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J A M E S J. D A V I S . Secretary

G R A C E A B B O T T . C h ief



R U R A L C H IL D W E L F A R E SE R IES N o. 5
Bureau Publication N o. 88


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Federal Reserve Bank of St. Louis

Owing to limited appropriations for printing it is not possible
to distribute this bulletin in large quantities. Additional copies
may be procured from the Superintendent of Documents, Govern­
ment Printing Office, Washington, D. C., at 10 cents per copy.
Federal Reserve Bank of St. Louis

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Letter o f transmittal---------------------------- —
.--------------------------------- ---------------5
Introduction------------------------------------------------------------------------------------ ------------- - -----7 -8
7 -8
Scope and method o f the survey---------------------------------------r------- ¿X .-----------Selection of counties— ----------------- :— — L ----------------------------------------7
Sources o f information--------— --------------------------------—
Main features in social and economic background of families visited------- 9 -2 0
Population---------- ------------------------------------------------ i— i -------------------—--------- u - " 9 -10
Urban and rural population--------------------------- -------------------- --------------- 9
Density o f population.----------------------------------------- --— — — -------------0
Means o f communication--------------------------------------------------------- — -------------- 10-11
------ j----------10
Roads and mail service----------------------------------------- -— - — ---------4%—
_________ jl—J --------------------------------— —
---------------- -—
Farming conditions------ _■------------------------—--------------- — — - — — — ------- - 11-15
S o ils ------------------------------------------------------- ---------------— — — ------------------11
Climate____________________ ,j------------------------------------------------ —*----------- U
Crops apd live stock---------- --------------------------— — — i---------- ;■--------------l2
Plantation system o f land tenure--------------------- --------------------------— —
Tenure and acreage-------- *---------------------------- — ----------------— - — —
Removals from farm to farm ----------------------- — -— — — -----------------14
Occupation of chief breadwinner______ _______ :------------------- — -------- ;
Illiteracy and education----------------------------------------------:-f— --------------- 15-16
Illiteracy-------------------------- _— -------,-----------------------------------------------—
Schools_______i ------------------- --------------- .— ---------------------------------------- —
Home demonstration and agricultural agents-------------- -l— -----------16
Public health work in the county--------------------------------------- \— ----------------10
Housing and sanitation---------------------------------- *— --------------------------------------18-20
Houses__- _________________ — ------- --------------------------- ---------------- '----------18
Overcrowding— -------------------------------------- ----------------------------------- --------18
Screening-------------------------------- ?------- — >---------------------- — *------------- --------19
W ater su pply-------- ---------------------------------------------------------- *•----------— —

Privies------------ ------------------------- ^

----------------—---------- :—


Maternity care—.----------------------- ----------------------------------------— - - - — - - - ■
— S ------ 21-34
The need for education;----------------------------------i - ^ 4 — — J.------- — •
Maternity care available-------- — ;-------------- ------ ------------- ---------------------------- 21-23
H ospitals--------------------------------------------------- — ------- ----------- ----------—— 21
Physicians-------------------------------- ----------------------------------------—
— ------21
Midwives--------------------------------------------------------------- -------- *■-— — -— —
Maternity histories o f mothers visited------------ — — - — ----------- - - —
Prenatal care-------------- — i ------- ------------------------- -----------^----------------- —-------- - 24-26
Mothers receiving prenatal care--------------------------- a -------------------------—
Analysis of care given--------------------------------------------------------------------- —
Use of home remedies during pregnancy----------------- —'— --------- —
Information through reading--------------------------------------— -------------—
Attendant at confinement— --------------------- ---------------- -------- ------------------------ 26-28
Kind o f attendant— .------ ----------------------------------- 1— --------------------------26
Distance from attendant-------------------------------------------------------------------—
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Maternity care— Continued.
Care o f the mother after delivery___________ __________
Medical care______________________________^ __v__—
Nursing care_____________________ ____________________ 4
Days in b e d ___ ________________ .__________________—
Costs of confinement____ __________ ______ _____________ w '__
Total costs and free service___,___ ^________ __________
Costs item ized________ ___________________ _____k ____ ikl.
Cost of confinement and economic status of family
Maternal m o r ta lity .-_______ ___ - __ ________________ _______
Maternal deaths in the county___ ________________
Deaths from causes other than childbirth-._________
Mothers’ work in relation to ehildbearing— - ____ , ____________
Usual farm and household w o rk _l____ ___________________
Farm work— _____ _________i_______________ _______
Household conveniences and household help____ ____
W ork during pregnancy and after confinement___________
Kind of household help secured-;____________ ___
Relief from work before confinem ent---______ l___
Resumption of work after confinement______________„
Effect of farming season on mothers’ work___ J-____
Care of children___________________________ j ____ _______________
Birth registration______________ ________ ____ _______ ____ i__
Instruction in infant care__________________________________
Feeding customs_____________________ .______________________
Breast feeding___ ________________________|_____________
Solid food and family d ie t-____ M ___ L _ _ _______
Children’s illnesses_____________ ________ .__________
Medical care________ i________________________________
Nursing care_'______________ ___ ___ _____________________ r_
Deformities_________ _____________ ___ g___________ __ !
Accidents_______4_,________________ .________ _________
Illnesses________ ____ --__________________ ____ |________ m
Home remedies for children_____________________ _____
Infant deaths_____________ .____________j_____ i______ _______
Medical care________________ ________ - ;___ |____ ■____ ___ _
Causes o f death____ _________ ___ ___ ____________ .______
Children’s health conferences--.__________'_____________________
Previous public health work__.______ ____________
Attendance and places o f meeting_____ :_______ _______ __J_
Examination of children— ___ _ i ________ ______________ _
Exhibits_________ ________ - ___ __ ¿j...__— __ _______ __________
Results o f the conferences_____ ____ _______________
Summary ----------------- ----- W_________ _________________ & __ X______
Conclusions_____ ________ ____________— __ ____ __ —
In d e x ____________*_______________ — ____ \______

____ t ___Ik -

P late I. The conference at a country schoolhouse.
P late II. An examination at a Negro conference.
Federal Reserve Bank of St. Louis

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C h i l d r e n ’s B


Washington, June 14,1921.
S i r : I transmit herewith a report entitled “ Maternity and Child
Care in Selected Rural Areas o f Mississippi.” This is one o f a
series o f studies o f child welfare in rural areas undertaken by the
Children’s Bureau.
The study was made under the general direction o f the Hygiene
Division o f the Children’s Bureau. The report was written by Miss
Helen M. Dart, who was in charge of the field work. Dr. Frances
Sage Bradley was in charge o f the children’s health conferences held
in connection with the inquiry.
The Children’s Bureau wishes to express its appreciation of the
generous cooperation given by Dr. W. S. Leathers, secretary, Missis­
sippi State Board o f Health; Dr. R. W. Hall, director o f the State
Bureau of Vital Statistics; local physicians; school authorities; and
members o f the Woman’s Division o f the Council o f National Defense.
Respectfully submitted.
J u l i a C. L a t h r o p , Chief.
Hon. J a m e s J . D a v i s ,

Secretary of Labor.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

The present report upon Maternity and Child Care in Selected
Rural Areas o f Mississippi is one o f a series o f studies o f the con­
ditions affecting maternity and child welfare in rural sections o f
the United States begun by the Children’s Bureau in 1916. That
there is urgent need for the study o f such problems and for the
adoption o f measures that will eventually lead to an amelioration
o f the conditions that give rise to them has already been shown in
previous reports of the bureau1 and need not be restated here in
detail. A survey was undertaken under the direction o f the Hygiene
¡Division o f the Children’s Bureau in the spring o f 1918 at the request
o f the Mississippi Board o f Health, and the secretary o f the board, in
advocating the establishment o f a bureau o f child welfare, stated:
This phase of health activity in Mississippi has been neglected in the past.
No special provision has been made for conserving the health o f the children
of the State. There is no greater need in Mississippi to-day than the study of
infant mortality with the hope o f reducing deaths among children less than 2
years o f age. * * * W hen it is known that thousands o f children die
in Mississippi from preventable causes before reaching 2 years of age, it is
imperative that steps be taken to check and control this slaughter o f the
innocents.2 .


Selection of counties.—A county in the southern part o f the
State, where some public health work had already been done by the
Mississippi State Board o f Health, in cooperation with the Inter­
national Health Board (formerly the Rockefeller Sanitary Commis­
sion), was chosen as the field for a series o f children’s health con fer-'
ences, which included the examination by a Government physician o f
children under 6, simple talks to parents, stereopticon views, and ex1 Children’s Bureau Publication No. 26, Maternity and Infant Care in a Rural County
Kansas; Children’s Bureau Publication No. 34, Maternity Care and the Welfare of
■«Ibung Children in a Homesteading County in M ontana; Children’s Bureau Publication
No. 46, Maternity and Infant Care in Two Rural Counties in Wisconsin; Children’s Bureau
Publication No. 33, Rural Children in Selected Counties of North Carolina.
“ Report of the State Board of Health of Mississippi, .Tune 1, 1915, to June 30, 1917J
p. 17, Jackson, Miss., 1918.

Federal Reserve Bank of St. Louis



hibits relating to child care. For the intensive survey o f maternity
and infant welfare a county in the northern part o f the State was
selected which was typical o f the “ hill country ” of that part of the
State in respect to the conditions o f child care, general economic and
farming conditions, and racial and industrial distribution o f popula­
tion. Comparatively little public health work had been done in the
county, and while it was not progressive in this respect, neither was it
the most backward in the State. The study was Confined to rural
communities in the northern county; the two county seats, towns of
about 500 and 4,500 inhabitants where strictly rural conditions did
not prevail, were not included in the area studied.
Sources of information.— General information was secured from
the county health officer, the county superintendent o f schools, the
county agricultural agent, the home demonstration agent, from
physicians, and from many other responsible persons in the county.
But in this, as in all similar surveys made by the Children’s Bureau,
the information most pertinent to child and maternity care was
secured through personal interviews with individual mothers by the
woman agents o f the bureau. Effort was made to secure interviews
with the mother o f every baby born in the area studied between
April 1,1916, and April 1,1918. Information was obtained in regard
to 685 babies (299 white and 386 colored) born to 675 mothers (295
white and 380 colored). In a few cases in which it was impossible
to see either the mother or the father, information was secured
from relatives and others in a position to know the facts sought. The
local registrars for births and deaths helped in finding all the babies
within the scope o f the survey, and death certificates for all babies
whose deaths had been registered were secured at the beginning o f
the work. Since birth registration was incomplete, a house-to-house
canvass was made o f the county.
Federal Reserve Bank of St. Louis

The county in which the intensive survey was made is located in
the northern part o f the State and is typical of the “ hill country ”
o f Mississippi with rolling hills, open fields, broad fertile river bot­
toms, and a good deal o f cut-over woodland.

The census o f 1910 showed that the percentage of Negroes in
Mississippi, 56 per cent, was greater than for any other State in the
Union,1 and in the county studied more than half the total popula­
tion o f 22,959 was Negro.2 O f the mothers interviewed 56 per cent
were Negro, and only 1 mother was foreign bom.
Urban and rural population.—About 20 per cent of the population
was urban, owing to the fact that there was one city o f 4,649 inhabi­
tants.3 In spite o f its size it exerted very little more influence for
progress than did the other county seat, a village o f about 500 in­
habitants. The population o f the county exclusive of these two
towns was about 17,800 in 1918. Scattered over the county there
were eight small towns in which living conditions were essentially
rural. They varied in size from 10 to 475 inhabitants and contained
from 1 to 12 stores. None o f these towns had more than one
physician in regular practice, and three had no physician at all.
A ll but one had post offices and all but two were on the railroad. O f
these two, one was about 7, the other about 9 miles from a railroad
station. In none o f them was there a town water supply or sewerage
Density of population.— In 1910 the density o f the rural popula­
tion o f the State was 84.3 persons per square, mile, o f the county 35.2
persons per square mile.4 In the open country it was seldom more
than a quarter o f a mile from one house to the next, and even in the
rougher parts o f the county it was unusual to visit a family who had
no neighbors in sight. This was quite different from the county
1 Thirteenth Census, 1910, Population, vol. 1, p. 135.
a Estimated for Apr. 15, 1918, on basis of Thirteenth Census, 1910, Population, vol. 2,
p. 1058.
Estimated for Apr. 15, 1918, on. basis of figures given, Thirteenth Census, 1910, Popu­
lation, vol. 2, pp. 1035 and 1058.
4 Thirteenth Census, 1910, Population, vol. 2, pp. 1044-1058.

48532°— 21------ 2
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studied in Montana, where it was unusual to find families living less
than one-half mile apart. Most o f the Negroes lived on the river
bottoms as tenants on the large plantations, while the whites lived
in the hills where the plantations had been broken up into small

Railroads.—Two divisions of the Illinois Central Railroad crossed
the county from north to south. Stations were only from 4 to 7
miles apart. None o f the families visited lived more than 10 miles
from a railroad station. The large markets were St. Louis and
Memphis. Shipments o f cotton, hay, cattle, hogs, and other produce
were arranged for in carload lots by the county agricultural agent.
Only a very small part o f the stock and grain raised in the county
was used by the local market.
Roads and mail service.— On account of the many hills and gullies
even the public roads were winding and had many steep grades. The
soil was so sandy that the roads dried quickly, and so loose that they
washed out easily and needed constant care to keep them in condition.
However, the main roads were usually very good and well graded,
and practically every part of the county was accessible by automobile.
Even in bad weather the roads were seldom impassable for more than
a few days at a time, and only a few instances were reported where
a father had difficulty because of bad roads in getting a doctor or
midwife to attend a confinement. According to the southern custom,
most o f the houses were not on the main road but back on the plan­
tations. The roads leading to them were private and not so well
worn or well kept as the public roads. Some o f the houses were 1-|
or 2 miles from the main road; a few were almost inaccessible by
automobile even when the weather was good, because the roads lead­
ing to them were rough and steep or the bridges insecure.
Good roads made possible daily mail delivery for every part o f
the county. No place in the county was more than 3 miles from a
rural mail delivery route and most places were not so far away as
Telephones.— Telephone lines followed most o f the main roads.
O f the 675 families visited, 84 white families and 2 colored had
telephones in the homes. Nearly one-half were less than a mile from
some neighbor who had a telephone, 182 were 1 to 3 miles distant, and
only 20 o f the families (19 o f them colored) were reported as living
over 5 miles from a telephone. Only 4 mothers reported trouble in
getting a physician for confinement because the telephone service
was cut off.
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Over four-fifths of the land of the county was in farms,5 but it was
estimated by the county agricultural agent that about one-half o f
this land was still unimproved, although more was being brought
under cultivation each year. Much o f the land under cultivation
had not yet been cleared o f stumps, and in many fields the trees had
been girdled instead o f cut in order that the land might be immedi­
ately planted in cotton or corn. Nearly one-half the farm acreage
o f the county was in woodland.6
Soils.—-The soil of the bottom lands, though liable to overflow,
afforded some o f the best farming land o f the State, while the upland
soil was probably more suitable for grazing than for any other pur­
pose. T o quote from the State geological survey:
Most of this region has been long in cultivation. The* high, well-drained
condition of the surface, the healthfulness of the climate and the fertility of
the soil at an early period in the State’s development invited settlement. In
the antebellum days, under slavery régime, these lands were owned and worked
in large plantations. A s elsewhere in the State, cotton was the staple cropi
with just enough corn to supply the needs of the plantation. The methods of
cultivation were very exhausting to the soil. Crops were, year after year,
taken off the land and nothing returned to it.7

The report states further that the exclusive cultivation o f cotton
exhausted the humus and other elements o f fertility. Since the
Ciyil W ar the exhaustion o f these lands had been more rapid than
ever before, and careless terracing or circling o f the hill slopes had
caused many o f them to wash out badly. It was only within the
past few years that agricultural methods had begun to show im­
Climate.— Hot weather usually continues unbroken from the latter
part of May to early October, and farmers count on a frost-free
growing season o f about seven months. The temperature does not
rise any higher than it does' in some northern States, but the longcbntinued unbroken heat and the humidity makes the climate more
enervating. Only occasionally in a severe winter does the ther­
mometer drop below zero.
The rainfall is well distributed throughout the year but the
heaviest occurs in the late winter and early spring. The total
precipitation for the year 1917 was 53.98 inches.8 The snowfall is
slight, even in the northern part o f the State. The prevailing winds
are from the south. Tropical storms and thunder showers which
^cause great damage to crops are not infrequent.
5 Thirteenth Census, 1910, Agriculture, Vol. VI, pp. 870—871.
8 Thirteenth Census, 1910, Agriculture, Vol. VI, pp. 870—871.
7 Mississippi State Geological Survey, Bulletin No. 12, p. 213, Jackson, Miss., 1915.
8 Climatological data, Mississippi Section Annual Summary, 1917, p. 101.
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Crops and live stock.— Until 1911, when the boll weevil appeared
in the county, cotton was by far the most important crop and a large v
part o f the foodstuffs consumed was imported. With the dwindling
o f the cotton crop to about one-third its former size, other crops had
assumed a greater relative importance and more attention had been
given to stock raising. Diversified farming had reacted beneficially
on the people as well as on the soil. They no longer staked a whole
year’s effort on one crop nor depended on the market value o f that
crop to buy their foodstuffs. One o f the illiterate colored farmers
said that he and his fellow tenants on the plantation had been much
more prosperous'and independent since each household had begun to
raise its own grain and meat, and garden produce. For the first
time in years they had been able to get out o f debt at harvest time.
There were as yet few stock or dairy farms, but practically every
farmer in the cohnty was raising a few hogs and cattle for market,
and a few farmers were shipping milk to a creamery outside the
county. About three-fourths o f the families visited owned some
cattle and about the same number were reported as keeping hogs.
Some mules and houses and a few sheep and goats were raised for the
market. The number o f sheep had decreased considerably since the
law requiring the fencing o f pastures made their upkeep more
expensive. O f the 674 families reporting, 280 o f the white and 279
o f the colored families had milch cows. In 46 cases the family did
not own the cow, but had the use of her as part o f the rental contract
or in return for some service. Fifteen white and 100 colored
families neither owned, hired, nor had the use o f a cow. It must be
taken into consideration, however, that not all the families reporting
cows had fresh milk all the year round, and the importance o f milk
in the children’s diet needed emphasis here as in many other farming
Plantation system of land tenure.—The conditions of tenant farm­
ing in the area studied were peculiar to the plantations o f the South,
the form of tenure having been developed there in the reconstruction
period to supplant slavery conditions. To quote from the special
study o f plantation areas in the South made by the census in 1910 :
A large proportion of the tenants in the South actually occupied a very
different economic position from that usually occupied by tenants in other
parts of the country. The plantation as a unit for general purposes o f
administration has not disappeared, and in many cases the tenants on plan­
tations are subjected to quite as complete supervision by the owner, general
lessee, or hired manager as that to which the wage laborers are subjected
on large farms in the North and W est, and indeed in the South. W here t h i^
is the case a tenant is very similar in his economic position to the hired farm
laborer, practically the only difference being that he confines his work to a
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particular parcel of land which he works by himself and that he is paid by
a share of the crop instead o f by wages.9

Along with the plantation system o f land tenure was the credit
system peculiar to it. From the time, early in the year, when the
tenant signed the contract until the crop was marketed the landlord
“ carried ” him. Unless the planter wished to supply the tenant from
his own commissary, he arranged credit for him through either a
bank or a store for a weekly or monthly allowance for food and
clothing, though in many cases the arrangements were less system­
atic. This advance, with interest, was deducted from the tenant’s
share o f the crop at harvest. Since the- colored- tenant was usually
ignorant and often illiterate, the bookkeeping was completely in
the hands o f the landlord; and there was, without question, some
exploitation. One tenant working in partnership, with another re­
ported that after deductions had been made for the debts incurred
for her living expenses she received $5 and 3% loads o f com as
earnings for the year’s work.
Tenure and acreage.—The plantation system necessitated a large
proportion o f tenant farmers. Fifty-six per cent o f the white
families on farms were tenants and 89 per cent o f the colored. O f
the families who were reported as having farms, 75 per cent were
tenants, 22 per cent owners, while for the remaining number the form
of tenure was too irregular to be classified because the farmers were
working farms belonging to their relatives, who in the majority of
cases lived with the family but took only a minor part, if any, in the
management and operation o f the farm. Altogether only 45 farmers
were renting on a cash basis or were paying a standard rent o f a fixed
amount o f produce (usually a bale o f cotton), while by far the greater
proportion (over 80 per cent) o f the tenants were renting on shares.
Thirty per cent o f the white and 68 per cent o f the Negro tenant
farmers were renting on half shares. Economically these were the
lowest in the scale. The farm implements and work animals they
used were owned by the landlord. More than four-fifths o f the ten­
ants o f this class owned neither a horse nor a mule; about two-fifths
owned no cattle; and nearly one-third owned no pigs. A quarter
share rental was reported by 67 tenant farmers and 54 were paying
one-fourth o f the cotton and one-third of the corn. Cash and stand­
ard-rent tenants received but little supervision, but the share tenants
were supervised with regard to the planting, cultivation, and harvest­
ing o f the crops.
i Most o f the small farms were in the rougher, parts o f the county,
while the rich bottom lands were held by large plantation owners.
U. S. Bureau of the Census, Plantation Farming in the United States, p. 7,
ton. 1916.
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The number o f small farms was large, but most o f the land in the
county was in large holdings. F or the 121 farm owners for whom
acreage was reported, 21 had farms o f less than 50 acres, 28 had farms
of 50 to 100 acres, and 35 had farms o f 100 to 175 acres. There were
11 farms o f 500 acres or more, and 2 o f 1,000 or more. Farms be­
longing to colored farmers averaged smaller than those belonging
to white farmers. The average size o f farms among tenants was
much smaller than among owners, because it was not customary for
a man to rent more land than he and his family could work by their
own labor, and furthermore rented farms included little unimproved
land, while practically one-fralf o f the land o f the owned farm was
not under cultivation. O f the tenants reporting acreage, 42 had
farms of from 10 to 20 acres; 116 (nearly one-half) had farms of
from 20 to 30 acres; and 57, farms o f from 30 to 50 acres. There were
only 20 tenant farms of more than 50, acres and none o f more than
260 acres.
Removals from farm to farm.—As may be expected in a section
where the proportion o f tenant farmers is large, there was consider­
able moving from one farm to another. Nearly one-third o f the
families visited reported that they had lived in their present dwelling
less than a year. Seventy-five families (1 in 9) had lived on the
average less than a year in a place during married life, and nearly
one-half o f the families visited had lived on an average less than
three years in a place. One mother said she had moved so many
times she could not keep count of the number, while in another
family the older daughter said they had moved every two years
since she could remember. Families who move every year or two
do not stay in one neighborhood long enough to get the full benefit
of the schools, churches, and other community enterprises, and they
have little interest in community projects, such as the building of a
county hospital or the employment o f a county nurse.
Removals were naturally more frequent among tenants than among
farm owners. As the share tenant was supplied not only with a
house but with most of his furniture, farm implements, and stock,
moving was a relatively simple operation, in many cases consisting
o f loading all his household goods and family into a one-horse wagon
and moving over to another farm without losing any time from work.
The most shifting element of the population was the white tenant
farmer. Only about 1 in 8 had stayed for an average o f three years
or more in one place. On the whole removals among the colored
families were but little more frequent than among white families^
The tendency to remain for a long time on one farm seemed to be
stronger among the Negro than among the white families, consider­
ing the fact that the proportion o f tenant families was much greater
among the Negroes. Many spent their whole lives on one plantation.
Federal Reserve Bank of St. Louis



Occupation of chief breadwinner.— In 93 per cent of the families
visited the chief breadwinner was a farmer, farm manager, or farm
laborer. Only 39 per cent o f the white and 9 per cent o f the colored
farmers were farm owners. O f the remaining 7 per cent nearly onehalf were railroad employees and the rest were professional men,
merchants, salesmen- postal employees, or skilled mechanics. In 2
white and 16 colored families the mother was the chief breadwinner;
13 o f these mothers were farmers, and 1 was a farm laborer.

Illiteracy. Illiteracy and low standards o f education were serious
enough in this part o f the State to present a real obstacle to better
health work. Many a mother refused to take the Children’s Bureau
pamphlets on Infant Care and Prenatal Care because she could not
read and had no one who could read them to her. The percentage of
illiteracy was much greater among the Negro than among the white
parents, and the percentage o f illiteracy among fathers was higher
than among mothers. O f the white families visited, 9 fathers and 8
mothers were reported as illiterate, while o f the colored families 110
fathers and 100 mothers were thus reported. In 5 white and 48
colored families neither parent could read or write. The figures for
illiteracy indicate to only a small extent the ignorance which existed
among most o f the white tenant farmers and Negroes. These people
had very few books and subscribed for practically no magazines or
papers, and were unable to use readily the means which the more
intelligent and progressive farmers employed to counteract the
isolation o f rural life.
Schools.— The schools o f the county were handicapped by the lack
o f a compulsory education law.10 When school attendance is volun­
tary it is likely to be irregular. The-school session came in the
months when it was least likely to interrupt farm work, and this
made the term fall within the period o f bad weather which caused
much irregularity o f attendance. The term, too, was so short that
many children forgot between terms what they had learned, and
many left school with only a slight knowledge o f reading and writ­
ing. The term for rural schools for white children was five months
in the southwestern part o f the county and five and a half months
A compulsory education law requiring 60 days’ attendance, with exemptions, went
into effect Sept. 1, 1918. This law was applicable only to those counties which elected
vto come under its provisions. (Mississippi Acts of 1918, ch. 258.)
A new law requiring
« 0 days’ attendance, with exemptions, went into effect Aug. 1, 1920. This law applied to
the entire State, but permitted any county to release itself from the provisions of the act
by a majority vote of the qualified electors at an election held for that purpose.
sippi Acts of 1920, ch. 156.)
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in the northeastern, the difference being due to the additional income
in the northeastern part o f the county from the Chickasaw fund.
Terms in the colored schools averaged about four months. Three or
four districts levied a special tax for a longer term. Teachers o f the
first or highest grade ( “ grade” being based on educational require­
ments and type o f examinations passed) were required, to have only
a common-school education. Practically all o f the white teachers
were o f the first grade, with salaries averaging $50 a month. Most
o f the colored teachers were of the third grade, with salaries ranging
from $16 to $25 a month.11 The rural schoolhouse served to some ex­
tent as a social center for the community. Some of the schoolhouses
were well-constructed buildings, while some were rough, unceiled
frame houses with uncomfortable homemade benches. Several o f
them had no toilet facilities' whatever. A t the time of the survey
the county had no consolidated schools, but in one or two localities
there were good prospects that such schools would soon be established.
Home demonstration and agricultural agents— The home demon­
stration agent of the county, employed under the joint supervision
of the State and the United States Department of Agriculture,
worked with the women and girls to promote better methods o f
household economy. She organized in close cooperation with the
schools canning ciubs, poultry clubs, and home economics clubs. An
important part o f her work was the promotion of better care and
more intelligent feeding o f babies and children. The first publichealth nurse in the county will find her work made easier by the or­
ganizations already formed and methods already put in practice by
the home demonstration agents. The agricultural agent worked
with the men much as the home demonstration agent worked with
the women. He made a scientific study o f the soils of the county,
advised the farmers in methods o f cultivation and stock raising and
promoted cooperative seed buying and the cooperative sale o f farm

The county was at the time o f this survey the unit o f administra­
tion in public-health work in Mississippi. One of the physicians
resident in a county was appointed as health officer. His duties
were to make monthly statements o f mortality statistics •compiled
from the reports o f the registrars o f the- various voting precincts o f
the county, to enforce quarantine regulations, and to act as assistant
sanitary inspector in enforcing the rules o f the State board o f healthin regard to the sanitation of public buildings, markets, milk depots,

Statement of county superintendent of schools.
Federal Reserve Bank of St. Louis



etc.12 He was charged also with the enforcement o f the law passed in
January, 1916, for the prevention o f blindness in the new born,
which involved the recording o f all cases o f ophthalmia neonatorum,
and the registration of the midwives of the county and their in­
struction in the use o f the prophylactic measures prescribed by the
law.13 Most of the county health officers o f the State worked only on
part time and had to depend upon private practice for their living.
Salaries o f these part-time officers varied from $150 to $1,800 a year.
The officer o f the county studied received about $300 a year. In re­
viewing the results o f this type o f organization the secretary o f the
State board o f health wrote as follow s:
In many of the counties the part-time man achieves results for which he
is by no means compensated. In the main, the part-time county health officers
of Mississippi have been, so fa r as the system will permit, reasonably effective
public-health workers. But * * * this business o f conserving the public
health requires the undivided and aggressive effort o f those who serve in this

Special emphasis had been laid upon campaigns against the dis­
eases peculiar to the region— pellagra, malaria, hookworm, and soilpollution diseases. Special effort to reach rural districts had been
made through the Division o f .Rural Sanitation.15 In 1914 a study
o f the dietary causes o f pellagra was made in cooperation with
the United States Public Health Service in two orphanages in Jackson.16 Intensive work had also been done on malaria. In 1910
the State board o f health, in cooperation with the counties and the
International Health Board, formerly the Rockefeller Sanitary Com­
mission, began a State-wide survey of hookworm and soil pollution.
None o f the intensive health work had been done in the county
studied because it is not situated in the part o f the State where
these diseases were most prevalent. The preliminary survey had
shown that the infection from hookworm based on the examination o f
570 children in the county was only 2.3 per cent.17 Nevertheless, the
propaganda attendant upon this work in other parts o f the State
had undoubtedly had some influence. The local physicians had
done some educational work in connection with their practices. One
physician said that when he began to practice, most o f his time was
taken up with treatment o f malaria. His insistent warnings against
12 Report of the Board of Health of Mississippi, 1915-1917, pp. 166-201. Jackson,
Miss., 1918.
13 Report of the Board of Health of Mississippi, 1915-1917, pp. 301-302. Jackson,
Miss., 1918.
14 Report of the Board of Health of Mississippi, 1915-1917, pp. 21-22. Jackson, Miss.,
15 Report of the Board of Health of Mississippi, 1915-1917, pp. 29-30. Jackson, Miss.
16 Report of the Board of Health of Mississippi, 1915-1917, pp. 309-310.
17 Report of the Board of Health of Mississippi, 1913-1915, p. 26.

48532°— 21—

Federal Reserve Bank of St. Louis



mosquitoes had resulted in the screening of many o f the homes in his
community and a decrease in the prevalence of malaria. Another, in
connection with his typhoid cases, had raised the standards o f sani­
tation and cleanliness in some o f the country homes.

Houses.— The three-room one-story house with a wide, open pas­
sage from front to back and chimneys for fireplaces at each end
o f the building was the type o f farmhouse most often seen. Some­
times-a porch extended across the whole front of the house, some­
times a kitchen was built on at the back. Many o f the larger houses
were built on much the same plan, while the smaller houses had a
chimney at only one end. Many o f the cabins were o f rough boards
or logs with generous cracks between. Only about 4 per cent o f the
houses were plastered on the inside, and about 30 per cent were
finished with ceiling. A few o f the board houses were finished
with a second layer of boards on the inside; some were not even
clapboarded. Many were papered with newspapers to keep out the
cold. - Some o f the poorer cabins had no glass windows, but merely
holes in the walls fitted with wooden shutters; when these shutters
were closed the house was dark except for the light that came in
through the cracks. Comparatively few houses were painted; some
were whitewashed inside and out.
The houses among the Negroes were on the whole much poorer than
those o f white families, many of them being old ramshackle cabins
in wretched condition. Less than 1 per cent were plastered and only
21 per cent were ceiled. For the greater part o f the year such houses
were comfortable, but in the few winter months there was real suf­
fering from the cold. Over 96 per cent o f the houses were set up on
piles so that the .circulation o f air underneath might make them
cooler and drier; unless this space under the house was inclosed,
chickens, pigs, cats, and dogs used it as a shelter. The houses of the
prosperous white planters were comfortably furnished, but many of
the tenant cabins had only the most necessary things— a bed, a few
chairs, and a table. In some houses rough homemade benches took
the place o f chairs; homemade cradles, beds, and tables were often
Overcrowding.—It is surprising to find that there are as serious
instances o f overcrowding in the country as in large cities, but the
fact that there is no crowding of one house against another does not
insure plenty o f room inside the house. When a family o f 8 mem­
bers or more lives in a house o f two rooms or less (17 o f the f amilies
were thus reported), there is bound to be crowding, lack o f privacy,
and inconvenience for the housekeeper, no matter how much space
there may be outside the house.
Federal Reserve Bank of St. Louis



The size o f the families varied from 2 persons to 16; about 85
per cent o f the white families had from 3 to 8 members ; most o f the
Negro families had from 3 to 11 members. Fifteen colored families
had 12 or more members, 4 had 14 or mole. The house most commonly found had three rooms, but many o f the families visited
were living in smaller quarters ; 15 families had only one room, and
HT, or 17 per cent, had two-room houses. Less than one-half o f the
families visited were living in houses o f four rooms or more.
Forty per cent o f the families visited reported 2 or more persons
per room ; 10 white and 70 colored families were living with 3 or
more persons to a room. About one-third o f the white families re­
ported 2 to 3 persons per sleeping room ; about one-fourth 3 to 4
persons per sleeping room; 28, or nearly one-tenth, reported 4 to 5
persons per sleeping room. There were 27 instances o f 5 or more per­
sons per sleeping room. Only 23 per cent reported less than 2 per­
sons per sleeping room. Overcrowding o f sleeping rooms in Negro
families was still more evident. More than two-thirds reported 3
persons or more per sleeping room, and only 6 per cent less than 2
persons. In 43 families (over 11 per cent) there were 6 or more
persons per sleeping room ; 6 cases were found o f 8 in one sleeping
room, 3 instances o f 9, and 3 cases o f 10 persons sleeping in one room.
Screening.—-Even in northern Mississippi the climate is such that
screening against mosquitoes is desirable as a precaution against
malaria. Flies should be kept out o f the house to guard- against con­
tamination o f food, and in the summer screens are very desirable to
keep chickens and live stock out o f the house. In one o f the homes
visited, a goat was wandering around inside the house, and in other
cases chickens had come in and made themselves at home on the beds.
Only 23 per cent o f the white families and 3 per cent o f the colored
families were living in houses screened at all doors and windows.
One o f the fathers said that he had done his best to screen the house,
but there were so many cracks in the walls and floor that flies and
mosquitoes came in anyhow.
Water supply.—The geologic formation was such that good water
was easily obtainable.18 Flowing wells varying in depth from 160 to
200 feet were found at both county seats and along the river bot­
toms. Among the families visited, 41 reported a drilled well, in
many cases an artesian well, as the source o f water supply; 156
families reported springs; 9 secured their water from a river or
¿peek; 16 used cisterns; 109 had bored wells; and 344 (51 per cent)
had dug wells. The artesian wells furnished much the cleanest water,
since they were drilled to a considerable depth and the piping kept
18Crider, A. F„ and Johnson, L. C .: Summary of the Underground Water Resources of
Mississippi, p. 39. Water Supply and Irrigation Paper No. 159, U. S. Geological Survey
Washington, 1906.
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out surface water; river or creek water was liable to pollution from
animals and fowls, and was usually m uddy; springs, unless carefully
protected, were likely to be dirty; and many o f the dug wells were
insufficiently protected from surface pollution. The bored wells were
subject to much the same dangers from surface water as dug wells,
but the opening was so much smaller that animals or insects were
less likely to get in. Many of the dug wells were equipped with a
windlass or pulley, which made them easier to use, but did not insure
any more cleanliness. Eight families had water in the house, and in
21 cases the source o f water supply was on the porch. For more
than one-third o f the families the source o f water supply was less
than 25 feet from the house; for more than one-half, less than 100
feet. On the other hand, about one-third of the families had to go,
100 yards or more, and 53 had to go a quarter o f a mile or more.
Negro mothers reported on the whole longer distances from water
supply. A few did* not have wells on the premises, but had to go to a
neighbor’s for water; in some cases one well served a group o f tenant
Privies.— The disposal of human excreta is a particularly important
problem in the South, where special precautions are needed against
soil pollution diseases. The survey showed that this problem had
hardly been touched in the area studied. Among white families, 61
per cent had no toilets whatever ; among Negro families, 85 per cent
had no toilets. O f the 166 families who had privies, 143 reported
the open-back type, in which the refuse is unprotected not only
from flies but also from chickens, pigs, and other domestic animals.
Only two families had water-closets. The State board o f health was
doing effective Work in rural sanitation, but thus far little o f it had
touched the county studied. The report o f the State board o f health
for 1913 to 1915 19 showed the results o f an investigation of sanitary
conditions in over 500 rural homes of the county; 303 had openback privies and 270 had no privies. This gave the county a sanitary
index based on the type o f privies found o f 5.2 on the scale o f 100.
The fact that this index was about the average for the whole State
indicated that the problem was State wide.
19 Report of State Board of Health of Mississippi, 1913-1915, p. 27.
Federal Reserve Bank of St. Louis


In Mississippi as well as in other parts o f the* country ignorance
o f the value o f good maternity care was largely responsible for the
lack o f it, and several physicians in the county stated that the most
important factor in getting adequate care o f this kind was to educate
the mothers to recognize the need o f it. One physician said that
when he heard incidentally that mothers were having swollen feet
and other dangerous symptoms during pregnancy, he could not con­
vince them o f the necessity o f reliable medical advice, and they con­
sidered visits to him unnecessary. The board o f health attributed
the high maternal mortality rate in the State to the fact that “ a very
large majority o f the confinement cases among the Negroes are
* attended by Negro midwives, in which case little protection is
afforded "the patient, consequently the death rate from this cause is
unusually high. It is also trtle that a large percentage o f the confine­
ment cases in this State as a whole are not attended by licensed phy­
sicians.” 1

Hospitals.— A t the time o f the study the hospital nearest the
county was located at Memphis, Tenn., nearly 100 miles away, and
the nearest one that received patients free o f charge was at Jackson,
over 100 miles away. Distance and expense made hospital care im­
possible for the great majority o f mothers and children o f the
county. Only one o f the 675 mothers scheduled had been confined
in a hospital.
Physicians.—-At the time o f the survey there were 14 physicians in
regular practice in the county, and, in addition, there were 3 or 4
who had retired from active practice, 4 or 5 who had enlisted for
war work, and 1 or 2 who held no licenses but occasionally helped
their neighbors in case o f illness.
Midwives.— There were probably over 100 midwives practicing in
the county during the period covered by the survey, and 87 o f these
^(8 white and 79 colored) were interviewed by the agents o f the
Children’s Bureau with the object o f finding out the status o f mid­
wifery in the county. In respect to education, the white mid wives
1 Report of the Board of Health of Mississippi, 1915-1917, p. I l l ,

Federal Reserve Bank of St. Louis



were superior to the colored, as all could read and write, while twothirds o f the colored midwives were illiterate ; but on the whole the
white midwives di$ not differ either in training or practice from the
Negro midwives. The informations gleaned from the interviews dis­
closed the fact that none o f the midwives had had adequate training,
and most of them lacked even the elementary education that would
make such training possible.
Various accounts were given as to the training received to fit them
for midwifery and the reasons for adopting this practice. Some
o f them had been taken to confinement cases and taught by phy­
sicians; some were midwives because their mothers and grand­
mothers had been; others had become experienced in handling emer­
gencies or in bearing their own children; while still others said that
they had been “ called by the Lord.” Many o f them believed in
various superstitions such as “ Girls come at the full moon and boys
on the new moon,” and “ Babies born on a wasting moon haven’t
all their senses.” One midwife always cut the cord long because
she had heard the saying, “ Long cord, long life.” Many o f the
midwives were very o ld ; and decrepit, before-the-war “ aunties had
more prestige among their neighbors than any o f the younger midwives. One o f those interviewed said: “ I ’m not going out on night
cases any more, because I ’m getting old- and can t keep awake.
Some o f their methods were amazingly primitive. Over ninetenths used no antiseptics whatever in making preparations for de­
livery; one said: “ No washing is necessary if grease is used plenti­
fully.” Various questionable expedients were used to bring the
afterbirth; some o f the midwives used a method o f warming the
patient suddenly by putting her over a bucket o f hot ashes or burn­
ing feathers, while two advocated putting an umbrella or a black
hat over her face. Some o f the more intelligent ones knew that
childbed fever was caused by uncleanliness and tried to guard against
it, but among many the old custom still held o f not changing the bed
coverings for at least three days.
Many of them said that they always called a doctor when any
complication occurred, but several told o f attending cases o f ad­
herent afterbirth, severe hemorrhage, breech presentation, prolonged
labor, and stillbirth without the aid o f a physician, and it is probably
true that many o f them failed to recognize minor complications and
mild cases o f childbed fever. The midwife’s most dangerous fault
was her failure to recognize her own limitations; ignorance pre­
vented her from recognizing cases where the attention o f a physician
was imperative, and in many cases it fostered a fatalistic attitude
which was manifested in such expressions as “ Women are born to
suffer and it’s wrong to interfere,” and “ I f the baby is born to die,
nothing can be done.”
Federal Reserve Bank of St. Louis



Several o f the more intelligent midwives said that they would be
glad to have a county nurse to advise them and to teach them better
methods o f practice. A t the time o f the survey there were no rural
county nurses in the State, and practically nothing had been done
in the area studied in regard to the supervision of midwives beyond
urging them to register births. In 1916 the State legislature passed
a bill for the prevention o f blindness from inflammation o f the
eyes o f the newborn, and the State board o f health (1917), in the
enforcement o f the law, required that all midwives register with the
county health officer at least once a year; that all midwives as well
as physicians use a 1 per cent solution o f silver nitrate in the eyes
o f every newborn baby, and report cases o f inflammation of the eyes
within six hours after they had been observed. A t the time o f the
survey the law was not being enforced in the county, as was shown
by the fact that only 3 o f the 87 midwives interviewed reported
having used any drops in the eyes at birth.

The maternity histories obtained from the mothers showed frequent
pregnancies and large families. It was customary for girls to marry
early and to begin bearing children when quite young. Almost onetenth o f the mothers whose ages at marriage were reported had been
married before they were 16 years o f age; one-third o f them before
18; and slightly over three-fifths before 20. Very early marriages
were more common among the colored mothers than among the
white; about 1 in 8 had married before the age o f 16 (two at less than
14) , and nearly two-fifths when less than 18. O f the white mothers
13 said they had been less than 17 years old at the time o f their first
confinement, and 102 under 20. O f the colored mothers, 79 reported
the first confinement at less than 17 years, and 227 under 20 years.
About 1 in 7 o f the mothers visited had been under 20 when the baby
scheduled was born, and 28 o f these had had two or three previous
confinements. Nearly one-half (318) were in the age group 20 to 30
years; less than one-third were in the group 30 to 40 years. More
than one-half o f all mothers had had four or more pregnancies, and
nearly one-fourth had had seven or more. Eighteen per cent o f the
white mothers and 28 per cent o f the Negro mothers had had more
than 6 pregnancies. One white mother and 9 Negro mothers had
had more than 12 pregnancies.
Sixty-four o f the 380 Negro mothers were unmarried at the time
the baby scheduled, was born; 52 had never been married; 6 had
been married at some time previous;,6 were married after the baby
was born. H alf these mothers were under 20 years o f age, 7
were under 17 years o f age. F ifty per cent had had one or more
pregnancies previous to the birth o f the baby scheduled.
Federal Reserve Bank of St. Louis




Mothers receiving prenatal care— The figures relating to prenatal
care point plainly to the conclusion that lack o f prenatal care was
due in large measure to ignorance o f the need for it. Only 116
mothers, about 1 in 6, had any prenatal care whatever, and o f these
only 9 had care because they thought that pregnancy was in itself
a reason for seeking medical advice. In only 9 cases o f the 116
could the care received be classed as fair, and in only 1 case was the
prenatal care adequate.2 O f these 10 mothers who had adequate or
fair care, all had either had difficulties in previous confinements or
such illness during pregnancy that attention from a physician seemed
The standards o f maternity care were much lower among the
Negroes than among the whites, the proportion o f Negro mothers
receiving some prenatal care being just about half that for the
white mothers. Only 45 o f the Negro mothers, 12 per cent, had any
care at all, and only 1 o f these had fair care; 10 had a physical
examination and 3 a urinalysis.
While illness seemed to have been responsible for prenatal care
in the majority o f cases, it can not be assumed that all mothers who
felt the need o f care sought a physician. One white mother said that
she did not feel well all through her pregnancy, though not sick
enough to call a doctor. One o f her older daughters was strong
enough to do the housework so the family could get along. Another
mother said she suffered a great deal from varicose veins but did
not see a physician. Still another had no prenatal care, even though
hardly able to be about during the last three months o f pregnancy.
Although ignorance .of the need o f good prenatal care was in a
large measure accountable for its lack, yet there were other factors
that entered in, such as family income, distance from doctor, and
traveling facilities. It is significant that the proportion o f mothers
receiving prenatal care was. highest among f amilies in which the chief
breadwinner was not a farmer, and that they lived in or near towns,
not far from a doctor. The heads o f these families were for the most
part ministers, doctors, merchants, salesmen, skilled mechanics, and
railroad employees in the towns; over three-fourths o f them were
' 2 Prenatal care was classed as : Adequate, if there had been a monthly urinalysis, fifth
to ninth months; if the mother had been under the supervision of a physician fifth to
ninth months; if an abdominal examination had been made, and, m the case of a first
child if pelvic measurements had been taken. Fair, if urinalysis had been made but less
than’ five times at monthly .intervals, if the mother had had some supervision by a
Dhvsician, and if an abdominal examination had been made, and, m case of a first c ild,
if pelvic measurements had been taken. Inadequate, if there had been visits to a phy­
sician, but no urinalysis, no abdominal examination, or, in the case of a first child, no
pelvic measurements. Urinalysis with no visits to physician was also counted as inade­
quate care.
Federal Reserve Bank of St. Louis



Analysis of care given.— In the majority of cases o f women receiv­
ing some kind o f prenatal care the matter ended when the mother
had seen a physician. There was no realization of the importance
o f urinalysis, still less o f abdominal and pelvic examination. Study
o f the number o f visits, urinalysis, and kind o f physical examina­
tions made brought out the fact that 9 o f the 116 mothers receiving
care had urinalysis only, and did not see a physician personally. O f
the 107 mothers reporting visits to or from a physician, 53 reported a
single visit. Less than one-third o f the 116 mothers had one or more
urinalyses made during pregnancy, and 92 per cent o f these mothers
were white. It is interesting to consider some o f the few cases in
which the need o f such care was realized. One mother had learned
through reading and through consultation with a trained nurse that
monthly urinalysis should be made, and accordingly sent specimens to
her physician during the last five months o f pregnancy, although she
did not see him personally. In another instance the grandmother
who came to stay with the mother insisted upon urinalysis because
she had heard that serious complications might result from kidney
trouble. One mother during pregnancy had convulsions which her
physician said were caused by kidney trouble and necessitated regular
urinalysis, but she insisted that they were caused by a sunstroke she
had had as a girl, and refused to send specimens after the second
time. Her attitude is typical o f a large proportion of mothers
visited. In one case a mother who had had alarming symptoms dur­
ing pregnancy had been told by her physician to send specimens o f
urine for examination, but her husband, more through ignorance
than ill nature, refused to act as messenger.
Only four o f the mid wives reported it as their custom to see the
mother during pregnancy; six said they might make some examina­
tion if they happened to see the mother before confinement. There
were often chance meetings, o f course, during which the mother
casually sought advice; some mothers consulted the midwife when
they came to engage her, and some called her in when they were not
feeling as well as they thought they should; but for the great ma­
jority o f confinement cases the midwife was summoned only after
labor had begun.
Use of home remedies during pregnancy.— Aside from the advice
which can properly be classed as prenatal care, some mothers learned
something about prenatal care through reading or took medicine
not prescribed by a doctor. Two were instructed by a trained nurse.
A few consulted midwives, but in the majority o f cases the advice
given could not be considered any better than that which might have
been given by any experienced neighbor. Advice was also picked up
48532°— 21-------4
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from various other sources. One mother used liniment purchased «
from an agent who was canvassing the county; while another said
she had written to a firm in a northern city for medicine. More
than one-half (most of them Negroes) o f those who used home
remedies said that they took some kind of patent medicine. One
mother said she had taken six bottles o f a patent medicine during
her last pregnancy, and another said that she had taken “ more patent
medicines than she could mention ” during the 10 years she had been
“ complaining.” Simple home remedies, such as castor oil, magnesia,
calomel, kerosene, and camphor, were also used, and several Nep?o
mothers said they took teas o f various kinds, such as “ tansy tea” or
“ pepper tea.”
Information through reading.—Thirty-two white mothers and 14colored had read something about the care needed by a pregnant
woman. It can not be supposed, however, that the literature read
was really instructive in every case, for almost none o f the books
mentioned were standard. Several were general “ doctor books,”
which dealt with many subjects besides childbirth; others were
pamphlets or almanacs* published as advertisements; while many
others were advertisements designed primarily to promote the sale
o f patent medicines. More than one-half o f the Negro mothers who
said they had received some instruction through reading had only
read advertisements o f this kind. Probably only the 19 mothers who
read the current women’s magazines and farm papers received on
the whole up-to-date and authoritative instruction.

Kind of attendant.— Only two-fifths o f all the mothers studied
were attended by a physician at confinement, while nearly thr^e-fifths
were attended by midwives. The remainder, only per cent, were at­
tended either by their husbands or by other women who were not
midwives. One mother had no attendant at all. In a few instances
some attempt was made to secure a physician, but the call did not
reach him on account of interrupted telephone service or bad roads.
In several of these latter cases the mother was attended by a wholly
inexperienced person or by a Negro midwife. One mother told of
being alone with her sister and husband when the baby was born.
Her husband,' realizing that the baby would be born bef ore the doctor
could possibly arrive, called in his wife’s sister. She knew nothing
about confinement cases, but “ risked cutting the cord.” Others told
o f very similar experiences.
Federal Reserve Bank of St. Louis



Number and per cent distribution o f scheduled' mothers o f specified race ac­
cording to attendant at confinement.

R a c e o f m oth er.
T o ta l m oth ers.
- W h ite .

A tte n d a n t a t con fin em e n t.
P er ce n t
N u m b er. d istrib u ­
tio n .

N egro.

P er cen t
N u m b er. d istrib u ­
tio n .

P er cen t
N u m b e r. d istrib u ­
tion .

T o t a l co n fin e m e n ts ..............







P h y s ic ia n .........................
M id w ife ............
O ther w o m a n ............
F a th e r .......................
N o n e ..............





' 334


The choice between physician and widwife seemed to depend in
some degree upon custom. Seventy-nine per cent o f the white women
were attended by physicians, while nearly 88 per cent o f the colored
mothers were attended by midwives. One instance was found o f
a hi egro family who lived in town only a few blocks from a physi­
cian, but sent 3 miles into the country for a colored midwife. The
proportion o f native white mothers attended by a physician at
confinement was the highest that had been found in any rural district
studied by the Children’s Bureau except the one surveyed in Kansas.
However, it was lower than any o f the cities studied by the bureau.
A physician had been in attendance at every confinement for about
two-thirds o f the white mothers, but for only 3 per cent o f thè Negro
mothers. Moreover, 11 o f the 13 Negro mothers had had but one
confinement. The custom among the Negroes seemed to be to call a
physician only when some complication arose which the midwife
could not handle. There were, however, 23 white mothers who had
never had a doctor at confinement, and 14 o f these had had three or
more pregnancies. O f the total confinements to all mothers (3,017),
64 per cent were attended by midwifes or other women and 35 per
cent by physicians. O f the remaining 1 per cent o f the confinements
reported, 16 were attended by the father and for 11 there was no
The difference in the choice o f attendant might have been *due
partly to the difference in economic well-being between the white
and colored families. On the whole, the Negro families were much
poorer than the white, and since the midwife’s fee was so much
lower than a physician’s the choice o f attendant was in many cases
conditioned by the family’s ability to pay. The percentage o f
mothers, both white and colored, who were attended by a physician
Federal Reserve Bank of St. Louis



at confinement was much higher among those families living on
farms o f their own than among farm tenants, and was lowest among
the half-share tenants.
Distance from attendant.—Another factor that entered into the
choice of attendant at confinement was the distance the physician
had to travel to reach the patient. Sixty-six white families were
living 7 miles or more from a doctor, and on the other hand 155 white
families, more than half, were less than 5 miles from a doctor. For
white families the proportion o f mothers attended by physicians was
lower for those living 7 miles or more from a doctor than for those
living nearer, and the proportion o f cases attended by midwives was
higher. In this connection, however, transportation facilities and
the condition o f the roads must be taken into account. A ll mothers,
both white and colored, who lived in the more remote parts o f the
county ran greater risks at confinement than those in or near towns,
because o f the time and difficulty usually involved in getting a physi­
cian in an emergency, but under favorable conditions it was usually
possible even fo r families living far from town to get a physician in
time. There were, however, instances o f unfortunate coinbinations
o f circumstances which prevented the mother from securing a physi­
cian for confinement. One mother told o f difficulty at confinement be­
cause the first physician they called was ill and the next one was away
on another case, so that she was alone with her husband and a neigh­
bor when the baby was born. Another mother told o f failure to get
a physician because a man had taken down some of the telephone wire
to repair his wagon. Still another had a. baby born in January when
a severe storm was raging. The telephone was out o f order and her
husband had to go through the storm to use a neighbor’s telephone.
He succeeded in reaching the doctor, but the latter was delayed by
having to heat water in order to start his car, and when he finally
reached his patient the baby had been born two hours. By that time
the grandmother had cut the cord and rendered the other necessary
There were many midwives scattered through the different sections
of the county and probably no family lived more than 2 or 3 miles
from one.

Medical care— Only one-third of the 266 mothers who were'at­
tended by a physician at confinement reported any: after care by a
physician; 46 received but one visit, 25 received three or more, and
only five reported more than six visits. O f the 25 confinements for
which the physician made three or more visits, 14 were cases in which
either the mother or the baby was in a serious condition after delivery.
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In 6 o f the 11 remaining cases the family was living less than a mile
from the attending physician, and in 3 other cases the mothers were
the wives o f prosperous farmers.
Nursing care.— One of the most serious obstacles to good maternity
care was the scarcity o f nursing care. There was no trained nurse
working regularly in the area, and most o f the practical nurses were
midwives whose practice was largely among Negro mothers. Very
few o f them were really competent. Only 7 mothers o f the 675
secured trained nurses, and less than one-fourth reported care by a
practical nurse or midwife. It was also very hard to find anyone
who could be hired to do the housework during the mother’s lying-in
period, and in the majority o f cases the person who nursed the
mother had most o f the responsibility for the housework, too. This
scarcity o f help many times resulted in poor care for the mother
and made her feel that she ought to get up at the first possible
moment-. One mother who had stayed in bed only a week explained
that it was her custom to stay longer but that this time she could
get no nurse; she was worried because the baby was not doing as
well as he should, and she felt that she must get up to attend to
him. Another said she had been unable to get either a trained or
a practical nurse, even though all her children had whooping cough
when she was confined. She finally secured a colored woman to
care for her and do the housework. In another family the father
nursed the mother while the older daughters, girls o f 12 and 16, did
all the housework and washihg. One woman told o f a miscarriage
brought on by'overwork in nursing her husband and her father at a
time when no woman could be found to help with either the nursing
or the housework.
Less than one-fourth of the midwives interviewed reported that
they stayed in the mother’s home a day or more after delivery; most
o f them stayed only a few hours. The majority o f midwives went
to see the mother afterwards from one to five times, but most o f the
care given during the lying-in period was for the baby rather than
for the mother.
In about 1 case in 7 most o f the nursing was done by the father.
In about 1 case in 5 the nurse did not stay with the mother con­
stantly, but came in for a few hours during the day. This practice
was most common among the midwives, but there were other cases
in which the mother depended upon daily visits from some neighbor
for nursing care. In most cases such care was gratuitous—a neigh­
borly service to be repaid only in kind. One mother said that her
mother came in several times a day, but that it was a busy time on
the farm and she was left alone much o f the day with only the
children to wait on her. Another said she secured a colored woman
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to come and stay with, her, and one o f the neighbors to come in for
an hour or so every day to bathe her and the baby.
In 72 cases the nurse left before the mother was able to be up,
and in only 17 cases did the nurse stay until after the mother was
able to be up for most o f the day. In nearly two-fifths o f all cases
no extra person was called in, but the mother was cared for by
some member o f the household. Only about 21 per cent of the
mothers had paid nursing care, and only 13 per cent paid for all
nursing care received.
The quality o f nursing care was on the whole much poorer for
Negro mothers than for white. None had a trained nurse. Less
than one-third had nursing care by a midwife or practical nurse,
and one-third o f these mothers had practical nurses who made only
a few visits and did not stay in the mother’s home. The percentage
o f mothers nursed only by their husbands was larger among Negro
than among white families. Four had only such care as could be
given by a child under 14 years o f age— in one instance a little girl
5 years old. Tw o Negro mothers had no nursing care at all. Need­
less to say, these mothers got up as soon as possible after confinement.
Days in bed.—As a result o f the scarcity o f nurses, the pressure o f
work, and the inadequate supervision by physicians and midwives,
many mothers did not have the rest in bed after delivery that is
considered essential. O f the white mothers visited, there were 20,
or 7 per cent, who stayed in bed less than a\ week, and nearly 60 per
cent who stayed in bed 10 days or more. O f the Negro mothers, 150,
or 39 per cent, stayed in bed less than a week, and 30 per cent 10
days or more. One Negro mother explained rather apologetically
that she had stayed in bed for a week after the last baby was born,
because the weather was so cold. Ordinarily she stayed only three
days. In spite o f the custom among many of the Negro mothers of
staying in bed only a few days, some still held to the tradition that
the mother should “ stay in her month.” One said that she had been
told by the midwife who attended her-first confinement to stay in
bed for a month, and she had followed this advice at each o f her
four subsequent confinements.
The season o f the year in which the confinement occurred deter­
mined to some extent the length of time which the mother spent in
bed. One Negro mother explained that she stayed in bed for only
four days with a “ summer-time baby,” but with one born at any
other time o f the year she stayed in bed longer. During the busy
spring and fall seasons the mother was likely to feel that she ought
to help if she possibly could, and even if she did not go into the
fields for work herself she might try to release for field work those
who were helping with the nursing and housework.
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The •costs of confinement tabulated for this study include the
attendant’s fee, the cost o f prenatal care, the cost o f hospital care,
and the combined cost o f nursing care and help with the housework;
expenses for medicine and for extra supplies or transportation are not
Total costs and free service.— O f the white mothers who reported
the cost o f confinement, 62 per cent gave totals ranging from $10 to
$25, and 16 per cent reported an expense of $25 or over. O f the
colored mothers who gave information on this point, 65 per cent
reported a total cost o f less than $5 and 25 per cent a cost o f less
than $2.50. These costs average lower than those found in any
other rural district surveyed. In Kansas 54 per cent reported an
expense o f $25 or over for confinement, while in Montana physicians’
fees alone were usually over $25 for confinement, prenatal care,
and postnatal care. Forty-six mothers, 16 white and 30 colored,
reported no money whatever paid out for the services specified.
Analysis o f cost by different items of expense shows that most
mothers received free service o f some kind. Forty received free
care from the attendant midwife, and 4 paid nothing to the attend­
ant physician. In 488 cases (three-fourths o f the total reporting)
there was nothing paid out for either nursing or housework. In
such cases by far the largest item o f expense was that for the
attendant at confinement. Other costs rarely equaled or exceeded
the attendant’s fee, and in a great many instances it was the only
expense incurred.
Costs itemized.— It was customary for the physician to charge a
fee for confinement and, in addition, regular fees for each pre­
natal or postnatal visit, rather than a lump sum to cover all care
during pregnancy and confinement. The physician’s usual fee for a
normal delivery was $10 or $15. O f those who reported the phy­
sician’s charge for confinement alone, 193 (87 per cent) paid from
$10 to $25, and only 16 paid over $25. The expense averaged higher
i f prenatal care had been given.' Five o f the nine mothers who re­
ceived fair prenatal care (see p- 24) paid a physician $25 or more.
About 1 in T o f the mothers reporting inadequate care paid over $25.
F or the confinement fee alone only about 1 mother in 14 o f those
who reported paid $25 or over. None o f the mothers who paid the
attendant physician less than $10 received any postnatal care; ap­
proximately 28 per cent*of those who paid $10 to $25 received post­
natal care; and 10 of the 16 mothers who paid over $25 received
postnatal care. The distance which the physician had to travel
seemed to be a factor of no importance in the expense. Distances
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were small compared to those found in Montana,3 where the phy­
sician’s fee for mileage was sometimes greater than his fee for
service. No instance was discovered in this study o f a physician’s
making a charge for transportation or mileage.
Approximately two-thirds o f those reporting payment to a mid% wife paid her less than $5 and in only 3 instances was the charge
over $10. It is natural, therefore, that the poorer and the more
ignorant families should employ the midwife rather than the
physician whose fees were higher. One Negro mother stated frankly
that she had tried both and preferred the midwife because she did
more and charged less. The midwife’s fees varied somewhat ac­
cording to the difficulty o f the case, the distance from the patient,
and the ability o f the family to pay. One midwife said she charged
more for boys than for girls because wboys are harder to handle and
mothers want them more.”
In many cases there were informal arrangements such as exchange
o f services, and payments in chickens, pigs, grain, and other prod­
uce instead o f money payments. One mother said she gave the
midwife a bottle o f snuff (valued at 25 cents) for confinement care,
including nursing and help with the housework. About one-half o f
the white mothers and almost 95 per cent o f the colored who reported
on costs o f confinement said that they went to no expense for nursing
and housework; some o f these may be included in the 71 who paid
the midwife a lump sum for confinement and nursing, or in the 34
who paid her a lump sum for confinement, nursing, and housework.
Many families settled the debt on a neighborly give-and-take basis
which involved no money payment. One father worked his sister’s
crops a few days to pay her for helping his wife at confinement;
another gave his w ife’s sister a bottle of snuff in return for her serv­
ices. Negro help was often paid in left-overs from the table, milk,
or second-hand clothing. Rates per week for nursing and house­
work varied from 50 cents to $5 or (in a few cases) more. The usual
prices were $1.50, $2, or $2.50 a week. Nearly one-half the 136
white mothers who stated a definite charge for nursing and house­
work reported less than $5, 26 reported costs o f $10 to $25, and six
reported costs o f over $25 for these services. O f the 20 colored
mothers who paid for nursing and housework, 9 paid less than $2.50
and only 5 paid $5 or more.
Cost of confinement and economic status of family.— The percent­
age o f white families who reported a total confinement cost o f $25 or
more was higher among farm owners than among farm tenants, and
higher among owners o f the 100 to 500 acre plantations than among
the farm owners as a whole. More than one-third o f the white half3 U. S. Children’s Bureau Publication No. 34, Maternity Care and the Welfare of Young
Children in a Homesteading County in Montana, pp. 49, 50.
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share tenants reported charges o f less than $10, while about one-fifth
o f all white families reported charges o f less than $10. The percent­
age o f those receiving free care was much higher among half-share
tenants than among any other economic group. In general the
mothers o f the well-to-do white families got better care than the
mothers in the poorer families because they were better able to pay
for it. The doctor’s bill was a big item to the poorer tenant, and
in many cases ignorance and poverty combined to make him feel
that a physician’s services during pregnancy, and at confinement were
an unjustifiable expense to be incurred only in cases o f unusual
One/Negro mother had been miserable throughout her pregnancy;
she could scarcely walk, her feet were swollen, and she had to
kneel in order to hoe. She seemed pitifully eager for relief, but
said she could not afford to have a physician. “ I f I had a doc­
tor, then when winter came there would be nothing for clothes.
P oor families can’t have such things as doctors.” This mother had
been hurt by a falling tree two months before the interview, but
was still doing her house and field work, although unable to walk
without the help of two homemade crutches.
Share tenants usually depended upon the landlord to advance
credit for the doctor’s bill and to deduct it, with interest, from the
crops sold at harvest time.

Maternal deaths in the county.— Three mothers of the 675 for
whom information was secured for this study lost their lives in
childbirth, two from puerperal septicemia and one from hemorrhage
following confinement. The care received by the three mothers who
died was, on the whole, no better and no worse than that received by
most o f the mothers visited whose confinements did not terminate
fatally. None o f the three mothers had received any prenatal care.
A ll did their washing, housework, and other chores up to the time
o f confinement and none had trained or even partly trained nursing
care. Only one was attended by a physician at confinement, and in this
case the mother died o f hemorrhage which began after the attending
physician, the only doctor within a radius of 8 or 9 miles, had hur­
ried away on another call. One of the other mothers was attended by
a neighbor because the physician who was sent for had to come 5
miles over rough roads and was an hour late; she died o f puerperal
septicemia about four weeks later. The other case was that of a
Negro mother whose baby was bom while the father was on his way
for the midwife. She did not arrive until two hours later, when she
found the mother and baby shivering on the floor. The mother died a
few days later.
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By the death o f these three mothers 13 children were left mother­
less. Eleven were white and 2 were colored, and 10 o f them were
under 7 years o f age.
Deaths from causes other than childbirth.— Eleven mothers
who had been confined during the period covered by the survey died
from causes other than childbirth before the date of the inquiry, 10
of them within eight months after confinement. In nine o f these
cases pregnancy and childbirth may be considered a contributing
factor in hastening death. Five died from tuberculosis, all of them
colored women. One mother, also colored, died o f pellagra, the
mortality from which is relatively high among women o f childbearing age.4 The death of one white mother four days after the
delivery o f a stillborn child was ascribed to pernicious malaria. Two
mothers, one white and one colored, died from nephritis, one about
two months after the baby was born, the other about four months
after. Two o f these mothers had prenatal care o f “ inadequate ”
grade (see p. 24) ; the others had none at all. Four were attended
at confinement by physicians, 5 by midwives. The deaths o f these
women left 40 children motherless.
O f the last babies o f these mothers, 1 was stillborn, and 4 o f the
8 live-born babies died under 4 months o f age. One died o f an
intestinal disturbance two weeks after the mother’s death. Another
died while his mother was on a journey to see a doctor 30 miles away.
One baby whose mother was too ill to nurse him “ just got peakeder
and peakeder and finally was nothing but skin and bone.” The
fourth death was that of a tuberculous mother who had been unable
to nurse the baby.
4 Report of the Board of Health of Mississippi, 1915—1917, p. 344, Jackson, Miss.,
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Farm work.— Most of the mothers had been reared in the country
and were used to doing farm chores and field work as well as house­
work. Women reported doing almost every kind of field work which
was to be done— plowing, harrowing, hoeing, chopping, and cotton
picking. About 85 per cent o f the white 'mothers reported that their
principal occupation before marriage had been farm work o f some
kind, and about 70 per cent had done field work; 8 per cent had been
teachers, and a few had been employed in stores, cotton mills, or
offices. Nearly all the colored mothers had done field work before
marriage; a few had worked as domestic servants. About fiveeighths of the mothers did field work during the period covered by
the survey, and practically all of these), had done farm work o f some
kind before marriage. Somewhat more than one-fourth o f the
mothers who, as girls, had worked in the fields were relieved o f field
work during the period studied, this being due in some instances to
poor health, in others to pressure o f household work, or to highetr in­
come which made it unnecessary for the mother to work in the fields.
One father said he had taken work as a farm laborer rather than
as a tenant so that his wife would not have to work in the fields.
The importance of the different kinds o f chores as indicated by
the number o f mothers reporting them was as follow s: (1) Care o f
chickens, (2) care o f garden, (3) carrying water, (4 ) churning, (5)
milking, (6) care o f stock, and (7) running the cream separator.
Only one-tenth o f those who reported doing chores were doing less
than three o f those listed above, and more than one-half were doing
five or more. On the whole, the Negro mothers had fewer chores
to do than the white mothers, probably because a smaller proportion
o f the Negro families kept cows, pigs, or chickens. It was customary
in most families for the women to take care of the chickens, and
for the men to attend to feeding the cattle and work animals. Most
o f the mothers who reported care of stock took care of the pigs only.
About 79 per cent o f the white mothers carried water for house­
hold use; for nearly one-half o f these women the source o f water
supply was less than 25 feet from the house, but for more than one*fourth it was 300 feet or more from the house. About 54 per cent
had a pulley or windlass to draw up the water bucket; about 40 per
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cent had to dip water from the spring or pull it up from the well
by hand; only 6 o f the 222, the total number reporting, had a pump.
Eighty-five per cent o f the Negro mothers reported carrying water
as a regular chore. The distance averaged a little higher than those
reported by the white mothers, as more than two-thirds carried water'
25 feet or more, for two-fifths the source o f water supply was 300
feet or more from the house, and about 1 in 8 had to carry water a
quarter o f a mile. The proportion (49 per cent) o f mothers reporting
no equipment for drawing water was higher among the Negroes.
Household conveniences1 and household help.— Housekeeping in
most homes was rather primitive. Some o f the houses were very
barely furnished, with two or three splint-bottomed chairs,, a bed, a
bench, and a rough-board table. Some mothers did most o f the
cooking at an open fireplace. O f the white mothers, only 15 per cent
had more than two household conveniences, and 20 per cent had none
at all; o f the colored mothers, none had more than two, and 56 per
cent had none at all. The abundance o f cheap colored labor had
induced many white families to hire cheap hand labor rather than to
purchase labor-saving devices.
Sewing machines were the only modern convenience in general
use, yet only 75 per cent o f the white mothers and 42 per cent of
the colored mothers had them. Eight white mothers had water in
the house, and 2 o f these had a bath and sink also; 14 mothers had
washing machines and 13 had .refrigerators. Many said that they
kept food cool by letting it down in the well, putting it in the spring,
or in a tub o f cold water. Kerosene lamps were used for lighting in
all the homes visited. Eighty-six families had telephones and 14
had automobiles. In only 77 homes were there screens at all. the
doors and windows. While screening is primarily . a health pre­
caution, it also saved the mother much annoyance from chickens, pigs,
dogs, and cats, which otherwise came in at will. It was not unusual
for the agent’s interview with the mother to be interrupted while the
pig was pushed out o f the door or the chickens “ shooed ” away from
the table.
Forty-three per cent o f all mothers reported that they had some
help with the housework all the year round (as distinguished from
help during pregnancy and confinement). Three-fourths o f these
mothers received help from some other member o f the household— a
mother, sister, or grown daughter, who was living with the family.
1 Conveniences tabulated were as follows: Water in house, bath, sink, washing ma­
chine, sewing machine, refrigerator or ice box, iceless refrigerator, fireless cooker, bread
mixer,, vacuum cleaner, oil stove, furnace, gas or electric lights, engine for household use,
telephone, screens for all doors and windows, and automobile. While an automobile is.
not strictly a household convenience, it was so classed because it made it so much easier
for the mother to,get to market, to see her neighbors, and to reach help in time of
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Such arrangements were seldom made on a money basis, and were
usually independent of the economic status o f the family. O f the
123 white mothers who usually had help with the housework, nearly
half had hired help. While the proportion o f Negro mothers who
usually had some help with the housework was slightly higher than
among white mothers, none o f them hired such help.
For many families the only housework for which outside help was
hired was laundry work. About 88 per cent o f all mothers reported
that they did their own washing. The washing was usually done
out o f doors near the well or spring; the water was heated in a large
iron kettle over the outdoor fire and the clothes were boiled over this
Under the system o f tenant labor on the large plantations the
planter’s wife was not responsible for boarding or housing the field
hands. The tenant farmers and most o f the farm laborers lived in
houses by themselves and boarded themselves. Hired men who lived
with their employer’s family on a basis o f social equality were prac­
tically unknown, since the great bulk o f hired labor was Negro.
Even the domestic servants usually lived in separate houses with
their own families.

The health o f the mother and baby may be impaired by excessive
work during pregnancy or too soon after confinement. Ordinary
housework and the lighter farm chores are a very good form of exer­
cise i f they are not carried to the point o f fatigue, do not involve
heavy lifting or straining, and are not resumed too soon after de­
livery. It is important, therefore, to know what period o f rest
the mother had before delivery and how soon after confinement
she had to resume full responsibility of her usual work. The time
which these mothers actually spent in bed has already been dis­
cussed (see p., 30).
Mothers who could not afford to hire help and were unable to make
other arrangements could not secure the desirable period o f rest
before and after the baby’s birth. Pressure o f work in the busy
eotton-picking season, when all hands are in the fields, often made it
hard for the mother to get help.
Emergencies similar to the following were not unknown: A mother
confined in January said that during the latter part o f her pregnancy
her husband was taken ill, and the family was obliged to move to
make room for other tenants. The mother had to assume the whole
burden o f moving and settling in the new home. She cut enough
wood to last throughout the period of her confinement, and when
labor pains began she was building a hogpen.
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A few o f the white mothers left home for confinement, in most
cases to stay with relatives, where facilities for maternity care d if­
fered little from those in their own homes, but where they could
secure a more complete relief from responsibility for the housework
during the period o f confinement.
Kind of household help secured.—Many o f the mothers reported
that it was difficult to get reliable persons to help with the housework
while they were incapacitated. Only 28 per cent o f the white
mothers and 5 per cent o f the colored reported hired help for house­
work. Over 35 per cent o f all mothers reported free help given by
an outsider. Neighbors were usually ready to come in to help when
they were needed. One mother said that she and her sister who
lived near had agreed that when either was pregnant the other would
do the washing for both families. While there were no mothers
who reported no help at all with the housework, five o f the white
and nine o f the colored mothers said that the only help they had
was from a child less than 14 years old. Such help relieved the
mother o f the actual work, but it did not relieve her o f the respon­
sibility. In 9 per cent o f the white families and 14 per cent of the
Negro families, the housework was done by the husband or son; 21
per cent o f the white mothers and 41 per cent o f the Negro mothers
reported help given by some other adult member o f the household.
Relief from work before confinement.— O f the white mothers less
than one-fifth reported any relief from housework before confine­
ment and less than one-tenth reported a relief o f one month or m ore;
about 96 per cent did some farm chores during pregnancy and 80
per cent reported no cessation before delivery. I f the mother’s
work was lightened at all during the latter part o f pregnancy it
was likely to be done by relief from washing or field work. About
76 per cent o f the white mothers did the washing during pregnancy,
and 29 per cent o f these stopped one month or more before the baby
was born. Eighty-four white mothers, less than 30 per cent, re­
ported field work during pregnancy; 39 o f these had a rest o f three
months or more before confinement; 4 had from a week’s to a
month’s rest; and 18 worked in the field up to the day o f confinement.
Cessation o f work before delivery was. even less common among the
Negro mothers. Approximately 93 per cent reported that they did
their usual housework up to the time labor began; 89 per cent had
no relief from farm chores; 79 per cent had none from washing, and
nearly 40 per cent did field work up to the time o f confinement. One
o f the Negro mothers who was confined in the cotton-picking season
said she worked in a field 2 miles from home during the last day of
her pregnancy; she “ just did make it hom e” that night, but was
unable to get supper for the family. O f the 320 Negro mothers who
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did field work during pregnancy, only 70 stopped one to three months
before confinement, and only 79 three months or more.
Approximately 75 per cent of the white and 94 per cent o f the
colored mothers did housework, washing, and chores during preg­
nancy, and o f these 62 per cent o f the white and 79 per cent o f the
colored reported no cessation o f any o f the three kinds o f work
before confinement. Twenty-nine per cent o f the white and 81
per cent o f the colored mothers did field work in addition to their
housework, washing, and ehores, and o f these mothers 20 per cent o f
the white and 42 per cent o f the colored reported no cessation before
confinement. The one mother who had no one to attend her at
delivery hoed corn the whole day before confinement. She came
home a little early and the baby was born. Her husband was still in
the field and she could not get word to him.
Approximately 75 per cent o f the white mothers reported cessa­
tion o f some kind o f work (housework, washing, chores, or field
work) a month or more before confinement, and nearly 50 per cent
a cessation o f three months or more. Among Negro mothers nearly
50 per cent reported relief from at least one kind o f work a month
or more before confinement, and 27 per cent a relief o f three months
or more.
Resumption of work after confinement.—Among white mothers,
83 per cent reported that they resumed their usual housework less
than six weeks after confinement; 19 per cent resumed it less than
two weeks after. Only about 1 in 7 had a relief from housework of
six weeks or more after confinement. One mother said that although
she always had a hard time at confinement, she had to be up and
doing all her housework within a week afterwards. Another mother
who had a difficult delivery had been obliged to get up to look after
the other children when the baby was 1 week old. The weather was
very cold, but the family had to move when the baby was 3 weeks old
because someone else was taking possession. About 75 per cent o f
the white mothers began to do chores less than six weeks after con­
finement, and nearly one-half o f these began at less than four weeks.
Nearly 40 per cent began to do their washing within the first six
weeks; about 32 per cent o f the 145 white mothers confined in the
first year of the period did not do their washing in the year after
the baby was born. Only seven o f the white mothers worked in the
field during the first six weeks after confinement. Slightly over
one-fifth did field work in the year after confinement.
The proportion of mothers who resumed housework and chores
in the first six we'eks after confinement was approximately the same
for white and Negro. Sixty-two per cent o f the colored mothers be­
gan to do their washing less than six weeks after confinement, and
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14 per cent began less than four weeks after. Twenty-two per cent
did field work in the first six weeks after confinement. Following
the tradition expressed by one mother who said, “ I stayed out o f
the field my month,” all but six did no field work during the first
four weeks after confinement.
The mothers who had no rest from work before confinement were
also the ones who had to begin work soon after confinement. About
75 per cent o f the white and 80 per cent o f the Negro mothers re­
ported not only no relief from housework before confinement, but
also resumption at less than six weeks after. Thirty-six per cent of
the white mothers resumed their housework, washing, and chores less
than six weeks after the baby was born, and 2 per cent had also re­
sumed field work. Fifty-seven per cent o f the Negro mothers had
resumed housework, washing, and chores less than six weeks after
confinement; slightly over 10 per cent resumed it at less than four
weeks. In addition, field work had been resumed by 18 per cent o f
the Negro mothers at less than six weeks after the baby’s birth.
Many mothers gave accounts o f the ill effects o f heavy work. One
said she thought her baby had been born prematurely because o f the
heavy work she had been doing in the field in addition to her house­
work, washing, and chores. She stayed in bed 10 days after the baby
was born, and in three weeks began to work in the field again. She
endured the strain for a week, then had to give up, and was inca­
pacitated for a month.
Effect of farming season on mothers’ work.—In agricultural
communities the work in the house is intimately correlated with the
work in the fields, and pressure o f work in the busy farming season is
likely to mean additional work for the mother. Even if she does not
go into the fields to work herself, her husband and older children have
less time in which to help with the chores and housework. One
mother who was confined in the winter said that although she was up
in six days, she stayed in the warmest room most of the time for the
next two weeks, while her husband did the housework. Another
said that although she was feeling well, her husband did the work
for three weeks after the baby was bom , because he had no work to
do in the fields at the- time.
The climate was such that for only about two and one-half months
in the year was it impossible to work in the fields. The busiest sea­
sons were in May and June (hoeing time for cotton and corn), and
in October and November (picking time in the cotton fields). Each
season was likely to spread over two weeks before and after, and it
varied with the weather and the size of the crop. Accordingly, the
slack season may be considered as extending from the middle o f
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June to the middle o f September, and from the middle o f December
to the middle o f April.
In, the case o f white families the extent to which the mother might
be relieved o f overstrain during pregnancy and the weeks following
confinement usually depended on the financial ability of the family
to hire help, though in some instances economic conditions made no
difference one way or the other; because the mother had relatives
who came to help h er; or because she was wholly incapacitated and
had to be relieved whether she could afford it or n ot; or because at
the time no help could be secured. Very few Negro families could
afford to pay money to relieve the mother o f her usual duties during
pregnancy and after confinement.
The connection is more or less obvious between the various subjects
o f the study taken up thus far—maternity care, work of the mother,
housing and sanitation, and economic conditions— and the question of
the welfare o f the child. The lack o f specialists and hospital facili­
ties was as serious for the babies as for the mothers, and poorly built,
insanitary houses made living conditions dangerous for the one as well
as for the other. In this section of the report infant deaths and those
elements o f child care not already touched upon— feeding customs,
care o f sick children, home remedies used for children, etc.—will be

Complete birth registration is a prerequisite to any adequate study
o f infant mortality and child welfare. Since 1912, when the State
passed a law establishing a bureau of vital statistics under the State
board o f health, and providing for the registration o f births and
deaths, the board o f health had been working toward complete regis­
tration, but at the time o f this survey no part o f the State had been
admitted to the birth-registration area, and only the five largest cities
to the death registration area. Only 50 per cent o f the births in­
cluded in this study were registered. One of the'greatest obstacles
to good birth registration in the county was the difficulty o f getting
the midwives to register births. Many o f the colored midwives were
illiterate, and therefore had to get some one else to fill out the certifi­
cate or report by word o f mouth when they happened to go to town.
Often the names were written on old crumpled slips of paper and
were almost illegible. While the midwives were responsible for the
greater part o f the .unregistered births, only 76 per cent o f the births
attended by physicians were registered. Only 71 per cent o f the
infant deaths were registered.
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A general lack of knowledge of child care prevailed among the
mothers visited, as very few of them had received any instruction in
this matter beyond what they learned from their mothers or from
their own experience. Only 20 had received some instruction from a
physician and 2 had been advised by a trained nurse. Fifty-eight
had learned something o f infant care through reading, but the high
percentage o f illiteracy and low standards o f education prevailing
in the county made instruction through reading practically unattain­
able for a large proportion o f mothers in poor white as well as in
Negro families. The literature read, however, was not- really in­
structive in all cases, for while 2 had read books by Holt, 1 a bulletin
from the Department o f Agriculture, and 25 current magazines and
papers, the rest'had read only advertising pamphlets or almanacs or
“ doctor books ” o f one kind or another. Many mothers were very
glad to receive the Children’s Bureau pamphlet on Infant Care. *
The methods o f caring for children were in accordance with the
customs handed down by other generations. The midwife’s advice
was often sought, especially in regard to the care o f the baby during
the first few days of life, and the midwives were credited with being
responsible for encouraging dangerous methods of feeding and the
use of filthy and dangerous home remedies.

The almost universal custom o f breast feeding among the country
mothers in the county studied probably counteracted in many in­
stances methods o f feeding unwise in other respects. The tendency
o f the mothers was to nurse their babies not only through the first
year, but also through most o f the second year or even longer. A rti­
ficial feeding was haphazard and unscientific. In many cases it in­
cluded the whole range o f family diet— meat, corn bread, pie, etc.
Some mothers did not use cow’s milk because the “ bitter weed ” that
the cows ate made the milk bitter in taste, although not, so far as
could be learned, unwholesome.
Breast feeding.— The often-repeated criticism of the feeding cus­
toms o f rural mothers that they feed their babies from the table at
too early an age and delay weaning too long held true in the case o f
the mothers included in this study. Only 14 per cent o f all infants,
both white and colored, for whom information was secured, were
weaned before the middle o f the twelfth month; two-thirds were
nursed through the greater part o f the fifteenth month; nearly onehalf through the eighteenth month; and one-fourth through the
greater part o f the twenty-first month. Nine infants were nursed
through the greater part of the twenty-fourth month or longer.
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One instance was found at one o f the children’s health conferenceso f a child six years old who was still nursing.
The Negro mothers showed a tendency to wean their babies a
little earlier than the white mothers; by the middle of the eighteenth
month 63 per cent o f the Negro babies had been weaned as com­
pared with only 41 per cent of the white babies. O f the babies re­
ceiving exclusive breast feeding, the percentage was higher in each
month o f age for white than for colored babies; for babies receiving
some breast feeding, at the sixth month the percentage was slightly
higher for Negro than for white; and at 9 months the percentage
(92) was about the same for both races.
Solid food and family diet.— Artificial feeding may be necessary
in some cases at an early age, and, while not so good for the baby as
breast feeding, does not necessarily obviate the possibility of normal
development. Experts generally agree that fresh, clean, modified
cow’s milk is the best substitute for mother’s milk, and that no
solid food should be given during the first six months at least.
Only one-fourth o f the babies studied were receiving a strictly
liquid diet at 2 months. The solid food included bread or crackers
soaked in milk, gravy, or cereals, and did not necessarily include
the kind o f food eaten by the older members o f the family. H ow ­
ever, many mothers reported that the baby at an early age was
given “ tastes” o f everything that the mother ate. One mother
said with pride that her baby had eaten “ everything” since she
was 11 days old and had had all tjtie meat she wanted since 2 months
old. Another said there was nothing too hot with pepper or too
sour for her 14-months-old baby to eat. Eight per cent o f the
mothers reported that the baby had been given family diet when
less than 1 month old, 15 per cent at 2 months, and over half at
7 months. Only about 6 per cent were reported as 12 months or
more o f age before receiving family diet.
The tendency to give the baby solid food or family diet was more
pronounced among colored mothers than among white. At the
fourth month 60 per cent o f the colored babies were receiving solid
food as compared with slightly under 35 per cent o f the white
babies. Under the eighth month the percentage o f colored babies
receiving family diet was higher than that o f white babies receiving
solid food. A t the end of the twelfth month nearly 80 per cent
o f the colored babies were receiving family diet as compared with
about 60 per cent o f the white babies.

Medical care.— The accounts given by the mothers of their chil­
dren’s illnesses indicated the difficulties in caring for sick children
in these rural districts. Children’s specialists and hospitals were
Federal Reserve Bank of St. Louis



too far away and too expensive to be thought of by any but the
most prosperous parents, and many o f the poorer families living
in remote parts o f the county hesitated to call a doctor unless the
child seemed very seriously ill. As one mother said: “ A farmer only
gets money twice a year, and if the children get sick between
seasons they have to get along.”
One mother said that her baby began to have indigestion at two
months; he vomited frequently and had spasms. These symptoms
continued for over three months, but the doctor was called only
once. Another mother said that her baby had been ill for three
weeks with some trouble in the head; she bathed the baby’s head
with camphor and put sweet oil in her ears but did not call a
Only the two county seats had more than one physician, and
families out o f reach o f one or the other of these towns often had
to send 15 or 20 miles for the nearest physician available. Although
under ordinary circumstances a doctor could be secured in two or
three hours at most, there were, o f course, times when this was
not possible, and sometimes serious complications developed »so
rapidly in babies and young children that even a short delay proved
serious or even fatal. The baby o f a family living 4 miles from the
doctor in a house back in the woods, almost inaccessible from the
main road, became sick when 6 days old. The father consulted the
physician by telephone, and medicine was sent, but the baby died
the following day.
Nursing care.— Trained nurses were no more available for sick
children than they were for mothers at confinement, and, as in other
rural areas, home care was the rule when children were ill. Emer­
gencies frequently arose when there was really acute need for trained,
or even practical, nurses. One mother said that when the baby, was
born both the father and the other children had measles. It was an
unusually severe winter. No nurse could be found nor could they get
domestic help. A neighbor came in once a day for a little while, but
she was too busy with her own family cares to do much. The oldest
child died about a week after the baby’s birth. In another case, all
the members o f a family were ill at the time o f the mother’s con­
finement. The father, though convalescent, was not able to do much,
and as a last resort his brother came in and did the housework. In
another family the mother and four children were ill with malaria.
The father had to do the nursing and housework himself while he
hired cotton pickers to take his place in the fields, field laborers
being much easier to find than nurses and housekeepers.
Situations similar to these described were likely to be brought
about whenever the mother was incapacitated. Many mothers had
no one who could take their place as nurse, because relatives and
Federal Reserve Bank of St. Louis



neighbors were entirely occupied with their own family affairs,
and furthermore many o f the women, although willing to do their
utmost, lacked skill and experience in the proper care o f children
seriously ill.
Deformities.— Several children needed special attention on ac­
count o f some deformity. One white baby had deformed feet. The
father had given up his farm and secured work with the railroad in
order that he might earn money and perhaps secure a railroad pass
to take the child to a specialist and have the deformity corrected.
A mother was most anxious to know what ought to be done for her
year-old baby who had a deformed hand and wrist. She brought
the child to one o f the children’s health conferences, and the Gov­
ernment physician said that some manipulation and massage would
do a great deal o f good, but unfortunately there was no one in the
county who could do it. One baby had club feet and his father, a
Negro farm hand earning $19.50 a month, had never taken him to a
physician. Another Negro boy about 6 years old had a stiff knee
and back so that' he could not stand upright and could scarcely walk.
His mother said that his condition was caused by paralysis from
which he suffered while teething. The family owned a small farm
on the river bottom, but had never considered it possible to take the
boy to Memphis or Jackson. In several other cases similar to these
the need for special medical attention seemed imperative if the
children were to have a fair chance in life. A public health nurse
could do much toward teaching parents that it is possible to have
deformities corrected and toward making the necessary arrangements
with specialists and hospitals.
Accidents.— Children everywhere are liable to injury from acci­
dents o f one kind or another. But in Mississippi accidents occur­
ring'while the parents are absent in the fields are far too common.
The secretary o f the board of health, in commenting on the large
number o f deaths from burning, said: “ This carelessness which
resulted in the death and suffering o f so many- children for the last
two years * * * should be given thorough study' and means
provided, if possible, to reduce this unnecessary mortalityl” 2 As
the open fireplace was used for cooking in many o f the cabins, the
danger from fire was serious at all times o f the year. It was not
uncommon to find a little baby left alone in its; crib while its mother
was off in the fields at work. One colored mother told o f the death
o f her oldest son from burns. She had no one to leave him with while
she went out in the field to plant potatoes. Presently she heard him
scream, and rushed back to find his clothing all afire. In one family
visited, the baby had no toes on the right foot. The mother ex2 Report of the Board of Health of Mississippi, 19151-1917, p. 107.
Federal Reserve Bank of St. Louis

Jackson, Miss., 1918.



plained that she had left the baby on the floor while she went o u t,
for a little while, and that when she came back she found that the
baby, then 6 months old, had crawled to the fireplace and one little
foot was in the coals.
The custom o f leaving infants in the care o f older children too
young to accompany their mothers to the field is bound to lead to
serious results. During the hoeing season the Children’s Bureau
agents often found no one at home but a little 6 or 7 year old child in
charge-of one or two'younger children. Sometimes he could point
in the'direction in which his mother had gone, sometimes he did not
seem to know where she was. One mother left the baby with the
older children while she went to work. The baby’s dress caught
fire and he was badly burned. Accidents o f other kinds occurred
while older brothers or sisters were tending the baby. One baby
had been sick since the older children in their play let him fall out
o f bed while the mother was working in the field. Another mother
said her baby had been very sick when 12 months old. She thought
“ the children might a’ dropped the baby” while she was in the
field. Such accidents as these described were more common among
Negro babies because the Negro mothers did more field work than
the white mothers. Some mothers tried to solve the problem by
taking the babies with them to the field, but with no shelter from the
hot sun this arrangement did not seem very satisfactory.
Illnesses*—The accounts of children’s diseases given by the mothers
did not differ very much from those given by mothers in other parts
o f the country. Colds, indigestion, and colic were mentioned fre­
quently. In the winter previous to the survey there had been mild
epidemics o f measles and whooping Cough with no effective quaran­
tine regulations. The children were, o f course, liable to the diseases
peculiar to the South—malaria, hookworm, and pellagra. * One
physician said he had noticed a decided tendency among mothers to
attribute almost any illness which children had to “ worm s” and to
persist in the belief contrary to the doctor’s diagnosis. Several
mothers said that their children had had worms and that they had
used various home remedies, turpentine, soot tea, castor oil, etc.
Home remedies for children.—The great extent to which the
mothers in the area “ doctored ” their children presented one o f the
most serious phases of child care. Home remedies have a legitimate
place in every household, but stories told by many o f the mothers
indicated a widespread tendency toward overdosing and unwise se­
lection o f drugs for the home medicine chest. Patent medicines were
in common use, particularly among white mothers. ^The colored
mothers made frequent use o f teas o f one kind or another. More
or less superstition was evident in the remedies recommended by
colored mothers. The midwife instead of the doctor was frequently
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„summoned in case of illness, and she was often responsible for the
extravagant use o f home remedies.

' B i any locality where the birth and death registration is as incom-N
plete as in the rural areas surveyed by the Children’s Bureau, it is
impossible to discover all births during a given period even by a
house-to-house canvass. The number o f omissions is probably pro­
portionately greater for stillborn infants and babies who died early
in the period included in the canvass than for the others. The re­
turns are especially likely to be incomplete in districts similar to the
county studied in Mississippi where many families live on farms re­
mote from the traveled roads, and a large part o f the population is
shifting and illiterate. As a consequence, infant mortality rates for
the area studied, while as accurate as any that could be secured, are
somewhat lower than they would be if returns for deaths had been
as complete as for births. On the other hand, figures based not on a
canvass but on birth and death registration alone are likely to exag­
gerate death rates since death registration is usually more complete
than birth registration.O f 155 white children born alive to the mothers interviewed, 12
died in the first year o f life. This number includes only children
bom between A pril 1, 1916, and March 81, 1917, the first, year o f the
period covered by the study, since most of the children born later
than that were less than 1 year old at the time the information was
secured. The infant mortality rate for these white children was 77.4,4
a rate lower than was discovered in any o f the cities surveyed, but
high as compared with rates for other ‘rural districfs studied. The
rate found in Kansas was 40 to 1,000 live births; 5 the rate among
white infants in the lowland county o f North Carolina was 48.1;6
in the mountain county o f North Carolina the rate was 80.4;6 the rate
in Wisconsin was 54.7 The rate in Montana (although based upon,
an incomplete record o f deaths) was 71 per 1,000.8
3 Detailed information, in regard to maternal and infant care was secured only for the
last confinement of each mother; in considering infant deaths, however, all the births
occurring in the two years covered by the survey were included. Thus while detailed
information was secured for only 664 live births, 699 live births occurred to the mothers '
visited during the two years covered by the survey. Six deaths occurred among these 35
nonschedule births.
i As in previous studies made by the Children’s Bureau the rate is computed on the
basis of the number of deaths at less than 1 year of age among infants born in the given
BChildren’s Bureau Publication. No. 26, Maternity and Infant Care in a Rural County in
Kansas, p. 40.
6 Children’s Bureau Publication No. 33, Rural Children in Selected Counties of North .
Carolina, p. 36.
7 Children’s Bureau Publication No. 46, Maternity and Infant Care in Two Rural Coun­
ties in Wisconsin, p. 69.
8 Children’s Bureau Publication No. 34, Maternity Care and the Welfare of Young Chil­
dren in a Homesteading County in Montana, p. 70.
Federal Reserve Bank of St. Louis



The accuracy o f the infant mortality rate for Negro infants is open .
to more question than the rate for white, because o f the greater ob­
stacles to a complete canvass among Negro families. Therefore, for
purposes o f comparison, infant mortality rates are more sound which
are based upon the whole maternity histories o f the white and Negro
mothers while resident in the area. Even these rates are likely to-be
an upderstatement of infant mortality, because mothers who had had
many confinements often became confused as to the number and may
have forgotten at the time to tell o f the babies who died in early
infancy. Since this was particularly true o f Negro mothers, the fig­
ures show also an understatement o f the difference between rates for
white and Negro infants. The rate among white infants was 61.2 per
1,000 live births, while the rate for Negro infants was 107.3— a differ­
ence o f 46.1 in favor of infants born to white mothers.
Medical care.— One o f the most' significant aspects o f infant
mortality was the small proportion o f deaths attended by physicians.
Information was secured as to the attendant at death for 43 o f the
babies who died at less than 1 year of age; only 15 were attended at
death by a physician. Only 5 o f the 9 white babies who died under
2 weeks o f age were attended at death by -a physician, and only
4 o f the 6 who died over 2 weeks o f age were attended by a physician.
O f the 28 Negro babies who died at less than 1 year o f age, only 6
were attended by a physician.
The proportion o f deaths not attended by physicians was too1large
to be explained entirely by bad roads, poor telephone service, the
distance o f the family home from the physician, or by the fact that in
some instances Jhe baby died so suddenly that there was no time to
call a physician! Parents often failed to realize that their children
were sick, and did not appreciate the necessity o f securing the best
medical care possible for them.
One baby was sick for two days before death; her mother said
a she seemed to have griping in the stomach and the stretches.” The
mother cut red onions and bound them on the child’s hands and feet,
but did not call a physician. Another Negro mother said she
thought her baby died because she “ couldn’t keep the hives out on
him.” She said the baby was born “ puny ” because she had hoed
right up to the time o f confinement in very hot weather. This
mother had had no prenatal care, a midwife had attended her at
confinement, and no physician had been called for the baby. A
white mother whose husband had not been able to get a physician
for her confinement said that her baby had not been normal from
birth, and he died when 6 days old. Sha seemed satisfied with the
midwife’s explanation that “ the hives went in on it.” This family
Federal Reserve Bank of St. Louis



-.lived only 3 miles from a town with six physicians in it. One colored
mother said that her baby had a hemorrhage from the navel shortly
after birth, and that by the time they had brought the.midwife ^)ack
to tie the cord again, the baby had bled to death. Two colored babies
died o f whooping cough without the attention o f a physician.
Causes of death.— Discussion of the causes of death is hampered
at the outset by lack o f complete registration. F or 14 o f the 49 in­
fant deaths occurring in the period no death certificate was filed,
and in 20 instances, although a death certificate was filed, no cause
o f death was entered on it. For only 15 cases could a physician’s
certificate showing cause o f death be secured. Eight o f these deaths
were due to natal or prenatal causes (four o f the eight to prematur­
ity), and five to gastro-intestinal diseases.
Among white infants who died under 2 weeks o f age the death
rate per 1,000 live births was 40. The stillbirth rate, based on all
births in the area studied, to mothers interviewed was 2 per cent
for white infants and 4 per cent for Negro. About one-tenth o f all
pregnancies o f both white and colored mothers resulted in miscar­
riage, a stillbirth, or a live-bom infant that survived less than, 2
Obstetricians agree that most o f the deaths under 2 weeks o f age
are due to prenatal and natal causes and can be prevented in large
measure by good prenatal care and skilled care at confinement. In
rural communities, where few mothers receive any prenatal care at
all and where skilled help is not available, it is to be expected that the
number o f deaths in early infancy will be comparatively large.
Eeports on prenatal care were secured from 40 mothers whose babies
were stillborn or died under 2 weeks o f age. Only eight had any care,
and only one had care that could be classified as fa ir ; five o f those
who had care sought medical advice because they were ill during
pregnancy. Information was secured also in regard to the kind o f
attendant present at 21 o f the confinements resulting in a live-born
infant who survived less than 2 weeks. Six o f the 9 confinements of
white mothers were attended by a physician and 3 by a widwife or
other woman; 2 o f the 12 confinements o f Negro mothers were at­
tended by a physician and 10 by a midwife or other woman. A ll 10
stillbirths to white mothers and only 1 o f the 11 stillbirths to Negro
mothers were attended by a physician.
Improper feeding also contributed to infant mortality in the
county. One o f the registered deaths occurred when the baby was
•ijL about 2^ months old, about 2 weeks after the mother’s death. Cow’s
* milk had been used to supplement breast milk and the baby had been
given solid food some time before his death. Another baby at 2
Federal Reserve Bank of St. Louis



months o f age had tastes o f everything the family ate. The motherv
said that the baby had been bitten by mosquitoes a few days before its
death and she attributed death to malaria rather than to improper
feeding. Another baby weaned at 3 months o f age died about four
weeks later. The mother said-she had tried cow’s milk and then
malted milk. She thought that the baby had measles, but the cause
given on the death certificate was ileocolitis. Another mother said:
“ The baby was fine and healthy, but he had one o f the spells I had
at confinement (convulsions) and died o f that and whooping cough.”
In order to promote interest in child welfare, a series o f children’s
health conferences were held in two counties in the State—in the
county in which the intensive survey was made and in another located
in the south central part o f Mississippi which contains a city o f
more than 10,000 inhabitants known as one of the wealthiest cities in
the South. This city was very progressive; it had well-paved streets,
substantial public buildings, luxurious homes, good schools, and a
good city hospital o f 40 beds. Outside this city, however, the county
was no more progressive than neighboring counties.

An intensive sanitary survey of the southern county by the International Health Board (formerly the Rockefeller Sanitary Com­
mission), in cooperation with the State board o f health, had been
completed in January, 1918, shortly before the children’s health con­
ferences began. As part o f the work of the survey many persons
were examined and treated for hookworm and many inoculated
against typhoid. The survey also included a campaign for sanitary
privies both in the city and in the rural districts of the county, and
special attention was given to an educational campaign against
pellagra.9 The extensive public health work done through the sani­
tary survey made it possible to arrange for a series o f children’s
health conferences with a minimum o f effort and with some assur­
ance of response from the parents.
During the previous year a birth registration test had been made
in the city which disclosed the fact that about one-third o f the births
in the city were unregistered. The births o f 22 per cent of the
children brought to the children’s health conferences were definitely
reported as unregistered.

Report of the Board of Health of Mississippi, 1915-rl917, pp. 47 48.

Federal Reserve Bank of St. Louis

Jackson, Miss.,

■THE C O N F E R E N C E A T A C O U N T R Y S C H O O L H O U S E .
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis





The aggregate attendance at the 35 meetings held in the two
counties was about 3,000. In both counties meetings were held in
towns and in the country. Meetings were held in the courthouses
o f the county seats, in the country schoolhouses, in churches, one in
an open-air pavilion in the picnicking center, and in one o f the
smaller towns the proprietor o f a store suspended business for the
afternoon and expressed pleasure in turning over his store “ to the
use o f Uncle Sam.” The babies were examined on the counter and
stereopticon slides were shown in a dark corner at the back o f the
store. At some of the night meetings families straggled in late;
having worked all day in the fields, they had then dressed the chil­
dren, hitched up the horses, and driven to the conference.

A t these meetings children under 6 years o f age were examined
by a Government physician, and the results o f the examination,
together with special recommendations in regard to the care o f the
child, were written out and given to the person bringing the child
-for examination. In all, 544 children were examined by the physi­
cian, 375 white and 169 colored. I f the examination revealed defects
that needed special medical attention, the parents were told what was
wrong and were advised to consult the family doctor. Measures were
also recommended to promote better physical development. The ad­
vice given to many mothers concerned feeding alone. The physician
explained to these mothers that they had been giving their children
too much food, feeding them too often, or allowing them too much
starchy food ; and regularity o f feeding and a well-balapced diet
were recommended. A t the end o f one o f the conferences one mother
was heard to say emphatically that she would never have another
case o f “ summer complaint ” among her children.

An exhibit was shown at some o f the conferences o f miniature
models illustrating the proper clothing for a baby, baby’s bed and
mother’s bed, and the equipment needed for bathing a baby and for
preparing its food, and charts were shown illustrating various phases'
o f child welfare. A small model of an iceless refrigerator and a
homemade fireless cooker excited much interest. For conferences
held at night, when neither models nor charts could be shown to
advantage stereopticon slides were. used. The men who attended
the meetings often showed gTeat interest in the exhibits, and said
they were going to make play pens and separate beds for their
babies and fireless cookers and iceless refrigerators for their wives.
Federal Reserve Bank of St. Louis




The value o f the conferences was primarily educational. The
instruction received by individual parents was probably of no less
importance than the impetus given to systematic public health work
for mothers and children. The advisability o f securing a full-time
public health nurse for the county was widely discussed, and at
many o f the meetings the local committee circulated a petition to
the county supervisors asking that such a nurse be employed. This
movement was indorsed not only by parents but also by physicians
and others prominent in the county. Several o f the leaders among
the colored people desired to secure a nurse to work among the
colored people alone.
Federal Reserve Bank of St. Louis

Thé intensive survey o f maternity and child care was made in
a farming section typical of northern Mississippi. Over one-half
o f the population was Negro, and three-fourths of the farmers visited x
were tenants.
Six hundred and seventy-five families were visited, and most o f
these were living in poorly constructed houses far too small to
accommodate the whole family with any degree o f comfort. Very
few were plastered or ceiled on the interior, and about 40 per cent
o f the families were living two or more persons per room. Study
o f sanitary conditions disclosed the fact that only about one-fourth
o f the families had a privy o f any kind, and of these over fourfifths had the insanitary open-back type. Only 11 per cent of
the houses were adequately screened against flies and mosquitoes.
Although it was possible to obtain good water by drilling deep
wells, many families were using water from dug wells and from
springs which were not well protected against surface pollution.
Investigation of the status o f maternity care showed that the low
standards were due in large measure to ignorance o f the need of
it, to the scarcity o f physicians and nurses, and to poverty. There
were 14 physicians in active practice in the area studied; there was
no trained nurse working regularly in the county. The nearest hos­
pital was 100 miles away. There were about 100 midwives practic­
ing in the county, but a large majority o f them were untrained,
ignorant, and careless, and their methods were primitive and insani­
tary. While 79 per cent of the white women were attended at con­
finement by physicians, nearly 88 per cent o f the colored women
were attended by midwives.
Only 116 o f the 675 mothers studied received any prenatal care;
9 o f these received care that could be classed as fair, and only one
received really adequate care. Less than one-tenth o f the mothers
attended by a physician received three or more calls from the doctor
during the lying-in period ; only 7 mothers had trained nurses ; and
less than one-fourth had care by a practical nurse or midwife. Most
o f the mothers had great difficulty in securing anyone to do the nurs­
ing or help with the housework, and the majority had to depend on
relatives and neighbors. The lack o f conveniences made housework*
a rather strenuous task, and almost all o f the mothers were used to
Federal Reserve Bank of St. Louis



doing farm chores and field work as well as housework. As it was
so very difficult to hire help, many o f the mothers had neither adequate
relief from work before confinement nor a sufficient period o f rest
Children as well as mothers suffered from the lack o f skilled medi­
cal and nursing care. F requently the parents failed to recognize
that children were seriously ill, and they were content to use home
remedies and advice from neighbors rather than to secure the best
medical attention possible. Analysis o f feeding customs showed
that while the custom o f breast feeding, was almost universal the
mothers tended to nurse their babies too long and give them solid
food or the regular family diet too soon. Although about 85 per
cent were wholly or partially breast fed during the first year, at the
age o f 6 months 65 per cent were receiving solid food and 47 per
cent were given what the rest of the family ate. One-fifth o f the
children were still partially breast fed at 2 years o f age.
Incomplete birth and death registration handicapped the authori­
ties in studying the problem o f infant mortality.
Standards o f living were lower and the inadequacy of maternity
and child care more extreme among the Negroes than among the white
families. Only 8 per cent o f the Negroes were farm owners, and
about 57 per cent were half-share tenants—the lowest in the scale
economically. Their homes were smaller and more crowded than
those o f the white families and sanitation was not so good. The per­
centage o f illiteracy was high (26 per cent) among Negro mothers.
Few Negro mothers had received any prenatal care or been attended
by a physician at confinement. A larger proportion of Negro than
o f white mothers did field work, and they had less relief from work
before confinement and a shorter period of rest afterwards^
Children’s health conferences were held in two counties for the
purpose o f stimulating interest in public health activities. Children
were examined by a Government physician, and exhibits were shown.
The meetings had a large attendance and much interest was aroused.
In view o f the conditions found to exist in the county it was evi­
dent that the most necessary steps in securing better care for the
mothers and children were : The employment of a public health nurse
•for the county, and a county or district health officer on full time ;
the establishment o f a county hospital, with free care available for
those unable to pay; provision for the training and supervision o f
midwives; and the enforcement o f the birth and death registration
laws. In addition, it seemed imperative that steps should be taken
.to deal effectively with the problem o f illiteracy which existed to a
serious degree among the poor white and Negro families.
Federal Reserve Bank of St. Louis

The conditions revealed by this inquiry are by no means peculiar
to the county studied ; they are more or less typical o f those existing
in many rural communities. They call for a general constructive
program for the conservation o f the lives and health o f mothers and
babies, and of older children as well. Among the essential hygiene
features o f such a program are :
1. A county public health nurse (preferably one for white and
one for colored), who, by doing educational work thrpugh the schools,
clubs, and other organizations and by practical demonstrations o f
home nursing and preparation o f food for babies, could accomplish
much toward improving maternity and child care..
' A well-trained public health official, devoting his entire atten­
tion to health problems in the county or the district o f which it
might form a part.
3. A county hospital conveniently located for all residents o f the
4. The birth and death registration laws strictly enforced.
5. The law to prevent blindness in the new-born strictly enforced.
6. Midwifery practice controlled.
Federal Reserve Bank of St. Louis
Federal Reserve Bank of St. Louis

Accidents :
liability of children to_________ 4 5-46
unavailability of medical care
in time of^_._____ i ___ __ 43—46
Acreage and tenure. See Farming
Artificial feeding. See Feeding, arti­
Attendant, confinement.
See Care,
Birth registration:
enforcement of__________ 41, 50, 54, 55
incomplete_________________ 8, 47, 50, 54
reasons for____________ \___
law providing for (19 1 2)__
Blindness in newborn, prevention
(law passed Jan.,
191 6 )---------------------------- 1 7 ,2 3 ,5 5
Breast feeding. See Feeding, breast.
Bureau of vital statistics, law estab­
lishing (1 9 1 2 )_____
Campaigns, health. See Health cam­
Care, confinement :
a tte n d a n tfactors entering into selec­
tion of—
custom___ _____________
distance.________ L_______21, 28
economic condition of
fam ily__________ 2 7-28, 32
kind of__________________ 2 6 -28 , 49
per cent distribution of
mothers of specified race
according to________ i____
costs and free service___________31—33
Care, « m b é m é Mi
p o s tn a ta l
quate --------------------------21, 28-29
nursing care,scarcity of_____ 2 9 -30 , 44
resumption of work after con­
finement___ 30, 37, 39-40, 41, 54
Care, prenatal :
analysis of care given_____ .____ 25, 53
inadequacy of________ ._________ _ 24, 49
factors responsible for____ 21, 24
inadequacy of relief from work- 40, 54
information through reading___
use of home remedies__________
See Mortality, ma­
ternal, causes of.
See also Work of mothers in re­
lation to childbearing.
Children in study, number of_______
_ 8
Children’s health conferences." See
Health conferences, chil­

Colored people. See Negroes.
Communication, means o f ___________
Compulsory school-attendance law,
lack of_____________________ 1 5-16
Confinement :
care during. See Care, confine­
costs of________ ____ .____________ 31-33

length of_ I -----------------------------


registration, incompleteness
o f ------------------------41, 47, 49, 54
Death registration area, cities ad­
mitted to__________ ;______
Deaths. See Mortality. '
Deformities. See Illnesses, deformi­
ties, and accidents.
District health officer.
See Public
health officer (county).

Economic status of family, relation
of, to cost of confine­
ment______________________ 32-33
Economic and social background of
families visited___________ 9—20
Education :
lack of compulsory schoolattendance law___________
length of school terms-------15-16
mothers—instruction by home demon­
stration and agriculture
agents---------- ^___________
need of instruction—
in infant care_________
in maternity care__21, 24, 53
See also Illiteracy.
Examination of children, medical.
See Medical examination
e f children.
Federal Reserve Bank of St. Louis


Conveniencies on the farm, lack of__36, 53
Costs of confinement :
by economic status of family.— 32-33
itemized___________________________ 31-33
total, and free service_________
Counties, selection of. See Scope
and method of the survey.
County, population of. See Popu­
County public health nurse.
County public health 'officer.
Cows, milch, percentage of families
having________ ______ ,____.
Crops and live stock. See Farming
Cultivation of land, extent of____ __



P age.

Exhibits in child welfare:
nature of------------------------------ -— 7—8, 51
results of------------ -------,— ;---------- 51—52
Families, number interviewed---------8, 53
economic status------------------ 1 3,1 4
percentage o f ---------------------13
Negro------------ - -------- -— 15» 54
w hite-- ------------------------size of farms-------- r — - — —
economic status-------------- 12—13, 54
illiteracy ----------------------------15
length of tenancy— -------------- 14—15
percentage of------------------------ 13, 53
w hite__________________
size of farms worked---------14
Farming conditions:
climate------------------------------------- —
crops and live stock-------------------12
_ 14
removals from farm to farm----soils______________ —-----— ----------11
tenure and acreage------------------------ 12-14
liquid food—
percentage of children
receiving, by age---43
solid food—
kinds of----------------------- - 42—43
percentage of children
receiving, by age---- 43, 54
breast, prevalence of- 42—43, 54
improper, relation of, to infant
mixed, extent of--------------------- -— 43, 54
Free medical service in confinement
Gastro-intestinal diseases. See Mor­
tality, infant, causes of.
Government physician. See Physi­
cian, Government.
Health campaigns:
agencies responsible f o r -----------50
•nature o f ----------------------------------- 17, 50
results o f ------------------------- --------- 17 >50
Health conferences, children’s :
examination of children—
by whom examined- 7, 51, 54
number examined------51
exhibits_________ s----------------51, 54
attendance---------------------------*-----51, 54
location----------------------------------- — '7, 50.
places of meeting-----------------------51
purpose------------------------------- -------- 50, 54
results---------------------- •— :------- — 51-52
Health officer, county. See Public
health officer (county).
Health program suggested as result
of study------------------------- — 54, 55
Federal Reserve Bank of St. Louis


work, public. See Public
health work.
Hemorrhage. See Mortality, ma­
ternal, causes of.
Home demostration and agriculture
agents. See Education.
Home remedies, use of—
during .pregnancy----------— ---------25—26
for children--------------------------------- 4 6-47
Hookworm, campaign against---------- 17,50
Hospitals :
county, need o f ---------------- ----- — 54, 55
inaccessibility o f ------------------ 21, 43, 53
Housing and sanitation :
average number of persons
per room__ -----------------------19, 53
average number of persons
per sleeping room ---------19
sanitary, campaign for------50
type of_____ _—------- ■;---------- 20, 53


screening--------------- ------------- — 19, 53
types of houses---------------------------------18,53
water supply------------------------- 9 .1 9 , 53

See Mortality, infant,
causes of.
Illegitimacy, extent of—------------------23
Illiteracy, extent o f -------------------- 15, 42, 54
Illiteracy of midwives. See Mid­
Illnesses, deformities, and accidents
of children.
home remedies used------------ — - 46
medical care--------------------------------- 43—44
nursing care------------------ ------ -— 44-45
Industry, principal-----------------11-12
Information obtained by mothers,
sources o f :
in infant care---------------- ------------16, 42
in maternity care------------International
State board of health) :
campaign by — l-------------50
survey by—r.— !s?ii------ 17, 50


Land, cultivation of---------------------------H
Land tenure,, plantation system of— 12-13
Literature, instruction of mothers
in infant care-----------------------------42
in maternity care---------------------26
Live stock. See Farming conditions.
Lying-in period, care during.
Care, confinement.
Mail service. See Communication,
means of.
M alaria:
campaign against------ .------—-----pernicious. See M o r t a l i t y ,
maternal, causes, of.
Marriage, average age at----------------—
Maternal mortality. See Mortality,





N egroes— Continued.
pregnancies, frequency of____________ 23
worked— _________________
economic position_________ 1 3 , 5 4
length of tenancy__ J;_____ 14-15
Nephritis. See Mortality, maternal,
eauses of.
Nursing care, unavailability of____ 29-30,
44, 53

Mortality, maternal:
causes of___ ___________________
3 3 -3 4
relation of midwife attendance
to------------------------------------- 2 1 - 2 2
Mothers in study, number of_______
Mothers, unmarried,number of______
babies - in study—
feeding customs________:___ 4 2 -4 3
farm owners—
average size of farms______
number___ ____________
15, 5 4
housing and sanitary conditions
o f ---------------- --------- - 18-20, 54
illiteracy, extent of_____________ 15, 5 4
marriage, average age at_______
mothers as economic heads of
families, number________
mothers interviewed, percent­
percentage in county____________ 9 , 5 3
percentage in State_______________
Federal Reserve Bank of St. Louis

Pellagra, campaign against_________ 17, 50
See also Mortality, maternal,
causes of.
Physician, Government, examination
of children by_________ 7 , 51, 5 4
Physicians :
infant deaths attended by_____
mothers attended b y -_______ 26-28, 4 9
number of, in county________ 21, 44, 53
unavailability o f _________________ 4 3 - 4 4
Plantation system of land tenure___ 12-13
Population (census of 1910) :
county (Negro, ^ rural, urban,
w h ite )___________________
State (Negro, white)____________
Postnatal care. See Care, postnatal.
Pregnancy :
care during. See Care, prenatal.
use of home remedies during___ 2 5-26
work during— ---------- --------- 3 7 -3 9 ,4 1
See also Mortality, maternal,
causes of ; see also Ma­
ternity histories.
Prematurity. See Mortality, infant,
causes of.
Prenatal care. See Care, prenatal.
Privies. See Housing and sanitation.
Program, health, suggestions for___ 54, 55
Public health nurse (county), need
of — — ---------- 23, 29, 52, 54, 55
See also Nursing care.
Public health officer (county) :
appointment of_____ _£ _ _______ i
duties o f
________________ „
need of full-time____________ 17, 5 4 , 5 5
salaries of______________ __;_____
Public Health Service, United States,
cooperation of, in study
of pellagra______________
Public health work :
campaigns against diseases- 17, 50
investigation of sanitary
conditions_____ , _____ 16, 20, 50
health officer, appointment
o f -----— — -----------------------duties of ------------------------16-17
salaries of______ £i _—
above, health officer.
Puerperal septicemia. See Mortality,
maternal, causes of. ■






means of.
Reading, instruction through.:
in infant care___________________
in maternity care -------------------Registration :
births. See Birth registration,
deaths. See Death registration,
midwives. See Midwives, regis­
tration of.
Roads, condition of. See Communi­
cation, means of.
Sanitary Commission.
See International Health
Rural county nurse. See Public
health nurse (county).


Specialists, unavailability of------------ 4 3 -4
State board of health :
bureau of child welfare advo­
cated b y _________________
campaign and survey by (in co­
operation with the Inter­
national Health Board) _ 17, 50
rules by— ---------- ------- — ----------Stillbirths, percentage of— -------------49
See Communication,
means of.
Tenant farmers. See Farmers; ten­
Tenure and acreage. See Farming
Trained nurse.
See Public health
See also Nursing care.
Tuberculosis. See Mortality, mater­
nal, causes of.
Typhoid, campaign against--------------

See ' Public
health officer.
Sanitation. See Housing and sani­
United States Public Health Service.
See Public Health Serv­
School attendance. See Education.
ice, United States.
School terms. See Education.
-V ita l statistics, bureau off See Bu­
Scope and method of the survey :
reau of Vital statistics.
selection of counties------------------ 7, 8, 9
sources of information-------------W ater supply.
See Housing and
See Housing and sani­
Weaning, ages of--------------------------- — 42Selection of counties. See Scope and
Work of mothers in relation to child­
method of the survey.
bearing :
Social and economic background of
after' confinement—
families visited-------------9 -2 0
resumption of work---------- 30, 37,
39-40, 41
before confinement—
Soils. See Farming conditions.
nature of work---------------------- 38—39
Sources of information :
relief from w ork---------- 37—38, 41
obtained by the bureau—
See Scope and method of
the survey.
assistance, kind of---------------- 36—37
obtained by mothers—
conveniences, lack of----------36
in infant care-------------- -—
nature of------------------------------- 35-37
in maternity care-------------- -- . 26


Federal Reserve Bank of St. Louis