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U .S. DEPARTMENT OF LABOR
W. B. WILSON. Secretary
CHILDREN’S BUREAU
JULIA G. LATHROP, Chief
INFANT MORTALITY
RESULTS OF A FIELD STUDY IN AKRON, OHIO,
BASED ON BIRTHS IN ONE YEAR
By
THERESA S. HALEY
IN FA N T M O R TA LIT Y SERIES No. 11
Bureau Publication No. 72
WASHINGTON
GOVERNMENT PRINTING OFFICE
1920
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U . S 'S 6
CONTENTS.
Page.
Letter of transmittal.......................................................................................................
9
Introduction.....................................................................................
11-13
Description of city ..................................................................................................... 11-12
Population—size and composition................................................................
12
Method of procedure.......................................................................... . ................
12
13
Cooperation.....................................
Analysis of findings..................................................................................................... . . 15-65
Infant mortality rate...............................................................................................
15
Infant mortality, by districts.................................................................................. 15-17
16
Valley and business districts...............................................
East exchange and southwest district..........................................................
17
Nativity and nationality of mother........................................................................17-21
Slavs.....................................................................................................
18
Italians......................................................
19
Germans.........................................
20
Magyars..............................................................................................................
20
Cause of death.......................................................................................................... 21-26
Causes peculiar to early infancy...................................................................
22
Gastric and intestinal diseases.______
23
Respiratory diseases..................................
25
Superstitions concerning cause of death....................................................
26
Age at death.........................................................................................................
26
Stillbirths..................................................
27
Sex...... ...........................................................................................................
28
28
Age of mother..............................................‘............................................................
Order of birth..............................................................
29
Confinement care..........................................................
29-32
Attendant at birth........................................................................................... •
29
Confinement period............ ..................
31
Maternal mortality.........................................................
32
Feeding.................................................................................
32-36
Mortality rates, by kind of‘feeding......................‘........................................
34
Economic status of fam ily..................................-................................................... 36-44
General industrial conditions........................................................................
37
Poverty..................................
37
Earnings of father.............................................................................................
37
Infant mortality and earnings of father.......................................................
38
Earnings of father and gainful employment of mother.............................
40
Gainful employment of mother.....................................................................
42
Gainful employment of mother and infant mortality...............................
43
Employment history....... ......................................
43
H o u s in g ................................................................................................................... 44_50
Lot and block crowding........................................
45
Housing regulations and enforcement..............................
46
R entals.......................................................................................
47
Conditions Tinder which babies included in the study lived ..................
48
Room crowding.........................................................
49
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CONTENTS.
Analysis of findings—Continued.
Page.
Civic factors.......................... i ..................................................................... : . 50-65
Birth and death registration......... ............................... ............................. 50-51
Birth registration................................
50
Death registration....... ................ ......... ......... ....... .............. ................
51
Hospital work...............................................
52
Nursing work.......... ...................... ............ .......... ......................................
52
Day nursery.............
53
The board of health........ ....... ......... ..1 ..................................................... .. 53-58
Control of contagious diseases......................................... ......... ............
54
Sanitary inspection....... .'......... ....... *............................... ..................
54
55
Food inspection....... .......................... .................................. ...............
Milk supply............ .............. . ......... .....................................................
55
Vital statistics.............................
56
Expenditures..............................
56
Reorganization of health work...................... ................ ......................
57
Sanitation.............
58-65
Water supply................. .........
58
Sewerage system and sewage disposal......................................
61
Street paving and cleaning............................................. ......................
63
Refuse and garbage disposal..................................................................
64
Summary and conclusions................................... .......................................................67-69
Infant mortality r a te ............. . . ... ....... .................\ ...............................
67
N ationality..'.................... ........................................................ ......... .......
67
Attendant at birth................................................................ ........................
67
Type of feeding........................... .............................................................
67
Earnings of father.................... ........................................ ..... .............. .
68
Gainful employment of mother.................................................................
68
Birth registration ........................................................................................
68
Cause of death....... ....................... .'............................... ...............................
68
Prenatal care.......................... ............. .............. ............... ..........................
68
69
Infant-welfare work...... .................. 1............................................................
Appendix............................... ................................. ................................... ................ 71-81
Method of procedure................ ............................................................................. 71-81
Scope of inquiry........................'........ ................................. ; . ___ . . . .
71
Infant mortality rate........................... ...................................................
72
Live births excluded in Akron................................... ........................
78
Stillbirth rates................................ ..._................................................ .
80
Stillbirths excluded................... .................................................... ..
81
Index..................... ........... .............................................................................................
115
GENERAL TABLES.
Page.
T able 1. Births during selected year in each section of residence, according
to nationality of mother..........................................................................
Live births during selected year, infant deaths, and infant mortality
rate, according to literacy of mother....................................................
3. Live births to foreign-born mothers during selected year, infant
deaths, and infant mortality rate, according to nationality of
mother and her ability to speak English................................. ..........
4. Births during selected year to foreign-born mothers resident in the
United States specified number of years, according to nationality
of mother.................................................................................... ..............
85
2.
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CONTENTS.
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Page.
T able 5. Births from all pregnancies, live births, infant deaths, infant mor
tality rate, and number and per cent of stillbirths, according to
nationality of mother........................................ ............... ..... . ...............
6. Mothers reporting specified number of births from all pregnancies,
by nationality..........................................................................................
7. Number and per cent distribution of deaths among infants born
during selected year in Akron and of infant deaths in the regis
tration area in 1914, according to detailed cause of death............. .
8. Deaths from specified causes among infants born during selected
year, according to district of residence................................................
9. Deaths among infants born during selected year, occurring in speci
fied calendar month, by cause of death....................: ..................
10. Deaths among infants born during selected year, occurring in speci
fied month of life, by cause of death............................... ....................
11. Number and per cent distribution of deaths among infants born
during selected year in Akron, and per cent distribution of infant
deaths in the registration area, by age at death................................
12. Births from all pregnancies, live births, infant deaths, infant mor
tality rate, and per cent of stillbirths, according to order of preg
nancy and age of mother........................................................................
13. Births during selected year to mothers of specified nativity, according to kind and duration of help in confinement................ ...........
14. Births during selected year to mothers of specified nativity, accord
ing to usual hired household help.................. ..... ....... ......... ...............
15. Live births during selected year, infant deaths, and infant mortality
rate, according to interval between confinement and mother’s re
sumption of part of household duties, and nativity of m other.. . .
16. Number and per cent distribution of infants born during selected
year and surviving at end of specified month, according to type of
feeding during that month, and nationality of m other...................
17. Per cent of infants born during selected years in Johnstown, Pa.,
and in Akron, given specified type of feeding at 3, 6, and 9 months
of age, according to nativity of mother................................................
18. Infants born during selected year to mothers of specified nativity
and surviving at beginning of specified month of life, and subse
quent deaths in the first year of life and in specified month, accord
ing to month of life and type of feeding..............................................
19. Number and per cent of infants artificially fed among those surviving
at 3, 6, and 9 months of age, according to whether the mother had
commenced work, and nativity of mother..........................................
20. Births during selected year in each father’s earnings group, according
to occupation of father. .........................................................................
21. Births during selected year, infant deaths, infant mortality rate, and
per cent of stillbirths, according to earnings of father and nativity
of mother............................................................................. .....................
22. Births from all pregnancies, live births, infant deaths, infant mor
tality rate, and per cent of stillbirths, according to earnings of
father during year after birth of last child, and nativity of mother.
23. Births during selected year in families of specified numbers of per
sons and average number of persons per family, according to earn
ings of father and nativity of mother.................................................
24. Number and per cent distribution of births during selected year in
each father’s earnings group, according to total earnings of family.
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101
101
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CONTENTS.
Page.
Table 25. Births during selected year to gainfully employed mothers of speci
fied nationality, according to interval between cessation of work
and confinement......................................................................... - - .........
26. Births during selected year to mothers gainfully employed in specified
occupation during year preceding birth of infant, according to
interval between cessation of work and confinement, and nativity
of mother...................................................
27. Births during selected year, infant deaths at specified ages, infant
mortality rate, and per cent of stillbirths, according to interval
between cessation of work and confinement, and nativity of
mother............................................................................
28. Live births'during selected year, infant deaths, and infant mortality
rate, according to occupation of mother during year following in
fant’s birth.................................................. - ......... - ............... - ...............
29. Live births during selected year and infant deaths, according to
whether mother was gainfully employed, and age of infant if alive
when the mother resumed work......................
30. Number and per cent distribution of births during selected year to
gainfully employed mothers of specified nativity, according to
earnings of mother during year following birth of infant.................
31. Births during selected year to mothers of specified nationality, ac
cording to dominant gainful occupation of mother during her
lifetime.......................................................................
32. Births during selected year, live births, infant deaths, infant mor
tality rate, and per cent of stillbirths, according to number of dwell
ings in building......................
33. Births during selected year, live births, infant deaths, infant mor
tality rate, and per cent of stillbirths, according to tenure and
rental of home and nativity of mother.................................................
34. Infants born during selected year in families living in dwellings
having specified number of rooms, according to persons to dwelling
and nativity of mother............................................................................
35. Births during selected year to mothers of specified nationality, ac
cording to number of lodgers in household.........................................
36. Number and per cent distribution of births during selected year in
each district of residence, according to sanitary condition of
dwelling......................................................................................................
37. Births from all pregnancies to mothers married specified number of
years, stillbirths, and infant deaths, by number of births to mother.
38. Mothers reporting specified number of miscarriages, stillbirths, and
infant deaths, according to number of pregnancies to mother, and
nativity of mother.................................
39. Mothers reporting specified number of infant deaths, according to
number of live births to mother, and nativity of mother.......... : . .
102
103
103
104
105
105
106
107
107
108
109
110
I ll
113
114
CH ARTS.
Page.
Chart I.—Infant mortality rates from specified diseases among infants of all
mothers, and of native and foreign-born mothers separately..........
II.—Percentage of deaths under 1 month of age in the four cities
specified....................................................................................................
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CONTENTS.
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Chakt III.—Infant mortality rates according to father’s earnings for the four
cities specified........................................
IY.—Percentage of mothers gainfully employed during year following
infant’s birth, by nativity, according to earnings of father.......
39
41
ILLUSTRATIONS.
Map of Akron, Ohio........................................... , ................................................ faces p. 11
P late I.—Privies and chicken coops on bank of river (family a
little farther down uses river water for washing).
II.—Well and vault privy.
III. —Twelve tenements.
IV. —Toilet facilities for above.
V.—Views of open sewer and overflow from.
VI.—Unpaved street always wet.
VII.—Street badly washed.
V III.—A typically good street.
IX .—A dump.
X .—Pump and garbage vault.
X I.—Tenement houses.
X II.—Rear house.
X III. —Shacks.
XIV. —Alley 5 houses deep from street.
XV.—Block crowding (no sewers, bad yard drainage).
XVI.—Privies, sheds, rear house on river bank.
X V II.—Lot crowding (2 houses 19 inches apart) (Steam from canal just
north of a factory).
X V III.—Attractive gardens in small spaces.
X IX .—Cottage in the outskirts.
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LETTER OF TRANSMITTAL.
U. S.
D epartm ent of L abor,
C h i l d r e n ’s B u r e a u ,
Washington, November 1, 1919.
Herewith I transmit a study of infant mortality made by the
Children’s Bureau in the city of Akron, Ohio.
Miss Theresa S. Haley was director of the field work and has writ
ten the report. Special acknowledgment is made of the services of
the special agents, Mr. Frank Drown and the Misses Alice Gannett,
Alice Hill, Elizabeth Moore, E tta Philbrook, Marion Shaffner, Jessa
mine S. Whitney, Margaretta Williamson, and Mr. Harry Richards.
Dr. Robert M. Woodbury wrote the appendix on method of pro
cedure.
The Children’s Bureau acknowledges, with appreciation, the cordial
cooperation of municipal authorities, of volunteer associations, and
of the press of Akron.
J u l i a C. L a t h r o p , Chief.
Hon. W . B . W il s o n ,
Secretary of Labor.
Sir :
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1
1
2
3
KRÖN
OHIO
Ô
_
SCALE (
Prepared ■for
AKRON CHAM BER OF COMMERCE
Ä 3 1—T ~
1
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C O P Y R IG H T E D
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1917
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INFANT MORTALITY—AKRON, OHIO.
INTRODUCTION.
Akron, Ohio, was chosen as the seventh city in the series qf studies
made by the Children’s Bureau into the social and economic condi
tions underlying infant mortality. The population of Akron had
increased very rapidly within the past few years, chiefly by the addi
tion of persons of foreign birth, and 19 per cent of the population in
1910 were foreign born. Industrial conditions in Akron were differ
ent from those in the other cities studied; the rubber industry pre
dominated ; wages were relatively high. Located in the central part
of Ohio, it afforded an opportunity to study the effect upon infant
mortality of conditions in an industrial city of the Middle West. It
seemed desirable to make a study of such a city; and Akron, though
not in the birth-registration area, appeared to have fairly complete
records of births and deaths. The procedure adopted, discussed
fully in the appendix, included a house-to-house canvass to supple
ment the birth and death records.
DESCRIPTION OF CITY.
Akron lies 36 miles south of Cleveland, and in 1915 had a popula
tion of just over 100,000.1 I t covers 11£ square miles of rolling
country on the banks of the Little Cuyahoga River and the Ohio
Canal, and spreads out over the seven surrounding hills.
Excellent transportation facilities have contributed largely to the
rapid growth of the city. The canals were responsible for the early
development of Akron; the Ohio Canal, begun in 1825, connected
the city with Lake Erie at Cleveland and with the Ohio River at
Portsmouth; the Pennsylvania & Ohio Canal placed Akron in direct
line of communication between Pittsburgh and Cleveland. But both
these means of transportation have fallen completely into disuse.
At present the city is served by three trunk-line railroad systems.
The principal industries of the city a t the time of the study were
the manufacture of automobile tires and of sewer pipes. I t is the
largest rubber manufacturing center in the world. In the earlier
days cereal and grist mills represented the chief industry, but these
have now a lesser relative importance. Manufactures have always
1According to an enumeration of population made in connection with the house-to-house canvass for
births, there was a population of 100,079 on Apr. 10,1915. This was somewhat greater than the estimated
population of 82,958 for July 1,1915, based upon the average annual increase of the population of the city
from 1900 to 1910.
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INFANT MORTALITY.
constituted the city’s claim to distinction; and it has been known at
different periods as the Oatmeal Town, the Match Town, the SewerPipe Town, and the Rubber City, haying stood first in the country
in the manufacture of each of these products successively. Next in
importance to the rubber-goods industry is the sewer-pipe industry,
and the stacks of sewer pipes that stretch for miles in the eastern and
southern portions of the city and along the railroads bear witness to
the volume of the product. Foundries and machine shops have
always held an important place among the city’s industries; in the
early days they produced agricultural implements and mining ma
chinery, but now they produce largely materials for the rubber fac
tories.
Except for its large modern factories the city has few of the ex
ternal characteristics of an important industrial city; instead of sky
scrapers and rows of tenement houses it has modest though up-todate office buildings and low detached cottages with lawns, gardens,
and shade trees.
POPULATION—SIZE AND COMPOSITION.
Akron was incorporated as a city in 1836, and its growth has been
continuous and rapid. Since 1870 each decennial increase has ex
ceeded 50 per cent. The population was mainly of native stock until
after 1860. Beginning about th at date, however, large numbers of
emigrants from northern Europe found work in Akron and settled
there. In 1890 one-fifth of the population was foreign bom, chiefly
German and British. In 1910, 19 per cent of the population was
foreign bom, but of somewhat different racial stocks, coming prin
cipally from Austria-Hungary, Germany, Great Britain and Ireland,
Italy, and Russia. Besides these one-fourth of the population was
of foreign or mixed parentage. From 1900 to 1910 the increase in
the city’s foreign population was 86 per cent in contrast to an increase
in the native population of only 57 per cent.
The rapid increase in the foreign population of the city and its
changing character presented new problems of assimilation; the
growth of the city brought into the foreground the problems of sani
tation, water and milk supply, and hospital equipment, which each
city has to face and solve for itself.
METHOD OF PROCEDURE.
In Akron the infant mortality study was confined to babies born
in the city during a 12-month period—the year ended June 30, 1914.
Since Akron was not in the birth-registration area it was necessary
to check the completeness of the city’s birth registration and to sup
plement records of births by means of a house-to-house canvass.
The list of births thus secured, a total of 3,021, was used as the basis
for investigation.
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AKRON, OHIO.
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The primary purpose of the study was to reveal the economic,
social, and civic conditions with which in some measure the city’s
infant deaths might have been connected. Accordingly, the mother
of every baby born in Akron between July 1, 1913, and June 30, 1914,
was visited; and if the child had spent the entire first year of his life
in Akron, a schedule of his health and care was obtained, giving also
information on the economic and social conditions of the family and
the sanitary condition of the home for the first year of the child’s life.
Not all births discovered from the records and from the canvass
could be used in the study. In a number of instances mothers had
left the city and the neighborhood and could not, therefore, be con
veniently interviewed. A few cases were found where the mothers
were nonresident; in still other cases no trace could be found of the
mother or of the baby. Illegitimate births, a few of which were
found, were excluded from the study. A detailed description of the
procedure followed in excluding births, together with a discussion of
infant mortality rates for the excluded cases, will be found in the
appendix (p. 78); a complete discussion of the methods and results
of the canvass is also presented.
COOPERATION.
From the beginning of the bureau’s preliminary work in Akron the
press kept in close touch with the work and generously gave space
for articles on its purpose, scope, and progress. Various social and
other organizations showed their interest by asking for speakers to
address them on the subject of the study. So well was the study in
dorsed and advertised that without a single exception the mothers
gave the intelligent cooperation on which the success of any such
study is dependent.
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ANALYSIS OF FINDINGS.
INFANT MORTALITY RATE.
The births in the city during the selected year included in this
detailed study numbered 2,322. Sixty-nine of these were stillbirths,
3 per cent of the total. Of the 2,253 live-born infants 193 died during
the first year of life, giving an infant mortality rate of 85.7 per 1,000
five births.
Akron had a lower rate of infant mortality than that of any other
of the seven cities studied by the Children’s Bureau, with the excep
tion of Saginaw, Michy where the rate was 84.6. The following table
presents the relative standing of the seven cities studied:
Infant
mortality
rate.
City.
Manchester, N . H
Johnstown, Pa............
New Bedford, Mass............................
Waterbury, Conn....................
165.0
134.0
130.3
122.7
City.
Infant
mortality
rate.
Brockton, Mass........................
96.7
85.7
84.6
An infant mortality rate for the entire United States can not be
shown, since many States are not recognized by the United States
Bureau of the Census as having sufficiently trustworthy birth and
death records upon which to base statistics. In 1916 for the census
“ area of birth registration,” including 11 States and the District of
Columbia, the infant mortality rate was 101;2 for the cities within
these States, the rate, 104, was slightly higher than for the entire
birth-registration area. Both these rates were considerably higher
than the mortality rate in Akron.
»
Many cities, however, have reduced their infant mortality consider
ably below the average for the birth-registration area and also below
the infant mortality rate which Akron has attained. A m o n g the
cities of over 10,000 population in the birth-registration area, 65 had
in 1916 infant mortality rates of less than 85 and 7 of less than 50.
INFANT MORTALITY, BY DISTRICTS.
In Table I is shown the variation of infant mortality in different
sections of the city. The wards into which the city was divided
politically had no significance from a sociological point of view, since
most of them extended from the center of the city to the outskirts
and embraced the utmost diversity of conditions. For the purposes
of this study, therefore, the city was divided into nine compact areas
* See Appendix, p. 77, for comparability of rates.
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INFANT MORTALITY.
having as much sociological and topographical homogeneity as pos
sible (see map, p. 11). The infant mortality rates were the lowest in
the districts known as east exchange (53.8) and southwest (58.3),
and highest in the business (103.7) and the valley (112.9) districts.
T able I .—Births during selected year, infant deaths, infant mortality rates, and per cent
of stillbirths, according to district of residence.
Total
births.
District of residence.
Live
births.
Stillbirths.
Infant
Infant mortality
deaths.
Per
rate.» Number.
cent.«
The c ity .................. .........................
2,322
2,253
193
85.7
69
3.0
East exchange..............................................
Southwest....................................................
West.............................................................
321
249
378
76
203
338
118
308
331
316
240
370
73
198
327
111
299
319
17
14
30
6
18
30
11
31
36
53.8
58.3
81.1
5
9
8
3
5
11
7
9
12
1.6
3.6
2.1
North Hill
..........................
West Hill.....................................................
South central..............................................
East Hill......................................................
Business.......................................................
Valley..........................................................
90.9
91.7
99.1
103.7
112.9
2.5
3.3
5.9
2.9
3.6
a Not shown where base is less than 100.
A brief description follows of the districts having the highest and
lowest infant mortality rates in the city.
VALLEY AND BUSINESS DISTRICTS.
The valley and business districts had the highest infant mortality
rates. The greater part of these districts lies in the lowest section
of the city; through these districts runs the Little Cuyahoga River
and around them three lines of railroads. The Ohio Canal also
passes through this section. Large numbers of foreigners—chiefly
Italians and Slavs, with a few Syrians and Greeks—lived in these
districts.
In the valley district were several large factories, including some
of the largest rubber and sewer-pipe establishments. Housing condi
tions were relatively poor. Many of the houses were in bad repair.
Nearly all the streets were unpaved and fewer streets had sewers
than in other districts. In some instances sewer connections were
outside and in these cases sewer privies instead of water-closets were
common. In connection with the low-lying character of this section
it should be noted that the river was polluted with industrial wastes,
sewage, and garbage. During the period covered by the study there
was an open sewer on one street from which sewage spread out over
the low ground toward the river. In another section near the river
a drainpipe emptied into a depression in the ground, making a
stagnant pool. This section had two large dumps upon which
garbage was commonly deposited until 1915, and even in 1915
enough garbage was placed there to' be noticeable and to breed
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AKRON, OHIO.
17
swarms of flies. I t was common for families to throw garbage into
the river and onto its banks.
The business district comprised all the most congested areas in the
city. More than one-third the families included in the study that
lived in tenement houses with three or more families were located
in the business district. Many of the notoriously bad housing “spots”
were within this area, as well as the central mercantile districts,
railroad yards, and a number of large factories. Though it was in
the heart of the city this district contained streets without sewers,
and even on the sewered streets were found many outdoor vault
privies. The district had one large dump on which was placed
miscellaneous rubbish, including more or less garbage, which was
very offensive.
EAST EXCHANGE AND SOUTHWEST DISTRICT.
In contrast to these were the conditions in the east exchange
and southwest districts where the mortality among infants was
lowest. These sections comprised in the main comparatively high
land; practically all the streets had sewer and water mains and the
principal streets were well paved. With the exception of the gully
of Wolf Ledge Rim there were no dumps or other garbage nuisances,
no factories, and only a few tenement houses. The houses in general
were simple two-story frame buildings with well-kept yards and air
space oh four sides. These were not the wealthiest sections of the
city but were inhabited largely by families of prosperous wage earners.
Of the births which occurred in these two districts 72 per cent were
to native mothers as contrasted with only 45 per cent for the valley
and business districts.
NATIVITY AND NATIONALITY OF MOTHER.
In Akron, as in most of the other cities studied by the Children’s
Bureau, the infants of native mothers had a considerably lower
mortality than those of foreign-born mothers. Table II shows a
mortality rate of 70.1 for infants of native mothers and 109.3 for
infants of foreign-born mothers. Of the foreign groups the rate was
highest, 146.6, among the Slavs. The mortality of infants of Italian
mothers was 116.4; of German mothers, 105.0; and of Magyar, 102.8.
So few infants, of the other nationalities were included in the study
that no mortality rates are shown for these groups; since the study
included only 11 infants of colored mothers, no comparison can be
made of mortality among infants of white and colored mothers.
174247°—20---- 2
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INFANT MORTALITY.
T a b l e II. — Births during selected year, infant deaths, infant mortality rates, and per cent
of stillbirths, according to nationality of mother.
Nationality of mother.
Total
births.
Live
births.
Infant
deaths.
Stillbirths.
Infant
mortality
cent
rate, a Number. Per
of total
births.«
All mothers........................................
2,322
2,263
193
85.7
69
3.0
Native mothers...........................................
Foreign-bom mothers.................................
1,402
920
1,356
897
95
98
70.1
109.3
46
23
3.3
2.5
German..................................................
Italian...................................................
Slavic..............* ....................................
Magyar..................................................
English, Irish, Scotch, and Welsh &__
226
162
192
109
76
61
104
219
146
191
107
73
59
102
23
17
28
11
6
3
10
105.0
116.4
146.6
102.8
7
6
1
2
3
2
2
3.1
3.9
.5
1.8
All other c.......................................
98.0
1.9
«Not shown where base is less than 100.
6Including 46 English, 19 Irish, 9 Scotch, and 2 Welsh.
«Including 28 Syrian, 21 Scandinavian, 18 Roumanian, 11 Lithuanian, 11 Canadian (except French
Canadian), 9 French, 1 French Canadian, 1 Greek, 1 Armenian, 1 Dutch, and 2 foreign colored.
In connection with the differences in the mortality rates of infants
of foreign-born mothers it will be of interest to summarize briefly the
general characteristics of the nationalities. The Germans, Slays,
Italians, and Magyars were numerically the most important foreign
nationalities in the group selected for this study. In the following
sections the groups are discussed in the order of the infant mortality
rates shown for the selected year.
SLAVS.
In the Slavic population of Akron the largest groups were the
Serbo-Croatian and Slovak, but other Slavic nationalities were rep
resented. Among the mothers included in the study seven Slavic
races were represented.
Of all the foreign groups the Slavs had the highest infant mortality
rate. The mothers nursed their babies to alarge extent through the first
year of life, but frequently began, even in the early months, to give
them solid food in the belief that such food would make them strong.
The women were sturdy, able to do all the work in house and garden
without help, and often followed their old-country custom of carrying
on much of their housework outdoors and in bare feet. The mother
frequently took boarders under a so-called “ company plan.” Under
this plan each boarder paid S3 or $4 a month for sleeping quarters,
besides his share of the food bills; the mother paid for her share and
that of her small children by her services as cook. In spite of crowded
conditions and lack of household aids, the homes were generally
clean and comfortable.
Over one-fourth of the births to Slavic mothers were to mothers
who were unable to read and write, and over three-fourths were to
mothers who were unable to speak English.
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AKBON, OHIO.
19
The Slays of Akron had come chiefly from the villages and small
towns of Austria-Hungary and were of strong physique and suited to
the unskilled heavy work which, as a rule, they were doing in the
large factories. They showed a strong tendency to live in compact
settlements near their places of work; they showed also a strong
desire to own their own homes. As soon as possible the family
began to buy a house or to acquire land and build one. In the latter
case the house was frequently small and without modem conveniences
but usually surrounded by as large a garden for both flowers and
vegetables as the lot allowed. The Slavic families which had been
in Akron a long time and had prospered were proud of the fact that
they no longer took lodgers, and the size and attractiveness of their
houses showed that the insanitary and crowded conditions of the
homes of some of the newer comers must have been the result of
poverty rather than of choice.
ITALIANS.
Approximately one-sixth of the births to foreign-born mothers were
to mothers of Italian nationality. On the average these mothers
had been in this country slightly longer than the Slavs, but were
able to use English to an even less degree. Mothers of 83 per cent of
these infants could speak no English. This was due not only to a
clannish tendency among the Italians, but also to the custom of
keeping the women in the homes. A high percentage of illiteracy
also was found among the Italians, mothers of 49 per cent of the
infants being unable to read and write.
The Italian parents were devoted to their children, ready to the
best of their knowledge to do everything for their welfare. Though
the homes were often dirty the babies seldom looked neglected.
The proportion of infants breast fed was higher in the Italian group
than in any of the other foreign nationalities. Promiscuous feeding
in the early months was much more rare than among other nationality
groups. The custom of wrapping babies under 6 months in stiff
swaddling clothes, encasing both body and legs, was common.
Older children, especially if they had begun to walk, were often
scantily clothed. None of the Italian mothers in the group studied
had left her baby to go to work even though, during part of the period
under study, general unemployment caused much distress among
these families. Two-thirds of the Italian mothers who were visited
had kept lodgers at some time during the baby's first year, though
in many instances the persons recorded as lodgers were relatives or
former fellow townsmen taken in for accommodation rather than for
income. Few of these mothers kept more than five or six lodgers.
Approximately one-half the Italian wage earners were unskilled
laborers doing heavy construction work, repairing and cleaning
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20
INFANT MORTALITY.
streets, and performing other similar work. The average rate of pay
for such unskilled labor was about $2 a day, and when the seasonal
character of the work is taken into consideration it becomes evident
that the actual earnings were very low. Yet one-half of the Italian
families included in the study owned or were buying their homes, and
a number owned other property besides.
Until the flood, March, 1913, nearly all the Italians lived in the
upper end of the business district. The flood destroyed many of
their homes, and they had to scatter, spreading out around the foot
of North and West Hills and along the railroads tracks in the south
central district.
GERMANS.
Mothers in the German group nursed their babies to a large extent
and rarely left them or the home to go to work. Ninety-one per
cent of these mothers were able to read and write, but only about
one-half of the German mothers visited could speak English, though
over three-fourths of them had been in this country more than three
years. Only a small proportion of these families took boarders or
lodgers during the period under study.
Previous to 1900 most of the German-speaking immigrants had
come from Germany or Switzerland. In general they wete skilled
workmen who prospered and at the time of the study had become
practically assimilated. The more recent Germanic immigration was
for the most part from Hungary. These immigrants were of peasant
stock, strong, sturdy, able, and willing to do the heavy unskilled
work required by the city’s industries. Their thrift and love for
home life were shown in the large percentage of home owners about 50 per cent. Nearly one-half of the Germanic families included
in the study lived in the south central district close to the largest
rubber factory in the city.
MAGYARS.
The Magyar mothers clung to old-country customs in the care of
households and children. They nursed their babies to a less extent
than the Slavic mothers, but like them seldom left the babies or
homes in order to go to work. The mothers did the work of the house
and garden, frequently even up to the time of confinement. More
than two-thirds of the Magyar mothers visited were unable to speak
English though 61 per cent had been in America more than three
years. Eighty-seven per cent were able to read and write. The
Magyars as found in Akron were strong, sturdy men and women;
the fathers were employed usually in occupations requiring strength
and endurance rather than skill. Practically all of them were peasants
from the villages and small towns, who had been accustomed in the
old country to live in one- or two-room cottages with primitive arrange-
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21
AKRON, OHIO.
ments and so found it no hardship to live in one or two rooms, a tiny
cottage, often only a shack or a portion of a larger house. The most
recent comers often were found keeping house in one or two rooms in a
tenement. As soon as possible, however, they would buy or build a
shack and have independent living quarters; and later a larger and
better type of dwelling would be acquired, a portion perhaps being
sublet to help pay for it. With the exception of a few families who
lived in bad tenements, the Magyar families lived chiefly in small
detached houses. High rents in the better sections of the city
combined with a strong prejudice against foreigners as tenants tended
to keep the recently arrived Magyar families congested in one of the
poorest sections of the city. As these families improved their condi
tions financially they moved into the better portion of the south
central district and gradually into the west and southwest districts of
the city. They seemed to prefer to have small quarters and in
dependent living conditions rather than to share their homes with
other families or to take boarders. Nine-tenths of the families
visited were living in separate households, and only one-fourth had
boarders during the period covered by the study. When boarders
were kept it was almost invariably upon the “ company plan” as
among the Slavs.
CAUSE OF DEATH.
The causes of death, as given by the physicians on the death cer
tificates, were classified according to the International List of Causes
of Death, and then grouped into eight principal groups. The most
important single group was that of causes peculiar to early infancy,
which included 65 of the 193 deaths. The other two main groups of
causes to which infant deaths were attributed were gastric and intes
tinal diseases and respiratory diseases. In Table II I the distribution,
of the infant deaths in Akron is shown by cause of death.
T a b l e III. — Number and per cent distribution of deaths among infants born during selected
year, according to cause of death.
Infant deaths.
Cause of death.«
Per cent
Number. distribu
tion.
All causes.......................
193
100.0
Gastric and intestinal diseases.
Respiratory diseases................
Malformations.........................
Early infancy..........................
46
23
9
65
23.8
11.9
4.7
33.7
Premature birth................
Congenital debility............
Injuries at birth.................
39
20
6
20.2
10.4
3.1
Epidemic diseases......................
External causes.........................
Diseases ill defined or unknown
All other causes.........................
a See General Table 7 for detailed cause of death.
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13
6.7
10
5.2
13.5
1
26
.6
22
IN FA N T MORTALITY.
In Table IV a comparison is presented of the specific infant mortal
ity rates from each cause for the different cities studied by the
bureau.
T a b l e IV.— Infant mortality rates for specified cities, by cause of death.
Cause of death.
New WaterJohns Man Saginaw. Brock
ton. Bedford. bury.
town. chester.
Akron.
All causes.....................................
85.7
134.0
165.0
84.6
96.7
130.3
122.7
Gastric and intestinal diseases . ............
Respiratory diseases.............................
Malformations........................................
Early infancy.........................................
20.4
10.2
4.0
28.9
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
48.3
27.8
4.6
29.0
41.0
18.2
4.7
38.7
Premature birth..............................
Congenital debility.........................
Injuries at birth..............................
17.3
8.9
2.7
14.4
20.5
4.8
14.7
24.3
.6
12.2
24.5
1.0
16.5
14.9
5.8
9.7
15.5
3.9
15.9
16.8
6.1
Epidemic diseases.................................
External causes......................................
Diseases ill defined or unknown...........
All other causes......................................
5.8
.4
4.4
11.5
11.6
3.2
5.1
8.3
8.9
7.5
12.3
7.0
16.6
4.1
15.3
5.0
15.7
2.7
8.9
8.4
.5
1.9
9.3
CAUSES PECULIAR TO EARLY INFANCY.
The largest number of deaths in Akron occurred from the group
of causes peculiar to early infancy. Compared to the other cities
studied by the bureau, Akron had the lowest mortality rate from
this group of causes, though the mortality from these causes does
not vary much from city to city. The infants of native and foreignbom mothers had practically the same rates of mortality from this
group of causes.
Chart I.—Infant mortality rates from specified diseases among infants of all mothers, and of native
and foreign-born mothers separately.
fitttrT e and In te s tin a l D iseases
A ll aethers
n ative mothers
Foreign-horn mothers
All mothers
Native mothers
Foreign-horn aethers
Respiratory Diseases
A ll mothers
native mothers
Foreign-horn mothers
Obviously, most of the deaths from premature births, congenital
debility, and injuries at birth—the causes grouped under diseases of
early infancy—occur in the first two weeks or in the first month of
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AKRON, OHIO.
23
Iff®* Practically all the deaths that occur in the first two weeks of
life are to be attributed to one or the other of these causes, which in
general are due to prenatal or natal conditions. The stillbirths also
are caused by the same general conditions as are responsible for most
of the deaths under two weeks. Nearly all these deaths and still
births are due to conditions affecting the mother before birth or to
complications at confinement, most of which are preventable by
skilled obstetrical care. Of the 262 stillbirths and deaths, 69 were
stillbirths and 73 deaths occurred in the first two weeks of fife, a
total of 142, or 54 per cent of all the losses. A somewhat more
accurate way of measuring the importance of prenatal and natal
conditions upon infant mortality and death prior to birth is to add
to the stillbirths the deaths ascribed to diseases of early infancy.
This procedure gives a total of 134, or 69 per cent of the total losses
to be ascribed to natal and prenatal conditions.
T a b l e V .—Deaths among infants horn during selected year to mothers of specified nativity,
and specific infant mortality rates, by cause of death.
Deaths among infants bom during selected year to—
Cause of death.
All mothers.
Native mothers.
Foreign-bom
mothers.
Infant
Infant
Infant
Number. mortality Number. mortality Number. mortality
rate.
rate.
rate.
All causes.........................
193
85.7
95
70.1
98
109.3
Gastric and intestinal diseases..
Respiratory diseases..................
Malformations...........................
Early infancy............................
46
23
9
65
20.4
10.2
4.0
28.9
13
9
6
39
9.6
6.6
4.4
28.8
33
14
3
26
36.8
15.6
3.3
29.0
Premature birth.................
Congenital debility.............
Injuries at birth..................
39
20
6
17.3
8.9
2.7
27
9
3
19.9
6.6
2.2
12
11
3
13.4
12.3
3.3
13
1
10
26
5.8
0.4
4.4
11.5
8
5.9
5
5.6
3
17
2.2
12.5
7
9
7.8
10.0
Epidemic diseases.....................
External causes.........................
Diseases ill defined or unknown
All other causes..........................
The most effective method by which a community can reduce the
loss ratio from these causes is by providing care and instruction for
the pregnant mother and skilled attendance during her confinement.
Akron had at this time no public or private organization whose duty
it was to give prenatal care and advice; it had little hospital provision
for the care of maternity cases, and no physician specializing in
obstetrics. No attem pt was being made to reduce the largest factor
in its infant mortality rate by safeguarding infant life before and at
birth.
GASTRIC AND INTESTINAL DISEASES.
After diseases incident to early infancy, gastric and intestinal dis
eases were most fatal to babies included in the study. The mortality
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INFANT MORTALITY.
24
from gastric and intestinal diseases was higher than for either Saginaw
or Brockton, where the proportion of infants of foreign-born mothers
was relatively low, but lower than in Johnstown, Manchester, New
Bedford, and Waterbury, in which there was an unusually large
proportion of infants of foreign-born mothers. In Akron a striking
difference appeared in the mortality from gastric and intestinal
diseases of infants of native and of foreign-born mothers. The specific
mortality rate from these causes for infants of native mothers was
9.6 as contrasted with 36.8 for foreign-born mothers; the latter
nearly four times as high as the former. Among the Slavic group in
particular the mortality was exceptionally high, half the deaths being
due to these causes. This rate for infants of native-born mothers is
fairly comparable to the rates from these causes in Saginaw and
Brockton. The rate for infants of foreign-born mothers, on the other
hand, is considerably lower than similar rates for infants of foreignborn mothers in Johnstown, Manchester, and New Bedford, which
were, respectively, 54, 67.2, and 54.9.
The districts showing the highest mortality rate from these causes
were the south central and business districts, two of the more con
gested sections of the city.3 In this connection it is of interest that
in the valley district where bad housing conditions were found and
where a large number of Italian families lived, the mortality from
gastric and intestinal diseases was relatively low. The Italian mothers
gave their babies exclusive breast feeding to a much greater extent
than the mothers of any other nationality.
Climatic conditions play an important part in increasing the num
ber of deaths from gastric and intestinal diseases. Most of the deaths
from gastric and intestinal diseases occurred during the months of
July, August, and September. A comparison of conditions of
temperature and precipitation during the summer months of 1913
and 1914 with those of the preceding two years and the following
year shows that during the years under study the meteorological
conditions were normal and may be taken as fairly typical of Akron.
Temperature and precipitation for Akron, Ohio, 1911-1915.
[Furnished by the Weather Bureau, United States Department of Agriculture.]
Year.
Jan.
12Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. month
period.
MEAN TEMPERATURE.
1911........................
1912........................
1913........................
1914........................
1915........................
30
16
34
30
25
31
21
23
19
33
34
30
37
33
31
46
50
49
47
55
66
62
59
62
57
70
66
69
70
65
74
72
72
72
70
s General Table 8.
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72
68
72
71
(0)
52
66
66 . 54
54
64
63
57
54
67
36
42
43
40
42
34
32
34
26
29
(a)
51
48
51
49
AKRON, OHIO.
25
Temperature and precipitation for Akron, Ohio, 1911-1915—Continued.
Year.
12Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. month
period.
MAXIMUM TEMPERATURE.
1911........................
1912........................
1913........................
1914........................
1915........................
54
44
57
63
50
58
55
60
52
59
60
66
73
67
52
74
76
83
86
89
93
95
88
88
85
92
85
96
95
87
99
96
89
88
95 - 95
94
97
90
87
86
92
93
90
89
74
81
82
79
77
69
69
73
72
68
60
59
53
60
58
99
92
96
97
90
12
21
11
10
—12
MINIMUM TEMPERATURE.
1911.......................
1
13
1912........................ - 1 2 - 1 2
1913................ .
13
0
1914........................ - 1 - 6
1915........................ - 3
6
5
8
3
6
13
19
26
25
20
24
32
34
30
32
32
51
36
37
41
42
50
51
47
52
50
48
47
47
41
39
43
37
35
36
36
29
31
27
29
29
19
13
14 — 5
23
10
1
0
—6
- 3
PRECIPITATION (INCHES).
1911........................
1912...........; ...........
1913........................
1914........................
1915.......................
1.69 1.79 1.31
1.67 3.52
5.86 2.01 10.89
2.53 2.59 2.57
2.45 1.23 0.65
2.11
3.24
5.60
2.72
4.93
0.88
2.18
2.62
2.61
4.19
2.73
4.99
3.07
1.79
3.19
3.65
3.07
5.55
5.64
1.42
4. 91
4.88
2.71
1.98
5.77
4.67
5.42 6.40 2.82
4.27 2.18 1.48
3.10 3.99 2.96
2.20 3.31 2.16
3.59 2.01 2.75
3.50
1. 97
1.88
2.99
2.65
41.29
36,75
45.43
37.85
32.17
a No data available.
Infant deaths from gastric and intestinal diseases are largely
preventable if babies are given the proper feeding and are properly
cared for, especially during hot weather. Breast feeding is the
greatest safeguard against these diseases. A large proportion of the
babies who died were artificially fed. As will be shown later, many of
the foreign-born mothers gave evidence of ignorance of the funda
mental requirements of infant feeding. This is noteworthy in connec
tion with the comparatively high mortality rates from these diseases
among babies of foreign-born mothers.
In many cities great progress has been made in the prevention of
deaths of infants from these causes, through the work of publichealth nurses and of infant-welfare stations or centers. Through these
agencies the attempt is made to give to all mothers who need help
practical knowledge as to the best methods of feeding and care.
Mothers are encouraged to continue breast feeding. They are
taught how to care for their babies; and when artificial feeding is
necessary, it is supervised by a physician, while the mother is taught
in her own home by a nurse how to prepare feedings.
RESPIRATORY DISEASES.
Respiratory diseases also were responsible for a relatively large
number of infant deaths. As compared with other cities studied
by the bureau, Akron had as low a mortality from respiratory dis
eases as any city studied—equal to the rate in Saginaw. The mor
tality was less than one-half of that in Johnstown, Manchester, and
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26
INFANT MORTALITY.
New Bedford. The mortality from respiratory diseases among in
fants of foreign-born mothers in Akron was over twice as high as
that among infants of native-born mothers. (Table V.) The greater
number of these deaths occurred during the winter months.
SUPERSTITIONS CONCERNING CAUSE OF DEATH.
Some of the mothers believed in old superstitions common to
many races. The superstitions that especially affected the well
being of the child were those connected with belief in wicked spirits
and in the healing power of charms. The "powwow” doctor, or
charm healer, was frequently heard of during interviews with the
mothers. These doctors were generally women who took various
measurements of the sick person with a string which they either
burned or threw into some body of running water. Belief in the
efficacy of such treatment was not confined to foreigners. An Ameri
can mother told how her tenth child was born with the “ was ting
disease” (marasmus); a “ powwow” doctor measured the child when
he was 4 weeks old, but without curing him. Later, another “ pow
wow” doctor—a German woman—was called in; she passed her
hands over the child, and the very next day he began to improve.
A Hungarian mother gave the following cause for the death of her
3-months-0ld baby, whose death had been officially reported as from
stomach trouble. A neighbor woman, she said, who had just moved
near by, came in to see the mother, fixed her eye on the baby, and
remarked what a pice fat baby it was; the next day the baby died.
AGE AT DEATH.
Nearly half the infants who died in the first year of life died when
less than a month old. Of the total 193 infant deaths, 94 occurred
in the first month—33 of them on the first day. A somewhat larger
proportion of infants of native mothers died when under 1 month of
age than of infants of foreign-born mothers, the proportions being,
respectively, 57 and 43 per cent. Thirty-one per cent of the infant
deaths were at ages of 3 months and over; 36 per cent of the deaths
of infants of foreign-born mothers were a t ages of 3 months and
over, as contrasted with only 26 per cent of the deaths of infants of
native mothers.
The significance of these percentages is brought out more clearly
in connection with cause of death. Gastric and intestinal diseases
occur usually after the second or third month, and the higher pro
portion of deaths from gastric and intestinal diseases among infants
of foreign-born mothers increases relatively the proportion of deaths
after the third month and diminishes the proportion in the first
month. Most of the deaths that occur in the first two weeks and a
large part of those in the first month are caused by diseases of early
infancy.
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AKRON, OHIO.
27
Chart !!.— Percentage of deaths under 1 month of age in the four cities specified.
Akron, Ohio
T a b l e Y I.—Number and per cent distribution of deaths among infants born during
selected year to mothers of specified nativity, according to age at death.
Deaths among infants bom during selected year to—
Age at death.
All mothers.
Native mothers.
Foreign-born
mothers.
Per cent
Per cent
Per cent
Number. distribu Number. distribu Number. distribu
tion.
tion.
tion.
All ages..
193
100.0
95
100.0
98
100.0
Under 1 month.
94
48.7
54
56.8
40
40.8
33
5
17.1
20
21.1
13
13.3
Less than 1 day.......................
day but less than 2 ...............
days but less than 3 ..............
3 days but less than 7..............
1 week but less than 2 .............
2 weeks but less than 1 month.
1
2
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.
8
12
15
21
19
20
32
17
11
4
'7
7.8
10.9
9
4.2
7.4
6.3
8.4
9.5
9.8
10.4
16.6
8
8
12
12.6
2.6
4.1
6 .2
8.8
5.7
6
8
9
4
8.4
8.4
9.5
4.2
1
1
6
7
1 .0
1 .0
6.1
7.1
12
12.2
11
12
20
8
20.4
7
11.2
12.2
8 .2
7.1
STILLBIRTHS.
The percentage of stillbirths in Akron during the selected year was
3, as already stated. Compared with the percentages in other cities
studied by the bureau, Akron had a relatively low rate. I t is pos
sible that differences in regard to the faithfulness of physicians in
reporting stillbirths may exist in these cities. I t is difficult to make
comparison with other data on account of variations in the defini
tion of stillbirth; in these studies the term includes dead-born issues
of seven or more months' gestation.
The proportion of stillbirths was higher among male than among
female infants—3.4 as contrasted with 2.5; and it was likewise rela
tively high among infants born to mothers under 20 and over 35
and among first births and sixth and later births. The stillbirth
rate was apparently higher among births to native mothers than
among births to foreign-bom mothers—3.3 ancj 2.5, respectively.
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INFANT MORTALITY.
Since birth registration in Akron was less than 90 per cent complete
and since the canvass might easily fail to secure a complete record
of stillbirths, the stillbirth rates by nationality of mother are prob
ably not accurate enough to be of particular significance.
SEX.
Infant mortality rates by sex are shown in Table VII. The mor
tality of male infants is higher in both nativity groups. Among
male infants the rate was 91.9 as contrasted with 79.5 among females.
T a b l e VII —Births during selected year, infant deaths, infant mortality rates, and per
cent of stillbirths, according to sex of in f ant and nativity of mother.
"
Sex of infant and nativity of mother.
All mothers........................................
Total
births.
Live
births.
Infant
deaths.
Stillbirths.
Infant
mortality
cent
rate.» Number. Per
of total
births .“
2,322
2,253
193
85.7
69
3.0
1,160
1,161
1,121
1,132
103
90
91.9
79.5
39
29
3.4
2.5
1,402
1,356
95
70.1
46
3.3
710
692
684
672
49
46
71.6
68.5
26
20
3.7
2.9
920
897
98
109.3
23
2.5
450
469
437
460
54
44
123.6
95.7
13
9
2.9
1.9
1
1
1
1
a Not shown where base is less than 100.
AGE OF MOTHER.
An analysis of births and infant deaths by age of mother shows
that the infants of the youngest mothers had the highest mortality.
The rate for infants of mothers under 20 was 108.1, as contrasted
with 83.7 for all mothers over 20. The rate was also high for mothers
from 30 to 34.
T a b l e V III. — Births during selectedyear, infant deaths, infant mortality rates, andpercent
of stillbirths, according to age of mother at birth of child.
Age of mother at birth of child.
Total
births.
2,322
20 to 24.........................................................
25 to 29........................................................
30 to 34........................................................
35 to 39.......................................... ..............
Live
births.
2,253
192
821
682
354
185
800
663
343
210
200
63
62
Infant
deaths.
193
85.7
20
108.1
83.8
79.9
90.4
75.0
67
53
31
15
7
a Not shown where base is less than 100.
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Stillbirths.
Infant
mortal
Per cent
ity rate.“ Number. of total
births.“
69
3.0
7
3.6
21
19
11
10
1
2 .6
2 .8
3.1
4.8
AKRON, OHIO.
29
ORDER OF BIRTH.
Order of birth is a factor of infant mortality. The mortality
rate among first births in Akron was somewhat higher, 83.3, than
among second births, 75.6. For third births it was unusually
high, for fourth unusually low, but for fifth and later the rate was
consistently high. In general, the results of this study agree with
those for other cities in that the rates for first births were somewhat
higher than for second, and that rates for the fifth and later births
were relatively high.
A study of all births, including births previous to the selected year,
to the mothers included in the study shows much the same general
trend. The mortality rate among first births was much higher than
among second, 125.4 as compared with 107; but, in contrast to the
finding for births in the selected year, the mortality from the third
pregnancy was not so high as from the first. In general, the mortal
ity among fifth and later births was high. The rate for births eighth
and later in order of pregnancy was 167.3, higher than for any pre
ceding order.4
T a b l e IX.
Births during selected year, infant deaths, infant mortality rates, and per cent
of stillbirths, according to number of child in order of birth.
Number of child in order of birth.
All orders.................................
First............................
Second............................
Third.........................
Fourth.......................... .
Fifth............................
Sixth and seventh........................
Eighth and later.................... .
Total
births.
2,322
Live
births.
Infant
deaths.
2,253
nn
559
210
148
97
139
92
10
Stillbirths.
Infant
mortal
ity rate.« Number. Percent
of total
births.«
85.7
69
3.0
83.3
75.6
100.9
67.6
97.2
100.7
31
17
3.8
3.0
2
3
2
9
.6
1.4
1.4
6 .1
o Not shown where base is less than 100.
CONFINEMENT CARE.
ATTENDANT AT BIRTH.
The attendant at birth is all important in determining the character
of confinement care. Out of a total of 2,322 births in Akron, 1,735,
or three-fourths, were attended by physicians. Of these, 1,547 were
attended by physicians in the homes and 188 by physicians in hos
pitals. In addition, in 23 cases both a physician and a midwife were
in attendance.
Midwives were the only attendants at 505 births, or 22 per cent
of the total. Of these, 478 births were to foreign-born mothers.
4 Cenerai Table 12.
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30
INFANT MORTALITY.
Over half the births to foreign-born mothers were attended by mid
wives, as contrasted with less than 2 per cent of those to native
mothers (Table X).
T a b l e X .—Births during selected year with specified attendant, according to nationality
of mother.
Births during selected year.
Attended by—
Nationality of mother.
Total.
Physician.
Other per Attendant
not
Midwife. son
or none. reported.
All mothers..............................
2,322
1,758
505
Native mothers..................................
1,402
1,367
27
Both parents native....................
One or both parents foreign bom.
Parentage not specified...............
973
423
«955
o406
Foreign-bom mothers.....................
German......... . ....... .....................
Slavic.............................................
Italian.......................................
Magyar.........................................
English, Irish, Scotch, and Welsh
Jewish............................................
All other........................................
o2 mothers who had 2 attendants.
6 7 mothers who had 2 attendants.
57
6
6
920
391
478
50
226
192
152
109
76
61
104
6 97
125
4 ..................
28
1
4 ..................
7 ..................
o 41
c37
C20
76
6 52
d 68
122
111
82
8
30
1
1
6
c 4 mothers who had 2 attendants.
1 mother who had 2 attendants.
The custom of employing midwives was prevalent among the foreign
born. That it is not a deep-seated racial custom, however, is shown
by the fact that foreign-born women who had learned to speak
English were less likely to employ midwives than those who could not
speak English. Midwives attended 68 per cent of the births to
mothers who were unable to speak English, as compared with only 40
per cent of the births to mothers of the same nationalities who had
learned to speak English. Probably a chief reason was th at the
mother who could not speak English could secure a midwife who
could speak her language and could not always secure a doctor to
whom she could talk; the lower charge made by the midwife would
also be an important reason. The native-born daughters of foreign
or mixed parentage were seldom attended by midwives; only 3 per
cent of the 423 births to native mothers one or both of whose parents
were foreign born were attended by midwives. I t is further inter
esting to note th at no foreign-born mothers of English-speaking
nationalities employed midwives as attendants at confinement.
Under the Ohio law (1283-1, Ohio, 1913) all midwives practicing
in the State must be licensed and, in order to obtain a license, must
pass an examination in midwifery given by the State board of health.
At the time of the study the equivalent of a high-school education
and a diploma from a legally chartered school of midwifery in good
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31
AKRON, OHIO.
standing at the time the diploma was issued were necessary for ad
mission to the State examination; but a license to practice midwifery
in a foreign country was also accepted, if approved by the board.
In 57 instances neither physician nor midwife was in attendance,
and in 2 cases the attendant at birth, if any, was not reported.
Of the births attended by midwives, 44.4 per 1,000 died in the first
month, as contrasted with 40.6 per 1,000 of the births attended by
physicians.
T a b l e X I.—Births during selected year, infant deaths, infant mortality rate, and per cent
of stillbirths, according to attendant at birth.
Ï
Total
births.
Attendant at birth.
Live
births.
Infant
deaths.
Stillbirths.
Infant
mortal
cent
ity rate.“ Number. Per
of total
births.«
All classes...........................................
2,322
2,253
193
85.7
69
3.0
Physician.......... ........................................ .
Physician (at hospital)................................
Physician (not at"hospital).........................
Physician and midwife...............................
Midwife........................................................
Other, none, or not reported......................
1,735
188
1,547
23
505
59
1,681
180
1,501
18
495
59
121
72.0
54
8
3.1
4.3
3.0
10
2 .0
18
103
100.0
68.6
59
119.2
2
11
46
5
a Not shown where base is less than 100.
The infant mortality rate for births attended by physicians was 72
as contrasted with 119.2 for births attended by midwives. The dif
ference in the rates, which cover the period up to one year, is not
especially significant, as the attendant at birth—physician or mid
wife—is responsible only at the birth and during the early days of
life of the child. Moreover, most of the midwife cases were among
the foreign-born groups, among which the mortality rate, especially
from gastric and intestinal diseases, was high.
The high mortality among babies delivered by midwives is prob
ably, then, to be attributed to other causes. Of these births, 95 per
cent were born to foreign-born mothers and 69 per cent to mothers
who were unable to speak English. A classification according to the
district where the child spent the greater part of his first year shows
that the midwife cases were drawn largely from factory districts,
characterized by poor living conditions.
CONFINEMENT PERIOD.
The length of the lying-in period gives some indication of the
mother’s ability or willingness to take proper care of herself during
confinement, though custom and tradition may also play a part in
determining the length of this period. Eight and four-tenths per
cent of the mothers stayed in bed less than seven days after the birth
of the child; nine-tenths of these mothers were of foreign birth.
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32
INFANT MORTALITY.
A Magyar mother, 32 years old, who had been in this country 13
years, and who could read and write and speak English, told the fol
lowing story of her sixth confinement. She called in a midwife as
soon as she felt that her services would be needed, but the midwife
did not come, so the mother, with the “ help” of her 5-year-old
daughter, delivered the baby herself. One-half hour after the birth
the mother went to bed and stayed there until the following morning.
Then she got up, prepared breakfast, attended to the needs of three
children, and went back to bed. Later in the day a doctor was called
in; he examined the mother and child and pronounced everything
satisfactory. For the first two days the mother did all the house
work that had to be done, resting all she could. On the third day
she finished a washing which had been in progress when the baby was
born, carrying the wash water from the third house down the street.
A Bohemian mother, 28 years old, who had lived in this country
14 years, reported th at her fourth child had been born on a Satur
day at 3 p. m. During the night he began to cry, and, as her milk
had not come, the mother got up at midnight, made some tea, and
gave it to the child. On Monday she did her usual week’s washing
and scrubbing, getting some help in hanging out the clothes.
In another case, the midwife was told on the third day after the
confinement th at her services were no longer needed: On th at day,
the mother began to do some housework and within a week was
doing it all. She reported th at she had suffered from a lame back
ever since and thought th at perhaps she had not rested enough after
the confinement.
General Table 15 shows th at the native mother as a rule rested a
longer time after confinement than the foreign-bom mother, and that
in each nativity group the infant mortality rate was higher the
shorter the period of rest. The relatively high rate among the groups
resting longer than 15 days is probably due to the fact th at these
groups include a disproportionate number of the abnormal con
finement cases.
MATERNAL MORTALITY.
Perhaps nothing militates so strongly against an infant’s chances
to survive his first year as the mother’s death. Within the group
studied and during the year following the birth of the baby 12
deaths occurred among 2,306 mothers; 4 of these deaths occurred
during the first month after confinement—2 of these and 2 others
occurring within the second month were probably due to childbirth.
This is a comparatively low mortality rate from conditions connected
with childbearing, being less than 3 deaths per 1,000 births.
FEEDING.
In Table X II is shown the change in type of feeding for the first
nine months of life. The term type of feeding refers to the feeding
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33
AKRON, OHIO.
predominating during tlie month specified. Breast feeding means
that no kind of food other than mother’s milk was given; mixed,
that breast milk was supplemented by some other kind of food;
and artificial, that no breast milk was given. In the first month
of life, disregarding the infants who died in the month, 90 per cent
of the infants were breast fed exclusively. This proportion gradually
decreased until in the sixth month 55 per cent were breast fed and
in the ninth month only 29 per cent. A total of 163 infants were
artificially fed from birth.
The respective proportions of infants of native mothers and of
foreign-born mothers who were breast fed are shown in Table X III.
In each month of life a slightly larger proportion of the infants of
foreign-born mothers were breast fed exclusively. The same tend
ency is brought out also in Table XIV, which shows that in each
month of life a somewhat larger proportion of infants of native
mothers were artificially fed. Among the different foreign national
ities some variation in the custom of feeding appears. The Italian
and Slavic mothers had the lowest percentages of infants artificially
fed, while the German mothers and the group of all other nationalities,
which includes a considerable number of Magyars, had percentages
somewhat above the average for the infants of all foreign-born
mothers (Table XV).
T able X I I .—Number and per cent of infants surviving at end of specified month of
life who were breastfed during the month.
Total
infants.
Month of life.
2,159
2,140
2,120
Fourth.............................................................................................................
Fifth. . .
....................................................................................
2,106
2,095
2,088
2,082
2,077
2,071
Infants breast fed
exclusively.
Number. Percent.
1,936
1,743
1,582
1,393
1,280
1,149
881
754
595
89.7
81.4
74.6
66.1
61.1
55.0
42.3
36.3
28.7
T a b l e X III.—Number and per cent exclusively breast fed among infants born to mothers
of specified nativity and surviving at end of specified month of life.
Infants of native mothers.
Month of life.
Total.
Breast fed
exclusively.
Infants of foreign-bom
mothers.
Total.
Number. Percent.
First.............................................................
Second..........................................................
Third............................................................
Fourth.................................... .....................
Fifth.............................................................
Sixth...................^.......................................
Seventh........................................................
Eighth..........................................................
Ninth...........................................................
174247° — 20-
----------
3
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1,302
1,294
1,286
1,278
1,275
1,274
1,272
1,270
1,265
1,162
1,044
945
827
765
694
535
459
350
89.2
80.7
73.5
64.7
60.0
54.5
42.1
36.1
27.7
Breast fed
exclusively.
Number. Per cent.
857
846
834
828
820
814
810
807
806
774
699
637
566
515
455
346
295
245
90.3
82.6
76.4
68.4
62.8
55.9
42.7
36.6
30.4
34
INFANT MORTALITY.
T a b l e X IY .—Number and per cent artificially fed among infants born to native and
to foreign-barn mothers and surviving at end of specified month of life.
Infants of native mothers.
Month of life.
Infants of foreign-born
mothers.
Artificially fed.
Artificially fed.
Total.
Total.
Number. Per cent.
Number. Per cent.
First.............................................................
Second..........................................................
Third...........................................................
Fourth........................................................
Fifth............................................................
Sixth............................................................
Seventh........................................................
Eighth.........................................................
N inth..........................................................
1,302
1,294
1,286
1,278
1,275
1,274
1,272
1,270
1,265
Ill
173
243
297
321
343
369
387
410
8.5
13.4
18.9
23.2
25.2
26.9
29.0
30.5
32.4
857
846
834
828
820
814
810
807
806
52
69
93
114
126
139
153
176
204
6.1
8 .2
11.2
13.8
15.4
17.1
18.9
21.8
25.3
T a b l e XY .—Per cent of infants, of mothers of specified nationality, artificially fed
in month specified.
Per cent of infants artificially fed.
Month of life.
All for German Italian
Slavic
eign-born mothers.
mothers. mothers.
mothers.
10.9
16.7
25.2
11.3
19.4
26.3
8.1
14.4
27.5
7.4
12.6
18.3
Other.
13.8
lS.l
27.1
Analysis of the kind of feeding by earnings of father indicates that
in the lower earnings groups a much smaller proportion of the infants
was artificially fed. In the group where the fathers earned $1,250
and over, more than one-fifth of the infants were artificially fed in
the third month and over two-fifths in the ninth. Evidently the
higher mortality among the infants in the lower earnings groups
occurs in spite of a smaller proportion of infants artificially fed.
A comparison of Akron figures with those for Johnstown on the
question of type of feeding shows that Akron babies of native
mothers were exclusively breast fed to a much greater extent than
the babies of native mothers in Johnstown and that, though in the
first three months not so large a proportion of foreign-born mothers
in Akron nursed their babies as of foreign-born mothers in Johns
town, yet those who did nurse their babies continued it longer.5
MORTALITY RATES, BY KIND OF FEEDING.
In order to show the difference in mortality by kind of feeding,
monthly death rates have been calculated for each month of life.
In the first column of the table the tendency toward decrease in
mortality as the year advances is shown very clearly. In the first
6 General Table
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17.
35
AKRON, OHIO.
month 43 deaths per 1,000 births occurred, or if infants who died
without having been fed are excluded, 23 per 1,000 infants who were
fed died during the month. The mortality decreased rapidly to
9 per 1,000 in the second month, and after the third fell off gradually
until in the tenth to the twelfth months an average of less than 2 per
1,000 died. The next columns show the great disproportion in
mortality for the breast-fed and artificially-fed infants. In the
first month 20 per 1,000 infants who were breast fed died as compared
with 55 per 1,000 infants who were artificially fed. In the later
months, however, the difference is even greater. In the second
month the artificially fed had a mortality six times as high as that
among the breast-fed infants, and throughout the nine months of
life the mortality for the artificially fed is maintained at over four
times the rate for the breast-fed infants.
This contrast in mortality may be expressed in another way. If
to 1,000 infants who lived to be fed are applied the monthly death
rates for breast-fed infants there would be 960 surviving at the end
of the year—a mortality of 40.3 per 1,000. Applying in a similar
manner the rates for the artificially-fed infants only 830 would
survive at the end of the year, giving a mortality rate of 170.2 per
1,000. Thus the rate of infant mortality among the artificially fed
is shown to be more than four times that of the breast-fed infants.
T a b l e XVI. — Deaths in the month per 1,000 survivors at beginning of month and
monthly death rates per 1,000 infants fed in specified way, by month of life.a
Deaths in month per
Deaths in
1,000 infants.
month per
1,000 sur
vivors at
beginning
Artificially
of month. Breast fed.
fed.
Month of life.
First........................
Second......................
Third......................
Fourth...........................
Fifth............................
Sixth....................
Seventh.........................
Eighth....................
Tenth to twelfth (average)...................
5.1
.........................
5.2
2.9
1.1
1.8
.6
2 .2
a Derived from General Table 18.
not fed6 rate is Per 1,000 infants who lived to be fed. The rate per 1,000 live births is 41.7; 45 infants died
A review of the mothers' answers to the question, “ What did you
feed the baby?" shows in many cases ignorance of the underlying
principles of proper infant feeding and a tendency among certain
mothers, especially the foreign born, to express maternal love by
sharing with the baby whatever they themselves especially liked to
eat or drink. For instance, the mothers—chiefly from southeastern
Europe—of 131 babies reported giving coffee to the baby beginning
any time from birth to the end of the twelfth month. The amount.
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36
INFANT MORTALITY.
of course, was slight, just enough to flavor the bottle of milk or to
soften a piece of cracker, bread, or cake. Tea was not so popular,
only 28 cases of baby tea drinkers being reported. A few young
children were seen drinking beer, but only eight mothers—six of
them Slavic—reported having given beer to the baby before it was
1 year old.
Meat, especially bacon, was also considered a special treat for the
baby. A Slavic mother said that her baby was so fond of bacon that
she could not afford to give him all he wanted, and to fool him soaked
bread in lard and gave it to him to suck. A native mother said
that she gave her 3-months-old baby meat, and he liked it so much
that afterwards whenever he saw meat he screamed for it and had
to be given some. Many a mother firmly believed that colic could
be avoided by feeding the baby tastes of everything she herself ate
while nursing him and so accustoming the baby’s stomach to what
she believed to be the ingredients of her breast milk. The mothers
of 414 babies, according to their own testimony, gave the babies
family diet beginning any time from the third month on. Some
elaborated on the phrases “ family diet,” “ table diet,” '"everything
I eat,” by adding “ even cabbage,” “ fried eggs,” “ fried potatoes,”
“ onions,” and one child was reported as having so strong a liking
for anything sour that, although only 10 months old, he had to be
given sauerkraut.
In some cases, even though the diet was more limited, it was far
from scientific; for example, a 3-months-old baby was fed apricot
pie because he wanted it. A Slovak mother 25 years old reported
that the day after the birth of her fourth child she masticated some
cake, fed it to the baby, and then gave him coffee with which to
wash it down.
The importance of these statements of infant feeding lies in the
fact that they show that over 500 mothers made statements indi
cating that they were ignorant of the accepted principles of infant
feeding, or, if familiar with them, did not practice them.
This ignorance or indifference was not confined to foreign-born
women, although they formed the larger proportion of the mothers
who gave food unsuited to the age of the baby. A native mother
reported that she gave her 2-weeks-old baby ice cream, and that
before his sixth month he was sitting at the table “ eating every
thing.” When 11 months old he had spasms, and the mother did
not know why but the doctor advised her not to give the baby solid
food; and after the illness the baby did not want anything but bread
and cereal.
ECONOMIC STATUS OF FAMILY.
The economic status of the family depends in the main upon the
earnings of the father. These earnings are affected by the industrial
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AKRON, OHIO.
37
conditions in the city, by the amount of unemployment, and by the
degree of skill possessed and for which there is a market. One-half
of all the families in Akron were dependent directly upon the rubber
factories for their living. A large proportion of the remainder were
indirectly dependent upon these factories, as they were employed in
industries furnishing products necessary for the rubber factories,
foundry and machine shops being the most important. Besides
these the clay-product factories (sewer pipe and stoneware), and
cereal and flour mills claim attention as important factors in the
employment situation of the city.
GENERAL INDUSTRIAL CONDITIONS.
Conditions in industry bear a direct relation to the welfare of the
children, affecting either the financial condition of the family or the
physical welfare of the breadwinner,* or both. During part of the
period of the study thè rubber factories, upon which such a large
proportion of the families in Akron depended directly or indirectly
for their living, were affected by the depression following the .out
break of the war; but later, after about January 1, 1915, these
factories had to work day and night shifts in order to meet the
heavy demand. The demand for labor was so urgent, at least in
the latter part of the period under study, that the manufacturers
had to pay attractive wages in order to secure and keep a sufficient
supply of labor.
POVERTY.
That Akron had relatively few cases of real poverty during the
period of the study is indicated by the report of the charity organiza
tion society for the nine months ended December 31, 1914. This
society, besides its own charity work, had charge of the city relief
work. Although this period included five months of financial
depression and distress following the opening of the European war
only 478 families were given material relief through public charities.
EARNINGS OF FATHER.
Over two-thirds of the births occurred in families where the
fathers were engaged in manufacturing and mechanical pursuits and
over one-half of these in families where the fathers worked in fac
tories, chiefly in rubber industries.
In Table XVII is shown the distribution of births according to
earnings of the father. The greatest number of births occurred in
the group where the fathers earned between $650 and $850. Of
the total births, 47.1 per cent were in families where the father earned
over $850.
Akron had a much higher wage scale than the other cities in which
infant mortality studies had been made by the bureau. In New
Bedford 37.7 per cent of the births were in the earnings group under
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Federal Reserve Bank of St. Louis
38
INFANT MORTALITY.
$550, in Manchester 30.4 per cent, and in Waterbury 36.8 per cent;
but of the births in Akron only 16.1 per cent were in this group.
Similarly Akron showed in her proportion of births in the higher
earnings group, $1,250 and over, 13.2 per cent as contrasted with
the proportions in New Bedford, Manchester, and Waterbury, which
were 6.5, 6.4, and 8.7, respectively.
T a b l e XV II. — -Number and per cent distribution of births in selected year to mothers of
specified nativity, according to earnings of father.
Total births. >■
Births to native
mothers.
Births to foreignbom mothers.
Earnings of father.
Per cent
Per cent
Per cent
Number. distribu Number. distribu Number. distribu
tion.
tion.
tion.
All classes..........................................
2’322
100.0
1,402
100.0
920
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.......;............. . .........................
No report.....................................................
211
9.1
7.0
9.8
25.0
22.5
11.4
13.2
51
41
83
325
396
224
267
160
.8
1.1
9
3.6
2.9
5.9
23.2
28.2
16.0
19.0
.4
17.4
13.3
15.8
27.8
13.8
4.3
4.3
1.4
163
228
581
523
264
307
19
26
6
.6
122
145
256
127
40
40
13
17
1.8
INFANT MORTALITY AND EARNINGS OF FATHER.
The coincidence of low earnings of father and high infant mortality
is shown in Table XVIII. The highest rates are for the groups “under
$450” and “$450 to $549,” for which the rates were 117.1 and 118,
respectively. For the groups above $550 the mortality rate fell with
a single irregularity until it reached a minimum of 40 for the group
“ $1,250 and over.” As the father’s earnings increased the infant
mortality rate diminished.
T a b l e X V III. — Births during selected year, infant deaths, infant mortality rates, end
per cent of stillbirths, according to earnings offather.a
Earnings of father.
All mothers....................................
Under $450.............................................
$450 to $549..................... ..................
$550 to $649..................................
$650 to $849.......................................
$850 to $1,049...............................
$1,050 to $1,249.......................
$1,250 and over...............................
No earnings............................
Not reported...................................
Total
births.
Live
births.
2,322
2,253
193
85.7
69
3.0
211
205
161
223
563
500
257
300
18
24
19
117.1
118.0
89.7
103.0
82.0
58.4
40.0
6
2
2 .8
1 .2
2 .2
163
228
581
523
264
307
19
a For native and foreign-born mothers see General Table 21.
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Federal Reserve Bank of St. Louis
Stillbirths.
Infant
Infant mortality
deaths.
cent
rate .6 Number. Per
of total
births.(>
20
58
41
15
12
1
5
18
23
7
7
3.1
4.4
2.7
2.3
3
»Not shown where base is less than 100.
AKRON, OHIO.
39
This relation is brought out graphically in Chart III, which shows
the relation of infant mortality rates and earnings of fathers in the
different cities.
Chart III.— Infant mortality rates according to father’s earnings for the four cities specified.
Raid
This relationship also finds expression in the high infant mortality
rates, 165,123, and 130, respectively, in Manchester, Waterbury, and
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Federal Reserve Bank of St. Louis
INFANT MORTALITY.
40
New Bedford—cities which had relatively low wage scales. Brockton,
Saginaw, and Akron with relatively high wage scales had compara
tively low infant mortality rates, 97, 85, and 86, respectively.
As shown previously, the mortality rate for infants of foreign-born
mothers was considerably higher than for infants of native mothers.
A distribution of births in each of these groups by earnings of father
shows that the families of foreign-bom mothers had relatively a much
lower economic status than those of native mothers. In the native
group only 12.5 per cent of the births occurred in families where the
fathers earned less than $650 during the year, as contrasted with 46.5
per cent of the births in the foreign-born group which occurred in
families of this earnings class. But it is interesting to note that in
each earnings group for which rates are shown the mortality was
higher among infants of foreign-bom mothers than among those of
native mothers, indicating that other causes besides father’s earn
ings play a part in the difference in rates by nativity.
In both the native and the foreign-born groups the mortality rates
fell, with a few slight irregularities, as the father’s earnings increased.
In the earnings group “$650 to $850” the infant mortality rate for
the foreign-born was 135.5, higher even than that prevailing in the
income group “under $450.” For this group housing conditions were
relatively bad. General Table 20 shows th at 50 per cent of the
fathers in this group were factory operatives and factory laborers;
a large proportion of them lived near the factory and under some of
the worst living conditions that Akron presented. A study of the
location of the homes of the foreign-born mothers whose husbands’
yearly earnings were between $650 and $850 proved th at they were
either in the districts containing the large factories or in adjoining
districts.
A decrease in infant mortality as the father’s earnings increase
is shown when all births to the mothers included in the study
are considered, classified according to the earnings of the fathers
during the selected year. The mortality was highest, 162, for the
group less than $550 and lowest, 77.9, for the group earning $1,250
and over. The decrease from group to group is somewhat more regu
lar than in the figures of the selected year.
EARNINGS OF FATHER AND GAINFUL EMPLOYMENT OF MOTHER.
The proportion of mothers. gainfully employed during the year
after the infant’s birth varies with the earnings of the father. The
lower the father’s earnings the more need there is for the mother to
supplement the family income with gainful work. This relationship
is shown in Table XIX, in which the proportion of working mothers
declines as the yearly earnings of the fathers increase. The per
centage of mothers employed decreased from 51 in the group where
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41
AKRON, OHIO.
the father’s earnings were under $450 to 14 in the group where the
father’s earnings were $1,250 and over.
Chart IV.— Percentage of mothers gainfully employed during year following infant’s birth, by
nativity, adcording to earnings of father.
Under $1+50
$^50 to
$5^9
$550
to
$#49
$650
to
$850 $1050
to
to
$10^9 $12*19
$1250
and
over
T a b l e X IX —Number and per cent of births to mothers of specified nativity gainfully
employed during year following infant's birth, according to earnings of father.
Births to all mothers. Births tojiative mothers. Births to foreign-bom
mothers.
Gainfully employed.
Earnings oi father.
Total.
Number.
Gainfully employed.
Per
cent.»
Number.
Per
cent.»
19.6
All classes.
2,322
614
26.4
1,402
275
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...
211
108
69
78
133
51.2
42.3
34.2
22.9
19.1
23.5
14.3
51
41
83
325
396
224
267
21
8
163
228
581
523
264
307
19
26
100
62
44
•
12
8
6
9
»Not shown where base is less than
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Federal Reserve Bank of St. Louis
19
71
68
47
36
4
1
100.
Total.
Number.
17.2
21.0
13.5
Per
cent.a
920
339
36.8
~~ 160
87
61
53
62
32
15
8
g
54.4
50.0
40.7
24.2
25 2
122
21.8
Gainfully employed.
145
256
127
40
40
13
17
7
INFANT MORTALITY.
42
GAINFUL EMPLOYMENT OF MOTHER.
Slightly* over one-fourth (28 per cent) of the mothers included in
this study were gainfully employed during some part of the year
preceding the birth of their babies; but in most cases the work did
not take the mother out of the home. Mothers of only 175 infants
worked away from home during the year before the baby’s birth. In
the year after the confinement the mothers of 26 per cent of the
babies did gainful work, slightly less than the proportion of mothers
at work during pregnancy. This work, however, required leaving
the baby in care of some one besides the mother in only 37 cases. In
only 58 instances did the mother work away from home during the
year following the birth of the baby, and in 21 of these the mother
did not resume work until after the baby had died.
The reasons for the small amount of employment are chiefly
relatively high wages earned by the fathers, and comparatively few
opportunities for woman labor in the industries of the city. In this
connection the Ohio mothers’ pension law should be mentioned.6
This law provided that mothers who were the sole breadwinners in
their families, if they had small children, might receive a pension to
enable them to remain with the children. According to the pay roll
in the county treasurer’s office, in September, 1915, 103 mothers
were drawing pensions, of whom probably three-fourths lived in
Akron.
The compensation and insurance regulations of the rubber factory
which employed the largest number of women stated that the com
pany did not encourage the employment of married women. Pro
vision was made, however, in the benefit scheme for disability due
to pregnancy. The mother of a legitimate child was allowed com
pensation up to 13 weeks, providing she had refrained from work at
least 8 weeks before confinement and had been attended by a regis
tered physician during confinement. Before giving work to a married
woman this company always made inquiry into home conditions. If
the husband was able to work, an effort was made to convince him
of the desirability of arranging matters so that his wife might remain
at home; in many instances he was transferred to another job pro
viding better wages in order that he might be able to earn enough
for the support of his family. The woman physician in this factory
urged mothers to remain at home at least until the proper time for
weaning their babies had come, and until the babies had become
fully accustomed to bottle feeding. As mentioned above, their re
turn to the factory was discouraged.
«Laws of 1913, ch. 8 , pp. 877-879, as amended by laws of 1915, pp. 436-437. Pensions not exceeding $15 a
month for one child and $7 a month for each additional child are granted by the juvenile court to mothers
whose husbands are dead, permanently disabled, or prisoners, or whose husbands have deserted for three
years, providing these mothers are poor and the children are not‘old enough to receive an age and schooling
certificate.
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Federal Reserve Bank of St. Louis
43
AKRON, OHIO.
GAINFUL EMPLOYMENT OF MOTHER AND INFANT MORTALITY.
In Table XX are shown rates of infant mortality according to
whether or not the mother was gainfully employed during the year
before the infant’s birth. The mortality among infants whose
mothers were gainfully employed was 107.4 as contrasted with only
77.2 where the mothers were not employed. The mortality among
infants whose mothers were gainfully employed at home appears
higher than that for infants whose mothers were employed away
from home, the rates being 114.5 and 88.2, respectively.
None of the 37 infants whose mothers resumed work away from
home during the lifetime of their infants died in the first year of life.7
T a b l e X X .— Total births during selected year, live births, infant deaths, in f ant mortality
rate, ana per cent of stillbirths, according to gainful employment of mother at home and
away from home during year before infant’s birth, and nativity of mother.
Employment of mother during year before
infant’s birth, and nativity of mother.
All mothers__
Not gainfully employed....
Gainfully employed...
At home.......
Away from home__
Native mothers...........
Not gainfully employed. ..
Gainfully employed...
At home...........
Away from home..
Live
births.
2,322
2,253
1,666
656
481
175
1,620
633
463
170
1,402
1 356
1,125
277
216
61
Foreign-bom mothers.........
Not gainfully employed..
Gainfully employed..............
At home.........
Away from home__
Total
births.
Stillbirths.
Infant
Infant mortality
deaths.
cent
rate .a Number. . Per
of total
births.o
3.0
125
46
23
Ow
-- 266
207
59
3.5
3.7
2.9
46
3.3
35
3.1
4.0
4.2
11
8
2 .8
9
920
897
23
2.5
541
379
265
114
530
367
11
12
2 .0
111
oo
9
3
3.2
3.4
2 .6
“ Not shown where base is less than 100.
EMPLOYMENT HISTORY.
A slightly larger percentage of native mothers than of foreignborn mothers had never been gainfully employed. I t is interesting
to note that the percentage of mothers never gainfully employed
was higher in the Italian, and Jewish groups than in the group of
native mothers of native parentage. The foreign-born women were
as a rule unaccustomed to factory work. Only 27 per cent of the
mothers who had ever worked in a gainful occupation outside the
home for more than one year reported factory work as the chief
occupation. Fifty-five per cent of the foreign-born mothers in the
same group reported domestic service and 17 per cent farm work.
7 At average infant mortality rates for the city, applied to these infants at their ages when the mother
commenced work, there would have occurred 0.7 deaths among this group. The fact that no deaths
occurred is therefore not of particular significance, in view of the small size of the group.
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44
INFANT MORTALITY.
Only about one-sixth of the mothers supplemented the father’s
earnings by taking lodgers and few did it on a commercial scale; less
than two-fifths of the mothers who kept lodgers at any time during
the selected year had more than three. A larger proportion of
foreign-born mothers kept lodgers during the selected year than of
native mothers, and the proportion of Italian mothers who kept
lodgers was higher than that of any other nationality.
HOUSING.
Akron was predominantly a city of one-family houses; according
to figures obtained in the, preliminary canvass of the city, during
which every dwelling in the city was visited, 84 per cent of the
inhabited houses were in this class. The great majority of these
were detached, five- or six-room frame houses, usually of two stories,
with cellar, water and sewer connections, and usually individual
yards.
In an unusually large proportion of cases the people owned or
were buying their homes, which naturally meant a deeper interest
in the outside appearance of the houses. The amount of home
ownership is in general a good index of financial prosperity, and in
this respect Akron had an unusually favorable record. The United
States Census in 1910 credited Akron with 50.4 per cent of home
owners, the highest percentage of any city of its group—60,000 to
80,000 population—and one of the highest among all cities of over
60,000. The families of 34.9 per cent of the babies included in
this study owned their own homes. Foreign-bom fathers were
home owners to a somewhat greater extent than native fathers.
In this connection it should be mentioned that one of the rubber
factories had organized a building company and had built small,
attractive, up-to-date one-family houses which could be bought on
easy terms. Reduced rates were made to employees of the factory
and special precautions were taken to prevent the houses from falling
into the hands of speculators.
The city was clean and tidy, yards were well kept up, garbage
was carefully disposed of, trees and gardens even in rather poor
neighborhoods were frequent.
In Akron the general status of a neighborhood is closely connected
with the topography, for it is a city "of hills and valleys. There are
two main areas of low land—the valley of the Little Cuyahoga
River, which extends all along the eastern edge of the city and across
the northern end, and the shallower depression from Summit Lake
through the center of the city, through which runs the Ohio Canal.
These two valleys join a little north of the business section. The
Little Cuyahoga River Valley is from 100 to 200 feet deep and from
one-half to 1 mile wide. Its lower levels are damp and subject to
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AKRON, OHIO.
45
floods; here were found some of the worst living conditions in Akron.
North of the river, North Hill rises rather abruptly; from the top
of this rise a stretch of high land extends far beyond the city limits.
The Ohio Canal Valley is shallower and much broader, taking in
most of the central part of the city from the chain of bills—West,
Perkins, and Sherbondy—on the western edge to the East Akron
Hill.
As a general rule, insanitary conditions, including bad housing,
were found in the low-lying sections. To the east, owing to the
congestion in the center of the city, the limit of the area of bad
conditions was located farther up the hill than in other parts of
Akron; but this was the most important exception to the rule. Bad
housing conditions, in some respects the worst in the city, existed
in the apartments over stores along the business and factory streets;
but these streets were for the most part in the valleys.
A number of well-built-up and otherwise well-conditioned streets
were lacking, however, in sewer or water installation; and until the
summer of 1915 a satisfactory water supply had been out of the reach
of the great majority. Furthermore, in certain parts of the city
insanitary conditions of all kinds were found—bad housing, bad
drainage, and offensive refuse dumps.
LOT AND BLOCK CROWDING.
Rear houses were common in Akron, but in most neighborhoods
they did not create a sanitary problem. In the ordinary instance
two detached one- or two-family houses were placed on a fairly deep
lot, far enough from each other and from the neighboring houses to
have ample light and air, even if perhaps not all the privacy that
might be desirable. Akron was rather irregularly laid out, with
many abnormally deep lots; on these houses were often built more
than one deep; in such circumstances a private street or court was
sometimes opened up to give access to the rear houses. A number
of instances were observed where houses were much too close together,
and there were indications that this evil would grow with the growth
of the city, unless something was done to prevent.
Whole blocks in the center of the city were overcrowded also,
both with houses and with people. Three such blocks might be
mentioned. One was a notable example of a block “ cluttered u p ”
with houses; it housed 193 persons in 36 dwellings on an area of
about 2.4 acres. The second, the most closely built up and also the
smallest of the three (approximately 144 by 312 feet, or a little less
than 1 acre), had 20 dwellings, inhabited by 157 persons. The block
immediately adjoining this on the south housed 355 people in 37
dwellings, on an area approximately 312 feet square, about 2J acres.
Both these blocks were located near the largest rubber factory, were
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INFANT MORTALITY.
46
full of lodging houses, and probably showed as great a density of
population as any considerable area in Akron. There were no large
tenement bouses in either of these blocks; a few tenement houses
were of brick, with stores on the first floor, but mpst of the houses
were small, shabby, wooden buildings.
In another locality, where the population was reputed to be espe
cially dense, the houses were set four, five, and even six deep up the
side hill; here 437. persons lived in 59 houses, on an area of about
6 | acres. There was only one large house in this block—a brick
tenement; the other houses were practically all small frame buildings,
though many of them were occupied by more than one family.
The most unfortunate feature of the situation was th at the thor
oughfare giving access to the rear houses had been appropriated by
the railroad, so that the persons living in them had no access to. their
homes except by a footpath along the railroad tracks or by sufferance
through the yards of their neighbors.
The head of the local fire underwriters’ bureau stated that the
worst district for fire hazard was from the main business section
north to the foot of the hill. Although a business section, it still
contained many old, wooden buildings in very poor repair, the liv
ing quarters in which were let to a poor class Qf tenants. In one
small area in this section, 627 persons were found living in 72 houses,
most of them, it is safe to say, amid extremely undesirable sur
roundings. In this neighborhood the demolition of many old build
ings had been ordered by the State fire marshal.
HOUSING REGULATIONS AND ENFORCEMENT.
Municipal corporations are given the power—
To regulate the erection of buildings and the sanitary condition thereof, the repair
of, alteration in and addition to buildings, and to provide for the inspection of build
ings or other structures and for the removal and repair of insecure buildings.8
Akron adopted a building code on February 1, 191 i; this was
revised without material changes in February, 1914. Under the
provisions of the ordinance (secs. 1 and 2) the city had in 1915 a
building inspection department with the officials here listed, at the
salaries given:
Building inspector................................... ..................................... - ............................ $2,000
Assistant building inspector.............................................................................. .
1,000
Sanitary (plumbing) inspector.................................................................................... b 500
Electrician (electrical inspector)...................................................................... ....... . 1, 500
Clerk...............................................................................................................................
720
In 1913 and 1914 there were an assistant sanitary inspector and
an assistant electrician at salaries of $1,000 each; but in the first
months of 1915 building was very slack, and the council amended
«General Code 1910, sec. 3636, amended by Laws of 1913, p. 263.
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Federal Reserve Bank of St. Louis
AKRON, OHIO.
47
the ordinance by eliminating these two officials. There was also an
unsalaried board of appeal, consisting of an architect, a structural
engineer, and a builder, appointed by the mayor with the approval
of the council. This board heard and decided all appeals from the
decisions of the building inspector (sec. 7).
The main provisions of sanitary interest are: (a) Requirements
applicable to all dwellings that water-closets for all new buildings
must be inside (sec. 382), that no new cesspools, vaults, or privies
should be constructed on sewered streets (secs. 411 and 418), and
that existing vaults where there is a “ main sewer” should be aban
doned (sec. 418) ; (&) limitation of lot occupancy by new tenement
houses (defn., sec. 41), hotels, and lodging houses (sec. 420); and
(c) requirements applicable only to new tenement houses as to pro
vision of light, air, water supply, and toilet facilities (secs. 422-430
and 433-439).
Attention should be called to the fact that houses sheltering fewer
than three families are affected only by the first set of requirements;
a dwelling, or a group of dwellings and outhouses, or a dwelling over
a store, might, so far as the ordinances are concerned, occupy the
whole of an inside lot, or have dark rooms or rooms with windows
on the lot line (instances of this were found), or dispense with water
connections or toilet facilities.
Apparently the prohibition against new privies or outside waterclosets was generally obeyed; the same can not be said of the removal
of old vaults. The sanitary inspector of the health department
stated that in actual practice no one was required to install sewer
connections unless the neighbors complained of the condition of a
privy vault; in case of complaint, the m atter was taken up by the
health department and the owner was required to put in a watercloset within such period as it appeared he was financially able to
do so. There was no routine of enforcing the elimination of privy
vaults after a sewer was laid, nor were connections required to be
made within any specified time thereafter.
The building inspector stated that it took practically all his time
and that of his assistant to examine and pass upon plans submitted
to them in the office, and hence they were unable to make field inspec
tions. He also stated that they devoted most of their time to new
building and only occasionally attempted to clean up insanitary con
ditions in old tenements.
RENTALS.
In the mind of the ordinary householder, the most serious housing
problems in Akron were high rents and scarcity of houses. In the
five yeafs preceding this study building operations had not kept pace
with the growth of population; as previously mentioned, few houses
had been built for rent; and, except for a few months in 1914 and 1915,
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Federal Reserve Bank of St. Louis
48
INFANT MORTALITY.
it was difficult for prospective tenants to find quarters; during the
latter part of 1915 it became practically impossible. Rentals
amounted to at least $4 per room per month; lower figures than this
applied only to houses without bathrooms and usually without waterclosets, furnaces, or other* conveniences. These values held about
the same all over the city, except on West Hill, which was markedly
more expensive; practically the same prices were charged for miserable
quarters in the poorest parts of town as were paid for much better
accommodations in more desirable localities farther out. A family
that could afford $18 or $20 a month for rent could have a reasonably
well-built five-room detached cottage with cellar and bathroom in
the outlying sections of the city; e. g., on North Hill, away from the
car line, though vacancies in such houses were few and hard to find.
But anyone who had to have cheaper quarters than this faced a serious
lack. There seemed to be no satisfactory three- or four-room houses
for rent, and three-room tenements cost from $12 up often as high
as $15 or even $17 for rooms without adequate light or private toilet
facilities.
The cause of high rents seemed to have been a house scarcity
rather than a land scarcity. I t was stated by a member of a realestate firm dealing largely in rented property that detached houses
could not be rented profitably at prices which workingmen could pay,
i. e., at prevalent Akron prices; and that tenants would have to resort
more and more to flats and terraces.
CONDITIONS UNDER WHICH BABIES INCLUDED IN THE STUDY LIVED.
That the sanitary conditions surrounding the home affected the
child’s chance of surviving his first year has been suggested by the
.description of the districts in which infant mortality was highest. In
addition to this general description certain facts were secured for the
home in which the child spent the great part of his first year—in case
of stillbirth, the home in which the mother spent the great part of her
period of pregnancy. The principal items of interest are the sanitary
conveniences of these homes and the amount of room overcrowding.9
The sanitary conveniences of the homes are shown in Table XXI.
In nearly three-fourths of the homes the city water supply had been
introduced into the dwelling. In over half the cases—in 56.4 per cent
of the births included in the study—no bathtub was reported in the
home. Of the total number of births, 57.4 per cent were in families
where there was a water-closet in the house. In 145 instances sewerconnected privies were used, and in 843 instances privies not con
nected with the sewer. In 1 case no toilet was reported.
9
sine© the study was made, according to the board of health, th© city has been actively engaged in the
installation of sewerage and plumbing systems, so that a large percentage of homes now have sanitary
conveniences.
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AKRON, OHIO.
T a b l e X X I. — Number and per cent distribution of births during selected year to mothers
of specified nativity, according to sanitary conditions of dwelling.
Births to native
mothers.
Total births.
Sanitary condition of dwelling.
Per cent
Per cent
Per cent
Number. distribu Number. distribu Number. distribu
tion.
tion.
tion.
Water supply:
Bath:
In home................................................
Type of toilet:
. 2,322
100.0
1,402
100.0
920
ioo.o
1,682
640
72.4
27.6
- 1,093
309
78.0
22.0
589
331
64.0
36.0
1,010
43.5
56.4
.1
765
636
54.6
45.4
245
674
26.6
73.3
2
1,332
441
547
57.4
' 19.0
23.6
909
242
249
64.8
17.3
17.8
423
199
298
46.0
32,4
1,648
672
71.0
28.9
.1
1,073
327
76.5
28.3
.1
575
345
62.5
37.5
L310
1
1
Sewer-connected:
Births to foreignbom mothers.
2
1
1
1
2
.1
.1
.1
1
.1
21.6
«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 pregnancy period.
ROOM CROWDING.
The number of persons per room for the families included in the
study is shown in Table XX II. The infant mortality rate shows a
marked increase as the number of pèrsons per room increases.
Among the families visited were found 50 cases of foreign boarding
homes sheltering more than 10 persons where there were 2 or more
persons per room, and 20 where there were 3 or more persons per
room. In one instance 20 lodgers in addition to the family were
living in 5 rooms; in another 17 lodgers, day and night shifts, were
housed in a single basement room. Some rooming houses kept by
native Americans were badly overcrowded also.
Room crowding was definitely covered by the housing code which
specified the amount of air space per person (sec. 430), but this pro
vision, difficult of enforcement under any conditions, was entirely
inoperative with so inadequate an inspection service as Akron
supported. The building inspector took up extreme cases of crowd
ing that were brought to his notice from outside sources; he said that
he was able to enforce better conditions temporarily, but there was
no way of preventing a return of previous conditions.
Some house crowding was probably due to high rental and the
scarcity of houses. These factors undoubtedly increased the tend
ency to subdivide houses and force families to get along with fewer
rooms than they needed. But the greatest amount of serious over
crowding occurred in the houses inhabited by the foreign born,
174247°— 20---- 4
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INFANT MORTALITY.
among whom it is customary to use all available space for lodgers in
order to add to the family income. In this particular the infant
mortality investigation gave but little indication as to the extent of
such crowding because many of these boarding houses, especially the
largest and most crowded, did not harbor small children. In two
foreign tenement houses the preliminary canvass showed 149
persons living in 15 four-room tenements. Some of these families
used their cellars as kitchens, but even allowing for this there were
149 persons in from 60 to 70 rooms, or more than 2 per room in the
two houses. Most of these tenements were either subdivided for
two families or used as boarding houses.
T a b l e X X II. — Live births during selected year, infant deaths, and infant mortality
rates, according to number of persons per room.
Live
births.
Persons per room.«
a Excluding infant born dining selected-year.
6
Infant
Infant
deaths. mortality
rate.*
2,253
193
85.7
1,362
707
141
39
4
75
89
24
5
55.1
125.9
170.2
Not shown where base is less than 100.
CIVIC FACTORS.
BIRTH AND DEATH REGISTRATION.
The fundamental prerequisite to an effective program for reducing
infant mortality is complete birth and death registration. Without
complete registration the community does not know whether its
infant mortality rate is high or low, whether measures for the safe
guarding of infant lives are urgent, and whether measures adopted
are effective. With the information as to causes of death the com
munity can arrange a program suitable for its problems; the com
plete list of births is needed in order to take measures to safeguard
infants’ eyes, and to distribute educational leaflets and pamphlets
containing instructions for the mother. From the infant mortality
rates based on births and deaths, the community can determine the
condition of its infant population and measure its progress.
Birth registration.
The Ohio State law (sec. 1910, revised in sec. 218, 1913) requires
births to be “ immediately registered in the district in which it
occurs” ; within 10 days after the birth the physician or midwife in
attendance must file with the local registrar a certificate of birth.
A heavy penalty is imposed for the violation of this law and no fee is
paid to physicians for the filing of such certificates.
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51
The original law of 1910 contained a provision requiring the physi
cian or midwife in attendance to furnish and certify all the items
required in the standard birth certificate approved by the United
States Bureau of the Census. These sections of the law were held
unconstitutional, as exceeding the police power of the State. The
law was then revised; under the present law no penalty is imposed on
physician or midwife for failure to report certain of the items—in
general those relating to father or mother—provided that a certificate
is filed to the effect that it would be difficult to secure this informa
tion without a special inquiry. In such cases, it is the duty of the
registrar to secure such information. This amended law went into
effect on July 25, 1913; hence for almost one month of the year under
study there was no effective legal provision for enforcing birth
registration.
In his annual report for 1913 the Ohio State Registrar wrote:
The registration of births in Ohio for 1913 shows quite a marked improvement
over 1912, but it does not yet show sufficient completeness. * * * Since the
amended law became effective, it has been the aim of the bureau to put the birth
registration again upon its feet; but it is a more difficult task to rejuvenate an old
system than to establish an entirely new one. The great majority of the physicians
and midwives of the State are reporting births promptly. Some, during the time
for which no law was in operation, became negligent in the matter of reporting;
and while there is no disposition upon their part to evade the law, they have
gotten out of the custom of making reports. There have been a sufficient number in
this class to make the registration incomplete.10
Of the births in the detailed study, one-seventh had been unregis
tered. Midwives were but slightly more negligent in registration
than physicians, 14 per cent of midwife cases and 12 per cent of
physician’s cases having been unregistered.11 The presence of a
large number of foreign-born mothers who were unable to speak
English, and who may have been unaware of the law requiring
births to be registered, was not alone responsible for the incomplete
registration; for, although one out of every seven births to foreign
mothers was unregistered, one out of every eight births to native
mothers was unregistered.
Death registration.12
Failures to register deaths were also found. Of the 193 infant
deaths occurring in the group studied, 7, or 3.6 per cent, had not
been registered. Though the proportion thus found to be unregistered
was not so large as the omissions of births, it implied a much more
serious criticism of local registration, since it should be compara
tively easy to enforce the requirement of death registration in con
nection with burial permits.
10 Annual Report, Bureau of Vital Statistics, Ohio, 1913, p. 6.
11 Both physician and midwife attended 23 births, 3 (13.1 per cent) of which were not registered.
12Statements as to completeness of registration refer to the time of the study.
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IN FAN T MORTALITY.
HOSPITAL WORK.
Before March, 1915, Akron had but one general hospital—the City
Hospital—a private corporation supported by fees and donations.
Its capacity was 110 beds, but it had been for several years inade
quate for the needs of the community. After the Children’s Hospital
was opened in 1911, the City Hospital refused to admit patients under
12 years of age. No free beds were provided. Persons needing
hospital care and unable to pay for it were admitted through the
charity organization society and for their care the city paid a nominal
sum. Comparatively little maternity work was done—in 1914,
320 cases were delivered—probably due to the lack of room and proper
equipment for obstetrical work. The hospital made no provision for
prenatal care and up to August, 1915, did no social work in the
homes.
In March, 1915, the People’s Hospital was opened under private
auspices and for a while helped to relieve the congestion in the City
Hospital, but again no adequate provision was made for persons
unable to pay for hospital treatment.
The Children’s Hospital had grown out of the Mary Day Nursery,
which made over a part of its plant into a hospital in 1911. I t took
children under 12 years of age as patients, except those suffering from
contagious diseases. The hospital was small and the maximum
number of patients which could be accommodated was 55. The
regular charge was $1 per day, but treatment was given free to
all who were in need. Until September, 1915, the hospital had
received from the city an annual appropriation of $2,500, but at that
time the amount of appropriation was changed to a pro rata basis.
NURSING WORK.
The Visiting Nurse Association had nine nurses; four did school
and playground work and were paid by the board of education, one
specialized on tuberculosis cases and was paid by the Summit County
Health Protective Society from a fund secured by the sale of Red
Cross Christmas seals, one specialized on eye cases and the other three
did general nursing. The “ eye” nurse devoted her whole time to
treating eye cases, giving instructions about their care, and taking to
doctors children whose eyes were affected. She kept in touch with
the midwives in the city, and saw that they were supplied with
nitrate of silver. In 1914 the Visiting Nurse Association started a
milk station from which milk was dispensed for needy patients and
babies. The babies’ milk was either modified at the station or
mothers were taught how to modify it in their homes. Leaflets
giving instructions on the care of the baby were distributed. These
were printed in Magyar, Italian, German, and English. Care of
infants formed only a small part of the association’s work and was
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AKRON, OHIO.
confined practically to the care of babies in families where the nurse
had adult patients; the number in 1915 did not exceed 35 at any one
time.
Three nurses were employed by the city in the contagious disease
hospital under the board of health.
These 12 nurses, 9 of the Visiting Nurse Association, and 3 of the
board of health, constituted the staff of public-health nurses available
in 1914 for Akron with its population of approximately 100,000.
There was a noticeable increase in the nursing work in Akron in
1917 and 1918 in connection with the reorganization of the health
department.
DAY NURSERY.
The Mary Day Nursery—the only day nursery in the city—was
incorporated in 1891. In 1911, as already mentioned, a part of the
plant, which was too large for the day-nursery needs of the city, was
made over into the Children’s Hospital. During the year ended
June, 1914, the nursery took care of 139 children representing 93
families, more than one-half of which were reported as American.
At the time of the study there were no dispensaries or other medical
relief agencies in Akron.
THE BOARD OF HEALTH.
The powers of the board of health are defined in the General Code
of Ohio, 1910. The board is intrusted with the general care of the
public health and may make such regulations as it deems necessary
for the prevention and restriction of disease; and for the prevention,
abatement, or suppression of nuisances. I t is also empowered to
appoint sanitary police and inspectors of dairies, slaughterhouses,
shops, etc.
The organization of the Akron health department in 1915 was as
follows:
The board of health consisted of five members appointed by the
mayor, without salary, for a term of five years; the mayor was presi
dent ex officio. The board had the following officers and inspectors:
Health officer (part tim e )13.................................................... ......................
Dairy and food inspector............................................................................
Dog catcher.............................. .*............................................ •___
200
4 5qq
1* 020
Two sanitary police................................................................................
^
? qqq
f
Three nurses for contagious disease hospital.......................................................... J
,
.
Clerk and registrar 14.......................................................
City chem ist. .....................................................................
[
900
349
720
720
/x5\
>3The health officer gave only a part of his time to health department work, viz, one visit a day to the
contagious disease hospital, one hour a day to office work, and to consultations with physicians as called
upon.
14Plus fees from the State as registrar of vital statistics, which amount to between $700 and $800 a year.
16Part of salary paid by board of health and part by service department.
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IN FAN T MORTALITY.
Since 1913 appointments had been made under a classified civil
service.
The work of the health department covered the control of conta
gious diseases and sanitary and food inspection.
Control of contagious diseases.
This branch of its work.was given the most emphasis. Physicians
were required to report immediately cases of quarantinable diseases,
smallpox, diphtheria, membraneous croup, and scarlet fever. The
clerk stated that such cases were almost always reported where a
physician was in attendance. Cases of other reportable diseases,
however—typhoid, measles, whooping cough, chicken' pox, and tu
berculosis—were often not reported. According to the annual re
ports of the health officer, in 1914, only 17 cases of pulmonary tuber
culosis were reported, although 59 deaths occurred; this indicates an
extremely defective case registration. One of the two sanitary
police was assigned to contagious disease work, posting quarantine
placards, inspecting the observance of quarantine regulations, and
performing similar duties. In 1913, 66 cases of typhoid fever were
reported, with 15 deaths; in 1914, 84 cases and 23 deaths.
The health department had a small contagious-disease hospital
consisting of two wooden dwelling houses for the care of scarlet fever
and diphtheria only; and a detention hospital or pesthouse for small
pox. Patients who were unable to pay were cared for free in these
hospitals; others paid SI a day in the wards, or $2.50 for a private
room. As has been stated, three nurses were employed by the city in
connection with this hospital for contagious disease.
The health department had also another small furnished building
to which patients with erysipelas or trachoma were admitted. The
patient had to provide food and attendance, because the department
had no appropriation for the care of such cases.
The diagnostic work for the health department was done by the
city chemist, who had his laboratory at ’the Municipal University of
Akron. Physicians in Akron also had recourse to the State patho
logical laboratory for assistance of this kind. This branch of work
was extremely limited and consisted largely of the examination of
throat cultures for diphtheria.
Sanitary inspection.
The second of the two sanitary police in the enlploy of the health
department was assigned to sanitary inspection and abatement of
nuisances, such as those arising in connection with garbage condi
tions, privy vaults, stables, and chicken yards. No report was
available of the work done by this officer. He stated that he had
hardly time to attend to complaints coming to him and, therefore,
attempted nothing except to remedy conditions of which complaint
was made.
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AKEOK, OHIO*
55
Food inspection.
The Akron Board of Health in 1911 drew up and put into effect
a sanitary code covering the production, sale and care of milk,
meat, fish, poultry, game, vegetables, fruits, bread, pastry, confec
tions, ice cream, etc. This code was amended in 1911, 1912, and
1913. The enforcement of the provisions of this code for the safe
guarding of all kinds of foodstuffs, including the inspection of
dairies, slaughterhouses, markets, stores, etc., was .in the hands of
a single inspector, who received the highest salary paid in the
department. The provisions in regard to milk are discussed in the
next section.
Milk supply.
A most important duty of the board of health from the point of
view of reducing infant mortality is the regulating of the produc
tion and sale of milk. The sanitary code provided that cows
should be properly fed and housed and tuberculin tested at least
once a year; that milk should be handled under sanitary conditions
by persons free from contagious disease, and that it should be cooled
and kept below 65° F.; and that milk sold at retail should be con
tained in closed bottles and should reach certain chemical and
bacteriological standards; pasteurization was required. All persons
bringing milk into the city of Akron for sale were required to hold
a permit issued by the board of health on the recommendation of
the sanitary inspector, and permits were to be renewed annually
in January and revoked if conditions fell below standard. There
was, however, lack of proper provision for regular dairy inspection.
As has been seen, the enforcement of the sanitary code regulat
ing the production, sale, and care of milk, meat, fish, poultry, game,
vegetables, fruits, bread, pastry, confections, ice cream, etc., as well
as the handling of all cases of real or éuspected hydrophobia, was
in the hands of a single inspector. He had no adequate laboratory,
no means of conveyance, and no assistant, not even for clerical
work. The inspector stated that he was frequently unable to make
inspections for months after requests from dairymen for permits to
sell milk had been received, and consequently he had granted permits
and made inspections later. Since the results of inspection were not
published, the inspection work was of little value to the individual
proprietors or to the public. The inspector required no proof that
cows were tested with tuberculin because he feared that if this pro
vision were enforced dairymen would send their milk to near-by
towns where no such requirements were made. After the first
inspection the dairies and premises of licensed milk dealers were
not usually inspected further unless a complaint was made. No
score cards were required. Infrequently, perhaps once a year,
the food inspector tested milk for temperature, and enforced the
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INFANT MORTALITY.
law by dumping ajl milk found to be above 65° F. Twice a year,
spring and fall, samples of milk were taken from dealers and analyzed
by the city chemist. No bacteriological analyses were made.16
No records were found of any recent prosecutions for violations
of the milk provisions of the sanitary code.
More than half the milk was retailed at 7 cents per quart, and the
two dairies which provided milk—especially suited to babies—at 10
or 12 cents a quart served a very restricted area.
Vital statistics.
The registration of vital statistics in Akron was in the hands of
a registrar on the staff of the board of health. This subject so far
as it concerns birth and death registration has already been
discussed.17
Expenditures.
From 1909 to 1913 the expenditures 18 of the health department
were as follows:
1 9 0 9 .. ...................
$5,981.71
1 9 1 0 .. . . . . ........ ......... .................................... ............................ ........................... 8,152.75
1911 ............................ ........................................................... ................................... 8, 896.88
1912^
..................................... 7 ................ . . . . . ......... ................... 16,430.00
1913 ................
16,054.00
1 9 1 4 .. . . . . . . . v.......................
14,997.00
The amount shows some increase during this period, but the sums
expended in 1913 and 1914 by the health department, though over
twice the expenditure in 1909, were small for a city the size of Akron,
especially in view of the fact that nearly half the budget went for
the support of the contagious-disease hospital. The committee on
activities of municipal health departments of the American Public
Health Association has set the minimum per capita appropriation
required for a city health department at 50 cents.18 The per capita
expenditure for public health in Akron during 1913 was less than
13 cents.
In emergencies, such as epidemics or threatened epidemics, the
board of health may take steps to combat them; the State General
Code requires that the council pass the necessary appropriations to
cover expenses so incurred (sec. 4451).
1«In September, 1915, tbe newspapers announced weeks ahead that chemical tests of milk were to be
made. The food inspector was asked to have bacteriological analyses of a few of these samples made. Nine
analyses were made—all nine were above the minimum requirement of 3 per cent butter fats, some being
as high as 5.5 per cent; eight of the nine fell within the 500,000 bacteria maximum limit. One sample
gave a count of 1,000,000 bacteria per cubic centimeter. The sample giving the lowest bacterial count
represented one of the largest dealers, who pasteurized the milk and had a well-equipped laboratory with
a chemist and a bacteriologist.
WSee p. 50.
’8 The expenditures for the years 1909, 1910, and 1911 are taken from Financial Report, Akron, 1913,
p. 50; and for the years 1912,1913, and 1911 from Health Work in Akron, a summary of six years’ work,
1912 to 1917, together with Annual Report for 1918, Bureau of Municipal Research, p. 7. Akron, 1918.
19 MacNutt: Manual for Health Officers, p. 96.
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Reorganization of health work.
Since the period covered by this study the Akron health department
has undergone a complete reorganization and now has greatly broad
ened functions and increased usefulness to the city.20
A full-time health officer has been employed since 1916; also a
full-time epidemiologist and a full-time bacteriologist. A trained
public-health nurse was secured to organize a child-welfare depart
ment which later was merged in the division of public-health nurs
ing. By 1917 the health department’s appropriation, which in 1914
had been $14,462, had increased to $40,000—an amount which was
supplemented by private donations of about $25,000; the budget
for 1918 was $80,000. Its per capita expenditure increased from 15
cents in 1914 to an estimated 43 cents in 1917.21 The department
has been organized with divisions of public-health nursing, communi
cable diseases, sanitation, dairy and food control, laboratories, vital
statistics, and education.
Recognizing the great importance of infant and child conservation
in a public-health program, the health department has devoted a
considerable proportion of its resources to this work. In 1916 the
expenditure for the division of child welfare was $6,094; in 1917,
$27,453.22 However, the division carried on other nursing work
besides that for babies and children.
In 1916 the division took over the work of the George T. Perkins
Visiting Nurse Association. In 1917 the number of nurses employed
varied between 10 and 15. Three infant-welfare stations were estab
lished with the registration of 357 new babies. Together with chil
dren previously under supervision this made 1,634 infants under care.
A beginning was made in prenatal work, for 65 mothers were under
supervision.23 This work for babies and mothers was still-further
increased in 1918. The staff of the division, the name of which was
changed to the division of public-health nursing, averaged 14 field
nurses, 2 supervising field nurses, and the director of the division on
the regular city pay roll, and 4 nurses for tuberculosis work on the
Red Cross pay roll. The number of infant-welfare stations was
increased to four and 887 new babies were registered. Prenatal work
was increased; 443 mothers were under supervision during that year.
The station nurses also gave after-care to maternity cases.21 An
important addition to the work was made in that year, when the care
“ Health Work in Akron, a summary of six years’ work, 1912 to 1917, together with Annual Report for
1918, Bureau of Municipal Research. Akron, 1918.
21 Health Work in Akron, a summary of six years’ work, 1912 to 1917, together with Annual Report for
1918, Bureau of Municipal Research, p. 7. Akron, 1918.
22 Health Work in Akron, a summary of six years’ work, 1912 to 1917, together with Annual Report for
1918, Bureau of Municipal Research, p. 7. Akron, 1918.
23Health Work in Akron, a summary of six years’ work, 1912 to 1917, together with Annual Report for
1918, Bureau of Municipal Research, pp. 37-38. Akron, 1918.
24Health Work in Akron, a summary of six years’ work, 1912 to 1917, together with Annual Report for
1918, Bureau of Municipal Research, p. 16. Akron, 1918.
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INTAiBEF M 0 R3JMJTY.
of children 2 to 6 years of age was included in the work of the stations
and nurses; 464 children of this age were cared for in 1918.
The division of communicable diseases also has made great gains
since the period of this study. A more satisfactory reporting of com
municable diseases has developed, and in spite of better reporting a
lower incidence of disease was noted in 1918 than in 1917 for mumps,
poliomyelitis, measles, erysipelas, cerebrospinal meningitis, diph
theria, and trachoma. Since July 1, 1918, venereal diseases have
been reportable by State law; clinics have been held three times a
week and the smallpox hospital has been used for syphilitic patients.
The division has also developed educational activities, including
weekly reports sent to all physicians advising them of the disease
situation and of recent rulings of the State health department.
The division of sanitation has made a number of sanitary surveys
of certain sections of the city, covering housing conditions, water
supply, flushing, sewer connections, disposal of garbage and rubbish,
stables, and disposal of manure; these surveys should be helpful as
a basis for improved sanitation throughout the city.
The division of dairy and food inspection during 1918 made 2,722
inspections of various sorts in spite of having been handicapped
during the later months by the influenza epidemic. Of the total
inspections, 62 were of dairies, 56 of milk depots, 105 of milk wagons,
and 40 of pasteurizing plants. At the end of the year the health
officer reported that 89 per cent of the milk supply of the city was
passing through the process of pasteurization and stated as his opinion
that pasteurization should be made compulsory by law for all milk
sold in the city that showed a bacteria count, in samples taken from
a wagon, of more than 100,000 bacteria per cubic centimeter. The
health officer stated in his report for 1918 that the demand for service
made upon the food and dairy division was far greater than could be
satisfied by the present employees.
Over 11,000 bacteriological examinations were made in 1918 by
the division of laboratories, and the city chemist made 1,163 analyses.
During that year, however, only 25 milk examinations were made
by the division of laboratories and only 93 milk analyses by the city
chemist.
The greatly improved facilities of the city health department, since
the period covered by the Children’s Bureau study, for supervising
the city health and sanitation may be expected to play an important
part in reducing the city’s infant morbidity and mortality.
SANITATION.
Water supply.
The public water supply of the city of Akron during the period
covered by this study and until the end of August, 1915, was drawn
from Summit Lake in the southwestern corner of the city. This
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supply, with, its appurtenant distribution system, was developed by
a private corporation and was taken over by the city by purchase in
1912.
Summit Lake is fed partly from springs within its own area; at
its southern end it receives water from both the Ohio Canal and Falor
Creek. There is very little flow in the Ohio Canal; the water is pol
luted with factory wastes.25 Falor Creek drains a considerable area
of inhabited territory in the southeastern part of the city, receiving
factory wastes from two large manufacturing establishments. Sum
mit Lake itself is entirely surrounded by inhabited territory. Nearly
all this territory was sewered; but on the western side of the lake
house waste pipes drained into the lake; and privies, which were to
be found north, west, and south of the lake, might have caused con
tamination of the surface drainage.
The raw Summit Lake water was generally recognized to be unsafe.
Although treated with hypochlorite of lime at the waterworks, prior
to 1915, the city water was not considered fit for drinking and was
hardly ever used for that purpose.
Besides being contaminated, the Summit Lake water was very
hard and was frequently muddy or discolored and sometimes offensive
in odor. Moreover, it was insufficient in quantity; often it was inade
quate for the fire service, and not infrequently the domestic supply
in the higher parts of the city had to be cut off. The daily average
pumped during 1914 was 10,226,240 gallons.
Plans had been developed for taking water from the Cuyahoga
River, and by the end of August, 1915, work was practically completed
on the new plant and the water turned into the city mains. The
capacity of the plant was 20,000,000 gallons a day; this could be
increased when necessary. Bacteriological tests proved the water to
be safe for drinking purposes.
On November 1, 1915, the city had approximately 176 miles of
water mains. Using the city engineer’s office estimate of 210 miles
of streets, 84 per cent of the streets of the city had water mains by
the close of 1915. The waterworks department had no figures or
estimates of the number of houses connected with the water supply.
On January 1, 1915, the active service, including all business and
factory as well as domestic connections, numbered 14,600 and on
December 1, 1915, 16,300. They indicate, however, an increase
during 11 months of nearly 12 per cent in the number of water con
nections; and a considerable part of this increase may be attributed
to appreciation of the improved quality of the water supply. In the
infant mortality study 70 per cent of the houses scheduled had city
water.
ss Previous to January, 1914, there was much trouble with seepage into the canal from one of the salt
works.
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INFANT MOKTALITY.
m
As has been explained, prior to September, 1915, practically no one
in Akron drank city water. This situation necessitated some kind
of supplementary supply in almost every household.
Many springs on the various hills in and around Akron were thought
to give good water. Water from these springs was extensively used
for drinking by the people in their immediate neighborhood, a few
houses had spring water piped to them; and a great many families
bought spring water from various companies which delivered it by
wagon. The city chemist’s report for 1914 stated that he had
examined 64 samples of water from such venders, of which 50 were
satisfactory and 14 were condemned. During that year one springwater company was compelled to secure a new and uncontaminated
source of supply, and a second went out of business on account of
pressure from the health department.
Well water, however, was most commonly used for drinking. *
Both dug and drilled or driven wells were used drilled wells much the
more commonly. In most localities it was not necessary to go very
deep-(not over 75 feet) to reach water-bearing rocks. In the great
majority of cases more than one family used a well. The owners of
the well charged a small sum, usually from 15 cents to 25 cents a
month, for the privilege of drawing water.
No investigation of the well situation as a whole had ever been
made; no one knew exactly how many wells there were, nor what
proportion of them was contaminated. The city chemist examined
well water only on complaint—that is to say, he tested the water only
fro m wells, that were for some reason reported to him as suspected.
The chemist’s monthly reports for 1914 gave 29 wells condemned
and 21 satisfactory; for 1915 (11 months) 34 condemned and 19
satisfactory. This, of course, gives no indication of the general
situation. Wells which were condemned were usually merely placarded
with a notice that the water should not be used for drinking without
being boiled.27
The city chemist stated that as a general proposition wells less than
30 feet deep were unsafe, because the ground water was heavily
polluted. Besides the usual contamination found in any thickly
settled area, the leakage from the Akron sewers was unusually great.28
The flood in the spring of 1913 damaged greatly the sewer system,
and a broken sewer caused a number of cases of typhoid before the
break was discovered. Throughout the poorer districts of the city
wells were often found in close proximity to privies (see PI. II).
26 Such tests were made on report either from a physician or from a citizen, provided reasonable ground
for suspicion was shown. Wells were tested whenever a physician reported them as a probable source
of typhoid infection; wells also in the vicinity of one that was found to be contaminated were tested.
27 The health officers planned to make a survey of all the wells in the city during 1916 and to condemn and
close up all that were found polluted. The survey was started, and many wells examined, after which
a great many were closed. The survey was never completed.
28 See Report of Ohio State Board of Health, 1913, p. 411.
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PLATE
I.— PRIVIES A N D C H I C K E N C O O P S O N B A N K O F RIVER .
FAM ILY A
L I T T L E F A R T H E R D O W N USES RIV E R W A T E R FOR W A S H I N G .
P L A T E II.— W E L L A N D V A U L T PRIVY.
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plate
III.— t w e l v e t e n e m e n t s .
P L A T E IV.— T O I L E T F A C I L I T I E S FOR ABO VE.
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P LATE V — VIEWS OF OPEN S EW ER AND O V E R F L O W FROM SAME.
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PLATE V I I — S T R E E T BADLY W ASH ED O U T.
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P L A T E V ili .— A T Y P I C A L L Y G O O D S T R E E T .
P L A T E IX.— A D U M P .
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P L A T E X — P U M P A ND G A R B A G E V A U L T .
P L A T E XI.— T E N E M E N T H O U S E S .
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P L A T E XII,— REAR H O U S E .
P L A T E X III.— S H A C K S .
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M
%
P L A T E XI.V.— A L L E Y FIV E H O U S E S D E E P F R O M S T R E E T .
P L A T E XV.— B L O C K C R O W D I N G (N O S E W E R S ; BAD Y A R D D R A I N A G E ).
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P L A T E XVI.— PRIVIES, S H E D S , REAR H O U S E O N BAN K.
P L A T E XVII.— L O T C R O W D I N G (2 H O U S E S 19 I N C H E S A P A R T ).
CANAL JU S T N O R TH OF A FACTORY.
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STEAM FROM
PLATE
X V III—
A T T R A C T I V E G A R D E N S IN S M A L L SPACES.
P L A T E X I X — C O T T A G E IN T H E O U T S K I R T S .
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Federal Reserve Bank of St. Louis
AKRONj OHIO.
m
Although many of these privies were sewer connected, there was no
assurance of water-tight connections, and the seepage from these
might cause contamination.
Drilled wells going down to the “ rock w ater”—usually 50 to 60 feet
deep—were generally safe, according to the city chemist. An impor
tant exception was in the neighborhood of the depression running
through the center of the city, where what is known as a “ filter
gallery,” or trough where surface drainage settled, existed; in this
section wells 100 feet deep were often found to he polluted from dis
tant sources of contamination. Occasionally, too, ground water
seeping into drilled wells caused trouble.
Filtered cistern water was commonly used for drinking in certain
parts of the city, notably on North Hill. Whether or not such water
was safe depended entirely on the construction of the individual
cistern and whether the ground water was effectively excluded.
Since the study was made city water mains have been extended to
this district.
, v •.
Sewerage system and sewage disposal.
According to the city engineer’s office, 130 miles of sewers29 had
been laid a t the close of 1914, and approximately 10 miles more were
constructed in 1915. At the close of 1915, out of an estimated total
of 210 miles of streets, 140 miles, or 67 per cent, were sewered. The
construction of sewers had lagged behind the laying of water mains.
The service department had no figures of the number or proportion
of houses connected with the city sewers. About three-fourths of
the houses scheduled in the infant mortality investigation had
sewer connections of some kind, a somewhat higher proportion than
had the city water.
The sewer system was partly on the combined storm water and
sanitary sewage plan and partly on the separate plan. The first
trunk sewer, installed in 1880, was the only one regularly receiving
both storm water and sanitary sewage. This drained most of the
central portion of the city. The other trunk sewers were not in
tended to receive storm water, but as a m atter of fact many roof
drains had been connected with the sewers in all parts of the city,
though no more such connections were to be allowed. Furthermore,
according to the engineering department of the State board of health,
‘•The sanitary sewers are for the most part poorly constructed with
leaky joints which during wet weather admit large quantities of
ground water.” The combination of the two classes of sewage has
two disadvantages: (1) During severe storms it overtaxes and
sometimes wrecks the sewers; and (2) it needlessly increases the
volume of sewage to be handled by a disposal plant.
29 The State sanitary engineer’s estimate in June, 1913. was 100 miles.
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62
INEAHT MORTALITY.
Outside the Central District, water from the streets was discharged
from the catchment basins into separate storm sewers, which emptied
into the nearest natural drainage—creek or canal. Catchment
basins were as a rule located only at the low points along a street;
and many of the paved streets became almost impassible during a
heavy rainstorm.
The sanitary sewer system was badly weakened all over the city
by the flood of March, 1913.. A number of sewers were more or less
seriously broken; repairs on the worst damaged one—the East
Akron trunk sewer, which followed the general course of the Little
Cuyahoga River from near the southeastern city limits—were
commenced, and $30,000 expended; but the work had not been
completed. As a result of the break, sewage was discharged into
an open street from the caved-in sewer and spread out over the flat
ground between the street and the river in a most offensive pool.
In another case, a troublesome break caused sewage to “ back” into
cellars and to flow into the street; it was not repaired for more than
a year.
One of the trunk sewers in the eastern part of the city80 discharged
into the Little Cuyahoga River under a large bridge. The outlet
was some 2 feet above the level of the river a t normal times; the
odor arising was extremely unpleasant and persisted far down the
stream. The main outfall sewer for the whole system was an oval
brick conduit about 3 by 5 feet in diameter, and about 1,500 feet in
length. I t extended to a point known as Lock 16 where the bulk
of the sanitary sewage of the city was discharged into the river.
This point was well within the inhabited portion of the city—-the
north bank of the river, especially, having a number of dwellings
opposite and just below the sewer outlet. Until the summer of
1915 a small sewer from the north bank also discharged into the
river at this point. Previous to the 1913 flood, the city had con
structed a 2-mile extension sewer of reinforced concrete—5 feet in
diameter—from Lock 16, where the old sewer discharged, to Lock 20
beyond the city limits but had never connected this new conduit
with the old one. The new sewer was badly broken by the flood
and had to be repaired. Repairing was done in the summer of 1915
and the connection made in September, 1916.
The Little Cuyahoga River received considerable pollution all
along its course (see PI. I) through the city, but nevertheless
appeared comparatively clean through the western part of the city.
Below that point, in addition to the sewage of the whole city, it
received the waters of the Ohio Canal and the Hydraulic Canal,
which were highly polluted with industrial wastes. The engineer of
so Theoretically the Howard Street sewer entered the outfall sewer parallel to the river at this point, and
only storm water should have been discharged under the bridge. But the discharge of sewage as above
described continued throughout the time of this investigation.
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AKRON, OHIO.
63
the State board of health, in connection with a complaint from the
Board of Commissioners of Summit County against the city of Akron,
stated that—
The minimum dry ■weather flow [of the Little Cuyahoga River] is estimated at 5
second-feet. According to accepted standards this is sufficient to dilute the sewage of
somewhat more than 1,000 persons. It will readily be seen that during dry weather
the flow of the stream is totally insufficient to dilute the sewage from the city. * * *
The nuisance created is not only a cause for deterioration of the property value but
has also given rise to unhealthful conditions.
A sewage disposal plant had been under consideration by the city
from the summer of 1910 when plans were made and land purchased
near the junction of the Little Cuyahoga and Cuyahoga Rivers north
of the city limits. A preliminary testing station was constructed
and the 2-mile extension already mentioned of the trunk sewer
to the site of the proposed plant was undertaken.81
In the spring of 1913, preliminary plans for the disposal plant
were submitted to and approved by the State board of health. In
connection with the complaint of the commissioners of Summit
County, already mentioned, the State board of health ordered that
the installation of the sewage disposal plant be completed by June,
1915. The necessary bond issue was authorized in April, 1914;
contracts were let and work was begun in the summer of that year;
the plant was completed and put into operation in the autumn of
1916.
Street paving and cleaning.
According to the statement of the city engineer’s office (December,
1915), there were 104J miles of paved streets in Akron. This was
approximately one-half of the total street mileage (210) as estimated
by the same office.82 Practically all this pavement was hard
surface—brick, stone block, concrete, or asphalt; over 90 per cent
was brick. From a sanitary point of view, this makes an excellent
surface while new; but as laid in Akron it became uneven within a
few years and made cleaning difficult. This deterioration of the
pavement was found particularly on the main streets where traffic
was heavy. However, much of the brick pavement was new.
The practice of the service department was to do practically
nothing with a street until it was ready to put down a hard-surface
pavement. The unpaved streets were as a rule ungraded and without
gutters or drainage, and, therefore, often held water in the low spots
or were badly washed on the slopes (see Pis. V I-V III). Many of the
unimproved streets were in thickly settled parts of the city, as, for
31 Report of the State Board of Health, 1913, p. 610.
® The city engineer’s report for 1914 gave higher figures, viz, 116.45 miles of paved streets out of a total of
176.77 miles, or about two-thirds. This figure for pavements was undoubtedly too high, as was indicated
by the reduction in the later estimate. On the other hand, the Bureau of Municipal Research, in its
investigation of street cleaning in 1915, had all the paved streets measured, and found only 87 miles.
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64
IN FAN T MORTALITY.
example, the two shown in the photographs. Where the soil was
clay, these unpaved, streets were almost impassible in wet weather.
On the few macadamized streets, the surface was old and badly worn;
these streets were being repaved with brick as rapidly as possible.
Few of the alleys were paved.
The hard-surfaced streets were supposed to be cleaned from one to
six times a week. Except for the center of town, the cleaning season
did not last the whole year; in 1914 it lasted seven months (Apr. 1
to Oct. 30); in 1915 only six months (Apr. 20 to Oct. 20). The streets
were thus left uncleaned for a considerable part of the year. During
the winter of 1914-15, the charity organization society and city relief
department set their beneficiaries to work cleaning streets; for the
service department had no money for such work during the winter
even in the center of the city.
During the summer of 1913 and 1915, the streets were cleaned by
contract, the work being let in small jobs to different contractors
(in 1915, to 31 different men). In 1914 the work was done directly
by the service department using street flushers on the down-town
streets; in 1915, however, the work was done exclusively under
contract by hand sweeping, the council refusing to provide money
for the use of the department’s flushing machines on the streets.
Since 1915 the city service department has cleaned all streets, and
no more contracts have been let.
At the time of the study the service department had one inspector
whose duties were to inspect pavements and sewers laid, to investi
gate complaints, and to inspect street cleaning. Since the study the
department has been entirely reorganized, and Akron now has 40
inspectors for paving and street cleaning.
Refuse and garbage disposal.
Up to and including the period of the infant mortality investigation,
and throughout 1915, Akron had no public provision of any kind
for the collection or disposal of refuse or garbage.
Refuse not privately disposed of was ordinarily thrown on dumps,
of which there were a number—more or less officially recognized—in
different parts of the city. All were in places where the property
owners wished to fill in low land, and the miscellaneous rubbish
deposited was used for the under layers of the fill. Some of these
dumps were in thickly settled parts of the city, and in close prox
imity to dwelling houses. In one place on the northern slope
of North Hill an attractive wooded ravine had been spoiled by
allowing refuse to be dumped along its sides. Depositing or dump
ing garbage or material that would decay was prohibited by
city ordinance. The board of health posted notices to that effect
but did nothing to enforce the prohibition. In one instance the
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AKRON, OHIO.
65
property owner kept a watchman at the dump to see that objection^
able material was not deposited.
As a m atter of fact, more or less garbage was left a t the dumps,
many of which were malodorous throughout the. summer, and all of
which swarmed with flies. In many places in the poorest parts of
the city, it was customary to throw refuse and garbage into back
yards^ and vacant lots, over canal and railroad banks, and sometimes
even into the streets, practically forming miniature dumps.
The common method of garbage collection was by private contract.
The usual charge for this service was from 15 cents to 25 cents a week,
usually for two collections. The health department had no authority
over garbage collectors, unless they created a nuisance by spilling
garbage on to the streets. Anyone who wished could enter the
business, and each collector disposed of his collections as he saw fit.
One company did the great bulk of the business; this company
maintained a large garbage dump about 2 miles outside the city,
where the garbage collected by its wagons was burned or fed to
swine.
One great disadvantage of such commercial garbage collection was
that the collectors would not go where they could not secure enough
patrons to make it pay, and consequently many families who would
have liked: to have had their garbage removed could find no one
to do it.
A city garbage disposal plant had been under discussion for a
number of years. During the summer of 1914 a contract for the
garbage plant was let, a t about the same time as that for the sewage
purification works. Both plants are located on the same tract of
land, 2 miles down the river from the city. The garbage plant was
completed in January, 1916. Garbage collection has recently (1919)
been taken over by the bureau of sanitation of the city service depart
ment, which has exclusive control; private collection is no longer
permitted.
174247°—20----- 5
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SUMMARY AND CONCLUSIONS.
Akron is an industrial city in the Middle West with a large propor
tion of foreign born. The rubber industry predominates, and wages
are relatively high.
INFANT MORTALITY RATE.
One hundred and ninety-three out of 2,253 infants bom alive in
the year selected for study died during the first year of life, giving an
infant mortality rate of 85.7 per thousand live births. The still
birth rate was 3 per cent of the total births. Of the cities studied
by the bureau Akron had next to the lowest rate of infant mortality,
a rate which was in marked contrast to the high rates of Manchester,
Johnstown, New Bedford, and Waterbury. Though, as contrasted
with other cities studied by the bureau, Akron rates were low, the
experience of certain cities of the United States and other countries
shows that even these low rates may be very materially reduced.
NATIONALITY.
Of the total births, 39.4 per cent were to foreign-bom mothers.
The mortality rate for infants of foreign-bom mothers was considerably
higher than that for infants of native mothers, 109.3, as contrasted
with 70.1. Among the foreign-bom mothers the highest rate was
found for the Slavic group, 146.6; the rate for infants of Italian
mothers was 116.4, while the German had an infant mortality rate
of 105; the rate for Magyars was 1 0 2 .8 .
ATTENDANT AT BIRTH.
Approximately three-fourths of the births in Akron were attended
by physicians. Midwives were sole attendants in 505 cases, or 22
per cent of the total. Four hundred and seventy-eight of these were
births to foreign-bom mothers.
TYPE OF FEEDING.
One hundred and sixty-three infants were artifLcally fed from
birth. The proportion of infants of native mothers who were
artifically fed is slightly higher at all ages than for other groups.
Among the different foreign nationalities the Italian and Slavic
mothers had the lowest percentages of infants artifically fed. The
mortality among artificially fed babies was on the average more
than four times that among breast-fed babies.
67
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68
INFANT MORTALITY.
EARNINGS OF FATHER.
In the lowest earnings group, under $450, the infant mortality
rate was 117.1, while in the group $1,250 and over the rate was
only 40. As the earnings of the father increased the infant mor
tality rate diminished. As compared with other cities studied by
the bureau a much larger proportion of families was in the higher
wage groups—a fact which may in part explain the low general
infant mortality. In Akron 13.2 per cent of the births were in the
group over $1,250, as contrasted with 6.5, 6.4, and 8.7 in New Bed
ford, Manchester, and Waterbury, respectively.
GAINFUL EMPLOYMENT OF MOTHER.
A comparatively small proportion of mothers were gainfully em
ployed. About one-fourth were gainfully employed during the
year preceding the birth of their babies, but only 175, or 7.5 per
cent, worked away from home. The mortality among infants
whose mothers were gainfully employed during pregnancy was
higher than for infants of mothers not gainfully employed, 107.4,
contrasted with 77.2. For gainful employment of the mother after
the birth of the infant, the numbers were too small to be significant.
BIRTH REGISTRATION.
Both birth and death registration could have been improved.
The house-to-house canvass made in Akron showed that at least
from 10 to 14 per cent of the births during the year selected failed
to be registered. Of the deaths in infancy, 3 per cent were not
registered.
CAUSE OF DEATH.
The largest number of deaths was due to diseases of early infancy,
followed by gastric and intestinal diseases and respiratory diseases.
The mortality rate from gastric and intestinal diseases among in
fants of foreign-born mothers was almost four times as high as that
among infants of native mothers. The rate was especially high in
the Slavic group. A large proportion of the babies who died from
these diseases were artificially fed.
PRENATAL CARE.
The reorganized health department of Akron has made a begin
ning in the prevention of stillbirths and of infant mortality from
diseases of early infancy through the prenatal supervision and after
care of maternity cases already undertaken. In view of the rela
tively large proportion of deaths of babies in the early weeks of
life, this work is shown to be very important, and should be so in
creased that adequate prenatal and obstetrical care would be avail
able for all mothers in the city.
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AKRON, OHIO.
69
INFANT-WELFARE WORK.
Through, infant-welfare stations and the instructive work of
nurses in the homes, the infant death rate from gastric and intes
tinal diseases, and—to a less extent—that from respiratory dis
eases, may be lowered. The four stations already established by
the health department will undoubtedly accomplish much to this
end, but the number of stations and of nurses needs to be increased,
as pointed out by the city health officials in their 1918 reports.
The Public Health Commission of New York State recommended
that “ cities with an industrial population should have one infantwelfare station for approximately each 2 0,000 inhabitants.” The
increase in the number of public-health nurses working in Akron
has already been a remarkable one; but a further increase is needed
for the adequate health protection of its babies, mothers, and whole
population. Experts have estimated that a city needs one publichealth nurse for every 2,000 of its population ;33 on this basis, Akron
still needs a force.of nurses far in excess of that already at work.
33See Minimum Standards for Child Welfare, adopted by the Washington and Regional Conferences
on Child Welfare, 1919, p. 7. U. S. Children's Bureau Publication No. 62. Washington, 1919.
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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 othor period of life except old age.
The report of the Bureau of the Census on Mortality Statistics shows
that in 1910 for every 1,000 live births registered in the death-regis
tration States there were 124 infant 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 Dis
trict of 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
is much greater—from 54 in Brookline and Malden, Mass., to 196 in
Shenandoah, Pa.
T able I. — Infant mortality rates for States in the birth-registration area: 1915.a
State.
Infant
mortality
rate.
Infant
mortality
rate.
State.
107
105
101
86
70
110
99
no
120
85
a United States Bureau of the Census, Birth Statistics, 1915, p. 10, Washington, 1917.
I t 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 Bureau of the
Census throw little light. If inquiries were made in restricted
areas and information on the physical, social, economic, and civic
conditions were secured for all births and 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.
’The rate is too high since the registration of births was incomplete in these States; in many of them it
was very deficient. Figures are shown for the death-registration States of 1911 and are for 1910, except in
Kentucky and Missouri, where births and deaths are for 1911.
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INFANT MORTALITY.
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 where the mothers to be interviewed lived.
I t was further necessary to choose cities of such size th at they could
be covered thoroughly within a reasonable time by the few agents
available for the work. Certain characteristics of the cities chosen
are summarized in Table II. All were manufacturing cities, the popu
lations ranging, in 1910, from 50,000 to 100 ,0 0 0 . 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 of pop
ulation over 20 foreign bom, principal foreign nationality,a and principal industry of
the cities chosen for infant mortality studies.
Infant mor
tality rates.
City.
Johnstown, P a............
Manchester, N. H .......
Brockton, Mass......... .
Saginaw, Mich............
New Bedford, Mass...
Waterbury, Conn.......
Akron, Ohio...............
Percent
age of
adult
Popula
popula
tion in
tion
over
1910.
foreign
1910.& 1915.c 20born,
1910.
55.482
70,063
56,878
50,510
96,652
73,141
69.067
165
193
99
145
177
149
123
116
150
82
101
143
143
39.9
56.1
37.3
33.7
59.0
50.5
26.0
Principal foreign
nationality.«
Principal industry.
Varied Slavic d ........
French Canadian__
Lithuanian..............
German....................
Portuguese...............
Italian......................
German....................
Iron and steel.
Cotton textiles.
Shoe manufacture.
Varied industries.
Cotton textiles.
Brass manufacture.
Rubber manufacture.
a Principal foreign nationality of mothers of infants included in the infant mortality studies.
6 Figures published by the United States Bureau of the Census, Bulletin 109, Mortality Statistics, 1910,
pp. 18-19, based on provisional figures for births. The rate for Akron, Ohio, was furnished by the Ohio
State registrar. The rate for Saginaw, Mich., was based on State (final) figures for births.
c United States Bureau of the Census, Birth Statistics, 1915, Washington, 1917.
d No particular Slavic group of sufficient importance to mention separately.
Infant mortality rate.
An infant mortality rate expresses the probability of a live-born
infant dying before his first birthday and is usually stated as the
number of deaths under 1 year per 1,000 live births .2 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 regis
tered live births in the same year. The number of deaths thus
secured includes not only deaths of infants born in the same calendar
year, but also some deaths of infants born in the preceding year or in
a different area; it excludes deaths of infants included in the group
a Stillbirths are omitted from both births and deaths.
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of births if the death occurred either in a different area or in the fol
lowing calendar year. The two numbers—of deaths and births—do
not refer to the same group of infants. To avoid this inaccuracy, the
method employed by the Children’s Bureau in all studies has been to
follow each infant born in a given selected year in a certain area for
a period of 12 months. The deaths among these infants are then
compared to the births. In this way the deaths include no infants
not included in the births, and the true probability of dying in the
first year of life is secured.
The chief difficulty, in practice, in computing infant mortality
rates arises from the incompleteness of registration of births and deaths.
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. If the per cent
of omission of deaths under 1 year of age is equal to the per cent of
omissions of births, the infant mortality rate, though based on incom
plete data, will still be correct. In general, however, death regis
tration is better than birth registration. If birth registration is more
defective than registration of infant deaths, the infant mortality rate
will be too high. Inaccuracies will affect not only the general rate
for a given area but may affect also the comparability of the rates for
different classes within the area. In an analysis of births and deaths
by race and nativity classes, if the degree of completeness of registra
tion varies with the different classes, the rates found by dividing the
deaths by the births may not be comparable. For the purpose of
these investigations comparable rates are essential.
I t is not of so much importance that the rate secured shall charac
terize general conditions of infant mortality for a given area as that
rates for the different nativity classes, earnings groups, and other
subclasses shall indicate the true differences for the area in the
incidence of infant deaths. There are two methods of treating the
original data to make them more serviceable for this purpose. One
is to exclude the least accurate material, where it is known to be incomplete or inaccurate; the other is to make a selection of material
on some unbiased basis and use the data selected as representative of
the city. An alternative policy is so to supplement the original data
th at 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 by the bureau. The
groups for which the rates are most open to question and most diffi
cult to obtain are illegitimate births, births in families that have
moved away, and births to nonresident mothers.
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INFANT MORTALITY.
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 5 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 th at in most cases the
infant did not live in the city during his entire first year of life but also
on the ground th at 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 character
istic 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 th at 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 .3
The data submitted in the report apply, therefore, to births in the I
city during the selected year to resident married mothers who lived
there during the child’s first year and were found at the time of the
agent’s visit.
Though the records for births to resident married mothers are
much more complete and satisfactory than for all births in the city,
there still remains the difficulty that differences in the completeness
3 The rulings in two special cases might he mentioned: (1) lith e mother died during the child’s first year,
the birth was included if the infant (or, in case of death, his family) had lived in the city during the first
year after his birth. (2) In a few cases mother and child were away from the city for a part only of the
child’s first year but later moved back and were found by the agent. In the cities first studied agents were
not instructed to inquire as to continuous residence in the city. If, however, the fact that the mother had
moved away for a period was noted, the birth was excluded in tabulation, if the absence from the city had
been three months or more. In Akron, the birth was excluded in case of removal, a temporary absence on
account of summer vacation not being considered a removal.
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AKRON, OHIO.
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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. I t was found, however, in
examining the birth and death certificates that occasionally a death
had been registered of an infant bom 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 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 is 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 can
vass, 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 quarters. Agents
were instructed to take schedules for any infants found who were
born in Johnstown in 1911, even if the births 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.
In Akron a house-to-house canvass was made to supplement the
list of names secured from the birth register. This procedure was
the more necessary since Akron was not in the birth-registration area.
The canvass was undertaken not so much to complete the record of
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INFANT MORTALITY.
children born in Akron during the selected year, as to complete the
record of such children who lived in Akron during the first year of
life. Obviously it would be more difficult to secure records for chil
dren whose mothers moved away from the city before the end of
the first year of life, or for children who had died. The omission of
such births from the canvass would not have affected the validity of
the canvass for the purposes of this study. All the names secured
either by birth records or by the canvass were used as a basis of the
visits to mothers, and those cases for which the information secured
showed that the child had been born in Akron in the selected year and
had lived in the city during his lifetime up to the first birthday were
included in the special study. Incidentally the canvass greatly
facilitated the work of finding the mothers, for it gave the correct
address of most of the mothers to be interviewed.
Every effort was made to secure as complete a canvass as possible.
Agents were instructed to inquire for births in the city during 1913
and 1914. Since the selected year was from July 1 , 1913, to June
30, 1914, information was thus obtained for births just before and
just after the selected period, and thus an opportunity to check the
date of registration was afforded. A bonus was given to the agents
for each live birth discovered and a somewhat larger bonus for a death
or stillbirth.
The thoroughness of the canvass can be tested in the following way:
If the canvass had been complete, then it should have found all
infants whose births were registered and who were living in Akron
at the time the canvass was made. This figure would be approxi
mately equal to the number of such children whose births were
registered and who survived the first year of life, or 1,788. Of these
children, the canvass failed to find 136, or 7.6 per cent. In some
instances, however, the omission could be explained by temporary
absence at the time of the canvass, in 3 cases by death at over 1 year
of age before the canvasser arrived. Though theoretically it should
be possible to secure stillbirths and deaths by the canvass method,
yet in practice the canvassers were not nearly so successful in secur
ing such records.
As a result of the canvass 309 names were added to the registered
live births included in the study. These form 13.7 per cent of the
total number of live births included in the study. Besides these
the canvass found some 8 births in the city during the selected year
which had to be excluded for various reasons. Fourteen more were
added from the death records. The total number of unregistered
live births found was thus 331, or 11.4 per cent of the total live births
in the city. Obviously, as suggested above, owing to the difficulty
of finding by a canvass births to nonresident mothers or to mothers
who had removed from the city, the percentage first given is a more
significant index of the percentage of births not registered.
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By using records secured from these two independent sources, the
canvass, and the birth and death register, a very complete list of
the infants born and living in the city or who had died at less than
1 year of age was obtained. The chance of omissions both from the
birth register and from the canvass list is relatively negligible, prob
ably but 1 or 2 per cent.
Besides 309 live births added to the list of births registered, the
canvass added 12 cases of stillbirths and miscarriages that occurred
during the selected year.
With the general plan of the investigation determined, the more
important points in the detailed procedure were as follows. The first
step was to copy (from the records at the State capital) the birth
certificates for the 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.4 These records usually gave the address
of the mother, though not in all cases the present address. In cities
where a canvass was made the actual address of the mother was found
directly. If the mother had moved, the agent attempted to learn
from the neighbors or other sources her present address in the city
or whether she had moved away. Most of the information contained
in these reports is derived from the answers secured from the mothers
interviewed. Since the bureau has no power 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
information dépends.
In comparing, then, the rates for the group included in the study
with the rates for the corresponding calendar year computed in the
ordinary manner, the following points must be borne in mind:
First. In rates computed by the ordinary method the deaths
and births occur in the same year. In rates for the bureau studies
the births in a selected year are compared to the deaths among them.
The deaths are scattered over a period of two years, including the
selected year and the year following.
Second. Illegitimate births are excluded from these studies .5 The
death rate for illegitimate births is usually considerably higher than
the average rate. The rates as shown in these studies, therefore
may be expected to be somewhat lower than the rates as usually
computed.
Third. Births to nonresident mothers are excluded in order to
make the rates as characteristic as possible of the conditions of the
locality studied.
* Duplicates were omitted, and erroneous registrations of births occurring outside the city were eliminated.
6Except for Johnstown, where illegitimate births were included.
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INFANT MORTALITY.
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
impossible to use the figures except on the basis of arbitrary as
sumption. Deaths in the city of infants born elsewhere are also
excluded, because there is no information on age at migration. This
policy excludes, of course, infant deaths in foundling asylums, if the
birth did not occur in the city.
Fifth. In some of the cities rates are based on the deaths among the
registered births. Infant deaths where the birth was not recorded
have therefore been omitted, to correspond with the probable omis
sion of infants surviving the first year of life whose births were not
recorded.
Finally, in other cities the birth records have been completed or
supplemented by a canvass or by other means. In these cases it is
easy to show from the incompleteness of the records th a t 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 Akron.
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 2,906 live births in Akron. Of these, 496 moved out of town,
129 could not be found, and 13 were births to nonresident mothers—
a total of 638 which were excluded on grounds of nonresidence or
lack of information. Of these 638 births, 20 were unregistered—
14 were discovered through the death certificates; obviously no fair
rate could be based on these cases on account of the difficulty of
finding unregistered births to mothers who had moved away. Among
the 618 registered live births to mothers who could not be found or
had moved away, 49 deaths were known to have occurred. These
deaths registered in the city probably do not include all deaths
among this group. The mortality rate, therefore, of 79 is probably
somewhat less than the true rate for this group. Among the 13
registered live births excluded on grounds of nonresidence of the
mother, no deaths occurred in the city. In most cases these mothers
probably left the city soon after the birth of the child, and the deaths,
if any, occurring among this group were not registered in the city.
Of the births to mothers resident in the city both at the tune of the
infant’s birth and the agent’s visit, 15 were excluded on the ground
of illegitimacy; 2 of these died before the end of the first year. A
total of 2,253 live births, then, was included in the study and 193
infant deaths occurred among them.
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AKRON, OHIO.
The infant mortality rate for births included in the study was
85.7; for the excluded groups the rate varies with the reasons for
exclusion. The rate for illegitimate births is usually high. The
rate for cases where the mother was not found or had moved away
from the city is somewhat lower than the rates for births included in
the study, but is obviously less than the true rate. No fair rate can
be made for the group of infants whose mothers moved away from the
city or could not be found where the birth was not registered because
most of the information was obtained from death certificates. The
rate for all known live births, both included and excluded, was 8 8 .8 ,
a rate which is only slightly above the rate for the live births included
in the study.
E x c l u sio n T a b l e 1.—Registered and unregistered live births in Akron, infant deaths,
and infant mortality rates for births included in and for births excluded from detailed
analysis, by reason for exclusion.
Infant mortality rate.»
Infant deaths.
Live births.
Inclusions or exclusions and
reasons for exclusions.
Births Births
Births Births
Unreg
regis unreg Total. regis unreg
Total. Regis
tered. istered. Total. tered.
tered. istered.
istered.
88.8
85.7
99.5
80.4
80.2
80.8
14
98.7
79.3
3
100.8
79.4
11
100.8
81.4
Total known live births................. 2,906 2,575
Total live births included............... 2,253 1,944
631
653
Reasons for exclusion:
Nonresidence or lack of in638
618
formation: Total.............
331
309
22
258
193
65
207
156
51
51
"37
14
20
63
49
129
13
496
126
13
479
3
13
10
17
50
39
15
13
2
2
2
154.1
119.7
a Not shown where base is less than 100.
From the figures secured light may be thrown upon the complete
ness of registration of live births in Akron. If the deaths where the
births had not been registered are compared with the total deaths in
the city among births in the selected year, the figure of 19 per cent is
obtained as an index of the proportion of live births not registered.
This index gives the true percentage of births not registered only in
case the mortality in the groups where registration is faulty is the
same as the average. The mortality rates are usually high in the
foreign-born and low-earnings groups among which the registration is
probably least complete. This percentage, therefore, probably rep
resents a maximum statement of the percentage of births unregis
tered.
Another method of determining the percentage of five births not
registered is by comparing with the total number of births the unreg
istered births discovered. There were 331 unregistered live births—
11.4 per cent of the total number of live births known to have
occurred in the city in the selected year. As suggested above, a
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INFANT MORTALITY.
fairer comparison is of the 309 unregistered live births to mothers
who were resident in the city not only at the tune of the birth but
also at the time of the canvass and at the agent’s visit with the 2,253
live births in the same group. This gives a percentage of 13.7 unreg
istered. This percentage probably represents a somewhat conserva
tive statement of the births not registered because it includes only
those cases where an unregistered birth was known to have occurred.
It was shown above that of the registered births included in the
study, the canvass failed to find 7.6 per cent. If the same percentage
of omissions were applicable to the unregistered births included in
the study, approximately 1 per cent more births occurred which
should have been included. To find the percentage of omissions of
the births in the city, something should be added on account of the
infants whose mothers moved away from the city, which the canvass
might obviously fail to secure. The true percentage then lies above
13.7 but probably falls below the figure given by the first method.
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’ ges
tation, were excluded.
A policy of exclusions was followed similar to that for infant mor
tality. Stillbirths to nonresident mothers were excluded because of
the possible effect of other conditions; likewise stillbirths to mothers
who moved away prior to the visit of the agent. In the latter cases
the information would have been difficult to obtain, and there was
the same chance of omission of births as in calculating the infant mor
tality rate.
With reference to the accuracy of the data the registration of still
births has a margin of error of its own. Usually a stillbirth 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 registered.
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. I t is
obvious that such an omission is one of carelessness only, as ordi
narily the same person, usually a physician, would register both.
The number of unregistered stillbirths would be difficult to deter
mine. Twelve cases of omission of stillbirths were discovered in the
course of the canvass but others not found may have occurred. I t
is much more difficult to check up the registration of stillbirths by
means of a canvass than the registration of live births.
Omissions might be due to ignorance of the law or failure to observe
it. Doctors are probably more conversant with the law than mid
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Federal Reserve Bank of St. Louis
AKRON, OHIO.
81
wives. 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 miscar
riages, the number of stillbirths is probably more complete than where
they are not reported.
In the stillbirth rates presented in the infant mortality reports of
the Children’s Bureau, the stillbirths to resident married mothers that
were registered either as births or deaths have been compared to the
registered births to resident married mothers for Manchester, Brock
ton, and New Bedford; in other cities the figure for stillbirths is
compared to the total registered and known unregistered births to
resident married mothers.
Stillbirths excluded.
There were 115 known stillbirths and miscarriages in Akron.
Nineteen of these were excluded because they were known to be mis
carriages of less than 7 months’ gestation. Twenty-seven more
were excluded because the mothers had moved out of the city or were
nonresident or because they could not be found. In these cases it
could not always be determined definitely whether the birth was a still
birth or a miscarriage. There were 69 stillbirths to mothers resident
in the city both at the time of the birth of the child and at the agent’s
visit. No stillbirths were found to have been illegitimate. The
rate for the included group is formed by dividing 69 stillbirths by the
2,975 births included in the study, giving a percentage of stillbirths
of 2.3. No rate has been 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.
E x c l u sio n T a b l e 2. —Stillbirths and miscarriages in Akron, included in and excluded
from detailed analysis, by reason for exclusion.
Inclusions or exclusions and reason for exclusion.
Number.
Total known stillbirths and miscarriages..................
Total stillbirths included.......................
Total stillbirths and miscarriages excluded.........
Reasons for exclusion:
Nonresidence or lack of information: T otal...
115
09
46
Not found..............................
Nonresident..........................
Removed.......................
5
3
19
Miscarriages excluded...............
174247°—20----- 6
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19
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Federal Reserve Bank of St. Louis
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Federal Reserve Bank of St. Louis
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Federal Reserve Bank of St. Louis
GENERAL TABLES.
T
able
1 . —Births
during selected year in each section cf residence, according to nationality
of mother.
Section of residence.
Nationa'ity of mother.
Total
births.
East South
West South Val East Busi
Ex
West. North
Hill. Hill. Cen
tral. ley. Hill. ness.
change. West.
All mothers............................. 2,322
321
249
378
76
203
338
331
118
308
Native mothers................................. 1,402
228
182
252
64
162
134
149
93
138
Both parents native...................
Qne or both parents foreign bom.
973
423.
6
152
75
1
123
59
178
73
1
49
15
104
58
102
31
1
102
46
1
65
28
98
38
2
Foreign-born mothers.......................
German................................... .
920
226
152
192
109
93
40
5
12
4
67
12
19
13
126
39
4
14
18
12
3
7
41
13
1
2
204
72
15
43
44
182
17
62
65
17
25
7
2
2
170
32
56
37
11
76
61
104
14
6
12
16
3
4
11
33
16
1
1
9
8
8
3
2
25
9
3
9
8
1
5
5
4
25
Eng.ish, Irish, Scotch, and
W esha.....................................
Jewish.........................................
1
a Includes 46 Eng'ish, 19 Irish, 9 Scotch, and 2 We’sh.
b Includes 28 Syrian, 21 Scandinavian, 18 Roumanian, 11 Lithuanian, 11 English Canadian, 9 French,
1 French Canadian, 1 Greek, 1 Armenian, 1 Dutch, and 2 foreign colored.
T
able
2 . —Live
births during selected year, infant deaths, and infant mortality rate,
according to literacy of mother.
Literacy <*of mother.
All mothers...........................................................................................
Foreign-born mothers..............................................................................
Live
births.
Infant
deaths.
2,253
27013“
205
5
1,356
1,351
4
1
897
692
201
4
219
198
191
137
50
4
146
77
69
107
93
14
234
187
47
Infant
mortality
rate.*)
193
171
22
85.7
83.7
107.3
95
95
70.1
70.3
98
109.3
109.8
109.5
22
105.0
111.1
23
22
1
28
21
7
146.6
153.3
17
8
9
11
8
3
19
17
2
116.4
102.8
81.2
90.9
a Persons who can read and write in any language are reported literate.
b Not shown where base is less than 100.
85
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T
INFANT MORTALITY.
3 . —Live births to foreign-bom mothers during selected year, infant^ deaths, and
infant mortality rate, according to nationality of mother and her ability to speak
English.
able
Infant
mortality
rate.®
Infant
deaths.
Live
births.
Nationality of mother and ability to speak English.
All foreign-born mothers.....................................................................
897
98
109.3
Non-English speaking nationalities..............................................................
Able to speak English...........................................................................
Unable to speak English...................................................................... .- -
84
813
314
499
6
92
32
60
113.2
101.9
120.2
219
23
105.0
109
110
11
12
100.9
109.1
Able to speak English.......................................................................
Unable to speak English............. -....................................................
Other foreign-born mothers....................... ...............................
594
69
116.2
Able to speak English.......................................................................
Unable to speak English...................................................................
205
389
21
48
102.4
123.4
“ Not shown where base is less than 100.
T
able
Births during selected year to foreign-born mothers resident in the United
States specified number of years, according to nationality of mother.
4 .—
Births during selected year to foreign-bom mothers.
Nationality of mother.
Years of residence of mother in United States.
Total. Under 3 to
12 to 15 and No re
9 to
6 to
14.
over. port.
8.
11.
3.
5.
All foreign-born mothers......................
920
287
235
154
88
46
106
4
German...........................................
226
152
192
109
76
61
104
53
53
78
43
23
8
29
63
33
59
38
19
5
18
37
27
29
14
12
15
20
18
18
17
8
5
18
4
9
9
3
3
2
7
13
43
12
6
3
15
8
19
3
English, Irish, Scotch, and Welsh®
All other &......................................
1
a Includes 46 English, 19 Irish, 9 Scotch, and 2 Welsh.
b Includes 23 Syrian, 21 Scandinavian, 18 Roumanian, 11 Lithuanian, 11 English Canadian, 9 French,
I French Canadian, 1 Greek, 1 Armenian, 1 Dutch, and 2 foreign colored.
T
able
5 . —Births from
all pregnancies,a live births, infant deaths, infant mortality rate,
and number and per cent of stillbirths, according to nationality of mother.
Nationality erf mother.
All mothers....................................
Total
moth
ers.
2,287
Total
births.
Total Num
ber
live
infant
births. deaths.
Infant
mor
tality
rate.&
Stillbirths.
cent
Num Per
of total
ber. births.
&
6,287
6,101
746
122.3
186
3.00
294
452
91.8
156.0
102
84
3.1
2.8
Native mothers.......................................
Foreign-bom mothers.............................
1,384
903
3,305
2,982
3,203.
2,898
German.............................................
Italian..................... ..........................
Slavic:
Serbo-Croatian and Slovak «...
Other Slavic <*............................
Magyar.............................................
English, Irish, Scotch, and Welsh «.
Jewish...............................................
AH other!.........................................
220
149
737
531
714
514
101
81
141.5
157.5
23
17
3.1
3.2
144
43
108
77
61
101
496
140
355
187
224
312
488
137
344
181
213
307
108
18
69
20
15
40
221.3
131.4
200.6
110.5
70.4
130.3
8
3
11
6
11
5
1.6
2.1
3.1
3.2
4.9
1.6
a Excluding miscarriages.
6 Not shown where base is less than 100.
c includes 80 Serbo-Croatian and 64 Slovak. (61 Slovak and 3 Slovenian.)
d Includes 30 Polish, 3 Bohemian, 5 Russian, and 5 Ruthenian.
«Includes 46 English, 19 Irish, 10 Scotch, and 2 Welsh.
^ / Includes 28 Syrian, 21 Scandinavian, 18 Roumanian, 11 Lithuanian, 9 English Canadian, 9 French,
1 French Canadian, 1 Greek, 1 Armenian, 1 Dutch, and 1 foreign colored.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
AKBOH, OHIO.
T
able
6 .—
87
Mothers reporting specified number of births from all pregnancies, by
nationality._______________________ _________
Total
Mothers reporting specified number of births.«
moth
4
3
5 6 7 8 9 10 ii 12 13 15 17
2
1
ers.
1
All mothers............ 2,287 815 546 337 210 144 76 62 36 25 : 17 7 5 4 2
1
1 384 585 354 184 102 66 32 24 12 11 3 5 2 2 1
Foreign-born mothers---- '903 230 192 153 108 78 44 38 24 14 14 2 3 2 1
2
7 6 6
36 23 19 8
53
1
149 32 29 28 18 11 11 10 4 3 2
Slavic:
Serbo-C roatian
and Slovak b. . .
144 31 27 33 13 16 5 9 5 3 2
1
3 2 3 1
4
7
43 12 10
Other Slavic c__
108 26 20 21 18 10 4 2 2 2 1 2
English, Irish, Scotch,
3 3 1 1
10 H
1
1
7
8 4 3 3
10
61 13 ii
1
8 7 5 1 .... 2
101 32 23 11 11
Allother *..................
a Excluding miscarriages.
6 includes 80 Serbo-Croatian and 64 Slovak (61 Slovak and 3 Slovenian),
c Includes 30 Polish, 3 Bohemian, 5 Russian, and 5 Ruthenian.
d Includes 46 English, 19 Irish, 10 Scotch, and 2 Welsh.
..
■
e Includes 28 Syrian, 21 Scandinavian, 18 Roumanian, 11 Lithuaman, 9 Enghsh Canadian, 9 French
1 French Canadian, 1 Greek, 1 Armenian, 1 Butch, and 1 foreign colored.
Nationality of mother.
T
7 . —Number and per cent distribution of deaths among infants bom during selected
year in Akron and of infant deaths in the registration area in 1914, according to detailed
cause of death._____ _______________________ —= = = == = = = = = ^ = = 7
able
Infant deaths inRegistration area.
Akron.
Per cent
Per
cent
Num distri
distri
ber. bution. Number. bution.
155,075
100.0
100.0
193
All causes..........................
37,736
24.3
23.8
46
Gastric and intestinal diseases. c.
2,556
1.6
1.6
3
Diseases of the stomach.......
102,103..................
35,180
22.7
22.3
43
Diarrhea and enteritis..........
104'........................
24,036
15.5
11.9
Respiratory diseases d .................
23
3,458
1.6
2.2
3
Acute bronchitis..................
89..........................
8.8
13,653
6.2
91
12
6,925
4.5
4.1
8
Pneumonia......... .................
92 ..
6.2
9,663
4.7
9
150
Part of 33___
52,535
33.9
33.7
65
Early infancy..............................
18.2
28,270
20.2
39
151 (1) ...
Part of 33___ |l51 (2), 152 (2), 153.
12.0
10.4
18,549
20
Congenital debility...............
3.7
5,716
6
3.1
Part of 37___ 152 (1)
12,714
8.2
6.7
13
Epidemic diseases e ....................
1,041
.7
.5
1
K
Measles..................................
6............................
.1
2Ö4
7
2.5
3,899
2.1
4
Whooping cough..................
7
8............................
.6
977
.5
1
9............................
Diphtheria and croup..........
8
.3
481
10
.4
573
1.0
2
14
.5
740
18
.2
368
.6
883
.5
1
Tuberculosis of the lungs---28,29......................
13...
.7
1,118
1.0
2
Tuberculous
meningitis.......
30'..........................
14...
448
.3
31 22 22 34,25 .
1,982
1.3
1.0
2
1,926
1.2
.5
1
35
155 to 186...............
2,964
1.9
5.2
10
187,188,189............ Diseases ill defined or unknown.
38...
8.7
13,501
13.5
26
All other causes............... ..........
1.1
1,659
4
2.1
61..........................
17
1.9
2,950
1.6
3
71
.4
596
4
2.1
19........ ......... 79..........................
Organic diseases of the heart.
5.3
8,296
7.8
15
Other....................................
a The numbers indicate the classification in the abridged and the detailed lists, respectively, of the
Manual of the International List of Causes of Death.
b The causes of death included in this list are those used by the United States Bureau of the Census
(see Mortality Statistics, 1914, p. 660) in classifying the deaths of infants under 1 year. They are
those causes of death or groups of causes which are most important at this age. The numbers of the
detailed and abridged international lists will facilitate their identification. In order to make discussion
of the figures easier, these causes of death have been grouped in eight main groups.
c The term “ gastric and intestinal diseases” as used in the tables and discussion includes, as above
shown, only the diseases of this type which are most important among infants, i. e., diseases of. the
stomach, diarrhea, and enteritis. It does not include all “ diseases of the digestive system” as classified
under this heading according to the detailed International List.
¿ “ Respiratory diseases” as used in the tables and discussion similarly includes only those of the
respiratory diseases which are most important among infants, i. e., acute bronchitis, bronchopneumonia,
and pneumonia. It does notinclude all “ diseases of the respiratory system’’ as classified under this head •
ing according to the detailed International List.
.
« “ Epidemic diseases” as used in the tables and discussion includes only those of this group which are
most important amons inf?.«+£*
Abridged
International
list.«
Detailed.
International
List.«
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Federal Reserve Bank of St. Louis
Cause of death. &
88
T
INFANT MORTALITY.
able
8 . —Deaths from,
specified causes among infants bom during selected year, according
to district of residence.
Deaths from specified causes.
District of resi
dence.
Gas
tric
Total and
deaths. intes
tinal
dis
eases.
Early infancy.
Re
spira Malfortory maPre Con in
dis
ma genital juries
eases. tions. Total. ture de
at
birth. bility. birth.
Dis
Epi Ex eases
All
demic ternal ill de other
dis causes. fined causes..
eases.
or un
known.
All districts.
193
48
23
9
65
39
20
6
13
East Exchange__
Southwest.............
West.....................
North Hill............
West Hill.............
South Central.......
Valley...................
East Hill...............
Business...............
17
14
30
6
18
30
36
11
31
3
1
7
2
3
2
1
2
3
3
3
4
1
1
2
8
8
8
2
7
8
14
3
7
3
5
6
2
3
6
9
i
4
5
2
1
1
1
1
2
1
4
1
1
1
2
2
2
T
able
9 . —Deaths
1
15
7
1
11
i
i
3
3
2
4
1
2
1
10
26
3
1
1
1
3'
2
1
3
3
among infants born during selected year, occurring in specified calendar
month, by cause of death.
Deaths occurring in specified calendar month.
Total
infant
deaths. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec.
Cause of death.
All causes..................
193
14
18
20
13
14
10
17
24
23
12
13
15
Gastric and intestinal dis
eases..................................
Respiratory diseases...........
Malformations.....................
Early infancy..................... .
46
23
9
65
2
3
2
2
2
3
2
5
1
4
1
2
1
3
2
2
2
6
4
2
9
1
2
1
6
3
1
2.
3
9
1
1
7
9
1
3
39
20
6
13
1
i
i
2
2
2
1
4
2
3
2
1
5
2
2
2
• Premature birth...........
Congenital debility.......
Injuries at birth.. *.......
Epidemic diseases...............
E xternal causes...................
Diseases ill-defined or un
known..............................
All other causes...................
T
able
1 0 . —Deaths
10
26
9
i
4
3
2
2
4
2
2
6
1
3
3
1
3
i
1
2
11
5
5
1
5
1
1
1
1
2
2
5
6
3
1
1
1
3
2
1
2
1
2
%
1
among infants born during selected year, occurring in specified month,
of life, by cause of death.
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Federal Reserve Bank of St. Louis
AKRON, OHIO,
T
89
1 1 .— Number and per cent distribution of deaths among infants bom during selected
year in Akron, and 'per cent distribution of infant deaths in the registration area bv
age at death.
’ .
able
Infant deaths in—
Akron.
Registra
tion area,
1914«
Per cent (per cent
Number. distribu distribu
tion.
tion).
Age at death.
All ages............ ...................
193
100.0
100.0
Under 1 m onth.............................
94
48.7
45.5
Less than 1 day.......................
1 day hut 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
33
5
8
12
15
21
17.1
2.6
4.1
6.2
7.8
10.9
14.6
5.1
3.7
7.3
6.5
8.4
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.............
19
20
32
17
11
9.8
10.4
16.6
8.8
5.7
9.2
7.6
16.7
11.9
9.2
“ Derived from Table 11, p. 660, Mortality Statistics, 1914, Bureau of the Census.
T
able
12—Births from all pregnancies,a live births, infant deaths, infant mortality ratet
and per cent of stillbirths, according to order of pregnancy and age of mother.
Order of pregnancy and age of mother.
All pregnancies, all ages............
Under 20.........................
20 to 24...............
25 to 29.....................
30 to 34...................
35 to 3 9 . . . . . . . . . . . . . . . . . . . . . . . . . .
40 and over......................
Not reported...............
First pregnancy, all ages.......... ..
Total
births.
Live
births.
Infant
deaths.
Stilllbirths, -
Infant
mor
tality
rate, b
Number.
Per cent
of total
births', b
6,287
6,101
746
122.3
186
3.0
745
2,442
1,810
832
361
89
17
718
2,370
1,772
805
347
78
11
129
280
202
87
32
10
6
179.7
118.1
114.0
108.1
92.2
27
72
38
27
14
3.6
2.9
2.1
3.2
3.9
2,241
2,153
270
125.4
88
3.9
Under 20..................
20 to 24................
25 to 29.............
30 to 34..................
35 to 39................
40 and over..............
Not reported.............
594
1,133
410
84
16
1
-3
568
1,087
401
79
14
i
3
94
129
39
5
1
165.5
118.7
97.3
26
46
9
4.4
4.1
2.2
*
1,448
1,411
151
107.0
37
2.6
130
753
420
112
26
3
4
129
735
407
108
26
3
3
31
72
36
8
2
240.3
98.0
88.5
74.1
1
18
13
4
.8
2.4
3.1
3.6
921
907
121.3
14
1.5
17
363
374
124
37
4
2
17
358
369
121
36
4
2
110
3
42
48
13
3
117.3
130.1
107.4
5
5
3
i.4
1.3
2.4
Second pregnancy, all ages............
Under 20....................
20 to 24..................
25 to 29..................
30 to 3 4 ............
35 to 39...............
40 and over......................
Not reported............................
Third pregnancy, all ages...................
Under 20......................
20 to 24........................
25 to 29...............................
30 to-34* . . . . . . . . . . . . . . . . . .
35 to 39.......................
40 and over...................
Not reported....................................
£
i
2
i
a E x c lu d in g m i s c a r r ia g e s ,......................b N o t s h o w n w h e re b a s e is le ss th a n ICO.
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Federal Reserve Bank of St. Louis
90
T
IN FA N T MORTALITY.
12.—Births from all pregnancies, live births, infant deaths, infant mortality rate,
and per cent of stillbirths, according to order of pregnancy and age of mother—Contd.
able
Order of pregnancy and age of mother.
Fourth pregnancy, all ages..................
20 to 24.........................................................
25 to 29.........................................................
30 to 34.........................................................
35 to 39.........................................................
40 and over..................................................
Not reported................................................
Total
births.
Live
births.
Infant
mor
tality
rate.
Infant
deaths.
Stillbirths.
Number.
Per cent
of total
births.
595
581
65
111.9
14
2.4
3
147
284
128
30
3
3
145
277
125
29
2
1
25
28
11
172.4
101.1
88.0
2
7
3
1
1
1.4
2.5
2.3
144.7
6
1.5
143.6
• 128.0
1
2
1
2
1.1
.8
137.7
7
2.8
•
Fifth pregnancy, all ages......................
393
387
56
Under 20......................................................
20 to 24.........................................................
25 to 29.........................................................
30 to 34........................................................
35 to 39.........................................................
40 and over...................................................
Not reported................................................
1
33
183
126
40
9
1
1
32
181
125
38
9
1
6
26
16
4
3
1
Sixth pregnancy, all ages......................
254
247
34
20 to 24.........................................................
25 to 29.........................................................
30 to 34.........................................................
35 to 39.........................................................
40 and over...... ............................................
9
89
96
51
6
3
9
88
92
51
6
1
4
16
12
i
Seventh pregnancv, all ages.................
167
158
17
20 to 24.........................................................
25 to 29.........................................................
30 to 34.........................................................
35 to 39.........................................................
40 and over..................................................
Not reported................................................
4
28
77
46
10
2
4
27
72
44
10
1
2
4
5
6
Eighth pregnancy, all ages..................
104
99
14
5
25 to 29.........................................................
30 to 34.........................................................
35 to 39.........................................................
14
45
39
5
1
14
44
36
5
3
8
2
i
1
3
Not reported......................... ...........- .........
25 to 29.........................................................
30 to 34.........................................................
35 to 39.........................................................
30 to 34.........................................................
35 to 39.........................................................
30 to 34.........................................................
35 to 39.........................................................
30 to 34.........................................................
35 to 39.........................................................
1
2
107.6
9
5.4
1
5
2
i
i
i
67
66
5
24
28
10
5
23
28
10
36
33
6
3
3
9
16
7
1
3
9
14
7
1
2
2
i
2
25
24
i
i
5
13
7
5
12
7
i
17
17
6
2
ii
4
2
ii
4
1
4
1
10
1
6
3
Thirteenth pregnancv, all ages............
9
9
2
35 to 39....................................................
40 and over...................................................
5
4-
5
4
2
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Federal Reserve Bank of St. Louis
i
4
i
i
i
4.8
91
AKKOIT, OHIO.
T a b l e 12. —Births from all pregnancies, live births, infant deaths, infant mortality, rate,
and per cent of stillbirths, according to order of pregnancy and age of mother—Contd.
Stillbirths.
Order of pregnancy and age of mother.
Total
births.
Live
births.
Infant
deaths.
4
4
2
35 to 39
2
2
2
2
2
4
3
35 to 39
1
3
1
2
T
able
1 3 . —Births
Infant
mor
tality
rate.
•Per cent
Number. of total
births.
1
1
1
1
1
1
1
1
1
1
1
1
1
1
during selected year to mothers of specified nativity,
and duration of help in confinement.
Kind and duration of help in confinement.
a c c o r d in g
to ldnd
to
Births to Births
foreignnative
born
mothers. mothers.
Total
births.
All kinds.........................
2,322
1,402
920
None or members of household
Trained nurse...........................
318
253
125
225
193
28
Under 1 week.................
1 week, under 2 ..............
2 weeks, under 1 month..
1 month or more.............
No report.....................
20
48
158
27
16
39
148
22
4
9
10
5
Hospital.................................
200
145
55
Under 1 week.................
1 week, under 2..............
2 weeks, under l month.
1 month or m ore...____
No report........................
4
113
73
4
6
4
77
56
3
5
36
17
1
1
Other help............................
1,550
906
644
Under 1 week................
1 week, under 2.............
2 weeks, under 1 month.
1 month or more...........
No rep o rt.....................
84
384
775
302
5
14
178
505
206
3
70
206
270
96
2
1
1
No report.
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Federal Reserve Bank of St. Louis
92
INFANT MORTALITY.
j ■
T
able
1 4 .—
V
Births during selected year to mothers of specified nativity, according to usual
hired household help.
Usual hired household help.
Not reported...................................................................................................
to
Births to Births
foreignnative
bom
mothers. mothers.
Total
births.
2,322
1,402
920
1,864
358
91
3
6
1,028
291
76
2
5
836
67
1
1 5 .— Live births during selected year, infant deaths, and infant mortality rate,
according to interval between confinement and mother’s resumption of part of household
duties, and nativity of mother.
T able
Interval between confinement and mother’s resumption of part of house
hold duties after confinement, and nativity of mother.
Live
births.
Infant
deaths.
Infant
mortality
rate.ii
All mothers.
2,2.53
193
85.7
6 days or less.......
7 to 10 days..........
11 to 15 days........
Over 15 days____
Not reported &__
190
657
836
559
11
22
59
60
49
3
115.8
89.8
71.8
87.7
. Native mothers.
1,356
95
70.1
6 days or less..........
7 to 10 days.............
11 to 15 days,..........
Over 15 days. . . __
Not reported c........
18
328
573
429
1
8
Foreign-bom mothers
897
6 days or less....................
7 to 10 days.......................
11 to 15 days........ .............
Over 15 d a y s,.........., ___
Not reported d ..................
172
329
263
130
3
28
35
31
79.3
61.1
72.3
21
122.1
2
109.3
33
25
18
1
“ Not shown where base is less than 100.
i>Including 7 mothers who died after confinement before resuming any household duties,
c Including 6 mothers who died after confinement before resuming any household duties.
d Including 1 mother who died after confinement before resuming any household duties.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
100.3
95.1
138.5
Table 16.
Number and per cent distribution of infants_born during selected year and surviving at end of specified month, according to type of feeding
during that month, and nationality of mother.
Type of feeding and nationality of
mother.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Infarts born during selected year and surviving at end of—
Second
Third
Fourth
Fifth
month.
month.
month.
month.
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
dis<
dis
dis
dis
ber. tribu- ber.
tribu ber. tribu ber. tribu
tion.
tion.
tion.
tion.
2,140 100.0 2,120 100.0 2,106 100.0 2.095 100.0
1,734 81.0 1,574 74.2 1,389 66.0 1,277 61.0
171
217 10.2
8.0
315 15.0
379 18.1
234 10.9
329 15.5
402 19.1
439 21.0
1 (a)
1,294 100.0 1,286 100.0 1,278 100.0 1,275 100.0
1,043 80.6
942 73.3
826 64.6
765 60.0
85
108
6.6
8.2
162 12.7
192 15.1
166 12.8
238 18.5
.290 22.7
318 24.9
846 100.0
834 100.0
828 100.0
820 100.0
691 81.7
632 75.8
563 68.0
512 62.4
86 10.2
111 13.3
153 18.5
187 22.8
68
8.0
91 10.9
112 13.5
121 14.8
1
.1
207 100.0
203 100.0
203 100.0
202 100.0
153 73.9
139 68.5
117 57.6
108 53.5
37 17.9
41 20.2
53 26.1
58 28.7
16
23 11.3
7.7
33 16.3
33 17.8
1
.5
180 100.0
176 100.0
173 100.0
170 100.0
149 82.8
138 78.4
122 70.5
107 62.9
21 11.7
25 14.2
35 20.2
Ai 25.9
10
5.6
13
7.4
16
9.2
19 11.2
138 100.0
136 100.0
134 100.0
133 100.0
123 89.1
114 83.8
106 79.1
93 69.9
7
5.1
11
8.1
14 10.4
24 18.0
8
5.8
11
8.1
16 12.0
14. 10.4
97 100.0
97 100.0
96 100.0
96 100.0
79 81.4
68 70.1
58 60.4
53 55.2
9.3
9
16 16.5
25 26.0
28 29.2
9
9.3
13 13.4
13 13.5
15 15.6
224 100.0
222 100.0 „ 222 100.0
219 100.0
187 83.5
173 77.9
160 «72.1
151 68.9
12
5.4
18
8.1 ' 26 11.7
•33 15.1
25 11.2 1 31 14.0
33 16.2
35 16.0
o Less than one-tenth of 1 per cent.
Sixth
Seventh
Eighth
Ninth.
month.
month.
month.
month.
Per
Per
Per
Per
cent Num cent Num cent
Num cent
dis Num
dis ber.
dis ber.
dis
ber. tribu
ber. tribu
tribu
tribu
tion.
tion.
tion.
tion.
2,088 100.0 2,082 100.0" 2,077 100.0 2,071 100.0
1,148 55.0
880 42.3
753 36.3
595
28.7
461 22.1
685 32.9
764 36.8
41.8
865
. 479 22.9
517 24.8
560 27.0
611
29.5
1,274 100.0 1,272 100.0 1,270 100.0 1,265
694 54.5
534 42.0
459 38.1
350
237 18.6
370 29.1
426 33.5
507
343 26.9
368 28.9
408
385 30.3
814 100.0
810 100.0
807 100.0
808
454 55.8
346 42.7
294 36.4
245
224 27.5
315 38.9
338 41.9
358
136 16.7
149 18.4
175 21.7
203
201 100.0
97 48.3
65 32.3
39 19.4
167
96
50
21
132
84
29
19
96
48
32
16
218
129
48
41
100.0
57.5
29.9
12.6
100.0
63.6
22.0
i4.4
100.0
50.0
33.3
10.7
100.0
59.2
22.0
18.8
100.0
27.7
40.1
32.3
100.0
30.4
44.4
25.2
199 100.0
75 37.7
82 41.2
42 21.1
198 100.0
69 34.8
85 42.9
44 22.2
198
62
84
52
100; 0
31.3
42.4
26.3
105
08
75
22
132
09
42
21
93
32
47
17
218
102
69
47
164
58
80
28
131
50
51
30
96
29
47
20
218
90
75
53
104
48
83
30
131
41
54
100.0
29.3
52.4
18.3
100.0
31.3
41.2
27.5
100.0
28.1
42.7
29.2
100.0
30.9
42.9
23.3
100.0
41.2
45.5
13.3
100.0
52.3
31.8
15.9
100.0
33.3
49.0
17.7
lOfi. 0
46.8
31.7
21.6
100.0
34.1
48.8
17.1
100'. 0
38.2
38.9
22.9
100.0
30.2
49.0
20.8
100.0
41.3
34.4
24.3
96
27
41
28
217
67
. 93
, 57
OHIO,
All mothers.... ......................................
Breast exclusively...............................
Mixed....................................
Artificial exclusively..............................
Not reported............. ..............
Native mothers.........................
Breast exclusively.............................
Mixed............................
Artificial exclusively....................................
Foreign-born mothers............................
Breast exclusively.............................
Mixed........................
Artificial exclusively..........................
Not reported.........................................
German mothers...............................
Breast exclusively..........................
Mixed.............................
Artificial exclusi vely...........................
Not reported..............................
Slavic mothers..........................
Breast exclusively........................
Mixed.................................
Artificial exclusively............................
Italian mothers....................
Breast exclusively.......................
Mixed...................
Artificial exclusively..............................
Magyar mothers.......................
Breast exclusively.....................
Mixed..................
Artificial exclusively...............................
Other foreign-born mothers..............
Breast exclusively.................................
Mixed..................................
Artificial exclusively...............................
First
month.
Per
Num cent
dis
ber. tribu
tion.
2,159 100.0
1,897 87.9
107
5.0
154
7.1
1 (a)
1,302 100.0
1,144 87.9
53
4.1
8.1
105
857 100.0
753 87.9
54
6.3
49
5.7
1
.1
210 100.0
178 84.8
23 11.0
8
3.8
1
.5
182 100.0
164 90.1
12
6.6
6
3.3
140 100.0
127 90.7
5
3.6
8
5.7
100 100.0
87 87.0
7
7.0
6
6.0
225 100.0
197 87.6
3.1
7
21
9.3
c©
CO
94
IN FA N T MORTALITY.
T a b le 17.— Per cent of infants born during selected years in Johnstown, Pa., and in
Akron, given specified type of feeding at 3, 6, and 9 months of age, according to nativity
of mother.
Per cent of infants.
Nativity of mother and age of
infant.
Breast fed
exclusively.
Johns
town.
Native mothers:
Foreign-bom mothers:
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Akron.
Artificially fed
exclusively.
Mixed fed.
Johns
town.
Akron.
Johns
town.
Akron.
66.9
41.1
11.8
73.3
54.5
27.7
12.8
32.8
54.0
8.2
18.6
40.1
20.3
26.1
34.1
18.5
26.9
32.3
80.5
54.6
24.3
75.8
55.8
30.4
13.1
35.7
57.0
13.3
27.5
44.4
6.4
9.7
18.6
10.9
16.7
25.2
T
able
18.
Infants bom during selected year to mothers of specified nativity and surviving at beginning of specified month of life, and subsequent deaths
tn the first year of life and in specified month, according to month of life and type of feeding.
Infants bom dining selected year surviving at the beginning of specified month.
All mothers.
Month of life and type of feeding.
Native mothers.
Died in the—
Total.
Total.
Second month..............................
Third month.......................................................
Breast exclusively.............
Mixed................
Artificial exclusively...
Fourth month............
Breast exclusively...........
Mixed...................
Artificial exclusively....................
First year.
Total.
Number. Per cent.
Specified
month.
First year.
Number. Per cent.
Specified
month.
2,253
193
8.0
94
1,356
95
7.0
54
897
98
10.9
40
1,936
108
Ì63
45
108
7
33
45
5.6
6.5
20.2
39
1
9
45
1,162
54
111
29
39
2
25
29
3.4
3.7
22.5
X
18
1
6
29
774
54
52
16
1
69
5
8
16
8.9
9.3
15.4
x
21
2,159
99
4.6
19
1,302
41
3.1
8
857
58
6.8
11
«1,743
173
242
1
a 54
3.1
6.9
13.6
«9
1,044
85
173
19
1
«699
7
69
1
«35
10
13
5.0
11.4
18.8
«g
20
1.8
2.4
11.6
1
Breast exclusively..................
Mixed..........................
Artificial exclusivelv__
Not reported........ . ........
Specified
month.
Died in the—
12
33
X
8
3
16
1
2,140
80
3.7
20
1,294
33
2.6
8
846
47
5.6
12
«1,582
«222
336
«31
«14
35
2.0
6.3
10,4
«g
a 57
, « 945
106
243
a 12
«3
19
« 10
18
5
5
637
«116
93
3.0
17
1.3
3.8
7.0
19.4
2,120
60
2.8
14
1,286
25
1.9
8
834
35
4.2
6
1,393
18
1.3
4
6
827
1
* 506
.7
«316
«10
«1
162
3.1
«154
«411
«32
7.8
«9
«297
\ «14
4.7
«7
114
« Including 11jaby who lied at beginning of nnonth who was fed in specified way in pre.ceding month.
12
2.1
3.2
15.8
3
«1
2
a5
18
8 .6
AKROK, OHIO,
First month........................
Breast exclusively..............
Mixed.,..............................
Artificial exclusively.....................
Not fed, died at once..................
Not reported....................
Died in the-
First year.
Number. Percent.
Foreign-bom mothers.
2
CO
Ol
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
T
able
1 8 . —Infants
born during selected year to mothers of specified nativity and surviving at beginning of specified month of life, and subsequent deaths
in the first year of life and in specified months, according to month of life and type of feeding—Continued.
O
Infants born during selected year, surviving at the beginning of specified month.
Month of life and type of feeding.
Total.
First year.
Number. Per cent.
46
1,280
'379
447
13
9
24
•
2,2
1.0
2.4
5.4
Number. Per cent.
17
1.3
3
828
29
3.5
8
.5
2.6
2.5
3
515
187
126
9
4
16
1.7
2.1
12.7
3
8
4
5
8
1,275
14
4
5
5
1.1
1
820
21
2.6
6
1
455
226
139
3
6
12
.7
2.7
8.6
1
2
3
13
1.0
2
814
15
1.8
4,
1
.2
1.6
1.6
1
346
315
153
2
4
9
.6
1.3
5.9
4
2
810
11
1.4
3
2
a4
5
.7
1.2
2.8
1.7
Mixed................ I..........................................................
Artificial exclusively....................................................
1,149
'464
482
;6
2.4
3.5
i
3
3
694
238
343
Seventh month...................................................
2,088
28
1.3
6
1,274
3
10
15
.3
1.5
2.9
1
a
685
522
Specified
month.
765
192
321
7
11
17
a 881
Number. Per cent.
1,278
35
Artificial exclusivejy. .*................................................
First year.
3
2,095
a
Specified
month.
11
.
7
Sixth month.......................................................
Total.
First year.
a
5
535
369
a
6
6
11
.6
2.1
1.5
.9
a
1
5
Eighth month....................................................
2,082
22
in
5
1,272
2
10
.3
1.3
1.8
1
1
Artificial exclusively....................... .............................
754
a 765
563
3
459
426
387
6
5
1.4
1.3
2
295
a 339
176
Ninth month.......................................................
2,077
17-
.8
6
1,270
9
.7
5
807
8
1.0
i
595
868
614
.2
1.1
3
3
350
510
410
6
3
1.2
3
245
358
204
1
9
7
3
4
.4
.8
2.0
i
Artificial exclusively.................. ...............................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1
1.0
a
.7
2
» Including 1 baby who died at beginning of mouth who was fed in specified way in proceeding month,
a
1
1
i
m o r t a l it y ,
Artificial exclusively...............................................
2,106
Specified
month-
TSCEJl & E
Fifth month........................................................
Died in the-
Died in the-
Died in theTotal.
Foreign-bom mothers.
Native mothers.
All mothers.
97
AKRON- OHIO,
T
1 9 . —Number and per cent of infants artificially fed among those surviving at 8,
6, and 9 months of age, according to whether the mother had commenced work, and nativity
of mother.
able
Infants surviving at end of—
Sixth month.
Third month.
Gainful employment of mother at time
specified, and nativity of mother.
Artificially
fed.
Artificially
fed.
Total.
Total.
Ninth month.
Artificially
fed.
Total.
Num Per
ber. cent.
Num Per
ber. cent.
Num Per
ber. cent.
All mothers__ )................................... 2,120
329 15.5 2,088
479 22.9 2,071
611
29.5
Had no work or began after specified tim e... 1,744
Began work before time specified:
. At home............................. : ...................
360
8
8
Time of resumption not reported.................
278 15.9 1,651
393 23.8
1,587
474
29.9
46 12.8
4
1 12.5
415
14
8
78 18.8
7
1 12.5
454
23
7
123
13
1
27.1
Native mothers....................................... 1,286
238 18.5
1,274
343 26.9
1,265
408
32.3
Had no work or began after specified tim e.. 1,132
Began work before time specified:
At home..................................................
146
3
Time of resumption not reported.................
5
208 18.4
1,084
295 27.2 1,049
336
32.0
27 18.5
2
1 20.0
181
4
5
45 24.9
2
1 20.6
204
7
5
66
6
1
32.4
Foreign-born mothers.............................
834
91 10.9
814
136 16.7
806
203
25.2
Had no work or began after specified tim e..
Began work before time specified:
At home...................... ...........................
612
70 11.4
567
98 17.3
538
138
25.7
214
5
3
19
2
234
10
3
33 14.1
5
250
16
2
57
8
22.8
T
able
2 0 . —Births
8.9
14.3
20.0
during selected year in each father's earnings group, according to
occupation of father.
Births in specified father’s earnings group.
Total
births. Under $450 $550 $650 $850 $1,050 $1,250 No N.ot re
to
to
and earn
to
to
to
$450. $549.
$649. $849. $1,049. $1,249. over. ings. ported.
Occupation of father.
All occupations................... 2,322
211
163
228
581
523
264
307
19
26
Manufacturing and mechan
ical industries—.................. 1,600
152
129
175
420
390
181
140
4
9
2
2
2
4
1
5
1
4
2
4
16
1
8
10
3
3
4
1
8
7
240
14
212
14
4
7
99
6
91
2
4
7
31
2
27
2
Blacksmiths..................................
12
9
Boiler makers...............................
Builders and contractors..............
43
Compositors, linotype operators,
H
and pressmen............................
Electricians and electrical engi
21
neers..........................................
Engineers and firemen.................
26
Factory operatives and laborers.. 1,028
86
Metal......................................
824
Rubber...................................
118
Other......................................
Laborers, helpers, and appren
36
tices {not in factory).................
Machinists, millwrights, and
117
toolmakers.................................
Manufacturers, proprietors, man
90
agers, and officials.....................
Shoemakers and cobblers (not in
6
factory)................. ....... .........
168
Skilled mechanics, building trades
13
Tailors...........................................
20
Other pursuits..............................
174247°—20
-7
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
1
1
1
106 103
13, 18
65
65
20
28
144
12
105
27
3
3
302
20
258
24
17
4
6
7
2
1
4
31
41
30
8
1
1
1
6
16
3
60
9
1
1
2
13
2
1
3
42
5
5
19
2
1
1
1
1
2
1
1
1
44
2
7
1
20
3
1
1
1
17
1
1
1
1
i
1
INFANT MORTALITY,
98
T able 20.—Births during selected year in each father's earnings group, according to
occupation of father—Continued.
Births in specified father’s earnings group.
Total
births. Under $450 $550 $650 $850 $1,050 $1,250 No Not re
to
and earn ported.
to
to
to
to
$450. $549.
$649. $849. $1,049. $1,249. over. ings.
Occupation of fhther.
11
265
19
9
23
61
42
22
78
30
44
6
1
3
4
1
8
2
19
4
9
4
i
17
3
Retail and wholesale dealers (proprietors. officials, and managers)
Commercial travelers and sales-
116
10
8
7
18
15
10
38
10
60
9
1
20
1
Transportation.......................
143
29
45
6
Trade......................................
Bankers, brokers, real estate and
Chauffeurs, teamsters, and exConductors,
motormen,
and
26
Express, post, telegraph, and
42
Proprietors, officials, and managcrs........******
1
22
4
2
20
8
6
6
1
15
14
34
24
13
11
3
5
3
18
6
1
3
3
1
1
6
8
9
8
2
i
1
1
6
2
4
4
9
14
5
Clerical occupations; all in
dustries................................
129
1
1
6
43
34
25
19
Domestic and personal serv
ice........................................
82
3
4
7
17
25
7
17
TÏ
Janitors and elevator operators...
Saloon keepers and bartenders—
Professional and semiprofessional pursuits.....................
Public service.........................
Agriculture.............................
No occupation - -- -- -- -- -- -- --
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
20
17
9
20
2
1
1
1
6
5
2
2
2
4
2
2
1
1
8
2
4
5
6
1
5
i
1
9
62
1
2
4
10
38
17
5
5
7
5
1
4
4
3
4
1
3
1
2
2
3
9
i
i
1
9
i
i
1
15
i
3
3
2
2
1
2
1
2
1
1
15
99
AKRON, OHIO.
T able 21.— Births during selected year, infant deaths, infant mortality rate, and per cent
of stillbirths, according to earnings of father and nativity of mother.
Earnings of father and nativity of
mother.
Total
births.
Live
births.
Infant
deaths.
Stilli irths.
Infant
mortal
ity.
Per cent
rate.» Number. of total
births .<*
All mothers........................................
2,322
2,253
193
85.7
69
3.0
Native mothers.....................................
1,402
1,356
95
70.1
46
3.3
Under $450.......... ........................ ....... .......
$450 to $549...................................................
$550 to $649........ , .........................................
$650 to $849...................................................
$850 to $1,049................................................
$1,050 to $1,249...........................................
$1,250 and over.............................................
No earnings......................................... . .
No report.....................................................
51
41
83
325
396
224
267
6
9
49
41
81
312
379
219
260
6
9
4
5
6
24
29
15
10
76.9
76.5
68.5
38.5
2
13
17
5
7
4.0
4.3
2.2
2.6
Foreign-bom mothers............... ..........
920
897
98
109.3
23
2.5
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 T...................................................
160
122
145
256
127
40
40
13
17
156
120
142
251
121
38
40
12
17
20
14
14
34
12
128.2
116.7
98.6
135.5
99.2
4
2
3
5
6
2
2.5
1.6
2.1
2.0
4.7
2
2
2
1
1
1
<*Not shown where base is less than 100.
T able 22.— Births from all pregnancies, live births, infant deaths, infant mortality rate,
and per cent of stillbirths, according to earnings of father during year after birth of last
child and nativity of mother.
Earnings of father during year after birth
of last child and nativity of mother.
Total
births.
Live
births.
Infant
deaths.
Stillbirths.
Infant
mortal
Per cent
ity
rate.» Number. of total
births .a
All mothers........................................
6,287
6,101
746
122.3
186
3.0
Less than $550..............................................
$550 to $649...................................................
$650 to $849.........................
$850 to $1,049................................................
$1,050 to $1,249.............................................
$1,250 and over...................................... ......
No earnings..................................................
No report T...................................................
1,339
719
1,485
l' 238
634
722
54
96
1,290
706
1,441
l ' 193
620
706
52
93
209
100
191
117
51
55
8
15
162.0
141.6
132.5
98. i
82.3
77.9
49
13
44
45
14
16
2
3
3.7
1.8
3.0
3.6
2.2
2.2
Native mothers: ...................................
3,305
3,203
294
91.8
102
3.1
Less than $550..............................................
$550 to $649..................... .............................
$650 to $849..................................................
$850 to $1,049................................................
$1,050 to $1.249....... , ...................................
$1,250 and over.............................................
309
236
694
835
501
589
15
24
36
20
73
76
41
42
2
4
116.5
84.7
105.2
91.0
81.8
71.3
12
1
24
35
12
15
1
2
3.7
0.4
3.3
4.0
2.3
2.5
No report T...................................................
321
237
718
870
513
604
16
26
Foreign-born mothers...........................
2,982
2,898
452
155.9
84
2.8
Less than $550..............................................
$550 to $649...................................................
$650 to $849...................................................
$850 to $1,049................................................
$1,050 to $1,249.............................................
$1,250 and over.............................................
1,018
482
767
368
121
118
38
70
981
470
747
358
119
117
37
69
173
80
118
41
10
13
6
11
176.3
170.2
158.0
114.5
84.0
111.1
37
12
20
10
2
1
1
1
3.6
2.5
2.6
2.7
1.7
0.8
a
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Not shown where base is less than 100.
100
INFANT MORTALITY,
T a b le 23.—Births during selected year in families of specified numbers of persons and
average number of persons per family, according to eammgs of father and nativity of
mother.
Births in families of specified number of persons.«*
Aver
age
Earnings of father and na number Total
No
of per births.
tivity of mother.
4
5 '6 7 8 9 10 11 fam
1
2
3
sons per
ily.!»
family.
All mothers...............
3.3 2,322 10 954 587 338 205 99 66 33 15
211 5 48 59 43 22 15 4 7 4
163 1 43 45 27 22 6 12 4 2
228
82 53 40 26 10 7 5 4
271 140 73 47 24 17 5 2
581
523 1 249 135 54 35 24 15 6 1
120 61 40 22 8 5 5 1
264
1
307 1 125 85 51 29 8 4 i
9
1 1
2
3
3
19
7
1 3 "2
6
7
26
8
7 644 359 183 102 46 32 13 10
4 2 3 1 2
8
3 11 16
11 12
5 1 4 2 1
4
2 3
5 7
28 20 17
167 83 34 19 11 7 3 1
1 201 100 40 28 13 10 1 1
104 51 36 17 6 4 3 1
i 116 74 40 24 6 4 1 1
3
1
2
3
3
3
4
i
1
1
3 310 228 155 103 53 34 20
2 37 43 35 18 13 1 6
8 2
1 32 33 23 17
54 33 23 21 3 7 3
2
13
10
28
57
39
104
7 11 5 5
48 35 14
4
5
1
2
2
10
16
9 11 ii
5 2
1 1
6i 3
2
4
1 3 2
3 1 4
5
4
2
2
1
1
1
1
$850 to $1,049......................
3.8
3.8
3.5
3.2
3.1
3.2
3.2
2.7
3.7
Native mothers............
3.1
1,402
3.8
4.1
3.7
3.0
3.0
3.2
3.1
Under $450..........................
30
51
41
83
325
396
224
267
6
9
Foreign-born mothers..
3.6
920
Under $450 .........................
3.8
37
$650 to $849.........................
$850 to $1,049 ......................
3.4
3.5
160
122
145
256
127
$1,050 to $1,249..................-
40
13
17
a Infant not included in nunroer.
6 Infant not living with parents
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2
1
1
1
i
2
4
3
2
1
2
f-
1
2
1
1
1
1
3
2
1
1
L2
-.
T a b le 24.
Number and per cent distribution of births during selected year ineach father’s earnings groupt according to total earnings of family.
Births in specified father’s earnings group.
births.
Under $450.
$550 to $649.
$650 to $849. $850 to $1,049.
Sources of family income year following
baby’s birth.
$1,050 to
$1,249.
$1,250
and over.
No earnings.
No report.
Per
Per
Per
Per
Per
Per
Per
Per
Per
cent Num cent Num cent
cent Num cent Num cent
Num cent
Num cent
Num cent
dis Num
dis ber.
dis ber.
dis Num
dis
dis
dis
dis
ber. tribu
dis
ber. tribu
tribu
tribu ber. tribu ber. tribu ber. tribu ber. tribu ber. tribu
tion.
tion.
tion.
tion.
tion.
tion.
tion.
tion.
tion.
All sources.............
374 100.0
228 100.0
581 100.0
523 100.0
264 100.0
307 100.0
19 100.0
26
100.0
1,367
556
58.9
23.9
144
171
38.5
45.7
117
68
51.3
29.8
383
120
65.9
20.7
352
98
163
56
196
29
10
52.6
12
4
46.1
15.4
Under $550.....................
$550 to $649.............
$650 to $849...........
$850 to $1,049.....................
$1,050 to $1,249....................
$1,250 and over.....................
No report....................
84
38
93
114
87
127
13
3.6
1.6
4.0
4.9
3.7
5.5
.6
74
31
31
14
10
8
3
19.8
8.3
8.3
3.7
2.7
2.1
.8
7
32
14
6
8
1
3.1
14.0
6.2
2.6
3.5
.4
10
52.6
30
56
12
18
4
5.2
9.6
2.1
3.1
.7
30
44
23
1
5.7
8.4
4.4
.2
15
41
5.7
15.5
29
9.4
Earnings supplemented by other income__
No source.......................
395
4
17.0
.2
59
15.8
43
18.9
78
13.4
73
14.0
45
17.0
82
26.7
5
;4
26.3
21.1
67.3
18.7
61.8
21.2
63.8
9.4
4
15.4
10
38.5
AKRON, OHIO.
2,322 100.0
Derived from earnings only:
Father only wage earner.......
Other wage earners: Total earnings....
101
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
confinement.
102
T a b l e 25.— Births durinj selected year to gainfully employed mothers of specified nationality, according to interval between cessation of worl and
■____ -—----------------------------------------—sa—!--- '
Births to foreign-bom mothers.
Total births.
Gainful employment of mother during
Tear preceding hirth of infant, and in
terval between cessation of work and
confinement.
Magyar.
Slavic.
Italian.
Other.
656
374
14
48
167
42
11
1,666
100.0
57.0
2.1
7.3
25.5
6.4
1.7
277
155
9
18
66
23
6
1,125
100.0
56.0
3.2
6.5
23.8
8.3
2.2
379
219
5
30
101
19
5
541
100.0
57.8
1.3
7.9
26.6
5.0
1.3
71
19
8
35
6
3
155
241
109
192
152
226
920
1,402
100.0
90
100.0
101
100.0
51
100.0
66
100.0
26.8
80
88.9
11.3
49.3
8.4
4.2
3
7
3.3
7.8
62
3
9
21
5
1
9!
61.4
3.0
8.9
20.8
5.0
1.0
23
1
5
16
5
1
58
45.1
2.0
9.8
31.4
9.8
2.0
35
1
5
22
3
53.0
1.5
7.6
33.3
4.6
62
175
INFANT MORTALITY,
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
German.
Total.
Per
Per
Per
Per
Per
Per
Per
Per
cent
cent Num cent Num cent Num cent 'Num
Num cent Num cent Num cent Num distri
distri
ber.
distri
ber. distri ber. distri ber.
ber. distri ber. distri ber. distri ber.
bution.
bution.
bution.
bution.
bution.
bution.
bution.
bution.
2,322
Gainfully employed......................................
Interval:
Less than 2 weeks........... ...........-.........
2 weeks but less than 1 month...............
1 month but less than 3.........................
3 months but less than 9........................
9 months or over...... . ............................
Not reported..........................................
N ot gainfully employed...............................
Births to na
tive mothers.
AKRON, OHIO,
103
T a b l e 26 .—Births during selected year to mothers gainfully employed in specified occupa
tion during year preceding birth of infant, according to interval between cessation of
work, and confinement, and nativity of mother.
J
Births to mothers gainfully employed during year before
infant’s birth.
At home.
Interval between cessation of work and con
finement, and nativity of mother.
Total.
All mothers, gainfully employed.
Interval:
Under 2 weeks.....................
2 weeks but under 1 month.
1 month but under 3............
3 months but under 9..........
9 months or more...............
Not reported................
Native mothers, gainfully employed...
Interval:
Under 2 weeks.................................
2 weeks but under 1 month. . . . . . . . ' "
1 month but under 3..............................
3 months but under 9...............
9 months or more.........................
Not reported......................... ........
Away from home.
In factories.
Keep Other
ing
home
lodgers. work.
Rub
ber.
656
59
374
14
48
167
42
34
20
62
346
11
22
8
39
35
5
11
12
2
277
17
23
155
9
18
66
23
6
Foreign-bom mothers, gainfully em
ployed............................................
Interval:
Under 2 weeks.....................
2 weeks but under 1 month.
1 month but under 3...........
3 months but under 9..........
9 months or more.................
Not reported........................
Clerks,
sales Other
women, work.
All
teach
other.
ers.
46
205
5
15
15
3
30
101
19
5
26
39
12
1
Births during selected year, infant deaths at specified ages, infant mortality
rate, and per cent of stillbirths, according to interval between cessation of work and
confinement, and nativity of mother.
T a b l e 27.
Infant deaths.
Interval between cessation of gainful
Total Live
employment and confinement, and births.
births.
nativity of mother.
All mothers.
Gainfully employed............
Interval:
Under 2 weeks...............
2 weeks, under 1 month.
1 month, under 3...........
3 months, under 9.
.9 months or more..........
Not reported.................
Not gainfully employed......
Native mothers.
Gainfully employed.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2,322 2,253
Stillbirths.
Infant
Per
2
mor
1 tality
cent
Under weeks,
Num of
Total.
2
under month
rate.a
and
ber. total
weeks.
1
births.
month. over.
(«)
193
73
21
99
85.7
69
633
68
19
8
41
107.4
23
375
374
361
14
14
48
46
167
163
42
40
11
9
1,666 1,620
40
3
4
16
4
1
125
10
1
1
7
5
13
3.5
54
13
25 110.8
2
3
7 98.2
3
1
58 77.2
2
2
46
1,402 1,356
95
45
9
41 ' 70.1
46
3.3
14
ni
4.0
656
2
1
277 * 266 '
26
9
3
a Not shown where base is less than 100.
97.7 1
2
3.0
2.4
2.8
INFANT MORTALITY.
104
T a b le 27
Births durinq selected year, infant deaths at specified ages, infant mortality
T ^ u jn i p T iZ to f s tillb ir th s , a m i i i l g i o interval (etm en cessatwn of work and
confinement, and nativity of mother Continued.
Stillbirths.
Infant deaths.
Infant
Per
mor
Interval between cessation of gainful Total Live
2
cent
employment and confinement, and births. births.
Under weeks, month tality Num
of
under and rate.“ ber. total
nativity of mother.
2
Total.
weeks
1 over.
births.
month
(“)•
Interval:
Under 2 weeks...............
2 weeks, under 1 month.
1 month, under 3..........
3 months, under 9.........
9 months or more..........
Not reported.................
Not gainfully employed......
155
9
18
66
60.4
149
9
17
65
22
23
4
6
1,125 1,090
920
Foreign-bom mothers.
Gainfully employed............
Interval:
Under 2 weeks...............
2 weeks, under 1 month.
1 month, under 3...........
3 months, under 9.........
9 months or more..........
Not reported — ............
Not gainfully employed......
212
19
5
541
18
5
530
101
23
58 109.3
897
219
5
30
3.1
63.3
2.5
114.4
3.2
146.2
3.2
5
29
3.0
56
2.0
31 105.7
T a ble 28 —Live births during selected year, infant deaths, and_infant mortality rate,
according to occupation of mother during year following infant s birth.
Occupation of mother during year following infant’s birth.
Others in domestic and personal service................. ........................
Rul)l)6r
•
i
»Not shown where base is less than 100.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
Live
births.
Infant
Infant
deaths. mortality
rate.a
2,253
193
85.7
1,657
596
120
73
72.4
122.5
538
473
‘ 65
58
1
6
19
18
15
3
5
2
7
52
45
7
21
1
1
8
9
8
1
1
96.7
95.1
1
105
AKRON, OHIO,
T a b l e 29.—Live births during selected year and infant deaths, according to whether mother
was gainfully employed, and age of infant if alive when the mother resumed work.
Live
births.
Employment of mother and age of infant at mother’s resumption of work.
Infant’s age at time of resumption—
Infant
deaths.
2,253
193
1,657
596
120
73
42
552
2
538
21
515
2
58
21
37
42
29
2
52
21
29
2
21
21
2
6
2
3
1
22
1
T a b l e 30.—Number and per cent distribution of births during selected year to gainfully
employed mothers of specified nativity, according to earnings of mother during year
following birth of infant.
Births to gainfully employed mothers.
Earnings of mother during year following
infant’s birth.
Total mothers.
Native mothers.
Foreign-born
mothers.
Per cent
Per cent
Per cent
Number. distribu Number. distribu Number. distribu
tion.
tion.
tion.
All classes...........................................
614
100.0
275
100.0
339
100.0
Under $150.......... ........................................
$150 to $249...................................................
$250 to $349..................... .............................
$350 to $549...................................................
$550 and over...............................................
289
134
76
50
38
1
26
47.1
21.8
12.4
8.1
6.2
0. 2
4.2
141
60
31
13
17
51.3
21.8
11.3
4.7
6.2
13
4.7
148
74
45
37
21
1
13
43.7
21.8
13.3
10.9
6.2
02
3.8
Not reported...-...........................................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
106
T able 31.—Births during selected year to mothers of specified nationality, according to dominant gainful occupation of mother during her lifetime.
Births during selected year.
Births to foreign-bom mothers.
Births to native mothersDominant gainful occupation during
mother’s lifetime.
All mothers........................................
Total.
German.
Total.
Italian.
Slavic.
Magyar,
English,
Irish,
Scotch,
Welsh.
Jewish.
All
other.
2,322
1,402
973
423
6
920
226
192
152
109
76
61
104
294
199
1,823
300
259
41
1,623
606
523
239
74
74
108
184
123
1,091
108
82
26
983
265
375
214
69
142
99
730
83
64
19
647
190
207
155
56
40
24
358
25
18
7
333
74
166
59
13
2
15
23
187
15
12
3
172
86
64
7
9
19
163
39
39
21
1
1
1
12
3
1
1
1
32
13
1
5
14
90
20
17
3
70
32
11
1
1
18
7
19
4
38
9
6
3
29
' 39
2
2
36
9
107
89
86
3
18
1
6
1
1
5
4
8
1
67
3
1
2
64
28
21
7
2
60
4
3
3
1
1
110
76
732
192
177
15
540
240
148
25
5
74
48
2
i
i
i
6
8
18
6
80
17
16
1
63
33
13
2
1
7
7
1
1
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
With one Of par
Of
or both entage
native
not
parent- > parents
foreign specified.
age.
bom.
3
3
1
2
i
1
i
124
60
18
1
1
1
15
6
IN FAN T MORTALITY.
Gainfully employed, time not specified__
Total
births.
107
AKRON, OHIO,
T a b l e 32.— Births during selected year, live births, infant deaths, infant mortality rate,
and per cent of stillbirths, according to number of dwellings in building.
Dwellings to a building.
Buildings with specified number of dwell
ings:
1.............................................................
2...................................................... .
3.............................................................
4.............................................................
5__
6........ ....................................................
8.............................., .............................
9 .
11...........................................................
12...........................................................
13..........................................................
22...........................................................
Total
births.
Live
births.
Stillbirths.
Infant
Infant
deaths. mortality
rate.o Number. Per cent
of total
births, a
2,322
2,253
193
85.7
69
3.0
1,482
608
106
81
14
5
6
5
1
1
4
3
4
2
1,438
587
106
78
13
5
6
5
1
1
4
3
4
2
102
62
12
13
70.9
105.6
113.2
44
21
3.0
3.5
1
1
3
1
1
1
a Not shown where base is less than 100.
T a b l e 33.—Births during selected year, live births, infant deaths, infant mortality rate,
and per cent of stillbirths, according to tenure and rental of home and nativity of mother.
Tenure and rental of home and nativity
of mothers.
Total
births.
liv e
births.
Stfflbirths.
Infant
Infant
deaths. mortality
rate.o Number. Per cent
of total
births, o
All mothers........................................
2,322
2,253
193
85.7
69
.3.0
Home owned...............................................
By infant’s family................................
By other family in household..............
Home not owned........................................
Monthly rental—
Under $5.........................................
$5 but less than $10........................
$10 but less than $15......................
$15 but less than $20......................
$20 but less than $25.......................
$25 but less than $35......................
$35 but less than $50......................
$50 or more.....................................
Free................................................
Not reported...................................
920
812
108
1,398
893
790
103
1,356
65
57
8
127
72.8
72.2
77.7
93.7
27
22
5
42
2.9
2.7
4.6
3.0
10
245
440
367
149
88
29
7
13
50
3
1
10
238
421
361
145
87
28
6
13
47
3
1
32
36
32
9
8
1
134.5
85.5
88.6
62.1
7
19
6
4
1
1
1
2.9
4.3
1.6
2.7
Native mothers.....................................
1,402
1,356
95
70.1
46
3.3
Home owned...............................................
By infant’s family................................
By other family in household..............
Home not owned........................................
Monthly rental—
542
462
80
858
525
448
77
829
27
21
6
68
51.4
46.9
17
14
3
29
3.1
3.0
3
6
1
2
2
$5 but less than $10........................
70
65
6
$10 but less than $15 j .....................
267
255
20
$15 bnt less than $20.......................
256
252
22
$20 but less than $25......................
111
5
113
70
$25 but less than $35.......................
69
7
25
1
24
$35 but less than $50......................
■
$50 or more........................... .........
7
6
8
Free................................................
8
3
Not reported...................................
40
4
37
2
2
Boarding---- ...............................................
a Not shown where base is less than 100.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
3
82.0
78.4
87.3
45.0
5
12
4
2
1
1
1
3
3.4
4.5
1.6
1.8
108
T
INFANT MORTALITY.
3 3 . —Births during selected year, live births, infant deaths, infant mortality rate,
and per cent of stillbirths, according to tenure and rental of home and nativity of
mother—Continued.
able
Tenure and rental of home and nativity
of mothers.
Total
births.
Stillb irths.
Infant
Infant
deaths. mortality
Per cent
rate.
Number of total
births.
Live
births.
Foreign-bom mothers..........................
920
897
98
109.3
23
2.5
Home owned...............................................
By infant’s family................................
378
350
28
540
3C8
342
26
527
38
38
2
59
103.3
105.3
10
8
2
13
2.6
2.3
8
175
173
111
36
18
4
8
173
166
109
34
18
4
5
10
1
1
2
7
2
2
1.1
4.0
1.8
Home not owned........................................
Monthly rental—
Under $5.........................................
$5 but less than $10........................
$10 but less than $15..,.................
$15 but less than $20......................
$25 but less than $35......................
$35 but less than $50.............. ........
Free................................................
10
1
1
Not reported................................................
112.0
26
16
10
4
1
150.3
96.4
91.7
2
1
2.4
..........
3 4 .— Infants born during selected year in families living in dwellings having
specified number of rooms, according to persons to dwelling ana nativity of mother.
T able
Number of rooms in dwelling of residence.
Persons to dwelling Total
and n a t i v i t y of births.
mother.»
1
2
3
4
5
6
7
8
9
Not re
10 11 12 15 17 21 ported.
All mothers... 2,322 15 166 313 310 477 509 274 162 50 25
Persons to dwelling:
2.........................
• 3.........................
4.........................
5.........................
6.........................
7.........................
8.........................
9.........................
10.........................
11..........................
12.........................
13.........................
14.........................
15......... ................
16.........................
17.........................
18.........................
19.........................
20.........................
21.........................
22.........................
24.........................
27.........................
526
388
256
170
143
80
60
40
28
14
6
7
4
4
3
5
2
3
1
1
2
1
1
Native mothers. 1,402
Persons to dwelling:
2.........................
3.........................
4 .........................
5.........................
6.........................
7 . : ......................
8.........................
9.........................
10.........................
11.........................
12.........................
14.........................
27.........................
411
357
249
147
90
61
31
27
16
9
1
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2
1
10 80 110
5 48 87
20 36
8 35
6 17
4 14
8
4
130
112
80
50
27
31
14
6
7
5
3
2
2 1
2
2
1 1
1 2
1
106
70
36
26
19
17
11
15
1
2 4
... 1
91
120
101
61
37
36
19
10
15
6
4
2
1
1
2
1
1
1
33
55
60
38
34
11
13
9
7
3
3
i
2
1
3
2
__ 1___
76
99
77
40
24
23
28
51
53
31
22
7
6
5 6
3 5
7
5
2
1
1
5
1
1
1
2
1
2
1
1
2
1
1
1
4
1
1
1
1
1
1
1
1
T;.*'
..
1
1
12 3
18 4
31 10
25 6
15 6
11 4
7 2
6 1
3 1
4 1
1
2
3
1
... .
4 54 127 158 287 354 213 132 38 22
4 26 72 79 109
19 37 43 83
4 7 14 51
3
3 10 22
3 12
2
2 1 5 4
3 2 1
2 3
2
1
6
1
i
1
12 3
21 4
39 14
6
16 7
16 7
9 3
10 4
4 1
.6 1
1
8
3
7
4
2
1
1
4
7.
2
1
1
1
1
1
2
1
1
1
1
2
1
1
1
1
1
109
AKRON, OHIO,
T a b l e 34.—Infants born during selected year in families living in dwellings having
specified number of rooms, according to persons to dwelling and nativity of mother—
Continued.
Number of rooms in dwelling of residence.
Persons to dwelling Total
and nativity of births
mother.«»
Foreign-born
mothers.........
Persons to dwelling:
2....................
3...................... .
4.........................
5.........................
6.........................
7.........................
8.........................
9.........................
10..........................
11.........................
12.........................
13..........................
14.........................
15.........................
16.........................
17.........................
18.........................
19.........................
20.........................
21.........................
22.........................
24.........................
1
2
3
4
6
5
8
7
Not re
10 11 12 15 17 21 ported.
9
920 11 112 186 152 190 155 61 30 12
1
3
4
3
I
166 6 54
169 5 29
139
16
5
109
80
6
82
2
49
33
24
19
13
6
. .. .
5 .....
4
4
__
3
5
2
::::
3
1
1
. .. .
2
1
27
27
22
16
16
12
9
13
1
2 4
1
38
50
29
32
15
Ì3
5
2
2
. .. .
::::
... .
1
1
21
29
29
28
27
13
3
7
3
3
2
1
2
2
1
2
1
15
21 4
24 7
21 7
13 12
13 4
12 7
5 3
12 2
6 1
4 2
2 1
1 1
1 1
2
1
1
1
3
1
3
8
1
5
2
4
1
2
1
.......... i
1
4
1
3
1
3
1
1
1
2
1
1
i
1
_
1
1
1
1
1
i
1
a Infant not included in number.
1
T a b l e 35.—Births during selected year to mothers of specified nationality, according to
number of lodgers in household.
Births to foreign-bom mothers.
Number of lodgers.
All mothers..................
Lodgers........................
1 lodger..................................
2 lodgers.................................
3 lodgers.................................
4 lodgers.......................... ......
"No lodgers....................
Births
to
Total native
births. moth-.
Total.
ers.
Slavic.
Ger
man.
Italian. SerboCroa
tian Other.
and
Slovak.
Mag
yar.
Other
foreignbom.
2,322 . 1)402
920
226
152
147
45
109
241
398
163
76
35
37
9
17
12
15
5
6
23
1,924
243
66
43
28
30
7
11
10
15
5
6
22
677
31
17
6
2
2
1
83
10
19
19
17
4
4
2
6
1
1
47
5
5
2
4
2
5
5
4
3
1
11
100
14
3
7
1
1
28
7
2
3
3
40
24
4
1
3
1
1
1
4
2
2
5
81
2
4
201
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
155
97
33
7
7
2
6
2
i
1,247
1
1
1
195
69
1
31
110
INFANT MORTALITY.
T a b l e 36. —Number and per cent distribution of births during selected year in each district
of residence, according to sanitary condition of dwelling.
District of residence.
Total births.
East
Exchange.
Southwest.
West.
North Hill.
Sanitary condition of dwelling.
Per
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
Num cent
dis
dis
dis
dis
dis
ber. tribu ber. tribu ber. tribu ber. tribu ber.
tribu
tion.
tion.
tion.
tion.
tion.
Total dwellings “............ 2,322 100.0
Water supply:
In dwelling........................ 1,682
640
Not in dwelling.................
Bath:
In home............................. 1,010
Not in home...................... 1,310
2
Type of toilet:
Water-closet...................... 1,332
441
Sewer-connected privy —
547
Other privy.......... .............
1
1
Sewer connection:
Sink connected.................. 1,648
672
Sink not connected...........
2
321 100.0
249 100.0
378 100.0
76
100.0
72.4
27.6
229
92
71.3
28.7
193
56
77.5
22.5
294
84
77.8
22.2
58
18
76.3
23.7
43.5
56.4
.1
152
169
47.4
52.6
129
120
51.8
48.2
175
203
46.3
53.7
38
38
50.0
50.0
57.4
19.0
23.6
(b)
(*>)
71.0
28.9
.1
176
77
68
54.8
24.0
21.2
157
54
38
63.1
21.7
15.3
232
79
67
61.4
20.9
17.7
43
1
32
56.6
1.3
42.1
237
83
1
73.8
25.9
.3
194
55
77.9
22.1
287
91
75.9
24.1
43
33
56.6
43.4
•1
District of residence.
West Hill.
South
Central.
Valley.
East Hill.
Business.
Sanitary condition of dwelling.
Per
Per
Per
Per
Per
Num cent
Num cent
Num cent
Num cent
Num cent
dis
dis
dis
dis
dis
ber. tribu ber. tribu ber. tribu ber. tribu ber. tribu
tion.
tion.
tion.
tion.
tion.
Total dwellings <*............
203 100.0
338 100.0
331 100.0
118 100.0
308
100.0
186
17
91.6
8.4
216
122
63.9
36.1
166
165
50.2
49.8
102
16
86.4
13.6
238
70
77.3
22.7
161
42
79.3
20.7
30.2
69.5
.3
73
258
22.1
77.9
86
32
72.9
27.1
Type of toilet:
Water-closet......................
Sewer-connected privy__
Other privy.......................
102
235
1
94
213
L
30.5
69.2
.3
173
17
13
85.2
8.4
6.4
159
74
104
47.0
21.9
30.8
79.7
11.9
8.5
186
83
39
60.4
26.9
12.7
Sewer connection:
Sink connected..................
Sink not connected...........
.3
33.8
12.7
53.2
.3
94
14
10
1
112
42
176
1
188
15
92.6
7.4
211
126
1
62.4
37.3
.3
146
185
44.1
55.9
101
17
85.6
14.4
241
67
78.2
21.8
Water supplv:
In dwelling........................
Notin dwelling.................
Bath:
In home.............................
Not in home......................
-
a Dwelling means place in which family lived during greater part of year following infant’s birth, or, in
case of stillborn child, where mother spent greater part of her pregnancy period.
b Less than one-tenth of 1 per cent.
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
T a b le 37.
Births from all prey-nancies to mothers married specified number of years, stillbirths, and infant deaths, by number of births to mother.
Births to mothers married specified number of years.
Total Less
Number of births to mother. births
than
2.
Total births.........................
Live births...................
Stillbirths............................
6,287
6,101
186
746
Stillbirths..........................
Infant deaths....................
7 births:
Total births.......................
. Stillbirths..........................
Infant deaths....................
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
3
4
6
8
9
11 12 13 14 15 16 17 18 19 20
21
514 435 431 350 400 373 436
390 350 240 209 251 241 176 190 144 141 136 136
494
413
340 382 342 231 201 243 236 172 188 137 136 131 131
20 15 18
16 11 10 9 8 8 9 8
7
41 47 54 26 39 45 52 42 39 45 23 41 32 37 24 292 22 235 155 125
101
99
2
7
7
10
499 184 64 23 14 9 6 5 1
480 179 61 23 13 9 6 5 1
19 5 3
1
36 11 9 ”2 ’
”i’
" i‘
3
3
12 236 312 176 112 84 42 32 40
11 227 300 173 108 83 41 31 38
1 9 12 3 4 1 1 1 2
3 28 33 9 7 11
3 2
22
22
3, 15 51 135 213 14* 144 78 72
14 48 134 204 137 142 77 71
1 3 1 9 4 2 1 1
2 8 11 14 27 11 13 6 4
53
1
4
2
1
1
1
3
2
1
1
1
10
10
2
2
2
4
27 18 18
27 18 18
9 12
9 12
6
6
3
2
....
3
3
6
6
35 35
33 32
2 3
5 4
35
33
2
5
3
7
7
---15
14
1
2
1
15
15
3
3
3
5
5
4 16
4 16
_
42 42
42 41 28 35
1
” 6" 6 9 3
4
4
4
4
5 15
5 15
5
5
5
5
1
35
32
3
6 3
37
5
....
2
18 42 54 42 54 36 30 36 54 24
9 17 42 52 40 51 31 30 35 52 23
1
1 2 1
4 ” 9 ' 11
2 14 2 * 2
1 6 2
1
2
54 118 52 14 19
50 116 52 14 19
4 2
13 24 9 1 1
3
1
12
••••
23 24 25 26 27 28 29 30 31
1
5 25 65 100 120 85 75 45 60 50 20 35
5 25 63 97 119 84 72 45 59 50 17 35
2 3 1 1 3
1
3
6 15 14 16 12 8 10 6 4 4
6
5
1
?
22
2
2
4_| 16 56 108 160 116 108 80 32 44 32 16 20 12 8
16 54 103 158 113 105 79 32 42 32 15 20 12 8
2 5 2 3 3 1
2
1
i
1 5 14 24 14 6 7 2 8 2 2 2 3 . . . .
21
58
434
417
17
59
5
AKRON, OHIO,
1 birth:
Total births.......................
815
Live births........................
785
Still ullvlIS.
30
Infant deaths....................
63
2 births:
Total births....................... 1,092
Live births........................ 1,057
Stillbirths..........................
35
Infant deaths............
97
3 births:
Total births....................... 1,011
988
Stillbirths.................. .......
23
Infant deaths.....................
109
4 births:
Total births.......................
840
821
Stillbirths.........................
19
Infant deaths....................
93
5 births:
Total births.......................
720
706
Stillbirths..........................
14
Infant deaths....................
102
0 births:
Total births........ ..............
456
2
___
1
6 12 18 12
6 12 18 12
3
7 35 35
7 35 35
7
7
i
2
5
2
—
7
7
. .. .
Births to mothers married specified number of years.
Total Less
Number of births to mother. births.
than
2.
8
births:
9 births:
11
births:
12 births:
3
4
5
7
6
288
281
7
51
8
9
10
ii
12
8
8
8
8
8
7
1
225
221
4
35
4
1
9
9
9
9
2
1
13 14 15 16 17 18 19
40 64 40
38 61 40
9 3
3 12 7
9
9
170
167
3
35
20
21
22
8
8
24 24 24 24
24 24 24 23
8
8
8
8
3
2
4
1
2
2
4
9 18 36 18 27
9 18 36 18 26
9
9
9 36
8 31
9
9
9
9
1
1
1
1
10
10
10
10
20
20
1
4
9
7
1
3
5
20
20
20
3
5
10
10
10
10
19
4
4
7
11
11
77
74
3
13.
1
1
1
15 births:
17 births:
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
40
38
2
4
7
24
22
2
3
52
49
3
18
3
3
60
54
12
12
12
8
1
1
13
9
9
4
20
20
10
10
1
2
1
44
42
11
11
2
8
1
12
12
13
13
10
26
. 26
5
2
11
3
9
9
2
11
10
1
6
13 births:
23 24 25 26 27 28 29 30 31
INFANT MOBTALITY,
10 births:
2
30
29
1
3
17
17
5
|
........
17
17
__ 1___
0
1
1
112
Table 37 .— B irths fr o m a ll "pregnancies to m others m arried specified nu m ber o f years, stillbirth s, a n d in fa n t deaths, by n u m ber o f births to m other —Contd.
1
j
1
i
15
15
15
14
1
1
2
113
AKRON, OHIO.
T a b l e 38 .— Mothers reporting specified number o f miscarriages, stillbirths, and infant
deaths, according to num ber o f pregnancies to mother, ana n a tivity o f mother.
Pregnancies to mother and nativity
of mother.
All mothers............
Pregnancies:
1 ...................................
2 ...................................
.................
3
4
.................
5
.................
6
7
8
9
............
.................
............
.................
10 ...................................
11 ...................................
12 ...................................
13...................................
15...................................
17...................................
Total
moth
ers.
Mothers reporting specified number of miscarriages, still
births, and infant deaths.
None.
1
2,287
1,507
532
7S9
538
332
216
147
93
64
38
31
13
7
700
399
194
107
56
25
12
5
6
2
5
3
1,005
Pregnancies:
1 ...................................
2 ...................................
3 ................... ..............
4
............ .
5
.................
566
347
185
108
500
269
126
57
27
...........
68
40
................... .•................. 26
8
............
16
9...................................
14
10
...................
3
11 ...................................
4
12 ...................................
4
15...................................
2
17...................................
1
Foreign-bom mothers
Pregnancies:
1 ...................................
2 ........................
3
4
5
6
7
8
.................
.................
.................
............
.................
............
9...................................
10 ..................................
11 ...................................
12 ...................................
13..................................
15...................................
174247°—20----- 8
https://fraser.stlouisfed.org
Federal Reserve Bank of St. Louis
2
1
1,384
7
115
109
78
53
35
25
13
9
3
1
10
Native mothers.........
6
151
12
6
2
4
1
903
502
223
191
147
108
79
53
38
200
17
2
130
68
50
29
13
6
22
3
10
1
3
6
5
1
272
260
85
26
114
INFANT MORTALITY.
T able
3 9 .—
Mothers reporting specified number of infant deaths, according to number of
Uve births to mother, and nativity of mother.
Live births to mother, and nativity of
mother.
All mothers.....................................
Live births:
Mothers reporting specified number of infant deaths.
Total
moth
ers.
None.
2,252
1,704
813
537
333
205
150
67
56
36
443
237
127
77
33
21
11
22
7
19
2
6
2
1
2
3
422
85
21
68
5
9
15
19
89
84
61
50
20
20
12
5
7
4
...........................................
1
1
3
2
2
2
2
4
3
3
1
3
3
2
2
1
1
1
1
1
1,357
1,130
181
34
579
343
185
99
65
30
532
298
154
70
37
16
47
42
26
23
3
3
5
22
10
11
6
12
4
5
3
1
2
2
1
1
20
8
3
895
574
234
194
148
106
85
37
34
26
213
145
83
57
40
17
9
7
11
13
3
1
2
1
6
5
5
2
1
3
7
1
2
1
1
2
1
4
1
1
1
7
1
1
1
1
1
7
1
1
1
2
3
Live births:
6
1
X
Foreign-bom mothers........................
12
1
1
1
Live births:
4
4
7
6
1
3
l
Native mothers..................................
11
10
6
5
4
1
241
51
1
14
11
2
1
1
21
47
58
38
30
12
15
9
3
5
1
1
2
6
10
13
6
5
4
3
1
1
1
1
1
2
2
3
1
3
1
3
3
1
2
1
1
1
1
1
1
J_____
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Federal Reserve Bank of St. Louis
INDEX
Page.
Age at death, analysis of infant mortality by. 26-27
relation of, to cause of death......................
26
to nativity of mother...................... *' 26
Age of mother, analysis of births and infant
mortality rate by............................
28
Akron, canvass to supplement birth registrationin, completeness of.....................75-77
results of............................................... 76-77
comparison of infant mortality rate forj
with birth-registration area in 1916.
15
with other cities studied by Children’s
Bureau.......................................15,67
comparison of type of feeding in, with
Johnstown................................
34
description of.....................................
n
industrial conditions in.................. il-i2 ,37,67
not included in birth-registration area__
75
population of.............................................
11
reasons for selection of..............................
11
topography of....................... ................... 44-45
Annual Report for 1913, Bureau of Vital
51
Statistics, excerpt from............
Artificial feeding.^ See Feeding, artificial.
Association, Visiting Nurse. See Visiting
Nurse Association.
Benefit, maternity, provision for, by factory..
42
Birth, attendance at, analysis of...................29-31,67
by nationality ofmother..............
30
infant mortality rate by................
31
order of, analysis of infant mortality
rate b y ......................................
29
registration. See Registration, birth,
registration area, Akron not included
in .................................................. 11,12,75
infant mortality rate for, and for speci
fied States and cities in, in 1915........
71
infant mortality rate for, in 1916.........
15
still. See Stillbirth.
Births attended by midwives, mortality rate
forinfluence of other factors upon...
31
Births, distribution of, according to age of
mother.............................................
28
according to attendance at birth..............
31
according to earnings of father and nativ
ity of mother..................................... 38,40
according to gainful employment of
mother before childbirth, and
nativity...........................................
43
according to nativity of mother and sani
tary condition of dwelling.............
49
according to number of persons per
room................................................
50
according to sex of infant and nativity of
mother................................
28
illegitimate, effect of exclusion of, upon
infant mortality rate.......................
77
exclusiveof,forspecifiedreasons.. .73-74 77
live, exclusions among, analysis of............
78
registered, infant mortality rate for..........
79
number o f .........................................
79
specified exclusions of, reasons for.........
13,
73-74,77-78
to mothers of specified nativity gainfully
employed after childbirth, by earn
ings of father...............
41
unregistered, infant mortality rate for___
79
proportion of, in study...................... 51,79
Board of health, appointments by, under
civil service.....................................
54
diagnostic work for, by city chemist.........
54
food inspection by....................................
55
nurses employed b y ..................................
53
organization of........................................
53
Board of health, powers of...........................
regulation of milk supply by................
sanitary inspection a function of.............
State, completion of sewage disposal
53
55
54
plant ordered b y .............................
63
midwives examined by............................. 30
supervision of, over registration of vital
statistics..............................
work of..........................................
S e e a lso , Health department.
Breast feeding. S e e Feeding, breast.
Building inspection department, personnel of.
Bureau of Vital Statistics, annual report of,
_
for 1 9 1 3 , excerpt from....................
Business district. S e e District, business.
56
54
46
51
Case histories, relating to artificial feeding of
infant.............................................. 35-36
relating to length of confinement period.. 32
Canvass, birth registration supplemented by,
in specified cities........................
75
in Akron........................................
75-77
Cause of death. See Death, cause of.
Children’s Bureau, comparison of infant mor
tality rates for cities studied by__ 15,67
law creating, precedence given in, to
study of infant mortality__
71
method of determining infant mortality
rate b y .................................
73
Child welfare, division of....................................... 57
Cities, specified, comparison of economic
status of families in................... 37-38 68
comparison of mortality from gastric ’
and intestinal diseases in ...............
24
comparison of mortality from respira
25-26
tory diseases in ...............
infant mortality rate for............. ” ”
15
infant mortality rates for, by cause of
death................................................
22
infant mortality rates for, by father's
earnings............................................. 39-40
methods of overcoming incomplete
registration in .......................
75
reasons for selection of, for study of
infant mortality..............................
72
selected for investigation, character
istics of..........
72
Cleaning and paving of streets.'' See Streets'
_paving and cleaning of.
Climate, influence of, upon mortality from
gastric and intestinal diseases........
24
Communicable diseases. See Contagious dis
eases.
Conditions, improvement in, since tima of
study, througli:
Increase of mspectors for paving and street
cleaning...........................................
64
Increase of public-health nurses..............
69
Installation of new plant for water suppiy
59
63
Installation of sewage-disposal plant.......
Public collection of garbage........
65
Reorganization of health department__ 57-58
Confinement, care in .............................
29-32
Confinement period, length o f . . . . . . . . . . . . . . . 31-32
case Histories showing........................
32
relation of nativity to....................!. !
32
Cooperation in study...................................... 13 77
Contagious diseases, facilities for controi of__
’54
improvement in .................................
58
hospital for................................................
54
physicians required to report..................
54
non quarantinable, laxity in reporting...
54
115
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Federal Reserve Bank of St. Louis
Page.
116
INDEX,
Feeding, artificial, case histories relating to .. 35-36
Dairy. See Milk supply.
definition of........................................
33
Death, age at. See Age at death.
number of infants given, in specified
cause of, analysis of infant mortality by 21-26,68
month of life, by nativity of mother. 34
distribution of infant deaths by ........
21
proportion of infants given, by na
infant mortality rate among native
tionality of mother.........................
67
and foreign groups, by............ _—
23
relation of, to mortality from gastric
infant mortahty rates for specified
and intestinal diseases......................25,68
cities by...........................................
22
breast, among Italian group, prevalence
relation of, to age a t death................
26
of...................................................... 19,24
superstitions given a s .......................
26
33
definition of............, — -,.......... .—
registration. See Registration death,
number of infants given, in specified
registration area, infant mortahty rate for,
month
oflife,
by
nativity
of
mother.
33
71
in 1910.......................
mixed, definition of..................................
33
Deaths, infant, specified exclusions of, reasons
type of, among specified foreign nationalf o r .! .............................................. 74,78
* i&es............................................. 18,19,20
per cent of, unregistered................
51
analysis of.............................................33-36
Diseases, contagious. See Contagious dis
analysis of, by earnings of father................. 34
eases.
and nativity of mother, per cent of
communicable. See Contagious diseases,
infants surviving at end of specified
gastric and intestinal. See Gastric and
month of life, by............................- 33-34
intestinal diseases.
comparison of, in Akron and Johns
respiratory. See Respiratory diseases,
town ................................................
34
venereal. See Venereal diseases.
comparison of infant mortality by. 34-35,67
Diseases of early infancy, analysis of............. 22-23
definition
of..........................................32-33
prevention of, methods of........................
23
infant mortality in specified month
work of health department toward..........
68
oflife, b y .........................................
35
Dispensaries, lack of, at time of study............
53
District, business, description of.................... 16,17 Fire hazard. See Housing.
Flood,
damage
to
sewerage
system
b
y
.....................
62
housing congestion in.........................
17
east exchange, conditions favorable in ...
17 Food, inspection of, by board of health, pro
visions
for........................................
55
description of......................................
17
southwest, conditions favorable in ..........
17 Garbage, disposal of, no public provision for,
description of......................................
17
at time of study..............................
64
valley, description of................................
16
on dumps...........................................
65
16
infant mortality rate highest in ........
method of collection of ........ ; ................
65
District of residenee; infant mortality rate by. 16
disposal plant, completion of, in 1916....
65
Drainage. See Sanitation.
Gastric and intestinal diseases, mortality
Dumps, existence of, in some sections...........
45
from, analysis of.............................. 23-25
offensive conditions of..............................
45
by nativity of mother....... ............... 24,68
refuse and garbage deposited on................64-65
climatie conditions as affecting.........
24
Dwelling. See Housing.
comparison of, for specified cities. . . .
24
efficacy of infant-welfare stations in
prevention
of...................................
69
Early infancy, diseases of. See Diseases of
increase in, in summer months.........
24
early infancy.
methods of prevention of...................25,69
•R am in gs offatheT, analysis of type of feeding
relation of artificial feeding to— . .. . 25,68
by....................................................
54
20
German group, analysis of..............................
and gainful employment of mother, rela
tion between......................... -........40-41
Health,
board
of.
See
Board
of
health.
and nativity of mother, distribution of
births by........................................... 38,40 Health department, activities of, since time
of study__ . .............................----- 57-58
infant mortality rates b y ..................
40
appropriation for, increase i n ...................
57
births to mothers of specified nativity
child-welfare
department organized b y ..
57
gainfully employed after child
division
of
communicable
diseases
of,
41
birth, b y .......... ..............................
work
of............................................
58
comparison of, in specified cities............... 37-38
56
expenditures of.........................................
economic status determined by...............
36
increase
in...........................................
57
factors affecting...................................; - 36-37
extension and improvement of.................. 57-58
increase in, decline in infant mortality
effect of, upon infant mortality.................... 58
ra te liy ....................................... 38-39,40
lack of authority of, over garbage col
infant mortality rate b y ...........................
68
lectors.......................
65
in fa n t, mortality rates for specified cities,
minimum per capita appropriation Teby...................... . ...................... 39-40
quiredby..................- ....................
56
See also Economic status of family.
organization of...... ...................................
53
East exchange. See District, east exchange.
prenatal care an activity of......................
68
Economic status of family, comparison of, for
See
also.
Board
of
health.
specified cities.................................
68
52
earnings of father determines...................
36 Hospital, Children’s, description of...............
City, description of...................................
52
Employment history.................
43-44
facilities, inadequacy of............................
52
Employment of mother, gainful, after child
for contagious diseases..............
54
birth, and earnings of father, births
People’s, description of............................
52
to mothers of specified nativity,
Housing,
conditions
of....................................
44
bv...............................................—
41
fire hazard in ......................................
46
analysis of-............................... 42,43-44,68
home
ownership
a
factor
in.................
44
and earnings of father, relation be
in specified districts........................... 16-17
tw e en .................................—....... 40-41
relation
of
topography
to
..........
.
44-45
and infant mortality, relation be
congestion i n .....................................^5-46,49-^50
tween............................................-43
lodgers a factor in................... - ......... 49-50
and nativity, distribution of births
personnel of department for inspection of.
46
by.........................................
— 43
regulations
for........................................... 46-47
before childbirth, and nativity, in
enforcement of. . ................................. 46-47
fant mortality rate by....................
43
rental problem in......., .............................
47
discouragement of, by factory......................42
house scarcity cause of
.......47
relation of mothers’ pension law to.. 42
sanitary
condition
in,
distribution
of
English, ability of mother to speak............ 18,19,20
births to mothers of specified na
Exclusions of specified groups from study,
tivity, by.............. -........................
49
reasons for................ 13,73-74,77-78
relation of, to infant mortality.............. 48-49
Eyes, treatment of, by public-health nurse...
52
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Federal Reserve Bank of St. Louis
INDEX,
Page.
Illiteracy, percentage of, among specified
foreign nationalities................... 18,19,20
Improvement in - conditions since time of
study. See Conditions, improve
ment in.
Industrial conditions in Akron............ 11-12,37,67
Industrial conditions, relation of, to child
welfare.............................................
37
Infant-welfare stations, efficacy of, in pre
vention of gastric and intestinal dis
eases................................................ 23,69
number of, required in industrial com
munity............................................
69
Inspection department, building, inade
quacy of...........................................
47
personnel of........................................
46
Inspection, food, by board of health, pro
vision for............ .............
55
of milk supply, improvement in........
58
55
inadequate provision for..............
sanitary, by health department.........
54
Italian group, analysis of.......................... 19-20
Johnstown, comparison of type of feeding in,
with Akron................................
original plan for........................................
modification of...................................
34
75
75
Law creating Children’s Bureau, precedence
given in, to study of infant mortality
71
Law, mothers’ pension, provisions of......
42
relating to birth registration............. 50-51
penalty for failure to comply w ith...
50
relating to practice of midwifery..........30-31
License, requirement of, for practice of mid
wifery........................................
30
for sale of milk....................................
55
Literacy of mothers of specified foreign na
tionality...................................... 18,19,20
Lodgers, father’s earnings supplemented b y .. 18,
19,44
See also Housing, congestion in.
Lying-in period. See Confinement period.
Magyar group, analysis of........................ 20-21
Mary Day Nursery, Children’s Hospital
formed from..............................
52
work of................................................
53
Maternal mortality, relation oi, to infant
mortality..................................
32
Maternity benefit, provision for, by factory..
42
Maternity cases, hospitals not properly
equipped for..............................
52
Method of determining causes o i variations in
i niant mortality rate................
71
Method of determining infant mortality rate,
by Children’s Bureau............... 73,77
differences in ......................................
77
usual, inaccuracy of........................... 72-73
Method of procedure in study.............. 12-13,71-81
Midwives, attendance at birth by............. 29-31,67
influence of nationality upon......
30
licensing of, law pertaining to............ 30-31
mortality rate for births attended by,
influence of other factors upon.......
31
penalty for failure of, to register birth__
50
requirements for................................
30
Milk station, organization of, by Visiting
Nurse Association....................
52
Milk supply, bacteriological examinations of. 56,58
inspection of, inadequate provision for..
55
in 1918........................ , ................
58
pasteurization of.................................
58
provisions of sanitary code relating to—
55
Miscarriage, definition of..........................
80
Miscarriages, exclusion of.........................
80
Miyed feeding. See Feeding, mixed.
Mortality, infant, among artificially fed, com
parison of, with breast fed........35,67
by age at death, analysis of..........26-27
by cause of death, analysis of.......21-26,68
comparison of, with mortality at other
periods of life..........................
71
effect upon, of improved facilities of
health department...................
58
from gastric and intestinal diseases.
See Gastric and intestinal diseases.
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117
Page.
Mortality, infant, from respiratory diseases.
See Respiratory diseases,
in specified month of life, by type of
feeding in month............................
35
precedence given to study of, in law
creating Children’s Bureau............
71
relation of maternal mortality to......
32
relation of sanitary housing con
ditions to ........................................ 48-49
maternal, relation of, to infant mortality.
32
Mortality rate, infant, by age of mother at
infant’s birth...................................
28
by attendance at birth......................
31
by district of residence.......................
16
by earnings of father..................... 38-40,68
by earnings of father and nativity of
mother.............................................
40
by gainful employment of mother
before childbirth.............................
68
by gainful employment of mother
before childbirth and nativity................. 43
by nationality of mother.............. 17-18,67
by nativity of mother and cause of
death............................................... 23,68
by nativity of mother and sex of in
fant................................................:
28
by order of birth................................
29
comparison of, for cities studied by
Children’s Bureau.......................... 15,67
decline in, as earnings of father in
crease..................................... 38-39,40,68
definition of...................
72
differences in methods of determin
77
ing.................................... . ............
for birth-registration area in 1916__
15
for births attended by midwives,
influence of other factors upon.......
31
for births included in study...............
79
79
for excluded groups, analysis of.......
for specific classes, importance of
accuracy in determining.................
73
for specified cities, by cause of death.
22
for specified cities, by father’s earn
ings............................... .................39-40
for specified States and cities in birthregistration area in 1915...........
71
inaccuracy of usual method of deter
mining............................................ 72-73
increase in, as number of persons per
room increases................................. 49,50
incomplete registration as affecting..
73
in death-registration area in 1910......
71
method of determining, by Children’s
Bureau............................................
73
methods of securing accuracy i n .......
73
variations in, method of determining
71
causes of..........................................
Mothers’ pension law, provisions of...............
42
Nationality groups, analysis of:
Germans...................................................
20
Italians...................................................... 19-20
Magyars.......................................................20-21
Slavs......................................................... 18-19
Nationality of mother, attendance at birth by
30
infant mortality rate by ........................17-18,67
proportion ofinfants artificially fed, by 33-34,67
Nativity, influence of, upon room crowding. 49-50
Nativity of mother, and cause of death, infant
mortality rate by............................
23
and earnings of father, births to mothers
gainfully employed after childbirth,
b y ....................................................
41
distribution of births by....................38,40
infant mortality rates b y ...................
40
and gainful employment before child
birth, distribution of births, b y ....
43
infant mortality rate b y .................
43
and sanitary condition of dwelling, dis
tribution of births by......................
49
and sex of infant, infant mortality rate by
28
and type of feeding, per cent or infants
surviving at end of specified month
of life by...................
33-34
infant mortality from gastric and intes
tinal diseases, by.............................. 24,68
relation of, to age at death.......................
26
118
INDEX,
Page.
Nurse Association, Visiting. See Visiting
Nurse Association.
Nursery, Mary Day, Children’s Hospital
formed from.....................................
52
Nurses employed by board of health, number
53
of.....................................................
increase in ................................................ 57,69
Nurses, public health, estimated number of,
required....................................
69
Nursing, division of public-health, work of..
57
Order of birth. See Birth, order of.
Ordinances relating to housing and sanita
tio n .................................................. 46-47
Pasteurization. See Milk supply.
Paving and cleaning of streets. See Streets,
paving and cleaning of.
Penalty for failure to comply with law govern
ing birth registration......................
50
Physicians, attendance at birth b y ---- 29,30,31,67
Population of Akron.......................................
11
Population, proportion of, foreign born... 11,12,67
Poverty, extent of, in Akron..........................
37
Prenatal care, work of health department
toward...............................................57,68
Privies. See Sanitation; see also Housing.
Procedure, method of, in study............12-13,71-81
Public-health nursing, division of..................
57
Refuse, disposal of, no public provision for,
at time of study..............................
64
on dumps............................................
64
Registrar, State, excerpt from annual report
of, for 1913........................................
51
Registration, birth, canvass to supplement,
in Akron................................ 11,12,75-77
canvass to supplement, in Akron,
results of............................................76-77
canvass to supplement, in specified
cities................................................
75
excerpt from annual report of Ohio
State Registrar pertaining to .........
51
importance of...................... «............
50
law pertaining to ................................. 50-51
methods of determining completeness
of........................................................79-80
omissions in ........................................
68
penalty for failure to comply with
law pertaining to ............................
50
death, canvass to supplement..................
11
50
importance of.....................................
incompleteness of................................
51
omissions in ........................................
68
incomplete,infant mortality rates affected
by.....................................................
73
methods of overcoming, in specified
cities................................................
75
of stillbirths, margin of error in...............
80
of vital statistics, supervision over, by
56
board of health............................
Rentals. See Housing.
Respiratory diseases, analysis of mortality
from................................................. 25-26
comparison of mortality from, in specified
cities..................................................25-26
Room crowding. See Housing, congestion in.
Sanitary inspection, police in employ of
board of health in charge oft..........
54
Sanitation, division of, surveys made by......
58
provisions for............................................
47
lack of enforcement of........................
47
relation of, to infant mortality................. 48-49
Page.
Sanitation, unsatisfactory conditions in, in
specified sections........................ 16-17,45
See also Housing; Board of health; Water
supply; Sewerage system.
Sewage-disposal plant, completion of, ordered
by State board ofhealth.................
63
See also Sewerage system.
62
Sewerage system, damage to, by flood..........
description of......... ........................
61-62
extent of....................................................
61
inadequacy of......................... — ...........61-63
leakage in .. ¿ .......................................
60-61
See also Sewage disposal plant.
Sex of infant and nativity of mother, analysis
of births and infant mortality rate
28
b y ...................................................
Slavic group, analysis of................................. 18-19
Southwest district. See District, southwest.
Stations, infant-welfare. See Infant-welfare
stations.
Statistics, vital. See Vital statistics.
Stillbirth, definition of.................................... 27,80
Stillbirth rate............................................. 27-28,67
by age of mother.........................................27,28
by attendance a t birth.............................
31
38
by earnings of father................................
by order of birth....................................... 27,29
by sex of infant and nativity of mother... 27,28
80
method of determining............................
Stillbirths, number of.....................................
15
registration of............................................
80
margin of error in...............................
80
specified exclusions of, reasons for............. 80,81
Streets, paving and cleaning of........................ 63,64
increase of inspection for....................
64
insufficient appropriation for............
64
Study, cooperation in..................................... 13,77
method of procedure in .................. 12-13,71-81
Superstitions, prevalence of, among Akron
mothers...........................................
26
Toilet facilities. See Sanitation; see also
Housing.
Topography of Akron................................... .' 44-45
Type of feeding. See Feeding, type of.
Valley district. See District, valley.
Venereal diseases, reporting of.......................
58
Vital Statistics, Bureau of, excerpt from an
51
nual report of, for 1913....................
Vital statistics, registration of, in charge of
board of health...............................
56
See also Registration.
Visiting Nurse Association, milk station or
ganized by.......................................
52
52
personnel of.......... ...................................
work of...........................
52-53
taken over by health department....
57
Water supply, analysis of............................... 58-61
extent of......... ..........................................
59
for drinking purposes, unsatisfactory
condition of................
59,60,61
wells principalsource of......................60-61
improvement in, since installation of
new plant........................................
59
inadequacy o f..........................................
45
pollution of........................................... 59,60-61
sources of.................................................... 58-61
Welfare stations, infant. See Infant-welfare
stations.
Wells. See Water supply.
o
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