Full text of Maternity and Infant Care in Two Rural Counties in Wisconsin, Rural Child Welfare Series No. 4, Bureau Publication No. 46

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UDOC
L 5.20:46

U. S. DEPARTMENT OF LABOR

CHILDREN’S BUREAU
JULIA C. LATHROP, Chief

MATERNITY AND
INFANT CARE
IN TWO RURAL COUNTIES IN WISCONSIN
BY

FLORENCE BROWN SHERBON, M. D.
AND

ELIZABETH MOORE

R U R A L C H IL D W E L F A R E SE R IE S N o. 4
Bureau Publication N o. 46

WASHINGTON
GOVERNMENT PRINTING OFFICE
1919

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CONTENTS,
Page.
Letter of tr a n sm itta l.....................................................
Introduction.............................

7
9 -1 4

Object of the survey......................................................... •..................................................
Field of the survey..............................................................- ................................................

®
19

Scope and m eth od.......................................................
Summary of findings.............................................................................................................

H
12

Part I. The northern county.................................................- .................................................. 15-54
Economic and social conditions in the county......................................................... 11-22
Topography and soil................................................................- - - ...............................

Clim ate...............................................................................................................................
Agricultural developm ent................

1®
16

T yp e of farming............ ................................................................................................
Farm ownership..................... ...............................- ..........................................- ...........

17
18

Rural density.................................................. - ............... ..............................................

N ationality........................................................................................ .......... * .................
Social organization........................................................................................................

19
20

Means of communication................................................................................... - - - -

Industries........................................ - .............................. - ..............................................

Selected townships.............................................................
Fam ilies included in the su rvey..............................................................

22
23-26

N ationality....................................................................................................................
Father’s occupation...........................................................

23
25

Land tenure........................

M aternity ca re .______ .........................................................,........................................... - - * 2 6-38
A vailability of physicians. . . - . ..................................................................................
26
Attendant at birth ..................................................................
Hospital confinements..........................................................................

27
29

Obstetrical service b y physicians.............................

M idw ives............... ............................................................... ........ ................... .............*

Nursing care.............................................................................................r ......................

Prenatal care.................................

Maternal m ortality........................... .........................................................- ..........................
39
Mother’s work................................................
39-50
Rest before and after confinement.........1...........................................................-

Usual housework........................................................................................................- •

W ater su p ply................................................
Other household conveniences.................................................................................

42
42

Boarding hired m en ...............................................................

W ork for the dairy.........................................................................................................

M ilk in g............................. * .......... .................................................................... |.............
Other chores...................... ................................................................... .............-*•••*

44
44

F ield work................................................................................................ - - - .............- -

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CON TEN TS.

Part I . The northern county— Continued.

Page.

Infant welfare................................................................................ .........................................

50-50

Infant m o rtality...................................
Stillbirths and miscarriages......................................................................................

50
52

Feeding custom s.................. ..................................... •..................................................

Birth registration...........................

Part I I . The southern county...................................................................................................... 55-71
Economic and social conditions in the c o u n ty ., ................................. ....................55-60
Topography and soil............................................................................

T yp e of agriculture...................

Rural density......................................................................................................
Economic conditions.......................................... - - - - * ........ ........ ............................

®7
57

• N ationality................................. Y Y ..V ................................................... ........ .............

Literacy and education........ . . . ; ............- - .......... — .............- ............................
Means of communication......................

58
59

Selected townships.........................
60
Families included in the survey...... ......................................... .................................•• 5 0-61
N ationality............. - .............. .......................... .............................................................

Father’ s occupation.................................................................................

Land tenure.....................................................................................................................
51
Maternity care............................................ - ..........................- .............................................. 61-64
A vailability of physicians. . 1....................................................................................

Attendant at birth............ - ..........................................................................................

Hospital confinements......................................- ....................................... ; - •...........
Obstetrical service............................................................ - ..........................................

Nursing care......................................................... - .........................................................

Prenatal care.............................................................................
Maternal m ortality...............................................- .................................................. .............
55
Mother’ s w ork........................................................................................................* ............... 65-68
R est before and after confinement..............................................................................
Usual housework.............. .\ ................ - ......................................................................
W ater supply and other household conveniences........................................ -

55
56

Boarding hired m e n ..........................................................................................................

W ork for the dairy...............................................................- ................................ .. •*
Milking and other chores................................................................................................

68
68
68

H e ld w ork....................................................- ..................................................................
Infant welfare............................................. - ................... ...................................................... 68-71
Infant m ortality........................................................................................
Stillbirths and miscarriages......................................................................................

68
70

Feeding customs.............................................................................................................

Birth registration...........................................................................................................
Part I I I . Activities in W isconsin on behalf of the health of mothers and

babies............................................................................................................................
W ork of the State board of h ealth ..................................................................................

73-83
73-75

Birth registration......................................................................
Educational literature.................................................................................................
Prevention of blindness.......................................................- .....................................

74
74

Campaign against venereal disease........................................................................

Looal public-health administration...............................................- ..............................

W ork of the State board of m edical exam iners.. y ..................................................

W ork of the State u n iv ersity......................................................................... * ................. 77-78
University extension division........................................................................
Agricultural extension division...............................................................................
W ork of the Wisconsin Antituberculosis Association...........................................

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77
78
78

CON TEN TS.
Part I I I . A ctivities in W isconsin, etc.— Continued.
Rural public-health n ursing.......................................................................................

Page.

Local educational campaigns............................................................................................... 81-83
B aby W e e k .....................................................................................................................
81
Children’s health conference..................................................................................

Conclusions....... ............................................. L ,............................................................... ...............

A p p en d ix................................................... ....................................................... ...............................

91-92

Table I . Per cent of physicians’ obstetrical cases receiving postnatal visits.

Table I I . Infant mortality rates for each county, b y nationality of mother,
based on all births reported b y mothers included in the stu d y....................
Table I I I . Stillbirth rates for each county, b y nationality of
based on births in two years................................................

mother,

Table I V . Stillbirth and miscarriage rates for each county, b y nationality
of mother, based on all issues reported b y mothers included in the stu d y. .

Table V . Per cent of infants breast fed and artificially fed, b y mother’s
nationality, northern county........................................................................................

T able Y I . Comparison of feeding methods in Wisconsin with other rural
districts and with four cities in which infant mortality investigations
have been made

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L E T T E R OF TR A N SM IT T A L .

U . S . D e p a r t m e n t of L abor ,
C h il d r e n ’s B u r e a u ,

Washington, April 10, 1919.
S i r : Herewith I transmit the fourth report prepared by the
Children’s Bureau in its study o f conditions affecting infants and
mothers at childbirth in rural areas o f the United States. A com
parison o f such vital statistics as are available for the United States
with those o f other countries shows 10 other countries with relatively
fewer deaths among babies under 1 year o f age and 13 other countries
with relatively fewer deaths among women from conditions directly
related to childbirth.
Considerably more than half the births in the United States occur
in rural areas, and, although the mortality rate among babies under
1 year o f age is apparently somewhat lower in the rural part o f the
birth-registration area than in the cities, the difference seems to affect
only those babies who have survived the first month o f life. For
infant deaths during the first month—and these are more than twofifths of all infant deaths—and for maternal deaths, there is no
evidence o f a lower average rate in rural than in urban areas. The
need for clearer understanding o f rural conditions and for construc
tive measures is plain.
The present unit in the rural inquiry followed the schedule and
general plan prepared by Dr. Grace L. Meigs, as director of the
bureau’s division of child hygiene, and her assistant, Miss Viola I.
Paradise. Valuable help in planning the details o f the work in
Wisconsin was rendered by the Wisconsin State Board of Health and
by the extension division o f the University o f Wisconsin. The field
work was done and the report was written by Dr. Florence Brown
Sherbon and Miss Elizabeth Moore, o f the Children’s Bureau staff.
Respectfully submitted.
J u l i a C . L a t h r o p , Chief.
Hon. W m . B. W i l s o n ,
Secretary o f Labor.
7

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MATERNITY AND INFANT CARE IN TWO RURAL COUNTIES IN WISCONSIN.
INTRODUCTION.
OBJECT

THE

SURVEY.

This report is one o f a series of studies undertaken by the Chil
dren’s Bureau which deal with the conditions surrounding child
birth and infancy in typical rural communities. The subject o f
maternity care (including prenatal care) is emphasized in these
studies because it is one of the main factors influencing a child’s
chance o f being born alive, uninjured, and with sufficient vitality
to carry him through the hazardous period o f early infancy. How
serious and important a problem this is, is indicated by the fact that
two-fifths o f the deaths o f babies in the registration area of the
United States—over 60,000 deaths in a year—are due to premature
birth, injury at birth, congenital weakness, and malformations,1
conditions which can be prevented to a great extent through and
only through better care o f the mother during pregnancy and at
confinement. And even this large figure takes no account o f the
heavy losses—how heavy, no one knows—from stillbirths and mis
carriages.
Furthermore, it is a well-recognized fact that even a baby sturdy
at birth has a much better chance o f life and health if he has a
strong, well mother to nurse him and care for him. Yet it is esti
mated that in one year in the United States “ at least 15,000 women
* * * died from conditions caused by childbirth,” 2 and the
amount o f sickness and even permanent invalidism among the
mothers of the country caused by preventable complications of
childbearing can not even be estimated.
Evidence .coming to the bureau from many sources, especially
through letters from country women themselves, indicates that the
problem o f securing adequate medical and nursing cane at confine
ment is especially serious for country mothers; that in some districts
and for many mothers such care is practically unattainable, either
because o f actual isolation or because o f the expense resulting from
1 Mortality Statistics, 1915, p. 645, TJ. S. Bureau of the Census. Washington, 1917.
* Meigs, Dr. Grace L . : Maternal Mortality from A ll, Conditions Connected with Child
birth in the United States and Certain Other Countries, p. 7. U. S. Children’s Bureau
PubUcation No. 19, Miscellaneous Series No. 6. Washington, 1917.

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distance from physicians and nurses. Indeed, this appears to be one
o f the serious handicaps o f country life as at present organized; and
studies looking toward means for relieving this situation were, there
fore, considered urgent by the bureau. The first requisite in facing
this, as any, problem is knowledge o f the facts.
Three studies of maternity and infant care in rural communities
were made in 1916, in representative districts of Kansas, North Car
olina, and Wisconsin.
F IE L D

THE

SURVEY.

As the field of the inquiry in Wisconsin, two counties were
chosen, one in the southern and one in the north-central part of the
State. These are referred to throughout the report as the northern and
the southern counties. Both are fertile agricultural country, in which
dairying is the prevailing type o f farming. In both there is a con
siderable industrial population in some o f the villages and in certain
places in the open country. Both have poor roads; hence travel in
the country is apt to be difficult, and many homes are almost isolated.
In other respects the two districts are widely dissimilar. .
The northern county lies in what was originally lumber country
and is still largely in the transition stage from pioneer clearing o f
“ cut-over ” land to more settled farming. While some farming com
munities are well-established and wealthy, the larger part of the
county still faces the necessity o f ridding the soil of its brush, stumps,
and trees before crops can be raised. Consequently, like most pioneer
communities, these districts have little money to spend; and many
families live on isolated clearings or in remote settlements under
primitive conditions. The large majority o f the settlers have been
German, with an important Polish contingent in addition; both these
nationalities cling to their foreign customs and habit« of thought and
to a certain extent to their languages, making the district as a whole
distinctly foreign in its atmosphere. The northern county was
chosen in consultation with the State board o f health because of the
large proportion— about one-sixth, according to preliminary figures—
o f births attended by midwives. It was considered that a study in
such an area would throw light upon the problems o f rural mid
wifery in general. In addition, the county is typical of conditions
prevalent over large parts o f northern Wisconsin, Michigan, and
Minnesota, which were forest territory not much more than a gener
ation ago.
In its general economic and sociological features the southern
county is typical of large farming areas on the prairies o f southern
Wisconsin and Minnesota and northern Illinois. It is situated in the
older part o f the State, where farming has been well-developed for

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T W O R U R A L C O U N T IE S I N

W IS C O N S IN .

more than a generation and has changed little within that period;
it is, therefore, a rich, well-established community. While about
half its people are o f foreign parentage, they are in the main thor
oughly Americanized. This county was selected, on the advice o f the
extension division of the State university, because it is a prosperous
bwt conservative community in which it was hoped that a survey by
the Children’s Bureau, and the children’s health conference to be held
in connection therewith, would increase the interest in public pro
vision for the welfare o f children. Furthermore, the State vital sta
tistics, showing that this county had in 1914 an infant mortality rate
of 115 per 1,000 births, one o f the highest rural rates in the State, in
dicated that problems affecting the health o f babies needed special
attention.
Both counties were too large to make a survey of the whole area
practicable; therefore a limited number of townships, with the vil
lages therein, were covered. These townships were selected with a
view to representing as fully as possible the variety and rangé of
conditions in each county.
SCOPE

AND

M ETHOD.

The survey made in Wisconsin, like that in Kansas,1 covers two
main topics: The conditions affecting the health o f the childbearing
mother—the general living conditions o f the family, the work done
by the mother, and the chre she received during pregnancy and at
the time o f confinement; and the care—especially the feeding—and
survival o f the babies. Throughout these rural surveys, the chief
aim has been to give a picture of the district studied, rather than
to indicate any connection between certain conditions and the infant
mortality rate.
The information upon which the report is based was secured by
the bureau’s agents through personal interviews with mothers (or,
in cases where for some reason the mothers could not be seen, with,
their near relatives) who had borne children within the two years
preceding the survey, and who, when those children were born, were
living in the territory covered. As the first step in finding families
where there had been births, the names of the parents were copied
from the birth certificates of this territory for the designated period.
Secondly, a canvass was made in each district to find additional un
registered births. In nearly all cases the information was given by
the mother herself. The mothers interviewed were appreciative o f
the object o f the inquiry and answered the many personal questions
with generous frankness.
1 Moore, Elizabeth : Maternity and Infant Care in a Rural County in Kansas. U. S.
Children’s Bureau Publication No. 26, Rural Child Welfare Series No. 1. Washington,
1917.

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Records were filled out for stillbirths as well as for live births
within the given period, but not for miscarriages. No attempt was
made to interview the mothers of illegitimate children, even in the
few cases where such births were registered; in a study dealing with
the provision for maternity and infancy in normal families it was
considered that a few records o f abnormal conditions would add
nothing of value.
The records secured do not cover absolutely all the births which
occurred, for some families had moved out of reach. The number
thus lost was comparatively small, however, because the farming
population in the areas studied is not migratory.
In the northern county the survey covered the births o f the two
years from July 1, 1914, to June 30, 1916; in the southern county
the period was from May 1, 1914, to April 80, 1916. In each case
this was the two-year period immediately preceding the beginning
o f the survey.
The report is based upon information concerning 614 families
who lived in the selected districts— 453 in the northern and 161 in
the southern county. In 47 o f these families, the mother had borne
children twice during the two-year period o f the survey and within
the districts studied, so that the records cover the history o f 661 con
finements. Since nine pairs of twins and one set of triplets were born
in this group, 672 births are included; 648 o f these were live births
and 24 still births.
SUM M ARY

F IN D IN G S .

The infant mortality rate in the northern county was low com
pared to the average for the United States birth-registration area;
the stillbirth rate was somewhat higher than the rates found for six
o f the eight cities in which infant mortality studies have been made
by the bureau. The death rate of mothers from causes connected with
childbirth was high. Many births were attended by midwives in
certain sections o f this territory; a proportion as high as four-fifths
was found in one o f the Polish settlements. Moreover, it was not un
common for mothers in inaccessible neighborhoods to go without any
regular attendant at childbirth. Few women, even among those who
had a physician at childbirth, secured any prenatal care; postnatal
supervision was rare. Trained nurses were almost never employed
for childbed nursing and practical nurses seldom. In many neigh
borhoods the midwives were the only nurses available who had had
any obstetrical training. They gave some care during the lying-in
period to about half their patients and also nursed a few mothers
who had a doctor at confinement.

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W IS C O N S IN .

In this county the employment o f midwives appears to be both a
result of isolation in the Wisconsin forests and a survival o f Euro
pean custom. From the point o f view o f her patients the advantages
o f the midwife are: First, many foreign women prefer a woman
rather than a man to help at childbirth; second, the neighborhood
midwife is easier to secure than the doctor and more |ikely to be on
time for the delivery; third, some midwives render nursing service
during the lying-in period, which is highly appreciated; fourth, the
midwife is much cheaper than the doctor; fifth, in the experience o f
most o f these mothers the midwife whom they and their acquaint
ances have employed has seemed adequate to the situations which
have arisen. On the other hand, some of them have had unfor
tunate experiences while under the care o f physicians. Conse
quently they have come to believe that they get better service from
the midwives.
The chief argument against the midwife is that, while an experi
enced midwife may be successful in conducting normal deliveries,
she is a dangerously uncertain reliance if anything goes w rong; and
there is always the possibility that something may go wrong. On
an isolated farm it is even more unsafe than in the city to wait until
complications have developed before sending for a doctor. A re
mark made by a Polish father aptly illustrates this point. His wife
became sick during pregnancy and, though there was a physician
8 miles away, he sent to the county seat, 25 or 30 miles away, for a
doctor whom he knew. He said: “ When you get something for pro
tection, like a doctor, you want the best there is. It was worth the
money.” Substitute the words “ an attendant at birth ” for “ a
doctor ” in his phrase, and you have the crux o f the midwife problem.
This father employed a neighborhood midwife for his wife’s con
finement, two weeks later, because he and his wife regarded child
birth as a normal occurrence and did not realize that she then
needed “ something for protection—the best there is.”
In the southern county the infant mortality rate was higher than
in the northern county but the stillbirth rate was lower. Only one
mother died at childbirth. Practically all the births were attended
by physicians; there were no midwives in practice. The mothers,
however, received much less prenatal and postnatal care from their
doctors than their safety and the health o f their babies required.
Furthermore, the situation as to obstetrical nursing was far from
¡satisfactory; trained nurses were difficult to secure and competent
“ practical nurses ” or attendants were too few to fill the need for
their services.
In neither district were the housewives on the farms obliged to
provide for large crews o f hired men at any special season, for dairy
farming distributes the farm work more evenly through the year

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than does grain farming. But, on the other hand, it was common
in both districts for the women to help with the milking and to have
more or less dairy work added to their household duties. In the
northern district half the farm mothers helped with the field work
also, even in some cases with such heavy work as pitching hay and
grain or clearing land; many of the Polish immigrant women did
practically men’s work in the fields in addition to their housework.
In both districts at the sixth month half the babies were exclusively
breast fe d ; at 9 months o f age only between one-fifth and one-fourth
had been weaned. The record o f these Wisconsin mothers for nurs
ing their babies through the first nine months compares favorably
with that of city mothers where the Children’s Bureau has studied
this subject, but is not so good as in the other country districts
studied.
Birth registration proved to be defective in both districts, espe
cially the northern.

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A TYPICAL NORTHERN COUNTY SCENE.

PART I. THE NORTHERN COUNTY.
E C O N O M IC

AND

S O C IA L

C O N D IT IO N S

THE

COUNTY.

This comity is located near the center o f the northern half of Wis
consin, in the forest belt. It is one of the largest counties in the
State, 30 miles wide and 55 miles long; it is nearly half as large
again as the State o f Rhode Island. The population in 1910 was a
little over 55,000, an increase o f 27 per cent in the preceding decade.
Within the county at the time o f the survey there were 12 incor
porated villages, o f which the largest had at the last census less than
1,000 population; and one city of approximately 17,000, which is the
county seat.
Topography and soil.1
The Wisconsin River flows south nearly through the center o f the
county; its tributaries, some o f which are important streams, drain
the whole area. The sandy, alluvial soil which covers the river bot
tom, varying from less than a mile to 6 or 8 miles wide, is the poorest
soil in the county; over much o f its extent no attempt is made to
raise crops o f any kind.
Outside this valley, practically the whole of the county except the
southeastern corner is a gently rolling country, rising to about 400
feet above the river. Nearly all o f it is well drained. The uplands
are broad and nearly level, while the numerous stream valleys, though
deep, have gentle slopes. The soil of these uplands and valleys is
clay or loamy clay, very fertile and giving good yields of all crops
suitable to the northern climate. It is especially well adapted to hay
and forage crops. A t the time of the survey uncleared land o f
this type sold for about $25 an acre, while cleared land was valued
as high as $100 an acre. In the belt o f deeply weathered glacial clay,
which extends over the western third and across the northern edge
of the county, the older farming communities are exceedingly
prosperous.
In the southeastern section the soil is much lighter, and in the val
ley o f the Plover River decidedly sandy, though not so poor as that
along the Wisconsin River. This soil is the result o f much more
recent glacial drift than that in the western part o f the county and
1 Data from Preliminary Report on the Soils and Agricultural Conditions of North Cen
tral Wisconsin, Bulletin No. XI, Wisconsin Geological and Natural History Survey, 1903.
91202°—19------ 2

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is mueh. cumbered with stones and even bowlders. In this district
steep, stony ridges—glacial moraines— are a common feature o f the
landscape; and the intervening depressions are frequently so poorly
drained that swamps result.
Climate.
As far north as this the winters, o f course, are severe; but, while
the temperature is low, this district does not suffer from the high
winds or blizzards which are common farther west on the plains.
Fuel is so plentiful throughout the county that the winter cold is
not nearly so great a hardship as might be anticipated. The rainfall
is usually ample—the year o f the survey was an exception—for all
crop needs and keeps the pastures luxuriant through the summer.
Agricultural development.
All this part o f the State was originally forest country, covered
with dense growths o f hardwood, hemlock, and more scattered pine.
The first settlers were lumbermen who came for the pine timber, most
o f which was removed years ago. Almost the only vestiges o f those
logging days are the great pine stumps still standing in many places
among the lesser timber and brush; and an unpleasant reminder they
are, for they are huge—sometimes as large as a small house—and ex
tremely difficult to uproot. In more recent years the hardwood and
hemlock have become valuable assets; many tracts o f hardwood
forest are still standing, but hemlock is now becoming somewhat
scarce.
Farming began in certain parts o f the county 40 or 50 years ago
but did not become an important factor until within the past 25
years. The early agricultural settlements grew up around a number
o f distinct centers, often separated by miles o f forest; this isolation
o f one part o f the county from another still persists to a certain ex
tent. A t the present time all stages o f development are represented,
sometimes not many miles apRrt. In some o f the older districts, on
the rich clay soil, the farms are well improved, with ample buildings
and wide stretches of cleared land. In such districts farm values are
as high and people live as comfortably as in the southern part o f
the State. The present occupants are in many instances the children
o f those who cleared the land.
In other districts, pioneer conditions prevail to-day. Large areas
o f potential farms are still forest or what is called “ cut-over land ”
covered with brush or small timber and full o f stumps. Such tracts
are largely in the hands o f land companies—the successors o f the
earlier lumbering companies. It is still common for a young hus
band and wife to buy 80 acres, o f which little or none is stumped,
pay for it largely with a mortgage, build a rough two-room shack

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16-1

UNCLEARED CUT-OVER LAND.

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CUT-OVER LAND “BRUSHED” BUT NOT "STUMPED.”

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16-3
A CABIN IN A NEW CLEARING,

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A NEW BARN ALONGSIDE THE OLD CABIN.
16-4

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16-5
CLEARED LAND IN THE OLDER SECT ONS

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THE HOME ON A PROSPEROUS FARM.

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o f lumber from their own trees, and move onto the “ farm.” Dur
ing the first few years, the husband often works out by the day dur
ing the summer and works on his land in the winter, felling trees
and pulling stumps. Gradually, as they get pasture and hay land,
they develop a herd o f dairy cattle, building at first a rough barn
shed for them. After a few years, perhaps 5 or 10, they build a
large bam. And in a few years, usually not many after this, they
build for themselves a substantial, well-finished, roomy house. But
almost always the house comes after the bam, for it is a saying in
this country that “ the bam will build the house, but the house won’t
build the barn,” a proverb which seems economically sound. And all
this time the couple is rearing a family of children, not a small
family, either, in most cases, but a healthy one. “ Never had a
doctor in the house except when the babies were born ” is a common
report. The last stage in the evolution of the farm is usually the pay
ment o f the mortgage.
Most o f the land near the railroads where it is at all suitable
for farming has been occupied for a good many years; the newly
settled and unsettled districts are more remote. But accessibility was
evidently not the only factor in determining which parts of the
county were first chosen for farming, for two o f the oldest-settled
and richest townships have no railroad within 5 miles o f their bound
aries.
Although the State conservation commission in its 1909 report
estimated that from 75 to 80 per cent of the land area o f this county
was suitable for cultivation, the 1910 census showed that only 54 per
cent was included in farms, and only 35 per cent of this, or less than
one-fifth of the total area, improved. Even with the large growth
that has taken place since then there is still ample room for new set
tlers in this northern county.
Type of farming.
Over almost all the county, except on the comparatively small areas
o f sandy soil, dairying is the main source o f the farmers’ livelihood.
The greater part o f the farm land is in meadow or pasture, and the
chief grain crops—oats, barley, and rye—are those used for feeding
stock. Timothy, blue grass, and clover all thrive; clover does espe
cially well, making good hay for milk production. Even on partly
cleared land grass and clover will grow luxuriantly among the
stumps; consequently such land can be utilized for pasture before it
is stumped and ready for the plow. Milch cows are kept, and milk,
cream, or butter is sold from almost every farm in these dairy dis
tricts. As throughout Wisconsin, cheese is the most important dairy
product, and cheese factories are found in practically every country
side; but proportionately more butter is made here than in the south-

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ern county. In 1916 there were 118 cheese factories and 18 creameries
(butter factories). Though few o f the cheese factories are owned
by the farmers, the milk producers are nevertheless commonly paid
on the basis of the selling price of the cheese rather than at a flat
rate.
In the sandy areas, notably in the Plover River Valley, potatoes
are the chief crop. In fact, this is one o f the main potato-raising
districts of the State, and potato fields o f 10 acres or more are com
mon. Yields range from 90 to 150 bushels to the acre, sometimes
running as high as 200 or 300 bushels in especially good years; but
in the year when the survey was made (1916) the potato.crop was an
almost total failure. Farmers in the sandy districts also raise cucum
bers on a large scale.
Roughly speaking, 80 acres is the standard size for a farm in this
county; that is to say, it is the smallest farm on which it is considered
that a family can live with reasonable comfort. This does not mean
necessarily 80 acres under cultivation, for many dairy farmers man
age remarkably well with as little as 20 to 40 acres cleared; but on
a “ forty ” a farmer feels cramped as to his future as well as his
present. On the other hand, the owner o f more than an “ eighty ” is
on the way to prosperity; farms larger than a quarter section (160
acres) are unusual.
Over one-third o f the farms visited in the survey were from 80 to
120 acres in size; and the 1910 census reported the largest number—•
nearly one-half (43 per cent)— o f the farms in the county in the
group o f from 50 to 100 acres. That the comparatively small size o f
the farms in this county does not indicate poverty is due both to the
fertility o f the soil and to the fact that practically all of it can be
intensively cultivated as soon as it is cleared.
Farm ownership.
Tenantry is not a problem in this county, for tenants’ farms were
only 4 per cent o f the total number at the last census. In this terri
tory it is entirely possible for a prospective farmer with little capi
tal to become a landowner. But the usual road to that goal is not
through renting an already developed farm but through purchasing
comparatively cheap, uncleared land under a mortgage and building
up its value through the farmer’s own labor. This means a hard
struggle for both man and wife in the early years, with living re
duced to the simplest basis ; but such poverty as this is lightened by
the hope and prospect o f “ winning out ” to comfort and prosperity.
Rural density.
Outside the city and the incorporated villages, the population o f
the county in 1910 was 32,378. Since* the unincorporated villages
are all comparatively small, this is practically the open-country

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POLISH WOMEN IN THE HARVEST FIELD.

CABIN IN A POLISH SETTLEMENT, W ITH COW STABLE, HAYLOFT, AND
DWELLING UNDER ONE ROOF.
18-1

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THREE GENERATIONS.

A POLISH M IDW IFE W ITH HER OWN BABIES.
18-2

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population and gives a rural density o f approximately 20 persons
per square mile. This average covers large variations in density be
tween the thickly settled and the sparsely settled districts. Thirteen
townships had 25 or more inhabitants per square mile; 1 o f these is
adjacent to the city and 2 contained unincorporated villages of some
importance, while 9 lie in the northwestern section of the county in
the region o f the older German settlement and within the clay-soil
area. On the other hand, 11 townships in different parts o f the
county had less than 15 inhabitants per square mile; some o f these
are situated where the land is poor, while others were merely unde
veloped. Certain o f these latter districts have had a large growth
in population since the census year.
Nationality.
The great majority o f both the early and the later settlers in this
county were German; and over at least three-fourths of its area the
county is strongly German in custom, language, and habit o f mind
up to the present day. There are a few Irish, Bohemian, Dutch, and
Norwegian farmers in isolated groups; and in the southeastern quar
ter o f the county there are two important Polish communities. The
larger o f these, in the Plover Kiver Valley, originated a generation
ago as an offshoot of a much larger Polish settlement farther down
the river in the next county; this, therefore, is a well-established com
munity. The other Polish settlement is the result o f development
during the past few years by a land company, which brought com
paratively recent immigrants to rough, uncleared land.
According to the 1910 census, the population of the county (includ
ing the one city) was 26 per cent native white of native parentage,
52 per cent native o f foreign or mixed parentage, and 22 per cent
foreign born. For the whole county more than three-fourths (78 per
cent) of the natives o f foreign parentage had both parents born in
Germany, and nearly three-fourths (72 per cent) o f the foreign born
hailed from Germany. O f course, these figures include the Poles of
German origin.
The foreign element, as the census shows, is largely American
bom ; but the Germans and Poles have been so numerous and have
segregated themselves to such an extent that they have retained and
handed down their foreign characteristics. So markedly foreign is
the general atmosphere that the county agricultural extension
teacher, upon being asked to name an American township, replied:
“ All are strongly foreign.” Another indication o f the persistence
o f foreign influences is the fact that not only half o f all the foreignborn mothers visited in the county but also 16 American-born Polish
mothers and 2 American-born German mothers were unable to speak
English. In the older Polish settlement, though 'the majority o f

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those bom in the United States can speak English, it is not at all
unusual to find those who can n ot; and Polish is still to such an ex
tent the language o f the family and the church that commonly chil
dren come to school lacking acquaintance with the English language.
Social organization.
The foreigners among the farming population are mainly of
peasant origin. Consequently, side by side with the advantages o f
peasant stock—strong physique, industry, and thrift—the community
has the disadvantage of the peasant’s strong attachment to his an
cestral customs. While the rural illiteracy rate at the time o f the
last census was not excessive—2 per cent among the native born and
7 per cent among the foreign born—the farmers in the strongly for
eign townships often do not realize the value for their children of
any further education than the district or parochial schools can
give. As might be expected, the mothers in these communities know
nothing of modern principles o f hygiene. Not only ancestral farm
ing methods but also ancestral ways of feeding a baby or o f caring
for a woman at childbirth are considered fully satisfactory, whilo
“ newfangled notions ” are viewed with suspicion if not hostility.
To be sure, certain districts are much more progressive than others;
in general, the newer communities are the more open to new ideas.
With one exception, all the larger villages have high schools.
Cooperative production, as exemplified by the cheese factories of
the southern county, has not found favor in this county. In the
western third of the county one of the national farmers’ associations
is well organized and has active locals. In this district cooperative
buying and selling organizations are numerous and seem to be thriv
ing; some of these ship and market cattle for their members, while
others are engaged mainly in handling feed and flour. There are a
few farmers’ cooperative stores in other parts of the county, and a
cooperative packing plant at the county seat.
This county, in its organized political capacity, has made certain
provisions to meet public-health needs that are in advance o f the
average. To wit, there are a county tuberculosis sanitarium and a
county hospital. The latter is located on the grounds o f the county
almshouse, but is under separate management. It was primarily in
tended for cases o f sickness which would be county charges, but
sometimes receives pay cases; it will care for obstetrical patients.
The county also has at the county seat an agricultural school, sup
ported in part by the county and in part by the State. This is open
to boys and girls who have completed the district-school course and
gives instruction in agriculture, manual training, and domestic
science. Although it has been in existence since 1902, it has never
had a large patronage. One o f the most important branches o f the

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work o f this school is its agricultural extension service—directed
mainly toward the improvement of live-stock breedng, through the
introduction of pure-bred stock and the formation o f cow-testing
associations. The extension officer working under the school prac
tically takes the place o f the ordinary county agent.
As a whole, it may fairly be said that none o f the social-service
agencies o f the county, except perhaps the district schools, has come
into helpful contact with the Polish settlements.
Means of communication.
The map o f the county gives the appearance o f ample transporta
tion facilities, for the county is served by three main railroads and
by two or three short branch roads. Nevertheless, 9 o f the 10 town
ships in the county have no railroad within their borders, and parts
o f other townships are also remote from any railroad. Because o f
bad roads, intercourse with the outside world and with other parts
o f the county is seriously hindered and curtailed in those districts
which lack railroad communications.
By reason o f the location of the railroads, the county seat is ac
cessible to the central and most of the eastern portions o f the eounty
and is the urban center for this area. But the western end, as well
as sections along the northern and southern borders, are more ac
cessible to cities in neighboring counties, and their interests gravi
tate in those directions.
Speaking generally, the roads o f the county are poor. Only a few
stretches—5 per cent of the total mileage1—have been surfaced with
rock or gravel. Even what are considered the main roads, though
fairly well graded, are for parts o f the year almost impassable—those
on clay soil in wet weather and those on sandy soil in dry weather.
Some o f the minor roads, which are the only means o f approach to
a large proportion o f the farms, are so rough that the use o f an auto
mobile at any season is practically impossible, and even wagon
hauling is difficult. One mother, who lived 7 miles from town at the
very end o f such a road, exclaimed, when told that the Government
was working for the good o f the children: “ Well, tell them to fix a
road through this section so that our children can go to school; it’s
only a little time o f the year that they can possibly get through the
swamp and forest.”
Large areas were still without mail delivery at the time o f the
survey, notwithstanding the 31 rural routes then in operation. In
the more inaccessible half o f one o f the townships included in the
survey, about 40 families had no delivery service; some o f these had
to send as far as 12 miles for their mail.
1 Public Road Mileage and Revenues o f the Central, Mountain, and Pacific State», 1914.
U. S. Dept, o f Agriculture Bulletin- No. 389.

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Along the western border, telephone lines cover the settled dis
tricts reasonably well and most of the homes have telephones ; but
in the central and eastern sections, the lines do not, as a rule, reach
any great distance back from the railroads and villages, or they serve
only one important customer in a district—such as a creamery, saloon,
or land office—leaving many farms miles away from any telephone.
Only 20 of 280 country families visited in these districts reported a
telephone in the house; while 120 were 2 miles or more from a tele
phone; and 40, 5 miles or more. In one township, a third of the
families had to send at least 5 miles to reach a telephone, and in an
other the situation was nearly as bad.
This lack of telephone facilities is keenly felt by many families
in these isolated neighborhoods; but, for some reason, the farmers
and the company have not been able to come to any agreement as to
the terms on which lines should be built and telephones installed.
Industries.
Aside from farming, the chief industries o f this district are still
those dependent upon the supply of wood. There are still some log
ging camps in the county, though most of the timber now marketed
is brought in by the farmers from their own land. Sawmills provid
ing lumber for local use are fairly common; and in the city there are
large saw and planing mills and woodworking factories o f various
kinds. Away from the city, along the Wisconsin River, are three
large paper mills, each with its mill village or settlement; these con
sume such quantities o f pulp wood that they must send outside the
county for much o f their raw material. A tannery provides a market
for hemlock bark.
In the north-central part o f the county, on both sides o f the river,
there are quarries which are said to produce an unusually good qual
ity o f granite. But they are a comparatively unimportant factor in
the life o f the countryside, for they employ only a small number of
men.
SELECTED

T O W N S H IP S .

In the northern county, the survey covered 7 townships and the 6
villages lying therein. These were selected primarily with a view to
representing both the districts where midwives are employed and
those where they are not. Preliminary information, furnished by
the State board o f health or obtained from local sources, indicated
certain townships in which at least half the births were attended by
others than physicians. From this list 4 townships were chosen in
which both the number o f births and the proportion o f midwife cases
were large, and in which other conditions were varied. These town
ships happened to lie in the central part o f the county. Therefore, the

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22-1
LK GOES

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COUNTRY CH EESE FACTORY

22-2
PAPER

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LL AG

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W IS C O N S IN .

3 other townships, in which practically all the births were attended
by physicians, were selected, 2 from the western border and 1 from
the eastern border, in order to cover as far as possible the different
sections o f the county.
Four o f the selected townships are strongly German; one is almost
exclusively Polish; one about half German and half Polish; and one
of mixed nationalities—Norwegian, German, Polish, and American.
One of the important Polish settlements and half the other were
included; thus the Polish element was represented out of proportion
to its importance in the county as a whole.
Two of the German townships belong in the older and compara
tively well-developed districts, though in each there are sections
where conditions are still primitive. One of these is counted among
the most progressive communities in the county, the other among the
most conservative. The other two are in the main more recently
settled, with large areas o f wild land.
The villages comprised five which are rural community centers,
and one paper-mill town which had practically no organic relation
to the countryside. In this latter village were found a number of
Polish mill hands, though the township in which it lies is German.
A second paper mill is located within one o f the townships covered,
and many o f its operatives live near b y ; but there is nothing which
could be called a village. Two o f the villages lie on both sides o f the
county line; consequently, only part of each was covered in the
survey.
F A M IL IE S

IN C L U D E D

THE

SU RVEY.

The large majority o f the 453 families visited in the northern
county lived in the open country; less than one-fifth (87) were
villagers.
Nationality.
In the northern county live large groups o f persons o f German
and Polish nationality, who, even when born in the United States,
are practically unassimilated. They have retained to such an extent
the customs and language of the German and Pole, respectively, that
it was thought best, in order to give a true picture o f the life and
customs o f this community, to group them according to their na
tionality rather than according to their country o f birth.1 The par
ents in the families visited have been classified in four nationality
groups:
1. The native-born fathers and mothers o f native parentage on
both sides, who for the sake o f brevity are referred to as the Amer
ican group.
1 The term “ nationality ” is thus used to designate a racial group inheriting common
customs and a common language— its meaning in discussions of problems of immigration.
In this sense it has no implications in regard to allegiance or citizenship.

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% The German group, comprising those o f German “ nationality n
born abroad together with those b om in the United States whose
fathers were foreign-born Germans (the mothers o f this group, are
sometimes referred to as the German mothers).
3.. The Polish group, consisting similarly o f foreign-bora Poles
and. o f those born in the United States whose fathers were foreignborn Poles (the mothers o f this group are sometimes referred to as
the Polish mothers).
4. The “ miscellaneous and other foreign ” group, consisting of all
others o f foreign birth or o f foreign or mixed parentage. The last
three groups are combined into—
5. The “ foreign” group.1 Where it is necessary to differentiate
those born in Germany or Poland or abroad from those included in
the “ nationality ” or “ foreign ” groups,, the former are specifically
designated as born in Germany, born in Poland, or foreign bom.
Among the 898 parents whose nationality was reported, 162 (18
per cent) were natives of native parentage on both sides (the Ameri
can g ro u p ); 359 (40 per cent) were o f German birth or parentage
(the German group), of whom only 72 were o f foreign birth; 27£
(30 per cent) were o f Polish birth or parentage (the Polish group),
o f whom 167 were foreign born ; the miscellaneous group consisted
o f 104 persons, o f whom 29 were o f foreign birth. The foreign born
o f all nationalities, therefore, formed a little less than one-third
(30 per cent) of the whole group, while the native parents o f foreign
or mixed parentage made up over half the total (52 per cent).
As the figures show, the German was the largest group; it was in
the majority in three townships and one village and formed the
largest nationality group in another township and village. Even
these proportions understate the importance o f the German element
in the county as a whole, because while both the main Polish
settlements were included in the survey, it was impossible to cover
more than a. sample of the German districts. Four-fifths o f the
German parents visited were born in the United States.
The Polish group formed the majority in the two townships in
which lie the two large Polish settlements; in one o f these prac
tically all the Polish parents were foreign born, while in the other
most o f them had been born in the United States. In this latter com
munity, where all but 3 out of 53 families visited were Polish, 17
native Polish mothers were encountered who were unable to speak
1 On the schedule the nationality of each of the grandfathers of the baby was recorded.
Since in nearly all families- both grandparents on either, side were o f the same nationality,
the nationality of the grandfather given on this record was usually that of the grande
m o th e re v e n when the grandfather was foreign bora and the grandmother native she waa
practically always of the same nationality as her husband. On the other hand, when the
grandfather was native but the grandmother foreign born, the specific foreign nationality
was not recorded ; such cases have Been included o f necessity In the miscellaneous group.
They embraced only 2 fathers and 9 mothers out o f the 906 parents included in this study.

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English. The husband of one o f these women, himself foreign born
but with a good command o f English, told the agents that he would
like to move away from that district in order that his wife might
learn English. Nearly all 52 out o f 58—the foreign-born women
in this county who were unable to speak English were Poles.
Among the mothers visited in the northern county the illiteracy
rate was much higher than in the census figures—5.4 per cent for
the native born instead o f 1.6 per cent and 26.7 per cent among the
foreign born instead o f 6.8 per cent. These high rates are largely
chargeable to the Polish women, for while only 1 per cent of the
mothers o f native parentage were illiterate, and only 4 per cent of
the German mothers, 28 (36 per cent) o f the 78 foreign-born Polish
mothers and 12 (21 per cent) of 58 bom in the United' States were
unable to read and write in any language.
Father’s occupation.
As was to be expected, nine-tenths o f the fathers living in the
country were engaged in farming. Nearly all these were farmers
on their own account; only 7 farm laborers and 2 farm managers
were included. Eighteen o f the nonfarmers were paper-mill men,
most o f whom lived in a group in the country near a large paper
m ill; 5 fathers were cheese makers; 3 worked in the quarries, 4 in
the building trades, and 2 at lumbering.
In this county, a large proportion—between one-fourth and onethird— o f the farmers found it necessary to eke out their incomes by
some kind o f supplementary work, as loggers or woodcutters, masons
or carpenters, saw-mill or paper-mill hands, or farm laborers. This
was especially true o f the Poles in the new settlement; since most
o f them had for the basis o f their farming operations only 20, 30,
or 40 acres o f practically uncleared land, inevitably almost everyone
resorted to day labor of some kind. A number o f them walked daily
6 miles or more to the nearest paper mill.
The fathers living in the villages represented a greater diversity
o f occupations—masons, carpenters and builders, blacksmiths and
other mechanics, storekeepers, saloon keepers, bankers, laborers,
teamsters, etc. The largest group (27) was made up of the papermill hands. A few farmers and farm laborers lived in the villages.
Land tenure.
Ten per cent o f the fathers included in the survey were tenants.
This is much larger than the proportion of farms operated by ten
ants given in the census reports; to wit, 3.5 per cent. There is no
reason, however, to believe that the proportion o f tenants was actu
ally greater in the selected townships than in the county at large.
To some extent the apparent difference between the two figures
may be due to an actual increase in tenantry since the census date:

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but it seems more probable that the chief explanation lies in the
fact that the older farmers, who are more apt than the younger men
to be landowners, are as a rule not in the count when the fathers o f
young babies are enumerated.
More than half the landowning fathers were carrying mortgages
on their farms and many were newcomers, struggling through the
early stages o f land clearing. Therefore it is entirely natural that
in many o f these families as well as in the tenant families expendi
tures were carefully pruned down to what was regarded as abso
lutely necessary.
M A T E R N IT Y

CARE.

Childbearing is an experience which comes often to these country
mothers. Thirty-three of those interviewed had borne children
twice within the two-year period o f the survey; nearly two-thirds (65
per cent) o f those who had been married at least two years had
borne a child or had had a miscarriage more than once on the aver
age in every two years of their married lives. For 4^ of them, this
meant 10 or more pregnancies. This condition is reflected in the high
birth rate o f the rural districts o f the county— 30 per 1,000 popula
tion in 1914 and 1915.1 For such mothers, injuries from overwork
or neglected complications are all the more menacing, because their
effects become cumulative.
Availability of physicians.
The American Medical Association directory for 1916 lists 48
physicians in this county, the majority of them located at the county
seat. This means one doctor to about every 1,300 inhabitants, which
is nearly twice as large a number o f persons per physician as the
average for the United States (6912).
Most o f the villages had resident physicians at the time of the
survey; but five, including one place o f between 400 and 500 in
habitants, had none. This latter was included in the survey; a
doctor from the city held office hours there twice a week; but when
ever he was needed in an emergency he ordinarily had to come 7
miles by road. There are large areas where a country family may be
from 10 to 15 miles from a doctor. It is in exactly these sections
that the roads are roughest and most apt to be in bad condition, and
that often there is no direct road to the nearest doctor. Some of
these neighborhoods which are practically isolated from medical
service were included in the territory covered by the survey. Sixtysix of the 395 confinement cases in the open country occurred in
families living 10 miles or more from a doctor; for only 8 o f these
1 Twenty-sixth Report of the State Board of Health of Wisconsin, 1916, pp. 316 and 318.
* American Medical Association Bulletin, Jan. 15, 1917, p. 99.

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cases was a doctor secured. And in this county, outside the vil
lages where there was a resident doctor, only two-fifths o f the fami
lies were living within 5 miles o f a physician’s headquarters.
How serious may be the delay in getting a doctor when an emer
gency arises was shown by a tragic experience o f one o f those coun
try families, that lived 12 miles from a doctor and 6 miles from a
telephone in an isolated district o f rough roads. One evening in the
winter, when the snow was deep, the 6-year-old child had a nose
bleed which could not be stopped. A t midnight the doctor was sent
for, but he lost his way in the night, had to go back to town, and did
not reach the home until 3 o’clock the next day. The bleeding had
continued all the while, with the result that the child died just after
the doctor arrived. This family—which had seven other children—<
“ never had a doctor in the house ” except this one time.
Attendant at birth.
Before the survey was begun it was known that a large proportion
of the births in the county were attended by midwives. The investi
gation showed that the true proportion was even larger than the
official figures indicated, because many births attended by midwives
were either not registered or registered under the father’s name as
informant. As has been explained, four of the seven townships, with
the three villages therein, included in the study were chosen because
maternity care was largely in the hands of midwives. In these
townships and villages 50 per cent o f the 335 confinements for which
records were secured were attended by midwives, while 8 per cent
had no professional attendant. In one Polish township, only 5 out
o f 59 confinements were attended by physicians. In the other dis
tricts, where midwives' were practically unknown, o f 151 confine
ments 139 were physicians’ cases; 3 had no regular attendant; and
only 9 were attended by mid wives (8 o f these in one township).
The proportions for all districts together were: Physicians, 58 per
cent; midwife, 36 per cent; other attendant or none, 6 per cent.
O f the 28 mothers who had no professional attendant at confine
ment during the survey period (2 o f them twice during the 2 years),
22 belonged to the Polish group, 2 were foreign-born German, and 1
was Indian. Twenty o f these confinements were attended by a
neighbor, four by the father, three by the grandmother, one by an
aunt; and two mothers—one of whom was herself a midwife—de
livered themselves, as they had done at six and seven previous con
finements. None o f this group of mothers was giving birth to her
first baby and half had managed with similar informal assistance at
previous births. Among the other half who had had either a phy
sician or a midwife at each previous confinement, not a single one
had had a physician each time. Five mothers, including the Indian,

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had. never had either a doctor or a midwife present at confinement;
one o f these had borne 11 children,, one 8, one 7, one 6, and one 8.
Such a situation comes about sometimes without any particular
choice on the part o f the parents, as shown in the ease o f one Polish
family living at the end o f an almost impassable road. The father
stated that there was never time to go for help because his wife was
usually in labor less than an hour ; consequently he always tied the
cord and cared for the mother. Several mothers in the group re
ported labor o f less than an hour’s duration; as one expressed it, the
baby came alone,” or as the Polish women say, u it was born in two
pains,” with the consequence that u there was no one on hand but a
neighbor,” and sometimes even the neighbor was late. With the ma
jority, however, there was doubtless an element o f deliberate intent
in the situation, even if unacknowledged. Among the Poles espe
cially the opinion is not uncommon that a mother should be able
practically to deliver herself, and that a physician is not only super
fluous but even undesirable. One father stated vehemently: “ I
would not let a doctor come near my wife.” His wife, who had borne
eight children, said that she always delivered herself, cut the cord,
and washed the baby before going to bed, calling only upon a neigh
bor or her husband to hand her supplies. That such a practice can
not be counted upon for safety even when everything has repeatedly
gone well is exemplified by the experience o f this same mother. A t
her ninth confinement, which followed almost immediately after the
agent’s visit, spontaneous delivery was impossible because o f a face
presentation; after she had been in labor three days, the doctor had to
be summoned to turn the child.
One o f these women, who had lived all her married life within 2
miles o f a doctor, had tried all kinds o f obstetrical care m the course
o f her 20 years’ experience. She had had 3 miscarriages and had borne
15 children. Two o f the children were stillborn; both these births—
instrumental deliveries following protracted labor—were attended
by physicians. Two other children had died before they were a day
old, and a third at 8 days; all these were delivered by physicians,
in one case after 2 days’ labor. O f the 10 living children, 4 were
delivered by a doctor, 2 by a midwife, 1 by a neighbor, and 3 by the
father. Two o f the babies (including the last), who were ushered
into the world by their father, were born after very brief labors.
In the eases o f 23 mothers who are counted as physicians’ patients,
the doctor did not arrive until after the birth had occurred, some
times only a few minutes late but occasionally as much as two hours.
In the majority o f cases these doctors had to come 5 miles or more,
sometimes over bad roads; only one o f these births (a protracted,
labor which suddenly terminated while the doctor was away) oc-

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curred in the doctor’s home town. Most often, some neighbor or rela
tive who was present tied the cord and attended to the baby; but in a
few instances this was left for the doctor. One mother reported that
her baby “ just laid till the doctor came” and apparently suffered no
harm by the two hours’ wait. Usually the doctor examined the
mother and baby after he arrived ; thus the mother was to that extent
protected from complications. Occasionally, however, a story was
told o f a doctor who came late and neither looked at the baby nor
examined the mother.
In some instances the attendant midwife also failed to reach her
patient on time. Naturally this happens less often in a midwife’s
practice, both because she is apt to be closer at hand than the doctor
and also because she seldom has other patients to delay her.
Hospital confinements.
In the northern county there are two general hospitals at the
county seat, one o f 60 and one o f 24 beds. These and the county hos
pital are available for obstetrical work; a large hospital just outside
the comity line is easily accessible to the people along the western
border. A t the worst, in order to reach one o f these hospitals, a
railroad journey o f several hours might be necessary for the people
near the eastern border, since the connections are poor; and in the
isolated districts it might take two hours or more if the roads were
bad, to reach the railroad.
In spite o f facilities near at hand, the only mother included in the
survey who was confined in a hospital went to Milwaukee—not as an
emergency measure but as an insurance against possible difficulties.
However, hers was,a notable exception to the general attitude on this
subject. By most families in the county the idea of going to a hos
pital for confinement would undoubtedly be regarded as preposter
ous; certainly it is almost never done.
Obstetrical service by physicians.
The use of obstetrical forceps was much more frequent in this
county than it was found to be in the Kansas survey. In 10 per cent
(48 cases) o f all the deliveries included in the survey instruments
were used, instead of in less than 5 per cent as in Kansas; this was IT
per cent o f the confinements attended by physicians in the selected
districts. Twenty-one o f these forty-eight cases were first births,
seven were stillbirths, and one child died within the first few hours.
No physician used the forceps in any large number of cases; but if
the doctors who had the most cases in the area o f the survey (at least
10 eases each) are grouped according to their use of instruments, it
develops that out o f 86 births attended by one group only 5 were in
strumental, while among 49 attended by another group, 13 (over onefourth) were forceps cases.

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One o f the great difficulties in rural obstetrical practice is the
matter o f waiting for normal dilatation. A physician in general
practice may have other patients critically ill or may have other im
pending obstetrical cases; and it is very difficult for him to go miles
into the country, many times entirely away from a telephone, and to
wait 10 or. 15 hours or more for nature to take her course. The
saving o f time effected by the use of instruments is a great temptation.
The large majority o f the lacerations recognized by the mothers
had been repaired, though in a couple o f cases the operation had
been unsuccessful. But four mothers reported what they considered
severe lacerations which had been neglected by the attending physi
cian. A few other mothers felt strongly that they had suffered from
the doctor’s carelessness at the time of confinement.
Nearly half the country mothers attended at confinement by a
physician were never revisited after the baby was born, and only
one-fifth received more than one subsequent visit. This is prac
tically the same situation as that found in the lowland county in
North Carolina, but somewhat worse than in western Kansas or in
the southern part o f Wisconsin (see p. 63). Evidently the vital
importance of postnatal supervision is not recognized in any o f
these country districts. Since postnatal visits far out in the country
are difficult for a busy doctor to make, as well as expensive for th©
family, there is every incentive to take for granted the safe progress
o f mother and baby; but this is doubly dangerous in districts where
even telephone messages are hard for the family to send. That the
lack o f “ after care ” is not due wholly to inaccessibility is indicated
by the fact that out o f 35 mothers attended by physicians in villages
where there was a resident doctor, 7 (one-fifth) received no postnatal
visits and 10 received only 1.
Midwives.
The midwife is a factor definitely to be reckoned with in a study
of maternity care in this county. As has been mentioned, a large
proportion o f births in certain communities were attended by mid
wives; in all, records were secured for 175 midwives’ confinement
cases. Because of the importance of the problem, it was decided to
secure directly from these women certain additional facts about
their training and methods.
In classifying the attendant at birth, any woman who was con
sidered by the neighborhood competent to take the responsibility for
delivering a child and was engaged for that purpose was counted as
a midwife. Twenty-four women were so classified; some o f these
attended only one or two of the births included in the survey, but
all had had considerable experience and were looked upon as part
of the neighborhood’s resources in providing for childbirth. O f the
24 midwives included in the list, 6 had each delivered 10 or more

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children for whom schedules were secured, while 2 — 1 German and 1
Polish— delivered each more than 30. A number had a much larger
clientele than the schedules indicated, even during the survey period,
because they practiced outside the territory covered by the survey.
As thus used the term “ midwife ” does not necessarily imply train
ing or legal status. O f 14 midwives concerning whom the informa
tion was obtained, only 2 had attended a training school of any kind,
though several had been taught by physicians and worked under
their supervision; and only 2 out of the whole list of 24 held an
official certificate entitling them to practice.
The Wisconsin law provides that no midwife may practice for pay
without a certificate o f registration, issued by the State board of
medical examiners; the requisites for such certificates are (1) pre
senting a diploma from a reputable accredited school o f midwifery,
together with evidence o f good character, and (2) passing an ex
amination given by the board.1 In Wisconsin there is no school of
midwifery known to the authorities; consequently, only women
trained outside the State can qualify for the examination.
Only two o f the women who were found to be acting as midwives
were reported by the State board of medical examiners as registered.
These were both professional midwives living in the city and taking
occasional cases in the country ; the two attended only 3 out of the
175 widwife cases included in the survey. It is only to be expected
that women living in isolated neighborhoods and attending perhaps
only two or three confinements a year, should not trouble to secure
certificates. But that midwives with large practices should fail
to do so is a more serious matter. From the midwife’s point of
view, there are several reasons for this. One woman, with a large
practice and good training, was ignorant of the necessity of a State
certificate, considering her diploma all sufficient. Others knew that
they were debarred because they had no diplomas to present, having
never attended a school. Yet others feared the expense and trouble of
going to Milwaukee or Madison for the examination; to poor, illiter
ate Polish women who could not speak English such a prospect natu
rally seemed appalling. And though most of these women were aware
that a “ license ” was required—and were therefore chary of ad
mitting that they received pay for their services—they had practiced
unmolested for so long that they felt under no necessity to comply
with the law. Certain o f these unregistered midwives had filled out
birth certificates in their own names for years.
In part, the employment of midwives seems to have been a
natural—almost an inevitable—result of the isolation o f many o f the
early settlements and of many neighborhoods at the present day,
i Statutes 1917, secs. 1435b, 143Cf-12, and 1436f-13.

01202°—19---- 3

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making it expensive and often practically impossible to secure a
doctor. Under sucb circumstances it frequently happens that one o f
the neighbor women who are Galled upon to help in emergencies de
velops special skill in such work and soon finds herself more and
more drafted into service. In these communities the women are
often in labor only a short time—a few hours at most—and deliveries
usually proceed without difficulty. I f thrifty pioneers have once
had the experience o f paying the bill o f a physician who ar
rived too late to be o f any service—at least so it appears to them—
they are apt to ‘choose a neighboring midwife for the next occasion.
When to such conditions come settlers like the Germans and Poles,
who have been accustomed to the services of midwives in “ the old
country ” and prefer them to physicians, midwifery is likely to be
come an established institution.
A few o f the midwives encountered in the course of the survey
made their living by the practice of midwifery, but the majority
u went out ” mainly as an accommodation to their neighbors. They
were farmers’ wives, living in sparsely settled districts where there
would not be enough obstetrical cases to support a professional mid
wife. Some who had previously been in active practice would have
preferred to give up such strenuous work as they grew older; only,
as one elderly Polish woman said, “ I f I go not, what becomes o f
the women?”
H alf the midwives were Polish women practicing in Polish settle
ments ; nearly all the rest were German. Midwives attended 31 per
cent of the confinements of German mothers and 61 per cent o f those
o f Polish mothers, while only 16 per cent of the births to American
mothers o f native parentage were in the hands o f midwives. Polish
immigration is so recent as compared with the German, and the
Polish people have mingled with other nationalities so much less
even than the- Germans, that it is not surprising that the Polish
women have clung more tenaciously than the German to the oldworld custom o f employing midwives. From all accounts it seems
probable that the midwife W a s as commonly employed in the German
settlements a generation ago as she is to-day in the Polish settle
ments. The really surprising fact is that Polish mothers born in
America employed mid wives much more and physicians much less
than did the immigrants, though they were less likely to go without
any attendant. Why this should be is not clear. Inaccessibility of
physicians could not have been the chief cause o f this difference, for
they were about equally inaccessible to the two chief settlements.
Several of the foreign-born Polish women who employed a physi
cian had to have a version or an instrumental delivery performed;
others had had difficulties at previous confinements which made them
anticipate the necessity for a doctor.

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As a general proposition there is no question that the difficulty of
securing a doctor is one o f the important factors leading to the em
ployment o f midwives in the country districts. In most of the com
munities studied the midwife was a neighbor o f her patrons and was
employed in preference to doctors who were a long distance away.
Taking all the selected districts together, three-quarters of the midwives’ patients were 5 miles or more from a doctor, while three-fifths
o f the doctors’ cases lived within 5 miles. Where there was no doc
tor within 10 miles, a midwife was employed in three-fourths o f the
confinements and in another one-ninth there was no regular at
tendant. But in the country where there was a physician within 5
miles, a midwife was employed for only one-eighth o f the con
finements.
The greater convenience o f securing a midwife in isolated neigh
borhoods does not explain the whole situation in the county, how
ever, for a midwife was employed in over one-third o f the village
cases where there was a doctor in the same village. One o f the Ger
man midwives living in the city told the agents that she had some
times driven as far as 30 or 40 miles out into the country to care for
women at childbirth. And in one o f the German districts included in
the survey the midwife, who depends upon her work for her liveli
hood, lived in the village where there were three doctors and was
called upon both in the village and in all the surrounding town
ships in preference to these doctors. She had practiced in that
neighborhood for 20 years. In the village she attended two-thirds of
the births scheduled and in one o f the adjacent townships nearly
half; the majority of her patients were German, but a number were
American o f native parentage. One of the village physicians, when
asked how it happened that the doctors did so little o f the obstetrical
work, replied: “ Well, to tell the truth, it is largely our own fault.
We don’t like that kind o f work and have always more or less, turned
it over to Mrs. M.”
Mrs. M. was a well-educated woman, with a diploma from a school
o f midwifery; she gave the impression o f being both cleanly and
capable and had that reputation with the local doctors also. She
said that she used carbolic-acid solution in cleansing her hands and
in preparing the mother. She sometimes made several examinations
during labor, but “ sometimes there is not time to make any.” She
gave douches o f “ plain water,” but boiled the apparatus each time.
She carried a bag with cotton, gauze, umbilical tape, two syringes,
and a supply o f carbolic acid.
Among her patients she was highly esteemed; some o f them she
had attended at every childbirth—six, seven, or eight times—as long
as they had lived in her territory. One o f her regular patrons ex

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maternity and infant care

plained the attendance o f a physician at one birth by saying that
she “ wanted Mrs. M. that time but could not get her.” More than
one mother “ tried a doctor once” and had the midwife every time
afterwards. Mrs. M. frequently acted as nurse when a physician was
in charge o f the case. One or two mothers had her as nurse until
the last confinement, when, because the doctor could not be secured,
the midwife took charge. She was apparently careful to call a
doctor when anything seemed to her to be going wrong, and almost
never failed to do so in case of a miscarriage.
Mrs. M.’s. ordinary charge was $5. She expected her country pa
trons to furnish transportation and did not ordinarily revisit un
less they sent for her; in the village where she lived, however, she
customarily made two daily visits for 9 or 10 days. Naturally her
village patients were enthusiastic over the service secured; one o f
these mothers said that she liked the midwife much better than a
doctor, she does lots more for you.” She gave no prenatal super
vision to her country patients, but occasionally “ dropped i n ” to
advise those living in the village.
Typical o f the German neighborhood midwife was Mrs. R., whose
family homesteaded 40 years ago in an isolated neighborhood 9 or
10 miles from town, where they still live. Her first three children
were born in Germany, under a midwife’s care. On the Wisconsin
clearing eight more were born; she never had a doctor in the house
for any cause during all those 40 years; and at childbirth sometimes
had not even a neighbor’s assistance. She brought with her from
Germany a textbook on midwifery, and soon became the neighbor
hood’s mainstay for care at childbirth. A t one time she held a
State certificate but allowed it to lapse. She did not like to discuss
her practice or methods—she speaks no English—but said that in all
her experience in that neighborhood she had known o f only one
stillbirth and no maternal deaths at childbirth.
Records were secured o f 16 births which she had attended during
the two years o f the survey, o f which 5 were her own grandchildren.
She was then 65 years old, and said that she did not want to “ go
o u t” but the neighbors would not let her alone. No one would
admit that she made any charge, bub “ we just gave her something,”
usually about $2 or $3. She rarely saw her patients in her pro
fessional capacity either before or after confinement, even when the
baby was her own grandchild.
O f a different type was a much younger woman who had a large
practice in one o f the paper-mill villages, 7 miles from a resident
doctor. She began her work casually, through being summoned in
an emergency to help the doctor from the city. He thought her so
capable that he called upon her frequently after that, and before

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long recommended her as able to do as well for these women as he
could. For several years before her death the large majority of
the births in the village were in her hands. She studied assiduously
and even went to a hospital in Chicago for a few weeks. O f all the
midwives, she gave the most attention to her patients—advice dur
ing pregnancy as well as care during the puerperium—and seems to
have been really devoted to the work and to her patients. She in
sisted that her patients stay in bed 10 days; during that time she
made two visits daily, bathing mother and baby and doing every
thing possible to make them comfortable. Sometimes she even took
home and washed the soiled linen “ so as to have something clean
to put on them the next day.” For all this service she charged $12
to $15.
The Polish midwives, as a class, gave the impression o f being
much less cleanly than the German ones. But some o f them seem
to have developed skill in their work and to be remarkably success
ful. A neighboring doctor with a large practice among the Poles
begged the agents to try to get one o f these midwives to “ wash her
hands occasionally ” ; but almost in the same breath he acknowledged
that he had never known a Polish woman to get a puerperal in
fection.
One Polish midwife, herself an immigrant, delivered more than
half the babies born in the recent Polish settlement; most of her
neighbors regarded her as indispensable to their safety. She was
seldom called until labor began; many were the tales o f her running
2 or 3 miles to “ be on time for the baby,” since neither she nor her
patient had a horse. She practically supported her family through
her own work in the fields and among the neighbors, for her husband
had been disabled by an accident in the mill. When her patients
were within walking distance she usually made one or two visits a
day during the lying-in period and sometimes did the absolutely
necessary housework. Her statement as to compensation was: “ Some
times 50 cents, sometimes $2, sometimes $5, sometimes they forget to
pay anything.” She had no schooling and no formal training, but
had picked up some traditional midwives’ lore from her grandmother
and had worked under a physician’s supervision in another State
before coming to Wisconsin. She said that she used carbolic acid in
the water with which she washed her hands.
In the older Polish settlement the obstetrical practice was divided
among a number o f neighborhood midwives, most o f them old women
and illiterate. Four o f them were interviewed. A ll were crude and
primitive in their methods, without any training for their w ork; ac
cording to their statements they carried no equipment; and, with the
exception o f one who' had a bottle o f bichloride tablets given her

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by a doctor, they made no pretense o f using antiseptics. Before
making an examination they all “ washed their hands and greased
them with lard or any grease they had.” A ll claimed that they
called a doctor whenever complications appeared but that the neces
sity seldom arose. However, a patient o f one o f these women—her
own daughter-in-law, from whom a schedule was secured—was al
lowed to be in labor three days with what was probably a breech
presentation before a doctor was called. Only one made a practice
o f revisiting her patients. One charged $2, the others took “ what
they give.” These four women together probably cared for about
40 cases a year.
Seldom was the midwife consulted during pregnancy; in only
one-seventh of the mid wives’ cases did the mother see her attendant
until labor began. Only one midwife gave her patients any con
siderable prenatal supervision. On the other hand, nearly twothirds (65 per cent) o f the midwives’ patients were visited after con
finement, in contrast to a little over half (54 per cent) the physicians*
patients; half the mid wives’ patients (89) received at least two
postnatal visits. The case is, o f course, not exactly parallel with a
doctor’s practice, because the midwives who made more than one
visit to their patients after confinement were really acting in the
capacity o f obstetrical nurses; moreover, the midwives usually lived
closer to their patients and seldom revisited unless they did live
near.
No one o f the midwives interviewed used instruments or anaes
thetics, or repaired lacerations. They seldom interfered with the ex
pulsion o f the afterbirth; without exception they reported that it
was their custom to wait for it to “ com e” naturally. As a rule,
they used common twine to tie the cord. A ll stated that they called
a physician immediately i f they recognized an abnormal condition.
However, it seems fairly certain that at least some o f them were
willing to perform versions.
Among the 178 births attended by midwives for which records
were secured, there were 4 stillbirths and 6 deaths under 2 weeks of
age. There was 1 maternal death, due to sepsis developing about a
week after confinement.
Nursing care.
In none o f the districts studied was there a resident trained nurse;
but families in the central part o f the county could secure trained
nurses from the county seat. One o f the hospitals gives a nurses’
training course, and there are said to be about 18 trained nurses lo
cated in the city. Two country mothers—in addition to one who

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went to the city for confinement and the one mentioned who went
away to a hospital—had trained nurses at the time o f childbirth; one
o f these nurses was the mother’s sister; thus only one was employed.
In this county the practical nurse was replaced in the midwife
districts by the midwife as a semiskilled childbed nurse. O f 486
confinements, 24—practically all in communities where there were no
midwives—were nursed by practical nurses and 98 by midwives, giv
ing together a proportion of about one-fourth who had semitrained
nursing care. In 86 out of these 93 cases the midwife was the at
tendant at birth as well as the nurse. As has been said, these women
seldom remained in the home or did the housework, but rather made
visits once or twice a day.
The remaining three-fourths o f the mothers did as most country
women do at childbirth—depended upon relatives or neighbors for
their nursing care. It is difficult to see how the great majority o f
country mothers would manage if they could not call upon their
mothers and sisters for help in such emergencies. There are not
nearly enough nurses o f any grade to do all the childbed nursing
in any of these country districts in Wisconsin; and, aside from the
difficulty o f securing hired girls, those who can be secured could
hardly be trusted to give as conscientious care as the mother’s own
“ folks.” O f course hardships sometimes occur, as in the case o f one
mother who was left to care for herself and her baby for two days,
with only a daily visit from a neighbor. On the third day she be
came seriously ill; then her mother-in-law and the neighbor “ stayed
a day and a night, and worked over her all day
but after the fever
subsided she had to care for herself again.
Prenatal care.
Less than one-fifth (19 per cent) o f the mothers attended at birth
by physicians had any medical care or supervision during pregnancy;
only a very few (9) who were attended by midwives came under a
doctor’s care during pregnancy. In the districts covered, in only
one-eighth of the recorded pregnancies did the mother have any med
ical prenatal care. In the villages nearly one-third of the mothers
who had a doctor at childbirth had some care from him during
pregnancy; but in the country only 1 in 6. As was to be expected,
the mothers o f the foreign group sought medical care during preg
nancy much less than mothers o f the American group; one-fourth
o f the native mothers of native parentage had prenatal care, but
only one-eighth o f the German mothers, and only 1 in 50 o f the
Polish mothers. Taking the three foreign groups together only
1 in 32 o f the foreign-born mothers and approximately 1 in 10 o f
the native women o f foreign parentage had any prenatal care.

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Where a mother gets to town only once or twice a year, or where
the town in which the family does its business has no resident physi
cian,-it is hardly to be expected that she will secure medical super
vision during pregnancy; certainly not so long as she regards such
care as a superfluous luxury. This is emphatically the case in the
foreign groups, who consider a physician, even at confinement, an
unnecessary expense. Over a large part of the northern county, a
campaign of education of the general public will probably be neces
sary before the mothers as a rule will be willing to seek or accept
prenatal care.
For the purpose o f classifying the care received by mothers during
pregnancy, the following outline of requirements for adequate medi
cal prenatal care was drawn up after consultation with Dr. J. Whitridge Williams, professor of obstetrics in Johns Hopkins University:
1. A general physical examination, including an examination of
heart, lungs, and abdomen.
2. Measurement o f the pelvis in a first pregnancy to determine
whether there is any deformity which is likely to interfere with
birth.
3. Continued supervision by the physician, at least through the
last five months o f pregnancy.
4. Monthly examinations of the urine, at least during the last
five months.
Though this standard is no higher than is necessary to insure the
early detection o f abnormal symptoms and conditions, it is not a
standard which is generally attained in private or public practice,
either in cities or in rural districts.
Patients whose supervision fell short of these requirements but
included at least one personal interview with the physician, with
a physical examination and with measurement o f the pelvis if a
first pregnancy, and one urinalysis are classified as having had fair
care.
As the facts were reported by the mothers, only 2 of the 63 mothers
who came under a doctor’s supervision during pregnancy had ade
quate care according to this standard; neither o f these was carrying
her first child. Nine had fair care—only 1 of these was a first preg
nancy and in this case the pelvis was measured; 7 out of the 9, more
over, saw the physician only once and had no subsequent urinalysis.
Two others received care which would have been fair if they had not
been primiparse. O f the 52 who had inadequate care, 5 did not see
the physician; 29 who saw the doctor received no physical examina
tion ; and 40, or three-fourths, had no urinalysis. Evidently the im
portance of testing the urine for albumin—the only sure way o f de
tecting the beginning of toxemia or “ kidney trouble ”—needs especial
emphasis in this community.

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M ATERNAL

W IS C O N S IN .

M O R T A L IT Y .

Three maternal deaths connected with childbirth occurred in the
selected districts during the survey period. The causes o f death were
reported as “ toxemia, uremic eclampsia, pregnancy,” “ puerperal em
bolism o f the heart,” and “ septicemia.” Two of the three were doc
tors’ patients. The one who died o f septicemia was attended at
confinement by a m idw ife; the mother became ill after having been
up and around the house at the end of a week, and then called in a
physician. She died six weeks later, after two operations. Her
baby lived and thrived. The full record could not be secured for the
mother who was reported to have died o f toxemia, because the family
had moved away; she bore stillborn twins at that time. The third
mother “ felt fine” during her first pregnancy, but had a difficult
forceps delivery, followed by constant hemorrhage, which her hus
band believes was the cause of her death. Her baby was stillborn.
The county death certificates show IT deaths outside the city from
causes connected with childbirth -in the period of the survey. There
were 2,540 registered births during this period, which gives T mater
nal deaths per 1,000 births.1 In 1915, when the estimated population
of this rural area was approximately 42,500, there were 8 maternal
deaths connected with childbirth, or a maternal mortality rate o f 19
per 100,000.2 These rates are only slightly higher than the rates for
the birth-registration area and the death-registration area o f the
United States. But the rates for the registration areas are, in their
turn, considerably above the rates in certain foreign countries.3
M O T H E R ’S

W ORK.

Rest before and after confinement.
One-fourth of the mothers visited remained in bed for the cus
tomary period o f 10 days; more than half, however, were in bed less
than that tim e; and only one-fifth longer than the 10 days. In fact,
104 mothers (over one-fifth of the total) were up from.bed in less
than a week— 45 of them in less than four days. This state o f affairs
1 The rate is usually stated on the number of maternal deaths per 1,000 live births, but
since the number o f live births could not be accurately determined, the rate is stated as
the deaths per 1,000 registered live births and still births. Owing to the probable omission
of many births from registration, the number of registered live and still births prob
ably falls somewhat short of the total live births in the district for the period of the
survey.
2 In 1915, in the death registration area of the United States, the death rate from puer
peral fever was 6 per 100,000 population, and from other puerperal affections 9, giving
a total rate for causes connected with childbearing of 15 per 100,000. Mortality Sta
tistics, 1915, p. 59, U. S. Bureau of the Census.
In 1915 in the birth-registration area the death rate for all causes connected with
childbearing was 6.1 per 1,000 live births. Computed from Birth Statistics, 1915, and
Mortality Statistics, 1915, published by the U. S. Bureau of the Census.
3 Meigs, Dr. Grace L . : Maternal Mortality, Table X II, p. 56. U. S. Children’s Bureau
Publication No. 19.

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shows an alarming disregard for the mother’s safety, either on her
own part or on the part of other members o f the family. Even while
they were in bed some o f these hard-working women were not free
from household cares. One mother was found by a neighbor propped
up in bed the day after confinement “ with her dough board in front
o f her, trying to make biscuits ” ; this same mother had bathed her
baby that morning.
Nearly twice as large a proportion of country as of village mothers
secured less than 10 days’ rest after confinement. An equally great
difference was found between the customs o f the American and the
foreign group in this respect. In this county even the American
mothers had inadequate opportunity for recuperation after child
birth, for one-third of them got up in less than 10 days; but half the
German mothers and over two-thirds o f the Polish group ran the
same risk of injury. The Polish mothers took least care, o f them
selves; in fact the records indicate that 7 days in bed instead o f 10
was their standard. Nearly half the 88 foreign-born Polish mothers
stayed in bed less than a week. One did not go to bed at all after
her baby was born but got supper and milked the cow the same even
ing ; another was in bed less than a day; and two more, only one day.
The difference between the mothers o f the American and the for
eign groups in this respect is, of course, largely a matter o f physique
and racial custom, but also is influenced by economic conditions. The
American and German families as a whole are in better circum
stances than the Poles and are therefore better able to arrange for
the relief o f the women from the pressure of work. This is only a
general rule, however; there are American mothers hard pushed by
their work even in the first weeks after childbirth, and on the other
hand Polish mothers on prosperous farms who could have help if
they saw the need.
Getting up from bed too soon does not always mean “ pitching
into ” the housework immediately, but for many mothers it does.
Thirty mothers began to do their cooking or cleaning within a week
after the baby was born, and three even did the washing the first
week. Though a fortnight was the generally recognized standard for
rest from housework, about one-third of the mothers took up the lighter
work within the first two weeks. A fter that time the majority began
to do the heavy work as w ell; only about two-fifths waited as long
as a month before doing any washing or ironing.
As was the case with the mothers in other communities studied, the
large majority of those interviewed in this county kept up their
lighter housework until the time o f confinement, some from necessity
or custom and some because they had found that they felt better if
they kept active. Fifty-one reported that they did no housework for

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IN TWO RURAIi COUNTIES IN WISCONSIN.

at least the last two weeks before confinement; most of these mothers
reported poor health during those last weeks, and one-half o f them
had a hired girl during that time. Almost twice as many— one-fifth
o f the total— did not do their washing and ironing in the last two
weeks, but only a small proportion discontinued even this heavy work
through the last three months of pregnancy.
In addition to the few mothers who kept a hired girl regularly,
in 179 cases the mother had hired help with the housework during
the lying-in period; this is not quite two-fifths o f the total.
Usual housework.
In many farm homes the indoor work is simplified to the last
degree. The floors are bare or covered with linoleum; the articles
o f furniture are few and plain; there are few curtains or ornaments.
The family dining table is covered with oilcloth and stands in the
kitchen conveniently near the eookstove. Even in the matter o f
dishes and utensils there is economy. The everyday clothing is apt
to be o f a character which requires the minimum amount o f wash
ing and ironing. In some country families the amount o f washing,
sewing, and cleaning actually done is small. These facts must be
kept in mind in estimating the burden which farm women are called
upon to bear. The woman who tries to maintain a more elaborate
housekeeping standard and also meets the farm’s demands upon her
strength often breaks down under the strain.
Only three country mothers and seven village mothers among those
visited kept a hired girl for the greater part o f the time.
Nearly half the mothers visited had had five or more children.
A t the time o f the survey nearly half had households o f more than
5 persons in addition to the baby; about one-seventh had more than
8 in the house; and families o f 12 or more were sometimes found.
Many o f the larger households, o f course, contained other adults;
but the typical family consisted o f the parents and three or four
small children. A family o f this kind, where none o f the children
is old enough to be a real help, makes as much work for the house
wife as a larger one with older children.
Large families were more common in the country than in the
villages. Often where the families were largest the houses were
smallest, for a farmer who is engaged in clearing cut-over forest
land ordinarily can not build a commodious house until long after
the family has outgrown the original cabin. The resulting over
crowding is strikingly shown in the figures. Two or more persons—
not counting the baby—to every room in the house may surely be
considered overcrowding; and while few village families—less than
1 in 20—showed this condition, 1 in 4 o f the country families was
living with 2 or more persons to a room. Such a state o f affairs makes

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efficient housekeeping almost an impossibility, especially through
the long winters when the children must spend so much time in the
house and “ underfoot.” On the other hand, only about one-third
o f the country families were living with less than one person per
room.
Water supply.
Almost invariably wells furnish the water for drinking and for
household use. The water situation as a whole was far from satis
factory. In the first place, a large proportion of the wells in some of
the recently settled districts were so shallow as to be most insani
tary. In the new Polish settlement the condition was atrocious in
this respect; around many o f the homes the ground was almost solid
rock, and there would be either no water at all or an open hole in
the ground—perhaps not more than from 8 to 12 feet deep and filled
with water so roily that even an uninformed family recognized its
unfitness. Secondly, though the well water is hard, few families had
a rain-water supply. Thirdly, water in the house was almost un
known. Less than 1 in 10 (31) o f all the country families visited in
this county were provided with this elementary convenience; only
2 o f these had running water; while none had a bathroom or watercloset. In the four townships in the central part o f the county, only
7 families out o f 249—in one township not a single family—had in
side water. Eight families had an engine to run the house pump,
while 13 barn pumps were equipped with engines.
Just half the families who had to carry waiter had their souree
o f supply within 25 feet, and about one-tenth had to go 100 feet or
more. In this county it was the usual thing for the mother to have
to carry the household water herself. The hardest feature o f the
situation is that in most instances every bit o f water must be carried
up several steps, often o f the roughest construction. Moreover, all
household waste must be carried down these same steps.
None o f the villages included in the survey had a public water
supply available for family use; consequently each family had to
provide its own water just as though living in the country. About
one-sixth (14) o f the village families had water inside the house.
In most cases this was the usual hand pum p; only three families had
running water, bathroom, and water-closet. In the paper-mill vil
lage, a strictly “ company” town, there were only 11 wells for 81
dwellings.
Other household conveniences.
Sinks for the disposal o f waste water add almost as much to the
housewife’s convenience as does water in the house, and in most
cases they are probably less costly; 30 country and 7 village families
had sinks.

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LET T W O R U R A L C O U N T IE S I N

W IS C O N S IN . -

Aside from sewing machines, which were common in both farm
and village homes, the one mechanical labor saver possessed by a
large number of rural families is the washing machine. In this
county, however, only about one-fourth o f the mothers in the coun
try and one-fifth o f those in the villages had a washer. Twelve
country mothers, and two in the villages had their washing machines
run by engines.
A little intelligent care in planning homes would make work much
easier for the housewife. Houses are commonly built upon high,
damp-proof and frost-proof foundations. It almost never occurs
to the builder to locate the pump on a porch or platform level with
the kitchen floor. Fuel also is stored in a heap some distance from
the house, or in a separate woodhouse if it is sheltered. The cellars
often have no inside door, hence every trip to the cellar involves
going outdoors.
Boarding hired men.
Dairy farming has no such “ rush season ” as have other types of
farming whose main output is some one crop such as cotton, corn,
or wheat. The dairy farm has, it is true, a busy time when its chief
homegrown feed crop—hay or corn or whatever it may be—is har
vested ; but the bulk of the work, the care and feeding and milking of
the herd, goes forward steadily day by day throughout the year.
One result of this is that the labor force must be kept nearly uniform
through the year; if hired men are needed, they are apt to be kept
on hand all the time; and it is often possible for the family to man
age the work without outside help.
The small farms of the north country seldom require hired labor.
Consequently only 95 mothers out of 327 whose husbands were farm
ers or farm managers boarded hired men during the time covered
by the records, while 40 had hired men as usual members of their
households. In a number of cases these men were carpenters and
masons rather than farm hands, for house and barn building was
often in process. Having a regular hired man ordinarily involved
doing his washing as well as providing his bed and board, but this
would not usually be the case with builders or temporary help.
Work for the dairy.
Dairy farming, however, has disadvantages for the housewife as
well as the advantage of relieving her o f harvesting crews. In the
first place, it almost invariably—at least on these Wisconsin farms—
burdens her with the care of the dairy implements, pails, cans, and*
separator. The milk pails are always on hand to be washed and
scalded. The sale of cream is probably the method o f disposing of
dairy products which is usually easiest for the housewife, since
cleaning the separator, though troublesome, is not heavy work. On

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the other hand, i f she is called upon to operate the separator as one
o f her chores she does hard work, requiring much muscular effort.
Next in order comes the sale o f whole milk, which removes the sepa
rator but substitutes numerous 10-gallon milk cans—heavy, awk
ward objects to lift and clean.' This is the form in which milk is
most commonly sold. A mother who washes cans for a 10-cow
dairy farm up to the time o f confinement and begins again two or
three weeks afterwards, as did many mothers in the northern county,
runs a decided risk o f injuring herself. Last, and most arduous for
the housewife, comes the sale of butter. This involves a separator
to clean and perhaps to run, the care o f the cream and its storage'
vessels, usually the churning, and almost always the butter to “ make
up,” even if someone else runs the churn. Many mothers in this
county made butter for sale. About one-third o f the farm women
(103) stated that they churned and made butter either for the fami
ly’s use or for sale. The usual type of churn was the rotary or bar
rel churn, but a considerable number still used a dasher churn.
Milking.
The women commonly helped with the milking; among the Ger
man and Polish families, i f the herd was small, the milking was apt
to be left entirely to them. Three-fourths (256) o f the farm mothers
milked; and most of those who milked during pregnancy kept it up
until the time o f confinement. One Polish mother got up to milk
her cow on the fifth day after her baby was bom and then went back
to bed again for two days.
Other chores.
The care o f the garden and o f the chickens was the commonest
form o f outdoor work done by the mothers. More than three-fourths
o f all the mothers, both in the country and villages, worked in the
garden. The care of chickens was an almost universal duty but did
not usually mean a great deal o f work, because most families raised
only chickens enough for their own use.
Many mothers cared for the pigs and calves, and a few for other
stock, but this was not an important part o f their work. In the
newer districts some of them had to chop or saw the household sup
ply of firewood in addition to a multitude of other tasks. Nine did
this up to the day the baby was bom and one started in again a
week afterwards.
Field work.
In half (168) the farming families the mother reported having
done more or less field work during her last pregnancy or the year
following. Such work ran the whole gamut from u raking a little
hay ” or ‘c driving team for the unloader ” or f picking potatoes ” to

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W IS C O F S IF .

“ planting, hoeing, and digging potatoes, cultivating and picking
cucumbers, cutting com and oats,, carrying oat sheaves into the bam,
and sawing stove wood,” or “ raking and loading hay, hoeing and
digging potatoes, cutting and grubbing brush, pitching rocks, and
cutting stove wood and pulp wood for sale ”—in addition, o f course,
to milking, gardening, caring for chickens, and all the housework.
In the main the women who did field work belonged to the German
and Polish groups. Furthermore, though many German women
helped in the fields, few of them did anything like the amount and
variety o f field work which was the common lot o f the Polish women.
On the small farms of the recent Polish immigrants it was a usual
arrangement for the women to do the bulk o f the farm work as
well as much o f the land clearing while the men worked away from
home for wages. It was a common sight in harvest time to see a
group o f these women helping one another in the field, often cutting
oats among the stumps with hand sickles. A few o f these Polish
mothers even cut cordwood, at $1.50 a cord, to provide the necessary
groceries for the family, while the husband’s wages went to meet
the mortgage or the doctor’s bill.
Undeniably a moderate amount of outdoor exercise is good for
most women; and probably many women can do strenuous outdoor
as well as indoor work without injury if they have been accustomed
to it, as most o f these northern farm women had been from girlhood.
But it must be borne in mind that the records under discussion deal
with a special group of women, each o f whom had borne a child
during the period which the record covers. For such women the
possibility of injury from heavy work is closely connected with the
question of how near it came to the time of childbirth. When a
mother rakes hay on the day her baby is bom and again eight days
afterwards, the question o f risk of injury assumes a different aspect
from that which it would have at another time.
Field work has the additional disadvantage of depriving the baby
o f his mother’s care. These hard-working country mothers almost
always managed to nurse their babies, either taking them along to
the fields, or more commonly returning to the house when necessary;
but in the intervals a young baby was often left in the hands o f
children hardly old enough to meet such a responsibility. One baby
was said to have been fatally injured by being dropped by an older
child who was acting as nurse. Another Polish baby was burned
to death while his mother was out helping her husband in the woods;
the other children ran out from the burning house, but left the baby
in his cradle.
Inevitably most o f the field work done by these mothers, such as
planting, haying, harvesting, gathering potatoes, had to to be done
when the crop called for attention, without regard to the conven-

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ience o f the worker. As one overworked mother remarked, “ the work
has to be done.” It would not be surprising, therefore, to find that
mothers whose babies were bom in the summer had helped with the
rush work close to the time o f childbirth. As a matter of fact 36,
the majority o f whom were Polish, reported having worked in the
fields within four weeks o f confinement; considering the urgent need
for the women’s help on many farms, this is not a large proportion,
but from the point o f view o f the safety o f mother and baby the
matter is seen in a different light. Nineteen of these mothers worked
up to the day o f confinement; five were in the fields in a week or less
afterwards.
On the whole, the urgent work like haying and harvesting grain
was responsible for less o f the work done near the time of child
birth than was work like tending the potato crop or clearing land,
which is less pressing at any particular time. The probable explana
tion of this fact is that the latter class of work was common only
among the Polish women, who do not plan to spare themselves dur
ing pregnancy, while the women of other nationalities, who often
help with the rush work, would not usually do this close to the ex
pected time o f confinement or soon afterwards.
Haying time is the season o f greatest work pressure on the dairy •
farms o f this section o f the country. It ordinarily comes in July
and lasts from two to four weeks; immediately thereafter comes the
grain harvest (oats, rye, barley), making with the haying a busy
season of about two months. But the farms o f this county produce
so much more hay than grain that haying brings much more work
than harvest. And in this northern country the mother would often
go into the hayfield herself if help were needed. On many a small
farm the farmer and his wife and children managed the haying to
gether, with no outside help.
Three-fourths o f the mothers who did any field work helped with
the haying. Mostly they raked or shocked, or drove the wagon or
the unloader team, or stood on top of the load to pack the hay as it
was thrown up; some women, however, did all work at haying,
including loading and unloading, pitching hay on and off the wagon.
With the mothers of the German group haying was the most common
field task, and half the 62 who reported working in the fields did no
other field work. In spite o f the fact that haying is usually a u rush
job,” involving a serious loss if the crop is not attended to promptly,
only 10 mothers worked in the hayfield within a month before or
after confinement; four of these worked up to the last day before
the birth.
Haying and harvest work are commonly regarded as one con
tinuous task; thus a mother would report in one phrase that she
“ drove team for haying and harvest ” or “ pitched hay and grain ”

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or “ helped with all work at haying and harvest.” Nevertheless,
only about half as many mothers (56) worked in the harvest as at
haying; over half these harvesters were o f the Polish group. They
took part in all the necessary occupations—cutting, raking, binding,
shocking, loading, and unloading, and especially “ driving team.”
Only two mothers helped with harvesting up to the day of confine
ment.
Next to haying, work with the potatoes was the commonest, field
task. Mothers reported tending the potato crop through all its
stages, from planting, through hoeing, spraying, and “ bugging,”
to digging and picking. Planting and digging are the heaviest work,
and were reported by 75 mothers. Since the Poles are the chief po
tato raisers o f the county, it is natural that the majority o f Polish
mothers who did any field work worked “ in the potatoes.” For only a
few of them, however, was this the only task; the usual report included
haying and harvesting and clearing land as well. Eight mothers
worked with the potato crop up to the day o f confinement, and five
began again in a week or less afterwards.
In the pioneer districts many mothers also helped clear the l a n d cutting brush, grubbing roots, picking and pitching rocks, and even
pulling stumps. A ll this is heavy work but not especially rush work.
O f similar character are the various lumbering tasks reported by a
few mothers, who even cut and skidded logs, or cut and piled pulp
wood and cordwood for sale; in the Polish settlement cutting and
bringing in the stove wood was commonly a woman’s job. Prepar
ing the fields—plowing, driving drag, handling manuro—was work
which the women were seldom called upon to perform.
O f the other miscellaneous tasks reported, one o f the most arduous
because of the constant stooping, was picking cucumbers—a common
crop in the sandy areas. The mothers who cared for the ginseng bed,
who pitched pea vines, or who made maple sirup for four weeks in
the spring, represented unusual phases o f farming for this district.
How all this work may affect the life of the individual mother is
illustrated by the following stories:
A Polish family of mother, father, and two children lived on a
clearing o f 7 or 8 acres back in the woods 8 miles from town. The
mother did her housework and cared for her chickens and pigs up to
the day the baby was born, in September, and dug potatoes a week
before, in spite o f frequent fainting spells and a “ bad ” leg ; during
the preceding summer she cut brush, stove wood, and pulp wood,
picked<stones, hoed potatoes and garden, and raked and loaded hay!
She said that the farm work, whieh she never had done until she came
to the country three years before, was easy for her except when she
was pregnant; but then it was hard. Her husband nursed her and
the baby—except that she bathed the baby— and did the housework
for a week; after that she got up and cooked the meals, one week
91202°—19----- 4

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after a difficult instrumental delivery. A t the end o f two weeks
she was doing her chores, ineluding milking the cow; two months
afterwards, in the heart o f winter, she was again cutting brush and
wood in the forest, leaving the baby and a 2-year-old child in the
care o f their 8-year-old sister.
A Polish family with two small children came to a stony 40-acre
tract, o f which only 5 acres were cleared, and struggled to pay for
the land with the father’s wages as a day laborer. A baby was born
in October of the first year; the mother was in good health and
worked up to the last day, milking, caring for chickens, pigs, cow,
and calf, picking stones, sawing and piling stove wood. In the
summer she had made hay and earlier in the autumn had hoed and
dug potatoes. After the baby came the father did the housework
three days and the midwife did one washing; by the end of one week
everything— including chores and sawing wood— fell upon the
mother’s shoulders again. Another baby was born in April of the
second year. The mother had a fall a month before confinement
which kept her in bed the whole month; but up to that time she had
done everything as usual. Her husband did the housework for a week
after the confinement on this occasion, and she stayed in bed a whole
week, with daily visits from the midwife; afterwards she was more
careful about her chores also—did nothing out o f doors for two
weeks. But after the fortnight she milked two cows; churned;
made the garden; tended chickens, pigs, and cattle; hauled manure;
chopped, sawed, and piled w ood; and after three weeks she began to
plant the potato crop. When the baby was 2 months old the father
went away to Milwaukee to work, leaving all the farm work to the
mother. At that time the oldest o f the four small children was not
yet 5. This mother was used to heavy work, for as a girl in Ger
many she had worked as a farm hand, “ hauling manure, pitching
grain— everything.”
A Polish father and mother—living on a 40-acre farm, of which
they had brushed 10 acres and stumped one and a quarter since they
bought it, about three years previously—said that they did all the
farm work together, “ half and half.” This included clearing land
and cutting cordwood, as well as raising crops. There were three
small children, the oldest 2| years o f age. Throughout every preg
nancy the mother was afflicted with persistent vomiting; two o f her
babies had been delivered with instruments, after protracted labor.
The second baby was born in the dead o f winter; the mother ran
the separator and milked up to the last day, and cared for the stock
until a week before confinement, when her husband came home from
the paper m ill; but she did no field work after the potatoes were dug.
The father did the housework and took care o f her for two days; on
the third day she got up, cooked, and did the milking. She did the
washing and ran the separator a week after the baby was born and
was out cutting wood six weeks afterwards. In the summer she
picked stones, made garden, looked after the cattle, and worked in
the hay and harvest fields; in the autumn she dug potatoes again.
The third baby was born the following spring. The father worked
in the paper mills all winter until about three months before the
baby was born; but, even after his return, the mother did her share
o f the work; she picked stones up to the last week, milked, ran the

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separator, worked in the garden, and cut eordwood and brush until
the last day. Again she stayed in bed only three days,: with: her
husband as nurse, and immediately thereafter began to cook, care
fo r the house, and milk. Four days after confinement she worked
in her garden and planted potatoes in the field; a week after, she
did the washing and ran the separator; six weeks afterwards she
was working in the hay field. She had done farm work practically
all her life in Poland, beginning at 14 to do heavy work like spading,
reaping, binding, and loading: grain. She said that her work had
never injured her in any way.
A German mother, living on a 20-acre clearing near the end of a
rough “ blind-end n road 13 miles from town, drove team at haying
and harvest, shocked hay, and bound oats every summer. Her fourth
baby was born early in September, two weeks after she ceased her
work in the fields— and she complained of being “ weak in the back ”
that summer. The next baby was born in April of the second year
and was 3 months old before his mother went out to work “ in the
hay.”
She stayed in bed only three days each time, though she had
a hired, girl for a week. A fter the last confinment she began to get
the meals as soon as she got up; she washed, milked, churned,, and
made butter after two weeks, with the help only of her 7-year-old
daughter. The time before, she did all the housework after one week
but no outside work, except tending the chickens, until spring.
A German mother,, living on an 80-acre dairy farm 16 miles from
town, had four small boys, the oldest 10; She said that she always
helped with all the work on the farm—it had to be done. A ll through
her last pregnancy, which terminated just in haying time, she was
badly nauseated and miserable generally; yet up to the last day she
milked five cows, made butter for sale,, cared for her garden and chick
ens, and made hay. She had some fever after confinement but got up
the fourth day, when her mother left, and did her housework; the
next day she milked ; a week after confinement she washed, churned,
and began to look after her garden and chickens. When the baby was
three weeks old she was again doing “ all work ” on the farm ; hay
ing was then over, but harvesting was in full swing
A German mother with two small children lived on a 40-acre farm,
o f which about one-third was cleared, in the sandy country.. Before
the third confinement (in September) she was troubled with head
aches, varicose veins, and swollen hands and feet; but she kept up all
her housework and chores—milking and feeding two cows and
tending chickens— and cut com the last day. Two weeks be
fore, she had hoed potatoes and a. week before that picked cucum
bers. She had, a neighborhood midwife at confinement, who washed
the baby the first time; the father did the housework for one day. On
the second day after confinement the mother got up, washed the baby,
and cooked the meals; one week afterwards she was churning, milk
ing, and looking after the stock; but she had the washing done twice.
When the baby was 5 weeks old she went to the field to dig potatoes.
This woman; had never done any farm work until the family came
here six years ago to uncleared land,, and she said that it was too hard
for her; A t the time o f the interview she was “ nearly used up ” from
picking cucumbers in the sun.

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A German mother with six small children did all the housework with
the help of the two older children—girls of 8 and 10. Her next baby
was bom in the winter, at the season when there were two hired men
on hand to help with the logging. During the winter the mother
felt miserable and did no outdoor work except to care for the chickens.
But in the summer and autumn, both the year before and the year
after confinement, she planted, sprayed, and dug potatoes; in the
summer when she was pregnant she also pitched and unloaded both
hay and grain. 1She said that she had been accustomed to this kind
o f work from the time she was about 13 years old. The summer
following the birth of the last baby she did not make hay nor harvest,
but instead she boarded masons and carpenters for three months
while a new barn was being built.
IN F A N T

W ELFARE.

Infant mortality.
The term “ infant mortality rate” means the number o f deaths
under 1 year of age per 1,000 live births. In ordinary statistical
usage, such a rate is computed by dividing the registered deaths in
a given area by the registered live births in the same period. Its
value is dependent upon the completeness of both birth and death
registration, and it has the further disadvantage that the infants
who die are not necessarily the same ones who were born in the
period and district under consideration. In its studies the Children’s
Bureau computes the infant mortality rate by following up each
child born alive, to determine whether or not it was alive at the first
birthday, the number o f deaths in the group per 1,000 live births
giving the rate. A rate of this kind, if based on a thorough canvass,
can be obtained even where birth registration is incomplete, and gives
a reliable index o f the chances o f death or survival in the group. In
computing such a rate it is necessary to exclude all children born
within a year of the time the study was carried on, since it can not be
assumed that all those who were alive at the time o f the agent’s
visit would live to the first birthday.
For the rural portion o f the northern county—i. e., the whole
county exclusive of the one city—the rate, based on birth £tnd death
certificates, for 1914 and 1915, together, is 73 per ljOOO.1 With com
plete birth registration the actual county rate would probably have
been lower than this; but even as it stands, it is lower than the
average for the rural parts o f the urban counties (counties contain
ing cities o f at least 10,000 population) of the State, which was 83 in
1914 and 78 in 1915.2 The birth and death certificates for the town
ships chosen showed that taken altogether these districts were fairly
representative o f the county in respect to infant mortality.
1 Twenty-sixth Report of the State Board of Health of Wisconsin, 1916, pp. 316-318.
* Ibid., p. 310.

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The infant mortality rate, based on the death or survival of the
babies for whom schedules were secured, turned out to be consider
ably lower than the preliminary figures based on the certificates.
Namely, out of 237 babies born alive a year or more before the in
vestigation, 14 died before they were 1 year old, giving an infant
mortality rate of 59 per 1,000. Fourteen o f the 238 babies born alive
within the year had died before the visit was made, and a few more
deaths in the first year o f life might be expected in this group (giv
ing a rate probably somewhat in excess o f 59 per 1,000). Therefore,
the babies in this county have a considerably better chance of survival
than the average. Even the rate given by the survey, however (59
per 1,000), should not be accepted as satisfactory. It should always
be remembered that any deaths among babies means something wrong
somewhere, and every community should set as its aim the preserva
tion of all its children.
Premature birth and congenital debility were responsible for a
greater number o f deaths, 9 out o f 28, than any other group of
causes. O f similar significance is the fact that 7 o f the 28 deaths
occurred within the first day, and 15 (more than half) before the
child was 2 weeks old, in contrast with a proportion of 38 per cent of
deaths under 2 weeks in the death-registration area in 1915. The
main line o f attack in efforts to reduce infant mortality must clearly
be directed toward improved maternity care. That this condi
tion is general throughout the State was one o f the conclusions
reached in a State-wide.study made by Dr. Mendenhall,2 who says:
In W iscon sin the in fan t death rate is fallin g and is in general not excessively
h ig h ; but there is no decline in the deaths the first few w eeks o f life .

T h e w ork

d on e'to save the babies h as not as yet affected those who die at birth, w ho are
too injured, too diseased, or too w eak to live.

T h e health o f the m other and

the care she receives in pregnancy, in confinement, and in the lying-in period
m ust be studied if w e w ish to save the children w ho die at birth.

Excluding children born within the year preceding the investiga
tion, the mothers interviewed had borne during their entire child
bearing history, 1,821 live-born children and had lost 162 o f them
before they were a year old—an infant mortality rate of 89 per 1,000.
In this county (see Table II, p. 91) the mothers of the American
group had lost a somewhat larger proportion— 97 per 1,000 of their
babies than the German mothers—71 per 1,000. Among the babies
of the Polish mothers, however, the infant mortality rate had been
much higher— 114 per 1,000. The Polish mothers o f both foreign and
American birth had lost more than 1 in 10 of their babies; the Ameri
can-born Polish mothers had the worst record of any group—an
infant mortality rate o f 134 per 1,000. Within the survey period,
1 Mortality Statistics, 1915, p. 645. U. S. Bureau of the Census. Washington, 1917.
2 Mendenhall, Dr. Dorothy Reed: “ Prenatal and natal conditions in Wisconsin,” in
Wisconsin Medical Journal, Vol. XV, No. 10 (March, 1917), p. 353.

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also, the deaths among the babies o f the Polish mothers were exces
sive. This is not surprising, in view o f the unhygienic standards o f
living and o f feeding and caring for the children prevalent in the
Polish communities. The German mothers born in the United States
succeeded in bringing through the first year a larger proportion of
their babies than the American mothers;; but the foreign-born Ger
mans did not do so well.
Stillbirths and miscarriages.
Another problem dependent for its solution upon better prenatal
and obstetrical care is that o f the loss of potential child life through
stillbirths and miscarriages. This is evidently an important prob
lem in this county, for both the stillbirth and miscarriage rates were
high.
Within the two years o f the survey the mothers interviewed in the
northern county had 19 stillborn children—38 per 1,000 births. This
is somewhat higher than the average stillbirth rate—34 per 1,000__
in the seven cities where this problem has been studied by the
Children’s Bureau; apparently, therefore, rural, conditions as exem
plified in this district have not operated to cut down the stillbirth
rate. That it might be much lower is indicated by the fact that the
stillbirth rate in the Kansas study was only 11 per 1,000 births.
For the two-year period studied^.the German mothers had. propor
tionately more than twice as many stillbirths as the mothers o f the
American group, and also a higher proportion o f stillbirths than the
Polish mothers (see Table III, p.. 91) . When all the pregnancies o f
these mothers throughout their childbearing history are taken into
account (see Table IV , p. 92), the stillbirth rate, 2 per cent,, is lower
in the total: and in each group than when only the last two years’ his
tory is included; but the relations between the different nationality
groups are the same. The mothers of the miscellaneous foreign
group had the highest percentage of stillbirths— 6 per cent; next
came the German mothers, with a rate o f 3 per cent; then the
Polish, 2 per cent; and the American mothers had the low rate of
0.9 per cent. Without question the Polish mothers had the least ade
quate care at childbirth, but nevertheless they show the lowest still
birth rate o f any foreign group.
The mothers interviewed reported two or three times as many mis
carriages as stillbirths— 6>per cent o f their total issues. This is the
highest rate found1 m any o f the- Children’s Bureau rural studies
and nearly one-fifth higher than the average rate fo r all the cities
studied (5 per cent). Again we find the German, and especially the
“ other foreign,” mothers having more miscarriages than the Polish
m others; there was little difference between the American and the
German groups in this, respect.

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Feeding customs.
Breast feeding was general. Only a few (13) babies were arti
ficially fed from birth; 26 (6 per cent) were weaned before the middle
o f the first month. Only a small proportion, less than one-fourth, had
any other food than breast milk before the middle of the third month.
Nearly half the. babies were still exclusively breast fed in the sixth
month; but the proportion fell in the seventh month almost to onefourth because o f the custom o f beginning other food besides milk at
about 6 months of age. Only one-sixth of the 6-months-old babies had
been weaned and not quite one-fourth (23 per cent) o f those 9 months
old. Breast feeding was continued well into the second year; at 12
months, half (55 per cent) the babies were still nursing; at 15 months
over one-third; and at 18 months one-sixth; a few had not been
weaned even by the second birthday. This custom, common in
country districts, of nursing babies beyond the first year is dis
approved by most medical authorities.
It is usually believed that foreign-born mothers resort to artificial
feeding less than do native mothers. In this county such did not
prove to be the case with the younger babies. In the early months, as
indicated by the percentages in the first and third months, the Ameri
can mothers o f native parentage had a better record both for exclusive
breast feeding and for not weaning their babies than the mothers of
the German or the Polish group, or the whole group of foreignborn mothers. For the later months, however, as shown by the per
centages for the sixth and ninth months, a larger proportion o f the
babies o f foreign-born mothers were breast fed, indicating that these
mothers continue nursing longer than do the American mothers.
The Polish mothers continued exclusive breast feeding in these
months to a greater extent than either the German or the American
mothers. In the sixth month the percentage o f babies weaned was
lowest in the Polish group; but for the ninth, month it was the
German mothers who had the smallest proportion o f their babies
artificially fed (see Table V, p. 92). The foreign-born mothers post
poned weaning somewhat longer than the native mothers, especially
those of native parentage.
The proportion o f infants weaned was smaller in the villages than
in the country districts throughout the first year o f life.
Birth registration.
In the northern county 110 children whose births had not been reg
istered were found by the canvass. This was 24 per cent, nearly onefourth, o f the live births in the area. More than one-half (61) of
these unregistered births occurred in one township; in the rest of
the selected districts, the percentage o f nonregistered births was only
14. The township where registration was so poor—61 failures out

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of 109 live births—contained the recent Polish settlement, in which
only 6 out of 48 live births were reported. Elsewhere in this town
ship, however, the registration was worse than the average; and the
township clerk had made no effort to enforce registration in the
Polish settlement, although he was aware that the Polish midwife
was reporting none of the births she attended. In the older Polish
settlement, where practically all the births were attended by mid
wives, scarcely any went unregistered; this was due primarily to the
activity of the clerk, who saw to it that births were reported to him
even if only by word of mouth.
O f the 110 unregistered births discovered in this county 42 were
attended by physicians and 44 by midwives. Outside the one Polish
settlement where registration went so largely by default, only 15 un
registered births were attended by midwives; as a whole, therefore,
the midwives may be said to attend to the registration of their casea
at least as well as do the doctors. In one township the midwives,
had adopted the practice o f having their cases reported by the father
under his name as informant, with the result that the records showed
practically no births attended by midwives.
In the northern county much will have to be done in the way o f
education o f physicians and local registrars, as well as of parents,
and midwives, as to the importance and obligation o f registering
births before satisfactory registration is secured.
No unreported deaths of live-born children were discovered, but
there were no death certificates for 6 o f the 19 stillbirths, and no
birth certificates for 5.
On the whole, the impression left after the visits with the mothers
in this northern county was that they had met the demands of their
strenuous pioneer life with notable success. In spite of the serious
deficiency o f adequate medical and nursing service and notwith
standing the heavy work done by these child-bearing women, most
o f them had experienced remarkably little difficulty in bearing and
rearing their children. This, o f course, does not remove the obligation
o f the families to lighten the mothers’ work as far as possible, nor o f
the community to see that adequate care is provided. No mothers
nor children should be subjected to avoidable risks; even though
serious trouble may be infrequent, it is none the less calamitous when
it does occur.

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PART II. THE SOUTHERN COUNTY.
E C O N O M IC

AND

S O C IA L

C O N D IT IO N S

THE

COUNTY.

This county lies in the southwestern quarter of the State, to the
south of the Wisconsin River. It is approximately 25 by 30 miles
in extent. The population in 1910 was between 22,000 and 23,000 j
it had remained practically stationary since the census of 1870,
tending, however, to decrease. The decrease in the last decade was
general throughout the county except in a few villages; in all prob
ability it has continued during the years since 1910 except in the
mining district. Within the county are 10 villages ranging from
about 200 to 1,100 population; and two cities, of about 1,800 and
2,900. The smaller of these two cities, located near the center o f
the county, is the county seat. The larger is a center o f an important,
zinc mining district.
Topography and soil.1
This part of the State is a beautiful rolling or hilly country, with
many fine trees, ample farm buildings, fertile fields, and pastures
full o f cattle. The watershed between the Wisconsin and Pecatonica
Rivers crosses from east to west through the middle of the county,
forming a broad, level ridge nearly 500 feet above the Wisconsin
bottom. This ridge and the valleys of the streams leading down
from it in both directions are the important features of the local
topography.
The streams flowing northward toward the Wisconsin River have,
cut deep narrow valleys, with the result that the whole northern,
half o f the county is rugged and hilly, with precipitous ravines and
cliffs in many places. In this area the soil both on the hills and in
the valleys is silt loam o f good quality, the valleys being considered
exceptionally fertile where they are not subject to floods. But along
the sides o f the valleys are many steep, rocky bluffs which are use
less to the farmer; and the hillsides, even where the soil is good, wash
out in gullies if they are cultivated, and consequently can be utilized
best as pastures. In the rougher parts of this section, the oak woods;
which originally covered all the hills are still standing, giving a
wooded appearance to the whole landscape as seen from the ridge.
Along the ridge and in belts extending southward lies a rich
rolling prairie which toward the west widens out into a nearly level

1Data

from a soil survey made by the Wisconsin Geological and Natural History Survey-

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plain. This prairie soil is fertile, and practically all o f it can be
cultivated; corn and small grains thrive, and the pastures of grass
and clover are almost incredibly luxuriant.
The stream valleys leading southeasterly from the prairie repro
duce in a general way the soil and topography o f those to the north,
except that the hillsides are not so steep nor so rocky.
Type of agriculture.
In the early days—from about 1829, when the agricultural devel
opment o f the prairie uplands began, until about 1870—wheat was
the chief crop o f this county; this was followed for a time by flax.
The soil depletion resulting from the continued cultivation o f these
crops was one o f the causes o f the change to dairying and stock
raising which took place about 35 years ago.
At present dairying is the predominant branch of farming
throughout almost the entire county; the chief exception is the west
ern end of the prairie, where corn grows unusually well and many
farmers make a specialty o f raising or fattening market cattle and
hogs. Elsewhere almost every farm produces milk for sale. Dairy
farming is particularly well adapted to the hilly districts, comprising
fully two-thirds of the county, because it provides an advantageous
use for the hillside pastures; farms in these areas almost always in
clude some bottom or hilltop land upon which the necessary grain
and forage crops for winter feeding can be raised.
Nearly all the milk produced is sold to local cheese factories. In
1916 there were 131 of these factories; they are to be seen every few
miles through the countryside, while there were only 7 creameries.
A large number, probably more than half, of the cheese factories are
owned by cooperative associations o f farmers in the neighborhood.
Where the farmers own the whole plant, they usually pay the
cheese maker a fixed salary; where the cheese maker owns the ma
chinery and furnishes the materials, he is allowed to charge a certain
rate per pound for making the cheese and to take what profit he
can out of that, while the rest o f the proceeds goes to the farmers.
There is keen competition between the managers o f cooperative
plants and the owners o f factories in the same neighborhood, who
pay'a flat rate for milk, as to which shall yield the milk producers
the larger return.
Since dairy farming was introduced—i. e., since about 1880—there
has been little change in the agriculture o f the county. The amount
o f land included in farms increased only 8 per cent during this
period, and the acreage o f improved land only 11 per cent; in
the later years, along with the decrease in population, the number of
farms has been growing smaller, and their size somewhat larger.

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The proportion o f land improved (59 per cent at the last census)
is not far below the figure of 65 to 70 per cent, the proportion o f
the total area o f the county which the State conservation commission
estimated to be fit fo r cultivation.1 In brief, this county is, and has
been for a generation, a well-settled; district with- a stationary or
diminishing population and a stable type o f agriculture well suited
to its physical characteristics.
The ordinary farm at the present day runs well over 100 acres in
size. Aecordihg to the last census, the largest group o f farms—
one-third o f the total—was that containing from 100 to 175 acres,
and over half o f all the farms were between 100 and 260 acres.
Nearly half the farms visited in the course of the survey contained
at least 200 acres.
Rural density.
Excluding the cities and villages, the rural population of the
county in 1010 was; approximately 13,400, which gives a density for
the open country o f between 17 and 18 persons per square mile.
Economic conditions.
This county has the reputation o f being, one o f the notably pros
perous counties o f the State. Certainly in so far as fertility and
land values go it bears out its reputation; prairie land and arable
tracts along the creeks have a market value o f from $100 to $150
an acre. As a rule, the farms, especially on the prairie, present a
prosperous appearance. Houses, barns, silos, and other buildings
are ample in size and as a rule well built and well kept, though often
without modern improvements. Both meadows and grainfields or
dinarily yield good crops ; nearly every farm is well provided with
live stock, while valuable herds of cattle are not uncommon.
In spite o f its prosperity this county has employed no agricultural
agent and has allowed its county fair to lapse. There are no coop
erative undertakings except the cheese factories.
In this community farming has been long enough established to;
develop the tendency of well-to-do farmers to retire and rent their
farms to tenants. The point was reached long ago where a pros
pective farmer could not find new land out o f which to make a farm,
but must acquire one ready-made from a previous owner ; and land
is valued so high that a farm means a large investment. Naturally,
therefore,, a certain amount of tenancy results. In 1910,2 one-fifth of
the farms in the county were operated by tenants, a slight increase
over the 1900 figure ; this is not, an excessive proportion, though it
is considerably larger than the percentage (14) for the State as a
whole.
1 First report o f the Conservation Commission o f the State o f Wisconsin, 1909, p. 42.
* Thirteenth Cfensus o f the United States, 1910, Vol. VII, Agriculture; pp. 902; 922;

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It so happens that in this district the tenant in most instances oc
cupies a dwelling which the owner built for himself before retiring;
thus he is comfortably housed and has good farm buildings.' It takes
considerable capital for cattle and other equipment before a man
can farm even as a tenant in this district; consequently the really
poor renter is seldom found, except as an occasional immigrant
(usually Swiss) undertakes the seemingly impossible.
After an enterprising farmer has rented a farm for a time he
usually attempts to buy his land, and with prices as high as they are
this almost inevitably means a burdensome mortgage. A farmer in
this case is apt to have a worse time financially than a tenant. On
the other hand, farm owners who have their land paid for, or who
have inherited a farm, are as a rule in very comfortable circum
stances.
Nationality.
This county is predominantly native American; at the last census
only 14 per cent, or less than one-seventh, of the population was foreign
born. The American born were about equally divided between those
whose parents were native and those whose parents were immigrants.
English, German, and Norwegian were the chief foreign nationalities
represented, both among the foreign born and those born in the
United States. In the main, these nationalities are well assimilated
into the community, and the atmosphere is nowhere strongly foreign.
The more recent immigration, of smaller volume, falls into two dis
tinct classes— farmers, chiefly German Swiss, many of whom came
into the county as farm hands and subsequently took farms in the
rougher districts which the native farmer considered hopeless; and
mine laborers of various Slavic nationalities who are found in small
groups in the mining settlements.
Literacy and education.
As might be expected of a well-established, prosperous, native
farming district, there is little illiteracy. Outside the larger city
(the only one o f over 2,500 population), the illiteracy rate among
the native born was only 0.6 per cent, while among the foreign born
it was only 7 per cent.1 A ll the American-born mothers visited in
this county and all but two of the foreign born were able to read
and write.
The country schools are all one-teacher schools, and the salaries
paid are low, $320 a year being the most common stipend. The
villages do better in this respect, for they have graded schools and
the teachers receive a slightly higher salary, most commonly $450.
Nine-tenths o f the country schools had an eight-months’ term; 9 o f
the 10 villages in the county, as well as the two cities, maintain high
1 Thirteenth Census of the United States, 1910, Vol. Ill, Population, pp. 1087, 1099.

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schools. Consequently secondary education is fairly accessible to
country children in most parts o f the county and would be within
the reach o f nearly all if the roads in winter were better.
Means of communication.
Two main railroads and three branch lines cross the county; most
o f its area is sufficiently equipped with railroad facilities, though
there are isolated neighborhoods. However, the railroads are so
located that intercommunication is difficult. The lower half of the
Wisconsin River drainage slope has practically no railroad commu
nication and consequently almost no intercourse with the rest o f the
county; its urban center is a large city in the adjoining county. The
two cities in the county, though they are only about 12 miles apart,
have no direct railroad connection with each other, and none with
large sections o f the county. This situation is an obstacle to the
county’s uniting on any common plans or undertakings, for habitual
travel and lines of interest follow the railroads almost exclusively.
One reason why this community is so dependent upon its railroad
facilities is that its highroads are often difficult to travel. In 19141
there were only 20 miles o f sand-clay roads, 5 miles o f macadam, and
no gravel roads—only 2 per cent of the total mileage surfaced. In
some townships the dirt roads are well kept and even dragged
regularly; but in spite of good care they are bound to be heavy in
wet weather—which means several months o f the year. In the hilly
country it is so difficult to get about during the winter and spring
that some families away from the main roads reported that they
had been practically marooned for long periods. Many of the hill
roads are hardly more than ungraded tracks, painfully steep and
rocky. But the worst roads of all are in the mining district, where
the heavy hauling from the mines will ruin even a macadam road
within a short time.
A peculiarity o f this part of the State is that many homes are
located so far back from the highroads that it is necessary to cross
two or three fields, opening gates along the way, or to drive a long
distance across the hills over a rough farm road in Order to reach
the dwelling. This condition is said to have arisen from the fact
that the houses were'built before the roads were located; but what
ever the explanation, it certainly aggravates the isolation o f many a
family. One mother, whose home was reached only by climbing one
of these rough, hilly private roads, told the agent that she was able
to go to town only once a year and had no neighbors within walking
distance.
The county is well supplied over most o f its area both with rural
mail delivery and with telephone lines. Among the families visited,
1 Public Road Mileage and Revenues in the Central Mountain and Pacific States, 1914..
U. S. Department of Agriculture, Bulletin No. 389.

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only five had to go as far as half a mile and only one as far as a mile
to reach a telephone, while the large majority had their own tele
phones.
SELECTED

T O W N S H IP S .

The study covered 3 o f the 14 townships in the southern county.
These were selected to represent different localities. One is just south
o f the Wisconsin River, embracing some bottom land but lying
largely in the rough, hilly country; this township includes one vil
lage o f between 300 and 400 inhabitants. The other two are on the
southern border of the county; both include some prairie and some
more hilly land along the streams. One of the two latter townships
is purely agricultural and contains no village but only a couple o f
small hamlets. The other lies partly in the mining belt and includes,
two villages, in both o f which mining is an important factor.
F A M IL IE S

IN C L U D E D

THE

SURVEY.

In the southern county less than one-fourth (38) o f the 161 fam
ilies visited were village people; the others lived in the open country.
Nationality.
H alf (51 per cent) the parents in these families were native born
o f native parentage.
In this county, as distinguished from the
northern, the generation of parents who were the children of immi
grants had largely lost their foreign characteristics and did not
stand out as a distinct factor in the community. This group formed
a little over one-third (35- per cent) of the total; about one-fifth
were o f German (paternal) parentage,- and the rest o f various other
nationalities. Only about one-seventh (14 per cent) o f all the par
ents were foreign b om ; o f these one-third were German. These
German immigrants nearly all came from Switzerland. In the
mining districts five Serbian mothers and two Polish mothers had
babies who were included in the survey. O f 20 foreign-born mothers,
all but 7— 4 German Swiss and 3 Serbian—could speak English ; in
no instance had a native mother o f foreign parentage so far escaped
amalgamation as to be unable to- speak the language o f the country
where she was born and reared.
Father's occupation.
In this county 87 per cent o f the fathers in the country families
visited were engaged in farming; 3 farm managers and 10 farm
laborers were included in this group o f 107. Eleven zinc-mine
employees formed the largest group o f nonfarmers. Three cheese
makers, 1 storekeeper, and 1 “ odd-job ” laborer completed1the list.
In the villages, the zinc miners were in the majority ; the others
were scattered among the usual village occupations*

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Land tenure.
The proportion of farmers included in the survey who were tenants
(44 per cent) was twice as high as the census figure o f 20 per cent
for the entire county. Forty-four per cent is a high proportion of
tenancy and indicates that the fathers,, who were financially responsi
ble fo r the care o f the mothers and babies with whom this survey is
concerned, were not as well able to meet this responsibility as census
data for the county would imply.
M A T E R N IT Y

CARE.

O f the 161 mothers visited in this county, 14 had borne children
twice within the two-year period o f the survey; half (52 per cent)
those who had been married at least two years had borne children
or had a miscarriage on the average more than once for every two
years o f their married life.
Availability of physicians.
The American Medical Association Directory o f 1916 lists 22 physi
cians in the county; this gives approximately 1,000 persons per
physician, which is somewhat less than in the other county but still
higher than the average for the United States. A ll but one o f the
villages had resident physicians at the time o f the survey; neverthe
less there are a few places where a country family may be 10 miles or
more from a doctor. The central part of the Wisconsin River slope
is the most isolated district, and it is there in the hills that the roads
are worst. A distance o f 10 miles may be a serious barrier here
when travel is difficult because o f mud or snow. Only 2 out of the
135 confinements in the selected country districts occurred where
there was no doctor within 10 miles, while half (49 per cent) these
families had a doctor within 5 miles. But at 12 confinements the
attending physician was summoned from 10 miles or more away.
The one village without a doctor in the southern county was in
cluded in the survey. This place is 4 miles from a railroad and,
though there was a physician at the nearest railroad point and two
others 6 miles away, the doctors had to use roads cut up by the haul
ing o f ore from the mines—a state o f affairs not conducive to a
rapid response to a call.
Attendant at birth.
No midwife was practicing in any o f the districts where the in
vestigation was carried on nor, so far as could be learned, anywhere
in the county. A ll the confinements in the villages were attended by
physicians; and nearly all— 130 out o f 135—of those in the county.
A t the remaining five births there was no attendant except the
father or grandmother or a neighbor. One o f these cases was a

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sudden triple birth, in the middle o f the night, at which the astounded
father was compelled to assist after a fruitless attempt to summon
help over a disabled telephone. Fortunately he had had previous
experience in such emergencies, and nothing went wrong. It was
not the family’s intention to do without a doctor, but three out o f
five times they had been unable to have one on hand at the birth. In
another o f these families the doctor had been summoned but failed
to arrive in time to be of any service. The other three families de
liberately dispensed with the doctor’s services; in one instance, be
cause o f poverty; in one, because the grandmother did not approve
o f having a doctor at childbirth; and in the third, because the father
had called a doctor on two previous occasions but the physician had
not arrived on time; so he decided that “ we were just as well off
without.”
Among the mothers who are counted as physicians’ patients were
13 whose doctor did not arrive until after the birth had occurred,
sometimes only a few minutes late but in two cases as much as an
hour. Most o f these doctors had to come 5 miles or more.
Hospital confinements.
There is a general hospital o f 30 beds at the county seat, a private
hospital in the same city, and two small private hospitals in the other
city. Certain districts are more accessible to hospitals outside the
county; in no case would it be necessary to travel more than two or
at most three hours by rail to reach a hospital somewhere. O f course
for a good many families it is more difficult to get to the railroad
than to make the train trip ; yet patients do manage to reach a hos
pital when it seems imperative, though the delay in an emergency
may be serious. The general hospital at the county seat reported
caring for 18 obstetrical patients in 1916,10 o f whom came from out
side the city. However, only three mothers from the townships
studied went to hospitals for confinement during the period covered;
all these went outside the county. These mothers had no especial
reason to anticipate complications at confinement—and none arose
except an instrumental delivery in one case—but chose the hospital
as the most convenient method o f providing the necessary care.
Obstetrical service.
The use of obstetrical forceps proved to be even more common
here than in the northern county. Whereas less than 5 per cent
o f the deliveries in the county studied in Kansas were effected with
instruments and 10 per cent in the other Wisconsin county, the pro
portion here was 14 per cent, or 25 cases. Eleven o f these instru
mental deliveries were first births. One resulted in a stillbirth and
two in deaths within two days. The use of forceps was largely con
centrated in the practice of one physician, who performed 15 instru
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mental deliveries among 35 confinements attended within the survey
period; if his cases are deducted, only 7 per cent of the remaining
deliveries were instrumental. The physician who had the largest
obstetrical practice in the selected districts o f that county delivered
only 1 out o f 46 children with forceps.
It is, o f course, difficult, as has been said, for a country doctor
with a large area to cover to visit his patients as regularly as is
possible in city practice. Furthermore, the charge which a physician
must make for additional visits miles away from his headquarters
seems to many country families an expense which they are unwilling
to incur unless the necessity is forced upon them. Nevertheless a
mother is exposed to unjustifiable risks when, as happened to nearly
one-third of the country mothers in the survey, her doctor never sees
her after the day the baby is born. Only about one-fourth of the
country mothers attended by physicians had more than one visit
from the doctor subsequent to the delivery. In the villages the doc
tors revisited the majority of their obstetrical patients at least twice,
but two mothers in villages where there was a resident physician
were never seen by the doctor after the delivery of the baby. It
should be noted that the mothers in this county received considerably
more postnatal care than those in the north.
Nursing care.
In none o f the districts studied was there a resident trained nurse;
during part o f the time none could be secured anywhere in the
county. Consequently, aside from the expense of her salary, having
a trained nurse for confinement or any other sickness involved both
the trouble and the expense o f bringing her from outside the county;
moreover, many country families, even when they can afford a
trained nurse, do not appreciate the importance o f adequate nursing
care. Only two country mothers, and none in the villages, employed
a trained nurse at confinement; another secured a trained nurse two
weeks afterwards after blood poisoning had developed; another had
her sister, who was a trained nurse, to help the practical nurse in
charge o f the case.
In each o f the country districts and in two o f the villages studied
there were practical nurses, women who had had considerable ex
perience in obstetrical nursing—they were sometimes called baby
nurses. These were the main reliance o f the families who made a
point o f getting the best available care; many o f them were held in
high esteem, and in a number o f cases the family sent away to a
neighboring village or city to secure such a nurse who stood in good
repute. However, the history of one young mother showed the dan
ger of untrained and possibly ignorant nurses. In her inexperience
she intrusted her first baby to a so-called practical nurse who had
91202°— 19----- 5

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taken a correspondence course and “ thought she would start out
nursing,” She fed the baby cows’ milk and sweetened water the first
three days. Then after nursing one day, he was sick and would not take
the breast. The nurse tried various kinds o f food, consulting the
doctor only by telephone; she also “ kept the baby asleep with dope
nearly all the time.” Finally, on the tenth day, he died in con
vulsions.
More than one-fourth (49) of the mothers visited were nursed
during the puerperium by these practical nurses, but in only a few
cases (10) did they do the housework. The remaining three-fourths
o f the mothers, with few exceptions, had to depend upon neighbors
or relatives for nursing care.
Prenatal care.
The superiority o f postnatal supervision in the southern county is
accompanied by a much greater amount of prenatal supervision than
was found in the northern eounty. Twice as large a proportion o f
mothers attended at birth by physicians had some prenatal care in
the southern county (38 per cent) as in the northern (19 per cent).
The difference between the counties is not great for village mothers
but is very marked in the open country, a fact that is undoubtedly
related to the greater isolation o f the country districts studied in the
northern county. In neither county can the situation be regarded
as satisfactory; but any community where, as in the southern county,
more than one-third o f the mothers consult their physicians during
pregnancy, has evidently begun to realize that prenatal care is worth
while, both for the alleviation o f present discomfort and for the
prevention o f later complications. Nevertheless, much ignorance on
this point survives. For instance, one mother, living in comfortable
circumstances on a large farm, stated that she vomited throughout
pregnancy and was much troubled with headaches, swollen feet, and
swollen eyes (symptoms suggestive o f toxemia), but did not see the
doctor at all—“ just worried along.” Her baby was stillborn at
eight months.
The standards used in the study for classifying the medical pre
natal care reported by the mothers are described on page 38.
According to these standards, none o f the mothers in the southern
county had adequate care; 13 had fair care, o f whom only one was a
primípara (carrying her first ch ild ); 9 other primíparas had eare
which would have been fair except for the failure of the physician
to measure the pelvis. Merely sending for medicine or advice, with
out a personal interview, was counted as no care. Of. the 65 patients
who had some care, 11 never saw the doctor, but merely sent the
urine for examination; 19 others received no physical examination;
21 had no analysis o f the urine made: 23 saw the physician only once.

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M ATERNAL

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M O R T A L IT Y .

In the selected districts in the southern county only one mother
died at childbirth in the two years of the survey. The <jause stated
on her death certificate was pernicious anemia, with parturition and
nephritis contributory. The account given by her family agrees
with this diagnosis; the mother had suffered from pernicious anemia
for three years, and during her last pregnancy she was in very poor
health, the doctor under whose care she was having found albumin
in her urine. The child was born prematurely and lived only a few
hours; the mother died five days later.
The county records show during the survey period only one
other death from causes connected with the puerperal state. This
makes 2 maternal deaths out o f 887 registered births (live and
still born).1
M O T H E R ’S

W ORK.

Rest before and after confinement.
More than one-third o f the mothers visited (38 per cent) remained
in bed for the customary period o f 10 days; one-fourth, or less than
half as large a proportion as in the other county, stayed in bed
less than this time. Only 9 (1 in 19) were in bed less than a week;
and, on the other hand, more than one-third stayed in bed longer
than 10 days.
A considerably larger proportion o f mothers in the country than
in the villages secured less than 10 days’ rest after confinement. In
this county, as well as in the other, there was a notable difference
between the mothers o f native parentage and those of foreign birth
or parentage in this respect; 17 per cent o f the former and 34 per
cent o f the latter stayed in bed less than 10 days.
With these mothers, getting up from bed too soon commonly meant
“ pitching in to ” the housework immediately. In nine cases the
mother was out o f bed in less than a week, and five o f these mothers
were doing their cooking or cleaning within that first week, while
four even did the washing before a week was up. As a rule, however,
the mothers in the southern county did no cooking nor cleaning dur
ing the first two weeks after childbirth; and, while many undertook
the laundry work at two or three weeks, half of them obtained a
respite o f at least a month from this heavy work.
As often occurs, the large majority of the mothers kept up their
lighter housework until the time o f confinement. Twenty did no
housework for the last two weeks or more; in most instances these
were mothers who had a hired girl during that time. It was recog-

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nized by many o f the women that washing and ironing is too heavy
work for a pregnant woman toward the end o f her pregnancy; con
sequently one-third of the mothers did not do their washing in the
last two weeks. But even this part o f the housework was discontinued
throughout the last three months by only a small proportion.
In addition to the few mothers who kept a hired girl regularly, in
87 instances the mother had hired household help for the lying-in
period. This is the same proportion—one-half—that had f help ” in
the Kansas rural survey. Apparently village mothers found it no
easier to get help at such times than did those living in the open
country.
Usual housework.
Even on the prosperous farms o f the southern county, practically
all the housewives were obliged to do without hired help; even those
who could afford to pay fair wages frequently could not secure a
hired girl; many families who could afford to pay good wages for
temporary help in time o f sickness often, of course, could not meet
such an expense regularly. Only three country mothers among those
visited kept a hired girl for the greater part o f the time; six village
mothers had regular hired help, though a village housewife usually
needs help less than does one in the country.
There were not nearly so many large families here as in the north;
only one-third (instead of half) o f the mothers visited had house
holds o f more than five persons in addition to the baby. The most
usual family consisted o f the parents and two or three small chil
dren ; very large families, such as some o f those in the north, consist
ing o f 12 or more persons, were practically unknown.
In this county, there was little o f the house crowding which was
found to be common in the newer communities, not only in northern
Wisconsin but also in western Kansas. Only 1 in 15 of the country
families in southern Wisconsin was living with more than two
persons to a room; on the other hand, more than three-fifths had
more than one room per person (not counting the baby). This
is one advantage o f the commodious farmhouses seen throughout
the southern part o f the State. H alf the village homes where a
baby had been born also had at least one room per person.
Water supply and other household conveniences.
Well water is almost universally used for drinking. In this
county, the well water is so hard that most families have a supply
o f rain water also for general household use; and available soft
water makes an appreciable difference in the housework. Since the
cistern or tank is naturally built near or under the house, it is com
paratively easy to connect a hand pump in the kitchen with the

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cistern and thus give an inside water supply. O f 123 country fami
lies in this county, 25 reported water in the house; 21 of these had
only rain water and had to bring their well water from outside. O f
course, this arrangement is a great improvement ovei having to
carry all the household cleaning and wash water from outside, for
the purposes for which well water is required—drinking and cook
ing—take a much smaller quantity than do the cleaning and washing.
Even when the cistern pump or the rain-water barrel is outside,
it is apt to be much nearer the house than is the well, for the barn
has often a powerful attraction for the well. Partly as a result of
that fact, the majority (52 per cent) of the families who had to
bring in the household water had to carry it less than 25 feet and
few (about 1 in 11) had to carry it as far as 100 feet.
Only two homes had running water piped into the house; one of
these had a bathroom and water-closet. It is not uncommon in these
districts to find the barn well, but not the house well, equipped with
a windmill or engine to do the pumping; 16 families had an engine
connected with the barn pum p; and 14, one connected with the house
pump. On the other hand, it was common for mothers in this county
to tell the agents that they never had to carry the water, the men
always carried it in for them; others reported that the men carried
the water through the winter or carried the wash water. As in the
other county, the water usually had to be carried up steps to the
kitchen.
Both Wisconsin counties compare favorably with the one in Kan
sas as to nearness o f the water supply to the house, and the southern
county—but not the northern— as to the proportion o f homes having
inside water.
In this county, also, none o f the villages included in the survey
had a public water supply. About one-fourth of the village families
had water inside the houses, but only one o f these had running water
with bathroom and water-closet.
Thirty-one country and 12 village families in the southern county
had a sink for the disposal o f waste water; this is just a few more
than had inside water. H alf the mothers in both country and vil
lages had a washing machine; however, only one in the villages had
a power washer, while 15 in the country were so provided. One ran
her churn, and another the separator, by engine power.
Boarding hired men.
The large farms of the southern county naturally needed hired
men more often than the smaller ones in the northern county. Con
sequently, in the southern county 54 mothers (out o f 98 whose hus
bands were farmers or farm managers) reported that they had had
to board “ hands ’—usually only one—during the period covered by
the survey.

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Work for the dairy.
In the southern county it was almost the rule that the dairy farms
sold their milk to the cheese factories;: on many farms the whole
supply was hauled off immediately after the morning milking, leav
ing almost no milk even for the family’s use. This relieves the house
wife o f the tasks connected with butter making or the sale o f cream,
but usually burdens her with many heavy milk cans to clean. In
one southern township the cheese-factory manager said that the men
were beginning to wash the cans, and he “ couldn’t see but that they
did it about as well as the wojnen ” ; but it is usually considered a
woman’s job. Only one-fifth of the mothers living on the farms of
the townships included in the survey reported that they did churn
ing; many o f these made butter for their own families only. A good
many others made butter but had some one else run the chum.
Milking and other chores.
As a rule the women o f the southern county do little work outside
the house, but half those on farms milked.
The care o f the garden and o f the chickens was the commonest o f
the outdoor chores done by the mothers here as elsewhere. About
two-fifths o f the mothers, both in the country and villages, worked
in the garden. The care o f chickens was a common duty, but in
this county also the flocks were seldom large.
Field work.
Practically none o f the mothers in the southern county did any
work in the fields; field work for women goes absolutely against the
local standards. One mother said indignantly, when asked about
her w ork: “ Mothers who work outside just don’t care for their babies
right.” Three o f the five who reported any field work were German;
two o f these helped with the haying, one husked corn two or three
hours at a time, one picked corn and potatoes. One o f the others
picked apples and potatoes; one drove the plow and cultivator. The
German mother who said she pitched hay two months before con
finement was the only one who did any really heavy w ork; none o f
the five worked in the fields within a month o f confinement.
IN F A N T

W ELFARE.

Infant mortality.1
Among the 90 live-bom babies for whom records were secured in
the southern county who were born at least a year before the survey
began, T died before they were a year o ld ; this is equivalent to an
infant mortality rate of 78 per 1,000, or 1 death to 13 live births. O f
the 83 babies born during the year just preceding the survey, 9 had
died before the agent’s visit, or 1 in 10 (108 per 1,000). It is evident
1 For definition of the term, see p. 50.

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that this figure, though considerably higher than that for the pre
ceding year, is probably less than the true infant mortality rate for
this year; for some deaths in this group may have occurred after the
agent’s visit but prior to the first birthday, since most of these babies
at the time of the agent’s visit were not yet one year old. In other
words, at least 16 out of 173 babies in this county— approximately
1 in 11— died before they reached their first birthday. The prob
ability is that the true proportion was somewhat higher than this.
In this county, according to the official figures, the infant mortality
rate was 115 per 1,000 in 1914; in 1915 the rate fell to 88.1 The
combined rate for the two years was 102, or just a little over 1 in 10.
It appears, therefore, after allowing for the differences between the
two methods of computing the rates, that the agreement is reason
ably close.
One death in 10 is the average rate for the United States birthregistration area, which in 1915 was 100 per 1,000. But it was
slightly higher than the rate o f 94 in the rural part o f the birthregistration area, and is certainly higher than should exist in a
prosperous rural community. The average for all the rural counties
in Wisconsin was 76 per 1,000 in 1914 and 73 in 1915 ;2 and several
counties are credited with rates lower than 50 per 1,000.
In the southern county, and in the two counties together, the pro
portion o f deaths was less among the babies of the country districts
than among the village babies. O f the 260 country babies in the two
counties, 14 died— an infant mortality rate o f 54 per 1,000. This is
still somewhat higher than the corresponding rate o f 40 per 1,000
which was found among the babies o f the open country in Kansas.3
Premature birth was responsible for half the 16 deaths in the
southern county, in contrast with one-fifth of the deaths under 1
year o f age in the registration area.4 An excessive proportion— 10
out o f 16 deaths—occurred before the baby was 2 weeks old; 6 of
these were deaths within the first few hours. Evidently, therefore,
the effort to reduce infant mortality, in this county as in the other,
must be directed primarily toward better maternity and prenatal
care.
Excluding children born within the year preceding the investiga
tion, the mothers interviewed in the southern county had borne dur
ing their whole child-bearing history 415 live-born children and had
lost 34 o f them before they were a year old—an infant mortality rate
o f 82 per 1,000. For both counties there had been a much higher pro1 Twenty-sixth Report of the State Board of Health of Wisconsin, pp. 315 and 317,
Madison, 1917.
2Twenty-sixth Report of the State Board o f Health of Wisconsin, p. 310. Madison,
Wis., 1917.
sMaternity and Infant Care in a Rural County in Kansas, p. 40. U. S. Children’s Bu
reau Publication No. 20.
4 Mortality Statistics, 1915, p. 645. U. S. Bureau o f the Census. Washington, 1917.

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portion o f deaths than had occurred in the country families o f the
Kansas survey (55 per 1,000) or in the white families of the lowland
county in North Carolina (48 per 1,000); the Wisconsin rates are
about the same, however, as that in the mountain county in North
Carolina (80 per 1,000).
In the southern county, the mothers o f foreign birth or parentage
had lost a somewhat larger proportion o f their babies than the
mothers of native parentage. (See Table II, p. 91.)
Stillbirths and miscarriages.
Within the two years of the survey the mothers interviewed in the
southern county had 5 stillbirths, 28 per 1,000 births. This is some
what lower than the stillbirth rate (84 per 1,000) for the seven
cities where this problem had been studied by the Children’s Bureau.
That it might be still lower is indicated by the fact that the stillbirth
rate in the Kansas study was only 11 per 1,000 births.
The mothers of this county had had a smaller proportion of still
births (2 per cent) among all their issues than among the births o f
the past two years. Both in the survey period and during their whole
history the mothers o f native parentage had borne more stillborn
children than the mothers o f the foreign group; but they had lost a
smaller proportion through miscarriage. (See Tables I I I and IV ,
pp. 91, 92.)
Feeding customs.
As in the other county, only a few babies were artificially fed from
birth. Over four-fifths o f the 3-months-old babies were exclu
sively breast fed— a proportion even larger than in the northern
county. In the sixth month, the proportion was still over half; in
the seventh, it fell to only one-third. A large percentage o f the
babies not exclusively breast fed received some breast milk through
out the first nine months. Only one-sixth o f the 6-months-old
babies had been weaned; the proportion weaned had increased by the
ninth month to only one-fifth (20 per cent). Breast feeding was
continued in the second year for a large number, three-fifths o f the
12-months-old babies received some breast milk, and at 15 months
one-third were still nursing. Practically all were weaned, however,
before they were 18 months old.
When the customs of the different rural counties where these sur
veys have been carried on are compared (see Table V I, p. 92), the
mothers o f the two Wisconsin counties are found to have given their
babies breast milk without any other food to a less extent than those
in the western Kansas county, but to a much greater extent through
out the first eight months than the mothers o f the mountain county in
North Carolina. And the proportion artificially fed was throughout

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the first nine months higher in these two Wisconsin counties than in
any o f the other rural districts studied.
In all the rural counties the proportion weaned was lower through
out the first nine months than in any o f the four cities—two middle
western and two eastern—included in Table V I (see p. 92). Up
to the fourth or fifth months a larger proportion o f the Wisconsin
babies were exclusively breast fed than in any o f these cities; but
in the later months the percentages o f exclusive breast feeding are
higher for the cities.
Birth registration.
In the southern county, 17 live-born children, born in the area
studied, were discovered by the canvass to have been omitted from
the register of births. This was 10 per cent of the total live births
included in the survey; 15 o f these 17 births were attended by
physicians.
So far as indicated, therefore, by the selected districts, no great
improvement would be necessary to bring birth registration in the
southern county up to the minimum census standard of 90 per cent
completeness. In both counties all the unregistered births discovered
by the canvass were reported to the State board o f health and in
vestigated by it.
In the southern county it was found that three infant deaths (out
o f 16) had not been recorded. Failure to register deaths indicates
an even more serious violation of the law than does the deficiency
o f birth registration, because the need for death registration is more
widely recognized, and in general the registration o f deaths is much
more widely enacted and observed than is birth registration.
Through the requirement of a burial permit before interment, the
registration o f deaths can also be enforced more easily than that o f
births. Furthermore, if many deaths are omitted the apparent in
fant mortality rate is an understatement of the true mortality rate,
and a community when it becomes sufficiently interested to look up
the figures may fail to appreciate the actual conditions.
The southern county is of interest mainly as an example of one
o f the most prosperous agricultural sections o f the United States—
the prairie lands of the northern Middle West. The conditions re
vealed by this survey are undoubtedly typical o f the lives o f a larger
proportion o f the farm women o f the country than are those, in
many respects more striking, found in isolated districts in the South
and West. Moreover, there need be no financial difficulty in the com
munity’s providing adequately for the health of its mothers and
children, even though some of its families would be unable to do th jg
individually.

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PART

ACTIVITIES IN WISCONSIN ON BEHALF OF
THE HEALTH OF MOTHERS AND BABIES.

This section of the report deals with work undertaken up to the
close of the year 1917, for the protection o f the health of childbearing
mothers and o f young babies in the rural districts of Wisconsin.
Some o f these activities are State wide in their scope, and it is believed
that the account of these is complete. Others are local; and o f these
the report covers in full only the two counties in which the survey o f
maternity care was made.
No account o f conditions in Wisconsin would be complete without
mention of the active spirit o f cooperation among the various publichealth agencies. Often several different organizations are found
working together on a common enterprise, with the result that the
credit for accomplishment belongs not to any one but to the whole
group.
W ORK

THE

STATE

BOARD

HEALTH .

Birth registration.
Wisconsin is one o f the States recognized by the. census as having
an adequate birth-registration law. Each township or incorporated
village is a separate registration district for vital statistics, the town
ship or village clerk acting as local registrar. The clerk is required by
law to send the original birth and death certificates to the State office,
and a copy o f each to the county registrar o f deeds; village clerks
must also keep a local record, but in the township such a local reg
ister is not provided for. The county files of copies are also noto
riously incomplete; hence it is necessary in most instances to send to
the State office to find out whether a birth has been registered.
Within recent years the State board o f health has been progres
sively increasing its efforts toward the strict enforcement of the
birth-registration law. In 1917, it adopted the policy o f prosecuting
all failures to register which came to its attention, unless the o f
fender presented an adequate excuse and gave his written promise
to observe the law in the future. Knowledge o f unregistered births
is secured (1) from reports by local registrars, (2) from inquiries by
parents, and (3) from checking hospital records of births. During
1917 the board also requested each county medical society to devote
a meeting to birth registration, and where a society complied with
this request the deputy State health officers were frequently sent to
talk on the subject.
75

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Since 1914 the board has sent to parents a card certifying to the
receipt o f the birth certificate for their child. This practice is un
doubtedly a stimulus to the parents’ interest in birth registration.
During the course of the survey many mothers spoke of having these
“ papers ” or wondered why they had not received them. The State
board is said to receive about 200 inquiries a month from parents
who failed to receive their cards.
In the latter part of 1917 the United States Bureau of the Census
made a State-wide birth-registration test in Wisconsin, covering the
births o f two months. These tests were based not upon a canvass but
upon live births reported to the census agents by postmasters, mail
carriers, etc., throughout the State. In the outcome, 95 per cent of
the births thus reported in each o f the two counties studied in the
Children’s Bureau survey were found to have been registered.
Educational literature.
The State board of health publishes a bulletin on the care of
babies, which is sent out to any citizen of the State making a request
for it. The revised edition o f this pamphlet, printed in 1917, con
tains a section on prenatal care—the mother’s personal hygiene and
the complications which must be guarded against. On the birthregistration certificate card is printed a notice that anyone may
secure this bulletin free o f charge, and many requests result from
this notice. The pamphlet on the feeding of children published by
the agricultural extension division o f the State university (see p. 78)
is also distributed by the State board o f health.
Prevention of blindness.
The la w 1 in Wisconsin requires that every obstetrical attendant
must use a 1 per cent silver nitrate solution in the eyes o f each new
born infant as a preventive measure against ophthalmia neonatorum
or “ babies’ sore eyes,” and provides for the gratuitous distribution
o f the proper solution. In accordance with these provisions, the
State board of health sends out once a year to each physician, regis
tered midwife, and health officer in the State a case containing six
dozen ampules o f silver nitrate solution, each designed for the treat
ment of one case. Additional supplies are sent as requested ; about
2,000 requests are received in the course o f a year.
It is the opinion o f the executive officers that this prophylactic is
very generally used. The law also requires that cases o f inflam
mation o f infants’ eyes must be reported to the State board o f health.
Only about 10 such cases a year are reported.
Campaign against venereal disease.
Because o f the direct causative connection o f venereal disease with
infant mortality, the efforts o f the State board of health for the
1 Laws of 1915, sec. 1409a-l.

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prevention and cure of these diseases should be mentioned. Diag
nostic service is provided by the various laboratories under the con
trol of the board and by the State psychiatric institute; diagnoses
are made free o f charge for any licensed physician. The board of
health publishes a pamphlet on the dangers o f venereal diseases and
the necessity o f treatment by a physician; it also posts placards in
suitable places giving the same information.
L O C A L P U B L IC -H E A L T H

A D M IN IS T R A T IO N .

In Wisconsin the townships and villages are important organs of
local government. Among other functions, they are the units for
local public-health administration. There are township, village,
and city health officials, but none representing the county ; next above
the local unit stands the deputy State health officer, who is a full
time employee o f the State board of health and has under his juris
diction one o f the five sanitary districts into which the State is
divided. Each township or (incorporated) village board either acts
itself as the local board o f health or appoints such a board ; this board
then appoints the health officer, who may or may not be a physician.
In townships and villages the clerk acts as registrar of vital statistics.
A t the time o f the survey the State registrar stated that somewhat
less than half the local health officers in the State were physicians.
In the 10 townships where the survey was made, 5 o f the health
officers were physicians and 5 were farmers; o f the 5 incorporated
villages, 4 had medical health officers—the fifth had apparently neg
lected to provide itself with any.
The local board also fixes the compensation o f the health officer.
Judging from the survey, $10 a year is the usual rural salary; in
some cases the annual salary is supplemented, and in others re
placed, by payments “ by the visit,” but the largest sum paid to any
o f these officers for the year preceding the survey was $18.25.
Several had no compensation during that period because they “ had
put in no time ” ; one had been paid only $5 in five years, for posting
quarantine twice.
As a rule, almost the sole duty of these local rural officers is con
ceived to be the posting and removal o f quarantine notices and fumi
gation for the severe contagious diseases—scarlet fever, diphtheria,
and smallpox. Only a few of the rural health officers interviewed
made any serious attempt to placard measles or whooping cough or
to disinfect after tuberculosis- I f the officer is not a physician, he
ordinarily depends upon instructions from the attending physician
as to when and how long to quarantine, and in such cases the phy
sician is often paid by the township to do the fumigating. It is
only in very rare instances that a sanitary complaint is brought to

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the health officer’s attention, while it is practically never conceived
to be his duty to seek out insanitary conditions.
The general laxness found in the rural districts in enforcing or
observing isolation o f measles and whooping cough should be com
bated in the interest o f the babies as well as that o f the older children.
A small, but not a negligible, proportion of infant deaths is always
found to be due to these diseases. Whooping cough is especially apt
to be fatal to young babies. In Wisconsin in 1915, 124 babies under
a year old died of whooping cough, almost eight times as many as
died from diphtheria.1 In the families visited in the course o f the
Wisconsin survey, eight babies had died o f whooping cough before
they were a year old, in contrast with only two deaths from diph
theria. One township clerk, in discusssing measures needed for
the protection o f children’s health, complained especially o f the habit
o f some parents o f carelessly exposing other people’s children to the
diseases which their children had, and urged that persons doing this
be made liable fo r the results o f their indifference. In that par
ticular neighborhood such carelessness had extended even to scarlet
fever.
W ORK

THE

STATE

BOARD

M E D IC A L

E X A M IN E R S .

The law charges the State board o f medical examiners with the
duty o f enforcing the medical practice act, including the examina
tion and registration o f midwives. Obviously a law drafted for the
purpose o f protecting the mothers o f the State from untrained mid
wives does no good if not enforced. And that it is not enforced in
the rural districts the survey furnishes ample proof.
The secretary o f the board writes that a couple o f years ago the
midwives on a list made up from the birth-registration records
“ * * * were notified that they must become registered by examin
ation or cease to practice. Beyond this notification the State board
o f medical examiners have been able to do nothing. We found after
this investigation that the greatest majority o f midwives were
women along in the fifties and sixties, of foreign birth, who were
unable to comply with the law, due to the fact that they must pass a
written examination in the English language. The law provides for
gratuitous service and service in the case o f emergency, and their
attention was called to the fact that such service1was the only kind
which they could render under the law. I think most o f them under
stand the situation, but o f course we have no way o f knowing how
they are complying with these requirements.”
The attorney for the board stated that in the course o f his con
nection with the board, extending back to its organization in 1897,
1Mortaility

Statistics, 1916, p. 549. U. S. Bureau of the Census.

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Washington, 1917.

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he remembered only one or two prosecutions o f midwives for prac
ticing without registration. (Prosecutions for malpractice have
been more frequent.) He stated that’the law permits anyone to give
either gratuitous or emergency service, and that in case a physician
or registered midwife could not be secured in time for a delivery
it might be lawful for an unregistered midwife to charge for her
services, the law being ambiguous on that point.
It is obvious from the foregoing, as well as from the findings o f
the survey, that there is absolutely no supervision of the midwives
who are in practice. The medical practice act makes no provision
for any such supervision.
W ORK

THE

STATE

U N IV E R S IT Y .

The State university reaches the rural mothers and fathers of the
State in various ways through its extension service. There are two
separate extension departments, one known as the university exten
sion division, and the other as the extension service of the college o f
agriculture or more briefly as the agricultural extension division.
University extension division.
The university extension division gives several correspondence
courses in health subjects. Three o f these bear directly on the health
o f mothers and babies and were planned and are conducted by a
woman physician. They are entitled “ The Prospective Mother,”
dealing with the care o f the mother during pregnancy, confinement,
and the puerperium, and also with the care o f the newborn baby;
“ The Child in Health,” dealing especially with infant feeding and
general hygiene; and “ The Child in Disease,” dealing with the pre
vention o f the ordinary sicknesses o f childhood as well as with
home nursing. While the enrollment in these courses has not been
large, the students have been widely scattered over the Northwestern
States.
Another phase o f the educational work o f the extension division
is the series o f weekly health articles which it furnishes to the press
o f the State. These articles are so widely published that it is esti
mated they reach at least 300,000 readers a week. In this series, there
have been a considerable number o f articles dealing with various
phases o f infant hygiene, and also a few dealing with maternity
care.
The community institutes conducted by the university extension di
vision (sometimes in cooperation with the agricultural extension
service), in nearly all cases have made a feature o f popular instruc
tion in hygiene and the prevention o f disease; frequently they have
included talks by physicians on the care o f mothers and babies. The
programs are planned and advertised with the object o f attracting

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country people as well as townfolk, and the majority o f the institutes
have been held in places o f less than 2,500 population—a third in
villages smaller than 1,000 population. Consequently, these institutes
are to be counted among the forces working for the improvement of
rural health conditions.
Agricultural extension division.
During the three years 1915, 1916, and 1917, the agricultural ex
tension service has made health talks one of the main features o f its
agricultural schools, which are held for a few days at a time in small
towns and villages. These health talks and conferences have been
given by the woman physician who wrote the correspondence courses.
A t each place the series usually includes a general meeting on com
munity health problems and two or three informal meetings or con
ferences especially for women, at one o f which maternity care is the
main topic, and at the others child hygiene and infectious diseases.
This service has reached each year the women o f 15 to 20 rural com
munities. The interest o f the women in these topics, especially in
maternity problems, has been marked; and the meetings are often
followed by letters o f inquiry from perplexed mothers. The care of
the childbearing mother as a community problem is sometimes dis
cussed at the general evening meetings also.
As has been mentioned, the agricultural extension division has
also published a bulletin on the feeding o f children; this gives de
tailed instructions for feeding through the third year.
W ORK

THE

W IS C O N S IN

A N T IT U B E R C U L O S IS A S S O C IA T IO N .

The Wisconsin Antituberculosis Association is, in the scope of its
work, really a general public-health organization, because its man
agers believe that all health problems are intimately linked together ;
and that the influences which build up the individual’s strength are a
main reliance in combating all forms o f disease alike—that, for
example, a sturdy, healthy baby is not only more apt than a weakling
to survive the perils of infancy but also less apt to develop tubercu
losis in after life. Consequently this association has been one of the
instigators and promoters of most forms o f infant-welfare work
undertaken in the State. It has joined in the campaign for the edu
cation of mothers in the care o f themselves and their babies and has
added its quota to the instructive literature on this subject in the
form o f circulars and printed charts giving directions for infant
feeding.
The greatest contribution o f the association, however, has been
the promoting and supervising o f public-health nursing. The status
o f this work in rural communities is discussed on pages 79 to 81.
The Wisconsin Antituberculosis Association employs four field nurses,

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two supervising nurses who spend part of their time in visiting the
nurses throughout the State, and two demonstrating nurses who are
available for short-time demonstrations of community nursing. The
association also holds periodical conferences o f the public-health
nurses o f the State, keeps in touch with them through correspond
ence, and furnishes them with educational literature and with blank
forms needed in their work. It acts as an employment agency for
communities wishing nurses, and for the past two years it has main
tained training courses in order to help fill the dearth o f adequately
trained public-health workers.
Another valuable contribution is the research work by which the
association has directed attention to health conditions in rural com
munities. Its tuberculosis survey o f Dunn County in 1911 was a
pioneer rural study, a forerunner o f subsequent studies in many
States dealing with health conditions among country school children
and with infant mortality in rural districts. The research work of
the association was influential in securing the passage of the State
law authorizing the employment of county public-health nurses by
county boards o f supervisors, and of other enactments for the pro
motion o f the public health.
R U R A L P U B L IC -H E A L T H

N U R S IN G .

At the close o f 1917, 140 public-health nurses were at work in
Wisconsin. A large proportion of these were in the city of M il
waukee, the majority were in smaller cities, and only 5 were doing
strictly rural work. These 5 were all county nurses 52 of them were
employed by county boards o f supervisors, 2 by the trustees o f the
Milwaukee County institutions, and 1 was supported by the sale of
Red Cross seals. The last 3 concentrate their efforts chiefly upon
tuberculosis work.
The legislature passed an act in 1913 authorizing county boards
to employ nurses.1 None did so, however, for two or three years after
wards. In 1916 a nurse was employed by Chippewa County; Wau
paca County was added to the list in January, 1917; Lincoln in
August; and Eau Claire voted the appropriation in the autumn. All
these counties are in the north-central part of the State, in the same
general section as the northern county o f the survey. At the close
o f 1917 the nurses’ positions were vacant in two of these four coun
ties because no one could be found to fill the places;2 consequently
the nurses then in the service o f county boards numbered only two,
as has been stated. In both these counties the nursing work which
was started as an experiment for a year only was made permanent
at the next annual meeting.
* St. 1917, sec. 679—10m (constituting Laws 1913, ch. 93).
• These positions were filled early in 1918.

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In each o f these two counties—Lincoln and Waupaca—the nurse
made school visiting and the inspection o f school children the main
feature o f her work for the first year; one of the nurses expected to be
able to make the round of her schools in about a year, the other in a
year and a half. Both have been called upon to aid in checking
school epidemics o f contagious diseases. Both nurses established
women’s rest tents at their county fairs, where a simple health ex
hibit was displayed, literature was distributed, and the nurse was
on hand to talk with mothers who wanted information or advice.
In Waupaca County the nurse helped with the Baby Week cele
bration in the largest village in the county. She also tries to hold
a mothers’ meeting whenever she visits a school; at these meetings
she explains her work, and the mothers ask questions. Interest cen
ters largely upon the inspection of the school children and the mean
ing and cure of the various defects found.
In Lincoln County the nurse took up her work in the summer
with the belief that tuberculosis should be the first point of attack,
but upon consulting the county records she found that the deaths
from tuberculosis «(22) were far overshadowed by the stillbirths (33)
and deaths under 1 week of age (14) which, as she said, “ are practi
cally the same thing as stillbirths.” In other words, she found that
her biggest problem in life-saving would be that of prenatal and
natal care. She has not been able to start any organized work along
that line because o f the pressure o f school work beginning with the
opening o f the school term. But she says that she has spoken about
prenatal and maternity care whenever she has had a chance to ad
dress an audience o f women, and that she has found them much in
terested in the subject. Some women’s organizations, at her sugges
tion, have undertaken to provide maternity outfits for mothers in
need. The nurse has made an attempt also to get in touch with
prospective mothers and has found it possible to establish such rela
tions with a few pregnant women that she could give them advice
on prenatal care. She has met with no midwives in her territory,
though it is largely German.
In spite of the fact that neither of these two counties is excessively
large—only about half the size o f the northern county o f the sur
vey— each of the nurses felt strongly that her territory was much too
large for one nurse. One had thought of dividing her county into
four or five districts; then she believed that the work could be ade
quately handled.
The 1917 legislature made it legally possible to employ nurses
in smaller units than counties.1 B y the terms o f the act “ the local
board of health, health commissioner or health officer o f any town
{-ship], village or city may employ public health nurses ” ; “ towns,
1 St. 1917, sec. 1411g, as amended by Laws of 1917, ch. 123.

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villages, and cities may * * * employ public health nurses
jointly,” on the same principle o f sharing the cost according to popu
lation as joint-district high schools are now supported in many places.
So far no action has been taken under these provisions, but such an
arrangement seems to be the logical next step in the development of
rural nursing.
In the southern county o f the survey, there has been no publichealth nursing in the rural districts. The county seat employed a
school nurse on part time for the year following the survey (see
p. 8 8 ).

In the northern county, the county seat has had a full-time school
nurse for several years. In the city also is a small children’s in
firmary, in charge o f a trained nurse who devotes part o f her time
to visiting nursing. She occasionally makes calls in the country,
mainly for the purpose o f getting sick children into the hospital.
The county is so large, however, and so many districts are almost
inaccessible that only exceptional cases come to her notice. This
same infirmary nurse keeps a register o f nurses, both trained and
practical; she fills calls for trained nurses outside the city as well
as in, and sometimes even outside the county, but says that she has
never sent a practical nurse outside the city.
In the year following the survey one o f the largest paper mills,
located in one o f the townships included in the survey, employed* a
visiting nurse primarily to care for the mill employees and their
families. So far as her time allows, she also accepts other cases on
call from the attending physician and examines the children in neigh
boring village and rural schools. It is o f interest in connection with
the subject o f maternity care that for the first seven months of her
service she reported having made 24 prenatal calls and 329 obstetrical
nursing calls upon 33 patients.
LOCAL

E D U C A T IO N A L

C A M P A IG N S .

Baby Week.
Baby Week was widely celebrated in Wisconsin in both 1916 and
1917. The State-wide direction of the movement was primarily in
the hands of the State federation of women’s clubs; much assistance
in providing speakers, literature, and exhibits and in suggesting
programs was given by the Wisconsin Antituberculosis Association
and especially by the university extension division. There is no way
o f telling to what extent the celebration reached the rural districts.
However, the list o f places published by the university extension
division as observing Baby Week in 1916 contains a large proportion
(over one-third) under 2,500 population, showing that the interest
in Baby Week was by no means confined to the cities.

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In 1916, a Baby Week celebration was held in each o f the counties
included in the survey; in the southern county this took place in the
mining town (the larger o f the two cities) and in the northern county
in the county seat. In the latter, an elaborate program of lectures,
demonstrations, and exhibits was presented; the main feature, how
ever, was a Baby Health Contest, which lasted through four days, In
this county, an effort was made to include the rural districts in the
campaign. Extension meetings were held in seven villages; demon
strations were given by members o f the State agricultural extension
faculty, and speakers gathered for the city meetings brought to the
smaller places the message o f better care o f mothers and babies.
Twenty-five or thirty country babies were brought to the Baby Con
test in the city, and these were included in the follow-up work dur
ing which a nurse employed by the central committee was sent out
to visit the mothers of all babies registered in the contest.
In the following summer (1917) the committee which had charge
o f this “ Better Baby Campaign ” in the northern county employed a
trained nurse—the demonstrator from the Wisconsin Antitubercu
losis Association—for three months’ intensive work in the city.
Infant-welfare stations were opened in four public schools, at each
o f which a weekly conference was held, with a doctor and the nurse in
attendance; babies were examined by the doctor, talks on the care of
ba*bies were given by the doctor and the nurse, and literature was dis
tributed. The nurse called once a week at the home o f each o f the
97 babies enrolled at the stations; she also supervised a few prenatal
cases, making regular visits and examining the urine. No rural
work was undertaken this year.
Children’s health conference.
In 1916, in connection with the Children’s Bureau survey, a
children’s health conference was held in the county seat o f the south
ern county. This was undertaken, cooperatively, by the Children’s
Bureau, which furnished the physician and an assistant for the ex
amination of the children; by the university extension division, which
provided the exhibit, demonstrators, and speakers; by the State board
o f health, which sent a speaker; by the Wisconsin Antituberculosis
Association, which furnished speakers and an organizer; and by a
local committee of women who arranged places of meeting, provided
supplies, and advertised the conference.
The central feature o f this campaign was the physical examina
tion o f children by the Children’s Bureau physician. This differed
from a baby contest in that children were not scored nor prizes
given. Its object was to teach mothers how to observe their own
children and how to promote their health by suitable care and feed
ing, as well as to point out to the mothers defects which needed to

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be remedied either by better hygiene or by a physician’s care. In
spite o f cold weather and heavy rains which practically cut off the
attendance o f country families, 77 children were brought to the con
ference for examination.
As a result o f the interest in children’s health aroused by the con
ference, the local committee undertook to persuade the school dis
trict meeting to employ a school nurse. They were successful in this
attempt, and a part-time nurse was employed in 1916-17; but, in the
following year, “ the authorities did not feel disposed to retain the
nurse.”

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CONCLUSIONS.
The southern county in Wisconsin is an example, such as might
be found anywhere throughout large sections o f the Middle West,
o f a prosperous farming community on fertile soil, where the land
is cleared, crops are abundant, and the necessary farm improve
ments—houses, barns, fences—as well as live stock have been pro
vided. Therefore there should be no difficulty in financing any co
operative undertakings for the common good upon which the com
munity may decide.
The northern county represents a different range o f conditions.
As a community engaged in converting “ logged-out” land into
farms and homes, it illustrates conditions common in the forest belt
o f Michigan, Wisconsin, and Minnesota. Its foreign settlements,
also, are a feature common in those States and others as well, and
it has certain characteristics common to most communities in the
pioneer stage. As a whole it is still engaged in building up its farm
ing capital—land values, buildings and dwellings, and live stock
out of meager beginnings. Many a farmer finds it beyond his means
to provide adequate shelter and sometimes even adequate food for his
family, while conveniences and comforts are for the present entirely
beyond his contemplation. Even in those neighborhoods and fami
lies which have passed beyond that stage, the memory o f pioneer
hardships is still vivid and the habit o f pioneer economy sti ll strong.
Consequently it is difficult, and probably seems more difficult than
it really need be, to secure money for anything beyond the most
primitive needs o f the community. However, it should not be im
possible to persuade the fanners in even the newest settlements that
the protection o f the health o f their own wives and children is a
matter of vital concern to them. Fortunately the influence o f the
county seat and o f certain o f the smaller centers could probably
be counted upon to support a progressive public-health campaign.
Without question, the most urgent o f the common needs in both
counties, from the point o f view of general utility as well as from
that o f providing for the safety o f mothers and babies, is for good
permanent roads which will remain usable throughout the year.
None o f the other needs can be adequately met until such roads
cover the county so thoroughly that no home, even on the remote
hill farms or forest clearings, shall be a mile and a half—or even
half a mile— from a passable road.
85

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The provision o f a county public-health nurse would probably be
the most useful “ next step ” which the county authorities could
take in the interest of the mothers and babies on the farms and
small industrial settlements. As we have seen, four counties in
Wisconsin have already decided to provide such a nurse; there
seems no good reason why the children o f other counties in the
State should not have the advantages provided for these children.
Such a nurse could be of service to country and village mothers
in many ways, some of which can be foreseen from the experience
of other communities and some o f which would appear only as her
work developed to fit the local needs. In many counties rural publichealth nursing has begun with school nursing, including both the
inspection of school sanitation and the examination of the pupils;
but some counties might find it a good plan to begin with infant-?
welfare work. The nurse might establish a series o f periodical
mothers’ meetings in different local community centers, usually in the
villages but sometimes in a township hall or an accessible country
school, where she could weigh babies, give simple demonstrations in
infant care and home nursing, and talk with mothers who wish her
advice. How to keep a baby well through the summer; what to
do before the doctor comes, in an emergency such as croup or con
vulsions; how to nurse a sick child or a mother and newborn baby
at home—these are all questions about which women are anxious to
learn all they can. It is often a good plan to combine meetings
of this kind with the establishment o f a women’s rest room in the
village, where mothers coming to town for shopping and trading
may find toilet facilities and a clean, quiet place in which to care
for their children. A local committee should be organized to super
vise the rest room and to help the nurse in her work. Such a rest
room may in time be developed into a local health center, with
exhibits and literature for distribution. Similar exhibits and
mothers’ conferences held in connection with a rest tent at the county
fair have proved popular in other counties where they have been
established by the nurse.
As these meetings became well established, the program might be
widened to include such an examination o f children by physicians
as constitutes the main feature of a children’s health conference and
of many Baby Week celebrations. The experience o f other commu
nities, as well as the popularity of the examination held at the county
seat in each o f these counties in the year o f the survey, shows that
mothers are usually eager to take advantage o f such an opportunity
to secure expert advice about the health of their children when it is
brought within their reach and fully explained to them.
The nurse’s meetings with the mothers would usually in the begin
ning concern themselves with the health o f babies and the younger

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IN T W O R U R A L C O U N T IE S I N W IS C O N S IN .

children but would naturally develop to include advice as to the
mother’s care o f her own health, especially during pregnancy. The
experience of the Lincoln County nurse shows that Wisconsin mothers
are keenly interested in this subject also. A nurse who has had special
training and experience in prenatal work can be o f great help to the
prospective mothers in the country, and to their physicians. She
will so advise the mothers about daily details o f their care of them
selves that they will be able to avoid much discomfort and disability;
she will urge them to see their physicians early for a thorough pre
liminary examination and later when necessary; she will urge them
to send samples o f urine regularly to be examined; or, i f asked to
do so, she may make these tests and report the results to the
physicians.
In a territory so large and so difficult to get about in as are both
these counties— especially the northern one—it would be impossible
for any one county nurse to do any home nursing; in the north
ern county it would probably be impossible for her even to make
the round o f the rural schools more than once in two years. There
fore an effort might be made to arrange, possibly through private
contributions or through the interest o f an industrial plant in the
health o f its employees (as in the northern county), for a demonstra
tion in some limited neighborhood o f the advantages of a community
nurse, who would be available to help the mothers in time o f sickness,
to nurse them at confinement, and to show them how to apply the
principles o f hygiene in their own homes. On the basis o f such a
demonstration, the county could in time be divided into nursing
districts, each consisting probably of from two to five or six town
ships, with a trained nurse employed in each district. The last
legislature made it legally possible to provide community nurses for
such districts from public funds, on the same principle that jointdistrict high schools are now in many places supported by a village
and two or more townships, A t least three such districts would be
needed in the southern county and at least six in the northern, in
order to bring the district nurse into intimate contact with the
people who need her help.
Each nursing district would normally center around some village
which is a natural community center; each would have as a nucleus
of interest the school inspection, the mothers’ conference, and other
lines o f work previously established by the county nurse. The
county nurse would, of course, take the lead in organizing the nurs
ing service in the districts and should supervise the work in order to
unify it and keep it up to the highest possible standard of usefulness.
The need which is felt by the largest number o f country mothers
in connection with their confinement care is the need for better
nursing and household help. Therefore, they would undoubtedly

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welcome the establishment o f a service o f supervised trained attend
ants— competent women who have had some training and experience
in home care o f the sick and who will do the housework as well as
the nursing. In several communities it has already been proved
that women can be found willing and anxious to do this work. The
register o f “ practical nurses ” now kept by the infirmary nurse at
the county seat in the northern county might serve as a nucleus for a
county-wide register. With a combination o f county and district
public-health nursing, it should prove feasible in these counties to
conduct a county training course for attendants under the direction
of the county nurse and to keep a register in each district from
which mothers could obtain help in case o f sickness. The attendants
should always do their nursing under the supervision of the district
nurse; this supervision by a trained nurse is essential to the success
o f the plan.
Even in the foreign districts o f the northern county, where the
midwife is now the main reliance for childbed nursing as well as
for delivery, it should be practicable in time to make the supervised
trained attendant popular, for the more competent midwives are in
the main old women and none so trusted seem to be rising up to take
their places. In view of this fact, it seems probable that even in
the Polish settlements mothers will gradually come more and more
to engage physicians for confinement and to need some one to take
the midwife’s place as nurse. A trained attendant would necessarily
cost more than families o f this nationality have been used to paying
the midwife, but she would also give them more service, because she
would remain in the home instead of making visits.
In both sections o f the State there are hospitals to which mothers
who need hospital care at confinement can be taken. Many isolated
neighborhoods are at present almost out o f reach o f any o f these
hospitals so far as emergency service is concerned, but improvement
o f the roads would relieve this difficulty. A campaign of education
in which the public-health nurses would naturally be the main
agents is evidently needed to induce mothers (and physicians) to
make use of the hospital facilities now available.
The State board o f health has as yet no special division or officer
charged with the duty of promoting the health o f the children, the
work which it does along this line being handled by the general ad
ministrative officers. It is the hope o f the board that the next legis
lature may see fit to provide means for the establishment of such a
bureau. A bureau of child hygiene would be o f great service to
mothers and children throughout the State and especially to those
in rural districts who are out o f reach o f the various infant-welfare
activities o f the cities. It would serve to correlate many o f the
lines o f work now carried on in the State, and could also undertake

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T W O R U R A L C O U N T IE S I N

W IS C O N S IN .

new activities. A ll kinds o f work for the prevention o f infant mor
tality and o f children’s diseases would naturally fall within its
scope. Like the Kansas Division o f Child Hygiene, it might also
find means to carry on an extensive campaign o f education and ad
vice as to the best standards o f prenatal and maternity care. As the
survey has indicated, this is one o f the urgent needs in rural Wis
consin and therefore promises to be one o f the most fruitful lines o f
activity opening before a child-hygiene bureau.

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APPENDIX.
T able

I.— P er

cen t o f physicians' obstetrica l cases receiving postnatal visits.

Districts.

Villages:
Resident physician.......................................................

Per cent receiving specified
Number
number of postnatal visits.
of con
finements
attended
More
Not
by
than
re
Iphysicians. None. One.
one. ported.
281

237

35
9

20
67

29
22

46
11

Southern county........................................................

170

Country districts.................................................................
Villages:

130

22
18

9
6

36
39

55
55

T able

II.— In fa n t

m o rta lity rates fo r each cou n ty, b y nationality o f m other,
based on all births rep orted b y m oth ers included in the stu d y :“

County, and nationality of mother.

Live
births.

Nationality of mother: b

Nationality of mother:

Infant
mortality
rate.

Infant
deaths.

1,821

162

298
689
638
185
11

29
49
73
11

97
71
114
59

415

213
202

15
19

70
94

aExcept births occurring in the last year of the survey period.
bSee p. 23 for discussion of nationality.
« Includes one Indian mother.
T able

III. — Stillbirth

rates fo r each coun ty, b y n ationality o f m other, based on
births in tux> yea rs.

Stillbirths.
County, and nationality of mother.

All births.
Number.

Per cent of
all births.

Northern county..........................................

494

3.8

Nationality of mother: <*
American group..............................................
German group................................... ..............
Polish group....................................................
Miscellaneous and other foreign group...........
Not reported...................................................

99
180
157
53
5

2
8
5
4

2.0
4.4
3.2
7.5

Southern county..........................................

178

2.8

Nationality of mother:
American........................................................
Foreign bom or of foreign or mixed parentage

98
80

4
1

4.1
1.3

a See p. 23 for discussion of nationality.

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T a b l e I V . — S tillbirth „and m iscarriage ra tes fo r eabh county, b y n ationality o f

m other, based on all issu es rep orted b y m others included in the stu d y.

Stillbirths.

Miscarriages.

Total Total
Per
Per
issues. births. Num
cent of Num cent of
ber.
total
ber.
total
births.
issues.

County, and nationality of mother.

Northern county................................................................

2,214

2,087

2.3

127

5.7

Nationality of mother:«
American c to u d ............................. ........ ................................
German group....................................................
Polish group.......................................................
Miscellaneous and other foreign group...................
Not reported............................................... : _

370
840
740
250
14

350
792
710
221
14

3
21
11
13

0.9
2.7
1.5
5.9

20
48
30
29

5.4
5.7
4.1
11.6

Southern county................................................

522

504

1.8

3.4

Nationality of mother:
American......................................
Foreign bom or of foreign or mixed parentage.......

267
255

260
244

2.3
L2

7
11

2.6
4.3

aSee p. 23 for discussion of nationality.
T a b l e Y .— P er cen t o f in fan ts breast fed and artificially fed , b y m o th er’s na

tion ality, n orth ern county.

Nationality of mothers.

Per cent of infants exclusively
breast fed dining specified
month.

Per cent of infants artificially
fed during specified month.

1st.

3d.

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

89.3

75.5

48.9

14.2

5.6

9.4

15.8

22.8

American group................................
German group..................................
Polish group......................................
All others and not reported...............
All foreign born.................................

90.2
89.0
90.1
8a 5
89.9

77.1
75.3
74.6
76.0
73.9

49.2
42.5
62.4
34.0
58.7

13.0
12.4
22.2

3.3
6.7
5.6
5.8
5.9

7.2
12.7
9.7
2.0
9.0

18.5
ia s
14.7
12.8
14.1

25.9
20.4
24.4
21.9
19.5

6th.

9th.

19.5

1st.

3d.

6th.

9th.

T a b l e V I . — Com parison o f feedin g m eth ods in W iscon sin w ith oth e r rural dis

t r i c t s .and w ith fou r cities in w hich infant m o rta lity investigations have been
m ade.

Locality.

Rural districts:
Wisconsin—
Northern county..
Southenrcounty..
Kansas.......................
North Carolina—
Lowland county <*.
Mountain county.
Cities:
Saginaw. Mich___ ___
Akron, Ohio.......... .
Manchester, N. H ......
New Bedford, Mass...

Per cent of infants exclusively
breast fed during specified
month.
1st.

3d.

89.3
92.0
92.0

75.5
8L5
83.2

48.9
51.2
60.8

14.2
12.5
23.3

90.4
73.5

74.6
62.0

50.0
34.1

17.0
15.9

87.8
87.9
81.2
83.4

74.5
74.2
62.4
66.0

53.9
55.0
37.5
44.9

28.1
28.7
18.4
26.0

6th.

• White infants only.

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9th.

Per cent of infants artificially
fed during specified month.
1st.

5.6
5.6
2.1

9.0
7.1
. 15.0
12.3

3d.

9.4
11.3
A1

15.6
15.5
28.8
24.7

6th.

9th.

15.8 !
15.5
12.5

22.8
20.2
19.3

3.8
0.9

24.2
22.9
42.5 !
37.2

29.2
29.5
51.0
46.8

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Full text of Maternity and Infant Care in Two Rural Counties in Wisconsin, Rural Child Welfare Series No. 4, Bureau Publication No. 46

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