

adult population foreign bom , principal foreign nationality,a and principal industry
o f the cities chosen for infant mortality studies.
infant mortal­
ity rates.
Popula­
tion in
1910.

City.

Johnstown, Pa...................
Manchester, N. H ..............
Brockton, Mass.................
Saginaw, Mich....... . ..........
New Bedford, Mass. . . . . . .
Waterbury, Conn..............
Akron, Ohio......................

55,482
70,063
56,878
50,510
96,652
73,141
69,067

1910. b

165
193
99
145
177
149
123

Percent­
age of
adult
popula­ Principal foreign
tion over
nationality, a
foreign1915. c 20bom,
1910.
116
150 .
82
101
143
143

39.9
56.1
37.3
33.7
59.0
50.5
26.0

Varied Slavic d . . .
French Canadian..
Lithuanian...........
German.................
Portuguese............
Italian...................
German.................

Principal industry.

Iron and steel.
Cotton textiles.
Shoe manufacture.
Varied industries.
Cotton textiles.
Brass manufacture
Rubber factory.

a Principal nationality of foreign-bom mothers of infants included in the infant mortality studies.
b Figures published by the U. S. Bureau of the Census, Bulletin 109, Mortality Statistics, 1910, pp.
18-19, based on provisional figures for births. The rate for Akron, Ohio, was furnished by the Ohio State
Registrar.
c U. S. Bureau of the Census, Birth Statistics, 1915. Washington, 1917.
d No particular Slavic group of sufficient importance to mention separately.

Infant mortality rate.—An infant mortality rate expresses the
probability of a live-born infant dying before his first birthday
and is usually stated as the number of deaths under one year per
thousand live births.1 The usual approximate method oi finding
the infant mortality rate for a certain area is to divide the number
of registered deaths of infants under 1 year of age occurring in a given
calendar year by the number of registered live births in the same
year. The number of deaths thus secured includes not only deaths
of infants born in the same calendar year but also some deaths of
infants born in the preceding year or in a different area; it excludes
deaths of infants included in the group of births if the death occurred
either in a different area or in the following calendar year. The two
numbers (of deaths and births) do not refer to the same group of
infants. To avoid this inaccuracy, the method employed by the
Children’s Bureau in all studies has been to follow each infant born
in a given selected year in a certain area for a period of 12 months.
The deaths among these infants are then compared to the births; in
this way the deaths include no infants not included in the births
and the true probability of dying in the first year of life is secured.
The chief difficulty in practice in computing infant mortality
rates arises from the incompleteness of registration of births and
deaths. It is not always safe to compare infant mortality rates
in cities with those in country districts; in one State with those in
1 Stillbirths are omitted from both births and deaths.


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B R O C K T O N , M A SS.

. 61

another; in one city with rates in another; or even to compare rates
in one year with those for preceding years in the same city on account
of differences and changes in completeness of registration. If the
per cent of omissions of deaths tinder 1 year of age is equal to the
per cent of omissions of births, the infant mortality rate, though
based on incomplete data, will still be correct. In general, how­
ever, death registration is better than birth registration. If birth
registration is more defective than registration of infant deaths, the
infant mortality rate will be too high. Inaccuracies will affect not
only the general rate for a given area but may affect also the compara­
bility of the rates for different classes within the area. In an analysis
of births and deaths by race and nativity classes if the degree of
completeness of registration varies with the different classes the
rates found by dividing the deaths by the births may not be compar­
able. For the purpose of these investigations comparable rates
are essential.
It is not of so much importance that the rate secured shall char­
acterize general conditions of infant mortality for a given area, as
that rates for the different nativity classes, earnings groups, and
other subclasses shall indicate the true differences for the area in
the incidence of infant deaths. There are two methods of treating
the original data to make them more serviceable for this purpose. One
is to exclude the least accurate material, where it is known to be
incomplete or inaccurate. The other is to make a selection of
material on some unbiased basis and use the data selected as a
representative sample of the city. An alternative policy is so to
supplement the original data that the figures used include all the
evidence applicable to the groups studied in this city.
Certain groups for which the information is inaccurate or incom­
plete have been excluded in all the studies made by the bureau.
The groups for which the rates are most open to question and most
difficult to obtain are illegitimate births, births in families that
have moved away, and births to nonresident mothers.
The first of the groups that have been excluded from the general
analysis is the group oi illegitimate births. The information secured
is probably not so complete as for legitimate births; furthermore, it
relates to an abnormal family group. Special studies of mortality
rates for illegitimate children have been made for one or two cities,
but the findings can not be considered so satisfactory as those presented
in the general analysis.
.
Births to mothers who moved away in the first year of the infant s
life form the second group of exclusions. The information as to the
number of deaths that occurred in this group is not complete. Obvi­
ously, if the infant moved away from the city after the first few
weeks or months of life, his death, if he died before his first birthday,
would not be registered in the city. Deaths registered in the city
of infants born to mothers who later moved away also have to be
excluded; otherwise the rates would be biased by the exclusion of five
births only, with no exclusion of infant deaths to correspond.
A third group of exclusions is the births to nonresident mothers.
These were excluded not only on the ground that in most cases
the infant did not live in the city during his entire first year of life
but also on the ground that the conditions under which nonresident
mothers lived prior to entering the city hospitals may be different

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62

I N F A N T M O R T A L IT Y .

from those of the average mother in the city. In order to make the
rate as characteristic of the city as possible these births were excluded.
Births to mothers who could not be found were also excluded.
In such cases the probability was that the mother had m oved away.
No reliable information could be secured about these cases and hence
the only safe policy was to exclude them.
In practice since the agent’s visit always was made after the first
anniversary of the birth of the child, in *?ome cases a year or more
afterward, births were excluded if the mother had moved away
from the city prior to or could not be found at the time of the agent’s
visit.1
The data submitted in the report apply, therefore, to births in the
city during the selected year to resident married mothers who lived
there during the child’s first year and were found there at the time
of the agent’s visit.
Though the records for births to resident married mothers are
much more complete and satisfactory than for all births in the city,
there still remains the difficulty that differences in the completeness
of registration for different groups may affect the comparability of
rates. If all births and all infant deaths are registered, the rates for
these groups would be correct. It was found, however, in examining
the birth and death certificates that occasionally a death had been
registered of an infant born in the city whose birth had not been
recorded. Obviously the more incomplete the birth records are the
more frequently such cases would occur.
There were three possible methods of meeting this difficulty. The
first was to accept these death records and treat them as if the births
had been recorded. The second was to make a selection of births and
include only deaths among the births selected, the obvious basis of
selections being the fact of registration of birth. The third was to
attempt to complete the records of births and of deaths b y a canvass.
The first method was rejected in favor of the second and third, on
the ground that the inclusion of all these death records would tend
to exaggerate the mortality rates.
The second method was followed in Manchester, Brockton, and
New Bedford. In Brockton and New Bedford a special canvass is
made by State officials to check up registration of births during the
preceding year. Consequently in these cities a birth might have
been registered either by the physician soon after the birth or b y the
State canvasser on his visit. All births recorded, whether regularly
registered or added by this special canvass, were treated as registered
for the purposes of this study.
The third method, or a modification of it, was followed in the
other cities studied. In Johnstown, Pa., the original plan was to
limit the investigation to registered births in 1911. But during the
progress of the investigation it was found that many births to Serbian
mothers escaped registration and it was thought that this group was
too important to be omitted entirely. Accordingly the birth records
i The rulings in two special cases might be mentioned:
1. If the mother died during the child’s first year, the birth was included if the infant (or, in case of death,
his family) had lived in the city during the first year after his birth.
2. In a few cases mother and child were away from the city for a part only of the child’s first year, but
later moved back and were found by the agent. In the cities first studied agents were not instructed to
inquire as to continuous residence in the city. If, however, the fact that the mother had moved away
for a period was noted, the birth was excluded in tabulation, if the absence from the city had been three
months or more.


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B R O C K T O N , M ASS.

63

were supplemented by the baptismal records of the Serbian church,
and a canvass was made of the principal Serbian quarter. Agents
were instructed to take schedules for any infants found who were
bom in Johnstown in 1911, even if the birth had not been recorded.
In Saginaw the registered births were supplemented b y the births
secured in various ways— death certificates, baptismal records,
through neighborhood inquiries, and other sources. The agent
calling on each mother inquired if there were other children in the
neighborhood of about the same age. B y these means 116 births
to resident married mothers were added. In Saginaw three unregis­
tered deaths were added to the 113 recorded.
With the general plan of the investigation determined, the more
important points in the detailed procedure were as follows: The first
step was to copy the birth certificates for the year selected; then
the death certificates for the year selected and the year following
were examined and the facts as to birth and death for infants bom
in the year selected were transferred to the schedules. These records
usually gave the address of the mother, though not in all cases the
present address. In cities where a canvass was made, the actual
address of the mother was found directly. If the mother had moved,
the agent attempted to learn from the neighbors her present address
in the city or whether she had moved away. Most of the information
contained in these reports is derived from the answers secured from
the mothers interviewed. As the bureau has no power or desire to
compel answers, the information secured was based on the voluntary
statements of the mothers. To the willingness of the mothers to an­
swer all questions and to cooperate in every way, is due the complete­
ness of the records; upon this completeness the value of much of
the information depends.
In comparing, then, the rates for the group included in the study
with the rates for the corresponding calendar year computed in the
ordinary manner, the following points must be borne in mind:
^First. In rates computed by the ordinary method the deaths and
births refer to the same year. In the rates for these studies the
births in a selected year are compared to the deaths among them.
The deaths are scattered over a period of two years, including the
selected year and the year following.
Second. Illegitimate, births are excluded from these studies.1 The
death rate for illegitimate births is usually considerably higher than
the average rate. The rates as shown in these studies, therefore,
may be expected to be somewhat lower than the rates as usually
computed.
, *
Third. Births to nonresident mothers are excluded in order to
make the rates as characteristic as possible of the conditions of the
locality studied.
Fourth. Births of infants whose mothers moved away during the
year following the birth of the infant and deaths that occurred
in this group are excluded, because in the absence of data on age
at removal it is impossible to use the figures except on the basis
of arbitrary assumption. Deaths in the city of infants born elsewhere
are also excluded because there is no information on age at migration.
This policy, o f course, excludes infant deaths in foundling asylums,
if the birth did not occur in the city.
1 Except for Johnstown, where illegitimate births were included.


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64

IN F A N T M O R T A L IT Y .

Fifth. In some of the cities rates are based on the deaths among
the registered births. Infant deaths where the birth was not recorded
have therefore been omitted, to correspond with the probable omis­
sion of infants surviving the first year of fife, whose births were not
recorded.
Finally, in other cities the birth records have been completed or
supplemented by a canvass. In these cases the rates for the groups
included are probably more accurate than the rates as usually
computed.
Exclusions in Brockton.—With the foregoing explanation of the
method of procedure in mind, the significance of the exclusions and
the rates for the excluded groups may be more easily grasped. Dur­
ing the selected year there were 1,547 live births in Brockton; 174
of these had moved out'of town and no trace of 71 could be found, a
total of 245; 5 of these were found through death records. Obvi­
ously, owing to the difficulty of finding unregistered births to mothers
who had moved away and could not be found, nothing could be done
with these 5 live births and 5 deaths in forming a rate. Among the
240 registered live births to mothers who could not be found or had
moved away, 27 deaths were known to have occurred. These deaths
registered in the city probably do not include all deaths among this
group. The rate o f 112.5 is probably somewhat less than the true
rate.
There was one case where the infant survived his first birthday,
but the information was incomplete.
Among the 63 live births in the city excluded on grounds of non­
residence of the mother, 4 deaths occurred in the city. In most
cases these mothers probably left the city soon after the birth of the
child. The rate therefore, 63.5, represents an understatement of the
true rate for this group.
Eleven births to mothers resident in the city both at the time of
the infant’s birth and at the agent’s visit were excluded on the ground
of illegitimacy; 5, or nearly one-half, died before the end of the first
year.
T a b l e I I I .— Registered and unregistered live births in Brockton, infant deaths, and infant

mortality rates for births included in and for births excluded from detailed analysis, by
reason for exclusion.

Live births.
Inclusions or exclusions and reasons
for exclusions.

Reasons for exclusion:
Nonresidence or lack of informaData incomplete or unreliable.

Births
Births Births
Un­
un­
Regis­ regis­
un­ Total. Births
regis­ regis­
Total. regis­ regis­
Total. tered.
tered. tered.
tered.
tered. tered.
1,547
1,210
337

1,525
1,210
'315

22

5309
71
i
63
174
11
17

304
67
i
63
173
11

a Not shown where base is less than 100.


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Infant mortality
rate.»

Infant deaths.

110.5
96.7
160.2

100.3
96.7
114.3

5
4

116.5

102.0

1

120.7

115.6

22

171
117
54

153
117
36

18

5
4

36
11

31
7

4
21
5
13

4
20
5

i
17

18

13

6 Including illegitimate births to nonresident mothers.

BROCKTON, MASS.

65

Seventeen live births were excluded on the ground that the birth
had not been registered. In this group 13 deaths occurred. The
reason the proportion is so high is Decause all but 4 of the 17 live
births were found by means of the death certificates. The 4 not
found by death certificates were discovered only by accident. It is
difficult to form a rate for this group because no attempt was made
to supplement the records of births by a canvass of the city.
Light may be thrown upon the completeness of registration of
births in Brockton from these figures. If the deaths where the birth
had not been registered are compared to the total deaths in the city
among births in the selected year, the figure of 10.5 per cent is ob­
tained as an index of the proportion of births not registered. This
index gives the true percentage of births not registered only in case
the mortality among groups where registration is faulty is the same
as the average, and the fact of death in infancy has no effect upon
subsequent registration of the birth by the canvasser. But the
mortality rates are usually high in the foreign-born and low-earnings
'oups, among whom births are most likely to escape registration.
urthermore, in Brockton, the State canvasser, on his annual visit
to check up registration of births and deaths, is probably more likely
to find and register a birth in the previous year, if the infant is still
alive, than if a death had occurred. This percentage, therefore,
probably represents a maximum statement of the percentage of
births unregistered. Another method of determining the percentage
of births unregistered is by comparing the unregistered births with
the total. There were 22 unregistered live births in Brockton
during the selected year that were definitely known to have
occurred. If compared to the 1,547 live births, 1.4 per cent were
not registered. Perhaps a somewhat fairer comparison would be of
the 17 births that occurred to mothers known to have been resident
in the city both at the time of the infant’s birth and at the time of the
agent’s visit to the total of 1,238 in the same group; the percentage,
however, is only slightly lower. This percentage represents a mini­
mum statement of births unregistered, because it includes only those
cases where an unregistered birth was known to have occurred.
Owing to the fact that no special measures were taken to discover
other cases of omission, the true percentage is probably somewhat
above this figure.
The infant mortality rate for the births included in the study is 96.7.
For the excluded groups the rate varies with the reasons for exclusion.
The rate for illegitimate births is very high. The rate for the nonresi­
dent is relatively low, but does not include all the deaths. The rate
for cases where the mother was not found or had moved away from
the city is considerably higher than the rate for the selected group,
but obviously less than the true rate. No fair rates can be made for
the group oi infants where the birth was not registered, because
practically all were found from death certificates. The rate for the
excluded group as a whole, 160.2, means little unless taken in con­
nection with the reasons for exclusion. The rate for all live births
in the city, both included and excluded, was 110.5, but this rate, too,
is not so significant in many ways as the rate for the group included
in the study. If it could be assumed that all unregistered births to
resident married mothers were discovered, the rate for this group

f

6 9 4 8 4 °— 18------- 5


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66

INTACT MOBTALITY.

would be 105.9, a rate which would represent probably the nmyiinnm
for this group, for every additional unregistered birth discovered
would tend to lessen it. In case additional deaths had not been
registered, the rate would depend upon the respective proportion of
deaths and births unregistered.
Stillbirth rates.—Stillbirth rates were formed by dividing the
number of stillbirths by the total number of births, live ana still­
births. A stillbirth is defined as a dead-born issue of 7 or more
months’ gestation. Miscarriages, or dead-born issues of less than 7
months’ gestation, were excluded.
A policy of exclusions was followed similar to that for infant mor­
tality. Stillbirths to nonresident mothers were excluded because
of the possible effect of other conditions; likewise stillbirths to mothers
who^moved away prior to the visit of the agent. In the latter cases
the information would have been difficult to obtain, and there was
the same chance of omission of births as in calculating the infant
mortality rate.
With reference to the accuracy of the data the registration of still­
births has a peculiar margin of error of its own. Usually the still­
births must be registered both as a “ death,” and as a “ birth” ; in
some States the law is not clear whether stillbirths have to be regis­
tered at all; and in others miscarriages as well as stillbirths must be
registered. It sometimes happens that a stillbirth is registered as a
“ death” but not as a “ birth” where registration of both is required
by law. It is obvious that such an omission is one of carelessness
only, as ordinarily the same person, usually a physician, would register
both.
The number of unregistered stillbirths would be difficult to de­
termine. It would be much more difficult to find oases of omission
of stillbirths by canvass or other inquiry than to find cases of omission
of registration of live births. Omissions might be due to ignorance
of the law or failure to observe it. Doctors are probably more con­
versant with the law than midwives. There is chance for confusion
between stillbirths and infant deaths on the one hand, where it is
difficult to determine whether or not the child was born alive; and
between stillbirths and miscarriages on the other, where it is difficult
to state accurately the number of months of gestation. If the law
requires the reporting of miscarriages, the number of stillbirths is
probably more complete than where they are not reported.
In the stillbirth rates presented in the infant mortality reports of
the Children’s Bureau, the stillbirths to resident married mothers that
were registered either as births or deaths have been compared to the
registered births to resident married mothers for Manchester, Brock­
ton, and New Bedford; in other cities the figure for stillbirths is com­
pared to the total of registered and known unregistered births to resi­
dent married mothers.
Stillbirths excluded.—There were 66 known stillbirths and mis­
carriages in Brockton; birth certificates were found for 60 of
these. Fourteen were excluded because they were miscarriages o f
less than 7 months’ gestation; 13 more were excluded because the
mothers had moved out of the city or were nonresident or be­
cause information was lacking. In these cases it could not always
be determined definitely whether the birth was a stillbirth or a mis­
carriage. There were 39 stillbirths to mothers resident in the city

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m

BROCKTON, MASS.

both at the time of the birth of the child and at the agent’s visit.
Two of these were excluded on account of illegitimacy. The rate for
the included group is formed by dividing 37 stillbirths by the 1,247
registered births included in the study, giving a rate of 3.0. No rate
can be formed for the nonresident, not found, or removed groups,
because it can not be determined from the records whether or not the
birth,was a stillbirth or miscarriage.
>
T a b l e I V .— Stillbirths and miscarriages in Brockton included in and excluded from

detailed analysis, by reason for exclusion.
Number.

Inclusions or exclusions and reason for exclusion.
Total known stillbirths and miscarriages.....
Tothl stillbirths i n c l u d e d . ___ > . . .......
Total stillbirths and miscarriages excluded..
Reasons for exclusion:
Nonresidence or lack of information................ .
Not found................................... .................
Data incomplete or unreliable...................
Nonresident........................... : ..................'•
Removed.....................................................
Miscarriages excluded........................................
Stillbirths excluded on account of illegitimacy
'V.

a Includes 2 stillbirths and 4 miscarriages not registered as births, but which were found from death
certificates. Compare statement on p. 12.

Illegitimacy.—Illegitimate children were excluded from the general
tabulations for this study because of the relative incompleteness of
the facts secured for this group, on account of nonresidence of the
mother, and because the conditions were not those of the normal
family. The discussion following includes the principal facts among
the meager data secured.1
T a b l e V .— Illegitimate births during selected year, stillbirths, and status o f live births

at first birthday, according to nativity o f mother.
Live l >irths.

Nativity of mother.

Total
births.

Status at first birl hday.

Still­
births.
Total.

Alive.

Not
reported.

Dead.

All mothers........................................

39

3

36

17

7

12

Native mothers............................................
Foreign-bom mothers................................

24
IS

1
2

23
13

11
6

4
3

8
4

During the year selected, 39 illegitimate births were registered in
Brockton; this number comprises 2% per cent of all births recorded in
that period. Thirty-one of the mothers could not be located, and but
partial data could be obtained for these cases from different social
agencies in the city. Complete schedules were secured from mothers
oi eight infants.
i This discussion of illegitimacy is based not only on the births for which detailed information was secured
but it also includes a few for whom the only infornfation was that given on the birth certificate. In the pre­
ceding treatment of exclusions, illegitimate births to nonresident mothers are classed with those excluded
on grounds of nonresidence of the mother rather than with those excluded on account of illegitimacy.


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68

INFANT MORTALITY.

Birth certificates showed that 24 illegitimate babies were bora to
American mothers and 15 to foreign-bora mothers. Thirty-six of
these babies were live born, seven deaths under 1 year of age are known
to have occurred: it is probable that some of the 12 children who could
not be traced till their first birthday died outside the city. A t least
19 per cent of the live-born infants died during their first year, in­
dicating, though the basis for the figures is small, a tendency toward
a rate twice as nigh as for legitimate children.
Thirty-seven o f the mothers had physicians as attendants at birth,
one a midwife, and one, whose child was stillborn, had no attendant.
Ten of the 35 children who lived at least two weeks were known to
have lived with the mother; 12 were known to have lived away from
the mother; 4 boarded in a private family, 3 at a baby farm, 2 were
adopted, 1 was cared for in an infant asylum, 1 boarded out by the
State board, the other with relatives. In 13 cases the place where
the child lived was not reported.


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https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

GENERAL TABLES.
T

able

1 .— B irth s du rin g selected yea r, in fa n t deaths, in fa n t m orta lity rate, and per cent
o f stillbirth s, b y m on th o f birth.

Stillbirths.
Month of birth.

Total
births.

Live
births.

Infant
deaths.

Infant
mortality
Per cent
rate.
Number. of total
births.

Total................ ..................................

1,247

1,210

117

96.7

37

3.0

November, 1912................. ........................ ;
December, 1912......................................... .
January, 1913.................................. ............
February, 1913.............................................
March, 1913...................................................
April, 1913....................................................
May, 1913......................................................
June, 1913.......... ..........................................
July, 1913....’...............................................
August, 1913........................ ........................
September, 1913............................................
October, 1913...............................................

99
103
83
103
108
119
109
116
103
89
86
129

96
97
79
101
108
115
105
113
100
85
85
126

8
7
6
9
12
11
14
9
11
11
6
13

83.3
72.2
76.0
89.1
111.1
95.7
133.3
79.6
110.0
129.4
70.6
103.2

3
6
4
2

3.0
5.8
4.8
1.9

4
4
3
3
4
1
3

3.4
3.7
2.6
2.9
4.5
1.2
2.3

T

2 . — Number and per cent distribution o f deaths among infants born in Brockton
during selected year arm o f infant deaths in the registration area in 1918, by cause o f
death.
<

able

Infant deaths in—
Abridged
International
List No.a

Detailed
International
List No.a

Brockton.

Registration area.

Cause of death.5
Percent
cent
Num­ distri­ Number. Per
distri­
ber. bution.
bution.

24...................
20 ...............
22
Part of 3 3 ....

All causes............... ..........

117

100.0

159,435

100.0

Gastric and intestinal diseases c ..
Diseases of the stomach.......
102,103......................
Diarrhea and enteritis..........
104.............................
Respiratory diseases d .................
Acute bronchitis....... ...........
89..............................
B roncho-pneumonia.............
91..............................
92..............................
Pneumonia...........................
150.............................
Early in fan cy............................
151(1)........................
Premature birth...................
Congenital debility..............
}l51(2), 152(2), 153....
Injuries at birth...................
152(1)................. .

15
3
12
16
5
8
3
6
45
20
18
7

12.8
2.6
10.3
13.7
4.3
6.8
2.6
5.1
38.5
17.1
15.4
6.0

41,379
2,924
38,455
24,285
3,665
13,100
7,520
8,813
52,865
27,359
20,375
5,131

26.0
1.8
24.1
15.2
2.3
8.2
4.7
5.5
33.2
17.2
12.8
3.2

Part of 33___
Part of 3 7 ....
Part of 3 7 ....
a The numbers indicate the classification in the abridged and the detailed lists, respectively, of the Manual
of the International I ist of Causes of Death.
_ _
&The causes of death included in this list are those used by the United States Bureau of the Census (see
Mortality Statistics, 1913, p. 577) 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 eight main groups.
c 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
heading according to the Detailed International I ist.
d “ Respiratory diseases” as used in the tables and discussion similarly includes only those of the respira­
tory 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.
71


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72
T

INFANT MORTALITY.

2 . — Number and per cent distribution o f deaths among infants born in Brockton
during selected year and o f infant deaths in the registration area in 1913, by cause of
death— Continued.

able

Infant deaths in-^
• Abridged
International
List No.

Registration area.-

Brockton.

Detailed
International
List No.“

Cause of death. 5
Per cent'
Num­ Percent
distri­ Number. distri­
ber. bution.
bution.

ft
ft
8 ...
9.
Part of 1 2 ....
Part of 1 2 ....
Part of 37___
13 ..
14
1ft
Part of 3 7 ....
2ft
38....... .
17
Part of 3 7 ....
19

Epidemic diseases « ....................
Measles..................................
6 ...............................
7 .
Scarlet fever..........................
Whooping cough...................
8......................... .
Diphtheria and croup..........
9................................
Influenza...............................
10..............................
14
1 8 ............................
Erysipelas................ .
24..
Tuberculosis of the lungs___
28,29............... .........
Tuberculous meningitis.......
30'..............................
Other forms of tuberculosis. .
31,32,33,34,35..........
37............... i..
Ì55 to 186.................. External causes..........................
187,188,189............... Diseases ill defined or unknown . .
All other causes......................... .
Meningitis.............. .
6 1 ................... .........
71
Organic diseases of the heart.
79...
Other._________________—

10

8.5

6
1
1

5.1
.9
.9

2

1.7

1
6
18
1
3

.9
5.1
15.4
.9
2.6

14

12.0

8.4
1.3
.2
2.2
.6
.4
.4
.5
.2
.5.
.8
.3
1.2
1.2
2.1
8.5
1.1
2.0
.5
5.0

13,390
2,011
255
3,442
913
608
651
756
369
848
1,230
413
1,894
1,892
3,292
13,519
1,739
3,125
748
7,907

a The numbers indicate the classification in the abridged and the detailed lists, respectively, of the
Vammi of the International List of Causes of Death.
b The causes of death included in this list are those used by the United States Bureau of the Census
(see Morta ity Statistics, 1913, p. 577) 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 eight main groups.
c “ Epidemic diseases” as used in the tables and discussion includes only those of this group which are
most important among infants.
T a b l e 3 .— Deaths o f infants born during selected year occurring in specified month, by

cause o f death.


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1

2

ft

i

6
4
1
1
1

20

18
7
10

1

6

18

14

1
3
1
3

1

4
i
3
2
1

7

1
1

2

2
2
8
3
3
2
1

2

1
1

2.
3

6

3
2
1

7

6
2
4

1
3

1

15

10

12

'3

6

4

6

4
2
1
4
1
2
1

1

1
1
1
1

1
8
3
4
1
1
1

3
1
2

1

1

1
1
1

j December.

15

I November.

12

¡A

s

August.

April.

10

©
a
5

October.

15
16
6
45

tA
Cj
a

September.

Gastric and intestinal diseases..
Principal respiratory diseases...
Malformations...........................
Early infancy..............................
Premature birth...................
Congenital debility..............
Injuries at birth....... . —
Epidemic diseases......................
External causes..........................
Diseases ill defined or unknown.
All other causes..........................

117

March.

All causes...

January.

Cause of death.

February.

|

Month of death.

1
1
1

73

BROCKTON, MASS.

T able 4 .— Deaths o f infants horn during selected year in each ward o f residence, by cause
o f death.
Ward of residence.
Total
deaths.

Cause of death.

T

able

1

117

9

15
16
6
45
20
18
7
10
1
6
18

1
1

5

6

12

25

28

4
1

4
5
2
10
3
6
1

4
6
2
7
2
5

2
2

2
4

4

2

3

12

14
2
1

1
9
4
2
3

5
5

5
2
2
1
1

2

1
2

5
2
2
1

2

3

1

7
17
2
1
4
2
1
1
3
1
1
5

3

5 . — Births during selected year in each ward o f residence, according to nationality

o f mother.
Ward of residence.
9

Nationality of mother.

Total
births.

1

2

3

4

5

6

7

All mothers.......... ............................................

1,247

128

126

149

156

226

300

162

Native mothers...........................................................
Foreign-bom mothers— .........................................

613
634

83
45

82
44

79
70

75
81

98
128

109
191

87
75

133
118
90
62
57
33
22
60
20
39

10
7
1
1
5
2
14
1
4

17
16

2
7
35
1
3
5
9
1
7

23
26
16
5
2
1
5
1
2

36
16
3
46
8
5
4
1
9

118
6
9
4
2
6
6
13
14
13

15
24
9
3
2
6
2
8
2
4

Italian......................................................- ...........
Irish......................................................................
English, Scotch, and Welsh................................
French Canadian..................................................
O ther Canadian..................................................


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3
1
7

74

INFANT MORTALITY.

T a b l e 6 .— In fa n ts b o m d uring selected year to m others o f specified n a tiv ity and su rvivin gat begin n in g o f the m on th , n um ber and per cent o f in fa n ts d yin g su bseq u en tly in fir s t
year, and i f f ant deaths in specified m onth o f life , according to m on th o f life arid typ e o f
feed in g in the m on th .

Subsequent infant
deáths in—
Tota First year.
Month of life and type infant
sur­
of feeding.
viv­
ors.
Num­ Per
ber. cent.

Native mothers.

Foreign-bom mothers.

Subsea uent infant
deaths in—
In­
Speci­ fant
sur­
fied
month. viv­
ors.

First year.
Num­ Per
ber. cent.

Speci­
fied
month.

Subsequent infantdeaths in—
In­
fant
sur­
viv­
ors.

First year.
Speci­
fied
Num­ Per month.
ber. cent.

117

9.7

57

601

61

10.1

34

609

56

9.2

924
20
233
33

52
3
29
33

5.6

420
11
149
21

21
2
17
21

5.0
11.4

7
1
5
21

504
9
84
12

31
1
12
. 12

6.2

12.4

16
1
7
33

Second month.. 1,153

60

5.2

9

567

27-

4.8

3

586

33

5.6

6

815
31
307

25
2
33

3.1

4

1
2

16
1
16

3

9.0

452
16
118

3.5

5

9
1
17

2.5

10.7

363
15
189

13! 6

3

Third m onth... 1,144

51

4.5

10

564

24

4.3

5

580

27

4.7

5

15
2
34

2.0

3

1
4

8
1
18

2.

7.6

414
22
144

1.9

7

7
1
16

2.1

9.6

338
16
210

12.5

&

6

559

19

3.4

3

575

22

3.8

3

5
1
13

1.8

5
1
16

1.4

First month___ 1,210
Breast exclusively__
Mixed.........................
Artificial exclusively.
Not fed, died at once.

Breast exclusively__
Mixed.........................
Artificial exclusively.

Breast exclusively__
Artificial exclusively.

752
38
354

Fourth month. 1,134

, 25
9
2

12

41

3.6

650
65
419

10
2
29

1.5
6.9

6

281
28
250

5.2

3

369
37
169

9.5

3

Fifth month__ 1,128

35

3.1

6

556

16

2.9

1

572

19

3.3

&

608
83
437

8
2
25

1.3

1

264
257

4.3

1

344
48
180

4
1
14

1

5

4
1
11

1.2

5.7

7.8

4

Sixth m onth... 1,122

5

555

15

2.7

2

567

14

2.5

3

239

4

1.7

2
1
11

.6
5.9

3

2.0

2

Breast exclusively__
Mixed................ I___
Artificial exclusively.

Breast exclusively__
Mixed.........................
Artificial exclusively.

1.5

29

2.6

554
111
457

6
1
22

1.1
.9
4.8

5

271

11

4.1

2

315
66
186

Seventh month. 1,117

24

2.1

3

553

13

2.4

1

564

11

467
164
486

6
1
17

1.3
.6
3.5

1
1

195
74
284

4

2.1

1

1

9

3.2

272
90
202

8

Eighth month.. 1,114

21

1.9

4

552

12

2.2

3

562

4

1

3

1.7

1

9

2

1 .0

3.1

248
103
211

1

3

176
86
290

7

3.3

I

1.6

3

561

8

1.4

2

223
117
221

1

3

1
6

.4
.9
2.7

2

Breast exclusively__
M ixed .............. I___
Artificial exclusively.

Breast exclusively__
Artificial exclusively.

Breast exclusively__
Mixed.........................
Artificial exclusively.

424
189
501

16

.9
.5
3.2

Ninth month... 1,110

17

1.5

5

549

9

3
1'
13

.8
.4
2.5

145
109
295

2

1.4

5

7

2.4

Breast exclusively__
Mixed................ I___
Artificial exclusively.

368
226
516


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1

2

.7
4.0

1
1

9

1.6

I

1

, .4

1

75

BROCKTON, MASS.

T a b l e 7 . — Number and per cent distribution o f births during selected year to gainfully

employed mothers o f specified nativity, according to earnings o f mother during year
following birth o f infant.
Native mothers.

All mothers.
Earnings o f mother.

Per cent
distribu­
tion.

Total
births.

100.0

244

All classes............... .......... ..............

52.0
17.2
14.3
7.8
3.7
4.9

127
42
35
19
9
12

TJrider $150....................................................
$150 to $249........... .......................................
$250 to $349................ ..................................
$350 to $549...................................................
$550 and over................................................
Not reported........................... ........... .........

Per cent
distribu­
tion.

Births.

Fcreign-bcm moth­
ers.

Births.

Per cent
distribu­
tion.

84

100.0

160

100.0

33
18
12
11
3
7

39.3
21.4
14.3
13.1
3.6
8.3

94
24
23
8
6
5

58.8
15.0
14.4
5.0'
3.S
3.1

T a b l e 8 . — Births during selected year in each father's earnings group, according to occu­

pation offather.
Earnings of father.
Occupation of father.

All occupations.
Manufacturing and me­
chanical............................
Bakers............................................
Blacksmiths..................................
Builders and contractors..............
Compositors, linotypers, and
pressmen....................................
Electricians and electrical engi­
neers.......1..................... ............
Engineers, firemen.......................
Factory operatives:
Shoe and shoe findings indus­
try.......... .............................
Other industries........... .......
Laborers, helpers, and appren­
tices............................................
Machinists...................................
Manufacturers, officials, mana­
gers.............................................
Shoemakers and cobblers.............
Skilled mechanics, building trades
Tailors...........................................
Other pursuit's............ ..................
Trade...................................

Total
births. Under $450 $550 $650 $850 $1,050 $1,250 No Not re­
and earn­ ported.
to
to
to
to
to
$450. $549.
$649. $849. $1,049. $1,249. over. ings.
1,247

41

115

849

.28

93

1


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414

308

95

137

102

294

214

62

47

1

8
3
2

2

1
1
1

t;

634
34

20

73

22

16
24
4
59
11
9
159

1

1
C

4

2
4

2
3

2

87
3

245
9

148
10

37

, 20

4
X

o
4

3
5

5

1

1
1
16
4
4

5

1

4

17
3
2
36

6

15
1
4

9

1
3

4

13
2
9
1
21

:
5

2

7

1

3

1

1
2
1
!
1

1

. J .. . . . . . .
: I1

24
6

3

13
3
5

3

1

1

2

21

2

3

1

6
1

10

1

1

1
1

3
2
4

3

2
1
2

12

17

9

12

3

9

1

43

4

1

1

11

2

1

1

5

48
30
2

1
8

6

I- •

11
1
30

1

27

1

•
4

2

1
C

1

1
2

1

Deliverymen..............................
Laborers___, ...............................
Proprietors, officials, etc., mer­
cantile establishments.............
Real estate and insurance agents.
Salesmen, commercial travelers..
Other pursuits................ ............
Transportation....................
Chauffeurs, teamsters, expressmen........................ ................. .
Conductors, motormen, and train­
men. ..........................................
Laborers........................................
Post and telephone employees—
Proprietors, officials, managers...
Other pursuits....... ......................
Clerical occupations, all in­
dustries.............................

122

4

1
I
1

1

1

1

76

IN F A N T MORTALITY.

T a b le 8.

Births during selected year in each father's earnings group, according to occu­
pation o f father— Continued.

Earnings of father.
Total
births. Under $450 $550 $650 $850 $1,050 $1,250 No
tò
to
tto
to
to
and earn­ Not re­
3450. $549.
$649. $849. SI,049. $1,249. over. ings. ported.

Occupation of father.

Domestic and personal serv­
ice ....................................

44

3

Barbers........., ................
Janitors.............................
Restaurant and hotel proprietors
and employees............ .
Servants................. ..............
Other pursuits..........................

11
7

2

16
4
6

1
1

Public service......................

34

Firemen and police.......................
Laborers...................
Officials and inspectors.............

10
. 21
3

Professional and semipro­
fessional pursuits.............
Agriculture.......................,.

23
10

Farmers............................
Farm laborers......................

1

2

1
1

1

4
6

No occupation.....................

2

2

7

1

7

1

2

2

2

1
1

15

12

3

7

6
3

2
2

1

1

2
2
2

5
1
2

2

4

11

6

6

11

3
1
2

6

1
1

2
1

17
1

1

1

1

3
1

1
1

2
1
i

1

3

1

1

1

1

3

.......................

T a b l e 9 — Number and per cent distribution o f births during selected year in eachfather's

earnings group, according to source and amount o f fam ily income.

Earnings of father.
births.

$550 to
$649.

$650 to
$849.

$850 to
$1,049.

$1,050 to $1,250 and
$1,249. I over.

6

Not reported.

95 100.0 137 100.0

Number.

No earnings.

Per cent dis­
tribution.

Per cent dis­
tribution.

All sources. 1,247 100.0 156 100.0 122 100.0 414 100.0 308, 100.0

Number.

Per cent dis­
tribution.

Number.

Per cent dis­
tribution.

Number.

Per cen,t dis­
tribution.

| Number.

Per cent dis­
tribution.

| Number.

Per cent dis­
tribution.

Number.

J

Source cf family
income.

Under
$550.

9

Father’s earnings
Father’s earnings
and
other
sources............
Under $550...
$550 to $649...
$660 tj- $849...
$850to $1,049.
$1,050 to $1,249
$1,250. a n d
Not reported.
No source............

856

68.6

88

56.4

80

65.6 285

68.8 211

75

78.9 112

81.8 —

5

389
17
25
68
99
71

31.2
1.4
2.0
5.5
7.9
5.7

68
Ì5
22
16
7
1

43.6
9.6
14.1
10.3
4.5
.6

42

34.4 129

31.2

97

20

21.1

18.2

4

3
24
5
5

2.5
19.7
4.1
4.1

26
66
17

6.3
15.9
4.1

21
44

6.8
14.3

4

4.2

95
14
2

7.6
1.1
.2

4.
3

2.6
1.9

2

2.5
1.6

15
4

3.9
1.0

30
2

9.7
.6

16

16.8

.1


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

25

4
2

1.........

25

18.2

|

’ ***
1
3

17

BROCKTON, MASS.

T a b l e 1 0 . — Live births in families o f specified number o f persons, according to earnings

offather.
Number of persons in family.»

Total
live
births.

Earnings of father.

Total.

439

1,210

Under 1550.......
$550 to $649......
$650 to $849......
$850 to $1,049...
$1,050 to $1,249.
$1,250 and over.
No earnings___
Not reported...

9

8

70

109

277

10

11

12

14

19

51

149
116
401
301
93
136
5
9

1 t___
1
1

» Excluding infant bom during selected year.
T a b l e 1 1 . — Live births during selected year in dwellings o f specified number o f rooms, ,

according to number o f persons in dwelling.

Persons in dwelling.

Total
live
births.

Number of rooms in dwelling.
2

3

4

5
361

167

81

24
27
25
35

1 ,2 1 0

5

122

406

272
272
226
170

4

39
34
24
13
7
4

117
96
87
48
33

Persons in dwelling:
2 .......... ............................................
3.......................................................
4.......................................................
5.......................................................
6 ......................................................
7.......................................................
8 .......................................................
0 .......................................................
10 ..............................*.....................

1

100

64
52
26
16

10
12

1

3

7

6

100

58
53
18
26
14
8

3

12

21
11
11
6
6
1

69

10 or
more.

9

8

38

4
9

3
3

12

11

9
13
7
3
5
4
3

4

13

28.

3

3
5.
5

2
1
2
2
1
1
1

1
2

9
3
1
1

6
2.

1
6.

T a b l e 1 2 . — Births from all pregnancies, infant deaths, infant mortality rate, and per-

cent o f stillbirths, according to order o f pregnancy and age o f mother.
.
Order of pregnancy and age of mother.

Under 20 . ......................................................
20 to 24..........................................................
25 to 29.................. ........................................
30 to 34....................... . .................................
35 to 39..........................................................

20 to 24....................... ..................................
25 to 29..........................................................
30 to 3 4 .........................................................
35 t o 30 ...

Total
births.

Live
births.

Infant
deaths.

3,703

3,608

389

107.8

95

268
1,206
1,135
677
332
79

38
133
109
72
30

145.0

6

1 1 2 .6

25

6

262
1,181
1,114
658
312
76
5

1,241

1,2 1 1

126

104.0

30

211

206
601
294
87
19

23

111.7
109.8
81.6

5
16

94.5

20

617
300
88
20
1

97.8
109.4
96.2

66

24

21

19
20

2.6 .
2 .2
2 .1

1.9

2. 8 .
6 . 0’

3

6
1

1

11
2

6
1
1

2.4
2.4
2 .6
2 .0

1

4
824

3
804

47
358
267

46
354
260
107
35

1

76

2.4

1

10

40
20 to 24..........................................................
17
25 to 29........................................................ J
4
110
30 to 34
............ ........................ .........
4
40
35 to 3 9 .........................................................
2
2
1
Not reported.................................................
» Not shown where base is less than 100.


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

Stillbirths.
Infant
- mortal­
Percent
ity rate.» Number. of total
births.»

113.0
65.4
37.4

4
7
3
5

1 .1
2.6 ,

2.7-

78
T

IN F A N T MORTALITY.

1 2 . — Births from all pregnancies, infant deaths, infant mortality rate, and per
cent of stillbirths, according to order o f pregnancy and age o f mother— Continued.

able

Stillbirths.
Order of pregnancy and age of mother.

Third pregnancy, all ages..................
20 to 24............... ...........................................
25 to 29....................................................... .
50 to 34........ .................................................
35 to 39 .....................................................
Fourth pregnancy, all ages...............
20 to 24............................................. .............
25 to 29..........................................................
30 to 34.........................................................
35 to 39..........................................................
Fifth pregnancy, all ages...................

Total
births.

Live
births.

Infant
deaths.

561

541

62

8

8

4
19

156
238
113
41
5
378

151
234
106
37
5
367

2

2

57
171
107
36
4
252

57
169
101

34
4'
248

21
12
6

43

Infant
mortal­
cent
ity rate.® Number. Per
of total
births.®
114.6

20

3.6

125.8
89.7
113.2

5
4
7
4

3.3
1.7
6.3

117.2

11

2.9

3

1.7
5.6

1
6

19
15

112.4
148.5

2

29

116.9

6
2

4

15
94
80 to 3 4 .............................. ..........................
35 to 39..........................................................

93

100

100

Sixth pregnancy, all ages..................

173

36
4
169

16
7
4

70.0

38

16

94.7

20 to 24.................. .......................................
25 to 29..........................................................
30 to 34.................... ....................................
35 to 3 9 ........................................................

3
48
46

3
48
67
43

4
7
3

8

8

2

116

114

16

13
46
41
16
70

13
46
33
16
67

6
8
2

2

g

3

Seventh pregnancy, all ages..............
30 to 34..........................................................
35 to 39........................................ .................

25 to 29................................................ ..........
30 to 34..........................................................

25 to 2 9 .........................................................
30 to 34..........................................................
35 to 39........................................... ...............

30 to 40........................................ ..................
35 to 39................................... . ....................

30 to 34..........................................................
35 to 39.........................................................

30 to 34
35 to 39

................. ............................. ...
..................................... ............ .

68

4

1

140.4

2

2

23
29
13
38

1

1

14
17

14
17

6

6

1
2
2

27

26

4

1

5
14

5
13

1

2

4
3
5

8

8

13

13

2

1

1

7
5
5

7
5
5

1

1

3

3

1

1

4

4

1

.............
1
1
1
1

4
»

1
2

2
1
1

1
1

o Not shown where base is less than 100

2.3

3

2

4


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1
2
1

24
29
15
38

1

1 .6

2

1.7

T able 13.— Births to mothers married specified number o f years, stillbirths, and infant deaths, by number o f births to mothers.
Number of years of mother’ s married life.
Number of births to mother.

Total.

Total:
Totalbirths............................................

3,703

Infant deaths..........................................
1 birth:

389

95

8

births'

i

2

3

4 births:

5

15 908
3
2

21

111

34

8

3

4

42

12

8

552

3

18

44

2
1

484

4

49

3

14

6
1

7

102

64

52

375

9
5

52

births:

372
49

7 births:

336

8

9

66
1

4

3

2

2

2

28

20

14

8

10

8

births:

9 births:

256
5
23
. *•

99
1

Infant deaths;.................^......... .............


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

14

4

81 126 57

51

40

68

3

4
14

5

15

30

3

2

9

12

13

3
14

1

3

1

21

15

1

1

2

9

4

3

3

1

76
9
7

68

40

56

48
2

i
4

35 35
4
1
4 2
6
2

24
3
5

2
2

10

20

21

22

23

24

25

132 104
1
3
13 16

136

141

30

36

73

40

6

2
21

101
1
10

74

5

1

3

1
6

1
1

1

22

1

4

1

12
2
1

3

12

8

2

2

10

15

5
i

2

1

2

24

18

6
1
1

12
2

16

16

4

1
1

1

25
3

21
1

2

7
35

2

60
3

5

8

4

45
3
5

42

42

42

48

30

30

18

8
1
2

8

1

45

23 27

17

16

1

1

2

12

112

21

1

2
8

174 152 172 134
4
3
5
9
24 16 18 15

211

21

3

2
6

15

180
7

2

5

14

11

17

6

4

5.

3

6

9

3

3

7

14

14

14

56

49. 14

49

2

1
1

1
2

1

2
8

5

1

4

8

8

8

8

40

16

1

2

24

1

9
—

1

5

10

5

5
2

1
12

35
3
4

42

14

6

1

16

32

16

40 32

24

1

1
6

3

1
2

i

2

4

3

4

1

12
1
2

1

1
1

8

2

9

18

3

6
2

12
1
1

10

35

10

201
6

3

2
6

7

1

1

5 births:

6

15 216 190 180 199 206 283 206
7
3
7
4 3
6
9
2
23 20 15 13 14 35 23

76 194
3
2

3 births

4

BROCKTON, MASS.

37
2

Less
than
1.

6
1

6

1

6
1

12
1

7

7

18

9

9

18

4

1

1

4

4

7
1

1

1

9

6
1

8

9

7

00

T a b l e 1 3 . — Births to mothers married specified number o f years, stillbirths, and infant deaths, by number o f births to mothers— Continued.

O

Number of years of mother’s married life.
Number of births to mother.

10

Total.

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

births:

10
1

.........

10

4

18

21

40

20

10

20

11

9

22

23

24

11

33

11

22

2

2

4

3

4

2
8

24

3

5

1

13 births:

13

39
3

13
2

13
1

14

14
•

23

27

10

11

12
1

25

1

15
36


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

20

88

births:

14 births:

19.

18

IN F A N T MORTALITY.

12

1

births:
120
1

11

Less
than
1.

81

BBOCKTON, MASS.

T a b l e 14.— Mothers reporting specified number o f miscarriages, by number o f pregnancies

to mother.

Total
ers.

All mothers...................................................................
Pregnancies:

5
fi
7

........................................................
.........................................................
...........................1........................
.............................. ..........................
...............................................................
........................................................
. \ ......................... ................. 1a ,.
................................................
...............................................................

8

9
10
11
12

13

17

_

........ ..................................

Mothers reporting specified number
of miscarriages.
1

2

3

4

5

87

29

11

1

1

19
13
18

2

None.

1,231

1,099

392
260
179
130
74
62
47
31
18
19

392
241
164
107
61
47
35

8
2

6
1
2
1

5
3

5

10

1

9
5
7
3

5
5
3
4
3

2
1
2
1
2
1
1

1

1

20

9
13

2
1

6

7
1

2

.

1
1
2

1

1

T a b l e 15.- -Mothers reporting specified number o f stillbirths, by number o f births to

mother.

Births to mother.

Total
mothers.

Mothers reporting specified
number of stillbirths.
None.

All mothers............................................ . ...............................
Births:

1
.............................................................................................
2
.............................................................................................
3 ......................... ...................................................................
4......... ........................................................................................
5 ........................... ..................... ..............................................
6 ...............................................................................................
7 ................................ ................................................. ............
8 ..
.............................; ................................................
9 ..
.............................................................................
10
.
................................................................................
ii
......................... ..................................................
1 2 ................................ ..............................................................
*13
.........................................................................
14 ...............................................................................................

69484°— 18-------6


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis

1,231

1,147

410
261
184

402
250
168
108
61
58
39
27

121

75
62
48
32
11
12

8

3
3
1

10
11
8
1

3
1

3

2

1

76
8
10

15
12
11

5

1
1
1
1

3
8

5
1
1
2

1

3

2
1

82

INFANT MORTALITY.

T a b l e 16.— Mothers reporting specified number o f infant deaths, by number o f live births

to mother.

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Federal Reserve Bank of St. Louis


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Federal Reserve Bank of St. Louis


https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis