Full text of Infant Mortality : Results of a Field Study in Saginaw, Mich., Based on Births in One Year, Infant Mortality Series No. 9, Bureau Publication No. 52

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UDOC
L 5.20:52

U. S. DEPARTMENT OF LABOR

CHILDREN'S BUREAU
JU LIA C. LATHROP. Chiel

_____ '___

INFANT MORTALITY
RESULTS OF A FIELD STUDY IN SAGINAW, MICH.
BASED ON BIRTHS IN ONE YEAR

NILA F. ALLEN

INFANT MORTALITY SERIES No. 9
Bureau Publication No. 52

W ASHINGTON
GOVERNM ENT PRINTING OFFICE

1919

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ADDITION AL COPIES
OF THIS PUBLICATION MAY BE PROCURED FROM
THE SUPERINTENDENT OF DOCUMENTS
GOVERNMENT PRINTING OFFICE ■
WASHINGTON, D. C.
AT

25 CENTS P E R COPY

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CONTENTS.
Page.

Letter of transmittal.....................................
Introduction.......................................................................................................
Selection of Saginaw.................................................. .............................................. ........
Method and plan of study in Saginaw.......................................................................
Analysis of material.......................................................................................................... r . . .
Infant mortality rate................................ ............................................................. ..
Cause of d e a th ..........................................................................
Relative importance of causes óf death.............................................................
Age at death.........................................................................................................................
Stillbirths............................................... .............. . ................................................ .........
Attendant at birth.............................................................................................................
Sex................................................................................. I ____ : ............................................
Feeding..................................................... . . . . ....................................................................
Feeding and mother’s nativity............................. ......................... £..................
Nationality...................................................................... ....................................................
Nativity of population.......................................... ....................'...........................
Nativity of mother..............................................................................................
Years of residence in the United S ta te s............................................... ..........
Mother’s ability to speak English.......................................................................
Literacy...... ............................................................... ........................................................ ..
Age of mother........ ... ......................................................................... , . .............. ..
Order of birth......................................................................................................................
Economic factors........................................ ........................... . ............ .............................
Father’s earnings..........................................................................r .................. ..
Gainful employment of mother...........................................
Employment of mother during year preceding birth of infant.................
Employment of mother during year following birth of infant..................
Mother’s earnings...... .........................
Maternal histories................................................
Housing....................................................
Ward conditions...............................................
The c i t y . . ............. ....................
The West Side.................................................................................. .........................
The East S id e .............................................
Civic and social conditions..................................................
Description of the city.....................................................................................................
History.................
Climate.........................................
Population.................................................................................
- Political characteristics..................
Industries...........................
Physical characteristics..................................................
Sanitation.............................................................
Sewerage and surface drainage.................................
Water supply........................................................................... ...................-................. ..

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7
9- H
9
10
11-48

11
12-14

12
14
16
18
19
19-22
22
22-25
,

22
22
24 *
25
26
26
27
29-36
29

33
33
35
35
36

38
43-^8
43
44
46
48-60
48-50
48

48
49
49
49
50
50-51
50

CONTENTS.

Civic and social conditions— Continued.
Page.
Milk s u p p ly ........... .. ......... ................................. . . . . . . . . ------------------------------ 54-57
Character of s u pp l y . . . . . . - -Jr.-'-............. .......... ................................................
54
Ordinances.. ........... ............ ........................... - - - - ........1............ - - - ...................55Inspection............................. - .....................
— .....................................
56
Garbage and refuse disposal.....................................................................
57
Civic and social agencies............................................. .............................- - ................. 58-60Department of health and safety...................... .....................- - - .......................
58.
H ospitals............. . . . ..................................... .............................................. ---------5&
Visiting nurses............ ......................................................................- - .....................
59
Charities......................................... .................................................. ........ ...................
Mother’s pensions...........................................................................- .........................
60The Homestead................................................................................
60
The Home for the Friendless......................................................... - .....................
60Summary and conclusion.........................
60-63
Registration of births..................................................................... - ........................
61
Infant mortality rate............................................................................................. 4
61
Nativity of mother................. ..................................................................................
61.
Type of feeding..................... - ............................................................. |..................
61
Father’s earnings.................... ........................... - ............................................ - - - *
61
62
Certified cause of death and infant losses........................................................
Attendant at birth.............................. ............ - - ....................- ............ ........
62
Conclusion.........................................- - - ............ ..................................if . 1 . . . . . . .
62
.

Appendix:
'
Method of procedure......... ....................................................... - ............ ......................... 63-72
Scope of in q u iry .......................................................................................................
63
Infant mortality rate..........................- .......... |...................... .......... P ................
65
Birth and death registration in Saginaw...........................................................
69
Live births excluded in Saginaw..........................- .............. - ............ - ............
71
Stillbirth rates...... ...............................................- .....................................................
72
Stillbirths.and miscarriages excluded in Saginaw........................................
73
Schedule used in study.......................................................................- - * -----------------------

91-

CH ARTS.
Chart I. Per cent of stillbirths and deaths under 2 weeks to total stillbirths and
infant deaths in Saginaw, Mich., Johnstown, Pa., Manchester, N . H .,
and New Bedford, Mass.......................................................... Faces page . .
II. Graphs showing for Saginaw, Mich., Manchester, N . H ., and New
Bedford, Mass., the cumulative per cent of births occurring in
families where the father earned more than amount specified
..................................................................................................... Faces p a ge..

III. Per cent distribution of births in Saginaw, Mich., Manchester, N . H .,
and New Bedford, Mass., by father’s earnings groups. .Faces p a g e ..

G ENERAL TABLES.
Table

1. Number and per cent distribution of deaths of infants bom in Sagi
naw during selected year, b y cause of death..........................................
2. Deaths of infants bom during selected year occurring in specified
calendar month, by cause of death........................................ .....................
3. Number and per cent distribution of deaths of infants bom during
selected year to mothers of specified nativity, b y age at death----4. Births during selected year, infant deaths, infant mortality rate, and
,
per cent of stillbirths, according to month and year of birth............
5. Deaths of infants' born during selected year occurring in specified
month and year, according to month and year of birth......................

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76
76
77
77
78

CONTENTS.
:

■

•••••

: ;! '

•.

. . . Page.

Table 6. Infants bom during selected year to mothers of specified nativity
and surviving at beginning of specified month of life, number and
per cent of infants dying subsequently in first year, and infant
deaths in specified month of life, according to month of life and
type of feeding in the month........................................................................
79
7. Births during selected year in each ward of residence, according to
nationality of mother........................................................................................
80
8. Births during selected year in each father’s earnings group, accord
ing to occupation of father..............................................................................
81
9. Births during selected year in families of specified number of per
sons, and average number of persons per family, according to
amount of family income and nativity of mother.................................
82
10. Births during selected year to mothers of specified nativity and
number and per cent of births to mothers gainfully employed
during year following birth of infant, according to earnings of
father................................................................... ................ .................................. < 82
11. Births from all pregnancies, infant deaths, infant mortality rate, and
per cent of stillbirths, according to order of pregnancy and age of
m o t h e r ................ .............. ................................................................................
83
12. Births to mothers married specified number of years, stillbirths, and
infant deaths, by number of births to mother.........................................
85
13. Mothers reporting specified number of miscarriages, by number of
pregnancies to mother and»nativity of mother.........................................
87
14. Mothers reporting specified number of stillbirths, by number of
births to mother and nativity of mother...................................................
88
15. Mothers reporting specified number of infant deaths, by number of
live births to mother and nativity of mother......................... ................
89
16. Births during selected year in dwellings of specified number of
rooms, according to number of persons in dwelling and nativity
of mother............................................. .............. ................................... ............
90
17. Dwellings of families included in study in each ward or ward group,
according to specified sanitary condition..................................................
90

ILLUSTRATIONS.
Plates I to X V I
Map of Saginaw.

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............. Follow page. .
Follows illustrations.

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LETTER OF TR A N SM ITT A L .

U. S.

D epartment

L abor,

Ch il d r e n ’s B u r e a u ,

Washington, April 14-, 1919.
Si r : Herewith I transmit a report on infant mortality in Saginaw,
Mich., a city with an infant mortality rate somewhat lower than that
for the birth-registration area of the United States. The wide varia
tions in death rates within the community revealed by this detailed
study offer further evidence that every family must be able to main
tain a fair standard of living and every expectant mother must be
able to secure adequate care if every baby is to be given a fair chance
to live.
The study has followed the same plan as the bureau’s other studies
of rqfant mortality in cities. The cooperation, without which the
study could not have been made, was generously given by the Sagi
naw mothers and the various civic and other organizations in the
city.
The field work for the study was directed and the report was
written by Miss Nila F. Ailen. The special agents at work with
Miss Allen in the field were Misses Melissa Farrell, Roberta King,
Elizabeth Moore, Etta F. Philbrook, Jessie Riall, and Mary Van Zile!
Statistical and editorial revision was done by Miss Rena Rosenberg.
Dr. Robert M. Woodbury wrote the appendix on method of pro
cedure.
. Respectfully submitted. .
J u l i a C. L a t h r o p ,

Hon. W B . W ilson ,

Secretary of Labor.

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Chief.

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INFANT MORTALITY: SAGINAW, MICH.
IN T R O D U C T IO N .
SELECTION OF SAGINAW.

Saginaw, Mich., was the fourth city to be included in the Children’s
Bureau studies of the social conditions underlying infant mortality.
Previous studies had been made in cities in the birth-registration
States of Pennsylvania, Massachusetts, and New Hampshire. It
seemed desirable to make'a study in Michigan, the westernmost State
in the provisional birth-registration area at the time the choice was
made (1914), and Saginaw, a city of 50,000 population— not too large
for the limited field force available— was selected.
An important consideration in the selection of Saginaw was its
unlikeness to the cities previously visited. Saginaw is a city of
widely diversified industrial life, located in a rich agricultural region.
It possesses, therefore, few of the characteristics of Johnstown, Pa.,
Manchester, N. H., and Brockton, Mass., which are, respectively,
iron and steel, textile-mill, and shoe-factory cities. A study of infant
mortality in Saginaw would reveal, it was thought, interesting con
trasts in conditions. Furthermore, Saginaw had a relatively small
foreign-born population, only 23.2 per cent, mainly of German
nationality. A difference which might prove of considerable import
ance was that comparatively few women were employed in industry
in Saginaw, as contrasted with the large proportion at work in the
textile mills of Manchester.
In spite of the striking differences in conditions, the infant mor
tality rate in Saginaw was apparently high (137.9 *) in 1910, not so
high as either Johnstown (165) or Manchester (193), but considerably
above the rate for Brockton (99).
i The latest figures available when the choice was made gave a rate of 145 (U. S. Bureau of the Census,
Mortality Statistics 1910, Bulletin 109), based on the provisional figures for births. Even the figure given in
the text is probably an exaggeration of the true rate, because birth registration was so defective. The
apparent fall in the rate for 1910 to 1912 is due largely to improvement in birth registration, since the increase
in number of births registered was much greater proportionally than the estimated increase of population."
The study itself .showed a large percentage of births unregistered even in 1913. See Appendix, p. 69. It

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IN F A N T MORTALITY.

METHOD AND PLAN OF STUDY IN SAGINAW.

The method of procedure followed by the bureau in infant mortality
studies is stated at length in the Appendix, pp. 63 to 69. Briefly,
the study of infant mortality was based upon the births which
occurred in Saginaw during the year ended November 30> 1913, and
the deaths under 1 year of age occurring in this group. The plan
was to visit the homes and b y means of personal interviews with
mothers, to collect data about the babies’ lives to the end of their first
year, or until death if death occurred under 1 year of age. Birth
records were examined and in each ease the facts necessary to identify
the baby were transcribed, to the schedule1later used for the collection
of information from the mother. Death certificates were copied for
infants whose age showed their births to have occurred in the selected
year. A t this stage o f the work, even when both records existed, it
was not always possible to determine whether they referred to the
same child. In several cases the records were not matched until
after the call on the parents, when it would be found, for instance, that
the baby named “ Zartsch” on the death record was the one called
“ Sage” on the birth certificate. .
While these data were being taken from the records the general
public was informed of the nature and purpose of the inquiry. The
local press gave it wide publicity. The clergy, especially those
serving congregations of non-English speaking peoples, stated the
purpose o f the work to their charges, and thus secured for the inquiry
an earnest and intelligent response. The city officials, the civic
league, the mothers’ and other women’s clubs were interested and
most helpful. In fact, the city welcomed the inquiry heartily, and
left nothing undone that would add to its success.
When the copying of the records had been completed, the agents
of the bureau, who were all women, commenced their calls upon the
mothers. An attempt was made to visit personally the mother o f
every one of the babies and to get directly from her the facts about her
is, therefore, not.safe to compare figures for:infant mortality shown, in the study with the rates computed
from.the records of births.and deaths, as shown in the following table:

Year.

JQ10......................................................... .....
1Ql 1
...................................................................
|Q12...... ....................................... ..........................
1Q14 ......................................................................
1915
............. ................ ....................................
IQIfi ...................................................... ..............

Popula
tion,«

60,682
. 51,508:
52,334
53,161
53,988
54,815
55,642

Live
births.!»

950
942
1,052
1,076
1,147
1,108
1,204

Deaths.!»

131
11»
108
123
111
108
138

Infant
mortality
rate.

137.9
120.0
102.7
114.3
96.8
97.5
114.6

Registered
live births
per 1,000
population.
18.7
18.3
20.1
20.2
21.2
20.2
21.6

a U. S. Bureau of the Census Bulletin 133, estimated population July 1.
b From Annual Registration Reports of Michigan, containing vital statistics, for the years 1910 to 1913.
For the years 1914 to 1916, by letter from the division of vital statistics, department of state, Michigan.
1 See page 91.

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SA G IN AW , M IC H .

baby’s first year of life. The information asked was most freely and
willingly given, and not one mother visited declined to be interviewed.
N ot all mothers could be interviewed, however, for many had moved
out of the city and a few could not be located.
The number of registered births in Saginaw in the year ended
November 30, 1913, was 1,113. In the course of the preliminary
work it was learned that numerous births had not been registered.
(See Appendix, p. 68.) Every effort short of a house-to-house
canvass was made to discover all births in Saginaw during the
selected year. The agents were instructed to inquire of every
mother visited if she knew of other babies in the neighborhood, and
the mothers of these babies were in turn called upon. Possibly
because Saginaw, which is really three towns combined into a city,
retains the small-town characteristic of acquaintanceship among
neighbors, this method of locating unregistered babies proved the
most effective and closely approached the thoroughness of a canvass
in discovering the living child -still resident in Saginaw. Death
certificates revealed some unrecorded births for which data were
obtained; lists of births which had occurred in all the hospitals were
secured; the cards of entry of babies in a baby show held shortly
before the work was begun furnished many names; and bap
tismal records were copied and checked with names obtained in
other ways. B y these means a total of one hundred and fortyseven unregistered births known to have occurred in Saginaw in the
selected year were found. Three deaths which had not been regis
tered were found also.1
In addition to the cases excluded because the mother had moved
away or could not be found, illegitimate births were rejected, the
conditions in these cases not being those of the normal family.
Births to mothers temporarily resident in the city were also excluded,
since the environment previous to the birth of the baby may not
have been typical of the city. Included in the study are the 1,015
births in the selected year to married mothers resident in the city
at the birth of the child and living in the city during the infant’s
first year. '
AN ALYSIS OF M A T ER IA L.
INFANT MORTALITY RATE.

Of the 1,015 births included in the study, 34, or 3.3 per cent, were
stillbirths. Eighty-three of the 981 live-born infants died, giving a
mortality rate of 84.6 per 1,000.
1 See Appendix, pp. 69-72 for a more complete discussion of method.

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INFANT MORTALITY.

CAUSE OF DEATH.

Relative importance of causes of death.— Eighty-three deaths from
various causes occurred before the babies included in the study
were 1 year old. A distribution of these deaths according to cause
shows the relative importance of each cause of death (Table I).
T able I

— N u m ber and per cent d istrib u tion o f deaths am ong in fa n ts born in S agin aw
during the selected year and in fa n t m orta lity rate, by cause o f death.

Infant deaths.
Cause of death,«»

All causes.
Gastric and intestinal diseases----Respiratory diseases......................
Early infancy and malformations.
Epidemic diseases..........................
Externa causes.............................
Diseases ill defined or unknown..
All other causes..............................

Per cent
Number. distri
bution.

Infant
mortality
rate.

100.0

84.6

8
10
41
5
1
4
14

9.6
12.0
49.4
6.0
1.2
4.8
16.9

8.2
10.2
41.8
5.1
1.0
4.1
14.3

.
'

a For classification according to Detailed International List, see General Table 1.

Malformations and causes peculiar to early infancy resulted in 41
deaths, practically one-half of the total number; relatively few were
found in any of the remaining six groups. In the registration area
in 1913 the percentage of deaths from the same causes was 38.7;
according to the bureau studies, in Manchester, with an infant
mortality rate of 165, the percentage was only 29.4; and in Johns
town, with a rate of 134, it was 25.5. The percentage of deaths
from these causes was much larger among the Saginaw infants than
in any of the localities previously studied by the bureau which furnish
the only comparable statistics.
Gastric and intestinal diseases were not an important factor in
infant mortality in the group studied, these diseases causing only
eight deaths, 9.6 per cent. In the registration area for 1913, deaths
from this cause comprised 26 per cent, or slightly over one-fourth
of the total number of deaths. In Saginaw, the prevalence of breast
feeding may explain in part the small proportion of deaths from
gastric and intestinal diseases. Six of the eight deaths ascribed to
these causes occurred in the tenth or later months of the infant’s
first year, when exclusive breast feeding is not so commonly practiced.
Only one occurred in the summer; of the rest two occurred in the
winter and five in the spring and autumn (General Table 2).

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SAGI NAW, M IC H .
T a b l e II.

d ia

Deaths among infants born in Saginaw during selected year occurring in
specified month o f life, by cause o f death.

Deaths in specifled month of life.
First.

Total
deaths.

Cause of death.

Total.

All causes

Gastric and intestinal diseases___
Respiratory diseases......................
Early infancy and malformations.
Epidemic diseases..........................
Extemalcauses.............................
Diseases ill defined or unknown..
All other causes.............................

Under
2 weeks.

2 weeks
but
under 1
month.

Second.

Third.

8
10
41
5

4
14

Deaths in specified month of life.
Cause of death.

All causes..............
Gastric and intestinal
diseases.. ; ...................;
Respiratory diseases.......
Early infancy and mal
formations.....................
Epidemic diseases..........
External causes..........*...
Diseases ill defined or
unknown......................
All other causes...............

Fourth.

Fifth.

Sixth.

Sev
enth.

Eighth. Ninth. Tenth.
3

Elev
enth.

Twelfth.

1
1
3
1

The deaths from respiratory diseases were 10 in number, or 12
per cent of the total, slightly more than those from gastric and in
testinal diseases. Respiratory diseases, though ranking second in
number of deaths, were not of great importance as a cause of mortality
among the babies considered in this study. In the registration area,
deaths from this cause comprised 15.2 per cent of deaths from all
causes; in Manchester, which has practically the same latitude as
Saginaw, 15.9 per cent; and in Johnstown, a few degrees farther
south, 25.5 per cent. In Saginaw detached houses, adequate
means of ventilation, and lack of overcrowding, together with
appreciation on the part of mothers of the value of sunshine and
fresh air made a combination unfavorable to the spread of respira
tory diseases among' the babies. It is possible that the insular
climate of Saginaw may also account in part for the small percentage
of deaths from respiratory diseases.
Deaths from “ epidemic” diseases included one each from whooping
cough, dysentery, and syphilis, and two from tuberculous meningitis.
The one death from external causes was due to accidental asphyxia
tion. Deaths from ill-defined or unknown causes were of four

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INFANT MORTALITY.

infants less than 24 hours old; no report of the cause of death was
made by the physician. There were 14 deaths from various other
causes.
The chief causes of death, therefore, were found in malformations
and early infancy. Deaths in this group were caused by congenital
defects, prematurity, injuries at birth, marasmus, inanition, lack of
vitality, and other similar causes.
AGE AT DEATH.

The largest number of infant deaths occurred in the first three
months of life, 71.1 per cent of the entire number occurring during
this period. The age at death is shown in Table III.
T a b l e I I I . — Number and per cent distribution o f deaths among infants born during the

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

Per cent
Number. distribu
tion.

3 months but less than 6 ............................................................................................... . -

100'o

26
8
13
12
10
14

31.3
9.6
15.7
14.5
12.0
16.9

Twenty-six, or nearly one-third, of the total number of deaths
among the babies of the selected group occurred in the first week
after birth. In other words, more babies died in the first week than
in the last nine months of the year; and 47 deaths, or 56.6 per cent
of the total number, occurred in the first month. Compared with
similar percentages for the death registration area for the four-year
period 1910-1913,1 where slightly over one-fourth of the deaths oc
curred in the first week after birth and two-fifths in the first month,
the proportion in Saginaw at these periods of life was high. An
unusual feature is that there were no deaths under 1 day among the
foreign born (General Table 3)— a fact that suggests faulty registra
tion. Both births and deaths were fairly equally distributed through
out the different seasons of the year, except that births were some
what more numerous in the summer, and that a greater percentage of
the babies born in the winter season failed to survive. (General
Tables 4 and 5.)
The cause of death of an infant in the first week or so reaches back
into conditions that were exerting their influence before or at the
i U. S. Bureau of the Census, Mortality Statistics, 1910,1911,1912, and 191X

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SA G IN AW , M IC H .

time of birth. A normal infant, endowed with health and strength,
will survive for a considerably longer period, even when subjected
to the stress of disease or other adverse circumstances. If a baby
has only a small endowment of vitality or is prenatally handicapped
in some other way, its early death can not be rightfully attributed to
conditions encountered in its few days of life.
The stillbirths and deaths under 2 weeks have been grouped to
show more clearly the number of losses among the births studied
which have been affected by prenatal conditions. This group is
designated as “ fetal losses” by Dr. J. Whitridge Williams in an
address on prenatal care.1 With the exception of deaths from resph
ratory diseases,2 of which a single one occurred in Saginaw under 2
weeks of age, these losses may generally be ascribed to prenatal and
natal influences or conditions.
The relative importance of the losses among the Saginaw babies
due to prenatal causes is shown in Table IV.
T a b l e Ï Y .-N u m b er and per cent di^ u t i o n o f stülbvrths and infant deaths, by age at

Stillbirths and
infant deaths.
Age at death.
Number.

Per cent
distribu
tion.

117

100.0

Total losses.........
Stillbirths and deaths under 2 weeks
Stillbirths............
Deaths under 2 weeks. . .

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

infant deaths 2 weeks and over

58.1

34
34

29.1
29.1

41.9

26.5

Early infancy and malformations

Sixty-eight, or 58 per cent of the total infant losses, were stillbirths
and infant deaths under 2 weeks.
The true importance of these prenatal causes is more fully revealed
by adding the stillbirths to the deaths due to prenatal causes and
conditions. Of the deaths occurring after the second week of life
18 were ascnbed to causes peculiar to early infancy and malforma10 s and 23 of the 34 under 2 weeks were definitely certified as due
to these causes; m addition, 4 deaths that occurred on the first day
life, the causes of which were not reported, should be included—
1 Williams, J. Whitridge.
p. 33.

American Association for Study and Prevention of Infant Mortality, 1914,

S lo l h S . iT ’n . ?'
.U fth ?“ , °pneumonia and that the great number of stillbirths and L
by erne of

10'm

c~ * ™

bwts •« *»•

^isease deTel°ping after birth was
“ f* .
« J » « - be reduced

American Association for Study and I ^ v e n t io ^ o f ln t o t Mortality^l^hl,* ppU5^16(hl61A5B***>EilenC.

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INFANT MORTALITY.

a total of 79, or 67.5 per cent of the total losses, due probably to pre
natal causes.
In order to reduce infant mortality, therefore, measures must ob
viously be directed toward providing adequate prenatal care.
The proportion that the group of stillbirths and deaths under 2
weeks formed of the total losses is shown in Chart I for certain cities
studied by the bureau.
In Saginaw this proportion was greater than in any of the other
cities shown, though it had the lowest infant mortality rate and,
except New Bedford, the lowest percentage of stillbirths. Many
of these stillbirths and deaths in early infancy may be ascribed to
such indirect causes as lack of prenatal care, overwork, poverty,
alcoholism,1 and venereal diseases.2 For a determination of the
underlying causes of stillbirths and of many of the deaths under
two weeks proper care and supervision of mothers during preg
nancy, either by private physician or b y hospitals or similar institu
tion equipped for scientific diagnoses, are necessary, together with
a careful study of family and social conditions surrounding the
mother. Such close analyses are given apparently only in a few
of the large city hospitals. In Saginaw these underlying causes
were not known with scientific accuracy and could not therefore be
stated. The. immediate causes of stillbirths were certified when
known, but on account of the practical difficulties of securing ac
curate diagnoses, no analysis of the causes of these losses can be
made.
STILLBIRTHS.

For the purpose of this study, stillbirths are defined as dead-bom
issues of seven or more months’ gestation. To issues of lesser periods
the term “ miscarriage” is applied. There were 34 stillbirths in the
selected group of 1,015 births.
It is possible that a very considerable number of stillbirths were
not registered. The methods used to discover unregistered births
were most effective in finding living children, but might easily fail
to find unregistered stillbirths. Not a single stillbirth was reported
in the selected year by a midwife, all those reported having been
attended by physicians except one, where there was no attendant
at birth. In a difficult case, however, a midwife probably called in
a physician. No cause of the stillbirth was stated on the certifi
cates except in two cases, where premature birth was specified.
1 For seven months of the selected year, Saginaw had 158 saloons, and for the last five months, 134. Sev
eral clubs also dispensed liquor to their members. Shortly afterwards the number of saloons was reduced
by State law to 101, or one to every 500 population. On May 1,1918, a State prohibition law closed all
saloons.
2 Dr. J. Whitridge Williams says “ * * * it has long been known that this disease (syphilis) plays an
important part in the causation of fetal deaths * *
American Association for Study and Preven
tion of Infant Mortality, 1914, p. 35.

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CHART I.
P erceri

PER CENT OF STILLBIRTHS AND DEATHS UNDER TWO WEEKS TO TOTAL STILLBIRTHS AND INFANT DEATHS
IN
SAGINAW, MICH., JOHNSTOWN, PA., MANCHESTER, N. H., AND NEW BEDFORD, MASS.

100 <----->

Johnsiouin

Deaths under 2 weeks.

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SA G IN AW , M IC H .

Of the 1,015 births in the selected group, 34, or 3.3 per cent, were
stillbirths. The percentage of all stillbirths to the mothers included
in the study was somewhat greater, 3.8 per cent. The per cent of
stillbirths for the selected year was less than in the cities previously
studied by the Children’s Bureau with the exception of Brockton.
These rates ranged from 3 per cent for Brockton to 4.5 per cent for
Manchester.1
The stillbirth rate was 3.7 per cent for births to native mothers
and only 2.4 per cent for births to foreign-bom mothers. There
were more stillbirths of the male than of the female sex.
T a b l e V .— Total births and number 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.

Total
births.
Number. Per cent.

All mothers___

3.3

Males___
488
Native mothers...
Males.........

391

Foreign-bom mothers___
Males............

13fi
113

3. 8
2.9

3.7

17
11

4.3
2.9

2. 4

2.7

Of the stillbirths, 38.2 per cent (13 out of 34) were from first
pregnancies, whereas only 30.7 per cent of the live births resulted
from that pregnancy, indicating that the percentage of stillbirths
was high for first births. The percentage of stillbirths was highest
for sixth and later in order of birth for births both to native and to
foreign-born mothers. (See Table X V II, p. 28.)
If the births are classified on the basis of the age of the mother,
the stillbirth rate was highest for births to mothers under 20; it was
next highest for mothers over 30. (See Table X V I, p. 27.) If
classified on the basis of father’s earnings, the stillbirth rate was
greater in the higher than in the lower earnings groups. (See Table
Although the number of stillbirths is shown in several of the
tables of the report, it is difficult to draw sound conclusions from a
further analysis of the material because the data are meager and
incomplete.
1 Figures for stillbirths in the report for Johnstown, previously published, include miscarriages

105629°— 19------2

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INFANT MORTALITY.

ATTENDANT AT BIRTH.

In Saginaw the attendant at birth was usually a physician; only
occasionally was a midwife employed. The native mother, with
few exceptions, secured the services of a physician, and likewise the
foreign-born mother who had lived in this country for a number of
years— the latter more especially because one of her own nationality
was available. Four women physicians practiced in Saginaw, one
of whom attended numerous births in the selected year. The
mother who desired could have a physician of her own sex in attend
ance.
The data secured from mothers whose babies’ births had not been
registered revealed the fact that at least 14 persons were practicing
as midwives in Saginaw during the selected year; 2 of the 14 had
regularly made returns to the city hall of the births they attended.
Little could be learned about midwives, since there was neither
State nor local supervision or registration, nor any restrictions upon
the practice of midwifery.1 One midwife who had lived in this
country several years and could speak English was well qualified by
training and previous licensed practice in Germany. Midwives were
in demand among the poorer families, and chiefly among the recently
arrived Poles, Russians, and Hungarians.
The attendant at birth according to nativity of the mother is
shown in Table VI.
T a b l e V I .— Number and per cent distribution o f births in Saginaw during selected year

to mothers o f specified nativity, according to attendant at birth;
Birth s to—
Total births.
Native mothers.

Attendant at birth.
Number.

Foreign-bom
mothers.

Per cent
Per cent
Per cent
distri Number. distri- . Number. distri
bution.
bution.
bution.

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

1,015

100.0

766

100.0

249

100.0

Physician......................................................
Midwife..........................................................
Other or none................................................

930
66
19

91.6
6.5
1.9

735
20
11

96.0
2.6
1.4

195
46
8

78.3
18.5
3.2

A physician was employed as attendant for 91.6 per cent o f all of
the births in the group studied; a midwife was the attendant at only
6.5 per cent of the births; and the mothers o f 1.9 per cent of the in
fants were unattended by either physician or midwife. There were 19
births in this latter group; in one case a practical nurse attended, in
another— a stillbirth— the mother had no attendant, and in the re1 One midwife registered only 2 out of 21 births which she was known to have attended in the selected
year.

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SAGINAW, MICH.

maming cases the father or some other relative or a nonprofes
sional person took the place of a qualified attendant.
Midwives attended only 2.6 per cent of the births to native mothers,
but 18.5 per cent of those to foreign-born mothers. This shows the
greater tendency of the foreign-born mothers to employ midwives,
though over three-fourths of them preferred to employ physicians.
SEX.

The Saginaw study ipcluded 1,015 births, of which 527 were male
and 488 were female.
T a b l e V II .— B irth s d uring selected year, in fa n t deaths, in fa n t m orta lity rate, and per
cent o f stillbirth s, according to n a tiv ity o f m other and sex o f in fa n t.

Stillbirths.
Sex of infant and nativity of mother.

Total................................................
Hales.............................................................
Females.........................................................

Total
births.

Live
births.

Infant
deaths.

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

1,015

981

84.6

3.3

527
488

507
474

47
36

92.7
75.9

20
14

3.8
2.9

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

766

738

7a 5

3.7

Males.............................................................
Females.........................................................

391
375

374
364

29
23

77.5
63.2

17
11

4.3
2.9

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

249

243

127.6

2.4

136
113

133
110

18
13

135.3
118.2

3
3

2.2
2.7

■

Males........................................................ .
Females.........................................................

The mortality rate for male infants was greater than for female,
not only for total births but for each of the nativity groups, though
there was a very considerable difference in rates for the infants of
native and foreign-born mothers.
FEEDING.

The importance of the kind of feeding as a factor in infant health
can scarcely be overestimated. Authorities are agreed that exclu
sive breast feeding is safest and that mother's milk is the best food
for young infants.
Feeding is a changing process, difficult to express in tabular state
ment for a group through the period of infancy. An infant who
was receiving artificial food at the sixth month, for instance, might
have received another type of feeding for a considerable part of the
time; another infant who was breast fed exclusively at the sixth
month probably had the same type of feeding from birth.
Among the Saginaw babies each month of life showed a number of
infants who were changed from one type of feeding to another—
usually from breast to mixed or to artificial feeding. A small pro-

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INFANT MORTALITY.

portion of infants was fed artificially from birth. These proportions
and changes are shown in Table V III, in which the number of infants
breast fed and artificially fed is given month by month. The term
« exclusively breast fed ” means that the infant received no food
except breast milk during the greater part or all of the month in
question; “ artificially fed,” that he received no breast milk, and
“ mixed,” that he was given some breast milk in addition to other
food.
T able

V I I I .— In fa n ts su rvivin g at end o f specified m on th and n um ber and per cent fe d
in specified w a y during the m on th .

Month, of life.

Fifth

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

Exclusively breast
Total
Artificially fed.
fed.
infants
surviving
at end of
month. Number. Per cent. Number. Per cent.
934
924
922
916
915
912
910
907
906

821
742
684
599
546
487
375
312
251

87.9
80.3
74.2
65.4
59.7
53.4
41.2
34.4
27.7

85
119
148
187
206
223
242
251
270

9.1
12.9
16.1
20.4
22.5
24.5
26.6
27.7
29.8

Of the babies surviving at the end of the first month, 87.9 per cent
were exclusively breast fed from birth. This percentage slowly
decreased from month to month at about the same rate until the
seventh, when a marked decrease, twice as great as in most of the
preceding months, took place. The change was to mixed feeding,
apparently in preparation for weaning. The reduction thereafter in
the proportion of babies exclusively breast fed was at about the same
ra,te as before, but the proportion exclusively artificially fed did not
increase in a corresponding ratio, a large number of infants being
given mixed feeding.^ In the ninth month the exclusively breast
fed and the artificially fed infants were about equal in number.
Artificial feeding is necessary in some cases because infants are
unable to nurse, mothers are ill, or other conditions exist which
make breast feeding either unhealthful or impossible. In Saginaw
only 85, or 9.1 per cent, of the babies surviving at the end of the first
month were artificially fed during that month. Ninety-five infants
had been given artificial food exclusively; 10 of these had died.
(General Table 6.) The percentage of exclusively artificially fed
babies was low from the beginning, however, and increased but little
from month to month.
The difference in mortality by type of feeding during the month is
shown in Table IX .

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

death rate per 1,000 infants fed in specified way, by month o f life.a
Deaths j n month
Deaths
in month per 1,000 infen ts—
per 1,000
survivors
at begin
ArtifiBreast
ning of
ciallv
fed.
month.
fed."

Month of life.

First...................................................................
Second........................................................
Third...........................................
Fourth..........................................
Fifth.......................................
Sixth.................................................
Seventh.........................................
Eighth............................................................
Ninth..................................
I

622 1
1ft 7

6.7

2. 2

6 .7

3.3

1 1

4 .8

2 2
2. 2
2. 2

2.0
3.2
3.7

i.i

« Derived from General Table 6.
b The rate is per 1,000 infants who lived to be fed.
not fed.

The rate per 1,000 live births is 47.9: 15 infants died

In the first column is given the number of infants that died in the
month per 1,000 survivors at the beginning of the same month; the
mortality, though subject to fluctuations, shows a decided fall after
the first and second months. In the second and third columns are
presented the monthly death rates per 1,000 infants breast fed and
artificially fed. There is a very considerable difference in favor of
the breast-fed infants.
Much of the difference which appears in the first month of life is
doubtless due to other causes than type of feeding. Fifteen infants
died without having been fed; 19 others died in the first two weeks,
and their deaths, as stated previously, were probably due to some
prenatal cause or condition rather than to feeding.
T a b l e X .— Number and per cent distribution o f infants born during selected year and

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

Type of feeding and nativity of mother.

Third month.

Number.

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

Sixth month.

Ninth month.

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

922

100.0

912

100.0

906

100.0

684
90
148

74.2
9.8
16.1

487
202
223

53.4
22.1
24.5

251
385
270

27.7
42.5
29.8

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

703

100.0

695

100.0

691

100.0

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

517
71
115

73:5
10.1
16.4

364
151
180

52.4
21. 7
25.9

192
286
213

27.8
41.4
30.8

Foreign-born mothers...........................

219

100.0

217

100.0

215

100.0

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

167
19
33

76.3
8. 7
15.1

123
51
43

56. 7
23. 5
19.8

59
99
57

27.4
46. 0
26.5

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

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INFANT MORTALITY.

Feeding and mother’s nativity.— In the third month a slightly
larger percentage of the infants of native than of foreign-born mothers
were artificially fed. This difference was somewhat greater in the
sixth and ninth months. The value of exclusive breast feeding was
evidently well understood b y the Saginaw mothers, over half of whom
gave this type o f feeding for the first six months. This percentage
applies not only to the group of foreign-born mothers but also to the
native mothers, who are popularly believed less ready than the former
to assume this duty.
■ A comparison of the proportion of breast and artificially fed
infants in Saginaw and in cities previously studied b y the Children’s
Bureau shows, with one exception, a striking difference in favor of
Saginaw. Exclusive breast feeding was given to nearly three-fourths
of the Saginaw babies who survived the third month of life, to over
one-half of those who survived the sixth month, and to more than
one-fourth of those who survived the ninth months
In Manchester, artificial feeding was much more prevalent than in
Johnstown or Saginaw, owing perhaps to the large proportion of
mothers employed away from home. The percentage of infants
exclusively breast fed was higher in Johnstown than in Saginaw dur
ing the nine months for which information on feeding was secured.
In Johnstown, however, about one-half of the mothers, compared
with less than one-fourth in Saginaw, were foreign-bom.
The kind of feeding was no doubt primarily responsible for the
relatively large number of infant deaths from gastric and intestinal
diseases in Manchester,1 where artificial feeding was general, and the
relatively small number of deaths from these causes in Saginaw where
breast feeding was commonly practiced. The specific mortality rate
from gastric and intestinal diseases was 63.3 in Manchester compared
with 8.2 in Saginaw. In other words, relatively to the number of
infants, but one death occurred from this cause in Saginaw to 8 in
Manchester.
NATIONALITY.

Nativity of population.— The native white population of Saginaw
in 1910 was 76.2 per cent of the whole population, 42 per cent being of
foreign or mixed parentage and 34.2 per cent of native parentage.
The foreign-born white comprised 23.2 per cent of the total popula
tion; but of the population over 20, 33.8 per cent were of this group.
Only 0.6 of 1 per cent of the population were colored.
Nativity of mother.— In the group of mothers of infants studied
the nativity groups were represented in approximately the same pro
portions as in the total population. There was one birth to an Indian
mother and seven to Negro mothers.
1In Manchester, infants dying from gastric and intestinal disease, 99; artifieally fed during month of
death,62; m ixedfed,i9; and breast fed, 18. All but 3 of these deaths-were from diarrhea and enteritis.

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SA G IN AW , M IC H .

T able X I .— Births during selected year, infant deaths, infant mortality rate and per
cent o f stillbirths, according to nativity o f mother.

Stillbirths.
Nativity of mother.

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

Total
births.

Live
births.

Infant
deaths.

Infant
mortality
rate.

Number.

Per cent
oftotal
births.

1,015

981

84.6

3.3

766
249

738
243

52
31

70.5
127.6

28
6

3.7
2.4

Native mothers...
Foreign-born mothers..

The infant mortality rate of 70.5 for the children of native mothers
is markedly lower than the rate of 127.6 for infants o f foreign-born
mothers. Of the live births scarcely one-fourth were to foreign-born
mothers, yet three-eighths of all the infant deaths occurred in this
nativity group.
A distribution of the births to foreign-born mothers according to
the nationality o f the mother shows that the German, with 35.7 per
cent of the births, was the principal nationality represented. This
is in harmony with the fact that the largest nationality group in the
foreign-born population of Saginaw was the German.
T a b l e X I I .- -Births to foreign-born mothers, infant deaths, and stillbirths, according to

nationality o f mother.

Nationality of foreign-born mothers.
Foreign-bom mothers.......
German.................
Polish...........
Italian...................
French Canadian..............
Other Canadian. ..
English, Scotch, Irish, and Welsh
A n oth er«................
Not reported..............

Total
births.

Live
births.

Infant
deaths.

Still
births.

249

243

89
50
17
12
29
21
30
1

86
49
17
12
28
20
30
1

12
9
2
1
3
1
3

3
1
1
1

ivUiiOlOJU, O
Greek, Slovak, and Slavic not otherwise specified.

The births to Polish mothers were second in number, though the
Canadian group is second in population. The numbers of births in
the separate nationality groups were so small that mortality rates
for them are of little significance. I t appears, however, that the
mortality of infants of Polish and o f German mothers exceeded that
for the other groups.
The foreign-born residents were distributed throughout the city.
According to the distribution of births by ward and nationality of
mothers, as shown in General Table 7, the native mothers far out
numbered the foreign-born mothers in every section. In scarcely

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INFANT MORTALITY.

a ward was the number of births to foreign-born mothers over onethird of the whole.
Most of the German mothers of the infants studied lived on the
West Side and especially in the nineteenth and twentieth wards,
though the German families in Saginaw show no especial tendency
to group together. Among the families visited no differences in so
cial customs were noticed between the German and native mothers.
The Polish families were for the most part permanent residents,
owning their own homes. While they had not congregated in any
strictly defined area, most of them lived on the East Side in the
tenth, eleventh, and twelfth wards. Many of the recent immigrants
of this nationality lived just outside the city limits and consequently
were not included in this study.
Italian families were few in number and were scattered throughout
the city.
There were several families of Russian Germans in Saginaw among
which births occurred in the selected year. In the winter time most
of these families lived in. the city, but when the farming season
opened, they moved to the sugar-beet fields, where the whole family
worked from spring to late autumn. Owing to these changes of
residence, most of the infants of this group were excluded.
Years of residence in the United States.— A study of births to
foreign-born mothers, by length of the mother’s residence in the
United States, may be of some significance in connection with the
rapidity of assimilation and its effect upon infant welfare. The
principal foreign nationality represented in Saginaw is the German,
and English-speaking Canadian and British come next. Nearly
three-fifths of the births to foreign-bom mothers were to mothers of
these nationalities. These groups for the most part either have
customs similar to those of native mothers or have been here so
long that they have acquired them. The other nationalities where
assimilation is slower and more difficult are of less numerical im
portance.
Practically half of the births (121) were to mothers who had lived
in the United States 10 years or over. For this group the mortality
rate was 102.6, as contrasted with 155.7 for those whose mothers
had lived here for less than 10 years. It is possible that differences
in customs or characteristics or differences in economic status may
play a larger part than the length of residence in the United States.

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SA G IN AW , M IC H .

T a b l e X I I I .— Births to foreign-born mothers, infant deaths, and stillbirths, according

to length o f residence o f mother in the United States.

Length ofresidenoe of mother in the United States.

Births.

All foreign-born mothers.......
Under 1 year..............
1 to 2 years.................
2 to 3 years............. .
3 to 4 years........................
4 to 5 years..................
5 to 10 years...................
10 years and over................
Not reported..............

Live
births.

Infant
deaths.

249

243

2
13
15
16
14
64
121
4

2
13
14
16
14
63
117
4

1
2
3
4
9
12

Still
births.
6

1
1
4

Mother’ s ability to speak English.— A distribution of births
according to the ability of the mother to speak English is shown in
Table X IV .
T able XIV.

Births during selected year, infant deaths, infant mortality rate, and per
cent o f stillbirths, according to ability o f mother to speak English.

Stillt irths.
Ability of mother to speak English.'

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

Total
births.

Live
births.

Infant
deaths.

Infant
mor
tality
rate, a

Number.

Per cent
of total
births.

1,015

981

84.6

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

940
75

907
74

71
12

78.3
162.2

33
l

1.3

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

249

243

127.6

2.4

English-speaking nationalities...................
Non-English-speaking nationalities............

50
199

48
195

4
27

138.5

2.0

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

124
75

121
74

15
12

124.0
162.2

3
1

24
1.3

3.3

° Not shown where base is less than 50.

Of the total births, 92.6 per cent were to mothers who were able to
speak English. In no other city in which an infant mortality study
has been previously undertaken by the bureau has the proportion of
English-speaking mothers been nearly so large. While the percent
age speaking the language was very high and the mortality rate for
their infants was low, 78.3, it was not so low as that for infants of
native mothers only, 70.5. Of the births to foreign-born mothers,
one-fifth were to those of English-speaking nationalities and need,
therefore, no further consideration. Of the remainder, over threefifths were to mothers who had acquired a speaking knowledge
of English. Less than two-fifths were to mothers unable to speak
English. The rate for this group was highest; but since it was
composed largely of recent immigrants poverty and its attendant
evils are factors probably more important than the inability of the
mother to speak English.

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INFANT MORTALITY.

LITERACY.

Illiteracy is a handicap to a mother because it closes to her so
many avenues of knowledge. The percentage of literacy among the
mothers of infants included in this study was very high; mothers of
949 babies, or 93.5 per cent of the whole number, were able to read
and write. In Johnstown and Manchester the mothers of only 84
and 83 per cent of the babies, respectively, were literate.
T a b l e X V . — Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to literacy o f mother.
Stillbirths.
Literacy of mother.«

Total
births.

Live
births.

Infant
deaths.

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

1,015

981

84.6

3.3

949
63
3

919
59
3

71
12

77.3
203.4

30
4

3.2
6.3

a Persons who can read and write in any language are reported literate.
6 Including 4 births to illiterate native mothers.

In Saginaw only four, or one-half of 1 per cent, of the native
mothers were illiterate, illiteracy being confined practically to the
foreign-born group. Fifty-nine, or less than a fourth of the births
to foreign-born mothers, were to mothers who were illiterate. But
of the 63 births to illiterate mothers 4 were stillbirths and 12 of the
live-born infants did not survive the first year. The mortality rate
for these infants was excessively high— 203.4. Illiteracy of the
mother, however, is often accompanied b y poverty and ignorance,
and it is therefore difficult to determine how much importance
should be ascribed to illiteracy alone.
AGE OF MOTHER.

The age of the mother at the time her child is born appears to have
some influence on his chance of survival. Whether this influence is
traceable to physical causes, coincident with the degree of the
mother’s maturity, can not be definitely stated. Inexperience,
failure to observe or ignorance of simple hygienic measures may
affect the mortality and stillbirth rates of first births or births to
young mothers.

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SAGIN AW , M IC H .
T able X Y I.

Births during selected year, infant deaths, infant mortality rate and per
cent o f stillburths, according to age and nativity o f mother.

Stillbirths.
- Total
births.

Age and nativity of mother.

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

766

Under 20...........
..............

Foreign-born mothers.......
Under 20.......
............
...............

49
244

46
236

Infant
mortality
rate. «

Number.

Per cent
of total
births.»

84.6

3.3

115.4
105.4
73.8
70.5

3
8
9
12

5.5
2.6
2.9
3.9

70.5

3.7

84.7
59.3
öl, 3

3
8
9
7

3.3
3.7
3.5

2.4

5
1

4.6

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

25 to 29.......
30 to 39..........
40 and over.........

Infant
deaths.

1,015

Under 20..............
20 to 24.............
25 to 29............
30 to 39.......
40 and over...........

25 to 29.............
30 to 39..........
40 and over...........

Live
births.

5
20
14

249

243

127.6

'6
58
62
108
15

6
58
62
103
14

1
11
8
11

189.7
129.0
106.8

«N o t shown where base is less than 50.

The highest mortality was found among infants of mothers under
20 years of age, the rate being 115.4; the next highest rate, 105.4,
was among infants whose mothers were from 20 to 24 years old.
The mortality among infants of mothers who were 25 to 29 was mate
rially less, 73.8, and the rate was about the same for the group
aged from 30 to 39.
r
The mortality rate for the infants of the foreign-born mothers,
127.6, very much exceeded that for infants of the native mothers,
70.5, with corresponding differences in the mortality of the several
age groups for each nativity. For each nativity group, however, the
mortality among the children of the youngest mothers was the
highest.
In the group of infants born to native mothers, the rate (51.3)—
the lowest rate for any age group— is lowest for mothers aged
30 to 39. This result may be attributed partly to the fact that the
native mother is in her physical prime during these years; partly to
her experience in motherhood; and also to the relatively easy financial
circumstances that characterize this period for the native group.
ORDER OF BIRTH.

Some relation apparently exists between infant mortality and the
number of children to whom the mother has previously given birth.
The mother of a first child is often unacquainted with the essentials
of prenatal care. A later-born child profits from the mother’s

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INFANT MORTALITY.

•28

physical maturity and the knowledge and experience she has gained
with her previous children. In large families these advantages may
he counteracted by overwork of the mother, home overcrowding, or
poverty.
T v b l e X V 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 and nativity o f mother.
Stillb irths.
Number in order of birth, and nativity of
mother.

Total
births.

Live
births.

Infant
deaths.

Infant
mortality
Fer cent
rate.«
Number. of total
births.a

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

1,015

981

84.6

3.3

Fourth and fifth...........................................
Sixth and later..............................................

314
219
164
172
146

301
213
159
169
139

36
12
12
12
11

119.6
56.3
75.5
71.0
79.1

13
6
5
3
7

4.1
2.7
8.0
1.7

766 *

738

70.5

3.7

Fourth and fifth..................... - ....................
Sixth and later..............................................

273
172
120
115
86

262
166
115
113
82

26
8
8
5
5

99.2
48.2
69.6
44.2
61.0

11
6
5
2
4

4.0
3.5
4.2
1.7

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

249

243

127.6

41
47
44
57
60

39
47
44
56
57

10
4
4
7
6

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

Fourth and fifth..........................................
Sixth and later.................... ..................... - -

2.4

2
125.0
105* 3

1
3

1.8

a Not shown where base is less than 50.

The first born, 301 in number, comprised three-tenths of the whole
number of live births, but included over four-tenths of the deaths.
The infant mortality rate for first-born babies was 119.6— the highest
for any order of birth, and high in comparison with the rate of 84.6
for all infants included in the study. The second born had the most
favorable infant mortality rate, 56.3, a low one. The rate of 75.5 for
third-born children was considerably above that for the second in
order of birth. There was little difference between the rate for third
and the rates for later-born children. Very few mothers had had a
large number of children. Only 68 infants born during the selected
year were from eighth to fourteenth in order of birth.
These findings, confirmed in general by those for previous births
to the Saginaw mothers visited, have certain interesting points o f
difference from the findings of other studies. For all births to the
mothers included in these studies, the rate for Saginaw is highest
for first births, contrary to the showing for Manchester and Johns
town. The rates for the first and the second born, however— those
rates which are based on the largest number of cases— show the
same relative positions in Manchester as in Saginaw; the rate for the

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SA G IN AW , M IC H .

second is much more favorable. But in both Manchester and Johns
town the tendency for the rate to increase with the later orders of
birth was much more marked than in Saginaw; indeed the highest
rates appeared for fourth and for ninth and later in Manchester, and
for tenth and later in Johnstown. Figures presented by Hibbs 1 in
a chapter on Infant Mortality and Size of Family ako show a much
higher rate for the later-born children.
For infants born in the selected year, rates b y order of birth to
native and foreign-born mothers show in general the same differences.
The first births in both groups have the highest mortality. The pro
portion of first bom is much higher in the group of births to native
mothers than among births to foreign-born— one-third instead of
only one-sixth. The large proportion of births where the rate is
high among the native group tends, therefore, to minimize the true
difference between the infant mortality rates for infants of native and
of foreign-born mothers.
ECONOMIC FACTORS.

Father’ s earnings.— The term “ father’s earnings” means the
recompense received for services during the year after the baby’s
birth. Income from rents or from capital invested or other sources,
as well as earnings or income of other members of the family are ex
cluded, but the earnings and other income of each member of the family
for the same year were ascertained. No inquiries were made concern
ing the family expenses or budget except in regard to rent.
Fathers of babies included in this study were employed in a variety
of industries. One-half were engaged in manufacturing and mechan
ical pursuits, over one-fourth in trade and transportation, and the
remainder as miners, clerks, farmers, laborers, etc. Their occupations
(General Table 8) reveal a great diversity of employment, and show a
large number of business executives, professional men, skilled workmen,
and others whose earnings were ample for the support of a family.
The father’s earnings are assumed to be the best obtainable index
of the economic status and the standard of living of the family. In
some cases the father’s earnings are supplemented b y earnings of the
mother or an older child or b y income from rents or from other invest
ments. In other cases items like pensions, insurance, workmen’s
compensation, savings, or charity figure in the family income. But
income from these sources is often temporary or uncertain, and in
some cases it is impossible to separate net from gross income. For
these reasons father’s earnings for the year following the baby’s birth
have been used as a basis for classifying births and computing mor
tality rates. In case of stillbirths the earnings for the year preceding
i Hibbs, Henry H., jr. Infant Mortality: Its Relation to Social and Industrial Conditions, p. 39. Russell
Sage Foundation, New York, 1916.

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INFANT MORTALITY.

the birth were used. The total family income 1 is presented in con
nection with the size of the family.
T a b l e X V I I I .— Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to earnings o f father and nativity o f mother.
Stillbirths.
Earnings of father and nativity of mother.

All mothers.................
Under $450..........................
$450 to $549.........................
$550 to $649.........................
$650 to $849.........................
$850 to $1,049.....................
$1,050 to $1,249...................
$1,250 and over...................
No earnings........................
Not reported......................
Native mothers.......
Under $450.........................
$450 to $549.........................
$550 to $649.........................
$650 to 849.........................
$850 to $1049......................
$1,050 to $ 1 ,2 4 9 .......----$1,250 and over.................
No earnings......................
Not reported.....................
.

Foreign-bom mothers

Under $450........................
$450 to $549........................
$550 to 649.........................
$650 to $849.......... ............
$850 to $1,049...................
$1,050 to $1 ,249 ..............
$1,250 and over.................
No earnings.....................
Not reported.....................

Total
birtbs.

Live
births.

Infant
mortal
Per cent,
ity rate.« Number. of total
births.«

Infant
deaths.

1,015

981

84.6

3.3

79
103
151
255
159
94
143
7
24

98
145
246
157
91
135
7
24

14
11
15
26
7
3
3
1
3

179.5
112.2
103.4
105.7
44.6
33.0
22.2

1
5
6
9
2
3
8

1.3
4.9
4.0
3.5
1.3
3.2
5.6

766

738

70.5

3.7

67
106
206
123
79
125
6
16

38
63
102
197
121
76
119
6
16

9
8
8
14
5
3
2

127.0
78.4
71.1
41.3
39.5
16.8

4
4
9
2
3
6

6.0
3.8
4.4
1.6
3.8
4.8

249

243

127.6

2.4

ftft

41
36
49
36
15
18
1
3

40
35
43
49
36
15
16
1
8

6
3
7
12
2

1
1
2

1
1

»N o t shown where base is less than 50.

A striking relationship between the infant mortality rate and the
father’s earnings is shown in Table X V III. The highest rate, 179.5,
is for infants whose fathers are in the lowest earnings group, and the
lowest rate, 22.2, is for those whose fathers are in the highest group.
The mortality rate, with but a single exception, falls consistently as
the father’s earnings increase, but the rate does not fall below 100
until the group $850 to $1,049 is reached; from this point the fall in
the rate is very marked. In other words, the babies in families
where the earnings of the father are low die at a much higher rate than
do those whose fathers are able to provide sufficient cure for them.
Poverty with its concomitants is an important factor in infant
mortality.
In New Bedford and Manchester the mortality rates for infants in
the lowest father’s earnings group were respectively 201.9 and 242.9,
or three and four times as great as for those in the highest group, 59.9
i General Table 9.

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CHART I I . —GRAPHS SHOWING FOR SAGINAW. MICH., MANCHESTER, N. H ., AND NEW
BEDFORD, MASS., THE CUMULATIVE PER CENT OF BIRTHS OCCURRING IN FAMILIES
WHERE THE FATHER EARNED MORE THAN AMOUNT SPECIFIED.
Per cent.

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SA G IN AW , M IC H .

and 58.3. In Saginaw, in spite of the much lower rate for infants in
the low earnings group, the relative percentage difference in range is
even greater than in these other cities, owing to the extraordinarily
low rate bf 22.2 for infants in the highest earnings group.
Saginaw is in the center of a rich farming country and prices of food
products are relatively low, with no commission, storage, or transpor
tation charges to be paid. Beet sugar is made in a factory just out
side the city limits. Rents are low, nearly one-half of the families
visited owned their own homes. In many cases the home is set in
a small plot of ground, with a few fruit trees, a wired inclosure for
chickens, and a thriftily cultivated vegetable garden. The cost of
fuel is low, partly on account of the presence of coal mines in the city,
some of which are cooperatively owned. With these advantages,
the small family of Saginaw can live in simple comfort on earnings
that would spell poverty for the tenement-housed families in other
or larger cities.
The economic status of the Saginaw families visited is uniformly
superior to that of the Manchester or New Bedford families, as shown
in Chart II, which presents in the form of graphs the per cent of births
that occurred in families where the father earned over each amount.
In connection with the relatively high economic status, the small size
of families, and the low cost of living in Saginaw as compared with
other cities studied by the bureau, the significant fact may be noted
that the infant mortality rate is comparatively low.
Analysis of the rates by earnings of father and nativity of mother
(Table X V III) shows that for native mothers the rates consistently
decline as the earnings increase, a condition to be expected since
births to native mothers constituted over three-fourths of the whole
number. For infants of foreign-born mothers no rates are pre
sented, because the numbers are too small. For the father’s earnings
group under $550 the rate for infants of native mothers was 168.3 in
contrast to only 106.7 for those of foreign-born mothers. This differ
ence is especially noteworthy in view of the excess in the average rate
for the infants of foreign-born mothers, 127.6 as contrasted with 70.5
for infants of native mothers.
A special study of the families in which the father’s earnings were
less than $550, shows that three-fourths either had no other income,
or if they had income from supplementary sources, it was not enough
to raise the total above $550. Among the remaining one-fourth the
father’s earnings were supplemented in various ways. In 12 cases
the family had an income between $550 and $649; in 14, between $650
and $849; in 9, between $850 and $1,049; in 3, between $1,050 and
$1,249; and in 2, over $1,250. The infant mortality rate in families
in which the total income was under $550 was 125.
The classifications " N o earnings” and ‘ ‘ Not reported” apply only
to the earnings of the father. They do not mean that no information

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INFANT MORTALITY.

was obtained concerning the standard of living of these families, for
in most cases the amount available for the support of the family dur
ing the year was known. In the seven cases of “ No earnings,” three
fathers died prior to and one six weeks after the baby’s birth, one was
sick, and two deserted their wives. Four of these families had less
than $450 to live on, and the others had incomes of $630, $950, and
$3,500, respectively.
The “ Not reported” earnings class contained 24 families. No defi
nite income was ascertained for three of the families— one apparently
in straitened circumstances; five had incomes of less than $450 during
the year; seven, from $500 to $800; and nine had $1,000 or more or
were obviously prosperous.
T a b l e X I X . __ Number and per cent distribution o f births during selected year to mothers

o f specified nativity, according to earnings o f father.
Births to—

A ll mothers.

N ative mothers.

Earnings of father.

Number.

A ll classes................................................

1,015
79
103
151
255
159
94
143
7
24

Foreign-bom
mothers.

P er cent
Per cent
distri Number.
distri Number.
bution.
bution.

Per cent
distri
bution.

100.0

766

100.0

249

100.0

7.8
10.1
14.9
25.1
15.7
9.3
14.1
.7
2.4

38
67
106
206
123
79
125
6
16

5.0
8.7
13.8
26.9
16.1
10.3
18.3
.8
2.1

41
36
45
49
36
15
18
1
8

16.5
14.5
18.1
19.7
14.5
6.0
7.2
.4
3.2

The per cent distribution of births according to father’s earnings
(Table X IX ) shows that the fathers of nearly one-third of the
babies (32.8 per cent) earned less than $650; of one-fourth (25.1 per
cent) from $650 to $849; and of two-fifths (39.1 per cent) $850 and
over. Almost twice as many were in the highest class, $1,250 and
over, as in the lowest earnings class, under $450.
A like distribution of the births to native mothers shows a tendency
to larger proportions in the higher earnings groups. Instead of onethird, slightly over one-fourth of the births were in families where
the father earned less than $650. The highest earnings class con
tained over three times the number in the lowest earnings class.
On the other hand, the distribution of births to foreign-born mothers
shows father’s earnings to be generally lower, with twice as many in
the lowest as in the highest earnings group. Practically one-half of
the births were in the group where the father’s earnings were less
than $650, not quite one-fifth in the group $650 to $849, and slightly
over one-fourth in the group $850 and over.

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CHART I I I . —PER CENT DISTRIBUTION OF BIRTHS IN SAGINAW, MICH., MANCHESTER,
N. H., AND NEW BEDFORD, MASS., BY FATHER’S EARNINGS GROUPS.

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SAGINAW, MICH.

In Chart III the per cent distribution of births by father’s earnings
in the three broad classes of less than $550 (low), $550 to $849
(medium), and $850 and over (high) is presented for Saginaw, Man
chester, and New Bedford. I t shows not only the relatively high
economic status of the Saginaw group, but reveals interesting differ
ences in the distributions for the different cities. Of the Saginaw
births, slightly over one-sixth were in the father’s earnings class of
less than $550, while three-tenths of the births in Manchester and
over three-eighths of those in New Bedford were in the same low
earnings group. The percentage of births in the medium earnings
class, from $550 to $849, was about the same in all three cities. In
the highest earnings-class, $850 and over, the great difference be
tween these cities stands out sharply. Only a little over one-fifth of
the births in both Manchester and New Bedford, but practically
two-fifths of the Saginaw births, were in this class.
Gainful employment of mother.— The economic status of most of
the families visited in Saginaw was such that the mothers did not
have to engage in gainful employment. The industries of the city
were not of a character to draw women and girls in any considerable
number out of the home into the business world, and therefore enjoy
ment of economic independence previous to marriage played no part in
influencing mothers to take up extra-domestic employment afterward.
Few women were engaged in industrial pursuits in Saginaw.
Employment of mother during year preceding birth of infant.—

Employment of the mothers during the year before the baby’s birth
is shown in Table X X .
T

X X .— Births during selected year, infant deaths, infant mortality rate, and per
cent o f stillbirths, according to employment o f mother during year preceding birth of
infant and nativity o f mother.

able

E m ploym ent of mother during year pre
ceding birth o f infant and nativity o f
mother.

Total
births.

Live
births.

Infant
deaths.

Stillbirths.
Infant
m ortality
P ercent
rate, a
Num ber. o f total
births, o

A ll mothers.........................................

1,015

981

84.6

3.3

N ot gainfully em ployed.................................
Gainfully em ployed.........................................

868
113
74
39

68
15
7
8

78.3
132.7
94.6

33
1

3.7
.9

A w ay from hom e......................................

901
114
74
40

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

766

738

70.5

3.7

N ot gainfully em ployed.................................

676
62
40
22

48
4
i
3

71.0
64.5

4.0

A w ay from hom e......................................

704
62
40
22

Foreign-born mothers..........................

249

243

127.6

N ot gainfully em ployed.................................
Gainfully em ployed.........................................
A t hom e......................................................
A w ay from hom e......................................

197
52
34
18

192
51
34
17

20
11
6
5

104.2
215.7

5
1

105629°—19-----3

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N ot shown where base is less th a n 50.

2.4
2.5
1.9

IN F A N T MORTALITY.

Of the 1,015 babies included in this report, only 114, or slightly
over 11 per cent, had mothers who were gainfully employed at any
time in the year prior to the baby’s birth. B y “ gainful employ
m ent” is meant labor for which a money recompense is usually given..
Mothers of 40 infants were employed away from home, and mothers
of 74 had occupations which they carried on in their homes. The
mothers of 45 of this latter group kept lodgers. Usually the mother
had but one or two lodgers and frequently these were relatives,
so that this occupation in Saginaw was not so laborious as in some
towns, where, housed in congested quarters, the women cook, wash,
and care for rooms for a large number of lodgers. Keeping lodgers,
therefore, was not a material tax on the health and strength of the
Saginaw mothers, and was not a factor in infant mortality. The
gainful employment at the home of mothers of the remaining 29 *
infants consisted of sewing, washing, baking, and like occupations.
Mothers of 40 infants worked away from home in the year before
childbirth and 11 reported their occupations as domestic service,
cooking, or day’s work. The latter in Saginaw usually meant doing
the washing and weekly cleaning in an employer’s home. The one
stillbirth in the group of gainfully employed mothers occurred to a
mother who performed day’s work of any kind, and who, prior to
the baby’s birth in June, had been employed hoeing sugar beefs;
Her physician stated that the stillbirth was caused by overexertidfi
The mothers of the remaining 29 infants were engaged in a dozen
different occupations.
,
All but seven of the mothers working away from home had ceased
their work at least two months, most of them five months, and som e
as much as 10 months prior to the birth of the infant. Eight of the
babies born to this group died in infancy. Judging from the certi
fied cause and the age at death, prenatal causes not related to
the mother’s work were probably responsible fo r four of the eight
deaths. In no case did the mother resume her extra-domestic employ
ment before the death of her child.
The effect upon infant mortality of employment o f the mother
during the year before the baby’s birth is shown in Table X X . The
mortality rate for the infants of working mothers was 132.7 as con
trasted with 78.3 for infants of mothers not gainfully employed.
The excess mortality was among infants of the foreign-born mothers,
the group showing a rate o f 215.7. Although only one-fifth o f the
foreign-born mothers were employed, one-third of the infant deaths
in this nativity group occurred among their babies.
;
i Two. foreign-bora mothers, who worked! w ith their families in the sugar-beet field d u rfn f
and who w erenot separated from their babies on account o f w ork,w ere classed as mothers a t w ork at home.
Neither of the infants died.

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SAGISFAW, MICH.
Table X X I.

L ive births, infant deaths, and infant m ortality rate, aeeording to working
status o f mother during gear follow in g birth o f infant.

Working status of mother during year following birth of infant.

Total
live
births.

A ll m others...............
Gainful w ork.............
Resumed after infant’s death..
A t hom e.............
A w ay from hom e..........
N ot reported...........

Survived
one year.

Infant
deaths.

Infant
m ortality
rate.

898

84.8

858

794

64
19

74.6
154.5

14
109

104

14
5

(0)

6
13

(a)
(“ >
*•

® Rat0 n °t shown because not comparable with preceding rates.

Employment of mother during year following birth of infant.__
Mothers of 123 live-born infants (12.5 per cent) were gainfully em
ployed during the year after the baby was born. The mortality
rates, 154.5 for infants whose mothers worked and 74.6 for those of
mothers not gainfully employed, may be significant as an index of
the difference'in conditions in families where the mother was at work
and in those where she was not employed. But these rates do not
show the direct effect o f the employment of the mother, since in 14
cases the mother did not resume work till after the baby died. Ob
viously the death could not then be ascribed to the employment of
the. mother. For the rest, only 5 deaths occurred among the 109
infants whose mothers resumed work during the infant’s lifetime.
The postnatal gainful employments o f mothers were o f the same
general character as the prenatal— keeping lodgers for the most
part, and washing, sewing, or performing other domestic labor more
or less intermittently during the year. Extra-domestic employ
ment o f any character was exceptional.
In conclusion, only a relatively small proportion o f the mothers in
the Saginaw study were gainfully employed in the years preceding or
following the birth o f the infant. Practically all who worked in the
year preceding confinement discontinued work several months .before
the birth of the infant. Very few o f those who worked during the
baby’s lifetime did work that entailed absence from thé baby which
deprived him of breast feeding and other maternal care. Although
in one or two cases the employment o f the mother may be shown to
have been a primary cause of a stillbirth or an infant death, in most
cases the high mortality for infants of the mothers gainfully em
ployed may be ascribed to the general conditions associated with
low economic status found in these families.
Mother’s earnings.— The distribution of births to mothers gain
fully employed during the year following the birth o f the infant,
according to the earnings of the mother, is shown in Table X X I I

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INFANT MORTALITY.

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

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

Native mothers.

A ll mothers.
Earnings of mother during year following
birth of infant.

A ll classes...............................................

Total
-births.

125
64
31
14
1
6
9

Per cent
distri
bution.

Births.

Per cent
distri
bution.

Foreign-born
mothers.

Births.

Per cent
distri
bution.

100.0

51.2
24.8
11.2
.8
4.8
7.2

34
18
10

49.3
26.1
14. 5
1.4
1.4
7.2

30
13
4

53.6
23. 2
7 :1

5
4

8.9
7.1

1
5-

The earnings of the mother were occasionally a material con
tribution to the family income, but for the most part the sums were
not large. The gross earnings of one-half of the mothers who were
engaged in gainful employment during the year following the infant’s
birth were less than $150, practically one-fourth earned from $150
to $249, and one-sixth earned sums ranging from $250 to $550 and
over. Over one-half of the mothers earned their money b y keeping
lodgers. Five of the six mothers who are credited with haying
earned $550 or over kept lodgers; the sum represents gross receipts
and not a clear gain. In addition one kept a small store. All but
one were foreign bom .
The percentage of infants in each father’s earnings class whose
mothers were gainfully employed during the year following the
birth of the baby is shown in General Table 10. Mothers of only
12.3 per cent of the infants were so employed; the figures indicate
that as the earnings of the fathers increase the proportion of mothers
working decreases. In over half the instances (54.4 per cent)
where a mother was gainfully employed the father’s earnings were
less than $650. In each earnings class proportionately more of the
foreign-born than of the native mothers were employed, the differ
ence being marked when the father’s earnings were less than $850.
MATERNAL HISTORIES.

In addition to the facts about the Saginaw infants born during
the year ended November 30, 1913, a history of the earlier preg
nancies of each mother was secured. Among other details this
history included the duration and result o f each pregnancy, the
order and number of births, the sex, whether or not the infant
survived,1 and if not, the age at death. Many statements based
on data for the selected group are strengthened or confirmed by
analysis of the data furnished by the maternity record of the mothers.
i See schedule form, p. 9.

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SAGINAW, MICH.

The maternal histories number 997, or 18 less than the births (1,015),
in the detailed study, because the births included 10 sets of twins
and because a few of the mothers’ histories were excluded.1
The histories of these 997 mothers show a total of 3,0812 births,
of which 2,965 were live-born infants and 116 were stillbirths; in
addition there were 140 miscarriages. Of the 2,965 live-born babies,
271 died within the year after birth, constituting a mortality rate
of 91.4 for all the babies born to these mothers. This rate is some
what higher than that for the babies born in the selected year (84.6),
probably because the complete reproductive histories include all the
first births, among which the mortality is especially high.
The 116 stillbirths comprised 3.8 per cent of the total births,
compared with 3.3 per cent found in the selected group. It is reasonably certain, however, that the selected group contained less than
the actual number of stillbirths occurring in Saginaw in the year
studied. The highest stillbirth rate, 7.7 per cent, was found for
births to mothers 40 years old and over, and the lowest, 3 per cent,
for the age group 20 to 24. The stillbirth rate among first-born
children was 4.7 per cent, a rate that decreased for each later order
of birth until the sixth and later born, for whom the per cent was
5.9 (General Table 11).
Stillbirths and deaths at two weeks of age or less numbered 216,
0ff.55-8 per cent of the whole number (387) of stillbirths and infant
deaths. This figure may be compared with the 58.1 per cent for
stillbirths and deaths under two weeks among the babies born in the
selected year. Of the total number of infant deaths, 36.9 per cent
occurred within the first two weeks after birth, compared with 41
per cent in the selected group. One set of figures confirms the
findings of the other.
The mortality rate for all babies of the native mothers visited
was 86.4, compared with 70.5 for babies born in the selected year;
the rate for those of the foreign-born mothers was 102.3, compared
with 127.6, the rate for the selected year. The very divergent rates
of the infants in the selected year (70.5 and 127.6) tend to approach
each other (86.4 and 102.3) when all children of the selected mothers
are considered. This relation may be more nearly the true one,
since the larger number of infants and the longer period covered
Would subordinate those factors only temporarily important.
Families were usually small, three births being the average among
the mothers visited. Only 27 mothers reported ten or more births
and the largest number of children born to any mother was 14, of
whom ¿hh survived the first year.
i If a Mother's reproductive record was not com plete or if an illegitim ate birth was reported the his
tory was om itted from consideration.
* General Table 11.

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INFANT MORTALITY.

For the groups large enough to be significant the mortality in the
first year of life was highest for first births while the rate for
second-born babies was low; the rates for seventh and eighth preg
nancies were even lower though based on fewer cases. The mortality
was least among infants of mothers between the ages of 35 to 39
and greatest among babies whose mothers were under 20. The
mortality of first-born children was practically the same for all infants
of the mothers visited as for the selected group.
HOUSING.

Saginaw is not wholly without a' housing problem, though the city
creates a most favorable first impression with its detached residences
surrounded by lawns or grassplots and gardens, while trim walks lead
out to the excellent sidewalks flanking the wide, tree-bordered streets.
It appears to be a city in which the residents own their own homes and
where housing congestion and room overcrowding do not exist. This
lack of congestion is undoubtedly due to three circumstances. The
factories of Saginaw are not confined to one district but are scattered
over the city; Saginaw has four business centers; and the city has
no natural barriers, such as lakes and hills, to prevent expansion in
any direction.
The one-family detached house prevails; the infrequent two-famjly
house is also detached, and the rows of houses so common in large
cities and factory towns are unknown. A workingman’s horneáis
almost invariably a well-kept cottage or bungalow, one or two stories
high, which, being centered in its own plot of ground, has excellent
light and ventilation. Tenements and apartment houses being few
in number, there is practically no lot congestion; but as a result of the
lack of both State1 and city building codes, and of municipal health
regulations, a few tenements in the business sections and a few de
tached houses in the residential sections are in a very insanitary
condition.
An example of the results of the lack of building and sanitary laws
is found in one 3-story apartment and store block erected in one of
the business sections shortly before this study was made. This has
windows in front and rear only, the building having absolutely blank
walls on both sides. There are two stories of apartments above the
four long and narrow stores occupying the first floor, each story con
taining 12 apartments arranged three deep over each store. The
middle apartments (8 in all) depend in each case for light and ventila
tion upon an inadequate air shaft. Such conditions are very unusual,
however. In 854 of the houses visited the means of ventilation were
reported good; in 128, fair; and in only 22, poor.
i The Housing Law of Michigan applying to cities of 10,000 population and over was passed May 2 , 1917.
Michigan Public A cts 1917, No. 167.

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SA G IN A W , M IC H .

T a b l e X X I I I .— Dwellings o f infants included in the study having mothers o f specified

nativity, according to specified sanitary conditions.
Dwellings occupied b y —
Sanitary condition of dwelling.
A ll
Native
m others. mothers.

Total dwellings «
Drinking w ater:
One s ou rce .................

Foreignbom
mothers.

1,005

757

248

977

732

245

C ity 6 ...................
Dug w ell...............
Driven w ell........
Purchased...........

2
616
339
20

2
443
270
17

173
69
3

More than one source
N ot reported..............
T yp e of toilet:
Water-closet...............
P rivy............................
Sink:
Sewer connected........
Sewer not connected.
Means of ventilation:
G ood ............................ .
F a ir..............................
P oor..............................
N ot reported..............
B oom s:
Clean............................
Medium .......................
D irty............................
N ot reported..............

27
1

2
1

490
515

402
355

88
160

394
611

326
431

68
180

854
128
22
1

684
66
6
1

170
62
16

585
302
113
5

474
216
63
4

111
86
50
1

a The difference between total births shown in other tables and total dwellings, shown in this table, is
due to the fact that there were 10 sets of twins, 9 to native m others and 1 t o a foreign-born m other,
fr l n one case, water purified b y private filtration plant.

If the housing standard adopted by Robert Chapin1 of not more than
1J persons per room is applied to the Saginaw families visited, only 30
out of the 1,015 births included in the study occurred in overcrowded
homes. Lack of overcrowding is further indicated by the fact that
897 of the 1,015 births occurred in families who lived in homes having
five or more rooms; 54 in homes of four rooms; and only 56 in homes
of less than four rooms. In 8 instances the number of rooms was
not reported. (General Table 16.)
T a b l e X X I V .— Births during selected year, infant deaths, infant mortality rate, and per

cent o f stillbirths, according to average number o f persons per room.
Stillbirths.
Persons a per room .

Total
births.

L ive
births.

Infant
deaths.

Infant
m ortality
rate.ô

N um ber.

Per cent
of total
births.b

T otal.........................................................

1,015

981

84.6

3.3

Less than 1 ........................................................
1 but less than 2 ...............................................
2 o r m o r e ..fiJ ...................................................
N ot reported......................................................

771
222
13
9

748
213
12
8

58
22
3

77.5
103.3

23
9
1
1

3.0
4.1

« E xcluding infant b om during selected year.
6 N ot shown where base is less than 50.
1 Chapin, R obert Coit. The Standard of L iving Am ong W orkingm en’ s F am ilies in N ew Y o r k C ity,
p. 80. Bussell Sage Foundation.

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INFANT MORTALITY.

Three-fourths of the births occurred in homes where the number of
persons per room was less than one, and slightly over one-fifth where
the number of persons per room was one but less than two. The in
fant mortality rate and the percentage of stillbirths are both higher
in the latter group. Only 13 births were reported in families in which
there were two or more persons per room. The worst instance of
overcrowding reported, as measured by this index, was eight persons in
one room; this room was about 24 feet wide by 36 feet long. I t was
the single room of a one-room detached house, situated on the out
skirts of the city, and had plenty of air and sunlight, with about an
acre of lawn and garden surrounding it. This seemed to be rather a
case of freak construction than of overcrowding.
Bad housing conditions existed in spots, here and there in the
factory, business, and residential sections and especially on the out
skirts of the city and along the river. (See Plates I-X V I.) Poor
natural drainage, shallow wells, and yard privies frequently accom
panied bad housing. The chief items of the sanitary condition of
the dwellings studied are set forth in Table X X III, p. 39.
In 616 of the 1,005 dwellings visited, the supply of drinking water
was secured solely from surface or dug wells, and in 339 homes, from
driven wells. Less than half (490) the dwellings were provided with
water-closets connected with the sewer; the remainder (515) had
privies with no sewer connections. Only 394 of the homes contained
sewer-connected sinks. As 490 toilets and only 394 sinks were
sewer connected, it would appear that in 96 households, after connec
tion had been made with water main and sewer for the toilet, it was
not deemed worth while to connect the sink, on account of the poor
quality of the city water.
Although 611 homes lacked sewer-connected sinks, many of them
had sinks drained in some other way. The drainage pipes sometimes
emptied a few feet from the house or led out to a roadside ditch. One
mother told of moving into a very attractive cottage in a good resi
dence section in the spring, after being assured b y the landlord that
the sink drain was connected with the sewer. During the summer all
the family except the father became ill, two of the children having
typhoid fever. Investigation proved that the sink pipe simply
drained under the house.
The means of ventilation, largely on account of the type of housing
prevalent, were in almost all cases ample or sufficient, and bad ven
tilation as a factor in infant mortality was practically nonexistent.
Furthermore, the mothers were usually well informed as to the value
of fresh air. A division of the homes visited into three classes ac
cording to the degree of cleanliness showed almost nine-tenths of
them to be satisfactory. The less satisfactory sanitary conditions

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SA G IN AW , M IC H .

•M

were found in a greater proportion of the dwellings occupied by the
foreign-born mothers than of those occupied by native mothers.
Dwellings in all parts of the city are affected b y dampness. Houses
are usually built on a foundation 3 to 5 feet or more above the surface
level with provision for ventilating this space; but many of the cheaper
or older houses, without basement or cellar, have little, or perhaps
no foundation to lift them above the level of the ground and no pro
vision for the ventilation of the space between earth and floor.
Many houses are banked up tightly during much of the year as a pro
tection against cold. Often the owners of inexpensive houses have
had hardwood floors put in to keep out dampness. While dampness
is prevalent in all sections of the city, it is especially so in southern
Saginaw, where the land is so low that after a heavy rain or a melting
snow many houses are to be seen surrounded by pools of water,
which may not disappear for a week or more.
A few families whose infants are included in this study lived
on houseboats. (See Plates I and II.) In summer these boats
ply up and down the river; in winter they are anchored along
the banks of the river or in some landlocked bayou. One house
boat dweller pointed out that the ownership of a houseboat did
not entail the payment of taxes that the ownership of a house
did. The mothers living in houseboats invariably complained
of the dampness and of the hopelessness of keeping their homes
free from the mold caused by it, which attacked the floor eoverings, clothing, and bedding. They also spoke of the insanitary
conditions prevalent during the winter and frequently in sum
mer also. While some parents lived the year round on their house
boats, others used them for residences only in summer, seeking
employment which would keep them ashore in winter.

. 38 öißlc

ij net-

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42
T

INFANT MORTALITY.

X X V .— Births during selected year, infant deaths, infant mortality rate, and per
cent o f stillbirths, according to tenure and rental o f home and nativity o f mother.

able

Stillbirths.
Tenure and rental of home and nativity of
mother.

Total
births.

981

84.6

3.3

451
529

434
512

30
49

69.1
95.7

17
17

3.8
3.2

163
238
61
38
5
24
35

161
230
59
36
5
21
35

22
19
1
1
2
4
4

136.6
82. 6
16.9

2
8
2

L2
3.4
3.3

1,015

M onthly rental:
$7 50 to $12.49......................................
$12^50 to $17.49....................................

M onthly rental:
U nder $7.50.........................................
$7 !in to $12.49 .......................
$i2~50 to $17.49....................................

M onthly rental:
$7 fiO to $12 49
$12 50 to $17.49

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

Infant
mortality
Per eent
rate.®
Number. of total
births.®

Infant
deaths.

Live
births.

766

738

70.5

3.7

326
413

313
398

47.9
82.9

13
15

4.0
3.6

108
193
52
32
5
23
27

106
187
50
30
5
20
27

13
13
1

122.6
69.5
20.0

2
6
2
2

1.9
3.1
3.8

249

243

127.6

2.4

125
116

121
114

15
16

124.0
140.4

4
2

3.'2
1.7

55
45
9
6
1
8

55
43
9
6
1
8

9
6

163.6

2
4
4

1
1

2
i ..
1 «

Not shown where base is less than 50.

Births to parents who owned their own homes numbered 451, or
44.4 per cent of the total number; to parents not owning their homes,
the number was 529, or 52.1 per cent. Among the whole population
of Saginaw in 1910 the percentage of homes owned was 57.2,1 or
considerably greater than the 44.4 per cent found among the families
selected for study. In Manchester, less than 12 per cent of the
families visited owned their homes, the majority living in dwellings
containing three or more families. Rents were not high in Saginaw.
Of those who rented, nearly one-third paid less than $7.50 a month
and four-fifths paid less than $12.50.
The mortality rate for infants in home-owning families was con
siderably less than for those in families in which the home was not
owned; among infants of native mothers, the rate was almost twice
as high when the home was not owned, but the difference between
the two groups is relatively slight for infants of foreign-born uibthers.
The infants in families paying less than $7.50 per month for rent
i U . S. Bureau of the Census, 1910, V o l. 1, p . 1359.

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SAGIH AW , M IC H .

had a mortality rate of 136.6, which dropped in the next higher rental
group to 82.6. The infant mortality rate in all families paying a
rent of $7.50 or over was only 64.6.
The Saginaw health department had power to prevent houses
unsuitable for habitation from being reoeeupied after they had once
become vacant. (See Plate III.) The sanitary inspectors were
instructed to place a quarantine placard upon each dwelling of this
character as soon as vacated; and no house so placarded might be
reoccupied until put into a condition pronounced sanitary by the
health officer.1 Here and there about the city was evidence of the
department s activity in the shape of an old house lapsing into ruin
with the quarantine, placard still affixed.
In the newer sections of the city many bungalows and small cot
tages of attractive types had been built in recent years. These
houses of five, six, or seven rooms offered much better bousing at
low rentals than did the older dwelling's
WARD CONDITIONS.

The city.— Saginaw is divided into 20 wards— 12 on the East
Side, 8 on the West Side. The map at the end of this report shows
that 14 of them (7 on each side) border on the river and consequently
contain an area of unreclaimed flats and bayous. Railroads parallel
the river on both sides for much of the distance, and main tracks,
sidings, freight houses, elevators, lumberyards, and warehouses are
located along the water front. Next the railroad tracks is a harder
of dingy, cheap dwellings. Paralleling this section—for the most
part not more than two or three squares away— and extending the
length of the city on both the East and W est Sides are streets on
which are located the best residences in Saginaw. Beyond these
are neighborhoods of more humble structures, comprising the bulk of
the city. About one-third of the wards show, however, in the*
sections farthest from the river, stretches of open land with only an
occasional dwelling. Wards bordering on the river show all these
features and present, therefore, varying grades of city sanitation
and development. Six wards do not adjoin the river; of these, five
are thickly populated residence wards on the East Side, and the other
on the West Side, is rural in character.
Certain conditions were uniform in all the wards. Detached
dwellings with a generous measure of ground space and excellent
sidewalks prevailed in all parts of the city. In each ward the pro
portion, of foreign-horn mothers included in the study rarely exceeded
the proportion of foreign bom for the city; one or two exceptions were
tne^ ealtn ornoer

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ea^e

INFANT MORTALITY.

noted. The water supply,1 on the contrary, and the economic^
sanitary, and other civic conditions were quite dissimilar in different
sections of the city. For purposes of discussion, ward groups as
shown in Table X X V I are formed, each group containing wards
usually adjacent and most nearly alike in physical characteristics
and in the economic status.of their residents.
T a b l e X X V I .— Population in 1910, births during selected year, infant deaths, infant

mortality rate, and per cent o f stillbirths, according to ward o f residence.
Stillbirths.
W ard of residence.

Popula
tion in
1910.

Total
births.

Live
births.

Infant
deaths.

Infant
m ortality
Per cent
rate.
N um ber. of total
births.

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

50,510

1,015

981

84.6

3.3

East Side............... .................

30,742

565

548

67.5

3.0

66
118
103
69
59
150

65
114
99
66
59
145

5
4
3
2
7
16

76.9
35.0
30.3
30.3
118.6
110.3

1
4
4
3

1.5
3.4
3.9
4.3

11 and 12..................................

3,280
9,885
5,305
4,950
2,643
4'679

3.3

W est S ide................................

19,768

450

433

106.2

3.8

6,836
5,479
3,843
3,610
-

186
66
121
77

179
64
115
75

15
6
21
4

83.8
93.8
182.6
53.3

7
2
6
2

3.8
3.0
5.0
2.6

W ard:
1 .................................................
2 ,3 ,4 ,and 5 ..............................
7 and 8 .....................................

W ard:
13,14, and 18............. .............
15,16, and 1 7 . . . ................... .
19...............................................
2 0 . ............................................

The most striking point shown in Table X X V I is the disparity
between the infant mortality rates of the two parts of the c i t y 67.5 for the East Side and 106.2 for the West Side. The greater
number (56 per cent) of the infants included in the study lived on
the East Side; the lesser number, 44 per cent, were subjected to
conditions on the West Side where the death rate was so much higher.
The infant mortality rates for the separate ward groups ranged from
30.3 to 182.6. Although only small numbers are involved, such
wide divergence in rates for different sections of the same city directs
attention to the difference in economic, physical, sanitary, and
other neighborhood conditions, and the possible degree of their
influence upon infant mortality.
The W est Side.—As might be expected from its high average
mortality, the West Side included the nineteenth ward,2 which
had the highest rate in the city, 182.6. This ward, in the south
ernmost part of the West Side, has the Tittibawassee River on the
south and the Saginaw on the east, very poor natural drainage,
and more than its share of low ground and dampness. Only two or
three of the streets are paved, the rest resembling graded counfry'roads.
Several factories and coal mines are located near its outer limits.
1 General Table 17.

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2 See m ap at end of report.

SA G IN AW , M IC H .

The ward contains, for the most part, inexpensive one and two
story cottages and bungalows. They were usually new, clean, and
in good repair, but the housewives complained of dampness. Many
of the families owned their own homes, and rents were comparatively
low. About one-sixth of the homes visited were provided with
sewer-connected toilets, the yard privy being conspicuous through
out the ward. (See Plate IV.) Ten out of every 11 families visited
relied wholly on shallow-well water for drinking purposes.
Of the 121 births in the nineteenth ward, 821were to native mothers
and 39 to foreign-born mothers, the majority of the latter being
German. Fifteen of the 21 deaths and five of the six stillbirths
were of infants of native mothers. The proportion of foreign-bom
mothers among those visited in this ward was comparatively small—
about one-third— and the excessive infant mortality rate, as well
as the large per cent of stillbirths, in contrast to the low rates for
the city, was primarily for infants of native mothers.
Many of the fathers were employed by railroads or worked in the
mines and factories in the neighborhood; during the period covered
b y the inquiry they had had fairly steady employment. Of the 21
deaths which occurred among the infants in this ward, 18 were
of babies whose fathers earned less than $850.
' ; The thirteenth and fourteenth, the two northernmost wards of
the West Side, and the eighteenth, which is directly north of the
nineteenth, had an infant mortality rate of 83.8, some 22 points
below the rate for the West Side, but about the same as that for the
city. The business section of the thirteenth and fourteenth wards,
the “ North End,” is surrounded by a well built-up residence section,
in which paved streets, sewers, driven wells, and other municipal
advantages prevailed. Approximately three-fourths of the thir
teenth ward and the western half of the eighteenth were purely
farming country. The infants included in the study were found,
however, in the urban section which lies between the farms and the
river waste lands. A creek spreading out in semistagnant pools
flows from Weiss Street south near Eddy Street to the river. (See
Plates V, VI, and V II.) Sanitary and housing conditions along this
creek and in the immediate vicinity of the city dump near the Johnson
Street bridge, where refuse was being used to reclaim the land,
were probably worse than anywhere else in the city. Most of the
residents in this group of wards owned their own homes, and the
general economic condition of the families visited was slightly above
the average.
TJjLe rjjfteenth, sixteenth, and seventeenth wards, comprising the
central part of the West Side, had an infant mortality rate of 93.8.
The residents of these wards had a high economic rank, and, for the
i General Table 7.

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INFANT MORTALITY.

most part, other conditions were relatively good. All three wards
border on the river but lack the usual waste spaces, as this part
of the city, especially the West Side business section in the sixteenth
ward, is on unusually high ground. These wards were closely
built up, however, and in some parts garbage and refuse were
commonly thrown on the unpaved streets.
The twentieth ward, the only ward on the West Side not border
ing on the river, had an infant mortality rate of 53.3, the lowest
rate on the West Side and one of the lowest in the city. This ward
was largely rural in character. In the closely built-up part the houses
were sewer connected and deep wells furnished the drinking water.
In the rural section, where homes were scattered and sewers and
water mains were not yet laid, shallow wells and outdoor toilets
prevailed to such an ex'tent that three-fourths of the homes visited
in the' ward were thus equipped. The economic status of the
families visited, as shown by father’s earnings, was practically the
same as in the nineteenth ward, which had the highest infant mor
tality rate in the city.
The East Side.— On the East Side two groups of wards— the
seventh and eighth, and the sixth and ninth—had the extremely
low infant mortality rate of 30.3. The best residence section in
the city is included in the seventh and eighth wards. Part of this
residence section is very fittingly called “ The Grove.” Most of the
space near the river, formerly unsightly sloughs and wastes, is now
transformed into attractive lakes and parks. The sanitary conditions
in these wards were not surpassed elsewhere in the city, and the
families in general enjoyed freedom from economic pressure. Several
mothers employed servants, and a few mothers secured occasional
assistance. The sixth and ninth wards, for the most part, resembled
the seventh and eighth, but they did not have so high an economic
rank and in certain places did not attain the same standard of
sanitary excellence. These two wards had no frontage on the river
but bordered on the “ Big Ditch.” They had some open fields
and small areas devoted to railroad tracks and factories.
The second, third, fourth, and fifth wards, lying to the north of
the residential wards just described, had a rate of 35, the second
lowest reported. In 1910 these wards contained about one-fifth
of the city’s population, slightly over one-fourth of whom were
ioreign-bom.
The second ward, as a whole, was classed with the best residence
wards, but it presents the variety that practically every river-border
ing ward shows. The third ward contains the leading business section
of the city extending to the retaining wall at the river bank; the fourth
and fifth wards, located some distance back from the river, were
closely built-up residence wards. The whole section had paved or

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SA G IN AW , M IC H »

rock-surfaced streets, excellent sidewalks, goad street ear facilities,
uniformly sewer-coimected dwellings, and drainage and sanitary
conditions above the average» There were few non-English speaking
families among its residents. About one-fifth of the mothers visited
were of foreign birth, mostly German and Canadian. A large pro
portion of the residents of these wards owned their own homes,, the
men either being in business for themselves or making a salary or
wages ample for the comfortable support of a family» The civic and
economic conditions were favorable to a low infant mortality.
The rate of the first ward, the northernmost ward on the East Side,
was 76.9, which, though lower than the rate for the city, was above
that for the East Side. Semirural in general character, the* small
closely built-up section in the center of the ward was flanked on the
side toward the river b y factories, waste lands, and bayous, and on
the other by open fields with a few scattering farmhouses. This
ward is located on the lowest ground in the city. About half the
homes visited had sewer connections,, and more than half the families
drank shallow-well water. The economic status o f the families o f this
ward included in the present study was lower than the average. As
a whole the ward most resembled ward 20, but had a somewhat
higher mortality rate.
The infant mortality rate for the tenth ward was 118.6. Its
economic and civic features were somewhat less favorable than the
sections of the city previously described, except the first and nine
teenth wards.
The eleventh and twelfth wards, locally referred to as the “ South
Side,” had an infant mortality rate of 110.3. Both wards border
the river and have the usual variety of fiats, railroad tracks, and poor
housing merging info a narrow business district. The remainder o f the
South Side is sparsely built up but is not rural. Numerous comfort
able houses exist, but there are small shacks and tar-paper shanties
to be found in the open fields. This section is o f lower elevation
and not so well drained as most o f the East Side, and melting snows
or a heavy rainfall often turns the greater part of it into a series of
shallow pools. Eighty-four per cent of the families visited drank
water from shallow wells, and only one-twelfth of the homes were
sewer connected. Over one-third of the births included in the study
were to foreign-born mothers. The economic position o f the fami
lies visited was the lowest for any section of the city. In both eco
nomic and sanitary conditions the eleventh and twelfth wards closely
resembled the ninteenth ward on the West Side.
The; very evident relation existing between the infant mortality
rates for different parts of the city and the social, civic, and economic
conditions m ay perhaps in each case be ascribed more to one than
to another o f these conditions. The highest infant mortality rates

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INFANT MORTALITY.

were coexistent with poor drainage, insanitary disposition of garbage
and refuse, outdoor toilets, shallow-well drinking water, dwellings
which lacked sewer connection, and a low economic level. It is
evident that, among other disadvantages, a. low economic status
compels the family to live where rents are cheapest that is, in the
localities where all the above conditions are most likely to prevail.
Coincident with good drainage, better garbage and refuse disposal,
well-built sewer-connected houses, and an average or high economic
status was a low infant mortality rate. The only exception was in
the “ rural” wards, where rural conditions favor a low infant mortality;
but even here the rate was not so low as in those urban wards where
conditions were most favorable.
CIVIC AND SOCIAL C O N D ITIO N S.
DESCRIPTION OF THE CITY.

History.— The history of Saginaw begins with the advent of a
French fur trader who, in 1816, settled on the bank of the Saginaw
River about 20 miles inland from Saginaw Bay. A United States
fort and military post was established in 1822, but it was abandoned
in the autumn of the following year because of serious endemic dis
eases among the soldiers, consequent upon the flooding of the river
in the spring.
In 1848 the first of the lumbermen came,, attracted by the wealth
in the forests of the region and by the excellent facilities for trans
portation. The Saginaw River drained a forest-covered area of some
6,300 square miles, and was navigable for all the steam and sailing
vessels, except the very largest, which plied upon the Great Lakes.
Tens of thousands of logs were floated down the tributary streams
to the Saginaw, sawmills sprang up on both sides of the river, and
millions of feet of white pine, hemlock, and hardwoods were loaded
at the wharves for shipment direct to domestic and foreign ports. In
1860 the first successful salt well was sunk and large shipments of salt
were added to the lumber exports. As a lumber-producing center
Saginaw had a thriving existence until about a quarter of a century
ago. By that time the timber of the river basin was exhausted, the
logging activities had passed on to the northwest, and the city’s
industrial fife was changed accordingly.
Climate.— Saginaw has a very equable climate, due to the proximity
of the Great Lakes. The moisture from the lakes produces a com
paratively even temperature during the warmest summer months,
retards the advance of the early cold, and mitigates the severity of
the winters. The winter days are prevailingly cloudy. Long
heated periods in summer or abnormally protracted cold ones in
winter are very unusual. The country rarely suffers from drought.

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SAGINAW, MICH.

The summer of 1913 was exceptional in having a longer hot spell
than usual.
Population.— The Federal Census of 1910 reported Saginaw the
third largest city in Michigan, with a' population of 50,510. Of this
number, 50,183 were white and 327 colored. The native white of
native parentage numbered 17,257, or 34.2 per cent; the native white
of foreign or mixed parentage, the largest group, 21,225, or 42 per
cent; and the foreign-bom white, 11,701, or 23.2 per cent. The for
eign countries having the largest representation were Germany, 4,408;
Canada, 4,020, including 729 French Canadian; British Isles, 1,528;
and Russia, 762.
Political characteristics.— The city, formerly two distinct political
units, has had a single government since 1899, when East Saginaw
and West Saginaw were consolidated. A new city charter went into
effect on January 1, 1914, when the common council was superseded
by the commission form of government.
In some respects Saginaw is still two cities. The railroads main
tain stations on both sides of the river and each side has a post office
of the first class, a separate school system, and its own rate of munic
ipal taxation. Public buildings and improvements are more or less
impartially distributed. Neither side appears to have forgotten
wholly its former independence, and each seeks to secure for itself the
advantage in proposed improvements. A worthy proposition, there
fore, may be defeated by the inability of the two sections of the city
to agree on the question of location, for instance, though other advan
tages to be derived are common. The West Side is the older, but the
East Side has outgrown it, and now has the greater voting strength;
but neither can pass a proposition without help from the other.
Industries.— Saginaw industries to-day retain the impress of its
bygone greatness as a lumber town. A thousand and one articles,
ranging in size from ready-to-put-up houses down to toothpicks, are
made from all kinds of domestic and imported lumber. Other indus
tries and business activities have also been developed, among which
are coal mining, foundries and machine shops, railroad shops, sugar
manufacture (tons of sugar beets are grown in the surrounding
country), the production of graphite, plate glass, leather, canned
goods, knit goods, and clothing. In 1918, war activities had added
shipbuilding and the manufacture of munitions and of iron and steel
to this list.
As there is no larger city nearer than 90 miles, Saginaw is the dis
tributing and shipping center for the rich agricultural region sur
rounding it. Railroad and other transportation facilities are excel
lent, comprising fines of the Grand Trunk, Michigan Central, and
Pere Marquette Railroads, electric railways to Bay City and Detroit,
and the Saginaw River, navigable for lake traffic.
105629°—19---- 4

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INFANT MORTALITY.

Physical characteristics.— The city comprises 8,935 acres (about
12 square miles) of which the land area includes 8,750 acres and the
water area, 185. A ridge 25 feet above low-water mark extends for
a short distance along the western bank of the Saginaw River, other
wise the city is flat. It is rectangular in shape and the Saginaw River
flows north through the center, spreading out on each side over flats
into shallows, lakes, and bayous. On the southwest is the Tittibawassee River, which empties into the Saginaw and likewise spreads
out over the adjacent low-lying lands. Local energy and capital
have in some instances turned the defects caused b y the Saginaw into
advantages. An island park has been developed, a public natatorium
built, and several acres in a low oval-shaped tract have been drained,
forming an attractive natural amphitheater which is used for an
athletic field. The numerous parks of the city contain 220 acres of
land. Eleven bridges, four for railroad use only, connect the two
parts of the city.
On each side of the Saginaw transportation lines parallel the river.
Warehouses, bean and grain elevators, gas works, lumber and coal
yards, a few of the manufacturing plants, and the shipping industries
are located along the transportation lines and riverside. There are
four distinct business centers. Parts of the city are rural in character,
but even in the closely built-up portions there are no slum districts.
SANITATION.

Sewerage and surface drainage.— Saginaw has the combined
sanitary and storm sewerage system, with 117 miles of mains and
laterals and 27 outlets into the river or its adjoining bayous. Twelve
miles of streets in which sewers had been laid still lacked water mains
at the time of the inquiry, and consequently these sewers could not
be used. The sewage was discharged into the river untreated.
The city is situated in flat, low country, and there is no appreciable
slope toward the river. Natural surface drainage is, therefore, very
poor. In case of excessive rains, or of rapidly melting snow, it fre
quently happens that the sewers and roadside ditches and gutters
can not dispose of the water properly and then the surface of the
poorly drained sections of the city is under water for a week or two at
a time. When the river overflows it causes the sewers to “ backu p,”
floods basements and cellars and sometimes the streets, and spreads
out over the flats.
Besides the sewer mains, an open sewer known as the Big Ditch 1
carried off kitchen sewage and surface drainage along a greater part
of the eastern boundary of Saginaw. A similar but much shorter
ditch performed a like service for a small part of North Saginaw.
1 The city has recently made an appropriation tor substituting an underground drain for the Big D itch,
though in June, 1918, w ork upon it had not yet com m enced.

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SA G IN A W , M IC H .

The dwellings in “ The G rove/' an exclusive residential section bor
dering the river for nearly a mile between Holland Street and Rust
Avenue, had private sewers. Most of the residence streets are located
a considerable distance from the river and but few dwellings, there
fore, except the houseboats which anchor along the shore near the
bridges, were affected by proximity to the sewer outlets.
The excess cost of trunk sewers over estimated cost of 12-inch
laterals is paid by the city; the cost of lateral sewers 12 inches and
under is assessed against the property benefited, and the property
owner pays for the connection from the curb to the house. Since
connection with sewers is not compulsory, the mileage of sewers
laid is not an accurate index of the extent of their service to the
public. In the outlying sections of the city many yard privies were
in use. Each year property owners in one or two selected districts
were served with notices to install inside toilets, but if in a given
case the attendant expense was shown to constitute a hardship, the
owner might be granted an extension of time in which to make the
improvement. In 1913 there were 321 such sewer connections made,
and 272 in 1914.
No estimate of the total number of yard privies in use could be
obtained. The sanitary inspectors ordered them cleaned when it
was thought necessary. The frequency of cleaning varied from two
or three times a year to once in three or four years. Night soil had
to be removed and taken outside the city limits at the expense of the
householder. The city ordinance relating to privies required that
the vaults “ shall be walled up with 2-inch plank, brick, or stone.”
Cemented or tight vaults were not required and there were practically
none connected with the homes visited in this study.
Of the families visited, 51.2 per cent lived in houses having no
sewer connection whatever, and 19.6 per cent of those whose houses
had sewer connections for toilets had none for sinks. (See Table •
X X III , p. 39.) The last-mentioned condition was due principally
to the fact that the city water, which supplied the toilet, was so
unfit for household use that it was not considered worth the expense
of having it piped into the kitchen. Many homes provided with
sinks had cistern or well water, instead of city water, piped into them.
WATER SUPPLY.

Four kinds of water were in common use for domestic purposes in
Saginaw: (1) Water from the city main, (2) rain water from the
cisterns, (3) shallow-well water, and (4) deep-well water. The last
two only were used for drinking. Numbers of well-to-do people
bought bottled drinking water, either spring or distilled.
In many households four kinds of water were used— city water for
flushing the toilets, cistern water for bathing and washing, shallow
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INFANT MORTALITY.

well water for cooking and part of the laundry work, and either deepwell or bottled water for drinking. Practically every household used
at least two kinds of water— cistern water and either deep or shallow
well water. City water was not used for drinking.
The primary cause of this diversity in the water supply was the
amazingly bad quality of the water furnished by the city. This
water is taken from the Saginaw River, a sluggish, muddy stream,
which carried the drainage from a rather sparsely settled, flat basin of
approximately 6,300 square miles. A number of towns of consider
able size, however,* among them the city of Flint, drain into the
tributaries of the Saginaw River above the city, and in a few instances
not so very far from it.
The intake of the Saginaw East Side waterworks is well above the
city itself, though a new cemetery is located just above the intake.
The West Side intake is centrally located below the outlets of eleven
of the city sewers, the municipality itself polluting the source from
which it secures its water.1
Chemical analyses2 of the river water have shown that its bac
terial condition was frequently bad. The water was dirty, dark
colored, very hard, frequently offensive in odor, and tasted of salt
and other minerals, and was rightly considered fit only for flushing
toilets, sprinkling lawns, and other similar uses. Nevertheless, as
one mother said, it was sometimes impossible to keep small children
from drinking the water when it was accessible.
Rain water is collected in cisterns or in large wooden casks sunk
in the ground. For convenience, the cisterns are frequently located
under the house or in a back shed, and rain water more than any
other kind is directly available in the kitchen, often from an inside
pump. The soft water supplied by the cisterns is used only for
washing and cleansing; the roofs of the houses in the closely built-up
•sections of the city are, unfortunately, so sooty from soft-coal smoke
that the rain water is too dirty to be entirely satisfactory for these
purposes.
Over 95 per cent of the families visited drank well water only.
(See Table X X III , p. 39.) A sharp distinction is drawn, however,
between deep and shallow wells. Deep wells are usually from 100
to 200 feet deep. They are driven and maintained in working order
by the city for public use. There are 145 such wells located on street
corners about the town. (See Plates V III and IX .) In addition,
some families and a number of hotels and industrial establishments
have driven wells of their own.
1Disastrous fires having occurred recently in Saginaw, water is now (June, 1918) pum ped directly from
the river into the city mains of the East Side.
2 Heim , W illiam . Project for Saginaw B ay W ater, Auspices Saginaw Board of Trade, 1912.
University of Michigan, Laboratory of Hygiene Records, 1906.

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SAGINAW, MICH.

The water from these wells is very hard and more or less impreg
nated with salt, which makes it most disagreeable in taste to those
unaccustomed to it. But it is normally safe from pollution and is
usually found on analysis to he in good condition. Contamination,
however, arises from two sources: First, the openings of the many
abandoned salt wells “ permit the ingress of highly contaminated
surface waters” into the water-bearing strata,1 and, second, corroded
and defective iron well casings?—some over 20 years old— allow
leakage into them of sewage and badly polluted surface water.2
Shallow or surface wells in Saginaw are dug wells, usually between
12 and 20 feet in depth. A “ good, deep well” commonly turns out
to be 15 or 16 feet'deep. A very considerable proportion of the
residents of Saginaw drinks this kind of water, finding it more con
venient to procure and more agreeable in taste than that from the
deep wells. Over 60 per cent of the families visited drank it exclu
sively. (See Table X X I I I , p. 39.) In a letter relating to the Saginaw
water supply, R. C. Allen, director of the Michigan Geological and
Biological Survey, says:
* * * water is obtain ed from op en or dug w ells rarely m ore than 30 feet in d epth ,
w h ich reach dow n to th e th in w ater-bearing strata. T h ese w ells are so shallow that
d irect contam ination from th e surface m a y take p la ce through op en channels m ade
b y roots, burrow ing anim als, an d earthworm s. O n th e other han d th e im p erviou s
character o f th e surface m aterials togeth er w ith th e flat nature o f th e region causes
th e co u n try t o 'b e flood ed in tim es o f h e a v y rainfall. D urin g su ch periods surface
waters n early alw ays m ake th eir w a y in to these w ells increasing the contam ination.
U nder th e best of condition s su ch shallow w ells are a source of danger, b u t in th e
v ic in it y of villages and cities th e danger is so great that th e use of su ch w ells for drink
in g purposes should n ot b e perm itted u nder an y circum stances.

To make matters worse throughout the city of Saginaw, and
especially in the outlying sections where shallow wells are most
prevalent, yard privies were still in use. (See Plate X .) These
privies were built over mere holes in the ground, or, at best,
wooden boxes; water-tight cement vaults were almost unknown.
This condition means, of course, that the contents of the privy
seep into the surrounding soil. Shallow wells, fed from what is
practically surface water, were commonly found on the same lot
1 Letter from R . C. Allen, director of Michigan Geological and Biological Survey.
2 "T h e re are hundreds of cases of diarrhea produced each year in Saginaw b y drinking water. * * •
In one particular locality on South W ashington Avenue near the Auditorium the water from a w ell was
the cause of dozens of cases of this kind of trouble of a severe type, all because the w ell was polluted b y an
adjacent sewer, and on analyses the State bacteriologist found the water to contain dangerous numbers
of colon bacilli, which caused it all. * * * This was during flood tim e in May while the sewers were
full with no outlet, and as the water in the river subsided that in this particular w ell cleared up, and sub
sequent analyses proved negative. * * * This condition is b y no means constant * * * [the wells]
depend too m uch upon good sewage drainage for their safety. Just as soon as the river raises th ey show
signs of sewage pollution and very frequently at other tim es.” (Alger, Dr. G. L ., Prospectus Saginaw
B ay W ater Association.)

In April, 1917, analyses of the water of the deep wells of the city showed nine to be "dangerously
polluted and unfit for drinking or domestic use,” but samples taken from them in May of the same
year showed no unhealthful condition. (Records of Saginaw Department of Health.)

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IN F A N T

M O R T A L IT Y .

with such privies and supplied the family drinking water— “ the
best water in Saginaw/’ to quote the users.
Obviously, the perils of this situation were intensified in flood
time— an annual spring event in parts of Saginaw—when sewers
baek up and the ground water level is raised to or above the surface,
uniting sewers, privies, and wells in a common morass. It is proba
ble that the water supply 'was primarily responsible for the preva
lence of typhoid fever in Saginaw. Eighteen deaths from this cause
occurred in Saginaw in 1913/ giving a rate of 33.9 per 100,000 popu
lation, from typhoid fever. The rate for the State as a whole was
only 18.3. In the same year the death rate from typhoid fever was
18.2 in Grand Rapids, 17 in Flint, and 15 in Bay City.
Aside from the question of the transmission of infectious diseases,
another aspect of the unsatisfactory water situation affected family
well-being in Saginaw— the needless increase of household work.
Not only were the housewives obliged to have at hand three or four
kinds of water for different uses, but two or three of these had to be
pumped and carried by hand.
Campaigns for better water have been frequent in Saginaw, and
agitation of the question is almost chronic. Some have advocated
chemical treatment and filtration of the river water; others have
proposed the use of water from Saginaw Bay. The former plan
was more in favor at the time of this study (1913-14). Three times
in 1914 and 1915 the city voted on a bond issue for new water
works, but each time it failed of the three-fifths vote necessary to
authorize the issuance of bonds. One difficulty in securing the
necessary majority was the opposition of some adherents of the
policy of a good water supply to the use of river water under any
circumstances, water from the Saginaw Bay being preferred.
A second difficulty was the rivalry between the two sections of
the city for the location of the filtration and chemical plants.
MILK SUPPLY.

Character of supply.— Approximately 69 licensed dealers sold milk
(at retail) in Saginaw during the period 2 covered by the study.
Most of them did business on a small scale, either selling milk from
their own herds only or collecting the milk from several farms for
retail delivery. Two dealers handled the milk from as many as 30
or more farms each. Many of the residents of the outlying wards
kept one or two cows and sold milk to the neighbors.
The number of farms supplying the city with milk was variously
estimated at from 200 to 300. On these farms dairying was second
ary and the herds were small— probably less than 10 cows. With
1 Forty-seventh. Annual Report of Births and Deaths in Michigan, 1913, p. 209.
2 Dec. i , 1912, to N ov . 30,1914.

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SAGINAW, M ICH.

such small herds it is difficult to secure adequate control of the
conditions of milk production. There are more farms to be inspected;
and the farmer with only a few cows has less interest in improved
dairy construction and sanitary methods than the producer of milk
on a large scale.
One important advantage which Saginaw owes to its favorable
northern location is that the farmers have an abundance of ice
with which to cool the milk. Another advantage is that the milk
is delivered fresh. Prompt delivery is possible, since the great
bulk of the supply comes from within a radius of 5 miles and but
little from over 10 miles.
The milk-handling equipment of the small dealer is of the simplest
description. Few have arrangements for sterilization of the bottles,
though most of them bottle part of the milk, and have bottling and
bottle-washing apparatus of a kind. The dealers’ places of business
were under better control than the farms, since they were fewer
and more centrally located, and those visited were in good condition
as to cleanliness. In a few cases, complaints were made, however,
of insanitary practices.
The two large milk plants in the city at the time of the study
pasteurized their milk. The apparatus used was a cream-ripening
tank an apparatus not designed for pasteurization and lacking
a temperature-regulating device. The only method of testing the
temperature of the milk in the (ecream ripener” was by inserting
a thermometer in the water jacket surrounding the milk; the temper
ature of the milk was judged by that of the water. The results of
pasteurization were, therefore, often unsatisfactory. One company
claimed to have made monthly sediment tests of each farmer’s
milk, and no complaints were heard of its pasteurized milk product.
In the case of the other company, numerous complaints stated that
the milk sold was sour, scalded, or filthy in taste. In the few tests
made, pasteurized milk gave higher bacterial counts than most
of the raw milk, a condition due to inefficient pasteurization.
Two dairymen sold milk at prices above the local standard, claiming
that it was richer and cleaner than ordinary milk and especially suit
able for babies. These claims may have been justified, but the claim
made by one that he sold “ certified milk only” could hardly have
been true, since there was no certification commission in Saginaw.
Ordinances — Prior to October 20, 1914, the ordinances of the city
(December 11, 1911, and September 8, 1913) required that—
(1) All dairies where milk was produced for sale must score at
least 40 per cent on the United States score card.
(2) All cows must be proved to be free from tuberculosis, as shown
by the tuberculin test, and must be retested annually; and all
additions to the herds must be tested.

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INFANT MORTALITY.

(3)
The bacteriological count must not exceed 100,000 per cubic
centimeter.
So far as could be learned no systematic attempt was made to en
force these requirements. Some dairies were scored, but not all;
some dairymen were induced to have their herds tested for tuber
culosis, but none was obliged to; and the retesting was not carried
out. If any bacterial counts were made, no records of such work
were to be found, and certainly» the bacterial standard was not
enforced.
All these requirements were abolished by the ordinance of October
20, 1914, affecting the last six weeks of the period of the study.
In place of the minimum standard set by ordinances which were not
enforced a system of official grades was established. The grades
were three in number; for grade A, the highest, the requirements
specified that the bacterial count should not exceed 200,000 per
cubic centimeter at the time of delivery. The tuberculin test was
required for this grade. Grade B was established for pasteurized
milk, and the bacterial count should not exceed 1,000,000 before
pasteurization and after pasteurization not more than 50,000 at
time of delivery. For grade C a maximum of 1,000,000 per cubic
centimeter at time of delivery was prescribed. Milk containing
over 1,000,000 bacteria per cubic centimeter was classed “ insanitary”
and could not be sold.
The low standard of milk production prevailing in Saginaw is shown
by the fact that during the first three months of the operation of
the ordinance no certificate was issued for any but grade C. Popu
lar indifference is partly to blame for these conditions. As one man
said: “ The public has not yet learned to look at the bottom of a
bottle of milk instead of at the top.” Opposition on the part of
dealers to some of the requirements is also a factor in the situation.
A~n ordinance requiring all milk to be bottled was defeated by the
opposition of the milk dealers.
Inspection.— Prior to October 20, 1914, the inspection of food, as
well as of weights and measures, was in the hands of two inspectors,
neither of whom was required to give his whole time to his official
duties. The assistant inspector, who had to be a veterinary surgeon,
included in his duties the inspection of dairies and slaughterhouses
and their products. His salary was only $1,000 per annum, and
he naturally kept up his private practice. After October, 1914, a
single inspector was charged with the inspection of dairies, slaughter
houses and groceries, meat markets, fruit stores, and all other
places where food was sold. He had to make all the laboratory
tests. He had to be a veterinarian, and his salary was $1,200 a year,
though he was not expected or required to give all his time to his
official duties. There are obvious disadvantages in having an

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SA G IN AW , M IC H .

inspector partially dependent upon a professional practice among
patrons whose business it is his official duty to inspect.
During the period of the study, according to the milk inspectors,
few dairy herds were given the tuberculin test, although this was
one of the requirements of the ordinances, in force during the greater
part of that period. In no case was an annual test made. During
these two years the only recorded bacterial tests were made by the
city milk inspector in November, 1914. These were abandoned at
the end of six weeks because of the pressure of other duties. Of the
19 tests then made, with counts ranging from 6 „000 to 223,000, nine
showed less than 50,000 bacteria per cubic centimeter; five showed
between 50,000 and 100,000; and five over 100,000. The counts for
raw milk were surprisingly low, due probably to the freshness of the
milk and to cold weather.
In a series of samples tested in 1913-14 by students of chemistry
in the high school, a great deal of filthy sediment was found; besides
this, gelatin was discovered in a considerable number of the samples
first tested. The addition of gelatin to milk which has been diluted
with water or is poor in butter fat thickens it and gives it a deceptively
rich appearance. After the results of the tests were made public no
more gelatin was found in the samples.
GARBAGE AND REFUSE DISPOSAL.

The disposition of garbage and refuse was left mainly in the hands
of the individual householders. The city had no scavenger system
whatever, except that in winter it collected ashes, chiefly from the
paved-street sections. In the unpaved sections refuse of all kinds
was commonly thrown into the streets and the roadside drainage
ditches. (See Plate X I.) Garbage was sometimes collected by
farmers to feed swine, but in some sections it was often thrown with
other refuse into the streets or on the dumps.
There were two city dumps near the river where land was being
filled in. During the summer months two sanitary inspectors under
the direction of the health officer were supposed to spend one day
each week at the dumps to see that the regulations in regard to them
were complied with, but the duties of these officers were so numerous
that they visited the dumps only occasionally. Formerly waste
from fish and meat markets had been deposited at these dumps,
but at the time of the study this practice was forbidden b y the
department of health. Decayed fruit and vegetables, however,
might still be deposited there, provided they were covered by a
sufficient depth of earth or water.
Besides these two city dumps there were 16 others of lesser im
portance scattered over the city where depressions furnished a con
venient dumping ground for the neighborhood. Even the best

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IN F A N T MORTALITY.

residential wards of the city had these dumps, some very close to
dwellings. The largest, and perhaps the worst, of these places was
in the first ward, many yards from any dwelling, on the road to the
Sixth Street Bridge.1 (See Plate X II.) It was a constant menace
to health. Children often played there. Rats were numerous and
in summer flies abounded.
CIVIC AND SOCIAL AGENCIES.

There is in Saginaw no special agency that has for its purpose
the reduction of infant mortality or that exercises more than a very
indirect influence upon infant welfare.
Department of health and safety.— In any community the depart
ment of health should logically be the leading and most active
agency in reducing morbidity and mortality. The health depart
ment of Saginaw, however, at the time of this study did not regard
infant mortality as a distinct problem and had taken no special
action for its reduction.
The commissioner of health and safety is one of the five com
missioners composing the city council. Upon his recommendation
the council appoints a market and food inspector, a health officer,
plumbing, building, and other inspectors, and the other employees
of the health department. The duties of the market and food in
spector have been already mentioned.2 The health officer at the
time of the study regularly gave about one hour a day to his official
duties and received therefor a salary of S50 a month. With no
larger recompense, the city certainly could not expect him to give
much of his time to its service. Two sanitary inspectors were
detailed from the police force and gave only part time to healthdepartment duties.
The equipment and facilities provided for the health department
were limited. There was no laboratory and no vital statistics service
beyond that given and required b y the State. The publication of
the annual report setting forth the department’s activities and needs
was discontinued in 1910. The expenditures of the health depart
ment for the fiscal year ended June 30, 1914, were less than $9,500
and the appropriation for the following year, save for a sum for the
use and expansion of the tuberculosis hospital, was no larger. A
health department thus handicapped by inadequate financial support
and b y the lack of a full-time executive, full-time assistants, and
adequate scientific equipment could not be expected to give satis
factory service.
Hospitals.— The four hospitals of the city are general in character»
except the one which treats patients suffering from tuberculosis.
1 In June, 1918, probably because of p roxim ity to a recently established shipyard, this dum p had been
cleaned up and showed no signs of use.

* See p. 56.

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SAGIHAW, M ICH .

This was erected b y the city and is under the direction and control of
the department o f health. None of the hospitals has a special ward
for children. In one there are 14 beds for infants and another has 6
cots for the babies of private obstetrical cases. In all the hospitals
of the city there is a total of only five free beds which may be used for
babies or older children. Contagious diseases are eared for in the
annex of one hospital and in a cottage on the grounds of another.
The old tuberculosis hospital is used as a pesthouse.
Visiting nurses.— Saginaw has three visiting nurses, eaeh working
independently in entirely different fields. One nurse, whose salary
is paid out of a bequest to one o f the hospitals, does home visiting for
that institution. She cares for about 30 maternity cases in a year,
but answers only those calls., usually sent in b y physicians, that come
through the hospital.
A second nurse is employed by an insurance company to care for its
industrial policyholders. Each normal maternity ease is given eight
visits after confinement, and the nurse averages about 20 such cases
in the course of a year. As infants are not accepted as policyholders,
they are not attended b y the nurse.
A third nurse, who is given an office in the quarters of the depart
ment of health, attends only patients suffering from tuberculosis.
The city made no appropriation for public-health nursing.
In relation to the problem of infant mortality the activities of the
visiting nurses are limited to the care and instruction, usually after
confinement, of about 50 mothers, or approximately 4 per cent of the
number to whom babies were born in the selected year.
Charities.—The Saginaw Charity Association was not affiliated
with the charity organizations of other cities and employed no paid
workers.1 It distributed relief largely through the local branch of
the Salvation Army. The association included representatives from
all social agencies of the city.3 The churches of the eity were repre
sented by several members on the advisory board.
In the meetings of this organization, to which the public was invited,
cases requiring relief were discussed and referred to the society or
member deemed best able to manage it. Funds were raised by each
society for its own needs. Aid was usually given temporarily to tide
over a period of unemployment or illness. The churches, clubs,
and societies were very active through the medium o f the chari
ties association, which seemed to be quite successful in directing
charity into the proper channels and in protecting the public against
1 This poMcy has since been changed and the association now (1918) has a full-time salaried agent.
* To wit, the captain of police, the director of the poor, three visiting, nurses, the truant officer, probation
officers', the superintendent of the Homestead (a detention home and refuge for girls), the secretaries of the
Y . M. C. A. and Y . W . C; A„, the health officer, a woman physician, and representatives of the Rescue Mis
sion, Salvation Army, Saginaw General Hospital, St. Mary's Hospital, Civic League, Ministers’ Associa
tion, Soldiers and Sailors’ Relief Commission, and the Antituberculosis Society.

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ISFFAHT MORTALITY.

imposition. Less than half a dozen families included in this study
had received public aid— i. e., aid from this organization or from the
city— within the selected year.
Mother’ s pensions.— In 1913 a law was enacted providing for
pensions to mothers of dependent children under 17. T o be eligible,
a mother must be financially unable to care for her child but otherwise
a proper guardian. The pension, not to exceed $3 per week for each
child, is granted through the probate court and paid to the mother by
the county treasurer out of the general fund of the county. The
probation officer from time to time inspects the home. Two mothers
of infants included in this study received such pensions.
The Homestead.— This detention home and refuge was organized
by the civic league to care for girls, and receives chiefly those who are
homeless and in trouble or those detained while awaiting trial.
When able to do so they were expected to pay $2.50 a week for board
and rent, as well as the doctor’s bill in cases of confinement. The
city and county paid at the rate of $4 per week for cases committed.
The homeless mother of an illegitimate infant was cared for in the
woman’s hospital during confinement. She was expected to remain at
the Homestead at least three months and to keep her child one or two
months, after which she was encouraged to place him in another
home, preferably a private one. An attempt was made to force the
father of the child to assist in its support, but this was usually unsuc
cessful.
The Home for the Friendless.— This institution cared especially for
children under 14, but also admitted girls seeking work and aged
women. It accepted babies under 3 months only in emergencies and
until other arrangements could be made, and rarely had cases for
day-nursery care. During the year 1913 it cared for 12 adults and
for approximately 60 children, of whom about one-third were under
three months of age. One infant included in this study spent a part
of his first year in this institution.
S U M M A R Y AN D CONCLU SIO N.

Saginaw is a city of diversified industries located in the midst of
an agricultural region in the Middle West. The natural severity
of its northern climate is lessened b y proximity to the Great Lakes.
Three-fourths of its population were native, and of its foreign-born
residents few were recent immigrants. Housing congestion did not
exist in the city, though there were certain housing disadvantages
resulting from a poor water supply. Many homes suffered from
dampness on account of poor surface drainage. Families included
in the study had a high economic status compared with those in other
cities studied b y the bureau.

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SAGINAW, MICH.

Registration of births.— In the year ended November 30, 1913,
there were 1,260 known births and miscarriages in Saginaw; 147, or
11.7 per cent, had not been registered. Had a house-to-house can
vass for births been undertaken more would probably have been
discovered.
Infant mortality rate.— A selected group of 1,015 births occurring
in Saginaw in the year ended November 30, 1913, formed the basis
for this study. Of the 981 live-born infants in the group, 83 died,
giving an infant mortality rate of 84.6, a rate lower than that found in
any of the cities previously studied b y the bureau. For the East Side
the rate was only 67.5, compared with 106.2 for the West Side.
Infant mortality rates were very low in sections of the city where
municipal sanitation was relatively good and the economic status of
the residents high.
Nativity of mother.— Three-fourths of the births included in this
study were to native mothers. The mortality rate among the infants
of native mothers was only 70.5, very much lower than for the
infants of foreign-born mothers, 127.6. Of the live births, less than
one-fourth were to foreign-born mothers, yet three-eighths of all the
infant deaths occurred in this nativity grou p .. The foreign-born
mothers were chiefly German, Polish, and Canadian. Of the births
to foreign-born mothers practically half were to mothers who had
lived in the United States for 10 years or more. Of the total births,
92.6 per cent were to mothers who spoke English.
Type of feeding.— Of the infants surviving at the end of the first
month, 87.9 per cent were exclusively breast fed. A very large pro
portion continued to be so fed during the following months. When
a change was made from exclusive breast feeding it was usually to
mixed rather than to artificial feeding. The large proportion of
breast-fed infants gave little chance for gastro-intestinal diseases;
only a very small percentage of'* deaths resulted from that cause.
The mortality among artificially fed infants, however, was much
greater than among breast-fed infants; throughout the first nine
months the rate was at least twice as high.
Father’ s earnings.— Seventeen and nine-tenths per cent of the
births occurred in families where the father earned less than $550,
and 39 per cent in families where the earnings exceeded $850. In
comparison with Manchester and New Bedford, the proportion in the
lower earnings group was much smaller and in the higher earnings
group much larger. The mortality rate was highest, 179.5, for the
infants whose fathers were in the lowest earnings group, under $450.
It decreased as the earnings increased with but a single irregularity
to, a minimum of 22.2 for the group with father’s earnings $1,250
and over. For the group of births in families where the father earned
under $850 the mortality rate was 116.4; for the group over $850,

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INFANT MORTALITY.

the rate was only 33.9. A somewhat larger proportion of the infants
of the foreign-born mothers than of the native mothers were in the
low-earnings groups.
Certified cause of death and infant losses.— According to the
certified causes of deaths the most important group was deaths from
causes peculiar to early infancy and malformations. Of the total
losses 1 (117) in the group studied over one-half were stillbirths (34)
and deaths under two weeks of age (34). Eighteen of the deaths at
later ages were due to causes peculiar to early infancy and malforma
tions. Prenatal causes were responsible for over two-thirds of the
total losses.
Attendant at birth.— Physicians attended 96 per cent of the births
to native mothers and 78.3 per cent of those to foreign-born mothers.
Only 6.5 per cent of the total births were attended b y midwives.
Conclusion.— Any successful effort to reduce infant mortality in
Saginaw must be accompanied b y a more complete birth registration
than existed in 1913. Complete and prompt registration is a necessity
before the city can ascertain its infant mortality rate and correctly
determine its infant welfare problems. The provisions of the State
law on birth registration are excellent, but they were not all locally
enforced; local registration of births was far from complete, chiefly
because the people of Saginaw were not interested. The first step,
therefore, is to awaken the public to the value of birth statistics
and the need for better registration.
Since two-thirds of the infant losses in the selected group were
primarily due to prenatal causes, adequate prenatal care seems
essential if this class of losses is to be materially reduced. Such care
is especially needed for the inexperienced young mother and in
families in which the father’s earnings are low, judging from the high
mortality among the first-born babies and in the lower earnings
groups. Prenatal care should include regular examinations of the
prospective mother during pregnancy b y the family physician or at
clinics, and nurses’ visits during the same period. Instructive
visiting nurses who would call upon and instruct a mother in the
proper care of herself during pregnancy and confinement doubtless
would prove an effective means of reducing losses from prenatal
causes. The work of the three public-health nurses in Saginaw only
rarely touched the neglected fields of prenatal, postnatal, and
maternal care.
How great an influence the defects of municipal sanitation have
upon the welfare of Saginaw infants can not be definitely stated. The
installation of a supply of pure city water, ample for all household
purposes, is perhaps of the highest importance for the general public
1 Total losses include 83 deaths and 34 stillbirths.

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SAGINAW, MICH.

health and comfort. A housing code 1 abolishing the yard privies
except in the distinctly rural sections, requiring sewer connections
for both sinks and water-closets, and guaranteeing also to the city
the advantages it at present enjoys in respect to light and ventilation,
would remove two grave dangers to the general public—if not
distinctly to infant welfare. The proper collection and disposal of
refuse and garbage, and the abolition of the dumps with their menace
of flies and rats would still further contribute to general healthfulness.
The inspection and control of the milk supply is also important.
The tuberculin test should be given to all herds supplying milk to the
city.2 Milk is tested for dirt b y filtering through gauze; it should
also be analyzed for bacteria and for solid content, water, milk solids,
and butter fat. The findings should be published at intervals to make
the results available to the public.
It is evident that, to secure these improvements, the health de
partment should be provided with adequate machinery for enforcing
and carrying out the necessary measures. The health officer who ad
ministers these measures should be sufficiently well paid to give his
entire time to the city’s work. There should be a sufficiently large
corps of assistants, also with full-time pay, to perform all the neces
sary work of inspection, testing, and analysis. With pure city water
installed, a proper system for garbage disposal once established, and
the yard privies abolished, the problems of sanitation should be greatly
simplified. The city would then be in a position to give intensive
study to the special problems of infancy and early childhood, in the
confident expectation that an already rather favorable showing
under present conditions can be so bettered b y wise civic action as to
place Saginaw permanently among the cities of the United States
showing the lowest infant mortality rates.
APPENDIX.
METHOD OF PROCEDURE.

Scope of inquiry.— In the law creating the Children’s Bureau,
passed b y the Sixty-second Congress, infant mortality was specified
first in the list of subjects to be studied. 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 1910 for every 1,000 live births registered
in the death registration States, there were 124 deaths under 1 year of
1 The Housing Law of Michigan (Public Acts No. 167), passed May 2,1917, provides for all changes sug
gested in this paragraph.
a A bill to compel the tuberculin testing of all dairy cattle in the State is to be introduced in the next
session of the State legislature. If the object were sought b y means of a city ordinance, it would result,
in the opinion of the city milk inspector (June, 1918), in a local milk famine, since farmers would ship their
milk to Bay City and Flint instead of complying with Saginaw requirements.

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INFANT MORTALITY.

age.1 In 1915, in the birth registration area, including the New
England States, New York, Pennsylvania, Michigan, Minnesota, and
the District of Columbia, for every 1,000 live births registered there
were 100 infant deaths. In these States the infant mortality ratevaried from 70 to 120 for the State as a whole, while for cities in these
States having in 1910 a population of 25,000 or over 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
Infant
mortality
fate.

State.

107
105
101
86
70

State.

New Hamsphire........................................
New York..................................................
Pennsylvania............................................
Rhode Island............................................

Infant
mortality
rate.
110
99
no

120
85

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

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 ht tie
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 deaths under one year it would be possible to deter
mine the underlying causes that favored a low mortality or produced
a high rate.
With this object in view the Children’s Bureau selected a pumber of
cities that offered contrasts in economic, industrial, and social con
ditions 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 accepted birth regis
tration, on account of the facilities afforded b y the birth 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 thor
oughly within a reasonable time b y 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.
________ _______________ _
i The rate is too high since the registration of births was incomplete in these States; in many of them it
was very deficient. Figures are shown for the death registration States of 1911 and are for 1910, except
in Kentucky and Missouri, where births and deaths are for 1911.

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SAGINAW, MICH.

T able II. — Population in 1910, infant mortality rates 1910 and 1915, percentage of
adult population foreign born, principal foreign nationality,a and principal indus
try o f the cities chosen for infant mortality studies.

Infant mor
tality rates.
City.

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

Popula
tion in
1910.

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

6 1910.

165
193
99
6145
177
149
123

Percentage of
adult
popula
tion over
20 forc 1915.
eign
born,
1910.

116
150
82
101
143
143

39.9
56.1
37.3
33.7
59.0
50.5
26.0

Principal foreign
nationality, a

Principal industry.

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

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

a Principal foreign nationality of mothers of infants included in the infant mortality studies.
6 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 lor Akron, Ohio, was furnished by the ’Ohio
State registrar. For rate for Saginaw based on State (final) figures for births, see discussion, p. —.
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 1 year per 1,000
live births.1 The usual approximate method of finding the infant
mortality rate for a certain area is to divide the number of registered
deaths of infants under 1 year o f age occurring in a given calendar year
b y 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 b y 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.
I t is not always safe to compare infant mortality rates in cities
with those in country districts; in one State with those in 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 differ
ences and changes in completeness of registration. If the per cent
1 Stillbirths are omitted from both births and deaths.

105629°—19----- 5

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INFANT MORTALITY.

of omissions of deaths under 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, however, 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 comparability
of the rates for different classes within the area. In an analysis of
births and deaths b y race and nativity classes, if the degree of com
pleteness of registration varies with the different classes, the rates
found b y dividing the deaths b y the births may not be comparable.
For the purpose of these investigations comparable rates are essential.
It is n ot of so much importance that the rate secured shall charac
terize 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 repre
sentative of the city. An alternative policy is so to supplement the
original data that the figures used include all the evidence applicable
to the group studied in the city.
Certain groups for which the information is inaccurate or incomplete
have been excluded in all the studies made b y the bureau. The
groups for which the rates are most open to question and most diffi
cult 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 of 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 data 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. Ob
viously, if the infant moved away from the city after the first few
weeks or months of life, his death, if he died, 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 b y the exclusion of live births only, with no
exclusion of infant deaths to correspond.

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A third group of exclusions is the births to nonresident mothers.
These were excluded not only on the ground that 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 coming to the city may be different 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 moved 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 some cases a year or more
afterwards, a few births were excluded if the mother had moved
away from the city prior to the agent’s visit and could not be found at
this time.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 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 were registered the rates
for these groups would be correct. It was found, however, in exam
ining 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 selection being the fact of registration of birth. The third was
to attempt to complete the records of births and of deaths by a can
vass. 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
1 The ruling in one special case might be mentioned. 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.

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INFANT MORTALITY.

preceding year. Consequently, in these cities a birth might have
been registered either by the physician soon after the birth or by the
State canvasser on his visit. All births recorded, whether regularly
registered or added by this special canvass, were treated as regis
tered 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 rec
ords 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 born in Johnstown in 1911, even if the birth had not been
recorded.
In Saginaw, as explained in the report (p. 11), many sources of
information were used to find cases of unregistered births to add to
those registered. Baptismal records of the various churches, lists of
patients in hospitals receiving maternity cases, and cards of entry
of babies in a baby show were examined for information as to ad
ditional births in the selected year. From death records several
births were added to the number. The agents were instructed to in
quire of every mother visited if she knew of other babies in the neigh
borhood. This neighborhood inquiry proved an especially effective
means of finding additional births. In all 116 births to resident married
mothers were added. Death registration in Saginaw was found to be
by no means perfect. Three deaths that had not been registered that
occurred in the city in the selected group were discovered and added to
the 113 registered deaths that occurred in the city and to the 80 regis
tered deaths that occurred among the births included in the study.
W ith the general plan of the investigation determined, the more im
portant points in the detailed procedure were as follows. The first
step was to transfer to the schedule the birth certificate data for the year
selected. Then the infant death certificates for the year selected and
the year following were copied, and the facts as to death for infants born
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 or other sources
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. Since the
bureau has no power to compel answers, the information secured was

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SAGINAW, MICH.

based on the voluntary statements of the mothers. To the willing
ness of the mothers to answer all questions and to cooperate in every
way is due the completeness 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 occur in the same year. In rates for the bureau 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.
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 bom elsewhere
are also excluded because there is no information on age at migra
tion. This policy excludes, of course, infant deaths in foundling
asylums, if the birth did not occur in the city.
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 omission of
infants surviving the first year of life whose births were not recorded.
Finally, in other cities the birth records have been completed or
supplemented by a canvass or by other means. In these cases it is
easy to show from the incompleteness of the records that the rates
computed in the usual way on the basis of these records are much less
accurate than the rates given in these studies for the included groups.
Birth and death registration in Saginaw.— Michigan has a, good
birth-registration law, and was one of the first States admitted
to the registration area for births. But the enforcement of the law
in Saginaw leaves much to be desired. Early in course of the in
quiry it was found that certain physicians were lax in registering
births; that few of the midwives reported the births they attended;
and that a number of German and Polish mothers did not employ
any qualified attendant, but depended upon assistance at confinement
given b y husbands, relatives, or neighbors, none of whom registered
i Except for Johnstown, where illegitimate births were included.

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INFANT MORTALITY.

the birth. The law provides for a payment of $0.50 for each certificate
to the physician, midwife, or other person whose duty it is to register
births. Penalties for noncompliance are provided and enforcement
of the law is placed in the hands of the local registrars under the di
rection and supervision of the secretary of state. The office of the
secretary of state is charged with ordering prosecutions for failure
to register births, but, except in obstinate cases, efforts are made to
secure complete returns Without resorting to prosecution. No prose
cution for nonregistration of births has ever taken place in Saginaw.
From the figures secured light may be thrown upon the com
pleteness of registration of live births in Saginaw. Two methods
are available— one giving a maximum estimate and the other a
m i n i m u m statement.
If the deaths where the births had not been
registered are compared to the total deaths in the city among births
in the selected year, the figure of 25.9 per cent is obtained as an
index of the proportion of live births not registered. This index
gives the true percentage of births not registered only in case the
mortality in the groups where registration is faulty is the same as
the average. The mortality rates are usually high in the foreignbom and low-earnings groups, among which the registration is
probably least complete. The percentage thus found is therefore
an overstatement.
Another method of determining the percentage of live births
not registered is by comparing with the total number of births the
unregistered births discovered. There were 141 unregistered live
births that were definitely known to have occurred in the selected
year. If compared with the total of 1,206 live births, 11.7 per cent
were not registered. If the 115 live births that occurred to mothers
known to have been resident in the city both at the time of the
infant’s birth and throughout the selected year are. compared
with the 981 in the same group the same percentage is secured.
This percentage represents a minimum statement of live births
unregistered, since it includes only those cases where unregistered
live births were known to have occurred.
Obviously a neighborhood inquiry might fail to find births in
the city of infants who had moved away prior to the inquiry. The
true per cent would be somewhat above this figure, depending upon
the number of additional unregistered births that occurred in the city.
Neither of these methods gives a satisfactory estimate for the per
centage of stillbirths that were not registered.
The registration of infant deaths also was not perfect. Three
deaths were discovered for which no death certificates were on file.
In all three instances the births had been properly registered , the
infants died when less than a month old, and physicians were in at
tendance during illness. Obviously, it is especially difficult to dis-

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SAGINAW, M ICH.

t l

cover cases of omission of death certificates, especially in those
cases where both birth and death certificates were omitted.
Live births excluded in Saginaw.— With the foregoing explanation
of the method of procedure in mind, the significance of the exclu
sions and the rates for the excluded groups can be more easily grasped.
During the selected year the total number of five births known to
have occurred in Saginaw was 1,206. Of these, 23 were illegitimate—
18 registered and 5 unregistered. No schedules were taken for these
births on account of the abnormal conditions in the family group
nor was any systematic attempt made to learn whether the infants
were resident in Saginaw throughout the first year of life or had
lived elsewhere during a part of the year. Seven, or nearly one-third,
of these infants died.
The remainder of the exclusions (202) were made on grounds of
nonresidence or lack of information. One infant was excluded
because the information was incomplete or unreliable. Forty
births were to mothers who were not residents of the city. Nine
deaths were known to have occurred among them. An indication
of the mortality in this group,' somewhat fairer than that found by
dividing the 9 deaths by the 40 births, could be secured by com
paring the 4 deaths of infants whose births were registered to the 31
births registered of the “ nonresident” group.
The mothers of 149 infants had moved away from the city prior
to the visit of the agent. In 11 cases the birth had not been regis
tered, and of these, 6 were found through death certificates. For
the rest, 10 deaths occurred among 138 infants. The rate, 72.5, is
obviously too low to characterize the group, since other deaths
under 1 year of age may have occurred outside the city.
In 12 cases the mothers could no t be found. One of these infants died
and in this case the birth was discovered through the death certificate.
The rate for the births included in the study is 84.6. For the
excluded group the rate varies with the reasons for exclusion. The
rate for illegitimate births is high. The rate for the nonresident
group is relatively high; the rate for the “ removed group” is rela
tively high, but obviously less than the true rate, for not all the
deaths were included. No fair rates can be made for the infants
excluded for the groups where the births had not been registered,
since, owing to the difficulty of securing information where the mother
had moved away, the number of births is probably not complete.
The rate for the excluded group as a whole, 146.7, means little unless
taken in connection with the reasons for exclusion. The rate for all
live births in the city, both included and excluded, was 96.2, but'
this rate, too, is not so significant in many ways as the rate for the
group included in the study.
The rate of 84.6 for births to resident married mothers is based
upon known deaths and known births. The true rate for tbis group

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IN F A N T MORTALITY.

would be the ratio of total deaths and total births and would be
equal to this rate or above or below it, depending upon the ratio of
the unregistered deaths and unregistered births that were not
found. If additional births and deaths occurred, then, if for each
death there were 12 and only 12 unregistered births of infants who
lived in the city for the first year of life or till death and which were
not discovered by the methods adopted to locate unregistered births,
the rate of 84.6 of the study would be correct. If there were fewer
than 12 such unregistered and not found births for each such unregis
tered death the rate would be too low, and if more than 12, too high.
The rate of 84.6, based upon all the available information, may be
accepted with these reservations as typical of the groups studied.
T a b l e I I I .— Registered and unregistered live births in Saginaw, infant deaths, and

infant mortality rates, fo r each class o f exclusions.
Live births.
Reasons for exclusion.

Infant mortality
rate.«

Infant deaths.

Births
Un
Births Births
un
Regis regis
un Total Births
Total. tered.
regis regis
Total regis regis
tered. tered.
tered.
tered. tered.

Total known live births............. 1,206
Total live births included....................

1,065

141

116

96.2

80.8

212.8

981
225

866
199

115
26

83
33

66
20

17
13

84.6
146.7

76.2
100.5

147.8

202
12

181
11

21
1

26
1

12
1

128.7

77.3

1
40
149

1
31
138

9
n

9
16

4
10

5
6

107.4

72.5

Reasons for exclusion:
Nonresidence and lack of information—
Data incomplete or unreRemoved...........................

» Not shown where base is less than 50.

Stillbirth rates.— Stillbirth rates were formed by dividing the
the number of stillbirths by the total number of births—live and
stillbirths. A stillbirth is defined as a dead-bom issue of seven or
more months’ gestation. Miscarriages, or issues of less than seven
months’ gestation, were excluded.
A policy of exclusions similar to that for infant mortality was
followed. Stillbirths to nonresident mothers were excluded because
of the possible effect of conditions different from those of Saginaw;
likewise stillbirths to mothers who moved away prior to the end of
the selected year. In the latter case 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
stillbirths has a peculiar margin of error of its own. Usually a still
birth must be registered both as a “ death” and as a “ birth” ; in
some States the law is not clear whether stillbirths have to be régis-

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SAGINAW, MICH.

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
b y law. It is obvious that such an omission is one of carelessness
only, as ordinarily the same person, usually a physician, would
register both.
How many stillbirths escape registration would be difficult to
determine. It would be much more difficult to find by canvass or
other inquiry cases of omission of registration of stillbirths than to
find cases of similar omissions for live births. Omissions might be
due to ignorance of the law or failure to observe it. Doctors are
probably more conversant 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 bom 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,
Brockton, and New Bedford; in Saginaw and other cities the figure
for stillbirths is compared to the total of registered and known
unregistered births to resident married mothers.
Stillbirths and miscarriages excluded in Saginaw.— The total num
ber of stillbirths and miscarriages known to have occurred in the
selected year in Saginaw was 54. Nine were excluded because they
were of less than seven months’ gestation (see p. 16 for definition of
stillbirth). In 11 cases the birth had to be excluded on the ground
of removal or nonresidence. No stillbirths were excluded on the
ground of illegitimacy.
The stillbirth rate for resident married mothers is formed b y
dividing the 34 stillbirths by the total of 1,015 births in the same
group, giving a rate of 3.3. It is impossible to form comparable
rates for the excluded groups, because the proportion of miscarriages
is not known.
T

able

I V .— Stillbirths and miscarriages in Saginaw in year selected and number excluded
fo r specified reasons.
Reasons for exclusion.

Number.
54
34
20
4
7
9

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76
T

able

INFANT MORTALITY.
1 . — Number and per cent distribution o f deaths o f in f ants.born in Saginaw during

selected year, by cause o f death.
Infant deaths.
Abridged Interna
tional ® List N o.

Detailed Interna
tional « List No.

Cause o f death.6

er cent
N um Pdistri
ber.
bution.
83

A ll causes................................................
102, 103........................
104
89
91
92
150
151 (1)
P a rtof33 ; p a r t o f3 7 .. 151 (2), 152 (2), 1.53...
152 (1)
7

8
........................
14
30.
37
155 to 186...........
187, 188, 189...............

Gastric and intestinal diseases c ...................
Diseases o f the stom ach..........................
Diarrhea and enteritis........... •................
Respiratory diseases d .....................................
A cute bronchitis.......................................
Broncho-pneum onia.................................

1.2
8.4
12.0

12
1
5
1
1
2
1
1

1.2
6.0
1.2
1.2
2.4
1.2
1.2

9.6

Early in fa n cy....................................................

3
3
4
4
37

Congenital debility...................................

3.6
3.6
4.8
4.8
44.6
14.5
28.9

4
14

4.8
16.9

8.4

E pidem ic diseases « ............................... .........
W hooping cou gh.......................................
Tuberculous m eningitis..........................

External causes................................................
Diseases ill defined or u n k n ow n ...................
A ll other causes................................................
M eningitis..................................................
...................

61
71
79.................................

100.0

8
1
710

Organic diseases o f the heart.................
O t h e r .........................................................

1
5

1.2
1.2
6.0

a The numbers indicate the classification in the abridged and the detailed lists, respectively, of the Man
ual of the International List 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, 1914, p. 660), in classifying the deaths o f 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 o f death have been grouped in 8 main g r o u p s ...................
.
. , ,
,
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 stom
ach, diarrhea, and enteritis. It does not indude all “ diseases of the digestive system” as classified under
this heading according to the detailed International List.
_
. ,,
d “ Respiratory diseases” as used in the tables and discussion similarly includes only those o f the respi
ratory diseases which are most important among infants, i. e., acute bronchitis, broncho-pneumonia, and
pneumonia. It does not include all “ diseases of the respiratory system” as classified under this heading
according to the detailed International List.
. ,
, ,,
______
e “ Epidemic diseases” as used in the tables and discussion includes only those of this group which are
most important among infants.
T a b l e 2 — Deaths o f in f ants born during selected year occurring in specified calendar

•

month, by cause o f death.
Deaths occurring In specified calendar month.

Cause of death.

Total
deaths.

January. February.

All causes............................................
............................. .
„ _____

Early infancy...............................................

12
24
1

1
1

1
4
14

io
4

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March.
5

May.

April.
6

2
1

3
3

1
1

' SAGINAW, MICH.
T

able

Deaths o f infants horn during selected year occurring in specified calendar
month, by cause o f death— Continued.

Deaths occurring in specified calendar month.
Cause of death.
lune.
All causes....................................
Gastric and intestinal diseases............ .
Respiratory diseases...................... .
Malformations...........................
Early infancy.......................................

Sep
Decem
August. tember.
October. Novem
ber.
ber.

July.

1
1

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

2
2

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

2
• i

1
2

1
1

T a b l e 3 .— Number and per cent distribution o f deaths o f infants born during selected year

to mothers o f specified nativity, by age at death.

Deaths among infants born during selected year to—

Age at death.

All mothers.

Native mothers.

Foreign-bom
mothers.

Per cent.
Per cent
Per cent
Number. ! distri Number. distri Number. distri
bution.
bution.
bution.
All ages................................................

100.0

Less than 1 m onth. ! ....................................
Less than 1 day..................................
1 day but less than 2 .............................
2 days but less than 3 ..........................
3 days but less than 7............................
1 week but less than 2...........................
2 weeks but less than 1 month.............
1 month but less than 2 ...............................
2 months but less than 3 ..............................
3 months but less than 6 ..............................
6 months but less than 9 .............................
9 months but less than 12................ . ..........

47
7
10
2
7
8
13
9
3
10
6
8

56.6
8.4
12.0
2.4
8.4
9.6
15.7
10.8
3.6
12.0
7.2
9.6

28
7
6
1
5
3
6
6
1
8
4
5

53.8
13.5
11.5
1.9
9.6
5.8
11.5
11.5
1.9
15.4
7.7
9.6

19
4
1
2
5
7
3
2
2
2
3

100.0

Ifi 1

9.7

T a b l e 4 .— Births during selected year, infant deaths, infant mortality rate, and per cent

o f stillbirths, according to month and year o f birth.

Stillbirths.
Month df birth.

Total
births.

Live
births.

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

The year..............................................

1,015

981

84.6

3.3

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

251
254
280
230

246
242
273
220

28
17
20
18

113.8
70.2
73.3
81.8

5
12
7
10

2J)
4 7
2 5
4.3

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T a b l e 5 .__ Deaths o f infants born during selected year occurring in specified month and year, according to month and year o f birth.

Deaths occurring in—

Month of birth.

Total 1912
deaths.

1914

1913

Oct.
Dec. Jan. Feb. Mar. Apr. May, June. July. Aug. Sept. Oct. Nov. Dec. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept.
S3

December 1912.......
January, 1913..........

9
14
5
3
8
6
3
7
5
5
10
3

1
3

1
10
1

August, 191o«> ••••••
September,_1913___
November, 1913__ _

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Federal Reserve Bank of St. Louis

i
4

2
1

2
2

1
1

4
3

2
3

1
i

1
1

1
1
1

4
2

i
1

TANT MORTALITY,

The year.......

Nov.

SAGINAW, MICH,
T a b l e 6 .— Infants born during selected year to mothers o f specified nativity and surviving

at beginning o f specified month o f life, number and per cent o f infants dying subse
quently m first year, and infant deaths in specified month o f life, according to month
o f life and type o f feeding in the month.
All mothers.

Month of life and type of feeding.

O
>
>
y
g
pj
*3
o
m

Native mothers.

Subsequent
infant deaths
in—
First year.
*4
rÛ
I

tt
©
o
t-4
©
Ph

À
tt
o
a
*0
©
Pt
cn

Foreign-born mothers.

Subsequent
infant deaths
in—
2
o
>
f

First year.
4
©
§
3

À
+3
g
a
«ü
©
*3

’S
©
©
U
©
Ph

ÜQ

Subsequent
infant deaths
in—
M
0
>
fH
1

First year.
C
©
&
a
a
£

e
P
o©
U
£■

First month........................

9S1

8.5

738

7.0

213

12.8

Breast exclusively.......................
Mixed................ .......................
Artificial exclusively.................
Not fed, died at once...................

842
29
95
15

44
4
20
15

5.2

638
22
67
11

25
3
13
11

3.9

204

9.3

21.1

21
1
10
15

19.4

28
4

7
4

710

3.4

224

1.9
9.7

2
1
3

179
16
29

2.6

Second month..................

934

3.9

747
65
122

19
6
il

2. 5
9.2
9.0

.568
49
93

Third month....................

924

2.8

704

Breast exclusively....................
Mixed.....................

684
91
149

517
72
115

2.0
3.3
6.0

922

2.6

703

601
132.
189

916

546
163
207

9
1

915

Breast exclusively.......................
Mixed................ : ..........
Artificial exclusively.................

Fourth month................
Breast exclusively................
Mixed................ I ...
Artificial exclusively....... .
Fifth month..................
Breast exclusively................
Mixed....................
Sixth month......................
Breast exclusively.........................
Mixed.................I..
Seventh month..................
Breast exclusively................
Mixed................ r ...
Artificial exclusively...........
Eighth month................
Breast exclusivelv........
Mixed................ '
Artificial exclusivelv..............
Ninth month..........
Breast exclusively.........
Artificial exclusively.........

1
1

6
a
2.3
2
5.3 ~ 2
2.0

448

698
408
168

1.9

697

488
202
225

8
1

3.6

912

14
3

1.3
1.0
2.5

910

1.3

313
344
253
907
251
385
271

364

1.2
1.6

1.0

4
3
1
1

220

3.6

5
i
2

3.0

167
19
34

2.4

219

3.2

1.6
1.9

2
1
2

153
28
38

4
1
2

2.6

....

1.7

218

2.8 . . . .
2.9

138
41
39

1.2
•s
3.6

1.6

218

2.8

1.1

3.2

182

3.3

1.3

217

2.3

2.1

92
76
49

2
1
2

2.2
1.3

1.0

1.1

....

217

2.3

78
87
52

2
1
2

2.6
1.1
3.8

.9
1.2
1.0

215

1.4

1.4
.5

59
99
57

1
1
1

1.7
1.0
1.8

1
1

“ N o t s h o w n w h e r e b a s e is le s s t h a n 5 0 .

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

5.4

695

2S6
214

8
4.5
2 .........
2

124
51
43

257
201

5
4

4
1
6

2^3

1.7
2.8
6.1

151

1.6
.6 . . . .
3.9

375
293
244

SO
a
'd
©
Çp
Ü
©

"ï

.„.
...
...

able

_ B irth s during selected year in each ward o f residence, according to n a tion a lity o f m other.

Ward of residence (West Side )•

Ward of residence (East Side).
Nationality of mother.

All mothers............................
Native mothers. . .......... .................
Foreign-born mothers.................... .

1,015
766
249
89

1
66
50
16

19
16
3

T
8

2
7 ..........
1
3
1 ...... ......
2
1

28~
10

42
4

43
9

3
2

1
21
1
17
..‘ T
12
10
19 *“ *2* . . . . . . . . ' T "**4*
1
1
30
1

13
12
1

.....

50
6

44
7

48
11

2
5
2

3
2
1 ......

......

2
1

2
......

46
27

46
31

59
24

40
11

21
5

19
2

14
5

43
9

3
2
13
19
'2 . . . . . .

4
6

....„
....„

" * 'T . . . . „
l
•1

1
11

"T
1
2
2
2

¥
2
5

121

82~
39

56
21

25
1
6

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

a including 12 Lithuanian, 6 Russian, 3 Jewish, 2 Magyar, and 1 each of Danish, Dutch, Flemish, French, Greek, Slovak, and Slavic not otherwise specified.

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

1
1
2 ....... 4
1

GENERAL TABLES.

German.. i . ..........- ..................
Polish.................................
English, Irish, Scotch, and Welsh
Italian............................................
French Canadian..........................
English Canadian.........................
Other Canadian.............................
All other a .....................................
Not reported............ ....................

Total
births.

SAGIN AW , M ICH ,

T a b l e 8 . — B irth s during selected year in each fa th er’s earnings g ro u p , according to occu
p a tion o f fa th er.

Earnings of father.
Occupation of father.

Total
births.

All occupations........................... 1,015
Manufacturing and mechanical industries...........................................

514

Under $450
to
$450 $549

103

151

255

159

143

130

1
4

6
2
2

3
5
4

1
1
2

12
14
27
Compositors, linotype operators, a n d

Factory operatives a.............. ......................
Lumber, furniture, and wooden-

Machinists, mill Wrights,"and toolmakers..
Skilled mechanics, building tradesT....... ..
Trade..................................................
Bankers, brokers, real estate and insur-

Proprietors, officials, etc., mercantile establishments.......................... ..................

9
14
22
197
28

No earn
$550. $650 $850 $1,050 $1,250 ings and
to
to
to
and not re
to
$649 $849 $1,049 $1,249 over. ported.

2
2
1
i
1
17
3

3
1
4
6

34
3

2
4
41
5

5
4
62
9

3
5
32
7

2
3
4
1

10
2
2
11

15
9
'7
10
3

16
8
12
12
6

24
11
18
4
26

8
9
8

1
2

9
1

10
4

16
3

22
2
14
6

10
2
11
2

4
22
1
1

1
2

150

■8
55
18

1
1

5
5

12
7

12
2

3
10

5
14

57
12

4
5

2
2

3
1

6
3

28
1

74
38
71
27
64
19

4
2

1
1

Transportation..................................

128

Chauffeurs, teamsters, and expressmen. . .
Conductors, motormen, and trainmen___
Express, post, telegraph, and telephone

30
53

1
1

7
1

12
6

6
20

3
9

1
1

11
25
5
4

4
3

1
4

2
1

Clerical occupations, all industries...

Domestic and personal service.........

2
5
3
2

1
1

1
3

2
1
2
3

1
2

Extraction of minerals......................

6
12
6
12
Professional and semiprofessional

6
8

2
1

2
3

10
2
8
No occupation and not reported-----

3
3

3
2
2

2
2
1

1
8

a Excluding persons engaged in work in the factory which is not peculiar to the industry, as clerks,
machinists, boilermakers, etc.

105629°—19----- 6

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

82
T

GENERAL TABLES.

9 .— B irth s du rin g selected year in fa m ilies o f sp ecified n u m ber o f p erson s, and
average n u m ber o f p erson s p er fa m ily , according to a m ou n t o f fa m ily in com e and na
tiv ity o f m other.

able

Aver
age
num Total
ber»
of per births.
sons per
family.

Family income and nativity
of mother.

Birtl(is duririg selec ed year in—
F amilies of speciRed nuinbera o f person s.
1

5 or 6 7 or 8 Over 8.

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

3.7

1,015

342

242

171

158

Under $550.........................................
$550 to $649........................................
$650 to $849.........................................
$850 to $1,049......................................
$1,050 to $1,249...................................

3.4
3.5
3.6
3.8
4.0
3.7
2.0
4.6

140
138
258
172
111
160
1
35

2
1
i

57
45
86
49
36
58
1
10

34
30
70
43
23
40

18
34
39
40
13
22

18
19
43
23
19
24

9
8
16
13
14
8

2
1
4
4
5
8

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

3.5

766

294

181

126

108

Under $550.........................................
$550 to $649.........................................
$650 to $849.........................................
$850 to $1,049......................................
$1,050 to $1,249...................................

86
97
208
125
89
135
1
25

2
1

46
36
75
41
34
53
1
8

17
21
57
33
19
33

8
23
31
28
12
20

9
13
32
15
15
17

3
3
10
5
5
6

3
3
3
6

Not reported.....................................

3.0
3.3
3.5
3.5
3.6
3.5
2.0
4.6

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

4.4

249

4.0
4.0
4.2
4.4
5.8
4.6
4.6

54
41
50
47
22
25
10

11
9
11
8
2
5
2

10
11
8
12
1
2
1

g
6
11
8
4
7
5

6
5
6
8
9
2

1
1
1
1
2
2
1

Not reported......................................

13
10
4
7
1

a Excluding infant bom during selected year.
T a b l e 1 0 .— B irth s du rin g selected yea r to m others o f specified n a tiv ity and n u m ber a n d
p er cen t o f births to m others g a in fu lly em p lo yed du rin g yea r fo llo w in g birth o f in fa n t,
according to earnings o f fa th er.

All mothers.

Total
births.

All classes.....................
$450 to $549........................
$550 to $649..........
$650 to $849«............ .............
$850 to $1,049................ ..........
$1,050 to $1,249...

Gainfully
employed.

Earnings of father.

Births.
Num
ber.

Per
cent.»

Gainfully
employed.
Births.

Num
ber.

Per
cent.»

Num
ber.

1,015

125

12.3

766

9.0

249

79
103
151
255
159
94
143
7
24

26
19
23
27
15
4
2
4
5

32.9
18.4
15.2
10.6
9.4
4.3
1.4

38
67
106
206
123
79
125
6
16

9
11
11
'17
11
3
1
3
3

23.7
16.4
10.4
8.3
8.9
3.8
.8

41
36
45
49
36
15
18
1
8

a Not shown where base is less than 50.

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

Foreign-born mothers.

Native mothers.

Per
cent, a

56 j
17
8
12
10
4
1
1
1
2

22.5

S A G IN A W , M IC H ,

T abli

11 .— Births from, all p regn a n cies,in fa n t deaths, infant mortality rate, and per

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

Stillbirths.
Order of pregnancy and age of mother.

All pregnancies...............................
Under 20........................
20 to 24................................
25 to 29................................
30 to 34............. ........... .
35 to 39......................
40 and over....................
First pregnancy...................
Under 20...................
20 to 24...........................
25 to 29.........................
30 to 34.........................
35 to 39......................
Second pregnancy..........................
Under 20...................
20 to 24.............................
25 to 29......................
30 to 34......................
35 to 39....................
Third pregnancy.....................
Under 20.............................
20 to 2 4 . . . . . . . . . . . . . . . . .
25 to 29.........................
30 to 34......................
35 to 39......................
40 and over....................
Fourth pregnancy..................
20 to 24............................
25 to 2 9 . . . . . . . . . . . . . . . . .
30 to 34.........................
35 to 39......................
Fifth pregnancy................
20 to 24......................
25 to 2 9 . . . . . . . . . . . . . . . . .
30 to 34.........................
35 to 39......................
Sixth pregnancv.................... .
25 to 29..............................
30 to 34...........................
35 to 39......................
40 and over......................
Seventh pregnancy....... ...........
25 to 29.....................
35 to 39...................
Eighth pregnancv...................
25 to 29................................
30 to 34............................
40 and over...........................
a Excluding miscarriages.

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

Infant
Infant mortal
deaths. ity
rate.

Total
births.

Live
births.

3,081

2,965

303
906
505
225
52

285
1,057
875
484
216
48

1,003

956

243
487
209
56
g

228
467
203
7

690

671

271

Num
ber.

91.4

116
:jjn

101 8

33
31
21

477

463

3
187

3
182

4.7

15
20
6

6.2
4.1
2.9
8.9

2.8

3
6
2

5.3
2. 3
2. 9
3. 4

2.9

5
7
2

2.7
3.6
2. 7

2.6

6
2

3.9
2.8

35.1

115.4
98.6

18
4

308

300

51
154

51
148

30
2

' 30
2

212

207

17
86

17
83

2
6

23
5

22
5

1
1

140

130

22
6

19
6

12
52
29
5

11
51
28
5

3
29
28
6

3
27
27
3

90.0
7
15
4
1

137.3
101.4
58.0

3.8
5.9
3.0
3.4
4.2
4.0

57
348
205

Per cent
of total
births.*»

2.4
72.3
137.5

3
1
1

3.5
1.2

7.1
7.5

d&. U
1
2
2

39.2

1
2

6 Not shown where base is less than 50.

3.1
l
l
l

1.9

9.1

2
1
3

GENERAL TABLES.

T a b l e 11. — B irth s fr o m a ll p reg n a n cies,a in fa n t deaths, in fa n t m orta lity ra te, and per
per cen t o f stillb irth s, according to order o f p reg n a n cy and age o f m other— Continued.

Stillbirths.
Order of pregnancy and age of mother.

Total
births.

Ninth pregnancy.............................................

30 to 34.....................................................................
35 to 39.....................................................................
40 and over................................. '............................

14
25
7

Live
births.

Infant
Infant mortal
deaths. ity
rate.6 Num
ber.

13
23
7

3
1

1
2

Tenth pregnancy............................................

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

2
16
9

Eleventh pregnancy.......................................

30 to 34.......•........................................................... :
35 to 39.....................................................................

1
4
4

1
4
3

Twelfth pregnancy.........................................

35 to 39.....................................................................

1
3

Thirteenth pregnancy....................................

a Excluding miscarriages.

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

6 Not shown where base is less than 50.

Per cent
of total
births.6

T a b l e 12.— B irths to m others m arried specified num ber o f years, stillbirth s, and in fa n t deaths, by num ber o f births to m other.

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

Total
births. Under
2

131
1
18

151

192

104

142
8
11

117
2
11

114
9
11

130
4
14

112
7
13

82
2
8

2 .........
1

177
10
20

138
1
15

196
4
12

180
19

157
8
10

1 birth:
Births................................................
Stillbirths..........................................
Infant deaths....................................

308
13
34

169
10
17

12
2
2

434
15
30

66
1
6

146
2
6

76
3
7

3
3

26
2
1

18
2
2

27
2
4

90
4
9

84
3
3

51
2
5

16
1
1

56
1
8

4
4

1
2

30
2
5

2 births:
Births................................................
Stillbirths..........................................
3 births:
Births................................................
Stillbirths..........................................
Infant deaths....................................

483
16
37

4 births:
Births................................................
Stillbirths..........................................
Infant deaths. . . . . . . . . . . . . . . . . . . . . .

404
11
35

5 births:
Births................................................
StillDirths..........................................
Infant deaths....................................

330
12
29

6 births:
Births................................................
Stillbirths.........................................
Infant deaths....................................

264
11
31

7 births:
Births................................................
Stillbirths..........................................
Infant deaths....................................

224
6
22

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

18
1

24
1
2

12
1

24
2
2

12
1

2
21
1
2

2
6

12
3

399
20
30

42
1
3

. 30

14
2

6
1

55
1

20
and
over.

86
2
6

TABLES,

3,081
116
271

30
1

24
2
2

i
20

10
1
1

1
30
1

21
1

36
3

24
1
4
14

181

18
1

14
i

GENERAL

Total:
Total births.......................................
Stillbirths..........................................
Infant deaths.....................................

21
1
3

28
1
A

T a b l e 12.— B irth s to m others m arried specified nu m ber o f yea rs, stillb irth s, and in fa n t deaths, by n um ber o f births to m other — C ontinued.

w
F
TABLES,

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

GENERAL TABLES.

T a b l e 1 3 .— M others rep ortin g specified nu m ber o f m iscarriages, b y n u m ber o f pregnancies
to m other a n d n a tiv ity o f m other.

Mothers reporting specified number of miscarriages.
Pregnancies to mother and nativity of
mother

All mothers.
Pregnancies:

1.............
2.............
3 ............. .
4 .......... .
5
6

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

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

7................... .

Native mothers.

Total

mothers.

None.

997

895

296
216
154
106
71
48
28
23
21
17
10
4
3

296
204
140
86
54
37
26
15
16
14
4
2
1

11
11
19
14
11
1
3
2
1
3
1

1
3
1
3

754

676

258
171
112
72
47
33
18
12
6
12
7
3
3

258
160
101
57
36
24
17
6
3
9
2
2
1

10
10
14
8
9

1
1
1
3

2
1
1
2

3
1
2
1
1
1

243

219

38
45
42
34
24
15
10
11
15

38
44
39
29
18
13
9
9
13
5
2

3
1
2
1
1
1

1
1
2
1

1
1
1

pregnancies:

1.......

2 .......
3 ......
4 .......
5 ......
6 .....
7 ...........
8 .......

Foreign-bom mothers -

1
1
5
6

1
1
1
1

1
1

Pregnancies:

1 .......
2 ...........
3 .......
4 ... .
5 .......

....
......
......
9.......
10.......
6

7
8

11...........
12............
13............

3
1

1
1
1

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

GENERAL TABLES,

T a b l e 14.— Mothers reporting specified number o f stillbirths, by number o f births to

mother and nativity o f mother.
Mothers reporting specified number of
stillbirths.
Births to mother and nativity of mother.

Total
I mothers.

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

997

— - - - -1

Births:

|
901 1
295
203
146
92
57
37
27
10
14
13
4
3

13
13
14
7
6
5
4
8 !

754

684

256
159 1
106
60
40
24
15
6
5
9
3
1

11
12
V»
5
5
4
4
4
1
2

12.......................... ................... .....................\........
14..................- .........................................

267
172
116
67
47
29
20
12
6
11
4
2
1

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

243

217

41
45
45
34
If
li
12
1C
li
(
1
5

39
44
40
32
17
13
12
4
9
4
1
2

2
1
5
2
1
1

Births:

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

308
217
161
101
66
44
32
22
19
17
5
4
1

Births:

None.

•

1
1
2
3

1
4
1
1

i
i

1
1
2
2

1
2

............ I'
1 j...............
1

4
4

2
1

GENEKAL TABLES.

T a b l e 15.- - Mothers reporting specified number o f infant deaths, by number o f live births
to mother and nativity o f mother.

Live births to mother and nativity of
mother.

Total
mothers.

Mothers reporting specified number of infant
deaths.
None.

All mothers.

Native mothers.

Foreign-born mothers.

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

763

179

309
219
158
98
63
45
36
16
17
13
5
3
1

273
189
121
71
42
21
16
10
10
6
3

36
29
36
19
15
J7
14
4
3
5

742

597

121

269
170
114
65
45
30
19
7
8
9
4
1
1

243
148
90
49
30
14
7
5
4
4
2

26
21
23
11
11
11
10
2
2
4

241

166

40
49
.44
33
18
15
17
9
9
4
1
2

- 30
41
31
22
12
7
9
5
6
2
1

1
1
6
6
6
5
1
2
2
1

2
.1
1
1
1

1
18

1
1
4
4
4
1

1
1
1
1

1
1
1

10
8
13
8
4
6
4
2
1
1

2
2
2
4
1
2
1

90
T

GENERAL TABLES.

able

1 6 . — Births during selected year in dwellings o f specified number o f rooms,

according to number o f persons in dwelling and nativity o f mother.
Number of rooms in dwelling.
Persons a in dwelling and Total
births.
nativity of mother.

54 266 226

236
222
194
1
134
87
65
33 » 1
22
8
11
3

10
6
1
1
2
1

13
6
7
4
2

13 84 49
14 63 56
11 48 42
11 30 34
4 18 14
1 10 17
8
6
6
2
1
1
2
1

1,015
Persons in dwelling:

Native mothers___
Persons in dwelling:

Not reporto

766

....

204
174
152
92
59
45
15
16
4

6
1

10
4
3

1
1

249

35 191 170
9
9
8
8
1

74
49
34
17
10
5
2

43
42
34
18
11
13
3
5
1

Not
re
ported.

18
9
22 15
27 10
7
16
14 14
12
6
5
5
4
3
1
1
4
1

5
3
7
3
2
1
2
1
'1
1

1
1
2

170 122
30
35
36
25
16
15
5
5
2
.1

27
31
29
21
14
11
1
4

17
20
24
16
11
9
4
3

4
3
6
3
1
1
2
1
1

1
1
2

9
13
9
7
9
3
3
2
1

4
5
i
x
i

3
2
4
4
2

4
5
3
3
3
i

10
14
14
13
8
5

6
14
8
16
3
4
3
1

3
4
7
4
2
4
4
1
2

1
2
3

2
1

3
3
1

5
3
2
2

2
7

2
1
2
1

1
1

i
1

1
1

2
1
2

20
18 _ l
6
4
7

1
1

2
1
2
1

1
1

139 105

^......................
^..............

F o r e ig n -b o r n
Persons in dwelling:

1
3

a Excluding infant born during selected year.
T

able

VI .— Dwellings o f families included in study in each ward or ward group, according
to specified sanitary condition.
Ward of residence.

Sanitary condition of dwelling.

Total
dwell
ings.

2, 3,
4,5

1
Total <*...............................
Type of toilet:
Water-closet..........................
Privy....................................
Drinking water:
One source............................
Dug well........................
Driven well....................
Purchased......................
City................................
More than one source..........

West Side.

East Side.
6,9

7,8

15,16,
11,12 13,14,
18
17

1,005

118

102

149

184

118

490
515

32
33

104
14

65
37

61
8.

27
31

13
136

94
90

53
13

20
98

21
55

977
616
339
20
2
27
1

64
35
29

108
49
54
4
61
9
1

101
65
35
1

66
24
37
5

56
35
21

146
125
18
3

182
97
82
3

65
27
35
3

115
102
11
1
1
3

74
57
17

2
2
1
3
!
.
a Dwelling means place in which family lived during greater part of year following infant s birth, or, in
case of stillborn child, where mother spent the greater part of her pregnancy period.
b Purified by private filtration plant.

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SCHEDULE USED IN STUDY.
W A R D No. ................

B. C. No. __________

M OTHER.
1. M . F.
2. L. I.
4: Date birth
5. Phy’ n, M w f.— Name
Address
6. Death (a) Date
(c) Causes
(d) Physician

(b ) Age

Defects, D eform s.: None, Over.

Eyes: O K Over

7. Feeding (M o n th s ).

(a)
(b )
(c)
(d )

mos.

10 11

Breast
M ixed
Artificial
Night feedings

Reasons io r change

33. Pregnancies

BABY
Name

(a) Losses
Year
of—

Period

Cause

Age a t
D e a th
Born a t

1st
2d
3d
4th
5th
6th
7th
8th
9th
10th
11th
12th
13 th
14th
15th

M OTHER
Name
Address

FA TH ER
13. Y rs .U .S .

H O M E . 15. Street, alley. 16. Front, rear. 17. Fams. in bldg.
18. Persons: (a) Family
(b) Lodgers
(c) Others
(d) Total:
19. Rooms
20. Vent’n : ( a ) Means G. F.
(b) Results Good, Fair, Poor
21. Clean, M edium , Dirty
22. W ater (a) Source: City, Spring, Dug well, Driven well.
(b) In,
23. Toilet (a) Type
Fam. exc. use: Yes,
(b) House, porch, yard, cellar, (c) Persons using
24. Direct city sewer connection: (a) Sinks: Yes, No
(b) Toilet, Yes,
IN C O M E . 25. Annual earnings (a) Father,?
(b) M o th e r,?
(c) O ther income, ?

(d) Total, ?

M O N T H L Y RENTAL.

Own, free

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27. Nationality

34. Record of employments

Empr, OA, W E

26. A m ount,?

P.
out
No
No

Age

Name

1
2
3
4
5
6
7
8

Address

35. W o rk (a ) Yr. before conf.
(b ) Yr. a fter conf.
(c) Ceased
36. From baby ac. work from
(a) Reg., Irreg. (b ) Extent
(c) C aretaker: Relation
37. Usual home duties: Servant
(a ) Ceased part of duties
(c) Resumed part of duties

before

(d) Resumed
mo. to

after
mo.

Age
I
No servant Occasional help.
before (b ) All
before
;
after (d) All
after '

TABLES.

8. M ilk dealer (a) Name
(b) K ind: Grocery, D airy, Farm, Cow shed
F A T H E R . 9. Nationality
10. Age
11. Sp. Eng.: Y. N. 12. Rd. & W r .: Y. N.
14. Occ.
*hd.

2 8 - ASe
29. M arriage ages
duration
fears
30. Sp. Eng.: Yes, No
31. R d.and W r .: Yes, No
32. Y rs .U . S.

M o th er’s
age

GENERAL

3. L. B., S. B.; A t 1 year: Alive, Dead

D. C. No. ....................

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PLATE I.—THE ATTRACTIVE SIDE OF HOUSEBOATING.
IN LAKE LINTON.

TIED UP

FOR THE WINTER

PLATE I I —A REAR VIEW OF SOME HOUSEBOATS.
The surface of the water between the houseboats and the river bank is covered with rubbish and with
filth from a sewer opening not far away.

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' PLATE I I I . —A TYPE OF INSANITARY DWELLING.
The dwelling in the foreground is representative of those which, after they once become vacant, were
not permitted to be reoccupied until they were made sanitary. In-the shed in the rear a horse was
stabled. Equidistant between house and shed is the shallow well which supplied the water for house
hold use.

PLATE IV .—REAR OF HOUSES IN AN OUTLYING SECTION WHERE SEWER CONNECTION
HAD NOT BEEN MADE W ITH THEM.

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PLATE V.—A DRAINAGE PROBLEM IN SAGINAW.

PLATE V I.

NOT FAR FROM THE RIVER.

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HOUSING AND SANITARY CONDITIONS BAD.

PLATE V II.—REAR VIEW OF TWO HOUSES ALONG A SEMISTAGNANT STREAM.
CLASS OF HOMES JUST ACROSS THE STREET.

A BETTER

PLATE V I I I . —A MUNICIPAL DEEP WELL.
Located at the street corner and within a few feet of a sewer opening. The pump has a public drinking
cup attached.

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PLATE IX .—ANOTHER MUNICIPAL DEEP WELL.
Located in a good residence section with a public drinking cup attached to the pump.

PLATE X .—VIEW OF THE DUG WELL WHICH SUPPLIED DRINKING WATER TO
TWO FAMILIES.
Note position in relation both to privies and the slope of the ground. Drainage is so poor in this section
of the city that sidewalks and street are both elevated considerably above the natural surface level.

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PLATE X I.—V IE W OF A TYPICAL UNPAVED STREET IN SAGINAW.
Deep grass-grown roadside ditches containing ashes and rubbish, and excellent sidewalks, were found
B
along the unpaved streets.

PLATE X II.—LARGE RUBBISH DUMP.
A t the time of the study both animal and vegetable refuse was thrown here. I t became quite offensive
in the summer time and harbored rats at all seasons of the year.

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PLATE X III.

TYPE OF STRUCTURE COMMON NEAR THE RAILROAD TRACKS.

In this instance the lot is crowded and below street level, and the house has insufficient light and’ air.

PLATE X I V —A REAR HOUSE WAS RARELY SEEN IN SAGINAW.
The one above, located in a factory district, housed the family of a baby scheduled in the report
family included eight persons.
1

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This

PLATE X V .—FRAME BUILDINGS ON WOODE.I PILES.
Located in a low-lying part of the city not far from the river. Compare the street level with the surface
level.

PLATE X V I.—A NEARER VIEW OF THE SAME BUILDING.
CODE?

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DID THE CITY NEED A BUILDING

Full text of Infant Mortality : Results of a Field Study in Saginaw, Mich., Based on Births in One Year, Infant Mortality Series No. 9, Bureau Publication No. 52

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