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https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis . il P L A T E I.— G E N E R A L V I E W https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis OF SO U TH E R N PA RT O F N E W B E D F O R D , S H O W I N G T H E A C U S H N E T R IV E R . MANY COTTON M IL LS LOCATED ALONG T H E U. S. DEPARTMENT OF LABOR CHILDREN’S BUREAU JU LIA C . L A T H R O P , Chief INFANT MORTALITY RESULTS OF A FIELD STUDY IN NEW BEDFORD, MASS. BASED ON BIRTHS IN ONE YEAR By JESSAMINE S. WHITNEY « INFANT MORTALITY SERIES No. 10 Bureau Publication No. 68 WASHINGTON GOVERNMENT PRINTING OFFICE 1920 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis CONTENTS. loun Page. Letter of transmittal.............................................................................. ................................... 9 Introduction................................................................................................................................. 11-13 Choice of city................................. . . . ............................... .............................................. 11 Description of city................- ...................................... - .................................................. 12 13 Method of procedure.......... : ............................. ............................................................... Cooperation................................................ .......................................................................... 13 Analysis of findings........ , ................................................................................................. .. - - - 15-65 Infant mortality rate........................ - .................... ......................................................... 15-17 15 Distribution by precincts................................................. *.................................... 15 The ‘ ‘ unfavorable ” area................................... ............ ............................... .. Nationality...................................................................... - . - .............................................. 17-22 19 Length of residence in the United States........ .................................................. Literacy and ability to speak English.......... .................................................... ■ 20 Cause of death................................................................................. - ................................ 22-25 Gastric and intestinal diseases.............................. '............................................... 22 Respiratory diseases.................................................................................................. 24 24 Causes peculiar to early infancy.......................................................................... Comparison of “ unfavorable ” area with the rest of the city...................... 24 Cause of death, by calendar months................................................................ 25 Age at death........ .................................................................................. ............................. 25 Stillbirths............. ...................................................................................... .......... ............ - 27-28 Comparison with other cities................................................................................. 27 Stillbirth rates and nationality................................................................... 28 Stillbirth rates and other factors— ........................................................... .. 28 28 S e x . . . . . . . . . . ................................... .......... - ........................................................................ 29 Age of mother................................... . ........................... .....................- ............................. Order of birth........................................................................................ 29 Plural births........ ................................................ ..........................................- ................... 30 Attendance at birth............................................. .................- ................ ......................... 30-32 Infant mortality rates, by attendant at birth................................................. 31 Hospital facilities..................... 31 Midwives............................................................................. 31 Other or no attendant.............................. 32 Prevention of ophthalmia neonatorum............................................................. 32 Feeding...........................................................................- . . - ........ ...................................... 32-36 Proportions breast fed and artificially fed........................................................ 33 Feeding customs and nationality of mother.................................................... 33 Infant mortality rates, by type of feeding....................................................... 34 Feeding in relation to cause of death— ........................................................ 36 Economic factors............................................ .................................................. - .............. 36-47 Occupation of father........................................... 36 Basis of classification..................... 37 Distribution of economic groups............................... 37 Economic status and nativity of mother.................. ............................. .......... 38 Infant mortality rates according to father’s earnings............ . ..................... 38 Comparison of “ unfavorable” area with the rest of the city..................... 39 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 1 3 ^ 0 4 CONTENTS. Analysis of findings— Continued. Economic factors— Continued. Economic status and size of fam ily.................................. ....................... .......... Father’s earnings and employment of mother............................. ................... Gainful employment of mother......................... ................................................... Employment and nativity...................................................................................... Classification of employment........................................................... Employment during year preceding birth of baby. .................................. Work after childbirth.................... Gainful employment of mother and feeding:................................................. Employment of mothers in cotton mills.................................... ....................... Legislation in regard to employment of m other............................ .......... .... Civic’ and social factors............................................................................................... Birth registration.......................................... The board of health............................ ,............. ...................................................... Milk supply..............; .................... ................. . . . . .......................................... Sanitation.. .......................................................... ................................................ ; . . Water supply.......................................... Sewerage........ ............................... ................................... .......... .............. ........ Toilets........................ ................ ......................................................................... Sewage disposal........................................ Disposal of ashes, refuse, and garbage...... ................................................. Paving streets.......................... Cleaning, sprinkling, and oiling streets.......................................... .......... Social agencies............................................ ............ ............................. ..................... Instructive Nurses Association............................................................... .... Boarding homes.................................................................................. Housing.............................................. The river section....................... ................................................................................ Types of houses................... : ............................................................................ The well-to-do section................................... The native-colored district....................... ........................................................ .... The newer section ................ .................................................................................. Legislation.................................. Land congestion in relation to housing............................................................. Regulation................. . . . . . . . . . ..................................... .............. ......................... Findings of the study.................................................. .......... ........................... .. Nativity and housing..... ................................................... ...................... .. Housing in ‘ ‘ unfavorable ” area........... ....................... ............................... Illegitim acy............................................. Comparative rates for Massachusetts cities........................ .....................— Securing of data.................. 1............ .......... ............. ......... ........................•>_____ _ Infant mortality rate for infants of illegitimate birth.................................. Care in confinement................................. Disposition of infants.............. ............ .................. ................................................. Nationality..................................... Court action.................................. Age and occupation of mother. ............... ....................................... . . .............. Summary and conclusions........................................... ...................................................... .... Infant mortality rate.............................. ............................. .................................... Nationality........................................ ................ ...................................................... Cause of death..................................... Attendant at birth......................... F e e d in g ...................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Page. 40 40 41 41 42 42 43 45 46 47 47-54 47 48-51 49 51-53 51 51 52 52 53 53 53 54 54 54 55-62 55-57 56 57 58 58 59 60 60 61-62 62 62 63-65 63 64 64 64 64 65 65 65 66-69 66 66 66 67 67 CONTENTS. 5 Summary and conclusions— Continued. Page. Father’s earnings................................................................................................. - . . 67 Gainful employment of m other........................................... ............................... 67 Civic agencies......... . ........................... ...................................................................... 68 Contrast between New Bedford and Brockton................. ............................. 68 Appendix................................................................................................................... 71-80 Method of procedure................................................. .............. - .................................... 71-80 71 Scope of inquiry............................................ Infant mortality rate....................................................... 72 Live births excluded in New Bedford...................................................... 77 78 Stillbirth rates................... ................................................ - .......... ................... Stillbirths excluded................................ ........ .....................- ............ ............ 80 107 In dex..................................... GENERAL TABLES. Table 1. Births during selected year in each precinct of residence, according to nationality of mother..............................- .......... ........ ................................ 2. Births during selected year to foreign-born mothers, infant deaths, infant mortality rate, and per cent of stillbirths, according to years of residence of mother in the United States and nationality............ 3. Number and per cent distribution of deaths among infants born in selected year to mothers of specified nationality, by cause of death. . 4. Number and percen t distribution of deaths of infants bom in New Bedford in selected year and of infant deaths in the registration area in 1914, b y cause of death.. . - ...................................................... 5. Deaths of infants bom during selected year occurring in specified month, by cause of death............................................... ............................... 6. Deaths among infants born during selected year occurring in speci fied month of life, by cause of death............................ ............................. 7. Deaths among infants born during selected year in each precinct of residence, by cause of death.......................................................................... 8. ’Number and per cent distribution of deaths of infants born during selected year to mothers of specified nativity, by age at death.. . . 9. Births from all pregnancies, infant deaths, infant mortality rate, and per cent of stillbirths, according to order of birth and age of mother. 10. Mothers reporting specified number of stillbirths, according to the number of births to mother................................... ................ ..................... 11. Mothers reporting specified number of infant deaths, b y number of live births to mother.....................................- ....................... : ....................... 12. Total births and number and per cent of plural births resulting from all pregnancies, according to age of mother.................... — .................. 13. Births during selected year and number and per cent of births to mothers with specified kind of attendant, according to nationality of mother............ .................................................- .....................- -------- --------14. Births in selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to attendant at birth and nativity of mother......................................... .............. ......................................................... 15. Number and per cent distribution, b y type of feeding, of infants bom during selected year and surviving at end of third, sixth, and ninth months, according to nationality of mother......... ................................... 16. Infants bom during selected year to mothers of specified nativity and surviving at beginning of the month, number and per cent of infants dying subsequently i n first year, and infant deaths in specified month of life, according to month of life and type of feeding in the month................... ............................................................................................. .. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 83 83 84 85 86 86 86 87 87 89 89 89 96 90 91 92 6 CONTENTS. Page. Table 17. Infants bom during selected year and surviving at end of 3, 6, and 9 months of age, whose mothers had specified working status, and number and per cent artificially fed, according to nationality of mother.......... ....... ...................................................... .......................................... 18. Births during selected year in 3ach father’s earnings group, according to occupation of father.. ............................ . ......... ....................................... 19. Births during selected year in families of specified number of persons and average number of persons per family, according to earnings of father and nativity of mother........................ .............................................. 20. Number and per cent distribution of live births in selected year to mothers of specified nativity in and outside “ unfavorable’’area, according to earnings of father........... .................. ..................................... 21. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to employment of mother during year before birth of in fa n t............................................................................ 22. Births during selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to employment of mother during year preceding birth of infant and interval between cessation of work in cotton mills and confinement......... ............................................ 23. Live births during selected year, infant deaths, and infant mortality rate, according to employment of mother during year following birth of in fa n t............................: ........................... ......................................... 24. Live births, infant deaths, infant mortality rate, and per cent of deaths from gastric and intestinal diseases, according to employment of mother during year following birth of infant, and infant’s age when mother resumed work in cotton mills, and nationality of m other.. 25. Number and per cent distribution of births during selected year to gainfully employed mothers of specified nativity, according to earn ings of mother during year following birth of infant............................ 26. Births in selected year to foreign-bom mothers gainfully employed in specified way during year following birth of infant, according to literacy and nationality of mother........... ................................................... 27. Births in selected year to foreign-bom mothers gainfully employed in specified way during year following birth of infant, according to nationality and years of residence of mother in the United States. 28. Births in selected year to mothers employed in cotton mills during year following confinement, according to specified number of persons in family, and earnings of father and nationality of mother. _ 29. Dwellings occupied by mothers of specified nativity, according to specified sanitary condition of dwelling......... ....................................... 30. Births during selected year in dwellings of specified number of rooms, according to number of persons in dwelling and nativity of mother. 31. Births in selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to number of persons per room in selected area and nativity of mother.......................................................... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 93 94 95 96 96 97 98 98 100 100 101 102 103 104 105 7 CONTENTS. MAP AND CHARTS. „ Map. _ ,, , ___ Faces page. New Bedford, Mass., 1913, showing distribution of live births and infant deaths included injstudy, according to place of residence.. . Chart I. Infant mortality rates from specified diseases among infants of native and foreign-born mothers, and of Portuguese-white mothers sepa rately.................................................. ...................................................................... II. Deaths from respiratory and gastric and intestinal diseases, by calen dar months......................... ............................................................... ..; ................. I I I . Percentage of deaths under 1 month of age in the four cities speci fied............................................................................................... r :......................... I V . Relative mortality during first year of life for Manchester, New Bed ford, and the registration States in 1910....................................................... Y . Infant mortality rates according to father’s earnings for the three cities s p e c i f i e d . . . . . .............................................................................i .............. ........ VI. Percentage of mothers gainfully employed, by nativity, according to earnings of father......................... ..................................................................... .. ILLUSTRATIONS. Plate I. General view of southern part of New Bedford, showing the many cot ton mills located along the Acushnet River. Frontispiece. II. Two-family mill houses— one toilet in cellar for each two apartments. I II. Part of a group of 27 mill houses— toilet adjoining the kitchen in each apartment. IV . Brick mill tenements— toilets in the cellars. V . Large block tenement in which 56 persons were living— one toilet in the hall on each floor. Y I. A particularly bad block tenement— containing eight small apartments. V II. House containing small, ill-planned apartments— streets and the yard in the rear littered with rubbish and garbage. V I I I . Old cottages raised with stores built beneath. I X . View in the center of the native black section; here there is no paving, and privies are found in the yards. X . New three- and six-family tenements averaging five rooms to each apartment. X I. Model mill cottages containing six and eight rooms in “ Howland Vil lage. ” XII. Method of meeting the fire regulations, which require two exits. X I I I . Another way of complying with the fire regulations. X I V . Dwelling opposite a vacant lot used as dumping ground. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 15 24 25 26 27 40 44 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis LETTER OF TRANSMITTAL. U. S. D epartm ent of L abor, CfliLD R E N ’ s B , ureau , Washington October 11, 1919. S i r : Herewith I transmit a report upon infant mortality in Now Pedford, Mass. This study was made under the direction of Miss- Jessamine S. Whitney, who has written the report. Miss Helen Wilson made the special study of housing; Miss Viola I. Paradise and Miss R uth True are responsible for the study on illegitimacy; Miss Emma' Duke pre pared the statistical material. The report was revised and edited by Dr. Robert M. Woodbury. The Children’s Bureau wishes to express its appreciation of the liberal cooperation given by the municipal authorities, civic associa tions, and the press in New Bedford. J u l i a C. L a t h r o p , Chief. Hon. W . B. W il s o n , Secretary o f Labor. 9 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY, NEW BEDFORD,MASS IN TRO D U CTIO N . CHOICE OF CITY. New Bedford, Mass., was selected as one of the cities to be studied by the Children’s Bureau in its series of investigations of the social con ditions underlying infant mortality. Cities previously studied by the bureau and for which reports have been published are Johnstown, Pa., Manchester, N. H., Waterbury, Conn., Saginaw, Mich., and Brock ton, Mass. In 1913 New Bedford had the high infant mortality rate of 143 deaths under 1 year of age per 1,000 live births.1 Not only was the rate high for this particular year, but the rates for preceding years also had been consistently high. New Bedford is a textile manufactur ing city, and the four textile manufacturing cities— Fall River, Lowell, New Bedford, and Lawrence— had the highest infant mortality rates of any of the cities of Massachusetts of over 50,000 population except Holyoke (1.910) .2 (See Table I.) T a b l e I .— Infant mortality rates in 1913 for cities in Massachusetts having a population o f 50,000 or over in 1910:a City. L ynn........................ ................................. Somerville.................................................. Brockton............................ ....................... Cambridge................................ ................ Springfield................................................ Worcester................................................... Infant mortality rate. City. Infant mortality rate. 82 86 98 98 104 105 110 128 143 151 151 a Seventy-third Annual Report on Births, Marriages, and Deaths in Massachusetts for the year 1914, p. 207. Boston, 1915. Holyoke has been omitted from this table, since the presence of an infant asylum makes comparison unfair. The birth rate and general death rate for New Bedford were also above the average for the State; the former, 33.8s was the second 1 Seventy-second Report of Births, Marriages, and Deaths in Massachusetts for the year 1913, pp. 4 and 38. Boston, 1914. * Holyoke has an infant asylum which increases the rate abnormally, since deaths of infants in the asylum who were born outside the city are included. 3 Based on estimated population, Bureau of the Census, Bulletin 133, p. 22, and on births in 1913, Seventythird Annual Report on Births, Marriages, and Deaths in Massachusetts for the year 1914, p. 207. Boston, 1915. 11 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 IN F A N T M ORTALITY. highest rate among the 12 largest cities in the State, while the death rate, 15.6,1 was slightly above the average for Massachusetts. An investigation of the causes of the excessive mortality of infants in one of these industrial centers seemed desirable; a study might indicate whether these high rates were due to industrial conditions, such as low wages and employment of mothers, or whether factors connected with the customs of the immigrant population, such as type of feeding, were responsible. The study in Manchester, N. H .,2 also a textile-manufacturing city, has shown an excessive death rate among the infants of French-Canadian mothers, a large proportion of whom were gainfully employed. An important consideration in the selection was the contrast between New Bedford with a rate of 143 and Brockton, another industrial city about 30 miles away, with a rate of only 98. Studies were made b y the bureau in both cities; Brockton, a shoe-manufacturing city, had well-paid union labor, with a relatively small proportion of foreign bom ; while New Bedford, devoted mainly to the manufacture of textiles, was characterized by a large foreign population and a relatively large proportion of women gainfully employed. DESCRIPTION OF CITY. New Bedford, in 1913 a city of approximately 107,000 population, is located 57 miles southeast of Boston, at the mouth of Acushnet River, where it broadens into Buzzards Bay. The city is attractively situated and occupies a particularly favorable position commercially, extending along the west bank of the Acushnet River for a distance of lOf miles and having unusual dockage facilities. In former times it was the whaling center of the continent, but since the introduction of petroleum into general use as an illuminant the industry has declined. In the past 40 years New Bedford has led in the manufacture of textiles and especially in the production of fine cotton yams. The line of the water front, formerly indicated b y the masts of “ whalers” at anchor in the river, is now marked b y tall chimneys of cotton mills along the banks. Besides the cotton mills, other industries have developed in New Bedford, including the manufacture of cordage, cigars, shoes, glass, silverware, mechanical tools, twist drills, and manufactures of copper. The city has a large foreign element, attracted there b y the demand in the textile and shipping industries for unskilled and semiskilled labor. In 1910 over 45 per cent of the population were foreign born, i Seventy-third Annual Report on Births, Marriages, and Deaths in Massachusetts for the year 1914, p. 201. Boston, 1915. * Duncan, Beatrice Sheets, and Duke, Emma: Infant Mortality: Results of a Field Study in Manchester, N. H., based on births in one year. U. S. Children’s Bureau Publication No. 20, Infant Mortality Series No. 6. Washington, 1917. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 13 including large numbers of French Canadians, English, and Portu guese. Near the mills and along the river is crowded the bulk of the city’s population. The residential districts where most of the native Americans live lie toward the west at some distance from the busi ness section of the city. M ETHOD OF PROCEDURE. Registered births during the calendar year 1913 were used as the basis of this study. Birth certificates for 3,633 babies born in the city during this period were copied from the records in the office of the city clerk. The death certificate also for any of these infants who had died under 1 year of age was copied on the corresponding record. After arranging the records b y districts, women agents of the bureau visited the mothers to secure the information upon which the study was to be based. Not all these births could be used in the detailed analysis. The number of removals, nonresidents, and infants for whom full infor mation could not be obtained was 971. These were excluded. This study is based, then, upon 2,662 births, 2,587 five and 75 stillbirths.1 COOPERATION. Too much praise can not be given to the city officials, the press, the clergy, public-spirited citizens, civic associations, and other agencies for generous assistance in the work. The value of the report is due in large part to the completeness of the information given by the mothers of New Bedford, and thanks are especially due to them for the information and cooperation which they so willingly gave. i For the discussion of mortality rates for the excluded groups and of the general infant mortality rate for the city the reader is referred to Appendix, pp. 73-74,76, and especially pp. 77,78. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis NEW BEDFORD M ASSACHUSETTS •-J-ÔÜ'Srî 1913 S H O W IN G /■ DISTRIBUTION OF LIVE BIRTHS AND INFANT DEATHS INCLUDED IN STUDY ACCORDING TO PLACE OF RESIDENCE b u ttonw ood park n / □□□ Precinct of residence The City. Total live births Infant deaths _2.587. □ □ □ □ □ □ K EY Precinct I . . _____469_______ 65 2 -._ — 2 9 3 ~ ____ 52 3 _I90_______ 24 4 _70________ 2 _104-___ 10 5 6 _7 6 ________ 7 7______ 4 4 ________ 6 _20_______ 3 8 9 _5 9 ________ 5 _3 3 ________ 5 10 II._____ 4 5 ________ 7 12J_____ 5 4 ________ 3 13_____ 227________38 _4 8 ________ 2 14 15 _6 5 ________ 6 l6 .-_ _ .2 4 3 ______ 21 17 ____ 3 0 9 _______ 54 18 ________2 3 8 - - — ..2 7 Cotton m ills ...— P W a rd Boundaries Precinct Boundarie s ~7, la r n r H I n r n P" 00 I a a a a 1 11 oiir-1^ 9 Di=:3S E P -j Q H D Q .J m T m i e d n n a J Ua II 7 CO - HEW _ _ p a a E S ! f ? K S JL ,,J 3 D H E 3 Ö C B c L □ E Z D C Z IH h B B S S iS fiB / Infant deaths____ • J I B B a UOOC S od ^ -CaaauOOO □ E q o a g n a - infant survivals. ..o 337 , o a s i s t in y L OOÉ.n11 œ aCd □ E II II VQ/ftr n r II 11 : II ~]|— * II ~~ll-----—i r — JL. h h □ C UC \ jJ C lo t C H U trru 2 B S / a\ q DC □ c T — U— LL-chwpvh DC U n o r JO a SOOgDoeoaomr; SJ 15 H N £ T i / 'S / i 16 c y ID.P in n f f n \ balmep*r' / / / / U / / / 154220°— 20. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis (To face page 15.) m s H A n s: » S H N E ■ tìSÉSÉàSssSÉ -■■■' i'.'lï ■'■s»Éá ^asssMasf B W W I g :■ ; I ’ g :. . ■ " ' I ., §1 ; J H 3’ I S¿ '- . *.Mtó§glP; ' ,&ë< o4 • ./, Ä • lilis •> H f l &ÍR5 a ! ii væ ?£?/ IB liB B ' • - . .. I 1 ■ ■r ! J g iffS , ■ %K M T^á*8S& w SfSÉSSl fe M Í I Í # ^ p ^ Í Í 3 # P ^ » Í li^ í í. < ~ gpffi '■-> *Cf , »- mmmmmsm ■mmmm •; https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis ANALYSIS OF FIN D IN G S. INFANT MORTALITY RATE. • The infant mortality rate for the selected group in New Bedford for the year of t^T study was 130.3. Of 2,587 infants b om alive, 337 died before reaching the first birthday. DISTRIBUTION BY PRECINCTS. The distribution of births and deaths in the wards and precincts in New Bedford is shown in the spot map, and the infant mortality rates for the different precincts are given in Table II. Precincts 1, 2, 3, 13? and 17 all have high rates, precinct 2 having the highest rate in the city, 177.5. This analysis b y precincts shows the area in which the infant mortality problem in New Bedford was most serious. It should be mentioned that since the study was made the ward and precinct lines have been changed; the wards and precincts discussed and shown on the map refer to those existing at the time of the study. T a b l e I I . — Live births during selected year, infant deaths, and infant mortality rate, by district and precinct o f residence.a District or precinct of residence. The city..................................................... “ Unfavorable” area........................................................ Precinct 1............................................................... Precinct 2............................................................... Precinct 3 . . . . . . ................................................. Precinct 13............................................................. Precinct 17.......................................................... Live births. Infant deaths. Infant mortality rate.& 2 587 1 48$ 233 190 “ Favorable” area............................................................ Precinct 4............................................................ Precinct 5...........'.........'............................................... Precinct 6.................................................................. Precinct 7......................................................................... Precinct 8...................................................................... Precinct 9 ......................................................................... Precinct 10.................................................................... Precinct 11.......................... ......................................... Precinct 12.................................................................... Precinct 14................................................................. Precinct 15....................................................... Precinct 16.................................................... Precinct 18....................................................... a o 70 45 238 21 Wards and precincts according to ward and precinct lines existing at the time of the study. Not shown where base is less than 100. THE “ UNFAVORABLE” AREA. The five precincts designated as the “ unfavorable” area lie on the river front, the first three grouped together in the northern part of the city and the other two in the southern part. All are in the cottonmill section. Within this area were found 57 per cent of all live 15 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 16 IN F A N T MORTALITY. births included in the study and 69 per cent of the deaths in this group; the infant mortality rate was 156.6 compared with 94.6 for the rest of the city. . Of course, not- all parts of these precincts had unfavorable condi tions, as, for example, the northern part of precinct l , 1 which was almost rural in character; nor, on the other handagjhd these precincts include all the sections where conditions wer^unfavorable. The precinct boundary lines were merely the most convenient limits to adopt. Of the infants b om in the “ unfavorable” area as thus defined, fourfifths had foreign-bom mothers, the largest group being the Portu guese white. Two-thirds of all the infants of Portuguese mothers were found in this area, three-fourths of all the infants of FrenchCanadian mothers, and seven-eighths of all those of Polish'mothers. Precincts 1, 2, and 3,1 constituting ward l ,1 lie along the Acushnet River at the northern end of the city. Practically every nationality represented in the city is found in this ward, including native Amer icans, French Canadians, Portuguese, Poles, English, Irish, Hebrews, Italians, Greeks, Turks, and Syrians. Of one section of this ward it was said that “ one hears no English spoken on the streets here; the French-Canadian children play in the French language and the Portuguese children in Portuguese.” Sixty-eight per cent of the infants of French-Canadian mothers in the study lived in ward l,1 also 76 per cent of the infants of Polish mothers, and nearly 25 per cent of the infants of Portuguese mothers. A long-established FrenchCanadian colony was located in this ward. This group of families had its separate business center and its own local French-Canadian churches, parochial schools, doctors, and midwives. - The families of this group were generally living in modest but comfortable and well-kept homes; many were attempting to purchase their own homes. The largest Polish group of the city also is located in this ward; most of these families worked in the mills, although a number were engaged in small businesses, such as grocery stores, saloons, or lunch rooms. Many of the Polish women took in boarders on the basis of $2.50 or $3 a month each for sleeping space and the services of the landlady as cook and laundress. A day nursery for babies whose parents worked in the mill was maintained in the neighborhood and was largely patronized by Polish women. The ward was almost entirely populated b y working people, largely cotton-mill operatives. The majority of the families lived in two- to six-family frame tene ment buildings; the three-family buildings predominated. Single family cottages were rare. In one section of the ward a number of old and gloomy corporation houses were well filled. On business i Wards and precincts according to ward and precinct lines existing at the time of the study. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 17 streets, wooden block houses in bad repair, with stores on the ground floor and tenements above, were not uncommon. A t the time of the study, tenement rents in this ward averaged from $2 to $4.25 a week for four- or five-room flats, generally with a toilet, which, how ever, was often not in the apartment but in the entry or cellar. In precinct 131 lived almost the entire colony of Portuguese Negroes or “ Bravas” from the Cape Verde Islands, also 17 per cent of the Portuguese families included in this study, and a large Jewish colony. This was an old section of the city; the two-family house seemed to predominate, though the one-family houpe was sometimes found. Housing had changed with the changes of the population in this neighborhood; as the native-American families left, their onefamily dwellings were made over into two- and three-family dwellings for the Portuguese Negroes, each family having one floor. Precinct 171 had two almost distinct sections: The one bordering the Acushnet River was inhabited almost entirely b y Portuguese, with a few Poles and Jews; and in the other, the newer part, extending to Clarks Cove, lived a number of French Canadians, a few English, and a few Poles and Portuguese. Mill work was the most common occupation for the men, and also many of the women worked in the mills. A number of the Portuguese were fishermen, generally quahog diggers. Few mothers in the Portuguese colony spoke English. A number of mill blocks were located in this district; they were old and in bad repair, with no attempt b y builder, owner, or tenant to make them attractive.2 The predominating type of house was the three-family tenement; some had been remodeled from older, more pretentious homes. As a rule toilets were located in the entry or cellar. The unfavorable area included most of the colonies of the different foreign nationalities and most of the bad living conditions in the city. The inhabitants of these districts were predominantly mill workers; many of the women were gainfully employed. In the later analysis the effect of factors suggested b y the description o f these conditions will be discussed in detail.3 NATIONALITY. Of the total population of New Bedford in 1910, 44 per cent were foreign-bom white, 34 per cent native white of foreign or mixed parent age, and only 19 per cent native white of native parentage. The two largest nationality groups in 1910 were the French Cana dian and the English, the former group constituting 28 per cent of the i Wards and precincts according to ward and precinct lines existing at the time of the study. * One group of these mill tenements has since been tom down 8 See p. 55. 154220°— 20------ 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 18 IN F A N T MOKTALITY. foreign-born population, and the latter 22 per cent« The Portuguese ranked next in number, comprising 9 per cent of the foreign bom . The other groups were smaller in number. It was interesting to note how the groups kept themselves together in compact colonies, each speaking its own language. The French-Canadian and the Portu guese, groups were located in the ^so-called “ unfavorable” area. Besides these may be noted a group of Italians who lived near the river north of the center of the town, between the railroad station and the mills, and a small colony of Greeks who were settled near the river to the north of the Italian colony. The industrial development of New Bedford played a large part in determining the character of the foreign-bom population. During the days of the prosperity of the whaling industry, prior to 1880, a number of Portuguese immigrants came from the Azores and gradually formed a permanent colony which at the time of the study was the most important Portuguese center in the United States. The growth of the textile industry proved a great attractive force for immigration. When the cotton mills were established many skilled English workers were brought to New Bedford. Later, with the introduction of new machinery, French Canadians came in re sponse to the demand for unskilled labor; these were followed b y a Polish immigration and more recently by large numbers of Portu guese. Each nationality group has its own peculiar customs of infant feeding and of infant care, its superstitions and its preferences in the employment of physicians or midwives. In many cases the infant mortality rate for a particular nationality may be influenced by the conditions of the different sections of the city in which the group lives. The infant mortality rates according to nationality of the mother are shown in Table III. T a b l e I I I .— Births during selected year, infant deaths, infant mortality rate, and per cent o f stillbirths, according to nationality o f mother. Total births. Nationality of mother. Foreign-born mothers.................................. English................................................... a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live births. Infant deaths. Stillbirths. Infant mortality Per cent rate.® Number. of total births.« 2,662 2,587 337 130.3 75 2.8 753 1,909 729 1,858 79 258 108.4 138.9 24 51 3.2 2.7 685 415 226 223 76 70 60 27 126 1 667 407 218 217 71 68 59 27 124 134 47 22 26 7 3 4 •2 13 200.9 115.5 100.9 119.8 18 8 8 6 5 2 1 2.6 1.9 3.5 2.7 104.8 2 1 1.6 Not shown where base is less than 100.. N E W BEDFORD, MASS. 19 The highest infant mortality rate was 200.9 for the Portuguese white. This group was by far the largest of the foreign nationality groups represented among the births in the study, having 36 per cent of all the infants of foreign-bom mothers included. The Poles also had a relatively high rate of 119.8; they constituted one of the smaller groups. The French-Canadian group was second in size and showed a mortality of 115.5, a rate in sharp contrast to the figure of 224.7 found for infants of French-Canadian mothers in Manchester. The difference in these figures is the more difficult to explain, since both cities are textile centers and in both a large pro portion of the French-Canadian mothers worked in the mills. The New Bedford group represented an earlier immigration, and therefore many have already adopted American customs. The English formed the group next in size, with an infant mortality rate of 100.9. The rate for the British and Irish group, that is the English, Irish, Scotch, and Welsh combined, was 87.4. It appears from this analysis of infant mortality rates by national ity that the highest rates were found in certain foreign-bom groups and especially among the Portuguese. The greater part of the Portu guese in New Bedford were of recent immigration; a large number came from the Azores; more recently some have come from Lisbon and other places in Portugal. The small number of Portuguese who came to New Bedford during the days when the city was the center for the whaling industry had become part of the community, their chil dren and grandchildren taking an active part in the life of the city. There was also a group of Portuguese Negroes, commonly known as “ Bravas,” taking this name from the island of Brava of the Cape Verde group, from which most of them came. Other studies of infant mortality have shown high rates for the Portuguese. For example, the study made by Dr. Louis I. Dublin in Fall R iver1 showed an infant mortality rate for this group of 299, in contrast with the rate of 153 for infants of native mothers, of 172 for infants of Canadian mothers, and of 200 for all others. The question arises in this connection whether the differences in rates for the different nationalities were due to differences affecting the baby before birth, care of the baby, methods of feeding, or the economic and social conditions of life. The importance of these sev eral factors will be pointed out in the subsequent analysis. LENGTH OF RESIDENCE IN THE UNITED STATES. The length of residence of the mothers in this country may influence infant mortality rates because of gradual adoption of American cus toms or of gradual betterment of economic position. In General 1 Dublin, Louis I. Infant mortality in Fall River, Mass.: A survey of the mortality among 833 infants bom in June, July, and August, 1913. American Statistical Association, June, 1915. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 20 Table 2 the infants of foreign-born mothers are classified according to the number of years the mother had lived in this country. For the Portuguese-white group the infant mortality rate decreased in a striking manner as the length of residence increased. Where the residence was less than three years, the infant mortality rate was 283, while the infants whose mothers had lived here from 12 to 15 years had a mortality rate of only 95. This difference according to length of residence, however, does not appear so marked for the infants of mothers of other foreign nationalities. For the other groups the rates fluctuate considerably; but here, too, the lowest rates were for the groups in which the mothers had resided from 12 to 15 years in this country. LITERACY AND ABILITY TO SPEAK ENGLISH. The proportion of illiterate mothers in this study was unusually high. Of the total of 2,662 births, 740 were to mothers who were illiterate. One in every four of the mothers in this study was unable to read or write in any language. The infant mortality rates for the two groups showed a wide difference; for the group of illiterate mothers it was 188, contrasted with 107 for infants whose mothers were literate. (See Table IV.) T a b l e I 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.® All mothers......................................... Total births. 2,662 1,910 740 12 Live births. 2,687 1,858 718 11 Infant deaths. Infant mortality Per cent rate.6 Number. total of births.i> 337 130.3 75 2.8 199 135 3 107.1 188.0 52 22 1 2.7 3.0 Persons who can read and write in any language are reported literate. Not shown where base is less than 100. c Including 26 births to native mothers. a b The proportion of mothers unable to speak English was greater than the proportion of mothers unable to read and write. Of the total number of births, 1,006, or 38 per cent, were to mothers who were unable to speak English. Eliminating the English-speaking nationalities, the infant mortality rate for the remainder of the for eign-born group was 149.5; for those infants whose mothers were able to speak English, 97.4, as against 180.4 for those whose mothers could not speak English. Among the Portuguese were 571 infants whose mothers were unable to speak English; for these the infant mortality rate was 224.8. For those whose mothers were able to speak English https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 21 N E W BEDFORD, MASS. the mortality rate was only 82.9. Among the latter were included infants of mothers of the earlier immigration, among whom the pro cesses of assimilation had progressed much further. (See Table V.) In the French-Canadian group the infant mortality rate for those whose mothers could speak English was higher than for those who had non-English-speaking mothers, the rates being, respectively, 121.7 and 104.2. Among the other foreign bom the rates were 70.9 and 127, respectively. T a b l e V .— Births during selected year, infant deaths, infant mortality rate, and -per cent of stillbirths, according to nationality o f mother and her ability to speak English. Stillbirths. Ability of mother to speak English and nationality o f mother. Infant Total Live Infant mor births. births. deaths. tality rate.« Num ber. Per cent of total births.® 2,662 2,587 337 130.3 75 2.8 Able to speak English... . .................. TJnable to speak English 6................... Not reported............................. . ; . . . 1,655 1,006 1 1,605 981 1 159 177 1 99.1 180.4 60 25 3.0 2.5 'Foreign-tom m o t h e r s ....... . 1,909 1,858 258 138.9 51 2.7 English-speaking nationalities............ Nan-Engush-speabing nationalities... Able to speak English................... Unable to speak English....... . Not reported...................... 323 1,586 601 984 1 313 1,545 585 959 1 27 231 67 173 1 86.3 149/5 97.4 180.4 10 41 16 25 3.1 2.6 2.7 2.5 All mothers............... ■;..........; French-Canadian mothers.. 415 407 47 115.5 8 1.9 Able to speak English............ Unable to speak English....... 268 147 263 144 32 15 121.7 104.2 5 3 1.9 2.0 Portuguese mothers c ........ 761 738 141 191.1 23 3.0 Able to speak English............ Unable to'speak English....... Not reported........................... 189 571 1 181 556 1 15 125 1 82.9 224.8 8 15 4.2 2.6 Other foreign-bom mothers 410 400 43 107.5 10 2.4 Able to speak English.. . . . . . . Unable to speak English....... 144 266 141 259 10 33 70.9 127.4 3 7 2.1 2.6 Not shown where base is less than 100. Including 22 births to native mothers. c Including 76 births to Portuguese-Negro mothers, only 23 of whom were able to speak English. a b Of the total births to illiterate foreign-born mothers, 584, or 79.3 per cent, were to mothers who could not speak English. These mothers were doubly handicapped; they were cut off from the sources of information open to literate mothers, and in a foreign country were forced to rely almost wholly upon the customs and traditions brought with them and upon whatever assistance they could gain from their countrymen. The infant mortality rate for the 566 liveborn infants in this group was 203. While these factors— illiteracy and inability to speak English— are perhaps not in every case asso ciated with ignorance of the essentials of infant care, yet they make https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 22 IN F A N T MORTALITY. it difficult, if not impossible, for the mothers to take advantage of the medical and social resources of the community or of printed instruc tions as to the proper methods of caring for their infants. CAUSE OF DEATH. The immediate cause of death is certified by the physician who signs the death certificate. Frequently these causes, such as gastric and intestinal diseases or diseases peculiar to early infancy, offer clews to the ultimate causes, such as improper feeding, lack of care of the mother diming pregnancy, employment of the mother, or means insufficient to provide proper care for the infant. Methods of pre vention, to be effective, of course must take ultimate causes into account. Most of the infant deaths can be grouped into three main classes, viz, gastric and intestinal diseases, respiratory diseases, and causes peculiar to early infancy. The first group— gastric and intestinal diseases— caused the greatest loss of life among infants in this study, being responsible for 37.1 per cent of the total deaths. Twenty-two per cent were from causes peculiar to early infancy, 21 per cent from the principal respiratory diseases, and the remaining 20 per cent were ascribed to malformations, epidemic diseases, diseases ill defined and unknown, and all other causes. (See Table V I.) T a b l e V I . a— Number and per cent distribution o f deaths among infants bom in the selected year, by cause o f death. Infant deaths. Causes of death. a Per cent Number. distribu tion. 337 100.0 125 72 12 75 37.1 21.4 3.6 22.3 25 40 10 7.4 11.9 3.0 23 7 23 6.8 2.1 6.8 General Table 3. GASTRIC AND INTESTINAL DISEASES. The large percentage of deaths from gastric and intestinal diseases, 37 per cent, was much higher than the percentages either for the State of Massachusetts or for the death-registration area 1 of the 1 General Table 4. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 23 N E W BEDFORD, MASS. United States. In the State only 28 per cent of the infant deaths in 1913 and 1914 1 were from this cause, while in the registration area the percentage was only 24. It would he more significant to compare the infant mortality rates from different diseases. The mortality rates from gastric and in testinal diseases for cities studied by the Children’s Bureau is shown in Table VII. It appears that both in Manchester and in New Bedford’ the infant mortality rates from gastric and intestinal diseases were unusually high, and relatively high in Johnstown, while for Brockton and Saginaw the rates were very low. The general infant mortality rates for Manchester, Johnstown, and New Bedford were also high. Where the conditions favored high mortality from gastric and in testinal diseases the general infant mortality rate appeared to be high also. T a b l e V I I .— Infant mortality rates fo r specified cities, by cause o f death. Cause of death. All cities. New Bedford. Johns town. Man chester. Saginaw. Brock ton. . All causes............................................ 127.0 130.3 134.0 165.0 84.6 96.7 Gastric and intestinal diseases.................... Respiratory diseases..................................... Malformations...................................... ....... Early infancy....... ....................................... 37.8 22.8 5.3 35.5 48.3 27.8 4.6 29.0 32.8 26.7 3.4 39.6 63.3 26.2 9.0 39.6 8.2 10.2 4.1 37.7 12.4 13.2 5.0 37.2 Premature birth.................................... Congenital debility................................ Injuries at birth..................................... 12.9 19.2 3.3 9.7 15.5 3.9 , 14.4 20.5 4.8 14.7 24.3 .6 12.2 24.5 1.0 16.5 14.9 5.8 Epidemic diseases......................................... Diseases ill defined or unknown................. All other causes............................................ 7.7 5.0 12.9 8.9 2.7 8.9 11.6 7.5 12.3 3.2 7.0 16.6 5.1 4.1 15.3 8.3 5.0 15.7 The analysis of the mortality rates for infants of native and of foreign mothers indicates that much of the difference in the rates is to be attributed to mortality from gastric and intestinal diseases. The rate from these causes for the former group was 31.6, as con trasted with 54.9 for the latter. The rate for the foreign-bom group was thus almost one and three-fourths that for the native. The analysis by nationality shows that the Portuguese white with a rate of 101.9 were almost entirely responsible for this difference. In this group 1 baby in every 10 born alive died from these causes. For all other foreign born the rate was comparable with the rate for infants of native mothers— indeed, somewhat lower. In these groups only 1 death in every 35 live births occurred from these causes. (See Table V III.) 1 The percentages were computed from the figures for 1913 and 1914, the years in which the deaths of nfants included in this study occurred. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 24 IN F A N T MORTALITY. T a b l e V I I I .°— Mortality rates fo r infants o f mothers o f specified nationality, by cause o f death. Infant mortality rates. Foreign mothers. Cause of death. Native All mothers. mothers. Total. Portu guese white. French Cana dian. All other. All causes............................................ 130.3 108.4 138.9 200.9 115.5 98.2 Gastric and intestinal diseases.................... Respiratory diseases..................................... Malformations............................................... Early infancy................................................ 48.3 27.8 4.6 29.0 31.6 17.8 6.9 32.9 54.9 31.8 3.8 27.4 101.9 51.0 1.5 21.0 29.5 17.2 7.4 41.8 28.1 23.0 3.8 25.5 Premature birth.................................... Congenital debility................................ Injuries at birth..................................... 9.7 15.5 8.9 9.6 19.2 4.1 9.7 14.0 8.8 1.5 13.5 6.0 24.6 14.7 2.5 8.9 14.0 2.6 Epidemic diseases......................................... Diseases ill defined or unknown................. All other causes............................................ 8.9 2.7 8.9 4.1 5.5 9.6 10.8 1.6 8.6 15.0 1.5 9.0 7.4 2.5 9.8 8.9 1.3 7.7 a General Table 3. The experience of many cities has proved that infant deaths from gastric and intestinal diseases are largely preventable. The high mortality from these diseases has been markedly reduced b y making available to mothers, through the employment of public-health nurses and the establishment of infant-welfare centers, information as to proper methods of feeding and caring for babies; and by the improvement of the milk supply. RESPIRATORY DISEASES. In contrast with Brockton and Saginaw, New Bedford shows an unusually high infant mortality rate from respiratory diseases, though both Johnstown and Manchester had high rates. The rates among foreign b om for this group of diseases were nearly twice as high as among native. The Portuguese had the highest rate, prac tically three times the rate for the native group. CAUSES PECULIAR TO EARLY INFANCY. The specific rate from causes peculiar to early infancy did not vary greatly in the different cities studied by the bureau, but it was some what lower in New Bedford than in any of the other cities. The mortality from diseases of early infancy was higher in the native than in the foreign-bom group, the rates being 32.9 and 27.4, respectively. Among the French Canadians the rate from diseases of early infancy was highest, 41.8. The rate among the Portuguese white was unusually low, only 21. COMPARISON OF “ UNFAVORABLE” AREA WITH THE REST OF THE CITY. An analysis of the death rates from the different groups of causes for the “ unfavorable’7 area and for the rest of the city shows the causes to which the excessive mortality of the selected precincts is https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Chart II.— D E A T H S F R O M Number. R E S P I R A T O R Y A N D G A S T R IC A N D BY C A L E N D A R M O N T H S . • Gastric and intestinal. Respiratory. 24-2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis I N T E S T I N A L D IS EA SE S 25 N E W BEDFORD, MASS. * to be attributed. The rate from causes peculiar to early infancy was approximately the same as for the rest of the city. The rates for both gastric and intestinal and respiratory diseases, however, were over twice as high as for the rest of the city. The causes of these unfavorable conditions must be sought in the kind of care given to the infants, in the kind of feeding, and also in part in the customs of the mothers, and in the surroundings in which they live. (See Table IX .) T a b l e I X .— Deaths among infants horn in selected year in and outside o f “ unfavorable’1 area, and infant mortality rates, by cause o f death.a Deaths among infants bora in— Cause of death. “ Unfavorable” area. Rest of city. Infant Infant Number. mortality Number. mortality rate. rate. Total...................... Gastric and intestinal........................ Respiratory.......................... Malformations....................... Early infancy........................... Epidemic diseases........................... Diseases ill defined or unknown.............. All other........................... a 233 156.6 104 94.0 95 54 7 43 17 2 15 63.8 36.3 4.7 28.9 11.4 1.3 10.1 30 18 5 32 6 5 8 27.3 16.4 4.5 29.1 5.5 4.5 7.3 Derived from General Table 7. CAUSE OF DEATH, BY CALENDAR MONTHS. As uniformly observed in the earlier studies of infant mortality made b y the bureau, there was a large increase of deaths from gas tric and intestinal causes during the hot months, 68 per cent of these deaths occurring during July, August, and September. The deaths from respiratory diseases occurred chiefly during the winter months, although a few deaths from this cause occurred in every month except August. The number of deaths from gastric and intestinal diseases and from respiratory diseases by calendar month of death is shown in Chart II.1 AGE AT DEATH. It is a well-known fact that in the early days of a baby’s life the chances of survival are least. In the registration area, in 1913, 43 per cent of all infant deaths occurred under the age of 1 month.2 The causes of death most frequent at this time are congenital debility, injuries at birth, and premature birth, which are usually grouped' under the caption: “ Causes peculiar to early infancy.” The relatively high percentage of deaths in New Bedford in the first few weeks of life is shown in Table X . 1 General Table 5. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2U. S. Bureau of the Census, Mortality Statistics, 1913. 26 IN F A N T MOBTALITY. T a b l e X .— Number and per cent distribution o f deaths among infants bom in selected year, by age at death. Infant deaths. Age at death. •• > Per cent Number. distribu-. tion. - 2 weeks but less than 1 month..................................................................................... 337 100.0 102 30.3 41 9 4 15 15 18 12.2 2.7 1.2 4.5 4.5 5.3 32 24 79 63 37 9.5 7.1 23.4 18.7 11.0 A comparison between New Bedford and the cities previously studied b y the Children’s Bureau for percentage of deaths at various ages is presented in Table X L T a b l e X I . — Per cent distribution o f deaths among infants born in specified cities during selected periods, by age at death. Age at death. All cities. New Bedford. Johns town. Man chester. Saginaw. Brock ton. All ages................................................ 100.0 100.0 100.0 100.0 100.0 Less than 1 month........................................ 35.5 30.3 37.8 27.9 56.6 48.7 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.............. 11.8 2.9 2.2 5.8 5.0 7.8 12.2 2.7 1.2 4.5 4.6 5.3 14.3 1.0 2.0 5.6 7.1 7.7 6.6 2.3 3.1 5.8 3.9 6.2 8.4 12.0 2.4 8.4 9.6 15.7 20.5 1.7 3.4 7.7 2.6 12.8 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............................ 9.3 7.8 20.7 16.2 10.6 9.5 7.1 23.4 18.7 11.0 9.2 8.2 21.4 15.8 7» 7 9.3 9.3 22.1 19.0 12.4 10.8 3.6 12.0 7.2 9.6 7.7 8.5 14.5 10.3 10.3 > 100.0 All the other cities shown had a higher mortality from causes peculiar to early infancy than New Bedford. The percentages of deaths under 1 month of age for four cities— Manchester, Saginaw, Brockton, and New Bedford— are shown in Chart III. The cities with large native populations had large percentages of deaths at early ages, while the cities with large foreign-bom elements had relatively smaller percentages: In Saginaw, a city of predom inantly native population, over half the infant deaths occurred under 1 month of age; Brockton, also with a large majority of native moth- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 26-1 Chart I I I.— P E R C E N T A G E O F D E A T H S U N D E R 1 M O N T H O F A G E IN T H E FO UR C IT IE S S P E C IF IE D . Manchester, N. H. ¿ 7.9 Brocton, Mass. 4-6.7 Saginaw, 56.6 Mich. New Bedford, Mass. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 30.3 Chart IV .__R E L A T IV E M O R T A L IT Y D U R IN G F IR S T Y E A R O F L IF E FO R M A N C H E S T E R , N E W B E D F O R D , A N D T H E R E G IS T R A T IO N S T A T E S IN 1910. cq >-i © a p ■4-3 CO Ut © U © d d +3 ,P •4-3 d .0 »O (-4 'S d ' P & CO co t- 00 u* Ut Ut © *0 § 3 fiP ficPo +3 »© 05 f© -4 *0 © 'O § 3 43 p .P i- 43 p rP W Registration area. Manchester, N. . — 26-2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis H. _ ----- New Bedford, Mass. o tH u © $ 4 © 3 p p p 43 .p 05 1 lbut under 12 Rate. 27 N E W BEDFORD, MASS. ers, had a high percentage of deaths in early infancy; Manchester, with a very large foreign population, had the lowest percentage of deaths under 1 month. These percentages, of course, simply reflect the distribution of the causes of death; the heavy mortality from gastric and intestinal diseases in Manchester, for example, produces a high proportion of deaths late in infancy, since deaths from these diseases occur rela tively late in the first year of life. But they do serve to indicate, also, the direction in which preventive work should be especially directed in the different cities. In the cities with large foreign-born populations, the most urgent need is for infant-welfare stations to teach proper care of babies during infancy; while in cities with pre ponderantly native population, the teaching of the essentials of pre natal care is relatively more important. In the volume of United States Life Tables recently published by the Bureau of the Census, mortality rates are given for each month of life based on figures of deaths and births in the birth-registration area in 1910. These rates are for large groups and the curve of mortality was smoothed by mathematical processes. According to these figures the mortality rate shows a decline for each month from the first to the twelfth. The rates for New Bedford by months under 1 year show more fluctuation, due to the comparatively small numbers involved, but the tendency is the same as that in the curve for the registration area. The smooth curve given by the census figures and the irregular ones resulting from the New Bedford and Manchester figures are shown in Chart IV. STILLBIRTHS. A stillbirth in this study is defined as a dead-bom issue, resulting from seven or more months’ gestation. If the period of gestation was reported as less than seven months, the birth, even though reg istered as a stillbirth, was classed as a miscarriage and as such, ex cluded from the study. The number of stillbirths included was 75, giving a stillbirth rate, in comparison to the total of 2,662 live and stillbirths, of 2.8 per cent. COMPARISON WITH OTHER CITIES. The cities previously studied by the Children’s Bureau in its infant mortality investigations had considerably higher stillbirth rates, as shown in the following statement: New Bedford Brockton....... Saginaw......... Johnstown___ Manchester... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2. 8 3.0 3.3 4 .5 4 .8 IN F A N T MORTALITY. 28 STILLBIRTH RATES AND NATIONALITY. Native mothers had a larger proportion of stillbirths than foreignb o m mothers, the rates being, respectively, 3.2 and 2.7. For the racial groups large enough to be .significant the highest rate was for the English, 3.5; the lowest for the French Canadian, only 1.9: the Portuguese white had a rate of 2.6.1 STILLBIRTH RATES AND OTHER FACTORS. The stillbirth rate for males was somewhat in excess of that for females, the rates being 2.9 and 2.7, respectively. This excess for males was due to the comparatively high stillbirth rate of 4 for male births to native mothers, while for female births in the same group the rate was only 2.4.2 The stillbirth rate for first-bom children (3.8) was higher than that for births of later order up to the seventh-bom (5.5). For the fourth-bom child the stillbirth rate (0.6) was almost negligible.3 High stillbirth rates were found for mothers under 20 years of age (3.6) and for mothers of 30-39 (3,7); for mothers of 40 and over, the rate was highest (6.7). In the other age groups the rates were relativelylow.4 Of the 152 twins and triplets born either during the selected year or previously to the mothers included in the study, 15 were stillbirths, giving a stillbirth rate of 9.9 per cent. This rate is very much higher than the rate of 2.7 for single births. SEX. The number of male infants bom in New Bedford during the se lected year was only slightly in excess of the number of female, the figures being 1,340 and 1,322, respectively. The infant mortality rate was somewhat greater for male than for female, 139.9 for male, as contrasted with 120.5 for female infants. (See Table X II.) T a b l e X I I .— Births during selected year, infant deaths, infant mortality rate, and -per » .•tm * . r __ nfi/tt* //iM # nann annia'iYii'ii ft f 'ffi.ftih.PT . Sex of infant and nativity of mother. All mothers......................................... Total births. . 2,662 1,340 1,322 Native mothers...................................... Foreign-bom mothers. . : — .............. Female........................................................... 1 See Table III, p. 18. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live births. 2,587 1,301 1,286 Stillbirths. Infant Infant mortality Per cent deaths. Number. of total rate. births. 130.3 75 2.8 182 155 139.9 120.5 39 36 2.9 2.7 337 753 729 79 108.4 24 3.2 376 377 361 368 41 38 113.6 103.3 15 9 4.0 2.4 1,909 1,858 258 138.9 61 2.7 150.0 127.5 24 2.5 2.9 964 945 a See Table X II. 940 918 141 117 1See Table X IV. * See Table XI. 29 N E W BEDFORD, MASS. AGE OF MOTHER. The infant mortality rate for the infants of mothers aged 25 to 29 at the time of the baby’s birth was the lowest for any age group— 114. The infants of mothers under 20 had the extremely high rate of 259.3* A large proportion of first births among these births to young mothers may influence the rate, coupled with the fact that the mortality among second and third births that occur to mothers below the age of 20 years is likely to be excessive on account of too short intervals between the successive births. The largest number of births was to mothers in the age group 25 to 29, for which'the mortality rate was lowest. (See Table X III.) T a b l e X I I I .— Births during selected year, infant deaths, infant mortality rate, and -per cent o f stillbirths, according to age o f mother at birth o f infant. Total births. Age of mother. 20 to 24.......................................................... 25 to 29.......................................................... 30 to 39.......................................................... Live births. Infant deaths. Stillbirths. Infant Per cent mortality Number of total rate. births. 2,662 2,587 337 130.3 75 2.8 112 737 853 840 120 108 725 833 809 112 28 93 95 105 16 259.3 128.3 114.0 129.8 142.9 4 12 20 31 8 3.6 1.6 2.3 3.7 6.7 ORDER OF BIRTH. Another physical factor which undoubtedly influences infant mor tality is the order of birth. According to the results of this study the third child had the best chance o f survival and the second the next best chance. The infant mortality rate for first and fourth born children was comparatively high, and the rates for sixth, seventh, and later bom children were very high. The infant mortality rate for first-born children of native mothers was comparatively low— only 81— while that for first-born children of foreign-bom mothers was 166.2. T a b l e X I Y .— Births during selected year, infant deaths, infant mortality rate, and per cent o f stillbirths, according to number in order o f birth. Stillbirths. Number in order of birth. Total births. Live births. Infant deaths. Infant mortality rate. Total. Per cent of total births. All mothers....... ................................. 2,662 2,587 337 130.3 76 2.8 First.............................................................. Second........................................................... Third............................................................. Fourth........................................................ Fifth.............................................................. Sixth............................................................. Seventh..................................................... Eighth and later.......................................... 638 542 416 338 218 141 109 260 614 531 407 336 212 138 103 246 81 58 42 45 24 23 17 47 131.9 109.2 103.2 133.9 113.2 166.7 165.0 191.1 24 11 9 2 6 3 6 14 3.8 2.0 2.2 0.6 2.8 2.1 5.5 5.4 154220°— 20----- 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN FA N T MORTALITY. 30 PLURAL BIRTHS. Mothers of the infants born in the selected year had, including births previous to the selected year, a total of 9,340 births.1 Among these were 152 twins and triplets— 73 sets of twins and 2 sets of triplets. One in every 61 births was a plural birth. A classification of plural births according to age of mother indicates that the older mothers were more likely to have plural births than the younger mothers. The per cent of infants who were twins and triplets among the total infants born to mothers of the various age groups increased from less than 1 per cent for mothers under 20 to 6 per cent for mothers over 40. Among these plural births were 137 live-born twins and triplets; nearly half these (68) died during the first year of life, giving an in fant mortality rate for plural births of 496.4. The mortality rate among plural births was between three and four times as high as among single births. ATTENDANCE AT BIRTH. Physicians were in attendance at 72.7 per cent of the births of in fants included in the New Bedford study; midwives in 23.1 per cent; and relatives, friends, or neighbors in the remaining eases, 4.2 per cent. Of the confinements attended by physicians 115, or 4.3 per cent, occurred in hospitals. Foreign-born mothers employed midwives to a much greater extent than native mothers, influenced perhaps b y the customs of the Old World countries from which they came, where mid wives are more commonly employed. (See Table X V .) T a b l e X V .— Number and per cent distribution o f births in selected year to mothers o f speci fied nativity, according to attendant at birth. Total births. Attendant at birth. Births to native mothers. / Births to foreignborn mothers. Per cent Per cent Per cent Number. distribu Number. distribu Number. distribu tion. tion. tion. All classes........................................... 2,662 100.0 753 100.0 1,909 100.0 Physician...................................................... Midwife......................................................... Other, none, or not reported....................... 1,934 615 113 72.7 23.1 4.2 698 42 13 92.7 5.6 1.7 1,236 573 100 64.7 30.0 5.2 . In the foreign-born group 30 per cent of the births were to mothers employing midwives in confinement, while in the native group only 5.6 per cent were to mothers having the same kind of attendant. In Waterbury, where there was a large proportion of foreign-born mothers, 43.4 per cent of the births to foreign-born mothers were to 1 General Table 12. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 31 those employing midwives ; while in Manchester, where the predom inating foreign element was French Canadian, the percentage of births to foreign-bom mothers having midwives was only 13.6 per cent of all births to foreign-born mothers. In New Bedford the racial group which had the largest percentage of births attended by midwives was the Portuguese white, with 56.8 per cent; then followed in order the Portuguese Negro, with little over one-half; the Polish, slightly less than one-half; the English, with about 11 per cent; the Irish, Scotch, and Welsh, the Jewish, and the French Canadian with percentages practically negligible. The last group had only 2 births attended by midwives out of a total of 415. The reason for the employment of midwives by the non-Englishspeaking mothers was not, as might be supposed at first thought, solely the desire to have an attendant who spoke their language, for in each of the three large foreign groups— the Portuguese, the French Canadian, and the Polish—were physicians of the same nationality. Though many foreign-bom mothers did avail themselves of the services of a physician of their own race, the preference of a large proportion of mothers was for the midwife. This preference in many cases was due partly to the lower charge made by the midwife, partly to her practice of giving nursing care and assisting at the housework, but it was due also to the traditions of the nationality group. INFANT MORTALITY RATES, BY ATTENDANT AT BIRTH. The infant mortality rate for infants of mothers who were attended by midwives was 169.1; for infants whose mothers were attended at confinement by physicians, 115.5. Of the latter group, infants of mothers attended at home by physicians died at the rate of 117.9, while for those whose mothers had hospital care at confine ment the rate was only 75.5. HOSPITAL FACILITIES. The hospital facilities for obstetrical cases in New Bedford con sisted of four hospitals. The largest hospital had free wards accommo dating 19 maternity cases; of course private rooms were to be had, btxt they were out of the question for the majority of New Bedford mothers, most of whom belonged to mill workers’ families. The other hospitals had accommodations for about 12 maternity cases each. For a city the size of New Bedford the free hospital facili ties available were entirely inadequate according to modern health standards. MIDWIVES. The Massachusetts law ignores the existence of midwives, except in requiring the return of birth certificates for births attended by them.1 A t the time this study was made more than 20 midwives 1 Laws of 1912, eh. 280, secs. 1 and 2. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 32 IN F A N T MORTALITY. were practicing in New Bedford. The following excerpt from “ Midwives in Massachusetts/’ 1 a study made in 1909, would doubtless have described the situation in 1913, though of course the number practicing in the later year was somewhat larger: In New Bedford we find 12 women all over 40 years of age and three-fourths of them over 50 years of age, more than half of them illiterate and all but 1 without any obstetrical education. All of these women rendered rather more service to the mother than would have been given b y a physician. Additional information showed that only 5 of these women were caring for more than 50 cases a year, while only 3 cared for 150 as a maximum. Their fees ranged from $2 a case to $10 a week. OTHER OR NO ATTENDANT. One hundred and thirteen of the births in this study occurred without attendance of either doctor or midwife. Five of these were stillbirths. Thirteen of the births were to native mothers and 100 to foreign-born mothers. The attendant in 80 of these cases was the husband, some other relative, a friend, or a neighbor; 32 had no at tendant, and in 1 case the attendant was not reported. PREVENTION OF OPHTHALMIA NEONATORUM. On account of the danger of ophthalmia neonatorum resulting from unskilled care of the baby at birth, cases of swollen, red, or inflamed eyelids of newly born infants were required b y law to be reported to the board of health. The municipal nurse would be sent to cases thus reported and, if necessary, an oculist employed by the board of health visited the case. Since the law became operative and the board assumed the responsibility of caring for these infants, the oculist employed b y the board has not lost a single case.2 On account of the large number of Portuguese immigrants a Portu guese-speaking nurse was employed b y the board of health. FEEDING* The kind of feeding an infant receives during the early months of his life is of great importance in determining his chance of survival. Authorities are agreed that mother’s milk is the best food for infants. Not only is artificial feeding dangerous to the life and health of the infant, but differences in the methods of artificial feeding, in the cleanliness of the milk, and in the care exercised in the preparation of the food also affect the mortality rate. Artificial feeding with clean milk properly modified to meet the requirements of the indi vidual baby is not so harmful to the young infant as artificial feed ing with milk not so modified. 1 Huntington, J.L .,M .D .: “ Midwives in Massachusetts,” in Boston Medical and Surgical Journal, Vol. CLXVU , No. 16, pp. 642-548. * In 1916 the oculist was made a regular officer of the board of health and paid for full-time work. Pre viously he had been employed when necessary and compensated by fees. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 33 N E W BEDFORD, MASS. National and traditional customs and the gainful employment of the mother influence the type of feeding; ignorance plays a large part in the lack of care taken in the preparaion of artificial food. Nor is the ill effect of improper food confined entirely to a higher infant mortality rate. The rate is an index of the general health and welfare of the children; the infants artificially fed who live may not be physically as strong as if they had been breast fed. PROPORTIONS BREAST FED AND ARTIFICIALLY FED. Of the group of 2,587 live-born infants, 60 died before being fed; 322, or 12.7 per cent of the 2,527 babies who lived to be fed, were artificially fed in the first month. The proportion of infants exclu sively breast fed in the first month, 83.8 per cent, gradually decreased from month to month, as a larger and larger number were fed wholly or partly with artificial food. The shift in the proportions is shown in Table X V I. B y the middle of the fifth month of life, about onehalf the infants were given breast milk exclusively; in the ninth month only about one-fourth continued to be breast fed. The proportion mixed fed, that is, receiving some breast milk in addition to artificial food, gradually increased until it reached one-fourth in the eighth and ninth month. In the ninth month not quite half the babies were receiving artificial food exclusively.1 T a b l e X V I .— Infants bom in selected-year and surviving at end o f specified month, and number ana per cent fed in specified way during the month, by month o f life. Month of life. First........................... Second........................ Third.......................... Fourth........................ Fifth........................... Sixth.......................... Seventh...................... Eighth....... ................ Ninth.......................... Total surviv ors. 2,485 2,453 2,429 2,395 2,370 2,350 2,317 2,302 2,287 Breast fed. Mixed fed. Artificially fed. Number. Per cent. Number. Per cent. Number. Per cent. 2,082 1,833 1,602 1,354 1,210 1,054 832 716 594 83.8 74.7 66.0 56.5 61.1 44.9 35.9 31.1 26.0 96 162 226 805 351 422 539 587 623 8.9 6.2 9.3 12.7 14.8 ia o 23.3 25.6 27.2 306 467 600 735 808 873 945 998 1,069 12.3 19.0 24.7 30.7 34.1 37.1 40.8 43.1 46.7 Not re ported. 1 1 1 1 1 1 1 1 1 FEEDING CUSTOMS AND NATIONALITY OF MOTHER. A comparison of type of feeding by nativity of mother shows that exclusive breast feeding was slightly more prevalent among foreignborn mothers. In the first month 85.2 per cent of the infants of foreign-bom mothers were breast fed as contrasted with only 80.1 per cent in the native group. The difference gradually diminishes, until after the sixth month it is negligible. However, the percentage of infants receiving mixed feeding was considerably higher among the foreign-born group than among the native group at 3, 6, and 9 months of age. A much smaller percentage of the infants of Portuguese-white mothers than of other foreign nationalities was breast fed, smaller 1 The relation between type of feeding and gainful employment of the mother is discussed later, pp. 45-46. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 34 IN FA N T MORTALITY. even than of the infants of native mothers. The Portuguese con tributed the largest proportion of mixed-fed infants; in this nation ality group the percentage mixed-fed at the third month was 16.2, while for other foreign it was 7.7, and for infants of native mothers, 5.8. At the sixth month the percentages became, respectively, 22.5, 18.7, and 12.7.1 If the percentages of both mixed and artificially fed infants are added together, giving the total proportion of infants who received artificial feeding in whole or i$ part, the Portuguese head the list with 39.9 per cent receiving some artificial feeding in the third month as against 28.5 per cent of infants of other foreign-bom mothers and 37.7 per cent of infants of native mothers. In the sixth month, the percentages were 60.2, 52.2, and 55.4, respectively. In the ninth month, which is the customary time for weaning, the difference in this respect between Portuguese and other foreign bom was negligible. INFANT MORTALITY RATES, BY TYPE OF FEEDING. The difference in mortality of breast-fed and artificially fed in fants can be most clearly shown by contrasting the death rates in each month of life. As already pointed out, the mortality gradually declines as the infants grow older; but in each month of life there is a great difference in favor of the breast-fed infants. The death rate for the artificially fed in the first three months was over four times that for the breast-fed infants, with an even greater difference from the fifth to the seventh months; after the seventh, the relative dif ference was not so great, being only two or three times the mortality among infants receiving breast milk. These figures" indicate clearly the superiority of breast feeding. (See Table X V II.) T able X V I I .— Deaths in each month per 1,000 survivors at, beginning o f month and monthly death rates per 1,000 infants fed in specified way, by month o f life.a Deaths in month per 1,000 infants— Deaths in month per 1,000 survivors at begin ning of month. Month of life. Fifth ................................................... •.___ E ig h th ........................................................................... a Derived from General Table 16. 6 The rate given is per 1,000 live births. infants died not fed. 6 39.4 12.9 9.8 14.0 10.4 8.4 14.0 6.5 6.5 5.4 Breast fed. 11.4 7.0 4.4 5.9 3.3 1.9 1.2 4.2 3.4 2.2 Native Foreignbom Total. mothers. mothers. 49.7 29.1 26.0 26.5 24.2 15.8 23.8 9.9 10.2 7.5 24.0 22.2 13.5 34.4 18.1 13.8 16.0 3.0 6.6 The rate per 1,000 infants who lived to be fed was 16.6. i General Table 15. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Artificially fed. 66.0 33.2 33.0 22.3 27.2 16.7 27.5 13.3 15.1 7.9 Sixty F E W BEDFORD, MASS. 35 The difference between the mortality of breast-fed and artificially fed infants can be summed up in the following computation: If 1,000 infants who lived to be fed are assumed to have been breast fed throughout the first year of life, and the monthly death rates for breast-fed babies are applied successively to the survivors in each month, the infant mortality rate (per 1,000 infants who lived to be fed) would be 48.3. A similar computation for artificially fed would give a rate of 214.2, four and one-half times as great. The differences in rates for the artificially fed of the different nativity groups is almost as striking as the difference in rates between the breast and the artificially fed. There are many different types of artificial feeding; the mother who gives her baby modified milk in accordance with a physician’s prescription, and who observes care fully all the rules for cleanliness and sterilization, is classed as giving artificial feeding as well as the mother who is ignorant of the necessity of providing pure, clean milk or who gives her baby condensed milk, solid food, coffee, or tea. The contrast is well illustrated in the following descriptions of the feeding of two infants, both classed as artificially fed. When Baby A cried, his milk bottle was picked up from the dirty floor, partly filled with condensed milk from the can, then placed under the faucet and filled up with water. The nipple was also recovered from the floor, and Baby A was fed. For Baby B the bottles were kept sterilized; the milk, the best obtainable, was modified in accordance with a physician’s directions and the ingredients of the formula were carefully measured; the temperature was properly regulated. Baby B was fed at regular intervals; he was seen at least once a week by a doctor, and the milk formula was changed when necessary. Both these babies were “ artificially fed.” The contrast in the death rates for artificially fed infants of native and of foreign-born mothers is due probably in large part to differ ences in the method of feeding such as have been described. The rate for the foreign born is largely influenced by the heavy mortality among the babies of Portuguese white mothers, so large a propor tion of whom were both illiterate and unable to speak English. As already pointed out, a larger percentage of infants in the Portuguese group was artificially fed throughout the first nine months than of infants in the remainder of the foreign group. Yet the native mother, in even a larger proportion of instances than the Portuguese mother, fed her baby artificially, while the death rate, though much higher than the rate for the breast-fed infants, was considerably lower than for the babies of the Portuguese mothers. By applying the rates in each group to 1,000 infants who lived long enough to be fed, an infant mortality rate of 153.2 for artifi cially fed infants of native mothers can be contrasted with a rate of 247.1 for artificially fed infants of foreign-born mothers. With the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T MORTALITY. 36 same type of feeding, the infants of foreign-bom mothers died at a rate one and one-half times as great as that for the infants of the native group. FEEDING IN RELATION TO CAUSE OF DEATH. The large percentage of infants artificially fed, in whole or in part, among the Portuguese group, probably accounts for the very large proportion of deaths from gastric and intestinal causes among these infants. It was noted in an earlier section of the report that the mortality in New Bedford from gastric and intestinal causes was exceedingly high, and that over half the deaths among the infants of Portuguese mothers were from this cause. ECONOMIC FACTORS. The chief product of manufacture in New Bedford was cotton textiles. In this industry were many occupations requiring unskilled and semiskilled labor, and wages were generally low. Besides the cotton mills, which at the time of the study numbered over 30, there were the large establishments of a drill and machine company, a shoe factory, a silverware and glass factory, a cordage company, and a biscuit factory. In addition were several smaller factories manu facturing copper rolls, silks, ropes, lines, iron and brass screws, and sperm and whale oils. OCCUPATION OF FATHER. The commercial and industrial character of New Bedford is well illustrated in Table X V III, which classifies births according to the industry in which the father was employed. Comparatively few fathers were engaged in trade, transportation, or clerical and profes sional service, while approximately 65 per cent were in manufacturing and mechanical industries, including 41 per cent in cotton mills alone. T a b l e X V I I I .— Births in selected year, according to industry or occupation o f father. Industry or occupation of father. Births. All classes............ ...... ••- .................... Manufacturing and mechanical industries.. Cotton mills............................................ Other than cotton mills......................... Trade............. - ............................................... Transportation.............................................. Domestic and personal service..................... Public service................................................ Agriculture, fishing, and mining................. Clerical occupations (all industries)............ Professional and semiprofessional pursuits.. Not reported « ........................... .................... a No report on occupation for following reasons: In one instance the father lived on his income; in 35 in stances the father did not contribute to the support of the family—including 22 cases in which the father had deserted, 6 in which the father was dead, 5 in which the father was unable to work on account of sickness, the father of one baby was a student, and in one case the reason was not reported. ■ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 37 BASIS OF CLASSIFICATION. B y “ father's earnings" is meant the amount actually earned by the father during the year following the birth of the infant. These amounts, therefore, do not represent wage rates, since loss of time due to sickness, slack work, or unemployment was always deducted. Father's earnings were used as the basis of classifying the families according to economic status. This plan was simpler and was deemed more accurate and satisfactory than an attempt to classify families by the total income which they had received, as this income was sometimes made up not only of earnings but also of receipts from divi dends-, property, and other investments, from boarders, lodgers, and other sources. The gross income from boarders and lodgers was of course always reported, but it was practically impossible to compute the net income accurately in these cases. The net income from property— that is, the gross income less interest, taxes, insurance, repairs, etc.— was practically always unknown to the mother, who is usually the person who gives the information. In the majority of families the earnings of the fathers determine their economic status. Further, it is easier to secure a correct statement for the father’s earnings than for any of the other items which make up income; it was decided, therefore, to adopt as the basis for classification the actual amount earned b y the father during the year following the birth of the infant; it is believed that this amount is a sound index of the relative economic position of the family. DISTRIBUTION OF ECONOMIC GROUPS. Three-fourths of the infants in this study were in families where the father earned less than $850 a year. The largest single group of births was that in which the father earned between $650 and $849. The births in this group constituted 24 per cent of the total number. (See Table X I X .) Among the factory operatives and laborers the largest single group was that in which the father earned less than $450 a year.1 The industrial character of the city and the low scale of wages prevailing are emphasized in these figures. Between 6 and 7 per cent had fathers earning $1,250 and over. This latter group included, of course, all fathers who were in professional or highly paid commercial pursuits as well as fathers whose salaries were only slightly over $1,250. 1 General Table 18. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 38 T IN FA N T MORTALITY. a b le 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. All mothers. Earnings of father. Total births. Per cent distribu tion. Foreign-bom mothers. Native mothers. Births. Per cent distribu tion. Births. Per cent distribu tion. All classes... - - - ..............•>- .............. - 2,662 100.0 753 100.0 1,909 100.0 Under $450............... ..................................... $450 to $549........................................ - .......... $550 to $649.................................................... $650 to $849.................................... » ........... $850 to $1,049................................................. $1,050 to $1,249........................................... $1) 250 and over............................................. No earnings................................................... Not reported................................................. 551 453 387 625 308 85 173 36 44 20.7 17.0 14.5 23.5 11.6 3.2 6.5 1.4 1.7 60 67 107 194 146 44 102 17 16 8.0 8.9 14.2 25.8 19.4 5.8 13.5 2.3 2.1 491 386 280 431 162 41 71 19 28 25.7 20.2 14.7 22.6 8.5 2.1 3.7 1.0 1.5 ECONOMIC STATUS AND NATIVITY OF MOTHER. The economic status of families with native-born mothers was in general higher than of those with foreign-born mothers. Seventeen per cent of births to the native mothers were in families where the fathers earned less than $550, while 46 per cent of the births to foreign-born mothers belonged in this class. The modal group for native mothers was the one in which the father earned between $650 and $849, while the corresponding group for foreign-born mothers was that in which the father earned less than $450 a year. (See Table X IX .) INFANT MORTALITY RATES ACCORDING TO FATHER’ S EARNINGS. In Table X X infant mortality rates for the different groups clas sified according to earnings of the father are given. The infant mor tality rates decreased progressively for the higher earnings group, with a single irregularity in group $850 to $1,049, reaching the low point of 59.9 for babies whose fathers earned $1,250 or over. The lowest earnings group, that under $450, comprising over one-fifth of all births, had an infant mortality rate of 201.9. In the families of the very poor, 20 babies out of every 100 bom alive died before reach ing their first birthday. In the group earning $1,250 or over, only 6 out of every 100 babies bom alive died under 1 year of age. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 39 F E W BEDFORD, MASS. T a b l e X X . — Births in selected year, infant deaths, infant mortality rate, and per cent of stillbirths, according to earnings o f father and nativity o f mother. Stillbirths. Earnings of father and nativity of mother. All mothers............. Total births. Live births. Infant deaths. Infant mortality rate.® Number Per cent of total births.o 2,662 2,587 337 130.3 75 2.8 551 453 387 625 308 85 173 36 44 530 442 380 610 297 84 167 34 43 107 57 44 60 40 5 10 8 6 201.9 129.0 115.8 98. 4 134.7 21 11 7 15 11 8 2 1 2 2 59.9 6 3.5 Native mothers .•... . 753 729 79 108.4 24 3.2 Under *450................. *450 to *549.................... *550 to *649.................... *650 to *849............... *850 to *1,049..................... $1,050 to 11,249.............. *1,250 and over.......... Nò earnings........................ No report....................... 60 67 107 194 146 44 102 17 16 56 65 106 187 141 43 98 17 16 11 7 14 19 16 1 5 4 2 132.1 101.6 113.5 1 7 5 3 fi 34 1,909 1,858 258 138.9 51 2.7 491 386 280 431 162 41 71 19 28 474 377 274 423 156 41 69 17 27 96 50 30 41 24 4 5 4 4 202.5 132.6 109.5 96.9 153.8 17 9 6 8 6 - 3.5 2.3 2 1 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................... No report................... Foreign-born 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.................................. No report............................. . a £ 4 £ 4 6 n q 3.9 1 Q 3.7 Not shown where base is less than 100. This decline in infant mortality rates as the father’s earnings in crease is not peculiar to New Bedford. Chart V shows graphs for three cities studied by the bureau. In each city— Manchester, Sag inaw, and New Bedford— the infant mortality rate decreased from the lowest to the highest earnings groups. For the infants of both native mothers and foreign-born mothers in New Bedford the same decline in mortality rates b y father’s earn ings appears. In both nativity groups the rates were markedly higher for the low earnings groups, though the rates, based as they are upon fewer cases, show more fluctuations. COMPARISON OF “ UNFAVORABLE” AREA WITH THE REST OF THE CITY. The majority of the very poor included in the study lived in the so-called “ unfavorable” area, consisting of precincts 1, 2, 3, 13, and 17, as defined at the time of the study. In these precincts the poor est accommodations and the cheapest rents were found. The cottonmill workers, the majority of whom belonged in the lower economic groups, sought homes near the mills. Seventy-two per cent of the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T MORTALITY. 40 five births in-families in the lowest earnings group, under $450, were to mothers who lived in this area. It was not until the earnings group $850 to $1,049 was reached that the majority of the live births were to mothers who lived outside this area. A smaller proportion of the native mothers lived in the “ unfavorable” area than of the foreign-born mothers; a majority of native families lived outside the ‘‘ unfavorable” area for all earnings.groups above $550, while a ma jority of foreign-bom families in each earnings group lived within this area. This section represented the colonizing ground for most of the large groups of foreigners, and they still clung to their colonies even when a rise in economic status would have permitted them to live in better and more comfortable quarters elsewhere.1 ECONOMIC STATUS AND SIZE OF FAMILY. Forty per cent of all babies included in the study were fourth or later births. The average size of the family was 3.8 persons, exclu sive of the scheduled baby. The largest families were found in the two groups, $650 to $849 and $850 to $1,049, each of which had an average of 4 persons per family. In the lowest earnings groups, under $450 and $450 to $549— those in which the problem of making ends meet is the most serious— 47.2 per cent of the births occurred in f amilies of four or more persons, exclusive of the baby. For the entire group studied, over one-fourth of the births (28.6 per cent) occurred in families of five or more persons. In every earnings group the size of the families of the foreign-bom mothers was greater than of the corresponding group of native mothers. Even if wages had been relatively the same instead of not so high, the foreign groups would not have been so well off as the corresponding native groups, since the wages had to provide for a larger number. FATHER’ S EARNINGS AND EMPLOYMENT OF MOTHER. The coincidence of low earnings of the father and gainful employ ment of the mother seems to indicate that such employment is the. result of poverty rather than of custom or preference. Sixty-one per cent of the births to mothers whose husbands earned less than $450 were to mothers employed during the year following the babies’ births. In the higher earnings groups the percentage of mothers employed steadily decreases. In each earnings group a larger per centage of foreign-born than of native mothers were employed at some time during the year after the birth. (See Table X X I.) This excess may be due to the fact that the economic need is relatively greater on account of the large families of the foreign-bom mothers. 1 General Table 20. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Chart Under $450 $450 to $549 40-1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis $550 to $649 $650 $850 to to $849 $1,049 Manchester, N. H. - - - - - - - - - - - New Bedford, Mass. “ — - — Saginaw, Mich. $1,050 to ' $1,249 $1,250 and over. Chart V I — P E R C E N T A G E O F M O T H E R S G A IN F U L L Y E M P L O Y E D , A C C O R D IN G T O E A R N IN G S O F F A T H E R . Per cent. A ll mothers. Native mothers. Foreign-bom mothers. 40-2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BY N A T IV IT Y , 41 N E W BEDFORD, MASS. T ablb X X I .— Births during selected year and number and per cent o f births to mothers o f specified nativity gainfully employed during year following birth o f infant, according to earnings o f father. All mothers. Native mothers. Gainfully employed. Earnings of father. Total births. Gainfully employee!. Births. Num ber. Foreign-bom mothers. Per cent.“ Gainfully employed. Births. Num ber. Per cent.“ 27.0 37.4 29.9 13.0 12.3 All fathers.................... 2,662 1,077 40.5 753 203 $450 to $549............................. $550 to $649............ ................. $650 to $849............................. $850 to $1,049........................... $1,050 and over....................... 551 453 387 625 308 258 36 44 337 233 171 199 56 41 24 16 61.2 51.4 44.2 31.8 18.2 15.9 60 67 107 194 146 146 17 16 27 27 40 58 19 18 8 6 Num ber. Per cent “ 1,909 874 45.8 491 386 280 431 162 112 19 28 310 206 131 141 37 23 16 10 63.1 53.4 46.8 32.7 22.8 20.5 “ Not shown where base is less than 100. Chart VI illustrates the decline in per cent of mothers gainfully employed with the improvement in economic status. GAINFUL EMPLOYMENT OF MOTHER. The high infant mortality rates prevailing in textile towns, where large numbers of women are employed,'suggests that gainful em ployment of mothers is an important factor in infant mortality. It is difficult to isolate the effect of this single factor and to determine how large a part it plays in maintaining a high infant mortality rate. But b y contrasting the group of wage-earning women with the group of mothers not employed the relation between the infant mortality rate and the employment of the mother can be studied. According to the census,1 38 per cent of the wage earners in New Bedford in 1909 were women. This study shows a large proportiQn of mothers gainfully employed, 47 per cent of the births studied be ing to mothers gainfully employed during the year preceding the baby’s birth and 41 per cent to those so employed the year following. Most of these mothers were gainfully employed both the year before and the year after the birth of their infants. EMPLOYMENT AND NATIVITY. A much larger proportion of foreign-born than of native mothers, one-half and one-third, respectively, were gainfully employed dur ing the year before the birth of their babies. Fewer mothers in each group worked after the birth of the infants, but relatively more foreign-bom than native mothers.2 U. S. Bureau of the Census, 1910, Manufactures, Vol. IX , p. 540. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis * General Tables 22 and 24. IN F A N T MORTALITY. 42 CLASSIFICATION OF EMPLOYMENT. Gainful employment of mothers may he divided into two classes— work at home, including keeping lodgers, dressmaking, millinery, and helping in husband’s, business if this place of business adjoins or is practically part of the dwelling place of the mother; and employ ment away from home, which includes factory and store work, char work, domestic service, and other employments necessitating the mother’s absence from, the home. Work away from home would naturally be more detrimental to the welfare of the infant, since it would deprive him of breast feeding and his mother’s care during at least a part of the day. EMPLOYMENT DURING YEAR PRECEDING BIRTH OF BABY. During the selected year 1,242 births occurred to mothers em ployed at some time during the year preceding childbirth, and mothers of 882 of these infants were employed in extradomestic occupations, most of them in the textile mills. The infant mortality rates show a considerable difference in favor of the infants whose mothers were not gainfully employed prior to childbirth. The rate for this group was 108.8, as contrasted with 154.5 for infants of employed mothers. For infants of mothers employed away from home the rate was 167.8, and it was still higher— 175.4— for infants of mothers employed in the textile mills. (See Table X X II.) infant, and nativity o f mother. Stillbirths. Employment of mother during year pre ceding birth of infant, and nativity of mother. All mothers..................................... Native mothers................................... Eoreign-bom mothers........................ Total births. 2,662 Live births. 2,587 1,420 1,242 360 882 1,370 1,217 353 864 Infant deaths. Infant mortality Per vent rate.« Number. of total births.» 130.3 75 2.8 149~ 188 43 145 108.8 154.6 121.8 167.8 50 25 7 18 3.5 2.0 1.9 2.0 337 753 729 79 108.4 24 3.2 502 251 72 179 484 245 69 176 47 32 8 24 97.1 130.6 («) 136.4 18 6 3 3 3.6 2.4 <°) i 1.7 1,909 1,858 258 138.9 51 2.7 918 991 288 703 886 972 284 688 102 156 35 121 115.1 160.6 123.2 175.9 32 19 4 15 3.5 1.9 1.4 2.1 t a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where base is less than 100. N E W BEDFORD, MASS. 43 An analysis of the length of time before childbirth that employ ment ceased was made for the 812 births to mothers who worked in the cotton mills. In 8 cases the mother reported either no cessa tion before confinement or cessation of work the day before the birth of the baby; in 24, less than one month before confinement; and in 168 cases, or 21 per cent, less than three months before. The infant mortality rate for the group whose mothers reported no cessation or cessation of work less than three months before confinement was 184.5, while the rate for infants of gainfully employed mothers who ceased work with a longer interval before confinement was 174.9.1 The rate is slightly higher for the mothers who worked up to within three months of confinement; but in either case the mortality rate is high for infants of mothers gainfully employed in the cotton mills during pregnancy. WORK AFTER CHILDBIRTH. The mothers of 1,077 infants, or 40 per cent of the total included in this study, were gainfully employed at some time during the year following childbirth; in 599 instances, or 56 per cent, the mother was employed away from home. The story told by one of the mothers of her working day was per haps typical of the experiences of this group of mothers. She was a weaver in the mill and preferred working to being at home; she also needed the extra money. She worked from 6.45 in the morning until 5.30 in the afternoon and cooked supper, cleaned house, and did her ironing at night. Her mother-in-law, who lived upstairs, took care of the children and cooked the noon meal. This mother had worked in the mill since she was 12. She generally went back to her work two months after a confinement, changing the feeding of the infant at that time from breast to artificial. One child had died at the time of this change; the mother, therefore, fearing the change had caused the death of the child, had given the infant in the study arti ficial feeding from birth. Of the 578 live-bom infants of mothers employed outside the home, 146 died in the first year of life. The rate, 252.6, characterizes condi tions in families where the mother works— over three-fourths of these mothers employed after childbirth in extradomestic employment had also been employed before childbirth; but since deaths that oc curred before the mothers went to work are included, it does not show the direct effect of the mother’s employment after the baby’s birth upon his chance of survival. Of the 146 deaths, 103 occurred before the mother went to work. Clearly, in these cases, the death of the infant can not be attributed to the mother’s employment fol lowing the baby’s birth. 1 Derived from General Table 22. 154220°— 20-------4 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MORTALITY. 44 The effect upon infant mortality of the mother’s employment away from home during the year after the infant’s birth may be shown by the following calculation. There were 475 infants who were alive when their mothers commenced or resumed work. If the average in fant mortality rate for the city for the remainder of the year had pre vailed among them, a total of 29 deaths would have occurred; but actually 43 of these infants died. The ratio of 43 to 29 expresses the extra mortality among these infants of gainfully employed mothers. (See Table X X III .) T X X I I I .— Infants born in selected year whose mothers resumed work away from home during specified month o f infant’s life, average number o f subsequent deaths per 100 surviving at beginning o f month, actual subsequent deaths, and deaths expected at average rates. a b l e Subsequent deaths in year. Month of life of infant during which mother commenced work away from home. Total. Infants whose mothers com menced work. Average deaths i>er 100 surviv Expected ing at be at average ginning of mortality. month of life. 475 19 First....... Second... Third___ Fourth... Fifth....... Sixth...... Seventh.. Eighth... Ninth___ Tenth___ Eleventh. Twelfth.. 66 75 66 42 49 41 34 36 30 16 1 a Per 100 infants who lived to be fed. 28.8 43 2.1 6.3 4 14 a 11.0 9.5 8.3 7.4 6.1 5.1 4.3 2.9 2.3 6.2 4.9 2.6 2.5 1.8 1.0 1.6 .4 Actual. 8 9 3 1 3 1 .5 .1 ( 6) 5 Less than one-tenth of 1 per cent. An analysis by age of baby at mother’s resumption of work indi cates that almost all the excessive mortality occurred among the cases in which the mother took up work away from home when the baby was less than 4 months old. For this group, numbering 226, a total of 20 deaths would have been expected at average rates, but 35 deaths occurred. The mortality was, then, one and three-quarters times the average rate. For the remainder, there was practically no difference between the rate for all the infants included in the stu d y. and the rate for the infants whose mothers were gainfully employed during the infant’s lifetime. If reliance can be placed upon the indi cations afforded by these figures, it would appear that early resump tion of work by the mother is especially harmful to the welfare of her baby. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 45 N E W BEDFORD, MASS. GAINFUL EMPLOYMENT OF MOTHER AND FEEDING. One of the common consequences of a mother's having to seek gainful employment after the birth of her baby is that she is unable to nurse him. Table X X IV shows the relation between the type of feeding and the employment of the mother. T a b le X X I V .— Per cent artificially fed among infants bom in selected year to mothers o f specified working status, by selected age o f infant. Per cent of infants artificially fed. Age of infant. Mothers not gainfully employed before specified time. 24.3 33.4 41.7 Mothers gainfully em ployed before time specified— from At home. Away home. 18.0 29.1 39.0 45.9 68.5 73.7 Of the infants of mothers gainfully employed away from home a very large proportion was artifically fed, a proportion about twice as great at 3 and 6 months as for infants whose mothers were not at work. For infants aged 9 months nearly three-fourths of those whose mothers were employed away from home were artifically fed as contrasted with two-fifths for those whose mothers were not at work. A Portuguese grandmother, who cared for the baby during the day, told of the baby's mother having to go back to the mill when the baby was only 2 weeks old because of the desertion of her hus band. For two weeks after returning to work she came home at noon and nursed the baby; after this, however, she decided that when she was tired her milk was not good for the baby and weaned him altogether at the age of 1 month. The 4-months-old baby of an Italian mother was weaned when his mother returned to her spinning at the mill and was fed a proprietary food and anything else he wished, including ice cream and bananas. A French-Canadian mother who went back to her work as a weaver three weeks after her baby's birth weaned the baby soon after. The cow’s milk which the baby was fed after this time was not suited to him and at 4 months he died of malnutrition. Another mother (Portuguese) returned to her spinning at the mill three months after the baby’s birth. Her milk left her and the baby was weaned. Cow's milk was tried first, then condensed milk, and finally a proprietary food. The baby had convulsions at 4 months, again at 8 months, and at 12 months had convulsions for one month and died. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T MORTALITY. 46 That not all the infants of mothers employed away from home were artifically fed was due to the fact that in many instances mothers were employed near their homes. It was possible for these mothers to return at certain periods of the day to nurse their infants, or the infants might be brought to the places of employment. The fact that 46 per cent of the deaths of infants of mothers who worked in the milla were due to gastric and intestinal diseases while only 25 per cent of the deaths of infants of mothers not at work were from these causes would seem to show that the employment of the mother, as a rule entailing artificial feeding of the infant, was an important factor in causing the great number of deaths from this largely preventable cause. EMPLOYMENT OF MOTHERS IN COTTON MILLS. Since 540 of the 578 live births to mothers employed outside the home the year after the birth of the scheduled baby were to mothers who were cotton-mill operatives, a special study was made of this group. The mothers of 96 of these infants were native, and of 444 foreign born, including 194 Portuguese white.1 The classification of the 444 foreign-born mothers employed as cotton-mill operatives shows them to be of comparatively recent immigration, with 42 per cent illiterate and 58 per cent unable to speak English. The Portuguese white added the greatest number, proportionately, to the illiterate and non-English-speaking groups. Thirty-three per cent of this nationality group had been in this country less than 5 years, and 31 per cent had been here 10 years or more. Sixty-six per cent were alliterate and 78 per cent could not speak English. Among other foreign-born mothers these factors were not so pronounced; mothers of 55 per cent of the births in the groups of other non-English-speak ing nationalities were unable to speak English and 23 per cent were illiterate; mothers of 22 per cent had been in the United States less than five years.2 How great was the economic need which caused this employment of mothers in cotton milla is shown in General Table 28. Practically all the working mothers were in families where the father earned under $850, there being only 21 instances in the three income groups of over $850. In tbia connection it may be pointed out that in 12 instances of working mothers the mother had been deserted, in 6 cases the father had died, and in 1 case the father was sick the entire year. i General Table 24. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis * Derived from General Tables 26 and 27. N E W BEDFORD, MASS. 47 LEGISLATION IN REGARD TO EMPLOYMENT OF MOTHER. Massachusetts is one of four States1 which in 1913 had laws pro hibiting the employment of women immediately before or after confinement. The Massachusetts law 2 reads: Section 1. No woman shall knowingly be employed in laboring in a mercantile, manufacturing, or mechanical establishment within two weeks before or four weeks after childbirth. Section 2. The foregoing section shall be included in the notice with regard to the employment of women now required to be posted in mercantile, manufacturing, and mechanical establishments, and the provisions thereof shall be enforced by the district police. Section 3. Violations of section one of this act shall be punished by a fine not ex ceeding one hundred dollars. Section 4. This act shall take effect on the first day of January, nineteen hundred and twelve. No adequate provision was made for the enforcement of the law. Practically it can be carried out only where a matron or other person is appointed to see that its provisions are complied with. It could not be expected that the 34 State inspectors, whose territories were so large that it was impossible for them to make the rounds more than once in two or three years, could supervise the enforcement of this law. Only one New Bedford cotton mill employed a matron to see that the proper rest periods were observed. CIVIC AND SOCIAL FACTORS. BIRTH REGISTRATION. In Massachusetts the city clerks were charged with keeping the records of vital statistics. The State was one of the first admitted into the provisional birth-registration area, established by the United States Bureau of the Census; for inclusion in this area a registration 90 per cent complete is required.3 Physicians and midwives were required under the State law to file with the city clerk a partial report within 48 hours, and a com plete report within 15 days, of births which they had attended. The law provided for a fee of 25 cents to be.paid the physician or midwife so reporting a birth, and exacted a penalty of a fine not to exceed $25 for failure to report.4 Parents, householders, keepers of institutions, and masters of vessels were also required b y law to re port to the city clerk any-births occurring within their domain, and for failure to report a penalty of a fine not to exceed $5 was imposed.5 1 Connecticut, Massachusetts, New York, and Vermont. 2 Acts of 1911, ch. 229. Approved Mar. 31,1911. * Massachusetts had been admitted into the similarly constituted census area of adequate death regis tration in 1880. * Laws 1912, ch. 280, secs. 1 and 2: * Revised Laws 1902, ch. 29, secs. 6, 7, and 8. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T MORTALITY. 48 Various methods of checking and supplementing birth returns were in use in the office of the city clerk at New Bedford. Every year, in January, canvassers were appointed who visited every house in the city to ascertain whether any births had occurred there during the previous year. The canvassers’ returns were then compared with the birth records already obtained, and any births which had not been registered were then placed on record. This procedure resulted in making the returns more complete. The only difficulty lay in the fact that frequently canvassers’ returns were not identi fied with records already received on account of slight differences in name, date, or place of birth; many births were thus registered twice. In the course of the investigation, 97 registered births were found to be duplicates and 2 were triplicates. In addition to can vassing, the city clerk made a birth entry whenever a death certificate of an infant who was born in New Bedford and for whom he had[no birth record was returned to his office. Members of the clergy had been asked to cooperate with the city clerk in his efforts to securecomplete birth registration, by furnishing him with copies of their birth or baptismal records. That the various methods adopted in New Bedford for securing a complete registration of births have been effective is indicated by the fact that of the 3,542 total births found during the investigation to have occurred in 1913, only 49, or 1.4 per cent, were unregistered. It is evident that registration of births for this city is exceptionally thorough. THE BOARD OF HEALTH. The board of health as constituted in 1913 had 26 employees in various capacities and was headed by a full-time health officer. Only those of its activities which bear upon infant mortality will be summarized in this report. It was the duty of one of the two nurses employed by the board ol health “ to visit the homes of the newly born where midwives have officiated.” Many cases of ophthalmia neonatorum in its early stages were discovered and, as already mentioned, specialists were employed to give necessary treatment. During 1913 the nurse made 1,546 visits to homes where births had been reported to the board of health by attending physicians and midwives.2 ; The mother of every new-born cljild was mailed a printed circular giving her instructions as to the care of her child during infancy. The pamphlets were printed in English, French, Portuguese, and Polish, and emphasized the advantage of breast feeding, light cloth ing in summer, frequent bathing, fresh air, and medical attention 1 Municipal Manual, City of New Bedford, Mass., prepared b y Charles P. Sawyer, Clerk of Committees, . , 2 Ann,ml Report of the Board of Health, 1913, City of New Bedford, Mass., pp. 6 and 21. Clerk of Common Council, May 1,1914; pp. 38 and 39. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 49 in case of illness. The department, since 1914, had furnished to mothers copies of a pamphlet, “ The Baby and Y o u ,” supplied by the division of hygiene of the State department of health; additional instructions and explanations were given to the mothers in person by the visiting nurses. In its annual report for 1915, the board of health, in a discussion of “ Baby welfare w ork,” states that “ the problem of infant mortality demands the best efforts of the depart ment and the community. ” The report then discusses the various factors related to infant mortality— milk supervision, milk stations, good sanitary conditions, housing, feeding, prenatal conditions, in dustrial conditions— and concludes that “ our main reliance must be placed in educational work. Mothers must be instructed in the care of the baby both before and after it is born. The physician can contribute to this, but as doctors are often not called except at child birth, and sometimes not even then, other ways of reaching the mothers must be tried. The obvious ways are through printed in structions and public nurses, and of these the latter are by far the more helpful. ” Milk supply. The board of health also has the supervision of the milk supply of New Bedford, the milk ordinance providing that “ no person, firm or corporation shall engage in the production, sale, delivery, or dis tribution of milk in the city of New Bedford except in accordance with the rules and regulations of the board of health of New Bedford. ” Practically all the milk sold in New Bedford was produced within a radius of 12 miles, except for a very small amount which was brought in by one producer who lived 21 miles away. The total quantity amounted to about 50,000 quarts daily. Some of it was peddled by the producers themselves, and some was distributed by dealers, but at the time of this study a large part was sold in the form of loose milk by the various stores. The practice of the sale of loose milk has since been prohibited by the board of health. Only one inspector of the board of health was charged with in specting dairies and places where milk was sold. He also had to inspect bakeries, slaughterhouses, and stores selling fruit, vegetables, and other provisions.1 It was obviously impossible for one person to inspect with sufficient frequency over 400 dairy farms, over 150 ped dlers, and 300 stores where milk was sold, and to attend to the inspec tion of other food products besides. During 1913, 303 visits of in spection of dairy farms had been made; the inspector was unable to make the rounds even once a year. The regulations of the board of health covering the production and sale of milk (as revised August, 1 Annual Report of the Board of Health, 1913, City of New Bedford, Mass., pp. 20 and 21. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 50 IN F A N T M ORTALITY. 1913)1 included provisions that distributors of milk must be licensed annually and that both producer and distributor must proceed in accordance with the regulations prescribed by the board. The prin cipal provisions relating to the handling of milk were the following: Cow stables to be kept clean, well lighted and ventilated, and the tie-ups whitewashed twice a year; the keeping of swine prohibited within 50 feet of any barn or building; the hands of milkers to be washed before milking; milk to be cooled immediately after milking, all utensils used in the sale, delivery, or distribution of milk to be sterilized before using again and certain provisions are included in regard to the rooms in which milk may be stored. Dealers of milk must furnish the board of health with the list of producers from whom they secure their supply, and samples may be taken from time to time for bacterial count and the premises of the producers may be inspected to determine whether the regulations of the board are complied with. These regulations failed to include certain provisions which have been designated as ‘ ‘ cardinal points” in a good city milk ordinance.2 Omissions were as follows: 1. Temperature standards governing the temperature at which milk shall be held on the farm, in transit to the city, in storage, and on delivery wagons. 2. A policy in regard to the control of bovine tuberculosis. 3. Provision for the use of score cards. Chemical and bacteriological standards and standards for pas teurization, points not covered by the city ordinances, are regulated by the State laws. Samples of milk were collected by two of the sanitary inspectors and analyzed for bacterial count by the bacteriologist, who gave part time to this duty. In 1913, 633 samples of milk were collected and examined, an average of about 4 samples a year from each peddler. Since the time of the study the city has made tests for butter fats and total solids, as well as for bacterial count; previously the tests for butter fats and total solids were made by State authorities. The method employed in testing milk was to “ centrifuge” ; then a “ smear” was taken and examined under the microscope. The reports of the bacteriologist for the year 1913 3 showed 493 samples below 50,000 per c. c., and 85 above 200,000 per c. c., these figures being approximate only. The majority of the tests took place during the summer months when there was greater chance for pollution of the milk; in the winter months very few tests were made. 1 Regulations governing the production, care, and sale of milk in New Bedford, as revised and adopted Aug. 9,1913. » Parker, Horatio. City Milk Supply, pp. 378 and 379. s Annual Report of the Board of Health, 1913, City of New Bedford, p. 12. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 51 A full-time bacteriologist and more than one milk inspector might well be employed to safeguard properly the milk supply. With so high a mortality from gastric and intestinal diseases, more stringent measures to assure clean milk would seem especially urgent. Care in producing and handling milk has probably improved greatly among the dairies supplying New Bedford in the last few years. Some years prior to this study various public-spirited citizens, realizing the necessity for a clean supply of milk not only to reduce infant mortality but also to prevent diseases of adults, carried on a campaign to teach the dairymen the best methods of keeping milk clean and cool until its delivery in the city. A demonstration wagon was fitted up and visits were made to the whole countryside; actual demonstrations of handling milk were given, with tests showing that the methods were efficient as well as simple. This campaign of education doubtless contributed to more general production of clean milk. SANITATION. Water supply. New Bedford owns and manages its own system of waterworks. Since 1899 the whole water supply has been taken from Great and Little Quitticas Ponds, 11 miles north of the center of the city. The two ponds are connected and from Little Quitticas Pond the water enters a pumping station, first passing through coarse wire screens. From the pumping station it is forced into a reservoir on High Hill in the neighboring town of Dartsmouth. From this reservoir, after passing through finer screens, the water flows by gravitation into the city’s distributing system. The use of city water in New Bedford was practically universal. The water board in its annual report for 1914 1 estimated that during the year 103,000 of New Bedford’s estimated population of 108,000 were supplied with city water— approximately 95 per cent of the population. Of the families included in this study, 98 per cent were using city water. The remaining 2 per cent, who were using water from dug or driven wells, or in a few cases from springs, were families who lived in the rural area toward the north and west of the city, where water mains had not yet been introduced. Supervision of the water supply was under the direction of the State board of health, and a chemical analysis of samples was made six times a year. The findings were published in the annual reports of the local water board and in the reports of the State board of health. In general the water supply of New Bedford seemed satisfactory. Sewerage. The sewerage system in New Bedford seemed fairly adequate to serve the city. In 1913 it included 110.5 miles of sewers. Since the sections not supplied with sewers were for the most part rural in i Annual Report of the Water Board of the City of New Bedford, 1914, p. 67. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 52 IN FA N T MORTALITY. character, a comparison of the 110.5 miles of sewers with the 180.6 miles of accepted streets shows a fairly comprehensive provision for the collection of sewage in the city proper.1 The city engineer es timated that about 95 per cent of the dwellings in New Bedford were connected with the city sewers. Of the dwellings of families covered by this investigation, 97 per cent had sewer-connected sinks, and 94 per cent had toilets connected with the sewer. Toilets. At the request of the agent for the board of health the city assessors, when they went their rounds in the early part of 1914, counted the yard privies and reported 171. Making allowance for the probable incompleteness of the assessors’ returns, the board of health agent estimated that there were in New Bedford on April 1, 1914, approxi mately 200 yard privies. In general, these privies existed only in places where sewerage facilities were inadequate— that is, in a very few sections in the outlying districts. In this study there were found 132 privies, only 2 of which were connected with a cesspool, and one dwelling which had no toilet.2 This showing indicates that the city had made satisfactory progress in providing sewer connections for its dwellings and in banishing the objectionable yard privies. Sewage disposal. The system in operation in 1913, the year of the study, was essentially as follows: The sewers, some carrying only household and manufacturing wastes and some carrying storm water in addition, discharged from 31 outlets into the Acushnet River and from 16 out lets into Clarks Cove. The outlets into the Acushnet River, located in many cases close to the shore ends of docks, discharged the sewage into quiet and shallow waters where the current was not strong enough to carry it off properly. These outlets caused a considerable pollution of the shore waters of the Acushnet; offensive odors were constantly in evidence and were particularly objectionable near the points of discharge between long wharves. The Clarks Cove situa tion was even worse, for into this very shallow arm of the bay the sewage and drainage of a thickly settled residential section were discharged. With the completion of the new intercepting system in 1916, these objectionable features have been removed. A t the time of the study a new system of sewage disposal was under construction; begun in 1911, it was finally completed in 1916. Briefly outlined, the new system collects all sewage at points near the water front and conducts it to Buzzards Bay, where it is dis charged into deep water 3,300 feet from shore. The sewage is thus dispersed and diluted by the waters of the bay without danger of creating a nuisance or of causing pollution of the water front of towns along the shore. 1 Annual Report of Superintendent of Streets, 1913, City of New Bedford, p. 4. 2 General Table 29. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 53 Disposal of ashes, refuse, and garbage. The collection and disposal of ashes was under the supervision of the street department. Collection of ashes and other refuse was made once a w'eek and the waste material hauled to dumps and used to fill in low land. The dumps in New Bedford seemed to be unnecessarily numerous and unnecessarily near city dwellings. In addition to the dozen city dumps vacant lots in various sections of the city had accumu lated deposits of refuse which were not only unsightly but particu larly objectionable in that the children of the neighborhood used them as playgrounds. Plate 13 shows one of these dumps with a row of dwellings opposite and the street littered with scraps of paper and refuse. Many complaints had been made of the nuisances caused b y these dumps, and the street department, police, and board of health were cooperating in attempting to improve them. Before land could be used as a dump a permit had to be secured from the board of health. The collection and disposal of garbage was under the supervision of the board of health.1 A private company held a 10-year contract for the disposal of garbage and night soil, and they sublet the contract for its collection and removal. Garbage was collected twice a week from November 1 to May 1, and three times a week from May 1 to November 1. From hotels and restaurants it was collected every day. The extractor plant was located on the outskirts of the city, far enough away from dwellings to be unobjectionable. A t the ex tractor plant grease and other products were extracted from the garbage. Paving streets. Approximately two-thirds of New Bedford’s 181 miles of accepted streets were paved. Four-fifths of the paved streets were macadam ized.2 On a few of the older streets near the river and in the center of the city, and on the thoroughfares running west, cobblestone pavements were found, the stones usually very large and unevenly laid.3 The newer roads near the outskirts of the town were not paved at all. Cleaning, sprinkling, and oiling streets. Macadam and dirt roads and gutters were cleaned by street brooms two or three times a year; paved streets were cleaned mostly by hand or by the “ patrol” system. Streets were sprinkled or oiled from about the 1st of April until the 1st of October. Where the traffic was heavy the streets were oiled four times a year. 1 The contract for the disposal of garbage has been under the direction of the hoard of health and the con tract for the collection of garbage has been under the highway department since 1916. 2Annual Report of Superintendent of Streets, 1913, City of New Bedford, p. 4. 3 Since 1913 nearly all these streets have been repaved with stone-block pavements on a concrete base and grouted with cement (Hassam process). https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 54 IN F A N T MORTALITY. SOCIAL AGENCIES. Instructive Nurses Association. The Instructive Nurses Association, besides carrying on the usual work of such an institution, maintained two infant-welfare stations during the summer months. In 1913 these stations were located in two schoolhouses, one in the north end in precinct 3,1 where the majority of the Polish mothers, some of the French-Canadian, and many Portuguese-white mothers lived, the other in the south end on the border line between precincts 13 and 17. The latter station was accessible to the big colony of Portuguese-white and colored mothers who lived in this section of the city. These stations were opened in 1913 from July 6 until September 26, and in both stations together 379 babies under 1 year were enrolled during that period. Three nurses had charge of the work at each station, and doctors contributed their services for clinics at stated hours during the week. Milk is modified and pasteurized at the dairy by a graduate nurse, also in the homes when so ordered by thè attending physician. Since 1913 another station in the south end has been added. The money for the support of these stations was raised by private subscription. This association has been doing prenatal work for the past eight years, or since 1911. The nursing service of one of the more impor tant life-insurance companies is furnished through the nurses asso ciation, which in this way is able to give the expectant mothers who are insured in this company advice and treatment. BOARDING HOMES. The law of Massachusetts 2 provides that any person who keeps in return for reward more than one infant not related to him by blood or marriage must be licensed. These infant-boarding homes are under the control of the State board of charity. The law requires that the State board must be notified whenever an infant under 2 years of age is received for compensation by any person not related by blood or marriage. Licenses are granted by the State board of charity after the application has been approved by the local board of health. A t the time of this study six infant-boarding homes in New Bedford were licensed. The lack of official supervision of homes where babies are cared for during the day hours only was one of the conditions which needed attention in New Bedford. Since the time of the study a new daynursery law has gone into effect (July 26, 1919) requiring that places receiving three or more infants during the day shall be licensed by the board of health. 1Wards and precincts according to ward and precinct lines existing at the time oi the study. 1 Revised Laws 1902, ch. 83, sec. 2. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 55 HOUSING. The effect of housing on the life and health of infants can be shown only very imperfectly in a statistical study of this kind. Defective housing conditions, lack of fresh air, overcrowding, and exposure to infection through defective sanitary arrangements may influence infant health or infant mortality. It is possible to obtain certain definite facts regarding the number of rooms in the dwelling, number of persons per room, toilet facilities, water and sewerage arrange ments— facts which lend themselves readily to statistical presenta tion— and to show the proportion of the infants included in the study who lived under favorable or under unfavorable housing conditions. But it is relatively difficult to measure the influence o f housing con ditions on infant welfare, since these factors are so complex. The discussion of housing is presented in two parts— first, a general survey of housing conditions throughout the city, to indicate the prevalence of housing defects in the city; and second, a pres entation of housing conditions under which the infants of the study lived. THE RIVER SECTION. One of the oldest-—and probably the poorest, most congested, and most dilapidated— sections of the city was the strip along the river, extending from the group of mills in the northern end of the city to the mills in precincts 16 and 17 1 in the southern end of the city. This particular part of the city may be designated as the river section, and it included most of the “ unfavorable” area. In the center of this strip was the business district of the city and a long frontage of wharves which extended in both directions to the groups of mills at each end of the city. In one small section near the river the district is low; in one part of this section when the tide rises during especially stormy weather, water has been known to flow over the sidewalks and the doorsteps, but it has generally sub sided in a half hour or so. There was practically no home own ership in this section, and rents were as low as accommodations were poor. Here were the most congested parts of the city; a large pro portion of the lots were covered by large block houses. Considerable congestion also existed within the apartments. In many cases a number of families lived together. In this neighbor hood one of the agents of the bureau found five-room tenements occupied b y from 15 to 18 people. Often the crowding was due to a number of lodgers. In a four-room tenement, just north of the business center, was found a family of seven, where lodgers were taken for 10 cents a night to help pay the $2.50 a week rental. The father, mother, and four children slept in one room, and one child 1 Wards and precincts according to ward and precinct lines existing at the time of the study. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 56 IN F A N T MORTALITY. in the kitchen; as many lodgers as possible were crowded into the other two rooms, which were filled solidly with cots, six in one room and four in the other. These were in use constantly for day and night shifts. All windows were shut. The rooms were filthy and had a foul odor. y Most of the basement dwellings found were located in this section. Three young children were found living in two small, gloomy, damp rooms in a basement in the north end. In another case, in the south ern part of the section, a family of 10 lived in two cellar rooms. All but 8 of the 21 children had died. The father was sick and could not work. One older boy supported the family with the aid of the mother, who took in washing. The family had other rooms upstairs, but for the sake of economy in fuel these two dark, cellar rooms were used for cooking, eating, and living rooms; the whole family except one boy slept in these damp cellar rooms. Types of houses. In the river section the houses, though uniformly old and in dis repair, were of three types— the mill-house type, the large block type, and the oldresidence type. Five groups of mill houses were in this section. The largest was the group of some 30 houses built some time ago by one of the larger mills just north of the plant. These were four-tenement houses, three stories high, with two four-room apartments on each of the first and second floors, one on each side of the house. The occupants of each apartment had the use, also, of two rooms on the third floor, giving each apartment six rooms in all. A similar group of 50 houses lay to the west of those just men tioned. The houses of these groups were identical except that in the second group there were usually only two stories and two apart ments of eight rooms each, four on each floor. This type is shown in Plate II. These houses were built in bleakly symmetrical rows with large undrained courts between, paved only with mud and decorated with clothes poles* and fluttering rags. The toilets, damp and dark, were in the cellars, one for every two apartments. Another group of 27 newer tenements is illustrated in Plate III. These were two-tenement houses with six rooms to the apartment and with a toilet in each adjoining the kitchen. They were placed with the same monotonous regularity but were more sightly because of their new paint. Other min houses were scattered in this end of the river district; all were in poor repair; two contained 10 apartments each, with toilets in the cellars. In the southern end of the river section was a group of 20 mill houses built in two long rows. Neither the street on which they https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis BP PLATE II.— T W O - F A M I L Y M IL L HOUSES—ONE T O IL E T TW O APARTMENTS. IN C E L L A R FO R E A CH PL A T E I I I . — PA RT OF A G R O U P O F 27 M I L L H O U S E S —T O I L E T A D J O I N I N G K I T C H E N IN E A CH A P A R T M E N T . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis THE https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PL A TE IV.— B R I C K M I L L T E N EM E N T S —T O I LETS IN T H E CELLA RS . P LA TE V — L A R G E B LO C K T E N E M E N T IN W H I C H 56 P E R S O N S W E R E L I V I N G —O N E T O I L E T IN T H E H A L L O N EACH FLOOR, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PL A T E VI .— A P A R T IC U L A R L Y BAD B L O C K T E N E M E N T - C O N T A I N I N G E IG H T SMALL APARTMENTS. P L A T E V I I . — H O U S E C O N T A I N I N G S M A L L , IL L - P L A N N E D A P A R T M . E N T S — S T R E E T S A N D T H E Y A R D IN T H E REAR L I T T E R E D W I T H R UB B IS H A N D GA R BA GE . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PL A T E . V I I I — O L D C O T T A G E S RA IS ED , W I T H STORES B UILT BENEATH https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis P LA TE https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis X II— METHOD OF M E E T I N G T H E F I R E R E G U L A T I O N S W H I C H R E Q U I R E P E R P E N D I C U L A R S T A IR S O N T H E F R O N T OF T H E H O U S E . TW O E X IT S —A L M O S T ■AN OT H ER W A Y O F C O M P L Y I N G W I T H T H E F I R E R E G U L A T IO N S T W O T E N E M E N T S U S IN G A S I N G L E BACK E X IT . https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 57 faced nor the wide court or yard between the rows was paved. , Each contained two apartments of six rooms with a toilet for each in the hallway. Another mill in the south end built 17 houses, some of which are shown in Plate IV. Some of these houses contained two or four tenements each, and three were large boarding houses. The toilets were in the cellar. These were the only mill houses and almost the only tenements in the city made of brick. They were built, not in rows, but facing outward around the four sides of an unpaved and undrained yard. They had recently been sold by the mill which built them. . The large block house was most common along the business thor oughfares, where the first floor was rented as a store. These houses were almost always of frame construction, and those in this district were very old and in bad repair. The hallways were dark and narrow. The toilets were usually in the cellar, reached by steep, narrow stairs at the back o f the building. A four-story square ten ement in the north end of the river section contained 56 persons above a fish market and a grocery store on the first floor. A building with two tenement houses east of it is shown in Plate V. There was one toilet on each floor in the hall. In all these block tenements the tenants seemed to belong to the drifting or transient element. In many of them lived groups of men without families— Greeks, Poles, Turks, and Syrians. A particularly bad block is shown in Plate V I; it was two stories high and contained eight small tenements. At one time early in the winter, water stood a foot deep in the cellar. An interesting house is shown in Plate V II. This had been for merly a seamen’s boarding house. A t the time of the study it was filled with a very transient population, crowded into small ill-planned apartments. One of the babies included in the study lived in this block. The street along the side of the building was not paved, and both the streets and the yard in the rear were littered with rubbish and garbage. Many of the old cottages along the business streets had been raised and a store built underneath. This type is illustrated in Plate VTII, where a raised cottage is shown in the foreground, with a block house next to it and a number of raised cottages beyond. The picture was taken in a section sometimes called “ Death’ s Hole.” THE WELL-TO-DO SECTION. Many of the best residences in the city were quite as old as the dilapidated houses in the river section just described, but, sub stantially built in the beginning, they had been kept in good repair, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T M ORTALITY. 58 and were still fine, spacious, old residences. The well-to-do section formed an L slightly to the southwest of the center of the city. THE NATIVE-COLORED DISTRICT. North and west of the well-to-do district and almost entirely within the angle of the L which it formed was a section of old houses inhabited at the time of the study by a colony of native-colored people. These houses were probably of about the same date as the houses in the river section and in the well-to-do section already de scribed, but they resembled the dwellings of the former in their dilapi dation and ill repair. As a rule they were of one or two stories; there were a number of larger blocks. The streets in this section were not paved. Dry privies were found in the yards. A unique feature was the gay, picturesque coloring of the houses. In Plate I X the house at the end of the street was of a quiet buff color splashed with bright yellow, with bright blue blinds and steps. A brown house at the left had patches of red, and on the right— next to a dull blue cottage—part of a bright red house was visible. On the streets near this court were several blocks which housed a large number of families. It is interesting to note that in New Bed ford no evidence was found of discrimination against colored per sons in regard to the scale of rent or the condition in which the dwellings were kept. THE NEWER SECTION. From the southern boundary of the city north to Tarkiln Hill Road, which marked the southern limit of the rural district, stretched the newer section of the city. Along the central part west of the river district stood many comfortable and well-kept-up one and two family houses, each surrounded by its own yard. Toward the south, and also toward the north, the type of house changed to the three and six family tenement house illustrated in Plate X . This type of house, the “ three decker,” was the prevailing type. These houses averaged five rooms to the apartment and were commonly built flush with the sidewalk. They were of cheap frame construction, had small porches, and varied only in minor details from one another. The houses near the mills in the southwest part were older and the sanitary accommodations not so good. All had water piped to the kitchen or sink, but the toilets of the older houses were usually in the hallways outside the apartment. The newer houses of this section had a toilet and often a bathtub in each apartment. No dry yard privies and few cellar toilets were reported in this part of the city. In the southwestern part of this section was “ Howland Village, ” a group of mill-built houses which had been sold to individuals. This https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 59 group comprised 52 one-family six and eight room cottages, located on winding lanes, each having its own porch and garden space. They were provided with porcelain bathtubs. These cottages dif fered from the ordinary mill tenement not only in size and in the sanitary conveniences but also in attractiveness and Variety of design; many of them were shingled, were attractively painted, and had sloping roofs and dormer windows. Each cottage com manded a view of Clarks Cove. See Plate X I . Toward the West of this section were many one and two family dwellings, inhabited for the most part b y persons of the white race born in this country, and usually owned b y the occupant. LEGISLATION. Building in New Bedford had proceeded with little if any regu lation. The only legislation that touched housing conditions was contained in certain ordinances relating to nuisances, and in a State law and in focal regulations for fire protection. An ordinance of 1907 provided that all dwellings of two or more tenements thereafter erected should have not less than two inside stairways reaching each floor on which there were living rooms. Under the Massachusetts law of 1901 plans for buildings of more than two stories and designed for use as dwellings above the second floor must provide proper exits and fire stops approved by the city inspector of public houses. The Massachusetts law further required that proper exits must be pro vided for boarding, lodging, or tenement houses which housed 10 or more persons above the second story. In addition to these adequate laws for fire protection there was a State law allowing the local board of health at its discretion to order vacated any dwelling which, by reason of uncleanliness, excessive number of occupants, or any other cause, was unfit for habitation. This law was permissive rather than obligatory. A more recent ordinance, which would not have had much influence on conditions at the time of the study, provided that no frame builds mg should be erected within 4 feet of the side or rear lines of a lot or of a building on the same lot, or within 2 feet if the studding was filled in with not less than 4 inches of solid brick work. A new housing law which passed the legislature in 1915 was wider in scope than the State law in force at the time of the study but of the same nature, its enforcement being left entirely to the discretion of the local board of health. According to this law the board of health was authorized to limit the number of occupants in any tenement or lodging house, and if the number were exceeded to order the premises vacated, not to be occupied again until the board was satisfied that its ruling would be complied with. The board was also permitted to make “ such further regulations as to overcrowding, ventilation, and 154220°—20----- 5 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 60 IN F A N T MORTALITY. occupation of such, houses and the cellars thereof not inconsistent with other laws, as it m ay deem proper. 33 1 An illustration o f a common method of meeting the fire regulations in the old remodeled houses is shown in Plate X II. Because two exits were demanded a steep, almost perpendicular staircase was built to connect with a narrow wooden porch along the front of the house. A novel way of meeting this requirement of the law, in the case of one of the larger houses, is illustrated in Plate X II I. Instead of adding a stairway, the front and rear houses were connected by porches; thus the oecupants o f each house had the U3e of two stair ways. In case fire blocked the stairway in the front house, the occu pants of this house could use the stairway at the rear; but if the rear stairway were destroyed by fire the persons in the rear house would have no means o f exit, since they would have to pass over the porches to reach the stairways of the front house. In the case of another large block the only means of communication between the front and rear stairways was through a toilet located in the middle o f the house and used b y occupants in both front and rear tenements. For some of the large lodging and tenement houses fire escapes had been pro vided, but often they had only wooden landings. These methods of housing prevailed in the river section, where old houses had to be remodeled. LAND CONGESTION IN RELATION TO HOUSING. That there was no extensive lot overcrowding in New Bedford was due not to any building regulations but to the fact that in New Bedford the land famine which causes congestion in larger eities had not yet made itself felt. In almost every part o f the city except in the business sections patches of unused land were still to be found. The city had seven parks. The largest two, 88 and 94 acres, respectively, were located one in the extreme western and the other in the northern part of the city. Another park, 23 acres in extent, was located in the south end of the city. The common, covering 7 acres, was a small, green, open space a few minutes’ walk from the business center. The other parks were sm all Five playgrounds were located in different parks in the city. REGULATION. The housing problem in New Bedford may on the whole be con densed to one central question, that o f regulation. It was the lack of regulation o f the old houses that had allowed the conditions of dilapi dation and disrepair to go on unchecked in the river district and parts of the colored district. The lack o f regulation of new buildings i Special acts oi 1915, ch. 234. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis F E W BEDFOKD, MASS. 61 might easily bring to New Bedford the same evils of bad planning and lot congestion which lack of control has brought to other cities. So far as was found in the study there were no windowless rooms in New Bedford, and there were only a few basement apartments in use. The question of congestion in New Bedford was still largely one of crowding within the apartment. There was no land famine; but if the city continues its rapid increase, legislation will be needed to prevent lot congestion. This legislation should not only regu late the building of new tenements but should also cover the proper repairing of old houses so that they may not fall into the insanitary condition now existing in the old districts of New Bedford. FINDINGS OF THE STUDY. For infants included in the study certain facts in regard to the dwellings or apartments in which they spent the greater part of their first year or of their lives 1 were noted on the schedule. Among the homes of the babies in this study the five-room dwelling predominated, 37 per cent of the births occurring in families living in homes of that size. Four-room dwellings were next in number with 28 per cent, making 65 per cent of the births occurring in families that were housed in dwellings of four or five rooms. The rents, too, were not high, ranging from $2 to $3 a week for four- and five-room dwellings. Only 17 families lived in dwellings of two rooms, and only 1 family in one room. The last mentioned was a foreign family consisting of three persons.2 One hundred and sixty-two, or 6 per cent, of the births occurred in families living in homes of eight or more rooms. These figures in regard to number of rooms must be taken in con nection with the number in the family before any idea of the adequacy of the living quarters of a family can be secured. In the five-room dwellings, for instance, there might be 3 or 10 in the family; the average number of persons per room is the best measure of over crowding. Twelve hundred and fifteen, or 46 per cent, of the births were in families having less than one person to a room ; the infant mor tality rate for this group was 97. For the group which averaged less than two but more than one person to a room the infant mortality rate was 146; this group numbered 1,262, or 47 per cent of the whole number. Six per cent of the families lived in congested conditions, viz, with an average of from two to five persons per room; the infant mortality rate for this last group was 222. There were 34 instances in which the number of persons per room was not reported. (See Table X X V .) 1 For stillbirths the home scheduled was the one in which the mother spent the greater part of her preg nancy. a General Table 30. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 62 IN F A N T MORTALITY. T able X X V .— Births in selected year, infant deaths, infant mortality rate, and number and per cent o f stillbirths, according to average number o f persons per room. Average number of persons per room, a Allclasses...........................................- 2 but less than 5.......... ................................. Not reported................................................. a Total births. Live births. Infant deaths. Stillbirths. Infant mortality Per cent rate.6 Number. of total births.5 2,662 2,587 837 130.3 75 2.8 1,215 1,262 151 1,175 1,229 149 114 179 33 11 97.0 145.6 221.5 40 33 3.3 2.6 1.3 Excluding infants bom during selected year. 2 &Not shown where base is less than 100. The mortality in these groups must not be considered as caused solely by housing congestion. The families living in conditions of congestion were undoubtedly those with the lowest earnings and the lowest standards of living. Infants in these families were likely to be handicapped by other factors, discussed in the preceding sections of the report, such as artificial feeding or lack of care owing to the employment o f the mother outside the home. All these factors must be kept in mind in considering the above rates. Nativity and housing. The babies of foreign-bom mothers lived usually in more crowded . quarters than the babies of native mothers. This condition was caused not so much by the fact that the foreign-bom mother rented a smaller dwelling as b y the fact that the family was larger. The four- and five-room dwellings were most common among both the nativity groups; but while 64 per cent of babies of native mothers lived in dwellings averaging less than one person to a room, only 38 per cent of the babies of foreign-born mothers had the advantage of similar housing conditions. . Housing in “ unfavorable ” area. Practically all the poor housing in New Bedford was foupd in the “ unfavorable” area— precincts 1, 2, 3, 13, and 17.1 The greatest congestion within the home also occurred in this seetion. While 57 per cent of the births outside this area occurred in families who lived under comfortable conditions, viz, with less than one person per room, only 37 per cent in this area were in families enjoying like conditions. Seventy-eight per cent o f the births occurring in families with two or more 2 persons to a room were found in this area. iW ards and precincts according to ward and precinct lines existing at the time of the study. * Derived from Table X X V and General Table 31. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 63 N E W BEDFORD, MASS. ILLEGITIMACY. Infants of unmarried mothers in the city of New Bedford were made the subject of a special study. The conditions under which they live differ from those of a normal family and, though the facts concerning them were not comparable to those concerning infants born in wedlock, the mortality rate and the social and economic Conditions surrounding these children are of particular interest. In the State of Massachusetts the certificate of birth contains no statement in regard to legitimacy. I t is contrary to law to return any facts on a birth certificate about the father of a child of illegiti mate birth unless both father and mother consent in writing. Not even the name of the father may be made a matter of record. Con sequently the omission of the father’s name in most cases 1 indicates that the birth was illegitimate. The total of registered illegitimate births in New Bedford in the selected year was 104, exclusive of 3 foundlings for whom the»facts could not be ascertained. The pro portion of illegitimate in the total number of registered births was 2.9 per cent. This is a relatively low percentage compared with percentages for foreign countries.2 Little American material is available on this point.3 COMPARATIVE RATES FOR MASSACHUSETTS CITIES. A compilation of returns of registered births filed in the statehouse at Boston shows the percentage of illegitimate to total registered births for the 12 Massachusetts cities with a population (in 1910) of 50,000 and over. New Bedford had the highest percentage of ille gitimate births of any city except Boston. The figures quoted are for the year 1914. Per cent. Cambridge............................. ^. . ....................... ....................................- - ............ 1 Lawrence................................................................................ ....................................... Somerville....................................................................... LI Lowell................................. ....................................................................- ................ L 5 Springfield................................................................................................................L 5 Fall R iv e r..................................... ................................... - .................................... 1-6 B rockton .................................................................................. ....................... — 1-8 Lynn.....................................................- ................................................... 1*8 Worcester............................................................................................................... 2 .1 Holyoke...............- ...................- ......................................?------ : ........................... 2. 8 New Bedford............... - ............................................................... ......................... 2. 9 Boston........................................................................................................................ 8.9 The illegitimacy rate for New Bedford for 1914 was the same as for 1913. 1 In the course of securing information from the mother, several exceptions to this rule were found. * Statistique Internationale du Mouvement dela Population, 1901-1910. * A report entitled “ Illegitimacy as a Child-Welfare Problem, Pt. 2: A Study of Original Records in the City of Boston and the State of Massachusetts,” is in course of preparation by the Children’s Bureau. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 64 IN F A N T M ORTALITY. SECURING OF DATA. Complete schedules were obtained for 54 of the total of 104 illegi timate births in New Bedford, and for 9 more part of the information was secured, leaving 41 for whom no data could be obtained. The difficulty in securing schedules from the unmarried mothers was due in part to the large number of removals from town of mothers of this group. INFANT MORTALITY RATE FOR INFANTS OF ILLEGITIMATE BIRTH. Among the 63 births investigated 2 stillbirths and 18 deaths occurred; in 2 cases it was not reported whether the child survived the first year or not. The infant mortality rate for this group was therefore 305. I f the entire group o f 101 live births is compared with the 35 known deaths in this group as shown by death certi ficates, the infant mortality rate was even higher, 347. This rate was over two and a half times as high as the rate for infants of legitimate birth. Several causes are responsible for the excessive mortality among infants of illegitimate birth. The mother often does not have proper care during pregnancy. After confinement she is in many cases obliged to seek employment to support herself and her child. Many unmarried mothers, in a desire for concealment, arrange to have the infant cared for away from home. Often the child is placed in a cheap boarding home or in an institution, where his chances of sur vival are diminished. In either case the infant is deprived of breast feeding and a mother’s care. CARE IN CONFINEMENT. The care received by the unmarried mothers in confinement is shown in the following table: Total..................................... ......................... ............................... .............. 104 In hospitals.................................................................................... .......... .............. In almshouses............................... .................................................................... .. In private home, by physician.................................................- - - -V............ In private home, by midwife............................................................................ In private home, by neighbor..............................................................- .......... In private home, no attendant............................................. ........................... Report of care not.given................................................................................... - 22 2 42 22 4 2 10 DISPOSITION OF INFANTS. Of the 63 infants of illegitimate birth for whom partial or complete schedules were obtained, 6 were stillborn or died in the first two weeks of life; of the remaining 57, 9 lived with both parents, 28 remained with the mothers, 2 were supported b y the fathers in the fathers’ parental homes, and 18 were placed in institutions, boarded out, cared for by relatives, or adopted. The mortality rates for each https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 65 class were high,'but the numbers were too small to admit of com parison by groups. The number of removals of these infants before the final disposition as reported above was made may have been a factor in the high mortality among them. There were 36 shifts made, involving 27 babies. NATIONALITY. Of the 63 infants for whom nationality data were obtained, 25, or two-fifths, were born to native mothers. Five each were bom in the groups of Portuguese white, Portuguese Negro, and French. Canadian; and the rest were born in the Polish, English, Irish, and German groups. The large proportion of native white among these mothers is noteworthy, since the percentage of native white among the mothers of legitimate births was only 28. COURT ACTION. The father of a child of illegitimate birth, after paternity has been established b y a court, is liable under the law of Massachusetts in force since July, 1913, to pay confinement expenses and to “ con tribute reasonably to the support of the child during minority.” Court proceedings were begun in the cases of 16 of the 104 illegiti mate births in this study. Five were not brought to trial because the defendant could not be found. In 9 of the remaining 11 cases some provision for the child was made. A very small percentage, then, received aid through court action. Many mothers, of course, do not resort to the court because of the publicity involved and so lose the opportunity of getting such aid as might enable them to keep their children with them. AGE AND OCCUPATION OF MOTHER. A classification by age and occupation of mother affords an indica tion of the special circumstances in which these children of illegitimate birth lived during their first year. In 44 per cent of the 63 cases of illegitimate birth for which information was secured, the mothers were extremely young— under 20; and in only about 16 per cent were the mothers over 30. In 35 cases, or 56 per cent, the mothers worked in cotton mills; in 8, in domestic service; and the mothers of the rest were employed in 13 other occupations. In 5 cases employment was not reported. Only 1 was reported to have had no gainful employment during the year before the child’s birth. Ten mothers did not return to work the year after the birth of the infant. The father’s occupation was determined in 52 of the cases scheduled; in 11 instances the father worked in the mills, in 2 cases the father did not work, and in the remaining cases various occupations were reported. i Acts of 1913, ch. 563 (in force since July, 1913). https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 66 IN F A N T MORTALITY. SU M M AR Y AND CONCLUSIONS. New Bedford is a manufacturing city whose chief industry is cotton textiles. A large proportion of •the population of the city was foreign bom , especially Portuguese and French Canadian; a large proportion of women worked in the mills. Wages in New Bedford were low. INFANT MORTALITY RATE. The study of infant mortality in New Bedford included a total of 2,662 births. The infant mortality rate for the 2,587 live births was 130.3, a very high rate when compared with the rate of 100 for the birth registration area in 1915. The mortality rate in precincts 1, 2, 3, 13, and 17,1 constituting the so-called “ unfavorable” area, was 156.6 as contrasted with the figure of 94.6 for the rest of the city. In the precincts mentioned were most of the colonies of foreign nationalities, including a very large proportion of the French Cana dians, Portuguese, and Poles— groups in which the infant mortality rates were high. NATIONALITY. Almost three-fourths of the mothers of the study were foreign bom . The mortality rate for infants of foreign-bom mothers was 138.9 as contrasted with 108.4 for infants of native mothers. The largest nationality group represented was the Portuguese white, who contributed one-fourth of the births in the selected group, and who had the highest mortality rate in the city, 200.9. The FrenehCanadian group was next in size; it had an infant mortality rate of 115.5. The Poles had a rate of 119.8, and the English, 100.9. A large proportion of the foreign-bom mothers, and particularly of the Portuguese, were illiterate, or unable to speak English, or both. The mortality rate for infants of illiterate mothers was 188, as contrasted with 107.1 for babies whose mothers could read and write. Among infants bom to mothers of non-English-speaking nationalities, the mortality rate for the group whose mothers were able to speak English was 97.4 as contrasted with the rate of 180.4 for those whose mothers were unable to speak English. Mothers of 584 infants could neither read, write, nor speak English. The rate for this group was 203. CAUSE OF DEATH. Gastric and intestinal diseases caused 37.1 per cent of all deaths of infants in this study. Compared with other cities studied b y the bureau, the mortality rate from gastric and intestinal diseases was nearly four times as high in New Bedford as in Bro'ckton and nearly six i Wards and precincts according to ward and precinct fines existing at the time o f the study. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 67 times as high as in Saginaw; in both the textile towns, Manchester and New Bedford, the rate from gastric and intestinal diseases was high, in Manchester even higher than in New Bedford. The rate from these causes was over three times as high for infants of Portuguese-white mothers as for infants of native mothers. The mortality from respiratory diseases was higher in New Bedford than in any other city studied by the bureau, although only slightly higher than for Johnstown and Manchester. Practically all the ex cessive mortality from respiratory and gastric and intestinal diseases was due to the heavy mortality among infants of Portuguesewhite mothers. The rate for deaths from causes peculiar to early infancy was lower in New Bedford than in any city previously studied by the bureau. ATTENDANT AT BIRTH. Seventy-three per cent of the births of the study were attended by physicians and 23 per cent by midwives. Among the foreign bom 30 per cent of the births were attended by midwives. The Portu guese white had the largest proportion of confinements thus attended. FEEDING. The average mortality among artificially fed infants was approxi mately four and one-half times the rate among infants breast fed. A great difference was shown in the rates for artificially fed infants of native and of foreign-born mothers, the rate for the latter being nearly one and one-half times as high as the rate for the former. FATHER’ S EARNINGS. Fathers of 41 per cent of the babies in this study worked in the cotton mills during the greater part of the year following the babies’ births. Three-fourths of the infants were bom in families where the father earned less than $850 a year. In the group of infants whose fathers earned less than $450 a year, comprising over one-fifth of all the births, the infant mortality rate was 201.9. With one exception the rate decreased as the fathers’ earnings increased, to the low rate of 59.9 for infants whose fathers earned $1,250 or over. In the lowest earnings group 1 live-bom baby in every 5 died before reaching its first birthday; in the highest earnings group only 1 in 17 died. GAINFUL EMPLOYMENT OF MOTHER. Forty-seven per cent of the births were to mothers gainfully em ployed during the year preceding the baby’s birth and 41 per cent to those so employed during the year following. The lower the https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 68 IN F A N T MORTALITY. earnings of the father, the higher was the proportion of mothers gainfully employed. Very few of the hirths were to mothers gain fully employed where the father earned over $850. Gainful em ployment away from home during the year following the birth of the infant usually involved early artificial feeding. The mortality rate for infants of mothers who were gainfully em ployed prior to the birth was 154.5, as contrasted with a rate of 108.8 for infants of mothers not employed. The mortality among infants of mothers who were gainfully em ployed away from home during the lifetime of the infants was approx imately one and one-half times the average mortality. CIVIC AGENCIES. The Instructive Nurses Association carried on the infant-welfare work during the summer months from the milk stations, but at the time of the study these nurses were able to care for but a small pro portion of the infants in the city. Experience has shown that infantwelfare centers are the most effective means of giving practical in struction to the mothers in the right methods of caring for their ba bies and medical advice and trained-nursing care for the babies who are in especial need of them. In addition, facilities for public-health nursing should be sufficient to assure prenatal and postnatal care and instruction to those mothers who would otherwise be neglected, and these special services to mothers as well as to babies should be acces sible to all. During the years following this study, by means of printed pam phlets, advertisements, the lecture hall, and the motion-picture the ater the city health department has done valuable work in dissemi nating knowledge of simple health precautions against the spread of disease. Such methods, applied to the problems of infant welfare, have been found effective. CONTRAST BETWEEN NEW BEDFORD AND BROCKTON. Conditions in New Bedford are particularly striking in contrast to those in Brockton, the only other Massachusetts city studied. In the selected groups, New Bedford had the higher rate, 130.3, as compared to 96.7 in Brockton. Perhaps the most striking difference between the two cities, in so far as the explanation of the difference in the infant mortality rate is concerned, is in the nationality com position. New Bedford has a large proportion of Portuguese, with the excessively high infant mortality rate of 200.9; Brockton had no large single group with so high a rate, and indeed, the largest group, composed of Lithuanians and Poles, had an infant mortality rate of only 115.6. If the Portuguese group, with its high birth rate https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 69 and high mortality rate, were omitted from New Bedford, the rate would have been only 103.7, or much more nearly like that of Brockton. A second point of contrast is found in the much larger proportion of the births in New Bedford that occurred in the lower economic groups. Three-eighths of the births occurred in families in which the father earned less than $550; in Brockton only one-eighth o f the births were in such families. Twenty-five per cent of the births in New Bedford were in families whose fathers earned $850 or over; in Brockton 45 per cent earned over this amount. Evidently, since the infant mortality rate falls as the father’s earnings increase,, the infants in Brockton had a much better chance of survival than those in New Bedford. A third point of difference lies in the proportion of mothers gain fully employed away from home. In Brockton mothers of less than 4 per cent of the infants were so employed during the year following the baby’s birth; while in New Bedford mothers of 22 per cent were so employed. During the year preceding the birth, 12 per cent of the mothers were gainfully employed away from home in Brockton as contrasted with 33 per cent for New Bedford. The difference in the rates for the two cities is the more remarkable, since in type of feeding given to the babies New Bedford shows a larger proportion exclusively breast fed in each month of life. . These are the principal points of difference: New Bedford had lower standards of living, a larger proportion of mothers gainfully employed, a more difficult problem of assimilation of foreign elements. These differences reflect themselves in the excessively high mortality from gastric and intestinal diseases (nearly four times that of Brock ton) and from respiratory diseases (over twice the Brockton rate). Deaths from these causes are easily preventable; with proper care and feeding most of them would not occur. Relatively, New Bedford has a much larger and more difficult problem than Brockton in reducing its infant mortality rate. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis APPENDIX. METHOD OF PROCEDURE. Scope of inquiry. In the law creating the Children’ s Bureau, passed by the Sixtysecond 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 deathregistration States there were 124 deaths under 1 year of age.1 In 1915, in the birth-registration area, including the New England States, New York, Pennsylvania, Michigan, Minnesota, and the District o f Columbia, for every 1,000 live births registered there were 100 infant deaths. In these States the infant mortality rate varied 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 was 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: State. Connecticut................................ Maine.......... » ................... Massachusetts................................. Michigan............................ Minnesota........... I............... Infant mortality rate. 1117 105 101 86 70 State. 1915 a Infant mortality rate. Pennsylvania.................. 85 “ Ü. S. Bureau of the Census, Birth Statistics, 1915, p. 10, Washington, 1917. It is evident from these figures that conditions in some States and in some cities are much more favorable than in others. On the causes of low or high mortality the figures of the Census Bureau throw little light. I f inquiries were made in restricted areas and information on the physical, social, economic, and civic conditions were secured for all births and for all deaths under 1 year it would be possible to determine the underlying causes that favor a low mortality or produce a high rate. 1 The rate is too high since the registration o f births was incomplete in these States; in many of them it was very deficient. Figures are shown for the death-registration States o f 1911 and are for 1910, except in Kentucky and Missouri, where births mid deaths are for 1911. 71 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN F A N T MORTALITY. 72 With this object in view the Children’s Bureau selected a number of cities that offered contrasts in economic, industrial, and social conditions in which to make intensive studies of the conditions of infant life and infant mortality. The choice of the first cities to be studied was limited for practical reasons to cities with accepted birth registration, on account of the facilities afforded by the birth records for ascertaining the residence of the mothers to be interviewed. It was further necessary to choose cities of such size that they could be covered thoroughly within a reasonable time by the few agents avail able for the work. Certain characteristics of the cities chosen are summarized in Table II. All were manufacturing cities, the popula tions ranging in 1910 from 50,000 to 100,000. All had a large foreign element. In addition, judging by the provisional figures available when the choice was determined upon, every city with the exception of Brockton had a high infant mortality rate. T a b l e I I .— Population in 1910, infant mortality rates 1910 and 1915, percentage o f adult population foreign born, principal foreign nationality, and principal industry o f the cities chosen for infant mortality studies. Infan mor tality rai es. City. Popula tion in 1910. a Johnstown, Pa............ Manchester, N. H ....... Brocton, Mass.............. Saginaw, Mich............. New Bedford, Mass. . . Waterbury, Conn....... Akron, Ohio................. 55,482 70,063 56,878 50,510 96,652 73,141 69,067 1910 165 193 99 145 177 149 123 Per centage of adult popula tion over 20,foreign b 1915 bom , 1910. 116 150 82 101 143 143 39.9 56.1 37.3 33.7 59.0 50.5 26.0 Principal foreign nationality.« Varied Slavic <*............ French-Canadian........ Lithuanian.................. German........................ Portuguese................... Italian.......................... German........................ Principal industry. Iron and steel. Cotton textiles. Shoe manufacture. Varied industries. Cotton textiles. Brass manufacture. Rubber factory. Figures published by the TJ. S. Bureau of the Census, Bulletin 109, Mortality Statistics, m o , pp. 18-19, provisional figures for births. The rate for Akron, Ohio, was furnished by the Ohio State registrar, b U. S.^ureau of the Census, Birth Statistics, 1915, Washington, 1917. The rate for Saginaw, Mich., was bosed on State (final) figures for b ir t h s ........................, . . . , . . ... _ . . . c Principal foreign nationality of mothers of infants included in the infant mortality studies. d No particular Slavic group of sufficient importance to mention separately. a based m Infant mortality rate. An infant mortality rate expresses the probability of a live-bom 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 of age occurring in a given calendar year by the number of registered live births in the same year. The number of deaths thus secured includes not only deaths of infants bom in the same calendar year, but also some deaths of infants born in the i stillbirths are omitted from both births and deaths. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 73 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 o f infants. To avoid this inaccuracy, the method employed by the Children’s Bureau in all studies has been to follow each infant born in a given selected year in a certain area for a period of 12 months. The deaths among these infants are then compared to the births. In this way the deaths include no infants not included in the births’ and the true probability of dying in the first year of life is secured. The chief difficulty, in practice, in computing infant mortality rates arises from the incompleteness of registration of births and deaths. On account of differences and changes in completeness of registration, it 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. I f the per cent of omis sions of deaths under 1 year of age is equal to the per cent of omis sions 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. I f birth registration is more defective than registration of infant deaths, the infant mortality 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 by race and nativity classes, if the degree of completeness of registration varies with the different classes, the rates found by dividing the deaths b y the births may not be comparable. For the purpose of these investigations comparable rates are essential. I t is not o f 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 representative of the city. An alternative policy is so to supplement the original data that the figures used include all the evidence applicable to the groups studied in the city. Certain groups for which the information is inaccurate or incom plete 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- https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 74 IN F A N T M ORTALITY. 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 by the exclusion of live births only, with no exclusion of infant deaths to correspond. A third group of exclusions is the births to nonresident mothers. These were excluded not only on the ground that in most cases the infant did not live in the city during his entire first year of life but also on the ground that the conditions under which nonresident mothers lived prior to 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— 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 there at the time of the agent’s visit. i The rulings in two special cases might he mentioned: (1) I f the mother died during the child’s first year, the birth was included if the infant (or, in case of death, his family) had lived in the city during the first year after his birth. (2) In a few cases mother and child were away from the city for a part only of the child’s first year, and later moved back and were found b y the agent. In the cities first studied agents were not instructed to inquire as to continuousresidence in the city. If, however, the fact that the mother had moved away for a period was noted, the birth was excluded in tabulation if the absence from the city had been three months or more. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD; MASS. 75 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 canvass. The first method was rejected in favor of the second and third, on the ground that the inclusion of all these death records would tend to exaggerate the mortality rates. The second method was followed in Manchester, Brockton, and New Bedford. In Brockton and New Bedford as in other cities in Massachusetts a special canvass was made to check up registration of births during the preceding year. Consequently, in these cities a birth might have been registered either by the physician soon after the birth or by the special canvasser on his visit. All births recorded, whether regularly registered or added by this special canvass, were treated as registered for the purposes of this study. The third method, or a modification of it, was followed in the other cities studied. In Johnstown, Pa., the original plan was to limit the investigation to registered births in 1911. But during the progress of the investigation it was found that many births to Serbian mothers escaped registration, and it was thought that this group was too important to be omitted entirely. Accordingly, the birth records 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 the registered births were supplemented by the births secured in various ways— from death certificates, baptismal records, through neighborhood inquiries, and other sources. The agent calling on each mother inquired if there were other children in the neighborhood of about the same age. By these means 116 births to resident married mothers were added. Three unregistered deaths were added to the 113 recorded. 154220°— 20------6 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INFANT MOBTALITY. 76 With the general plan of the investigation determined, the more important points in the detailed procedure were as follow s: The first step was to copy the birth certificates for the year selected; then the death certificates for the year selected and the year following were examined and the facts as to birth and death for infants bom in the year selected were transferred to the schedules. These records usu ally gave the address of the mother, though not in all eases the present address. In cities where a canvass was made, the actual address of the mother was found directly. If the mother had moved, the agent attempted to learn from the neighbors her present address in the city or whether she had moved away. Most of the information contained in these reports is derived from the answers secured from the mothers interviewed. Since the bureau has no power nor desire to compel answers, the information secured was based on the voluntary state ments of the mothers. To the willingness 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 infor mation 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 m ind: 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. The rates as shown in these studies, therefore, may be expected to be somewhat lower than the rates as usually computed. Third. Births to nonresident mothers are excluded in order to make the rates as characteristic as possible of the conditions o f the locality studied. Fourth. Births of infants whose mothers moved away during the year following the birth and deaths that occurred in this group are excluded, because in the absence of data on age at removal it is im possible to use the figures except on the basis of arbitrary assumption. Deaths in the city of infants horn elsewhere are also excluded because there is no information on age at migration. This policy, of course, excludes infant deaths in foundling asylums, if the birth did not occur in the city. i Except for Johnstown., where iilegitixnate births were included. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFOKD, MASS. 77 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 o f infants surviving the first year of life, whose births were not re corded. 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 official 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. Live births excluded in New Bedford. With the foregoing explanation of the method of procedure in mind the significance of the exclusions and the rates for the excluded groups may be more easily grasped. During the selected year there were 3,542 known live births in New Bedford; of these, 346 had moved out of town and no trace of 441 could be found, a total of 787. One hundred and fifty-three of this group died in the first year, giving a rate of 194.4. These deaths registered in the city probably do not include all deaths in this group, since some infants may have died after leaving New Bedford and their deaths have not been recorded in the city. In 14 instances the births were excluded on account of incomplete or unreliable data; in 4 of these cases the infant died. Among the 59 five births excluded on account of nonresidence of the mother, 5 deaths occurred in the city. In most cases these moth ers probably left the city soon after the birth of the child. The mor tality rate, therefore, probably represents an understatement of the true rate for this group. Forty-nine births to mothers resident in the city both at the time of the infant's birth and at the agent’s visit were excluded on the ground of illegitimacy. Fourteen, or over one-fourth, of these babies died before the first birthday. This number, 49, does not represent all the illegitimate births in the city, since others were excluded on grounds of nonresidence or lack of information. Forty-six births were excluded on the ground that the birth had not been registered. Six of these babies died under 1 year of age. The mortality rate for this group was almost exactly equal to the rate for the births included in the study. Because no attempt was made to supplement records of births by a canvass of the city it was deemed advisable not to include these unregistered births. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 78 IN F A N T MORTALITY. T a b l e I I I .— Registered and unregistered live births in New Bedford, infant deaths, and infant mortality rate for births included in andfor births excludedfrom detailed analysis, by reason for exclusion. . Inclusions or exclusions and reasons for exclusion. Total known live births......... Births Births Births unreg Births unreg Regis Un Total. tered. regis Total. regis ister Total. regis ister tered. ed. tered. ed. tered. Not found.......................... Data incomplete or unreliable. Nonresident........................... . Removed................................ . Illegitimacy............ ...................... Nonregistration of births............. a 49 519 513 . 906 49 337 182 337 176 857 3 162 162 84 4 3,542 3,493 2 587 2 587 Total live births included............. Total live births excluded............. _ ,955 Reasons for exclusion: Nonresidence or lack of informamation: Total.............................. Infant mortality rate.« Infant deaths. Live births. 860 14 59 34ft 49 46 441 14 346 69 84 4 5 69 49 14 14 3 46 6 6 146.5 146.9 6 130.3 190.6 130.3 194.3 ........... 188.4 189.0 190. 5 190.5 199.4 199.4 6 Not shown where base is less than 100. From these figures light may he thrown upon the completeness of birth registration in New Bedford. Of the total of 3,542 live births, 49 were unregistered, giving a percentage unregistered of 1.4 per cent. This percentage of course would be an understatement, since a few additional unregistered births might have occurred. The infant mortality rate for the births included in the study was 130.3. For the excluded groups the rate varied with the reason for exclusion. The rate for illegitimate births was very high. The rate for nonresident was relatively low, but probably not all the deaths wer^ included. The rate for cases where the mother was not found or had moved away from the city was considerably higher than the rate for the selected group, but probably less than the true rate. The rate for the excluded group as a whole, 190.6, is not significant unless taken in connection with the reasons for exclusion. The rate for all live births in the city, both included and excluded, was 146.5, but this rate, too, is not so significant in many ways as the rate for' the group included in the study. Stillbirth rates. Stillbirth rates were formed by dividing the number of stillbirths by the total number of births, live and stillbirths. A stillbirth is defined as a dead-born issue of seven or more months’ gestation. Miscarriages, or dead-born issues of less than seven months’ gestation, were excluded. A policy of exclusions was followed similar to that for infant mor tality. .Stillbirths to nonresident mothers were excluded because of the possible effect of other conditions; likewise stillbirths to mothers https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis N E W BEDFORD, MASS. 79 who moved away prior to the visit of the agent. In the latter cases the information would have been difficult to obtain, and there was the same chance of omission of births as in calculating the infant mortality rate. With reference to the accuracy of the data the registration of still births has a peculiar margin of error of its own. Usually 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 registered at all, and in others miscarriages as well as stillbirths must be regis tered. I t sometimes happens that a stillbirth is registered as a “ death” but not as a “ birth” where registration of both is required by law. It is obvious that such an omission is one of carelessness only, as ordinarily the same person, usually a physician, would register both. The number of unregistered stillbirths would be difficult to deter mine. It would be much more difficult to find cases of omission of stillbirths by canvass or other inquiry than to find cases of omission of registration of live births. Omissions might be due to ignorance of the law or failure to observe it. Doctors are probably more con versant with the law than midwives. There is chance for confusion between stillbirths ,and infant deaths on the one hand, where it is difficult to determine whether or not the child was born alive; and between stillbirths and miscarriages on the other, where it is difficult to state accurately the number of months of gestation. If the law requires the reporting of miscarriages, the number of stillbirths is probably more complete than where they are not reported. In the stillbirth rates presented in the infant mortalitv 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 other cities the figure for stillbirths is compared to the total registered and known unregistered births to resident married mothers. T able IV . Stillbirths and miscarriages in New Bedford included in and excluded from detailed analysis, by reason for exclusion. Total known stillbirths and miscarriages. Total, stillbirths included............................. Total, stillbirths and miscarriages excluded. Reasons for exclusion: Nonresidence or lack of information: Total. Not found................................. Data incomplete or unreliable. N onresident......... ................... Removed............................." Miscarriages....................................... Stillbirths on account of illegitimacy.’ N onregistration of birth......... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 143 80 UDE&STX M ORTALITY. Stillbirths excluded. There were 143 known stillbirths and miscarriages in New Bedford. Of these 24 were excluded because they were miscarriages of less than seven months’ gestation. Thirty-eight more were excluded because the mothers had moved out of the city or were nonresident or because information was lacking. In these cases it could not always be deter mined definitely whether the birth was a stillbirth or a miscarriage. There were 81 stillbirths to mothers resident in the city both at the time of the birth of the child and at the agent’s visit. Five of these were excluded on aecount of illegitimacy and one on account of non registration of the birth. The rate for the included group is formed by dividing 75 stillbirths by the 2,662 registered births included in the study giving a rate of 2.8 per cent. No rate can be formed for the nonresident, not found, or removed groups, because it can not be determined from the records whether or not the birth was a stillbirth or a miscarriage. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis GENERAL TABLES. T able 1. Births during selected year in each precinct o f residence, according to nationality o f mother.a Births during selected yeaf. Nationality of mother. Precinct of residence. Total. 1 3 2 4 5 6 9 10 1 1 12 13 14 15 16 17 18 -- — — --- - — •--- *—— 2,662 478 300 197 71 108 81 49 22 60 34 47 55 234 49 66 248 318 245 7 All mothers......................... Native mothers.......................... Foreign-bom mothers.................... 8 — . — 753 106 71 28 23 49 47 18 17 46 16 28 35 27 33 35 63 50 61 1,909 372 229 169 48 59 34 31 5 14 18 19 20 207 16 31 185 268 184 Portuguese white................ Portuguese Negro................ French Canadian.................... Canadian (except French)___ English...................... Polish.................................... Irish, Scotch, and Welsh ¡>....... Jewish................................... All other «............... Not reported......... .................... 685 86 76 1 415 169 27 2 226 48 223 30 70 6 60 3 126 27 1 66 18 1 4 6 10 4 2 84 32 12 g 8 9 1 2 i 2 i l 12 9 6 28 10 1 42 98 2 2 3 12 3 l 4 2 3 2 1 2 16 6 19 1 19 1 3 3 1 7 1 5 113 59 6 14 13 175 150 i 1 1 2 2 4 1 1 ió : 4 1 21 6 3 4 1 ~2 2 1 5 2 9 63 19 i i 6 \ i 1 2 2 1 1 2 1 i 2 6 5 1 6 4 2 10 11 g 6 i ? “ Wards and precincts according to ward and precinct lines existing at the time'of the study. 6 Including 60 Irish, 8 Scotch, and 2 Welsh. c Incluaing 40 Italian, 16 German, 15 French, 15 Greek, 13 Syrian, 7 Bohemian and Moravian, 4 Swedish, foreign black, 3 Russian, 2 Lithuanian, 2 Magyar, 1 Armenian, 1 Flemish, 1 Norwegian, 2 all other. T 2 . — Births during selected year to foreign-horn mothers, infant deaths, infant mor tality rate, and per cent o f stillbirths, according to years o f residence o f mother in the United States and nationality. able Stillbirths. Years in United States and nationality. All foreign-born mothers................... Under 3 years................................ 3 to 5 years...................... 6 to 8 years........................... 9 to 11 years................................... 12 to 15 years.......................................... 16 years and over................................... Not reported...................... Portuguese-white mothers................. Under 3 years................................ 3 to 5 years............................. 6 to 8 years........................... 9 to 11 years................................ 12 to 15 years....................................... 16 years and over................................ Not reported............................................... Total births. I àve births. Infant Infant deaths. mortality rate.» Number. Per cent of total births.a 1,909 1,858 189 313 343 264 275 511 14 185 305 338 253 266 497 14 685 667 134 101 99 28 33 32 124 145 122 258 38) 57 50 37 22 50 4 106 85 3 142 116 105 80 3 Other foreign-born mothers.................. 1,224 1,191 124 Under 3 years............................................... 3 to 5 years.................................................. 6 to 8 years.................................................... 9 to 11 years................................................... 12 tol5~years.............................. .................. 16 years and over.......................................... Not reported................................................. 88 86 10 a 121 189 198 143 169 426 183 196 137 161 417 11 11 21 10 9 138.9 51 2.7 205.4 186.9 147.9 146.2 82.7 4 2 .1 2 .6 8 5 100.6 9 14 1.5 4.2 3.3 27 200.9 18 2.6 270.5 225.4 181.0 ’ 95.2 11 2 2 1 .6 2 .1 3 5 1 4.1 0.9 33 2.7 1 24 18 16 12 41 3 104.1 131.1 91.8 116.8 74.5 98.3 2 6 2 6 8 3.2 1 .0 4.2 4.7 2.r 9 Not shown where base is less than 100 . 83 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 84 T IN F A N T MORTALITY. able 3 . — Number and per cent distribution o f deaths among infants born in selected' year to mothers o f specified nationality, by cause o f death. Native mothers. All mothers. Cause of death. Foreign-bom mothers. Per Per Infant cent Infant Per Infant cent mor mor Total mor cent Deaths. tality dis Deaths. dis dis deaths. tality tribu tality tribu rate. tribu rate. tion. rate. tion. tion. 138.9 100.0 54.9 50 •31.8 7 3.8 51 27.4 39.5 22.9 2.7 19.8 18 26 7 9.7 14.0 3.8 1 0 .1 20 10.8 1 .6 8.6 1 .2 6 .2 All causes............................... 337 130.3 100.0 79 108.4 100.0 258 Gastric and intestinal diseases___ Respiratory diseases........................ Malformations.................................. Early inianey................................... 125 72 48.3 27.8 4.6 29.0 37.1 21.4 3.6 22.3 23 13 5 24 31.6 17.8 6.9 32.9 29.1 16.5 6.3 30.4 102 Premature birth........................ Congenital debility................... Injuries at birth........................ 25 40 10 9.7 15.5 3.9 7.4 11.9 3.0 7 14 3 9.6 19.2 4.1 8.9 17.7 3.8 Epidemic diseases...........; ............... Diseases ill defined or unknown— Allother causes.............................. 23 7 23 8.9 2.7 8.9 6.8 2 .1 6.8 3 4 7 4.1 5.5 9.6 3.8 5.1 8.9 12 75 Portuguese white. All causes.......................... ... 134 77 98.2 100.0 50.7 25.4 0.7 10.4 12 7 3 17 29.5 17.2 7.4 41.8 25.5 14.9 6.4 36.2 22 28.1 23.0 3.8 25.5 28.6 23.4 3.9 26.0 10 6 1 24.6 14.7 2.5 21.3 7 12 .8 2 .1 11 2 8.9 14.0 9.1 14.3 6.0 0.7 6.7 3.0 2 .6 2.6 15.0 1.5 9.0 7.5 0.7 4.5 3 7.4 2.5 9.8 6.4 7 2 .1 1 6 8.9 1.3 7.7 9.1 1.3 7.8 101.9 51.0 1.5 14 2 1.0 1 1.5 13.5 Epidemic diseases........................... Diseases ill defined or unknown— All other causes................................ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis . 10 1 6 All other foreign bom . 100.0 Premature birth........................ Congenital debility................... Injuries at birth........................ 9 4 7.8 115.5 68 1 2.7 47 200.9 Gastric and intestinal diseases....... Respiratory diseases........................ Malformations.................................. Early infancy................................... 34 French Canadian. 3 16 7.0 100.0 1 4 8.5 18 3 20 JSTEW BEDFORD, M ASS. T 4 .— Number and -per cent distribution o f deaths o f infants born in New Bedford in selected year and o f infant deaths in the registration area in 1914, by cause o f death. able. Infant deaths in- Abridged In ternational List.« Detailed Internar tional List.« Cause of death. 6 New Bedford. Per Num-? cent ber. distributton. A ll causes. 102,103. 104....... 20 . ................ Part of 2 3 ... 22 Part of 3 3 ... Part o f 3 3 ... Part of 33 ; part of 37 . Part of 3 7 ... 89.. 91.. 92.. 150. 1 5 1 fl)..:............ 15l<2), 152(2), 153... 152(1)................. 5................... 6 . . . . .................... 7 ................... 8 . . . . .................... 9................. 10............... Part of 12... 14...................... Part of I I . . . 18...................... Part of 3 7 ... 24...................... 1 3 .. . .................. 28,29.____. . . . . 14............ 3 0 ..................... 1&_______ 31, 32, 33,34, 35. Part of 37... 37............ .......... 3 5 .................. 1564o 186'......... 38_________ 187,188,189___ 17............... Part of 37__ 1 9 .. . . . ; ............. Numher. 337 100.0 155; 075 125 37.1 124 72 75 25 -40 36.8 21.4 3.6 13.6 4.2 3.6 22.3 7.4 11.9 37,736 2,556 35,180 24,036 3,458 13,653 6.925 9,663 52,535 28, 270 18,549 10 3.0 Gastric and intestinal diseases «... Diseases of the stomach......... Diarrhea and’ enteritis............ Respiratory diseases e ....... ........... Acute bronchitis.------- . . . . . . . Broncho-pneumonia............... Pneumonia.. . . __ . . . . . . . ___ ' 46 1.4 E arly infancy ........................ ..;.., Premature birth . .................... Congenital debility................. Injuries at birth........................ Epidemic diseases «•........... ............ Measles..................... .............. ; Scarlet fever______ __________ Whooping cough...................... Diphtheria and croup.............. Influenza;......... ......... .............. Dysentery......... ........ ............... Erysipelas.................... ............ Tetanus..................................... Tuberculosis of the lungs........ Tuberculosis meningitis .......... Other forms; of tuberculosis.. . . SypMBs____________ ___ _____ External causes............................. Diseases®!! defined or unknown... ABother causes....... ..... .............. . Ifeningftis..................... . Convulsions_________ . ______ Organic diseases o f the heart.., Other.............. ..................... ..... Malformations________________ Registration area. 1 12 12 23 Or8 6.8 3.0 0.6 0.3 0.9 0.6 1.2 0.3 '¿T 0.6 0.6 5,716 12,714 1,041 204 3,899 977 4SI 573 740 368 883 1,118 448 1,982 1.926 2,964 13,501 1.659 2,950 596 81 , 296 Per cent distri'button. m o 24.3 1,6 22; 7 15t 3- 2.2 8/8 4.5 6.2 33.9 18' 2 12.0 3.7 8.2 0.7 0 .1 2.5 0. 6 0.3 0.4 0. 5 0 .2 0 .6 0.7 0.3 1.3 1 .2 1.9 8.7 1.1 ft90.1 5 .3 ® The numbers indicate the classification in the abridged and detailed lists, respectively , of the Manual of the International Erst o f Causes o f Death, &The eauses of death ineludedinthis list are those used by the IT. S. Bureau of the Census! see Mortahtv Statistics, 1914,p. 660), in classifying the deaths of infants under 1 year. They are those causes of death or groups*» causes which are mostimportant at this age. The numbers of the detailed and abridgedinternationalnsts will facilitate their identification. In order to make discussion of the figures easier, these causes of death have been grouped in eight mam groups; c The terra gastric and intestinal diseases, as used! in the tables and discussion, includes, as above shown, onlythe diseases of this type which are mostimportant among infants, I. e., diseases of the stomach, maiTheaand enteritis. It does not include all “ diseases, of the digestive system” as classified under tans heading according to the detailed International List. d Respiratory diseases, as used in the tables-and discussion, similarly, includes only those of the respira tory diseases which are most important among infants, i. e., acute bronchitis, broncho-pneumonia and pneumonia. It does not include all “ diseases of the respiratory system ’ ’ as classified under this heading according to the detailed International List. e Epidemic diseases, as used in the tables and discussion, includes only those of this group which are most important among infants. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 86 T IN F A N T MORTALITY, able 5 . — Deaths o f infants born durinq selected year occurring in specified month, by cause o f death. Month of death. Total. deaths. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Cause of death. A ll causes................... Gastric and intestinal able 3 2 2 1 33 3 35 17 4 15 5 3 4 10 1 6 7 2 8 7 1 5 6 1 2 2 2 4 3 2 2 1 2 6 1 2 2 1 3 2 1 3 1 2 2 1 1 1 1 3 1 4 5 3 4 3 11 1 6 6 6 1 12 1 9 3 3 5 4 5 1 10 T 34 125 -72 Congenital debility....... A ll other causes.................... 34 26 25 40 or 42 31 75 defined 49 29 12 ill 12 22 Early infancy....................... Diseases 14 337 9 1 2 2 4 1 1 23 1 5 5 7 23 1 1 2 - 1 3 4 6 1 4 3 9 4 4 22 22 2 1 1 2 1 3 6 . — Deaths among infants born during selected year occurring in specified month q ' life, by cause o f death. Deaths in specified month of life. 2 weeks, but under 1 month. | Second. I Third. 1 Fourth. | Fifth. Sixth. | Seventh. I Eighth. I Ninth. j Tenth. | Eleventh. All causes.................................... 337 102 84 18 32 24 34 25 20 33 15 15 19 9 9 11 4 7 16 7 14 5 17 14 11 8 6 5 6 11 6 16 9 1 6 2 3 1 1 4 2 3 1 L 2 2 1 Total deaths. 125 72 12 Early infancy........................................ 75 able 4 12 68 2 11 2 1 63 5 1 25 33 24 29 10 10 10 23 7 23 3 1 1 2 25 40 T I Total. Cause of death. 1 3 2 3 4 1 5 1 1 1 2 3 3 5 5 3 6 4 1 1 2 5 Twelfth. Under 2 weeks. First. 5 2 1 1 1 7 . — Deaths among infants horn during selected year in each precinct o f residence, by cause o f death. Precinct of residence. Cause of death. All causes Total — deaths. ^ 4 5 6 7 8 9 10 1 1 12 13 14 15 16 17 18 3 5 2 10 7 6 *>0 7 5 3 1 1 2 2 6 1 2 1' 5 3 2 1 2 1 1 T 2 2 2 9 1 1 13 4 Premature birth... Congenital debility Injuries at b irth ... https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 337 65 52 24 Gastric and intestinal diseases----Respiratory diseases...................... Malformations................................ Early infancy................................. Epidemic diseases.......................... Diseases ill defined or unknown.. All other causes.............................. 2 23 3 7 ... 23 7 0 9 4 3 1 3 1 1 3 38 1 2 1 2 12 11 1 3 3 1 2 1 7 7 2 1 3 6 21 54 27 8 28 12 i 2 6 8 11 8 1 3 5 3 1 1 1 3 1 1 1 1 5 1 2 7 1 1 3 1 1 1 5 1 1 1 4 1 1 3 2 2 1 1 3 2 2 87 N E W BEDFORD, MASS. T able 8 . — 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. Age at death. Foreign-born mothers. Native mothers. All mothers. Per cent, Per cent Per cent Number. distribu« Number. distribu Number. distribu tion. ' tion. tion. 337 100.0 79 100.0 258 100.0 102 30.3 29 36.7 73 28.3 41 9 1 2 .2 12 15.2 3.8 29 1 1 .2 4 1 .2 15 15 18 32 24 79 63 37 2.7 3 4.5 4.5 5.3 7 ■ 2.3 6 4 1 .6 2 8 5 8.9 2.5 6.3 13 13 3.1 5.0 5.0 9.5 7.1 23.4 18.7 95 19 9 11.4 6.3 24.1 11.4 8.9 7.4 23.3 20.9 1 1 .0 8 1 0 .1 23 19 60 54 29 1 1 .2 T a b l e 9 . — Births from all pregnancies, infant deaths, infant mortality rate, and per cent o f stillbirths, according to order o f birth and age o f mother. Stillbirths. Order of birth and age of mother. Live births. Total births. Infant Infant cent deaths. mortality rate.« Number. Per of total births.« All pregnancies., 9,340 9,073 1,463 161.2 267 2.9 Under 20...................... 20 to 24......................... 25 to 29......................... 30 to 34......................... 35 to 39......................... 40 and over.................. Not reported.......... 755 3,234 2,949 1,555 667 174 735 3,158 232.7 167.8 140.9 142.6 170.8 186.7 20 76 81 53 29 2.6 8 2.4 2.7 3.4 4.3 4.6 6 171 530 404 214 109 31 4 6 2,868 1,502 638 166 , First pregnancy... 2,625 2,531 404 159.6 94 3.6 Under 20...................... 20 to 24......................... 25 to 29......................... 30 to 34......................... 35 to 39......................... 40 and over.................. 552 1,379 556 539 1,337 529 122 226.3 154.1 115.3 107.8 13 42 27 9 3 2.4 3.0 4.9 Second pregnancy. 206 61 102 20 11 4 1 1,981 1,928 285 147.8 53 2.7 Under 20...................... 20 to 24............... .— 25 to 29......................... 30 to 34......................... 35 to 39......................... 40 and over.................. 162 982 641 160 156 961 622 155 32 36 152 79 14 4 230.8 158.2 127.0 90.3 6 21 3.7 Third pregnancy.. 1,451 1,421 202 142.2 30 Under 20..................... 20 to 24......................... 25 to 29........................ 80 to 34......................... 35 to 39............. ......... 40 and over................ Not reported.............. 38 520 626 216 37 510 612 11 91 76 212 22 2 111 23 4 34 2 1 a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 19 5 8 .1 2 .1 3.0 3.1 2 2 45 4 i Not shown where base is less than 100. 178.4 124.2 103.8 1 10 14 4 1 2 .1 1.9 2 .2 1.9 ........... ............ 88 T IN F A N T MORTALITY, a b l e 9 . — Births from all pregnancies, infant deaths, infant mortality rate, and per cent o f stillbirths, according to order o f birth and age o f mother-—Continued. Stillbirths. Order at birth and age of mother. Fourth pregnancy............... .................. 20 to ........................................................... 25 to 29................. ................. ...................... 30 to 34..... ..................................................... 35 to 39 Total births. 1,038 2 238 480 255 54 7 20 to 24__ 25 to 29........................................................... 30 to 34.................................. ...................... 35 to 39........................................ ................. 158 2 1 236 472 252 53 50 75 24 7 1 710 693 104 1 1 86 1 21 87 307 233 66 14 2 Sixth pregnancy................................... 1,023 6 2 2 Fifth pregnancy..................................... Infant mortality Per cent rate. Number. of total births. Infant births. Live births. 491 302 225 64 13 44 29 7 2 2 473 77 18 179 190 74 6 30 26 154.4 15 1.4 211.9 158.9 95.2 2 8 0.8 3 150.1 17 145.7 128.9 5 18 3.7 5 2.7 5.0 I 162.8 12 1 11 1 Seventh pregnancy................................ 354 339 74 218.3 15 25 to 29... ................................ 30 to 34........................................................... 35 to 3 9 ...i . . _ ...................... , ........ 7 94 152 93 4 26 27 15 188.8 9 4 8 7 93 143 89 7 Eighth pregnancy.................................. 246 236 64 20 to 24... 25 to29 ... . .. 30 to 34............. ............................................. 35 to 39........................................................... 2 2 Ninth pregnancy................................... 20 to 25 to 30 to 35 to 24 29... 34 . 39 35 108 74 17 33 166 165 36 1 1 17 65 63 5 14 15 6 20 110 105 19 30 to 34 . ..................... 35 to 3 9 ............*.............................. ............. 4 27 56 23 4 27 52 7 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 305.6 4 3 2 8 4.2 5.9 4.1 3.6 1 218.2 1 181.0 5 0.6 1 2 4 1 271.2 4 Tenth pregnancy................................... 10 2 1 1 21 17 65 63 19 22 167.6 136.8 2 77 18 37 1 .6 3.4 12 2 1 112 2.4 1 18 184 76 1 .2 8 2 20 to 24.............................. ........................... 25 to 29........................................................... 30 to 34......................... ................................ 35 to 39... ................................ 200 1.7 .1 1 4 1 4.5 N E W BEDFORD, MASS. 89 T a b l e 10.— Mothers reporting specified number o f stillbirths, according to the number o f births to mother. Mothers reporting specified number of stillbirths. Total mothers. Number of births to mother. None. AH mother®.................... ...... .., 1 . . . ................... 2 ................................ 3....................................... 4.................................... 5 . . . ............................. 8 ............................. 7...................................... 3.......................................... 9.......................... 1 0 .................................... 1 1 ...................... 1 2 ............................. 13............................. 14............ ................... 15.................................... 16......... .............................. 17............................................ 1 i 2,604 2,38g 176 632 524 406 329 215 141 103 7» 62 37 25 18 13 608 500 375 303 tâ» 125 94 61 49 . 29 24 23 25 24 g 31 8 1 1 15 7 3 6 8 10 6 6 6 5 12 13 2 1 i 1 1 3 2 1 ................ T a b l e 1 1 .— Mothers reporting specified number o f mfemt deaths, by number o f live births to mother. Mothers reporting specified number of infant deaths. Total mothers. Ulve birth® to mother. None. AH mothers 2,579 1. 637 528 405 323 208 1« 114 68 57 39 22 13 10 7 6 2 2. 3. 4. 5. 6. 7. S. 9. 1 &. 11 . 12. 13. 14. 15. 18. T able 12. 1 1,656 ; 597 1,555 422 270 184 94 51 42 19 7 6 3 1 i 82 96 108 96 70 53 35 18 16 9 5 1 4 3 1 1 2 3 4 5 209 65 28 10 19 24 35 32 23 25 22 14 13 8 3 3 6 9 I® 8 5 6 8 2 2 3 1 2 2 3 2 4 4 5 3 3 1 1 6- 7 9 9 4 1 I 4 2 1 2 '3 2 I 1 2 2 ......... Total births and number and 'per cent o f plural births resulting from all pregnancies, according to age o f mother. Plural births. Age of mother. Total births. Number. Per cent.» A11 ages..................................... Under 20....................... 20 to 24.......................... 25 to 29.......................... 30 to 34.......................... 35 to 39............................... 40 and over..................... Not reported.................... ........................................... ....................................................... .............. ....................................... ................................................... ° Not shown where base is less than 100. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 9,340 152 1.6 755 3,234 2,949 1,555 667 174 6 4 42 51 30 14 11 .5 1.3 1.7 1.9 2.1 6.3 90 IN F A N T MORTALITY, T a b l e 1 3 . — Births during selected year and number and 'per cent o f births to mothers with specified kind o f attendant, according to nationality o f mother. Attendant at birth. Total births. Nationality of mother. Other, none, or not reported. Midwife. Physician. Number. Per cent. Number. Per cent. Number. Per cent. French Canadian................. Canadian (except French).. 2,662 1,934 72.7 615 23.1 113 753 1,909 698 1,236 92.7 64.7 42 573 . 5.6 30.0 13 685 76 415 27 223 226 60 70 126 210 30.7 43.4 99.3 96.3 54.3 86.7 98.3 97.1 389 40 56.8 52.6 .5 1 a T able 33 412 26 12 1 196 59 68 111 8 8 .1 . 2 100 1.7 5.2 86 1 2 .6 1 1 3.7 4 1 .8 3 45.7 11.5 1.7 2.9 8.7 102 26 1 2 11 ........ 4.2 3.9 .2 4 3.2 1 - 100.0 Including 60 Irish, 8 Scotch, and 2 Welsh. 1 4 .— Births in selected year, infant deaths, infant mortality rate, and per cent o f stillbirths, according to attendant at birth and nativity o f mother. Stillbirths. Attendant at birth and nativity of mother. Total births. Live births. Infant deaths. Infant mortality cent rate.® Number. Per of total births. All mothers.......................................... 2,662 2,587 337 130.3 75 2 .8 Physician........................................................ Midwife........................................................... Other, none, or not reported......................... 1,934 615 113 1,870 609 108 216 103 18 115.5 169.1 166.7 64 3.3 Native mothers....................................... .753 729 79 108.4 24 3.2 Physician........................................................ 698 42 13 677 42 71 104.9 3.0 10 6 2 21 Foreign-born mothers............................. 1,909 1,858 258 138.9 51 2.7 Physician........................................................ 1,236 573 121.5 171.1 163.3 3.5 100 145 97 16 43 Other, none, or not reported......................... 1,193 567 98 6 2 1 .0 2 .0 a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where base is less than 100. 6 5 1 .0 4.4 3 N E W BEDFORD, MASS, T 91 15. Number and per cent distribution, by type o f feeding, o f infants bovn during selected year and surviving at end o f third, sixth, and ninth months, according to nation ality o f mother. able Infants surviving at end of— Type of feeding and nationality of mother. Third month. Num ber.« All mothers............................. Breast exclusively................... Mixed.......................... Artificial exclusively................. Not reported............................. Per cent distri bution. 2,429 1,602 226 600 Sixth month. Num ber.® 2,350 66.0 1,054 1 9.3 24.7 (“ ) Native mothers................ 686 100.0 667 Breast exclusively................ . Mixed......................... Artificial exclusively................... 427 40 219 62.2 5.8 31.9 297 Foreign-born mothers............... Per cent distri bution. 873 44.9 (a) 44.5 285 Ninth month. Num ber.® Per cent distri bution. 2,287 100.0 594 623 1,069 26.0 27.2 46.7 (a) 658 100.0 163 143 352 24.8 21.7 53.5 1,629 100.0 431 480 717 26.5 29.5 44.0 1,743 100.0 1,683 1,175 186 381 67.4 10.7 21.9 757 1 0 .1 Portuguese-white mothers___ 619 100.0 583 100.0 549 100.0 Breast exclusively....................... Mixed............. ................. Artificial exclusively...................... 372 100 60.1 16.2 23.7 232 147 39.8 22 *o 146 149 254 26.6 27.1 46.3 1,124 100.0 1,10 0 100.0 1,080 100.0 803 86 71.4 7.7 1 20.8 0 .1 285 331 463 26.4 3u. 6 42.9 Breast exclusively........... Mixed.............................. Artificial exclusively................. Not reported..........'.................... Other foreign-born mothers................ Breast exclusively....................... Mixed................ *............. Artificial exclusively.................... Not reported.................... ........ ' a 1 234 0 .1 588 368 45.0 20.0 oo. O 1 Excluding one infant with foreign-born mother for whom feeding was not reported. 1 5 4 2 2 0 °— 2 0 ------- 7 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 0 .1 0 .1 IN F A N T MORTALITY, 92 T a b l e 16.— Infants bom during selected year to mothers o f specified nativity and sur viving at beginning o f the month, number and per cent o f infants dying subsequently in 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. Subsequent infant deaths in— Month of life and type of feeding. Foreign-born mothers. Native mothers. Subsequent infant deaths in— Subsequent infant deaths in— Total First year. infant sur vivors. TnSpeci faut fied sur- First year. month. vivSpeci Num Per ors. fied ber. <sent.“ Num Per month. ber. <sent.® Infont survivors. First year. Speci fied Num Per month. ber. 3ent.® 729 79 10 .8 29 1,858 258 13.9 73 569 2 18 16 125 17 60 38 6.7 16 17.6 148 13 54 43 9.6 2 22 8 1,537 1 80 27.4 13 43 32 700 50 7.1 9 1,785 185 10.4 23 13 5 14 491 29 180 19 3.9 5 26 "Ì4.*4 4 1,355 1 128 301 4 91 22 7? 6.7 17.2 23.9 9 4 19 1 1 Third m onth... 2,453 5.9 5 1,762 162 9.2 19 2 1,180 63 5.3 78 1 1 .2 3 21 First month___ 2,587 337 13.0 102 Breast exclusively. . . 2,106 98 Mixed......................... Artificial exclusively. 322 60 Not fed, died at once. 186 15 76 60 8.8 24 23.6 Second m onth. 2,485 235 9.5 Breast exclusively — 1,846 157 M ixed....................... Artificial exclusively. 481 110 6.0 3 17 17 1 17.2 20.4 27 98 24 8.3 203 7 4.5 Breast exclusively. . . 1,609 227 M ixed......................... 616 Artificial exclusively. 73 24 106 10 .6 17.2 16 Fourth month. 2,429 179 7.4 691 429 40 41 10 2.3 36 5.2 9 1,743 143 8 .2 25 6 3 27 1 .6 10.3 997 252 493 39 24 80 3.9 9.5 16.2 8 6 11 677 27 4.0 29 3.3 8.7 14.2 12 .6 Fifth m on th ... 2,395 145 6 .1 25 9 5 1,718 118 6.9 882 284 551 26 17 75 2.9 4 68 277 2 21 7.6 5 20 672 22 3.3 5 1,698 2 3 1 .0 1 17 5.9 758 341 598 17 2.5 30 19 96 1 1 .6 1 20 Sixth m onth... 2,370 120 5.1 2 .1 1 .2 100 4.0 9.1 4 14 4.3 33 667 2 ' 833 548 968 1 Eighth month.. 2,317 14 18 68 67 Breast exclusively.. Mixed....................... Artificial exclusively 719 589 1,008 45 Ninth month.. 2,302 52 Breast exclusively.. Mixed___ •.............. . Artificial exclusively 596 625 1,080 10 12 6 11 35 0.4 1.7 3.3 7.0 9 23 239 115 313 3 13 2 .6 2.9 15 660 10 •1.5 1.4 3 1 1 8 0.5 8 1 .2 1 4.5 2 10 198 133 329 2.3 15 658 2 .0 2 2 11 1 .0 1 .8 3.2 163 143 352 1 1 7 4.2 0 .8 2.4 0.7 2 .0 1 a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Not shown where base is less than 100. 4 1 15 98 5.8 15 19 15 64 2.5 4-4 10.7 4 19 7 1,683 83 4.9 26 594 433 655 13 15 55 2 .2 3.5 8.4 7 13 2 1,657 57 3.4 13 521 456 679 9 11 2 2 37 1.7 2.4 5.4 44 2.7 15 6 10 1.4 2 2 11 4 1 Breast exclusively.. Mixed....................... Artificial exclusively. 6.0 13.6 1 298 85 289 13 1 332 4 Breast exclusively__ 1,214 352 Mixed......................... 828 Artificial exclusively. 19.8 1 1 2,350 1 686 45 27 107 Seventh month 5 365 59 262 Breast exclusively. . . 1,362 311 Mixed......................... 755 Artificial exclusively. 17 81 187 394 34 8 - 6 20 22 1 222 1 Breast exclusively.. 1,056 426 Mixed......................... 887 Artificial exclusively 1 3 28 1 2.5 5.4 197 43 2 5 1 1 1 1 1 1 1 9 1 1,644 433 482 728 1 28 2 .1 3.8 93 N E W BEDFORD, MASS, T a b l e 1 7 .— Infants bom during selected year and surviving at end o f 3, 6, and 9 months o f age, whose mothers had specified working status, and number and per cent artificially fed according to nationality o f mother. Type of feeding at specified age and nation ality of mother. Total infant survivors. Mother not gainfully employed before specified time. Mother gainfully em ployed before speci fied time— At home. Away from home. Mother gainfully employed, but time of resump tion not reported. At home. ALL M OTH EKS. Infants living at end of 3 months. . Number artificially fe d ............ Per cent artificially fed ............ Infants living at end of 6 m onths.. Number artificially fed............ Per cent artificially fed ............ Infants living at end of 9 months. . Number artificially fe d ...........: Per cent artificially fed............ N A T IV E 2,429 600 24.7 2,350 873 37.1 2,287 1,069 46.7 24.3 33.4 41.7 1,873 456 1,629 544 1,469 613 18.0 29.1 39.0 384 69 406 118 413 161 45.9 68.5 73.7 157 72 302 207 392 289 15 3 20.0 13 4 30.8 13 6 46.2 M OTHERS. Infantslivingatend of3months___ Number artificially fed............ Per cent artificially fed ............ Infants living at end of 6 months. . Number artificially fed ............ Per cent artificially fed............ Infants living at end of 9 m onths.. Number artificially fed............ Per cent artificially fed ............ 686 31.9 42.7 53.5 219 667 285 658 352 30.8 39.6 49.3 598 184 538 213 511 252 33.3 57 19 27 55.6 68 44.1 56.9 30 72 41 72.4 80.6 58 42 4 1 25.0 3 72 58 3 1 33.3 F O R E IG N -B O R N M O T H E R S . Infants living at end of 3 m onths... Number artificially fed.............. Per cent artificially fe d .............. Infants living at end of 6 m onths... Number artificially fed .............. Per cent artificially fed .............. Infants living at end of 9 m onths... Number artificially fed .............. Per cent artificially fed.............. 21.9 34.9 44.0 1,743 381 1,683 588 21.3 30.3 1,629 717 37.7 1,275 272 1,091 331 958 361 15.3 327 50 338 26.0 35.2 88 341 120 43.8 67.6 72.2 130 57 244 165 320 231 11 2 18.2 10 4 40.0 10 5 50.0 Portuguese-w hite mothers. Infants living at end of 3 months. . . Number artificially fed .............. Per cent artificially fe d .............. Infants living at end of 6 months. . . Number artificially fe d .............. Per cent artificially fed .............. Infants living at end of 9 months. . . Number artificially fed .............. Per cent artificially fed .............. 23.7 619 147 583 37.7 46.3 220 549 254 22.8 29.4 430 98 16.0 340 100 102 44.1 121 28.1 286 35.7 119 19 34 12 1 39.7 48 71.7 73.6 68 2 120 86 2 30 140 103 50.0 2 1 O ther fo re ig n -h o rn mothers. Infants living at end of 3 months... Number artificially fed .............. Per cent artificially fed .............. Infants living at end of 6 m onths... Number artificially fed .............. Per cent artificially fed .............. Infants 1iving at end of 9 months. . . Number artificially fed .............. Per cent artificially fed .............. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 20.8 1,124 234 1,10 0 33.5 42.9 368 1,080 463 845 174 20.6 30.8 38.5 751 231 672 259 14.9 24.9 208 31 217 54 43.5 63.7 220 32.7 72 71.1 62 27 124 79 180 128 9 2 2 .2 50.0 50.0 2 8 4 g 4 94 IN F A N T MORTALITY. T a b l e 1 8 .— B irth s d u r in g se le c te d yea r in ea ch fa th e r 's ea rn in g s g rou p , a c c o r d in g to o c c u p a tio n o f fa th e r . Earnings of father. Occupation of father. Total births. Under $450 $550 to to $450. $549. $649. $650 to Not $850 $1,050 $1,250 No re and earn to to 1,049. $1,249. over. ings. ported. 2,662 453 387 625 308 85 173 Manufacturing and mechan ical industries.................. 1,730 321 257 425 188 44 61 All occupations. 36 Bakers................................ Blacksmiths................................. Builders and contractors............ Compositors and linotype oper ators........................... .............. Electricians.................................. Factory operatives and la borers.............................. 1,304 369 275 221 298 Cotton mills............................. 1,091 31 Other textile mills.................. 95 Metal and glass industries— 41 Shoe industry.......................... 46 Other industries— '............... 54 Firemen and stationary^ engineers Laborers,helpers and apprentices 41 (not in factory).......................... Machinists, millwrights, and tool46 makers......................................... Manufacturers, proprietors, man 27 agers, and officials...................... Shoemakers and cobblers (not in 9 factory).......... ........................... 164 Skilled mechanics, building trades 7 Tailors........................................... Others in maunfacturing and 5 mechanical industries.............. 329 14 16 4 230 190 249 Trade. Bankers, brokers, real estate and insurance agents......................... Deliverymen.................................. Laborers......................................... Retail and wholesale dealers (pro prietors, officials, and managers) Salesmen and commercial trav elers.......... ................................ . Others in trade............................. 6 2 24 6 .19 2 13 10 10 8 Domestic and personal service.......... .................... 14 6 23 10 10 18 3 10 21 7 3 53 1 2 86 354 20 70 29 144 85 6 10 20 Transportation. Chauffeurs, teamsters, expressmen.............................................. Conductors, motormen, locomo tive engineers, and trainmen— Express, post, telegraph, and tele phone employees........................ Laborers.......... ............................. Sailors, stevedores, and longshore men.......... ................................... Others in transportation.............. 21 68 36 9 31 26 8 120 18 19 36 Barbers......................................... Cooks and waiters........................ -Janitors and elevator operators.. Laborers....................................... Servants....................................... Others in domestic and personal service....................................... Public service. Firemen and policemen. Laborers......................... Others in public service. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 83 12 N E W BEDFOKD, MASS, T a b l e 18. 95 Births during selected year in each father's earnings group, accordino to occupation o f father— Continued. Earnings of father. Total births. Under $450 $550 $650 $850 $1,050 $1,250 No Not to to to to to and earn re $450. «549. $649. «849. «1,049. $1,249. over. ings. ported. Occupation of father. Agriculture, fishing, and mining............................. Farmers and farm workers.......... Fishermen.......................... 73 36 14 5 4 6 24 43 10 5 7 2 3 3 25 3 2 Clerical occupations (all industries)....... ............... Professional and semiprofessiona 1 pursuits.............. No occupation and not reported “ .......................... “ 55 3 6 33 1 6 11 2 1 « 2 1 1 1 1 1 6 5 13 . ...... A4 36 4 36 j 1 uase wnere me iatner uvea on Uis income and 35 in which the father did not contribute to t a o S t o & ^ S ^ S S - ’ 5 inabiUty t0 work because of sickness ’ 1 a student’ 511(1 T a b l e 1 9 — Births during selected year in families o f specified number o f persons and mother nUmher Persons P ^ fam ily, according to earnings o f father and nativity o f of mother. All mothers. Under $450....... $450 to $549...... $550 to $649...... $650 to $849___ $850to $1,049... $1,050 to $1,249. $1,250 and over. No earnings___ Not reported... Native mothers. Under $450....... $450 to $549___ $550 to $649___ $650 to $849___ $850 to $1,049.., $1,050 to $1,249. $1,250and over. No earnings.... Not reported... Foreign-born mothers. Under $450....... $450 to $5 49.... $550 to $649___ $650 to $849___ $850 to $1,049... $1,050 to $1,249. $1,250 and over. No earnings___ Not reported... a Births during selected year in families of specified number of persons, a Average number of per fam sons per All fami 5 7 Over ily. 6 family. lies, total 1 2 3 4 or 6 or 8 8 births. 3.8 2,662 16 760 634 486 482 201 79 4 3.9 3.8 3.7 4.0 4.0 3.7 3.7 2 1 2 148 136 128 165 81 29 56 134 108 79 153 81 15 1 11 11 51 14 ■24 3 9 45 34 27 43 25 41 7 106 84 67 114 56 13 32 3 100 4.2 551 453 387 625 308 85 173 36 44 3.4 753 13 271 193 128 3.5 3.2 3.3 3.5 3.5 3.5 3.3 • 2.4 3.5 60 67 107 194 146 44 2 1 1 20 14 16 23 49 46 11 12 102 2 2.6 17 16 4.0 1,909 3.9 3.9 3.9 4.3 4.4 4.0 4.1 491 386 280 431 162 41 71 19 28 2 .8 4.6 2 9 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 28 44 71 45 17 38 4 4 25 3 5 3 489 441 120 1 128 108 84 94 36 92 56 104 35 12 8 7 ...... Excluding infant born during selected year. 11 6 20 2 12 18 7 16 2 6 4 17 34 22 6 20 1 82 78 121 8 13 8 6 28 5 2 4 2 106 27 14 6 ' 8 4 1 2 1 6 4 4 1 1 2 17 30 25 7 4 4 5 11 1 1 358 376 174 65 95 72 50 80 34 7 94 74 61 91 26 7 13 41 33 13 7 12 2 6 2 8 1 1 22 37 21 7 9 6 24 6 Infants boarded out. i 1 1 1 3 1 10 3 i 3 1 1 2 1 1 IN F A N T MORTALITY. 96 T able 2 0 . — Num ber and per cent distribution o f live births in selected year to mothers o f specified nativity in and outside “ unfavorable” area, according to earnings o f father. Live births to mothers who lived— In “ unfavorable” area. Earnings of father. Outside “ unfavor able” area. Per cent Per cent Number. distribu Number. distribu tion. tion. ' A ll classes................. 1,488 100.0 1,099 100.9 Under $450.......................... $450 to $549......................... $550 to $649......................... $650 to $849....................... $850 to $1.049...................... $1,050 to $1,249................... $1,250 and over............... . No earnings...................... . Not reported...................... 380 298 234 316 25.5 2 1 .2 8 .1 2 .0 150 144 146 294 176 54 20 4.4 1.3 24 1 .6 14 19 13.6 13.1 13.3 ¿6.3 16.0 4.9 9.3 1.3 1.7 12 1 30 65 20.0 15.7 102 Native mothers.......... 276 100.0 453 100.9 Under $450......................... $450 to $549......................... $550 to $649....................... . $650 to $849....................... $850 to $1,049.................... . $1,050 to $1,249................. $1,250 and over.......... . No earnings............... . N ot reported............ .. 30 36 46 74 42 9 25 10.9 13.0 16.7 26.8 15.2 3.3 9.1 2.9 26 29 60 113 99 34 73 9 5.7 - 6.4 13.2 24.9 21.9 7.5 16.1 2 .2 10 2.0 2 .2 Foreign-born mothers 1 ,2 1 2 100.0 646 100.0 28.9 124 115 19.2 17.8 13.3 28.0 11.9 3.1 4.5 8 6 350 262 188 242 79 Under $450...................... $450 to $549...............'.----$550 to $649........ ....... . — $650 to $849................... . $850to $1,049.................... $1,050 to $1,249................. $1,250 and over................. No earnings....................... Not reported..................... T 2 1 .6 15.5 20.0 21 40 6.5 1.7 3.3 12 1 .0 18 1.5 86 181 77 20 29 5 9 0 .8 1.4 2 1 .— Births during selected year, infant deaths, infant m ortality rate, and per cent o f stillbirths, according to em ploym ent o f mother during year before birth o f infant. able Stillbirths. Employment of mother during year before birth ofinfant. Total births. Live births. Infant deaths. Infant mortality Percent rate.® Number. oftotal births.® All mothers. 2,662 2,587 337 130.3 Not gainfully employed. Gainfully employed....... 1,420 1,242 1,370 1,217 149 188 108.8 154.5 360 302 58 882 820 13 13 21 15 353 296 57 864 804 13 12 20 15 43 37 121.8 125.0 At home.................................... Keeping lodgers................. Other home work.............. Away from home...................... Textile m ill operatives___ Other factory operatives. . Clerks and saleswomen----Servants, charwomen, e tc. Other occupations.............. a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 6 145 141 Not shown where base is less than 100. 167.8 175.4 75 2.3 3.5 2.0 1.9 2.0 2.0 2.0 N E W BEDFORD, MASS, 97 T able 22.— Bvrths during selected year, infant deaths, infant mortality rate, and per cent o f stillbirths, according to employment o f mother during year preceding birth o f in f ant and interval between cessation o f work in cotton mills and confinement. Stillbirths. Employment of mother during year before birth of infant and interval between cessation of work in cotton mills and confinement. All mothers....... ............................. Not gainfully employed..................................... Gainfully employed"............................ Total births. Live births. Infant Infant deaths. ityrate.e 2,662 2,587 337 130.3 1,420 1,242 1,370 1,217 149 188 108.8 154.5 812 798 141 In cotton m ills................................................. Ceased work— Less than 1 week................................ 1 week but less than 1 month............ 1 month but less than 3 months....... 3 months but less than 6 months___ 6 months and over............................. No cessation............................................... No report.................................................. Other work away from home.......................... At home.......................................................... 5 19 144 389 249 5 4 19 140 383 246 5 3 24 70 40 70 360 353 Native mothers............................................ 753 Not gainfully employed......................................... Gainfully employed............................. In cotton mills........................... Ceased work— 1 month but less than 3 months....... 3 months but less than 6 months___ 6 months and over............................. No cessation............................................. No report...................................... Other work away from home.......................... At home........................ ~........... F oreign-bom mothers............................... Number Per cent oftotal births.« 50 25 3.5 14 1.7 4 2 .8 2 .8 2 171.4 182.8 162.6 3 4 43 1 2 1 .8 7 729 79 108.4 502 251 484 245 47 32 97.1 144 142 22 22 22 2 10 1 1 66 2 .6 2 6 1.5 1 .2 1.9 3.2 18 6 3.6 2.4 1.4 62 58 61 57 1 1 1 35 72 34 69 2 8 1,909 1,858 258 138.9 51 2.7 102 115.1 32 19 3.5 1.9 12 1 .8 4 5 L5 1 1 1 9 Not gainfully employed......................................... Gainfully e m p loy ed ..................................... 918 991 972 In cotton mills........................ Ceased work— Less than 1 week................................ 1 week but less than 1 month............ 1 month but less than 3 months....... 3 months but less than 6 m onths___ 6 months and over......................... No cessation....................................... Other work away from home...................... At hom e....................................... 668 656 5 19 327 191 4 35 288 4 19 118 322 189 4 32 284 60 31 Portuguese-white m others.......................... 685 667 134 312 373 302 365 50 84 257 251 1 3 54 127 71 1 1 3 53 124 69 274.2 3 2.4 1 1 34 19 19 181.0 2 1.9 Not gainfully employed................................ Gainfully employed............................... In cotton mills...................... Ceased work— Less than 1 week................................ I week but less than 1 month__ ___ 1 month but less than 3 months....... 3 months but less than 6 months. . . 6 months and over..................... No cessation........................ At home.................................... 122 9 107 105 1 a Not shown where base is less than 100. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 156 2 3 22 186.4 186.3 164,0 1 .0 2 35 1.4 200.9 2 .6 10 8 3.2 2 .1 2.3 11 % 98 IN F A N T MORTALITY. T a b l e 2 2 . — 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 o f infant and interval between cessation o f work in cotton mills and confinement— Contd. Stillbirths. Employment of mother during year before birth or infant and interval between cessation of work in cotton mills and confinement. Total Live births. • births. Infant Infant mortal deaths. ity cent rate.“ Number. Per of total births.“ Other foreign-born mothers......................... 1,224 1,191 124 104.1 33 2.7 Not gainfully employed......................................... Gainfully employed................................................ 606 618 584 607 52 72 89.0 118.6 22 11 3.6 In cotton mills................................................. Ceased work— 411 405 54 133.3 6 1.5 4 16 3 16 1 3 68 20Ò 120 198 26 120 131.3 12 1 2 100.0 1 week but less than 1 month............ 1 month but less than 3 months....... 3 months but less than 6 months. . . . At home........................................................... 1 11 3 23 179 3 26 181 1 .8 3 2 1 .0 3 16 89.4 2 1 .1 T a b l e 2 3 . — Live births during selected year, infant deaths, and infant mortality rate, according to employment o f mother during year following birth o f infant. Infant deaths. Infant mortality rate.“ 2,587 337 130.3 1,539 1,048 142 195 92.3 186.1 470 417 53 578 543 4 49 45 4 146 139 104.3 107.9 11 3 3 Live births. Employment of mother during year following birth of infant. At home............. ........................................................................................ Other liomework............................................... ................................. Other factory operatives................. .•......................... .................. / . . . Clerks and saleswomen....................................................................... Other o c c u p a t i o n s ......................................................................... 13 252.6 256.0 1 T a b l e 2 4 . — Live births, infant deaths, infant mortality rate, and per cent o f deaths from gastric and intestinal diseases, according to employment o f mother during year following birth o f infant, and infant’s age when mother resumed work in cotton mills, and nation ality o f mother. Employment of mother during year following birth of infant, and infant’s age when mother resinned work in cotton mills, and nationality of mother. Live births. Infant deaths. Infant mortality rate.“ Deaths from gastric and intestinal diseases. Number. Per cent of all deaths.“ All mothers.................................................... 2,587 337 130.3 125 37.1 Not gainfully employed................................................. Gainfully employed....................................................... 1,539 1,048 142 195 92.3 186.1 36 89 25.4 45.6 In cotton mills........................................................ Resumed after baby’s death........................... Resumed during baby’s life............................. Under 2 weeks...'....................................... 2 weeks and under 1 month...................... 1 month and under 2 ................................. 2 months and under 3................................ 3 months and over..................................... Other work away from home................................. At home................................................................... 540 97 443 138 97 41 255.6 92.6 63 39 24 56.1 11 104.3 22 a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 14 58 66 303 38 470 1 3 13 7 17 8 49 Not shown where base is less than 100. 1 2 3 4 N E W BEDFORD, MASS. 99 24 Live births, infant deaths, infant mortality rate, and per cent o f deaths from gastric and intestinal diseases, according to employment o f mother during yearfollowinq birth o f infant, and infant s age when mother resumed work in cotton mills, and nation ality o f mother— Continued. a b l e ™ a u .x» aj.k, o-iJ-VA a W I I t ill m o c i i e r r 0 S U I ll € work in cotton mills, and nationality of mother. T * Live births. Infant deaths. Infant mortality rate.“ Deaths from gastric and intestinal diseases. Number. Native mothers. 729 79 108.4 Not gainfully employed. Gainfully employed____ 534 195 41 38 76.8 194.9 In cotton mills................................. Resumed after baby’s death___ Resumed during baby’s life.___ Under 2 weeks...................... 2 weeks and under 1 month . 1 month and under 2 ........... 2 months and under 3.......... 3 months and over............... Other work away from hom e. . . . . . . At home......., .......................... Foreign-bom mothers. Not gainfully employed. Gainfully employed...... In cotton mills................................... Resumed after baby’s death___ Resumed during baby’s life...... Under 2 weeks...................... 2 weeks and under 1 month. 1 month and under 2 ........... 2 months and under 3.......... 3 months and over............... Other work away from home........... At home........................... Portuguese-white mothers. Not gainfully employed. Gainfully employed___ In cotton mills................................... Resumed after baby’s death___ Resumed during baby’s life...... Under 2 weeks...................... 2 weeks and under 1 month. 1 month and under 2 ........... 2 months and under 3 .......... 3 months and over............... Other work away from home........... A t home......................... Other foreign-bom mothers. Not gainfully em ployed. Gainfully employed........ In cotton mills................................... Resumed after baby’ s death___ Resumed during baby’s l i fe ..... 2 weeks and under 1 month. 1 month and under 2 ........... 2 months and under 3.......... 3 months and over............... Other work away from home....... At home...................... 96 20 76 23 27 20 7 1 1 1 1 3 11 9 52 15 84 6 1,858 258 138.9 1,005 853 101 157 100.5 184.1 24.8 49.0 111 250.0 47.7 444 77 367 1 11 4 5 77 34 111.4 51.8 667 134 200.9 321 346 49 85 152.6 245.7 194 31 163 57 31 26 293.8 1 8 50.7 1 11 28 194.4 1,191 124 104.1 684 507 52 72 76.0 142.0 250 46 204 54 46 216.0 8 1 39.2 6 68 9 5 144 16 29 153 15 242 39.5 2 12 7 13 3 43 5 31 28 98 102 92.6 47 57 251 23 386 3 2 2 3 15 ° Not shown where base is less than 100. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Per cent of all deaths.« 13.1 62.0 27.4 100 IN F A N T MORTALITY. T a b l e 25.— Number and per cent distribution o f births during selected year to gainfully employed mothers o f specified nativity, according to earnings o f rmther during year following birth o f infant. Earnings of mother. Total births. All classes............................................ TTnrlpr $150 - ....................................... Foreign-bom mothers. Native mothers. All mothers. Per cent distribu tion. Percent distribu tion. Births. Per cent distribu tion. Births. 1,077 100.0 203 100.0 874 100.0 419 269 176 141 31 41 38.9 25.0 16.3 13.1 2.9 3.8 72 43 44 26 3 15 35.5 347 226 132 115 28 26 39.7 25.» 15.1 13.2 3.2 3.0 2 1 .2 21.7 12 .8 1.5 7.4 T a b l e 26.— Births in selected year to foreign-horn mothers gainfully employed in specified . way during year following birth o f infant, according to literacy and nationality o f mother. Births to foreign-born mothers. Gainfully employed year after confinement. Not gainfully employed year after confine At home. ment. Literacy and nationality of mother. Total. Total. In cotton mills. Other work away from home. Foreign-born mothers___ 1,909 874 458 25 391 1,035 Able to read and write.............. Unable to read and write.......... Not reported............................... 1,183 714 265 191 14 9 12 497 368 9 2 218 168 5 346 3 2 686 Portuguese-white mothers. 685 354 200 8 148 331 Able to read and write.............. Unable to read and write.......... Not reported............................. 238 443 4 119 231 4 68 132 2 4 49 95 212 2 2 Other foreign-bom mothers 1,224 520 258 17 245 704 Able to read and w rite............. Unable to read and write----Not reported.............................. 945 271 g 378 137 5 197 59 12 169 73 3 567 134 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 5 119 101 N E W BEDFORD, MASS. T 2 7 .— Birthsin selected year to foreign-born mothers gainfully employed in specified way during yearfollow ing birth o f infant, according to nationality ana years o f residence o f mother m the United States. ' able Births to foreign-born mothers. Gainfully employed year after confinement. Nationality of mother and years in United States. Total. Total. All foreign-born mothers___ Less than 3 years.......... 3 to 4 years........................ 5 to 9 years.................... 10 years and over............. Not reported...... .......... Portuguese-white mothers................... Less than 3 years............... 3 to 4 years...................... 5 to 9 years................... 10 years and over............... Not reported................ Other foreign-born mothers............... Less than 3 years............. 3 to 4 years...................... 5 1o 9 years................... 10 years and over...................... Not reported........................ https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis In cotton mills. 1,909 874 458 189 217 528 961 14 117 116 283 353 5 59~ 64 153 180 685 354 101 Other work away from home. 25 ¡T At home. 391 Not gain fully em ployed year after confine ment. 1,035 2 2 6 11 53~ 50 124 162 M 2 245 608 9 200 8 146 331 72 51 123 107 36 30 72 62 3 1 1 2 33 50 43 110 1,224 520 258 17 245 704 88 45 65 160 246 4 23 34 81 118 2 1 20 43 69 83 233 265 3 134 295 696 11 1 2 5 9 20 30 74 1 1Q 72 101 29 32 158 102 IN F A N T MORTALITY, T a b l e 2 8 . — Births in selected year to mothers employed in cotton mills during year fo l lowing confinement, according to specified number o f persons in fam ily, and earnings o f father and nationality o f mother. Births during selected year to mothers employed in cotton mills year follow ing confinement. In families of specified num ber of persons, a Earnings of father and nationality of mother.Total. Less than 3. All mothers.................... Father’s earnings: 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............................. No report................................ Native mothers................ Father’s earnings: Under $450............................... $450 to $549.............................. $550 to $649.............................. $650 to $849.............................. $850 to $1,049........................... $1,250 and over........................ No earnings............................ No report...............................Foreign-born mothers___ Father’s earnings: Under $450............................... $450 to $549.................. . $550 to $649.............................. $650 to $849.............................. $850 to $1,049........................... $1,050 to $1,249........................ $1,250and over....................... No earnings............................. N o report................................ Portguese-white mothers... Father’s earnings: Under $450............................... $450 to $549............. ................ $550 to $649.............................. $650 to $849.............................. $850 to $1,049........................... No earnings............................. No report.............................. . Other foreign-born mothers Father’s earnings: 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............................ No report................................ a https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 but less than 6. 6 and over. 557 253 263 41 190 134 81 59 48 40 9 97 62 46 43 5 12 3 15 7 1 2 12 1 3 5 1 99 55 40 4 20 ii 9 14 8 1 10 8 1 1 2 100 90 16 2 18 25 21 11 1 1 9 13 6 7 2 5 4 1 1 7 5 2 2 458 198 223 37 170 116 75 69 70 50 34 29 5 89 53 36 35 4 11 2 11 2 2 8 1 1 7 1 1 1 13 5 5 2 5 1 3 1 200 105 87 8 99 49 29 16 51 29 15 45 19 4 4 1 6 71 67 46 53 10 2 2 4 3 Excluding infant born during selected year. 3 1 2 2 2 2 258 12 8 1 93 136 29 19 44 34 24 27 3 8 12 21 19 23 5 1 1 3 1 1 1 1 1 3 3 2 1 103 _ N E W BEDFORD, MASS. T a b l e 29.— Dwellings a occupied by mothers o f specified nath\ty, according to specified sanitary condition o f dwelling. Dwellings occupied by— Sanitary condition of dwelling. Total dwellings......... Rooms: Clean............................. Medium........................ Dirty............................. Not reported............... Water supply: C ity........................... Dug well...................... Driven well.................. Spring........................... Not reported................ Type of toilet: Water-closet................. Wet privy.................... Dry p rivy.................... Cesspool........................ No toilet....................... Not reported................ Location of toilet: In dwelling.................. On porch...................... In yard......................... In cellar........................ No toilet....................... Not reported................ Sewer connection: Sink connected............ Sipk not connected. . . , Not reported................ Toilet connected.......... Toilet not connected... No toilet....................... Not reported................ All Native Foreignborn mothers. mothers. mothers. 2,638 747 1,891 1,166 1,249 159 64 404 285 36 762 964 123 42 2,586 27 9 4 733 22 8 2 1 12 3 2,502 43 87 713 1,853 19 7 3 9 27 1,789 37 60 3 1 2 1 2 1,815 19 137 656 555 6 2 1 1,260 9 104 509 2 1 8 10 1 10 2,565 728 17 66 7 2,491 140 1 6 33 147 - 2 709 36 1,837 49 5 1,782 104 2 4 1 a Dwelling means place in which family lived during greater part of year following baby’s birth, or in case of stillborn child, where mother spent greater part of her period of pregnancy. Difference between number of dwellings and number of births shown in other tables is due to the fact that there were 22 sets of twins, 6 to native mothers and 16 to foreign-born mothers, and 1 set of triplets to foreign-born mother. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 104 IN F A N T MORTALITY. T a b l e 3 0 . — 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. Total births. Persons® in dwelling and nativity of mother. 2 3 4 5 6 7 8 9 1 17 152 745 990 360 210 78 33 22 8 21 360 1 463 458 . . . 376 291 248 169 104 69 3 7 45 36 32 139 173 159 105 77 55 27 114 160 171 143 109 109 73 42 31 32 33 55 51 50 45 45 28 15 14 23 1 8 11 2 1 13 5 13 5 5 5 7 1 1 1 2 4 4 5 7 2 1 1 6 1 7 15 18 27 30 15 26 28 15 29 37 Total.............................. 2,662 Persons in dwelling: 2 ......................................... 3............................ . . . . . . . 4......................................... 5......................................... 6 ......................................... 7....................................... 8 ........................................ 9......................................... 10 ....................................... 2 2 1 1 1 20 11 4 3 1 102 32 Native mothers................ Persons in dwelling: 2 ......................................... 3............................. ........... 4......................................... 5......................................... 6 ......................................... 7............ ............................ 8 ....................................... 9........................................ 10 ....................................... 6 2 1 1 753 . . . . 2 33 184 232 133 72 144 167 133 103 83 51 27 i 1 12 53 50 41 48 59 39 27 27 15 9 3 4 16 31 6 8 4 10 2 4 1 20 12 21 9 7 2 1 9 4 Foreign-bom mothers___ 1,909 Persons in dwelling: 2 ......................................... 3 . . . . ............ ........ ............. 4 ......................................... 5......................................... 0 ................... ...................... 7......................................... 8 ......................................... 9......................................... 10 ....................................... 1 1 or more......................... Not reported..................... 206 296 325 273 208 197 142 84 57 93 28 1 1 15 119 2 6 2 2 1 22 1 1 2 1 33 32 18 7 4 561 86 123 118 84 68 48 25 5 2 1 1 20 22 20 11 2 5 11 8 1 13 6 6 8 5 3 3 758 227 138 66 10 1 17 24 31 28 25 34 26 7 9 16 17 9 6 10 ii 20 1 4 8 9 1 132 116 82 94 64 39 27 31 6 3 6 2 10 1 1 3 3 4 2 2 2 1 3 1 1 22 14 6 1 2 1 1 3 4 ? 5 4 5 3 2 1 2 1 3 3 3 3 2 1 41 ' l l 1 1 6 5 4 8 1 1 2 2 1 3 1 25 1 2 2 1 1 i i i 5 23 15 3 i 4 i 3 1 2 2 1 1 2 2 6 1 1 1 1 2 3 22 1 1 8 2 20 20 12 5 3 7 27 i i i 1 2 1 3 3 1 20 1 a Excluding infant bom during selected year. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 12 and No re over. port. 1 N E W BEDFORD, MASS, T 105 31. Births in selected year, infant deaths, infant mortality rate, and per cent stillbirths, according to number o f persons per room in selected area and nativity mother. * able Stillbirths. Persons a per room and nativity 6f mother. All mothers............ '........... In unfavorable area: All mothers............................. Less than 1............................... 1but less than 2 ........................... 2 but less than 3 ........................... 3 but less than 5...................... Not reported............................. Native mothers............................ Less than 1.......................... 1but less than 2 ....................... 2 but less than 3 ...................... Foreign-bom mothers.......................... Less than 1............................ 1but less than 2................ 2 but less than 3.............................. 3 but less than 5............................ Not reported............................. In favorable area: All mothers...................... Native mothers................... F oreign-bom mothers.......................... a Total births. Infant deaths. Infant mortality rate.& 2,662 1,527 565 819 113 5 25 282 147 125 1,488 546 801 1,245 418 694 103 5 25 1,212 5 25 3 9 1,135 471 664 1,099 453 646 41 63 10 Excluding infant born during selected year. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Live births. 111 5 25 276 143 124 9 403 677 102 b 129 25 3 9 4 195 107 161.0 Number. Per cent of total births, b 75 2.8 39 19 18 2.6 3.4 2.2 1.8 1 160.9 136.5 33 15 17 1 905 Not shown where base is less than 100. 2.1 2.7 0.8 2.7 3.6 2.4 1.0 3.2 3.8 2.7 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INDEX. Page. at death, analysis of infant mortality b y . 25-27 causes of death reflected by...................... -27 Age of mother, analysis of infant mortality rate b y ..................................... 29 analysis of plural births b y ....................... 30 and occupation, classification of illegiti mate births b y ................................ 65 stillbirth rate b y ...................... 28 Annual report of board of health for 1915, ex cerpt from................ 49 Area, registration, birth. S e e Birth-registra tion area. death. See Death-registration area, “ unfavorable.” S e e “ Unfavorable” area. Artificial feeding. S e e Feeding, artificial. Ashes, refuse, and garbage, disposal of.......... 53 Association, Instructive Nursing. S e e In structive Nursing Association. Asylum, infant, in Holyoke, infant mortality rate increased b y ............................. 11 Attendance at birth. S e e Birth, attendance at. Average number of persons per room. S e e Housing. 18 Azores, Portuguese immigrants from the....... Age Bacteriologist, samples of milk analyzed by.. 50 See also Milk supply. Birth, attendance at, by midwives, according to nationality................................ 30-31,67 30,67 by physicians................. infant mortality rate by..................... 31 other than physician or midwife....... 32 Birth certificate, fee provided for return o f.. 47 for child of illegitimate birth, information concerning father prohibited on... 63 midwives required to return..................... 31,47 penalty for failure to return................ 47 physicians and midwives required to 47 return, in specified time................. statement in regard to legitimacy omitted from................. ........... ...... . ............. 63 Birth, child of illegitimate,. court action against father of............................... 65 data unsatisfactory for....... ................ 74 disposition of....................................... 64 information concerning father pro hibited on birth certificate for.'___ 63 order of, analysis of infant mortality rate b y ......................... 29 analysis of stillbirths by.....................28,29 Birth rate for New Bedford......................... 11-12 Birth-registration area, admission to, of Massachusetts.................................. 47 requirement for.. — .......................... 47 infant mortality rate for, and for specified States and cities in, in.1915............ 66,71 States comprised in, in 1915. j................... 71 154220°— 20— - 8 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Page. Births, classes of, included m report............... 74 excluded, infant mortality rates for.. 77-78 distribution of, by earnings of father....... 67 by earnings of father and nativity of m other...................... 3g by occupation of father................. . 36,67 illegitimate, classification of, by age, occupation, and n a t i o n a l i t y of mother................................... 65 comparison of mortality rate for, with average rate...................................... 76 comparison of mortality rate for, with rate for legitimate births................ 64 comparison of rates for, in specified Massachusetts cities........................ 63 comparison of, with percentages for 63 foreign countries.............................. •xcessive mortality among, causes of. 64 exclusion of.................. ................. 74,76,77 liability of father under law in cases o f.............................. ................... . 65 mothers of, care received in confine ment b y ............................................ 64 proportion of, among total registered bifth s............................................... 63 stillbirths among, number of............. 64 l i v e , exclusions of, for specified rea sons............................................ 13,74,76,77 per cent of, in “ unfavorable” area... 15 number of, according to average number of persons per r o o m ......................... 61-62 by age of mother................................. 29 by order of birth........... ................. 7. 29 by sex, and by nativity 0 f mother.. . 28 plural, analysis of, by age of mother........ infant mortality rate for.................. stillbirth rate for................................. 30 30 28 proportion of, in lower economic groups. 37-38 69 to illiterate mothers............................ 20,66 registered, canvass to supplement........... 75,77 infant mortality rate for................ 78 " proportion of illegitimate births among................ 63 use of, as basis for study..................... 13 registration of stillbirths as....................... still. S e e Stillbirths, to mothers of specified nationality, ac cording to their ability to speak English.......................................... 21 to mothers of specified nativity gainfully employed after childbirth, by earn ings of father.................................... 41 79 unregistered, exclusion of, from stu d y ... 77 exclusion of infant deaths among___ 77 percentage of, in study........... ........... 48,78 107 108 INDEX, Page. Board of charity, State, control of infant 54 hoarding homes by....................... licenses for infant-boarding homes granted by........................................ 54 Board of health, activities of, toward pre vention of infant mortality.............48-49 annual report of, for 1915, excerpt from. . 49 cooperation of, in improvement of dumps...........................................-53 54 licensing of day nurseries by............. oculist employed by.............................. 32 permit secured from, for use of land as dump.... ............ 53 48 personnel of---------------power of, to limit number of occupants in tenement or lodging house_____ 59 to order vacated any dwelling unfit for habitation....... *................... ...... 59 Portuguese-speaking nurse employed by. 32 provisions of, covering milk supply------- 49-50 State, supervision of water supply by.,.. 51 supervision by, over collection and dis posal of garbage....................... 53 over milk supply............................>.. 49 symptoms of ophthalmia neonatorum to 32 be reported to---------------------------treatment of ophthalmia neonatorum by oculist employed by.................... 32,48 visits of nurse from.................. 48 Boarding homes, infant, control of, by State board of charity..................... 54 law relating to............................... 54 licensed, number of,in New Bedford. 54 Brava, island of, emigration from, by Portu guese Negroes........... ......... 19 “ Bravas,” Portuguese Negroes known as— 17,19 Brockton and New Bedford. S e e New Bed ford and Brockton. Campaign for improvement of milk supply.. 51 Canvass, registered births supplemented by a 75,77 Cape Verde Islands, “ Bravas” from.............. 17,19 Care of unmarried mothers in confinement. . 64 Causes of death. S e e Death, causes of. Causes of variations in infant mortality rates, method of determining— ............. 71 Certificate, birth. See Birth certificate. Characteristics of cities investigated............... 72 Charity, board of. S e e Board of charity. Child bom out of wedlock. S e e Birth, child of illegitimate. Child, illegitimate. S e e Birth, child of illegiti mate. Children’s Bureau, law creating, passage of, by Sixty-second Congress............... 71 precedence given in, to study of infant m ortality.....------- --------- . . . . . . . . 71 method of determining infant mortality ; rate b y .................................... 73 studies of infant mortality previously made b y ........................................... 11 Cities selected for investigation, characteris tics o f.......................... — .............. 72 Cities, specified, comparison of, by rates for illegitimate births............................ 63 comparison of infant mortality rates for, by age at death,............................... 26 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Page. Cities, comparison of infant mortality rates for, by cause of death............ 23-24,66-67 ^ infant mortality studies previously m ad ein ............................... 11 stillbirth rates for, comparison of. — 27 textile manufacturing, infant mortality rates for............. H City water. S e e Water, city. Civic and social factors.............................. 47-54,68 Clinics, services of physicians for................... 54 Conditions, improvement in, since time of study, through: Activities of health department.............. 68 Housing law of 1915..........................i ----- < 59 New system of sewage disposal............... 52 54 Passage erf new day-nursery law............ Confinement, care received in, b y unmarried mothers............................. ; ........... 64 Conclusions of the study................................. 66-69 Contrast between New Bedford and Brock ton. S e e New Bedford and Brock ton, contrast between. Cooperation of city officials, etc., in study— 13 of mothers in study.......... ........................ 13,76 Cotton mills. S e e Mills, cotton. Cottontextiles, manufacture of, chief industry. 36 Court action against father of child of illegiti mate birth.......... ......... 65 Court proceedings in specified cases of ille gitimacy............................................ 65 Dairies. S e e Milk supply. Data submitted in report, births covered by. 74 D ay nurseries, lack of official supervision o f.. 54 licensing of, requirement of law of 1919 pertaining t o ...............................— 54 16 Day nursery in ward 1........ — ....... - ..........- Death, age at__________ ______ - ....................25-27 influence of nationality upon...............26-27 cause o f............................ - .................. 22,66-67 25 by calendar months............... relation of feeding to............................ 36 causes of, age at death reflects.................. 27 under 1 month........... ......................... 25 S e e a lso Mortality. I Death rate. S e e Mortality rate. Death-registration area, admission to, of Massachusetts—. ................. 47 i in 1910, infant mortality rate for.............. 71 mortality in, under 1 month..................... 25 |Deaths and stillbirths, confusion between.. . 79 i “ Death’s Hole,” type of cottage in ................ 57 Deaths, per cent distribution of, by age........ 26 per cent of, in “ unfavorable” area........... 16 registration of stillbirths as...... ............... 79 specified, exclusion of, from study............ 74,76 i Definition, of infant mortality rate.................. 72 of miscarriage.. . v .........- .........................27,78 of stillb irth .,.............................................. 27,78 Demonstration wagon, work of, in “ better m ilk” campaign...... ........................ 51 Diseases of early infancy, mortality rate from, by nationality.................................. 24 comparison of, with cities previously studied.,................................ 24,67 Diseases, gastric and intestinal. S e e Gastric and intestinal diseases. IN D E X , Page. Diseases, ophthalmia neonatorum. S e e Oph thalmia neonatorum, respiratory. S e e Respiratory diseases, specified, comparison of mortality from, for “ unfavorable” area with rest of city............................... 24-25 Disposal of ashes, refuse, and garbage......... 53 Disposal of sewage. S e e Sewage, method of disposal of. Distribution of economic groups.......................37-38 District. S e e Housing: Section {specified]. Dublin, Dr. Louis I., infant mortality study by, in Fall River, Mass...................... 19 Dumps, complaints against, as nuisances... 53 improvement of, cooperation in .............. 53 permit required for use o f lands as......... 53 use of, as playgrounds.......................... 53 Dwellings. S e e Housing: Dwellings. 109 Page. Employment of mother, gainful, before childbirth, influence of, upon in fant mortality rate.......................... 42-43 41 by-nativity......................................... classification of................................. 42 distribution of births, b y ................... 67 in cotton mills, analysis of................. 46 influence of, upon infant mortality rate............................................... 41-45,68 legislation in regard to........................ 47 poverty the cause o f................. 40-41,67-68 English, ability of mother to speak, infant mortality rate by............ ................ 66 and nationality, infant mortality rate and per cent of stillbirths b y ___ 21 Exclusion of specified births, reasons fo r ___ 13, 73-74,76-78 Exclusion of specified deaths, reasons for___74,76 Exclusion of miscarriages..................... 78 Exclusion of specified stillbirths, reasons for.......................... ...................... 78-79,80 Exclusions, infant mortality rate for specified classes of, analysis of....... ................ 78 Eyes, care of, at birth...................................... 32 diseased, symptoms of, to be reported to board of health............ ....... 32 S e e a lso Ophthalmia neonatorum. Early infancy, diseases of. S e e Diseases of early infancy. Earnings of father and gainful employment of mother, relation between.......... 40-41, 46,67-68 Earnings of father and nativity of mother, distribution of births b y ....... ....... 38 infant mortality rate b y ............................38-39 relation between........................................ 38 stillbirth rate b y . . ; ................ ; ................ 39 Factors, civic and social............................... 47-54 Earnings of father, births to mothers of speci economic................... ................................ 36-47 fied nativity gainfully employed Fall River, Mass., results of infant mortality after childbirth, by............. 41 study in, by Dr. Louis I. Dublin.. 19 distribution of births b y ...................... 37-38,67 Families, distribution of, by earnings of economic status classified b y ................... 37 father................................................ 37-38 influence of, upon infant morta lity rate. 39,67,69 Family, economic status of, determined by S e e a lso Economic status. earnings of father............................. 37 Economic groups, distribution of..................... 37-38 40 size of, and economic status.................... Economic status and size of family, relation relation of nativity to......................... 40 between..... ............ 40 Father, liability of, under law, in cases of Economic status, earnings of father basis of illegitimate births......... ................. 65 classification for.............................. 37 Father’s earnings. S e e Earnings of father. influence of, upon housing congestion... 62 Feeding, artificial, among infants of mothers upon infant mortality rate............ 38-39,67 of specified working status, by age relation of, to gainful employment of of infant........................................... 45 mother............................... 40-41,46,67-68 comparison of, with breast feeding.. 34-36 Economic status of families, in river section.. 55-56 importance of right methods in...........32,35 in “ unfavorable” area......................... 39-40 breast, comparison of, with artificial feed Economic status of mothers employed in ing..................................................... 34-36 cotton mills............................. 46 importance of..................................... 32 S e e also Earnings of father. relation of, to cause of death.................... 36 Employment of mother away from home type of, and employment of mother, re after childbirth, influence of, upon lation between........................ 45 infant mortality rate..................: . . 43-44 by month of life.................................... 33,34 upon mortality from gastric and intes comparison of, by nationality of tinal diseases.................................... 46 mother..................................... 33-34 upon type of feeding...................... 33,45-46 infant mortality affected by.............. 32 Employment of mother before childbirth infant mortality rates by.............. 34-36,67 and nativity of mother, births, in influence of gainful employment of fant mortality rate, and stillbirths mother upon............................... 33,45-46 b y ......................— ........................ 42 influence of nationality upon............. 33 Employment of mother, classification of influence of, upon health of surviving illegitimate births b y .................... 65 infants............. 33 gainful, after childbirth, births to mothers proportions of infants fed, by..................... 33 of specified nativity in each eco Fire protection. S ee Housing: Fire protec nomic group, b y ............................... 41 tion. away from home, comparison of, for Foreign-born mothers, literacy and ability New Bedford and Brockton........... 69 of, to speak English...........................20,66 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 110 INDEX, Page. Illegitimacy, court proceedings in specified cases of................... .......................... 65 special study of.......................................... 63-65 Gainful employment of mother. See Em Illegitimate births. S e e Births, illegitimate. ployment of mother, gainful. Illegitimate child. S e e Birth, child of ille Garbage, collection and disposal of................ 63 gitimate. supervision over, by board of health. 53 Immigration, effect upon, of industrial de extractor plant for...................................... 53 velopment.......................... 18 Gastric and intestinal diseases, mortality Improvement in conditions since time of from, among Portuguese. 23,36,67 study, through: by nativity of mother........................ 23 Activities of health department............ . * 68 comparison of, in specified cities.. 66-67,69 Housing law of 1915................................ 59 25 in summer months............................New system of sewage disposal................ 52 methods of prevention of............. 24,69 Passage of new day-nursery law................ 54 relation of feeding to............................ 24,36 Industries in New Bedford........................... 12,36 relation of gainful employment of Industry, development of, as affecting immi mother to.....................- .................. 46 gration........................................ 18 Infant mortality. S ee Mortality, infant. Health, board of. See Board of health. Infant welfare, problems of, methods applica Holyoke, infant asylum in, infant mortality ble t o . . . . . . . ...................................... 68 rate increased by............................. H Infant-welfare stations, efficacy of, in pre Homes, boarding. See Boarding homes. vention of infant mortality.............. 54,68 Hospital facilities for obstetrical cases..................... 31 maintenance of, by Instructive Nursing Hospitals, infant mortality rate for confine Association....................................... 54,68 ments in .. ..............................- ........ 31 volunteer services of physicians for......... 54 Housing: Inquiry, scope o f......................... 71-72 Average number of persons per room, in Instructive Nursing Association, work of— 54,68 fant mortality rate by..............— 61-62 Intestinal diseases. S e e Gastric and intes number of births by..............................61-62 tinal diseases. stillbirth rate by...................... . .......... 62 Dwellings unfit for habitation, power of board of health to order vacated. . . 59 Johnstown, Pa.,birth registration in, methods of supplementing............................. 75 Fire protection, legislation in regard to .. 59 methods of meeting regulations in 60 regard to.............__ ___ - ................. 60 Land congestion in relation to housing......... Law creating Children’s Bureau, passage of, Legislation, need of, to prevent lot con by Sixty-second Congress............... 71 61 gestion.........«.................................... precedence given in, to study of infant Section, “ Death’s Hole,” type of cottage mortality.......................... 71 in ........... ............................................ 57 “ Howland Village,” description of.. 58-59 Law, liability of father under, in cases of illegitimate births...................... 65 native-colored, description of............. 58 prohibiting information concerning father newer, description of............................ 58-59 on certificate for i Ilegitímate birth. 63 river, congestion in............................... 55-56 relating to employment of mothers......... 47 description of...................................55-57 enforcement of..................................... 47 economic status of families in-----55-56 relating to fire protection.......................... 59 typeis of houses in...... ....................55-56 relating to housing...................................... 59-60 ‘ ‘ unfavorable ’ ’ area included in . 55 relating to i nfant-boarding homes............ 54 well-to-do, description of......................57-58 Legislation, need of, to prevent lot conges Tenement or lodging house, number of tion............. 61 occupants in, power of board of S e e a ls o Law. health to limit.................................. 59 Legitimacy, statement in regard to, omission Housing, conditions of, no discrimination 63 of, from birth certificate.................. against colored persons in............... 58 Length of residence. S e e Residence, length congestion in, influence of economic fac of, in the United States. 62 tors upon......................................... within the home....................................61,62 Licenses for day nurseries, requirement of law pertaining t o .................................... 54 effect of, upon infant welfare.................... 55 findings of the study on.............................. 61-62 Licenses for infant-boarding homes, approval of board of health required for----54 land congestion in relation to................. 60 legislation in regard to.................................59-60 Life Tables, United, States, decline in mor tality rates shown in, by month method of discussion of............................. 55 of l if e ................................................ 27 nativity as related to................................ 62 poor, comprised in “ unfavorable” area. . 62 Literacy of mother and ability to speak Eng lish, influence of, upon infant mor problem of, that of regulation.....................60-61 tality rate........ ........................... 20- 22,66 “ Howland Village.” S e e Housing: Section, Literacy of mothers employed in cotton mills. 46 “ Howland Village.” Page. Foreign b o m , percentage of, in New Bedford. 12-13 proportion of,in “ unfavorable” area----66 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis INDEX, 111 Page. Page. Manchester, infant mortality rate for FrenchMortality, infants, b y order of birth.............. 29 Canadian group in........................... 12 causes of, by calendar m onths......... 25 and New Bedford, infant mortality rates comparison of, with mortality at for French-Canadian group in, con 71 other periods of life.................... trast between................................... 19 data, methods of treating.................. 73 Manufacture, cotton textiles chief product of. 36 efficacy of infant-welfare stations in Massachusetts, admission of, to birth-regis prevention o f ............ .................... 68 47 tration area....................... ............... excessive, among Portuguese group. 19, to death-registration area................... 47 67,68 Method of determining causes of variations in feeding in relation to......................... . 32,36 infant mortality rates..................... 71 24 from diseases of early infancy........... Method of determining infant mortality rate, from gastric and intestinal diseases. 22-24, by Children’s Bureau........... ............73,76 36,66-67 usual, inaccuracy of....................... 72-73,76,77 from respiratory diseases.....................24,67 Method of determining stillbirth rate............ 78-80 influence o f housing upon........ .'........ 55 Method of procedure in study....................13,71-80 Influence of nationality upon.. 18-19,26-27 Methods applicable to problems of infant precedence given to study of, in law welfare......................... 68 creating Children’ s Bureau............ 71 Methods of prevention, influence of national prevention of, activities of board of ity upon.................. 27 health tow ard...... ............................ 48-49 Methods of treating data, specified, true 76 study, method of procedure in ......... differences in the incidence of in study of, in Fall River, Mass., b y Dr. fant deaths obtained b y ................. 73 Louis I. D u b lin ............................. 19 Midwives, attendance at birth by............... 30-31,67 Mortality rate, infant, according to earnings of according to nationality....... ............. 31 father and nativity of mother.......... 38-39 cases attended by, visited by board of according to average number of per health nurse................1.................... 48 sons per room...................... 61-62 31 law ignores existence of............................. b y age 0 f mother......... ....................... 29 return of birth certificates required of.. .. 31,47 by attendance at birth........................ 31 “ Midwivesin Massachusetts,” excerpt from.. 32 by literacy of mother.......................... 20,66 Milk, method of testing.................................... 50 by mother’s ability to speak English. 20,66 Milk siipply, analysis of, by bacteriologist. . . 50 by mother’s length of residence in distribution of........ .................................. 49 the United States............................. 19-20 improvement of, campaign for................. 51 by nationality o f mother...............18-19,66 49 inspection of.............................................. by nationality of mother and ability methods of handling, improvement in. . . 51 to speak English ........... 21 omissions in regulations governing........: 50 by nativity of mother and employ provisions covering......................... 49-50 ment before childbirth.................... 42 regulation of specified standards for, by by precinct of residence...................... 15 State laws......................................... 50 by sex of infant and nativity of relation of cleanliness in, to gastric and mother.............................................. 28 intestinal diseases............ .............. 51 by type o f feeding....... .........................34-36 supervision of, by board of health........... 49 comparison of, for legitimate and ille Mill houses. See Housing. gitimate births................................ 64,76 Mills, cotton, economic status of mothers em conditions shown b y .......................... 71 ployed in.................... 46 decline in, as earnings of father in length of time before childbirth that crea se......................................... 39,67,69 mother’s employment in, ceased. . 43 decline in, for each month of life..................27 literacy 0 f mothers employed in........ 46 definition of......................................... 72 nativity of mothers employed in....... 46 differences in, according to gainful textile, mortality rate for infants of employment of mother before child mothers employed before child birth at home and away from home. 42 birth in............................................. 42 effect upon, of exclusion of illegiti Miscarriage, definition of................................. 27,78 mate births........................ 76 Miscarriages, exclusion of................................ 78,79 exclusive of Portuguese group......... . 68-69 registration of, accuracy of registration for artificially fed, differences in, by of stillbirths increased by............... 79 nativity.................. 35-36,67 and stillbirths, confusion between........... 79 for birth-registration area, in 1915____ 66,71 Mortality, infant, among illegitimate births, for births included in study.............. 15,78 factors in.............................. ; ......... 64 for death-registration area in 1910___ 71 by age at death, comparision of, for first-born children, by nationality for specified cities........................... 26 of mother.......................................... 29 by causes... . . ........... 22 for groups excluded from study.......... 77-78 by month of life of infant during for illegitimate births.................... 64 which mother commenced work for New Bedford and Brockton, con away from home .•........................... 44 trast between............................... .. 12,68 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 112 INDEX, Page. New Bedford and Brockton, birth registra tion supplemented in, by canvass. . 75 12,68-69 contrast between..................... 69 proportion of infants breast fed in ........... New Bedford and Manchester, contrast be tween, in infant mortality rates for French-Canadian group............... 19 Night soil, removal of, contract for, by private 53 company...................... j.................. Nurse employed by board of health, visits of, 48 in cases of childbirth................. Nurse, Portuguese-speaking, employed by board of health...................... •........ 32 Nursery, day. S e e Hay nursery. Nursing Association, Instructive. S e e In structive Nursing Association. Nationality, attendance at birth by mid Nursing, public-health, importance of ade wives , according to.......................... 31 quate facilities for................................ 68 effect of, upon customs of infant care— 18 groups, proportion of, in “ unfavorable” Obstetrical cases, hospital facilities for.......... 31 area............................ 16,17,66 Occupation and age of mother, classification influence of, upon infant’s age at death... 26-27 65 ofillegitimate births b y ...................... upon infant mortality rate for New Occupation of father, distribution of births by 36,67 Bedford and Brockton.......... , ........ 68 Oculist employed by board of health, treat upon methods of preventive work----27 ment of ophthalmia neonatorum by 32,48 upon type of feeding...................... 33 Ophthalmia neonatorum, treatment of, by population by.................................... 17-18,66 oculists employed by board of 28 stillbirth rates by.................................. health................................................32,48 Nationality of mother and ability to speak Order of birth. See Birth, order of. English, infant mortality rate and Ordinance relating to milk supply................... 49 per cent of stillbirths by................... 21 Ordinances relating to housing.........................59-60 Nationality of mother, comparison of type of 60 feeding by ................................... 33-34,67 Parks, number of, in New Bedford................ Pasteurization. S e e Milk supply. infant mortality rate, b y .......... ..........18-19,66 Penalty for failure to return birth certificates. 47 from specified diseases, b y .................. 23-24 Physicians, attendanc e at birth b y ................30,67 infants of illegitimate birth, by.......... 65 return of birth certificates required of, in influence of, upon attendance at birth... 30-31 specified tim e................................... 47 Native-colored district. See Housing: Sec services of, volunteer, for infant-welfare tion, native-colored. station s.......... .................... 54 Nativity, families living in “ unfavorable” Playgrounds, dumps used as.......................... 53 40 area, by........................................- number of, in New Bedford....................: 60 • influence of, upon infant mortality rates for artificially fed........................ 35-36,67 Plural births. S e e Births, plural. Police, cooperation of, in improvement of relation of, to gainful employment of dumps.............................................. 53 mother................... - .................... 40-42,46 Population of New Bedford........... ................ 12 to housing...................................... 62 Population, proportion of, foreign born— 12-13 to size of family................................. 40 17-18,66 Nativity of mother and earnings of father, 18 infant mortality rate by.................. 39 Portuguese, colony of, in New Bedford......... immigration b y ......................................... 19 per cent distribution of births by.......... 38 infant mortality excessive among, from relations between................................ 38 gastric and intestinal diseases... 23,36,67 stillbirth rate by................................. 39 infant mortality rate for New Bedford Nativity of mother and sex of infant, infant exclusive o f ..................................... 69 mortality rate and stillbirths by. . . . 28 Nativity of mother, attendance at birth by. . . 30 Portuguese Negroes, emigration by, from is land of Brava......................... 19 Negroes, no discrimination against, in condi Portuguese white, attendance upon, by mid 58 tions of housing......................... wives.......................... 67 New Bedford, birth rate for.................... 11 per cent of infants breast fed among........33-34 cotton textiles chief industry of.......... 12,36,66 death rate for....... — .............. ................. 12 Poverty, gainful employment of mother caused b y ........................... - ........... 40-41 description of............................ . . . . . . . . . 12 foreign element in............. "....................... 12 Precinct of residence, infant mortality rate b y ....................'............... ................ 15 industrial development of. . . . . . . . .... 12 Precincts 1, 2,3,13, and 17, description o f . .. 16 infant mortality fate for, in 1913....... 11 comprised i n “ unfavorable ’ ’ area........... 39 population of............................... 12 Prevention, methods of, influence of nation reasons for selection o f . . . . . . . .......... 11-12 ality upon....................... 27 wages low in............................... 66 Page. Mortality rate, infant, for New Bedford in 11 1913.......................................... - ....... for plural births................................... 30 for specified cities, by cause of death. 23 for specified Massachusetts cities....... 11 for States and cities in birth-registra tion area in 1915, variations in....... 71 for “ unfavorable” area, comparison of, with rest of city..................... 16,24-25,66 incomplete registration as affecting.. . 73,75 influence upon, of economic factors.. 38, 41-45,62,68 methods of determining............... 72-73,76 Mothers, unmarried, care received in confine ment by..............................— 64 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN D E X . Page. Privies, namber o f........................................... 52 Procedure, method of, in study............... . 13,71-80 Proceedings, court, in specified cases of ille 65 gitimacy..................... ..................... Piiblic-health nursing. S e e Nursing, public health. 113 Page. Stillbirth, definition of......... ............... ..........27,78 Stillbirth rate, by age of mother....................28,29 by average number of persons per room.. 62 by earnings of father and nativity of mother.............................................. 39 by literacy of mother............ ....... .......... 20 28 by nationality of mother.......................... Rate, birth. S e e Birth rate, by nationality o f mother and ability to death. S e e Mortality rate, speak English................................. 21 infant mortality. S e e Mortality rate, in by nativity of mother and employment fant. 42 before childbirth............................. stillbirth. S e e Stillbirth rate. by order of birth ....................................28,29 Refuse, disposal of, on dumps............ ........... 53 28 by sex, and by nativity of mother.......... S e e a lso Dumps. for plural births...................... .................. 28 Registered births. S e e Births, registered. foi specified cities, comparison of.............. 27 Registration area, birth. S e e Birth-registra methods of determining.................... ...... 78,79 tion area. Stillbirths, exclusions of, for specified rea death. S e e Death-registration area. sons...........'. . ............................. i 78-79,80 Registration,birth,canvass to supplement. 48,75,77 number of, among illegitimate births....... 64 comparison of,with deathregistration. 73 number and rate of................................... 27 influence of, upon choice of cities registration of, as births and deaths........ 79 72 to be studied............ ............ difficulty in supplementing....... ....... 79 methods of supplementing................... 48,75 increase in accuracy of, by registra thoroughness of, in New Bedford___ 48 tion of miscarriages........................ 79 death, comparison of, with birth registra law doubtful as to, in some States. . . 79 tion ................................................... 73 margin of error in................... 79 incomplete, comparability of infant mor physicians more conversant than tality rates affected b y . ................... 73,75 midwives with law concerning...... 79 methods of overcoming................. . . . 75 Street department, collection and disposal of Registration of miscarriages in some States. . . 79 ashes under supervision of................ 53 Registration of stillbirths as births and’ cooperation of, in improvement of dumps. 53 deaths.......... ..................................... 79 Streets, cleaning, sprinkling, and oiling of.. . 53 Registration of stillbirths, difficulty in sup paving of.................................................... 53 plementing.................................... 79 Study, cities selected for, characteristics of... 72 law doubtful as to, in some States........... 79 cooperation in, by city officials, e t c . 13 margin of error in ............................ 79 , by mothers............ ............ ................13,76 Residence, length of, in the United States, method of procedure in ....................... 13 71-80 influence of mother’ s, upon infant Summary and conclusions._ __________ _____ 66-69 mortality rate........................... 19 -20 Respiratory diseases, mortality from, amnng Tenements. S e e Housing. infants of Portuguese-white Test for milk. S e e Milk supply. mothers....... ..................................... 67 Textile mills. S e e MiHs, textile. comparison of, m specified cities. . . 24,67,69 Textiles, cotton, chief industry of New Bed 25 in winter months............................. ford.................................... .............. 36,66 prevention o f..... ...................... 69 Toilets, per cent of, connected with sewer___ 52 River section. S ee Housing: Section, river. S e e a lso Sewerage system; a lso Hous ing. Saginaw, birth registration in, methods of supplementing................................. 75 Type of feeding. S e e Feeding, type of. Sanitation...................... . . . . . ' ................ 5 1-5 3 “ Unfavorable” area, comparison of infant * S e e a lso Housing. mortality rate for, with rest of Scope of inquiry................ 71-72 City.................... 16,24-25,66 Section [specifiedj-of city, description of. S e e day nursery in .......................................... 45 Housing: Section.description of................................... 15-17,39-40 Sewage, method of disposal of, in 1913........... 52 families living in, economic status of.......39-40 in 1916......................................... 52 nativity o f......... ............................ 16,40,66 Sewerage system, adequacy of...... .................. 5 1-5 2 housing, poor, comprised in ......... . 62 Sex of infant and nativity of mother, analysis per cent of deaths in ......... ...................... 43 of infant mortality rate b y ............. 28 per cent of live births in ....... .................. 45 stillbirth rate b y ........................ 28 precincts 1,2, 3,13, and 17 comprised in, Sex, stillbirth rate b y ...................................... 28 description o f .. ........... .............. 16-17 39 Social agencies........................ 54 S e e a lso Housing: Section, river. Social and civic factors.................................... 47-54 United States Life Tables, decline in mor Stations, infant-welfare. S e e Infant-welfare tality rates shown in, by month of stations. life................. 27 Statistics, vital, records of, city clerks charged with keeping.......................... 47 Vital statistics. S e e Statistics, vital. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 114 INDEX, Page. Wages in New Bedford.................................... 66 Wagon, demonstration, work of, in “ better m ilk” campaign.............................. 51 Ward 1, day nursery in................................ . 16 description of................. ........................... 16,17 Water, city, generaluse of, b y population— 51 51 Water supply, source o f.............................. •• supervision of, by State board of health» 51 Page. Wedlock, child born out of. S e e Birth, child of illegitimate. Welfare, infant. See Infant welfare. stations, infant. S ee Infant-welfare sta tions. Well-to-do section. S e e Housing: Section, well-to-do. O https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis